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      <title>Shifting Determinants of Mortality Risk After Orthotopic Heart Transplantation Identified by Machine Learning</title>
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      <abstractText>Background: Orthotopic heart transplantation (OHT) remains the gold standard for end-stage heart failure, yet individualized risk assessment for postoperative mortality remains challenging. We aimed to develop and interpret random forest-based models for predicting 30-day and 1-year mortality and to examine whether the key predictors differ between the 30-day and 1-year models. Methods: We analyzed 581 patients who underwent OHT between 2012 and 2024. The 30-day and 1-year mortality rates were 9.9% and 17.6%, respectively. Eighty-seven preoperative and forty-eight postoperative variables were considered as input features for model development. Random forest models were trained and validated using five-fold cross-validation, and explainability was assessed using SHapley Additive exPlanations (SHAP). Results: Using preoperative features only, the random forest models achieved AUCs of 0.62 (95% CI, 0.48–0.75) for 30-day and 0.67 (95% CI, 0.56–0.78) for 1-year mortality. SHAP analysis revealed that early mortality predictions were primarily driven by features reflecting acute physiological stress—hepatic dysfunction, inflammation, and hemodynamic instability—whereas long-term predictions were increasingly influenced by renal function, metabolic reserve, and frailty. Incorporating postoperative features improved performance (AUC 0.98 [95% CI, 0.97–0.99] and 0.86 [95% CI, 0.80–0.92], respectively), with model predictions dominated by the severity and persistence of organ dysfunction: short-term risk driven by hepatic injury, hemodynamic compromise, and critical illness, and long-term risk by sustained hepatic and renal impairment, metabolic resilience, and duration of circulatory support. Conclusions: Random forest models integrating preoperative and immediate postoperative data could predict short- and mid-term mortality after OHT. SHAP analysis demonstrated temporal shifts in the most important predictors, supporting the role of dynamic, data-driven risk assessment in transplant care.</abstractText>
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      <label>Koritsánszky Kinga Bianka et al. Shifting Determinants of Mortality Risk After Orthotopic Heart Transplantation Identified by Machine Learning. (2025) JOURNAL OF CARDIOVASCULAR DEVELOPMENT AND DISEASE 2308-3425 12 12</label><template>&lt;div class=&quot;JournalArticle Publication short-list&quot;&gt; &lt;div class=&quot;authors&quot;&gt; &lt;span class=&quot;author-name&quot; mtid=&quot;10077047&quot;&gt; &lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10077047&quot; target=&quot;_blank&quot;&gt;Koritsánszky, Kinga Bianka&lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-type&quot;&gt; &lt;/span&gt; ; &lt;span class=&quot;author-name&quot; mtid=&quot;10085179&quot;&gt; &lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10085179&quot; target=&quot;_blank&quot;&gt;Szentgróti, Rita&lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-type&quot;&gt; &lt;/span&gt; ; &lt;span class=&quot;author-name&quot; mtid=&quot;10079466&quot;&gt; &lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10079466&quot; target=&quot;_blank&quot;&gt;Szijártó, Ádám&lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-type&quot;&gt; &lt;/span&gt; ; &lt;span class=&quot;author-name&quot; mtid=&quot;10064500&quot;&gt; &lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10064500&quot; target=&quot;_blank&quot;&gt;Tokodi, Márton&lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-type&quot;&gt; &lt;/span&gt; ; &lt;span class=&quot;author-name&quot; mtid=&quot;10090356&quot;&gt; &lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10090356&quot; target=&quot;_blank&quot;&gt;Vereb, Alexandra&lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-type&quot;&gt; &lt;/span&gt; ; &lt;span