About

Therese Bittermann, MD, MSCE, is an Adjunct Associate Professor of Medicine in the Division of Gastroenterology at the University of Pennsylvania's Perelman School of Medicine. She is also a Senior Fellow at the Leonard Davis Institute of Health Economics. Her clinical expertise includes caring for patients with viral hepatitis, autoimmune diseases of the liver, fatty liver disease, liver tumors, and cirrhosis, with particular focus on pre- and post-transplantation management. Her research concentrates on the relationship between immunosuppression strategies and outcomes after liver transplantation. She has previous research experience related to organ allocation, living donor liver transplantation, transplant policy-making, disparities in liver care, and variability in patient care across centers, spanning both adult and pediatric transplant populations. Additionally, her research interests include autoimmune hepatitis and alcohol-associated liver disease. Dr. Bittermann holds an advanced degree in clinical epidemiology and has expertise in observational study designs, large databases, and statistical analysis.

Research topics

• Medicine
• Internal medicine
• Psychiatry
• Gerontology
• Virology
• Pathology
• Emergency medicine
• Demography
• Intensive care medicine

Selected publications

• Screening for Food Insecurity in Patients With Cirrhosis

  Journal of Clinical Gastroenterology · 2026-04-02

  articleSenior author

  INTRODUCTION: Data collection on food insecurity and barriers to a healthy diet is not routinely done in hepatology clinics, although the prevalence of food insecurity is likely high. This is a pilot study to estimate the prevalence of food insecurity and characterize food-insecure patients with cirrhosis who receive routine outpatient care. METHODS: Prospective survey of outpatients with cirrhosis to screen for food insecurity in the waiting room on the day of their appointment. Responses were linked to electronic medical record data for demographic, comorbidity, and health care utilization data. Descriptive statistics were calculated for patients who were food insecure versus food secure. Univariate and multivariable models were constructed to evaluate the relationships between patient factors and food insecurity. RESULTS: Of 150 respondents, 25% (n=38) screened positive for food insecurity. In total, 69% (n=104) reported difficulty making the best food choices for their cirrhosis, 89% (n=34) among the food insecure, and 54% (n=60) among the food secure. Compared with food-secure individuals, those with food insecurity were younger (mean age 58.1 vs. 63.5 y, P=0.02), had lower BMI (mean 27.9 vs. 30.9, P=0.03), and were more likely to be Hispanic (15.8% vs. 4.5%, P=0.05) and Medicaid-insured (28.9% vs. 10.7%, P=0.01). Both groups had similar cirrhosis etiologies, co-morbidities, decompensation events, ED visits, and hospital admissions within the past year. CONCLUSION: One in 4 patients screened during a routine outpatient hepatology visit reported food insecurity. Over 69% of patients reported difficulties with making cirrhosis-specific food choices, most of whom did not screen positive for food insecurity. Our findings underscore an urgent need for tailored screening and for interventions that address the unique barriers faced by cirrhosis patients.

  PublisherDOI

• Heterogeneity in liver transplantation practices for critically ill patients with chronic liver disease in the U.S.

  Liver Transplantation · 2026-02-02

  articleSenior authorCorresponding

  Liver transplantation (LT) in critically ill patients with chronic liver disease is a high-risk procedure. Recent studies show that the frequency of intensive care unit (ICU) LTs has risen, and outcomes of such transplants have improved significantly. Variation in practices and the impact of center experience with ICU LTs on outcomes is unknown outside of acute liver failure (ALF). This study evaluated the impact of center experience with ICU LT on outcome metrics. Using the United Network for Organ Sharing database, we conducted a retrospective analysis of adult liver transplants performed 2014-2023 in which the patient was in an ICU before transplant, excluding those listed for multiorgan, retransplant, or ALF. Critical care requirements, in-hospital, 1-year, and 3-year mortality, and retransplant were compared by center ICU LT volume quartiles. In total, 9542 ICU LTs were performed across 130 centers (12.8% of total LTs). Over half of U.S. centers performed fewer than 5 ICU LTs per year on average, while the centers in the highest quartile performed nearly two-thirds of all ICU LTs in this period. Utilization of dialysis and of concurrent critical care therapies in ICU LT recipients was higher at high-volume centers ( p <0.05). In-hospital, 1-year, and 3-year mortality for ICU LTs overall were 6.2%, 10.4%, and 23.1%, respectively, with no differences across center volume quartiles (all p >0.05). Adjusting for severity of illness, center volume of ICU LTs in the prior year was associated with a small but significant reduction in 1-year post-ICU LT mortality: aOR 0.96 per 5 ICU LTs ( p <0.001). Expansion of LT for ICU candidates does not appear to threaten center-based metrics and may even offer important benefits to future candidates.

