From the Research
For patients with simultaneous kidney-pancreas transplants, Prospera may offer slight advantages over Allosure in detecting rejection, with a sensitivity of 85.7% and specificity of 93.7% in detecting biopsy-proven acute rejection of the pancreas graft, as demonstrated in a recent study 1.
Key Points
- Both Allosure and Prospera cell-free DNA tests measure donor-derived cell-free DNA in the recipient's blood, which increases during rejection as damaged donor cells release DNA fragments.
- Prospera's multi-gene SNP approach may provide a more comprehensive assessment compared to Allosure's single-nucleotide polymorphism method.
- The optimal approach may involve using these tests as complementary tools to conventional monitoring (creatinine levels, clinical assessment), with testing every 1-3 months during the first year post-transplant and during suspected rejection episodes.
- A study using the Prospera test found that incorporating dd-cfDNA quantity along with dd-cfDNA fraction outperformed dd-cfDNA fraction alone to detect active rejection 1.
- Another study using Allosure found that dd-cfDNA may help differentiate rejection from graft injury, with median values in rejection 2.25%, injury 0.36%, and quiescence 0.18% (P = 0.0006) 2.
Considerations
- Insurance coverage varies for both tests, so verifying coverage before ordering is important.
- The choice between Allosure and Prospera should be made in consultation with the transplant team based on institutional experience, availability, and individual patient factors.
- While both tests are validated primarily for kidney transplants, Prospera has shown promise in detecting pancreas graft rejection, with a study demonstrating its potential as a noninvasive biomarker for early detection of rejection 1.