About the Transplantation Fellowship Program
The Thomas E. Starzl Transplantation Institute at the University of Pittsburgh has had a post-graduate training program in multiorgan abdominal transplantation since 1981. This program has been certified continuously by the American Society of Transplant Surgeons and meets the training requirements for certification as “Primary Transplant Surgeon” for liver, kidney, and pancreas transplantation by UNOS. The multiorgan transplant fellowship requires completion of a general surgery residency and surgical board eligibility (or its foreign equivalent) and falls under the jurisdiction of the Office of Graduate Medical Education at the University of Pittsburgh. The program is a full two-year clinical fellowship with an optional third year for research or advanced clinical training (e.g. pediatric or intestinal transplantation).
The Starzl Transplantation Institute also offers a two-year renal transplant clinical fellowship. Fellows must have completed either a general surgery or urology residency program with corresponding board eligibility (or its foreign equivalent). The program provides training in kidney transplantation, laparoscopic donor nephrectomy, and pancreas transplantation. Renal transplant fellows also have the option of spending the second fellowship year as a dedicated research year.
The multiorgan transplant fellowship at the University of Pittsburgh has been designed to provide a comprehensive experience in the pre- and post-operative care of the transplant patient. This broad exposure includes medical and surgical management in renal, pancreas, hepatic, and intestinal transplantation. Medical evaluation and selection of recipients, surgical technique, immunosuppression, critical care management, as well as dealing with medical and surgical complications, are stressed to all transplant fellows. With almost 600 abdominal organ transplants being performed each year (see table) and a correspondingly high number of organ retrievals including living donation, the operative experience for surgically oriented fellows is intended to develop preeminent transplant surgeons. Cutting-edge procedures such as laparoscopic living donor nephrectomy, living donor hepatectomy, split-liver procurement, intestinal and multivisceral transplantation, and pediatric transplantation help to develop transplant surgeons with broad surgical exposure. In addition, a large number of ancillary procedures such as decompressive shunt surgery, liver resection, ablative liver procedures, and intestinal reconstructive procedures train our fellows in other important diagnostic and therapeutic options.
During the first year, fellows are taught to manage patients with end-stage organ failure. First-year fellows rotate for 24 weeks (six months) in adult liver transplantation, eight weeks in pediatric transplantation, eight weeks in kidney/pancreas transplantation, eight weeks in intestinal/multivisceral transplantation, and four weeks in the hepatobiliary service. They are taught donor procurement and kidney transplantation as well as laparoscopic living donor nephrectomy. During the second year, fellows rotate for eight weeks on the kidney/pancreas service, eight weeks on the hepatobiliary service, and 28 weeks (eight months) on the adult liver service. During this time, they assume operative responsibilities in liver and pancreas transplantation and also participate in living donor hepatectomies. The hepato-pancreatobiliary rotation is an outstanding experience. The UPMC Liver Cancer Center (LCC) of the Starzl Transplantation Institute is a multidisciplinary health care team that provides clinical services, innovative treatment strategies, and fundamental research for liver cancer. More than 100 liver cancer resections and/or ablations for liver cancer and pancreatic operations such as Whipple procedures are performed each year in the service.
|
Adult |
Pediatric (Children's Hospital) |
| Liver |
519 (cadaver 462; living donor 57) |
78 (cadaver 68; live donor 10) |
| Intestine |
54 |
47 |
| Kidney |
383 (cadaver 298; living donor 185) |
22 (cadaver 6; live donor 16) |
| Pancreas |
67 |
|
Facilities
The clinical facilities at UPMC include a 24-room outpatient facility integrated with a 10-bed transplant observation facility and provide an outpatient transition unit as well as 23-hour observation facilities with 24-hour access for physician assessment. The inpatient facilities include a dedicated 28 bed transplant ICU and transplant wards at UPMC Montefiore. The Children’s Hospital of Pittsburgh of UPMC facility is in an adjoining dedicated pediatric facility with a multipurpose ICU and dedicated transplant ward, with dedicated outpatient facility within that facility.
Computer facilities include the Medical Archival Records System (MARS) and the Electronic Database Interface for Transplantation (EDIT), which allows electronic access to medical records, laboratory data and outpatient records, with HIPAA compliance. Research inquires are performed under IRB regulated “honest brokers”. Fellows are assigned to a variety of clinical research and review projects.
