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Montalvá E, Rodríguez-Perálvarez M, Blasi A, Bonanad S, Gavín O, Hierro L, Lladó L, Llop E, Pozo-Laderas JC, Colmenero J. Consensus Statement on Hemostatic Management, Anticoagulation, and Antiplatelet Therapy in Liver Transplantation. Transplantation 2022; 106:1123-1131. [PMID: 34999660 PMCID: PMC9128618 DOI: 10.1097/tp.0000000000004014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] [Imported: 08/29/2023]
Abstract
Anticoagulation and antiplatelet therapies are increasingly used in liver transplant (LT) candidates and recipients due to cardiovascular comorbidities, portal vein thrombosis, or to manage posttransplant complications. The implementation of the new direct-acting oral anticoagulants and the recently developed antiplatelet drugs is a great challenge for transplant teams worldwide, as their activity must be monitored and their complications managed, in the absence of robust scientific evidence. In this changing and clinically heterogeneous scenario, the Spanish Society of Liver Transplantation and the Spanish Society of Thrombosis and Haemostasis aimed to achieve consensus regarding the indications, drugs, dosing, and timing of anticoagulation and antiplatelet therapies initiated from the inclusion of the patient on the waiting list to post-LT surveillance. A multidisciplinary group of experts composed by transplant hepatologists, surgeons, hematologists, transplant-specialized anesthesiologists, and intensivists performed a comprehensive review of the literature and identified 21 clinically relevant questions using the patient-intervention-comparison-outcome format. A preliminary list of recommendations was drafted and further validated using a modified Delphi approach by a panel of 24 transplant delegates, each representing a LT institution in Spain. The present consensus statement contains the key recommendations together with the core supporting scientific evidence, which will provide guidance for improved and more homogeneous clinical decision making.
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Affiliation(s)
- Eva Montalvá
- Department of HPB Surgery and Transplantation, La Fe University Hospital and University of Valencia, Instituto de Investigación Sanitaria de La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Manuel Rodríguez-Perálvarez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, University of Córdoba, Córdoba, Spain
| | - Annabel Blasi
- Department of Anesthesiology, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Santiago Bonanad
- Unidad de Hemostasia y Trombosis, Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Olga Gavín
- Departamento de Hematología y Hemoterapia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Loreto Hierro
- Department of Liver Transplantation, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Lladó
- Liver Transplant Unit, Department of Surgery, Bellvitge University Hospital, IDIBELL, University of Barcelona, Barcelona, Spain
| | - Elba Llop
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, University of Córdoba, Córdoba, Spain
- Servicio de Aparato Digestivo, Instituto de Investigación Puerta de Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
| | | | - Jordi Colmenero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Department of Hepatology and Liver Transplantation, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
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2
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Santos Lucio A, Rodríguez Tirado I, Aparicio Serrano A, Jurado García J, Barrera Baena P, González Galilea Á, Poyato González A, Pleguezuelo Navarro M, Costán Rodero G, Casáis Juanena L, Montero Álvarez JL, de la Mata M, Hervás Molina AJ, Rodríguez-Perálvarez ML. Endoscopic findings unrelated to portal hypertension in patients with liver cirrhosis undergoing a varicose vein screening programme. Gastroenterol Hepatol 2021; 45:450-456. [PMID: 34400186 DOI: 10.1016/j.gastrohep.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/29/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022] [Imported: 08/29/2023]
Abstract
AIM To determine the prevalence of endoscopic lesions unrelated with portal hypertension in patients with cirrhosis. PATIENTS AND METHODS Cross-sectional study including a consecutive cohort of patients with liver cirrhosis enrolled in a screening program of oesophageal varices who underwent an upper gastrointestinal endoscopy from November, 2013, to November, 2018. Clinical predictors of endoscopic lesions unrelated to portal hypertension were analyzed by univariate and multivariate logistic regression. RESULTS A total of 379 patients were included. The most frequent aetiology of liver disease was alcohol consumption (60.4%). The prevalence of endoscopic lesions unrelated with portal hypertension was 39.6% (n=150). Among 96 patients with peptic lesions, urease was obtained in 56.2% of patients (positive in 44.4% of them). The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. Smokers had a trend to increased prevalence of endoscopic lesions unrelated to portal hypertension (43.2% vs. 34.6%; p=0.09), particularly peptic ulcer (6.4% vs. 0.6%; p=0.05) and peptic duodenitis (17.3% vs. 6.3%; p=0.002). Active smoking was the only independent predictor of peptic ulcer or duodenitis (OR=2.56; p=0.017). CONCLUSION Active smoking is a risk factor for endoscopic lesions unrelated to portal hypertension. This finding should be further investigated to reassess endoscopic screening programs in cirrhotic smokers.
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Affiliation(s)
- Ana Santos Lucio
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Isabel Rodríguez Tirado
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Ana Aparicio Serrano
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Juan Jurado García
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Pilar Barrera Baena
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Ángel González Galilea
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Antonio Poyato González
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - María Pleguezuelo Navarro
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Guadalupe Costán Rodero
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Luis Casáis Juanena
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - José Luis Montero Álvarez
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España; CIBER de enfermedades hepáticas y digestivas (CIBERehd), Madrid, España
| | - Manuel de la Mata
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España; CIBER de enfermedades hepáticas y digestivas (CIBERehd), Madrid, España; Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Córdoba, Córdoba, España
| | - Antonio José Hervás Molina
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Manuel Luis Rodríguez-Perálvarez
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España; CIBER de enfermedades hepáticas y digestivas (CIBERehd), Madrid, España; Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Córdoba, Córdoba, España.
