1. UK National Renal Transplant EQA Scheme Ian Roberts Department of Cellular Pathology, Oxford Radcliffe Hospitals The National Renal Transplant EQA Scheme is sponsored by Fujisawa Ltd

2. EQA in Histopathology maintenance & improvement of diagnostic standards education vs performance assessment required for CPD and CPA RCPath EQA steering committee - sets performance standards investigates substandard performance

3. EQA in Histopathology substandard performance: anonymous letter of enquiry NQA Advisory panel informed and determine whether low EQA scores reflect standards of routine practice site visit review panel Medical Director informed

4. EQA in Histopathology “ these procedures should be activated only in exceptional circumstances, and should cause no more concern to EQA participants than the possibility of being reported for incompetence by a colleague”

5. slides circulated to participants responses submitted to scheme organiser feedback of group diagnoses to participants cases discussed at participants meeting diagnoses scored persistent substandard performers identified remedial action EQA in Histopathology

6. slides circulated to participants responses submitted to scheme organiser feedback of group diagnoses to participants cases discussed at participants meeting Renal Transplant EQA Scheme slides circulated to participants responses submitted to scheme organiser feedback of group diagnoses to participants cases discussed at participants meeting diagnoses scored persistent substandard performers identified remedial action

7. Renal Transplant EQA Scheme 44 participants from 31 centres Case submission: 7 sets of slides (H&E and PAS/silver) diagnostic lesion is present in all slides biopsy is adequate by Banff criteria

9. Renal Transplant EQA Scheme participants divided into 6 cells Circulations organised using Genpath software: sets circulation dates automatic reminder letters

12. Educational value enables pathologists to compare their diagnoses and their Banff grading with the whole group identifies differences in use of terminology identifies misunderstanding of the Banff classification and its application ongoing measure of the reproducibility of Banff criteria highlights areas of diagnostic difficulty

13. Terminology

14. Application

15. Reproducibility

16. mononuclear cell interstitial inflammation i1 (i2,t0,v0) acute cellular rejection, type IA (i1,t1,v1) acute rejection mild grade 1 (i1,t2,v0) acute rejection, typeIA acute rejection, typeIIA acute rejection, typeIIB acute vascular rejection, NOS 1 1 1 1 15 8 1 acute tubular necrosis donor vascular disease 2 1 Case 21

17. Reproducibility Case 22borderline changes/suspicious of rejection acute rejection, typeIA (i2/3,t1,v0) acute rejection, typeIA acute rejection, typeIB severe acute parenchymal rejection, type IIA (i3,t2,v0) acute rejection, moderate grade 2 (i3,t3,v0) acute cellular rejection chronic allograft nephropathy ?polyoma virus infection 3 5 9 3 1 1 1 4 1 CAN ?CsA/tacrolimus toxicity acute tubular injury arteriolitis 7 2 1 1

18. Difficult diagnoses acute pyelonephritis, no rejection borderline changes/suspicious of rejection acute rejection (i?,t1) acute rejection, typeIA acute rejection, typeIB chronic allograft nephropathy inadequate specimen Case 23 11 4 1 9 1 1 1 12 8 4 2 1 1 acute pyelonephritis donor vascular disease chronic allograft nephropathy CsA toxicity exclude obstruction ?interstitial nephritis

19. Difficult diagnoses

20. Renal Transplant EQA Scheme identifies practical difficulties in the application of the Banff schema in routine practice identifies areas of diagnostic difficulty that should be specifically addressed in the future

21. Renal Transplant EQA Scheme identifies practical difficulties in the application of the Banff schema in routine practice identifies areas of diagnostic difficulty that should be specifically addressed in the future for the patients: improves the diagnostic accuracy of the pathologist looking at their biopsy