Identifying scenarios of benefit or harm from kidney transplantation during the COVID-19 pandemic: A stochastic simulation and machine learning study

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
Allan MassieDorry L Segev

Abstract

Clinical decision-making in kidney transplant (KT) during the coronavirus disease 2019 (COVID-19) pandemic is understandably a conundrum: both candidates and recipients may face increased acquisition risks and case fatality rates (CFRs). Given our poor understanding of these risks, many centers have paused or reduced KT activity, yet data to inform such decisions are lacking. To quantify the benefit/harm of KT in this context, we conducted a simulation study of immediate-KT vs delay-until-after-pandemic for different patient phenotypes under a variety of potential COVID-19 scenarios. A calculator was implemented (http://www.transplantmodels.com/covid_sim), and machine learning approaches were used to evaluate the important aspects of our modeling. Characteristics of the pandemic (acquisition risk, CFR) and length of delay (length of pandemic, waitlist priority when modeling deceased donor KT) had greatest influence on benefit/harm. In most scenarios of COVID-19 dynamics and patient characteristics, immediate KT provided survival benefit; KT only began showing evidence of harm in scenarios where CFRs were substantially higher for KT recipients (eg, ≥50% fatality) than for waitlist registrants. Our simulations suggest that KT cou...Continue Reading

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Citations

Jul 13, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Lisa McElroyBradley Collins
Aug 9, 2020·Transplant International : Official Journal of the European Society for Organ Transplantation·Soufian MeziyerhAiko P J de Vries
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Aug 14, 2020·Nature Reviews. Nephrology·Sami Alasfar, Robin K Avery
Nov 6, 2020·Transplantation·Yorg AzziEnver Akalin
Jan 4, 2021·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Krista L LentineMichelle A Josephson
Oct 13, 2020·Chaos, Solitons, and Fractals·Mohammad-H Tayarani N
Jan 28, 2021·International Journal of Environmental Research and Public Health·Leonardo B FurstenauNicola Luigi Bragazzi
Oct 13, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Rebecca Craig-SchapiroDarshana M Dadhania
Mar 30, 2021·World Journal of Gastroenterology : WJG·Riccardo De CarlisLuciano De Carlis
May 21, 2021·KI Reports·Amanda J VinsonKarthik K Tennankore
Jul 29, 2021·World Journal of Transplantation·Nurhan Seyahi, Seyda Gul Ozcan
Dec 8, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Robin K AveryAllan B Massie
Aug 4, 2021·Current Transplantation Reports·Issac R Schwantes, David A Axelrod
Dec 17, 2021·Current Urology Reports·David Andrés Castañeda MillánAna María Autrán-Gómez
Jan 1, 2022·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Burcu YazıcıoğluUNKNOWN European Society for Pediatric Nephrology

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