News

The BASL Annual Meeting 2017 was held between 20th to 22nd September on the Warwick University Campus with a splendid evening of dinner and jousting at Warwick Castle. Here we summarise some clinical highlights from the meeting.

In the Wednesday transplant section, Andrew Holt and Kerry Webb discussed individualisation of transplant assessment for patients with alcohol related liver disease, outlining guidelines which move away from the ‘six month rule’ of pre-transplantation abstinence and aim to provide uniformity of care amongst transplant units to avoid a perceived geographical variation in access to liver transplantation for this indication. The severe alcoholic hepatitis pilot was discussed by Ewen Forrest, who updated the group on the failure to recruit any patients to the pilot, but also stressed the lack of a robust statistical model to predict transplant need in this cohort.

In the field of stem cell transplantation, Fotis Sampaziotis presented his novel study demonstrating applicability of human derived stem cells to successfully populate a bioengineered mouse bile duct in vivo. Peter Friend delivered the Williams-Calne Lecture, which was a state of the art update on the current and future role of organ reperfusion preservation techniques in improving outcomes after liver transplant.

On Thursday morning, Ian Fellows’ erudite lecture highlighted the important role of sarcopenia in prognostication for patients with cirrhosis (perhaps best measured on the L3 slice of a non-contrast abdominal CT). He emphasised that patients with end stage chronic liver disease are invariably malnourished and require nutritional and dietetic support with high protein, high calorie supplementation ‘little and often’.

Tariq Iqbal presented data on a causal association between dysbiosis and liver disease in mouse models, thus highlighting potential novel therapeutic approaches in the field. Sotiris Mastoridis showed that exosomal MiRNA profiles may provide prognostic information in the field of acute liver failure. Gwilym Webb’s study of the epidemiological profile of autoimmune liver disease in the UK identified an interesting association between latitude and prevalence. Julia Verne presented the 2nd atlas of variation in risk factors and healthcare for liver disease in England. This forms an important reference document for all involved in hepatology service provision (https://fingertips.phe.org.uk/profile/atlas-of-variation).

Intrahepatic cholangiocarcinoma continues to confer a poor prognosis. Ali Yousuf presented a systematic review of the application of loco-regional therapies for inoperable disease. The SIRCCA trial is an international study comparing standard therapy versus selective internal radiation therapy (SIRT) for Inoperable disease and is open to recruitment in the UK.

George Mells, speaking on behalf of the UKPBC group, proposed a predictive model for identifying non-responders to ursodeoxycholic acid using pre-treatment parameters. The British Liver Trust Lecture given by Mary Ramsey outlined the economic and political hurdles which were overcome to provide the recently rolled out universal childhood hepatitis B vaccination programme in the UK. Tion Lim presented two cases of steroid resistant AIH which showed treatment response to interleukin-2 therapy that merits further evaluation in larger studies. The afternoon’s highlight was John O’ Grady’s Ralph Wright Lecture in which he emphasized the over-reliance on the p-value in the medical literature. He discussed the syndrome of “acute on chronic liver failure”, the contents of which he lays out in the October 2017 issue of Liver Transplantation.

Friday morning turned to case presentations. Lauren Johansen and Marianne Samyn presented the case of a young boy with juvenile PSC, highlighting the autoimmune element of the disease and the challenges of immune suppression management. Nowlan Selvapatt and Shahid Khan’s case led to a discussion of biomarker development in the field of cholangiocarcinoma and the need for larger studies in the field. Geoff Dusheiko and Shirin Demma expertly interweaved case and case discussion of a patient with active HDV, stressing the importance of universal HDV testing for patients with HBsAg seropositivity. Charlotte Grant and John Iredale discussed fibrosis regression in liver disease, exemplified by a case of recompensation after alcohol cessation and venesection in a patient with haemochromatosis and ARLD cirrhosis. Kris Bennett and Guru Aithal’s case led to a discussion of MRI in assessing for portal venous haemodynamics.

There were a number of noteworthy posters. Amongst these, Jayaswal showed that SVR12 is associated with reduction in liver fibroinflammation as assessed by MRI. Sherman demonstrated the potential value of combining ARFI and a “spleen-platelet/portal vein Doppler score” to predict clinically significant portal hypertension. Verne observed that the rate of cirrhosis related hospital admissions has more than doubled in the last ten years and that there was a high degree of variation in admission rates for paracentesis and oesophageal varices across different CCGs in England. Kamarajah showed that paired liver stiffness measurement compared favourably with paired liver biopsies in determining fibrosis progression for patients with NAFLD in Malaysia. Warburton demonstrated a complex biliary microbiome in “normal” human bile. Srivastava showed comparable liver transplant survival data between patients managed in a non-transplant and transplant liver centres in the UK. Delvincourt highlighted the role of self-expanding metal stents in the management of early post-transplant anastomotic biliary strictures. Campbell described the benefits of a shared palliative care liver pathway for the management of advanced liver disease in a hospice setting. Marra showed that 8-weeks of therapy with sofosbuvir/velpatasvir for patients with G3 HCV and advanced fibrosis achieved a 95% SVR.

