Multimodal deep learning integration for predicting renal function outcomes in living donor kidney transplantation: a retrospective cohort study.

BACKGROUND

Accurately predicting post-transplant renal function is essential for optimizing donor-recipient matching and improving long-term outcomes in kidney transplantation (KT). Traditional models using only structured clinical data often fail to account for complex biological and anatomical factors. This study aimed to develop and validate a multimodal deep learning model that integrates computed tomography (CT) imaging, radiology report text, and structured clinical variables to predict 1-year estimated glomerular filtration rate (eGFR) in living donor kidney transplantation (LDKT) recipients.

MATERIALS AND

METHODS

A retrospective cohort of 1,937 LDKT recipients was selected from 3772 KT cases. Exclusions included deceased donor KT, immunologic high-risk recipients ( n = 304), missing CT imaging, early graft complications, and anatomical abnormalities. eGFR at 1 year post-transplant was classified into four categories: >90, 75-90, 60-75, and 45-60 mL/min/1.73 m 2 . Radiology reports were embedded using BioBERT, while CT videos were encoded using a CLIP-based visual extractor. These were fused with structured clinical features and input into ensemble classifiers including XGBoost. Model performance was evaluated using cross-validation and SHapley Additive exPlanations (SHAP) analysis.

RESULTS

The full multimodal model achieved a macro F1 score of 0.675, micro F1 score of 0.704, and weighted F1 score of 0.698 - substantially outperforming the clinical-only model (macro F1 = 0.292). CT imaging contributed more than text data (clinical + CT macro F1 = 0.651; clinical + text = 0.486). The model showed highest accuracy in the >90 (F1 = 0.7773) and 60-75 (F1 = 0.7303) categories. SHAP analysis identified donor age, BMI, and donor sex as key predictors. Dimensionality reduction confirmed internal feature validity.

CONCLUSION

Multimodal deep learning integrating clinical, imaging, and textual data enhances prediction of post-transplant renal function. This framework offers a robust and interpretable approach for individualized risk stratification in LDKT, supporting precision medicine in transplantation.