Machine Learning for 1-Year Mortality Prediction in Lung Transplant Recipients: ISHLT Registry

Optimizing lung transplant candidate selection is crucial for maximizing resource efficiency and improving patient outcomes. Using data from the International Society for Heart and Lung Transplantation (ISHLT) registry (29,364 patients), we developed a deep learning model to predict 1-year survival after lung transplantation. Initially, 25 pretransplant factors were identified, and their importance was assessed using SHapley Additive exPlanations values. We refined the model by selecting the top 10 most influential factors and compared its performance with the original model. Additionally, we conducted external validation using an independent in-house dataset. Among the 29,364 patients, 4,729 (16.1%) died within 1 year, while 24,635 survived. The Gradient Boosting Machine (GBM) model achieved the highest performance (AUC: 0.958, accuracy: 0.949). Notably, the streamlined model using only the top 10 factors maintained identical performance (AUC: 0.958, accuracy: 0.949). The in-house dataset used for external validation showed significant compositional differences compared to the ISHLT dataset. Despite these differences, the GBM model performed well (AUC: 0.852, accuracy: 0.764). Notably, the Multilayer Perceptron model demonstrated superior generalization with an AUC of 0.911 and accuracy of 0.870. Our machine learning-based approach effectively predicts 1-year mortality in lung transplant recipients using a minimal set of pretransplant factors.