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Benítez C, Arnold J, Cambindo V, Schoenfeldt F, Cancino A, Ibáñez S, Grandy C, Hunfan P, González J, Guerra C, Godoy E, Araneda V, Mollo C, Poniachik J, Urzúa A, Cattaneo M, Roblero JP, Oppenheimer I, Pizarro V. Effect of acute on chronic liver failure over post-transplant survival. Ann Hepatol 2023; 28:101128. [PMID: 37331597 DOI: 10.1016/j.aohep.2023.101128] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/06/2023] [Accepted: 05/26/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION AND OBJECTIVES Acute-on-chronic liver failure (ACLF) is associated with reduced short-term survival, and liver transplantation is frequently the only therapeutic option. Nonetheless, the post-transplantation prognosis seems to be worse in ACLF patients. MATERIALS AND METHODS The databases of two university centers were retrospectively evaluated, and adult patients with cirrhosis who underwent transplantation between 2013 and 2020 were included. One-year survival of patients with ACLF was compared to that of patients without ACLF. Variables associated with mortality were identified. RESULTS A total of 428 patients were evaluated, and 303 met the inclusion criteria; 57.1% were male, the mean age was 57.1 ± 10.2 years, 75 patients had ACLF, and 228 did not. The main etiologies of ACLF were NASH (36.6%), alcoholic liver disease (13.9%), primary biliary cholangitis (8.6%) and autoimmune hepatitis (7.9%). Mechanical ventilation, renal replacement therapy, the use of vasopressors and the requirement of blood product transfusion during liver transplantation were significantly more frequent in ACLF patients. Among those recipients without and with ACLF, survival at 1, 3 and 5 years was 91.2% vs. 74.7%, 89.1% vs. 72.6% and 88.3% vs. 72.6%, respectively (p=0.001). Among pre-transplantation variables, only the presence of ACLF was independently associated with survival (HR 3.2, 95% CI: 1.46-7.11). Post-transplantation variables independently associated with survival were renal replacement therapy (HR 2.8, 95% CI: 1.1-6.8) and fungal infections (HR 3.26, 95% CI: 1.07-9.9). CONCLUSIONS ACLF is an independent predictor of one-year post-transplantation survival. Importantly, transplant recipients with ACLF require the use of more resources than patients without ACLF.
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Affiliation(s)
- Carlos Benítez
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile.
| | - Jorge Arnold
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
| | - Verónica Cambindo
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
| | | | - Alejandra Cancino
- Instituto de Trasplante, Hospital Clínico UC Christus, Lira 40, Santiago, Chile
| | - Samuel Ibáñez
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
| | - Catalina Grandy
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
| | - Paola Hunfan
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
| | - Jorge González
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
| | - Catalina Guerra
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
| | - Esteban Godoy
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
| | - Verónica Araneda
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
| | - Constanza Mollo
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
| | - Jaime Poniachik
- Departamento de Medicina. Sección Gastroenterología. Hospital Clínico Universidad de Chile, Dr. Carlos Lorca Tobar, Independencia, Chile
| | - Alvaro Urzúa
- Departamento de Medicina. Sección Gastroenterología. Hospital Clínico Universidad de Chile, Dr. Carlos Lorca Tobar, Independencia, Chile
| | - Máximo Cattaneo
- Departamento de Medicina. Sección Gastroenterología. Hospital Clínico Universidad de Chile, Dr. Carlos Lorca Tobar, Independencia, Chile
| | - Juan Pablo Roblero
- Departamento de Medicina. Sección Gastroenterología. Hospital Clínico Universidad de Chile, Dr. Carlos Lorca Tobar, Independencia, Chile
| | - Ilan Oppenheimer
- Escuela de Medicina Universidad de Chile, Avenida Independencia 1077, Independencia, Chile
| | - Vicente Pizarro
- Escuela de Medicina Universidad de Chile, Avenida Independencia 1077, Independencia, Chile
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Benítez C. Pressure Measurements Under Pressure: Simplifying the Diagnosis of Clinically Significant Portal Hypertension. Dig Dis Sci 2022; 67:2711-2713. [PMID: 34739622 DOI: 10.1007/s10620-021-07283-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Carlos Benítez
- Liver Transplant Unit, Gastroenterology Department, Hospital Clínico de la Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile.
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Benítez C, Muñoz A, Poniachik J, Ramírez F, Muñoz C, Cermenati T, Martínez N, Díaz P, Meneses L. [Embolization of spontaneous portosystemic shunts as treatment for refractory hepatic encephalopathy]. Rev Med Chil 2022; 150:879-888. [PMID: 37906821 DOI: 10.4067/s0034-98872022000700879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 03/07/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Hepatic encephalopathy (HE) is a common complication of cirrhosis associated with a reduced survival. The presence of high-flux spontaneous porto-systemic shunts can induce HE even in patients with preserved liver function. AIM To evaluate the effect of spontaneous porto-systemic shunt embolization (SPSE) over HE and its long-term evolution. MATERIAL AND METHODS Retrospective analysis of 11 patients (91% males) with severe HE non-responsive to medical treatment in whom a SPSE was performed. The grade of HE (employing West Haven score), survival, MELD and Child-Pugh score, ammonia levels, degree of disability (employing the modified Rankin scale (mRs)) were evaluated before and at thirty days after procedure. RESULTS The most common etiology found was non-alcoholic steatohepatitis (63.6%). A reduction of at least two score points of HE was observed in all patients after thirty days. There was a significant reduction on median (IQR) West Haven score from 3 (2-3) at baseline to 1 (0-1) after the procedure (p < 0.01). Twelve months survival was 63.6%. There was a decrease in median ammonia level from 106.5 (79-165) (ug/dL) to 56 (43-61) after SPSE (p = 0.006). The median mRS score before and after the procedure was 3 (3-5) and 1 (1-2.5), respectively (p < 0.01). CONCLUSIONS According to our experience, SPSE is a feasible and effective alternative to improve HE and functionality of patients with refractory EH.
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Affiliation(s)
- Carlos Benítez
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ana Muñoz
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jaime Poniachik
- Departamento de Gastroenterología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Felipe Ramírez
- Departamento de Gastroenterología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Claudia Muñoz
- Departamento de Gastroenterología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Tomás Cermenati
- Departamento de Radiología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Nicolás Martínez
- Departamento de Radiología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Pía Díaz
- Centro de Terapia Endovascular, Hospital Clínico UC Christus, Santiago, Chile
| | - Luis Meneses
- Departamento de Radiología, Pontificia Universidad Católica de Chile, Santiago, Chile
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Soto R, Díaz LA, Rivas V, Fuentes-López E, Zalaquett M, Bruera MJ, González C, Mezzano G, Benítez C. Frailty and reduced gait speed are independently related to mortality of cirrhotic patients in long-term follow-up. Ann Hepatol 2022; 25:100327. [PMID: 33596465 DOI: 10.1016/j.aohep.2021.100327] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Frailty is characterized by a poor restoration of homeostasis after a stressor event. Although it is not usually diagnosed, it has been associated with decreased survival in cirrhotic patients. We aimed to evaluate the impact of frailty and decreased gait speed over survival in cirrhotic patients at long-term follow-up. MATERIALS AND METHODS We included stable cirrhotic patients Child-Pugh B-C or MELD ≥12, ≥50 years old. We performed a clinical evaluation, anthropometry, and laboratory tests. Frailty was diagnosed using Fried Frailty Index. We evaluated survival at a 4-year follow-up. RESULTS We included 126 patients; mean age 64±8.3 years, median MELD-Na 15[12-17], median follow-up was 881 [349-1277] days. The main etiology was MAFLD (31.4%). Frailty was diagnosed in 65.1% of patients. There were no significant differences in baseline characteristics per frailty condition. Mortality was higher in frail patients than non-frail patients (68.2% versus 20.6% at 48 months, respectively; p-value <0.001). The mean gait speed in frail and non-frail patients was 0.86±0.3m/s and 1.16±0.2m/s, respectively (p-value <0.001). Interestingly, 26.9% of patients presented a reduced gait speed (≤0.8m/s). Patients with decreased gait speed also had higher mortality than patients with normal gait speed (79.9% versus 40.8%, respectively; p-value <0.001). A multivariate-adjusted model showed that decreased gait speed (HR=3.27, 95%CI:1.74-6.14; p<0.001) and frailty (HR=4.24, 95%CI:1.89-9.51; p<0.001) were associated with mortality. CONCLUSIONS Frailty is independently associated with decreased survival at long-term follow-up. Reduced gait speed is strongly associated with mortality and could be a surrogate marker of frailty in clinical practice.
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Affiliation(s)
- Rubén Soto
- Unidad de Medicina Interna, Universidad Finis Terrae, Santiago, Chile; Unidad de Geriatría, Fundación Arturo López Pérez, Santiago, Chile
| | - Luis Antonio Díaz
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Violeta Rivas
- Unidad de Gastroenterología, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Eduardo Fuentes-López
- Departamento de Ciencias de la Salud, Carrera de Fonoaudiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - María José Bruera
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia González
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gabriel Mezzano
- Sección de Gastroenterología, Hospital del Salvador, Santiago, Chile
| | - Carlos Benítez
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Arab JP, Dirchwolf M, Álvares-da-Silva MR, Barrera F, Benítez C, Castellanos-Fernandez M, Castro-Narro G, Chavez-Tapia N, Chiodi D, Cotrim H, Cusi K, de Oliveira CPMS, Díaz J, Fassio E, Gerona S, Girala M, Hernandez N, Marciano S, Masson W, Méndez-Sánchez N, Leite N, Lozano A, Padilla M, Panduro A, Paraná R, Parise E, Perez M, Poniachik J, Restrepo JC, Ruf A, Silva M, Tagle M, Tapias M, Torres K, Vilar-Gomez E, Costa Gil JE, Gadano A, Arrese M. Latin American Association for the study of the liver (ALEH) practice guidance for the diagnosis and treatment of non-alcoholic fatty liver disease. Ann Hepatol 2021; 19:674-690. [PMID: 33031970 DOI: 10.1016/j.aohep.2020.09.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) currently represents an epidemic worldwide. NAFLD is the most frequently diagnosed chronic liver disease, affecting 20-30% of the general population. Furthermore, its prevalence is predicted to increase exponentially in the next decades, concomitantly with the global epidemic of obesity, type 2 diabetes mellitus (T2DM), and sedentary lifestyle. NAFLD is a clinical syndrome that encompasses a wide spectrum of associated diseases and hepatic complications such as hepatocellular carcinoma (HCC). Moreover, this disease is believed to become the main indication for liver transplantation in the near future. Since NAFLD management represents a growing challenge for primary care physicians, the Asociación Latinoamericana para el Estudio del Hígado (ALEH) has decided to organize this Practice Guidance for the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease, written by Latin-American specialists in different clinical areas, and destined to general practitioners, internal medicine specialists, endocrinologists, diabetologists, gastroenterologists, and hepatologists. The main purpose of this document is to improve patient care and awareness of NAFLD. The information provided in this guidance may also be useful in assisting stakeholders in the decision-making process related to NAFLD. Since new evidence is constantly emerging on different aspects of the disease, updates to this guideline will be required in future.
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Affiliation(s)
- Juan Pablo Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Melisa Dirchwolf
- Unidad de Trasplante Hepático, Servicio de Hepatología, Hospital Privado de Rosario, Rosario, Argentina.
| | - Mário Reis Álvares-da-Silva
- Hepatology Division, Hospital de Clinicas de Porto Alegre, Brazil; School of Medicine, Universidade Federal do Rio Grande do Sul, Brazil; Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Francisco Barrera
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Carlos Benítez
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | | | - Graciela Castro-Narro
- Gastroenterology Department, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico.
| | | | - Daniela Chiodi
- Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
| | - Helma Cotrim
- School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil.
