EASL Recognition Award Recipient 2023: Prof. Julia A. Wendon.

It is my great honour and privilege to present Prof Julia A. Wendon with the EASL recognition award 2023. Julia or “Jules” as she is widely known within the liver community represents an individual who has founded a brand-new discipline within the field of Hepatology. Building on the work of her great mentor Prof. Roger Williams, Jules truly established and developed the field of Liver Intensive Care Medicine. Jules arrived to King's College Hospital London with the goal of undertaking haemodynamic research and thence returning to a career as a Cardiologist. Before long, her interest and aptitude for critical analysis of the haemodynamic and metabolic changes associated with organ failure including acute liver failure (ALF) and cirrhosis caused her to switch direction in her career.[1]Wendon J. Smithies M. Sheppard M. Bullen K. Tinker J. Bihari D. Continuous high volume venous-venous haemofiltration in acute renal failure.Intensive Care Med. 1989; 15: 358-363Crossref PubMed Scopus (99) Google Scholar For that we are grateful. Jules grew up in Wales, one of two children. Having graduated from Medical School at the University of Dundee in 1982, Jules arrived at King's in 1988 at a time that coincided with the development of the Institution as an independent liver transplant centre evolving from the combined King’s/Cambridge programme. The programme focussed initially on patients with ALF and on indications then considered to be “non-standard” such as hepatitis B virus infection.[2]O'Grady J. Wendon J. Tan K.C. Potter D. Cottam S. Cohen A. et al.Liver transplantation after paracetamol overdose.BMJ. 1991; 303: 221-223Crossref PubMed Scopus (82) Google Scholar Not only did Jules contribute to ground-breaking research in the care of patients with ALF from a physiological and clinical standpoint, with defining interventions such as the use of N-acetylcysteine in ALF generally, but more specifically in the context of paracetamol (acetaminophen) toxicity.[3]Harrison P.M. Wendon J.A. Gimson A.E. Alexander G.J. Williams R. Improvement by acetylcysteine of hemodynamics and oxygen transport in fulminant hepatic failure.N Engl J Med. 1991; 324: 1852-1857Crossref PubMed Scopus (483) Google Scholar Her early work defined the haemodynamic and oxygen transporting effects of various vasopressors and vasodilators used in the management of liver failure.[4]Wendon J.A. Harrison P.M. Keays R. Gimson A.E. Alexander G.J. Williams R. Effects of vasopressor agents and epoprostenol on systemic hemodynamics and oxygen transport in fulminant hepatic failure.Hepatology. 1992; 15: 1067-1071Crossref PubMed Scopus (62) Google Scholar Subsequently. her group generated experiments that tested hypotheses, modified clinical care, then re-tested them such that the standards of care we consider the norm in the management of critically ill patients with liver disease were generated. Her impact in the field of ALF is abundant. She has tested multiple generations of extracorporeal liver support devices and worked with Fin Larsen to deliver the randomised trial on plasma exchange in ALF.[5]Larsen F.S. Schmidt L.E. Bernsmeier C. Rasmussen A. Isoniemi H. Patel V.C. et al.High-volume plasma exchange in patients with acute liver failure: an open randomised controlled trial.J Hepatol. 2016; 64: 69-78Abstract Full Text Full Text PDF PubMed Scopus (365) Google Scholar A Physician Scientist at heart, she examined the changes both systemically and at a tissue level. Her group identified the importance of blood lactate as a key predictor of outcome in paracetamol-induced ALF and this has been widely adopted into poor prognostic criteria and guidelines that determine suitability and listing for liver transplantation.[6]Bernal W. Donaldson N. Wyncoll D. Wendon J. Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study.Lancet. 2002; 359: 558-563Abstract Full Text Full Text PDF PubMed Scopus (400) Google Scholar All aspects of pathophysiology in ALF have been interrogated including the performance of clinical trials using hypertonic saline.[7]Murphy N. Auzinger G. Bernal W. Wendon J. The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure.Hepatology. 2004; 39: 464-470Crossref PubMed Scopus (292) Google Scholar She recognised the immune dysfunction and immunoparesis associated with ALF and encouraged younger investigators under her guidance to examine these heretofore unexplored avenues of research.[8]Antoniades C.G. Berry P.A. Davies E.T. Hussain M. Bernal W. Vergani D. et al.Reduced monocyte HLA-DR expression: a novel biomarker of disease severity and outcome in acetaminophen-induced acute liver failure.Hepatol. 2006; 44: 34-43Crossref PubMed Scopus (124) Google Scholar Her collaborative and mentoring approach within King’s and beyond is widely known. She has supervised over 20 Doctorate students, and welcomed visitors from all over the world to the Liver Intensive Therapy unit (LITU) at King's College Hospital. She has published over 300 papers and book chapters including 32 in Hepatology, 27 in The Journal of Hepatology, four in the New England Journal of Medicine and seven in The Lancet. She has also led the EASL Clinical Practice Guidelines on Acute Liver Failure. Within King's, she drove the expansion of the original (1973) two-bed liver failure unit to five beds in 1991. Her appointment as Senior Lecturer at King’s College London and Consultant in Intensive Care Medicine in 1992, resulted in further growth of the unit to 10 beds until ultimately a new 15-bed Liver Intensive Therapy (LITU) unit opened in 2003 which is synonymous with her name. Since then, an additional four high dependency area beds have been added. Jules model of critical care has been replicated in many centres worldwide, including The Hospital Clinic in Barcelona and indeed a 36-bed ICU and 24-bed transplant ICU has been named in her honour at The Rela Hospital in Chennai, India. Within Kings, she has held leadership roles as Clinical Director of the Institute of Liver Studies, Clinical Director of Intensive Care and has also served as Chief Medical Officer for King's College Hospital NHS Foundation Trust and as Executive Director for Clinical Strategy for King’s and Guys and St Thomas’ Foundation Trust (GSTT FT). During the recent pandemic her organisational skills were recognised and she was Clinical Director for NHS England in the delivery of Critical Care responses and readiness across London. Although she claims not to be a Hepatologist, she has forgotten more Hepatology than many of us will learn. She attributes her success to the team around her and it is this humility that makes her unique in the world of Liver Medicine and Critical Care. To quote her “I am now a clinician again and revelling in patient care and the joy that my students are now my teachers.” She is dedicated to her two boys Alex and Jake. Her pursuit of excellence is legendary and has inspired us all as colleagues to do better, aim higher and improve outcomes for our patients.[9]Bernal W. Wendon J. Acute liver failure.N Engl J Med. 2013; 369: 2525-2534Crossref PubMed Scopus (784) Google Scholar