Transplant Hepatology Fellowship

Welcome

Cleveland Clinic's Hepatology fellowship program has been training fellows for more than 40 years. The program is designed to provide sophisticated training in the care of patients with all forms of liver disease, focusing on patients with acute and chronic liver disease requiring transplant. The fellowship is based within the Hepatology Section of the Department of Gastroenterology, Hepatology and Nutrition in Cleveland Clinic's Digestive Disease Institute. The section is comprised of 15 physicians with a diverse range of clinical and research interests. Because of the multidisciplinary nature of many liver diseases, the staff and fellows work closely with physicians and surgeons in liver transplant, critical care, interventional radiology, oncology, nutrition, infectious diseases, pediatric hepatology, and general gastroenterology, among others.

Cleveland Clinic's Liver Transplant Program remains one of the largest liver transplant programs in the United States, performing > 200 transplants per year (235 transplants in 2023, 255 transplants in 2024). The living donor liver transplant program at Cleveland Clinic additionally offers innovative laparoscopic surgery for donors as well as a paired donation program.

Dedicated rotations on the primary inpatient hepatology service, Medical Intensive Liver Unit (MILU), and consult services expose fellows to a wide array of clinical issues in caring for patients with acute and end stage liver disease. Outpatient rotations in hepatology and transplant, as well as in endoscopy, infectious disease, radiology, and oncology take further advantage of training opportunities across the broad spectrum of hepatology.

A centerpiece of the fellowship is training and mentoring in research methods. Our goal is that fellows will be successful academically, having had an opportunity to design, execute, and present or publish their research over the course of their training. We are committed to educating our fellows to become clinically excellent as well as leaders in hepatology.

Graduates of the program have been consistently successful in obtaining faculty positions as Transplant Hepatologists, with a majority continuing to practice in academic environments.

We look forward to meeting you and introducing our training program to you in more detail.

Robert S. O’Shea MD, MSCE
Fellowship Program Director, Hepatology
Department of Gastroenterology, Hepatology & Nutrition

Dian Chiang MD, MPH
Section Head, Hepatology
Department of Gastroenterology, Hepatology & Nutrition

Curriculum

Cleveland Clinic Hepatology Fellowship program goals

The goal of our fellowship program is to train the best academic and clinical hepatologists to meet the future needs of our profession in patient care, teaching, and research.

Our commitment is to train physicians to a high level of clinical, academic, and systems competence, becoming professional leaders throughout their career in this rapidly changing field.

Research and professional development

Although the fellowship is designed to be predominantly clinical in focus, we stive to support fellows interested in clinical research. The research opportunities and support at Cleveland Clinic are unparalleled; within our section, we have dedicated support in terms of both research design and statistical analysis. Fellows have access to multiple institutional databases, our electronic medical record which houses our massive clinical experience, and national databases.

Each fellow works with individual Staff to assist with developing research projects and publications. Research staff within the hepatology section are available to help with study design, implementation and analysis.

Clinical training

The current Hepatology training program is based on training guidelines published by the American Gastroenterological Association (AGA) and the American Association for the Study of Liver Diseases (AASLD).

Physicians who have completed a gastroenterology fellowship receive an intense, broad-based experience in hepatology with the goal of preparing them to manage patients with end stage liver disease, as well as pre and post-transplant. The requirements for earning a certificate of added qualification in Transplant Hepatology, as well as the UNOS guidelines for training physicians to become a medical director of a liver transplant program are met in this curriculum.

Rotations

Hepatology clinic (outpatient)

The outpatient experience, which comprises of a total of 22 weeks of the year, is designed to offer experience in the initial diagnosis and evaluation of patients with liver diseases, including the management of patients with a broad spectrum of common liver disorders. This includes the appropriate testing and treatment for patients with acute and chronic liver disorders, along with indications for treatment, and the side effects of therapy.

The fellow will rotate between both general hepatology and subspecialized clinics at the Cleveland Clinic Main Campus, to allow exposure to the full breadth and depth of the field. These specialized clinic rotations include a dedicated weekly transplant evaluation clinic, fatty liver clinics, a multidisciplinary alcohol liver disease clinic, a drug induced liver disease clinic, a weekly liver tumor clinic, and short- and long-term post-transplant follow-up clinics, among others. Fellows also have a weekly continuity clinic for their own patients, allowing them an opportunity to follow patients whom they have met during hospital admission or as new consults.

