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Guevara-Martínez J, La-Noire FP, Arteaga-Asensio P, Pascual-Miguelañez I, Moraes Souza R, Quiles M, Montes M, Fondevila C, Álvarez-Gallego M. Proctitis in patients with monkeypox infection: a single-center analysis of 42 consecutive cases from a multidisciplinary observational study on monkeypox proctitis. Tech Coloproctol 2023; 27:1211-1218. [PMID: 37086291 PMCID: PMC10638120 DOI: 10.1007/s10151-023-02782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/07/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND The current monkeypox (MP) virus outbreak was declared an international emergency in July 2022. The aim of this report is to describe our initial experience with patients with MP, focusing on proctitis. METHODS We conducted an observational study between 20 May and 31 July 2022, on patients with MP at a reference tertiary center in Madrid, Spain. A descriptive analysis on MP was performed, focusing on its characteristics, symptoms, diagnosis, and outcomes. RESULTS A total of 143 positive MP cases were diagnosed in our center; 42 of them [all male, median age 39 years (range: 22-57 years)] had proctitis (29.37%), and 3 patients (2.09%/MP total cases and 7.14%/MP proctitis) required surgical drainage of a perianal abscess. CONCLUSIONS General and digestive surgeons must be aware of the presence of proctological impairment and complications due to MP virus.
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Affiliation(s)
- J Guevara-Martínez
- General and Digestive Surgery, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Investigación, Hospital Universitario La Paz, Madrid, Spain
| | - F Prieto La-Noire
- General and Digestive Surgery, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, Spain
| | - P Arteaga-Asensio
- General and Digestive Surgery, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, Spain
| | - I Pascual-Miguelañez
- General and Digestive Surgery, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Investigación, Hospital Universitario La Paz, Madrid, Spain
| | - R Moraes Souza
- Dermatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - M Quiles
- Microbiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - M Montes
- Internal Medicine Department, Hospital Universitario La Paz, Madrid, Spain
| | - C Fondevila
- General and Digestive Surgery, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Investigación, Hospital Universitario La Paz, Madrid, Spain
| | - M Álvarez-Gallego
- General and Digestive Surgery, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, Spain.
- Instituto de Investigación, Hospital Universitario La Paz, Madrid, Spain.
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York E, Guevara J, Gómez J, Corripio R, Zapata C, Recarte M, Sánchez J, Larrañaga I, Fondevila C. Fluorescence guided fully endoscopic axillary dissection for locally advanced breast cancer. A feasible novel technique. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Korenblik R, Olij B, Aldrighetti LA, Hilal MA, Ahle M, Arslan B, van Baardewijk LJ, Baclija I, Bent C, Bertrand CL, Björnsson B, de Boer MT, de Boer SW, Bokkers RPH, Rinkes IHMB, Breitenstein S, Bruijnen RCG, Bruners P, Büchler MW, Camacho JC, Cappelli A, Carling U, Chan BKY, Chang DH, Choi J, Font JC, Crawford M, Croagh D, Cugat E, Davis R, De Boo DW, De Cobelli F, De Wispelaere JF, van Delden OM, Delle M, Detry O, Díaz-Nieto R, Dili A, Erdmann JI, Fisher O, Fondevila C, Fretland Å, Borobia FG, Gelabert A, Gérard L, Giuliante F, Gobardhan PD, Gómez F, Grünberger T, Grünhagen DJ, Guitart J, Hagendoorn J, Heil J, Heise D, Herrero E, Hess GF, Hoffmann MH, Iezzi R, Imani F, Nguyen J, Jovine E, Kalff JC, Kazemier G, Kingham TP, Kleeff J, Kollmar O, Leclercq WKG, Ben SL, Lucidi V, MacDonald A, Madoff DC, Manekeller S, Martel G, Mehrabi A, Mehrzad H, Meijerink MR, Menon K, Metrakos P, Meyer C, Moelker A, Modi S, Montanari N, Navines J, Neumann UP, Peddu P, Primrose JN, Qu X, Raptis D, Ratti F, Ridouani F, Rogan C, Ronellenfitsch U, Ryan S, Sallemi C, Moragues JS, Sandström P, Sarriá L, Schnitzbauer A, Serenari M, Serrablo A, Smits MLJ, Sparrelid E, Spüntrup E, Stavrou GA, Sutcliffe RP, Tancredi I, Tasse JC, Udupa V, Valenti D, Fundora Y, Vogl TJ, Wang X, White SA, Wohlgemuth WA, Yu D, Zijlstra IAJ, Binkert CA, Bemelmans MHA, van der Leij C, Schadde E, van Dam RM. Dragon 1 Protocol Manuscript: Training, Accreditation, Implementation and Safety Evaluation of Portal and Hepatic Vein Embolization (PVE/HVE) to Accelerate Future Liver Remnant (FLR) Hypertrophy. Cardiovasc Intervent Radiol 2022; 45:1391-1398. [PMID: 35790566 PMCID: PMC9458562 DOI: 10.1007/s00270-022-03176-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/08/2022] [Indexed: 12/02/2022]
Abstract
STUDY PURPOSE The DRAGON 1 trial aims to assess training, implementation, safety and feasibility of combined portal- and hepatic-vein embolization (PVE/HVE) to accelerate future liver remnant (FLR) hypertrophy in patients with borderline resectable colorectal cancer liver metastases. METHODS The DRAGON 1 trial is a worldwide multicenter prospective single arm trial. The primary endpoint is a composite of the safety of PVE/HVE, 90-day mortality, and one year accrual monitoring of each participating center. Secondary endpoints include: feasibility of resection, the used PVE and HVE techniques, FLR-hypertrophy, liver function (subset of centers), overall survival, and disease-free survival. All complications after the PVE/HVE procedure are documented. Liver volumes will be measured at week 1 and if applicable at week 3 and 6 after PVE/HVE and follow-up visits will be held at 1, 3, 6, and 12 months after the resection. RESULTS Not applicable. CONCLUSION DRAGON 1 is a prospective trial to assess the safety and feasibility of PVE/HVE. Participating study centers will be trained, and procedures standardized using Work Instructions (WI) to prepare for the DRAGON 2 randomized controlled trial. Outcomes should reveal the accrual potential of centers, safety profile of combined PVE/HVE and the effect of FLR-hypertrophy induction by PVE/HVE in patients with CRLM and a small FLR. TRIAL REGISTRATION Clinicaltrials.gov: NCT04272931 (February 17, 2020). Toestingonline.nl: NL71535.068.19 (September 20, 2019).
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Affiliation(s)
- R Korenblik
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - B Olij
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - M Abu Hilal
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - M Ahle
- Deparment of Radiology, University Hospital, Linköping, Sweden
| | - B Arslan
- Department of Radiology, Rush University Medical Center, Chicago, USA
| | - L J van Baardewijk
- Department of Radiology, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - I Baclija
- Department of Radiology, Clinic Favoriten, Vienna, Austria
| | - C Bent
- Department of Radiology, Bournemouth and Christuchurch, The Royal Bournemouth and Christchurch Hospitals, Bournemouth and Christuchurch, UK
| | - C L Bertrand
- Department of Surgery, CHU UCLouvain Namur, Namur, Belgium
| | - B Björnsson
- Department of Surgery, Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden
| | - M T de Boer
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - S W de Boer
- Deparment of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R P H Bokkers
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - I H M Borel Rinkes
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Breitenstein
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - R C G Bruijnen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Bruners
- Department of Radiology, University Hospital Aachen, Aachen, Germany
| | - M W Büchler
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - J C Camacho
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - U Carling
- Department of Radiology, University Hospital Oslo, Oslo, Norway
| | - B K Y Chan
- Department of Surgery, Aintree University Hospitals NHS, Liverpool, UK
| | - D H Chang
- Department of Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - J Choi
- Department of Surgery, Western Health Footscray, Footscray, Australia
| | - J Codina Font
- Department of Radiology, University Hospital Dr. Josep Trueta de Girona, Girona, Spain
| | - M Crawford
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - D Croagh
- Department of Surgery, Monash Health, Clayton, Australia
| | - E Cugat
- Department of Surgery, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - R Davis
- Department of Radiology, Aintree University Hospitals NHS, Liverpool, UK
| | - D W De Boo
- Department of Radiology, Monash Health, Clayton, Australia
| | - F De Cobelli
- Department of Radiology, Ospedale San Raffaele, Milan, Italy
| | | | - O M van Delden
- Department of Radiology, Amsterdam University Medical Centers Location AMC, Amsterdam, The Netherlands
| | - M Delle
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - O Detry
- Department of Surgery, CHU de Liège, Liège, Belgium
| | - R Díaz-Nieto
- Department of Surgery, Aintree University Hospitals NHS, Liverpool, UK
| | - A Dili
- Department of Surgery, CHU UCLouvain Namur, Namur, Belgium
| | - J I Erdmann
- Department of Surgery, Amsterdam University Medical Centers Location AMC, Amsterdam, The Netherlands
| | - O Fisher
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - C Fondevila
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Å Fretland
- Department of Surgery, University Hospital Oslo, Oslo, Norway
| | - F Garcia Borobia
- Department of Surgery, Hospital Parc Taulí de Sabadell, Sabadell, Spain
| | - A Gelabert
- Department of Radiology, Hospital Parc Taulí de Sabadell, Sabadell, Spain
- Department of Radiology, University Hospital Mútua Terassa, Terassa, Spain
| | - L Gérard
- Department of Radiology, CHU de Liège, Liège, Belgium
| | - F Giuliante
- Department of Surgery, Gemelli University Hospital Rome, Rome, Italy
| | - P D Gobardhan
- Department of Surgery, Amphia, Breda, The Netherlands
| | - F Gómez
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T Grünberger
- Department of Surgery, HPB Center Vienna Health Network, Clinic Favoriten, Vienna, Austria
| | - D J Grünhagen
- Department of Surgery, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - J Guitart
- Department of Radiology, University Hospital Mútua Terassa, Terassa, Spain
| | - J Hagendoorn
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Heil
- Department of Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - D Heise
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - E Herrero
- Department of Surgery, University Hospital Mútua Terassa, Terassa, Spain
| | - G F Hess
- Department of Surgery, Clarunis University Hospital, Basel, Switzerland
| | - M H Hoffmann
- Department of Radiology, St. Clara Spital, Basel, Switzerland
| | - R Iezzi
- Department of Radiology, Gemelli University Hospital, Rome, Italy
| | - F Imani
- Department of Radiology, Amphia, Breda, The Netherlands
| | - J Nguyen
- Department of Radiology, Western Health Footscray, Footscray, Australia
| | - E Jovine
- Department of Surgery, Ospedale Maggiore di Bologna, Bologna, Italy
| | - J C Kalff
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - G Kazemier
