50 years ago, organ transplant procedures in Ireland were transformed forever. The first lab dedicated to histocompatibility and immunogenetics was established in the state, allowing transplant recipients to finally be matched with compatible donors. This milestone is being celebrated at an event in the RCPI on 13 November – which is International Pathology Day.
In a momentous year for organ transplantation in Ireland (2024 marks the 60th anniversary of the first kidney transplant procedure in the State), the RCPI is putting a spotlight on the essential role played by pathologists.
“For transplanted organs to survive, the immunological barrier needs to be assessed, and transplantation can proceed when the immunological risk can be managed with long term immunosuppression,” says Prof Mary Keogan, Consultant Immunologist, Beaumont Hospital, Dublin.
Nowadays, that testing is done by highly skilled scientists in the National Histocompatibility and Immunogenetics Service for Solid Organ Transplantation (NHISSOT), where Prof Keogan works.
NHISSOT provides immunology support to several transplant services, such as the National Renal Transplant Service in Beaumont Hospital, the National Cardiothoracic Transplant Service in the Mater Misericordiae University Hospital, Dublin, and the National Liver and Pancreatic Transplant Programmes in St Vincent’s University Hospital, Dublin.
History
Prof Keogan, who is Dean of the RCPI Faculty of Pathology, has an insight into how that immunology service started 50 years ago.
“The fascinating early days of histocompatibility and immunogenetics in Ireland have been described by medical laboratory scientist Joe Phelan in his book Sailing to Antarctica – A Memoir. Phelan was the scientist charged with establishing the Irish Kidney Transplant Service in 1974.
“Before that, urologists from Dublin had co-established the London Transplant Group in 1968, and developed a laboratory that tested tissue-types of organ donors and recipients. Ultimately, the support needed to develop a sustainable service was lacking, and this research lab closed in December 1972,” she says.
For renal transplantation in Ireland to proceed, a lab dedicated to histocompatibility and immunogenetics was essential. Joe Phelan established a lab in Jervis Street, opening on 1 April 1974, introducing compatibility testing for living donors.
As demand for histocompatibility and immunogenetics services for renal transplantation grew, so did the need for additional staff and space.
“The shortage of space in laboratories was no less of a problem in the 1970s than it is now,” says Prof Keogan.
“When the convent attached to Jervis Street Hospital was vacated, the histocompatibility and immunogenetics lab moved to the vacated space, and additional scientists were recruited. The laboratory subsequently moved to Beaumont Hospital, in November 1987. Histocompatibility and immunogenetics laboratories are focused on ensuring that no opportunity to transplant is missed,” she says.
The lab went from strength to strength. In 2002, it gained national recognition as the NHISSOT, and, in addition to providing immunology services to the renal transplant service, it took on support for cardiothoracic and liver transplant programmes. It also has been accredited by the European Federation of Immunogenetics since 2012.
Meeting
For the event at RCPI, Prof Keogan has programmed a line-up of presentations celebrating what has been achieved in organ transplantation, as well as looking to new developments.
A session focusing on donation will hear from Dr Colm Henry (HSE Chief Clinical Officer) and Dr Barry O’Brien (Director of Organ Donation Transplant Ireland) addressing health service structural changes, as well as legislative changes. Dr Catherine Motherway, Consultant Anaesthesiologist and former Clinical Lead in Organ Donation at University Hospital Limerick, will address care of donors and donors’ families.
Dr James O’Rourke, Consultant Anaesthesiologist, Beaumont Hospital, Dublin, will address donation after cardiac death. Dr Breda Lynch, Clinical Microbiology Consultant, Mater Misericordiae University Hospital, will speak about donors where there are infection risks, and Ms Martina Goggin, founder of Strange Boat Donor Foundation, will speak from a donor’s family’s perspective.
In a session on renal transplantation, Mr Tiberius Pereira, founder of Patient Safety Ireland, will address patient experience and practical steps to empowering people to be active partners. Advances in that kind of renal transplantation will be discussed by Mr Suman Haroon, Transplant Surgeon, Beaumont Hospital, while updates in renal pathology will be shared by Prof Brendan Doyle, Consultant Pathologist, Beaumont Hospital.
Throughout the event, there will be similar pairings of surgical perspectives with pathological insights. Cardiothoracic transplantation will be addressed by Ms Aisling Kinsella, Cardiothoracic Surgeon, Mater Misericordiae University Hospital, and its associated pathology will be discussed by Prof Aurelie Fabre, Consultant Histopathologist, St Vincent’s University Hospital.
Liver transplantation will be discussed by Mr Emir Hoti, Director of National Liver Transplant Programme, St Vincent’s University Hospital, while the contribution of the histopathologist to liver transplantation will be addressed by Dr Niamh Nolan, Consultant Histopathologist, St Vincent’s University Hospital.
Other presentations will focus on therapeutic drug monitoring (Dr Colleen Flannery, Consultant Chemical Biologist, University Hospital Waterford); living donor transplantation (Dr Carol Traynor, Consultant Nephrologist and Transplant Physician, Beaumont Hospital); and options when living kidney donors are incompatible (Dr Aisling Courtney, Consultant Transplant Nephrologist, Belfast City Hospital).
Prof Keogan elaborated on this wealth of collaboration between specialists: “Optimal transplant outcomes require excellence from every member of the transplant team: patients cannot be transplanted without the whole team.”
“Irish transplant outcomes are excellent. We have much to celebrate. The science moves so fast that as we celebrate what has been achieved, we are already working on the next improvement,” she says.
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