Scottish Donation and Transplant Group written update: December 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: Two Band six biomedical scientist posts for recruitment following maternity leave and staff member moving to NHS Blood and Transplant (NHSBT).

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 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 four hours of sample receipt (target = 90%).

Quarter One in 2023-24: 81% (in Edinburgh) and 100% (in Glasgow)

Quarter Two in 2023-24: 88% (in Edinburgh) and 100% (in Glasgow)

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

Donor Characterisation Review

NHSBT to introduce electronic reporting of deceased donor HLA typing and microbiology/virology results to avoid transcription errors. The go-live date for HLA typing data now likely early 2024/25.

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, July and October 2023 runs.

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. Discussions on implementation in Scotland are ongoing between NHS Lothian and NHS Greater Glasgow and Clyde. Before patients are considered for Imlifidase use likely to be discussed at a joint multidisciplinary team. HI processes have been agreed and policies/standard operating procedures updated.

UK British Society for Histocompatibility and Immunogenetics (BSHI) and BTS guideline on the detection of alloantibodies in solid organ (and islet) transplantation

Guidelines have been updated, substantially through the work of Dr Richard Battle from the Edinburgh HI lab. Published in the November issue of the ‘International Journal of Immunogenetics.’