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Barajas A, Pelaez T, González O, Usall J, Iniesta R, Arteaga M, Jackson C, Baños I, Sánchez B, Dolz M, Obiols JE, Haro JM, Ochoa S, Arranz B, Arteaga M, Asensio R, Autonell J, Baños I, Bañuelos M, Barajas A, Barceló M, Blanc M, Borrás M, Busquets E, Carlson J, Carral V, Castro M, Corbacho C, Coromina M, Dachs I, De Miquel L, Dolz M, Domenech MD, Elias M, Espezel I, Falo E, Fargas A, Foix A, Fusté M, Godrid M, Gómez D, González O, Granell L, Gumà L, Haro JM, Herrera S, Huerta E, Lacasa F, Mas N, Martí L, Martínez R, Matalí J, Miñambres A, Muñoz D, Muñoz V, Nogueroles R, Ochoa S, Ortiz J, Pardo M, Planella M, Pelaez T, Peruzzi S, Rivero S, Rodriguez MJ, Rubio E, Sammut S, Sánchez M, Sánchez B, Serrano E, Solís C, Stephanotto C, Tabuenca P, Teba S, Torres A, Urbano D, Usall J, Vilaplana M, Villalta V. Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset. Early Interv Psychiatry 2019; 13:414-424. [PMID: 29116670 DOI: 10.1111/eip.12498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/16/2017] [Accepted: 08/20/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension. AIM To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis. METHODS Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed. RESULTS Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained. CONCLUSION In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.
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Affiliation(s)
- Ana Barajas
- Department of Research, Centre d'Higiene Mental Les Corts, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Hospital Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Esplugues de Llobregat, Barcelona, Spain.,Fundació Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain.,Department of Clinical and Psychology, School of Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Trinidad Pelaez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Olga González
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Judith Usall
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Raquel Iniesta
- Fundació Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Maria Arteaga
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Chris Jackson
- Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Iris Baños
- Fundació Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Bernardo Sánchez
- Hospital Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Esplugues de Llobregat, Barcelona, Spain
| | - Montserrat Dolz
- Hospital Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Esplugues de Llobregat, Barcelona, Spain
| | - Jordi E Obiols
- Department of Clinical and Psychology, School of Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Josep M Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | | | - Susana Ochoa
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 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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Campos-Varela I, Moreno A, Morbey A, Guaraldi G, Hasson H, Bhamidimarri KR, Castells L, Grewal P, Baños I, Bellot P, Brainard DM, McHutchison JG, Terrault NA. Treatment of severe recurrent hepatitis C after liver transplantation in HIV infected patients using sofosbuvir-based therapy. Aliment Pharmacol Ther 2016; 43:1319-29. [PMID: 27098374 DOI: 10.1111/apt.13629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/14/2016] [Accepted: 03/26/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND For liver transplant recipients with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection, recurrence after LT is associated with a higher risk of graft loss than for HCV mono-infected patients. Prior HCV treatment options were limited by side effects and drug-drug interactions. AIM To evaluate treatment outcomes with sofosbuvir (SOF)-based therapy among HIV/HCV coinfected liver transplant recipients. METHODS Access to SOF and ribavirin (RBV) prior to regulatory approval was attained via an international compassionate access program for transplant recipients with a life expectancy of 1 year or less in the absence of HCV treatment. This report focuses on the short and longer term outcomes in HCV-HIV co-infected liver transplant recipients. RESULTS Twenty patients were treated, nine with early severe recurrence and 11 with cirrhosis. Eleven patients received SOF and RBV, one SOF, RBV and Peg-interferon, three SOF, RBV and simeprevir and five SOF, RBV and daclatasvir. Of the 18 patients who completed treatment, 16 (89%) achieved sustained virological response 12 weeks after the end of treatment (SVR12). Liver function tests (including bilirubin and albumin) improved significantly over time. Nineteen serious adverse events occurred in eight (40%) patients, none of them related to SOF. Two patients died during treatment and another, 1 year after the end of therapy, due to progressive end-stage liver disease. Importantly, HIV suppression was not compromised. No significant drug-drug interactions were reported. CONCLUSIONS Sofosbuvir-based regimens are safe, well-tolerated and provide high rates of SVR in HCV-HIV co-infected patients with severe recurrence after-liver transplant.
