CUSTOMER SPOTLIGHT: Northwestern University Transplant Immunology Laboratory

Bridging the Gap: Implementing Multiple Single Antigen Vendors to Ensure Confidence in Results.

More labs have been implementing a second vendor for their antibody testing as they continue to see beyond the limits of single antigen testing.

In a recent customer spotlight, Northwestern University Transplant Immunology Laboratory located outside of Chicago, Illinois, USA, spoke to their experience with validating a second vendor for their single antigen testing and how it ensured confidence in their results. Northwestern University Laboratory, led by Dr. David Pinelli, PhD, D(ABHI) and Dr. Anat Tambur, DMD, PhD, D(ABHI), adopted LABScreen® (Thermo Fisher Scientific) single antigen bead (SAB) testing in 2011 and since then has used allele-level information for pre- and post-transplant donor-specific antibody
(DSA) evaluation.

The United Network for Organ Sharing (UNOS) only requires low-resolution, antigen level typing for solid organ transplantation, but high-resolution, allele-level information is now often available for many donors. This is critical for accurately detecting DSA that can determine graft outcome post-transplant. The Northwestern lab initially wanted to consider using an additional vendor to screen for all potential donor-specific alleles, many of which were not represented on the panels in use. Upon implementation, they were also able to utilise the secondary vendor to investigate potential non-physiologic reactivity observed with their primary panels.

The lab had several concerns that lead to the need for a secondary vendor.

  1. Many common donor alleles were not represented on panels in use
  2. Non-specific binding patterns were observed that included auto antigens
  3. Non-physiologic reactivity observed (denatured antigens)
  4. Assay results include broad C-Locus reactivity with negative PRA assay results
  5. High negative control values for highly sensitised patients that may result in missed weak specificities due to high background.

Northwestern validated and implemented the use of the Immucor® LIFECODES® LSATM Class I and Class II as their secondary vendor. They have found that the improvements made to the assay allow them to better assess challenging cases and suspected non-specific or non-physiologic reactivity with their primary panel. The lab utilises the Immucor LIFECODES LSA assay to monitor patients for donor alleles that are only present on the LSA panel.

Additionally, when a patient is identified to have non-specific binding patterns, including non-specific C-locus reactivity, or high background with the primary SAB assay, the patient profile is updated in the laboratory information system (LIS) so that future samples for that patient are exclusively tested with the Immucor LIFECODES LSA assay. Northwestern is a modern HLA lab, seeing beyond the limits of traditional testing. By implementing a diverse antibody testing toolkit, Dr. Pinelli and Dr. Tambur are committed to the evolution and advancement of clinical HLA testing and to the safety of their patients. The application of multiple tools allows for careful analysis and has increased confidence in providing accurate antibody identification & DSA monitoring for all their patients.

This customer spotlight was written in collaboration with Northwestern University Transplant Immunology Laboratory and Immucor, Inc.

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