Q&A: Designing the Future of Pediatric Liver Transplant

Over the last year, the transplant arena has seen major changes related to organ allocation, trust in the system, technology improvements, new research and more. At Children’s Hospital Colorado, the transplant team has met these moments with new leadership at the helm.

Megan Adams, MD, Surgical Director of Pediatric Abdominal Transplant Surgery, took on her role early last year after her predecessor and mentor, Michael Wachs, MD, passed away. Since then, she’s played an integral role in leading the team in new directions, alongside Trevor Nydam, MD, Chief of the Division of Transplant Surgery in the University of Colorado’s Department of Surgery and surgeon at UCHealth, who stepped into his new role in June 2025. Because of the close affiliation between CU Anschutz, Children’s Colorado and UCHealth, Dr. Nydam’s role oversees transplant and ensures alignment across the medical campus.

Together, Dr. Adams and Dr. Nydam discuss their plans for the future of transplant, and the unique partnership between their organizations.

Looking toward the future of transplant

Q: What have been some of your immediate priorities since taking on your new role?

Dr. Adams: My broader goals for our transplant program clinically are to be able to offer living-donor liver transplant to all patients. There are just not many centers west of the Mississippi that currently do it. The priority is getting out the word that we will transplant kids that other centers aren't willing to transplant. We're ready to be innovative.

Q: What are you most excited about for the future of your department and particularly pediatric liver transplant?

Dr. Nydam: What excites me most about the future of our department is the momentum we are building — clinically, academically, and as a truly integrated program across pediatric and adult transplant. We are in a position where innovation, collaboration and experience are all coming together in a way that will meaningfully change how we care for patients.

I’m also incredibly excited about the people and the culture we are building. We are training the next generation of transplant leaders while fostering an environment that embraces innovation, collaboration and compassion.

When you bring all of that together, the future of liver transplantation is incredibly bright. We have the opportunity not only to improve outcomes, but to redefine what is possible for our patients and their families.

A transplant partnership that’s making an impact

Q: What is special about our partnership with UCHealth and CU Anschutz and how does that support our program?

Dr. Adams: Our whole group is centered under one division of transplant, with Dr. Nydam in charge. He is an adult transplant surgeon. He keeps our group cohesive. Our successes are also their successes. Our coordinators talk multiple times a week. I talk to the adult surgeons multiple times a week. Everybody functions under one giant umbrella. I don't think that happens everywhere, especially when you have two different freestanding institutions. Having a leader in Dr. Nydam, who is inclusive of everybody and wants to see everybody succeed, is hugely helpful to both programs.

Dr. Nydam: What makes the partnership between the university and Children’s Colorado truly special is that it is not just a collaboration — it is a mission-driven relationship that spans the entire continuum of care, from the adult living donor evaluation through pediatric transplant surgery. We are aligned clinically, academically and operationally, which allows us to care for living donors and transplant recipients as one unified program. Our level of continuity is incredibly rare and directly translates to better long-term outcomes, for both the living donor and pediatric recipient.

Q: What are some of the key challenges facing the transplant specialty and how is the partnership between Children’s Colorado and CU working to address them?

Dr. Nydam: The transplant field is facing several significant and evolving challenges. Most important among them is the ongoing shortage of deceased donor organs, which continues to limit access to lifesaving transplantation for many patients. This challenge is even more pronounced in pediatrics, where patients require appropriately size-matched organs — something that can be particularly difficult to find, especially for infants and small children. This is what makes living donor options so important. For pediatric patients, having close alignment between our programs allows for thoughtful, creative approaches to size-matching and organ acceptance, ensuring that we maximize opportunities for transplant while maintaining safety and excellent outcomes.

At the same time, we are caring for increasingly complex patients, navigating the need for lifelong, highly coordinated care, and addressing persistent barriers related to access, cost and health equity. As outcomes improve, more patients are living longer after transplant, which further increases the demand on systems designed to support them over decades. We are uniquely positioned to care for patients across the full lifespan. Pediatric transplant recipients are surviving and thriving into (and beyond) adulthood, and our integrated programs allow for a seamless transition with shared clinical pathways, aligned teams, and continuity of expertise. This directly addresses another one of the field’s biggest challenges: ensuring successful, lifelong outcomes.

Expertise on the Anschutz Medical Campus

Q: What kind of capabilities do we have that others might not? What kind of innovations are we willing to explore that others might not be able to?

Dr. Adams: Our hepatologists here are very good at getting kids ready for transplant — they’re good at keeping their nutrition up and are early to start total parenteral nutrition (TPN). We're using perfusion technologies now, which gives us access to more grafts. We have the living-donor option, and we have a pretty big team and a good group that we can bounce ideas off, and we have surgeons that are creative.

Q: How do our outcomes compare nationally, and in what areas are we particularly strong?

Dr. Adams: In 2025 and the first half of 2026, we have had 100% patient and graft survival for liver, which is excellent. We're transplanting everybody that comes to us. Our wait list time is short. And this is why our Living-Donor Program is so important, because we can transplant children before they get so sick that their only option is a deceased donor liver. If you can transplant them while they're relatively healthy, it's going to be more successful, they're going to recover better, and they're going to get home faster.

Q: What are some of our research priorities right now?

Dr. Adams: I think the big things happening in transplantation are happening in the perfusion arena — trying to rehabilitate marginal organs. Then, in terms of the immune suppression and infection prevention arena, we are looking at how to make lives more sustainable posttransplant without all of the complications that come with immunosuppression.

Setting goals for living-donor liver transplant

Q: When it comes to liver transplant in particular, why is taking an aggressive approach and being proactive especially valuable?

Dr. Adams: We're taking on cases that people probably wouldn't take on. Something that my mentor, Michael Wachs, very heavily instilled in me is that you can't make a decision based on what your outcomes are, because there's a real child and a real family right in front of you.

Q: Why aren't others doing living-donor transplant to the same degree that we are or as often as we are?

Dr. Adams: It can be scary to take a very healthy person to the operating room and take out 70% of their liver and put it into somebody else. It also requires a tremendous amount of people. You need two surgeons on the living donor and two on the recipient side, so it's a heavy lift. Not every hospital system has the capability for living-donor transplants, and that has had an impact on Medicaid’s willingness to cover the procedure, as well.

Advocating and building community support

Q: It sounds like much of your work over the next few years may be focused on advocacy. Why is that an important part of your role?

Dr. Adams: I think advocacy is going to become more important than ever. And talking to political figures and working with the government has never been a strong desire of mine, but I feel that's where we're going and that we're going to have to be involved for the sake of our patients and families.

Q: How else does our program work to support families beyond the clinical side of things?

Dr. Adams: One of the major barriers for families to multi-list at other centers is usually funds. Where are they going to stay while they're up here for six weeks or three months? How are they going to afford groceries and take care of their other kids at home? And when Dr. Wachs passed away, we set up a fund through the Children’s Hospital Colorado Foundation under his name to help families that are coming from out of state have money for housing, money for groceries. If we can even help five families using those funds, I think it'll make a difference.