Liver Transplant Faculty Research
The physician-researchers at Lurie Children’s have pioneered influential new methods of studying pediatric liver disease and transplantation and receive substantial funding from the National Institutes of Health (NIH). Their significant investment in and commitment to research allows the Siragusa Transplantation Center to lead the way in improving the health of children with liver disease.
Dr. Alonso’s Research
Estella M. Alonso, MD, is a nationally recognized researcher in medical and psychosocial outcomes in children following liver transplantation. Dr. Alonso is the Medical Director of the Pediatric Liver Transplant program at Lurie Children’s. Dr. Alonso is an active member in both the Northwestern University Transplant Outcomes Research Collaborative and the newly developed Institute for Public Health and Medicine since inception of these programs and is a member of the teaching faculty for the Medical Decision Making course at Northwestern University.
Over ten years, Dr. Alonso has developed a multi-faceted program in clinical health outcomes research. This research group includes physician scientists, psychologists, a research pharmacist, clinical research nurses, epidemiologists and statistical consultants, and has successfully conducted multiple federally funded studies. The studies Dr. Alonso is involved with seek to identify factors and treatments that are associated with better medical outcomes, quality of life, and normal growth and development following the transplant process. Her current research projects include the following:
The Pediatric Acute Liver Failure (PALF)Study Group
Dr. Alonso has a long-standing track record in research in the clinical care of patients with acute liver failure. She is a current member of the senior leadership team of the PALF Study Group, which is a NIH-funded pediatric consortium. Also, our research group at Lurie Children’s led by Dr. Alonso and Dr. Sorensen serves as the Neurocognitive Research Core for the PALF study. The PALF study aims are to collect and maintain clinical, epidemiological, and outcome data in children with acute liver failure, as well as serum, tissue, and DNA specimens so as to develop predictors of prognosis, analyze trends, and provide materials to investigators. Within this study group, Dr. Alonso has been actively involved in research to better understand the role of acetaminophen in liver injury.
A Study to Evaluate Medication Adherence in Children Who Had a Liver Transplant (MALT)
The long-term survival of several thousand children who have received a liver transplant is dependent on immunosuppressant medications, but many stop taking them. Dr. Alonso is the site principal investigator for the NIH funded MALT study which proposes to validate a method to identify children who are at risk because of not taking their medications. The results will help transplant centers identify these children and improve overall post-transplant survival.
Immunosuppression Withdrawal for Stable Pediatric Liver Transplant Recipients (iWITH)
Dr. Alonso has been a part of the senior leadership team in development of the Withdrawal of Immunosuppression (iWITH) Trial and will lead an analysis of Health-Related Quality of Life embedded in that trial. This is a multi-center project funded by the NIH that involves a gradual and complete withdrawal of immunosuppression in pediatric liver transplant patients. This study aims to determine if immunosuppression withdrawal can be done safely with an acceptable rate of allograft rejection.
Dr. Caicedo’s Research
Juan Carlos Caicedo, MD, is a transplant surgeon interested the full spectrum of adult and pediatric transplantation surgery, including pediatric and adult kidney, pancreas, liver and small bowel transplantation, as well as hepatopancreatobiliary surgery, vascular access and laparoscopic donor nephrectomy.
Clinical/Surgical Outcomes Research at Northwestern Memorial Hospital
Clinical/surgical outcomes research at Northwestern Memorial Hospital with a special interest in outcomes in solid organ transplantation in Hispanic patients. In addition, his interests include quality of life after transplantation and health communication and literacy of patients after organ transplantation.
Dr. Mohammad's Research
Saeed Mohammad, MD, is a pediatric hepatologist with a research interest in outcomes after liver transplantation, specifically improving long term outcomes in a cost effective manner. In addition, Dr. Mohammad has completed a Masters in Health Services and Outcomes Research at the Institute for Healthcare Studies at Northwestern University. Beyond the research described below, Dr. Mohammad is a physician leader on a process improvement initiative developing hospital-wide guidelines to reduce the number of days patients are intubated after solid organ transplantation. This multidisciplinary group’s objective is to advance quality of care, reduce practice variation and lower hospital costs through consensus guidelines. Dr. Mohammad uses these opportunities to forge effective, collaborative relationships, exchange ideas with a diverse group of researchers who encompass all aspects of outcomes research within the hospital/university community. His current research projects include the following:
Health Status in Young Adults Two Decades after Pediatric Liver Transplantation
Dr. Mohammad led a multi-center retrospective analysis of the health status of young adults who underwent liver transplantation as children twenty years ago. This involved locating patients, many of whom were lost to follow up, and having them complete quality of life and health utility surveys. He received a Young Investigator Award from the American Transplant Congress and presented this research at their annual meeting in 2011. Dr. Mohammad’s research showed that although cured of their liver disease, transplant recipients continue to face many challenges over the course of their lives. These results led to Dr. Mohammad’s recent interest in designing interventions to improve long term outcomes and to change the focus of our healthcare delivery to preempt common co-morbidities.
Withdrawal of Immunosuppression Following Pediatric Liver Transplantation: A Markov Analysis
Interest in improving healthcare services and their cost-effectiveness led Dr. Mohammad to study modeling and decision analysis. Dr. Mohammad developed a Markov model assessing the effect of immunosuppression withdrawal on survival after pediatric liver transplantation. Additional steps in model development include the incorporation of costs of therapies and the direct measurement of health utilities from patients. Direct utility measurement has never been performed in the pediatric transplant population; however they are essential for a true cost effectiveness analysis. Until now, Dr. Mohammad has been using indirect measurements to assess health utilities, however Dr. Mohammad was recently awarded a private foundation grant to pursue direct utility measurements as well.
