Dr Ashwin Dhanda
Profiles

Dr Ashwin Dhanda

Associate Professor in Hepatology

Peninsula Medical School (Faculty of Health)

Biography

Biography

I am a Consultant Hepatologist and Clinician Scientist with an interest in translational research relating to inflammatory liver diseases, particularly alcohol-related liver disease. I am part of a national MRC funded consortium aiming to minimise death from alcoholic hepatitis and am leading a workstream to validate a novel bioassay to measure response to glucocorticoid (steroid) therapy. I am seeking biomarkers of survival from alcohol-related liver disease including measures of immune function and circulating microbiome. I am also Chief Investigator of a pilot randomised controlled trial of Functional Imagery Training to treat alcohol dependence in patients with alcohol-related liver disease.

On a national level I lead the British Association for the Study of the Liver (BASL) Special Interest Group for alcohol-related liver disease (https://www.basl.org.uk/index.cfm/content/page/cid/35). This multidisciplinary group brings together active clinicians and researchers to develop national studies and trials in alcohol-related liver disease.

I am an active clinician as a Consultant Hepatologist and manage patients with acute and chronic liver disease at the South West Liver Unit at Derriford Hospital, University Hospitals Plymouth NHS Trust (https://www.plymouthhospitals.nhs.uk/dhanda-a).

Qualifications

BSc (Hons), University of Edinburgh 2000

MBChB, University of Edinburgh 2003

MRCP, Royal College of Physicians of London 2006

PGCert Health Education, St George's University of London 2007

PhD, University of Bristol 2014

FRCP, Royal College of Physicians of London 2021



Roles on external bodies

Lead of British Association for the Study of the Liver Special Interest Group on alcohol-related liver disease
Topic Expert for NICE Clinical Guidelines Update Committee for Alcohol Use Disorders
Committee member of the British Society of Gastroenterology Liver Clinical Research Group

