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[Music]
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I would like to welcome you to the
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transplantation and hepatobiliary
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fellowship at the Ley hospital and
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Medical Center our liver transplant
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program is one of the most active
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programs in New England and one of the
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largest in the country last year we
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performed over 100 liver transplants
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seven of them were from living donors we
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also have an active kidney transplant
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program that offers both living and
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diseased donor kidney transplants we
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performed the first robotic kidney
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transplant in New England following in
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the long surgical tradition of Ley
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Pioneers our team offers extensive
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experience in complex liver bilary and
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pancreatic surgery this includes robotic
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and laparoscopic techniques as well as
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more traditional open surgery the
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transplant fellows are integral part of
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the multidisciplinary team and gain
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extensive experience in Pre and
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post-operative care of the transplant
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and hipodil patients transplant fellows
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gain Rich operative experience with
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large volume of cases and they gain
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independence as they advance in their
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training experience in pediatric liver
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transplantation in collaboration with
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Boston Children Hospital is available
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for those fellows who are interested in
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pediatric
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transplantation dactic teaching involves
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weekly fellows educational conference
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fellows are encouraged to engage in
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clinical research and our fellows have
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presented their data in National and
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international meetings what makes our
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program unique is the emphasis we place
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on training the future transplant and
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hepatobilary surgeons and the
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individualized mentoring that we provide
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to ensure that our graduates are
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competent surgeons more importantly our
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fellows are part of our family and are
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treated with dignity and respect we make
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sure that they enjoy their training in a
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collegial environment our program is one
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of the oldest transplant programs in the
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country established by Dr Roger Jenkins
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in the 1980s welcome to the Ley Clinic
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transplant program this is a program
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that is steeped in history beginning
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back in
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1983 when most of the team was down at
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what was then the Deaconess
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hospital and a team which later migrated
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to the Ley clinic in 1999 to form the
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team that is as assembled now this is a
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program that not only specializes in
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liver transplantation including an
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aggressive live donor liver transplant
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program but also kidney
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transplantation and the treatment of all
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diseases related to the liver my own
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road to this program is a little bit
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different than I would have anticipated
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ated many years ago uh back in the late
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'70s I was at the Deacon's hospital and
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I was in the general surgery program
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there and planning on becoming a cardiac
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surgeon but one day after doing an
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operation I was hijacked by the chief
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surgery drct William
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McDermot and he brought me up to his
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office and in a haze of cigar smoke
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asked me if I'd be willing to go spend a
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long weekend with Dr Tom starel out in
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Pittsburgh and see whether or not liver
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transplant Plantation might be something
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that we could bring back to what was
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then the Deacon's hospital I went out to
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Pittsburgh in late 1982 early 1983 and I
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worked with Dr Tom starzl and his team
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learning how to do liver transplants
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there were other people from three other
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hospitals in the Boston area that sent
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people out to work with the team
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intermittently but I lived out there
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with them I took call in the hospital I
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scrubbed on all the cases and I went out
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and did as many of the donor operations
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as I could I was really trying to get
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myself ready to come back and run a
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program from scratch we came back
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in mid
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1983 and the hospital in the meantime
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had assembled what we thought we needed
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to start doing liver transplants the
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only problem was that liver transplants
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at that point were not allowed in the
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state of Massachusetts nor were heart
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transplants we were ready however to to
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perform liver transplants and we had a
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patient um by the name of Richard who
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was dying in the Intensive Care Unit and
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really needed a liver transplant and the
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chief of surgery at the Deacon's
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hospital at that point Dr William
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McDermot Petition of the commissioner of
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health and we got permission to go ahead
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and do a single liver transplant
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operation we called the Oregon bank and
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listed this patient with the Oregan bank
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which was the first time it had really
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been done in the area for a liver and
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within 15 minutes we had a call that
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there was a donor organ available I
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called Dr Thomas starel out in
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Pittsburgh uh for some advice and to see
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if he might be able to lend a hand and
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not only did he lend a hand but he
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brought with him four other transplant
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surgeons who came to various phases of
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the operative procedure some of them
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assisting some of them watching and
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starel himself parti ipating in the
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donor
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operation We performed that operation
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and it went relatively flawlessly for
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first time event and we ended up with a
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patient who although still desperately
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sick was uh on his way to recovery and
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who actually lived for a couple of years
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after his liver transplant before dying
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from some infectious
