1
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Søborg A, Reekie J, Sengeløv H, Da Cunha-Bang C, Lund TK, Ekenberg C, Lodding IP, Moestrup KS, Lundgren L, Lundgren JD, Wareham NE. Trends in underlying causes of death in allogeneic hematopoietic cell transplant recipients over the last decade. Eur J Haematol 2024; 112:802-809. [PMID: 38183302 DOI: 10.1111/ejh.14172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
OBJECTIVES Improved survival after hematopoietic cell transplantation (HCT) and an increasingly comorbid transplant population may give rise to new trends in the causes of death. METHODS This study includes all adult allogeneic HCT recipients transplanted at Rigshospitalet between January 1, 2010 and December 31, 2019. Underlying causes of death were determined using the Classification of Death Causes after Transplantation (CLASS) method. RESULTS Among 802 HCT recipients, 289 died during the study period. The main causes of death were relapse (N = 133, 46.0%), graft-versus-host disease (GvHD) (N = 64, 22.1%) and infections (N = 35, 12.1%). Multivariable analyses showed that with increasing transplant calendar year, a decreased risk of all-cause mortality (HR 0.92, 95% CI 0.87-0.97) and death from GvHD (HR 0.87, 95% CI 0.78-0.97) was identified, but not for other specific causes. Standardized mortality ratios (SMRs) for all-cause mortality decreased from 23.8 (95% CI 19.1-28.5) to 18.4 (95% CI 15.0-21.9) for patients transplanted in 2010-2014 versus 2015-2019, while SMR for patients who died from GvHD decreased from 8.19 (95% CI 5.43-10.94) to 3.65 (95% CI 2.13-5.18). CONCLUSIONS As risk of all-cause mortality and death from GvHD decreases, death from relapse remains the greatest obstacle in further improvement of survival after HCT.
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Affiliation(s)
- Andreas Søborg
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Joanne Reekie
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Henrik Sengeløv
- Department of Hematology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Caspar Da Cunha-Bang
- Department of Hematology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Thomas Kromann Lund
- Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Christina Ekenberg
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Isabelle Paula Lodding
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Kasper Sommerlund Moestrup
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Louise Lundgren
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Jens D Lundgren
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Neval Ete Wareham
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
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Hegland NØ, Rezahosseini O, Pedersen CR, Møller DL, Bugge TB, Wareham NE, Arentoft NS, Hillingsø J, Lund TK, Rasmussen A, Nielsen SD. Anemia in liver transplant recipients: prevalence, severity, risk factors, and survival. APMIS 2024; 132:152-160. [PMID: 38084017 DOI: 10.1111/apm.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/11/2023] [Indexed: 02/17/2024]
Abstract
Information about anemia in liver transplant (LTx) recipients is scarce. We investigated the prevalence and severity of anemia before and within the first-year post-LTx, risk factors for having anemia before LTx, and 1-year survival according to anemia status before LTx. This retrospective cohort study received data from The Knowledge Center for Transplantation database at Rigshospitalet, Copenhagen, Denmark. Uni- and multivariate logistic regression were used to investigate factors associated with anemia and a Kaplan-Meier plot to illustrate the probability of survival. We included 346 first-time adult LTx recipients. The median age was 50 years (IQR: 42-57), and 203 (59%) were male. The prevalence of anemia before and 1-year post-LTx were 69 and 45%, respectively. Male sex (aOR 4.0 [95% CI: 2.2-7.2]; p < 0.001) and each unit increase in MELD score (aOR 1.2 [95% CI: 1.1-1.2]; p < 0.001) were positively associated with anemia before LTx. Compared to autoimmune liver diseases, LTx recipients with fulminant hepatic failure (aOR 0.03 [0.00-0.17]; p = 0.001) had lower odds for anemia. The 1-year survival in LTx recipients who had and did not have anemia before transplantation were 93 and 91% (p = 0.47). Anemia was frequent among LTx recipients, and anemia before LTx did not affect 1-year survival.
