Distance No Barrier to Transplant Pathologists in Pittsburgh and Palermo:
Surgeons doing routine consults through telepathology system

A telepathology system developed by the University of Pittsburgh Medical Center has been found to be an effective means for a transplant pathologist working alone in a UPMC-managed facility in Palermo, Sicily, to receive real-time consults from transplant pathologists in Pittsburgh.

In the past year, more than 150 cases have been reviewed using the static image telepathology system, reported Yukako Yagi, director of telepathology at UPMC’s Center for Pathology Informatics, at the annual meeting of the American Telemedicine Association.

“This rapid and interactive telepathology system not only helped to avoid misdiagnoses, it allowed the on-site pathologist in Palermo to confirm her impressions and diagnoses with colleagues in Pittsburgh, thus improving diagnosis, treatment, and patient care,” said Yagi.

The success of the system is relevant because a pathologist’s diagnosis often can determine if an organ transplant or liver resection operation will proceed, even as the patient is on the operating room table. In addition, diagnosing organ rejection can be tricky, as there can be nuances in how rejection can manifest itself. The pathologist’s report determines in large part if and how rejection is to be treated by the transplant team.

UPMC pathologists and information systems experts developed the system in-house because no commercial system was available to meet the specific requirements of transplant pathologists. The system is available 24 hours a day, seven days a week, and operates over a secure private network between Marta Ida Minervini, M.D., the UPMC-trained pathologist at the Mediterranean Institute of Transplantation and Advanced Specialized Therapies in Palermo, and pathologists at UPMC in Pittsburgh. It allows for real-time chat, and all interactions are stored to maintain discussion context when decisions are made over several days.

With a six-hour time difference between Pittsburgh and Palermo — and because organ transplants can occur at any time— it is not uncommon for pathologists in Pittsburgh to be notified of cases during off hours. As such, each pathologist has a high-end laptop and a specially equipped home computer and monitor upgraded to display images at high resolution. The system automatically pages the consulting pathologist in Pittsburgh when a new case is submitted. In Palermo, the pathologist’s microscope contains a high-definition camera and software that capture and send images to Pittsburgh.

“Given our experience with this system to date, I would estimate that up to 85 percent of all transplant pathology consultation could be done directly via the Internet, assuming there are committed and experienced users on either end,” said Anthony J. Demetris, professor of pathology and director of the division of transplant pathology at the University of Pittsburgh ‘s Thomas E. Starzl Transplantation Institute, who helped to conceive and develop the system.

The same system was recently installed at the University of Kyushu in Fukuoka, Japan, where there is an active liver transplant program. The team also plans to collaborate with a center in India.

The Mediterranean Institute for Transplantation and Advanced Specialized Therapies, or Istituto Mediterraneo per i Trapianti e Terapie ad Alta, is a joint venture of the UPMC Health System, the Italian government, and Civico and Cervello hospitals of Palermo, Sicily, currently offering liver transplantation, living related kidney transplantation, and hepatobiliary reconstruction and liver resection operations. As part of the agreement, funded by the Italian government under a health reform law, UPMC manages the facility as it would an American medical center, incorporating the most advanced technologies.

Surgeons at UPMC have performed more than 11,000 organ transplants, a single-center experience unmatched by any other program in the world.

—Lisa Rossi