Kidney and pancreas transplant inpatient service

As a renal transplant fellow, you are part of an integrated medical and surgical hospital team consisting of transplant nephrologists and transplant surgeons, nephrology and transplant surgery trainees, and a midlevel provider.

The typical census for the hospital service varies between 10 and 20 patients, including recent living-donor and deceased-donor kidney recipients, recent pancreas transplant recipients, recent living kidney donors, as well as transplant recipients within one year of transplant with acute medical and surgical illness.

You gain extensive experience in routine post-transplant management, initiation and modification of immunosuppressive therapy, and management of a wide range of transplant-related complications. Fellows evaluate patients daily and coordinate diagnostic, management and dismissal plans with the inpatient and outpatient teams.

As part of the program, you share responsibility for general nephrology fellow and midlevel provider supervision with the attending physician and are primarily responsible for medical evaluation of all deceased-donor transplant recipients and transplant recipients with acute medical illness.

On-call duties are in accordance with Accreditation Council for Graduate Medical Education (ACGME) requirements for at-home call.

Kidney and pancreas transplant outpatient clinic

This clinic serves recently discharged kidney and pancreas transplant recipients, in addition to recipients requiring acute evaluation or ongoing management of medical and surgical complications. The clinic operates in a paperless environment with clinical documentation, laboratory results and radiological images available electronically.

The outpatient team consists of a transplant nephrologist, a renal transplant fellow, a nephrology fellow and a midlevel provider (advanced registered nurse practitioner or physician assistant), with consultation by transplant surgeons directly available. You are primarily responsible for generating diagnostic, consultative, therapeutic and follow-up plans with ample opportunities to discuss cases with supervising physicians and maintain continuity of care on individual patients.

You also evaluate many patients undergoing transplant biopsy for graft surveillance as well as for acute graft dysfunction. There are routine opportunities to personally review and discuss biopsies with a renal pathologist consultant. Potential kidney and pancreas transplant recipients and donors are also evaluated in the clinic, as well as patients presenting for annual update on the list.

Research

A broad range of research opportunities are available within the Renal Transplant Fellowship. Five months during the fellowship are devoted to one or more research projects.

Potential research projects are discussed soon after the fellowship starts to allow you to identify a mentor and an area of interest before the research rotation. Research projects are facilitated by the availability of excellent database and data analysis support. The fellowship also supports the preparation of manuscripts for publication and travel to national and international meetings to present research data.

Tissue typing, transfusion medicine, apheresis and allograft biopsy

Observational and didactic instruction in methods of blood and tissue typing, assays for cross matching and alloantibody measurement, and the use of therapeutic apheresis for conditioning and treatment of specific transplant patients is provided within the tissue typing and apheresis laboratories. These are coordinated by the consultant and technical staff of the laboratories.

Transplant and organ procurement surgery

To fulfill United Network for Organ Sharing (UNOS) certification requirements, you observe kidney and pancreas transplant surgeries, as well as living-donor nephrectomies. You also accompany the transplant surgery team on organ procurements.