National Variation in Use of Immunosuppression for Kidney Transplantation: A Call for Evidence-Based Regimen Selection

D. A. Axelrod, A. S. Naik, M. A. Schnitzler, D. L. Segev, V. R. Dharnidharka, D. C. Brennan, S. Bae, J. Chen, A. Massie, K. L. Lentine

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Immunosuppression management in kidney transplantation has evolved to include an increasingly diverse choice of medications. Although informed by patient and donor characteristics, choice of immunosuppression regimen varies widely across transplant programs. Using a novel database integrating national transplant registry and pharmacy fill records, immunosuppression use at 6–12 and 12–24 mo after transplant was evaluated for 22 453 patients transplanted in 249 U.S. programs in 2005–2010. Use of triple immunosuppression comprising tacrolimus, mycophenolic acid or azathioprine, and steroids varied widely (0–100% of patients per program), as did use of steroid-sparing regimens (0–77%), sirolimus-based regimens (0–100%) and cyclosporine-based regimens (0–78%). Use of triple therapy was more common in highly sensitized patients, women and recipients with dialysis duration >5 years. Sirolimus use appeared to diminish over the study period. Patient and donor characteristics explained only a limited amount of the observed variation in regimen use, whereas center choice explained 30–46% of the use of non–triple-therapy immunosuppression. The majority of patients who received triple-therapy (79%), cyclosporine-based (87.6%) and sirolimus-based (84.3%) regimens continued them in the second year after transplant. This population-based study of immunosuppression practice demonstrates substantial variation in center practice beyond that explained by differences in patient and donor characteristics.

Original languageEnglish
Pages (from-to)2453-2462
Number of pages10
JournalAmerican Journal of Transplantation
Volume16
Issue number8
DOIs
StatePublished - Aug 1 2016

Keywords

  • clinical research/practice
  • health services and outcomes research
  • immunosuppressant
  • immunosuppressant
  • immunosuppressive regimens
  • immunosuppressive regimens
  • kidney transplantation/nephrology
  • maintenance
  • steroid

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