Diagnostic Pathology: Transplant Pathology

Dr. Chang attended Johns Hopkins University for his B.A. in molecular biology prior to entering Georgetown University School of Medicine for his MD. He then completed his pediatric residency at Children's Hospital National Medical Center and his pediatric cardiology fellowship at Children's Hospital of Philadelphia. He accepted a position as attending cardiologist in the cardiovascular intensive care unit of Boston Children's Hospital and as assistant professor at Harvard Medical School. He has been the medical director of several pediatric cardiac intensive care programs (including Children's Hospital of Los Angeles, Miami Children's Hospital, and Texas Children's Hospital). He is currently the Chief Intelligence and Innovation Officer and Medical Director of the Heart Failure Program at Children's Hospital of Orange County. He has also been named a Physician of Excellence by the Orange County Medical Association multiple years.

SECTION 1: IMMUNOLOGY

4 Immune Response in Organ Transplantation
Roshini Sarah Abraham, PhD
8 Regulatory Immune Cells and Transplant Tolerance
Roshini Sarah Abraham, PhD
14 Viral Infections and Immune Response
Sanya J. Thomas, MD and Roshini Sarah Abraham, PhD
20 Genetics of Complement Variants in Atypical HUS and TMA
Roshini Sarah Abraham, PhD
24 Laboratory-Based Immune Monitoring in Organ Transplantation
Sanya J. Thomas, MD and Roshini Sarah Abraham, PhD
30 Introduction to Xenotransplantation
Roshini Sarah Abraham, PhD
32 Graft-vs.-Host Disease in Solid Organ Transplantation
Sanya J. Thomas, MD and Roshini Sarah Abraham, PhD

SECTION2: HLA TESTING

36 Human Leukocyte Antigen System
Manish J. Gandhi, MD
38 Histocompatibility Testing
Manish J. Gandhi, MD
40 Transplantation and HLA
Manish J. Gandhi, MD
44 ABO Blood Group Antigens and Transplantation
Manish J. Gandhi, MD
46 Apheresis and Transplantation
Manish J. Gandhi, MD
48 HLA and Transfusion
Manish J. Gandhi, MD

SECTION 3: IMMUNOSUPPRESSIVE DRUGS

52 Mechanism of Action of Immunosuppressive Drugs
Loralie Langman, PhD and Florian Lemaitre, PharmD, PhD
54 Therapeutic Drug Monitoring in Transplant Patients
Loralie Langman, PhD and Florian Lemaitre, PharmD, PhD
58 History of Immunosuppression Drugs in Transplantation
Loralie Langman, PhD and Florian Lemaitre, PharmD, PhD

SECTION 4: KIDNEY TRANSPLANTATION

62 History of Kidney Transplantation
Lynn D. Cornell, MD
64 Pathologic Classification of Renal Allograft Diseases
Robert B. Colvin, MD
66 Examination of End-Stage Kidney
Shane Meehan, MB, BCh
72 Evaluation of End-Stage Kidney
Shane Meehan, MB, BCh
78 Evaluation of Allograft Kidney
Lynn D. Cornell, MD and Evan Farkash, MD, PhD
84 Evaluation of Donor Kidney
Lynn D. Cornell, MD and Evan Farkash, MD, PhD
90 Evaluation of Transplant Nephrectomy
Shane Meehan, MB, BCh and Evan Farkash, MD, PhD
94 Evaluation of Fibrosis
A. Brad Farris, III, MD, MBA
98 Protocol Biopsies
Lynn D. Cornell, MD and Evan Farkash, MD, PhD
102 Accommodation
Lynn D. Cornell, MD
104 Tolerance
Robert B. Colvin, MD

SURGICAL COMPLICATIONS

108 Acute Allograft Ischemia
A. Brad Farris, III, MD, MBA
112 Size Mismatch Allograft Injury
Anthony Chang, MD and Yael K. Heher, MD, MPH
114 Urine Leak
A. Brad Farris, III, MD, MBA
115 Lymphocele
A. Brad Farris, III, MD, MBA
116 Multinucleated Endotheliopathy
Jonathan Zuckerman, MD, PhD
120 Transplant Renal Artery Stenosis
A. Brad Farris, III, MD, MBA
122 Transplant Renal Artery or Vein Thrombosis
A. Brad Farris, III, MD, MBA
124 Kidney Xenografts
Ivy A. Rosales, MD

