MOLECULAR DIAGNOSTICS :: TRANSPLANT TESTING
As an example, long travel times and inflexible scheduling can worsen a patient’s access, ultimately lowering the likelihood of compliance. It is important, therefore, to meet transplant patients where they are, and invest in their care. By offering a mobile testing option, both transplant recipients and living donors can complete specimen collection at a time and place convenient for them, especially when they may be at suboptimal health. It is important for providers to continue to find ways to remove barriers to care and increase access to testing. Additionally, a hospital or transplant center can work with a collaborator to improve logistics access by offering specimen collection through a nationwide network of patient access points. This is particularly critical in cases where a living donor or recipient lives far from the institution that will or has performed the transplant procedure. By working with a testing provider, patients may cut down on otherwise excessive travel times and see benefits related to scheduling and walk-in appointment availability. As one example, when we heard from clients that our trans-
plant offering needed improvements, we made efforts to stream- line patient education, help phlebotomists fast-track specimens, decrease turnaround times, and increase access to at-home testing through our ExamOne mobile phlebotomy business. Yale New Haven Hospital in Connecticut, which piloted the improved transplant offering we debuted earlier this year, has said that working with us has helped expand access for patients who previously would have had to visit a transplant center to receive testing — in many cases, one that was extremely far from a patient’s home. Other clients have reported the same, and that reducing patient noncompliance has eased strain from overloaded health system workers who lacked the time needed for follow-up.
Exploring advancements in transplant testing: How genetic testing can impact patients Beyond the traditional battery of tests associated with trans- plantation, advanced genetic tests may also provide invaluable insights for donors and recipients. Genetic testing is traditionally used to identify differences in a person’s DNA that can influence the way their cells func- tion. Examining these DNA variants is often useful for both identifying a person’s risk of disease development and the likelihood that a certain disease might respond to a specific therapy. Different types of genetic tests look for different kinds of DNA variants, and sometimes different combinations of genetic variations. There are many different technologies that can help detect
genetic variations. For transplant patients, these tests are most often utilized when assessing kidney recipients or donors. Specifically, the National Institute of Health cites three main applications of genetic testing in clinical kidney transplantation: (1) the risk assessment of donors, (2) disease characterization of recipients, and (3) improving drug selection and dosing for recipients using pharmacogenomic data.6 One such test, Apolipoprotein L1 (APOL1) renal risk variant genotyping, is an advanced genetic test to help evaluate kidney disease risk for donors. The test identifies those who have a “high-risk genotype,” and increased susceptibility to certain types of non-diabetic kidney disease, compared to individuals with a “low-risk genotype.” Data shows the APOL1 status of the donor can impact post-donation renal function in the donor and recipient.7 It is worthwhile to explore whether genetics affect donor suitability, particularly for those with a family history of cystic
Genetic testing is traditionally used to identify differences in a person’s DNA that can influence the way their cells function.
kidney disease. As living donations become more popular, genetic testing may also see an uptick in utilization. Its assess- ments can be valuable in both determining match favorability and understanding risks for both donors and recipients, so that when working with a physician, the appropriate actions can be taken.
Conclusion: Improving testing availability remains a priority for providers As the number of yearly transplants increases nationwide, and as younger patients receive more transplants, the need for more testing and monitoring over a longer period will also continue to increase.
Health systems and healthcare professionals caring for these vulnerable patients need to consider not just quality of testing but also location in order to optimize patient compliance. When the health of the patient is centered in all care decisions, the best outcomes for all parties can be achieved.
REFERENCES
1. Bryant C. U.S. reaches historic milestone of 1 million organ transplants. The Organ Donation and Transplantation Alliance. Published September 9, 2022. Accessed August 7, 2023.
https://www.organdonationalliance.org/alli- ance-news/u-s-reaches-historic-milestone-of-1-million-organ-transplants/.
2. Quest Diagnostics. Data on file. 2020. Based on the number of individual tests run and frequency of testing heard for a typical patient.
3. All-time records again set in 2021 for organ transplants, organ donation from deceased donors - OPTN.
Hrsa.gov. Accessed August 7, 2023. https://
optn.transplant.hrsa.gov/news/all-time-records-again-set-in-2021-for-or- gan-transplants-organ-donation-from-deceased-donors/.
4. Live-donor liver transplants on the rise at Johns Hopkins. Hopkinsmedicine. org. Accessed August 7, 2023.
https://www.hopkinsmedicine.org/news/ articles/live-donor-liver-transplants-on-the-rise-at-johns-hopkins.
5. OPTN policies to align with 2020 U.S Public Health Service Guideline - OPTN.
Hrsa.gov. Accessed August 7, 2023. https://
optn.transplant.hrsa.gov/professionals/by-topic/patient-safety/ optn-policies-to-align-with-2020-us-public-health-service-guideline/.
6. Marin EP, Cohen E, Dahl N. Clinical applications of genetic discoveries in kidney transplantation: A review. Kidney360. 2020;1(4):300-305. doi:10.34067/ KID.0000312019.
7. Apolipoprotein L1 (APOL1) renal risk variant genotyping. Questdiagnos-
tics.com. Accessed August 7, 2023.
https://www.questdiagnostics.com/ healthcare-professionals/clinical-education-center/faq/faq287.
Robert S. Jones, DO, MS, FACP, FIDSA, CPE is the Medical Director for Infectious Diseases at Quest Diagnostics. Dr. Jones is a physician executive and healthcare leader with more than 30 years of experience. Dr. Jones is board certified in infectious diseases by the American Board of Internal Medicine and received his Bachelor of Arts from Gettysburg College before attending Seton Hall University, where he
received his Master of Science in biology. After earning his DO at the Philadelphia College of Osteopathic Medicine, Dr. Jones completed his internal medicine residency at The Wright Center, followed by an infectious diseases fellowship at the Temple University Health Sciences Center.
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