What happens when a kidney becomes available?

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What happens when a kidney becomes available?

• Bridget Montague

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UKT Registration

• Requirements
• ABO group
• Tissue Type HLA A, B, C, DR, DQ
• Lymphocytotoxic antibody status
• Unacceptable antigens

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• Regular lymphocytotxic antibody screening is
  essential to prevent unexpected positive
  crossmatches at time of possible transplant
• Antibodies can be screened by
• Serology requires large panels of cells of
  known Tissue Type either by CDC or Flow Cytometry
• ELISA antigen is attached to polystyrene plates
• Luminex technology using beads coated either in
  groups of antigens or single antigens
• Patients on the waiting list should be screened
  every three months or more frequently if they
  receive a transfusion.

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Local donors

• Sample are sent to the laboratory urgently
• Tests performed
• Class I and II typing by serology and molecular
  methods
• Blood group
• Transplant co-ordinator sends sample to
  Microbiology laboratories for screening for HIV,
  HBsAg, HBcAb, HCV, CMV and Syphillis

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Local donors 2

• When all results are complete they are faxed to
  UKT using their standard form
• UKT will the perform a matching run
• Kidneys are offered to patients according to the
  current allocation scheme
• Tier A 000 mismatched paeds highly sensitised
  or HLA-DR homozygous
• Tier B 000 mismatched paeds other
• Tier C 000 mismatched adults highly sensitised
  or HLA-DR homozygous

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Local donors 3

• Tier D 000 mismatched adult patients others and
  favourably matched paeds (100, 010, 110
  mismatches)
• Tier E all other eligible patients
• Patients also prioritised according to waiting
  time
• HLA match and age combined
• Donor- recipient age difference
• Location of patient relative to donor
• HLA-DR homozygosity
• HLA-B homozygosity
• Blood group match

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Donor becomes available

• Samples are received by the laboratory from the
  recipient for crossmatching
• Lymph node and / or spleen samples are received
  from the donor
• If the donor is an import UKT will fax the Tissue
  Typing results to the laboratory
• Procedure for local donors
• Blood group confirmation performed using rbc
  obtained from spleen sample

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Donor becomes available 2

• Lymphocyotoxic crossmatch performed using
  patients serum sample(s) (current and highest
  frequency historical serum if patient is
  sensitised) and donor lymphocytes
• Allo and auto crossmatch performed by CDC
• Allo only by Flow Cytometry
• Results interpreted according to laboratory
  protocol and policies

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Donor becomes available 3

• A paper report produced at time of crossmatch is
  faxed to the ward and receipt confirmed by
  telephone
• A final copy report is sent to the consultant
• Procedure for imported donors
• Exactly the same but the donor is HLA Class I and
  II typed by serology at the time
• Donor HLA-C and DR/DQ are confirmed by molecular
  methods before the final report is issued.