Research

Research

Research groups

Publications

Publications

Key publications

Key publications are highlighted

Journals
Articles
Subhani M, Dhanda A, Olaru A, Dunford L, Ahmad N, Wragg A, Frost K, Greenwood J, King M & Jones KA (2024) 'Top ten research priorities for alcohol use disorder and alcohol-related liver disease: results of a multistakeholder research priority setting partnership' The Lancet Gastroenterology & Hepatology , DOI
Dhanda A, Andrade J, Allende H, Allgar V, Bailey M, Callaghan L, Cocking L, Goodwin E, Hawton A & Hayward C (2024) 'Mental Imagery to Reduce Alcohol-related harm in patients with alcohol use disorder and alcohol-related liver damaGE: the MIRAGE randomised pilot trial results' BMJ Open Gastroenterology 11, (1) , DOI Open access
Pohl K & Dhanda A (2023) 'Nutritional assessment of patients with cirrhosis in the South West requires improvement: results of the Evaluation of NutRItion in CirrHosis (ENRICH) Study' Frontline Gastroenterology , DOI
Parker R, Allison M, Anderson S, Aspinall R, Bardell S, Bains V, Buchanan R, Corless L, Davidson I & Dundas P (2023) 'Quality standards for the management of alcohol-related liver disease: consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology ARLD special interest group' BMJ Open Gastroenterology 10, (1) , DOI Open access
Avades T & Dhanda A (2023) 'Health promotion and public health' Evidence-Based Nursing , DOI Open access
Boeira P, Tan H, Yates E & Dhanda A (2023) 'Assessment of immune function and prediction of survival and infection in patients with severe alcoholic hepatitis: An exploratory study' JGH Open , DOI Open access
Bodger K & Dhanda A (2023) 'Editorial: the burden of alcohol‐related liver disease emergency admissions in England may be twice as high as previously thought—authorsʼ reply' Alimentary Pharmacology & Therapeutics 57, (4) 437-438 , DOI
Allison MED, Verne J, Bernal W, Clayton M, Cox S, Dhanda A, Dillon JF, Ferguson J, Foster G & Gilmore I (2022) 'Deaths from alcohol-related liver disease in the UK: an escalating tragedy' The Lancet 401, (10375) 418-420 , DOI
Dhanda A, Bodger K, Hood S, Henn C, Allison M, Amasiatu C, Burton R, Cramp M, Forrest E & Khetani M (2022) 'The Liverpool alcohol‐related liver disease algorithm identifies twice as many emergency admissions compared to standard methods when applied to Hospital Episode Statistics for England' Alimentary Pharmacology & Therapeutics , DOI Open access
Horrell J, Callaghan L & Dhanda A (2022) 'Alcohol misuse in patients with alcohol‐related liver disease: How can we do better? A narrative review of the literature' Alcoholism: Clinical and Experimental Research 46, (8) 1364-1370 , DOI Open access
Pohl K, Moodley P & Dhanda A (2022) 'The effect of increasing intestinal short‐chain fatty acid concentration on gut permeability and liver injury in the context of liver disease: A systematic review' Journal of Gastroenterology and Hepatology , DOI Open access
Dhanda A, Allende H, Allgar V, Andrade J, Bailey MP, Callaghan L, Cocking L, Goodwin E, Hawton A & Hayward C (2022) 'Mental Imagery to Reduce Alcohol- related harm in patients with alcohol dependence and alcohol-related liver damaGE: the MIRAGE pilot trial protocol' BMJ Open Gastroenterology 12, (5) , DOI Open access
Tanase A, Dhanda A, Cramp M, Streeter A & Aroori S (2022) 'A UK survey on variation in the practice of management of choledocholithiasis and laparoscopic common bile duct exploration (ALiCE Survey)' Surgical Endoscopy 36, (8) 5882-5896 , DOI Open access
Dhanda AD, Felmlee D, Boeira P, Moodley P, Tan H, Scalioni LDP, Lilly K, Sheridan DA & Cramp ME (2022) 'Patients with moderate to severe COVID-19 have an impaired cytokine response with an exhausted and senescent immune phenotype' Immunobiology 227, (2) , DOI Open access
Pohl K, Moodley P & Dhanda AD (2021) 'Alcohol’s Impact on the Gut and Liver' Nutrients 13, (9) 3170-3170 , DOI Open access
