TY - JOUR
T1 - Center practice drives variation in choice of US kidney transplant induction therapy
T2 - a retrospective analysis of contemporary practice
AU - Dharnidharka, Vikas R.
AU - Naik, Abhijit S.
AU - Axelrod, David A.
AU - Schnitzler, Mark A.
AU - Zhang, Zidong
AU - Bae, Sunjae
AU - Segev, Dorry L.
AU - Brennan, Daniel C.
AU - Alhamad, Tarek
AU - Ouseph, Rosemary
AU - Lam, Ngan N.
AU - Nazzal, Mustafa
AU - Randall, Henry
AU - Kasiske, Bertram L.
AU - McAdams-Demarco, Mara
AU - Lentine, Krista L.
N1 - Funding Information:
This work was conducted under the auspices of the Minneapolis Medical Research Foundation (MMRF), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US Government-sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for manuscript editing. An abstract describing this work was presented at the American Transplant Congress, May 2017, Chicago, IL.
Funding Information:
This work was supported by a grant from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01-R01DK102981.
Publisher Copyright:
© 2017 Steunstichting ESOT
PY - 2018/2
Y1 - 2018/2
N2 - To assess factors that influence the choice of induction regimen in contemporary kidney transplantation, we examined center-identified, national transplant registry data for 166 776 US recipients (2005–2014). Bilevel hierarchical models were constructed, wherein use of each regimen was compared pairwise with use of interleukin-2 receptor blocking antibodies (IL2rAb). Overall, 82% of patients received induction, including thymoglobulin (TMG, 46%), IL2rAb (22%), alemtuzumab (ALEM, 13%), and other agents (1%). However, proportions of patients receiving induction varied widely across centers (0–100%). Recipients of living donor transplants and self-pay patients were less likely to receive induction treatment. Clinical factors associated with use of TMG or ALEM (vs. IL2rAb) included age, black race, sensitization, retransplant status, nonstandard deceased donor, and delayed graft function. However, these characteristics explained only 10–33% of observed variation. Based on intraclass correlation analysis, “center effect” explained most of the variation in TMG (58%), ALEM (66%), other (51%), and no induction (58%) use. Median odds ratios generated from case-factor adjusted models (7.66–11.19) also supported large differences in the likelihood of induction choices between centers. The wide variation in induction therapy choice across US transplant centers is not dominantly explained by differences in patient or donor characteristics; rather, it reflects center choice and practice.
AB - To assess factors that influence the choice of induction regimen in contemporary kidney transplantation, we examined center-identified, national transplant registry data for 166 776 US recipients (2005–2014). Bilevel hierarchical models were constructed, wherein use of each regimen was compared pairwise with use of interleukin-2 receptor blocking antibodies (IL2rAb). Overall, 82% of patients received induction, including thymoglobulin (TMG, 46%), IL2rAb (22%), alemtuzumab (ALEM, 13%), and other agents (1%). However, proportions of patients receiving induction varied widely across centers (0–100%). Recipients of living donor transplants and self-pay patients were less likely to receive induction treatment. Clinical factors associated with use of TMG or ALEM (vs. IL2rAb) included age, black race, sensitization, retransplant status, nonstandard deceased donor, and delayed graft function. However, these characteristics explained only 10–33% of observed variation. Based on intraclass correlation analysis, “center effect” explained most of the variation in TMG (58%), ALEM (66%), other (51%), and no induction (58%) use. Median odds ratios generated from case-factor adjusted models (7.66–11.19) also supported large differences in the likelihood of induction choices between centers. The wide variation in induction therapy choice across US transplant centers is not dominantly explained by differences in patient or donor characteristics; rather, it reflects center choice and practice.
KW - immunosuppression
KW - induction
KW - kidney transplantation
KW - practice patterns
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U2 - 10.1111/tri.13079
DO - 10.1111/tri.13079
M3 - Article
C2 - 28987015
AN - SCOPUS:85040325155
SN - 0934-0874
VL - 31
SP - 198
EP - 211
JO - Transplant International
JF - Transplant International
IS - 2
ER -