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.

Abstract Background: Post-transplant lymphoproliferative disorder (PTLD) is a dangerous complication of liver transplantation. This study aimed to analyze the risk factors associated with PTLD after liver transplantation in children. Method: We retrospectively analyzed collected clinical and laboratory data of patients treated and followed-up at Shanghai Children’s Medical Center between January 2012 and January 2019. Twenty-four patients with PTLD were enrolled in this study using a 1:2 pairing design. Each case was matched with two controls who had undergone liver transplantation within the same year and did not develop PTLD during the follow-up period. In total, 72 patients were included in this study. Result: No differences in age, gender, weight, primary disease, or type of liver transplantation were observed between those with and without PTLD. Graft weight, graft body weight ratio, transplant type, intraoperative blood loss, blood type, and CMV/EBV infection status of donors and recipients were not related to the occurrence of PTLD. Univariate analysis demonstrated statistically significant differences in EBV infection, tacrolimus blood concentration, PTL, AST, ALT, and CHOL between those with and without PTLD. Multivariate logistics regression analysis demonstrated that EBV infection was an independent risk factor for PTLD. A close relationship was observed between EBV-DNA peak time after transplantation and PTLD onset time. Additionally, the higher the tacrolimus blood concentration, the more difficult it was to control EBV infection. Conclusion: EBV infection is an independent risk factor for PTLD. When uncontrolled proliferation of EBV occurs after organ transplantation, the dosage of immunosuppressive agents should be appropriately reduced