360.6: A mate-kidney analysis examining the impact of Delayed Graft Function on kidney survival; implications for the clinician and clinical trial design.
Notice bibliographique
Résumé
Background: Delayed graft function (DGF) following kidney transplant is associated with inferior long-term outcomes. Trials examining interventions to mitigate DGF and its effects have been uniformly unsuccessful. Concordant DGF, where both recipients of kidney transplants from a single deceased donor, is poorly understood. The impact of concordant or discordant DGF on longer-term outcomes, specifically death censored graft loss (DCGL) has not been described systematically. We leveraged the power of a mate-kidney analysis to explore this relationship. Methods: We performed a mate-kidney analysis, examining recipients of deceased donor kidney transplants between 2018-2019, using data extracted from the Scientific Registry of Transplant Recipients (SRTR). We identified rates of DGF, concordance and discordance in DGF. We devised competing risks models for graft failure, with death as a competing risk, to explore the impact of concordant/discordant DGF on DCGL. Results: Of 11,547 deceased donors between 2018-2019 where both kidneys were transplanted into individual, first, kidney-only recipients there were 6,947 cases of DGF (30.1%); 1,778 (15.44%) donors where concordant DGF occurred, a rate that was higher than expected by chance alone, and which was higher for DCD compared to DBD donors. Discordant DGF occurred in 3,391 donors (29.3%), where one recipient developed DGF and the mate did not. Among donors with discordant DGF, the cumulative incidence of DCGL in the mate who did not develop DGF was no different than that seen in recipients of kidneys from a donor where neither recipient developed DGF (HR 1.02, CI 0.86-1.20). This is most clearly seen among donors with KDPI 21-85%, and particularly in DBD donors, as seen in the middle panels in Figure 1.Conclusions: DGF impacts kidney survival, but among recipients of deceased donor transplants where there was discordant DGF, the kidney survival in the mate who did not develop DGF was not different to recipients of transplants from donors where neither recipient developed DGF. For recipients of deceased donor transplants who themselves do not develop DGF, understanding the fate of the mate does not provide prognostic information, especially in the case of DBD donors. In recipients of transplants from donors with KDPI 21-85%, development of DGF appears to be a major factor through which the increased risk of DCGL is mediated. Clinical trials examining interventions to attenuate DGF should not focus on the highest risk groups (i.e. KDPI ≥ 85%) alone, but should ensure adequate representation from donors with KDPI 20-85% also.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,181 | 0,275 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,005 | 0,013 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,004 | 0,005 |
| Science ouverte | 0,003 | 0,004 |
| Intégrité de la recherche | 0,003 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,025 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».