Liver Transplant Division
About
The Liver Transplant Anesthesia Division provides specialty care to patients undergoing hepatobiliary as well as abdominal transplant surgeries. We aim to provide cutting edge clinical care for these patients, including the use of ERAS protocols, advanced monitoring techniques, continuous cardiac output PACs, and transthoracic & transesophageal echocardiography.
Our division is extensively involved in the education of residents. Several members of the group serve as members of the Residency Leadership Committee. Our faculty lead a biannual liver and coagulation teaching block and offer a liver transplant elective for our CA3 residents, visiting USN residents, and interested residents from other anesthesia residency programs. Please reach out to inquire about ways to rotate with our division.
A Message from the Division Chief
Welcome to the Division of Liver Transplant Anesthesia Web Page. We have a robust clinical practice of hepatobiliary surgery as well as abdominal transplant performing 70-100 livers, 150-200 kidneys, and approximately 20 pancreas transplants per year. We are actively involved in educational endeavors as well as clinical research projects to advance the education of our residents and the care of our patients.
Our Division
Katherine T. Forkin, MD
Katherine T. Forkin, MD, Liver Transplant Division Chief
Dr. Forkin is an Associate Professor of Anesthesiology at the University of Virginia. She specializes in the care of patients undergoing liver transplantation.
Dr. Forkin serves on the American Society of Anesthesiologists (ASA) Committees for Patient Blood Management, Transplant Anesthesia, and Women Anesthesiologists.
Read Dr. Forkin’s Full Bio
Link to Dr. Forkin’s Publications
Stephen R Collins, MD
Stephen R Collins, MD
Dr. Collins is an Associate Professor of Anesthesiology. He was born in Virginia and graduated from The College of William and Mary, and the University of Virginia SOM. He completed an internship at Yale New-Haven Hospital. He finished with an Anesthesiology Residency at UVA with specialty training in liver transplantation.
Dr. Collins is ABMS Certified in Anesthesiology and joined the UVA Faculty in 2010. His anesthesiology practice includes patients for general surgery, vascular surgery, and liver transplantation. At UVA, he serves as the Core Program Director of our ACGME Anesthesiology Residency.
Dr. Collins was awarded the annual Resident Faculty Teaching Award three times, the GME Master Educator Award, and is a member of the Academy of Distinguished Educators. He is a national board examiner for the American Board of Anesthesiology, and has served on the University of Virginia School of Medicine Admissions Committee.
Dr. Collins and his wife, an endocrinologist, live in Charlottesville with their two daughters. He greatly enjoys time with his family when away from the hospital.
Read Dr. Collins’ Full Bio
Link to Dr. Collins’ Publications
Amanda M. Kleiman, MD
Amanda M. Kleiman, MD
Dr. Kleiman is an Associate Professor of Anesthesiology at the University of Virginia. Her clinical interest/focus centers on caring for patients undergoing cardiothoracic and major vascular surgery as well as liver transplantation. Her research interests include improvement of the care of cardiothoracic surgical patients, echocardiography, and education research focusing on maximizing the quality of resident and medical student education.
Dr. Kleiman serves as an Assistant Program Director for our core Residency and is the Director of curriculum development, exam preparation. and assessment. She has grant funded research examining sleep disturbance following cardiac surgery and its relationship to delirium and dementia. Her particular education research interests include biases in education, the effect of stress, sleep, and wellness on resident training, and novel education/learning techniques. Outside of work, she enjoys being outside with her friends and golden retriever puppy.
Read Dr. Kleiman’s Full Bio
Link to Dr. Kleiman’s Publications
Eryn Thiele, MD
Eryn Thiele, MD
Eryn Thiele completed medical school at the University of Colorado and came to the University of Virginia to complete residency and serve as a chief in her final year. She completed a liver transplantation fellowship at UVA in 2021 and stayed on as faculty.
Dr. Thiele is passionate about resident and medical student education. She was awarded the annual Resident Faculty Teaching Award twice and serves as an Assistant Program Director for the core Residency and as well as the Director of our FAM (Foundations of Anesthesia) program and orientation training for our CA0/1s.
Outside of work, Dr. Thiele enjoys spending time with her husband and their two boys.
Resident Rotation
UVA performs all solid organ transplants except small bowel transplants, and residents get an early and extensive exposure to these complex and exciting cases. Beginning in the CA0 year, residents may participate in a living or deceased donor kidney transplant, of which we perform around 120 procedures per year. During the CA1 year, it is possible to complete liver transplants (70-80/year) which can be some of the most challenging anesthetics to perform due to the massive blood loss, metabolic derangements, arrhythmias, and fluid shifts.
Our CA2 and CA3 residents have more opportunity to participate in liver transplants, including a capstone CA3 liver transplant rotation where they cover all transplants which occur and solidify their management of these difficult cases. Additionally, residents have the opportunity to take care of heart transplant patients (about 30/year) and lung transplant cases (around 30-50/year and growing).
Most of our residents choose an elective transplant rotation during their final year of training.
The Growth of Our Clinical Volumes
See the chart below.
Liver Transplant Anesthesia Research:
- Completed enrollment of 40 liver transplant patients evaluating Quantra Q-stat (a new viscoelastic monitoring device) in comparison to results obtained from ROTEM as part of a multicenter trial (Forkin PI)
- Published key articles in premier anesthesia journals related to transplant anesthesia as well as other topics
- Several Resident Case Presentations at National Meetings (ASA, IARS, liver society meetings)
- Effects of CirQPOD Intrathoracic Pressure Regulation on Non-invasive Cardiac Output in Patients Undergoing Hepatic Resection
- Utility of Pre-operative Transthoracic Echocardiogram to Predict Day-of-Transplant Right Heart Hemodynamics
- Evaluation of the Clinical Performance of the Quantra System with the QStat Cartridge in Trauma and Liver Transplantation
Publications:
Forkin KT, Colquhoun DA, Nemergut EC, Huffmyer JL. “The coagulation profile of end-stage liver disease and considerations for intraoperative management.” Anesth Analg. 2018 Jan;126(1):46-61.
Walters SM, Richter EW, Lutzker T, Patel S, Vincent AN, Kleiman AM. “Perioperative Considerations Regarding Sex in Solid Organ Transplantation.” Anesthesiol Clin. 2020 Jun;38(2):297-310.
Leaders in state and national societies
- American Society of Anesthesiologists: Committee on Transplant Anesthesia
- DC/Maryland/Virginia Liver Transplant Anesthesiologists: Annual Meeting Planning Committee
- ERAS for Liver Transplantation (ERAS4OLT): Expert Working Group Panel Member, Coagulation & Transfusion
- A&A Editorial Board Membership