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Changes in place to HLA Typing requirements for KPD donors and candidates

Changes in place to HLA Typing requirements for KPD donors and candidates

Audience:

  • KPD program participants
  • Kidney transplant hospital staff
  • Histocompatibility lab staff

Implementation Date:
January 21, 2016

At-a-glance
We have made policy and system changes that require HLA typing for kidney paired donation (KPD) donors and candidates, in order to be eligible for match runs in the OPTN KPD program. These changes were approved by the OPTN/UNOS Board of Directors in November 2014, in an effort to decrease future match failures and improve program results.

Resources

Summary of Changes

These new policies apply to OPTN KPD program participants only. HLA typing, using molecular methods, are now required for KPD donors and candidates to participate in match runs.

The KPD donor’s hospital is responsible for all HLA typing for paired donors and for arranging shipment of the matched donor blood sample to the candidate’s hospital or lab for the crossmatch.

The KPD candidate’s hospital is responsible for:

  • All HLA typing for candidate and confirming the matched donor’s HLA type.
  • Performing and reporting antibody screenings of active candidates at the required frequency (every 110 days, when a potentially sensitizing event occurs, when a candidate is reactivated after being inactive for 90 days, or when an unacceptable and positive physical crossmatch occurs).
  • Performing crossmatches at the specified times and communicating the results to UNOS and the donor hospital.

KPD System Changes now in place

We added new ineligibility reasons and removed some existing ones due to the following new eligibility requirements:

  • Review of candidate’s unacceptable antigens in KPD prior to appearing on first KPD match run (applies to candidates added to KPD system on or after January 21, 2016)
    • HLA requirements for candidates and donors
    • Positive crossmatch reported on matches require review of candidate’s unacceptable antigens (applies to crossmatch results reported for KPD matches run on or after January 21, 2016)
  • On the candidate’s HLA and Unacceptables tab, we added a new section to assist in reporting data for the new requirements that includes:
    • Check box for review and approval of unacceptable antigens when required for:
      • candidate’s initial listing to KPD system or
      • report of positive crossmatch
      • Antibody testing fields; including reminders when testing is due
  • We added a new section to the Transplant Center KPD Dashboard to assist in monitoring antibody screenings. In addition, we added a new KPD Candidate Antibody Testing Report as a resource to the user. This report lists candidate’s status for antibody testing based upon selected criteria.
    We modified the following fields:

    • CW label is now C
    • DQ label is now DQB1
    • DQA label is now DQA1
    • DP label is now DPB1
  • For HLA loci A, B, DR, C, DQB1, DQA1 and DPB1, we will apply the following to
    any candidate or donor in the KPD system beginning January 21, 2016: if the first antigen value is reported and the second antigen value is blank, we will set the missing second antigen value to “No second antigen detected”. You will need to report the second antigen if one exists.
  • Existing DQA1 values remain as is. We converted DPB1 values. Please refer to the chart below for conversions.

Important: DPB1 values 2 and 4 are no longer be valid. You need to report new DPB1 values in order for candidates and donors to be eligible to participate in match runs beginning January 25th.

See DPB1 Conversion Table.

Current values for DPB1 (before January 21st) …will be automatically converted to the following values (exceptions noted)
1 01:01
2 No automatic conversion; members will need to report either 02:01 or 02:02 for donors and candidates to be eligible beginning with the January 25th match run.
3 03:01
4 No automatic conversion; members will need to report either 04:01 or 04:02 for donors and candidates to be eligible beginning with the January 25th match run.
5 05:01
6 06:01
8 08:01
9 09:01
10 10:01
11 11:01
13 13:01
14 14:01
15 15:01
17 17:01
18 18:01
19 19:01
20 20:01
23 23:01
28 28:01
201 02:01
401 04:01
402 04:02

 

Training and Help Documentation
Online help documentation is also available in UNet.

Questions?
If you have policy or general questions about these changes, contact your UNOS Regional Administrator at 804-782-4800. If you have questions related to the KPD system in UNet, contact the UNet Help Desk at 800-978-4334.

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