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Affiliation(s)
- Nina Øksnes Hegland
- Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Omid Rezahosseini
- Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Christian Ross Pedersen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dina Leth Møller
- Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Terese Brun Bugge
- Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Neval Ete Wareham
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Nicoline Stender Arentoft
- Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jens Hillingsø
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Kromann Lund
- Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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Harboe ZB, Hald A, Ekenberg C, Ete Wareham N, Fogt Lundbo L, Holler JG, Qvist T, Rask Hamm S, Bjerrum S, Rezahosseini O, Suno Krohn P, Gustafsson F, Perch M, Rasmussen A, Dam Nielsen S. Implementation of a vaccination clinic for adult solid organ transplant candidates: A single-center experience. Vaccine 2023; 41:6637-6644. [PMID: 37775467 DOI: 10.1016/j.vaccine.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Abstract
Vaccination is an evidence-based strategy to prevent or reduce the severity of infectious diseases (ID). Here, we aimed to describe the experience of implementing a vaccination clinic specifically targeting liver, heart, lung, and combined dual organ transplantation at a single transplantation center in Denmark. In this cohort of 242 solid organ transplant (SOT) candidates, we investigated seroprotection and the proportion of recommended vaccinations documented before transplantation. Furthermore, we registered completed vaccinations after ID consultations. The median age in our cohort was 53 years (IQR, 42-60), 60% were males (n = 135), and liver transplants (n = 138; 57%) were the most frequently planned organ transplants. Before the consultation to the vaccination clinic, influenza and pneumococcal vaccines had the highest proportion of documented vaccination (58% and 37%, respectively). Serological protection was more frequently observed for measles, mumps, or rubella (MMR, approximately 90% for each), while only 30% (n = 72) of SOT candidates showed seroprotection against pneumococcal disease. All SOT candidates required at least one of the recommended vaccines, and over 90% required three or more. At least 10% of patients in our cohort needed a live attenuated vaccine for either MMR or yellow fever. The most frequently administered vaccine was the tetanus-diphtheria-acelullar pertussis (Tdap) booster (n = 217; 90%), influenza vaccination was either administered (n = 16; 7%) or recommended (n = 226; 93%), PCV13 was administered (n = 155; 64%) or recommended (n = 27; 11%), and PPSV23 was either administered (n = 18; 7.4%) or recommended (n = 140; 58%). All SOT candidates adhered completely to their vaccination schedules. Based on our findings, we recommend prioritizing vaccination before transplantation by providing ID consultations for SOT candidates.
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Affiliation(s)
- Zitta Barrella Harboe
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.
| | - Annemette Hald
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Christina Ekenberg
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand, Denmark
| | - Neval Ete Wareham
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Lene Fogt Lundbo
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jon Gitz Holler
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand, Denmark
| | - Tavs Qvist
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Sebastian Rask Hamm
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Stephanie Bjerrum
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Omid Rezahosseini
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand, Denmark
| | - Paul Suno Krohn
- Department of Surgical Gastroenterology, Liver Transplant Unit, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Heart and Lung Transplant Unit, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Michael Perch
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Heart and Lung Transplant Unit, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology, Liver Transplant Unit, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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4
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Gjesdal G, Lundgren J, Czuba T, Wareham NE, Gustafsson F, Nilsson J, Smith JG, Braun OÖ. Validation of cause of death classification after heart transplantation and cause-specific life expectancy compared to the general population. Clin Transplant 2022; 36:e14756. [PMID: 35726189 PMCID: PMC9787622 DOI: 10.1111/ctr.14756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 05/26/2022] [Accepted: 06/03/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Post heart-transplant survival has increased, but information is lacking on specific causes of death and life expectancy. We aimed to assess cause-specific loss of life-years compared to the general population, evaluate classification for cause of death after heart transplantation, and assess validity of cause of death data from the International Society of Heart and Lung Transplant (ISHLT) registry. METHODS In this single center study, we included 239 heart recipients transplanted between 1988 and 2019 in Lund, Sweden (n = 239, 50% of the transplanted population where the cause of death was available). Two cardiologists retrospectively assigned causes of death according to a published classification (CLASS) in the 91 recipients who died during follow-up. Life expectancy was compared to data from the general population. RESULTS Compared to the average Swedish population, life expectancy for heart transplant recipients was 20 years shorter (IQR 12.9-27.2). The largest number of life-years lost were for deaths due to acute (49 years) and chronic rejection (27 years). Primary graft dysfunction (24 years) accounted for 24% of deaths, followed by malignancy (20 years) and infection (17 years), each accounting for ∼20% of deaths. Use of CLASS revealed moderate inter-rater agreement (56%) and moderate agreement with the ISHLT registry (62%). CONCLUSIONS Survival after heart transplantation was 20 years lower than in the general population. In the young, more life-years were lost due to acute graft rejection, whereas chronic graft rejection and primary graft failure were more important causes of death in older patients. Agreement was moderate between CLASS and the ISHLT registry classifications.
