Deirdre Kelly | |
---|---|
Born | India |
Nationality | Irish |
Occupation(s) | Clinician, academic and author |
Awards | The Lunar Medal, Lunar Society Commander of the British Empire, Government of the United Kingdom |
Academic background | |
Education | BA MB BCh BAO MD |
Alma mater | Trinity College Dublin |
Academic work | |
Institutions | Birmingham Women's and Children's NHS Foundation Trust University of Birmingham General Medical Council NHS England NHS Blood and Transplant |
Deirdre Kelly CBE DL is an Irish clinician,academic,and author. She is Professor of Paediatric Hepatology at the University of Birmingham and Clinical Lead for National Paediatric Hepatitis C Operational Delivery Network. [1] She chairs the Board of Pension Trustees at the General Medical Council and is a non-executive director at NHS Blood and Transplant. [2]
Kelly has authored numerous publications including articles in peer-reviewed journals and has edited numerous books including Atlas of Pediatric Hepatology and Diseases of the Liver and Biliary System in Children. Her research is in the fields of the genetics of neonatal liver disease,management and treatment of pediatric liver diseases,particularly focusing on auto-immune liver disease,biliary atresia,cholestatic liver disease,and long-term outcome of liver transplantation in children. [3]
Kelly held the Deputy Editorship of the health journal Liver Transplantation from 2015 to 2020. [4]
Kelly completed her Bachelor of Arts from Trinity College,University of Dublin in 1971,where she also earned an MB BCh BAO degree in 1973. In 1979,she completed her Doctor of Medicine degree from the University of Dublin. She then acquired accreditation for General Medicine and Gastroenterology from JCHMT in 1984. In 1990,she was awarded a fellowship at the Royal College of Physicians of Ireland,and in 1995 fellowship from the Royal College of Physicians,London followed by a fellowship at the Royal College of Paediatrics and Child Health in 1997. [1]
In 1976 Kelly joined Sir Patrick Dun's Hospital as a Research Registrar and worked there until 1978. From 1978 to 1980 she performed duties as a Medical Registrar at St Vincent's Hospital. She then joined Trinity College Dublin as a Lecturer of Clinical Medicine in 1980 and served until 1982. In 1982,she joined Royal Free Hospital as a Wellcome Research Fellow until 1984. She re-trained in paediatrics and worked as a Paediatric Registrar at the Queen Elizabeth Hospital in Hackney and then at the Hospital for Sick Children Great Ormonde Street from 1984 to 1987. She was a lecturer in Child Health at St Bartholomew's Hospital,in 1987. In the same year she joined the University of Nebraska as an assistant professor in Paediatrics and served up until 1988. In 1989 she was appointed as Director of the Liver Unit and Consultant Paediatric Hepatologist at Birmingham Women's and Children's NHS Foundation Trust. She is Professor of Paediatric Hepatology at the University of Birmingham,from 2001. [1]
Kelly was a founding member of the International Pediatric Transplant Association (IPTA) and served as its vice president from 1998 to 2002 and President from 2002 to 2005. She was the President of the British Society of Paediatric Gastroenterology &Hepatology (2004–07) and the European Society of Paediatric Gastroenterology &Hepatology (2007–10). She is the Chairperson of the Public Affairs Committee at the European Society of Paediatric Gastroenterology Hepatology Nutrition since 2017. [5] She is the Clinical Lead for the National Paediatric Hepatitis C Operational Delivery Network at NHSE since 2021.
She has had a number of public sector appointments focusing on standards in healthcare and patient safety. She has served on the Boards of the Healthcare Commission (2007–09),the Care Quality Commission (2008–13),the Health Research Authority (2015–18) and the General Medical Council (2013–20) and is a Non-executive Director at NHS Blood &Transplant since 2020. [2] She currently chairs the Board of Pension Trustees at the General Medical Council.
She has been a Deputy Lieutenant of the West Midlands since 2008. [6]
Kelly has authored numerous publications including articles in peer-reviewed journals. Her research interests lie in the fields of the genetics of neonatal liver disease,management and treatment of pediatric liver disease,particularly focusing on auto-immune liver disease,viral hepatitis,biliary atresia,cholestatic liver disease and the long term outcome following liver transplantation. [3]
Kelly conducted research on pediatric hepatic diseases with a particular focus on biliary atresia. She advocated centralizing the Kasai Portoenterostomy (a surgical procedure) for the treatment of Biliary Atresia in infants,citing its ability to greatly enhance bile drainage along with keeping serum bilirubin levels within range,thus improving the patient's quality of life. [7]
She evaluated the success ratio of kasai portoenterostomy and demonstrated a higher success and overall survival rate within children who were treated at high volume centers compared to those who were treated at low volume centers. [8]
She was also part of the team that analyzed the handling of Biliary Atresia patients in England and Wales from 1999 to 2002 in supra-regional centers. The study involved 148 infants and the results showed that out of 96% of the infants that underwent kasai portoenterostomy,57% of them recovered from jaundice,while the remaining 37% had to go for a liver transplant. The 4-year survival rate improved to 89%,indicating that surgical outcomes can be enhanced by centralizing care to supra-regional centers. [9] She also identified the need for prompt transfer of care from pediatric to adult-oriented liver treatment centers for patients who have successfully achieved adulthood. [10] She evaluated the prospects of conventional visual screening and systematic screening of babies with neonatal jaundice and suggested that conventional visual screening is not as effective,due to its ability to yield numerous false positives.
