Comparative long-term evaluation of tacrolimus and cyclosporine in pediatric liver transplantation

Ashok Jain, George Mazariegos, Randeep Kashyap, Mike Green, Cindy Gronsky, Thomas E. Starzl, John Fung, Jorge Reyes

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Abstract

Background. In this report, we compare the long-term outcome of pediatric liver transplantation (LTx) patients maintained with tacrolimus-based and with cyclosporine (CsA)-based immunosuppressive therapy. We examine long-term patient and graft survival, the incidence of rejection, and immunosuppression-related complications. Method. There were 233 consecutive primary LTx in children (ages <18 years) performed between October 1989 and December 1994 with tacrolimus-based immunosuppressive therapy (Group I). These were compared with 120 consecutive primary LTx performed with CsA-based immunosuppressive therapy between January 1988 and October 1989(Group II). Children in both groups were followed until July 1999. Mean follow-up was 91.41±17.7 months (range 55.6-117.8) for Group I, and 128±6.1 months (range 116.7-138.6) for Group II. Results. At 9 years of follow-up, actuarial patient and graft survival were significantly improved (patient survival 85.4% in Group I vs. 63.8% in Group II, P=0.0001; graft survival Group I 78.9% vs. 60.8% Group II, P=0.0003) and the rate of re -transplantation was significantly lower among patients in Group I (12% in Group I vs. 22.5% in Group II P=0.01). Children in Group I also experienced a significantly reduced incidence of acute rejection (0.97 per patient Group I vs. 1.5 per patient Group II P=0.002) and significantly less steroid resistant acute rejection episodes (3.1% in Group I vs. 8.6% in Group II P=0.0001). The mean steroid dose was significantly lower in Group I compared with Group II at all time points (P=0.0001) after LTx. Freedom from steroid was also significantly higher in Group I compared with Group H at all time points after LTx (ranging from 78% to 84% in Group I and 9% to 32% in Group H during a 1- to 7-year posttransplant period P=0.0001). The rate of hypertension was significantly lower in Group I than Group II (P=0.0001), and the severity of hypertension (need for more than one anti-hypertensive medication) was also significantly lower in Group I than Group II (P=0.0001). Although the rate of posttransplant lymphoproliferative disorder (PTLD) was not significantly different (13.7% Group I vs.8.3% Group II, P=0.13), the survival after PTLD was significantly better for Group I at 81.2% than for Group II at 50% after 5 years (P=0.034). Conclusion. The results suggest that tacrolimus-based therapy provides significant long-term benefit to pediatric LTx patients, evidenced by significantly improved patient and graft survival, reduced rate of rejection, and hypertension with lower steroid doses.

Original languageEnglish (US)
Pages (from-to)617-625
Number of pages9
JournalTransplantation
Volume70
Issue number4
DOIs
StatePublished - Aug 27 2000

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All Science Journal Classification (ASJC) codes

  • Transplantation

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Jain, A., Mazariegos, G., Kashyap, R., Green, M., Gronsky, C., Starzl, T. E., Fung, J., & Reyes, J. (2000). Comparative long-term evaluation of tacrolimus and cyclosporine in pediatric liver transplantation. Transplantation, 70(4), 617-625. https://doi.org/10.1097/00007890-200008270-00015