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Tangri N, Ferguson TW, Bamforth RJ, Leon SJ, Arnott C, Mahaffey KW, Kotwal S, Heerspink HJL, Perkovic V, Fletcher RA, Neuen BL. Machine learning for prediction of chronic kidney disease progression: Validation of the Klinrisk model in the CANVAS Program and CREDENCE trial. Diabetes Obes Metab 2024; 26:3371-3380. [PMID: 38807510 DOI: 10.1111/dom.15678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/26/2024] [Accepted: 05/04/2024] [Indexed: 05/30/2024]
Abstract
AIM To validate the Klinrisk machine learning model for prediction of chronic kidney disease (CKD) progression in patients with type 2 diabetes in the pooled CANVAS/CREDENCE trials. MATERIALS AND METHODS We externally validated the Klinrisk model for prediction of CKD progression, defined as 40% or higher decline in estimated glomerular filtration rate (eGFR) or kidney failure. Model performance was assessed for prediction up to 3 years with the area under the receiver operating characteristic curve (AUC), Brier scores and calibration plots of observed and predicted risks. We compared performance of the model with standard of care using eGFR (G1-G4) and urine albumin-creatinine ratio (A1-A3) Kidney Disease Improving Global Outcomes (KDIGO) heatmap categories. RESULTS The Klinrisk model achieved an AUC of 0.81 (95% confidence interval [CI] 0.78-0.83) at 1 year, and 0.88 (95% CI 0.86-0.89) at 3 years. The Brier scores were 0.020 (0.018-0.022) and 0.056 (0.052-0.059) at 1 and 3 years, respectively. Compared with the KDIGO heatmap, the Klinrisk model had improved performance at every interval (P < .01). CONCLUSIONS The Klinrisk machine learning model, using routinely collected laboratory data, was highly accurate in its prediction of CKD progression in the CANVAS/CREDENCE trials. Integration of the model in electronic medical records or laboratory information systems can facilitate risk-based care.
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Affiliation(s)
- Navdeep Tangri
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Thomas W Ferguson
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Ryan J Bamforth
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
| | - Silvia J Leon
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
| | - Clare Arnott
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Sradha Kotwal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Nephrology, Prince of Wales Hospital, Sydney, Australia
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Robert A Fletcher
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Brendon L Neuen
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia
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2
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Stefanopoulos S, Qiu Q, Ren G, Ahmed A, Osman M, Brunicardi FC, Nazzal M. A Machine Learning Model for Prediction of Amputation in Diabetics. J Diabetes Sci Technol 2024; 18:874-881. [PMID: 36476059 PMCID: PMC11307232 DOI: 10.1177/19322968221142899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diabetic foot ulcer (DFU) and the resulting lower extremity amputation are associated with a poor survival prognosis. The objective of this study is to generate a model for predicting the probability of major amputation in hospitalized patients with DFU. METHODS The National Inpatient Sample (NIS) database from 2008 to 2014 was used to select patients with DFU, who were then further divided by major amputation status. International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) and Agency for Healthcare Research and Quality (AHRQ) comorbidity codes were used to compare patient characteristics. For the descriptive statistics, the Student t test, the χ2 test, and the Spearman correlation were utilized. The five most predictive variables were identified. A decision tree model (CTREE) based on conditional inference framework algorithm and a random forest model were used to develop the algorithm. RESULTS A total of 326 853 inpatients with DFU were identified, and 5.9% underwent major amputation. The top five contributory variables (all with P < .001) were gangrene (odds ratio [OR] = 11.8, 95% confidence interval [CI] = 11.5-12.2), peripheral vascular disease (OR = 2.9, 95% CI = 2.8-3.0), weight loss (OR = 2.6, 95% CI = 2.5-2.8), systemic infection (OR = 2.5, 95% CI = 2.4-2.53), and osteomyelitis (OR = 1.7, 95% CI = 1.6-1.73). The model performance of the training data was 77.7% (76.1% sensitivity and 79.3% specificity) and of the testing data was 77.8% (76.2% sensitivity and 79.4% specificity). The model was further validated with boosting and random forest models which demonstrated similar performance and area under the curve (AUC) (0.84, 95% CI = 0.83-0.85). CONCLUSION Utilizing machine learning methods, we have developed a clinical algorithm that predicts the risk of major lower extremity amputation for inpatients with diabetes with 77.8% accuracy.
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Affiliation(s)
- Stavros Stefanopoulos
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Qiong Qiu
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Gang Ren
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Ayman Ahmed
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Mohamed Osman
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - F. Charles Brunicardi
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Munier Nazzal
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
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Gulla A, Jakiunaite I, Juchneviciute I, Dzemyda G. A narrative review: predicting liver transplant graft survival using artificial intelligence modeling. FRONTIERS IN TRANSPLANTATION 2024; 3:1378378. [PMID: 38993758 PMCID: PMC11235265 DOI: 10.3389/frtra.2024.1378378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/22/2024] [Indexed: 07/13/2024]
Abstract
Liver transplantation is the only treatment for patients with liver failure. As demand for liver transplantation grows, it remains a challenge to predict the short- and long-term survival of the liver graft. Recently, artificial intelligence models have been used to evaluate the short- and long-term survival of the liver transplant. To make the models more accurate, suitable liver transplantation characteristics must be used as input to train them. In this narrative review, we reviewed studies concerning liver transplantations published in the PubMed, Web of Science, and Cochrane databases between 2017 and 2022. We picked out 17 studies using our selection criteria and analyzed them, evaluating which medical characteristics were used as input for creation of artificial intelligence models. In eight studies, models estimating only short-term liver graft survival were created, while in five of the studies, models for the prediction of only long-term liver graft survival were built. In four of the studies, artificial intelligence algorithms evaluating both the short- and long-term liver graft survival were created. Medical characteristics that were used as input in reviewed studies and had the biggest impact on the accuracy of the model were the recipient's age, recipient's body mass index, creatinine levels in the recipient's serum, recipient's international normalized ratio, diabetes mellitus, and recipient's model of end-stage liver disease score. To conclude, in order to define important liver transplantation characteristics that could be used as an input for artificial intelligence algorithms when predicting liver graft survival, more models need to be created and analyzed, in order to fully support the results of this review.
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Affiliation(s)
- Aiste Gulla
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Ivona Juchneviciute
- Faculty of Mathematics and Informatics, Institute of Data Science and Digital Technologies, Vilnius University, Vilnius, Lithuania
| | - Gintautas Dzemyda
- Faculty of Mathematics and Informatics, Institute of Data Science and Digital Technologies, Vilnius University, Vilnius, Lithuania
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Yanagawa R, Iwadoh K, Akabane M, Imaoka Y, Bozhilov KK, Melcher ML, Sasaki K. LightGBM outperforms other machine learning techniques in predicting graft failure after liver transplantation: Creation of a predictive model through large-scale analysis. Clin Transplant 2024; 38:e15316. [PMID: 38607291 DOI: 10.1111/ctr.15316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND The incidence of graft failure following liver transplantation (LTx) is consistent. While traditional risk scores for LTx have limited accuracy, the potential of machine learning (ML) in this area remains uncertain, despite its promise in other transplant domains. This study aims to determine ML's predictive limitations in LTx by replicating methods used in previous heart transplant research. METHODS This study utilized the UNOS STAR database, selecting 64,384 adult patients who underwent LTx between 2010 and 2020. Gradient boosting models (XGBoost and LightGBM) were used to predict 14, 30, and 90-day graft failure compared to conventional logistic regression model. Models were evaluated using both shuffled and rolling cross-validation (CV) methodologies. Model performance was assessed using the AUC across validation iterations. RESULTS In a study comparing predictive models for 14-day, 30-day and 90-day graft survival, LightGBM consistently outperformed other models, achieving the highest AUC of.740,.722, and.700 in shuffled CV methods. However, in rolling CV the accuracy of the model declined across every ML algorithm. The analysis revealed influential factors for graft survival prediction across all models, including total bilirubin, medical condition, recipient age, and donor AST, among others. Several features like donor age and recipient diabetes history were important in two out of three models. CONCLUSIONS LightGBM enhances short-term graft survival predictions post-LTx. However, due to changing medical practices and selection criteria, continuous model evaluation is essential. Future studies should focus on temporal variations, clinical implications, and ensure model transparency for broader medical utility.
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Affiliation(s)
| | - Kazuhiro Iwadoh
- Department of Transplant Surgery, Mita Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Miho Akabane
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Yuki Imaoka
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, California, USA
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kliment Krassimirov Bozhilov
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Marc L Melcher
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Kazunari Sasaki
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, California, USA
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5
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Chongo G, Soldera J. Use of machine learning models for the prognostication of liver transplantation: A systematic review. World J Transplant 2024; 14:88891. [PMID: 38576762 PMCID: PMC10989468 DOI: 10.5500/wjt.v14.i1.88891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/08/2023] [Accepted: 12/11/2023] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND Liver transplantation (LT) is a life-saving intervention for patients with end-stage liver disease. However, the equitable allocation of scarce donor organs remains a formidable challenge. Prognostic tools are pivotal in identifying the most suitable transplant candidates. Traditionally, scoring systems like the model for end-stage liver disease have been instrumental in this process. Nevertheless, the landscape of prognostication is undergoing a transformation with the integration of machine learning (ML) and artificial intelligence models. AIM To assess the utility of ML models in prognostication for LT, comparing their per formance and reliability to established traditional scoring systems. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a thorough and standardized literature search using the PubMed/MEDLINE database. Our search imposed no restrictions on publication year, age, or gender. Exclusion criteria encompassed non-English stu dies, review articles, case reports, conference papers, studies with missing data, or those exhibiting evident methodological flaws. RESULTS Our search yielded a total of 64 articles, with 23 meeting the inclusion criteria. Among the selected studies, 60.8% originated from the United States and China combined. Only one pediatric study met the criteria. Notably, 91% of the studies were published within the past five years. ML models consistently demonstrated satisfactory to excellent area under the receiver operating characteristic curve values (ranging from 0.6 to 1) across all studies, surpassing the performance of traditional scoring systems. Random forest exhibited superior predictive capa bilities for 90-d mortality following LT, sepsis, and acute kidney injury (AKI). In contrast, gradient boosting excelled in predicting the risk of graft-versus-host disease, pneumonia, and AKI. CONCLUSION This study underscores the potential of ML models in guiding decisions related to allograft allocation and LT, marking a significant evolution in the field of prognostication.
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Affiliation(s)
- Gidion Chongo
- Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
| | - Jonathan Soldera
- Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
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Al Moussawy M, Lakkis ZS, Ansari ZA, Cherukuri AR, Abou-Daya KI. The transformative potential of artificial intelligence in solid organ transplantation. FRONTIERS IN TRANSPLANTATION 2024; 3:1361491. [PMID: 38993779 PMCID: PMC11235281 DOI: 10.3389/frtra.2024.1361491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/01/2024] [Indexed: 07/13/2024]
Abstract
Solid organ transplantation confronts numerous challenges ranging from donor organ shortage to post-transplant complications. Here, we provide an overview of the latest attempts to address some of these challenges using artificial intelligence (AI). We delve into the application of machine learning in pretransplant evaluation, predicting transplant rejection, and post-operative patient outcomes. By providing a comprehensive overview of AI's current impact, this review aims to inform clinicians, researchers, and policy-makers about the transformative power of AI in enhancing solid organ transplantation and facilitating personalized medicine in transplant care.