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complications so we had a situation now
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where we had a whole team that had been
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trained a hospital that had invested
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large amounts of resources and Personnel
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to a transplant operation and we were
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able to successfully perform that
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transplant that was the start of the uh
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transplant process in the Boston area
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and as part of that since we had other
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surgeons in other hospitals that were
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interested in doing liver transplants we
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actually worked together in that day and
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age where we would help each other out
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in the operating room and I participated
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in a number of the other firsttime
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transplants in other hospitals trying to
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help the other
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surgeons um get through the donor
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operation or the recipient operation so
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that everybody could be successful and
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that process led to the development of
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what was later known as the Boston
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Center for liver
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transplantation where we performed all
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sorts of Cooperative research Ventures
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and operative procedures helping one
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another over the next decade or so the
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fellowship in
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transplantation
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began in the second or third year after
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we had started doing transplants as we
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had more and more people that were
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excited by the concept of liver
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transplantation the surgery that it
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involved the Immunology the research
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potential and um Rick rora was really
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although he came on board as an
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attending surgeon was really our first
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fellow
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and uh he went on to run the New England
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Medical Center transplant program uh a
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couple of years later and each year we
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began to have somebody that we would
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focus on to work very closely with us
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and who we could train over a couple of
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years to be ready to do liver
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transplants and go off and run programs
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on their own and through the years we
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have trained dozens of people that are
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now out running liver transplant
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programs around the country and in each
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and every case they've been very
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successful and in some cases have become
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the heads of hospitals never mind uh
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heads of liver transplant
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programs so it's been an exciting time
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and that mission to educate people into
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the whole field of liver transplantation
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and liver surgery in general has been
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one of our strongest drives within the
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program one of the things about liver
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transplantation uh that has
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changed Health Care overall in the
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Boston area and probably worldwide has
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been the fact that it requires
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excellence in all areas and that meant
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excellence in blood Banking and
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anesthesia and infectious disease and
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everything else so that when you develop
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a liver transplant program you actually
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have to develop excellence in all these
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other areas and so that was one of the
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things that we observed when we be began
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and continued to develop the program at
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the Deacon's hospital and it continued
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until after the merger of the uh
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Deacon's hospital with the Beth Israel
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system to form the Beth Israel Deacon's
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Hospital many of the major operations
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that were carried out through the Ley
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Clinic were done at the Deacon's
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hospital or the Baptist hospital and
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these were all hospitals where I had
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trained and I had worked with many Ley
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surgeons and in fact at one point during
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the early years of our program we had a
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combined program between deonis hospital
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and Ley Clinic where we were
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transplanting Ley Clinic patients as
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well as Deacon's patients so it seemed a
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natural thing for us to consider moving
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the program and we moved out to lehey
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clinic in spite of a number of options
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that were available at the time once we
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got to the lehey clinic we were able to
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continue that growth in the volume of
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transplantation and also bring on that
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excellence in all areas that we had
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noticed
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always came when a new liver transplant
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program was established in any Hospital
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the continued growth in hepatobilary and
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pancreatic surgery as well as the growth
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in
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transplantation
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were natural to be together and I've
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always felt strongly that you should
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become excellent in All Phases of liver
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surgery not just transplantation alone
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but in management of all of the things
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that surround the liver and since the
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biod and the pancreas are part of that
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whole process it's natural to assume
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that the surgeons that are good in
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transplantation are going to be good in
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uh the management of biliary and
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pancreatic disorders and it's also meant
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learning a lot about cancer which is an
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area that I've always had a considerable
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amount of interest in uh cancer is not
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as big an issue in the transplant world
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except for hepatocellular carcinoma but
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it certainly is in the uh field of
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biliary and pancreatic disorders so I
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think it's a a
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natural uh assumption that trainees that
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come to the program are going to learn
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not only about liver transplantation but
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they're going to learn about how to
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manage people with pancreatic disorders
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and biliary disorders in doing this over
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the past 40 years I've seen a number of
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changes that have continued to improve
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the care that we give to
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patients in the early days it was the
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use of genov venous bypass which allowed
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us to get a patient through an operative
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procedure when there was hemodynamic
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instability and risk of dying on the
