Our Program consists of a team of highly skilled and experienced hepatologists, endoscopists, surgeons and radiologists to provide expert consultation and longitudinal care for patients with a full range of acute and chronic liver conditions.

• Blake 4
• Massachusetts General Hospital
• 55 Fruit Street
• Boston, MA 02114
• (617) 724-6006

Staff

Raymond T Chung, MD Director of Hepatology Director, Liver Program	Daniel Pratt, MD Director LBP Center
Jules Dienstag, MD Hepatology	Andrea Reid, MD Hepatology
Michael Thiim, MD Hepatology	Abigail Mithoefer, PA-C

Overview

The Liver Program offers expert consultative and longitudinal care for patients with acute and chronic liver disorders. Our experienced team of hepatologists seeks to individualize care for each patient. The Center works in seamless collaboration with four outstanding partners: the Liver Transplant Program, the Interventional Endoscopy Service, the Medical and Surgical Oncology Service and the Interventional Radiology Service. Our physicians participate in a wide array of clinical trial protocols to maximize our ability to provide state-of-the-art care to all patients.

Hepatitis B and C

Hepatitis literally means inflammation of the liver. There are many causes of hepatitis, among which are several different viruses; these are named the hepatitis A, B, C, D, and E viruses. While all of these viruses can cause acute, or short-term, viral hepatitis, hepatitis B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong, and can progress to cirrhosis. Our team employs the latest in disease management approaches for chronic hepatitis, particularly hepatitis B and C, the most common of the chronic hepatitis viruses. These approaches can provide maximal viral suppression (in the case of hepatitis B) and even sustained virus clearance (in the case of hepatitis C). In addition, we are a nationally recognized center for clinical trials of novel antiviral agents for chronic hepatitis B and C, including protease and polymerase inhibitors against hepatitis C. We are also nationally recognized for conducting fundamental research in the mechanisms by which these viruses cause liver damage and are active in clinical trials of HCV in special populations, such as patients who underwent liver transplant, as well as HCV-HIV coinfected persons.

Genetic Liver Disease

The Liver Program also cares for patients with inherited forms of chronic liver disease. These include hereditary hemochromatosis, a disorder leading to progressive iron overload of the liver and other organs, alpha-1-antitrypsin deficiency, a protein deficiency disorder that can lead to cirrhosis, and Wilson's disease, a condition that results in copper overload and liver disease.

Alcoholic Liver Disease

We offer expert care for persons suffering from the complications of chronic alcoholic liver disease. Alcohol can cause both hepatitis and cirrhosis. While abstinence and optimal nutrition are the keys to successful treatment, we have adopted a coordinated approach with our colleagues in Addiction Services to help promote commitment to abstinence.

Nonalcoholic Liver Disease

Fatty liver is estimated to affect about 10% of the adult US population, in large measure a medical consequence of obesity. Fatty infiltration of the liver can produce inflammation (steatohepatitis) and scarring (fibrosis) that ultimately can lead to cirrhosis. Thus, recognition and treatment of fatty liver, using dietary modifications, weight reduction, and novel drug therapies are a key activity of the Liver Program.

Autoimmune Liver Disease

The term "autoimmune liver disease" mainly refers to autoimmune hepatitis, a condition where one's own immune system inappropriately identifies parts of the liver as foreign and causes damage. Left untreated or partially treated, autoimmune hepatitis can progress to cirrhosis. Our team has extensive experience in the appropriate management of autoimmune hepatitis and has a particular interest and experience in managing patients with "refractory" autoimmune hepatitis. Refractory autoimmune hepatitis describes cases that fail to respond to standard therapy. Our team is also experienced with "overlap" autoimmune conditions, a rare circumstance where patients display manifestations of more than one immune related liver disease. Examples of this include overlap between autoimmune hepatitis and primary biliary cirrhosis (PBC - see the Cholestatic Liver Disease section) and overlap between autoimmune hepatitis and primary sclerosing cholangitis (PSC - see the Cholestatic Liver Disease section).

Cholestatic Liver Disease

Included under this heading are primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC).

