Review of HLA tables

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Proposal Overview

Status: Implemented

Sponsoring Committee: Histocompatibility

Strategic Goal: Improve waitlisted patient, living donor, and transplant recipient outcomes

Effective date: 12/2018

Policy notice (PDF - 677 K; 12/2017)

Board-approved policy language

Histocompatibility Committee Board briefing paper (PDF - 353 K; 12/2017)

The Histocompatibility Committee (the Committee) is charged with reviewing the equivalency tables in Policy 4.10: Reference Tables of HLA Antigen Values and Split Equivalences and recommending any updates as needed. During the 2016-2017 review of the equivalency tables, the Committee identified a need to include HLA-DPB1 equivalences in policy. The Committee created a DPB1 unacceptable antigen equivalency table that includes G allele equivalences, and also made updates the existing tables to reflect advancements in HLA testing since the last comprehensive update. This proposal also updates the nomenclature in all equivalency tables in policy. By updating the equivalency tables, members have a current resource to use when performing and interpreting final crossmatches and considering organ offers. For candidates with antibodies to newly added antigens, these updates can help improve graft survival. The table updates in this proposal will provide members with new antigen equivalences that can help them make more informed transplantation decisions.

Read the full proposal (PDF - 337 K)

Feedback requested

The Committee is looking for feedback on the inclusion of HLA-DPB1 G alleles in Table 4-14: HLA DPB1 Unacceptable Antigen Equivalences. Specifically, the Committee would like to hear from the community about the relevance and importance of including DPB1 G alleles in an equivalency table. The Committee also welcomes the opportunity for any feedback on the changes to the equivalency tables.

Impact points

Large: UNOS IT effort to update tables, create new fields, and other changes is estimated at 1,640 hours
Research and Policy provide implementation support.
Immediate implementation upon programming for members
Minimal staff cost to implement

Project size/complexity

UNOS

IT implementation effort is large. It includes updates for existing equivalency and matching tables, updating CPRA for candidates, creating new fields, and adjusting for match policy.
Research provides implementation support and monitors data after implementation.

Policy provides implementation support during internal meetings with IT and preparing updates for the Committee.

MEMBER

Lab: Implementation and ongoing effort associated with the update is minimal. If the update encourages labs to use higher resolution products, this could be a variable or optional cost. The update also allows staff to enter additional alleles for matching and unacceptables, which may require more time.

Hospital and OPO: Minimal or no impact.