Solid Organ and Hematopoietic Stem Cell Transplantation Laboratory Testing for Donors and Recipients

This Test Guide discusses the use of laboratory tests that help match donors and recipients for solid organ and bone marrow transplantation, and also discusses tests that identify and monitor infectious disease in post-transplant recipients.

Solid Organ and Hematopoietic Stem Cell Transplantation: Laboratory Testing for Transplant Recipients

Test Guide

Solid Organ and Hematopoietic Stem Cell Transplantation

Laboratory Testing for Donors and Recipients

This Test Guide provides a description of tests available for transplant donors and recipients. Laboratory testing includes US Food and Drug Administration (FDA)-required testing of donors for certain infectious diseases,1 testing for genetic kidney diseases to evaluate donor candidates,2 guideline-indicated compatibility testing (human leukocyte antigen [HLA] typing and HLA antibody screening) for transplant donors and recipients,3 and post-transplant testing to monitor immunosuppressive and antifungal drug therapies and follow-up for infectious disease.

This Test Guide is provided for informational purposes only and is not intended as medical advice. Test selection and interpretation, diagnosis, and patient management decisions should be based on the physician’s education, clinical expertise, and assessment of the patient.

Donor testing

Laboratory testing can help avoid transmission of infectious disease through transplanted human cells, tissues, and cellular-based products (HCT/Ps) by identifying diseases or disease agents in potential donors with active or latent infections; immunosuppressive drugs used to prevent transplant rejection can reactivate latent infections.4

The FDA requires testing of all donors of HCT/Ps for infections including HIV-1, HIV-2, hepatitis B virus (HBV), hepatitis C virus (HCV), and Treponema pallidum (syphilis); testing for West Nile virus (WNV) is required for living donors.1 Depending on HCT/P type, requirements may also include testing for human T-lymphotropic virus (HTLV), cytomegalovirus, Chlamydia trachomatis, Neisseria gonorrhea, and Trypanosoma cruzi, the parasite that causes Chagas disease (Table 1).5,6

For potential living kidney donors who self-report African ancestry, detection of any 2 APOL1 risk alleles (G1/G1, G2/G2, or G1/G2) indicates an increased risk for developing APOL1-associated chronic kidney disease. The risk of premature allograft loss associated with a high-risk genotype in a living donor is currently unknown, but a high-risk genotype in a deceased donor is associated with shorter allograft survival in transplant recipients.7,8

Quest Diagnostics offers a menu of pretransplant tests that includes APOL1 renal risk variant genotyping and donor screening panels for infectious diseases (Table 1); components of panels can be ordered separately. These panels, based on FDA guidelines for approved testing,5,9 include tests for HIV-1/2, HBV, HCV, CMV, T pallidum, and others.

Table 1. APOL1 Risk Variant and Infectious Disease Testing for Donors

Test code	Test name	Primary clinical use
Genotyping
1291	Apolipoprotein L1 (APOL1) Renal Risk Variant Genotyping	Assist evaluation of a potential donor for kidney transplantation
Infectious disease testing
91986	Donor, Chagas Screen	Screen for Trypanosoma cruzi infection in potential donors of HCT/Ps
17385	Donor, Chlamydia trachomatis/Neisseria gonorrhoeae, RNA, TMA	Screen for C trachomatis and N gonorrhoeae RNA in potential donors of reproductive HCT/Ps
17388	Donor, Cytomegalovirus Antibody, Total	Screen for CMV infection in potential donors of viable, leukocyte-rich cells or tissues
90557	Donor, Cytomegalovirus Antibody, Total With Reflex to (IgG, IgM)a	Screen with reflex to diagnostic testing for CMV infection in potential donors of viable, leukocyte-rich cells or tissues
19618	Donor, Cytomegalovirus Antibody Total With Reflex Non-donor CMV IgMa
17378	Donor, Hepatitis B Core Total Antibody	Screen for history of HBV infection in potential donors of HCT/Ps
17375	Donor, Hepatitis B Surface Antigen With Reflex to Confirma	Screen and confirmation for acute or chronic HBV infection in potential donors of HCT/Ps
93305	Donor, Hepatitis C Antibody (Anti-HCV)	Screen for acute or chronic HCV infection in potential donors of HCT/Ps
19854	Donor, HIV/HCV/HBV NAT Procleix® With Reflexesa	Screen for HIV-1 RNA, HIV-2 RNA, HCV RNA, and HBV DNA in potential donors of HCT/Ps
17380	Donor, HIV-1/2 Plus O Antibody Screen	Screen for HIV-1 and HIV-2 infection in potential donors of HCT/Ps
94973	Donor, HIV-1/2 Plus O Antibody Screen With Reflex to Differentiationa	Screen for HIV-1 and HIV-2 infection with reflex to confirmation/differentiation in potential donors of HCT/Ps
17379	Donor, HTLV-I/II Antibody Screen	Screen for human T-cell lymphotrophic virus I and II infection in potential donors of viable, leukocyte-rich cells and tissues
93309	Donor, Stem Cells Donor Panel	Screen for CMV, HBV, HCV, HIV, HTLV-I/II, syphilis, and WNV in potential stem cell donors
17389	Donor, Syphilis IgG Antibody	Screen for acute or chronic Treponema pallidum infection in potential donors of HCT/Ps
93308	Donor, Tissue Donor Panel Includes donor, hepatitis B core total antibody; donor, hepatitis B surface antigen with reflex to confirm; donor, hepatitis C antibody (anti-HCV); donor, HIV/HCV/HBV NAT Procleix® with reflexes; donor, HIV-1/2 plus O antibody screen; donor, syphilis IgG antibody; donor, West Nile virus, NAT.	Screen for infectious diseases in potential tissue or blood donors
19412	Donor, West Nile Virus, NAT	Screen for WNV RNA in potential donors of HCT/Ps

CMV, cytomegalovirus; HBV, hepatitis B virus; HCV, hepatitis C virus; HCT/Ps, human cells, tissues, and cellular and tissue-based products; HIV, human immunodeficiency virus;; HTLV, human T-cell lymphotropic virus; NAT, nucleic acid amplification; TMA, transcription-mediated amplification; WNV, West Nile virus.
a	Reflex tests are performed at an additional charge and are associated with an additional CPT® code(s).

Compatibility testing for transplant donors and recipients

A person's HLA type and antibody profile are important for assessing immunological compatibility between donor and recipient, as incompatibility can result in transplant rejection. HLA typing and antibody testing can help assess donor-recipient immunological risk. Testing options vary by HLA class and resolution (Table 2).

