scholarly journals Quantifying the Treatment Effect of Kidney Transplantation Relative to Dialysis on Survival Time: New Results Based on Propensity Score Weighting and Longitudinal Observational Data from Sweden

2020 ◽  
Vol 17 (19) ◽  
pp. 7318
Author(s):  
Ye Zhang ◽  
Ulf-G. Gerdtham ◽  
Helena Rydell ◽  
Johan Jarl
Keyword(s):  
Kidney Transplantation ◽  
Renal Replacement Therapy ◽  
Propensity Score ◽  
Survival Time ◽  
Replacement Therapy ◽  
Observational Data ◽  
Treatment Effect ◽  
Average Treatment Effect ◽  
Survival Advantage ◽  
Propensity Score Weighting

Using observational data to assess the treatment effects on outcomes of kidney transplantation relative to dialysis for patients on renal replacement therapy is challenging due to the non-random selection into treatment. This study applied the propensity score weighting approach in order to address the treatment selection bias of kidney transplantation on survival time compared with dialysis for patients on the waitlist. We included 2676 adult waitlisted patients who started renal replacement therapy in Sweden between 1 January 1995, and 31 December 2012. Weibull and logistic regression models were used for the outcome and treatment models, respectively. The potential outcome mean and the average treatment effect were estimated using an inverse-probability-weighted regression adjustment approach. The estimated survival times from start of renal replacement therapy were 23.1 years (95% confidence interval (CI): 21.2−25.0) and 9.3 years (95% CI: 7.8−10.8) for kidney transplantation and dialysis, respectively. The survival advantage of kidney transplantation compared with dialysis was estimated to 13.8 years (95% CI: 11.4−16.2). There was no significant difference in the survival advantage of transplantation between men and women. Controlling for possible immortality bias reduced the survival advantage to 9.1–9.9 years. Our results suggest that kidney transplantation substantially increases survival time compared with dialysis in Sweden and that this consequence of treatment is equally distributed over sex.

scholarly journals Is There Decreasing Public Interest in Renal Transplantation? A Google TrendsTM Analysis

2020 ◽  
Vol 9 (4) ◽  
pp. 1048
Author(s):  
Andreas Kronbichler ◽  
Maria Effenberger ◽  
Jae Il Shin ◽  
Christian Koppelstätter ◽  
Sara Denicolò ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Public Interest ◽  
Public Awareness ◽  
Relative Reduction ◽  
Special Focus ◽  
Search Term ◽  
Search Queries

Background and objectives: Renal transplantation is the preferred form of renal replacement therapy for the majority of patients with end stage renal disease (ESRD). The Internet is a key tool for people seeking healthcare-related information. This current work explored the interest in kidney transplantation based on Internet search queries using Google TrendsTM. Design, setting, participants, and measurements: We performed a Google TrendsTM search with the search term “kidney transplantation” between 2004 (year of inception) and 2018. We retrieved and analyzed data on the worldwide trend as well as data from the United Network for Organ Sharing (UNOS), the Organización Nacional de Trasplantes (ONT), the Eurotransplant area, and the National Health Service (NHS) Transplant Register. Google TrendsTM indices were investigated and compared to the numbers of performed kidney transplants, which were extracted from the respective official websites of UNOS, ONT, Eurotransplant, and the NHS. Results: During an investigational period of 15 years, there was a significant decrease of the worldwide Google TrendsTM index from 76.3 to 25.4, corresponding to an absolute reduction of −50.9% and a relative reduction by −66.7%. The trend was even more pronounced for the UNOS area (−75.2%), while in the same time period the number of transplanted kidneys in the UNOS area increased by 21.9%. Events of public interest had an impact on the search queries in the year of occurrence, as shown by an increase in the Google TrendsTM index by 39.2% in the year 2005 in Austria when a person of public interest received his second live donor kidney transplant. Conclusions: This study indicates a decreased public interest in kidney transplantation. There is a clear need to raise public awareness, since transplantation represents the best form of renal replacement therapy for patients with ESRD. Information should be provided on social media, with a special focus on readability and equitable access, as well as on web pages.

