ACGME Transplant Hepatology Fellowship

The Transplant Hepatology Fellowship Training Program at the University of California is a one year intensive clinical training program designed to comply with ACGME requirements and to provide training that meets ABIM requirements for Board Eligibility for certification in Transplant Hepatology.

Mission Statement and Program Aims

The mission of our fellowship program is to train the future leaders in hepatology and liver transplant through diverse, comprehensive, multidisciplinary clinical experiences in the inpatient and outpatient settings. Our fellows receive outstanding clinical training through direct care of a diverse patient population, as well as a didactic curriculum dedicated to growing their expertise in hepatology.

fellows on a hike
 Socially distanced hike with current fellows, Danielle Brandman, Neil Mehta, and Monika Sarkar.

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Clinical Program Description

Example Fellow Schedule

Month Description
JUL Liver Transplant Unit (LTU) Primary Inpatient Service
AUG Ambulatory Rotation
SEP LTU Inpatient Consult / Ambulatory Rotation
OCT LTU Primary Inpatient Service
NOV Ambulatory Rotation
DEC Ambulatory Rotation
Month Description
JAN Liver Transplant Unit (LTU) Primary Inpatient Service
FEB Ambulatory Rotation
MAR Ambulatory Rotation
APR LTU Primary Inpatient Service
MAY Ambulatory Rotation
JUN LTU Inpatient Consult / Ambulatory Rotation

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UCSF Liver Transplant Program

The UCSF Liver Transplant Program was established in 1988, and over 3000 liver transplants have been performed since. We remain one of the largest liver transplant programs in the US, performing 170-180 transplants per year, 20-25 of which are living donor liver transplantations. We evaluate about 600 patients for transplant and add 300 patients to the waitlist annually. Our pre- and post-transplant outcomes are excellent, despite transplanting extremely ill patients.

Inpatient Experience

The hepatology fellows typically spend 4 months on the primary inpatient service rotation, and two half-month blocks on inpatient consults.

Primary Inpatient Service Rotation

The UCSF Liver Transplant Unit (LTU) is a multidisciplinary, primary service that cares for liver transplant candidates and recipients, as well as complex liver patients undergoing surgical and/or interventional radiology procedures. The service assumes primary care for patients in the ICU and on the general medical floors. The transplant hepatology fellows play an integral role in the care of patients and education of other trainees who rotate through the service. Our fellows collaborate with the transplant surgical fellows and inpatient advanced practice providers (APPs) to provide care for a complex patient population. 

  • Team members
    • Fellows: transplant hepatology, 2nd year gastroenterology, transplant surgery
    • Residents: medicine (2), surgery (1-3)
    • APPs:  3 nurse practitioners
    • Social workers (2-3)
    • RN coordinator
    • Transplant pharmacist
    • RN case managers
    • Administrative assistant
    • Ancillary services:  rehabilitation services, nutrition, speech therapy
  • Specific fellow roles on primary service inpatient rotation
    • Leadership of the team
    • Supervision of interns, APPs, nightfloat residents
    • Discussion of liver transplant candidates in weekly selection conference
    • Education of trainees (formal and informal)
    • Coordination of care
    • Procedures for hospitalized patients (e.g., endoscopy, liver biopsy)
    • Provide consultative care, split with GI fellow (when no fellow on consult rotation)
Inpatient Consultations

Hepatology consultations are requested by primary services, with consult questions for both common and rare topics within hepatology and liver transplantation.  Hepatology fellows provide inpatient consultative service during their consult rotation and/or primary inpatient service rotation. During several months each year, gastroenterology fellows from outside institutions assist with performing consultations. Consult requests are shared amongst the hepatology and GI fellows who are rotating on the primary inpatient service. 

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Ambulatory Rotation

Example Schedule

  Mon Tues Weds Thurs Fri

AUG

Academic/Admin

Pre-LT Clinic Endoscopy Continuity Clinic HCC Clinic
SEPT Academic/Admin* Pre-LT Clinic* Endoscopy* Continuity Clinic HCC Clinic*
NOV Pre-LT Clinic Pre-LT Clinic Endoscopy General Hepatalogy Clinic | Continuity Clinic IR/OR Obs
DEC Academic/Admin Pre-LT Clinic Endoscopy General Hepatology Clinic | Continuity Clinic IR/OR Obs
FEB Academic/Admin Post-LT Clinic Fibroscan/Endoscopy Continuity Clinic HCC
MAR Pre-LT Clinic HCV Fibroscan/Endoscopy General Hepatology Clinic | Continuity Clinic IR/OR Obs
MAY Selective TBD Post-LT Clinic Fibroscan/Endoscopy Continuity Clinic IR/OR Obs
JUNE Selective TBD* Pre-LT Clinic* Fibroscan/Endoscopy* Continuity Clinic HCC*

Time spent on the ambulatory rotation will expose the hepatology fellows to a broad range of diseases in liver transplant candidates and recipients and patients with common and uncommon liver-related pathology.

Pre-transplant Clinic

10-12 patients are seen in the ambulatory setting each week for a full-day liver transplant evaluation, where they are seen by a hepatologist, transplant surgeon, RN, social worker, and nutritionist. Fellows will perform 1-2 new patient evaluations per pre-transplant clinic session, as well as several patients who are already listed for transplant. The fellows discuss transplant candidates in selection conference on a weekly basis.

Multidisciplinary Hepatocellular Carcinoma (HCC) Clinic

The HCC clinic occurs on a weekly basis, staffed by one of the hepatologists with special expertise in HCC (Drs. Mehta, Sherman, Yao). CTs and MRIs are reviewed in the multidisciplinary tumor board the evening prior to this clinic. Patients are seen by a hepatologist and other providers as indicated (e.g., surgery, interventional radiology, oncology, radiation oncology) in the same clinic session. Fellows participate in this clinic most months of their ambulatory rotations.

