Principal Investigator: Xiaoying Liu, PhD The term cholestasis describes any condition that impairs normal bile flow from the liver into the bile ducts and then into the intestine. This disease state can cause chronic liver damage, cirrhosis, end-stage liver disease (requiring a liver transplant), and death. Cholestatic liver diseases include primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC). Cholestasis also occurs frequently after liver transplantation, which can result in the need for repeat liver transplantation or death. Unfortunately, the molecular drivers of cholestasis are still poorly understood with few effective medical therapies. The liver unfolded protein response (UPR) is a molecular pathway that protects cells from injury. UPR has been demonstrated to be important in many liver diseases, although its role in cholestasis remains unknown. Dr. Liu intends to investigate the activation of the liver UPR pathways in liver transplant patients with cholestasis. Identifying new UPR protein and gene targets will ultimate aid in developing novel drug therapies and improving liver transplant...
Principal Investigator: Lisa B. VanWagner, MD Liver transplantation extends the lives of many patients with liver failure. Yet, one in three recipients will experience a heart disease event after liver transplant surgery due to the effects of immunosuppression causing a high prevalence of cardiovascular risk factors, such as high blood pressure (BP). Decreasing hypertension in these patients could help improve their outcomes. While there are different methods for detecting high BP, some are better than others. Home monitors and portable/wearable 24-hour monitoring devices often best reveal how blood pressure readings relate to daily activities and sleep and provide keener insights into patients’ true blood pressure levels than measurements taken in the clinic. Dr. VanWagner’s study will involve measuring blood pressure over time in 50 Northwestern liver transplant recipients. Her team will use the office, home, and 24-hour blood pressure measurement approaches to enable interventions to lower blood pressure and prevent dangerous heart disease events after transplant...
Principal Investigator: Sri Komanduri, MD, MS, FASGE, AGAF; Co-Principal Investigator: Robert Schenck, MD The thought of potentially having cancer is stressful enough without undergoing an invasive biopsy to diagnose it and finding out that the procedure needs to be repeated due to inadequate sample collection. This project aims to optimize strategies for acquiring tissue samples to assist gastroenterologists (and pathologists) in diagnosing many diseases, including cancers. Relying on endoscopic ultrasound guidance, the two methods currently utilized are fine needle aspiration, which is the gold standard, and a new method called fine needle biopsy. Drs. Komanduri and Schenck are conducting the largest study to date to compare these different strategies. After collecting data from patients who have undergone one of these procedures over a five-year period, the investigator will perform advanced statistical modeling to determine the strategy that best optimizes patient outcomes (including obtaining accurate diagnoses and minimizing repeat invasive procedures) and costs. Once identified, this strategy will ultimately be implemented throughout the Northwestern Digestive Health Center to enhance patient...
Principal Investigator: Lisa B. VanWagner, MD The portal vein carries blood from digestive organs to the liver. Portal hypertension occurs when pressure increases within this vein due to blockage in blood flow through the liver. Cirrhosis, or scarring, of the liver is the most common cause. This condition often results in fluid build-up in the abdomen and bleeding from veins in the esophagus that can impair quality of life and even lead to death due to intestinal bleeding or infection. An artificial shunt procedure known as TIPS (transjugular intrahepatic portosystemic shunt) helps reduce portal hypertension. It works by connecting two veins: the portal vein that carries blood from the digestive organs to the liver and the hepatic vein that carries blood from the liver to the right part of the heart. While the lifesaving procedure may cause heart failure in some patients because of increased blood flow directly to the heart, others experience improvement in heart function. However, predicting outcomes for these patients is currently unknown. Dr. VanWagner’s study aims to better understand changes in heart function after a TIPS procedure to better intervene and prevent heart failure in these at-risk...
Principal Investigator: Daniel Ganger, MD; Co-Principal Investigator: Justin R. Boike, MD Chronic liver disease remains a significant burden on society, despite the ability to treat and cure hepatitis C. With the growing obesity epidemic in the United States, fatty liver disease will soon overtake hepatitis C as the primary cause of chronic liver disease and cirrhosis. While liver transplantation offers a cure, it is not an option for many individuals who face complications of cirrhosis such excessive fluid retention and internal bleeding. Transjugular intrahepatic portosystemic shunt (TIPS) procedures offer an effective tool for treating these complications. In some patients, though, TIPS can worsen liver failure and sometimes cause debilitating confusion called hepatic encephalopathy. It is believed that excessive shunting of blood flow from the liver may be the culprit. In this study, the researchers will study the ability of a new laboratory test to measure the percentage of blood shunted away from the liver to better predict those patients at greatest risk for hepatic encephalopathy after a TIPS procedure. This tool could dramatically help guide the use of TIPS and promote earlier use of TIPS in low-risk...
