ASTS-Approved Multiorgan Transplantation Fellowship

Overview

Fellowship training in liver-kidney-pancreas-small bowel transplantation is offered as a combined two-year program. Candidates must have completed an accredited general surgical residency (or its foreign equivalent) prior to beginning the fellowship. During this period of training, intensive experience is provided in all aspects of clinical transplant surgery. Yearly total clinical activity on the services includes approximately 150-200 liver transplants, 110 kidney transplants, 20 small bowel or multivisceral transplants, 12 pancreas transplants, and 100 hepatic resections.

The two-year clinical program is meant to provide comprehensive training in all aspects of transplant management. The fellow receives early intensive training in organ procurement and preservation. Within months the fellow develops expertise in procurement techniques for liver, small bowel, pancreas, and kidneys as well as an understanding of the current concepts of organ preservation. It is expected that within a few months the fellow will independently lead procurement teams. Along with this procurement function, there is a learning process in donor evaluation.

Along with proficiency in donor surgery, attention is also focused on the recipient operations. The fellows participate in all the recipient procedures and after a period of time will be expected to function in a semi-independent fashion. Recent fellows have performed 40 to 50 liver transplant procedures as the primary surgeon by the end of their training period.

The transplant fellow is expected to participate in the out-patient area and become integrally involved in the work-up of patients referred for possible transplantation. This includes working with team hepatologists and nephrologists and attending candidate evaluation conferences and presentation of these patients to appropriate review committees. The fellow is expected to know the evaluation process and facilitate the expeditious determination of candidacy.

Post transplant care of the transplant patient, including the direction of immunosuppression, the treatment of rejection and the handling of postoperative complications is the primary responsibility of the transplant team. There is a full complement of dedicated specialists in immunology, infectious disease, pulmonary medicin,e and cardiology as well as nephrologists, gastroenterologists, and hepatologists who are part of the team. The fellow directs the daily care of the patient under supervision of the attending staff, becoming more independent with time.

By the end of the fellowship, it is expected that the fellow will have mastered not only the surgical techniques, but also those of immunosuppression and general management of the transplant patient.

Clinical and basic science research is fundamental to the transplant center. With more than 2,000 patients transplanted and an expectation of transplanting 250-350 patients a year, there is much to learn about all aspects of transplantation.

We are now involved in many ongoing clinical prospective trials, as well as having basic science laboratories. Our fellows have had the opportunity to participate in the projects, as well as present at major transplant meetings.