Top

Published in:

01-03-2019 | Opioids | METHODS

The meaning of confounding adjustment in the presence of multiple versions of treatment: an application to organ transplantation

Authors: Kerollos Nashat Wanis, Arin L. Madenci, Mary Katherine Dokus, Mark S. Orloff, Mark A. Levstik, Roberto Hernandez-Alejandro, Miguel A. Hernán

Published in: European Journal of Epidemiology | Issue 3/2019

Abstract

Causal inference for treatments with many versions requires a careful specification of the versions of treatment. Specifically, the existence of multiple relevant versions of treatment has implications for the selection of confounders. To illustrate this, we estimate the effect of organ transplantation using grafts from donors who died due to anoxic drug overdose, on recipient graft survival in the US. We describe how explicitly outlining the target trial (i.e. the hypothetical randomized trial which would answer the causal question of interest) to be emulated by an observational study analysis helps conceptualize treatment versions, guides selection of appropriate adjustment variables, and helps clarify the settings in which causal effects of compound treatments will be of value to decision-makers.

Available only for authorised users

Hernán MA, VanderWeele TJ. Compound treatments and transportability of causal inference. Epidemiology. 2011;22:368–77.CrossRefPubMedPubMedCentral

VanderWeele TJ, Hernan MA. Causal inference under multiple versions of treatment. J Causal Inference. 2013;1:1–20.CrossRefPubMedPubMedCentral

Goldberg DS, Blumberg E, McCauley M, Abt P, Levine M. Improving organ utilization to help overcome the tragedies of the opioid epidemic. Am J Transpl. 2016;16:2836–41.CrossRef

Goss M, Reese J, Kueht M, Vierling JM, Mindikoglu AL, Sussman NL, et al. A surge in cadaveric liver donors and a national narcotic epidemic: is there an association? letters from the Frontline. Liver Transpl. 2017;23:698–700.CrossRefPubMed

Lan X, Rai P, Chandel N, Cheng K, Lederman R, Saleem MA, et al. Morphine induces albuminuria by compromising podocyte integrity. PLoS ONE. 2013;8:e55748.CrossRefPubMedPubMedCentral

Samarghandian S, Afshari R, Farkhondeh T. Effect of long-term treatment of morphine on enzymes, oxidative stress indices and antioxidant status in male rat liver. Int J Clin Exp Med. 2014;7:1449–53.PubMedPubMedCentral

Salahshoor MR, Khashiadeh M, Roshankhah S, Kakabaraei S, Jalili C. Protective effect of crocin on liver toxicity induced by morphine. Res Pharm Sci. 2016;11:120–9.PubMedPubMedCentral

Atici S, Cinel I, Cinel L, Doruk N, Eskandari G, Oral U. Liver and kidney toxicity in chronic use of opioids: an experimental long term treatment model. J Biosci. 2005;30:245–52.CrossRefPubMed

Gonzalez SA, Trotter JF. The rise of the opioid epidemic and hepatitis C positive organs: a new era in liver transplantation. Hepatology. 2018;67:1600–8.CrossRefPubMed

10.

Wood DM, Dargan PI, Jones AL. Poisoned patients as potential organ donors: postal survey of transplant centres and intensive care units. Crit Care Lond Engl. 2003;7:147–54.CrossRef

11.

Durand CM, Bowring MG, Thomas AG, Kucirka LM, Massie AB, Cameron A, et al. The drug overdose epidemic and deceased-donor transplantation in the United States: a national registry study. Ann Intern Med. 2018;168:702–11.CrossRefPubMedPubMedCentral

12.

Feng S, Goodrich NP, Bragg-Gresham JL, Dykstra DM, Punch JD, DebRoy MA, et al. Characteristics associated with liver graft failure: the concept of a donor risk index: characteristics associated with liver graft failure. Am J Transpl. 2006;6:783–90.CrossRef

13.

Rao PS, Schaubel DE, Guidinger MK, Andreoni KA, Wolfe RA, Merion RM, et al. A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. Transplantation. 2009;88:231–6.CrossRefPubMed

14.

Hernán MA, Sauer BC, Hernández-Díaz S, Platt R, Shrier I. Specifying a target trial prevents immortal time bias and other self-inflicted injuries in observational analyses. J Clin Epidemiol. 2016;79:70–5.CrossRefPubMedPubMedCentral

15.

Hernán MA, Robins JM. Using big data to emulate a target trial when a randomized trial is not available: Table 1. Am J Epidemiol. 2016;183:758–64.CrossRefPubMedPubMedCentral

16.

Hernán MA. With great data comes great responsibility: publishing comparative effectiveness research in epidemiology. Epidemiology. 2011;22:290–1.CrossRefPubMedPubMedCentral

17.

Hernán MA. The hazards of hazard ratios. Epidemiology. 2010;21:13–5.CrossRefPubMedPubMedCentral

18.

D’Agostino RB, Lee ML, Belanger AJ, Cupples LA, Anderson K, Kannel WB. Relation of pooled logistic regression to time dependent Cox regression analysis: the Framingham Heart Study. Stat Med. 1990;9:1501–15.CrossRefPubMed

19.

Efron B. Logistic regression, survival analysis, and the Kaplan–Meier curve. J Am Stat Assoc. 1988;83:414.CrossRef

20.

Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999–2016. NCHS Data Brief, no 294. Hyattsville: National Center for Health Statistics; 2017.

21.

Hedegaard H, Warner M, Minino AM. Drug overdose deaths in the United States, 1999–2015. NCHS Data Brief, no. 293. Hyattsville: National Center for Health Statistics; 2017.

22.

Ford MD. Clinical toxicology. New York: WB Saunders Company; 2001.

23.

OPTN/SRTR 2015. Annual data report: preface. Am J Transpl. 2017;17:1–10.

Title: The meaning of confounding adjustment in the presence of multiple versions of treatment: an application to organ transplantation
Authors: Kerollos Nashat Wanis
Arin L. Madenci
Mary Katherine Dokus
Mark S. Orloff
Mark A. Levstik
Roberto Hernandez-Alejandro
Miguel A. Hernán
Publication date: 01-03-2019
Publisher: Springer Netherlands
Keywords: Opioids
Opioids
Published in: European Journal of Epidemiology / Issue 3/2019
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI: https://doi.org/10.1007/s10654-019-00484-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The meaning of confounding adjustment in the presence of multiple versions of treatment: an application to organ transplantation

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2019

Premenopausal cardiovascular disease and age at natural menopause: a pooled analysis of over 170,000 women

Menopausal hormone therapy and breast cancer risk: effect modification by body mass through life

The disjunctive cause criterion by VanderWeele: An easy solution to a complex problem?

Guidelines and recommendations for ensuring Good Epidemiological Practice (GEP): a guideline developed by the German Society for Epidemiology

Theory meets practice: a commentary on VanderWeele’s ‘principles of confounder selection’

Principles of confounder selection