STEVEN JOSEPH LOBRITTO, MD

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This study looked at how children who had a liver transplant and their caregivers perceive the child's health-related quality of life. Researchers found that when there were bigger differences in responses between the child and caregiver, it was linked to poorer health-related quality of life, with a significant correlation of around -0.47. Understanding these discrepancies is important because reducing them could lead to better care and outcomes for children after transplantation.

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The Society of Pediatric Liver Transplantation (SPLIT) studied over 3,500 children who received their first liver transplant between 2011 and 2023, examining how outcomes have changed over time. They found that while the reasons for liver transplants remained the same, more infants under one year old were receiving them, and there was an increase in the use of special criteria to approve transplants (from 45% to 56%). Additionally, patient survival rates stayed high, and complications like blood clots in the liver artery decreased from 7% to 5%, showing improvements in liver transplant outcomes for kids.

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The GUARDIAN study tested whether genome sequencing is a feasible addition to standard newborn screening in a racially and ethnically diverse New York City population, enrolling 4,000 newborns across six hospitals. Testing succeeded in over 99% of cases, 72% of families consented, and 3.7% of newborns had a positive screen — including for treatable conditions not currently covered by standard tests. These results show genome sequencing can be implemented at scale in diverse communities, expanding the window for early intervention.

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This study looked at how different liver transplant centers manage medications given to children right after they receive a transplant. It found that centers with more consistent medication practices had a significantly lower likelihood—2.72 times less likely—of the child experiencing organ rejection within the first year. Understanding and reducing differences in these medication approaches could help improve transplant outcomes for kids.

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This study looked at the long-term health of children who received liver transplants and stopped taking immunosuppressive drugs compared to those who continued on these medications. It found that among 33 children off the drugs, none needed another transplant or experienced worse health issues compared to 66 similar children who stayed on the medication, indicating they fared equally well. This is important because it shows that some pediatric liver transplant patients may be able to live without these medications safely, reducing their risk of side effects.

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This single-center study assessed health literacy in adolescent liver transplant recipients and their caregivers, finding limited health literacy in 57% of patients and 47% of caregivers. Patients with adequate health literacy showed significantly higher readiness to transition to adult care, while health literacy did not significantly affect adherence or clinical outcomes in this sample. Routinely measuring health literacy before the transfer to adult care could identify teenagers who need extra support to make that transition successfully.

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This study looked at how different early treatments to suppress the immune system affect the success of liver transplants in kids during their first year after surgery. It found that using a type of antibody called T-cell depleting antibodies can improve chances of survival in some cases but may also increase risks in others, showing contrasting results in two data sources. Overall, the research highlights the need for better teamwork among hospitals to find the best treatment strategies for these young patients.

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This study tested whether a once-daily tacrolimus formulation (LCP-tacrolimus) improved medication adherence in young transplant patients aged 12 and up, who are known to struggle with daily medications. Switching to the once-daily version showed numerically better adherence by both provider assessment and a standard measurement tool, though the improvements did not reach statistical significance — likely because the group was too small. The drug was safe and effective, but did not reduce pill burden and sometimes cost more, so it may be best suited for carefully selected patients.

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This study looked at how a specific protein, HERV1-env, affects regulatory T cells (Tregs) in patients with autoimmune hepatitis, a liver disease where the body's immune system attacks its own liver cells. The researchers found that HERV1-env levels are higher in the Tregs of these patients, leading to stress within the cells that alters their function, which can worsen the disease. They discovered that reducing HERV1-env improves Treg function, highlighting the protein's role in immune response and liver inflammation. Who this helps: This benefits patients with autoimmune hepatitis by offering insights into potential new treatments.

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This study looked at infections in children who received liver transplants, focusing on how often they experienced bacteremia (bacteria in the blood), septic shock, and bacterial meningitis in outpatient settings. Out of 336 evaluations, 5.5% had bacteremia, with more than half of those cases occurring within the first three months after the transplant. Identifying high-risk factors, like being close to the transplant date and having a central line, can help doctors manage infections better and use antibiotics more effectively. Who this helps: This helps doctors and healthcare teams caring for pediatric liver transplant patients.

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Researchers looked into whether a specific quality-of-life questionnaire for kids who had liver transplants could be used easily in doctor’s offices. They found that while many parents found it easy to fill out the questionnaire on a mobile app, only two out of ten hospitals continued using it regularly due to time and staffing issues worsened by the pandemic. Making it easier for parents to use the app outside of clinic visits may help more hospitals adopt this important tool for tracking kids' well-being after surgery.

