Fellowship Objectives

1. To learn the evaluation process of potential lung transplant candidates


2. Evaluation of potential lung transplant candidates
   • Types of advanced lung diseases for which transplantation is an option
   • Indications for bilateral vs. single vs. heart-lung transplant
   • Indications for transplantation
   • Contraindications to transplantation


3. Evaluation of the potential lung donor and observation of organ recovery at a donor hospital


4. Observation of lung transplant surgery


5. Bronchoscopy of lung transplant recipients and management of post transplant airway complications


6. In-house management of lung transplant recipients in the peri-operative period
   • Ventilator management of lung recipients
   • ECMO management
   • Hemodynamic management of lung recipients
   • Infectious disease prophylaxis
   • Diagnosis and management of acute allograft rejection
   • Immunosuppression


7. Outpatient management of lung transplant recipients
   • Outpatient monitoring of the lung allograft, inlcluding evaluation for acute cellular and antibody-mediated rejection
   • Diagnosis and management of acute allograft rejection including histopathological evaluation and grading
   • PFT interpretation in lung recipients
   • Outpatient immunosuppression management
   • Recognition and management of long-term complications including chronic rejection


8. To gain enough experience in above to earn UNOS certification
   • Primary and follow up care of at least 15 newly transplanted lung recipients (documented in a log with the date of transplant and patient’s UNOS number/EPIC MRN; the log must be signed off by the director of the training program)
   • Participate in the evaluation, the donation process and management of 3 multiple organ donors (who are donating a lung or heart/lung) (documented in a log)
   • Observe at least 3 lung or heart/lung procurements (documented in a log with a date that includes the date of procurement, location of the donor and UNOS donor ID)
   • Observe at least 3 lung transplants


9. Management of patients with pulmonary hypertension
   • Assessment and work-up of patients with pulmonary hypertension
   • Indications for the various available therapies and appropriate indications and use of the available oral therapies
   • Initiation and ongoing management of patients with continuous intravenous epoprostenol, treprostinil, SQ treprostinil and inhaled therapies
   • Observe/participate in performance of RHCs (maintain precedures in a log)
   • Experience in reading PH ECHOs
   • Participation in the monthly PH conference


10. Diagnosis and management of patients with interstitial lung disease
    • Participation in the multidisciplinary pathology conference
    • Assessment and work up of various ILD diseases
    • Initiation and ongoing management of patients on immunosuppresive and anti-fibrotic therapy


11. Diagnosis and management of patients with cystic fibrosis and non-CF bronchiectasis
    • Indication for genetic therapy
    • Treatment of chronic disease (both pulmonary and extra-pulmonary manifestations)
    • Management of acute exacerbation in the inpatient and outpatient setting