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Carrión L, Clemente-Sánchez A, Márquez-Pérez L, Orcajo-Rincón J, Rotger A, Ramón-Botella E, González-Leyte M, Echenagusía-Boyra M, Luis Colón A, Reguera-Berenguer L, Bañares R, Rincón D, Matilla-Peña A. Portal hypertension increases the risk of hepatic decompensation after 90Yttrium radioembolization in patients with hepatocellular carcinoma: a cohort study. Therap Adv Gastroenterol 2023; 16:17562848231206995. [PMID: 37920686 PMCID: PMC10619355 DOI: 10.1177/17562848231206995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023] Open
Abstract
Background Transarterial radioembolization (TARE) is increasingly used in patients with hepatocellular carcinoma (HCC). This treatment can induce or impair portal hypertension, leading to hepatic decompensation. TARE also promotes changes in liver and spleen volumes that may modify therapeutic decisions and outcomes after therapy. Objectives We aimed to investigate the impact of TARE on the incidence of decompensation events and its predictive factors. Design In all, 63 consecutive patients treated with TARE between February 2012 and December 2018 were retrospectively included. Methods We assessed clinical (including Barcelona Clinic Liver Cancer stage, portal hypertension assessment, and liver decompensation), laboratory parameters, and liver and spleen volumes before and 6 and 12 weeks after treatment. A multivariate analysis was performed. Results In total, 18 out of 63 (28.6%) patients had liver decompensation (ascites, variceal bleeding, jaundice, or encephalopathy) within the first 3 months after therapy, not associated with tumor progression. Clinically significant portal hypertension (CSPH) and bilobar treatment independently predicted the development of liver decompensation after TARE. A significant volume increase in the non-treated hemi-liver was observed only in patients with unilobar treatment (median volume increase of 20.2% in patients with right lobe TARE; p = 0.007), especially in those without CSPH. Spleen volume also increased after TARE (median volume increase of 16.1%; p = 0.0001) and was associated with worsening liver function scores and decreased platelet count. Conclusion Bilobar TARE and CSPH may be associated with an increased risk of liver decompensation in patients with intermediate or advanced HCC. A careful assessment considering these variables before therapy may optimize candidate selection and improve treatment planning.
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Affiliation(s)
- Laura Carrión
- Department of Gastroenterology and Hepatology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Clemente-Sánchez
- Department of Gastroenterology and Hepatology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centre for Biomedical Research in Liver and Digestive Diseases Network, Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Márquez-Pérez
- Department of Gastroenterology and Hepatology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Javier Orcajo-Rincón
- Department of Nuclear Medicine, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Amanda Rotger
- Department of Nuclear Medicine, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Enrique Ramón-Botella
- Department of Diagnostic Radiology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Manuel González-Leyte
- Department of Interventional Radiology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Miguel Echenagusía-Boyra
- Department of Interventional Radiology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Arturo Luis Colón
- Department of Hepatobiliary and Pancreatic Surgery, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Laura Reguera-Berenguer
- Department of Nuclear Medicine, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Rafael Bañares
- Department of Gastroenterology and Hepatology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centre for Biomedical Research in Liver and Digestive Diseases Network, Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Diego Rincón
- Department of Gastroenterology and Hepatology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centre for Biomedical Research in Liver and Digestive Diseases Network, Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, SpainCalle del Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Ana Matilla-Peña
- Department of Gastroenterology and Hepatology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centre for Biomedical Research in Liver and Digestive Diseases Network, Instituto de Salud Carlos III, Madrid, Spain
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Revuelta-Herrero JL, Giménez-Manzorro A, Matilla-Peña A, Herranz-Alonso A, Sanjurjo-Sáez M. Concomitant use of sorafenib with ombitasvir/paritaprevir/ritonavir and dasabuvir: Effectiveness and safety in clinical practice. J Clin Pharm Ther 2018; 43:906-909. [DOI: 10.1111/jcpt.12727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/31/2018] [Indexed: 01/10/2023]
Affiliation(s)
- J. L. Revuelta-Herrero
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - A. Giménez-Manzorro
