1
|
Durán M, Calleja R, Hann A, Clarke G, Ciria R, Nutu A, Sanabria-Mateos R, Ayllón MD, López-Cillero P, Mergental H, Briceño J, Perera MTPR. Machine perfusion and the prevention of ischemic type biliary lesions following liver transplant: What is the evidence? World J Gastroenterol 2023; 29:3066-3083. [PMID: 37346149 PMCID: PMC10280793 DOI: 10.3748/wjg.v29.i20.3066] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/01/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023] Open
Abstract
The widespread uptake of different machine perfusion (MP) strategies for liver transplant has been driven by an effort to minimize graft injury. Damage to the cholangiocytes during the liver donation, preservation, or early posttransplant period may result in stricturing of the biliary tree and inadequate biliary drainage. This problem continues to trouble clinicians, and may have catastrophic consequences for the graft and patient. Ischemic injury, as a result of compromised hepatic artery flow, is a well-known cause of biliary strictures, sepsis, and graft failure. However, very similar lesions can appear with a patent hepatic artery and these are known as ischemic type biliary lesions (ITBL) that are attributed to microcirculatory dysfunction rather than main hepatic arterial compromise. Both the warm and cold ischemic period duration appear to influence the onset of ITBL. All of the commonly used MP techniques deliver oxygen to the graft cells, and therefore may minimize the cholangiocyte injury and subsequently reduce the incidence of ITBL. As clinical experience and published evidence grows for these modalities, the impact they have on ITBL rates is important to consider. In this review, the evidence for the three commonly used MP strategies (abdominal normothermic regional perfusion [A-NRP], hypothermic oxygenated perfusion [HOPE], and normothermic machine perfusion [NMP] for ITBL prevention has been critically reviewed. Inconsistencies with ITBL definitions used in trials, coupled with variations in techniques of MP, make interpretation challenging. Overall, the evidence suggests that both HOPE and A-NRP prevent ITBL in donated after circulatory death grafts compared to cold storage. The evidence for ITBL prevention in donor after brain death grafts with any MP technique is weak.
Collapse
Affiliation(s)
- Manuel Durán
- Department of Liver Transplantation, Reina Sofía University Hospital, Córdoba 14004, Spain
| | - Rafael Calleja
- Department of Liver Transplantation, Reina Sofía University Hospital, Córdoba 14004, Spain
| | - Angus Hann
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TH, United Kingdom
| | - George Clarke
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TH, United Kingdom
| | - Ruben Ciria
- Department of Liver Transplantation, Reina Sofía University Hospital, Córdoba 14004, Spain
| | - Anisa Nutu
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
| | | | - María Dolores Ayllón
- Department of Liver Transplantation, Reina Sofía University Hospital, Córdoba 14004, Spain
| | - Pedro López-Cillero
- Department of Liver Transplantation, Reina Sofía University Hospital, Córdoba 14004, Spain
| | - Hynek Mergental
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TH, United Kingdom
| | - Javier Briceño
- Department of Liver Transplantation, Reina Sofía University Hospital, Córdoba 14004, Spain
| | - M Thamara P R Perera
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TH, United Kingdom
| |
Collapse
|
2
|
Pozo-Laderas J, Guler I, Rodríguez-Perálvarez M, Robles J, Mula A, López-Cillero P, de la Fuente C. Early postoperative mortality in liver transplant recipients involving indications other than hepatocellular carcinoma. A retrospective cohort study. Med Intensiva 2021. [DOI: 10.1016/j.medin.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
3
|
Pozo-Laderas JC, Guler I, Rodríguez-Perálvarez M, Robles JC, Mula A, López-Cillero P, de la Fuente C. Early postoperative mortality in liver transplant recipients involving indications other than hepatocellular carcinoma. A retrospective cohort study. Med Intensiva 2021; 45:395-410. [PMID: 34563340 DOI: 10.1016/j.medine.2020.02.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/11/2020] [Indexed: 11/28/2022]
Abstract
AIMS To analyze the perioperative differences in a consecutive cohort of liver transplant recipients (LTRs) classified according to the indication of transplantation, and assess their impact upon early mortality 90 days after transplantation. DESIGN A retrospective cohort study was carried out. SCOPE A single university hospital. PATIENTS A total of 892 consecutive adult LTRs were included from January 1995 to December 2017. Recipients with acute liver failure, retransplantation or with grafts from non-brain death donors were excluded. Two cohorts were analyzed according to transplant indication: hepatocellular carcinoma (HCC-LTR) versus non-carcinoma (non-HCC-LTR). MAIN VARIABLES OF INTEREST Recipient early mortality was the primary endpoint. The pretransplant recipient and donor characteristics, surgical time data and postoperative complications were analyzed as independent predictors. RESULTS The crude early postoperative mortality rate related to transplant indication was 13.3% in non-HCC-LTR and 6.6% in HCC-LTR (non-adjusted HR=2.12, 95%CI=1.25-3.60; p=0.005). Comparison of the perioperative features between the cohorts revealed multiple differences. Multivariate analysis showed postoperative shock (HR=2.02, 95%CI=1.26-3.24; p=0.003), early graft vascular complications (HR=4.01, 95%CI=2.45-6.56; p<0.001) and multiorgan dysfunction syndrome (HR=18.09, 95%CI=10.70-30.58; p<0.001) to be independent predictors of mortality. There were no differences in early mortality related to transplant indication (adjusted HR=1.60, 95%CI=0.93-2.76; p=0.086). CONCLUSIONS The crude early postoperative mortality rate in non-HCC-LTR was higher than in HCC-LTR, due to a greater incidence of postoperative complications with an impact upon mortality (shock at admission to intensive care and the development of multiorgan dysfunction syndrome).
Collapse
Affiliation(s)
- J C Pozo-Laderas
- Intensive Care Medicine, Reina Sofia University Hospital and Maimonides Biomedical Research Institute (IMIBIC), Cordoba, Spain.
| | - I Guler
- Methodology and Biostatistics, IMIBIC, Cordoba, Spain
| | | | - J C Robles
- Intensive Care Medicine, Reina Sofia University Hospital and Maimonides Biomedical Research Institute (IMIBIC), Cordoba, Spain
| | - A Mula
- Intensive Care Medicine, Reina Sofia University Hospital and Maimonides Biomedical Research Institute (IMIBIC), Cordoba, Spain
| | - P López-Cillero
- Surgery and Liver Transplantation, Reina Sofia University Hospital and IMIBIC, Cordoba, Spain
| | - C de la Fuente
- Intensive Care Medicine, Reina Sofia University Hospital and Maimonides Biomedical Research Institute (IMIBIC), Cordoba, Spain
| |
Collapse
|
4
|
Fernández-Carbonell A, Rodríguez-Guerrero E, Merino-Cejas C, Conejero-Jurado MT, Villalba-Montoro R, Romero-Morales MDC, Alados-Arboledas P, Casares-Mediavilla J, Fernández-Carbonell M, López-Cillero P, Caro-Barrera JR. Predictive Factors for Pulmonary Homograft Dysfunction After Ross Surgery: A 20-Year Follow-up. Ann Thorac Surg 2020; 111:1338-1344. [PMID: 32827551 DOI: 10.1016/j.athoracsur.2020.06.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/03/2020] [Revised: 05/31/2020] [Accepted: 06/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND We studied the determinants of hemodynamics and analyzed the incidence, risk factors, and clinical impact of pulmonary homograft dysfunction following Ross surgery, after a 20-year follow-up at our referral center. METHODS From 1997 to 2017, a total of 142 patients underwent surgery using the Ross procedure. The development of moderate-severe stenosis (peak transhomograft pressure gradient 36 mm Hg or greater) and surgical or percutaneous Ross homograft reinterventions were evaluated by echocardiography in the immediate postoperative period and at annual intervals. RESULTS After 20 years of follow-up, 31% of patients had moderate-severe homograft stenosis, and 9.1% had had to undergo one or two reinterventions, of which, six were valve replacements and seven were percutaneous interventions. At 1, 5, and 20 years, 89.4%, 74.6%, and 69% of these patients, respectively, were free from moderate-severe stenosis; and 99.3%, 95.7%, and 90.9%, respectively, had freedom from homograft reintervention. The pediatric group had a higher risk factor for homograft stenosis (hazard ratio 3.70; 95% confidence interval, 1.56 to 7.20, P = .002), whereas donor age behaved as a protective factor (hazard ratio 0.98; 95% confidence interval, 0.95 to 0.99; P = .044). Pulmonary homograft stenosis tended to appear in the first year (10.6%) or at 5 years (25.4%). CONCLUSIONS Pulmonary homografts implanted in the Ross procedure offer satisfactory long-term results, but the level of homograft dysfunction is not negligible. Young recipient and donor age were associated with a higher rate of homograft stenosis during follow-up. Moreover, homograft dysfunction usually occurred during the first few years of follow-up, and may have been related to immune responses.
