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«Histocompatibility Fellowship Tissue Typing Laboratory and Department of Pathology and Laboratory Medicine Director Training Program GOALS 1. To ...»

Histocompatibility Fellowship

Tissue Typing Laboratory and Department of Pathology and

Laboratory Medicine

Director Training Program


1. To provide intensive didactic and technical training in the field of

histocompatibility testing and transplant immunology.

2. To provide the fellow with the knowledge and skills to assume an HLA

Laboratory Director position.

3. To prepare the fellow for certification examination by the American Board of Histocompatibility and Immunogenetics (ABHI).

4. To prepare the fellow for certification by the American Society of Histocompatibility and Immunogenetics (ASHI) Director Training Review Committee (DTR).

5. To involve the fellow in research projects relevant to clinical applications of Immunogenetics and histocompatibility.


This is a two year training program.


The fellow must have earned an MD or a PhD in Immunology, genetics or related biological science from an accredited institution.

Histocompatibility Fellowship Objectives.doc 24/11/2006 1 of


First Year The first year will emphasize the technical aspects of histocompatibility testing and transplant immunology. On-the-bench training will be provided in each area of the laboratory testing. The fellow will be expected to keep a log of all testing performed and will be certified as competent to perform a task through the Calgary Laboratory Services, Tissue Typing Laboratory Master Training System when training is successfully completed. Monthly reports will be made to document short-term goals and accomplishments.

The training will consists of the following components for each rotation:

1. Didactic – reading and discussing principles and concepts of procedures; mini tutorials with the laboratory director and supervisors; attending journal clubs, seminars, conferences.

2. Practical – performing the procedures, documentation of tests performed, successful mastery of all tasks outlined in the manual.

3. Quality Assurance (QA) – understanding what quality control (QC) is necessary for each test performed, why it is done and actual performance of the QC when possible. Understanding the measures instituted by the laboratory to monitor QA.

4. Interpretation and Application – interpretation of results, troubleshooting and uses for the tests.

Clinical Rotations Serological Assays 4 months

• Cytotoxicity

• Genotyping

• Crossmatch assays

• Antibody screening Flow based assays 2 months

• Flow PRA

• Flow Crossmatch Molecular assays 4 months



• Reverse Blot

• Luminex Research and Development Projects – Two years Rotations

–  –  –

Note: The above training components are not necessarily received sequentially.

Additional training is available during the second year.

Second Year The second year of training will concentrate more on the director’s responsibilities and management skills. At this time, the trainee may be placed on the On-Call schedule for Donor Workups. The following components will be stressed during the

second year of training:

1. Review of worksheets and co-signing reports

2. Review of Proficiency Testing results; documentation of corrective actions

3. Analysis of PRA screens and antibody identification

4. Review and analysis of tray QC; using information obtained in interpretation of results

5. Research and Development projects

6. Developing management skills and nurturing “team spirit” within the laboratory

7. Completion of portfolio for documentation of training

8. Preparing of ASHI DTR oral examination

9. Preparing for ABHI Director’s examination

10. Continued bench training as needed

11. Special projects


The fellow will maintain a Case Book of personally studied patient work-ups and followup studies that included demographic, pre- and post-transplant clinical information, serum screening analysis, crossmatching evaluations, HLA typings and antigen/haplotype matching, any other patient data (e.g. transplant biopsy data), appropriate literature references, and the program director’s signature indicating review


• 60 cadaver renal transplants, including as many recipients of different ethnic groups as possible.

• 60 living related renal transplants of different ethnicity (with haplotype analysis) • 60 HSC/BM Transplantation: Related Donor • 60 HSC/BM Transplantation: Unrelated Donor • 10 non-renal solid organ transplant (heart, liver, or pancreas) • 60 Cases of HLA transfusion support • 60 Cases of Non-Transplant Clinical Purposes (e.g. HLA Disease Association)

Test performance will be documented for:

Histocompatibility Fellowship Objectives.doc 24/11/2006 3 of Provide a listing of cases reviewed by the applicant for each technology.

(Minimum # of cases listed below). Include a brief description of the case or reference the case from a category of testing where the technology is used • 60 tests using serology: complement dependent and solid phase methods • 60 tests using molecular methods • 60 tests using flow cytometry Note: At least 30 of the cases will be completed in the first year of training. The confidentiality of the patients is protected.


