Transplant fellowship

Kim M. Olthoff, MD is the Donald Guthrie Professor of Surgery in the Division of Transplantation at Penn, Chief of the Division of Transplant Surgery at Penn, and the Vice Chair for Faculty for Development. She attended the University of Chicago Pritzker School of Medicine and completed a residency in general surgery at UCLA followed by a fellowship in transplantation and hepatobiliary surgery at the Dumont – UCLA Transplant Center and joined the faculty at Penn in 1995. Dr. Olthoff’s clinical practice focuses on adult and pediatric liver transplantation, living donor liver transplantation, and hepatobiliary surgery. She co-directs the multidisciplinary hepatobiliary tumor conference and the Liver Tumor Clinic at the Penn Transplant Institute and is the Surgical Director of the Liver Transplant Program at CHOP.

Dr. Olthoff is a Past-President for the American Society of Transplant Surgery and was previously the Chair of the Liver-intestine Committee and on the Board of Directors of the United Network for Organ Sharing (UNOS).

Dr. Olthoff’s research is focused on translational and clinical studies in liver regeneration, early allograft dysfunction, living donor transplantation, and transplant genomics. She has authored or coauthored over 250 original papers and book chapters.

Peter Abt, MD attended Brandeis University and received his medical degree at Dartmouth. He completed his general surgery residency at the University of Rochester in 2001 followed by a research and clinical fellowship in transplantation at the University of Pennsylvania. After fellowship he joined the faculty at the University of Rochester and was recruited back to Penn in 2007. Dr. Abt’s clinical practice focuses on adult and pediatric liver, kidney, and pancreas transplantation as well as living kidney and liver donation. In addition, he has an active practice in dialysis access and laparoscopic liver surgery.

Dr. Abt’s research interests primarily involve answering clinical questions related to transplantation through the use of national and regional data registries. Current investigations focus on understanding the benefit of kidney transplantation in non-renal transplant recipients and dual organ transplants. Ongoing translational studies address acute kidney injury in liver transplant recipients. Dr. Abt has authored or coauthored over 150 papers and book chapters, is an Associate Editor of the American Journal of Transplantation, and on the editorial boards of Liver Transplantation as well as Clinical Transplantation. Dr. Abt has served on various committees for the United Network of Organ Sharing (UNOS) as well as the American Society of Transplant Surgeons.

Samir Abu-Gazala, MD grew up in Jerusalem and graduated with honors from the Hebrew University Medical School in Jerusalem. He completed his general surgery residency at the Hadassah Medical Center in Jerusalem and the Icahn School of Medicine at The Mount Sinai Medical Center in New York. He completed his fellowship in abdominal organ transplantation at the University of Pennsylvania. Later, he returned to Jerusalem to join the liver and kidney transplant and HPB programs in Hadassah and later became the director of the liver transplant and HPB surgery. Dr Abu-Gazala joined the faculty at the University of Pennsylvania in 2021 in the Division of Transplantation.

Dr Abu-Gazala’s surgical focus is liver and kidney transplantation, laproscopic HPB and laparoscopic donor nephrectomy. His research interest involves liver transplant immunology, liver cancer, and endocrine changes after bariatric surgery. He authored and co-authored over 30 publications and book chapters and serves as a reviewer in Transplantation and Surgery of Obesity and Related Disease.

Kyle R. Jackson, MD, PhD received his medical degree from the University of Pittsburgh School of Medicine. He completed his general surgery residency at Johns Hopkins Hospital, where he simultaneously earned a PhD in Clinical Investigation from the Johns Hopkins Bloomberg School of Public Health. He completed his abdominal transplant surgery fellowship at Emory University Hospital and joined the faculty at the University of Pennsylvania in 2024. His clinical practice focuses on adult and pediatric kidney transplantation, pancreas transplantation, and laparoscopic kidney donation.

Dr. Jackson is also a Senior Scholar at the Penn Center for Clinical Epidemiology and Biostatistics. His primary research interest is in characterizing the impact of climate change and environmental pollutants on human health, with a particular focus on healthcare utilization and disease burden. His clinical practice has also led to a special interest in understanding how these environmental factors impact transplant patients, who are uniquely susceptible to these effects due to the profound immunomodulation necessary to facilitate successful transplantation as well as highly prevalent place-based vulnerabilities. He also uses national registry and claims-based datasets to solve clinically relevant problems in solid organ transplantation - such as identifying optimal transplant strategies for the immunologically high-risk, quantifying and improving equity and access to organ transplantation, and characterizing the clinical and financial impact of post-transplant complications.

