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Introducing W. Ray Kim, MD, our 2024 AASLD president

2023; Lippincott Williams & Wilkins; Volume: 79; Issue: 1 Linguagem: Inglês

10.1097/hep.0000000000000650

1527-3350

Young‐Suk Lim, Allison J. Kwong, Alina M. Allen,

Multiple and Secondary Primary Cancers

It is our distinct honor to introduce a luminary in the field of hepatology, Dr. W. Ray Kim, who will serve as the 75th president of the American Association for the Study of Liver Diseases (AASLD) in 2024. Ray is not just an excellent physician and a researcher—he is truly a lifesaver in the most literal sense. His landmark work on the development and continuous improvement of the Model for End-Stage Liver Disease (MELD) has revolutionized the care of patients with liver disease. Having known Ray for over 2 decades as our mentor and current colleague, it is with enormous pride that we share some of the personal history and professional accomplishments that this remarkably talented role model, mentor, and scientific leader of hepatology would be too humble to tell. BACKGROUND, EDUCATION, AND TRAINING Ray was born in 1962 in Seoul, the vibrant capital of South Korea. He attained early academic distinction in 1986 when he graduated with the Dean's Award, the highest academic honor of the Seoul National University College of Medicine. His calling for hepatology was shaped during his third year of medical school by Professor CY Kim, who was a legend in Korea after developing a hepatitis B vaccine and implementing the national universal vaccination program. While in the medicine ward one day, Ray was called by Professor Kim, who appeared without the usual entourage, and gestured him to a patient's bedside. In his unique brusque manner, he grabbed Ray's hand and put it on the patient's abdomen, and said: "This is what cirrhotic liver feels like. Remember this." Then he took Ray to another patient and did the same, except he said: "This is what HCC feels like. Remember this." Then he went off, without asking his name or saying another word. This "Mr. Miyagi"-like teaching moment had an indelible impact on Ray, who eventually became his graduate student and a lifelong learner of hepatology. Ray is honoring Professor Kim's legacy by sponsoring an annual travel award in his name through the AASLD Foundation. After completing residency training in Internal Medicine at the Seoul National University Hospital in 1990, Ray made a momentous decision to pursue a Master of Business Administration at the University of Pennsylvania in Philadelphia, with the goal of returning to Korea to forge an unconventional path merging medicine with health care administration. However, upon completing the degree in 1992, he stood at a critical crossroads—and chose to remain in the United States to expand his medical horizons, which changed his life's trajectory. Ray undertook an additional residency in Internal Medicine at the University of Arkansas in Little Rock, followed by a fellowship in Gastroenterology/Hepatology and Liver Transplantation at Mayo Clinic in Rochester in 1994. His Gastroenterology/Hepatology training brought another transformative turn. He was introduced to the enticing world of epidemiology by Dr. Rick Locke, who also connected him with Dr. L. Joseph Melton, III, Ray's first mentor as he joined the faculty of Mayo Clinic College of Medicine in 1998. Ray rapidly rose through the academic ranks to become Professor of Medicine in 2012. SCIENTIFIC CONTRIBUTIONS "The answer is only important if you ask the right question." Ray's greatest legacy is the introduction and refinement of MELD for liver transplant allocation. The score was initially developed by his colleague Dr. Patrick S. Kamath, to predict survival after elective TIPS placement. Ray led the effort along with Drs. Kamath and Russell Wiesner to validate these findings in patients with cirrhosis to measure liver disease severity and predict mortality more accurately. In 2002, the MELD score was adopted by the United Network of Organ Sharing to identify and rank the "sickest first" in need of a life-saving liver transplant. This represented a disruptive innovation because it allocated donated organs based on an objective measure of mortality risk, rather than waiting time or more subjective variables. Few scientific contributions have had such an enormous and immediate impact, as the implementation of MELD in the United States led to a significant reduction in waitlist mortality. MELD-based liver allocation has since been adopted by most other countries and is credited to have saved tens of thousands of lives. MELD has also proven to be an effective clinical tool in the care of patients with advanced liver disease and one of the most accurate predictive scores used in modern clinical medicine. With tenacity and purpose to further improve the liver allocation system, Ray has continued his work to improve mortality prediction for patients with cirrhosis and to address sex-based and race-based disparities in access to liver transplantation, supported by research grants from the US National Institutes of Health. The score was updated and adopted by the US organ allocation system to include sodium (New England Journal of Medicine, 2008), and more recently additional variables, to address the disadvantage that women faced due to the underestimation of renal dysfunction using creatinine alone (Gastroenterology, 2021). Professor Terry Therneau, an internationally renowned statistician and longstanding collaborator at the Mayo Clinic, has described Ray's ideal balance between the pursuit of