Introduction 
Biliary atresia (BA) is the leading cause of end-stage liver disease and primary indication of solid organ transplantation in children in the United States¹. Patient and family perspectives highlight gaps in BA care, from newborn screening through transplant and transition of care. To address this, we conducted roundtable sessions at the 2025 Cholestatic Liver Disease Summit in Denver, CO². 

Methods 
Participants from all cholestatic liver diseases including families, clinicians, researchers and industry partners were engaged in structured roundtable discussions across six domains: pruritus, nutrition, transplant, transition of care, mental health, and Comparative Effectiveness Research (CER)⁴. Each participant engaged in two topic-specific tables. Real-time qualitative notes were systematically coded using thematic analysis and supplemented with descriptive frequency counts to generate mixed-methods findings². 

Results 
BA-specific insights were prominent in Transplant (43%), Transition of Care (36%), and CER (21%) discussions. Transplant-related concerns focused on tacrolimus variability, toxicity, and long-term renal impact, with participants questioning optimal transplant timing in the evolving ileal bile acid transporter (IBAT) inhibitor therapeutic era. Transition challenges were universal, emphasizing inadequate adult-provider preparedness, limited communication, and psychological readiness needed for successful transition³. CER themes highlighted delayed or missed BA diagnoses. Families described inconsistent post-transplant experiences, medication burden, and unmet mental health needs. 

Conclusion 
As increasing numbers of BA patients reach adulthood, persistent medical, psychosocial, and care-coordination challenges underscore the need for longitudinal, lifespan-oriented care models³. We identified gaps in BA-specific transplant pathways, transition of care infrastructure, and standardized newborn screening. These priority areas should guide future biliary atresia research.