World leaders celebrate liver disease successes and prepare for challenges ahead
Yale’s liver program began with a biopsy in October 1947, one of the first liver biopsies ever performed. Gerald Klatskin, MD, founded the Liver Study Unit and developed the techniques that allowed him to perform the biopsy, even designing the biopsy needle. Klatskin, who was David Paige Smith Professor at the Yale School of Medicine (YSM), was also an amateur photographer. During his career, he assembled about 50,000 Kodachromes from 10,000 liver biopsies, said James L. Boyer, MD, FACEP, who trained with Klatskin in 1969.
Boyer, an associate professor of medicine (digestive diseases) and director emeritus of the Yale Liver Center, recalled how Klatskin recorded his data with a McBee Card Co punch card system. were when they were taken,” Boyer said at a talk celebrating Yale’s liver program.
The Yale Diamond Jubilee, Celebrating 75 years of Academic Hepatology at Yale, was held on February 25. The virtual meeting attracted an international roster of presenters and audience members, many of whom were former or current members of the Liver Program. Nearly 350 people registered for the one-day event. Presenters discussed the program’s global impact, its many successes in diagnosing and treating liver disease, while preparing for the challenges ahead.
The day began with welcoming remarks from Michael H. Nathanson, MD, PhD, Gladys Phillips Crofoot Professor of Medicine (Digestive Diseases) and Professor of Cell Biology, and Director of the Yale Liver Center. The keynote address was delivered by Dean Nancy J. Brown, MD.
The Liver Center is one of only three research centers in the country that focuses entirely on the liver and is sponsored by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK). Now in his 36’sand year of funding, the center has 86 members from 24 YSM departments and sections. Of those, 75% have joint posts with other center members, Nathanson said. The three thematic areas of the center are immunology/inflammation, hepatic metabolism and epithelial biology.
Nathanson pointed to the growing need for liver care in Connecticut. In the past year, one in seven people discharged from Yale New Haven Hospital had a primary or secondary liver diagnosis; The Yale Liver Tumor Committee discussed 619 patients; 2,170 liver-related interventional radiology procedures were performed; and 1,024 liver biopsies were reviewed. Yale has 65 outpatient liver clinics each week, including fatty liver clinics; liver cancer; Gaucher disease and other inherited liver diseases; viral hepatitis; liver transplant; alcohol and addiction in liver disease; and undiagnosed liver disease.
Today, the Yale Liver Center is more diverse than ever, Nathanson said. Of the clinical hepatology faculty members, half are women and more than 20% belong to underrepresented minorities.
One of its pioneering wives, Guadalupe Garcia-Tsao, MD, FRCP, Professor of Medicine (Digestive Diseases) and Chief of Digestive Diseases at VA-CT Hospital in West Haven, discussed groundbreaking hypertension research portal that she conducted with her mentor, Roberto Groszmann, MD. Garcia-Tsao also reported on the VA Hospital’s clinical practice of evaluating all veterans for hepatitis C (HCV) risk factors. The West Haven VA was one of four National Hepatitis C Resource Centers that created and implemented performance measures and initiatives to ensure patients with HCV were diagnosed and treated, a- she declared. Currently, about 90% of veterans with HCV have been treated and cured, she said.
The clinical practice also includes a tele-hepatology clinic that allows West Haven hepatologists to speak to veterans at clinics in central and western Massachusetts. “We can save patients a lot of time that it would take them to travel to us,” she said.
A tumor tracking system, based on radiology reports, was first implemented in West Haven VA, and has been expanded to include many other sites. The system was created by Tamar Taddei, MD, who will succeed Garcia-Tsao as VA Liver Chief beginning in July 2022.
In his presentation, Mario Strazzabosco, MD, PhD, professor of medicine and co-director of the Yale Liver Center, discussed future challenges in the diagnosis and treatment of liver disease. “Despite the tremendous therapeutic advances generated by academic hepatology, liver disease remains a growing global and national healthcare challenge, and the second leading cause of lost working life years,” Strazzabosco said. He urged the medical community to focus on prevention, screening, early diagnosis and therapy. “Clinical guidance in patients with liver disease is always oriented towards advanced disease and its complications, whereas the early and reversible stages of disease are often ignored and overlooked,” he explained. Liver disease results from potentially preventable epidemics of viral hepatitis, alcohol consumption, obesity, diabetes, and inequalities in underserved populations, including lack of health insurance that does not allow for a proper prevention.
Addressing the stigma often associated with liver disease should also be a priority, he added. Fear of being stigmatized causes people to delay or avoid seeing a doctor, and can lead to an increase in unhealthy behaviors as well as social isolation. As a result, more people will have serious liver disease in the future, he said.
As an introduction to subsequent sessions, Strazzabosco showed that liver research at Yale transcends the boundaries of specialties, sections, and departments. He reminded the audience that although improvements in medicine have thus far been driven by specialization, this will not hold in a future where hepatology must adopt models of care geared towards centered liver care. on the patient beyond traditional medical boundaries. The Liver Center can facilitate this transition by ensuring that clinical practice and research remain close, because there is research in health care and health care in research, he said.