Moodley P, Whyte AF & Dhanda A (2021) 'Recurrent Chronic HEV in Severe Combined Immunodeficiency' Journal of Clinical Immunology 41, (5) 1103-1105 , DOI Open access
Parker R, Cabezas J, Altamirano J, Arab JP, Ventura-Cots M, Sinha A, Dhanda A, Arrese M, McCune CA & Rowe IA (2021) 'Trajectory of Serum Bilirubin Predicts Spontaneous Recovery in a Real-World Cohort of Patients With Alcoholic Hepatitis' Clinical Gastroenterology and Hepatology , DOI Open access
Williams EL, Stimpson ML, Lait PJP, Schewitz-Bowers LP, Jones LV, Dhanda AD, Lee RWJ & Bradbury CA (2020) 'Glucocorticoid treatment in patients with newly diagnosed immune thrombocytopenia switches CD14 ++ CD16 + intermediate monocytes from a pro‐inflammatory to an anti‐inflammatory phenotype' British Journal of Haematology 192, (2) 375-384 , DOI Open access
Moodley P & Dhanda AD (2020) 'Editorial: can quantitative fibrosis assessment be used to enhance prediction of outcomes in patients with alcohol-related liver disease?' Alimentary Pharmacology and Therapeutics 53, (1) 183-184 Author Site Publisher Site , DOI Open access
Tan HK, Streeter A, Cramp ME & Dhanda AD (2020) 'Effect of zinc treatment on clinical outcomes in patients with liver cirrhosis: A systematic review and meta-analysis' World Journal of Hepatology 12, (7) 389-398 , DOI Open access
Tan HK, Yates E, Lilly K & Dhanda AD (2020) 'Oxidative stress in alcohol-related liver disease' World Journal of Hepatology 12, (7) 332-349 , DOI Open access
Tan HK, Streeter A, Cramp ME & Dhanda AD (2020) 'Effect of zinc treatment on clinical outcomes in patients with liver cirrhosis: A systematic review and meta-analysis' World Journal of Hepatology 12, (7) 390-399 , DOI Open access
Dhanda A, Atkinson S, Vergis N, Enki D, Fisher A, Clough R, Cramp M & Thursz M (2020) 'Trace element deficiency is highly prevalent and associated with infection and mortality in patients with alcoholic hepatitis' Alimentary Pharmacology & Therapeutics , DOI Open access
Dhanda AD, Yates E, Schewitz-Bowers LP, Lait PJ, Lee RWJ & Cramp ME (2019) 'Ex Vivo T Cell Cytokine Expression Predicts Survival in Patients with Severe Alcoholic Hepatitis' Gut and Liver , DOI Open access
Dhanda AD, Williams EL, Yates E, Lait PJP, Schewitz-Bowers LP, Hegazy D, Cramp ME, Collins PL & Lee RWJ (2019) 'Intermediate Monocytes in Acute Alcoholic Hepatitis Are Functionally Activated and Induce IL-17 Expression in CD4+ T Cells' The Journal of Immunology 203, (12) 3190-3198 , DOI
Forrest EH, Storey N, Sinha R, Atkinson SR, Vergis N, Richardson P, Masson S, Ryder S, Thursz MR & Allison M (2019) 'Baseline neutrophil‐to‐lymphocyte ratio predicts response to corticosteroids and is associated with infection and renal dysfunction in alcoholic hepatitis' Alimentary Pharmacology & Therapeutics 50, (4) 442-453 , DOI
Bennett K, Enki DG, Thursz M, Cramp ME & Dhanda AD (2019) 'Systematic review with meta‐analysis: high mortality in patients with non‐severe alcoholic hepatitis' Alimentary Pharmacology and Therapeutics , DOI Open access
Forrest EH, Atkinson SR, Richardson P, Masson S, Ryder S, Thursz MR, Allison M, McCune A, Gleeson D & Austin A (2017) 'Application of prognostic scores in the STOPAH trial: Discriminant function is no longer the optimal scoring system in alcoholic hepatitis' Journal of Hepatology 68, (3) 511-518 , DOI Open access
Dhanda AD, Sinha A, Hunt V, Saleem S, Cramp ME & Collins PL (2017) 'Infection does not increase long-term mortality in patients with acute severe alcoholic hepatitis treated with corticosteroids' World Journal of Gastroenterology 23, (11) 2052-2052 , DOI Open access
Williams EL, Stimpson ML, Collins PL, Enki DG, Sinha A, Lee RW & Dhanda AD (2016) 'Development and validation of a novel bioassay to determine glucocorticoid sensitivity' Biomarker Research 4, 26-26 , DOI Open access