HLA proteins are grouped into 2 classes: class I includes A, B, and C antigens, and class II includes DR, DQ, and DP antigens. HLA A, B, and DR antigens are considered the most important in transplant survival; however, current Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) guidelines mandate molecular typing of all HLA loci, which may be performed at different levels of resolution depending on transplant center requirements.3 DNA-based typing at low resolution identifies the group of alleles that encode a particular HLA antigen. Intermediate-resolution typing is limited to particular allele groups expected in a population. High-resolution typing allows for a more precise determination of an allelic variant by identifying variants based on differences in antigen recognition site domains. HLA antibody tests identify preformed antibodies to donor HLA antigens in transplant recipients, which may develop from prior sensitization.10

Table 2. Donor–Recipient Compatibility Tests for Solid Organ and Bone Marrow Transplantation

Test code	Test name
HLA typing
92157	HLA A, B, C, Class I Typing, Intermediate Resolutiona
92076	HLA-A, B, C, DRB1 and DQ High Resolution
92078	HLA-A, B, C High Resolution
15484	HLA A, B, C Low Resolutiona
92158	HLA-A, B, Intermediate Resolutiona
15757	HLA A, B Low Resolutiona
92044	HLA A 02:01 Determinationa
10951	HLA A Low Resolutiona
17397	HLA A Typing, High Resolutiona
92746	HLA-B*15:02 Determination with Reflex to HLA-B High Resolutiona
10950	HLA B Low Resolutiona
17395	HLA C High Resolutiona
15463	HLA C Low Resolutiona
95730	HLA DPB1 Typing, High Resolutiona
19525	HLA DQA1 Low Resolutiona
10953	HLA DQB1 Low Resolutiona
17394	HLA DQB1 Typing, High Resolutiona
92159	HLA DRB1, DQB1, Intermediate Resolutiona
15485	HLA DRB1, DQB1 Low Resolutiona
97112	HLA DRB1,3,4,5,DQB1, Low Resolutiona
10952	HLA DRB1 Low Resolutiona
19526	HLA DRB3,4,5 Low Resolutiona
17393	HLA DRB1 Typing, High Resolutiona
95732	HLA DRB3,4,5 Typing, High Resolutiona
92160	HLA DRB1 Typing, Intermediate Resolutiona
92161	HLA DRB3,4,5 Typing, Intermediate Resolutiona
HLA antibody screening and identification
95731	HLA Antibody Identification, Class Ia
97111	HLA Antibody Identification, Class IIa
95735	HLA Antibody Screen, Class Ia
95736	HLA Antibody Screen, Class IIa

This test was developed and its performance characteristics determined by this laboratory. It has not been cleared or approved by the US Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. This test is used for clinical purposes. It should not be regarded as investigational or for research. This laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) as qualified to perform high-complexity clinical laboratory testing.

Post-transplant infectious disease testing

The risk of post-transplant infection varies with a patient’s state of immunosuppression and source of infectious exposures.11,12 Reactivation of donor-derived latent infections commonly occur within the first 4 weeks after transplantation, followed by a 1- to 12-month period during which patients who are immunosuppressed are at risk for opportunistic bacterial, fungal, or viral infections.11 After 1 year, patients are at highest risk for community-acquired infections.11 Certain types of infectious diseases are more common depending on epidemiological exposure, which may help guide diagnostic testing (Table 3).

Table 3. Post-transplant Tests for Infectious Diseases

Test code	Test name
39950	Specialized Transplant Services, Post-Transplanta
Donor-derived latent infections (<4 weeks)
18143	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Bloodb
18142	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Plasmab
18144	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Respiratoryb
18141	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Serumb
18060	Post-Transplant, Hepatitis B Virus DNA, Real-Time PCR, Plasmab
18059	Post-Transplant, Hepatitis B Virus DNA, Real-Time PCR, Serumb
18104	Post-Transplant, Hepatitis C Viral RNA, Real-Time PCR, Plasmab
18103	Post-Transplant, Hepatitis C Viral (HCV) RNA, Real-Time PCR, Serumb
18003	Post-Transplant, HIV-1 RNA, Real-Time PCR, Plasmab
Opportunistic (1 month to 12 months) and community acquired infections (>12 months)
18122	Post-Transplant, Adenovirus DNA, Real-Time PCR, Bloodb
18120	Post-Transplant, Adenovirus DNA, Real-Time PCR, Plasmab
18124	Post-Transplant, Adenovirus DNA, Real-Time PCR, Respiratoryb
18118	Post-Transplant, Adenovirus DNA, Real-Time PCR, Serumb
18126	Post-Transplant, Adenovirus DNA, Real-Time PCR, Urineb
18000	Post-Transplant, Aspergillus DNA, Qualitative Real-Time PCR, Bloodb
18001	Post-Transplant, Aspergillus DNA, Qualitative Real-Time PCR, Respiratoryb
18051	Post-Transplant, BK Virus DNA, Real-Time PCR, Bloodb
18050	Post-Transplant, BK Virus DNA, Real-Time PCR, Plasmab
18049	Post-Transplant, BK Virus DNA, Real-Time PCR, Serumb
18052	Post-Transplant, BK Virus DNA, Real-Time PCR, Urineb
18143	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Bloodb
18142	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Plasmab
18144	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Respiratoryb
18141	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Serumb
18090	Post-Transplant, Epstein-Barr Virus DNA, Real-Time PCR, Bloodb
18089	Post-Transplant, Epstein-Barr Virus DNA, Real-Time PCR, Plasmab
18088	Post-Transplant, Epstein-Barr Virus DNA, Real-Time PCR, Serumb
18060	Post-Transplant, Hepatitis B Virus DNA, Real-Time PCR, Plasmab
18059	Post-Transplant, Hepatitis B Virus DNA, Real-Time PCR, Serumb
18104	Post-Transplant, Hepatitis C Viral RNA, Real-Time PCR, Plasmab
18103	Post-Transplant, Hepatitis C Viral RNA, Real-Time PCR, Serumb
18022	Post-Transplant, Herpesvirus 6 DNA, Real-Time PCR, Bloodb
18020	Post-Transplant, Herpesvirus 6 DNA, Real-Time PCR, P0lasmab
18078	Post-Transplant, Herpesvirus 7 DNA, Real-Time PCR, Bloodb
18076	Post-Transplant, Herpesvirus 7 DNA, Real-Time PCR, Plasmab
18074	Post-Transplant, Herpesvirus 7 DNA, Real-Time PCR, Serumb
18132	Post-Transplant, Herpesvirus 8 DNA, Real-Time PCR, Bloodb
18130	Post-Transplant, Herpesvirus 8 DNA, Real-Time PCR, Plasmab
18128	Post-Transplant, Herpesvirus 8 DNA, Real-Time PCR, Serumb
18003	Post-Transplant, HIV-1 RNA, Real-Time PCR, Plasmab
18011	Post-Transplant, JC Virus DNA, Real-Time PCR, CSFb
18010	Post-Transplant, JC Virus DNA, Real-Time PCR, Plasmab
18009	Post-Transplant, JC Virus DNA, Real-Time PCR, Serumb
18070	Post-Transplant, Parvovirus B19 DNA, Real-Time PCR, Bloodb
18068	Post-Transplant, Parvovirus B19 DNA, Real-Time PCR, Plasmab
18066	Post-Transplant, Parvovirus B19 DNA, Real-Time PCR, Serumb
18146	Post-Transplant, Varicella-zoster Virus DNA, Real-Time PCR, Bloodb
18148	Post-Transplant, Varicella-zoster Virus DNA, Real-Time PCR, CSFb
18005	Post-Transplant, Pneumocystis jiroveci, Real-Time PCR, Respiratoryb

a	Specialized transplant services include collection and shipping kits provided to the customer, direct shipping via FedEx, post-transplant-specific requisitions, and rapid turnaround (8-12 hours from laboratory receipt of sample). Test code 39950 designates special handling for these services; it is a single-use test code that may be applied to 1 or more tests in this section.
b	This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

Other tests

Laboratory tests can also be used to monitor immunosuppressive and antifungal drug therapies (Table 4) and help optimize dose, avoid toxicity, and assure patient adherence.

