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Dongelmans E, Erler N, Adam R, Nadalin S, Karam V, Yilmaz S, Kelly C, Pirenne J, Acarli K, Allison M, Hakeem A, Dhakshinamoorthy V, Fedaruk D, Rummo O, Kilic M, Nordin A, Fischer L, Parente A, Mirza D, Bennet W, Tokat Y, Faitot F, Antonelli BB, Berlakovich G, Patch D, Berrevoet F, Ribnikar M, Gerster T, Savier E, Gruttadauria S, Ericzon BG, Valdivieso A, Cuervas-Mons V, Perez Saborido B, Croner RS, De Carlis L, Magini G, Rossi R, Popescu I, Razvan L, Schneeberger S, Blokzijl H, Llado L, Gomez Bravo MA, Duvoux C, Mezjlík V, Oniscu GC, Pearson K, Dayangac M, Lucidi V, Detry O, Rotellar F, den Hoed C, Polak WG, Darwish Murad S. Recent outcomes of liver transplantation for Budd-Chiari syndrome: A study of the European Liver Transplant Registry (ELTR) and affiliated centers. Hepatology 2024:01515467-990000000-00750. [PMID: 38358658 DOI: 10.1097/hep.0000000000000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/06/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND AIMS Management of Budd-Chiari syndrome (BCS) has improved over the last decades. The main aim was to evaluate the contemporary post-liver transplantant (post-LT) outcomes in Europe. APPROACH AND RESULTS Data from all patients who underwent transplantation from 1976 to 2020 was obtained from the European Liver Transplant Registry (ELTR). Patients < 16 years with secondary BCS or HCC were excluded. Patient survival (PS) and graft survival (GS) before and after 2000 were compared. Multivariate Cox regression analysis identified predictors of PS and GS after 2000. Supplemental data was requested from all ELTR-affiliated centers and received from 44. In all, 808 patients underwent transplantation between 2000 and 2020. One-, 5- and 10-year PS was 84%, 77%, and 68%, and GS was 79%, 70%, and 62%, respectively. Both significantly improved compared to outcomes before 2000 ( p < 0.001). Median follow-up was 50 months and retransplantation rate was 12%. Recipient age (aHR:1.04,95%CI:1.02-1.06) and MELD score (aHR:1.04,95%CI:1.01-1.06), especially above 30, were associated with worse PS, while male sex had better outcomes (aHR:0.63,95%CI:0.41-0.96). Donor age was associated with worse PS (aHR:1.01,95%CI:1.00-1.03) and GS (aHR:1.02,95%CI:1.01-1.03). In 353 patients (44%) with supplemental data, 33% had myeloproliferative neoplasm, 20% underwent TIPS pre-LT, and 85% used anticoagulation post-LT. Post-LT anticoagulation was associated with improved PS (aHR:0.29,95%CI:0.16-0.54) and GS (aHR:0.48,95%CI:0.29-0.81). Hepatic artery thrombosis and portal vein thrombosis (PVT) occurred in 9% and 7%, while recurrent BCS was rare (3%). CONCLUSIONS LT for BCS results in excellent patient- and graft-survival. Older recipient or donor age and higher MELD are associated with poorer outcomes, while long-term anticoagulation improves both patient and graft outcomes.
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Affiliation(s)
- Edo Dongelmans
- Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Nicole Erler
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rene Adam
- Department of Hepato-Biliary Surgery, Cancer and Transplantation Unit, Hospital Paul Brousse, Villejuif, France
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, Universitätsklinik Tübingen, Tubingen, Germany
| | - Vincent Karam
- Department of Hepato-Biliary Surgery, Cancer and Transplantation Unit, Hospital Paul Brousse, Villejuif, France
| | - Sezai Yilmaz
- Department of Surgery, Liver Transplant Institute, Turgut Özal Medical Center, Malatya, Turkey
| | - Claire Kelly
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Jacques Pirenne
- Department of Abdominal Transplant Surgery, Universitaire Ziekenhuizen Leuven, Belgium
| | - Koray Acarli
- Department of Liver and Biliary Tract Surgery, Memorial Hospital, Istanbul, Turkey
| | - Michael Allison
- Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge NIHR Biomedical Research Center, Cambridge, UK
| | - Abdul Hakeem
- Department of HPB Surgery and Liver Transplantation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Dzmitry Fedaruk
- Department of Transplantation, Minsk Scientific and Practical Center for Surgery, Transplantology and Hepatology, Minsk, Belarus
| | - Oleg Rummo
- Department of Transplantation, Minsk Scientific and Practical Center for Surgery, Transplantology and Hepatology, Minsk, Belarus
| | - Murat Kilic
- Department of Surgery, Kent Hospital, Izmir, Turkey
| | - Arno Nordin
- Transplantation and Liver Surgery Unit, Helsinki University Hospital, Helsinki, Finland
| | - Lutz Fischer
- Department of Surgery, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Darius Mirza
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - William Bennet
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Yaman Tokat
- Department of General Surgery, International Liver Center and Acibadem Health Care Hospitals, Istanbul, Turkey
| | - Francois Faitot
- Department of HPB Surgery and Transplantation, C.H.R.U. de Strasbourg, Strasbourg, France
| | - Barbara B Antonelli
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriela Berlakovich
- Department of Transplantation Surgery, Medical University of Vienna, Wien, Austria
| | - David Patch
- Department of Hepatology and Liver Transplantation, Royal Free Hospital, London, UK
| | - Frederik Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Gent, Ghent, Belgium
| | - Marija Ribnikar
- Department of Gastroenterology, University Medical Center Lubljana, Ljubljana, Slovenia
| | - Theophile Gerster
- Department of Gastroenterology and Hepatology, C.H.U. de Grenoble, Grenoble, France
| | - Eric Savier
- Department of Digestive Surgery and Liver Transplantation, Pitie Salpetriere university hospital, Sorbonne University, Paris, France
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
- Department of Surgery and Medical and Surgical Specialties, University of Catania, Catania, Italy
| | - Bo-Göran Ericzon
- Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Andrés Valdivieso
- Department of HBP Surgery and Liver Transplantation, Cruces University hospital, Bilbao, Spain
| | | | - Baltasar Perez Saborido
- Department of General and Digestive Surgery, Hospital Universitario "Rio Hortega", Valladolid, Spain
| | - Roland S Croner
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, Germany
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, University of Milano-Bicocca, Milan, Italy
| | - Giulia Magini
- Department of Surgery, Hôpital Universitaire de Genève, Geneve, Switzerland
| | - Roberta Rossi
- Department of Gastroenterology and Transplantation, Università Politecnica delle Marche, Ancona, Italy
| | - Irinel Popescu
- Department of Surgery, University of Medicine "Carol Davila", Bucharest, Romania
| | - Laze Razvan
- Department of Surgery, University of Medicine "Carol Davila", Bucharest, Romania
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, University Hospital, Innsbruck, Austria
| | - Hans Blokzijl
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Laura Llado
- Department of Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Christophe Duvoux
- Department of Medical Liver Transplant Unit and Liver, Hôpital Henri Mondor, Creteil, France
| | - Vladimír Mezjlík
- Department of Transplantation, Center of cardiovascular surgery and transplantations, Brno, Czech Republic
| | - Gabriel C Oniscu
- Edinburgh Transplant Center, Royal Infirmary of Edinburgh, Edinburg, UK
| | - Kelsey Pearson
- Edinburgh Transplant Center, Royal Infirmary of Edinburgh, Edinburg, UK
| | - Murat Dayangac
- Center for Organ Transplantation, Medipol University Hospital, Istanbul, Turkey
| | - Valerio Lucidi
- Department of abdominal surgery, Unit of Hepato-biliary surgery and Liver Transplantation, Hôpital Erasme, Cliniques Universitaires de Bruxelles, Brussels, Belgium
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, CHU Liege, Liege, Belgium
| | - Fernando Rotellar
- Department of General and Digestive Surgery, Clinica Universitaria de Navarra, Pamplona, Spain
| | - Caroline den Hoed
- Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Wojciech G Polak
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Belli LS, Fondevila C, Cortesi PA, Conti S, Karam V, Adam R, Coilly A, Ericzon BG, Loinaz C, Cuervas-Mons V, Zambelli M, Llado L, Diaz-Fontenla F, Invernizzi F, Patrono D, Faitot F, Bhooori S, Pirenne J, Perricone G, Magini G, Castells L, Detry O, Cruchaga PM, Colmenero J, Berrevoet F, Rodriguez G, Ysebaert D, Radenne S, Metselaar H, Morelli C, De Carlis LG, Polak WG, Duvoux C. Protective Role of Tacrolimus, Deleterious Role of Age and Comorbidities in Liver Transplant Recipients With Covid-19: Results From the ELITA/ELTR Multi-center European Study. Gastroenterology 2021; 160:1151-1163.e3. [PMID: 33307029 PMCID: PMC7724463 DOI: 10.1053/j.gastro.2020.11.045] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking. METHODS Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis. RESULTS Between March 1 and June 27, 2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39 of 204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10-23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age >70 (HR, 4.16; 95% CI, 1.78-9.73) had a negative effect and tacrolimus (TAC) use (HR, 0.55; 95% CI, 0.31-0.99) had a positive independent effect on survival. The role of co-morbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR, 1.95; 95% CI, 1.06-3.58) and chronic kidney disease (HR, 1.97; 95% CI, 1.05-3.67) emerged as associated with death CONCLUSIONS: Twenty-five percent of patients requiring hospitalization for COVID-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose.