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Affiliation(s)
- I Campos-Varela
- Universidade de Santiago de Compostela (CLINURSID), Santiago de Compostela, Spain.,Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,University of California-San Francisco, San Francisco, CA, USA
| | - A Moreno
- Hospital Ramón y Cajal, Madrid, Spain
| | - A Morbey
- Hospital Curry Cabral, Lisbon, Portugal
| | - G Guaraldi
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - H Hasson
- Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - K R Bhamidimarri
- Division of Hepatology, University of Miami-Miller School of Medicine, Miami, FL, USA
| | - L Castells
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain.,Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - P Grewal
- Mount Sinai School of Medicine, New York, NY, USA
| | - I Baños
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - P Bellot
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.,Hospital General Universitario, Alicante, Spain
| | | | | | - N A Terrault
- University of California-San Francisco, San Francisco, CA, USA
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Nuñez C, Ochoa S, Huerta-Ramos E, Baños I, Barajas A, Dolz M, Sanchez B, Del Cacho N, Genipe G, Usall J. Heavy cannabis use impairs verbal memory of first psychotic episode patients. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IntroductionCannabis consumption is known to be increased in both schizophrenic and first psychotic episode patients. Contrary to what has been reported in studies with healthy people, all published studies so far have reported no impairments or even beneficial effects on neurocognition associated with cannabis consumption in schizophrenia and first psychotic episode patients. However, these studies did not address the effects of very high cannabis consumption.ObjectiveOur aim in this study was to assess the effects on neurocognition of regular and heavy cannabis consumption in first psychotic episode patients.MethodsA total of 74 patients were included in the study and assigned to 3 different groups according to their mean cannabis consumption during the last year (non-users, regular users, and heavy users). Participants were administered verbal memory, attention, processing speed, working memory, vocabulary, arithmetic and spatial orientation tasks.ResultsOur results showed the heavy cannabis group of first psychotic episode patients to be significantly impaired in all the verbal memory measures with respect to the non-users group. There were no significant differences between regular users and non-users. Moreover, regular cannabis consumption was associated with an improvement in some attention and processing speed measures.ConclusionsOur data showed heavy cannabis consumption to impair verbal memory in first psychotic episode patients and suggest a dose-related effect of cannabis consumption, since regular consumption did not impair verbal memory and may be beneficial for other tasks.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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González J, Baños I, León I, Contreras-García J, Cocinero EJ, Lesarri A, Fernández JA, Millán J. Unravelling Protein–DNA Interactions at Molecular Level: A DFT and NCI Study. J Chem Theory Comput 2016; 12:523-34. [DOI: 10.1021/acs.jctc.5b00330] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- J. González
- Departamento
de Química Física, Facultad de Ciencia y Tecnología, Universidad del País Vasco-UPV/EHU, Barrio Sarriena s/n, Leioa, 48940 Spain
| | - I. Baños
- Departamento
de Química, Facultad de Ciencias, Estudios Agroalimentarios
e Informática, Universidad de La Rioja, Madre de Dios,
53, Logroño, 26006 Spain
| | - I. León
- Departamento
de Química Física, Facultad de Ciencia y Tecnología, Universidad del País Vasco-UPV/EHU, Barrio Sarriena s/n, Leioa, 48940 Spain
| | - J. Contreras-García
- Sorbonne Universités,
UPMC Univ. Paris 06, UMR7616, Laboratoire de Chimie Théorique, F-75005, Paris, France
- CNRS, UMR 7616,
Laboratoire de Chimie Théorique, F-75005, Paris, France
| | - E. J. Cocinero
- Departamento
de Química Física, Facultad de Ciencia y Tecnología, Universidad del País Vasco-UPV/EHU, Barrio Sarriena s/n, Leioa, 48940 Spain
| | - A. Lesarri
- Departamento
de Química Física y Química Inorgánica,
Facultad de Ciencias, Universidad de Valladolid, 47011 Valladolid, Spain
| | - J. A. Fernández
- Departamento
