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Each specialist within the Liver Transplant Program has at least two fields of expertise. One is providing compassionate care to families. The other is learning more about ways to advance care for the diseases and treatments that brought them to Boston Children’s.

Eliminating waitlist mortality for children

Infants and young children have the highest risk of death on the liver transplant waiting list, mainly due to the shortage of appropriately sized organs. To combat this, Heung Bae Kim, MD, director of Boston Children’s Pediatric Transplant Center, has been researching ways to change that statistic.

In 2014, Dr. Kim and his team of researchers at Boston Children’s published their findings in Liver Transplantation, where data suggests that both split and whole organs had similarly low rates of both graft failure and mortality for liver transplant patients under the age of 2. These findings suggest that their use could be increased to meet the demand for smaller grafts.

In a separate study, data on graft survival and mortality for adult split liver (R lobe) recipients (after children got the smaller left part) was compiled. The research showed that with the exception of a small, very sick population of adult patients, adults who receive a split graft can expect to fare as well as those who received a whole organ.

Based on his findings, Dr. Kim has been consistently advocating for changes in how donor livers are allocated — automatically placing infants and small children at the top of the liver waitlist. With this, pediatric transplant surgeons are given the option to split the first graft to become available. Once the liver has been split, the smaller portion is transplanted into a child and the larger portion is transplanted into the next appropriate adult on the list.

Assessing liver transplant graft health without a liver biopsy

Although modern immunosuppression has shown great results, some liver transplant grafts can develop scar tissue (called fibrosis) over some years. Previously, the only way to measure fibrosis was by liver biopsy. Our team members have assessed the ability of using transient elastography (FibroScan) to non-invasively assess for significant scar tissue (fibrosis). Based on our findings, this approach will be used yearly in liver transplant patients.

Quality improvement research for improving long-term kidney health

Chronic kidney disease can develop in all liver transplant recipients who take modern immunosuppression over many years. The transplant program has investigated specific factors in their clinical care patterns that could lead to improvement in kidney function. This led to a one-year improvement in kidney function in our patients, and the clinical pathways have continued to be implemented in our program.