The Importance of Diagnostics in Post-Transplant Care
Prevention & Treatment Learn how diagnostic tests that can help doctors diagnose and treat post-transplant infections are helping improve patient outcomes.
Despite the promise of new life that transplant surgeries allow, individuals with donated organs must also take immunosuppressive drugs for the rest of their lives to prevent their bodies from rejecting the foreign organ. While helpful, these drugs also increase the patients’ risk for infection due to their weakened immune systems.
Indeed, a study published in December 2017 in the journal Pediatric Nephrology shows infections are the leading cause of hospitalizations among transplant patients after surgery.
Diagnostics’ role in post-transplant surgery
That’s why diagnostic tests that help doctors identify post-transplant infections early are key, says Michelle Altrich, Ph.D., HCLD (ABB), Chief Scientific Officer and Clinical Laboratory Director of Viracor Eurofins. “Diagnosing early is critical – there can be an absence of early symptoms with infection and symptoms of rejection and infection can be similar, making it hard to determine if it’s an infection or complication from medication,” Altrich explains.
Data suggest common post-transplant infections include invasive fungal infections, for which lung and blood and marrow transplant (BMT) recipients are at the greatest risk; Cytomegalovirus (CMV) and Epstein-Barr virus (EBV), to which heart transplant recipients are most prone; and BK virus (BKV), for which kidney transplant recipients are most at risk.
Altrich notes most critical infections are contracted 180 days post-transplant, but luckily, “Newer diagnostic laboratory methods have added much-needed capacity to identify the presence and types of pathogens, often early enough to prevent or mitigate severe infection.”
“Talking openly with your physician about concerns, questions or symptoms you experience throughout the process will help you feel better and more informed.”
Why timing and accuracy are crucial
Timing is key: a study published in July 2006 in the journal Clinical Infectious Diseases suggests a treatment delay of three days increases the mortality from fungal infections from 15 to 40 percent.
Accuracy is crucial, too. “There can be variability within the genetic makeup of a given pathogen,” Altrich says, adding that because some pathogens adapt, they’re increasingly difficult to diagnose and treat. “It’s very important that the diagnostic tests used to detect these pathogens are comprehensive enough to detect all strains, and to ensure the patient doesn’t receive a false negative, where it appears negative when the pathogen is indeed present.”
Because infections may be localized, diagnostic tests that can be used on various samples to identify isolated infections are critical. “When the lab has validated and can accept multiple specimen types, it provides the physician and patient more options for diagnosing localized infections,” she says.
Diagnostics for infections in transplant patients have come a long way. Today, some, such as Viracor Eurofins’ CMV antiviral resistance test, use gene sequencing to analyze antiviral resistance and enable doctors to change treatments precisely. “Treatment modification based solely on clinical suspicion may result in added toxicity and increased complexity in patient management,” says Altrich, adding that the CMV T Cell Immunity Panel can also help determine whether the patient’s body can fight CMV on its own or if they need to use antivirals to fight it.
What patients can do
For those transplant patients and their families concerned about infections, Altrich notes it’s important to be proactive in post-transplant care and to be open and honest with physicians along the way. “Talking openly with your physician about concerns, questions or symptoms you experience throughout the process will help you feel better and more informed,” she says, “and also provide your physician with information that, along with diagnostics, can help you and your clinical team develop and follow the best plan and path to stay healthy.”