Evaluation of transplant benefits with the U.S. Scientific Registry of Transplant Recipients by semiparametric regression of mean residual life

Abstract: Kidney transplantation is the most effective renal replacement therapy for end stage renal disease patients. With the severe shortage of kidney supplies and for the clinical effectiveness of transplantation, patient's life expectancy post transplantation is used to prioritize patients for transplantation; however, severe comorbidity conditions and old age are the most dominant factors that negatively impact post-transplantation life expectancy, effectively precluding sick or old patients from receiving transplants. It would be crucial to design objective measures to quantify the transplantation benefit by comparing the mean residual life with and without a transplant, after adjusting for comorbidity and demographic conditions. To address this urgent need, we propose a new class of semiparametric covariate-dependent mean residual life models. Our method estimates covariate effects semiparametrically efficiently and the mean residual life function nonparametrically, enabling us to predict the residual life increment potential for any given patient. Our method potentially leads to a more fair system that prioritizes patients who would have the largest residual life gains. Our analysis of the kidney transplant data from the U.S. Scientific Registry of Transplant Recipients also suggests that a single index of covariates summarize well the impacts of multiple covariates, which may facilitate interpretations of each covariate's effect. Our subgroup analysis further disclosed inequalities in survival gains across groups defined by race, gender and insurance type (reflecting socioeconomic status).