Scientists keep it simple
President-elect hones in on journals, membership, funding
Symposium critiques research by young investigators
Accidental acetaminophen poisoning causes ALF in adults
TIPS has role as salvage therapy for variceal hemorrhage
Plenary addresses liver transplantation, debates hepatology training prorgam
AASLD presents noteworthy Reaearch Highlights
Presidential Profile

Scientists keep it simple

Paraphrasing the classic KISS principle, a senior gastroenterologist co-chairing the AASLD Career Development Symposium Monday advised junior researchers to keep their scientific presentations simple, try not to convey too much information, and to “sell” their strongest research points.

“Show us what you really demonstrated conclusively [in your presentation] that makes your point, and don’t make conclusions about things that you did not demonstrate,” said Anna Mae Diehl, MD, chief, division of gastroenterology, Duke University Medical Center.

She and co-chairs Arun J. Sanyal, MD, and John G. McHutchison, MD, critiqued five junior investigators’ oral reports on Monday. AASLD’s career development sessions at DDW® allow junior investigators to practice presenting their research on liver disease before a friendly, non-threatening audience.

“Don’t be intimidated,” Dr. Sanyal, professor of medicine and chair, division of gastroenterology, Virginia Commonwealth University Medical Center, Richmond, told the young investigators before the session.

Among the participants was Christine K. Lee, MD, a fellow at Children’s Hospital, Boston, presenting research on “High Prevalence Psychiatric and Attention-Deficit/Hyperactivity Disorders in Children with NAFLD at Children’s Hospital Boston 1995–2005: A Retrospective Study.”

The authors found that 33.9 percent of NAFLD patients were on medication for psychiatric disorders and/or ADD/ADHD, and recommended further studies on the relationship between NAFLD and psychiatric disorders and ADD/ADHD.

Dr. Sanyal praised Dr. Lee’s presentation, but suggested that future research create a timeline for the appearance of NAFLD and psychological symptoms, and also for the time medications started. Dr. Lee said that would be considered for a prospective study.

In an interview after the session, Dr. Diehl said “keeping it simple” is not always easy for young investigators — or for some experienced speakers, either.

“People presenting [material] they’ve worked on for a long time tend to forget that not everyone in the audience is as familiar with that topic,” Dr. Diehl said. “Sometimes you have to ‘not’ tell everything, just the important things — you can’t convey everything in a ten-minute presentation.”

The other presenters were Gadi Lalazar, MD, Hadassah-Hebrew University Medical Center, Jerusalem; Dominik Huster, MD, University of Heidelberg, Germany; Tania M. Welzel, MD, National Cancer Institute, Bethesda, MD; and Guido Beldi, MD, Beth Israel Deaconess Medical Center, Boston.

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President-elect hones in on journals, membership, funding

AASLD President-elect Arthur J. McCullough, MD, possesses a keen interest in the association’s journal offerings — one that drives him to strengthen the scope of its publications.

Beyond Hepatology and Liver Transplantation, he is looking at creating a task force that would examine the future of AASLD’s journals overall. While the organization produces premier publications in the field of hepatology, there may be a need for a new journal focusing on clinical and global hepatology, said Dr. McCullough, professor of medicine at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University and chairman of the gastroenterology and hepatology department at the Cleveland Clinic.

“There’s been considerable emphasis on the research side of the organization, but I’ve been concerned that we have not been serving the clinical needs of our membership as much as we should,” said Dr. McCullough, whose journalistic interests have not been limited to the field of hepatology.

He was editor of his high school literary journal at Fordham Preparatory School, Bronx, NY, and was a staff writer for Fordham University’s student newspaper.

Beyond the possible introduction of a clinical journal, Dr. McCullough said he realizes that an examination of how best to move forward with the current journals is necessary. Given the journal’s 19 percent manuscript acceptance rate and the subsequent publication of rejected manuscripts in other reputable journals, an assessment of rejected Hepatology articles is warranted.

Additionally, Dr. McCullough’s journal agenda includes a review of their electronic presence, future avenues in advertising and whether self-publishing is a viable option.

