Curriculum
The intent of our Abdominal Transplant Fellowship is to produce proficient and competent physicians. That does not mean just knowing the operations, it means performing them.
All staff aim to serially progress our trainees through each transplant operation until you are able to complete the operation on your own. Of course, each fellow progresses at their own rate, but our job as educators is to understand this and to give more responsibility and autonomy as you become ready for it.
Clinical training
During the two years of clinical training in the Abdominal Transplant Surgery Fellowship, you will spend the first year focusing on kidney and multi-organ transplantation along with some time on liver. The second year is focused on liver transplantation as well as laparoscopic donor nephrectomies with continued time on kidney transplantation. Time is also built into the schedule for research and education on top of the clinical training. During your second year, fellows may also choose to perform an elective transplant rotation at another Mayo Clinic campus — Jacksonville, Florida, or Phoenix/Scottsdale, Arizona — or on a hepatobiliary surgery service.
Rotation descriptions
See an overview of the main clinical rotations below.
Kidney-pancreas transplant service
The goal of this rotation is to provide experience in kidney transplantation — both living and deceased donors — and pancreas transplantation. The major emphasis of this rotation is surgical experience as well as the postoperative management of these patients and their complications.
The surgical fellows become familiar with:
- Pre-transplant evaluation of potential recipients
- Operative planning
- Immunosuppressive management
- Medical complications of transplant recipients
Unique aspects of the kidney transplant program at Mayo Clinic's campus in Rochester, Minnesota, include:
- Positive crossmatch and ABO-incompatible kidney transplantation
- Pediatric transplantation
In addition, the fellows will have experience with one of the largest volumes of living donor kidney transplant programs in the country.
Liver transplant service
The goal of this rotation is to provide significant experience with liver transplantation, including:
- Pre- and post-operative management of adult and pediatric recipients
- Deceased donor whole organ liver transplantation
- Deceased donor split organ liver transplantation
- Living donor liver transplantation
- Pediatric liver transplantation
The surgical fellows also become familiar with common medical issues in liver transplant patients, such as:
- Management of hyponatremia
- Spontaneous bacterial peritonitis
- Intractable ascites
- Addiction issues
- Fulminant hepatic failure
Lastly, fellows are exposed to innovative treatments, including:
- Transplantation for extrahepatic cholangiocarcinoma
- Domino transplantation for amyloid
Donor service
The aim of this rotation is to provide experience with multi-organ abdominal procurements and living-donor nephrectomy. As a fellow, you also gain additional experience with hemodialysis access and will have time to dedicate to research during this rotation.
Didactic training
The Abdominal Transplant Surgery Fellowship has a strong didactic program with many weekly meetings, including:
- Morbidity and Mortality. Monthly Transplant Center conference where interns, residents, fellows, and specialty staff discuss one or two cases led by a fellow, with expert commentary from various fellows and staff.
- Transplant Grand Rounds. Weekly Transplant Center conference where all staff, fellows, residents, and other guests attend, with a variety of intramural and invited expert speakers.
- Kidney and Liver Selection Committees. Weekly meeting where Transplant Center staff discuss potential transplant recipient and donor approval.
- Laboratory.
- Liver Transplant Pathology Conference.
- Kidney Biopsy Conference.
- Fellows Education Conference. Weekly educational meeting that is specifically geared toward surgical fellows that involves transplant hepatology, transplant nephrology, and surgical staff.
Additional didactic opportunities include Surgery Grand Rounds and innumerable basic science lectures complementing the Mayo Clinic academic atmosphere.
Research training
Your research opportunities at Mayo Clinic are outstanding. You are encouraged to participate in research projects with the consulting staff, which include opportunities for clinical studies and laboratory-based projects.
The research experience includes opportunities for research in:
- Endothelial cell biology
- Immunology
- Artificial liver support devices
- Cholangiocarcinoma
- Transplantation obesity
- Other basic research projects in all facets of transplantation.
We feel strongly that a year of research is an important beginning to your career in transplantation surgery. Research is a core value for a well-rounded academic surgeon.
What research topics are faculty and fellows currently working on?
