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Jimenez-Romero C, Justo-Alonso I, del Pozo-Elso P, Marcacuzco-Quinto A, Martín-Arriscado-Arroba C, Manrique-Municio A, Calvo-Pulido J, García-Sesma A, San Román R, Caso-Maestro O. Post-transplant biliary complications using liver grafts from deceased donors older than 70 years: Retrospective case-control study. World J Gastrointest Surg 2023; 15:1615-1628. [PMID: 37701699 PMCID: PMC10494601 DOI: 10.4240/wjgs.v15.i8.1615] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/27/2023] [Accepted: 06/25/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older donors. AIM To determine the incidence, outcomes, and risk factors for biliary complications (BC) in liver transplantation (LT) using liver grafts from donors aged > 70 years. METHODS Between January 1994 and December 31, 2019, 297 LTs were performed using donors older than 70 years. After excluding 47 LT for several reasons, we divided 250 LTs into two groups, namely post-LT BC (n = 21) and without BC (n = 229). This retrospective case-control study compared both groups. RESULTS Choledocho-choledochostomy without T-tube was the most frequent technique (76.2% in the BC group vs 92.6% in the non-BC group). Twenty-one patients (8.4%) developed BC (13 anastomotic strictures, 7 biliary leakages, and 1 non-anastomotic biliary stricture). Nine patients underwent percutaneous balloon dilation and nine required a Roux-en-Y hepaticojejunostomy because of dilation failure. The incidence of post-LT complications (graft dysfunction, rejection, renal failure, and non-BC reoperations) was similar in both groups. There were no significant differences in the patient and graft survival between the groups. Moreover, only three deaths were attributed to BC. While female donors were protective factors for BC, donor cardiac arrest was a risk factor. CONCLUSION The incidence of BC was relatively low on using liver grafts > 70 years. It could be managed in most cases by percutaneous dilation or Roux-en-Y hepaticojejunostomy, without significant differences in the patient or graft survival between the groups.
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Affiliation(s)
- Carlos Jimenez-Romero
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Iago Justo-Alonso
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Pilar del Pozo-Elso
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Alberto Marcacuzco-Quinto
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | | | - Alejandro Manrique-Municio
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Jorge Calvo-Pulido
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Alvaro García-Sesma
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Ricardo San Román
- Department of Radiology, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Oscar Caso-Maestro
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
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2
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Fernández-Ruiz M, Olea B, Almendro-Vázquez P, Giménez E, Marcacuzco A, San Juan R, Justo I, Calvo-Pulido J, García-Sesma Á, Manrique A, Caso O, Cambra F, Talayero P, López-Medrano F, Remigia MJ, Ruiz-Merlo T, Parra P, Paz-Artal E, Jiménez C, Loinaz C, Navarro D, Laguna-Goya R, Aguado JM. T cell-mediated response to SARS-CoV-2 in liver transplant recipients with prior COVID-19. Am J Transplant 2021; 21:2785-2794. [PMID: 34092033 PMCID: PMC8222887 DOI: 10.1111/ajt.16708] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/11/2021] [Accepted: 05/30/2021] [Indexed: 01/25/2023]
Abstract
Whether immunosuppression impairs severe acute respiratory syndrome coronavirus 2-specific T cell-mediated immunity (SARS-CoV-2-CMI) after liver transplantation (LT) remains unknown. We included 31 LT recipients in whom SARS-CoV-2-CMI was assessed by intracellular cytokine staining (ICS) and interferon (IFN)-γ FluoroSpot assay after a median of 103 days from COVID-19 diagnosis. Serum SARS-CoV-2 IgG antibodies were measured by ELISA. A control group of nontransplant immunocompetent patients were matched (1:1 ratio) by age and time from diagnosis. Post-transplant SARS-CoV-2-CMI was detected by ICS in 90.3% (28/31) of recipients, with higher proportions for IFN-γ-producing CD4+ than CD8+ responses (93.5% versus 83.9%). Positive spike-specific and nucleoprotein-specific responses were found by FluoroSpot in 86.7% (26/30) of recipients each, whereas membrane protein-specific response was present in 83.3% (25/30). An inverse correlation was observed between the number of spike-specific IFN-γ-producing SFUs and time from diagnosis (Spearman's rho: -0.418; p value = .024). Two recipients (6.5%) failed to mount either T cell-mediated or IgG responses. There were no significant differences between LT recipients and nontransplant patients in the magnitude of responses by FluoroSpot to any of the antigens. Most LT recipients mount detectable-but declining over time-SARS-CoV-2-CMI after a median of 3 months from COVID-19, with no meaningful differences with immunocompetent patients.
