Tucked away at the back of the building on the first floor of the Welsh Blood Service headquarters in Llantrisant. That’s where you’ll find the Welsh Transplantation and Immunogenetics Laboratory – known around the building as WTAIL for short.
Don’t let this hidden location give you the impression that what goes on here is of little significance. In fact – it’s quite the opposite.
Some of Wales’ most ground breaking renal research takes place here with links to the Wales Kidney Research Unit, one of Health and Care Research Wales’ funded centres.
Clinical scientist and researcher, Amy De’Ath, is here to show us around. Amy takes us through the doors, where we find typical white lab benches and various testing devices.
“In this lab we perform HLA typing (human leukocyte antigen) and antibody screening,” explained Amy.
“If you think about A, B and O blood groups. They’re on your red cells, whereas HLA is on practically every other cell in your body, and it allows your body to tell itself from its ‘non-self’.
“So for instance if you had a bacterial infection or viral infection, your white blood cells can’t suddenly check every cell of your body. The HLA is like a key that your white blood cells contact and say ‘yes, you’re me, you’re me’ and then it will come across a bacteria and say ‘oh you’re not me’ and your body will then mount an immune response.
“That’s what HLA does, which is great because it allows you to live and function, but it’s not good for a transplant scenario because if we put an organ into you and your immune cells don’t recognise that key, immediately you would get an immune response and in the most drastic settings that’s called hyper acute rejection.
“We use the HLA typing and antibody screening tests to compile a profile of a patient. We then register them with a central agency, NHS Blood and Transplant Organ Donation and Transplantation (ODT), which holds all the lists for people needing a transplant of all different organs.
“So for kidneys we’ll register them with their HLA type and then what we call their unacceptable antibodies – the ones that if we gave them a kidney with those corresponding HLA on, they would probably reject straightaway. So when the ODT get the offer of a kidney transplant, they’ll run a list to find a suitable patient.”
Right now Amy and her team are working on a study that is hoping to reduce a patient’s antibodies to give them a better chance of matching with a donor organ, which their body is more likely to accept.
‘Improving Transplant Opportunities for Patients who are Sensitised’ (ITOPS) is funded by Kidney Research UK and is being led by Dr Siân Griffin, Health and Care Research Wales specialty lead for renal and an investigator affiliated with the Wales Kidney Research Unit.
“Some patients don’t have any antibodies, some patients have a lot of antibodies, so it’s the ones that have a lot of antibodies who find it harder to get a transplant,” said Amy.
“Those are the ones we’re targeting in the ITOPS trial, to try and reduce their antibodies down, using drug therapy, to hopefully enable them to get a transplant because even if we can only reduce their antibody profile by a little bit, it can make a massive difference to the likelihood of them getting a transplant.
“You can get transplants from deceased donors, so that would be someone who died and was willing to give their organs, or you can have it from a live donor, a friend or a relative who is willing to give you a kidney. ITOPS is hoping to open up both options for patients.”
There’s a lot of activity as lab staff come and go; hanging up their white coats on the hooks and meticulously washing their hands before they leave through the double doors.
“ITOPS is recruiting now,” added Amy. “Some patients are in the control arm, so they’re actually not receiving any treatment, and some are in the intervention arm, so they are receiving study treatment.
“It’s a 12 week treatment and then we start monitoring their antibodies to see if they’re going down and then if their antibody profile hasn’t dropped they can opt to have a second round of treatment, in a hope that would then cause a drop.
“But hopefully they’ll get a drop in that first block of treatment and then we’ll monitor them over a year, testing their antibodies don’t rebound.
“Sometimes you can reduce someone’s antibodies but it doesn’t last. That can be useful because it still gives them a window of opportunity where they could have a live transplant or be offered a deceased donor transplant, but we’re hoping that there will be a longevity of effects so over the course of a year it will bring their antibodies down to a level that gives them access to transplantation.”
The Clinical Scientists here in WTAIL, like Amy, undertake years of specialist training, giving them the skills and knowledge to help them make decisions about transplantation. As a result, they’re on standby 24 hours a day to respond to potential organ matches.
“If we get an offer of a donated kidney, because somebody locally has donated their organs, we perform the HLA typing and we report that type to ODT,” described Amy.
“ODT then run the national lists and if they match the organ with one of our local patients, we’ll come in and do something called a cross match. It’s like a final check that all our antibody screening and our HLA typing is right, and that the organ and the patient are compatible.
“That’s what we do on call basically. It’s the last test of ‘yes you can go ahead and transplant the organ and it should be fine’.”
The Welsh Blood Service is looking to support more studies like ITOPS in the future, as it increases its research activity.
So, this might not be the last time we climb the stairs to the first floor, and make our way to this hidden location at the back of the building, to discover the next big thing happening in renal research.