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Manuel-Vázquez A, Balakrishnan A, Agami P, Andersson B, Berrevoet F, Besselink MG, Boggi U, Caputo D, Carabias A, Carrion-Alvarez L, Franco CC, Coppola A, Dasari BVM, Diaz-Mercedes S, Feretis M, Fondevila C, Fusai GK, Garcea G, Gonzabay V, Bravo MÁG, Gorris M, Hendrikx B, Hidalgo-Salinas C, Kadam P, Karavias D, Kauffmann E, Kourdouli A, La Vaccara V, van Laarhoven S, Leighton J, Liem MSL, Machairas N, Magouliotis D, Mahmoud A, Marino MV, Massani M, Requena PM, Mentor K, Napoli N, Nijhuis JHT, Nikov A, Nistri C, Nunes V, Ruiz EO, Pandanaboyana S, Saborido BP, Pohnán R, Popa M, Pérez BS, Bueno FS, Serrablo A, Serradilla-Martín M, Skipworth JRA, Soreide K, Symeonidis D, Zacharoulis D, Zelga P, Aliseda D, Santiago MJC, Mancilla CF, Fragua RL, Hughes DL, Llorente CP, Lesurtel M, Gallagher T, Ramia JM. A scoring system for predicting malignancy in intraductal papillary mucinous neoplasms of the pancreas: a multicenter EUROPEAN validation. Langenbecks Arch Surg 2022; 407:3447-3455. [PMID: 36198881 DOI: 10.1007/s00423-022-02687-2] [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] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE A preoperative estimate of the risk of malignancy for intraductal papillary mucinous neoplasms (IPMN) is important. The present study carries out an external validation of the Shin score in a European multicenter cohort. METHODS An observational multicenter European study from 2010 to 2015. All consecutive patients undergoing surgery for IPMN at 35 hospitals with histological-confirmed IPMN were included. RESULTS A total of 567 patients were included. The score was significantly associated with the presence of malignancy (p < 0.001). In all, 64% of the patients with benign IPMN had a Shin score < 3 and 57% of those with a diagnosis of malignancy had a score ≥ 3. The relative risk (RR) with a Shin score of 3 was 1.37 (95% CI: 1.07-1.77), with a sensitivity of 57.1% and specificity of 64.4%. CONCLUSION Patients with a Shin score ≤ 1 should undergo surveillance, while patients with a score ≥ 4 should undergo surgery. Treatment of patients with Shin scores of 2 or 3 should be individualized because these scores cannot accurately predict malignancy of IPMNs. This score should not be the only criterion and should be applied in accordance with agreed clinical guidelines.
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Affiliation(s)
- Alba Manuel-Vázquez
- Department of General and Digestive Surgery, Hospital Universitario de Getafe, Carretera de Toledo, Km 12, 500, 28905, Madrid, Spain.
| | - Anita Balakrishnan
- Department of Hepatopancreatobiliary Surgery, Addenbrooke's Hospital, and Department of Surgery, University of Cambridge, Cambridge, UK
| | - Paul Agami
- Moscow Clinical Scientific Center, Moscow, Russia
| | - Bodil Andersson
- Department of Clinical Sciences Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden
| | - Frederik Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | | | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Damiano Caputo
- General Surgery Department, Medico University of Rome, Campus Bio, Rome, Italy
| | - Alberto Carabias
- Department of General and Digestive Surgery, Hospital Universitario de Getafe, Carretera de Toledo, Km 12, 500, 28905, Madrid, Spain
| | | | - Carmen Cepeda Franco
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Team, Virgen del Rocio University Hospital, Seville, Spain
| | - Alessandro Coppola
- General Surgery Department, Medico University of Rome, Campus Bio, Rome, Italy
| | | | - Sherley Diaz-Mercedes
- Department of Pathology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Michail Feretis
- Department of Hepatopancreatobiliary Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Constantino Fondevila
- Department of General and Digestive Surgery, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, CIBERehd, Spain
| | - Giuseppe Kito Fusai
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Giuseppe Garcea
- Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - Victor Gonzabay
- Department of General and Digestive Surgery, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, CIBERehd, Spain
| | - Miguel Ángel Gómez Bravo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Team, Virgen del Rocio University Hospital, Seville, Spain
| | - Myrte Gorris
- Academic Medical Center, Amsterdam, The Netherlands
| | - Bart Hendrikx
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | - Camila Hidalgo-Salinas
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | | | - Dimitrios Karavias
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Emanuele Kauffmann
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Amar Kourdouli
- Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - Vincenzo La Vaccara
- General Surgery Department, Medico University of Rome, Campus Bio, Rome, Italy
| | - Stijn van Laarhoven
- Department of HPB Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Mike S L Liem
- Division of HPB Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Nikolaos Machairas
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | | | - Adel Mahmoud
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Marco V Marino
- Azienda Ospedaliera, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Marco Massani
- Department of Surgery, Regional Hospital "Ca Foncello"Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| | | | | | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Jorieke H T Nijhuis
- Division of HPB Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Andrej Nikov
- Department of Surgery, Military University Hospital Prague, Prague, Czech Republic
| | - Cristina Nistri
- Department of Surgery, Regional Hospital "Ca Foncello"Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| | - Victor Nunes
- HPB Surgery, Hospital Prof Dr Fernando Fonseca, Amadora, Portugal
| | - Eduardo Ortiz Ruiz
- Department of Pathology, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
| | | | - Baltasar Pérez Saborido
- Department of General and Digestive Surgery, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Radek Pohnán
- Department of Surgery, Military University Hospital Prague, Prague, Czech Republic
| | - Mariuca Popa
- Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | | | | | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Saragossa, Spain
| | | | - James R A Skipworth
- Department of HPB Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Piotr Zelga
- Department of Hepatopancreatobiliary Surgery, Addenbrooke's Hospital, Cambridge, UK
| | | | | | | | | | - Daniel Llwyd Hughes
- Department of HPB Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | | | - Mickaël Lesurtel
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, University of Lyon I, Hospices Civils de Lyon, Lyon, France
| | - Tom Gallagher
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
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Ferreras D, Ruiz de Angulo D, Sánchez Bueno F. Gastrointestinal bleeding in a pancreatic arteriovenous malformation successfully treated by transarterial embolization. Rev Esp Enferm Dig 2020; 112:505-506. [PMID: 32379477 DOI: 10.17235/reed.2020.6518/2019] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pancreatic arteriovenous malformation (PAVM) is a rare case of upper gastrointestinal bleeding (UGIB), but it must be recognized in clinical practice, as it may be a potentially lethal condition in case of rupture and haemorrhage. This anatomic alteration is extremely rare as less than a hundred cases are reported in the scientific literature. The aim of this work is to report a case of PAVM presented as upper gastrointestinal bleeding (UGIB) and successfully treated by transarterial embolization.
