Optimal acceptance of incompatible kidneys
针对终末期肾病患者，研究在脱敏治疗可行时如何最优接受可能不相容的肾脏，通过马尔可夫决策模型得出易计算的控制限策略，帮助医生和患者权衡移植风险与等待收益。
Incompatibility between patient and donor is a major barrier in kidney transplantation (KT). The increasing shortage of kidney donors has driven the development of desensitization techniques to overcome this immunological challenge. Compared with compatible KT, patients undergoing incompatible KTs are more likely to experience rejection, infection, malignancy, and graft loss. We study the optimal acceptance of possibly incompatible kidneys for individual end-stage kidney disease patients. To capture the effects of incompatibility, we propose a Markov Decision Process (MDP) model that explicitly includes compatibility as a state variable. The resulting higher-dimensional model makes it more challenging to analyze, but under suitable conditions, we derive structural properties including control limit-type optimal policies that are easy to compute and implement. Numerical examples illustrate the behavior of the optimal policy under different mismatch levels and highlight the importance of explicitly incorporating the incompatibility level into the acceptance decision when desensitization therapy is an option.