Nierenersatzverfahren: Information, Aufklärung, Dokumentation

2018 ◽  
Vol 143 (12) ◽  
pp. 863-870
Author(s):  
Jan Galle ◽  
Jana Reitlinger
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Transplantation ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Donation ◽  
Living Donation ◽  
Short Term ◽  
Donor Kidney ◽  
Kidney Replacement Therapy ◽  
Caring Environment

AbstractIn renal replacement therapy, different methods are available: hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx). In addition, variants can be used: HD as a home HD or center HD, PD as a conventional PD or automated (cycler) PD, KTx as a potentially short-term predictable living donation or conventional donor kidney donation. The patient and his familiar or caring environment must be informed accordingly. This means first of all: information about which procedures of kidney replacement therapy are possible and can be offered. Then the specific risks associated with each procedure should be elucidated (e. g. HD and shunt bleeding, PD and peritonitis, KTx and infections/neoplasias). This necessarily includes a structured documentation of the educating center/doctor about the communicated information and decisions taken.

Propensity score specification for optimal estimation of average treatment effect with binary response

2020 ◽  
Vol 29 (12) ◽  
pp. 3623-3640
Author(s):  
John A Craycroft ◽  
Jiapeng Huang ◽  
Maiying Kong
Keyword(s):  
Propensity Score ◽  
Treatment Effect ◽  
Propensity Scores ◽  
Optimal Estimation ◽  
Theoretical Explanation ◽  
Average Treatment Effect ◽  
Adaptive Lasso ◽  
Confounding Bias ◽  
Average Treatment ◽  
The Impact

Propensity score methods are commonly used in statistical analyses of observational data to reduce the impact of confounding bias in estimations of average treatment effect. While the propensity score is defined as the conditional probability of a subject being in the treatment group given that subject’s covariates, the most precise estimation of average treatment effect results from specifying the propensity score as a function of true confounders and predictors only. This property has been demonstrated via simulation in multiple prior research articles. However, we have seen no theoretical explanation as to why this should be so. This paper provides that theoretical proof. Furthermore, this paper presents a method for performing the necessary variable selection by means of elastic net regression, and then estimating the propensity scores so as to obtain optimal estimates of average treatment effect. The proposed method is compared against two other recently introduced methods, outcome-adaptive lasso and covariate balancing propensity score. Extensive simulation analyses are employed to determine the circumstances under which each method appears most effective. We applied the proposed methods to examine the effect of pre-cardiac surgery coagulation indicator on mortality based on a linked dataset from a retrospective review of 1390 patient medical records at Jewish Hospital (Louisville, KY) with the Society of Thoracic Surgeons database.

Impact of mobile money access on internal remittances, consumption expenditure and household welfare in Ghana

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Priscilla Twumasi Baffour ◽  
Wassiuw Abdul Rahaman ◽  
Ibrahim Mohammed
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Treatment Effect ◽  
Average Treatment Effect ◽  
Consumption Expenditure ◽  
Content Type ◽  
Mobile Money ◽  
Money Transfer ◽  
Per Capita ◽  
Transfer Services

PurposeThe purpose of this study is to examine the impact of mobile money access on internal remittances received, per capita consumption expenditure and welfare of household in Ghana.Design/methodology/approachThe study used data from the latest round of the Ghana Living Standards Survey (GLSS 7) and employed the propensity score matching technique to estimate average treatment effect between users and non-users of mobile money transfer services.FindingsThe study finds that using mobile money is welfare enhancing, particularly for poor households and the channel by which it impacts on welfare is through higher internal remittances received and per capita expenditure. The results from the average treatment effect indicate that mobile money users receive significantly higher remittances and consequently spend averagely higher on consumption than non-users.Research limitations/implicationsAlthough the data employed in this study is limited to one country, the findings support the financial inclusion role and developmental impact of mobile money transfer services. Hence, mobile money transfer services should be promoted and facilitated by the telecommunication and financial sector regulators.Originality/valueIn addition to making original contribution to the literature on the welfare impact of mobile money, the study's use of the propensity score matching is unique.

scholarly journals ABO-incompatible kidney transplantation as a renal replacement therapy—A single low-volume center experience in Japan

PLoS ONE ◽  
2018 ◽  
Vol 13 (12) ◽  
pp. e0208638 ◽  
Author(s):  
Akihiro Kosoku ◽  
Junji Uchida ◽  
Shunji Nishide ◽  
Kazuya Kabei ◽  
Hisao Shimada ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Low Volume

scholarly journals Living Donor Kidney Transplantation Improves Graft and Recipient Survival in Patients with Multiple Kidney Transplants

