I have a hard life. I’m trying to keep my new owner alive, but I am under the constant threat of attack. The person knows they need me, can’t survive without me, but to certain cells in their immune system, I look like a foreigner who must be eliminated. Why is this happening, and how can we live harmoniously?
A person’s immune system protects it from substances that may be harmful such as bacteria and viruses. It does this by recognizing proteins called antigens that coat their surfaces. If the immune system recognizes that these antigens are not from the person’s body, it sees them as “foreign” and attacks them.
Organs like me also have antigens on their surfaces. When a person receives an organ from someone else, that person’s immune system may recognize that it is foreign if the antigens are different or do not “match.” This can cause transplant or organ rejection.
To help prevent this from happening, doctors type or match both the person who will donate the organ (donor) and the person who is receiving the organ (recipient). The more similar the antigens are between them, the less likely that the organ will be rejected. In particular, they are looking at the human leukocyte antigens (HLAs). These are proteins on the surface of cells that are responsible for the regulation of the immune system in humans.
Did you know that a couple of Luminex’s partners, One Lambda and Immucor, offer several lines of histocompatibility (HLA) typing tests and are the worldwide leaders in HLA typing? Do you recognize the LABScan and LIFECODES instruments?
After the transplant, the recipient will have to take medications to suppress their immune system to prevent it from attacking the newly transplanted organ. If these medicines are not taken, the body will almost always launch an immune response and destroy the foreign tissue—me!
While I am happy that my new owner takes these medications to prevent an attack on me from the immune system, this also lowers their ability to fight off infections from bacteria and viruses. My new owner is also at a greater risk for invasive fungal infections.
Because of this, a transplant recipient has to be more careful and vigilant when they get sick. Early and specific diagnosis of infections result in better clinical outcomes.
BK virus is particularly problematic in the case of kidney transplants. Most people are exposed to BK early in childhood which generally causes a “flu-like” illness. After the primary infection, BK remains latent primarily in the renourinary tract. The virus can become reactivated in immunosuppressed individuals as evidenced by detecting BK in urine samples. BK virus is believed to transition from viruria (presence in the urine) to viremia (presence in the bloodstream) to nephropathy (disease in the kidney). Loss of a transplanted kidney due to BK nephropathy ranges from 30% up to >80% of cases.
To prevent this from occurring, most transplant centers monitor the levels of BK virus in the urine and plasma at defined time intervals post-transplant, with the goal of keeping the levels of detected virus below defined thresholds. If the levels of BK virus surpass the thresholds, reducing the patient’s level of immunosuppression is most often the first line of defense.1
Luminex offers the following tests:
- MultiCode assays (Real-time PCR):
- Cytomegalovirus (CMV)
- BK
- Herpes Simplex Virus (HSV 1/HSV2)
- Adenovirus
- Epstein Barr Virus (EBV)
- Enterovirus
- Multiplex bead assays:
- Respiratory virus panel
- Gastrointestinal pathogen panel
- Fungal Analyte Specific Reagents (ASRs):
- albicans
- glabrata
- lusitaniae
- tropicalis
- parapsilosis
- guilliermondii
- krusei
- terreus
- fumigatus
- flavus
- niger
- capsulatum
- immitis
- neoformans
- dermatitidis
- apiospermum
- prolificans
- Fusarium
- microsporus
- arrhizus
- indicus
- bertholletiae
- jirovecii
- Virus Analyte Specific Reagents (ASRs):
- Human parechovirus
- Enterovirus
- Human herpesvirus 1 (HSV 1)
- Human herpesvirus 2 (HSV 2)
- Human herpesvirus 3 (VZV)
- Human herpesvirus 4 (EBV)
- Human herpesvirus 5 (CMV)
Although transplant surgeries have become common procedures, the number of donor organs needed vastly exceeds the number of organs available for transplantation. I sure hope my new owner’s physician has access to tests like those above for when my new owner is sick. My new owner is lucky to have me and our lives depend on it!
See the statistics below available from http://donatelife.net/statistics/.
- More than 122,000 men, women, and children currently need lifesaving organ transplants.
- Every 10 minutes another name is added to the national organ transplant waiting list.
- An average of 18 people die each day from the lack of available organs for transplant.
References
1. Costa C, Cavallo R. Polyonmavirus-associated nephropathy. World J Transplant 2012;2(6):84–94.