Improving Cord Blood Typing with Next-Generation Sequencing: Impact of Allele-Level HLA and NIMA Determination on Their Selection for Transplantation

Allele-level HLA compatibility in cord blood transplantation, together with noninherited maternal antigen or NIMA matching, have been associated with better transplant outcomes. The aim of this work is to develop a cost-efficient high-resolution HLA typing strategy based on next-generation sequencing to improve the quality of the Barcelona Cord Blood Bank's inventory, and to investigate the impact of high-resolution HLA typing and NIMA determination on the preferential selection of cord blood for transplantation. In this line, the developed strategy was validated and theHLA-A,-B,-C,-DRB1, and-DQB1genes of 5000 cord blood units and 2500 of their associated maternal samples were typed. Subsequently, three study groups of 2012 units each were monitored for up to 2 years: (1) units with high-resolution and maternal HLA typing, (2) units with high-resolution but not maternal typing, and (3) units typed at low-resolution for class I and only high-resolution forHLA-DRB1. Despite a trend toward a greater selection of units with high-resolution typing, no significant impact of these variables was observed. These results highlight the need for evidence-based and globally accepted criteria for cord blood selection, together with the necessity to improve the accessibility of clinicians to donor registry's data.