Daclizumab Induction Therapy Associated With Tacrolimus-MMF Has Better Outcome Compared With Tacrolimus-MMF Alone in Pediatric Living Donor Liver Transplantation

Abstract

Aims Imunosuppression therapy for the control of immunologic rejection is a key aspect in liver transplantation. The objective of this study was to evaluate induction therapy with daclizumab (DAC) in living donor liver transplantation (LDLT) in children. Methods We compared 2 different imunosuppression protocols in 30 children undergoing LDLT. The patients were divided into 2 groups: 12 patients received tacrolimus with mycophenolate mofetil (TAC-MMF), and 18 patients received tacrolimus with MMF and DAC induction therapy at days 0 and 14 after LDLT (DAC–TAC-MMF). Both groups were similar with regard to age, sex, weight, and indication for liver transplantation. The incidence of biopsy-proved rejection episodes, posttransplantation lymphoproliferative disease (PTLD), and renal dysfunction were evaluated. Tacrolimus levels at posttransplantation day 14 and at 2 months after transplantation were compared in the 2 groups. Results Acute rejection episodes were observed in 8 patients in the TAC-MMF group (66%), and none in the DAC–TAC-MMF group (0%; P < .05). Neither PTLD nor renal dysfunction was seen in any patient. Mean Tacrolimus level on posttransplantation day 14 was 10.67 ± 5.4 ng/mL in the TAC-MMF group and 5.65 ± 3.6 ng/mL in the DAC–TAC-MMF group ( P < .05). After the second month the mean tacrolimus levels were 7.2 ± 2.9 ng/mL and 6.8 ± 3.5 ng/mL in the TAC-MMF and DAC–TAC-MMF groups, respectively. ( P = NS). Conclusion Induction therapy with DAC is safe and associated with a lower incidence of rejection episodes among children undergoing LDLT.