Predicting the graft survival for heart-lung transplantation patients: An integrated data mining methodology

Background: Predicting the survival of heart-lung transplant patients has the potential to play a critical role in understanding and improving the matching procedure between the recipient and graft. Although voluminous data related to the transplantation procedures is being collected and stored, only a small subset of the predictive factors has been used in modeling heart-lung transplantation outcomes. The previous studies have mainly focused on applying statistical techniques to a small set of factors selected by the domain-experts in order to reveal the simple linear relationships between the factors and survival. The collection of methods known as 'data mining' offers significant advantages over conventional statistical techniques in dealing with the latter's limitations such as normality assumption of observations, independence of observations from each other, and linearity of the relationship between the observations and the output measure(s). There are statistical methods that overcome these limitations. Yet, they are computationally more expensive and do not provide fast and flexible solutions as do data mining techniques in large datasets. Purpose: The main objective of this study is to improve the prediction of outcomes following combined heart-lung transplantation by proposing an integrated data-mining methodology. Methods: A large and feature-rich dataset (16,604 cases with 283 variables) is used to (1) develop machine learning based predictive models and (2) extract the most important predictive factors. Then, using three different variable selection methods, namely, (i) machine learning methods driven variables-using decision trees, neural networks, logistic regression, (ii) the literature review-based expert-defined variables, and (iii) common sense-based interaction variables, a consolidated set of factors is generated and used to develop Cox regression models for heart-lung graft survival. Results: The predictive models' performance in terms of 10-fold cross-validation accuracy rates for two-multi-imputed datasets ranged from 79% to 86% for neural networks, from 78% to 86% for logistic regression, and from 71% to 79% for decision trees. The results indicate that the proposed integrated data mining methodology using Cox hazard models better predicted the graft survival with different variables than the conventional approaches commonly used in the literature. This result is validated by the comparison of the corresponding Gains charts for our proposed methodology and the literature review based Cox results, and by the comparison of Akaike information criteria (AIC) values received from each. Data mining-based methodology proposed in this study reveals that there are undiscovered relationships (i.e. interactions of the existing variables) among the survival-related variables, which helps better predict the survival of the heart-lung transplants. It also brings a different set of variables into the scene to be evaluated by the domain-experts and be considered prior to the organ transplantation. (C) 2009 Elsevier Ireland Ltd. All rights reserved.