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Aim The aim of this study was to develop a Virtual Crossmatch (VXM) tool utilizing our HLA database program Histotrac. The goal was to quickly visualize a patient’s current and historical anti-HLA antibody history, PRA, HLA match, sensitizing events and most recent serum. Following a director’s interpretation the program will order the test and generate a clinical report for distribution to the requesting transplant professional. Methods For this study we used our labs database system Histotrac. A customized program was generated based on the several factors we requested needed to be visualized in order to make a virtual crossmatch assessment. Flow PRA and single antigen bead testing were performed using One Lambda reagents and analyzed using Fusion software. All current and historical anti-HLA antibody data from Kidney, Heart, and Lung patients were sent from Fusion to Histotrac database thru a direct interface. Local donors were HLA typed by RTPCR using SABR kits. For imports, donor HLA typing was reviewed in DonorNet including the attached HLA typing report. All donor HLA data was entered into Histotrac and required to run the VXM tool. Results Our lab receives on average 250 VXM per month requiring an hour to complete each one from initial request to report. The VXM tool displays the current DSA MFI and searches all historical samples to identity the peak MFI for each DSA >1000 MFI. In validation, the VXM tool was refined to be 100% accurate compared to manual review. The VXM tool was able to decrease this time to 30 min per VXM and 15 min if the donor HLA typing was added in advance. With our transplant centers running VXM on 5 patients per donor this could be completed in 30 min saving an average of 2 h 30 min. Conclusions Virtual Crossmatch has become a widely utilized method for assessing donor-recipient compatibility in the absence of a physical crossmatch. We have developed a VXM tool that is capable of rapidly assessing a patient’s current and historic anti-HLA antibody history compared to a donor HLA typing. This procedure is able to significantly decrease the on call time required by the lab from initial request to virtual crossmatch report sent out. Furthermore, this shortens the time to where transplant coordinators and physicians receiving this information can assess donor organ offers and living donor paired exchanges.

Aim The UCLA Immunogenetics Center (UIC) uses HistoTrac for transplant patient data storage, analysis and reporting to UCLA Health System’s EMR EPIC:CareConnect. Currently, paper reports are uploaded from UIC to EPIC as a scanned PDF. To improve reporting workflows from HistoTrac to the EMR, we developed and mapped components in EPIC:CareConnect to allow numeric reporting of Single Antigen Bead (SAB) reports from HistoTrac. Methods A new State of the Art reporting workflow (Figure 1a) was designed and validated in the test environments. The build was completed for multiple orderables: SAB Class I, Class II or Class I/II combo, and modifications- titration and C1q (specificity, strength/MFI’s and interpretative comments). Results After migration of the reporting workflow to the live environment, baseline system performance data evaluated over a 9 week period showed that ∼4.5/100 tests were resulting in EPIC as “Preliminary” or “In Process” instead of “Final Result” with only common cause variation (Figure 1b). Classic quality improvement methods were employed to improve the process with the aim of reporting 100% of tests as “Final Result”. An audit system was developed and a Pareto Analysis identified two errors accounting for 79% of common system level failures- Status/Timing Errors, and HL-7 Warning Errors. We used the Model For Improvement for system transformation. Status/Timing and HL-7 Warning Errors were completely resolved through the process improvement. Through the audit process, the remaining common system level failures due to technical errors in ordering/reporting, result delays, and HL-7 Fatal errors are identified and resolved. Continuous monitoring reviled a system level shift with only ∼1.9/100 tests resulting in EPIC as “Preliminary” or “In Process” instead of “Final Result” (Figure 1b). Conclusions The study demonstrates that high complexity SAB bead data can be numerically reported to the EPIC EMR from HistoTrac. Through the process improvement, 100% of tests result to EPIC as “Final Result”. Download : Download high-res image (226KB) Download : Download full-size image

Aim One of Mayo Clinic’s missions is to standardize care through an integrated clinical practice. Reporting histocompatibility results is very complex and HLA labs have different ways of interpreting results. By standardizing across the three sites we improve the interchangeability of test results, reduce resources to support our practice, provide the best standard of care for our patients and support for our physicians for the Mayo paired kidney exchange program. Methods Integration was defined as: Each lab will use HistoTrac as the lab management system. HistoTrac will interface with the lab integrated system (LIS) for processing of orders and reporting results to the medical record. Each lab will report the same discreet result values and interpretive reports. Each lab will use the same vendor and lot number if possible for antibody and typing tests. A project group was created which includes: a director and technical specialist from each site, a business analyst, and a computer programmer. This team worked together using conference calls and web meetings to establish standardization for reporting HLA typing, antibody and crossmatch results. Results The results reported at each site will use the same test definitions, reporting templates, and will be transferred to the LIS. We encountered some obstacles due to: lab practice differences, transplant policies and business requirements. The convergence effort is still ongoing at each site: MN: update reporting and implement interpretive reports AZ: implement an interface to the LIS and update interpretive reports FL: implement HistoTrac with an interface to the LIS and update interpretive reports Conclusion All histocompatibility data and interpretive reports will be available in the medical record at each mayo site. Convergence of reporting test results will improve the communication and understanding when evaluating a patient while making the process cost effective. The next step in convergence is reporting to one medical record at all three sites. Download full-size image