Transplant Pathology Clinical Fellowship Program

Transplant Pathology Environment

Formally established in 1990, the Division of Hepatic and Transplantation Pathology plays an integral part in the comprehensive transplant program at the University of Pittsburgh Medical Center (UPMC) and its satellite center in Palermo, Italy, as well three PO1 grants and four multicenter trials sponsored by the Immune Tolerance Network and Clinical Trials in Organ Transplantation (CTOT). In recognition of the contributions to the field of liver transplantation, Dr. Demetris, as a representative of the group, was the recipient of 2012 Lifetime Achievement Award by the International Liver Transplantation Society for their contributions to the field of liver transplantation.

The mission of the Division is to provide start-of-the-art laboratory service support emphasizing continued excellence in patient care, to provide expert consultation, to foster an academic environment devoted to education and training, and to conduct basic and clinically oriented research in native liver, kidney, and transplantation pathology. A nucleus of professionals with expertise in pathology, immunology and molecular biology is actively involved in many transplantation related research projects at the Thomas E. Starzl Transplantation Institute.

The Division offers a wide range of laboratory tests and tissue analyses for patients and experimental studies. Routine histology, specialized immunocytochemistry, multiplex labeling, in situ hybridization procedures, electron microscopy, and high resolution whole slide imaging, are performed on native liver and kidney tissues from patients under consideration for transplantation, on native organ resections and on post-transplant biopsies. These procedures assure consistency of analysis and continuity of patient care. Post-transplant monitoring assays deal with detection of activation of cellular and humoral or antibody-mediated arms of the immune system, cytokine production, detection of a wide variety of viruses and other infectious agents, graft-versus-host disease, and immunosuppression-related neoplasia.

The division has established and maintains an active telepathology consultation service and offers a completely digital pathology workflow system for ITN and CTOT studies using specific HIPAA-compliant software that is used to triage and respond to cases and harvest data for studies. Included in our division is the Tissue Typing Laboratory, which offers histocompatibility-testing services to the UPMC organ transplantation program. This laboratory performs donor workups on liver, living-related liver, heart, lung and heart/lung, kidney, canceled kidney donors, living-related kidney, pancreas and pancreas/kidney, and small bowel/multi visceral and composite tissue transplantation.

The Division offers comprehensive consultation in native and allograft liver, kidney, intestine, composite tissue, and solid organ transplantation pathology to community and university-based physicians. The scope of this service encompasses the evaluation of native and allograft liver, heart, intestinal, composite tissue, and kidney disease in prospective transplantation candidates, donor recipient histocompatibility issues, the examination of native explanted organs, and the evaluation of post-transplant biopsies or resections to evaluate the causes of allograft dysfunction such as infection, ischemia, rejection, technical complications, recurrent disease and post-transplant malignancies. These consultation services are also available through the Internet.

The clinical base of the fellowship is the internationally recognized solid organ transplant program. Each year liver, kidney, lung, heart, pancreas, and small intestine transplant procedures are performed. About 5000 surgical specimens are evaluated in state-of-the art laboratories equipped with all modern investigative tools. Numerous teaching, clinical and research conferences are held weekly. Quality assurance conferences held weekly facilitate review of all interesting cases by faculty, fellows, residents and visiting physicians. Members of the Division have extensive research collaborations with numerous local Centers and Departments (e.g. The Thomas E. Starzl Transplantation Institute, The Pittsburgh Cancer Institute, and the Divisions of Molecular Diagnostics and Cellular/Molecular Biology).