HLA compatible red cells

Background

  1. HLA antibodies may form following exposure to foreign HLA antigens through pregnancy, solid organ transplantation, or blood transfusion.
  2. In living donor renal transplantation, donor specific HLA antibodies may stop the planned transplant proceeding or increase the risk of antibody-mediated rejection and post-transplant graft loss.

Avoiding transfusion-related HLA alloimmunisation may increase the chance of successful transplantation. Although it is not yet clear if this significantly alters the incidence of new (organ) donor-specific antibody formation after the transplant or affects longer-term graft survival.

 

When should I use this modification?

HLA compatible red cells can be requested for the following indications:

  • Living donor kidney transplant patients (where the HLA type of the kidney donor is known)
    • transplant-naïve patients during work-up for transplant and pre-transplant but not for the transplant surgery or post-operatively
    • Patients with an existing transplanted kidney that is failing or failed, planned for a second living donor kidney transplant and who are not already heavily alloimmunised, may be considered 

Red cells will be selected for HLA compatibility with the patient and avoidance of HLA mismatches shared with the kidney donor. 

  • Paediatric Chronic Kidney Disease (CKD) patients to the age of 18 years
    Considered on a case-by-case basis and limited to paediatric CKD stage 3-5 (GFR <60 mL/min) or clinical likelihood of progressing to stage 5. 

      HLA compatible red cell support prior to the age of 18 may continue beyond 18 if a renal transplant is considered likely.

Red cell antigen and/or phenotype matching

Red cell antigen and/or phenotype matching will be prioritised over HLA compatibility and may limit our ability to supply HLA compatible red cells in the following situations:

  • Presence or history of a red cell antibody
    HLA compatible red cells must be negative for the relevant red cell antigen 
  • Paediatric patients and patients of childbearing potential (females <50 years)
    HLA compatible red cells to be matched or compatible for RhD and K type (if known).

HLA compatible red cells will not be approved for the following:

  • Urgent transfusion (within 7 days);
    Please note: exceptional cases where a patient needs an urgent transfusion must be discussed with a Lifeblood Immunologist after submitting the clinical request. 
  • Chronic transfusion support (red cells or platelets)
  • Patients already heavily sensitised to HLA (with High cPRA) may not be suitable for HLA compatible red cells.

In these cases transfusion of standard red cell components will be advised.

HLA compatible red cells are not approved for prevention of HLA alloimmunisation in other settings, including patients awaiting other solid organ transplants or mismatched/haploidentical stem cell transplantation.

Requesting HLA compatible red cells

HLA compatible red cells can only be requested during normal business hours and for non-urgent, planned transfusions.  Please allow up to 7 days from request to supply.

Requests must be submitted using the HLA Compatible Red Cells Clinical Request form

Email the completed request form to:  TS@redcrossblood.org.au

For further information, or other enquiries regarding HLA compatible red cells, please contact Lifeblood on 1300 669 054.