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Using Unsupervised Clustering to Characterize Phenotypes Among Older Kidney Transplant Recipients: A Cohort Study.

Sareen Singh1, Syed Sibte Raza Abidi2, Syed Asil Ali Naqvi2

  • 1Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.

Canadian Journal of Kidney Health and Disease
|March 17, 2025
PubMed
Summary

Older kidney transplant recipients with more comorbidities face a higher risk of graft failure. Donor quality further impacts outcomes, highlighting the need for personalized care strategies in older kidney transplant recipients.

Keywords:
clusteringgraft failurekidney transplantmachine learningolder adults

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Area of Science:

  • Nephrology
  • Transplantation
  • Machine Learning in Healthcare

Background:

  • Older kidney transplant recipients generally experience poorer outcomes than younger individuals.
  • Donor characteristics can further exacerbate the risks associated with kidney transplantation in elderly patients.

Purpose of the Study:

  • To apply unsupervised machine learning to identify distinct phenotypes among older kidney transplant recipients (≥65 years).
  • To assess the association between these identified phenotypes and graft failure.
  • To evaluate the influence of donor quality on transplant outcomes in older recipients.

Main Methods:

  • A retrospective cohort study utilizing the Scientific Registry of Transplant Recipients (2000-2017).
  • Unsupervised clustering based on 16 recipient factors to define phenotypes.
  • Kidney Donor Risk Index (KDRI) used to assess donor quality.
  • Multivariable Cox regression analyzed all-cause graft failure.

Main Results:

  • Three distinct recipient phenotypes were identified among 16,364 older kidney transplant recipients.
  • Cluster 3 (males with higher comorbidity burden) showed a significantly higher risk of graft failure compared to Cluster 2 (males without diabetes).
  • Cluster 3 recipients receiving lower quality kidneys (KDRI ≥1.45) had the highest graft failure risk.

Conclusions:

  • Unsupervised clustering successfully identified three clinically relevant phenotypes in older kidney transplant recipients.
  • These phenotypes offer potential for improved organ allocation, prognostic insights, and tailored post-transplant management for elderly recipients.
  • The findings underscore the importance of considering both recipient phenotype and donor quality for optimizing kidney transplant outcomes.