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!