Wang Wen, Bray Mathieu, Song Peter X-K, Kalbfleisch John D
Department of Biostatistics, University of Michigan, Ann Arbor, MI, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI.
Stat Biosci. 2017 Dec;9(2):453-469. doi: 10.1007/s12561-016-9155-y. Epub 2016 Jul 6.
While there is a growing need for kidney transplants to treat end stage kidney disease, the supply of transplantable kidneys is in serious shortage. Kidney paired donation (KPD) programs serve as platforms for candidates with willing but incompatible donors to assess the possibility of exchanging donors, thus opening up new transplant opportunities for these candidates. In recent years, non-directed (or altruistic) donors (NDDs) have been incorporated into KPD programs beginning chains of transplants that benefit many candidates. In such programs, making optimal decisions in transplant exchange selection is of critical importance. With the aim of improving the selection of chains beginning with an NDD, this paper introduces a look-ahead multiple decision strategy to select chains, that are easy to extend in the future. Simulation studies are adopted to assess performance of this strategy. Taking into account the extensibility of chains increases the number of realized transplants.
虽然治疗终末期肾病对肾移植的需求日益增长，但可用于移植的肾脏供应严重短缺。肾脏配对捐赠（KPD）项目为那些有意愿捐赠但供体不匹配的候选者提供了一个平台，用以评估交换供体的可能性，从而为这些候选者开辟新的移植机会。近年来，非指定（或利他性）供体（NDDs）已被纳入KPD项目，开启了使许多候选者受益的移植链条。在这类项目中，在移植交换选择中做出最优决策至关重要。为了改进以NDD开始的链条的选择，本文引入了一种前瞻性多决策策略来选择链条，这种策略便于未来扩展。采用模拟研究来评估该策略的性能。考虑到链条的可扩展性会增加实际完成的移植数量。
