Immune Sensitization and Mortality On the Waiting List for Kidney Transplantation.
Bibliographic record
Abstract
Purpose: Cardiovascular mortality is the leading cause of death in end-stage renal disease (ESRD) patients. Inflammation has been shown to play a role in cardiovascular disease. Anti-HLA antibodies, measured as panel reactive antibodies (PRA), may also be a marker of inflammation. PRA is routinely monitored in ESRD patients on the waiting list to facilitate transplantation with a compatible donor. Whether PRA is a risk factor for cardiovascular mortality in ESRD is unknown. Methods: Using the Scientific Registry of Transplant Recipients, we conducted a retrospective cohort study in first-time adult kidney transplant candidates. The relationship between PRA modeled as a time-varying categorical variable (PRA 0%, PRA 1-19%, PRA 20-79%, and PRA 80-100%) and cardiovascular mortality was assessed in Cox proportional hazards models. All-cause mortality was a secondary endpoint. The analysis was repeated in a subcohort of transplant candidates at low risk for significant comorbidity. Competing risk analyses evaluating the effect of time-fixed PRA category upon activation on study endpoints were also conducted. In these analyses, transplantation and non-cardiovascular mortality were considered competing events. Results: Among 161,308 kidney transplant candidates, Cox models showed an increase in the hazard ratio (HR [95% confidence interval]) for cardiovascular mortality (HR 1.04 [0.95, 1.13], 1.23 [1.12, 1.36], and 1.45 [1.28, 1.65]) and all-cause mortality (HR 1.01 [0.95, 1.08], 1.11 [1.02, 1.21], and 1.17 [1.05, 1.31]) in PRA 1-19%, PRA 20-79%, and PRA 80-100% categories compared with PRA 0%, respectively. The relationship was accentuated in patients at low risk for significant comorbidity (cardiovascular mortality: HR 1.14 [0.64, 2.06], 1.85 [1.07, 3.21], and 3.90 [2.21, 6.90]; all-cause mortality: HR 0.97 [0.78, 1.20], 1.25 [1.01, 1.56], and 1.53 [1.18, 2.00]) and in the competing risks models (cardiovascular mortality: HR 1.03 [0.94, 1.12], 1.22 [1.09, 1.36], and 1.58 [1.37, 1.84]; all-cause mortality: HR 1.05 [1.01, 1.08], 1.20[1.15, 1.25], and 1.52 [1.44, 1·62]). Conclusion: Our findings suggest that PRA may be an independent risk factor for mortality on the waiting list for kidney transplantation. Current organ allocation schemes may need to consider this additional risk of mortality in sensitized candidates awaiting kidney transplantation. Whether transplantation modifies the risk of cardiovascular mortality in sensitized patients requires further study.
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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 | 0.004 |
| 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 | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| 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".