COVID-19 Prompts New Home Test for Kids with Organ Transplants

Mail-in Blood Test Measures Anti-Rejection Drug Levels and Avoids Clinic Visits

Wednesday, May 13, 2020

A new mail-in blood test for children with transplanted organs eliminates the need for vulnerable immunosuppressed patients to visit the hospital to have blood drawn in person.

The test was developed by scientists at Cincinnati Children’s Hospital Medical Center in response to the COVID-19 pandemic. The public health emergency has prompted the temporary closure of most hospital outpatient clinics.

“Given the current pandemic, this is game-changing for these transplant patients and it helps reduce their risk of possible COVID-19 infection. At the same time, it allows patients to maintain their post-transplant follow-up,” said Kenneth D. Setchell, PhD, Professor and Director of the Clinical Mass Spectrometry Laboratory that developed the test.

Transplant patients have to take anti-rejection drugs to help minimize risk for organ rejection. These immunosuppressant drugs can be toxic to the body and blood levels must be carefully monitored.

Levels for immunosuppressant drugs like tacrolimus, sirolimus, everolimus and Cyclosporin A, are normally measured in whole blood following venipuncture performed at a clinic. Patients on these medications are at much greater risk of COVID-19 and stay-at-home instructions complicates the process of blood draw at the hospital, according to Setchell.

Setchell and his team in the Division of Pathology and Laboratory Medicine worked around this problem in a matter of weeks by developing new clinical assays to measure immunosuppressant levels from a dried blood spot on a piece of paper.

A kit is mailed to the patient, who is instructed to prick a finger and spot the blood onto a paper card, let it dry and then place it in an envelope that is mailed back to the Clinical Mass Spectrometry Laboratory at Cincinnati Children’s. After the sample arrives at the lab, a circular disc is punched out of the blood spot and the immunosuppressant is extracted and analyzed by high resolution tandem mass spectrometry to determine the drug concentration.

Setchell said the mail-in test provides comparable blood concentrations as whole blood, is very convenient, and has a rapid turnaround time. This allows clinicians to determine appropriate dosing of immunosuppressant levels.

The test was developed in collaboration with Thomas Ryan, MD, PhD, and the Heart Transplant Team at Cincinnati Children’s. Setchell and his team include Junfang Zhao, Rong Huang, Wujuan Zhang, Xeuheng Zhao and Stephanie Galandi.