The fellow will also have an opportunity to perform endoscopic procedures under the supervision of the adult hepatology staff during outpatient blocks.

Hepatology inpatient services

The inpatient hospital service rotations make up six months of the year and are designed to expose the fellow to the most severely ill patients who have suffered complications of their liver disease. These rotations include caring for patients on our primary hepatology service, on consultation on the medical and surgical services, as well as a specialized rotation in the Medical Liver Intensive Care Unit, where patients are co-managed by hepatology as well as pulmonary / critical care services. This is a unique collaboration between the intensivists and the hepatology staff, typically managing 5 -10 ICU patients with acute liver failure or acute on chronic liver failure.

In addition, transplant hepatology fellows rotate on the surgical liver transplant service, as well as with the transplant infectious disease team.

The primary hepatology inpatient service is a hybrid team comprised of both interns and residents as well as advanced practice providers, caring for a total census of 15 – 25 patients daily. This may include patients with a large spectrum of liver disease including

patients undergoing evaluation for transplant or complications post-transplant, as well as a panoply of acute and chronic liver disease.

The Hepatology consult service is responsible for caring for patients with acute and chronic liver disease who are admitted to other services throughout the main hospital (a 1400 bed hospital, and the referral center of a network of 15 regional hospitals, with a total of 5,053 beds).

The educational goal of this rotation for fellows is to develop consultative skills in the management of the hospitalized patient with concomitant liver disease. Fellows spend mornings co-managing patients in our Medical Liver Intensive Care Unit (MILU), and afternoons consulting on patients throughout the hospital.

Fellows also rotate on the surgical liver transplant service, as part of the surgical team; this allows them experience in managing patients and immunosuppression immediately post-transplant (both in the ICU and hospital floor). During that rotation, fellows typically have an opportunity to meet the criteria for observing both organ procurement and liver transplant (both cadaveric and live donor).

Specialized rotations also include a rotation on the transplant infectious disease service, where fellows gain exposure and experience in dealing with infectious complications peri- and post transplant.

Research

The research component of the fellowship will be derived from the specific interests of the fellow. Interests of the adult Hepatology section are varied, with expertise in chronic viral hepatitis, fatty liver disease, portal hypertension, end-stage liver disease, public health and epidemiology, and transplant Hepatology. Under the guidance of a faculty mentor, the fellow will be supported through the process of developing an idea, designing and writing a protocol, IRB submission, and carrying out the project, along with data analysis, manuscript preparation and submission. The section has a PhD level epidemiologist who is able to help develop and refine study ideas and facilitate moving a research idea through the various stages of research to presentation and publication.

Clinical conferences

A significant portion of the fellowship education process comes from participating in several dedicated conferences. These include:

• Didactic Conferences
• Management conferences

The goal of this conference is to develop a logical approach to the differential diagnosis of common and uncommon hepatology presentations and clinical problems, and to become familiar with the management and treatment strategies for these problems.

During this one-hour conference, one case is discussed. During the first half of the conference, relevant data are presented in an organized fashion, and the presenting fellow solicits input and opinions from the audience regarding an appropriate differential diagnosis and diagnostic approach. The second half of the conference is reserved for a presentation on the topic being reviewed.

The section also has an active visiting professor lecture series, inviting faculty (either in person or virtually) to present on topics within their area of expertise.

Journal Club

The section has a monthly journal club, during which the fellow presents two papers from the current literature, with guidance from the faculty. The discussion that ensues typically is wide ranging, based on the broad experience and diverse interests of the audience. We are fortunate to have the active involvement of past fellows as well as faculty members from the Cleveland Clinic Weston FLA transplant program and staff at Cleveland Clinic London.

Transplant Grand Rounds

Fellows are able to participate in monthly enterprise -wide transplant grand rounds remotely, during which an invited guest speaker presents on cutting edge topics in research or emerging areas in the field.

