Prof Christian Trautwein | European Association for the Study of the Liver (EASL) Ethics Committee Chairperson
The Department of Gastroenterology, Metabolic Disorders, and Internal Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
Becoming a doctor is a long training process; at what point did you decide to specialise in hepatology?
Actually, I decided to go into hepatology quite early when I put together my Doctor of Medicine thesis with Professor Michael Manns at the Department of Internal Medicine in Mainz, Germany (Prof Dr Karl-Hermann Meyer zum Büschenfelde). It then became clear to me to continue this topic and therefore I started my training in gastroenterology. Here, hepatology was always my favoured topic. I would like to mention that in Germany there is no specialisation for hepatology as it is part of gastroenterology.
How has your research focus on endoscopic examination methods aided your clinical work on diagnostic and therapeutic endoscopic procedures?
Right from the beginning, during my education, I had a strong interest in endoscopy, especially for endoscopic retrograde cholangiopancreatography (ERCP). Up until now, ERCP is something I perform very frequently as diagnostic and therapeutic procedures are very important for the field of hepatology. The relevance of the biliary system, due to my ERCP activity, also made it important for me to scientifically focus on the gut–liver axis.
You are familiar with the transjugular intrahepatic portosystemic shunt (TIPS) procedure and have carried out the surgery yourself. A lot of the literature describes risks of complications following the procedure; therefore, how important do you believe patient selection to be?
In Aachen, Germany, where I am right now, we do this together with the radiology department. It’s not a procedure which we do ourselves. We do it in combination with other departments, as we are very closely linked to radiology, and therefore the potential problems we have are not very frequent. But of course, I also tell this to the patients. Patient selection is absolutely important because of these risks. I mean in the last years, because of an increase in the number of publications, we have incorporated a very specific selection criterion. However, we also know that TIPS have a very good impact on further follow-up clinically; therefore, TIPS is currently a standard procedure in the clinic, and we do this very frequently.
Could you tell our readers the key take-home message(s) of your recent publication: “Heterozygous carriage of the alpha1-antitrypsin Pi*Z variant increases the risk to develop liver cirrhosis.”
We started this some years ago with the help of the EASL and started to better understand what alpha1-antitrypsin is doing and how important it is. We realise right now that this is a very important genetic risk factor and because of this I think it is becoming clear worldwide that alpha1-antitrypsin was underestimated until now. Meanwhile it has become obvious to everyone that it is a very important risk factor for the progression of liver diseases.
As the European Association for the Study of the Liver (EASL) Ethics Committee Chairperson, what is your societal role?
We are very strongly involved in any potential conflicts of interest (COI) of any individual involved in the EASL. Therefore, we try to standardise it so that everybody has the same chances to have a COI or no COI. We have also developed thresholds that indicate when a person cannot take a job at the EASL to ensure that the industrial connection to the EASL is as low as possible. I think it’s very important to have a clear standard of care for therapy and diagnostics and therefore we are very careful about potential COI. During my time as the Chairperson of the Ethics Committee, I want to establish absolute transparency concerning financial disclosures so that we can attain a clear separation between industry and academic societies. This is one of the main goals I have.
Not all medical associations have an ethics committee; how large a threat do you believe real or perceived bias to be to the integrity of medical guidelines?
I would suggest that every society and every board have an ethics committee to ensure that there is an independent surveillance of all the things which are ongoing. Therefore, I very much appreciate that the EASL has a very strong focus on this. I think it is very dangerous not to have an ethics committee. The clear line between industry, and especially academic research, should be made because if there was a close connection, industry-driven interests might take too much influence.
The Digital International Liver Congress (ILC) 2020 scientific programme has been adapted to incorporate sessions relating to coronavirus disease (COVID-19). Could you tell us how the disease is thought to impact the liver?
It was a physical congress originally and was supposed to take place in London, UK, before it was postponed. The format was completely changed into digital sessions. The relationship between COVID-19 and the liver lies in the angiotensin-converting enzyme 2 (ACE2) receptor. Obviously, the ACE2 receptor is also in liver cells and because of that, the liver is also directly involved. We also know that some patients only display liver complications but no other problems or symptoms and therefore the liver plays an essential role in the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Which of the numerous sessions at The Digital ILC 2020 did you enjoy the most?
I only sat in for two sessions where I was involved. Nonetheless, it is discovering the newest trends in research that I always enjoy the most. This involves the newest research topics and where novel advances might take us; especially the work on the gut–liver axis, which is my focus topic. I think this is a very important research topic for the future.
What would your advice be to the younger generation that are following the same path and just beginning their career?
I think the important thing is that people have a clear leadership concept; they need to be supported and guided by somebody who is really interested in research and likes to invest in their career. I personally think this is the most essential component for young people, who are smart and willing to work hard and make a career.