Christina Ekenberg1, Caspar da Cunha-Bang1,2, Isabelle P Lodding1, Søren S Sørensen3, Henrik Sengeløv2, Michael Perch4, Allan Rasmussen5, Finn Gustafsson6, Neval E Wareham1, Nikolai Kirkby7, Jesper Kjaer1, Marie Helleberg1, Joanne Reekie1, Jens D Lundgren1. 1. Department of Infectious Diseases, Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 2. Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 3. Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 4. Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 5. Department of Abdominal Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 6. Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 7. Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Abstract
BACKGROUND: Cytomegalovirus (CMV) infection is common among solid organ transplant (SOT) recipients and may cause CMV disease. To optimize the implementation of existing prevention strategies, the Management of Post-transplant Infections in Collaborating Hospitals (MATCH) program was developed. Two key performances of MATCH (diagnosing CMV infection at low viral load (VL) and before the onset of CMV disease) were assessed prior to, during and after the implementation of MATCH. METHODS: The MATCH program included a personalized surveillance plan, prophylaxis and preemptive therapy determined by the recipient's risk of CMV infection. The plan was composed through predefined algorithms and implemented through harvesting of real-time data from medical records. Risk of CMV disease was compared for recipients transplanted during and after vs prior to the implementation of MATCH. Lung and non-lung transplants were analyzed separately. RESULTS: A total of 593, 349, 520, and 360 SOT recipients were transplanted before (2007-2010), during (2011-2012), early after (2013-2015), and late after (2016-2017) implementation of MATCH with an observed reduction of diagnostic VL (P < .001) over time. Risk of CMV disease was reduced among non-lung transplant recipients transplanted during (adjusted hazard ratios [95% CI] 0.15 [0.04-0.54], P = .003), early after (aHR 0.27 [0.11-0.63], P = .003), and late after (aHR 0.17 [0.06-0.52], P = .002) compared with prior to MATCH. No significant change was observed among lung transplants. CONCLUSION: Implementation of CMV preventive strategies through MATCH was associated with a reduced risk of CMV disease among non-lung transplant recipients. Furthermore, the limitations of VL as a sole indicator for CMV disease in lung transplants were emphasized.
BACKGROUND:Cytomegalovirus (CMV) infection is common among solid organ transplant (SOT) recipients and may cause CMV disease. To optimize the implementation of existing prevention strategies, the Management of Post-transplant Infections in Collaborating Hospitals (MATCH) program was developed. Two key performances of MATCH (diagnosing CMV infection at low viral load (VL) and before the onset of CMV disease) were assessed prior to, during and after the implementation of MATCH. METHODS: The MATCH program included a personalized surveillance plan, prophylaxis and preemptive therapy determined by the recipient's risk of CMV infection. The plan was composed through predefined algorithms and implemented through harvesting of real-time data from medical records. Risk of CMV disease was compared for recipients transplanted during and after vs prior to the implementation of MATCH. Lung and non-lung transplants were analyzed separately. RESULTS: A total of 593, 349, 520, and 360 SOT recipients were transplanted before (2007-2010), during (2011-2012), early after (2013-2015), and late after (2016-2017) implementation of MATCH with an observed reduction of diagnostic VL (P < .001) over time. Risk of CMV disease was reduced among non-lung transplant recipients transplanted during (adjusted hazard ratios [95% CI] 0.15 [0.04-0.54], P = .003), early after (aHR 0.27 [0.11-0.63], P = .003), and late after (aHR 0.17 [0.06-0.52], P = .002) compared with prior to MATCH. No significant change was observed among lung transplants. CONCLUSION: Implementation of CMV preventive strategies through MATCH was associated with a reduced risk of CMV disease among non-lung transplant recipients. Furthermore, the limitations of VL as a sole indicator for CMV disease in lung transplants were emphasized.
Authors: Isabelle P Lodding; Mette Jørgensen; Marc Bennedbæk; Nikolai Kirkby; Klaudia Naegele; Finn Gustafsson; Michael Perch; Allan Rasmussen; Henrik Sengeløv; Søren S Sørensen; Hans H Hirsch; Jens D Lundgren Journal: Open Forum Infect Dis Date: 2021-09-04 Impact factor: 3.835
Authors: Susanne Stampf; Nicolas J Mueller; Christian van Delden; Manuel Pascual; Oriol Manuel; Vanessa Banz; Isabelle Binet; Sabina De Geest; Pierre-Yves Bochud; Alexander Leichtle; Stefan Schaub; Jürg Steiger; Michael Koller Journal: BMJ Open Date: 2021-12-15 Impact factor: 2.692
Authors: Philip B Andreasen; Omid Rezahosseini; Dina L Møller; Neval E Wareham; Magda T Thomsen; Ranya Houmami; Andreas D Knudsen; Jenny Knudsen; Jørgen A L Kurtzhals; Andreas A Rostved; Christian R Pedersen; Allan Rasmussen; Susanne D Nielsen Journal: Immun Inflamm Dis Date: 2021-10-29
Authors: Andreas Søborg; Joanne Reekie; Allan Rasmussen; Caspar Da Cunha-Bang; Finn Gustafsson; Kasper Rossing; Michael Perch; Paul Suno Krohn; Søren Schwartz Sørensen; Thomas Kromann Lund; Vibeke Rømming Sørensen; Christina Ekenberg; Louise Lundgren; Isabelle Paula Lodding; Kasper Sommerlund Moestrup; Jens Lundgren; Neval Ete Wareham Journal: PLoS One Date: 2022-07-25 Impact factor: 3.752