Administrative claims data could provide a unique opportunity to identify acute rejection events by use of specific anti-rejection medications and validate rejection data reported to the Organ Procurement Transplant Network (OPTN). This retrospective cohort study examined differences in registry-reported events and those identified via claims data among adult kidney transplant recipients from 2012-2017 using Standard Analysis Files from the United States 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 3,841 acute rejection events within 12 months of transplant reported by centers in the registry; claims data yielded 2,945 events. Of all events occurring within 12 months of transplant, 48.5% were reported by registry only, 32.9% were identified using claims only, and 18.6% were identified by both approaches. 3-year death-censored graft survival probabilities were 90.0%, 88.4%, and 81.2% (p<0.001) for acute rejections identified by 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 OPTN registry. These findings have important implications for analyses that use acute rejection data and underscores the need for improved capture of clinically meaningful events.
Keywords: acute allograft rejection; kidney transplant; outcome measures.
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