PMID- 28987015
OWN - NLM
STAT- MEDLINE
DCOM- 20180822
LR  - 20220318
IS  - 1432-2277 (Electronic)
IS  - 0934-0874 (Print)
IS  - 0934-0874 (Linking)
VI  - 31
IP  - 2
DP  - 2018 Feb
TI  - Center practice drives variation in choice of US kidney transplant induction 
      therapy: a retrospective analysis of contemporary practice.
PG  - 198-211
LID - 10.1111/tri.13079 [doi]
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.
CI  - (c) 2017 Steunstichting ESOT.
FAU - Dharnidharka, Vikas R
AU  - Dharnidharka VR
AUID- ORCID: 0000-0001-8000-1385
AD  - Department of Pediatrics, Division of Nephrology, Washington University School of 
      Medicine, St. Louis, MO, USA.
FAU - Naik, Abhijit S
AU  - Naik AS
AD  - Department of Medicine, Division of Nephrology, University of Michigan, Ann 
      Arbor, MI, USA.
FAU - Axelrod, David A
AU  - Axelrod DA
AD  - Department of Surgery, Division of Transplantation, Lahey Clinic, Burlington, MA, 
      USA.
FAU - Schnitzler, Mark A
AU  - Schnitzler MA
AD  - Center for Abdominal Transplantation, Saint Louis University School of Medicine, 
      St. Louis, MO, USA.
FAU - Zhang, Zidong
AU  - Zhang Z
AD  - Center for Abdominal Transplantation, Saint Louis University School of Medicine, 
      St. Louis, MO, USA.
FAU - Bae, Sunjae
AU  - Bae S
AD  - Center for Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA.
FAU - Segev, Dorry L
AU  - Segev DL
AD  - Center for Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA.
FAU - Brennan, Daniel C
AU  - Brennan DC
AD  - Center for Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA.
FAU - Alhamad, Tarek
AU  - Alhamad T
AD  - Transplant Nephrology, Washington University School of Medicine, St. Louis, MO, 
      USA.
FAU - Ouseph, Rosemary
AU  - Ouseph R
AD  - Center for Abdominal Transplantation, Saint Louis University School of Medicine, 
      St. Louis, MO, USA.
FAU - Lam, Ngan N
AU  - Lam NN
AD  - Division of Nephrology, University of Alberta, Edmonton, AB, Canada.
FAU - Nazzal, Mustafa
AU  - Nazzal M
AD  - Center for Abdominal Transplantation, Saint Louis University School of Medicine, 
      St. Louis, MO, USA.
FAU - Randall, Henry
AU  - Randall H
AD  - Center for Abdominal Transplantation, Saint Louis University School of Medicine, 
      St. Louis, MO, USA.
FAU - Kasiske, Bertram L
AU  - Kasiske BL
AD  - Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
FAU - McAdams-Demarco, Mara
AU  - McAdams-Demarco M
AD  - Center for Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA.
FAU - Lentine, Krista L
AU  - Lentine KL
AUID- ORCID: 0000-0002-9423-4849
AD  - Center for Abdominal Transplantation, Saint Louis University School of Medicine, 
      St. Louis, MO, USA.
LA  - eng
GR  - R01 DK102981/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, N.I.H., Extramural
DEP - 20171102
PL  - Switzerland
TA  - Transpl Int
JT  - Transplant international : official journal of the European Society for Organ 
      Transplantation
JID - 8908516
RN  - 0 (Antibodies, Monoclonal, Humanized)
SB  - IM
MH  - Adult
MH  - Antibodies, Monoclonal, Humanized/pharmacology/*therapeutic use
MH  - Cohort Studies
MH  - Female
MH  - Graft Rejection/immunology/*prevention & control
MH  - Graft Survival
MH  - Humans
MH  - Kidney Failure, Chronic/diagnosis/mortality/surgery
MH  - Kidney Transplantation/adverse effects/*methods
MH  - Male
MH  - Middle Aged
MH  - Precision Medicine/*methods
MH  - Registries
MH  - Remission Induction/*methods
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Survival Analysis
MH  - Tissue and Organ Procurement/organization & administration
MH  - Transplantation Immunology
MH  - Treatment Outcome
MH  - United States
MH  - Young Adult
PMC - PMC5862637
MID - NIHMS911685
OTO - NOTNLM
OT  - immunosuppression
OT  - induction
OT  - kidney transplantation
OT  - practice patterns
COIS- DISCLOSURES/CONFLICTS OF INTEREST: The authors report no conflicts of interest.
EDAT- 2017/10/08 06:00
MHDA- 2018/08/23 06:00
PMCR- 2019/02/01
CRDT- 2017/10/08 06:00
PHST- 2017/07/10 00:00 [received]
PHST- 2017/08/29 00:00 [revised]
PHST- 2017/09/28 00:00 [accepted]
PHST- 2017/10/08 06:00 [pubmed]
PHST- 2018/08/23 06:00 [medline]
PHST- 2017/10/08 06:00 [entrez]
PHST- 2019/02/01 00:00 [pmc-release]
AID - 10.1111/tri.13079 [doi]
PST - ppublish
SO  - Transpl Int. 2018 Feb;31(2):198-211. doi: 10.1111/tri.13079. Epub 2017 Nov 2.