Is it time to perform NGS HLA typing exclusively on deceased Donors?

Abstract

Given the growing number of HLA alleles, typing methodologies utilizing specific primers or probes are facing increasing difficulty in keeping up with such an increase. Indeed, sequencing of HLA alleles seems to be the methodology of the future for solid organ patients and donors. Due to the time constraints of traditional Sanger-based sequencing and sequencing by synthesis of next generation sequencing, sequencing for HLA typing has not been used for initial deceased donor (DD) typing. Since next generation sequencing methodologies have become more rapid, it is now possible to perform high resolution HLA typing on deceased donors in a timeframe commensurate with real-time PCR. In this case-study, a null allele was not adequately resolved by the originating HLA laboratory typing of a deceased donor utilizing real-time PCR. The laboratory of the center receiving a kidney from the same deceased donor performed confirmatory typing of the deceased donor by next generation sequencing and discovered the discrepancy at HLA-A. The case presented in this manuscript demonstrates the need for laboratories to adopt next generation sequencing for DD HLA typing as soon as possible.