Abstract：
Graft failure and recipient death with functioning graft are important competing outcomes after kidney transplantation. Risk prediction models typically censor for the competing outcome thereby overestimating the cumulative incidence. The magnitude of this overestimation is not well described in real-world transplant data. This retrospective cohort study analyzed data from the European Collaborative Transplant Study (n = 125 250) and from the American Scientific Registry of Transplant Recipients (n = 190 258). Separate cause-specific hazard models using donor and recipient age as continuous predictors were developed for graft failure and recipient death. The hazard of graft failure increased quadratically with increasing donor age and decreased decaying with increasing recipient age. The hazard of recipient death increased linearly with increasing donor and recipient age. The cumulative incidence overestimation due to competing risk-censoring was largest in high-risk populations for both outcomes (old donors/recipients), sometimes amounting to 8.4 and 18.8 percentage points for graft failure and recipient death, respectively. In our illustrative model for posttransplant risk prediction, the absolute risk of graft failure and death is overestimated when censoring for the competing event, mainly in older donors and recipients. Prediction models for absolute risks should treat graft failure and death as competing events.
摘要：
移植失败和有功能移植物的受体死亡是肾移植后重要的竞争结果。风险预测模型通常会对竞争结果进行审查，从而高估了累积发生率。这种高估的程度在现实世界的移植数据中没有得到很好的描述。这项回顾性队列研究分析了来自欧洲合作移植研究（CTS；n=125250）和美国移植接受者科学注册（SRTR；n=190258）的数据。单独的特定原因的危险模型，使用捐赠者和接受者年龄作为连续预测因子，为移植物衰竭和受体死亡而开发。移植物失败的危险随着供体年龄的增加而增加，而随着受体年龄的增加而减少。随着供体和受体年龄的增加，受体死亡的危险呈线性增加。由于竞争性风险审查导致的累积发生率高估在两种结果的高风险人群中最大（老捐赠者/接受者），移植失败和受体死亡有时达8.4和18.8个百分点，分别。在我们移植后风险预测的说明性模型中，当审查竞争事件时，移植失败和死亡的绝对风险被高估了，主要是年长的捐赠者和接受者。绝对风险的预测模型应将移植物失败和死亡视为竞争事件。