Another area of interest for Dr. McCullough is the AASLD’s interactions with international associations, whose members have made it a priority to attend the AASLD Liver Meeting each fall.

“This is important to me because, like all areas of medicine, hepatology is becoming global,” he said. “We have an energetic and early association with the European Association for the Study of the Liver, but other organizations, including the Asian Pacific Association for the Study of the Liver and African Association for the Study of Liver Diseases, are worthy of our attention.”

From developing memorandums of understanding, to applying for joint research grants, to sharing funded fellowships, the partnership possibilities are considerable, he said.

“This is not an arranged marriage situation. We know each other, and we want to concentrate on science together,” Dr. McCullough said.

An example of doing just that is AASLD’s involvement in co-hosting a scientific meeting with the International Association for the Study of the Liver later this fall. While the meeting is held annually, it takes place in the U.S. every 10 years.

With membership increasing to all-time highs, so, too, is AASLD increasing in membership diversity. In this vein, another priority of Dr. McCullough’s is for AASLD to create a more inclusive environment for its surgeon members.

Part and parcel of developing a program that meets the needs of a more diverse membership is to foster young investigators in the field of hepatology, said Dr. McCullough, whose own early interests set the stage for research focused on metabolism and metabolic liver disease.

“My feeling is that we need to try to attract people to come to hepatology earlier in their careers,” Dr. McCullough said. “The future of our profession and liver wellness for our country is dependent upon the next generation of scientists and clinicians.”

The decrease in physicians entering internal medicine impacts all subspecialties, and AASLD has been working with the ACP Subspeciality Council to devise strategies to attract young physicians. Until recently, Dr. McCullough was the AASLD representative to this council.

While he is clearly enthusiastic about serving AASLD, he is keenly aware that one of its greatest challenges — funding — must be resolved. Given the current state of federal and industry funding opportunities, Dr. McCullough believes that AASLD must seek out alternate forms of support.

Funding has become less available than ever before, he said, and future success depends upon creating a foundation within AASLD or in collaboration with the American Liver Foundation.

“With industry support lessening, it is important to raise funds,” he said. “As the organization focused solely on advancing the science and practice of hepatology, this is necessary to help maintain the highest of ethical standards.”

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Symposium critiques research by young investigators

The AASLD presented its first-ever Career Development Symposium Monday morning to highlight a group of innovative abstracts related to liver disease from young physician-scientists in training. The goal of the session was not only to emphasize the research but also to evaluate the way the physicians presented the data and evaluated the results.

Following each presentation, the session’s chairs, Gregory J. Gores, MD, Scott L. Friedman, MD, and Laurie D. DeLeve, MD, gave the presenters feedback on their presentation, data and conclusions.

Some comments criticized the effectiveness and relevance of the slides the young researchers used to illustrate the data, saying that some slides did not match the data being presented and that some were not effective graphically.

The chairs often asked the scientists the broad implications of the results and conclusions of their studies. The chairs also asked the presenters if they had considered other conclusions from the results they found. In addition, the presenters were asked if they were planning future studies that would explore different aspects of their research or expand on their current research.

Researchers at the Kitasato Medical Center Hospital and two other research centers in Japan investigated the role of vascular endothelial growth factor (VEGF) on the caveolin-1 protein that is present in hepatic sinusoidal endothelial cells by isolating sinusoidal endothelial cells from rat livers using a collagenase infusion method.

They found that when sinusoidal endothelial cells were cultured in VEGF, the growth factor facilitate transport of Src-dependent phosphorylated caveolin-1 to the cells, which promotes cell fenestration and vascular permeability, said Hiroaki Yokomori, MD, who presented the study.

Investigators at the University of Toyama, Japan, tried to elucidate the precise pathogenesis of nonalcoholic steatohepatitis (NASH) to help point the way to a possible therapy for the disease. They evaluated the effects of the angiotensin II receptor blocker telmisartin, an antihypertensive agent and peroxisome-proliferator activated receptor-gamma agonist, on a murine NASH model.

They found that telmisartin attenuated the progression of NASH by decreasing the expression of the CC-chemokind ligand 2/monocyte chemoattractant protein-1 on circulating monocytes and by reducing the number of macrophages infiltrating the liver, thus preventing liver fibrosis, said presenter Hiroshi Kudo, MD. The researchers concluded that telmisartin might be a potential therapy for NASH.

