Liver Transplant Fellowship

The Emory Hepatic Transplantation Anesthesiology (HTA) Fellowship position is available at Emory University Hospital, one of the largest liver transplant centers in the country.

This fellowship program provides a comprehensive curriculum emphasizing perioperative care with ample research opportunities and collaboration of colleagues in surgery, hematology, and critical care medicine. By the end of the training year, fellows achieve sufficient qualification to become a contributing member of any liver transplant team in any major medical center.

The objectives of the one-year fellowship include:

• Clinical
• Education
• Research components

The clinical program emphasizes a comprehensive perioperative approach. Fellows are encouraged to participate in the weekly preoperative evaluation of the candidates at weekly selection conference, intraoperative anesthetic care, and postoperative visits. They are expected to participate in the bi-monthly Monday HTA Morbidity and Mortality Conference for an extensive discussion of candidates, perioperative care of patients, and other clinical issues.

The program also can be tailored to meet special goals and needs, such as pediatric HTA. The teaching program is supported by eight attending anesthesiologists with a great depth of expertise in the evaluation of liver transplantation candidates, including those with:

• the central nervous system
• Cardiopulmonary system
• Renal system
• Coagulation defects.

Our educational program consists of a didactic curriculum with a dedicated manual, overseen by faculty members on the HTA service, covering preparation, assessment, and management of each organ’s function. The process continues with an extensive discussion of any difficult cases at the Monday transplant morbidity and mortality conference.

This format allows fellows to gain in-depth knowledge of organ transplantation. In addition, fellows are encouraged to participate in the education of junior residents and student anesthetists at Emory University Hospital.

Clinical Goals

The clinical goals for the year will focus on liver transplant and non-transplant surgery for patients with hepatic/pancreatic/biliary disease. Fellows will also provide care for advanced vascular OR cases.

Research Goals

The research goals will focus on research in transplantation, in the sub-area of the fellow’s interest. The participant will be encouraged to attend the annual International Liver Transplantation Society (ILTS) perioperative (one-day) meeting accompanying the ASA annual meeting or the ILTS International Congress (2½ day meeting). Educational funds, which will be provided, can be used for this purpose.

Educational Goals

The educational goals will focus on developing teaching skills relevant to training residents in major surgical procedures and/or procedures in high acuity patients.
Echo, blood bank and liver transplant ICU rotations will be offered as options. The participant will gain experience in TEE image acquisition and interpretation, a key requirement for basic certification in echocardiography.  Echo case conferences will supplement hands-on experience.
 
The ACGME/RRC does not regulate the fellowship. Thus, regularly scheduled time working as an attending in the main operating room would be included. Given that the fellow will be providing some clinical services as an attending, your salary as a fellow has been supplemented to reflect this blended role.
 
The focus for the first portion of the year will be on autonomy; in the latter part of the year, the focus of the fellowship will shift to include increased resident supervision and acquisition of teaching skills.
 
Subject areas for the fellowship (not including the core curriculum in transplantation medicine) may include the following:

Biochemistry

• Apoptosis
• Biochemical basis of ischemic-anoxic injury
• Reperfusion injury
• Antioxidant biochemistry
• Promising treatment modalities for reperfusion injury
• Physiology and pathophysiology
• Acid-base equilibrium
• Hepatic physiology and mechanisms of hepatic drug metabolism
• Renal physiology, renal failure, and renal function tests
• The autonomic nervous system and receptor pharmacology
• Hypothermia and perioperative temperature control
• Coagulation
• Reperfusion syndrome in clinical liver transplantation
• End-stage liver disease and clinical manifestations *

Clinical sciences

• Organ procurement and donation
• Anesthesia for organ donation
• Anesthesia for organ transplantation
• Transfusion medicine
• Anesthesia for patients with hepatocellular disease
• Invasive hemodynamic monitoring
• Non-invasive hemodynamic monitoring * Shock states
• Cardiopulmonary-cerebral resuscitation
• Cardiac emergencies and their management
• Intensive care management of the liver transplant patient
• History and organization of organ transplantation
• Infectious diseases and transplantation

Specialized training and skill areas 

In each of the following areas the trainee must demonstrate clinical proficiency in starred areas:

• Anesthetic management of the organ donor
• Anesthetic management for *kidney, kidney-pancreas, *liver, *liver-kidney, liver-CABG, liver-lung
• Advanced cardiac life support
• Central venous catheterization - femoral, internal jugular and subclavian veins
• Right heart catheterization - pulmonary artery catheter placement
• Arterial line placement
• Management of the difficult airway
• Transesophageal and transthoracic echocardiography
• Arterial blood gas analysis

Clinical rotations take place at two sites: 

• Emory University Hospital
• Egelston Hospital at Children's Healthcare of Atlanta 

Clinical and scientific meetings will also take place at Emory University Hospital and the Emory Clinic. Trainees will be exposed to Hepatic, Combined Hepatic-Heart, Combined Hepatic-Renal transplantation, and CABG-Hepatic transplantation.

There will be elective external rotations: 

• Intensive Care Unit - following and managing patients who have undergone solid organ transplantation
• Hepatology Clinic - evaluation and management of potential transplant candidates in conjunction with hepatologists.
• Blood Bank - fellows will spend two weeks in a structured program working with hematologists and hematology fellows in the blood bank setting.

If you are interested in Emory's Anesthesiology Liver Transplant Fellowship program, please contact: 

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