ACGME Transplant Hepatology Fellowship

The hepatology fellows spend a total of four to six months on inpatient rotations, with a combination of work on the primary service and the consult service.

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, 2^nd year gastroenterology, transplant surgery
  • Residents: medicine (2), surgery (1-3)
  • APPs:  4 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)

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. 

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.

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.

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.

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.

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.

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.

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 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.