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Affiliation(s)
- Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain,Correspondence Mario Fernández-Ruiz, Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain.
| | - Beatriz Olea
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Patricia Almendro-Vázquez
- Department of Immunology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Estela Giménez
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Alberto Marcacuzco
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Rafael San Juan
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain,Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Iago Justo
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Jorge Calvo-Pulido
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Álvaro García-Sesma
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Alejandro Manrique
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Oscar Caso
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Félix Cambra
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Paloma Talayero
- Department of Immunology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain,Department of Medicine, Universidad Complutense, Madrid, Spain
| | - María José Remigia
- Department of Hematology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Tamara Ruiz-Merlo
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Patricia Parra
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Estela Paz-Artal
- Department of Immunology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Carlos Jiménez
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain,Department of Surgery, Universidad Complutense, Madrid, Spain
| | - Carmelo Loinaz
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain,Department of Surgery, Universidad Complutense, Madrid, Spain
| | - David Navarro
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain,School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Rocío Laguna-Goya
- Department of Immunology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - José M. Aguado
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain,Department of Medicine, Universidad Complutense, Madrid, Spain
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3
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Gómez-Massa E, Lasa-Lázaro M, Gil-Etayo FJ, Ulloa-Márquez E, Justo I, Loinaz C, Calvo-Pulido J, Paz-Artal E, Talayero P. Donor helper innate lymphoid cells are replaced earlier than lineage positive cells and persist long-term in human intestinal grafts - a descriptive study. Transpl Int 2020; 33:1016-1029. [PMID: 32246810 DOI: 10.1111/tri.13609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/18/2020] [Revised: 03/04/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022]
Abstract
Intestinal grafts carry large donor lymphoid load that is replaced by recipient cells. The dynamics of this process may influence the tolerance, rejection or graft-versus-host disease. We analysed distribution and turnover of T and B (Lin+) lymphocytes, natural killer (NK) and helper innate lymphoid cells (hILC) in intestinal epithelium (IEp) and lamina propia (LP) from a long-term cohort of eight intestinal recipients and from a single patient monitored deeply during the first 8 months post-transplant (posTx). Long-term intestinal grafts showed significantly higher %hILC than native bowels in IEp and LP until 10 years posTx and recovery to normal levels was observed afterwards. We also observed an imbalance between hILC subsets in IEp [increase of type 1 (ILC1) and decrease in type 3 (ILC3) innate lymphoid cells] that persisted along posTx time even when %hILC was similar to native bowels. Regarding hILC origin, we still detected the presence of donor cells at 13 years posTx. However, this chimerism was significantly lower than in Lin+ and NK populations. According to these findings, observation from the patient monitored in early posTx period showed that recipient hILC repopulate earlier and faster than Lin+ cells, with increase in ILC1 related to rejection and infection episodes.
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Affiliation(s)
- Elena Gómez-Massa
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain.,Imas12 Research Institute, University Hospital 12 de Octubre, Madrid, Spain
| | - María Lasa-Lázaro
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain.,Imas12 Research Institute, University Hospital 12 de Octubre, Madrid, Spain
| | | | | | - Iago Justo
- HPB Surgery and Abdominal Transplantation Unit, General Surgery Service, University Hospital 12 de Octubre, Madrid, Spain
| | - Carmelo Loinaz
- HPB Surgery and Abdominal Transplantation Unit, General Surgery Service, University Hospital 12 de Octubre, Madrid, Spain
| | - Jorge Calvo-Pulido
- HPB Surgery and Abdominal Transplantation Unit, General Surgery Service, University Hospital 12 de Octubre, Madrid, Spain
| | - Estela Paz-Artal
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain.,Imas12 Research Institute, University Hospital 12 de Octubre, Madrid, Spain.,School of Medicine, Complutense University, Madrid, Spain.,Section of Immunology, San Pablo CEU University, Madrid, Spain
| | - Paloma Talayero
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain.,Imas12 Research Institute, University Hospital 12 de Octubre, Madrid, Spain
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4
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Caso-Maestro O, Jiménez-Romero C, Justo-Alonso I, Calvo-Pulido J, Lora-Pablos D, Marcacuzco-Quinto A, Cambra-Molero F, García-Sesma A, Pérez-Flecha M, Muñoz-Arce C, Loinaz-Segurola C, Manrique-Municio A. Analyzing predictors of graft survival in patients undergoing liver transplantation with donors aged 70 years and over. World J Gastroenterol 2018; 24:5391-5402. [PMID: 30598583 PMCID: PMC6305532 DOI: 10.3748/wjg.v24.i47.5391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/24/2018] [Accepted: 12/01/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To increase the number of available grafts.
