Frailty Survival Model Analysis of the National Deceased Donor Kidney Transplant Dataset Using Poisson Variance Structures
利用泊松方差结构分析亡故供者肾移植数据的脆弱性生存模型AI 解读 ↓
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利用泊松方差结构分析亡故供者肾移植数据的脆弱性生存模型
- 研究问题
- 在已记录的供者特征之外，未测量的供者因素与未记录的移植中心因素，是否仍与移植肾失效风险差异相关？
- 方法与思路
- 作者使用含交叉随机效应的多元脆弱性模型，将其似然联系到混合泊松回归，并以惩罚准似然进行数值估计。
- 材料陈述的贡献
- 摘要称该联系使交叉随机效应生存分析可实施；应用显示已测特征解释约三成供者相关变异，剩余供者与中心变异仍显著。
- 阅读关注点
- 应核对脆弱性模型与混合泊松似然成比例的条件、交叉效应的设定，以及约三成解释比例和显著性的计算依据。
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- 仅据版本未注明的OpenAlex索引摘要；所报变异属于模型内关联，不能据此识别具体未测因素或认定中心实践的因果效应。
原文摘要
In a recent study of transplant outcomes, donor age, cerebrovascular accident as the cause of death (CVA), renal insufficiency (serum creatinine >1.5 mg/dL), and history of hypertension have been identified as donor factors associated with elevated risk of kidney transplant failure. It is of great interest to know whether there remain other unmeasured donor factors associated with elevated risk of graft failure. In this article we study a sample of 6,024 deceased donor kidney transplants performed in 194 centers from 1995 to 2000. In addition to variation among transplant recipients, there are two other random effects: unmeasured donor and unrecorded center factors (data not available at the physician level). These two random effects are crossed, because the two kidneys from the same donor can be transplanted in different centers. Multivariate frailty models are applied to analyze the data. The likelihood functions of both parametric (e.g., with piecewise constant baseline hazard) and semiparametric multivariate frailty models are shown to be proportional to the likelihood functions of a class of mixed Poisson regression models. The penalized quasi-likelihood method is used as the numerical procedure for these mixed Poisson regression models. Thus we are able to estimate and model crossed random-effects structures for survival analysis. Although about 30% of recipient graft survival rate variation due to donor factors is explained by the measured donor characteristics, the remaining variation among donors in graft survival rate is still statistically significant, suggesting that there may be other unmeasured donor factors associated with a reduced graft survival rate. We also find significant variation of graft failure rates among transplant centers due to unrecorded center factors. Therefore, this study suggests that practice patterns at transplant centers and identification of other donor factors may merit further investigation.