Journal Article

Machine Learning for Predicting Pulmonary Graft Dysfunction After Double-Lung Transplantation: A Single-Center Study Using Donor, Recipient, and Intraoperative Variables

Vallée, Alexandre, Messika, Jonathan, Fessler, Julien, Ma, Wenting, Komorowski, Matthieu, Brugière, Olivier, Devaquet, Jerôme, Gouy-Pailler, Cédric, Fischler, Marc, Le Guen, Morgan, Sage, Edouard, Glorion, Matthieu, Roux, Antoine

2025

Overview

Grade 3 primary graft dysfunction at 72 h (PGD3-T72) is a severe complication following lung transplantation. We aimed to develop an intraoperative machine-learning tool to predict PGD3-T72. We retrospectively analyzed perioperative data from 477 patients who underwent double-lung transplantation at a single center between 2012 and 2019. Data were structured into nine chronological steps, and supervised machine-learning models (XGBoost and logistic regression) were trained to predict PGD3-T72, with hyperparameters optimized via grid search and cross-validation. PGD3-T72 occurred in 83 patients (17.3%). XGBoost outperformed logistic regression, achieving peak performance at second graft implantation with an AUROC of 0.84 IQR: 0.065, p < 0.001, with a sensitivity of 0.81 and a specificity of 0.68. The top predictors included extracorporeal membrane oxygenation (ECMO) use, blood lactate levels, PaO2/FiO2 ratio, and total lung capacity mismatch. Subgroup analyses confirmed robustness across ECMO and non-ECMO cohorts. PGD3-T72 can be reliably predicted intraoperatively, offering potential for early intervention.

• Publisher: Frontiers Media SA,Frontiers Media S.A
• Subject: Adult / Algorithms / Blood levels / Body mass index / Chronic obstructive pulmonary disease / Creatinine / ECMO / Extracorporeal Membrane Oxygenation / Female / Gender / gradient-boosting / Grafting / Hemoglobin / Humans / Ischemia / Learning algorithms / Lung transplantation / Lung Transplantation - adverse effects / Lung Transplantation - methods / Lung transplants / Lungs / Machine Learning / Male / Middle Aged / Nitric oxide / Oxygenation / primary graft dysfunction / Primary Graft Dysfunction - diagnosis / Primary Graft Dysfunction - etiology / Pulmonary arteries / Pulmonary hypertension / Regression analysis / Retrospective Studies / Risk factors / Subgroups / Thoracic surgery / Tissue Donors / Transplantation / Variables / Veins & arteries / Ventilators