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.