Transplantation Technologies & Research

ISSN: 2161-0991

Open Access

Articles in press and Articles in process

    Letter Pages: 1 - 3

    Technology-driven Performance Improvement of a Biomarker Panel in Kidney Transplant: OmniGraf

    Patricia M. West-Thielke, Cortney C. Miller, Winston Ally, April Sutton, Rohita Sinha, Mikaela Miller, Steve Kleiboeker and Juston C. Weems*

    Here we present the impact of the transition from TruGraf microarray to TruGraf PCR on the performance of OmniGraf, the combination of TruGraf Gene expression and TRAC dd-cfDNA tests. Using the same biopsy-paired samples as previously published, we saw an improvement in the NPV from 88% to 94% when both assays were negative. Perhaps more importantly, we observed an increase in the PPV from 81% to 89% when both tests were positive. False negative results were reduced from 31% to 17%, while true negative results improved from 74% to 81%. Within our cohorts, we observed 26.2% of results to be positive for one test and negative for the other: 11.7% showed elevated TRAC (+) and a negative TruGraf (-); 14.5% showed a TruGraf positive (+) and low TRAC score (-). The previous publication demonstrated that TruGraf microarray was significantly better at detecting subclinical TCMR and TRAC was significantly better at detecting subclinical ABMR, highlighting the importance of the combination of the tests.  The methodological improvement in TruGraf technology increased its detection of both TCMR and ABMR subtypes of rejection, leading to a higher NPV and PPV. In the field of transplant biomarkers, where high NPV values have been the focus, we present novel clinical validation data on the first commercial biomarker panel with a high PPV. With the data presented here, OmniGraf results provide a high probability of either immune quiescence or subclinical rejection to support clinical decision-making.

      Research Article Pages: 1 - 4

      Human T-Cell Lymphoma Virus-Positive Allograft Used For Effective Orthotopic Liver Transplantation: A Case Report and Review of the Literature

      TR Harring, NT Nguyen, JA Goss and CA O’Mahony

      Introduction: The human T cell lymphoma virus was screened for previously in organ donors secondary to concern for progressive disease in an immunocompromised host. However, due to the low prevalence of the virus, a shortage of suitable allografts, and the lack of a time effective test, this practice has been abandoned in the United States. The human T cell lymphoma virus type I may cause progression to several diseases, including human T cell lymphoma virus associated myelopathy, and adult T cell lymphoma/l eukemia. Moreover, there is an overall lack of data relating to the safety profile in the medical literature with use of human T cell lymphoma virus positive allografts.

      Aim: To determine the safety of human T cell lymphoma virus positive allografts in orthotopic liver transplantation.

      Materials and Methods: Our database was queried for recipients of known human T cell lymphoma virus positive allografts at time of transplantation. We present one patient case report followed by a review of the medical literature.

      Results: The patient was transplanted secondary to cirrhosis due to alcohol and hepatitis C virus infection with hepatocellular carcinoma. When a suitable allograft became available, the patient was advised that it was human T cell lymphoma virus type I positive. The risks and benefits were discussed thoroughly with the patient and he elected to proceed with the operation. His operation and post operative course were unremarkable. He continues to do well during on follow up of over 777 day s, and currently he has no symptoms of any human T cell lymphoma virus associated disease. Review of the medical literature demonstrates few reports on human T cell lymphoma virus related complications after orthotopic liver transplantation; however, the re are theories that immunosuppresion may cause progressive disease in these patients.

      Conclusions: Human T cell lymphoma virus type I positive donors can be life saving sources of allografts. Our center supports the use of these allografts in patients that otherwise continue to be on the waiting list.

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