The Australian donation and transplantation sector currently use a physical complement-dependent cytotoxicity (CDC) crossmatch to identify compatible donor and recipients. The supply of consumables in Australia required to conduct a CDC crossmatch are diminishing, with a number of suppliers advising that they are no longer producing required reagents/consumables.

As such, the OrganMatch Strategic Governance Committee endorsed the proposal to transition to Virtual Crossmatching (VXM); aligning Australia with international practice and agreed to TSANZ entering into a work schedule with the OTA to establish a resourced VXM working group to facilitate the national transition to VXM by 31 July 2021.

VXM is a HLA antibody based assessment of compatibility without a physical crossmatch. VXM uses the complete HLA type of the donor and the current antibody profile of the recipient to assess transplant compatibility. VXM significantly reduces the workload for donor compatibility assessment and provides a faster turnaround time to generate compatible recipient lists allowing transplant units to identify suitable recipients in a much shorter timeframe that is currently experienced.

Educational resources have been identified as one of the key elements for the implementation of VXM. This is a dedicated educational resources page providing a central repository for a reference case library and educational videos/presentations on the various topics for consideration to ensure consistent knowledge surrounding the implementation of VXM.

Watch this presentation by Dr Dave Lowe, Director, Clinical Market Development at One Lambda Inc, Thermo Fisher Scientific discussing:

  • Overview of Virtual Crossmatching
  • Advantages of Virtual Crossmatching
  • Why should we make the switch?
  • What will this mean for the labs and Clinicians?
  • What have we learned?

Watch this presentation by Dr Dave Lowe, Director, Clinical Market Development at One Lambda Inc, Thermo Fisher Scientific discussing:

  • What to do with and how to define "unreal" antibodies.
  • How to approach potential denatured antigens - understanding these results amongst increased assay sensitivity.
  • Working towards a national process - setting the same cut-off nationally.

Watch this presentation by A/Prof Rob Carroll covering:

  • Fundamentals of Luminex and Flow Crossmatch
  • Historical data on outcomes and Flow positive and Flow negative transplantation with and without DSA
  • Understanding the rationale of using different MFI thresholds for HLA A, B, DR DQ in a virtual crossmatch

Watch this presentation by A/Prof Rob Carroll covering:

  • Epitope and Eplet matching and correlation with HLA match
  • Concept of anti HLA  antibodies being antibodies against particular epitopes on the HLA structure
  • Concept of shared epitopes between differing HLA molecules
  • Understanding low Luminex MFI readings in the setting of strong positive flow crossmatch
  • Understanding how patient's own HLA type increases the risk of sensitization with HLA mismatched allografts