The field of anesthesia for abdominal organ transplantation is rapidly expanding as the need for liver, intestine, kidney, and pancreas transplants increases and the complexity of the patients eligible to undergo these operations continues to grow. Fellowship training in liver and abdominal transplant anesthesia immerses the trainee in the care of high-acuity patients before, during, and after they undergo high-risk abdominal organ transplantation, vascular, and hepatobiliary surgery. Additionally, with rotations and experience in echocardiography, transplant critical care, coagulation management, and blood banking, fellows can expect to leave training poised to become leaders in the perioperative care of acutely ill patients undergoing major abdominal surgery.

“I encourage residents with a genuine interest in anesthesia for organ transplantation to consider a career in the field, as caring for this patient population provides a unique route to a tremendously impactful and rewarding career as an anesthesiologist.”

The decision as to whether to pursue a fellowship is specific to an individual’s professional goals. I had an interest in practicing as a subspecialist at an academic medical center and enjoyed the team-based approach to patient care. As such, it was a natural choice to pursue a fellowship. I found anesthesia for transplant surgery to be particularly exciting because of the opportunity to participate in the care of very medically complex patients who oftentimes have a remarkable turnaround in quality of life after surgery. Additionally, with the constantly rising number of transplant cases and the expanding number of transplant centers nationally, the field of abdominal transplant anesthesia is growing rapidly, and the demand for anesthesiologists specifically trained to care for this unique patient population is considerable. While transplant centers historically tended to be located at academic medical centers predominantly in large metropolitan areas, it is becoming increasingly common to find transplant programs as part of private practice community hospitals.

I was an anesthesia resident at one of the highest-volume transplant centers in the country and elected to complete a two-month abdominal transplant rotation at the end of my second year of residency. On this rotation, I participated in several liver, multivisceral, pancreas, and kidney transplants. When not in transplant cases, I participated in complex hepatobiliary, surgical oncology, and vascular cases. Participation in this rotation was instrumental in my decision to pursue a liver transplant anesthesia fellowship. Even when a dedicated liver transplant rotation is not available during residency, I highly encourage current residents to seek out opportunities to engage in these cases early on, allowing time to consider it as a potential career path. Liver and multivisceral transplant operations provide exposure to great learning cases for anesthesia residents with significant hemodynamic implications and large-volume resuscitation in patients with complex medical problems. As abdominal transplantation continues to grow as a subspecialty, liver transplant cases will ideally become a required component of anesthesiology residency training programs.

Should you decide to pursue liver transplant anesthesia fellowship training, keep in mind that because these programs are not ACGME-accredited, the application process is not standardized. Each program accepts applications individually and conducts interviews according to their own timeline. Personally, I approached a few centers I was interested in and selected a program that matched my interests both clinically and geographically. I encourage interested residents to first review the websites of desirable programs and contact the fellowship program directors for specific application details. Additionally, I found it beneficial to speak with current fellows and recent graduates of the various fellowship programs to gain insight into their experiences as well as to grasp a sense of where graduates frequently practice following the fellowship.

Since the programs are not ACGME-accredited, the structure of the programs can be highly variable. I would recommend inquiring about the day-to-day role of the fellow, including the type and number of cases the fellow can expect to engage in, any role in teaching residents and/or medical students, participation on committees, elective rotations (ICU, TEE, blood bank, etc.), and opportunities to engage in research. Since transplant cases do not necessarily occur each day of the week, it is important to inquire about the type of cases or activities the fellow will engage in outside of transplantation and whether that will occur as a clinical fellow, as an attending anesthesiologist, or in a research capacity. Prospective applicants can find more information about the volume of transplant cases, average patient acuity, and outcomes of individual programs on the Scientific Registry of Transplant Recipients (SRTR) and Organ Procurement and Transplantation Network (OPTN) websites. Additionally, the Society for the Advancement of Transplant Anesthesia offers resources describing the various abdominal transplant anesthesia fellowship programs, recommended fellowship objectives, and a robust fellowship lecture series available to interested residents.

Overall, when considering subspecialty fellowship training in anesthesia, the field of transplant anesthesia offers an exciting opportunity to gain comprehensive exposure to the perioperative care of acutely ill patients undergoing large, life-saving operations. The increasing complexity of transplant candidates and the rapidly expanding number of patients requiring organ transplantation has created a strong demand for fellowship-trained transplant anesthesiologists nationally. I encourage residents with a genuine interest in anesthesia for organ transplantation to consider a career in the field, as caring for this patient population provides a unique route to a tremendously impactful and rewarding career as an anesthesiologist.