Classification of death causes after transplantation (CLASS)

Wareham, Neval Ete; Cunha‐Bang, Caspar da; Borges, Álvaro H.; Ekenberg, Christina; Gerstoft, Jan; Gustafsson, Finn; Hansen, Ditte; Heilmann, Carsten; Helleberg, Marie; Hillingsø, Jens; Krohn, Paul Suno; Lodding, Isabelle Paula; Lund, Thomas Kromann; Lundgren, Louise; Mocroft, Amanda; Perch, Michael; Petersen, Solveig; Petruskevicius, Irma; Rasmussen, Allan; Rossing, Kasper; Rostved, Andreas Arendtsen; Sengeløv, Henrik; Sørensen, Vibeke Rømming; Sørensen, Søren Schwartz; Lundgren, Jens D

doi:10.1097/md.0000000000011564

Cited by 15 publications

(25 citation statements)

References 23 publications

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“…The cause of death was obtained by the Classification of Death Causes after Transplantation (CLASS) method, where all deceased LTXr were evaluated by clinicians in a standardized procedure, as previously described [35].…”

Section: Cause Of Deathmentioning

confidence: 99%

Achromobacter spp. in a Cohort of Non-Selected Pre- and Post-Lung Transplant Recipients

et al. 2022

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Achromobacter is an opportunistic pathogen that mainly causes chronic lung infections in cystic fibrosis (CF) patients and is associated with increased mortality. Little is known about Achromobacter spp. in the lung transplant recipient (LTXr) population. We aimed at describing rates of Achromobacter spp. infection in LTXr prior to, in relation to, and after transplantation, as well as all-cause mortality proportion in infected and uninfected LTXr. We included 288 adult LTXr who underwent lung transplantation (LTX) between 1 January 2010 and 31 December 2019 in Denmark. Bronchoalveolar lavage was performed at regular intervals starting two weeks after transplantation. Positive cultures of Achromobacter spp. were identified in nationwide microbiology registries, and infections were categorized as persistent or transient, according to the proportion of positive cultures. A total of 11 of the 288 LTXr had transient (n = 7) or persistent (n = 4) Achromobacter spp. infection after LTX; CF was the underlying disease in 9 out of 11 LTXr. Three out of the four patients, with persistent infection after LTX, also had persistent infection before LTX. The cumulative incidence of the first episode of infection one year after LTX was 3.8% (95% CI: 1.6–6.0). The incidence rates of transient and persistent infection in the first year after LTX were 27 (12–53) and 15 (5–37) per 1000 person-years of follow-up, respectively. The all-cause mortality proportion one year after LTX was 27% in the Achromobacter spp. infected patients and 12% in the uninfected patients (p = 0.114). Achromobacter spp. mainly affected LTXr with CF as the underlying disease and was rare in non-CF LTXr. Larger studies are needed to assess long-term outcomes of Achromobacter spp. in LTXr.

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Section: Cause Of Deathmentioning

confidence: 99%

Achromobacter spp. in a Cohort of Non-Selected Pre- and Post-Lung Transplant Recipients

et al. 2022

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“…This multi-institute approach should be considered as a model for sepsis research initiatives moving forward, as both a discovery phase for identifying clinically relevant phenotypes and/or biomarkers, but also as a platform for implementing any observations into a clinical setting. Such a collaborative research would also facilitate the standardisation and sharing of research methods, expertise (both analytical and clinical), as well as descriptions/definitions of clinical outcomes and causes of death, in a similar way to what has been done in HIV and transplant research [ 44 , 45 ]. The most common approach today is post hoc collaborations across centres with biomaterial and data from previous investigations.…”

Section: How To Apply Omics In Sepsis Researchmentioning

confidence: 99%

Sepsis: Personalized Medicine Utilizing ‘Omic’ Technologies—A Paradigm Shift?