de Química Física, Facultad de Ciencia y Tecnología, Universidad del País Vasco-UPV/EHU, Barrio Sarriena s/n, Leioa, 48940 Spain
| | - J. Millán
- Departamento
de Química, Facultad de Ciencias, Estudios Agroalimentarios
e Informática, Universidad de La Rioja, Madre de Dios,
53, Logroño, 26006 Spain
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Rubio-Abadal E, Ochoa S, Barajas A, Baños I, Dolz M, Sanchez B, Del Cacho N, Carlson J, Huerta-Ramos E, Usall J. Birth weight and obstetric complications determine age at onset in first episode of psychosis. J Psychiatr Res 2015; 65:108-14. [PMID: 25890850 DOI: 10.1016/j.jpsychires.2015.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/12/2015] [Accepted: 03/20/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Earlier age at onset of psychosis (AOP) has been associated with poor social adjustment and clinical outcome. Genetic and environmental factors such as obstetric complications, parental history of psychosis, advanced paternal age at time of birth, low birth weight and gestational age, and use of drugs have been described as bringing AOP forward. This study aims to evaluate the relationship between AOP and these factors in a sample of first episode of psychosis (FEP) patients. METHODS Clinical and sociodemographic data, age at FEP, age of parents at birth, parental history of psychosis, drug-use habits of the mother during pregnancy and of the patient before psychotic onset, and Lewis and Murray obstetric complication scale were obtained from 90 patients with FEP. Statistical analysis was performed by means of Pearson correlations, Chi-square tests, Student T-test analyses and a linear regression model using SPSS version 22. RESULTS Pre-eclampsia, need for incubator at birth, use of forceps, parental history of psychosis, and low birth weight were associated with an earlier AOP. Use of forceps and birth weight are the variables which best predict AOP in FEP. Stimulant drugs, which were mostly used together with cannabis and cocaine, were the only substances associated with an earlier AOP. CONCLUSIONS Our findings are consistent with previous study results and underline the role of the prenatal period in the development of psychosis and the importance of careful monitoring of pregnancy and delivery, especially in cases with familial history.
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Affiliation(s)
- E Rubio-Abadal
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona (UB), CIBERSAM, GTRDSM, C/ Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
| | - S Ochoa
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona (UB), CIBERSAM, GTRDSM, C/ Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - A Barajas
- Research Unit, Centre d'Higiene Mental Les Corts, GTRDSM, Numància 107-109 Planta B, 08029, Barcelona, Spain
| | - I Baños
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona (UB), CIBERSAM, GTRDSM, C/ Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - M Dolz
- Psychiatry Department, Hospital Sant Joan de Déu, CIBERSAM, Passeig Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - B Sanchez
- Psychiatry Department, Hospital Sant Joan de Déu, CIBERSAM, Passeig Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - N Del Cacho
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona (UB), CIBERSAM, GTRDSM, C/ Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - J Carlson
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona (UB), CIBERSAM, GTRDSM, C/ Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - E Huerta-Ramos
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona (UB), CIBERSAM, GTRDSM, C/ Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | | | - J Usall
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona (UB), CIBERSAM, GTRDSM, C/ Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, 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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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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Roustan G, Yebra M, Rodriguez-Braojos O, Baños I, Jaurena J, Simón A. Cutaneous and pulmonary sarcoidosis in a patient with HIV after highly active antiretroviral therapy. Int J Dermatol 2007; 46:68-71. [PMID: 17214725 DOI: 10.1111/j.1365-4632.2006.02545.x] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G Roustan
- Department of Dermatology, Clínica Universitaria Puerta de Hierro, Madrid, Spain.
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