The importance of analyzing graft and patient survival by cause of failure: An example using pediatric small intestine transplant data

Jeffrey Gaynor, Tomoaki Kato, Gennaro Selvaggi, Jang I. Moon, David M. Levi, Seigo Nishida, Juan R. Madariaga, Debbie Weppler, Phillip Ruiz, Andreas G. Tzakis

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background. Although graft and patient survival are vital in reporting overall results of clinical transplant studies, these outcomes do not account for distinct types of graft failure and death, which clearly exist in pediatric small intestine transplantation (Itx). The use of a cause-specific hazard (CSH) approach may provide more precise identification and thus greater insight as to why certain factors are prognostically important. Methods. Among 119 pediatric patients who received primary Itx at our center since 1994, Cox model stepwise regression analyses were performed to identify prognostic factors for the following CSH rates: intestinal graft failure (IGF)/death due to rejection, death due to infection not triggered by IGF, and intestinal graft loss/death due to other causes. Results. Two factors were associated with a significantly higher rate of developing IGF due to rejection (23 such failures): receiving an isolated intestine or liver-intestine transplant (P=0.00001) and receiving no induction agent (P=0.006). Conversely, age at transplant <1 year was the single factor associated with a significantly higher death rate due to infection (P=0.0005) (21 such deaths). Two characteristics were associated with a significantly higher death rate due to other causes: being in the hospital pretransplant (P=0.007) and not receiving daclizumab induction therapy (P=0.02) (24 such deaths). Although these four factors (transplant type/age/hospital status/induction therapy) were, for the most part, associated with graft/patient survival, the CSH analysis more precisely identified their prognostic value and achieved greater statistical power. Conclusions. A CSH approach should be used in conjunction with overall outcome analyses.

Original languageEnglish
Pages (from-to)1133-1140
Number of pages8
JournalTransplantation
Volume81
Issue number8
DOIs
StatePublished - Apr 1 2006

Fingerprint

Graft Survival
Small Intestine
Pediatrics
Transplants
Intestines
Mortality
Age Factors
Infection
Proportional Hazards Models
Transplantation
Regression Analysis
Liver
Therapeutics

Keywords

  • Cause-specific failure
  • Hazard rate
  • Pediatric small intestine transplantation
  • Prognostic factors

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

The importance of analyzing graft and patient survival by cause of failure : An example using pediatric small intestine transplant data. / Gaynor, Jeffrey; Kato, Tomoaki; Selvaggi, Gennaro; Moon, Jang I.; Levi, David M.; Nishida, Seigo; Madariaga, Juan R.; Weppler, Debbie; Ruiz, Phillip; Tzakis, Andreas G.

In: Transplantation, Vol. 81, No. 8, 01.04.2006, p. 1133-1140.

Research output: Contribution to journalArticle

Gaynor, Jeffrey ; Kato, Tomoaki ; Selvaggi, Gennaro ; Moon, Jang I. ; Levi, David M. ; Nishida, Seigo ; Madariaga, Juan R. ; Weppler, Debbie ; Ruiz, Phillip ; Tzakis, Andreas G. / The importance of analyzing graft and patient survival by cause of failure : An example using pediatric small intestine transplant data. In: Transplantation. 2006 ; Vol. 81, No. 8. pp. 1133-1140.
@article{793c26a5e67c48958d5011929de6f778,
title = "The importance of analyzing graft and patient survival by cause of failure: An example using pediatric small intestine transplant data",
abstract = "Background. Although graft and patient survival are vital in reporting overall results of clinical transplant studies, these outcomes do not account for distinct types of graft failure and death, which clearly exist in pediatric small intestine transplantation (Itx). The use of a cause-specific hazard (CSH) approach may provide more precise identification and thus greater insight as to why certain factors are prognostically important. Methods. Among 119 pediatric patients who received primary Itx at our center since 1994, Cox model stepwise regression analyses were performed to identify prognostic factors for the following CSH rates: intestinal graft failure (IGF)/death due to rejection, death due to infection not triggered by IGF, and intestinal graft loss/death due to other causes. Results. Two factors were associated with a significantly higher rate of developing IGF due to rejection (23 such failures): receiving an isolated intestine or liver-intestine transplant (P=0.00001) and receiving no induction agent (P=0.006). Conversely, age at transplant <1 year was the single factor associated with a significantly higher death rate due to infection (P=0.0005) (21 such deaths). Two characteristics were associated with a significantly higher death rate due to other causes: being in the hospital pretransplant (P=0.007) and not receiving daclizumab induction therapy (P=0.02) (24 such deaths). Although these four factors (transplant type/age/hospital status/induction therapy) were, for the most part, associated with graft/patient survival, the CSH analysis more precisely identified their prognostic value and achieved greater statistical power. Conclusions. A CSH approach should be used in conjunction with overall outcome analyses.",
keywords = "Cause-specific failure, Hazard rate, Pediatric small intestine transplantation, Prognostic factors",
author = "Jeffrey Gaynor and Tomoaki Kato and Gennaro Selvaggi and Moon, {Jang I.} and Levi, {David M.} and Seigo Nishida and Madariaga, {Juan R.} and Debbie Weppler and Phillip Ruiz and Tzakis, {Andreas G.}",
year = "2006",
month = "4",
day = "1",
doi = "10.1097/01.tp.0000205754.58604.a8",
language = "English",
volume = "81",
pages = "1133--1140",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - The importance of analyzing graft and patient survival by cause of failure

