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Update from the Pathology Council - Recap of 2017 Annual Meeting

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Brandon T. Larsen, MD PhD
Mayo Clinic Arizona
Scottsdale, AZ, USA

Although we are only a small subset of the broader ISHLT membership, the Pathology Council is an active and exciting group that continues to provide vital clinical, research, and educational expertise to advance the Society's initiatives, strengthen the transplantation community, and most importantly to help the patients we serve! This past April, we enjoyed a highly productive Annual Meeting, where we were enriched not only by great scientific content, but also by the close comradery of our excellent colleagues. At this meeting, we saw a renewed emphasis on several Council initiatives and heard several new proposals aiming to expand our research and educational efforts as we seek to improve the care of our patients and enhance the skills of our pathology colleagues who are not (yet) members of the Society. We also witnessed a change in leadership in our Council, with Dr. Robert F. Padera assuming the role of Council Chair for the next two years, and Dr. Martin J. Goddard stepping down and assuming the role of Council Past Chair. We are grateful to Dr. Goddard for his leadership and service, and look forward to having Dr. Padera at the helm!

Pathology Council Initiatives

The Pathology Council remains committed to educational initiatives, and several were discussed at the Annual Meeting. In particular, members of the Council continue to be engaged in concerted efforts to develop better online tools for transplant pathology. In recent years, members of our Council have developed an online tutorial on cardiac ACR and AMR for pathologists, including online quiz components, in partnership with the Society for Cardiovascular Pathology and Association for European Cardiovascular Pathology (http://scvp.net/acr/index.html). Members of our Council are also developing online tools to aid pathologists in interpretation of lung transplant biopsies. Our European colleagues led by Dr. Fiorella Calabrese have developed a tutorial website for pulmonary AMR, hosted by the European Society of Pathology (http://lungtransplant.dctv.unipd.it/amr/index.php). This website is a work in progress, but is coming together nicely. If you encounter good examples of diagnostic grades of rejection or other entities that could be included in this online resource, please contact Dr. Calabrese at fiorella.calabrese@unipd.it. Both of these online resources continue to be well received, but suggestions for improvement are welcome. Not to be outdone, Dr. Dylan Miller is continuing his legacy as a computer guru and developer of fine online tutorial products, and reported his progress on a new online "eQA" resource and aid for heart transplant biopsy interpretation. Although still under development, this promises to be a highly useful and practical resource where scanned slides can be reviewed for educational purposes and compared with interpretations of other users, perhaps also including a quiz component. Stay tuned...

A number of research initiatives were also discussed at the Annual Meeting. Dr. Gerry Berry, Dr. Jean Paul Duong Van Huyen, and colleagues are forging ahead with a project investigating inflammatory burden in cardiac AMR in collaboration with other institutions, and this project is ongoing. Hopefully, this project will shed some light on the significance of different inflammatory components in heart transplant biopsies. This group met earlier in Washington, D.C. and subsequently in San Diego, and the project is moving forward as they accrue patients with rich clinical information and DSA data. There is also interest in developing research projects investigating the significance of intravascular versus extravascular inflammatory cells in this context, as well as studies evaluating reproducibility in interpretation of heart transplant biopsies. Perhaps Dr. Miller's "eQA" platform will also aid in these efforts, and we hope to see many of you participating in these efforts.

The Pathology Council remains small compared to other Councils in the ISHLT, and this has unfortunately not changed very much in recent years. Most pathologists who evaluate heart and lung transplant biopsies are not ISHLT members and do so as a small component of their broader practices. The ISHLT Board is keen that we continue to engage with our pathology colleagues, including those who are non-members. With this in mind, the Council discussed ways to increase our membership and to better understand the barriers preventing others from joining our group. Ideas included a suggestion to establish a best poster award, to be given as part of our Annual Meeting to a trainee or junior member, as an incentive to increase participation in the Council. It was also suggested that we re-attempt to reach transplant programs that lack an ISHLT member pathologist, as Dr. Goddard attempted last year, in an effort to hopefully connect with and attract future members. It was also suggested that a survey of transplant pathologists may be useful to illuminate the issues and barriers preventing others from joining. Again, perhaps Dr. Miller's "eQA" platform might provide another solution for some of these challenges, perhaps offering additional incentive or value for prospective members. These issues will undoubtedly remain topics of discussion over the coming year. However, we also urge our Council members to continue reaching out to pathologists in other centers who practice transplant pathology, to keep them informed and to encourage them to consider joining us. There is considerable expertise in transplant pathology out there among non-members that remains untapped. Please bang the drum and spread the word.

Recap of 2017 Annual Meeting and Scientific Sessions in San Diego, CA

It was great to see many of you at the Annual Meeting in April, and those who were there enjoyed a rich and dynamic agenda, including several excellent pathology-oriented sessions. Although there were many great sessions throughout the week, this year saw an important change in the format of the meeting, whereby program content relevant to the Pathology Council was clustered into a single day (Friday), instead of being distributed throughout the entire meeting over several days. This concentration of program content shortened the time required to attend the meeting for many of us, and was generally well received. Hopefully, this concentration of content into a shorter time period will provide additional incentive for those who wanted to attend in the past, but could not due to time constraints. Please spread the word to your non-member colleagues about this change, so we can hopefully see more pathologists in attendance next year.

For those of you who were not able to attend, this year's meeting included an excellent Sunrise Symposium on mixed rejection in the cardiac allograft, which remains a challenging and somewhat controversial topic and is certainly deserving of more attention and research. Although this was early in the morning, it packed several highly informative talks into a single hour and was well attended. Our Council also hosted an Oral Session the same day, discussing various diagnostics in heart and lung transplantation. Lastly, there was an excellent moderated Poster Session in the evening that highlighted a number of important ongoing studies from many of our Council members… and most importantly, included a wine and cheese reception! These sessions were energizing and we look forward to seeing many of you at the next annual meeting, April 11-14, 2018 in Nice, France. Mark your calendars. ■

Disclosure Statement: The author has no conflicts of interest to disclose.

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