METHODS: This retrospective cohort study included 2,382 transplant recipients (680 BMT, 1,702 solid organ) at Ann & Robert H. Lurie Childrens Hospital of Chicago from 2007-2017. Post-transplantation FA was defined as incident physician diagnosis of FA after transplant using ICD-9/10 coding. We determined gender, age at transplant, transplant type and Tacrolimus exposure on all subjects. Chi-square and Fischer's exact tests were used to compare categorical variables. Multinomial logistic regression determined the odds of FA controlling for gender, transplant type and age at transplant. Joint analysis determined the combined and independent effects of transplant type and Tacrolimus exposure on odds of FA.
RESULTS: Subjects were older children (median age 11.0 years) and 54.7% male. Post-transplantation FA developed in 2.23% overall, and in 0.9% of BMT recipients, 2.8% of all solid organ transplant recipients and 5.5% of liver transplant recipients. Compared to BMT, solid organ transplant recipients were 2.6-fold more likely to develop FA (95%CI: 1.1-6.3; p=0.038). Liver transplant recipients had 2.3-fold increased odds of FA compared to other solid organ transplant recipients (95%CI: 1.3-4.2; p=0.007). Compared to BMT recipients without Tacrolimus, solid organ transplant recipients exposed to Tacrolimus had 4.8-fold increased odds of FA (95%CI: 1.9-12.4; p=0.001).
CONCLUSIONS: This large, retrospective cohort study of BMT and solid organ transplant recipients found that solid organ transplant recipients exposed to Tacrolimus had a 5-fold increased risk of FA.