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A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney
Author(s) -
Wey Andrew,
Salkowski Nicholas,
Kremers Walter K.,
Schaffhausen Cory R.,
Kasiske Bertram L.,
Israni Ajay K.,
Snyder Jon J.
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14506
Subject(s) - medicine , kidney , proportional hazards model , survival analysis , decision analysis , intensive care medicine , actuarial science , surgery , statistics , mathematics , business
We developed a kidney offer acceptance decision tool to predict the probability of graft survival and patient survival for first‐time kidney‐alone candidates after an offer is accepted or declined, and we characterized the effect of restricting the donor pool with a maximum acceptable kidney donor profile index (KDPI). For accepted offers, Cox proportional hazards models estimated these probabilities using transplanted kidneys. For declined offers, these probabilities were estimated by considering the experience of similar candidates who declined offers and the probability that declining would lead to these outcomes. We randomly selected 5000 declined offers and estimated these probabilities 3 years post‐offer had the offers been accepted or declined. Predicted outcomes for declined offers were well calibrated (<3% error) with good predictive accuracy (area under the curve: graft survival, 0.69; patient survival, 0.69). Had the offers been accepted, the probabilities of graft survival and patient survival were typically higher. However, these advantages attenuated or disappeared with higher KDPI, candidate priority, and local donor supply. Donor pool restrictions were associated with worse 3‐year outcomes, especially for candidates with high allocation priority. The kidney offer acceptance decision tool could inform offer acceptance by characterizing the potential risk–benefit trade‐off associated with accepting or declining an offer.