Danilo Schmidt

Charité Universitätsmedizin Berlin | Charité

Background: High numbers of unknown classifications and inconsistent methodologies in previous studies make the interpretation of causes leading to graft loss difficult. In addition, data on a holistic view looking at both death with a functioning graft (DWF) and death-censored graft failure (DCGF) are sparse. Methods: In this single-center stud...

Background De novo donor-specific HLA antibodies (dnDSA) are key factors in the diagnosis of antibody-mediated rejection (ABMR) and related to graft loss. Methods This retrospective study was designed to evaluate the natural course of dnDSA in graft function and kidney allograft survival and to assess the impact of mean fluorescence intensity (MFI...

Background: In the information extraction and natural language processing domain, accessible datasets are crucial to reproduce and compare results. Publicly available implementations and tools can serve as benchmark and facilitate the development of more complex applications. However, in the context of clinical text processing the number of accessi...

Patient care after kidney transplantation requires integration of complex information to make informed decisions on risk constellations. Many machine learning models have been developed for detecting patient outcomes in the past years. However, performance metrics alone do not determine practical utility. Often, the actual performance of medical pr...

Background Transplant glomerulopathy (TG) may indicate different disease entities including chronic AMR (antibody-mediated rejection). However, AMR criteria have been frequently changed, and long-term outcomes of allografts with AMR and TG according to Banff 2017 have rarely been investigated. Methods 282 kidney allograft recipients with biopsy-pr...

Immunosuppression increases the risk of severe coronavirus disease 2019 (COVID-19). Morbidity and mortality of this disease in kidney transplant patients are higher than in the general population. As the vaccination response of transplant patients is weak, serological monitoring was performed. In this cohort study, we analyzed the determinants of v...

The Banff 2017 report permits the diagnosis of pure chronic antibody-mediated rejection (cAMR) in absence of microcirculation inflammation. We retrospectively investigated renal allograft function and long-term outcomes of 67 patients with cAMR, and compared patients who received antihumoral therapy (cAMR-AHT, n = 21) with patients without treatmen...

Background: Transplant glomerulopathy (TG) is one of the main causes of post-transplant proteinuria (PU). The features and possible risk factors for proteinuria in TG patients are uncertain. Methods: We investigated all patients who had biopsy-proven TG from 2000 to 2018 in our center. The clinical and histological data were compared between two gr...

Background and Aims Patients with chronic kidney disease suffer often from cardiovascular diseases, especially high blood pressure and its complications such as stroke and heart attack. After kidney transplantation, this condition persists and can in addition harm the graft. However, outpatient care surveillance is not ideal to treat high blood pre...

Background Few studies have thoroughly investigated the causes of kidney graft loss (GL), despite its importance. Methods A novel approach assigns each persistent and relevant decline in renal function over the lifetime of a renal allograft to a standardized category, hypothesizing that singular or multiple events finally lead to GL. An adjudicati...

TBase is an electronic health record (EHR) for kidney transplant recipients (KTR) combining automated data entry of key clinical data (e.g., laboratory values, medical reports, radiology and pathology data) via standardized interfaces with manual data entry during routine treatment (e.g., clinical notes, medication list, and transplantation data)....

The MACCS (Medical Assistant for Chronic Care Service) platform enables secure sharing of key medical information between patients after kidney transplantation and physicians. Patients provide information such as vital signs, well-being, and medication intake via smartphone apps. The information is transferred directly into a database and electroni...

Background: The number of patients returning to dialysis after graft failure increases. Surprisingly, little is known about the clinical and immunological outcomes of this cohort. Methods: We retrospectively analyzed 254 patients after kidney allograft loss between 1997-2017 and report clinical outcomes such as mortality, relisting, retransplant...

Introduction Acute kidney injury (AKI) is an important complication in COVID-19, but its precise etiology has not fully been elucidated. Insights into AKI mechanisms may be provided by analyzing the temporal associations of clinical parameters reflecting disease processes and AKI development. Methods We performed an observational cohort study in 2...

Proteinuria and transplant glomerulopathy (TG) are common in kidney transplantation. To date, there is limited knowledge regarding proteinuria in different types of TG and its relationship to allograft survival. A retrospective cohort analysis of TG patients from indication biopsies was performed to investigate the relationship of proteinuria, hist...

Background De-novo malignancies after kidney transplantation represent one major cause for mortality after transplantation. However, most of the studies are limited due to small sample size, short follow-up or lack of information about cancer specific mortality. Methods This long-term retrospective analysis included all adult patients with complet...

eHealth (“electronic” Health) is a new field in medicine that has the potential to change medical care, increase efficiency, and reduce costs. In this review, we analyzed the current status of eHealth in transplantation by performing a PubMed search over the last 5 years with a focus on clinical studies for post‐transplant care. We retrieved 463 ma...

