A field-defining shortage, an intellectually demanding specialty, and a training path that begins earlier than most students realize. This guide walks you through every stage — from MS1 to fellowship — with the information you need to build a career in hepatology and transplant medicine.
Why Hepatology?
62%
ACGME transplant hepatology fellowship positions unfilled in 2023
35%
Projected shortage of hepatology providers by 2033
777
Transplant hepatologists caring for over 106,000 transplant recipients in the US (ABIM, 2025)
Hepatology is one of the most intellectually demanding, procedurally rich, and socially impactful fields in medicine. Transplant hepatologists sit at the intersection of chronic disease management, acute critical illness, surgical interventions, and transplant immunology — caring for patients from diagnosis through the transplant evaluation, the operation, and years of post-transplant follow-up.
The shortage is structural, not incidental. It reflects years of underexposure at the medical school level. LIMES™ was built to change that pipeline from the beginning.
Select your current stage to see what to prioritize now.
Build the Foundation
The habits and connections you build in the first two years shape what rotations you seek, future mentors, and how competitive your application looks by MS4.
Complete the LIMES™ curriculum — all 23 topics across 6 domains
Join AASLD and AST as a student member (under $30/year combined — the most cost-effective investment in this list)
If hepatologists are at your institution: attend hepatology grand rounds, reach out to faculty for an observership, join them in clinic
If no hepatologists at your institution: work with GI faculty who can direct you to their hepatology referral network
Consider reaching out about a summer research project — even a retrospective chart review builds your CV and gets your name in the department
Building toward:
A hepatology-focused elective in MS3 or MS4
A research project suitable for abstract submission (see the Calendar page for deadlines)
An understanding of what transplant hepatology involves day-to-day
Gain Clinical Exposure and Demonstrate Interest
The third and fourth years are when your interest becomes visible. Rotations, research output, and mentor relationships are the primary currency.
Pursue a hepatology or GI elective in MS3 or MS4 — ideally at a transplant center
Consider a sub-internship or away rotation at a liver transplant program if strongly interested
Submit an abstract to AASLD, ATC, or ACG — even a case report or QI abstract counts
Apply for AST LICOP or TYFCOP travel grants to attend ATC — no abstract required for TYFCOP
Solidify a letter of recommendation from a hepatologist or transplant physician for your residency application
Residency programs in internal medicine respond well to a demonstrated subspecialty interest — it signals focus, not limitation. Frame hepatology as your long-term destination while emphasizing that internal medicine is the foundation every subspecialist needs.
Internal Medicine Residency — Maintain Momentum
Residency is not a holding pattern — it is where you build the clinical core and maintain visibility in hepatology.
Seek hepatology consult service rotations whenever available
Identify a hepatology or GI research mentor at your institution early in intern year
GI fellowships are very competitive and successful applicants often have multiple poster presentations, publications, and volunteer experience
Join AASLD and/or AST and attend at least one national meeting — the Liver Meeting or ATC
Consider the AASLD Emerging Liver Scholars Program (residents with research interest in hepatology)
Identify programs offering the combined GI/TH pathway before fellowship applications if that is your goal
Apply for GI fellowship in early PGY-3 year through ERAS — mention transplant hepatology explicitly in your personal statement
GI Fellowship — Choose Your Pathway
GI fellowship is where your path to board certification in transplant hepatology formally begins. Two ACGME-recognized routes exist from here — see the Pathways section below.
Express interest in hepatology to your GI program director early in fellowship (within the first 6 months)
Continue with research productivity during GI fellowship
Apply for the 4th-year ACGME TH fellowship during PGY-2 year of GI fellowship (applications open January–March, match in May), unless you are already in a dual-accredited path
Attend The Liver Meeting when possible — use AASLD member discounts and student/trainee programs
ACGME Training Pathways
ACGME Training Pathways
Two ACGME-accredited routes lead to board certification in transplant hepatology.
Pathway A — Transplant Hepatology After GI ("The Fourth Year")
Complete a standard 3-year ACGME-accredited GI fellowship, then apply separately for a 1-year ACGME-accredited Transplant Hepatology Fellowship. Total: 4 years of fellowship after IM residency (7 years post-residency including IM).
ACGME Requirements for the TH Fellowship Year
Completion of 3-year ACGME GI fellowship required for entry
~80% of the year devoted to clinical activities
Required rotations: inpatient hepatology ward and consult service, outpatient transplant hepatology and general hepatology clinics, liver pathology, liver radiology (CT/MRI, tumor boards), pediatric hepatology (at many programs), multidisciplinary liver transplant evaluation clinics
Fellows must achieve UNOS competency: perioperative care of ≥20 liver transplant patients at a UNOS-approved center
Scholarly activity: at least one project suitable for abstract or manuscript submission
Application Process
Applications submitted through the AASLD Transplant Hepatology Fellowship Application System (aasldapp.org)
Application window: January–March of the year prior to start (apply in 2026 for July 2027 start)
Interviews: March–April
Match Day: May
Apply during PGY-2 year of GI fellowship
Best Suited For
Trainees interested in academic hepatology
Those planning significant research or an advanced degree during GI fellowship
Those wanting flexibility to train at a different institution for TH
Trainees who want more time to develop GI competency before specializing
Pathway B — Dual GI/TH Combined Certification
Integrated training in both gastroenterology and transplant hepatology over 3 total years at a single institution holding both ACGME-accredited GI and TH programs. Saves one year compared to the standard pathway.
