A machine learning approach towards assessing consistency and reproducibility: an application to graft survival across three kidney transplantation eras.

Background: In South Africa, between 1966 and 2014, there were three kidney transplant eras defined by evolving access to certain immunosuppressive therapies defined as Methods: This study explored the effectiveness of nine ML algorithms in predicting 10-year graft survival across the three eras. We developed and internally validated these algorithms using data spanning the specified eras. The predictive performance of these algorithms was assessed using the area under the curve (AUC) of the receiver operating characteristics curve (ROC), supported by other evaluation metrics. We employed local interpretable model-agnostic explanations to provide detailed interpretations of individual model predictions and used permutation importance to assess global feature importance across each era. Results: Overall, the proportion of graft failure decreased from 41.5% in the Conclusions: Our study emphasises the significance of analysing post-kidney transplant outcomes and identifying era-specific factors mitigating graft failure. The proposed framework can serve as a foundation for future research and assist physicians in identifying patients at risk of graft failure.