Dr. Jackson has published over 50 manuscripts and given over 20 national and international talks. The quality of his research has been recognized by national and international awards from the American Transplant Congress, the American Association for the Study of Liver Disease, and the European Society of Organ Transplantation. He has received direct research support as a Principal Investigator from both foundational and federal sources, such as the NIH and the Doris Duke Foundation. He has also served as a fellow on the editorial board of the American Journal of Transplantation, and currently sits on the Transplant Informatics Workgroup of the American Society of Transplantation KPCOP.

Matthew Levine, MD, PhD attended Brown University, followed by a combined MD/PhD at Yale University, completing his PhD in immunobiology in the laboratory of Charles Janeway Jr., with work focusing on the discovery of positive selection events in the peripheral development of B cells. He then went on to general surgery residency at the Massachusetts General Hospital and a fellowship in abdominal organ transplantation at the University of California, San Francisco. He joined the faculty at the University of Pennsylvania in 2009. Dr. Levine is Surgical Director of the Transplant Center at Children’s Hospital of Philadelphia and Director of the Penn Multiorgan Transplant Surgery Fellowship. He is clinically active in liver and kidney transplantation in adults and children, pancreas transplantation, laparoscopic/robotic kidney donation, and is medical director of the limb transplantation (VCA) program at Penn.

Dr. Levine’s basic science research is focused on defining the role that histone deactylases (HDACs) and heat shock proteins (hsps) play in tolerance of renal ischemia-reperfusion as well as investigation that estrogens play in renal ischemia tolerance. Both of these projects have been supported by the NIH/NIDDK. This work has demonstrated significant renal function protection via HDAC inhibition by drug and by gene knockout. Additional directions of this work are defining the role that HDACs play in liver ischemia reperfusion injury and acetaminophen toxicity. Dr. Levine has initiated a Perioperative Estrogen in Renal Transplantation (PERT) clinical trial as an offshoot of these basic science efforts. Dr. Levine has collaborated with Wayne Hancock and Scott Levin of the Orthopedics program on several limb transplant related projects mitigating organ rejection and ischemia that have been funded by the Department of Defense. He is active in clinical research as well, with projects pertaining to liver transplantation for hepatocellular carcinoma and efficacy and utility of renal transplantation in certain clinical scenarios, particularly pediatric transplantation. He was named a “Rising Star in Transplantation” by the ASTS in 2018. He is a member of the American Society of Transplant Surgeons and is a councilor of its executive board as well as sitting on the ASTS Foundation Board and serves on the National Kidney Foundation Transplant Advisory Committee and on the NCCN Hepatobiliary Cancers panel. He is a deputy editor for the American Journal of Transplantation, Associate Editor for Current Opinion in Organ Transplantation, and an associate editor of Liver Transplantation.

After 16 years as Chief of the Transplant Surgery Division at Mass General Hospital, James F. Markmann MD, PhD rejoined Penn in December of 2023 as the VP Transplant Institute and VC Transplant in the Department of Surgery at the Hospital of the University of Pennsylvania. He specializes in liver, kidney, pancreas, and islet transplantation. Dr. Markmann completed his MD, PhD in Immunology, and surgical residency training at The University of Pennsylvania under Chairman Clyde F. Barker, after which he did a Transplant Surgery Fellowship at the University of California Los Angeles to specialize in liver transplantation. He is active in numerous societies, editorial boards and organizations and is Past President of the International Pancreas and Islet Transplant Association and will become President for the American Society of Transplant Surgeons in August of 2025. His research interests include immune tolerance by regulatory B cells, ex vivo organ perfusion, stem cell derived islet cell transplantation, immune tolerance, and xenotransplantation. He has published over 430 scientific papers over the last 30 years and has held continuous NIH funding for over 20 years.

Ali Naji, MD, PhD completed his clinical residency and fellowship training in general, vascular and transplantation surgery at the Hospital of the University of Pennsylvania in Philadelphia, where he also obtained his PhD in Immunology. He joined the faculty at Penn in 1981 and is currently the J. William White Professor of Surgery. He is the Director of the Penn Islet Transplantation Program, and Associate Director of the Institute for Diabetes, Obesity and Metabolism at the University of Pennsylvania School of Medicine.

