Transplant Test | Prospera Organ Transplantation Assessment


The need for something better

Transplant clinicians who manage patients across the entire transplant continuum seek accurate, timely diagnosis of rejection. Early identification of organ transplant rejection may enable effective treatment supporting long-term allograft survival.

Tests For:

Assessment of Kidney Active Rejection and Injury

Collection Sample:


Turn Around Time

~3 days

Organ Rejection is a Problem

Many kidney transplant failures occur within the first five to ten years6,7 because organ rejection isn't caught early enough and treated effectively. As a result, the patient may need a new organ and must start the waitlist process again.

In order to keep you healthy, the body’s immune system will attack antigens, or foreign substances, that threaten homeostasis. Unfortunately, organ rejection occurs when the recipient’s immune system mistakes the new organ for an invader. If the donated organ has too many unfamiliar antigens, the immune system may trigger a rejection response.

To help reduce the chance of a rejection, doctors compare the donor and recipient before an operation. The better the match, the less likely it is that the organ will be rejected. Additionally, the recipient is given medicine to help suppress any adverse immune system response.

There are three types of organ rejection: 

  • Hyperacute — This rejection occurs within minutes after a transplant.
  • Acute — This can occur any time from a week to three months after an operation.
  • Chronic — With chronic rejection, the body’s immune system may damage the transplanted organ over years.

Signs and symptoms of organ rejection include:

  • Fever
  • Fatigue
  • Flu-like symptoms
  • Decreased urine output
  • Edema, or swelling throughout the body
  • Pain or tenderness at the site of the surgery 

Luckily, if chronic transplant rejection is caught early with a transplant test, it can be treated right away, increasing the chance that the recipient can continue to use the donated kidney.

Introducing Prospera

Prospera is powered by highly optimized, proprietary cell-free DNA (cfDNA) technology. As part of your toolkit to watch for signs of active rejection, Prospera assesses all types of kidney transplant rejection with great precision.1

  • Simpler and less invasive than biopsy: Prospera measures the amount of donor DNA from a transplant recipient through a blood test.

  • More sensitive and specific than current assessment tools across all types of rejection:2,3,5 Serum creatinine tests are the current baseline screening standard, yet are not accurate enough for kidney transplant injury. Since then, first generation cell-free DNA technology has exhibited high variability. Prospera’s published data shows better performance than both assessment methods.

  • Up to 5x less variability than first-generation donor-derived cell-free DNA technology:1,3 Backed by our legacy and deep expertise in performing over 2 million cell-free DNA prenatal tests, Prospera exhibited a significantly tighter range in results when compared to first generation cell-free DNA tests - providing reliable, more precise information.1,3

  • Covered by Medicare: Prospera is now covered by Medicare for all kidney transplant recipients, including those with multiple kidney transplants


Prospera's core technology

Developed by Natera with our trusted legacy cell-free DNA, Prospera is thoughtfully optimized to be a precise and reliable tool for early, clinically meaningful rejection assessment.1,3



Understanding your Prospera result

The Prospera result represents the percent of cell-free DNA in the patient’s blood that originates from the donated kidney to determine whether or not the patient may be experiencing active rejection. It may also indicate other types of renal injury.



Prospera can give two helpful insights about the health of the new kidney:

  1. Personalized cfDNA baseline: Establishing a baseline tells the patient and care team the “normal state” of the new kidney. New results are measured against this baseline.

  2. A way to track your cfDNA over time: Following the patient's dd-cfDNA levels in the future reveals the ongoing health of the new kidney.

Natera: Providing Cutting-Edge Testing to Help Identify Organ Rejection  

At Natera, our proprietary bioinformatics and extensive experience with cfDNA can provide you with highly accurate transplant evaluation results. Our mission is to help you determine the best medical course of action for your future.

Prospera utilizes cutting-edge testing technology that can alert you to signs of organ rejection, increasing the odds that the kidney transplant will be successful. Talk to your doctor about whether Prospera is right for you.

Learn more

Download: Physician Brochure

Download: Clinicians Guide to Results

Download: Indications for Use


  1. Altuğ Y, Liang N, Ram R, et al. Analytical validation of a single-nucleotide polymorphism-based donor-derived cell-free DNA assay for detecting rejection in kidney transplant patients. Transplantation, 2019.
  2. Sigdel TK, Archila FA, Constantin T, et al. Optimizing detection of kidney transplant injury by assessment of donor-derived cell-free DNA via massively multiplex PCR. J Clin Med. 2019;8(1):19.
  3. Grskovic M, Hiller DJ, Eubank LA, et al. Validation of a clinical-grade assay to measure donor-derived cell-free DNA in solid organ transplant recipients. J Mol Diagn. 2016;18(6):890-902.
  4. Bloom RD, Bromberg JS, Poggio ED, et al. Cell-free DNA and active rejection in kidney allografts. J Am Soc Nephrol. 2017;28(7):2221-2232. doi: 10.1681/ASN.2016091034.
  5. Huang, et al. Early clinical experience using donor‐derived cell‐free DNA to detect rejection in kidney transplant recipients. Transplantation. 2019, doi: 10.1111/ajt.15289.
  6. Stegall et al, Through a Glass Darkly: Seeking Clarity in Preventing Late Kidney Transplant Failure, J Am Soc Nephrol. 2015; 26 (1):20-9.
  7. Lamb et al, Long-term renal allograft survival in the United States: a critical reappraisal, Am J of Transplantation. 2011; Mar;11(3):450-62.5.
  8. Organ Donation Statistics. U.S. Department of Health and Human Services. U.S. Government Information on Organ Donation and Transplantation. Published March 31, 2016.
  9. Kidney Disease Statistics for the United States. National Institute of Diabetes and Digestive and Kidney Diseases. Published Dec. 1, 2016.