Portal de Periódicos da CAPES

In Memoriam: Professor Bernard Portmann 1940–2018

2018; Elsevier BV; Volume: 69; Issue: 6 Linguagem: Inglês

10.1016/j.jhep.2018.08.023

1600-0641

Roger Williams, Alberto Quaglia,

Liver Diseases and Immunity

Born in Geneva, Switzerland on 6th February 1940, Professor Bernard Portmann obtained his medical degree in 1961, before undertaking his post-graduate training in Histopathology at Geneva University, proceeding to MD in 1972 with a thesis on Hepatic Granulomas. He joined the liver unit at King’s College Hospital in London in 1973, where he spent the rest of his career until his retirement at the end of 2009. Finally recruited by one of us, I seem to remember, over lunch at the World Health Organisation centre in Geneva, initially as a research fellow, he obtained the Royal College of Pathologists membership in 1977 (fellowship in 1981). He was appointed Consultant Histopathologist at King’s in 1978 and was granted a personal Chair of Hepato-pathology by King’s College London in 1997. A travelling fellowship from the British Society of Gastroenterology in 1982 sponsored his visit to Dr Hans Popper at Mount Sinai Medical Centre in New York. Professor Portmann created the liver histopathology laboratory at King’s, as part of a unique set of liver laboratories located inside the new liver unit, which had been built on the roof above the dedicated liver ward. This came at the time of rapidly increasing activity in the Liver Unit, including pioneering work in liver transplantation, acute liver failure, and immunological based disorders. The Unit’s work was based on the physical integration of clinicians with basic scientists and Bernard Portmann’s input, in multi-disciplinary groups. Back then, the immediate correlation between clinical manifestations at the bedside and their counterpart at the microscope was felt to be vital for patient management but at the time it was unchartered territory on both sides. The liver histopathology laboratory and the other adjacent research laboratories, along with the nearby clinical unit grew together, reciprocally entangled, learning from each other and paving the way to a new understanding of liver pathophysiology and the new joint approach already referred to. Bernard Portmann was always in the lab at the start of reporting on a new biopsy, even when no one else was around to process and stain liver tissue samples. A seemingly trivial chore, first-hand acquaintance with histology techniques and direct involvement of a dedicated liver pathologist close to the clinical setting, in designing the laboratory and all its protocols and routines, made the liver histopathology laboratory at King’s the benchmark in the field for technical quality and efficiency. It also gave Professor Portmann an additional interpretative edge, marked by his ability to tone down or emphasize the significance of histological changes depending on the tissue and stain conditions. Various anecdotes come to mind, including when Bernard, one afternoon, politely reminded the laboratory staff that it was time to change the potassium permanganate solution because both the orcein and reticulin stains did not look fine. “When you are done, repeat the orcein, because this biopsy looks biliary and there must be granules of copper-binding protein around some of those portal tracts” were his words. No need to say that he was right when the new sections came through. Bernard Portmann authored or co-authored some 400 original papers and numerous review articles and book chapters. The seminal observations he made on the abundance of deposits of copper-binding protein in the livers of children affected by Indian childhood cirrhosis[1]Portmann B. Tanner M.S. Mowat A.P. Williams R. Orcein-positive liver deposits in Indian childhood cirrhosis.Lancet. 1978; 1: 1338-1340Abstract PubMed Scopus (44) Google Scholar was the one that he himself considered the most important. It led to the conclusion that the lesion was caused by copper-toxicity from brass utensils used to feed cow or buffalo milk to infants. The necessary preventive measurements eradicated the disease.[2]Tanner M.S. Role of copper in Indian childhood cirrhosis.Am J Clin Nutr. 1998; 67: 1074S-1081SCrossref PubMed Scopus (115) Google Scholar A close collaboration with Professor Alex Mowatt was critical in laying the foundations of King’s paediatric liver service as an international centre of excellence. Other clinically important studies were in liver transplantation with the first description of vanishing bile duct syndrome for chronic rejection,3Calne R.Y. McMaster P. Portmann B. Wall W.J. Williams R. Observations on preservation, bile drainage and rejection in 64 human orthotopic liver allografts.Ann Surg. 1977; 186: 282-290Crossref PubMed Scopus (84) Google Scholar, 4Portmann B. Williams R. Histopathology of the transplanted liver.in: Williams R. Cantoni L. Recenti progressi in epatologia. Casa Editrice Ambrosiana, Milan1979: 369-381Google Scholar, 5Portmann B. Neuberger J.M. Williams R. Intrahepatic bile duct lesions.in: Calne R.V. Liver transplantation. Grune & Stratton, London1983: 279-287Google Scholar and the fibrosing cholestatic hepatitis related to recurrent hepatitis B virus infection.