General Hepatology Clinic

Most of the hepatologists have a general hepatology clinic in addition to a pre-transplant clinic. A broad range of diseases are seen within these clinics.  Additionally, several hepatologists have more specialized expertise in different diseases, such as NAFLD (Brandman, Hameed, Sarkar), polycystic liver disease (Brandman), alcohol associated liver disease (Sherman), women’s health and liver disease (Sarkar), and hepatitis C (Price). The hepatology fellows will work with each of these attending physicians in the respective attending’s clinic and/or in the fellow’s continuity clinic.

Continuity Clinic

Each fellow has his/her own panel of patients seen weekly throughout the entire year, both during the inpatient and ambulatory rotations. A broad range of patients are followed in this clinic, including liver transplant candidates and patients with hepatocellular carcinoma, fatty liver, alcohol associated liver disease, autoimmune hepatitis, viral hepatitis, and many others. The fellows take primary ownership over these patients, with supervision provided by the faculty.

Post-transplant Clinic

Following liver transplantation, patients are cared for by the post-transplant team, which is comprised of APPs and transplant surgeons. Fellows participate in the care of early and late liver transplant recipients, managing surgical and medical problems including immunosuppression, infection prophylaxis, recurrent disease, and/or metabolic syndrome monitoring.

Fibroscan Rotation

An instructional session is provided by one of the hepatologists to the fellows to educate them about the performance and interpretation of Fibroscan. Fellows observe the hepatology techs perform Fibroscan and are then given the opportunity to perform Fibroscan. A repository of Fibroscan images and reports are available to the fellows to assist in their ability to become competent in image  interpretation.

Selective Rotation

Fellows are given the opportunity to customize their ambulatory experience during the last quarter of the year in order to better prepare them for specific career path following graduation. The rotations may occur within hepatology/transplant or in other disciplines. Examples of past selective rotations in specialties outside of hepatology include GI oncology (HCC-focused), reproductive endocrinology, and addiction medicine.  

Telehealth

Telehealth has become a growing part of the care of patients and has been critical in our ability to continue to provide care for patients during the COVID pandemic. Many patients are seen via Zoom for both new and established patients in all clinics in which the fellows rotate. They are provided with special training around use of telehealth for patient care.

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Procedures and Other Clinical Experience

two surgeons operating
Source: UCSF image

 

Liver Biopsies

  • The fellows will reach competence in performance and interpretation of liver biopsies
  • Each fellow will perform at least 30 percutaneous liver biopsies
  • The fellows will interpret at least 200 liver biopsies through routine clinical care and monthly pathology conference

Endoscopy

  • Inpatient endoscopy will be performed on an as-needed basis, with cases divided between the hepatology and gastroenterology fellows on the inpatient and consult rotation
  • Fellows on the ambulatory rotation will perform endoscopy 2-3 times per month with the hepatologist

Procedures Observed

  • Liver transplantation: The fellows will observe at least 2 deceased and one living donor liver transplantation, and go on a donor run
  • Interventional radiology: The fellows will observe TIPS, TACE, microwave ablation, radioembolization.

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Didactics and Other Conferences

people studyingUCSF is a leader in research, and the work produced by our group has had a meaningful impact on the field of hepatology and liver transplantation. Numerous educational and clinical conferences occur throughout the transplant hepatology fellowship. The hepatology research program has been strengthened by the leadership of Dr. Jennifer Lai, the chief of hepatology research. The hepatology fellows’ course occurs each Friday afternoon, with presentations given by fellows (with a faculty discussant) or faculty (hepatology, transplant surgery, and other). Two recent manuscripts are discussed during monthly journal club.  Pathology conference occurs on a monthly basis, with a pathology fellow or attending showing liver histology from different liver diseases (or patterns of injury) once per month. Tumor board takes place twice per week, with imaging studies discussed by hepatologists, surgeons, radiologists, interventional radiologists, oncologists, and radiation oncologists. Gastroenterology grand rounds and quality improvement/assurance sessions are open to hepatology fellows.

Conference Schedule

 

  Morning Afternoon
Mon.   2-3pm LTU Intern Teaching
Tues.   2-3pm LTU Intern Teaching
4:30-5:30pm HCC Tumor Board
Weds. 7-8am GI QI/QA (1st Weds.)
8-9am or 8-10am GI Grand Rounds
12-2pm Transplant Selection Conference
3-4pm LTU Intern Teaching
5-6 pm Pathology Conference (3rd Weds.)
Thurs.   4:30-5:30pm HCC Tumor Board
Fri. 8-9am Transplant Surgery M&M 2-3pm Tx Hep Fellows Course
3-4pm M&M Conference (3rd Fri.)

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Scholarly Activity

female hep fellow
2015 AASLD Conference
2 male hep fellows
2015 AASLD Conference

Fellows have the opportunity to engage in scholarly activity, largely during the ambulatory months. Mentorship from hepatology and/or surgical faculty is plentiful. Engagement in quality improvement (QI) activities is encouraged. The goal is for each fellow to complete a project that results in a presentation at a national/international conference and/or manuscript.

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Facilities

UCSF is an internationally recognized medical center, and has consistently been ranked within the top 10 medical centers in the US, and is #3 in California. The UCSF Helen Diller Medical Center and the outpatient clinics are located at the Parnassus Heights campus.

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How to Apply

 

Program Leadership

Neil MehtaNeil Mehta
Associate Program Director
[email protected]

empty userKaren Wong
Program Coordinator
[email protected]