Renal Transplant Fellowship Curriculum

Didactic Sessions

Weekly transplant didactic conference:

The didactic weekly conference follows the guidelines established by The AST’s Primer on Transplantation. The current scheduled topics are:

a. Management of chronic renal insufficiency and therapeutic options

b. Principles of alloimmunity

c. Histocompatibility testing, cross-matching and immune surveillance

d. Organ procurement, preservation and allocation policies

e. Principles and pharmacology of immunosuppression

f. Evaluation of the organ transplant recipient

g. Evaluation of the living donor

h. Transplant surgical procedures and complications

i. The immediate post-transplant period

j. Post-transplant medical complications

k. Post-transplant infections

l. Diagnostic imaging following transplantation

m. Pathology aspects of renal and pancreas transplantation

n. Ethical, legal, psychosocial and financial aspects of renal and pancreas transplantation
 

Renal Grand Rounds:

Renal Grand Rounds is teleconferenced between BWH and MGH and occurs weekly. Each first-year clinical fellow is responsible for four case presentations in diverse areas of nephrology throughout the academic year, which includes a brief but comprehensive literature review on a topic relevant to the case.  One fourth of the cases will be transplant related. The remainder of the Grand Rounds sessions consists of lectures given by invited outside speakers or members of the BWH/MGH faculty. Approximately, one fourth of the invited speakers will be transplant professionals. Mortality and Morbidity conferences are hosted by each hospital every 6 months held during Renal Grand Rounds.

Journal Club:

Weekly Journal Club at BWH consists of individual presentations by both faculty and fellows. The goal of Journal Club is for it to be both informative and stimulating, but also to give the audience insight into how to critically review papers.  The presentation includes a brief discussion of the background, why the article was chosen for journal club, main hypothesis of paper, relevance of work proposed (a priori), methods used, alternative methods which could have been used and critique, data exposition, conclusions supported by data, conclusions claimed by authors, relevance of paper (a posteriori), future questions and directions suggested by paper.

Pathology Conference:

Every first Thursday of each month, Pathology Conference is held instead of Journal Club. Pathology Conference is a monthly conference presented by Dr. Helmut Rennke and Dr. Vanesa Bijol, BWH renal pathologists.  Cases from the BWH Renal Division as well as outside cases will be selected for presentation.  The pathology is presented by the Drs. Rennke and Bijol, and all participants discuss the cases, diagnostic  and management approaches.

Summer Didactic Fellow Teaching Conference:

During July and August, there are didactic teaching conferences every Tuesday morning held during Renal Grand Rounds hiatus. This is an important introduction to the basics of clinical nephrology, including the handling of all common renal emergencies, and is tailored specifically for all new clinical fellows.  One module of those conferences is transplant mediated. This is also a joint effort between BWH/MGH and BIDMC nephrology fellowship programs.

Fellow Didactic Teaching Conference:

The Fellow Didactic Teaching Conference is intended to be a teaching session given by BWH clinical faculty specifically for first and second year clinical fellows, and will cover the essential topics in general nephrology, dialysis, transplantation, and renal pathology at a more advanced level than the introductory summer teaching conferences. Thematic topics are arranged in one-month modules such as transplantation, dialysis, glomerular diseases and pathology, fluid and electrolytes/acid-base disorders, and radiology and interventional nephrology.

Clinical Research Conference:

Clinical Research Conference provides an important forum for faculty and trainees engaged in epidemiology and patient-oriented research.  These twice monthly conferences showcase works in progress and allows for constructive suggestions to be given in a supportive and stimulating atmosphere. Most of the clinical research projects that make their debut at this meeting have subsequently been presented as abstracts, free communications at meetings and/or published as original investigations in peer-reviewed journals. 

Early Investigator Basic Science Conference:

Early Investigator Basic Science Conference provides an important forum for faculty and trainees engaged in basic science research.  These monthly conferences showcase works in progress and allows for constructive suggestions to be given in a supportive and stimulating atmosphere. Most of the basic science research projects that make their debut at this meeting have subsequently been presented as abstracts, free communications at meetings and/or published as original investigations in peer-reviewed journals. 

Clinical experience:

 Clinical experience also includes supervised involvement in pre- and post-transplant care, including:

  • Clinical and laboratory diagnosis of all forms of rejection
  • Evaluation and selection of transplant candidates
  • Immediate postoperative management of transplant recipients, including administration of immunosuppressants to a minimum of 10 new renal transplant recipients
  • Management in the ambulatory setting for at least three months of at least 20 patients per fellow
  • Management in the intensive care unit setting for patients with renal disorders
  • Medical management of rejection, including use of immunosuppressive drugs and other agents
  • Preoperative evaluation and preparation of transplant recipients and donors
  • Psychosocial and ethical issues of renal transplantation
  • Recognition and medical management of the surgical and nonsurgical complications of transplantations

Direct supervision of procedures that include ultrasound-guided allograft biopsies performed by each fellow occurs until proficiency has been acquired and documented by the program director. Faculty teaches and supervises the fellows in the performance and interpretation of procedures, which are documented in each fellow’s record.

This documentation occurs in New Innovations (NI); each faculty on relevant rotations is asked to evaluate procedures the fellow has completed. Additionally, each fellow logs his or her procedures in NI, which the faculty supervisor also verifies.

Clinical schedule and duties:

Inpatient: the fellow will attend the inpatient transplant rounds for 9 months of the year. These rounds occur daily from 7:15 AM to 9:00 AM. During rounds, all of the new transplant patients as well as any patient readmitted for either surgical or medical complications are seen by the medical and surgical teams who round together. Fellow would have responsibility for at least 30 new patients in the course of the year. The fellow would take responsibility for the workup, performance, and interpretation of at least ten biopsies in the course of  the year.

Outpatient: The fellow would attend three renal transplant clinics per week for a period of nine months and two clinics per week for additional three months. The clinics would provide an opportunity for the fellow to follow all of the patients seen during their transplant admissions as well as a broad spectrum of patients who have had their kidney transplants for a longer period of time and have some of the chronic sequellae of transplantation. During these clinic sessions the fellow would also have the opportunity to do candidate evaluation and evaluations of donors for suitability for transplantation. We expect that the kidney transplant fellow will see approximately fifteen patients per week under the supervision of a transplant nephrologist. The fellow will have the primary responsibility for longitudinal follow up of at least 30 patients in the outpatient clinic over 12 months. The duty hours will comply with currently mandated ACGME work hour limitations.

Elective Opportunities

Research: There are over ten investigators in the Transplantation Research Center and the Renal Division who are engaged in clinical, translational or basic research in kidney transplantation or immunogenetics. Fellows will have the opportunity to work with an investigator of their choice and to craft a program of study or focused research, which would lead to a deeper understanding of the immunobiology, physiology, pharmacology, or risk factors and clinical outcome of kidney transplantation.

Tissue typing: The renal transplant fellow will be required to spend at least 2 weeks (can request up to 6 weeks) in the Histocompatability Lab, learning the principles, methodology, and interpretation of tissue typing and crossmatching for renal transplantation, including various lymphocytotoxic assays, ELISA, flow crossmatches and luminex.

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