Members of the University of Rochester Medical Center’s Department of Pathology & Laboratory Medicine will join thousands of pathologists from across the globe to present abstracts at the 2018 meeting of the United States and Canadian Academy of Pathology (USCAP).
The meeting, which is the largest of its kind in the world, will be held March 17-23 in Vancouver, BC, Canada. Below is a schedule of events that include URMC faculty and residents. In addition to presenting research, we are pleased to again host a cocktail reception for alumni and friends at the conference on Monday, March 19 (details below). All are welcome!
For general USCAP meeting information, please visit their website.
PP – Pan Pacific Vancouver
FW – Fairmont Waterfront
FPR – Fairmont Pacific Rim
PH – Pinnacle Hotel Harbourfront
SUNDAY, MARCH 18, 2018
University of Rochester Fellowship Fair
5:30 - 7:30 PM
Table #4, VCC West Ballroom D
MONDAY, MARCH 19, 2018
8:00 AM - 12:00 PM
Real Time Cytopathology Feedback (RTCF) versus traditional Rapid On-Site Evaluation (ROSE) for Endobronchial Ultrasound Guided Fine-Needle Aspiration (EBUS-FNA) of mediastinal lymph nodes (MLN). Alexandra Danakas, Carolyn E Jones, John Plavnicky, Christian G Peyre, Sierra Kovar, Joseph J Wizorek, Mary Beth Kearns, Donna Russell, Shawn Evans, Luis De Las Casas.
HIV Enteropathy: Real or Myth? A Histologic Review. ILKe Nalbantoglu1, Raul S Gonzalez.
Poster Session I
9:30 AM - 12:00 PM
74 Significance of Clinicopathologic Parameters, Including Margin Distance and Tumor Budding, on Local Disease Recurrence Following Esophageal Endoscopic Mucosal Resection. Phoenix Bell, ILKe Nalbantoglu, Justin Cates, Raul S Gonzalez.
85 Perineal Carcinoma Cuniculatum: Histology Review of 38 Cases. Dongwei Zhang, Raul S Gonzalez, Michael Feely, Hwajeong Lee, Kavita Umrau, Daniela Allende, Dipti Karamchandani, Michael P Zaleski, Jingmei Lin, Maria Westerhoff, Xuchen Zhang, Lindsay Alpert, Jinping Lai, Xiuli Liu.
171 NKX3.1 Expression in Salivary Gland Neoplasms: A Marker for Mucinous Differentiation and a Potential Diagnostic Pitfall. Anna-Karoline Israel, Abberly Lott Limbach.
273 Extent of Lesional Cell Spread in Hepatic Epithelioid Hemangioendothelioma: Implications for the Diagnosis in Minimal Samples. Diana Agostini-Vulaj, Burcin Pehlivanoglu, Sharon Weiss, Alyssa Krasinskas, Michael Feely, Jason L Hornick5, Justin Cates, N. Volkan Adsay, Raul S Gonzalez.
1:00 PM - 3:00 PM
Moderators:Timothy D'Alfonso and Megan Troxell
Room: VCC West 211
A Novel Detection Methodology for HER2 Protein Quantitation in Clinical Samples: Correlation with Pathologic Response to Trastuzumab-Based Neoadjuvant Therapy. Bradley M. Turner, Brandon Buscaglia, Hideki Goda, Loralee Mcmahon, Takako Natori, Hisatake Okada, Armen Soukiazian, Yasushi Nakano, David Hicks.
Moderators:Tracy George and Annette Kim
Room: VCC West 208 - 209
Microarray CGH-SNP Analysis Detects Frequent Chromosomal Abnormalities Indicating Clonal Cytopenia(s) in Patients With Indeterminate Bone Marrow Dysplasia - An Institutional Study Of 94 Cases. Nisha Patel, Michelle Pitch, Andrew G Evans, M. Anwar Iqbal.
