A key strength of the Renal Transplant Fellowship is the exposure to a large, wide-ranging population of kidney and pancreas transplant recipients within a highly integrated, patient-centered clinical program at Mayo Clinic's campus in Arizona. Renal Transplant fellows train in inpatient, acute outpatient and long-term outpatient settings.
Throughout the fellowship, you work closely with consultants in:
- Transplant nephrology
- Transplant surgery
- Renal pathology
- Transplant infectious diseases
- HLA and tissue typing
- Renal radiology
- Transfusion medicine
You also interact regularly with specialists in endocrinology, cardiology, dermatology and psychiatry who have focused expertise in the care of recipients with transplants. In addition, you have opportunities to share the care of multitransplant recipients with members of the liver, heart-lung and bone marrow transplant groups.
Specific areas of clinical and didactic teaching include:
- Recipient evaluation and preparation for kidney and pancreas transplantation
- Evaluation of potential living kidney donors
- The biologic basis of HLA and transplant rejection
- Methods of tissue typing, crossmatching, alloantibody measurement and clinical application of these methods
- Pharmacology and clinical use of established and emerging immunosuppression for kidney and pancreas transplantation
- Evaluation and comparison of different combinations of immunosuppressive medication in kidney and pancreas transplantation
- Perioperative and early outpatient care of recipients with kidney and pancreas transplants
- Recognition of surgical complications of kidney and pancreas transplantation
- Evaluation and management of acutely ill recipients of kidney or pancreas transplants
- Diagnosis and management of infections in transplant recipients
- Long-term medical management of kidney and pancreas transplant recipients
- Diagnosis, pathogenesis and clinical management of renal allograft dysfunction
- The use of plasmapheresis, intravenous immunoglobulin and other techniques to lower or modify anti-HLA antibody in sensitized patients
- Allocation of deceased-donor organs for transplantation
- Ethical considerations in organ transplantation
|HLA laboratory (outpatient)
|Transplant nephrology (inpatient)
|Transplant nephrology clinic (outpatient)
|Transplant infectious disease
Inpatient kidney and pancreas transplant service
Renal Transplant fellows are part of an integrated medical and surgical hospital team that consists of transplant nephrologists and transplant surgeons, nephrology fellows and transplant surgery fellows, general surgery residents, and a physician assistant.
The typical census for the hospital service varies between seven and 15 patients, including recent recipients of living- or deceased-donor kidneys, recent pancreas transplant recipients, and recent living kidney donors, as well as transplant recipients with acute medical and surgical illness.
You gain extensive experience in routine post-transplant management, initiation and modification of immunosuppressive therapy, as well as management of a wide range of transplant-related complications. You evaluate patients daily and coordinate diagnostic, management and dismissal plans with the inpatient and outpatient teams.
Along with Transplant Surgery fellows, Renal Transplant fellows share responsibility for resident supervision and teaching. You are primarily responsible for medical evaluation of all recipients of deceased-donor transplants and of transplant recipients with acute medical illness.
You round daily with the consultant nephrologist and, on nonsurgical days, with the entire team. You participate directly in the coordination of care for patients undergoing special clinical protocols — such as removal of preformed alloantibody — and patients participating in clinical research protocols.
Acute kidney and pancreas transplant
You evaluate recently discharged recipients of living- and deceased-donor kidney and pancreas transplants, as well as recipients requiring acute evaluation or ongoing management of medical and surgical complications. The clinic operates in a paperless environment with clinical documentation, laboratory results and radiological images available electronically.
The outpatient team consists of a transplant nephrologist, a Renal Transplant fellow or Nephrology fellow, and a physician assistant with transplant surgeon consultation directly available. You are primarily responsible for generation of diagnostic, consultative, therapeutic and follow-up plans with ample opportunities to discuss cases with supervising physicians and to maintain continuity of care on individual patients.
You evaluate many patients undergoing transplant biopsy for graft surveillance, as well as for acute graft dysfunction. Opportunities are routinely available to review and discuss biopsies with a consultant renal pathologist.
Long-term kidney and pancreas transplant
Recipients of kidney and pancreas transplants who have had their transplants for one year or longer are seen annually for a detailed review of graft function, immunosuppressive therapy and related medical issues. Long-term graft recipients with acute or subacute medical illness are also evaluated.
The clinic is staffed by a transplant nephrologist, a Renal Transplant fellow or Nephrology fellow, and transplant nurse practitioners.
You are primarily responsible for comprehensive care of the patients and gain experience working with midlevel providers specializing in long-term care of transplant patients, as well as in the design and application of management protocols for hypertension, bone disease, hyperlipidemia, cardiovascular disease, obesity and chronic renal allograft dysfunction.
Donor and recipient evaluation
Potential recipients of kidney and pancreas transplants and potential kidney donors are evaluated. You conduct initial evaluations with the supervision of a nephrologist who has expertise in the evaluation of potential donors and recipients. You participate in the weekly multidisciplinary review of candidates and in the formal selection conference meetings.
Transplant infectious disease
You are assigned on the inpatient transplant infectious disease service. Exposure includes a wide variety of pathology among recipients of kidney, pancreas, liver, heart and bone marrow transplants.
You have four weeks of dedicated renal pathology training, which involves working closely with the renal pathologist reviewing biopsies and receiving one-on-one didactic training.
A broad range of research opportunities are available within the kidney and pancreas transplant program. Two months during this fellowship are devoted to one or more research projects.
Potential research projects are discussed soon after beginning the fellowship to identify a mentor and area of interest prior to the research rotation. Research projects are facilitated by the availability of excellent database and data analysis support.
The Renal Transplant Fellowship also actively supports the preparation of manuscripts for publication and travel to national and international meetings to present research data.
Tissue typing, transfusion medicine and apheresis
As part of this fellowship, observational and didactic instruction in methods of blood and tissue typing, assays for crossmatching and alloantibody measurement, and the use of therapeutic apheresis for conditioning and treatment of specific transplant patients are provided within the tissue typing and apheresis laboratories, coordinated by the consultant and technical staff of the laboratories.
Transplant and organ procurement surgery
To fulfill UNOS certification requirements, Renal Transplant fellows observe kidney and pancreas transplant surgeries and living-donor nephrectomies. You also accompany the transplant surgery team on organ procurements.
You are on home call only during the inpatient transplant rotation with no call responsibility during the outpatient rotation. Mayo Clinic follows the recommendations of the Accreditation Council for Graduate Medical Education (ACGME).
You may moonlight with program director approval, but only during outpatient rotations. Moonlighting should not interfere with the required learning and must not violate the duty-hour rules of the Accreditation Council for Graduate Medical Education (ACGME) or visa regulations.
The fellowship provides a wide range of didactic exposure, including:
- Renal Pathology Conference (bimonthly)
- Transplant Clinical Case Vignette (monthly)
- Transplant Organ Review (monthly)
- Transplant Morbidity and Mortality Conference (monthly)
- Transplant Grand Rounds (monthly)
- Transplant Journal Club (monthly)
- Transplant Selection Conference (weekly)
- Internal Medicine Grand Rounds (weekly)
- Nephrology Core Curriculum Lectures (weekly)
Along with Transplant Surgery fellows, you share responsibility for resident supervision and teaching on the inpatient service. You also present at conferences, including Grand Rounds and journal club.
To ensure that you acquire adequate knowledge and develop the appropriate technical skills to meet program expectations, your performance is monitored carefully during the Renal Transplant Fellowship. You are formally evaluated by supervising faculty members after each clinical rotation and meet with the program director to review these evaluations. In addition, you regularly evaluate the faculty to confirm that your educational needs are being met.
Oct. 05, 2017