Machine learning in liver transplantation: a tool for some unsolved questions?

2021 ◽  
Author(s):  
Alberto Ferrarese ◽  
Giuseppe Sartori ◽  
Graziella Orrù ◽  
Anna Chiara Frigo ◽  
Filippo Pelizzaro ◽  
...  
Keyword(s):  
Machine Learning ◽  
Liver Transplantation

scholarly journals Efficiency of Machine Learning Algorithms for the Determination of Macrovesicular Steatosis in Frozen Sections Stained with Sudan to Evaluate the Quality of the Graft in Liver Transplantation

Sensors ◽  
2021 ◽  
Vol 21 (6) ◽  
pp. 1993
Author(s):  
Fernando Pérez-Sanz ◽  
Miriam Riquelme-Pérez ◽  
Enrique Martínez-Barba ◽  
Jesús de la Peña-Moral ◽  
Alejandro Salazar Nicolás ◽  
...  
Keyword(s):  
Machine Learning ◽  
Liver Transplantation ◽  
Learning Algorithms ◽  
Selection Procedure ◽  
Machine Learning Algorithms ◽  
Liver Biopsies ◽  
Convenient Technique ◽  
End Stage ◽  
Macrovesicular Steatosis

Liver transplantation is the only curative treatment option in patients diagnosed with end-stage liver disease. The low availability of organs demands an accurate selection procedure based on histological analysis, in order to evaluate the allograft. This assessment, traditionally carried out by a pathologist, is not exempt from subjectivity. In this sense, new tools based on machine learning and artificial vision are continuously being developed for the analysis of medical images of different typologies. Accordingly, in this work, we develop a computer vision-based application for the fast and automatic objective quantification of macrovesicular steatosis in histopathological liver section slides stained with Sudan stain. For this purpose, digital microscopy images were used to obtain thousands of feature vectors based on the RGB and CIE L*a*b* pixel values. These vectors, under a supervised process, were labelled as fat vacuole or non-fat vacuole, and a set of classifiers based on different algorithms were trained, accordingly. The results obtained showed an overall high accuracy for all classifiers (>0.99) with a sensitivity between 0.844 and 1, together with a specificity >0.99. In relation to their speed when classifying images, KNN and Naïve Bayes were substantially faster than other classification algorithms. Sudan stain is a convenient technique for evaluating ME in pre-transplant liver biopsies, providing reliable contrast and facilitating fast and accurate quantification through the machine learning algorithms tested.

scholarly journals Survival prediction models since liver transplantation - comparisons between Cox models and machine learning techniques

2020 ◽  
Author(s):  
Georgios Kantidakis ◽  
Hein Putter ◽  
Carlo Lancia ◽  
Jacob de Boer ◽  
Andries E Braat ◽  
...  
Keyword(s):  
Machine Learning ◽  
Neural Networks ◽  
Liver Transplantation ◽  
Prediction Models ◽  
Machine Learning Techniques ◽  
Brier Score ◽  
Survival Prediction ◽  
Cox Models ◽  
Learning Techniques ◽  
Random Survival Forest

Abstract Background: Predicting survival of recipients after liver transplantation is regarded as one of the most important challenges in contemporary medicine. Hence, improving on current prediction models is of great interest.Nowadays, there is a strong discussion in the medical field about machine learning (ML) and whether it has greater potential than traditional regression models when dealing with complex data. Criticism to ML is related to unsuitable performance measures and lack of interpretability which is important for clinicians.Methods: In this paper, ML techniques such as random forests and neural networks are applied to large data of 62294 patients from the United States with 97 predictors selected on clinical/statistical grounds, over more than 600, to predict survival from transplantation. Of particular interest is also the identification of potential risk factors. A comparison is performed between 3 different Cox models (with all variables, backward selection and LASSO) and 3 machine learning techniques: a random survival forest and 2 partial logistic artificial neural networks (PLANNs). For PLANNs, novel extensions to their original specification are tested. Emphasis is given on the advantages and pitfalls of each method and on the interpretability of the ML techniques.Results: Well-established predictive measures are employed from the survival field (C-index, Brier score and Integrated Brier Score) and the strongest prognostic factors are identified for each model. Clinical endpoint is overall graft-survival defined as the time between transplantation and the date of graft-failure or death. The random survival forest shows slightly better predictive performance than Cox models based on the C-index. Neural networks show better performance than both Cox models and random survival forest based on the Integrated Brier Score at 10 years.Conclusion: In this work, it is shown that machine learning techniques can be a useful tool for both prediction and interpretation in the survival context. From the ML techniques examined here, PLANN with 1 hidden layer predicts survival probabilities the most accurately, being as calibrated as the Cox model with all variables.

