ASTS Abdominal Transplant Surgery
Cleveland Clinic has a group of internationally renowned abdominal transplant surgeons and physicians. These individuals have both clinical and academic commitments and come from institutions with established post-graduate training program in multiorgan transplantation.
Under the new structure of the fellowship training programs there will be 3 tracks. The first track is the Multi-Organ Abdominal (MOA) Transplant track where the fellows will be trained in liver, kidney, and pancreas transplantation (one fellow every year). The second track is the Liver Transplant (LT) track where the fellow will be trained in liver transplantation only (one fellow every year). The third track will be the Kidney/Pancreas (K/P) track where the fellow will be trained in kidney and pancreas only (1 fellow every other year).
This is different than the currently approved structure where there is one Multi-Organ Fellow every year, one Kidney/Pancreas Fellow every year, and one Liver Fellow every other year. With this reorganization we will be switching the every-other year position to Kidney/Pancreas track and then making Liver track every year. This will provide better training and education of all our fellows and more specifically the Multi-Organ Fellows will receive more kidney/pancreas. There will be no positions taken outside the match so that this does not take away from their training and experience.
The transplant fellowship program at Cleveland Clinic has been designed to provide a comprehensive experience in the pre- and post-operative care of the transplant patient. This broad exposure includes medical and surgical management hepatic and other visceral transplantation. Medical evaluation and selection of recipients, surgical technique, immunosuppression, critical care management, as well as dealing with medical and surgical complications, are stressed to all transplant fellows. With almost 300 abdominal organ transplants being performed each year, and a correspondingly high number of organ retrievals, including living donation, the operative experience for surgically oriented fellows is intended to develop pre-eminent transplant surgeons.
We believe that our program offers unparalleled training that will allow you to reach your goals of developing into an outstanding Gastroenterologist/Hepatologist.
Bijan Eghtesad, MD
Program Director, ASTS Abdominal Transplant Surgery Fellowship
Venkatesh Krishnamurthi, MD
Program Co-Director, Kidney Pancreas Transplant Surgery Fellowship
Kareem Abu-Elmagd, MD, PhD
Director, Transplant Center
Multi-Organ Abdominal Transplant (MOA)
Training in multiple organ procurement begins during the first year of fellowship. The MOA Transplant Fellows are taught to manage patients with end-stage organ failure and to become independent in donor procurement. They will spend eight months in liver transplantation where they are taught donor procurement, participate in the recipient hepatectomies and implantation, and patient management on liver transplant service and transplant ICU. The other four months of the first year, fellows rotate in kidney/pancreas transplantation where they are taught donor procurement and kidney/pancreas transplantation. The MOA fellow provides medical care for the inpatient kidney/pancreas transplant service. The MOA fellow scrubs on all kidney and pancreas transplant procedures. Emphasis is placed on surgical procedures related to kidney transplantation, specifically implantation of the kidney, deceased donor nephrectomy and allograft nephrectomy. With respect to living donor renal transplantation, fellows alternate participation on the recipient operation and the donor operation.
During the second year the MOA fellow will spend eight months in liver transplantation. The fellows are taught cutting-edge procedures, living donor hepatectomy, split-liver procurement, multi-organ transplantation, pediatric transplantation, and advanced hepatobiliary surgery to help develop surgeons with broad surgical exposure. In addition, a large number of ancillary procedures, such as decompressive shunt surgery, liver resection, ablative liver procedures and intestinal reconstructive procedures, along with training our fellows in other important diagnostic and therapeutic options.
The other four months of the second year, the MOA fellows rotate in kidney/pancreas transplantation where Transplant fellow provides medical care for the inpatient kidney/pancreas transplant service. Transplant fellow scrubs on all kidney and pancreas transplant procedures. Emphasis is placed on surgical procedures related to pancreas transplantation, specifically implantation of the pancreas, and living donor nephrectomy (laparoscopic and open). During this time, they assume operative responsibility in liver and pancreas transplantation.
