Objective: To observe the efficacy of recombinant anti-cluster of differentiation 25 (CD25) humanized monoclonal antibody plus steroid reduction immune induction regimen in preventing acute rejection (AR) in pediatric liver transplant (LT) recipients.   
Methods: Retrospective analysis was conducted for 79 pediatric LT recipients between July 2015 and August 2024. Based upon perioperative immune induction regimens, they were assigned into two groups of steroid (n=60) and CD25 monoclonal antibody (n=19). The former group received full-dose steroid induction perioperatively, followed by tacrolimus plus steroids for postoperative immunosuppression. And the latter group received recombinant anti-CD25 humanized monoclonal antibody plus half-dose steroid induction perioperatively, followed by tacrolimus monotherapy for postoperative immunosuppression. The incidence rates of postoperative AR, infection, steroid-related complications and other primary outcomes were compared between two groups. Secondary outcomes, including intensive care unit (ICU) stay, graft survival, patient survival, length of hospitalization stay and hospitalization expenses were also compared.
Results: The incidence of AR (4/19 vs 16/60), infection complications (12/19 vs 40/60) and steroid-related complications (11/19 vs 24/60) in CD25 monoclonal antibody group did not significantly differ from steroid group (P>0.05). Additionally, no significant inter-group differences existed in ICU stay [7.5(3.0, 11.0) vs 3.5 (0.0, 12.0) d], hospitalization expenses [18.99(13.13, 41.45) vs 19.54(15.22, 29.32) ten thousand yuan], graft survival rate (18/19 vs 59/60) or patient survival rate (19/19 vs 54/60) (P>0.05). However, length of hospitalization stay was significantly shorter in CD25 monoclonal antibody group than that in steroid group [24.0(17.0, 34.0) vs 35.0(27.0, 46.5) day, P<0.05].  
Conclusion: The recombinant anti-CD25 humanized monoclonal antibody plus steroid reduction immune induction regimen is both safe and effective, achieving similar immunosuppression with tapered steroid dosing. However, as compared with steroid group, it does not significantly lower the incidence of AR, infections or steroid-related complications.