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Affiliation(s)
- Luca S. Belli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy,Correspondence Address correspondence to: Luca S. Belli, Department of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Constantino Fondevila
- Department of General and Digestive Surgery, Hospital Clínic, Institut d’Investigacion Biomediques August Pi-Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Paolo A. Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Vincent Karam
- European Liver Transplant Registry, Centre Hépatobiliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul-Brousse, Paris-Saclay University, Villejuif, France
| | - Rene Adam
- European Liver Transplant Registry, Centre Hépatobiliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul-Brousse, Paris-Saclay University, Villejuif, France
| | - Audrey Coilly
- Centre Hepato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul-Brousse, Paris-Sud Saclay University, Villejuif, France
| | - Bo Goran Ericzon
- Division of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Carmelo Loinaz
- Chirugía General, Doce de Octubre Universidad Complutense de Madrid, Madrid, Spain
| | - Valentin Cuervas-Mons
- Departimento de Medicina, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marco Zambelli
- Department of Surgery, “Papa Giovanni XXIII” Hospital, Bergamo, Lombardia, Italy
| | - Laura Llado
- Liver Transplant Unit, Hospital Uniersitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Fernando Diaz-Fontenla
- Unidad de Trasplante Hepático, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Federica Invernizzi
- Division of Gastroenterology and Hepatology, University of Milan, Milan, Italy
| | - Damiano Patrono
- Liver Transplantation Center, Molinette Hospital, Turin, Italy
| | - Francois Faitot
- Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Strasbourg, France
| | - Sherrie Bhooori
- Department of Surgery and Oncology, Istituto Nazionale Tumori, Milan, Italy
| | - Jacques Pirenne
- Department of Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Giovanni Perricone
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - Giulia Magini
- Service de Transplantation, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Lluis Castells
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Oliver Detry
- Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire Liege, University of Liege, Liege, Belgium
| | - Pablo Mart Cruchaga
- Cirugía General y Digestiva, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jordi Colmenero
- Department of General and Digestive Surgery, Hospital Clínic, Institut d’Investigacion Biomediques August Pi-Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Frederick Berrevoet
- Department of General and Hepatobiliary Surgery, Ghent University, Ghent, Belgium
| | - Gonzalo Rodriguez
- Department of General & Digestive Surgery, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
| | - Dirk Ysebaert
- Department of Surgery, Antwerp University Hospital, Antwerp University, Edegem, Belgium
| | - Sylvie Radenne
- Service d’Hépato-Gastroentérologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Herold Metselaar
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Cristina Morelli
- Liver and Multi-organ Transplantation, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luciano G. De Carlis
- General Surgery and Abdominal Transplantation Unit, Niguarda-Cà Granda Hospital, and School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Wojciech G. Polak
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Christophe Duvoux
- Department of Hepatology and Medical Liver Transplant Unit, Henri Mondor Hospital Assistance Publique-Hôpitaux de Paris, Paris-Est University, Creteil, France
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3
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Cuervas-Mons V, López-Hoyos M. Preface. Transplant Proc 2019; 51:249. [DOI: 10.1016/j.transproceed.2019.01.001] [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: 11/25/2022]
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Citores MJ, Lucena JL, de la Fuente S, Cuervas-Mons V. Serum biomarkers and risk of hepatocellular carcinoma recurrence after liver transplantation. World J Hepatol 2019; 11:50-64. [PMID: 30705718 PMCID: PMC6354126 DOI: 10.4254/wjh.v11.i1.50] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/13/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation (LT) is the only potentially curative treatment for selected patients with cirrhosis and hepatocellular carcinoma (HCC) who are not candidates for resection. When the Milan criteria are strictly applied, 75% to 85%of 3- to 4-year actuarial survival rates are achieved, but up to 20% of the patients experience HCC recurrence after transplantation. The Milan criteria are based on the preoperative tumor macromorphology, tumor size and number on computed tomography or magnetic resonance imaging that neither correlate well with posttransplant histological study of the liver explant nor accurately predict HCC recurrence after LT, since they do not include objective measures of tumor biology. Preoperative biological markers, including alpha-fetoprotein, des-gamma-carboxiprothrombin or neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio, can predict the risk for HCC recurrence after transplantation. These biomarkers have been proposed as surrogate markers of tumor differentiation and vascular invasion, with varied risk magnitudes depending on the defined cutoffs. Different studies have shown that the combination of one or several biomarkers integrated into prognostic models predict the risk of HCC recurrence after LT more accurately than Milan criteria alone. In this review, we focus on the potential utility of these serum biological markers to improve the performance of Milan criteria to identify patients at high risk of tumoral recurrence after LT.
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Affiliation(s)
- Maria J Citores
- Department of Internal Medicine, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda 28222, Spain
| | - Jose L Lucena
- Liver Transplantation Unit, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda 28222, Spain
- Department of Surgery, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda 28222, Spain
| | - Sara de la Fuente
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda 28222, Spain
| | - Valentin Cuervas-Mons
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda 28222, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid 28029, Spain
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5
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Manzardo C, Londoño MC, Castells LL, Testillano M, Luis Montero J, Peñafiel J, Subirana M, Moreno A, Aguilera V, Luisa González-Diéguez M, Calvo-Pulido J, Xiol X, Salcedo M, Cuervas-Mons V, Manuel Sousa J, Suarez F, Serrano T, Ignacio Herrero J, Jiménez M, Fernandez JR, Giménez C, Del Campo S, Esteban-Mur JI, Crespo G, Moreno A, de la Rosa G, Rimola A, Miro JM. Direct-acting antivirals are effective and safe in HCV/HIV-coinfected liver transplant recipients who experience recurrence of hepatitis C: A prospective nationwide cohort study. Am J Transplant 2018; 18:2513-2522. [PMID: 29963780 DOI: 10.1111/ajt.14996] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 12/31/2017] [Revised: 06/04/2018] [Accepted: 06/22/2018] [Indexed: 01/25/2023]
Abstract
Direct-acting antivirals have proved to be highly efficacious and safe in monoinfected liver transplant (LT) recipients who experience recurrence of hepatitis C virus (HCV) infection. However, there is a lack of data on effectiveness and tolerability of these regimens in HCV/HIV-coinfected patients who experience recurrence of HCV infection after LT. In this prospective, multicenter cohort study, the outcomes of 47 HCV/HIV-coinfected LT patients who received DAA therapy (with or without ribavirin [RBV]) were compared with those of a matched cohort of 148 HCV-monoinfected LT recipients who received similar treatment. Baseline characteristics were similar in both groups. HCV/HIV-coinfected patients had a median (IQR) CD4 T-cell count of 366 (256-467) cells/µL. HIV-RNA was <50 copies/mL in 96% of patients. The DAA regimens administered were SOF + LDV ± RBV (34%), SOF + SMV ± RBV (31%), SOF + DCV ± RBV (27%), SMV + DCV ± RBV (5%), and 3D (3%), with no differences between the groups. Treatment was well tolerated in both groups. Rates of SVR (negative serum HCV-RNA at 12 weeks after the end of treatment) were high and similar for coinfected and monoinfected patients (95% and 94%, respectively; P = .239). Albeit not significant, a trend toward lower SVR rates among patients with advanced fibrosis (P = .093) and genotype 4 (P = .088) was observed. In conclusion, interferon-free regimens with DAAs for post-LT recurrence of HCV infection in HIV-infected individuals were highly effective and well tolerated, with results comparable to those of HCV-monoinfected patients.
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Affiliation(s)
| | - Maria C Londoño
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - LLuís Castells
- CIBEREHD, Barcelona, Spain.,Liver Unit, Internal Medicine Department, Hospital Vall d'Hebrón, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - José Luis Montero
- CIBEREHD, Barcelona, Spain.,Hospital Universitario Reina Sofía-IMIBIC Córdoba, Cordoba, Spain
| | - Judit Peñafiel
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Marta Subirana
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ana Moreno
- Hospital Universitario Ramón y Cajal-IRYCIS, Madrid, Spain
| | | | | | | | - Xavier Xiol
- Hospital de Bellvitge-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | - Trinidad Serrano
- CIBEREHD, Barcelona, Spain.,Hospital Universitario Lozano Blesa, ISS Aragón, Zaragoza, Spain
| | - Jose Ignacio Herrero
- CIBEREHD, Barcelona, Spain.,Clínica Universidad de Navarra, IdiSNA, Pamplona, Spain
| | | | - José R Fernandez
- Servicio de Digestivo, Hospital Universitario Cruces, Barakaldo, Barakaldo
| | | | | | - Juan I Esteban-Mur
- CIBEREHD, Barcelona, Spain.,Liver Unit, Internal Medicine Department, Hospital Vall d'Hebrón, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Gonzalo Crespo
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHD, Barcelona, Spain
| | - Asunción Moreno
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Antoni Rimola
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHD, Barcelona, Spain
| | - Jose M Miro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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Benítez-Gutiérrez L, de Mendoza C, Baños I, Duca A, Arias A, Treviño A, Requena S, Citores MJ, Cuervas-Mons V. Drug-Induced Lung Injury in a Liver Transplant Patient Treated With Sofosbuvir. Transplant Proc 2016; 48:2515-2518. [PMID: 27742338 DOI: 10.1016/j.transproceed.2016.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/08/2023]
Abstract
New direct-acting antivirals (DAAs) have dramatically improved sustained virologic response (SVR) rates in patients treated for chronic hepatitis C. Although the safety of these agents has been very good in registration trials, unexpected side effects have been reported after much broader use of DAAs on marketing. We retrospectively examined all liver transplant recipients with chronic hepatitis C that received sofosbuvir-based regimens at our clinic. A total of 24 liver transplant recipients with recurrent chronic hepatitis C had received sofosbuvir up to April 2015. Regimens were as follows: sofosbuvir+simeprevir (8), SOF+ledipasvir (6), sofosbuvir+daclatasvir (5) and sofosbuvir+ribavirin (5). Overall, treatment was very well tolerated with only mild adverse events in 42% of patients. However, a 52-year-old woman developed severe respiratory failure within 10 days after beginning sofosbuvir+daclatasvir. High-resolution computerized tomography showed areas of diffused ground-glass opacities in both lungs, suggesting drug-induced lung injury. The bronchoalveolar lavage showed marked signs of acute inflammation without recovering any infectious agent. The patient was treated with high-dose corticosteroids and steadily recovered. DAA therapy was not discontinued, but sofosbuvir was replaced by simeprevir. She reached sustained virologic response after completing 24 weeks of DAA therapy. Given the close temporal association, radiologic and bronchoalveolar lavage findings, and negative work-up for infectious agents, we postulated that sofosbuvir was the most likely explanation for drug-induced lung injury in our patient.
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Affiliation(s)
- L Benítez-Gutiérrez
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain; Internal Medicine Laboratory, Puerta de Hierro Research Institute, Majadahonda, Spain.
| | - C de Mendoza
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain; Internal Medicine Laboratory, Puerta de Hierro Research Institute, Majadahonda, Spain
| | - I Baños
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain
| | - A Duca
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain
| | - A Arias
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain
| | - A Treviño
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain; Internal Medicine Laboratory, Puerta de Hierro Research Institute, Majadahonda, Spain
| | - S Requena
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain; Internal Medicine Laboratory, Puerta de Hierro Research Institute, Majadahonda, Spain
| | - M J Citores
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain; Internal Medicine Laboratory, Puerta de Hierro Research Institute, Majadahonda, Spain
| | - V Cuervas-Mons
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain; Department of Medicine, Autonomous University, Madrid, Spain
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Citores MJ, Pérez-Pulgar S, Duca A, Crespo G, de la Fuente S, Vilches C, Navasa M, Cuervas-Mons V. Rapidity of fibrosis progression in liver transplant recipients with recurrent hepatitis C is influenced by toll-like receptor 3 polymorphism. Clin Transplant 2016; 30:810-8. [PMID: 27101936 DOI: 10.1111/ctr.12754] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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] [Accepted: 04/15/2016] [Indexed: 02/05/2023]
Abstract
Liver transplantation activates the innate immune system through toll-like receptors (TLRs), potentially leading to allograft rejection and graft failure. We evaluated the association of single-nucleotide polymorphisms in TLR genes with the severity of hepatitis C virus recurrence after liver transplantation (LT). This is a two-center study of 176 adult patients who received a first LT from deceased donors for hepatitis C virus (HCV) cirrhosis. Eleven polymorphisms were evaluated by real-time polymerase chain reaction and melting curves analyses: TLR1 (Asp248Ser and Ser602Ile), TLR2 (Arg753Gln), TLR3 (Leu412Phe), TLR4 (Asp299Gly), TLR5 (Arg392Stop), TLR6 (Ser249Pro), TLR7 (Gln11Leu), TLR8 (Met1Val), and TLR9 (-1237T/C and -1486C/T). The CC genotype of TLR3 Leu412Phe in liver recipients was associated with severe recurrence (odds ratio (OR) = 2.01, 95% confidence interval (95% CI) = 1.02-3.93, p = 0.04). We also analyzed this polymorphism in 72 of their donors but no association was found with severity of HCV recurrence (p = 0.89). Multivariate analysis showed donor age older than 40 yr (OR=2.93; 95% CI = 1.49-5.8, p = 0.002) and the TLR3 Leu412Phe CC genotype (OR=2.02, 95%CI=1.01-4.05, p = 0.046) were independently associated with severe HCV recurrence. Our results show that the TLR3 Leu412Phe CC genotype is independently associated with severity of hepatitis C recurrence after LT.