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operating table anesthesia continued to
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get better as time wore on so that that
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became less of an issue and the
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development of techniques like piggyback
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liver techniques allowed us to jettison
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the potential risk of venovenous bypass
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and perform operations that were
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hemodynamically more stabilizing for the
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patient we developed the technique of
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live donor liver transplantation which
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allows us to offer transplantation to
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people that may not have any option of
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living long enough to get the cavic
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transplantation we've improved the
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ability to take out livers from
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heartbeating donors as well as brain de
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dead donors that allow us to have more
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organs available and the use of
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normothermic and hypothermic profusion
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continues to improve our ability to make
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organs available for the number of
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people that are waiting for
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transplantation we've improved our
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knowledge of Immunology recognizing
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acute rejection as well as chronic
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rejection and developing techniques of
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managing at such as
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plasmaferesis so there continue to be
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improvements at all levels in
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transplantation from all of the
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ancillary services that continue to make
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survival better and better so that where
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we were looking at survival rates of
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60% in the early 1980s we're now looking
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at survival rates of 95% today you as
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trainees will become part of the
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improving solution for patients as time
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goes on we try to improve the ability of
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our
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trainees both technically and from a
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cerebral level so that they can deliver
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the best care possible and so so they're
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starting at a much higher level than we
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were when we started so that they can
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continue to bring those improvements to
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a much higher level yet the Hallmark of
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our program is caring about the people
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so our major responsibility is to make
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certain that we support the patient and
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their family members as we're trying to
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find an organ for a transplant fix an
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injury to a bile duct take out a tumor
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of the pancreas and this is what we try
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to teach along with the technical
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aspects of liver transplantation or
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liver resection or biliary
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reconstruction I'm Keith bernes first
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year transplant HPB fellow I'm Andrew
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comr I'm the second year transplant and
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HPB fellow so the average day uh for a
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call transplant fellow uh involves um
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you know getting here in the morning
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looking at all the information for the
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patients that happened overnight um and
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then there's a a team of our physician
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assistants uh as well as our residents
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that round on all the floor patients and
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then we meet in the ICU and see all the
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ICU patients and then following that we
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round as a multi-disciplinary team it's
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transplant so you know uh we have to be
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very flexible and at any moment there
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could be a liver a kidney transplant um
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we do a fair amount of living donor
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liver as well as kidney transplants so
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that's sort of scheduled um we have you
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know various meetings so the average day
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is very different from day to day but
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that's generally what a call would do so
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I'm the first year fellow um and I've
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had just such an awesome experience here
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um when you choose
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transplant uh you know it's going to be
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hard uh and it is hard but just being
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able to be involved in the patients
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lives and being able on a daily basis to
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do such large cases and have such a
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large impact um has been an amazing
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thing and so why Ley um he has such a
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rich history uh in liver transplant and
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hepatopancreatic biliary surgery um it's
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sort of a no-brainer um and you never
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really know what you're going to get
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when you're on the other side of the
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camera when you're considering where to
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go but I am incredibly fortunate to have
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matched at this place both for the rich
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history the
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infrastructure the the
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multi-disciplinary team that we've
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amassed the people that you work with um
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really are not just colleagues they're
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friends and I've only really been here
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for you know 8 months um as the as the
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first year fellow um so I'm incredibly
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lucky to be here and the attendings um
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that are teaching us to be uh transplant
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surgeons uh take that as a badge of
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honor and really have a lot of pride in
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Ley that the product or the surgeon that
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they graduate um they want to be the
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best transplant surgeon they can be um
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and in doing that they really try and
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Mentor us and train us um in such a
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profound and special way you have to
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know going into a transplant Fellowship
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you're not signing up for a walk in the
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park uh sometimes the hours are very
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long sometimes the work is challenging
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we are uh taking care of very sick
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patients
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and uh it's important to recognize that
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from the beginning being able to see the
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very significant impact that we have on
00:16:59
our patients lives uh is a very strong
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motivator and it makes it a lot easier
00:17:06
to come to work every day and look
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forward to uh the work that we do
00:17:13
and uh
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seeing potentially the sickest patients
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in the hospital walk out on their own
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two feet a few weeks
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later um and nothing really comes close
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to that there's a lot that Ley has to
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offer in terms of training and and uh
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the fellowship program carries a very
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strong reputation for producing
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excellent transplant
00:17:37
surgeons and it's nice to be a part of
00:17:39
that and both to have that
00:17:42
responsibility and
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also uh the privilege of being a Ley