Collapse
Affiliation(s)
| | | | - Carlos Merino-Cejas
- Department of Cardiovascular Surgery, Reina Sofía University Hospital, Córdoba, Spain
| | | | - Rafael Villalba-Montoro
- Regional Blood Transfusion Center and Tissue Bank, Reina Sofía University Hospital, Córdoba, Spain
| | | | | | | | | | - Pedro López-Cillero
- Hepatobiliary Surgery and Liver Transplant Service, Reina Sofía University Hospital, Córdoba, Spain
| | - José Rafael Caro-Barrera
- Department of Statistics, Econometrics, and Operational Research, University of Córdoba, Córdoba, Spain
| |
Collapse
|
5
|
Ciria R, Gómez-Luque I, Cortés M, Khorsandi SE, Ayllón MD, Rodríguez-Perálvarez M, López-Cillero P, De La Mata M, O'Grady J, Heaton N, Briceño J. Interaction between tacrolimus, MELD score and acute kidney injury after liver transplantation. Analysis on a large contemporary bicenter meld-era series. Clin Transplant 2020; 34:e13890. [PMID: 32356404 DOI: 10.1111/ctr.13890] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/18/2020] [Accepted: 04/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) after liver transplantation (LT) is a common problem with complex management. The aims were to analyze the profile of AKI-RIFLE categories in the post-transplant setting of a wide multicentre cohort of patients in the MELD era and to specifically determine the effect of tacrolimus-based (TACRO) immunosuppressive regimes on the development of AKI. METHODS A retrospective analysis of 550 (2007-2012) consecutive patients transplanted at Reina Sofia, Cordoba, and King's College Hospital, London, was performed. Inclusion criterion was to have CNI as part of initial immunosuppression immediately after LT. RESULTS After exclusion criteria, a total of 477 patients were analyzed. Incidence of AKI within the first 2 weeks after LT was 65.8% (AKI-Risk), 41.3% (AKI-Injury), and 12.3% (AKI-Failure). The development of any type of AKI had no impact on short- and/or long-term survival up to 3 years after the transplant. Moreover, AKI was almost universal in the early post-transplant period and TACRO trough concentrations during the first 2 weeks after the transplant were not predictors of AKI in none of its categories in the multivariate analyses. CONCLUSIONS Low-TACRO-based regimes were not as useful as expected in the prevention of AKI when analyzed in the context of a large contemporary LT series.
Collapse
Affiliation(s)
- Rubén Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Córdoba, Spain
| | - Irene Gómez-Luque
- Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Córdoba, Spain
| | - Miriam Cortés
- Institute of Liver Studies. King's College Hospital, King's Health Partners, London, UK
| | - Shirin E Khorsandi
- Institute of Liver Studies. King's College Hospital, King's Health Partners, London, UK
| | - Maria D Ayllón
- Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Córdoba, Spain
| | - Manuel Rodríguez-Perálvarez
- Unit of Hepatology and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain
| | - Pedro López-Cillero
- Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Córdoba, Spain
| | - Manuel De La Mata
- Unit of Hepatology and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain
| | - John O'Grady
- Institute of Liver Studies. King's College Hospital, King's Health Partners, London, UK
| | - Nigel Heaton
- Institute of Liver Studies. King's College Hospital, King's Health Partners, London, UK
| | - Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Córdoba, Spain
| |
Collapse
|
6
|
Ayllón MD, Ciria R, Gómez-Luque I, Rodriguez-Perálvarez M, Padial A, Luque A, López-Cillero P, de la Mata M, Briceño J. Use of Peritoneovenous Shunt for the Management of Refractory Ascites. Transplant Proc 2019; 51:41-43. [PMID: 30655143 DOI: 10.1016/j.transproceed.2018.04.089] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/05/2018] [Accepted: 04/27/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Guidelines for the management of refractory ascites (RA) recommend transjugular intrahepatic portosystemic shunting (TIPS), diuretics, and paracentesis as the main strategies, discouraging use of surgical peritoneovenous shunts (PVSs). However, PVSs, including both Denver (DS) or saphenoperitoneal (SPS) modalities, may still have indications. Herein we report our experience with PVSs in the context of modern surgical and anesthetic management. METHODS In our unit, PVSs are offered to patients with ascites refractory to diuretics in which TIPS are contraindicated. Heart function and spontaneous bacterial peritonitis must be assessed before surgical indication. RESULTS Seven procedures were performed on 5 patients (6-DS, 1-SPS) in 2013. Their mean age was 61 (range, 54-68) years. In 3 patients, the indication was RA without options for liver transplant; 2 patients were on the waiting list for liver transplantation, which were performed to improve renal function and quality of life (QOL). The median hospital stay was 6.5 (range, 3-12) days. All patients were alive after 12 months. One patient died 2 years after the first DS and another later died due to liver insufficiency with patency of the DS. The ascites was well-controlled in 4 of 5 patients at up to 48 months of follow-up. Decreases in diuretics doses, proper weight maintenance, and a dramatic improvement in QOL (measured by a modified Ascites Symptom Inventory-7 [ASI-7] test) were observed after the procedures. CONCLUSION PVSs are useful for the treatment of patients with RA who develop resistance to common therapies, leading to a major improvement in QOL. These surgical procedures should be included in the armamentarium of experienced liver surgeons.
Collapse
Affiliation(s)
- M D Ayllón
- Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain
| | - R Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain.
| | - I Gómez-Luque
- Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain
| | - M Rodriguez-Perálvarez
- Unit of Hepatology and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain
| | - A Padial
- Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain
| | - A Luque
- Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain
| | - P López-Cillero
- Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain
| | - M de la Mata
- Unit of Hepatology and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain
| | - J Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain
| |
Collapse
|
7
|
Ciria R, Navarro E, Sánchez-Frías M, Gallardo AB, Medina J, Ayllón MD, Gomez-Luque I, Ruiz-Rabelo J, Luque A, de la Mata M, Rufián S, López-Cillero P, Briceño J. Preliminary results from the use of intraoperative real-time biliary oxygen monitoring in liver transplantation. Clin Transplant 2018; 32:e13433. [PMID: 30365182 DOI: 10.1111/ctr.13433] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Biliary anastomosis is a frequent area of complications after liver transplantation (LT) and a potential area of "microangiopathy". The concept of a "marginal bile duct" is unexplored. The main aim was to make a preliminary evaluation of the utility of an innovative real-time oxygen microtension (pO2mt) testing device for the assessment of bile duct viability during LT and to correlate these pO2mt values with microvascular tissue quality by histopathology and outcomes. PATIENTS AND METHODS Observational prospective cohort study with 23 patients. Oxygen microtension measurements were made placing a micropO2 probe in different areas of recipient and donor's bile duct intraoperative. RESULTS Mean pO2mt in the graft bile duct at the level of the anastomosis 103.82 (31-157) mm Hg, being 121.52 (55-174) mm Hg 1.5 cm proximal to the hilar plate (P < 0.001). Mean pO2mt in the recipient's bile duct was 117.87 (62-185) mm Hg, while a value of 137.30 (81-198) mm Hg was observed 1.5 cm distal to the anastomosis (P < 0.001). Cystic duct resection (12 cases) was also related with higher pO2mt values at anastomosis [117.8 (93-157) vs 88.54 (31-124) mm Hg] and distal to anastomosis [135.6 (111-174) vs 106.2 (55-133) mm Hg; P < 0.001]. Patients with 1-, 3-, and 12-month biliary complications had significantly lower pO2mt in the intraoperative measurements. CONCLUSION Our preliminary results show that distal borders of donor and recipient bile ducts may be low-vascularized areas. Tissue pO2mt is significantly higher in areas close to the hilar plate and to the duodenum in donor and recipient's sides, respectively. Bile duct injury and biliary complications are associated with worse tissue pO2mt.
Collapse
Affiliation(s)
- Ruben Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Elena Navarro
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | | | - Ana-Belen Gallardo
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Javier Medina
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - María-Dolores Ayllón
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Irene Gomez-Luque
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Juan Ruiz-Rabelo
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Antonio Luque
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Manuel de la Mata
- Liver Research Unit, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, Cordoba, Spain
| | - Sebastián Rufián
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Pedro López-Cillero
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| |
Collapse
|
8
|
Sánchez-Hidalgo JM, Rodríguez-Ortiz L, Arjona-Sánchez Á, Ayllón-Terán MD, Gómez-Luque I, Ciria-Bru R, Luque-Molina A, López-Cillero P, Rufián-Peña S, Briceño-Delgado J. "Super-rapid" Technique in Donation After Circulatory Death Liver Donors: Advantages and Disadvantages. Transplant Proc 2018; 51:25-27. [PMID: 30655137 DOI: 10.1016/j.transproceed.2018.05.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/28/2018] [Accepted: 05/21/2018] [Indexed: 12/14/2022]
Abstract
In recent years, donation after circulatory death (DCD) has increased as an option to overcome the organ donor shortage crisis and to decrease the large number of patients on liver transplant waiting lists. The "super-rapid" technique is now the "gold standard" procurement method because of its availability, reproducibility, low cost, and extensive experience. Recently, extracorporeal support has been implemented, with encouraging results. Strict donor acceptance criteria have proven to be essential to optimize the DCD liver graft outcomes and minimize biliary complication rates. In this study we assessed the state of the art of DCD liver transplantation with regard to its development and the actual strategies to prevent graft complications, with aim of expanding the pool of marginal liver donors.