Tools and resources to automatically process clinical text are very limited, particularly outside the English speaking world. As many relevant patient information within electronic health records are described in unstructured text, this is a clear drawback. In order to slightly overcome this problem, we present information extraction models for Ger...

Patienten nach erfolgreicher Nierentransplantation müssen meist einen komplizierten Medikationsplan einnehmen und im Alltag verschiedene Vorgaben beachten. Nicht jedem gelingt dies, was zu kurz-oder langfristigem Verlust der Transplantatfunktion mit der dann notwendigen Wiedereinleitung der Dialyse führen kann. Die Dialyse erzeugt hohe Kosten für d...

ZUSAMMENFASSUNG In Anbetracht der hohen Inzidenz und Mortalität von AKI (Acute Kidney Injury) sowie der unzureichenden Erkennung von AKI-Episoden im klinischen Alltag, sind AKI-Frühwarnsysteme ein einfacher und naheliegender Ansatz, um die Versorgung von AKI-Patienten zu verbessern. Obwohl AKI-Alerts in prospektiven Studien bisher keine konsistente...

Background: In de novo kidney transplant recipients (KTR) treatment with belatacept has been established as a comparable option as maintenance immunosuppression, preferably as a strategy to convert from calcineurin inhibitor (CNI)- to belatacept-based immunosuppression. Switch to belatacept demonstrated improved renal function in patients with CNI...

Background: Mycophenolic acid (MPA) is a standard immunosuppressant in organ transplantation. A simple monitoring biomarker for MPA treatment has not been established so far. Here, we describe inosine 5'-monophosphate dehydrogenase (IMPDH) monitoring in erythrocytes and its application to kidney allograft recipients. Methods: IMPDH activity meas...

Background and Aims This study compared epidemiology, short- and long-term outcomes for patients with community-acquired (CA) and hospital-acquired (HA) acute kidney injury (AKI). Method We retrospectively analyzed all episodes of AKI over a period of 3.5 years (2014–2017) on the basis of routinely obtained serum creatinine measurements in 103,161...

Für die Digitalisierung im Gesundheitswesen braucht es innovative Projekte zur Optimierung veralteter Arbeitsprozesse. Das Medical Allround Care Service Solutions (MACSS) stellt prototypisch eine neuartige Smart-Health-Serviceplattform für eine integrierte Versorgung chronisch kranker Patienten zur Verfügung, die eine bidirektionale Kommunikation z...

Background: Studies from multiple countries have shown that acute kidney injury (AKI) in hospitalized patients is associated with mortality and morbidity. There are no reliable data at present on the incidence and mortality of AKI episodes among hospitalized patients in Germany. The utility of administrative codings of AKI for the identification o...

The secondary use of data from electronic medical records has become an important factor to determine and to identify various causes of disease. For this reason, applications like informatics for integrating biology and the bedside (i2b2) offer a GUI-based front end to select patient cohorts. To make use of those tools, however, clinical data need...

In this work, we present a syntactic parser specialized for German clinical data. Our model, trained on a small gold standard nephrological dataset, outperforms the default German model of Stanford CoreNLP in parsing nephrology documents in respect to LAS (74.64 vs. 42.15). Moreover, retraining the default model via domain-adaptation to nephrology...

Background Outcomes of patients with end-stage renal disease are mainly affected by their comorbidities. Detailed data evaluating the impact of pre-transplant comorbidities on long-term outcome after kidney transplantation are largely missing. Methods In a long-term retrospective analysis, we investigated 839 deceased donor kidney transplant recip...

Background The correct valganciclovir dose for cytomegalovirus (CMV) prophylaxis depends on renal function estimated by the Cockcroft–Gault (CG) estimated creatinine clearance (CG-CrCl) formula. Patients with delayed or rapidly changing graft function after transplantation (tx) will need dose adjustments. Methods We performed a retrospective inves...

MACSS (Medical All-round Care Service Solutions) ist ein Projekt mit dem Ziel, eine patientenzentrierte Smart-Health-Service-Plattform zur Verbesserung der Patientensicherheit nach einer Nierentransplantation zu entwickeln. Neben der Uberwachung der Arzneimittelsicherheit, soll die Kommunikation zwischen Arzt und Patient, aber auch unter allen beha...

