Gastroenterology

New Surgical Liver Transplant Director Hopes to Build on Transplant Center’s Success

Dr. Marcos Pozo Jatem joined Children’s of Alabama as the surgical liver transplant director in September 2022.

In March 2023, the Children’s of Alabama Transplant Center will celebrate its 10^th anniversary. It’s a decade that’s been marked by growth, and leaders believe more is ahead.

One reason for that belief is the arrival of a new surgical liver transplant director. Marcos Pozo Jatem, M.D., arrived in September after completing a fellowship in pediatric transplant and hepato-pancreato-biliary (HPB) surgery at Lurie Children’s Hospital of Chicago. He’s also completed fellowships in abdominal transplant surgery and clinical bioethics at Northwestern and was a resident at Johns Hopkins. He’s a member of 10 professional societies related to surgery and transplant, holds nine board certifications and has won several surgery and teaching awards.

Pozo Jatem was drawn to the Children’s Transplant Center because of its history of success and potential for growth. The program currently serves three to five patients per year; he believes it can serve at least eight to ten. He hopes to build a referral pattern, especially for children in Alabama. A transplant hospitalization, he says, can last a couple months, depending on how complicated the transplant is. He doesn’t want a transplant family to have the additional burden of traveling outside the state to get the services they need.

“It is a significant investment for the family, not just economically, but also for rearranging other children that they may have, their school, the parents’ work commitments, and it’s sometimes very, very difficult for a parent, for a whole family to be uprooted like that to another state,” he said.

He also hopes to begin offering partial liver transplants, which are often ideal for smaller babies. For these patients, finding a donor match with a perfectly sized liver can be rare, even when the donor is similar in size to the recipient. Giving that child a portion of a larger liver can reduce the amount of time the child is on the transplant waiting list.

“Being on the waiting list and needing a liver is still a risky position to be in sometimes,” he said.

So far, Pozo Jatem has been impressed with the center’s culture. He says he’s humbled to join the transplant team, led by Jayme Locke, M.D., director of the Division of Transplantation; and Mike Chen, M.D., chief of the Division of Pediatric Surgery. The team also includes two hepatologists, Helena Gutierrez, M.D., and Henry Shiau, M.D., who have a partnership in patient care. “We share medical decisions; we constantly communicate and discuss evaluations, assessments and plans,” Gutierrez, the medical director of the liver transplant program, said. “We have a great partnership that has been built on open communication, respect and support.”

Pozo Jatem recognizes the team’s past efforts and the resulting growth and says he looks forward to helping the center grow more.

“I think the arc of progress has led us to this point that we can now expand on the services we can provide,” he said. “So that’s the thing that I’m most proud of—being part of a team that is interested in providing the best for children.”

January 16, 2023 by childrensal

Gastroenterology

Children’s Physicians Identify Adenovirus as Common Link in Hepatitis Outbreak

Adenovirus in the blood was a common link between cases during a recent hepatitis outbreak, according to researchers at Children’s of Alabama.

When a cluster of Alabama children were diagnosed with severe hepatitis in the fall of 2021, pediatric physicians at Children’s of Alabama and the University of Alabama at Birmingham (UAB) notified public health leaders and began investigating. As a result of their efforts, the Centers for Disease Control and Prevention (CDC) issued a health alert to warn the public about the spread of the illness. Hundreds more cases were subsequently discovered across the United States and Europe, many with a common link: adenovirus within the blood.

Researchers at Children’s and UAB discovered the link in the Alabama cases through a routine screening.

“We were able to uncover the possible association with the adenovirus-41 strain because it is our standard practice to screen patients diagnosed with hepatitis for adenovirus,” said Markus Buchfellner, M.D., a pediatric infectious disease physician at Children’s and UAB.

But the outbreak was something of a mystery to doctors. The nine patients in the Alabama cluster—all between 2 and 11 years old—were previously healthy. They lived in different parts of Alabama, and none attended the same day care or had known contact with any of the others. All developed severe hepatitis, with some experiencing acute liver failure and even requiring liver transplants.

“The adenovirus is typically associated with respiratory infections as well as gastrointestinal infections,” said Helena Gutierrez, M.D., Medical Director of the UAB and Children’s Pediatric Liver Transplant Program. “It is very rare for a healthy person to develop a severe illness that requires hospitalization from this virus.”

Gutierrez investigated the cases alongside Buchfellner and their colleague Henry Shiau, M.D., a pediatric hepatologist at Children’s and UAB. She served as lead author of the study, which was ultimately published in the New England Journal of Medicine. It showed that while the adenovirus was a common finding among the Alabama cases, it was unclear whether adenovirus infection itself, or a combination of the virus with other factors, led to the pediatric hepatitis outbreak.

Researchers noted that the timing of the outbreak during the COVID-19 pandemic should be considered, but it’s role also was unclear. COVID-19 is known to cause elevation of liver enzymes and multisystem inflammatory syndrome in children. The nine children tested negative for COVID-19 upon hospital admittance but did not receive antibody testing. While the outbreak remains a mystery, it’s clear that the work done by researchers at Children’s and UAB made an impact on the worldwide medical community. They led the way in researching the outbreak and alerting the public about symptoms and protective measures.

January 16, 2023 by childrensal