Transplant Rotation (2

nd
year)
Length of Rotation: 4 weeks
Type of Rotation: mandatory
Overview:
Each fellow will participate in an intensive transplant rotation for one month in the 1
st
year and one month
in the 2
nd
year of training. The fellow will become eperienced in the management of transplant patients
in both inpatient and o!tpatient settings. The fellow will be s!pervised in the management of
preoperative eval!ation" perioperative care and ac!te and chronic post#transplant management.
Principle Teaching/Learning Activities:
$ (ATC) Acute Transplant Clinic: %ellows will attend ac!te transplant clinic in the &oye &edical ''
(!ilding. They will be involved in the management of imm!nos!ppression and medical management
of their contin!ity transplant patients.
$ (CTC) Chronic Transplant Clinic: %ellows will attend chronic transplant clinic at E)*
+ephrology. They will see 2#, patients each T!esday morning half#day clinic and be s!pervised
directly by a transplant attending.
$ (TR) Transplant Recipient valuation: %ellows will perform all inpatient and o!tpatient
transplant recipient eval!ations d!ring this rotation. They will be s!pervised by the cons!lt attending
for inpatient eval!ations and by the office attending for o!tpatient eval!ations. 'n addition" fellows
will attend at least one family conference and social worker eval!ation at the E)* Transplant )linic
in &oye &edical ''.
$ (!TR) !npatient Transplant Rounds: %ellows on this rotation will not be responsible for inpatient
transplant patients. -c!te transplant recipients will be eval!ated by the )ons!lt %ellow !nder the
s!pervision of the )ons!lt -ttending .with or witho!t the assistance of the Transplant -ttending" at
the discretion of both the )ons!lt %ellow and/or )ons!lt -ttending0. )hronic transplant patients will
be eval!ated by the 1ervice fellow !nder the s!pervision of the 1ervice -ttending .with or witho!t the
assistance of the Transplant -ttending" at the discretion of both the 1ervice %ellow and/or 1ervice
-ttending0.
$ (T") Transplant "onor valuation: %ellows will attend o!tpatient transplant donor eval!ations at
the Eastern +ephrology office d!ring this rotation. They will be directly s!pervised by an Eastern
+ephrology attending who is eperienced in donor eval!ation.
$ (#LA) #LA la$: %ellows will spend 1#2 ho!rs with Lorita Rebellato" 2h3 reviewing 4L-
methodology and techni5!es.
$ (L) Lectures: %ellows will attend 6 core transplant lect!res d!ring the month.
$ (T%) Transplant %eetings: %ellows will attend the monthly transplant b!siness meeting" recipient
selection committee meeting" and donor selection committee meeting.
$ (T&) Transplant &urgeries: Each fellow will attend as many sched!led living donor transplant
s!rgeries as possible. The fellows will complete training in proper sterile techni5!e so they can scr!b
in on transplant s!rgeries. Each fellow is responsible for participating in one deceased donor
transplant s!rgery.
$ (A&) Access &urgeries: %ellows will also !tili7e this month as an opport!nity to scr!b in on as many
access s!rgeries as possible.
$ (#"R) #e'odialysis Rounds: %ellows will ro!nd independently once d!ring the month on their
o!tpatient hemodialysis shift and once d!ring the month with the hemodialysis shift teaching
attending.
$ (RL) Reading List: Reading list as o!tlined at the bottom of this page. 1pecifically refer to the
8E)* Transplant &an!al9 provided at the beginning of the rotation.
Principle ducational (oals $y Relevant Co'petency
'n the tables below" the principle ed!cational goals for the +ephrology Transplant Rotation are listed for
each of the si -):&E competencies. The second col!mn of the table indicates the most relevant
principle teaching/learning activity for each goal" !sing the legend above.

)) Patient Care
Principle ducational (oals Learning Activity
Eval!ate and select transplant candidates. TRE" RL" T&
)ond!ct preoperative eval!ation and preparation of transplant recipients
and donors.
TRE" 4L-" T&
;bserve living and deceased donor transplant s!rgeries. T1
2erform immediate postoperative management of transplant recipients. T1" -T)" T&
-dminister imm!nos!ppressive medications. T1" -T)" )T)" T&" L
&edically manage transplant re<ection in patients. -T)" )T)" T&" L
2rovide long#term management of transplant recipients in the
amb!latory setting.
