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Caballero-Marcos A, Romero-Cristóbal M, Puerto M, Fernández-Yunquera A, Dieguez L, Navarrete C, Clemente A, Diaz-Fontenla F, Catalán P, Rincón D, López-Baena JÁ, Bañares Cañizares R, Salcedo M. HCV eradication in recurrent hepatitis C after liver transplantation normalizes enhanced endothelial activation. Transpl Int 2021; 34:2214-2225. [PMID: 34346111 DOI: 10.1111/tri.14000] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/30/2021] [Accepted: 07/26/2021] [Indexed: 02/01/2023]
Abstract
The increased risk of cardiovascular disease (CVD) conferred by hepatitis C virus (HCV) is especially relevant after liver transplantation (LT), but its mechanism is still not well defined. This study aimed to evaluate the influence of HCV eradication in inflammatory and endothelial activation markers after LT. We evaluated inflammatory (TNF-alfa, IL-6, IL-8, and MCP-1) and endothelial activation (E-selectin, ICAM-1, VCAM-1, and MMP-9) markers before and after eradication in 45 LT recipients with HCV infection (LT+/HCV+) and 44 non-transplanted HCV-infected patients (LT-/HCV+). We also considered an additional group of 40 LT recipients without HCV infection (LT+/HCV-). LT+/HCV+ patients presented a higher endothelial activation status before eradication compared with LT+/HCV- patients. However, levels of E-selectin, ICAM-1, VCAM-1, and MMP-9 were comparable between LT+/HCV+ and LT-/HCV+ patients before eradication. HCV eradication decreased ICAM-1 (5466.55 pg/ml vs. 3354.88 pg/ml, P < 0.001) and VCAM-1 (10456.52 pg/ml vs. 6658.85 pg/ml, P < 0.001) levels in LT+/HCV+ and LT-/HCV+ patients. Remarkably, HCV eradication restored levels of endothelial activation markers of LT+/HCV+ patients compared with that of LT+/HCV- patients. HCV plays a major role in endothelial dysfunction after LT. Furthermore, HCV eradication restores endothelial activation despite the exposure to immunosuppressive therapy.
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Affiliation(s)
| | - Mario Romero-Cristóbal
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marta Puerto
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Lucia Dieguez
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Navarrete
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Clemente
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Fernando Diaz-Fontenla
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Catalán
- Department of Microbiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Diego Rincón
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Rafael Bañares Cañizares
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Magdalena Salcedo
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain
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Belli LS, Fondevila C, Cortesi PA, Conti S, Karam V, Adam R, Coilly A, Ericzon BG, Loinaz C, Cuervas-Mons V, Zambelli M, Llado L, Diaz-Fontenla F, Invernizzi F, Patrono D, Faitot F, Bhooori S, Pirenne J, Perricone G, Magini G, Castells L, Detry O, Cruchaga PM, Colmenero J, Berrevoet F, Rodriguez G, Ysebaert D, Radenne S, Metselaar H, Morelli C, De Carlis LG, Polak WG, Duvoux C. Protective Role of Tacrolimus, Deleterious Role of Age and Comorbidities in Liver Transplant Recipients With Covid-19: Results From the ELITA/ELTR Multi-center European Study. Gastroenterology 2021; 160:1151-1163.e3. [PMID: 33307029 PMCID: PMC7724463 DOI: 10.1053/j.gastro.2020.11.045] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [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: 07/31/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking. METHODS Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis. RESULTS Between March 1 and June 27, 2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39 of 204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10-23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age >70 (HR, 4.16; 95% CI, 1.78-9.73) had a negative effect and tacrolimus (TAC) use (HR, 0.55; 95% CI, 0.31-0.99) had a positive independent effect on survival. The role of co-morbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR, 1.95; 95% CI, 1.06-3.58) and chronic kidney disease (HR, 1.97; 95% CI, 1.05-3.67) emerged as associated with death CONCLUSIONS: Twenty-five percent of patients requiring hospitalization for COVID-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose.