METHODS This is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation (LT) were performed with donors ≥ 70 years old (study group). Then, we selected the first cases that were performed with donors < 70 years old immediately after the ones that were performed with donors ≥ 70 years old (control group).
RESULTS Graft and patient survivals were similar between both groups without increasing the risk of complications, especially primary non-function, vascular complications and biliary complications. We identified 5 risk factors as independent predictors of graft survival: recipient hepatitis C virus (HCV)-positivity [hazard ratio (HR) = 2.35; 95% confidence interval (CI): 1.55-3.56; P = 0.00]; recipient age (HR = 1.04; 95%CI: 1.02-1.06; P = 0.00); donor age X model for end-stage liver disease (D-MELD) (HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); donor value of serum glutamic-pyruvic transaminase (HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); and donor value of serum sodium (HR = 0.96; 95%CI: 0.94-0.99; P = 0.00). After combining D-MELD and recipient age we obtained a new scoring system that we called DR-MELD (donor age X recipient age X MELD). Graft survival significantly decreased in patients with a DR-MELD score ≥ 75000, especially in HCV patients (77% vs 63% at 5 years in HCV-negative patients, P = 0.00; and 61% vs 25% at 5 years in HCV-positive patients; P = 0.00).
CONCLUSION A DR-MELD ≥ 75000 must be avoided in order to obtain the best results in LT with donors ≥ 70 years old.
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Affiliation(s)
- Oscar Caso-Maestro
- Unit of HBP Surgery and Abdominal Organs Transplantation, Department of General Surgery, “12 de octubre” University Hospital, Madrid 28041, Spain
| | - Carlos Jiménez-Romero
- Unit of HBP Surgery and Abdominal Organs Transplantation, Department of General Surgery, “12 de octubre” University Hospital, Madrid 28041, Spain
| | - Iago Justo-Alonso
- Unit of HBP Surgery and Abdominal Organs Transplantation, Department of General Surgery, “12 de octubre” University Hospital, Madrid 28041, Spain
| | - Jorge Calvo-Pulido
- Unit of HBP Surgery and Abdominal Organs Transplantation, Department of General Surgery, “12 de octubre” University Hospital, Madrid 28041, Spain
| | - David Lora-Pablos
- Clinical Research Department, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), “12 de octubre” University Hospital, Madrid 28041, Spain
| | - Alberto Marcacuzco-Quinto
- Unit of HBP Surgery and Abdominal Organs Transplantation, Department of General Surgery, “12 de octubre” University Hospital, Madrid 28041, Spain
| | - Félix Cambra-Molero
- Unit of HBP Surgery and Abdominal Organs Transplantation, Department of General Surgery, “12 de octubre” University Hospital, Madrid 28041, Spain
| | - Alvaro García-Sesma
- Unit of HBP Surgery and Abdominal Organs Transplantation, Department of General Surgery, “12 de octubre” University Hospital, Madrid 28041, Spain
| | - Marina Pérez-Flecha
- Unit of HBP Surgery and Abdominal Organs Transplantation, Department of General Surgery, “12 de octubre” University Hospital, Madrid 28041, Spain
| | - Carlos Muñoz-Arce
- Unit of HBP Surgery and Abdominal Organs Transplantation, Department of General Surgery, “12 de octubre” University Hospital, Madrid 28041, Spain
| | - Carmelo Loinaz-Segurola
- Unit of HBP Surgery and Abdominal Organs Transplantation, Department of General Surgery, “12 de octubre” University Hospital, Madrid 28041, Spain
| | - Alejandro Manrique-Municio
- Unit of HBP Surgery and Abdominal Organs Transplantation, Department of General Surgery, “12 de octubre” University Hospital, Madrid 28041, 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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6
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Silva JT, San-Juan R, Fernández-Caamaño B, Prieto-Bozano G, Fernández-Ruiz M, Lumbreras C, Calvo-Pulido J, Jiménez-Romero C, Resino-Foz E, López-Medrano F, Lopez-Santamaria M, Maria Aguado J. Infectious Complications Following Small Bowel Transplantation. Am J Transplant 2016; 16:951-9. [PMID: 26560685 DOI: 10.1111/ajt.13535] [Citation(s) in RCA: 37] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 01/25/2023]
Abstract