Moderators: Dhanpat Jain and Lei Zhao
Room: VCC West 224
Does ASS1 Immunohistochemistry Predict an Increased Risk of Hemorrhage in Hepatocellular Adenomas? Heidi Lehrke, Taofic Mounajjed, Raul S Gonzalez, Riyam T Zreik, Laura J Denham, Rory Smoot, Daniela Allende, Bita V Naini, Roger K Moreira, Rondell Graham.
Poster Session II
1:00 PM - 4:30 PM
123 Immunohistochemistry of Androgen Receptor and Related Signaling Pathways in Bladder Cancer as Prognosticators. Satoshi Inoue, Taichi Mizushima, Hiroki Ide, Takashi Kawahara, Guiyang Jiang, George J Netto, Hiroshi Miyamoto.
191 Acinic Cell Carcinoma of Salivary Gland Expresses Low Levels of PD-L1 with Retained MMR Proteins: A Potential Biomarker for Therapy. Abberly Lott Limbach.
How to Get Started and Succeed in Academics: Mistakes We Made and What We Wish We’d Known on Day One
Room: VCC WEST 302-304
- Raul S. Gonzalez, MD, University of Rochester Medical Center, Rochester, NY
- Rondell P. Graham, MBBS, Mayo Clinic, Rochester, MN
- Laura W. Lamps, MD, University of Michigan Hospitals, Ann Arbor, MI
- Rhonda K. Yantiss, MD, Weill Cornell Medical College, New York, NY
Description: Making the leap from training to a career in academic medicine is daunting for many pathology residents and fellows. As there are few resources specifically devoted to transitioning from pathology training to academic practice, this Special Course would offer trainees and new academic attendings an in-depth look at the first 1-5 years of academic practice. Through the experience of the faculty, participants will hear about mistakes made along the way, lessons learned in areas where there is little formal training, and strategies that have led to successes. The program will discuss useful approaches to securing an academic position, tips, and pitfalls for the first year, and positioning oneself for academic promotion. The program will also discuss how to develop an early career research program, balancing academic activity and clinical work, and avoiding burnout.
University of Rochester Medical Center Alumni Reception
5:30 - 7:30 PM
Room: Fairmont Waterfront, MacKenzie Rm. II
No RSVP required, all are welcome!
TUESDAY, MARCH 20
Poster Session III
9:30 AM - 12:00 PM
101 Should Ki67 Immunohistochemistry Be Performed on All Lesions in Multifocal Small Intestinal Neuroendocrine Tumors? Numbereye Numbere, Aaron Huber, Chanjuan Shi, Justin Cates, Raul S Gonzalez
104 Mesenteric Tumor Deposits Arising from Small Intestinal Neuroendocrine Tumors are Frequently Associated with Sclerosis and IgG4-Expressing Plasma Cells. Jordan Andrew Roberts, Raul S Gonzalez, Frank Revetta, Chanjuan Shi.
117 Clinical Outcome of Perineal Carcinoma Cuniculatum in a Cohort of 38 Cases. Dongwei Zhang, Raul S Gonzalez, Michael Feely, Kavita Umrau, Hwajeong Lee, Daniela Allende, Dipti Karamchandani, Michael P Zaleski, Jingmei Lin, Maria Westerhoff, Xuchen Zhang, Lindsay Alpert, Jinping Lai, Xiuli Liu.
154 Liver Histology in Septic Patients: Is It All About Ductular Cholestasis? Caroline Bsirini, Raul S Gonzalez.
1:00 PM - 2:45 PM
Moderators: Deepti Dhall and Laura Lamps
Room: Vancouver Convention Centre West 224
Mesenteric Tumor Deposit Number, But Not Size, Affects Prognosis of Patients with Small Intestinal Well- Differentiated Neuroendocrine Tumors. Raul S Gonzalez, Justin Cates, Chanjuan Shi.
