Network May Improve Transplant Care

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It would track organs and tissues, potentially allowing more rapid detection of transmitted diseases

 

TORONTO—A new online communication system under development promises to allow the tracking of every tissue or organ from donor to recipient in the United States. Such a system could reduce morbidity and mortality from donor-derived diseases.

 

Called the Transplantation Transmission Sentinel Network (TTSN), it will feature unique tissue/organ identifiers that use numbers and bar codes to track where all tissues are shipped. The system would enable tracking of the final disposition of tissue. If an infection or complication occurs in a recipient, it would be possible to notify other clinicians anywhere in the country about adverse events related to the organ or tissue from a given donor.

 

TTSN is a major initiative of the Centers for Disease Control and Prevention and the United Network for Organ Sharing. The system is expected to be in place in early 2008.

 

“This system will allow individual clinicians to query a database to ask questions regarding adverse reactions in other recipients of organs from the same donor,” said Jay Fishman, MD, associate professor of medicine at Harvard Medical School in Boston and the director of the Transplant Infectious Disease and Compromised Host Program at Massachusetts General Hospital in Boston. “We are very excited. We should be able to track specific syndromes, such as encephalitis, or by specific microbiologic diagnosis. In terms of specific microbiologic diagnoses, we will be able to better track West Nile virus, or even more common things like streptococcus.”

 

Speaking here at the 44th annual meeting of the Infectious Diseases Society of America, he presented an overview on TTSN and how it may benefit the transplant community.  The system will not only improve communication among institutions, public health authorities, and individual clinicians, but it also would give a much more accurate picture of donor-derived infections on a nationwide scale, he stressed.

 

Dr. Fishman, who is also the past president of the American Society of Transplantation, said that with this new system, transplant recipients may actually serve as “sentinels” for new infectious disease outbreaks, emerging infections, and even possibly bioterrorism.  In the future, rapid donor screening may be available for such things as Eastern equine en-cephalitis, Japanese encephalitis, dengue, and the avian flu.

 

He said he hopes that in the next 12 to 24 months clinicians will have “rapid multiplex diagnostics” that make it possible to test for multiple organisms simultaneously. He envisions results from these molecular-based tests becoming available within a few hours. These molecular tests might replace serologic tests or some antibody-based tests. The widespread use of these tests, in conjunction with the TTSN, may make it possible to detect and treat infections much more rapidly and aggressively.

 

“For example, serologic tests don't always turn positive quickly enough in immunosuppressed in-dividuals. If someone is infected with hepatitis C, they may not seroconvert for three weeks, and during that time they may transmit viral infection. It is very important to avoid that,” Dr. Fishman said. “Currently, there are a number of companies that are developing molecular-based tests and the first ones should roll out within the next year or so.”

 

The TTSN may benefit kidney/ pancreas transplantation programs in particular because the pancreas, like the lungs and heart, is quite fragile. The pancreas requires transplantation faster than the kidneys. Through improved diagnostic assays it may be possible to tailor the medical management of these patients in a way that has not been possible in the past.

 

For example, if a donor of a pancreas had been exposed to a pathogen prior to transplantation, the TTSN will rapidly notify the recipient's physicians so they can provide prophylactic antimicrobial therapy. “Bacterial or fungal infections, though rare, remain much more likely than West Nile virus or Chagas' disease,” Dr. Fishman explained. “And for these infections, we have excellent antimicrobial agents that will allow us to prevent invasive infection. We just need to know when to deploy them and in whom.”

 

 

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