Research opens the advantages of organ transfer to wider groups of people, including heart patients and reformed addicts.
People on methadone programs or with certain forms of heart disease are among liver patients who could now benefit from transplantation, Professor Geoff McCaughan head of the Centenary Institute’s Liver Injury and Cancer research program will tell the world’s largest annual conference of liver specialists in Boston today.
As an invited speaker to the joint meeting International Liver Transplantation Society and the American Association for the Study of Liver Diseases, Professor McCaughan will argue that advances in technology and medical therapy over the past decade mean that transplantation can improve the quality and expectancy of life of an increasing proportion of those suffering from liver disease.
Almost at the same time, his Centenary Institute colleague Dr Nick Shackel will be introducing postgraduate students attending the conference to systems biology—how genomic studies and bioinformatics can be used to help unravel the causes of liver disease and provide new possibilities for treatment.
“This is a holistic approach looking at everything in unity rather than at individual genes,” he says. “It partly stems from a recognition that liver disease, like diabetes or lung cancer or breast cancer or whatever, are likely to be caused by 50 or 60 different genes all acting together.”
“The fact that two speakers from the same research program at Centenary Institute have been invited to talk about widely different aspects of liver disease—cellular research and treatment protocol—not only illustrates worldwide recognition of the Institute’s work in the area, but also encapsulates how it forms a bridge between laboratory and clinic”, commented Centenary’s executive director, Professor Mathew Vadas, AO.
“We deliver the whole package,” says Professor McCaughan. “I work with Nick on genomics studies, and he works with me on the clinical side.”
And the message they will take to the conference is by no means the full story of what is happening in the program. It does cover work funded by the US National Institutes of Health, for instance, on what triggers alcohol-related liver disease. This study, in collaboration with Dr Devanshi Seth and Professor Paul Haber, is looking at the genetic basis of why some patients develop alcohol-related liver injury and others do not.
Determining the most appropriate candidates for transplantation—given the decreasing availability of livers for such purposes—is a complex and sensitive process. The patient has to be ill enough for a transplant to be of significant benefit, yet not so debilitated medically or socially that he or she would have difficulty in coping.
“But there is an increasing recognition that previously marginal candidates for liver transplantation can now receive therapies that allow a transplant to take place,” writes Professor McCaughan in a paper published this month in the journal, Liver Transplantation.
The paper calls for a revision of the guidelines used at present to determine who will receive transplants, particularly in the area of psychosocial issues, such as mental health and support mechanisms, where there are currently no written policies and in areas such as age limits and recovery from drug or alcohol addiction.