Introduction: Immunosuppression varies among centers. Few comparative studies are published defining the best evidence-based approach. Pediatric patients are ideal to explore differences being a more homogeneous population with a lower rate of comorbidities

Methods: A retrospective study of patients receiving first liver transplantation in the four participating centers between January 2015 and 2019 was conducted. Patients were classified based on the immediate post-transplant immunosuppression in Group A (Basiliximab + Steroids + Tacrolimus), B (same as A + Thymoglobulin), and C (Steroids + Tacrolimus). Patients with other schemes were excluded. Main variables were incidence of rejection, infections, and first-year patient and graft survivals. A sub-set of Biliary Atresia patients was carried out to assess a more homogeneous population. GraphPad was used for statistical analysis; a p-value of 0.05 was considered significant.

Results: 97 patients from 4 centers were recruited (Group A n= 52, Group B n= 25, Group C n= 20). Proportion of living donors were similar (p=0.93). No differences in rejection (p=0.12), CMV (p=0.10) or EBV (p=0.12) replication,  nor other viral or bacterial infections (p=0.96) were noted. Patient (p=0.12) and graft (p=0.30) survival were similar (Table ). Results were similar among biliary atresia except for CMV replication, more frequent in group B when compared to Group C (p=0.04). Patient and graft survival were 100% in all groups.

Conclusion: Results are comparable regardless of the immunosuppression protocol in this series. Since our study has been retrospective, a multicenter prospective properly powered study would be required to validate this conclusion.