[Survival analysis with competing risks: estimating failure probability].
OBJECTIVE
To show the impact of competing risks of death on survival analysis.


METHODS
We provide an example of survival time without chronic rejection after heart transplantation, where death before rejection acts as a competing risk. Using a computer simulation, we compare the Kaplan-Meier estimator and the multiple decrement model.


RESULTS
The Kaplan-Meier method overestimated the probability of rejection. Next, we illustrate the use of the multiple decrement model to analyze secondary end points (in our example: death after rejection). Finally, we discuss Kaplan-Meier assumptions and why they fail in the presence of competing risks.


CONCLUSIONS
Survival analysis should be adjusted for competing risks of death to avoid overestimation of the risk of rejection produced with the Kaplan-Meier method.
Llorca
Javier
J
Medicina Preventiva y Salud Pública. Facultad de Medicina de la Universidad de Cantabria. Santander. Spain.
Delgado-Rodríguez
Miguel
M
D006084:Graft Rejection / Q000401:mortality; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D018570:Risk Assessment; D015996:Survival Rate