class=&quot;author-name&quot; mtid=&quot;10052232&quot;&gt; &lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10052232&quot; target=&quot;_blank&quot;&gt;Kőszegi, Andrea&lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-type&quot;&gt; &lt;/span&gt; ; &lt;span class=&quot;author-name&quot; mtid=&quot;10022860&quot;&gt; &lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10022860&quot; target=&quot;_blank&quot;&gt;Sax, Balázs&lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-type&quot;&gt; &lt;/span&gt; ; &lt;span class=&quot;author-name&quot; mtid=&quot;10035614&quot;&gt; &lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10035614&quot; target=&quot;_blank&quot;&gt;Kovács, Attila&lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-type&quot;&gt; &lt;/span&gt; ; &lt;span class=&quot;author-name&quot; mtid=&quot;10002691&quot;&gt; &lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10002691&quot; target=&quot;_blank&quot;&gt;Merkely, Béla&lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-type&quot;&gt; &lt;/span&gt; ; &lt;span class=&quot;author-name&quot; mtid=&quot;10021986&quot;&gt; &lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10021986&quot; target=&quot;_blank&quot;&gt;Székely, Andrea ✉&lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-type&quot;&gt; &lt;/span&gt; &lt;/div &gt;&lt;div class=&quot;title&quot;&gt;&lt;a href=&quot;/gui2/?mode=browse&amp;params=publication;36483502&quot; mtid=&quot;36483502&quot; target=&quot;_blank&quot;&gt;Shifting Determinants of Mortality Risk After Orthotopic Heart Transplantation Identified by Machine Learning&lt;/a&gt;&lt;/div&gt; &lt;div class=&quot;pub-info&quot;&gt; &lt;span class=&quot;journal-title&quot;&gt;JOURNAL OF CARDIOVASCULAR DEVELOPMENT AND DISEASE&lt;/span&gt; &lt;span class=&quot;journal-volume&quot;&gt;12&lt;/span&gt; : &lt;span class=&quot;journal-issue&quot;&gt;12&lt;/span&gt; &lt;span class=&quot;page&quot;&gt; Paper: 486 , 17 p. &lt;/span&gt; &lt;span class=&quot;year&quot;&gt;(2025)&lt;/span&gt; &lt;/div&gt; &lt;div class=&quot;pub-end&quot;&gt;&lt;div class=&quot;identifier-list&quot;&gt; &lt;span class=&quot;identifiers&quot;&gt; &lt;span class=&quot;id identifier oa_none&quot; title=&quot;none&quot;&gt; &lt;a style=&quot;color:blue&quot; title=&quot;10.3390/jcdd12120486&quot; target=&quot;_blank&quot; href=&quot;https://doi.org/10.3390/jcdd12120486&quot;&gt; DOI &lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;id identifier oa_none&quot; 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&lt;div class=&quot;authors&quot;&gt;
	&lt;img title=&quot;Forrásközlemény&quot; style=&quot;float: left&quot; src=&quot;/frontend/resources/grid/publication-core-icon.png&quot;&gt;
	&lt;img title=&quot;Idézőközlemény&quot; style=&quot;float: left&quot; src=&quot;/frontend/resources/grid/publication-citation-icon.png&quot;&gt;

		&lt;div class=&quot;autype autype0&quot;&gt;				&lt;span class=&quot;author-name&quot; mtid=&quot;10077047&quot;&gt;&lt;a 
																				   href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10077047&quot; target=&quot;_blank&quot;&gt;Koritsánszky Kinga Bianka
	            (&lt;span class=&quot;authorship-author-name&quot;&gt;Koritsánszky Kinga Bianka&lt;/span&gt;
	            &lt;span class=&quot;authorAux-mtmt&quot;&gt; Aneszteziológia Intenzív Terápia&lt;/span&gt;)
			&lt;/a&gt;
    &lt;/span&gt;
&lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/Doktori Iskola; &lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/Aneszteziológiai és Intenzív Terápiás Klinika; &lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/Városmajori Szív- és Érgyógyászati Klinika&lt;/span&gt;
;&amp;nbsp;&amp;nbsp;&amp;nbsp;
							&lt;span class=&quot;author-name&quot; mtid=&quot;10085179&quot;&gt;&lt;a 
																				   href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10085179&quot; target=&quot;_blank&quot;&gt;Szentgróti Rita
	            (&lt;span class=&quot;authorship-author-name&quot;&gt;Szentgróti Rita&lt;/span&gt;
	            &lt;span class=&quot;authorAux-mtmt&quot;&gt; aneszteziológia és intenzív terápia&lt;/span&gt;)
			&lt;/a&gt;
    &lt;/span&gt;
&lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/Doktori Iskola&lt;/span&gt;
;&amp;nbsp;&amp;nbsp;&amp;nbsp;
							&lt;span class=&quot;author-name&quot; mtid=&quot;10079466&quot;&gt;&lt;a 
																				   href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10079466&quot; target=&quot;_blank&quot;&gt;Szijártó Ádám
	            (&lt;span class=&quot;authorship-author-name&quot;&gt;Szijártó Ádám&lt;/span&gt;
	            &lt;span class=&quot;authorAux-mtmt&quot;&gt; informatika, mesterséges intelligencia&lt;/span&gt;)
			&lt;/a&gt;
    &lt;/span&gt;
&lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/Doktori Iskola; &lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/Városmajori Szív- és Érgyógyászati Klinika&lt;/span&gt;
;&amp;nbsp;&amp;nbsp;&amp;nbsp;
							&lt;span class=&quot;author-name&quot; mtid=&quot;10064500&quot;&gt;&lt;a 
																				   href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10064500&quot; target=&quot;_blank&quot;&gt;Tokodi Márton
	            (&lt;span class=&quot;authorship-author-name&quot;&gt;Tokodi Márton&lt;/span&gt;
	            &lt;span class=&quot;authorAux-mtmt&quot;&gt; kardiológia, echocardiographia&lt;/span&gt;)
			&lt;/a&gt;
    &lt;/span&gt;
&lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/Városmajori Szív- és Érgyógyászati Klinika&lt;/span&gt;
;&amp;nbsp;&amp;nbsp;&amp;nbsp;
							&lt;span class=&quot;author-name&quot; mtid=&quot;10090356&quot;&gt;&lt;a 
																				   href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10090356&quot; target=&quot;_blank&quot;&gt;Vereb Alexandra
	            (&lt;span class=&quot;authorship-author-name&quot;&gt;Vereb Alexandra&lt;/span&gt;
	            &lt;span class=&quot;authorAux-mtmt&quot;&gt; Aneszteziológia és intenzív terápia&lt;/span&gt;)
			&lt;/a&gt;
    &lt;/span&gt;
&lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/Doktori Iskola&lt;/span&gt;
;&amp;nbsp;&amp;nbsp;&amp;nbsp;
							&lt;span class=&quot;author-name&quot; mtid=&quot;10052232&quot;&gt;&lt;a 
																				   href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10052232&quot; target=&quot;_blank&quot;&gt;Kőszegi Andrea
	            (&lt;span class=&quot;authorship-author-name&quot;&gt;Kőszegi Andrea&lt;/span&gt;
	            &lt;span class=&quot;authorAux-mtmt&quot;&gt; szívsebészet&lt;/span&gt;)
			&lt;/a&gt;
    &lt;/span&gt;
&lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/&lt;span title=&quot;Városmajori Szív- és Érgyógyászati Klinika&quot;&gt;VAROSMAJOR_SZÍVÉRGYÓGY&lt;/span&gt;/Kardiológia Központ - Kardiológiai Tanszék; &lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/Városmajori Szív- és Érgyógyászati Klinika&lt;/span&gt;
;&amp;nbsp;&amp;nbsp;&amp;nbsp;
							&lt;span class=&quot;author-name&quot; mtid=&quot;10022860&quot;&gt;&lt;a 
																				   href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10022860&quot; target=&quot;_blank&quot;&gt;Sax Balázs
	            (&lt;span class=&quot;authorship-author-name&quot;&gt;Sax Balázs&lt;/span&gt;
	            &lt;span class=&quot;authorAux-mtmt&quot;&gt; Orvostudományok&lt;/span&gt;)
			&lt;/a&gt;
    &lt;/span&gt;
&lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/&lt;span title=&quot;Városmajori Szív- és Érgyógyászati Klinika&quot;&gt;VAROSMAJOR_SZÍVÉRGYÓGY&lt;/span&gt;/Kardiológia Központ - Kardiológiai Tanszék&lt;/span&gt;
;&amp;nbsp;&amp;nbsp;&amp;nbsp;
							&lt;span class=&quot;author-name&quot; mtid=&quot;10035614&quot;&gt;&lt;a 
																				   href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10035614&quot; target=&quot;_blank&quot;&gt;Kovács Attila
	            (&lt;span class=&quot;authorship-author-name&quot;&gt;Kovács Attila&lt;/span&gt;
	            &lt;span class=&quot;authorAux-mtmt&quot;&gt; kardiológia, sportkardiológia&lt;/span&gt;)
			&lt;/a&gt;
    &lt;/span&gt;
&lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/Városmajori Szív- és Érgyógyászati Klinika&lt;/span&gt;
;&amp;nbsp;&amp;nbsp;&amp;nbsp;
							&lt;span class=&quot;author-name&quot; mtid=&quot;10002691&quot;&gt;&lt;a 