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA.
| | | | - Javier Díaz
- Departamento del Aparato Digestivo, Hospital Edgardo Rebagliati Martins, EsSalud, Lima, Peru.
| | - Eduardo Fassio
- Sección Hígado, Vías Biliares y Páncreas, Servicio de Gastroenterología, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Buenos Aires, Argentina.
| | - Solange Gerona
- Liver Unit, Hospital de Fuerzas Armadas, Montevideo, Uruguay.
| | | | - Nelia Hernandez
- Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
| | | | - Walter Masson
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | | | - Nathalie Leite
- School of Medicine, Internal Medicine Department and Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Adelina Lozano
- Unidad de Hígado, Servicio de Gastroenterología, Hospital Nacional Arzobispo Loayza, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru.
| | | | - Arturo Panduro
- Department of Molecular Biology in Medicine, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.
| | - Raymundo Paraná
- School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil.
| | - Edison Parise
- Department of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Marlene Perez
- Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic.
| | - Jaime Poniachik
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - Juan Carlos Restrepo
- Hepatobiliary and Liver Transplant Program, Hospital Pablo Tobon Uribe-Universidad de Antioquia, Medellín, Colombia; Grupo Gastrohepatologia, Facultad de Medicina, Universidad of Antioquía UdeA, Medellin, Colombia.
| | - Andrés Ruf
- Unidad de Trasplante Hepático, Servicio de Hepatología, Hospital Privado de Rosario, Rosario, Argentina.
| | - Marcelo Silva
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina.
| | - Martín Tagle
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Monica Tapias
- Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.
| | - Kenia Torres
- Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic.
| | - Eduardo Vilar-Gomez
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | | | - Adrian Gadano
- Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Marco Arrese
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Sampaio FC, Malheiros Z, Benítez C, Stewart B, Bönecker M. Dental Caries in Latin American and Caribbean countries: urgent need for a regional consensus. Braz Oral Res 2021; 35:e057. [PMID: 34076081 DOI: 10.1590/1807-3107bor-2021.vol35.0057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Fabio Correia Sampaio
- Universidade Federal da Paraíba - UFPB, Health Science Center, Department of Clinical and Community Dentistry, João Pessoa, PB, Brazil
| | - Zilson Malheiros
- Colgate Palmolive Company, Colgate Technology Center, Piscataway, NJ, USA.,Latin American Oral Health Association, LAOHA, São Paulo, SP, Brazil
| | - Carlos Benítez
- Latin American Oral Health Association, LAOHA, São Paulo, SP, Brazil
| | - Bernal Stewart
- Colgate Palmolive Company, Colgate Technology Center, Piscataway, NJ, USA.,Latin American Oral Health Association, LAOHA, São Paulo, SP, Brazil
| | - Marcelo Bönecker
- Latin American Oral Health Association, LAOHA, São Paulo, SP, Brazil.,Universidade de São Paulo - USP, School of Dentistry, Department of Pediatric Dentistry, São Paulo, SP, Brazil
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7
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Muñoz-Martínez S, Sapena V, Forner A, Nault JC, Sapisochin G, Rimassa L, Sangro B, Bruix J, Sanduzzi-Zamparelli M, Hołówko W, El Kassas M, Mocan T, Bouattour M, Merle P, Hoogwater FJH, Alqahtani SA, Reeves HL, Pinato DJ, Giorgakis E, Meyer T, Villadsen GE, Wege H, Salati M, Mínguez B, Di Costanzo GG, Roderburg C, Tacke F, Varela M, Galle PR, Alvares-da-Silva MR, Trojan J, Bridgewater J, Cabibbo G, Toso C, Lachenmayer A, Casadei-Gardini A, Toyoda H, Lüdde T, Villani R, Matilla Peña AM, Guedes Leal CR, Ronzoni M, Delgado M, Perelló C, Pascual S, Lledó JL, Argemi J, Basu B, da Fonseca L, Acevedo J, Siebenhüner AR, Braconi C, Meyers BM, Granito A, Sala M, Rodríguez-Lope C, Blaise L, Romero-Gómez M, Piñero F, Gomez D, Mello V, Pinheiro Alves RC, França A, Branco F, Brandi G, Pereira G, Coll S, Guarino M, Benítez C, Anders MM, Bandi JC, Vergara M, Calvo M, Peck-Radosavljevic M, García-Juárez I, Cardinale V, Lozano M, Gambato M, Okolicsanyi S, Morales-Arraez D, Elvevi A, Muñoz AE, Lué A, Iavarone M, Reig M. Assessing the impact of COVID-19 on liver cancer management (CERO-19). JHEP Rep 2021; 3:100260. [PMID: 33644725 PMCID: PMC7901294 DOI: 10.1016/j.jhepr.2021.100260] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 02/06/2023] Open
Abstract
Background & Aims The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). Herein, we evaluated whether the schedule of LC screening or procedures has been interrupted or delayed because of the COVID-19 pandemic. Methods An international survey evaluated the impact of the COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international, and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave. Results Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia, and Africa (73.7%, 17.1%, 5.3%, 2.6%, and 1.3% per continent, respectively). Eighty-seven percent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening programme, 50% cancelled curative and/or palliative treatments for LC, and 41.7% modified the liver transplantation programme. Forty-five out of 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service before the COVID-19 pandemic (n = 19/37). Conclusions The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with liver cancer. Modifications in screening, diagnostic, and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision-making. Lay summary The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems globally. Herein, we assessed the impact of the first wave pandemic on patients with liver cancer and found that routine care for these patients has been majorly disrupted, which could have a significant impact on outcomes.
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Affiliation(s)
- Sergio Muñoz-Martínez
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Victor Sapena
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Alejandro Forner
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Jean-Charles Nault
- Service d'hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris, France.,Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
| | - Gonzalo Sapisochin
- Abdominal Transplant & HPB Surgical Oncology, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Bruno Sangro
- Unidad de Hepatología, Clínica Universidad de Navarra, IDISNA, CIBERehd, Pamplona, Spain
| | - Jordi Bruix
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Marco Sanduzzi-Zamparelli
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Mohamed El Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Tudor Mocan
- 3rd Medical Department, 'Octavian Fodor' Institute for Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Mohamed Bouattour
- AP-HP, Hôpital Beaujon, Department of Digestive Oncology, Clichy, France
| | - Philippe Merle
- Department of Hepatology, Groupement Hospitalier Lyon Nord, Lyon, France
| | - Frederik J H Hoogwater
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, the Netherlands
| | - Saleh A Alqahtani
- Department of Liver Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Helen L Reeves
- Liver Unit, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Emmanouil Giorgakis
- Division of Transplantation, Department of Surgery, UAMS Medical Center, Winthrop P. Rockefeller Cancer Institute, Little Rock, AK, USA
| | - Tim Meyer
- Department of Oncology, Royal Free Hospital, London, UK
| | | | - Henning Wege
- Department of Internal Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Massimiliano Salati
- Department of Clinical and Experimental Medicine, University Hospital of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Beatriz Mínguez
- Liver Unit, Hospital Universitari Vall d'Hebron, Liver Diseases Research Group, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus. Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Christoph Roderburg
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany
| | - María Varela
- Department of Gastroenterology and Hepatology. Hospital Universitario Central de Asturias, IUOPA, ISPA, Universidad de Oviedo, Oviedo, Spain
| | - Peter R Galle
- I. Department of Internal Medicine, University Medical Center Mainz, Mainz, Germany
| | - Mario Reis Alvares-da-Silva
- GI/Liver Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jörg Trojan
- Medical Clinic 1, Goethe University Hospital, Frankfurt, Germany
| | - John Bridgewater
- Department of Oncology, University College of London, London, UK
| | - Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Palermo, Italy
| | - Christian Toso
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Anja Lachenmayer
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Tom Lüdde
- Clinic for Gastroenterology, Hepatology and Infectious Disease, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Rosanna Villani
- Liver Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | | | | | - Monica Ronzoni
- Medical Oncology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Manuel Delgado
- Department of Digestive Disease, University Hospital La Coruña, La Coruña, Spain
| | - Christie Perelló
- Department of Gastroenterology and Hepatology, University Hospital Puerta de Hierro, Majadahonda, Spain
| | | | - José Luis Lledó
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Josepmaria Argemi
- Internal Medicine - Liver Unit, Clinica Universidad de Navarra, Pamplona, Spain
| | - Bristi Basu
- Department of Oncology, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Leonardo da Fonseca
- Department of Clinical Oncology, Sao Paulo Clinicas Liver Cancer group, Insitituto do Cancer do Estado de São Paulo, University of São Paulo, San Paulo, Brazil
| | - Juan Acevedo
- South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Alexander R Siebenhüner
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Chiara Braconi
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | - Brandon M Meyers
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Alessandro Granito
- Division of Internal Medicine, Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Margarita Sala
- Department of Gastroenterology, Hepatology Unit, Hospital Doctor Josep Trueta, CIBERehd, Girona, Spain
| | - Carlos Rodríguez-Lope
- Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Lorraine Blaise
- Service d'hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris, France.,Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
| | - Manuel Romero-Gómez
- SeLiver group, UGC de Enfermedades Digestivas, Instituto de Biomedicina de Sevilla, Hospital Virgen del Rocío, CIBERehd, Seville, Spain
| | - Federico Piñero
- Liver Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Dhanny Gomez
- HPB Surgery and Hepatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Alex França
- Department of Medicine, Federal University of Sergipe, Aracaju, Brazil
| | | | - Giovanni Brandi
- Division of Oncology - Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gustavo Pereira
- Gastroenterology and Hepatology Unit, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Susanna Coll
- Hepatology Section, Gastroenterology Department, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Maria Guarino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Carlos Benítez
- Department of Gastroenterology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Juan C Bandi
- Department of Hepatology, Hospital Italiano, Buenos Aires, Argentina
| | - Mercedes Vergara
- Unitat d'Hepatologia, Servei d'Aparell Digestiu, Parc Taulí Sabadell Hospital Universitari, Institut d'Investigació i Innovació I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBERehd, Instituto Carlos III, Madrid, Spain
| | - Mariona Calvo
- Oncología Médica, Institut Català d'Oncologia, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Markus Peck-Radosavljevic
- Innere Medizin & Gastroenterologie, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
| | - Ignacio García-Juárez
- Gastroenterology Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy
| | - Mar Lozano
- Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Martina Gambato
- Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.,Multivisceral Transplant Unit, Gastroenterology, Padua University Hospital, Padua, Italy
| | - Stefano Okolicsanyi
- Department of Surgical Disciplines, Gastroenterology and Digestive Endoscopy, Umberto Parini Hospital, Aosta, Italy
| | - Dalia Morales-Arraez
- Department of Gastroenterology and Hepatology, Hospital Universitario de Canarias, La Laguna, Spain
| | - Alessandra Elvevi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, San Gerardo Hospital University of Milano-Bicocca School of Medicine, Monza, Italy
| | - Alberto E Muñoz
- Sección Hepatología, Hospital Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Alberto Lué
- Gastroenterology, Hepatology and Nutrition Unit, San Jorge General Hospital, Huesca, Spain
| | - Massimo Iavarone
- Foundation IRCCS Ca' Granada Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC 'A.M. and A. Migliavacca' Center for Liver Disease, Milan, Italy
| | - Maria Reig
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
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8
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Jofré P, Grassi B, Benítez C. [Management of chylous ascites and chylothorax. Report of one case]. Rev Med Chil 2021; 148:1202-1206. [PMID: 33399787 DOI: 10.4067/s0034-98872020000801202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 08/10/2020] [Indexed: 11/17/2022]
Abstract
Chylous Ascites (CA) and chylothorax (CTx) are associated with obstruction, disruption or insufficiency of the lymphatic system. We report a 68-year-old male, with a history of alcoholic cirrhosis, who had recurrent events of CTx and CA. After a complete study, no other etiologies other than portal hypertension were found. Therapy with diuretics, nothing per mouth, parenteral feeding plus octreotide did not relieve symptoms. A transjugular intrahepatic portosystemic shunt (TIPS) was successfully placed and pleural effusion subsided. This case shows that CA and CTx can be caused by portal hypertension and they may subside employing a multimodal management strategy.
