Development and Distribution of Transplant Pathology Utilizing Internet and Imaging Tools Experience

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Development and Distribution of Transplant
Pathology Utilizing Internet and Imaging
ToolsExperience with TPIS, Banff Working Group,
ISMETT, and Immune Tolerance Network

• A.J. Demetris, M.D.

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Transplant Pathology

• Clinical and anatomic pathology services to
  potential and actual donors and recipients of
  organ allografts.
• Experience/training in immunology, and
  inflammatory and organ-specific (e.g. kidney,
  liver, lung, etc.) pathology highly desirable.

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An Evolving Approach
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Creation of a CommunityTransplant Pathology
Internet Services Originshttp//tpis.upmc.edu/

• Initiative to make Transplant Pathology material
  freely available via WWW undertaken in 1996 with
  seed funding from CAP Foundation Scholars Program
• Original goal - to educate physician
  pathologists and emphasize collaborative efforts
  among academic institutions
• Original setup - static HTML based on 480 MHz
  UNIX server

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TPIS Main Clinical Components

• Didactic areas
• 8 sections focusing on transplant pathology of
  heart, kidney, liver, lung, pancreas, small
  bowel, PTLD, and immunobiology
• Grading Systems
• 25 transplant-related grading systems for
  rejection and other disease (e.g., hepatitis,
  PTLD)
• Consult Case area containing over 100 annotated
  pathology cases
• Case Conference area for interactive case
  presentation and discussion, also contains gt100
  cases
• Macroscopic and Ultrastructural Pathology areas
  for liver, kidney
• Full textbook Diagnostic Liver Pathology (Lee,
  RG)
• Matchmaker Program for specialized HLA matching

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TPIS Recent Status

• Prior year site statistics
• 3,772,679 hits with 99.3 gigabytes of data
  transferred
• 41.3 of transfers represent image data
• Case Conference most visited individual link,
  accounting for 3.53 of activity
• Activity steady at approx. 300,000 hits/month
  except in May when site was down for HIPAA
  compliance evaluation.
• Google search on Transplant Pathology returns
  TPIS first (of 1,840,000), showing strong usage
  and correlation for intended audience

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TPIS Recent Developments

• TPIS completing planned upgrade that will be
  publicly released in near future
• Entire site rewritten to convert from static html
  and .cgi scripting to JAVA J2EE based .jsp and
  servlet technology
• This will modernize look and feel and allow for
  more dynamic content
• First example infrastructure installed to
  provide whole slide digital imaging of
  transplant-related slides
• Conversion of correlative slides for various
  grading systems will be integrated first Slide
  repositories for multicenter studies also planned

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Creation of an Algorithm of System
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Accessing the Warehouse
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The Power to Explore
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One Patient per Record per TransplantObject
Layers (J. McMichaels)
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HCV RNA vs Time after Txaccording to path
diagnosis
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ISMETTMediterranean Institute for
Transplantation and Advanced Specialized Therapies

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http//www.immunetolerance.org
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Immune Tolerance Network Sites
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Overview Comparisons
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Typical Findings
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Nuclear Area Measurements/Statistics
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Liver Ageing by Nuclear Morphometrics
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Telomere Area AnalysisTelometer Plugin for
ImageJ (John Hopkins Univ.)
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Creation of a Community Resource
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Integrated Attributes
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Centers Participating in Transplant Telepathology
Consortium
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Acknowledgements

• UPMC DSI, ISD, Pathology Informatics,
  Administration
• TPIS administration and support staff
• Banff Working Group on Liver Allograft Pathology
• ISMETT faculty and administration
• ITN NIH and Juvenile Diabetes Foundation

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Conclusions

• The internet and use of imaging and digital
  pathology tools have greatly facilitated the
  development and advancement of transplant
  pathology.
• The best is yet to come!
• Evolution of pathology from a subjective to
  objective discipline
• Whole slide registries of interesting and
  valuable cases
• Data harvesting from multi-center studies