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Affiliation(s)
- Mouhamad Al Moussawy
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Zoe S Lakkis
- Health Sciences Research Training Program, University of Pittsburgh, Pittsburgh, PA, United States
| | - Zuhayr A Ansari
- Health Sciences Research Training Program, University of Pittsburgh, Pittsburgh, PA, United States
| | - Aravind R Cherukuri
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Khodor I Abou-Daya
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, United States
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7
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Juneja D. Artificial intelligence: Applications in critical care gastroenterology. Artif Intell Gastrointest Endosc 2024; 5:89138. [DOI: 10.37126/aige.v5.i1.89138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 02/20/2024] Open
Abstract
Gastrointestinal (GI) complications frequently necessitate intensive care unit (ICU) admission. Additionally, critically ill patients also develop GI complications requiring further diagnostic and therapeutic interventions. However, these patients form a vulnerable group, who are at risk for developing side effects and complications. Every effort must be made to reduce invasiveness and ensure safety of interventions in ICU patients. Artificial intelligence (AI) is a rapidly evolving technology with several potential applications in healthcare settings. ICUs produce a large amount of data, which may be employed for creation of AI algorithms, and provide a lucrative opportunity for application of AI. However, the current role of AI in these patients remains limited due to lack of large-scale trials comparing the efficacy of AI with the accepted standards of care.
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Affiliation(s)
- Deven Juneja
- Department of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
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8
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Lu F, Meng Y, Song X, Li X, Liu Z, Gu C, Zheng X, Jing Y, Cai W, Pinyopornpanish K, Mancuso A, Romeiro FG, Méndez-Sánchez N, Qi X. Artificial Intelligence in Liver Diseases: Recent Advances. Adv Ther 2024; 41:967-990. [PMID: 38286960 DOI: 10.1007/s12325-024-02781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/03/2024] [Indexed: 01/31/2024]
Abstract
Liver diseases cause a significant burden on public health worldwide. In spite of great advances during recent years, there are still many challenges in the diagnosis and treatment of liver diseases. During recent years, artificial intelligence (AI) has been widely used for the diagnosis, risk stratification, and prognostic prediction of various diseases based on clinical datasets and medical images. Accumulative studies have shown its performance for diagnosing patients with nonalcoholic fatty liver disease and liver fibrosis and assessing their severity, and for predicting treatment response and recurrence of hepatocellular carcinoma, outcomes of liver transplantation recipients, and risk of drug-induced liver injury. Herein, we aim to comprehensively summarize the current evidence regarding diagnostic, prognostic, and/or therapeutic role of AI in these common liver diseases.
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Affiliation(s)
- Feifei Lu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
| | - Yao Meng
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, Dalian Medical University, Dalian, China
| | - Xiaoting Song
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, Dalian Medical University, Dalian, China
| | - Xiaotong Li
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Zhuang Liu
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Chunru Gu
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Xiaojie Zheng
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Yi Jing
- Neusoft Research of Intelligent Healthcare Technology, Co. Ltd., Shenyang, China
| | - Wei Cai
- Neusoft Research of Intelligent Healthcare Technology, Co. Ltd., Shenyang, China
| | - Kanokwan Pinyopornpanish
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Andrea Mancuso
- Medicina Interna 1, Azienda di Rilievo Nazionale Ad Alta Specializzazione Civico-Di Cristina-Benfratelli, Palermo, Italy.
| | | | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic and Foundation, National Autonomous University of Mexico, Mexico City, Mexico.
| | - Xingshun Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China.
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China.
- Postgraduate College, Dalian Medical University, Dalian, China.
- Postgraduate College, China Medical University, Shenyang, China.
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Watson CJ, Gaurav R, Butler AJ. Current Techniques and Indications for Machine Perfusion and Regional Perfusion in Deceased Donor Liver Transplantation. J Clin Exp Hepatol 2024; 14:101309. [PMID: 38274508 PMCID: PMC10806097 DOI: 10.1016/j.jceh.2023.101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/27/2023] [Indexed: 01/27/2024] Open
Abstract
Since the advent of University of Wisconsin preservation solution in the 1980s, clinicians have learned to work within its confines. While affording improved outcomes, considerable limitations still exist and contribute to the large number of livers that go unused each year, often for fear they may never work. The last 10 years have seen the widespread availability of new perfusion modalities which provide an opportunity for assessing organ viability and prolonged organ storage. This review will discuss the role of in situ normothermic regional perfusion for livers donated after circulatory death. It will also describe the different modalities of ex situ perfusion, both normothermic and hypothermic, and discuss how they are thought to work and the opportunities afforded by them.
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Affiliation(s)
- Christopher J.E. Watson
- University of Cambridge Department of Surgery, Box 210, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
- The Roy Calne Transplant Unit, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
| | - Rohit Gaurav
- The Roy Calne Transplant Unit, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
| | - Andrew J. Butler
- University of Cambridge Department of Surgery, Box 210, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
- The Roy Calne Transplant Unit, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
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10
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Al-Bahou R, Bruner J, Moore H, Zarrinpar A. Quantitative methods for optimizing patient outcomes in liver transplantation. Liver Transpl 2024; 30:311-320. [PMID: 38153309 DOI: 10.1097/lvt.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023]
Abstract
Liver transplantation (LT) is a lifesaving yet complex intervention with considerable challenges impacting graft and patient outcomes. Despite best practices, 5-year graft survival is only 70%. Sophisticated quantitative techniques offer potential solutions by assimilating multifaceted data into insights exceeding human cognition. Optimizing donor-recipient matching and graft allocation presents additional intricacies, involving the integration of clinical and laboratory data to select the ideal donor and recipient pair. Allocation must balance physiological variables with geographical and logistical constraints and timing. Quantitative methods can integrate these complex factors to optimize graft utilization. Such methods can also aid in personalizing treatment regimens, drawing on both pretransplant and posttransplant data, possibly using continuous immunological monitoring to enable early detection of graft injury or infected states. Advanced analytics is thus poised to transform management in LT, maximizing graft and patient survival. In this review, we describe quantitative methods applied to organ transplantation, with a focus on LT. These include quantitative methods for (1) utilizing and allocating donor organs equitably and optimally, (2) improving surgical planning through preoperative imaging, (3) monitoring graft and immune status, (4) determining immunosuppressant doses, and (5) establishing and maintaining the health of graft and patient after LT.
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Affiliation(s)
- Raja Al-Bahou
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Julia Bruner
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Helen Moore
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ali Zarrinpar
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
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11
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Michelson AP, Oh I, Gupta A, Puri V, Kreisel D, Gelman AE, Nava R, Witt CA, Byers DE, Halverson L, Vazquez-Guillamet R, Payne PRO, Hachem RR. Developing machine learning models to predict primary graft dysfunction after lung transplantation. Am J Transplant 2024; 24:458-467. [PMID: 37468109 DOI: 10.1016/j.ajt.2023.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/21/2023]
Abstract
Primary graft dysfunction (PGD) is the leading cause of morbidity and mortality in the first 30 days after lung transplantation. Risk factors for the development of PGD include donor and recipient characteristics, but how multiple variables interact to impact the development of PGD and how clinicians should consider these in making decisions about donor acceptance remain unclear. This was a single-center retrospective cohort study to develop and evaluate machine learning pipelines to predict the development of PGD grade 3 within the first 72 hours of transplantation using donor and recipient variables that are known at the time of donor offer acceptance. Among 576 bilateral lung recipients, 173 (30%) developed PGD grade 3. The cohort underwent a 75% to 25% train-test split, and lasso regression was used to identify 11 variables for model development. A K-nearest neighbor's model showing the best calibration and performance with relatively small confidence intervals was selected as the final predictive model with an area under the receiver operating characteristics curve of 0.65. Machine learning models can predict the risk for development of PGD grade 3 based on data available at the time of donor offer acceptance. This may improve donor-recipient matching and donor utilization in the future.
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Affiliation(s)
- Andrew P Michelson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA; Institute for Informatics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Inez Oh
- Institute for Informatics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Aditi Gupta
- Institute for Informatics, Washington University School of Medicine, Saint Louis, Missouri, USA; Division of Biostatistics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Andrew E Gelman
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Ruben Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Chad A Witt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Derek E Byers
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Laura Halverson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Rodrigo Vazquez-Guillamet
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Philip R O Payne
- Institute for Informatics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Ramsey R Hachem
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA.
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12
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Luo X, Tahabi FM, Rollins DM, Sawchuk AP. Predicting future occlusion or stenosis of lower extremity bypass grafts using artificial intelligence to simultaneously analyze all flow velocities collected in current and previous ultrasound examinations. JVS Vasc Sci 2024; 5:100192. [PMID: 38455094 PMCID: PMC10918260 DOI: 10.1016/j.jvssci.2024.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/26/2023] [Indexed: 03/09/2024] Open
Abstract
Objective Routine surveillance with duplex ultrasound (DUS) examination is recommended after femoral-popliteal and femoral-tibial-pedal vein bypass grafts with various intervals postoperatively. The presently used methodology to analyze bypass graft DUS examination does not use all the available data and has been shown to have a significant rate for missing impending bypass graft failure. The objective of this research is to investigate recurrent neural networks (RNNs) to predict future bypass graft occlusion or stenosis. Methods This study includes DUS examinations of 663 patients who had bypass graft operations done between January 2009 and June 2022. Only examinations without missing values were included. We developed two RNNs (a bidirectional long short-term memory unit and a bidirectional gated recurrent unit) to predict bypass graft occlusion and stenosis based on peak systolic velocities collected in the 2 to 5 previous DUS examinations. We excluded the examinations with missing values and split our data into training and test sets. Then, we applied 10-fold cross-validation on training to optimize the hyperparameters and compared models using the test data. Results The bidirectional long short-term memory unit model can gain an overall sensitivity of 0.939, specificity of 0.963, and area under the curve of 0.950 on the prediction of bypass graft occlusion, and an overall sensitivity of 0.915, specificity of 0.909, and area under the curve of 0.912 predicting the development of a future critical stenosis. The results on different bypass types show that the system performs differently on different types. The results on subcohorts based on gender, smoking status, and comorbidities show that the performance on current smokers is lower than the never smoker. Conclusions We found that RNNs can gain good sensitivity, specificity, and accuracy for the detection of impending bypass graft occlusion or the future development of a critical bypass graft stenosis using all the available peak systolic velocity data in the present and previous bypass graft DUS examinations. Integrating clinical data, including demographics, social determinants, medication, and other risk factors, together with the DUS examination may result in further improvements. Clinical Relevance Detecting bypass graft failure before it occurs is important clinically to prevent amputations, salvage limbs, and save lives. Current methods evaluating screening duplex ultrasound examinations have a significant failure rate for detecting a bypass graft at risk for failure. Artificial intelligence using recurrent neural networks has the potential to improve the detection of at-risk bypass graft before they fail. Additionally, artificial intelligence is in the news and is being applied to many fields. Vascular surgeons need to know its potential to improve vascular outcomes.
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Affiliation(s)
- Xiao Luo
- School of Engineering and Technology, Indiana University Purdue University at Indianapolis, Indianapolis, IN
| | - Fattah Muhammad Tahabi
- School of Engineering and Technology, Indiana University Purdue University at Indianapolis, Indianapolis, IN
| | | | - Alan P. Sawchuk
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
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13
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Ding S, Tan Q, Chang CY, Zou N, Zhang K, Hoot NR, Jiang X, Hu X. Multi-Task Learning for Post-transplant Cause of Death Analysis: A Case Study on Liver Transplant. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:913-922. [PMID: 38222347 PMCID: PMC10785876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Organ transplant is the essential treatment method for some end-stage diseases, such as liver failure. Analyzing the post-transplant cause of death (CoD) after organ transplant provides a powerful tool for clinical decision making, including personalized treatment and organ allocation. However, traditional methods like Model for End-stage Liver Disease (MELD) score and conventional machine learning (ML) methods are limited in CoD analysis due to two major data and model-related challenges. To address this, we propose a novel framework called CoD-MTL leveraging multi-task learning to model the semantic relationships between various CoD prediction tasks jointly. Specifically, we develop a novel tree distillation strategy for multi-task learning, which combines the strength of both the tree model and multi-task learning. Experimental results are presented to show the precise and reliable CoD predictions of our framework. A case study is conducted to demonstrate the clinical importance of our method in the liver transplant.
