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Proposal to Update the HLA Equivalency Tables

Histocompatibility CommitteeFall 2015

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What problems will the proposal solve? Some equivalences have changed since last update

Proposed solution - update equivalency tables based on: advances in HLA typing the frequencies of antigens reported for donors and antigens and unacceptable

antigens reported for candidates

Some HLA antigen dropdowns in UNetSM disadvantage candidates with antibodies against some alleles but not all of them Proposed solution - update dropdowns in UNet

Policy references to HLA DPB, DQA, and DQB are out of date Proposed solution – change policy references to these loci to DPB1, DQA1, and DQB1

Increase opportunities for candidates to receive offers Compatible donors will not be excluded based on outdated or broad

HLA typing constraints of prior equivalency tables

Reduce risk of positive crossmatch after shipping kidneys nationally and regionally

What is the goal of the proposal?

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Supporting Evidence

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Broad antigens reported for deceased donors (2013-2014)

* C3 was reported by 33 labs for 264 donors. Note: Labels show the number of labs for each broad antigen.

Transplant Programs: Request updated HLA typing using molecular methods for existing

candidates who may be affected by the changes to the equivalences tables

Review/modify unacceptable antigens reported for candidates with antibodies against alleles that are being added   

Labs: Assign split (not broad) antigens to candidates

How will members implement this proposal?

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Strategic Goal ImpactIncrease the number of transplants Improve efficiency of allocation for sensitized

candidates

Improve equity in access to transplants

Allow members to enter more specific data to ensure candidates are not excluded from donors against whom they don’t have UAs

Improve waitlisted patient, living donor, and transplant recipient outcomes

• Table updates will lead to better compatibility and decrease probability of post-transplant rejection

• Allocation to candidates less likely to have a positive crossmatch reduces cold ischemia time

Promote living donor and transplant recipient safety

Reduce risk of organ discards due to futile shipments

How does this proposal support the OPTN Strategic Plan?

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Dolly Tyan, Ph.D.Committee Chair dtyan@stanford.edu

Regional representative name (RA will complete) Region X Representative email address

Geoff ZindrenCommittee Liaison Geoffrey.Zindren@unos.org

Questions?

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