The Comparative Effectiveness of Dual vs. Single Deceased Donor Kidney Transplantation in the Modern Era.
Bibliographic record
Abstract
BACKGROUND: The use and outcomes of dual (DKT) vs. single (SKT) kidney transplantation has not been well studied in the modern era. METHODS: This is a cohort study of all incident adult deceased donor kidney transplant recipients from 1 Jan 2000 to 31 Dec 2010 using the Scientific Registry of Transplant Recipients. The relation between DKT (vs. SKT) and delayed graft function (DGF) was assessed in logistic regression models. Cox proportional hazards models were fitted to determine the association of DKT with total graft failure, death-censored graft failure, death with graft function, and total mortality. We also used propensity score (PS) matching to balance all measured recipient and donor confounders. The Kidney Donor Risk Index was also calculated for SKT and DKT. RESULTS: The total study cohort and PS subcohort comprised of 75,081 (SKT 73,911, DKT 1,170) and 2,326 (SKT 1,163, DKT 1,163) patients, respectively. DKT recipients were older, more likely diabetic, and had longer cold ischemia times. DKT donors were older, had lower kidney function, and were more likely expanded criteria donors. DKT group had better graft function at 6 and 12 months post transplant compared to SKT in the PS cohort. DKT was associated with an adjusted relative odds of DGF in the total study cohort of 0.69 (95% CI: 0.60, 0.80). DKT showed a protective effect on graft failure but no significant effect on mortality (see Table). The protective effect of DKT was significantly diminished in patients with DGF. Similar findings were observed in the PS subcohort. We ascertained the 50th percentile of the Kidney Donor Risk Index score from the SKT group (i.e., 0.99) and found that 18% of the DKT group was under this threshold CONCLUSIONS: DKT is associated with reduced rates of DGF and graft failure vs. SKT of similar quality. The occurrence of DGF may modify the protective effect of DKT on graft outcomes. The potential impact on life expectancy from transplanting two SKTs vs. one DKT using kidneys with qualities similar to those in this cohort requires further study.Table: No Caption available.DISCLOSURE:Kim, S.: Grant/Research Support, Astellas Pharma Canada, Novartis Pharma Canada, Genzyme Canada.
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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 | 0.009 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 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".