I. Serological Assays A. Practical

–  –  –

1. Use of DNA typing in bone marrow transplantation

2. Use of DNA typing in solid organ transplantation

3. Disease associations with HLA Class I and Class II alleles

4. HLA polymorphism and human anthropology

5. Forensic medicine and paternity testing

6. Mutation detection IV. Management The fellow will be given basic management principles together with specific skills unique to histocompatibility and transplantation laboratories. These skills will be

learned by:

• Attending selected management meeting

• Participating in daily problem solving in laboratory

• Attend and participate in weekly laboratory meeting with technologists, supervisors, lab manager and director.

• Reading of training manuals

• Attending management seminars and workshops

• Rotating in pertinent CLS departments (e.g. purchasing, finance, HR)

The following topics are incorporated in the training:

–  –  –

B. Accounting principles applied to the laboratory

1. Budget preparation and monitoring

2. Developing charges, cost accounting, billing

3. Computer break-even point (BEP) C. Personnel Management

1. Recruitment, salaries and fringe benefits

2. Defining job descriptions, objectives, responsibilities

3. Training and continuing education

4. Personnel evaluations D. Laboratory organization and management principles

1. Developing structure and lines of authority

2. Logistics of laboratory operation-laboratory organization

3. Inventory and ordering

4. Evaluation of laboratory efficiency, distribution of workload

5. Evaluation of workload and turnaround time V. Research The fellow is supposed to engage in research projects throughout the training period. These projects are related to immunogenetics and histocompatiblity.


Transplant Meeting- Once a week (1h30). Review of cases by transplant surgeons, nurses, pathologists, social workers and other transplant professionals. These cases consist of kidney and/or pancreas recipients.

Bone Marrow Meeting – Once a week (1h00). Review of potential autologous and allogenic peripheral stem transplant patients by the staff of the Tom Baker Cancer Centre. These patients include individuals with CML, ALL, MM, NHL, PLL.

Lab Weekly Meeting – Once a week (1h00). Review of lab business on a weekly basis.

QA/QI Monthly Meeting- Once a month (1h00). Review of monthly QA variances, approve initiation of QI programs, follow trends, update QA indicators.

Histocompatibility Fellowship Objectives.doc 24/11/2006 7 of Test Results Review – Daily (45 min). The fellow will discuss the results of clinical typing with the laboratory director and/or laboratory supervisor.

Research Meeting – Once a week (1h00). The fellow will meet with the director to discuss the progress of the research projects.

Quarterly Research and Development Progress Meeting – Once every three months (2h00). Fellow meets with the director to review participation in research projects, scientific presentations, publications, and grant proposal writing.


CST Annual Meetings ASHI Annual Meetings ASHI Regional Workshops AFDT Courses Transplant Congress


Noureddine Berka, PhD., is the Clinical Director of the Calgary Laboratory Services Tissue Typing Laboratory. Dr. Berka will supervise the progress of the fellow and provide didactic instruction. He will work with the fellow in developing interpretative skills and troubleshooting problems. He will also serve together with other scientists as a scientific mentor for the fellow.

Serdar Yilmaz, M.D., Ph.D., F.A.C.S. is Regional Division Chief of Transplant Surgery Calgary Health Region, Calgary, Alberta Medical Director Southern Alberta Transplant Program (ALTRA). Dr. Yilmaz and his team will provide the fellow the opportunity to rotate in ALTRA and interact with transplant surgeons, transplant nephrologists, and transplant coordinators.

James Russell, M.D. Allogeneic & Autologous Stem Cell & Bone Marrow Transplantation. Doug Stewart, M.D. Allogeneic & Autologous Stem Cell & Bone Marrow Transplantation Lymphoma, Breast Cancer.

Drs. Russell and Stewart will allow the fellow to rotate in Southern Alberta ALTRA and interact with Stem Cell & Bone Marrow Transplant.

Adnan Mansoor, M.D. Division Head, Department of Haematology and Transfusion Medicine. The fellow will rotate in different aspect of flow cytometry and transfusion medicine to acquire experience in HLA transfusion support.

Patricia Campbell, MBChB, MRCP(UK), Director of Histocompatibility Laboratory Department of Laboratory Medicine & Pathology, Edmonton, Alberta. In Dr. Campbell’s laboratory the fellow will get the opportunity to document Non-renal solid organ transplant cases (e.g. heart, liver, lung).

Luz Stamm, B.S., C.H.A., is the Laboratory Supervisor with over 23 years of experience. Luz will provide the fellow with expertise in the technical performance of clinical histocompatibility testing. The technical staff at the Tissue Typing Laboratory has an average of 17 years of experience each.

Histocompatibility Fellowship Objectives.doc 24/11/2006 8 of

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