2020 ◽  
Vol 9 (7) ◽  
pp. 2118 ◽  
Author(s):  
Maria Irene Bellini ◽  
Aisling E Courtney ◽  
Jennifer A McCaughan
Keyword(s):  
Kidney Transplantation ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Living Donor ◽  
Patient Survival ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Background: Failed kidney transplant recipients benefit from a new graft as the general incident dialysis population, although additional challenges in the management of these patients are often limiting the long-term outcomes. Previously failed grafts, a long history of comorbidities, side effects of long-term immunosuppression and previous surgical interventions are common characteristics in the repeated kidney transplantation population, leading to significant complex immunological and technical aspects and often compromising the short- and long-term results. Although recipients’ factors are acknowledged to represent one of the main determinants for graft and patient survival, there is increasing interest in expanding the donor’s pool safely, particularly for high-risk candidates. The role of living kidney donation in this peculiar context of repeated kidney transplantation has not been assessed thoroughly. The aim of the present study is to analyse the effects of a high-quality graft, such as the one retrieved from living kidney donors, in the repeated kidney transplant population context. Methods: Retrospective analysis of the outcomes of the repeated kidney transplant population at our institution from 1968 to 2019. Data were extracted from a prospectively maintained database and stratified according to the number of transplants: 1st, 2nd or 3rd+. The main outcomes were graft and patient survivals, recorded from time of transplant to graft failure (return to dialysis) and censored at patient death with a functioning graft. Duration of renal replacement therapy was expressed as cumulative time per month. A multivariate analysis considering death-censored graft survival, decade of transplantation, recipient age, donor age, living donor, transplant number, ischaemic time, time on renal replacement therapy prior to transplant and HLA mismatch at HLA-A, -B and -DR was conducted. In the multivariate analysis of recipient survival, diabetic nephropathy as primary renal disease was also included. Results: A total of 2395 kidney transplant recipients were analysed: 2062 (83.8%) with the 1st kidney transplant, 279 (11.3%) with the 2nd graft, 46 (2.2%) with the 3rd+. Mean age of 1st kidney transplant recipients was 43.6 ± 16.3 years, versus 39.9 ± 14.4 for 2nd and 41.4 ± 11.5 for 3rd+ (p < 0.001). Aside from being younger, repeated kidney transplant patients were also more often males (p = 0.006), with a longer time spent on renal replacement therapy (p < 0.0001) and a higher degree of sensitisation, expressed as calculated reaction frequency (p < 0.001). There was also an association between multiple kidney transplants and better HLA match at transplantation (p < 0.0001). A difference in death-censored graft survival by number of transplants was seen, with a median graft survival of 328 months for recipients of the 1st transplant, 209 months for the 2nd and 150 months for the 3rd+ (p = 0.038). The same difference was seen in deceased donor kidneys (p = 0.048), but not in grafts from living donors (p = 0.2). Patient survival was comparable between the three groups (p = 0.59). Conclusions: In the attempt to expand the organ donor pool, particular attention should be reserved to high complex recipients, such as the repeated kidney transplant population. In this peculiar context, the quality of the donor has been shown to represent a main determinant for graft survival—in fact, kidney retrieved from living donors provide comparable outcomes to those from single-graft recipients.

scholarly journals Estimating Treatment Effects of Unit-Based Pricing of Household Solid Waste Disposal

2018 ◽  
Vol 48 (1) ◽  
pp. 21-43
Author(s):  
Christopher Wright ◽  
John M. Halstead ◽  
Ju-Chin Huang
Keyword(s):  
Propensity Score ◽  
Municipal Solid Waste ◽  
Solid Waste ◽  
Propensity Score Matching ◽  
Waste Disposal ◽  
Treatment Effect ◽  
Treatment Effects ◽  
Average Treatment Effect ◽  
Solid Waste Disposal ◽  
Annual Reduction

Propensity score matching is used to estimate treatment effects when data are observational. Results presented in this study demonstrate the use of propensity score matching to evaluate the average treatment effect of unit-based pricing of household trash for reducing municipal solid waste disposal. Average treatment effect of the treated for 34 New Hampshire communities range from an annual reduction of 631 pounds per household to 823 pounds per household. This represents an annual reduction of 42 percent to 54 percent from an average of 1530 pounds per household if a town did not adopt municipal solid waste user fees.

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