Will Gelson
Consultant Hepatologist

Saqib Mumtaz
Hepatology Specialist Trainee

Specialist Clinical Fellow in Hepatology

Job Reference: 304-JSD-B079

Employer: University Hospital Birmingham NHS Foundation Trust - medical and dental

Department: Hepatology

Location: Birmingham

Salary: £50,500 - £68,680

Closing date 7th December 2017

For further information about this vacancy view on NHS Jobs by clicking > here. 

Responding to the UK Supreme Court judgment that minimum unit pricing is legal, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK, said:

“We are delighted with the Supreme Court’s judgement that minimum unit pricing is legal and can be implemented in Scotland. The decision today represents a great victory for the health of the public.

“Five years ago the legislation introducing MUP passed through the Scottish Parliament without opposition. It has taken five years to implement for the simple reason that the Scottish Whisky Association and others chose to challenge it in the courts. In that time many families have needlessly suffered the pain and heartache of losing a loved one.

“This decision has implications far beyond Scotland. Wales, Northern Ireland and the Republic of Ireland are now clear to progress their own plans for minimum unit pricing.

“The spotlight should now fall on England, where cheap alcohol is also causing considerable damage. Over 23,000 people in England die every year from alcohol-related causes, many of them coming from the poorest and most vulnerable sections of society. We urge the Westminster Government to act now and introduce the measure in England. A failure to do so will needlessly cost more lives.”

Information on the AHA’s campaign for minimum unit pricing, along with facts and figures on the estimated impacts of MUP, is available on the AHA website: http://ahauk.org/campaigning-minimum-unit-price-alcohol/ . 

About the Alcohol Health Alliance UK
The Alcohol Health Alliance UK (AHA) is a group of over 50 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. The AHA works together to:
- Highlight the rising levels of alcohol-related health harm
- Propose evidence-based solutions to reduce this harm
- Influence decision makers to take positive action to address the damage caused by alcohol misuse

For further information, please contact Matt Chorley, the AHA’s Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk  or on 0203 075 1726.

The Medical Research Foundation have recently launched a funding opportunity focused on Viral Hepatitis research. Due to overwhelming demand the deadline has been extended for applications to Friday 10th November 2017.

This funding is aimed at Mid-Career researchers, who are making the transition to independence, and will support research that will increase the understanding of the disease mechanisms underlying viral hepatitis.

This competition is open to all UK researchers at eligible institutions (UK HEIs, Research Council research institutes, hospitals, and other independent research organisations). Applicants must hold a PhD, DPhil or MD and be in the process of, or be ready for, transition to research independence.

There is up to £1.6 million available in this competition and applicants may apply for up to £300,000 to support their research, over a maximum of a three year period.

The application process is now open and the deadline has been extended to Friday 10th November 2017.

More information can be found on the Medical Research Foundation website > here.

The National Institute for Health and Care Excellence (NICE) is looking to appoint a number of people with the necessary experience and skills to fulfill the following roles:

• Health service representative – up to 3 people
• Lay member – 2 people

The appeal panel is responsible for hearing appeals against our draft final recommendations in the technology appraisal (new drugs and other technologies used in the NHS) and highly specialised technologies (the evaluation of technologies for treating patients with very rare diseases and very complex healthcare needs) programmes.

When an appeal is submitted an appeal panel comprising five members is drawn from those appointed to hear NICE appeals.

The health service representative must hold an active registration with the appropriate professional body (including for doctors, a licence to practise).

The lay representative must be a patient or carer, or a member of an organisation that represents patients or carers.

Appointees will need to have an ability to draw out and articulate a balanced view on the issues arising from an appeal that are relevant to patients, carers and/or members of the public, and an ability to critique and weigh up competing arguments and make decisions (sometimes difficult ones) in meetings that are open to the public. Appeal panels are established infrequently and appointees may only need to sit on a panel two to three times a year.

NICE welcome applicants from all interested parties. For further information on the role and how apply please refer to the NICE website: https://www.nice.org.uk/Get-Involved/join-a-committee . Alternatively you can contact Maria Pitan, Project Manager – Corporate Office by email maria.pitan@nice.org.uk .

Deadline for applications is midnight on Monday 2 October 2017.