Introduction
The Toronto General Hospital is currently the largest transplant centre in Canada and North America. The Abdominal Organ Transplant Anesthesia program offers a unique learning opportunity with extensive exposure to kidney, liver, pancreas and multi-visceral transplants. We implement the use of state-of-the-art technology such as point-of-care coagulation testing in all our cases. The staff has vast experience in the most complex transplant cases and are excited to share their knowledge with the fellows in all environments, including the operating room, pre-anesthesia assessment, pain management, teaching rounds and research.
Clinical Curriculum
The Abdominal Organ Transplantation Anesthesia Fellowship program was developed at Toronto General Hospital.
The fellow will be actively involved in the perioperative and intraoperative care of patients undergoing liver transplant, kidney transplant, kidney-pancreas transplant and occasional "multivisceral" transplantation.
The Toronto General Hospital is a high-volume transplant centre. In 2023 alone we performed 197 kidney transplants, 202 liver transplants and 59 pancreas transplants. Our institution also comprises the largest Living Donor Liver Transplant program in North America with around 80 of these transplants performed every year.
Another component of this fellowship is the anesthetic care of patients undergoing major surgical oncology procedures on the hepatobiliary, pancreatic and general surgery.
A fellow is assigned each day to see patients who are candidates to be listed for transplant and are seen in the outpatient clinic. The fellow will assess the patient, review the considerations for transplant with the consulting clinic attending staff and, together, they will plan further investigations and optimization. There is an expanding living donor-related program for both liver and kidney recipients. In addition to transplant recipients, the fellows will be involved in the screening and teaching of prospective living-related donors. Counselling regarding thoracic epidurals and the management of postoperative pain is a major commitment of the department and the transplant program.
Call Duties
Fellows will be on call exclusively for liver transplants. Home call for liver transplants is shared between 4 fellows and on average come to 4 to 5 weekday calls and 2 weekends per month.
Educational Curriculum
Listing Rounds
End-stage liver disease is complex, and each patient requires a multidisciplinary approach and specific treatment planning that starts with potential candidacy and risk stratification. The anesthesia team plays a significant role in the selection and preparation of these patients before they reach transplant surgery.
Liver Transplant Listing Rounds occur each Friday. Fellows are encouraged to attend approximately once every month to participate, together with anesthesia staff, in discussions involving perioperative patient management.
Kidney transplant listing meetings occur later in the day on Friday and input from anesthesia is always requested. Attendance at this listing meeting is usually staff-led, but fellows are encouraged to attend.
Learning Opportunities
Tuesday weekly Fellows' teaching rounds at 17:00 are mandatory and encompass a vast selection of topics selected and provided by the TGH Anesthesia Staff and by other specialists within the institution.
Since 2022, Dr. Carla Luzzi, together with Dr. Cynthia Tsien (Transplant Hepatology) and Dr. Chaya Shwartz (Transplant Surgery) have created the Group for Advancing Education in Liver Transplantation. Once every 3 months, the group promotes educational events that bring all three specialties together to discuss and share important knowledge in liver transplantation. These events also look forward to promoting the interaction of fellows from all three specialties creating a sense of learning community that should follow even after their program is done. Fellows are expected to attend these sessions.
Transesophageal and Transthoracic Echocardiography
Transesophageal teaching and reading rounds are conducted each week on Wednesday and Thursday, respectively. All fellows are encouraged to attend. For more hands-on training in perioperative TEE, special arrangements will be made on a case basis.
