Overview: HLA DSA PRA Screen TestIntroduction: The HLA DSA PRA Screen Test detects donor-specific HLA antibodies and panel-reactive antibodies (PRA) to assess transplant rejection risk. Following 2023 ASHI guidelines, it uses PCR for high specificity, supporting transplant screening. This test is critical for guiding transplant decisions, managing rejection risk, and improving outcomes in molecular pathology for patients undergoing organ or bone marrow transplantation.
Other Names: HLA DSA-SAB Assay, PRA Screening Test.
FDA Status: Laboratory-developed test (LDT), meeting molecular pathology standards for diagnostic accuracy.
Historical Milestone: HLA antibody screening began in the 1970s with transplant immunology. PCR-based DSA and PRA assays improved in the 2000s, enhancing rejection risk assessment.
Purpose: Detects donor-specific HLA antibodies and PRA to assess transplant rejection risk and guide immunosuppression in patients.
Test Parameters: 1. Donor Specific & PRA Antibodies
Pretest Condition: No fasting required. Collect serum at any time. Report history of transplants, transfusions, or pregnancies, and list medications.
Specimen: 2-5 mL serum (SST). Centrifuge within 1 hour. Transport in a biohazard bag within 24 hours.
Sample Stability at Room Temperature: 24 hours
Sample Stability at Refrigeration: 48 hours
Sample Stability at Frozen: Not frozen
Medical History: Document history of transplants, transfusions, pregnancies, or HLA sensitization. Include current medications, especially immunosuppressants, and prior transplant history.
Consent: Written consent required, detailing the tests purpose, rejection risk implications, and potential need for immunosuppression planning.
Procedural Considerations: Uses PCR to detect donor-specific HLA antibodies and PRA. Results are available in 3-5 days, supporting clinical decisions. Performed in laboratories, often for transplant risk assessment.
Factors Affecting Result Accuracy: Improper sample handling or contamination can affect results. Recent transfusions or pregnancies may influence antibody levels.
Clinical Significance: Positive DSA or high PRA indicates increased rejection risk, guiding immunosuppression or donor selection. Negative results suggest lower risk but require monitoring.
Specialist Consultation: Consult a transplant immunologist or nephrologist for result interpretation and transplant planning.
Additional Supporting Tests: HLA typing, crossmatch testing, or complement-dependent cytotoxicity to confirm rejection risk.
Test Limitations: False positives may occur due to non-HLA antibodies. Clinical correlation and repeat testing are needed.
References: ASHI HLA Guidelines, 2023; American Journal of Transplantation, Tambur AR, 2022.
