Introduction

Welcome to the Advanced Hepatology Fellowship at Gastrointestinal Unit at Massachusetts General Hospital. This is an advanced fellowship open only to those doctors who have already completed their three year specialized Gastroenterology fellowship at an accredited institution.

The overall goal of advanced training in liver disease is to prepare hepatologists competent to manage the full spectrum of hepatological problems, including the management of patients undergoing liver transplantation. All training programs must provide trainees with a broad knowledge of the physiology of the liver and a thorough knowledge of the management of patients with hepatobiliary diseases. The goal of the program is for the trainee to be qualified to sit for the Certificate of Added Qualification for Transplant Hepatology sanctioned by the ABIM. In so doing, the trainee will satisfy requirements for United Network for Organ Sharing (UNOS) certification for Transplant Hepatology.

1. Training and experience in management of end stage liver disease
2. Training in the selection of appropriate transplant recipients and donors (cadaveric and living), including ethical issues
3. Understanding of transplant surgical procedures
4. Understanding of immediate and long-term care of the transplant recipient
5. Management of immunosuppressive agents, including pharmacokinetics and drug-drug interactions
6. Evaluation of allograft dysfunction
7. Experience in the management of at least 20 allograft recipients
8. Evaluation and pre and postoperative management of living donors

On this page you can download application forms. The deadline for the 2007 fellowship is August 1st, 2006. Please contact Dr. Raymond Chung, Director of Hepatology, for further information: (617) 724-7562 or by email.

Program Staff

Raymond Chung, MD Associate Professor of Medicine, Harvard Medical School Director, Hepatology Clinic Medical Director, Liver Transplant Program Massachusetts General Hospital	Jules Dienstag, MD Carl W. Walter Professor of Medicine Harvard Medical School
Andrea Reid, MD MPH Assistant Professor of Medicine Harvard Medical School	Daniel Pratt, MD Assistant Professor of Medicine Harvard Medical School
Michael Thiim, MD Clinical Instructor in Medicine Harvard Medical School

Training Schedule and Responsibilites

The overall goal of advanced training in liver disease is to prepare hepatologists competent to manage the full spectrum of hepatological problems , including the management of patients undergoing liver transplantation. All training programs must provide trainees with a broad knowledge of the physiology of the liver and a thorough knowledge of the management of patients with hepatobiliary diseases. The goal of the program is for the trainee to be qualified to sit for the Certificate of Added Qualification for Transplant Hepatology sanctioned by the ABIM. In so doing, the trainee will satisfy requirements for United Network for Organ Sharing (UNOS) certification for transplant hepatology.

Our program will ensure that the trainee acquires the following:

1. Training and experience in management of end stage liver disease
2. Training in the selection of appropriate transplant recipients and donors (cadaveric and living), including ethical issues
3. Understanding of transplant surgical procedures
4. Understanding of immediate and long-term care of the transplant recipient
5. Management of immunosuppressive agents, including pharmacokinetics and drug-drug interactions
6. Evaluation of allograft dysfunction
7. Experience in the management of at least 20 allograft recipients
8. Evaluation and pre and postoperative management of living donors

During the training period, comprehensive teaching of the following subjects is essential:

1. Experience in the management of patients at high listing status in the intensive care setting, including acute liver failure, refractory ascites and hepatic hydrothorax, hepatorenal syndrome, hepatopulmonary syndrome, portopulmonary hypertension, and refractory portal hypertensive bleeding.
2. Detailed familiarity with transjugular intrahepatic portosystemic shunts.
3. Diagnosis and management of hepatocellular carcinoma and cholangiocarcinoma, including the role of radiofrequency ablation, chemoembolization, chemotherapy, resection, and liver transplantation
4. Management of chronic viral hepatitis in the pretransplant and posttransplant settings
5. Management of acute liver failure, including principles of intracranial pressure monitoring
6. Psychosocial evaluation of all transplant candidates, in particular those with a history of substance abuse.
7. Working knowledge of transplant immunology, including histocompatibility and tissue typing, and infectious and malignant complications of immunosuppression
8. Nutritional support of patients with chronic liver disease
9. Use of interventional radiology in the diagnosis and management of portal hypertension, as well as biliary and vascular complications
10. Ethical considerations relating to liver transplant donors, non-heart beating donors, criteria for brain death.
11. Liver pathology, including histological interpretation and specific pathological techniques, and including interpretation of allograft histology in patients undergoing liver transplantation
12. An understanding of the principles of experimental design, clinical biostatistics, and epidemiology sufficient to critically interpret the medical literature
13. Pediatric and congenital hepatobiliary disorders

Components of Training in Transplant Hepatology

Blocks

6 months on inpatient liver service in 1st year. Rotation includes several components:

1. inpatient consultations
2. inpatient care of patients awaiting liver transplantation who are hospitalized with complications of liver disease
3. participation in postoperative care of patients undergoing liver transplantation at MGH (expect to be involved in care of 20+ patients who have undergone liver transplantation)
4. performance of endoscopy and liver biopsy on inpatients with liver disease

Longitudinal

1. Hepatology Clinic- weekly = day outpatient experience for advanced fellow paired with Hepatologists specializing in chronic viral disease, cholestatic and autoimmune liver disease (Dr. Chung, Pratt, Thiim, Reid)
2. Post-liver transplant clinic weekly = day outpatient experience for advanced fellow paired with Dr. Hertl (Surgical Director, Liver Transplant)
3. Outpatient endoscopy
4. Outpatient liver biopsy
5. LBP Rounds (weekly)
6. Ellison Rounds (weekly)
7. Core curriculum conference (biweekly)
8. Didactic lectures (biweekly)
9. Liver Pathology Rounds (weekly)
10. Biweekly Liver Case Conference- multidisciplinary conference (Radiology, GI, Path)
11. Clinical Journal Club (weekly)
12. Research Journal Club (weekly)
13. Informal contact with hepatology faculty (Chung, Pratt, Thiim, Reid, Dienstag)
14. Independent research project (6 months dedicated but continuous for 12 months)
15. Teaching fellow will participate in regular minitalks during the inpatient service months for the team (attending, 1st year fellow, residents, students); will also regularly host case conference in rotation with the 4 Hepatology attendings (every 10th week).