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Rodríguez-Perálvarez M, Colmenero J, Salcedo M. Reply to: "Age and comorbidity are central to the risk of death from COVID-19 in liver transplant recipients". J Hepatol 2021; 75:228-229. [PMID: 33862040 PMCID: PMC8056821 DOI: 10.1016/j.jhep.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/25/2021] [Accepted: 04/03/2021] [Indexed: 01/08/2023] [Imported: 08/29/2023]
Affiliation(s)
- Manuel Rodríguez-Perálvarez
- Department of Hepatology and Liver Transplantation, Hospital Universitario Reina Sofía, IMIBIC, University of Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
| | - Jordi Colmenero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain,Liver Transplant Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | - Magdalena Salcedo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain,Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
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Rodriguez-Peralvarez M, Salcedo M, Colmenero J, Pons JA. Modulating immunosuppression in liver transplant patients with COVID-19. Gut 2021; 70:1412-1414. [PMID: 32816964 DOI: 10.1136/gutjnl-2020-322620] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 01/11/2023] [Imported: 08/29/2023]
Affiliation(s)
- Manuel Rodriguez-Peralvarez
- Hepatology and Liver Transplantation, Reina Sofia University Hospital, Cordoba, Andalucía, Spain .,Grupo G02, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain.,CIBEREHD, Madrid, Madrid, Spain
| | - Magdalena Salcedo
- CIBEREHD, Madrid, Madrid, Spain.,Hepatology, Hospital General Universitario Gregorio Marañón, Madrid, Madrid, Spain
| | - Jordi Colmenero
- CIBEREHD, Madrid, Madrid, Spain.,Hepatology and Liver Transplantation, Hospital Clinic, Barcelona, Catalunya, Spain
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Amado V, González-Rubio S, Zamora J, Alejandre R, Espejo-Cruz ML, Linares C, Sánchez-Frías M, García-Jurado G, Montero JL, Ciria R, Rodríguez-Perálvarez M, Ferrín G, De la Mata M. Clearance of Circulating Tumor Cells in Patients with Hepatocellular Carcinoma Undergoing Surgical Resection or Liver Transplantation. Cancers (Basel) 2021; 13:cancers13102476. [PMID: 34069569 PMCID: PMC8160727 DOI: 10.3390/cancers13102476] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] [Imported: 08/29/2023] Open
Abstract
BACKGROUND In patients with hepatocellular carcinoma (HCC), a complete clearance of circulating tumor cells (CTCs) early after liver transplantation (LT) or surgical resection (LR) could prevent tumor recurrence. METHODS prospective pilot study including patients with HCC who underwent LR or LT from September 2017 to May 2020. Enumeration of CTCs was performed in peripheral blood samples (7 mL) using the Isoflux® system (Fluxion Biosciences) immediately before surgery, at post-operative day 5 and at day 30. A clinically relevant number of CTCs was defined as >30 CTCs/sample. RESULTS 41 HCC patients were included (mean age 58.7 ± 6.3; 82.9% male). LR was performed in 10 patients (24.4%) and 31 patients (75.6%) underwent LT. The main etiology of liver disease was chronic hepatitis C (31.7%). Patients undergoing LR and LT were similar in terms of preoperative CTC count (p = 0.99), but clearance of CTCs within the first month was more pronounced in the LT group. Clusters of CTCs at baseline were associated with incomplete clearance of CTCs at day 30 (54.2% vs. 11.8%, p = 0.005), which in turn impacted negatively on survival (p = 0.038). CONCLUSION Incomplete clearance of CTCs after surgery could be a surrogate marker of HCC aggressiveness.
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Affiliation(s)
- Víctor Amado
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain; (V.A.); (J.Z.); (R.A.); (J.L.M.); (M.D.l.M.)
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (S.G.-R.); (M.L.E.-C.); (C.L.); (G.G.-J.); (R.C.); (G.F.)
| | - Sandra González-Rubio
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (S.G.-R.); (M.L.E.-C.); (C.L.); (G.G.-J.); (R.C.); (G.F.)
- Centro de Investigación Biomédica en Red de Enfermedades hepáticas y digestivas (CIBERehd), 28029 Madrid, Spain
| | - Javier Zamora
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain; (V.A.); (J.Z.); (R.A.); (J.L.M.); (M.D.l.M.)
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (S.G.-R.); (M.L.E.-C.); (C.L.); (G.G.-J.); (R.C.); (G.F.)
| | - Rafael Alejandre
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain; (V.A.); (J.Z.); (R.A.); (J.L.M.); (M.D.l.M.)
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (S.G.-R.); (M.L.E.-C.); (C.L.); (G.G.-J.); (R.C.); (G.F.)
| | - María Lola Espejo-Cruz
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (S.G.-R.); (M.L.E.-C.); (C.L.); (G.G.-J.); (R.C.); (G.F.)
| | - Clara Linares
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (S.G.-R.); (M.L.E.-C.); (C.L.); (G.G.-J.); (R.C.); (G.F.)
