Machine learning to predict transplant outcomes: helpful or hype? A national cohort study

Summary An increasing number of studies claim machine learning (ML) predicts transplant outcomes more accurately. However, these claims were possibly confounded by other factors, namely, supplying new variables to ML models. To better understand the prospects of ML in transplantation, we compared ML to conventional regression in a “common” analytic task: predicting kidney transplant outcomes using national registry data. We studied 133 431 adult deceased‐donor kidney transplant recipients between 2005 and 2017. Transplant centers were randomly divided into 70% training set (190 centers/97 787 recipients) and 30% validation set (82 centers/35 644 recipients). Using the training set, we performed regression and ML procedures [gradient boosting (GB) and random forests (RF)] to predict delayed graft function, one‐year acute rejection, death‐censored graft failure C, all‐cause graft failure, and death. Their performances were compared on the validation set using ‐statistics. In predicting rejection, regression ( C  =  0.601 0.611 0.621 ) actually outperformed GB ( C  =  0.581 0.591 0.601 ) and RF ( C  =  0.569 0.579 0.589 ). For all other outcomes, the C ‐statistics were nearly identical across methods (delayed graft function, 0.717–0.723; death‐censored graft failure, 0.637–0.642; all‐cause graft failure, 0.633–0.635; and death, 0.705–0.708). Given its shortcomings in model interpretability and hypothesis testing, ML is advantageous only when it clearly outperforms conventional regression; in the case of transplant outcomes prediction, ML seems more hype than helpful.