Genomic Biomarker Surveillance in the Care of Solid Organ Transplant Recipients: An Update for the General Clinician during the Coronavirus (CoVid-19) Pandemic

Abstract

Biomarker surveillance after solid organ transplant is an advancing field with promise for further elucidation through high-throughput analyses and “omics” technologies. To date, Gene Expression Profiling (GEP; AlloMapâ ) is the only FDA-cleared genomic assay as surveillance for moderate-severe TCMR versus allograft quiescence after heart transplantation. Clinical validity and utility, however, have been recently established after kidney and heart transplantation, for analysis of donor-derived cell-free DNA in the assessment for potential “Allograft Tissue Injury” that may occur during diverse processes such as T-Lymphocyte mediated (TCMR) or Antibody-mediated (ABMR) allograft rejection or allograft-associated infection. These genomic analytes are currently being explored and evaluated across the spectrum of solid organ transplantation and the focus of numerous robust clinical transplant study registries. “Multi-Modality Surveillance” is currently firmly established within the armamentarium and practice algorithms of the transplant center specialist. However, such diagnostics which are performed on peripheral blood samples obtained during routine laboratory surveillance are now available and widely applicable during the inevitable clinical transition in care that is increasingly relegated to the General Practitioner. Noninvasive Biomarker assessment may prove invaluable for surveillance to thereby avoid the predominance of invasive protocol biopsy procedures. Further, during times of increased risk of infectious contagion exposure, such as the SARS-CoV-2 (CoVid-19) pandemic, laboratory Biomarker surveillance may prove invaluable in deferring routine scheduled office or clinic appointments and the inherent exposures.