Dr. Kim Solez discusses "Confronting the Question of Stem Cells and the Future of Transplantation" for the Alberta Transplant Institute Fellows Lecture Series on September 2nd, 2014 at the University of Alberta in Edmonton, Canada.

1. Kim Solez, MD

2. Who Am I?

3. Who Am I?

5. Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney, began
1991, updated and expanded every two years in
consensus meeting.

6.  1991 First Conference
 1993 First Kidney International publication
 1995 Integration with CADI
 1997 Integration with CCTT classification
 1999 Second KI paper. Clinical practice guidelines. Implantation biopsies.
 2001 Classification of antibody-mediated rejection: Regulatory agencies
participating
 2003 Genomics focus, ptc cell accumulation scoring
 2005 Gene chip analysis. Elimination of CAN, identification of chronic
antibody-mediated rejection.
 2007 First meeting far from a town called “Banff” – La Coruna, Spain.
 2009 Working groups. Meeting in Banff, Alberta, Canada
 2013 Establishment of Banff Foundation for Allograft Pathology

7. Significance of ‘Banff papers’
• 4244 citations of the 9 Banff meeting reports
• 790 Banff / Transplantation papers in PubMed
• Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
• 3 Banff meeting reports are among the top 4 cited AJT articles

8. Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees:
K. Solez (Chair), L. Racusen, D. Glotz, J. Demetris, M. Mengel, M. Mihatsch, D. Seron, N.
Schmidt
2015 Scientific program committee:
Alex Loupy (Chair)
Mark Haas, Banu Sis, Kathryn Tinkham, Candice
Rofousse, Chris Bellamy, Lynn Cornell, Carmen
LeFaucheur
Composite tissues: Linda Cendales
Heart : Rene Rodriguez
Liver: Jake Demetris
Lung: William Wallace and Carol Farver
Pancreas/Islets: Cinthia Drachenberg and John
Papadimitriou
progress
reports to Budged
2015 Local Conference
chair: Michael Mengel
reports to
Secretary/Treasurer:
Michael Mengel
reports to
Organ Steering committee
Chairs:
Composite tissues: Linda Cendales
Heart : Rene Rodriguez
Kidney: Mark Haas
Liver: Jake Demetris
Lung: William Wallace and Carol
Farver
Pancreas: Cinthia Drachenberg
funding
collaboration
collaboration
Banff Working Group (BWG) Leads:
Molecular transplantation pathology: Michael Mengel, Banu Sis
Isolated v-lesions: Banu Sis, Ed Kraus
Quality assurance in transplantation diagnostics: Michael Mengel and
Parmjeet Randhawa
C4d-negative ABMR: Mark Haas, Banu Sis, Alexandre Loupy
Fibrosis scoring: Robert Colvin, Brad Farris, Michael Mengel
Digital Pathology in Transplantation: Jake Demetris
collaboration
reports to
collaboration
proposal and
accountability
for meeting
costs
support

11. Target Audience for the 2015 joint
CST/Banff meeting: total ~600 expected
delegates
 Basic Scientists
 Pathologists
 Immunogeneticists and HLA experts
 Transplant Physicians: Internal Medicine, Surgery,
Infectious Diseases, Critical Care
 Allied Health Care
 Students, Trainees, Fellows

12. The Banff Process
Consensus communication in renal transplantation
a
The Banff
lesions
g, i, t, v - score
The Banff
community
Pathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff
classification
Current consensus for
diagnostics
moderated
Banff meetings
thesis-antithesis-synthesis
tentative
thresholds
participate
Banff Working refinement
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New members
Biostaticians
Molecular Biologists
“Omics”-specialists
Off-springs
Liver
Pancreas
Lung, Heart
CTA

13. The Banff Schema was first developed
at a meeting of pathologists, clinicians
and surgeons in Banff, Alberta, Canada,
August 2-4, 1991 and has become the
worldwide standard for the interpretation
of transplant biopsies.

14. The Banff Schema was first developed
at a meeting of pathologists, clinicians
and surgeons in Banff, Alberta, Canada,
August 2-4, 1991 and has become the
worldwide standard for the interpretation
of transplant biopsies.

16.  Moore’s Law&Eroom’s Law , the
technological Singularity and
exponential change, exponential
decline in # new drugs per
billion dollars R&D expenditure.

17. The Technological
Singularity

18. The Banff Foundation for Allograft Pathology
Must Remain Youthful and Relevant for the
Future – Must Adapt, Plan for Changes
 As the field changes and stem-cell-grown organs replace
transplantation, the organization must change with it
 Transplantation may be loosing its luster but luster of the
Banff Foundation for Allograft Pathology can remain
strong.
 As an exercise in alternative realities I asked participants
to consider the very different life of David Crippen, my
counterpart in critical care medicine. We need to consider
changes that large!

19. The spectacular dynamics influencing the
pace of stem generation of organs replacing
transplantation in the future.
 There were YouTube videos (now removed) suggesting
that stem cell generation of complex organs in humans
would be routine by 2020. Problems of clotting, endothelial
loss, and cell type selection errors not mentioned.
 The dramatic slowdown of new drug approvals (Eroom’s
Law) by the FDA suggests that the FDA is ripe for
disruptive innovation. Has happened.
 However stem cell therapies may be the last area the FDA
will relax regulation in, as unproven bogus stem cell
therapies are causing widespread suffering and protection
of the general public is needed.

20. Many problems with stem cell generate
organs not being discussed. Do not exclude
yourself from the action in this area!

21. Many problems with stem cell generate
organs not being discussed. Need to get
those conversations to happen.
 The recellularized organ clots like crazy, impossible to
regenerate more than 80% of endothelial surface. Artificial
heparized surface not fenestrated. Cell traffic abnormal.
 Hard to get right types of cells to right places.
 Podocytes seems to be terminally differentiated cells,
when attempt to culture them they turn into different type of
cell.
 Kidney progenitor stem cell difficult to identify, kidney work
has lagged behind.
 Easy to make stem cell generated kidneys that lack loop of
Henle. Could produce lethal polyuria. What is “function”?
 Many old fashioned questions of physiology about how the
stem cell generated organ works, not just true for kidney,
true for every organ.

22.  Transplant
pathologists will also
become tissue
engineering
pathologists,
pathologists who
analyse organs grown
from stem cells. This is
not something beyond
us, we can adapt to a
work life that includes
stem cells.. Someone
needs to cross the
disciplines,

23.  Many of the questions
that need to be posed
about stem cell
generated organs are old
fashioned questions,
intact nephron
hypothesis, cell
regeneration, stunned
myocardium, contraction
band necrosis etc. Use
your nostalgia! Stimulate
conversations between
stem cell researchers and
transplant physicians.

24. Turtles
All
the
Way
Down
abstrusegoose.com/155

25. Animal
Analogies
Limited.
Need Human
Alter Egos

26. CCM-L
Characters
Off-Topic
Discussions
NEPHROL
No Characters
No Off-Topic
Discussions

27. Many Military
Awards, Karate
Black Belt
No Civilian Awards
Never Served in
Military
Many Civilian
Awards

28. Rock Band
Motorcycles
Colorful History in
60’s and 70’s
No Band or
Motorcycle
Boring Young Person

29. Crippen A
Myth?
Proves the
Metaphor
Works!