Makoto Nakamuta, MD, and colleagues at Kyushu University in Fukuoka, Japan, evaluated the expression of genes related to fatty-acid metabolism using liver biopsy samples from 26 patients with nonalcoholic fatty liver disease (NAFLD) and 10 normal controls in an effort to understand the pathogenesis of the disease.

Their research using real-time polymerase chain-reaction analysis indicated that increased de novo synthesis and uptake of fatty acid led to further accumulation of fatty acids in hepatocytes and that mitochondrial fatty acid oxidation was fully activated in NAFLD.

Dr. Nakamuta said that sterol regulatory element-binding protein 1c (SRBP1c), a transcriptional factor, positively regulates fatty acid synthesis. He and his colleagues concluded that increased fatty acid synthesis, which is considered a primary event in NAFLD, could be attributed to enhanced SRBP1c regulation controlled by a balance between adenosine monophosphate kinase and insulin.

Tatiana Kisseleva, MD, from the University of California, San Diego, presented a study designed to determine if bone marrow cells give rise to activated hepatic stellate cells/myofibroblasts in response to liver injury in a mouse model. Dr. Kisseleva said that activation of hepatic stellate cells into collagen type 1 expressing myofibroblasts plays a key role in the pathogenesis of liver fibrosis, which is associated with many chronic liver diseases.

She and her colleagues concluded that the liver is the major source of hepatic stellate cells that play a role in liver fibrosis and that these cells are activated in response to injury. However, transdifferentiation of bone marrow cells into hepatic stellate cells/myofibroblasts occurs in vivo, but with low frequency.

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Accidental acetaminophen poisoning causes ALF in adults

Acetaminophen poisoning due to accidental overdose is an increasingly frequent cause of acute liver failure (ALF) in adults and accounts for about half the acetaminophen cases of ALF in the U.S. But how could a person take that much acetaminophen by accident?

“Oftentimes people have the flu and are taking acetaminophen to control the fever and a cold medication that they don’t realize also contains acetaminophen. They also are fasting, so the threshold for acetaminophen toxicity is lower,” said Timothy J. Davern II, MD, associate professor of medicine at the University of California, San Francisco.

Dr. Davern will discuss the diagnosis, etiology, complications and management of ALF in one of today’s AASLD State-of-Art Lectures.

Accidental poisonings, or so-called “therapeutic misadventures,” also can occur when a patient takes acetaminophen for long-term chronic pain.

“They may be overdosing on a regular basis by taking huge doses of acetaminophen, often in the form of an acetaminophen-opiate combination, such as Vicodin,” Dr. Davern said. “But they don’t develop liver failure until they develop an intercurrent illness with fasting or unwittingly taking additional acetaminophen above and beyond their chronic doses.”

“Acetaminophen-opiate combinations are inherently dangerous, ill-conceived drugs, and they should be removed from the market.”

The risk increases when patients take an acetaminophen-opiate combination for chronic pain. If they begin to tolerate the opiate and have inadequate pain relief, they might increase their dosage and again push the acetaminophen to a toxic level, he said.

“That’s a critical point. These aren’t people who have cirrhosis and suddenly have acute liver failure,” Dr. Davern said. “They will have no history of liver disease, but they suddenly become critically ill with little, if any, warning.”

ALF accounts for approximately 6 percent of liver transplants in the U.S., but Dr. Davern said that some patients could recover without transplant if treated early. If given before severe liver injury develops, acetaminophen antidote N-acetyl cysteine (NAC) is highly effective, even with very large ingestions of acetaminophen, he said.

“Physicians should have a very low threshold to start NAC because it has very few side effects and is highly effective if administered early,” Dr. Davern said.

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TIPS has role as salvage therapy for variceal hemorrhage

Most complications of cirrhosis, including variceal hemorrhage, ascites and encephalopathy, are due to portal and sinusoidal hypertension. A variety of therapies are available for these complications, such as endoscopic and pharmacologic therapy, surgery and transjugular intrahepatic portosystemic shunt (TIPS).

