*Purpose: The Final Rule from the U.S. Department of Health and Human Services mandates that patient geography should have a minimal role in organ transplant outcomes, a mandate the field of lung transplantation (LT) has made little progress towards over the past two decades due, in part, to a gap in knowledge on residential history. Residential history is codified as both current and previous home addresses and a necessary link to understanding socioeconomic, geographic, and environmental disparities which can influence health outcomes. Frequent re-location may signify housing and economic instability, and portends worse health outcomes through the unintended fracturing of continuous healthcare. Our hypothesis was that our institutional electronic health record could be leveraged to create a dataset codifying LT recipient residential history and linked to clinical data.

*Methods: We identified recipients transplanted at our center between January 1, 2016-December 31, 2017. Residence was defined as a self-reported recipient address used to register in the electronic health record and was updated or verified at any clinical encounter. The number of unique addresses per recipient were recorded. We excluded recipients who moved from outside the U.S. solely for transplant, PO Box addresses, and temporary addresses used by recipients during the peri-operative period. We tested our dataset by assessing whether recipients experienced ≥1 episode of moderate grade biopsy proven acute lung rejection (International Society of Heart and Lung Transplant grade ≥A2).

*Results: There were 232 LTs with 389 unique addresses identified through the health system electronic health record. Unique addresses per recipient ranged from 1 to 11, with an average 1.7 addresses per recipient and a median of 1. Among recipients with biopsy proven moderate grade early rejection there was an average 1.84 addresses (possibly more mobility), while those without rejection averaged 1.59 addresses (possibly less mobility). There was no significant difference.

*Conclusions: We successfully merged recipient residential history with clinical data. Recipients of LT have a modest relocation rate compared to non-transplant populations. The relocation rate of other organ transplant types is unknown. This information is essential for place based studies to address geographic disparities and reduce misclassification bias. While our preliminary analysis did not identify a difference by risk for early rejection, other clinical outcomes warrant investigation. Limitations of our approach were that recipient reasons for relocation were unknown, the self-reported nature of home address, and that residential history prior to becoming a patient at our health system was unknown. Our approach is innovative by reaching beyond the walls of our hospital and shifting the LT field towards the assessment of non-clinical, geography-driven risk factors on clinical outcomes.

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