Dr. Naji has had continuous NIH funding during his faculty tenure at Penn whose basic research efforts have focused on the immunobiology of transplantation and immune pathogenesis of autoimmune diabetes. His investigations were the first to demonstrate the critical role of recurrent anti-beta cell autoimmunity as a basis for the failure of islet transplantation for treatment of Type 1 diabetes mellitus (T1D). Most recently, his group's efforts have focused on the role of B lymphocytes in the pathogenesis of T1D and organ transplant rejection demonstrating the requisite role of B lymphocytes as antigen presenting cells in the pathogenesis of islet inflammation and immunologic rejection. Translation of his basic research in islet transplantation studies have demonstrated the efficacy of B lymphocyte targeting for the induction of islet allograft tolerance in diabetic non-human primates. Dr. Naji and his group are investigating the clinical efficacy of B lymphocyte directed immunotherapy as part of the cooperative NIH sponsored islet transplantation consortium. He has received numerous awards for his work in diabetes, and has served as chair of the Medical Science Advisory Board of the Juvenile Diabetes Research Foundation

Dr. Naji has published over 200 peer-reviewed manuscripts and served on numerous NIH study sections including Surgery/Anesthesia/ Trauma, Immunological Sciences and Transplantation/ Tolerance/Tumor Immunology. He is an associate editor for the journals Transplantation, Diabetes and Transplantation Immunology.

Ronald F. Parsons, MD is an Associate Professor of Surgery at the Penn Transplant Institute at the Perelman School of Medicine at the University of Pennsylvania. Over the past 15 years his research has focused on strategies to improve access to and outcomes after kidney, pancreas, and allo-/auto- islet transplantation. His basic science research investigates primarily humoral immunity, B-cell homeostasis, and transplant tolerance induction, as well as strategies to deplete plasma cells in pre-sensitized hosts. His passion of B-cell immunobiology has translated well into his current clinical investigations which are centered around novel desensitization strategies for highly sensitized candidates. His other clinical investigations involve optimizing patient readiness for transplantation, whether related to obesity, frailty, donor- related opportunities, or structural challenges that face disadvantaged patients. He serves as the Principal Investigator at Penn for several multi-center clinical trials and is the surgical director of kidney and pancreas transplantation at the Penn Transplant Institute. He strives for administrative, academic, and clinical excellence to improve outcomes for all patients.

Abraham Shaked, MD, PhD is the Eldridge L. Eliason professor of Surgery, and the Executive Director of the Penn Transplant Institute at the University of Pennsylvania. He completed his residency at Mount Sinai in New York and continued his clinical and scientific work at UCLA in Los Angeles. Dr. Shaked was recruited to direct the liver transplant program at the Hospital of the University of Pennsylvania (HUP) and the Children Hospital of Philadelphia (CHOP) in 1995. He is the past Chief of the Transplant Division, and currently the Director of the Penn Transplant Institute (PTI); a large center that provides the infrastructure for all thoracic, abdominal, and VCA clinical transplantation, performing over 500 solid organ transplants per year. Dr. Shaked is a past president of the American Society of Transplant Surgeons.

Dr. Shaked research interests are focused on investigating donor/recipient genetic interactions, and exploring omics biomarkers, in the setting of alloimmune activation, diagnosis of rejection, management of immunosuppression, and the long-term well-being of the recipient. We have established extensive biobank, storing donor and recipient specimens, that is linked to an electronic clinical database. Assayed and clinical data are shared with local and national investigators, resulting in productive scientific studies that contributing to better understanding of transplantation immunology, and improving patient management.

Fred Vyas, MBBS received his MBBS and post graduate training in General Surgery at Medical College Baroda, Vadodara, India. After completing his training, he joined Christian Medical College (CMC) in Vellore, India as a faculty in the department of General Surgery before transitioning to HPB Surgery. He completed his fellowship in Transplant Surgery at the Hospital of University of Pennsylvania and an additional pediatric and multi-visceral transplant at fellowship at Children’s Hospital of Pittsburgh.

