Patients throughout Denmark will soon benefit from experience at Rigshospitalet in detecting and preventing severe infections in transplant patients. Rigshospitalet has established a collaboration agreement with Odense University Hospital to use the MATCH database for patients that undergo transplant surgery at Odense University Hospital. A similar agreement is being negotiated with Aarhus University Hospital.
Allan Rasmussen, transplant surgeon, and Finn Gustafsson, heart surgeon, share the chairmanship of the MATCH collaboration.
“It’s great that the MATCH database can now be used throughout Denmark. It is an innovative approach to infection prevention, which has shown impressive results. We’ve been using the MATCH database for five years now, and the results are so good that we felt it was time to include more hospitals. A database covering all transplant patients in Denmark will be unique in the world,” said Allan Rasmussen.
High risk of infection
Infection specialist and transplant specialists are working together using the MATCH database to detect potentially life-threatening infections at an early stage so as to prevent the infection from becoming serious, while also preventing overtreatment of patients that are only at low risk of infection. Infections are a common complication in organ transplant and bone marrow transplant surgery, according to Neval Wareham, physician and PhD student from the Centre for Health and Infectious Diseases Research, CHIP, which is a part of the Department of Infectious Diseases and Rheumatology and in charge of the day-to-day operation of the MATCH database.
“The immune system of transplant patients is deliberately suppressed to lower the risk of transplant rejection. This means that the patient is vulnerable to infection originating from outside the patient or from the donor, as well as to any dormant viruses in the patient that might be reactivated,” she said.
Individualised treatment plans
Treatment plans with the MATCH database are launched before the transplant surgery itself, with blood samples being taken from both the donor and the recipient.
“Both samples are tested for 12 different viruses, including the very critical cytomegalovirus (CMV), which affects 30% transplant patients. Based on the results, we assess the patient’s risk profile and recommend an individual treatment plan, which includes taking blood samples from the patient when the risk of infection is greatest,” said Neval Wareham.
As a general rule, patients in the highest risk group should have 17 blood samples taken during the first year, while patients in the lowest risk group only need to have nine samples taken. The plans are adjusted if an infection develops.
When a treatment plan has been determined, the MATCH employees monitor the patient closely through the samples taken. All sample results on infections are reported to the physician responsible for the patient’s treatment and to the database. This means that specialists who may be far away from the patient are often the first to discover signs of problems in the individual patient. If there are signs of infection or an increase in viral load, the system will trigger a warning notice to Neval Wareham, who will then follow up on this with the physician responsible for the patient’s treatment.
The employees in MATCH also monitors that various controls and check-ups are being performed as planned. The relevant departments receive a reminder if they fail to take the scheduled blood samples from a patient, or if the treatment plan needs to be revised. This takes place in close and ongoing collaboration.
The results of this adapted and close follow-up on transplant patients are significant. Around 30% of transplant patients still develop CMV, but whereas it used to be that around half of these became so ill that they required hospitalisation, today only around 5% of infections lead to hospitalisation. The reason for this change is that the viral load in the patient’s blood is monitored and that the patient can often be treated with antiviral medicine before the viral load makes them ill.
Consultant surgeon Allan Rasmussen has been monitoring his renal transplant patients himself, and he has seen the effect of the collaborative work in MATCH in his everyday work.
“Now I almost never see patients admitted to the department because of a CMV infection, unless there are complications due to antiviral drug resistance. Even in situations with antiviral drug resistance, we often have time to change our treatment before the disease breaks out, because we monitor the patients so closely. Previously, a CMV infection could be fatal. MATCH has really made a difference here,” he said.
There are a number of research projects linked to the MATCH database. These will develop new treatment options for transplant patients.
“Based on our experience with viral infections, we have several projects planned to assess the risk of other complications after transplant surgery, such as complications from the post-transplant lymphoproliferative disease (PTLD), which is a type of cancer. Our options in this field have improved further now that the university hospitals in Odense and Aarhus have joined the collaboration,” said Allan Rasmussen.