Transplant Hepatology Fellowship

ACGME Fellowship Requirements

• Liver biopsies, optional (The requirement for 20 completed biopsies ended in 2022)
• 200 liver pathology slides
• Scholarly activity
• Attendance at AASLD
• Three Liver transplants
• One -- three procurements (of note the program requirement is one, but to become a director of liver transplant the requirement is three)
• Attendance at Patient Selection Committee (PSC) every Monday at 8 a.m.
• Attendance at liver pathology conference the second and fourth Monday of the month at 12 p.m.
• Attendance at liver tumor board on Fridays at 7:30 a.m.
• Lecture series for the general GI fellows on hepatology topics
• Surgical experience

Lectures to fellows

• Autoimmune diseases of the liver
• Evaluation of the outpatient liver patient
• Management of portal hypertension
• Liver transplant- indications and complications
• Immune suppression
• Viral hepatitis

Reading list

The goal of the fellowship is to provide a well-rounded education through patient driven clinical experience, as well as didactic lectures and a selection of suggested readings based on the contents of the ACGME Transplant Hepatology board exam. The outline below is meant to guide fellows and provide suggested topics with the understanding that education is a dynamic process, and many topics and readings may be shaped by the clinical experience of the fellows on rotation.

• Quarter 1: Transplant, pathology, acute liver failure, immunology
• Quarter 2: Viral hepatitis, autoimmune liver diseases, alcoholic liver disease
• Quarter 3: Metabolic diseases, pediatric liver diseases, liver cancers
• Quarter 4: Pregnancy and liver disease, statistics, outpatient hepatology 

Sample weekly schedule 

Monday morning: Livery biopsy / Path
Monday afternoon: HCC clinic

Tuesday morning: Clinic
Tuesday afternoon: Tx clinic

Wednesday morning: Research
Wednesday afternoon: Research

Thursday morning: Endo
Thursday afternoon: Wellner clinic

Friday morning: Tx clinic
Friday afternoon: Endo

Inpatient training

Fellows will complete eight weeks of inpatient service, which includes acting as the attending for a resident service, as well as management of an active consult ad post-transplant service. Additionally, fellows will work closely with our surgery service, including rotating with them four weeks of the year. Our transplant center performs 140 transplants each year, including living liver donors, liver-kidney and heart-liver.  

Outpatient training

During outpatient rotations, transplant fellows will have two general hepatology clinics and two post-transplant clinics per week. The focus of the general hepatology clinics is to see patients with a variety of liver conditions, including those who may be referred or under evaluation for liver transplantation. Fellows will also have dedicated endoscopy time to maintain and develop their endoscopic skills. Additionally, there’s dedicated time with the hepato-pathology team for one-on-one instruction and every other week conferences. There’s also opportunities for time with interventional radiology for optional training in liver biopsies and to observe procedures such as TIPS/TACE/BRTO.  

Research

Fellows participate in a variety of ongoing or new clinical research projects related to liver disease or liver transplantation.

Olivo, Raquel, James V. Guarrera, and Nikolaos T. Pyrsopoulos. "Liver transplantation for acute liver failure." Clinics in liver disease 22.2 (2018): 409-417. https://pubmed.ncbi.nlm.nih.gov/29605075/

Ramzan, Moazma, et al. "Comparison of CLIF-C ACLF score and MELD score in predicting ICU mortality in patients with acute-on-chronic liver failure." Cureus 12.2 (2020). https://pubmed.ncbi.nlm.nih.gov/32226688/

Zaccherini, Giacomo, Emmanuel Weiss, and Richard Moreau. "Acute-on-chronic liver failure: Definitions, pathophysiology and principles of treatment." JHEP Reports 3.1 (2021): 100176. https://pubmed.ncbi.nlm.nih.gov/33205036/

AASLD practice guidance on drug, herbal, and dietary supplement–induced liver injury
https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.32689

Thursz, Mark R., et al. "Prednisolone or pentoxifylline for alcoholic hepatitis." New England Journal of Medicine 372.17 (2015): 1619-1628. https://www.nejm.org/doi/full/10.1056/NEJMoa1412278

