H&I Laboratory, Scottish National Blood Transfusion Service, Royal Infirmary of Edinburgh, Edinburgh, UK.
H&I Laboratory, NHS Greater Glasgow and Clyde, Gartnavel General Hospital, Glasgow, UK.
HLA. 2019 Jul;94(1):3-10. doi: 10.1111/tan.13558. Epub 2019 May 8.
The methods used for assessment of immunological risk for a patient receiving a kidney from a deceased donor have undergone significant change in the last few years. Many centres now proceed to transplant without any additional laboratory-based HLA testing for patients who are well defined as HLA antibody negative. Using rapid HLA antibody tests at the time of donor offer, such as Luminex, it is also possible to omit wet crossmatches in many sensitised patients. This virtual crossmatch (vXM) approach provides benefits in reducing cold ischaemia time (CIT), but also carries risks such as missing clinically relevant non-HLA reactivity or allelic HLA antibody reactivity. A number of factors need to be in place in a laboratory to enable a vXM policy to be extended to both sensitised and non-sensitised patients including access to complete donor HLA typing, ability to undertake Luminex-based HLA antibody testing out of working hours, and access to senior H&I Scientist expertise to assess and interpret results. Other approaches, such as using peripheral blood lymphocytes for crossmatching, may also enable a reduction in CIT and transplant units need to assess the risks of extending vXM processes for their patients against potential benefits.
在过去的几年中，评估接受已故供体肾脏的患者免疫风险的方法发生了重大变化。许多中心现在为明确 HLA 抗体阴性的患者进行移植，而不进行任何额外的基于实验室的 HLA 检测。在供体提供时使用快速 HLA 抗体测试，如 Luminex，也可以在许多致敏患者中省略湿交叉匹配。这种虚拟交叉匹配 (vXM) 方法可减少冷缺血时间 (CIT)，但也存在风险，例如错过临床相关的非 HLA 反应性或等位基因 HLA 抗体反应性。实验室需要具备一些因素才能将 vXM 策略扩展到致敏和非致敏患者，包括获得完整的供体 HLA 分型、能够在工作时间外进行基于 Luminex 的 HLA 抗体测试以及获得高级 H＆I 科学家的专业知识来评估和解释结果。其他方法，如使用外周血淋巴细胞进行交叉匹配，也可能降低 CIT，移植单位需要评估为患者扩展 vXM 过程的风险与潜在收益。
