Individualized Immunosuppression for Kidney Transplant Recipients

肾移植受者的个体化免疫抑制

基本信息

批准号：
10664609
负责人：
Sunjae Bae
金额：
$ 15.7万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-05-22 至 2028-02-29
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10664609
关键词：
Accounting Acute Address American Antibodies Benefits and Risks Biometry Cardiovascular Diseases Caring Cessation of life Clinical Cluster randomized trial Communities Consensus Data Data Set Decision Analysis Doctor of Philosophy Epidemiology Equilibrium Foundations Future Goals Grant Health Immunosuppression Individual Infection Intervention Interview Kidney Transplantation Knowledge Longevity Machine Learning Malignant Neoplasms Measures Medical Education Mentored Research Scientist Development Award Mentors Mentorship Methodology Methods Modeling Nephrology Non-Insulin-Dependent Diabetes Mellitus Operative Surgical Procedures Outcome Paired Comparison Paper Patient Recruitments Patients Population Positioning Attribute Protocols documentation Public Health Schools Published Comment Quality-Adjusted Life Years Regimen Research Research Methodology Research Training Respondent Risk Risk Factors Risk-Benefit Assessment Scholarship Science Societies Statistical Computing Steroids Subgroup Surveys Techniques Training Transplant Recipients Transplant Surgeon Transplantation Universities Variant Withdrawal Work analytical method career development clinical practice clinically relevant computerized tools design disability weights efficacy outcomes evidence base experience feasibility testing gradient boosting graft failure high risk implementation science improved infection risk insight machine learning prediction medical schools mortality multidisciplinary novel outcome prediction participant interview patient oriented patient oriented research personalized predictions personalized risk prediction population health predictive modeling prevent professor response risk prediction risk prediction model safety outcomes side effect skills tool

项目摘要

PROJECT SUMMARY/ABSTRACT Dr. Sunjae Bae is an Assistant Professor of Surgery and Population Health at NYU Grossman School of Medicine. He completed his PhD in epidemiology and Master’s in biostatistics at Johns Hopkins Bloomberg School of Public Health. Prior to his research training, he received his medical education at Kyung Hee University and practiced as a clinician. His previous research has focused on immunosuppression and clinical outcomes after kidney transplantation (KT), with the support from the American Society of Nephrology and Mogam Science Scholarship Foundation. Dr. Bae’s long-term goal is to help >230,000 KT recipients live longer and healthier by creating an evidence- based, patient-centered tool for determining the ideal immunosuppression regimen. Lifelong immunosuppression is a defining feature in the care of KT recipients. Immunosuppression is the primary intervention to prevent acute rejection; however, it causes various side effects, notably 2.1- to 6.2-fold risk of infections, cancers, and cardiovascular diseases, which collectively account for >65% of deaths in this population. Since the risks of acute rejection and immunosuppression-related side effects are unique in each recipient, the selection of the immunosuppression regimen should be individualized according to the recipient’s unique risk profile. The transplant community has long recognized the importance of immunosuppression individualization. However, there is little scientific evidence guiding how it should be done, mainly due to 3 methodological challenges. First, traditional analytic methods are ineffective in providing individualized predictions of the risks and benefits after immunosuppression. Second, a method to objectively assess the risk-benefit balance from patients’ perspectives is lacking. Lastly, the new individualization protocol must be clinically relevant. However, given the lack of consensus on how the individualization should be done, the relevance of a new protocol cannot be assessed objectively. This K01 Mentored Research Scientist Development Award will enable Dr. Bae to expand his research skillset and lay the groundwork for addressing these 3 challenges. We propose the following approaches. First, we will create a machine learning-based individualized risk prediction model that can process statistical interactions efficiently and transparently. Second, we will conduct interviews and paired-comparison surveys to quantify the patients’ viewpoints on the risk-benefit balance, e.g., how much reduction in acute rejection is worth risking a 10% increase in type 2 diabetes. Third, we will survey KT clinicians to characterize their clinical practice and perspectives on individualization. Dr. Bae will enhance his analytical skills and expand his domain knowledge through didactic coursework in patient-oriented research methods and implementation science, and research mentorship by a team of multidisciplinary experts committed to Dr. Bae’s career development.

项目摘要/摘要 Sunjae Bae博士是NYU Grossman School的手术和人口健康助理教授药品。他在约翰·霍普金斯彭博（John Hopkins Bloomberg）的流行病学和生物统计学硕士学位上完成了博士学位公共卫生学院。在接受研究培训之前，他在Kyung Hee接受医学教育大学，作为临床实践。他以前的研究重点是免疫抑制和临床肾脏移植后的结果（KT），在美国肾脏病学会的支持下 Mogam Science奖学金基金会。 BAE博士的长期目标是通过创建证据来帮助> 230,000 kt的接受者寿命更长，更健康 - 基于患者以患者为中心的工具，用于确定理想的免疫抑制方案。终身免疫抑制是KT接受者护理中的一个定义特征。免疫抑制是主要的干预以防止急性排斥；但是，它会引起各种副作用，尤其是2.1至6.2倍的风险感染，癌症和心血管疾病，总计占死亡人数的65％人口。由于急性排斥和免疫抑制相关的副作用的风险在每个方面都是独特的接受者，应根据接收者的选择来选择免疫抑制方案独特的风险概况。移植社区长期以来已经认识到免疫抑制个性化的重要性。但是，几乎没有科学证据指出应该如何做，这主要是由于3方法学挑战。首先，传统的分析方法在提供风险的个性化预测方面无效和免疫抑制后的好处。第二，一种客观评估风险效益平衡的方法缺乏患者的观点。最后，新的个性化协议必须在临床上相关。然而，鉴于缺乏关于如何完成个性化的共识，新协议的相关性无法客观评估。这个K01指导的研究科学家发展奖将使BAE博士扩大其研究技能并为解决这三个挑战奠定了基础。我们提出以下方法。首先，我们会的创建一个基于机器学习的个性化风险预测模型，该模型可以处理统计互动有效，透明。其次，我们将进行访谈和配对的调查，以量化患者对风险效益余额的观点，例如，急性拒绝减少多少值得一 2型糖尿病增加10％。第三，我们将调查KT临床医生的临床实践和关于个性化的观点。 BAE博士将提高他的分析技能并扩大其领域知识通过以患者为导向的研究方法和实施科学的教学课程和研究由跨学科专家团队的遗产致力于Bae博士的职业发展。