Introduction
Perioperative high-intensity immunosuppression has the theoretical
benefit of reducing the risk of rejection following orthotopic heart
transplant (OHT) (1–4), where several contemporary randomized trials
that have evaluated the impacts of various induction therapy agents,
have also come to disparate conclusions (5,8). Prior studies have
demonstrated that patients with higher pre-transplant predicted risks of
rejection may garner benefit from receiving induction immunotherapy
(9,10). The current guidelines from the International Society of Heart
and Lung Transplantation (ISHLT) recommend antibody-based induction
immunosuppression as an alternative for patients at high risk of renal
dysfunction or rejection (11), although predicting which patients carry
sufficient risk remains challenging. Considering this uncertainty, many
centers have developed their own protocols for induction therapy
utilization. Institutional factors greatly influence outcomes following
OHT (12, 14) and may also be key determinants in the likelihood of a
patient to receive induction therapy as well as their odds of rejection.
As such, our objective was to evaluate the degree of center variability
in the utilization of induction therapy and its implications on clinical
outcomes following OHT.