Poster Session IV
1:00 PM - 4:30 PM
40 Quantitative Measurement of Human Epidermal Growth Factor Receptor-2 (HER2) Protein Expression in ‘Classical’ and ‘Non-Classical’ FISH Categories: A Comparative Study. Jian Shen, Brandon Buscaglia, Hideki Goda, Bradley M. Turner, Hisatake Okada, Loralee Mcmahon, Jill Henry, Yasushi Nakano, David Hicks.
102 Lymphocytic Esophagitis in Adult Crohn’s Disease is Characterized by Younger Age, Lower Incidence of Reflux Symptoms, and a CD4 Predominant Infiltrate. Elizabeth Yiru Wu, Deepa T Patil, Michael Drage, Amitabh Srivastava.
116 What Remains of Appendiceal Adenocarcinoma After LAMN and Goblet Cell Neoplasms are Excluded? Raul S Gonzalez, Joseph Misdraji, Rhonda Yantiss
132 Clinicopathologic Analysis of Benign Lipomatous Lesions of the Colon. Sam L Barron, Raul S Gonzalez
136 Interobserver agreement in the diagnosis of anal dysplasia. Sohaib Abu-Farsakh, Michael Drage, Aaron Huber, Bradley M. Turner, Sharlin Varghese, Xi Wang, Christa Whitney- Miller, Raul S Gonzalez.
150 Significance of Method of Lymph Node Involvement in Pancreatic Ductal Adenocarcinoma. Diana Agostini-Vulaj, Justin Cates, Richard Dunne, Raul S Gonzalez.
151 Low Union (Lower Insertion of Cystic Duct into Common Hepatic Duct) as a Major Etiologic Factor in the Development of Pancreatic, Distal Bile Duct and Ampullary Cancers: An analysis of 860 pancreatobiliary resections. Takashi Muraki, Michelle Reid, Raul S Gonzalez, Aarti Sekhar, Bahar Memis, Burcin Pehlivanoglu, Yue Xue, Pardeep Mittal, Juan M Sarmiento, David Kooby, Shishir Maithel, Ken Cardona, Bassel El-Rayes, Alyssa Krasinskas, Gwen Lomberk, Raul Urrutia, Kathleen K Christians, Susan Tsai, Douglas Evans, N. Volkan Adsay, Alpharetta.
162 Loss of ARID1A Expression Predicts Worse Overall Survival in Patients with Resected Pancreatic Adenocarcinoma and Is Associated with Inactivating Mutations of the ARID1A Gene. Annacarolina da Silva, Vicente Morales-Oyarvide, Douglas A Rubinson, Margaret M Kozak, Wenjia Wang, Diana Agostini-Vulaj, Aaron Huber, Daniel T Chang, Thomas E Clancy, Aram F Hezel, Shuji Ogino, Brian M Wolpin, Jonathan A Nowak.
202 Clinical Significance of Perivesical Lymph Node Metastasis in Radical Cystectomy for Bladder Cancer. Meenal Sharma, Jerome Jean-Gilles, Hiroshi Miyamoto.
261 AID-Generated Acquired IGH Glycosylation Sites but Not Somatic Hypermutation Rate Differentiate Low-grade versus High-grade Follicular Lymphoma. Chad Hudson, Janice Spence, Diana G Adlowitz, Richard Burack.
262 Increased AID-Generated Acquired Glycosylation Sites in Diffuse Large B-cell Lymphomas with IGH-BCL2 and CD10 Expression. Chad Hudson, Janice Spence, Diana G Adlowitz, Madalynn Bryant, Richard Burack.
277 Unexpectedly High Prevalence of Cystoisospora belli in Acalculous Gallbladders of Younger Patients. Mushal Noor, Christa Whitney-Miller, Laura W Lamps, Raul S Gonzalez, Aaron Huber, Jennifer J Findeis-Hosey, Zhongren (David) Zhou, Lawrence J Saubermann, Rebecca L Abell, Philip J Katzman, Michael Drage.
WEDNESDAY, MARCH 21
Poster Session V
9:30 AM - 12:00 PM
103 Relationships Among Histologic Characteristics, Molecular Phenotypes, and Patient Outcomes in Mucinous Colorectal Carcinoma. Raul S Gonzalez, Justin Cates, Mary Kay Washington.
