Development of a machine learning-based prediction model for early hospital readmission after kidney transplantation: a retrospective study

Purpose: This study aimed to develop and validate a machine learning-based prediction model for early hospital readmission (EHR) post-kidney transplantation. Methods: The study was conducted at the organ transplantation center of a university hospital, utilizing data from 470 kidney transplant recipients. We built and trained four machine learning models and tested them to identify the strongest EHR predictors. Predictive performance was evaluated using confusion matrices and the area under the receiver operating characteristic curve (ROC AUC). Results: Among the 470 kidney transplant recipients with a mean age of 46.1 ± 12.02 years, 322 (68.5%) were males, and 74 (15.7%) were readmitted within 30 days after kidney transplantation. In total, 241 (51.2%) recipients were found to have experienced EHR after applying the random over-sampling examples method. The random forest model achieved the best performance, with an ROC AUC of .87 (validation set) and .82 (test set). The 15 most important features were steroid pulse therapy (recipient), cerebrovascular accident (recipient), heart failure (recipient), male sex (donor), cardiovascular disease (recipient), weekend discharge (recipient), peritoneal dialysis (recipient) cerebrovascular accident as the cause of brain death (donor), current smoker (recipient), cardiac arrest (donor), previous kidney transplantation (recipient), age (donor), hypertension (donor), male sex (recipient), and dialysis duration (recipient). Conclusion: Our framework demonstrated strong predictive interpretability. It can support appropriate and effective clinical decision-making by assisting transplant professionals in stratifying recipients based on their risk of EHR. prioritizing post-discharge care and follow-up for high-risk individuals, and allocating targeted interventions such as closer monitoring or education.