perfection and timely impact: "Reliable research requires thinking through what the important issues might be and taking the needed time to investigate and work through them. Practical research requires knowing when to wrap up the process, as there is always another rock to look under. As a statistician working with Ray, I never felt pressure to overlook something, to hurry the thought process of an analysis, or to curtail discussion. But his clear focus on the question to be answered, integration of results, and ability to know when to say enough kept the program on track and productive." As a senior staff member for the Scientific Registry of Transplant Recipients, a policy research organization commissioned by the US Department of Health and Human Services, Ray, along with Dr. Jack Lake at the University of Minnesota, has also helped direct data analyses for the US organ transplant system beyond MELD, broadly influencing and shaping the nationwide policy to improve the outcomes of patients in need of liver transplantation. Ray's research impact extends into related spheres of liver disease, advancing our understanding of viral hepatitis, primary biliary cholangitis, hepatobiliary malignancies, and cirrhosis-related renal dysfunction, among others. His research program has been supported over the past 25+ years through federal, foundation, and industry funding, and his current National Institutes of Health-funded research applies his expertise in survival analysis and prediction modeling to risk-stratify patients with metabolic dysfunction–associated steatotic liver disease using the Steatosis-Associated Fibrosis Estimator score. Ray's applied skills in clinical epidemiology, population health, and patient-oriented effectiveness research in liver disease are exceptional, and he holds a broad view of the past, present, and future needs in hepatology. Ray's approach to research is meticulous, and he maintains that modeling requires not only statistical expertise but also deep content knowledge of the underlying biologic and clinical processes to ensure accuracy and practical application—and this is undoubtedly what has made his scientific career so successful. MENTORSHIP "First learn stand, then learn fly. Nature rule Daniel-san, not mine." Mentorship is central to Ray's identity as a physician and scientist. Being Ray's mentee is like being given a researcher's playground, where one learns to stand, where all the gadgets are free to use, where one is encouraged independence, critical thinking, and trial and error, but one is miraculously caught before an impending fall, a place where one learns fundamental skills that can be transferred to other research areas and allow the mentee to "fly" successfully to the sky they choose. Most importantly, he models how intelligence, integrity, and humility lay the path to excellence and academic achievement. For more than one of us, this playground has been a transformative place, where the seed for a new passion for a research career first sprouted. Ray is generous and intentional in providing opportunities for mentees to thrive and succeed in their chosen path—and often guiding them, subtly and not so subtly, toward a better path. Ray's global reputation as a mentor has led numerous scholars around the world to come to his lab to study. He has mentored dozens of US and international researchers, many of whom are leading successful academic careers of their own and have become prominent leaders at academic institutions. Ray firmly believes that foundational training in research methods is key to a successful research career and encourages his mentees to invest in formal research training. He directed the postdoctoral programs at the Mayo Clinic Center for Clinical and Translational Science and has promoted the development of early career investigators with support from the National Institutes of Health (K24, T32). Ray has been deeply committed to advancing AASLD's educational mission and developing the next generation of clinical researchers, particularly in regions without critical expertise and resources for advanced training. He has conducted research methodology workshops around the world in collaboration with sister societies in Asia, Africa, and Central and South America. Ray's efforts in the global arena were channeled by the AASLD Global Outreach and Engagement Committee, for which he was the inaugural Chair. LEADERSHIP "If the root is strong, the tree will survive." Ray has garnered respect for his leadership as Chief of the Division of Gastroenterology and Hepatology at Stanford University School of Medicine, where he was recruited in 2013. In this role, he has transformed the department into a world-class academic center equipped with excellence in basic and clinical research, comprehensive patient services in digestive and liver diseases, innovative training curricula for future leaders in academic medicine, and a highly effective team-focused culture among the faculty and staff. Under Ray's leadership, Stanford Health Care has rapidly risen to the top 10 of the best hospitals for gastroenterology and gastrointestinal surgery as ranked by US News and World Report in 2023. He has expanded the faculty fourfold, invigorated the fellowship program, and renewed the focus on research and academic discovery. Implementing his vision has not been without challenges, but he has faced these with respect, dignity, and transparency. He leaves a long-lasting legacy—although his work here is not yet finished! Ray's vision includes the Stanford Center for Asian Leaders in Medicine (CALM), with the goal to