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Affiliation(s)
- Maria J Citores
- Servicio de Medicina Interna, Instituto de Investigación Sanitaria Puerta de Hierro-Majadahonda (IDIPHIM), Madrid, Spain
| | - Sofia Pérez-Pulgar
- Unidad de Trasplante Hepático, Hospital Clinic, IDIBAPS, CIBERedh, Barcelona, Spain
| | - Ana Duca
- Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Gonzalo Crespo
- Unidad de Trasplante Hepático, Hospital Clinic, IDIBAPS, CIBERedh, Barcelona, Spain
| | - Sara de la Fuente
- Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Carlos Vilches
- Grupo de Inmunogenética e Histocompatibilidad, Servicio de Inmunología, Instituto de Investigación Sanitaria Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Miquel Navasa
- Unidad de Trasplante Hepático, Hospital Clinic, IDIBAPS, CIBERedh, Barcelona, Spain
| | - Valentin Cuervas-Mons
- Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
- Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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Ramos A, Múñez E, García-Domínguez J, Martinez-Ruiz R, Chicharro C, Baños I, Suarez-Massa D, Cuervas-Mons V. Mucosal leishmaniasis mimicking squamous cell carcinoma in a liver transplant recipient. Transpl Infect Dis 2015; 17:488-92. [PMID: 25816835 DOI: 10.1111/tid.12380] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 10/26/2014] [Accepted: 02/22/2015] [Indexed: 11/29/2022]
Abstract
Organ transplant recipients living in endemic regions are at increased risk of Leishmania infections. Visceral leishmaniasis is the most common kind of presentation in the Mediterranean basin. Rarely, Leishmania infantum may cause localized mucosal disease. We present the first case, to our knowledge, of a liver transplant recipient with localized mucosal leishmaniasis. Twenty-two years after transplantation, a painless, very slow growing ulcer appeared on the inner side of the patient's upper lip. A biopsy performed in the community hospital showed non-specific chronic inflammation without neoplastic signs. Because of a high suspicion of malignancy, the patient was transferred to the referral hospital to consider complete excision. The excisional biopsy revealed a granulomatous inflammatory reaction together with intracellular Leishmania amastigotes within macrophages. Leishmaniasis was confirmed by the nested polymerase chain reaction assay. The clinical and laboratory findings did not suggest visceral involvement. The patient received meglumine antimoniate for 21 days without relevant adverse effects.
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Affiliation(s)
- A Ramos
- Infectious Diseases Unit (Internal Medicine), Universidad Autónoma de Madrid, HU Puerta de Hierro, Majadahonda, Madrid, Spain
| | - E Múñez
- Infectious Diseases Unit (Internal Medicine), Universidad Autónoma de Madrid, HU Puerta de Hierro, Majadahonda, Madrid, Spain
| | - J García-Domínguez
- Plastic Surgery Department, HU Puerta de Hierro, Majadahonda, Madrid, Spain
| | - R Martinez-Ruiz
- Microbiology Department, HU Puerta de Hierro, Majadahonda, Madrid, Spain
| | - C Chicharro
- Parasitology Department, Instituto Nacional de Salud "Carlos III", Majadahonda, Madrid, Spain
| | - I Baños
- Liver Transplantation Unit (Internal Medicine), Universidad Autónoma de Madrid, HU Puerta de Hierro, Majadahonda, Madrid, Spain
| | - D Suarez-Massa
- Pathology Department, HU Puerta de Hierro, Majadahonda, Madrid, Spain
| | - V Cuervas-Mons
- Liver Transplantation Unit (Internal Medicine), Universidad Autónoma de Madrid, HU Puerta de Hierro, Majadahonda, Madrid, Spain
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Arias M, Cuervas-Mons V, González Molina M. Preface. Transplant Proc 2015. [DOI: 10.1016/j.transproceed.2014.12.004] [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: 12/01/2022]
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de la Fuente S, Citores MJ, Baños I, Duca A, Cuervas-Mons V. Long-term survivors after pediatric liver transplatation are at increased risk for development of cardiovascular disease events: analysis of 30 cases. Transplant Proc 2014; 46:3111-3. [PMID: 25420837 DOI: 10.1016/j.transproceed.2014.10.003] [Citation(s) in RCA: 4] [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: 02/08/2023]
Abstract
BACKGROUND Liver transplantation (LT) in adult patients is associated with a higher incidence of cardiovascular risk factors (CVRF), chronic kidney disease (CKD), and cardiovascular disease mortality than the general population. Available information about these problems in adult patients with LT from a pediatric age is limited. The aim of this study was to analyze the incidence of CVRF, risk of developing CKD, and risk of 10-year coronary event in adult patients who received LT in childhood. METHODS Thirty adult patients (11 female, 19 male; mean age, 29.3 years) who underwent LT in childhood were analyzed, and CVRF, estimated glomerular filtration rate, and current immunosuppressive regimen were recordered. The risk of 10-year coronary event was calculated with the use of validated equations (Framingham and Regicor) and compared with the estimated risk in the general population. RESULTS None of the patients had CVRF before LT, except 1 patient who received a transplant because of familial hypercholesterolemia. Median age of patients at the time of study was 28.6 years (range, 19.3-43.1 y), and mean follow-up after LT was 17.83 ± 5.21 years. Twenty-nine patients (96.7%) were receiving a calcineurin inhibitor (69% tacrolimus, 31% cyclosporine), along with steroids in 13 of them. The average CVRF per patient was 2, and 11 patients (43.33%) had ≥3. Thirteen patients (43.33%) had CKD. The estimated risk of developing a coronary event at 10 years according to the Framingham score was 3%, higher than expected in the general population of same age and sex. With the use of the Regicor equation, adapted to the Spanish population, the estimated cardiovascular risk was 1.6%, corresponding to Spanish men without CVRF aged 50-55 years. None of the patients had cardiovascular events during the follow-up. CONCLUSIONS Our data show a high incidence of CVRF and CKD in young adults who received LT in childhood, resulting in an increased risk of cardiovascular disease.
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Affiliation(s)
- S de la Fuente
- Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain.
| | - M J Citores
- Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - I Baños
- Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - A Duca
- Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - V Cuervas-Mons
- Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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Cuenca AB, Citores MJ, de la Fuente S, Duca AM, Escamilla N, Baños I, Cuervas-Mons V. TT genotype of transforming growth factor beta1 +869C/T is associated with the development of chronic kidney disease after liver transplantation. Transplant Proc 2014; 46:3108-10. [PMID: 25420836 DOI: 10.1016/j.transproceed.2014.10.002] [Citation(s) in RCA: 4] [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: 02/08/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a frequent complication in patients with liver transplantation (LT), and calcineurin inhibitor chronic nephrotoxicity, mediated by transforming growth factor beta1 (TGF-β1) is an important contributing factor. The aim of this study was to assess the influence of genetic polymorphisms of TGF-β1 in the development of CKD at 6 months after transplantation. METHODS One hundred sixty-four LT patients (63.4% male; overall mean age, 48.7 ± 11.6 years) were included in the analysis. CKD was considered at the 6th month after LT and was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m(2) as calculated on the basis of Modification of Diet in Renal Disease 4-variable equation. TGF-β1 +869 C/T and +915 G/C polymorphisms were analyzed with the use of hybridization with fluorescent probes and analysis by means of flow cytometry with the Luminex system. The association between the presence of CKD at 6 months and these polymorphisms, as well as with other known risk factors for CKD after LT, was considered. RESULTS In the univariate analysis, the TT genotype of TGF-β1 +869 (P = .036; odds ratio, 2.1; 95% confidence interval, 1.1-4.2), age at LT (P < .001), pre-transplantation serum creatinine levels (P = .03), eGFR (P < .001), CKD (P = .027), and immunosuppression with cyclosporine (P = .017) were associated with CKD at 6 months after transplantation. In the multivariate analysis, TGF-β1 +869TT genotype (P = .017), immunosuppression with cyclosporine (P = .002), age at LT (P = .024), and pre-transplantation CKD (P < .001) remained as independent variables associated with the development of CKD at 6 months after transplantation. CONCLUSIONS The genetic polymorphism TGF-β1 +869 C/T may be an independent risk factor for CKD after liver transplantation.