Assessment of Quality of Life Among Patients With Chronic Liver Disease
Dr. Mohammad is working to validate a new quality of life scale for infants with chronic liver disease aged 1-24 months, the PedsQLTM Infant Scale. The widely used PedsQLTM series of scales has previously been limited to children aged 2 years and older. As over 50% of our patients are transplanted as infants, it is essential we have a method to capture the early changes in quality of life prior to and following liver transplantation.
Dr. Skaro’s Research
Anton I. Skaro, MD, PhD, is a transplant surgeon interested the full spectrum of adult and pediatric transplantation surgery, including pediatric and adult kidney, pancreas, liver and small bowel transplantation, as well as hepatopancreatobiliary surgery, vascular access and laparoscopic donor nephrectomy. In addition, he has completed a PhD in transplantation-immunology, which focused on cytotoxic T lymphocyte effector mechanisms involved in the development of chronic allograft rejection. His current research projects include the following.
The Immunologic Mechanisms Involved in Transplantation Tolerance
A collaborative effort at Ann & Robert H. Lurie Children’s Hospital of Chicago Research Center focused on the investigation of the immunologic mechanisms involved in transplantation tolerance.
Clinical/Surgical Outcomes Research at Northwestern Memorial Hospital
Clinical/surgical outcomes research at Northwestern Memorial Hospital with a special interest in patient-centered outcomes following transplantation and the provision of quality surgical care to patients with organ failure.
Dr. Superina’s Research
Riccardo A. Superina, MD, is an internationally recognized pediatric surgeon dedicated to advancing surgery in pediatric transplantation, pediatric liver disorders, living-donor and reduced-size, split-liver transplantation, liver disease (biliary atresia), hepato-biliary surgery and bowel transplantation. His current research projects include the following:
Dr. Superina is also interested in portal hypertension. With the help of philanthropic support, he and his team are expanding and improving the information available on treatment options for portal hypertension for both families and health care professionals.
The Effects of Portal Vein Thrombosis on the Liver
Additionally, he heads a research lab to study the effects of portal vein thrombosis on the liver, which includes clinical and basic science studies, funded primarily from philanthropic support. He has operated on more than 80 children with portal vein thrombosis. These children have been referred here from Brazil, Argentina, Chile, Cuba and Canada, in addition to over 20 states in the U.S. He has been invited to three continents and seven countries to demonstrate and teach portal hypertension surgery in children.
Dr. Whitington’s Research
Peter F. Whitington, MD, is an internationally recognized pediatric hepatologist interested in studying liver diseases of children, specifically biliary atresia, genetic cholestasis, obesity-associated fatty liver disease, and neonatal hemochromatosis. He is the director of Organ Transplantation and the Siragusa Transplantation Center. His current research projects include the following:
Childhood Liver Disease Research Network (ChiLDReN)
Dr. Whitington is the site principal investigator for this multi-site prospective study titled Childhood Liver Disease Research Network (ChiLDReN), which investigates various cholestatic liver diseases affecting children. Cholestatic liver disease is a major interest of Dr. Whitington’s and has been for three decades. The major goals of this project are to conduct longitudinal multi-centered studies of eight causes of neonatal cholestatic liver disease including biliary atresia, neonatal hepatitis, Alagille syndrome, alpha-1 antitrypsin deficiency, bile acid synthesis defects, progressive familial intrahepatic cholestasis, mitochondrial hepatopathies and cystic fibrosis liver disease.
Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH) Clinical Research Network
Dr. Whitington’s career has been devoted to improved care for children with liver disease. Fatty liver disease (NAFLD/NASH) is by far the most prevalent condition affecting the liver of U.S. children and is likely to be a prominent cause of end-stage liver disease in these same individuals as they mature. The objectives of this study are to continue to investigate the etiology, pathogenesis, natural history, diagnosis, treatment, and prevention of nonalcoholic fatty liver disease (NAFLD) and to provide a resource for clinical trials and ancillary studies of the pathogenesis, natural history, diagnosis or diagnostic biomarker development and treatment of NAFLD, NASH, or NASH-related cirrhosis.
The study of fatty liver disease has been a focus of Dr. Whitington’s laboratory and clinical research over the past several years. NAFLD is a complex medical condition that several important determinants – genetic, social, societal, and others – that make it a distinctly human disease, not to be easily emulated in laboratory animals. It must be studied in humans: thus, the NASH CRN represents a unique opportunity for the medical research community to make substantial advances in the understanding of pediatric NAFLD, to improve its treatment, and to improve the outcomes of affected children. Our research group at Lurie Children’s has contributed significantly to the success of the pediatric protocols of the NASH CRN.
The Pathophysiology of Childhood Liver Diseases
In addition, Dr. Whitington heads a lab that studies the pathophysiology of childhood liver diseases. The lab is involved in translational research utilizing animal and cell-based models and molecular approaches to understand the immune mechanisms involved in the pathogenesis of neonatal hemochromatosis and biliary atresia. In addition, they are also interested in hepatocyte “survival” cell signaling involved in nutrient sensing and fatty liver disease and in the protective response to cholestasis.