A predictive nomogram for choosing tacrolimus or cyclosporine as immunosuppression drugs for pediatric recipients after liver transplantation

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.