News

An international study led by researchers at Oxford University Hospitals NHS Foundation Trust has shown that patients with cirrhosis are at increased risk of dying as a result of COVID-19.

The study, published in the Journal of Hepatology, found that mortality from COVID-19 was particularly high among patients with more advanced cirrhosis (called Childs-Pugh B or C cirrhosis) and those with alcohol-related liver disease.

The study was a collaboration between scientists at the Oxford Liver Unit, based at Oxford’s John Radcliffe Hospital, and colleagues at the University of North Carolina (USA), and was supported by the European Association for the Study of the Liver (EASL)

The paper presented data on over 1,300 patients from 29 different countries and compared COVID-19 outcomes between patients with and without liver disease.

“Our study confirms that severity of liver disease is closely associated with poor outcomes from COVID-19, with cirrhosis patients being at significantly increased risk of death,” said Dr Thomas Marjot, who leads the study alongside Professor Eleanor Barnes of the University of Oxford’s Nuffield Department of Medicine.

“Given the huge global burden of cirrhosis, with an estimated 112 million people affected, and the resurgence of the virus in many areas of the world these findings have far-reaching implications for how we manage patients with liver disease during the pandemic. This includes the need to consider enhanced protection and social distancing for patients with advanced cirrhosis,” Dr Marjot explained.

The study found that mortality among patients with cirrhosis was 32%, compared with 8% in those without. However, the risk of mortality increased in those with more advanced forms of cirrhosis, rising as high as 51% in those in the most severe category. Other risk factors for death included advancing age and alcohol-related liver disease.

The majority of deaths in cirrhosis patients (71%) were from respiratory failure caused by COVID-19. The virus also seemed to cause a deterioration in liver function, with patients developing complications such as ascites or encephalopathy even in the absence of typical respiratory symptoms of COVID-19.

This work follows a recent publication from the same group in The Lancet Gastroenterology & Hepatology which showed that liver transplant recipients did not appear to be at increased risk of death from the virus.

Dr Andrew Moon at The University of North Carolina said: “This study nicely compliments our findings in patients with prior liver transplantation. In contrast to the presence of advanced cirrhosis, having a liver transplantation was not associated with increased risk of death from COVID-19. This suggests that we should aim to continue liver transplant services during the pandemic wherever possible.”

Professor Thomas Berg, EASL Vice-Secretary General and Head of the Division of Hepatology at Leipzig University Medical Centre in Germany, said: “The findings from this large registry study are very relevant to clinicians and patients worldwide, as we continue to optimise liver disease management during the pandemic.

“These results are timely and reinforce the recommendations made in the joint Position Papers by EASL and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) published in JHEP Reports, which offer guidance on how to approach patients with different types and stages of liver disease.”

ENDS

Contact:
Roy Probert, Senior Communications Manager
Mobile: 07341 115585 
roy.probert@ouh.nhs.uk 

The UK National Screening Committee (UK NSC) is welcoming you to take part in the 5th ‘Annual Call for New Topics’. This is an opportunity for you to propose a national screening programme for a condition not yet considered by the UK NSC.

If you have an idea for a proposal, then please follow this link to be taken to the guidance:
https://www.gov.uk/government/publications/uk-nsc-evidence-review-process/appendix-d-how-to-submit-a-proposal-to-the-uk-nsc .

Please ensure you read through it carefully and use the template submission form. This will help you through the various requirements of a proposal.

The deadline for submissions is midnight, Sunday 6th December 2020.

Evidence Team
UK National Screening Committee
www.screening.nhs.uk 

Public Health England hosts the UK National Screening Committee

Members are invited to vote for their next President Elect.

The successfully nominated candidates are:

• Professor Rajiv Jalan
• Professor David Jones
• Dr Rebecca Jones

If you are a BASL member and have not received a voting link please contact judy@basl.org.uk . 

Deadline for voting 23:59hrs on Thursday 10th September 2020. 

It is with great sadness that we record the passing of Professor Neil McIntyre on 19th July, aged 86. Neil was born on the 1st of May 1934 in Ferndale in the Rhondda Valley in Wales, and was educated at Rhondda County Grammar School for Boys. In 1951 he started his pre-clinical medical studies at King’s College, London, also achieving a 1st class BSc degree in Physiology in 1955. His clinical studies were at King’s College Hospital Medical School and he graduated MB BS in 1958 with distinctions in Pathology and Applied Pharmacology and Therapeutics. Thus he already had academic aspirations at that time, and indeed was co-author of publications in Nature and the British Journal of Experimental Pathology in 1955 and 1956. His early postgraduate training from 1959 to 1960 was at King’s College Hospital and the Hammersmith Hospital. In 1960 he was called up and was posted as a flight lieutenant in the Royal Air Force Medical Branch to what was then the State of Aden, where he spent three years.