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Affiliation(s)
- Sirui Ding
- Texas A&M University, College station, TX, USA
| | - Qiaoyu Tan
- Texas A&M University, College station, TX, USA
| | | | - Na Zou
- Texas A&M University, College station, TX, USA
| | - Kai Zhang
- University of Texas Health Science Center, Houston, TX, USA
| | - Nathan R Hoot
- McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Xiaoqian Jiang
- University of Texas Health Science Center, Houston, TX, USA
| | - Xia Hu
- Rice University, Houston, TX, USA
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14
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Li C, Jiang X, Zhang K. A transformer-based deep learning approach for fairly predicting post-liver transplant risk factors. J Biomed Inform 2024; 149:104545. [PMID: 37992791 DOI: 10.1016/j.jbi.2023.104545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/11/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
Liver transplantation is a life-saving procedure for patients with end-stage liver disease. There are two main challenges in liver transplant: finding the best matching patient for a donor and ensuring transplant equity among different subpopulations. The current MELD scoring system evaluates a patient's mortality risk if not receiving an organ within 90 days. However, the donor-patient matching should also consider post-transplant risk factors, such as cardiovascular disease, chronic rejection, etc., which are all common complications after transplant. Accurate prediction of these risk scores remains a significant challenge. In this study, we used predictive models to solve the above challenges. Specifically, we proposed a deep learning model to predict multiple risk factors after a liver transplant. By formulating it as a multi-task learning problem, the proposed deep neural network was trained to simultaneously predict the five post-transplant risks and achieve equal good performance by exploiting task-balancing techniques. We also proposed a novel fairness-achieving algorithm to ensure prediction fairness across different subpopulations. We used electronic health records of 160,360 liver transplant patients, including demographic information, clinical variables, and laboratory values, collected from the liver transplant records of the United States from 1987 to 2018. The model's performance was evaluated using various performance metrics such as AUROC and AUPRC. Our experiment results highlighted the success of our multi-task model in achieving task balance while maintaining accuracy. The model significantly reduced the task discrepancy by 39 %. Further application of the fairness-achieving algorithm substantially reduced fairness disparity among all sensitive attributes (gender, age group, and race/ethnicity) in each risk factor. It underlined the potency of integrating fairness considerations into the task-balancing framework, ensuring robust and fair predictions across multiple tasks and diverse demographic groups.
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Affiliation(s)
- Can Li
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xiaoqian Jiang
- Department of Health Data Science and Artificial Intelligence, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kai Zhang
- Department of Health Data Science and Artificial Intelligence, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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15
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Ge J, Digitale JC, Fenton C, McCulloch CE, Lai JC, Pletcher MJ, Gennatas ED. Predicting post-liver transplant outcomes in patients with acute-on-chronic liver failure using Expert-Augmented Machine Learning. Am J Transplant 2023; 23:1908-1921. [PMID: 37652176 PMCID: PMC11018271 DOI: 10.1016/j.ajt.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/04/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023]
Abstract
Liver transplantation (LT) is a treatment for acute-on-chronic liver failure (ACLF), but high post-LT mortality has been reported. Existing post-LT models in ACLF have been limited. We developed an Expert-Augmented Machine Learning (EAML) model to predict post-LT outcomes. We identified ACLF patients who underwent LT in the University of California Health Data Warehouse. We applied the RuleFit machine learning (ML) algorithm to extract rules from decision trees and create intermediate models. We asked human experts to rate the rules generated by RuleFit and incorporated these ratings to generate final EAML models. We identified 1384 ACLF patients. For death at 1 year, areas under the receiver-operating characteristic curve were 0.707 (confidence interval [CI] 0.625-0.793) for EAML and 0.719 (CI 0.640-0.800) for RuleFit. For death at 90 days, areas under the receiver-operating characteristic curve were 0.678 (CI 0.581-0.776) for EAML and 0.707 (CI 0.615-0.800) for RuleFit. In pairwise comparisons, both EAML and RuleFit models outperformed cross-sectional models. Significant discrepancies between experts and ML occurred in rankings of biomarkers used in clinical practice. EAML may serve as a method for ML-guided hypothesis generation in further ACLF research.
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Affiliation(s)
- Jin Ge
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA.
| | - Jean C Digitale
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
| | - Cynthia Fenton
- Division of Hospital Medicine, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
| | - Jennifer C Lai
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
| | - Efstathios D Gennatas
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
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16
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Drezga-Kleiminger M, Demaree-Cotton J, Koplin J, Savulescu J, Wilkinson D. Should AI allocate livers for transplant? Public attitudes and ethical considerations. BMC Med Ethics 2023; 24:102. [PMID: 38012660 PMCID: PMC10683249 DOI: 10.1186/s12910-023-00983-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Allocation of scarce organs for transplantation is ethically challenging. Artificial intelligence (AI) has been proposed to assist in liver allocation, however the ethics of this remains unexplored and the view of the public unknown. The aim of this paper was to assess public attitudes on whether AI should be used in liver allocation and how it should be implemented. METHODS We first introduce some potential ethical issues concerning AI in liver allocation, before analysing a pilot survey including online responses from 172 UK laypeople, recruited through Prolific Academic. FINDINGS Most participants found AI in liver allocation acceptable (69.2%) and would not be less likely to donate their organs if AI was used in allocation (72.7%). Respondents thought AI was more likely to be consistent and less biased compared to humans, although were concerned about the "dehumanisation of healthcare" and whether AI could consider important nuances in allocation decisions. Participants valued accuracy, impartiality, and consistency in a decision-maker, more than interpretability and empathy. Respondents were split on whether AI should be trained on previous decisions or programmed with specific objectives. Whether allocation decisions were made by transplant committee or AI, participants valued consideration of urgency, survival likelihood, life years gained, age, future medication compliance, quality of life, future alcohol use and past alcohol use. On the other hand, the majority thought the following factors were not relevant to prioritisation: past crime, future crime, future societal contribution, social disadvantage, and gender. CONCLUSIONS There are good reasons to use AI in liver allocation, and our sample of participants appeared to support its use. If confirmed, this support would give democratic legitimacy to the use of AI in this context and reduce the risk that donation rates could be affected negatively. Our findings on specific ethical concerns also identify potential expectations and reservations laypeople have regarding AI in this area, which can inform how AI in liver allocation could be best implemented.
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Affiliation(s)
- Max Drezga-Kleiminger
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, OX1 2JD, UK
| | - Joanna Demaree-Cotton
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, OX1 2JD, UK
| | - Julian Koplin
- Monash Bioethics Centre, Monash University, Melbourne, Australia
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, OX1 2JD, UK
- Murdoch Children's Research Institute, Melbourne, Australia
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dominic Wilkinson
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, OX1 2JD, UK.
- Murdoch Children's Research Institute, Melbourne, Australia.
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- John Radcliffe Hospital, Oxford, UK.
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17
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Sharma P, Arora A. Basic Understanding of Liver Transplant Immunology. J Clin Exp Hepatol 2023; 13:1091-1102. [PMID: 37975047 PMCID: PMC10643508 DOI: 10.1016/j.jceh.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/14/2023] [Indexed: 11/19/2023] Open
Abstract
The liver is a specialized organ and plays an important role in our immune system. The liver constitutes parenchymal cells which are hepatocytes and cholangiocytes (60-80%) and non-parenchymal cells like liver sinusoidal endothelial cells (LSECs), hepatic satellite/Ito cells, Kupffer cells, neutrophils, mononuclear cells, T and B lymphocytes (conventional and non-conventional), natural killer cells, and natural killer T (NKT) cells. The liver mounts a rapid and strong immune response, under unfavorable conditions and acts as an immune tolerance to a variety of non-pathogenic antigens. This delicate and dynamic interaction between different kinds of immune cells in the liver maintains a balance between immune screening and immune tolerance. The liver allografts are privileged immunologically; however, allograft rejection is not uncommon and is classified as cell or antibody-mediated. Advancements in transplant immunology help in the prevention of allografts rejection by immune reactions of the host thus leading to better graft and host survival. Fewer patients may not require immunosuppression due to systemic donor-specific T-cell tolerance. The liver tolerance mechanism is poorly studied, and LSEC and unconventional lymphocytes play an important role that dampens T cell response either by inducing apoptosis of cells or inhibiting co-stimulatory pathways. Newer cell-based therapy based on Treg, dendritic cells, and mesenchymal stromal cells will probably change the future of immunosuppression. Various invasive and non-invasive biomarkers and artificial intelligence have also been investigated to predict graft survival, post-transplant complications, and immunotolerance in the future.
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Affiliation(s)
- Praveen Sharma
- Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Arora
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi, India
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18
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Schattenberg JM, Chalasani N, Alkhouri N. Artificial Intelligence Applications in Hepatology. Clin Gastroenterol Hepatol 2023; 21:2015-2025. [PMID: 37088460 DOI: 10.1016/j.cgh.2023.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 03/16/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
Over the past 2 decades, the field of hepatology has witnessed major developments in diagnostic tools, prognostic models, and treatment options making it one of the most complex medical subspecialties. Through artificial intelligence (AI) and machine learning, computers are now able to learn from complex and diverse clinical datasets to solve real-world medical problems with performance that surpasses that of physicians in certain areas. AI algorithms are currently being implemented in liver imaging, interpretation of liver histopathology, noninvasive tests, prediction models, and more. In this review, we provide a summary of the state of AI in hepatology and discuss current challenges for large-scale implementation including some ethical aspects. We emphasize to the readers that most AI-based algorithms that are discussed in this review are still considered in early development and their utility and impact on patient outcomes still need to be assessed in future large-scale and inclusive studies. Our vision is that the use of AI in hepatology will enhance physician performance, decrease the burden and time spent on documentation, and reestablish the personalized patient-physician relationship that is of utmost importance for obtaining good outcomes.
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Affiliation(s)
- Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Center Mainz, Mainz, Germany
| | - Naga Chalasani
- Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana
| | - Naim Alkhouri
- Arizona Liver Health and University of Arizona, Tucson, Arizona.
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19
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Feldman K, Baraboo J, Dinakarpandian D, Chan SS. Machine Learning Algorithm Improves the Prediction of Transplant Hepatic Artery Stenosis or Occlusion: A Single-Center Study. Ultrasound Q 2023; 39:86-94. [PMID: 36103456 DOI: 10.1097/ruq.0000000000000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The aim of this study was to determine if machine learning can improve the specificity of detecting transplant hepatic artery pathology over conventional quantitative measures while maintaining a high sensitivity.This study presents a retrospective review of 129 patients with transplanted hepatic arteries. We illustrate how beyond common clinical metrics such as stenosis and resistive index, a more comprehensive set of waveform data (including flow half-lives and Fourier transformed waveforms) can be integrated into machine learning models to obtain more accurate screening of stenosis and occlusion. We present a novel framework of Extremely Randomized Trees and Shapley values, we allow for explainability at the individual level.The proposed framework identified cases of clinically significant stenosis and occlusion in hepatic arteries with a state-of-the-art specificity of 65%, while maintaining sensitivity at the current standard of 94%. Moreover, through 3 case studies of correct and mispredictions, we demonstrate examples of how specific features can be elucidated to aid in interpreting driving factors in a prediction.This work demonstrated that by utilizing a more complete set of waveform data and machine learning methodologies, it is possible to reduce the rate of false-positive results in using ultrasounds to screen for transplant hepatic artery pathology compared with conventional quantitative measures. An advantage of such techniques is explainability measures at the patient level, which allow for increased radiologists' confidence in the predictions.