In a State-of-the-Art Lecture Sunday, Guadalupe Garcia-Tsao, MD, described the role of TIPS in relieving portal and sinusoidal hypertension and treating variceal hemorrhage and ascites. Dr. Garcia-Tsao is professor of medicine at Yale University School of Medicine and director of the Connecticut VA Hepatitis C Resource Center in West Haven.

“TIPS is a non-surgical, radiologically placed shunt. In Europe, hepatologists perform the procedure, but in our country, interventional radiologists must perform TIPS. The procedure connects an intrahepatic branch of the central hepatic vein through the liver parenchyma and acts to normalize both portal and sinusoidal pressure,” Dr. Garcia-Tsao said.

TIPS treats sinusoidal pressure to stop or reduce ascites formation, and it reduces portal pressure to prevent rebleeding from varices, she explained. However, it also increases portosystemic shunting of blood and thereby the risk of encephalopathy. “That’s why this is not the perfect therapy,” she said.

Some complications of the procedure are related to placement of the shunt and include puncture of the liver capsule with resulting abdominal hemorrhage and the creation of fistulae. Other complications are related to the stent that is placed in the central hepatic vein. They include biliary obstruction and late TIPS stenosis. The incidence of stenosis ranges from 18 percent to 78 percent. Physicians usually detect stenosis using Doppler ultrasound.

A major indication for the use of TIPS is as salvage therapy for patients with acute variceal hemorrhage refractory to pharmacologic and endoscopic therapy, Dr. Garcia-Tsao said. Its success rate is high, from 90 percent to 100 percent.

After varices have bled once, the risk of rebleeding is at least 50 percent, and many patients die. The use of TIPS is indicated after a second rebleed, but it should not be used to prevent rebleeding in patients who have bled only once from esophageal varices, she said.

Studies that have compared TIPS with shunt surgery to prevent rebleeding refractory to medical therapy have found similar rates of rebleeding, encephalopathy and all-cause mortality. However, TIPS therapy was associated with a significant reintervention rate, although the studies involved the use of bare metal stents, while coated stents are now routinely used for most TIPS procedures, which produce better outcomes. Dr. Garcia-Tsao concluded that TIPS and surgical shunts are now probably equivalent in outcomes.

TIPS is indicated as second-line therapy for patients with refractory ascites associated with cirrhosis after treatment with large-volume paracentesis and albumin, she said. TIPS decreases the need for repeated large-volume paracentesis, but it should only be used for patients who cannot tolerate repeated paracentesis.

Finally, the absolute contraindications to using TIPS include congestive heart failure, multiple hepatic cysts, uncontrolled systemic infection or sepsis, and unrelieved biliary obstruction. The relative contraindications include hepatoma (especially if central), obstruction of all hepatic veins and portal vein thrombosis, Dr. Garcia-Tsao said.

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Plenary addresses liver transplantation, debates hepatology training program

Sunday, the AASLD Plenary session ranged from the clinical, in which a possible advance in liver donation was unveiled, to the political, in which the concept of a subspecialty in hepatology was proposed.

Study suggests HCV-positive livers may benefit HCV-positive transplant patients

Liver transplant recipients with hepatitis C show a slower rate of progression to fibrosis when they receive HCV-positive livers, which suggests the infection may confer a survival advantage in these patients, Sydney Wilson, MD said at the AASLD plenary session.

“We are seeing a trend,” affirmed Dr. Wilson, an internal medicine resident at the University of Indiana in Indianapolis. Results from the case-control study seem to improve the outlook for use of HCV-positive donor-livers (genotype 1) in patients with HCV. However, the investigation relied on findings from about 30 patients who have been followed for only a year, Dr. Wilson noted. So far, there are no differences in survival among the graft recipients.

One explanation for the comparatively slower fibrosis is that an HCV-positive liver, when transplanted, goes into a “peaceful coexistence” with an HCV-positive patient — in terms of a physiologic response, explained Paul Kwo, MD, the lead author of the investigation and director of liver transplantation program at the University of Indiana.

