Wednesday October 16, 2019 

NASPGHAN Single Topic Symposium 2019
Chronic Liver Disease Management for the Gastroenterologist
Saeed Mohammad, MD
Mercedes Martinez, MD

Objective: The objective of this program is to provide guidance on practical aspects of the management of children with chronic liver disease and liver transplantation, including updates on new therapies for chronic liver diseases.

Target Audience: Practitioners with a primary focus in general gastroenterology and trainees.


8:00am - 8:10am   Introduction

Saeed Mohammad MD, Ann and Robert H. Lurie Children’s Hospital, Course Director

Session I - Diagnostic Challenges in Pediatric Liver Disease (Session 1 Materials Here)

Moderators:  Saeed Mohammad MD and Vania Kasper MD

8:10am - 8:30am  How do I best evaluate a cholestatic infant?
Sanjiv Harpavat MD, PhD Texas Children’s Hospital
  • Identify limitations of commonly-ordered diagnostic tests
  • Review new diagnostic tests that may soon be a part of routine clinical care
  • Generate an algorithm to efficiently evaluate cholestatic infants, including those less than 30 days old
8:30am - 8:50am How do I interpret genetic results?
Saul J. Karpen MD, PhD, Emory University School of Medicine/Children's Healthcare of Atlanta
  • Understand the fundamental features of genetic test technologies available to clinicians
  • Understand the language common to genetic testing reports—benign, pathogenic, VOUS, etc.
  • Determine when your approach to diagnosis and care may benefit from early incorporation of genetic testing— i.e., genotype before phenotype
  • Avoiding over-and under-interpretation of genetic variant reports
8:50am - 9:10am  What do abnormal liver enzyme levels mean in a tween?
William F. Balistreri MD, Cincinnati Children’s Hospital Medical Center
  • Discuss the differential of abnormal liver enzyme levels in a toddler and adolescent
  • Understand the initial approach to evaluate a patient presenting with this profile
  • Review the next level diagnostic strategy - non-invasive approaches and the indications for liver biopsy
9:10am - 9:30am What do I do with this abnormal radiology finding?
Jean Molleston MD, Riley Children’s Hospital
  • Outline the differential diagnosis and evaluation of focal liver lesions
  • Recognize congenital and acquired vascular abnormalities of the liver
  • Identify appropriate imaging approaches to suspected biliary tract disease
  • Differentiate various parenchymal liver abnormalities
9:30am - 9:50am     Discussion/Question

9:50am - 10:00am  Break

Session II - Frontiers in Liver Therapeutics (Session II Materials Here)

Moderators: Mercedes Martinez MD and Parvathi Mohan MD

10:00am -  10:20am  Keynote Speaker: Outcomes for the future: How do we improve on the status quo?
Ronald J. Sokol, MD, FAASLD, Children’s Hospital Colorado
  • Understand current gaps in therapies for pediatric liver diseases
  • Understand new technologies for development of novel therapeutics
  • Understand pipeline of new therapeutics, based on biology of cholestatic liver diseases
10:20am - 10:40am  Recognition and stabilization of the pediatric patient with acute liver failure
Robert Squires MD Children’s Hospital of Pittsburgh at UPMC
  • Recognize variable presentations of acute liver failure
  • Implement a prioritized immediate management plan for acute liver failure
  • Identify clinical features of acute liver failure that prompt early contact with and transfer to a pediatric liver transplant center
10:40am - 11:00am  What would Hamlet say: To treat or not to treat?
Regino P. Gonzalez-Peralta MD, AdventHealth for Children
  • Review the life-cycle of HBV and HCV
  • Understand currently available treatment options for HBV and HCV in children
  • Identify patients who would most benefit from treatment (and those who would not)
11:00am - 11:20am  Are there any medical therapies for NASH?  
Marialena Mouzaki, MD, Cincinnati Children's Hospital Medical Center
  • Present the gaps in the therapeutic armamentarium for pediatric NASH
  • Evaluate the preliminary data on the efficacy of novel medications currently being investigated for the treatment NASH
11:20-11:40  Discussion/Questions

11:45am - 12:45pm   Lunch Session - Group discussion on difficult cases

Moderator: Cara Mack MD
Panel: Simon Ling MD, Hospital for Sick Kids
Ronald J. Sokol MD, Children’s Hospital Colorado
Estella Alonso MD, Ann and Robert H. Lurie Children’s Hospital