Collapse
Affiliation(s)
| | - L Rodríguez-Ortiz
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - Á Arjona-Sánchez
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - M D Ayllón-Terán
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - I Gómez-Luque
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - R Ciria-Bru
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - A Luque-Molina
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - P López-Cillero
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - S Rufián-Peña
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - J Briceño-Delgado
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| |
Collapse
|
9
|
Ciria R, López-Cillero P, Gallardo AB, Cabrera J, Pleguezuelo M, Ayllón MD, Luque A, Zurera L, Espejo JJ, Rodríguez-Perálvarez M, Montero JL, de la Mata M, Briceño J. Optimizing the management of patients with BCLC stage-B hepatocellular carcinoma: Modern surgical resection as a feasible alternative to transarterial chemoemolization. Eur J Surg Oncol 2015; 41:1153-61. [PMID: 26118317 DOI: 10.1016/j.ejso.2015.05.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 05/06/2015] [Accepted: 05/31/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To analyse the impact of liver resection (LR) in patients with Hepatocellular Carcinoma (HCC) within the Barcelona-Clinic-Liver-Cancer (BCLC)-B stage. METHODS Analysis of patients with BCLC-B HCC treated with LR or transarterial chemoembolization (TACE) between 2007 and 2012 in our hospital. Survival/recurrence analyses were performed by log-rank tests and Cox multivariate models. Further analyses were specifically obtained for the HCC subclassification (B1-2-3-4) proposed recently. RESULTS Eighty patients were treated (44-TACE/36-LR). Number of nodules was [1.8(1.1)], being multinodular in 50% of cases. Although resected patients had a higher hospital stay than those who underwent TACE (14 ± 13 vs 7 ± 6; P = 0.004), the rate and severity of complications was lower measured by Dindo-Clavien scale (P < 0.05). Overall survival was 40% with a median follow-up of 29.5 months (0.07-96.9). Five-years survival rates were 62.9%, 28.1% and 15.4%, respectively (P = 0.004) for B1, B2 and B3-4 stages. Cox model showed that only total bilirubin [OR = 2.055(1.23-3.44)] and BCLC subclassification B3-4 [OR = 2.439(1.04-5.7)] and B2 [OR = 2.79(1.35-5.77)] vs B1 were independent predictors of 5-years-survival. In B1 patients, surgical approach led a significant decrease in 5-years recurrence-rate (25% vs 60%; P = 0.018). In the surgical subgroup analysis, better results were observed if well/moderate differentiation combined with no microvascular-invasion (VI) in 5-years-survival (84.6%; P = 0.001) and -recurrence (23.1%; P = 0.041), respectively. These survival and recurrence trends were remarkable in B1 stages. CONCLUSIONS Management of Intermediate BCLC-B HCC stage should be more complex and include updated criteria regarding B-stage subclassifications, VI and tumour differentiation. Modern surgical resection would offer improved survival benefit with acceptable safety in selected BCLC-B stage patients.
Collapse
Affiliation(s)
- R Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Cordoba, Spain.
| | - P López-Cillero
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Cordoba, Spain
| | - A-B Gallardo
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Cordoba, Spain
| | - J Cabrera
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Cordoba, Spain
| | - M Pleguezuelo
- Unit of Hepatology and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofia, Cordoba, Spain
| | - M-D Ayllón
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Cordoba, Spain
| | - A Luque
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Cordoba, Spain
| | - L Zurera
- Unit of Vascular and Interventional Radiology, University Hospital Reina Sofía, Cordoba, Spain
| | - J-J Espejo
- Unit of Vascular and Interventional Radiology, University Hospital Reina Sofía, Cordoba, Spain
| | - M Rodríguez-Perálvarez
- Unit of Hepatology and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofia, Cordoba, Spain
| | - J-L Montero
- Unit of Hepatology and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofia, Cordoba, Spain
| | - M de la Mata
- Unit of Hepatology and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofia, Cordoba, Spain
| | - J Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Cordoba, Spain
| |
Collapse
|
10
|
Ferrín G, Rodríguez-Perálvarez M, Aguilar-Melero P, Ranchal I, Llamoza C, Linares CI, González-Rubio S, Muntané J, Briceño J, López-Cillero P, Montero-Álvarez JL, de la Mata M. Plasma protein biomarkers of hepatocellular carcinoma in HCV-infected alcoholic patients with cirrhosis. PLoS One 2015; 10:e0118527. [PMID: 25789864 PMCID: PMC4366144 DOI: 10.1371/journal.pone.0118527] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/26/2014] [Indexed: 12/18/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common and lethal cancers in the world, with limited options for treatment unless timely diagnosed. Chronic hepatitis C virus (HCV) infection and persistent heavy alcohol consumption are independent risk factors for HCC development, which may induce a specific protein expression pattern different from those caused separately. The aim of the study was to identify protein biomarkers for the detection of HCC in HCV-infected alcoholic patients with cirrhosis in order to improve survival. We compared protein expression profiles of plasma samples from 52 HCV-infected alcoholic patients with and without HCC, using 2-D DIGE coupled with MALDI-TOF/TOF mass spectrometry. The 2-D DIGE results were analyzed statistically using Decyder software, and verified by western-blot and ELISA. In plasma samples from HCV-infected alcoholic patients, we found significantly differential expression profiles of carboxypeptidase-N, ceruloplasmin (CP), complement component 4a (C4a), fibrinogen-alpha (FGA), immunoglobulin mu chain C region, serum albumin, and serum paraoxonase/arylesterase 1 (PON1). Deregulation of plasma/serum levels of the identified proteins was associated to HCV, ethanol consumption, and/or HCC progression. In the validation through ELISA, C4a serum concentration was increased in HCC patients (2.4±1 ng/mg vs 1.8±0.6 ng/mg; p = 0.029), being the only independent predictor of HCC in the multivariate analysis (OR = 2.15; p = 0.015), with an AUROC = 0.70. The combination of C4a, FGA, CP and PON1 improved slightly the predictive ability of C4a alone (AUROC 0.81). In conclusion, we identified proteins related to acute-phase response, oxidative stress, or immune response, whose differential expression in plasma may be attributed to the presence of HCC. Among them, C4a, and its combination with CP, FGA and PON1, could be considered as potentially reliable biomarkers for the detection of HCC in HCV-infected alcoholic patients.
Collapse
Affiliation(s)
- Gustavo Ferrín
- Maimónides Institute for Biomedical Research in Córdoba (IMBIC), Reina Sofía University Hospital, Córdoba, Spain
- Biomedical Research Centre Network, Digestive and Liver Diseases (CIBERehd), Córdoba, Spain
- * E-mail:
| | - Manuel Rodríguez-Perálvarez
- Maimónides Institute for Biomedical Research in Córdoba (IMBIC), Reina Sofía University Hospital, Córdoba, Spain
- Biomedical Research Centre Network, Digestive and Liver Diseases (CIBERehd), Córdoba, Spain
- Hepatology and Liver Transplantation Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - Patricia Aguilar-Melero
- Maimónides Institute for Biomedical Research in Córdoba (IMBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Isidora Ranchal
- Maimónides Institute for Biomedical Research in Córdoba (IMBIC), Reina Sofía University Hospital, Córdoba, Spain
- Biomedical Research Centre Network, Digestive and Liver Diseases (CIBERehd), Córdoba, Spain
| | - Camilo Llamoza
- Hepatology and Liver Transplantation Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - Clara I. Linares
- Maimónides Institute for Biomedical Research in Córdoba (IMBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Sandra González-Rubio
- Maimónides Institute for Biomedical Research in Córdoba (IMBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Jordi Muntané
- Maimónides Institute for Biomedical Research in Córdoba (IMBIC), Reina Sofía University Hospital, Córdoba, Spain
- Biomedical Research Centre Network, Digestive and Liver Diseases (CIBERehd), Córdoba, Spain
| | - Javier Briceño
- Maimónides Institute for Biomedical Research in Córdoba (IMBIC), Reina Sofía University Hospital, Córdoba, Spain
- Biomedical Research Centre Network, Digestive and Liver Diseases (CIBERehd), Córdoba, Spain
- Hepatology and Liver Transplantation Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - Pedro López-Cillero
- Maimónides Institute for Biomedical Research in Córdoba (IMBIC), Reina Sofía University Hospital, Córdoba, Spain
- Biomedical Research Centre Network, Digestive and Liver Diseases (CIBERehd), Córdoba, Spain
- Hepatology and Liver Transplantation Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - José Luis Montero-Álvarez
- Maimónides Institute for Biomedical Research in Córdoba (IMBIC), Reina Sofía University Hospital, Córdoba, Spain
- Biomedical Research Centre Network, Digestive and Liver Diseases (CIBERehd), Córdoba, Spain
- Hepatology and Liver Transplantation Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - Manuel de la Mata
- Maimónides Institute for Biomedical Research in Córdoba (IMBIC), Reina Sofía University Hospital, Córdoba, Spain
- Biomedical Research Centre Network, Digestive and Liver Diseases (CIBERehd), Córdoba, Spain
- Hepatology and Liver Transplantation Unit, Reina Sofía University Hospital, Córdoba, Spain
| |
Collapse
|
11
|
Ayllón-Terán MD, Valverde-Martínez A, Díaz-Nieto R, Ciria-Bru R, Luque-Molina A, López-Cillero P, Briceño-Delgado J. Carcinoid tumor of the common bile duct. Rev Esp Enferm Dig 2014; 106:560-561. [PMID: 25544419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
12
|
Arjona-Sánchez A, Sánchez-Hidalgo J, Ciria-Bru R, Muñoz-Casares F, Ruiz-Rabelo J, Gallardo A, Orti R, Luque A, Rufián-Peña S, López-Cillero P, de la Mata M, Briceño-Delgado F. Prediction Model to Discard A Priori Liver Allografts. Transplant Proc 2014; 46:3076-8. [DOI: 10.1016/j.transproceed.2014.09.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
13
|
Ferrín G, Ranchal I, Llamoza C, Rodríguez-Perálvarez ML, Romero-Ruiz A, Aguilar-Melero P, López-Cillero P, Briceño J, Muntané J, Montero-Álvarez JL, De la Mata M. Identification of candidate biomarkers for hepatocellular carcinoma in plasma of HCV-infected cirrhotic patients by 2-D DIGE. Liver Int 2014; 34:438-46. [PMID: 23944848 DOI: 10.1111/liv.12277] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 07/17/2012] [Accepted: 06/23/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND The current methods available for screening and detecting hepatocellular carcinoma (HCC) have insufficient sensitivity and specificity, and only a low percentage of diagnosis of small tumours is based on these assays. Because HCC is usually asymptomatic at potentially curative stages, identification of biomarkers for the early detection of HCC is essential to improve patient survival. AIM The aim of this study was to identify candidate markers for HCC development in the plasma from hepatitis C virus (HCV)-infected cirrhotic patients. METHODS We compared protein expression profiles of plasma samples from HCV-infected cirrhotic patients with and without HCC, using two-dimensional fluorescence difference gel electrophoresis (2-D DIGE) coupled with MALDI-TOF/TOF mass spectrometry. The 2-D DIGE results were analysed statistically using Decyder™ software, and verified by western blot and enzyme-linked immunosorbent assay (ELISA). RESULTS In the plasma of HCV-infected HCC patients, we observed decreased expression of complement component 9, ficolin-3 (FCN3), serum amyloid P component (SAP), fibrinogen-gamma and immunoglobulin gamma-1 chain, and increased expression of vitronectin (VTN) and galectin-3 binding protein (G3BP) by DIGE analysis. ELISA confirmed DIGE results for VTN and G3BP but not for SAP or FCN3 in a larger patient population. CONCLUSIONS The proteins VTN and SAP are candidate biomarkers for HCC development in HCV-infected cirrhotic patients.