Marot, Astrid, Christophe Moreno, and Pierre Deltenre. "Liver transplant for alcoholic hepatitis: a current clinical overview." Expert review of gastroenterology & hepatology 14.7 (2020): 591-600. https://pubmed.ncbi.nlm.nih.gov/32511039/

Kumbala, Damodar, and Rubin Zhang. "Essential concept of transplant immunology for clinical practice." World journal of transplantation 3.4 (2013): 113-118. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879520/

Mack, Cara L., et al. "Diagnosis and management of autoimmune hepatitis in adults and children: 2019 practice guidance and guidelines from the American Association for the Study of Liver Diseases." Hepatology 72.2 (2020): 671-722. https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.23584

Lindor, Keith D., et al. "Primary biliary cholangitis: 2018 practice guidance from the American Association for the Study of Liver Diseases." Hepatology 69.1 (2019): 394-419. https://www.aasld.org/sites/default/files/2022-04/PracticeGuidelines-PBC-November2018_1.pdf

Chapman, Roger, et al. "Diagnosis and management of primary sclerosing cholangitis." Hepatology (Baltimore, Md.)51.2 (2010): 660-678. https://europepmc.org/article/med/20101749

Alam, Seema, and Bikrant Bihari Lal. "Recent updates on progressive familial intrahepatic cholestasis types 1, 2 and 3: Outcome and therapeutic strategies." World Journal of Hepatology 14.1 (2022): 98. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8790387/

Krishna, Murli. "Microscopic anatomy of the liver." Clinical liver disease 2.Suppl 1 (2013): S4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448667/

Sibulesky, Lena. "Normal liver anatomy." Clinical liver disease 2.Suppl 1 (2013): S1. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6448666/

Duke pathology slides
https://pathology.oit.duke.edu/siteParts/avaps/06.15.1_Liver_Pathology_Final.pdf

Selection and evaluation

Levitsky, J., et al. "The American Society of Transplantation Consensus Conference on the use of hepatitis C viremic donors in solid organ transplantation." (2017): 2790-2802. https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.14381

Lai, Jennifer C., et al. "Development of a novel frailty index to predict mortality in patients with end‐stage liver disease." Hepatology 66.2 (2017): 564-574. https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.29219

Miller, Charles M., et al. "The international liver transplantation society living donor liver transplant recipient guideline." Transplantation 101.5 (2017): 938. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5642345/

Surgical approach

Makowka, Leonard, et al. "Surgical technique of orthotopic liver transplantation." Gastroenterology Clinics of North America 17.1 (1988): 33-51. https://www.sciencedirect.com/science/article/pii/S0889855321003423

Perioperative complications

Mohanraj, B. Sharmila, Amol S. Rangnekar, and Joseph G. Timpone. "Infections in liver transplantation." Principles and Practice of Transplant Infectious Diseases. Springer, New York, NY, 2019. 41-72. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120017/

Amara, Dominic, et al. "Surgical complications after living and deceased donor liver transplant: The NSQIP transplant experience." Clinical Transplantation (2022): e14610. https://doi.org/10.1111/ctr.14610

Baheti, Akshay D., et al. "Surgical techniques and imaging complications of liver transplant." Radiologic Clinics 54.2 (2016): 199-215. https://pubmed.ncbi.nlm.nih.gov/26896220/

Kochhar, Gursimran, et al. "Biliary complications following liver transplantation." World Journal of Gastroenterology: WJG19.19 (2013): 2841. https://pubmed.ncbi.nlm.nih.gov/23704818/

Chen, Jun, et al. "Surgical and endovascular treatment of hepatic arterial complications following liver transplant." Clinical Transplantation 28.12 (2014): 1305-1312. https://pubmed.ncbi.nlm.nih.gov/25091402/

Hoppmann, Nicholas, and Omar Massoud. "Medical care of liver transplant patients." Expert Review of Gastroenterology & Hepatology 14.10 (2020): 901-918. https://www.tandfonline.com/doi/abs/10.1080/17474124.2020.1797483?casa_token=P6Eh_Kw_d9kAAAAA:SzbahWa5S9jo5FGg-Fz4NQs3R3YpZOO-4Al2YukQ_RKt69NM17_ydiBiIdtSoKh81ELvLdx_Bag