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Affiliation(s)
- A B Cuenca
- Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de investigación sanitaria Hospital Puerta de Hierro Majadahonda (IDIPHIM) Madrid, Spain.
| | - M J Citores
- Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de investigación sanitaria Hospital Puerta de Hierro Majadahonda (IDIPHIM) Madrid, Spain
| | - S de la Fuente
- Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de investigación sanitaria Hospital Puerta de Hierro Majadahonda (IDIPHIM) Madrid, Spain
| | - A M Duca
- Unidad de Trasplante Hepatico, Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de investigación sanitaria Hospital Puerta de Hierro Majadahonda (IDIPHIM), Madrid, Spain
| | - N Escamilla
- Unidad de Trasplante Hepatico, Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de investigación sanitaria Hospital Puerta de Hierro Majadahonda (IDIPHIM), Madrid, Spain
| | - I Baños
- Unidad de Trasplante Hepatico, Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de investigación sanitaria Hospital Puerta de Hierro Majadahonda (IDIPHIM), Madrid, Spain
| | - V Cuervas-Mons
- Unidad de Trasplante Hepatico, Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de investigación sanitaria Hospital Puerta de Hierro Majadahonda (IDIPHIM), Madrid, Spain
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Duca AM, de la Fuente S, Citores MJ, Cuenca AB, Cisneros E, Escamilla N, Baños I, Vilches C, Cuervas-Mons V. CC genotype at rs12979860 of IL28B is associated with lower risk of new-onset diabetes after transplantation in adult patients with liver transplantation for hepatitis C cirrhosis. Transplant Proc 2014; 46:3114-6. [PMID: 25420838 DOI: 10.1016/j.transproceed.2014.10.004] [Citation(s) in RCA: 4] [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: 02/05/2023]
Abstract
INTRODUCTION New-onset diabetes mellitus after transplantation (NODAT) in patients undergoing liver transplantation (LT) for hepatitis C virus (HCV)-related cirrhosis is associated with more aggressive HCV recurrence on the graft, rapid progression of fibrosis, and lower rate of sustained viral response to antiviral therapy. The CC genotype at rs12979860 of the IL28B is associated with greater rates of spontaneous clearance of HCV and response to antiviral therapy. IL28B acts on the interferon-stimulated genes through the JAK-STAT pathway, which is related to the development of insulin resistance. The aim of this study was to investigate whether IL28B rs12979860 polymorphism is associated with the development of NODAT after LT for cirrhosis owing to HCV infection. METHODS We analyzed 99 patients (age, 52.7 ± 9.4 years; 70% male) who underwent LT for HCV-related cirrhosis, with ≥1 year of follow-up and with available DNA sample. NODAT was defined starting from the sixth month after LT, according to the international consensus guidelines. Genotyping was carried out by real-time polymerase chain reaction and analysis of the melting temperature with the LightCycler 480 system. RESULTS Twenty-eight patients (28.3%) developed NODAT. CC genotype at rs12979860 of IL28B was associated with a lesser incidence of NODAT versus non-CC genotypes (P = .05; odds ratio, 0.31; 95% CI, 0.11-0.92). We did not find any association between NODAT and age at transplantation, gender, pretransplant body mass index, presence of hepatocellular carcinoma, type of initial immunosuppression (cyclosporine, tacrolimus or corticosteroids) or acute rejection treated with steroids. CONCLUSION The CC genotype at rs12979860 of IL28B is a protective factor for NODAT in patients with LT for HCV-related cirrhosis.
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Affiliation(s)
- A M Duca
- Unidad de Trasplante Hepático, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | - S de la Fuente
- Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHIM), Madrid, Spain
| | - M J Citores
- Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHIM), Madrid, Spain
| | - A B Cuenca
- Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHIM), Madrid, Spain
| | - E Cisneros
- Laboratorio de Inmunogenética e Histocompatibilidad, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - N Escamilla
- Unidad de Trasplante Hepático, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - I Baños
- Unidad de Trasplante Hepático, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - C Vilches
- Laboratorio de Inmunogenética e Histocompatibilidad, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - V Cuervas-Mons
- Unidad de Trasplante Hepático, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Citores MJ, Baños I, Noblejas A, Rosado S, Castejon R, Cuervas-Mons V. Toll-like receptor 3 L412F polymorphism may protect against acute graft rejection in adult patients undergoing liver transplantation for hepatitis C-related cirrhosis. Transplant Proc 2011; 43:2224-6. [PMID: 21839239 DOI: 10.1016/j.transproceed.2011.05.011] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Liver transplantation activates the innate immune system by toll-like receptors (TLRs), potentially leading to allograft rejection and graft failure. The aim of this study was to evaluate the possible association of different single nucleotide polymorphisms (SNPs) in several TLR genes with the incidence of acute graft rejection in liver transplant recipients for hepatitis C virus (HCV)-related cirrhosis. This is a single-center study of 100 adult patients who received a first whole only liver graft from deceased donors at our institution between 1988 and 2009 for cirrhosis due to HCV infection. We examined 10 SNPs in the TLR1 (S6021), TLR2 (R753Q), TLR3 (L412F), TLR4 (D299G and T399I), TLR5 (R392X), TLR6 (S249P), TLR7 (Q11L), and TLR9 (-1237T/C and -1486C/T) genes. Genotyping was carried out with the LightSNiP typing assay (TIB-MolBiol, Berlin, Germany) by analyzing the melting curves with the LightCycler 480 system (Roche Applied Science, Mannheim, Germany). Recipient allelic and genotypic distributions for each SNP were compared among patients with and without acute rejection within the first 3 months after transplantation. We found the homozygous mutant TT genotype for TLR3 L412F was associated with a lower rate of acute rejection when compared with the homozygous wild-type genotype [odds ratio (OR) = 0.1, 95% confidence interval (95% CI) = 0.01-0.86; P = .017], and showed a trend toward a lower graft rejection rate when compared with patients carrying one or two C alleles (OR = 0.15, 95% CI = 0.02-1.2, P = .05). No other associations with acute rejection rates were found for any other SNP evaluated. This preliminary study suggests an important role for SNP TLR3 L412F in acute rejection in liver transplant patients for HCV-related cirrhosis. Nevertheless, these findings must be prospectively validated in other cohorts of patients as well as in patients after liver transplantation for other etiologies than HCV.
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Affiliation(s)
- M J Citores
- Laboratorio de Medicina Interna, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
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Otero A, Varo E, de Urbina JO, Martín-Vivaldi R, Cuervas-Mons V, González-Pinto I, Rimola A, Bernardos A, Otero S, Maldonado J, Herrero JI, Barrao E, Domínguez-Granados R. A prospective randomized open study in liver transplant recipients: daclizumab, mycophenolate mofetil, and tacrolimus versus tacrolimus and steroids. Liver Transpl 2009; 15:1542-52. [PMID: 19877219 DOI: 10.1002/lt.21854] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [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: 12/15/2022]
Abstract
This open-label, randomized study compared the efficacy of a regimen of corticosteroids and tacrolimus (standard therapy group, n = 79) with a regimen of daclizumab induction therapy in combination with mycophenolate mofetil and tacrolimus (modified therapy group, n = 78) in primary liver transplant recipients. The primary endpoint was biopsy-proven acute rejection (BPAR) at 24 weeks. Secondary endpoints included time to rejection and patient and graft survival. The incidence of BPAR was significantly reduced in the modified therapy group compared to the standard therapy group (11.5% versus 26.6%, respectively, P = 0.017). The time to rejection was significantly shorter in the standard therapy group compared with the modified therapy group (P = 0.044). There was no significant difference between groups in patient or graft survival. Hepatitis C virus-positive patients exhibited no differences from hepatitis C virus-negative patients with respect to the incidence of BPAR. A steroid-sparing regimen of daclizumab, mycophenolate mofetil, and tacrolimus was effective and well tolerated in the prevention of BPAR in adult liver transplant recipients in comparison with a standard regimen of tacrolimus and steroids.
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Redondo I, Otón E, Bárcena R, Del Campo S, Rodriguez-Gandía M, Cuervas-Mons V. Hepatitis C virus sensitivity to combined antiviral therapy in liver transplant versus immunocompetent patients. Transplant Proc 2009; 41:2195-6. [PMID: 19715871 DOI: 10.1016/j.transproceed.2009.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Recurrent hepatitis C virus (HCV) after orthotopic liver transplantation (OLT) frequently causes allograft failure, because viral aggressiveness has been shown to be increased among immunosuppressed patients. Several studies have reported lower efficacy of antiviral therapy after OLT associated with worse tolerability. The aim of this study was to compare the logarithmic falls in viral loads at 4 and 12 weeks of treatment with pegylated interferon alpha and ribavirin among OLT versus immunocompetent patients. OLT patients (group 1) were recruited from 3 Spanish centers. Two age- and sex-matched controls (group 2) were randomly assigned to each case. We excluded coinfection with human immunodeficiency virus or hepatitis B or cholestatic hepatitis. Among group 1 (n = 66) were 72.7% men with an overall mean age of 52.7 +/- 10.1 years; 90.9% were genotype 1. The mean baseline viral load was 6.0 +/- 0.6 log10 IU/mL, and 19% of patients had cirrhosis. Among group 2 (n = 132) were 72.7% men with an overall mean age of 50.1 +/- 10.1 years; 92.4% were genotype 1. The mean baseline viral load was 5.9 +/- 0.5 log10 IU/mL, and 17% of patients had cirrhosis. There were no significant differences in patient characteristics between the 2 groups. The logarithmic falls in viral loads at 4 weeks of treatment were similar in groups 1 and 2: 2.3 +/- 2.1 vs 2.4 +/- 1.9 log10 IU/mL (P = .49); they were also similar at 12 weeks of treatment: 3.9 +/- 1.9 vs 3.7 +/- 2.4 log10 IU/mL (P = .66). In conclusion, in our study HCV sensitivity to combined antiviral therapy was the same among transplant versus immunocompetent patients.
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Affiliation(s)
- I Redondo
- Liver-Gastroenterology Service, Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, Spain
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Rubio E, González J, Jimenéz M, Lucena JL, Gimenez L, Martinez Arrieta F, Cuervas-Mons V, Turrión VS. Right adrenal metastases of hepatocarcinoma after liver transplantation: case report and literature review. Transplant Proc 2009; 41:1067-9. [PMID: 19376429 DOI: 10.1016/j.transproceed.2009.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) represents one of the most common malignancies globally, accounting for nearly one million new cases per year. Although the treatment of extrahepatic metastases from primary liver tumors is essentially palliative, a solitary metastasis from such tumors offers a possibility of cure by surgical resection. The adrenal gland is an uncommon site for metastasis from primary liver tumors. METHODS We report a liver transplantation case of HCC and hepatitis B virus in a 23-year-old man with an excellent postoperative result. However, because an increased alpha-fetoprotein was evident and complete radiologic and blood tests were performed, all of which were normal. Three years posttransplantation, a right adrenal mass was identified by CT. PAAF was performed as well as adrenalectomy for a solitary adrenal metastasis from hepatocellular carcinoma. RESULTS The patient underwent adrenalectomy for the right adrenal metastasis at 3 years following liver transplantation for HCC. He is presently alive and disease-free 24 months after adrenalectomy. CONCLUSION Carefully selected patients with solitary metastasis from HCC may be considered for resection.
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Affiliation(s)
- E Rubio
- Unidad de Trasplante Hepático, Hospital Universitario, Puerta de Hierro, UAM, Madrid, Spain.