In an interview, Dr. Kwo noted that some centers already are transplanting HCV-positive donor livers into HCV-positive recipients, but often it is after the donor-liver criteria have been broadened. When asked whether these livers should instead be first-line therapy in HCV-positive patient groups, Dr. Kwo replied, perhaps, but the answer won’t be clear until more studies are conducted.

Hepatology training program proposed, debated

Market demand for a larger pool of specialists to treat patients with liver disease is a compelling reason to consider a hepatology training program, said Bruce Bacon, MD, the James F. King, MD, endowed chair in gastroenterology and professor of internal medicine at Saint Louis University School of Medicine in St. Louis.

Traditionally, transplant hepatology programs have been a component of gastroenterology training, he noted. Current requirements mandate three years of internal medicine, three subsequent years of gastroenterolgy and another year of education in transplant hepatology. After that, a certificate of added qualifications can be attained. That’s a long time stretch, he said.

A two-year program for hepatology after internal medicine training would shorten the time for specifically learning about treating the liver without reducing the quality of training, he said. In fact, it could be done along with a gastroenterology program, allowing for the possibility of “double-boarding” from a new kind of four-year program down the line. “This confronts the reality of the needs,” he said.

Not everyone agreed. “Separating hepatology and gastroenterology is a very thorny issue,” said Lawrence S. Friedman, MD, chair of the subspecialty board on gastroenterology for the American Board of Internal Medicine. The idea of a “focus certification,” however has taken root with the advent of hospitalists. Such a process allows certification by exam after a practice period.

“I am not certified, but that [a hepatologist] is what I am,” declared Milton Mutchnick, MD, professor of medicine at Wayne State University in Detroit. He expressed skepticism about change: “We have been talking about this for 35 years,” he said.

Some of those who attended the session wondered whether a “hepatologist” would be able to practice, in an economically viable way, outside of medical academia.

“I have seen group practices where this has been done,” commented Emmet Keeffe, MD, professor of medicine and chief of hepatology at Stanford University Medical Center in Palo Alto, CA.

Nicholas F. LaRusso, MD, incoming president of the AGA Institute, said he thinks there is an even more pressing problem with regard to training: the diminishing interest of medical-school graduates in internal medicine. However, in terms of any subspecialty training, the case could be made for shortening the path, in a more tailored approach. “New models for training have to be explored,” he said.

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AASLD presents noteworthy Research Highlights

A full audience attended the AASLD’s Research Highlights session at DDW® Saturday, a session that featured noteworthy research from the AASLD 2006 Annual Meeting, Clinical Research Single Topic Conference (STC) on alcoholic and non-alcoholic steatohepatitis (ASH/NASH), and Endpoints STC on hepatocellular carcinoma.

The session began with research highlights from the 2006 Liver Meeting on hepatitis B, hepatitis C and cirrhosis.

Hepatitis B

Anna S.F. Lok, MD, professor of internal medicine and director of clinical hepatology at the University of Michigan Health System, Ann Arbor, reviewed last year’s important presentations on new data on HBV therapies, management of lamivudine-resistant virus and predictors of mortality among HBsAg-positive persons.

Among the new drugs she discussed was telbivudine (LdT, Tyzeka), a beta-L nucleoside inhibitor of HBV polymerase. Dr. Lok said that in phase-IIb clinical trials comparing telbivudine with lamivudine, patients receiving telbivudine were shown to have a greater degree of viral suppression and a high proportion with normalized ALT. But in trials combining telbivudine with lamivudine, the combination study arm actually faired worse than with telbivudine alone, she said.

Telbivudine was well tolerated in phase-II trials, Dr. Lok said, but unfortunately it selects for the M204I mutation but not for the M204V mutation, and it is cross resistant with lamivudine.

Data from a phase-III study comparing telbivudine with lamivudine showed resistance developing already in 52 weeks. By week 104 there was 22-percent resistance among the HBsAg-positive patients and 9 percent in HBeAg-negative patients, compared with 35 percent and 22 percent, respectively, with lamivudine, indicating telbivudine offered a likelihood of resistance 40 percent to 50 percent of that of lamivudine.