develop and nurture a community of Asian physicians to lead the future of medicine and health care in the United States and globally. This initiative is inspired by his own learned and lived experience, and although early in its development, the Center aims to increase the visibility and effectiveness of Asian academic physicians taking on leadership positions, as well as conduct research, advocacy, and public education to dispel stereotypes. PERSONAL LIFE AND FAMILY "Better learn balance. Balance is key." Ray met an enchanting classmate, Amy, in the Seoul National University College of Medicine, who would later become not only his spouse but also his lifelong soulmate, and they married during her residency in Pediatrics. They have 2 sons and 1 daughter, all of whom have now embarked on their own successful careers. Ray jokingly laments that none have followed him into medicine, in spite of—or perhaps because of—his best attempts at "reverse psychology," and not pressuring them into a career in medicine. Family is extremely important to Ray and where he finds his balance. He was known to attend his children's extracurricular events with utmost dedication and will readily accept speaking engagements in East Asia to visit his elderly parents in South Korea. At 41 years of age, Ray was diagnosed with non-Hodgkin's lymphoma, which had an unshakable impact on him at the beginning of his career and shaped him as a person. At the time, he was quoted a median survival of 15 years and told that it was incurable, with most patients eventually dying of, not with, the disease. Although it clearly caused much pain and anxiety, especially on the part of Amy, his diagnosis crystallized what is important in his life and career. Professionally, he learned to laser-focus on what is important and ignore petty things, invest in things that will outlast him, and serve people he is able to help. Most importantly, having been on the other side, he was able to relate on a different level to his patients with incurable, fatal diseases. At the same time, he reminds himself that no one on their deathbed wishes to have spent more time in their office, and he is intentional about reserving time for personal care to maintain physical, mental, and spiritual health and well-being, as well as for his family. After 20 years, thankfully, Ray is currently in remission. He is blessed to be under the care of world-renowned hematologists, Drs. Tom Witzig at Mayo and Ron Levy at Stanford. AASLD: PAST SERVICE AND FUTURE VISION AS A PRESIDENT "Man who catch fly with chopstick accomplish anything." Over the years, Ray has made impactful contributions to the AASLD, serving as chair of key committees (Clinical Research; Development; and Global Outreach and Engagement), Treasurer, and most recently on the Governing Board as Councilor. Ray's signature contribution to the organization has been to foster international relationships and collaborations with other associations around the globe. He has cochaired the American Gastroenterological Association-AASLD Academic Skills Workshop and AASLD-European Association for the Study of the Liver Masterclass, among other initiatives to support the development of early career investigators, and served as an Associate Editor for Hepatology, an AASLD journal, from 2007 to 2012. As president, Ray aims to further establish AASLD's global standing as the leading scientific organization for liver disease. His vision and priorities include (1) creating opportunities for greater involvement and representation of the international membership to bolster AASLD as a global organization; (2) positioning AASLD as the driver of innovation in the research and management of hepatobiliary malignancies; and (3) defining the scope of practice for hepatologists and health care delivery models to effectively prevent, diagnose, and treat liver disease across the spectrum. In particular, he advocates for the concept of preventive hepatology, which leverages the skills of both primary care and specialty care providers to target liver disease at its earliest stages and reduce the overall burden of liver disease in the coming decades. CONCLUSION For the Karate Kid fans who recognized the famous Mr. Miyagi quotes in this narration, here comes the disappointing news: Ray is not a karate prodigy. He reached as far as a yellow belt in taekwondo by third grade, when it was clear that he was not coordinated enough to advance to a higher level. Ray loves running and is more suited for endurance sports. However, his life philosophy follows the core values of the martial arts: focus, discipline, respect, tradition, altruism, and humility. Ray is a truly outstanding individual who has demonstrated never-ending dedication to service in his institution and AASLD and will continue to have a major impact on our society and the field of hepatology (Figure 1). As his mentees and colleagues, we are extremely proud and delighted to introduce the incomparable W. Ray Kim as the 2024 President of the AASLD.FIGURE 1: Dr. Kim is immensely grateful to the mentors, sponsors, and colleagues who helped shape his career, his leadership, and his life in general. Individuals in the figure, top row from left: Hyo-Suk Lee, Alina Allen, Robert Harrington, Anna Lok, Young-Suk Lim, Lewis Roberts, and Norah Terrault. Second row: Vijay Shah, Gregory Gores, Patrick Kamath, E. Rolland Dickson, Laurie Deleve, and G. Richard Locke III. Third row: Uri Ladabaum, Allison Kwong, Amy Kim, Ray Kim, Paul Kwo, Chung Yong Kim, and Linda Nguyen. Last row: John Poterucha, Julie Heimbach, Terry Therneau, and Keith Lindor.