A novel learning algorithm to predict individual survival after liver transplantation for primary sclerosing cholangitis

PLoS One. 2018 Mar 15;13(3):e0193523. doi: 10.1371/journal.pone.0193523. eCollection 2018.

Abstract

Deciding who should receive a liver transplant (LT) depends on both urgency and utility. Most survival scores are validated through discriminative tests, which compare predicted outcomes between patients. Assessing post-transplant survival utility is not discriminate, but should be "calibrated" to be effective. There are currently no such calibrated models. We developed and validated a novel calibrated model to predict individual survival after LT for Primary Sclerosing Cholangitis (PSC). We applied a software tool, PSSP, to adult patients in the Scientific Registry of Transplant Recipients (n = 2769) who received a LT for PSC between 2002 and 2013; this produced a model for predicting individual survival distributions for novel patients. We also developed an appropriate evaluation measure, D-calibration, to validate this model. The learned PSSP model showed an excellent D-calibration (p = 1.0), and passed the single-time calibration test (Hosmer-Lemeshow p-value of over 0.05) at 0.25, 1, 5 and 10 years. In contrast, the model based on traditional Cox regression showed worse calibration on long-term survival and failed at 10 years (Hosmer-Lemeshow p value = 0.027). The calculator and visualizer are available at: http://pssp.srv.ualberta.ca/calculator/liver_transplant_2002. In conclusion we present a new tool that accurately estimates individual post liver transplantation survival.

MeSH terms

  • Adult
  • Algorithms
  • Cholangitis, Sclerosing / mortality*
  • Cholangitis, Sclerosing / therapy*
  • Female
  • Graft Survival
  • Humans
  • Liver Transplantation / methods*
  • Male
  • Middle Aged
  • Models, Theoretical
  • Prognosis
  • Regression Analysis
  • Software
  • Treatment Outcome

Grants and funding

The authors received no specific funding for this work.