Transplants: blood test to test for rejection

Posted by hello1234 @hello1234, May 22 5:43am

Hi Transplants,
Has anyone had a blood test to test for signs of rejection? The one my nephrologist suggested is called Allosure by CareDx as an alternative tool to be used as a less invasive way to watch for rejection than invasive protocol biopsies. Have you ever heard of a blood test like this or has your doctor recommended a blood test like that to you?

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Heart transplant recipient here. In the first year your test to determine heart rejection is like yours, a surgical biopsy where the team enters a vein in your neck and goes into the heart to clip samples. Rejection is determined by tissue analysis. Memory says I had one a month for the first three months and then at least three the rest of the year. Surgery is always risky and so after year one I went onto the CareDx blood analysis system. For the heart, it looks at thirteen markers in the blood that would indicate rejection and you receive a composite score obviously with acceptable and unacceptable limits. I now do that system once a year and I have a lot of confidence in it.

Note I did have some insurance issues with the test at first. Surgery is cheaper and of course the insurance bastards (did I say that out loud?) were not happy about forking over the additional cost. But we did work through it.

Good luck and
Best always,
s!

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Hi @scottij 😊 Thanks so much for responding! I am a kidney recipient. I just took the Allosure test and it showed. 18% I read the literature and at first it looked like .05 was the best score so I was concerned with my .18%. Then I read another page on the website and saw that .21 is the median for stable patients. What is your understanding of a good score and how to read the results? Has your scores been around that number too? Many thanks Scott…. (By the way, I will keep you posted on whether my insurance will pay!)

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I'm a liver and kidney recipient (simultaneous donation). I am 13 years post transplant. I have never heard of the Allosure test. I've only had protocol 1,2,3,5,and 10 year surgical kidney biopsies and will only need another if needed (?). Only post liver biopsy was right after the transplant.

@scottij, @hello1234 – Were/are the Allosure tests in place of a 'routine ' protocol surgical procedure? Or are they an additional test due to rejection signs?

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@rosemarya

I'm a liver and kidney recipient (simultaneous donation). I am 13 years post transplant. I have never heard of the Allosure test. I've only had protocol 1,2,3,5,and 10 year surgical kidney biopsies and will only need another if needed (?). Only post liver biopsy was right after the transplant.

@scottij, @hello1234 – Were/are the Allosure tests in place of a 'routine ' protocol surgical procedure? Or are they an additional test due to rejection signs?

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Rosemary,
It is my understanding that they are mutually supportive. So I have allosure/CareDX as a monitor and a biopsy at my annual checkup.
It is a pretty new technology and hence some of the insurance issues I had.

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@scottij

Rosemary,
It is my understanding that they are mutually supportive. So I have allosure/CareDX as a monitor and a biopsy at my annual checkup.
It is a pretty new technology and hence some of the insurance issues I had.

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@rosemarya @scottij
I told my local nephrologist how concerned I am about my upcoming protocol biopsy. I had very traumatic and frightening kidney biopsies as a child (in the 1960's they did not use ultrasound to guide the needle, they would draw on my back with a magic marker where my ribs were, hip bones, etc and then "guess" where the kidney may be. They missed several times. When they hit the kidney, there was lots of bleeding involved. Not good memories. Fast forward to my biopsy last year (with modern day ultrasound thankfully!). Before the procedure, the doctor listed all the possible adverse outcomes (possible bleeding needing surgical intervention, possibly losing the transplant, etc). I signed the paper and proceeded with the biopsy. All was well. When I told my local nephrologist that I really don't want another invasive protocol biopsy with their associated risks if it can be avoided, he recommended to get the Allosure blood test so we can have some level of confidence that there are no signs of rejection in the blood. Allosure catches rejection before it shows up in reduced kidney function. I will be discussing the possibility of using the Allosure results in lieu of the biopsy with my Mayo doctor. My understanding is Mayo uses Allosure with heart transplant patients so they do respect it. All this said, I always want to do the right thing to take excellent care of my miracle. I am just not sure what the right thing is considering everything involved. I am leaning towards relying on the Allosure and hoping that's the right thing to do. Nothing is 100% so it becomes difficult to choose. I am not sure what the biopsy may show, that Allosure is not telling us. I had my 4 month and one year biopsies. This would be my two year biopsy. What are your thoughts?