Microbiological spectrum and outcome of infectious complications following small bowel transplantation (SBT) have not been thoroughly characterized. We performed a retrospective analysis of all patients undergoing SBT from 2004 to 2013 in Spain. Sixty-nine patients underwent a total of 87 SBT procedures (65 pediatric, 22 adult). The median follow-up was 867 days. Overall, 81 transplant patients (93.1%) developed 263 episodes of infection (incidence rate: 2.81 episodes per 1000 transplant-days), with no significant differences between adult and pediatric populations. Most infections were bacterial (47.5%). Despite universal prophylaxis, 22 transplant patients (25.3%) developed cytomegalovirus disease, mainly in the form of enteritis. Specifically, 54 episodes of opportunistic infection (OI) occurred in 35 transplant patients. Infection was the major cause of mortality (17 of 24 deaths). Multivariate analysis identified retransplantation (hazard ratio [HR]: 2.21; 95% confidence interval [CI]: 1.02-4.80; p = 0.046) and posttransplant renal replacement therapy (RRT; HR: 4.19; 95% CI: 1.40-12.60; p = 0.011) as risk factors for OI. RRT was also a risk factor for invasive fungal disease (IFD; HR: 24.90; 95% CI: 5.35-115.91; p < 0.001). In conclusion, infection is the most frequent complication and the leading cause of death following SBT. Posttransplant RRT and retransplantation identify those recipients at high risk for developing OI and IFD.
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Affiliation(s)
- J T Silva
- Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain
| | - R San-Juan
- Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain
| | - B Fernández-Caamaño
- Department of Pediatric Gastroenterology, University Hospital "La Paz," Department of Medicine, Universidad Autónoma, Madrid, Spain
| | - G Prieto-Bozano
- Department of Pediatric Gastroenterology, University Hospital "La Paz," Department of Medicine, Universidad Autónoma, Madrid, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain
| | - C Lumbreras
- Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain
| | - J Calvo-Pulido
- Department of General and Digestive Surgery and Abdominal Organ Transplantation, University Hospital "12 de Octubre," Madrid, Spain
| | - C Jiménez-Romero
- Department of General and Digestive Surgery and Abdominal Organ Transplantation, University Hospital "12 de Octubre," Madrid, Spain
| | - E Resino-Foz
- Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain
| | - F López-Medrano
- Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain
| | - M Lopez-Santamaria
- Department of Pediatric Surgery, University Hospital "La Paz," Department of Medicine, Universidad Autónoma, Madrid, Spain
| | - J Maria Aguado
- Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain
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Talayero P, Mancebo E, Calvo-Pulido J, Rodríguez-Muñoz S, Bernardo I, Laguna-Goya R, Cano-Romero FL, García-Sesma A, Loinaz C, Jiménez C, Justo I, Paz-Artal E. Innate Lymphoid Cells Groups 1 and 3 in the Epithelial Compartment of Functional Human Intestinal Allografts. Am J Transplant 2016; 16:72-82. [PMID: 26317573 DOI: 10.1111/ajt.13435] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/27/2015] [Accepted: 06/21/2015] [Indexed: 01/25/2023]
Abstract
We examined intraepithelial lymphocytes (IELs) in 213 ileal biopsies from 16 bowel grafts and compared them with 32 biopsies from native intestines. During the first year posttransplantation, grafts exhibited low levels of IELs (percentage of CD103(+) cells) principally due to reduced CD3(+) CD8(+) cells, while CD103(+) CD3(-) cell numbers became significantly higher. Changes in IEL subsets did not correlate with histology results, isolated intestine, or multivisceral transplants, but CD3(-) IELs were significantly higher in patients receiving corticosteroids. Compared with controls, more CD3(-) IELs of the grafts expressed CD56, NKp44, interleukin (IL)-23 receptor, retinoid-related orphan receptor gamma t (RORγt), and CCR6. No difference was observed in granzyme B, and CD3(-) CD127(+) cells were more abundant in native intestines. Ex vivo, and after in vitro activation, CD3(-) IELs in grafts produced significantly more interferon (IFN)-γ and IL-22, and a double IFNγ(+) IL-22(+) population was observed. Epithelial cell-depleted grafts IELs were cytotoxic, whereas this was not observed in controls. In conclusion, different from native intestines, a CD3(-) IEL subset predominates in grafts, showing features of natural killer cells and intraepithelial ILC1 (CD56(+) , NKp44(+) , CCR6(+) , CD127(-) , cytotoxicity, and IFNγ secretion), ILC3 (CD56(+) , NKp44(+) , IL-23R(+) , CCR6(+) , RORγt(+) , and IL-22 secretion), and intermediate ILC1-ILC3 phenotypes (IFNγ(+) IL-22(+) ). Viability of intestinal grafts may depend on the balance among proinflammatory and homeostatic roles of ILC subsets.