Collapse
Affiliation(s)
- Gustavo Ferrín
- Maimónides Institute for Biomedical Research in Córdoba (IMBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain; Networked Biomedical Research Center, Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Aguilar-Melero P, Luque A, Machuca MM, Pérez de Obanos MP, Navarrete R, Rodríguez-García IC, Briceño J, Iñiguez M, Ruiz J, Prieto J, de la Mata M, Gomez-Villamandos RJ, Muntane J, López-Cillero P. Cardiotrophin-1 reduces ischemia/reperfusion injury during liver transplant. J Surg Res 2012; 181:e83-91. [PMID: 22906559 DOI: 10.1016/j.jss.2012.07.046] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 07/06/2012] [Accepted: 07/11/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Orthotopic liver transplantation (OLT) is currently the elective treatment for advanced liver cirrhosis and acute liver failure. Ischemia/reperfusion damage may jeopardize graft function during the postoperative period. Cardiotrophin-1 (CT-1) has demonstrated cytoprotective properties in different experimental models of liver injury. There is no evidence to demonstrate its potential use in the prevention of the ischemia/reperfusion injury that occurs during OLT. The present study is the first report to show that the administration of CT-1 to donors would benefit the outcome of OLT. MATERIALS AND METHODS We tested the cytoprotective effect of CT-1 administered to the donor prior to OLT in an experimental pig model. Hemodynamic changes, hepatic histology, cell death parameters, activation of cell signaling pathways, oxidative and nitrosative stress, and animal survival were analyzed. RESULTS Our data showed that CT-1 administration to donors increased animal survival, improved cardiac and respiratory functions, and reduced hepatocellular injury as well as oxidative and nitrosative stress. These beneficial effects, related to the activation of AKT, ERK, and STAT3, reduced caspase-3 activity and diminished IL-1β and TNF-α expression together with IL-6 upregulation in liver tissue. CONCLUSIONS The administration of CT-1 to donors reduced ischemia/reperfusion injury and improved survival in an experimental pig model of OLT.
Collapse
Affiliation(s)
- Patricia Aguilar-Melero
- Liver Research Unit, Instituto Maimónides para la Investigación Biomédica de Córdoba, Reina Sofia University Hospital, Córdoba, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Sánchez-Hidalgo JM, Naranjo A, Ciria R, Ranchal I, Aguilar-Melero P, Ferrín G, Valverde A, Rufián S, López-Cillero P, Muntané J, Briceño J. Impact of age on liver regeneration response to injury after partial hepatectomy in a rat model. J Surg Res 2011; 175:e1-9. [PMID: 22341343 DOI: 10.1016/j.jss.2011.11.1022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 10/12/2011] [Accepted: 11/17/2011] [Indexed: 12/29/2022]
Abstract
BACKGROUND Liver resection is a feasible treatment for multiple liver diseases. There is no evidence about the impact of age on liver regeneration. OBJECTIVE To assess the effect of age on liver regeneration in an experimental in vivo animal model of 70%-partial hepatectomy. METHODS Forty young (Y) and old (O) Wistar male rats (n = 80) were distributed into four groups [controls (C), sham operated (SO), hepatectomy 6 h (H6), and 48 h (H48)]. Different morphometric and biochemical factors, oxidative and nitrosative stress, lipid peroxidation, cytokines kinetics, and histopathologic tissular parameters were determined. RESULTS Early postoperative mortality was higher in aged rats (P = 0.049). Morphometric determinations, liver regeneration index, and total volume weight were favorable to young rats. Serum transaminase levels were higher in aged rats. Parameters of necrosis (measured by histopathologic injury [HI: 0-I-II-III]), regeneration (measured by bromodeoxyuridine-BrdU incorporation) and apoptosis (determined by the TDT-mediated dUTP nick end labeling-TUNEL) were well-synchronized in young rats. Parameters of oxidative stress such as reduced (GSH), oxidized (GSSG) glutathione and lipid peroxidation (measured by hepatic malondialdehyde -MDA-) were lower in young animals throughout the studied period. Nitrosative stress measured by nitric oxide (NO) end-products was higher in late stages in resected old rats. Pro-inflammatory cytokines (TNF- α) reached higher and earlier levels in aged rats while pro-regenerative cytokines (IL-6) were significantly higher in early stages for young rats and in late stages for aged rats. The levels of TGF-β were higher in young rats. CONCLUSION Liver regeneration is delayed and reduced in aged animals submitted to liver resection.
Collapse
|
16
|
Herencia C, Rodríguez-Ariza A, Canalejo A, Naranjo A, Briceño FJ, López-Cillero P, De la Mata M, Muñoz-Castañeda JR. Differential bone marrow hematopoietic stem cells mobilization in hepatectomized patients. J Gastrointest Surg 2011; 15:1459-67. [PMID: 21512847 DOI: 10.1007/s11605-011-1541-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 04/05/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The involvement of bone marrow hematopoietic stem cells (BMHSC) mobilization during liver regeneration from hepatectomized patients is under debate. The main aim of this study was to investigate the role of BMHSC mobilization after hepatic resection in 33 patients with liver disease. METHODS AND RESULTS Mobilization of CD34(+) BMHSC after 72 h of surgery was found in peripheral blood of some, but not all, of the hepatectomized patients. These CD34(+) cells co-expressed other stem cells markers. The patients without BMHSC mobilization showed high levels of circulating and liver tissue BMHSC (CD34(+) cells) previous to surgery. Therefore, two types of patients: "mobilizers" and "non-mobilizers" were distinguished based on the values of CD34(+) cells before and after surgery. Changes in cytokines involved in the hepatic regeneration (HGF and TGF-β), and in BMHSC mobilization process (SCF, SDF-1, IL-12, or MMP-2), were detected in both groups. In addition, a higher activation previous to surgery of the SDF-1/CXCR4 axis in liver tissue was observed in non mobilizers patients compared to mobilizer patients. CONCLUSION BMHSC mobilization seems to be associated with variations in the levels of cytokines and proteolytic enzymes involved in hepatic regeneration and bone marrow matrix degradation. Hepatectomy may be an insufficient stimulus for BMSHC mobilization. The pre-hepatectomy higher levels CD34(+) cells in peripheral blood and liver, associated to the activation of hepatic SDF-1/CXCR4 axis, suggest a BMHSC mobilization process previous to surgery in non mobilizer patients.
