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 substantially 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.