Personalized Exercise Program Improves Survival Rate in Liver Transplant Patients

Principal Investigator: Daniela P. Ladner, MD, MPH, Interim Director, Comprehensive Transplant Center; Professor of Surgery (Organ Transplantation) and Medical Social Sciences, Northwestern University Feinberg School of Medicine Patients with poor physical conditioning who are diagnosed with cirrhosis frequently experience worse outcomes before and after receiving a liver transplant. Exercise helps reduce frailty and leads to better outcomes, but patients face a variety of financial and logistical barriers to the regular physical activity needed to maintain strength. Additionally, transplant teams often expect patients to optimize their physical health on their own with little guidance. The Ladner research team seeks to optimize patient outcomes through a practical and affordable approach to enhance physical conditioning in the pre- and post-liver transplant setting. The researchers are developing a simple and cost-effective intervention called LIFT (Liver FrailTY), which will include a full in-person strength assessment, an exercise program with smart phone guidance, and remote coaching. Regular and frequent check-ins will be essential to encouraging patients to achieve recommended levels of exercise. Dr. Ladner’s study will then measure the impact of LIFT on strength as well as on positive clinical outcomes, such as increased survival and fewer hospitalizations for patients facing liver...

Division of Gastroenterology and Hepatology Northwestern Medicine/Feinberg School of Medicine
Center for Artificial Intelligence and Mathematics in Gastroenterology

Division of Gastroenterology and Hepatology Northwestern Medicine/Feinberg School of Medicine Center for Artificial Intelligence and Mathematics in Gastroenterology The Center for Artificial Intelligence and Mathematics in Gastroenterology (AIM-GI) is a first of its kind program developed in a division of Gastroenterology.  Artificial Intelligence and Machine Learning have the potential to vastly improve our ability to accurately predict, diagnose and treat our patients living with digestive diseases.  Through collaboration with engineers at the McCormick School of Engineering and physician scientists at the Feinberg School of Medicine at Northwestern University, our team has been incorporating mathematical modeling and advanced programming to study the mechanisms that lead to poor gastrointestinal function.  This work led to the development of a more formalized center that focuses on three main initiatives. Development of virtual organs which can be used to study the effects of surgery and medications; Development of new hybrid diagnostic tools using AI and machine learning to enhance diagnosis; Using machine learning and neutral networks to predict disease outcome. Although this is a new program, we have already had success developing an NIH funded Center of Research Expertise (CORE) and we have also developed new AI prototypes that can improve diagnostic accuracy and reliability of motility tests.  This work is supported by the generosity of the Digestive Health Foundation and these funds help provide the computational power and expertise required to continue to develop these innovative tools.  Our goal is to continue invent and develop new approaches and our partnership with the Digestive Disease Foundation will continue to allow us to grow and evolve this...

Novel Protective Mechanism against Liver Damage in Liver Transplant Patients

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...

Blood Pressure Measurement Methods in Liver Transplant Patients

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...

Developing Laboratory Markers to Predict Recurrence of Fatty Liver after Liver Transplantation

Principal Investigator: Mary Rinella, MD The most common cause of liver injury in the United States, non-alcoholic fatty liver disease (NAFLD) occurs when extra fat builds up in liver cells. A serious offshoot of NAFLD, nonalcoholic steatohepatitis (NASH) can cause the liver to become inflamed. Those who develop NASH often require a liver transplant. Even after liver transplant, these patients face an uphill battle. They remain at particularly high risk of NASH recurrence, which can lead to graft failure and even death. Currently painful and invasive needle biopsies are the only way to diagnose and stage NASH. As NASH reoccurs, byproducts of the disease process appear in the blood that may provide important clues to disease progression. Supported by a grant from the Digestive Health Foundation, Mary Rinella, MD, a gastroenterology and hepatology faculty member and her co-investigators hope to develop a blood-based alternative by identifying biomarkers that can accurately indicate the onset or recurrence of NASH. The investigators will focus on patients who have undergone liver transplantation at Northwestern Memorial Hospital from 1987 to present. Their pilot study will look at participants from the “Mini-Liver” cohort: patients who have had liver biopsy after transplantation, several of whom have recurrent NASH. Plasma samples are collected from all patients in this group and immediately stored at the time of biopsy for future reference and research studies. Dr. Rinella’s study will involve the use of a validated blood serum-based biomarker panel test (OWLiver assay) that has shown great promise in diagnosing NASH in the non-transplant setting to test the existing biobanked plasma samples. The researchers will also review clinical data drawn...