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Curriculum
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. As a transplant nephrology fellow at Mayo Clinic in Rochester you will train in inpatient, acute outpatient and long-term outpatient settings.
Throughout the year, you will work closely with consultants in transplant nephrology, transplant surgery, renal pathology, transplant infectious diseases, tissue typing/transfusion medicine and renal radiology. You also will gain experience from consultants in endocrinology, cardiology, dermatology and psychiatry who specialize in the care of transplant recipients.
In addition, you will have frequent opportunities to share the care of multi-transplant recipients with members of the liver, heart/lung and bone marrow transplant groups.
Specific areas where you will receive clinical and didactic teaching are:
- Recipient evaluation and preparation for kidney and pancreas transplantation.
- Evaluation of the potential living kidney donor
- The biologic basis of HLA and transplant rejection
- Methods of tissue typing, cross matching, allo-antibody 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
- Peri-operative and early outpatient care of kidney and pancreas transplant recipients
- Recognition of surgical complications of kidney and pancreas transplantation
- Evaluation and management of the acutely ill kidney or pancreas transplant recipient
- 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
Rotations |
Length |
Inpatient kidney and pancreas transplant service |
16 weeks |
Acute kidney and pancreas transplant outpatient clinic |
16 weeks |
Long-term kidney and pancreas transplant outpatient clinic |
8 weeks |
Research |
8 weeks |
Tissue typing/transfusion medicine/apheresis experience |
1.5 weeks |
Transplant and organ procurement surgery experience |
1.5 weeks |
Rotation Descriptions
Inpatient kidney and pancreas transplant service
You will be part of an integrated medical and surgical hospital team consisting of consultants in nephrology and transplant surgery, transplant nephrology and surgery trainees, general surgery residents and a physician assistant.
The typical census for the hospital service varies between 12 and 25 patients. The patients include recent living and deceased donor kidney recipients, recent pancreas transplant recipients, recent living kidney donors, as well as transplant recipients with acute medical and surgical illness.
You will gain extensive experience in routine post-transplant management, institution and modification of immunosuppressive therapy, as well as a wide range of transplant-related complications. Your duties will consist of daily patient evaluations and coordination of diagnostic, management and dismissal plans with the surgical fellow and residents.
Along with the surgical fellow, you will share responsible for resident supervision and teaching. You will be primarily responsible for medical evaluation of all deceased donor transplant recipients and of transplant recipients with acute medical illness.
You will round daily with the consultant nephrologist and, on non-surgical days, with the entire team. On-call duties are in accordance with current ACGME requirements, being no more frequent than one night in four with one full day off each week.
You will have the opportunity to participate directly in the coordination of care for patients undergoing special clinical protocols (such as removal of pre-formed alloantibody), as well as patients participating in clinical research protocols.
Acute kidney and pancreas transplant outpatient clinic
This clinic serves recently discharged 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 consultant nephrologist, a transplant nephrology trainee, a physician assistant and available consultation from transplant surgery. You will be primarily responsible for generation of diagnostic, consultative, therapeutic and follow-up plans. You will have ample opportunities to discuss cases with consultant staff and to maintain continuity of care on individual patients.
You also will evaluate many patients undergoing transplant biopsy for graft surveillance as well as for acute graft dysfunction. You will have the opportunity to review and discuss biopsies with a consultant renal pathologist.
Long-term kidney and pancreas transplant outpatient clinic
This clinic serves kidney and pancreas transplant recipients who are transplanted one year ago or longer. Patients are seen annually at this clinic 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 consultant nephrologist, transplant nephrology fellow, transplant nurse practitioner, and nurse coordinator.
During this clinic rotation you will have access to all patient categories and will be primarily responsible for generation of diagnostic, consultative, therapeutic and follow-up plans together with the consultant staff.
You will also gain experience working with mid-level 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 graft dysfunction.
Research
A broad range of research opportunities are available within the kidney and pancreas transplant program. You will have an eight-week rotation devoted to one or more research projects.
You are encouraged to discuss potential research projects with the transplant nephrology consultant staff soon after beginning the fellowship and 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.
Our program also actively supports travel to national and international meetings in order to present research data as well as the preparation of manuscripts for publication.
Tissue typing/transfusion medicine/apheresis experience
You will have observational and didactic instruction in methods of blood and tissue typing, assays for cross matching and alloantibody measurement, and the use of therapeutic apheresis for conditioning and treatment of specific transplant patients.
This rotation occurs within the tissue typing and apheresis laboratories and is coordinated by the consultant and technical staff of the laboratories.
Transplant and organ procurement surgery experience
You will attend kidney and pancreas transplant surgeries and living donor nephrectomies, as well as to accompany the transplant surgery team on organ procurements.
In addition to providing direct observational experience of the common surgical procedures involved in kidney and pancreas transplantation, this rotation will facilitate your meeting the requirements for UNOS certification as a renal and/or pancreas transplant physician.
Didactic Training
The fellowship provides an excellent range of didactic training including:
- Daily interactions with transplant nephrology and transplant surgery consultant staff
- Weekly Transplant Grand Rounds conference with formal presentations on all aspects of transplantation from internal faculty as well as many visiting external faculty
- Transplantation core curriculum lectures – a series of lectures given by Mayo Clinic faculty that covers basic science and clinical topics relevant to transplantation. The lectures are organized into three separate half-day symposia.
- Weekly renal biopsy conference with presentation and discussion of transplant and native kidney biopsies by renal pathology and nephrology groups
- Monthly morbidity and mortality conference to discuss cases from kidney/pancreas and liver transplant hospital services
- Twice monthly recipient review conference
- Twice monthly research conference
- Support for travel to American Society of Transplantation fellow's symposium and for presentation of research projects at one major transplant-related conference
As a member of the Nephrology and Hypertension Division you will also be welcome to attend and take part in the didactic programs linked with the Mayo Clinic Nephrology fellowship, including:
- A weekly Nephrology Journal Club presented by fellows
- Weekly nephrology core lectures by Mayo Clinic faculty
- Weekly Nephrology Grand Rounds presentations by Mayo Clinic faculty and prominent visiting faculty
- Monthly renal radiology conference co-presented by nephrology fellows and Mayo Clinic radiology faculty
- Visiting faculty research forum – evening presentations by visiting faculty hosted by the Nephrology and Hypertension Division
Moonlighting
Moonlighting is permitted for licensed residents and fellows beyond the PGY-1 level at the discretion of the Program Director. Moonlighting activities may be scheduled during those times when you are assigned to consultative or outpatient rotations. Moonlighting should not interfere with required learning and must not violate the Accreditation Council for Graduate Medical Education’s (ACGME) work hour rules. Moonlighting should not compromise your education, but rather enhance it.
Evaluation
To ensure that you acquire adequate knowledge and develop your technical skills, your performance will be monitored carefully during the course of your fellowship. You will be evaluated formally by your supervising faculty member after each clinical rotation. In addition, you will regularly evaluate the faculty to ensure that your educational needs are being met.
Call Frequency
The call schedule is different for each rotation but does not exceed one in four for any rotation. Mayo Clinic College of Medicine follows the recommendations of the Accreditation Council for Graduate Medical Education (ACGME) for all training programs including the Transplant Nephrology fellowship.
Teaching Opportunities
Along with the surgical fellow, you will share responsible for resident supervision and teaching. You will present at conferences including Grand Rounds and Journal Club.
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