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Molecular monitoring’s true value focuses on those methods that can be used to help determine early warning signals and help identify patients at higher risk of allograft injury. Tests should be minimally invasive for the patient; the risk should be low and with high diagnostic accuracy – which is the potential of active surveillance. Unfortunately, when a biopsy is needed, this is generally more invasive and tailored for clinically indicated testing rather than to be used as an active surveillance method. However, there are some instances where a biopsy can also be used as an active surveillance method, such as with heart transplants.
Molecular advances led to the rise of several post-transplant methods that have flexibility as both active surveillance tools and clinically indicated tests, with increasing sensitivity and specificity1. Earlier rejection detection, improving graft viability, and enhancing patient quality of life remain characteristics of modern monitoring methods. Clinicians will use a thorough approach of both active surveillance and clinically indicated testing with a range of blood draws and invasive biopsies respectively on a need by basis.
Overall, whether clinically indicated or active surveillance, many methods are used to complement and augment one another to improve diagnostic and clinical interpretation. The following methods are routinely used for molecular monitoring.
A biomarker is a measurable substance in the body indicating the progression of a disease, biological process or if treatment is occurring. In the case of HLA monitoring, biomarkers can help track immune system activity related to HLA in terms of transplant rejection or immune response changes.
Viral load is the amount of virus present in a person’s blood. In terms of HLA monitoring, measurement of the amount of virus present can be used to determine how well the treatment is working or the state of the patient.
A microarray is a tool used to test many genes via a small chip that contains probes in a grid pattern. For HLA monitoring, microarray-based platform testing is used to quickly analyze many HLA genes to detect changes or mismatches that could affect transplant compatibility or immune responses.
Single cell technology analyzes at the single cell level for any characteristic changes. In HLA monitoring, this technology identifies how individual cells react to the transplanted issue as opposed to analyzing the average response from all cells together.
Epigenetic is the study of how genes are activated without any changes to the DNA sequence. Epigenetic monitoring for HLA looks at the chemical changes that control HLA gene activity, which could be used to determine how transplant tolerance and rejection may occur.
Next-Generation Sequencing is a technology that analyzes considerable amounts of reads and the ability to produce large amounts of DNA for analysis. With HLA monitoring, NGS provides detailed information about HLA genes, allowing for detection of variations or immune changes for both transplant matching and rejection monitoring.
The information provided on this page is intended for educational purposes only. It is not a substitute for professional training, regulatory guidance, or clinical judgment. While every effort has been made to ensure accuracy, methodologies and assays may vary by laboratory and manufacturer. Users are encouraged to consult relevant standards, institutional protocols, and product documentation before implementing any procedures.
Rumpler, Marc J., Christopher McCloskey, and Christopher Lawrence. “A New Era in Post-Transplant Monitoring.” Association for Diagnostics & Laboratory Medicine (ADLM), 1 Apr. 2023, https://myadlm.org/cln/articles/2023/april/a-new-era-in-post-transplant-monitoring
The information presented on this website is intended solely for educational and general informational purposes. It is not intended to provide medical advice, constitute clinical guidance, or serve as a substitute for professional judgment in patient care.