Fellowship Overview

Description

The Abdominal Organ Transplant Fellowship at the University of Toronto is a 2-year clinical training program in transplantation offered by the G.I. Transplant Program of the Multi-Organ Transplant Program, and the Division of General Surgery in the Department of Surgery at the University of Toronto.

It consists of a first clinical “core” year in Transplantation and HPB Surgery followed by a second year in Abdominal Organ Transplantation (liver, pancreas, small intestine and kidney) and associated research. The Abdominal Organ Transplant Fellowship is offered to two individuals every year.

This Fellowship operates within the Department of Surgery, University of Toronto and within the guidelines outlined in the Task Force on Clinical Fellows document.

The aim of the Abdominal Organ Transplant Fellowship is develop outstanding, academic Transplant Surgeons. We provide the trainee with the basic and clinical education and the clinical experience necessary for that individual to become expert in the understanding, diagnosis, and management (including the necessary surgical skills) in the treatment of diseases of the liver, biliary tract and pancreas and for that individual to be a competent, academic Abdominal Organ Transplant and Hepato-Pancreato-Biliary Surgeon. Clinical and/or translational research productivity is a vital component of the Fellowship.

Toronto has become a very large transplant program in North America, performing yearly more than 200 liver transplants, 45 pancreas transplants and 150 kidney transplants. Our live donor liver transplant program is recognized as the premier program in the west with over 45 adult and 15 paediatric liver transplants performed each year. The Toronto case volumes also allow us to offer excellent training in pancreas transplant, paediatric liver (live & deceased donor), NDD and DCD organ procurement, laparoscopic donor nephrectomy and live donor kidney transplant and vascular access. Through integration with HPB Surgical Oncology Fellowship Program, the Transplant Fellow is also trained in complex HPB Surgery. At any one time there are 6 to 8 Fellows in Transplant and HPB Surgery making Toronto a large Fellowship program.

Transplant and HPB Fellows 2002
Transplant & HPB Fellows, 2002.

The Fellows work with 10 staff surgeons. The Transplant program has 7 staff surgeons: Drs. Cattral, Ghanekar, Grant, Greig, McGilvary, Sapisochin & Selzner. The HPB Surgical Oncology Program has 3 staff surgeons: Drs. Gallinger, Moulton, and Wei.

Fellows are expected to transition to independent operating during their Fellowship. It is anticipated that each Fellow should be capable of independent deceased donor procurement (liver, pancreas and kidney) by the 3rd or 4th month of the first year. Independence in adult liver, pancreas and kidney transplantation is expected by mid-second year.

 

 The Role of the University of Toronto

Clinical fellows play a significant role in our healthcare system, and the University of Toronto is a leading institution in the training of clinical fellows. According to the most recent data of the Canadian Post MD Education Registry (CAPER), 68% of all the clinical fellows in Ontario and 47% of all the clinical fellows in Canada are registered at the University of Toronto. This share of the total provincial and national clinical fellowship enrolment has belonged to the University of Toronto since 2007.

Clinical fellowship education involves the participation of numerous, and varied, stakeholders. To ensure the widest possible understanding of the University of Toronto’s role in the advanced postgraduate medical training of these doctors, the University has prepared concise documentation outlining the role of the University in Fellowship Training. This item is directly accessible via the following web link: http://pg.postmd.utoronto.ca/?ddownload=4004

 

Rotations

First Year

During the first year, the Transplant and HPB Fellowships are integrated and each Fellow does deceased donor and transplant procedures, elective HPB Surgery and in-patient management, HPB & transplant clinics, and all transplant & HPB rounds, seminars and educational activities.

Transplant Surgery and Call
  • Donor call: 1 in 5-6 throughout the year
  • Liver recipient and MOT ward call: 1 in 5-6 throughout the year
  • Pancreas/kidney call: 1 in 5-6 throughout the year

Note that Fellows’ call for donor, recipient, and MOT ward occurs throughout the year (usually 1 week for each, every month). This is in contra-distinction to a schedule of blocks (often 2-3 months) of pure donor call, liver call, pancreas call, and kidney call. This is ensure optimal exposure to donors and recipients throughout the year and avoid the inequity of a first year Fellow being assigned to liver transplant during the first three months, vs the last three months of the year.

HPB Elective Surgery and Call
  • Three month rotations with one or two HPB Staff for their clinics and elective surgery
  • Three month rotations on HPB in-patient service, without donor or recipient call, responsible for HPB emergencies (CBD injuries, ruptured adenomas etc.)
Transplant and HPB Fellows 2006
Transplant & HPB Fellows, 2006.

Second Year

During the second year, The Transplant Fellow continues deceased donor transplant activity and focuses on complex transplant activities:

  • Liver re-transplants
  • Live donor liver donor & transplantation
  • Laparoscopic donor nephrectomy and live donor kidney transplant
  • Pediatric liver transplant
  • Multivisceral transplants
  • The transplant clinics:
    • Donor call: 1 in 5-6 throughout the year (usually none in the last 3 months)
    • Liver recipient and ward call: 1 in 5-6 throughout the year
    • Pancreas/kidney call: 1 in 5-6 throughout the year
  • Research projects are identified and initiated during the first year and completed in the second year

Curriculum & Didactic Teaching

For Transplant, our curriculum follows the ASTS Academic Universe. Fellows are required to complete the requisite modules as proscribed by the ASTS. For HPB, our curriculum follows the Fellowship Council’s Advanced GI Curriculum for Hepato-Pancreato-Biliary Surgery Fellowship. Fellows are required to contribute to the online myHPB cases discussions as proscribed by the AHPBA. The Toronto Video Atlas of Liver, Pancreas & Transplant Surgery has been developed specifically for Fellowship training. An extensive series of transplant and HPB cases has been developed for the Fellows integrating 3D reconstructions of anatomy, intraoperative videos and graphic overlays using a case-based teaching methodology.

