*Purpose: To assess the validity and reliability of the PROMIS Anxiety item bank administered using Computer Adaptive Test (PROMIS-A CAT) in patients who received solid organ transplant.

*Methods: A cross-sectional convenience sample of adult kidney (KTR), kidney-pancreas (KPTR), and liver (LTR) transplant recipients completed PROMIS-A CAT, General Anxiety Disorder-7 (GAD7), Patient Health Questionnaire (PHQ-9), Kidney/Liver Disease Quality of Life-36 (KDQoL/LDQoL), Edmonton Symptom Assessment System Revised (ESASr) and EuroQoL EQ-5D (EQ5D) questionnaires on an electronic data capture platform. Sociodemographic and clinical variables were collected from medical records. A sub-group of participants was asked to retake PROMIS-A CAT within 14 days; test-retest reliability was assessed using intraclass correlation coefficient (ICC). Construct validity was confirmed using correlation between PROMIS-A CAT scores and scores on questionnaires measuring similar constructs, and also using “known group” comparisons. Discrimination of PROMIS-A CAT was assessed using receiver operating characteristic (ROC) analysis and an established cut-off on GAD7 (≥10) for moderate/severe anxiety.

*Results: A cross-sectional, convenience sample of 431 participants were recruited (mean [SD] age: 53 [14] years, 65% male, 68% Caucasian). 251 (58%) were KTRs, 18 (4%) were KPTRs and 162 (38%) were LTRs. 13% reported moderate/severe anxiety (GAD7 score ≥10). Mean (SD) PROMIS-A CAT score was 52.4 (8.5); participants answered an average of 5 questions. PROMIS-A CAT showed good test-retest reliability (ICC: 0.802). PROMIS-A CAT showed moderate correlation with GAD7 (rho=0.63, p<0.001), PHQ9 (rho=0.60, p<0.001), and KDQoL/LDQoL SF-12 Mental Health Composite Score (rho=-0.56, p<0.001). In “known group” comparisons, mean (SD) PROMIS-A CAT scores were significantly higher for females compared to males (54 [7], 51 [9]; p<0.001) and for albumin (g/L) ≤35 compared to ≥40 (56 [8], 52 [8]; p=0.024). PROMIS-A CAT scores were also significantly higher for patients who reported ≥30 score on ESASr compared to <30 (59 [8], 51 [8]; p<0.001), and for patients who reported moderate/severe compared to no/slight anxiety/depression on EQ5D (56 [9], 51 [8]; p<0.001). PROMIS-A-CAT had excellent discrimination with an area under of the ROC curve of 0.87 (95% CI: 0.82, 0.93).

*Conclusions: These results provide support the validity and reliability of PROMIS-A CAT among patients who received a solid organ transplant and support its use in research and clinical care.

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