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Affiliation(s)
- David Ferreras
- Cirugía General y del Aparato Dige, Hospital Universitario Virgen de la Arrixaca
| | - David Ruiz de Angulo
- Cirugía General y del Aparato Dige, Hospital Clinico Universitario Virgen de la Arrixaca, ESPAÑA
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Ferreras D, López-López V, Robles Campos R, Sánchez Bueno F, Ramírez P. Liver transplantation as a rescue surgery after failure of embolization of a giant hepatic artery pseudoaneurysm. Rev Esp Enferm Dig 2019; 111:798-801. [PMID: 31526011 DOI: 10.17235/reed.2019.6223/2018] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present the case of a male diagnosed with a giant hepatic artery aneurysm, which first presented with pain and hemorrhage due to a partial rupture of the aneurysm. After discarding treatment with a stent or surgery due to the wide extension, we chose to embolize the hepatic artery with coils. However, the progress was unfavorable after the procedure, with the appearance of liver failure that was resolved by an urgent liver transplantation. Giant hepatic artery pseudoaneurysms are an infrequent entity and their management is a great challenge. The diagnosis is usually delayed due to non-specific clinical signs and the life of the patient may be threatened in the case of rupture. Thus, endovascular or surgical treatment is recommended. Aneurysm embolization or ligation has been described in the literature as a valid treatment option in cases where revascularization by stent or bypass is not possible, as it preserves the viability of the liver due to the portal flow and collateral arteries. However, in the case of the failure of these treatments, liver transplantation is a rescue option.
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Affiliation(s)
- David Ferreras
- Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, España
| | - Víctor López-López
- Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, España
| | - Ricardo Robles Campos
- Cirugía General y Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca
| | | | - Pablo Ramírez
- Cirugía General y Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca
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Ríos A, Febrero B, Ramírez P, Rodriguez JM, Robles R, Bueno FS, Medina JG, Capel A, Parrilla P. Successful Embolization of a Cytomegalovirus-Related Duodenal Ulcer in a Kidney-Pancreas Transplant Recipient. Prog Transplant 2013; 23:217-9. [DOI: 10.7182/pit2013574] [Citation(s) in RCA: 2] [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] [Indexed: 01/23/2023]
Abstract
One of the complications that can occur in pancreas transplant is a massive intestinal hemorrhage, although such a hemorrhage is very rarely caused by ulcers due to cytomegalovirus infection. Treatment is fundamentally based on relaparatomy, although in some cases interventional radiology can be an efficient alternative because it allows the exact bleeding point to be located and therapeutic embolization to be performed. In this case, a man with diabetes type 1 who was given a simultaneous kidney-pancreas transplant had an ulcer due to cytomegalovirus infection develop in the duodenal graft (in the early postoperative period), causing a severe hemorrhage in the lower part of the gastrointestinal tract that was controlled via selective embolization of a branch of the pancreaticoduodenal artery.
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Affiliation(s)
- Antonio Ríos
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain (AR, BF, PR, JMR, RR, FSB, JGM, AC, PP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; AR, BF, PR, JMR, RR, FSB, PP)
| | - Beatriz Febrero
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain (AR, BF, PR, JMR, RR, FSB, JGM, AC, PP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; AR, BF, PR, JMR, RR, FSB, PP)
| | - Pablo Ramírez
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain (AR, BF, PR, JMR, RR, FSB, JGM, AC, PP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; AR, BF, PR, JMR, RR, FSB, PP)
| | - Jose Manuel Rodriguez
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain (AR, BF, PR, JMR, RR, FSB, JGM, AC, PP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; AR, BF, PR, JMR, RR, FSB, PP)
| | - Ricardo Robles
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain (AR, BF, PR, JMR, RR, FSB, JGM, AC, PP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; AR, BF, PR, JMR, RR, FSB, PP)
| | - Francisco Sánchez Bueno
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain (AR, BF, PR, JMR, RR, FSB, JGM, AC, PP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; AR, BF, PR, JMR, RR, FSB, PP)
| | - José García Medina
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain (AR, BF, PR, JMR, RR, FSB, JGM, AC, PP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; AR, BF, PR, JMR, RR, FSB, PP)
| | - Antonio Capel
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain (AR, BF, PR, JMR, RR, FSB, JGM, AC, PP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; AR, BF, PR, JMR, RR, FSB, PP)
| | - Pascual Parrilla
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain (AR, BF, PR, JMR, RR, FSB, JGM, AC, PP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; AR, BF, PR, JMR, RR, FSB, PP)
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Cascales Campos PA, Romero PR, Gonzalez R, Zambudio AR, Martinez Frutos IM, de la Peña J, Bueno FS, Robles Campos R, Miras M, Pons Miñano JA, Sanmartin Monzo A, Domingo J, Bixquert Montagud V, Parrilla Paricio P. Improving the waiting list by using 75-year-old donors for recipients with hepatocellular carcinoma. Transplant Proc 2010; 42:627-30. [PMID: 20304209 DOI: 10.1016/j.transproceed.2010.02.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The best treatment for hepatocellular carcinoma (HCC) associated with liver cirrhosis is liver transplantation and the best results are obtained when the tumors fulfill the Milan criteria. However, although the number of transplants is increasing, the organ deficit is growing, which lengthens time on the waiting list, increasing the risk of tumor progression of and exclusion from the list. The use of elderly donors is a valid option for patients on the transplant waiting list with HCC, reducing time on the waiting list. We report our experience with patients transplanted for HCC associated with hepatic cirrhosis using livers from donors >75 years of age. Our preliminary results supported the use of elderly suboptimal donors making it possible to give priority to these patients. All patients in the series achieved good graft function after a follow-up of 2 years with a 100% disease-free survival rate. More extensive long-term studies are needed to confirm these findings.
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Affiliation(s)
- P A Cascales Campos
- Liver Transplant Unit, Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain.
