Training & Research

Liver Transplant Fellowship

CLBS is a premier program committed to excellence in patient care, education, and research. The Training program was founded by Dr. Subhash Gupta, who has played a major role as a Senior liver transplant consultant worldwide. CLBS is a world-class transplant program that performs more than 300 transplants annually, including Living Donor Liver transplants, with outstanding transplant hepatologists, faculty, and fellows.

Requirements for Application:

Our transplant surgery fellowship training program aims to develop proficiency in the surgical and medical management of patients with end-stage organ diseases amenable to transplantation. We require that candidates for this training must have completed a surgical residency that satisfies the educational requirements for certification by the Medical Council of India.

Organization of the transplant fellowship rotations:

The Liver Transplant fellowship at CLBS is a one-year fellowship that involves clinical rotations in all fields of liver transplantation.

Currently, there are 6-7 fellows at one time. The clinical fellows rotate Every week between the Donor, Recipient, ward, and ICU works along with pediatric rotation. During these rotations, the fellows cover all transplant procedures, manage patients in the intensive care units and the floor, see consults, and attend the pre-transplant and post-transplant clinics. The fellows gain experience in recipient and living donor evaluations and patient selection. They acquire extensive knowledge in donor procurements, liver transplantation, and pediatric transplantation. They also have a significant amount of non-transplant surgery that involves both fellow and senior residents, GI surgical procedures, hepatobiliary procedures, and general surgery on transplant patients. The transplant fellow participates in and eventually independently performs procurements of liver grafts and recipient hepatectomies. They are fully trained in ICU management of donor management.

Liver rotation – covers all liver transplants and all hepatobiliary cases and performs all recipient operations when on the first call. The liver fellow will cover all liver pre-transplant evaluation, post-transplant clinics, and hepatobiliary patients.

They will assist with all transplants, as feasible, with second-call fellows and senior residents available for backup and donors.

The call schedule follows the recommendations of the Indian Medical Council for fellow work hours. It is a weekly schedule with rotating weekend coverage with a primary and secondary call fellow.

Weekend calls are rotated among fellows. Every duty night is compensated with a post-duty off.

All fellows can attend national conferences, particularly if work is accepted for presentation.

The attendings and fellows for Nephrology and Hepatology are involved in both the pre and post-clinics of our transplant patients and the inpatient care. Still, the surgeons and transplant fellows “run” the service, with the nephrologists, diabetologists, and hepatologists serving as consultants. There is frequent communication between the nephrologists, hepatologists, and our transplant fellows to formulate a plan for those awaiting transplantation and the management of the post-transplant patients. Immunosuppression management is done on inpatient rounds with the transplant surgery attendings.

Interaction with transplant coordinators, nurse practitioners, and physician assistants: Three inpatient transplant coordinators cover the service seven days a week, and three pre-transplant and three post-transplant liver coordinators.

These coordinators are involved in a significant amount of the care and planning of our transplant patients and work side-by-side with our transplant fellows in the clinics, on the clinical transplant floor, in the ICU, and on call to deal with day-to-day issues, transfers, emergency room visits, immunosuppression management, and follow-up with referring physicians.

Surgical experience

The transplant fellow’s surgical responsibilities grow as their experience grows. In the first days to weeks, they will first assist with liver transplants.

In the liver, they will begin as the first assistant, but depending on skill and experience, they are usually the primary surgeon on straightforward liver transplants by the middle or end of their first year. An attending surgeon is almost always present for the entire liver transplant.

All procedures must be recorded on the case logs, which the Program Director reviews every six months.

Transplant conferences: The fellowship begins with a two-day orientation to CLBS, Max Super Speciality Hospital, Saket, and the transplant service. The academic schedule is regular, with weekly audits on Mondays, research meetings on Tuesdays, pre-transplant discussions on Wednesdays, and scientific discussions addressing all issues on liver transplantation on Fridays.