Association of Kidney Transplantation with Survival in Patients with Long Dialysis Exposure
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Evidence that kidney transplantation is associated with better survival compared to dialysis stems from data in populations with short durations of dialysis exposure. Recent changes in allocation policy increase access to transplantation for patients with longer dialysis exposure. The objective of this study was to determine the association of transplantation with survival in patients with ≥10 years of dialysis treatment. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: =5365 patients in the Scientific Registry of Transplant Recipients determined the adjusted relative risk of death in recipients of a deceased donor kidney transplant after ≥10 years of dialysis treatment compared with waitlisted patients with the same dialysis exposure in a time-dependent nonproportional hazards analysis. RESULTS: =2320 transplant recipients compared with patients on dialysis who had equal lengths of follow-up from their 10-year dialysis anniversary was 0.60 (95% confidence interval, 0.53 to 0.68), and this benefit was observed in a variety of patient subgroups, including patients ≥65 years of age and patients with diabetes. However, transplant recipients were at higher risk of death for 180 days after transplantation and did not derive survival benefit until 657 days after transplantation, despite receiving good-quality kidneys. The study patients were younger and had higher expected post-transplant survival than patients currently waitlisted with ≥10 years of dialysis. CONCLUSIONS: Transplantation is associated with better survival in patients who were actively waitlisted with dialysis exposure ≥10 years. Whether transplantation is associated with better survival in currently waitlisted patients with similar dialysis exposure and whether transplantation of lower-quality deceased donor kidneys is associated with better survival are uncertain.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".