A predictive nomogram for choosing tacrolimus or cyclosporine as
immunosuppression drugs for pediatric recipients after liver
transplantation
Abstract
Background: Tacrolimus (TAC) is the first choice of calcineurin
inhibitors (CNIs) for recipients after pediatric LT. But there are some
special pediatric recipients present an unsatisfied prognosis with the
therapy of TAC. We aimed to construct a simple clinical model to predict
the effectiveness of TAC in recipients after pediatric LT and help
clinicians to choose CsA for an alternative quickly. Methods: Patients
who received pediatric LT from 2006 to 2019 at RenJi Hospital, Shanghai
Jiaotong University School of Medicine were included in this study.
Retrospective data, including demographics, comorbidities, pre-operative
lab values, outcome based on post-transplantation events were collected.
A nomogram estimating the risk of poor curative effects of those
recipients who receive an IS protocol based on TAC was constructed using
multivariate logist regression analysis. Results: A total of 2032
recipients were included in this study. Seven parameters (recipient CYP
type, cholangitis before LT, GRWR, spleen long diameter, serum albumin,
graft volume reduction, donor CYP type) were used to construct the
nomogram. The nomogram showed good discriminative performance with the
area under receiver operating characteristic (ROC) curve (AUC) of
74.5%, and good calibration. Decision curve analysis demonstrated that
the model had a high clinical application potential. Conclusions: A
simple clinical model with well performance in predicting the risk of
poor curative effects of those recipients who receive an IS protocol
based on TAC was constructed. The nomogram can help clinicians quickly
choose CsA as an alternative if there are high risks.