Collapse
Affiliation(s)
- Carmen Herencia
- Instituto Maimónides de Investigación Biomédica de Córdoba, (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | | | | | | | | | | | | |
Collapse
|
17
|
González R, Cruz A, Ferrín G, López-Cillero P, Fernández-Rodríguez R, Briceño J, Gómez MA, Rufián S, Mata MDL, Martínez-Ruiz A, Marin JJG, Muntané J. Nitric oxide mimics transcriptional and post-translational regulation during α-tocopherol cytoprotection against glycochenodeoxycholate-induced cell death in hepatocytes. J Hepatol 2011; 55:133-44. [PMID: 21145864 DOI: 10.1016/j.jhep.2010.10.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [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: 04/22/2010] [Revised: 10/07/2010] [Accepted: 10/12/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Reactive oxygen species (ROS) and nitric oxide (NO) exert a relevant role during bile acid-induced hepatotoxicity. Whether α-Tocopherol regulates oxidative and nitrosative stress, bile acid transporter expression and their NO-dependent post-translational modifications, and cell death were assessed in vitro and in vivo. METHODS α-Tocopherol and/or NO donors (DETA-NONOate or CSNO, and V-PYRRO/NO) were administered to glycochenodeoxycholic acid (GCDCA)-treated cultured human hepatocytes or to bile duct obstructed rats. Cell injury, superoxide anion (O⁻₂) production, as well as inducible nitric oxide synthase (NOS-2), cytochrome P4507A1 (CYP7A1), heme oxygenase-1, (HO-1) and bile acid transporter expression were determined. Cysteine S-nitrosylation and tyrosine nitration of Na(+)-taurocholate co-transporting polypeptide (NTCP), as well as taurocholic acid (TC) uptake were also evaluated. RESULTS GCDCA-induced cell death was associated with increased (O⁻₂) production, NTCP and HO-1 expression, and with a reduction of CYP7A1 and NOS-2 expression. α-Tocopherol reduced cell death, (O⁻₂) production, CYP7A1, NTCP, and HO-1 expression, as well as increased NOS-2 expression and NO production in GCDCA-treated hepatocytes. α-Tocopherol and NO donors increased NTCP cysteine S-nitrosylation and tyrosine nitration, and reduced TC uptake in hepatocytes. α-Tocopherol and V-PYRRO/NO reduced liver injury and NTCP expression in obstructed rats. CONCLUSIONS The regulation of CYP7A1, NTCP, and HO-1 expression may be relevant for the cytoprotective properties of α-Tocopherol and NO against mitochondrial dysfunction, oxidative stress and cell death in GCDCA-treated hepatocytes. The regulation of NO-dependent post-translational modifications of NTCP by α-Tocopherol and NO donors reduces the uptake of toxic bile acids by hepatocytes.
Collapse
Affiliation(s)
- Raúl González
- Instituto Maimónides para la Investigación Biomédica de Córdoba, Reina Sofia University Hospital, Córdoba, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Briceño J, Ciria R, de la Mata M, Montero JL, Rufián S, López-Cillero P. Extended criteria donors in liver transplant candidates with hepatorenal syndrome. Clin Transplant 2011; 25:E257-E263. [DOI: 10.1111/j.1399-0012.2011.01402.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
19
|
Briceño J, Naranjo A, Ciria R, Díaz-Nieto R, Sánchez-Hidalgo JM, Luque A, Rufián S, López-Cillero P. A Prospective Study of the Efficacy of Clinical Application of a New Carrier-Bound Fibrin Sealant After Liver Resection. ACTA ACUST UNITED AC 2010; 145:482-8. [PMID: 20479348 DOI: 10.1001/archsurg.2010.62] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, Department of General Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Ciria R, Sánchez-Hidalgo JM, Briceño J, Naranjo A, Pleguezuelo M, Díaz-Nieto R, Luque A, Jiménez J, García-Menor E, Gilbert JJ, de la Mata M, Pérez-Navero JL, Solórzano G, Rufián S, Pera C, López-Cillero P. Establishment of a pediatric liver transplantation program: experience with 100 transplantation procedures. Transplant Proc 2010; 41:2444-6. [PMID: 19715946 DOI: 10.1016/j.transproceed.2009.06.072] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To analyze the primary factors that influence the development and consolidation of a pediatric liver transplantation program. PATIENTS AND METHODS This was a retrospective study of 100 liver transplantation procedures performed in 84 pediatric patients between May 1990 and November 2007. The male-female ratio was 40:60. Mean (SD) age was 5 years (40 patients were younger than 2 years); cold ischemia time was 7.10 (3.1) hours; surgery time was 5.2 (2.2) hours; and time on the waiting list for transplantation was 75 (range, 1-1012) days. Indications for transplantation included cholestatic disease (43%), acute hepatic failure (AHF; 34%), metabolic disorders (14%), and cirrhosis (9%). Transplanted organs included 3 split grafts, 29 partial grafts, and 8 living-donor grafts. RESULTS Mean graft survival was 70.4%, 59.2%, and 58.1% at 1, 3, and 5 years, respectively. Factors that influenced graft outcome were age younger than 2 years; surgery time more than 6 hours; and AHF vs cholestatic disease, metabolic disorders, and cirrhosis. There were no significant differences in long-term (51% vs 59%) and short-term (71% vs 70%) graft survival between procedures performed in 1990-1998 compared with those performed in 1999-2007; however, there was a higher percentage (P = .005) of recipients at high risk (age younger than 2 years or with AHF) in the later period. All data were consistent with those of the European Liver Transplant Registry 2007. CONCLUSIONS A pediatric liver transplantation program can be established by a group experienced in liver transplantation.
Collapse
Affiliation(s)
- R Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, Reina Sofía University Hospital, Cordoba, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
López-Sánchez LM, Collado JA, Corrales FJ, López-Cillero P, Montero JL, Fraga E, Serrano J, De La Mata M, Muntané J, Rodríguez-Ariza A. S-nitrosation of proteins duringd-galactosamine-induced cell death in human hepatocytes. Free Radic Res 2009; 41:50-61. [PMID: 17164178 DOI: 10.1080/10715760600943918] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 01/12/2023]
Abstract
Nitric oxide (NO) participates in the cell death induced by d-Galactosamine (d-GalN) in hepatocytes, and NO-derived reactive oxygen intermediates are critical contributors to protein modification and hepatocellular injury. It is anticipated that S-nitrosation of proteins will participate in the mechanisms leading to cell death in d-GalN-treated human hepatocytes. In the present study, d-GalN-induced cell death was related to augmented levels of NO production and S-nitrosothiol (SNO) content. The biotin switch assay confirmed that d-GalN increased the levels of S-nitrosated proteins in human hepatocytes. S-nitrosocysteine (CSNO) enhanced protein S-nitrosation and altered cell death parameters that were related to S-nitrosation of the executioner caspase-3. Fifteen S-nitrosated proteins participating in metabolism, antioxidative defense and cellular homeostasis were identified in human hepatocytes treated with CSNO. Among them, seven were also identified in d-GalN-treated hepatocytes. The results here reported underline the importance of the alteration of SNO homeostasis during d-GalN-induced cell death in human hepatocytes.
Collapse
|
22
|
Briceño J, Sánchez-Hidalgo JM, Naranjo A, Ciria R, Pozo JC, Luque A, de la Mata M, Rufián S, López-Cillero P. Model for end-stage liver disease can predict very early outcome after liver transplantation. Transplant Proc 2009; 40:2952-4. [PMID: 19010157 DOI: 10.1016/j.transproceed.2008.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Postoperative Model for End-stage Liver Disease (MELD) values have never been assessed to predict very early (<1 week) death after liver transplantation (OLT). We retrospectively reviewed 275 consecutive OLTs performed in 252 recipients reported in a prospective database. We calculated the MELD score (pre-MELD) and consecutive postoperative MELD (post-MELD) scores computed daily during the first postoperative week and on days 15 and 30 after OLT. Post-MELD scores from nonsurviving recipients displayed on a scatterplot of immediate probability of death were adjusted to the best goodness-of-fit curve, and, finally, depicted graphically as a receiver operating characteristic (ROC) curve. Nonsurviving recipients showed higher post-MELD scores: day 1: 23.5 versus 16.6 (P = .05); day 3: 25.1 versus 12.5 (P = .000); day 5: 25.7 versus 11.8 (P = .000); and day 7: 22.1 versus 10.2 (P = .000). Overall comparisons were performed using a time-dependent general linear regression model, revealing higher post-MELD scores for nonsurviving recipients, irrespective of postoperative time (P = .002). The best goodness-of-fit curve was displayed when adjusting to a theoretical exponential regression curve calculated as follows: Probability of dying within the first week (%) = 3.36 x e(0.079 x (post-MELD)) (r = .89; P = .000). The area under the ROC curve was 0.783 (95% confidence interval, 0.630-0.935; P = .001). The model had a positive predictive value of 82.3%, a negative predictive value of 33.1%, and an accuracy of 79.2%. In conclusion, this study corroborated the suggestion that the MELD score may serve as a reliable tool to assess very early death after OLT.
