Concurrent Use of Two Methods Prevents Erroneous HLA Typing of Deceased Organ Donors – An Essential Strategy for Patient Safety and Accurate Virtual Crossmatching for Broader Sharing
Immunogenetics and Transplantation Laboratory (ITL), University of California San Francisco, San Francisco, CA
Meeting: 2022 American Transplant Congress
Abstract number: 709
Keywords: Allocation, Cadaveric organs, Histocompatibility, HLA matching
Topic: Clinical Science » Kidney » 31 - Kidney Deceased Donor Allocation
Session Information
Session Name: Kidney Deceased Donor Allocation
Session Type: Poster Abstract
Date: Saturday, June 4, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-7:00pm
Location: Hynes Halls C & D
*Purpose: Comprehensive and accurate typing for ever-increasing alleles of all eleven HLA genes within a short turnaround time is a crucial initial step for allocating deceased donor (DD) organs for transplantation. The erroneous HLA typing of DD can be catastrophic and result in the recipient’s death, failed transplant, and organ wastage due to inappropriately matched donors. The real-time PCR method is widely used as the sole HLA typing method for DD because of its simplicity and speed. However, the accuracy of the exclusive RT-PCR method is not documented. Although efforts are made to avoid data entry errors, the OPTN/UNOS does not have a timely mechanism for detecting HLA typing errors before match runs used for organ allocation. We hypothesize that concurrent use of two methods provides error-free HLA typing for DD.
*Methods: We type all local DD for all 11 HLA genes using two distinct methods concurrently (SSO and RT-PCR or RT-PCR methods from two different vendors) before the match run is performed for organ allocation.
*Results: Herein, we report four DD cases encountered from August 2018 to August 2021, showing discrepant HLA typing by two DNA-typing methods. We could have erroneously reported the HLA typing of these donors if we used a single method, which would have profound patient safety implications. DD case#1 describes the challenges we handled when we encountered a novel DPB1 allele. DD case#2 describes an erroneous drop out of HLA-DR7 by a single method. Typing by a single method could have resulted in incorrect organ allocation and be deleterious if the organ was transplanted following virtual crossmatch to a sensitized candidate showing strong donor-specific HLA-DR7 antibodies. DD case#3 describes a discrepant DPA1 typing. DD case#4 describes an unusual HLA-DR16 type lacking the linked DR51 gene.
*Conclusions: This case study series suggest that concurrent typing by two methods is the best practice for obtaining accurate and reliable DD HLA typing in a setting with time constraints. This strategy is vital because precise HLA typing is essential for accurate virtual crossmatching that facilitates continuous distribution and broader geographic sharing of DD organs.
To cite this abstract in AMA style:
Rajalingam R, Cruz Tdela, Dames C, Pagaduan L, Cho Y, Kong D. Concurrent Use of Two Methods Prevents Erroneous HLA Typing of Deceased Organ Donors – An Essential Strategy for Patient Safety and Accurate Virtual Crossmatching for Broader Sharing [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/concurrent-use-of-two-methods-prevents-erroneous-hla-typing-of-deceased-organ-donors-an-essential-strategy-for-patient-safety-and-accurate-virtual-crossmatching-for-broader-sharing/. Accessed May 5, 2025.« Back to 2022 American Transplant Congress