149 Evaluation of Histologic Changes in the Livers of Patients With Early and Late Hepatic Artery Thrombosis. Michael J Lee, Raul S Gonzalez.
243 Autoimmune Disease and Lymphoma: A Method for Large Scale Search of the Electronic Medical Record Enables Correlation of Clinical Parameters with Type and Risk of Lymphoproliferative Disease. Genevieve M Crane, Amy Duffield.
265 Next Generation Sequencing-Assays Detect B-Lymphocyte Clonality in Formalin-Fixed Paraffin Embedded Specimens of Classical Hodgkin Lymphoma without Microdissection. Cynthia Reyes Barron, Andrew Campbell, Paul G Rothberg, Richard Burack, Yi Ding DING4 1University of Rochester Medical Center, Victor, NY, 2University of Rochester Medical Center, 3University of Rochester, Rochester, NY, 4University of Rochester Medical Center, Rochester, NY
350 Is the Rate of Frozen Section Discordance Affected by Subspecialty Sign Out? Joseph H Blitman, Brandon Buscaglia, Christa Whitney- Miller, David Hicks, Aaron Huber.
Poster Session VI
1:00 PM - 4:00 PM
162 MCM7 Expression Correlates With Tumor Size and Ki67 Index in Well-Differentiated Small Intestinal Neuroendocrine Tumors. Zhongren (David) Zhou, Numbereye Numbere, Aaron Huber, Chanjuan Shi, Raul S Gonzalez.
167 Expression of TIM3 (CD366) and LAG3 (CD223) in Colorectal Carcinoma-associated Inflammatory Infiltrate Suggest Novel Therapeutic Targets for Immune Checkpoint Blockade. Michael Drage, Max Klapholz, Ana C Anderson, Amitabh Srivastava.
280 L1 CAM – A Potential Biomarker for Recurrent and Aggressive Endometrial Carcinoma. Ioana Moisini, James R Richter, Tanya Pulver, Raphael Hellwegg, Boris Winterhoff, Molly Klein.
318 Lack of MUM1 Expression Characterizes B-Lymphoblastic Leukemia/Lymphoma. Chad Hudson, Roula Katerji, Richard Burack.
THURSDAY, MARCH 22
7:30 PM – 9:30 PM
Secrets from the Consult Files: Puzzling Cases Solved Piece by Piece
Room: VCC WEST 301-305
Moderator: Michael Torbenson, MD, Mayo Clinic, Rochester, MN
- Maria Westerhoff, MD, University of Michigan, Ann Arbor, MI
- Tom Smyrk, MD, Mayo Clinic Rochester, MN
- ILKe Nalbantoglu, MD, Yale University, New Haven, CT
- Raul Gonzalez, MD, University of Rochester Medical Center, Rochester, NY
- Oyedele (Dele) Adeyi, MD, University of Toronto, ON, Canada
Nearly five months have passed since Hurricane Maria struck the island of Dominica, yet most of its residents still can’t turn their lights on.
Joan Polidore, who lives on the island in the Eastern Caribbean, recently visited Rochester. Her daughter, Julia Polidore, is a URMC Pathology employee who coordinated a collection drive to send food and supplies to their home country.
Joan and her husband are pastors who have opened the doors of their churches to provide shelter and resources to their neighbors. Dominica, which already had widespread poverty, was set back even further by the devastation.
“The people are very stressed,” she said. “Some have lost everything and some have lost family members. Many still don’t have housing.”
Schools have not reopened since the storm, forcing some students to relocate to neighboring islands or the United Kingdom to attend school. To help local children, Joan hosts some group activities like arts and crafts at church during the week.
The country's infrastructure remains in a state of crisis. Clean water is available, but crews are still working to restore power to residential areas. This is complicated by the fact that most people live inland in mountainous regions inland, and government buildings, hospitals, and businesses take priority when it comes to having the electricity turned back on.
