Advanced Hepatology Fellowship

The goal of advanced training in liver disease is to create hepatologists competent to manage the full spectrum of hepatological problems including patients undergoing liver transplantation and to fulfill the requirements of the ABIM Certificate of Added Qualifications in Transplant Hepatology.

 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.

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

 

This is an advanced fellowship open only to those doctors who have already completed their three year specialized Gastroenterology fellowship at an accredited institution.


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

  • 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.
  • Detailed familiarity with transjugular intrahepatic portosystemic shunts.
  • Diagnosis and management of hepatocellular carcinoma and cholangiocarcinoma, including the role of radiofrequency ablation, chemoembolization, chemotherapy, resection, and liver transplantation
  • Management of chronic viral hepatitis in the pretransplant and posttransplant settings
  • Management of acute liver failure, including principles of intracranial pressure monitoring
  • Psychosocial evaluation of all transplant candidates, in particular those with a history of substance abuse.
  • Working knowledge of transplant immunology, including histocompatibility and tissue typing, and infectious and malignant complications of immunosuppression
  • Nutritional support of patients with chronic liver disease
  • Use of interventional radiology in the diagnosis and management of portal hypertension, as well as biliary and vascular complications
  • Ethical considerations relating to liver transplant donors, non-heart beating donors, criteria for brain death.
  • Liver pathology, including histological interpretation and specific pathological techniques, and including interpretation of allograft histology in patients undergoing liver transplantation
  • An understanding of the principles of experimental design, clinical biostatistics, and epidemiology sufficient to critically interpret the medical literature
  • Pediatric and congenital hepatobiliary disorders

Components of Training in Transplant Hepatology:

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

  • Inpatient consultations
  • Inpatient care of patients awaiting liver transplantation who are hospitalized with complications of liver disease
  • 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)
  • Performance of endoscopy and liver biopsy on inpatients with liver disease

Longitudinal:

  • Hepatology Clinic- weekly = day outpatient experience for advanced fellow paired with Hepatologists specializing in chronic viral disease, cholestatic and autoimmune liver disease (Drs. Ray Chung, Dan Pratt, Michael Thiim, Karin Andersson)
  • Post-liver transplant clinic weekly = day outpatient experience for advanced fellow paired with Dr. James Markann (Surgical Director, Liver Transplant) and Dr. Nahel Elias
  • Outpatient endoscopy
  • Outpatient liver biopsy
  • LBP Rounds (weekly)
  • Ellison Rounds (weekly)
  • Core curriculum conference (biweekly)
  • Didactic lectures (biweekly)
  • Liver Pathology Rounds (weekly)
  • Biweekly Liver Case Conference- multidisciplinary conference (Radiology, GI, Path)
  • Clinical Journal Club (weekly)
  • Research Journal Club (weekly)
  • Informal contact with hepatology faculty (Drs. Ray Chung, Dan Pratt, Michael Thiim, Karin Andersson)
  • Independent research project (6 months dedicated but continuous for 12 months)
  • 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).

 

On this page you can download application forms for fellowships beginning in July 2014. The deadline for the fellowship appliction is August 1st, 2014. Please contact either Dr. Raymond Chung, Director of Hepatology, for further information at rtchung@partners.org or Amy Nash at (617) 724-7450 or alnash@partners.org