- Department of Surgery, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - T P Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Kleeff
- Department of Surgery, University Hospital Halle (Saale), Halle, Germany
| | - O Kollmar
- Department of Surgery, Clarunis University Hospital, Basel, Switzerland
| | - W K G Leclercq
- Department of Surgery, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - S Lopez Ben
- Department of Surgery, University Hospital Dr. Josep Trueta de Girona, Girona, Spain
| | - V Lucidi
- Department of Surgery, Hôpital Erasme, Brussels, Belgium
| | - A MacDonald
- Department of Radiology, Oxford University Hospital NHS, Oxford, UK
| | - D C Madoff
- Department of Radiology, Yale School of Medicine, New Haven, USA
| | - S Manekeller
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - G Martel
- Department of Surgery, The Ottawa Hospital, Ottawa, Canada
| | - A Mehrabi
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - H Mehrzad
- Department of Radiology, Queen Elizabeth Hospital Birmingham NHS, Birmingham, UK
| | - M R Meijerink
- Department of Radiology, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - K Menon
- Department of Surgery, King's College Hospital NHS, London, UK
| | - P Metrakos
- Department of Surgery, McGill University Health Centre, Montréal, Canada
| | - C Meyer
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - A Moelker
- Department of Radiology and Nuclear Medicine, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - S Modi
- Department of Radiology, University Hospital Southampton NHS, Southampton, UK
| | - N Montanari
- Department of Radiology, Ospedale Maggiore Di Bologna, Bologna, Italy
| | - J Navines
- Department of Surgery, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - U P Neumann
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - P Peddu
- Department of Radiology, King's College Hospital NHS, London, UK
| | - J N Primrose
- Department of Surgery, University Hospital Southampton NHS, Southampton, UK
| | - X Qu
- Department of Radiology, Zhongshan Hospital, Fundan University, Shanghai, China
| | - D Raptis
- Department of Surgery, Royal Free Hospital NHS, London, UK
| | - F Ratti
- Department of Surgery, Ospedale San Raffaele, Milan, Italy
| | - F Ridouani
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - C Rogan
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - U Ronellenfitsch
- Department of Surgery, University Hospital Halle (Saale), Halle, Germany
| | - S Ryan
- Department of Radiology, The Ottawa Hospital, Ottawa, Canada
| | - C Sallemi
- Department of Radiology, Fondazione Poliambulanza, Brescia, Italy
| | - J Sampere Moragues
- Department of Radiology, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - P Sandström
- Department of Surgery, Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden
| | - L Sarriá
- Department of Radiology, University Hospital Miguel Servet, Saragossa, Spain
| | - A Schnitzbauer
- Department of Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - M Serenari
- Department of Surgery, General Surgery and Transplant Unit, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - A Serrablo
- Department of Surgery, University Hospital Miguel Servet, Saragossa, Spain
| | - M L J Smits
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Sparrelid
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - E Spüntrup
- Department of Radiology, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | - G A Stavrou
- Department of Surgery, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | - R P Sutcliffe
- Department of Surgery, Queen Elizabeth Hospital Birmingham NHS, Birmingham, UK
| | - I Tancredi
- Department of Radiology, Hôpital Erasme, Brussels, Belgium
| | - J C Tasse
- Department of Radiology, Rush University Medical Center, Chicago, USA
| | - V Udupa
- Department of Surgery, Oxford University Hospital NHS, Oxford, UK
| | - D Valenti
- Department of Radiology, McGill University Health Centre, Montréal, Canada
| | - Y Fundora
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T J Vogl
- Department of Radiology, University Hosptital Frankfurt, Frankfurt, Germany
| | - X Wang
- Department of Surgery, Zhongshan Hospital, Fundan University, Shanghai, China
| | - S A White
- Department of Surgery, Newcastle Upon Tyne Hospitals NHS, Newcastle upon Tyne, UK
| | - W A Wohlgemuth
- Department of Radiology, University Hospital Halle (Saale), Halle, Germany
| | - D Yu
- Department of Radiology, Royal Free Hospital NHS, London, UK
| | - I A J Zijlstra
- Department of Radiology, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - C A Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - M H A Bemelmans
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - C van der Leij
- Deparment of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E Schadde
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
- Department of Surgery, Rush University Medical Center Chicago, Chicago, USA
| | - R M van Dam
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany.
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Ceresetto JM, Tajer C, Duboscq C, Bottaro F, Casais P, Korin J, Fondevila C, Giumelli C, Scazziota A, Rossi A, Botto F, Ariscancela ME, Martinuzzo M, Zaidel E, Fitz Maurice M, Bahit C, Vazquez F, Molnar S, Saizberg S, Negri Aranguren P, Rosa C, Fedele JL, Comignani P, Pombo G, Raña P, Adamczuk Y, Martí A, Charask A, Penchasky D, Riveros D, Mariani J, Puente D, Celebrin L, Bosio M, Brodsky A, Sanchez Lucero A, Castillo Costa Y, Hirschson A, Arbesú G, Viñuales S, Kazelian L, Maneyro A, Gutierrez V, Castro Rios M, Gagliardi J, Lescano A, Repetto F. [MANAGEMENT RECOMMENDATIONS FOR DIRECT ORAL ANTICOAGULANTS (DOACs) ANTI Xa AND ANTI IIa]. Medicina (B Aires) 2022; 82 Suppl 2:1-55. [PMID: 35344926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Direct oral anticoagulants have emerged as the drugs that have changed the management of the antithrombotic treatment in the last 15 years. Their advantages, like a more friendly way of anticoagulation and their lower risk of bleeding, especially in the brain, have positioned these new anticoagulants as the first drug of choice in the two most frequent indications of anticoagulation, atrial fibrillation, and the venous thromboembolic disease. However, not all the patients can receive these agents, not all the direct oral anticoagulants have the same characteristics, and most importantly, not all the diseases with an indication of an anticoagulant drug can be treated with them. Therefore, it is mandatory that all the faculties involved in the management of these drugs must know them in depth, to decide the best treatment for the patient. This position paper, from a group of experts in anticoagulation in Argentina, can help the general practitioner in the daily use of direct oral anticoagulants based on the new evidence and the experience of a wide group of professionals. The way we relate to the anticoagulant treatment has changed in the last years. The doctors who work with them must also do so.
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Affiliation(s)
- José M Ceresetto
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina. E-mail:
| | - Carlos Tajer
- Hospital El Cruce Néstor Kirchner, Florencio Varela, Provincia de Buenos Aires, Argentina
| | | | | | | | - Jorge Korin
- Sanatorio de los Arcos, Buenos Aires, Argentina
| | | | - Carla Giumelli
- Instituto de Cardiología de Corrientes Juan Francicso Cabral, Corrientes, Argentina
| | | | - Andrea Rossi
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Fernando Botto
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | - Claudio Rosa
- Hospital Universitario Austral, Provincia de Buenos Aires, Argentina
| | | | | | | | - Pablo Raña
- Clínica Dr. Roberto Raña, Neuquén, Argentina
| | - Yolanda Adamczuk
- Hospital General de Agudos Dr. Enrique Tornú, Buenos Aires, Argentina
| | - Alejandra Martí
- Hospital El Cruce Néstor Kirchner, Florencio Varela, Provincia de Buenos Aires, Argentina
| | | | | | - Dardo Riveros
- Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, CEMIC, Buenos Aires, Argentina
| | - Javier Mariani
- Hospital El Cruce Néstor Kirchner, Florencio Varela, Provincia de Buenos Aires, Argentina
| | - Dolores Puente
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Lucia Celebrin
- Hospital General de Agudos Dr. Enrique Tornú, Buenos Aires, Argentina
| | - Martín Bosio
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Andrés Brodsky
- Hospital Nacional de Clínicas, José de San Martín Buenos Aires, Argentina
| | - Analía Sanchez Lucero
- Departamento de Hemostasia y Trombosis, IIHEMA, Academia Nacional de Medicina, Buenos Aires, Argentina
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5
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Viguera L, Blasi A, Reverter E, Arjona B, Caballero M, Chocron I, García-López JA, Gutierrez R, Martin MJ, Pérez-Peña J, Pitera J, Zarragoikoetxea I, Sabaté A, Belmonte C, Bustamante J, Beltran J, Colmenero J, Costa M, Fondevila C, Galan P, García-Palenciano C, Garrido JL, Gomez-Serrano J, Gonzalez S, de la Fuente JC, Jimeno C, Leon A, Lopez-Toribio P, Marín A, Del Mazo A, de Nadal M, Ojinaga G, Padilla J, Tevar J, Torres M, Zaballos M. Liver transplant with controlled donors after circulatory death with normothermic regional perfusion and brain dead donors: A multicenter cohort study of transfusion, one-year graft survival and mortality. Int J Surg 2021; 96:106169. [PMID: 34848373 DOI: 10.1016/j.ijsu.2021.106169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/01/2021] [Revised: 09/14/2021] [Accepted: 11/02/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Controlled donation after circulatory death (cDCD) has expanded the donor pool for liver transplantation (LT). However, transfusion requirements and perioperative outcomes should be elucidated. The aim of this multicenter study was to assess red blood cell (RBC) transfusions, one-year graft and patient survival after LT after cDCD with normothermic regional perfusion (NRP) compared with donors after brain death (DBD). METHODS 591 LT carried out in ten centers during 2019 were reviewed. Thromboelastometry was used to manage coagulation and blood product transfusion in all centers. Normothermic regional perfusion was the standard technique for organ recovery. RESULTS 447 patients received DBD and 144 cDCD with NRP. Baseline MCF Extem was lower in the cDCD group There were no differences in the percentage of patients (63% vs. 61% p = 0.69), nor in the number of RBC units transfused (4.7 (0.2) vs 5.5 (0.4) in DBD vs cDCD, p = 0.11. Twenty-six patients (6%) died during admission for LT in the DBD group compared with 3 patients (2%) in the cDCD group (p = 0.15). To overcome the bias due to a worse coagulation profile in cDCD recipients, matched samples were compared. No differences in baseline laboratory data, or in intraoperative use of RBC or one-year outcome data were observed between DBD and cDCD recipients. CONCLUSIONS cDCD with NRP is not associated with increased RBC transfusion. No differences in graft and patient survival between cDCD and DBD were found. Donors after controlled circulatory death with NRP can increasingly be utilized with safety, improving the imbalance between organ donors and the ever-growing demand.
