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

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