Prediction of New Onset Diabetes after Liver Transplant

Abstract

25% of people who received a liver transplant will go on to develop diabetes within the next 5 years. These thousands of individuals are at 2-fold higher risk of cardiovascular events, graft loss, infections, as well as lower long-term survival. This is partly due to the medication used during and/or after transplant that significantly impacts metabolic balance. To assess which medication best suits the patient's condition, clinicians need an accurate estimate of diabetes risk. Both patient's historical data and observations at the current visit are informative in predicting whether the patient will develop diabetes within the following year. In this work we compared a variety of time-to-event prediction models as well as classifiers predicting the likelihood of the event within a year from the current checkup. We are particularly interested in comparing two types of models: 1) standard time-to-event predictors where the historical measurements are merely concatenated, 2) incorporating Deep Markov Model to first obtain low-dimensional embedding of historical data and then using this embedding as an additional input into the model. We compared a variety of algorithms including standard and regularized Cox proportional-hazards model (CPH), mixed effect random forests, survival-forests and Weibull Time-To-Event Recurrent Neural Network (WTTE-RNN). The results show that although all methods' performances varied from year to year and there was no clear winner across all the time points, regularized CPH model that used 1 to 3 years of historical visits data on average achieved a high, clinically relevant Concordance Index of .863. We thus recommend this model for further prospective clinical validation and hopefully, an eventual use in the clinic to improve clinicians' ability to personalize post-operative care and reduce the incidence of new-onset diabetes post liver transplant.