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Update from the Pathology Council

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

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, help the patients we serve! Antibody-mediated rejection (AMR) continues to be a strong focus of our Council's efforts as we seek to better understand the phenomenon of AMR in cardiac and pulmonary allografts, refine our diagnostic criteria and relevant biomarkers for such, and disseminate this information to pathologists. To this end, the Council put together several collaborative research groups over the last year to facilitate multi-center studies on these topics, and our members continue to expand available online resources for transplant pathology.

Pathology Council Initiatives

Over the last year, the Council has established several working groups to investigate various aspects of AMR. Gerry Berry together with Ornella Leone, Annalisa Angelini, Patrick Bruneval, and Jean Paul Duong Van Huyen are forging ahead with a project investigating inflammatory burden in cardiac AMR in collaboration with other institutions, and this project is ongoing. Second, the Council has increased its efforts to investigate potential markers of chronic rejection in biopsies, learning from experiences gained in other solid organ transplants. Martin Goddard, Elizabeth Hammond, Bobby Padera, and Annalisa Angelini are moving forward with research efforts on this topic in collaboration with other institutions. An excellent summary of the unanswered pathology questions in cardiac AMR was published in January by Patrick Bruneval and colleagues in AJT, and is an excellent read for those wishing to see where we are going from here (https://www.ncbi.nlm.nih.gov/pubmed/27862968).

For those of you who missed it, Dr. Levine and colleagues in the ISHLT Pulmonary AMR Working Group (including several members of our Council) published a much-needed and long-awaited consensus definition for pulmonary AMR a few months ago, including degrees of diagnostic certainty and incorporating clinical, serologic, and histologic features into the definition (https://www.ncbi.nlm.nih.gov/pubmed/27044531). This publication also includes a very useful online supplement that outlines current research priorities, many of which are being actively investigated by members of our Council. Hopefully these problems will also prompt you to join the effort! Stay tuned for updates, and we look forward to seeing many of you at the Annual Meeting next month so we can coordinate these efforts and push forward.

Members of the Pathology Council also 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, including online quiz components, on cardiac ACR and AMR for pathologists in partnership with the Society for Cardiovascular Pathology and Association for European Cardiovascular Pathology (http://scvp.net/acr/index.html). Pulmonary pathologists have also begun to develop online tools to aid pathologists in interpretation of lung transplant biopsies. In the last year, our European colleagues led by 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. If you encounter good examples of diagnostic grades of rejection or other entities in lung transplant pathology that could be included in this online resource, please contact Fiorella Calabrese at fiorella.calabresse@unipd.it. Both of these online resources continue to be well received, but suggestions for improvement are welcome.

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. We 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.

2017 Annual Meeting & Scientific Sessions in San Diego, CA.

Perhaps the most important news related to the upcoming Annual Meeting in 2017 for busy pathologists is a change in the format of the Annual Meeting. Beginning with this meeting, program content relevant to the Pathology Council will be clustered into a single day (Friday, April 7), instead of being distributed throughout the entire meeting over several days. Hopefully this concentration of program content will shorten the time away from our practices and allow more of our members to attend. Please spread the news to your pathology colleagues, especially the ones who may have been interested in the past but couldn't attend due to time constraints. In any case, you don't want to miss our exciting pathology-oriented sessions in San Diego next month.

For more details about the upcoming Annual Meeting and the official program of scheduled events, please check the ISHLT website at http://www.ishlt.org/meetings/annualMeeting.asp.

See you in San Diego! ■

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

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