Sinha A, Dhanda A & Collins P (2015) 'PTH-122 Multidisciplinary team approach is accurate in diagnosing benign liver lesions: Abstract PTH-122 Table 1' Gut 64, (Suppl 1) A461.2-A462 , DOI
Dhanda A, Sinha A, Hunt V, Saleem S & Collins P (2015) 'PWE-089 Abstinence from alcohol is the most important factor in predicting long term survival after hospitalisation with severe alcoholic hepatitis' Gut 64, (Suppl 1) A251.1-A251 , DOI
Liu B, Dhanda A, Hirani S, Williams EL, Sen HN, Martinez Estrada F, Ling D, Thompson I, Casady M & Li Z (2015) 'CD14++CD16+ Monocytes Are Enriched by Glucocorticoid Treatment and Are Functionally Attenuated in Driving Effector T Cell Responses' The Journal of Immunology 194, (11) 5150-5160 , DOI
Schewitz-Bowers LP, Lait PJP, Copland DA, Chen P, Wu W, Dhanda AD, Vistica BP, Williams EL, Liu B & Jawad S (2015) 'Glucocorticoid-resistant Th17 cells are selectively attenuated by cyclosporine A' Proceedings of the National Academy of Sciences 112, (13) 4080-4085 , DOI
Dhanda AD (2015) 'Immune dysfunction in acute alcoholic hepatitis' World Journal of Gastroenterology 21, (42) 11904-11904 , DOI
Powter L, Beale A, Probert B & Dhanda A (2014) 'Development and validation of a tool to select patients for admission to medical short stay units' Clinical Medicine 14, (4) 371-375 , DOI
Dhanda AD, di Mambro AJ, Hunt VL, McCune CA, Dayan CM, Dick AD, Lee RWJ & Collins PL (2014) 'Long‐term outcome in patients with severe alcoholic hepatitis can be reliably determined using an in vitro measure of steroid sensitivity' Hepatology 61, (3) 1099-1099 , DOI
Dixon SW, Valliani T, Fayyaz F, Tate D, Arthurs E, Lim L, Dhanda A & Lockett M (2014) 'PWE-064 Management Of Large Colonic Polyps In The Severn Deanery Hospitals: An Audit Of Current Practice' Gut 63, (Suppl 1) A151.2-A152 , DOI
Dhanda A, Liu B, Nussenblatt R, Dick AD, Lee RW & Collins PL (2014) 'P161 CD14CD16 MONOCYTES FROM PATIENTS WITH SEVERE ALCOHOLIC HEPATITIS DRIVE MEMORY T CELL PROLIFERATION AND POLARISE THEM TO A STEROID RESISTANT TH17 PHENOTYPE' Journal of Hepatology 60, (1) S119-S119 , DOI
Hanna MS, Portal AJ, Dhanda AD & Przemioslo R (2013) 'UK wide survey on the prevention of post-ERCP pancreatitis' Frontline Gastroenterology 5, (2) 103-110 , DOI
Dhanda A, Mambro AD, McCune A, Gordon F, Portal J & Collins P (2013) 'OC-004 In Vitro Steroid Sensitivity Accurately Predicts 6 Month Mortality in Patients with Severe Alcoholic Hepatitis' Gut 62, (Suppl 1) A2.1-A2 , DOI
Hanna MS, Portal AJ, Dhanda AD & Przemioslo R (2013) 'PWE-064 Uk Wide Survey On the Prevention of Post-Ercp Pancreatitis' Gut 62, (Suppl 1) A156.3-A157 , DOI
Dhanda A, di Mambro A, Gordon F, Portal J, McCune A & Collins P (2013) '524 IN VITRO STEROID SENSITIVITY ACCURATELY PREDICTS 6 MONTH MORTALITY IN PATIENTS WITH SEVERE ALCOHOLIC HEPATITIS' Journal of Hepatology 58, S215-S215 , DOI
Dhanda AD (2013) 'Is liver biopsy necessary in the management of alcoholic hepatitis?' World Journal of Gastroenterology 19, (44) 7825-7825 , DOI
Ayres LRO, Clarke S, Digby-Bell J, Dhanda AD, Dharmasiri S, Caddick K & Collins PL (2012) 'Fragility fracture risk in cirrhosis: a comparison of the fracture risk assessment tool, British Society of Gastroenterology and National Institute for Health and Clinical Excellence guidelines' Frontline Gastroenterology 3, (4) 220-227 , DOI
Dhanda A, Lee R & Collins PL (2012) 'PMO-112 Is primary biliary cirrhosis a steroid sensitive autoimmune disease?' Gut 61, (Suppl 2) A118.1-A118 , DOI
Dhanda A, Lee R & Collins P (2012) 'Is primary biliary cirrhosis a steroid‐sensitive autoimmune disease?' Hepatology Research 42, (6) 619-620 , DOI
Sands BE, Sandborn WJ, Creed TJ, Dayan CM, Dhanda AD, Van Assche GA, Greguš M, Sood A, Choudhuri G & Stempien MJ (2012) 'Basiliximab Does Not Increase Efficacy of Corticosteroids in Patients With Steroid-Refractory Ulcerative Colitis' Gastroenterology 143, (2) 356-364.e1 , DOI
