Utilizing proficiency testing survey data to create advanced educational content: the virtual crossmatch challenge...

Area of Science:

• Transplantation immunology
• Clinical laboratory science
• Medical education

Background:

• Traditional T-cell and B-cell physical crossmatches are evolving for Human Leukocyte Antigen (HLA) compatibility assessment.
• Advancements in solid phase assays, HLA typing, and donor allocation schemes have led to the increased use of the virtual crossmatch (VXM).
• VXM is a critical clinical decision-making tool based on pre-transplant HLA data interpretation, not a direct analyte test.

Purpose of the Study:

• To describe the American Society for Histocompatibility and Immunogenetics (ASHI) Proficiency Testing (PT) Educational Virtual Crossmatch (VXM) Challenge model.
• To utilize PT survey data for creating advanced educational content beyond simple grading.
• To probe common laboratory practices and risk assessment in HLA antibody evaluation.

Main Methods:

• Development and implementation of the ASHI PT Educational VXM Challenge using existing PT survey data.
• Analysis of VXM Challenge components and results from 2018-2022.
• Identification of key learning points and discrepancies in VXM interpretation among participating laboratories.

Main Results:

• The VXM Educational Challenge effectively highlights strengths and limitations of VXM assessment.
• Identified lack of correlation between VXM and physical crossmatch in specific scenarios, including low-level donor-specific antibodies (DSA) or antibodies against non-panel donor alleles/shared epitopes.
• Revealed significant variability in HLA testing and VXM result interpretation among laboratories.

Conclusions:

• The ASHI PT Educational VXM Challenge is a valuable model for creating educational content from PT data.
• VXM assessment requires careful interpretation, considering factors like low-level DSA and antibody specificities.
• Educational challenges are crucial for improving consistency and accuracy in HLA laboratory practices and clinical decision-making.