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Affiliation(s)
- Grunde Gjesdal
- Department of CardiologyClinical SciencesLund UniversityLundSweden,Section for Heart Failure and Valvular Disease, Department of Heart and Lung MedicineSkåne University HospitalLundSweden
| | - Jakob Lundgren
- Department of CardiologyClinical SciencesLund UniversityLundSweden,Section for Heart Failure and Valvular Disease, Department of Heart and Lung MedicineSkåne University HospitalLundSweden
| | - Tomasz Czuba
- Department of CardiologyClinical SciencesLund UniversityLundSweden,The Wallenberg Laboratory, Department of Molecular and Clinical MedicineInstitute of MedicineGothenburg University and the Department of CardiologySahlgrenska University HospitalGothenburgSweden
| | - Neval Ete Wareham
- Centre of Excellence for Health, Immunity and InfectionsRigshospitaletCopenhagenDenmark
| | | | - Johan Nilsson
- Department of Translational Medicine, Cardiothoracic surgery and bioinformaticsLund University and Skåne University HospitalLundSweden
| | - J. Gustav Smith
- Department of CardiologyClinical SciencesLund UniversityLundSweden,Section for Heart Failure and Valvular Disease, Department of Heart and Lung MedicineSkåne University HospitalLundSweden,The Wallenberg Laboratory, Department of Molecular and Clinical MedicineInstitute of MedicineGothenburg University and the Department of CardiologySahlgrenska University HospitalGothenburgSweden,Wallenberg Center for Molecular Medicine and Lund University Diabetes CenterLund UniversityLundSweden
| | - Oscar Ö. Braun
- Department of CardiologyClinical SciencesLund UniversityLundSweden,Section for Heart Failure and Valvular Disease, Department of Heart and Lung MedicineSkåne University HospitalLundSweden
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5
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Søborg A, Reekie J, Rasmussen A, Cunha-Bang CD, Gustafsson F, Rossing K, Perch M, Krohn PS, Sørensen SS, Lund TK, Sørensen VR, Ekenberg C, Lundgren L, Lodding IP, Moestrup KS, Lundgren J, Wareham NE. Trends in underlying causes of death in solid organ transplant recipients between 2010 and 2020: Using the CLASS method for determining specific causes of death. PLoS One 2022; 17:e0263210. [PMID: 35877606 PMCID: PMC9312393 DOI: 10.1371/journal.pone.0263210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 07/10/2022] [Indexed: 11/19/2022] Open
Abstract
Monitoring specific underlying causes of death in solid organ transplant (SOT) recipients is important in order to identify emerging trends and health challenges. This retrospective cohort study includes all SOT recipients transplanted at Rigshospitalet between January 1st, 2010 and December 31st, 2019. The underlying cause of death was determined using the newly developed Classification of Death Causes after Transplantation (CLASS) method. Cox regression analyses assessed risk factors for all-cause and cause-specific mortality. Of the 1774 SOT recipients included, 299 patients died during a total of 7511 person-years of follow-up (PYFU) with cancer (N = 57, 19%), graft rejection (N = 55, 18%) and infections (N = 52, 17%) being the most frequent causes of death. We observed a lower risk of all-cause death with increasing transplant calendar year (HR 0.91, 95% CI 0.86–0.96 per 1-year increase), alongside death from graft rejection (HR 0.84 per year, 95% CI 0.74–0.95) and death from infections (HR 0.86 per year, 95% CI 0.77–0.97). Further, there was a trend towards lower cumulative incidence of death from cardiovascular disease, graft failure and cancer in more recent years, while death from other organ specific and non-organ specific causes did not decrease. All-cause mortality among SOT recipients has decreased over the past decade, mainly due to a decrease in graft rejection- and infection-related deaths. Conversely, deaths from a broad range of other causes have remained unchanged, suggesting that cause of death among SOT recipients is increasingly diverse and warrants a multidisciplinary effort and attention in the future.