Table 4. Post-transplant Testing for Therapeutic Drug Monitoring

Test code	Test name	Primary clinical use
Immunosuppressive therapy
10720	Cyclosporine A Panel (Trough, 1 Hour, 2 Hour Post)	Monitor immunosuppressive therapy to optimize dose, avoid toxicity, and help assure adherence to a treatment regimen
10719	Cyclosporine A Peak (2 Hour), Blood
8812	Cyclosporine A, Trough, Blood
15220	Cyclosporine A Trough, LC/MS/MS, Blooda
18883	Everolimus, LC/MS/MS, Blooda
10662	Mycophenolic Acida
36712	Sirolimus, LC/MS/MSa
70007	Tacrolimus, Highly Sensitive, LC/MS/MSa
91745	Thiopurine Metabolitesa
Antifungal therapy
94092	Itraconazolea	Monitor drug levels when unexpected toxicity is encountered; optimize dosage when drug interactions are suspected
94010	Posaconazolea
94096	Voriconazolea
94692	Voriconazole, CSFa

a	This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by the FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

Laboratory tests can also be used during early follow-up to evaluate transplant viability, bone marrow cell engraftment, cell-mediated immune response complications, and the possibility of rejection or complications (Table 5).

Table 5. Post-transplant Testing for Early Follow-up

Test code	Test name	Primary clinical use
4944	Beta-2-Microglobulin, Random Urine	Evaluate transplant viability and anticipate rejection
38994	Beta-2-Microglobulin, Random Urine with Creatinine
852	Beta-2-Microglobulin, Serum
14619	FISH, X/Y, Post Opposite Sex Bone Marrow Transplant (BMT)	Monitor progression of bone marrow cell engraftment when bone marrow is from a donor of the opposite sex
15435	Immune Cell Function	Monitor cell-mediated immune response to optimize immunosuppressant therapy
34298	Interleukin-2 Receptor Alpha Chain (IL-2Ra/CD25), Solublea	Assess possibility of acute transplant rejection
34473	Interleukin-6 (IL-6), Seruma	Assess possibility of transplant-related complications after hematopoietic stem cell transplantation (SCT)
93917	Neopterin, Serumb	Monitor cell-mediated immunity

a	This test was performed using a kit that has not been cleared or approved by the FDA. The analytical performance characteristics of this test have been determined by Quest Diagnostics. This test should not be used for diagnosis without confirmation by other medically established means.
b	This test was performed using a kit that has not been cleared or approved by the FDA. The analytical performance characteristics of this test have been determined by Laboratory Corporation of America (LabCorp). This test should not be used for diagnosis without confirmation by other medically established means.

References

Donor screening and testing. Centers for Disease Control and Prevention. Updated October 13, 2022. Accessed May 1, 2024. https://www.cdc.gov/transplant-safety/hcp/clinical-guidance/?CDC_AAref_Val=https://www.cdc.gov/transplantsafety/protecting-patient/screening-testing.html
Lentine KL, Kasiske BL, Levey AS, et al. Summary of kidney disease. Transplantation. 2017;101(8):1783-1792. doi:10.1097/tp.0000000000001770
Policies. The Organ Procurement and Transplantation Network. Updated May 29, 2024. Accessed June 1, 2024. https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf#nameddest=Policy_07
Malinis M, Boucher HW. Screening of donor and candidate prior to solid organ transplantation—guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13548. doi:10.1111/ctr.13548
Guidance for industry: eligibility determination for donors of human cells, tissues, and cellular and tissue-based products (HCT/Ps). US Food and Drug Administration. Updated May 2, 2024. Accessed May 13, 2024. https://www.fda.gov/media/73072/download
Use of serological tests to reduce the risk of transmission of Trypanosoma cruzi infection in blood and blood components. Guidance for industry. US Food and Drug Administration. Updated May 16, 2019. Accessed May 13, 2024. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/use-serological-tests-reduce-risk-transmission-trypanosoma-cruzi-infection-blood-and-blood
Freedman BI, Pastan SO, Israni AK, et al. APOL1 genotype and kidney transplantation outcomes from deceased African American donors. Transplantation. 2016;100(1):194-202. doi:10.1097/tp.0000000000000969
Reeves-Daniel AM, DePalma JA, Bleyer AJ, et al. The APOL1 gene and allograft survival after kidney transplantation. Am J Transplant. 2011;11(5):1025-1030. doi:10.1111/j.1600-6143.2011.03513.x
Complete list of donor screening assays for infectious agents and HIV diagnostic assays. US Food and Drug Administration. Updated April 12, 2024. Accessed May 13, 2024. https://www.fda.gov/vaccines-blood-biologics/complete-list-donor-screening-assays-infectious-agents-and-hiv-diagnostic-assays
HLA testing for solid organ transplantation. American Association of Clinical Chemistry. Updated August 27, 2019. Accessed June 20, 2024. https://www.myadlm.org/Science-and-Research/Clinical-Chemistry/Clinical-Chemistry-Trainee-Council/Pearls-of-Laboratory-Medicine-in-English/2019/HLA-Testing-for-Solid-Organ-Transplantation
Fishman JA. Infection in organ transplantation. Am J Transplant. 2017;17(4):856-879. doi:10.1111/ajt.14208
Singh N, Limaye AP. Infections in solid-organ transplant recipients. In: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 2015:3440-3452. doi:10.1016/b978-1-4557-4801-3.00313-1

Content reviewed 08/2024

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Test Guide List

Solid Organ and Hematopoietic Stem Cell Transplantation: Laboratory Testing for Transplant Recipients

