Abstract

Delayed-graft function (DGF) might be responsible for shorter graft survival. Therefore, a clinical tool predicting its occurrence is vital for the risk assessment of transplant outcomes. In a single-center study, we conducted data mining and machine learning experiments, resulting in DGF predictive models based on random forest classifiers (RF) and an artificial neural network called multi-layer perceptron (MLP). All designed models had four common input parameters, determining the best accuracy and discriminant ability: donor’s eGFR, recipient’s BMI, donor’s BMI, and recipient–donor weight difference. RF and MLP designs, using these parameters, achieved an accuracy of 84.38% and an area under curve (AUC) 0.84. The model additionally implementing a donor’s age, gender, and Kidney Donor Profile Index (KDPI) accomplished an accuracy of 93.75% and an AUC of 0.91. The other configuration with the estimated post-transplant survival (EPTS) and the kidney donor risk profile (KDRI) achieved an accuracy of 93.75% and an AUC of 0.92. Using machine learning, we were able to assess the risk of DGF in recipients after kidney transplant from a deceased donor. Our solution is scalable and can be improved during subsequent transplants. Based on the new data, the models can achieve better outcomes.

Highlights

  • Delayed-graft function (DGF) after a kidney transplantation (KTx) refers to an acute kidney injury (AKI) requiring at least one dialysis session within the first week after surgery

  • The ability to predict DGF is crucial in decision-making processes at the time of transplantation, including declining the offer, selecting a recipient with a lower DGF risk, implementing efforts to shorten the cold ischemia time (CIT), or postponing an initiation of treatment with calcineurin inhibitors (CNIs)

  • The other configuration with the estimated post-transplant survival (EPTS) and the kidney donor risk profile (KDRI) achieved an accuracy of 93.75% and an an area under curve (AUC) of 0.91

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Summary

Introduction

Delayed-graft function (DGF) after a kidney transplantation (KTx) refers to an acute kidney injury (AKI) requiring at least one dialysis session within the first week after surgery. It is associated with prolonged hospitalization, higher rates of acute rejection, and, shorter graft survival [1,2,3]. The most widely used tool, with about 70% accuracy, is the Irish risk calculator, which is based on 20 recipient- and donor-derived risk factors; it can identify the most significant aspects such as CIT, a donor’s terminal creatinine concentration, a donor’s body mass index (BMI), procurement after DCD, and a donor’s age [6]

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