Clinical notes and discharge summaries are commonly used in the clinical routine and contain patient related information such as well-being, findings and treatments. Information is often described in text form and presented in a semi-structured way. This makes it difficult to access the highly valuable information for patient support or clinical st...

Background The aim of this study is to analyze the long-term immunologic outcomes of living-related kidney transplantations depending on the donor-recipient relationship. Methods This retrospective single-center study included adult kidney transplant recipients (KTR) transplanted between 2000 and 2014. Among 1117 KTRs, 178 patients (15.9%) receive...

The MACSS (Medical Allround-Care Service Solutions) prototype represents a novel patient-centered smart health service platform for the integrated cross-sectoral care of kidney transplant recipients. In contrast to all currently existing eHealth solutions in Germany, the MACSS project allows a secure and bi-directional data exchange between patient...

We thank Guidicelli et al. for sharing their valuable thoughts on our recent publication (1) and appreciate the suggestions and ideas for further improvements of PIRCHE-matching (2). Missing consideration of some allopeptides is a limitation of the version of PIRCHE used in this study. The latest version takes more HLA allopeptide sources into acco...

Background Conversion to belatacept at a later point after kidney transplantation (KT) as a rescue therapy has been shown to be beneficiary in an increasing number of patients, but prognostic factors for a favorable outcome have never been investigated. Methods The present study analyzed all KT patients after late conversion to belatacept in a sin...

Background Prevalence of extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-E) has risen in kidney transplant (KT) patients, with no long-term data so far on graft function or survival. Methods KT patients with ESBL-E–positive urine culture were retrospectively analyzed regarding initial adequate antimicrobial therapy, recurrent i...

De novo donor-specific HLA antibodies (dnDSA) are recognized as risk factor for premature allograft failure. Determinants of DSA specificity are generated via the indirect allorecognition pathway. Here, we present supportive data for the relevance of predicted indirectly recognizable HLA epitopes (PIRCHE) to predict dnDSA following kidney transplan...

This work focuses on the integration of multifaceted extensive data sets (e.g. laboratory values, vital data, medications) and partly unstructured medical data such as discharge letters, diagnostic reports, clinical notes etc. in a research database. Our main application is an integrated faceted search in nephrology based on information extraction...

An important subtask in clinical text mining tries to identify whether a clinical finding is expressed as present, absent or unsure in a text. This work presents a system for detecting mentions of clinical findings that are negated or just speculated. The system has been applied to two different types of German clinical texts: clinical notes and di...

In this work we present a fine-grained annotation schema to detect named entities in German clinical data of chronically ill patients with kidney diseases. The annotation schema is driven by the needs of our clinical partners and the linguistic aspects of German language. In order to generate annotations within a short period, the work also present...

Pneumocystis jirovecii pneumonia (PJP) affects immunocompromised patients. As a result of effective prophylaxis in the 1st months after kidney transplantation, PJP is increasingly diagnosed in the long term after transplantation. The present study evaluates course and outcome of PJP in a single transplant center from 2010 to 2015. Twenty-three pati...

In kidney transplant recipients with chronic graft dysfunction, long-term immunosuppression with calcineurin inhibitors (CNIs) or mTOR inhibitors (mTORi) can be challenging due to adverse effects, such as nephrotoxicity and proteinuria. Seventy-nine kidney transplant recipients treated with CNI-based or mTORi-based maintenance immunosuppression who...

MACSS (Medical Care Allround-Service Solutions) ist ein Projekt, dessen Ziel es ist, in Zusammenarbeit von Wissenschaft, Wirtschaft, Krankenkassen und Patientenverbanden, den Prototypen einer neuartigen patientenzentrierten E-Health-Plattform zur Verbesserung der Patientensicherheit nach Nierentransplantation zu entwickeln. Neben einer Verbesserung...

Background The Eurotransplant Senior Program (ESP) neglects HLA matching for elderly (≥65 years) kidney transplant recipients (KTR). Few data regarding the influence of DR matching on clinical and immunologic outcome in elderly KTR exist. Methods This retrospective long-term observational study included 244 elderly out of n = 972 adult KTR between...

Transplant patients are at increased risk for developing severe norovirus (NoV) infections with secondary complications such as rejection episodes and acute transplant failure. This single‐center retrospective study included all kidney transplant patients tested positive for NoV RNA between January 2007 and December 2011. Data were compared to a co...

Background: Antibody-mediated rejection (AMR) can induce and develop thrombotic microangiopathy (TMA) in renal allografts. A definitive AMR (dAMR) co-presents three diagnostic features. A suspicious AMR (sAMR) is designated when one of the three features is missing. Methods: 32 TMA cases overlapping with AMR (AMR+ TMA) were studied, which involv...

