Restricted mean models for transplant benefit and urgency
Restricted mean models for transplant benefit and urgency
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DOI：
10.1002/sim.4450
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发表时间：
2012-03-15
影响因子：
2
通讯作者：
Murray, Susan
中科院分区：
文献类型：
--
作者：
Xiang, Fang;Murray, Susan
美国的肺分配政策在定义肺分配分数(LAS)时估计每个个体的紧迫性和移植收益。根据器官采购和移植网络胸科委员会的定义，移植益处是指在接下来的一年里，如果移植与不移植相比，获得的生命天数。紧迫性是通过在接下来的一年里没有移植的生命天数来衡量的。在这两种定义中，都需要准确估计等待列表的生存天数，即等待列表受限的平均生存时间。风险因素在列出时可用于评估患者的紧迫性，更多的紧急患者在死亡或移植后从等待名单中删除。随着患者病情的进展，移植的优先顺序(审查)也会相应地改变。因此，在模拟生活的日子里，调整依赖审查是至关重要的。我们建立了一个限制均值作为协变量的函数的模型，通过使用伪观测来解释与一系列纵向测量(LAS)相关的删失。仿真结果表明，我们的方法在与LAS设置相当的情况下表现良好。应用等待名单和移植后模型结果，解释了对等待名单患者的依赖审查，我们获得了对许多更迫切需要移植的患者更大的移植益处的估计。在适当考虑依赖审查的情况下，个体LAS的差异对为这些患者提供器官的优先顺序和时机有很大影响。版权所有(C)2012 John Wiley&Sons，Ltd.
The US lung allocation policy estimates each individual's urgency and transplant benefit in defining a lung allocation score (LAS). Transplant benefit, as defined by the Organ Procurement and Transplantation Network Thoracic Committee, is the days of life gained over the following year if transplanted versus not transplanted. Urgency is measured by days of life during the next year without transplant. In both definitions, accurate estimation of wait list days lived, or a wait list restricted mean lifetime, is required. Risk factors are available to estimate patient urgency when listed, with more urgent patients removed from the wait list upon death or transplant. As a patient progresses, priority for transplant (censoring) changes accordingly. Therefore, it is crucial to adjust for dependent censoring in modeling days of life. We develop a model for the restricted mean as a function of covariates, by using pseudo-observations that account for dependent censoring linked to a series of longitudinal measures (LAS). Simulation results show that our method performs well in situations comparable with the LAS setting. Applying wait list and post-transplant model results that account for dependent censoring to wait list patients, we obtain estimates of transplant benefit that are larger for many of the more urgent patients in need of transplant. The difference in LAS for an individual, when properly accounting for dependent censoring, has high impact on the priority and timing of an organ offer for these patients. Copyright (c) 2012 John Wiley & Sons, Ltd.