Kelly studied auto-immune disease and identified a female predominance in both of its types i.e. (AIH type 1) and (AIH type 2). She stressed the importance of prompt medical attention with medication including azathioprine and steroids and advocated for long-term treatment,due to the possibility of the disease relapsing at any given time. [11] She also studied the outcomes of liver transplantation in children with autoimmune sclerosing cholangitis(AISC) and autoimmune hepatitis(AIH). In a separate study,she demonstrated that AIH patients who underwent a liver transplant took a longer time to recover compared to those who didn't. She stressed the fact that while liver transplantation is an effective therapeutic option for progressive AISC and AIH,the potential relapse of the primary auto-immune process greatly reduces its outcomes. [12]
Kelly has conducted research on liver failure with a particular focus on pediatric liver failure. She studied drug-related hepatotoxicity and its role in causing acute liver failure in children,and discouraged the use of acetaminophen (as it accounts for 15% of all ALF in children in the US and UK) along with other drugs to prevent acute liver failure. [13] She also termed paracetamol overdose as one of the leading causes of acute liver failure along with other inevitable natural factors such as having a genetic metabolic liver disease. [14]
Kelly's unit in Birmingham was one of the first groups to work on liver transplantation for infants. She has evaluated the long-term benefits of infant liver transplantation,quality of life,the natural history of graft injury [15] and defined the effect of the transition to adult services on long-term survival. [16] [17]
She has played an integral part in clarifying the optimal use of post-transplant immunosuppression through her role as Chief Investigator of multi-centre clinical trials including the only definitive randomised study of tacrolimus and cyclosporine in children. [18]
Hepatitis is inflammation of the liver tissue. Some people or animals with hepatitis have no symptoms,whereas others develop yellow discoloration of the skin and whites of the eyes (jaundice),poor appetite,vomiting,tiredness,abdominal pain,and diarrhea. Hepatitis is acute if it resolves within six months,and chronic if it lasts longer than six months. Acute hepatitis can resolve on its own,progress to chronic hepatitis,or (rarely) result in acute liver failure. Chronic hepatitis may progress to scarring of the liver (cirrhosis),liver failure,and liver cancer.
Hepatology is the branch of medicine that incorporates the study of liver,gallbladder,biliary tree,and pancreas as well as management of their disorders. Although traditionally considered a sub-specialty of gastroenterology,rapid expansion has led in some countries to doctors specializing solely on this area,who are called hepatologists.
Alcoholic hepatitis is hepatitis due to excessive intake of alcohol. Patients typically have a history of at least 10 years of heavy alcohol intake,typically 8–10 drinks per day. It is usually found in association with fatty liver,an early stage of alcoholic liver disease,and may contribute to the progression of fibrosis,leading to cirrhosis. Symptoms may present acutely after a large amount of alcoholic intake in a short time period,or after years of excess alcohol intake. Signs and symptoms of alcoholic hepatitis include jaundice,ascites,fatigue and hepatic encephalopathy. Mild cases are self-limiting,but severe cases have a high risk of death. Severe cases may be treated with glucocorticoids. The condition often comes on suddenly and may progress in severity very rapidly.
Autoimmune hepatitis,formerly known as lupoid hepatitis,plasma cell hepatitis, or autoimmune chronic active hepatitis, is a chronic,autoimmune disease of the liver that occurs when the body's immune system attacks liver cells,causing the liver to be inflamed. Common initial symptoms may include fatigue,nausea,muscle aches,or weight loss or signs of acute liver inflammation including fever,jaundice,and right upper quadrant abdominal pain. Individuals with autoimmune hepatitis often have no initial symptoms and the disease may be detected by abnormal liver function tests and increased protein levels during routine bloodwork or the observation of an abnormal-looking liver during abdominal surgery.
Biliary atresia,also known as extrahepatic ductopenia and progressive obliterative cholangiopathy,is a childhood disease of the liver in which one or more bile ducts are abnormally narrow,blocked,or absent. It can be congenital or acquired. It has an incidence of one in 10,000–15,000 live births in the United States,and a prevalence of one in 16,700 in the British Isles. Biliary atresia is most common in East Asia,with a frequency of one in 5,000.
Primary biliary cholangitis (PBC),previously known as primary biliary cirrhosis,is an autoimmune disease of the liver. It results from a slow,progressive destruction of the small bile ducts of the liver,causing bile and other toxins to build up in the liver,a condition called cholestasis. Further slow damage to the liver tissue can lead to scarring,fibrosis,and eventually cirrhosis.
Primary sclerosing cholangitis (PSC) is a long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts,which normally allow bile to drain from the gallbladder. Affected individuals may have no symptoms or may experience signs and symptoms of liver disease,such as yellow discoloration of the skin and eyes,itching,and abdominal pain.
