Presentation on theme: "The Swiss Transplant Cohort Study 1.5.2008 – 30.6.2013 PD Dr Michael T Koller National Epidemiologist & Head of the data center of the STCS On behalf of."— Presentation transcript:
The Swiss Transplant Cohort Study 1.5.2008 – 30.6.2013 PD Dr Michael T Koller National Epidemiologist & Head of the data center of the STCS On behalf of all members of the STCS firstname.lastname@example.org www.stcs.ch
2 We write the medical history that others read. 4) 4) Not long ago, the University Hospital of Zurich transplanted to two patients simultanously a double lung by segmentation of the donor lung. The girl and the jung men, who suffered from birth of CF got a new life – and medicine a new chapter of history.
An example of STCS collaboration E-Mail the ad to … email@example.com What was exactly done in Zürich? How was the outcome in the recipients? Response time from Zürich: 45’ !! 3
USZ: segmentation of the donor lung … Donor: 33y old male † ICH R1: 19 y young male (80001753). Double lung. R2: 14 y young female (80001757). Double lung. 16.12.2010 15.12.2010
Recipient 80001757 & 80001753: The STCS psychosocial questionaire: «Patient, how is your life?» The 14 years old femaleVisitThe 19 years old man No PSQ: child.BL FUP 6 FUP 12 FUP 24 FUP 36 PSQ 0: not available PSQ 1: student, never misses a dose of IS; sleep quality of 10/10!; No smoking; No problems to perform usual activities; No pain or discomfort. Most of the time cheerful; Single; PSQ 2: no change PSQ 3 (V2): phys activity 2/week 60 min, easy; QoL: 86/100 VAS. Team trust: 10/10. Full adherent to medication. PSQ 4(V2): phys activity 3/week 45 min, very hard!! QoL: 91/100 VAS; Team trust: 10/10. No smoking. Full adherent to drugs. Still single.
«The destiny of individual patients» 7
«The destiny of all solid organ recipients in Switzerland» 8
Example 1 Lung transplantation (LTX) surivival 9
STCS post-LTX overall patient survival 10 Freeman Hospital, Newcastle, adult CF only, 1994 - 2004 US: Columbia University Medical Center (CUMC), 2001-2008, n=274 UNOS Data from 15`642 adult lung TPX recipients between 1987 and 2009 and in US 61 centers ISHLT Registry (worlwide, US, Europe). 2004-2010, n=17’715 40% 12% 25%
Post-LTX overall patient survival: STCS vs ISHLT 11
Lessons from international benchmarking Compared to the others: we perform well! But: 40% of all LTX recipients are dead by 5 years 12
Example 2 Heart transplantation (HTX) survival 13
Post-HTX overall patient survival CTS Registry (Europe). 1985-2011, n=28’828 Only first TPX ISHLT Registry (worlwide, US, Europe). 1982-2011, n=103’299 UNOS Data, 8029 HTX recipients between 2001 and 2009 and in US 61 centers 25% 22% 18%
Post-HTX center-specific survival: The early STCS experience: 1.5.2008 – 31.12.2011 15
Lessons from national HTX benchmarking Center-specific differences in post-HTX survival disappeared with time… 1.The increase of the sample size (n=85 n=169) reduced differences due to random variation 2.The discussion of center-specific data lead to critical review of case fatalities with impact on patient care 17
Example 3 Renal transplantation (RTX) by type of donor 18
Post-RTX incidence of graft-failure by donor-type AB0 compatible / AB0 incompatible 21 4 «simultaneous» failures of AB0 incompatible allografts failure rate stable at ~ 5% -ACR vascular + TMA -ACR vascular + ATN -ACR vascular + «ARF» -AHR CenterAB0 not c USZ26 USB38 CHUV0 BE8 HUG16 SG3 Total91
RTX recipients from living vs deceased donation Baseline characteristics RTX recipients deceased donation RTX recipients living donation Number of patients769552 Recipient age (in yrs), median56.150.5 - IQR(44.8, 63.7)(37.2, 60.2) Pediatric, n (%)37 (4.8%)22 (4%) Male gender, n (%)491 (63.8%)367 (66.5%) Donor age (in yrs), median5553 - IQR(41, 63)(45, 61) HLA A compatible*, n (%)107 (14.1%)78 (14.3%) HLA B compatible*, n (%)42 (5.5%)55 (10.1%) HLA DR compatible*, n (%)98 (12.9%)79 (14.5%) Class I DSA pos109 (44.1%)53 (35.1%) Class II DSA pos86 (41%)47 (36.2%) DGF, n (%)122 (15.9%)8 (1%) PNF, n (%)8 (1.4%)0 (0%) Current smoker, n (%)110 (14.3%)59 (10.7%) Higher education, n (%)119 (15.5%)169 (30.6%) No work capacity (0%), n (%)318 (41.4%)184 (33.3%) * Number of mismatches = 0
Donor-type by center in RTX 23
Example 4 Is there anything similar between lung and liver transplantation? 24
Failure-free survival in liver vs lung tpx recipients 25 Exactly the same first-year survival !
