1. 1 Proposal to Update the HLA Equivalency Tables Histocompatibility Committee Fall 2015

2. 2 What problems will the proposal solve?  Some equivalences have changed since last update  Proposed solution - update equivalency tables based on:  advances in HLA typing  the frequencies of antigens reported for donors and antigens and unacceptable antigens reported for candidates  Some HLA antigen dropdowns in UNet SM disadvantage candidates with antibodies against some alleles but not all of them  Proposed solution - update dropdowns in UNet  Policy references to HLA DPB, DQA, and DQB are out of date  Proposed solution – change policy references to these loci to DPB1, DQA1, and DQB1

3.  Increase opportunities for candidates to receive offers  Compatible donors will not be excluded based on outdated or broad HLA typing constraints of prior equivalency tables  Reduce risk of positive crossmatch after shipping kidneys nationally and regionally What is the goal of the proposal? 3

4. Supporting Evidence 4 Broad antigens reported for deceased donors (2013-2014) * C3 was reported by 33 labs for 264 donors. Note: Labels show the number of labs for each broad antigen.

5.  Transplant Programs:  Request updated HLA typing using molecular methods for existing candidates who may be affected by the changes to the equivalences tables  Review/modify unacceptable antigens reported for candidates with antibodies against alleles that are being added  Labs:  Assign split (not broad) antigens to candidates How will members implement this proposal? 5

6. Strategic GoalImpact Increase the number of transplantsImprove efficiency of allocation for sensitized candidates Improve equity in access to transplants Allow members to enter more specific data to ensure candidates are not excluded from donors against whom they don’t have UAs Improve waitlisted patient, living donor, and transplant recipient outcomes Table updates will lead to better compatibility and decrease probability of post-transplant rejection Allocation to candidates less likely to have a positive crossmatch reduces cold ischemia time Promote living donor and transplant recipient safety Reduce risk of organ discards due to futile shipments How does this proposal support the OPTN Strategic Plan? 6

7. Dolly Tyan, Ph.D. Committee Chair dtyan@stanford.edu Regional representative name (RA will complete) Region X Representative email address Geoff Zindren Committee Liaison Geoffrey.Zindren@unos.org Questions? 7