Calleja Lozano, RafaelRivera Gavilán, MarcosGuijo Rubio, DavidHessheimer, Amelia JudithRosa, Gloria de laGastaca, MikelOtero Ferreiro, AlejandraRamírez Romero, PabloBoscà Robledo, AndreaSantoyo, JulioMarín Gómez, Luís MiguelVillar del Moral, JesúsFundora, YilianLladó Garriga, LauraLoinaz, CarmeloJiménez Garrido, ManuelRodríguez Laíz, GonzaloLópez Baena, José ÁngelCharco, RamónVaro, EvaristoRotellar Sastre, FernandoAlonso, AyayaRodríguez Sanjuan, Juan CarlosBlanco-Fernández, GerardoNuño, JavierPacheco Sánchez, DavidColl, ElisabethDomínguez Gil, BeatrizFondevila Campo, ConstantinoAyllón, María DolorsDurán Martínez, ManuelCiria, RubénGutiérrez, Pedro AntonioGómez Orellana, AntonioHervás Martínez, CesarBriceño, Javier2025-10-032025-10-032025-070041-1337https://hdl.handle.net/2445/223493Background. Several scores have been developed to stratify the risk of graft loss in controlled donation after circulatory death (cDCD). However, their performance is unsatisfactory in the Spanish population, where most cDCD livers are recovered using normothermic regional perfusion (NRP). Consequently, we explored the role of different machine learning-based classifiers as predictive models for graft survival. A risk stratification score integrated with the model of end-stage liver disease score in a donor-recipient (D-R) matching system was developed. Methods. This retrospective multicenter cohort study used 539 D-R pairs of cDCD livers recovered with NRP, including 20 donor, recipient, and NRP variables. The following machine learning-based classifiers were evaluated: logistic regression, ridge classifier, support vector classifier, multilayer perceptron, and random forest. The endpoints were the 3- and 12-mo graft survival rates. A 3- and 12-mo risk score was developed using the best model obtained. Results. Logistic regression yielded the best performance at 3 mo (area under the receiver operating characteristic curve = 0.82) and 12 mo (area under the receiver operating characteristic curve = 0.83). A D-R matching system was proposed on the basis of the current model of end-stage liver disease score and cDCD-NRP risk score. Conclusions. The satisfactory performance of the proposed score within the study population suggests a significant potential to support liver allocation in cDCD-NRP grafts. External validation is challenging, but this methodology may be explored in other regions.9 p.application/pdfengcc-by-nc-nd (c) Calleja Lozano, Rafael et al., 2025http://creativecommons.org/licenses/by-nc-nd/3.0/es/Aprenentatge automàticDonants d'òrgansMachine learningOrgan donorsinfo:eu-repo/semantics/article7603882025-10-03info:eu-repo/semantics/openAccess39780307