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Marín C, Robles R, Fernández JA, Bueno FS, Ramírez P, Miras M, Parrilla P. Role of liver transplantation in the management of unresectable neuroendocrine liver metastases. Transplant Proc 2007; 39:2302-3. [PMID: 17889171 DOI: 10.1016/j.transproceed.2007.06.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [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: 12/14/2022]
Abstract
UNLABELLED The use of OLT in the management of liver metastases of any origin is highly controversial, as most patients receiving a transplant for this indication display poor results owing to early tumor spread secondary to the effects of immunosuppression. However, as they have a better biological behavior, neuroendocrine (NE) tumors may be a good indication for OLT. Our aim was to present our experience in the management of unresectable liver metastases of tumors of NE origin. PATIENTS AND METHODS Between January 1996 and April 2006, 10 patients underwent OLT for unresectable liver metastases of a neuroendocrine origin, accounting for 1.2% of all transplants performed to date in our unit (n = 626). The most common location of the primary tumor was the pancreas in six cases: three in the pancreatic tail--one carcinoid tumor, one gastrinoma, and one nonfunctioning NE [NF-NE] tumor; and three cases in the pancreatic head--three NF-NE tumors. In the remaining four cases, including three carcinoid tumours and one NF-NE tumors, two were located in the small bowel (at the ileum and ileocecal valve) and two in the lung. The liver metastases were synchronous with the primary tumor in seven cases and metachronous in three cases. RESULTS The morbidity rate was 75% and the mortality rate, 10% (n = 1). The tumor recurrence rate was 33% with 1- and 3-year survival rates of 86% and 57%, respectively.
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Affiliation(s)
- C Marín
- Virgen de la Arrixaca University Hospital, Department of General Surgery, Liver Transplant Unit, Murcia, Spain.
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Abstract
UNLABELLED The indications of progressive neurological deterioration despite no hepatic insufficiency, for liver transplant (OLT) in patients with Wilson's disease (WD) who do not improve with medical treatment is widely debated. The aim of this paper was to present our OLT experience in WD. PATIENTS AND METHODS Fourteen patients were given a transplant after the diagnosis of WD for the following indications: in four patients, a steady neurological deterioration that failed to respond to chelation treatment (all with Child grade A liver function); in nine patients, Child grade C hepatic insufficiency, in whom medical treatment had failed (one of these patients also presented with severe neurological alterations); and in one patient, acute hepatic failure secondary to E. Coli infection of the ascitic fluid. RESULTS Two patients died, one due to severe pancreatitis in the immediate postoperative period and the other, who was transplanted for neurological involvement, experienced an acute rejection episode treated with methylprednisolone in the first postoperative month and, in the 4th month, another episode of acute rejection, failed to respond to corticoids and required OKT-3 administration. She subsequently developed bilateral bronchopneumonia due to cytomegalovirus that led to her death. During the immediate postoperative period all of the cupremia, cupriuria, and ceruloplasmin levels returned to normal. The liver function in the 12 patients currently alive was totally normal after a follow-up of 8 years (range, 1-15 years) with actuarial 5-year survival of 85.7%. CONCLUSIONS These cases demonstrated that OLT may mobilize copper sufficiently from the central nervous system to correct severe neurological deficits, a result that medical therapy alone cannot achieve. We suggest that OLT be considered for patients with WD who have crippling neurological and psychological diseases, even if liver function is stable.
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Affiliation(s)
- C Marin
- Virgen de la Arrixaca University Hospital, Department of General Surgery, Liver Transplant Unit, Murcia, Spain.
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Palenciano CG, Acosta F, Segura B, Sansano T, Ramírez P, Fernandez-Rodriguez O, Majado M, Ríos A, Munoz A, Robles R, Bueno FS, Parrilla P. Hemodynamic changes during reperfusion of the graft in an animal model of liver xenotransplantation. Transplant Proc 2007; 39:2441-2. [PMID: 17889213 DOI: 10.1016/j.transproceed.2007.06.064] [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: 10/22/2022]
Abstract
UNLABELLED Our goal was to determine the hemodynamic changes that are witnessed during the initial minutes of reperfusion of the graft in liver xenotransplantation from pig to baboon. METHOD We studied a group of 12 baboons undergoing transplantation of a pig liver via the classic technique with arterial anastomosis to the aorta. The anesthesia technique was similar to that used in humans. Hemodynamic monitoring, due to the size of the recipient, consisted of heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP) recorded at the beginning and end of each of the three phases: preanhepatic (A1, A2), anhepatic (B1, B2), and neohepatic (C1 and C2). We aimed to maintain the following values by means of crystalloids, colloids, and blood derivates: HR >50 beats/minute; MAP >60 mm Hg; and CVP >10 mm Hg. RESULTS Both HR and CVP remained unchanged throughout the procedure. MAP droped briefly after vascular clamping (B1) but not on reperfusion (C1). CONCLUSION In cirrhotic patients there is an autonomic dysfunction, demonstrated as cardiovascular instability at times like the clamping of major vessels and reperfusion of the graft. On the other hand, the intact baboon has an intact nervous system. After vascular clamping, the sharp decrease in venous return lead to an adequate vasopressor response. Likewise, the extreme vasodilatation involved with reperfusion managed to maintain MAP above 70 mm Hg.
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Affiliation(s)
- C G Palenciano
- Liver Transplant Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
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Cabezuelo JB, Ramírez P, Ríos A, Acosta F, Torres D, Sansano T, Pons JA, Bru M, Montoya M, Bueno FS, Robles R, Parrilla P. Risk factors of acute renal failure after liver transplantation. Kidney Int 2006; 69:1073-80. [PMID: 16528257 DOI: 10.1038/sj.ki.5000216] [Citation(s) in RCA: 213] [Impact Index Per Article: 11.8] [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: 12/14/2022]
Abstract
The objective of this study was to determine the risk factors of postoperative acute renal failure (ARF) in orthotopic liver transplantation (OLT). We reviewed 184 consecutive OLT. Postoperative ARF was defined as a persistent rise of 50% increase or more of the S-creatinine (S-Cr). The patients were classified as early postoperative ARF (E-ARF) (first week) and late postoperative ARF (L-ARF) (second to fourth week). Preoperative variables were age, sex, comorbidity, indication for OLT, Child-Pugh stage, united network for organ sharing status, analysis of the blood and urine, and donor's data. Intraoperative variables were systolic arterial pressure, mean arterial pressure, pulmonary capillary wedge pressure, cardiac index, and systemic vascular resistance index. Surgical technique, number of blood products transfused, need for adrenergic agonist drugs, and intraoperative complications were also important. Postoperative variables were duration of stay in the intensive care unit, time on mechanic ventilation, liver graft dysfunction, need for adrenergic agonist drugs, units of blood products infused, episodes of acute rejection, re-operations, and bacterial infections. Firstly we carried out a univariate statistical analysis, and secondly a logistic regression analysis. The risk factors for E-ARF were: pretransplant ARF (odds ratio (OR)=10.2, P=0.025), S-albumin (OR=0.3, P=0.001), duration of treatment with dopamine (OR=1.6, P=0.001), and grade II-IV dysfunction of the liver graft (OR=5.6, P=0.002). The risk factors for L-ARF were: re-operation (OR=3.1, P=0.013) and bacterial infection (OR=2.9, P=0.017). The development of E-ARF is influenced by preoperative factors such as ARF and hypoalbuminemia, as well as postoperative factors such as liver dysfunction and prolonged treatment with dopamine. The predicting factors of L-ARF differ from E-ARF and correspond to postoperative causes such as bacterial infection and surgical re-operation.
