Generalizability of Kidney Transplant Data in Electronic Health Records - The Epic Cosmos Database versus the Scientific Registry of Transplant Recipients.

Developing real-world evidence from electronic health records (EHR) is vital to advance kidney transplantation (KT). We assessed the feasibility of studying KT using the Epic Cosmos aggregated EHR dataset, which includes 274 million unique individuals cared for in 238 U.S. health systems, by comparing it with the Scientific Registry of Transplant Recipients (SRTR). We identified 69,418 KT recipients transplanted between January 2014 and December 2022 in Cosmos (39.4% of all US KT transplants during this period). Demographics and clinical characteristics of recipients captured in Cosmos were consistent with the overall SRTR cohort. Survival estimates were generally comparable, although there were some differences in long-term survival. At 7 years post-transplant, patient survival was 80.4% in Cosmos and 77.8% in SRTR. Multivariable Cox regression showed consistent associations between clinical factors and mortality in both cohorts, with minor discrepancies in the associations between death and both age and race. In summary, Cosmos provides a reliable platform for KT research, allowing EHR-level clinical granularity not available with either the transplant registry or healthcare claims. Consequently, Cosmos will enable novel analyses to improve our understanding of KT management on a national scale.
Competing Interests: Declaration of Competing Interest ☒ The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Michal Mankowski reports financial support was provided by National Institute of Diabetes and Digestive and Kidney Diseases. Dorry Segev reports financial support was provided by National Institute of Allergy and Infectious Diseases. Sunjae Bae reports financial support was provided by National Institute of Diabetes and Digestive and Kidney Diseases. Allan Massie reports was provided by National Institute of Diabetes and Digestive and Kidney Diseases. Alexandra Strauss reports was provided by National Institute of Diabetes and Digestive and Kidney Diseases. Dorry Segev reports a relationship with Sanofi, Novartis, CLS Behring, Jazz Pharmaceuticals, Veloxis, Mallinckrodt, Thermo Fisher Scientific that includes: consulting or advisory and speaking and lecture fees. Eric Oermann reports a relationship with Sofinnova, Google Inc., income from Eikon Therapeutics, and equity in Artisight, Delvi. that includes: consulting or advisory, employment, and equity or stocks. Alexandra Strauss is a member of the Epic Hepatology Specialty Steering Board. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024. Published by Elsevier Inc.)