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Affiliation(s)
- Andreas Søborg
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - Joanne Reekie
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgery, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Caspar Da Cunha-Bang
- Department of Hematology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Kasper Rossing
- Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Michael Perch
- Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Paul Suno Krohn
- Department of Surgery, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Thomas Kromann Lund
- Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Vibeke Rømming Sørensen
- Department of Nephrology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Christina Ekenberg
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Louise Lundgren
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Isabelle Paula Lodding
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Kasper Sommerlund Moestrup
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Neval Ete Wareham
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
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6
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Abdulovski R, Møller DL, Knudsen AD, Sørensen SS, Rasmussen A, Nielsen SD, Wareham NE. Early- and late onset post-transplant lymphoproliferative disorders (PTLD) among adult kidney and liver transplant recipients. Eur J Haematol Suppl 2022; 109:343-350. [PMID: 35719018 PMCID: PMC9543731 DOI: 10.1111/ejh.13815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Post-transplant lymphoproliferative disorder (PTLD) in solid organ transplant recipients has a high mortality and may present early (<2 years) or late (≥ 2 years) post-transplantation. We investigated the clinical characteristics of early and late PTLD among kidney and liver transplant recipients. METHODS Recipients, transplanted at Rigshospitalet, with PTLD development as adults from January 2010 to August 2020, were included. Clinical characteristics, laboratory parameters, and pathology of early and late PTLD were compared. RESULTS Thirty-one PTLD cases were detected where 10 (32%) were early and 21 (68%) were late PTLD. EBV DNA in plasma was detected in 78% vs 28% in early and late PTLD (p = 0.037). None of the recipients with early PTLD and 9 recipients with late PTLD (47%) had Ann Arbor stage IV at the time of their diagnosis (p = 0.006). Cyclophosphamid-Hydroxyrubicin-Oncovin-Prednisolon (CHOP) was used for treatment in 10 (48%) recipients with late PTLD (p = 0.032) only. There was no difference in mortality between the two groups. CONCLUSIONS Recipients with late PTLD had a lower prevalence of detectable EBV DNA in plasma, were diagnosed with more advanced disease, and were more frequently treated with chemotherapy compared to recipients with early PTLD. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ranya Abdulovski
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dina Leth Møller
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Dehlbaek Knudsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Neval Ete Wareham
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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7
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Dos Santos Q, Hornum M, Terrones-Campos C, Crone CG, Wareham NE, Soeborg A, Rasmussen A, Gustafsson F, Perch M, Soerensen SS, Lundgren J, Feldt-Rasmussen B, Reekie J. Posttransplantation Diabetes Mellitus Among Solid Organ Recipients in a Danish Cohort. Transpl Int 2022; 35:10352. [PMID: 35449717 PMCID: PMC9016119 DOI: 10.3389/ti.2022.10352] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/15/2022] [Indexed: 12/15/2022]
Abstract
Post-transplant diabetes mellitus (PTDM) is associated with a higher risk of adverse outcomes. We aimed to describe the proportion of patients with diabetes prior to solid organ transplantation (SOT) and post-transplant diabetes mellitus (PTDM) in three time periods (early-likely PTDM: 0–45 days; 46–365 days and >365 days) post-transplant and to estimate possible risk factors associated with PTDM in each time-period. Additionally, we compared the risk of death and causes of death in patients with diabetes prior to transplant, PTDM, and non-diabetes patients. A total of 959 SOT recipients (heart, lung, liver, and kidney) transplanted at University Hospital of Copenhagen between 2010 and 2015 were included. The highest PTDM incidence was observed at 46–365 days after transplant in all SOT recipients. Age and the Charlson Comorbidity Index (CCI Score) in all time periods were the two most important risk factors for PTDM. Compared to non-diabetes patients, SOT recipients with pre-transplant diabetes and PTDM patients had a higher risk of all-cause mortality death (aHR: 1.77, 95% CI: 1.16–2.69 and aHR: 1.89, 95% CI: 1.17–3.06 respectively). Pre-transplant diabetes and PTDM patients had a higher risk of death due to cardiovascular diseases and cancer, respectively, when compared to non-diabetes patients.