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Affiliation(s)
- J B Cabezuelo
- Nephrology Unit, Santa María del Rosell Hospital, Cartagena, Spain
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Acosta F, Sansano T, Palenciano CG, Domenech P, Falcon L, Robles R, Bueno FS, Ramirez P, Parrilla P. Differential response of the systemic and pulmonary circulation related to disease severity of cirrhosis. Transplant Proc 2006; 37:3889-90. [PMID: 16386574 DOI: 10.1016/j.transproceed.2005.10.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/21/2022]
Abstract
BACKGROUND In cirrhotic patients, the degree of hepatic insufficiency has been related to a physiological landmark: arterial vasodilatation. We sought to assess how the severity of disease, which was stratified according to the Child-Pugh criteria, influences the pulmonary and systemic circulation among patients undergoing liver transplantation. METHODS We studied 86 cirrhotic patients in three groups: grade A (n = 10), grade B (n = 54), and grade C (n = 22). The outurnes were classified based upon a complete hemodynamic profile obtained using a pulmonary artery catheter (RVEF, Baxter-Edwards, Calif, USA) after induction of anesthesia. The variables were mean arterial and pulmonary artery pressures and cardiac index (CI). Using standard formulae, afterload was calculated as elastance of systemic (Es) and pulmonary (Ep) arterial beds, expressed by the ratio of end-systolic pressure to stroke volume. The relation between pulmonary and systemic circulation was also evaluated by the ratio (Ep/Es). RESULTS Es was significantly lower in each class than in previous one. Also, Ep was smaller in class B than in class C patients. In addition, CI was significantly higher with disease severity. CONCLUSION We observed that the hyperdynamic circulation in cirrhosis is directly related to severity of disease. Nevertheless Ep/Es was progressively higher among each group; these data suggest that the hyperdynamic circulation is mainly due to circulatory alterations in the splanchnic area. We conclude that pulmonary vasodilatation is directly related to the severity of cirrhosis, although its evolution is independent of other vascular areas.
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Affiliation(s)
- F Acosta
- Liver Transplantation Unit, University Hospital V, Arrixaca, Murcia, Spain.
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Acosta F, Sansano T, Palenciano CG, Falcón L, Doménech P, Robles R, Bueno FS, Ramírez P, Parrilla P. Effects of rapid paracentesis on right ventricular-arterial coupling in liver transplantation. Transplant Proc 2006; 37:3867-8. [PMID: 16386566 DOI: 10.1016/j.transproceed.2005.10.065] [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: 10/25/2022]
Abstract
BACKGROUND In cirrhotic patients intra-abdominal pressure (IAP) changes markedly modify splanchnic and systemic hemodynamics. Previous studies have evaluated the effects of increased IAP on steady-state cardiac performance, showing that right ventricular (RV) function becomes more depressed than that of the left ventricular. We sought to evaluate the effects of paracentesis on RV function and ventricular-arterial coupling among cirrhotics undergoing liver transplantation (OLT). METHODS Twelve cirrhotic patients undergoing OLT underwent hemodynamic profiles before and 5 minutes after paracentesis, employing a right ventricular ejection fraction catheter in the pulmonary artery. We studied heart rate, systolic pulmonary artery pressure, central venous pressure (CVP), stroke volume index (SVI), RV end-diastolic volume index (RVEDI), and RV ejection fraction. In addition RV stroke work index (RVSWI), RV end-diastolic compliance (RVEDC), RV end-systolic elastance (Ees), pulmonary artery effective elastance (Ea), and RV coupling efficiency (Ees/Ea ratio) were calculated employing standard formulas. RESULTS After removal of mean ascites volume of 5.6 +/- 2.2 L (range 4.0 to 8.04 L), SVI, RVEDI, RVSWI, and RVEDC were significantly increased and conversely CVP, Ees, and Ea were decreased with an ea/ea ratio unchanged. CONCLUSIONS Before paracentesis Ees/Ea is preserved by increased of RV contractility; after paracentesis the coupling was maintained.
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Affiliation(s)
- F Acosta
- Liver Transplantation Unit, University Hospital V, Arrixaca, Murcia, Spain.
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12
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Acosta F, Sansano T, Palenciano CG, Falcon L, Domenech P, Robles R, Bueno FS, Ramirez P, Parrilla P. Effects of Dobutamine on Right Ventricular Function and Pulmonary Circulation in Pulmonary Hypertension During Liver Transplantation. Transplant Proc 2005; 37:3869-70. [PMID: 16386567 DOI: 10.1016/j.transproceed.2005.10.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 10/25/2022]
Abstract
INTRODUCTION In the setting of orthotopic liver transplantation (OLT), pulmonary hypertension (PH) affects right ventricular (RV) function. When RV failure occurs, reducing RV afterload, optimizing RV preload, and preserving coronary perfusion through maintenance of systemic blood pressure are the primary goals of intraoperative treatment. PATIENTS AND METHODS To verify the effect of dobutamine on RV function and RV-arterial coupling, we compared a group of 9 cirrhotic patients with mild PH treated with OLT to a group of 20 patients with normal mean pulmonary artery pressure (MPAP). All patients received dobutamine (5-10 microg/kg/min) to maintain a cardiac index (CI) >3 L/min/m(2), during the anhepatic phase. Hemodynamic profile, using a pulmonary artery catheter, was performed before and during dobutamine infusion, studying MPAP, CI, and RV end-diastolic volume index (RVEDVI). RV stroke work index (RVSWI), RV end-systolic elastance (Ees), pulmonary effective elastance (Ea), and RV-arterial coupling efficiency as the Ees/Ea ratio were also calculated. RESULTS RV contractility (Ees and RVSWI) and afterload (Ea) were significantly higher among the PH group. In both groups, all the studied variables improved with dobutamine: RV contractility increased, afterload decreased, and thus Ees/Ea coupling markedly increased. CONCLUSION Cirrhotic patients with mild PH who were undergoing OLT still have a reserve of RV contractile performance and pulmonary vasodilation.
