The MedStar Health—Georgetown University Hospital Fellowship in Transplant Nephrology
The MedStar Georgetown Transplant Institute, centered at the MedStar Georgetown University Hospital, is a multidisciplinary program dedicated to providing solid organ transplants to the greater Washington, D.C., community. The transplant nephrology fellowship is part of the transplant institute’s overall academic mission. The center is not only one of the largest in the country, but also one of the few to perform all four abdominal transplants (kidney, liver, pancreas, small bowel). Transplant fellows will gain exposure to all of these types of transplants.
The transplant nephrology fellowship is a one-year clinically oriented fellowship program. It includes three components:
A clinical component in which the fellow is involved in primary management of both inpatient and outpatient care of transplant patients
A didactic component with weekly one-hour sessions on a variety of topics
A year-long project component designed to expand knowledge in a specific area of transplant and to prepare the fellow for future academic work
Why train here
With over 300 kidney transplants, 100 liver transplants, 30 pancreas transplants, and 15 small bowel transplants performed annually, we can offer experience in all facets of solid organ transplantation.
Beyond the size of the program, our strength is rooted in our collaborative approach, with all aspects of the transplant team working as part of an integrated transplant institute. In addition to transplant surgeons and transplant nephrologists, the institute has a strong infrastructure including pathology, an on-site histocompatibility lab, a dedicated transplant floor, and specialized transplant nursing to form one of the most comprehensive transplant centers in the country.
Fellows are exposed to all types of kidney transplants, including crossmatch positive transplants, ABO incompatible transplants, HIV- and HCV-positive transplants (including HCV into non-HCV recipients), paired kidney exchange and transplants from non-directed donors, and PHS increased risk transplants. They will have firsthand experience in seeing the recipient operation as well as procurement of a donor organ. They will do biopsies of transplanted kidneys as well as plasmapheresis and dialysis. They’ll also learn about a variety of research protocols used in transplantation including combined kidney/bone marrow transplantation.
During the year, fellows have opportunities to take part in ongoing clinical research protocols and pursue their own topic in either clinical or basic science research. They are also part of the educational program at the institute, helping to teach and mentor general nephrology fellows as well as residents and students doing their transplant rotations.
This will involve work in both the outpatient and inpatient areas with a focus on patient care. Fellows are expected to attend inpatient rounds daily. While rounds cover all kidney and pancreas transplants, the fellow is primarily responsible for a subset of patients transplanted during their fellowship for whom they will maintain longitudinal care. The fellow also has a full clinic schedule including one donor clinic, one recipient evaluation clinic, one waitlist clinic, and three post-transplant clinics each week.
Fellows are expected to attend the living donor team meeting, the listing meeting, and the HLA (human leukocyte antigen) meeting to discuss the patients they saw over the prior week. In addition to direct clinical responsibilities, fellows attend the quarterly Quality Assurance and Performance Improvement (QAPI) meetings to review issues of patient and waitlist management and quality improvement in transplant centers. Fellows are encouraged to participate in existing QAPI projects and suggest their own projects as well.
HLA lab rotation
For this month, the fellow’s primary responsibility is with the histocompatibility team. Fellows work under the supervision of Dr. Sandra Rosen-Bronson. Their activities in the lab will include a didactic component of selected talks from Georgetown’s “Current Topics in Transplant” audio conference series. They also participate in one-on-one case discussions with the histocompatibility laboratory director and technical supervisor. They observe all histocompatibility procedures relevant to renal transplantation, including HLA molecular techniques, antibody assays, and crossmatch assays.
By the end of the month, the fellow should have an excellent background in topics including:
Basics of HLA and antibody testing
Interpretation of results
List management of highly sensitized patients
The placement of current testing in the context of historic tests (CDC crossmatching)
Concepts and current thinking in antibody monitoring
During this month, fellows still attend the weekly listing meetings and HLA conference and maintain their post-transplant clinic responsibilities (though not the other outpatient clinics). They also continue to go to the weekly transplant lecture series.
For this month, the fellow’s primary responsibility will be to develop a comprehensive basis for interpretation of transplant renal biopsies. The fellow will be working under the guidance of Dr. Bhaskar Kallakury. The fellow will be expected to be available to read all biopsies with Dr. Kallakury during this month as well as additional teaching cases to fill any gaps in the current clinical biopsies. The fellow will also be expected to perform (with the transplant nephrologists) all scheduled biopsies during this month.
To facilitate this, they will maintain only their basic clinical responsibilities of post-transplant clinics, the listing and HLA meetings, and the transplant lecture series.
Fellows spend their month in pediatrics at Children’s National Medical Center (CNMC) under the supervision of Dr. Asha Moudgil. They participate both in inpatient transplant rounds as well as outpatient transplant clinics for pediatric patients. The goals of this month are to appreciate the different challenges, both technical and social, for the transplantation of both young children and adolescents. Fellows learn the impact of transplant on growth and development and how the different needs in the pediatric setting demand different listing and allocation mechanics and how this differs from adult transplantation.
During this rotation, which is at a separate site, fellows do not have any clinical responsibilities at MedStar Health Georgetown University Hospital other than the standard didactic lecture components.
This rotation occurs late in the transplant fellowship year and provides intensive time for finishing the fellow’s year-long project and to write and submit a manuscript on their research. It is expected that by the beginning of this rotation, their work will be mostly complete, allowing for the focused time needed for final data analysis and publication.
During this month, the fellow’s only clinical responsibilities will be the post-transplant clinics and standard didactic lectures.
Fellows receive time off and support to attend the AST Transplant Fellows Symposium offered each September. Fellows are encouraged to submit their research for presentation at the American Transplant Congress held each spring. They are allotted time off to attend, and if their work is accepted for presentation, their travel expenses will be covered by MGTI.
How we evaluate fellows
Formal review and evaluation by the program director will occur midway through (at six months) and at the end of the fellowship. Additional interim reviews will be scheduled on an as-needed basis as deemed necessary.
Fellows must keep a log of the following procedures and experiences:
Primary patients managed (their ‘panel’): minimum 30 patients inpatient and outpatient
Primary pancreas transplant patients: minimum five patients (may also count for kidney primary)
Transplant recipient evaluations: minimum 25 patients
Pancreas evaluations: minimum five patients (may also count as kidney evaluations)
Living donor evaluations: minimum 10 patients
Renal transplant surgery observation: minimum three operations (including at least one living and one deceased donor)
Organ recovery observation: minimum three operations
Transplant kidney biopsies: minimum 10 procedures
Upon completing the program, fellows meet criteria set forth by UNOS for designation as a renal transplant physician and a pancreas transplant physician as well as being eligible to be the primary transplant physician at a CMS-certified program.
A nonprofit, acute care teaching and research hospital with 609 located in Northwest Washington, D.C., Read more about their mission to service our patients.
3800 Reservoir Rd. NW
Washington, D.C., 20007
A 912-bed, major teaching and research hospital. MedStar Washington is the largest private, not-for-profit hospital in the nation’s capital and among the 100 largest hospitals in the country. It is a major referral center for treating complex cases of illness.
110 Irving St. NW
Washington, D.C., 20010
Interested in applying?