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Affiliation(s)
- Paulina Jofré
- Departamento de Nutrición, Diabetes y Metabolismo, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bruno Grassi
- Departamento de Nutrición, Diabetes y Metabolismo, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Benítez
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
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9
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Kulkarni AV, Arab JP, Premkumar M, Benítez C, Tirumalige Ravikumar S, Kumar P, Sharma M, Reddy DN, Simonetto DA, Rao PN. Terlipressin has stood the test of time: Clinical overview in 2020 and future perspectives. Liver Int 2020; 40:2888-2905. [PMID: 33065772 DOI: 10.1111/liv.14703] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 02/13/2023]
Abstract
Vasoactive drugs form the mainstay of therapy for two of the most important complications of liver disease: hepatorenal syndrome (HRS) and acute variceal bleed (AVB). With cumulative evidence supporting the use in cirrhosis, terlipressin has been recommended for the management of HRS and AVB. However, owing to the safety concerns, terlipressin was not approved by food and drug administration (FDA) until now. In this review, we discuss the pharmacology and the major practice-changing studies on the safety and efficacy of terlipressin in patients with cirrhosis particularly focusing on existing indications like AVB and HRS and reviewing new data on the expanding indications in liver disease. The references for this review were identified from PUBMED with MeSH terms such as "terlipressin," "hepatorenal syndrome," "varices, esophagal and gastric," "ascites" and "cirrhosis." Terlipressin, a synthetic analogue of vasopressin, was introduced in 1975 to overcome the adverse effects of vasopressin. Terlipressin is an effective drug for HRS reversal in patients with liver cirrhosis and acute-on-chronic liver failure. There is documented mortality benefit with terlipressin therapy in HRS and AVB. Adverse effects are common with terlipressin and need to be monitored strictly. There is some evidence to support the use of this drug in refractory ascites, hepatic hydrothorax, paracentesis-induced circulatory dysfunction and perioperatively during liver transplantation. However, terlipressin is not yet recommended for such indications. In conclusion, terlipressin has stood the test of time with expanding indications and clear prerequisites for clinical use. Our review warrants a fresh perspective on the efficacy and safety of terlipressin.
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Affiliation(s)
- Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Juan Pablo Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Carlos Benítez
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Pramod Kumar
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mithun Sharma
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Douglas A Simonetto
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Padaki Nagaraja Rao
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
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10
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Benítez C, Inzunza M, Dib M, Garrido M, Martínez JA. Reply. Liver Transpl 2020; 26:1375. [PMID: 32686336 DOI: 10.1002/lt.25849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Carlos Benítez
- Liver Transplant Program UC-CHRISTUS Health Hospital, Pontificia Universidad Católica de Chile, Santiago, Chile.,Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martin Inzunza
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martin Dib
- Liver Transplant Program UC-CHRISTUS Health Hospital, Pontificia Universidad Católica de Chile, Santiago, Chile.,Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcelo Garrido
- Department of Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge A Martínez
- Liver Transplant Program UC-CHRISTUS Health Hospital, Pontificia Universidad Católica de Chile, Santiago, Chile.,Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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11
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Abstract
Acute liver failure (ALF) is a severe condition secondary to a myriad of causes associated with poor outcomes. The prompt diagnosis and identification of the aetiology allow the administration of specific treatments plus supportive strategies and to define the overall prognosis, the probability of developing complications and the need for liver transplantation. Pivotal issues are adequate monitoring and the institution of prophylactic strategies to reduce the risk of complications, such as progressive liver failure, cerebral oedema, renal failure, coagulopathies or infections. In this article, we review the main aspects of ALF, including the definition, diagnosis and complications. Also, we describe the standard-of-care strategies and recent advances in the treatment of ALF. Finally, we include our experience of care patients with ALF.
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Affiliation(s)
- Maximiliano Rovegno
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Magdalena Vera
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Alex Ruiz
- Unidad de Gastroenterología, Instituto de Medicina, Escuela de Medicina, Universidad Austral de Chile, Chile
| | - Carlos Benítez
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile.
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12
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Benítez C, Inzunza M, Riveros S, Rivas V, Garrido M, Dib M, Barrera F, Arab JP, Torres J, Cortinez LI, Briceño E, Guerra JF, Fernandes E, Martínez JA. Living Donor Liver Transplantation for Imatinib-Resistant Gastrointestinal Stromal Tumor Liver Metastases: A New Therapeutic Option in Transplant Oncology. Liver Transpl 2020; 26:945-948. [PMID: 32246733 DOI: 10.1002/lt.25769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/27/2020] [Accepted: 03/13/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Carlos Benítez
- Liver Transplant Program, UC-CHRISTUS Health Hospital, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.,Department of Gastroenterology, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Martin Inzunza
- Department of Digestive Surgery, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Sergio Riveros
- Department of Digestive Surgery, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Violeta Rivas
- Liver Transplant Program, UC-CHRISTUS Health Hospital, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Marcelo Garrido
- Department of Oncology, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Martin Dib
- Liver Transplant Program, UC-CHRISTUS Health Hospital, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.,Department of Digestive Surgery, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Francisco Barrera
- Liver Transplant Program, UC-CHRISTUS Health Hospital, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.,Department of Gastroenterology, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Juan P Arab
- Liver Transplant Program, UC-CHRISTUS Health Hospital, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.,Department of Gastroenterology, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Javiera Torres
- Department of Pathology, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Luis I Cortinez
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Briceño
- Liver Transplant Program, UC-CHRISTUS Health Hospital, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.,Department of Digestive Surgery, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Juan F Guerra
- Liver Transplant Program, UC-CHRISTUS Health Hospital, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.,Department of Digestive Surgery, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.,MedStar Georgetown Transplant Institute, Washington, DC
| | - Eduardo Fernandes
- Transplant Unit, School of Medicine, Adventista Silvestre Cosme Velho Hospital, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Jorge A Martínez
- Liver Transplant Program, UC-CHRISTUS Health Hospital, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.,Department of Digestive Surgery, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
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13
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Gaete MI, Díaz LA, Arenas A, González K, Cattaneo M, Fuster F, Henríquez R, Soza A, Arrese M, Barrera F, Arab JP, Benítez C. Baveno VI and Expanded Baveno VI criteria successfully predicts the absence of high-risk gastro-oesophageal varices in a Chilean cohort. Liver Int 2020; 40:1427-1434. [PMID: 31916360 DOI: 10.1111/liv.14373] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/02/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Baveno VI and expanded Baveno VI criteria have been recommended to circumvent the need for endoscopy screening in patients with a very low probability of varices needing treatment (VNT). AIM To validate these criteria in a Latin American population. METHODS The ability of Baveno VI criteria (liver stiffness measurement (LSM) <20 kPa and platelet count >150 × 103/μL) and expanded Baveno VI criteria (LSM < 25kPa and platelet count >110 × 103/μL) to exclude the presence of VNT was tested in a prospectively recruited cohort of patients with Child-Pugh A liver cirrhosis and with no previous variceal haemorrhage who attended the liver clinics of three major hospitals in Chile. RESULTS Three hundred patients were included. The median (IQR) age was 61 [18-86] years, median MELD was 8.0 (6-17), median LSM was 17.2 (10.2-77) kPa and median platelet count was 137 (23-464) × 103 /μL. The main aetiology was non-alcoholic fatty liver disease (67.3%). VNT were present in 18% of patients. The Baveno VI criteria had a sensitivity of 98.1% and a specificity of 38.2%, potentially sparing 31.3% of upper endoscopies with a very low risk of missing VNT (1.1%). The expanded Baveno VI criteria had a sensitivity of 90.7% and a specificity of 61%, potentially sparing 51.3% of upper endoscopies with a risk of missing VNT of 3.6%. Both criteria were independently associated with the absence of VNT. CONCLUSION We validated the Baveno VI and expanded Baveno VI criteria in Chilean population, potentially sparing 31.3% and 51.3% of endoscopies, respectively, with a very low risk of missing VNT. Fondecyt 1191183.
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Affiliation(s)
- María I Gaete
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis A Díaz
- Department of Gastroenterology, Faculty of medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alex Arenas
- Department of Gastroenterology, Faculty of medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Digestive Diseases Unit, Hospital Sótero del Río, Santiago, Chile
| | - Katherine González
- Department of Gastroenterology, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Máximo Cattaneo
- Department of Gastroenterology, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Francisco Fuster
- Digestive diseases unit, Hospital Dr. Gustavo Fricke, Viña del Mar, Chile
| | - Romina Henríquez
- Department of Gastroenterology, Faculty of medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandro Soza
- Department of Gastroenterology, Faculty of medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marco Arrese
- Department of Gastroenterology, Faculty of medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Barrera
- Department of Gastroenterology, Faculty of medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan P Arab
- Department of Gastroenterology, Faculty of medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Benítez
- Department of Gastroenterology, Faculty of medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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14
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Martínez JA, Pacheco S, Bachler JP, Jarufe N, Briceño E, Guerra JF, Benítez C, Wolff R, Barrera F, Arrese M. Accuracy of the BAR score in the prediction of survival after liver transplantation. Ann Hepatol 2020; 18:386-392. [PMID: 31036493 DOI: 10.1016/j.aohep.2019.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/21/2018] [Accepted: 01/23/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM The Balance of Risk (BAR) Score, a simple scoring system that combines six independent donor and recipient variables to predict outcome after liver transplantation (LT), was validated in a large U.S./European cohort of patients. This study aims to assess the performance of the BAR score to predict survival after liver transplantation and determine the factors associated with short and long-term survival in Latin-American patients. MATERIAL AND METHODS A retrospective cohort study was performed in 194 patients [112 (55.4%) males; mean age 52±14 years] who underwent 202 LT during the period 2003-2015. Demographic, clinical, pathological and surgical variables, as well as mortality and survival rates, were analyzed. The BAR score was investigated through a receiver operating characteristics (ROC) curve with the calculation of the area under the curve (AUC) to evaluate the predictive score power for 3-month, 1 and 5-year mortality in a matched donor-recipient cohort. Youden index was calculated to identify optimal cutoff points. RESULTS The AUC of BAR score in predicting 3-month, 1-year and 5-year mortality were 0.755 (CI95% 0.689-0.812), 0.702 (CI95% 0.634-0.764) and 0.610 (CI95% 0.539-0.678) respectively. The best cut-off point was a BAR score ≥15 points. In the multivariate analysis BAR score <15 was associated with higher survival rates at 3 months and 1 and 5-years. CONCLUSIONS BAR score <15 points is an independent predictor of better short and long-term survival in Latin-American patients undergoing LT. The BAR scoring system has an adequate diagnostic capacity allowing to predict 3 and 12-month mortality.
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Affiliation(s)
- Jorge A Martínez
- Department of Digestive Surgery & Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile.
| | - Sergio Pacheco
- Department of Digestive Surgery & Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Jean P Bachler
- Department of Digestive Surgery & Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Nicolás Jarufe
- Department of Digestive Surgery & Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Eduardo Briceño
- Department of Digestive Surgery & Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Juan F Guerra
- Department of Digestive Surgery & Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Carlos Benítez
- Department of Digestive Surgery & Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Rodrigo Wolff
- Department of Digestive Surgery & Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Francisco Barrera
- Department of Digestive Surgery & Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Marco Arrese
- Department of Digestive Surgery & Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
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15
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Guerra JF, Quezada JL, Cancino A, Arrese M, Wolff R, Benítez C, Pattillo JC, Gana JC, Concha M, Cortínez L, Vera M, Miranda P, Rubilar F, Troncoso A, Briceño E, Dib M, Jarufe N, Martínez J. [Liver transplantation: development, learning curve and results after the first 300 cases]. Rev Med Chil 2019; 147:955-964. [PMID: 31859959 DOI: 10.4067/s0034-98872019000800955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/05/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Liver transplantation (LT) is an option for people with liver failure who cannot be cured with other therapies and for some people with liver cancer. AIM To describe, and analyze the first 300 LT clinical results, and to establish our learning curve. MATERIAL AND METHODS Retrospective cohort study with data obtained from a prospectively collected LT Program database. We included all LT performed at a single center from March 1994 to September 2017. The database gathered demographics, diagnosis, indications for LT, surgical aspects and postoperative courses. We constructed a cumulative summation test for learning curve (LC-CUSUM) using 30-day post-LT mortality. Mortality at 30 days, and actuarial 1-, and 5-year survival rate were analyzed. RESULTS A total of 281 patients aged 54 (0-71) years (129 women) underwent 300 LT. Ten percent of patients were younger than 18 years old. The first, second and third indications for LT were non-alcoholic steatohepatitis, chronic autoimmune hepatitis and alcoholic liver cirrhosis, respectively. Acute liver failure was the LT indication in 51 cases (17%). The overall complication rate was 71%. Infectious and biliary complications were the most common of them (47 and 31% respectively). The LC-CUSUM curve shows that the first 30 patients corresponded to the learning curve. The peri-operative mortality was 8%. Actuarial 1 and 5-year survival rates were 82 and 71.4%, respectively. CONCLUSIONS Outcome improvement of a LT program depends on the accumulation of experience after the first 30 transplants and the peri-operative mortality directly impacted long-term survival.