Clinical Care Conferences

Liver Transplant Selection Committee Meeting

The goal of this conference is to present and discuss specific patients undergoing evaluation for liver transplantation. The fellow serves as the primary advocate for the patients he/she has evaluated and presents a clinical overview to a committee of hepatologists, surgeons, social workers, ethicists, transplant coordinators, and other transplant professionals.

Pathology conferences

The goal of this conference is to develop expertise in interpreting liver histopathology. Fellows will review slides remotely or on a teaching microscope in a multi-disciplinary conference, including pathologists, hepatologists, and liver transplant surgeons. At the end of the fellowship, the fellow will have far exceeded the number of liver biopsies of both transplant and nontransplant patients required to sit for the CAQ.

Liver tumor board

Fellows participate in a weekly multidisciplinary tumor board, during which cases and imaging of patients with liver tumors are discussed by hepatologists, surgeons / transplant surgeons, medical and radiation oncologists, as well as radiologists and interventional radiologists. Patients – both undergoing transplant evaluation and non-transplant patients

are clinically evaluated, with review of their lab and imaging data, and a management strategy is derived. A separate liver transplant tumor board meets weekly with a focus specifically on patients who are pre-transplant with malignancies who are in the process of evaluation or on the wait list.

Wait List Management Conference

This is a weekly conference designed to improve patient well-being and maximize suitability for patients awaiting transplant.

Fellows & Alumni

2017-2018 transplant hepatology fellows

• Christina Lindenmeyer, MD
• Sasan Sakiani, MD
• Nicole Welch, MD

Alumni career pathways

• 2011 Graduate - Naim Alkhouri, Pediatric and Adult Hepatology, Cleveland Clinic, OH
• 2010 Graduate - Emily Carey, Gastroenterology, Cleveland Clinic, OH
• 2008 Graduates - Achuthan Sourianarayanane (2009 Clinical Associate Hepatology), Gastroenterology, Cleveland Clinic, OH

Staff Physicians

• Robert O’Shea, MD, Program Director, Transplant Hepatology Fellowship
• Dian-Jung Chiang, MD, Hepatology Section Head
• Jamak Modaresi Esfeh, MD, Medical Director, Liver Transplantation
• Christina Lindenmeyer, MD, Co-Director, Medical Liver Intensive Care Unit
• Talal Adhami, MD
• Olumuyiwa Awoniyi, MD
• William D. Carey, MD
• Srinivasan Dasarathy, MD
• Shilpa Junna, MD, Co-Director, Liver Tumor Program
• Sobia Laique, MD, Medical Director, Multidisciplinary MASLD Clinic
• Walaa Mahmoud, MD
• Jamile Wakim-Fleming, MD, Director, Fatty Liver Disease Program
• Nicole Welch, MD
• Nizar Zein, MD

Locations

Cleveland Clinic

Cleveland Clinic was founded in 1921 by George Crile Sr., a general and endocrine surgeon; Frank Bunts, a neurosurgeon; William Lower, a urologist; and John Phillips, an internist. It was a new kind of medical center: a physician-led, not-for-profit, integrated hospital and group practice, equally dedicated to patient care, research, and education. Cleveland Clinic quickly became a world-renowned training hospital, medical school and research institute, known for offering the most advanced medical care.

Cleveland Clinic's main campus consists of 41 buildings and more than 85 operating rooms, with constant expansion and renovation. The Gastroenterology offices are on the third floor and fifth floor of the A building (desks A30 and A50) in the Digestive Disease and Surgery Institute.

Q3: New, state-of-the-art endoscopy unit

The Digestive Disease and Surgery Institute’s advanced endoscopy unit, located in Glickman tower on Cleveland Clinic’s main campus, emphasizes both safety and quality. The 15,000-square-foot facility was built to improve both access and patient experience. The expansion doubled the number of therapeutic endoscopy suites for performing endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) and deep enteroscopy. Specialized fluoroscopic equipment will allow for the next generation of 3-D cholangiography, which is available at only a handful of units nationally. The unit was designed to improve patient satisfaction and features private recovery rooms with TVs and seating for family members. It will help maximize communication between patients and caregivers and enable close interaction with the staff from other specialties, including anesthesiology, hepatobiliary surgery, colorectal surgery, thoracic surgery, oncology and radiation oncology, during treatment.

