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    Transplant Hepatology Fellowship Curriculum

    Curriculum

    1. Outpatient clinic (4 months): assess pre OLT and general hepatology Clinic patients. Fellow expected to take a complete H/P and formulate an assessment and plan. Needs to be capable to assess the need for further studies. Assess need for additional consultants.

    2. Transplant Continuity Clinic (4 months twice weekly, 5 month weekly): The use of immunosuppressants in the setting of liver or combined liver/kidney transplantation is discussed for each patient. Identification of surgical complications. Diagnosis and management of recurrent disease in Transplanted Liver. Prevention and management of extrahepatic complications of OLT.

    3. Inpatient rotation (ICU/Surgical) (2 months): Management of acute complications of liver diseases as well as acute liver failure ALF. Management of post operative liver surgery patients including OLT, hepatic resection, biliary reconstruction etc. The Fellow will provide Hepatology consultation to other ICU/CCU patients. One weekly continuity clinic.

    4. Inpatient rotation (Hepatology patients) (3 months): management of patients with acute and chronic liver disease not necessitating ICU care. The Fellow is responsible of scheduling and performing endoscopic procedures on his/her patients, One weekly continuity clinic.

    5. Research rotation (2 months): The Fellow will choose 2 projects at the beginning of the year, to be completed during the academic year. At least 1 is expected to result in publication in a peer-reviewed journal. Alternatively, laboratory rotation is available if approved by the Fellowship committee.

    6. Literature review: The fellow will rotate with the GI Fellows in presenting GI/Liver case conference on Thursday noon, as well as Journal Club liver articles, and GI/Liver research meetings. The patient will attend all Transplantation Grand Rounds and will present at least once during the year.
    7. Conferences: selection committee, transplant grand rounds, GI grand rounds, transplant journal club, clinical case conference, radiology conference, pathology conference, M&M conference, research conference.

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    Objectives

    By the end of the fellowship year, our fellow will have had the opportunity to meet (and surpass) the ACGME requirements for training in transplant hepatology, including:

    1. Presentation of 10 potential transplant candidates at selection conference
    2. Clinical follow-up of at least 3 months for 20 new transplant recipients
    3. Clinical follow-up of at least 6 months for 20 transplant recipients who have survived more than one year after transplantation
    4. Observation of 1 cadaveric liver procurement and 3 liver transplant surgeries
    5. Interpretation of 200 native and/or allograft liver biopsies
    6. Performance of 30 percutaneous liver biopsies

    Additional, rotation-specific objectives related to the ACGME Transplant Hepatology program requirements include:

    Inpatient Hepatology
    1. Demonstrate competence in the management of complications of cirrhosis, including refractory ascites, hepatic hydrothorax, hepatorenal syndrome, hepatopulmonary syndrome, portopulmonary hypertension and refractory portal hypertensive bleeding.
    2. Demonstrate competence in the ethical considerations relating to liver transplant donors and recipients, including living donors, deceased donors and donors with cardiac death.
    3. Demonstrate competence in the management of fulminant liver failure.
    4. Demonstrate competence in the psychosocial evaluation of all transplant candidates.
    5. Demonstrate knowledge of the principles of donor selection and rejection.

    Outpatient Hepatology
    1. Demonstrate competence in the diagnosis and management of hepatocellular carcinoma and cholangiocarcinoma.
    2. Demonstrate competence in the management of chronic viral hepatitis in the pre-, peri- and post-transplantation settings.
    3. Demonstrate competence in the nutritional support of patients with chronic liver disease.
    4. Demonstrate competence in the prevention of acute and chronic liver disease.

    Transplant Clinic
    1. Demonstrate knowledge of the organizational and logistic aspects of liver transplantation, including the role of the nurse coordinators and social workers, organ procurement and UNOS policies regarding organ allocation.
    2. Demonstrate knowledge of transplant immunology, including infectious and malignant complications of immunosuppression.
    3. Demonstrate knowledge of indications for, contraindications for and complications of allograft biopsy.

    Research Rotation
    1. Systematically analyze clinical practice using quality improvement methods and implement changes with the goal of practice improvement
    2. Locate, appraise and assimilate evidence from scientific studies related to patients’ health problems.

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    Faculty

    Faculty: Physician Team at the San Francisco Center for Liver Disease


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