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Affiliation(s)
| | - José Luis Quezada
- Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Marco Arrese
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Wolff
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Benítez
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Mario Concha
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Cortínez
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Magdalena Vera
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Miranda
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Andres Troncoso
- Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Martín Dib
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Jarufe
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Martínez
- Pontificia Universidad Católica de Chile, Santiago, Chile
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16
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Benítez C, Zúñiga P, Kramer F, Valladares X, Rojas P, Pimentel E, Gómez F, Cancino A, Briceño E, Guerra JF, Martínez J. [Liver transplantation in hemophilia A. Report of one case]. Rev Med Chil 2019; 147:378-383. [PMID: 31344177 DOI: 10.4067/s0034-98872019000300378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 03/04/2019] [Indexed: 11/17/2022]
Abstract
Due to blood derivative requirements, many patients with hemophilia were exposed to Hepatitis C virus infection (HCV) before the availability of HCV testing. We report a 46-year-old male with Hemophilia A with a hepatitis virus C infection since 2004 causing a cirrhosis. Due to a hepatopulmonary syndrome, he received a liver allograph using a factor VIII replacement protocol, after eradicating the virus C. He had a good postoperative evolution, and no more factor VIII was required after transplantation until his last assessment.
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Affiliation(s)
- Carlos Benítez
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pamela Zúñiga
- Departamento de Hematología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Kramer
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Patricio Rojas
- Departamento de Hematología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Pimentel
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Gómez
- Sección de Gastroenterología, Hospital del Salvador, Santiago, Chile
| | | | - Eduardo Briceño
- Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Francisco Guerra
- Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Martínez
- Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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17
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Serrano CA, Ling SC, Verdaguer S, León M, Jarufe N, Guerra JF, Pattillo JC, Benítez C, Villagrán A, Torres J, Concha M, Villarroel L, Dellepiane P, Domínguez P, Martínez J, Gana JC. Portal Angiogenesis in Chronic Liver Disease Patients Correlates with Portal Pressure and Collateral Formation. Dig Dis 2019; 37:498-508. [PMID: 31067534 DOI: 10.1159/000500115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/03/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND/AIMS One hallmark of chronic liver disease in patients with portal hypertension is the formation of portal-systemic collaterals in which angiogenesis has a fundamental role. We studied patients with chronic liver disease undergoing liver transplantation to correlate levels of circulating angiogenic factors in portal and peripheral circulation with portal pressure and portal-systemic collaterals. METHODS Sixteen patients who underwent liver transplantation were enrolled. During transplant surgery, we determined portal venous pressure and portal-systemic collateral formation. We determined angiogenics mediator levels in systemic and portal plasma. Peripheral plasma from healthy donors was measured as controls. RESULTS Vascular endothelial growth factor (VEGF)-R1 and 2, Ang-1 and 2, Tie2, FGF- 1 and 2, CD163, PDGFR-β, PDGFsRα, PDGF-AB and BB, CD163, TGF-β VASH-1 levels were significantly different in the controls in comparison to cases. Significantly decreased portal venous levels of Ang-1, FGF-1, PDGF-AB/BB, and CC were observed in patients with higher portal pressure. Peripheral VEGF, Ang-1, pPDGF-AB, BB, and CC were significantly decreased in patients with more severe collateral formation. While peripheral VEGF-R1 was higher in patients with severe collateral formation. For portal circulation, VEGF, Ang-1, -pPDGF-AB, BB, and CC were significantly decreased in patients with more severe collateral formation Conclusions: Angiogenesis factors correlated with portal pressure and collateral formation and different patterns of circulating angiogenesis mediators were found in peripheral and portal blood of patients with chronic liver disease. These results support the importance of angiogenic pathways in cirrhosis and portal hypertension and highlight areas for further study to identify clinically useful noninvasive markers of portal pressure and collateral formation.
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Affiliation(s)
- Carolina A Serrano
- Department of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Simon C Ling
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sofia Verdaguer
- Department of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Miguel León
- Department of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Jarufe
- Digestive Surgery Department, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Francisco Guerra
- Digestive Surgery Department, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Carlos Pattillo
- Pediatric Surgery Section, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Benítez
- Department of Gastroenterology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrea Villagrán
- Department of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Torres
- Pathology Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mario Concha
- Anesthesiology Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paulina Dellepiane
- Department of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pilar Domínguez
- Digestive Surgery Department, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Martínez
- Digestive Surgery Department, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Cristóbal Gana
- Department of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile,
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18
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Guerra JF, Troncoso A, Ceballos ME, Arrese M, Barrera F, Norero B, Soza A, Rivas V, Wolff R, Arias A, Cancino A, Torres J, Briceño E, Jarufe N, Martínez J, Benítez C. [Liver transplantation in a patient with human immunodeficiency virus (HIV). Case report]. Rev Med Chil 2019; 146:1215-1219. [PMID: 30724988 DOI: 10.4067/s0034-98872018001001215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 09/14/2018] [Indexed: 11/17/2022]
Abstract
Abstrac: Before the advent of highly active antiretroviral therapy (HAART), patients infected with human immunodeficiency virus (HIV) were considered as having an absolute contraindication for liver transplantation (LT). Considering the increased life expectancy in HIV positive patients under HAART and the improvements in the management of graft recipients, these patients are now suitable for carrying out transplants in selected cases. We report a 26 years old HIV positive male who developed acute liver failure possibly caused by drug induced liver injury who underwent a successful liver transplantation.
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Affiliation(s)
- Juan Francisco Guerra
- Programa Trasplante Hepático, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Troncoso
- Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Elena Ceballos
- Departamento de Enfermedades Infecciosas del Adulto, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marco Arrese
- Programa Trasplante Hepático, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Barrera
- Programa Trasplante Hepático, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Blanca Norero
- Programa Trasplante Hepático, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandro Soza
- Programa Trasplante Hepático, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Violeta Rivas
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Wolff
- Programa Trasplante Hepático, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Arias
- Programa Trasplante Hepático, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Cancino
- Programa Trasplante Hepático, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Torres
- Departamento de Anatomía Patológica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Briceño
- Programa Trasplante Hepático, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Jarufe
- Programa Trasplante Hepático, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Martínez
- Programa Trasplante Hepático, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Benítez
- Programa Trasplante Hepático, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile
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19
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Benítez C, Wolff R. Current Status and Future Challenges of Liver Transplantation Programs in Chile. Liver Transpl 2018; 24:1757-1761. [PMID: 30194815 DOI: 10.1002/lt.25332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/31/2018] [Accepted: 09/04/2018] [Indexed: 12/12/2022]
Abstract
Liver transplantation (LT) was performed for the first time in Chile in 1969, but only since the 1990s has it been systematically performed. Our health system is strongly centralized, which is a severe limitation for the patients who need to be evaluated and subsequently listed. Although proper human and technological resources are available and our results are comparable to international outcomes (overall patient survival at 1, 5, and 10 years of 82%, 70%, and 64%, respectively), we are limited because of a severe scarcity of grafts, which translates into an availability of approximately 7 organs per million persons and a wait-list dropout rate of 40% every year. Thus, our main challenge for the next few years is to improve access to LT among the populations from the extreme regions of the country and overall to improve the availability of grafts by increasing the awareness of physicians in intensive care units and emergency departments, to develop living donor LT programs, to educate the population in order to decrease family refusal, and to reinforce the system of potential donor detection. Although hard work is mandatory for these improvements, none of these tasks seem to be unreachable in the midterm.
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Affiliation(s)
- Carlos Benítez
- Department of Gastroenterology and Liver Transplant Unit, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Wolff
- Department of Gastroenterology and Liver Transplant Unit, Pontificia Universidad Católica de Chile, Santiago, Chile
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20
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Affiliation(s)
| | - Sara Maquilón
- Corporación Nacional de Fomento de Trasplante, Chile
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21
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Arenas A, Urzúa Á, Poniachik J, Carlos Diaz J, Castillo J, Saure A, Lembach H, Cancino A, Ibarra J, Besa C, Wolff R, Arrese M, Benítez C. Reversibility of Acquired Hepatocerebral Degeneration After Liver Transplantation. Liver Transpl 2018; 24:1133-1137. [PMID: 30142251 DOI: 10.1002/lt.25211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/22/2016] [Accepted: 10/31/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Alex Arenas
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Álvaro Urzúa
- Departamento de Medicina Interna, Sección de Gastroenterología
| | - Jaime Poniachik
- Departamento de Medicina Interna, Sección de Gastroenterología.,Unidad de Trasplante Hepático, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Juan Carlos Diaz
- Cirugía, Hospital Clínico Universidad de Chile, Santiago, Chile.,Unidad de Trasplante Hepático, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Jaime Castillo
- Cirugía, Hospital Clínico Universidad de Chile, Santiago, Chile.,Unidad de Trasplante Hepático, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Alexandre Saure
- Cirugía, Hospital Clínico Universidad de Chile, Santiago, Chile.,Unidad de Trasplante Hepático, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Hans Lembach
- Cirugía, Hospital Clínico Universidad de Chile, Santiago, Chile.,Unidad de Trasplante Hepático, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Alejandra Cancino
- Unidad de Trasplante Hepático, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - José Ibarra
- Unidad de Trasplante Hepático, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Cecilia Besa
- Radiología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Wolff
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile.,Unidad de Trasplante Hepático, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marco Arrese
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile.,Unidad de Trasplante Hepático, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Benítez
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile.,Unidad de Trasplante Hepático, Pontificia Universidad Católica de Chile, Santiago, Chile
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22
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Candia R, Norero B, Agüero C, Díaz L, Ortega JP, Wolff R, Hernández-Rocha C, Duarte I, Soza A, Benítez C, Arrese M. Validation of the Simplified Criteria for the Diagnosis of Autoimmune Hepatitis in Chilean-Hispanic Patients. Ann Hepatol 2018; 16:772-779. [PMID: 28809732 DOI: 10.5604/01.3001.0010.2787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM In 2008 the International autoimmune hepatitis (AIH) Group proposed the simplified diagnostic criteria for this disease. The original cohort study was performed in 11 international centers, but validation studies are scarce in Latin-America. The aim of this study is validate these criteria in Hispanic patients. MATERIAL AND METHODS A retrospective cohort of patients undergoing percutaneous liver biopsy and follow-up of at least 12 months was recruited from a Chilean University hospital. Patients with previous immunosuppressive therapy and liver transplant recipients were excluded. The diagnostic accuracy was analyzed using as gold standard the clinical course during long-term follow-up. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) and area under the ROC curve (AUROC) were calculated. RESULTS Four hundred eighty one patients were evaluated, 294 were included. 218 (74.15%) were female, mean age 48.5 (± 12.3) years, mean follow-up 34 (± 18) months. 66 patients had AIH or overlap syndrome (22.45%), 96 (32.65%) non-alcoholic steatohepatitis, 40 (13.61%) primary biliary cholangitis, 31 (10.54%) hepatitis C, 8 (2.72%) hepatitis B, 53 (18.02%) other etiologies. The AUROC for AIH simplified criteria was 0.976. Using a cutoff ≥ 6 and ≥ 7 points, the sensitivity was 86.4% and 54.6%; specificity, 98.7% and 99.6%; PPV, 95% and 97.3%; and NPV, 96.2% and 88.6%, respectively. CONCLUSION Simplified criteria for the diagnosis of AIH have a high accuracy in our Chilean-Hispanic cohort. The female gender is strongly associated to AIH and could help in difficult cases. Further studies with a prospective design are necessary to confirm these observations.