  PublisherDOI

• Outcomes of Simultaneous Liver-Kidney Transplant and Kidney After Liver Transplant Using the Safety Net Criteria—A Single-center Experience

  Transplantation Direct · 2026-04-22

  articleOpen access

  Background. The impact of revised Organ Procurement and Transplantation Network policy defining eligibility for simultaneous liver-kidney (SLK) and the safety net criteria for kidney after liver (KAL) transplantation remains insufficiently characterized. Methods. We conducted a retrospective study of adults (&gt;18 y) evaluated for liver transplant alone (LTA), SLK, or KAL at the University of Pennsylvania from August 10, 2017, to February 28, 2023. The primary outcome was mortality among SLK and KAL recipients and those patients waitlisted for KAL. Secondary outcomes included native kidney recovery in LTA recipients, estimated glomerular filtration rate (eGFR) at 1 y post-kidney transplant, and time between liver and kidney transplants. Results. Of 1655 patients evaluated, 57 (3.4%) met SLK criteria; 49 (86%) underwent SLK and 8 (14%) received LTA. Among 1598 LTA candidates, 1010 (63%) were waitlisted and 717 (71%) received LTA. After excluding 9 early deaths (1.3%) that were unrelated to KAL delay, 67 survivors (9.5%) met KAL safety net criteria. Thirty-four (50.8%) were waitlisted (15 transplanted over a median of 220 d), 30 (44.8%) declined, and 3 (4.8%) remained under evaluation. Mortality was 4.1% after SLK and no deaths occurred after KAL &gt;3.7 and 3.1 y of follow-up, with 3 deaths (8.8%) among KAL waitlisted patients. Of the 16 KAL waitlisted patients alive without kidney transplant at last follow-up, 2 (12.5%) were delisted after documented renal recovery and an additional 9 (56.3%) had eGFR &gt;20 ml/min/1.73 m 2 and were being considered for delisting; together, 11 (68.8%) met predefined criteria for substantial native kidney recovery. One-year median eGFR was similar (SLK 51 versus KAL 54 mL/min/1.73 m 2 ; P = 0.6). Conclusions. Early post-LTA mortality was unrelated to delayed KAL transplantation. Recovery of native kidney function while waiting for KAL was frequent. KAL transplants occurred within a year of LTA with favorable survival and graft outcomes.

  PublisherDOI

• Stains in primary biliary cholangitis: Untangling promise from bias

  Hepatology · 2026-02-19

  article1st authorCorresponding
  PublisherDOI

• Delisting for clinical improvement as a proxy for recompensated cirrhosis on the U.S. liver transplant waitlist: A retrospective cohort study

  Liver Transplantation · 2026-04-21

  articleSenior author

  Recompensation is emerging as a concrete outcome for patients with effective disease-modifying treatments for cirrhosis. Delisting due to clinical improvement (DCI) from the liver transplant (LT) waitlist may serve as a proxy for recompensation. This study investigated factors associated with time on the waitlist and risk of relisting. This was a retrospective cohort study of patients listed for LT between January 1, 2005, and December 12, 2024, using the Organ Procurement and Transplantation Network (OPTN) database. Timing of DCI was categorized as: <1 year, 1-3 years, and ≥3 years. Of 127,168 patients, 6.9% achieved DCI. The proportion of patients experiencing DCI was highest for hepatitis B virus (9.9%), alcohol-associated liver disease (8.3%), and autoimmune hepatitis (8.2%). Median time to DCI was 2.5 years: 19% were delisted in <1 year, 39% in 1-3 years, and 42% in ≥3 years. Among patients waitlisted as Child-Turcotte-Pugh (CTP) class B or C, only 40.6% improved to CTP A at DCI. Relisting after DCI occurred in 9.6%, with 33% of these driven by hepatocellular carcinoma. In multivariable analysis, only patients with both MELD score improvement ≥3 points and CTP class improvement had significantly lower relisting risk after DCI (adjusted HR 0.52; p <0.001), but not those meeting either criterion individually. Additional relisting predictors included albumin <3.5 g/dL at DCI, male sex, and cirrhosis etiology (all p <0.001). The occurrence of DCI is variable across disease etiologies. Achieving combined improvement in MELD and CTP class may better identify durable clinical improvement and guide safe waitlist removal decisions.

  PublisherDOI

• Favorable outcomes for living donor liver transplantation in patients with rare neoplastic indications: results from the NALLDIG Consortium

  American Journal of Transplantation · 2026-01-01

  articleOpen access
  PublisherOA PDFDOI

• Cardiac sarcoidosis: new insights beyond the granuloma using spatial proteomics

