Increases in unhealthy alcohol use have led to the rapid rise of alcohol associated liver disease making it an urgent health problem.  University of Michigan has led the way in advancing care for patients living with ALD. In 2018, the Michigan Alcohol Improvement Network (MAIN) ALD clinic was created as a state-of-the-art, evidence-based co-located liver treatment program. The clinic integrates addiction, behavioral and medical care to provide enhanced alcohol liver disease related care.  Combining experts from psychiatry, social work, nursing and hepatology, the clinic supports patients with a multidisciplinary team of providers. Reducing deaths and hospitalizations due to alcohol associated liver disease and improving access to cutting edge care is a priority of the MAIN ALD program. In 2024, the program recruited Dr. Ponni Perumalswami to lead it. 

The Michigan Cirrhosis Program is amongst the largest in the country. Led by Dr. Elliot Tapper, we take pride in elevating the quality of care provided to our patients while pushing the leading edge of research. We maintain a prospective registry of over 2,000 patients and counting. Dr. Tapper and Dr. Neehar Parikh investigators in the national, NIH-funded Liver Cirrhosis Network. Dr. Tapper and his colleagues led or co-led multiple NIH-funded projects including the Transitional Liver Clinic Trial and PCORI-funded projects including LiveSMART and PAL-LIVER. Additional investigators include Dr. Patricia Bloom who is discovering novel therapeutics and diagnostic tests for patients with or at-risk for hepatic encephalopathy. And Dr. Nik Mazumder is personalizing therapy for patients with cirrhosis and ascites with or at-risk for kidney injury.

Robert Fontana, MD, is recognized as an international authority in drug-induced liver injury (DILI). As the co-chair of the Drug-Induced Liver Injury Network (DILIN) funded by the NIDDK for the past 15 years, Dr. Fontana has published important papers on the etiology and outcomes of DILI both in children and adults from the Unites States.

Recently, Dr. Fontana has published papers demonstrating an increased susceptibility to minocycline and terbinafine hepatotoxicity among patients with unique HLA genotypes. These observations may improve the ability to more rapidly diagnose patients with idiosyncratic DILI. Other studies have reported an alarming increase in the incidence of liver injury attributed to a variety of herbal and dietary supplements. The DILIN is currently developing a prospective clinical trial for patients with severe acute DILI and also has a companion study exploring novel diagnostic and prognostic biomarkers. To learn more, visit the DILIN website.

The Liver Transplant Program at Michigan Medicine is a leader in the conditioning of donor organs from high-risk donors. A clinical trial with 10 other transplant sites is ongoing using a portable normothermic extracorporeal perfusion device, the Organox System, which has shown great promise in Europe.

If successful, this novel approach could enable us to substantially expand the donor supply and provide transplants to more patients."

- Robert Fontana, MD, Medical Director of the U-M Liver Transplant Program

Dr. Fontana is also involved in the implementation of protocols to expand the use of anti-HCV + donor livers and kidneys into recipients with HCV infection as well as those without pre-existing HCV via the use of potent Direct acting antiviral agents post-transplant

Dr. Fontana is also the Co-PI of Acute Liver Failure Study Group. This consortium of 13 major medical centers has played an important role in moving the field forward in improving outcomes and demonstrating the safety and efficacy of IV N-acetylcysteine to patients with non-acetaminophen related ALF. Other ongoing studies are exploring the use of Rotational Thromboelastography (ROTEM) in ALF patients as well as the deployment of a radiolabeled methacetin breath test to identify patients who may recover without a transplant.

Dr. Pratima Sharma was also the first to show that MELD-based allocation policy was associated with increased risk of new onset end stage renal disease. She and colleagues further constructed and validated a renal-risk index (RRI) that would predict the future risk of post-LT End Stage Renal Disease (ESRD). RRI model included 14 recipient factors independently associated (p<.05) with post-LT ESRD.

Dr. Christopher Sonnenday, Surgical Director for the liver transplant program, and Dr. Englesbe spearheaded the work on sarcopenia and frailty among liver transplant candidates and recipients. Now they are actively working towards incorporating their work in the Prehab Program for liver transplant candidates. Research protocols offering the latest treatments for patients with hepatitis C, alcoholic hepatitis and cholangiocarcinoma are also ongoing. Other studies include efforts led by Dr. Monica Tincopa regarding the optimal means of assessing cardiac risk prior to and after liver transplantation. Finally, Michigan Medicine has been a leader in the use of radiation therapy and other neo-adjuvant treatments for the management of liver cancer such as Y-90, which have led to improved outcomes and more patients becoming eligible for transplant.

The MASLD Clinic at Michigan Medicine is dedicated to comprehensive care of patients with steatotic liver disease, a condition that affects >30% of adults in the US and is a leading cause of end-stage liver disease. We consult with patients to thoughtfully assess the status of their liver disease and develop personalized care plans including dietary and exercise counseling, surgical and non-surgical procedures, and medications. We are also leaders in research on the causes, trajectories, and treatments of steatotic liver disease.

Vincent Chen, MD, MS is interested in precision health in MASLD—understanding why different people with MASLD have different clinical pictures ranging from stable disease to rapidly worsening disease, and eventually offering tailored treatment accordingly. He is an expert in clinical management of MASLD and was lead author on a 2024 national guideline document on drug therapy in MASLD. He also has a research interest in population genetics and has shown that genetics affects rate of disease progression and response to drug treatment, and he is interested in translating some of these findings to patient care.