Establishment of an HLA laboratory in Madagascar: Technical and economic difficulties in developing country

Background: Chronic renal failure is a worldwidepublic health issue. In Madagascar, this condition of heavy care is a medical challenge in a low-income country. In 2016, an estimated 8,000 - 10,000 people with kidney failure and only 1.26% have access to hemodialysis. About 30 patients were able to access live organ transplantation abroad.Our objectives are to set up an HLA histocompatibility laboratory providing HLA typing, search for anti-HLA antibodies, and crossmatch. Evaluate the available structures of the Immunology laboratory. Look for partner laboratories for more specialized research. Materials and methods: The Joseph Ravoahangy Andrianavalona University Hospital Immunology Laboratory is equipped with a conventional PCR and real-time PCR platform, an ELISA immunoassay platform, and inverted fluorescence microscope. Results: The techniques to be implemented in Madagascar for the HLA Laboratory are the HLA typing of the donor and the recipient by the PCRSSP and microlymphocytotoxicity (LCT) technique. The search for anti-HLA antibodies will be done by ELISA and LCT and crossmatch in LCT.We have created cooperation with the Réunion France histocompatibility laboratory for the identification of recipient and donor HLA antibodies and crossmatch by Luminex. Conclusion: The presence of HLA platform in Madagascar will allow preparing the establishment of a future kidney transplant in the country but also for improved management of patients waiting on abroad transplant list in regards of donor selection and post-transplant monitoring. Keywords: Kidney transplant, HLA laboratory, Developing country, Madagascar