Study Implications
The major implication of this analysis is that the substantial variability observed in clinical practice across centers with regards to induction therapy utilization in OHT is not explained by differences in the estimated composite risks of rejection at the patient-level, further reflecting the uncertainty behind decision analysis on induction therapy utilization across U.S.
The data also suggest that there are other unmeasured factors that are contributing significantly to differences in 1-year rejection that are not accounted for by induction therapy use. These may include factors such as educational processes surrounding medication compliance or staffing and center resources for monitoring, diagnosing and treating rejection. It is unclear from our analysis what constitutes these center-level factors, although their importance appears significant in the preservation of longitudinal, rejection-free outcomes in OHT recipients.