Transplant?

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Chrismander

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Can urologists subspecialize in renal transplant? can they do the transplant itself, or does that get done by a general surgeon trained in transplant?
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I think if the urology guys are involved, it's usually to do/help with the donor nephrectomy and the transplant guys do the rest.
 
There are lots of centers where urology does the whole thing. It isn't a very technically demanding case. The hard part is managing the immunosuppression, especially chronicly.
 
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I'd be interested to know the answer to this. I just assumed transplant guys did the whole thing.
 
it is very common for the donor kidney, particularly live donor, to be harvested via urology. most live donor kidneys are obtained via. lap. nephrectomy. the transplant guys aren't as proficient as a lap. trained urologist. i've never heard of uro doing the implantation into the reciepient. the placement of the kidney is typically on the iliac artery - which would require substantial vascular training (uncommon in uro training). additionally, the "medical" management of these patients would be well beyond the scope of a urologist.
 
I'd be interested to know what centers do this. It might be an interesting place to train.
 
I did med school at UMass at urologists did all the harvesting and about half of the transplants. Not sure if this is still true or not (was 2-3 years ago).
 
cytoskelement said:
I'd be interested to know what centers do this. It might be an interesting place to train.
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Oregon and Lahey come to mind where urology does a heck of a lot of transplants.

Frankly, transplant = no sleep. The vascular surgery aspect is good to know. It's a good experience to know how to sew on vessels. But the post op managent really bites.
 
bobbyseal said:
Oregon and Lahey come to mind where urology does a heck of a lot of transplants.

Frankly, transplant = no sleep. The vascular surgery aspect is good to know. It's a good experience to know how to sew on vessels. But the post op managent really bites.
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Word to that. I know we do A LOT of kidney transplants here. In fact, our transplant fellowship for surgery only lasts one year b/c of such high volume.

What are everyone's thoughts on Lahey? I've heard good things but don't know much about specifics. I know there Uro service is incredibly busy.
 
cytoskelement said:
Word to that. I know we do A LOT of kidney transplants here. In fact, our transplant fellowship for surgery only lasts one year b/c of such high volume.

What are everyone's thoughts on Lahey? I've heard good things but don't know much about specifics. I know there Uro service is incredibly busy.
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Lahey is da bomb. I rotated there a little while back.

However, it's fairly rough. 2 years of general. 1 year of research. By the time you're a PG 4 (when most programs you're a senior resident with some independence), you're basically an intern on the urology service. YOu're the low man on the totem pole. They don't have interns rotate on service and so as a PG4 you're taking all the primary calls. Also, call is in house. So no operating on your post call day.

That being said, Lahey has one of if not the best chief years in the country. Operate all the time, back up call. All of the chiefs rock. I wanted to go there, but wasn't up for a 6 year program.
 
Those who have done urology residency (solely) do not do transplants.

Urologists are eligible, however, to apply for fellowships in transplant surgery. Having completed their fellowship, they can do kidney transplants.

If they did liver transplants as part of their fellowship, they currently cannot do liver transplants afterwards. Its a silly rule, and one which the AUA is fighting against, but it is true. Only general surgeons can do liver transplants.
 
a few urologists do transplants. It is what you are credentialed to do that counts. Some residency do a lot of transplant because that is what their program guy does...e.g. john barry the urologist at oregon. San Antonio has a fellowship in renal transplant that can be done by either an uroloogist or gen surgeon post grad. The urologist who works with the transplant surgeon Francis Wright will do the transplants when he is on call or Francis is on vacation and the kidney comes in. It is likely everything else... technical ability improves with mentorship and practice and results tend to follow volume. The harder part is the management... which is done on a non acute basis by the transplant nephrons and making the medical legal decisions on how to stay out of court. If you wanted to be an urologist and do transplant you could either do a fellowship or go to a program that is intricately involved in transplant and spew out that this is the residency for you because you have to be both an urologist and transplant kidneys. That will flatter them and hint that you would like to do some publications in transplant. That ups your odds a little bit. Sincerity counts too. Too be honest... though I would probably rec doing the gen surgery route as you may always have some inferiority complex or be taken less seriously by your real peers if you couldn't do livers. Those are the guys who are truly fearless. The gen surgery residency teaches you how to be the A hole that most true transplant surgeons need to be. Taking care of people who are truly sick and represent a threat to die at any moment- you can tolerate residents or nurses making mistakes, assumptions, or oversights.
 
Hi. This thread is probably dead. But you should know that it typically depends on the program. At Cleveland Clinic, the only doctors who perform renal transplants are Urologists. However, they have to have completed a renal transplant fellowship. No general surgeons perform renal transplants because thats the way the Cleveland Clinic likes it. 1 mile down the street at Case Western's hospital UH, kidney transplants are done by general surgeons. Go figure. There are a number of urologists at the Clinic that perform open donor nephronectomies (laps), and also implantation. It all depends on the program and the hospital.
 
So "Renal Transplantation" is done more commonly by General Surgeons, that it is by Urologists?
 
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