{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T13:55:59Z","timestamp":1767707759825,"version":"3.41.2"},"reference-count":9,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T00:00:00Z","timestamp":1736294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Despite the existence of institutional protocols, liver transplant centers often have variability in early immunosuppression practices. We aimed to measure within\u2010center variability in early immunosuppression after pediatric liver transplant (LT) and examine its association with one\u2010year outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed pediatric LTs from 2013 to 2018 in the United Network for Organ Sharing registry, with data aggregated by center. We categorized induction regimen as corticosteroids only vs. T\u2010cell depleting antibody vs. non\u2010T\u2010cell depleting antibody. Primary exposures were coefficient of immunosuppression variability (CIV) in (1) induction and (2) mycophenolate mofetil (MMF) use. Primary outcomes were one\u2010year graft survival, patient survival, and acute rejection rate within the first year after transplant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study cohort included 2542 LT recipients from 67 LT centers. Sixteen centers (24%) had no MMF variability; twenty\u2010five centers (37%) had no induction variability. In multivariable analysis, induction CIV was associated with 2.72 times greater odds of acute rejection in the first year (OR 2.72; 95% CI 1.66\u20134.45; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). MMF CIV was not associated with rejection (OR 1.22, 95% CI 0.66\u20132.25, <jats:italic>p<\/jats:italic>\u2009=\u20090.527). Neither one\u2010year graft nor patient survival were associated with induction or MMF CIV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Induction CIV is associated with higher one\u2010year acute rejection odds and did not impact short\u2010term graft or patient survival. Improved understanding of the reasons for high CIV will inform future work aiming to determine whether reducing variability may improve outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.70018","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T10:20:10Z","timestamp":1736331610000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between Early Immunosuppression Center Variability and One\u2010Year Outcomes After Pediatric Liver Transplant"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6555-9732","authenticated-orcid":false,"given":"Vikram K.","family":"Raghu","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott D.","family":"Rothenberger","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6979-8987","authenticated-orcid":false,"given":"James E.","family":"Squires","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Eisenberg","sequence":"additional","affiliation":[{"name":"Patient and Family Voice Starzl Network for Excellence in Pediatric Transplantation  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0327-1378","authenticated-orcid":false,"given":"Anna L.","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnati College of Medicine  Cincinnati Ohio USA"},{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8447-9068","authenticated-orcid":false,"given":"Jennifer","family":"Halma","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology Children's Mercy Kansas City  Kansas City Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swati","family":"Antala","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Mount Sinai Kravis Children's Hospital Icahn School of Medicine at Mount Sinai Hospital  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8767-331X","authenticated-orcid":false,"given":"Irini D.","family":"Batsis","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Mount Sinai Kravis Children's Hospital Icahn School of Medicine at Mount Sinai Hospital  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ke\u2010You","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Stanford University School of Medicine  Stanford California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4021-5615","authenticated-orcid":false,"given":"Amy G.","family":"Feldman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Colorado School of Medicine and Children's Hospital Colorado  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel H.","family":"Leung","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven J.","family":"Lobritto","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition Columbia University Irving Medical Center, Morgan Stanley Children's Hospital  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6767-8874","authenticated-orcid":false,"given":"John","family":"Bucuvalas","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Mount Sinai Kravis Children's Hospital Icahn School of Medicine at Mount Sinai Hospital  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon P.","family":"Horslen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2624-8632","authenticated-orcid":false,"given":"George V.","family":"Mazariegos","sequence":"additional","affiliation":[{"name":"Thomas E. Starzl Transplantation Institute  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily R.","family":"Perito","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics University of California San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2023.03.008"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpn3.12112"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13873"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13528"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/10691898.2007.11889465"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000003728"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002974"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rdc.2021.07.010"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2024.01.014"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T12:47:01Z","timestamp":1737982021000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,8]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1111\/petr.70018"],"URL":"https:\/\/doi.org\/10.1111\/petr.70018","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"type":"print","value":"1397-3142"},{"type":"electronic","value":"1399-3046"}],"subject":[],"published":{"date-parts":[[2025,1,8]]},"assertion":[{"value":"2024-09-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70018"}}