our divisions Emergency Medicine Human Anatomy General Surgery Bariatric Surgery Colon & Rectal Surgery Gastrointestinal Surgery Surgical Oncology Trauma & Critical Care Pediatric General Surgery Plastic & Reconstructive Surgery Multi-organ Transplantation Vascular Surgery

Each year the Stanford University transplant programs perform about 100 adult kidney, 25 pediatric kidney, 10-15 pancreas, 30 pediatric liver, 40-50 adult liver and 10 intestinal transplants.  Dr. Carlos Esquivel is the Chief of the Division of Transplantation Surgery and the Director of the Fellowship program. Other members of the transplant surgical faculty are Dr. Oscar Salvatierra, Dr. Stephan Busque, Dr. Maria Millan and Dr. C. Andrew Bonham and Dr. Waldo Concepcion.

The large clinical volume coupled with the academic environment and strong basic science at Stanford and the beautiful setting of Northern California make this Fellowship a premiere training program. We are dedicated to the idea that trainees of our program will be highly selected and will emerge from the program not only well trained in clinical transplantation but also scholars in transplantation ­ its history, immunology, and basic science underpinnings. The mission of the Stanford Transplant Fellowship is to train the future leaders in transplantation.

The clinical fellowship is two years in duration. At any given time there are two fellows, a junior and a senior fellow, respectively. This allows for much greater exposure for the fellow of all surgical aspects of transplantation. A third year spent in the research laboratory is optional but encouraged.

American Society of Transplant Surgeons (ASTS) has accredited fellowship programs since 1982. An American Board of Surgery accreditation in transplant surgery does not exist. The Stanford Fellowship Program is accredited for renal and liver transplantation since 1995 by the ASTS.

The clinical responsibilities of the Transplant Fellow include the participation in evaluation of all potential recipients and live donors. The Fellow will be called upon to meet with new patients usually with the attending surgeon and physician to discuss the proposed surgery and long-term process of transplantation. The Fellow will attend the presentation of candidates at the weekly transplant evaluation committee meetings. It is during these meetings that the difficult decisions regarding candidacy and pre-operative work-up are vigorously discussed.

The Fellow has a major role in the care of transplant recipients. All transplant recipients are cared for by the surgical team, which consists of transplant fellows, surgical residents, medical colleagues and transplant nurse coordinators. There are dedicated transplant social workers and dieticians. Twice daily rounds are multidisciplinary (including appropriate medical attending and fellow). Orders and decisions about immunosuppression are made by surgeons in concert with medical colleagues. Patients are admitted to the transplant service, cared for in the post-operative period by the surgical team and followed long-term in the outpatient clinic. Patients are re-admitted to the transplant surgery service except in cases of specific surgery (e.g., hip replacement) or other circumstances (e.g., acute myocardial infarct).

The Fellow will play a major role in the surgery and perioiperative care of the recipients. After a period of training as first assistant in the operating room, the Fellow will become the primary surgeon under the guidance of the attending surgeon. The Fellow will perform surgery ancillary to transplantation (e.g., hemodialysis access). In addition the Fellow will perform general surgery procedures related to transplantation and associated diseases (e.g., biliary tract reconstructions).

The Fellow will take part in the majority of organ procurements. This includes both living kidney donors (including laparoscopic donor nephrectomy) and deceased donor operations. After achieving proficiency, the fellow will become the primary surgeon with a 3rd year surgical resident as assistant. The fellow will also learn the techniques for live liver procurement, split liver transplantation and procurement of organs from donors after cardiac death.

The Fellow is to attend the following conferences: weekly Grand Rounds, Patient Selection, Patient Management, Liver Pathology, Journal Club, Transplant Research and monthly morbidity and mortality. The Fellow is given the opportunity to attend at least one transplant related meeting annually (such as the yearly meeting of the ASTS). Submission of scientific papers and presentation at transplant meetings is encouraged.

The Fellow is an important educational resource for the housestaff and medical students. Teaching of the housestaff and medical students is a major responsibility. The uncovering of pertinent literature regarding a specific problem is also considered the role of the Fellow.

At the conclusion of the clinical Fellowship, it is anticipated that the Fellow will have sufficient experience in all aspects of multi-organ transplantation to function independently as a proficient transplant surgeon.

In the third year, the Fellow will have the opportunity to carry out basic transplantation immunology research. This will be a combination of continued work in ongoing projects and the development of independent studies. The Fellow will participate in the writing of grants, the design of experiments, the presentation and analysis of data as well as the writing and publication of scientific data. Currently, the areas of interest in the transplant laboratory include the induction of tolerance, cytokine patterns in allograft rejection and vascular biology of transplantation. The laboratory effort runs the gamut from molecular biology, cellular immunology, small animal and primate models. It is also a major goal of the transplant fellowship at Stanford to provide the Fellow with the background to develop a solid foundation in transplant science through clinical and/or laboratory investigation.