UCL Division of Medicine



Cirrhosis is scarring (fibrosis) of the liver caused by long-term liver damage. The scar tissue prevents the liver from working properly. Professor Alastair O'Brien’s team conducts large-scale clinical trials, feasibility studies and data analyses to try to improve outcomes in people with cirrhosis.

Our work

Cirrhosis is the impaired liver function caused when scar tissue formed after liver disease gradually replaces normal functioning tissue. It can take years to develop.

Cirrhosis is often caused by alcoholic liver disease, heroin use, and chronic hepatitis B / C. Non-alcoholic steatohepatitis (NASH) can be caused by obesity, high blood pressure or cholesterol, type 2 diabetes, and metabolic syndrome.

It causes an array of symptoms, from fatigue, nausea and stomach pain, to swelling, jaundice and infections from fluid that collects in the abdomen. In serious cases, it can cause bleeding from swollen veins, or even liver cancer.

We completed the national ATTIRE trial (Albumin to prevent infection in chronic liver failure), and our ASEPTIC trial (Primary Antibiotic Prophylaxis using Cotrimoxazole to Prevent Spontaneous Bacterial Peritonitis in Cirrhosis) is now in the follow-up phase.

Professor O’Brien is also the Clinical Director of the UCL Comprehensive Clinical Trials Unit.

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Our experts

Prof. Alistair O'Brien

Prof. Alastair O'Brien
Principal Investigator

Iulia Munteanu

Iulia Munteanu
Research nurse (Royal Free/UCLH)

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Marisa Chau
UCL CCTU: Clinical Project Manager

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Nishtha Kotriwala
UCL CCTU: Data Manager

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Leanne Crisp
UCL CCTU: Trial Manager

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Tasheeka Jeyapalan
UCL CCTU: Trial Manager

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Norin Ahmed
UCL CCTU: Statistics

Ekaterina Bordea

Ekaterina Bordea
UCL CCTU: Health Economics

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Dr Reem Alsowaiegh
UCL CCTU: PhD student

Louise China

Dr Louise China
NHS collaborator (Royal Free)



Selected publications

  1. China L, Tittanegro T, Crocombe D, Forrest E, Kallis Y ... O'Brien, A (2023). Investigating potential confounding by indication when considering the association between proton pump inhibitor use, infection, hepatic encephalopathy and mortality in hospitalised decompensated cirrhosis: a post-hoc analysis of the ATTIRE trial. eClinicalMedicine, 58, 101924.
  2. Tittanegro T, China L, Forrest E, Kallis Y, Ryder SD ... O'Brien A (2023). Use of non-selective B-blockers is safe in hospitalised decompensated cirrhosis patients and exerts a potential anti-inflammatory effect: Data from the ATTIRE trial. eClinicalMedicine, 55, 101716.
  3. Kutmutia R, Tittanegro T, China L, Forrest E, Kallis Y, Ryder SD ... O'Brien, A (2022). Evaluating the role of antibiotics in patients admitted to hospital with decompensated cirrhosis: lessons from the ATTIRE trial. American Journal of Gastroenterology.
  4. China L, Freemantle N, Forrest E, Kallis Y, Ryder SD, Wright G, O'Brien A (2021). Targeted Albumin Therapy Does Not Improve Short-Term Outcome in Hyponatremic Patients Hospitalized With Complications of Cirrhosis: Data From the ATTIRE Trial. Am J Gastroenterol. 2021 Nov 1;116(11):2292-2295.
  5. Maini AA, Becares N, China L, Tittanegro TH, Patel A, De Maeyer RPH, Zakeri N, Long TV, Ly L, Gilroy DW, O'Brien A (2021). Monocyte dysfunction in decompensated cirrhosis is mediated by the prostaglandin E2-EP4 pathway. JHEP Rep. 2021 Aug 4;3(6):100332. eCollection 2021 Dec.
  1. China L, Freemantle N, Forrest E, Kallis Y, Ryder SD, Wright G ... O'Brien A, ATTIRE Trial Investigators (2021). A Randomized Trial of Albumin Infusions in Hospitalized Patients with Cirrhosis. The New England Journal of Medicine, 384 (9), 808-817.
  2. Aithal GP, Palaniyappan N, China L, Härmälä S, Macken L, Ryan JM, Wilkes EA, Moore K, Leithead JA, Hayes PC, O'Brien AJ, Verma S (2020). Guidelines on the management of ascites in cirrhosis. Gut 2020.
  3. Becares N, Härmälä S, China L, Colas RA, Maini AA, Bennet K, Skene SS, Shabir Z, Dalli J, O'Brien A (2019). Immune Regulatory Mediators in Plasma from Patients with Acute Decompensation are Associated With 3-month Mortality. Clin Gastroenterol Hepatol. 2019 Aug 22. pii: S1542-3565(19)30911-5.
  4. China L, Maini A, Skene S, Shabir Z, Sylvestre, Colas R, Ly L, Becares Salles N, Belloti V, Dalli J, Gilroy DW & O'Brien AJ (2017). Albumin Counteracts Immune-suppressive Effects of Lipid Mediators in Patients With Advanced Liver Disease. Clin Gastroenterol Hepatol. 2017 Aug 28. pii: S1542-3565(17)30993-X.
  5. O'Brien AJ, Fullerton JN, Massey KA, Auld G, Sewell G, James S, Newson J, Karra E, Winstanley A, Alazawi W, Garcia-Martinez R, Cordoba J, Nicolaou A, Gilroy DW (2014). Immunosuppression in acutely decompensated cirrhosis is mediated by prostaglandin E2. Nature Medicine. 2014;20(5):518-23.

Funding and partnerships

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UCL Institute for Liver and Digestive Health
Upper 3rd Floor, Division of Medicine
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