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Affiliation(s)
- Quenia Dos Santos
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mads Hornum
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cynthia Terrones-Campos
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Cornelia Geisler Crone
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Neval Ete Wareham
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Soeborg
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Michael Perch
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Jens Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Joanne Reekie
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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8
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Møller DL, Sørensen SS, Wareham NE, Rezahosseini O, Knudsen AD, Knudsen JD, Rasmussen A, Nielsen SD. Bacterial and fungal bloodstream infections in pediatric liver and kidney transplant recipients. BMC Infect Dis 2021; 21:541. [PMID: 34103013 PMCID: PMC8188646 DOI: 10.1186/s12879-021-06224-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 05/19/2021] [Indexed: 12/11/2022] Open
Abstract
Background Bacterial and fungal bloodstream infections (BSI) are common after pediatric liver and kidney transplantations and associated with morbidity and mortality. However, knowledge about incidence rates, pathogen composition, and resistance patterns is limited. We aimed to describe the pattern of bacterial and fungal BSI in a cohort of pediatric liver and kidney transplant recipients. Methods A prospective study of 85 pediatric liver and kidney transplant recipients transplanted from 2010 to 2017 with a total of 390 person-years of follow-up. Clinical characteristics and BSI were retrieved from national registries assuring nationwide follow-up for at least 1 year. BSI incidence rates and pathogen composition were investigated and stratified by the time post-transplantation and type of transplanted organ. Results A total of 29 BSI were observed within the first 5 years post-transplantation with 16 different pathogens. The overall incidence rate of first BSI was 1.91 per 100 recipients per month (95% CI, 1.1–3.1) in the first year post-transplantation. The most common pathogens were Enterococcus faecium, Candida albicans, Escherichia coli, and Klebsiella pneumoniae. The pathogen composition depended on the transplanted organ with a higher proportion of BSI with Enterobacterales in kidney transplant recipients than in liver transplant recipients (67% vs. 20%, p = 0.03), while multiple pathogens were detected in the liver transplant recipients. Conclusions BSI were common in pediatric liver and kidney transplant recipients and the pathogen composition differed between liver and kidney transplant recipients. Guidelines for empiric antibiotic therapy should consider the type of transplanted organ as well as the local resistance patterns. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06224-2.
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Affiliation(s)
- Dina Leth Møller
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, DK-2100, Copenhagen Ø, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Neval Ete Wareham
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Omid Rezahosseini
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, DK-2100, Copenhagen Ø, Denmark
| | - Andreas Dehlbæk Knudsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, DK-2100, Copenhagen Ø, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, DK-2100, Copenhagen Ø, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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9
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Gynthersen RMM, Mens H, Wegener M, Wareham NE. Intracranial hypertension and papilloedema as a complication to low antiretroviral therapy adherence in a man living with chronic HIV. BMJ Case Rep 2021; 14:14/3/e237504. [PMID: 33727285 PMCID: PMC7970204 DOI: 10.1136/bcr-2020-237504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a 61-year-old man living with HIV on antiretroviral therapy (ART), who presented with headache, dizziness and blurred vision. Latest CD4+ cell count 3 months prior to admission was 570×106 cells/mL and HIV viral load <20 copies/mL. The patient was diagnosed with cerebrospinal fluid (CSF) lymphocytic pleocytosis, raised intracranial pressure and papilloedema. Neuroimaging showed normal ventricular volume and no mass lesions, suggesting (1) neuroinfection (2) idiopathic intracranial hypertension or (3) retroviral rebound syndrome (RRS) as possible causes. Neuroinfection was ruled out and idiopathic intracranial hypertension seemed unlikely. Elevated plasma HIV RNA level was detected consistent with reduced ART adherence prior to admission. RRS is a virological rebound after ART interruption, which can mimic the acute retroviral syndrome of acute primary infection. To the best of our knowledge, we describe the second case of RRS presenting as CSF lymphocytic pleocytosis and elevated intracranial pressure after low ART adherence.
