Transplant Hepatology Fellowship

In the Pre-Liver Transplant Clinics, our transplant hepatology fellows gain in-depth exposure to the management of patients with end-stage liver disease who are being evaluated for transplantation. They participate in comprehensive assessments, including medical, surgical and psychosocial reviews, diagnostic workups, and pre-transplant screening. Fellows work closely with the multidisciplinary liver transplant team to evaluate patients for eligibility, participate in liver transplant team conferences, optimize patients’ medical management, and discuss the transplant process and potential risks with patients. This clinic provides valuable experience in coordinating care and developing long-term management strategies for patients being considered for or awaiting liver transplantation.

The Post-Liver Transplant Clinic experience is designed to train our transplant hepatology fellows to manage patients following liver transplantation, in both the immediate post-operative period and during long-term follow up. Fellows work closely alongside our transplant hepatology and transplant surgery team members to learn how to adeptly diagnose and manage basic and complex issues of immunosuppression and post liver transplant management, including but not limited to rejection, drug-drug interactions, biliary and vascular complications, infections, post-transplant malignancies, and post-transplant metabolic and other chronic medical conditions. This rotation offers fellows the opportunity to refine their skills in longitudinal care and patient education, while ensuring optimal outcomes for patients who have undergone a liver transplant.

The Liver Health and Recovery Clinic (LHARC) provides a clinical training experience designed to immerse our transplant hepatology fellows in the management of patients with alcohol associated liver disease, including those who may be potential candidates for liver transplantation. Effectively managing this patient population requires a multidisciplinary approach that includes not only medical management, but also psychosocial support, substance use treatment, and careful evaluation for transplant eligibility.

The Palliative Care Clinic offers fellows the opportunity to work alongside specialists in palliative care to integrate palliative care principles into the management of patients with end-stage liver disease, focusing on symptom relief, quality of life, and advanced care planning. This rotation enhances fellows’ ability to provide compassionate, holistic care for patients with serious, life-limiting liver conditions.

The Living Donor Evaluation Clinic focuses on the assessment and management of potential living liver donors. Fellows participate in the comprehensive evaluation process, which includes detailed medical history review, physical exams, imaging studies, and psychological assessments. This clinic provides fellows with important experience in communicating with potential living liver donors, to explain the risks, benefits, and ethical considerations associated with living liver donation.

In the UPMC Liver Cancer Center, fellows work with a multidisciplinary team including surgical oncologists, medical oncologists, and transplant specialists to diagnose and manage patients with primary liver tumors, including hepatocellular carcinoma, cholangiocarcinoma, and select patients with metastatic liver involvement. Fellows learn about the multidisciplinary approach to treatment, including surgical, medical, and interventional options, including but not limited to surgical resection, liver transplantation, microwave ablation, radiofrequency ablation, radioembolization, transarterial chemoembolization, and immunotherapies. This rotation provides valuable experience in managing complex oncologic liver conditions and coordinating care among various specialties to determine the best course of treatment for each patient.

The UPMC Liver Steatosis and Metabolic Wellness Program focuses on the management of patients with metabolic dysfunction associated steatotic liver disease (MASLD), metabolic dysfunction associated steatohepatitis (MASH), and related metabolic disorders. Fellows engage in the evaluation and treatment of patients with liver steatosis, discussing lifestyle interventions, metabolic disease management, the role of cutting-edge pharmacologic therapies, and the role of therapeutic clinical trial participation to manage these conditions. This rotation emphasizes the growing importance of addressing liver disease in the context of metabolic syndrome and offers fellows insight into innovative strategies for managing these increasingly common conditions.

The endoscopy rotation allows fellows to hone their expertise in diagnostic and therapeutic endoscopy relevant to transplant hepatology, including EGD, colonoscopy, and variceal banding. Fellows participate in endoscopic procedures both in inpatient consults for hospitalized patients and during outpatient blocks. This hands-on experience is crucial for managing liver-related complications such as varices, gastrointestinal bleeding, and screening for esophageal varices in patients with cirrhosis.

Fibroscans are a key tool in the non-invasive assessment of liver fibrosis and cirrhosis. During this rotation, fellows gain experience in performing and interpreting liver elastography, enhancing their skills to conduct a comprehensive liver workup and learning when a liver biopsy may be reasonably averted.

The radiology rotation provides fellows with exposure to the imaging techniques that are crucial in the diagnosis and monitoring of liver disease, including ultrasound, contrast-enhanced ultrasound, CT, MRI, and PET scan. Fellows work closely with our dedicated liver radiologists to learn key aspects of interpreting liver imaging studies. There is also opportunity to work with our Interventional Radiology Team to gain insights and exposure to procedures relevant to liver disease management (TIPS, percutaneous biliary drains, imaging-guided liver biopsies, etc.). This rotation enhances fellows’ understanding of how imaging complements clinical care in hepatology and liver transplantation.

In the pathology rotation, fellows work closely with UPMC’s world-class liver pathologists to gain experience with liver biopsy interpretations, identification of key pathologic features of the spectrum of acute and chronic liver disease entities, liver-related malignancies, infections, and post-liver transplant rejection. This rotation is essential for developing a deep understanding of the microscopic characteristics of liver disease, which is critical to achieve accurate clinical diagnoses and treatment decisions.

The inpatient liver consult rotation exposes fellows to a wide range of acute and chronic liver disease presentations. Fellows work as part of a multidisciplinary team to assess hospitalized patients, provide diagnostic workups, and manage complex cases. This experience is critical for developing the skills necessary to provide high-quality, acute care for patients with liver disease in a hospital setting.

During the transplant surgery inpatient rotation, fellows work closely with our expert team of liver transplant surgeons to observe both deceased and living donor liver transplant surgeries and participate in post-transplant management. Fellows will also gain exposure to living liver donor surgeries, deceased donor organ procurements, machine perfusion, and NRP. This rotation provides valuable exposure to the technical and clinical aspects of liver transplantation, enhancing fellows’ understanding of the surgical procedures that are integral to transplant hepatology.

The research block/elective rotation facilitates fellow pursuit of quality improvement initiatives and/or independent research projects or exploration of specialized areas of interest within hepatology and transplant medicine.