Kelly, Deirdre A., et al. "Long‐term medical management of the pediatric patient after liver transplantation: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation." Liver Transplantation 19.8 (2013): 798-8 https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/lt.23697

Lee, Way S., and Ronald J. Sokol. "Liver disease in mitochondrial disorders." Seminars in liver disease. Vol. 27. No. 03. Copyright© 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA., 2007. https://www.thieme-connect.com/products/ejournals/html/10.1055/s-2007-985071

Kamal, Natasha, Pallavi Surana, and Christopher Koh. "Liver disease in patients with cystic fibrosis." Current opinion in gastroenterology 34.3 (2018): 146. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7232742/

Rake, Jan, et al. "Guidelines for management of glycogen storage disease type I–European Study on Glycogen Storage Disease Type I (ESGSD I)." European journal of pediatrics 161.1 (2002): S112-S119.

Ross, Katalin M., et al. "Dietary management of the glycogen storage diseases: evolution of treatment and ongoing controversies." Advances in Nutrition 11.2 (2020): 439-446.

Ross, Katalin M., et al. "Safety and efficacy of chronic extended release cornstarch therapy for glycogen storage disease type I." JIMD Reports, Volume 26. Springer, Berlin, Heidelberg, 2015. 85-90.

Strong, Alanna, et al. "Hepatic Manifestations of Urea Cycle Disorders." Clinical Liver Disease 18.4 (2021): 198. https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/cld.1115


Palumbo, Chiara Saroli, and Michael L. Schilsky. "Clinical practice guidelines in Wilson disease." Annals of translational medicine 7.Suppl 2 (2019). https://pubmed.ncbi.nlm.nih.gov/31179302/

Bacon, Bruce R., et al. "Diagnosis and management of hemochromatosis: 2011 practice guideline by the American Association for the Study of Liver Diseases." Hepatology (Baltimore, Md.) 54.1 (2011): 328. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149125/

Singal, Ashwani K., et al. "Liver transplantation in the management of porphyria." Hepatology 60.3 (2014): 1082-1089. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498564/

Chalasani, Naga, et al. "The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases." Hepatology 67.1 (2018): 328-357. https://www.aasld.org/sites/default/files/2022-06/NAFLD%20Guidance%202018.pdf

Jain, Arpan, et al. "L‐ornithine L‐aspartate in acute treatment of severe hepatic encephalopathy: A double‐blind randomized controlled trial." Hepatology 75.5 (2022): 1194-1203. https://doi.org/10.1002/hep.32255

European Association For The Study Of The Liver. "EASL Clinical Practice Guidelines on nutrition in chronic liver disease." Journal of hepatology 70.1 (2019): 172-193. https://pubmed.ncbi.nlm.nih.gov/30144956/

Hilscher, Moira B., et al. "Fontan-associated liver disease." Hepatology 75.5 (2022): 1300-1321. https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.32406

IVIG and serologies

King, Catherine, Una Sutton-Fitzpatrick, and Julieanne Houlihan. "Transient derangements in Hepatitis B serology in patients post-intravenous immunoglobulin therapy—a case-based review." Irish Journal of Medical Science (1971-) 189.2 (2020): 617-620. https://pubmed.ncbi.nlm.nih.gov/31643027/

Arnold, Donald M., et al. "Misleading hepatitis B test results due to intravenous immunoglobulin administration: implications for a clinical trial of rituximab in immune thrombocytopenia." Transfusion 50.12 (2010): 2577-2581.

Hui, Edwin Pun. "Immunoglobulin therapy and passive transfer of anti-HBc: too often forgotten." The Lancet Haematology 5.10 (2018): e437-e438.

Polycystic liver disease

van Aerts, Rene MM, et al. "Lanreotide reduces liver growth in patients with autosomal dominant polycystic liver and kidney disease." Gastroenterology 157.2 (2019): 481-491.

