Prospera Test Reduces Need for Invasive Lung Transplant Biopsies by 75% in Ohio State Study
Key Insights
A prospective clinical trial at Ohio State University demonstrated that Prospera (search)-guided monitoring allowed physicians to safely omit routine 9-month surveillance biopsies in approximately 75% of low-risk lung transplant patients.
The study of 78 lung transplant recipients showed that 95% of patients who skipped the 9-month biopsy remained free of acute rejection (search) requiring treatment at one year post-transplant.
Patients who omitted the invasive procedure maintained similar lung function and immunologic stability compared to those who underwent the standard biopsy protocol.
A new prospective clinical trial published in Transplantation Direct demonstrates that donor-derived cell-free DNA (search) (dd-cfDNA) surveillance using the Prospera (search) test can safely reduce invasive biopsy procedures in lung transplant patients by approximately 75%. The study, conducted by The Ohio State University Wexner Medical Center (OSU-WMC), represents a significant advancement in post-transplant monitoring protocols.
Study Design and Patient Population
The research involved 78 lung transplant recipients monitored with the Prospera (search) test for one year post-transplant. As part of a quality assurance and performance improvement (QAPI) initiative launched due to increasing transplant volumes at OSU-WMC, investigators sought to determine whether dd-cfDNA surveillance could safely eliminate the routine 9-month surveillance biopsy.
Prospera (search) testing was incorporated at approximately 8 months post-transplant to categorize patients as low risk (< 1.0% dd-cfDNA) or high risk (≥ 1.0%) for rejection. Physicians could then choose to forgo the 9-month surveillance biopsy for low-risk, clinically stable patients, while all participants were still recommended for a protocol biopsy at 12 months post-transplant.
Clinical Outcomes and Safety Profile
The study yielded compelling safety and efficacy data. Physicians chose to omit the 9-month biopsy in approximately 75% of patients with low-risk Prospera (search) results. For these patients over the ensuing 3 months, there was no significant difference in acute rejection (search) rates, spirometry indices, or donor-specific antibodies compared to patients who underwent the standard biopsy procedure.
At one year post-transplant, approximately 95% of patients who omitted the 9-month biopsy did not have acute rejection (search) that needed any treatment. Additionally, patients who omitted the 9-month biopsy maintained lung function and immunologic stability similar to those who underwent the procedure.
Clinical Significance and Expert Perspectives
"This study highlights how monitoring with Prospera (search) can improve both the patient experience and the sustainability of transplant programs," said Justin Rosenheck, D.O., clinical assistant professor of internal medicine at The Ohio State University Wexner Medical Center and principal investigator of the study. "These compelling results support our goal of providing more personalized and efficient medical care without compromising patient safety or outcomes."
The findings address a significant clinical need, as lung transplant patients are typically monitored with transbronchial biopsies at one, three, six, nine, and 12 months after transplantation. These procedures are invasive, costly and associated with significant morbidity.
David Ross, M.D., senior medical director of lung transplantation and molecular diagnostics at Natera, emphasized the clinical utility of the approach: "The Prospera (search) test provided actionable patient risk assessments within a structured QAPI framework. These data support fewer routine biopsies during dd-cfDNA surveillance while maintaining lung function and immune response."
Future Implications
The research suggests that dd-cfDNA surveillance could transform standard post-transplant monitoring protocols. Dr. Ross noted that "future clinical studies could further support the safe omission of protocol biopsies implementing the Prospera (search) Lung test, ultimately reducing invasive procedural risks and burdens with optimized health."
The study represents a significant step toward more personalized transplant care, potentially reducing healthcare costs and patient morbidity while maintaining the high safety standards required in post-transplant monitoring.