Collapse
Affiliation(s)
- J Briceño
- Liver Transplantation Unit, Hospital Reina Sofía, Cordoba, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
González R, Ferrín G, Hidalgo AB, Ranchal I, López-Cillero P, Santos-Gónzalez M, López-Lluch G, Briceño J, Gómez MA, Poyato A, Villalba JM, Navas P, de la Mata M, Muntané J. N-acetylcysteine, coenzyme Q10 and superoxide dismutase mimetic prevent mitochondrial cell dysfunction and cell death induced by d-galactosamine in primary culture of human hepatocytes. Chem Biol Interact 2009; 181:95-106. [PMID: 19523936 DOI: 10.1016/j.cbi.2009.06.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 05/28/2009] [Accepted: 06/03/2009] [Indexed: 11/30/2022]
Abstract
D-Galactosamine (D-GalN) induces reactive oxygen species (ROS) generation and cell death in cultured hepatocytes. The aim of the study was to evaluate the cytoprotective properties of N-acetylcysteine (NAC), coenzyme Q(10) (Q(10)) and the superoxide dismutase (SOD) mimetic against the mitochondrial dysfunction and cell death in D-GalN-treated hepatocytes. Hepatocytes were isolated from liver resections. NAC (0.5 mM), Q(10) (30 microM) or MnTBAP (Mn(III)tetrakis(4-benzoic acid) porphyrin chloride (1mg/mL) were co-administered with D-GalN (40 mM) in hepatocytes. Cell death, oxidative stress, mitochondrial transmembrane potential (MTP), ATP, mitochondrial oxidized/reduced glutathione (GSH) and Q(10) ratios, electronic transport chain (ETC) activity, and nuclear- and mitochondria-encoded expression of complex I subunits were determined in hepatocytes. d-GalN induced a transient increase of mitochondrial hyperpolarization and oxidative stress, followed by an increase of oxidized/reduced GSH and Q(10) ratios, mitochondrial dysfunction and cell death in hepatocytes. The cytoprotective properties of NAC supplementation were related to a reduction of ROS generation and oxidized/reduced GSH and Q(10) ratios, and a recovery of mitochondrial complexes I+III and II+III activities and cellular ATP content. The co-administration of Q(10) or MnTBAP recovered oxidized/reduced GSH ratio, and reduced ROS generation, ETC dysfunction and cell death induced by D-GalN. The cytoprotective properties of studied antioxidants were related to an increase of the protein expression of nuclear- and mitochondrial-encoded subunits of complex I. In conclusion, the co-administration of NAC, Q(10) and MnTBAP enhanced the expression of complex I subunits, and reduced ROS production, oxidized/reduced GSH ratio, mitochondrial dysfunction and cell death induced by D-GalN in cultured hepatocytes.
Collapse
Affiliation(s)
- Raúl González
- Liver Research Unit, Reina Sofía University Hospital, Córdoba, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Briceño J, Ciria R, Pleguezuelo M, de la Mata M, Muntané J, Naranjo A, Sánchez-Hidalgo J, Marchal T, Rufián S, López-Cillero P. Impact of donor graft steatosis on overall outcome and viral recurrence after liver transplantation for hepatitis C virus cirrhosis. Liver Transpl 2009; 15:37-48. [PMID: 19109846 DOI: 10.1002/lt.21566] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [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: 12/12/2022]
Abstract
The aim of this study was to determine the influence of donor graft steatosis on overall outcome, viral recurrence, and fibrosis progression in orthotopic liver transplantation (OLT) for hepatitis C virus (HCV) cirrhosis. One hundred twenty patients who underwent OLT for HCV cirrhosis between 1995 and 2005 were included in the study. Donor steatosis was categorized as absent (0%-10%; n = 40), mild (10%-30%; n = 32), moderate (30%-60%; n = 29), or severe (>60%; n = 19). A Cox multivariate analysis for marginal donor variables and a Model for End-Stage Liver Disease index were performed. Fibrosis evolution was analyzed in liver biopsies (fibrosis < 2 or > or =2) 3, 6, and 12 months post-OLT and in the late post-OLT period. Fifty-six grafts were lost (46%). The survival of the grafts was inversely proportional to donor liver steatosis: 82%, 72%, and 72% at 1, 2, and 3 years post-OLT in the absence of steatosis; 73%, 63%, and 58% with mild steatosis; 74%, 62%, and 43% with moderate steatosis; and 62%, 49%, and 42% with severe steatosis (P = 0.012). HCV recurrence was earlier and more frequent in recipients with steatosis > 30% (46% versus 32% at 3 months, P = 0.017; 58% versus 43% at 6 months, P = 0.020; 70% versus 56% at 12 months, P = 0.058; and 95% versus 69% at 3 years post-OLT, P = 0.0001). Graft survival was lower in alcoholic liver disease recipients versus HCV recipients when steatosis was >30% at 3, 6, and 12 months post-OLT (P = 0.042) but not when steatosis was <30% (P = 0.53). A higher fibrosis score was obtained 3 months post-OLT (P = 0.033), 6 months post-OLT (P = 0.306), 12 months post-OLT (P = 0.035), and in the late post-OLT period (P = 0.009). In conclusion, donor graft steatosis influences the outcome of OLT for HCV cirrhosis. HCV recurrence is more frequent and earlier in recipients of moderately and severely steatotic livers. Fibrosis evolution is higher when graft steatosis is >30%. OLT with >30% steatotic donor livers should be precluded in HCV recipients.
Collapse
Affiliation(s)
- Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, Reina Sofía University Hospital, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas CiberEHD, Córdoba, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Briceño J, Ruiz J, Ciria R, Naranjo A, Sánchez-Hidalgo J, Luque A, Rufián S, de la Mata M, López-Cillero P. Factors Affecting Survival and Tumor Recurrence in Patients Transplanted for Hepatocellular Carcinoma and Coexistent Hepatitis C Virus. Transplant Proc 2008; 40:2990-3. [DOI: 10.1016/j.transproceed.2008.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
26
|
López-Sánchez LM, Corrales FJ, González R, Ferrín G, Muñoz-Castañeda JR, Ranchal I, Hidalgo AB, Briceño J, López-Cillero P, Gómez MA, De La Mata M, Muntané J, Rodríguez-Ariza A. Alteration of S-nitrosothiol homeostasis and targets for protein S-nitrosation in human hepatocytes. Proteomics 2008; 8:4709-20. [DOI: 10.1002/pmic.200700313] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
27
|
Rodríguez-Ariza A, Monrobel A, Martínez-Galisteo E, Alicia Padilla C, Bárcena JA, Fraga E, Costán G, Barrera P, Poyato A, Montero JL, López-Cillero P, Muntané J, de la Mata M. [Prognostic factors associated with postoperative complications in liver transplant]. Rev Esp Enferm Dig 2008; 100:129-38. [PMID: 18416637 DOI: 10.4321/s1130-01082008000300002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES the postoperative evolution of patients submitted to orthotopic liver transplant (OLT) is frequently associated with the appearance of different types of complications such as renal failure, graft rejection, infections, and neurological disorders. These complications are the most significant causes of early morbidity and mortality in patients undergoing OLT. The purpose of the present study was the identification of factors related to the different postoperative complications after OLT. EXPERIMENTAL DESIGN a prospective study was carried out. PATIENTS seventy-eight variables were analyzed in 32 consecutive patients undergoing OLT. The factors independently associated with the appearance of postoperative complications were identified using a stepwise logistic regression analysis. RESULTS the multivariate analysis showed that malondialdehyde and creatinine pretransplant serum levels were associated with the development of renal dysfunction. The pretransplant levels of haemoglobin and the units of platelets administered during surgery were prognostic factors of infections. Acute graft rejection was predicted by ?-glutamyl transpeptidase and total bilirubin serum levels. The pretransplant sodium and glutaredoxin levels in serum were associated with neurological complications. CONCLUSIONS we propose these markers for the identification of high-risk patients allowing an early surveillance and/or treatment to improve morbidity and survival in patients submitted to OLT.
Collapse
Affiliation(s)
- A Rodríguez-Ariza
- Seccion de Hepatología, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal s/n, Córdoba
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Ciria-Bru R, Naranjo-Torres A, Sánchez-Hidalgo JM, Briceño-Delgado J, López-Cillero P. [Right hepatectomy due to hepatic actinomycosis]. Cir Esp 2008; 83:327-8. [PMID: 18570851 DOI: 10.1016/s0009-739x(08)70587-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
29
|
González R, Collado JA, Nell S, Briceño J, Tamayo MJ, Fraga E, Bernardos A, López-Cillero P, Pascussi JM, Rufián S, Vilarem MJ, De la Mata M, Brigelius-Flohe R, Maurel P, Muntané J. Cytoprotective properties of alpha-tocopherol are related to gene regulation in cultured D-galactosamine-treated human hepatocytes. Free Radic Biol Med 2007; 43:1439-52. [PMID: 17936189 DOI: 10.1016/j.freeradbiomed.2007.07.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 07/03/2007] [Accepted: 07/21/2007] [Indexed: 11/21/2022]
Abstract
Vitamin E (alpha-tocopherol) has demonstrated antioxidant activity and gene-regulatory properties. d-Galactosamine (D-GalN)-induced cell death is mediated by nitric oxide in hepatocytes, and it is associated with hepatic steatosis. The beneficial properties of alpha-tocopherol and their relation to oxidative stress and gene regulation were assessed in D-GalN-induced cell death. Hepatocytes were isolated from human liver resections by a collagenase perfusion technique. alpha-Tocopherol (50 microM) was administered at the advanced stages (10 h) of D-GalN-induced cell death in cultured hepatocytes. Cell death, oxidative stress, alpha-tocopherol metabolism, and NF-kappaB-, pregnane X receptor (PXR)-, and peroxisome proliferator-activated receptor (PPAR-alpha)-associated gene regulation were estimated in the hepatocytes. D-GalN increased cell death and alpha-tocopherol metabolism. alpha-Tocopherol exerted a moderate beneficial effect against apoptosis and necrosis induced by D-GalN. Induction (rifampicin) or inhibition (ketoconazole) of alpha-tocopherol metabolism and overexpression of PXR showed that the increase in PXR-related CYP3A4 expression caused by alpha-tocopherol enhanced cell death in hepatocytes. Nevertheless, the reduction in NF-kappaB activation and inducible nitric oxide synthase expression and the enhancement of PPAR-alpha and carnitine palmitoyl transferase gene expression by alpha-tocopherol may be relevant for cell survival. In conclusion, the cytoprotective properties of alpha-tocopherol are mostly related to gene regulation rather than to antioxidant activity in toxin-induced cell death in hepatocytes.