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Affiliation(s)
- Roberto Candia
- Pontificia Universidad Católica de Chile. Santiago, Chile Departamento de Gastroenterología, Facultad de Medicina
| | - Blanca Norero
- Pontificia Universidad Católica de Chile. Santiago, Chile Departamento de Gastroenterología, Facultad de Medicina
| | - Carlos Agüero
- Pontificia Universidad Católica de Chile. Santiago, Chile Departamento de Gastroenterología, Facultad de Medicina
| | - Luis Díaz
- Pontificia Universidad Católica de Chile. Santiago, Chile Departamento de Gastroenterología, Facultad de Medicina
| | - Juan Pablo Ortega
- Pontificia Universidad Católica de Chile. Santiago, Chile Departamento de Gastroenterología, Facultad de Medicina
| | - Rodrigo Wolff
- Pontificia Universidad Católica de Chile. Santiago, Chile Departamento de Anatomía Patológica, Facultad de Medicina
| | - Cristian Hernández-Rocha
- Pontificia Universidad Católica de Chile. Santiago, Chile Departamento de Gastroenterología, Facultad de Medicina
| | - Ignacio Duarte
- Pontificia Universidad Católica de Chile. Santiago, Chile Departamento de Anatomía Patológica, Facultad de Medicina
| | - Alejandro Soza
- Pontificia Universidad Católica de Chile. Santiago, Chile Departamento de Gastroenterología, Facultad de Medicina
| | - Carlos Benítez
- Pontificia Universidad Católica de Chile. Santiago, Chile Departamento de Gastroenterología, Facultad de Medicina
| | - Marco Arrese
- Department of Gastroenterology. Faculty of Medicine. Pontificia Universidad Católica de Chile
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23
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Ahumada V, Tejos R, Moraga F, Achurra P, Godoy I, Loyola S, Torres J, Kolbach M, Benítez C, Guerra JF, Jarufe N, Martínez J. [Liver transplant as treatment for cardiac failure secondary to hereditary hemorrhagic telangiectasia. Report of one case]. Rev Med Chil 2017; 145:799-803. [PMID: 29171631 DOI: 10.4067/s0034-98872017000600799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 05/22/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Vanessa Ahumada
- División de Cirugía, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Tejos
- División de Cirugía, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Moraga
- División de Cirugía, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Iván Godoy
- División de Enfermedades Cardiovasculares, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Soledad Loyola
- Departamento de Radiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Torres
- Departamento de Anatomía Patológica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marianne Kolbach
- Departamento de Dermatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Benítez
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Francisco Guerra
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Jarufe
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Martínez
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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24
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Benítez C, Vargas JI, Solari S. Letter: sublingual dosing of tacrolimus in transplant patients-interesting concept to overcome first pass effects. Authors' reply. Aliment Pharmacol Ther 2017; 46:80. [PMID: 28589580 DOI: 10.1111/apt.14103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/08/2022]
Affiliation(s)
- C Benítez
- Gastroenterology Department, Facultad De Medicina, Hospital Clinico, Pontificia Universidad Catolica De Chile, Santiago, Chile.,Liver Transplant Unit, Hospital Clinico, Pontificia Universidad Catolica De Chile, Santiago, Chile
| | - J I Vargas
- Gastroenterology Department, Facultad De Medicina, Hospital Clinico, Pontificia Universidad Catolica De Chile, Santiago, Chile
| | - S Solari
- Clinic Laboratory Department, Hospital Clinico, Pontificia Universidad Catolica De Chile, Santiago, Chile
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25
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Arab JP, Hernández-Rocha C, Morales C, Vargas JI, Solís N, Pizarro M, Robles C, Sandoval D, Ponthus S, Benítez C, Barrera F, Soza A, Riquelme A, Arrese M. Fragmento sérico de citoqueratina-18 como marcador no invasivo de esteatohepatitis no alcohólica en población chilena. Gastroenterología y Hepatología 2017; 40:388-394. [DOI: 10.1016/j.gastrohep.2017.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/15/2017] [Accepted: 02/10/2017] [Indexed: 02/07/2023]
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26
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Bustamante V, Arab JP, Terc F, Poggi H, Goycoolea M, Arrese M, Quiroga T, Benítez C. [Persistent elevation of aspartate aminotransferase (AST) due to the presence of macro-AST: Report of one case]. Rev Med Chil 2017; 144:1078-1082. [PMID: 27905656 DOI: 10.4067/s0034-98872016000800017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 04/19/2016] [Indexed: 11/17/2022]
Abstract
We report an asymptomatic 23-year-old woman with an isolated and persistent increase in serum levels of aspartate aminotransferase (AST). An extensive work up including laboratory and image testing revealed no abnormalities thus suggesting the presence of macro-AST. A polyethylene glycol (PEG) precipitation assay was performed and confirmed the presence of macro-AST.
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27
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Arab JP, Barrera F, Gallego C, Valderas JP, Uribe S, Tejos C, Serrano C, Serrano C, Huete Á, Liberona J, Labbé P, Quiroga T, Benítez C, Irarrázaval P, Riquelme A, Arrese M. High prevalence of undiagnosed liver cirrhosis and advanced fibrosis in type 2 diabetic patients. Ann Hepatol 2017; 15:721-8. [PMID: 27493111 DOI: 10.5604/16652681.1212434] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UNLABELLED Background. Patients with type 2 diabetes mellitus (T2DM) are at risk for developing end-stage liver disease due to nonalcoholic steatohepatitis (NASH), the aggressive form of non-alcoholic fatty liver disease (NAFLD). Data on prevalence of advanced fibrosis among T2DM patients is scarce. AIM To evaluate prevalence of steatosis, advanced fibrosis and cirrhosis using non-invasive methods in T2DM patients. MATERIAL AND METHODS 145 consecutive T2DM patients (> 55 years-old) were prospectively recruited. Presence of cirrhosis and advanced fibrosis was evaluated by magnetic resonance imaging (MRI) and NAFLD fibrosis score (NFS) respectively. Exclusion criteria included significant alcohol consumption, markers of viral hepatitis infection or other liver diseases. Results are expressed in percentage or median (interquartile range). RESULTS 52.6% of patients were women, the median age was 60 years old (57-64), mean BMI was 29.6 ± 4.7 kg/m2 and diabetes duration was 7.6 ± 6.9 years. A high prevalence of liver steatosis (63.9%), advanced fibrosis assessed by NFS (12.8%) and evidence of liver cirrhosis in MRI (6.0%) was observed. In a multivariate analysis GGT > 82 IU/L (P = 0.004) and no alcohol intake (P = 0.032) were independently associated to advanced fibrosis. CONCLUSION A high frequency of undiagnosed advanced fibrosis and cirrhosis was observed in non-selected T2DM patients. Screening of these conditions may be warranted in this patient population.
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Affiliation(s)
- Juan P Arab
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Barrera
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Consuelo Gallego
- Departamento de Nutrición, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan P Valderas
- Departamento de Nutrición, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Uribe
- Departamento de Radiología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Tejos
- Escuela de Medicina and Departamento de Ingeniería Eléctrica, Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristóbal Serrano
- Departamento de Radiología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristóbal Serrano
- Departamento de Radiología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Álvaro Huete
- Departamento de Radiología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jessica Liberona
- Departamento de Nutrición, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pilar Labbé
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Teresa Quiroga
- Departamento de Laboratorio Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Benítez
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Irarrázaval
- Escuela de Medicina and Departamento de Ingeniería Eléctrica, Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arnoldo Riquelme
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marco Arrese
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
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Norero B, Serrano CA, Sanchez-Fueyo A, Duarte I, Torres J, Ocquetau M, Barrera F, Arrese M, Soza A, Benítez C. Conversion to mycophenolate mofetil monotherapy in liver recipients: Calcineurin inhibitor levels are key. Ann Hepatol 2017; 16:94-106. [PMID: 28051798 DOI: 10.5604/16652681.1226820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Indexed: 02/04/2023]
Abstract
The use of calcineurin inhibitors (CNI) after liver transplantation is associated with post-transplant nephrotoxicity. Conversion to mycophenolate mofetil (MMF) monotherapy improves renal function, but is related to graft rejection in some recipients. Our aim was to identify variables associated with rejection after conversion to MMF monotherapy. Conversion was attempted in 40 liver transplant recipients. Clinical variables were determined and peripheral mononuclear blood cells were immunophenotyped during a 12-month follow-up. Conversion was classified as successful (SC) if rejection did not occur during the follow-up. MMF conversion was successful with 28 patients (70%) and was associated with higher glomerular filtration rates at the end of study. It also correlated with increased time elapsed since transplantation, low baseline CNI levels (Tacrolimus ≤ 6.5 ng/mL or Cyclosporine ≤ 635 ng/mL) and lower frequency of tacrolimus use. The only clinical variable independently related to SC in multivariate analysis was low baseline CNI levels (p = 0.02, OR: 6.93, 95%, CI: 1.3-29.7). Mean baseline fluorescent intensity of FOXP3+ T cells was significantly higher among recipients with SC. In conclusion, this study suggests that baseline CNI levels can be used to identify recipients with higher probability of SC to MMF monotherapy. Clinicaltrials.gov identification: NCT01321112.
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Affiliation(s)
- Blanca Norero
- Departamentos de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile
| | - Carolina A Serrano
- Departamentos de Gastroenterología y Nutrición Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile
| | - Alberto Sanchez-Fueyo
- Institute of Liver Studies, MRC Centre for Transplantation, King's College London, London SE5 9RS, United Kingdom
| | - Ignacio Duarte
- Patología y Escuela de Medicina, Pontificia Universidad Católica de Chile
| | - Javiera Torres
- Patología y Escuela de Medicina, Pontificia Universidad Católica de Chile
| | - Mauricio Ocquetau
- Hemato-Oncología, Escuela de Medicina, Pontificia Universidad Católica de Chile
| | | | - Marco Arrese
- Departamentos de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile
| | - Alejandro Soza
- Departamentos de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile
| | - Carlos Benítez
- Departamentos de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile
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29
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Martínez J, Besa S, Arab JP, Quintana JC, Regonesi C, Huete A, Jarufe N, Guerra JF, Benítez C, Arrese M. Gastrointestinal neuroendocrine tumor with unresectable liver metastases: an example of multimodal therapeutic approach. Ann Hepatol 2016; 14:752-5. [PMID: 26256906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gastrointestinal neuroendocrine tumors (NET) frequently present with unresectable hepatic metastases, which poses a barrier for curative treatment. Resection of the primary tumor and subsequent orthotopic liver transplantation (OLT) has been proposed as a treatment approach but available data in this regard is limited. We present a clinical case of an otherwise asymptomatic 44-yo man complaining of abdominal pain and dyspepsia that was diagnosed of a 10 cm duodenal tumor with multiple hepatic metastases. A CT-guided biopsy confirmed a NET. He underwent first a Whipple's procedure, and then was listed for liver transplantation. During the waiting time a multimodal therapeutic approach was used including the use of radioactive 177lutetium-labeled somatostatin analogues, long-acting somastostatin analogues and antiangiogenic antibodies (bevacizumab) in order to keep neoplastic disease under control. Two years after Whipple's procedure and given disease stability he underwent OLT with an uneventful postoperative evolution. Patient condition and graft function are optimal after a 4-year follow-up period with no evidence of recurrence. This case report underscores how a multimodal approach involving careful patient selection, resective surgery as well as use of somatostatin analogues and antiangiogenic biological therapy followed by liver transplantation can achieve excellent long-term results in this difficult patient population.
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Affiliation(s)
- Jorge Martínez
- Departments of School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Santiago Besa
- Departments of School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan P Arab
- Gastrointestinal Surgery School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan C Quintana
- Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Alvaro Huete
- Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Jarufe
- Departments of School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan F Guerra
- Departments of School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Benítez
- Gastrointestinal Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marco Arrese
- Gastrointestinal Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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30
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Crespo G, Castro-Narro G, García-Juárez I, Benítez C, Ruiz P, Sastre L, Colmenero J, Miquel R, Sánchez-Fueyo A, Forns X, Navasa M. Usefulness of liver stiffness measurement during acute cellular rejection in liver transplantation. Liver Transpl 2016; 22:298-304. [PMID: 26609794 DOI: 10.1002/lt.24376] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 04/29/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 12/11/2022]
Abstract
Liver stiffness measurement (LSM) is a useful method to estimate liver fibrosis and portal hypertension. The inflammatory process that takes place in post-liver transplant acute cellular rejection (ACR) may also increase liver stiffness. We aimed to explore the association between liver stiffness and the severity of ACR, as well as to assess the relationship between liver stiffness and response to rejection treatment in a prospective study that included 27 liver recipients with biopsy-proven ACR, 30 stable recipients with normal liver tests, and 30 hepatitis C virus (HCV)-infected LT recipients with histologically diagnosed HCV recurrence. Patients with rejection were stratified into 2 groups (mild and moderate/severe) according to the severity of rejection evaluated with the Banff score. Routine biomarkers and LSM with FibroScan were performed at the time of liver biopsy (baseline) and at 7, 30, and 90 days in patients with rejection and at baseline in control patients. Median baseline liver stiffness was 5.9 kPa in the mild rejection group, 11 kPa in the moderate/severe group (P = 0.001), 4.2 kPa in stable recipients (P = 0.02 versus mild rejection), and 13.6 kPa in patients with recurrent HCV (P = 0.17 versus moderate/severe rejection). The area under the receiver operator characteristic curve of LSM to discriminate mild versus moderate/severe ACR was 0.924, and a LSM value of 8.5 kPa yielded a positive predictive value of 100% to diagnose moderate/severe rejection. Liver stiffness improved in 7%, 21%, and 64% of patients with moderate/severe rejection at 7, 30, and 90 days. In conclusion, according to the results of this exploratory study, LSM is associated with the severity of ACR in liver transplantation and thus may be of help in its assessment.
