About the Program
The Transplant Nephrology Fellowship at The Ohio State University Wexner Medical Center is a one-year intensive clinical program approved by the American Society of Transplantation. There is one position available each year, and this position is filled for 2017.
Since this fellowship is not accredited by the Accreditation Council for Graduate Medical Education (ACGME), it is only available to candidates who have completed two years of an ACGME-accredited (or equivalent) nephrology fellowship.
Candidates completing this training are considered eligible for United Network for Organ Sharing-approved medical directorships for individual transplant programs.
Program Highlights
The Transplant Nephrology Fellowship at Ohio State's Wexner Medical Center provides fellows with extensive inpatient and outpatient clinical experience, as well as longitudinal didactic teaching.
The program prepares fellows to:
- Manage kidney and pancreas transplant recipients at all stages of their care
- Become competent in immunosuppressive regimens
- Diagnose and manage complex nephrology issues
The Transplant Nephrology fellow is expected to perform at the level of a junior faculty member since he or she has completed the traditional nephrology fellowship and is board eligible. Therefore, fellows are allowed a significant amount of input in all decisions regarding immunosuppression as well as patient management.
Our Comprehensive Transplant Center
The Comprehensive Transplant Center at Ohio State's Wexner Medical Center is one of the largest organ transplant programs in the nation, performing approximately 200 kidney and 30 pancreas transplants annually.
The four full-time transplant nephrologists participate in all aspects of patient management, working alongside the transplant surgeons. Post-transplant care is provided as a multidisciplinary, collaborative model both in inpatient and outpatient settings. The center also provides long-term care for the duration of the allograft function, regardless of longevity.
Application Process
If you are interested in applying for the Transplant Nephrology Fellowship at Ohio State, you will need to contact us with these documents:
- Letter of interest
- CV, including publications
- Three letters of recommendation
- United States Medical Licensing Examination (USMLE) transcript
Mail or email the above to:
Uday Nori, MD
Program Director
Uday.Nori@osumc.edu
The Ohio State University Wexner Medical Center
Division of Nephrology
395 W. 12th Ave., Ground floor
Columbus, OH 43210
Curriculum
Transplant immunology
- Normal immune response
- Response to allografts
- Tolerance
- Crossmatches, flow cytometry
- Identification of anti-HLA (human leukocyte antigen) antibodies and donor-specific antibodies
Pharmacology and immunosuppression
- Immunosuppression agent categories
- Review mechanisms of the agents
- Current pharmacotherapy
- Investigational agents
- Therapeutic drug monitoring of immunosuppressive therapies
- Steroid avoidance and withdrawal
- Calcineurin inhibitor (CNI) elimination, minimization and withdrawal
- Drug interactions
- Drug adverse effects
- Long-term reduction of immunosuppression
Medical complications of transplantation
- Opportunistic infections
- Bacterial
- Viral
- Fungal
- Hypertension
- Atherosclerosis
- Hyperlipidemia
- New onset of diabetes after transplantation (NODT)
- Transplant-associated malignancies
- Viral-driven malignancy, including post-transplant lymphoproliferative disease (PTLD), cervical cancer, Kaposi’s sarcoma, nasopharyngeal cancer
- Non-virally driven malignancy, such as renal cell and skin
- Hepatobiliary disease, hepatitis C virus
- Musculoskeletal, bone and mineral metabolism
- Post-transplant erythrocytosis
- Metabolic syndrome
Organ allocation
Pre-transplant evaluation of the recipient
Evaluation of the living kidney donor
Graft dysfunction
- Acute rejection – cell-mediated and antibody-mediated
- Chronic rejection, chronic allograft dysfunction
- Surgical and operative complications
- Infection
- Nephrotoxicity
- Recurrent glomerular disease
- De novo disease
- Renal artery stenosis
Expected outcomes and risk factors
- Living related donor (LRD)
- Deceased donor organs
- Standard criteria donor (SCD)
- Expanded criteria donor (ECD)
- Donation after cardiac death (DCD)
- Pediatric en bloc
- Living unrelated donor (LURD)
- Race
- Human leukocyte antigen (HLA) matching
- Relapse of native kidney disease
Special issues in pediatric renal transplantation
Pregnancy and contraception
Transplantation ethics
Pancreas transplantation
Kidney transplantation in other solid organ transplant recipients
- After other organs
- Combined kidney and “other” organ
Transplantation of ABO-incompatible and cross-match incompatible individuals
Paired kidney exchange programs
Business administrative aspects
Training
Transplant Nephrology Fellowship Rotations
The experiences during the 12-month training period tally up to the following breakdown:
- 7 month (minimum) of inpatient rounds
- 1 month of tissue-typing lab and working with the organ procurement organization (OPO)
- 2 months of research – clinical or retrospective chart reviews
- 1 month of elective
- 1 month for vacation and to attend national conferences
Conferences and Lectures
In addition to the didactic sessions meant for the Division of Nephrology, these are considered mandatory for the transplant fellow:
-
Patient Selection Committee Meeting
-
Transplant Pathology Conference
-
Comprehensive Transplant Center (CTC) Grand Rounds
-
Transplant Nephrology Core Curriculum Lecture Series
Transplant Pathology Series
- Review of Banff criteria
- Acute and chronic rejection, subclinical rejection
- Calcineurin inhibitor toxicity
- Recurrent disease
- C4d staining
- BK virus nephropathy
- Thrombotic microangiopathy
- Clinical management of pathologic findings
- Protocol transplant biopsies
Research
Fellows participate in a variety of ongoing or new clinical research projects related to kidney disease or kidney and pancreas transplantation.
Resource Materials
The following are some of the primary materials that the transplant fellow is expected to use for training. In addition, journal articles will be used as supplementary materials on a regular basis.- Handbook of Kidney Transplantation, fifth edition – Danovitch G.
- Primer on Transplantation, third edition – Hricik D.
- Transplant Nephrology Core Curriculum by the American Society of Nephrology