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Affiliation(s)
- Laura Viguera
- Anaesthesia Department, Hospital Clinic de Barcelona, IDIBAPS, Spain Anaesthesia Department, Hospital Reina Sofia, Spain Anaesthesia Department, Hospital Vall d'Hebron, Spain Anaesthesia Department, Hospital Clínico Universitario Virgen de la Arrixaca, Spain Anaesthesia Department, Hospital de Cruces, Spain Anaesthesia Department, Hospital Universitario de Badajoz, Spain Anaesthesia Department, Hospital Universitario de la Fe, Spain Anaesthesia Department, Hospital Universiari Bellvitge, Spain Hepatology Department, Hospital Clinic Barcelona, IDIBAPS, Spain Anaesthesia Department, Hospital Universitario Gregorio Marañon de Madrid, Spain Surgery Department, Hospital Clinic de Barcelona, IDIBAPS, Spain Anaesthesia Department, Hospital Universitari Bellvitge, Spain Hepatology Department, Hospital Clinic Barcelona, Spain Anaesthesia Department, Complejo Hospitalario Universitario A Coruña, Spain Anaesthesia Department, Hospital Universitario Gregorio Marañón Madrid, Spain Anaesthesia Department, Hospital Universitari Bellvitge, University of Barcelona, IDIBELL, Spain
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6
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Ceresetto JM, Duboscq C, Korin J, Fondevila C, Casais P, Rossi A, Scazziota A, Martinuzzo M, Aris Cancela ME, Rosa C, Pombo G, Guimelli C, Adamczuk Y, Martí A, Penchasky D, Riveros D, Puente D, Celebrin L, Molnar S, Meschengieser S, Castro Ríos M, Blanco A, Hendler H, Brodsky A, Sánchez Luceros A, Negri Aranguren P, Fedele JL, Merlo C, Raña P, Gumpel C, Colorio C, Grand B, Canónico V, Rossi E, Colimodio P, Orlando S, Fassi D, Arias M, Viudez L, Farreras R, Martínez P, Ferro H, Casali C, Baques A, Arbesú G, Viñuales S, Medina F, Cortés V, Gallo MDC, Ehelou L, Barrera L, Rey I, de Larrañaga G, Figueroa F, Vilaseca A, Kuri I, Maneyro A, Otaran M, Xavier DL, Garbiero S, Salviú J, Fontenla P, Eckhardt A, Bomparola C, Fornasiero L. [Argentine Consensus in effective management of anticoagulation clinics for the use of vitamin k antagonists]. Medicina (B Aires) 2020; 80 Suppl 4:1-26. [PMID: 32897867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
Treating an anticoagulated patient with vitamin K antagonists (VKA) remains a challenge, especially in areas where dicoumarins are still the first drug of choice due to the cost of other oral anticoagulants. Anticoagulation clinics have proven to be the most efficient and safe way to avoid thrombotic and hemorrhagic complications and to keep patients in optimal treatment range. However, they require adequate infrastructure and trained personnel to work properly. In this Argentine consensus we propose a series of guidelines for the effective management of the anticoagulation clinics. The goal is to achieve the excellence in both the clinical healthcare and the hemostasis laboratory for the anticoagulated patient. The criteria developed in the document were agreed upon by a large group of expert specialists in hematology and biochemistry from all over the country. The criteria presented here must always be considered when indicating VKA although they had to be adapted to the unequal reality of each center. Taking these premises into consideration will allow us to optimize the management of the anticoagulated patient with VKA and thus minimize thrombotic and hemorrhagic intercurrences, in order to honor our promise not to harm the patient.
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Affiliation(s)
| | | | - Jorge Korin
- Consultorios Hematológicos, Buenos Aires, Argentina
| | | | | | | | | | | | | | - Claudio Rosa
- Hospital Universitario Austral, Pilar, Provincia de Buenos Aires, Argentina
| | | | - Carla Guimelli
- Instituto de Cardiología de Corrientes Juana Francisca Cabral, Corrientes, Argentina
| | - Yolanda Adamczuk
- Hospital General de Agudos Dr. Enrique Tornú, Buenos Aires, Argentina
| | - Alejandra Martí
- Hospital El Cruce - Néstor Kirchner, Florencio Varela, Provincia de Buenos Aires, Argentina
| | | | - Dardo Riveros
- Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina
| | | | - Lucía Celebrin
- Hospital General de Agudos Dr. Enrique Tornú, Buenos Aires, Argentina
| | | | | | | | - Alicia Blanco
- IIHEMA-Academia Nacional de Medicina, Buenos Aires, Argentina
| | | | - Andrés Brodsky
- Hospital de Clínicas José de San Martín, Buenos Aires, Argenitna
| | | | | | | | - Claudio Merlo
- Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina
| | - Pablo Raña
- Clínica Dr. Roberto Raña, Neuquén, Argentina
| | | | | | - Beatriz Grand
- Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires, Argentina
| | | | - Eleonora Rossi
- Laboratorio de Salud Pública, San Miguel de Tucumán, Argentina
| | | | - Sergio Orlando
- Hospital Interzonal General de Agudos Dr. Rodolfo Rossi, La Plata, Provincia de Buenos Aires, Argentina
| | - Daniel Fassi
- Clínica de la Esperanza, Buenos Aires, Argentina
| | - Mirta Arias
- Hospital Dr. César Milstein, Buenos Aires, Argentina
| | | | - Roberto Farreras
- Hospital Interzonal General de Agudos Dr. Oscar E. Alende, Mar del Plata, Provincia de Buenos Aires, Argentina
| | - Pablo Martínez
- Hospital Interzonal Dr. José Penna, Bahía Blanca, Provincia de Buenos Aires, Argentina
| | - Hugo Ferro
- Clínica Suizo Argentina, Buenos Aires, Argentina
| | | | - Alejandra Baques
- Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich, Buenos Aires, Argentina
| | | | | | - Fernanda Medina
- Instituto de Cardiología de Corrientes Juana Francisca Cabral, Corrientes, Argentina
| | - Verónica Cortés
- Instituto de Investigaciones Médicas Alfredo Lanari, Buenos Aires, Argentina
| | | | | | | | - Irene Rey
- Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina
| | | | - Flavia Figueroa
- Hospital de Día Pte. Néstor C. Kirchner, San Miguel de Tucumán, Argentina
| | | | | | | | - María Otaran
- Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina
| | - David Luis Xavier
- Clínica Privada Monte Grande, Monte Grande, Provincia de Buenos Aires, Argentina
| | - Susana Garbiero
- Hospital Interzonal Dr. José Penna, Bahía Blanca, Provincia de Buenos Aires, Argentina
| | - Julieta Salviú
- 4Centro de Hematología Pavlovsky, Buenos Aires, Argentina
| | - Patricia Fontenla
- Hospital San Juan de Dios, Ramos Mejía, Provincia de Buenos Aries, Argentina
| | - Andrea Eckhardt
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina
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Loinaz C, Ochando F, Vicente E, Serrablo A, López Cillero P, Gomez M, Fabregat J, Varo E, Miyar de León A, Fondevila C, Valdivieso A, Blanco G, Sanchez B, López Andújar R, Fundora Y, Cugat E, Diez Valladares L, Herrera J, García Gil A, Morales R, Pardo F, Sabater L, Lopez Baena J, Muñoz Bellvis L, Martin Perez E, Perez Saborido B, Suarez M, Meneu J, Albiol M, Sanjuanbenito A, Ramia J, Pereira F, Paseiro G, Palomo J, León M. Results of a survey on peri-operative nutritional support in pancreatic and biliary surgery in Spain. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1577] [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: 10/28/2022]
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Pavel M, Sanchez Cabus S, Crespo G, Ferrer J, Fondevila C, Fuster J, Garcia-Valdecasas J. Role of Adult Living Donor Liver Transplantation in the Treatment of Hepatocellular Carcinoma Within and Beyond Milan Criteria: A Comparative Study. Transplant Proc 2018; 50:1386-1395. [DOI: 10.1016/j.transproceed.2018.02.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/17/2018] [Indexed: 02/07/2023]
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Kaufman T, Magosevich D, Moreno MC, Guzman MA, D'Atri LP, Carestia A, Fandiño ME, Fondevila C, Schattner M. Nucleosomes and neutrophil extracellular traps in septic and burn patients. Clin Immunol 2017; 183:254-262. [PMID: 28863968 DOI: 10.1016/j.clim.2017.08.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/28/2017] [Accepted: 08/28/2017] [Indexed: 11/30/2022]
Abstract
NETosis is a host defense mechanism associated with inflammation and tissue damage. Experimental models show that platelets and von Willebrand factor (VWF) are key elements for intravascular NETosis. We determined NETosis in septic and burn patients at 1 and 4days post-admission (dpa). Nucleosomes were elevated in patients. In septics, they correlated with Human Neutrophil Elastase (HNE)-DNA complexes and SOFA score at 1dpa, and were associated with mortality. Patient's neutrophils had spontaneous NETosis and were unresponsive to stimulation. Although platelet P-selectin and TNF-α were increased in both groups, higher platelet TLR-4 expression, VWF levels and IL-6 were found in septics at 1dpa. Neither platelet activation markers nor cytokines correlated with nucleosomes or HNE-DNA. Nucleosomes could be indicators of organ damage and predictors of mortality in septic but not in burn patients. Platelet activation, VWF and cytokines do not appear to be key mediators of NETosis in these patient groups.
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Affiliation(s)
- Tomás Kaufman
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine-CONICET, National Academy of Medicine, José Andrés Pacheco de Melo 3081, Buenos Aires, Argentina
| | - Débora Magosevich
- Sagrado Corazón Clinic, Bartolomé Mitre 1955, Buenos Aires, Argentina
| | | | | | - Lina Paola D'Atri
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine-CONICET, National Academy of Medicine, José Andrés Pacheco de Melo 3081, Buenos Aires, Argentina
| | - Agostina Carestia
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine-CONICET, National Academy of Medicine, José Andrés Pacheco de Melo 3081, Buenos Aires, Argentina
| | | | | | - Mirta Schattner
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine-CONICET, National Academy of Medicine, José Andrés Pacheco de Melo 3081, Buenos Aires, Argentina.
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10
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Affiliation(s)
- A J Hessheimer
- General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - C Fondevila
- General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - R Matesanz
- Organización Nacional de Trasplantes, Madrid, Spain
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11
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Ariza X, Graupera I, Coll M, Solà E, Barreto R, García E, Moreira R, Elia C, Morales-Ruiz M, Llopis M, Huelin P, Solé C, Fabrellas N, Weiss E, Nevens F, Gerbes A, Trebicka J, Saliba F, Fondevila C, Hernández-Gea V, Fernández J, Bernardi M, Arroyo V, Jiménez W, Deulofeu C, Pavesi M, Angeli P, Jalan R, Moreau R, Sancho-Bru P, Ginès P. Neutrophil gelatinase-associated lipocalin is a biomarker of acute-on-chronic liver failure and prognosis in cirrhosis. J Hepatol 2016; 65:57-65. [PMID: 26988732 DOI: 10.1016/j.jhep.2016.03.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [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: 10/09/2015] [Revised: 03/03/2016] [Accepted: 03/06/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS Acute-on-chronic liver failure (ACLF) is a syndrome that occurs in cirrhosis characterized by organ failure(s) and high mortality rate. There are no biomarkers of ACLF. The LCN2 gene and its product, neutrophil gelatinase-associated lipocalin (NGAL), are upregulated in experimental models of liver injury and cultured hepatocytes as a result of injury by toxins or proinflammatory cytokines, particularly Interleukin-6. The aim of this study was to investigate whether NGAL could be a biomarker of ACLF and whether LCN2 gene may be upregulated in the liver in ACLF. METHODS We analyzed urine and plasma NGAL levels in 716 patients hospitalized for complications of cirrhosis, 148 with ACLF. LCN2 expression was assessed in liver biopsies from 29 additional patients with decompensated cirrhosis with and without ACLF. RESULTS Urine NGAL was markedly increased in ACLF vs. no ACLF patients (108(35-400) vs. 29(12-73)μg/g creatinine; p<0.001) and was an independent predictive factor of ACLF; the independent association persisted after adjustment for kidney function or exclusion of variables present in ACLF definition. Urine NGAL was also an independent predictive factor of 28day transplant-free mortality together with MELD score and leukocyte count (AUROC 0.88(0.83-0.92)). Urine NGAL improved significantly the accuracy of MELD in predicting prognosis. The LCN2 gene was markedly upregulated in the liver of patients with ACLF. Gene expression correlated directly with serum bilirubin and INR (r=0.79; p<0.001 and r=0.67; p<0.001), MELD (r=0.68; p<0.001) and Interleukin-6 (r=0.65; p<0.001). CONCLUSIONS NGAL is a biomarker of ACLF and prognosis and correlates with liver failure and systemic inflammation. There is remarkable overexpression of LCN2 gene in the liver in ACLF syndrome. LAY SUMMARY Urine NGAL is a biomarker of acute-on-chronic liver failure (ACLF). NGAL is a protein that may be expressed in several tissues in response to injury. The protein is filtered by the kidneys due to its small size and can be measured in the urine. Ariza, Graupera and colleagues found in a series of 716 patients with cirrhosis that urine NGAL was markedly increased in patients with ACLF and correlated with prognosis. Moreover, gene coding NGAL was markedly overexpressed in the liver tissue in ACLF.
