{"doi":"10.1111/petr.70018","title":"Association Between Early Immunosuppression Center Variability and One‐Year Outcomes After Pediatric Liver Transplant","abstract":"BACKGROUND: Despite the existence of institutional protocols, liver transplant centers often have variability in early immunosuppression practices. We aimed to measure within-center variability in early immunosuppression after pediatric liver transplant (LT) and examine its association with one-year outcomes. METHODS: 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-cell depleting antibody vs. non-T-cell depleting antibody. Primary exposures were coefficient of immunosuppression variability (CIV) in (1) induction and (2) mycophenolate mofetil (MMF) use. Primary outcomes were one-year graft survival, patient survival, and acute rejection rate within the first year after transplant. RESULTS: The study cohort included 2542 LT recipients from 67 LT centers. Sixteen centers (24%) had no MMF variability; twenty-five 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 1.66-4.45; p < 0.001). MMF CIV was not associated with rejection (OR 1.22, 95% CI 0.66-2.25, p = 0.527). Neither one-year graft nor patient survival were associated with induction or MMF CIV. CONCLUSIONS: Induction CIV is associated with higher one-year acute rejection odds and did not impact short-term 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.","journal":"Pediatric Transplantation","year":2025,"id":551093,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8887,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":284379,"name":"Scott D. Rothenberger","orcid":"0000-0001-8300-5947","position":1,"is_corresponding":false},{"id":296201,"name":"James E. Squires","orcid":"0000-0001-6979-8987","position":2,"is_corresponding":false},{"id":1446936,"name":"Elizabeth Eisenberg","orcid":null,"position":3,"is_corresponding":false},{"id":881138,"name":"Anna L. Peters","orcid":"0000-0003-0327-1378","position":4,"is_corresponding":false},{"id":1446564,"name":"Jennifer Halma","orcid":"0000-0002-8447-9068","position":5,"is_corresponding":false},{"id":922296,"name":"Swati Antala","orcid":null,"position":6,"is_corresponding":false},{"id":1446565,"name":"Irini Batsis","orcid":"0000-0001-8767-331X","position":7,"is_corresponding":false},{"id":1124426,"name":"Ke‐You Zhang","orcid":"0000-0002-9820-8058","position":8,"is_corresponding":false},{"id":366956,"name":"Amy G. Feldman","orcid":"0000-0003-4021-5615","position":9,"is_corresponding":false},{"id":277194,"name":"Daniel H. Leung","orcid":"0000-0002-2139-5959","position":10,"is_corresponding":false},{"id":286085,"name":"Steven Lobritto","orcid":"0000-0003-1482-1128","position":11,"is_corresponding":false},{"id":286075,"name":"John C. Bucuvalas","orcid":"0000-0002-6767-8874","position":12,"is_corresponding":false},{"id":286716,"name":"Simon Horslen","orcid":"0000-0001-5949-7363","position":13,"is_corresponding":false},{"id":286076,"name":"George Mazariegos","orcid":"0000-0002-2624-8632","position":14,"is_corresponding":false},{"id":277497,"name":"Emily R. Perito","orcid":"0000-0002-2911-9684","position":15,"is_corresponding":false},{"id":85989,"name":"Vikram Raghu","orcid":"0000-0002-6555-9732","position":0,"is_corresponding":true}],"reference_count":9,"raw_metadata":null,"created_at":"2026-07-19T02:54:20.915388Z","pmid":"39777775","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}