In addition to the transplant surgery fellow, the transplant surgery attending, and the transplant hepatology attending, the Liver Transplant Service consists of two surgical interns, two medical interns, a third-year surgical resident, two senior gastroenterology fellows, an inpatient nurse coordinator, and a transplant pharmacist along with medical and/or pharmacy students. The transplant surgery fellow and attending surgeon has primary responsibility for the care of post-transplant patients while the gastroenterology fellows and the hepatologist have primary responsibility for the care of pre-transplant liver patients and perform all inpatient liver allograft biopsies. Similar to the Kidney/Pancreas Service, patients are examined; results of laboratory, radiological, and histological tests are reviewed; and a plan for patient care is determined. Typically, the service census averages 18 to 20 patients with 4 to 6 in the Intensive Care Unit.
For those who come in for transplant from home, the transplant fellow is expected to review all pre-admission workups to determine whether the evaluation is satisfactory and complete. The transplant fellow is expected to attend the weekly multidisciplinary Liver Transplant Selection Committee Meeting where all pre-transplant candidates are presented and concerns regarding candidacy are discussed. As for the peri- and post-transplant population, the goal of delivering comprehensive medical, surgical, and immunosuppressive care is quite similar to the Kidney/Pancreas Service.
We believe that the UCSF Liver Transplant Service rotation provides unique and invaluable training. The full integration of hepatology and transplant surgery and of the pre-transplant and the post-transplant care exposes the fellow to the full spectrum of medical and surgical management. The fellow will gain intimate familiarity with the physiology of acute and chronic liver disease, the tempo of decompensation, the potential for recovery, and the appropriate application and timing of liver transplantation.