Reference: September 2025 | Issue 9 | Vol 11 | Page 12
The 2nd Annual Irish Liver Foundation (ILF) Study Day took place at the Royal College of Surgeons in Ireland (RCSI) in Dublin on 18 January 2025.
The ILF was set up in December 2022 by healthcare professionals working in liver disease in Ireland. One of the goals of the ILF is to support continuous education and the study days are short but vital. They are a fantastic way to get the most up-to-date, evidence-based information on liver disease in Ireland.
The charity has been expanding rapidly and held a patient-specific study day in October 2024 in collaboration with the Liver Ireland Support Network (LISN), a peer support charity aimed at those with liver disease, in particular anyone on a liver transplant journey.
On behalf of the ILF, we wish to acknowledge the profound loss of Mr Brendan McAtamney, co-founder of LISN, who sadly passed in December 2024. The Annual Study Day in January was dedicated to his memory.
Opening remarks
Prof John Ryan, Consultant Hepatologist at Beaumont Hospital, Dublin, as well as ILF Co-Founder and Director, opened the meeting, saying: “Since the 1970s, the death rates of most major diseases, including cardiovascular disease, diabetes, heart attacks, and strokes have reduced. Whereas deaths from liver disease have risen, with death rates four times higher than in 1970.
“A spotlight needs to be shone on liver disease in Ireland. While we know that prevention and early detection of liver disease lead to better outcomes for patients, we must have a clear evidence-based plan in place to identify how we do this and where resources are most needed.”
Prof Ryan pointed out that the ILF has been able to sponsor research in liver disease in Ireland by establishing the very first ILF Fellow position. The current ILF Fellow is Dr Clare Foley, who won best oral presentation and best clinical abstract at the Irish Society of Gastroenterology Winter Meeting in November 2024.
At the 2025 ILF Study Day Dr Foley gave an overview of her research, which focuses on the burden of liver disease on acute hospitals in Ireland. This has involved analysing data from the previous six years and identifying areas that need investment the most.
Dr Foley’s preliminary findings suggest that between 2017 and 2023, there was a total of 21,528 inpatient hospital admissions for liver disease in the acute hospital system. These admissions had an average length of stay of 11 days and sadly 1,733 inpatient liver disease deaths were recorded.
Dr Foley also found that patients admitted to acute hospitals with a liver disease had mortality rates of up to 18 per cent in some centres, and a 30 day readmission rate of 18 per cent. Over the studied six years of admissions, this equated to 245,961 inpatient bed days, with 13,197 of those being critical care bed days. Dr Foley’s research is still in its infancy, however, her take-away points were:
1. The burden of liver disease on acute hospitals in Ireland is significant.
2. Alcohol-related liver disease had:
- a. Longer lengths of stay, including in critical care
- b. High mortality
- c. High 30-day readmission rates
- d. Higher cost of care.
3. Inpatient cirrhosis death rates are double that of COPD and heart attacks.
4. Inpatient mortality rates in those with liver disease are unacceptable. Rates vary across the country and we need to determine why that is.
5. Patients admitted to hospital with liver disease cost more than other common conditions.
Prevention and early detection of liver disease will be imperative to have a real impact on the burden of liver disease in Ireland.
Early detection
Dr Paul Brennan, Clinical Lecturer at the University of Dundee in Scotland, explained that the European Association for the Study of the Liver (EASL) – Lancet Commission, has recognised that more than 300,000 lives are prematurely lost to liver disease each year in Europe.
The focus, therefore, should be on prevention and early detection of liver disease, as well as implementing appropriate treatment and management to reduce overall morbidity and mortality.
Dr Brennan gave a run down of the approach used in primary care in Scotland. A tactical algorithm called iLFT (intelligent liver function test) is used on individuals presenting to primary care with abnormal liver function blood tests. These patients then have a more robust assessment looking at clinical details, including alcohol consumption, BMI, and metabolic factors. Patients also undergo reflex testing iron studies, liver antibody testing, caeruloplasmin, alpha-1 anti-trypsin, and fibrosis staging.