- Centro de Investigación Biomédica en Red de Enfermedades hepáticas y digestivas (CIBERehd), 28029 Madrid, Spain
| | | | - Gema García-Jurado
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (S.G.-R.); (M.L.E.-C.); (C.L.); (G.G.-J.); (R.C.); (G.F.)
| | - José Luis Montero
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain; (V.A.); (J.Z.); (R.A.); (J.L.M.); (M.D.l.M.)
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (S.G.-R.); (M.L.E.-C.); (C.L.); (G.G.-J.); (R.C.); (G.F.)
- Centro de Investigación Biomédica en Red de Enfermedades hepáticas y digestivas (CIBERehd), 28029 Madrid, Spain
| | - Rubén Ciria
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (S.G.-R.); (M.L.E.-C.); (C.L.); (G.G.-J.); (R.C.); (G.F.)
- Department of Hepatobiliary Surgery and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain
| | - Manuel Rodríguez-Perálvarez
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain; (V.A.); (J.Z.); (R.A.); (J.L.M.); (M.D.l.M.)
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (S.G.-R.); (M.L.E.-C.); (C.L.); (G.G.-J.); (R.C.); (G.F.)
- Centro de Investigación Biomédica en Red de Enfermedades hepáticas y digestivas (CIBERehd), 28029 Madrid, Spain
- Correspondence:
| | - Gustavo Ferrín
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (S.G.-R.); (M.L.E.-C.); (C.L.); (G.G.-J.); (R.C.); (G.F.)
- Centro de Investigación Biomédica en Red de Enfermedades hepáticas y digestivas (CIBERehd), 28029 Madrid, Spain
| | - Manuel De la Mata
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain; (V.A.); (J.Z.); (R.A.); (J.L.M.); (M.D.l.M.)
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (S.G.-R.); (M.L.E.-C.); (C.L.); (G.G.-J.); (R.C.); (G.F.)
- Centro de Investigación Biomédica en Red de Enfermedades hepáticas y digestivas (CIBERehd), 28029 Madrid, Spain
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6
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Colmenero J, Rodríguez-Perálvarez M, Salcedo M, Arias-Milla A, Muñoz-Serrano A, Graus J, Nuño J, Gastaca M, Bustamante-Schneider J, Cachero A, Lladó L, Caballero A, Fernández-Yunquera A, Loinaz C, Fernández I, Fondevila C, Navasa M, Iñarrairaegui M, Castells L, Pascual S, Ramírez P, Vinaixa C, González-Dieguez ML, González-Grande R, Hierro L, Nogueras F, Otero A, Álamo JM, Blanco-Fernández G, Fábrega E, García-Pajares F, Montero JL, Tomé S, De la Rosa G, Pons JA. Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients. J Hepatol 2021; 74:148-155. [PMID: 32750442 PMCID: PMC7395653 DOI: 10.1016/j.jhep.2020.07.040] [Citation(s) in RCA: 234] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023] [Imported: 08/29/2023]
Abstract
BACKGROUND & AIMS The incidence and outcomes of coronavirus disease 2019 (COVID-19) in immunocompromised patients are a matter of debate. METHODS We performed a prospective nationwide study including a consecutive cohort of liver transplant patients with COVID-19 recruited during the Spanish outbreak from 28 February to 7 April, 2020. The primary outcome was severe COVID-19, defined as the need for mechanical ventilation, intensive care, and/or death. Age- and gender-standardised incidence and mortality ratios (SIR and SMR) were calculated using data from the Ministry of Health and the Spanish liver transplant registry. Independent predictors of severe COVID-19 among hospitalised patients were analysed using multivariate Cox regression. RESULTS A total of 111 liver transplant patients were diagnosed with COVID-19 (SIR = 191.2 [95% CI 190.3-192.2]). The epidemiological curve and geographic distribution overlapped widely between the liver transplant and general populations. After a median follow-up of 23 days, 96 patients (86.5%) were admitted to hospital and 22 patients (19.8%) required respiratory support. A total of 12 patients were admitted to the ICU (10.8%). The mortality rate was 18%, which was lower than in the matched general population (SMR = 95.5 [95% CI 94.2-96.8]). Overall, 35 patients (31.5%) met criteria of severe COVID-19. Baseline immunosuppression containing mycophenolate was an independent predictor of severe COVID-19 (relative risk = 3.94; 95% CI 1.59-9.74; p = 0.003), particularly at doses higher than 1,000 mg/day (p = 0.003). This deleterious effect was not observed with calcineurin inhibitors or everolimus and complete immunosuppression withdrawal showed no benefit. CONCLUSIONS Being chronically immunosuppressed, liver transplant patients have an increased risk of acquiring COVID-19 but their mortality rates are lower than the matched general population. Upon hospital admission, mycophenolate dose reduction or withdrawal could help in preventing severe COVID-19. However, complete immunosuppression withdrawal should be discouraged. LAY SUMMARY In liver transplant patients, chronic immunosuppression increases the risk of acquiring COVID-19 but it could reduce disease severity. Complete immunosuppression withdrawal may not be justified. However, mycophenolate withdrawal or temporary conversion to calcineurin inhibitors or everolimus until disease resolution could be beneficial in hospitalised patients.