PBC is a classic autoimmune condition. It is caused by one's own immune system inappropriately identifying the smallest bile duct in the liver as foreign and damaging them. PBC is believed to be a universally progressive condition. However, there are some therapies that have potential benefit for individual patients and it is critical that each patient be considered as an individual to allow for implementation of the most effective treatment plan.

PSC is a condition marked by damage to larger bile ducts, both inside and outside the liver. There is no currently FDA approved treatment for PSC. The management of this condition is complex and requires a multidisciplinary approach including hepatologists, interventional endoscopists and radiologists, and surgeons.

Our team has a long experience managing both of these conditions and is involved in clinical trials looking at novel therapies to treat these conditions, providing hope for the future.

End-stage liver Disease and Liver Transplanation

Liver transplantation is the surgical removal of a diseased liver and replacement with a healthy liver from an organ donor. A liver transplant is necessary when chronic or acute liver disease leads to failure of organ function. The most common reason for liver transplantation in adults is cirrhosis, a condition of insufficient healthy liver cells and severe liver scarring. The most common reasons for liver transplantation in adults are chronic hepatitis C, alcoholic cirrhosis, primary biliary cirrhosis, autoimmune hepatitis, and fatty liver disease.

Liver transplantation is usually performed when medical treatment cannot keep a damaged liver functioning. The survival rates have continued to improve over the past many years because of the development of drugs (cyclosporine and tacrolimus) that suppress the immune system and keep it from attacking and damaging the new liver. MGH was instrumental in the development of original immunosuppressive strategies in transplantation and is now at the forefront in developing strategies aimed at minimizing the requirement for immunosuppression by inducing host tolerance to the transplanted organ. Other state-of-the-art work being performed at MGH is aimed at someday making it possible to transplant customized organs from non-human species into humans (xenotransplantation) to alleviate the wide disparity between available donor organs and the enormous number of persons in need of transplantation.

Drug Induced Liver Disease

A wide array of prescription and non-prescription drugs, along with complementary and alternative medications, can produce liver injury, sometimes severe. In some cases, this injury is predictable and related to dose, but in others it is unpredictable. The Liver Program has extensive experience in the diagnosis and treatment of drug-induced liver disease, including the use of antidotes against specific forms of drug injury or the use of immunosuppressives for drug-induced immune-mediated injury.

Acute (Fulminant) Liver Failure

Patients may uncommonly present with acute liver failure, a rapidly progressive condition (encephalopathy within 8 weeks of onset of jaundice). This condition is seen in patients with no prior history of liver disease and is associated with high mortality rates. The MGH Liver Program is an active member of the NIH-supported Acute Liver Failure Study Group, which is conducting a randomized trial of IV N-acetylcysteine for acute liver failure attributable to causes unrelated to acetaminophen. Clinical trials of exciting liver assist devices and hypothermia are also planned by the ALFSG.

Living Donor Liver Transplantation

Under specific and carefully considered circumstances, it is possible family member or friend to donate part of their liver to a loved one in need of a liver transplant. This is an increasingly important option in liver transplantation because of the lack of sufficient donor organs, particularly among those who face a long waiting time to receive a cadaveric donor organ. Our team offers a careful, multidisciplinary approach to the evaluation and management of both the living donor as well as prospective recipients.

Hepatocellular Cancer

Chronic liver diseases with cirrhosis are increasingly being recognized as an important risk factor for the development of hepatocellular carcinoma (HCC). At MGH, we offer a multidisciplinary approach to the management of persons with HCC. Depending on the size, number and location of the HCC, treatment approaches include consideration of liver transplantation (see above), systemic or localized chemotherapy under the management of our Oncology colleagues, or ablation (creating a thermal burn) using high frequency radio waves. Together with our partners in Surgery, Oncology, and Radiation Oncology, we are also examining state-of-the-art modalities for use in clinical trials for HCC. These include hepatic resections, proton beam radiation, novel chemotherapeutic agents, and glass beads that emit radiation when placed near the tumor in the liver.

Cholangiocarcinoma

Cholangiocarcinoma is a rare cancer of the bile ducts. A risk factor for cholangiocarcinoma is PSC (see above). Our team has a particular interest in cholangiocarcinoma and is involved in research seeking new methods for early detection of this disease. We also provide state of the art endoscopic, surgical, and oncologic care for cholangiocarcinoma.