ABIM Requirements for Dual Certification (as of 2019)
Minimum 3 years of accredited combined training
≥18 months of clinical training in gastroenterology
≥12 months of clinical training in transplant hepatology
All training must be completed at a single institution
Continuity outpatient clinic maintained throughout all 3 years
Must complete all 3 years before sitting for the GI certification exam
Upon completion: eligible for both GI board certification and TH board certification
How to Pursue This Pathway
Identify GI fellowship programs offering the dual GI/TH pathway before applying for GI fellowship
Ask explicitly during GI fellowship interviews
Express interest to your GI program director during first year of GI fellowship
Not all ACGME-accredited TH programs offer the dual pathway — check the AASLD program directory
Best Suited For
Trainees with a clear, established clinical hepatology interest
Those who prefer shorter total training duration
Those who want to enter the hepatology workforce earlier
Trainees confident they don't need a full separate GI year before specializing
Non-ACGME Programs
Non-ACGME Hepatology Fellowship Options
Non-ACGME hepatology fellowships provide clinical training in liver disease but do not qualify graduates to sit for the ABIM Transplant Hepatology Certification Examination. They do not confer board eligibility in transplant hepatology. Understand this distinction before applying.
Despite this, non-ACGME fellowships can serve important purposes and remain active at several institutions.
Who These Programs Are For
IM-trained physicians (without GI fellowship) seeking clinical hepatology exposure
International medical graduates seeking US hepatology experience
Trainees wanting to strengthen their GI fellowship application
Trainees interested in hepatology-focused clinical positions in non-transplant settings
Researchers pursuing a dedicated hepatology research year (e.g., NIH)
Program
Duration
Focus
Notes
NIH / NIDDK (Bethesda, MD)
2–3 years
Clinical + research
Prestigious research-focused program; prior fellows have made landmark contributions to hepatology; 1–2 positions/year
Temple University (Philadelphia, PA)
1 year
Inpatient + outpatient general and transplant hepatology
3 months inpatient, 9 months outpatient; strong transplant exposure; does not sponsor J-1
Loyola University Medical Center (Maywood, IL)
1 year
Outpatient-focused general hepatology
Active transplant center (~60 LTs/year); clinical instructor role
University of Missouri
1 year
Inpatient + outpatient; sponsored rotation at Wash U
Good for IM-trained applicants; suited for those building toward GI fellowship
Carolinas Medical Center / Atrium Health (Charlotte, NC)
1 year
Clinical + research
25% research time; IRB project expected; competitive for GI fellowship track
UNMC
1 year
General and transplant hepatology
Requires completion of IM residency only (not GI fellowship); ACGME pathway also available for GI-trained applicants
Program availability changes year to year. Always verify directly with the program coordinator before applying. Some programs accept applications outside ERAS; many have December–February application windows.
NIH NIDDK Program — Special Note
The NIDDK Hepatology Fellowship is a 2–3 year combined clinical and research fellowship with a long tradition of training academic hepatologists. Prior fellows have made foundational contributions to viral hepatitis, liver fibrosis, and MASLD research. Best suited for trainees with a strong research interest who are willing to commit to an academic career. Applications reviewed on a rolling basis.
The Role
What Does a Transplant Hepatologist Do?
A common question for students who have never been on a liver service. The scope varies by practice setting, but across most academic programs:
Post-transplant care — immunosuppression management, rejection surveillance, long-term complications
General hepatology — MASLD, ALD, viral hepatitis, autoimmune liver diseases
Onco-hepatology — manage patients with cholangiocarcinoma, hepatocellular carcinoma, isolated colorectal mets to the liver
Procedures (varies by program)
Paracentesis
Liver biopsy (percutaneous)
Endoscopies including upper endoscopies and colonoscopies
Research & Education
Most academic transplant hepatologists carry an active research portfolio
Teaching responsibilities for medical students, residents, and GI fellows
Society involvement (AASLD, AST) — guideline writing, task forces, committee members
References
References
Kobashigawa, J., Levitsky, J., Taber, D., Morin, L., Blumberg, E., Hricik, D., & Hartwig, M. (2025). AST Task Force Report on the state of transplant medicine education. American Journal of Transplantation. https://doi.org/10.1016/j.ajt.2024.10.006
Asrani, S. K., Devarbhavi, H., Eaton, J., & Kamath, P. S. (2019). Burden of liver diseases in the world. Journal of Hepatology, 70(1), 151–171. https://doi.org/10.1016/j.jhep.2018.09.014