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Transplant Surgery Fellowship Curriculum

 

 

 

Teaching at Baylor University Medical Center’s Abdominal Transplant Surgery Fellowship program is multifaceted and is provided during formal rounds, didactic sessions, oral examinations, web tutorials and a weekly transplant surgery conference, which includes a monthly journal club, division morbidity and mortality, and invited lecturers.

 

Renal Transplantation

 

The 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.

 

The Fellow will participate in:

  • Evaluation and admission of the pre-renal transplant recipients
  • The kidney transplant
  • Intensive care management
  • Basic medical management
  • Immunosuppression management
  • Diagnosis and management of surgical complications
  • Evaluation of post-renal transplant patients with potential surgical complications

 

Higher-level management of complex medical problems is handled by medical specialists. The Fellow and Attending Physician work closely with the specialists to allow the best possible outcome for the kidney transplant recipient.

 

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
  • Workup and operative management of post-kidney transplant complications

 

Living Donor Renal Transplantation

 

Living donor renal transplantation makes up nearly a quarter of the kidney transplants performed at Baylor University Medical Center.  Fellows are expected to participate in the living donor nephrectomy. The donor nephrectomies are performed laparoscopically and robotically by attending physicians on our transplant team.

 

The living donor recipient operation is performed by the transplant surgeon and Fellow.

 

Liver Transplantation

 

Candidates for liver transplantation are evaluated by hepatology physicians on the medical staff at Baylor University Medical Center. Fellows participate in the surgical evaluation of the potential recipient. Cases are discussed at the weekly liver transplant selection committee meetings. This committee consists of transplant surgeons, hepatologists, social workers, transplant coordinators and other specialists on the hospital’s medical staff. Once a candidate is approved for transplant, the patient is listed according to United Network for Organ Sharing (UNOS) guidelines.

 

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.

 

Intensive care unit management of the liver transplant patient is intense and complex. The Fellow will take an active part in the management of the patient’s care. This includes fluid and transfusion management, immunosuppression management, ventilator management, management of vasoactive agents and interpretation of PA catheter data. Medical management also is part of the Fellow’s role in the ICU.

 

Inpatient liver transplant care also is provided by the Fellow. The basics of floor management include fluid/diuretic management, immunosuppression management, analysis of liver function tests, diagnosing rejection, management of co-morbid conditions and workup of infectious causes. Fellows are involved in all patient care until discharge.

 

Fellows also see patients in the outpatient clinic. Patients may require readmission for infection, rejection, or observation. Transplant patients are seen annually after transplant.  The Fellows will learn to perform bedside liver biopsies and interpret results of the follow-up studies.

 

Adult-to-adult living donor liver transplantation is also performed at Baylor University Medical Center. Fellows participate in the donor workup and subsequent donor hepatectomy. Deceased in situ split liver donors also are performed on occasion. Fellows are involved in the postoperative management of both the living donor and recipient.

 

Surgical Responsibilities:

  • Completion of a liver transplant
  • Completion of number of liver transplants to achieve ASTS certification for liver transplant (45 cases)
  • Posttransplant ICU medical and surgical management
  • Participation in both living and deceased liver harvests
  • Diagnosis and management of surgical complications (nontransplant related) after liver transplant
  • Diagnosis and management of surgical complications after living donor hepatic lobectomy

 

Pancreas Transplantation

 

Fellows also will participate and learn about donor and recipient selection for pancreas transplantation. The patient will either receive simultaneous kidney-pancreas transplant, pancreas after kidney transplant or pancreas alone transplant. The Fellow will learn the various techniques of pancreas implantation and learn to manage these patients posttransplant.

 

Organ and Tissue Procurement and Preservation

 

Deceased donor harvests are completed by Fellows and a supervising transplant surgeon. Fellows are expected to become the primary surgeon on the procurement. Livers, kidneys and pancreases are the principal organs harvested.

 

The Fellows will achieve a mastery of:

  • Deceased donor whole liver transplant
  • Deceased donor kidney harvest
  • Deceased donor pancreas harvest (for whole organ and islet)
  • Deceased donor multi-organ harvest techniques (i.e., donation after cardiac death [DCD] donors)
  • Knowledge of preservation solution types
  • Management of the unstable donor


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