Liver Transplant

The 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.

Clinical Experience

The objectives of the one year fellowship include clinical, education, and 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 bimonthly Monday HTA Morbidity and Mortality Conference for 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 evaluation of liver transplantation candidates, including those with central nervous system, cardiopulmonary system, renal system, and coagulation defects. During a one-year experience, the fellow will participate in more than 50 cases of liver transplantation.

Educational Program

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 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 education of junior residents and student anesthetists at Emory University Hospital.

Research Opportunities

Our research program encourages HTA Fellows to participate in on-going or newly developed investigative projects. Departmental financial and intellectual support is available with clinical or basic projects, and fellows are expected to be able to present research abstract at national or international liver transplant-oriented meetings.

Fellowship 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.
 
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.
 
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 to 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 fellowship is not regulated by the ACGME/RRC. 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 portion 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

Clinical rotations take place at two sites:  Emory University Hospital and Egleston Children’s Hospital. 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 optional 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.

Application Process

Interested candidates should contact:

Cinnamon Sullivan, MD
Assistant Professor, Department of Anesthesiology
Chief, Division of Liver Transplant Service
1364 Clifton Rd NE, 3B South
Atlanta, GA 30322
clsulli@emory.edu