On his return, he was appointed to the Royal Free Hospital and School of Medicine as a Medical Research Council Junior Research Fellow, and Registrar in Medicine to Professor Sheila Sherlock on the Academic Unit. His research led to his MD thesis (“Oral glucose tolerance; the physiological importance of the intestine and liver”)(1967). Meanwhile in 1966 he was awarded a two year Medical Research Council Travelling fellow at Harvard Medical School, working in the Gastrointestinal Unit, at the Massachusetts General Hospital with Professor Kurt Isselbacher.

After this in 1968 he returned to the UK and was appointed Senior Lecturer in the Department of Medicine (Liver Unit) at the Royal Free Hospital and School of Medicine, and was promoted through the years to Reader and then Professor. When Sheila Sherlock retired in October 1983, he was appointed to Chairman of the Department. With the joining of the Royal Free and University College Medical Schools he subsequently became Director of the Division of Hepatology at University College London Medical School and The Royal Free Hospital School of Medicine. He also served as Vice Dean and Clinical Sub-Dean until his retirement in 1999.

Neil enjoyed a long and productive academic career. Remarkably, as an undergraduate, he co-authored the two papers described above on the effects of denervation on the histochemical appearance of cholinesterase at the myoneural junction. Few could claim such a distinction. He and his team’s publications focussed on carbohydrate metabolism and insulin secretion, lipids, lipoproteins and cell membranes (particularly lecithin:cholesterol acyltransferase activity in liver disease), and the effect of lipoprotein changes on cell membranes composition and function. However he was the author of a myriad of clinical papers. His wide ranging interests in hepatology reflected the breadth and depth of his expertise, in a time when a narrow range of research topics was less required. Apart from the topics noted above, his publications ranged from haematological disorders in liver disease, portal hypertension, drug induced liver injury, alcoholic liver disease, genetic diseases, primary biliary cholangitis, computers in hospitals (in 1981), and computerised medical information (in 1974). A search of his seminal papers includes a classic description of haemolytic episodes in children and young people with Wilson's disease (New England Journal of Medicine, 1967).

He was the lead editor of the first edition of the Oxford Textbook of Clinical Hepatology in 1992, and co-editor of the second edition in 1999 with other renowned European hepatologists. This textbook presented a comprehensive account of clinical hepatology comprising more than 150 chapters by international experts in two volumes. Other books included 'Therapeutic Agents and the Liver', edited with Sheila Sherlock (1965); 'The Problem Orientated Medical Record: its Use in Hospital, General Practice, and Medical Education', edited with J.C. Petrie (1979); and
'Lipids and Lipoproteins in Clinical Practice' with David Harry in 1991.

Neil McIntyre had a particular lifelong interest in medical education and was instrumental in developing an up-to-date medical student curriculum at the Royal Free Hospital School of Medicine. He was always a stickler for the practice of clinical medicine and emphasized Oslerian traditions of history taking, and examination. He fostered, with considerable enthusiasm, Problem Orientated Medical Records (POMR), and audit. Amongst his more notable papers in these areas is one in the British Medical Journal which he co-authored with Sir Karl Popper, one of Britain’s foremost philosophers and social commentators, entitled “The critical attitude in medicine: the need for a new ethics”.

Neil also contributed to many learned Societies, including as secretary to the Medical Research Society (1972-1977) and the nascent European Association for the Study of the Liver (EASL)(1975-1977), as well as being a Council Member for Europe of the International Association for the Study of the Liver (IASL)(1978-1982). He was also a member of the Committee for the British Association for the Study of the Liver (1976-1978), as well as a member of Council of the British Society of Gastroenterology and of the Association for the Study of Medical Education. Between 1976 and 1978 he was also President of the Osler club of London. In 2006-2007 he was President of the History of Medicine Society of Wales. Neil was a member of Council and a member of the research committee of the Royal College of Physicians of London. He served as an associate editor of the Journal of Hepatology and on the editorial board of Gut

Neil was renowned for his eclectic interests and chose his subjects with considerable perspicacity. A keen medical historian from his student days, he spent much of his time in retirement working on his treatise “How British Women Became Doctors: The Story of the Royal Free Hospital and its Medical School” and on other historical topics. “I was concerned that the school’s remarkable past might be airbrushed from history and that the hospital might also fail to get the attention it deserved,” he said. In this book he described how a group of young female students formed the London School of Medicine for Women in 1874. They had been blocked from qualifying as doctors through any of the British universities, so took matters into their own hands. The Royal Free, then based at Gray’s Inn Road, stepped up to train the 14 students, admitting the women for clinical studies. This initiative “laid the ‘foundation stone’” for the medical education, qualification and licensing of women in Britain and many other countries.

He wrote of his interest in medical statues: “My interest in medical statues began as a student at King’s in the late 1950s when I wrote a short biography of its founder Robert Bentley Todd for the King’s College Hospital Gazette.” This led (as described in the publication of his lecture at the RCP of London) to his novel ‘hobby’: Neil identified more than 300 statues worldwide, and many busts and other monuments to doctors.