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Affiliation(s)
- Jordi Colmenero
- Liver Transplant Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Manuel Rodríguez-Perálvarez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Hepatology and Liver Transplantation, Hospital Universitario Reina Sofía, IMIBIC, Cordoba, Spain.
| | - Magdalena Salcedo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Ana Arias-Milla
- Hepatology and Liver Transplant Unit, Hospital Puerta de Hierro, IDIPHIMSA, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alejandro Muñoz-Serrano
- Hepatology and Liver Transplant Unit, Hospital Puerta de Hierro, IDIPHIMSA, Universidad Autónoma de Madrid, Madrid, Spain
| | - Javier Graus
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Digestive Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Javier Nuño
- Hepatobiliary and Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mikel Gastaca
- Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Biocruces Bizkaia Health Research Institute, Bilbao, Spain
| | - Javier Bustamante-Schneider
- Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Biocruces Bizkaia Health Research Institute, Bilbao, Spain
| | - Alba Cachero
- Liver Transplant Unit, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Lladó
- Liver Transplant Unit, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Aránzazu Caballero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Ainhoa Fernández-Yunquera
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Carmelo Loinaz
- Department of Hepatology/HPB-surgery/Transplantation, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Inmaculada Fernández
- Department of Hepatology/HPB-surgery/Transplantation, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Constantino Fondevila
- Liver Transplant Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Miquel Navasa
- Liver Transplant Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Mercedes Iñarrairaegui
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Liver Unit, Clínica Universidad de Navarra, IDISNA, Pamplona, Spain
| | - Lluis Castells
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Internal Medicine, Liver Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sonia Pascual
- Liver Unit, Hospital General Universitario de Alicante, Alicante, Spain
| | - Pablo Ramírez
- Liver Transplantation Unit, Liver Unit, Department of Surgery, IMIB, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Carmen Vinaixa
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Hepatology and Liver Transplantation, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María Luisa González-Dieguez
- Liver Unit and Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rocío González-Grande
- Department of Liver Transplantation, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Loreto Hierro
- Department of Paediatric Hepatology and Liver Transplantation, Hospital Universitario La Paz, Madrid, Spain
| | - Flor Nogueras
- Department of Hepatology and Liver Transplantation, Hospital Virgen de las Nieves, Granada, Spain
| | - Alejandra Otero
- Liver Transplant Unit, Hospital de A Coruña, A Coruña, Spain
| | - José María Álamo
- Liver Transplant Unit, Hospital Virgen del Rocío, Seville, Spain
| | - Gerardo Blanco-Fernández
- Department of HPB surgery and Liver Transplantation, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Emilio Fábrega
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Digestive Diseases, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - José Luis Montero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Hepatology and Liver Transplantation, Hospital Universitario Reina Sofía, IMIBIC, Cordoba, Spain
| | - Santiago Tomé
- Department of Liver Transplantation, Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Gloria De la Rosa
- Registro Español de Trasplante Hepático (RETH) y Organización Nacional de Trasplantes (ONT), Madrid, Spain
| | - José Antonio Pons
- Liver Transplantation Unit, Liver Unit, Department of Surgery, IMIB, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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Rodríguez-Perálvarez M, Salcedo M, Pons JA, Colmenero J. Letter: unknown denominator and misleading conclusions in COVID-19. Aliment Pharmacol Ther 2020; 52:1241-1242. [PMID: 33016543 DOI: 10.1111/apt.16038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] [Imported: 08/29/2023]
Affiliation(s)
- Manuel Rodríguez-Perálvarez
- Department of Hepatology and Liver Transplantation, Hospital Universitario Reina sofía, IMIBIC, Córdoba, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Magdalena Salcedo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - José Antonio Pons
- Liver Transplantation Unit, Liver Unit, Department of Surgery, IMIB, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Jordi Colmenero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Liver Transplant Unit, Hospital Clínic, IDIBAPS, University of Barcelona (Spain), Barcelona, Spain
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Rodríguez‐Perálvarez M, Salcedo M, Colmenero J, Pons JA. Increased incidence of COVID‐19 among liver transplant patients in Europe. Transpl Int 2020; 33:1823-1824. [DOI: 10.1111/tri.13729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] [Imported: 08/29/2023]
Affiliation(s)
- Manuel Rodríguez‐Perálvarez
- Department of Hepatology and Liver Transplantation IMIBIC CIBERehd Hospital Universitario Reina Sofía Córdoba Spain
| | - Magdalena Salcedo
- Hepatology and Liver Transplantation Unit CIBERehd Hospital General Universitario Gregorio Marañón Universidad Complutense Madrid Spain
| | - Jordi Colmenero
- Liver Transplant Unit IDIBAPS CIBERehd Hospital Clínic University of Barcelona Barcelona Spain
| | - José Antonio Pons
- Liver Transplantation Unit IMIB Hospital Universitario Virgen de la Arrixaca Murcia Spain
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Ferrín G, Guerrero M, Amado V, Rodríguez-Perálvarez M, De la Mata M. Activation of mTOR Signaling Pathway in Hepatocellular Carcinoma. Int J Mol Sci 2020; 21:ijms21041266. [PMID: 32070029 PMCID: PMC7072933 DOI: 10.3390/ijms21041266] [Citation(s) in RCA: 197] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/17/2022] [Imported: 08/29/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer and occurs mainly in patients with liver cirrhosis. The mammalian target of rapamycin (mTOR) signaling pathway is involved in many hallmarks of cancer including cell growth, metabolism re-programming, proliferation and inhibition of apoptosis. The mTOR pathway is upregulated in HCC tissue samples as compared with the surrounding liver cirrhotic tissue. In addition, the activation of mTOR is more intense in the tumor edge, thus reinforcing its role in HCC proliferation and spreading. The inhibition of the mTOR pathway by currently available pharmacological compounds (i.e., sirolimus or everolimus) is able to hamper tumor progression both in vitro and in animal models. The use of mTOR inhibitors alone or in combination with other therapies is a very attractive approach, which has been extensively investigated in humans. However, results are contradictory and there is no solid evidence suggesting a true benefit in clinical practice. As a result, neither sirolimus nor everolimus are currently approved to treat HCC or to prevent tumor recurrence after curative surgery. In the present comprehensive review, we analyzed the most recent scientific evidence while providing some insights to understand the gap between experimental and clinical studies.