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Affiliation(s)
| | - Graciela Castro-Narro
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico DF, Mexico
| | - Ignacio García-Juárez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico DF, Mexico
| | - Carlos Benítez
- Liver Transplant Unit, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Pablo Ruiz
- Liver Unit, University of Barcelona, Barcelona, Spain
| | - Lydia Sastre
- Liver Unit, University of Barcelona, Barcelona, Spain
| | | | - Rosa Miquel
- Pathology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona, Spain
| | | | - Xavier Forns
- Liver Unit, University of Barcelona, Barcelona, Spain
| | - Miquel Navasa
- Liver Unit, University of Barcelona, Barcelona, Spain
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31
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Bonaccorsi-Riani E, Pennycuick A, Londoño MC, Lozano JJ, Benítez C, Sawitzki B, Martínez-Picola M, Bohne F, Martínez-Llordella M, Miquel R, Rimola A, Sánchez-Fueyo A. Molecular Characterization of Acute Cellular Rejection Occurring During Intentional Immunosuppression Withdrawal in Liver Transplantation. Am J Transplant 2016; 16:484-96. [PMID: 26517400 DOI: 10.1111/ajt.13488] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 07/26/2015] [Accepted: 08/02/2015] [Indexed: 01/25/2023]
Abstract
Acute cellular rejection occurs frequently during the first few weeks following liver transplantation. During this period, its molecular phenotype is confounded by peri- and postoperative proinflammatory events. To unambiguously define the molecular profile associated with rejection, we collected sequential biological specimens from 55 patients at least 3 years after liver transplantation who developed rejection during trials of intentional immunosuppression withdrawal. We analyzed liver tissue and blood samples obtained before initiation of drug withdrawal and at rejection, alongside blood samples collected during the weaning process. Gene expression profiling was conducted using whole-genome microarrays and real-time polymerase chain reaction. Rejection resulted in distinct blood and liver tissue transcriptional changes in patients who were either positive or negative for hepatitis C virus (HCV). Gene expression changes were mostly independent from pharmacological immunosuppression, and their magnitude correlated with severity of histological damage. Differential expression of a subset of genes overlapped across all conditions. These were used to define a blood predictive model that accurately identified rejection in HCV-negative, but not HCV-positive, patients. Changes were detectable 1-2 mo before rejection was diagnosed. Our results provide insight into the molecular processes underlying acute cellular rejection in liver transplantation and help clarify the potential utility and limitations of transcriptional biomarkers in this setting.
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Affiliation(s)
- E Bonaccorsi-Riani
- Department of Liver Studies, Division of Transplantation Immunology and Mucosal Biology, Medical Research Council Centre for Transplantation, Faculty of Life Sciences and Medicine, King's College London University, King's College Hospital, Denmark Hill, London, UK
| | - A Pennycuick
- Department of Liver Studies, Division of Transplantation Immunology and Mucosal Biology, Medical Research Council Centre for Transplantation, Faculty of Life Sciences and Medicine, King's College London University, King's College Hospital, Denmark Hill, London, UK
| | - M-C Londoño
- Liver Unit, Hospital Clinic Barcelona, Institut d' Investigacions Biomedicas August Pi i Sunyer (IDIBAPS), Networked Biomedical Research Centre of Hepatic and Digestive Diseases (CIBERehd), University of Barcelona, Barcelona, Spain
| | - J-J Lozano
- Bioinformatics Platform, CIBEREHD, Barcelona, Spain
| | - C Benítez
- Liver Unit, Hospital Clinic Barcelona, Institut d' Investigacions Biomedicas August Pi i Sunyer (IDIBAPS), Networked Biomedical Research Centre of Hepatic and Digestive Diseases (CIBERehd), University of Barcelona, Barcelona, Spain
| | - B Sawitzki
- AG Transplantationstoleranz, Charite Universitätsmedizin, Institut für Med. Immunologie, Berlin, Germany
| | - M Martínez-Picola
- Liver Unit, Hospital Clinic Barcelona, Institut d' Investigacions Biomedicas August Pi i Sunyer (IDIBAPS), Networked Biomedical Research Centre of Hepatic and Digestive Diseases (CIBERehd), University of Barcelona, Barcelona, Spain
| | - F Bohne
- Institute of Virology, Technische Universität München/Helmholtz Zentrum München, Munich, Germany
| | - M Martínez-Llordella
- Department of Liver Studies, Division of Transplantation Immunology and Mucosal Biology, Medical Research Council Centre for Transplantation, Faculty of Life Sciences and Medicine, King's College London University, King's College Hospital, Denmark Hill, London, UK
| | - R Miquel
- Department of Liver Studies, Division of Transplantation Immunology and Mucosal Biology, Medical Research Council Centre for Transplantation, Faculty of Life Sciences and Medicine, King's College London University, King's College Hospital, Denmark Hill, London, UK
| | - A Rimola
- Liver Unit, Hospital Clinic Barcelona, Institut d' Investigacions Biomedicas August Pi i Sunyer (IDIBAPS), Networked Biomedical Research Centre of Hepatic and Digestive Diseases (CIBERehd), University of Barcelona, Barcelona, Spain
| | - A Sánchez-Fueyo
- Department of Liver Studies, Division of Transplantation Immunology and Mucosal Biology, Medical Research Council Centre for Transplantation, Faculty of Life Sciences and Medicine, King's College London University, King's College Hospital, Denmark Hill, London, UK.,Liver Unit, Hospital Clinic Barcelona, Institut d' Investigacions Biomedicas August Pi i Sunyer (IDIBAPS), Networked Biomedical Research Centre of Hepatic and Digestive Diseases (CIBERehd), University of Barcelona, Barcelona, Spain
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32
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Soza A, Labbé P, Arrese M, Riquelme A, Barrera F, Benítez C, Huete A, Balcells ME, Labarca J. Mycobacterium abscessus pulmonary infection during hepatitis C treatment with telaprevir, peginterferon and ribavirin. Ann Hepatol 2015; 14:132-6. [PMID: 25536652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The first generation protease inhibitors has been the mainstay of hepatitis C treatment for the last couple of years, showing marked improvement in sustained virological response, but also increased side effects. Infection has emerged as a common complication of telaprevir and boceprevir in combination with peginterferon and ribavirin, usually caused by common pathogens. We present the case of a 65 years old man who developed a Mycobacterium abscessus pulmonary infection during treatment with telaprevir, peginterferon and ribavirin. The patient was successfully treated with amikacin, imipenem and chlarithromycin. The present case is relevant for increasing awareness for recognition of opportunistic infections and particularly nontuberculous mycobacterial infections in patients receiving triple therapy for chronic hepatitis C, especially in cirrhotic subjects who develop significant lymphopenia.
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Affiliation(s)
- Alejandro Soza
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile
| | - Pilar Labbé
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile
| | - Marco Arrese
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile
| | - Arnoldo Riquelme
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile
| | - Francisco Barrera
- Afiliacja Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile
| | - Carlos Benítez
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile
| | - Alvaro Huete
- Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile
| | - M Elvira Balcells
- Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile
| | - Jaime Labarca
- Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile
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33
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Bohne F, Londoño MC, Benítez C, Miquel R, Martínez-Llordella M, Russo C, Ortiz C, Bonaccorsi-Riani E, Brander C, Bauer T, Protzer U, Jaeckel E, Taubert R, Forns X, Navasa M, Berenguer M, Rimola A, Lozano JJ, Sánchez-Fueyo A. HCV-induced immune responses influence the development of operational tolerance after liver transplantation in humans. Sci Transl Med 2015; 6:242ra81. [PMID: 24964989 DOI: 10.1126/scitranslmed.3008793] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pathogen-induced immune responses prevent the establishment of transplantation tolerance in experimental animal models. Whether this occurs in humans as well remains unclear. The development of operational tolerance in liver transplant recipients with chronic hepatitis C virus (HCV) infection allows us to address this question. We conducted a clinical trial of immunosuppression withdrawal in HCV-infected adult liver recipients to elucidate (i) the mechanisms through which allograft tolerance can be established in the presence of an ongoing inflammatory response and (ii) whether anti-HCV heterologous immune responses influence this phenomenon. Of 34 enrolled liver recipients, drug withdrawal was successful in 17 patients (50%). Tolerance was associated with intrahepatic overexpression of type I interferon and immunoregulatory genes and with an expansion of exhausted PD1/CTLA4/2B4-positive HCV-specific circulating CD8(+) T cells. These findings were already present before immunosuppression was discontinued and were specific for HCV infection. In contrast, the magnitude of HCV-induced proinflammatory gene expression and the breadth of anti-HCV effector T cell responses did not influence drug withdrawal outcome. Our data suggest that in humans, persistent viral infections exert immunoregulatory effects that could contribute to the restraining of alloimmune responses, and do not necessarily preclude the development of allograft tolerance.
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Affiliation(s)
- Felix Bohne
- Liver Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona 08036, Spain. Institute of Virology, Technische Universität München-Helmholtz Zentrum München, Munich 81675, Germany
| | - María-Carlota Londoño
- Liver Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona 08036, Spain
| | - Carlos Benítez
- Liver Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona 08036, Spain
| | - Rosa Miquel
- Department of Pathology, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona 08036, Spain
| | - Marc Martínez-Llordella
- Institute of Liver Studies, MRC Centre for Transplantation, King's College London, London SE5 9RS, UK
| | - Carolina Russo
- Clinical Cooperation Group Monitoring, Helmholtz Zentrum München, Munich 81675, Germany
| | - Cecilia Ortiz
- Liver Unit, Hospital La Fe Valencia, CIBERehd, University of Valencia, Valencia 46026, Spain
| | - Eliano Bonaccorsi-Riani
- Institute of Liver Studies, MRC Centre for Transplantation, King's College London, London SE5 9RS, UK
| | - Christian Brander
- Irsicaixa AIDS Research Institute, Institució Catalana de Recerca i Estudis Avançats, Barcelona 08916, Spain
| | - Tanja Bauer
- Clinical Cooperation Group Monitoring, Helmholtz Zentrum München, Munich 81675, Germany
| | - Ulrike Protzer
- Institute of Virology, Technische Universität München-Helmholtz Zentrum München, Munich 81675, Germany
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Hannover 30625, Germany
| | - Richard Taubert
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Hannover 30625, Germany
| | - Xavier Forns
- Liver Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona 08036, Spain
| | - Miquel Navasa
- Liver Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona 08036, Spain
| | - Marina Berenguer
- Liver Unit, Hospital La Fe Valencia, CIBERehd, University of Valencia, Valencia 46026, Spain
| | - Antoni Rimola
- Liver Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona 08036, Spain
| | | | - Alberto Sánchez-Fueyo
- Liver Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona 08036, Spain. Institute of Liver Studies, MRC Centre for Transplantation, King's College London, London SE5 9RS, UK.
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Martínez J, Bächler JP, Moisan F, Torres J, Duarte I, Pérez RM, Benítez C, Arrese M, Domínguez P, Guerra JF, Jarufe N. [Outcomes using two preservation solutions (UW/HTK) in liver transplantation from brain death donors]. Rev Med Chil 2015; 142:1229-37. [PMID: 25601106 DOI: 10.4067/s0034-98872014001000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 09/10/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Preservation solutions are critical for organ transplantation. In liver transplant (LT), the solution developed by the University Of Wisconsin (UW) is the gold-standard to perfuse deceased brain death donor (DBD) grafts. Histidine-Tryptophan-Ketoglutarate (HTK), formerly a cardioplegic infusion, has been also used in solid organ transplantation. AIM To compare the outcomes of LT in our center using either HTK or UW solution. PATIENTS AND METHODS Retrospective study including 93 LT DBD liver grafts in 89 patients transplanted between March 1994 and July 2010. Forty-eight grafts were preserved with UW and 45 with HTK. Donor and recipient demographics, total infused volume, cold ischemia time, post-reperfusion biopsy, liver function tests, incidence of biliary complications, acute rejection and 12-month graft and patient survival were assessed. Preservation solution costs per liver graft were also recorded. RESULTS Donor and recipient demographics were similar. When comparing UW and HTK, no differences were observed in cold ischemia time (9.6 ± 3 and 8.7 ± 2 h respectively, p = 0.23), biliary complications, the incidence of acute rejection, primary or delayed graft dysfunction. Histology on post-reperfusion biopsies revealed no differences between groups. The infused volume was significantly higher with HTK than with UW (9 (5-16) and 6 (3-11) l, p < 0.001). The cost per procurement was remarkably lower using HTK. CONCLUSIONS Perfusion of DBD liver grafts with HTK is clinically equivalent to UW, with a significant cost reduction.
