Use of Machine Learning Consensus Clustering to Identify Distinct Subtypes of Kidney Transplant Recipients With DGF and Associated Outcomes

被引:3
|
作者
Jadlowiec, Caroline C. [1 ]
Thongprayoon, Charat [2 ]
Leeaphorn, Napat [3 ]
Kaewput, Wisit [4 ]
Pattharanitima, Pattharawin [5 ]
Cooper, Matthew [6 ]
Cheungpasitporn, Wisit [2 ]
机构
[1] Mayo Clin, Div Transplant Surg, Phoenix, AZ 85054 USA
[2] Mayo Clin, Dept Med, Div Nephrol & Hypertens, Rochester, MN USA
[3] Univ Missouri, Kansas City Sch Med, Renal Transplant Program, St Lukes Hlth Syst, Kansas City, MO USA
[4] Phramongkutklao Coll Med, Dept Mil & Community Med, Bangkok, Thailand
[5] Thammasat Univ, Fac Med, Dept Internal Med, Pathum Thani, Thailand
[6] Georgetown Univ, Medstar Georgetown Transplant Inst, Washington, DC USA
关键词
kidney transplant; delayed graft function; clustering; machine learning; artificial intelligence; DELAYED GRAFT FUNCTION; SURVIVAL; DISPARITIES; ALLOGRAFT;
D O I
10.3389/ti.2022.10810
中图分类号
R61 [外科手术学];
学科分类号
摘要
Data and transplant community opinion on delayed graft function (DGF), and its impact on outcomes, remains varied. An unsupervised machine learning consensus clustering approach was applied to categorize the clinical phenotypes of kidney transplant (KT) recipients with DGF using OPTN/UNOS data. DGF was observed in 20.9% (n = 17,073) of KT and most kidneys had a KDPI score <85%. Four distinct clusters were identified. Cluster 1 recipients were young, high PRA re-transplants. Cluster 2 recipients were older diabetics and more likely to receive higher KDPI kidneys. Cluster 3 recipients were young, black, and non-diabetic; they received lower KDPI kidneys. Cluster 4 recipients were middle-aged, had diabetes or hypertension and received well-matched standard KDPI kidneys. By cluster, one-year patient survival was 95.7%, 92.5%, 97.2% and 94.3% (p < 0.001); one-year graft survival was 89.7%, 87.1%, 91.6%, and 88.7% (p < 0.001). There were no differences between clusters after accounting for death-censored graft loss (p = 0.08). Clinically meaningful differences in recipient characteristics were noted between clusters, however, after accounting for death and return to dialysis, there were no differences in death-censored graft loss. Greater emphasis on recipient comorbidities as contributors to DGF and outcomes may help improve utilization of DGF at-risk kidneys.
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页数:11
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