Immunogenetics and Transplantation
The HLA and Immunogenetics Laboratory at Cedars-Sinai supports the Blood and Marrow Transplant Program and all of the solid organ transplant programs of Cedars-Sinai. The lab performs serologic, molecular and flow cytometric assays for HLA typing, antibody screening and donor and recipient cross-matching for transplanting solid organs. High-resolution sequencing and engraftment assays are performed for the purposes of bone marrow transplantation.
The recipient is typed by high-resolution serology and by intermediate resolution molecular methods when necessary for Class I using PCR-SSP to ensure proper assignment and rule out null alleles. For Class II, PCR-SSP is routinely performed. All WHO-defined alleles can be detected.
Donors are typed according to the same strategy used for recipient typing. The degree of match is always reported to help the transplant physicians choose the best-matched donor. For living donors, several donors may be typed to determine which is the best match.
Recipient Antibody Screening
To determine whether a potential recipient has preformed antibodies to potential donors, several tests are performed. A quick screen is a short antibody screen designed to give a rough approximation of the percent panel reactive antibody (PRA). This is done to list the patient on the national waitlist. An autoantibody test is also performed to see if the patient has antibodies to their own cells. An antibody screen and identification is also performed against a full panel to determine what the actual PRA is and which exact antibodies are present, if any. This predicts how difficult it will be to find a donor who is compatible with the patient.
Donor and Recipient Cross-Matching
Once a donor is selected and found to be available or if a cadaver donor is selected, serum from the recipient is cross-matched with the donor cells by flow cytometry and cytotoxicity to determine compatibility. Several serum dates may be used to assure that the patient does not have antibody currently or historically. To find the best potential living donor, several such cross-matches may be done, one set for each potential donor.
Special in Vitro IVIG Testing
Special prognostic testing with intravenous gamma globulin (IVIG), not available anywhere else in the United States, is performed in this laboratory. This testing allows the prediction of highly sensitized patients who would benefit from treatment with IVIG, rendering them more likely to receive a transplant than those who do not benefit from the treatment.