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Affiliation(s)
| | - Justin Baraboo
- Department of Biomedical Engineering, Northwestern University, Chicago, IL
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20
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Bhat M, Rabindranath M, Chara BS, Simonetto DA. Artificial intelligence, machine learning, and deep learning in liver transplantation. J Hepatol 2023; 78:1216-1233. [PMID: 37208107 DOI: 10.1016/j.jhep.2023.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 05/21/2023]
Abstract
Liver transplantation (LT) is a life-saving treatment for individuals with end-stage liver disease. The management of LT recipients is complex, predominantly because of the need to consider demographic, clinical, laboratory, pathology, imaging, and omics data in the development of an appropriate treatment plan. Current methods to collate clinical information are susceptible to some degree of subjectivity; thus, clinical decision-making in LT could benefit from the data-driven approach offered by artificial intelligence (AI). Machine learning and deep learning could be applied in both the pre- and post-LT settings. Some examples of AI applications pre-transplant include optimising transplant candidacy decision-making and donor-recipient matching to reduce waitlist mortality and improve post-transplant outcomes. In the post-LT setting, AI could help guide the management of LT recipients, particularly by predicting patient and graft survival, along with identifying risk factors for disease recurrence and other associated complications. Although AI shows promise in medicine, there are limitations to its clinical deployment which include dataset imbalances for model training, data privacy issues, and a lack of available research practices to benchmark model performance in the real world. Overall, AI tools have the potential to enhance personalised clinical decision-making, especially in the context of liver transplant medicine.
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Affiliation(s)
- Mamatha Bhat
- Ajmera Transplant Program, University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Madhumitha Rabindranath
- Ajmera Transplant Program, University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Beatriz Sordi Chara
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas A Simonetto
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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21
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Rogers MP, Janjua HM, Read M, Cios K, Kundu MG, Pietrobon R, Kuo PC. Recipient Survival after Orthotopic Liver Transplantation: Interpretable Machine Learning Survival Tree Algorithm for Patient-Specific Outcomes. J Am Coll Surg 2023; 236:563-572. [PMID: 36728472 DOI: 10.1097/xcs.0000000000000545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Elucidating contributors affecting liver transplant survival is paramount. Current methods offer crude global group outcomes. To refine patient-specific mortality probability estimation and to determine covariate interaction using recipient and donor data, we generated a survival tree algorithm, Recipient Survival After Orthotopic Liver Transplantation (ReSOLT), using United Network Organ Sharing (UNOS) transplant data. STUDY DESIGN The UNOS database was queried for liver transplants in patients ≥18 years old between 2000 and 2021. Preoperative factors were evaluated with stepwise logistic regression; 43 significant factors were used in survival tree modeling. Graft survival of <7 days was excluded. The data were split into training and testing sets and further validated with 10-fold cross-validation. Survival tree pruning and model selection was achieved based on Akaike information criterion and log-likelihood values. Log-rank pairwise comparisons between subgroups and estimated survival probabilities were calculated. RESULTS A total of 122,134 liver transplant patients were included for modeling. Multivariable logistic regression (area under the curve = 0.742, F1 = 0.822) and survival tree modeling returned 8 significant recipient survival factors: recipient age, donor age, recipient primary payment, recipient hepatitis C status, recipient diabetes, recipient functional status at registration and at transplantation, and deceased donor pulmonary infection. Twenty subgroups consisting of combinations of these factors were identified with distinct Kaplan-Meier survival curves (p < 0.001 among all by log rank test) with 5- and 10-year survival probabilities. CONCLUSIONS Survival trees are a flexible and effective approach to understand the effects and interactions of covariates on survival. Individualized survival probability following liver transplant is possible with ReSOLT, allowing for more coherent patient and family counseling and prediction of patient outcome using both recipient and donor factors.
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Affiliation(s)
- Michael P Rogers
- From the OnetoMAP Analytics, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL (Rogers, Janjua, Read, Cios, Kuo)
| | - Haroon M Janjua
- From the OnetoMAP Analytics, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL (Rogers, Janjua, Read, Cios, Kuo)
| | - Meagan Read
- From the OnetoMAP Analytics, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL (Rogers, Janjua, Read, Cios, Kuo)
| | - Konrad Cios
- From the OnetoMAP Analytics, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL (Rogers, Janjua, Read, Cios, Kuo)
| | | | | | - Paul C Kuo
- From the OnetoMAP Analytics, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL (Rogers, Janjua, Read, Cios, Kuo)
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22
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Gary PJ, Lal A, Simonetto DA, Gajic O, Gallo de Moraes A. Acute on chronic liver failure: prognostic models and artificial intelligence applications. Hepatol Commun 2023; 7:02009842-202304010-00015. [PMID: 36972378 PMCID: PMC10043584 DOI: 10.1097/hc9.0000000000000095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/04/2023] [Indexed: 03/29/2023] Open
Abstract
Critically ill patients presenting with acute on chronic liver failure (ACLF) represent a particularly vulnerable population due to various considerations surrounding the syndrome definition, lack of robust prospective evaluation of outcomes, and allocation of resources such as organs for transplantation. Ninety-day mortality related to ACLF is high and patients who do leave the hospital are frequently readmitted. Artificial intelligence (AI), which encompasses various classical and modern machine learning techniques, natural language processing, and other methods of predictive, prognostic, probabilistic, and simulation modeling, has emerged as an effective tool in various areas of healthcare. These methods are now being leveraged to potentially minimize physician and provider cognitive load and impact both short-term and long-term patient outcomes. However, the enthusiasm is tempered by ethical considerations and a current lack of proven benefits. In addition to prognostic applications, AI models can likely help improve the understanding of various mechanisms of morbidity and mortality in ACLF. Their overall impact on patient-centered outcomes and countless other aspects of patient care remains unclear. In this review, we discuss various AI approaches being utilized in healthcare and discuss the recent and expected future impact of AI on patients with ACLF through prognostic modeling and AI-based approaches.
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Affiliation(s)
- Phillip J Gary
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Multidisciplinary Epidemiology and Translational Research in Intensive Care Group, Mayo Clinic, Rochester, Minnesota, USA
| | - Amos Lal
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Multidisciplinary Epidemiology and Translational Research in Intensive Care Group, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas A Simonetto
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Multidisciplinary Epidemiology and Translational Research in Intensive Care Group, Mayo Clinic, Rochester, Minnesota, USA
| | - Alice Gallo de Moraes
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Multidisciplinary Epidemiology and Translational Research in Intensive Care Group, Mayo Clinic, Rochester, Minnesota, USA
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23
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Artificial Intelligence-The Rising Star in the Field of Gastroenterology and Hepatology. Diagnostics (Basel) 2023; 13:diagnostics13040662. [PMID: 36832150 PMCID: PMC9955763 DOI: 10.3390/diagnostics13040662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Artificial intelligence (AI) is a term that covers a multitude of techniques that are used in a manner that tries to reproduce human intelligence. AI is helpful in various medical specialties that use imaging for diagnostic purposes, and gastroenterology is no exception. In this field, AI has several applications, such as detecting and classifying polyps, detecting the malignancy in polyps, diagnosing Helicobacter pylori infection, gastritis, inflammatory bowel disease, gastric cancer, esophageal neoplasia, and pancreatic and hepatic lesions. The aim of this mini-review is to analyze the currently available studies regarding AI in the field of gastroenterology and hepatology and to discuss its main applications as well as its main limitations.
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24
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Chung YH, Jung J, Kim SH. Mortality scoring systems for liver transplant recipients: before and after model for end-stage liver disease score. Anesth Pain Med (Seoul) 2023; 18:21-28. [PMID: 36746898 PMCID: PMC9902634 DOI: 10.17085/apm.22258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/13/2023] [Indexed: 02/01/2023] Open
Abstract
The mortality scoring systems for patients with end-stage liver disease have evolved from the Child-Turcotte-Pugh score to the model for end-stage liver disease (MELD) score, affecting the wait list for liver allocation. There are inherent weaknesses in the MELD score, with the gradual decline in its accuracy owing to changes in patient demographics or treatment options. Continuous refinement of the MELD score is in progress; however, both advantages and disadvantages exist. Recently, attempts have been made to introduce artificial intelligence into mortality prediction; however, many challenges must still be overcome. More research is needed to improve the accuracy of mortality prediction in liver transplant recipients.
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Affiliation(s)
| | | | - Sang Hyun Kim
- Corresponding Author: Sang Hyun Kim, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea Tel: 82-32-621-5328 Fax: 82-32-621-5322 E-mail:
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Ivanics T, So D, Claasen MPAW, Wallace D, Patel MS, Gravely A, Choi WJ, Shwaartz C, Walker K, Erdman L, Sapisochin G. Machine learning-based mortality prediction models using national liver transplantation registries are feasible but have limited utility across countries. Am J Transplant 2023; 23:64-71. [PMID: 36695623 DOI: 10.1016/j.ajt.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/04/2022] [Accepted: 10/14/2022] [Indexed: 01/13/2023]
Abstract
Many countries curate national registries of liver transplant (LT) data. These registries are often used to generate predictive models; however, potential performance and transferability of these models remain unclear. We used data from 3 national registries and developed machine learning algorithm (MLA)-based models to predict 90-day post-LT mortality within and across countries. Predictive performance and external validity of each model were assessed. Prospectively collected data of adult patients (aged ≥18 years) who underwent primary LTs between January 2008 and December 2018 from the Canadian Organ Replacement Registry (Canada), National Health Service Blood and Transplantation (United Kingdom), and United Network for Organ Sharing (United States) were used to develop MLA models to predict 90-day post-LT mortality. Models were developed using each registry individually (based on variables inherent to the individual databases) and using all 3 registries combined (variables in common between the registries [harmonized]). The model performance was evaluated using area under the receiver operating characteristic (AUROC) curve. The number of patients included was as follows: Canada, n = 1214; the United Kingdom, n = 5287; and the United States, n = 59,558. The best performing MLA-based model was ridge regression across both individual registries and harmonized data sets. Model performance diminished from individualized to the harmonized registries, especially in Canada (individualized ridge: AUROC, 0.74; range, 0.73-0.74; harmonized: AUROC, 0.68; range, 0.50-0.73) and US (individualized ridge: AUROC, 0.71; range, 0.70-0.71; harmonized: AUROC, 0.66; range, 0.66-0.66) data sets. External model performance across countries was poor overall. MLA-based models yield a fair discriminatory potential when used within individual databases. However, the external validity of these models is poor when applied across countries. Standardization of registry-based variables could facilitate the added value of MLA-based models in informing decision making in future LTs.
