Past Grants

A Novel CMV-Specific Cell-Mediated Immunity Assay to Predict CMV Infection in Renal Transplant Recipients – A Pilot Prospective Study

Dr. Sara Belga

Dr. Sara Belga’s project seeks to design a blood test to assess immunity to Cytomegalovirus (CMV) to personalize care in kidney transplant patients.

CMV is a common virus that typically does not cause serious problems in people with normal immune systems. Following transplantation, anti-rejection medications can dampen the immune system, allowing the virus to resurface and cause problems. Currently, transplant patients who are at risk of developing CMV infection are given antiviral medications; however, these medications can have serious side effects.

The goal of this study is to trial one immune monitoring test in kidney transplant patients to assess those at risk for CMV infection. We will use these blood tests to track patients’ immune system during the first-year post-transplant to identify warning signs before patients develop CMV disease. This test will be a personalized approach to CMV monitoring that may improve patient outcomes by allowing for early identification of those at high risk of CMV infection.

Pharmacogenomics is the study of how the variation in a person’s DNA can affect drug response, helping predict how well a drug will work and the potential for drug side effects. The intent of this project is to learn about whether pharmacogenomic testing can help tailor medications for transplant recipients.

Lung transplant recipients require potent life-long immunosuppressive medications to prevent organ rejection; however, chronic suppression of the immune suppression increases the risk of life-threatening fungal infections such as Aspergillosis. The medication of choice for treatment and prophylaxis of Aspergillus infection is voriconazole (VRC). VRC requires routine therapeutic drug monitoring (TDM) as low drug concentrations are predictive of treatment failure and high concentrations are associated with significant toxicity. It is anticipated that genetic variation in some lung transplant recipients will result in customized medication plans that will reduce side effects or improve medication efficiency.

Patient partners play an integral role throughout this project, from the development of patient-specific education materials on pharmacogenomics to creating patient surveys that will describe the patient perspectives on using pharmacogenomics in transplant care. This project will improve the care of transplant recipients through customization of medications.

For patients who undergo a kidney transplant, one of the major factors that contribute to premature transplant failure is the lack of adherence to immunosuppressant drugs. Risk factors for non-adherence include a lack of health literacy and self-efficacy, and cognitive deficits.

To help improve adherence rates, this study will examine use of a personalized patient-adherence plan. Kidney transplant patients will be recruited during routine pre-transplant evaluations to participate in a one-month adherence assessment using mock immunosuppressant medication, as well as assessment of their health literacy, self-efficacy and cognition. During this period, patients will be required to make dose adjustments to mimic the medications changes that are typically required after transplantation. Based on the results, a personalized patient adherence plan will be developed and shared with the patient to assist them with their medication adherence following their transplant surgery.

“This study has the potential to transform the current standard of care for all organ transplant recipients at St. Paul’s Hospital and Vancouver Coastal Health,” says Leung. “Because the plan will be approved by patients themselves, they will be more engaged in their own care and establish a more positive relationship with their care teams.”