Journal article
Center practice drives variation in choice of US kidney transplant induction therapy: a retrospective analysis of contemporary practice
Transplant international, Vol.31(2), pp.198-211
02/01/2018
DOI: 10.1111/tri.13079
PMCID: PMC5862637
PMID: 28987015
Abstract
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.
Details
- Title: Subtitle
- Center practice drives variation in choice of US kidney transplant induction therapy: a retrospective analysis of contemporary practice
- Creators
- Vikas R. Dharnidharka - Washington University in St. LouisAbhijit S. Naik - University of Michigan–Ann ArborDavid A. Axelrod - Lahey Hospital and Medical CenterMark A. Schnitzler - Saint Louis UniversityZidong Zhang - Saint Louis UniversitySunjae Bae - Johns Hopkins UniversityDorry L. Segev - Johns Hopkins UniversityDaniel C. Brennan - Johns Hopkins UniversityTarek Alhamad - Washington University in St. LouisRosemary Ouseph - Saint Louis UniversityNgan N. Lam - University of AlbertaMustafa Nazzal - Saint Louis UniversityHenry Randall - Saint Louis UniversityBertram L. Kasiske - Hennepin County Medical CenterMara McAdams-Demarco - Johns Hopkins UniversityKrista L. Lentine - Saint Louis University
- Resource Type
- Journal article
- Publication Details
- Transplant international, Vol.31(2), pp.198-211
- Publisher
- Wiley
- DOI
- 10.1111/tri.13079
- PMID
- 28987015
- PMCID
- PMC5862637
- ISSN
- 0934-0874
- eISSN
- 1432-2277
- Number of pages
- 14
- Grant note
- R01DK102981 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) R01-R01DK102981 / National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
- Language
- English
- Date published
- 02/01/2018
- Academic Unit
- Surgery
- Record Identifier
- 9984321864902771
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