By conducting these tests and acting appropriately as per the algorithm, Dr Brennan’s research identified a more than 80 per cent reduction in GP contacts and a 75 per cent reduction in the need to refer to secondary care. The application of the iLFT model was widely accepted within primary care and its diagnostic accuracy was over 90 per cent.
Dr Brennan demonstrated how clever use of widely available blood tests can be helpful in primary care. Furthermore, the use of non-invasive testing such as FibroScan is of enormous potential benefit and stakeholders should be looking at ways in which they can make this more accessible in the primary care setting, he said.
MASLD
During her presentation, Dr Marie Boyle, Consultant Gastroenterologist/Hepatologist at Tallaght University Hospital, noted that sometimes it is hard to keep up with changing nomenclature in medicine. None more so than when it comes to the condition now referred to as metabolic-associated steatotic liver disease (MASLD) formerly known as NAFLD.
The American Association for the Study of Liver Diseases (AASLD) announced the change in June 2023 and this move has been significant. NAFLD was a diagnosis of exclusion – it is not alcohol causing this issue. Whereas with MASLD, it is a diagnosis of inclusion.
Dr Boyle described the current lifestyle interventions available to those with MASLD, which encompass weight loss (diet, bariatric surgery, exercise), supplements, and alcohol reduction/elimination.
Dr Boyle explained that in a 2017 study, it was demonstrated that with a 10 per cent total body weight loss, 100 per cent of patients saw improvement in the amount of steatosis; 81 per cent experienced fibrosis regression; and 90 per cent saw a resolution of steatohepatitis. Unfortunately, only 10 per cent of the patient cohort achieved a 10 per cent total body weight loss, which proves that while weight loss is extremely beneficial, it is also extremely difficult to achieve.
Dr Boyle discussed the top three current diets that patients are using to aid weight loss, including the Mediterranean diet, intermittent fasting, and the ketogenic diet. While it is possible to lose weight with all three approaches, the Mediterranean diet has the best outcomes in terms of longevity. Both intermittent fasting and ketogenic diets are difficult to maintain long-term and can have deleterious effects, such as micro-nutrient deficiencies and they are unsuitability for those with diabetes.
Supplements were also discussed, including vitamin D, vitamin E, omega 3 fatty acids, antioxidants, and alpha-lipoic acid. The evidence is still unclear as to the benefit of these vitamins in liver disease; however, one interesting recommendation was coffee.
Coffee, which contains antioxidants, caffeine, and polyphenols, has been shown to have a positive impact on metabolic syndrome, while also reducing fibrosis progression and overall mortality. The optimal dose of coffee is ‘three cups a day, keeps the fat away’.
Finally, novel therapies such as GLP-1 analogues, which are associated with significant weight loss and an associated reduction in liver fat and fibrosis, show promise in an area desperate for novel treatments. In addition, a thyroid hormone receptor agonist called resmetirom, which was recently approved by the US FDA, has shown benefit in MASLD, but its use may be limited by cost.
Alcohol-related liver disease
We were spoiled this year to have international expert speakers. Dr Stephanie Rutledge, Hepatologist at New York Presbyterian, US, gave an overview of therapies commonly used to treat alcohol-related liver disease (ArLD) and alcohol use disorder (AUD). She opened with a brief overview of the STOPAH trial, which changed how alcohol-related hepatitis is treated.
While steroids still play a role in treatment, not every patient will respond. The optimal liver score is the Model for End-Stage Liver Disease (MELD) score rather than the typically used Maddrey’s Discriminant Function. Those with a MELD score of 25-39 are most likely to benefit from steroids. The Lille model is used to reassess progress after seven days to identify non-responders, and stop or continue steroids as appropriate.
Dr Rutledge then explained the various pharmacotherapies available for AUD that are safe in the presence of ArLD. These include acamprosate, naltrexone, baclofen, and gabapentin.
