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.