Dhanda AD, Creed TJ, Greenwood R, Sands BE & Probert CS (2012) 'Can endoscopy be avoided in the assessment of ulcerative colitis in clinical trials?' Inflammatory Bowel Diseases 18, (11) 2056-2062 , DOI
Dhanda AD (2012) 'Molecular targets in the treatment of alcoholic hepatitis' World Journal of Gastroenterology 18, (39) 5504-5504 , DOI
Dawson C, Dhanda A, Conway-Campbell B, DiMambro A, Lightman S & Dayan C (2011) 'NFκB and glucocorticoid receptor activity in steroid resistance' Journal of Receptors and Signal Transduction 32, (1) 29-35 , DOI
Ayres L, Digby-Bell J, Clarke S, Dhanda A, Caddick K & Collins P (2011) 'P25 Fragility fracture risk in cirrhosis: a comparison of the fracture risk assessment tool (FRAX_), BSG and NICE guidelines' Gut 60, (Suppl 2) A11-A12 , DOI
Dhanda AD, Creed TJ, Greenwood R, Sands BE & Probert CS (2011) 'Can Endoscopy Be Avoided in the Assessment of Ulcerative Colitis in Clinical Trials?' Gastroenterology 140, (5) , DOI
Dhanda AD, Greenwood R, Creed TJ & Probert CS (2011) 'Endoscopy can be avoided in the assessment of ulcerative colitis in clinical trials' Gut 60, (Suppl 1) A140-A141 , DOI
Caddick KJ, Dhanda AD, Collins PL, Gordon FH, McCune AC & Portal AJ (2010) 'PTH-068 Development of nurse led paracentesis service' Gut 59, (Suppl 1) A150.3-A151 , DOI
Chapters
Cramp M, Dhanda A & Naoumov NV (2020) 'Hepatitis viruses (excluding hepatitis C virus)' Oxford Textbook of Medicine Oxford University PressOxford 889-C8.5.21.P45 , DOI
Conference Papers
Ahmed A, Dhanda A, Hegazy D, Felmlee D, Sheridan D & Cramp M (2016) 'Sustained viral clearance of HCV with DAA treatment is associated with restoration of effector T cell phenotype' 745A-745A
Presentations and posters
Tan H, Boeira P, Yates E, Cramp M & Dhanda A Tan H, Boeira P, Yates E, Cramp M & Dhanda A 'High oxidative stress in T cells and monocytes correlates with mortality from alcoholic hepatitis' Author Site , DOI
Tan H, Yates E & Dhanda A Tan H, Yates E & Dhanda A 'P78 Patients with alcohol related liver disease have high levels of oxidative stress' , DOI
Yates E, Cramp M & Dhanda A Yates E, Cramp M & Dhanda A 'A NOVEL FUNCTIONAL BIOASSAY PREDICTS 90-DAY SURVIVAL IN PATIENTS WITH SEVERE ALCOHOLIC HEPATITIS' , DOI Open access
Yates E, Tan H & Dhanda A Yates E, Tan H & Dhanda A 'A novel lymphocyte proliferation assay accurately predicts 90-day survival in severe alcoholic hepatitis patients' , DOI
Tanase A, Aroori S, Dhanda A, Cramp M & Streeter A Tanase A, Aroori S, Dhanda A, Cramp M & Streeter A 'A UK Survey on Variation in Practice of Management of Choledocholithiasis and Laparoscopic Common Bile Duct Exploration (ALiCE Survey)' , DOI
Dhanda A, Yates E & Cramp M Dhanda A, Yates E & Cramp M 'Corticosteroid treatment is associated with a resolution of altered CD4+ T cell phenotype in patients with severe alcoholic hepatitis' , DOI
Tanase A, Aroori S, Dhanda A, Cramp M & Streeter A Tanase A, Aroori S, Dhanda A, Cramp M & Streeter A 'HPB O07 Complication profile of laparoscopic common bile duct exploration: Results from R-ALiCE Study' , DOI
Dhanda A, Williams E, Yates E, Collins P, Lee R & Cramp M Dhanda A, Williams E, Yates E, Collins P, Lee R & Cramp M 'Intermediate (CD14++CD16+) monocytes from patients with acute severe alcoholic hepatitis are activated and functionally similar to classical (CD14++CD16−) monocytes' , DOI
Lilly K, Boeira P & Dhanda A Lilly K, Boeira P & Dhanda A 'OP05 Antioxidant supplementation alters immune cell phenotype and function in patients with alcohol-related hepatitis' , DOI
Tan H, Cramp M & Dhanda A Tan H, Cramp M & Dhanda A 'P026 Differential epigenetic regulation in survivors and non-survivors from severe alcoholic hepatitis' , DOI
Tan H, Boeira P, Cramp M & Dhanda A Tan H, Boeira P, Cramp M & Dhanda A 'P03 Mortality from severe alcoholic hepatitis is associated with increased oxidative stress and epigenetic alterations' , DOI