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Len O, Gavaldà J, Blanes M, Montejo M, San Juan R, Moreno A, Carratalà J, de la Torre-Cisneros J, Bou G, Cordero E, Muñoz P, Cuervas-Mons V, Alvarez MT, Borrell N, Fortun J, Pahissa A. Donor infection and transmission to the recipient of a solid allograft. Am J Transplant 2008; 8:2420-5. [PMID: 18925908 DOI: 10.1111/j.1600-6143.2008.02397.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Transmission of infection from donor to recipient is a potential complication of transplantation. More data on this issue are needed to expand the insufficient donor pool. This study evaluates the incidence of donor nonviral infection, transmission from infected donors and the effect of donor infection on 30-day recipient survival. Data from 211 infected donors contributing to 292 (8.8%) of 3322 consecutive transplant procedures within RESITRA (Spanish Research Network for the Study of Infection in Transplantation) were prospectively compiled and analyzed. Lung was the most likely transplanted organ carried out with an infected donor and Staphylococcus aureus was the most commonly isolated microorganism. In more than a half of donors, the lung was the site of infection. Donor-to-host transmission was documented in 5 patients out of 292 (1.71%), 2 of whom died of the acquired infection (40%). Nonetheless, there was no difference in 30-day patient survival when comparing transplant procedures performed with organs from infected or uninfected donors. In conclusion, donor infection is not an infrequent event, but transmission to the recipient is quite low. Hence, with careful microbiological surveillance and treatment, the number of organs available for transplantation may be increased.
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Affiliation(s)
- O Len
- Hospital Vall d' Hebron, Barcelona, Spain.
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Asensio A, Ramos A, Cuervas-Mons V, Cordero E, Sánchez-Turrión V, Blanes M, Cervera C, Gavalda J, Aguado JM, Torre-Cisneros J. Effect of antibiotic prophylaxis on the risk of surgical site infection in orthotopic liver transplant. Liver Transpl 2008; 14:799-805. [PMID: 18508358 DOI: 10.1002/lt.21435] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [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: 12/14/2022]
Abstract
Surgical site infections are common bacterial infections in orthotopic liver transplantation. The purpose of this study was to determine the incidence, timing, location, and risk factors, specifically antibiotic prophylaxis, for surgical site infections. A prospective study was performed that included a population of 1222 consecutive patients (73.0% males) who underwent liver transplantation in Spanish hospitals belonging to the Red de Estudio de la Infección en el Trasplante research network. One hundred seven patients developed surgical site infections. The predominant infection sites were incisional wound (53 episodes) and peritonitis (40 episodes). The timing of the organ/space surgical site infections was slightly delayed in comparison with incisional surgical site infections. Enterococcus spp., Escherichia coli, Staphylococcus aureus, and Acinetobacter baumannii were the predominant pathogens. Choledochojejunal or hepaticojejunal reconstruction (odds ratio, 4.2; 95% confidence interval, 1.6-10.7), previous liver or kidney transplant (odds ratio, 2.6; 95% confidence interval, 1.1-6.3), and more than 4 red blood cell units transfused (odds ratio, 2.0; 95% confidence interval, 1.1-3.4) were independently associated with the development of surgical site infections. Biliary reconstruction by choledochojejunostomy or hepaticojejunostomy increases the risk of surgical site infections.
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Affiliation(s)
- Angel Asensio
- Infectious Diseases Unit, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
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Oton E, Barcena R, Moreno-Planas JM, Cuervas-Mons V, Moreno-Zamora A, Barrios C, Garcia-Garzon S, Moreno A, Boullosa-Graña E, Rubio-Gonzalez EE, Garcia-Gonzalez M, Blesa C, Mateos ML. Hepatitis C recurrence after liver transplantation: Viral and histologic response to full-dose PEG-interferon and ribavirin. Am J Transplant 2006; 6:2348-55. [PMID: 16869810 DOI: 10.1111/j.1600-6143.2006.01470.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [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: 01/25/2023]
Abstract
Hepatitis C recurrence after liver transplantation (LT) is universal, and frequently leads to cirrhosis and death. The aim of our study was to assess the efficacy and safety of 48-weeks of full-dose peg-interferon-alpha-2a (n = 4) or alpha-2b (n = 51) plus ribavirin (>11 mg/kg/day) in a multicentric cohort of 55 patients > or =12 months after LT. All subjects had histologically proven HCV recurrence, excluding severe cholestatic recurrence. Mean age was 54.3 +/- 9.7, 77% male, 90.9% genotype 1, 32.7% cirrhotics. All but 5 patients received monotherapy with tacrolimus (54.5%), cyclosporine (30.7%) or mycophenolate mofetil (5.5%). The rates of end-of-treatment response and sustained virological response (SVR) were 66.7% and 43.6%, respectively. Low baseline HCV-RNA (p = 0.005) and a length from LT to therapy between 2-4 years (p = 0.011) were predictors of SVR. The lack of achieving a viral load decrease > or =1-log10 at week 4 and/or 2-log10 at week 12 was 100% predictive of failure. The most frequent side effects were neutropenia (76,4%), anemia (60%) and infectious complications (30.9%). Toxicity led to peg-interferon withdrawal in 16 (29%) subjects. In 15 patients with post-treatment biopsy, the histological activity index was significantly improved (p = 0.006), whereas fibrosis did not change (p = 0.14). Three patients died (cholangitis, hepatic artery thrombosis and lung cancer). In conclusion, HCV therapy after LT was very effective, although it led to a significant rate of toxicity.
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Affiliation(s)
- E Oton
- Liver-gastroenterology Department, Ramon y Cajal Hospital, Madrid
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20
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Oton E, Barcena R, Moreno-Planas JM, Cuervas-Mons V, Moreno-Zamora A, Barrios C, Garcia-Garzon S, Moreno A, Boullosa-Graña E, Rubio-Gonzalez EE, Garcia-Gonzalez M, Blesa C, Mateos ML. Hepatitis C recurrence after liver transplantation: Viral and histologic response to full-dose PEG-interferon and ribavirin. Am J Transplant 2006. [PMID: 16869810 DOI: 10.1111/j.1600-6143.2006.01470] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hepatitis C recurrence after liver transplantation (LT) is universal, and frequently leads to cirrhosis and death. The aim of our study was to assess the efficacy and safety of 48-weeks of full-dose peg-interferon-alpha-2a (n = 4) or alpha-2b (n = 51) plus ribavirin (>11 mg/kg/day) in a multicentric cohort of 55 patients > or =12 months after LT. All subjects had histologically proven HCV recurrence, excluding severe cholestatic recurrence. Mean age was 54.3 +/- 9.7, 77% male, 90.9% genotype 1, 32.7% cirrhotics. All but 5 patients received monotherapy with tacrolimus (54.5%), cyclosporine (30.7%) or mycophenolate mofetil (5.5%). The rates of end-of-treatment response and sustained virological response (SVR) were 66.7% and 43.6%, respectively. Low baseline HCV-RNA (p = 0.005) and a length from LT to therapy between 2-4 years (p = 0.011) were predictors of SVR. The lack of achieving a viral load decrease > or =1-log10 at week 4 and/or 2-log10 at week 12 was 100% predictive of failure. The most frequent side effects were neutropenia (76,4%), anemia (60%) and infectious complications (30.9%). Toxicity led to peg-interferon withdrawal in 16 (29%) subjects. In 15 patients with post-treatment biopsy, the histological activity index was significantly improved (p = 0.006), whereas fibrosis did not change (p = 0.14). Three patients died (cholangitis, hepatic artery thrombosis and lung cancer). In conclusion, HCV therapy after LT was very effective, although it led to a significant rate of toxicity.
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Affiliation(s)
- E Oton
- Liver-gastroenterology Department, Ramon y Cajal Hospital, Madrid
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21
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Rubio Gonzalez EE, Moreno Planas JM, Jimenez Garrido MC, Lucena de la Poza JL, Martínez Arrieta F, Cuervas-Mons V, Sanchez Turrión V. Results of liver transplantation in patients with previous portosystemic shunts. Transplant Proc 2005; 37:1491-2. [PMID: 15866651 DOI: 10.1016/j.transproceed.2005.02.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although liver transplantation is performed successfully in some patients with previous portosystemic shunts (PSS), these surgical procedures have been considered a relative contraindication for orthotopic liver transplantation (OLT). We aimed to determine whether a previous PSS worsens the prognosis of patients who undergo OLT. PATIENTS AND METHODS Between March 1986 and October 2003, 520 liver transplants were performed in 467 patients in our center. Thirteen patients had undergone a PSS before OLT. The types of PSS were: portocaval (n = 8), splenorenal (n = 3), mesocaval (n = 1), and portoatrial (n = 1). We compared patients with previous PSS (cases) and the three patients with an OLT immediately before each case (controls). We analyzed the following variables: age, Child-Pugh stage, pretransplant liver disease, surgical times, transfusion requirements, infections, intensive care unit (ICU) stay, postoperative evolution, and survival. RESULTS Age, Child-Pugh stage, and pretransplant liver disease were similar in both groups. There were no statistical differences in age, surgical times, ischemia time, anhepatic phase, transfusion requirements, ICU stay, infections, or hospital stay. The postoperative course was similar in both groups. Long-term survival was 84.62% in cases versus 78.5% in controls. CONCLUSIONS Previous PSS should not be considered a contraindication for liver transplantation, even though this group of patients involves a special surgical challenge.
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Affiliation(s)
- E E Rubio Gonzalez
- Liver Transplant Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain.
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22
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González-Pinto IM, Rimola A, Margarit C, Cuervas-Mons V, Abradelo M, Alvarez-Laso C, Londoño MC, Bilbao I, Sánchez-Turrión V. Five-year follow-up of a trial comparing Tacrolimus and cyclosporine microemulsion in liver transplantation. Transplant Proc 2005; 37:1713-5. [PMID: 15919441 DOI: 10.1016/j.transproceed.2005.03.128] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We evaluate 5-year results of a prospective randomized trial that compared cyclosporine microemulsion (CsA-me) and Tacrolimus (Tac) for primary immunosuppression. One hundred one adult patients undergoing liver transplantation were randomized to receive Tac (n = 50) or CsA-me (n = 51). The most frequent indication for the procedure was cirrhosis due to virus C followed by alcoholism. Survival rates at 1, 3, and 5 years were 86%, 75%, and 72%, respectively; there was no significant difference between CsA-me versus Tac arms. Acute rejection occurred in 30 cases (30%), independent of the type of primary immunosuppression. Serious adverse events were reported significantly more among patients under CsA-me (48 episodes) than under Tac (32 episodes). Nineteen patients were switched to the other calcineurin inhibitor. The switch was much more frequent from CsA-me to Tac (n = 15; 29.4%), mainly because of lack of efficacy (n = 10; 19.6%). There were no cases of chronic rejections in the Tac arm. Four patients were switched from Tac to CsA-me for side effects; only 1 remains alive, after treatment was changed from CsA-me to an antimetabolite. There were no statistical differences in renal dysfunction, diabetes, hypertension, neurologic disorders, new-onset malignancies, or infections. There were no differences in survival or rejection among the intention-to-treat groups. Serious adverse events, total patients with switch of calcineurin inhibitor, as well as switches due to lack of efficacy, were statistically more frequent under CsA-me. Tacrolimus seems to be a more appropriate drug to be used for primary immunosuppression in liver transplantation.
