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.
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.
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. 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 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 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. Mark Cattral, Anand Ghanekar, Ian McGilvray, Mike Robinette and Markus Selzner. 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.
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.
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.