Cruz Thea Dela, Dames Charlyn, Pagaduan Louise, Cho Young, Kong Denice, Rajalingam Raja
Immunogenetics and Transplantation Laboratory, Department of Surgery, University of California San Francisco, San Francisco, CA, United States.
Immunogenetics and Transplantation Laboratory, Department of Surgery, University of California San Francisco, San Francisco, CA, United States.
Hum Immunol. 2022 May;83(5):458-466. doi: 10.1016/j.humimm.2022.02.004. Epub 2022 Feb 19.
Comprehensive and accurate human leukocyte antigen (HLA) typing within a short turnaround time is a crucial initial step for allocating deceased donor organs for transplantation. Erroneous HLA typing of deceased donors can be catastrophic and result in recipient death, failed transplant, and organ wastage due to inappropriately matched donors. The real-time polymerase chain reaction method is widely used as the sole method for HLA typing of deceased donors because of its simplified workflow. Herein, we have reported cases of four deceased donors showing discrepant HLA typing discovered using two independent methods concurrently. The HLA typing of these donors could have been erroneously reported if a single method had been used, which would have profound patient safety implications. In one case, the drop out of HLA-DR7 using a single method could have resulted in harmful organ allocation if the organ was transplanted after a virtual crossmatch to a sensitized candidate showing strong donor-specific HLA-DR7 antibodies. In conclusion, this case series suggests that concurrent dual typing is essential for accurate HLA typing of deceased donors. This strategy is vital because precise HLA typing is critical for accurate virtual crossmatching, which facilitates continuous distribution and broader geographic sharing of the deceased donor organ.
在短时间内进行全面准确的人类白细胞抗原(HLA)分型是分配已故捐赠者器官用于移植的关键初始步骤。已故捐赠者的HLA分型错误可能是灾难性的,会导致受者死亡、移植失败以及由于供者匹配不当而造成器官浪费。实时聚合酶链反应方法因其简化的工作流程而被广泛用作已故捐赠者HLA分型的唯一方法。在此,我们报告了4例已故捐赠者的病例,这些病例通过同时使用两种独立方法发现了不一致的HLA分型。如果仅使用单一方法,这些捐赠者的HLA分型可能会被错误报告,这将对患者安全产生深远影响。在一个案例中,如果在与显示强供者特异性HLA-DR7抗体的致敏候选者进行虚拟交叉配型后移植器官,使用单一方法检测到的HLA-DR7缺失可能会导致有害的器官分配。总之,这个病例系列表明,同时进行双重分型对于准确进行已故捐赠者的HLA分型至关重要。这一策略至关重要,因为精确的HLA分型对于准确的虚拟交叉配型至关重要,而虚拟交叉配型有助于已故捐赠者器官的持续分配和更广泛的地理共享。