Potential liver and kidney recipients are evaluated by the transplant team and listed when approved by the appropriate selection committee. Patients are admitted on the transplant surgery service for their procedure and are subsequently discharged to the outpatient clinic. Once surgical issues are resolved, liver transplant recipients are followed by the transplant hepatologist and the transplant nephrologists follow kidney recipients. Patients are readmitted on the transplant surgery service for all transplant related problems.
Service: The transplant fellow will be expected to evaluate patients for transplantation in the appropriate transplant clinic. He will be assigned to a transplant clinic for 2 half days a week, covering both liver and kidney transplant patients. The fellow will conduct multidisciplinary rounds on the inpatient service and is expected to be involved with the daily clinical decision-making, immunosuppression management and discharge planning. The transplant service is a surgical service and the fellow would be the most senior surgical trainee with supervision responsibilities over the surgical residents rotating on the service. Autonomy will be incremented as the fellow acquires more expertise and it is expected that the fellow would manage the service independently with staff oversight by the latter part of the first year. He will also review with senior staff all radiological studies and transplant biopsies as they come up.
The fellow is expected to share in the performance of liver and kidney allograft biopsies with the hepatology and nephrology fellows. All inpatient biopsies will be assigned to the surgical transplant fellow, depending on his availability.
The fellow would share call with the senior surgical resident on the service but would be his backup for complex decision-making issues. The fellow would assist as needed, if his schedule allows, in covering vascular access emergencies on call. The fellow will be encouraged to take a fully protected weekend off every month and maintain his shared call as noted above.
Operative: The fellow will be expected to perform at least half of all cadaver and living donor organ procurements during his training period. Preferably, he would alternate cadaver donor calls with the senior surgical resident on the service in order to be available for all organ implants. It is expected that the fellow will perform well over 55 multiorgan/liver procurements and 30 laparoscopic donor nephrectomies as a primary surgeon during his training period.
The fellow is expected to be involved with all liver transplant procedures, depending on his availability. Operative strategy and technique will be emphasized and it is expected that the fellow will be the primary surgeon on most primary liver transplants by the 2nd or 3rd month after the start of the fellowship. The fellow will perform acute re-transplants for PNF and HAT. Re-transplants for chronic disease states will be performed by the fellow during his second year, earlier if technically capable by the judgment of the Program Director. It is expected that the fellow will perform well over 60 liver transplants as a primary surgeon during his training period.
The fellow would be expected to perform kidney transplants with the senior staff surgeon from the outset. Once comfortable with the procedure, he would first assist senior surgical residents, with senior staff presence, at performing kidney transplants. The transplant fellow will perform the majority of living donor kidney procedures, with senior staff assistance. It is expected that the fellow will perform well over 60 kidney transplants as a primary surgeon during his training period.