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Affiliation(s)
- X Ariza
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - I Graupera
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - M Coll
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - E Solà
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - R Barreto
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - E García
- Data Management Centre, EASL-CLIF Consortium, Barcelona, Spain
| | - R Moreira
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - C Elia
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - M Morales-Ruiz
- University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain; Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Llopis
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - P Huelin
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - C Solé
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - N Fabrellas
- University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - E Weiss
- Inserm, U1149, Centre de Recherche sur l'Inflammation (CRI), Clichy and Paris, France; UMRS1149, Université Paris Diderot, Paris, France; Département Hospitalo-Universitaire (DHU) UNITY, Service d'Hépatologie, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France; Laboratoire d'Excellence Inflamex, ComUE Sorbonne Paris Cité, Paris, France
| | - F Nevens
- Division of Liver and Biliopancreatic Disorders, University Hospitals of Leuven, KU Leuven, University of Leuven, Belgium
| | - A Gerbes
- Liver Center Munich, Department of Internal Medicine II, University Hospital LMU Munich, Grosshadern, Munich, Germany
| | - J Trebicka
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - F Saliba
- Hôpital Paul Brousse, Villejuif, France
| | - C Fondevila
- University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain; Hepatobiliary Surgery & Liver Transplant, Hospital Clínic de Barcelona, Barcelona, Spain
| | - V Hernández-Gea
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain; Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Fernández
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - M Bernardi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - V Arroyo
- EASL-CLIF Consortium, Barcelona, Spain
| | - W Jiménez
- University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain; Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - C Deulofeu
- Data Management Centre, EASL-CLIF Consortium, Barcelona, Spain
| | - M Pavesi
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain; Data Management Centre, EASL-CLIF Consortium, Barcelona, Spain
| | - P Angeli
- Unit of Hepatic Emergencies and Liver Transplantation, Department of Surgery, University of Padova, Padova, Italy
| | - R Jalan
- Liver Failure Group, University College London Institute for Liver and Digestive Health, University College London Medical School, Royal Free Hospital, London, United Kingdom
| | - R Moreau
- Inserm, U1149, Centre de Recherche sur l'Inflammation (CRI), Clichy and Paris, France; UMRS1149, Université Paris Diderot, Paris, France; Département Hospitalo-Universitaire (DHU) UNITY, Service d'Hépatologie, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France; Laboratoire d'Excellence Inflamex, ComUE Sorbonne Paris Cité, Paris, France
| | - P Sancho-Bru
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - P Ginès
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain.
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Blasi A, Hessheimer AJ, Beltrán J, Pereira A, Fernández J, Balust J, Martínez-Palli G, Fuster J, Navasa M, García-Valdecasas JC, Taurá P, Fondevila C. Liver Transplant From Unexpected Donation After Circulatory Determination of Death Donors: A Challenge in Perioperative Management. Am J Transplant 2016; 16:1901-8. [PMID: 26601629 DOI: 10.1111/ajt.13621] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 01/25/2023]
Abstract
Unexpected donation after circulatory determination of death (uDCD) liver transplantation is a complex procedure, in particular when it comes to perioperative recipient management. However, very little has been published to date regarding intraoperative and immediate postoperative care in this setting. Herein, we compare perioperative events in uDCD liver recipients with those of a matched group of donation after brain death liver recipients. We demonstrate that the former group of recipients suffers significantly greater hemodynamic instability and derangements in coagulation following graft reperfusion. Based on our experience, we recommend a proactive recipient management strategy in uDCD liver transplantation that involves early use of vasopressor support; maintaining adequate intraoperative levels of red cells, platelets, and fibrinogen; and routinely administering tranexamic acid before graft reperfusion.
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Affiliation(s)
- A Blasi
- Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - A J Hessheimer
- General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J Beltrán
- Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - A Pereira
- Hemotherapy & Hemostasis, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - J Fernández
- Hepatology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J Balust
- Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - G Martínez-Palli
- Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - J Fuster
- General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Navasa
- Hepatology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J C García-Valdecasas
- General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - P Taurá
- Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - C Fondevila
- General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Rivadeneyra L, Pozner RG, Meiss R, Fondevila C, Gómez RM, Schattner M. Poly (I:C) downregulates platelet production and function through type I interferon. Thromb Haemost 2015; 114:982-93. [PMID: 26134179 DOI: 10.1160/th14-11-0951] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 05/24/2015] [Indexed: 12/21/2022]
Abstract
Thrombocytopenia is a frequent complication of viral infections; the underlying mechanisms appear to depend on the identity of the virus involved. Previous research, including reports from our group, indicates that as well as having antiviral activity type I interferons (IFN I) selectively downregulate platelet production. In this study we extended understanding of the role of endogenous IFN I in megakaryo/thrombopoiesis by evaluating platelet and megakaryocyte physiology in mice treated with polyinosinic:polycytidylic acid [poly (I:C)], a synthetic analogue of double-stranded RNA, Toll-like receptor-3 ligand and strong IFNβ inducer. Mice-treated with poly (I:C) showed thrombocytopaenia, an increase in mean platelet volume and abnormal haemostatic and inflammatory platelet-mediated functionality, indicated by decreased fibrinogen binding and platelet adhesion, prolonged tail bleeding times and impaired P-Selectin externalisation, RANTES release and thrombin-induced platelet-neutrophil aggregate formation. These changes were associated with an increase in size and an abnormal distribution of bone marrow megakaryocytes within the vascular niche and were directly correlated with the plasmatic and bone marrow IFNβ levels. All these effects were absent in genetically modified mice lacking the IFN I receptor. Our results suggest that IFN I is the central mediator of poly (I:C)-induced thrombocytopenia and platelet dysfunction and indicate that these abnormalities are due to changes in the last stages of megakaryocyte development. These data provide new evidence for the role of IFN I in megakaryocyte distribution in the bone marrow niches and its influence on thrombopoiesis and haemostasis.
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Affiliation(s)
| | | | | | | | | | - Mirta Schattner
- Mirta Schattner, Institute of Experimental Medicine, Pacheco de Melo 3081, Buenos Aires 1425, Argentina, Tel.: +5411 48073926, Fax: +5411 48050712,
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14
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Vendrell M, Hessheimer AJ, Ruiz A, de Sousa E, Paredes D, Rodríguez C, Saavedra S, Fuster J, Alcaraz A, Oppenheimer F, Taurá P, García-Valdecasas JC, Fondevila C. Coagulation profiles of unexpected DCDD donors do not indicate a role for exogenous fibrinolysis. Am J Transplant 2015; 15:764-71. [PMID: 25655040 DOI: 10.1111/ajt.13058] [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: 08/06/2014] [Revised: 10/08/2014] [Accepted: 10/11/2014] [Indexed: 01/25/2023]
Abstract
It has been suggested that vascular stasis during cardio-circulatory arrest leads to the formation of microvascular thrombi and the viability of organs arising from donation after circulatory determination of death (DCDD) donors may be improved through the application of fibrinolytic therapy. Our aim was to comprehensively study the coagulation profiles of Maastricht category II DCDD donors in order to determine the presence of coagulation abnormalities that could benefit from fibrinolytic therapy. Whole blood from potential DCDD donors suffering out-of-hospital cardiac arrest was sampled after declaration of death in the emergency department, and rotational thromboelastomeric analysis was performed. Between July 2012 and December 2013, samples from 33 potential DCDD donors were analyzed. All patients demonstrated hyperfibrinolysis (HF), as reflected by maximum clot lysis of 98-100% in all cases, indicating that there is no role for additional fibrinolytic therapy in this setting. As well, we observed correlations between thromboelastomeric lysis parameters and maximum hepatic transaminase levels measured in potential donors and renal artery flows measured during ex situ hypothermic oxygenated machine perfusion, indicating that further studies on the utility of thromboelastometry to evaluate organ injury and perhaps even viability in unexpected DCDD may be warranted.
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Affiliation(s)
- M Vendrell
- Anesthesiology, Hospital Clínic, University of Barcelona, Barcelona, Spain
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15
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Ceresetto JM, Duboscq C, Fondevila C, Tezanos Pinto M. [Acquired haemophilia (acquired factor VIII inhibitor)]. Medicina (B Aires) 2015; 75:231-238. [PMID: 26339881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Acquired haemophilia is a rare disorder. The clinical picture ranges from mild ecchymosis and anaemia to life threatening bleeding in up to 20% of patients. The disease is produced by an antibody against Factor VIII and it usually occurs in the elderly, with no previous history of a bleeding disorder. It can be associated to an underlying condition such as cancer, autoimmune disorders, drugs or pregnancy. It has a typical laboratory pattern with isolated prolonged activated partial thromboplastin time (aPTT) that fails to correct upon mixing tests with normal plasma and low levels of factor VIII. Treatment recommendations are based on controlling the acute bleeding episodes with either bypassing agent, recombinant activated factor VII or activated prothrombin complex concentrate, and eradication of the antibody with immunosuppressive therapy.
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Affiliation(s)
- José M Ceresetto
- Servicio de Hematología y Hemoterapia, Hospital Británico de Buenos Aires, Argentina. E-mail:
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16
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Etulain J, Fondevila C, Negrotto S, Schattner M. Platelet-mediated angiogenesis is independent of VEGF and fully inhibited by aspirin. Br J Pharmacol 2014; 170:255-65. [PMID: 23713888 DOI: 10.1111/bph.12250] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 12/17/2012] [Revised: 05/08/2013] [Accepted: 05/17/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Platelets are major players in every step of vessel development through the local delivery of angiogenesis-modulating factors, including the pro-angiogenic protein VEGF and the anti-angiogenic endostatin. Although thrombin is a potent agonist and is highly elevated in angiogenesis-related diseases, studies regarding its action on the release of platelet angiogenic factors are scarce and controversial. Herein, we have investigated the role of thrombin not only in VEGF and endostatin release but also in net platelet angiogenic activity. EXPERIMENTAL APPROACH Human platelets were stimulated with thrombin in the presence of the various inhibitors of the signalling pathways involved in platelet activation. Supernatants/releasates were used to determine the levels of angiogenic molecules and to induce angiogenic responses. KEY RESULTS We found that thrombin induced the secretion of both VEGF and endostatin; however, the overall effect of the releasates was pro-angiogenic as they promoted tubule-like formation and increased the proliferation of endothelial cells. Both responses were only slightly suppressed in the presence of a VEGF receptor-neutralizing antibody. Pharmacological studies revealed that while inhibitors of PKC, p38, ERK1/2, Src kinases or PI3K/Akt exerted only partial inhibitory effects, aspirin fully blocked the pro-angiogenic activity of the releasate. CONCLUSIONS AND IMPLICATIONS In contrast to current belief, platelet pro-angiogenic responses are independent of VEGF and appear to be the result of the combined action of several molecules. Moreover, our data reinforce the notion that aspirin is a good candidate for a therapeutic agent to treat angiogenesis-related diseases.