2018

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Sepsis has over the years proven a considerable challenge to physicians and researchers. Numerous pharmacological and non-pharmacological interventions have been tested in trials, but have unfortunately failed to improve the general prognosis. This has led to the speculation that the sepsis population may be too heterogeneous to be targeted with the traditional one treatment suits all’ approach. Recent advances in genetic and biochemical analyses now allow genotyping and biochemical characterisation of large groups of patients via the ‘omics’ technologies. These new opportunities could lead to a paradigm shift in the approach to sepsis towards personalised treatments with interventions targeted towards specific pathophysiological mechanisms activated in the patient. In this article, we review the potentials and pitfalls of using new advanced technologies to deepen our understanding of the clinical syndrome of sepsis.

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“…Further, using national death causes registries where cause of death more often refers to the underlying disease leading to transplantation may be misleading and thus less useful in a transplant setting[20]. Therefore, the aim of this work was to determine the specific underlying causes of death in SOT recipients using the recently developed Classification of Death Causes after Transplantation (CLASS) method[20], which includes a thorough investigation of the events leading to death and a review process by independent transplant specialists. This method has previously shown relatively high discrepancy when compared with national registries, resulting in reclassification of causes of death in more than 60% of cases[20].…”

Section: Introductionmentioning

confidence: 99%

“…A common limitation in previous studies has been incomplete classification of causes of death with up to 60% of deaths attributed to unknown or missing causes in large cohort studies [13,[16][17][18][19]. Further, using national death causes registries where cause of death more often refers to the underlying disease leading to transplantation may be misleading and thus less useful in a transplant setting [20]. Therefore, the aim of this work was to determine the specific underlying causes of death in SOT recipients using the recently developed Classification of Death Causes after Transplantation (CLASS) method [20], which includes a thorough investigation of the events leading to death and a .…”

Section: Introductionmentioning

confidence: 99%

Trends in underlying causes of death in solid organ transplant recipients between 2010 and 2020: Using the CLASS method for determining specific causes of death

Søborg

Reekie

Rasmussen

et al. 2022

Preprint

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Monitoring specific underlying causes of death in solid organ transplant (SOT) recipients is important in order to identify emerging trends and health challenges. This retrospective cohort study includes all SOT recipients transplanted at Rigshospitalet between January 1st, 2010 and December 31st, 2019. The underlying cause of death was determined using the newly developed Classification of Death Causes after Transplantation (CLASS) method. Cox regression analyses assessed risk factors for all-cause and cause-specific mortality. Of the 1774 SOT recipients included, 299 patients died during a total of 7511 person-years of follow-up (PYFU) with cancer (N=57, 19%), graft rejection (N=55, 18%) and infections (N=52, 17%) being the most frequent causes of death. We observed a lower risk of all-cause death with increasing transplant year (HR 0.91, 95% CI 0.86-0.96 per 1-year increase), alongside death from graft rejection (HR 0.84 per year, 95% CI 0.74-0.95) and death from infections (HR 0.87 per year, 95% CI 0.77-0.98). Further, there was a trend towards lower cumulative incidence of death from cardiovascular disease, graft failure and cancer in more recent years, while death from other organ specific and non-organ specific causes did not decrease. All-cause mortality among SOT recipients has decreased over the past decade, mainly due to a decrease in graft rejection- and infection-related deaths. Conversely, causes from a broad range of diseases have remained unchanged, suggesting that cause of death among SOT recipients is increasingly diverse and warrants a multidisciplinary effort and attention in the future.

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Classification of death causes after transplantation (CLASS)

Abstract: Supplemental Digital Content is available in the text

Cited by 15 publications

References 23 publications

Achromobacter spp. in a Cohort of Non-Selected Pre- and Post-Lung Transplant Recipients

Achromobacter spp. in a Cohort of Non-Selected Pre- and Post-Lung Transplant Recipients

Sepsis: Personalized Medicine Utilizing ‘Omic’ Technologies—A Paradigm Shift?

Trends in underlying causes of death in solid organ transplant recipients between 2010 and 2020: Using the CLASS method for determining specific causes of death

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