Scottish Donation and Transplant Group written update: March 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 & Clyde

Staffing

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

On call rotas

The one in four Consultant/Principal Clinical Scientist rota supporting deceased donor kidney, Simultaneous Pancreas-Kidney (SPK), islet and cardiac transplantation in Scotland continues to work well. We will be back to a 1:4 over the next months following a return from maternity leave.

Quality in Organ Donation (QuOD) project

UK wide study, ongoing. Samples are processed by HI staff in HI Edinburgh. Agreement now reached between University of Oxford and Lothian Health Board 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).

For the third quarter 2022/23 the HI labs had a rate of 100% (in Edinburgh) and 100% (in Glasgow) for HLA types being reported within four hours of sample receipt (the target is 90%). This has been reported to NHSBT.

Donor characterisation review

NHSBT hoping to introduce electronic reporting of deceased donor HLA typing and microbiology/virology results to Organ Donation and Transplantation to avoid transcription errors. The ‘Go live’ date for HLA typing data is hoped to be in 2023/24. The NHSBT contract for providing deceased donor typing is still with Contracts departments within Scottish National Blood Transfusion Service (SNBTS) and NHS Greater Glasgow and Clyde for sign off.

NHSBT LivingPath

New electronic system for managing patient information for the National Kidney Sharing Scheme (NKSS) is now live. It will be used by HI labs for data reporting for the April 2023 run.

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. The two HI labs are discussing the most appropriate mechanism for introducing screening for HNA antibodies into routine practice. A manuscript is being submitted to describe these cases.

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.