T2 - An example using pediatric small intestine transplant data

AU - Gaynor, Jeffrey

AU - Kato, Tomoaki

AU - Selvaggi, Gennaro

AU - Moon, Jang I.

AU - Levi, David M.

AU - Nishida, Seigo

AU - Madariaga, Juan R.

AU - Weppler, Debbie

AU - Ruiz, Phillip

AU - Tzakis, Andreas G.

PY - 2006/4/1

Y1 - 2006/4/1

N2 - Background. Although graft and patient survival are vital in reporting overall results of clinical transplant studies, these outcomes do not account for distinct types of graft failure and death, which clearly exist in pediatric small intestine transplantation (Itx). The use of a cause-specific hazard (CSH) approach may provide more precise identification and thus greater insight as to why certain factors are prognostically important. Methods. Among 119 pediatric patients who received primary Itx at our center since 1994, Cox model stepwise regression analyses were performed to identify prognostic factors for the following CSH rates: intestinal graft failure (IGF)/death due to rejection, death due to infection not triggered by IGF, and intestinal graft loss/death due to other causes. Results. Two factors were associated with a significantly higher rate of developing IGF due to rejection (23 such failures): receiving an isolated intestine or liver-intestine transplant (P=0.00001) and receiving no induction agent (P=0.006). Conversely, age at transplant <1 year was the single factor associated with a significantly higher death rate due to infection (P=0.0005) (21 such deaths). Two characteristics were associated with a significantly higher death rate due to other causes: being in the hospital pretransplant (P=0.007) and not receiving daclizumab induction therapy (P=0.02) (24 such deaths). Although these four factors (transplant type/age/hospital status/induction therapy) were, for the most part, associated with graft/patient survival, the CSH analysis more precisely identified their prognostic value and achieved greater statistical power. Conclusions. A CSH approach should be used in conjunction with overall outcome analyses.

AB - Background. Although graft and patient survival are vital in reporting overall results of clinical transplant studies, these outcomes do not account for distinct types of graft failure and death, which clearly exist in pediatric small intestine transplantation (Itx). The use of a cause-specific hazard (CSH) approach may provide more precise identification and thus greater insight as to why certain factors are prognostically important. Methods. Among 119 pediatric patients who received primary Itx at our center since 1994, Cox model stepwise regression analyses were performed to identify prognostic factors for the following CSH rates: intestinal graft failure (IGF)/death due to rejection, death due to infection not triggered by IGF, and intestinal graft loss/death due to other causes. Results. Two factors were associated with a significantly higher rate of developing IGF due to rejection (23 such failures): receiving an isolated intestine or liver-intestine transplant (P=0.00001) and receiving no induction agent (P=0.006). Conversely, age at transplant <1 year was the single factor associated with a significantly higher death rate due to infection (P=0.0005) (21 such deaths). Two characteristics were associated with a significantly higher death rate due to other causes: being in the hospital pretransplant (P=0.007) and not receiving daclizumab induction therapy (P=0.02) (24 such deaths). Although these four factors (transplant type/age/hospital status/induction therapy) were, for the most part, associated with graft/patient survival, the CSH analysis more precisely identified their prognostic value and achieved greater statistical power. Conclusions. A CSH approach should be used in conjunction with overall outcome analyses.

KW - Cause-specific failure

KW - Hazard rate

KW - Pediatric small intestine transplantation

KW - Prognostic factors

UR - http://www.scopus.com/inward/record.url?scp=33646773569&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33646773569&partnerID=8YFLogxK

U2 - 10.1097/01.tp.0000205754.58604.a8

DO - 10.1097/01.tp.0000205754.58604.a8

M3 - Article

C2 - 16641598

AN - SCOPUS:33646773569

VL - 81

SP - 1133

EP - 1140

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 8

ER -