Abstract
Lung transplantation is a critical procedure performed in end-stage pulmonary patients. The number of lung transplantations performed in the USA in the last decade has been rising, but the survival rate is still lower than that of other solid organ transplantations. First, this study aims to employ machine learning models to predict patient survival after lung transplantation. Additionally, the aim is to generate counterfactual explanations based on these predictions to help clinicians and patients understand the changes needed to increase the probability of survival after the transplantation and better comply with normative requirements. We use data derived from the UNOS database, particularly the lung transplantations performed in the USA between 2019 and 2021. We formulate the problem and define two data representations, with the first being a representation that describes only the lung recipients and the second the recipients and donors. We propose an explainable ML workflow for predicting patient survival after lung transplantation. We evaluate the workflow based on various performance metrics, using five classification models and two counterfactual generation methods. Finally, we demonstrate the potential of explainable ML for resource allocation, predicting patient mortality, and generating explainable predictions for lung transplantation.
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Balch, J.A., et al.: Machine learning applications in solid organ transplantation and related complications. Front. Immunol. 3707 (2021). https://doi.org/10.3389/fimmu.2021.739728
Barbosa Jr, E.J.M., et al.: Machine learning algorithms utilizing quantitative CT features may predict eventual onset of bronchiolitis obliterans syndrome after lung transplantation. Acad. Radiol. 25(9), 1201–1212 (2018). https://doi.org/10.1016/j.acra.2018.01.013
Berra, G., et al.: Association between the renin-angiotensin system and chronic lung allograft dysfunction. Eur. Respir. J. 58(4) (2021). https://doi.org/10.1183/13993003.02975-2020
Berrevoets, J., Alaa, A., Qian, Z., Jordon, J., Gimson, A.E.S., van der Schaar, M.: Learning queueing policies for organ transplantation allocation using interpretable counterfactual survival analysis. In: Meila, M., Zhang, T. (eds.) Proceedings of the 38th International Conference on Machine Learning. Proceedings of Machine Learning Research, vol. 139, pp. 792–802. PMLR (2021)
Cantu, E., et al.: Preprocurement in situ donor lung tissue gene expression classifies primary graft dysfunction risk. Am. J. Respir. Crit. Care Med. 202(7), 1046–1048 (2020). https://doi.org/10.1164/rccm.201912-2436LE
Colvin, M., et al.: OPTN/SRTR 2019 annual data report: heart. Am. J. Transplant. 21(S2), 356–440 (2021). https://doi.org/10.1111/ajt.16492
Connor, K.L., O’Sullivan, E.D., Marson, L.P., Wigmore, S.J., Harrison, E.M.: The future role of machine learning in clinical transplantation. Transplantation 105(4), 723–735 (2021). https://doi.org/10.1097/TP.0000000000003424
Dandl, S., Molnar, C., Binder, M., Bischl, B.: Multi-objective counterfactual explanations. In: Bäck, T., et al. (eds.) PPSN 2020. LNCS, vol. 12269, pp. 448–469. Springer, Cham (2020). https://doi.org/10.1007/978-3-030-58112-1_31
Davis, H., Glass, C., Davis, R., Glass, M., Pavlisko, E.: Detecting acute cellular rejection in lung transplant biopsies by artificial intelligence: a novel deep learning approach. J. Heart Lung Transplant. 39(4), S501–S502 (2020). https://doi.org/10.1016/j.healun.2020.01.100
Deb, K., Pratap, A., Agarwal, S., Meyarivan, T.: A fast and elitist multiobjective genetic algorithm: NSGA-II. IEEE Trans. Evol. Comput. 6(2), 182–197 (2002). https://doi.org/10.1109/4235.996017
