Mi Zhibao, Novitzky Dimitri, Collins Joseph F, Cooper David Kc
Cooperative Studies Program Coordinating Center, VA Maryland Health Care Systems, Perry Point, MD, USA.
Department of Cardiothoracic Surgery, University of South Florida, Tampa, FL, USA.
Clin Epidemiol. 2014 Dec 22;7:17-27. doi: 10.2147/CLEP.S71403. eCollection 2015.
The management of brain-dead organ donors is complex. The use of inotropic agents and replacement of depleted hormones (hormonal replacement therapy) is crucial for successful multiple organ procurement, yet the optimal hormonal replacement has not been identified, and the statistical adjustment to determine the best selection is not trivial. Traditional pair-wise comparisons between every pair of treatments, and multiple comparisons to all (MCA), are statistically conservative. Hsu's multiple comparisons with the best (MCB) - adapted from the Dunnett's multiple comparisons with control (MCC) - has been used for selecting the best treatment based on continuous variables. We selected the best hormonal replacement modality for successful multiple organ procurement using a two-step approach. First, we estimated the predicted margins by constructing generalized linear models (GLM) or generalized linear mixed models (GLMM), and then we applied the multiple comparison methods to identify the best hormonal replacement modality given that the testing of hormonal replacement modalities is independent. Based on 10-year data from the United Network for Organ Sharing (UNOS), among 16 hormonal replacement modalities, and using the 95% simultaneous confidence intervals, we found that the combination of thyroid hormone, a corticosteroid, antidiuretic hormone, and insulin was the best modality for multiple organ procurement for transplantation.
脑死亡器官捐献者的管理很复杂。使用血管活性药物和补充消耗的激素（激素替代疗法）对于成功获取多个器官至关重要，但尚未确定最佳的激素替代方案，且确定最佳选择的统计调整并非易事。传统的每对治疗之间的两两比较以及与所有治疗的多重比较（MCA）在统计上较为保守。许氏与最佳治疗的多重比较（MCB）——改编自邓尼特与对照的多重比较（MCC）——已被用于基于连续变量选择最佳治疗。我们采用两步法为成功获取多个器官选择最佳的激素替代方式。首先，通过构建广义线性模型（GLM）或广义线性混合模型（GLMM）估计预测边际，然后鉴于激素替代方式的测试是独立的，应用多重比较方法来确定最佳的激素替代方式。基于器官共享联合网络（UNOS）的10年数据，在16种激素替代方式中，并使用95%的同时置信区间，我们发现甲状腺激素、一种皮质类固醇、抗利尿激素和胰岛素的组合是用于移植的多个器官获取的最佳方式。
