Design and methodology of the Swiss Transplant Cohort Study (STCS): a comprehensive prospective nationwide long-term follow-up cohort

Koller, Michael; Delden, Christian van; Müller, Nicolas; Baumann, Philippe; Lovis, Christian; Marti, Hanspeter; Fehr, Thomas; Binet, Isabelle; Geest, Sabina De; Bucher, Heiner C.; Meylan, Pascal; Pascual, Manuel; Steiger, Jürg

doi:10.1007/s10654-012-9754-y

Cited by 107 publications

(147 citation statements)

References 15 publications

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“…diseases end points in the Swiss Transplant Cohort Study (19), infections are likely to assume even a more pronounced relevance in the long term.…”

Section: Discussionmentioning

confidence: 99%

Risk Stratification for Rejection and Infection after Kidney Transplantation

Cippà¹,

Schiesser²,

Ekberg

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Definition of individual risk profile is the first step to implement strategies to keep the delicate balance between under-and overimmunosuppression after kidney transplantation. Results Despite different temporal dynamics, rejections and severe infections had similar overall incidences in the first year after transplantation (23.4% and 25.5%, respectively), and infections were the principal cause of death (43.2% of all deaths). Recipient older age, deceased donor, higher number of HLA mismatches, and high risk for cytomegalovirus disease were associated with infection; deceased donor, higher number of HLA mismatches, and immunosuppressive therapy including cyclosporin A (compared with tacrolimus), with rejection. These factors were integrated into a two-dimensional risk stratification model, which defined four risk groups: low risk for infection and rejection (30.8%), isolated risk for rejection (36.1%), isolated risk for infection (7.0%), and high risk for infection and rejection (26.1%). In internal validation, this model significantly discriminated the subgroups in terms of composite end point (low risk for infection/rejection, 24.4%; isolated risk for rejection and isolated risk for infection, 31.3%; high risk for infection/rejection, 54.4%; P,0.001), rejection episodes (isolated risk for infection and low risk for infection/rejection, 13.0%; isolated risk for rejection and high risk for infection/ rejection, 24.2%; P=0.001), and infection episodes (low risk for infection/rejection and isolated risk for rejection, 12.0%; isolated risk for infection and high risk for infection/rejection, 37.6%; P,0.001). External validation confirmed the applicability of the model to an independent cohort.Conclusions We propose a two-dimensional risk stratification model able to disentangle the individual risk for rejection and infection in the first year after kidney transplantation. This concept can be applied to implement a personalized immunosuppressive and antimicrobial treatment approach.

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“…diseases end points in the Swiss Transplant Cohort Study (19), infections are likely to assume even a more pronounced relevance in the long term.…”

Section: Discussionmentioning

confidence: 99%

Risk Stratification for Rejection and Infection after Kidney Transplantation

Cippà¹,

Schiesser²,

Ekberg

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…The STCS is a multicenter cohort study including SOT performed in Switzerland from May 2008 onward (19). The acceptance rate of participating in the STCS is approximately 95% among all SOT recipients.…”

Section: Study Design and Data Collectionmentioning

confidence: 99%

“…The aim of our study was to assess the incidence, risk factors and transplant outcomes associated with CMV disease in a large nationwide cohort of SOT recipients (Swiss Transplant Cohort Study [STCS]) (19). We specifically evaluated the impact of antiviral prophylaxis and preemptive therapy on the incidence of CMV disease and transplant outcomes, taking advantage of the variable strategies used in local transplant programs.…”

Section: Introductionmentioning

confidence: 99%

Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients

Manuel

Kralidis

Mueller

et al. 2013

American Journal of Transplantation

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We assessed the impact of antiviral prophylaxis and preemptive therapy on the incidence and outcomes of cytomegalovirus (CMV) disease in a nationwide prospective cohort of solid organ transplant recipients.Risk factors associated with CMV disease and graft failure-free survival were analyzed using Cox regression models. One thousand two hundred thirty-nine patients transplanted from May 2008 until March 2011 were included; 466 (38%) patients received CMV prophylaxis and 522 (42%) patients were managed preemptively. Overall incidence of CMV disease was 6.05% and was linked to CMV serostatus (Dþ/RÀ vs. Rþ, hazard ratio [HR] 5.36 [95% CI 3.14-9.14], p < 0.001). No difference in the incidence of CMV disease was observed in patients receiving antiviral prophylaxis as compared to the preemptive approach (HR 1.16 [95% CI 0.63-2.17], p ¼ 0.63). CMV disease was not associated with a lower graft failure-free survival (HR 1.27 [95% CI 0.64-2.53], p ¼ 0.50). Nevertheless, patients followed by the preemptive approach had an inferior graft failure-free survival after a median of 1.05 years of follow-up (HR 1.63 [95% CI 1.01-2.64], p ¼ 0.044). The incidence of CMV disease in this cohort was low and not influenced by the preventive strategy used. However, patients on CMV prophylaxis were more likely to be free from graft failure.

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“…We made use of the Swiss Transplant Cohort Study, a large prospective multicenter effort collecting data and bio samples on all solid organ transplants performed in Switzerland, 17 to address whether recipient KIR genotype associates with the risk of viral infections in recipients of SOT.…”

Section: And the Swiss Transplant Cohort Studymentioning

confidence: 99%

“…17 Written informed consent was obtained from all study participants, and the study was approved by the institutional review boards in all centers.…”

Section: Patients and Materials Patientsmentioning

confidence: 99%

Protection From Varicella Zoster in Solid Organ Transplant Recipients Carrying Killer Cell Immunoglobulin-Like Receptor B Haplotypes

et al. 2015

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BACKGROUND: Natural killer cell function is regulated by inhibitory and activating killer cell immunoglobulin-like receptors (KIR). Previous studies have documented associations of KIR genotype with the risk of cytomegalovirus (CMV) replication after solid organ transplantation. METHODS: In this study of 649 solid organ transplant recipients, followed prospectively for infectious disease events within the Swiss Transplant Cohort Study, we were interested to see if KIR genotype associated with virus infections other than CMV. RESULT: We found that KIR B haplotypes (which have previously been linked to protection from CMV replication) were associated with protection from varicella zoster virus infection (hazard ratio, 0.43; 95% confidence interval, 0.21-0.91; P = 0.03). No significant associations were detected regarding the risk of herpes simplex, Epstein-Barr virus or BK polyomavirus infections. CONCLUSIONS: In conclusion, these data provide evidence that the relative protection of KIR haplotype B from viral replication after solid organ transplantation may extend beyond CMV to other herpes viruses, such as varicella zoster virus and possibly Epstein-Barr virus.

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Design and methodology of the Swiss Transplant Cohort Study (STCS): a comprehensive prospective nationwide long-term follow-up cohort

Cited by 107 publications

References 15 publications

Risk Stratification for Rejection and Infection after Kidney Transplantation

Risk Stratification for Rejection and Infection after Kidney Transplantation

Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients

Protection From Varicella Zoster in Solid Organ Transplant Recipients Carrying Killer Cell Immunoglobulin-Like Receptor B Haplotypes

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