Owing to service obligations with government of India and CMC Vellore, on completion of fellowship, Dr. Vyas returned back to CMC Vellore in Department of HPB Surgery and Liver Transplantation and assumed leadership of the department in December 2018, where he was responsible for expanding the liver transplant program by establishing the living donor and pediatric transplant programs, and was able to position the Department of HPB Surgery and Liver Transplantation as a Center of Excellence in India.

His areas of interest include liver transplantation, living donor liver transplants and pediatric transplantation as well as liver surgery and operations for hilar cholangiocarcinoma. He has authored or co-authored over 38 publications.

Requirements for Application:

The objective of our transplant surgery fellowship training program is to develop proficiency in the surgical and medical management of patients with end-stage organ diseases amenable to transplantation. We require that candidates for this training must have satisfactorily completed a surgical residency that satisfies the educational requirements for certification by the American Board of Surgery, the American Board of Urology, or foreign equivalency. Foreign candidates must have completed steps 1-3 of USMLE exams, obtained their ECFMG certificate, and have a J-1 or H1B visa that is valid for 2 years from the starting date of the fellowship.

Organization of the Transplant Fellowship Rotations:

The abdominal transplant fellowship at Penn is a 2-year fellowship that involves clinical rotations at the Hospital of the University of Pennsylvania (HUP) and the Children’s Hospital of Philadelphia (CHOP). Currently, there are 2-3 fellows at one time. The clinical fellows rotate every month between the liver, kidney/pancreas, and pediatric CHOP services. While on the pediatric rotation, they also cover donor organ procurements. During these rotations, the fellows cover all transplant procedures, manage patients in the intensive care units and the floor, see consults, and attend the pre-transplant and post-transplant clinics. The fellows gain experience in both recipient and living donor evaluations and patient selection. They acquire extensive knowledge in donor procurements, kidney, liver and pancreas transplantation, pediatric transplantation, and gain experience in living donor laparoscopic and robotic nephrectomy techniques, living donor and split liver transplantation, in-situ and ex-situ liver perfusion, and exposure to clinical islet cell transplantation. There is also a significant amount of non-transplant surgery that involves both the fellow and senior resident, such as vascular access, hepatobiliary procedures, and general surgery on transplant patients. The transplant fellow participates in, and eventually independently performs, procurements of liver, kidney and pancreas grafts. They are fully trained in donor management and the policies of the local organ procurement organization (Gift of Life) and UNOS and obtain experience and exposure to the Penn HLA lab.

Liver Rotation - covers all liver transplants, all hepatobilliary cases, perform all recipient operations when on first call or second call on weekends. The liver fellow will cover all liver pre-transplant evaluation and post-transplant clinics and hepatobiliary patients.

Kidney/Pancreas Rotation - covers all kidney and pancreas transplants, all access cases, performs all recipient (kidney and pancreas) operations when on first call on weekends. Covers kidney evaluation and post op clinics and access clinics. There is devoted time to rotation in the HLA lab.

Donor/CHOP Rotation - covers all pediatric kidney and liver transplants, access and hepatobiliary cases at CHOP. Performs all procurements during the week and when on second call on weekends. Split liver, pediatric, and DCD procurements will be covered by the second-year fellow with an attending. Assists with kidney and liver evaluation and post clinics.

Weekend and Primary Call - the primary fellow covering for the weekend will be responsible to round on both liver and kidney/pancreas patients, as well as the CHOP patients and the pre-txp patients on the hepatology service. They will assist with all transplants, as feasible, with second call fellow and senior resident available for backup and donors.

Service Call and Coverage: The fellows rotate on a monthly basis. The call schedule is established in 3-month blocks and distributed to the attending surgeons for approval prior to disbursement. The second-year fellows will begin the year on donor rotations to ensure the timely certification of the firstyear fellow for procurements. Adequate cross-coverage must be arranged between fellows at least one month prior to attending meetings, and before making travel arrangements.

The call schedule follows the recommendations of the ASTS for fellow work hours. There is a monthly schedule with rotating weekend coverage with a primary and secondary call fellow. Each fellow will have at least 1 weekend (Friday evening to Monday morning) free from call every third weekend, and 2 additional 24-hour periods off call in the month. Fellows have 28 days off for vacation and or meetings during the academic year. All fellows are allowed to attend national conferences, particularly if work is accepted for presentation. All second-year fellows are expected to attend the ASTS Fellows Symposium in the Fall if they are a “Fellow in Good Standing” and have completed all their operative logs.

