Curriculum

Didactic education in transplant and immunology will include modules from the ASTS academic universe along with the self-assessment questions. There will be an hour long session each week to complete 1-2 modules from the Academic Universe. In addition, we are working with the Immunology lab to develop a two-year lecture series on histocompatibility and tissue typing/transplant immunology.

Major hepatic and gallbladder procedures (excluding liver transplantation and isolated cholecystectomy).

• Minimum of 35 cases per year:
• Major anatomic hepatectomy procedures that involve the resection of two or more segments of the liver and include living donor hepatectomy and deceased donor split liver procurements.  Must have a minimum of 20 cases per year.
• Major non-anatomic resection or enucleation (e.g. for symptomatic cystic disease, hemangioma, gallbladder CA and metastatic liver tumors).

Complex Biliary Procedures (excluding CBD-CBD anastomosis during liver transplantation)

• Bile duct resection and reconstruction
• Bile duct reconstruction without resection (i.e. Roux-en-y hepatico-jejunostomy)

There is a weekly tumor board where all cases are discussed and a clinical plan is determined.  The fellow will be present and part of these discussions. The fellow will also be participating in the pre-operative, operative and post-operative management of these patients. The HPB fellow will also participate in all educational and clinical conferences. The fellow will be an active participant the first year and an instructor the second year for training the residents.

Immunology Curriculum

Mode of presentation: The topics will be presented in a live didactic session by one of the HLA lab personnel knowledgeable about the topic. These will consist of 30 to 60 minute lectures with adequate time for discussion and questions following the lecture.

Lecture schedule: A lecture will be presented every 1-2 months and will be on a 2 year cycle.

Attendees: The renal transplant fellow and residents on service will attend. Other potential attendees may include the medicine renal transplant fellow, the BMT fellow, the transfusion medicine fellow, and others.

Topics to be covered:

• Types of histocompatibility (H) antigens
• Major (HLA) vs. minor
• Genetics of H antigen inheritance (co-dominance)
• Basic biochemistry and biology of HLA class I and class II antigens
• Immune responses to H antigens
• Antibody mediated
• Cell mediated
• Mixed rejection
• Hyperacute, acute, chronic rejection
• HLA typing
• Antibody testing: SAB testing, PRA, DSA definition of MFI and how to interpret
• Process of cross-matching: sample to processing to result interpretation. Description of flow cytometry and cyotic assays
• Non-HLA antibodies that cause rejection (anti-Endothelial ab, ATIR ab, etc
• What is needed to set up HLA lab