The Abdominal Organ Transplant Fellowship Program is a nationally recognized, two-year program certified by the American Society of Transplant Surgeons in liver, kidney and pancreas transplant and HPB surgery. Established in 1992, the program is tailored to suit the individual interests and previous experience of the trainee.
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Program Overview
The program’s goals are to provide fellows:
- Well-rounded training in abdominal transplant and HPB surgery in a collegiate environment with emphasis on clinical excellence
- Exposure to the latest advances in transplant and HPB surgery including MIS and Robotics for HPB and Transplant
- Early graded autonomy in patient care and in operating room
- A strong foundation for a successful career as a leader in the field of transplant and HPB surgery.
Fellows function at level of junior faculty with expectations to be involved in resident and medical student education. The fellowship program cultivates a skillset that makes the graduating fellow highly attractive to transplant surgery programs upon completion.
One kidney and liver transplant fellow matriculates in the program each year. One kidney only transplant fellow matriculates every other year. The fellowship program offers all fellows comprehensive and multi-faceted training in workup and management of adult and pediatric solid organ transplant patients, as well as patients with complex diseases of the hepato-pancreato-biliary system and GI track, in a program with dual certification from the ASTS for transplant surgery and the AHPBA for HPB surgery.
Six full-time Washington University School of Medicine liver and kidney transplant surgeons provide training to the fellows. Transplant nephrologists and hepatologists, a dedicated transplant nursing staff, social workers, dietitians, financial analysts, and a fellowship training office administrator and secretary also offer support.
Clinical Responsibilities
Typically, the first 12 to 18 months of the fellowship are dedicated to clinical responsibilities. The kidney and liver services are not separated. The transplant fellow has responsibility for inpatient and outpatient management of both services.
The fellow participates in the vast majority of all cadaveric multi-organ donor operations, living donor nephrectomies, living donor hepatectomies, kidney transplants, liver transplants and small bowel transplants.
The fellow also receives experience in a number of other clinical areas:
- Islet cell transplantation. Washington University Medical Center is an international leader in this field.
- Solid pancreas transplantation. This program was initiated in recent years.
- Vascular access procedures. The fellow participates in 20% to 50% of the 500 to 700 vascular access procedures performed annually, depending upon experience and interest.
- Non-transplant hepatobiliary (HPB) cases. The fellow may participate in a significant number of HPB cases, depending on the level of interest.
- Pre- and post-transplant care for both liver and kidney transplant patients is provided in a clinic operated jointly by the departments of surgery and medicine. The fellow participates in the clinics and performs biopsies under the supervision of attending physicians, both medical and surgical.
Fellows gain experience in open and minimally invasive (laparoscopic and robotic) techniques with structured training and high case volumes. Fellows regularly participate in a number of cases far exceeding the ASTS requirement, with many fellows involved in more than double the required cases. Below are transplant case volumes for 2020:
| Liver Transplants | 140 |
| Kidney Transplants | 301 |
| Pancreas Transplants | 9 |
| Living Donors (Kidney) | 70 |
Similarly, the fellow participates in a high volume of HPB surgery cases, including minimally invasive (laparoscopic and robotic) HPB surgery. Below are select institutional HPB case volumes for 2019:
| Bile Duct Resections and Reconstructions | 83 |
| Bile Duct Resections without Reconstruction | 24 |
| Major Non-transplant Related Hepatectomies | 54 |
| Major Non-anatomic Hepatic Resections | 78 |
| Pancreaticoduodenectomies (Whipple) | 92 |
| Total or Partial Pancreatectomies (Non-Whipple) | 59 |
Research
Research comprises 6-12 months of the fellowship, as determined by the prior experience and interest of the fellow. An active research program in the Department of Surgery provides many opportunities for fellows to pursue their interests. Research mentors also may be selected from other departments within the Medical Center.
Fellows are expected to develop an independent research project and to present their findings at one of the program’s weekly conferences. In addition, fellows are strongly encouraged to present their experimental data at a national meeting and to publish their outcomes in peer-reviewed journals. The goal is for trainees to develop a plan for continued research and prepare to compete for extramural funding as independent investigators, if they wish to pursue opportunities in the field of transplantation research.
The fellow has access to the institutional database of transplant and HPB surgery, and opportunities for multi-institutional collaboration and access to the national transplant database for outcomes research.
Fellows with an interest in public health research have the opportunity to collaborate with the Washington University School of Public Health for new and ongoing research projects.
In basic science research, the fellow can work with a transplant surgery research mentor as part of an existing project or to work on new ideas for transplantation research.
Education
The fellow participates in ASTS curriculum and AHPBA grand rounds, as well as institutional meetings and conferences, as part of their formal training.
The fellow also has access to the Washington University Institute for Surgical Education (WISE) Center for simulation training in robotic and laparoscopic techniques. The WISE Center is a dry lab setting for surgical skills practice. It was one of the first surgical skills labs in the country established to serve a general surgery residency program and continues to train practicing surgeons, all surgical trainees, physicians from other disciplines, medical students, and nurses.
The simulation center has a broad curriculum that includes the use of endoscopy and laparoscopic simulators, training in surgical techniques and instrumentation, cadaver dissection, instruction in emergent procedures and preparation for performing specific surgical procedures. Learn more about the opportunities at WISE.
The fellow is also expected to participate in training Washington University surgical residents, medical students and visiting sub-interns during rounds, clinics and in the OR. The goal of this training is to prepare fellows for a career in transplant surgery at an academic medical center.