The clinical teams
15 clinical departments participate in our institute, based in 4 hospital sites
Hepatology and Addictology Department
The Hepatology Department (Chair: F. Zoulim) at the North Hospital is one of the largest Hepatology Departments in France (59 inpatient and 15 outpatient units dedicated to chronic liver diseases, including liver transplantation and addictology) and is the cornerstone of EVEREST. The department is organized with a specialized academic medical staff for HCC (Prof P. Merle, PUPH,), liver transplantation (Dr T. Antonini, PH; Dr F. Lebossé, MCU-PH), NAFLD (Prof M. Levrero, PUPH), Addictology (Dr F Bailly, PH) and viral hepatitis (Prof F. Zoulim, PUPH). The department runs weekly multidisciplinary board meetings dedicated to these pathologies as well as for difficult cases with a network of public or private physicians in the AURA Region. Thanks to a large patient recruitment territory, the department is involved in cohort studies, proof of concept clinical trials as well as pivotal trials. The research program is actively funded by PHRC, INCA, ANRS-EID, Europe H2020, and industry. The department is involved in the training of young specialists in Hepatology.
Addictology clinical activities cover alcohol and chemical dependence as well as behavioral dependance, and are efficiently integrated with the hepatology department. They are carried out within the CHU by two united teams: the University Service of Addictology of Lyon (SUAL, Prof B. Rolland, PUPH), and the unit of Addictology and Hepatology of the North Hospital (Dr F. Bailly, PH). These two multidisciplinary teams provide inpatient and outpatient care for addiction withdrawals, complications of addictions and somatic or psychiatric comorbidities. These teams support teaching, as well as clinical and translational research activities on addictions and their complications.
General Digestive Surgery and Liver Transplantation Department
The General Digestive Surgery and Liver Transplantation Department is currently the 3rd largest liver transplant center in France, offering up-to-date treatment for end-stage liver disease and liver cancer. The department manages ~100 adult and ~20 pediatric liver transplantations, and ~120 selective hepatectomies per year. Beside the adult and paediatric deceased donor liver transplant program, there is also an active living donation program for paediatric recipients. The surgical team consists of 4 academic surgeons (Prof JY Mabrut, PUPH; Prof K Mohkam, PUPH; Dr S. Mezoughi, PH; Dr H Demian, PH) and 4 surgical fellows (Dr X Muller, Dr G Rossignol, Dr J Couillerot, Dr A. Breton, Dr N. Boulanger). The department has an active role in training of surgical residents as well as basic and clinical research. It has implemented an active pre-clinical and clinical research program to make transformative changes in the surgical management of patients regarding selective hepatectomy and liver transplantation.
Anaesthesia and Intensive Care Department
Headed by Pr F. Aubrun (PUPH), the department has a team dedicated to the management of end-stage liver disease (ESLD and ACLF), selective hepatectomy, liver transplantation and the early post-transplant phase, supervised by Drs A. Blet (PH) and C. Guichon (PH). The liver intensive care unit (ICU) team (Dr. C. Guichon, PH, Dr. A. Blet, PH, Dr. MC Delignette, PHC, Dr. C. Patay, CCA) is a local and regional hepatic reference center. The liver ICU has established in cooperation with the Hepatology Department a regional hotline for liver emergencies: “HOtline Urgence Foie (HOUF)”. Its permanence is ensured by the hepatologists and the intensivists of the two departments. The team has initiated the Liver in Anesthesia and Intensive Care network (“Foie en Anesthésie-Réanimation (FAR)” coordinated by Dr C. Guichon (PH) at the national level within the Société Française d'Anesthésie-Réanimation (SFAR). We also provide expert activity for anesthetic and peri-operative management (Dr A. Blet, PH, Dr M. Gazon, PH, Dr A. Bonnet, PH) of primary liver and biliary tract tumors, and liver transplantation in tight collaboration with the clinical department of Pr Mabrut.