However, clinical medicine, basic science, medical education and medical history were not his only enthusiasms. He was a born and bred Welshman who espoused this part of his being enthusiastically throughout his life. He enjoyed rugby, which he played as a student, and cricket, and continued to play golf for as long as he was able. We remember him practicing his putting across his spacious office in the Academic Unit. Through this and the clinical and academic work Neil encouraged the Royal Free “international family” to continue their strong ties as first engendered by Sheila Sherlock. He will be remembered with respect and affection by numerous colleagues nationally and internationally and by a generation of Royal Free graduates.

Neil married Wendy Anne Kelsey in 1966, the year that she qualified from the Royal Free School of Medicine, and she became a highly respected general practitioner and trainer. They had one son, and one daughter and three grandchildren. His daughter also studied medicine at the Royal Free, continuing its proud tradition of women students.

We send our heartfelt condolences to Wendy, and all his family

Geoff Dusheiko and James Dooley
August 2020

I recall my first conversation with Dr Williams, nearly forty years ago in November 1980. Adrian Eddleston had accepted my application to join him as a research fellow in immunology on the Liver Unit pending an interview with the head of department. Laura, my first daughter, decided to make an entry on the morning of the interview, not unexpectedly since childbirth after a certain point never is, but certainly not on any planned schedule. I rang the Liver Unit very early that morning to apologise for my failure to attend the interview and to my surprise went straight through to Dr Williams. I had expected some warm words of congratulation, but the message was very short and simple. If I really wanted to work on the unit I must visit as soon as possible. I took that advice and attended for an interview the following week (we only discussed sailing) and as with so many people who preceded or followed me with “Roger” as our mentor it was the point in a career when Hepatology became the only option. That first conversation made me realise the professional commitment that he expected of himself and his colleagues. That conversation also instilled a feeling that persisted over 40 years in all my contacts with Roger that I had never quite worked hard enough. I have never met anyone with such a strong work ethic, nor anyone so driven to continue to research into liver disease. Often a difficult character, with views he held strongly, he earned the respect of all of us in the field and I will remember him with both respect and affection that only increased over 40 years. One word sums him up: unique.

He established the Liver Unit at King’s College Hospital in 1966, leading it for 30 years, by which time the unit was recognised internationally as one of the foremost liver centres for both clinical practice and clinical research. The early work in Acute Liver Failure in particular, was ground-breaking and established a clinical model that has since been copied everywhere. His contribution to clinical practice in Liver Transplantation was a first both in Europe and the UK and several years passed before other UK centres followed his example. Undoubtedly, physicians trained in his unit (or their trainees) comprise a majority of leading Hepatologists now practising in the UK, with many others trained on the Liver Unit leading similar units across the world. Perhaps only two UK physicians are recognised universally as giants in our field with professional lifespans exceeding many decades, namely the late Professor Dame Sheila Sherlock and Professor Roger Williams. He was awarded the order of CBE in the Queen’s Birthday Honours list of 1993, recognition of his outstanding contribution to medicine in the UK and in particular to Hepatology. In 2006 he was further honoured by the Queen, when included in a celebration for those who had continued to contribute to public service beyond the age of 65 years.

On his “retirement” from King’s College Hospital in 1996 Professor Williams continued his career in Hepatology as Professor of Hepatology and Director of the newly established Institute of Hepatology at University College London and also held an appointment as an Honorary Consultant Physician at UCLH NHS Foundation Trust; then in 2010 he established and became Director of the Institute of Hepatology and Foundation for Liver Research, where he remained at work 60 years from the start of his career in liver disease.

He was hyperactive in research (more than 2,500 original peer reviewed papers in a 60-year career with 340 published in the past 10 years); he continued to present keynote and ‘state of the art lectures’ (over 60 in his career with 25 since “retirement” in 1996); he continued to receive recognition from colleagues across the globe and received multiple awards for his contribution to Hepatology including highpoints such as the Hans Popper Life Achievement Award of the International Liver Congress in 2008, the Distinguished Service Award of the International Liver Transplantation Society in 2011 and most notably the Distinguished Achievement Award of the American Association for the Study of Liver Disease (AASLD) in 2013, the first and only time this award had been made to a UK Hepatologist. Similar career recognition by the European Association for the Study of the Liver had been planned for the annual meeting this year.

A major contribution to our field in the past decade was the Lancet Commission on Liver Disease in the UK alongside The Lancet’s Dr Richard Horton. This multi-disciplinary group, both created and held together by the force of Professor William’s character, has now published six annual reports with a seventh under review. Each of these highlights the worrisome prevalence of liver disease and liver cancer in the UK population, problems that increase year on year, are linked clearly to poverty and compounded by inequity of access to adequate liver services. He has illustrated the clinical problem for the next generation to resolve.

Professor Williams spent his life in Hepatology and BASL will undoubtedly celebrate the life of our own pioneer when large gatherings become possible once more. But for now, our thoughts are with his wife Stephanie, his family and his colleagues at the Institute of Liver Studies.

Graeme Alexander
July 2020