Histocompatibility and Immunogenetics: Shedding Light on this Underrecognized Field of Laboratory Medicine

The work of laboratory professionals and pathologists spans a wide variety of roles and areas of medicine. One often underrecognized area of the laboratory is histocompatibility and immunogenetics, or human leukocyte antigen testing, (HLA), the two sides of organ transplant medicine, which work together. While laboratory work, in general, has been traditionally treated as a hidden profession due to its tendency to have less direct patient care, “It’s a complete black hole when it comes to visibility of what we do,” according to Phillip R. E. Fisher Jr, CHS (ACHI), Technical Laboratory Specialist in Immunology with Atrium Health Systems.

“It’s very specialized and often unrecognized,” Mr. Fisher adds. “Most people have never even heard of HLA labs. Even within the transplant community, a lot of the time when you hear about successful transplants, surgeons, pathologists, nephrologists, nurses, and coordinators are all recognized for their contributions, but there is almost never any mention of our part in making it happen.”

Mr. Fisher describes HLA as being like “the transmission of the engine that is transplantation. Because while people may know that there’s a transmission in their car, very few people can tell you what it is or how it works, and they only really notice it if something went wrong.”

Life-saving work

Meanwhile, these laboratory professionals are busy literally saving people’s lives, and doing so in a wide variety of interesting and complex ways, Mr. Fisher explains. Laboratory professionals in HLA provide services without which organ and bone marrow transplants cannot function.

“We do risk assessment testing so that surgeons can have confidence in desirable transplant outcomes. The testing we do spans molecular HLA typing, solid phase antibody screens, virtual crossmatching and flow crossmatching. Even post-transplant, we do antibody monitoring to ensure donor specific antibodies aren’t forming against the graft which could lead to rejection. We are doing work that gives people the gift of time and quality of life. While transplants are the primary focus in our space, we do have other functions as well. Some of which include providing relative risk markers for diseases and treatments that are linked to specific HLA genes,” Mr. Fisher says.

A quiet job with big rewards

Though the jobs in this field may exist outside of the spotlight, “It’s a deeply rewarding career,” Cordy Kudika, MA, CHS (ABHI), Director of Clinical Education, and Assistant Professor in the Division of Medical Laboratory Science for UT Health, San Antonio, says. “The unique thing about histocompatibility and immunogenetics is that we’re still behind that veil of the lab, but you grow with the patients.”

Ms. Kudika explains there is nothing like seeing a patient you’ve had on a transplant list for years finally get the life-saving organ they’ve needed. “Definitely seeing your patients get transplanted, that is the best part, hands down. When you see them on the top of the list and get them transplanted, that’s one of the best feelings to know that you helped give them that second shot at life.”

Job diversity and satisfaction

In addition to the rewards of helping patients, Ms. Kudika points out that it’s a job with a wide variety of tasks to keep the work interesting. “There’s a molecular component. There’s a flow cytometry component. There’s the compatibility component. And they’re constantly developing these new techniques for compatibility, so you are always on the cutting edge of science.”

Cathy Gebhart, MB (ASCP)^CM, PhD F(ACHI), Director at LifeLink®Transplantation Immunology Lab, describes it as a “very interactive position in most laboratories, where you’re not just sitting in front of a single analyzer all day.” For laboratory professionals who like a diversity of tasks, she says this is a great job to have. “It’s very stimulating and very engaging and there’s always something to learn and do. I think if you like puzzles, if that’s the type of personality you have, it’s a great fit for you.”

This type of job may be especially appealing to younger people, Dr. Gebhart says, “They want to help people, that’s why they chose healthcare. When you work in histocompatibility and immunogenetics, you get feedback, you feel the joy of getting these people transplanted and seeing how successful they are with the transplant.”

Mr. Fisher echoes these sentiments, adding that the work itself is also somewhat unusual for laboratory work. “Usually when you work in these different clinical labs, they’re very focused on one specific methodology, whereas our lab is a mix of techniques and technology. We do molecular testing, we do solid phase, and we do flow.” He says that the cross analysis of these three very different areas of testing “is uncommon in the laboratory space.”

Hard to replace with automation

Another bonus of this work is that because it is high complexity, it is also highly valued.

“For most areas of clinical laboratory science, a great deal of automation has taken center stage. For Immunology, HLA and a few notable exceptions, most labs are still doing the work manually on the bench. Part of this is that there is still ongoing growth and changes in the HLA field. Even if a lab decided to automate an assay, the analysis is something far too nuanced to get the same treatment. The amount of knowledge and expertise that’s required to analyze our tests are something that even the surgeons and the pathologists don’t always fully understand,” Mr. Fisher says.

Skills needed

Currently, laboratory professionals only need a Bachelor of Science degree to work in HLA labs, even though it is considered high-complexity testing, which is unique, Mr. Fisher says. “The reason why this is allowed is because the field of HLA is still evolving and there is little standardized information. This in turn leads to little representation of the field in clinical laboratory science degrees or programs. To become certified, training is done on the job.”

This allows people who have just that basic science background to come in and sub-specialize in this field and continue to move up in it, Mr. Fisher says. “And you’re getting to do clinical work, you’re getting to work in a high complexity environment that’s still ever-changing.”

Different states do have different requirements for certification, however, which might require additional schooling.

Good pay and upward mobility

Additionally, Mr. Fisher notes, anecdotally, that HLA jobs offer “significantly better pay than the majority of research lab positions pretty much out there." And salaries are comparable for those with MLS degrees and certifications to most other laboratories.

“So, for people that really want to make an impact and be able to keep it long term, this is a really good option,” Mr. Fisher says.