Clinical Programs

Liver Transplant Program

The Liver Transplant Program functions within the Multi-Organ Transplant (MOT) Program of the University Health Network and the Toronto General Hospital (UHN and TGH) and the Pediatric Academic Multi-Organ Transplant Program (PAMOT) of the Hospital for Sick Children (HSC).
The Staff are:

  • 6 Surgeons: Drs. Cattral, Grant, Greig, Ghanekar, McGilvary & Selzner
  • 5 Hepatologists: Drs. Avitzur, Lilly, Levy, Renner & Selzner
  • 6 Surgical Fellows: 4 Transplant Fellows (2 first year and 2 second year) and the first year HPB Fellow and the non-Matched Fellow
  • 3 – 4 Hepatology Transplant Fellows
  • 3 Nurse Practitioners: Ms. Healey, Sawicka & Tarani
  • Junior Resident in General Surgery
  • Medical Student in Transplant

The adult program serves approximately 75% of the province of Ontario (13.5M), and most patients from the province of Manitoba, and the pediatric program serves all of Ontario, Manitoba, and approximately half of the Maritimes. The program volumes for 2014 were:

Adult deceased donors 130
Adult live donors 48
Pediatric deceased donors 20
Pediatric live donors 22
Total 220

Liver Transplant Volumes: 2000 – 2014

liver chart A

Transplant Service

The adult liver transplant in-patient service is comprised of three Nurse Practitioners, the Transplant Surgeon and Hepatologist, the Transplant Surgical and Hepatology Fellow, a PGY1 Resident in General Surgery, and a Medical Student (CC3). Staff and Fellows are on service for one week at a time; Staff rotates on Friday and Fellows rotate on Monday. Joint rounds are held at 7am and 3pm daily. The service has 25 – 35 patients including listed, pre-op liver patients, postoperative recipients on the admission of their transplant, and late post-transplant patients. Patients are managed with the Intensivists in the closed MedSurg ICU, and by the Transplant team on the Transplant ACU, and on the Multi-Organ Transplant Unit. The Hepatology & Surgical Fellows take second call.

Fellows are expected to rotate through the Medical and Surgical Liver transplant clinics in the second year.

Living Donor Liver Transplant

Fellows 2011
Transplant & HPB Fellows, 2011.

The Toronto Living Donor Liver Transplant program is the largest in North America with approximately 50 adult and 20 pediatric LDLTs per year, and over 600 LDLTs to-date.

The majority of the adults receive right lobe grafts, and children receive left lobe grafts. Over 200 potential donors are assessed each year and the Fellows perform all the volumetric analyses using the Myriam Software on dedicated computers. The living donor hepatectomy and transplantation are an important part of our teaching curriculum and the Fellows actively participate in the donor and recipient transplant procedures.

Pediatric Liver Transplant

Fellows 2012
Transplant & HPB Fellows, 2012.
Each year, 30-40 pediatric transplants are performed making Toronto one of the largest pediatric liver transplant programs in North America. Recipient procedures are performed at the Hospital for Sick Children. Approximately half of the pediatric transplants are from living donors. Approximately one-quarter are deceased donor split liver transplants. Fellows are fully integrated into the donor and recipient procedures and are expected to be pediatric-competent (donor, split and recipient) upon graduation. Fellows are expected to rotate through the Pediatric Liver Transplant Clinic.

The Pediatric Transplant surgeons are: Dr. David Grant, Dr. Mark Cattral and Dr. Anand Ghanekar. The Medical Director is Dr. Vicky Ng and Hepatologists include Dr. Yaron Ivitzur, Dr. Binta Kamath and Dr. Simon Ling.

Pancreas Transplant Program

The pancreas transplant program is the 2nd largest pancreas program in North America, performing between 40-50 pancreas transplants per year.