scholarly journals Survival prediction models since liver transplantation - comparisons between Cox models and machine learning techniques

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Georgios Kantidakis ◽  
Hein Putter ◽  
Carlo Lancia ◽  
Jacob de Boer ◽  
Andries E. Braat ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Neural Networks ◽  
Liver Transplantation ◽  
Prediction Models ◽  
Machine Learning Techniques ◽  
Brier Score ◽  
Cox Models ◽  
Learning Techniques ◽  
Random Survival Forest

Abstract Background Predicting survival of recipients after liver transplantation is regarded as one of the most important challenges in contemporary medicine. Hence, improving on current prediction models is of great interest.Nowadays, there is a strong discussion in the medical field about machine learning (ML) and whether it has greater potential than traditional regression models when dealing with complex data. Criticism to ML is related to unsuitable performance measures and lack of interpretability which is important for clinicians. Methods In this paper, ML techniques such as random forests and neural networks are applied to large data of 62294 patients from the United States with 97 predictors selected on clinical/statistical grounds, over more than 600, to predict survival from transplantation. Of particular interest is also the identification of potential risk factors. A comparison is performed between 3 different Cox models (with all variables, backward selection and LASSO) and 3 machine learning techniques: a random survival forest and 2 partial logistic artificial neural networks (PLANNs). For PLANNs, novel extensions to their original specification are tested. Emphasis is given on the advantages and pitfalls of each method and on the interpretability of the ML techniques. Results Well-established predictive measures are employed from the survival field (C-index, Brier score and Integrated Brier Score) and the strongest prognostic factors are identified for each model. Clinical endpoint is overall graft-survival defined as the time between transplantation and the date of graft-failure or death. The random survival forest shows slightly better predictive performance than Cox models based on the C-index. Neural networks show better performance than both Cox models and random survival forest based on the Integrated Brier Score at 10 years. Conclusion In this work, it is shown that machine learning techniques can be a useful tool for both prediction and interpretation in the survival context. From the ML techniques examined here, PLANN with 1 hidden layer predicts survival probabilities the most accurately, being as calibrated as the Cox model with all variables. Trial registration Retrospective data were provided by the Scientific Registry of Transplant Recipients under Data Use Agreement number 9477 for analysis of risk factors after liver transplantation.

scholarly journals Prediction of Acute Kidney Injury after Liver Transplantation: Machine Learning Approaches vs. Logistic Regression Model

2018 ◽  
Vol 7 (11) ◽  
pp. 428 ◽  
Author(s):  
Hyung-Chul Lee ◽  
Soo Yoon ◽  
Seong-Mi Yang ◽  
Won Kim ◽  
Ho-Geol Ryu ◽  
...  
Keyword(s):  
Machine Learning ◽  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Kidney Injury ◽  
Gradient Boosting ◽  
Learning Approaches ◽  
Gradient Boosting Machine

Acute kidney injury (AKI) after liver transplantation has been reported to be associated with increased mortality. Recently, machine learning approaches were reported to have better predictive ability than the classic statistical analysis. We compared the performance of machine learning approaches with that of logistic regression analysis to predict AKI after liver transplantation. We reviewed 1211 patients and preoperative and intraoperative anesthesia and surgery-related variables were obtained. The primary outcome was postoperative AKI defined by acute kidney injury network criteria. The following machine learning techniques were used: decision tree, random forest, gradient boosting machine, support vector machine, naïve Bayes, multilayer perceptron, and deep belief networks. These techniques were compared with logistic regression analysis regarding the area under the receiver-operating characteristic curve (AUROC). AKI developed in 365 patients (30.1%). The performance in terms of AUROC was best in gradient boosting machine among all analyses to predict AKI of all stages (0.90, 95% confidence interval [CI] 0.86–0.93) or stage 2 or 3 AKI. The AUROC of logistic regression analysis was 0.61 (95% CI 0.56–0.66). Decision tree and random forest techniques showed moderate performance (AUROC 0.86 and 0.85, respectively). The AUROC of support the vector machine, naïve Bayes, neural network, and deep belief network was smaller than that of the other models. In our comparison of seven machine learning approaches with logistic regression analysis, the gradient boosting machine showed the best performance with the highest AUROC. An internet-based risk estimator was developed based on our model of gradient boosting. However, prospective studies are required to validate our results.