These struggles were more widely publicized after the storm hit, but awareness has diminished in the months since. Julia Polidore is continuing to collect funds and non-perishables to help in the rebuilding effort.
The initial outpouring of support from Rochester (13 shipping barrels full of food and supplies) was extremely appreciated, but the goods were used up almost as soon as they arrived. That’s why Julia says the effort to support Dominica must continue.
“It’s not in the headlines anymore, but the aftermath is the challenging piece,” she said. “There is not as much attention given to how they’re picking up the pieces. We have to give them hope that people care and won’t leave them hanging."
Joan agrees. The roof of her home was torn off by the hurricane (which has since been repaired) yet she sees others with greater needs, and continues to look for ways to help. She regularly uses her experience as a retired counselor to listen to those who are struggling and encourage them during this difficult time.
“Brighter days are coming, so we live in hope,” she said.
How to Give
Financial gifts can be made online via the following link: Hurricane Relief Effort for Dominica W.I. (YouCaring). Donated items may also be brought in person to either of the following locations:
- Center for Community Health & Prevention
46 Prince St., Rochester, NY
- 1199 Service Employees International Union
259 Monroe Ave., Rochester, NY
- Canned Goods (chicken, tuna, beef)
- Rice/Macaroni Products
- Dry Milk/Juice Mix
- Dry cereal/Oatmeal
- Flour, Sugar, Salt
- Oil, Lemon Juice
- Bottled Water
- Water Filters
- Generators/Commercial Tents
- School Supplies
- Bedding (sheets, mattresses, etc.)
About James Musser, MD, PhD
Career – Joined Baylor College of Medicine and Houston Methodist Hospital (1991-99). He then led the Laboratory of Human Bacterial Pathogenesis for the National Institute of Allergy and Infectious Diseases, NIH, at Rocky Mountain Laboratories in Montana (99-03), and returned to Texas to work at Houston Methodist Hospital and Research Institute (2004-present).
Current - At Houston Methodist Hospital he is the Fondren Presidential Distinguished Endowed Chair, Chair of the Department of Pathology and Genomic Medicine, and Director, Center for Molecular and Translational Human Institute.
Hometown – Originally from Bellefonte, PA and now lives in Houston, TX.
Family – Wife, Dr. Camille Leugers, a family physician (also a University of Rochester graduate and former resident). They have two daughters, Sophie, 23, and Grace, 23, and one dog, Biscuit.
Education – Earned his MD, PhD from University of Rochester (1988). He spent the following year doing a postdoctoral fellowship at Penn State University, continuing research on bacterial pathogenesis and population genetics with Robert K. Selander, previously of the UR Department of Biology. His residency training was at the Hospital of the University of Pennsylvania.
Dr. James Musser is a distinguished pathologist who got his start at the University of Rochester as a medical student. To this day, he is quick to give credit to the University for putting him on the right career path.
“One of the crucial themes in my career—and I really think in large part it is because of the University of Rochester—has been the desire to work across traditional academic boundaries to weave together seemingly disparate biomedical research areas,” he said.
His laboratory uses molecular pathology, microbial pathogenesis, and population genomics in its approach to important infectious disease problems. Chief among these problems is Group A Streptococcus, the culprit behind strep throat and so-called “flesh-eating” disease (necrotizing fasciitis).
There is currently no licensed vaccine for Group A Strep, which can lead to life threatening illnesses if left untreated. The World Health Organization reports that 700 million cases of infections are caused by the pathogen every year worldwide. These range from common infections like strep throat to more severe infections like necrotizing fasciitis or rheumatic fever.
Musser has devoted much of his career to understanding how Group A Strep causes human infections at the molecular level. He and his research colleagues aim to lay the groundwork for a licensed vaccine for strep throat and its more serious iterations. This is easier said than done.
