Feature Importance of Acute Rejection among Black Kidney Transplant Recipients by Utilizing Random Forest Analysis: An Analysis of the UNOS Database

Background: Black kidney transplant recipients have worse allograft outcomes compared to White recipients. The feature importance and feature interaction network analysis framework of machine learning random forest (RF) analysis may provide an understanding of RF structures to design strategies to prevent acute rejection among Black recipients. Methods: We conducted tree-based RF feature importance of Black kidney transplant recipients in United States from 2015 to 2019 in the UNOS database using the number of nodes, accuracy decrease, gini decrease, times_a_root, p value, and mean minimal depth. Feature interaction analysis was also performed to evaluate the most frequent occurrences in the RF classification run between correlated and uncorrelated pairs. Results: A total of 22,687 Black kidney transplant recipients were eligible for analysis. Of these, 1330 (6%) had acute rejection within 1 year after kidney transplant. Important variables in the RF models for acute rejection among Black kidney transplant recipients included recipient age, ESKD etiology, PRA, cold ischemia time, donor age, HLA DR mismatch, BMI, serum albumin, degree of HLA mismatch, education level, and dialysis duration. The three most frequent interactions consisted of two numerical variables, including recipient age:donor age, recipient age:serum albumin, and recipient age:BMI, respectively. Conclusions: The application of tree-based RF feature importance and feature interaction network analysis framework identified recipient age, ESKD etiology, PRA, cold ischemia time, donor age, HLA DR mismatch, BMI, serum albumin, degree of HLA mismatch, education level, and dialysis duration as important variables in the RF models for acute rejection among Black kidney transplant recipients in the United States.

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Immune regulation and graft survival in kidney transplant recipients are both enhanced by HLA-DR sharing

Human Immunology ◽

10.1016/j.humimm.2003.08.032 ◽

2003 ◽

Vol 64 (10) ◽

pp. S19

Author(s):

D.S. Rodriguez ◽

E. Jankowska-Gan ◽

L.D. Haynes ◽

G. Leverson ◽

D. Heisey ◽

...

Keyword(s):

Kidney Transplant ◽

Graft Survival ◽

Immune Regulation ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Hla Dr

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Immune Monitoring in Kidney Transplant Recipients Could Predict Acute Rejection by a New Method: Flow Cytometric Microcarrier Assay

Transplantation Proceedings ◽

10.1016/j.transproceed.2013.01.018 ◽

2013 ◽

Vol 45 (4) ◽

pp. 1508-1510 ◽

Cited By ~ 1

Author(s):

Z.-K. Jin ◽

C.-X. Xu ◽

P.-X. Tian ◽

W.-J. Xue ◽

T.-C. Mao ◽

...

Keyword(s):

Acute Rejection ◽

Kidney Transplant ◽

Immune Monitoring ◽

New Method ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Flow Cytometric

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Association of Factor V Leiden Mutation with Delayed Graft Function, Acute Rejection Episodes and Long-term Graft Dysfunction in Kidney Transplant Recipients

Thrombosis and Haemostasis ◽

10.1055/s-0037-1612972 ◽

2002 ◽

Vol 87 (02) ◽

pp. 194-198 ◽

Cited By ~ 32

Author(s):

Torsten Slowinski ◽

Ingeborg Hauser ◽

Birgit Vetter ◽

Lutz Fritsche ◽

Daniela Bachert ◽

...

Keyword(s):

Acute Rejection ◽

Kidney Transplant ◽

Graft Function ◽

Factor V Leiden ◽

Factor V ◽

Transplant Recipients ◽

Graft Dysfunction ◽

Kidney Transplant Recipients ◽

Factor V Leiden Mutation

SummaryWe analysed whether the factor V Leiden mutation – the most common hereditary predisposing factor for venous thrombosis – is associated with early and long-term graft dysfunction after kidney transplantation in 394 Caucasian kidney transplant recipients. The presence of factor V Leiden mutation was identified by allele specific PCR. The prevalence of the factor V Leiden mutation was compared to 32216 unselected neonates. The prevalence of the factor V Leiden mutation (GA genotype) was similar in 394 kidney transplant recipients and 32216 neonates. The frequency of known factors predicting long-term graft function were similar in patients with the GA genotype and with the normal factor V gene (GG genotype). The GA genotype was associated with the occurrence of no primary graft function (risk: 2.87; 95% confidence interval: 1.01-8.26; p < 0.05), the number of dialysis after transplantation in patients with no primary graft function until graft function (7.5 ± 2.06 dialysis in GA patients; 4.2 ± 0.36 dialyses in GG patients; p < 0.05), and the risk for at least one acute rejection episode (risk: 3.83; 95% confidence interval: 1.38-10.59; p < 0.02). The slope of 1/creatinine per year was significantly lower in patients with the GA genotype (GA patients: – 0.0204 ± 0.008 dl/mg per year; GG patients: 0.0104 ± 0.004 dl/mg per year; p < 0.02). The annual enhancement of the daily protein excretion rate was elevated in patients with the GA genotype (GA patients: 38.5 ± 16.6 mg/24 h per year; GG patients: 4.9 ± 4.4 mg/24 h per year; p < 0.02). Our study showed that the factor V Leiden mutation is associated with the occurrence of delayed graft function, acute rejection episodes and chronic graft dysfunction after kidney transplantation.

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Impact of antiretroviral therapy on clinical outcomes in HIV+ kidney transplant recipients: Review of 58 cases

F1000Research ◽

10.12688/f1000research.10414.1 ◽

2016 ◽

Vol 5 ◽

pp. 2893 ◽

Cited By ~ 15

Author(s):

Rossana Rosa ◽

Jose F. Suarez ◽

Marco A. Lorio ◽

Michele I. Morris ◽

Lilian M. Abbo ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Acute Rejection ◽

Clinical Outcomes ◽

Kidney Transplant ◽

Graft Survival ◽

Patient Survival ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Serious Infections ◽

The Impact

Background: Antiretroviral therapy (ART) poses challenging drug-drug interactions with immunosuppressant agents in transplant recipients. We aimed to determine the impact of specific antiretroviral regimens in clinical outcomes of HIV+ kidney transplant recipients. Methods: A single-center, retrospective cohort study was conducted at a large academic center. Subjects included 58 HIV- to HIV+ adult, first-time kidney transplant patients. The main intervention was ART regimen used after transplantation. The main outcomes assessed at one- and three-years were: patient survival, death-censored graft survival, and biopsy-proven acute rejection; we also assessed serious infections within the first six months post-transplant. Results: Patient and graft survival at three years were both 90% for the entire cohort. Patients receiving protease inhibitor (PI)-containing regimens had lower patient survival at one and three years than patients receiving PI-sparing regimens: 85% vs. 100% (p=0.06) and 82% vs. 100% (p=0.03), respectively. Patients who received PI-containing regimens had twelve times higher odds of death at 3 years compared to patients who were not exposed to PIs (odds ratio, 12.05; 95% confidence interval, 1.31-1602; p=0.02). Three-year death-censored graft survival was lower in patients receiving PI vs. patients on PI-sparing regimens (82 vs 100%, p=0.03). Patients receiving integrase strand transfer inhibitors-containing regimens had higher 3-year graft survival. There were no differences in the incidence of acute rejection by ART regimen. Individuals receiving PIs had a higher incidence of serious infections compared to those on PI-sparing regimens (39 vs. 8%, p=0.01). Conclusions: PI-containing ART regimens are associated with adverse outcomes in HIV+ kidney transplant recipients.

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