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Affiliation(s)
- F Acosta
- Liver Transplantation Unit, University Hospital V. Arrixaca, Murcia, Spain.
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13
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Acosta F, Sansano T, Palenciano CG, Domenech P, Falcon L, Robles R, Bueno FS, Ramirez P, Parrilla P. Portopulmonary Hypertension and Liver Transplantation: Hemodynamic Consequences at Reperfusion. Transplant Proc 2005; 37:3865-6. [PMID: 16386565 DOI: 10.1016/j.transproceed.2005.10.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 10/25/2022]
Abstract
BACKGROUND The absence of portopulmonary hypertension (PH) upon preoperative evaluation for liver transplantation (OLT) does not exclude the occasional occurrence of an acquired PH while awaiting a graft. We sought to estimate hemodynamic changes and right ventriculoarterial coupling during reperfusion. METHODS We studied 11 cirrhotic patients diagnosed with mild PH, according to the current classification: mean pulmonary artery pressure (MPAP)-25 to 34 mm Hg. These patients underwent OLT, using the piggyback technique (group PH). None of them had exhibited criteria for PH on preoperative echocardiography. This cohort was compared with 20 consecutive cirrhotic patients with normal MPAP at OLT. We performed a complete hemodynamic profile using a pulmonary artery catheter (RVEF, Baxter-Edwards, Calif, USA) before and 5 minutes after reperfusion. The variables were MPAP and right ventricular (RV) end-diastolic volume index (RVEDVI). Using standard formulas we calculated RV stroke work index (RVSWI), RV end-systolic elastance (Ees), pulmonary effective elastance (Ea), and RV-arterial coupling efficiency as the Ees/Ea ratio. Systolic ventricular function was expressed as RVSWI versus RVEDVI. RESULTS During the anhepatic phase, MPAP, Ees, Ea, and RVSWI were higher in the PH group; but RVEDVI was lower. After reperfusion the pressure (MPAP), contractility (RVSWI) and preload (RVEDVI) increased in both groups. However, afterload (Ea) decreased in the non-PH group; accordingly, Es/Ea increased only in these patients. DISCUSSION At reperfusion, the expansion in preload and cardiac output, without a similar afterload decrease, is responsible for the steady increase in pressure. Our results have shown that in the PH patient group, systolic ventricular function improves during reperfusion by a Frank-Starling mechanism; however, ventricular-arterial uncoupling is maintained (Ees/Ea < 1) because ventricular contractility is not appropriately balanced by simultaneous declines in afterload.
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Affiliation(s)
- F Acosta
- Liver Transplantation Unit, University Hospital V, Arrixaca, Murcia, Spain.
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14
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Robles R, Figueras J, Turrión VS, Margarit C, Moya A, Varo E, Calleja J, Valdivieso A, Valdecasas JCG, López P, Gómez M, de Vicente E, Loinaz C, Santoyo J, Fleitas M, Bernardos A, Lladó L, Ramírez P, Bueno FS, Jaurrieta E, Parrilla P. Spanish experience in liver transplantation for hilar and peripheral cholangiocarcinoma. Ann Surg 2004; 239:265-71. [PMID: 14745336 PMCID: PMC1356221 DOI: 10.1097/01.sla.0000108702.45715.81] [Citation(s) in RCA: 209] [Impact Index Per Article: 10.5] [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: 12/15/2022]
Abstract
OBJECTIVE To assess the real utility of orthotopic liver transplantation (OLT) in patients with cholangiocarcinoma, we need series with large numbers of cases and long follow-ups. The aim of this paper is to review the Spanish experience in OLT for hilar and peripheral cholangiocarcinoma and to try to identify the prognostic factors that could influence survival. SUMMARY BACKGROUND DATA Palliative treatment of nondisseminated irresectable cholangiocarcinoma carries a zero 5-year survival rate. The role of OLT in these patients is controversial, due to the fact that the survival rate is lower than with other indications for transplantation and due to the lack of organs. METHODS We retrospectively reviewed 59 patients undergoing OLT in Spain for cholangiocarcinoma (36 hilar and 23 peripheral) over a period of 13 years. We present the results and prognostic factors that influence survival. RESULTS The actuarial survival rate for hilar cholangiocarcinoma at 1, 3, and 5 years was 82%, 53%, and 30%, and for peripheral cholangiocarcinoma 77%, 65%, and 42%. The main cause of death, with both types of cholangiocarcinoma, was tumor recurrence (present in 53% and 35% of patients, respectively). Poor prognosis factors were vascular invasion (P < 0.01) and IUAC classification stages III-IVA (P < 0.01) for hilar cholangiocarcinoma and perineural invasion (P < 0.05) and stages III-IVA (P < 0.05) for peripheral cholangiocarcinoma. CONCLUSIONS OLT for nondisseminated irresectable cholangiocarcinoma has higher survival rates at 3 and 5 years than palliative treatments, especially with tumors in their initial stages, which means that more information is needed to help better select cholangiocarcinoma patients for transplantation.
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Robles R, Figueras J, Turrión VS, Margarit C, Moya A, Varo E, Calleja J, Valdivieso A, Garcia-Valdelcasas JC, López P, Gómez M, de Vicente E, Loinaz C, Santoyo J, Casanova D, Bernardos A, Fernández JA, Marín C, Ramírez P, Bueno FS, Jaurrieta E, Parrilla P. Liver transplantation for hilar cholangiocarcinoma: Spanish experience. Transplant Proc 2003; 35:1821-2. [PMID: 12962808 DOI: 10.1016/s0041-1345(03)00724-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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: 12/19/2022]
Abstract
INTRODUCTION Palliative treatment for nondisseminated irresectable hilar cholangiocarcinoma (HCC) carries a 0% 5-year survival rate. The role of orthotopic liver transplantation (OLT) in these patients is controversial because the survival rate is lower than that for other indications for transplantation and the lack of available donor organs. The aim of this paper was to review the Spanish experience in OLT for HCC and identify prognostic factors for survival. METHODS We retrospectively reviewed 36 patients undergoing OLT for HCC over 13 years. RESULTS The actuarial survival rate at 1, 3, and 5 years was 82%, 53%, and 30%, respectively. The main cause of death was tumor recurrence (53%). In the univariate analysis, the factors for a poor prognosis were vascular invasion (P<.001) namely 0% survival at 3 years when present versus 63% and 35% at 3 and 5 years, respectively, when it was not; and stages III to IVA (P<.05), namely 15% survival at 5 years versus 47% for stages I to II. Lymph node and perineural invasion also reduce survival. In the multivariate analysis, the factors for poor prognosis included vascular invasion (P<.01) and stages III to IVA (P<.01). CONCLUSION OLT for nondisseminated irresectable HCC has higher survival rates at 3 and 5 years than palliative treatments, especially with initial stage tumors, which means that more information is needed to better select cholangiocarcinoma patients for transplantation.