Group A Strep has many genetic variations that Musser likens to different makes and models of cars; there are different kinds of Fords or Toyotas, and each is built differently. And in the same way some models can go faster than others, the Group A Strep pathogen contains different combinations of genes that allow more severe diseases to spring forth under certain conditions. These genetic varieties have made it difficult for a reliable vaccine to be developed despite decades of research.
“We have a lot of unfinished business,” Musser said. “We still really need to understand all aspects of how the organism causes human epidemics. These are long term problems that are likely to persist well into the future.”
Musser’s early career began at Baylor College of Medicine and Methodist Hospital in Houston, where he moved up through the traditional academic ranks from assistant to full professor. In 1999 he was hired by the NIH’s National Institute of Allergy and Infectious Diseases (NIAID). There, he was tasked with significantly upgrading and developing new areas of research at Rocky Mountain Laboratories, in Hamilton, MT.
One of his contributions at RML was the introduction of genome-scale investigative strategies and helping to plan a biosafety level 4 laboratory, a so called “hot zone” laboratory.” This Integrated Research Facility houses scientists that study infectious microbes with the goal of finding new ways to treat diseases like ebola, zika, flu strains, and so forth.
Musser resumed working for the 8-hospital Houston Methodist Health System in 2004 where he wears many hats. As chair of Pathology and Genomic Medicine, he divides his time between clinical responsibilities, research, and overseeing a department of 65 faculty.
“Everyone is very busy in academic medicine these days,” he said of his workload. “I don’t think that I’m doing anything especially unique in that regard.”
He was first drawn to the UR because of its signature biopsychosocial model of disease.
“I knew that the UR was the right place for me because it had its head on right about how medical students should be taught, and emphasized the critical importance of biopsychosocial factors in human illness and daily interactions,” said Musser.
UR is also where he met his future wife, Dr. Camille Leugers, and the two remain active in the UR alumni organization in Houston, recently hosting 35 UR graduates at their home.
Musser has returned to the UR since walking the halls as a student. He recently came back to give the Whipple lecture, named after the Medical Center founder and Nobel Prize-winning pathologist. He was also bestowed the Rous-Whipple Award by American Society for Investigative Pathology. This award, whose name is also a nod to his alma mater, is given to a scientist who has worked to advance the understanding of disease.
Looking back, Musser is thankful for the many mentors he encountered at UR along the way, including Ron Yasbin (Microbiology), Marilyn Menegus (Pathology), Bernard Panner (Pathology), and Frank Young (Dean of the School of Medicine), to name a few.
“I believe there are mentors all around us,” he said. “I firmly believe that if we talk less and listen more, they will appear.”
We recently caught up with Dr. Brooke Koltz, a former Pathology resident at the University of Rochester (2008-2012) and Cytopathology fellow (2012-2013).
After training and working in Rochester, she and her family moved to the Philadelphia, PA area for a year and recently moved to Perrysburg, OH, near Toledo. This is a homecoming of sorts for Koltz, who grew up in nearby Whitehouse, OH.
She will start a new role this month at the University of Toledo Medical Center (where she also attended medical school). Her clinical responsibilities will include surgical pathology, cytopathology, and resident education. Here, she shares more about the experiences that led her to this moment in her career.
Tell us about your family.
I am married to Peter Koltz, who was also a resident at University of Rochester in Plastic and Reconstructive Surgery. We have four children, Eleanora (9), Henry (7), Cecilia (4), and Simon (2).
What first sparked your interest in pathology?
I went into medical school thinking I would become an emergency medicine physician, but I am so glad that I didn’t. I was one of those rare students that was fascinated by histology and pathology labs in the first and second year of medical school.
Even so, I was still set in pursuing clinical medicine until I took an elective pathology rotation on a whim late in my third year. In about a week, my whole outlook changed. As I sat across the multi-headed scope from the attendings and residents, I realized that what they did was ‘medicine’ to me. From then on I pursued a career in pathology. So far, I have no regrets.
When you look back on your time here, is there a particular person or experience that made a great impact on you professionally or personally?
