A Roadmap From Feasibility to Reality: Can Greece Establish and Sustain a Transplant-Hepatopancreatobiliary (HPB) Fellowship?

摘要

Hepatopancreatobiliary (HPB) and transplant surgery in Greece has expanded significantly, with high-volume centers in Athens and Thessaloniki achieving outcomes that meet international benchmarks. Despite adequate case volume, no structured fellowship pathway exists, driving many surgeons abroad and perpetuating workforce attrition. We assessed the feasibility of establishing a national transplant-HPB fellowship in Greece and defined key structural requirements. We reviewed national case volumes in HPB and transplant surgery, benchmarked outcomes against international standards, and identified systemic barriers to fellowship development. We then developed a proposed framework for a national consortium fellowship, including curriculum design, accreditation pathways, funding strategies, and faculty recruitment. Barriers include a lack of formal accreditation mechanisms, fragmented case distribution, insufficient protected faculty time, and limited integration of robotics and simulation. A roadmap for implementation includes (1) creation of a national training consortium; (2) adoption of competency-based curricula aligned with International Hepato-Pancreato-Biliary Association (IHPBA)/American Society of Transplant Surgeons (ASTS) standards; (3) diversified funding through the National Health System, universities, foundations, and professional societies; and (4) repatriation of internationally trained faculty to strengthen mentorship and accreditation compliance. Greece possesses sufficient case volume and expertise to support an accredited transplant-HPB fellowship. Establishing a national program through resource consolidation, diversified funding, and international collaboration would not only mitigate surgical brain drain but also position Greece as a regional training hub in advanced HPB and transplant surgery.