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Affiliation(s)
| | - Helene Mens
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Wegener
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Neval Ete Wareham
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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10
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Rezahosseini O, Ekenberg C, Møller DL, Sørensen SS, Wareham NE, Perch M, Gustafsson F, Rasmussen A, Kirkby N, Reekie J, Lundgren J, Nielsen SD. Incidence and impact of parvovirus B19 infection in seronegative solid organ transplant recipients. J Infect Dis 2021; 224:865-869. [PMID: 33458766 DOI: 10.1093/infdis/jiab024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/13/2021] [Indexed: 12/22/2022] Open
Abstract
Routine monitoring of Parvovirus B19 (B19V) the first six months post-transplantation was performed in 241 seronegative solid organ transplant (SOT) recipients. Incidence rates (IR) during the 1st month and the 2nd to 6th months post-transplantation were 1.2 (95% CI, 0.33-3.2) and 0.21 (95% CI, 0.06-0.57) per 100 recipients per-month, respectively. Of the 6 SOT recipients with positive B19V PCR, 3 (50%) were admitted to hospital and 2 (33%) were treated with intravenous immunoglobulin. Thus, routine monitoring of B19V in seronegative SOT recipients may not be necessary. Targeted screening one-month post-transplantation and screening upon clinical suspicion could be an alternative strategy.
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Affiliation(s)
- Omid Rezahosseini
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina Ekenberg
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dina Leth Møller
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Neval Ete Wareham
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael Perch
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Kirkby
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Joanne Reekie
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Rezahosseini O, Sørensen SS, Perch M, Ekenberg C, Møller DL, Knudsen AD, Kirkby N, Lundgren J, Lodding IP, Wareham NE, Gustafsson F, Rasmussen A, Nielsen SD. Measles, mumps, rubella, and varicella-zoster virus serology and infections in solid organ transplant recipients during the first year post-transplantation. Clin Infect Dis 2020; 73:e3733-e3739. [PMID: 32564061 DOI: 10.1093/cid/ciaa824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/16/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mumps, measles, rubella, and varicella-zoster viruses (MMRV) may cause severe infections in seronegative adult solid organ transplant (SOT) recipients but can be prevented by vaccination. We aimed to determine MMRV serostatus in adult SOT recipients before and one-year post-transplantation as well as evidence of MMRV infections in a large, prospective cohort of SOT recipients. METHODS A prospective study of 1182 adult SOT recipients included in the Management of Posttransplant Infections in Collaborating Hospitals (MATCH) cohort from 2011 to 2017 with a one-year follow-up. Systematic monitoring of MMRV serology was performed prior to transplantation and one-year post-transplantation. PCR was used to confirm viral replication in SOT-recipients presenting with clinical evidence of infection. RESULTS Among 1182 adult SOT recipients, 28 (2.4%), 77 (6.5%), 65 (5.5%), and 22 (1.9%) were seronegative for measles, mumps, rubella, and VZV, respectively, and 165 (14%) were seronegative for at least one of the MMRV viruses. One-year post-transplantation, 29/823 (3.5%) of seropositive SOT recipients had seroreverted, and 63/111 (57%) of seronegative SOT recipients seroconverted for at least one MMRV virus. No evidence of MMR infections was found, but 8 (0.7%) SOT recipients developed symptoms and had a positive VZV PCR. CONCLUSIONS A large proportion of SOT recipients were seronegative for at least one of the MMRV viruses. MMRV infections in SOT recipients may disseminate and become fatal, and although only few cases of VZV infection were detected, results from this study suggest increase attention towards vaccination of patients waiting for SOT.
