Claims-Based Phenotyping of Acute Kidney Transplant Rejection in a National Medicare Cohort.
7 affiliations
- 1Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.
- 2Columbia University Renal Epidemiology Group, New York, New York, USA.
- 3Department of Biomedical Informatics, Columbia University Medical Center, New York, New York, USA.
- 4Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA.
- 5Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
- 6Department of Surgery, University of Colorado, Aurora, Colorado, USA.
- 7Department of Epidemiology, School of Public Health, University of Colorado, Aurora, Colorado, USA.
Abstract
Introduction
National transplant registries record acute rejection (AR) without the granularity needed to study rejection heterogeneity and prognosis at scale. Whether AR can be stratified by type and severity in national claims data using a claims-based algorithm, and whether these phenotypes correlate with graft outcomes, remains unclear.Methods
We conducted a cohort study using the US Renal Data System (USRDS) data including adult kidney transplant recipients from 2012-2021. AR within 12 months posttransplant was identified using International Classification of Diseases codes for transplant complications with evidence of antirejection treatment within 2 weeks. Episodes were categorized by type and severity based on treatment regimen. Biopsy-associated AR was defined by renal biopsy within 14 days before the treatment. Death-censored graft survival was assessed using Kaplan-Meier methods and multivariable Cox proportional hazards models.Results
Among 92,845 recipients, 5712 AR episodes were identified (69.4% mild acute-cellular rejection [ACR], 8.8% severe ACR, 19.7% antibody-mediated rejection [AMR], and 2.1% mixed [ACR + AMR]). Among 3052 biopsy-confirmed episodes, 3-year death-censored graft survival differed meaningfully across phenotypes (87.9% mild ACR, 80.7% severe ACR, 73.5% AMR, and 68.4% mixed [ACR + AMR] [P < 0.05]), with trends persisting after adjustment for recipient and donor characteristics.Conclusion
Claims-based phenotyping can identify clinically meaningful AR subtypes and prognostic gradients at national scale, enabling more granular national rejection surveillance.
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BibTeX
@article{ekanayake2026claimsbased,
title = {{Claims-Based Phenotyping of Acute Kidney Transplant Rejection in a National Medicare Cohort.}},
author = {Cameron Ekanayake and Miko Yu and Karthik Natarajan and Syed A Husain and Chetan Sree Muppavarapu and Jesse Schold and Sumit Mohan},
journal = {Kidney international reports},
year = {2026},
month = sep,
doi = {10.1016/j.ekir.2026.107060},
url = {https://europepmc.org/article/MED/42898365},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Claims-Based Phenotyping of Acute Kidney Transplant Rejection in a National Medicare Cohort.
AU - Cameron Ekanayake
AU - Miko Yu
AU - Karthik Natarajan
AU - Syed A Husain
AU - Chetan Sree Muppavarapu
AU - Jesse Schold
AU - Sumit Mohan
PY - 2026
DA - 2026/09/03
JO - Kidney international reports
DO - 10.1016/j.ekir.2026.107060
UR - https://europepmc.org/article/MED/42898365
AB - Introduction National transplant registries record acute rejection (AR) without the granularity needed to study rejection heterogeneity and prognosis at scale. Whether AR can be stratified by type and severity in national claims data using a claims-based algorithm, and whether these phenotypes correlate with graft outcomes, remains unclear.Methods We conducted a cohort study using the US Renal Data System (USRDS) data including adult kidney transplant recipients from 2012-2021. AR within 12 months posttransplant was identified using International Classification of Diseases codes for transplant complications with evidence of antirejection treatment within 2 weeks. Episodes were categorized by type and severity based on treatment regimen. Biopsy-associated AR was defined by renal biopsy within 14 days before the treatment. Death-censored graft survival was assessed using Kaplan-Meier methods and multivariable Cox proportional hazards models.Results Among 92,845 recipients, 5712 AR episodes were identified (69.4% mild acute-cellular rejection [ACR], 8.8% severe ACR, 19.7% antibody-mediated rejection [AMR], and 2.1% mixed [ACR + AMR]). Among 3052 biopsy-confirmed episodes, 3-year death-censored graft survival differed meaningfully across phenotypes (87.9% mild ACR, 80.7% severe ACR, 73.5% AMR, and 68.4% mixed [ACR + AMR] [P < 0.05]), with trends persisting after adjustment for recipient and donor characteristics.Conclusion Claims-based phenotyping can identify clinically meaningful AR subtypes and prognostic gradients at national scale, enabling more granular national rejection surveillance.
SN - 2468-0249
ER -