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Affiliation(s)
- J Etulain
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine, CONICET-National Academy of Medicine, Buenos Aires, Argentina
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17
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Hessheimer AJ, Escobar B, Muñoz J, Flores E, Gracia-Sancho J, Taurá P, Fuster J, Rimola A, García-Valdecasas JC, Fondevila C. Somatostatin therapy protects porcine livers in small-for-size liver transplantation. Am J Transplant 2014; 14:1806-16. [PMID: 24935350 DOI: 10.1111/ajt.12758] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/17/2014] [Accepted: 03/25/2014] [Indexed: 01/25/2023]
Abstract
Small-for-size (SFS) injury occurs in partial liver transplantation due to several factors, including excessive portal inflow and insufficient intragraft responses. We aim to determine the role somatostatin plays in reducing portal hyperperfusion and preventing the cascade of deleterious events produced in small grafts. A porcine model of 20% liver transplantation is performed. Perioperatively treated recipients receive somatostatin and untreated controls standard intravenous fluids. Recipients are followed for up to 5 days. In vitro studies are also performed to determine direct protective effects of somatostatin on hepatic stellate cells (HSC) and sinusoidal endothelial cells (SEC). At reperfusion, portal vein flow (PVF) per gram of tissue increased fourfold in untreated animals versus approximately threefold among treated recipients (p = 0.033). Postoperatively, markers of hepatocellular, SEC and HSC injury were improved among treated animals. Hepatic regeneration occurred in a slower but more orderly fashion among treated grafts; functional recovery was also significantly better. In vitro studies revealed that somatostatin directly reduces HSC activation, though no direct effect on SEC was found. In SFS transplantation, somatostatin reduces PVF and protects SEC in the critical postreperfusion period. Somatostatin also exerts a direct cytoprotective effect on HSC, independent of changes in PVF.
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Affiliation(s)
- A J Hessheimer
- Department of Surgery, Institut de Malalties Digestives I Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
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18
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Rivadeneyra L, Carestia A, Etulain J, Pozner RG, Fondevila C, Negrotto S, Schattner M. Regulation of platelet responses triggered by Toll-like receptor 2 and 4 ligands is another non-genomic role of nuclear factor-kappaB. Thromb Res 2013; 133:235-43. [PMID: 24331207 DOI: 10.1016/j.thromres.2013.11.028] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [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: 07/29/2013] [Revised: 11/06/2013] [Accepted: 11/26/2013] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Platelets express Toll-like receptors (TLRs) that recognise molecular components of pathogens and, in nucleated cells, elicit immune responses through nuclear factor-kappaB (NF-κB) activation. We have shown that NF-κB mediates platelet activation in response to classical agonists, suggesting that this transcription factor exerts non-genomic functions in platelets. The aim of this study was to determine whether NF-κB activation is a downstream signal involved in TLR2 and 4-mediated platelet responses. MATERIAL AND METHODS Aggregation and ATP release were measured with a Lumi-aggregometer. Fibrinogen binding, P-selectin and CD40 ligand (CD40L) levels and platelet-neutrophil aggregates were measured by cytometry. I kappa B alpha (IκBα) degradation and p65 phosphorylation were determined by Western blot and von Willebrand factor (vWF) by ELISA. RESULTS Platelet stimulation with Pam3CSK4 or LPS resulted in IκBα degradation and p65 phosphorylation. These responses were suppressed by TLR2 and 4 blocking and synergised by thrombin. Aggregation, fibrinogen binding and ATP and vWF release were triggered by Pam3CSK4. LPS did not induce platelet responses per se, except for vWF release, but it did potentiate thrombin-induced aggregation, fibrinogen binding and ATP secretion. Pam3CSK4, but not LPS, induced P-selectin and CD40L expression and mixed aggregate formation. All of these responses, except for CD40L expression, were inhibited in platelets treated with the NF-κB inhibitors BAY 11-7082 or Ro 106-9920. CONCLUSION TLR2 and 4 agonists trigger platelet activation responses through NF-κB. These data show another non-genomic function of NF-κB in platelets and highlight this molecule as a potential target to prevent platelet activation in inflammatory or infectious diseases.
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Affiliation(s)
- Leonardo Rivadeneyra
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine (CONICET), National Academy of Medicine, Buenos Aires, Argentina
| | - Agostina Carestia
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine (CONICET), National Academy of Medicine, Buenos Aires, Argentina
| | - Julia Etulain
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine (CONICET), National Academy of Medicine, Buenos Aires, Argentina
| | - Roberto G Pozner
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine (CONICET), National Academy of Medicine, Buenos Aires, Argentina
| | - Carlos Fondevila
- Service of Hematology, Bazterrica Clinic, Buenos Aires, Argentina
| | - Soledad Negrotto
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine (CONICET), National Academy of Medicine, Buenos Aires, Argentina
| | - Mirta Schattner
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine (CONICET), National Academy of Medicine, Buenos Aires, Argentina.
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Carestia A, Rivadeneyra L, Romaniuk MA, Fondevila C, Negrotto S, Schattner M. Functional responses and molecular mechanisms involved in histone-mediated platelet activation. Thromb Haemost 2013; 110:1035-45. [PMID: 23965842 DOI: 10.1160/th13-02-0174] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [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: 02/26/2013] [Accepted: 07/24/2013] [Indexed: 01/09/2023]
Abstract
Histones are highly alkaline proteins found in cell nuclei and they can be released by either dying or inflammatory cells. The recent observations that histones are major components of neutrophil extracellular traps and promote platelet aggregation and platelet-dependent thrombin generation have shown that these proteins are potent prothrombotic molecules. Because the mechanism(s) of platelet activation by histones are not completely understood, we explored the ability of individual recombinant human histones H1, H2A, H2B, H3 and H4 to induce platelet activation as well as the possible molecular mechanisms involved. All histones were substrates for platelet adhesion and spreading and triggered fibrinogen binding, aggregation, von Willebrand factor release, P-selectin and phosphatidylserine (PS) exposure and the formation of platelet-leukocyte aggregates; however, H4 was the most potent. Histone-mediated fibrinogen binding, P-selectin and PS exposure and the formation of mixed aggregates were potentiated by thrombin. Histones induced the activation of ERK, Akt, p38 and NFκB. Accordingly, histone-induced platelet activation was significantly impaired by pretreatment of platelets with inhibitors of ERK (U 0126), PI3K/Akt (Ly 294002), p38 (SB 203580) and NFκB (BAY 11-7082 and Ro 106-9920). Preincubation of platelets with either aspirin or dexamethasone markedly decreased fibrinogen binding and the adhesion mediated by histones without affecting P-selectin exposure. Functional platelet responses induced by H3 and H4, but not H1, H2A and H2B, were partially mediated through interaction with Toll-like receptors -2 and -4. Our data identify histones as important triggers of haemostatic and proinflammatory platelet responses, and only haemostatic responses are partially inhibited by anti-inflammatory drugs.
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Affiliation(s)
- A Carestia
- Mirta Schattner, Instituto de Medicina Experimental, CONICET-ANM, Pacheco de Melo 3081, Buenos Aires 1425, Argentina, Tel.: +54 11 4805 5759 ext. 301, Fax: +54 11 4805 0712, E-mail:
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20
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Manyalich M, Menjívar A, Yucetin L, Peri J, Torres X, Dias L, Hiesse C, Papachristou C, Fehrman-Ekholm I, Kvarnström N, Ballesté C, Paredes D, Revuelta I, Diekmann F, Rimola A, Fondevila C, Martínez M, Legendre C, Pereira R, Carvalho I, Lopes A. Living Donor Psychosocial Assesment/Follow-up Practices in the Partners' Countries of the ELIPSY Project. Transplant Proc 2012; 44:2246-9. [DOI: 10.1016/j.transproceed.2012.07.106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Fondevila C, Hessheimer AJ, Flores E, Ruiz A, Mestres N, Calatayud D, Paredes D, Rodríguez C, Fuster J, Navasa M, Rimola A, Taurá P, García-Valdecasas JC. Applicability and results of Maastricht type 2 donation after cardiac death liver transplantation. Am J Transplant 2012; 12:162-70. [PMID: 22070538 DOI: 10.1111/j.1600-6143.2011.03834.x] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [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
Maastricht type 2 donation after cardiac death (DCD) donors suffer sudden and unexpected cardiac arrest, typically outside the hospital; they have significant potential to expand the donor pool. Herein, we analyze the results of transplanted livers and all potential donors treated under our type 2 DCD protocol. Cardiac arrest was witnessed; potential donors arrived at the hospital after attempts at resuscitation had failed. Death was declared based on the absence of cardiorespiratory activity during a 5-min no-touch period. Femoral vessels were cannulated to establish normothermic extracorporeal membrane oxygenation, which was maintained until organ recovery. From April 2002 to December 2010, there were 400 potential donors; 34 liver transplants were performed (9%). Among recipients, median age, model for end-stage liver disease and cold and reperfusion warm ischemic times were 55 years (49-60), 19 (14-21) and 380 (325-430) and 30 min (26-35), respectively. Overall, 236 (59%) and 130 (32%) livers were turned down due to absolute and relative contraindications to donate, respectively. One-year recipient and graft survivals were 82% and 70%, respectively (median follow-up 24 months). The applicability of type 2 DCD liver transplant was <10%; however, with better preservation technology and expanded transplant criteria, we may be able to improve this figure significantly.
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Affiliation(s)
- C Fondevila
- Department of Surgery, Liver Transplant Unit, Hospital Clínic, CIBERehd, University of Barcelona, Barcelona, Spain.
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23
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24
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Ramirez S, Perez-Del-Pulgar S, Carrion JA, Costa J, Gonzalez P, Massaguer A, Fondevila C, Garcia-Valdecasas JC, Navasa M, Forns X. Hepatitis C virus compartmentalization and infection recurrence after liver transplantation. Am J Transplant 2009; 9:1591-601. [PMID: 19459796 DOI: 10.1111/j.1600-6143.2009.02666.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [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
Hepatitis C virus (HCV) compartmentalization may have important implications in the pathogenesis of HCV infection. The aim of this study was to investigate the presence and relevance of HCV compartmentalization in the setting of liver transplantation (LT). We collected samples of serum, peripheral blood mononuclear cells (PBMC), perihepatic lymph nodes (PLN) and liver explant at the time of LT, and serum and PBMC after transplantation from 57 HCV-infected cirrhotic patients undergoing LT: 38 individuals received antiviral treatment before LT and 19 were untreated controls. HCV-RNA levels were determined by real-time PCR and the hypervariable region 1 (HVR-1) was sequenced. HCV-RNA was detected in all samples from control patients. In virological responders, recurrence after LT was associated with residual HCV-RNA in the liver explant. Within the entire cohort, 47% of patients harbored differences in direct sequences from distinct compartments. Quasispecies analysis revealed that in most cases, HVR-1 sequences recovered after infection recurrence were identical or closely related to those isolated from the liver explant and serum at the time of LT. Our study shows that a significant proportion of HCV-infected cirrhotic patients exhibit compartmentalization. Viral variants originating within the liver appear to be the main cause of HCV recurrence after LT.
