Eurotransplant Reference Laboratory

The Eurotransplant Reference Laboratory (ETRL) is an integral part of Eurotransplant and has an important role in the quality system of the Eurotransplant organisation. It serves as the link between Eurotransplant and the tissue typing laboratories affiliated to transplantation centres collaborating within the framework of Eurotransplant. The ETRL is situated in the department of Immunology of the LUMC.

The Eurotransplant Reference Laboratory (ETRL) was founded in the 1970s, shortly after the central Eurotransplant registry was established. The initial aim of the ETRL was to increase the reliability of transplantation-related histocompatibility testing, including HLA typing, crossmatching, and screening for HLA specific antibodies in patient sera. In the early days of histocompatibility testing, the ETRL provided HLA typing sets to the laboratories participating in the framework of Eurotransplant, and retyped all organ donors. In addition, External Proficiency Testing (EPT) was initiated by the ETRL to assure quality control of the laboratories with in the Eurotransplant region. Eurotransplant was the first organ exchange organisation which established EPT for DNA typing and requires an accreditation of the European Federation for Immunogenetics (EFI) or its American sister organisation American Society for Histocompatibility and Immunogenetics (ASHI) for the laboratories that report histocompatibility data to the Eurotransplant Network Information System (ENIS).


In 1989, Eurotransplant initiated a special program for highly sensitised patients after several studies performed by the ETRL. Highly sensitised patients have a longer waiting time because of a high number of unacceptable antigens, resulting in a high percentage virtual panel reactive antibodies (vPRA). The Acceptable Mismatch Program significantly increases the chance for highly sensitised patients to receive a compatible organ offer, with excellent graft survival rates. The ETRL is actively engaged in research to make sure that allocation within Eurotransplant is performed using the latest insights in histocompatibility.


The main activities of the ETRL are:

  1. Organization of the External Proficiency Testing (EPT) including the release of the certificates of fulfilment and/or participation.
  2. Organization and supervision of the Acceptable Mismatch (AM) program for highly sensitised patients.
  3. Provision of 24/7 immunological back-up for all transplant centres and the Eurotransplant allocation office.
  4. Quality assurance and training of all tissue typing laboratories affiliated to Eurotransplant, as well as training and guiding of new laboratories and/or laboratories situated in possible future member states of Eurotransplant.
  5. Performing histocompatibility related assays for laboratories not accredited by the European Federation for Immunogenetics (EFI), situated in future member states of Eurotransplant. Performing histocompatibility assays has been delegated to the Leiden HLA diagnostics laboratory (NLBTT) under a Service Level Agreement.

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