ABSTRACT
HLA typing in solid organ transplantation (SOT) is necessary for determining HLA-matching status between donor-recipient pairs and assessing patients' anti-HLA antibody profiles. Histocompatibility has traditionally been evaluated based on serologically defined HLA antigens. The evolution of HLA typing and antibody identification technologies, however, has revealed many limitations with using serologic equivalents for assessing compatibility in SOT. The significant improvements to HLA typing introduced by next-generation sequencing (NGS) require an assessment of the impact of this technology on SOT. We have assessed the role of high-resolution 2-field HLA typing (HR-2F) in SOT by retrospectively evaluating NGS-typed pre- and post-SOT cases. HR-2F typing was highly instructive or necessary in 41% (156/385) of the cases. Several pre- and posttransplant scenarios were identified as being better served by HR-2F typing. Five different categories are presented with specific case examples. The experience of another center (Temple University Hospital) is also included, whereby 21% of the cases required HR-2F typing by Sanger sequencing, as supported by other legacy methods, to properly address posttransplant anti-HLA antibody issues.
Subject(s)
HLA Antigens/classification , Histocompatibility Testing/methods , Histocompatibility , Organ Transplantation/methods , Patient Selection , Tissue Donors/statistics & numerical data , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , HLA Antigens/genetics , HLA Antigens/immunology , High-Throughput Nucleotide Sequencing/methods , Humans , Immunogenetics , Infant , Male , Prognosis , Retrospective Studies , Risk Factors , Sequence Analysis, DNAABSTRACT
INTRODUCTION: The Children's Hospital of Philadelphia (CHOP) Global Health Allies program in the Dominican Republic trains nine health promoters (HPs) in various health subjects with the goal to educate the community. This time we evaluated our teaching session on sleep and sleep disorders. METHODS: Questionnaires were randomly administered to HPs, and community members in the Dominican Republic before and after the HP educational intervention. Nine HPs already enrolled in the CHOP program, received a 4-hour training session in sleep and sleep disorders. HPs were then instructed to educate the community as they usually do during their supervised weekly home visits. RESULTS: The nine HP demonstrated knowledge of sleep disorders in their post-training assessment. In the community, 93 adults responded to the initial questionnaire. Although 92 (99%) stated that sleep is important, very few knew about obstructive sleep apnea (n = 17; 18%) and narcolepsy (n = 11; 12%). The post-education questionnaire revealed no statistically significant change in the knowledge about sleep and sleep disorders in the community. CONCLUSION: The HP knowledge about sleep disorders improved after a 4-hour training session. The community knowledge did not change after education by HPs. Barriers to community education must be explored and the need for other forms of community education about sleep and sleep disorders should be addressed.