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35
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Benítez C, Londoño MC, Miquel R, Manzia TM, Abraldes JG, Lozano JJ, Martínez-Llordella M, López M, Angelico R, Bohne F, Sese P, Daoud F, Larcier P, Roelen DL, Claas F, Whitehouse G, Lerut J, Pirenne J, Rimola A, Tisone G, Sánchez-Fueyo A. Prospective multicenter clinical trial of immunosuppressive drug withdrawal in stable adult liver transplant recipients. Hepatology 2013; 58:1824-35. [PMID: 23532679 DOI: 10.1002/hep.26426] [Citation(s) in RCA: 229] [Impact Index Per Article: 20.8] [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: 07/12/2012] [Accepted: 03/22/2013] [Indexed: 12/12/2022]
Abstract
UNLABELLED Lifelong immunosuppression increases morbidity and mortality in liver transplantation. Discontinuation of immunosuppressive drugs could lessen this burden, but the safety, applicability, and clinical outcomes of this strategy need to be carefully defined. We enrolled 102 stable liver recipients at least 3 years after transplantation in a single-arm multicenter immunosuppression withdrawal trial. Drugs were gradually discontinued over a 6 to 9-month period. The primary endpoint was the development of operational tolerance, defined as successful immunosuppressive drug cessation maintained for at least 12 months with stable graft function and no histopathologic evidence of rejection. Out of the 98 recipients evaluated, 57 rejected and 41 successfully discontinued all immunosuppressive drugs. In nontolerant recipients rejection episodes were mild and resolved over 5.6 months (two nontolerant patients still exhibited mild gradually improving cholestasis at the end of follow-up). In tolerant recipients no progressive clinically significant histological damage was apparent in follow-up protocol biopsies performed up to 3 years following drug withdrawal. Tolerance was independently associated with time since transplantation (odds ratio [OR] 1.353; P = 0.0001), recipient age (OR 1.073; P = 0.009), and male gender (OR 4.657; P = 0.016). A predictive model incorporating the first two clinical variables identified subgroups of recipients with very high (79%), intermediate (30%-38%), and very low (0%) likelihood of successful withdrawal. CONCLUSION When conducted at late timepoints after transplantation, immunosuppression withdrawal is successful in a high proportion of carefully selected liver recipients. A combination of clinical parameters could be useful to predict the success of this strategy. Additional prospective studies are now needed to confirm these results and to validate clinically applicable diagnostic biomarkers.
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Affiliation(s)
- Carlos Benítez
- Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
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36
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Pérez-Gutiérrez OZ, Hernández-Rocha C, Candia-Balboa RA, Arrese MA, Benítez C, Brizuela-Alcántara DC, Méndez-Sánchez N, Uribe M, Chávez-Tapia NC. Validation study of systems for noninvasive diagnosis of fibrosis in nonalcoholic fatty liver disease in Latin population. Ann Hepatol 2013; 12:416-24. [PMID: 23619258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background. The incidence of liver cirrhosis is significantly high in Latin population. The high prevalence of nonalcoholic fatty liver disease NAFLD is likely partially responsible for these figures. Liver biopsy is not a practical diagnostic option in this scenario. The validation of noninvasive markers of fibrosis is important in populations with a high prevalence of NAFLD. Aim. To compare the diagnostic value of noninvasive assessment systems to detect fibrosis in a cohort of Latin patients with biopsy-proven NAFLD. Material and methods. Patients with biopsy-proven NAFLD were included. Noninvasive evaluations included calculations of NAFLD fibrosis, FIB-4, BARD scores, APRI, and AST/ALT ratio. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver-operating characteristic curve (AUROC) were calculated. Results. A total of 228 patients (mean age, 48.6 ± 12.7 years) were included. Fifty-one percent were women; 48% were overweight and 23% were obese. The severity of fibrosis was classified as G0, 56.6%; G1, 25%; G2, 6.6%; G3, 7%; and G4, 4.8%. The AUROC values for advanced fibrosis were 0.72 for the NAFLD fibrosis score, 0.74 for FIB-4 score, 0.67 for AST/ALT ratio, 0.66 for APRI score, and 0.65 for BARD score. In 54% of patients with undetermined FIB-4 score and in 60% of patients with undetermined NAFLD fibrosis score, fibrosis was observed in the liver biopsy. Conclusions. The NAFLD fibrosis, FIB-4, and APRI scores can be used for the noninvasive diagnosis of fibrosis. However, 25% of patients evaluated by these methods have an indeterminate degree of fibrosis.
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Arab JP, Meneses L, Pérez RM, Arrese M, Benítez C. Hepatic encephalopathy in a liver transplant recipient with stable liver function. Hepatology 2013; 57:1672-4. [PMID: 23390114 DOI: 10.1002/hep.26298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 10/13/2012] [Accepted: 01/15/2013] [Indexed: 01/24/2023]
Abstract
Postshunt hepatic encephalopathy after liver transplantation (LT) is an infrequent condition and is commonly associated with portal occlusion or stenosis and the presence of a patent portosystemic shunt. Portal vein stenosis (PVS) or thrombosis (PVT) are uncommon complications after LT. The overall frequency of both complications is reported to be less than 3%. When PVS or PVT develop early after LT, the occlusion of the portal vein can have catastrophic consequences to the graft including acute liver failure and graft loss. Late PVT/PVS are asymptomatic in approximately 50% of the cases and mainly diagnosed by a routine ultrasound. Symptomatic postshunt hepatic encephalopathy (HE) is a very infrequent condition after LT that has been scarcely reported in the literature. We present here the case of a liver recipient with normal graft function who presented with hepatic encephalopathy 3 months after LT with stable liver function but a severe portal stenosis and the presence of a spontaneous portosystemic shunt whose successful endovascular treatment was followed by the complete resolution of the HE.
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Affiliation(s)
- Juan Pablo Arab
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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38
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Norero B, Pérez-Ayuso RM, Duarte I, Ramirez P, Soza A, Arrese M, Benítez C. Portal hypertension and acute liver failure as uncommon manifestations of primary amyloidosis. Ann Hepatol 2013; 13:142-9. [PMID: 24378278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hepatic involvement in primary amyloidosis is an infrequent challenge to the hepatologist. Although usually asymptomatic, amyloidosis may have unusual manifestations. Liver biopsy is an important diagnostic tool for this condition. Herein, we report three cases of portal hypertension related to primary hepatic amyloidosis, one of them in the form of acute liver failure.
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Affiliation(s)
- Blanca Norero
- Departments of Gastroenterology School of Medicine, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Rosa María Pérez-Ayuso
- Departments of Gastroenterology School of Medicine, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Ignacio Duarte
- Department of Pathology School of Medicine, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Pablo Ramirez
- Department of Hemato-oncology, School of Medicine, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Alejandro Soza
- Departments of Gastroenterology School of Medicine, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Marco Arrese
- Departments of Gastroenterology School of Medicine, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Carlos Benítez
- Departments of Gastroenterology School of Medicine, Pontificia Universidad Católica de Chile. Santiago, Chile
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Bohne F, Martínez-Llordella M, Lozano JJ, Miquel R, Benítez C, Londoño MC, Manzia TM, Angelico R, Swinkels DW, Tjalsma H, López M, Abraldes JG, Bonaccorsi-Riani E, Jaeckel E, Taubert R, Pirenne J, Rimola A, Tisone G, Sánchez-Fueyo A. Intra-graft expression of genes involved in iron homeostasis predicts the development of operational tolerance in human liver transplantation. J Clin Invest 2011; 122:368-82. [PMID: 22156196 DOI: 10.1172/jci59411] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 10/26/2011] [Indexed: 12/13/2022] Open
Abstract
Following organ transplantation, lifelong immunosuppressive therapy is required to prevent the host immune system from destroying the allograft. This can cause severe side effects and increased recipient morbidity and mortality. Complete cessation of immunosuppressive drugs has been successfully accomplished in selected transplant recipients, providing proof of principle that operational allograft tolerance is attainable in clinical transplantation. The intra-graft molecular pathways associated with successful drug withdrawal, however, are not well defined. In this study, we analyzed sequential blood and liver tissue samples collected from liver transplant recipients enrolled in a prospective multicenter immunosuppressive drug withdrawal clinical trial. Before initiation of drug withdrawal, operationally tolerant and non-tolerant recipients differed in the intra-graft expression of genes involved in the regulation of iron homeostasis. Furthermore, as compared with non-tolerant recipients, operationally tolerant patients exhibited higher serum levels of hepcidin and ferritin and increased hepatocyte iron deposition. Finally, liver tissue gene expression measurements accurately predicted the outcome of immunosuppressive withdrawal in an independent set of patients. These results point to a critical role for iron metabolism in the regulation of intra-graft alloimmune responses in humans and provide a set of biomarkers to conduct drug-weaning trials in liver transplantation.
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Affiliation(s)
- Felix Bohne
- Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
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40
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Benítez C, Arancibia JP, Arrese M, Soza A, Domínguez P, Jarufe N, Martínez J, Pérez-Ayuso RM. Operational tolerance after liver transplantation, more common than we think: a case report. Ann Hepatol 2011; 10:361-4. [PMID: 21677341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Operational tolerance after liver transplantation has been described in around 20% of the recipients. These patients are able to maintain a normal graft function in the absence of immunosuppressive drugs, thus being free of adverse effects that are common and frequently severe. Here we present a well-documented case of operational tolerance after liver transplantation and discuss current concepts on this topic with emphasis on recent findings that will potentially allow for identifying graft-tolerant patients.
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Affiliation(s)
- Carlos Benítez
- Department of Gastroenterology, Medical School, Pontificia Universidad Católica de Chile, Santiago, Chile.
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41
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Puig-Pey I, Bohne F, Benítez C, López M, Martínez-Llordella M, Oppenheimer F, Lozano JJ, González-Abraldes J, Tisone G, Rimola A, Sánchez-Fueyo A. Characterization of γδ T cell subsets in organ transplantation. Transpl Int 2011; 23:1045-55. [PMID: 20477999 DOI: 10.1111/j.1432-2277.2010.01095.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
γδ T cells are innate-type lymphocytes that preferentially act as regulators of local effector immune responses. Recent reports found an altered distribution of the two main subpopulations of blood γδ T cells (Vδ1 and Vδ2) in operationally tolerant liver transplant recipients. Based on this, γδ T cells subset quantification was proposed as a biomarker of immunologic risk in liver transplantation. The specific characteristics of γδ T cell subsets in transplantation remain however unknown. We have investigated here the phenotype, repertoire and functional properties of γδ T cell subsets in a large population of allograft recipients. Our results indicate that alterations in the γδ T cell compartment are not restricted to tolerant liver recipients. In fact, most immunosuppressed liver and kidney recipients also display an enlarged peripheral blood γδ T cell pool mainly resulting from an expansion of Vδ1 T cells exhibiting an oligoclonal repertoire and different phenotypic and cytokine production traits than Vδ2 T cells. We propose that persistent viral infections are likely to contribute to these alterations. Our data provide novel insight in the biology of γδ T cells and a rationale for exploring these lymphocytes in more depth into the pathogenesis of viral infections in transplantation.
