Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (566 page)

   For deceased donors, history of active viral infection, malignancy, renal disease, and hypertension is obtained.

   Exclusion Criteria for Donors

   Kidney problems: impaired renal function, proteinuria, hematuria, kidney disease, or vascular abnormalities of the kidney or urinary tract

   Diabetes mellitus

   Active viral infection (HIV, HBV, HCV or CMV)

   Active or history of malignancy

   Presence of chronic disease (pulmonary, cardiac, neurologic, hepatic, autoimmune)

   Sever hypertension

   Pregnancy

   HLA Testing in Kidney Transplantation
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HLA testing has been an indispensable component in transplantation since the recognition that antibodies, directed against lymphocytes, were associated with allograft failure. This crucial finding led to the discovery of the MHC and the appreciation of the importance of HLA testing in transplantation. Early approaches focused on the importance of HLA matching and were an important aspect of deceased donor organ allocation. As a direct result of improvements in immunosuppression in recent years, we are now challenged with selecting donor–recipient pairs based on acceptable mismatches, especially for patients with HLA alloantibodies. Therefore, routine HLA testing for kidney transplantation is more comprehensive, including both HLA typing/matching and antibody identification. Posttransplant monitoring also becomes a common practice to provide early antibody-mediated rejection warning. The testing plan listed below is recommendation only. Developing a testing agreement with the transplant team is a requirement by the United Network for Organ Sharing (UNOS) and can be unique to each transplant center.

A.  New patient testing

   All new transplant candidates and potential donors are prospectively typed for HLA-A, HLA-B (include Bw4/6), HLA-C, HLA-DRB1, HLA-DQA1, HLA-DQB1, and HLA-DRB345. HLA-DPB1 typing is performed for all patients and their potential donors if the patient has DPB1 antibodies or is enrolled in a paired exchange program.

   All new transplant candidates are screened for the presence of anti-HLA IgG antibodies. All confirmed positive screens should have multiple samples and assays to assign antibody specificity, monitor antibody strength, and identify possible interference, such as IgM, endogenous complement masking, or prozone effect.