Overview of Program

Introduction

The Ochsner Transplant Institute is the largest transplant center in the region, with over 150 kidney and combined kidney pancreas transplants last year.

We also have a very active heart, lung, combined liver/kidney and liver transplant program.

Currently we have four full time transplant nephrologists, eight transplant surgeons, over 15 transplant coordinators, a tissue typing laboratory, a world class renal pathologist and all the structure necessary to develop excellent care to our transplant patients and education to our trainees.

Why Choose Ochsner’s Fellowship?

Learn why to choose Ochsner for organ transplants

Two graduates from our newly ACGME approved Nephrology Fellowship program have joined two well recognized nephrology fellowship training program, which speaks of our commitment to education to our nephrology fellows.

Our transplant nephrology fellowship program will develop a dedicated, competent, academically oriented transplant nephrologist, who will deliver the highest standard of care to transplant allograft recipients with medical renal disease. In this era of lifelong learning the core competency model and patient safety remain critical to the delivery of health care that is compassionate and driven by evidence based medicine.

The Role of the Transplant Nephrology Fellow in the Management of Transplant Patients

The transplant nephrology fellow will have a crucial role in the assessment and management of our allograft recipients through the evaluation process, hospital care and in the ambulatory setting.

The transplant fellow (with supervision provided by the staff transplant nephrologist) will be responsible for the evaluation of transplant recipients, discussion during transplant selection meeting, perioperative care, performance of allograft biopsies and follow up in our outpatient clinic.

The fellow will provide co-management responsibility with the transplant surgeon from the perioperative through the outpatient period in both deceased donor as well as living donor transplant recipients.

The fellow (as integral part of the transplant team) will be responsible for the selection and administration of induction and maintenance immunosuppression according with accepted protocols in our institution. His/her input will be critical for the decision making process including indications, contraindications and potential side effects.

Goals

Educational

• The educational goal is to: provide the fellow with the knowledge and skills for the care of kidney, kidney pancreas and other recipients of solid organs with chronic kidney disease in an academic environment with patients of different social and ethnic backgrounds.

Patient Care

Fellow should be able to:

• gather all pertinent data, convey information to the transplant team and stablish a comprehensive assessment and plan
• assist in the selection of transplant recipients and preoperative management
• demonstrate the ability to diagnose and treat common medical and surgical post-operative complications, including delayed graft function
• provide medical management of rejection, performance of kidney biopsies, dialysis modalities, infectious complications

Medical Knowledge

The fellow should be able to:

• demonstrate knowledge in the core aspects of kidney transplantation described in our core curriculum
• demonstrate progressive improvement during the training program until he/she is deemed competent for the practice without supervision
• The fellow should attend all the didactics, transplant selection meetings, patient care meetings, patient safety (morbidity and mortality) meetings and the conferences by visiting professors.
• Also the fellow is strongly encouraged to attend a CME activity at the national or regional level.

Communication Skills

The fellow should:

• demonstrate excellent skills to communicate with patients and family members of different financial, age, race and cultural backgrounds
• Fellow should also show the ability to communicate with all the members of the transplant team, referring nephrologists, consultants, residents, medical students and other allied health professionals.

Professionalism

• The fellow will demonstrate compassion and understanding to a group of diverse group of patients. The transplant fellow will be a role model showing leadership skills for other trainees and members of the transplant team.

Practice-Based Learning Improvement

• Evidence–based medicine will be a critical part of our training for our future transplant nephrologist. Daily patient care will be complemented with literature review to consolidate knowledge.

System-Based Practice

• The fellow will learn to interact with all the members of the transplant team, the departments involved with the care of our transplant recipients including radiology and renal pathology, the interaction with the regulatory bodies in the country (UNOS, CMS), our performance outcomes and the strategic plan to strengthen patient safety patient satisfaction and allograft survival.

Education Program to be Provided to the Transplant Nephrology Fellow

• The program has access to a wide range of resources to support the educational mission. A diverse and committed faculty is a key resource of the program and essential for the orchestration of daily educational activities.

Daily Educational Activities include:

• daily teaching rounds
• core curriculum lectures
• longitudinal outpatient clinics
• pre transplant and donor clinic
• patient safety conference
• transplant selection meeting
• patient care meeting
• renal pathology conferences twice a week with Vanderbilt Department of Pathology

The curriculum is designed to provide a comprehensive review of the core topics in transplant nephrology. In addition to daily mentorship, review papers and input from all members of the transplant clinic will create the fund of knowledge for our trainee.

