Screening Strategies for Patients on the Kidney Transplant Waiting List

• 成果类型: Article
• 署名作者: Sabouri, Alireza; Huh, Woonghee Tim; Shechter, Steven M. .
• 署名单位: University of Calgary; University of British Columbia
• 刊物名称: OPERATIONS RESEARCH
• ISSN/ISSBN: 0030-364X
• DOI: 10.1287/opre.2017.1632
• 发表日期: 2017
• 页码: 1131-1146
• 关键词: long-term survival; maintenance models; cardiovascular-disease; clinical epidemiology; cardiac-disease; living-donor; policies; FAILURE; SURVEILLANCE; allocation

摘要

Transplant centers screen patients on the kidney transplant waiting list to identify patients with severe conditions such as cardiovascular disease (CVD), which makes them ineligible for a transplant. We propose a model for finding screening strategies, with the objective of minimizing the sum of the expected screening cost and the expected penalty cost associated with transplanting an organ to an ineligible patient. Our results suggest that current screening guidelines, which are based only on patients' risk for developing CVD, are significantly dominated by policies that also consider factors related to patients' waiting time. In particular, our numerical experiments based on waiting list data in British Columbia show that compared with the current screening policy, our model-based policy results in a 35.6% reduction in the total annual cost by reducing the percentage of kidneys offered to patients with undetected CVD by 57.4% while using only 5% more screenings per year.