1. OPTN/UNOS Histocompatibility Committee
Spring 2016
Hello I’m ______ and I’ll be updating you on the Histocompatibility Committee’s activities since the last regional meeting.

2. Recent Public Comment Proposals
Proposal to add HLA DQA1 Unacceptable Antigen Equivalences Table
Out for public comment
Board of Directors review June 2016
Proposal to Update the HLA Equivalency Tables 2015
Passed by Board in December 2015
Slated for implementation in Q4 2016
Currently, the committee has a project out for public comment. This proposal adds a DQA1 Unacceptable Antigen Equivalence Table. This proposal is on the non-discussion agenda, and I encourage you to read the proposal and submit any feedback you have. You can find the proposal on the OPTN website.
In December 2015 the OPTN/UNOS Board of Directors passed the update to the HLA Equivalency Tables for The proposal makes the following changes:
Makes label changes to DPB, DQA, and Cw, changing them to DPB1, DQA1, and C, respectively. This particular change was implemented as part of the changes implemented on January 21, 2016.
Adds dropdown options for DR51, 52, and 53 in the UNet system
Lastly, the proposal updates the HLA matching equivalencies and HLA unacceptable antigen equivalency tables.
The updates to the equivalency tables are currently scheduled to be implemented during the fourth quarter of 2016.

3. Policy Implementation Dates
Required reporting of HLA-DQA1 and DPB1 for Donors
Implemented January 21, 2016
Changes to Kidney Paired Donation HLA testing policies
Add General Supervisor to Key Personnel
Second half of 2016
Several Histocompatibility policies were implemented since the last meeting:
On January 21, the requirements to report DQA1 and DPB1 for donors went live. Additionally, on that same date, there were changes made to the Kidney Paired Donation HLA testing policies.
Several training videos were released prior to the implementation of these changes, which are available on the OPTN website and through Unet.
Changes coming later this year include the addition of General Supervisor to the labs Key Personnel. You can expect to see information about this change coming from UNOS staff soon.

4. Entering DQA1 Unacceptable Antigens
Selecting broad value as unacceptable
These are some screen shots of the DQA1 Unacceptable antigen entry page in UNet. With the new requirements implemented on January 21, you have the ability to enter broad antigen values and subtypes on the DQA1 unacceptable antigen entry screen. However, the system is not programmed to recognize that donors with subtypes should be excluded when a broad value is chosen as an unacceptable antigen.
Thus, it is possible for candidates to receive offers from donors who have unacceptable subtype antigens.
Doesn’t exclude donors with a subtype value, and candidates can match with donors if subtypes aren’t selected

5. Members must select broad antigens and subtypes
By selecting the broad type AND subtypes, members can successfully exclude all donors with DQA1 unacceptable subtype antigens
In order to avoid matching candidates with donors that have unacceptable DQA1 subtype antigens, it is important for you to choose the broad type and all subtypes as unacceptable antigens, as seen in the screen above.

6. Warnings appear in UNetSM
WARNING: For DQA1, select all unacceptable antigens that apply (parent and subtype). For example, if candidate is to be excluded from donors with parent values for DQA1*03, select DQA1*03 (parent) and all subtypes of DQA1*03 (e.g. 03:01, 03:02, etc.). Selecting only value DQA1*03 will NOT exclude donors reported as 03:01, 03:02, etc.
UNOS has added warnings in UNet that tell members about this issue. It is important that you and any staff entering unacceptable antigen data pay attention to these warnings in order to avoid matching with incompatible donors. This picture comes from the DQA1 unacceptable antigen entry screen in Wait List.

7. Warnings for HLA DQA1 appear on:
Candidate unacceptable antigens entry section in WL
Candidate Add, Edit, and View pages in WL
Import Unacceptable Antigen Data page
Import Unacceptable Antigen Data Results page
Unacceptable Antigen Cross Reference Table report
Additional warnings related to DQA1 unacceptable antigen entry appear in several other places in Wait List, on the Import Unacceptable Antigen utility screens, and on the Unacceptable Antigen Cross Reference Table report.
Lastly, I’d like to point out that the Histocompatibility Committee has a proposal out for public comment that will fix this problem in the long run. As you know, this proposal is on the non-discussion agenda. You can read the proposal on the OPTN public comment website and attend a webinar to hear about the proposals on the non-discussion agenda.
For reference only:
Unacceptable Antigen Cross Reference Table: Waitlist report used to display all unacceptable antigens stored for candidates listed for a selected organ

8. Questions?
Dolly Tyan, PhD, D(ABHI) Histocompatibility Committee Chair Geoffrey Zindren Histocompatibility Committee Liaison
At this time I’d like to answer any questions you might have.
Additionally, the contact information for the Histocompatibility Chair and Committee Liaison are on the screen.