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, Kjaer Jesper, Helleberg Marie, Reekie Joanne, Lundgren Jens D
Department of Infectious Diseases, Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Transpl Infect Dis. 2020 Apr;22(2):e13252. doi: 10.1111/tid.13252. Epub 2020 Feb 10.
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.
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.
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.
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.
巨细胞病毒（CMV）感染在实体器官移植（SOT）受者中很常见，可能导致CMV疾病。为了优化现有预防策略的实施，制定了合作医院移植后感染管理（MATCH）计划。在MATCH实施之前、期间和之后，对MATCH的两个关键表现（在低病毒载量（VL）时且在CMV疾病发作之前诊断CMV感染）进行了评估。
MATCH计划包括根据受者CMV感染风险确定的个性化监测计划、预防和抢先治疗。该计划通过预定义算法制定，并通过从医疗记录中收集实时数据来实施。比较了MATCH实施期间及之后与实施之前移植的受者发生CMV疾病的风险。分别对肺移植和非肺移植进行了分析。
在MATCH实施之前（2007 - 2010年）、期间（2011 - 2012年）、早期（2013 - 2015年）和后期（2016 - 2017年）分别有593、349、520和360例SOT受者接受移植，随着时间的推移，观察到诊断性VL有所降低（P <.001）。与MATCH实施之前相比，在MATCH实施期间（调整后风险比[95%置信区间]0.15[0.04 - 0.54]，P =.003）、早期（调整后风险比0.27[0.11 - 0.63]，P =.003）和后期（调整后风险比0.17[0.06 - 0.52]，P =.002）移植的非肺移植受者中，CMV疾病风险降低。肺移植受者中未观察到显著变化。
通过MATCH实施CMV预防策略与非肺移植受者中CMV疾病风险降低相关。此外，强调了VL作为肺移植中CMV疾病唯一指标的局限性。
