Basaal I - P43 - The delicate balance between fraud and patient care

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B.G Hepkema, L.B. Bungener, C. Roozendaal, A. Lambeck, B.J. Kroesen, S.P. Berger

Chair(s): prof. dr. Irma Joosten, immunoloog, Radboudumc, Nijmegen

Thursday 10 march 2016

13:30 - 14:00h at Foyer

Categories: Postersessie

Parallel session: Postersessies XI - Opgesplitst in 3 tijdblokken en 3 categoriëen (klinisch, basaal, donatie)

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Integer behavior is a general prerequisite for all persons involved in patient care and recent incidents in Germany have demonstrated the disastrous consequences for the complete transplantation society if these requirements are not met. Taking this into account it is hard to conceive that for the sake of the patient we deliberately manipulated laboratory results.

A patient was listed for a second renal transplant and the result of the HLA antibody screening indicated the presence of multispecific HLA antibodies, including HLA antibodies specific for the HLA mismatches of the first transplant and antibodies specific for a self-HLA antigen of the patient (DR51). High resolution typing of the patient revealed that the patients DRB5 allele was a variant without protein expression (DRB5*01:08N; so-called null-allele) explaining the immunization against the non-expressed apparent self antigen DR51. Although this allele is listed as “common” (see cwd.immunogenomics.org), it is not encountered frequently and almost all DR15 matched kidney offers would result in a positive B cell cross match due to the DR15 linked expression of DR51. Therefore, the HLA matching phenotype of the patient was changed in ENIS by removing  DR15 and DR51 and designating these antigens as unacceptable. The patient was listed for the Acceptable Mismatch Program and, within a few months, received a DR15-DR51 negative renal offer with only a single HLA-B locus mismatch and a split mismatch for HLA-DR, which tested negative in the prospective cross match. The transplantation was uneventful with stable excellent renal function 6 months after transplantation.

Without this manipulation this patient would probably never have received an acceptable kidney offer. There was no personal gain for any of the professionals involved; the manipulation was not performed secretly and was communicated with the Eurotransplant Reference Laboratory. In our opinion this example and similar cases with allele specific HLA antibodies are exceptional examples of justified manipulation of laboratory results. For transparency reasons we suggest to include this option in the Eurotransplant manual.