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UF Health University of Florida
Division of Pulmonary, Critical Care & Sleep Medicine Department of Medicine in the College of Medicine
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Education Overview

Lung Transplant Fellowship Program

Fellowship Program Director: Cynthia Montuoro-Gries

The rotation provides an outstanding learning experience for the pulmonary trainee regarding pre- and post-lung transplant medical management.  The fellow will be involved in assessing patients with advanced lung disease and help determine the timing of listing for lung transplant. They will be exposed to donor selection and management of the donor in the ICU.  In addition, they will be actively involved in recovery of newly transplanted recipients and learn about the peri and the immediate post-operative care.  Finally, the fellow will learn about the continuity of care of lung transplant recipient in and out of the hospital.  The rotation also provides a unique exposure to extra corporeal life support as a bridge to transplant and as a bridge to recovery. 

Requirements:

  • Fellows who have completed at least 6 months of PCCM rotations.

Specific Objectives

  1. Appreciate the recommendations for referral for lung transplantation
  2. Master the criteria and contraindications for listing patients for lung transplant
  3. Know the basis of the composite allocation system.
  4. Understand the criteria of donor selection and management of donor organs
  5. Grasp the physiological changes after lung transplant
  6. Comprehend the ICU management in patients who have recently been transplanted.
  7. Understand the basics of immunosuppression, their adverse effects and interactions with other medications
  8. Recognize the common complications following lung transplantation
  9. Learn the risks, prevention and management of opportunistic infections after lung transplantation
  10. Master the risks, clinical presentation and management of acute cellular rejection.
  11. Appreciate the risks, clinical presentation and management of antibody mediated rejection.
  12. Grasp the risks, clinical presentation and management of Chronic Lung Allograft Dysfunction
  13. To understand outcomes and survival following transplantation.

Core Lung Transplantation Curriculum

The lung transplant fellow will be expected to complete a full academic year as the lung transplant fellow. The year will be broken down into the following rotations:

  • Transplant ICU rounds (3 months):The fellow is responsible for pre-rounding, gathering of data and formulating a plan. The fellow will be responsible for all procedures in the ICU and for daily check out to the Critical Care Medicine team extender at 6 pm.
  • Transplant floor rounds (3 months): The fellow is responsible for pre-rounding, gathering of data and formulating a plan. The fellow will be responsible for all procedures including outpatient bronchoscopies.
  • Participate in outpatient clinic (3 months):
    • Pre-transplant clinic. The fellow will staff the patients with the lung transplant attending and come up with a common assessment and plan.
    • Post-transplant clinic. The fellow will responsible for seeing the patients, staff the patients with the lung transplant attending and come up with a common assessment and plan.
  • Donor call (3 months overlapping with outpatient clinic months): The fellow will share call with the lung transplant attending and will learn more about donor selection, choice of increased risk donors, donor management prior to transplant and HLA mismatching.
  • Participate in selection committee meeting (MRB): Thursday 3-5pm; Zoom. This committee is responsible for deciding on the eligibility of patients with advanced lung disease for listing for lung transplantation. Fellows will be expected to present the patients that they have seen in outpatient clinic in full detail.
  • Research (1 month): The fellow is expected to participate in an outcomes research or a quality improvement project.  The fellow will be given one dedicated month towards research but is expected to be working on their research or quality improvement during the entire year.  The expectation is for at least one publication during this fellowship.
  • Electives (1 month): The fellow may select from any of the following electives:
    • Thoracic Pathology
    • Transplant Infectious Disease
    • Medical ICU rotation
    • Thoracic Radiology
    • HLA lab experience
    • Advance Lung Disease Rotation (ILD, CF, PAH)
  • Vacation (1 month)

Expected Procedures

  1. Bronchoscopy with BAL
  2. Transbronchial biopsies
  3.  Thoracentesis
  4. Pigtail/percutaneous chest tube placement
  5. Intubation
  6. Pleural ultrasound
  7. Central lines
  8. Arterial line

UNOS Certification

The fellow will be certified for UNOS by the end of their year rotation.  UNOS certification is required for any lung transplant doctor that would like to become medical director. The fellow should participate and keep logs of the following:  

  • The fellow should have participated in the primary care of 15 or more lung and/or heart/lung transplant patients from the time of their transplant.
  • Should be involved in the management of 15 or more lung transplant recipients in their first three months of the post-operative course.
  • Have been an observer in 3 or more lung or heart/lung procurement procedures This must be supported by a recipient log.