Discover important donor-recipient risk factors and interactions in heart transplant primary graft dysfunction with machine learning.

Objectives: Primary graft dysfunction (PGD) is an essential outcome after the heart transplant, which causes severe complications and symptoms for recipients. The in advance prediction of PGD can help the transplant physician better manage the risks of PGD occurrence for patients. Domain experts have identified some important risk factors leading to PGD. However, a widely accepted PGD prediction method is lacking from a computational perspective. In this work, we focus on the prediction of PGD after heart transplant with machine learning (ML).

Materials and methods: With the strong power of artificial intelligence, we propose to design a ML algorithm to precisely predict the PGD with the donor and recipient features. Moreover, we apply the computational method to automatically identify important features and interactions between them.

Results: To evaluate the effectiveness of the ML algorithm in PGD prediction, we curated a PGD patients' cohort from the United Network for Organ Sharing database, which contains 8008 recipients. 5 commonly used ML models are used for performance comparison. The multi-layer perceptron model achieves superior performance, as measured by area under the receiver operating characteristic curve (AUROC), at 0.868. We identify the top 20 important features and interactions between donors and recipients. Clinical analyses are conducted on the identified features and interactions.

Discussion: We summarize the contributions of this work from three aspects including methodology, clinical analysis, and insights. We discuss the limitations of this work on data, model, and real-world implementation perspectives. Additionally, we further discuss the future directions to extend this work to more organ types and diseases.

Conclusion: In summary, ML has promising applications in PGD prediction as a computational tool for clinical study. We can also use the ML model to help us identify and discover new risk factors and interactions between donor and recipient.