Test Guide

Solid Organ and Hematopoietic Stem Cell Transplantation

Laboratory Testing for Donors and Recipients

Donor testing

Table 1. APOL1 Risk Variant and Infectious Disease Testing for Donors

Test code	Test name	Primary clinical use
Genotyping
1291	Apolipoprotein L1 (APOL1) Renal Risk Variant Genotyping	Assist evaluation of a potential donor for kidney transplantation
Infectious disease testing
91986	Donor, Chagas Screen	Screen for Trypanosoma cruzi infection in potential donors of HCT/Ps
17385	Donor, Chlamydia trachomatis/Neisseria gonorrhoeae, RNA, TMA	Screen for C trachomatis and N gonorrhoeae RNA in potential donors of reproductive HCT/Ps
17388	Donor, Cytomegalovirus Antibody, Total	Screen for CMV infection in potential donors of viable, leukocyte-rich cells or tissues
90557	Donor, Cytomegalovirus Antibody, Total With Reflex to (IgG, IgM)a	Screen with reflex to diagnostic testing for CMV infection in potential donors of viable, leukocyte-rich cells or tissues
19618	Donor, Cytomegalovirus Antibody Total With Reflex Non-donor CMV IgMa
17378	Donor, Hepatitis B Core Total Antibody	Screen for history of HBV infection in potential donors of HCT/Ps
17375	Donor, Hepatitis B Surface Antigen With Reflex to Confirma	Screen and confirmation for acute or chronic HBV infection in potential donors of HCT/Ps
93305	Donor, Hepatitis C Antibody (Anti-HCV)	Screen for acute or chronic HCV infection in potential donors of HCT/Ps
19854	Donor, HIV/HCV/HBV NAT Procleix® With Reflexesa	Screen for HIV-1 RNA, HIV-2 RNA, HCV RNA, and HBV DNA in potential donors of HCT/Ps
17380	Donor, HIV-1/2 Plus O Antibody Screen	Screen for HIV-1 and HIV-2 infection in potential donors of HCT/Ps
94973	Donor, HIV-1/2 Plus O Antibody Screen With Reflex to Differentiationa	Screen for HIV-1 and HIV-2 infection with reflex to confirmation/differentiation in potential donors of HCT/Ps
17379	Donor, HTLV-I/II Antibody Screen	Screen for human T-cell lymphotrophic virus I and II infection in potential donors of viable, leukocyte-rich cells and tissues
93309	Donor, Stem Cells Donor Panel	Screen for CMV, HBV, HCV, HIV, HTLV-I/II, syphilis, and WNV in potential stem cell donors
17389	Donor, Syphilis IgG Antibody	Screen for acute or chronic Treponema pallidum infection in potential donors of HCT/Ps
93308	Donor, Tissue Donor Panel Includes donor, hepatitis B core total antibody; donor, hepatitis B surface antigen with reflex to confirm; donor, hepatitis C antibody (anti-HCV); donor, HIV/HCV/HBV NAT Procleix® with reflexes; donor, HIV-1/2 plus O antibody screen; donor, syphilis IgG antibody; donor, West Nile virus, NAT.	Screen for infectious diseases in potential tissue or blood donors
19412	Donor, West Nile Virus, NAT	Screen for WNV RNA in potential donors of HCT/Ps

CMV, cytomegalovirus; HBV, hepatitis B virus; HCV, hepatitis C virus; HCT/Ps, human cells, tissues, and cellular and tissue-based products; HIV, human immunodeficiency virus;; HTLV, human T-cell lymphotropic virus; NAT, nucleic acid amplification; TMA, transcription-mediated amplification; WNV, West Nile virus.
a	Reflex tests are performed at an additional charge and are associated with an additional CPT® code(s).

Compatibility testing for transplant donors and recipients

Table 2. Donor–Recipient Compatibility Tests for Solid Organ and Bone Marrow Transplantation

Test code	Test name
HLA typing
92157	HLA A, B, C, Class I Typing, Intermediate Resolutiona
92076	HLA-A, B, C, DRB1 and DQ High Resolution
92078	HLA-A, B, C High Resolution
15484	HLA A, B, C Low Resolutiona
92158	HLA-A, B, Intermediate Resolutiona
15757	HLA A, B Low Resolutiona
92044	HLA A 02:01 Determinationa
10951	HLA A Low Resolutiona
17397	HLA A Typing, High Resolutiona
92746	HLA-B*15:02 Determination with Reflex to HLA-B High Resolutiona
10950	HLA B Low Resolutiona
17395	HLA C High Resolutiona
15463	HLA C Low Resolutiona
95730	HLA DPB1 Typing, High Resolutiona
19525	HLA DQA1 Low Resolutiona
10953	HLA DQB1 Low Resolutiona
17394	HLA DQB1 Typing, High Resolutiona
92159	HLA DRB1, DQB1, Intermediate Resolutiona
15485	HLA DRB1, DQB1 Low Resolutiona
97112	HLA DRB1,3,4,5,DQB1, Low Resolutiona
10952	HLA DRB1 Low Resolutiona
19526	HLA DRB3,4,5 Low Resolutiona
17393	HLA DRB1 Typing, High Resolutiona
95732	HLA DRB3,4,5 Typing, High Resolutiona
92160	HLA DRB1 Typing, Intermediate Resolutiona
92161	HLA DRB3,4,5 Typing, Intermediate Resolutiona
HLA antibody screening and identification
95731	HLA Antibody Identification, Class Ia
97111	HLA Antibody Identification, Class IIa
95735	HLA Antibody Screen, Class Ia
95736	HLA Antibody Screen, Class IIa