Liver Transplant (LT)
The Liver Transplant fellowship entails 24 consecutive months of inpatient and outpatient training in the management of liver transplant recipients. The Liver Transplant (LT) Fellow provides medical care for the inpatient Liver Transplant Service, and scrubs on all liver transplant procedures. During the first year, LT Fellows are taught to manage patients with end-stage organ failure. They are taught to become independent in donor procurement and start their experience in recipient hepatectomies and implantation. During the second year, LT fellows rotate for 4 months on the Hepatopancreatobiliary (HPB) surgery, and the liver transplant service. During this time, they assume more independent operative responsibilities in liver transplantation. They also participate in the living donor hepatectomies. A summary of the objectives for liver transplantation are attached.
Kidney/Pancreas Transplant (K/P)
The Kidney/Pancreas Transplant fellowship entails 24 consecutive months of inpatient and outpatient training in the management of kidney and pancreas transplant recipients. The Kidney/Pancreas (K/P) Transplant Fellow provides medical care for the inpatient Kidney/Pancreas Transplant Service. The K/P Fellow scrubs on all kidney and pancreas transplant procedures. During the first clinical year, emphasis is placed on surgical procedures related to kidney transplantation, specifically implantation of the kidney, living donor nephrectomy (laparoscopic and open), deceased donor nephrectomy and allograft nephrectomy. With respect to living donor renal transplantation, fellows alternate participation on the recipient operation and the donor operation. Given this fact and combined with the nearly 70-75 living donor transplants (per year) done at our institution, adequate training in living donor transplantation is available for the K/P and MOA Transplant Fellows.
During the 2nd year, the focus shifts more to pancreas transplant procedures including donor pancreatectomy, bench preparation of the pancreas and implantation of the pancreas allograft.
Following adequate training by the attending transplant surgeons, transplant fellows independently perform donor nephrectomy (approximately 85-100 kidney procurements annually) and donor pancreatectomy (approximately 25 procurements annually).
Each fellow will complete the ASTS required modules in liver, kidney, and pancreas transplantation during the 24 month fellowship period. This will be monitored by the Program Director and Coordinator.
Scholarly activities in the form of clinical research are emphasized throughout the entire fellowship period. Fellows are encouraged to study a clinical question, present at scientific meetings and compose related manuscripts. The Cleveland Clinic provides numerous resources to assist Fellows in these pursuits, including access to a transplant specific database and biostatistical help. Basic science research in Transplant Immunobiology can also be pursued.
Computer facilities include the EPIC Integrated Health Care System and the Electronic Database Interface for Transplantation (EDIT), which allows electronic access to medical records, laboratory data and outpatient records, with HIPAA compliance. Research inquires are performed under IRB regulated “honest brokers”. Fellows are assigned to a variety of clinical research and review projects during their fellowship.
Morbidity and Mortality Conference/Readmission
Each month the fellows report cases for the M&M conference and Readmissions Conference. The conference faculty moderator selects cases for presentation based on their teaching merit, and moderates the discussion. The fellow who managed the patient presents the case and pertinent literature while focusing on clinical decision making, reasons for any complications and alternative management options., The main focus of the conference is improving clinical decision making to improve patient care.
Liver Transplant Education Conference/Subspecialty Conferences
Each subspecialty holds its own conferences (IBD, Liver Transplant, HPB, Intestinal Transplant, Clinical Nutrition, etc.) These conferences are made available to all fellows that wish to attend.
These one-hour seminars by esteemed Cleveland Clinic and visiting faculty are diverse presentations aimed at faculty, fellows, and residents. Presentations are on a broad range of topics, including clinical topic updates, world health, surgical history, etc. These are held monthly for Internal Medicine, General Surgery, and Transplant Center.
- Kareem Abu-Elmagd, MD, PhD
- Charles Miller, MD
- Bijan Eghtesad, MD
- Dympna Kelly, MD
- Cristiano Quintini, MD
- Federico Aucejo, MD
- Koji Hashimoto, MD
- Teresa Diago-Uso, MD
- Masato Fujiki, MD
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 as demonstrated leadership abilities, academic productiveness, knowledge base, and positive personal qualities among applicants from diverse backgrounds.