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Affiliation(s)
- R Robles
- Virgen de la Arrixaca University Hospital, Murcia, Spain.
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16
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Acosta F, Sansano T, Palenciano CG, Roqués V, Clavel N, González P, Robles R, Bueno FS, Ramírez P, Parrilla P. Does mixed venous oxygen saturation reflect the changes in cardiac output during liver transplantation? Transplant Proc 2002; 34:277. [PMID: 11959284 DOI: 10.1016/s0041-1345(01)02762-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V.Arrixaca, Murcia, Spain
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17
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Acosta F, Rodriguez MA, Sansano T, Palenciano CG, Roques V, Clavel N, González P, Robles R, Bueno FS, Ramirez P, Parrilla P. Influence of the basal cardiovascular state on the need for venovenous bypass during liver transplantation. Transplant Proc 2002; 34:273-4. [PMID: 11959281 DOI: 10.1016/s0041-1345(01)02759-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V. Arrixaca, Murcia, Spain
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18
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Acosta F, Sansano T, Palenciano CG, Roqués V, Clavel N, González P, Robles R, Bueno FS, Ramírez P, Parrilla P. Physiological changes induced by continuous arteriovenous hemodialysis during liver transplantation. Transplant Proc 2002; 34:276. [PMID: 11959283 DOI: 10.1016/s0041-1345(01)02761-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V.Arrixaca, Murcia, Spain
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19
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Ramirez P, Chavez R, Majado M, Munitiz V, Muñoz A, Hernandez O, Palenciano CG, Pino-Chavez G, Loba M, Minguela A, Yelamos J, Gago MR, Vizcaino AS, Asensi H, Cayuela M, Segura B, Marin F, Rubio A, Fuente T, Robles R, Bueno FS, Sansano T, Acosta F, Rodriguez JM, Rios A, Montoya M, Navarro F, Cabezuelo J, Cozzi E, White DJG, Parrilla P. Transgenic pig-to-baboon liver xenotransplantation: clinical, biochemical, and immunologic pattern of delayed acute vascular rejection. Transplant Proc 2002; 34:319-20. [PMID: 11959306 DOI: 10.1016/s0041-1345(01)02834-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- P Ramirez
- Liver Transplant Unit, Department of Surgery, University Hospital Virgen Arrixaca, Murcia, Spain.
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20
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Fernández JA, Claver MA, Llorente S, Gimeno L, Robles R, Ramírez P, Bueno FS, Rodríguez JM, Luján JA, Munítiz V, Parrilla P. Clinical noninvasive evaluation of simultaneous pancreas-kidney transplants with the combined use of gammagraphy, Doppler ultrasound, and serum markers. Transplant Proc 2002; 34:209-10. [PMID: 11959250 DOI: 10.1016/s0041-1345(01)02728-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J A Fernández
- Servicio de Ciurgía I, Unidad de Trasplante, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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21
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Acosta F, Sansano T, Palenciano CG, Roqués V, Clavel N, González P, Robles R, Bueno FS, Ramirez P, Parrilla P. Relationship between cardiovascular state and degree of hepatic dysfunction in patients treated with liver transplantation. Transplant Proc 2002; 34:266-7. [PMID: 11959277 DOI: 10.1016/s0041-1345(01)02755-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V. Arrixaca, Murcia, Spain
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22
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Acosta F, Sansano T, Palenciano CG, Roqués V, Clavel N, González P, Robles R, Bueno FS, Ramírez P, Parrilla P. Changes in pulmonary circulation during liver transplantation. Transplant Proc 2002; 34:272. [PMID: 11959280 DOI: 10.1016/s0041-1345(01)02758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V.Arrixaca, Murcia, Spain
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23
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Acosta F, Sansano T, Palenciano CG, Roqués V, Clavel N, González P, Robles R, Bueno FS, Ramírez P, Parrilla P. Effects of norepinephrine on right ventricular function during liver transplantation. Transplant Proc 2002; 34:275. [PMID: 11959282 DOI: 10.1016/s0041-1345(01)02760-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V. Arrixaca, Murcia, Spain
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24
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Cabezuelo JB, Ramirez P, Chavez R, Majado M, Munitiz V, Muñoz A, Hernandez Q, G-Palenciano C, Pino-Chávez G, Loba M, Yélamos J, Vizcaino AS, Cayuela M, Segura B, Marin F, Rubio A, Fuente T, Gago MR, Ríos A, Montoya M, Esteban A, Bueno FS, Robles R, Cozzi E, White DJG, Parrilla P. Assessment of renal function during the postoperative period following liver xenotransplantation from transgenic pig to baboon. Transplant Proc 2002; 34:321-2. [PMID: 11959307 DOI: 10.1016/s0041-1345(01)02782-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J B Cabezuelo
- Liver Transplant Unit, University Hospital V. Arrixaca, El Palmar, Murcia, Spain
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Robles R, Ramírez P, Bueno FS, Fernández JA, Rodríguez JM, Luján JA, Munítiz V, Marín C, Parrilla P. Importance of training in liver resection surgery to implement programs of living donor liver transplantation. Transplant Proc 2002; 34:240. [PMID: 11959264 DOI: 10.1016/s0041-1345(01)02742-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- R Robles
- Virgen de la Arrixaca University Hospital, Department of General Surgery, Liver Transplant Unit, Murcia, Spain
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26
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Palenciano CG, Segura B, Ramirez P, Chavez R, Munitiz V, Cayuela MG, Acosta F, Sansano T, Majado M, Muñoz A, Hernandez O, Pino-Chavez G, Loba M, Yelamos J, Gago MR, Vizcaino AS, Asensi H, Marin F, Rubio A, Fuente T, Rios A, Montoya M, Robles R, Bueno FS, Rodriguez JM, Navarro F, Cabezuelo J, Cozzi E, White DJG, Parrilla P. Acid-base and electrolyte disturbances in an experimental model of orthotopic liver xenotransplantation from pig to baboon after graft reperfusion: differences between h-DAF livers and unmodified livers. Transplant Proc 2002; 34:325-6. [PMID: 11959309 DOI: 10.1016/s0041-1345(01)02784-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- C G Palenciano
- Liver Transplant Unit, University Hospital V. Arrixaca, El Palmar, Murcia, Spain
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Fernandez JA, Robles R, Ramirez P, Bueno FS, Rodriguez JM, Lujan JA, Munitiz V, Martinez E, Llorente S, Gimeno L, Parrilla P. Arterioenteric fistula due to cytomegalovirus infection after pancreas transplantation. Transplantation 2001; 72:966-8. [PMID: 11571472 DOI: 10.1097/00007890-200109150-00042] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pons JA, Ramirez P, Miras M, Robles R, Bueno FS, Marin C, Alberca F, Torrella E, Parrilla P. Hepatitis C in liver transplant patients. Transpl Int 2001; 7 Suppl 1:S213-5. [PMID: 11271205 DOI: 10.1111/j.1432-2277.1994.tb01349.x] [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: 11/28/2022]
Abstract
The aim of this study was to determine whether infection by the hepatitis C virus (HCV) recurs after orthotopic liver transplantation (OLT) and to define the natural history of post-transplantation chronic hepatitis due to HCV. Of 70 patients, 10 (14.3%) were found to have antibodies to HCV before transplantation. After OLT 14 of the 70 patients (20%) had positive anti-HCV antibodies: 8 of 10 positive pre-OLT (80%) and 6 of 60 negative pre-OLT (10%). Of 14 patients anti-HCV+ post-OLT (57%), developed 8 chronic hepatitis: chronic persistent hepatitis in three patients, chronic lobular hepatitis in three patients and chronic, active hepatitis in two patients. We treated four patients with interferon obtaining normalization of transaminases in three of them after 6 months, but with a severe relapse in two. These results suggest that hepatitis C recurs in a majority, of liver transplant recipients and that morbidity is an important consideration. Interferon treatment of these patients requires further study to obtain conclusive results.
