A consensus conference to define the utility of advanced infectious disease diagnostics in solid organ transplant recipients

Abstract

A virtual consensus conference proposal on advanced diagnostics for transplant infectious diseases was submitted by the AST Transplant Diagnostics Community of Practice (TxDxCOP) for consideration and subsequently approved for funding. The consensus conference was fully virtual; participants received no funds from private enterprises. AST provided organizational and technical support for pre-conference and conference proceedings. A steering committee comprising members of TxDxCOP and the Infectious Diseases Community of Practice developed conference definitions, aims, scope, and format. Advanced or novel assays were defined as assays with the capacity for one or more of the following: To detect (1) pathogens, (2) genotypic or phenotypic antimicrobial susceptibility, or (3) pathogen-specific host responses, with an enhanced range of target detection, sensitivity, specificity, speed and/or simplicity of use, relative to conventional methods. Assay categories that met the above definition and for which some data on clinical performance/utility was available were included in this consensus conference.

Rapid antimicrobial resistance detection methods for bloodstream infection in solid organ transplantation: Proposed clinical guidance, unmet needs, and future directions

“…Details of the conference aims, scope, format, and findings have previously been described. 17 For the rapid antimicrobial resistance detection methods working group, the goal was to evaluate RGRD and RPAST methods and (1) determine their advantages and limitations, (2) provide laboratory and clinical guidance for "best use" in SOT recipients based on available data, and (3) identify unmet needs and areas for future investigation. For purposes of the conference, the working group focused only on U.S. Food and Drug Administration (FDA) approved, commercially available assays and methods used to detect antimicrobial resistance from positive blood cultures.…”

“…To address the optimal use and interpretation of advanced diagnostics in SOT recipients, a virtual consensus conference sponsored by the American Society of Transplantation was held on December 7th, 2021, which included a working group dedicated to the examination of rapid antimicrobial resistance detection methods. 17 The methods and findings of this working group, which was presented during this conference, are described. Using clinical scenarios, we present recommendations for the "best use" of rapid antimicrobial resistance detection methods based on the established advantages and limitations of these assays and provide laboratory and clinical guidance for the evaluation of discordant results between rapid methods and conventional AST.…”

A review of transplant infectious diseases and pediatric transplant infectious diseases curriculum

“…An AST working group examined the utility of five diagnostic test categories in a 2022 consensus paper including multiplex molecular assays; rapid antimicrobial resistance detection methods; pathogen-specific T-cell reactivity assays; next-generation sequencing assays; and mass spectrometry-based assays. Trainees in TID should develop an understanding of diagnostic stewardship, utility, barriers, and the clinical role of such testing [26].…”

Reliability of QuantiFERON®‐CMV in predicting CMV recurrence in heart transplant recipients: A single‐center retrospective study

“…1,8 International guidelines consider using such assays in a routine application but highlight the need for further studies. 4,9 In particular, data in this field are lacking in HTR and management of CMV recurrence.…”