[6]Davies S.E. Portmann B.C. O'Grady J.G. Aldis P.M. Chaggar K. Alexander G.J. et al.Hepatic histological findings after transplantation for chronic hepatitis B virus infection, including a unique pattern of fibrosing cholestatic hepatitis.Hepatology. 1991; 13: 150-157Crossref PubMed Scopus (412) Google Scholar Initially controversial was his description of recurrence of primary biliary cirrhosis in the graft, and later of autoimmune hepatitis along with forms of graft injury mimicking autoimmune hepatitis.7Neuberger J. Portmann B. Macdougall B.R. Calne R.Y. Williams R. Recurrence of primary biliary cirrhosis after liver transplantation.N Engl J Med. 1982; 7: 1-4Crossref Scopus (191) Google Scholar, 8Neuberger J. Portmann B. Calne R. Williams R. Recurrence of autoimmune chronic active hepatitis following orthotopic liver grafting.Transplantation. 1984; 37: 363-365Crossref PubMed Scopus (128) Google Scholar, 9Kerkar N. Hadzić N. Davies E.T. Portmann B. Donaldson P.T. Rela M. et al.De-novo autoimmune hepatitis after liver transplantation.Lancet. 1998; 351: 409-413Abstract Full Text Full Text PDF PubMed Scopus (339) Google Scholar He also led on interpretation of malignant and benign liver tumours including hormonal influences.10Westaby D. Portmann B. Williams R. Androgen related primary hepatic tumors in non-Fanconi patients.Cancer. 1983; 51 (1947-5)Crossref PubMed Scopus (57) Google Scholar, 11Davis M. Portmann B. Searle M. Wright R. Williams R. Histological evidence of carcinoma in a hepatic tumour associated with oral contraceptives.Br Med J. 1975; 4: 496-498Crossref PubMed Scopus (107) Google Scholar Other seminal observations included those on the histological changes associated with liver recovery after acute liver injury,12Portmann B. Talbot I.C. Day D.W. Davidson A.R. Murray-Lyon I.M. Williams R. Histopathological changes in the liver following a paracetamol overdose: correlation with clinical and biochemical parameters.J Pathol. 1975; 117: 169-181Crossref PubMed Scopus (105) Google Scholar, 13Koukoulis G. Rayner A. Tan K.C. Williams R. Portmann B. Immunolocalization of regenerating cells after submassive liver necrosis using PCNA staining.J Pathol. 1992; 166: 359-368Crossref PubMed Scopus (64) Google Scholar the detection and distribution of hepatitis B antigens in liver tissue,14Portmann B. Galbraith R.M. Eddleston A.L. Zuckerman A.J. Williams R. Detection of HBSAG in fixed liver tissue – use of a modified immunofluorescent technique and comparison with histochemical methods.Gut. 1976; 17: 1-9Crossref PubMed Scopus (39) Google Scholar, 15Naoumov N.V. Portmann B.C. Tedder R.S. Ferns B. Eddleston A.L. Alexander G.J. et al.Detection of hepatitis B virus antigens in liver tissue. A relation to viral replication and histology in chronic hepatitis B infection.Gastroenterology. 1990; 99: 1248-1253Abstract Full Text PDF PubMed Scopus (40) Google Scholar the histological features of the acute presentation of Wilson’s disease[16]Davies S.E. Williams R. Portmann B. Hepatic morphology and histochemistry of Wilson’s disease presenting as fulminant hepatic failure: a study of 11 cases.Histopathology. 1989; 15: 385-394Crossref PubMed Scopus (46) Google Scholar and the role of liver biopsy in the diagnosis of biliary atresia.[17]Manolaki A.G. Larcher V.F. Mowat A.P. Barrett J.J. Portmann B. Howard E.R. The prelaparotomy diagnosis of extrahepatic biliary atresia.Arch Dis Child. 1983; 58: 591-594Crossref PubMed Scopus (67) Google Scholar Bernard Portmann was regarded as one of the finest interpreters of liver histological changes. Over the early years of the 1970s and 1980s, King’s was fortunate to have a person comparable to Hans Popper in the USA, with a similar emphasis on clinical pathological interpretation, although personalities (and physical characteristics) were somewhat different! Bernard’s membership of societies and associations included the British Association for Study of the Liver (BASL) for which he also served as committee member, the International Academy of Pathology, the European Association for Study of the Liver (EASL), the Association of Clinical Pathologists, the British Society of Gastroenterology, the European Society of Pathology, the Pathological Society of Great Britain and Ireland, the American Association for the Study of Liver Disease (AASLD), and the Hans Popper Hepatopathology Society. Hugely respected by his peers, Bernard Portmann was invited to join the International Liver Pathology Study Group (“The Elves”) in 1990, and the International Liver Group (“The Gnomes”) in 1992. Among his many accolades was the Distinguished Service Award of the BASL in 2008. He served as Co-Editor of the 5th and 6th edition of MacSween’s “Pathology of the Liver”, widely regarded as the bible of liver pathology (“If it's not in MacSween’s, it's not in the liver!”). But perhaps, the best testimony to Bernard Portmann’s international stature, are the innumerable colleagues from all over the world, who came to King’s to learn liver histopathology from him or sent him liver samples for his opinion. He leaves behind a beloved wife, Elisabeth, who gave him great support throughout his professional life together with his children and grandchildren.