Machine-learning algorithms for predicting results in liver transplantation

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Javier Briceno ◽  
María Dolores Ayllón ◽  
Rubén Ciria
Keyword(s):  
Machine Learning ◽  
Liver Transplantation ◽  
Learning Algorithms ◽  
Machine Learning Algorithms

Application of machine learning in liver transplantation: a review

2022 ◽  
Author(s):  
Jason Tran ◽  
Divya Sharma ◽  
Neta Gotlieb ◽  
Wei Xu ◽  
Mamatha Bhat
Keyword(s):  
Machine Learning ◽  
Liver Transplantation

scholarly journals An explainable supervised machine learning predictor of acute kidney injury after adult deceased donor liver transplantation

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yihan Zhang ◽  
Dong Yang ◽  
Zifeng Liu ◽  
Chaojin Chen ◽  
Mian Ge ◽  
...  
Keyword(s):  
Machine Learning ◽  
Decision Making ◽  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Supervised Machine Learning ◽  
Gradient Boosting ◽  
Support Vector ◽  
Adaptive Boosting ◽  
Validation Set

Abstract Background Early prediction of acute kidney injury (AKI) after liver transplantation (LT) facilitates timely recognition and intervention. We aimed to build a risk predictor of post-LT AKI via supervised machine learning and visualize the mechanism driving within to assist clinical decision-making. Methods Data of 894 cases that underwent liver transplantation from January 2015 to September 2019 were collected, covering demographics, donor characteristics, etiology, peri-operative laboratory results, co-morbidities and medications. The primary outcome was new-onset AKI after LT according to Kidney Disease Improving Global Outcomes guidelines. Predicting performance of five classifiers including logistic regression, support vector machine, random forest, gradient boosting machine (GBM) and adaptive boosting were respectively evaluated by the area under the receiver-operating characteristic curve (AUC), accuracy, F1-score, sensitivity and specificity. Model with the best performance was validated in an independent dataset involving 195 adult LT cases from October 2019 to March 2021. SHapley Additive exPlanations (SHAP) method was applied to evaluate feature importance and explain the predictions made by ML algorithms. Results 430 AKI cases (55.1%) were diagnosed out of 780 included cases. The GBM model achieved the highest AUC (0.76, CI 0.70 to 0.82), F1-score (0.73, CI 0.66 to 0.79) and sensitivity (0.74, CI 0.66 to 0.8) in the internal validation set, and a comparable AUC (0.75, CI 0.67 to 0.81) in the external validation set. High preoperative indirect bilirubin, low intraoperative urine output, long anesthesia time, low preoperative platelets, and graft steatosis graded NASH CRN 1 and above were revealed by SHAP method the top 5 important variables contributing to the diagnosis of post-LT AKI made by GBM model. Conclusions Our GBM-based predictor of post-LT AKI provides a highly interoperable tool across institutions to assist decision-making after LT. Graphic abstract

scholarly journals An explainable supervised machine learning predictor of acute kidney injury after adult deceased donor liver transplantation

2021 ◽  
Author(s):  
Yihan Zhang ◽  
Dong Yang ◽  
Zifeng Liu ◽  
Chaojin Chen ◽  
Mian Ge ◽  
...  
Keyword(s):  
Machine Learning ◽  
Decision Making ◽  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Clinical Decision Making ◽  
Kidney Injury ◽  
Supervised Machine Learning ◽  
Gradient Boosting ◽  
Support Vector ◽  
Adaptive Boosting

Abstract Background: Early prediction of acute kidney injury (AKI) after liver transplantation (LT) facilitates timely recognition and intervention. We aimed to build a risk predictor of post-LT AKI via supervised machine learning and visualize the mechanism driving within to assist clinical decision-making.Methods: Data of 894 cases that underwent liver transplantation from January 2015 to September 2019 were collected, covering demographics, donor characteristics, etiology, peri-operative laboratory results, co-morbidities and medications. The primary outcome was new-onset AKI after LT according to Kidney Disease Improving Global Outcomes guidelines. Predicting performance of five classifiers including logistic regression, support vector machine, random forest, gradient boosting machine (GBM) and adaptive boosting were respectively evaluated by the area under the receiver-operating characteristic curve (AUC), accuracy, F1-score, sensitivity and specificity. SHapley Additive exPlanations (SHAP) method was applied to evaluate feature importance and explain the predictions made by ML algorithms.Results: 430 AKI cases (55.1%) were diagnosed out of 780 included cases. The GBM model achieved the highest AUC (0.76, CI 0.70 to 0.82), F1-score (0.73, CI 0.66to 0.79) and sensitivity (0.74, CI 0.66 to 0.8). High preoperative indirect bilirubin, low intraoperative urine output, long anesthesia time, low preoperative platelets, and graft steatosis graded NASH CRN 1 and above were revealed by SHAP method the top 5 important variables contributing to the diagnosis of post-LT AKI made by GBM model.Conclusions: Our GBM-based predictor of post-LT AKI provides a highly interoperable tool across institutions to assist decision-making after LT.

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