Collapse
Affiliation(s)
- Raul González
- Liver Research Unit, Reina Sofía University Hospital, Ciberehd, E-14004 Córdoba, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Briceño J, Ciria R, Pleguezuelo M, Naranjo A, Sánchez-Hidalgo J, Ruiz-Rabelo J, López-Cillero P, Luque A, de la Mata M, Rufián S. Contribution of marginal donors to liver transplantation for hepatitis C virus infection. Transplant Proc 2007; 39:2297-9. [PMID: 17889169 DOI: 10.1016/j.transproceed.2007.07.069] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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: 01/11/2023]
Abstract
The use of marginal liver donors can affect the outcomes of liver transplantation in patients with hepatitis C virus (HCV) infection. There are no firm conclusions about which donor criteria are important for allocation of high-risk grafts to recipients with HCV cirrhosis. We performed 120 consecutive liver transplantations for HCV infection between 1995 and 2005. Marginal donor criteria were considered to be: age >70 years, macrovesicular steatosis >30%, moderate-to-severe liver preservation injury, high inotropic drug dose (dopamine >15 microg/kg/min; epinephrine, norepinephrine, or dobutamine at any doses), peak serum sodium >155 mEq/L, any hypotensive episode <60 mm Hg and >1 hour, cold ischemia time >12 hours, ICU hospitalization >4 days, bilirubin >2 mg/dL, AST and/or ALT >200 UI/dL. Graft survival with donors showing these marginal criteria was compared with optimal donors using Kaplan-Meier analysis and the log-rank test. Independent predictors of survival were computed with the Cox proportional hazards model. Fifty-six grafts (46%) were lost during follow-up irrespective of the Model for End-Stage Liver Disease (MELD) scores of the recipients in each category. Upon univariate analysis, grafts with moderate-to-severe steatosis (P = .012), those with severe liver preservation injury (P = .007) and prolonged cold ischemia time (P = .0001) showed a dismal prognosis at 1, 3, and 5 years. Upon multivariate analysis, fat content (P = .0076; OR = 4.2) and cold ischemia time >12 hours (P = .034; OR = 7.001) were independent predictors of graft survival. Among HCV recipients, marginal liver donors worked similar to those from "good" donors, except for those with fatty livers >30%, especially when combined with a prolonged cold ischemia time.
Collapse
Affiliation(s)
- J Briceño
- Liver Transplantation Unit, Hospital Reina Sofia, Córdoba, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Montero JL, Cerezo A, Fraga E, Barrera P, López-Cillero P, Costán G, Poyato A, Bescansa E, Muntané J, de la Mata M. Acute liver failure in a patient with multiple sclerosis treated with interferon-β. Mult Scler 2007; 13:820. [PMID: 17613614 DOI: 10.1177/1352458506070893] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
32
|
Pérez de Luque D, López Vallejos P, Montero Alvarez JL, Fraga Rivas E, Barrera Baena P, Costán Rodero G, Rufian Peña S, Díaz Iglesias C, López-Cillero P, Briceño Delgado J, Padillo Ruiz J, Pozo Laderas JC, Marchal Molina T, Solórzano Peck G, de la Mata García M. Survival of patients receiving a liver transplant for hepatocellular carcinoma, and risk of tumor recurrence. Rev Esp Enferm Dig 2006; 98:899-906. [PMID: 17274695 DOI: 10.4321/s1130-01082006001200002] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The goal of this research has been to evaluate the survival, in long and short term, of the patient receiving liver transplant for hepatocellular carcinoma (HCC), the risk of post-transplant tumor relapse and factors related to this complication. DESIGN Retrospective study of a consecutive series of patients having had liver transplant for HCC. PATIENTS AND METHODOLOGY Transplant patients for HCC from 1989 to November 2003. Patients were selected due to general limitations of nodule size and quantity, which were subsequently published as Milan criteria. Also, criteria agreed in the Conference of Barcelona were followed in the pre-transplant diagnosis. RESULTS The survival of this 81 patients group was of the 80, 61 and 52% for 1, 5 and 10 years respectively. In the 32% of the cases the HCC was an incidental finding in the explant. In the 12.3%, the tumor relapse was verified. The multivariate research identified the size of the nodule (OR=1,7944) (IC 95%=1,1332-2,8413) and the vascular invasion (OR=6,6346) (IC 95%=1,4624-30,1003) as risk factors of relapse. CONCLUSIONS The liver transplant in selected patients with HCC has good results in medium and long term. The risk of post-transplant tumor relapse becomes notably reduced and is associated with the size of the nodule and the microscopic vascular invasion.
Collapse
Affiliation(s)
- D Pérez de Luque
- Unit of Digestive Diseases, Service of Pathology, University Hospital Reina Sofía, Córdoba, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Montero JL, Pozo JC, Barrera P, Fraga E, Costán G, Domínguez JL, Muntané J, Rodriguez-Ariza A, Pleguezuelo M, Rufián S, López-Cillero P, de la Mata M. Treatment of Refractory Cholestatic Pruritus With Molecular Adsorbent Recirculating System (MARS). Transplant Proc 2006; 38:2511-3. [PMID: 17097984 DOI: 10.1016/j.transproceed.2006.08.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [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: 10/23/2022]
Abstract
UNLABELLED Pruritus is a common complication of cholestatic liver diseases or liver graft dysfunction. Current medical therapies lack efficacy. The molecular adsorbent recirculating system (MARS) represents an interesting therapeutic option. Our objective was to report our experience in the management of four patients with intractable pruritus with MARS. PATIENTS AND METHODS The MARS treatment cycle included three consecutive treatments, each of 8 hours duration. The four patients with intractable pruritus who were treated had primary biliary cirrhosis/autoimmune hepatitis overlap syndrome (n = 1), ductopenic allograft rejection (n = 2), or posttransplant cholestatic HCV recurrence (n = 1). Intensity of pruritus was documented 24 hours before as well as 24 hours, 7 and 30 days after MARS therapy, and at the end of follow-up. We measured complete blood cell counts, glucose, BUN, creatinine, sodium, potassium, AST, ALT, GGT, alkaline phosphatase, bilirubin, prothrombin activity, and activated partial thromboplastin time. RESULTS MARS therapy was well tolerated. Patient 1 experienced temporal relief of pruritus, but needed another MARS cycle because of relapse. Patient 2 experienced partial and temporary relief of pruritus, was listed for retransplantation, and received a liver graft 2 months later. Patient 3 showed a dramatic reduction in the degree of pruritus with MARS. Pruritus in patient 4 decreased promptly with MARS therapy and conversion of immunosuppression to tacrolimus, thereby avoiding retransplantation. CONCLUSION MARS therapy is a promising, safe therapeutic option to treat refractory pruritus caused by cholestatic liver disorders.
Collapse
Affiliation(s)
- J L Montero
- Liver Transplant Unit, University Reina Sofía Hospital, Av. Menéndez Pidal, 14004 Córdoba, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Bernal E, Montero JL, Delgado M, Fraga E, Costán G, Barrera P, López-Vallejos P, Solórzano G, Rufián S, Briceño J, Padillo J, López-Cillero P, Marchal T, Muntané J, de la Mata M. Adjuvant Chemotherapy for Prevention of Recurrence of Invasive Hepatocellular Carcinoma After Orthotopic Liver Transplantation. Transplant Proc 2006; 38:2495-8. [PMID: 17097979 DOI: 10.1016/j.transproceed.2006.08.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 12/18/2022]
Abstract
UNLABELLED Orthotopic liver transplantation (OLT) is the best treatment for nonresectable hepatocellular carcinoma (HCC), but tumor recurrence reduces long-term and medium-term survival. The effectiveness of adjuvant chemotherapy to prevent tumor recurrence has not been fully established. METHODS Three hundred eighty-seven consecutive patients, including 43 with HCC superimposed on liver cirrhosis, underwent OLT. Twelve patients with one or more prognostic criteria for HCC recurrence were entered into a prospective prophylaxis protocol with monthly cycles of cisplatin (60 mg/m(2)) and adriamycin (30 mg/m(2)), beginning the fourth week post-OLT for a maximum of seven sessions. RESULTS The 5-year survival of the non-HCC patients was 65.7% and that of the HCC patients was 60.46% (P = NS). Chemotherapy was reasonably well tolerated, but the 9 patients with hepatitis C- or B-associated cirrhosis showed viral and histological recurrence of the primary disease. A high proportion of patients (7 of 12) developed tumor recurrence during the first year after OLT. Six of these patients died, all but one due to HCC relapse. Five patients remain healthy and tumor free at 58 to 130 months. Post-OLT adjuvant chemotherapy does not avoid tumor recurrence and its fatal consequences but may contribute to prolonged tumor-free survival among a significant proportion of patients with high-risk HCC. However, the uncertain implications on viral recurrence and the lack of control groups do not allow post-OLT chemotherapy to be recommended outside controlled clinical trials, which are clearly warranted.