Example 5 Is there anything similar between … heart and kidney-pancreas transplantation? 26
Failure-free survival in HTX vs Kidney-Pancreas recipients 27
Incidence of graft-failure by organ 28
Graft-failure in double TPX 29 KidneyLiverPancreasTotal Kidney - Liver1102 Kidney – Pancreas (n=57) 0010 Pancreas - Small bowel0011 Total111113
STCS project status 30 http://www.stcs.ch/publications/stcs-reports/
Patient recruitment by organ 31 TotalRe- TPX (%) Secon d TPX (%) Kidney132115.31.9 Liver4813.71.5 Lung2343.01.3 Heart1690.60.0 Kidney - Pancreas 570.07.0 ….………
Number of patients 32 Patients(%) Total number2358100.0 Pediatric patients1235.4 Single Tpx at enrolment224195.0 Double Tpx at enrolment1144.8 Triple Tpx at enrolment30.1 1st Tpx at enrolment205787.2 Re-Tpx at enrolment23710.1 2nd Tpx at enrolment642.7
Patients follow-up 33 Follow-up Median follow-up duration (years)2.7 IQR (years)1.4 - 4.08 Patient with longest follow-up (years)5.6 Number of deaths261 Patients with (at least one) graft failure154 Patients lost to follow-up*14
Current informed consent by center 34
Achievements and challenges 35
Achievements Scientific committee: completed / published projects 36 1: Bucheli E, Kralidis G, Boggian K, Cusini A, Garzoni C, Manuel O, Meylan PR, Mueller NJ, Khanna N, van Delden C, Berger C, Koller MT, Weisser M; The Swiss Transplant Cohort Study. Impact of enterococcal colonization and infection in solid organ transplantation recipients from the Swiss Transplant Cohort Study. Transpl Infect Dis. 2013 Dec 16. 2: De Geest S, Burkhalter H, Berben L, Bogert LJ, Denhaerynck K, Glass TR, Goetzmann L, Kirsch M, Kiss A, Koller MT, Piot- Ziegler C, Schmidt-Trucksäss A; Psychosocial Interest Group, Swiss Transplant Cohort Study. The Swiss Transplant Cohort Study's framework for assessing lifelong psychosocial factors in solid-organ transplants. Prog Transplant. 2013 Sep;23(3):235- 46. 3: Burkhalter H, Wirz-Justice A, Cajochen C, Weaver T, Steiger J, Fehr T, Venzin RM, De Geest S. Validation of a single item to assess daytime sleepiness for the Swiss Transplant Cohort Study. Prog Transplant. 2013 Sep;23(3):220-8. 4: Manuel O, Kralidis G, Mueller NJ, Hirsch HH, Garzoni C, van Delden C, Berger C, Boggian K, Cusini A, Koller MT, Weisser M, Pascual M, Meylan PR; Swiss Transplant Cohort Study. Impact of antiviral preventive strategies on the incidence and outcomes of cytomegalovirus disease in solid organ transplant recipients. Am J Transplant. 2013 Sep;13(9):2402-10. 5: Koller MT, van Delden C, Müller NJ, Baumann P, Lovis C, Marti HP, Fehr T,Binet I, De Geest S, Bucher HC, Meylan P, Pascual M, Steiger J. Design and methodology of the Swiss Transplant Cohort Study (STCS): a comprehensive prospective nationwide long-term follow-up cohort. Eur J Epidemiol. 2013 Apr;28(4):347-55. 6: Berger C, Boggian K, Cusini A, van Delden C, Garzoni C, Hirsch HH, Khanna N,Koller M, Manuel O, Meylan P, Nadal D, Weisser M, Mueller NJ; Transplant Infectious Diseases Working Group, Swiss Transplant Cohort Study. Relevance of cohort studies for the study of transplant infectious diseases. Curr Opin Organ Transplant. 2012 Dec;17(6):581-5.