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Affiliation(s)
- Tommy Ivanics
- Multi-Organ Transplant Program, University Health Network Toronto, Ontario, Canada; Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA; Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden
| | - Delvin So
- The Centre of Computational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marco P A W Claasen
- Multi-Organ Transplant Program, University Health Network Toronto, Ontario, Canada; Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - David Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine and Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Madhukar S Patel
- Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Annabel Gravely
- Multi-Organ Transplant Program, University Health Network Toronto, Ontario, Canada
| | - Woo Jin Choi
- Multi-Organ Transplant Program, University Health Network Toronto, Ontario, Canada
| | - Chaya Shwaartz
- Multi-Organ Transplant Program, University Health Network Toronto, Ontario, Canada
| | - Kate Walker
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lauren Erdman
- The Centre of Computational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gonzalo Sapisochin
- Multi-Organ Transplant Program, University Health Network Toronto, Ontario, Canada.
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Predicting graft failure in pediatric liver transplantation based on early biomarkers using machine learning models. Sci Rep 2022; 12:22411. [PMID: 36575218 PMCID: PMC9794703 DOI: 10.1038/s41598-022-25900-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/06/2022] [Indexed: 12/28/2022] Open
Abstract
The early detection of graft failure in pediatric liver transplantation is crucial for appropriate intervention. Graft failure is associated with numerous perioperative risk factors. This study aimed to develop an individualized predictive model for 90-days graft failure in pediatric liver transplantation using machine learning methods. We conducted a single-center retrospective cohort study. A total of 87 liver transplantation cases performed in patients aged < 12 years at the Severance Hospital between January 2010 and September 2020 were included as data samples. Preoperative conditions of recipients and donors, intraoperative care, postoperative serial laboratory parameters, and events observed within seven days of surgery were collected as features. A least absolute shrinkage and selection operator (LASSO) -based method was used for feature selection to overcome the high dimensionality and collinearity of variables. Among 146 features, four variables were selected as the resultant features, namely, preoperative hepatic encephalopathy, sodium level at the end of surgery, hepatic artery thrombosis, and total bilirubin level on postoperative day 7. These features were selected from different times and represent distinct clinical aspects. The model with logistic regression demonstrated the best prediction performance among various machine learning methods tested (area under the receiver operating characteristic curve (AUROC) = 0.898 and area under the precision-recall curve (AUPR) = 0.882). The risk scoring system developed based on the logistic regression model showed an AUROC of 0.910 and an AUPR of 0.830. Together, the prediction of graft failure in pediatric liver transplantation using the proposed machine learning model exhibited superior discrimination power and, therefore, can provide valuable information to clinicians for their decision making during the postoperative management of the patients.
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Zhang X, Gavaldà R, Baixeries J. Interpretable prediction of mortality in liver transplant recipients based on machine learning. Comput Biol Med 2022; 151:106188. [PMID: 36306583 DOI: 10.1016/j.compbiomed.2022.106188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 09/24/2022] [Accepted: 10/08/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Accurate prediction of the mortality of post-liver transplantation is an important but challenging task. It relates to optimizing organ allocation and estimating the risk of possible dysfunction. Existing risk scoring models, such as the Balance of Risk (BAR) score and the Survival Outcomes Following Liver Transplantation (SOFT) score, do not predict the mortality of post-liver transplantation with sufficient accuracy. In this study, we evaluate the performance of machine learning models and establish an explainable machine learning model for predicting mortality in liver transplant recipients. METHOD The optimal feature set for the prediction of the mortality was selected by a wrapper method based on binary particle swarm optimization (BPSO). With the selected optimal feature set, seven machine learning models were applied to predict mortality over different time windows. The best-performing model was used to predict mortality through a comprehensive comparison and evaluation. An interpretable approach based on machine learning and SHapley Additive exPlanations (SHAP) is used to explicitly explain the model's decision and make new discoveries. RESULTS With regard to predictive power, our results demonstrated that the feature set selected by BPSO outperformed both the feature set in the existing risk score model (BAR score, SOFT score) and the feature set processed by principal component analysis (PCA). The best-performing model, extreme gradient boosting (XGBoost), was found to improve the Area Under a Curve (AUC) values for mortality prediction by 6.7%, 11.6%, and 17.4% at 3 months, 3 years, and 10 years, respectively, compared to the SOFT score. The main predictors of mortality and their impact were discussed for different age groups and different follow-up periods. CONCLUSIONS Our analysis demonstrates that XGBoost can be an ideal method to assess the mortality risk in liver transplantation. In combination with the SHAP approach, the proposed framework provides a more intuitive and comprehensive interpretation of the predictive model, thereby allowing the clinician to better understand the decision-making process of the model and the impact of factors associated with mortality risk in liver transplantation.
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Affiliation(s)
- Xiao Zhang
- Department of Computer Science, Universitat Politècnica de Catalunya, Barcelona, 08034, Spain.
| | | | - Jaume Baixeries
- Department of Computer Science, Universitat Politècnica de Catalunya, Barcelona, 08034, Spain
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Crossroads in Liver Transplantation: Is Artificial Intelligence the Key to Donor-Recipient Matching? MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121743. [PMID: 36556945 PMCID: PMC9783019 DOI: 10.3390/medicina58121743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022]
Abstract
Liver transplantation outcomes have improved in recent years. However, with the emergence of expanded donor criteria, tools to better assist donor-recipient matching have become necessary. Most of the currently proposed scores based on conventional biostatistics are not good classifiers of a problem that is considered "unbalanced." In recent years, the implementation of artificial intelligence in medicine has experienced exponential growth. Deep learning, a branch of artificial intelligence, may be the answer to this classification problem. The ability to handle a large number of variables with speed, objectivity, and multi-objective analysis is one of its advantages. Artificial neural networks and random forests have been the most widely used deep classifiers in this field. This review aims to give a brief overview of D-R matching and its evolution in recent years and how artificial intelligence may be able to provide a solution.
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Tonon M, Moreau R. Using machine learning for predicting outcomes in ACLF. Liver Int 2022; 42:2354-2355. [PMID: 36162084 DOI: 10.1111/liv.15399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Marta Tonon
- Unit of Internal Medicine and Hepatology, University Hospital of Padova, Padova, Italy
| | - Richard Moreau
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), Barcelona, Spain.,INSERM, Université de Paris Cité, Centre de Recherche sur l'Inflammation (CRI), Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), and Hôpital Beaujon, Service d'Hépatologie, Clichy, France
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Lung Transplantation Advanced Prediction Tool: Determining Recipient's Outcome for a Certain Donor. Transplantation 2022; 106:2019-2030. [PMID: 35389371 PMCID: PMC9521589 DOI: 10.1097/tp.0000000000004131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Many risk-prediction models for lung transplantation are centered on recipient characteristics and do not account for impact of donor and transplant-related factors or only examine short-term outcomes (eg, predicted 1-y survival). We sought to develop a comprehensive model guiding recipient-donor matching. METHODS We identified double lung transplant recipients (≥12 y old) in the United Network for Organ Sharing Registry (2005-2020) to develop a risk scoring tool. Cohort was divided into derivation and validation sets. A total of 42 recipient, donor, and transplant factors were included in the analysis. Lasso method was used for variable selection. Survival was estimated using Cox-proportional hazard models. An interactive web-based tool was developed for clinical use. RESULTS A derivation cohort (n = 10 660) informed the model with 13-recipient, 4-donor, and 2-transplant variables. Adjusted risk scores were computed for every transplant and grouped into 3 clusters. Model-estimated survival probabilities were similar to the observed in the validation cohort (n = 4464) for all clusters. The mortality increases for medium- and high-risk groups was similar in both derivation and validation cohorts (C statistics for 1-, 5-, and 10-y survival were 0.67, 0.64, and 0.72, respectively). The web-based application estimated 1-, 5-, 10-y survival and half-life for low- (92%, 73%, 52%; 10.5 y), medium- (89%, 62%, 38%; 7.3 y), and high-risk clusters (85%, 52%, 26%; 5.2 y). CONCLUSIONS Advanced methods incorporating machine/deep learning led to a risk scoring model (including recipient, donor, and transplant factors) and a web-based clinical tool providing short- and long-term survival probabilities for recipient-donor matches. This will enable risk-based matching that could improve utilization of and benefit from a limited donor pool.
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Radiomic analysis of liver grafts from brain-dead donors can predict early allograft dysfunction following transplantation: a proof-of-concept study. HPB (Oxford) 2022; 24:1527-1534. [PMID: 35382981 DOI: 10.1016/j.hpb.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Selection of liver grafts suitable for transplantation (LT) mainly depends on a surgeon's subjective assessment. This study aimed to investigate the role of radiomic analysis of donor-liver CTs after brain death (DBD) to predict the occurrence of early posttransplant allograft dysfunction (EAD). METHODS We retrospectively extracted and analyzed the left lobe radiomic features from CT scans of DBD livers in training and validation cohorts. Multivariate analysis was performed to identify predictors of EAD. RESULTS From 126 LTs included in the study in the training cohort, 27 (21.4%) had an EAD. For each patient, 279 radiomic features were extracted of which 5 were associated with EAD (AUC = 0.81) (95% CI 0.72-0.89). Among donor and recipient clinical characteristics, cardiac arrest, steatosis on donor's CT, cold ischemic time and age of recipient were also identified as independent risk factors for EAD. Combined radiomic signature and clinical risk factors showed a strong predictive performance for EAD with a C-index of 0.90 (95% CI 0.84-0.96). A validation cohort of 23 patients confirmed these results. CONCLUSION Radiomic signatures extracted from donor CT scan, independently or combined with clinical risk factors is an objective and accurate biomarker for prediction of EAD after LT.
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Yu YD, Lee KS, Man Kim J, Ryu JH, Lee JG, Lee KW, Kim BW, Kim DS. Artificial intelligence for predicting survival following deceased donor liver transplantation: Retrospective multi-center study. Int J Surg 2022; 105:106838. [PMID: 36028137 DOI: 10.1016/j.ijsu.2022.106838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/23/2022] [Accepted: 08/11/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous studies have indicated that the model for end-stage liver disease (MELD) score may fail to predict post-transplantation patient survival. Similarly, other scores (donor MELD score, balance of risk score) that have been developed to predict transplant outcomes have not gained widespread use. These scores are typically derived using linear statistical models. This study aimed to compare the performance of traditional statistical models with machine learning approaches for predicting survival following liver transplantation. MATERIALS AND METHODS Data were obtained from 785 deceased donor liver transplant recipients enrolled in the Korean Organ Transplant Registry (2014-2019). Five machine learning methods (random forest, artificial neural networks, decision tree, naïve Bayes, and support vector machine) and four traditional statistical models (Cox regression, MELD score, donor MELD score and balance of risk score) were compared to predict survival. RESULTS Among the machine learning methods, the random forest yielded the highest area under the receiver operating characteristic curve (AUC-ROC) values (1-month = 0.80; 3-month = 0.85; and 12-month = 0.81) for predicting survival. The AUC-ROC values of the Cox regression analysis were 0.75, 0.86, and 0.77 for 1-month, 3-month, and 12-month post-transplant survival, respectively. However, the AUC-ROC values of the MELD, donor MELD, and balance of risk scores were all below 0.70. Based on the variable importance of the random forest analysis in this study, the major predictors associated with survival were cold ischemia time, donor ICU stay, recipient weight, recipient BMI, recipient age, recipient INR, and recipient albumin level. As with the Cox regression analysis, donor ICU stay, donor bilirubin level, BAR score, and recipient albumin levels were also important factors associated with post-transplant survival in the RF model. The coefficients of these variables were also statistically significant in the Cox model (p < 0.05). The SHAP ranges for selected predictors for the 12-month survival were (-0.02,0.10) for recipient albumin, (-0.05,0.07) for donor bilirubin and (-0.02,0.25) for recipient height. Surprisingly, although not statistically significant in the Cox model, recipient weight, recipient BMI, recipient age, or recipient INR were important factors in our random forest model for predicting post-transplantation survival. CONCLUSION Machine learning algorithms such as the random forest were superior to conventional Cox regression and previously reported survival scores for predicting 1-month, 3-month, and 12-month survival following liver transplantation. Therefore, artificial intelligence may have significant potential in aiding clinical decision-making during liver transplantation, including matching donors and recipients.
