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Identifying appropriate recipients for CDC infectious risk donor kidneys.
Chow, E K H; Massie, A B; Muzaale, A D; Singer, A L; Kucirka, L M; Montgomery, R A; Lehmann, H P; Segev, D L.
Afiliación
  • Chow EK; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Am J Transplant ; 13(5): 1227-34, 2013 May.
Article en En | MEDLINE | ID: mdl-23621162
Over 10% of deceased donors in 2011 met PHS/CDC criteria for infectious risk donor (IRD), and discard rates are significantly higher for kidneys from these donors. We hypothesized that patient phenotypes exist for whom the survival benefit outweighs the infectious risk associated with IRDs. A patient-oriented Markov decision process model was developed and validated, based on SRTR data and meta-analyses of window period risks among persons with IRD behaviors. The Markov model allows patients to see, for their phenotype, their estimated survival after accepting versus declining an IRD offer, graphed over a 5-year horizon. Estimated 5-year survival differences associated with accepting IRDs ranged from -6.4% to +67.3% for a variety of patient phenotypes. Factors most predictive of the survival difference with IRD transplantation were age, PRA, previous transplant, and the expected time until the next non-IRD deceased donor offer. This study suggests that survival benefit derived from IRD kidneys varies widely by patient phenotype. Furthermore, within the inherent limitations of model-based prediction, this study demonstrates that it is possible to identify those predicted to benefit from IRD kidneys, and illustrates how estimated survival curves based on a clinical decision can be presented to better inform patient and provider decision-making.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Donantes de Tejidos / Salud Pública / Técnicas de Apoyo para la Decisión / Trasplante de Riñón / Centers for Disease Control and Prevention, U.S. / Selección de Donante / Infecciones Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Determinantes_sociais_saude Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: Am J Transplant Asunto de la revista: TRANSPLANTE Año: 2013 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Donantes de Tejidos / Salud Pública / Técnicas de Apoyo para la Decisión / Trasplante de Riñón / Centers for Disease Control and Prevention, U.S. / Selección de Donante / Infecciones Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Determinantes_sociais_saude Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: Am J Transplant Asunto de la revista: TRANSPLANTE Año: 2013 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos