AlloSure is a key part of my care plan to detect transplant rejection
A columnist shares his experience with a post-transplant surveillance product
Michel de Notredame, more commonly known as Nostradamus, was a French astrologer, physician, and to many, seer. He recorded his prophecies in the 16th-century book “Centuries,” and some consider his view of the future incredibly accurate.
More recently, Eric Arthur Blair, using the pen name George Orwell, wrote the 1949 novel “1984,” which some say predicts the impact of totalitarianism. Some consider Orwell’s fiction to be predictions that relate loosely to world events today.
Are these predictions folklore, or are there too many coincidences to ignore? Arguments can be made to affirm or refute the ideas of Nostradamus and Orwell. Some of these predictions, however, seem quite accurate to me.
Now, predicting the future has come to transplant medicine, and the forecasts seem amazingly accurate.
Part of my care plan since 2021
I follow a number of discussions in social media groups and frequently find topics there that become column ideas. One topic I’ve recently seen discussed is the use of the AlloSure product to test transplant patients for rejection, the leading cause of transplant recipient deaths. I have no relationship with AlloSure or its producer, CareDx, other than being a lung transplant recipient whose rejection risk is tested using AlloSure. Because so many have been interested in AlloSure, I want to share my experience here.
AlloSure provides a predictive surveillance solution for post-transplant patients. Initially, the product provided surveillance for kidney and heart transplant patients. CareDx introduced AlloSure Lung in 2021 to provide a similar service for lung transplant patients.
I was fortunate to receive a bilateral lung transplant in July 2021, after being diagnosed with idiopathic pulmonary fibrosis in January 2017. AlloSure Lung became part of my post-transplant care plan.
For the first year after my transplant, my AlloSure Lung plan required two tubes of blood to be drawn and shipped overnight to California for processing. Since that first year, samples have been drawn quarterly.
Why AlloSure is important
The AlloSure test, CareDx says, has been able to predict rejection issues earlier in the rejection cycle. The company points to the LARGO clinical trial (NCT00751309) as evidence of that success.
I welcome any test that provides my care team with the ability to predict a risk of rejection, because the earlier we catch rejection, the easier it is to treat. Usually my team asks me to monitor for symptoms of rejection, and if those arise or I have a drop in lung function, I may need to get a bronchoscopy. This feels like a hindsight solution while AlloSure provides foresight through a predictive surveillance solution.
A January 2022 CareDx press release quotes Shambhu Aryal, medical director of the lung transplant program at the Inova Medical Group, as saying, “[T]he use of a noninvasive blood test helps physicians reduce the number of surveillance bronchoscopies. This is important for lung transplant patients because around 5% of lung biopsies result in pneumothorax, or a collapsed lung, with more than half of them requiring chest tube drainage, which is a serious complication that can result in extended hospitalization and an increased risk of infections.”
Aryal, who is a member of my care team at Inova Fairfax in Virginia, has conducted a number of my post-transplant bronchoscopies. With each of those bronchoscopies comes a reminder of those pneumothorax statistics. Now, with more than a year behind me, rejection represents the greatest mortality risk. The signs of rejection are many, so the surveillance offered by AlloSure Lung provides some level of confidence regarding any rejection occurring.
In a clinic appointment last Thursday, my care team reported that my AlloSure Lung score was excellent and showed no signs of chronic rejection. They have confidence in this test, and so do I. Those of us living with donated organs understand the challenges associated with being immunosuppressed and the risk of rejection. Those risks were amplified for me when I had pneumonia in late September 2022 and then COVID-19 last month.
Predictive surveillance is preventive medicine. Despite these comforts, it is imperfect, and so like any other test in the life of a post-transplant patient, its value is best used in conjunction with all other lab and test results.
I treasure the gift of the donor lungs I received. I intend to do everything within my power to preserve my donor’s legacy by caring for these lungs. It’s how I can make every breath count.
Note: Pulmonary Fibrosis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Pulmonary Fibrosis News or its parent company, BioNews, and are intended to spark discussion about issues pertaining to pulmonary fibrosis.