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Curriculum

  • Transplant Surgery (kidney) - Curriculum

    Rotations | Research

    Curriculum Rotations

    Our ASTS approved Kidney Transplant Fellowship is at the PGY-6 and PGY-7 level.  Applicants must be board eligible or certified in General or Urologic Surgery in the US, or hold a foreign equivalent.

    Responsibilities include comprehensive pre and post - operative management and surgical experience in kidney transplant surgery, vascular access and clinical research, as well as active living donor programs in kidney transplant. There is also experience in liver and pancreas transplantation with deceased donors and research opportunities.

    Our primary teaching responsibility is towards the Transplant Fellow, and the academic environment is contributed to further by rotating Hepatology and GI Fellows, General Surgery and Internal Medicine Residents and medical students.

    During the first 3-6 months of training the fellow concentrates on learning to manage patients outside of the O.R., on the wards. This allows the fellow to become familiar with the day-to-day management of patients with end-stage-organ-disease and of transplant recipients.  They learn to diagnose and manage pre and post-transplant complications, on the general wards and in the ICUs.  They are introduced to the basics of transplantation immunology and immunosuppression management.

    Emphasis in the O.R. during the first few months of training is placed on learning to operate as the primary surgeon for multi-organ donor procurements, kidney transplants and vascular access cases; and learning to first assist during liver transplants and resections.  Within a few months, the fellow assumes the position of surgeon for most cases, including liver transplants (50-60/yr), hepatobiliary cases (>40 major cases/yr and >60 minor cases/yr, including laparoscopies, ablations and hepatic artery chemoinfusion pumps), kidney transplants (40-50/yr), live donor nephrectomies (~20/yr), pancreas transplants (~5/yr), vascular access cases (>500/yr) and multi-organ procurements (60-80/yr, including many procurements from extended donors).  By the second year of training the fellow operates as an independent multi-organ donor surgeon and continues to be the primary surgeon (supervised) for most other cases.

    The senior fellow is given much independence in routine patient management, including immunosuppression, and matures in management of complex problems.  Emphasis is placed on mastering the use of ancillary radiology, pathology, immunology and clinical laboratory procedures.  The senior fellow also becomes increasingly involved with the care of out-patients undergoing pre-transplant evaluation and post-transplant follow up.  The fellow also learns the implications and ins/outs of the organ allocation system.

    Rotations | Research | Top

    Research Requirements

    During the 2 year clinical fellowship there are research requirements.  Research is performed during the clinical rotations, as there is no off-service time.  The fellows participate in clinical trials and perform analytic reviews using our up-to-date database.  They learn about the IRB process and work with our full-time transplant research coordinators as well as with the institutional statistician.  Most fellows choose to work in the animal lab where we have several ongoing experiments - mostly using swine models.  The fellows are guided in preparation of manuscripts. Each fellow must submit a minimum of 1 abstract for conference presentation. Fellows are encouraged to prepare peer review journal publications.  Each fellow attends at least 1 national meeting per year.

    Additionally, the fellow serves as a supervisor and teacher for the rotating residents and medical students.