As a result of the recent trend towards digitization-- which increasingly affects evidence-based medicine, accountable care, personalized medicine, and medical "Big Data" analysis --growing amounts of clinical data are becoming available for analysis. In this paper, we follow the idea that one can model clinical processes based on clinical data, wh...

Background: Primary focal segmental glomerulosclerosis (FSGS) often causes nephrotic proteinuria and frequently results in end-stage renal disease and recurrence after kidney transplantation. Recent studies describe soluble urokinase-type plasminogen activator receptor (suPAR) as a circulating factor implicated in FSGS. Methods: This single-cent...

Background: MicroRNAs (miRNAs, miR) hold important roles in the post-transcriptional regulation of gene expression. Their function has been correlated with kidney disease, and they might represent a new class of biomarkers for frequent evaluation of renal graft status. We analyzed their potential in identifying severe T cell-mediated vascular rejec...

This article is about a new project that combines clinical data intelligence and smart data. It provides an introduction to the “Klinische Datenintelligenz” (KDI) project which is founded by the Federal Ministry for Economic Affairs and Energy (BMWi); we transfer research and development results (R&D) of the analysis of data which are generated in...

It is unclear if the category of acute rejection with intimal arteritis (ARV) is relevant to short- and long-term clinical outcomes and if the graft outcomes are affected by the severity of intimal arteritis. One hundred forty-eight ARV episodes were reviewed and categorized according to the 2013 Banff criteria of AMR: T cell-mediated rejection wit...

Objectives: Whether T-cell-mediated rejection Banff classification type Ib (severe tubulointerstitial rejection) and type IIa (mild vascular rejection) are associated with responses to antirejection therapy and long-term graft survival are unclear. Materials and methods: One hundred ten patients were enrolled who had at least 1 episode of T-cell...

Objective: We conducted this study to determine whether it is justifiable for transplant centers to reject cadaveric donor organs based on marginal organ quality. There is a growing discrepancy between the demand for renal transplants and the number of transplants conducted. For the many patients on the renal transplant waiting list, this translat...

Objectives: To determine the pathologic features of early- and late-onset acute cellular rejection that may contribute to graft loss after kidney transplant. Materials and methods: There were 247 patients who had acute cellular rejection included in the study. The biopsy that showed the highest acute cellular rejection severity was evaluated for...

Background: It is unclear if the severity or the timing of acute cellular rejection (ACR) defined by Banff classification 2009 is associated with graft survival. Methods: Borderline changes, TCMR I (interstitial rejection), and TCMR II/III (vascular rejection) were defined as low, moderate, and high ACR severity, respectively. Approximately 270...

There exists a major concern regarding toxic effects of immunosuppressive medication on the kidney graft during post-transplant care, with observed variation in individual susceptibility to adverse drug effects amongst patients. To date, there has been no possibility to identify susceptible patients prospectively. This study analyzes medical data w...

The impact of isolated v-lesions on clinical outcome in biopsies with acute cellular rejection (ACR) is unclear. Two hundred and sixty-five biopsies showing the highest ACR severity for each patient were recruited and classified into four groups: (i) acute interstitial rejection (AIR) I with minimal tubulointerstitial inflammation (TI), (ii) AIR II...

In this paper we define Clinical Data Intelligence as the analysis of data generated in the clinical routine with the goal of improving patient care. We define a science of a Clinical Data Intelligence as a data analysis that permits the derivation of scientific, i.e., generalizable and reliable results. We argue that a science of a Clinical Data I...

The Charité hospital in Berlin possesses one of the most secure records of hundreds of kidney transplants, most of which originate from the electronic patient record TBase©. One of the grave problems after kidney transplantation is the recipient body's immune rejection of the transplanted organ. T-cells and antibodies attack the organ, which in the...

Pneumocystis jirovecii pneumonia (PCP) incidence is increasing in kidney transplant recipients (KTR), but risk factors remain poorly defined. CD4 + T lymphopenia and mannose-binding lectin (MBL) deficiency are common immunodeficiencies in KTR. Here, we investigated whether CD4 + T lymphopenia and/or MBL deficiency would be risk factors for PCP in K...

Recurrent urinary tract infections (UTIs) increase mortality and reduce graft survival after renal transplantation. Strategies to prevent recurrent UTIs include L-methionine, cranberry juice, and antibiotics. Data on the efficacy of cranberry and L-methionine, however, are controversial in the general population; there are few data in renal transpl...