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Affiliation(s)
- Gustavo Ferrín
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, 14004 Córdoba, Spain; (G.F.); (M.G.); (V.A.); (M.D.l.M.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 14004 Córdoba, Spain
| | - Marta Guerrero
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, 14004 Córdoba, Spain; (G.F.); (M.G.); (V.A.); (M.D.l.M.)
- Department of Hepatology and Liver Transplantaton, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
| | - Víctor Amado
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, 14004 Córdoba, Spain; (G.F.); (M.G.); (V.A.); (M.D.l.M.)
- Department of Hepatology and Liver Transplantaton, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
| | - Manuel Rodríguez-Perálvarez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, 14004 Córdoba, Spain; (G.F.); (M.G.); (V.A.); (M.D.l.M.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 14004 Córdoba, Spain
- Department of Hepatology and Liver Transplantaton, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
- Correspondence: ; Tel.: +34-617854692
| | - Manuel De la Mata
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, 14004 Córdoba, Spain; (G.F.); (M.G.); (V.A.); (M.D.l.M.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 14004 Córdoba, Spain
- Department of Hepatology and Liver Transplantaton, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
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Rodríguez-Perálvarez M, Amado V, de la Mata M. Letter: mechanistic target of rapamycin inhibitors as adjuvant therapy for patients with hepatocellular carcinoma undergoing liver transplantation. Aliment Pharmacol Ther 2019; 50:478-479. [PMID: 31359472 DOI: 10.1111/apt.15300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] [Imported: 08/29/2023]
Affiliation(s)
- Manuel Rodríguez-Perálvarez
- Department of Hepatology and Liver Transplantation, IMIBIC, CIBERehd, Reina Sofía University Hospital, Córdoba, Spain
| | - Victor Amado
- Department of Hepatology and Liver Transplantation, IMIBIC, CIBERehd, Reina Sofía University Hospital, Córdoba, Spain
| | - Manuel de la Mata
- Department of Hepatology and Liver Transplantation, IMIBIC, CIBERehd, Reina Sofía University Hospital, Córdoba, Spain
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Guerrero M, Ferrín G, Rodríguez-Perálvarez M, González-Rubio S, Sánchez-Frías M, Amado V, Pozo JC, Poyato A, Ciria R, Ayllón MD, Barrera P, Montero JL, de la Mata M. mTOR Expression in Liver Transplant Candidates with Hepatocellular Carcinoma: Impact on Histological Features and Tumour Recurrence. Int J Mol Sci 2019; 20:ijms20020336. [PMID: 30650598 PMCID: PMC6359509 DOI: 10.3390/ijms20020336] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
(1) Background: The mammalian target of rapamycin (mTOR) pathway activation is critical for hepatocellular carcinoma (HCC) progression. We aimed to evaluate the mTOR tissue expression in liver transplant (LT) patients and to analyse its influence on post-LT outcomes. (2) Methods: Prospective study including a cohort of HCC patients who underwent LT (2012⁻2015). MTOR pathway expression was evaluated in the explanted liver by using the "PathScan Intracellular Signalling Array Kit" (Cell Signalling). Kaplan-Meier and Cox regression analyses were performed to evaluate post-LT HCC recurrence. (3) Results: Forty-nine patients were included (average age 56.4 ± 6, 14.3% females). Phospho-mTOR (Ser2448) was over-expressed in peritumoral tissue as compared with tumoral tissue (ΔSignal 22.2%; p < 0.001). The mTOR activators were also increased in peritumoral tissue (phospho-Akt (Thr308) ΔSignal 18.2%, p = 0.004; phospho-AMPKa (Thr172) ΔSignal 56.3%, p < 0.001), as they were the downstream effectors responsible for cell growth/survival (phospho-p70S6K (Thr389) ΔSignal 33.3%, p < 0.001 and phospho-S6RP (Ser235/236) ΔSignal 54.6%, p < 0.001). MTOR expression was increased in patients with multinodular HCC (tumoral p = 0.01; peritumoral p = 0.001). Increased phospho-mTOR in tumoral tissue was associated with higher HCC recurrence rates after LT (23.8% vs. 5.9% at 24 months, p = 0.04). (4) Conclusion: mTOR pathway is over-expressed in patients with multinodular HCC and is it associated with increased post-LT tumour recurrence rates.
