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OPTN Kidney Paired Donation (KPD) Histocompatibility Testing Policies. Kidney Transplantation Committee Spring 2014. Background. Kidney Committee distributed KPD policies for public comment in March 2012 A number of commenters had concern with histo section due to missing requirements

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OPTN Kidney Paired Donation (KPD) Histocompatibility Testing Policies

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Optn kidney paired donation kpd histocompatibility testing policies

OPTN Kidney Paired Donation (KPD) Histocompatibility Testing Policies

Kidney Transplantation Committee

Spring 2014


Background

Background

  • Kidney Committee distributed KPD policies for public comment in March 2012

  • A number of commenters had concern with histo section due to missing requirements

  • Professional societies brought together a KPD consensus conference around same time

  • This proposal incorporates

    • spring 2012 OPTN public comment feedback

    • findings from KPD consensus conference

    • recommendations from OPTN Histo Committee


The problem

The Problem

  • Low match success rate in KPD program

  • Antibody related issues and positive crossmatches continue to account for a number of match failures

  • Insufficient histocompatibility testing requirements to prevent match failure


Goal of the proposal

Goal of the Proposal

  • Increase match success rate in KPD program by preventing unexpected positive crossmatches that can break chains and prevent candidates and donors from accessing subsequent match runs and transplant opportunities

  • Promote transplant safety through more effective screening of kidney offers


Proposed hla typing

Proposed: HLA Typing

  • Molecular HLA typing required for donors and candidates

  • Loci required for donors: HLA-A, B, Bw4, Bw6, C, DR, DR51, DR52, DR53, DPB, DQA, DQB

  • Loci required for candidates: HLA-A, B, Bw4, Bw6, DR

  • If candidate has unacceptable antigens, additional loci required: C, DR51, DR52, DR53, DPB, DQA, DQB

  • Candidate’s hospital must retype donor to confirm HLA type


Proposed antibody screenings

Proposed: Antibody Screenings

  • Candidate’s transplant hospital must screen for antibodies at all of the following times:

    • every 90 days

    • when potentially sensitizing event occurs

    • if candidate reactivated after more than 90 inactive days

    • if unacceptable positive crossmatch occurs that prevents transplant with matched donor

  • Labs must use method at least as sensitive as crossmatch method

  • Physician/surgeon (or designee) and lab director (or designee) must review and confirm UA’s listed for candidate


Proposed crossmatching

Proposed: Crossmatching

  • Candidate’s transplant hospital must perform physical crossmatch before donor’s nephrectomy is scheduled

  • Must report crossmatch results to donor’s transplant hospital and UNOS

  • If unacceptable positive crossmatch occurs between candidate and matched donor, candidate’s hospital must inactivate candidate before next match run, review the unacceptable antigens (UA), and report reason to UNOS w/in 7 days

  • Candidate can be reactivated once review and update (if applicable) of UAs is complete


Supporting evidence

Supporting Evidence

  • Crossmatch-related refusals (postive crossmatch or unacceptable antigens) account for ~30% of failed matches

  • 61 programs had accepted at least one match offer for which the entire exchange fell through

  • Some programs may have had a disproportionately high number of crossmatch-related refusals

  • 39 programs refused at least one match offer due to a crossmatch-related reason


Specific feedback request

Specific Feedback Request

  • If unacceptable positive crossmatch occurs between candidate and matched donor, candidate’s hospital must inactivate candidate in the KPD program before next match run

  • If this change is approved, is it less burdensome for transplant programs if the inactivation is automatic (completed by UNOS)?


Specific feedback request1

Specific Feedback Request

  • Is it burdensome to require antibody screenings every 90 days for ALL candidates (even if not sensitized?)

  • Should longer timeframe between screenings apply for non-sensitized candidates?

    • 180 days?


What members will need to do

What Members will Need to Do

  • Donor’s transplant hospital responsible for reporting donor HLA info, arranging shipment of donor blood sample to candidate’s hospital or histo lab

  • Candidate’s transplant hospital responsible for reporting candidate HLA info, confirming donor HLA info, antibody screening requirements, crossmatching requirements


Questions

Questions?

  • Richard Formica, MD Committee Chair

  • Name Region # Representative Email

  • Gena Boyle Committee Liaison gena.boyle@unos.org


Backup slides

Backup Slides


Optn kidney paired donation kpd histocompatibility testing policies

KDPI


Point changes sensitization

Point changes: Sensitization

CPRA Sliding Scale (Allocation Points)

(CPRA<98%)

20

17.30

18

New

16

14

12.17

12

10.82

10

Points

8

Current

6.71

6

4.05

4

2.46

1.58

2

1.09

0.81

0.48

0.34

0

0

0.21

0.08

0

0

0

10

20

30

40

50

60

70

80

90

100

CPRA

CPRA


Summary member responsibilities

Summary: Member responsibilities


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