ALLOGRAFT REJECTION

128 Hyperacute Rejection
Lynn D. Cornell, MD and Michael Mengel, MD
132 Acute T-Cell-Mediated Rejection
Lynn D. Cornell, MD and Michael Mengel, MD
142 Chronic T-Cell-Mediated Rejection
Lynn D. Cornell, MD and Michael Mengel, MD
146 Acute Antibody-Mediated Rejection
Lynn D. Cornell, MD and Michael Mengel, MD
154 Chronic Antibody-Mediated Rejection
Lynn D. Cornell, MD and Michael Mengel, MD
166 Transcript Analysis of Renal Transplant Biopsies
Michael Mengel, MD and R. Neal Smith, MD, PhD

RECURRENT AND DE NOVO DISEASES

170 Diseases That Recur in Allografts
Anthony Chang, MD, Lynn D. Cornell, MD, and R. Neal Smith, MD, PhD
176 De Novo Focal Segmental Glomerulosclerosis
Anthony Chang, MD and Astrid Weins, MD, PhD
178 De Novo Membranous Nephropathy
Anthony Chang, MD
182 Anti-GBM Disease in Alport Syndrome
Anthony Chang, MD and R. Neal Smith, MD, PhD
184 Chimerism Transition Syndrome
A. Brad Farris, III, MD, MBA
186 Late Posttransplant Histology
Lynn D. Cornell, MD

KIDNEY PATHOLOGY OF RECIPIENTS OF OTHER TRANSPLANTS

188 Kidney Diseases in Nonrenal Transplant Recipients
Robert B. Colvin, MD
192 Graft-vs.-Host Glomerulopathies
Anthony Chang, MD and Yael K. Heher, MD, MPH

DRUG TOXICITIES

194 Calcineurin Inhibitor Toxicity
Shane Meehan, MB, BCh
200 mTOR Inhibitor Toxicity
Lynn D. Cornell, MD

INFECTIONS

202 Acute Pyelonephritis
Neeraja Kambham, MD
210 Polyomavirus Nephritis
Anthony Chang, MD and Evan Farkash, MD, PhD
218 Adenovirus Infection
Anthony Chang, MD and R. Neal Smith, MD, PhD
220 Cytomegalovirus Infection
Anthony Chang, MD and R. Neal Smith, MD, PhD
222 Mucormycosis
Anthony Chang, MD
224 Histoplasmosis
Anthony Chang, MD
225 Candidiasis
Anthony Chang, MD
226 Cryptococcosis
Anthony Chang, MD
227 Aspergillosis
Anthony Chang, MD
228 Coccidioidomycosis
Anthony Chang, MD
229 Paracoccidioidomycosis
Anthony Chang, MD
230 Microsporidiosis
Robert B. Colvin, MD
232 Tuberculosis
Neeraja Kambham, MD
234 Malakoplakia
Neeraja Kambham, MD
238 Nocardiosis
Neeraja Kambham, MD

SECTION 5: LIVER TRANSPLANTATION

242 Pathologic Classification of Liver Allograft Diseases
Lindsay Alpert, MD and John Hart, MD
244 Gross Evaluation of Native Liver
Lindsay Alpert, MD and John Hart, MD
248 Evaluation of Failed Liver Allograft
Lindsay Alpert, MD and John Hart, MD
250 Evaluation of Donor Liver
John Hart, MD
254 History of Liver Transplantation
Anthony Chang, MD and John Hart, MD

POSTTRANSPLANT SURGICAL COMPLICATIONS

256 Preservation Injury
Hanlin L. Wang, MD, PhD
258 Hepatic Artery Thrombosis
Lisa Yerian, MD and John Hart, MD
260 Portal Vein Thrombosis
Lisa Yerian, MD and John Hart, MD
262 Bile Duct Stricture, Leak, Sludge, Biloma
Hanlin L. Wang, MD, PhD
264 Hepatic Venous Outflow Obstruction
Hanlin L. Wang, MD, PhD
268 Small-for-Size (Hyperperfusion) Syndrome
Hanlin L. Wang, MD, PhD

ALLOGRAFT REJECTION

270 T-Cell-Mediated Rejection, Liver
Lisa Yerian, MD and John Hart, MD
274 Antibody-Mediated Rejection, Liver
Hanlin L. Wang, MD, PhD, Robert B. Colvin, MD, and Richard Masia, MD, PhD
278 Chronic (Ductopenic) Rejection
Matthew M. Yeh, MD, PhD and John Hart, MD