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Affiliation(s)
- Young-Dong Yu
- Division of HBP Surgery & Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, South Korea.
| | - Kwang-Sig Lee
- AI Center, Korea University College of Medicine, Seoul, South Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Je Ho Ryu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Busan, South Korea
| | - Jae-Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Bong-Wan Kim
- Department of Liver Transplantation and Hepatobiliary Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Dong-Sik Kim
- Division of HBP Surgery & Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, South Korea.
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Briceño J, Calleja R, Hervás C. Artificial intelligence and liver transplantation: Looking for the best donor-recipient pairing. Hepatobiliary Pancreat Dis Int 2022; 21:347-353. [PMID: 35321836 DOI: 10.1016/j.hbpd.2022.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/28/2022] [Indexed: 02/07/2023]
Abstract
Decision-making based on artificial intelligence (AI) methodology is increasingly present in all areas of modern medicine. In recent years, models based on deep-learning have begun to be used in organ transplantation. Taking into account the huge number of factors and variables involved in donor-recipient (D-R) matching, AI models may be well suited to improve organ allocation. AI-based models should provide two solutions: complement decision-making with current metrics based on logistic regression and improve their predictability. Hundreds of classifiers could be used to address this problem. However, not all of them are really useful for D-R pairing. Basically, in the decision to assign a given donor to a candidate in waiting list, a multitude of variables are handled, including donor, recipient, logistic and perioperative variables. Of these last two, some of them can be inferred indirectly from the team's previous experience. Two groups of AI models have been used in the D-R matching: artificial neural networks (ANN) and random forest (RF). The former mimics the functional architecture of neurons, with input layers and output layers. The algorithms can be uni- or multi-objective. In general, ANNs can be used with large databases, where their generalizability is improved. However, they are models that are very sensitive to the quality of the databases and, in essence, they are black-box models in which all variables are important. Unfortunately, these models do not allow to know safely the weight of each variable. On the other hand, RF builds decision trees and works well with small cohorts. In addition, they can select top variables as with logistic regression. However, they are not useful with large databases, due to the extreme number of decision trees that they would generate, making them impractical. Both ANN and RF allow a successful donor allocation in over 80% of D-R pairing, a number much higher than that obtained with the best statistical metrics such as model for end-stage liver disease, balance of risk score, and survival outcomes following liver transplantation scores. Many barriers need to be overcome before these deep-learning-based models can be included for D-R matching. The main one of them is the resistance of the clinicians to leave their own decision to autonomous computational models.
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Affiliation(s)
- Javier Briceño
- Unit of Liver Transplantation, Department of General Surgery, Hospital Universitario Reina Sofía, Córdoba, Spain; Maimónides Institute of Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain.
| | - Rafael Calleja
- Unit of Liver Transplantation, Department of General Surgery, Hospital Universitario Reina Sofía, Córdoba, Spain; Maimónides Institute of Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain
| | - César Hervás
- Maimónides Institute of Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain; Department of Computer Sciences and Numerical Analysis, Universidad de Córdoba, Córdoba, Spain
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34
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Effah CY, Miao R, Drokow EK, Agboyibor C, Qiao R, Wu Y, Miao L, Wang Y. Machine learning-assisted prediction of pneumonia based on non-invasive measures. Front Public Health 2022; 10:938801. [PMID: 35968461 PMCID: PMC9371749 DOI: 10.3389/fpubh.2022.938801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Pneumonia is an infection of the lungs that is characterized by high morbidity and mortality. The use of machine learning systems to detect respiratory diseases via non-invasive measures such as physical and laboratory parameters is gaining momentum and has been proposed to decrease diagnostic uncertainty associated with bacterial pneumonia. Herein, this study conducted several experiments using eight machine learning models to predict pneumonia based on biomarkers, laboratory parameters, and physical features. Methods We perform machine-learning analysis on 535 different patients, each with 45 features. Data normalization to rescale all real-valued features was performed. Since it is a binary problem, we categorized each patient into one class at a time. We designed three experiments to evaluate the models: (1) feature selection techniques to select appropriate features for the models, (2) experiments on the imbalanced original dataset, and (3) experiments on the SMOTE data. We then compared eight machine learning models to evaluate their effectiveness in predicting pneumonia Results Biomarkers such as C-reactive protein and procalcitonin demonstrated the most significant discriminating power. Ensemble machine learning models such as RF (accuracy = 92.0%, precision = 91.3%, recall = 96.0%, f1-Score = 93.6%) and XGBoost (accuracy = 90.8%, precision = 92.6%, recall = 92.3%, f1-score = 92.4%) achieved the highest performance accuracy on the original dataset with AUCs of 0.96 and 0.97, respectively. On the SMOTE dataset, RF and XGBoost achieved the highest prediction results with f1-scores of 92.0 and 91.2%, respectively. Also, AUC of 0.97 was achieved for both RF and XGBoost models. Conclusions Our models showed that in the diagnosis of pneumonia, individual clinical history, laboratory indicators, and symptoms do not have adequate discriminatory power. We can also conclude that the ensemble ML models performed better in this study.
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Affiliation(s)
| | - Ruoqi Miao
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Emmanuel Kwateng Drokow
- Department of Radiation Oncology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Clement Agboyibor
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Ruiping Qiao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongjun Wu
- College of Public Health, Zhengzhou University, Zhengzhou, China
- *Correspondence: Yongjun Wu
| | - Lijun Miao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Lijun Miao
| | - Yanbin Wang
- Center of Health Management, General Hospital of Anyang Iron and Steel Group Co., Ltd, Anyang, China
- Yanbin Wang
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Gotlieb N, Azhie A, Sharma D, Spann A, Suo NJ, Tran J, Orchanian-Cheff A, Wang B, Goldenberg A, Chassé M, Cardinal H, Cohen JP, Lodi A, Dieude M, Bhat M. The promise of machine learning applications in solid organ transplantation. NPJ Digit Med 2022; 5:89. [PMID: 35817953 PMCID: PMC9273640 DOI: 10.1038/s41746-022-00637-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Solid-organ transplantation is a life-saving treatment for end-stage organ disease in highly selected patients. Alongside the tremendous progress in the last several decades, new challenges have emerged. The growing disparity between organ demand and supply requires optimal patient/donor selection and matching. Improvements in long-term graft and patient survival require data-driven diagnosis and management of post-transplant complications. The growing abundance of clinical, genetic, radiologic, and metabolic data in transplantation has led to increasing interest in applying machine-learning (ML) tools that can uncover hidden patterns in large datasets. ML algorithms have been applied in predictive modeling of waitlist mortality, donor–recipient matching, survival prediction, post-transplant complications diagnosis, and prediction, aiming to optimize immunosuppression and management. In this review, we provide insight into the various applications of ML in transplant medicine, why these were used to evaluate a specific clinical question, and the potential of ML to transform the care of transplant recipients. 36 articles were selected after a comprehensive search of the following databases: Ovid MEDLINE; Ovid MEDLINE Epub Ahead of Print and In-Process & Other Non-Indexed Citations; Ovid Embase; Cochrane Database of Systematic Reviews (Ovid); and Cochrane Central Register of Controlled Trials (Ovid). In summary, these studies showed that ML techniques hold great potential to improve the outcome of transplant recipients. Future work is required to improve the interpretability of these algorithms, ensure generalizability through larger-scale external validation, and establishment of infrastructure to permit clinical integration.
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Affiliation(s)
- Neta Gotlieb
- Ajmera Transplant Program, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Amirhossein Azhie
- Ajmera Transplant Program, University Health Network, Toronto, ON, Canada
| | - Divya Sharma
- Department of Gastroenterology, Toronto General Hospital Research Institute, Toronto, ON, Canada
| | - Ashley Spann
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nan-Ji Suo
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
| | - Jason Tran
- Ajmera Transplant Program, University Health Network, Toronto, ON, Canada
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Bo Wang
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - Anna Goldenberg
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - Michael Chassé
- Department of Medicine (Critical Care), University of Montreal Hospital, Montréal, QC, Canada.,Canadian Donation and Transplantation Research Program, Data and Innovation Expert Group, Toronto, ON, Canada
| | - Heloise Cardinal
- Canadian Donation and Transplantation Research Program, Data and Innovation Expert Group, Toronto, ON, Canada.,Centre hospitalier de l'Université de Montréal Research Center, Université de Montréal, Montréal, QC, Canada
| | - Joseph Paul Cohen
- Canadian Donation and Transplantation Research Program, Data and Innovation Expert Group, Toronto, ON, Canada.,Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Stanford, CA, USA.,Mila, Quebec Artificial Intelligence Institute, Montréal, QC, Canada
| | - Andrea Lodi
- Canadian Donation and Transplantation Research Program, Data and Innovation Expert Group, Toronto, ON, Canada.,Canada Excellence Research Chair, Polytechnique Montréal, Montréal, QC, Canada
| | - Melanie Dieude
- Canadian Donation and Transplantation Research Program, Data and Innovation Expert Group, Toronto, ON, Canada.,Centre hospitalier de l'Université de Montréal Research Center, Université de Montréal, Montréal, QC, Canada.,Department Microbiology, Infectiology and Immunology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Héma-Québec, Montréal, QC, Canada
| | - Mamatha Bhat
- Ajmera Transplant Program, University Health Network, Toronto, ON, Canada. .,Canadian Donation and Transplantation Research Program, Data and Innovation Expert Group, Toronto, ON, Canada. .,Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Naruka V, Arjomandi Rad A, Subbiah Ponniah H, Francis J, Vardanyan R, Tasoudis P, Magouliotis DE, Lazopoulos GL, Salmasi MY, Athanasiou T. Machine learning and artificial intelligence in cardiac transplantation: A systematic review. Artif Organs 2022; 46:1741-1753. [PMID: 35719121 PMCID: PMC9545856 DOI: 10.1111/aor.14334] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 01/09/2023]
Abstract
Background This review aims to systematically evaluate the currently available evidence investigating the use of artificial intelligence (AI) and machine learning (ML) in the field of cardiac transplantation. Furthermore, based on the challenges identified we aim to provide a series of recommendations and a knowledge base for future research in the field of ML and heart transplantation. Methods A systematic database search was conducted of original articles that explored the use of ML and/or AI in heart transplantation in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to November 2021. Results Our search yielded 237 articles, of which 13 studies were included in this review, featuring 463 850 patients. Three main areas of application were identified: (1) ML for predictive modeling of heart transplantation mortality outcomes; (2) ML in graft failure outcomes; (3) ML to aid imaging in heart transplantation. The results of the included studies suggest that AI and ML are more accurate in predicting graft failure and mortality than traditional scoring systems and conventional regression analysis. Major predictors of graft failure and mortality identified in ML models were: length of hospital stay, immunosuppressive regimen, recipient's age, congenital heart disease, and organ ischemia time. Other potential benefits include analyzing initial lab investigations and imaging, assisting a patient with medication adherence, and creating positive behavioral changes to minimize further cardiovascular risk. Conclusion ML demonstrated promising applications for improving heart transplantation outcomes and patient‐centered care, nevertheless, there remain important limitations relating to implementing AI into everyday surgical practices.
