Chronic Liver Disease

Transcript

• 00:05The liver has an incredible
• 00:07regenerative ability
• 00:08to allow us to keep
• 00:10living
• 00:10and being able to respond
• 00:12to injuries
• 00:14or to surgeries, which may
• 00:16remove part of it and
• 00:17allow it to reconstitute
• 00:19and perform its incredibly important
• 00:22functions for us. So liver
• 00:23has many functions,
• 00:25such as metabolizing
• 00:27toxins and produce proteins
• 00:29and coagulation factors.
• 00:32The liver is a powerhouse
• 00:33of biochemical
• 00:35function in the body.
• 00:37So chronic liver disease is
• 00:39the result
• 00:40of
• 00:41an ongoing
• 00:43damage and inflammation to the
• 00:45liver and an ongoing attempt
• 00:47to repair. This continuous
• 00:49repair rather than resolution
• 00:52ends up in the scarring
• 00:53of the liver
• 00:55and the regeneration
• 00:57among the scarring.
• 00:59This ultimately
• 01:00result in
• 01:01liver cirrhosis.
• 01:03We will eventually be able
• 01:04to find
• 01:06other pathways where we can
• 01:08accelerate the mechanisms of repair
• 01:10to remove some of that
• 01:12scar and allow
• 01:13the restitution
• 01:14of function within the liver.
• 01:16But sometimes it crosses a
• 01:18boundary.
• 01:19When is the liver
• 01:20progress to, end stage liver
• 01:22disease, liver transplant is the
• 01:24ultimate treatment
• 01:26options.
• 01:31Liver transplantation
• 01:32has really developed in incredibly
• 01:35from the nineteen seventies on
• 01:37and is now actually part
• 01:39of our standard armamentarium
• 01:41for treating patients either with
• 01:43severe acute liver failure or
• 01:45more commonly
• 01:46for the treatment of patients
• 01:48with chronic liver disease.
• 01:50We remove diseased liver and
• 01:52replacing with either from,
• 01:55deceased donor or or living
• 01:57donor liver. And that liver
• 01:59will regenerate
• 02:00in that individual
• 02:01to its
• 02:02same size. And then that
• 02:04segment that's removed from the,
• 02:07donor can be placed into
• 02:09the recipient and itself will
• 02:11regenerate and restore
• 02:13normal size, normal function of
• 02:15the liver.
• 02:17The goal is the people
• 02:19who doesn't have a good
• 02:20access to a deceased donor
• 02:22to have more transplant opportunity.
• 02:24Somebody who is very sick
• 02:26patient, deceased donor will be
• 02:28appropriate.
• 02:29And somebody who is not
• 02:31sick enough,
• 02:32does not have a good
• 02:34opportunity
• 02:34to have a deceased donor,
• 02:36living donor has a very
• 02:38viable option.
• 02:40We have such a dear
• 02:41organ shortage, and this is
• 02:43being worked on by trying
• 02:45to find ways of using
• 02:46other donor organs that might
• 02:48not have been able to
• 02:49be used before.
• 02:50So we incorporated new technology.
• 02:52It is called normothermic
• 02:54machine perfusion,
• 02:55which keeps our liver warm
• 02:57and also more viable. Using
• 02:59this technology,
• 03:00we can check liver function
• 03:03and also improve donor use.
• 03:05Transfer is physical because of
• 03:07basic research in immunology, because
• 03:09of basic research in how
• 03:10the liver react, because of
• 03:12a lot of research how
• 03:13do we transfer more liver
• 03:15that otherwise they would be
• 03:16discarded.
• 03:17But on the other hand,
• 03:18we learn from,
• 03:20the transplant
• 03:21and we
• 03:22learn from studying
• 03:24the explants.
• 03:29So here at Yale, we
• 03:30have a number of different
• 03:32groups that are involved in
• 03:34very excellent research and translational
• 03:36research.
• 03:38The mission of the liver
• 03:40center is actually to find
• 03:41better treatment for liver disease,
• 03:43and we do that by,
• 03:45improving the
• 03:47knowledge of the pathophysiology
• 03:48of the liver.
• 03:50We have three main themes.
• 03:53So one is inflammation,
• 03:54the other is metabolism, and
• 03:56the other is epithelial liver
• 03:57cell biology.
• 03:59But
• 04:00the intersection of these three
• 04:02then is relevant
• 04:04for
• 04:05basically
• 04:06all kind of liver diseases.
• 04:09There will be in the
• 04:10future therapies that will be
• 04:13able
• 04:14to interrupt the natural history
• 04:16of the disease otherwise
• 04:18and prevent the progression of
• 04:20disease, and some of these
• 04:22patients may never need a
• 04:23transplant.
• 04:24And so this is the
• 04:26wonderful
• 04:27nature of being involved in
• 04:28these major advancements and disruptors
• 04:31that have actually changed the
• 04:33natural course of disease. So
• 04:35it's a great time, but
• 04:36we need to do more
• 04:37still.