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Affiliation(s)
- Marta Guerrero
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | - Gustavo Ferrín
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | - Manuel Rodríguez-Perálvarez
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | - Sandra González-Rubio
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | | | - Víctor Amado
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | - Juan C Pozo
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
| | - Antonio Poyato
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | - Rubén Ciria
- HPB Surgery and Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain.
| | - María D Ayllón
- HPB Surgery and Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain.
| | - Pilar Barrera
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | - José L Montero
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | - Manuel de la Mata
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
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Amado V, Rodríguez-Perálvarez M, Ferrín G, De la Mata M. Selecting patients with hepatocellular carcinoma for liver transplantation: incorporating tumor biology criteria. J Hepatocell Carcinoma 2018; 6:1-10. [PMID: 30613572 PMCID: PMC6306074 DOI: 10.2147/jhc.s174549] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] [Imported: 08/29/2023] Open
Abstract
Liver transplantation (LT) is the optimal therapeutic option for patients with liver cirrhosis and hepatocellular carcinoma (HCC). Due to universal donor shortage, only the patients with limited tumor burden (under the so-called Milan criteria) are considered as potential candidates for LT in most institutions. It is expected that in the near future, more liver grafts will be available for patients with HCC due to the implementation of new direct antivirals against hepatitis C, leaving a prone scenario to consider expanding Milan criteria. A moderate expansion of Milan criteria could be implemented without increasing the risk of tumor recurrence if patients with favorable biological behavior are carefully selected. Incorporating information regarding tumor biology in the decision-making algorithm would result in a more rational use of LT in patients with HCC. In the present review, surrogate markers of tumor biology are critically evaluated as potential tools to be combined with existing radiological criteria. In addition, the current state of liquid biopsy is discussed, as this cutting-edge technology may reshape the management of HCC in the upcoming years.
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Affiliation(s)
- Víctor Amado
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain,
| | - Manuel Rodríguez-Perálvarez
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain,
| | - Gustavo Ferrín
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain,
| | - Manuel De la Mata
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain,
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Pérez P, Rodríguez-Perálvarez M, Guerrero L, González V, Sánchez R, Centeno M, Poyato A, Briceño J, Sánchez-Frías M, Montero JL, De la Mata M. Incidental hepatocellular carcinoma after liver transplantation: Prevalence, histopathological features and prognostic impact. PLoS One 2017; 12:e0175010. [PMID: 28403219 DOI: 10.1371/journal.pone.0175010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/20/2017] [Indexed: 12/12/2022] [Imported: 08/29/2023] Open
Abstract
Background Incidental hepatocellular carcinoma (iHCC) is a histological finding after liver transplantation (LT) which relevance has been scarcely studied. Aims to describe the histopathological features of iHCC and to determine its prognostic impact in terms of tumor recurrence and overall survival. Methods Observational study including 451 consecutive adult LT patients (2000–2013). Patients aged<18, retransplanted or with early postoperative death were excluded. Median follow-up after LT was 58 months. Multiple Cox’s regression was used to assess the prognostic impact of iHCC on tumor recurrence and mortality while controlling for potential confounders. Results 141 patients had known HCC before LT (31.3%). Among the remaining 310 patients, the prevalence of iHCC was 8.7% (n = 27). In the explanted liver, 36.2% of patients with known HCC and 25.9% of patients with iHCC trespassed Milan criteria (p = 0.30). Patients with known and iHCC had similar rates of multinodular disease (50.4% vs 55.6%; p = 0.62), macrovascular invasion (6.5% vs 3.7%; p = 0.58), microvascular invasion (12.9% vs 14.8%; p = 0.76) and moderate-poor tumor differentiation (53.9% vs 70.4%; p = 0.09). In the multivariate analysis, iHCC and known HCC had identical recurrence-free survival after controlling for histological features (RR = 1.06, 95%CI 0.36–3.14; p = 0.90). Cumulative 5-year overall survival rates were similar between patients with known and iHCC (65% vs 52.8% respectively; log rank p = 0.44), but significantly inferior as compared with patients without HCC (77.8%) (p = 0.002 and p = 0.007 respectively). Indeed, in the overall cohort, iHCC was an independent predictor of mortality (RR = 3.02; 95%CI 1.62–5.65; p = 0.001). Conclusion The risk of tumor recurrence after LT is similar in patients with iHCC and known HCC. A close imaging surveillance is strongly recommended for patients awaiting LT in order to detect HCC prior to LT, thus allowing for an adequate selection of candidates, prioritization and indication of bridging therapies.