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - A. Matilla-Peña
- Gastroenterology Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - A. Herranz-Alonso
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - M. Sanjurjo-Sáez
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
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Cortejoso L, García-Lledó J, Giménez-Manzorro A, Salcedo-Plaza M, Matilla-Peña A, Sanjurjo-Sáez M. Antiangiogenic drugs and cardiogenic shock: a case report. Am J Ther 2013; 21:e163-5. [PMID: 23344105 DOI: 10.1097/mjt.0b013e31826a94fc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 56-year-old man attended the emergency room with respiratory failure, deteriorated general status, fatigue, and diarrhea. His clinical history included a liver transplant because of alcoholic cirrhosis, which developed to hepatocellular carcinoma. Initial immunosuppression consisted of corticosteroids, tacrolimus, and mycophenolate mofetil. Examination of the explant revealed vascular invasion, and tacrolimus was replaced with everolimus. The patient presented recurrence of the carcinoma with peritoneal implants, and treatment with sorafenib was started. He was admitted to the gastroenterology department and, after withdrawal of sorafenib, the patient improved clinically. However, 6 days later, he was admitted to the intensive care unit with acute respiratory failure and metabolic acidosis. The final diagnosis was cardiogenic shock. Although cardiogenic shock is not mentioned in the summaries of product characteristics of sorafenib or everolimus, there are reports of a relationship between cardiotoxicity and antiangiogenic therapy that inhibits the proliferation of vascular smooth muscle cells, as is the case with these drugs. We believe that there is a relationship between sorafenib (especially when combined with everolimus) and cardiogenic shock. Application of the Karch and Lasagna algorithm to assess the causality of the reaction induced by the combination of sorafenib and everolimus revealed the relationship to be probable.
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Affiliation(s)
- Lucía Cortejoso
- 1Pharmacy Department; and 2Gastroenterology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Sanz-García C, Matilla-Peña A, Nogales-Rincón O, Núñez-Martínez O, Clemente-Ricote G. [Hepatoportal sclerosis and liver angiosarcoma: an infrequent association with a possible common etiology]. Gastroenterol Hepatol 2005; 28:555-7. [PMID: 16277963 DOI: 10.1157/13080609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hepatoportal sclerosis is characterized by fibrosis of the intima of the portal vein and its branches leading to the development of presinusoidal portal hypertension. We describe the case of a 58-year-old woman with idiopathic hepatoportal sclerosis, who was admitted to our service due to impairment of liver function, with rapid clinical worsening and finally the development of multiorgan failure. Autopsy showed a diffuse liver angiosarcoma with splenic metastases. The patient had no history of domestic or occupational exposure to substances involved in the development of hepatoportal sclerosis or liver angiosarcoma. The development of liver angiosarcoma in a patient with hepatoportal sclerosis is exceptional, even though both diseases may have a common etiology.
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Affiliation(s)
- C Sanz-García
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Molina-Infante J, Sanz-García C, Catalina-Rodríguez MV, Nogales-Rincón O, Matilla-Peña A, Núñez-Martínez O, Clemente-Ricote G. Trombosis venosa masiva abdominal con insuficiencia hepática aguda y megacolon tóxico como presentación de colitis ulcerosa. Gastroenterología y Hepatología 2005; 28:551-4. [PMID: 16277962 DOI: 10.1157/13080608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The prevalence of systemic thromboembolic complications is higher in patients with inflammatory bowel disease than in the general population. This hypercoagulable state is due to an increased production of procoagulant substances proportionally related to the inflammatory activity of the disease, although recent reports have focused on the presence of inherited thrombophilic disorders in this entity. We present the case of a 32-year-old woman with no relevant medical history who presented with massive abdominal vein thrombosis, including suprahepatic, portal, splenic and superior mesenteric veins, and secondary acute liver failure in her first ulcerative colitis flare and who later developed toxic megacolon requiring emergency total colectomy despite steroids and cyclosporine. Anticoagulant therapy achieved complete resolution of suprahepatic thrombosis and partial resolution in the splenic and superior mesenteric veins, with final cavernous transformation of the portal vein.
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Affiliation(s)
- J Molina-Infante
- Sección de Hepatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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