News

The BASL Equality, Diversity and Inclusiveness Strategy 2021-2024 document has been compiled as part of the BASL Inclusiveness Project and has received BASL Committee approval.

This, alongside our updated Equality, Diversity and Inclusiveness Policy and the policies that have been developed to support it can be found in the members area of our website by logging on > here .

With the rapid rise in cases of the Omicron variant of COVID-19 in the UK the NHS potentially faces another surge in hospital admissions and we are all facing familiar uncertainty and drawing on our resilience mechanisms again. The uncertainty is compounded by not yet knowing the severity or otherwise compared to the Delta variant, the moderating effect of vaccination and whether enough of the population are either vaccinated or boosted to exert this effect, and how the new monoclonal antibody drugs for symptomatic mild to moderate disease in the community will impact on admissions. Below is a summary from the relevant policies, with links, for your information.

These new monocolonals now have conditional marketing authorisation for use in non-hospitalised patients in the UK (read the cas.mhra.gov.uk website alert by clicking > here ). 

• Sotrovimab is given by single intravenous infusion and is reported to reduce the relative risk of hospitalisation or death by 85%.
• Molnupiravir is given orally by capsules for 5 days and is reported to reduce the relative risk of hospitalisation or death by 30%.

Patients must meet all of the eligibility criteria and none of the exclusion criteria. Prehospitalised patients are eligible for treatment if:
• SARS-CoV-2 infection is confirmed by polymerase chain reaction (PCR) testing within the last 5 days
AND
• Onset of symptoms of COVID-193 4 within the last 5 days
AND
• A member of a ‘highest’ risk group (as defined in Appendix 1).

Symptoms listed are: feverish, chills, sore throat, cough, shortness of breath or difficulty breathing, nausea, vomiting, diarrhoea, headache, red or watery eyes, body aches, loss of taste or smell, fatigue, loss of appetite, confusion, dizziness, pressure or tight chest, chest pain, stomach ache, rash, sneezing, sputum or phlegm, runny nose.

Appendix 1 includes liver disease in the following categories:
• Patients with cirrhosis Child’s-Pugh class B and C (decompensated liver disease).
• Patients with a liver transplant
• Liver patients on immune suppressive therapy (including patients with and without liver cirrhosis)
• Patients with cirrhosis Child’s-Pugh class A who are not on immune suppressive therapy (compensated liver disease)

Patients will be anxious, and as clinicians we may be contacted for advice. How the delivery of these drugs is to be organised is being worked out at local operational levels. Members are advised to make enquiries within their Trusts for local arrangements. The Liverpool COVID-19 interactions checker is a useful resource (click > here ). We checked these drugs against the more commonly used immunosuppressants and, for those not familiar with this tool, it is easy to use (no expected interactions for tacrolimus, ciclosprin, azathioprine, mycophenolate, prednisolone).

Members will no doubt be aware that casirivumab and imdevimab (Ronapreve®) has authorisation in hospitalised patients admitted with acute COVID-19. This seems to be less effective in patients with the Omicron variant. Thus where Omicron accounts for more than 50% of the local hospital prevalence, Ronapreve is only recommended where genotyping results are available and confirm infection with a non-Omicron variant. Where genotyping is not available or genotyping confirms infection with the Omicron variant, the December 2021 rapid policy statement advises nMABs can only be offered as part of a formal trial.

Nosocomial acquisition is a bit different. Ronapreve can be used in non-Omicron cases where known, meeting high risk criteria and Sotrovimab has also now been authorised for hospitalised patients who acquire Omicron variant COVID-19 during their hospital stay and meet high risk criteria - for our patients with liver disease, these are the same as those listed above. (read the cas.mhra.gov.uk website alert by clicking > here ). 

Again, members are advised to check their local Trust policies, but nosocomial acquisition of COVID-19 in patients with liver disease may well meet criteria for the use of these drugs so we thought we would draw your attention to this.

Hepatologists and gastroenterologists have faced very challenging changes to practice over the last two years and rising numbers of patients with liver disease. We know the changing Covid-19 landscape continues to bring new challenges. We hope you all stay safe and well during this period.

Rebecca Jones, President BASL
John Dillon, Vice President Hepatology, BSG

Download Joint BASL_BSG message re monoclonal antibody drugs vs COVID-19.pdf

(Added December 20th 2021)

First Call for Applications

The Foundation for Liver Research has set up a new Small Grants Scheme in memory of the late Professor Roger Williams CBE (1931-2020). This scheme is open to any applicant in the UK.

Outline of the Small Grants Scheme

An Application form can be downloaded from the Foundation for Liver Research website > here . 

The closing date for the first Call is 1st March 2022.

For details of eligibility and the application process, contact Natalie Day, Chief Executive of the Foundation for Liver Research n.day@researchinliver.org.uk .

A survey of HCC surveillance in the UK was last conducted in 2014, which highlighted some weaknesses in service provision nationally. We are repeating the survey to see if things have changed, and extending the survey to include additional questions on surveillance imaging and secondary surveillance. We have worked with the HCC UK Committee in developing this survey, and the project is supported by BASL. We hope that this will generate a valuable contemporary overview of UK HCC surveillance service delivery, and stimulate discussion and innovation.

The link to the survey is found here > https://forms.gle/U46TZq7oeVfJveAs7 

This time we are seeking service level responses (one response per organisation or service).We expect the survey will only take 10-15 minutes to complete, although some of the questions might require input from other clinical colleagues e.g. section 3 is about imaging and may require input from a radiologist. We will acknowledge the lead contributor from each organisation in a report of this survey.

Many thanks in advance for your time.

Dr Aloysious Aravinthan, Consultant Hepatologist, Nottingham University Hospitals NHS Trust
Dr James Franklin, Consultant Radiologist, University Hospitals Dorset NHS Foundation Trust
Dr Christopher Clarke, Consultant Radiologist, Nottingham University Hospitals NHS Trust
Professor Steve Ryder, Consultant Hepatologist, Nottingham University Hospitals NHS Trust
Professor Shahid Khan, Professor of Practice (Hepatology), Imperial College London

The IQILS accreditation programme has grown significantly in the last 18 months. There has been a rapid increase in the level of engagement from services, committed to progressing with IQILS accreditation. The programme currently has 60 registered services, an increase of 8 services in 2021 alone. 11 services are currently signed off for the level 1 standards; A list of all these services can be found on the IQILS website. Three services will be undergoing a full accreditation assessment in the latter part of 2021.

The programme is also offering registered services, that are not an operational delivery hub for the Hepatitis C network, peer review support opportunities. The peer reviews are taking place remotely and will provide your service with an opportunity to receive feedback and guidance on how to progress with the accreditation standards.

In other news, Dragana Smith has recently been appointed as the new IQILS programme manager. Dragana previously worked as programme manager for the pulmonary rehabilitation accreditation programme, and prior to joining the Royal College of Physicians, worked in the fields of legal practice and medical education.

Registration to the programme is open to all liver services across the UK. If your service is interested in registering, please visit our website to sign up: https://www.iqils.org/UserRegistration/ 

Services registered to the programme receive access to the following benefits:
• The full accreditation standards
• Access to the IQILS website and self-assessment webtool
• Regular virtual training session on the accreditation process and standards
• Online repository of best practice templates and documents
• Regular newsletters on the programme with updates
• Support from the IQILS office team

Please contact the IQILS team at askiqils@rcp.ac.uk or 0203 3075 1508 if you would like to speak to the IQILS team about the programme.