Introduction
The routine and widespread use of
immunosuppression (IS) drugs have
resulted in step-wise improvements in post-transplant survival
rates[1]. That may be reflected in the decreased rates of early
severe acute rejection and rejection-related graft loss, and more than
63% of late mortality after liver transplantation (LT) is non-hepatic
cause[2]. Calcineurin inhibitors [CNIs,
tacrolimus (TAC) or cyclosporine
(CsA)], corticosteroids and antimetabolites [most often mycophenolic
acid (MPA)] are currently among the most common choice for LT
immunosuppression[3]. CNIs, particularly TAC, is the primary choice
in IS drugs, and more than 80% of recipients are treated with the basis
of TAC after pediatric LT[4]. However, long-term utilization of CNIs
presents significant side effects, such as malignancy, infection
metabolic disorders, and organ
toxicities[5, 6]. Therefore, individual therapy
should be performed to minimize the side effects.
Because of a much higher potent and a better post-transplant survival
rate than CsA, TAC is the first line CNIs drugs in pediatric LT, and CsA
has been used less frequently[4]. Although the side effects are
similar between TAC and CsA, including hypertension, nephrotoxicity,
neurotoxicity and lipid metabolic disorders, they have different
immunological mechanisms and pharmacokinetics[7]. Recipients may
develop different benefit and harm
profiles with the therapy of TAC or
CsA. Clinicians usually consider switching TAC to CsA when recipients
develop severe side effects or present an unsatisfied efficacy during
therapy of TAC (Table 1).
It is more beneficial for the
special recipient population to
receive CsA over alternative TAC.
Therefore, it is significant that if we are able to choose IS drugs with
respect to patient’s pretransplant and/or intraoperative risk
factors[8]. We designed a retrospective study in pediatric liver
transplantation with a large sample size. In this study, we analyzed
risk factors of switching IS drugs
after pediatric LT. This study
aimed to construct a simple clinical model using common clinical
features for the early evaluation and prediction of the effectiveness of
TAC in recipients after pediatric LT and
help clinicians to choose CsA for
an alternative quickly.