Interpretable machine learning model for early complication prediction after split liver transplantation
Di Wang1, Jun-Yan Zhang1, Yan Xie1
1Department of Liver Transplantation, First Central Hospital of Tianjin Medical University, Tianjin 300380, China.
Background:
Split liver transplantation (SLT) effectively expands the donor pool but carries a higher risk of early postoperative complications (EPC) due to the extensive transection surface and altered hemodynamics of partial grafts.
Aim:
To establish an interpretable machine learning framework to identify risk factors for EPC in adult recipients undergoing right tri-segment SLT.
Methods:
We retrospectively analyzed 109 adult SLT recipients, including 37 who developed EPC. A comprehensive set of perioperative donor and recipient variables was evaluated using four machine learning algorithms (random forest, support vector machine, extreme gradient boosting, and logistic regression). SHapley Additive exPlanations were employed to rank variable importance. Independent predictors were further validated through multivariate logistic regression, and a diagnostic nomogram was constructed. Restricted cubic spline, receiver operating characteristic, and survival analyses were conducted to evaluate model performance and clinical outcomes.
Results:
EPC occurred in 33.9% of recipients. Among the machine learning models, random forest demonstrated the best predictive performance. SHapley Additive exPlanations analysis identified the log-transformed systemic immune-inflammation index (LnSII), albumin-to-fibrinogen ratio, model for end-stage liver disease (MELD) score, partial lobectomy of segment IV (IV PL), intraoperative blood loss, and operation time as major contributors to the model. Multivariate logistic regression confirmed LnSII, MELD scores, IV PL, and blood loss as independent predictors of EPC. The nomogram constructed from these factors showed good discrimination and calibration (area under the curve = 0.788, 95% confidence interval: 0.734-0.906). Kaplan-Meier analysis revealed that both LnSII and MELD scores were associated with five-year overall survival (P < 0.05), while MELD score and IV PL were significantly correlated with early postoperative liver function recovery.
Conclusion:
IV PL during right tri-segment SLT appears to reduce the risk of EPC and enhance postoperative liver function recovery. Together with LnSII, blood loss, and MELD score, these factors offer a reliable foundation for individualized perioperative risk stratification and management.