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Affiliation(s)
- Luca S. Belli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy,Correspondence Address correspondence to: Luca S. Belli, Department of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Constantino Fondevila
- Department of General and Digestive Surgery, Hospital Clínic, Institut d’Investigacion Biomediques August Pi-Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Paolo A. Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Vincent Karam
- European Liver Transplant Registry, Centre Hépatobiliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul-Brousse, Paris-Saclay University, Villejuif, France
| | - Rene Adam
- European Liver Transplant Registry, Centre Hépatobiliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul-Brousse, Paris-Saclay University, Villejuif, France
| | - Audrey Coilly
- Centre Hepato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul-Brousse, Paris-Sud Saclay University, Villejuif, France
| | - Bo Goran Ericzon
- Division of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Carmelo Loinaz
- Chirugía General, Doce de Octubre Universidad Complutense de Madrid, Madrid, Spain
| | - Valentin Cuervas-Mons
- Departimento de Medicina, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marco Zambelli
- Department of Surgery, “Papa Giovanni XXIII” Hospital, Bergamo, Lombardia, Italy
| | - Laura Llado
- Liver Transplant Unit, Hospital Uniersitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Fernando Diaz-Fontenla
- Unidad de Trasplante Hepático, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Federica Invernizzi
- Division of Gastroenterology and Hepatology, University of Milan, Milan, Italy
| | - Damiano Patrono
- Liver Transplantation Center, Molinette Hospital, Turin, Italy
| | - Francois Faitot
- Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Strasbourg, France
| | - Sherrie Bhooori
- Department of Surgery and Oncology, Istituto Nazionale Tumori, Milan, Italy
| | - Jacques Pirenne
- Department of Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Giovanni Perricone
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - Giulia Magini
- Service de Transplantation, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Lluis Castells
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Oliver Detry
- Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire Liege, University of Liege, Liege, Belgium
| | - Pablo Mart Cruchaga
- Cirugía General y Digestiva, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jordi Colmenero
- Department of General and Digestive Surgery, Hospital Clínic, Institut d’Investigacion Biomediques August Pi-Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Frederick Berrevoet
- Department of General and Hepatobiliary Surgery, Ghent University, Ghent, Belgium
| | - Gonzalo Rodriguez
- Department of General & Digestive Surgery, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
| | - Dirk Ysebaert
- Department of Surgery, Antwerp University Hospital, Antwerp University, Edegem, Belgium
| | - Sylvie Radenne
- Service d’Hépato-Gastroentérologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Herold Metselaar
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Cristina Morelli
- Liver and Multi-organ Transplantation, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luciano G. De Carlis
- General Surgery and Abdominal Transplantation Unit, Niguarda-Cà Granda Hospital, and School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Wojciech G. Polak
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Christophe Duvoux
- Department of Hepatology and Medical Liver Transplant Unit, Henri Mondor Hospital Assistance Publique-Hôpitaux de Paris, Paris-Est University, Creteil, France
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3
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Romero-Cristóbal M, Mombiela T, Caballero A, Clemente A, Fernández-Yunquera A, Diaz-Fontenla F, Rincón D, Ripoll C, Bermejo J, Catalina MV, Matilla AM, Ibáñez-Samaniego L, Pérez-Peña J, López-Baena JÁ, Díaz-Zorita B, Fernández-Avilés F, Salcedo MM, Bañares R. Clinical Utility of a Risk-Adapted Protocol for the Evaluation of Coronary Artery Disease in Liver Transplant Recipients. Liver Transpl 2019; 25:1177-1186. [PMID: 31106506 DOI: 10.1002/lt.25493] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/08/2018] [Accepted: 04/22/2019] [Indexed: 01/13/2023]
Abstract
The prevalence and management of coronary artery disease (CAD) in liver transplantation (LT) candidates are not well characterized. The aims of this study were to evaluate the impact on clinical outcomes of a specifically designed protocol for the management of asymptomatic CAD in LT candidates and to investigate noninvasive risk profiles for obstructive and nonobstructive CAD for 202 LT candidates. Those with high baseline cardiovascular risk (CVR; defined by the presence of classic CVR factors and/or decreased ejection fraction) received coronary angiography and significant arterial stenosis and were treated with percutaneous stents. Patients were followed up after LT until death or coronary event (CE). There were 78 patients who received coronary evaluation (62 direct angiography, 14 computed tomography coronary angiography, and 2 both). Of them, 39 (50%) patients had CAD of any severity, and 6 (7.7%) had significant lesions (5 were amenable to be treated with stents, whereas 1 patient had diffuse lesions which contraindicated the LT). Insulin-dependent diabetes was the only factor related to CAD of any severity (odds ratio, 3.44; 95% confidence interval [CI], 1.00-11.97). A total of 69 patients (46 with coronary evaluation) received LT. The incidence of CEs and overall survival after LT were similar between patients with and without coronary evaluation. Furthermore, no differences occurred between these groups in a multivariate competing risk model (subhazard ratio, 0.84; 95% CI, 0.27-2.61; P = 0.76). In conclusion, the application of an angiographic screening protocol of CAD in a selected high-risk Mediterranean population is safe and effective. The short- and medium-term incidence rates of CEs and death after LT in this population are similar to that observed in low-risk patients.
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Affiliation(s)
- Mario Romero-Cristóbal
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Teresa Mombiela
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Aranzazu Caballero
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Clemente
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Fernando Diaz-Fontenla
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Diego Rincón
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Cristina Ripoll
- Innere Medizin I, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - María-Vega Catalina
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana-María Matilla
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Luis Ibáñez-Samaniego
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Pérez-Peña
- Department of Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Benjamín Díaz-Zorita
- Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - M Magdalena Salcedo
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Rafael Bañares
- Liver Unit and Digestive Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain
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