Get to Know: Pediatric Hepatologist Frank DiPaola, MD

At a Glance
• Title: Associate Professor
• Fellowships: Cincinnati Children’s Hospital, Pediatric Gastroenterology and Pediatric Transplant Hepatology
• Residency: Monroe Carell Jr. Children’s Hospital, Vanderbilt University

Board-certified in pediatric gastroenterology and pediatric transplant hepatology, Frank DiPaola, MD, has a national reputation for excellence in the care of children with acute and chronic liver disease. He joins UVA as director of Pediatric Hepatology and medical director of Pediatric Liver Transplantation.

Why did you choose to specialize in pediatrics?

I happened to have early mentorship from a really great community pediatrician. The bond he shared with patients and families was distinctive and impressive. This experience stuck with me as I considered my career path during medical school. Out of all the specialties, I found working in pediatrics during training brought me the most joy. Children have a unique enthusiasm for the world that is fun to be around.

How would you describe your approach to patient care?

I want children and families to know we are absolutely committed to them. In order to accomplish this, my view is we need to communicate our recommendations clearly and provide appropriate, high-quality care at all times. It is equally important that we listen to our patients and families, are always available and responsive to their questions and concerns, and empower them to participate fully with our team in developing their plan of care.

What was it about liver transplantation in particular that appealed to you?

The relationship between the members of the transplant team and the families is what is most special to me about liver transplant medicine. Successful liver transplantation (the before, during and after) requires the coordination of services across the entire hospital, and this forges a camaraderie with colleagues at work that is really fulfilling. I particularly value bonds with families. We offer a major therapy that is life-renewing, but requires lifelong follow-up. It is a special privilege to share in the many years of new life that our patients and families experience following liver transplantation.

What are some of the most common conditions you treat?

We welcome referrals whenever there is suspicion of liver disease for any reason (jaundice or abnormal liver enzymes, for example). We routinely diagnose and manage the full range of acute and chronic pediatric liver disease. Our program offers emergent evaluation and management of acute liver failure and liver tumors.

Acute liver disease can be the result of an infection like viral hepatitis, toxins or medications, or interrupted blood flow to the liver. Chronic liver disease may include biliary atresia, metabolic liver diseases like alpha-1 antitrypsin deficiency and Wilson disease, and immune-mediated liver disease, such as autoimmune hepatitis and primary sclerosing cholangitis (PSC). We also treat chronic liver infections, such as hepatitis B and hepatitis C; inherited forms of liver disease, such as progressive familial intrahepatic cholestasis syndromes (aka PFIC syndromes); nonalcoholic fatty liver disease and liver masses/tumors and diseases of the liver vessels. Many of these conditions can be treated without the need for liver transplantation.

In addition to the care of children with primary liver disease, we offer evaluation and management of children with inborn errors of metabolism like urea cycle disorders, which can be cured or ameliorated by liver transplantation. We offer evaluation of children with special risk factors for the future development of liver disease. Finally, we also provide expert care for children with portal hypertension who can benefit from meso-Rex bypass or splenorenal shunting instead of a transplant. In short, if your child has a condition involving the liver or the blood vessels of the liver, we can offer all care options.

What are some of the challenges of caring for this patient population?

Children with chronic liver disease can, in some cases, become quite ill and require very close management. For example, they may develop difficulties tolerating nutrition and maintaining a healthy body weight. In these circumstances, patients and families must cope with the stress of intensive management on top of all of the other stresses that come along with everyday life.

Some families are especially challenged due to limited social or financial resources that can make it more difficult for them to participate in their care. Our patients and their parents are at special risk for psychological distress in the form of anxiety, depression and, in some cases, post-traumatic stress disorder. For all of these reasons, we work hard to help our patients and their families anticipate and plan for what might be coming ahead in their care. We walk with them through every phase of their care, and we surround them with a full range of support personnel, including dietary, social work/financial services and mental health services.

How do you hope to make an impact at UVA?

We have an excellent pediatric liver transplant team. I am very excited to work with our Transplant Center Director, Dr. Jose Oberholzer; the Surgical Director of Pediatric Liver Transplantation, Dr. Nico Goldaracena; my hepatology colleague, Dr. Michael Mendoza; and our nurse practitioners Shelly Dean and Stephanie Kidney; as well as the entire Transplant Center administration.

My most immediate priority is to help maintain all of the current strengths of our pediatric liver transplant program. This includes sustaining our very important partnership with the Pediatric Liver Transplant program at UPMC Children’s Hospital of Pittsburgh and upholding our excellent transplant outcomes, all while we grow our hepatology services to reach even more children across the state of Virginia. We want to offer care for every child in Virginia who is in need of liver care, including liver transplantation.

Will you be involved in research at UVA? If so, what will be your focus?

The pediatric liver transplant program at UVA actively participates in clinical/research networks, such as Society of Pediatric Liver Transplantation (SPLIT) and the recently founded Starzl Network for Excellence in Pediatric Liver Transplantation (SNEPT). These networks link our program to other leading pediatric liver transplant centers in the U.S. and Canada in the conduct of research geared towards improving liver transplant outcomes for children. We are happy to continue to offer the benefits of participation in these networks to our patients and families.

In addition, one of my particular clinical research interests is Fontan-associated liver disease (liver disease that occurs as the result of the Fontan operation for the repair of congenital single-ventricle heart disease), and I plan to continue my research activities at UVA.

Is there anything in particular that excites you about the future of transplant medicine?

We will continue to see advances in our understanding of the causes and treatments of childhood liver disease, particularly exciting as one of our goals in the field has to be to lessen the need for liver transplantation by developing new and better medical therapies. Just one present example are ongoing trials investigating the utility of selective, apical bile acid transport inhibitors for the treatment of itching among children with certain inherited forms of cholestasis. Itching can be a particularly devastating consequence of cholestasis and, in some cases, leads to the need for liver transplantation. We look forward to the possibility of new treatment for some of these patients.

Another stimulating area of active investigation is the potential utility of advanced imaging modalities, such as liver elastography, to noninvasively profile the health of the liver and help to direct treatment of children with certain forms of chronic liver disease, such as Fontan-associated liver disease.

I am also very excited about the power of multicenter collaborations like SPLIT, and learning networks like the Starzl Network, to continue to improve outcomes for children who do require liver transplantation. This is taking place across a range of concerns, from access to organs and immune suppression adherence/tolerance to the transition of our older patients from pediatric to adult provider teams.

How would you describe your relationship with referring providers and why do you feel it’s important to maintain that relationship?

Referring providers are critical links between children and getting them the care that they need.

Our job is to:
• First, make sure that practices across the state of Virginia know and understand the services we provide to children and families
• Second, always be available for consultation
• Third, make it easy for patients to access our services in the form that is best for them, whether virtually or in clinic
• Fourth, provide excellent communication back to referring providers.

To refer your patient to UVA Children’s Hospital, call UVA Physician Direct at 800.552.3723