00:17:47
graduate that is something that I think
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a lot of us will appreciate a little bit
00:17:52
better down the line and it's not
00:17:54
something that you can necessarily see
00:17:55
in these short very busy two years but
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uh it's something that I think will pay
00:18:01
off and it's very much worth the time
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and the effort that goes
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into the training long hours um there's
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a lot of
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camaraderie if you're lucky enough to
00:18:14
have a co- fellow that you can tolerate
00:18:17
most days of the
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week um then you're uh you're set and
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it's
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uh it's it's a place that I think a lot
00:18:27
of the trainees residents and fellows
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included uh can form lifelong
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friendships and colleagues that they
00:18:35
can rely on and occasionally go out go
00:18:39
out for a bite to eat and uh enjoy a
00:18:43
fellow's conference once a week There's
00:18:45
a heavy focus on technical skills manual
00:18:48
dexterity how to handle a needle and how
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to be efficient in the
00:18:53
O uh there's a strong emphasis on the
00:18:57
fact that everything we do in the
00:18:58
operator room can potentially have a
00:18:59
lifelong effect for the patient and uh
00:19:04
that plays a significant role
00:19:06
and in our uh our operative
00:19:10
planning we also have uh a very strong
00:19:13
emphasis on peroperative
00:19:16
care uh especially in the ICU and taking
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care of very sick
00:19:21
patients uh after they get out of the
00:19:24
O we work closely with uh the
00:19:27
nephrologist and the hepatologists
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and uh they try to impart as much of
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their very vast knowledge into us in a a
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brief two years and they do a very good
00:19:39
job of
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it uh matching organs to recipients to
00:19:45
get the best outcomes is also a big part
00:19:46
of our training it's something
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that a lot of programs I think don't
00:19:51
focus on very heavily but uh it's
00:19:54
something that we have the opportunity
00:19:55
to develop here as fellows hi my name is
00:19:58
Ken I'm one of the transplant surgery
00:20:00
Pas here at Ley I've been here since
00:20:03
2021 to tell you a little bit about the
00:20:05
role myself as other Pas on the team we
00:20:08
are here to support you in any way that
00:20:10
we can we're here from early morning
00:20:13
rounds until the end of the day uh we
00:20:16
order um any sort of tests write notes
00:20:20
um answer pages and um really just try
00:20:23
and help with continuity of care since
00:20:25
our role doesn't really switch week to
00:20:27
week everybody on our team te is very
00:20:29
passionate we work super closely with
00:20:31
Pharmacy nutrition and Social Work hi my
00:20:33
name is Thomas mlof I'm the senior PA
00:20:35
here on the aail and Transplant surgical
00:20:37
service at L Hospital Medical Center
00:20:40
I've been here for 14 years and have
00:20:41
been a PA for a total of 24 years the PA
00:20:44
role here is to work in close proximity
00:20:46
with the fellows and residents to
00:20:49
provide a critical Link in the continue
00:20:51
of care and passing on clinical
00:20:53
information in an appropriate and
00:20:55
expeditious fashion as needed it's also
00:20:59
to be part of this multi-disciplinary
00:21:01
group and working as a team with
00:21:03
hepatologists nephrologists transplant
00:21:06
nutritionist transplant pharmacists
00:21:08
clinical coordinators physical therapist
00:21:10
the nursing staff and the case managers
00:21:15
[Music]
00:21:34
he
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[Music]
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[Applause]
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[Music]
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n
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[Music]
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[Applause]
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[Music]
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my name is Ashley Smith I am the
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clinical nurse leader here on six
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Central our inpatient medical surgical
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transplant unit I came to Ley in the
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year of March 2020 um I came as a
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critical care nurse um at Ley I really
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saw that they invested in my
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professional growth um through
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professional governance and nurse shared
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decision-making um so that welcomed me
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into my world of leadership um so
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Britney hoer U and myself work together
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as leadership team here in six Central I
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love Ley because we are exceptional
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nurses delivering extraordinary care it
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is a patient centered organization we
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have wonderful collaboration with our
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providers and we really enjoy caring for
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each and every one of our patients my
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favorite part about working at Ley is
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the teamwork and um the team atmosphere
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that we have here on six Central but in
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the organization we rely on all of our
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interdisciplinary colleagues to provide
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exceptional patient care we love all of
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our patients and I love that I have the
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best team that I can rely on in these
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hard times I work directly with our
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transplant population we on six Central
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see our transplant patients before and
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after transplant we get to build a
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rapport with them before their surgery
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and we get to meet their families and
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guide them through what this journey is
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going to look like they head to the
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surgical ICU after surgery and then they
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are back with us after trans plan and we
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really allow with the nurses and the
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Physicians and the teamwork that we have
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to create an amazing patient pathway so
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that they are safe on their journey home
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so I work as the clinical nurse leader
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very closely with our transplant fellows
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we work on projects as well as
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assessment of quality metrics um this
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current year our 2024 goal was the
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development of a transplant patient
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pathway and we have heavily involved our
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fellows and our nursing colleagues to
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band together to create a pathway that
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is best for our patients our fellows
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here are highly you know certified to
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trained Physicians they work really
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collaboratively with nursing we're very
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happy to have them our nurses love that
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they can bring them in and teach them
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something but that that they can also
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you know um be be a support for them in
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emergency situations or when you know
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when we need them the most our
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fellowship here is is so collaborative
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so interdisciplinary and we're grateful
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to have them here at Ley
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[Music]
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n
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[Music]
00:25:58
he
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[Applause]
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[Music]
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n
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[Music]
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[Applause]
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[Music]
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a fellowship is an opportunity and an
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honor it's an honor to take care of
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patients and give them the trust that
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they
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require but it's an opportunity also for
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fellows to develop their own interests
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along the way and continue to improve
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the whole product of liver
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transplantation and a patab bilary
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surgery I thank you for taking the time
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to look at our program and hope that you
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can share in the excitement that we all
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feel here in the field of
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transplantation at Ley Clinic thank you
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[Music]
