Transplant Hepatology Fellowship Program | DC | MedStar Health

The MedStar Health—Georgetown University Hospital Fellowship in Transplant Hepatology

The MedStar Georgetown Transplant Institute is one of the highest volume transplant programs in the United States. Over 8,500 liver, kidney, small bowel, colon and multivisceral transplants have been performed. The liver transplant program is one of the largest programs in the Mid-Atlantic region and one of the best in terms of patient and graft survival. We perform both deceased donor and living donor liver transplants with excellent outcomes. Currently, we have 7 liver transplant and hepatobiliary surgeons and 9 transplant hepatologists.

Overview

The MedStar Georgetown Transplant Institute and MedStar Georgetown University Hospital are proud to offer a one-year Accreditation Council for Graduate Medical Education (ACGME) fellowship in transplant hepatology. Training will follow the guidelines to meet the milestone and competency requirements set forth by ACGME, the American Board of Internal Medicine (ABIM), and the United Network of Organ Sharing (UNOS). Successful completion of fellowship will afford the fellow the opportunity to sit for the ABIM Transplant Hepatology Certification Exam and to serve as a United Network for Organ Sharing (UNOS)-certified primary liver transplant physician. All applicants must have completed an ACGME-accredited fellowship in gastroenterology and be Board Certified or Board Eligible in gastroenterology. Transplant hepatology training will be obtained within the MedStar Georgetown Transplant Institute and MedStar Georgetown University Hospital. Transplant hepatology fellows will be exposed to a wide array of inpatient and outpatient clinical rotations, didactic experiences, and research pertaining to transplant hepatology and liver transplantation. Additionally, fellows will reap the benefits of a multi-disciplinary approach to care through collaboration with, but not limited to diagnostic and interventional radiologists, hepatic pathologists, hepatobiliary and transplant surgeons, transplant infectious disease specialists, nutritionists, nurse practitioners, physician assistants, and transplant coordinators.

-Amol Rangnekar, M.D., Program Director

Why train here

Procedures

Trainees are expected to understand the indications, contraindications, complications, and limitations of liver biopsy as well as alternative noninvasive methods of fibrosis assessment. Fellows will review at least 200 biopsies of native liver and allografts at a pathology conference. Trainees will be expected to perform esophagogastroduodenoscopy (EGD) and colonoscopy on their patients in the pre and post transplant settings.

Curriculum

Transplant hepatology fellows will spend approximately 6 months on the inpatient hepatology service. The fellow will be exposed to pre- liver transplant patients with a broad array of acute and chronic liver diseases that arise as a consequence of viral, metabolic, and autoimmune disorders. Moreover, fellows will gain expertise in the management of patients with benign and malignant hepatobiliary tumors. Additionally, fellows will be exposed to patients with a variety of disorders that arise early and late after liver transplantation. During the inpatient experience, transplant hepatology fellows will learn the multidisciplinary approach to management of patients before and after liver transplantation. Fellows will perform a variety of procedures including but not limited to upper endoscopy and colonoscopy.

In addition to the inpatient experience above, fellows will gain expertise in managing patients with acute and chronic liver diseases in a variety of clinics including but not limited to general hepatology clinic, post transplant clinic, pre-liver transplant evaluation clinic, and a fellows’ continuity clinic. Approximately 6 months will be devoted to outpatient rotations. Transplant hepatology fellows will be expected to present patients seen in transplant evaluation clinic at the weekly transplant selection committee meeting. Fellows will also perform endoscopic procedures during their outpatient rotations.

One of the benefits of the transplant hepatology fellowship at Georgetown is the variety of conferences that are offered. Fellows are expected to attend weekly core curriculum, transplant selection committee, hepatobiliary radiology, pathology, transplant surgery, morbidity and mortality, and journal club conferences. Moreover, fellows can attend gastroenterology conferences applicable to the fields of hepatology, transplant hepatology, and liver transplantation. Additionally, fellows are encouraged to attend the annual AASLD Liver Meeting.