Dr. Lok summarized the telbivudine studies saying the drug was found to have more potent antiviral activity than lamivudine and adefovir, but that it was cross resistant with lamivudine and had a high rate of drug resistance.

She said there is a proposal to start patients on telbivudine for 24 weeks, assess response, and if suboptimal suppression is seen then another drug should be added.

“Telbivudine has a limited role as monotherapy and may be best used in combination therapy,” Dr. Lok said.

Hepatitis C

The summary of the 2006 Liver Meeting continued with Michael W. Fried, MD, professor of medicine and director of hepatology at the University of North Carolina at Chapel Hill, speaking on hepatitis C. He focused on presentations dealing with improving patient response with currently available agents, concerning the challenge of using these agents in special populations, and addressing specifically targeted antiviral therapy for hepatitis C (STAT-C).

One way to improve response to current treatments is for patients to take their full doses and to complete their treatments. According to Dr. Fried, a Canadian study found a strong association between full compliance taking ribavirin and sustained virological response. Patients who took much less for whatever reason — nonadherence, side effects, etc. — were unlikely to have a sustained virological response.

He noted that this study was different than most previous studies because it was conducted in community-based practices versus universities.

Another study, WIN-R, evaluated weight-based ribavirin dosing. Earlier reports from this study found weight-based dosing to be important, and new findings reported in 2006 were that weight-based dosing is important in treating patients who weigh more than 125 kilograms. Patients in WIN-R with genotype-1 who were treated with 1400 mg ribavirin — the highest dose for the highest weight category — had a sustained 43-percent response rate compared with 15 percent in patients on a fixed dose that delivered a much lower amount of the drug.

Dr. Fried presented data from his own pilot study of patients with treatment-resistant characteristics such as genotype-1, high levels of viremia and weight of more than 85 kilograms. They were randomly assigned to standard doses of peg-interferon and ribavirin, to a higher dose of peg-interferon with a standard ribavirin dose, or to higher doses of both. He said the difference in impact was seen already in week four, a 28-percent rate of sustained response in the standard-dose arm versus 47 percent in the arm receiving intensified doses of both drugs.

Dr. Fried summarized his presentation with “headlines,” saying that ribavirin is still an important drug, nonresponders have limited options and “peg-interferon will be with us for the foreseeable future.”

Cirrhosis

Program chair Guadalupe Garcia-Tsao, MD, professor of medicine, at Yale University, New Haven, CT, and director of the Connecticut Veterans Affairs Hepatitis C Resource Center, West Haven, CT, said one of the specific complications that mark the transition from compensated to decompensated cirrhosis is hepatic venous pressure gradient.

She described a presentation at the 2006 meeting on predicting decompensation. The study included 213 patients with cirrhosis who did not have varices but did have portal hypertension with a hepatic venous pressure of gradient greater than six.
She said 52 patients developed decompensation by 51 months, and the strongest predictor of decompensation in these patients was the hepatic venous pressure gradient.

The best cutoff was 10 mmHg, she said. Patients who had an hepatic venous pressure gradient of less than 10 at baseline would not be compensated within their first two years.

Beta blockers versus ligation

Dr. Garcia-Tsao said patients with large varices are typically given primary prophylaxis with either beta blockers or ligation. Consensus conferences have recommended starting with beta blockers except for patients who cannot tolerate beta blockers or who have contraindications.

“All in all (efficacy of) beta blockers and ligation are pretty much the same,” she said, but a study presented at the 2006 meeting considered the preference of patients regarding their treatment. Using an interactive computer tablet, study participants completed a questionnaire, which compared the side effects of each treatment, and asked participants questions such as would they rather be fatigued or have a perforation.

“The bottom line was that 61 percent of patients preferred ligation and 39 percent preferred beta blockers,” Dr. Garcia-Tsao said.
She said the overwhelming points that influenced the majority in their decision were not wanting to be short of breath or have symptoms of low blood pressure or fatigue.

Encouraging young physicians to seek careers in hepatology was not a goal that AASLD President Gregory J. Gores, MD, selected lightly. After all, the mentors he encountered and looked to during his own training left lasting impressions.

