National variation in use of Immunosuppression for kidney transplantation: A call for evidence-based regimen selection

David Axelrod; Abhijit S. Naik; Mark A. Schnitzler; Dorry L. Segev; Vikas R. Dharnidharka; Daniel C. Brennan; Sunjae Bae; Jiajing Chen; Allan Massie; Krista L. Lentine

doi:10.1111/ajt.13758

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National variation in use of Immunosuppression for kidney transplantation: A call for evidence-based regimen selection

Journal article

Open access

Peer reviewed

National variation in use of Immunosuppression for kidney transplantation: A call for evidence-based regimen selection

David Axelrod, Abhijit S. Naik, Mark A. Schnitzler, Dorry L. Segev, Vikas R. Dharnidharka, Daniel C. Brennan, Sunjae Bae, Jiajing Chen, Allan Massie and Krista L. Lentine

American journal of transplantation, Vol.16(8), pp.2453-2462

03/31/2016

DOI: 10.1111/ajt.13758

PMCID: PMC5513703

PMID: 26901466

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Abstract

Immunosuppression management in kidney transplantation has evolved to include an increasingly diverse choice of medications. While informed by patient and donor characteristics, choice of immunosuppression regimen varies widely across transplant programs. Using a novel database integrating national transplant registry and pharmacy fill records, immunosuppression use 6–12 and 12–24 months post-transplant was evaluated for 22,453 patients transplanted at 249 U.S. programs in 2005–2010. Use of triple immunosuppression comprising tacrolimus, mycophenolic acid or azathioprine, and steroids varied widely (0–100% of patients per program), as did use of steroid-sparing regimens (0–77%), in sirolimus-based regimens (0–100%) and cyclosporine-based regimens (0–78%). Use of triple therapy was more common in highly sensitized patients, women, and recipients with dialysis duration > 5 years. Sirolimus use appeared to diminish over the study period. Overall, patient and donor characteristics explained only a limited amount of the observed variation in regimen use, while center choice explained 30–46% of the use of non-triple therapy immunosuppression. The majority of patients who received triple therapy (79%), cyclosporine-based (87.6%) and sirolimus-based regimens (84.3%) continued these regimens in the second year post-transplant. This population-based study of immunosuppression practice demonstrates substantial variation in center practice beyond that is explained by differences in patient and donor characteristics.

Details

Title: Subtitle: National variation in use of Immunosuppression for kidney transplantation: A call for evidence-based regimen selection
Creators: David Axelrod - Dartmouth–Hitchcock Medical Center
Abhijit S. Naik - University of Michigan
Mark A. Schnitzler - Saint Louis University
Dorry L. Segev - Johns Hopkins University
Vikas R. Dharnidharka - Washington University in St. Louis
Daniel C. Brennan - Washington University in St. Louis
Sunjae Bae - Johns Hopkins University
Jiajing Chen - Saint Louis University
Allan Massie - Johns Hopkins University
Krista L. Lentine - University of Michigan
Resource Type: Journal article
Publication Details: American journal of transplantation, Vol.16(8), pp.2453-2462
DOI: 10.1111/ajt.13758
PMID: 26901466
PMCID: PMC5513703
NLM abbreviation: Am J Transplant
ISSN: 1600-6135
eISSN: 1600-6143
Grant note: DOI: 10.13039/100000002, name: National Institutes of Health; DOI: 10.13039/100000062, name: National Institute of Diabetes and Digestive and Kidney Diseases, award: R01DK102981
Language: English
Date published: 03/31/2016
Academic Unit: Surgery
Record Identifier: 9984322799902771

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