Ursodeoxycholic acid (UDCA),also known as ursodiol,is a secondary bile acid,produced in humans and most other species from metabolism by intestinal bacteria. It is synthesized in the liver in some species,and was first identified in bile of bears of genus Ursus,from which its name derived. In purified form,it has been used to treat or prevent several diseases of the liver or bile ducts.
Cholestasis is a condition where the flow of bile from the liver to the duodenum is impaired. The two basic distinctions are:
Neonatal cholestasis refers to elevated levels of conjugated bilirubin identified in newborn infants within the first few months of life. Conjugated hyperbilirubinemia is clinically defined as >20% of total serum bilirubin or conjugated bilirubin concentration greater than 1.0 mg/dL regardless of total serum bilirubin concentration. The differential diagnosis for neonatal cholestasis can vary extensively. However,the underlying disease pathology is caused by improper transport and/or defects in excretion of bile from hepatocytes leading to an accumulation of conjugated bilirubin in the body. Generally,symptoms associated with neonatal cholestasis can vary based on the underlying cause of the disease. However,most infants affected will present with jaundice,scleral icterus,failure to thrive,acholic or pale stools,and dark urine.
A hepatoportoenterostomy or Kasai portoenterostomy is a surgical treatment performed on infants with Type IVb choledochal cyst and biliary atresia to allow for bile drainage. In these infants,the bile is not able to drain normally from the small bile ducts within the liver into the larger bile ducts that connect to the gall bladder and small intestine.
Children's Liver Disease Foundation (CLDF) is a UK charity taking action against the effects of childhood liver disease,providing information,emotional support,research funds and a voice for all affected.
Liver cancer is cancer that starts in the liver. Liver cancer can be primary or secondary. Liver metastasis is more common than that which starts in the liver. Instances of liver cancer are increasing globally.
Ischemic hepatitis,also known as shock liver,is a condition defined as an acute liver injury caused by insufficient blood flow to the liver. The decreased blood flow (perfusion) to the liver is usually due to shock or low blood pressure. However,local causes involving the hepatic artery that supplies oxygen to the liver,such as a blood clot in the hepatic artery,can also cause ischemic hepatitis.
Liver kidney microsomal type 1 antibody (anti-LKM1) is an autoantibody associated with autoimmune hepatitis (AIH). Specifically,its presence in AIH defines type 2 AIH,although it has been proposed that anti-liver cytosol type 1 autoantibody without detectable anti-LKM1 can be seen in type 2 AIH. It is one of the several subtypes of anti–liver-kidney microsome antibodies that are known. The frequent association of anti-LKM-1 antibodies and hepatitis C virus (HCV) infections and the probable existence of an infection-associated autoimmune form of anti-LKM-1-associated hepatitis,requiring a different therapeutic strategy,necessitate the exact determination of anti-LKM-1 specificities.
Cirrhosis,also known as liver cirrhosis or hepatic cirrhosis,and end-stage liver disease,is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease. Damage to the liver leads to repair of liver tissue and subsequent formation of scar tissue. Over time,scar tissue can replace normal functioning tissue,leading to the impaired liver function of cirrhosis. The disease typically develops slowly over months or years. Early symptoms may include tiredness,weakness,loss of appetite,unexplained weight loss,nausea and vomiting,and discomfort in the right upper quadrant of the abdomen. As the disease worsens,symptoms may include itchiness,swelling in the lower legs,fluid build-up in the abdomen,jaundice,bruising easily,and the development of spider-like blood vessels in the skin. The fluid build-up in the abdomen may develop into spontaneous infections. More serious complications include hepatic encephalopathy,bleeding from dilated veins in the esophagus,stomach,or intestines,and liver cancer.
Thomas D. Schiano is an American specialist in liver transplantation,intestinal transplantation and in the diagnosis and treatment of acute and chronic liver disease. He serves as associate editor for the journals Hepatology and Liver Transplantation and has published more than 200 peer-reviewed articles and abstracts and more than 20 book chapters.
Morio Kasai was a Japanese surgeon who had a strong interest in pediatric surgery. While Kasai went into practice at a time when pediatric surgery was not an established subspecialty,much of his clinical and research work was related to the surgical care of children. He is best known for devising a surgical procedure,the hepatoportoenterostomy,to address a life-threatening birth defect known as biliary atresia. The modern form of the operation is still known as the Kasai procedure.
James Michael Millis is an American academic and surgeon specializing in pediatric and adult liver transplantation. He is Professor of Surgery and Vice Chair of Global Surgery at University of Chicago. He is also the director of Clinical Leadership Development Fellowship and Hepatobiliary Surgery at the University of Chicago Medical Center. He is known for developing new techniques of liver surgery that improved outcomes following liver transplantation and non transplant liver and biliary tract surgery.
Alexander Parker Mowat was a Scottish paediatric hepatologist. He established the paediatric hepatology unit at King's College Hospital,London,which became a referral centre for children across Britain with liver diseases.