Evaluation of an electronic, patient-focused management system aimed at preventing cytomegalovirus disease following solid organ transplantation
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Standard
Evaluation of an electronic, patient-focused management system aimed at preventing cytomegalovirus disease following solid organ transplantation. / Ekenberg, Christina; da Cunha-Bang, Caspar; Lodding, Isabelle P; Sørensen, Søren S; Sengeløv, Henrik; Perch, Michael; Rasmussen, Allan; Gustafsson, Finn; Wareham, Neval E; Kirkby, Nikolai; Kjær, Jesper; Helleberg, Marie; Reekie, Joanne; Lundgren, Jens D.
I: Transplant Infectious Disease, Bind 22, Nr. 2, e13252, 2020.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Evaluation of an electronic, patient-focused management system aimed at preventing cytomegalovirus disease following solid organ transplantation
AU - Ekenberg, Christina
AU - da Cunha-Bang, Caspar
AU - Lodding, Isabelle P
AU - Sørensen, Søren S
AU - Sengeløv, Henrik
AU - Perch, Michael
AU - Rasmussen, Allan
AU - Gustafsson, Finn
AU - Wareham, Neval E
AU - Kirkby, Nikolai
AU - Kjær, Jesper
AU - Helleberg, Marie
AU - Reekie, Joanne
AU - Lundgren, Jens D
N1 - © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
KW - Adult
KW - Antiviral Agents/therapeutic use
KW - Cytomegalovirus
KW - Cytomegalovirus Infections/drug therapy
KW - Disease Management
KW - Female
KW - Health Plan Implementation/organization & administration
KW - Hospitals/standards
KW - Humans
KW - Lung Transplantation/adverse effects
KW - Male
KW - Middle Aged
KW - Organ Transplantation/adverse effects
KW - Risk Factors
KW - Transplant Recipients/statistics & numerical data
KW - Viral Load
U2 - 10.1111/tid.13252
DO - 10.1111/tid.13252
M3 - Journal article
C2 - 31997565
VL - 22
JO - Transplant Infectious Disease
JF - Transplant Infectious Disease
SN - 1398-2273
IS - 2
M1 - e13252
ER -
ID: 259993074