Joan Cordoba Cordona (1964–2014): A dedicated clinician, great scientist, mentor, friend, collaborator, critic…
Authors: Rajiv Jalan, Rafael Esteban
Journal: Journal of Hepatology (2014)

Joan was born on September 11th, 1964 in Barcelona, Spain. He was the oldest of 4 brothers and a sister. With his parents, Joan and Maria Queralt, at the age of one, Joan moved to Oviedo, where his father, a great criminal lawyer, had been appointed Professor of Law at the University. Joan completed his first years of education at a German school in Valencia where his family relocated as his father accepted a new academic position. The whole family moved back to Barcelona in 1971, when Joan was 7. Joan began studying medicine at the University of Barcelona at the age of 18, amazingly, the same year his mother was finishing her degree. Joan met his wife Mercedes during his second year in Medicine, while studying in the library. They married when Joan finished medical school on 11th September, the day of his 23rd birthday. His brilliance was exhibited early as he obtained cum laude in every subject. Even as a resident, his mentors recognized him as a potential leader in the future and Dr Guardia and Dr Esteban played an important role in his growth. Joan was the type of person who achieved excellence and enjoyed whatever he did. He loved to be active and do sports; he used to row in an 8-man boat and won a medal at the national championships. Once he and his team tried to row from Tarragona to Barcelona (approx. 100 km). They rowed all night only to have the boat sink just before arriving in Barcelona. However disappointed, Joan claimed it was a great adventure. Joan loved to ski and swim, his favorite sports to stay in shape. He also enjoyed climbing, running, and was a great fan of the Barcelona football club. He was very fond of music and art and use to say, ‘life deserved beauty’. He also treasured friendship as much as he loved family. His wife Mercedes says ‘Family was so important to Joan; he was a great role model as an older brother, a true partner for me never to be replaced and above all a loving and close father for his children, Joan and Valentina’. Joan worked long hours but still enjoyed coming home to cook. Dr Andy Blei, who Joan trained and spent several years with, recognized the potential of Joan as a future leader, fostered his interest in Hepatology and hepatic encephalopathy research. Joan quickly rose to become a Professor of Hepatology. He was a great supporter of ISHEN and worked as Executive Secretary of the organization. Latterly, he was a key member of the steering committee of the EASL CLIF-Consortium. After battling hard with brain cancer for over 3-years, Joan passed away in his home, surrounded by his family, his wife Mercedes, son Joan and daughter Valentina . Joan was a dedicated clinician, great scientist, colleague, critic, collaborator, mentor, and a very good friend. In a word, he was a great man. I (RJ) had the privilege of sharing some of the best times of my life with him meeting in exotic locations around the world spending long evenings discussing science, politics, football, and family. Although we knew of each other’s existence, we became friends after a wild night at a hepatic encephalopathy meeting in Turkey. One evening after having dinner in a palace, we landed up, as you do, in a Turkish nightclub. We laughed, sang, and danced at a party, which amongst others included Christopher Rose, his very good friend and collaborator and, the late Andy Blei, his mentor. That evening did not end when the Turkish club closed, as we got lost on our way back to the hotel and ended in the middle of nowhere, arriving back at the hotel at 6 am, ready for a meeting at 8 am. At that time we knew that a friendship was born. Fun aside, Joan was a rare and brilliant clinical scientist, a leader of men, without parallel. His research focused on the brain dysfunction of liver disease and he rapidly became a true leader in the field. Joan’s academic brilliance was discovered and nurtured by the late Andy Blei, who was amazed at this young man’s diligence, honesty, and ability. Over a mere 15 years, he rapidly rose to the top publishing over 150 papers in the highest ranked journals and making many very important scientific discoveries and seminal observations which have impacted directly on patient care. A few of his seminal observations were:•Description of the kinetics of ammonia removal with hemofiltration, which was the basis of the current use of high volume hemofiltration in hyperammonemic patients with acute liver failure [[1]Cordoba J. Blei A.T. Mujais S. Determinants of ammonia clearance by hemodialysis.Artif Organs. 1996; 20: 800-803Crossref PubMed Scopus (66) Google Scholar].•Demonstration of cerebral hyperemia in acute liver failure, which informed the decision to treat these patients with hypothermia [[2]Córdoba J. Crespin J. Gottstein J. Blei A.T. Mild hypothermia modifies ammonia-induced brain edema in rats after portacaval anastomosis.Gastroenterology. 1999; 116: 686-693Abstract Full Text Full Text PDF PubMed Scopus (111) Google Scholar].•Role of low sodium in hepatic encephalopathy leading to the current use of hypertonic saline in the treatment of liver failure patients [[3]Córdoba J. Gottstein J. Blei A.T. Chronic hyponatremia exacerbates ammonia-induced brain edema in rats after portacaval anastomosis.J Hepatol. 1998; 29: 589-594Abstract Full Text PDF PubMed Scopus (92) Google Scholar].•Brain white matter lesions in patients with hepatic encephalopathy. Until his observations, hepatic encephalopathy was thought to be a disease of the grey matter and led to studies describing the defects in the corticospinal tracts in hepatic encephalopathy [[4]Córdoba J. Raguer N. Flavià M. Vargas V. Jacas C. Alonso J. et al.T2 hyperintensity along the cortico-spinal tract in cirrhosis relates to functional abnormalities.Hepatology. 