• 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
  • Longterm 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

• 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

• Inpatient transplant medicine service – staffed by an internal medicine resident and intern, as well as a nurse practitioner who assists with patient management and discharges
• Transplant consult service – provides care for all transplanted patients in the medical center admitted to other services, including the transplant surgery services

• Daily multidisciplinary bedside rounds on all new post-transplant recipients
• Daily notes in the electronic medical records (EMR) on all new consults and follow-up patients
• Performing procedures, including dialysis and transplant renal biopsies
• Assisting in the education and supervision of house staff

The fellow attends one early post-transplant management clinic and one longterm management clinic each week, under supervision.

In this setting, the fellow has the opportunity to evaluate and manage immunosuppression regimens as well as common post-transplant complications such as glucose intolerance, hypertension and opportunistic infection.

Attending the longterm management clinic allows the fellow to understand the concepts of safe immunosuppression reduction to prevent cardiovascular morbidity and manage the various metabolic complications associated with longterm immunosuppression.

Each of the four transplant nephrologists has two half-day clinics every week covering living donor evaluations, pre-transplant kidney and pancreas evaluations and post-transplant follow-ups. The transplant fellow will be assigned to two half-day continuity clinics every week, one to do pre-transplant evaluations and the other to do post-transplant follow-ups.

The fellow will be responsible for the overall care of the patients seen in the clinic for the duration of the training year – vis-à-vis monitoring of the labs, modifying immunosuppression and answering any questions raised the patients.

This format will offer independence in decision making and experience in continuity of care for the patients. Since there are outpatient clinics every day, there will ample opportunities for both the transplant and the general nephrology fellow to work independent of each other.

• 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

• 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