Didactic Components
Outpatient clinics are held on a daily basis and are staffed by both Faculty and Transplant Fellows. These clinics are designed to evaluate both pre- and post-transplant patients and allow participation of Transplant Fellows in the long-term care of the transplant patient.
A number of clinical conferences are held for both educational and clinical purposes. These conferences are:
- Liver Transplant Morbidity and Mortality
- Transplant Infectious Disease
- Renal Transplant Morbidity and Mortality
- Intestinal Transplant Morbidity and Mortality
- Transplant Pathology
- Liver Tumor Conference
In addition, a weekly transplant research conference is held to discuss the results of ongoing clinical and basic science research projects.
Research Components
The Department of Surgery and the Division of Transplantation are dedicated to the advancement of an active clinical and basic science research program. Areas of clinical research deal with:
- organ preservation and monitoring
- new immunosuppressive agents
- living donor liver transplants
- infectious complications
- expanding indications for transplant
- malignancies following transplant
- modulating antibody sensitization
- cellular transplantation
- small bowel transplantation
Areas of basic science research include:
- reperfusion injuries
- chronic liver inflammation (hepatitis B and C)
- mechanisms of graft rejection
- mechanisms of recurrent disease
- lymphoproliferative diseases
- tolerance induction
- animal transplant models
- xenotransplantation
The interaction between the clinical and basic science research programs is unique because of the close interactions between the clinicians and scientists. Results obtained from the laboratory are converted into clinical protocols, and important clinical observations can therefore be studied.
The research activities are distributed among a multidisciplinary research team, including: surgery, pathology, medicine, immunology, and molecular biology. The research facilities are housed in the Transplant Research Center, which is a 44,000 sq. ft. state-of-the-art laboratory space for investigators interested in transplant research.
| Program Director |
Program Coordinator |
Michael E. de Vera, MD
Director, Fellowship Program
Assistant Professor of Surgery
Thomas E. Starzl Transplantation Institute
UPMC Montefiore, 7 South
3459 Fifth Ave.
Pittsburgh, PA 15213
Phone: 412-647-5174
Fax: 412-647-5480
E-mail: deverame@upmc.edu
|
Pamela J. Slivinske
Faculty Manager
Thomas E. Starzl
Transplantation Institute
UPMC Montefiore, 7 South
3459 Fifth Ave.
Pittsburgh, PA 15213
Phone: 412-647-5173
Fax: 412-647-5480
E-mail: slivinskepj@upmc.edu |
| Clinical Teaching Staff |
|
Liver:
Michael E. de Vera, MD
Paulo Fontes, MD
Abhi Humar, MD
Roberto Lopez, MD
J. Wallis Marsh, MD
Thomas E. Starzl, MD
Kidney/Pancreas:
Ron Shapiro, MD
Amit Basu, MD
Deanna Blisard, MD
Abhi Humar, MD
Cynthia Smetanka, MD
Henkie Tan, MD
|
Pediatrics:
George Mazariegos, MD
Rakesh Sindhi, MD
Kyle Soltys, MD
Small Bowel:
Kareem Abu-Elmagd, MD
Geoffrey Bond, MD
Guilherme Costa, MD
UPMC Liver Cancer Center:
David A. Geller, MD
J. Wallis Marsh, MD |
Application Procedures
Applications for transplant fellowships will be accepted throughout the year. Candidates for clinical fellowships in multiorgan transplants should be board eligible or certified in general surgery. Candidates for clinical fellowships in renal transplants should be board eligible or certified in general or urologic surgery.
The Starzl Transplantation Institute participates in the annual Abdominal Transplant Surgery Fellowship Match run by the National Resident Matching Program (NRMP). The match is performed on year prior to the beginning of the fellowship, usually in June. Details of the match can be obtained at the NRMP website. Candidates will need to register with the NRMP in order to participate in the match.
A letter of inquiry, along with curriculum vitae, should be addressed to:
Thomas E. Starzl Transplantation Institute
UPMC Montefiore, 7 South
3459 Fifth Ave.
Pittsburgh, PA 15213