transplants

Hi everyone, today I would like to discuss the role of pathology in the field of transplant medicine.

Specifically, I want to hone in on one of the most common solid organ transplant procedure performed - kidney, with possible simultaneous pancreas or pancreatic islet cell transplant. For anyone curious about this topic, I suggest Leiden University's Clinical Kidney, Pancreas and Islet Transplantation on Coursera. I've been slowly working my way through this course and can say that it has been extremely rewarding.

A major role of the clinical lab before such a transplant is to determine suitability of potential donor candidates to the recipient by finding out (1) the human leukocyte antigen subtypes and (2) antibodies. Here, clinical pathologists might serve in an advisory role.

During and after the operation, surgical pathologists may be involved in assessment of the viability of harvested tissue, gross examination of the explant, and determination of the type and severity of rejection if it occurs post-transplant. There are many histologic findings depending on the type of rejection, and in which organ. For example, here is a video on PathCast which shows histology of liver transplant. And here is a webisode from the Wustl series on renal transplant. These are good starting points for individual study.

This week, I watched Mixed Match, a hour-long documentary which delves into the complexities of finding HLA-compatible bone marrow transplant donor for people of mixed ethic heritage. It can be watched here, however you have to use a VPN to set your country's location to Canada. The bonus scenes (which can be accessed at the movie/production site) show the process of stem cell donation and cord blood banking from newborns.

Here is an open access article that discusses HLA in more detail.
Figure 6 talks about how HLA is genetically inherited.
Human Leucocyte Antigen (HLA) System in Solid Organ Transplantation and Few Novel Concepts on HLA Matching

These ideas are fascinating to me overall...

Please share your thoughts/comments below!

Online Resources

For the past few weeks, I have been spending my Wednesday mornings in nephrology outpatient clinic at unnamed academic medical center, in order to fulfill the 'longitudinal clinical experience' requirement of getting through medical school. Because of this exposure, I find myself more interested in renal pathology.

I stumbled upon a wonderful resource, the Washington University in St. Louis Nephrology Web Series, created by Timothy Yau, M.D. which is a YouTube series of webisodes that discuss aspects of physiology, history, and pathology related to the kidney. Many of them involve a renal pathologist and nephrology fellow collaboratively interpreting kidney biopsy images. While watching his videos, I came across an online textbook which helped me understand some of the finer points of renal physiology. Another for those interested in nephropathology is Arkana lab's Blog. Another site is NephSim, a website which is also mobile phone compatible. Also AJKD's cases.

Now that I am on the topic of youtube and pathology, I would like to list channels and videos that I personally have found helpful/entertaining.

pathCast - pathology experts from a variety of institutions
Cleveland Clinic Laboratories - Pathology Insights series
Jerad Gardner - dermato- and soft tissue pathologist involved in social media
Mount Sinai Department of Pathology - didactics that are streamed

Websites:

PathologyOutlines - outlines in bullet point form
Board Review Pathology - navigate by changing the last number (1 to 2648)
International Society of Urological Pathologists - access imagebase/cases with an account
Bethesda System for Cervical Cytopathology - helpful for cervical cytology

Honorable mention:
Video
DermPro DermPath - compilation of derm spotters
UAMS Pathophysiology - from the very basic to beyond
Web Pathology - pictures with detailed explanations
Libre Pathology - aims to be Wikipedia for pathology (some pages not filled in)
Clinical Key - if your institution has a subscription, you can read pathology books for free!
ImmunoQuery - helps you rule in / out diagnoses based on IHC (my home institution does not have a subscription).

Share your resources in the comments below!

First Post

Hi readers! This is my first blog post.

What I hope to accomplish:
- review topics that interest me
- share resources (online, print)
- discuss guidelines

My ultimate goal for this blog is to generate curiosity about pathology as a medical specialty. My personal goal is to continue to stay motivated towards my goal of becoming a pathologist while in medical school. I hope reading this blog will be entertaining and helpful no matter where you are in your education/training.