Post-transplant infectious disease testing

Table 3. Post-transplant Tests for Infectious Diseases

Test code	Test name
39950	Specialized Transplant Services, Post-Transplanta
Donor-derived latent infections (<4 weeks)
18143	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Bloodb
18142	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Plasmab
18144	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Respiratoryb
18141	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Serumb
18060	Post-Transplant, Hepatitis B Virus DNA, Real-Time PCR, Plasmab
18059	Post-Transplant, Hepatitis B Virus DNA, Real-Time PCR, Serumb
18104	Post-Transplant, Hepatitis C Viral RNA, Real-Time PCR, Plasmab
18103	Post-Transplant, Hepatitis C Viral (HCV) RNA, Real-Time PCR, Serumb
18003	Post-Transplant, HIV-1 RNA, Real-Time PCR, Plasmab
Opportunistic (1 month to 12 months) and community acquired infections (>12 months)
18122	Post-Transplant, Adenovirus DNA, Real-Time PCR, Bloodb
18120	Post-Transplant, Adenovirus DNA, Real-Time PCR, Plasmab
18124	Post-Transplant, Adenovirus DNA, Real-Time PCR, Respiratoryb
18118	Post-Transplant, Adenovirus DNA, Real-Time PCR, Serumb
18126	Post-Transplant, Adenovirus DNA, Real-Time PCR, Urineb
18000	Post-Transplant, Aspergillus DNA, Qualitative Real-Time PCR, Bloodb
18001	Post-Transplant, Aspergillus DNA, Qualitative Real-Time PCR, Respiratoryb
18051	Post-Transplant, BK Virus DNA, Real-Time PCR, Bloodb
18050	Post-Transplant, BK Virus DNA, Real-Time PCR, Plasmab
18049	Post-Transplant, BK Virus DNA, Real-Time PCR, Serumb
18052	Post-Transplant, BK Virus DNA, Real-Time PCR, Urineb
18143	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Bloodb
18142	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Plasmab
18144	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Respiratoryb
18141	Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Serumb
18090	Post-Transplant, Epstein-Barr Virus DNA, Real-Time PCR, Bloodb
18089	Post-Transplant, Epstein-Barr Virus DNA, Real-Time PCR, Plasmab
18088	Post-Transplant, Epstein-Barr Virus DNA, Real-Time PCR, Serumb
18060	Post-Transplant, Hepatitis B Virus DNA, Real-Time PCR, Plasmab
18059	Post-Transplant, Hepatitis B Virus DNA, Real-Time PCR, Serumb
18104	Post-Transplant, Hepatitis C Viral RNA, Real-Time PCR, Plasmab
18103	Post-Transplant, Hepatitis C Viral RNA, Real-Time PCR, Serumb
18022	Post-Transplant, Herpesvirus 6 DNA, Real-Time PCR, Bloodb
18020	Post-Transplant, Herpesvirus 6 DNA, Real-Time PCR, P0lasmab
18078	Post-Transplant, Herpesvirus 7 DNA, Real-Time PCR, Bloodb
18076	Post-Transplant, Herpesvirus 7 DNA, Real-Time PCR, Plasmab
18074	Post-Transplant, Herpesvirus 7 DNA, Real-Time PCR, Serumb
18132	Post-Transplant, Herpesvirus 8 DNA, Real-Time PCR, Bloodb
18130	Post-Transplant, Herpesvirus 8 DNA, Real-Time PCR, Plasmab
18128	Post-Transplant, Herpesvirus 8 DNA, Real-Time PCR, Serumb
18003	Post-Transplant, HIV-1 RNA, Real-Time PCR, Plasmab
18011	Post-Transplant, JC Virus DNA, Real-Time PCR, CSFb
18010	Post-Transplant, JC Virus DNA, Real-Time PCR, Plasmab
18009	Post-Transplant, JC Virus DNA, Real-Time PCR, Serumb
18070	Post-Transplant, Parvovirus B19 DNA, Real-Time PCR, Bloodb
18068	Post-Transplant, Parvovirus B19 DNA, Real-Time PCR, Plasmab
18066	Post-Transplant, Parvovirus B19 DNA, Real-Time PCR, Serumb
18146	Post-Transplant, Varicella-zoster Virus DNA, Real-Time PCR, Bloodb
18148	Post-Transplant, Varicella-zoster Virus DNA, Real-Time PCR, CSFb
18005	Post-Transplant, Pneumocystis jiroveci, Real-Time PCR, Respiratoryb

a	Specialized transplant services include collection and shipping kits provided to the customer, direct shipping via FedEx, post-transplant-specific requisitions, and rapid turnaround (8-12 hours from laboratory receipt of sample). Test code 39950 designates special handling for these services; it is a single-use test code that may be applied to 1 or more tests in this section.
b	This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

Other tests

Laboratory tests can also be used to monitor immunosuppressive and antifungal drug therapies (Table 4) and help optimize dose, avoid toxicity, and assure patient adherence.

Table 4. Post-transplant Testing for Therapeutic Drug Monitoring

Test code	Test name	Primary clinical use
Immunosuppressive therapy
10720	Cyclosporine A Panel (Trough, 1 Hour, 2 Hour Post)	Monitor immunosuppressive therapy to optimize dose, avoid toxicity, and help assure adherence to a treatment regimen
10719	Cyclosporine A Peak (2 Hour), Blood
8812	Cyclosporine A, Trough, Blood
15220	Cyclosporine A Trough, LC/MS/MS, Blooda
18883	Everolimus, LC/MS/MS, Blooda
10662	Mycophenolic Acida
36712	Sirolimus, LC/MS/MSa
70007	Tacrolimus, Highly Sensitive, LC/MS/MSa
91745	Thiopurine Metabolitesa
Antifungal therapy
94092	Itraconazolea	Monitor drug levels when unexpected toxicity is encountered; optimize dosage when drug interactions are suspected
94010	Posaconazolea
94096	Voriconazolea
94692	Voriconazole, CSFa

a	This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by the FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

Table 5. Post-transplant Testing for Early Follow-up

Test code	Test name	Primary clinical use
4944	Beta-2-Microglobulin, Random Urine	Evaluate transplant viability and anticipate rejection
38994	Beta-2-Microglobulin, Random Urine with Creatinine
852	Beta-2-Microglobulin, Serum
14619	FISH, X/Y, Post Opposite Sex Bone Marrow Transplant (BMT)	Monitor progression of bone marrow cell engraftment when bone marrow is from a donor of the opposite sex
15435	Immune Cell Function	Monitor cell-mediated immune response to optimize immunosuppressant therapy
34298	Interleukin-2 Receptor Alpha Chain (IL-2Ra/CD25), Solublea	Assess possibility of acute transplant rejection
34473	Interleukin-6 (IL-6), Seruma	Assess possibility of transplant-related complications after hematopoietic stem cell transplantation (SCT)
93917	Neopterin, Serumb	Monitor cell-mediated immunity

a	This test was performed using a kit that has not been cleared or approved by the FDA. The analytical performance characteristics of this test have been determined by Quest Diagnostics. This test should not be used for diagnosis without confirmation by other medically established means.
b	This test was performed using a kit that has not been cleared or approved by the FDA. The analytical performance characteristics of this test have been determined by Laboratory Corporation of America (LabCorp). This test should not be used for diagnosis without confirmation by other medically established means.

References

Donor screening and testing. Centers for Disease Control and Prevention. Updated October 13, 2022. Accessed May 1, 2024. https://www.cdc.gov/transplant-safety/hcp/clinical-guidance/?CDC_AAref_Val=https://www.cdc.gov/transplantsafety/protecting-patient/screening-testing.html
Lentine KL, Kasiske BL, Levey AS, et al. Summary of kidney disease. Transplantation. 2017;101(8):1783-1792. doi:10.1097/tp.0000000000001770
Policies. The Organ Procurement and Transplantation Network. Updated May 29, 2024. Accessed June 1, 2024. https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf#nameddest=Policy_07
Malinis M, Boucher HW. Screening of donor and candidate prior to solid organ transplantation—guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13548. doi:10.1111/ctr.13548
Guidance for industry: eligibility determination for donors of human cells, tissues, and cellular and tissue-based products (HCT/Ps). US Food and Drug Administration. Updated May 2, 2024. Accessed May 13, 2024. https://www.fda.gov/media/73072/download
Use of serological tests to reduce the risk of transmission of Trypanosoma cruzi infection in blood and blood components. Guidance for industry. US Food and Drug Administration. Updated May 16, 2019. Accessed May 13, 2024. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/use-serological-tests-reduce-risk-transmission-trypanosoma-cruzi-infection-blood-and-blood
Freedman BI, Pastan SO, Israni AK, et al. APOL1 genotype and kidney transplantation outcomes from deceased African American donors. Transplantation. 2016;100(1):194-202. doi:10.1097/tp.0000000000000969
Reeves-Daniel AM, DePalma JA, Bleyer AJ, et al. The APOL1 gene and allograft survival after kidney transplantation. Am J Transplant. 2011;11(5):1025-1030. doi:10.1111/j.1600-6143.2011.03513.x
Complete list of donor screening assays for infectious agents and HIV diagnostic assays. US Food and Drug Administration. Updated April 12, 2024. Accessed May 13, 2024. https://www.fda.gov/vaccines-blood-biologics/complete-list-donor-screening-assays-infectious-agents-and-hiv-diagnostic-assays
HLA testing for solid organ transplantation. American Association of Clinical Chemistry. Updated August 27, 2019. Accessed June 20, 2024. https://www.myadlm.org/Science-and-Research/Clinical-Chemistry/Clinical-Chemistry-Trainee-Council/Pearls-of-Laboratory-Medicine-in-English/2019/HLA-Testing-for-Solid-Organ-Transplantation
Fishman JA. Infection in organ transplantation. Am J Transplant. 2017;17(4):856-879. doi:10.1111/ajt.14208
Singh N, Limaye AP. Infections in solid-organ transplant recipients. In: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 2015:3440-3452. doi:10.1016/b978-1-4557-4801-3.00313-1