Gevers, Tom JG, et al. "Effect of lanreotide on polycystic liver and kidneys in autosomal dominant polycystic kidney disease: an observational trial." Liver International 35.5 (2015): 1607-1614.

Neijenhuis, M.K., Gevers, T.J., Nevens, F. et al. Somatostatin analogues improve health-related quality of life in polycystic liver disease: a pooled analysis of two randomised, placebo-controlled trials. Aliment Pharmacol Ther. 2015; 42: 591–598

Short telomere syndrome

Schratz, Kristen E. "Extrahematopoietic manifestations of the short telomere syndromes." Hematology 2014, the American Society of Hematology Education Program Book 2020.1 (2020): 115-122. https://ashpublications.org/hematology/article/2020/1/115/474343/Extrahematopoietic-manifestations-of-the-short

Armanios, Mary, and Elizabeth H. Blackburn. "The telomere syndromes." Nature Reviews Genetics 13.10 (2012): 693-704. https://pubmed.ncbi.nlm.nih.gov/22965356/

Kalra, Avash, and J. P. Norvell. "Cause for confusion: noncirrhotic hyperammonemic encephalopathy." Clinical Liver Disease 15.6 (2020): 223. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326631/

Bozbas, Serife Savas, and Huseyin Bozbas. "Portopulmonary hypertension in liver transplant candidates." World Journal of Gastroenterology 22.6 (2016): 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4726675/

Iwakiri, Yasuko, and Jonel Trebicka. "Portal hypertension in cirrhosis: Pathophysiological mechanisms and therapy." JHEP Reports 3.4 (2021): 100316. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318926/

Koch, David G., and Michael B. Fallon. "Hepatopulmonary syndrome." Clinics in liver disease 18.2 (2014): 407-420. https://pubmed.ncbi.nlm.nih.gov/24679503/

Russell, Michelle A., and Sabrina D. Craigo. "Cirrhosis and portal hypertension in pregnancy." Seminars in perinatology. Vol. 22. No. 2. WB Saunders, 1998.

Aggarwal, N., et al. "Non-cirrhotic portal hypertension in pregnancy." International journal of gynecology & obstetrics 72.1 (2001): 1-7.

Aggarwal, Neelam, et al. "Pregnancy with portal hypertension." Journal of clinical and experimental hepatology 4.2 (2014): 163-171.

Sarkar, Monika, et al. "Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases." Hepatology (Baltimore, Md.) (2020). https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.31559

Goel, Ashish, et al. "Pregnancy-related liver disorders." Journal of Clinical and Experimental Hepatology 4.2 (2014): 151-162. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116710/

Krousel-Wood, Marie A., Richard B. Chambers, and Paul Muntner. "Clinicians' guide to statistics for medical practice and research: part I." The Ochsner Journal 6.2 (2006): 68. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3121570/

Ascha, Mustafa S., Mona L. Ascha, and Ibrahim A. Hanouneh. "Management of immunosuppressant agents following liver transplantation: less is more." World journal of hepatology 8.3 (2016): 148. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4724578/

Charlton, Michael, et al. "International liver transplantation society consensus statement on immunosuppression in liver transplant recipients." Transplantation 102.5 (2018): 727-743. https://journals.lww.com/transplantjournal/Fulltext/2018/05000/International_Liver_Transplantation_Society.13.aspx?casa_token=om4erDyDLawAAAAA:qywBkW1eG20sBVipCyYPW8Ucd6mPqFBzoOtRZ99ftcGzSQHet_4ZzPOBrcfrH6572LIodtULEGDnknBYkLjexw

Demetris, Anthony J., et al. "Banff schema for grading liver allograft rejection: an international consensus document." Hepatology 25.3 (1997): 658-663. https://mayoclinic.pure.elsevier.com/en/publications/banff-schema-for-grading-liver-allograft-rejection-an-internation

Demetris, A. Jake, et al. "2016 Comprehensive update of the Banff Working Group on liver allograft pathology: introduction of antibody‐mediated rejection." (2016): 2816-2835. https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.13909

