Prediction of mortality following pediatric heart transplant using machine learning algorithms

Background Optimizing transplant candidates’ priority for donor organs depends on the accurate assessment of post‐transplant outcomes. Due to the complexity of transplantation and the wide range of possible serious complications, recipient outcomes are difficult to predict accurately using conventional multivariable regression. Therefore, we evaluated the utility of 3 ML algorithms for predicting mortality after pediatric HTx. Methods We identified patients <18 years of age receiving HTx in 2006‐2015 in the UNOS Registry database. Mortality within 1, 3, or 5 years was predicted using classification and regression trees, RFs, and ANN. Each model was trained using cross‐validation, then validated in a separate testing set. Model performance was primarily evaluated by the area under the receiver operating characteristic (AUC) curve. Results The training set included 2802 patients, whereas 700 were included in the testing set. RF achieved the best fit to the training data with AUCs of 0.74, 0.68, and 0.64 for 1‐, 3‐, and 5‐year mortality, respectively, and performed best in the testing data, with AUCs of 0.72, 0.61, and 0.60, respectively. Nevertheless, sensitivity was poor across models (training: 0.22‐0.58; testing: 0.07‐0.49). Discussion ML algorithms demonstrated fair predictive utility in both training and testing data, but the sensitivity of these algorithms was generally poor. With the registry missing data on many determinants of long‐term survival, the ability of ML methods to predict mortality after pediatric HTx may be fundamentally limited.