Transplant Immunology - Guidelines on Appropriate Tests

Guidelines on the Appropriate Use of Tests

Transplant Patients for Registration with ODT for Solid Organ Transplantation
HLA (Human Leucocyte Antigens) are expressed on the surface of cells and involved in the recognition of self and non-self. They are used in matching donor/recipient pairs in accordance with the national allocation scheme.

Potential kidney transplant recipients will be typed for HLA Class I and II antigens (HLA A, B, Cw, DR, DQ), blood grouped and screened for HLA-specific antibodies. Once tests have been performed the laboratory will complete the appropriate sections of the on-line ODT registration form and place in the holding area for completion and submission.

Transplant Patient/Donors for Live Transplant
Patient and donor are typed for HLA Class I and II antigens (HLA A, B, Cw, DR, DQ), blood grouped and crossmatched.

Patients for living donor transplantation are progressed to transplantation through a tiered programme of tests. A copy of the test schedule may be obtained from the laboratory on request.

Haematopoietic Stem Cell Transplant Patients/Donors
Exact matches at the DNA level are required for HSCT to minimise the chances of GvHD.

Patients are typed for Class I and Class II antigens using molecular techniques (HLA A, B, Cw, DR, DQ, DP).

Family donors are Class I typed and if matched Class II typed.

HLA-specific antibody testing is also performed on HSCT patients.

Volunteer Unrelated Haematopoietic Stem Cell Donors
In cases where there is no suitably matched donor from within the family a donor may be found from one of the Haematopoietic Stem Cell panels, either from within the UK or from abroad.

Volunteer unrelated donor (VUD) are typed for HLA class I and class II using molecular techniques (HLA A, B, Cw, DR, DQ, DP).

HLA-specific Antibody Screening
Patients can form HLA antibodies following transfusion, transplantation and pregnancy. It is essential that patients on the ODT kidney/pancreas waiting list are monitored every three months or following a sensitising event. All changes to the patientís sensitisation status are reported to UKT by the laboratory.

Crossmatching
Performed prior to transplantation to exclude donors expressing antigens to which the patient has preformed antibodies thus minimising the risk of hyperacute rejection.

Disease Association
Certain diseases have been shown to have positive or negative association with certain HLA antigens/alleles (quantified as 'relative risk'). Normally HLA B27 typing is performed, but other HLA antigen can be tested on request. HLA B27 results are reported as positive or negative as appropriate.