The entire Cytopathology department had an impact on me both professionally and personally. Not only did the department educate me and prepare me for my future career, but I truly enjoyed being a small part of the talented team for a few years.
I often find myself repeating things that Dr. Giampoli, Dr. Zhou, and Dr. Yao taught me when I sit down with residents. The entire team of cytotechnologists, including Donna Russell, Mary Ann Rutkowski, and Michael Facik, accepted me into their offices, the occasional inside joke, and gave me the benefit of their years of experience and knowledge. I couldn’t have asked for a better fellowship.
Aside from the Cytopathology department, many of the surgical pathology attendings, especially Dr. Hicks and Dr. Whitney-Miller, encouraged me and gave me a solid experience to pursue my career goals. My co-residents were fun and supportive as well. There are too many people to name, but I appreciated my time in Rochester and felt that I received a positive educational and personal experience.
How do you like to spend your free time? Do you have any hobbies/interests?
Like most mothers, my free time is often spent chasing my kids around and getting them to their various activities. But I do love to read books, and I read often. I am happy to read almost anything: fiction, non-fiction, poetry. I also enjoy playing and watching sports, including soccer.
What’s next for you career wise?
I am looking forward to spending more time teaching residents, medical students, and student fellows in my new position. I have always enjoyed teaching, and am happy that I have found a position that puts a large emphasis on education.
What advice would you give up-and-coming pathology trainees looking to start their careers?
Because I am one half of a two physician household, I have had to change jobs frequently in the last four years as my husband’s training has taken him to various hospitals. While I haven’t always wanted to leave positions, the benefit has been that I have gained experience in a lot of different practice settings.
My advice would be to learn as much as you can from each place you end up, even if it isn’t necessarily your dream job. Seek to find what you can take away from each place or experience that will grow your knowledge. Each place (and person!) has something unique to teach you that will contribute to your success as a physician, a pathologist, and a person.
Organ recipient, Janine Cassata, right, with HLA lab supervisor, Angela Busacco.
On December 16, Janine Cassata will celebrate the one-year anniversary of her organ transplant.
The 50-year-old realtor from Chili was diagnosed with Type 1 diabetes when she was just 2 years old. It wasn’t until after she suffered an e-coli infection as an adult and her kidneys began to fail that her doctor told her she would need a kidney transplant. He suggested a pancreas transplant as well.
Just six months after being added to a waiting list, Cassata was woken up by an early morning phone call. It was the organ transplant coordinator at Strong Memorial Hospital.
“He said, ‘We have a kidney and a pancreas for you and you need to come in right away if you’re interested,” recalls Cassata. “I had to collect my thoughts,” she said. “I was in shock.”
An hour later, she went in for the procedure, which was a success. Months later, she got the rare chance to meet someone who played a part in her transplant behind the scenes.
Cassata was at a graduation at her neighbor’s house when the host introduced her to a fellow party guest, Angela Busacco.
Unbeknownst to her, Busacco is the chief supervisor in the HLA Typing Laboratory at URMC. This lab performs that complex testing that makes it possible to match organ donors and recipients.
Lab employees almost never get the chance to meet the people they help. So when Busacco was introduced to Cassata, tears came to her eyes. What’s more, she remembered her by name. The women talked and embraced.
“These names that we see on a regular basis; they become people,” said Busacco.
The organ donation process is highly collaborative – with a team of people and organizations working around the clock to ensure the best match possible. Here we describe how the lab plays a key role in this journey from Day 1.
How it Works:
The HLA/Tissue Typing Lab team at Strong Memorial Hospital.
When a patient needs an organ transplant, they go through an initial medical evaluation that includes blood and serum tests.
The DNA in their blood cells is tested to identify which human leukocyte antigen (HLA) genes and antigens the patient is born with. Importantly, the recipient’s serum must also be screened for HLA antibodies that could cause a transplant to be unsuccessful.
HLAs are microscopic proteins that exist on the surface of white blood cells. They help the body’s immune system respond to foreign cells by presenting information to T and B cells that may target and attack foreign cells.