“In my life, I’ve had excellent role models in a variety of senior hepatologists — people like E.R. Dickson, who was a prominent hepatologist, and Nicholas LaRusso, who is now president of the AGA Institute and a former president of AASLD,” he said.

Just as theses leaders have left their enduring mark, Dr. Gores has made it a priority to return the favor tenfold. By emphasizing career development in his presidency, he is hopeful that prominent AASLD members will not only provide junior members with personal and professional feedback, but help them achieve their goals.

“We want to make sure that they have access to appropriate career development opportunities and get them off on the right foot to begin careers in hepatology,” said Dr. Gores, the Reuben R. Eisenberg professor of medicine, chair of the division of gastroenterology and hepatology and director of the Center for Basic Research in Digestive Diseases at the Mayo Clinic College of Medicine, Rochester, MN.

While AASLD provides a career development workshop at its Annual Meeting, Dr. Gores helped bring the program to this year’s DDW® as well. On Saturday, fellows in gastroenterology and hepatology presented their first-authored work before mentorship experts during an interactive symposium. These established academicians, or as Dr. Gores referred to them, “gentle, nurturing souls,” are interested in the career development of fellows in gastroenterology and hepatology training programs.

Attracting individuals to the profession is vital because of the current inadequate supply of hepatologists, he said. One proposal to develop a two-year hepatology training program separate from the gastroenterology training program may help ease that strain on the field of hepatology.

“As part of my presidency, we will have a task force look at the future of the specialty. I would like the task force to assess the long-term needs, training required to meet those needs, differentiation of the specialty, and changes in demographics,” Dr. Gores said.
Beyond the manpower requirements of the profession, Dr. Gores is keenly aware that external, medically specific forces are fundamentally tied to the direction of the profession.

“While hepatitis C should become less prevalent as we cut down on the number of new cases,” he said, “obesity and obesity-related diseases may become more of a problem. We will look at how such forces will modulate the profession.”

His desire to enrich young minds is constant, as exemplified in his effort to partner with the AGA Institute on an academic skills workshop. This project for junior faculty would allow AASLD to bring the hepatology experience to the fore of that forum.

“We’re very sensitive to promoting the interests of trainees in our specialty, and we want to make sure that they have access to appropriate career-development opportunities,” he said. “Everything that happens is a team approach, but this has been a concerted interest of mine.”

Working with the AGA Institute and other like-minded societies is intuitive to Dr. Gores. Just in the last year, AASLD began to solidify a memorandum of understanding with the European Association for the Study of the Liver (EASL), including helping to host several conferences — one on metabolic liver disease and another on hepatocellular carcinoma.

Another goal for Dr. Gores was to create a therapeutic consensus-driven endpoints conference, which AASLD achieved late last year with its conference on hepatocellular carcinoma. AASLD is now in the process of producing a white-paper publication from this conference, which was endorsed by EASL and the AGA Institute. During the Research Highlights presentation Saturday at DDW, AASLD gave attendees summaries of the high-profile presentations from this conference, as well as from its 2006 Annual Meeting and its Clinical Research Single Topic Conference (STC) on alcoholic and non-alcoholic steatohepatitis (ASH/NASH).

Such conferences have been so successful that AASLD has decided to offer an Endpoints Conference in portal hypertension, he said.
For Dr. Gores, it’s good business sense to partner with other like-minded societies.

“We will continue to work with other societies to develop stronger partnerships in career development, thematic conferences and, perhaps, in areas of public policy,” he said.

He also has made it a goal to collaborate with other American medical societies regarding issues of universal concern, such as partnering to establish common practice guidelines.

“It makes sense for us to have a unified perspective and plan regarding governmental programs,” he said. “We’ve made rapid progress in this arena because the societies have common goals and objectives to address these external pressures. It’s been mutually beneficial.”

An example of his efforts to partner with other societies has been for AASLD to develop an ABIM Transplant Hepatology Certificate of Added Qualification (CAQ) review course, which was co-sponsored by the American Society of Transplantation, International Liver Transplantation Society and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition. The first course was held last year.

“By partnering with other societies, we support a common mission to train hepatologists for the future and help advance the science and practice of hepatology,” Dr. Gores said.

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