AUD and ArLD are both on the rise, she noted. ArLD is now the leading cause for liver transplantation. Treating AUD reduces the potential progression to ArLD cirrhosis. Clinicians should be more confident in using pharmacotherapy in AUD. Dr Rutledge did caution however, that multidisciplinary team input is essential for overall long-term success.
Paediatric liver disease
Dr Emer Fitzpatrick, Consultant Paediatric Hepatologist, Children’s Health Ireland, discussed paediatric liver disease. Approximately 700 children in Ireland have liver disease, which presents as a mix of congenital, genetic, or metabolic liver disease.
In particular, Dr Fitzpatrick discussed surgical and medical biliary diversion methods for biliary atresia and highlighted the work being conducted in gene identification and its implications on diseases such as Alagille syndrome.
Dr Fitzpatrick said there has been an increase in steatotic liver disease in children. When we talk about early identification and prevention of liver disease, it should include the whole human life cycle, not just the adult population. While the aetiology of childhood-onset liver disease may be different to adults, there is a final common pathway.
Young people with liver disease are at an increased risk of growth, development, and psychological impairment. Success in paediatric hepatology is measured in achievement of childhood milestones and personal goals. As Dr Fitzpatrick concluded: “We should be pushing the boundaries in diagnosis and liver transplantation.”
Portal hypertension
Dr Audrey Dillon, Consultant Hepatologist, St Vincent’s University Hospital, Dublin, highlighted the important topic of portal hypertension in liver disease. For anyone who has any experience of treating a patient with portal hypertension, it can be a complex journey where patients can experience episodes of decompensation very frequently.
However, portal hypertension can also lead to other complications such as variceal bleeding and portal vein thrombus. Liver transplantation is life-changing for these patients, however, not all patients are suitable for transplant.
Dr Dillon explained the role of the trans jugular intrahepatic porto systemic shunt (TIPSS) procedure which can reduce the risks of further episodes of decompensation. It is not without its caveats, however.
Dr Dillon said, when considering TIPSS, it is essential to balance the risk of improved ascites, nutrition, renal function, and bleeding against the risk of hepatic encephalopathy, cardiac overload, etc.
The takeaway points on portal hypertension were:
1. Identify and treat the aetiology, if possible.
2. Carvedilol, the non-selective beta blocker, is the drug of choice.
3. If a patient requires large volume paracentesis (LVPs) in quick succession, TIPSS should be considered. Patients who undergo TIPSS have better outcomes then those who have frequent LVPs.
4. Liver transplant candidates with portal vein thrombus should be anticoagulated.
Hepatocellular carcinoma
The final speaker of the day was Prof Grainne O’Kane, Medical Oncologist, SVUH, and Professor of Oncology, University College Dublin, who discussed the strides that have been made in treating hepatocellular carcinoma (HCC). Prof O’Kane explained that over a million new HCC diagnoses are expected globally in 2025. There is now a higher incidence of non-cirrhotic HCC cases.
Prof O’Kane summarised the most recent treatments for HCC and the research currently ongoing. Immunotherapy has been remarkably successful in recent times. Even though incredible strides have been made and the standard care has been improved and updated, there are still important complications that need to be considered.
Diagnostic work-up of individuals with suspected adverse events depends on the affected organ.
Prof O’Kane highlighted the need to monitor thyroid and liver function. Other common adverse events include vitiligo, arthralgia, arthritis, and myocarditis. Prof O’Kane suggested that a national policy is needed for variceal management while patients are receiving treatment for HCC.
SVUH is the national referral centre for HCC treatment and the multidisciplinary liver cancer clinic is on every Thursday afternoon in the liver unit.
Conclusion
The study day was an enormous success, as was reflected in our feedback. There were over 150 attendees from varying areas within healthcare and from all over the country. A special thank you to our speakers, attendees, our host the RCSI, and our sponsors and volunteers.
For more information on the work of the ILF and resources on liver disease, see www.liverfoundation.ie