  European Heart Journal · 2025-12-17 · 2 citations

  article

  BACKGROUND AND AIMS: Cardiac sarcoidosis (CS) is poorly understood, challenging to diagnose, and portends a poor prognosis. A lack of animal models necessitates the use of residual human samples to study sarcoidosis, which in turn necessitates the use of analytical tools compatible with archival, fixed tissue. This study employed high-plex spatial protein analysis to characterize the immunologic, fibrotic, and metabolic landscape of CS. METHODS: Cardiac tissues from 64 patients-39 with CS and 25 without CS (Controls)-were analysed using the GeoMx Digital Spatial Profiler. Regions of interest (ROIs) with and without granulomatous inflammation were selected to examine protein abundance. ROIs were further divided into areas of illumination to separately analyse distinct protein profiles in myocytes, stroma, and vessels. A 79-protein panel was used to characterize immune and parenchymal cell populations. Differential protein abundance was evaluated using mixed-effects modeling. A predictive model was developed using a subset of seven proteins to distinguish inflammation-free CS ROIs from control ROIs. RESULTS: Spatial profiling demonstrated marked heterogeneity within and between sarcoidosis granulomas. Inflammation-free ROIs from CS hearts exhibited a 'distance gradient', with protein abundance varying by proximity to granulomatous inflammation. The seven-protein predictive model achieved 95.9% accuracy and an area under the receiver operating characteristic curve of 0.993 in differentiating inflammation-free CS ROIs from Controls. CONCLUSIONS: Spatial proteomics revealed novel features of the CS microenvironment and identified a distinct immune signature in tissue lacking overt inflammation. These findings may improve diagnostic accuracy in clinical biopsies from patients with suspected CS.

  PublisherDOI

• Liver Transplantation for Autoimmune Hepatitis and Risk of Recurrent Disease

  Current Hepatology Reports · 2025-10-06

  articleOpen accessSenior author

  Abstract Purpose of Review This review addresses recent advances in the pre- and post-transplant clinical course and treatment of patients with autoimmune hepatitis (AIH), as well as current insights on disease recurrence. Recent Findings Patients transplanted for AIH have generally good outcomes after transplant but are at higher risk of rejection, disease recurrence, and infection than non-autoimmune liver diseases. There is no standardized post-transplant immunosuppression approach for this population. Summary Immunosuppression following liver transplantation for AIH should balance graft survival with disease recurrence and rejection while minimizing adverse outcomes of long-term immunosuppression. Future research should aim to address knowledge gaps related to the prevention, early detection, and treatment of AIH recurrence in high-risk populations. Appropriate characterization of these patients is essential to optimize and tailor their post-transplant care.

  PublisherOA PDFDOI

• Resource Utilization in Adolescent and Adult Cardiomyopathy and Heart Failure

  The Journal of Heart and Lung Transplantation · 2025-04-01

  article
  PublisherDOI

• The impact of food insecurity on chronic liver disease: A systematic review of the literature

  Hepatology Communications · 2025-10-21 · 1 citations

  reviewOpen access

  BACKGROUND: Chronic liver disease (CLD) poses a significant healthcare burden, with diet playing a crucial role in its management. Food insecurity, defined as limited or uncertain access to adequate food, may worsen liver disease outcomes due to reliance on nutrient-poor diets. While its association with chronic conditions is well-established, its impact on liver disease remains underexplored. This systematic review synthesizes evidence on the impact of food insecurity on liver disease development, progression, and outcomes, identifying gaps and informing future research and public health strategies. METHODS: Databases including Medline, CINAHL, Embase, and Web of Science were searched comprehensively through April 2025. Studies evaluating food insecurity and liver disease outcomes were included. Data on study design, population, definitions, and findings were extracted. Quality and risk of bias were assessed using the Mixed Methods Appraisal Tool. RESULTS: Of 17,609 studies identified, 17 met the inclusion criteria, predominantly from the United States. Most studies focused on metabolic dysfunction-associated steatotic liver disease (MASLD). Food insecurity was linked to increased odds of MASLD, advanced fibrosis, and mortality, with higher rates of hepatic steatosis, liver stiffness, and fibrosis progression in both pediatric and adult populations. Food insecurity was measured primarily using the USDA Household Food Security Survey Module, and liver outcomes via noninvasive techniques and biomarkers. CONCLUSIONS: Food insecurity is a potentially modifiable risk factor for liver disease progression, emphasizing the need for targeted interventions. Further research should explore food assistance interventions, its impact on diet and implement screening programs in hepatology clinics to inform tailored strategies addressing this critical determinant of liver health.

  PublisherDOI

Recent grants

• Impact of immunosuppression variability on outcomes after liver transplantation

  NIH · $171k · 2018–2023

• Impact of immunosuppression variability on outcomes after liver transplantation

  NIH · $762k · 2018–2024

Frequent coauthors

• David S. Goldberg

  Sylvester Comprehensive Cancer Center

  38 shared

• Peter L. Abt

  University of Pennsylvania

  23 shared

• Douglas E. Schaubel

  14 shared

• Nadim Mahmud

  13 shared

• James D. Lewis

  University of Pennsylvania

  13 shared

• Marina Serper

  University of Pennsylvania

  12 shared

• Kim M. Olthoff

  University of Pennsylvania

  11 shared

• K. Rajender Reddy

  University of Pennsylvania Health System

  11 shared

Labs

• Therese Bittermann LabPI