Content reviewed 08/2024

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Test Code 10662

Mycophenolic Acid, LC/MS/MS

Mycophenolic acid is an immunosuppressant used in tissue transplants. It prevents graft rejection by the host's immune system. It is very important to monitor its level. Too little of this drug will cause graft rejection, while too much will lead to infection. Monitoring its level is essential to optimize therapeutic effects, avoid toxicity, and assure compliance.

Test Code 10950

HLA B Low Resolution

Test Code 10952

HLA DRB1 Low Resolution

Test Code 10953

HLA DQB1 Low Resolution

Test Code 14619

FISH, X/Y, Post Opposite Sex Bone Marrow Transplant

Test Code 15484

HLA A,B,C Low Resolution

Test Code 15485

HLA DRB1,DQB1 Low Resolution

Test Code 17395

HLA C High Resolution

Test Code 17397

HLA A Typing, High Resolution

Test Code 19526

HLA DRB3,4,5 Low Resolution

Test Code 34473

Interleukin-6 (IL-6), Serum

To evaluate the level of IL-6 in serum samples.

Test Code 92157

HLA A,B,C, Class I Typing, Intermediate Resolution

Test Code 92078

HLA-A, B, C High Resolution

Test Code 18090

Post-Transplant, Epstein-Barr Virus DNA, Quantitative Real-Time PCR, Blood

Monitoring EBV DNA levels by quantitative PCR in patients at risk of EBV-associated lymphoproliferative disorders may allow timely recognition of virus reactivation and permit installment of antiviral treatment. Reportable range is 200-2,000,000 copies/mL (2.30 to 6.30 Log copies/mL).

Test Code 18011

Post-Transplant, JC Virus DNA, Real-Time PCR, CSF

JC Polyoma Virus is the cause of Progressive Multifocal Leukoencephalopathy (PML), a severe demyelinating disease of the central nervous system. PML is a particular concern for individuals infected with the human immunodeficiency virus. Quantification of JC virus DNA is based upon the real-time PCR amplification and detection of JCV genomic DNA. Reportable range is 50 to 50,000,000 IU/mL (1.70 to 7.70 Log IU/mL).

Test Code 18052

Post-Transplant, BK Virus DNA, Real-Time PCR, Urine

This test detects and quantitates BK Virus DNA in urine specimens of kidney transplant recipients who are at risk of developing BKV-associated nephropathy (BKVAN) and associated hemorrhagic cystitis leading to kidney failure. Prospective viral load monitoring of BKV DNA in urine (and plasma) is useful to exclude a diagnosis of BKVAN and to monitor the course of BKV infection. The assay is calibrated to the First World Health Organization International Standard for BKV DNA with a Reportable Range

Test Code 18128

Post-Transplant, Herpesvirus 8 DNA, Real-Time PCR, Serum

Human herpesvirus-8 (HHV-8) is associated with the development of all forms of Kaposi's sarcoma, as well as with some other rare lymphoproliferative diseases, such as primary effusion lymphoma and multicentric Castleman's disease. Quantitative PCR may be used to monitor the level of viremia in a patient, often in the context of therapy. Reportable range is 1,000 to 10,000,000 copies/mL (3.00 to 7.00 Log copies/mL).

Test Code 93917

Neopterin, Serum

Increased levels of neopterin are found during impaired renal function and viral infections in transplant patients. Elevated levels are also indicators for conditions related to impaired cellular immunity.

Test Code 18130

Post-Transplant, Herpesvirus 8 DNA, Real-Time PCR, Plasma

Test Code 18118

Post-Transplant, Adenovirus DNA, Real-Time PCR, Serum

This test is used to determine the presence of adenovirus in a patient's specimen. Organisms may be detected by PCR prior to diagnosis by immunological methods. PCR provides more rapid results than other methods, including culture. Reportable range is 500 to 2,000,000 copies/mL (2.70-6.30 Log copies/mL).

Test Code 18148

Post-Transplant, Varicella-Zoster Virus DNA, Real-Time PCR, CSF

Varicella-Zoster virus (VZV) is a member of the Herpesviridae family that causes chickenpox as a primary infection and can reactivate later in life as herpes zoster or shingles. VZV infection in immunocompromised individuals often leads to a progressive disease state involving multiple organs. The detection of Varicella-Zoster Virus (VZV) DNA is based upon the real-time amplification and detection of specific VZV genomic DNA sequences by PCR from total DNA extracted from the specimen. Reportable

Test Code 38994

Beta-2-Microglobulin, Random Urine with Creatinine

Beta-2 Microglobulin (B2M) is a low molecular weight protein that forms the light chain component of the histocompatibility antigen. It is synthesized by all nucleated cell types. It is an integral part of the class I MHC antigens and is present in all body fluids. B2M is filtered through the glomeruli of the kidney and is then reabsorbed and catabolized by the proximal tubular cells. In normal patients only trace amounts of B2M appear in the urine. Elevated urine B2M is seen in tubulo-interstit

Test Code 18089

Post-Transplant, Epstein-Barr Virus DNA, Quantitative Real-Time PCR, Plasma

Test Code 18141

Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Serum

In patients who are immunocompromised, CMV may cause disseminated, severe disease. CMV is also the most common cause of congenital viral infection in humans. Quantitative PCR methods may be useful in monitoring CMV replication in immunosuppressed patients or in determining the viral load of CMV in amniotic fluid. Reportable range is 200-2,000,000 IU/mL (2.30 to 6.30 Log IU/mL).

Test Code 34298

Interleukin-2 Receptor Alpha Chain (IL-2Ra/CD25), Soluble

Test Code 8812

Cyclosporine A Trough, Blood

Cyclosporine (Cyclosporin A) is an immunosuppressant therapeutic agent used in the prevention of organ graft rejection. Measurement of blood levels is recommended due to the inter-individual variability of metabolism as well as the toxicity associated with excessive dosage.

