A photo of Alexander Miethke.

Alexander G. Miethke, MD

  • Medical Director, Liver Transplant Program
  • Assistant Professor, UC Department of Pediatrics



Autoimmune liver diseases, like autoimmune hepatitis and primary sclerosing cholangitis, entail liver inflammation that occurs when the immune system attacks the liver or bile duct epithelial cells. If these conditions are left untreated, they can lead to liver failure. Other complications include liver cancer, enlarged veins in the esophagus and fluid build-up in the abdomen. Studying these conditions should provide better strategies for preventions and therapies so patients have lower risk of long-term complications.

My research delves into immune mechanisms driving liver inflammation and fibrosis in children with biliary atresia or autoimmune liver disease. My colleagues and I are also looking into the genetic causes of acute and chronic liver diseases and circulating and imaging biomarkers for liver inflammation or fibrosis so we can avoid an invasive procedure to monitor the disease.

Our research includes:

  • The signaling molecules regulating liver inflammation and fibrosis in fibrosing cholangiopathies, which can be targeted with innovative treatments
  • Novel immune therapies based on what genes predispose patients to pediatric liver disease
  • Ways to detect and determine the various types of circulating and imaging biomarkers from liver injury and fibrosis in order to use them as surrogate endpoints in clinical trials for primary sclerosing cholangitis (PSC) and autoimmune hepatitis

We have many translational studies at Cincinnati Children’s and are developing an infrastructure for a multi-center learning network to promote research and improve care for children with autoimmune liver disease across North America.

I started to pursue this area of research during my pediatric residency when I encountered infants with chronic liver disease from biliary atresia awaiting liver transplantation. The absence of medical therapies as an alternative to liver transplantation made me determined to discover new treatments. I’m grateful for my first research opportunities in Dr. Jorge Bezerra's laboratory during my residency and fellowship at Cincinnati Children’s, which helped me to develop independent research programs to find novel therapies for biliary atresia and autoimmune liver diseases.

There are many causes for liver disease in infants and children, including genetic, infectious or autoimmune etiologies. We still do not know enough about the mechanisms of various pediatric liver diseases, which impairs our ability to deliver safe, effective and targeted treatments. My research goal in pediatric hepatology is to find mechanisms through translational research that lead to new therapies. However, for more severe cases, the best way to save lives will be via liver transplantation. As the medical director of our liver transplant program, I lead the efforts of our team of physicians, nurses and care managers to maintain excellent transplant outcomes through innovative therapies and quality improvement sciences.

Some of the honors and awards I have received over the years include:

  • Director of the Center for Autoimmune Liver Disease (CALD) founded with extraordinary philanthropic support to find cures for PSC and autoimmune hepatitis
  • Holding the Robert and Sydney Anning Endowed Chair in Autoimmune Liver Disease at Cincinnati Children's Hospital since March 2020
  • NIH R01 level funding to study biliary atresia in animal models and human samples
  • Multiple research awards from the American Association for the Study of Liver Diseases (AASLD) to initiate my research

Additional Languages



Insurance Information

Cincinnati Children's strives to accept a wide variety of health plans. Please contact your health insurance carrier to verify coverage for your specific benefit plan.

View Insurance Information


Associations between MRI T1 mapping, liver stiffness, quantitative MRCP, and laboratory biomarkers in children and young adults with autoimmune liver disease. Mahalingam, N; Trout, AT; Gandhi, DB; Sahay, RD; Singh, R; Miethke, AG; Dillman, JR. Abdominal Radiology. 2021.

Sarcopenia is highly prevalent in children with autoimmune liver diseases and is linked to visceral fat and parent-perceived general health. Amevor, AA; Yodoshi, T; Trout, AT; Dillman, JR; Singh, R; Jarvis, R; Fei, L; Liu, C; Taylor, A; Miethke, A; et al. Liver International. 2021.

Isolation and Culturing Primary Chaolangiocytes from Mouse Liver. Kudira, R; Sharma, BK; Mullen, M; Mohanty, SK; Donnelly, B; Tiao, GM; Miethke, A. Bio-protocol. 2021; 11.

Clinicopathologic Conference: A Four-Year-Old Child With Digital Clubbing. Schultz, K; Divanovic, A; Towe, C; Miethke, A; Wusik, K; Hammill, A; Brunner, H. Arthritis Care and Research. 2021; 73:1379-1386.

Assessment of agreement between manual and automated processing of liver MR elastography for shear stiffness estimation in children and young adults with autoimmune liver disease. Gandhi, DB; Pednekar, A; Braimah, AB; Dudley, J; Tkach, JA; Trout, AT; Miethke, AG; Franck, MD; Heilman, JA; Dzyubak, B; et al. Abdominal Radiology. 2021; 46:3927-3934.

Deleterious Variants in ABCC12 are Detected in Idiopathic Chronic Cholestasis and Cause Intrahepatic Bile Duct Loss in Model Organisms. Pham, DH; Kudira, R; Xu, L; Valencia, CA; Ellis, JL; Shi, T; Evason, KJ; Osuji, I; Matuschek, N; Pfuhler, L; et al. Gastroenterology. 2021; 161:287-300.e16.

Colorectal Dysplasia and Cancer in Pediatric-Onset Ulcerative Colitis Associated With Primary Sclerosing Cholangitis. El-Matary, W; Guthery, SL; Amir, AZ; DiGuglielmo, M; Draijer, LG; Furuya, KN; Gupta, N; Hochberg, JT; Horslen, S; Kerkar, N; et al. Clinical Gastroenterology and Hepatology. 2021; 19:1067-1070.e2.

Oral Vancomycin, Ursodeoxycholic Acid, or No Therapy for Pediatric Primary Sclerosing Cholangitis: A Matched Analysis. Deneau, MR; Mack, C; Mogul, D; Perito, ER; Valentino, PL; Amir, AZ; DiGuglielmo, M; Draijer, LG; El-Matary, W; Furuya, KN; et al. Hepatology. 2021; 73:1061-1073.

The Sclerosing Cholangitis Outcomes in Pediatrics (SCOPE) Index: A Prognostic Tool for Children. Deneau, MR; Mack, C; Perito, ER; Ricciuto, A; Valentino, PL; Amin, M; Amir, AZ; Aumar, M; Auth, M; Broderick, A; et al. Hepatology. 2021; 73:1074-1087.

Four Biomarkers Linked to Activation of Cluster of Differentiation 8-Positive Lymphocytes Predict Clinical Outcomes in Pediatric Acute Liver Failure. Leonis, MA; Miethke, AG; Fei, L; Maynor, S; Chapin, CA; Bleesing, JJ H; Alonso, EM; Squires, RH. Hepatology. 2021; 73:233-246.

From the Blog

Patient Ratings and Comments

All patient satisfaction ratings and comments are submitted by actual patients and verified by a leading independent patient satisfaction company, NRC Health. Patient identities are withheld to ensure confidentiality and privacy. Only those providers whose satisfaction surveys are administered through Cincinnati Children’s Hospital Medical Center are displayed. Click here to learn more about our survey