Kim Solez FINAL Whatever You Can Do, Or Dream You Can, Begin It- Report from the Early Days of Banff 1.pptx
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Kim Solez emphasizes the significant contributions of women in the Banff transplant process and highlights the historical importance of the Banff 97 meeting report. He reflects on key discoveries such as tubulitis and their role in advancing the Banff classification over the decades, while also acknowledging the friendships and collaborations that shaped this journey. Solez concludes by encouraging innovative approaches in transplantation, particularly in xenotransplantation, recognizing that past methods may not suffice for future challenges.
Kim Solez FINAL Whatever You Can Do, Or Dream You Can, Begin It- Report from the Early Days of Banff 1.pptx
- 2. I have no Disclosures. “Whatever You Can Do, Or Dream You Can, Begin It: Boldness has Genius, Power, and Magic in It.” Many of the most important bold moves in Banff were moves by Women. There should be an effort to honor the Women of Banff. Probably the leadership of Banff will become majority female. For those of us there at the beginning in the early 1990’s the most important bold move of that era is at the top of our Google Scholar Profile: The 1997 Meeting Report. Negotiated by Kim Solez and Bob Colvin but Lorraine Racusen wrote the paper and is first author! The paper is timeless and a citation classic!
- 4. Special thanks for Lorraine Racusen for everything over the past 31 years, but especially for the bold move of writing of the pivotal Banff 97 paper! We have benefitted enormously from the high quality of that paper and her continued devotion to the Banff Process throughout the decades!
- 5. A Special Thanks for Robert Colvin, A True Gentleman to Negotiate with. The process was fun and productive! We have benefitted enormously from the high quality of the negotiations in the beginning and Bob’s continued devotion to the Banff Process throughout the decades!
- 6. On December 6, 2021, a Halloran lightening bolt of out the blue! “Who identified tubulitis as a marker of TCMR? I learned about it from you. It is a fundamental discovery! It outperforms many of the gene transcript sets as a predictor!” Phil said. I poured over many editions of Heptinstall’s textbook. Kendrick Porter’s chapter mentioned finding lymphocytes in urine during rejection but tubulitis was not described.
- 7. What was the trajectory of the foundational discovery of tubulitis? The first four editions of Heptinstall’s book 1966-92 contained no reference to tubulitis, but just reference to lymphocytes in the urine in rejection seen by cytology with references back to 1964 in the Transplantation chapter by Kendrick Porter. Larger lymphocytes were seen at peaks of rejection. Graphics by University of Montreal Pathology Resident Qing Yin Wang.
- 8. Tubulitis was first described in native kidney interstitial nephritis by Victor Pollak in 1975 who included the peritubular infiltrate. Richard Sibley inaccurately described it as lymphocytes invading tubular cytoplasm in transplants in 1983. Regina Verani described it vaguely in transplants in 1984. We were the first to accurately describe it in the transplanted kidney in 1985. Graphics by University of Montreal Pathology Resident Qing Yin Wang. Pollak 1975 Sibley 1983 Verani 1984 Solez 1985
- 9. The fundamental discoveries of the Banff Classification were foreshadowed in the clinical trials of cyclosporine between the mid 1970s and early 1980s. In 1983 cyclosporine received FDA approval. That year James Burdick and I started a protocol biopsy study of cyclosporine treated patients biopsied at 1 and 4 weeks. In 1985 we described tubulitis in those biopsies as “Mononuclear cells lying between tubular epithelial cells, or beneath them just inside the tubular basement membrane.” This became the crucial backdrop against which the Banff Classification was created 6 years later. Graphic by University of Montreal Pathology Resident Qing Yin Wang.
- 10. In the original Banff Classification article in KI in 1993 Editor Tom Andreoli thought the specificity of tubulitis for acute TCMR and the nonspecificity of the interstitial inflammatory infiltrate was so important that everything about that should be put on the first page and that was done.
- 11. In the original Banff Classification article in KI in 1993 Editor Tom Andreoli thought the specificity of tubulitis for acute TCMR and the nonspecificity of the interstitial inflammatory infiltrate was so important that everything about that should be put on the first page and that was done. That paragraph begins and ends with tubulitis! We described the nonspecificity of interstitial infiltrates in 1984 and the specificity of tubulitis in 1985.
