Duke University Hospital Program

The Liver Transplant Program at Duke University Hospital is recognized as one of the leading centers for liver transplantation in the United States. With an extensive history since its establishment, the program has successfully performed over 2,000 liver transplants. Notably, the program is ranked among the best in the nation for its outcomes, particularly for patients who are often rejected by other centers due to the complexity of their medical conditions.

The liver transplant team at Duke is composed of experienced specialists who employ a comprehensive, multidisciplinary approach to patient care. This includes not only transplant surgeons and hepatologists but also nurse coordinators, social workers, psychologists, dietitians, and pharmacists, all contributing to a patient-centered care model that follows individuals through the transplant process.

Curriculum and Training

The training for transplant hepatology fellows is extensive and includes both clinical and research experiences. The curriculum encompasses fundamental aspects of liver disease management, preoperative assessments, transplantation procedures, and postoperative care, ensuring that fellows gain a holistic understanding of the transplant process. Fellows engage in supervised clinical practice with an emphasis on diagnosing and managing complex hepatological disorders.

Clinical Rotations

Clinical rotations involve comprehensive evaluations for liver transplant candidates, which include psychosocial assessments, imaging studies, and laboratory analyses tailored to individual patient needs. Each candidate undergoes a rigorous evaluation process that involves meeting with various specialists to determine their suitability for transplantation. The extensive evaluation can span several days depending on individual needs.

Research Opportunities

Research is a cornerstone of the liver transplant program at Duke, with the faculty actively involved in innovative studies aimed at improving transplant outcomes and developing new therapies. The program emphasizes the importance of clinical trials and provides opportunities for fellows to participate in ongoing research initiatives. Fellows may investigate areas such as immunosuppression strategies, management of post-transplant complications, and techniques to enhance organ viability.

Unique Aspects of the Program

Duke's program is distinguished by its commitment to accepting and successfully transplanting patients who are often viewed as high-risk by other centers. This includes individuals with prior surgeries, severe comorbidities, or those who require complex multi-organ transplants. The program's expertise in advanced techniques such as split liver transplants and living-donor liver transplants further highlights its innovative approaches to donor organ utilization.

Training Sites

The primary training site for the liver transplant program is Duke University Hospital, which is equipped with cutting-edge technology and specialized units dedicated to organ transplant patients. The hospital features a dedicated transplant unit where patients receive comprehensive pre-operative and post-operative care.

Visa Support and Sponsorship

The program is known to support international fellows with appropriate visa options. Typically, fellows can apply for J-1 visas for clinical training in the United States. Candidates should verify details regarding visa requirements and support available during their interview and application process.

Competitiveness and Application Requirements

The program is competitive, attracting candidates from diverse backgrounds, including International Medical Graduates (IMGs) and both Doctor of Osteopathy (DO) and allopathic (MD) graduates. Applicants should be aware of special application requirements, which may include a limit on the number of failed STEP exams and considerations regarding the year of graduation from medical school.

Support During Training

The program provides considerable support to fellows, including mentorship from experienced faculty, participation in multi-disciplinary rounds, and involvement in complex case discussions. This support is pivotal to help fellows navigate the complexities of managing liver transplant patients and developing their surgical and clinical skills.

Patient Management and Follow-Up

Post-transplant management is equally crucial. Duke's program places a strong emphasis on the importance of follow-up care, which is vital for detecting acute rejection, monitoring liver function, and ensuring adherence to medication regimens. The transplant coordinators play a significant role in educating patients about the lifestyle modifications necessary for maintaining a healthy liver post-transplant.