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Yes I was in that study at my initial transplant. I was doing both as part of a research study and I haven't heard if it's actually being used instead of biopsy. I do know that's the goal. I'm not sure if it's for all transplants as mine was a Heart. But I do know it was showing progress . Mine was 4 years ago now so maybe its gotten more reliable. I'll admit tho that at first I looked forward to hearing the news of no rejection seen after each biopsy. But I do know that the procedure itself did come with some discomfort as the initial numbing for Me Either the groan area or neck was a bit painful. I did tho find out after the first few of a lanocain cream that I applied an hour before the procedure that helped with the initial numbing process. So if you do need to get them Anyway the cream may help with that part. I would love to hear if the study I was part of may have had positive results. Could you let me know what you find out? Thanks and l look forward to hearing how it goes.
Blessings

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Hi Dana! 😊 Great to hear from you, as always! It's exciting to hear you were part of the clinical trial for Allosure at Mayo! How often did you have Allosure and how often were you biopsied? Do you still use Allosure like Scott, along with your annual biopsy? I believe it was a successful trial showing that it was very accurate, but still missed things about 10-20% of the time. The biopsy picks up additional trouble like infections, etc that Allosure misses. Therefore, Scott is correct that Allosure is not replacing the protocol biopsies at this time. There are several different brands of this test so maybe there will be additional studies to compare them. I will keep you posted when I hear more! Please keep us posted if you get any additional information at one of your transplant visits or from your trial lead doctor. I am a kidney transplant and I believe the trial was done with heart patients so you may have access to more information from your team (especially the folks that ran the trial). Thanks again Dana for sharing your trial experience and telling me about the numbing cream!

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@hello1234

Hi Dana! 😊 Great to hear from you, as always! It's exciting to hear you were part of the clinical trial for Allosure at Mayo! How often did you have Allosure and how often were you biopsied? Do you still use Allosure like Scott, along with your annual biopsy? I believe it was a successful trial showing that it was very accurate, but still missed things about 10-20% of the time. The biopsy picks up additional trouble like infections, etc that Allosure misses. Therefore, Scott is correct that Allosure is not replacing the protocol biopsies at this time. There are several different brands of this test so maybe there will be additional studies to compare them. I will keep you posted when I hear more! Please keep us posted if you get any additional information at one of your transplant visits or from your trial lead doctor. I am a kidney transplant and I believe the trial was done with heart patients so you may have access to more information from your team (especially the folks that ran the trial). Thanks again Dana for sharing your trial experience and telling me about the numbing cream!

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Yes on frequency here are the dates of mine and in depending order the values were 31, 36, 32 31 was the most recent. I don't know the range on the numbers but also I have not rejected so I'm guessing they are in the good range and pretty steady

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@danab

Yes on frequency here are the dates of mine and in depending order the values were 31, 36, 32 31 was the most recent. I don't know the range on the numbers but also I have not rejected so I'm guessing they are in the good range and pretty steady

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@danab The Allosure "stable" result numbers are different for heart transplant and kidney transplant. From what I see on their website documentation, all of your numbers are appropriate for a "stable" no rejection heart transplant recipient, so that's great news! Thank you for participating in the Mayo trial! Whenever someone is part of a trial I appreciate that they are looking out for all of us….it contributes to the common good for our transplant community! Thank you Dana 😊

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My husband had a kidney transplant on 10/1/2016, at Scripps Green Medical Institute in La Jolla, California. We have since moved to southern Oregon. His post-transplant care and annual checkup is now done through Legacy Good Samaritan Hospital in Portland [OR], a 4 hour drive for us.

About 6 months ago, his local nephrologist indicated that he is part of a study testing a new pre-rejection protocol of bloodwork. We have had a traveling nurse come out to the house to draw blood twice, now. I believe it may be the Care DX. Each time the results are indicating there is no sign of rejection, thank goodness! Labwork drawn every three months also show no issues or concerns at this time, for which we are grateful. Knowing that our medical professionals are interested in developing a method to monitor for rejection of transplanted solid organs bodes well for everyone!
Ginger

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Hi @gingerw 😊 It's great to hear from you! Thanks so much for jumping into the conversation. Yes, that's the test! It's Allosure by CareDx. I had a mobile lab technician come to my house too. Do you remember what your husband's result numbers were. For kidney transplant patients it says the median average stable patient is .21 and anything over 1.0 is showing concern. My last result was .18 which was classified as stable.
I am excited that your husband was part of the study. It sounds like Allosure is getting a lot of attention from the transplant community which is wonderful!

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@hello1234

Hi @gingerw 😊 It's great to hear from you! Thanks so much for jumping into the conversation. Yes, that's the test! It's Allosure by CareDx. I had a mobile lab technician come to my house too. Do you remember what your husband's result numbers were. For kidney transplant patients it says the median average stable patient is .21 and anything over 1.0 is showing concern. My last result was .18 which was classified as stable.
I am excited that your husband was part of the study. It sounds like Allosure is getting a lot of attention from the transplant community which is wonderful!

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@hello1234 I'll check with him to see what the numbers were. What had us so concerned, was the call came from out-of-the-blue, scheduling the mobile nurse. No warning from the doctor. So we called in a panic, not knowing if something had showed up in labwork that we weren't privy to. From what we gathered, his doctor was signed on to supply patients for the testing. Didn't give us an option to decline, but Bill wouldn't have anyways!

About 1.5 years after his transplant, he had to go through emergency testing, as the recipient of the second kidney from same deceased donor showed Hep C. Turns out it wasn't the donor, but the recipient with an issue. Bill was okay. And I went through a vaccine series to make sure, too. Can you believe my dr wasn't going to do that; I had to threaten to take him to the administration of the hospital!
Ginger

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