Hepato-Gastro-Enterology department
The hepato-gastroenterology department of the Edouard Herriot Hospital, headed by Prof JC Saurin (PUPH), is an expert center for gastroenterology, diagnostic and interventional endoscopy, and GI oncology and oncogenetics. It also encompasses an important clinical hepatology activity coordinated by Prof J. Dumortier (PUPH) and Dr Chambon-Augoyard (PH) for general hepatology, NAFLD and ALD, and post-transplant management. This hepatology team is a member of the national network of rare disease centers for Wilson's disease, vascular liver diseases and autoimmune hepatobiliary diseases. It works in close collaboration with the Hepatology department (Pr Zoulim), Diabetes and Nutrition Department (Pr Caussy), and the GI and liver surgery departments (Pr Mabrut and Pr Adham).
Digestive Surgery department
The digestive surgery department of HCL Center Hospital (Chair: M Adham, PUPH) is an expert for digestive surgery, endocrine tumor surgery, hepato-biliary and pancreatic surgery, and bariatric surgery for obesity. Under the supervision of Prof M Robert (PUPH), the Integrated Obesity Centre (IOC) was developed to offer multidisciplinary care for obesity and bariatric surgery. It will thus work in close collaboration with EVEREST, especially for the M/NAFLD research program.
Paediatrics Hepatogastroenterology department
The pediatrics hepatogastroenterology and nutrition department is managed by Prof N Peretti (PUPH) and Dr N Laverdure (PH). It will provide an important contribution to EVEREST for pediatric liver diseases. The pediatric hepatology team headed by Dr N Laverdure is involved in reference centers of rare liver diseases (FILFOIE) on Wilson’s disease (Dr E Couchonnal, PH) and on biliary atresia & neonatal cholestasis (Dr M Ruiz, PH), and cohort studies on alpha1 antitrypsin deficiency (Prof A Lachaux, PUPH). This team is actively involved in national (GFHGNP) and international (ESPGHAN) pediatric liver societies. The department manages the pre- and post-transplant pediatric patients, and has developed a unique “pediatric to adult transition” program in collaboration with the Hepatology department accompanied by the first education and counseling program in France (LIFT).
Uro-visceral, thoracic surgery and transplantation in children
This department headed, by Prof PY Mure, brings together all the skills and expertise for pediatric visceral surgery. It is one of the four French centers for pediatric liver transplantation. This program is successfully led by Dr R Dubois (PH) in tight collaboration with the adult liver transplantation department (Prof JY Mabrut, see above CU2). With 20 pediatric transplantations performed each year (out of 80 to 90 in France), this department is an important partner of the Institute.
Endocrinology, Diabetes and Nutrition Department
Because of the high prevalence of M/NAFLD which is a key topic of the Institute research program, this department, managed by Pr E. DISSE, is be a key player of our Institute. Prof C. CAUSSY is in charge of the expert management of metabolic liver diseases. Based on the expert clinical care of patients with metabolic diseases including type 2 diabetes (DT2), obesity and NAFLD, this unit has established a French Obesity Research Centre of Excellence (FORCE) providing innovative care, lifestyle intervention, pharmacotherapy, bariatric surgery and multidisciplinary education programs. A strong expertise in non-invasive liver fibrosis assessment of M/NAFLD was developed in close collaboration with the Hepatology department via a dedicated multidisciplinary NASH board to accompany patient referral, discuss treatment indication, and propose enrollment in clinical trials.
Imaging department
The Imaging Department is developing active research in liver imaging. It has state-of-the-art radiology equipment including four dual-energy scanners, four MRIs (1.5 T and 3T) and two complete interventional radiology platforms. It works in close collaboration with the research units CREATIS and LabTau. With a team of senior academic radiologists (Prof L Boussel, PUPH; Dr A Rode, PH; Prof L Milot, PUPH; Prof P Douek, PUPH), the department is developing a photon counting CT scanner with a prototype available for clinical research, innovative liver MR techniques, advanced interventional techniques (beyond TIPPS and radiofrequency), and HIFU and AI-based image processing methods which contribute to innovative research projects within EVEREST. This team has been involved in two recent H2020 EU funded projects (SPCCT (Spectral Photon Counting CT), and Scan N Treat).
