Implementing virtual crossmatch based diagnostic management teams in human leukocyte antigen laboratories and transplant programs

Histocompatibility testing has continuously evolved since its inception. One such advancement is the implementation of the virtual crossmatch (VXM). Recent changes to allograft allocation schemes have resulted in increased organ sharing over greater distances, resulting in expanded utilization of the VXM to assess donor: recipient compatibility. In fact, the VXM has become a major arbitrator of pre-transplant compatibility assessment prior to both deceased and living donor organ allocation. This shift in pre-transplant practice is concurrent with the US healthcare systems' move towards more inclusive and coordinated team-based management approach to disease diagnosis. Diagnostic Management Teams (DMTs) exemplify this shift in patient care. Our institution seized the opportunity to build and implement a VXM DMT to improve and streamline pre-transplant assessment. This VXM DMT is compliant with US regulatory standards and provides a consultative report containing relevant pre-transplant information, test interpretation as well as recommendations for HLA additional (if any) testing. Herein we describe the development of and experience with the VXM DMT a year after its launch.