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A survey of pediatric liver transplant centers in the SPLIT registry documented wide variation in routine monitoring practices — including lab frequency, protocol biopsies, and imaging — after the first post-transplant year. All centers reduced monitoring over time, but practices differed substantially, and half performed routine surveillance biopsies while half did not, often because results would not change management. This snapshot of practice variation sets the stage for studies linking specific monitoring strategies to outcomes.

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This multicenter study examined whether live vaccines for measles, mumps, rubella, and varicella are safe and effective in children who had received solid organ transplants, including 281 recipients from 18 centers. The majority of children developed protective antibody levels after vaccination, most maintained protection at one year, and serious adverse events were rare — with only five mild varicella cases and no graft rejections following vaccination. The results support reconsidering blanket restrictions on live vaccines for selected, stable pediatric transplant recipients.

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This joint position paper from two major pediatric hepatology societies synthesized evidence on how COVID-19 affects children with chronic liver disease and liver transplant recipients. Children with liver disease can develop acute liver injury from COVID-19, and those on immunosuppression may face hepatic decompensation, though severe COVID-19 is less common in children than adults. The paper provides evidence-based guidance on prevention and treatment for this vulnerable population.

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This study looked at how well children with liver cancer, specifically hepatoblastoma (HB) and hepatocellular carcinoma (HCC), do after receiving a liver transplant. It found that three years after the transplant, 81% of children with HB and 62% of those with HCC were still doing well without disease complications. These findings are important because they highlight the overall good chances of survival for children undergoing liver transplants due to these cancers, helping doctors make better decisions about treating young patients with severe liver tumors.

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This study looked at how stopping immunosuppressive medication affects the quality of life for children who received liver transplants. Over three years, the researchers found that the specific quality of life related to their liver transplant improved for all 88 participants, while their overall quality of life remained the same. It’s important because it shows that stopping immunosuppression can be safe and potentially beneficial for these young patients without harmful effects, even if some experience organ rejection. Who this helps: Pediatric liver transplant recipients and their families.

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This study looked at the safety and effectiveness of a medication called glecaprevir/pibrentasvir (GLE/PIB) in treating children aged 3 to under 12 with chronic hepatitis C virus (HCV) infections. Out of 80 children treated, 96% (77) were free of the virus 12 weeks after ending treatment. The results show this medication works well and is safe for young children, which is important because effective treatments are needed to manage HCV in this age group. Who this helps: This helps children with chronic HCV and their doctors.

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This study looked at 15 children with cholestatic liver disease (CLD) who experienced bone fractures due to weakened bones, a condition that's common in these patients. It found that 5 of these children were reported for possible child abuse because their fractures resembled those typically caused by injury, not medical conditions. This matters because it highlights that doctors need to be aware that children with CLD can have broken bones from their illness, not just from abuse. Who this helps: Patients with CLD and their families.

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Researchers studied the effects of using ketorolac, a pain-relieving medication, alongside tacrolimus, a common drug given after liver transplants in children. They found that 25.8% of children receiving ketorolac experienced acute kidney injury, compared to 29.2% of those who did not, indicating safety in using both drugs together. Additionally, kids on ketorolac needed less opioid medication for pain and had shorter hospital stays. Who this helps: This benefits pediatric liver transplant patients and their healthcare teams.

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This study examined how children with liver diseases, including those who had liver transplants, were affected by COVID-19. Out of 91 children infected with the virus, those with native liver disease were more likely to need hospital care (70% compared to 43% for liver transplant patients) and even intensive care (32% vs. just 4% for transplants). The findings show that children with liver disease, particularly those with nonalcoholic fatty liver disease, face a higher risk of severe illness from COVID-19, highlighting the need for focused care and treatment strategies for these vulnerable groups. Who this helps: This helps pediatric patients with liver disease and their healthcare providers.

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The study focused on improving care for children receiving liver transplants by creating a collaborative system called the Starzl Network for Excellence in Pediatric Transplantation. The team identified key areas to improve, like medication management and patient quality of life, and found ways to share practices between hospitals to ensure every child gets consistent and effective treatment. This matters because it helps all pediatric liver transplant patients benefit from the best available research and practices, ultimately leading to better health outcomes.

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This study looked at recent graduates of pediatric transplant hepatology (PTH) fellowships to understand their training and experiences. Out of 43 graduates, 38 responded, and most (95%) completed a research project during their fellowship. While the fellowship is widely viewed positively and 84% of graduates now work at academic transplant centers, there is inconsistency in the training each program offers, suggesting a need for better standardization.