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Affiliation(s)
- Omid Rezahosseini
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael Perch
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina Ekenberg
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dina Leth Møller
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Dehlbæk Knudsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Kirkby
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Lundgren
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Isabelle P Lodding
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Neval Ete Wareham
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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12
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Ekenberg C, Cunha-Bang CD, Lodding IP, Sørensen SS, Sengeløv H, Perch M, Rasmussen A, Gustafsson F, Wareham NE, Kirkby N, Kjær J, Helleberg M, Lundgren JD. 1579. Evaluation of MATCH: an Electronic Individual Patient-Focused Management System Aimed at Preventing Cytomegalovirus Disease Following Solid Organ Transplantation. Open Forum Infect Dis 2018. [PMCID: PMC6253135 DOI: 10.1093/ofid/ofy210.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Cytomegalovirus (CMV) infection is common among solid-organ transplant (SOT) recipients and may cause CMV disease, if not promptly treated. Strategies to prevent CMV disease include chemoprophylaxis and pre-emptive monitoring and treatment of emerging subclinical infection. To optimize the implementation of these strategies as part of routine care, we developed and implemented a proactive and patient-tailored CMV management system for SOT patients (the MATCH program) in our center. Two key performance characteristics of success of MATCH are diagnosing CMV at low levels and avoiding CMV disease at diagnosis; these characteristics are assessed here before (2007–2010), during (2011–2012) and after (2013–2015) the implementation of the MATCH program. Methods In MATCH, SOT recipients follow a personalized, yet standardized, plan for monitoring, prophylaxis and pre-emptive therapy depending on underlying risk for CMV infection. The plan is composed in accordance with the recipient’s a priori risk as to CMV IgG serostatus and is continually updated during the post-transplant course according to patient′s current situation. Each individual patient plan is produced and implemented by a rule-based artificial intelligence (AI) platform, harvesting relevant real-time data from electronic medical records. Via predefined algorithms, plans and revisions are created and alerts are generated in case of missed planned monitoring for or molecular detection of CMV infection. Prior to its implementation, prevention of CMV disease was left at the discretion of the individual physician. Results A total of 603, 357, and 531 patients received an SOT before, during and after implementing MATCH, resp., of whom 88 (14.6%), 56 (15.7%) and 119 (22.4%) developed CMV infection within the first year of transplantation (Table 1). Among those with CMV infection, the % with high viral load decreased as did the % with CMV disease at the time of diagnosis of CMV infection during and after the implementation of MATCH relative to before (Figure 1). ![]()
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Conclusion The implementation of a rule-based AI platform guiding routine prevention of CMV disease among SOT recipients was associated with improved CMV-specific outcome, indicating its ability to identify the CMV infection sooner after onset and before causing disease. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Christina Ekenberg
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Caspar Da Cunha-Bang
- Department of Haematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Isabelle Paula Lodding
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Henrik Sengeløv
- Department of Haematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael Perch
- Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Neval Ete Wareham
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Kirkby
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Kjær
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marie Helleberg
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens D Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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13
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Wareham NE, Da Cunha-Bang C, Borges ÁH, Ekenberg C, Gerstoft J, Gustafsson F, Hansen D, Heilmann C, Helleberg M, Hillingsø J, Krohn PS, Lodding IP, Lund TK, Lundgren L, Mocroft A, Perch M, Petersen SL, Petruskevicius I, Rasmussen A, Rossing K, Rostved AA, Sengeløv H, Sørensen VR, Sørensen SS, Lundgren JD. Classification of death causes after transplantation (CLASS): Evaluation of methodology and initial results. Medicine (Baltimore) 2018; 97:e11564. [PMID: 30024557 PMCID: PMC6086480 DOI: 10.1097/md.0000000000011564] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Correct classification of death causes is an important component of transplant trials.We aimed to develop and validate a system to classify causes of death in hematopoietic stem cell (HSCT) and solid organ (SOT) transplant recipients.Case record forms (CRF) of fatal cases were completed, including investigator-designated cause of death. Deaths occurring in 2010 to 2013 were used for derivation; and were validated by deaths occurring in 2013 to 2015. Underlying cause of death (referred to as recorded underlying cause) was determined through a central adjudication process involving 2 external reviewers, and subsequently compared with the Danish National Death Cause Registry.Three hundred eighty-eight recipients died 2010 to 2015 (196 [51%] SOT and 192 [49%] HSCT). The main recorded underlying causes of death among SOT and HSCT were classified as cancer (20%, 48%), graft rejection/failure/graft-versus-host-disease (35%, 28%), and infections (20%, 11%). Kappa between the investigator-designated and the recorded underlying cause of death was 0.74 (95% CI 0.69-0.80) in derivation and comparable in the validation cohort. Death causes were concordant with the Danish National Death Cause Registry in 37.2% (95% CI 31.5-42.9) and 38.4% (95% CI 28.8-48.0) in the derivation and validation cohorts, respectively.We developed and validated a method to systematically and reliably classify the underlying cause of death among transplant recipients. There was a high degree of discordance between this classification and that in the Danish National Death Cause Registry.
