As the waiting list for transplants continues to grow, experts in the transplant diagnostics industry are looking for ways to expand access and improve long-term patient outcomes.
Here, Tina Liedtky, President of Transplant Diagnostics at Thermo Fisher Scientific, shares her thoughts on addressing the health inequities that are present in the transplant space, and discusses the diagnostic innovations that could improve patient access.
Meet Tina Liedtky
I have over 20 years of experience in the medical device and diagnostics industry, working for companies like Abbott, Medtronic, and Boston Scientific prior to joining Thermo Fisher Scientific in 2021. After initially leading the clinical diagnostics team, I moved to transplant diagnostics in early 2024.
Being passionate about the work that is done within the transplant community, I am fortunate to have been inspired by so many peers, customers, and organizations that strive to improve outcomes – not only for transplant recipients, but also for their families and caretakers.
Although the field of transplantation has advanced dramatically over the last few decades, there are still several unmet clinical needs. The emergence of innovative diagnostic tests is slowly but surely helping shrink this gap. It’s an exciting time in this space and I’m proud that Thermo Fisher is at the forefront of shaping its evolution via advanced diagnostic solutions.
What biases have you observed in the transplant industry, and how are they affecting patient outcomes?
Some of the most persistent biases within the transplant space pertain to socioeconomic inequities. There’s no escaping the fact that transplant procedures are expensive, with costs ranging from tens of thousands of dollars to over a million dollars per transplant in the US. This is not surprising considering the complexity of the process, from pre-transplant diagnostics to organ procurement and transplantation, to post-transplant monitoring. While these costs are shared between healthcare systems, manufacturers, insurance companies, and other entities, patients often need to shoulder a significant portion of the burden – which, for many, is not a viable option.
Beyond cost, to even qualify for a transplant and get on the waitlist, patients must live near a major hospital or transplant center where the surgery would be performed. What’s more, patients receiving a heart transplant might be asked to stay within a 30-minute driving distance of the transplant center for the first six weeks after surgery, given the frequency of follow up visits and monitoring. This requirement can be difficult for patients who do not reside near a transplant center and who may need to travel great distances, sometimes across states, to have a chance at a transplantation.
To help address some of these challenges, nonprofits such as Ava’s Heart were founded to provide critically needed assistance to organ transplant patients. They provide temporary housing near major transplant centers for patients who cannot easily access or afford it.
Biases around race and gender can also impact patient care within the transplant community. For example, up until 2022, some algorithms used to calculate kidney function included a race variable. The use of this race-inclusive calculation was prohibited after researchers determined it inaccurately estimated a higher level of kidney function for Black individuals than for non-Black individuals. This resulted in some Black patients being identified and treated for kidney failure at a much later stage of their disease and delaying their access to transplantation.
Additionally, a recent study in ERJ Open Research found that women wait longer for – and are less likely to receive – lung transplants, despite the fact that post-transplant survival is significantly higher for female recipients.
How might these sorts of health inequities be addressed in the transplant field?
It starts with raising awareness of inequities and re-examining transplant policies. Alongside that, we need to enhance the patient experience and help address some of these inequities by continuing to develop minimally invasive transplant diagnostic options. These solutions tend to be less risky, and often less costly, than traditional options such as biopsies. Not only can they ease the financial burden for patients and their families – minimally invasive diagnostics may also help expand patient access to care. For example, if samples can be collected at a doctor’s office or local clinic, long-distance journeys to a transplant center could be minimized.
Additionally, it’s vital to encourage regular reviews of industry practices and policies to ensure that those in marginalized groups are being given the same opportunity for treatment as others. Advocating for policies that support equitable access to transplant and treatment options on the federal level are also important.
What are some of the unmet needs in transplant diagnostics?
There are certainly gaps in managing immunosuppression and post-transplant care. Today, most transplant recipients receive standardized immunosuppression protocols based on broad clinical and demographic factors. But this “one size fits all” approach may not lead to the best outcomes for patients. There is a pressing need for more individualized assessment of immunosuppression.
Furthermore, minimally or non-invasive transplant diagnostics are urgently needed for post-transplant monitoring. An organ transplant is not a cure; it is a lifelong treatment that requires ongoing surveillance. Invasive biopsies to monitor for rejection can impact both the physical and mental health of a patient, due to uncertainty and heightened anxiety surrounding the results.
What diagnostic advancements are helping to bridge these gaps?
Recently, we introduced a minimally invasive pre-transplant risk assessment assay to help provide clinicians with information about risk of rejection based on the patient’s unique genetic profile. Data from the assay may help clinicians make more informed decisions about post-transplant management and better balance a patient’s risk of rejection against the adverse effects of over-immunosuppression.
On the post-transplant front, non-invasive diagnostics such as a urine-based CXCL10 biomarker test are now available. It can detect elevated CXCL10 chemokine levels, which can be associated with inflammation and early graft dysfunction. The test is economical and produces results in as little as 24 hours, ultimately providing clinicians with valuable insights more quickly than standard diagnostics.
How do you think transplant diagnostics will evolve over the next decade?
I expect the future of transplant diagnostics to be shaped by advanced digital technologies, automation, and machine learning. These technologies are integrating into the laboratory workflow across industries; transplant diagnostics will likely follow a similar trajectory.
I predict that advanced software solutions will use machine learning to aggregate and analyze large sets of data for both individual patients and patient populations along the transplant journey. This will enable clinicians to make more informed decisions based on individual patient history and risk profiles.
By leveraging tools like machine learning, we will be able to compare results more efficiently from whole populations by race, gender, geographic location, or socioeconomic status. That will help determine if there are trends that can inform treatment protocols for certain populations. The next evolution for transplantation has just begun!
Newsletters
Receive the latest pathologist news, personalities, education, and career development – weekly to your inbox.
