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Machine learning-based mortality prediction models using national liver transplantation registries are feasible but have limited utility across countries
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery. Univ Hlth Network Toronto, Multi Organ Transplant Program, Toronto, ON, Canada.;Henry Ford Hosp, Dept Surg, Detroit, MI USA..ORCID iD: 0000-0002-1312-4470
Hosp Sick Children, Ctr Computat Med, Toronto, ON, Canada..
Univ Hlth Network Toronto, Multi Organ Transplant Program, Toronto, ON, Canada.;Univ Med Ctr Rotterdam, Erasmus MC Transplant Inst, Dept Surg, Div HPB & Transplant Surg, Rotterdam, Netherlands..ORCID iD: 0000-0001-8218-3119
Kings Coll Hosp NHS Fdn Trust, London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, London, England.;Kings Coll Hosp NHS Fdn Trust, Inst Liver Studies, London, England..ORCID iD: 0000-0002-8959-7741
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2023 (English)In: American Journal of Transplantation, ISSN 1600-6135, E-ISSN 1600-6143, Vol. 23, no 1, p. 64-71Article in journal (Refereed) Published
Abstract [en]

Many countries curate national registries of liver transplant (LT) data. These registries are often used to generate predictive models; however, potential performance and transferability of these models remain unclear. We data from 3 national registries and developed machine learning algorithm (MLA)-based models to predict 90 post-LT mortality within and across countries. Predictive performance and external validity of each model assessed. Prospectively collected data of adult patients (aged >= 18 years) who underwent primary LTs between January 2008 and December 2018 from the Canadian Organ Replacement Registry (Canada), National Service Blood and Transplantation (United Kingdom), and United Network for Organ Sharing (United were used to develop MLA models to predict 90-day post-LT mortality. Models were developed using each registry individually (based on variables inherent to the individual databases) and using all 3 registries combined iables in common between the registries [harmonized]). The model performance was evaluated using area the receiver operating characteristic (AUROC) curve. The number of patients included was as follows: Canada, = 1214; the United Kingdom, n = 5287; and the United States, n = 59,558. The best performing MLA-based model was ridge regression across both individual registries and harmonized data sets. Model performance diminished from individualized to the harmonized registries, especially in Canada (individualized ridge: AUROC, 0.74; range, 0.73-0.74; harmonized: AUROC, 0.68; range, 0.50-0.73) and US (individualized ridge: AUROC, range, 0.70-0.71; harmonized: AUROC, 0.66; range, 0.66-0.66) data sets. External model performance countries was poor overall. MLA-based models yield a fair discriminatory potential when used within individual databases. However, the external validity of these models is poor when applied across countries. Standardization of registry-based variables could facilitate the added value of MLA-based models in informing decision making future LTs.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC Elsevier, 2023. Vol. 23, no 1, p. 64-71
Keywords [en]
machine learning algorithm, international liver registry, liver transplantation, outcome prediction
National Category
Cardiology and Cardiovascular Disease
Identifiers
URN: urn:nbn:se:uu:diva-506986DOI: 10.1016/j.ajt.2022.12.002ISI: 001006569300001PubMedID: 36695623OAI: oai:DiVA.org:uu-506986DiVA, id: diva2:1778811
Available from: 2023-07-03 Created: 2023-07-03 Last updated: 2025-02-10Bibliographically approved

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Ivanics, Tommy

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