Solid Organ Transplantation

Module details

Title

Solid Organ Transplantation

Type

Specialist

Module code

SLS143

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with knowledge and understanding of the mechanism of hypersensitivity and allergy. They will understand the clinical presentation and investigation of a range of conditions associated with hypersensitivity and allergy. They will become familiar with methods and strategies to investigate hypersensitivity and allergy and gain experience of the interpretation of patient results in a variety of clinical settings.

This module will provide the trainee with the practical application of knowledge and skills relating to Histocompatibility and Immunogenetics techniques applicable to solid organ transplantation and blood transfusion.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Assess patients for registration onto the national transplant list and perform the tests necessary to achieve this including: HLA typing HLA antibody detection/definition	Action View
# 2	Learning outcome 1,2,4,5	Competency Interpret data from HLA antibody identification tests and prepare clinically meaningful reports on patients awaiting solid organ transplantation.	Action View
# 3	Learning outcome 1,2,3,4,7	Competency Interpret crossmatch data and produce a crossmatch report for clinical colleagues according to local protocol.	Action View
# 4	Learning outcome 2,3	Competency HLA type a deceased potential donor according to local protocols and complete a donor HLA report form for submission to NHSBT-ODT.	Action View
# 5	Learning outcome 2,3	Competency Assess the suitability of potential kidney/pancreas recipients for a deceased donor organ.	Action View
# 6	Learning outcome 2,3	Competency Assess the suitability of potential cardio thoracic or other solid organ (liver, islets, bowel) recipients for a deceased donor.	Action View
# 7	Learning outcome 2,3,4,7	Competency Analyse crossmatch data for a potential transplant recipient according to local policy and prepare a crossmatch report for clinical colleagues.	Action View
# 8	Learning outcome 2,3,4,7	Competency Perform a virtual crossmatch assessment for a potential transplant recipient according to local policy and prepare a cross-match report for clinical colleagues.	Action View
# 9	Learning outcome 2,3,4,7	Competency Assess the suitability of potential kidney donor/recipients for a living donor transplant and produce an interpretive report for clinical colleagues.	Action View
# 10	Learning outcome 5	Competency Perform tests to detect or monitor donor specific antibodies for post transplant patients.	Action View
# 11	Learning outcome 6	Competency Work in partnership with other clinical specialisms in the investigation of solid organ transplantation and platelet transfusion and, where appropriate with service users and support staff.	Action View
# 12	Learning outcome 6	Competency Communicate effectively with the healthcare team recognising and responding appropriately to situations where it is necessary to share information to safeguard service users or the wider public.	Action View
# 13	Learning outcome 7	Competency Analyse antibody data for a patient referred for platelet refractoriness and produce an interpretive report for clinical colleagues	Action View
# 14	Learning outcome 7	Competency Select appropriate platelet units for patients requiring HLA/Human Platelet Antigen (HPA) selected platelets	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Perform tests for deceased donor recipient crossmatching	DOPS
Perform tests for living donor recipient crossmatching	DOPS
Prepare a prospective or retrospective crossmatch report	DOPS
Perform tests to monitor post-transplant donor specific antibodies	DOPS
Perform a virtual crossmatch for deceased or living donation	DOPS
HLA type a potential deceased donor	DOPS
Prepare a living donor assessment report	DOPS
Perform a risk assessment for cardiothoracic donation according to UK guidelines	DOPS
Prepare a platelet refractoriness assessment report	DOPS
Identify compatible HLA selected platelet units	DOPS
Attend ward rounds and/or clinics at which patients are being worked up for, or monitored following solid organ transplantation and describe to the patient the involvement of the Laboratory in their care	OCE
Attend a living donor transplant	OCE
Attend a multidisciplinary review meeting at which laboratory results are presented.	OCE

Learning outcomes

1. Perform the clinical and laboratory work up of patients awaiting solid organ transplantation, including the interpretation and reporting of results in the correct clinical context.
2. Assess the suitability of patients for crossmatch and transplantation within the national deceased donor organ allocation scheme.
3. Analyse and report laboratory tests for donor and recipient compatibility to facilitate transplantation within the national deceased donor organ allocation scheme.
4. Assess the suitability of patients for crossmatch and transplantation for living donation.
5. Perform clinical and laboratory monitoring of patients who have received a solid organ transplant.
6. Work in partnership with other clinical specialisms in the investigation of solid organ transplantation and platelet transfusion and, where appropriate with service users and support staff.
7. Assess the suitability of patients for HLA/HPA selected platelets and identify compatible platelet units.

Learning outcomes

1. Explain the immunological barriers to solid organ and haematopoietic stem cell transplantation.
2. Describe the mechanisms of graft rejection and the relevance of pre-sensitisation.
3. Describe the mechanisms of current immunosuppressive therapies in the control of graft rejection
4. Discuss the role of the histocompatibility and immunogenetics laboratory in the pre transplant work-up and
   post-transplant management of patients.
5. Describe the design, operation and performance of appropriate laboratory tests in support of HLA antibody
   identification and definition, HLA typing and data analysis
6. Describe the design, operation and performance of appropriate laboratory tests in support of cross-matching
   for solid organ transplantation.
7. Describe the partnership between the histocompatibility and immunogenetics laboratory and other clinical
   specialisms in solid organ and haematopoietic stem cell transplantation and patient care.

Indicative content

• Histocompatibility antigens
  • Structure and function
  • Generation of polymorphism
  • Nomenclature
• Mechanisms of allograft rejection
  • Alloantigen recognition
  • Classification of rejection reactions
  • Graft versus host reactions
  • HLA typing
  • Pre-transplant sensitisation
• Immunosuppressive therapy
  • Drugs
  • Biological modifiers
  • NICE recommendations
  • Adverse effects of immunosuppressive therapies
• Clinical transplantation
  • Renal transplantation (selection of recipient and donor; post-transplantation period; clinical rejection;
    immunopathology of rejection; graft survival; complications)
  • Other types of organ transplantation (liver; heart; lung; pancreas; pancreatic islets; skin; cornea)
  • Haematopoietic stem cell transplantation (indications and selection of patients; donor–recipient
    matching requirements; management; complications and prevention; results and prognosis; sources of
    stem cells for transplantation; stem cell transplantation for non-malignant indications)

Activities

• Actively participate in ward rounds and/or clinics at which patients are being worked up for or monitored following solid organ transplantation. Discussion and critical reflection of your experiences and the involvement of the laboratory in the management of patients.
• Actively participate in multidisciplinary review meetings at which laboratory results are presented as part of the clinical record in patients being worked up for living donor transplantation.
• Actively participate in multidisciplinary review meetings at which laboratory results are presented as part of the clinical record in patients being monitored following solid organ transplantation.
• Shadow clinical scientists performing on call laboratory and clinical assessments of potential recipients and donors for transplantation in the acute situation and discuss their experience of on-call.
• With permission talk to a patient and family and explore their experience of transplantation and critically reflect on your learning and how it will affect your future practice. (Whilst it is recognised that this experience may be difficult to arrange it is recommended that as far as possible, all trainees are given this opportunity to meet with a patient and their family)
• Observation of a living donor transplant procedure, including critical reflection on your experience and the impact it may have on your future role as a clinical scientist.
• Critically reflect on your own experience of supervision and mentoring and identify how you will use these in your learning training, supervising and mentoring of others.