Survival Benefit of Kidney Transplantation From Expanded Criteria Donors Undergoing Donation After Circulatory Death.
Bibliographic record
Abstract
Background Kidney transplantation from donors after cardiac death (DCD) as well as expanded criteria donors (ECD) has been increasing in frequency over time. Prior research showed that DCD kidneys have a slightly increased risk of graft failure vs non-DCD kidneys, but the relative risk was not significantly greater amongst ECD vs non-ECD kidneys. However, the survival benefit of combined ECD/DCD kidney transplantation in comparison to remaining on the wait-list is unknown. Methods A retrospective cohort study of patients with end stage renal disease waitlisted for ECD kidney transplantation between 1 Jan 2000 and 31 Dec 2009 was conducted using the Scientific Registry of Transplant Recipients. Previous kidney and multi-organ transplant recipients were excluded. ECD/DCD kidney transplantation was considered a time-varying exposure and a multivariable Cox proportional hazards models was fitted to evaluate the relative hazard of death in ECD/DCD kidney transplant recipients in comparison to remaining on the wait-list for a non-ECD or ECD/non-DCD kidney (conservative therapy). Results There were 72,437 patients included in the cohort, of which 534 received an ECD/DCD kidney transplant. Recipients of ECD/DCD kidneys were older at the time of listing, more likely to be male and less likely to be Black or Hispanic. Overall, combined ECD/DCD kidney transplantation was associated with a survival benefit in comparison to conservative therapy (adjusted HR 0.83 [95% CI 0.68, 0.99], p = 0.04). This represents a cumulative average hazard ratio over follow-up but the hazard of death is likely highest immediately post-transplant and subsequently decreases over time. Individual hazard ratios at critical time points post-transplant as well as the time to equal mortality risk are currently being evaluated. Conclusion This study suggests that combined ECD/DCD kidney transplantation is associated with an overall survival advantage in comparison to remaining on the wait-list for a non-ECD or ECD/non-DCD kidney transplant. Further work is required to determine the time to equal mortality risk as well as subgroups of patients that may benefit most from this strategy.
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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 | 0.005 |
| 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 | 0.001 |
| 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".