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Transplant Transmitted Infections

Ensuring the gift of life is safely delivered

For certain health conditions, transplantation of solid organs, tissues, or cells from a donor to a recipient is often the only cure.

End-stage organ failure is estimated to affect more than six million people worldwide.1 Advancements in surgical techniques, immunosuppression, donor–recipient matching, and antimicrobial agents have all contributed to increase patient success during transplant procedures.2

However, complications due to infection after transplantation are one of the main causes of post-operative morbidity and mortality— including rejection or loss of the graft or the transplant, among other challenges.3

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Donor-derived infections highlight the need for pre-transplant screening

Due to high demand for organs and cells, every potential donor should be considered. However, this can open the possibility of transmitting infections and to a lesser extent malignancy, from the donor organ to the immunosuppressed recipient, possibly affecting long-term organ function.4

Addressing this requires an appropriate assessment of the potential risks of infections pre-transplantation (including the use of donations testing positive for treatable infections) to ensure a successful graft.

Opportunistic infection can cause post-transplant complications if not managed

Immunosuppressive regimes are critical in controlling organ rejection but can increase the susceptibility of patients to certain infections.5 Cytomegalovirus (CMV) is one of the major sources of transplant-transmitted infections, affecting about 60-100% of adults after transplantation.6 Other notable pathogens include BK virus (BKV), Epstein-Barr virus (EBV), Herpes Simplex Virus (HSV), Varicella Zoster Virus (VZV), Toxoplasma gondii (Toxo), human Adenovirus (hADV) and, more recently, SARS-CoV-2.7-9

Pre- and post-transplantation laboratory testing is critical to making the most out of every donation and to ensuring patients get the life-saving surgeries they need.

Clinical laboratorians play a key role in the success of transplant programs

Minimizing risk requires comprehensive and reliable pre- and post-transplant testing.

From initial screening to post-transplantation follow-up, several samples are needed to run multiple tests for possible pathogens. Across serologic and molecular testing, increased automation, broad testing menus, and streamlined workflows are enabling laboratories to more efficiently process samples and identify potentially problematic pathogens.

Pre-transplantation

Serologic screening is an integral part of clinical management, helping to:10

  • Identify infections which may disqualify the recipient or the donor
  • Match the right donor with the right recipient
  • Implement strategies to mitigate the risk of infection post-transplant

Only with appropriate screening for infectious diseases pre-transplant is it possible to assess all the risks associated with the transplant, which is essential for its success.

Roche transplant testing solutions lung
Roche transplant testing solutions kidney

Post-transplantation

Nucleic acid amplification testing (NAT) techniques, like polymerase chain reaction (PCR) testing, are commonly used to:

  • Aid in the diagnosis and management of transplant patients
  • Measure viral load to inform the need for treatment
  • Monitor a patient’s response to therapy

The widespread application of PCR for the detection of viral nucleic acid (DNA or RNA) is the most important innovation in laboratory diagnosis and clinical management of post-transplant infections.11

Two female lab technicians working in a lab
Providing end-to-end coverage from the inside out

Roche’s robust portfolio of transplant screening, infection monitoring, and therapeutic drug monitoring assays is designed to support you in giving patients the best chance at a second chance.

Across the diagnostic continuum of transplant donors and recipients, Roche offers a comprehensive range of serological and molecular tests that cover 80% of the most common infections.

  • Highly specific and sensitive assays minimize unnecessary discarding of transplants and ensure safe transplantations
  • Traceability of viral load results allows for convenient patient follow-up

To optimize infection management, Roche’s fully automated systems can run multiple tests from a single sample, delivering trusted results quickly.

  • Fully automated workflows reduce the potential for human error
  • Standardized processes ensure predictable turnaround times
  • Reproducible results allow for confident decision-making
Close up of assays in a laboratory instrument

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    References

    1. Levin A, Tonelli M, Bonventre J, et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet. 2017;390(10105):1888-1917. doi:10.1016/S0140-6736(17)30788-2.
    2. Rana A, Godfrey EL. Outcomes in Solid-Organ Transplantation: Success and Stagnation. Tex Heart Inst J. 2019;46(1):75-76.
    3. Jha V. Post-transplant infections: An ounce of prevention. Indian J Nephrol. 2010;20(4):171-178.
    4. Rao YG, Mirza DF. Infections transmitted from donors to recipients following organ transplantation. Natl Med J India. 2005;18(4):189-194.
    5. Kumar R, Ison MG. Opportunistic Infections in Transplant Patients. Infect Dis Clin North Am. 2019;33(4):1143-1157.
    6. Almaghrabi RS, Omrani AS, Memish ZA. Cytomegalovirus infection in lung transplant recipients. Expert Rev Respir Med. 2017;11(5):377-383.
    7. Vanichanan J, Udomkarnjananun S, Avihingsanon Y, Jutivorakool K. Common viral infections in kidney transplant recipients. Kidney Res Clin Pract. 2018;37(4):323-337.
    8. Robert-Gangneux F, Meroni V, Dupont D, et al. Toxoplasmosis in Transplant Recipients, Europe, 2010-2014. Emerg Infect Dis. 2018;24(8):1497-1504.
    9. Ahn C, Amer H, Anglicheau D, et al. Global Transplantation COVID Report March 2020. Transplantation. 2020;10.1097.
    10. The American Association for Clinical Chemistry. The Laboratory’s Role in Solid Organ Transplantation.
      https://www.aacc.org/publications/cln/articles/2016/november/the-laboratorys-role-in-solid-organ-transplantation. [Accessed September 2023].
    11. Razonable RR, Paya CV, Smith TF. Role of the laboratory in diagnosis and management of cytomegalovirus infection in hematopoietic stem cell and solid-organ transplant recipients.