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Affiliation(s)
- Vinci Naruka
- Department of Cardiothoracic Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Arian Arjomandi Rad
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | | | - Jeevan Francis
- Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | - Robert Vardanyan
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Panagiotis Tasoudis
- Department of Cardiothoracic Surgery, University Hospital Thessaly, Larissa, Greece
| | | | - George L Lazopoulos
- Department of Cardiothoracic Surgery, University Hospital Thessaly, Larissa, Greece.,Department of Cardiac Surgery, University Hospital of Heraklion, Crete, Greece
| | | | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Cardiothoracic Surgery, University Hospital Thessaly, Larissa, Greece
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37
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Tran J, Sharma D, Gotlieb N, Xu W, Bhat M. Application of machine learning in liver transplantation: a review. Hepatol Int 2022; 16:495-508. [PMID: 35020154 DOI: 10.1007/s12072-021-10291-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Machine learning (ML) has been increasingly applied in the health-care and liver transplant setting. The demand for liver transplantation continues to expand on an international scale, and with advanced aging and complex comorbidities, many challenges throughout the transplantation decision-making process must be better addressed. There exist massive datasets with hidden, non-linear relationships between demographic, clinical, laboratory, genetic, and imaging parameters that conventional methods fail to capitalize on when reviewing their predictive potential. Pre-transplant challenges include addressing efficacies of liver segmentation, hepatic steatosis assessment, and graft allocation. Post-transplant applications include predicting patient survival, graft rejection and failure, and post-operative morbidity risk. AIM In this review, we describe a comprehensive summary of ML applications in liver transplantation including the clinical context and how to overcome challenges for clinical implementation. METHODS Twenty-nine articles were identified from Ovid MEDLINE, MEDLINE Epub Ahead of Print and In-Process and Other Non-Indexed Citations, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials. CONCLUSION ML is vastly interrogated in liver transplantation with promising applications in pre- and post-transplant settings. Although challenges exist including site-specific training requirements, the demand for more multi-center studies, and optimization hurdles for clinical interpretability, the powerful potential of ML merits further exploration to enhance patient care.
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Affiliation(s)
- Jason Tran
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Divya Sharma
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Neta Gotlieb
- Ajmera Transplant Program, University Health Network, Toronto, ON, Canada
| | - Wei Xu
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Mamatha Bhat
- Ajmera Transplant Program, University Health Network, Toronto, ON, Canada.
- Division of Gastroenterology, Department of Medicine, University of Toronto, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
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Are MELD and MELDNa Still Reliable Tools to Predict Mortality on the Liver Transplant Waiting List? Transplantation 2022; 106:2122-2136. [PMID: 35594480 DOI: 10.1097/tp.0000000000004163] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Liver transplantation is the only curative treatment for end-stage liver disease. Unfortunately, the scarcity of donor organs and the increasing pool of potential recipients limit access to this life-saving procedure. Allocation should account for medical and ethical factors, ensuring equal access to transplantation regardless of recipient's gender, race, religion, or income. Based on their short-term prognosis prediction, model for end-stage liver disease (MELD) and MELD sodium (MELDNa) have been widely used to prioritize patients on the waiting list for liver transplantation resulting in a significant decrease in waiting list mortality/removal. Recent concern has been raised regarding the prognostic accuracy of MELD and MELDNa due, in part, to changes in recipients' profile such as body mass index, comorbidities, and general condition, including nutritional status and cause of liver disease, among others. This review aims to provide a comprehensive view of the current state of MELD and MELDNa advantages and limitations and promising alternatives. Finally, it will explore future options to increase the donor pool and improve donor-recipient matching.
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Dani A, Heidel JS, Qiu T, Zhang Y, Ni Y, Hossain MM, Chin C, Morales DLS, Huang B, Zafar F. External validation and comparison of risk score models in pediatric heart transplants. Pediatr Transplant 2022; 26:e14204. [PMID: 34881481 PMCID: PMC9157612 DOI: 10.1111/petr.14204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/16/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric heart transplant (PHT) patients have the highest waitlist mortality of solid organ transplants, yet more than 40% of viable hearts are unutilized. A tool for risk prediction could impact these outcomes. This study aimed to compare and validate the PHT risk score models (RSMs) in the literature. METHODS The literature was reviewed to identify RSMs published. The United Network for Organ Sharing (UNOS) registry was used to validate the published models identified in a pediatric cohort (<18 years) transplanted between 2017 and 2019 and compared against the Scientific Registry of Transplant Recipients (SRTR) 2021 model. Primary outcome was post-transplant 1-year mortality. Odds ratios were obtained to evaluate the association between risk score groups and 1-year mortality. Area under the curve (AUC) was used to compare the RSM scores on their goodness-of-fit, using Delong's test. RESULTS Six recipient and one donor RSMs published between 2008 and 2021 were included in the analysis. The validation cohort included 1,003 PHT. Low-risk groups had a significantly better survival than high-risk groups as predicted by Choudhry (OR = 4.59, 95% CI [2.36-8.93]) and Fraser III (3.17 [1.43-7.05]) models. Choudhry's and SRTR models achieved the best overall performance (AUC = 0.69 and 0.68, respectively). When adjusted for CHD and ventricular assist device support, all models reported better predictability [AUC > 0.6]. Choudhry (AUC = 0.69) and SRTR (AUC = 0.71) remained the best predicting RSMs even after adjustment. CONCLUSION Although the RSMs by SRTR and Choudhry provided the best prediction for 1-year mortality, none demonstrated a strong (AUC ≥ 0.8) concordance statistic. All published studies lacked advanced analytical approaches and were derived from an inherently limited dataset.
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Affiliation(s)
- Alia Dani
- Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Justin S. Heidel
- Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tingting Qiu
- Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Yin Zhang
- Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Yizhao Ni
- Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Md Monir Hossain
- Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Clifford Chin
- Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - David L. S. Morales
- Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bin Huang
- Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Farhan Zafar
- Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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40
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Christou CD, Tsoulfas G. Role of three-dimensional printing and artificial intelligence in the management of hepatocellular carcinoma: Challenges and opportunities. World J Gastrointest Oncol 2022; 14:765-793. [PMID: 35582107 PMCID: PMC9048537 DOI: 10.4251/wjgo.v14.i4.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/24/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) constitutes the fifth most frequent malignancy worldwide and the third most frequent cause of cancer-related deaths. Currently, treatment selection is based on the stage of the disease. Emerging fields such as three-dimensional (3D) printing, 3D bioprinting, artificial intelligence (AI), and machine learning (ML) could lead to evidence-based, individualized management of HCC. In this review, we comprehensively report the current applications of 3D printing, 3D bioprinting, and AI/ML-based models in HCC management; we outline the significant challenges to the broad use of these novel technologies in the clinical setting with the goal of identifying means to overcome them, and finally, we discuss the opportunities that arise from these applications. Notably, regarding 3D printing and bioprinting-related challenges, we elaborate on cost and cost-effectiveness, cell sourcing, cell viability, safety, accessibility, regulation, and legal and ethical concerns. Similarly, regarding AI/ML-related challenges, we elaborate on intellectual property, liability, intrinsic biases, data protection, cybersecurity, ethical challenges, and transparency. Our findings show that AI and 3D printing applications in HCC management and healthcare, in general, are steadily expanding; thus, these technologies will be integrated into the clinical setting sooner or later. Therefore, we believe that physicians need to become familiar with these technologies and prepare to engage with them constructively.
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Affiliation(s)
- Chrysanthos D Christou
- Department of Transplantation Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54622, Greece
| | - Georgios Tsoulfas
- Department of Transplantation Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54622, Greece
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41
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Miller RJH, Sabovčik F, Cauwenberghs N, Vens C, Khush KK, Heidenreich PA, Haddad F, Kuznetsova T. Temporal Shift and Predictive Performance of Machine Learning for Heart Transplant Outcomes. J Heart Lung Transplant 2022; 41:928-936. [DOI: 10.1016/j.healun.2022.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 02/25/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022] Open
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Balsano C, Alisi A, Brunetto MR, Invernizzi P, Burra P, Piscaglia F. The application of artificial intelligence in hepatology: A systematic review. Dig Liver Dis 2022; 54:299-308. [PMID: 34266794 DOI: 10.1016/j.dld.2021.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023]
Abstract
The integration of human and artificial intelligence (AI) in medicine has only recently begun but it has already become obvious that intelligent systems can dramatically improve the management of liver diseases. Big data made it possible to envisage transformative developments of the use of AI for diagnosing, predicting prognosis and treating liver diseases, but there is still a lot of work to do. If we want to achieve the 21st century digital revolution, there is an urgent need for specific national and international rules, and to adhere to bioethical parameters when collecting data. Avoiding misleading results is essential for the effective use of AI. A crucial question is whether it is possible to sustain, technically and morally, the process of integration between man and machine. We present a systematic review on the applications of AI to hepatology, highlighting the current challenges and crucial issues related to the use of such technologies.
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Affiliation(s)
- Clara Balsano
- Dept. of Life, Health and Environmental Sciences MESVA, University of L'Aquila, Piazza S. Salvatore Tommasi 1, 67100, Coppito, L'Aquila. Italy; Francesco Balsano Foundation, Via Giovanni Battista Martini 6, 00198, Rome, Italy.
| | - Anna Alisi
- Research Unit of Molecular Genetics of Complex Phenotypes, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maurizia R Brunetto
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center of Autoimmune Liver Diseases, Department of Medicine and Surgery, San Gerardo Hospital, University of Milano, Bicocca, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology, Gastroenterology, Padua University Hospital, Padua, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
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43
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Mucenic M, de Mello Brandão AB, Marroni CA. Artificial intelligence and human liver allocation: Potential benefits and ethical implications. Artif Intell Gastroenterol 2022; 3:21-27. [DOI: 10.35712/aig.v3.i1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Since its implementation almost two decades ago, the urgency allocation policy has improved the survival of patients on the waiting list for liver transplantation worldwide. The Model for End-Stage Liver Disease score is widely used to predict waiting list mortality. Due to some limitations related to its use, there is an active investigation to develop other prognostic scores. Liver allocation (LA) entails complex decision-making, and grafts are occasionally not directed to the recipients who are more likely to survive. Prognostic scores have, thus far, failed to predict post-operatory survival. Furthermore, the increasing use of marginal donors is associated with worse outcomes. Adequate donor-recipient pairing could help avoid retransplantation or futile procedures and reduce postoperative complications, mortality, hospitalization time, and costs. Artificial intelligence has applications in several medical fields. Machine learning algorithms (MLAs) use large amounts of data to detect unforeseen patterns and complex interactions between variables. Artificial neural networks and decision trees were the most common forms of MLA tested on LA. Some researchers have shown them to be superior for predicting waiting list mortality and graft failure than conventional statistical methods. These promising techniques are increasingly being considered for implementation.