Evolution of scientific projects applications 37
International collaborations 38 Collaboration / PartnerTopic A. Humar, Edmonton (Toronto)CMV pathogenesis Giral/Foucher, DIVAT cohort, FranceLong-term evolution after kidney transplantation German Center for Infection Research, Munich, Germany Sharing of infrastructural experience Comprehensive ID outcome collection SysClad (EU project), FranceSystems prediction of Chronic Lung Allograft Dysfunction J Wilson‐McManus, PROOF, CanadaBiomarkers in Transplantation Aguado, Resitra cohort, SpainEuropean analysis of rare Infectious Diseases endpoints (Aspergillosis)
Achievements Recent SNSF Re-funding … the 3 rd period! Active working groups: LDM, PSIG, ID, Genetic, Lab Comprehensive reporting on TPX outcomes Operating data center providing project support and data upates 39
Challenges IT IS INCREASING! Patients, Transplantations, Organs, Follow-up, Events, Samples, Projects, Disk volume, Staff, Meetings, Data requests, official/political requests … Increase the scientific output Perform sophisticated national and international center benchmarking Don’t stop to let that system grow! 40
Challenges … our patients 41
Heart 3 Liver (incl. small bowel) 3 Kidney 6 Pancreas islet 2 Stem cell Alogeneiic 3 ID 2 Lung 2 Scientific Committee Data center Executive Office (MP, CVD + JS) Coordination Board of Representatives 1 per center (6, with one vote each) Representation Ticino (1) to be discussed Stem cell (1) Pediatrics (1) Swisstransplant (1) Executive office (3, 1 vote) IT and Epidemiology (no vote) Pediatrics 1 Swisstransplant 1 Immunology 2 IT 1 Epidemiology incl. data management center 1 Executive office 3 (1 vote) Psychosocial group 2 Working groups Lab group (PM) Psycho social group (SDG) ID group (CVD) Local data managers group (EB) Pediatric group (DN) Stem cell group (JP) Head: MK Central Data Mana- gement (JR,MW) Epidemio- logy (MK) Bio- Statistician (SS) IT Head: CL (PB)
Recipients 80001757 & 80001753 48 The 14 years old femaleVisitThe 19 years old man Donor: 33 y, male, † ICH TPX: 16.12.2010, double lung! BLDonor: 33 y, male, † ICH TPX: 15.12.2010, double lung! 2 RT infections: - Mycobacterium other than tuberculosis (MOTT) - Aspergillus fumigatus Complications: Pleural effusion No PSQ: child. FUPNo infections! No complications! PSQ 1: student, never misses a dose of IS, sleep quality of 10/10!; No smoking; No problems to perform usual activities; Most of the time cheerful; Single; PSQ 3 (V2!): phys activity 2/week 60 min, easy; QoL: 86/100 VAS. Team trust: 10/10. Full adherent to drugs. PSQ 4: phys activity 3/week 45 min, very hard!! QoL: 91/100 VAS; Team trust: 10/10. No smoking. Full adherent to drugs. Still single.