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Update Human Leukocyte Antigen (HLA) Equivalency Tables

eye iconAt a glance

Current policy

Histocompatibility laboratories test compatibility of transplant candidate and organ donor tissues using the human leukocyte antigen (HLA) system. This process is also known as HLA typing. When a candidate is more compatible with the donor, there is less risk the candidate’s body will reject the transplant.

The laboratories use commercially available kits to do the tests. The antigens used in the testing are included in tables in OPTN policy and programmed into the OPTN computer system. 

The antigens in the tables are reviewed and updated every year to make sure they include the most up-to-date information. 

In addition, some HLA reporting is not required for deceased donors, but is entered for transplant candidates. Requiring the HLA to be reported for both the donor and transplant candidate would make matching donors with transplant candidates more accurate.

Supporting media

Presentation

View presentation

Proposed changes

  • Updates to existing HLA reference tables in OPTN Policy 4.10: Reference Tables of HLA Antigen Values and Split Equivalences
  • Add new reference table to be programmed into the OPTN computer systems
  • Add a requirement for HLA typing on deceased donors to be reported in the OPTN computer system

Anticipated impact

  • What it's expected to do
    • Align data collection for deceased donors and transplant candidates
    • More accurately prioritize transplant candidates whose immune system makes it more likely they will reject organs from a large percentage of organ donors
  • What it won't do
    • Change the Calculated Panel Reactive Antibodies (CPRA) calculation or frequency data used for the calculation

Themes

  • Patient Safety

Terms to know

  • Calculated Panel Reactive Antibody (CPRA): An algorithm used to determine what proportion of deceased donors a potential candidate may be unable to accept due to immunologic incompatibility
  • Histocompatibility: The examination of HLA in a patient, often referred to as "tissue typing" or "genetic matching." Tissue typing is routinely performed for all donors and transplant candidates to help match the donor with the most suitable recipients to help decrease the likelihood of rejecting the transplanted organ. 
  • Human leukocyte antigen (HLA) system: A group of proteins that helps the immune system distinguish the body's own cells from foreign invaders.
  • UNetSM: Computer system used to house all donor information, transplant patient information and data reports needed to evaluate the nation’s organ donation and transplant system.

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Provide feedback

eye iconComments

Region 1 | 09/24/2021

Region 1 sentiment: 2 Strongly Support, 6 Support, 0 Neutral/Abstain, 0 Oppose, 0 Strongly Oppose. No comments.

American Nephrology Nurses Association (ANNA | 09/23/2021

ANNA supports

Attachment

Region 6 | 09/23/2021

Region 6 sentiment: 7 Strongly Support; 14 Support; 2 Neutral/Abstain; 0 Oppose; 0 Strongly Oppose. No comments.

Region 8 | 09/22/2021

Region 8 sentiment: 9 strongly support, 9 support, 5 neutral/abstain, 0 oppose, 0 strongly oppose. Comments: Region 8 supports this proposal.

Region 7 | 09/15/2021

Region 7 sentiment: 5 strongly support, 9 support, 3 neutral/abstain, 0 oppose, 0 strongly oppose. No comments.

Region 9 | 09/15/2021

Region 9 sentiment:  2 Strongly Support; 4 Support; 3 Neutral/Abstain; 0 Oppose; 0 Strongly Oppose. No comments .

Linda Cagle | 09/14/2021

Would like to see the CPRA algorithm updated to include HLA-DQA1, DPA1, DPB1 unacceptable antigens to improve organ matching/allocation. Transplant candidates with only antibodies to HLA-DQA1, -DPA1 and -DPB1 are at a disadvantage when they are (highly) sensitized; however, their CPRA does not currently reflect their actual HLA antibody profile.

Region 3 | 09/10/2021

Region 3 sentiment: 4 strongly support, 9 support, 2 neutral/abstain, 0 oppose, 0 strongly oppose

Region 2 | 09/10/2021

• Region 2 sentiment: 8 Strongly Support, 15 Support, 4 Neutral/Abstain, 0 Oppose, 0 Strongly Oppose • Comments: This was not discussed during the meeting but OPTN representatives were able to submit comments with their sentiment. The region supported the proposal, but one member noted that there should be more impetus in CLASS II matching especially DQ and EPLET matching in pediatric transplant recipients. Another member expressed disappointment that the proposal does not change the Calculated Panel Reactive Antibodies (CPRA) calculation. The member noted that the committee should address this in the near future.

Region 5 | 08/30/2021

Region 5 sentiment: 7 strongly support, 15 support, 5 neutral/abstain, 0 oppose, 0 strongly oppose. Region 5 supported the proposal for the Update to HLA Equivalency Tables.

Region 4 | 08/27/2021

3 strongly support, 6 support, 2 neutral/abstain, 0 oppose, 0 strongly oppose. Region 4 supported this proposal.