First national digital pathology trial

18 Dec, 2019

Daniel Simmons, Senior BMS and Deputy Quality Manager at the Royal Free Hospital, describes the pioneering new digital pathology service supporting kidney transplants

Daniel was recently the lead author of the team that won the cellular pathology poster competition at the IBMS Congress. The winning poster’s subject described trialling of the first national digital pathology service “PITHIA” to support kidney transplants.

Can you tell us some more about what the PITHIA trial is?

There are around 5,000 people waiting for a kidney transplant in the UK. While the number of donors has risen, so has the proportion of kidneys from older people. Only 28 percent of kidneys from donors aged 60+ are currently utilised because of the specialist knowledge that’s required to assess kidney function.

PITHIA – or to give it its full name, Pre-Implantation Trial of Histopathology in Renal Allografts, is a national biopsy service. It gives access to specialist knowledge for diagnosis 24 hours a day, seven days a week, via digital pathology. We estimate that when the service is fully operational it will allow for an extra 130 transplants per year.

How does it work on a national scale?

The trial is working thanks to the great collaboration between a lot of people and organisations; there is a network of six participating laboratories in England and Scotland. As soon as a specimen kidney is removed and inspected, the National Organ Retrieval Service team will take a biopsy.

NHS Blood and Transplant Hub Operations contact one of the network’s labs directly to advise them of the sample’s arrival time. Samples are processed urgently, the sections are cut, stained, mounted and then scanned, the whole process taking up to just three-and-a-half hours. At this point, one of 12 on-call Renal Histopathologist can access the slide from wherever they are in the country to assess and score the specimen.

How did you become involved in PITHIA trial?

The role of a BMS in cellular pathology is very varied. We receive and process tissue from all sites of the human body and contribute to the diagnosis of many different diseases.

Assessment for organ donation is one of the more rapid assessments we offer and can occur at any time of day.

Our lab offers a 24 hour, on-call service, meaning there’s a BMS on call from Friday 5:30pm to the following Friday 9am. So, we already had the infrastructure in place that complemented the PITHIA trial. We just had to incorporate the digital pathology aspect.

In a diagnostic lab we don’t often get the chance to take part in such a wide reaching and impactful research trial. My other colleagues on the on-call rota, Max Owusu-Ansah and Reshmi Patel, were all happy to expand our service to incorporate the trial. We simply could not have anticipated the immediate positive effect for patients on the renal transplant waiting list.

What lessons has the PITHIA trial given you about wider use of digital pathology?

We’re very proud that the trial has proved successful and we understand that the model is now being considered for liver transplantation.

HSL is a partnership between The Doctors Laboratory, Royal Free London NHS Foundation Trust (the Royal Free London) and University College London Hospitals NHS Foundation Trust (UCLH)

Health Services Laboratories
Health Services Laboratories
Health Services Laboratories