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Affiliation(s)
- S Ramirez
- Liver Unit. Institut de Malalties Digestives, CIBERehd, IDIBAPS and University of Barcelona, Barcelona, Spain
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Amador A, Grande L, Martí J, Deulofeu R, Miquel R, Solá A, Rodriguez-Laiz G, Ferrer J, Fondevila C, Charco R, Fuster J, Hotter G, García-Valdecasas JC. Ischemic pre-conditioning in deceased donor liver transplantation: a prospective randomized clinical trial. Am J Transplant 2007; 7:2180-9. [PMID: 17697262 DOI: 10.1111/j.1600-6143.2007.01914.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [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: 01/25/2023]
Abstract
To assess the immediate and long-term effects of ischemic preconditioning (IPC) in deceased donor. liver transplantation (LT), we designed a prospective, randomized controlled trial involving 60 donors: control group (CTL, n = 30) or study group (IPC, n = 30). IPC was induced by 10-min hiliar clamping immediately before recovery of organs. Clinical data and blood and liver samples were obtained in the donor and in the recipient for measurements. IPC significantly improved biochemical markers of liver cell function such as uric acid, hyaluronic acid and Hypoxia-Induced Factor-1 alpha (HIF-1 alpha) levels. Moreover, the degree of apoptosis was significantly lower in the IPC group. On clinical basis, IPC significantly improved the serum aspartate aminotransferase (AST) levels and reduced the need for reoperation in the postoperative period. Moreover, the incidence of primary nonfunction (PNF) was lower in the IPC group, but did not achieve statistical significance. We conclude that 10-min IPC protects against I/R injury in deceased donor LT.
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Affiliation(s)
- A Amador
- Hospital de Sabadell, Consorci Sanitari Parc Taulí, Hepato-Biliary-Pancreatic Surgery Unit, Catalonia, Barcelona, Spain.
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Amador A, Charco R, Martí J, Navasa M, Rimola A, Calatayud D, Rodriguez-Laiz G, Ferrer J, Romero J, Ginesta C, Fondevila C, Fuster J, García-Valdecasas JC. Clinical trial on the cost-effectiveness of T-tube use in an established deceased donor liver transplantation program. Clin Transplant 2007; 21:548-53. [PMID: 17645718 DOI: 10.1111/j.1399-0012.2007.00688.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of our study was to assess the advantages and disadvantages of T-tube use in liver transplantation, with also paying attention to the economic costs derived from its use. Patients were prospectively randomized to T tube or no T tube. One hundred and seven patients, 53 with T tube and 54 without T tube, were analyzed. Minimum follow-up was three months. Nine patients (8.4%) had bile leak: six in the T-tube group (11.3%) and three in the group without T tube (5.5%), p = ns. Four patients (3.5%) had anastomotic biliary stenosis: one in the T-tube group (1.8%) and three in the group without T tube, p = ns. Twenty of the 53 patients (37.7%) with T tube had T-tube-related complication. The number of diagnostic and therapeutic resources were higher in the T-tube group compared with non-T tube (81 and 17 vs. 18 and 10, respectively, p <0.05). The costs of therapeutic procedures required for the treatment of complications were 28 232 euro in the T-tube group vs. 16 088 euro in the no T-tube group, p <0.05. In conclusion, the systematic use of the T tube in biliary reconstruction in liver transplantation cannot be justified.
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Affiliation(s)
- A Amador
- Liver Transplantation Unit, ICMDM, Hospital Clinic i Provincial, IDIBAPS, Barcelona, Spain
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Fondevila C, Hessheimer AJ, Ruiz A, Calatayud D, Ferrer J, Charco R, Fuster J, Navasa M, Rimola A, Taurá P, Ginés P, Manyalich M, García-Valdecasas JC. Liver transplant using donors after unexpected cardiac death: novel preservation protocol and acceptance criteria. Am J Transplant 2007; 7:1849-55. [PMID: 17564639 DOI: 10.1111/j.1600-6143.2007.01846.x] [Citation(s) in RCA: 217] [Impact Index Per Article: 12.8] [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: 01/25/2023]
Abstract
Donors after cardiac death (DCD) suffer irreversible cardiac arrest prior to donation. We describe our liver transplant experience with DCD whose cardiac arrest is unexpected, not following the removal of ventilatory support, whom we maintain with normothermic extracorporeal membrane oxygenation (NECMO). A potential donor goes into cardiac arrest outside the hospital and is brought to the hospital under continuous cardiopulmonary resuscitation (CPR). The donor is declared dead and placed on a cardiocompressor. Femoral vessels are cannulated and connected to cardiopulmonary bypass (CPB) to establish NECMO. Blood parameters and CPB pump flow are monitored throughout NECMO, which is continued until cold preservation. From April 2002 to May 2006, 10 of 40 potential DCD livers were transplanted. Only one graft was lost to primary nonfunction (PNF) and another to hepatic artery thrombosis. Posttransplant hepatic function was good. Certain parameters, such as CPR and NECMO times, hepatic transaminases during NECMO, and donor age, determined the viability of DCD liver grafts and were used to establish criteria for their acceptance. Though considered marginal, unexpected DCD can represent an important source of viable livers for transplant if strict acceptance criteria are employed and they are maintained with NECMO prior to recovery.
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Affiliation(s)
- C Fondevila
- Department of Surgery, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
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Morales-Ruiz M, Fondevila C, Muñoz-Luque J, Tugues S, Rodríguez-Laiz G, Cejudo-Martín P, Romero JM, Navasa M, Fuster J, Arroyo V, Sessa WC, García-Valdecasas JC, Jiménez W. Gene transduction of an active mutant of akt exerts cytoprotection and reduces graft injury after liver transplantation. Am J Transplant 2007; 7:769-78. [PMID: 17391122 DOI: 10.1111/j.1600-6143.2006.01720.x] [Citation(s) in RCA: 13] [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: 01/25/2023]
Abstract
Akt is expected to be an effective target for the treatment of ischemia-reperfusion injury (I/R) due to its anti-apoptotic properties and its ability to activate the endothelial nitric oxide synthase (eNOS) enzyme. Therefore, this study was aimed to determine the efficacy of an active mutant of Akt (myr-Akt) to decrease I/R injury in a model of orthotopic liver transplantation in pigs. In addition, we analyzed the contribution of nitric oxide in the Akt-mediated effects by using an eNOS mutant (S1179DeNOS) that mimics the phosphorylation promoted by Akt in the eNOS sequence. Donors were treated with adenoviruses codifying for myr-Akt, S1179DeNOS or beta-galactosidase 24 h before liver harvesting. Then, liver grafts were orthotopically transplanted into their corresponding recipients. Levels of transaminases and lactate dehydrogenase (LDH) increased in all recipients after 24 h of transplant. However, transaminases and LDH levels were significantly lower in the myr-Akt group compared with vehicle. The percentage of apoptotic cells and the amount of activated-caspase 3 protein were also markedly reduced in myr-Akt-treated grafts after 4 days of liver transplant compared with vehicle and S1179DeNOS groups. In conclusion, myr-Akt gene therapy effectively exerts cytoprotection against hepatic I/R injury regardless of the Akt-dependent eNOS activation.
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Affiliation(s)
- M Morales-Ruiz
- Department of Biochemistry and Molelular Genetics, Hospital Clinic, IDIBAPS, University of Barcelona and IRSIN, Spain
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Abstract
In the initial experience of liver transplantation, complete thrombosis and portal vein occlusion were considered to be absolute contraindications for liver transplantation. The incidence of portal thrombosis in patients being prepared for transplantation varies between 5% and 15% according to published series. There are 2 surgical techniques to solve absent or low portal vein flow due to thrombosis. The most widely used technique is thrombectomy and the second technique is insertion of a shunt with a venous graft in the permeable portion of the superior mesenteric vein or in a vein in the splanchnic territory. Portal thrombosis recurrence rates vary among series, ranging from 0% to 25% or even 30%, depending on its extension and severity and also on time the transplantation was performed. Although overall survival is somewhat lower, there are no significant differences in most of the series when patients with portal thrombosis who underwent transplantation are compared with those without.
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Affiliation(s)
- R Charco
- Liver Transplantation Unit, IMDiM, Hospital Clinic i Provincial, Barcelona, Spain.
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30
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Charco R, Rimola A, García-Valdecasas JC, Fuster J, Fondevila C, Navasa M, Julian M, Forta V, Brunet M. Steroids and Living Liver Donation Increase Tacrolimus Blood Levels in Living Donor Liver Transplantation. Transplant Proc 2005; 37:3930-1. [PMID: 16386588 DOI: 10.1016/j.transproceed.2005.10.082] [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: 10/25/2022]
Abstract
The aim of this study was to determine the tacrolimus blood levels in recipients of living donor liver transplants (LDLT) compared with recipients who undergo whole cadaveric liver grafts and to correlate the tacrolimus trough levels with the 12-hour area under the concentration (AUC) curve. From June 2002 to June 2003, the 10 LDLT were prospectively compared with 11 cadaveric transplants. The main immunosuppression was tacrolimus plus steroids. Intraoperative methylprednisolone was administered to all cadaveric organ recipients and only 6 of the 10 LDLT. Median tacrolimus trough levels at day 10 were 14.1 ng/mL for the LDLT group and 9.1 ng/mL for the CLT group (P = NS). The median tacrolimus AUC at day 10 were 185.2 ngxh/mL and 148.1 ngxh/mL for the LDLT group and the cadaveric group, respectively (P = NS). Median tacrolimus trough levels at day 2 were 24.3 ng/mL versus 9.9 ng/mL in the LDLT recipients with and without steroids, respectively (P < .05). Also, median tacrolimus AUC at day 2 were 239 ngxh/mL and 179.7 ngxh/mL when we compared LDLT recipients with and without steroids (P = NS). A significant correlation was observed between tacrolimus trough levels and AUC in the LDLT group (C.C. = 0.936; P < .0001). In conclusion, LDLT recipients display higher tacrolimus blood levels in comparison with cadaveric liver recipients, with a good correlation between tacrolimus trough levels and AUC. Intraoperative steroid administration induces higher tacrolimus levels in LDLT recipients.
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Affiliation(s)
- R Charco
- Liver Transplant Unit, Hospital Clinic i Provincial, Barcelona, Spain.
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31
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Amador A, Charco R, Martí J, Ferrer J, Mans E, Fondevila C, Fuster J, Grande L, Visa J, Rimola A, Navasa M, García-Valdecasas JC. One Thousand Liver Transplants: The Hospital Clinic Experience. Transplant Proc 2005; 37:3916-8. [PMID: 16386583 DOI: 10.1016/j.transproceed.2005.09.167] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Our goal was to study a consecutive series of 1000 liver transplants performed in our institution to evaluate the changes over time in donors, recipients, and results. PATIENTS AND METHODS With the aim to evaluate differences between transplantation in the first period and the present period, the first consecutive 100 liver transplants performed from June 1988 to June 1990 (first period) were compared with the last consecutive 200 liver transplants performed from January 2001 to June 2003 (second period). RESULTS Increased donor age, change in donor cerebral death etiology, and increasing numbers of grafts from alternative methods using cadaveric donors were observed in the second period. Piggy-back technique and the biliary anastomosis without a t-tube was also started in the second period. One-year actuarial patient survival was higher in the second period (84% vs 91.3%). The need for retransplantation in the overall series was 95%. One-, 5-, and 10-year actuarial retransplant survival was 67.7%, 51.3%, and 39.4%, respectively. CONCLUSIONS Technical innovations, better understanding of donor and recipient aspects, and global improvements were the reasons for time-related improved results of liver transplantation.