”This expansion will increase our ability to handle additional volume to speed up diagnosis and treatment of patients.” – John Vargo, MD, MPH

Cleveland Clinic is a large facility, how do I find my way around?

While Cleveland Clinic has a large campus, it is easily walkable from the visitor parking garages and the two on-campus hotels: the InterContinental Hotel and the InterContinental Suites. Cleveland Clinic is immediately adjacent to the University Circle Neighborhood, home of the Case Western Reserve University, the Cleveland Orchestra, and the Cleveland Museum of Art. Cleveland Clinic is centrally located and accessible from the downtown, east, and west side residential neighborhoods.

Application Information

What are you looking for in an applicant?

We are looking for outstanding individuals to immerse in a high-volume environment that offers high-quality, scientifically advanced care in an economically savvy environment. We seek the most promising physicians with demonstrated leadership abilities, academic productiveness, knowledge base and positive personal qualities.

What is your application process?

Cleveland Clinic has minimum requirements for fellowship application and employment, all of which are required in the standard ERAS application. We have no secondary application form. We review every submitted application completely and carefully, and a selected group is offered on-site interviews.

What are your NRMP program codes?

Gastroenterology AAMC ID: 1968144F0

What are your fellows' employment benefits?

Residents are Cleveland Clinic employees with standardized salaries and other benefits.

What VISAs are supported by Cleveland Clinic?

• Clinical Programs: For graduate medical education purposes (residency, fellowship and clinical research fellowship), Cleveland Clinic will accept H-1B temporary worker or J-1 exchange visitor (alien physician category – sponsored by the ECFMG) visas. International students enrolled in U.S. medical schools may use the post-graduate year of Optional Practical Training (OPT) for the first year of residency training. Information on this process should be obtained from the Designated School Official (DSO) at the medical school. Cleveland Clinic does not sponsor immigrant (permanent resident) petitions for research or clinical trainees (residents, clinical fellows, clinical research fellows, research fellows or postdoctoral fellows).
• Research Programs: The H-1B, the J-1 Exchange Visitor (research scholar category – sponsored by CCF) or F-1 student (sponsored by a U.S. college or university) with employment authorization are accepted by Cleveland Clinic for research purposes. Cleveland Clinic does not sponsor immigrant (permanent resident) petitions for research or clinical trainees (residents, clinical fellows, clinical research fellows, research fellows or postdoctoral fellows).

Are there specialized opportunities available to apply for?

Orascom Construction Industries has established an endowed fellowship program in memory of the late Karim Camel-Toueg

This program is designed to provide an Egyptian physician a focused training opportunity in the evaluation and treatment of all forms of common and uncommon hepatic disorders, elevate their ability to provide the best care for patients with liver disease, while also learning to be academically productive. The aim of this experience is to increase the number of qualified hepatologists to care for the millions of Egyptians with liver disease.

Interested candidates must meet the requirements established by Cleveland Clinic Graduate Medical Education. Clinical Programs for graduate medical education purposes (residency, fellowship and clinical research fellowship) at the Cleveland Clinic will accept H-1B temporary worker or J-1 exchange visitor (alien physician category – sponsored by the ECFMG) visas. Cleveland Clinic does not sponsor immigrant (permanent resident) petitions for research or clinical trainees.

For more information, please send a cover letter expressing your interest in the Karim Camel-Toueg International Fellowship and how this training opportunity would advance the care of patients in Egypt with liver disease as well as a CV, ECFMG and USMLE scores, and three letters of reference to Cheryl Borowski, Education Coordinator, at borowsc@ccf.org.

Contact Us

Hepatology Education Coordinator
Cheryl Borowski
Gastroenterology Education Coordinator
216.445.7204
Fax: 216.636.2508
borowsc@ccf.org

International Physician Services/Visa
Janice M. Bianco
Manager, International Physician Services
Responsible Officer, Exchange Visitor Program
216.445.7681
biancoi@ccf.org

Observerships/CIME
Graduate Medical Education
Main Office
216.444.5690
800.323.9259
Fax: 216.444.6112

Cleveland Clinic Operator
216.444.2200