Collapse
Affiliation(s)
- E Bernal
- Liver Transplant Unit, Reina Sofia University Hospital, Córdoba, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Ranchal I, González R, López-Sánchez LM, Barrera P, López-Cillero P, Serrano J, Bernardos A, De la Mata M, Rodríguez-Ariza A, Muntané J. The differential effect of PGE(1) on d-galactosamine-induced nitrosative stress and cell death in primary culture of human hepatocytes. Prostaglandins Other Lipid Mediat 2006; 79:245-59. [PMID: 16647638 DOI: 10.1016/j.prostaglandins.2006.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Revised: 02/16/2006] [Accepted: 02/17/2006] [Indexed: 12/17/2022]
Abstract
The pre-administration of PGE(1) reduced inducible nitric oxide synthase (NOS-2) expression and cell death induced by d-galactosamine (d-GalN) in cultured rat hepatocytes. The present study evaluated the role of nitric oxide (NO) during PGE(1) treatment in fully established d-GalN-induced cytotoxicity in cultured human hepatocytes. Human hepatocytes were isolated from liver resections by classic collagenase perfusion. PGE(1) (1 microM) was administered at 2 h before d-GalN (40 mM), or 2 or 10 h after d-GalN in cultured hepatocytes. The production of NO was inhibited by N-omega-nitroso-l-arginine methyl ester (l-NAME) (0.5 mM). Various parameters related to oxidative and nitrosative stress, mitochondrial dysfunction, NF-kappaB activation, NOS-2 expression and cell death were evaluated in hepatocytes. NO mediated mitochondrial disturbances, nitrosative stress and cell death in d-GalN-treated hepatocytes. The administration of PGE(1) 10 h after d-GalN enhanced NF-kappaB activation, NOS-2 expression and nitrosative stress. Although PGE(1) administered at 2 h before or 2h after d-GalN reduced apoptosis and necrosis, its administration 10 h after d-GalN had no beneficial effect on cell death. In conclusion, the administration of PGE(1) during advanced d-GalN cytotoxicity induced nitrosative stress and lost its cytoprotective properties in cultured human hepatocytes.
Collapse
|
36
|
de la Mata M, Barrera P, Fraga E, Montero JL, de la Torre J, López-Cillero P, Briceño J, Solórzano G, Alonso M. [Liver transplantation in patients with HIV infection]. Gastroenterol Hepatol 2004; 27:425-8. [PMID: 15461943 DOI: 10.1016/s0210-5705(03)70492-0] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M de la Mata
- Unidad de Trasplante Hepático, Hospital Universitario Reina Sofía, Córdoba, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Briceño J, López-Cillero P, Fraga E, Pera C. Results of liver transplantation in a Spanish group: a report from the Cordoba unit. Clin Transpl 2002:187-94. [PMID: 12211781] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The liver transplantation unit from Córdoba, Spain, performed its first liver transplantation in 1989. Since then, 500 liver transplants have been performed in our institution up to November 2001. Our one-year recipient and graft survival rates are 77% and 76%, respectively. These recipient and graft survival rates are lower when compared with other results in the English language literature, and we present evidence here that the disparity results from 4 especially problematic aspects of our program: 1) the expanded use of donors, 2) the policy of allocation and prioritization in our institution, 3) the recurrence of primary liver disease and 4) de-novo neoplasms. Liver transplantation with unstable, hypernatremic donors or donors with a lengthy hospitalization and grafts with a prolonged cold ischemia time leads to diminished graft survival. When several marginal criteria accumulate in a donor, the results are even poorer. Consequently, the delayed non-function rate is especially high in our series. Attention to severe liver preservation injury as a primary mechanism of graft losses with marginal donors is given. The impact of the policy of the "sickest-first" principle in our center with a long waiting list seems to benefit urgent but not elective patients. Survival in elective patients is poorer than expected considering their clinical condition. The use of the sickest-first or urgency principle in our unit has not been efficient or equitable and may partially explain the poorer survival of our patients. Finally, the recurrence of primary disease and incidence of de-novo tumors after transplantation in our unit are similar those reported in English language literature.
Collapse
Affiliation(s)
- J Briceño
- Liver Transplantation Unit, Hospital Reina Sofía, Córdoba, Spain
| | | | | | | |
Collapse
|
38
|
Figueras J, Ibañez L, Ramos E, Jaurrieta E, Ortiz-de-Urbina J, Pardo F, Mir J, Loinaz C, Herrera L, López-Cillero P, Santoyo J. Selection criteria for liver transplantation in early-stage hepatocellular carcinoma with cirrhosis: results of a multicenter study. Liver Transpl 2001; 7:877-83. [PMID: 11679986 DOI: 10.1053/jlts.2001.27856] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Orthotopic liver transplantation (OLT) offers the only chance to eliminate both tumor and liver disease in patients with hepatocellular carcinoma (HCC) and cirrhosis. However, tumor progression while on the waiting list and recurrence after OLT are frequent. We undertook a large multicenter study to assess survival and related factors of recurrence after OLT. This retrospective study analyses data from 307 consecutive patients with HCC and cirrhosis treated with OLT between 1990 and 1997 in eight centers in Spain. OLT was indicated only for small (<5 cm) localized tumors. Five-year rates after OLT were 63% for survival, 58% for disease-free survival, and 21% for recurrence. Tumor diameter larger than 5 cm was associated with other tumor characteristics that were significant indicators of poor outcome (absence of capsule, three or more nodules, bilobularity, satellite nodules, and vascular invasion). However, in multivariate analysis, alpha fetoprotein (AFP) levels greater than 300 ng/mL (P = .04; P = .02) and macroscopic vascular invasion (P = .01; P = .0001) were the only factors independently associated with mortality and recurrence, respectively. OLT is indicated in patients with small HCCs who have low AFP levels and no macroscopic vascular invasion or extrahepatic disease. By increasing our ability for preoperative tumor imaging, we will achieve better selection of patients with HCC before OLT.
Collapse
Affiliation(s)
- J Figueras
- Ciudad Sanitaria y Universitaria (CSU) Bellvitge, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Castilla Cabezas JA, López-Cillero P, Jiménez J, Fraga E, Arizón JM, Briceño J, Solórzano G, De la Mata M, Pera C. Role of orthotopic liver transplant in the treatment of homozygous familial hypercholesterolemia. Rev Esp Enferm Dig 2000; 92:601-8. [PMID: 11138242] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
UNLABELLED Homozygous familial hypercholesterolemia is an inherited metabolic disease that leads to decreased catabolism of low-density lipoprotein cholesterol. As a result coronary artery disease ensues by the first or second decade. Because most low-density lipoprotein receptors (50-75%) are located in the liver, liver transplantation has been introduced as a therapeutic option in this disorder. AIMS To report our experience in the treatment of homozygous familial hypercholesterolemia with ortothopic liver transplantation. We evaluated metabolic results and patient survival. METHOD We treated two affected siblings. One of them received a sequenced heart-liver transplantation because of cardiac failure due to severe coronary disease. RESULTS The operative and postoperative course was favourable in both patients, with a decrease in cholesterol levels to normal values. Four years later both were alive and both had normal liver and heart functions. Neither patient needed cholesterol-lowering drugs, and the disease had not progressed. CONCLUSIONS As shown by our results and those reported by others, liver transplantation is the treatment of choice for homozygous familial hypercholesterolemia until gene therapy becomes a viable option. Transplantation should be done before of cardiovascular complications develop.
Collapse
|
40
|
de la Mata M, Montero JL, Fraga E, Delgado M, Costán G, Padillo J, Díaz C, Rufián S, López-Cillero P, Solórzano G, Pera C, Miño G. [Indications and results of liver transplantation in cholestatic diseases]. Gastroenterol Hepatol 2000; 23 Suppl 1:39-42. [PMID: 11968341] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- M de la Mata
- Unidad Clínica de Aparato Digestivo, Unidad de Trasplante Hepático, Hospital Reina Sofía, Córdoba
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
de la Mata M, Fraga E, López-Cillero P, Miño G. [Rejection of the liver graft]. Gastroenterol Hepatol 1995; 18:94-100. [PMID: 7621284] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- M de la Mata
- Unidad de Trasplante Hepático, Hospital Reina Sofía, Córdoba
| | | | | | | |
Collapse
|
42
|
de la Mata M, Rufián S, Gómez F, Varo E, López-Cillero P, Costán G, Solórzano G, González R, Miño G, Pera C. Recurrent fulminant liver failure caused by hepatitis B virus after liver transplantation. J Clin Gastroenterol 1994; 19:238-41. [PMID: 7806837 DOI: 10.1097/00004836-199410000-00015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report a 44-year-old man who received a liver graft because of fulminant liver failure due to hepatitis B virus. Nine months later a new episode of acute hepatitis B followed a fulminant course and led to another transplantation. The patient died due to invasive aspergillosis and multiorgan failure 3 weeks after the second transplant. This case reveals that hepatitis B virus reinfection may also occur after transplantation in patients with fulminant hepatitis B and under immunosuppression circumstances. Although immunoprophylaxis with hepatitis B hyperimmune globulin may prevent hepatitis B reinfection, it does not guarantee complete protection even in patients presumed to have low risk of reinfection. Finally, this case confirms the high risk of fungal infections in patients with fulminant liver failure and the need to establish early antifungal therapy.
Collapse
Affiliation(s)
- M de la Mata
- Liver Transplant Unit, Reina Sofía Hospital, University of Cordoba, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|