{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T12:00:40Z","timestamp":1776254440345,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["DK129777"],"award-info":[{"award-number":["DK129777"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Efforts to identify barriers and improve access to kidney transplantation in the United States are limited by a lack of population\u2010level data on early steps in the transplant evaluation process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We used a rule\u2010based natural language processing (NLP) approach with clinical notes in the US Veterans Affairs Healthcare System (VA) electronic health record (EHR) and linkage with the United States Renal Data System registry to characterize sequential steps in the kidney transplant evaluation process. Adults with advanced kidney disease (estimated glomerular filtration rate \u226420\u00a0mL\/min\/1.73m\n                      <jats:sup>2<\/jats:sup>\n                      ) from 1\/1\/2012\u201312\/31\/2019 who were receiving care within the VA were followed through 12\/31\/2021.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 45,174 cohort members, the median age was 71 (IQR 64, 80) years, and 97.2% were men. There was documentation of kidney transplant being mentioned as a treatment option for 46.3% of cohort members, 28.2% engaged in some type of evaluation for transplant, and 8.4% were referred to and 5.4% evaluated at a VA kidney transplant center. 6.9% of cohort members were added to the national deceased donor waitlist and 3.1% received a kidney transplant. Compared with events identified through EHR chart search and manual review by two clinicians, NLP identified events within 90 days with a precision of 0.82\u20130.94 and recall of 0.56\u20130.89.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These results illuminate the substantial proportion of patients who engage in early steps in the kidney transplant evaluation process. The work also demonstrates that NLP can accurately identify these key steps in the process as documented in patients\u2019 EHRs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70441","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T16:03:43Z","timestamp":1768406623000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Using Natural Language Processing to Characterize Early Steps in the Kidney Transplant Evaluation Process Documented in the National Veterans Affairs Electronic Health Record"],"prefix":"10.1111","volume":"40","author":[{"given":"Hannah","family":"Eyre","sequence":"first","affiliation":[{"name":"Seattle\u2010Denver Health Systems Research Center of Innovation for Veteran\u2010Centered and Value\u2010Driven Care Veterans Affairs Puget Sound Health Care System  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6761-5606","authenticated-orcid":false,"given":"David K.","family":"Prince","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine and the Kidney Research Institute University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Abrahamson","sequence":"additional","affiliation":[{"name":"Nephrology Section, Hospital and Specialty Medicine Veterans Affairs Puget Sound Health Care System  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard K.","family":"Blankenhorn","sequence":"additional","affiliation":[{"name":"Seattle\u2010Denver Health Systems Research Center of Innovation for Veteran\u2010Centered and Value\u2010Driven Care Veterans Affairs Eastern Colorado Health Care System  Denver Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan P.","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Biostatistics &amp; Informatics Colorado School of Public Health University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan J.","family":"Laundry","sequence":"additional","affiliation":[{"name":"Seattle\u2010Denver Health Systems Research Center of Innovation for Veteran\u2010Centered and Value\u2010Driven Care Veterans Affairs Puget Sound Health Care System  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Whitney","family":"Showalter","sequence":"additional","affiliation":[{"name":"Seattle\u2010Denver Health Systems Research Center of Innovation for Veteran\u2010Centered and Value\u2010Driven Care Veterans Affairs Puget Sound Health Care System  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Todd\u2010Stenberg","sequence":"additional","affiliation":[{"name":"Seattle\u2010Denver Health Systems Research Center of Innovation for Veteran\u2010Centered and Value\u2010Driven Care Veterans Affairs Puget Sound Health Care System  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann M.","family":"O'Hare","sequence":"additional","affiliation":[{"name":"Seattle\u2010Denver Health Systems Research Center of Innovation for Veteran\u2010Centered and Value\u2010Driven Care Veterans Affairs Puget Sound Health Care System  Seattle Washington USA"},{"name":"Division of Nephrology, Department of Medicine and the Kidney Research Institute University of Washington  Seattle Washington USA"},{"name":"Nephrology Section, Hospital and Specialty Medicine Veterans Affairs Puget Sound Health Care System  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9174-8038","authenticated-orcid":false,"given":"Catherine R.","family":"Butler","sequence":"additional","affiliation":[{"name":"Seattle\u2010Denver Health Systems Research Center of Innovation for Veteran\u2010Centered and Value\u2010Driven Care Veterans Affairs Puget Sound Health Care System  Seattle Washington USA"},{"name":"Division of Nephrology, Department of Medicine and the Kidney Research Institute University of Washington  Seattle Washington USA"},{"name":"Nephrology Section, Hospital and Specialty Medicine Veterans Affairs Puget Sound Health Care System  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.08530719"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.2215\/cjn.17691120"},{"key":"e_1_2_8_4_1","unstructured":"\u201cThe Southeastern Kidney Transplant Coalition. E\u2010STAR: Early Steps to Transplant Access Registry \u201d accessed May 6 2025 https:\/\/sektc.org\/early\u2010tx\u2010access\u2010registry\/."},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2013.10.046"},{"key":"e_1_2_8_6_1","unstructured":"C.Chen \u201cSupport for Veterans With Kidney Disease: VA Currently Cares for 600 000 Veterans With Kidney Disease \u201d VA News (2023) accessed Jan 1 2025 https:\/\/news.va.gov\/119226\/support\u2010for\u2010veterans\u2010with\u2010kidney\u2010disease\/#:~:text=NIDDK%20reports%20that%20VA%20currently CKD%20than%20the%20U.S.%20population."},{"issue":"8","key":"e_1_2_8_7_1","first-page":"12","article-title":"Access to Transplant Care and Services Within the Veterans Health Administration","volume":"35","author":"Gunnar W.","year":"2018","journal-title":"Federal Practitioner"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15295"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2022.1379"},{"key":"e_1_2_8_10_1","unstructured":"\u201cVeterans Health Administration: About VHA \u201d accessed May 10 2025 https:\/\/www.va.gov\/health\/aboutvha.asp."},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.2196\/15708"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.2196\/12239"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooae013"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare10112270"},{"key":"e_1_2_8_15_1","first-page":"438","article-title":"Launching Into Clinical Space With medspaCy: A New Clinical Text Processing Toolkit in Python","volume":"2021","author":"Eyre H.","year":"2021","journal-title":"Amia Annual Symposium Proceedings"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2009.05.002"},{"key":"e_1_2_8_17_1","unstructured":"\u201cBogart S. SankeyMATIC v. 1.2.0 \u201d accessed April 1 2025 https:\/\/sankeymatic.com\/build\/."},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2024.6653"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.6388"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882\u2010020\u201001951\u20101"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2024.03.017"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70441","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.70441","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70441","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T11:09:59Z","timestamp":1776251399000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.70441"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/ctr.70441"],"URL":"https:\/\/doi.org\/10.1111\/ctr.70441","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-09-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70441"}}