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Acevedo Ribó M, Moreno Planas JM, Sanz Moreno C, Rubio González EE, Rubio González E, Boullosa Graña E, Sanchez-Turrión V, Sanz Guajardo D, Cuervas-Mons V. Therapy of Intractable Pruritus With MARS. Transplant Proc 2005; 37:1480-1. [PMID: 15866646 DOI: 10.1016/j.transproceed.2005.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Pruritus is the most disabling symptom in patients with cholestatic liver diseases. Many drug therapies have been used for the treatment of these diseases, with different outcomes. The molecular adsorbent recirculating system (MARS) has been used in the treatment of intractable pruritus in cholestatic syndromes. We report our experience with MARS in 3 patients with intractable pruritus on the waiting list: 2 liver transplant recipients and a patient with primary biliary cirrhosis. PATIENTS AND RESULTS Two middle-aged women and 1 middle-aged man, who were recipients of an orthotopic liver transplant for primary biliary cirrhosis, underwent three (n = 2) and two (n = 1) 6-hour sessions of MARS due to medically uncontrollable pruritus. All noted marked improvement of pruritus, with decreased bilirubin levels, but this improvement lasted only a few days in all cases. We observed no changes in transaminase or albumin levels, or prothrombin time. Complications included an episode of angina due to anemia caused by jugular catheter bleeding, and thrombocytopenia in all patients. CONCLUSIONS MARS is an effective treatment for intractable pruritus in cholestatic liver diseases, although its beneficial effect is short. This extracorporeal liver device is safe, because most related adverse events are mild.
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Affiliation(s)
- M Acevedo Ribó
- Department of Nephrology, Hospital Puerta de Hierro, Madrid, Spain
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24
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Cuervas-Mons V. Infección bacteriana temprana en el paciente con trasplante hepático. Gastroenterol Hepatol 2004. [DOI: 10.1157/13067458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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25
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Moreno JM, Cuervas-Mons V, Rubio E, Pons F, Herreros de T A, Turrión VS, Millán I. Chronic renal dysfunction after liver transplantation in adult patients: prevalence, risk factors, and impact on mortality. Transplant Proc 2003; 35:1907-8. [PMID: 12962843 DOI: 10.1016/s0041-1345(03)00642-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Although chronic renal dysfunction (CRD) is a common complication among patients undergoing liver transplantation (OLT) its prevalence, risk factors, and impact on outcome have not been well defined. We aimed to assess the incidence of CRD, its associated risk factors and its impact on outcome. PATIENTS AND METHODS The cohort of 289 consecutive adult first liver transplant patients with posttransplant follow-up longer than 6 months received cyclosporine in 230 patients (153 oil-based and 81 microemulsion formulation), tacrolimus in 55. CRD was defined as serum creatinine levels greater than 1.3 mg/dL for more than 6 months. RESULTS After a mean follow-up of 67 months, 138 patients (47.8%) displayed CRD. The prevalence of CRD was 30.9%, 41.5%, and 38.9% at 1, 5, and 13 years after OLT, respectively. Twelve patients (4.1%) developed end-stage renal failure. Male gender, older recipient age, pretransplant renal dysfunction and hyperuricemia, posttransplant in-hospital renal dysfunction and hyperuricemia, and renal dysfunction during the first 6 months after OLT were each significantly associated with the development of CRD. Survival was significantly lower (63%) among liver transplant patients with CRD than those without this complication (71%, P=.024). CONCLUSIONS CRD is an important cause of morbidity after OLT, although end-stage renal disease is infrequent. Because early renal dysfunction is associated with the development of CRD, and decreased long-term patient survival, efforts should be made to avoid early renal dysfunction after liver transplantation.
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Affiliation(s)
- J M Moreno
- Departments of Medicine and Surgery, Liver Transplantation Unit, Puerta de Hierro University Hospital, Universidad Autónoma, Madrid, Spain.
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26
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Rosen HR, Prieto M, Casanovas-Taltavull T, Cuervas-Mons V, Guckelberger O, Muiesan P, Strong RW, Bechstein WO, O'grady J, Zaman A, Chan B, Berenguer J, Williams R, Heaton N, Neuhaus P. Validation and refinement of survival models for liver retransplantation. Hepatology 2003; 38:460-9. [PMID: 12883491 DOI: 10.1053/jhep.2003.50328] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.0] [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: 01/10/2023]
Abstract
Orthotopic liver retransplantation (re-OLT) is highly controversial. The objectives of this study were to determine the validity of a recently developed United Network for Organ Sharing (UNOS) multivariate model using an independent cohort of patients undergoing re-OLT outside the United States, to determine whether incorporation of other variables that were incomplete in the UNOS registry would provide additional prognostic information, to develop new models combining data sets from both cohorts, and to evaluate the validity of the model for end-stage liver disease (MELD) in patients undergoing re-OLT. Two hundred eighty-one adult patients undergoing re-OLT (between 1986 and 1999) at 6 foreign transplant centers comprised the validation cohort. We found good agreement between actual survival and predicted survival in the validation cohort; 1-year patient survival rates in the low-, intermediate-, and high-risk groups (as assigned by the original UNOS model) were 72%, 68%, and 36%, respectively (P <.0001). In the patients for whom the international normalized ratio (INR) of prothrombin time was available, MELD correlated with outcome following re-OLT; the median MELD scores for patients surviving at least 90 days compared with those dying within 90 days were 20.75 versus 25.9, respectively (P =.004). Utilizing both patient cohorts (n = 979), a new model, based on recipient age, total serum bilirubin, creatinine, and interval to re-OLT, was constructed (whole model chi(2) = 105, P <.0001). Using the c-statistic with 30-day, 90-day, 1-year, and 3-year mortality as the end points, the area under the receiver operating characteristic (ROC) curves for 4 different models were compared. In conclusion, prospective validation and use of these models as adjuncts to clinical decision making in the management of patients being considered for re-OLT are warranted.
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Affiliation(s)
- Hugo R Rosen
- Division of Gastroenterology/Hepatology, Portland VAMC and Oregon Health and Science University, Portland, OR 97207, USA.
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27
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Mazuelos F, Abril J, Zaragoza C, Rubio E, Moreno JM, Turrión VS, Cuervas-Mons V. Cardiovascular morbidity and obesity in adult liver transplant recipients. Transplant Proc 2003; 35:1909-10. [PMID: 12962844 DOI: 10.1016/s0041-1345(03)00640-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
There is a direct relationship between the grade of obesity and mortality based on the increased cardiovascular diseases, cancer, etc. However, the results of studies in renal and liver allograft recipients relating obesity to morbidity and mortality are contradictory. A retrospective cohort study of 170 patients transplanted between March 1987 and July 1997 showed obesity to be identified in 77 (45.3%) patients. During the mean follow-up of 5 years posttransplantation, 16 (9.4%) patients experienced cardiovascular complications, including 10 patients with ischemic cardiac syndromes (five acute infarctions and five angina), five patients with acute cerebrovascular accidents, and one patient with intermittent lower limbs claudication. The prevalence of obesity at 1, 3, 5, 7, and 9 years after transplantation was 58.2%, 56.9%, 60.3%, 59.5%, and 66.4%, respectively. Compared with the baseline value, the BMI was increased at 1 year posttransplantation (25.78), a significant difference. No significant differences were found between the mean BMI values of patients with and without cardiovascular diseases, or overweight and morbidly obese patients compared to the normal weight population. Among liver transplant recipients, obesity was a frequent complication after transplantation, but it was not clearly associated with increased morbidity and mortality secondary to cardiovascular disease.
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Affiliation(s)
- F Mazuelos
- Department of Medicine, Hospital Universitario Puerta de Hierro, Universidad Autónoma, Madrid, Spain
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28
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De la Revilla NJ, Moreno JM, Rubio E, de Herreros TA, Navarrete E, Lopez MJ, Turrion VS, Jimenez M, Lucena M, Cuervas-Mons V. Usefulness of chemotherapy as prophylaxis of tumor recurrence after liver transplantation in advanced hepatocellular carcinomas. Transplant Proc 2003; 35:1830-1. [PMID: 12962812 DOI: 10.1016/s0041-1345(03)00583-9] [Citation(s) in RCA: 10] [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: 01/11/2023]
Abstract
INTRODUCTION The effectiveness of chemotherapy as prophylaxis of tumor recurrence after liver transplantation in patients with advanced hepatocellular carcinoma is controversial. AIM Our goal was to assess the outcomes of patients with advanced hepatocellular carcinoma treated with chemotherapy after liver transplant. METHODS Ten patients with liver transplants performed between 1993-2002 were men of mean age 55 years. The etiology of cirrhosis was hepatitis C in four patients, alcoholic cirrhosis in four, and cryptogenic cirrhosis in two. Immunosuppressive therapy was cyclosporine in five patients and tacrolimus in five. The chemotherapy regimen used adriamycin (20 mg/m2 weekly for 20 weeks). Six patients were stage IVA and four stage III. Hepatocellular carcinoma was known in five patients and incidental in the other five. Pathology revealed well-differentiated hepatocellular carcinoma in six patients and moderately differentiated hepatocellular carcinoma in four. Five patients had vascular invasion. RESULTS After a mean posttransplant follow-up of 28 months, six patients (60%) were alive without tumor recurrence, three (30%) had died from tumor recurrence and one due to P. carinii pneumonia. Disease-free survival among patients with stage III was 50% and 80% for stage IVA. Three patients with vascular invasion died of tumor recurrence, and the other two are alive and free of disease. Disease-free survival rates were 83% in patients with well-differentiated hepatocellular carcinoma and 25% in those with moderately differentiated hepatocellular carcinoma. Tolerance of chemotherapy was good with two withdrawals due to nephrotoxicity and myelotoxicity and one death from pneumonia. CONCLUSION The use of adriamycin in patients undergoing liver transplant due to advanced hepatocellular carcinoma may be useful to prevent tumor recurrence; it is well tolerated. The presence of vascular tumor invasion and a lower grade of histologic differentiation were associated with a poor prognosis.