In order to be matched with a suitable donor, the recipient must not have antibodies that would actively target transplanted tissue. You can acquire HLA antibodies in different ways, such as having a prior transplant (successful or unsuccessful) or through a blood transfusion. They can also be present in women who have had multiple pregnancies.
All of this information is reported back to the clinicians before the patient gets listed in a national database (managed by the United Network for Organ Sharing, or UNOS) to be eligible to receive a deceased donor organ as it becomes available.
Each patient has their own unique profile when it comes to antigens and antibodies, so every case must be examined closely.
“Some people know you by face, but we get to know somebody by their antibody profile,” said Myra Coppage, Ph.D., Lab Director.
Kidneys are the most transplanted organ at Strong Memorial Hospital. Half of these transplants are from living donors, often relatives who closely match the recipient’s blood and HLA typing. The other half, currently about 350 patients, are waiting for kidneys from deceased organ donors.
Each month, the HLA Lab obtains a serum sample from every patient on the waiting list. The serum is tested on an ongoing basis to monitor any changes and to check for any new HLA antibodies.
A large portion of the daily work flowing through the lab is HLA typing for potential donors who must undergo the same thorough screening. Lab techs perform flow cytometry cross matching to check for compatibility. In this case, cells from the donor are mixed in the same tube with serum from the recipient to see if a rejection reaction takes place.
William Femec (MT) and Helene McMurray; Ph.D. in the HLA Laboratory.
There is always a lab tech on call 24/7 to respond to a call for a deceased donor. This is when an organ donor dies and their HLA typing from DNA must be performed as soon as possible to identify a matching recipient who is willing and able to receive the organ while it’s still viable.
When a call about a deceased donor comes in, time is crucial, explains Helene McMurray, Ph.D., the HLA Lab’s director-in-training.
“It’s a little bit like being Batman,” said McMurray. “When the bat signal goes off, somebody has to show up to work.”
Oftentimes, calls for deceased donors come in late at night or in the early morning when the on-call tech must perform the HLA typing as soon as possible. The process includes manual and automated steps that follow a tight protocol. It can take up to five hours for the tech to finish each step.
“They are juggling HLA typing on the patient, doing the cross match procedure, and potentially antibody screening at the same time by themselves,” said Busacco. “The stuff that we batch and rotate among everybody in the lab (during the day) – that person is doing it all alone.”
The tech must multitask like a chef juggling different side dishes on a tight deadline. Meanwhile, they are taking calls from doctors, nurses, and organ procurement staff checking on the status of the results.
After the HLA typing is complete, the donor’s information is entered into the UNOS database so the organ can be matched with a list of potential recipients.
Once the ordered list of matching recipients is generated, the transplant center coordinators can contact recipients like Janine Cassata and offer them a lifesaving opportunity to receive a transplant.
It is not unusual for the lab tech to get most of the way through the lengthy HLA typing process only to learn that the donation will not happen. This could either because the family of the deceased has chosen not to move forward, or the organ procurement organization determines the organs are not of acceptable quality. This is a difficult but familiar part of the job.
At the end of the day, however, the HLA team knows that each piece of their highly technical role directly impacts positive patient outcomes.
“A transplant is not happening without our piece of it,” said Busacco. “There wouldn’t be an error where we were skipped over or weren’t needed. It just wouldn’t happen.”
Helping ‘Complicated’ Patients
As Laboratory Director, Dr. Myra Coppage has advocated for patients on a national level with the American Society for Histocompatibility and Immunogenetics (ASHI), where she has held a variety of roles, most recently, Program Director for Laboratory Accreditation.
Coppage has served on committees that changed the national rules specifically addressing transplants for immunologically complicated patients who can sit on waiting lists for years.
Patients who have multiple antibodies, either from having many children or failed transplants, were previously stuck waiting for a match while others skipped ahead of them.
“The techs have people they’re always pulling for because they come to the top a lot and have been waiting for a long time,” said Coppage. “Those are the people who need us.”