Emma White 1; Natalia Diaz-Burlinson 2; Dr Delordson M. Kallon 1
1 Clinical Transplant Laboratory, Barts Health NHS Trusts, Royal London Hospital
2 Transplantation Laboratory, Manchester Royal Infirmary (MRI)
After consent has been received for a patient to proceed as an organ donor, the donor work up can begin. Part of this workup is carrying out HLA typing of the donor so that they can be matched with a patient on the transplant list. This work is often done out of hours on an on-call basis. The HLA typing is utilised by the recipient transplant centre to carry out a virtual crossmatch (VXM) and make an immunological risk assessment.
Once the HLA typing is completed it must be submitted to NHSBT-ODT Hub Operations on a form dedicated for this purpose (FRM4365/2). Currently the donor details and HLA type are manually transcribed on to a PDF version of the form from the analysis software and emailed to ODT Hub Operations.
This manual method has resulted in numerous transcription errors nationwide over the years. The implications of a transcription error at this stage can be a potentially serious event if an organ is offered and transplanted based on an incorrect type in this era of virtual crossmatches. Therefore we have decided to develop an automated way of importing typing results into the ODT form, thereby eliminating manual transcription.
To develop an electronic method of importing HLA typing results from SureTyper software into the HLA report to send to ODT Hub Operations
The electronic ODT form was based on a Microsoft Excel version of the ODT form originally developed by Guys hospital H&I Laboratory. This was further developed using a Macro in Microsoft Excel to import the HLA results directly from the XML results file generated by the SureTyper (Linkage Biosciences) software (see Figure 1) for use with LinkSeq ABCDRDQDP 384+ HLA typing kits.
The methodology of this Macro is to locate the HLA type within the data of the XML file and apply certain formatting rules to the result so that it conforms with the HLA type format as required by ODT.
Once the code for the Macro was developed it was rigorously validated in order to eliminate all errors. Versions 1-5 and 11 of the form were validated by Barts Health and versions 6-10 were jointly validated by Barts Health and MRI transplantation laboratories. When HLA import errors were noted these were fed back and alterations to the import algorithm were made by Barts Health laboratory.
A total of 143 HLA types were imported in versions 1-10 of the e-form, covering most frequently seen HLA specificities. Upon completion of v11, 50 further HLA types were imported with no discrepancies; therefore this version was put into routine use.
The electronic HLA ODT form has been made freely available on github for the H&I community (see below for address) along with instructions for use. In order to comply with UKAS certain parts of the spreadsheet and the Macro code have been password protected.
The Barts Health and MRI laboratories have found that this automated ODT form has greatly helped in deceased donor HLA type reporting. The nature of deceased donor HLA typing is that it is often done out-of-hours and carrying out manual transcription during anti-social hours increases the likelihood of transcription errors. This electronic solution reduces this risk and speeds up the reporting process.
However, it should be also noted that due to the considerable number of possible HLA type combinations it has not been possible to test every combination in the validation, therefore the HLA report still requires checking by a Clinical Scientist before submission. Since implementation, a further 112 live results have been imported at Barts Health and MRI laboratories with no errors.