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Affiliation(s)
- N J De la Revilla
- Liver Transplantation Unit, Hospital Universitario Puerta de Hierro, Universidad Autónoma, Madrid, Spain
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Moreno JM, Rubio E, Gómez A, Lopez-Monclus J, Herreros A, Revilla J, Navarrete E, Sánchez Turrión V, Jimenez M, Cuervas-Mons V. Effectiveness and safety of mycophenolate mofetil as monotherapy in liver transplantation. Transplant Proc 2003; 35:1874-6. [PMID: 12962831 DOI: 10.1016/s0041-1345(03)00643-2] [Citation(s) in RCA: 28] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Calcineurin inhibitors (CIs) cause substantial long-term morbidity and mortality among orthotopic liver transplantation (OLT) patients. Our aim was to evaluate the effectiveness and safety of mycophenolate mofetil (MMF) among OLT patients with CI-related side effects. PATIENTS Thirty three adult patients, including 29 men and 4 women of mean age 57 years, underwent OLT between 1986 and 2000 under treatment with CIs (28 cyclosporine and five tacrolimus). Mean follow-up after OLT was 59 months. Adverse effects were renal dysfunction in 26, hypertension in 23, and neurotoxicity in two. MMF was added gradually while simultaneously reducing the dosage of CI. RESULTS After a mean 15-months follow-up of MMF treatment, CIs had been withdrawn in 28 patients (85%). The mean time from the initiation of MMF and CI withdrawal was 5 months. During the first year of follow-up chronic renal dysfunction improved in 16 of 26 patients (61.6%) accompanied by a decreased serum creatinine and urea and an increase in creatinine clearance. Among 13/23 (56.5%) hypertensive patients, there was a significant decrease in blood pressure or the number of antihypertensive drugs (P<.05). One patient with neurotoxicity improved. Twenty-two patients (66%) displayed adverse events: five rejections (15%) including four acute episodes, controlled by CI re-introduction, and one chronic reaction. The most frequent adverse effects were herpes simplex infection in 10 patients (30%), asthenia in nine (27%), diarrhea in five (15%) and thrombocytopenia in four (12%). Nevertheless, only six patients (19%) required MMF dose reduction, namely, three patients with GI intolerance, two with repeated VHS infections, and one with anemia. CONCLUSIONS MMF monotherapy improves renal function and blood pressure levels in more than 50% of patients with chronic renal impairment and hypertension after OLT. Many of the side effects of MMF were mild; it was safe accompanied by a low incidence of rejection reactions.
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Affiliation(s)
- J M Moreno
- Department of Medicine, Hospital Universitario Puerta de Hierro, Universidad Autónoma, Madrid, Spain.
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Alonso I, Herreros de Tejada A, Moreno JM, Rubio E, Lucena JL, De la Revilla J, Sánchez Turrión V, Gomez A, Lopez J, Cuervas-Mons V. Effectiveness of low-dose intramuscular anti-VHB immune globulin in the prophylaxis of viral B hepatitis reinfection after liver transplantation: preliminary report. Transplant Proc 2003; 35:1850-1. [PMID: 12962821 DOI: 10.1016/s0041-1345(03)00634-1] [Citation(s) in RCA: 13] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Prophylaxis using high-dose intravenous anti-HBV immune globulin (HBIG) is effective to prevent reinfection due to hepatitis B virus (HBV) after orthotopic liver transplantation (OLT). However, this treatment is expensive and intravenous administration is difficult during outpatient care. Our aim was to assess the effectiveness of low-dose intramuscular HBIG to prevent HBV reinfection after OLT. PATIENTS Six patients (all men, mean age 41 years, negative HBV DNA without hepatotropic virus coinfection) were transplanted in our institution due to HBV cirrhosis and included in a prospective noncomparative study. Intramuscular HBIG (2000 IU) was administered during the anhepatic phase of OLT, followed by daily 2000 IU doses for 7 days and then monthly. HBV antibody titers were measured every month. Reinfection was defined as the recurrence of surface HBV antigen in serum after transplantation. RESULTS After 1 year follow-up, none of the six patients had detectable HBV surface antigen and the liver biopsies were normal in all cases. Using 2000 IU, anti-HBs levels were: 880+/-356 IU/L at 1 month, 191+/-123 at 6 months, and 225+/-49 after 1 year. In all cases anti-HBs titers were above 100 IU/L during the follow-up. CONCLUSIONS Monthly administration of low-dose (2000 IU) intramuscular HBIG effectively prevents recurrence of HBV infection as well as attains a protective level of anti-HBs antibodies (over 100 IU/L) for at least the first year after transplantation.
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Affiliation(s)
- I Alonso
- Liver Transplant Unit, Hospital Puerta de Hierro, Madrid, Spain
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Abstract
INTRODUCTION De novo tumors (DNTs) are the leading cause of late death among liver transplant recipients with an incidence of 5% to 15%, which is significantly greater than the general population. In this retrospective study, we compared this complication in liver transplant recipients to sex- and age-matched controls. PATIENTS Among 410 patients who received liver allografts between March 1986 and December 2000, 32 (7.8%) developed a DNT. Epidermoid tumors were the most frequent histologic lineage. A complete response was observed in 19 patients (59.4%), a partial response in eight (25%), and no response in five (15%). Survival was lower among liver transplant recipients than controls, a difference that was statistically significant. Treatment consisted of surgery in 76.7%, radiotherapy in 16.7%, chemotherapy in 13.3%, and reduction of immunosuppression in 10%. RESULTS The mean survival time in transplant patients of 122.97 months (95% CI; range 98-147 months) was significantly shorter than controls, 156.5 months (95% CI; range 141-171 months). About 50% of patients were smokers (active or ex-smokers), compared to 20.7% of controls (P=.049). Significant differences were also found when the three subgroups (smokers, previous smokers, and nonsmokers) were analyzed separately (P=.013). Patients were smokers (active or nonactive) among 45% of cases of skin tumors; 60% of hematological tumors; 71.4% of epidermoids; and 33% of sarcomas. CONCLUSIONS DNTs, a complication of long-term immunosuppression in patients after liver transplantation, most frequently presented as skin tumors and PTLD. Occurrence of a DNT was an adverse prognostic factor for survival. Smoking represents an independent risk factor for these tumors.
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Affiliation(s)
- E Rubio
- Liver Transplantation Unit, Hospital Puerta de Hierro, Universidad Autónoma, Madrid, Spain.
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Prieto M, Clemente G, Casafont F, Cuende N, Cuervas-Mons V, Figueras J, Grande L, Herrero JI, Jara P, Mas A, de la Mata M, Navasa M. [Consensus document on indications for liver transplantation. 2002]. Gastroenterol Hepatol 2003; 26:355-75. [PMID: 12809573 DOI: 10.1016/s0210-5705(03)70373-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- M Prieto
- Servicio de Medicina Digestiva. Hospital Universitario La Fe. Valencia. España
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Moreno JM, Rubio E, Pons F, Velayos B, Navarrete E, Herreros de Tejada A, López-Monclús J, Sánchez-Turrión V, Cuervas-Mons V. Usefulness of mycophenolate mofetil in patients with chronic renal insufficiency after liver transplantation. Transplant Proc 2003; 35:715-7. [PMID: 12644108 DOI: 10.1016/s0041-1345(03)00061-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J M Moreno
- Liver Transplantation Unit, Department of Medicine, Puerta de Hierro University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
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Salguero O, Moreno JM, Seijas MC, Rubio E, Salas C, Laporta R, Cuervas-Mons V. Recurrence of primary biliary cirrhosis after liver transplantation. Transplant Proc 2003; 35:721-2. [PMID: 12644111 DOI: 10.1016/s0041-1345(03)00064-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- O Salguero
- Liver Transplantation Unit, Puerta de Hierro University Hospital of Madrid, Madrid, Spain
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Affiliation(s)
- J M Valero
- Liver Transplantation Unit, Puerta de Hierro University Hospital, Madrid, Spain
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Figueras J, Bernardos A, Prieto M, Gómez M, Rimola A, Ortiz de Urbina J, Cuervas-Mons V, de la Mata M, Dominguez-Granados R. Steroid-free regimen with daclizumab, mycophenolate mofetil, and tacrolimus in liver transplant recipients. Transplant Proc 2002; 34:1511-3. [PMID: 12176461 DOI: 10.1016/s0041-1345(02)02951-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J Figueras
- Department of Surgery, Hospital Bellvitge, Feixa Llarga, S/N Hospitalet de Llobregat, 08907 Barcelona, Spain
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Gómez-Moreno J, Cuervas-Mons V. [Infection caused by human herpesvirus-6 and organ transplantation]. Rev Clin Esp 2002; 202:182. [PMID: 11996753 DOI: 10.1016/s0014-2565(02)71021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- J Gómez-Moreno
- Servicio de Urgencias. Clínica Puerta de Hierro. Madrid. Spain
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Calmus Y, Scheele JR, Gonzalez-Pinto I, Jaurrieta EJ, Klar E, Pageaux GP, Scudamore CH, Cuervas-Mons V, Metselaar HJ, Prestele H, Girault D. Immunoprophylaxis with basiliximab, a chimeric anti-interleukin-2 receptor monoclonal antibody, in combination with azathioprine-containing triple therapy in liver transplant recipients. Liver Transpl 2002; 8:123-31. [PMID: 11862588 DOI: 10.1053/jlts.2002.30882] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [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
Acute graft rejection remains a major problem among additional sequelae in liver transplant recipients. Basiliximab, a chimeric monoclonal antibody with high affinity for the CD25 chain of the interleukin-2 receptor, has significantly reduced the incidence of acute rejection episodes in renal transplant recipients. This single-arm, open-label, multicenter study investigated the efficacy and tolerability of basiliximab immunoprophylaxis in adult patients undergoing first elective liver transplantation. One hundred one patients (70 hepatitis C virus [HCV]-negative patients, 31 HCV-positive patients) were administered basiliximab, 20 mg, by intravenous bolus injection the day of transplantation (day 0) and day 4. In addition, all patients were administered triple immunosuppressive therapy with cyclosporine, steroids, and azathioprine. The efficacy of basiliximab was assessed by conventional parameters, and tolerability was assessed by the incidence of adverse events, infections, and laboratory test result abnormalities. At 6 months, the incidence of first acute biopsy-confirmed rejection episodes was 22.8%. Rejections were more frequent in the HCV-positive (29.0%) than HCV-negative subgroup (20.0%; P =.441). No rejection episode was graded histologically as severe, and no patient required antibody therapy for the management of acute rejection. Ten patients (9.9%) required treatment with tacrolimus for acute rejection episodes. Patient and graft survival rates at 12 months were 90.1% and 88.1%, respectively. Basiliximab caused no injection-site reactions, anaphylaxis, or cytokine release syndrome. Five malignancies were reported at 12 months: of these, three malignancies predated transplantation surgery. Compared with earlier studies, the addition of basiliximab immunoprophylaxis to triple immunosuppressive therapy provides increased efficacy in reducing the incidence of acute rejection episodes, with no clinically significant increase in adverse events.
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Affiliation(s)
- Yvon Calmus
- Hôpital Cochin, Service de Transplantation Hépatique, Paris, France.
