Overview: Liver disease and transplantation

Abstract

Australia has had a proud and enviable record of seminal contributions to hepatology, with many contributors. Thus, any attempt to summarize these contributions ab initio in a brief review article is a significant challenge, primarily because it is so easy to overlook or underestimate particular aspects. In this article, I have confined my comments primarily to the areas where the contributions have had a significant global impact and have clearly been recognized internationally. This means that many worthwhile Australian additions will be omitted if there was less apparent international impact. The first significant interest in liver disease in Australia was from the Melbourne group at the Walter and Eliza Hall Institute (WEHI) and Royal Melbourne Hospital, leading to seminal contributions to the description, diagnosis, aetiopathogenesis and therapy of autoimmune hepatitis and primary biliary cirrhosis. Others from Royal Prince Alfred Hospital in Sydney contributed substantially to the effects of immunosuppression of autoimmune hepatitis and to early descriptions of primary sclerosing cholangitis. Other areas where Australians have contributed significantly include steatohepatitis, iron metabolism (and in particular hemochromatosis), viral hepatitis (both at the molecular and clinical level), portal hypertension, and transplant immunology. The remarkable contribution of Professor Dame Sheila Sherlock to Australian hepatology is also summarized.

The liver and the waistline: Fifty years of growth

“…While endoplasmic reticulum CYPs are one potential source of hepatic oxidant stress, 63 mitochondria, peroxisomes, inflammatory cells, and iron are among other potentially more important factors 51,57,101 . Because iron likely mediates fibrogenesis in iron storage disorder 2 , and several studies have implicated raised serum ferritin and possible minor increases in iron stores in T2D and metabolic syndrome, 111 it was logical to establish whether hepatic iron could play a role in NASH pathogenesis. Lawrie Powell's group published the first major paper on this issue, first authored by DK George (Table 1).…”

“…The Gastroenterological Society of Australia was formed in 1959, at the peak of post‐world war 2 economic prosperity for Australia, when peptic ulcer disease (attributed by Australian research to aspirin abuse (reviewed by N Yeomans), 1 and later by Marshall and Warren to Helicobacter pylori ), inflammatory bowel disease, alcoholic and autoimmune liver diseases were the main interests of gastroenterologists and hepatology was in its infancy. The profile of diseases and technologies encompassed by the specialty has changed since then, with endoscopy, reflux disease (gastroesophageal reflux disease (GERD) ), cancers, irritable and inflammatory bowel disorders, hepatitis B and C, liver transplantation, and pancreatic disease among current pre‐occupations (see reviews in this Supplement) 1–9 . Pari passu the genetic and physical make‐up of Australians has changed in ways that influence the prevalence and pathogenesis of common diseases.…”

Fifty years of Australian gastroenterology and hepatology: A golden era of contributions to the region

“…These have been garnered from international exchange, including with Asia, and from the increasingly strong Australian Research Institutes. Yet, from the start, Australian investigators, for the most part working in Australia but also studying abroad, have made substantial contributions to a host of important gastrointestinal and liver disorders, in adults and in children; 1–3 the latter include discovery of the rotavirus and subsequent vaccine development 4 …”

“…In the early years, a focus was on autoimmune liver disease, to which Ian Mackay has made numerous outstanding contributions. Then, during the 1970s to the present, Lawrie Powell, June Halliday and many other members of their Brisbane group have led the world in characterizing iron‐storage disorders 2 . More recently, Australian researchers have contributed substantially to knowledge about hepatitis C and its treatment (reviewed by Geoff McCaughan), 5 mutations of the hepatitis B virus (Stephen Locarnini is the world guru) and to non‐alcoholic fatty liver disease (many leading investigators) 6 …”

“…Russell Strong pioneered this field in Australia (and more recently in Malaysia) and made several major advances, 11 including split‐liver transplantation that has made living‐related transplantation the safe, life‐saving operation that it now is in Japan, Korea, China including Hong Kong, Singapore, Malaysia and India. In this Supplement, Strong reviews the hurdles (particularly medico‐political) that had to be surmounted for all this to be achieved 2,11,12 . Meanwhile, current and future challenges in liver transplantation are reviewed by Elwyn Elias from Birmingham, UK, and this will be of great interest to colleagues in the region, 13 while Geoffrey Cleghorn has reviewed the important advances made in improving nutrition prior to successful pediatric liver transplantation 12 …”