Hépatinov brings together clinicians, researchers, professors and entrepreneurs in order to foster innovation in the treatment of liver diseases.
The liver is the largest organ in the human body. Its functions are vital and multiple.
- The liver detoxifies.
- The liver synthesizes.
- The liver stores.
Fig and goose
The goose loves figs (lat. ficus) and becomes fat. Goose foie gras (b. Lat. ficátum) has gradually broadened its meaning and has finally designated the liver in general.
Hepatitis
The liver is a central organ of the body to the point that an impairment of its functioning can have repercussions on that of other organs (heart, kidneys, brain, lungs, etc.). It has the particularity of asymptomatic diseases or diseases with symptoms that are difficult to interpret, even when they are chronic (abdominal pain, fever, fatigue, yellowing of the skin, etc.). Such diseases develop over many years, and their diagnosis is often late.
However, the liver also has also the unique characteristic of being able to fully regenerate itself if the disease has not damaged it too severely.
Thus, once the cause of acute hepatitis has been eliminated (less than 6 months), the liver returns to normal functioning.
On the other hand, in the event of chronic hepatitis (persistence of more than 6 months), the liver can suffer irreversible damage due to scarring which generates fibrosis; fibrosis can deteriorate into cirrhosis. Sudden failure can then be triggered. More than half of cirrhosis is diagnosed at a stage where the patient's life is in danger. The median survival is only two years.
The causes of liver disease can be viruses (250,000 hepatitis B and 100,000 hepatitis C in France), certain drugs (paracetamol in excessively large doses), drug consumption, consumption of alcohol or sugar in excess, a hereditary disease (accumulation of copper, for example) or a defective vascularization.
Lifestyle hepatitis
While the viral or alcoholic causes of hepatitis are declining, the «fatty liver disease» has been growing dramatically and steadily for several decades. 20% of young adults (between 18 and 28) suffer from it (from 10% in Africa to 30% in Latin America), and in most cases they ignore it (see above).
Changes in lifestyle and particularly in consumption habits have triggered an obesity «epidemic» which today affects children.
Non-Alcoholic Hepatic Steatosis (NASH) results from the accumulation of fat in the liver due to a diet that is too fatty and especially too sweet. This build-up can lead to inflammation causing fibrosis which can progress to cirrhosis and even cancer.
In France today, 17% of the population has a fatty liver and 300,000 people in France have liver fibrosis. Preventing and curing NASH is a global health issue.
Liver tumors
Benign tumors are not cancer. Mainly detected by chance, they are most often not dangerous to health.
Hepatocellular carcinoma or hepatocarcinoma is the main type of primary malignant tumor of the liver (90%). It takes its name from hepatocytes, the main cells in the organ. Most often, it appears in a liver damaged by a disease. Its occurrence increases due to the spectacular progression of NASH, responsible for fibrosis evolving into cirrhosis and cancer.
Rare forms affect cells of blood vessels such as epithelioid hemangioendothelioma or cells of bile ducts such as cholangiocarcinoma.
Cancer is considered primary if it has developed from cells of the liver. Cancer is secondary when the liver is affected by metastases formed by cancer cells detached from a tumor affecting another organ. The treatments for these two types of cancer are completely different.
To find out more about the liver and its pathologies, visit the website of the Hépato-Biliaire Center of the Paul-Brousse Hospital (AP-HP) , one of the largest European centers for the treatment of liver diseases and a leader in Hépatinov.
Liver transplantation
It is the standard curative treatment for serious liver diseases. Its progress is such that the chances of survival are almost 90% at one year. Its rise is due to the improved effectiveness of immunosuppressive treatments which prevent transplant rejection.
In 2020, in France, 1,128 liver transplants were performed (17% less than the previous year due the Covid pandemic) and at the end of 2020, 15,121 patients were living with a transplant. The number of transplantations is constantly increasing, as is the number of patients on the waiting list, i.e., 1,647 candidates on the 1st of January 2021. See the annual scientific report of the Biomedicine Agency .
The indications for liver transplantation concern patients who suffer from hepatocellular carcinoma for about a third of them; for a quarter of them they suffer from alcoholic cirrhosis, for 10% from biliary and autoimmune diseases and for 5% because of an acute liver failure. The indications for hepatitis B and C are decreasing thanks to new antiviral molecules (approximately 5%).
The graft donors (a part of the liver only) are less and less oftenliving donors and more often dead donors. Since 2014, graft harvesting after spontaneous cardiac arrests have been supplemented by harvesting after cardiac arrests following the interruption of care (so-called Maastricht III criterion).
The allocation of transplants is the responsibility of the Biomedicine Agency which manages the national waiting list. It has developed a tool, the "Liver score" aimed at efficient (use and survival criteria) and fair allocation (all candidates are eligible regardless of their illness and place of hospitalization). The final decision is, however, left to the discretion of the doctors in charge.
While in some cases the attribution of a graft is «super-urgent» and of national priority for about 10% of cases, in most cases the «Liver score» is used. It takes into account the type of disease, the severity of the condition (mainly via the MELD or «Model for End Stage Liver Disease» indicator), the waiting time and the distance between the sites of harvest and transplant. Any graft harvested on the national territory is offered to the patient with the highest score.
After transplant, the patient is prescribed immunosuppressive therapy for life in to minimize the risk of rejection. Research aims to reduce the adverse effects affecting the survival of patients and grafts.
To learn more about liver transplantation, visit the Hépato-Biliaire Center of Paul-Brousse Hospital (AP-HP) .
