My research has concentrated on finding out the reason why patients in advanced stages of cirrhosis develop complications. It is a stage of the disease called decompensated cirrhosis, when patients are at risk for developing trouble in other organ systems, and then their condition suddenly deteriorates. This scenario is known as acute-on-chronic liver failure, where there is a risk for kidney, brain and lung failure. So far, we know that bacterial infections are a major cause of acute-on-chronic liver failure, but there are other situations when there is inflammation without infection can also cause multi-organ failure. I have spent some time investigating kidney failure associated with liver failure. This is related to both a change in the circulation in these patients as well as the presence of inflammation. I have been studying the role of a group of compounds called vasoconstrictors to manipulate the circulation. These have helped to improve kidney function in these patients, suggesting that abnormalities in the circulation can cause kidney failure to occur in patients with cirrhosis. I have also been involved in studies to find out how changes of the bacteria in patients' guts can cause complications of cirrhosis. We are in the process of designing further studies to manipulate gut bacteria to reduce the risk for these patients to develop complications.