Bray Mathieu, Wang Wen, Song Peter X-K, Kalbfleisch John D
Department of Biostatistics, University of Michigan, Ann Arbor, MI.
Department of Biostatistics, University of Michigan, Ann Arbor, MI. Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI.
Stat Biosci. 2018 Apr;10(1):255-279. doi: 10.1007/s12561-018-9214-7. Epub 2018 Mar 1.
In kidney paired donation (KPD), incompatible donor-candidate pairs and non-directed (also known as altruistic) donors are pooled together with the aim of maximizing the total utility of transplants realized via donor exchanges. We consider a setting in which disjoint sets of potential transplants are selected at regular intervals, with fallback options available within each proposed set in the case of individual donor, candidate or match failure. We develop methods for calculating the expected utility for such sets under a realistic probability model for the KPD. Exact expected utility calculations for these sets are compared to estimates based on Monte Carlo samples of the underlying network. Models and methods are extended to include transplant candidates who join KPD with more than one incompatible donor. Microsimulations demonstrate the superiority of accounting for failure probability and fallback options, as well as candidates joining with additional donors, in terms of realized transplants and waiting time for candidates.
在肾配对捐赠（KPD）中，不相容的供体-受者对以及非指定（也称为利他性）供体被集中在一起，目的是通过供体交换实现的移植总效用最大化。我们考虑这样一种情况，即定期选择不相交的潜在移植集，并且在个体供体、受者或匹配失败的情况下，每个提议的集合中都有备用选项。我们开发了在KPD的现实概率模型下计算此类集合的预期效用的方法。将这些集合的精确预期效用计算结果与基于基础网络的蒙特卡洛样本的估计值进行比较。模型和方法被扩展到包括与多个不相容供体加入KPD的移植受者。微观模拟表明，在已实现的移植和受者等待时间方面，考虑失败概率和备用选项以及有额外供体加入的受者具有优越性。
