Abstract
Background: Black kidney transplant recipients have worse allograft outcomes compared to White recipients. The feature importance and feature interaction network analysis framework of machine learning random forest (RF) analysis may provide an understanding of RF structures to design strategies to prevent acute rejection among Black recipients. Methods: We conducted tree-based RF feature importance of Black kidney transplant recipients in United States from 2015 to 2019 in the UNOS database using the number of nodes, accuracy decrease, gini decrease, times_a_root, p value, and mean minimal depth. Feature interaction analysis was also performed to evaluate the most frequent occurrences in the RF classification run between correlated and uncorrelated pairs. Results: A total of 22,687 Black kidney transplant recipients were eligible for analysis. Of these, 1330 (6%) had acute rejection within 1 year after kidney transplant. Important variables in the RF models for acute rejection among Black kidney transplant recipients included recipient age, ESKD etiology, PRA, cold ischemia time, donor age, HLA DR mismatch, BMI, serum albumin, degree of HLA mismatch, education level, and dialysis duration. The three most frequent interactions consisted of two numerical variables, including recipient age:donor age, recipient age:serum albumin, and recipient age:BMI, respectively. Conclusions: The application of tree-based RF feature importance and feature interaction network analysis framework identified recipient age, ESKD etiology, PRA, cold ischemia time, donor age, HLA DR mismatch, BMI, serum albumin, degree of HLA mismatch, education level, and dialysis duration as important variables in the RF models for acute rejection among Black kidney transplant recipients in the United States.
Highlights
Black kidney transplant recipients have worse allograft outcomes compared to White recipients [1,2,3,4,5,6,7]
A total of 22,687 black kidney transplant recipients were eligible for analysis
Patients with rejection were less likely to receive depleting induction and were more likely to receive basiliximab. They were more likely to be on cyclosporine, mycophenolate, azathioprine, and mTOR inhibitors for maintenance immunosuppression
Summary
Black kidney transplant recipients have worse allograft outcomes compared to White recipients [1,2,3,4,5,6,7]. Identified factors possibly responsible for these disparities have include lower living donor rates [5], longer dialysis vintage [8], longer cold ischemia times [9], delays in listing and time on transplant waiting list [10,11], greater rates of marginal donor kidneys [9,12,13], higher rates of delayed graft function (DGF) [14], less favorable human leucocyte antigen (HLA) matching [9,15,16,17], variability in the pharmacokinetics of immunosuppressive drugs and immunologic responsiveness [18,19], and more comorbidities, such as hypertension [20] and diabetes mellitus [21] Such discrepancies have been thought to contribute to a higher rate of acute rejection in Black recipients, resulting in increased allograft loss [14,22,23,24,25]. The feature interaction network analysis framework of RF may provide an understanding of the interaction among multiple features in order to design strategies to prevent acute rejection and explore the mechanisms of variable interactions influencing acute rejection among
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