A key strength of this fellowship is the exposure to a large, wide-ranging population of kidney and pancreas transplant recipients within a highly integrated, patient-centered clinical program at Mayo Clinic in Rochester. Renal transplant fellows train in inpatient, acute outpatient and long-term outpatient settings.

Throughout the year, you will work closely with consultants in:

• Transplant nephrology
• Transplant surgery
• Renal pathology
• Transplant infectious diseases
• Tissue typing/transfusion medicine
• Renal radiology

You also will interact regularly with specialists in endocrinology, cardiology, dermatology and psychiatry who have focused expertise in the care of transplant recipients.

In addition, you will have opportunities to share the care of multi-transplant recipients with members of the liver, heart/lung and bone marrow transplant groups.

Specific areas of clinical and didactic teaching are:

• Recipient evaluation and preparation for kidney and pancreas transplantation
• Evaluation of the potential living kidney donor
• The biologic basis of HLA and transplant rejection
• Methods of tissue typing, cross matching, allo-antibody measurement and clinical application of these methods
• Pharmacology and clinical use of established and emerging immunosuppression for kidney and pancreas transplantation
• Evaluation and comparison of different combinations of immunosuppressive medication in kidney and pancreas transplantation
• Perioperative and early outpatient care of kidney and pancreas transplant recipients
• Recognition of surgical complications of kidney and pancreas transplantation
• Evaluation and management of acutely ill kidney or pancreas transplant recipients
• Diagnosis and management of infections in transplant recipients
• Long-term medical management of kidney and pancreas transplant recipients
• Diagnosis, pathogenesis and clinical management of renal allograft dysfunction
• The use of plasmapheresis, intravenous immunoglobulin and other techniques to lower or modify anti-HLA antibody in sensitized patients
• Allocation of deceased donor organs for transplantation
• Ethical considerations in organ transplantation

Rotation	Length
Inpatient kidney and pancreas transplant service and acute kidney and pancreas transplant outpatient clinic	6 months
Donor and recipient evaluation	1 month
Long-term kidney and pancreas transplant outpatient clinic	2 months
Research	2 months
Tissue typing/apheresis/allograft biopsy/elective	1 month
Transplant and organ procurement surgery	Ongoing

Rotation descriptions

Inpatient kidney and pancreas transplant service

Renal transplant fellows are part of an integrated medical and surgical hospital team consisting of transplant nephrologists and transplant surgeons, nephrology and transplant surgery trainees, general surgery residents, and a physician assistant.

The typical census for the hospital service varies between 10 and 25 patients, including recent living and deceased donor kidney recipients, recent pancreas transplant recipients, recent living kidney donors, as well as transplant recipients with acute medical and surgical illness.

You will gain extensive experience in routine post-transplant management, initiation and modification of immunosuppressive therapy, as well as 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.

Along with transplant surgery fellows, renal transplant fellows share responsibility for resident supervision and teaching and are primarily responsible for medical evaluation of all deceased donor transplant recipients and of transplant recipients with acute medical illness.

Fellows round daily with the consultant nephrologist and, on nonsurgical days, with the entire team. On-call duties are in accordance with current Accreditation Council for Graduate Medical Education's (ACGME) requirements for at-home call.

Renal transplant fellows participate directly in the coordination of care for patients undergoing special clinical protocols (such as removal of preformed alloantibody), and patients participating in clinical research protocols.

Acute 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 or nephrology fellow, and a physician assistant with consultation by transplant surgeons directly available. Renal transplant fellows are primarily responsible for generation of diagnostic, consultative, therapeutic and follow-up plans with ample opportunities to discuss cases with supervising physicians and to maintain continuity of care on individual patients.

Renal transplant fellows also evaluate many patients undergoing transplant biopsy for graft surveillance as well as for acute graft dysfunction. There will be routine opportunities to personally review and discuss biopsies with a consultant renal pathologist.

Long-term kidney and pancreas transplant outpatient clinic

This clinic serves kidney and pancreas transplant recipients who have had their transplant for one year or longer. Patients are seen annually at this clinic for a detailed review of graft function, immunosuppressive therapy and related medical issues. Long-term graft recipients with acute or subacute medical illness are also evaluated.