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This multicenter trial systematically withdrew immunosuppression over 36-48 weeks in 88 stable, long-term pediatric liver transplant recipients to identify those who had developed tolerance. Thirty-eight percent achieved operational tolerance — meaning their grafts functioned normally without any immunosuppression for at least one year. Even patients who rejected during withdrawal had reversal of rejection with treatment, and no long-term graft damage occurred in either tolerant or non-tolerant patients, supporting further investigation of immunosuppression minimization strategies.

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A survey of pediatric liver transplant centers in the SPLIT registry found that while core practices are similar — all use written protocols, tacrolimus for maintenance, and steroids for induction — significant variation exists in how centers handle ABO-incompatible grafts, presume rejection, and treat acute rejection. The survey establishes a baseline picture of current immunosuppression practices across institutions. Connecting these practice patterns to outcomes in future research will help identify best practices.

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Liver removal surgery in children carries real risks, but population-level data on complications are limited. Using a national pediatric surgical database, researchers identified which factors—including wound class and operative time—predict unplanned readmission within 30 days of hepatectomy. These benchmarks help hospitals identify high-risk patients and plan better follow-up care.

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This study looked at how young people with liver transplants do after switching from child-focused to adult health care. Researchers found that after moving to adult care, 28% of the patients died, and there was a drop in regular doctor visits. They also noted an increase in health issues and health care costs following the transfer. This is important because it shows that this transition period can be risky for young liver transplant patients, highlighting the need for better support during the changeover. Who this helps: This helps young liver transplant patients and their medical teams.

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This study looked at how pediatric liver transplant centers handle the use of live vaccines after transplantation, especially after new guidelines suggested they might be safe. Researchers sent surveys to 44 centers and found that only 12 (29%) provide live vaccines to post-transplant patients, each with their own eligibility rules. Many centers are still hesitant to use these vaccines due to safety concerns and lack of agreement among staff. Who this helps: This helps pediatric liver transplant patients who may benefit from live vaccines.

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This study looked at the use of budesonide, an oral corticosteroid, to treat acute cellular rejection in children who received liver transplants. They found that 29 children showed a significant decrease in liver enzyme levels (ALT) after starting budesonide, with results improving at 1, 3, and 6 months post-treatment. This matters because it suggests that budesonide could be a safer and effective alternative to traditional steroids, which often have more side effects. Who this helps: This helps pediatric liver transplant patients by providing a potentially safer treatment option for managing rejection.

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This study focuses on a 6-month-old baby who received a liver transplant and was diagnosed with COVID-19 just four days later. After initially recovering well, her liver enzyme levels rose significantly, indicating liver irritation, but her condition improved after treatment with hydroxychloroquine and other medications. This finding highlights the potential complications that COVID-19 can cause in young liver transplant patients and the importance of monitoring and adjusting their treatment. Who this helps: This helps pediatric patients who have undergone liver transplants and their healthcare providers.

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This study looked at how the COVID-19 pandemic affected children with chronic health issues and those needing organ transplants. It found that during the first six months of the pandemic, pediatric transplant programs in the U.S. faced delays and significant differences in how regions responded, with living-related transplants being particularly affected. Understanding these impacts is important because it helps improve care and guidelines for these vulnerable children as they navigate their health needs during and after the pandemic.

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This study looked at the effectiveness and safety of a combination treatment using mini-tablets for children aged 3 to 11 with a specific type of Hepatitis C. Out of 26 children treated for 12 weeks, 25 achieved a cure rate of 96%, with only one child not completing treatment. The treatment was generally safe, with only a few serious side effects noted, meaning it could be a good option for young children suffering from this illness.

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This study focused on a new network called the Starzl Network for Excellence in Pediatric Transplantation, which aims to enhance pediatric liver transplantation. During its first meeting, various stakeholders, including medical professionals and patient families, collaborated to address challenges and opportunities in transplant care. The goal is to improve the overall outcomes for children needing liver transplants by sharing knowledge and strategies. Who this helps: This benefits patients, their families, and healthcare providers involved in pediatric liver transplantation.

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This study looked at a treatment called partial splenic embolization (PSE) for children with portal hypertension, which can cause serious bleeding and low platelet counts. Researchers reviewed the results for 26 patients aged between 18 months and 20 years who received PSE between 2010 and 2017. They found that 80% of the children had improved platelet counts after the treatment, and only a few needed further therapies for related complications, making PSE a safe and effective option that helps preserve spleen function. Who this helps: This treatment benefits children with portal hypertension and their healthcare providers.

