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For further details, please contact: Mr Ahmed Halawa, Course Director at ([email protected]) or Mr Ajay Sharma, Associate Director at ([email protected]).
University of Liverpool Postgraduate Certificate/Diploma/Master
Degree in Transplantation Science (60/120/180 credits)
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Contributors 1- Ahmed Halawa (Course Director)
Consultant Transplant Surgeon, Sheffield Teaching Hospital, UK
2- Ajay Sharma (Associate Director)
Consultant Transplant Surgeon, Liverpool University Hospital, UK
3- Julie Bridson-Walton
PGT Lead of Institute of Learning and Teaching, Programme
Director MSc Med. Sci., Postgraduate School of Medicine,
University of Liverpool.
4- Denise Prescott
CPD Lead of Institute of Learning and Teaching, University of
Liverpool.
5- William Mckane
Consultant Nephrologist, Sheffield Teaching Hospital, UK.
6- Aimun Ahmed
Consultant Nephrologist, Royal Preston Hospital, Lancashire
Teaching Hospitals, UK.
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7- Professor Derek Middleton
Director of HLA Laboratory Royal Liverpool University Hospital.
8- Professor David Talbot
Consultant Transplant and Hepatobiliary Surgeon,
Freeman Hospital, Newcastle upon Tyne, UK.
9- Professor Hussein Sheashaa
Professor of Nephrology and Transplantation, University of
Mansoura, Egypt.
10- Tim Key
Head of Histocompatibility and Immunogenetics Laboratory.
Sheffield Teaching Hospitals, Sheffield, UK.
11- Mohsen El Kosi
Consultant Nephrologist, Doncaster Royal Infirmary, Doncaster,
UK.
12- Andrew Raftery
Consultant Transplant Surgeon, Sheffield Teaching Hospital, UK.
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13- Veronica Lennon
Transplant Co-ordinator, Sheffield Teaching Hospital, UK.
12- Peter Brown
Consultant Radiologist, Sheffield Teaching Hospitals, UK.
14- Sanjay Sinha
Consultant Transplant Surgeon, Oxford University Hospital,
Oxford, UK.
15- Michael Schulz
Consultant Nephrologist, Liverpool University Hospitals, UK.
16- Howida Shawki
Consultant Histopathologist, Liverpool University Hospitals, UK.
17- Afshin Tavakoli
Consultant Transplant Surgeon, Manchester Royal Infirmary, UK.
18- Mohan Shenoy
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Consultant Paediatric Nephrologist, Manchester Royal Infirmary,
UK.
19- Roberto Cacciola
Consultant Transplant Surgeon, Bart’s' Health NHS Trust, UK.
20- Simon Curran
Consultant Nephrologist, Sheffield Teaching Hospital, UK.
21- David Lowe
Clinical Scientist, Transplant Immunology, Royal Liverpool
University Hospital, UK.
22- Arif Khwaja
Consultant Nephrologist, Sheffield Teaching Hospital, UK.
23- Mustafa Al Mousawi
Consultant Surgeon, Organ Transplantation Centre, Kuwait.
24- Tarek S H Mahmoud
Consultant Nephrologist, Organ Transplantation Centre, Kuwait.
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Aims and Objectives
The University of Liverpool has recently launched a suite of 4 modules related to
transplantation sciences for transplant surgeons, nephrologists and urologists.
Experience in these subspecialties is essential. These modules are offered wholly
online study using an interactive electronic platform, which produces a high quality
interface for learning and teaching through interactive keynote lectures, discussion
board and journal clubs. Each module is 30 credits at Master level. Master Degree is
awarded after successful completion of all 4 modules and dissertation. English
Language Exam is NOT required for those who studied medicine in English.
The course is designed to deliver up-to-date knowledge and evidence based clinical
experience in transplantation. It focuses on renal (adult and paediatric) and pancreatic
transplantation. The course is not a substitute for practical training in the field of
transplantation, but it enhances the training and boosts the gained clinical experience
of the transplant clinicians by providing reflective leaning.
The course is delivered by experienced transplant clinicians from different UK and
reputable overseas transplant centres to enhance the exposure of the candidates to
different clinical experience and practice. The education is delivered in the form of
online lectures, case discussion, critical appraisal of scientific papers and problem
solving exercises. Clinical scenarios and real-life practical experience are discussed
online by senior transplant clinicians. The lectures are delivered as 100%
asynchronous approach to overcome the time zone difference and to facilitate
engagement.