Session III - Update on Portal HTN: Assessment and Management (Session III Materials Here)

Moderators: Samar Ibrahim MD and Alexander Weymann MD

12:45pm - 1:15pm   When there is good function, but the flow is all wrong: Approach to non-cirrhotic portal hypertension
Evelyn Hsu, MD, Seattle Children's Hospital
  • Understand the key aspects of the diagnostic evaluation of children with portal hypertension
  • Evaluate and understand the pathogenesis of nodular regenerative hyperplasia and non-cirrhotic portal fibrosis
1:15pm - 1:35pm     What do I do now? The management of portal hypertensive complications: Varices, ascites, and encephalopathy
Rene Romero MD, Children’s Hospital of Atlanta
  • Understand appropriate medical management (including pharmacologic and endoscopic) of acute variceal hemorrhage
  • Understand dosing and monitoring of diuretics in the management of ascites, and the appropriate use of paracentesis
  • Approaches to the recognition and management of chronic encephalopathy in pediatric liver disease

1:35pm - 1:55pm   The role of the interventional radiologist in the treatment of portal HTN: How can I help you?
Jared Green MD, Ann and Robert H. Lurie Children's Hospital
  • Understand role of Interventional Radiology in management of pediatric portal hypertension
  • Evaluate Interventional Radiology techniques available to address complications of portal hypertension
  • Evaluate Interventional Radiology options to restore or improve antegrade portal flow

1:55pm - 2:15pm   When to consider surgery in the treatment of portal HTN?
Riccardo Superina, MD, FRCS(C), FACS, Northwestern University
  • Learn about the different types of procedures available for the treatment of portal hypertension in children
  • Learn about the differences in physiological consequences between the procedures that restore blood flow to the liver and those that  divert blood flow from the liver
  • Learn about how to determine who needs a shunt and who needs a transplant
  • Learn about indications for meso Rex bypass and when the best time to do it is

2:15pm - 2:30pm   Discussion/Questions

2:30pm - 2:45pm   Break

Session IV - Liver Transplant: Pre- and Post-Transplant Considerations (Session IV Materials Here)

Moderators: James Squires MD and Jennifer Vittorio MD

2:45pm - 3:05pm   Referring your patient for liver transplantation
Shikha S. Sundaram, MD MSCI, FAASLD, Children’s Hospital Colorado
  • Understand when to refer a patient for a transplant evaluation
  • Understand what happens during a transplant evaluation
  • Understand indications/contraindications for liver transplantation
  • Understand how to help your patient choose a transplant program
3:05pm - 3:25pm   Where will we get our organs from in 2020?
Jean Emond MD, Columbia University
  • Understand the role of living donation and split livers in a pediatric program
  • Understand current data on PHS increased risk donations
  • Be familiar with updates in xeno and bioengineered organs
3:25pm - 3:45pm   What should I do if my liver transplant patient has elevated liver tests?
Udeme Ekong MD, Georgetown University Hospital
  • Recognize the differential diagnoses of elevated liver tests in a pediatric liver transplant recipient
  • Become familiar with testing to consider in the setting of liver allograft dysfunction
  • Become familiar with proposed diagnostic criteria for acute and chronic antibody mediated rejection
 3:45pm - 4:05pm   What is a “normal” childhood after liver transplantation? 
Estella Alonso MD, Ann and Robert H Lurie Children’s Hospital
  • Be able to identify the common physical and psychosocial challenges children experience following liver transplantation
  • Be able to identify risk factors for lower than expected physical function and school performance following liver transplantation
  • Be able to design screening programs to implement in a post-transplant ambulatory care setting that will identify children with high risk for lower psychosocial outcomes

4:05pm - 4:25pm   Discussion/Questions

4:25pm - 4:30pm   Closure
Mercedes Martinez MD, Columbia University School of Medicine, Course Director

4:30pm - 6:00 pm   Reception

CME Information

Acknowledgement of Commercial Support 


The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGAN) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. NASPGHAN designates this live activity for a maximum of 7.75 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Conflict of Interest
The following table of disclosure information is provided to learners and contains the relevant financial relationships that each individual in a position to control the content disclosed to NASPGHAN.  All of these relationships were treated as a conflict of interest, and have been resolved.  (C7 SCS 6.1-­‐6.2, 6.5)
All individuals in a position to control the content of CE are listed in the program book. If their name is not listed below, they disclosed that they had no relevant financial relationships.