GraftIQ: Hybrid multi-class neural network integrating clinical insight for multi-outcome prediction in liver transplant recipients.

Journal: Nature communications
Published Date: May 28, 2025

Abstract

Liver transplant recipients (LTRs) are at risk of graft injury, leading to cirrhosis and reduced survival. Liver biopsy, the diagnostic gold standard, is invasive and risky. We developed a hybrid multi-class neural network (NN) model, 'GraftIQ,' integrating clinician expertise for non-invasive graft pathology diagnosis. Biopsies from LTRs (1992-2020) were classified into six categories using demographic, clinical, and lab data from 30 days pre-biopsy. The dataset (5217 biopsies) was split 70/30 for training/testing, with external validation at Mayo Clinic, Hannover Medical School, and NUHS Singapore. Bayesian fusion was used to combine clinician-derived probabilities with NN predictions, improving performance. Here we show that GraftIQ (MulticlassNN+clinical insight) achieved an AUC of 0.902 (95% CI:0.884-0.919), up from 0.885 with NN alone. Internal and external validation demonstrated 10-16% higher AUC than conventional ML models. GraftIQ demonstrates high accuracy in identifying graft etiologies and offers a valuable clinical decision support tool for LTRs.

Authors

  • Divya Sharma
    Biostatistics Department, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2C1, Canada.
  • Neta Gotlieb
    Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
  • Daljeet Chahal
    Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
  • Joseph C Ahn
    Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MA, USA.
  • Bastian Engel
    Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.
  • Richard Taubert
    Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.
  • Eunice Tan
    Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.
  • Lau Kai Yun
    Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.
  • Sara Naimimohasses
    Ajmera Transplant Program, University Health Network, Toronto, ON, Canada.
  • Ankit Ray
    Ajmera Transplant Program, University Health Network, Toronto, ON, Canada.
  • Yoojin Han
    Ajmera Transplant Program, University Health Network, Toronto, ON, Canada.
  • Sara Gehlaut
    Ajmera Transplant Program, University Health Network, Toronto, ON, Canada.
  • Maryam Shojaee
    Ajmera Transplant Program, University Health Network, Toronto, ON, Canada.
  • Surabie Sivanendran
    Ajmera Transplant Program, University Health Network, Toronto, ON, Canada.
  • Maryam Naghibzadeh
    Transplant AI Initiative, Ajmera Transplant Program, University Health Network, Toronto, ON, Canada.
  • Amirhossein Azhie
    Multi Organ Transplant Program, University Health Network, Toronto, ON, Canada.
  • Sareh Keshavarzi
    Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
  • Kai Duan
    Department of Pathology, University Health Network, Toronto, ON, Canada.
  • Leslie Lilly
    Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Multi Organ Transplant Program, University Health Network, Toronto, ON, Canada.
  • Nazia Selzner
    Ajmera Transplant Program, University Health Network, Toronto, ON, Canada; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
  • Cynthia Tsien
    Ajmera Transplant Program, University Health Network, Toronto, ON, Canada; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
  • Elmar Jaeckel
    Ajmera Transplant Program, University Health Network, Toronto, ON, Canada; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
  • Wei Xu
    College of Food and Bioengineering, Henan University of Science and Technology, Luoyang, 471023 China.
  • Mamatha Bhat
    Transplant AI Initiative, Ajmera Transplant Program, University Health Network, Toronto, ON, Canada.

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