This higher degree emphasizes the practical implementation of transplantation science
and fosters analysis, questioning and reasoning of the current practice, and compares
it with the current best available scientific evidence. The candidates will be
encouraged to formalize a treatment plant for routine, difficult and complex clinical
cases. E-library provides key scientific papers and textbooks covering different topics
in transplantation and also a list of suggested readings.
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Assessment
Candidates have to submit 3 formative assessments per each module in the form of
coursework, reflective essay questions and case scenarios. Formative assessment is
known to drive learning, enriches the teaching process and it has a long lasting
educational outcome. Employing a variety of assessment strategies negates the
drawbacks of each other and adds strength to the assessment process. The assessment
is supervised by senior clinicians in the relevant fields to ensure achieving the planned
learning objectives and to direct education.
Re-sit
One resubmission of any unsatisfactory assignment is allowed normally within 3
months of the date of the board of examiners at which marks were ratified.
Degree
Certificate in Transplantation Science (60 credits) is awarded (University of
Liverpool) after successful completion of module 1 and module 2 (26 weeks per
module) Diploma in Transplantation Science (University of Liverpool) is awarded
after successful completion of the four modules (120 credits). Candidates applying for
the master degree (MSc) have to submit (online) a dissertation (60 credits) before the
end of the third academic year. The dissertation (one12000 words or 2 x 6000 words)
is marked by two independent tutors according to the University of Liverpool
regulations. The candidate can start preparing the dissertation after successful
completion of module 2. Candidates applying for the master degree will be taught a
mandatory short module on ACADEMIC WRITING, PLAGIARISM and CRITICAL
APPRIASAL OF SCIENTIFIC PAPERS delivered by experienced university staff
with no pass/fail marking of this module.
Syllabus
Four modules and dissertation are taught over 3 academic years. Each module teaches
essential steps in the patient’s journey through transplantation. Successful completion
of all modules is mandatory for awarding the diploma (module 1&2 for the Certificate
in Transplantation Science). Each module is taught by experienced tutors in the
relevant subspecialties. Formative assessments (3 per each module) are submitted
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DURING and/or AT THE END of each module and marked by the course tutors
according the University of Liverpool regulations.
Module 1 (Code MDSC175) (16 lectures) The syllabus will focus on the complex issues of Chronic Kidney Disease (CKD) and
various renal replacement modalities in relation to the transplantation options. Also
transplant immunology, introduction to tissue typing and cross matching are taught as
foundation in this module to underpin the advanced clinical acumen for dealing with
immunosuppression and the immunology of rejection. Ethical issues are complex in
transplantation science and therefore medical ethics will be a theme which runs
through all the transplantation science modules and explored in depth and in more
details in module 4.
1. History of Transplantation (Andrew Raftery) (One lecture)
2. Chronic Kidney Disease (Michael Schulz/Ahmed Halawa) (3 lectures)
a. Epidemiology of ESRD
b. Stages of ESRD
c. Estimation of GFR
d. Treatment options
i- Haemodialysis
ii- Peritoneal dialysis
iii- Transplantation
e. Patient Survival
f. Quality of life
g. Cost of treatment
3. Immunology of Graft Rejection (Tim Key and David Lowe) (2 lectures)
a. Major histocompatibility complex
i. Structure and function of HLA
ii. Linkage disequilibrium
iii. HLA match and mismatch
iv. Definition of haplotype and phenotype
v. Identical and fraternal twins
b. Minor histocompatibility complex
c. Pathway of alloantigen presentation
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i. Direct antigen recognition
ii. Indirect antigen recognition
d. Role of graft injury in alloresponse
h. Innate versus adaptive immunity
i. Lymphocyte activation
i. T Lymphocyte
ii. T-Cell co-stimulation
iii. B Lymphocyte
h. Effector mechanism of graft injury
j. Tolerance
4. Histocompatibility and Immunogenetics (Derek Middleton) (2 lectures)
a. HLA typing
i. Microcytotoxicity test
ii. DNA typing
b. Identification of HLA specific antibodies
i. Complement-dependent cytotoxicity (CDC)
ii. Augmented cytotoxicity
iii. Flow Cytometry (FCXM)
iv. Solid-phase assay
v. Panel reactive antibodies (PRA)
vi. Calculated reaction frequency (CRF)
vii. Unacceptable antigens
c. Crossmatching
i. Flow cytometry crossmatch (FCXM)