The clinic is staffed by a transplant nephrologist, renal transplant or nephrology fellow and transplant nurse practitioners.

Renal transplant fellows are primarily responsible for comprehensive care of the patients and gain experience working with mid-level providers specializing in long-term care of transplant patients, as well as in the design and application of management protocols for hypertension, bone disease, hyperlipidemia, cardiovascular disease, obesity, and chronic renal allograft dysfunction.

Donor and recipient evaluation clinic

Potential kidney and pancreas transplant recipients and potential kidney donors are evaluated in this dedicated clinic. Renal transplant fellows conduct initial evaluations with the supervision of a nephrologist who has expertise in the evaluation of potential donors and recipients. Fellows participate in the weekly multidisciplinary review of candidates and in the formal selection conference meetings.

Research

A broad range of research opportunities are available within the kidney and pancreas transplant program. Two months during this fellowship are devoted to one or more research projects.

Potential research projects are discussed soon after beginning the fellowship to identify a mentor and area of interest prior to the research rotation. Research projects are facilitated by the availability of excellent database and data analysis support.

Mayo Clinic's Renal Transplant Fellowship also actively supports the preparation of manuscripts for publication and travel to national and international meetings to present research data.

Tissue typing/transfusion medicine/apheresis

As part of this fellowship, 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 are provided within the tissue typing and apheresis laboratories, coordinated by the consultant and technical staff of the laboratories.

Transplant and organ procurement surgery

To fulfill UNOS certification requirements, renal transplant fellows observe kidney and pancreas transplant surgeries and living donor nephrectomies. Fellows also accompany the transplant surgery team on organ procurements.

Didactic Training

The fellowship provides a wide range of didactic training including:

• Daily interactions with transplant nephrologists and transplant surgeons.
• Weekly Transplant Grand Rounds conferences with formal presentations on all aspects of transplantation from internal faculty and many visiting external faculty.
• Transplantation core curriculum lectures – a series of multidisciplinary lectures given by Mayo Clinic faculty that covers basic science and clinical topics relevant to transplantation. The lectures are organized into three separate half-day symposia.
• Weekly renal biopsy conferences with presentation and discussion of transplant and native kidney biopsies by renal pathology and nephrology groups.
• A weekly journal club presented by fellows.
• Monthly morbidity and mortality conferences to discuss cases from the kidney/pancreas and liver transplant hospital services.
• Twice-monthly recipient review conferences.
• Twice-monthly research conferences.
• Support for travel to the American Society of Transplantation fellow's symposium and for presentation of research projects at one major transplant-related conference.

As a member of the Division of Nephrology and Hypertension renal transplant fellows are encouraged to participate in the didactic programs linked with the Mayo Clinic Nephrology Fellowship, including:

• Weekly nephrology core lectures by Mayo Clinic faculty
• Weekly Nephrology Grand Rounds presentations by Mayo Clinic faculty and prominent visiting faculty
• Visiting Faculty Research Forum – evening presentations by visiting faculty hosted by the Division of Nephrology and Hypertension

Moonlighting

Moonlighting is permitted for fellows at the discretion of the program director. Moonlighting activities may be scheduled only during outpatient rotations. Moonlighting should not interfere with required learning and must not violate the Accreditation Council for Graduate Medical Education's (ACGME) work hour rules. Moonlighting should not compromise education, but rather enhance it.

Evaluation

Competency-based electronic evaluations are completed by supervising faculty members after each clinical rotation. In addition, fellows evaluate the faculty and rotations to ensure that educational needs are being met.

Call frequency

The call schedule varies by rotation but does not exceed one in four for any rotation. Mayo Clinic College of Medicine and Science follows the recommendations of the Accreditation Council for Graduate Medical Education (ACGME) for all training programs including the Renal Transplant Fellowship.

Teaching opportunities

Along with transplant surgery fellows, renal transplant fellows share responsibility for resident supervision and teaching on the inpatient service. Fellows also present at conferences including Grand Rounds and Journal Club.