RECURRENT DISEASES IN LIVER ALLOGRAFT

280 Recurrent Hepatitis B Virus
Lindsay Alpert, MD and John Hart, MD
282 Recurrent Hepatitis C Virus
Lindsay Alpert, MD and John Hart, MD
286 Fibrosing Cholestatic HBV or HCV Hepatitis
Lindsay Alpert, MD and John Hart, MD
288 Recurrent Autoimmune Hepatitis
Lindsay Alpert, MD and John Hart, MD
290 Recurrent Primary Biliary Cholangitis
Lindsay Alpert, MD and John Hart, MD
292 Recurrent Primary Sclerosing Cholangitis
Lindsay Alpert, MD and John Hart, MD
294 Recurrent Fatty Liver Disease
Lindsay Alpert, MD and John Hart, MD

INFECTIONS

296 Cytomegalovirus
Maria Westerhoff, MD and Lei Zhao, MD, PhD
298 Herpes Simplex Virus
Maria Westerhoff, MD and Lei Zhao, MD, PhD
300 Adenovirus, Liver
Maria Westerhoff, MD and Lei Zhao, MD, PhD
302 Hepatitis E Virus
Maria Westerhoff, MD and Lei Zhao, MD, PhD
304 Epstein-Barr Virus, Liver
Maria Westerhoff, MD and Lei Zhao, MD, PhD
308 Fungal Infections, Liver
Maria Westerhoff, MD and Lei Zhao, MD, PhD

LATE-GRAFT DYSFUNCTION

310 Plasma Cell-Rich Rejection
Lisa Yerian, MD and John Hart, MD
312 Graft-vs.-Host Disease, Liver
Lisa Yerian, MD and John Hart, MD

SECTION 6: HEART TRANSPLANTATION

316 Pathologic Classification of Cardiac Allograft Diseases
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
318 Evaluation of Failed Native and Transplanted Heart
Aliya N. Husain, MD and Phillip D. McMullen, MD, PhD
320 History of Heart Transplantation
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD

EVALUATION OF EXPLANTED HEART

322 Ischemic Heart Disease
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
326 Dilated Cardiomyopathy
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
330 Hypertrophic Cardiomyopathy
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
334 Congenital Heart Disease
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
338 Sarcoidosis, Heart
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
340 Arrhythmogenic Cardiomyopathy
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
344 Other Causes of End-Stage Heart Disease
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD

ALLOGRAFT REJECTION

350 Acute Cellular Rejection, Heart
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
354 Antibody-Mediated Rejection, Heart
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
356 Chronic Allograft Vasculopathy, Heart
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD

NONINFECTIOUS LESIONS

358 Quilty Lesions
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
360 Site of Previous Biopsy
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD

INFECTIONS

362 Myocarditis
Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD

SECTION 7: LUNG TRANSPLANTATION

370 Pathologic Classification of Lung Allograft Diseases
Jefree J. Schulte, MD and Aliya N. Husain, MD
372 Examination of Native and Transplanted Lungs
Jefree J. Schulte, MD and Aliya N. Husain, MD
374 History of Lung Transplantation
Jefree J. Schulte, MD and Aliya N. Husain, MD

EVALUATION OF FAILED NATIVE LUNG

376 Emphysema
Jefree J. Schulte, MD and Aliya N. Husain, MD
378 Cystic Fibrosis
Jefree J. Schulte, MD and Aliya N. Husain, MD
380 Idiopathic Pulmonary Fibrosis
Jefree J. Schulte, MD and Aliya N. Husain, MD
382 Connective Tissue Disease-Associated Interstitial Lung Disease
Jefree J. Schulte, MD and Aliya N. Husain, MD
384 Sarcoidosis, Lung
Jefree J. Schulte, MD and Aliya N. Husain, MD
386 Pulmonary Arterial Hypertension
Jefree J. Schulte, MD and Aliya N. Husain, MD
388 Other Causes of End-Stage Lung Disease
Jefree J. Schulte, MD and Aliya N. Husain, MD

SURGICAL COMPLICATIONS

392 Surgical Aspects and Complications, Lung
Jefree J. Schulte, MD and Aliya N. Husain, MD

ALLOGRAFT REJECTION

394 Pathologic Classification of Rejection
Jefree J. Schulte, MD and Aliya N. Husain, MD
396 Antibody-Mediated Rejection, Lung
Jefree J. Schulte, MD and Aliya N. Husain, MD
398 Acute Cellular Rejection, Grade A
Jefree J. Schulte, MD and Aliya N. Husain, MD
400 Acute Cellular Rejection, Grade B
Jefree J. Schulte, MD and Aliya N. Husain, MD
402 Chronic Allograft Dysfunction, Lung
Jefree J. Schulte, MD and Aliya N. Husain, MD

