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| Main Authors: | , , , , , , , |
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| Format: | Artículo Open Access |
| Published: |
Wiley
2024
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| Subjects: | |
| Online Access: | https://onlinelibrary.wiley.com/doi/10.1111/ctr.15470 |
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Table of Contents:
- Reexamining Transplant Outcomes in Acute Kidney Injury Kidneys Through Machine Learning Caroline C. Jadlowiec Charat Thongprayoon Supawadee Suppadungsuk Supawit Tangpanithandee Napat Leeaphorn Raymond Heilman Matthew Cooper Wisit Cheungpasitporn Clinical Transplantation ABSTRACTBackgroundDespite many people awaiting kidney transplant, kidney allografts from acute kidney injury (AKI) donors continue to be underutilized. We aimed to cluster kidney transplant recipients of AKI kidney allografts using an unsupervised machine learning (ML) approach.MethodsUsing Organ Procurement and Transplantation Network–United Network for Organ Sharing (OPTN/UNOS) data, a consensus clustering cohort analysis was performed in 12 356 deceased donor kidney transplant recipients between 2015 and 2019 in whom donors had a terminal serum creatinine ≥1.5 mg/dL. Significant cluster characteristics were determined, and outcomes were compared.ResultsThe median donor terminal creatinine was 2.2 (interquartile range [IQR] 1.7–3.3) mg/dL. Cluster analysis was performed on 12 356 AKI kidney recipients, and three clinically distinct clusters were identified. Young, sensitized kidney re‐transplant patients characterized Cluster 1. Cluster 2 was characterized by first‐time kidney transplant patients with hypertensive and diabetic kidney diseases. Older diabetic recipients characterized Cluster 3. Clusters 1 and 2 donors were young and met standard kidney donor profile index (KDPI) criteria; Cluster 3 donors were older, more likely to have hypertension or diabetes, and meet high KDPI criteria. Cluster 1 had a higher risk of acute rejection, 3‐year patient death, and graft failure. Cluster 3 had a higher risk of death‐censored graft failure, patient death, and graft failure at 1 and 3 years. Cluster 2 had the best patient‐, graft‐, and death‐censored graft survival at 1 and 3 years. Compared to non‐AKI kidney recipients, the AKI clusters showed a higher incidence of delayed graft function (DGF, AKI: 43.2%, 41.7%, 45.3% vs. non‐AKI: 25.5%); however, there were comparable long‐term outcomes specific to death‐censored graft survival (AKI: 93.6%, 93.4%, 90.4% vs. non‐AKI: 92.3%), patient survival (AKI: 89.1%, 93.2%, 84.2% vs. non‐AKI: 91.2%), and overall graft survival (AKI: 84.7%, 88.2%, 79.0% vs. non‐AKI: 86.0%).ConclusionsIn this unsupervised ML approach study, AKI recipient clusters demonstrated differing, but good clinical outcomes, suggesting opportunities for transplant centers to incrementally increase kidney utilization from AKI donors. 10.1111/ctr.15470 http://onlinelibrary.wiley.com/termsAndConditions#vor