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Affiliation(s)
- A Amador
- Institut de Malaties Digestives i Metabólícas, Hospital Clínic i Provincial, Barcelona, Spain
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Amador A, Charco R, Marti J, Alvarez G, Ferrer J, Mans E, Fuster J, Fondevila C, Garcia-Valdecasas JC. Cost/efficacy clinical trial about the use of T-tube in cadaveric donor liver transplant: preliminary results. Transplant Proc 2005; 37:1129-30. [PMID: 15848645 DOI: 10.1016/j.transproceed.2005.01.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
UNLABELLED Biliary reconstruction is the most common cause of morbidity associated with orthotopic liver transplantation. Our objective was to assess the complications and hospital resources related to the use of a T-tube. MATERIAL AND METHODS Among 95 liver transplants performed from October 2002 to November 2003, 84 patients were randomized to receive a T-tube or no T-tube. We analyzed all patients with a follow-up of at least of 3 months. RESULTS Fifty-five transplants were analyzed with 8 months mean follow-up, including twenty eight with T-tube and twenty seven without a T-tube. No patient died during the follow-up. The overall rate of biliary complications was 45.4% (25/55) including 21/28 (75%) in the T-tube group and 4/27(14.8%) in the non-T-tube group (P < .0001). Complications related to T-tube extraction occurred in 48.2% (13/27), including 3 cholangitis and 10 leaks. The costs of hospital resources due to radiological studies were 5329 capital JE, Ukrainian for the T-tube group vs 5785 capital JE, Ukrainian for the non-T-tube group. The costs of hospital resources due to treatment were 28,280 capital JE, Ukrainian for the T-tube group vs 10,088 capital JE, Ukrainian for the non-T-tube group. CONCLUSIONS Use of a T-tube during orthotopic liver transplantation does not seem justified. Biliary anastomosis stenting is followed by an increased incidence of complications, most of which are related to its use. Hospital stay, radiological studies, and cost of hospital resources are higher among the T-tube patients. Therefore its systematic use is not advisable.
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Affiliation(s)
- A Amador
- Liver Transplantation Unit, ICMDM, Hospital Clinic i Provincial, Barcelona, Spain
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33
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Moore C, Shen XD, Fondevila C, Gao F, Coito AJ. Blockade of fibronectin-alpha4beta1 adhesive interactions down-regulates cyclooxygenase-2 inducible nitric oxide synthase and prolongs recipient survival in a 24-hour model of cold hepatic ischemia-reperfusion injury. Transplant Proc 2005; 37:1682-3. [PMID: 15919429 DOI: 10.1016/j.transproceed.2005.03.146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated the effects of the connecting segment-1 (CS1) peptide, which blocks fibronectin (FN)-alpha4beta1 integrin interactions, upon recipient survival and extent of tissue injury in a well-established rat liver model of ex vivo 24-hour cold ischemia followed by isotransplantation. In this model, CS1 peptides were administered through the portal vein of rat livers prior to and after cold ischemic storage. In addition, recipients of orthotopic liver transplants (OLT) received a dose of CS1 peptides 1 hour post-OLT. CS1 peptide therapy significantly inhibited the intragraft recruitment of T lymphocytes and neutrophil activation/infiltration, and repressed important mediators of inflammation, such as cyclooxygenase-2, and inducible nitric oxide synthase expression. Importantly, CS1 peptide therapy improved function/histological preservation of liver grafts and extended their 14-day survival from 50% in control to 100% in CS1-treated OLTs. Thus, CS1 peptide-mediated blockade of FN-alpha4beta1 interaction protects against severe ischemia-reperfusion injury experienced otherwise by OLTs. These novel findings document the potential of targeting FN-alpha4beta1 in vivo interaction for improving OLT outcomes.
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Affiliation(s)
- C Moore
- The Dumont-UCLA Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
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Fondevila C, Shen XD, Moore C, Busuttil RW, Coito AJ. Cyclic RGD peptides with high affinity for alpha5beta1 integrin protect genetically fat Zucker rat livers from cold ischemia/reperfusion injury. Transplant Proc 2005; 37:1679-81. [PMID: 15919428 DOI: 10.1016/j.transproceed.2005.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We tested a hypothesis that interactions between fibronectin (FN), a key extracellular matrix component, and its integrin alpha5beta1 receptor are important in the development of ischemia/reperfusion (I/R) injury of steatotic liver transplants. We examined the effect of a cyclic RGD peptide (cRGD), with high affinity for alpha5beta1 integrin, in a well-established steatotic rat liver model of ex vivo cold ischemia followed by isotransplantation. In this model, cRGD peptides were administered through the portal vein of steatotic Zucker rat livers prior to and after cold ischemic storage. Lean Zucker recipients of fatty orthotopic liver transplants (OLTs) received an additional course of cRGD peptides 1 hour posttransplantation. cRGD peptide therapy significantly inhibited the recruitment of monocyte/macrophages, and repressed the expression of pro-inflammatory cytokines, such as tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma. Moreover, it resulted in selective inhibition of inducible nitric oxide synthase (iNOS), and MMP-9 expression. Importantly, cRGD peptide therapy improved the function and histologic preservation of steatotic liver grafts, extending their 14-day survival in lean recipients from 50% in untreated to 100% in cRGD-treated OLTs. Thus, cRGD peptide-mediated blockade of FN-alpha5beta1 interaction protects against severe I/R injury otherwise experienced by steatotic OLTs.
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Affiliation(s)
- C Fondevila
- Dumont-UCLA Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
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35
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Vidal O, Metges JP, Soriano-Izquierdo A, Palacín A, Elizalde I, Castells A, Fondevila C, Robaszkiewiecz M, Volant A, Pera M. Prognostic value of angiogenesis in patients following curative resection of gastric cancer (GC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.9605] [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: 11/20/2022] Open
Affiliation(s)
- O. Vidal
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - J. P. Metges
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - A. Soriano-Izquierdo
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - A. Palacín
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - I. Elizalde
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - A. Castells
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - C. Fondevila
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - M. Robaszkiewiecz
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - A. Volant
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - M. Pera
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
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Abstract
Upregulation of heme oxygenase (HO)-1, a heat shock protein 32, protects against hepatic ischemia/reperfusion (I/R) injury. Activation of "innate" toll-like receptor (TLR) 4 system triggers the I/R injury cascade. This study explores cytoprotective functions of HO-1 overexpression following exogenous administration of cobalt protoporphyrin (CoPP), and its relationship with the TLR4 pathway in a model of mouse partial hepatic warm I/R injury. CoPP treatment markedly improved hepatic function and histology, and suppressed pro-inflammatory cytokine elaboration profile, as compared with untreated controls. Although administration of CoPP did not affect intrahepatic TLR4, it downregulated IFN-inducible protein 10 (IP-10) expression. As IP-10 is the major product of type-1 IFN pathway downstream of TLR4, we then infused recombinant IFN-beta (rIFN-beta) directly into mouse livers. Interestingly, infusion of rIFN-beta upregulated hepatic IP-10 expression. In contrast, adjunctive CoPP treatment decreased IP-10 levels in mouse livers infused with rIFN-beta. Thus, CoPP-induced HO-1 upregulation suppresses type-1 IFN pathway downstream of TLR4 system in hepatic warm I/R injury model.
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Affiliation(s)
- S Tsuchihashi
- The Dumont-UCLA Transplant Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-7054, USA
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37
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Moore C, Shen XD, Fondevila C, Coito AJ. Fibronectin-α4β1 integrin interactions modulate p42/44 MAPK phosphorylation in steatotic liver cold ischemia-reperfusion injury. Transplant Proc 2005; 37:432-4. [PMID: 15808667 DOI: 10.1016/j.transproceed.2004.12.206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated the effects of the connecting segment-1 (CS1) peptide, which blocks fibronectin (FN)-alpha4beta1 integrin interactions upon cell signaling, leukocyte migration, and secretion of proinflammatory cytokines, in a well-established steatotic rat liver model using ex vivo cold ischemia followed by isotransplantation. In this model, CS1 peptides were administered through the portal vein of steatotic Zucker rat livers prior and after cold ischemic storage. Lean Zucker recipients of fatty orthotopic liver transplantation (OLT) received an additional 3-day course of CS1 peptides post-OLT. CS1 peptide-treated steatotic OLTs harvested at 1, 3, and 7 days showed moderated levels of p42/44 mitogen-activated protein kinase (MAPK) phosphorylation, comparable to those observed in steatotic naive livers. In contrast, p42/44 MAPK phosphorylation was found up-regulated in 1- to 3-day damaged control OLTs. However, 7-day control OLTs were characterized by virtually lack of p42/44 MAPK phosphorylation. Lack of p42/44 MAPK phosphorylation in 7-day control OLTs was correlated with massive presence of leukocytes in the grafts and elevated levels of proinflammatory cytokines. CS1 peptide-treated OLTs at 7 days showed a profound decrease in T-cell (10 +/- 3 vs 56 +/- 20, P < .03) and monocyte/macrophage (+/++ vs +++) infiltration and significantly reduced levels of cytokine expression, such as IL-2 (approximately sixfold), and IFN-gamma (approximately three- to fourfold), as compared with controls.
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Affiliation(s)
- C Moore
- Dumont-UCLA Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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38
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García-Valdecasas JC, Fuster J, Charco R, Fondevila C, Rimola M, Navasa A, Bruix J. El trasplante hepático en adulto de donante vivo hoy. Gastroenterol Hepatol 2004. [DOI: 10.1157/13067451] [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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39
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Farmer DG, McDiarmid SV, Edelstein S, Renz JF, Hisatake G, Cortina G, Fondevila C, Correa M, Rhodes S, Zafar A, Chavez Y, Yersiz H, Busuttil RW. Induction therapy with interleukin-2 receptor antagonist after intestinal transplantation is associated with reduced acute cellular rejection and improved renal function. Transplant Proc 2004; 36:331-2. [PMID: 15050149 DOI: 10.1016/j.transproceed.2004.01.099] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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
PURPOSE To determine the effectiveness of induction immunotherapy with interleukin-2 receptor antagonists (IL2RA) after intestinal transplantation (IT). METHODS A single-center, retrospective study was undertaken of all patients undergoing IT using existing medical records and database. Immunotherapy was either triple (standard maintenance triple therapy [SMTT]) or IL2RA [induction IL2RA plus SMTTx] or OKT3 [induction antilymphocyte preparations plus SMTTx]). Data was collected for the first 175 postoperative days. Outcomes included pretransplant renal function, posttransplant serum creatinine normalized to age (nl-sCR), rejection (ACR), and survival. Standard statistical analysis was undertaken. RESULTS There were no significant differences in the groups: triple (n = 10, median age 3.5 years, cGFR 106 +/- 44 mL/min), IL2RA (n = 13, median age 3.2 years, cGFR 101 +/- 61 mL/min), OKT3 (n = 4, median age 7.7 years, cGFR 104 +/- 27 mL/min). nl-sCR was significantly (P <.01) lower in IL2RA at most postoperative weeks. IL2RA had significantly fewer rejection and infectious episodes than the other two groups. Three-year patient survival was 92% in IL2RA versus 50% triple and OKT3. CONCLUSIONS IL2RA immunotherapy after IT is associated with a lower incidence of renal dysfunction as compared with historical controls. Furthermore, IL2RA therapy resulted in a lower incidence of rejection and improved survival. IL2RA should be considered in select patients undergoing IT.
