Assessing Renal Transplant Candidate Survival at Listing Using a Risk-Adjusted Multi-State Semi-Markov Model
1Industrial Engineering, Northwestern University, Evanston, IL
2RAND Corporation, Boston, MA.
Meeting: 2018 American Transplant Congress
Abstract number: B81
Keywords: Economics, Waiting lists
Session Information
Session Name: Poster Session B: Kidney Deceased Donor Allocation
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Newly listed candidates for kidney transplant must navigate several processes over the course of their treatment. Of special interest to such candidates is their expected survival time – the calculation thereof being complicated by the possibility of being removed from the waitlist in the future; by the performance of the organ procurement and transplantation network; and by the uncertainty in time-to-transplantation and post-transplant survival. Recent work has acknowledged the need for competing risks and multi-state time-to-event modeling. We construct and analyze a multi-state Semi-Markov survival model that captures the salient events in the transplantation process and calculates the expected survival time at listing for a given patient profile. Patient profiles consists of risk-adjustments for individual characteristics; clinical factors such as diagnoses, comorbidities, and immunology; donor characteristics and quality; and also volumes, waiting times, and level of competition for the patient's transplant center or organ procurement organization. The multi-state model with risk-adjustments is estimated for adult deceased-donor kidney transplant candidates from 2007 through 2016 with no prior or multiple transplants. Risk-adjusted expected survival times for candidates at listing were computed from the results. These estimates of survival times at listing may aid individualized decision-making for treatment or at listing.
| Patient Profile | Expected time to Transplant | Time to Wt. List Mortality | Transplant Survival Time | Overall Expected Time |
| 65-year old rural patient, sensitized (most recent CPRA =50), peripheral vascular disease, diagnosis for transplant is diabetes, low-volume transplant center with negligible waiting time, other characteristics set to reference category or 0 | 153 days(0.42 years) | 701 days(1.92 years) | 1,549 days(4.24 years) | 1,899 days(5.20 years) |
| 65-year old rural patient, sensitized (most recent CPRA =50), peripheral vascular disease, diagnosis for transplant is diabetes, high-volume transplant center with mean waiting time of 730 days, patient will receive a KDPI 95+ transplant, other characteristics set to reference category or 0 | 710 days(1.94 years) | 420 days(1.15 years) | 1,140 days(3.12 years) | 1,723 days(4.72 years) |
CITATION INFORMATION: Mehrotra S., Kilambi V. Assessing Renal Transplant Candidate Survival at Listing Using a Risk-Adjusted Multi-State Semi-Markov Model Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Mehrotra S, Kilambi V. Assessing Renal Transplant Candidate Survival at Listing Using a Risk-Adjusted Multi-State Semi-Markov Model [abstract]. https://atcmeetingabstracts.com/abstract/assessing-renal-transplant-candidate-survival-at-listing-using-a-risk-adjusted-multi-state-semi-markov-model/. Accessed May 9, 2025.« Back to 2018 American Transplant Congress