Hepatitis C Virus Infected Kidney Wait List Patients
Bibliographic record
Abstract
Introduction Currently many centers transplant HCV positive (+) donor kidneys into HCV+ recipients. Directed donation of HCV+ organs reduces the wait time to transplantation. Direct acting antiviral (DAA) therapy has the ability to cure HCV infection. Some have suggested that treatment of HCV+ wait listed patients be deferred with the hope that earlier transplantation will provide better outcomes than early DAA therapy. However there are not enough organs to guarantee prompt transplantation for the current wait list of infected candidates. If you are on the list is it better to wait or be treated early with DAA therapy? Materials and Methods A Markov medical decision analysis model was created to compare the overall outcomes of delay DAA therapy (Option 1) to immediate DAA therapy (Option 2) in wait listed HCV+ patients. Option 1 patients could receive either HCV+ or HCV- kidney and be treated at the time of transplantation, Option 2 would receive only HCV- organs. US mortality rates for adult wait-listed, functioning transplant and dialysis (failed transplant) cohorts and graft survival rates were used (baseline case age 50). The perspective was the patient, time horizon 50 years, and time 0 was wait listing date. DAA therapy resulted in cure. Relative mortality risk (RR) in HCV+ patients was 1.29 (1.11-1.79) compared to non-infected HCV- US patients. Treatment reduced RR of death by 65% (0.5-0.8). Results and Discussion Option 1 patients were modeled to be transplanted 1 year earlier with a higher cumulative transplant incidence (60% versus 54% for Option 2) (Figure 1).Despite this, Option 2 provided 0.43 (95% CI, 0.38, 0.49) more life years than Option 1. The Tornado plot (Figure 2) shows the differences between Option 1 and 2 for the key variables.Over the range of most variables Option 2 provided more added (incremental) life years than Option 1, except in situations of a very low associated mortality with HCV infection and regions with much greater access to HCV+ organs (Figure 3).The findings were the same for younger (age 30) and older recipients (age 65). Including quality of life scores and calculating QALYS resulted in similar conclusions. The best option from an individual patient’s perspective will differ by region and candidate. Early transplantation does not always overcome the excess risk of delayed HCV treatment. Early treatment with DAA should be considered in regions with relatively high demand (many on the wait list with HCV) but low supply of HCV+ organs or if there is a higher chance that delay will result in significant burden of disease associated mortality.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| 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 | 0.000 |
| Insufficient payload (model declined to judge) | 0.012 | 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".