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Affiliation(s)
- J A Pons
- Liver Transplant Unit, Hospital Universitario V. Arrixaca, Muricia, Spain
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Acosta F, Sansano T, Palenciano CG, Reche M, Roques V, Beltran R, Robles R, Bueno FS, Ramirez P, Parrilla P. Preoperative pulmonary function in patients treated with liver transplantation. Transplant Proc 2000; 32:2644. [PMID: 11134739 DOI: 10.1016/s0041-1345(00)01819-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
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30
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Acosta F, Moreno J, Fuente T, Diaz J, Sansano T, Palenciano CG, Reche M, Beltran M, Roques V, Robles R, Bueno FS, Ramirez P, Parrilla P. Influence of surgical technique on the plasma concentration of beta-endorphin during liver transplantation. Transplant Proc 2000; 32:2658. [PMID: 11134748 DOI: 10.1016/s0041-1345(00)01828-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
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Acosta F, Diaz J, Sansano T, Palenciano CG, Reche M, Beltran R, Roques V, Robles R, Bueno FS, Ramirez P, Parrilla P. Evolution of the plasma concentration of norepinephrine in cirrhotic patients during liver transplantation. Transplant Proc 2000; 32:2659-60. [PMID: 11134749 DOI: 10.1016/s0041-1345(00)01829-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
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Acosta F, Sansano T, Beltran R, Palenciano CG, Reche M, Roques V, Robles R, Bueno FS, Ramirez P, Parrilla P. Is femoral and radial artery pressure different during reperfusion in liver transplantation? Transplant Proc 2000; 32:2647. [PMID: 11134741 DOI: 10.1016/s0041-1345(00)01821-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
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33
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Acosta F, Sansano T, Palenciano CG, Reche M, Beltran R, Roques RV, Robles R, Bueno FS, Ramirez P, Parrilla P. Hemodynamic effects of rapid paracentesis on liver transplantation. Transplant Proc 2000; 32:2661. [PMID: 11134750 DOI: 10.1016/s0041-1345(00)01830-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
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34
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Acosta F, Sansano T, Palenciano CG, Reche M, Roques V, Beltran R, Robles R, Bueno FS, Ramirez P, Parrilla P. Efficiency of the vasoconstrictor response to vascular exclusion in patients with alcoholic cirrhosis undergoing liver transplantation. Transplant Proc 2000; 32:2662-3. [PMID: 11134751 DOI: 10.1016/s0041-1345(00)01831-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
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35
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Acosta F, Diaz J, Sansano T, Palenciano CG, Reche M, Roques V, Beltran R, Robles R, Bueno FS, Ramirez P, Parrilla P. Hemodynamics related to metabolic changes at reperfusion during liver transplantation. Transplant Proc 2000; 32:2649-50. [PMID: 11134743 DOI: 10.1016/s0041-1345(00)01823-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
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36
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Acosta F, Rodriguez MA, Sansano T, Palenciano CG, Reche M, Roques V, Beltran R, Robles R, Bueno FS, Ramirez P, Parrilla P. Influence of surgical technique on diuresis during liver transplantation. Transplant Proc 2000; 32:2657. [PMID: 11134747 DOI: 10.1016/s0041-1345(00)01827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
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Ramirez P, Chavez R, Majado M, Munitiz V, Muñoz A, Hernandez Q, Palenciano CG, Pino-Chavez G, Loba M, Minguela A, Yelamos J, Gago MR, Vizcaino AS, Asensi H, Cayuela MG, Segura B, Marin F, Rubio A, Fuente T, Robles R, Bueno FS, Sansano T, Acosta F, Rodriguez JM, Navarro F, Cabezuelo J, Cozzi E, White DJ, Calne RY, Parrilla P. Life-supporting human complement regulator decay accelerating factor transgenic pig liver xenograft maintains the metabolic function and coagulation in the nonhuman primate for up to 8 days. Transplantation 2000; 70:989-98. [PMID: 11045632 DOI: 10.1097/00007890-200010150-00001] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.1] [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: 11/25/2022]
Abstract
BACKGROUND It is not known whether the pig liver is capable of functioning efficiently when transplanted into a primate, neither is there experience in transplanting a liver from a transgenic pigs expressing the human complement regulator human complement regulator decay accelerating factor (h-DAF) into a baboon. The objective of this study was to determine whether the porcine liver would support the metabolic functions of non-human primates and to establish the effect of hDAF expression in the prevention of hyperacute rejection of porcine livers transplanted into primates. METHODS Five orthotopic liver xenotransplants from pig to baboon were carried out: three from unmodified pigs and two using livers from h-DAF transgenic pigs. FINDINGS The three control animals transplanted with livers from unmodified pigs survived for less than 12 hr. Baboons transplanted with livers from h-DAF transgenic pigs survived for 4 and 8 days. Hyperacute rejection was not detected in the baboons transplanted with hDAF transgenic pig livers; however, it was demonstrated in the three transplants from unmodified pigs. Baboons transplanted with livers from h-DAF transgenic pigs were extubated at postoperative day 1 and were awake and able to eat and drink. In the recipients of hDAF transgenic pig livers the clotting parameters reached nearly normal levels at day 2 after transplantation and remained normal up to the end of the experiments. In these hDAF liver recipients, porcine fibrinogen was first detected in the baboon plasma 2 hr postreperfusion, and was present up to the end of the experiments. One animal was euthanized at day 8 after development of sepsis and coagulopathy, the other animal arrested at day 4, after an episode of vomiting and aspiration. The postmortem examination of the hDAF transgenic liver xenografts did not demonstrate rejection. INTERPRETATION The livers from h-DAF transgenic pigs did not undergo hyperacute rejection after orthotopic xenotransplantation in baboons. When HAR is abrogated, the porcine liver maintains sufficient coagulation and protein levels in the baboon up to 8 days after OLT.
