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Med."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Artificial intelligence (AI)-based risk prediction is increasingly implemented in clinical care, but randomized evidence on communication and shared decision-making (SDM) outcomes is limited. In the single-center PRIMA-AI trial, 76 kidney transplant recipients with estimated glomerular filtration rate &lt;30\u2009mL\/min\/1.73\u2009m\u00b2 were randomized 1:1 to usual care or usual care plus an electronic health record (EHR)-integrated machine-learning model predicting 1-year graft loss risk. The primary outcome was patient-reported conversations about treatment options after graft loss during 12 months. Conversation frequency did not differ between groups (intervention 14\/36 [39%] vs control 16\/40 [40%]; chi-square\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20091.00). No significant between-group differences were observed for secondary clinical, SDM-related, relationship, or distress outcomes. Post-study user feedback suggested low and variable tool uptake with workflow barriers. Passive EHR availability of AI risk estimates did not improve communication or SDM-related outcomes. Future interventions should strengthen workflow integration and directly support SDM. Trial Registration: ClinicalTrials.gov number, NCT0605651, registered 2023-09-21.\n                  <\/jats:p>","DOI":"10.1038\/s41746-026-02757-5","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T11:44:46Z","timestamp":1778759086000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Randomized trial of electronic health record implemented AI risk prediction in kidney transplant care"],"prefix":"10.1038","volume":"9","author":[{"given":"Bilgin","family":"Osmanodja","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakob Joachim","family":"Spencker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00d6mer Ege","family":"\u00d6mero\u011flu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeineb","family":"Sassi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland","family":"Roller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sascha","family":"Vu-Eickmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aljoscha","family":"Burchardt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Hahn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tabea","family":"Ott","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Dabrock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"M\u00f6ller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klemens","family":"Budde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Herrmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"2757_CR1","doi-asserted-by":"publisher","DOI":"10.2196\/59956","volume":"27","author":"JH Pierce","year":"2025","unstructured":"Pierce, J. 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