The use of induction therapy in liver transplantation is highly variable and is associated with posttransplant outcomes

Therese Bittermann, Rebecca A. Hubbard, James D. Lewis, David S. Goldberg

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


The use of induction immunosuppression in liver transplantation (LT) remains controversial. This was a retrospective cohort study of adult, first-time liver-alone recipients (N = 69 349) at 114 US centers between 2005 and 2018 using data from the United Network for Organ Sharing. The comparative effectiveness of nondepleting and depleting induction (NDI and DI) was assessed. Overall, 27% of recipients received induction with 65.7% of the variance in the receipt of induction being attributed to transplant center alone. NDI and DI were associated with a lower risk of death/graft failure compared to no induction (adjusted hazard ratio 0.90 [95% confidence interval (CI): 0.86-0.95] and 0.91 [95% CI: 0.85-0.97], respectively; P <.001). In nondialysis recipients at the mean transplant estimated glomerular filtration rate (eGFR), NDI was associated with an adjusted gain in eGFR by 6 months of +3.8 mL/min per 1.73 m2 and DI of +3.33 mL/min per 1.73 m2 compared to no induction (P <.001). Recipients with lower eGFR at LT had greater predicted improvement in eGFR (interaction P <.001). Only NDI was associated with a reduced risk of acute rejection in the first year post-LT (odds ratio 0.87, 95% CI: 0.8-0.94). Significant variability in induction practices exists, with center being a major determinant. The absolute incremental benefits of NDI and DI over no induction were small.

Original languageEnglish (US)
Pages (from-to)3319-3327
Number of pages9
JournalAmerican Journal of Transplantation
Issue number12
StatePublished - Dec 1 2019
Externally publishedYes


  • clinical research/practice
  • health services and outcomes research
  • immunosuppression/immune modulation
  • immunosuppressive regimens – induction
  • liver allograft function/dysfunction
  • liver transplantation/hepatology

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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