Risk factors for 1-year allograft loss in pediatric heart transplant patients using machine learning: An analysis of the pediatric heart transplant society database.

Autor: Wisotzkey BL; Division of Cardiology, Phoenix Children's Center for Heart Care, University of Arizona College of Medicine, Phoenix, Arizona, USA., Jaeger B; Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA., Asante-Korang A; Division of Cardiology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA., Brickler M; Department of Pediatrics, Section of Cardiology, Medical College of Wisconsin, The Herma Heart Institute, Children's Wisconsin, Milwaukee, Wisconsin, USA., Cantor RS; Kirklin Solutions, Birmingham, Alabama, USA., Everitt MD; Division of Cardiology, Children's Hospital Colorado, University of Colorado, Colorado, Aurora, USA., Kirklin JK; Kirklin Solutions, Birmingham, Alabama, USA., Koehl D; Kirklin Solutions, Birmingham, Alabama, USA., Mantell BS; Department of Pediatrics, Division of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Thrush PT; Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Kuhn M; Division of Cardiology, Loma Linda University Children's Hospital and Medical Center, Loma Linda, USA, California.
Jazyk: angličtina
Zdroj: Pediatric transplantation [Pediatr Transplant] 2023 Dec; Vol. 27 (8), pp. e14612. Date of Electronic Publication: 2023 Sep 19.
DOI: 10.1111/petr.14612
Abstrakt: Background: Pediatric heart transplant patients are at greatest risk of allograft loss in the first year. We assessed whether machine learning could improve 1-year risk assessment using the Pediatric Heart Transplant Society database.
Methods: Patients transplanted from 2010 to 2019 were included. The primary outcome was 1-year graft loss free survival. We developed a prediction model using cross-validation, by comparing Cox regression, gradient boosting, and random forests. The modeling strategy with the best discrimination and calibration was applied to fit a final prediction model. We used Shapley additive explanation (SHAP) values to perform variable selection and to estimate effect sizes and importance of individual variables when interpreting the final prediction model.
Results: Cumulative incidence of graft loss or mortality was 7.6%. Random forests had favorable discrimination and calibration compared to Cox proportional hazards with a C-statistic (95% confidence interval [CI]) of 0.74 (0.72, 0.76) versus 0.71 (0.69, 0.73), and closer alignment between predicted and observed risk. SHAP values computed using the final prediction model indicated that the diagnosis of congenital heart disease (CHD) increased 1 year predicted risk of graft loss by 1.7 (i.e., from 7.6% to 9.3%), need for mechanical circulatory support increased predicted risk by 2, and single ventricle CHD increased predicted risk by 1.9. These three predictors, respectively, were also estimated to be the most important among the 15 predictors in the final model.
Conclusions: Risk prediction models used to facilitate patient selection for pediatric heart transplant can be improved without loss of interpretability using machine learning.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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