Transplant hepatology fellows are expected to work with a mentor on a clinical research project during the 1-year fellowship. The MedStar Transplant Institute has a variety of projects pertaining to liver transplantation and transplant hepatology. We anticipate that fellows will produce work suitable for publication in peer-reviewed journals.


Conferences

  • Post Transplant Management Conference

    Transplant hepatology fellows are expected to attend the weekly Monday post transplant management conference over the course of the 12-month program. The purpose of the conference is to make medical and surgical treatment decisions on newly transplanted inpatients and outpatients as well as complicated long-term liver transplant recipients. Trainees will interact with transplant hepatologists, transplant surgeons, post transplant nurse practitioners, and transplant pharmacists.

  • Core Curriculum Conference

    Transplant hepatology fellows are expected to attend the weekly Tuesday core curriculum conference over the course of the 12-month program. The purpose of the conference is to discuss the physiology, pathophysiology, evaluation, and management of acute and chronic hepatobiliary diseases. Topics to be discussed include but are 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, alpha-1-antitrypsin deficiency, and benign and malignant hepatobiliary tumors. Additionally, trainees will gain an understanding of complications of portal hypertension including prevention and treatment of variceal bleeding and re-bleeding, 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 and post-transplant settings. Fellows will understand the indications, contraindications, and side effects of immunosuppressive medications and other agents applicable to the post-transplant setting. Other topics to be discussed include the variety of medical and surgical complications that can arise after transplantation.

    The core curriculum conference will consist of didactic lectures, case presentations, and journal club. Fellows will be expected to periodically lead select conferences over the course of the 12-month program. We anticipate that key clinical faculty will mentor fellows in preparation for their presentations. All presentations at core curriculum conferences will be uploaded on the Georgetown Transplant institute share drive for later reference.

  • Research Conference

    Transplant hepatology fellows are expected to attend research conferences over the course of the 12-month program. The MedStar Georgetown transplant institute has a variety of protocols pertaining to non-transplant and transplant hepatobiliary programs. Trainees are expected to present their work at these conferences.

  • Transplant Surgery Academic Conference

    Trainees are expected to attend the weekly Friday transplant surgery academic conference over the course of the 12-month program. A variety of topics are discussed including but not limited to journal club, morbidity and mortality conference, and didactics pertaining to hepatobiliary and transplant surgery. Guest speakers in addition to Georgetown faculty are frequently invited to present at these conferences.

  • Pathology Conference

    Transplant hepatology fellows are expected to attend the weekly Wednesday pathology conference. As per ACGME, fellows are expected to review over 200 native and allograft biopsies over the course of the 12-month program. Trainees will interact closely with pathologists, transplant hepatologists, transplant surgeons, and post transplant nurse practitioners. Fellows are expected to present inpatients and outpatients whom they have seen during their mandatory rotations.

  • Transplant Selection Committee Conference

    Transplant hepatology fellows are expected to attend the weekly Tuesday transplant selection committee conference. As per ACGME requirements, fellows will present a minimum of 10 patients undergoing liver transplant evaluations over the course of the year. Given the volume of the transplant program, fellows will typically present many more patients than the minimum required by ACGME. Fellows will interact closely with transplant hepatologists, transplant surgeons, pre liver transplant coordinators, nutritionists, social workers, psychiatrists, financial counselors and other staff as appropriate.

  • Hepatobiliary Tumor Conference

    Transplant hepatology fellows are expected to attend the weekly Tuesday multidisciplinary hepatobiliary tumor conference over the course of the 12-month program. The purpose of the conference is to review imaging and make treatment decisions on patients with benign and malignant hepatobiliary tumors. Trainees will present cases and interact with transplant hepatologists, hepatobiliary surgeons, oncologists, radiation oncologists, diagnostic radiologists, and interventional radiologists.

Rotations

  • 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 re-bleeding, 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 and colonoscopies.

    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. Fellows will 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 biweekly half day continuity clinic. Fellows will have the opportunity to work with a single mentor or a variety of key clinical faculty. 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.


Application information

Interested in applying?

Contact us

For additional information please contact:

Lisa Townsend
Fellowship Program Administrator
Lisa.Townsend@gunet.georgetown.edu