Dhanda A, Allison M, Bodger K, Forrest E, Hood S, MacGilchrist A, Masson S, Parker R, Simpson K & Vergis N Dhanda A, Allison M, Bodger K, Forrest E, Hood S, MacGilchrist A, Masson S, Parker R, Simpson K & Vergis N 'P032 Increasing burden of alcohol-related liver disease in the UK associated with the coronavirus pandemic' , DOI
Phoolchund A, Babar N, Backhouse L, Badrulhisham F, Donnelly H, Keelty N, Lee I, Marley F, Nott J & Saunsbury E Phoolchund A, Babar N, Backhouse L, Badrulhisham F, Donnelly H, Keelty N, Lee I, Marley F, Nott J & Saunsbury E 'P380 Inpatients with advanced alcohol-related liver disease are not being considered for transplantation: a regional audit' , DOI
Moodley P & Dhanda A Moodley P & Dhanda A 'PTU-025 Obesity is associated with severity and outcome of alcoholic hepatitis' , DOI
Forrest E, Dhanda A, Katarey D, Potts J, Verma S, Parker R & Hayes P Forrest E, Dhanda A, Katarey D, Potts J, Verma S, Parker R & Hayes P 'THU-261-Validation of the pre-treatment neutrophil-to-lymphocyte ratio to predict response to corticosteroids in severe alcoholic hepatitis' , DOI
Dhanda A, Atkinson S & Thursz M Dhanda A, Atkinson S & Thursz M 'Variation in the use of corticosteroids for the treatment of acute severe alcoholic hepatitis in the post-STOPAH era: results of a UK national survey' , DOI Open access
Parker R, Cabezas J, Altamirano J, Sinha A, Dhanda A, Arrese M, Abad JP, Vargas V, McCune CA & Bataller R Parker R, Cabezas J, Altamirano J, Sinha A, Dhanda A, Arrese M, Abad JP, Vargas V, McCune CA & Bataller R 'OC-008 Stratification of patients with alcoholic hepatitis by analysis of trajectory of serum bilirubin concentration' Author Site , DOI
Dhanda A, Allgar V, Andrade J, Callaghan L, Hudson B, Ingram W, King A, Lavers V, Lomax J & McCune A Dhanda A, Allgar V, Andrade J, Callaghan L, Hudson B, Ingram W, King A, Lavers V, Lomax J & McCune A 'Strategies are needed to support people with alcohol use disorder and alcohol-related liver disease to take part in randomised clinical trials: results from the MIRAGE pilot trial of functional imagery training' , DOI Open access
Vergis N, Patel VC, Bogdanowicz K, Czyzewska-Khan J, Keshinro R, Fiorentino F, Day E, Middleton P, Atkinson S & Cross M Vergis N, Patel VC, Bogdanowicz K, Czyzewska-Khan J, Keshinro R, Fiorentino F, Day E, Middleton P, Atkinson S & Cross M 'Il-1beta Signal Inhibition in acute alcoholic hepatitis: a multicentre, randomised, double-blind, placebo-controlled phase 2 trial of canakinumab therapy (ISAIAH)' Author Site , DOI
Tanase A, Dhanda A, Cramp M, Streeter A & Aroori S Tanase A, Dhanda A, Cramp M, Streeter A & Aroori S 'Can We Get Consensus on the Best Surgical Approach to Symptomatic Gallstones and Common Bile Duct Stones? Results from a Prospective Multi-centre UK Wide Study (P-ALICE)' , DOI
Tanase A, Dhanda A, Cramp M, Streeter A & Aroori S Tanase A, Dhanda A, Cramp M, Streeter A & Aroori S 'Laparoscopic Common Bile Duct Exploration: Results From a Prospective Multi-centre Prospective UK-wide Study (P-ALiCE)' , DOI
Tanase A, Dhanda A, Cramp M, Streeter A & Aroori S Tanase A, Dhanda A, Cramp M, Streeter A & Aroori S 'Outcomes of Laparoscopic Common Bile Duct Exploration: Results from a Multi-centre UK-wide Study (R-ALiCE)' , DOI
Tanase A, Dhanda A, Cramp M, Streeter A & Aroori S Tanase A, Dhanda A, Cramp M, Streeter A & Aroori S 'Trans-cystic versus Trans-choledochal Approach for Treating Common Bile Duct Stones: Which Approach Is Better? Results from R-ALICE Study' , DOI
Tanase A, Dhanda A, Cramp M, Streeter A & Aroori S Tanase A, Dhanda A, Cramp M, Streeter A & Aroori S 'Variations in the Trans-choledochal Laparoscopic Bile Duct Exploration: Is this Time for Consensus Guidelines? Results from a Retrospective Multi-centre Study (R-ALICE)' , DOI