2003; 38: 1026-1033Crossref PubMed Google Scholar].•The standard of care for patients with hepatic encephalopathy was to reduce their protein intake. He performed the first clinical trial to show that, patients with encephalopathy should be fed rather than starved, which has changed clinical practice [[5]Córdoba J. López-Hellín J. Planas M. Sabín P. Sanpedro F. Castro F. et al.Normal protein diet for episodic hepatic encephalopathy: results of a randomized study.J Hepatol. 2004; 41: 38-43Abstract Full Text Full Text PDF PubMed Scopus (377) Google Scholar].•He made the seminal discovery that the brain of a patient with encephalopathy did not recover fully after liver transplantation providing a rationale for preventive therapy and generating new insights into the mechanisms of hepatic encephalopathy [[6]García Martínez R. Rovira A. Alonso J. Aymerich F.X. Huerga E. Jacas C. et al.A long-term study of changes in the volume of brain ventricles and white matter lesions after successful liver transplantation.Transplantation. 2010; 89: 589-594Crossref PubMed Scopus (33) Google Scholar].•He described the only animal model of HE that provides objective neurophysiological information to test new drugs [[7]Chavarria L. Oria M. Romero-Gimenez J. Alonso J. Lope-Piedrafita S. Cordoba J. Diffusion tensor imaging supports the cytotoxic origin of brain edema in a rat model of acute liver failure.Gastroenterology. 2010; 138: 1566-1573Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar].•He performed a first in man study of ornithine phenylacetate providing proof of concept that this could reduce ammonia concentration leading to a large clinical trial, which is now underway [[8]Ventura-Cots M. Arranz J.A. Simón-Talero M. Torrens M. Blanco A. Riudor E. et al.Safety of ornithine phenylacetate in cirrhotic decompensated patients: an open-label, dose-escalating, single-cohort study.J Clin Gastroenterol. 2013; 47: 881-887Crossref PubMed Scopus (53) Google Scholar]. Most importantly, he contributed to the efforts of many, many young and older colleagues in the field of hepatic encephalopathy. The amazing thing was that he never really claimed anything, such was his humility. Joan continued to evolve, and over the past 5 years or so he took on the role of the senior statesman, mentor to the community of researchers providing critical, positive guidance. He has played, as they say ‘a blinder’ in generating a consensus statement on the diagnosis and management of hepatic encephalopathy. His human and intellectual skills were crucial in generating a true consensus. From a personal perspective, I (RJ) always looked to Joan as a sanity check to validate, some of my ideas, which were sometimes a little far fetched. Despite our friendship, he always remained completely true to the literature, saying, ‘sorry Rajiv, that is a little far-fetched’. Of course, he was right. The last 3-years have however, been the most inspiring for a lot of us who knew him well and a real testament to his bravery and positive attitude. In the face of the terrible disease he suffered from, multiple operations and chemotherapy, many of us would have closed shop and withdrawn into ourselves. Not Joan. He seemed to be more energized focusing on his mentees and his work producing some of the finest science during these years, and even to the last weeks. This was a true exhibition of character, an example to us all. Within 2 days of his passing, we have shared over a hundred messages about Joan. We want to share a few of these from his closest colleagues, mentees and friends:(1)German Soriano (colleague and friend): Joan, we will always remember you not only as a good doctor and very clever investigator but mainly because of your humility and generosity towards all of us. You have been one of those few people that show that wisdom and humility goes hand in hand.(2)The current fellows (Maria, Laia, Jordi, and others): During all these years we have learnt from you your positivism, your wisdom, your calm even in the most stress situations, your sane madness, your strength, your generosity… among a large list of lessons… We did learn a lot not only from what you taught us, but also from your unintended acts.(3)Rita Garcia-Martinez (past fellow and mentee): I discovered your strength, your honesty, generosity and humility. You have been granted with a great virtue among many others: you bring out the best of us, and that makes you the best mentor and someone unforgettable.(4)Javier Vaquero (colleague and friend): Meeting Joan was a privilege, and I feel that yesterday I lost a role model as well as a good friend. I will deeply miss Joan’s input, interaction, advices, happiness, and humor.(5)Ramon Bataller (colleague and friend): I was deeply impressed with the bravery that he faced his disease. His example of strength and dignity will inspire me all through my life.(6)Rafael Benares (colleague and friend): An outstanding person: Friendship, Honesty, Commitment, Truth, Science.(7)Christopher Rose (friend, colleague, and mentee): A mentor, a colleague and a great friend. Joan was very influential in my career as a researcher. I knew I wanted to stay in hepatic encephalopathy because I wanted to work with Joan. His knowledge and willingness to teach as well as his humble and honest approach to science were priceless. Many of Joan’s friends and colleagues have helped put this together including German Soriano, Rita Garcia-Martinez, Chris Rose and most of all his wife, Mercedes Balcells.