The Yale 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 the David Paige Smith Professor at Yale School of Medicine (YSM), also was 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, ensign professor of medicine (digestive diseases) and emeritus director, Yale Liver Center, recalled how Klatskin recorded his data with a punch card system from McBee Card Co. “The Kodachromes are every bit as beautiful today as they were when they were taken,” Boyer said during a talk celebrating Yale’s liver program.
The “Yale Diamond Jubilee, Celebrating 75 years of Academic Hepatology at Yale,” took place Feb 25. The virtual meeting drew an international roster of presenters and audience members, many of whom were alumni or current members of the liver program. Nearly 350 individuals registered for the day-long event. Presenters discussed the program’s world-wide impact, its many successes in diagnosing and treating liver disease, while preparing for the challenges ahead.
The day began with welcoming remarks by 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 opening address was by Dean Nancy J. Brown, MD.
The Liver Center is one of only three research centers in the country that is focused entirely on the liver that is sponsored by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK). Now in its 36th year of funding, the center has 86 members from 24 YSM departments and sections. Of these, 75% have joint publications with other center members, Nathanson said. The center’s three thematic areas are immunology/inflammation, hepatic metabolism, and epithelial biology.
Nathanson pointed out the growing need for liver care in Connecticut. During the past year, one in seven people discharged from Yale New Haven Hospital had a primary or secondary liver diagnosis; Yale’s liver tumor board 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 every week, including clinics for fatty liver; liver cancer; Gaucher’s and other inherited liver diseases; viral hepatitis; liver transplant; alcohol and addiction in liver disease; and undiagnosed liver diseases.
Today, the Yale Liver Center is more diverse than ever, Nathanson said. Of the clinical hepatology faculty members, half are women and over 20% are under-represented minorities.
One of its pioneering women, Guadalupe Garcia-Tsao, MD, FRCP, professor of medicine (digestive diseases) and the digestive diseases chief at the VA-CT hospital in West Haven, discussed the ground-breaking research on portal hypertension that she conducted with her mentor, Roberto Groszmann, MD. Garcia-Tsao also reported on the VA hospital’s clinical practice of assessing all veterans for risk factors for Hepatitis C (HCV). The West Haven VA was one of four national Hepatitis C Resource Centers that created and implemented performance measures and initiatives to ensure that patients with HCV were diagnosed and treated, she said. 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 the hepatologists in West Haven to talk 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 radiological reports, was first implemented at the 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 the VA’s liver chief as of July 2022.
In his presentation, Mario Strazzabosco, MD, PhD, professor of medicine and co-director of the Yale Liver Center, dealt with future challenges in the diagnosis and treatment of liver disease. “Despite tremendous therapeutic advances generated by academic hepatology, liver disease remains an increasing global and national health care challenge, and the second leading cause of years of working life lost,” Strazzabosco said. He urged the medical community to focus on prevention, screening, and early diagnosis and therapy. “The clinical focus in patients with liver disease is still oriented towards advanced disease and its complications, whereas early and reversible disease stages are frequently disregarded and overlooked,” he explained. Liver disease results from potentially preventable epidemics of viral hepatitis, alcohol consumption, obesity, diabetes, and inequalities in underserved populations, including the lack of health insurance that does not allow adequate prevention.
Fighting the stigma that often is associated with liver disease should also be a priority, he added. The fear of being stigmatized causes people to delay or avoid seeing a doctor, and can cause an increase in unhealthy behavior as well as social isolation. As a result, more people will have severe liver disease in the future, he said.
As an introduction to the following sessions, Strazzabosco showed that liver scholarship at Yale transcends specialty, sectional and departmental boundaries. He reminded the audience that although improvements in medicine have so far been driven by specialization, this will not hold in a future in which hepatology will need to embrace care models oriented towards a patient-centered liver care across classical medical boundaries. The Liver Center can facilitate that transition by making sure clinical practice and research remain close, as there is research in health care and health care in research, he said.