The ASTS Abdominal Organ Transplant Fellowship at the University of British Columbia is a 2-year clinical training program in transplantation offered through the Department of Surgery and the Department of Urologic Sciences based in Vancouver, British Columbia, Canada.
It consists of exposure to all aspects of organ procurement (deceased donor, live kidney donor) abdominal organ transplantation (liver, kidney, pancreas), and HPB Surgery with associated research. The Abdominal Organ Transplant Fellowship is offered to one individual every year.
The Abdominal Organ Transplant Fellowship aims to develop outstanding clinical and academic Transplant Surgeons. We will provide the trainee with the clinical experience necessary for that individual to become an expert in the understanding, diagnosis, and management (including the necessary surgical skills) of both patients with end-stage organ disease as well as in the treatment of diseases of the liver, biliary tract, and pancreas. Our expectation is that each fellowship-trained individual will have the potential to be a competent, academic Abdominal Organ Transplanter and/or a Hepato-Pancreato-Biliary Surgeon. Clinical and/or translational research will be available and encouraged throughout your Fellowship.
The University of British Columbia is a large transplant program, performing yearly around 125 organ procurement procedures (with about 30-40 of these being DCD liver/kidney procedures) 100 liver transplants, and over 300 kidney transplants with anywhere from 60 – 100 living kidney donors/year. Our pancreas program is gaining traction and involves both whole pancreas and an islet program. Our hope would be to do about 12 whole pancreas transplants per year with an equal number of islet procedures. We also have plans to start a live donor liver program over the coming years. In addition to adult transplantation experience, we also offer support for pediatric kidney transplantation at BC Children’s Hospital. Vascular access procedures can be available for those wishing for this experience. Through integration with HPB Surgical Oncology Fellowship Program, the Transplant Fellow is also trained in complex HPB Surgery (>150 cases/year). The HPB Surgical Oncology Fellowship also takes 1 fellow per year.
The fellows will work with Transplant and HPB Surgical Oncology staff surgeons: Drs. Chartier-Plante, Chung, Segedi, Kim, Bleszynski and Oldani from the Department of Surgery, along with Drs. Harriman, Nguan, Eng and Mayson from the Department of Urologic Sciences.
Fellows are expected to transition to independent operating during their fellowship. By mid-second year, the fellow is expected to be competent to perform deceased donor procurement (liver, pancreas, and kidney), adult liver and kidney transplantation, laparoscopic donor nephrectomy and multiple HPB-related procedures.
Program Structure
The fellowship duration is 24 months for each fellow. The fellow will rotate on the kidney transplant service, the HPB, and liver transplant service and spend time with the Transplant Hepatologists and Nephrologists to have more focused months on immunosuppression and long-term management of transplant recipients. A dedicated month of research and ambulatory clinic will be offered to consolidate learning toward the end of the first year. Other electives can be arranged depending on interest (Pathology, Radiology, Immunology, Medical, and Radiation Oncology). The fellowship has a large clinical component with the fellow likely expected to perform an average of 1 in 4 on-call services throughout their training, however, this may vary from block to block depending on the opportunity. The fellow will be able to participate in at least one major transplant meeting over the course of the 2-year fellowship and will be provided support to attend ASTS-certified fellowship events.
Pre-Transplant Evaluation and Recipient Selection
The fellow will participate in the liver and kidney pre-transplant assessment clinics with gradual responsibilities. The fellow will also review the inpatient liver transplant assessments with the on-call liver transplant staff. The fellow will be encouraged to attend weekly multidisciplinary liver selection round on Thursday morning at 0700 and the weekly multidisciplinary kidney selection round on Tuesday at 1430. The surgical service works closely with the medical service on both liver and kidney transplant services. Patients are seen by both services and discussed in a multidisciplinary setting once the evaluation is completed. The fellow will also do a month-long rotation with each non-surgical service to gain a deeper understanding of their respective role in the pretransplant assessment, emphasizing the full workup of these complex patients.
The surgical service is involved in making sure patients with HCC, cholangiocarcinoma or neuroendocrine tumor still meet transplant criteria. The surgical service also re-evaluates patients for frailty and contraindication for surgery. The fellow will be part of these assessments. The fellow will also see the patient admitted for transplant and ensure they do not have a contraindication to proceed to transplant. They will review with the surgical staff and discuss operative planning. As the fellow gains experience, they will also have a role in organ allocation and direct kidney and liver list management.
We will encourage the fellow to participate in our candidate selection meeting for kidney and liver transplants and participate in the liver & pancreas tumor rounds. Surgical Transplant M&Ms are reviewed on a monthly basis, and the fellow will be asked to discuss relevant cases with all staff present to enrich learning.
Monday afternoon rounds are dedicated to reviewing imaging for the hepatobiliary patients who will be operated on in the next week.
Tuesday afternoon rounds are dedicated to renal activation rounds and teaching multidisciplinary rounds meeting.
Post-Transplant Care and Teaching
The fellow will be expected to round on the transplant service inpatients and review with the surgical staff on a daily basis while on service. The fellow will also guide junior team members, including junior fellows, residents, and medical students. Didactic teaching sessions and presentations will be regularly held that coincide with the ASTS academic universe to ensure fellows receive the breadth of transplant knowledge. The fellow will also have opportunities to present interesting transplant topics at teaching and research rounds.
The figure below represents a list of the subjects that will be covered over a 2-year period. The fellow will also have to complete the ASTS modules on the academic universe during downtime while on rotation.
Figure: Teaching round subject to be covered over a 2-year period
GET IN TOUCH