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Affiliation(s)
- Isabel Puig-Pey
- Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain
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42
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Herrera J, Amigo L, Husche C, Benítez C, Zanlungo S, Lütjohann D, Miquel JF, Nervi F. Fecal bile acid excretion and messenger RNA expression levels of ileal transporters in high risk gallstone patients. Lipids Health Dis 2009; 8:53. [PMID: 19995447 PMCID: PMC2797496 DOI: 10.1186/1476-511x-8-53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 12/08/2009] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cholesterol gallstone disease (GS) is highly prevalent among Hispanics and American Indians. In GS, the pool of bile acids (BA) is decreased, suggesting that BA absorption is impaired. In Caucasian GS patients, mRNA levels for ileal BA transporters are decreased. We aimed to determine fecal BA excretion rates, mRNA levels for ileal BA transporter genes and of regulatory genes of BA synthesis in Hispanic GS patients. RESULTS Excretion of fecal BA was measured in seven GS females and in ten GS-free individuals, all with a body mass index < 29. Participants ingested the stool marker Cr2O3 (300 mg/day) for 10 days, and fecal specimens were collected on the last 3 days. Chromium was measured by a colorimetric method, and BA was quantitated by gas chromatography/mass spectroscopy. Intake of calories, nutrients, fiber and cholesterol were similar in the GS and GS-free subjects. Mean BA excretion levels were 520 +/- 80 mg/day for the GS-free group, and 461 +/- 105 mg/day for the GS group. Messenger RNA expression levels were determined by RT-PCR on biopsy samples obtained from ileum during diagnostic colonoscopy (14 GS-free controls and 16 GS patients) and from liver during surgery performed at 8 and 10 AM (12 GS and 10 GS-free patients operated on for gastrointestinal malignancies), all with a body mass index < 29. Messenger RNA level of the BA transporter genes for ileal lipid binding protein, multidrug resistance-associated protein 3, organic solute transporter alpha, and organic solute transporter beta were similar in GS and GS-free subjects. Messenger RNA level of Cyp27A1, encoding the enzyme 27alpha-hydroxylase, the short heterodimer partner and farnesoid X receptor remained unchanged, whereas the mRNA level of Cyp7A1, the rate limiting step of BA synthesis, was increased more than 400% (p < 0.01) in the liver of GS compared to GS-free subjects. CONCLUSION Hispanics with GS have fecal BA excretion rates and mRNA levels of genes for ileal BA transporters that are similar to GS-free subjects. However, mRNA expression levels of Cyp7A1 are increased in GS, indicating that regulation of BA synthesis is abnormal in Hispanics with GS.
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Affiliation(s)
- Jorge Herrera
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ludwig Amigo
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Constanze Husche
- Labor für spezielle Lipiddiagnostik, Zentrum Innere Medizin, Institut für Klinische Chemie und Pharmakologie, Universitätsklinikum Bonn, Germany
| | - Carlos Benítez
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Silvana Zanlungo
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Dieter Lütjohann
- Labor für spezielle Lipiddiagnostik, Zentrum Innere Medizin, Institut für Klinische Chemie und Pharmakologie, Universitätsklinikum Bonn, Germany
| | - Juan Francisco Miquel
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Flavio Nervi
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Martínez-Llordella M, Lozano JJ, Puig-Pey I, Orlando G, Tisone G, Lerut J, Benítez C, Pons JA, Parrilla P, Ramírez P, Bruguera M, Rimola A, Sánchez-Fueyo A. Using transcriptional profiling to develop a diagnostic test of operational tolerance in liver transplant recipients. J Clin Invest 2008; 118:2845-57. [PMID: 18654667 DOI: 10.1172/jci35342] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 06/11/2008] [Indexed: 02/06/2023] Open
Abstract
A fraction of liver transplant recipients are able to discontinue all immunosuppressive therapies without rejecting their grafts and are said to be operationally tolerant to the transplant. However, accurate identification of these recipients remains a challenge. To design a clinically applicable molecular test of operational tolerance in liver transplantation, we studied transcriptional patterns in the peripheral blood of 80 liver transplant recipients and 16 nontransplanted healthy individuals by employing oligonucleotide microarrays and quantitative real-time PCR. This resulted in the discovery and validation of several gene signatures comprising a modest number of genes capable of identifying tolerant and nontolerant recipients with high accuracy. Multiple peripheral blood lymphocyte subsets contributed to the tolerance-associated transcriptional patterns, although NK and gammadeltaTCR+ T cells exerted the predominant influence. These data suggest that transcriptional profiling of peripheral blood can be employed to identify liver transplant recipients who can discontinue immunosuppressive therapy and that innate immune cells are likely to play a major role in the maintenance of operational tolerance in liver transplantation.
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Affiliation(s)
- Marc Martínez-Llordella
- Liver Transplant Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
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44
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Ordóñez C, Benítez C, González JL. Amino acid production from a sunflower wholemeal protein concentrate. Bioresour Technol 2008; 99:4749-4754. [PMID: 17980581 DOI: 10.1016/j.biortech.2007.09.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 09/21/2007] [Accepted: 09/22/2007] [Indexed: 05/25/2023]
Abstract
A study was undertaken to investigate the influence of protein concentration and the addition of different doses of endopeptidase (Alcalase) and exopeptidase (Flavourzyme) on the sequential enzymatic hydrolysis of a protein concentrate obtained from defatted sunflower wholemeal. The results show that the greatest degree of hydrolysis (37.8%) is achieved by hydrolyzing an aqueous substrate with a 5% protein concentrate, and using a 0.02 g Alcalase/g of protein concentrate of the substrate. The aminograms performed reveal that the free amino acid found in the highest proportion in the hydrolysate was aspartic acid, which accounted for over 50% of the free amino acids present, regardless of the substrate concentration and the enzyme dosage used. Finally, the hydrolysate obtained from a substrate containing a 5% protein concentrate and a 0.02 g Alcalase/g of protein concentrate displayed characteristics that indicate its suitability for use as a vegetable-origin plant growth regulator.
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Affiliation(s)
- C Ordóñez
- Departamento de Química Agrícola y Edafología, Facultad de Ciencias, Universidad de Córdoba, Campus de Rabanales, Edificio Marie Curie, Ctra. Nacional IV-a, km. 336, 14014 Córdoba, Spain
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45
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Abstract
Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPS) is an autoinflammatory disorder associated to a mutation of the Tumor Necrosis Factor Receptor 1 (TNFR1) whose clinical presentation consists on recurrent episodes of prolonged fever, abdominal pain, myalgias, migratory cutaneous erythema, conjunctivitis or periorbitary edema. The diagnosis is confirmed by genetic analysis of the TNFR1 gene. Its main complication is amyloidosis and the treatment is based on the use of corticosteroids or anti-TNF antibodies. We report a 17 year-old male and 23 year-old female with the syndrome. Both cases had heterozygous mutations of the TNFR1 gene, C30R in the first case and T50M in the second case.
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Affiliation(s)
- Manuel Alvarez-Lobos
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile.
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Ordoñez C, Tejada M, Benítez C, González JL. Characterization of a phosphorus-potassium solution obtained during a protein concentrate process from sunflower flour. Application on rye-grass. Bioresour Technol 2006; 97:522-8. [PMID: 16216734 DOI: 10.1016/j.biortech.2005.02.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Revised: 02/28/2005] [Accepted: 02/28/2005] [Indexed: 05/04/2023]
Abstract
The process that permits the ability to obtain a protein extract from defatted sunflower flour also produces a solution very rich in phosphorus (P) and potassium (K), which also contains small concentrations of humic substances. The aim of this study has been to determine the possible agricultural use of this extract. Therefore the phosphorus-potassium solution (experimental solution) was analyzed to determinate its pH and its content of nitrogen, proteins, organic carbon, humic substances potassium and phosphorous. The experimental solution was applied on rye-grass (Lolium multiflorum Lam.) and afterwards the results were analyzed we calculated the germination percentage and the fresh and dry weights that were obtained after each cut throughout the duration of the experiment. In addition the different pigment types (chlorophyll a, chlorophyll b and carotenoids) were quantified. The conclusions of the study examine how this time-stable experimental solution improves the long-term effects and also the level of pigments, especially carotenoids, of the plants that have been treated.
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Affiliation(s)
- C Ordoñez
- Departamento de Química Agrícola y Edafología, Facultad de Ciencias, Universidad de Córdoba, Campus de Rabanales, Edificio C-3, Ctra. Nacional IV, km. 339.6, 14014 Córdoba, Spain
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Benítez C, Andresen M, Farías G, Castillo C, Henríquez M, Pereira J. [Indications, adverse effects and results of plasmapheresis in critical care patients]. Rev Med Chil 2006; 133:1441-8. [PMID: 16446871 DOI: 10.4067/s0034-98872005001200005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Plasmapheresis is a therapeutic alternative for diseases in which a "humoral factor" has pathogenetic relevance. However it is not devoid of adverse effects. AIM To review the indications, number of procedures, morbidity and clinical evolution of plasmapheresis in critical patients. PATIENTS AND METHODS A retrospective and descriptive study in four intensive care units of an University hospital. The severity of patients was evaluated with APACHE II and SOFA scores. RESULTS Twenty patients were studied. The most common indications of plasmapheresis were thrombotic thrombocytopenic purpura (TTP) in 50% of subjects and small vessel vasculitides in 30%. The number of procedures per patient oscillated between 2 and 14 (mean: 7.1+/-3.3). The registered adverse effects were hypocalcemia in 50% of patients, hypotension in 42.1%, coagulopathy in 35%, hypokalemia in 29%, rash in 20%, procedure related infections in 18% and fever in 10%. There was a significant decrease of 17+/-28% in prothrombin time, after the procedures. Seventy five percent of patients had a favorable evolution. Global mortality rate was 15%. All deaths occurred in patients with TTP and were attributed to the progression of the disease. No death was attributed to the procedure. The initial APACHE II and SOFA scores were 12.4+/-8.4 and 5.3+/-2.9, respectively. Both scores decreased after the procedure. Among other therapeutic measures, 15% of the patients received immunosuppressant treatment, 27% were dialyzed and 32% were mechanically ventilated. CONCLUSIONS The most common indication of plasmapheresis was TTP. Adverse effects were frequent, however there was no procedure related mortality. The global mortality rate was 15% and all deaths occurred in patients with TTP.
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Affiliation(s)
- Carlos Benítez
- Unidad de Cuidados Intensivos, Programa de Medicina Intensiva, Hospital Clínico, Facultad de Medicina, Pontificia Universidad Católica de Chile
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48
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Andresen M, Henríquez M, Mercado M, Farías G, Castillo C, Benítez C, Dougnac A. [Comparison of cardiac output measurement in critical patients using transesophageal Doppler or thermodilution: a preliminary report]. Rev Med Chil 2005; 133:761-6. [PMID: 16341381 DOI: 10.4067/s0034-98872005000700002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiac output can be measured non invasively by transesophageal Doppler. This is an alternative to measure it by thermodilution with a catheter in the pulmonary artery. AIM To compare both methods of cardiac output measurement. MATERIAL AND METHODS Simultaneous measurement of cardiac output by transesophageal Doppler and thermodilution with a catheter in the pulmonary artery in four male critical patients, aged 60+/-12 years, hospitalized in a University Hospital. The Bland and Altman method to compare the concordance between two measurements, was used. RESULTS Forty measurements were performed. The results of both methods had a correlation coefficient of 0.98. According to the Bland and Altman method, the difference between both methods was -0.5 L with a precision of 0.52 L/min (95% confidence interval -1.51 to 0.52 L/min). Considering that a change between two sequential measurements is considered significant when the difference is more than 15%, both measurements agreed in 83% of cases, that there was a change in cardiac output. CONCLUSIONS Transesophageal Doppler is a promising non invasive technique to measure cardiac output in critical care patients. It becomes a valid alternative to the thermodilution technique. This preliminary experience must be confirmed in a larger series.
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Affiliation(s)
- Max Andresen
- Unidad de Tratamiento Intensivo Médico, Facultad de Medicina, Hospital Clínico Pontificia Universidad Católica de Chile.
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49
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Benítez C, Quintero J, Torres R. [Prevalence of risk for mental disorders among undergraduate medical students at the Medical School of the Catholic University of Chile]. Rev Med Chil 2001; 129:173-8. [PMID: 11351469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Stress caused by the high physical, intellectual and emotional demands imposed to medical students, renders them specially susceptible to the development of mental disorders. AIM To assess the prevalence of risk for mental disorders among undergraduate students at the Medical School of the Catholic University of Chile. MATERIAL AND METHODS The Twelve Item General Health Questionnaire (GHQ 12) was voluntarily answered by medical students from the first to the fifth year. RESULTS Sixty eight percent of the total population (305 students) answered the questionnaire. Forty one percent of students were at risk, defined as scoring five or more points in the GHQ 12. The average score was 3.9 +/- 2.2. First year students had a higher score than fourth year students (4.6 +/- 2.2 and 3.4 +/- 2.1 points respectively, p < 0.05). No gender differences were observed. CONCLUSIONS Our results are similar to those of other publications concerning psychiatric risk among medical students.
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Affiliation(s)
- C Benítez
- Departamento de Psiquiatría, Hospital Clínico Pontificia Universidad Católica de Chile. Marcoleta 387, 2o piso, Santiago
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