OBJECTIVES The objective of the study was to characterize variance in the utilization of immunosuppressant agents among kidney transplant patients across academic medical centers (AMC), and to illustrate potential differences in clinical and economic outcome measures. METHODS A retrospective database analysis, representing 48 AMCs participating in the University HealthSystem Consortium's (UHC) Clinical Resource Manager (CRM), was conducted on inpatients discharged between July 2007 and June 2008. Administrative data examined included total discharges for kidney transplants, source of renal allograft, cases with complications, immunosuppressant utilization, length of therapy (LOT), length of stay (LOS), days in intensive care unit (ICU), in-hospital mortality rate, estimated immunosuppressant cost, and estimated hospital costs. Descriptive statistics were used to evaluate data. RESULTS The mean LOT and number of institutions utilizing particular agents varied. Cyclosporine was used in an average 16% of transplants. Tacrolimus and mycophenolate mofetil had a mean utilization of 83% (4% to 100%) and 92% (39% to 100%) respectively. Sirolimus and azathioprine were administered in an average 12% (1% to 75%) and 2% (<1% to 8%) respectively. Antithymocyte globulin, equine was dispensed in an average 28% (<1% to 91%) of cases. Antithymocyte globulin, rabbit was used in an average 53% (1% to 100%) of cases. Basiliximab and daclizumab were utilized in an average 31% (1% to 96%) and 33% (1% to 89%). Thirty-three institutions utilized three or more agents in greater than 50% of their kidney transplants. Agents that contributed most significantly to immunosuppressant cost were antithymocyte globulin and basiliximab. The mean LOS index was 1.1 (0.6 to 1.7). The mean days spent in the ICU was 2.8 (1.6 to 8.0) days. The mean in-hospital mortality rate was 0.47%. The estimated average immunosuppressant cost per case was $4249. CONCLUSIONS Considerable variation exists among institutional utilization of immunosuppressive agents, LOT, and associated medication costs per case.