Motivating Reading Compliance: Adaptation of Monte Carlo Quizzes for Online Delivery.

Getting students to complete reading assignments is often a source of frustration for nurse educators. Monte Carlo Quizzes (MCQs) were adapted for online delivery in a hybrid nursing course to encourage timely completion and deep processing of readings. Students indicated that MCQs motivated them to complete the assigned readings and to read more carefully. However, there were no significant differences on scores for other course assignments between those who completed readings and those who did not.

Preformed donor-specific HLA antibodies are associated with increased risk of early mortality after liver transplantation.

There is limited evidence for a negative impact of preformed, donor-specific HLA antibodies (DSA) identified by cross-matching on outcomes after liver transplantation. Three recent studies have suggested an association between preformed DSA detected by Luminex and reduced graft or recipient survival in liver transplant cohorts with a high prevalence of hepatitis C. This study investigated the impact of preformed DSA identified by Luminex in the Scottish liver transplant population. All recipients of liver transplants in Scotland between 2007 and 2015 with samples available for day of transplant antibody testing and donor HLA typing were included (n=459); 96% of the cohort were white and 19% had a primary diagnosis of hepatitis C. The median follow-up time was 36 months. Preformed DSA were detected in 88 recipients. In multivariate analysis, preformed DSA with a median fluorescent intensity ≥10 000 were associated with recipient mortality at 1 year. There was no association between DSA and overall graft or recipient survival. This study adds to the growing body of evidence supporting a detrimental impact of preformed, high-level DSA in a subset of liver transplant recipients by identifying an association in an ethnically and demographically distinct liver transplant population.

Establishment and operation of a Good Manufacturing Practice-compliant allogeneic Epstein-Barr virus (EBV)-specific cytotoxic cell bank for the treatment of EBV-associated lymphoproliferative disease.

Epstein-Barr virus (EBV) is associated with several malignancies, including post-transplant lymphoproliferative disorder (PTLD). Conventional treatments for PTLD are often successful, but risk organ rejection and cause significant side effects. EBV-specific cytotoxic T lymphocytes (CTLs) generated in vitro from peripheral blood lymphocytes provide an alternative treatment modality with few side effects, but autologous CTLs are difficult to use in clinical practice. Here we report the establishment and operation of a bank of EBV-specific CTLs derived from 25 blood donors with human leucocyte antigen (HLA) types found at high frequency in European populations. Since licensure, there have been enquiries about 37 patients, who shared a median of three class I and two class II HLA types with these donors. Cells have been infused into ten patients with lymphoproliferative disease, eight of whom achieved complete remission. Neither patient with refractory disease was matched for HLA class II. Both cases of EBV-associated non-haematopoietic sarcoma receiving cells failed to achieve complete remission. Thirteen patients died before any cells could be issued, emphasizing that the bank should be contacted before patients become pre-terminal. Thus, this third party donor-derived EBV-specific CTL cell bank can supply most patients with appropriately matched cells and most recipients have good outcomes.

Status report from 'double agent HLA': health and disease.

The human major histocompatibility complex is a multi-gene ~4 Mb of DNA including the highly polymorphic HLA genes which are fundamental in effecting a healthy immune response. Detailed knowledge of the structure and function of HLA genes and their alleles and HLA proteins and their allotypes has rapidly evolved because of their role in clinical transplantation. A significant additional finding is the association or linkage of a wide range of diseases with HLA. We review the function of HLA and the history of disease association studies and focus on specific informative examples in the context of recent genome-wide screening analyses.