Scottish Donation and Transplant Group written update: April 2024

Histocompatibility and Immunogenetics (HI) support for transplantation in Scotland

Update given by:

• Dr David Turner, Consultant Clinical Scientist, Scottish National Blood Transfusion Service 
• Dr Ann-Margaret Little, Consultant Clinical Scientist, NHS Greater Glasgow and Clyde

Staffing 

• Glasgow HI: Fully staffed
• Edinburgh HI: Fully staffed

On call rotas

The consultant/principal clinical scientist rota supporting deceased donor kidney, Simultaneous Pancreas-Kidney (SPK), islet and cardiac transplantation in Scotland continues as a 1:4.

No issues with Biomedical Scientist/Clinician Scientist rota for on call lab work.

Donor Human Leukocyte Antigen (HLA) typing

Since April 2022 this service is commissioned and funded by NHS Blood and Transplant (NHSBT) in England. In devolved areas of the UK, HI and microbiology labs are not funded centrally from NHSBT but are obliged to sign a contract to agree to Key Performance Indicators (KPIs). 

KPI for HLA types being reported within 4 hours of sample receipt (target = 90%).

• Quarter 1 in 2023-24: 81% (in Edinburgh) and 100% (in Glasgow)
• Quarter 2 in 2023-24: 88% (in Edinburgh) and 100% (in Glasgow)
• Quarter 3 in 2023-24: 83% (in Edinburgh) and 100% (in Glasgow)
• Quarter 4 in 2023-24: 92% (in Edinburgh) and 100% (in Glasgow)

Results have been reported to NHSBT. 

Donor Characterisation Electronic Results Transfer (DCERT)

NHSBT to introduce electronic reporting of deceased donor HLA typing and microbiology/ virology results to Organ Tissue Donation Transplantation (OTDT) directorate at NHSBT, to avoid transcription errors. Roll out for HLA typing for both Glasgow and Edinburgh labs is now planned for July 2024.

During preparation for DCERT changes it was noted that on occasion HLA types are performed before a donor is at ‘Proceeding’ status on the OTDT system. This would mean that the electronically reported HLA type could not be received. OTDT have held a series of meetings with HI labs to discuss how to overcome this, with the outcome that instructions will be added to packaging to indicate whether HLA testing should proceed. Unlikely to have a significant impact in Scotland.

NHSBT LivingPath

New electronic system for managing patient information for the National Kidney Sharing Scheme (NKSS) is now live. The system appears to be working well.

Human Leukocyte Antigen-incompatible (HLAi) transplants facilitated by Imlifidase

UK British Transplant Society (BTS) guidelines for the use of imlifidase to facilitate renal transplant for highly HLA sensitised patients with long waiting time are published. In Scotland before patients are considered for imlifidase they are discussed at a joint multidisciplinary team (MDT). HI processes have been agreed and policies/Standard Operating Procedures (SOPs) updated. One patient at both sites has had ‘unacceptable’ antigens removed to increase offers for these patients that may ultimately require the use of imlifidase.