A key strength of this 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 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
- Tissue typing and transfusion medicine
- Renal radiology
You also interact regularly with specialists in endocrinology, cardiology, dermatology and psychiatry who have focused expertise in the care of transplant recipients. 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 kidney and pancreas transplant recipients
- Recognition of surgical complications of kidney and pancreas transplantation
- Evaluation and management of acutely ill kidney or pancreas transplant recipients
- 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 lab, outpatient
|Transplant nephrology, inpatient
|Transplant nephrology clinic, outpatient
Inpatient kidney and pancreas transplant service
Renal Transplant fellows are part of an integrated medical and surgical hospital team consisting 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 living-donor and deceased-donor kidney recipients, recent pancreas transplant recipients, and recent living kidney donors, as well as transplant recipients with acute medical and surgical illness.
Fellows 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. Fellows 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. Fellows are primarily responsible for medical evaluation of all deceased-donor transplant recipients and of transplant recipients with acute medical illness.
Fellows round daily with the consultant nephrologist and, on nonsurgical days, with the entire team. On-call duties are in accordance with the current Accreditation Council for Graduate Medical Education requirements for at-home call.
Renal Transplant fellows 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
This clinic evaluates recently discharged living-donor and deceased-donor kidney and pancreas transplant recipients, 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. Renal Transplant fellows 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.
Renal Transplant fellows 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
Kidney and pancreas transplant recipients 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.
Renal Transplant fellows 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 kidney and pancreas transplant recipients and potential kidney donors are evaluated. Renal Transplant fellows conduct initial evaluations with the supervision of a nephrologist who has expertise in the evaluation of potential donors and recipients. Fellows participate in the weekly multidisciplinary review of candidates and in the formal selection conference meetings.
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.
Mayo Clinic in Arizona's 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. Fellows also accompany the transplant surgery team on organ procurements.
The fellowship provides a wide range of didactic training, including:
- Daily interactions with transplant nephrologists and transplant surgeons
- Renal biopsy conference, twice a month
- Transplant selection conference, weekly
- Nephrology and transplant journal club, twice a month
- Kidney and pancreas transplant academic conference, twice a month
- Transplant Grand Rounds, monthly
- Support for travel to the American Society of Transplantation Fellows Symposium and for presentation of research projects at one major transplant-related conference
Moonlighting is permitted for fellows at the discretion of the program director. Moonlighting activities may be scheduled only during outpatient rotations. Moonlighting should not interfere with required learning and must not violate the Accreditation Council for Graduate Medical Education work hour rules. Moonlighting should not compromise education, but rather enhance it.
The call schedule varies by rotation but does not exceed one in four for any rotation. Mayo Clinic in Arizona follows the recommendations of the Accreditation Council for Graduate Medical Education for all training programs including the Renal Transplant Fellowship.
Along with Transplant Surgery fellows, Renal Transplant fellows share responsibility for resident supervision and teaching on the inpatient service. Fellows also present at conferences, including grand rounds and journal club.
Competency-based electronic evaluations are completed by supervising faculty members after each clinical rotation. In addition, fellows have opportunities to evaluate the faculty and rotations throughout the fellowship.