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This case report describes a Sudanese child with Crigler-Najjar syndrome type 1 — a severe inherited inability to process bilirubin — in whom standard genetic testing failed to find a known mutation. A novel homozygous gene variant was identified, and laboratory testing confirmed it completely blocks the relevant enzyme's function. The case highlights that genetic diversity across populations means known mutation panels miss some patients, arguing for broader inclusion of diverse populations in genomic research.

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This study examined the effectiveness of different surgical options for patients with two types of genetic liver diseases: familial intrahepatic cholestasis 1 (FIC1) and bile salt export protein (BSEP) deficiencies. Researchers looked at 102 patients who underwent surgeries like biliary diversion and liver transplantation. They found that while biliary diversion helped improve symptoms for many, BSEP patients with certain mutations had better long-term outcomes, needing fewer transplants, while FIC1 patients often faced ongoing complications after surgery. Who this helps: This research benefits patients with FIC1 and BSEP deficiencies, as well as their doctors in making treatment decisions.

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This research focused on understanding the immune system's role in autoimmune hepatitis (DAIH), a condition that can harm liver transplant patients. The study found that certain immune cells, when activated by specific signals, continue to produce a protein that keeps the inflammation going, worsening the condition. In contrast, liver transplant patients without DAIH showed lower levels of this inflammatory activity, indicating a potential path to better treatment options. Who this helps: This research benefits patients with autoimmune hepatitis and their doctors by providing insights that could lead to improved therapies.

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This study looked at patients with lysosomal acid lipase deficiency (LAL-D) who received liver transplants. Among 18 cases examined, 61% experienced a return of disease symptoms, and 33% died after transplantation. While liver transplants can help patients with liver failure, the study found that they do not stop the disease's progression because the underlying problem is related to a lack of an important enzyme. Who this helps: Patients with lysosomal acid lipase deficiency and their doctors.

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This cross-sectional study biopsied 157 apparently healthy pediatric liver transplant recipients with consistently normal liver tests to look for hidden chronic graft injury. Subclinical inflammation or fibrosis was found in most patients, with those showing interface activity on biopsy having a gene expression pattern linked to T-cell-mediated rejection. The findings challenge the assumption that normal blood tests mean a healthy graft, and suggest silent immune activity may be damaging livers even when children appear well.

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This study examined a treatment for hepatitis C in adolescents aged 12 to 17, using a combination of medications for 12 to 24 weeks. All 38 participants responded positively, achieving a 100% success rate in clearing the virus after treatment, with no serious side effects reported. This is significant because it shows that an effective treatment option available for adults can also work safely and effectively for teens with hepatitis C.

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This single-center study tracked how donor livers change in size as pediatric transplant recipients grow over 10 years. Liver volume grew by 59% by five years and 170% by 10 years post-transplant, closely matching expected liver size for the child's height and weight by year five. The findings confirm that transplanted livers in children adapt appropriately to the recipient's growth, which has practical implications for graft sizing decisions at the time of transplant.

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Children who receive livers from living donors—usually parents—have better long-term outcomes than those receiving deceased-donor organs, but living donor transplants remain rare in the U.S. This study found that living-donor recipients also showed immunological advantages, with lower rejection rates likely tied to the partial genetic match with a parent donor. The data make a strong case for expanding living donor programs for children.

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In patients without cirrhosis, portal vein blockage can cause parts of the liver to shrink while others compensate. This study examined liver atrophy patterns in such patients and found that surgical shunts to relieve portal hypertension allowed meaningful liver regeneration. These findings support surgical intervention rather than watchful waiting in non-cirrhotic portal vein thrombosis.

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A 12-year-old boy who had received a liver transplant as an infant developed a stone in his intestine that blocked food from moving through his bowel, cutting off blood flow to that section of intestine and causing it to die. Doctors had to remove the damaged intestine and rebuild his surgical connection between the liver and intestine to fix the problem. **Why it matters:** This rare complication should be on doctors' radar when transplant patients develop fever and stomach pain, and it shows that sometimes fixing the underlying anatomy—not just treating the stone—prevents the problem from happening again.

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This study looked at a serious condition called portopulmonary hypertension (PoPH) in children, which affects blood pressure in both the liver and lungs. The researchers reviewed the cases of five pediatric patients diagnosed with PoPH, finding that three of them (60%) died despite receiving targeted treatments. The average time from diagnosis to death was between three days and three years, highlighting the urgent need for better ways to diagnose and treat this dangerous condition early. Who this helps: This helps children with portopulmonary hypertension and their families by highlighting the need for improved care options.