Liver transplantation is a multifaceted procedure marked by both risks and benefits. For individuals grappling with end-stage liver disease, it presents a beacon of hope, promising an enhanced quality of life and prolonged survival. Remarkable strides have been made in short-term survival rates, with established liver transplant centers achieving over 90% one-year survival rates today. However, global publications, spanning from South Korea to Spain, France, and the United States, converge on a sobering reality: there has been no discernible improvement in the long-term survival of liver transplant recipients.

While the commendable achievements in short-term survival deserve recognition, it’s imperative to recognize the broader context. Beyond mere survival, advancements in managing recurrent diseases, complications, and concurrent conditions have significantly enriched the quality of life for transplant recipients. Despite the escalation in illness severity at the time of transplantation, as evidenced by the Model for End-Stage Liver Disease (MELD) scoring, the one-year survival rate continues to exhibit a steady upward trajectory.

Yet, the triumphs of liver transplantation are juxtaposed against a poignant dilemma. A burgeoning population of immunosuppressed transplant recipients, endowed with extended life through a functional graft, grapples with persistent mortality challenges. Long-term outcomes have seen minimal enhancements, as recipients persistently confront complications stemming from prolonged immunosuppressive therapy. Malignancies, infections, cardiovascular ailments, and renal insufficiency are among the array of afflictions exacerbated by these necessary medications.

While liver transplantation heralds remarkable successes in short-term survival and quality of life, there remains an urgent imperative to address the enduring challenges faced by transplant recipients in the long term, particularly concerning the complications arising from immunosuppressive therapies.

Breakthrough Science:

Biomarkers provide guidance for titration of immunosuppressive therapy

Gene Expression Profiling

Gene expression profiling is a powerful tool used in liver transplant diagnostics. It provides a comprehensive analysis of genetic activity specific to immune responses, which can help establish a guardrail to prevent against the dangers of rejection while titrating immunosuppression.

Gene expression refers to the process by which the genetic information stored in DNA is converted into functional proteins that carry out specific cellular functions. The expression of certain genes can be upregulated or downregulated in response to external stimuli, such as injury or infection, to enable appropriate responses by the body’s cells. By identifying the specific genes that are activated or suppressed during the rejection process, clinicians can make more informed decisions about therapy optimization and improve patient outcomes.

Donor-Dervied Cell-Free DNA

Donor-derived cell-free DNA (dd-cfDNA) is another powerful biomarker that can be used to monitor transplant health. When a transplant is performed, the transplanted organ contains cells from the donor, which can release fragments of DNA into the recipient’s bloodstream. By measuring the levels of dd-cfDNA in a patient’s blood, clinicians can detect early signs of organ injury and monitor the effectiveness of treatment over time.

Donor-derived cell-free DNA (dd-cfDNA) refers to the fragments of DNA from the transplanted donor that circulate in the recipient’s bloodstream. These fragments are released into the bloodstream as a result of normal cellular turnover and cell death in the transplanted organ, and they can be detected in the recipient’s blood. Monitoring dd-cfDNA levels can help detect early signs of organ rejection or damage, and can guide decisions about treatment and follow-up care. Additionally, dd-cfDNA testing can help distinguish between rejection and other potential causes of organ dysfunction, such as infection or drug toxicity.

Biomarkers are a Vital Tool for Personalized Post-Transplant Care

Biomarker science is changing the way we approach post-transplant care for liver transplant recipients. Current tools in the arsenal for transplant care teams provide insight into the health of the graft, but are non-specific for rejection. Molecular biomarkers provide a more comprehensive, non-invasive view of the health of a transplant liver.

Our biomarkers tests that are revolutionizing kidney transplant monitoring

At Eurofins transplant genomics, we’re committed to improving the long-term outcomes of liver transplant. What’s why we’ve combined two molecular biomarkers to form the most powerful guidance tool for physicians seeking to titrate immunosuppressive therapy.

OmniGraf Liver:

A powerful combination of gene expression profiling and donor-derived cell-free DNA to guide titration of immunosuppression

OmniGraf Liver is the first product of its kind for liver transplant recipients. Clinicians can use this tool to rule out rejection in stable patients and ensure that steps taken to lower immunosuppressive therapy are effective at managing rejection, reducing the risk of complications later in life.