Novel Program Cuts CMV-Related Admissions in Transplant Patients

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SAN FRANCISCO—Danish researchers have developed a new program that could help dramatically lower rates of hospital admissions due to cytomegalovirus (CMV) infection among recipients of solid organ transplants (SOT).

“We were able to identify a number of processes which potentially could be optimized in a systematic way in order to diagnose the infection at an earlier stage, before it causes clinical disease and where it is easier to manage,” said lead investigator Caspar da Cunha-Bang, MD, an attending physician at the University of Copenhagen.

Dr. da Cunha-Bang described the program at the 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy.

CMV infection was growing concern at his institution because these infections were contributing to morbidity and mortality among SOT patients, he said. Many SOT recipients were presenting with severe CMV infection, so he and his colleagues developed the MATCH program, which involves a standardized prophylactic and monitoring schema according to an individual's risk profile.

“The principle we have established is to use chemoprophylaxis initially for the high-risk patients and once discontinued to consistently and frequently screen for emerging CMV infection,” Dr. da Cunha-Bang explained. “The database has direct and real-time links to the databases where medicine is prescribed and results of blood tests are downloaded directly from the viral laboratories.”

If chemoprophylaxis is not prescribed and/or planned blood tests not performed according to the initial plan generated as part of the program, an alert is generated and corrective action is taken.

The researchers compared the outcomes of recipients transplanted prior to (2007-2008) with the outcomes of recipients after the program was started (2009-2010) and those who received transplants in 2011.

The investigators analyzed the incidence of CMV infection among recipients transplanted in each of the three different calendar periods. They also assessed severity of infection (mild/moderate/severe) and rate of admission at time of diagnosis.

The study included 809 SOT recipients (48% kidney, 24% lung, 20% liver, 8% heart), including 279 in 2007-2008, 337 in 2009-2010, and 193 in 2011. CMV infection developed in 148 patients (18%); the incidence did not vary over time.

At diagnosis, the prevalence of moderate/severe CMV infection decreased from 49% in 2007-2008 to 41% in 2009-201 and 10% in 2011. In addition, the rate of CMV-related admissions changed from 44% to 52% and 10%.

“An approach similar to the MATCH program has not previously been described in the literature, Dr. da Cunha-Bang said. “It is challenging to restructure the approach to prevent severe CMV and other infectious complications in a large transplant hospital, and our projection was that although the MATCH program would be expected to be beneficial in terms of reduced rate of severe CMV infection and be cost effective, we had not expected that these benefits would be so marked and could be achieved so shortly after its introduction.”

The researchers concluded that the clinical prognosis of CMV infection radically improved through the systematic and rational screening for emerging infection introduced by this rather simple program. In addition, the researchers say this is a program can be implemented at any transplant unit.

“The results of our study show that implementation of this optimized approach indeed resulted in markedly lower risk of clinical disease caused by the CMV infection,” Dr. Cunha-Bang told Renal & Urology News.  Additionally, the cost in handling this frequent infectious complication to the course after transplantation was reduced in patients that followed the MATCH Program relative to the cost prior to the introduction of the program. As such, these findings are indeed very clinically relevant and can be applied also by other transplant hospitals with similar problems.”

After he and his colleagues publish their findings in a peer-reviewed journal, they plan to provide other transplant units with the technical details required to use the MATCH program.

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