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Rodríguez-Perálvarez ML, Miñano-Herrrero JA, Hervás-Molina AJ, Benítez-Cantero JM, García-Sánchez V, Naranjo-Rodríguez A, Pleguezuelo-Navarro M, Soler-Cantos MDM, de la Mata-García M. Radio induced cancer risk during ERCP. Is it a real clinical problem? Rev Esp Enferm Dig 2015; 103:191-5. [PMID: 21526872 DOI: 10.4321/s1130-01082011000400004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] [Imported: 08/29/2023]
Abstract
BACKGROUND in recent years many factors have been shown to influence dose received by the patient during ERCP. Therefore it is necessary to update radio induced cancer risk. OBJECTIVES to calculate lifetime attributable risk of cancer during ERCP. To compare the risk with the most common X-ray examinations. DESIGN descriptive study with 393 consecutive ERCP performed at one center. Equipment used was Philips BV pulsera. In each exploration demographic and anthropometric variables of the patient were collected. Dosimetric quantities were calculated from exposure parameters. Effective dose was estimated using specific conversion factors. Organ doses and radio induced cancer incidence was estimated. RESULTS dose area product was 0.82 mGym2(IQR 0.4-1.5) with an average fluoroscopy time of 2 minutes and 45 seconds. Entrance surface dose was 30.7 mGy (IQR 15-60.8) and effective dose was 0.44 mSv (IQR 0.2-0.9). Multivariate analysis identified that difficult papillary cannulation (β 0.4; p = 0.009), patient age (β-0.01; p = 0.001) and therapeutic applied (β= 0.89; p < 0.001) influenced dose-area product. The ERCP dose would be equivalent to the radiation received by twenty chest radiographs and would be about fourteen times smaller than a barium enema or twenty times less than that received during an abdominal CT. Life-time attributable risk of cancer incidence was 4.08 and 16.81 per million procedures in diagnostic and therapeutic ERCP respectively. CONCLUSIONS from the radiological point of view, ERCP is a safe technique that uses low exposure levels compared to other explorations commonly used in medicine. It implies a reasonably low risk of radio induced cancer.
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Rodríguez-Perálvarez M, Pérez-Medrano I, Guerrero-Misas M, González V, Poyato A, Barrera P, Ferrín G, Pozo JC, Sánchez-Frías M, Ciria R, Briceño J, Montero JL, De la Mata M. Everolimus is safe within the first month after liver transplantation. Transpl Immunol 2015; 33:146-51. [PMID: 26392195 DOI: 10.1016/j.trim.2015.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 02/06/2023] [Imported: 08/29/2023]
Abstract
BACKGROUND & AIMS Sirolimus should not be started within the first month after liver transplantation (LT) because of an increased risk of adverse outcomes. The evidence regarding everolimus is lacking but the manufacturer transposed the same warning. We aimed to evaluate the safety of everolimus started within the first month after LT. METHODS A consecutive cohort 187 LT patients (2009-2013) with a tacrolimus-based immunosuppression was evaluated. Patients starting everolimus within the first month after LT (n = 33; 17.6%) were compared with those starting everolimus thereafter (n = 25; 13.4%) or not receiving everolimus (n = 129; 69%). The median follow-up after LT was 21 months (IQR 7-36). Prospective outcomes were evaluated by using Kaplan-Meier curves and Cox's regression. RESULTS The incidence of hepatic artery thrombosis was not significantly different in patients early treated with everolimus when compared with the remaining cohort (0% vs 9.1%; p = 0.12). Other vascular complications occurred in 9.1% of patients with early everolimus vs 7.3% in the remaining cohort (p = 0.72). No wound healing complications were detected with early everolimus. There were similar rates of incisional hernia (p = 0.31), infections (p = 0.15), renal impairment (p = 0.37), and histologically-proven acute rejection (p = 0.24) between groups. The rates of hyperlipidemia were increased with early everolimus (29.9% vs 16.5% at 3 years; p = 0.018). Graft loss and mortality rates were similar between groups (p = 0.34 and p = 0.94 respectively), after adjusting for possible confounding factors. CONCLUSIONS Everolimus combined with reduced tacrolimus proved to be safe within the first month after LT. Future trials may be allowed to implement everolimus early after LT.
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Affiliation(s)
- Manuel Rodríguez-Perálvarez
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
| | - Indhira Pérez-Medrano
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
| | - Marta Guerrero-Misas
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
| | - Víctor González
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
| | - Antonio Poyato
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
| | - Pilar Barrera
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
| | - Gustavo Ferrín
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain
| | - Juan C Pozo
- Intensive Care Unit, Reina Sofía University Hospital, Córdoba, Spain.
| | | | - Rubén Ciria
- Department of General Surgery and Abdominal Transplantation, Reina Sofía University Hospital, Córdoba, Spain.
| | - Javier Briceño
- Department of General Surgery and Abdominal Transplantation, Reina Sofía University Hospital, Córdoba, Spain.
| | - José L Montero
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
| | - Manuel De la Mata
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
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Guerrero-Misas M, Rodríguez-Perálvarez M, De la Mata M. Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation. World J Hepatol 2015; 7:649-661. [PMID: 25866602 PMCID: PMC4388993 DOI: 10.4254/wjh.v7.i4.649] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/15/2014] [Accepted: 01/19/2015] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
Liver transplantation is the only therapeutic option which allows to treat both, the hepatocellular carcinoma and the underlying liver disease. Indeed, liver transplantation is considered the standard of care for a subset of patients with cirrhosis and hepatocellular carcinoma. However, tumour recurrence rates are as high as 20%, and once the recurrence is established the therapeutic options are scarce and with little impact on prognosis. Strategies to minimize tumour recurrence and thus to improve outcome may be classified into 3 groups: (1) An adequate selection of candidates for liver transplantation by using the Milan criteria; (2) An optimized management within waiting list including prioritization of patients at high risk of tumour progression, and the implementation of bridging therapies, particularly when the expected length within the waiting list is longer than 6 mo; and (3) Tailored immunosuppression comprising reduced exposure to calcineurin inhibitors, particularly early after liver transplantation, and the addition of mammalian target of rapamycin inhibitors. In the present manuscript the available scientific evidence supporting these strategies is comprehensively reviewed, and future directions are provided for novel research approaches, which may contribute to the final target: to cure more patients with hepatocellular carcinoma and with an improved long term outcome.
