Bio

Bio


My career goal is to improve the health and lives of children with liver disease by making meaningful scientific contributions in the field of transplant hepatology that impact clinical care and improve outcomes for this patient population.

Clinical Focus


  • Pediatric Gastroenterology
  • Pediatric Transplant Hepatology

Academic Appointments


Administrative Appointments


  • Associate Program Director of the Transplant Hepatology Fellowship Program, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stanford University (2020 - Present)
  • Director of the Alagille Syndrome Program, Lucile Packard Children's Hospital, Stanford University (2019 - Present)

Honors & Awards


  • Young Investigator Travel Award, Society of Pediatric Liver Transplantation (SPLIT) (2019)
  • Advanced/Transplant Hepatology Fellowship Award, American Association for the Study of Liver Diseases (AASLD) (7/2017-7/2018)
  • Travel Award, Society of Pediatric Liver Transplantation (SPLIT) (2017)
  • Council Award to examine Hepatic Artery Thrombosis following Pediatric Liver Transplantation, Society of Pediatric Liver Transplantation (SPLIT) (9/2016-9/2017)
  • T32 Institutional National Research Service Award, NIH (3/2016-3/2017)
  • Young Investigator Travel Award, American Association of the Study of Liver Diseases (AASLD) (2016)
  • Research Grant to support examination of growth differences in children with VEO-IBD, University of California, San Francisco (6/2013-6/2014)
  • Patient Care Fund Award, UCSF, Benioff Children's Hospital (2013)
  • Patient Care Fund Award, San Francisco General Hospital (2013)
  • Teaching and Tomorrow Travel Award, NASPGHAN (2012)
  • Excellence in Pediatrics Award, Boston University School of Medicine (2011)
  • Gold Humanism Honor Society, Boston University School of Medicine (2010)
  • Master's Thesis Honors, Boston University School of Medicine (2007)
  • Arnold Award, Anatomy course, Boston University School of Medicine (2007)

Boards, Advisory Committees, Professional Organizations


  • Hepatology Special Interest Group Member, North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) (2019 - Present)
  • Member, Society of Pediatric Liver Transplantation (SPLIT) (2019 - Present)
  • Member, American Association for the Study of Liver Diseases (AASLD) (2015 - Present)
  • Member, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) (2014 - Present)
  • Member, American Academy of Pediatrics (AAP) (2011 - Present)

Professional Education


  • Board Certification: Transplant Hepatology, American Board of Pediatrics (2018)
  • Fellowship: UCSF Pediatric Transplant Hepatology (2018) CA
  • Board Certification: Pediatric Gastroenterology, American Board of Pediatrics (2017)
  • Fellowship: Seattle Children's Hospital Pediatric Gastroenterology Fellowship (2017) WA
  • Board Certification: Pediatrics, American Board of Pediatrics (2014)
  • Residency: UCSF Pediatric Residency (2014) CA
  • Medical Education: Boston University School of Medicine Office of the Registrar (2011) MA

Research & Scholarship

Current Research and Scholarly Interests


Current projects include:
-Alagille syndrome guidelines
-Long-term outcomes after liver transplantation for Alagille syndrome
-Perioperative management and long term outcomes after liver transplantation for metabolic liver disease
-Liver transplantation in congenital heart disease
-Acute liver failure in neonatal lupus
-de Novo autoimmune hepatitis after liver transplantation
-Biliary complications after liver transplantation
-Hepatic artery thrombosis after liver transplantation

Teaching

Graduate and Fellowship Programs


  • Gastroenterology & Hepatology (Fellowship Program)

Publications

All Publications


  • Decreased Incidence of Hepatic Artery Thrombosis in Pediatric Liver Transplantation Utilizing Technical Variant Grafts: Report of the Society of Pediatric Liver Transplantation (SPLIT) Experience. The Journal of pediatrics Ebel, N. H., Hsu, E. K., Dick, A. A., Shaffer, M. L., Carlin, K., Horslen, S. P. 2020

    Abstract

    OBJECTIVE: To evaluate risk factors for hepatic artery thrombosis (HAT) and examine the long-term outcomes of graft and patient survival following HAT in pediatric recipients of liver transplantation.STUDY DESIGN: Utilizing multicenter data from the Society of Pediatric Liver Transplantation (SPLIT), Kaplan-Meier and Cox regression analyses were performed on first-time pediatric (aged <18 years) liver transplant recipients (n=3801) in the United States and Canada between 1995 to 2016.RESULTS: Of children undergoing their first liver transplantation, 7.4% developed HAT within the first 90 days of transplantation and of those who were re-transplanted, 20.7% developed recurrent HAT. Prolonged warm ischemia times increased the odds of developing HAT (OR 1.11, p=0.02). Adolescents aged 11-17 years (OR 0.53, p=0.03) and recipients with split, reduced or living donor grafts had decreased odds of HAT (OR 0.59, P < .001 compared with whole grafts). Fifty percent of children who developed HAT developed graft failure within the first 90 days of transplantation (AHR 11.87, 95% CI 9.02,15.62) and had a significantly higher post-transplant mortality within the first 90 days of transplantation (AHR 6.18, 95% CI 4.01,9.53).CONCLUSIONS: These data from an international registry demonstrate poorer long-term graft and patient survival in pediatric recipients whose post-transplant course is complicated by HAT. Notably, recipients of technical variant grafts had lower odds of HAT compared with whole liver grafts.

