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The program is American Society of Transplant Surgery (ASTS)-approved. Each year, there is one transplant surgical fellow and a 4th year surgical resident, 3rd year surgical resident, and intern on the service. The program is integrated between the surgery and the nephrology fellowship programs in order to benefit from the expertise of all its members. The program thrives from a true multidisciplinary effort.
Staff coverage and supervision in the transplant unit is provided by both a staff transplant surgeon as well as a staff transplant nephrologist at all times. In addition, a clinical nephrology fellow rotates through the transplant unit on a monthly basis.
Transplant rounds are held twice daily with the transplant surgeon and transplant nephrologists, residents, fellows, and other support staff in attendance. Decisions regarding immunosuppression are made with reference to jointly established policy guidelines and protocols. Infectious disease consultants are present on morning and evening rounds and available at all times.
There are weekly Chief's Rounds, which is an academic conference conducted by Dr. Paul Russell, professor emeritus and former Chief and founder of the Transplant Unit. This conference involves clinical presentations with additional research focus, provided by members of the Transplant Biology Unit, particularly Dr. David Sachs, as well as the head of the Bone Marrow Transplant Unit. Dr. Tom Spitzer and Dr. Benedict Cosimi (former director of the transplant division). Also, members of the hepatology unit present and discuss lever transplant patients. The sessions are an opportunity for the fellow to present clinical cases.
There is a weekly transplantation conference, which again brings together members of the different departments working in transplantation-related fields. During these sessions, invited guests both national and international, present different areas in the field of transplantation. The fellow also has the opportunity to present research and clinical reviews at these conferences.
Both the Division of Nephrology and Massachusetts General Hospital are equal opportunity employers. Before beginning the Transplant Fellowship Program in Nephrology, a candidate should have completed at least two (preferably three) years of training in internal medicine and be board-certified or board-eligible in nephrology.
The Transplant Fellow will attend (with the other renal fellows) a weekly didactic conference which currently follows the guidelines established by The AST’s Primer on Transplantation. The current scheduled topics are:
The fellow will be attend:
As part of the program, the transplant fellow will be involved with 3 presentations at Journal Clubs, renal conferences, and at least 4 additional educational sessions.
Will attend the AST and ASN annual meeting and be given the option of attending the AST sponsored Transplant Nephrology Fellows symposium.
Will learn the basic statistical principles as applied to transplantation.
The transplant nephrology fellow will develop expertise in the following areas of renal and pancreas transplantation through medical, surgical, and research experience and by satisfying the requirements of the American Transplant Society and the American Society of Nephrology.
(Work-up of at least 30 potential recipients)
Trough participation in the already established multidisciplinary transplant recipient evaluation clinics, the fellow will understand the risks and benefits of dialysis versus renal transplant and will be involved with the counseling, evaluation, education, and selection of potential recipients for kidney transplantation, as well as kidney-pancreas transplants.
(Evaluation of at least 20 potential donors, and involvement with the surgical procedures in at least 4 live donor nephrectomies)
The trainee will be educated in the pros and cons of using living donors; the short- and long-term risks and follow-up of the live kidney donor; the evaluation, education and counseling of the living-related and unrelated kidney donor; and the differences between the open procedure and laparoscopic procedure.
The transplant nephrology fellow will be involved in at least 5 multi-organ retrievals, and be involved with:
It is the expectation that the transplant nephrology fellow will:
In addition, the transplant fellow will be exposed to pediatric renal transplantation, and the special consideration involved in evaluating a donor and selection of immunosuppression, as well as issues related to growth and development with renal transplant.
The renal transplant fellow will be required to spend at least 2 weeks in the Histocompatability Lab, learning the principles, methodology, and interpretation of tissue typing and crossmatching for renal transplantation, including various lymphocytotoxic assays, ELISA, and flow crossmatch.
The fellow will perform at least 20 transplant biopsies and will review the biopsies with renal pathologists according to the Banff criteria. The fellow will attend the weekly renal pathology conference and present patients at monthly morbidity and mortality conference.
