The Survival Benefit of Expanded Criteria Donor Transplantation in Sensitized Patients.
Bibliographic record
Abstract
In the seminal study by Merion and colleagues,* the benefit of ECD transplantation in recipients with PRA ≥10% was uncertain. Using data from USRDS between 1995-2007 and multivariate non-proportional hazards analyses, we determined the survival benefit of ECD transplantation (defined by Kidney Donor Profile Index (KDPI) cut-points of > 0.8, and 0.9) among sensitized patients with PRA >50% compared to the alternative strategy of continued waiting or transplantation with an SCD transplant. In these models transplantation was treated as a time varying covariate to account for the fact that patients switched treatment with dialysis to transplantation at different times, and patients were censored if they received a living donor transplant or were permanently removed from the wait-list. Results: The median waiting time to transplantation among n =28,711 candidates aged 18-49 years was 2.8 (Q1,Q4 1.4,4.5) years; while that among the n=21,660 candidates aged ≥50 years was 2.2 (Q1,Q4 1.0,3.6) years. The figure shows the relative risks of death at different time points after ECD transplantation compared to similar patients who continued wait-listing or received an SCD transplant.Figure: No Caption available.Transplantation with a KDPI > 0.80 was associated with a lower risk of death in candidates aged 18-49 and ≥50 years compared to the alternative strategy of waiting or SCD transplantation (panel A in Figure). However, transplantation with a KDPI > 0.90 was not associated with a survival benefit in those aged 18-49 years, and was associated with a decreased survival benefit after five years of transplantation in those >50 years related to allograft failures (panel B in Figure. Conclusions: There is a threshold of KDPI beyond which highly sensitized patients do not derive a survival benefit from ECD transplantation. As waiting times and the characteristics of high KDPI donors are subject to change over time, frequent reevaluation of the survival benefit ECD transplantation in highly sensitized patients is warranted. * JAMA: 2005;294(21):2727-33.
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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 | 0.002 | 0.003 |
| 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".