NONINFECTIOUS LESIONS

404 Organizing Pneumonia
Jefree J. Schulte, MD and Aliya N. Husain, MD
406 Microaspiration
Jefree J. Schulte, MD and Aliya N. Husain, MD

INFECTIONS

408 Bacterial Infections
Jefree J. Schulte, MD and Aliya N. Husain, MD
410 Viral Infections
Jefree J. Schulte, MD and Aliya N. Husain, MD
414 Fungal Infections, Lung
Jefree J. Schulte, MD and Aliya N. Husain, MD

SECTION 8: INTESTINAL TRANSPLANTATION

420 Pathologic Classification of Intestinal Allograft Diseases
Sarangarajan Ranganathan, MD
422 Indications and Evaluation of Explant
Sarangarajan Ranganathan, MD
426 Reperfusion Injury
Sarangarajan Ranganathan, MD
430 History of Intestinal and Multivisceral Transplantation
Sarangarajan Ranganathan, MD

ALLOGRAFT REJECTION/IMMUNOLOGICAL INJURY

432 Acute Antibody-Mediated Rejection, Intestine
Sarangarajan Ranganathan, MD
436 Acute Cellular Rejection, Intestine
Sarangarajan Ranganathan, MD
444 Chronic Rejection, Intestine
Sarangarajan Ranganathan, MD
448 Stomach Rejection
Sarangarajan Ranganathan, MD
452 Colon Rejection
Sarangarajan Ranganathan, MD
456 Graft-vs.-Host Disease, Intestine
Sarangarajan Ranganathan, MD

INFECTIONS

460 Bacterial and Fungal Infections
Sarangarajan Ranganathan, MD
464 Adenovirus, Intestine
Sarangarajan Ranganathan, MD
468 Rotavirus, Cytomegalovirus, and Herpes Simplex Virus
Sarangarajan Ranganathan, MD
472 Epstein-Barr Virus, Intestine
Sarangarajan Ranganathan, MD

SECTION 9: PANCREAS TRANSPLANTATION

480 Pathologic Classification of Pancreas Allograft Diseases
Surya V. Seshan, MD and Billie S. Fyfe, MD
482 Clinical Considerations in Pancreas Transplant Evaluation
Surya V. Seshan, MD and Billie S. Fyfe, MD
488 History of Pancreas Transplantation
Surya V. Seshan, MD and Billie S. Fyfe, MD
490 History of Islet Transplantation
Piotr Witkowski, MD, PhD and Sarah A. Gondek, BS

SURGICAL COMPLICATIONS

492 Surgical Aspects and Complications, Pancreas
Piotr Witkowski, MD, PhD, Sarah A. Gondek, BS, and Surya V. Seshan, MD

ALLOGRAFT REJECTION

500 T-Cell-Mediated Rejection, Pancreas
Surya V. Seshan, MD, Billie S. Fyfe, MD, and Erika R. Bracamonte, MD
506 Antibody-Mediated Rejection, Pancreas
Surya V. Seshan, MD and Billie S. Fyfe, MD
510 Pancreas Allograft Fibrosis/Graft Sclerosis
Surya V. Seshan, MD, Billie S. Fyfe, MD, and Erika R. Bracamonte, MD

GRAFT DYSFUNCTION

514 Recurrent Diabetes Mellitus
Surya V. Seshan, MD and Billie S. Fyfe, MD
518 Islet Cell Toxicity and Islet Amyloid Deposition
Surya V. Seshan, MD and Billie S. Fyfe, MD

INFECTIONS

520 Intraabdominal and Opportunistic Infections
Surya V. Seshan, MD and Billie S. Fyfe, MD

SECTION 10: VASCULARIZED COMPOSITE ALLOTRANSPLANTATION

528 History of Vascularized Composite Allotransplantation
Linda Cendales, MD, J. Andres Hernandez, MD, MBA, and Emmanuel O. Emovon, III, BS
530 Complications of Vascularized Composite Allotransplantation
Linda Cendales, MD, J. Andres Hernandez, MD, MBA, and Emmanuel O. Emovon, III, BS

ALLOGRAFT REJECTION

532 Acute T-Cell- and Antibody-Mediated Rejection
A. Brad Farris, III, MD, MBA, Ivy A. Rosales, MD, and Robert B. Colvin, MD
540 Chronic Rejection
A. Brad Farris, III, MD, MBA, Robert B. Colvin, MD, and Ivy A. Rosales, MD

SECTION 11: POSTTRANSPLANT NEOPLASTIC DISORDERS

544 Posttransplant Lymphoproliferative Diseases
A. Brad Farris, III, MD, MBA