{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:42:46Z","timestamp":1784544166376,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,10,5]],"date-time":"2024-10-05T00:00:00Z","timestamp":1728086400000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Despite many people awaiting kidney transplant, kidney allografts from acute kidney injury (AKI) donors continue to be underutilized. We aimed to cluster kidney transplant recipients of AKI kidney allografts using an unsupervised machine learning (ML) approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using Organ Procurement and Transplantation Network\u2013United Network for Organ Sharing (OPTN\/UNOS) data, a consensus clustering cohort analysis was performed in 12\u00a0356 deceased donor kidney transplant recipients between 2015 and 2019 in whom donors had a terminal serum creatinine \u22651.5\u00a0mg\/dL. Significant cluster characteristics were determined, and outcomes were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median donor terminal creatinine was 2.2 (interquartile range [IQR] 1.7\u20133.3) mg\/dL. Cluster analysis was performed on 12\u00a0356 AKI kidney recipients, and three clinically distinct clusters were identified. Young, sensitized kidney re\u2010transplant patients characterized Cluster 1. Cluster 2 was characterized by first\u2010time kidney transplant patients with hypertensive and diabetic kidney diseases. Older diabetic recipients characterized Cluster 3. Clusters 1 and 2 donors were young and met standard kidney donor profile index (KDPI) criteria; Cluster 3 donors were older, more likely to have hypertension or diabetes, and meet high KDPI criteria. Cluster 1 had a higher risk of acute rejection, 3\u2010year patient death, and graft failure. Cluster 3 had a higher risk of death\u2010censored graft failure, patient death, and graft failure at 1 and 3 years. Cluster 2 had the best patient\u2010, graft\u2010, and death\u2010censored graft survival at 1 and 3 years. Compared to non\u2010AKI kidney recipients, the AKI clusters showed a higher incidence of delayed graft function (DGF, AKI: 43.2%, 41.7%, 45.3% vs. non\u2010AKI: 25.5%); however, there were comparable long\u2010term outcomes specific to death\u2010censored graft survival (AKI: 93.6%, 93.4%, 90.4% vs. non\u2010AKI: 92.3%), patient survival (AKI: 89.1%, 93.2%, 84.2% vs. non\u2010AKI: 91.2%), and overall graft survival (AKI: 84.7%, 88.2%, 79.0% vs. non\u2010AKI: 86.0%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this unsupervised ML approach study, AKI recipient clusters demonstrated differing, but good clinical outcomes, suggesting opportunities for transplant centers to incrementally increase kidney utilization from AKI donors.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.15470","type":"journal-article","created":{"date-parts":[[2024,10,5]],"date-time":"2024-10-05T11:40:55Z","timestamp":1728128455000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Reexamining Transplant Outcomes in Acute Kidney Injury Kidneys Through Machine Learning"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7860-9519","authenticated-orcid":false,"given":"Caroline C.","family":"Jadlowiec","sequence":"first","affiliation":[{"name":"Division of Transplant Surgery Mayo Clinic  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8313-3604","authenticated-orcid":false,"given":"Charat","family":"Thongprayoon","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Medicine Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1597-2411","authenticated-orcid":false,"given":"Supawadee","family":"Suppadungsuk","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Medicine Mayo Clinic  Rochester Minnesota USA"},{"name":"Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathobodi Hospital Mahidol University  Samut Prakan Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6103-2338","authenticated-orcid":false,"given":"Supawit","family":"Tangpanithandee","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Medicine Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3133-4479","authenticated-orcid":false,"given":"Napat","family":"Leeaphorn","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Medicine Mayo Clinic  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0367-2008","authenticated-orcid":false,"given":"Raymond","family":"Heilman","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Medicine Mayo Clinic  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3438-9638","authenticated-orcid":false,"given":"Matthew","family":"Cooper","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9954-9711","authenticated-orcid":false,"given":"Wisit","family":"Cheungpasitporn","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Medicine Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,10,5]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16982"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16920"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.18634"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13260"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15653"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002792"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14465"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13966"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14279"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2016.01.028"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002309"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/ti.2022.10849"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2018.08.047"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc5713"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40472-021-00336-z"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000003424"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2022.1286"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40472-021-00336-z"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1023949509487"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/btq170"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep06207"},{"key":"e_1_2_11_23_1","unstructured":"G.Guerra Kidney Transplant Success: Strategic Organ Selection\/Optimization and Patient Selection\u2014To Infinity and Beyond(Mayo Clinic Grand Rounds Phoenix Arizona:Mayo Clinic 2023)."},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14949"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15274"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/tri.13406"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20106143.2011.03741.x"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/XCS.0000000000000870"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.15470","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T12:48:24Z","timestamp":1748350104000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.15470"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10]]},"references-count":27,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1111\/ctr.15470"],"URL":"https:\/\/doi.org\/10.1111\/ctr.15470","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10]]},"assertion":[{"value":"2024-04-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e15470"}}