ROTATION DESCRIPTION:
The UCLA Abdominal Transplant Programs are among the largest in the world. The services perform roughly 200 liver (The Largest in the U.S.), 300 kidney, 8-10 small intestine, and 10-15 pancreas transplants per year. In addition, the liver division also has a high volume hepatobiliary-pancreatic surgery component.
This rotation provides an excellent opportunity to learn about and manage patients with liver failure in the critical care and acute care settings. In addition, this rotation provides the student with exposure to the problems and complexity of transplantation and post transplant patient management.
GOALS
The overall goal of this rotation is to introduce the student to the principles of patient evaluation, intraoperative and post operative management of a wide array of liver transplant and hepatobiliary patients. The student will be participating in most of the activities with the attendings, fellows, and residents on the liver service. The student is responsible, under proper guidance, for managing patients with liver failure from the initial evaluation through the transplant operation and into the post-operative period.
The student will be expected to participate in donor, recipient, and elective transplant and hepatobiliary surgeries, assist with the management of pre – and post-transplant patients.
1. Knowledge of the pathogenesis, natural history, diagnosis and
management of patients with acute and chronic liver failure.
2. Management and care of the orthotopic liver transplant patient.
3. Participation in operative procedures, including all aspects of the liver transplant operation.
4. Knowledge and insight into the immunological problems of transplantation (i.e., rejection).
5. Diagnosis and management of the complications associated with liver transplantation.
6. Ability to examine and cost effectively evaluate patients with liver failure.
7. Knowledge and experience in managing critical care patients.
8. Awareness of the indications for liver transplantation.
9. Management of patients with liver malignancies
10. Exposure to a multidisciplinary approach in the care and management of the transplant patient.

FUND OF KNOWLEDGE (Knowledge base)
1. Understand causes and management concepts for chronic liver disease.
2. Understand the physiology of ascites and SBP.
3. Understand the causes and treatment of hepatic encephalopathy.
4. Understand and utilize treatment principles for patients before and following
liver transplantation.
5. Understand the concept of ARF and hepatorenal syndrome and the
indications for use of renal replacement therapy in this patient population.
6. Understand the causes and management of portal hypertension.
7. Learn basic concepts in pharmacologic immunosuppression.
8. Understand and utilize management principles for patients following liver
resection and major biliary procedures.
9. Understand the basic technical aspects of liver transplantation and gain insight into the management of vascular and biliary complications.
10. Gain a historical perspective into the evolution of liver transplantation.
PATIENT EVALUATION ( Clinical Skills )
1. Participate in the pre and postoperative surgical management of patients after organ transplantation.
2. Participate in the perioperative management of immunosuppressive drug therapy, including monitoring drug levels and treating potential toxicity.
3. Diagnose acute and chronic organ rejection using clinical signs and symptoms as well as serum chemistries.
4. Recognize and manage postoperative surgical complications, including wound infection, anastamotic stenoses and leaks, and lymphocele formation in immunosuppressed patients.
5. Participate in the evaluation of potential candidates for living related and cadaveric organ transplantation, including: a. clinical suitability b. strength of social support c. expected graft and patient survival.
6. Participate in the evaluation of patients suspected of organ rejection to Include:a. laboratory and radiologic testing. b. administration of immunosuppressive agents
7. Following patients for potential acute and chronic side effects
8. The student should learn how to take a focused surgical history and physical exam, develop a differential diagnosis, and propose a reasonable treatment plan for each of their patients at the time of patient admission.
9. In the operating room the student will have the opportunity to assist in operations. they should make every effort to prepare by knowing the patients’ history and practicing basic knot tying skills prior to going to the operating room.
10. The student should learn to work with the surgical team as an integral member of the Service.

REQUIREMENTS
1. At least one comprehensive H & P to be performed per week and copies turned in to the ICU resident, Fellow or attending for feedback and discussion.
2. Attendance to Daily Rounds
3. Attendance to weekly Liver Transplant Lecture Series.
4. Attendance to observe at least one Liver transplant or Liver Procurement.
5. Anatomy is of great importance of in the evaluation and treatment of transplant patients. It is therefor essential for the student to review hepato-biliary anatomy.
6. One oral case presentation before the conclusion of the rotation.
7. There is no mandatory call. However, students are to be available for night time operations including procurements and transplants on average once per week.
8. Students are required to check in with the second year ICU resident or the liver fellow before leaving for the day on a daily basis.
SCHEDULE of ROUNDS CONFERENCES and CLINICS
Daily
Rounds
Monday Tuesday Wednesday Thursday Friday
7-9 AM ICU
Fellow
Rounds
7-10 AM
General
Surgery
Grand Rounds
/ M &M
8-9:30 AM
Floor
Fellow
Rounds
1-3 PM
Attending
Rounds
10:00 AM
Transplant
Evaluation
Clinic
1-3 PM
Attending
Teaching
Rounds
10:30-11:30
AM Liver
Transplant
Lecture Series
1-4 PM Liver
Cancer Clinic
10:00 AM
Transplant
Post-Op
Clinic
1-3 PM
Attending
Teaching
Rounds
11-12:30 PM
Patient
Selection
Committee
4-5 PM Tumor
Board ( Every
Other Week)
5 PM
Pathology
Conference
5 PM
*Conference
*2nd Tues Monthly at 5pm
*3rd Tues Monthly at 5pm
Liver Grand Rounds/ Visiting Professor
Morbidity & Mortality Conference
*4th Tues Monthly at 6:30pm Journal Club (Clinical alternating with basic science)

Students should page the Liver Fellow On-Call for the Liver service before they begin the rotation to find out where and when to meet. The name of the Fellow and pager can be obtained from the UCLA Page operator (310) 206-6766. If the Fellow is unavailable please contact
Dr. Kaldas’ assistant Gladys Ruiz (310) 267-9612.