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Abstract
PURPOSE OF REVIEW Long-term survival of liver transplant recipients is threatened by increased rates of de-novo malignancy and recurrence of hepatocellular carcinoma (HCC), both events tightly related to immunosuppression. RECENT FINDINGS There is accumulating evidence linking increased exposure to immunosuppressants and carcinogenesis, particularly concerning calcineurin inhibitors (CNIs), azathioprine and antilymphocyte agents. A recent study including 219 HCC transplanted patients showed that HCC recurrence rates were halved if a minimization of CNIs was applied within the first month after liver transplant. With mammalian target of rapamycin (mTOR) inhibitors as approved immunosuppressants for liver transplant patients, pooled data from several retrospective studies have suggested their possible benefit for reducing HCC recurrence. SUMMARY Randomized controlled trials with sufficiently long follow-up are needed to evaluate the influence of different immunosuppression protocols in preventing malignancy after LT. Currently, early minimization of CNIs with or without mTOR inhibitors or mycophenolate seems a rational strategy for patients with risk factors for de-novo malignancy or recurrence of HCC after liver transplant. A deeper understanding of the immunological pathways of rejection and cancer would allow for designing more specific and safer drugs, and thus to prevent cancer after liver transplant.
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Affiliation(s)
- Manuel Rodríguez-Perálvarez
- Department of Hepatology and Liver Transplantation. Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain
| | - Manuel De la Mata
- Department of Hepatology and Liver Transplantation. Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain
| | - Andrew K. Burroughs
- The Royal Free Sheila Sherlock Liver Centre and Institute of Liver and Digestive Health, UCL, London, United Kingdom
- Deceased
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Rodríguez-Perálvarez ML, García-Sánchez V, Villar-Pastor CM, González R, Iglesias-Flores E, Muntane J, Gómez-Camacho F. Role of serum cytokine profile in ulcerative colitis assessment. Inflamm Bowel Dis 2012; 18:1864-71. [PMID: 22238172 DOI: 10.1002/ibd.22865] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 12/03/2011] [Indexed: 12/12/2022] [Imported: 08/29/2023]
Abstract
BACKGROUND Several cytokines are overexpressed in the colonic mucosa of patients with ulcerative colitis (UC). The measurement of these parameters in plasma could be useful in diagnosis and disease assessment. METHODS In all, 67 UC patients and 21 healthy controls were enrolled. At inclusion, clinical, endoscopic, and histological disease activity were assessed using the Ulcerative Colitis Activity Index (UCAI) and the Baron and Geboes scales, respectively. Serum cytokine concentrations were analyzed with a multiplex system (Bio-Plex pro, Bio-Rad) measuring interleukin (IL)-1-β, IL-2, IL-6, IL-8, IL-10, IL-13, IL-17, interferon-gamma (IFN-γ), and tumor necrosis factor alpha (TNF-α). Multiple logistic regression was used to design a serum cytokines profile. RESULTS In the UC group the disease activity was moderate to severe based on clinical evaluation in 35 patients (52.2%), by endoscopic appearance in 45 (67.2%), and in 53 patients (81.6%) using histology. With respect to controls, the multivariate analysis identified that UC patients had higher IL-8 (odds ratio [OR] = 1.37; P = 0.002) and IL-10 concentrations (OR = 3.88; P = 0.012) with lower levels of IFN-γ (OR = 0.95; P = 0.002). The model had an accuracy of 77.3%, which increased to 94.6% when only newly diagnosed patients were considered. Patients with moderate to severe disease according to their clinical score showed a higher concentration of IL-8 (OR = 1.16; P = 0.012) and IL-10 (OR = 1.76; P = 0.039) with lower levels of IL-17 (OR = 0.97; P = 0.021). The IL-8 serum concentration was also related to endoscopic and histological severity (OR = 1.10; P = 0.026 and OR = 1.33, P = 0.017, respectively). CONCLUSIONS A serum cytokine profile may be an auxiliary tool for the diagnosis and severity assessment of UC. IL-8 seems to be a reliable biomarker, closely related to disease activity.
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Rodríguez-Perálvarez ML, Jurado-García J, Benítez-Cantero JM, Vignote-Alguacil M, González-Galilea A, Pleguezuelo-Navarro M, González-Menchen A, Gómez-Morá A, De Dios Vega JF. [Fulminant ischemic gastropathy: the final stage of a difficult-to-diagnose disease]. Gastroenterol Hepatol 2010; 33:700-3. [PMID: 21051112 DOI: 10.1016/j.gastrohep.2010.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 07/26/2010] [Accepted: 08/03/2010] [Indexed: 12/23/2022] [Imported: 08/29/2023]
Abstract
Ischemic gastropathy is highly infrequent in daily medical practice. In the last few years, the number of reported cases has increased. Although the guiding symptom is usually abdominal pain, the clinical spectrum of the disease is highly variable. Early diagnosis and treatment are essential to change the natural history of the disease. We present the case of a 75-year-old man with chronic abdominal pain who developed a fulminant form of necrotizing gastric ischemia and died within less than 24h.
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