)T)
2articipate in vasc!lar access s!rgeries !tili7ed in the maintenance of
chronic vasc!lar access patency.
-1
2) %edical *nowledge
Principle ducational (oals Learning Activity
3escribe the basic principles of imm!nology. L" 4L-
Eplain the biology of transplant re<ection. L" 4L-
3escribe the indications and contraindications to renal transplantation. TRE" L
3emonstrate !nderstanding of the principles of transplant recipient
eval!ation and selection.
TRE" RL
3emonstrate !nderstanding of the principles of transplant donor
eval!ation and selection .both deceased donor and living donor0.
T3E" RL
3emonstrate !nderstanding of the principles of organ harvesting"
preservation" and sharing.
L
=now the pathogenesis and management of ac!te renal fail!re in the
transplant setting.
-T)" )T)" L" RL
Recogni7e and manage the infectio!s complications of transplantation. -T)" )T)" L" RL
+) Practice,-ased Learning and !'prove'ent
Principle ducational (oals Learning Activity
(ecome familiar with the peri#transplant process and develop
!nderstanding of where common pitfalls in contin!ity of care occ!r.
TRE" -T)" )T)
3evelop !nderstanding abo!t ways to optimi7e co#management of ac!te
and chronic transplant patients between the medical and s!rgical teams.
TRE" -T)
-naly7e the way post#transplant care is provided and ad<!st yo!r plan of
care based on g!idelines and recommendations.
-T)" RL
Review yo!r o!tpatient hemodialysis shift to ens!re that appropriate
referral for transplantation has occ!rred.
43R
.) !nterpersonal &/ills and Co''unication
Principle ducational (oals Learning Activity
2articipate in disc!ssions with patients and their families as they are
ed!cated abo!t transplantation.
TRE
)omm!nicate effectively with physician colleag!es" n!rsing and other
staff to ass!re timely" comprehensive patient care.
TRE" -T)" T&
)omm!nicate effectively with fellow colleag!es when signing o!t
patients or following post#transplant patients who wo!ld normally be
seen by the cons!lt fellow.
TRE" -T)
)omm!nicate effectively with the cons!lt attending while managing
patients hospitali7ed on the transplant service.
-T)
0) Pro1essionalis'
Principle ducational (oals Learning Activity
(ehave professionally toward patients" families" colleag!es" transplant
coordinators and staff" floor n!rses and staff and all other members of
the health care team.
-ll
2rovide individ!ali7ed care of both donors and recipients that provides
the best possible care independent of the impact this may have on the
patient>s respective donor or recipient.
T3E" TRE
2) &yste's,-ased Practice
Principle ducational (oals Learning Activity
3evelop !nderstanding and !tili7e the m!ltidisciplinary reso!rces
necessary to provide optimal care to the transplant patient: transplant
s!rgeon" transplant n!rsing coordinator" transplant administrative staff"
transplant social worker" pharmacist" inpatient n!rsing staff" referring
nephrologist.
TRE" T3E" -T)" )T)" T&" T1
)ollaborate with other members of the transplant team to ins!re
comprehensive care for patients who are !ndergoing or have received a
kidney transplant.
TRE" T3E" -T)" )T)" T&" T1
Reco''ended Resources:
# The fellow will be given a packet of reading 'aterial that incl!des articles/hando!ts
on: imm!nology" imm!nos!ppression" donor eval!ation" recipient eval!ation"
preoperative cardiac clearance and g!idelines on the longterm management of renal
transplant recipients.
# ;ther !sef!l internet reso!rces incl!de:
http://www.!nos.org/
http://www.!stransplant.org/inde.php
http://www.optn.org
http://www.a#s#t.org/
http://www.transplantation#soc.org/
valuation %ethods:
%ellows are formally eval!ated by the E)* Transplant -ttending.s0 !sing the standard competency#based
-('& eval!ation form on +ew 'nnovations. This eval!ation will be disc!ssed with the fellow face#to#
face at the end of the rotation.
Approved $y (overning -ody 3/4/536 0/3/)5
Revised 03/15/11; 9/3/14