Administrative claims data could provide a unique opportunity to identify acute rejection (AR) events using specific antirejection medications and to validate rejected data reported to the Organ Procurement and Transplantation Network. This retrospective cohort study examined differences in registry-reported events and those identified using claims data among adult kidney transplant recipients from 2012 to 2017 using Standard Analysis Files from the US Renal Data System. Rejection rates, survival estimates, and center-level differences were assessed using each approach. Among 45 880 first-time kidney transplant recipients, we identified 3841 AR events within 12 months of transplant reported by centers in the registry; claims data yielded 2945 events. Of all events occurring within 12 months of transplant, 48.5% were reported using registry only, 32.9% were identified using claims only, and 18.6% were identified using both approaches. A 3-year death-censored graft survival probability was 90.0%, 88.4%, and 81.2% ( < .001) for ARs identified using registry only, claims data only, and both approaches, respectively. The large discordance between registry-reported and claims-based events suggests incomplete and potentially inaccurate reporting of events in the Organ Procurement Transplant Network registry. These findings have important implications for analyses that use AR data and underscore the need for improved capture of clinically meaningful events.

中文翻译：

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国家肾移植登记处对临床上显着的急性排斥反应的报告不完整


行政索赔数据可以提供独特的机会来识别使用特定抗排斥药物的急性排斥（AR）事件，并验证报告给器官采购和移植网络的拒绝数据。这项回顾性队列研究使用美国肾脏数据系统的标准分析文件，检查了 2012 年至 2017 年成人肾移植受者中注册报告事件和使用索赔数据确定的事件之间的差异。使用每种方法评估拒绝率、生存估计和中心水平差异。在 45,880 名首次肾移植受者中，我们在登记中心报告的移植后 12 个月内发现了 3841 起 AR 事件；索赔数据产生了 2945 个事件。在移植后 12 个月内发生的所有事件中，48.5% 仅使用登记进行报告，32.9% 仅使用声明进行识别，18.6% 使用两种方法进行识别。对于仅使用登记、仅使用索赔数据和两种方法识别的 AR，3 年死亡审查移植物存活概率分别为 90.0%、88.4% 和 81.2% ( < .001)。登记处报告的事件和基于索赔的事件之间存在巨大差异，表明器官采购移植网络登记处的事件报告不完整且可能不准确。这些发现对于使用 AR 数据的分析具有重要意义，并强调需要改进对具有临床意义的事件的捕获。