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Affiliation(s)
- P Talayero
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain.,I+12 Research Institute, University Hospital 12 de Octubre, Madrid, Spain
| | - E Mancebo
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain.,I+12 Research Institute, University Hospital 12 de Octubre, Madrid, Spain
| | - J Calvo-Pulido
- Department of General and Digestive Surgery and Abdominal Organ Transplantation, University Hospital 12 de Octubre, Madrid, Spain
| | - S Rodríguez-Muñoz
- Department of Gastroenterology, University Hospital 12 de Octubre, Madrid, Spain
| | - I Bernardo
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain
| | - R Laguna-Goya
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain.,I+12 Research Institute, University Hospital 12 de Octubre, Madrid, Spain
| | - F L Cano-Romero
- I+12 Research Institute, University Hospital 12 de Octubre, Madrid, Spain
| | - A García-Sesma
- Department of General and Digestive Surgery and Abdominal Organ Transplantation, University Hospital 12 de Octubre, Madrid, Spain
| | - C Loinaz
- Department of General and Digestive Surgery and Abdominal Organ Transplantation, University Hospital 12 de Octubre, Madrid, Spain
| | - C Jiménez
- I+12 Research Institute, University Hospital 12 de Octubre, Madrid, Spain.,Department of General and Digestive Surgery and Abdominal Organ Transplantation, University Hospital 12 de Octubre, Madrid, Spain.,School of Medicine, Complutense University, Madrid, Spain
| | - I Justo
- Department of General and Digestive Surgery and Abdominal Organ Transplantation, University Hospital 12 de Octubre, Madrid, Spain
| | - E Paz-Artal
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain.,I+12 Research Institute, University Hospital 12 de Octubre, Madrid, Spain.,School of Medicine, Complutense University, Madrid, Spain.,Section of Immunology, San Pablo CEU University, Madrid, Spain
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Caso-Maestro Ó, Justo-Alonso I, Cambra-Molero F, Manrique-Municio A, Calvo-Pulido J, Jiménez-Romero C. Adult hepatoblastoma: case report with adrenal recurrence. Rev Esp Enferm Dig 2015; 105:638-9. [PMID: 24641466 DOI: 10.4321/s1130-01082013001000014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jiménez-Romero C, Justo-Alonso I, Cambra-Molero F, Calvo-Pulido J, García-Sesma &A, Abradelo-Usera M, Caso-Maestro O, Manrique-Municio A. Incidence, risk factors and outcome of de novo tumors in liver transplant recipients focusing on alcoholic cirrhosis. World J Hepatol 2015; 7:942-953. [PMID: 25954477 PMCID: PMC4419098 DOI: 10.4254/wjh.v7.i7.942] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/15/2014] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
Orthotopic liver transplantation (OLT) is an established life-saving procedure for alcoholic cirrhotic (AC) patients, but the incidence of de novo tumors ranges between 2.6% and 15.7% and is significantly increased in comparison with patients who undergo OLT for other etiologies. Tobacco, a known carcinogen, has been reported to be between 52% and 83.3% in AC patients before OLT. Other risk factors that contribute to the development of malignancies are dose-dependent immunosuppression, advanced age, viral infections, sun exposure, and premalignant lesions (inflammatory bowel disease, Barrett’s esophagus). A significantly more frequent incidence of upper aerodigestive (UAD) tract, lung, skin, and kidney-bladder tumors has been found in OLT recipients for AC in comparison with other etiologies. Liver transplant recipients who develop de novo non-skin tumors have a decreased long-term survival rate compared with controls. This significantly lower survival rate is more evident in AC recipients who develop UAD tract or lung tumors after OLT mainly because the diagnosis is usually performed at an advanced stage. All transplant candidates, especially AC patients, should be encouraged to cease smoking and alcohol consumption in the pre- and post-OLT periods, use skin protection, avoid sun exposure and over-immunosuppression, and have a yearly otopharyngolaryngeal exploration and chest computed tomography scan in order to prevent or reduce the incidence of de novo malignancies. Although still under investigation, substitution of calcineurin inhibitors for sirolimus or everolimus may reduce the incidence of de novo tumors after OLT.
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