    View details for DOI 10.1016/j.jpeds.2020.06.053

    View details for PubMedID 32585237

  • Hepatic Venous Pressure Gradient Measurements in Children: Correlation With Hepatic Histology and Clinical Indicators of Portal Hypertension. Journal of pediatric gastroenterology and nutrition Ebel, N. H., Carlin, K., Shaffer, M. L., Shivaram, G., Hawkins, M., Lane, E. R., Cooper, K., Lindquester, W. S., Gadodia, G., Murray, K. F. 2019; 68 (6): 788–92

    Abstract

    In adults, elevated hepatic venous pressure gradients (HVPGs) are correlated with the degree of liver fibrosis on histopathology and predict worse outcomes including variceal bleeding and death. We aimed to examine the association between HVPG measurements, histopathologic findings, and clinical indicators of portal hypertension in children.Utilizing retrospective data from 2 pediatric centers between 2006 and 2015, we identified children who underwent simultaneous HVPG measurement and transjugular liver biopsy. Medical charts were reviewed for histopathology, imaging, endoscopic, and clinical data.Forty-one children (median age 11 years) were included in the analysis with diagnoses of acute hepatitis (n = 15), chronic liver disease (n = 12), hepatic noncirrhotic portal hypertension (n = 4), acute liver failure (n = 3), and nonhepatic causes of portal hypertension (n = 7). Elevated mean HVPG measurements were found in children with acute liver failure (10 mmHg, range 4-12) and chronic liver disease (7 mmHg, range 1-12). HVPG measurements did not correlate with the histological severity of fibrosis (ρ = 0.23, P = 0.14) or portal inflammation (ρ = 0.24, P = 0.29), and no difference was found in HVPG when comparing children with and without a history of variceal bleeding (P = 0.43).HVPG measurements do not correlate significantly with the degree of hepatic fibrosis on biopsy. Furthermore, HVPG measurements are not associated with the presence of varices or history of variceal bleeding, suggesting the possibility of intrahepatic shunting in children with advanced liver disease. Therefore, unlike in adults, HVPG measurements may not accurately predict children who are at risk of complications from portal hypertension.

    View details for DOI 10.1097/MPG.0000000000002327

    View details for PubMedID 30921261

  • Editorial: an expert consensus for the management of chronic hepatitis B in Asian Americans. Alimentary pharmacology & therapeutics Ebel, N. H., Rosenthal, P. 2018; 47 (11): 1541–42

    View details for DOI 10.1111/apt.14620

    View details for PubMedID 29878412

  • Disparities in Waitlist and Posttransplantation Outcomes in Liver Transplant Registrants and Recipients Aged 18 to 24 Years: Analysis of the UNOS Database. Transplantation Ebel, N. H., Hsu, E. K., Berry, K., Horslen, S. P., Ioannou, G. N. 2017; 101 (7): 1616–27

    Abstract

    We evaluated liver transplantation waitlist and posttransplantation outcomes in those aged 18 to 24 years compared with both younger (0-17 years) and older (25-34 years) registrants and recipients.Using national data from the United Network for Organ Sharing, competing risk, Cox regression and Kaplan-Meier analyses were performed on first-time liver transplant registrants (n = 13 979) and recipients (n = 8718) ages 0 to 34 years between 2002 and 2015.Nonstatus 1A registrants, registrants aged 0 to 17 and 25 to 34 years were less likely to experience dropout from the waiting list compared with those aged 18 to 24 years (adjusted hazard ratio, 0-5 years = 0.36; 6-11 = 0.29; 12-17 = 0.48; 18-24 = 1.00; 25-34 = 0.82). Although there was no difference in risk of graft failure across all age groups, both younger and older age groups had significantly lower risk of posttransplant mortality compared with those aged 18 to 24 years (adjusted hazard ratio, for 0-5 years = 0.53, 6-11 = 0.48, 12-17 = 0.70, 18-24 = 1.00, 25-34 = 0.77). This may be related to lower likelihood of retransplantation after graft failure in those aged 18 to 24 years.This national registry study demonstrates for the first time poorer waitlist and postliver transplant outcomes in young adults ages 18 to 24 years at the time of listing and transplantation compared to older and younger age groups. Given the potential survival benefit in transplanting young adults and the shortage of solid organs for transplant, future studies are critical to identify and target modifiable risk factors to improve waitlist and long-term posttransplant outcomes in 18- to 24-year-old registrants and recipients.

    View details for DOI 10.1097/TP.0000000000001689

    View details for PubMedID 28230640

    View details for PubMedCentralID PMC5481466

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