Candidates for liver transplantation are evaluated by hepatology physicians on the medical staff at Baylor Dallas along with the fellows. Cases are discussed at the weekly meetings of the liver transplant selection committee, which consists of transplant surgeons, hepatologists, and other specialists on the hospital’s medical staff, along with social workers and transplant coordinators. Once a candidate is approved for transplant, the patient is listed according to United Network for Organ Sharing (UNOS) guidelines.
Fellows participate in the admission and workup of patients at the time of surgery. After transplant, Fellows continue to care for the post-liver transplant recipient in all aspects of his/her medical and surgical needs.
Surgical responsibilities include:
- Completion of a liver transplant
- Completion of number of liver transplants to achieve ASTS certification for liver transplant (45 cases)
- Pre- and post-transplant ICU medical and surgical management
- Participation in both living and deceased liver harvests
- Diagnosis and management of surgical complications (nontransplant related) after liver transplant
- Diagnosis and management of surgical complications after living donor hepatic lobectomy
Intensive Care Unit
Intensive care unit management of the liver transplant patient is intense and complex. Fellows take an active part in the management of the patient’s care, including:
- Fluid and transfusion management
- Immunosuppression management
- Ventilator management
- Management of vasoactive agents
- Interpretation of PA catheter data
- Medical management
Inpatient Care
Inpatient liver transplant care also is provided by fellows, who are involved in all patient care until discharge. The basics of inpatient management include:
- Fluid/diuretic management
- Immunosuppression management
- Analysis of liver function tests
- Diagnosing rejection
- Management of co-morbid conditions
- Workup of infectious causes
Outpatient Care
Fellows also see patients in the outpatient clinic. Patients may require readmission for infection, rejection or observation. Transplant patients are seen annually after transplant. Fellows learn to perform bedside liver biopsies and interpret results of the follow-up studies.