# Phase-specific kidney graft failure prediction with machine learning model

## TL;DR

This paper introduces machine learning models that predict kidney transplant failure at different time intervals, improving early detection and long-term care.

## Contribution

The novelty lies in developing phase-specific machine learning models for kidney graft failure prediction across distinct post-transplant intervals.

## Key findings

- Mid-term predictions (9–15 months) achieved the highest accuracy with ROC AUC of 0.92 and F1 score of 0.85.
- Long-term predictions (39–72 months) were more challenging with lower performance metrics.

## Abstract

Accurate prediction of kidney graft failure at different phases post-transplantation is critical for timely intervention and long-term allograft preservation. Traditional survival models offer limited capacity for dynamic, time-specific risk estimation. Machine learning (ML) approaches, with their ability to model complex patterns, present a promising alternative.

This study developed and dynamically evaluated phase-specific ML models to predict kidney graft failure across five post-transplant intervals: 0–3 months, 3–9 months, 9–15 months, 15–39 months, and 39–72 months. Clinically relevant retrospective data from deceased donor kidney transplant recipients were used for training and internal validation, with performance further confirmed on a blinded external validation cohort. Predictive performance was assessed using ROC AUC, F1 score, and G-mean.

The ML models demonstrated varying performance across time intervals. Short-term predictions in the 0–3 month and 3–9 month intervals yielded moderate accuracy (ROC AUC = 0.73 ± 0.07 and 0.72 ± 0.04, respectively). The highest predictive accuracy observed in mid-term or the 9–15-month window (ROC AUC = 0.92 ± 0.02; F1 score = 0.85 ± 0.03), followed by the 15–39-month period (ROC AUC = 0.84 ± 0.04; F1 score = 0.76 ± 0.04). Long-term prediction from 39 to 72 months was more challenging (ROC AUC = 0.70 ± 0.07; F1 score = 0.65 ± 0.06).

Phase-specific ML models offer robust predictive performance for kidney graft failure, particularly in mid-term periods, supporting their integration into dynamic post-transplant surveillance strategies. These models can aid clinicians in identifying high-risk patients and tailoring follow-up protocols to optimize long-term transplant outcomes.