Abdominal Transplant Surgery Fellowship

Renal transplantation

Pre-renal transplant patients are worked up by nephrologists on the medical staff. These cases are presented at the weekly kidney transplant selection committee for approval. The committee consists of transplant surgeons, nephrologists, social workers, transplant coordinators and other consultants.

After the kidney transplant, the recipient is under the primary care of the transplant surgical team.

Fellows participate in:

• Donor offer evaluation
• Evaluation and admission of the pre-renal transplant recipients
• The kidney transplant
• Intensive care management
• Basic medical management
• Manejo de inmunosupresión
• Diagnosis and management of surgical complications
• Evaluation of post-renal transplant patients with potential surgical complications

Fellows' surgical responsibilities for kidney transplantation include:

• Completing a kidney transplant as primary surgeon
• Completing the number of kidney transplants as described by American Society of Transplant Surgeons (ASTS) certification guidelines (40 cases)
• Participating in deceased donor renal procurements
• Becoming familiar with and using renal perfusion pumps
• Performing workup and operative management of post-kidney transplant complications

Liver donor renal transplantation

Living donor renal transplantation makes up nearly a quarter of the kidney transplants performed. All donor nephrectomies are performed robotically.

Fellows are expected to learn and eventually perform living donor nephrectomies (ASTS requires fellows to perform 12 cases)

Trasplante de hígado

Candidates for liver transplantation are evaluated by fellow and transplant surgeon. Cases are discussed at the weekly meetings of the liver transplant selection committee, which consists of transplant surgeons, hepatologists, and other specialists on the hospital’s medical staff, along with social workers and transplant coordinators.

Fellows participate in the admission and workup of patients at the time of surgery. After transplant, Fellows continue to care for the post-liver transplant recipient in all aspects of his/her medical and surgical needs.

Surgical responsibilities include:

• Completion of a liver transplant
• Completion of the number of liver transplants to achieve ASTS certification for liver transplant (45 cases)
• Pre- and post-transplant ICU medical and surgical management
• Performing deceased donor liver procurements (both DBD and DCD)
• Participation and performing robotic live donor hepatectomies
• Diagnosis and management of surgical complications after liver transplant
• Diagnosis and management of surgical complications after living donor hepatectomy

Unidad de Cuidados Intensivos

Intensive care unit management of the liver transplant patient is intense and complex. Fellows take the lead in the management of the patient’s care, together with the intensivist team:

• Fluid and transfusion management
• Manejo de inmunosupresión
• Ventilator management
• Management of vasoactive agents
• Interpretation of PA catheter data
• Administración medica

Cuidado de paciente hospitalizado

Inpatient liver transplant care also is provided by fellows, who are involved in all patient care until discharge. The basics of inpatient management include:

• Fluid/diuretic management
• Manejo de inmunosupresión
• Analysis of liver function tests
• Diagnosing rejection
• Management of co-morbid conditions
• Workup of infectious causes

Atención ambulatoria

Fellows also see patients in the outpatient clinic. Patients may require readmission for infection, rejection or observation. Transplant patients are seen by the surgical team for 6 weeks postop and as needed thereafter. Fellows learn to perform bedside liver biopsies and interpret results of the follow-up studies.

Trasplante de páncreas

Fellows participate in and learn about donor and recipient selection for pancreas transplantation.

Fellows' surgical responsibilities for pancreas transplantation include:

• Completing a pancreas transplant as primary surgeon
• Completing the number of pancreas transplants as described by American Society of Transplant Surgeons (ASTS) certification guidelines (10 cases), backtable (10 cases), and pancreas procurements (10 cases)
• Performing deceased donor pancreas procurements
• Performing workup and operative management of post-pancreas transplant complications

Organ procurement

Deceased donor procurements are completed by fellows and a supervising transplant surgeon. Fellows are expected to become the primary surgeon on the organ and tissue procurement and preservation team. Livers, kidneys and pancreases are the principal organs procuremented.

Fellows gain experience in:

• Deceased donor whole liver transplant
• Deceased donor kidney procurement
• Deceased donor pancreas procurement (for whole organ)
• Multiorgan procurement in donation after circulatory death (DCD)
• Use of perfusion technologies including NRP & NMP