loading page

Nationwide Variability in the Use of Induction Immunosuppression for Adult Heart Transplantation
  • +6
  • Carlos Diaz-Castrillon,
  • Laura Seese,
  • Michael Mathier,
  • Mary Keebler,
  • Gavin Hickey,
  • Dennis McNamara,
  • Mark SImon,
  • Ed Horn,
  • Arman Kilic
Carlos Diaz-Castrillon
University of Pittsburgh Medical Center
Author Profile
Laura Seese
University of Pittsburgh Medical Center Health System
Author Profile
Michael Mathier
University of Pittsburgh Medical Center Health System
Author Profile
Mary Keebler
University of Pittsburgh Medical Center Health System
Author Profile
Gavin Hickey
University of Pittsburgh Medical Center Health System
Author Profile
Dennis McNamara
University of Pittsburgh Medical Center
Author Profile
Mark SImon
University of Pittsburgh Medical Center
Author Profile
Ed Horn
University of Pittsburgh Medical Center
Author Profile
Arman Kilic
University of Pittsburgh Medical Center Health System
Author Profile

Abstract

Background: Institutional factors have been shown to impact outcomes following orthotopic heart transplantation (OHT). This study evaluated center variability in the utilization of induction therapy for OHT and its implications on clinical outcomes. Methods: Adult OHT patients between 2010 and 2018 were identified from the UNOS registry. Transplant centers were stratified based on their rates of induction therapy utilization. Mixed-effects logistic regression models were created with drug-treated rejection within 1-year as primary endpoint and individual centers as random parameter. Risk-adjusted Cox regression was used to evaluate patient-level mortality outcomes. Results: In 17,524 OHTs performed at 100 centers, induction therapy was utilized in 48.6% (n=8411) with substantial variability between centers (IQR 21.4 – 79.1%).There were 36, 30, and 34 centers in the low (<29%), intermediate (29-66%), and high (>67%) induction utilization terciles groups, respectively. Induction therapy did not account for the observed variability in the treated rejection rate at 1-year among centers after adjusting for donor and recipient factors (p=0.20). No differences were observed in postoperative outcomes among induction utilization centers groups (all, p>0.05). Furthermore, there was a weak correlation between the percentage of induction therapy utilization at the center-level and recipients found to have moderate (r=0.03) or high (r=0.04) baseline risks for acute rejection at 1-year. Conclusions: This analysis demonstrates there is substantial variability in the use of induction therapy among OHT centers. In addition, there was a minimal correlation with baseline recipient risk or 1-year rejection rates, suggesting a need for better-standardized practices for induction therapy use in OHT.

Peer review status:ACCEPTED

04 Jun 2020Submitted to Journal of Cardiac Surgery
06 Jun 2020Submission Checks Completed
06 Jun 2020Assigned to Editor
07 Jun 2020Reviewer(s) Assigned
20 Jun 2020Review(s) Completed, Editorial Evaluation Pending
25 Jun 2020Editorial Decision: Revise Minor
10 Jul 20201st Revision Received
17 Jul 2020Submission Checks Completed
17 Jul 2020Assigned to Editor
29 Jul 2020Reviewer(s) Assigned
08 Aug 2020Review(s) Completed, Editorial Evaluation Pending
17 Aug 2020Editorial Decision: Accept