What is your application process?
Cleveland Clinic has minimum requirements for fellowship application and employment. We use Cleveland Clinic Internal GME Fellowship application and applicants must participate in the NRMP subspecialty match. We review every submitted application completely and carefully, and a selected group is offered on-site interviews.
- Cleveland Clinic GME Internal Application Form
- Cover Letter and CV
- Support documentation ECFMG and Steps 1, 2,3 (as applicable)
- Diplomas, other certificates
- 3 letters of recommendation
All documents are to be submitted to:
APPLICATION DEADLINE is FEBRUARY 1 of the previous year, the NRMP Match is in May/June.
(Example: if you are applying for 2016 fellowship position – application deadline is Feb 1, 2015)
What are your NRMP program codes?
Multi-Organ Abdominal Transplant Fellowship AAMC ID: 1968S02F0
Liver Transplantation Fellowship AAMC ID: 1968S02F2
Kidney/Pancreas Transplant Fellowship AAMC ID: 1968S02F1
What are your fellows' employment benefits?
Residents are Cleveland Clinic employees with standardized salaries and other benefits.
What VISAs are supported by Cleveland Clinic?
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).
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).
Digestive Disease Institute Education Manager
ASTS Abdominal Transplant Surgery Fellowship Coordinator
Beth Christoff, BSN, MBA
International Physician Services/Visa
Janice M. Bianco
Manager, International Physician Services
Responsible Officer, Exchange Visitor Program
Observerships / CIME
Graduate Medical Education
Cleveland Clinic Operator
Advanced Heart Failure & Transplant Cardiology
The program is a 1-year training program, which begins July 1 and concludes June 30. At the end of the program, the fellow will qualify to serve as a medical director of a UNOS certified heart transplant program and be eligible for certification in the subspecialty, Advanced Heart Failure and Transplant Cardiology, by the American Board of Internal Medicine (ABIM).
Learn more about the program:
The Hepatology Section of Cleveland Clinic's Digestive Disease Institute has had a long-standing fellowship program, which is designed to afford fellows the opportunity to receive sophisticated training in the care of patients with all forms of liver disease. In particular, the training program aims to give a broad base of experience in transplant hepatology, beyond what would be typically acquired in a general gastroenterology fellowship.
Director, Hepatology Fellowship
Robert O’Shea, MD
Cleveland Clinic - Department of Gastroenterology
Toll-free: 800.223.2273 ext. 46518
Learn more about the program:
Intestinal & Multivisceral Transplantation
Specific Program Description:
I. Clinical Activities:
The intestinal and multivisceral transplant fellowship requires completion of general surgery residency program. The program is a full one-year of clinical and research fellowship designed for trainees who are seeking training in intestinal and multivisceral transplantation including a different combination of en bloc visceral organs such as stomach, duodenum, small bowel, pancreas and liver. During the fellowship period, trainees will participate in the management of both the adult and pediatric intestinal and multivisceral recipients.
The intestinal and multivisceral transplant fellowship has been designed to provide comprehensive training in patient care, surgical techniques, and clinical research. The medical management before transplantation focuses on the nutritional support of the short bowel syndrome patients, gut rehabilitation, pathology of the complex gastrointestinal disorders and candidate selection. Teaching the cutting edge surgical techniques of donor and recipient operations including allograft implantation aims to polish the surgical skills of the transplant fellow, increase the creativity and broaden the surgical ability to safely handle complex abdominal diseases. The transplant fellow will master the post-operative care of the most complex and highly immunogenic allograft recipients including monitoring of immunosuppression and critical care management with prompt response to the post-operative medical and surgical complications. With more than 200 patients being evaluated annually for gut rehabilitation including surgical reconstruction and transplantation, the intestinal and multivisceral transplant fellow is intended to develop a cumulative experience in the medical and surgical treatment of patients with intestinal failure. The case volume is an equal mix of both adult and pediatric transplants. In addition, the fellows will participate in a large number of ancillary procedures such as portal hypertensive surgery and intestinal reconstructive procedures.