- 12. Today and into the future tubulitis remains just as important as ever. It figured prominently in the the three articles in the March 2022 issue of AJT with cover graphic “Acute T Cell-Mediated Rejection: Still a Worthy Opponent”. For decades tubulitis has been the focus of morphometry programs, and so now the best machine detection systems use a combination of hand-crafted features, texture analysis, and machine learning, see recent March and May 2022 Banff Digital Pathology Working Group videos with Ulysses Balis https://youtu.be/KkVS7Hucvh0 https://youtu.be/uwodKQIamkE
- 13. The success of the Banff Classification resulted in the adoption of “biopsy proven rejection” as an end point in clinical trails, and of identifying a central pathologist for those trials. Thirty years ago, in 1992, clinical trials began with mycophenolic acid with me as the central pathologist. For the next three decades I saw 3- 7 times more biopsies from clinical trials than I did from local patients, with many different clinical trails of different compounds. There were informal educational uses of the digital images for fellow training in 2010 and 2019 when the fellow and I were in the same room but only this year have we included such teaching into the formal contracts. It took 30 years to accomplish that! We cannot identify the clinical trials involved. “A clinical trial.”
- 14. The Rebel Spirit was Evident Early On, Heckling At USCAP First Presentation of Banff Schema in 1992. DALL-E Image.
- 15. You might have expected a falling out after this, but exactly the opposite happened. Agnes Fogo became one of my closest friends and there are many pictures of my wife and me doing things with her over the years. 1998
- 16. You might have expected a falling out after this, but exactly the opposite happened. Agnes Fogo became one of my closest friends and there are many pictures of my wife and me doing things with her over the years. 1999 with Larry Hunsicker
- 17. You might have expected a falling out after this, but exactly the opposite happened. Agnes Fogo became one of my closest friends and there are many pictures of my wife and me doing things with her over the years. 1999 with Larry Hunsicker
- 18. You might have expected a falling out after this, but exactly the opposite happened. Agnes Fogo became one of my closest friends and there are many pictures of my wife and me doing things with her over the years. 1999 hiking in Banff
- 19. You might have expected a falling out after this, but exactly the opposite happened. Agnes Fogo became one of my closest friends and there are many pictures of my wife and me doing things with her over the years. 2001 with Larry Hunsicker and Bob Colvin
- 20. You might have expected a falling out after this, but exactly the opposite happened. Agnes Fogo became one of my closest friends and there are many pictures of my wife and me doing things with her over the years. 2001 with Larry Hunsicker and Bob Colvin
- 21. Agnes was most often the person who got discussions unstuck when we were at an impasse, Bob and Larry also did that. However, that alone does not completely explain my enthusiastic embrace of the rebel voice. To fully understand that you need to know about Gary Green and Michele Hales. See also Sept. 9 video: https://www.youtube.co m/watch?v=4ViyIwHaxy w
- 22. We were rebels too! That explains my enthusiastic embrace of the rebel voice. You need to know about Gary Green’s and Michele Hales’s role. Another bold move by a woman! See also Sept. 9 video: https://www.youtube.co m/watch?v=4ViyIwHaxy w Anothere
- 23. Finally, a word about consensus generation styles which is part of what Mark Haas is talking about next. Sam Kaner has a book on the subject 1996-2022, but we have been consistently ahead of him through the decades. In 1996 he talked about “incorporating troublemakers”. Banff calls them “spirited debaters”. Much better! They are part of our past and future! Long live the rebel spirit! Always something to look forward to!
- 24. A final word about how “we cannot go home again”. In 1999 Agnes Fogo waded in Cavell Pond at the base of Mount Edith Cavell in Banff. Thirteen years later 60% of the Ghost Glacier fell into that pond in the early morning of Aug. 10, 2012, when no one was in the park. It took six years to reopen that part of the park! We cannot do something new like Xeno using old ways! Looking forward to the new! The pond Agnes Fogo waded in in 1999 was completely obliterated when the Ghost Glacier fell in 2012. We cannot start the Xenotransplantation Pathology Classification like we started other things thirty years ago.