Multi-Organ Transplantation Surgery Fellowship

The Abdominal Transplant Surgery Program is a combined, two-year clinical fellowship that provides experience in adult and pediatric organ transplantation and hepatobiliary surgery. Accredited by the American Society of Transplant Surgeons (ASTS) to train fellows in liver and kidney transplantation, the program is approved and overseen by the Graduate Medical Education Committee of Mount Sinai School of Medicine.

This intensive training exposes fellows to all aspects of clinical transplant surgery of the liver, kidney, pancreas, and small bowel. Annual clinical activity on the services includes more than 100 liver transplants, over 200 kidney transplants, 10 small bowel or multivisceral transplants, 12 pancreas transplants, and about 200 hepatic procedures. In the first year, fellows complete a standard curriculum. In the second year, fellows concentrate on specialized areas of interest. By the end of the fellowship, fellows master surgical techniques as well as the general management of transplant patients.

It is the responsibility of each clinical transplant fellow on each of the separate transplant rotations to provide comprehensive clinical care to all patients on his or her service. In each clinical rotation, fellows are involved in all aspects of pre- and post-transplant evaluation and care, particularly in the work-up and listing of transplant candidates, the evaluation of living and deceased donors, and the management of immunosuppression and its side effects and complications. The fellows participate in all operative procedures, starting in their first rotation, and their operative responsibilities increase proportionately to their experience and operative skills. Fellows are expected to demonstrate excellent clinical documentation skills and to be knowledgeable about and compliant with federal and state law, hospital policy, legal precedent, and the requirements of ACS, the American Board of Surgery, ASTS, and the United Network for Organ Sharing. Fellows are also subject to work-hour limitations, as required by New York State Hospital Code 405.

Fellows achieve competency in transplant management and receive early intensive training in organ procurement and preservation. Fellows quickly develop expertise in procurement techniques for liver, small bowel, pancreas, and kidneys as well as an understanding of the concepts of organ preservation. Within months of beginning their training, fellows independently lead procurement teams.

While attaining proficiency in donor surgery, fellows participate in all recipient procedures and ultimately function semi-independently. Following ASTS requirements, each fellow must perform a minimum number of transplant procedures as the primary surgeon by the end of their training in order to be considered accredited in each particular area. The program exceeds the minimum requirements of ASTS, which are as follows:

Fellows provide outpatient care to transplant patients and become integrally involved in the work-up of patients referred for possible transplantation, working with team hepatologists and nephrologists, attending candidate evaluation conferences, and presenting patients to appropriate review committees. While mastering the evaluation process, fellows learn to facilitate the expeditious determination of transplant candidacy.

Fellows are an essential link on the transplant team, whose primary responsibility is the post-transplant care of the transplant patient. This includes the direction of immunosuppression, the treatment of rejection, and the handling of postoperative complications. The team is composed of a full complement of dedicated specialists in immunology, infectious disease, pulmonary medicine, cardiology, nephrology, gastroenterology, and hepatology. The fellow directs the daily care of the patient under sthe upervision of the attending staff, becoming more independent with time.

Rotations

The fellowship consists of five rotations:

• Adult liver transplant
• Pediatric liver transplant and intestinal transplant (pediatric and adult)
• Kidney/pancreas
• Hepatobiliary surgery
• Donor surgery (deceased and living donors)

Fellows rotate through each of these services in four-week blocks over the course of two years. Each transplant service has a multidisciplinary team that includes:

• Attending surgeon
• Fellow surgeon
• Attending hepatologist/nephrologist/pediatrician
• Residents/physician assistants (PAs)/nurse practitioners (NPs)
• Social worker
• Nurse coordinator
• Nutritionist
• Pharmacist
• Other allied health personnel, as required

Primary in-house call is the responsibility of residents/PAs/NPs. Fellows often serve as the primary back-up. When fellows are unavailable (e.g., multiple operative cases, travel, duty hours restrictions), the attending physicians serve as primary back-up.

Transplant calendar of meetings and lectures

Fellows are required to attend clinics and conferences on each rotation. There are also several conferences that all fellows are expected to attend. Many of these conferences cover topics in histopathology, immunology, allograft biopsy interpretation, tissue typing, and histocompatability. Please refer to the schedule below for a breakdown of these meetings and lectures:

RMTI Fellowship Calendar [PDF]

Research

While there is no laboratory research requirement, fellows are strongly encouraged to identify clinical research projects early in their training with a faculty mentor. Fellows typically contribute to one or more ongoing clinical projects, resulting in abstracts, presentations, and papers by the end of their training.

Special topics

Fellows spend one day visiting the histocompatability laboratory to learn about HLA typing, cross matching, flow cytometry, donor-specific antibody testing, ELISAs, and other advanced immunologic testing.

They spend another day visiting the local organ procurement agency to learn about organ allocation issues, UNOS and DonorNet, the evaluation of deceased donors, and the kidney preservation laboratory.

Mentoring

Fellows are formally evaluated each month by the attendings with whom they work. The program director reviews these evaluations with each fellow at least quarterly, and reviews the number of cases each fellow performs at least semiannually to ensure compliance with ASTS training requirements.

The program director meets at least bi-weekly with all fellows as a group to review a variety of clinical and administrative topics, to address technical and communications issues, and to elicit feedback from the fellows on any difficulties they may encounter.

A multitude of conferences and rounds provide fellows with ongoing, direct, and daily interactions, including teaching, and mentorship between the fellow and attending physicians.

How to apply

Candidates must have completed an accredited general surgical residency or its foreign equivalent prior to beginning the fellowship.