Dania Brigham, MD, Provides Expert Insights on Pediatric Liver Transplantation

During her medical school rotations, Dania Brigham, MD, worked with pediatric patients for the first time. After that, she says, there was no going back. Drawn to the resilience of children and their simple desire to get back to playing and being a kid, Dr. Brigham has devoted her career to pediatric liver transplant. Through a focus on increasing liver transplant options for kids, fostering collaboration and training the next generation, Dr. Brigham has made a notable impact on not just patients, but their families and her team members.

In the following interview, edited for length, she shares key milestones in her career and what excites her about the future of pediatric liver transplantation.

Q: What drew you to the liver transplant field?

A: My path into pediatric liver transplant really began with an early fascination with how resilient children are and how transformative liver transplantation can be for them and their families. I came to Children's Hospital Colorado for my gastrointestinal (GI) fellowship. And during fellowship, I was really drawn to hepatology because it combines complex physiology, multidisciplinary care and the opportunity to build long-term relationships with patients. During fellowship I chose to continue with my training and to do an extra year of pediatric transplant hepatology fellowship to truly solidify my interest in this field. But really, the biggest guiding light for me was just seeing the ripple effect of what a liver transplant can do — not just for survival of the patient, but for restoration of childhood and just making the family feel like they have their child again.

Q: What are the moments that stand out to you in the work that you've done so far?

A: A few milestones stand out to me. Clinically, just being a part of a growing Living Donor Liver Transplant Program has been one of the most meaningful milestones. We helped establish pathways to safely expand living donation in pediatrics specifically. Not only is it lifesaving, but also life-restoring for families who would otherwise face very long wait times or clinical decline while waiting for a deceased donor organ.

Another major milestone has been our combined heart-liver transplant we recently completed, because we had never done that before. Being a part of the multidisciplinary team that coordinated all the care between cardiology, hepatology and transplant surgery was both humbling and very inspiring. It just took so many people to come to the table and come up with the pathway to take care of these patients.

Beyond the clinical work, continuing to contribute to multicenter research and education around both living donor and combined organ transplantation has been incredibly rewarding. And I'm also the Pediatric GI Fellowship Program Director. Teaching our fellows about care for liver patients and liver transplant patients has been greatly rewarding for me.

Q: Where have you been able to integrate research into your practice, and what research are you most excited about?

A: I'm more of a clinical hepatologist; however, I do have an interest in Fontan-associated liver disease. My clinical research in the past few years has been dedicated to Fontan-associated liver disease and figuring out which patients would benefit from a combined heart-liver transplant. Which patient would do well with a heart-only transplant? There are so many questions still left unanswered in that patient population, but we're gathering data from all the Fontan patients that we serve in our clinic.

Q: I wanted to talk a little bit more about the fellowship directing role that you've taken on. When did you take on that role? Why is that something you wanted to do?

A: I started in February 2022. Having done my fellowship here, I was able to bring that experience to the job. It's a three-year fellowship, and we have three fellows a year, so we have a total of nine fellows. It's been a very steep learning curve for me, but it's also great to be a part of a division where all the faculty really care about the education of our fellows. They want to train the next generation of GI doctors or hepatologists, and so it's been a really fun learning experience, and I love teaching. 

Q: How have you seen the field change since you began your career?

A: What's really exciting about how this field has changed is the spirit of collaboration across different disciplines. Pediatric transplant is no longer working in a siloed environment. It's integrating care with so many different multidisciplinary teams. We also work very closely with the interventional radiologist team. We could not take care of our liver transplant patients without them, because a lot of times patients develop complications post-transplant that require an interventional radiologist’s help. That's another big partnership that has grown immensely over the past couple of years.

Q: What are some of the biggest challenges facing the field?

A: I think the biggest thing in liver transplant is organ availability, especially for pediatric patients. That's where living donor liver transplant is becoming transformative, because it allows us to not only depend on the deceased donors or people that sign up to be deceased donors.

Another challenge is ensuring equitable access, because a lot of families from underrepresented backgrounds are those with limited resources or language barriers. They face more obstacles navigating the complex transplant process. There are studies showing that families from underrepresented backgrounds have less access to living donation as well. That's something that I bring up to the fellows so that when they start their journey as faculty, they can also challenge those problems and disparities.

Q: What are some of the advancements we're seeing with immunosuppression?

A: Researchers are studying which patients can come off of immunosuppressants completely. Currently, when we evaluate patients for liver transplant, it's a two-day process. They meet with every single member of our team — the surgeon, the pharmacist, the infectious disease team, the psychosocial team, the dietician, the liver transplant coordinator — everybody. And one of the big messages we tell them is that your child is going to be on immunosuppressants for the rest of their lives. However, that is likely going to change in their life or in their child's lifetime.

Q: What's coming down the line that you are excited about?

A: I'm most excited about a future where every child who needs a liver transplant can receive one and in time. Living donation is a key part of that vision, but so are advances in imaging, surgical techniques and immunosuppression care. I'm also very jazzed and energized about how we use innovation and collaboration to reach more patients and families. We're so uniquely positioned because we are one of the centers that does the most living donor liver transplants in the whole nation.