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Assessment of Inter-Laboratory Variability for Flow Cytometric Crossmatch Testing: Lessons Learned from Proficiency
Mary Carmelle Philogene1, Olga A Timofeeva2, Idoia Gimferrer3
1Histocompatibility and Immunogenetics Laboratory, Virginia Commonwealth University, Richmond, VA, United States.
Human Immunology
|December 3, 2024
Summary
Histocompatibility laboratories show good agreement in detecting human leukocyte antigen (HLA) antibodies using flow cytometric crossmatch (FCXM) and antibody tests. This consistency is vital for assessing immunological risk in transplantation.
Area of Science:
- Immunology and Transplantation Science
- Clinical Laboratory Medicine
Background:
- Accurate detection of human leukocyte antigen (HLA) antibodies is crucial for Histocompatibility laboratories.
- Proficiency testing surveys assess inter-laboratory concordance of HLA antibody and crossmatch assays.
Purpose of the Study:
- To evaluate inter-laboratory variability in flow cytometric crossmatch (FCXM) and antibody assays.
- To assess the concordance of HLA antibody detection and crossmatching results over a six-year period.
Main Methods:
- Analysis of ASHI Proficiency Testing (PT) antibody and crossmatching (AC) survey results from a 6-year period.
- Review of over 10,000 T cell and 10,000 B cell FCXM results from national and international laboratories.
- Evaluation of consensus based on an 80% threshold for FCXM and 90% for donor-specific HLA antibodies (DSA).
Main Results:
- High consensus rates were achieved: 92.5% for T cell FCXM and 91.7% for B cell FCXM.
- Consensus results correlated with the presence or absence of donor-specific HLA antibodies (DSA).
- Discrepancies in 7.5% (T cell) and 8.3% (B cell) FCXM results were linked to DSA consensus issues.
Conclusions:
- Good inter-laboratory consensus exists for the FCXM assay, despite variations in testing protocols.
- FCXM demonstrates strong correlation with bead-based antibody detection assays.
- Combined use of FCXM and antibody assays provides reliable data for immunological risk assessment.
