New Support for Liver Transplants: A Healthy Microbiome
Trillions of bacteria, fungi, and viruses live inside the human body. Some aid in digestion while others promote a healthy immune system. When these microbes get out of balance, this can set the stage for disease.
For more than three decades, NYP/Columbia researchers have been leaders in the study of these microbes. Since 2007, our scientists and clinicians have been participating in The Microbiome Project, funded by the National Institutes of Health, naming and describing its different elements.
More recently, Elizabeth C. Verna, MD, Assistant Professor of Medicine at Columbia, received a major grant—more than half a million dollars—from the National Institute of Diabetes and Digestive and Kidney Diseases to see if keeping a healthy microbiome after liver transplant surgery may help to prevent scarring of the liver and also cut down on the need for reoperation.
“In a normal person, the intestine contains these microbes, but in patients with chronic liver disease, including hepatitis C, the intestine becomes a leaky sieve,” says Dr. Verna. "This results in a shift in the gut ecology, one that allows pathogens (bad bacteria) to proliferate. When patients come to a liver transplant—a complex operation—with an abnormal intestinal microbiome, this puts them at greater risk for liver injury.
For three years, Dr. Verna has been studying the blood and stool samples of patients about to undergo a liver transplant, then following their progress after the procedures. What has she learned so far? That it’s not enough to take a single snapshot of the microbiome after surgery. This environment changes over time, and so patients need to be tracked long-term. “Eventually we will know enough to target specific microbes or metabolic pathways for therapeutic interventions that will improve liver health in both transplant and non-transplant patients.
This innovative approach will add to CUMC’s already advanced knowledge of liver disease.
Changes in the intestinal microbiome are likely very important factors in the development of liver inflammation, liver scarring (cirrhosis) and liver cancer. This research stands to benefit patients with many forms of chronic liver disease, including HCV and non-alcoholic fatty liver disease (NAFLD)— even those who will never need a transplant.