Division of nephrology

Transplant Fellowship

 

The Medical University of South Carolina is one of the top twenty busiest transplant centers in the country with over two hundred renal transplants in the last year and a very active pancreas transplant program.  Our center’s outcomes are among the best in the nation.  The transplant nephrology division includes five faculty members and three mid-level practitioners with robust support from transplant surgery, pharmacy, and infectious diseases. 

We offer two one-year renal transplant nephrology fellowship positions. Applicants must be in good standing or have completed a two year ACGME-accredited nephrology fellowship.  Our fellowship is designed to meet the United Network of Organ Sharing, American Society of Transplantation (AST), and the American Society of Nephrology criteria for certification as a transplant physician and to be eligible to qualify to be a medical director.  Our goal is to produce both an excellent clinician and scientist who is well qualified for a career in transplant nephrology. 

  •  Broad and diversified exposure to all aspects of renal and pancreas transplantation.
  •  Didactic sessions based on AST core curriculum and protected time in HLA Lab
  • Collegial and supportive environment
  • Multi-disciplinary rounds with transplant surgery
  • Dedicated transplant pharmacy, infectious diseases, and pathology departments
  • Consulted on other solid organ transplants including combined organ transplant evaluations  
  •  Busy inpatient service that involves peri– and immediate post-operative care, and long-term post-transplant care
  • Robust outpatient experience with involvement in both evaluation of potential transplant recipients and living donors, and all post-transplant care.
  • Supervise and teach rotating general nephrology fellows
  • Perform renal transplant biopsies with instruction on ultrasound guidance and imaging of the transplant
  • Participation in collaborative research including ongoing clinical trials.

The following are requirements for completion of the Transplant Nephrology Fellowship:

1.  Each fellow’s training must be completed within 12 continuous months. A minimum of six months of training must be performed in inpatient clinical service and the remaining training period should be designed to gain experience in tissue typing, experience on another organ transplant service and exposure to transplant pathology. The fellows should also be involved in an activity that provides experience in transplant related scholarship. Examples of this include, but are not limited to performing research, writing up case reports, and drafting reviews or chapters. 

2.  Each program must perform a sufficient number of kidney transplants to allow for adequate training: 10 kidney transplants for each first-year general nephrology fellow and 30 for each renal transplant fellow. This criterion ensures that the renal transplant fellowship program will not encroach upon the Residency Review Committee of Internal Medicine's requirement that all nephrology trainees must manage 10 new transplant recipients or equivalent requirements by other national accrediting organizations. 

3.  The program must provide patient co-management responsibility with transplant surgeons from the peri-operative through the outpatient period in both deceased donor as well as living donor transplant recipients. The renal fellow must primarily manage the transplant recipient's medical care including hypertension, diabetes, and dialytic problems. Fellows must also serve as primary members of the transplant teams and participate in making decisions about immunosuppression. Each transplant nephrology fellow must be primarily responsible for 30 inpatient renal transplant recipients and 30 outpatient recipients (the inpatient and outpatient encounters can involve the same patients). Outpatient follow-up must be continuous for a minimum of at least three months.

4.  The program must provide training in: a) the indications for, b) the performance of, and c) interpretation of, renal transplant biopsies. Each transplant nephrology fellow must perform a minimum of 10 transplant biopsies during the training period. Documentation of the completion of these biopsies is required. Furthermore, the program must provide didactic pathological experience with the fellow reviewing renal transplant biopsies with an experienced renal transplant pathologist. 

5.  The program must provide training and experience in an accredited histocompatibility/tissue typing laboratory and training and experience in the procedures and activities of an organ procurement organization. 

6.  Each fellow must observe at least three renal transplants, at least one of which is a living donor transplant and one is a deceased donor transplant. Each fellow also must observe at least three organ recovery procedures, at least one of which is from a deceased donor and one is from a living donor. 

7.  Each fellow must obtain experience evaluating potential kidney transplant recipients, potential living donors as well as participate in selection committee meetings. 

8.  If a training program cannot provide any aspect of the required elements, such as experience in living or deceased donor transplantation or tissue typing, the program can make arrangements with another Renal Transplant Physician Training Program to have the fellow receive training in that element at that program. The contracted program must be accredited by the AST/ASN Renal Transplant Fellowship Training Program. In general, the amount of time spent in an outside training program should not exceed 3 months. 

9.  Documentation that the transplant nephrology fellow has successfully completed the prerequisite number of 30 in-patient and 30 outpatient recipient management experiences; 3 surgical observations, 3 procurement observations and 10 renal transplant biopsies must be kept by the fellow. Documentation should, at a minimum, be in the form of a log that contains the date of patient contact, type of examination, type of procedure performed or observed and the signature of the transplant physician present. 

10.  The fellow will be required to complete an evaluation form six months into the program and at the completion of the 12-month fellowship. Each training program director will be responsible to ensure that the fellow receives and completes the forms. The forms should be sent by the program director to the AST National Office. Upon receipt, the Committee will review the forms. 

11.  The renal transplant fellowship program director must provide a letter to each fellow within two months of successful fellowship completion, stating that the fellow has met all of the above criteria and if the training occurred in a UNOS approved transplant center, is capable of being certified as a UNOS transplant physician. A copy of this letter along with a written statement validating the transplant fellow's participation in the required didactic sessions and patient management experiences must be sent to the AST National Office for the program file.

Recent Publications and Abstracts:

  • Generic immunosuppression:  deciphering the message our patient are receiving.  Annals of Pharmacotherapy; published ahead of print, May 2012.
  • Leflunomide Efficacy and Pharmacodynamics for the Treatment of BK Viral Infection. CJASN; published ahead of print, March 29, 2012.
  • A critical analysis of racial difference with mycophenolate mofetil dosing, clinical outcomes and adverse effects in pediatric kidney transplant patients.  Clin Transplant 2011;25:534-40
  • Management of Hypertension in Renal Transplant Patients: A Comprehensive Review of Non-Pharmacologic and Pharmacologic Treatment Strategies. Ann Pharmacother 2010;44(7):1259-70.
  • Are Protocol Biopsies Useful for Predicting Renal Transplant Recipient Outcomes?  American Transplant Congress, Boston, MA, June 2012.  [abstract]  (Received Award of Distinction at ATC Mtg)
  • Are Protocol Biopsies Useful for Predicting Renal Transplant Recipient Outcomes?  American Transplant Congress, Boston, MA, June 2012.  [abstract]  (Received Award of Distinction at ATC Mtg)
  • Prospective Comparative Efficacy of Induction Therapy in a High−Risk Kidney Transplant (KTX) Population.  American Transplant Congress, Boston, MA, June 2012. [abstract/oral]
  • Determining How to Efficiently Utilize Induction Therapy in Kidney Transplant (KTX) Patients Using a Risk to Benefit Ratio. American Transplant Congress, Boston, MA, June 2012. [abstract]
  • Improving Patient Safety After Solid Organ Transplantation: A Focused Approach to Prevent Medication Errors.  American Transplant Congress, Boston, MA, June 2012. [abstract]
  • Critical Analysis of BK infection in Kidney Transplant Recipients with Modern Immunosuppression.  American Transplant Congress, Boston, MA, June 2012. [abstract]
  • Cardiac Catheterization: Important Tool to Predict African American Cardiovascular Outcomes after Renal Transplantation.  ASTS State of the Art Winter Symposium, Miami Beach, Fl, Jan 2012. [oral/abstract]
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