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de Bree E, Tsiftsis DD, Santos RM, Lavelle SM, Cuervas-Mons V, Gauthier A, Gips C, Malchow-Moeller A, Molino G, Rohr G, Theodossi A, Tsantoulas D. Objective assessment of the contribution of each diagnostic test and of the ordering sequence in jaundice caused by pancreatobiliary carcinoma. Scand J Gastroenterol 2000; 35:438-45. [PMID: 10831270 DOI: 10.1080/003655200750024038] [Citation(s) in RCA: 3] [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: 02/04/2023]
Abstract
BACKGROUND Computer-assisted diagnostic systems are not substantially more accurate than the clinician in the differential diagnosis of jaundice but may help in optimal selection and sequencing of tests. The present study aimed to assess with an electronic diagnostic tool the pattern of ordering tests and the diagnostic contribution and related financial cost of each test in jaundiced patients with pancreatobiliary carcinoma, in an effort to make the clinician's diagnostic behaviour more efficient and economical. METHODS Clinical and diagnostic test data were prospectively gathered from 356 jaundiced patients with pancreatobiliary carcinoma and entered in a Bayesian diagnostic programme. The test results were added to the existing diagnostic evidence, and the programme calculated the diagnostic contribution of each test. RESULTS A total of 1804 diagnostic tests were ordered. Quantitative assessment of the diagnostic contribution of each test showed that percutaneous transhepatic cholangiography and computed tomography were associated with the highest provision of information. The most cost-effective tests were ultrasonography and liver function tests. CONCLUSIONS It is possible to determine objectively the diagnostic contribution of each test in establishing the diagnosis of pancreatobiliary carcinoma. The observed physician behaviour in ordering the various diagnostic tests might be improved with regard to its efficacy and its cost-effectiveness profile.
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Affiliation(s)
- E de Bree
- Dept. of Surgical Oncology, University Hospital, Herakleion, Crete, Greece
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Garcia-Villalón A, Prados E, Garcia-Vizuete S, Moreno JM, Cuervas-Mons V. PREVALENCE AND IMPACT ON LATE MORTALITY OF CARDIOVASCULAR RISK FACTORS IN AN ADULT LIVER TRANSPLANT POPULATION. Transplantation 2000. [DOI: 10.1097/00007890-200004271-01129] [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: 11/25/2022]
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Cuervas-Mons V, Colás A, Rivera JA, Prados E. In vivo efficacy of a bioartificial liver in improving spontaneous recovery from fulminant hepatic failure: a controlled study in pigs. Transplantation 2000; 69:337-44. [PMID: 10706039 DOI: 10.1097/00007890-200002150-00005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Bioartificial liver may be useful as a bridge to liver transplantation but there are no data of its efficacy in successfully bridging to spontaneous recovery in fulminant hepatic failure. The aim of our study was to evaluate the efficacy of a bioartificial liver in increasing the spontaneous recovery of pigs with hepatic failure. METHODS The bioartificial liver consisted in a semipermeable dialyzer with 0.6 x 10(9) cryopreserved allogenic hepatocytes. Hepatic failure was induced by portacaval shunt plus 70% hepatectomy and 1 hour occlusion of the hepatic artery. Forty-one pigs were distributed 24 hr after liver failure induction to a group treated with the bioartificial liver (4 hr daily) until recovery or death (n=16), or to a control group (n=25). Intracranial pressure was monitored in 18 additional pigs, before and 4 hr after treatment with the bioartificial liver with (n=12) or without hepatocytes (n=6). RESULTS Fifteen days after induction of hepatic failure, 44% of the treated animals had survived and recovered from liver failure versus 22% controls (P=0.030). Intracranial pressure decreased from 13.13+/-5.1 to 7.19+/-2.06 mmHg (P=0.02) in treated animals, and remained unchanged in sham-treated animals (14.08+/-1.92 to 12.54+/-3.82, ns). CONCLUSIONS Bioartificial liver increases survival and allows spontaneous recovery in pigs with fulminant hepatic failure.
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Affiliation(s)
- V Cuervas-Mons
- Liver Transplant Unit and Surgery Department, Puerta de Hierro Clinic, Madrid, Spain
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Cuervas-Mons V, Prados E. [Recurrence of autoimmune liver disease after liver transplantation]. Gastroenterol Hepatol 2000; 23 Suppl 1:71-6. [PMID: 11968349] [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)
- V Cuervas-Mons
- Unidad de Trasplante Hepático, Hospital Universitario Puerta de Hierro, Madrid
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Hernández-Pérez J, Yebra-Bango M, Jiménez-Martínez E, Sanz-Moreno C, Cuervas-Mons V, Alonso Pulpón L, Ramos-Martínez A, Fernández-Fernández J. Visceral leishmaniasis (kala-azar) in solid organ transplantation: report of five cases and review. Clin Infect Dis 1999; 29:918-21. [PMID: 10589910 DOI: 10.1086/520457] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.4] [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: 11/03/2022] Open
Abstract
Visceral leishmaniasis is an infectious disease that occurs only rarely in recipients of solid organ grafts but is associated with an elevated mortality rate despite proper treatment. We report five cases diagnosed in our hospital. All the patients were men aged 30 to 60 years who had undergone kidney transplantation (3 patients), heart transplantation (1), or liver transplantation (1). Three of the patients died, one had multiple recurrences, and one developed post-kala-azar cutaneous leishmaniasis. We review the clinical features, treatments, and outcomes of 26 previously reported cases, pointing out the lower cure rate associated with human immunodeficiency virus infection.
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Affiliation(s)
- J Hernández-Pérez
- Service of Nephrology, Clínica Puerta de Hierro, Universidad Autónoma de Madrid, Spain
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Vizuete SG, Encinas JL, Prados E, Haro J, Cuervas-Mons V. Influence of antiviral therapy on the natural history of hepatitis B virus recurrence after liver transplantation: retrospective study of 14 cases. Transplant Proc 1999; 31:2461-3. [PMID: 10500671 DOI: 10.1016/s0041-1345(99)00418-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- S G Vizuete
- Unidad de Transplante Hepático, Clínica Puerta de Hierro, Universidad Autónoma, Madrid, Spain
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Villanueva M, Navarro F, Sanchez A, Provencio M, Bonilla F, Cuervas-Mons V, España P. Hepatocellular carcinoma: adjuvant chemotherapy postliver transplant. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)80945-9] [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: 10/27/2022]
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Galve ML, Cuervas-Mons V, Figueras J, Herrero I, Mata M, Clemente G, Prieto M, Margarit C, Bernardos A, Casafont F. Incidence and outcome of de novo malignancies after liver transplantation. Transplant Proc 1999; 31:1275-7. [PMID: 10083569 DOI: 10.1016/s0041-1345(98)01994-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- M L Galve
- Spanish Liver Transplantation Group, Madrid, Spain
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Prados E, Cuervas-Mons V, de la Mata M, Fraga E, Rimola A, Prieto M, Clemente G, Vicente E, Casanovas T, Fabrega E. Outcome of autoimmune hepatitis after liver transplantation. Transplantation 1998; 66:1645-50. [PMID: 9884253 DOI: 10.1097/00007890-199812270-00013] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recurrence of autoimmune hepatitis after liver transplantation is not rare, but there is little information about its time of onset, risk factors, response to treatment and prognosis. The aim of this study was to evaluate the rate of recurrence and outcome of autoimmune hepatitis after transplantation. METHODS The records of patients transplanted in eight centers in our country between 1984 and 1996 were retrospectively analyzed. RESULTS Forty-three of the 2331 (1.8%) recipients fulfilled diagnostic criteria of autoimmune hepatitis at the time of transplantation. Sixteen patients were excluded from evaluation. Nine (33%) of the 27 patients evaluated fulfilled criteria for recurrence of autoimmune hepatitis, with a mean time of recurrence after orthotopic liver transplantation of 2.6+/-1.5 years. Patients with recurrence had a longer follow-up time after transplantation (5.1 vs. 2.5 years, P=0.0012) and were receiving less immunosuppressive treatment. The estimated risk of recurrence of autoimmune hepatitis in the graft increased over time: 8% over the first year and 68% 5 years after transplantation. None of the seven patients with liver-kidney microsomal-positive antibodies recurred (P=0.059). Fifty percent of the patients failed to respond or responded only partially to therapy, although none of the patients have deteriorated clinically after 2.4+/-1.06 years of follow-up after recurrence. CONCLUSIONS Recurrence of autoimmune hepatitis in the graft is a common event with an incidence that increases over time as immunosuppression is reduced. Although response to treatment is poor, patient and graft survival do not appear to be decreased.
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Affiliation(s)
- E Prados
- Liver Transplant Unit, Clínica Puerta de Hierro, Madrid, Spain
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Margarit C, Rimola A, Gonzalez-Pinto I, Cuervas-Mons V, Edo A, Andreu H, Moreno-Gonzalez E, Calleja JL. Efficacy and safety of oral low-dose tacrolimus treatment in liver transplantation. Transpl Int 1998; 11 Suppl 1:S260-6. [PMID: 9664992 DOI: 10.1007/s001470050474] [Citation(s) in RCA: 14] [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: 11/24/2022]
Abstract
Eighty-four adult patients were recruited from four centres in Spain to evaluate the efficacy and safety of low-dose (0.1 mg/kg per day) oral tacrolimus plus corticosteroid immunosuppression in liver transplantation. The median daily dose of tacrolimus was increased during the first 3 weeks of therapy from an initial dose of 0.1 mg/kg per day to a maximum of 0.145 mg/kg per day and was subsequently decreased gradually to a minimum of 0.076 mg/kg per day at 1 year. At 7 days posttransplantation, 87.7% of patients had trough whole blood levels of tacrolimus within the therapeutic range (5-20 ng/ml), and the median levels remained fairly constant during the rest of the year (10.1-11.8 ng/ml). None of the patients required intravenous administration of tacrolimus. At 1 year, Kaplan-Meier estimates showed that 73.8% of the patients were receiving tacrolimus monotherapy without the need for corticosteroids. One-year patient and graft survival were 75.9% and 72.3%, respectively. The incidence of acute rejection was 51.2%; 9.5% of cases resolved spontaneously without antirejection therapy and 10.7% were corticosteroid resistant. Only 1 patient (1.2%) developed chronic rejection. The most important adverse events were hypertension (45.2%), tremor (44.0%), diabetes mellitus (33.3%), diarrhoea (31%) and nephrotoxicity (29.8%). Severe neurotoxicity-like convulsions (4.8%), dysarthria (9.5%), delirium (1.2%), coma (1.2%) and the need for haemodialysis (3 patients) were uncommon. In conclusion, low-dose oral tacrolimus immunosuppression is associated with low toxicity without compromising efficacy.
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Affiliation(s)
- C Margarit
- Unidad de Trasplante Hepatico, Servicio de Cirugia General, Hospital General Vall de Hebrón, Barcelona, Spain. margarit@.vhebron.es
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Margarit C, Rimola A, Gonzalez-Pinto I, Cuervas-Mons V, Edo A, Andreu H, Moreno-Gonzalez E, Calleja JL. Efficacy and safety of oral low-dose tacrolimus treatment in liver transplantation. Transpl Int 1998. [DOI: 10.1111/j.1432-2277.1998.tb01129.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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