The liver doctors (hepatologists) of the Pediatric Liver Program are specially trained in the diagnosis and management of all types of childhood liver disease, including the care of children and adolescents before and after liver transplantation. We can address a wide variety of general liver concerns such as the assessment of abnormal liver laboratory results, abnormal liver imaging findings including liver tumors, infant jaundice, infant cholestasis, and cirrhosis. We also provide ongoing care for children with chronic liver conditions including biliary atresia, Alagille syndrome, alpha-1 antitrypsin deficiency, autoimmune hepatitis, primary sclerosing cholangitis, nonalcoholic fatty liver disease, hepatitis B and hepatitis C, and Wilson’s disease. Finally, we are happy to provide second opinions to help community doctors develop their care plans for children with liver disease. We will work with all patients, families, and their doctors to provide high-quality, individualized care.
Director – Dr. Frank DiPaola
All childhood liver tumors require careful assessment, and we use state-of-the-art methods including advanced MRI imaging and (where needed) imaging-directed biopsy to characterize tumors and to develop treatment plans. Our program includes pediatric radiologists (MRI specialists), interventional radiologists (doctors trained to do procedures using imaging such as imaging-directed liver biopsy), and liver surgeons. Not all tumors are caused by cancer, but whenever there is suspicion for cancer, we collaborate closely with our pediatric cancer specialists and adult liver cancer specialists to provide management for all types of liver cancer including hepatoblastoma, hepatocellular carcinoma, cholangiocarcinoma, and others. We have close relationships with the adult liver specialists and adult cancer specialists at the University of Michigan, to assist us in the management of children and adolescents with cancers that are more commonly seen in adults. Our multidisciplinary, collaborative team allows us to rapidly characterize liver tumors, and to discuss with experts the full range of treatment options for each tumor type in order to provide the best possible outcome for patients.
Multidisciplinary Post-Fontan Cardiac/Hepatology Clinical Care Program
Pediatric Transplant Hepatology – Dr. Frank DiPaola
We are working closely with the Pediatric Cardiology team to develop a multidisciplinary clinic and care program that is focused on the particular needs of the long-term survivors of congenital heart disease (particularly those who have undergone the Fontan procedure) who have developed liver changes secondary to their congenital heart disease. The program is structured to provide care and to develop better tools for the evaluation and assessment of liver dysfunction in this important clinical setting. It is particular important to have routine multidisciplinary assessment for those who might become candidates for heart transplantation as they become older. Together the cardiologists and Dr. Frank DiPaola in transplant hepatology are investigating methods to better identify the changes in liver structure and function as part of our concern about improving long-term outcomes for each patient.
Non-Alcoholic Fatty Liver Disease (NAFLD ) and Non-Alcoholic Steatohepatitis (NASH) Program
Director – Dr. Jacob Bilhartz
Fat accumulation in the liver can be the consequence of a variety of diseases. The most common reason for fat in the liver is related to obesity. As this is a growing problem in the United States, we see more and more patients with this problem. Of particular concern is screening for other potential diseases especially when the transaminases (liver enzymes) are elevated. We have developed a standardized approach to this liver problem including laboratory diagnostic studies, imaging of the liver, timing of a liver biopsy, and recommended treatment for the problem.
Portal Hypertension Multidisciplinary Program
Surgical Director – Dr. Mike Englesbe
Medical Director – Dr. M. James Lopez
Children can develop portal hypertension (high pressure of blood within the vessels draining to the liver) due either to scarring within the liver (cirrhosis) or abnormalities of the liver blood vessels. Most children with portal hypertension do not require liver transplantation, but all require specialized care due to minimize risk of complications. Our center offers a broad array of diagnostic and interventional approaches to help these children. We have a clinic for initial evaluation of children staffed by pediatric liver specialists and liver surgeons. After the first clinic visit, each case is carefully reviewed by a multidisciplinary team of doctors including the liver specialists and surgeons, as well as pediatric radiologists (MRI specialists) and interventional radiologists (doctors trained to do procedures using imaging). This team develops an individualized recommendation for management of the portal hypertension that balances risks and benefits to achieve the best possible outcome. Patients receiving care under within the program can be followed regularly by our liver specialists, often in collaboration with the community, referring doctor.
Medical Director – Dr. M. James Lopez
Surgical Director – Dr. John Magee
The University of Michigan Pediatric Liver Transplant Program is the oldest and largest pediatric liver transplant program in Michigan. The program routinely is in the top 12-15 programs in the country with respect to total number of transplants per year and, more importantly, is among the top programs in the country in terms of quality and outcomes. We are willing to assess any child for the possible need for liver transplant. The diseases for which we provide liver transplant include, but are not limited to: biliary atresia, tumors and cancers of the liver, autoimmune liver disease including autoimmune hepatitis and primary sclerosing cholangitis, and metabolic liver diseases that can be effectively cured by transplant such as alpha-1 antitrypsin deficiency, urea cycle disorders, and maple syrup urine disease.
CLINICAL EDUCATION PROGRAM
Trainee (Learner) Education Program
Dr. Haley Neef - Medical Student Education
Dr. Jacob Bilhartz – Pediatric Resident Education
Dr. Pamela Brown – Pediatric Gastroenterology Fellow Education
We believe that education is one of the fundamental missions of an academic Pediatric Gastroenterology Program and, thus, spend a great deal of our time in supervision of medical students, pediatric residents, and pediatric GI fellows (often called learners). Learners (trainees) often see patients with us in most clinics and in the inpatient setting as part of their learning to become excellent physicians. As we are part of one of the best medical schools in the world, we are constantly challenged to review our educational curriculum and integration of clinical care into education. Our learners engage in our patient safety, quality improvement, population management, and patient/family centered care initiatives. They are an important part of ensuring that care is delivered in an effective and patient-centered manner. Although having many people ask you the same questions or not have all the answers can be frustrating, we thank each of you who entrust us and all our learners with your care and allow us to learn from our interactions with each of you.