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The Critical Role of Laboratory Testing in Transplantation

Organ-procurement organizations, tissue, eye and stem cell banks, transplant clinicians and recipients notice improved outcomes when they work with specialized-transplant laboratories that offer comprehensive and innovative testing. This ensures the delivery of accurate and timely test results.

Laboratory partners should be able to provide specialized, comprehensive testing services with a commitment to delivering fast results.

Donor screening

Prior to the transplant, your lab will perform infectious disease testing to look for antibodies (using serological tests) and molecular DNA/RNA (using molecular tests). Your physician will determine what tests to order based on industry guidelines for each type of transplant. Apart from HIV and Hepatitis B and C testing that is performed on all donors, donations of tissues that potentially contain white blood cells must also be screened for human T-lymphotropic virus and cytomegalovirus. Reproductive donations must always be tested for Chlamydia trachomatis and Neisseria gonorrhea.

Different ways of testing

Human leukocyte antigen testing is used to successfully match organ and bone marrow transplant recipients with compatible donors. Matching of donor and recipient antigens improves graft survival and lowers rejection rates as well as incidents of infection due to decreased use of immunosuppression.

Donor cells and tissues that are transplanted must be devoid of microorganisms so that the recipient does not become infected with harmful bacteria, fungus and yeast. Examples of donation include, stem cells, joints and bone products. Materials for transplant are processed under sterile conditions — however, laboratory testing is also performed to demonstrate that there are no harmful microorganisms.

Lymphocytes and antibodies are responsible for acute and chronic rejection causing inflammation and organ damage. Patients are given immunosuppressant treatment to prevent rejection. Since every patient is unique, non-invasive tests to measure immune function and organ rejection status can help the clinician personalize treatment doses.

Transplant patients are particularly susceptible to several opportunistic pathogens due to the need for immunosuppression. The ability to receive lab results quickly for important pathogens such as CMV, BKV and HHV-6 among others is critical for patient care.

Lab tests also play a role in helping clinicians recommend immunosuppression dose modifications and in monitoring a patient’s drug levels. Gene sequencing is used to analyze antiviral resistance and enables doctors to change treatments precisely. Treatment modification based solely on clinical evaluation may result in added toxicity and increased complexity in patient management. Testing for T-cell immunity can help determine whether the patient’s body can fight certain pathogens on its own or if they need to use antivirals to fight it.

Patients and clinicians should openly discuss testing options that are available, and partner with a lab that has the focused expertise necessary to improve transplant outcomes.

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