ABSTRACT
Solid organ transplantation represents the best (and in many cases only) treatment option for patients with end-stage organ failure. The effectiveness and functioning life of these transplants has improved each decade due to surgical and clinical advances, and accurate histocompatibility assessment. Patient exposure to alloantigen from another individual is a common occurrence and takes place through pregnancies, blood transfusions or previous transplantation. Such exposure to alloantigen's can lead to the formation of circulating alloreactive antibodies which can be deleterious to solid organ transplant outcome. The purpose of these guidelines is to update to the previous BSHI/BTS guidelines 2016 on the relevance, assessment, and management of alloantibodies within solid organ transplantation.
Subject(s)
Isoantibodies , Organ Transplantation , Humans , Organ Transplantation/adverse effects , Histocompatibility Testing , Isoantigens , United Kingdom , HLA Antigens , Graft RejectionABSTRACT
A review of the British Society for Histocompatibility and Immunogenetics (BSHI) Guideline 'HLA matching and donor selection for haematopoietic progenitor cell transplantation' published in 2016 was undertaken by a BSHI appointed writing committee. Literature searches were performed and the data extracted were presented as recommendations according to the GRADE nomenclature.
Subject(s)
Donor Selection/standards , Hematopoietic Stem Cell Transplantation/standards , Histocompatibility , Tissue Donors , ABO Blood-Group System/analysis , Adult , Algorithms , Allografts , Amino Acid Substitution , Blood Group Incompatibility , Consultants , Cord Blood Stem Cell Transplantation/standards , Female , Genotyping Techniques , HLA Antigens/analysis , HLA Antigens/genetics , HLA Antigens/immunology , Haplotypes/genetics , Histocompatibility Testing , Humans , Isoantibodies/immunology , Male , Maternal-Fetal Exchange , Pregnancy , Receptors, Immunologic , Societies, Medical/standards , Tissue and Organ ProcurementABSTRACT
The methods used for assessment of immunological risk for a patient receiving a kidney from a deceased donor have undergone significant change in the last few years. Many centres now proceed to transplant without any additional laboratory-based HLA testing for patients who are well defined as HLA antibody negative. Using rapid HLA antibody tests at the time of donor offer, such as Luminex, it is also possible to omit wet crossmatches in many sensitised patients. This virtual crossmatch (vXM) approach provides benefits in reducing cold ischaemia time (CIT), but also carries risks such as missing clinically relevant non-HLA reactivity or allelic HLA antibody reactivity. A number of factors need to be in place in a laboratory to enable a vXM policy to be extended to both sensitised and non-sensitised patients including access to complete donor HLA typing, ability to undertake Luminex-based HLA antibody testing out of working hours, and access to senior H&I Scientist expertise to assess and interpret results. Other approaches, such as using peripheral blood lymphocytes for crossmatching, may also enable a reduction in CIT and transplant units need to assess the risks of extending vXM processes for their patients against potential benefits.