Faculty research topics
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The biggest challenge in the transplant field is the shortage of donor organs. My research is aimed at solving the organ shortage through tissue engineering, cell therapies, and other regenerative treatments such as novel drugs and/or a liver support device. Scott Nyberg, M.D., Ph.D. |
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I am working with several of my partners on a preclinical model, ultimately aimed at optimizing outcomes for patients following living donor liver transplantation using mesenchymal stem cells to reduce the likelihood of biliary strictures. We have also pioneered a program here in Rochester for patients with liver disease and severe obesity which involves a combined liver transplant and sleeve gastrectomy, and we are working to optimize outcomes for patients who are enrolled. Julie Heimbach, M.D. |
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Obesity has affected many aspects of medical care and also has had a substantial impact on transplantation. My research focuses on how obesity impacts both access and outcomes for renal transplant patients. We have extensively studied the role of bariatric surgery within this high-risk population with encouraging results and plan to develop a clinical model that appropriately addresses obesity within our population of patients. Ty Diwan, M.D. |
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I lead a research group whose major interests are improving long-term renal allograft survival and understanding the biology of antibody-secreting plasma cells (the source of alloantibody). Recent efforts include developing Deep Learning Networks to automate the assessment of renal allograft biopsies (basically teaching a computer to read a kidney biopsy, part of our ongoing surveillance biopsy cohort with >15,000 biopsies), investigating the long-term outcomes of patients with obesity and/or Type 2 diabetes, and developing novel agents that deplete plasma cells. Mark Stegall, M.D. |
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My clinical practice focuses on liver transplantation, and my laboratory research is aimed primarily at understanding the interaction between the transplanted liver and the recipient's immune responses. Our research has demonstrated that liver allografts induce hyporesponsiveness to alloantigens in the recipients, providing immunoprotection to simultaneously transplanted organs. These findings have recently paved the way for an innovative trial of cell-based therapy in kidney transplant recipients with the goal to limit recipients’ exposure to immunosuppressive medications. Timucin Taner, M.D., Ph.D. |
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My clinical research focuses on simultaneous laparoscopic bilateral native nephrectomy at the time of kidney transplantation. We published two papers in 2020 describing this novel surgical approach and associated outcomes, with more publications underway. Mikel Prieto, M.D. |
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Our collaborative, team-based approach to patient care enabled us to develop multidisciplinary protocols to treat patients with unresectable hilar cholangiocarcinoma and metastatic neuroendocrine cancer. Our results lead to the acceptance of these diseases as indications for liver transplantation and appropriate assignment of MELD exception scores. As a major referral center for patients with hilar cholangiocarcinoma, our program performs the highest number of liver transplants for this indication in the world. Ongoing clinical research aims to achieve better understanding of prognostic factors, adopt technical improvements, and improve our results. Charles Rosen, M.D. |
Fellow research topics
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I am currently working on a project with Dr. Taner on peripheral blood myeloid derived suppressor cells as a marker for subclinical rejection and tolerance in kidney transplant recipients. Another project I am working on with Dr. Diwan deals with outcomes of kidney transplantation in patients that underwent bariatric surgery. Niv Pencovici, M.D., Ph.D. |
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I am currently working on a multi-center study of patient reported outcomes after kidney transplantation to identify effects of medication side effects on recipients. I am also interested in long-term outcomes of transplant recipients to determine if we can lower the risk of death that results from immunosuppressive complications. Randi Ryan, M.D. |
Call frequency
Each fellow takes call approximately every other weekend following the ASTS Managed Time Policy.
Patient population
There is no denying that the transplant patient population is one that can be complex and challenging clinically. The key is to have appropriate mentorship to our trainees so they feel comfortable as they grow into their knowledge of transplant. We encourage fellows to contact staff with any questions, day or night.
Teaching opportunities
Residents and other trainees are always rotating on the transplant service and fellows will have the opportunity to provide teaching to residents and to junior fellows. It is our firm belief that teaching relevant subject matter teachers helps trainees transform into experts. Teaching is done routinely on rounds and in didactic settings. Fellows are encouraged to lead teaching sessions and staff are always present to assist.
Evaluation
To ensure that residents acquire adequate knowledge and develop their technical skills, performance is monitored carefully throughout the Abdominal Transplant Surgery Fellowship. Fellows are evaluated formally by all surgical faculty members. As per ASTS guidelines, all fellows have operative and non-operative milestones assessed every six months in addition to quarterly meetings with the program director. Fellows also evaluate the faculty regularly to ensure that educational needs are being met.