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.

中文翻译：

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肾移植数据在电子健康记录中的泛化性 - Epic Cosmos 数据库与移植受者的科学登记处。


从电子健康记录 （EHR） 中开发真实世界证据对于推进肾移植 （KT） 至关重要。我们通过将 Epic Cosmos 聚合 EHR 数据集与移植受者科学登记处 （SRTR） 进行比较，评估了使用 Epic Cosmos 聚合 EHR 数据集研究 KT 的可行性，该数据集包括在美国 238 个卫生系统中接受护理的 2.74 亿名独特个体。我们确定了 2014 年 1 月至 2022 年 12 月期间在 Cosmos 移植的 69,418 例 KT 受者（占同期美国所有 KT 移植的 39.4%）。在 Cosmos 中捕获的受者的人口统计学和临床特征与整个 SRTR 队列一致。生存率估计值通常具有可比性，尽管长期生存率存在一些差异。移植后 7 年，Cosmos 患者生存率为 80.4%，SRTR 患者生存率为 77.8%。多变量 Cox 回归显示，在两个队列中，临床因素与死亡率之间存在一致的关联，而死亡与年龄和种族之间的关联存在微小差异。总之，Cosmos 为 KT 研究提供了一个可靠的平台，允许移植登记或医疗保健索赔不可用的 EHR 级临床粒度。因此，Cosmos 将进行新的分析，以提高我们在全国范围内对 KT 管理的理解。