The fellow will be involved with family meetings, to discuss the risks and benefits of transplant with the patient, family, psychiatrist, nephrologists, surgeon, transplant coordinator, and social worker, and will learn about the ethics of organ donation.
he transplant nephrology fellow will be involved with creating and managing the renal transplant waiting list, and will attend the weekly interdisciplinary transplant conference to determine candidacy.
The fellow will obtain knowledge of other procurement and transplant systems, including UNOS, as well as the economics of transplantation. The fellow will be involved with organ awareness programs.
Assessment of patients referred for renal transplantation, in association with a staff transplant nephrologist. After evaluating the patient, the fellow will present to the transplant team for possible listing or scheduling of living-related donor transplants. Living Donor TransplantsThe fellow will examine and evaluate living donor candidates during their pre-admission testing day. Potential donors will also be examined at this time. The patients will be presented and reviewed with the staff nephrologist.Inpatient CareThe renal transplant unit consists of 18 beds. Four of these are ICU beds. The service is shared by the Hepatobiliary Surgery service, where kidney and pancreas transplants are performed, as well as heart and lung transplants. It is expected that the Transplant Fellow will spend at least 6 months in the inpatient clinical service.Outpatient Follow-upThe renal transplant fellow will participate (for 12 months) in the longitudinal follow-up of renal and pancreas post-transplant patients. In addition, he/she will be expected to attend (for a period of 3 months) a multidisciplinary transplant recipient and living donor selection clinic. Patients will be reviewed by the staff physician prior to discharge from the clinic. The fellow will review blood work and patient concerns with the clinic nurses, and also be responsible for calls from outside referring physicians and internists, requesting medical assistance. Back-up is always available by the attending nephrologist or surgeon. The fellow is expected to take regular Call along with the transplant surgical fellow and other trainees covering the transplant unit.
Dr. Susan Saidman, director of the Tissue Typing Laboratory of Massachusetts General Hospital. The transplant fellow spends a two-week rotation in the Tissue Typing Lab in order to become familiar with the methodology, utility, and reliability of various tissue typing, cross match and immune surveillance technology.
The transplant fellow will learn the art of renal biopsy, under the auspices of Dr. Winfred Williams, Dr. Nelson Goes, Dr. Eliot Heher, Dr. Waichi Wong and Dr. Mario Rubin, who will supervise the performance of the biopsies at MGH. The interpretation of transplant biopsies will be coordinated with Dr. Robert Colvin, Chief of Pathology and Renal Pathologist at MGH. The fellow will gain experience with the interpretation of these biopsies, the knowledge of Banff criteria, and a translation of clinical issues.
There is a weekly renal pathology conference at MGH, at which these biopsies are reviewed.
Coordinator, Dr. Francis Delmonico, Division of Transplant Surgery, Director of New England Organ Bank. Topics in transplantation are presented by members of the nephrology, immunology, and transplant community in areas of basic science research as well as in clinical care. These conferences are attended by members of both divisions and attendance by the fellow would be required.
Coordinator, Dr. James Markmann, Chief of Transplantation. These rounds review all medical and surgical complications and are prepared in coordination with the clinical fellow.
There are ample opportunities for the transplant fellow’s participation in clinical and/or basic science research. Clinical and animal studies in tolerance, ABO incompatibility and desensitization are ongoing.
Interested applicants should submit a copy of their CV and three (3) letters of recommendation to Wendy De Milleby emailbetween May 1 and September 15, 2014, for positions beginning July 1, 2015. The information will then be reviewed and invitations to interview will be sent out after August 1, 2014. Out-standing candidates will be invited for a one-day interview process in September through October 2014.
For additional information, please contact:
Wendy De Mille, Manager, Nephrology Academic Affairs and Dialysis Services
Division of Nephrology Massachusetts General Hospital 55 Fruit Street, GRB 1003K Boston, MA 02114 Phone: 617-726-3706 Fax: 617-726-2288Email
Fellowship Training Program
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