Scottish Donation and Transplant Group written update: August 2023

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 back to a 1:4 following a return from maternity leave.

Quality in Organ Donation (QuOD) project

Ongoing.

Samples are processed by HI staff in HI Edinburgh. Agreement now reached between University of Oxford and NHS Lothian to allow funding to be made available. Mechanism for payment to Edinburgh HI for QuOD work has now been established.

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 (the target is 90%).

Quarter four in 2022/23: 79% (in Edinburgh) and 100% (in Glasgow)

Quarter one in 2023/24: 81% (in Edinburgh) and 100% (in Glasgow)

Results have been reported to NHSBT. Edinburgh is looking to change to a more rapid kit for HLA typing to improve turnaround.

Donor characterisation review

NHSBT is hoping to introduce electronic reporting of deceased donor HLA typing and microbiology/virology results to avoid transcription errors. Go live date for HLA typing data is hoped to be in 2023/24.

NHSBT LivingPath

New electronic system for managing patient information for the National Kidney Sharing Scheme (NKSS) is now live. Has been used by HI labs for data reporting for the April 2023 and July 2023 runs.

Human Neutrophil Antigens (HNA) antibody testing

HNA antibodies have been implicated in small numbers of kidney transplant Antibody Mediated Rejection (AMR) when Human Leukocyte Antigen/ Donor-Specific Antibodies (HLA-DSA) are absent. Two cases have been identified in the last few years in Edinburgh, and one in Glasgow. These cases have been published recently in the August issue of ‘Transplant Immunology.’

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

UK guidelines for the use of Imlifidase to facilitate renal transplant for highly HLA sensitised patients with long waiting time have now been published. Imlifidase breaks down IgG antibodies and therefore reduces HLA specific antibodies that prevent transplant in sensitised patients. Patients will be at increased risk of antibody mediated rejection and extra HI testing will be necessary pre, peri and post-transplant. Discussions on implementation in Scotland are ongoing between NHS Lothian and NHS Greater Glasgow and Clyde.