In addition to SPK and PAK transplants we now offer PTA transplants to patients with severe hypoglycemic unawareness. Type II Diabetics are also being considered for pancreas transplantation. Fellows are expected to become independently capable of pancreas procurement (both NDD and DCD) and certified for pancreas transplantation by exceeding ASTS volume requirements.

The Surgical Director of Pancreas Transplant is Dr. Mark Cattral; the Medical Director is Dr. Jeffrey Schiff and the surgeons are Drs. Markus Selzner, Paul Greig, Ian McGilvray and Mark Cattral. The Nurse Practitioners are Alicia Healey and Zanita Sawicka.

Pancreas Chart A
Pancreas transplant activity (as of June 30, 2014).

Pancreas Transplant Service

The Pancreas transplant service is staffed by the Transplant Surgeon and Fellow on call for the week, and one Transplant Nurse Practitioner. The in-patient service has 5 – 10 patients at any time. Fellows are expected to attend the Pancreas transplant clinic during the second year.

Kidney Transplant Program

In Toronto, kidney transplantation occurs at the Toronto General Hospital, St. Michael’s Hospital and the Hospital for Sick Children. Our program at TGH does all the deceased donor procurements (NDD and DCD) for Toronto, and the kidney transplants at TGH. Of the 160 – 180 kidney transplants performed at TGH each year, approximately 50% of procedures are living donor kidney transplants of which approximately 70% are laparoscopic donor nephrectomies. Fellows are expected to be fully trained all aspects of kidney donation and transplantation and patient management.

Kidney Chart A

Kidney transplant activity at TGH (as of June 30, 2014).

Kidney Transplant Service

The Surgical Director of Kidney Transplant is Dr. Anand Ghanekar and the Medical Director is Dr. Joe Kim. The surgeons are Drs. Paul Greig, Markus Selzner, Ian McGilvray, David Grant, Anand Ghanekar, Mark Cattral and Mike Robinette. The nephrologists are Drs. Joe Kim, Ed Cole, Katherine Tinkham, Jeffery Schiff and Istvan Mucsi.

Small Intestine Transplant Program

Each year 1-2 adult or pediatric small intestinal transplants are performed. The majority are multi-visceral grafts with liver, pancreas and stomach. Fellows are integrated into donor and recipient procedures and post-operative care.

Vascular Access Program

Fellows 2013
Transplant & HPB Fellows, 2013.
Vascular Access is performed by Dr. Mark Cattral, performing approximately 80 procedures per year. Fellows are expected to become proficient in Vascular Access Procedures.

Deceased Donor Procurement

Deceased donor procurement is performed by the Surgical Fellows. It is anticipated that all first-year Fellows will become independent in the multi-organ procurement operation by their 3rd to 4th month. Fellows are assisted by the Residents in General Surgery on their transplant rotation. In general, donation after cardiac death (DCD) donors and pancreas donors are performed by two Fellows.

The Organ Procurement Organization for the Province of Ontario is the Trillium Gift of Life Network. All donor offers and allocation is coordinated by TGLN. Coordination of the organ donation process is coordinated by TGLN. The TGH program is responsible for organ procurement from hospitals in the Toronto region. Since the majority of hospitals in Ontario and Manitoba do not have a transplant program, the Toronto Fellows procure the majority of organs that are allocated to Toronto.

Combined Organ Transplantation

Fellows 2014
Transplant & HPB Fellows, 2014.

Combined Organ Transplants are performed frequently. They include:

  • Liver Kidney
  • Liver Heart
  • Liver Lung
  • Liver Pancreas
  • Lung Liver Pancreas

HPB Surgery Program

The Toronto Transplant Fellowship is accredited by both the ASTS and the AHPBA for training in HPB Surgery. During the first year our Transplant and HPB Fellowships are integrated and Fellows are assigned to 3-month rotations with HPB surgeons for their clinics and elective HPB surgery. Our transplant fellows achieve the AHPBA target volumes for liver, biliary, and pancreas procedures. Further information regarding the HPB Fellowship is available on our HPB website.