Test Code 95730

HLA DPB1 Typing, High Resolution

Test Code 95731

HLA Antibody Identification, Class I

Test Code 95735

HLA Antibody Screen, Class I

Test Code 97112

HLA DRB1,3,4,5,DQB1, Low Resolution

Test Code 95736

HLA Antibody Screen, Class II

Test Code 18009

Post-Transplant, JC Virus DNA, Real-Time PCR, Serum

Test Code 18051

Post-Transplant, BK Virus DNA, Real-Time PCR, Blood

This test is used to determine the presence of BK Virus DNA in patient's specimens. Detection of the virus in these specimens may be indicative of an active infection, as PCR detects the presence of the virus, and not the host's reaction to the virus. Polyomavirus BK DNA detection in urine or plasma is associated with an increased risk of graft rejection in renal recipients. Quantitative testing may indicate change in risk over time. Reportable range is 500 to 500,000,000 copies/mL (2.70 to 8.70

Test Code 18068

Post-Transplant, Parvovirus B19 DNA, Real-Time PCR, Plasma

Parvovirus B19 infection has a wide variety of disease manifestations, including Fifth disease, transient aplastic crisis, persistent anemia and congenital hydrops fetalis. Quantification of parvovirus B19 genomic DNA is based upon Real-Time PCR amplification and detection. Reportable range is 100 to 100,000,000 copies/mL (2.00 to 8.00 Log copies/mL).

Test Code 94096

Voriconazole

The antifungal drug voriconazole is commonly used in the treatment of various types of fungal infections. An increased fungal resistance to similar drugs of greater toxicity has promoted the use of voriconazole in treating infections caused by aspergillus and other fungal species. The chronic nature of fungal infections demands constant monitoring of voriconazole levels within a patient to ensure that adequate therapeutic levels of the drug are administered, absorbed and subsequently excreted.

Test Code 18142

Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Plasma

In patients who are immunocompromised, CMV may cause disseminated, severe disease. CMV is also the most common cause of congenital viral infection in humans. Quantitative PCR methods may be useful in monitoring CMV replication in immunosuppressed patients. This is a quantitative molecular test, with a reportable range of 34.5-10,000,000 IU/mL (1.54--7.00 log IU/mL).

Test Code 18122

Post-Transplant, Adenovirus DNA, Real-Time PCR, Blood

Test Code 18103

Post-Transplant, Hepatitis C Virus RNA, Real-Time PCR, Serum

Useful in monitoring therapy and/or disease progression. Reportable range is 15 to 100,000,000 IU/mL (1.18 to 8.00 log IU/mL).

Test Code 18078

Post-Transplant, Herpesvirus 7 DNA, Real-Time PCR, Blood

This test is used in the diagnosis of human herpesvirus 7 infection. HHV-7 is closely related to HHV-6 and CMV and can reactivate in transplant patients or other immune-compromised individuals. PCR may detect infection earlier than immunological methods and provides more rapid results than culture, but does not provide information on past exposure or immunity. Quantitative measurement may provide information on disease regression. Reportable range is 500 to 10,000,000 copies/mL (2.70 to 7.00 Log

Test Code 18104

Post-Transplant, Hepatitis C Virus RNA, Real-Time PCR, Plasma

Useful in monitoring therapy and/or disease progression. Reportable range is 15 to 100,000,000 IU/mL (1.18 to 8.00 log IU/mL).

Test Code 39950

Specialized Transplant Services, Post-Transplant

Quest Advanced Specialized Transplant Services (QASTS) Post-Transplant Kit Code should be used whenever Post-Transplant infectious disease testing is ordered for enhanced and expedited services including rapid turnaround time and white glove customer service.

DO NOT order with Quest Advanced Specialized Transplant Services Donor Kit Code or any other Donor QASTS testing. To find related Post-Transplant codes type "Post-Transplant" in the Test Directory.

Test Code 18070

Post-Transplant, Parvovirus B19 DNA, Real-Time PCR, Blood

Test Code 18143

Post-Transplant, Cytomegalovirus DNA, Real-Time PCR, Blood

Test Code 15220

Cyclosporine A Trough, LC/MS/MS, Blood

Cyclosporine is a commonly used immunosuppressive drug in patients receiving transplants. LC/MS/MS methods have higher specificity for the parent compound than immunoassay. Therapeutic drug monitoring is useful to optimize dose and avoid toxicity. High cyclosporine levels can lead to nephrotoxicity; Low levels can lead to organ rejection following transplant. Peak concentrations are reached at around 3.5 hours after oral dosage. Elimination half-life is 10-27 hours.

Test Code 15757

HLA A,B Low Resolution

Test Code 15463

HLA C Low Resolution

Test Code 17393

HLA DRB1 Typing, High Resolution

Test Code 17394

HLA DQB1 Typing, High Resolution

Test Code 18883

Everolimus, Blood

Test Code 19525

HLA DQA1 Low Resolution

Test Code 36712

Sirolimus, LC/MS/MS

Sirolimus is an immunosuppressant drug used to prevent organ graft rejection. Therapeutic drug monitoring is used to optimize dose and avoid toxicity. Peak concentrations are reached in 2 hours following oral administration. Elimination half-life in males is approximately 72 hours; in females approximately 61 hours.

Test Code 92076

HLA-A, B, C, DRB1 and DQ High Resolution

Test Code 92158

HLA-A, B, Intermediate Resolution

HLA typing is used to match donors and recipients for bone marrow and solid organ transplantation.

Test Code 92159

HLA-DRB1, DQB1, Intermediate Resolution

HLA typing is used to match donors and recipients for bone marrow and solid organ transplantation.

Test Code 92160

HLA DRB1 Typing, Intermediate Resolution

Test Code 92161

HLA DRB3,4,5 Typing, Intermediate Resolution

Test Code 94010

Posaconazole

The antifungal drug posaconazole is indicated for prophylaxis of invasive aspergillus and candida infections in severely immunocompromised patients. It may also be used in the treatment of oropharyngeal candidiasis refractory to itraconazole and fluconazole. The chronic nature of fungal infections demands constant monitoring of posaconazole levels within a patient to ensure that adequate therapeutic levels of the drug are administered, absorbed and subsequently excreted.

Test Code 18088

Post-Transplant, Epstein-Barr Virus DNA, Quantitative Real-Time PCR, Serum

Test Code 18144

Post-Transplant, Cytomegalovirus DNA, Qualitative Real-Time PCR, Respiratory

In patients who are immunocompromised, CMV may cause disseminated, severe disease. CMV is also the most common cause of congenital viral infection in humans.

Test Code 18005

Post-Transplant, Pneumocystis jirovecii, Real-Time PCR, Respiratory

Detection of Pneumocystis jirovecii DNA by real-time PCR is a useful tool for the rapid diagnosis of Pneumocystis pneumonia. Quantification can be used to gauge effectiveness of therapy. Reportable range is 250 to 125,000,000 copies/mL (2.40 to 8.10 Log copies/mL).

Test Code 18132

Post-Transplant, Herpesvirus 8 DNA, Real-Time PCR, Blood

Test Code 18003

Post-Transplant, HIV-1 RNA, Real-Time PCR, Plasma

This test is intended for use in conjunction with clinical presentation and other laboratory markers of disease progress for the clinical management of HIV-1 infected patients. The test can be used to assess patient prognosis by measuring the baseline HIV-1 RNA level or to monitor the effects of antiretroviral therapy by measuring changes in EDTA plasma HIV-1 RNA levels during the course of antiretroviral treatment. Reportable range is 20 to 10,000,000 copies/mL (1.30-7.00 Log copies/mL).