Dueñas-Jurado, J., et al.: New models for donor-recipient matching in lung transplantations. PLoS ONE 16(6), e0252148 (2021). https://doi.org/10.1371/journal.pone.0252148
Goodman, B., Flaxman, S.: European union regulations on algorithmic decision-making and a “right to explanation”. AI Mag. 38(3), 50–57 (2017). https://doi.org/10.1609/aimag.v38i3.2741
Gottlieb, J.: Lung allocation. J. Thorac. Dis. 9(8), 2670 (2017). https://doi.org/10.21037/jtd.2017.07.83
Halloran, K., et al.: Molecular phenotyping of rejection-related changes in mucosal biopsies from lung transplants. Am. J. Transplant. 20(4), 954–966 (2020). https://doi.org/10.1111/ajt.15685
Kwong, A.J., et al.: OPTN/SRTR 2019 annual data report: liver. Am. J. Transplant. 21(S2), 208–315 (2021). https://doi.org/10.1111/ajt.16494
Mothilal, R.K., Sharma, A., Tan, C.: Explaining machine learning classifiers through diverse counterfactual explanations. In: Proceedings of the 2020 Conference on Fairness, Accountability, and Transparency, pp. 607–617 (2020). https://doi.org/10.1145/3351095.3372850
Oztekin, A., Al-Ebbini, L., Sevkli, Z., Delen, D.: A decision analytic approach to predicting quality of life for lung transplant recipients: a hybrid genetic algorithms-based methodology. Eur. J. Oper. Res. 266(2), 639–651 (2018). https://doi.org/10.1016/j.ejor.2017.09.034
Shahmoradi, L., Abtahi, H., Amini, S., Gholamzadeh, M.: Systematic review of using medical informatics in lung transplantation studies. Int. J. Med. Inform. 136, 104096 (2020). https://doi.org/10.1016/j.ijmedinf.2020.104096
Spann, A., et al.: Applying machine learning in liver disease and transplantation: a comprehensive review. Hepatology 71(3), 1093–1105 (2020). https://doi.org/10.1002/hep.31103
Valapour, M., et al.: OPTN/SRTR 2019 annual data report: lung. Am. J. Transplant. 21(S2), 441–520 (2021). https://doi.org/10.1111/ajt.16495
Vitali, F.: A survey on methods and metrics for the assessment of explainability under the proposed AI act. In: Legal Knowledge and Information Systems: JURIX 2021: The Thirty-fourth Annual Conference, Vilnius, Lithuania, 8–10 December 2021, vol. 346, p. 235. IOS Press (2022). https://doi.org/10.3233/FAIA210342
Wachter, S., Mittelstadt, B., Russell, C.: Counterfactual explanations without opening the black box: automated decisions and the GDPR. Harv. J. Law Technol. 31(2), 841 (2018)
Watson, D.S., et al.: Clinical applications of machine learning algorithms: beyond the black box. BMJ 364 (2019). https://doi.org/10.1136/bmj.l886
Xu, C., Alaa, A., Bica, I., Ershoff, B., Cannesson, M., van der Schaar, M.: Learning matching representations for individualized organ transplantation allocation. In: Banerjee, A., Fukumizu, K. (eds.) Proceedings of the 24th International Conference on Artificial Intelligence and Statistics. Proceedings of Machine Learning Research, vol. 130, pp. 2134–2142. PMLR (2021)
Acknowledgements
This work was supported in part by the Health Resources and Services Administration contract 234-2005-370011C, the Digital Futures EXTREMUM project on “Explainable and Ethical Machine Learning for Knowledge Discovery from Medical Data Sources”, as well as by the Horizon2020 ASME project on “Using Artificial Intelligence for Predicting the Treatment Outcome of Melanoma Patients”.
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Rugolon, F., Bampa, M., Papapetrou, P. (2023). A Workflow for Generating Patient Counterfactuals in Lung Transplant Recipients. In: Koprinska, I., et al. Machine Learning and Principles and Practice of Knowledge Discovery in Databases. ECML PKDD 2022. Communications in Computer and Information Science, vol 1753. Springer, Cham. https://doi.org/10.1007/978-3-031-23633-4_20
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