Assy, Nimer, et al. "Characteristics of common solid liver lesions and recommendations for diagnostic workup." World journal of gastroenterology: WJG 15.26 (2009): 3217. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2710776/

Hackl, Christina, et al. "Liver transplantation for malignancy: current treatment strategies and future perspectives." World Journal of Gastroenterology: WJG 20.18 (2014): 5331. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017048/

Al‐Adra, David P., et al. "Pretransplant solid organ malignancy and organ transplant candidacy: a consensus expert opinion statement." American Journal of Transplantation 21.2 (2021): 460-474. https://onlinelibrary.wiley.com/doi/10.1111/ajt.16318

Rosen, Charles B., Julie K. Heimbach, and Gregory J. Gores. "Liver transplantation for cholangiocarcinoma." Transplant International 23.7 (2010): 692-697. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1432-2277.2010.01108.x

Hepatitis C

Hepatitis C treatment guidelines by AASLD and the IDSA https://www.hcvguidelines.org/

Ghany, Marc G., Timothy R. Morgan, and AASLD‐IDSA hepatitis C guidance panel. "Hepatitis C guidance 2019 update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America recommendations for testing, managing, and treating hepatitis C virus infection." Hepatology 71.2 (2020): 686-721. https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.31060

Hepatitis B

Terrault, Norah A., et al. "Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance." Hepatology 67.4 (2018): 1560-1599. https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.29800

Spyrou, Elias, Coleman I. Smith, and Marc G. Ghany. "Hepatitis B: Current status of therapy and future therapies." Gastroenterology Clinics 49.2 (2020): 215-238. https://pubmed.ncbi.nlm.nih.gov/32389360/

Ekpanyapong, Sirina, and K. Rajender Reddy. "Hepatitis B virus reactivation: what is the issue, and how should it be managed?." Clinics in Liver Disease 24.3 (2020): 317-333. https://pubmed.ncbi.nlm.nih.gov/32620274/

Huang, Daniel Q., Guan Sen Kew, and Seng Gee Lim. "Controversies in Treating Chronic Hepatitis B virus: The Role of Hepatitis B Virus DNA and Surface Antigen Titer." Clinics in Liver Disease 25.4 (2021): 763-784. https://pubmed.ncbi.nlm.nih.gov/34593152/

HAV, HDV, HEV

Abutaleb, Ameer, and Shyam Kottilil. "Hepatitis A: epidemiology, natural history, unusual clinical manifestations, and prevention." Gastroenterology Clinics 49.2 (2020): 191-199. https://pubmed.ncbi.nlm.nih.gov/32389358/

Niro, Grazia A., et al. "Hepatitis delta virus: From infection to new therapeutic strategies." World Journal of Gastroenterology 27.24 (2021): 3530. https://pubmed.ncbi.nlm.nih.gov/34239267/

Hercun, Julian, Christopher Koh, and Theo Heller. "Hepatitis delta: prevalence, natural history, and treatment options." Gastroenterology Clinics 49.2 (2020): 239-252. https://pubmed.ncbi.nlm.nih.gov/32389361/

Aslan, Abdullah Tarık, and Hatice Yasemin Balaban. "Hepatitis E virus: Epidemiology, diagnosis, clinical manifestations, and treatment." World journal of gastroenterology 26.37 (2020): 5543. https://pubmed.ncbi.nlm.nih.gov/33071523/

Other viral infections

Jothimani, Dinesh, et al. "COVID-19 and the liver." Journal of hepatology 73.5 (2020): 1231-1240. https://www.journal-of-hepatology.eu/article/S0168-8278(20)30377-9/fulltext

Faruqui, Saamia, et al. "Cholangiopathy after severe COVID-19: clinical features and prognostic implications." Official journal of the American College of Gastroenterology| ACG116.7 (2021): 1414-1425. https://pubmed.ncbi.nlm.nih.gov/33993134/

Spengler, Ulrich, Hans-Peter Fischer, and Wolfgang H. Caselmann. "Liver Disease Associated with Viral Infections." Zakim and Boyer's Hepatology (2012): 629. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152320/