Test Code 18020

Post-Transplant, Herpesvirus 6 DNA, Real-Time PCR, Plasma

This test is used to determine the presence of HHV-6 DNA in patients' specimens. Organisms may be detected by PCR prior to detection by immunological methods. PCR provides more rapid results than other methods, including culture. Reportable range is 500 to 2,000,000 copies/mL (2.70 to 6.30 Log copies/mL).

Test Code 18010

Post-Transplant, JC Virus DNA, Real-Time PCR, Plasma

Test Code 18074

Post-Transplant, Herpesvirus 7 DNA, Real-Time PCR, Serum

Test Code 18049

Post-Transplant, BK Virus DNA, Real-Time PCR, Serum

Test Code 852

Beta-2-Microglobulin, Serum

Beta-2-microglobulin normally passes through the glomerulus into the proximal tubule where much of it is reabsorbed. Serum levels are therefore an index of glomerular function. When impaired, serum levels rise in inverse ratio to glomerular filtration rate. Increased amounts of beta-2-microglobulin are excreted in several renal disorders, e.g., Balkan nephropathy, heavy metal poisoning and renal tubular disease due to therapeutic agents. Serial levels of beta-2-microglobulin in serum and urine a

Test Code 4944

Beta-2-Microglobulin, Urine

Beta-2-Microglobulin (B2M) is a low molecular weight protein that forms the light chain component of the histocompatibility antigen. It is synthesized by all nucleated cell types. It is an integral part of the class I MHC antigens and is present in all body fluids. B2M is filtered through the glomeruli of the kidney and is then reabsorbed and catabolised by the proximal tubular cells. In normal patients only trace amounts of B2M appear in the urine. Elevated urine B2M is seen in tubulo-inte

Test Code 70007

Tacrolimus, Highly Sensitive, LC/MS/MS

Tacrolimus is an immunosuppressant drug which has been shown to be effective for the treatment of rejection following transplantation.

Test Code 92044

HLA A 02:01 Determination

Test Code 91745

Thiopurine Metabolites

6-Mercaptopurine (Purinethol) and its imidazolyl derivative, Azathioprine (Imuran), are immunosuppressive drugs. 6-Mercaptopurine (6-MP) is indicated for remission induction and maintenance therapy of acute lymphoblastic leukemia (ALL). Azathioprine is indicated as an adjunct for the prevention of rejection in renal allograft (kidney transplant) patients, for the management of rheumatoid arthritis, and for the management of inflammatory bowel disease.
Azathioprine is cleaved to 6-MP. 6-MP

Test Code 94092

Itraconazole

The antifungal drug itraconazole is active in the treatment of aspergillosis, blastomycosis, histoplasmosis, sporotrichosis, and onychomycosis. It is a protein-bound drug and thus has negligible CSF penetration. It may also be utilized in the treatment of systemic candidiasis and cryptococcosis, especially when other drugs are contraindicated or ineffective. The chronic nature of fungal infections demands constant monitoring of itraconazole levels within a pat

Test Code 97111

HLA Antibody Identification, Class II

Test Code 95732

HLA DRB3,4,5 Typing, High Resolution

Test Code 18050

Post-Transplant, BK Virus DNA, Real-Time PCR, Plasma

This test detects and quantitates BK Virus DNA in plasma specimens of kidney transplant recipients who are at risk of developing BKV-associated nephropathy (BKVAN) and associated hemorrhagic cystitis leading to kidney failure. Prospective viral load monitoring of BK DNA in plasma (and urine) is useful to exclude a diagnosis of BKVAN and to monitor the course of BKV infection. The assay is calibrated to the First World Health Organization International Standard for BKV DNA with a Reportable range

Test Code 18059

Post-Transplant, Hepatitis B Virus DNA, Real-Time PCR, Serum

This test is intended for use in conjunction with clinical presentation and other laboratory markers for the clinical management of patients with chronic HBV infection undergoing antiviral therapy. The test can be used to measure HBV DNA levels at baseline and during treatment to aid in assessing response to treatment.

The cobas® HBV Test is not intended for use as a screening test for the presence of HBV in blood or blood products or as a diagnostic test to confirm the presence of HB

Test Code 18120

Post-Transplant, Adenovirus DNA, Real-Time PCR, Plasma

Test Code 18060

Post-Transplant, Hepatitis B Virus DNA, Real-Time PCR, Plasma

Test Code 18001

Post-Transplant, Aspergillus DNA, Qualitative Real-Time PCR, Respiratory

Diagnostic methods based on Real-Time PCR offer the possibility of expedient detection of Aspergillus from a variety of clinical specimens. Rapid, specific diagnosis of A. terreus is important because this organism is often refractory to amphotericin B treatment.

Test Code 18000

Post-Transplant, Aspergillus DNA, Qualitative Real-Time PCR, Blood

Test Code 18066

Post-Transplant, Parvovirus B19 DNA, Real-Time PCR, Serum

Test Code 18126

Post-Transplant, Adenovirus DNA, Real-Time PCR, Urine

Test Code 18076

Post-Transplant, Herpesvirus 7 DNA, Real-Time PCR, Plasma

Test Code 18022

Post-Transplant, Herpesvirus 6 DNA, Real-Time PCR, Blood

Test Code 10719

Cyclosporine A Peak (2 Hour), Blood

Cyclosporine (Cyclosporin A) is an immunosuppressant therapeutic agent used in the prevention of organ graft rejection. Clinical measurement of blood levels is required due to the inter-individual variability of metabolism as well as the toxicity associated with excessive dosage.

Test Code 10720

Cyclosporine A Panel (Trough, 1 Hour, 2 Hour Post)

Test Code 10951

HLA A Low Resolution

Test Code 18146

Post-Transplant, Varicella-Zoster Virus DNA, Real-Time PCR, Blood

Test Code 18124

Post-Transplant, Adenovirus DNA, Real-Time PCR, Respiratory

Test Guide

Donor Transplant Eligibility: Laboratory Testing

This Test Guide discusses the use of laboratory tests that can help avoid transmission of infectious disease through transplanted human cells, tissues, and cellular and tissue-based products (HCT/Ps).

IG/Reference Manual

Test Guide List

This page is a complete list of Test Guides created by Quest Diagnostics.

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Reference ranges are provided as general guidance only. To interpret test results use the reference range in the laboratory report.

The tests listed by specialty and category are a select group of tests offered. For a complete list of Quest Diagnostics tests, please adjust the filter options chosen, or refer to our Directory of Services.

Solid Organ and Hematopoietic Stem Cell Transplantation Laboratory Testing for Donors and Recipients

Solid Organ and Hematopoietic Stem Cell Transplantation Laboratory Testing for Donors and Recipients

Test Guide

Test Guide

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