Pharmacy department
Beside its daily support to clinical activities, the North Hospital Pharmacy provides equipment, human resources and expertise to support development of new drug strategies. The Pharmacy department includes a clinical trial unit for the management of investigational products. It provides assistance for regulatory authorization procedures for academic clinical trials and is authorized by French health regulations to prepare drugs and placebos for clinical trials. The pharmacy is engaged in more than 180 clinical trials and works in close collaboration with the North hospital CRC for the support of academic and industry sponsored clinical studies.
Clinical Virology Laboratory
The clinical virology laboratory of the North Hospital (Chair Prof B Lina, PUPH) is part of the Infectious Diseases Institute, where 240 people (medical, technical and residents) worked together to perform more than 1.1 million medical biology acts in 2021, within several platforms (serology, molecular biology, automated microbiology, sequencing, conventional virology, bacteriology and parasitology. The virology laboratory provides its expertise to all HCL clinical units for the diagnosis of viral infections including acute (respiratory viruses including COVOD-19, enteroviruses, etc) and chronic infections (HIV, viral hepatitis, CMV, EBV, etc), and has received the label of National Reference Center for enteroviruses and for respiratory infections (influenza and COVID-19). It manages a large daily volume of quantitative PCR assays on a high tech qPCR equipment platform. The viral hepatitis diagnosis team is headed by Dr C. Scholtes (MCUPH) and provides its expertise in the diagnosis and monitoring of HCV, HBV, HDV, HEV infections. The clinical virology laboratory In close collaboration with the hepatology department is actively involved in the viral hepatitis board for the management of patients with viral hepatitis, and in clinical cohort studies and clinical trials such as the RHU CirB-RNA cohort and the H2020 IPcureB clinical trial. In addition to quantitative viral biomarker assessment, it will provide its expertise for viral genotyping and NGS sequencing.
Pathology Department
The HCL department of Pathology has a strong expertise in the diagnosis of liver diseases. This activity, supervised by Dr V Hervieu (MCUPH), includes 1350 liver biopsies and 260 surgical specimens (including tumor resections and liver transplantation). The proximity to the molecular biology platform enables expert molecular diagnosis of hepatocellular adenomas or the search for actionable targets in cholangiocarcinomas. The department provides rapid management and diagnosis whenever needed, e.g. liver transplantation, of « maastricht 3 » liver grafts, acute alcoholic hepatitis or fulminant hepatitis. The liver pathology team consists of 2 senior academic pathologists who provide their expertise in multidisciplinary boards (NASH, Viral Hepatitis, Liver Cancer, Liver Transplantation). The department maintains a tissue bank of frozen samples of liver and bile duct tumors as well as liver explant fragments which are available for future translational studies within EVEREST. The department is involved in AI-based image processing which will be an important component of the IHU research program.
Biochemistry Laboratory
The Biochemistry laboratory of the North Hospital is part of the Central Biology Laboratory of all the HCL hospitals. It manages a high volume of clinical samples for daily routine management of hospitalized and patients seen in oupatient clinics. The biochemistry activity linked to liver diseases is supervised by Dr S Zaepfel (PH) and Dr L Lacaille (PH). The close collaboration with the North hospital Hepatology department allow implementation of non invasive assessments for the staging of liver diseases. This began with the acti-test and fibro-test for the management of chronic hepatitis C, and was followed by the implementation of the NAFLD score and FIB-4 score which contribute now to the expert management of patients and multidisciplinary board decisions (CU1, CU4, CU6, . Other studies are ongoing to validate predictive scores for HCC, beyond the REACH-B and PAGE-B scores, for instance with the LCR1/LCR2 tests. The implication of this team will be instrumental in EVEREST strategy to develop novel biomarkers towards the implementation of a precision medicine strategy.