The supervising faculty member bears medical and legal responsibility for all final decisions relating to the management of potential transplant candidates, transplant recipients and complications related to patient care.

Supervising faculty will be committed to the educational goals and objectives of the transplant nephrology training program. Accordingly the schedule of the supervising faculty member will be adjusted to allow for protected time during teaching rotations for the supervision of the fellow in both the in-patient and out-patient settings. Teaching rounds will be approximately three hours per day.

In the event that a conflict between service duties and educational activities occurs, the supervising faculty will be responsible for patient care activities and the fellow will be instructed to attend the educational conferences.

The program director will be responsible for maintaining the balance between education and clinical responsibilities.

Topics covered during the core curriculum lectures:

• Transplant immunology
• Pharmacology/immunosuppression
• Medical complications of transplantation
• Organ allocation
• Pretransplant evaluation of the recipient
• Pretransplant evaluation of the living donor
• Graft dysfunction
• Expected outcomes/risk factors special issues in pediatric renal transplantation
• Pregnancy and contraception
• Ethics of transplantation
• Pancreas transplantation
• Kidney transplantation in other solid organs transplant recipients
• Transplantation of ABO-incompatible and cross match incompatible individuals
• Paired kidney exchange program
• Business and administrative aspects of transplantation

Resource Materials to be Used

• Ochsner Medical Library provides access to subspecialty journals and electronic media to assist the fellow in the preparation of journal clubs, case reports and renal biopsy conference. These can be accessed from any computer at Ochsner and can also be accessed remotely from home.
• At the beginning of the program the fellow will receive a memory card with the capacity to store multiple review articles covering the core topics of transplant nephrology.
• The fellow will have access to the renal core curriculum topics in the field of transplant nephrology.
• The transplant fellow is also encouraged to attend the general nephrology lectures. The transplant core curriculum will not interfere with the lecture schedule with general nephrology didactics.
• The program will cover expenses for a CME activity in the field of transplant nephrology.
• In the ASN learning distance program the fellow will have available for review core topics of transplant nephrology by national experts in the area.

Research Opportunities

• In addition to the daily clinical activities, fellows will have an opportunity to do research/scholarly activities and to publish abstracts and other publications (case report or case series).
• The fellow is also welcome to participate in pharmacologic company sponsored research. Under faculty mentorship the fellow will participate in the design of the research project: including the development of hypothesis to be tested, appropriate methodology and results and statistical analysis.
• Faculty members will provide the background reading and theory for research projects.
• The IRB has a series of lectures titled “Responsible Conduct in Research” lecture series, which are given on a monthly basis the second Tuesday of the month at 12 p.m. In the lecture the speaker usually addresses FDA regulation, legal and ethical aspects of research. These lectures will be incorporated into the core curriculum for the transplant nephrology fellowship.
• All the trainees participating in research are required to take the CITI (Collaborative Institutional Training Initiative) course for the protection of human subjects. Completion of the CITI course is one of the requirements for protocol approval by the IRB. Ochsner Health provides access to the required training through an interactive online tutorial.
• We have a strong general nephrology fellowship training program (with six positions) which was approved by the ACGME in 2012 and underwent a very successful site visit in June 2015. Each general nephrology fellow rotates one month per year (a total two months during the entire training). We also have nephrology fellows from Louisiana State University (LSU).
• We maintain an excellent relation with both programs and are delighted to provide a very comprehensive educational experience to both institutions. As a testimony two of our graduates chose to pursue a career in transplant nephrology and obtained positions at top class institutions in the United States.
• Due to the transplant volume in the last five years, in-patient census, outpatient referrals, transfers from other institutions, transplant allograft biopsies and outpatient follow ups we have no doubt that all the trainees will have enough patients to meet their educational needs. Staff transplant nephrologists will meet with the rotating fellow and transplant fellow to discuss patient assignment on a daily basis. New consults will be distributed in a sequential fashion to maintain balance and fairness. In the case more than one fellow is on the in-patient service, the new consults will be rotated on a daily basis, as well as the new transplant to maintain the continuity of care throughout the period rotating in the acute care setting.