Fellowship Rotations

Transplant Hepatology

 

 

Inpatient rotations

Transplant hepatology fellows will spend approximately 6 months on the inpatient consult hepatology service at MedStar Georgetown University Hospital. Fellows will interact with the attending transplant hepatologist, gastroenterology fellows, internal medicine residents, and medical students rotating on the service. During this rotation, the fellow will participate in the assessment and management of patients prior to liver transplantation who present with a variety of acute and chronic liver diseases including but not limited to viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, acute liver failure, drug-induced liver injury, vascular diseases of the liver, primary biliary cholangitis, primary sclerosing cholangitis, autoimmune hepatitis, hemochromatosis, Wilson disease, hepatobiliary diseases related to pregnancy, and alpha-1-antitrypsin deficiency. Moreover, fellows will evaluate patients with benign and malignant hepatobiliary tumors in close collaboration with specialists in internal medicine, transplant hepatology, hepatobiliary surgery, medical oncology, radiation oncology, and interventional radiology. We anticipate that at the completion of training, fellows will be able to adequately manage patients with complications of portal hypertension including prevention and treatment of variceal bleeding and rebleeding, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax. Transplant hepatology fellows will also gain an appreciation of the importance of nutrition, medical imaging, and pathology when assessing patients with acute and chronic liver diseases in the pre-transplant setting. Ethical issues frequently arise in patients with severe liver diseases and fellows will frequently be involved with issues regarding prolongation of life and palliative care. During the inpatient rotation, fellows will perform upper endoscopies, colonoscopies, and liver biopsies.

 

In addition to evaluation and treatment of pre-transplant patients with acute and chronic liver diseases above, fellows will frequently consult on patients with problems arising early or late after transplantation. Fellows will gain an appreciation of the importance of bedside examination in combination with the laboratory tests, medical imaging, and liver biopsy in evaluating and treating patients after liver transplantation. Over the course of the 12-month curriculum, transplant hepatology fellows will understand the indications, contraindications, and side effects of immunosuppressive medications and other agents applicable to the post-transplant setting. Fellows will understand the variety of medical and surgical complications that can arise shortly after transplantation and issues that can arise long after transplantation. Additionally, trainees will be able to understand and treat the multitude of medical problems that can arise early or late after transplantation.

 

While on inpatient rotations, fellows will be expected to present inpatients who are in need of liver transplant evaluation and listed patients to the weekly transplant selection committee. Additionally, fellows will be expected to attend weekly core curriculum lectures, hepatobiliary conferences, pathology conferences, and morbidity and mortality conferences while on the inpatient service. During the 12-month fellowship experience, fellows will gain autonomy in managing critically ill patients with liver diseases and have the opportunity to serve in the attending physician role with the guidance of the attending transplant hepatologist during the inpatient experience. The inpatient rotations will satisfy ACGME requirements for fellowship training. 

Outpatient rotations

General Hepatology Clinics

 

Approximately 6 months will be devoted to outpatient clinics. All sessions will be held in the Georgetown Transplant Institute clinics. Transplant hepatology fellows will see a variety of patients with acute and chronic liver diseases as described in the inpatient rotation portion of the curriculum. We expect that fellows will assess and treat patients with liver disease in collaboration with key clinical faculty mentors. Ideally, fellows should rotate with different members of the key clinical faculty in order to appreciate different approaches to patient care in the outpatient setting. As with the inpatient rotations, education in the physiology and pathophysiology of liver disease, assessment, and treatment approaches will be stressed. The general hepatology clinics will satisfy ACGME requirements for fellowship training.

 

Trainees are expected to attend a weekly ½ day continuity clinic. We anticipate that 4 to 8 pre-transplant patients will be assigned to this clinic. Fellows will have the opportunity to work with a single mentor or a variety of key clinical faculty based upon trainee preference. The continuity clinic experience will continue during inpatient hepatology service rotations.

 

Transplant Evaluation Clinic

 

Transplant hepatology fellows will be expected to attend the weekly transplant evaluation clinic when not on inpatient hepatology service rotations. All sessions will be held in the Georgetown Transplant Institute clinics.  They will evaluate and manage patients with a variety of disorders as discussed in detail in the inpatient rotation section. Typically, 5 to 10 patients with acute and chronic liver diseases are seen in this clinic during an 8-hour period. Fellows will work closely with key clinical faculty and other ancillary transplant personnel assigned to the clinic on a weekly basis.  Additionally, fellows will present all patients seen to the transplant selection committee the following week. This rotation will satisfy the ACGME requirements for transplant hepatology training.

 

Post Transplant Evaluation Clinic

 

Trainees will be expected to attend a weekly post-transplant evaluation clinic. All sessions will be held in the Georgetown Transplant Institute clinics. They will work closely with post-transplant nurse practitioners and hepatologists in evaluating and managing patients early and late after transplantation. Fellows will gain an appreciation for the indications, contraindications, and side effects of immunosuppressive and other medications used after transplantation. Additionally, fellows will gain expertise in managing medical and surgical problems that can arise early and long after transplantation. Fellows will learn how to amalgamate clinical information with laboratory tests, medical imaging, and liver biopsy to make rational treatment decisions. Fellows will be required to review at least 200 native and allograft biopsies as required by ACGME guidelines. Additionally, trainees will be required to observe 3 liver procurements and 3 liver transplants as per UNOS and ACGME guidelines and preferably follow recipients of these transplants in the post transplant clinic. This rotation will satisfy the ACGME requirements for transplant hepatology training.