Labs play a crucial role in the rapidly evolving field of organ transplantation. Simply processing tests no longer reflects the expertise and knowledge they bring to transplant teams. On July 30, three speakers at the 70th AACC Annual Scientific Meeting & Clinical Lab Expo will discuss all of the ways in which labs touch and influence the transplant process for clinicians, patients, and donors.
The hope is by the end of this scientific session, (32412) The Role of Clinical Laboratory in Transplantation, “laboratorians will want to go home and seek out their transplant colleagues to start to build their relationships,” Tiffany Roberts, PhD, DABCC, DABHI, a transplant immunologist at KentuckyOne Jewish Hospital’s Trager Transplant Center in Louisville, Kentucky, and the session’s moderator, told CLN Stat. Roberts joins John Lunz, PhD, director of the histocompatibility and immunogenetics laboratory at Gift of Hope Organ and Tissue Donor Network, and Christopher Jones, MD, division chief of transplant surgery at the University of Louisville School of Medicine, to discuss the role of clinical labs in the pre- peri- and postoperative stages of transplantation.
Laboratorians can often feel disconnected from the patients they serve. “We want folks in this session to feel the humanity of what they do every day and know they make a huge difference in the lives of actual people,” Roberts said. In most instances, patients are essentially anonymous accession numbers once their sample arrives in the lab. This is not the case in the world of transplantation, however.
“After initial work-up, the average wait time for a kidney can range from 2 years to as high as 10 years, depending on geography. Patients actively waiting for organs are monitored monthly. So, we see the same patients over and over for years,” Roberts said. A laboratorian gets to know a patient’s story and when something happens to them—such as an infection or complication. “We feel their elation when they get transplanted, and we monitor them for the rest of their lives,” she added.
While labs play critical roles in all stages of the transplantation process, this is particularly true in the postoperative stage,when therapeutic drug monitoring (TDM) to track immunosuppression comes to the fore, Roberts emphasized.
“I don’t think laboratories always have a good grasp of just how critical and important those values are. The clinicians walk a razor’s edge in balancing between too much (nephrotoxicity) and too little (rejection),” she said. “Getting those labs as accurately and as quickly as possible can sometimes make the difference between keeping and losing an organ (or a patient in extreme cases).”
Clinicians don’t know the nuances of TDM, nor do they understand the differences between detecting analytes via immunoassay or mass spectrometry, or even the reasons for not being able to compare values from one lab to another, Roberts continued. This is especially true when a patient is remote from the transplant center and gets lab work done at different local hospitals. “When you take that fact into account, I think having the expertise of a clinical laboratorian would be invaluable to the teams,” she emphasized.
As a histocompatibility lab director, Roberts attends every transplant selection committee meeting, providing information crucial to listing patients on the federal waitlist for organs and to monitoring patients for rejection after they have received a new organ. “The surgeons, nephrologists, cardiologists, and pulmonologists all have my cellphone number and have zero hesitation to call me anytime day or night if they have a question,” she said.
In an ideal world, clinicians should also have this type of relationship with clinical chemistry lab directors, who are often left out of this process, Roberts continued, recalling one time when such expertise could have prevented an error. “I had a particular heart transplant (pre-transplant) case in which the patient’s creatinine increased significantly from one month to the next. It wasn’t until we got done with the antibody evaluation in the histocompatibility laboratory that we realized we had an incorrect specimen,” she recalled. Roberts had to call the coordinators and suggest that the patient get re-drawn and retested. “I feel like this is something that a clinical chemist may have caught sooner, had they been involved,” she added.
Register now to attend this informative session on labs and transplantation at the 70th AACC Annual Scientific Meeting & Clinical Lab Expo July 29–August 2 in Chicago. The session, which will takes place from 12:30 p.m. to 2 p.m. on July 30, is worth 1.5 CE hours.