The focus during the first 3 months of the fellowship year is on the state-of-art management of short bowel syndrome and postoperative care of both adult and pediatric intestinal and multivisceral recipients. Meanwhile, they participate in the donor operation learning the surgical techniques of retrieving the different types of intestinal allografts including intestine, en bloc liver/intestine, and multivisceral. They will also learn the bench technique of preparing the visceral allograft particularly the required complex vascular reconstruction. At the end of the first half of the year, fellows are able to take the lead in the donor operation and actively participate in the recipient procedure particularly removal of the native organs. During the second half of the fellowship period, the trainees are usually able to perform part of the lengthy and very challenging transplant operation including vascular reconstruction and restoration of continuity of the gastrointestinal tract. At the end of the fellowship, the fellow is usually capable of performing straight forward cases of isolated intestinal and combined liver/intestinal transplantation. Fellows with gifted hands and fine surgical techniques are usually able to take full responsibility in transplanting complex patients with multivisceral transplantation.
II. Clinical Research:
Intestinal and multivisceral transplantation is an evolving field with great opportunities for clinical research and establishment of a unique academic career for a young transplant surgeon. One of the academic goals of this highly specialized program is to assist the transplant fellow in conducting valuable clinical research activities that will help him to better understand the different aspects of the procedure. For further advancement of the field of intestinal and multivisceral transplantation, the program is currently focusing on the following areas of relevant clinical research:
- Organ preservation and monitoring of ischemia reperfusion injury
- Allograft Immunogenicity and induction of tolerance
- Innate immunity and intestinal transplantation
- Outcome analysis and causes of late graft loss
- Long-term graft survival and risk factors
- Chronic rejection particularly of the intestinal component of the visceral allograft
- The immunoprotective effect of the concomitantly transplanted liver
- Opportunistic infections and risk of post-transplant lymphoma
- Monitoring of intestinal allograft functions and achievement of nutritional autonomy
- Intestinal allograft recipients and micronutrients deficiencies
Outpatient clinics are held four times a week. All of the staff mentioned below participates in the relevant clinic with full-time clinical and teaching activities. Two clinics are designed for the adult pre-transplant evaluation and gut rehabilitation. One clinic is devoted for post-operative care and are staffed mainly by the transplant physicians and coordinators. The last clinic specifically for pediatric services. The Transplant Fellows participate in the decision making process of monitoring immunosuppression and prompt diagnosis of underlying pathology of patient symptoms. In addition, the fellows take part in the endoscopic examination of the intestine for monitoring allograft rejection. On a weekly basis, a morbidity and mortality conference, patient selection conference, and intestine pathology conference, for both the pediatric and adult services, are held for patient care and continued medical education. Furthermore, the research activities of the program are discussed on a regular basis for educational and publication purposes.
The staff of the Center for Gut and Rehabilitation & Transplantation (CGRT) is a multidisciplinary team that includes surgeons, gastroenterologists, psychiatrist, nurse practitioner, nutritionist, pharmacist, social worker, case manager and transplant coordinators. The teaching physicians that carry full responsibility and supervise the fellows are:
- Kareem Abu-Elmagd, MD
- Cristiano Quintini, MD
- Bijan Eghtesad, MD
- Koji Hashimoto, MD
- Masato Fujiki, MD
- Ajai Khanna, MD
- Donald Kirby, MD
- Abdullah Shatnawei, MD
- Mansour Parsi, MD
- Kathy Coffman, MD
Kareem M. Abu-Elmagd, MD, PhD, FACS
Director, Transplant Center
Director, Center for Gut Rehabilitation & Transplantation (CGRT)
9500 Euclid Avenue
Cleveland, OH 44195