ii. Complement-dependent cytotoxicity (CDC)
iii. Autoantibodies and positive cross match
5. Immunosuppression and Protocols (Ajay Sharma, Ahmed Halawa, H
Sheashaa and Will McKane) (8 lectures)
a. Maintenance Immunosuppression (Ajay Sharma)
• Calcineurin inhibitors (Cyclosporine and Tacrolimus)
• Antimetabolites (Azathioprine and Mycophenolate Mofetil
• mTOR inhibitors (Sirolimus and Everolimus)
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• Corticosteroids
b. Induction therapy (Ahmed Halawa)
• Anti-CD 25 monoclonal antibodies
• Thymoglobulin
• OKT3
• Alemtuzumab
• Intravenous immunoglobulin
• Rituximab
c. Novel Immunosuppression (Ahmed Halawa)
• Belatacept
• Bortezomib
• Eculizumab
• Other novel immunosuppressive drugs
d. Allograft rejection (H Sheashaa)
• Acute cell-mediated rejection
i- Acute cellular rejection
ii- Acute vascular rejection
• Acute antibody-mediated rejection
• Chronic antibody-mediated rejection
e. Highly sensitised patients (Will McKane)
f. ABO incompatible renal transplantation (Will McKane)
g. Renal transplantation across positive cross-match (David Lowe)
h. Pregnancy and transplantation (Will McKane)
Module 2 (Code MDSC174) (19 lectures)
Objectives: This module teaches detailed recipient work up from different
perspectives (medical, immunological and surgical). Detailed donor (living
and deceased) work up and organ retrieval process are discussed with great
emphasis on the donor selection criteria and understanding the new
approaches in organ allocation (paired and altruistic donation). Organ
allocation and preservation is addressed in this module with analysis of current
evidence. Transplantation of marginal kidneys is explianed in details
addressing the factors associated with adverse graft outcome. Paediatric
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transplantation is explored with emphasis on the current UK practice. The
transplant operation with its post-operative complication is demonstraed. The
candidates are taught the different approaches of the management of these
complications and how to differentiate between the medical and surgical
complications in the early and late postoperative period.
1. Recipient Work up (Aimun Ahmed) (3 lectures)
• Patient selection criteria
• Cardiovascular system
• Respiratory system
• Cerebrovascular disease
• Peripheral vascular disease
• Malignancy
• Infection
• Coagulopathy
• Gastrointestinal disease
• Urological evaluation
• Obesity
• Diabetes Mellitus
• Management of patients on the waiting list
• Non-adherence
2. Living Donation (Reberto Cacciola) (3 lectures)
• Living donor work up
i- Donor selection criteria
ii- Psychological evaluation
iii- Cardiovascular assessment
iv- Hypertension
v- Diabetes Mellitus
vi- Obesity
vii- Laboratory investigation
viii- Assessment of renal function
ix- Imaging
• Open donor nephrectomy
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• Laparoscopic donor nephrectomy
• Long-term postnephrectomy outcome
• Paired (chain) donation
• Altruistic donation
3. Deceased Donors (David Talbot) (4 lectures)
• Donation after brain stem death
• Donation after cardiac death
• Expanded criteria donor
• Multiorgan retrieval
• Kidney preservation
i- Principles of cold storage preservation
ii- Perfusion fluids
iii- Hypothermic and normothermic machine perfusion
• Deceased donor kidney allocation
4. The Renal Transplant Operation and Post-transplant Complications
(Mustafa Al Mousawi/Tarek Said) (4 lecture)
• First transplantation and re-transplantation (second, third and fourth
Tx)
• Postoperative management
i- First 3 months
ii- Long-term management
• Medical complications
• Surgical complications
5. Kidney Transplantation in Children (Afshin Tavakoli/ Mohan
Shenoy) (4 lectures)
• Epidemiology of CKD in children
• Access to transplantation
• Timing of transplantation
• Prognostic factors influencing graft survival
• HLA matching in children
• Evaluation of renal transplant donor and recipient
• Perioperative management and transplant operation
• Immunosuppression and management of graft dysfunction
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• Recurrence of the original disease
• Long-term management
• Non-adherence
6. Peri-operative fluid management in Renal Transplantation
(Ahmed Halawa) (1 lecture)
• Principles of fluid therapy
• Preoperative fluid status
• Intraoperative fluid management and monitoring
• Postoperative fluid management
• Urinary catheter and ureteric stent
Module 3 (Code MDSC176) (15 lectures)
Objectives: This module deals with the common bacterial and viral infection
complications affecting renal transplant recipients, the various treatment
options and the long term outcome. Also tropical infection is addressed in this
module. Post-transplant malignancy is discussed in detail, the surveillance,
and the various treatment modalities supported by the best available evidence.