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Affiliation(s)
- P Ramirez
- Department of Surgery, University Hospital Virgen Arrixaca, Murcia, Spain
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38
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Acosta F, De La Morena G, Villegas M, Sansano T, Reche M, Beltran R, Roques V, Contreras RF, Robles R, Bueno FS, Ramirez P, Parrilla P. Evaluation of cardiac function before and after liver transplantation. Transplant Proc 1999; 31:2369-70. [PMID: 10500622 DOI: 10.1016/s0041-1345(99)00383-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
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39
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Robles R, Parrilla P, Acosta F, Bueno FS, Ramirez P, Lopez J, Lujan JA, Rodriguez JM, Fernandez JA, Picó F. Complications related to hepatic venous outflow in piggy-back liver transplantation: two- versus three-suprahepatic-vein anastomosis. Transplant Proc 1999; 31:2390-1. [PMID: 10500634 DOI: 10.1016/s0041-1345(99)00395-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- R Robles
- Department of Surgery, V Arrixaca University Hospital, Murcia, Spain
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40
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Acosta F, Sansano T, Reche M, Roques V, Beltran R, Rodriguez MA, Contreras RF, Robles R, Bueno FS, Ramirez P, Parrilla P. Is there a cirrhotic myocardiopathy in patients proposed for liver transplantation? Transplant Proc 1999; 31:2368. [PMID: 10500621 DOI: 10.1016/s0041-1345(99)00382-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
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41
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Acosta F, De La Morena G, Villegas M, Sansano T, Reche M, Beltran R, Roques V, Contreras RF, Robles R, Bueno FS, Ramirez P, Parrilla P. Cardiac evaluation of patients with familial amyloidotic polyneuropathy proposed for liver transplantation. Transplant Proc 1999; 31:2372. [PMID: 10500624 DOI: 10.1016/s0041-1345(99)00385-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
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Robles R, Parrilla P, Hernández Q, López J, Ramírez P, Bueno FS, Acosta F, Rodriguez JM, Luján JA. Surgery for esophageal varix bleeding in cirrhotic patients during the era of liver transplants. Transplant Proc 1999; 31:2386-7. [PMID: 10500632 DOI: 10.1016/s0041-1345(99)00393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R Robles
- Department of General Surgery, Virgen de Arrixaca University Hospital, Murcia, Spain
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Robles R, Parrilla P, Acosta F, Bueno FS, Ramirez P, Lujan JA, Rodriguez JM, López J, Fernandez JA. Portosuprahepatic shunt as an alternative to portocaval shunt in an hepatic patients waiting for an orthotopic liver transplant. Transplant Proc 1999; 31:2400-1. [PMID: 10500639 DOI: 10.1016/s0041-1345(99)00400-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- R Robles
- Virgen de la Arrixaca University Hospital, Murcia, Spain
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44
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Majado MJ, Ramírez P, Minguela A, Hernández Q, González C, Loba M, Munítiz V, Rubio A, Chávez R, Acosta F, García C, Pino G, Robles R, Bueno FS, Asensi H, Candel R, Parrilla P. Evolution of blood coagulation factors and hemotherapeutic support in three pig-to-baboon orthotopic liver xenotransplants. Transplant Proc 1999; 31:2622-4. [PMID: 10500747 DOI: 10.1016/s0041-1345(99)00474-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M J Majado
- Hematology Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
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45
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Acosta F, Sansano T, Contreras RF, Reche M, Beltran R, Roques V, Rodriguez MA, Robles R, Bueno FS, Ramirez P, Parrilla P. Changes in serum potassium during reperfusion in liver transplantation. Transplant Proc 1999; 31:2382-3. [PMID: 10500630 DOI: 10.1016/s0041-1345(99)00391-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
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46
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Acosta F, Sansano T, Robles R, Contreras RF, Reche M, Beltran R, Roques V, Rodriguez MA, Bueno FS, Ramirez P, Parrilla P. Hemodynamic consequences of portal and lateral clamping of the inferior vena cava during liver transplantation. Transplant Proc 1999; 31:2413-4. [PMID: 10500647 DOI: 10.1016/s0041-1345(99)00408-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
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47
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Robles R, Parrilla P, Bueno FS, Ramírez P, Luján JA, Rodríguez JM, Acosta F, López J, Hernández Q. Liver transplantation in the management of Klatskin's tumor. Transplant Proc 1999; 31:2494-5. [PMID: 10500686 DOI: 10.1016/s0041-1345(99)00433-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- R Robles
- Department of General Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain
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48
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Robles R, Parrilla P, Sicilia J, Ramírez P, Bueno FS, Rodríguez JM, Luján JA, Fernandez JA, López J. Indications and results of liver transplants in Wilson's disease. Transplant Proc 1999; 31:2453-4. [PMID: 10500667 DOI: 10.1016/s0041-1345(99)00414-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- R Robles
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain
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49
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Acosta F, Sansano T, Contreras RF, Reche M, Beltran R, Roques V, Rodriguez MA, Robles R, Bueno FS, Ramirez P, Parrilla P. Hemodynamic profile in cirrhotic patients undergoing liver retransplantation due to chronic rejection. Transplant Proc 1999; 31:2371. [PMID: 10500623 DOI: 10.1016/s0041-1345(99)00384-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
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50
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Acosta F, Serrano E, Diaz J, Carbonell L, Sansano T, Beltran R, Roques V, Contreras RF, Robles R, Bueno FS, Ramirez P, Parrilla P. Hemodynamic consequences of oxidative stress following reperfusion during liver transplantation. Transplant Proc 1999; 31:2375-6. [PMID: 10500626 DOI: 10.1016/s0041-1345(99)00387-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
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