The following regularly scheduled rounds, and conferences are held:

Date Frequency Name Mandatory
Monday 7-9am weekly Surgical Oncology Seminar Series
Monday 4:30-5:30pm weekly General Surgery Quality Rounds  mandatory
Monday 6-8pm monthly HPB/Hepatology Faculty Club Series
Tuesday 8-9am weekly Live Liver Donor Review
Tuesday 4-5pm weekly Hepatoma Review Board
Tuesday 5-6pm weekly GI Tumour Review Board
Tuesday 6-9pm quarterly HPB Journal Club mandatory
Wednesday 8-9am weekly Multi-Organ Transplant Rounds
Wednesday 5-6pm monthly HPB Video Conference Grand Rounds mandatory
Thursday 4-5pm monthly Transplant Quality Review mandatory
Thursday 4:30-5:30pm monthly Teach Residents at HPB Seminars mandatory
Thursday 6-9pm quarterly Transplant Journal Club mandatory
Friday 7:30-8:30am weekly University or Hospital – Wide Rounds
Friday 9-10am weekly Liver Transplant Listing Conference
Friday 10-11am weekly HPB Clinical Research Rounds mandatory
Friday 11-12pm weekly Professor Round: Case Review mandatory
Friday 12-1pm weekly HPB Tumor Board/Multidisciplinary Cancer Conference mandatory

The Toronto Video Atlas of Liver, Pancreas & Transplant Surgery (TVASurg)

Toronto Video Atlas banner The Toronto Video Atlas is an important component of our transplant curriculum. The website is designed to instruct surgeons in the care of patients with complex problems in liver, pancreas and transplant surgery, and highlight the advanced surgical techniques required for the management of these diseases. The curriculum and cases have been targeted to surgeons who have completed their training in General Surgery and are enrolled in Fellowship training in liver, pancreas and transplant surgery. In each case the discussion regarding the pre-operative planning is enhanced by 3D reconstructions of the patient’s anatomy taken directly from the patient’s imaging, and the intraoperative video images are augmented with graphic overlays and 3D reconstructions to re-orient the viewer appropriately. The Atlas continues to grow with one new case added to the website each month. The Transplant Section contains donor and recipient procedures for both adult and pediatric recipients. Click here for an example of a live donor liver transplant using a right lobe graft. The website is publicly available.

Invited Professors

The following Invited Professorships have been made possible through generous donations to the Transplant & HPB Fellowship programs at the University of Toronto.

The Mummenhoff Invited Professor in Transplantation

Dr. Jean Emond (2009)

Professor of Surgery, Columbia University; New York, New York
“Organ Allocation”

Dr. John Roberts (2012)

Professor of Surgery, University of California; San Francisco, California
“Live Donor Liver Transplantation”

Dr. William Chapman (2016)

Professor of Surgery, Washington University; St. Louis, Missouri

“Development of an Organ Donor Recovery Center”

Dr. Lucas McCormack (2017)

Professor of Surgery, Universidad de Buenos Aires; Argentina

“Liver Transplantation for HCC in Argentina: How can we make it better?”

 

The Feeney Invited Professor

Dr. William Jarnagin (2014)

Professor of Surgery, Memorial Sloan Kettering Cancer Center; New York, New York
“The Enigma of Gall Bladder Cancer”

Dr. Elijah Dixon (2015)

Associate Professor, University of Calgary; Calgary, Alberta

Clinical Trials & Tribulations”

Dr. Jen Jen Yeh (2017)

Associate Professor, University of North Carolina; Chapel Hill, North Carolina

“Deconstructing Pancreatic Cancer to Understand Tumour-Specific Signals”

 

The Charbonneau Invited Professor

Dr. Jean Nicolas Vauthey (2013)

Professor of Surgery, M D Anderson Cancer Center; Houston, Texas
“Colorectal Liver Metastases”

Dr. Rebecca Minter (2015)

Associate Professor, University of Michigan; Ann Arbor, Michigan
“Can I trust you to do my whipple?”

Dr. Alan Hemming (2017)

Professor of Surgery, University of California; San Diego, California
“Extending the Limits of Liver Surgery: Can this high-risk surgery be justified?”

 

The Rogan Invited Professor

Dr. Robert Padbury (2013)

Professor of Surgery, University of Adelaide; Adelaide, Australia
“Quality in HPB Surgery”

Dr. Nicolas O’Rourke (2012)

Professor of Surgery, University of Queensland; Brisbane, Australia
“Laparoscopic HPB Surgery”

 

The John Palmer Lecture (University of Toronto)

Dr. Mike Choti (2012)

Professor of Surgery, Johns Hopkins School of Medicine; Baltimore, Maryland
“Image-Guided Liver Surgery: Current Status and Future Directions”

Dr. Tim Pawlik (2015)

Professor of Surgery, Johns Hopkins School of Medicine; Baltimore, Maryland

Dr. David Kooby (2016)

Professor of Surgery, Emory University School of Medicine; Atlanta, Georgia

“Minimally Invasive Pancreatic Resection: Where We Are and Where We Need to Go”

 

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