Download - Nancy L. Reinsmoen, PhD., Chair
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OPTN/UNOS HISTOCOMPATIBILITY COMMITTEE
REPORT TO THE BOARD OF DIRECTORSJUNE 25-26, 2012RICHMOND, VA
Nancy L. Reinsmoen, PhD., Chair
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1. Update HLA frequencies used to calculate CPRA for kidney, kidney/pancreas and pancreas registrations
2. Add HLA-C to CPRA calculation
3. Add mandatory field to Waitlistsm to better interpret 0% CPRA value
14-Support, 0-Opposed, 0-Abstain
Updates to CPRA
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Problem: CPRA calculation is based on outdated data.
CPRA currently calculated using HLA frequencies gathered from deceased kidney donors from Jan 1, 2003-Dec 31, 2004
Updated data are available (gathered from January 1, 2007-December 31, 2008)
Data show updated frequencies will improve accuracy and substantially increase CPRA values (above 80%) for some kidney registrations (=500)
Updating HLA Frequencies
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Problem: The current CPRA calculation disadvantages candidates sensitized to HLA-C
Candidates with HLA-C are screened from match runs but do not receive points toward higher CPRA value
More than 10,000 kidney registrations have at least one unacceptable HLA-C antigen reported
Addition of HLA-C to CPRA Calculation
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Problem: The current field displaying CPRA score does not provide needed information on candidates with 0% CPRA who have unacceptable antibodies or have not been tested
Current field does not describe reason for 0% CPRA or indicate if testing occurred /patient is sensitized
Mandatory field in Waitlist℠ will provide info on testing and presence of antibodies
Question: Was this candidate tested for antibodies?
Yes, antibodies detected
Yes, no antibodies detected
No, not tested
Mandatory Waitlist℠ Field for 0% CPRA
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Number of Positive Crossmatches Reported as a Reason for Organ Refusal for Adult Kidney Alone Registrations
Note: The data are based on deceased donor kidney match runs for donors with at least one kidney accepted for transplant. Offers that could not be accepted for a registration were excluded from the total offer count except for those refused due to the positive crossmatch. Multiple offers for the same donor were counted only once per registration.
10,545
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Update to CPRA: Public Comment
Type of Response
Response Total In Favor
In Favor as Amended Opposed
No Vote/No
Comment/ Did not Consider
Individual 31 24 (92.3%) 0 2
(7.7%) 5
Regional 11 10(90%)
1 (10%) 0 0
Committee 19 7(100%) 0 0 12
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RESOLVED, that the CPRA calculation and related fields in Waitlist℠ shall be modified as set forth in Resolution 17, effective pending programming and notice to the membership: Update the HLA frequencies used to calculate CPRA; Add HLA antigen C to the CPRA algorithm; and Add mandatory field to Waitlist℠ for all kidney,
kidney/pancreas, and pancreas candidates to determine if a candidate has been tested for antibodies and having this field display in reports and on match runs.
Resolution
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Problem: The UNOS/OPTN bylaws governing histocompatibility laboratories are antiquated.
Part of larger effort to consolidate, re-organize and simplify OPTN/UNOS bylaws
Some amendments made and language withdrawn post-public comment period; Committee will revisit later this year
Final committee vote was in support with amendment to retain word “exempt” in subcontracting language
Committee vote:
3-Support , 9-Support with Amendment , 1-Opposed; 0-Abstain
Revisions to Appendix C
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Revisions to Appendix CPublic Comment
Type of Response
Response Total In Favor In Favor as
AmendedOpposed
No Vote/No
Comment/ Did not Consider
Individual 89 27 (32.1%) 0 57
(67.9%) 5
Regional 11 10(100%)
1 (10%) 0 1
Committee 19 1(50%) 0 1
(50%) 17
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RESOLVED, that the following modifications to Appendix C (Membership Requirements for Histocompatibility Laboratories) are hereby approved as set forth in Resolution 2, effective September 1, 2012:
Resolution
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RAIS was recently revised
Original assessment assumed need for match run testing but only change is a display field in candidate information section in DonorNet
Clarification resulted in more than a 50% decrease in the number of hours associated with the proposal.
Cost of proposal is under $100K
CPRA Update: Cost Assessment