Deploying Minimally Invasive Transplant Tests in Kidney Disease Treatment

Minimally invasive tests play a growing role in a transplant patient’s overall treatment plan, helping clinicians carefully monitor organ health to ensure the best possible transplant outcome while also reducing the burden of transplant monitoring on patients. These innovations are becoming more relevant, particularly for the monitoring of kidney transplants—the most performed organ transplant worldwide. 

As rates of chronic kidney disease (CKD) continue to rise, the need for kidney transplants is increasing. CKD affects an estimated one in seven adults in the US, and the number has been climbing due to an increase in diabetes and hypertension, longer life expectancy, and unhealthy diets. 

As a patient’s CKD progresses, they will require a myriad of treatments to manage the disease. At the most advanced stages of CKD, dialysis or a kidney transplant become the only viable treatment options to replace lost kidney function.  

The ongoing burden of post-transplant monitoring

Between 2013 and 2023, kidney transplantation rose by 59 percent, with 144,842 Americans on the waiting list in 2023. This rise in transplants can be attributed in part to innovations in testing solutions, which provide clinicians with more in-depth information to help them more accurately match donors and transplant recipients and to monitor patients more closely post-transplant. 

While a kidney transplant is one of the most effective treatments for CKD, the treatment doesn’t stop when the surgery is performed. Transplant recipients require lifelong immunosuppressive medications to reduce the risk of rejection and frequent monitoring to ensure the long-term health of the transplanted organ. 

Traditional monitoring paradigms often include regular biopsies to assess the health of the transplanted organ and monitor for signs of rejection. Biopsies are invasive, can be uncomfortable for patients, and carry the risk of certain complications, such as excess bleeding. They typically need to be performed at a transplant center, which can further increase the burden on patients who may need to travel long distances to their closest transplant center. In addition, invasive monitoring methods such as biopsies can be costly for both patients and the healthcare system.

Improving patient outcomes and experience with minimally invasive transplant tests

Given the burden of biopsy, there is a rising need for less invasive and more accessible solutions. Minimally invasive testing options can be less risky and less expensive compared to biopsy, and in some cases, may be performed outside of transplant centers. This ultimately reduces the burden on patients, which may increase their adherence to post-transplant monitoring guidelines.

One such minimally invasive testing option is a urine-based CXCL10 biomarker test. Elevated urinary CXCL10 levels have been associated with inflammation and early graft disfunction. A CXCL0 biomarker test enables testing through noninvasive and cost-effective urine sample collection, and yields results in as little as 24 hours, providing clinicians with valuable information faster than many currently used tests. Having access to results in a timely manner may enable clinicians to more effectively manage patient care.  

Other minimally invasive testing options include cell-free DNA testing, which is a simple blood test designed to detect and analyze circulating donor-derived cell-free DNA (dd-cfDNA). Elevated levels dd-cfDNA may indicate early signs of injury to the transplanted organ, such as the type of cellular injury that can occur in episodes of rejection.  

As kidney transplants continue to rise, widespread adoption of less invasive testing options will be a priority for improving patient care and outcomes. To make these testing methods more widely available, the first step is to raise awareness and promote the adoption of noninvasive and minimally invasive solutions, which play a critical role in mitigating the challenges that come with traditional, invasive monitoring and in improving the patient experience throughout the transplant journey.