Training the Next Generation: Pediatric Transplant Hepatology Fellowship at UPMC Children’s Hospital of Pittsburgh

The Pediatric Transplant Hepatology Fellowship at UPMC Children’s Hospital of Pittsburgh is a one-year, ACGME-accredited program that provides advanced training in hepatobiliary disorders and pediatric liver transplantation. Directed by James E. Squires, MD, MS, the fellowship is designed for physicians who have completed a three-year pediatric gastroenterology fellowship. Graduates are eligible for the American Board of Pediatrics Certificate of Added Qualification (CAQ) in Transplant Hepatology.

Clinical Depth and Multidisciplinary Collaboration

UPMC Children’s is home to one of the nation’s oldest and most experienced pediatric transplant programs. Its breadth of experience in living donor transplantation and metabolic disease expands the learning environment for fellows, who are immersed in both inpatient and outpatient care.

Each fellow spends six months on the inpatient hepatology service managing complex patients, fulfilling case and procedural requirements, and leading rounds, consults, and on-call assessments. The remaining months are flexible, allowing fellows to pursue individualized interests such as translational science, medical education, or advanced clinical electives. Weekly continuity clinics provide exposure to both pre- and posttransplant populations.

A core objective is to prepare fellows to function at the level of an attending physician in highly complex care environments. Trainees work closely with transplant surgeons, intensivists, pharmacists, and subspecialists across the hospital. They evolve from the role of information reporter to interpreter and decision-maker, integrating diverse perspectives into cohesive management plans.

Procedural Competency and Surgical Integration

Fellows gain hands-on experience performing liver biopsies alongside hepatology faculty and interventional radiologists, and they learn to integrate pathology results into care strategies. They also participate directly in perioperative management, observe organ procurements, and stand alongside surgeons during liver transplant procedures.

“The year is clinically intensive, which provides continuity with chronic care patients and exposes fellows to the full arc of the transplant journey, including both successes and complications,” says Dr. Squires. “Being shoulder to shoulder with the surgeons in the OR gives insights that directly shape postoperative management and patient counseling.”

Research and Scholarly Activity

Although the program’s emphasis is clinical, fellows are expected to engage in scholarly work. Each completes a project, often a case series of at least three patients, with the goal of producing a peer-reviewed publication. The fellowship also offers a structured research curriculum covering study design, statistics, grant writing, and presentation skills.

Fellows contribute to collaborative networks such as the Starzl Network for Excellence in Pediatric Transplantation and the Studies in Pediatric Liver Transplantation (SPLiT) consortium. These connections provide access to multicenter working groups, biweekly national lectures, and a peer community across the 12 U.S. fellowship sites.

“SPLiT has solved a key challenge,” explains Dr. Squires. “When you only have one fellow per year, it’s difficult to provide a comprehensive didactic series locally. By pooling resources, fellows gain structured education and vital peer connection.”

Program Significance

Beyond strengthening UPMC’s position as a national leader in pediatric liver transplantation, the fellowship reinvigorates the academic environment. “Trainees bring fresh energy and perspectives,” says Dr. Squires. “They ask why we do things a certain way, which forces us to revisit the literature and avoid institutional dogma. That questioning benefits faculty, staff, and ultimately our patients.”

Since its launch in 2018, the program has trained six physicians, all of whom have gone on to academic careers at major institutions. Two remain as part of the UPMC Children’s team. Graduates have contributed to cost-effectiveness studies, registry analyses, and national working groups, while maintaining active involvement in clinical innovation and scholarship.

“My vision is to attract the best candidates and graduate colleagues who will advance the field of pediatric hepatology and liver transplantation,” says Dr. Squires. “It is still a young program, but our graduates are publishing, collaborating, and shaping care at leading centers. Watching their careers develop has been incredibly rewarding.”

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