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Affiliation(s)
- Marcos Mucenic
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, RS, Brazil
| | | | - Claudio Augusto Marroni
- Hepatology, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre 90050-170, RS, Brazil
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Yang M, Peng B, Zhuang Q, Li J, Liu H, Cheng K, Ming Y. Models to predict the short-term survival of acute-on-chronic liver failure patients following liver transplantation. BMC Gastroenterol 2022; 22:80. [PMID: 35196992 PMCID: PMC8867783 DOI: 10.1186/s12876-022-02164-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background Acute-on-chronic liver failure (ACLF) is featured with rapid deterioration of chronic liver disease and poor short-term prognosis. Liver transplantation (LT) is recognized as the curative option for ACLF. However, there is no standard in the prediction of the short-term survival among ACLF patients following LT. Method Preoperative data of 132 ACLF patients receiving LT at our center were investigated retrospectively. Cox regression was performed to determine the risk factors for short-term survival among ACLF patients following LT. Five conventional score systems (the MELD score, ABIC, CLIF-C OFs, CLIF-SOFAs and CLIF-C ACLFs) in forecasting short-term survival were estimated through the receiver operating characteristic (ROC). Four machine-learning (ML) models, including support vector machine (SVM), logistic regression (LR), multi-layer perceptron (MLP) and random forest (RF), were also established for short-term survival prediction. Results Cox regression analysis demonstrated that creatinine (Cr) and international normalized ratio (INR) were the two independent predictors for short-term survival among ACLF patients following LT. The ROC curves showed that the area under the curve (AUC) ML models was much larger than that of conventional models in predicting short-term survival. Among conventional models the model for end stage liver disease (MELD) score had the highest AUC (0.704), while among ML models the RF model yielded the largest AUC (0.940). Conclusion Compared with the traditional methods, the ML models showed good performance in the prediction of short-term prognosis among ACLF patients following LT and the RF model perform the best. It is promising to optimize organ allocation and promote transplant survival based on the prediction of ML models. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02164-6.
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Affiliation(s)
- Min Yang
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Bo Peng
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Quan Zhuang
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Junhui Li
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Hong Liu
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Ke Cheng
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Yingzi Ming
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.
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Veerankutty FH, Jayan G, Yadav MK, Manoj KS, Yadav A, Nair SRS, Shabeerali TU, Yeldho V, Sasidharan M, Rather SA. Artificial Intelligence in hepatology, liver surgery and transplantation: Emerging applications and frontiers of research. World J Hepatol 2021; 13:1977-1990. [PMID: 35070002 PMCID: PMC8727218 DOI: 10.4254/wjh.v13.i12.1977] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/09/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
The integration of artificial intelligence (AI) and augmented realities into the medical field is being attempted by various researchers across the globe. As a matter of fact, most of the advanced technologies utilized by medical providers today have been borrowed and extrapolated from other industries. The introduction of AI into the field of hepatology and liver surgery is relatively a recent phenomenon. The purpose of this narrative review is to highlight the different AI concepts which are currently being tried to improve the care of patients with liver diseases. We end with summarizing emerging trends and major challenges in the future development of AI in hepatology and liver surgery.
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Affiliation(s)
- Fadl H Veerankutty
- Comprehensive Liver Care, VPS Lakeshore Hospital, Cochin 682040, Kerala, India
| | - Govind Jayan
- Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Manish Kumar Yadav
- Department of Radiodiagnosis, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Krishnan Sarojam Manoj
- Department of Radiodiagnosis, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Abhishek Yadav
- Comprehensive Liver Care, VPS Lakeshore Hospital, Cochin 682040, Kerala, India
| | - Sindhu Radha Sadasivan Nair
- Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - T U Shabeerali
- Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Varghese Yeldho
- Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Madhu Sasidharan
- Gastroenterology and Hepatology, Kerala Institute of Medical Sciences, Thiruvananthapuram 695029, India
| | - Shiraz Ahmad Rather
- Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
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46
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Kezer CA, Shah VH, Simonetto DA. Advances in Predictive Modeling Using Machine Learning in the Field of Hepatology. Clin Liver Dis (Hoboken) 2021; 18:288-291. [PMID: 34976373 PMCID: PMC8688898 DOI: 10.1002/cld.1148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 02/04/2023] Open
Abstract
Content available: Author Interview and Audio Recording.
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Affiliation(s)
| | - Vijay H. Shah
- Department of MedicineDivision of Gastroenterology and HepatologyMayo ClinicRochesterMN
| | - Douglas A. Simonetto
- Department of MedicineDivision of Gastroenterology and HepatologyMayo ClinicRochesterMN
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47
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Machine learning to guide clinical decision-making in abdominal surgery-a systematic literature review. Langenbecks Arch Surg 2021; 407:51-61. [PMID: 34716472 PMCID: PMC8847247 DOI: 10.1007/s00423-021-02348-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/03/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE An indication for surgical therapy includes balancing benefits against risk, which remains a key task in all surgical disciplines. Decisions are oftentimes based on clinical experience while guidelines lack evidence-based background. Various medical fields capitalized the application of machine learning (ML), and preliminary research suggests promising implications in surgeons' workflow. Hence, we evaluated ML's contemporary and possible future role in clinical decision-making (CDM) focusing on abdominal surgery. METHODS Using the PICO framework, relevant keywords and research questions were identified. Following the PRISMA guidelines, a systemic search strategy in the PubMed database was conducted. Results were filtered by distinct criteria and selected articles were manually full text reviewed. RESULTS Literature review revealed 4,396 articles, of which 47 matched the search criteria. The mean number of patients included was 55,843. A total of eight distinct ML techniques were evaluated whereas AUROC was applied by most authors for comparing ML predictions vs. conventional CDM routines. Most authors (N = 30/47, 63.8%) stated ML's superiority in the prediction of benefits and risks of surgery. The identification of highly relevant parameters to be integrated into algorithms allowing a more precise prognosis was emphasized as the main advantage of ML in CDM. CONCLUSIONS A potential value of ML for surgical decision-making was demonstrated in several scientific articles. However, the low number of publications with only few collaborative studies between surgeons and computer scientists underpins the early phase of this highly promising field. Interdisciplinary research initiatives combining existing clinical datasets and emerging techniques of data processing may likely improve CDM in abdominal surgery in the future.
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Kröner PT, Engels MML, Glicksberg BS, Johnson KW, Mzaik O, van Hooft JE, Wallace MB, El-Serag HB, Krittanawong C. Artificial intelligence in gastroenterology: A state-of-the-art review. World J Gastroenterol 2021; 27:6794-6824. [PMID: 34790008 PMCID: PMC8567482 DOI: 10.3748/wjg.v27.i40.6794] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/15/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
The development of artificial intelligence (AI) has increased dramatically in the last 20 years, with clinical applications progressively being explored for most of the medical specialties. The field of gastroenterology and hepatology, substantially reliant on vast amounts of imaging studies, is not an exception. The clinical applications of AI systems in this field include the identification of premalignant or malignant lesions (e.g., identification of dysplasia or esophageal adenocarcinoma in Barrett’s esophagus, pancreatic malignancies), detection of lesions (e.g., polyp identification and classification, small-bowel bleeding lesion on capsule endoscopy, pancreatic cystic lesions), development of objective scoring systems for risk stratification, predicting disease prognosis or treatment response [e.g., determining survival in patients post-resection of hepatocellular carcinoma), determining which patients with inflammatory bowel disease (IBD) will benefit from biologic therapy], or evaluation of metrics such as bowel preparation score or quality of endoscopic examination. The objective of this comprehensive review is to analyze the available AI-related studies pertaining to the entirety of the gastrointestinal tract, including the upper, middle and lower tracts; IBD; the hepatobiliary system; and the pancreas, discussing the findings and clinical applications, as well as outlining the current limitations and future directions in this field.
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Affiliation(s)
- Paul T Kröner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Megan ML Engels
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, United States
- Cancer Center Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, Amsterdam 1105, The Netherlands
| | - Benjamin S Glicksberg
- The Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Kipp W Johnson
- The Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Obaie Mzaik
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Amsterdam 2300, The Netherlands
| | - Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, United States
- Division of Gastroenterology and Hepatology, Sheikh Shakhbout Medical City, Abu Dhabi 11001, United Arab Emirates
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX 77030, United States
- Section of Health Services Research, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX 77030, United States
| | - Chayakrit Krittanawong
- Section of Health Services Research, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX 77030, United States
- Section of Cardiology, Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States
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49
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Christou CD, Tsoulfas G. Challenges and opportunities in the application of artificial intelligence in gastroenterology and hepatology. World J Gastroenterol 2021; 27:6191-6223. [PMID: 34712027 PMCID: PMC8515803 DOI: 10.3748/wjg.v27.i37.6191] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/06/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) is an umbrella term used to describe a cluster of interrelated fields. Machine learning (ML) refers to a model that learns from past data to predict future data. Medicine and particularly gastroenterology and hepatology, are data-rich fields with extensive data repositories, and therefore fruitful ground for AI/ML-based software applications. In this study, we comprehensively review the current applications of AI/ML-based models in these fields and the opportunities that arise from their application. Specifically, we refer to the applications of AI/ML-based models in prevention, diagnosis, management, and prognosis of gastrointestinal bleeding, inflammatory bowel diseases, gastrointestinal premalignant and malignant lesions, other nonmalignant gastrointestinal lesions and diseases, hepatitis B and C infection, chronic liver diseases, hepatocellular carcinoma, cholangiocarcinoma, and primary sclerosing cholangitis. At the same time, we identify the major challenges that restrain the widespread use of these models in healthcare in an effort to explore ways to overcome them. Notably, we elaborate on the concerns regarding intrinsic biases, data protection, cybersecurity, intellectual property, liability, ethical challenges, and transparency. Even at a slower pace than anticipated, AI is infiltrating the healthcare industry. AI in healthcare will become a reality, and every physician will have to engage with it by necessity.
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Affiliation(s)
- Chrysanthos D Christou
- Organ Transplant Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54622, Greece
| | - Georgios Tsoulfas
- Organ Transplant Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54622, Greece
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50
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Balch JA, Delitto D, Tighe PJ, Zarrinpar A, Efron PA, Rashidi P, Upchurch GR, Bihorac A, Loftus TJ. Machine Learning Applications in Solid Organ Transplantation and Related Complications. Front Immunol 2021; 12:739728. [PMID: 34603324 PMCID: PMC8481939 DOI: 10.3389/fimmu.2021.739728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
The complexity of transplant medicine pushes the boundaries of innate, human reasoning. From networks of immune modulators to dynamic pharmacokinetics to variable postoperative graft survival to equitable allocation of scarce organs, machine learning promises to inform clinical decision making by deciphering prodigious amounts of available data. This paper reviews current research describing how algorithms have the potential to augment clinical practice in solid organ transplantation. We provide a general introduction to different machine learning techniques, describing their strengths, limitations, and barriers to clinical implementation. We summarize emerging evidence that recent advances that allow machine learning algorithms to predict acute post-surgical and long-term outcomes, classify biopsy and radiographic data, augment pharmacologic decision making, and accurately represent the complexity of host immune response. Yet, many of these applications exist in pre-clinical form only, supported primarily by evidence of single-center, retrospective studies. Prospective investigation of these technologies has the potential to unlock the potential of machine learning to augment solid organ transplantation clinical care and health care delivery systems.
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Affiliation(s)
- Jeremy A Balch
- Department of Surgery, University of Florida Health, Gainesville, FL, United States
| | - Daniel Delitto
- Department of Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Patrick J Tighe
- Department of Anesthesiology, University of Florida Health, Gainesville, FL, United States.,Department of Orthopedics, University of Florida Health, Gainesville, FL, United States.,Department of Information Systems/Operations Management, University of Florida Health, Gainesville, FL, United States
| | - Ali Zarrinpar
- Department of Surgery, University of Florida Health, Gainesville, FL, United States
| | - Philip A Efron
- Department of Surgery, University of Florida Health, Gainesville, FL, United States
| | - Parisa Rashidi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States.,Department of Computer and Information Science and Engineering University of Florida, Gainesville, FL, United States.,Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, United States.,Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, United States
| | - Gilbert R Upchurch
- Department of Surgery, University of Florida Health, Gainesville, FL, United States
| | - Azra Bihorac
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, United States.,Department of Medicine, University of Florida Health, Gainesville, FL, United States
| | - Tyler J Loftus
- Department of Surgery, University of Florida Health, Gainesville, FL, United States.,Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, United States
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