Attending and Consultant Coverage and Interaction: The surgery attendings rotate on-service, usually 4-7 days in a row, with one covering kidney/pancreas at HUP, one covering kidney txp at CHOP, and one covering liver transplant at HUP and CHOP at any given time. Daily attending rounds are each afternoon for both kidney/pancreas and liver patients. The attendings and fellows for both Nephrology and Hepatology are very involved in both the pre and post clinics of our transplant patients, and the inpatient care, but it is the surgeons and transplant fellows who “run” the service, with the nephrologists, diabetologists, and hepatologists serving as consultants. There is frequent communication between the nephrologists and hepatologists and our transplant fellows to formulate a plan for those awaiting transplantation, and the management of the post-transplant patients. Immunosuppression management is done on inpatient rounds with the transplant surgery attendings, and via the transplant database as an outpatient, the day after post-transplant clinic.

Interaction with Transplant Coordinators, Nurse Practitioners, Physician Assistants: There is a full complement of inpatient transplant advanced practice providers that cover the service 7 days a week, 4 pre-transplant and 5 post-transplant liver coordinators, 5 pre-transplant and 4 post-transplant kidney coordinators, 4 living donor coordinators, 1 liver cancer coordinator and 4 pediatric coordinators (2 liver, 2 kidney). In addition, there are 4 surgical physician assistants who first assist on donor procurements, assist in the OR and see patients in the clinic. These coordinators/NPs/PAs are involved in a significant amount of the care and planning of our transplant patients and work sideby-side with our transplant fellows in the clinics, on the clinical transplant floor, in the ICU, and on call, to deal with day-to-day issues, transfers, emergency room visits, immunosuppression management, and follow-up with referring physicians.

Surgical Experience:

The transplant fellow’s surgical responsibilities grow as they accrue experience. The degree of responsibility depends on the fellow’s prior experience and the difficulty of the specific transplant. The goal of the fellowship is to train technically adept surgeons who are independently facile in the operative management of liver and kidney recipients. Fellows have extensive exposure to living donor kidney and liver transplantation.

Procurements are first performed with the assistance of the transplant attending or the senior fellow. Once the fellow has demonstrated significant expertise, and fulfilled the requirements of our local OPO, they perform the procurements independently with the assistance of our experienced Transplant Physican Assistant or the transplant surgical resident.

All procedures must be recorded on the ASTS case log which is reviewed regularly by the Program Director. We utilize the ASTS milestone evaluation forms to assess the fellow’s progress in the operating room and on the ward.

Transplant Conferences:

The fellowship begins with several days of orientation to the Department of Surgery, HUP, CHOP and the transplant service. Throughout the year, the Penn Transplant Institute has several weekly conferences, including The Penn Transplant Integrated Conference (PITC), kidney and liver patient selection committee meetings, a multidisciplinary hepatobiliary tumor conference, a transplant nephrology conference, GI/liver conference, weekly research conference, and a monthly vascular access conference. In addition, there are monthly patient review conferences at CHOP for both liver and kidney. There are also monthly CHOP Transplant Center conferences addressing all issues in pediatric solid organ transplant. There are regular pathology review sessions for both kidney and liver pathology. While there is no formal tissue typing conference, the HLA lab personnel participate in the regular transplant conferences and tissue typing is learned during the kidney transplant rotations.

The PITC includes invited speakers from inside Penn as well as outside invited experts, a monthly transplant morbidity and mortality conference, and quality metric review, and informal fellows’ educational meetings where administrative issues/concerns are discussed, and topics covered using the ASTS Academic Universe as a guide.

Research Experience:

The Penn Transplant Institute prides itself on being a program that is known for both excellence in clinical care and world-class research. We have extensive well-funded research programs in basic, translational, and clinical areas and have one of the highest funded transplant divisions in the country. We encourage our fellows to become involved in transplant-focused research while they are here. While there is no “protected” time for bench research during the 2-year clinical fellowship, there is ample opportunity to participate in clinical and translational research. The month of CHOP and donor coverage particularly can offer periods of time to perform clinical database focused research. There is significant infrastructure support for data collection, statistical analysis, IRB issues and manuscript review. Any research that is submitted and accepted for presentation is supported with travel funds to national meetings