Comments

Region 8 | 09/19/2023

Sentiment: 8 strongly support, 7 support, 3 neutral/abstain, 0 oppose, 0 strongly oppose

This was not discussed during the meeting, but attendees were able to submit comments with their sentiment. The region supports the updated tables and noted the addition of the P-groups was especially helpful.   

Association of Organ Procurements Organizations | 09/19/2023

AOPO strongly supports updates to HLA equivalency tables proposed by the OPTN during the summer comment period. The OPTN’s recent incorporation of P groups for HLA-DPB1 provided much needed clarification but did not account for the remaining HLA loci. Incorporation of P groups without addressing the remaining HLA loci has led to “discrepant typings” of lab results when, for example, an OPO lab types using a low-resolution method and the receiving transplant center uses a high-resolution method, such as Next-Generation Sequencing (NGS).

 OPO Lab Directors are HLA subject matter experts and understand that “discrepancies” can occur when an OPO lab, using low-resolution testing, reports the presence of an unacceptable DPB1-Locus antigen, like DPB1*03:01P, and the transplant center, using high-resolution testing, obtains an HLA value of DPB1*104:01 which has no equivalent DPB1-Locus antigen in the current equivalency table because only the DPB1*03:01 antigen is listed. Because the HLA equivalency table does not currently include the DPB1*03:01P antigen, this situation would cause the transplant centers to view the OPO laboratory result as erroneous even though there is no discrepancy because the P group is shared. The shared P group is not specified in the current HLA-DPB1 equivalency table because only the DPB1*03:01antigen is included in the table and not DPB1*03:01P antigen.

This “discrepancy” does not present an actual risk to patient safety because DPB1*03:01P and DPB1*104:01 are both considered equivalent to the unacceptable DPB1*03:01 antigen. However, the UNOS Patient Safety flagging system recognizes these differing results as posing an unacceptable risk to patients. When these “discrepant” results are flagged, very busy lab directors are required to “resolve discrepancies” that do not actually exist by initiating an investigation into the “discrepancy” and communicating the results of the investigation and a lengthy explanation of the issue to the OPTN’s Membership and Professional Standards Committee. Updates to the equivalency table will reduce the necessity for needless administrative exercises and permit OPO laboratories to focus on their lifesaving missions.

Further, as HLA typing methodologies continue to advance and future technologies are developed to provide two-field high-resolution in the same time frame as laboratories currently perform donor HLA typing, equivalency tables updates will become even more critical. Proactively supporting the proposed update to the HLA equivalency tables is a positive step toward supporting novel and developing technologies now, rather than trying to play catch up in the future.

 

Region 9 | 09/19/2023

Sentiment: 5 strongly support, 5 support, 3 neutral/abstain, 0 oppose, 0 strongly oppose

Region 3 | 09/19/2023

Sentiment: 2 strongly support, 10 support, 4 neutral/abstain, 0 oppose, 0 strongly oppose

Region 10 | 09/19/2023

Sentiment: 4 strongly support, 8 support, 4 neutral/abstain, 0 oppose, 0 strongly oppose

This was not discussed during the meeting, but attendees were able to submit comments with their sentiment. An attendee stated that this update is needed in order to alleviate waitlist issues in the current process and decrease required communication of OPO HLA representatives with transplant program HLA representatives.  

UC San Diego Health | 09/19/2023

The UC San Diego Health Center for Transplantation appreciates the Histocompatibility Committee’s ongoing efforts to better ensure safety, equity, and accuracy in matching donors with transplant candidates. The importance of keeping the reference tables within OPTN policy and programmed into the OPTN computer system up to date with clinical practice cannot be overstated.

OPTN Kidney Transplantation Committee | 09/18/2023

The OPTN Kidney Committee thanks the OPTN Histocompatibility Committee for the opportunity to provide a public comment on the proposal. The Committee supports the proposal as it will improve and impact long-term outcomes, thereby decreasing the need for repeat transplants, making more organs available for initial transplants.

Region 7 | 09/18/2023

Sentiment: 1 strongly support, 9 support, 5 neutral/abstain, 0 oppose, 0 strongly oppose

Region 1 | 09/15/2023

Sentiment: 0 strongly support, 2 support, 3 neutral/abstain, 0 oppose, 0 strongly oppose

Gift of Life Michigan | 09/15/2023

We appreciate the Histocompatibility Committee's work to update these equivalency tables, and strongly support their adoption.

Region 6 | 09/15/2023

Sentiment: 3 strongly support, 9 support, 0 neutral/abstain, 0 oppose, 0 strongly oppose

American Society of Transplantation | 09/15/2023

The American Society of Transplantation (AST) supports the proposal, “Update Human Leukocyte Antigen (HLA) Equivalency Tables, 2023.”

View attachment from American Society of Transplantation

American Society for Histocompatibility and Immunogenetics | 09/14/2023

The American Society for Histocompatibility (ASHI) and its National Clinical Affairs Committee (NCAC) appreciate the opportunity to provide feedback around the update to the HLA Equivalency tables. ASHI agrees with these updates. Additionally, ASHI and NCAC recommend removing older nomenclature such as B5, B17, DR5, DR6, etc. to reduce confusion when reporting HLA antigens. With the increased use of molecular typing, a complete revamp of these tables would be useful.

View attachment from American Society for Histocompatibility and Immunogenetics

Region 5 | 09/13/2023

Sentiment: 6 strongly support, 16 support, 0 neutral/abstain, 0 oppose, 0 strongly oppose

An attendee inquired about the rationale in Table 4-2, whether there was concern this will create confusion; for example, one can select both A*01:01 or A*01:01P—why not just use the P group. A*32:04 is listed as matched equivalent to A3. Yet, this allele bears sequences (eplets 76ESI, 81ALR) not present in A3 but present in other A32 and A25, etc.

Region 11 | 09/12/2023

Sentiment: 5 strongly support, 6 support, 2 neutral/abstain, 0 oppose, 0 strongly oppose

Michael Gautreaux | 09/12/2023

I support this change.

American Nephrology Nurses Association (ANNA) | 09/11/2023

ANNA supports this update and agree that changes should reflect current practices.

Region 2 | 09/01/2023

Sentiment: 8 strongly support, 7 support, 5 neutral/abstain, 0 oppose, 0 strongly oppose

This was not discussed during the meeting, but attendees were able to submit comments with their sentiment. It was noted that this update is needed for high resolution results.

Region 4 | 08/30/2023

Sentiment: 8 strongly support, 11 support, 2 neutral/abstain, 0 oppose, 0 strongly oppose

This was not discussed during the meeting, but attendees were able to submit comments with their sentiment. One attendee commented that this update is a good step forward but was concerned that the high-resolution list is incomplete. They added that some alleles don't exist in the proposed table and are only identified at low resolution or serology. They went on to comment that using the International ImMunoGeneTics (IMGT) for the nomenclature/coding would have been strongly preferred. They were also concerned about the use of P groups as these are only a part of protein and although they predict T cell immunity, they are a poor proxy for antibody reactivity. Another attendee commented that the updates will enhance compatibility opportunities.