Are We Too Selective? Access To, and the Survival Benefit of Repeat Transplantation.
Bibliographic record
Abstract
Given the organ shortage, we wondered whether the current practice of selecting patients for repeat transplantation was too liberal or too conservative. We assessed access to transplantation, and the survival benefit of transplantation in adult incident ESRD patients without overt contraindications to transplantation and compared these findings to those in repeat transplant recipients captured in the USRDS between 1995-2007. Among 1,119, 206 adult incident ESRD patients, n =178,462 (16%) were wait-listed and 61,959 (35%) received a deceased donor transplant by end of follow up (Dec 31, 2007); whereas among 91,306 patients with first transplant failure during the same time period, n= 15,596 (17%) were wait-listed and n =4,014(26%) received a deceased donor transplant. Patients wait-listed for a second transplant were younger (mean age (STD) 43(13) versus 50(13) years); more likely to be white (64% vs 59%); less likely to have diabetes (16% vs 34%); and less likely to have comorbid conditions (IHD (5 vs 9%); CHF (8 vs 13%)) than patients wait-listed for a primary transplant (p <0.05, for all comparisons). The figure shows the results of a multivariate time to event analysis to determine the relative risk of death after transplantation in first and repeat transplant recipients compared to similar patients who remained on the waiting list. Compared to first transplant recipients, repeat transplant recipients had a lower risk of perioperative death and derived a larger and more rapid survival benefit from transplantation. The time to equal risk of death in transplant recipients compared to comparable patients who remained on the waiting list was 70 vs 128 days in repeat and primary transplant recipients, while the time to equal survival was 158 vs 256 days. We conclude that repeat transplant recipients derive a greater relative survival advantage from transplantation compared to primary transplant recipients. Given that only 17% of patients with transplant failure are wait-listed, current clinic practice may be too restrictive in selecting patients for repeat transplantation.Figure: No Caption available.Figure title: The relative risk of death after transplantation in first and repeat transplant recipients compared to similar patients who remained on the waiting list.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.004 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".