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Affiliation(s)
- Neval Ete Wareham
- Department of Infectious Diseases
- Centre of Excellence for Health, Immunity and Infections (CHIP)
| | | | - Álvaro H. Borges
- Department of Infectious Diseases
- Centre of Excellence for Health, Immunity and Infections (CHIP)
| | - Christina Ekenberg
- Department of Infectious Diseases
- Centre of Excellence for Health, Immunity and Infections (CHIP)
| | | | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | - Ditte Hansen
- Department of Nephrology, Copenhagen University Hospital/Herlev Hospital, Herlev
| | | | - Marie Helleberg
- Department of Infectious Diseases
- Centre of Excellence for Health, Immunity and Infections (CHIP)
| | - Jens Hillingsø
- Department of Surgery, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | - Paul Suno Krohn
- Department of Surgery, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | - Isabelle Paula Lodding
- Department of Infectious Diseases
- Centre of Excellence for Health, Immunity and Infections (CHIP)
| | - Thomas Kromann Lund
- Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | - Louise Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP)
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Michael Perch
- Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | | | - Irma Petruskevicius
- Department of Hematology, Aarhus University Hospital/Skejby Hospital, Aarhus N
| | - Allan Rasmussen
- Department of Surgery, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | - Kasper Rossing
- Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | - Andreas A. Rostved
- Department of Surgery, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | | | - Vibeke Rømming Sørensen
- Department of Nephrology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Jens D. Lundgren
- Department of Infectious Diseases
- Centre of Excellence for Health, Immunity and Infections (CHIP)
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14
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Wareham NE, Da Cunha-Bang C, Borges ÁH, Ekenberg C, Gerstoft J, Gustafsson F, Hansen D, Helleberg M, Heilmann C, Hillingsø J, Krohn PS, Lodding IP, Lund TK, Lundgren L, Mocroft A, Perch M, Petersen SL, Petruskevicius I, Rasmussen A, Rossing K, Rostved A, Sengeløv H, Sørensen VR, Sørensen SS, Lundgren J. Classification of Death Causes after Transplantation (CLASS): Evaluation of Methodology and Initial Results. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Álvaro H Borges
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Jan Gerstoft
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ditte Hansen
- Copenhagen University Hospital, Herlev Hospital, Copenhagen, Denmark
| | - Marie Helleberg
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Carsten Heilmann
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jens Hillingsø
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Paul Suno Krohn
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Louise Lundgren
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Michael Perch
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Allan Rasmussen
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kasper Rossing
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Rostved
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Sengeløv
- Department of Haematology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Jens Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
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15
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Wareham NE, Heilmann C, Sengeløv H, Sørensen SS, Gustafsson F, Iversen M, Rasmussen A, Cunha-Bang CD, Lundgren J. Epstein-Barr Virus (EBV) DNAemia and Post-Transplant Lymphoproliferative Disorders (PTLD) Among Transplant Recipients. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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