The few individuals who have completed the Pediatric Transplant Hepatology fellowship at Cincinnati Children’s are a rare breed of super-specialists.

To get into this highly specialized fourth-year training program, physicians must have already completed a fellowship in gastroenterology.

“This is a boutique program designed to prepare physicians to take care of patients with advanced liver disease who likely will require transplantation,” says William Balistreri, MD, medical director, Pediatric Liver Care Center and associate chair for subspecialty training, Department of Pediatrics. “The protocols and teamwork involved in handling these advanced cases can become very complex. There is a need for a special level of training that can be validated and certified.”

Cincinnati Children’s Division of Gastroenterology, Hepatology and Nutrition was rated No. 1 in the country in 2011 by U.S. News and World Report. Our liver care team attracts patients from around the world, conducts extensive research and has performed more than 500 liver transplants.

“We started the Pediatric Liver Care Center in 1985 with the idea that we wanted to establish a liver transplant program — and then put it out of business,” Balistreri says. “We want to do more than provide transplants. We want to find causes and cures for liver disease.”

In 2008, Cincinnati Children’s and Emory University in Atlanta became the first to offer approved fellowships in pediatric transplant hepatology. The fellowships reflect the increasing specialization occurring within pediatric medicine.

Even now, only five centers nationwide provide the training needed to obtain a Certificate of Added Qualification (CAQ) from the American Board of Pediatrics (ABP) in this subspecialty. Each program accepts only one fellow a year, and so far, fewer than 100 specialists have passed the certification exam.

Of the five fellows trained at Cincinnati Children’s since 2008, two have joined the faculty here: Kathleen Campbell, MD, and Alexander Miethke, MD. Other graduates lead programs in Minnesota, Utah and Wisconsin.

Balistreri predicts a rising need for transplant hepatologists. Obesity and hepatitis C infections have fueled a surge in end-stage liver disease in adults – patients who will need expert care and focused research.

“The obesity epidemic already has made fatty liver disease the number one cause of chronic liver disease in adults and will remain so into the future,” Balistreri says.