Renal osteodystrophy and hyperthyroidism with emphasis on renal
hyperthyroidism are discussed with analysis of the current practice against the
best available evidence.
1. Post-transplant Malignancy and Surveillance (Ahmed Halawa) (3
lectures)
• Epidemiology
• Skin cancer
• PTLD
• Other malignancies
2. Post-transplant Infection complications (Aimun Ahmed) (3 lectures)
• Bacterial infection
• Viral infection
i. CMV
ii. BK
iii. Norovirus
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iv. Other viral infection
3. Kidney Transplantation in Patients with Viral Hepatitis
(Ahmed Halawa) (2 lectures)
• HBV
• HCV
• Other hepatitis viral infection
4. Kidney Transplantation and HIV (Ahmed Halawa) (One lecture)
• HIV-associated nephritis (HIVAN)
• HIV positive recipients
5. Tropical Transplantation (H Sheashaa) (3 lectures)
• Parasitic infestation (protozoa and helminths) with emphasis on
Schistosomiasis
• Bird flue and swine flue
• Mycobacterium (TB and atypical mycobacterium)
• Fungal infection
6. Surgical and Medical Aspects of CKD-BMD post-transplantation
(M El Kosi and Ahmed Halawa) (3 lectures)
• CKD-Bone Mineral Disease post-transplantation
• Primary HPT in renal/transplant patients
• Secondary HPT
• Tertiary HPT
Module 4 (Code MDSC177) (17 lectures)
Objectives: This module explores pancreatic transplantation, combined kidney
and other organ transplantation with emphasis on the outcome of the other
forms of transplantation on kidney transplantation. Chronic graft loss, the
diagnosis and the available treatment options are explained in great details
with analysis of the current practise against the best available evidence.
Histology of the various pathological conditions affecting kidney
transplantation is addressed briefly with reference to the clinical presentation
and the various diagnostic modalities. A brief introduction to the transplant
radiology is presented in this module with emphasis on the choice of the best
diagnostic modality, the sensitivity and specificity of each diagnostic
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approach. Finally the ethics of transplantation is discussed with reference to
the recent British and international guidelines.
1. Pancreatic Transplantation (Sanjay Sinha) (3 lectures)
• Diabetic nephropathy
• Evaluation of pancreatic transplant recipient
• Donor selection and organ retrieval
• Pancreatic transplantation (PA, SPK & PAK)
• Enteric versus bladder drainage
• Postoperative complications
• Management of acute and chronic graft dysfunction
• Long-term follow up
• Pancreas allocation
• Pancreatic islets transplantation
2. Combined Kidney and Other Organ Transplantation (David Talbot)
(One lecture)
• Kidney and liver transplantation
• Kidney after other organ transplantation
3. Chronic Deterioration of Kidney Function
(Simon Curran and Mohsen El Kosi) (3 lectures)
• Chronic allograft dysfunction
• Recurrence of original disease and de novo nephritis
4. Pathology of renal transplantation (Howida Shawki) (2 lectures)
• Acute tubular necrosis
• Acute cellular rejection
• Acute antibody mediated rejection
• Banff classification
• Differential diagnosis of acute rejection
• CNI toxicity
• Chronic allograft nephropathy and chronic antibody mediated
rejection
• Recurrence of original disease
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• CMV and BKV infection
5. Transplant Kidney Biopsy (Aimun Ahmed) (One lecture)
6. Imaging in Kidney Transplantation (Peter Brown) (2 lectures)
• Nuclear Medicine Imaging and estimation of the GFR
• Post-transplant follow up
i. Acute tubular necrosis
ii. Acute rejection
iii. Urological Complications (urine leak and obstruction)
iv. Lymphocele
v. Vascular Complications (perinephric haematoma, renal
artery stenosis, vascular thrombosis, anastomotic aneurysm
and arterio-venous fistula)
7. Ethics of Transplantation
(Andrew Raftery/Veronica Lennon) (2 lectures)
• Determination of death
• Ethical issues in allocation of deceased donor organs
• Ethical issues in living transplantation
• Ethical issues in paediatric transplantation
• Commercial transplantation and coercion.
