ArticleWorld journal of gastroenterology2025
Interpretable machine learning model for early complication prediction after split liver transplantation.
Article in World journal of gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSplit 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.
aimTo establish an interpretable machine learning framework to identify risk factors for EPC in adult recipients undergoing right tri-segment SLT.
methodsWe 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.
resultsEPC 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 (
conclusionIV 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.
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