																				   href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10002691&quot; target=&quot;_blank&quot;&gt;Merkely Béla
	            (&lt;span class=&quot;authorship-author-name&quot;&gt;Merkely Béla Péter&lt;/span&gt;
	            &lt;span class=&quot;authorAux-mtmt&quot;&gt; Kardiológia&lt;/span&gt;)
			&lt;/a&gt;
    &lt;/span&gt;
&lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/&lt;span title=&quot;Városmajori Szív- és Érgyógyászati Klinika&quot;&gt;VAROSMAJOR_SZÍVÉRGYÓGY&lt;/span&gt;/Kardiológia Központ - Kardiológiai Tanszék; &lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/&lt;span title=&quot;Városmajori Szív- és Érgyógyászati Klinika&quot;&gt;VAROSMAJOR_SZÍVÉRGYÓGY&lt;/span&gt;/Repülõ- és Űrorvostani Tanszék; &lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/&lt;span title=&quot;Városmajori Szív- és Érgyógyászati Klinika&quot;&gt;VAROSMAJOR_SZÍVÉRGYÓGY&lt;/span&gt;/Sportorvostan Tanszék&lt;/span&gt;
;&amp;nbsp;&amp;nbsp;&amp;nbsp;
							&lt;span class=&quot;author-name&quot; mtid=&quot;10021986&quot;&gt;&lt;a 
																				   href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10021986&quot; target=&quot;_blank&quot;&gt;Székely Andrea ✉
	            (&lt;span class=&quot;authorship-author-name&quot;&gt;Székely Andrea&lt;/span&gt;
	            &lt;span class=&quot;authorAux-mtmt&quot;&gt; Aneszteziológia és intenzív terápia, szívsebészet&lt;/span&gt;)
			&lt;/a&gt;
    &lt;/span&gt;
&lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Egészségtudományi Kar&quot;&gt;ETK2007&lt;/span&gt;/Oxiológiai és Sürgősségi Ellátás Tanszék; &lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/Aneszteziológiai és Intenzív Terápiás Tanszék; &lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/Városmajori Szív- és Érgyógyászati Klinika&lt;/span&gt;

				    &lt;/div&gt;
&lt;/div&gt;
&lt;div class=&quot;title&quot;&gt;&lt;a href=&quot;/gui2/?mode=browse&amp;params=publication;36483502&quot; target=&quot;_blank&quot;&gt;Shifting Determinants of Mortality Risk After Orthotopic Heart Transplantation Identified by Machine Learning&lt;/a&gt;&lt;/div&gt;    &lt;div&gt;		&lt;span class=&quot;journal-title&quot;&gt;JOURNAL OF CARDIOVASCULAR DEVELOPMENT AND DISEASE&lt;/span&gt;

        &lt;span class=&quot;journal-issn&quot;&gt;( &lt;a target=&quot;_blank&quot; href=&quot;https://portal.issn.org/resource/ISSN/2308-3425&quot;&gt;2308-3425&lt;/a&gt;)&lt;/span&gt;:
		&lt;span class=&quot;journal-volume&quot;&gt;12&lt;/span&gt; &lt;span class=&quot;journal-issue&quot;&gt;12&lt;/span&gt;
&lt;span class=&quot;page&quot;&gt;
		Paper 486.
	 17 p. 
&lt;/span&gt;		 &lt;span class=&quot;year&quot;&gt;(2025)&lt;/span&gt;  
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							&lt;a style=&quot;color:blue&quot; title=&quot;https://www.mdpi.com/2308-3425/12/12/486&quot; target=&quot;_blank&quot; href=&quot;https://www.mdpi.com/2308-3425/12/12/486&quot;&gt;
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				&lt;div class=&quot;journal-subject&quot;&gt;Folyóirat szakterülete: Scopus - Pharmacology, Toxicology and Pharmaceutics (miscellaneous)&amp;nbsp;&amp;nbsp;&amp;nbsp;SJR indikátor:&amp;nbsp;Q1&lt;/div&gt;
				&lt;div class=&quot;journal-subject&quot;&gt;Folyóirat szakterülete: Scopus - Pharmacology (medical)&amp;nbsp;&amp;nbsp;&amp;nbsp;SJR indikátor:&amp;nbsp;Q2&lt;/div&gt;
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			Idézett közlemények száma: 6
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Forrás	 Idéző
	
	
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&lt;div class=&quot;funder&quot;&gt; Nemzeti Kardiovaszkuláris Laboratórium(RRF-2.3.1-21-2022-00003) Támogató: NKFIH,    (2025-2.1.1-EKÖP-2025-00014)   &lt;/div&gt;
&lt;div class=&quot;lastModified&quot;&gt;Utolsó módosítás: 2026.02.05. 09:04 Molnár-Taga Márta (SE 4-es admin)
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	&lt;pre class=&quot;comment&quot; style=&quot;margin-top: 0; margin-bottom: 0;&quot;&gt;&lt;u&gt;Megjegyzés&lt;/u&gt;: Összes idézések száma a WoS-ban: 0&lt;/pre&gt;
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