Division of Transplantation and Hepatic Pathology

Mission Statement

Lymphoplasmacytic inflammation in focal nodular hyperplasia lesions of the liver
Lymphoplasmacytic inflammation in focal nodular hyperplasia lesions of the liver

The Division of Transplantation Pathology is an integral part of the comprehensive transplant program at the University of Pittsburgh Medical Center. Its mission is to provide up-to-date laboratory services emphasizing continued excellence in patient care, to foster an academic environment devoted to education and training, and to conduct basic and clinically oriented research in transplantation pathology. A nucleus of experienced professionals with expertise in pathology, immunology and molecular biology is actively involved in many transplantation related research projects at the Medical Center.

The Division of Transplantation and Hepatic Pathology at the University of Pittsburgh Medical Center provides broad-based and skilled pathology support for the Thomas E. Starzl Transplantation Institute and the Division of Gastroenterology, Hepatology and Nutrition of the Department of Medicine. All aspects of Transplantation Pathology and native liver disease are covered by our Division as part of our service mission and the trainee will receive intensive exposure to a variety of conditions that occur in both the transplant and non-transplant setting. Our educational mission includes training of residents, fellows and visiting pathologists by individual case discussion, conferences, teaching sets, handout material, and web-based educational material.

The Divisional staff have developed or co-developed a number of the classification systems in present use in Transplantation Pathology, and are recognized authorities in this field. Exposure to the largest collection of transplant-related case material in the world provides a foundation for education, and close clinical interactions on a daily basis provide a contextual framework from which the trainee can gain confidence in the role of the transplant pathologist as both a diagnostic physician and a clinical consultant. We have active consultation and teleconsultation services and use these to supplement our basic educational objectives. Our research mission centers on issues that arise, either directly or indirectly, from developments in the field of Transplantation.

All members of the Division are engaged in research, covering topics such as bile duct regeneration and neoplasia, polyoma virus infection in immunosuppressed individuals, organ preservation, xenotransplantation, HLA analysis, and posttransplant lymphomas. Trainees are encouraged to discuss these topics with staff pathologists and to explore possible shared interests.

Clinical Laboratory Services

The Division offers a wide range of laboratory tests and tissue analyses for patients and for experimental studies. Routine histology, immunocytochemistry and in situ hybridization are performed on tissues and fine needle aspirates from patients under consideration for transplantation, native organ resections and post-transplant biopsies. These procedures assure consistency of analysis and continuity of patient care. Post-transplant monitoring assays deal with lymphocyte reactivity and cytokine production and on detection of cytomegalovirus, Epstein-Barr virus, and hepatitis viruses. Procedures for fine needle aspiration analysis have been added to post-transplant immunologic monitoring.

The Tissue Typing Laboratory operates with Central Laboratory Services, Inc., and serves UPMC-HS affiliated hospitals and Children's Hospital of Pittsburgh. These facilities use serologically and molecularly based HLA typing methodologies to gauge donor-recipient compatibility in both solid organ and bone marrow transplantation. Considerable emphasis is placed on the detection and specificity analysis of alloantibodies in sensitized transplant candidates to identify potential donors with suitable HLA types.

Training and Teaching Activities

The Division is strongly devoted to teaching and training in transplantation pathology. Its professional staff directs postdoctoral fellows, graduate students and medical students in various aspects of molecular immunogenetics, transplantation biology and clinical care. Many visitors visit the Division for further training in transplant pathology. An elective three-month rotation program is offered to pathology residents interested in acquiring a basic understanding of the molecular and cellular mechanisms of transplant immunity, allograft rejection, opportunistic infections, organ preservation injury, recurrent disease, drug toxicity, graft versus host disease and lymphoproliferative disease. Special emphasis is placed on the application of modern technologies including flow cytometry, immunostaining, in situ hybridization, gene transcription by polymerase chain reaction and molecular testing for genetic polymorphisms. The Division conducts five weekly conferences on heart, kidney, liver and intestinal transplant pathology and native liver pathology. Another conference in conjunction with Transplant Surgery deals with liver transplant tumors. A weekly Transplant Grand Rounds was initiated this year. A basic research conference is held each week.

Research Activities

Electron microscopy showing polyomavirus BK being excreted in urine
Electron microscopy showing polyomavirus BK being excreted in urine

The Division has a strong commitment to research in transplantation. The faculty is actively engaged in research projects frequently in collaboration with members of other departments, in particular, Transplant Surgery. Current research activities deal with a variety of projects, including:

  • dendritic cells in microchimerism after organ transplantation and tolerance induction
  • cytokine-induced activation of biliary epithelium
  • immune mechanisms of chronic vasculopathy
  • stress proteins in transplant immunity
  • histocompatibility and liver transplant outcome
  • transplantation of highly sensitized patients
  • immune profiles in bronchoalveolar lavages from lung transplant patients during CMV and bronchiolitis obliterans
  • cellular immunity and treatment of post-transplant lymphoproliferative disease.
  • mechanisms of small intestinal transplant rejection

Transplant Pathology Research Services Laboratory

The Transplant Pathology Research Services (TPRS) Laboratory is located in the Thomas E. Starzl Biomedical Science Tower at the University of Pittsburgh. Our goal is to provide routine and specialized histology, single and multiplex immunohistochemistry, high resolution digital imaging, image analysis services, and digital spatial profiling to principal investigators and researchers throughout the University and in the external biomedical community. We operate in a collaborative manner focusing on transplant specific projects.

The TPRS lab serves as the Core Liver and Kidney Laboratory for the Immune Tolerance Network (ITN) and multiple corporate sponsored clinical trials, providing histology services for ongoing clinical patient research studies throughout the world. 

We are certified through the College of American Pathologists (CAP's) Laboratory Accreditation Program and maintain Clinical Laboratory Improvement Amendments (CLIA) standards as administered by the Centers for Medicare & Medicaid Services (CMS).

Telepathology and Internet Resources

The Division runs a telepathology consultation service for the transplantation program at Istituto Mediterra-neo per i Trapianti e Terapie ad Alta Specializzazione (IsMeTT), in Palermo, Sicily. Additionally, the Division maintains an interactive Internet site called Transplant Pathology Internet Services (TPIS). TPIS is a dynamic, Web-based, collaborative tool for transplant physicians, and an educational resource for health care professionals in the field of Transplantation Medicine. The URL for this resource is: http://tpis.upmc.com