Royal Free PSC Service

 

 

 

 

 

The PSC Service at Royal Free Hospital, Hampstead, London

The Sheila Sherlock Liver Centre at the Royal Free Hospital was the first liver unit in the UK. Established by the pioneer Professor Dame Sheila Sherlock, who was both the first Professor of Hepatology and first female Professor of Medicine in the UK, the unit has extensive clinical and research experience in liver and digestive diseases including autoimmune and cholestatic liver disorders. The unit is one of the 7 UK liver transplant units and has a large tertiary referral practice for all liver diseases. The Free is characterized by the excellence of supporting clinical services including an excellent Gastroenterology and Inflammatory Bowel Disease unit, advanced general and liver and biliary Endoscopy service, a large hepatopancreobiliary (HPB) and liver transplant surgical unit. All of this is enhanced by superb HPB and interventional radiology, a large specialist intensive care unit (ICU), excellent liver pathology services and specialist nurses teams offering patients complete support from diagnosis to treatment. At the Free, the clinical service has never been an end in itself and has always provided a platform for research and teaching in liver disease and this has been enhanced in recent times by University College London (UCL) establishing the UCL Institute of Liver and Digestive Health (ILDH) based at the Royal Free Hospital. Professor Massimo Pinzani is the Director of the UCL ILDH.

Recently Dr Douglas Thorburn (Consultant Hepatologist and Clinical Director for Liver Transplantation, Hepatology, HPB Surgery, Gastroenterology and Endoscopy) and Dr Aileen Marshall (Consultant Hepatologist) have set up a specialist Autoimmune and Cholestatic Liver Disease clinic that takes place on a Monday afternoon at the Royal Free Hospital. A multidisciplinary team of specialist and trainee doctors, specialist and research nurses, basic scientists and medical researchers have collaborated to create a dedicated clinic for patients with primary sclerosing cholangitis, primary biliary cholangitis, autoimmune hepatitis, patients with Overlap Syndromes and other cholestatic liver diseases. The clinic takes place in the general outpatient department of the Royal Free Hospital with associated research space in the UCL Institute of Immunity and Transplantation where research staff are based throughout the clinic. This provides the expertise, manpower and space to run a fully integrated research clinic where we try to encourage every patient we see to participate in research and provide early access to new treatments for patients with PSC and the other conditions outlined.

Our group is participating in a number of studies into PSC which are local investigator led, the product of national collaborations as the London hub centre for UK-PSC and international collaborations through our participation in the International PSC Study Group (iPSCSG). To this end we invite all of our patients to participate in our biobank where we store human blood, tissue and other biological samples for current and future research projects once consent has been obtained. All the materials biobanked are excess samples collected during routine clinical care, for example if patients require a blood test for clinical reasons they would be asked for consent to give extra blood for the biobank. All samples are prepared and stored according to standardised procedures agreed internationally.

Currently areas of particular interest include better understanding the natural history of PSC and better predicting who and when individuals will experience complications of their liver disease. This is made possible by having access to new methods for the non-invasive assessment of liver diseases including tissue elastography (Fibroscan®) and shear wave elastography which are available for all patients as part of our biobanking protocol.

A further area of interest is studying the risk of HPB cancer in patients with PSC. Dr Steve Pereira (Reader in HPB Medicine) is interested in this area and a number of trials are currently recruiting. Our advanced biliary endoscopy service has access to new methods for evaluating bile duct strictures in patients with PSC including Spyglass Cholangioscopy and Confocal Laser Endomicroscopy which we are currently evaluating in patients with PSC.

Given the lack of effective medical therapies currently, we are evaluating new treatments for PSC. There are a number of clinical trials of new medical treatments for PSC, which will be opening in 2015, and we are keen to offer these to as many patients with PSC as possible who may be eligible and willing to attend the Royal Free Hospital to participate.

Thanks to our patients’ support, we endeavour to continually improve our expertise, our clinical service and our research in order to offer them the best possible care. We have strong and active links with PSC Support and happily provide assistance to both the organisation and to individual patients. We are very happy to see any patients with PSC who are interested in attending the Royal Free Hospital for assessment, management or are interested in participating in PSC research. We will keep PSC Support informed of current and forthcoming trials at the Royal Free so that interested patients can approach us to participate.

For any further queries please contact Dr Douglas Thorburn