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Affiliation(s)
- D G Farmer
- Dumont-UCLA Transplant Program, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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40
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Farmer DG, McDiarmid SV, Edelstein S, Yersiz H, Vargas J, Cortina G, Renz JF, Fondevila C, Hisatake G, Reyen L, Correa M, Rhodes S, Zafar A, Chavez Y, Busuttil RW. Improved outcome after intestinal transplantation at a single institution over 12 years. Transplant Proc 2004; 36:303-4. [PMID: 15050139 DOI: 10.1016/j.transproceed.2004.01.098] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 11/25/2022]
Abstract
PURPOSE To evaluate the outcomes of patients undergoing intestinal transplantation (IT). METHODS Retrospective review was undertaken using existing medical records and database. RESULTS Between November 1991 and May 2003, 114 patients were referred for consideration for IT, of which 33 patients received 37 intestinal allografts. All patients had intestinal failure and all patients had significant complications from total parenteral nutrition (TPN). TPN was the predominant cause of liver failure (63%). Combined liver intestinal grafts were used in the majority of patients. Overall 1- and 3-year patient survival is 77% and 52% with patients transplanted since 1999 having a 1- and 3-year survival of 94% and 73%, respectively. The most common cause of death was sepsis. No graft or patient was lost to cytomegalovirus or Epstein-Barr virus disease. Twenty-seven percent of allografts were lost to rejection. Long-term TPN independence is 82% for grafts more than 30 days after IT. Statistical analysis revealed several important factors impacting outcome. CONCLUSIONS Successful IT defined as prolonged patient and graft survival and TPN independence can be readily achieved in select patients with IF and complications related to TPN therapy. Outcomes have improved with experience gained and control of viral infections and rejection.
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Affiliation(s)
- D G Farmer
- Dumont-UCLA Transplant Program, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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41
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Ziring D, Tran R, Edelstein S, McDiarmid SV, Vargas J, Cortina G, Gajjar N, Ching N, Cherry J, Krogstad P, Renz JF, Fondevila C, Busuttil RW, Farmer DG. Infectious enteritis after intestinal transplantation: incidence, timing, and outcome. Transplant Proc 2004; 36:379-80. [PMID: 15050165 DOI: 10.1016/j.transproceed.2004.01.093] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To review the incidence, timing, and outcome of infectious enteritis after intestinal transplantation (IT). METHOD A retrospective review of all patients undergoing IT at a single institution between 1991 and 2003 was analyze with standard statistical tools. RESULTS Among 33 IT recipients, 13 (39%) developed 20 culture- or biopsy-proven episodes of infectious enteritis. The recipient demographics were 77% men and median age 2.6 years. Infections were diagnosed at a median of 76 days (32 to 1800) after IT. There were 14 viral (CMV one, rotavirus eight, adenovirus four, EBV one, three bacterial (Clostridium difficile), and three other infections (Giardia lamblia one, cryptosporidium two). Complete resolution was achieved in 17 (94%) infectious after appropriate antimicrobial or conservative therapy. Interestingly, there were six rejection episodes following infectious enteritis. Grafts were lost to rejection after rotaviral enteritis (n = 1) and adenoviral enteritis misdiagnosed as rejection (n = 1). Patient and graft survival were not adversely affected by infections. CONCLUSIONS Infectious enteritis occurs frequently after IT. Viral agents are the cause in two-thirds of cases. With supportive care and appropriate treatment, resolution is possible in the majority of cases. Differentiating rejection and infection by histopathology can be difficult.
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Affiliation(s)
- D Ziring
- Dumont-UCLA Transplant Program, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Fondevila C, Metges JP, Fuster J, Grau JJ, Palacín A, Castells A, Volant A, Pera M. p53 and VEGF expression are independent predictors of tumour recurrence and survival following curative resection of gastric cancer. Br J Cancer 2004; 90:206-15. [PMID: 14710231 PMCID: PMC2395306 DOI: 10.1038/sj.bjc.6601455] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This study was undertaken to determine the value of tumour microvessel density (MVD) and the expression of p53 and vascular endothelial growth factor (VEGF) as prognostic markers in patients with gastric cancer operated on for cure. In all, 156 patients with curatively resected gastric cancer constituted the basis of this blinded retrospective evaluation. Patients were treated with either surgery alone (n=53) or surgery plus adjuvant chemotherapy (n=103). Tumour MVD, p53 expression, and VEGF expression were assayed using immunohistochemical techniques. After a mean follow-up of 43 months, 64 (41%) patients had died and 55 (35%) patients developed tumour recurrence. Positive correlations between MVD and both p53 (P=0.005) and VEGF (P=0.005) expression were observed. Both MVD >/=100 (P=0.05) and positive VEGF expression (P<0.02) were associated with shorter disease-free survival, and positive VEGF expression (P=0.01) was also associated with shorter overall survival. Multivariate analysis confirmed that, in addition to the pathological tumour stage, lymph node ratio, the extent of lymphadenectomy and perineural invasion, p53 expression, and VEGF expression were independently associated with both disease-free survival (P<0.0005 and 0.02, respectively) and overall survival (P<0.02 and 0.01, respectively). Finally, patients whose tumours did not show p53 expression had a survival benefit compared to those expressing p53 when treated with adjuvant chemotherapy (P=0.01). This investigation demonstrates that p53 expression and VEGF expression are independent prognostic factors for both disease-free survival and overall survival in patients with curatively resected gastric cancer, and that p53 status may also influence response to chemotherapy.
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Affiliation(s)
- C Fondevila
- Services of Gastrointestinal Surgery, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona Medical School, Barcelona, Spain
| | - J P Metges
- Departments of Pathology and Medical Oncology, Centre Hospitalier Universitaire Cavale Blanche and Morvan, Brest, France
| | - J Fuster
- Services of Gastrointestinal Surgery, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona Medical School, Barcelona, Spain
| | - J J Grau
- Department of Medical Oncology, Hospital Clínic, IDIBAPS, University of Barcelona Medical School, Barcelona, Spain
| | - A Palacín
- Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona Medical School, Barcelona, Spain
| | - A Castells
- Services of Gastroenterology, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona Medical School, Barcelona, Spain
| | - A Volant
- Departments of Pathology and Medical Oncology, Centre Hospitalier Universitaire Cavale Blanche and Morvan, Brest, France
| | - M Pera
- Services of Gastrointestinal Surgery, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona Medical School, Barcelona, Spain
- Services of Gastrointestinal Surgery, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona Medical School, Barcelona, Spain. E-mail:
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Fondevila C, Ghobrial RM, Fuster J, Bombuy E, García-Valdecasas JC, Busuttil RW. Biliary complications after adult living donor liver transplantation. Transplant Proc 2003; 35:1902-3. [PMID: 12962841 DOI: 10.1016/s0041-1345(03)00646-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We evaluated the causes and outcomes of biliary complications occurring after adult living donor liver transplantation (ALDLT) in a large patient cohort. Among 46 patients who underwent ALDLT at two different centers early bile duct complications occurred in 11 recipients (23.9%), consisting of leakage from the anastomotic site or from the cut surface of the liver. T-tube-associated biliary complications occurred in four patients. Late complications, primarily anastomotic strictures, occurred in 15 patients (32.6%) at 6.7+/-3.5 months after transplantation. Surgical intervention was generally required for early biliary complications but rarely necessary for late complications. No graft loss was caused by biliary complications. Thus, ALDLT is accompanied by a high rate of biliary complications, which in our series have been of low severity. However, long-term effects on graft function are not yet known.
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Affiliation(s)
- C Fondevila
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif 90095, USA
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Abstract
OBJECTIVE To explore putative cytoprotective functions of biliverdin during hepatic ischemia/reperfusion (I/R) injury in rat models. MATERIAL AND METHODS Male Sprague Dawley (SD) rat livers were harvested and stored for 24 hours at 4 degrees C in University of Wisconsin (UW) solution (n=18), and then perfused with blood for 2 hours on an isolated rat liver perfusion apparatus equipped for temperature (37 degrees C), pressure (13 cm H2O), and pH (7.3) maintenance. Biliverdin was added to the blood at concentrations of 10 and 50 micromol in two groups of six animals. Portal vein blood flow, bile production, and GOT/GPT levels were assessed serially. At the conclusion of the experiment, liver samples were collected for histologic evaluation using Suzuki criteria. RESULTS BV exerted protective effects against liver I/R injury. Adjunctive biliverdin improved portal venous blood flow (mL/min/g) from the beginning of reperfusion (1.33+/-0.17 versus 0.98+/-0.15; P<.001) and increased bile production (mL/g) as compared with the control group (3.40 versus 1.88; P<.003). I/R-induced hepatocellular damage as measured by GOT/GPT release (IU/L) was diminished in the biliverdin group (91 versus 171 and 46 versus 144, respectively; P<.0001). Improved liver function by biliverdin was accompanied by preservation of the histologic structure as assessed by Suzuki criteria (3.7+/-1.4 versus 6.8+/-0.8 in untreated controls; P<.005). CONCLUSIONS Biliverdin attenuates the ischemia/early reperfusion injury of rat liver grafts as assessed by hemodynamics, function, enzyme analysis, and histology. This study provides the rationale for novel therapeutic approaches using biliverdin to maximize the organ donor pool through the safer use of liver transplants despite prolonged periods of cold ischemia.
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Affiliation(s)
- C Fondevila
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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García-Valdecasas JC, Fuster J, Charco R, Bombuy E, Fondevila C, Navasa M, Rodríguez-Laiz G, Ferrer J, Amador MA, Llovet JM, Forns X, Rimola A. Trasplante hepático de donante vivo en adultos. Análisis de los 30 primeros casos. Gastroenterología y Hepatología 2003; 26:525-30. [PMID: 14642237 DOI: 10.1016/s0210-5705(03)70406-3] [Citation(s) in RCA: 5] [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: 01/19/2023]
Abstract
INTRODUCTION In the last 2-3 years, adult living donor liver transplantation (ALDLT) has been developed on an international scale, multiplying the number of procedures performed. Despite this, analysis of the results is still incomplete. The aim of the present study was to perform a descriptive analysis of the results after the first 3 years of the initiation of the program. MATERIAL AND METHODS During this period, 30 ALDLT were performed. In all procedures, right lobe grafts were used. The mean age of donors and recipients was 31.8 and 52.7 years, respectively. The main indication for liver transplantation was liver cirrhosis due to hepatitis C virus (70%) and 38% of recipients were stage C in the Child-Pugh classification. A total of 46.7% of recipients had hepatocellular carcinoma. RESULTS Donors: The mean volume of the remnant liver was 632 cc (40.5% of the previous hepatic mass). Ten donors (33%) presented complications. The most frequent complication was biliary fistula (20%) and three patients required reintervention. The mean length of hospital stay among donors was 11.7 days. Recipients: The mean weight of the graft was 775 g, with a mean difference between graft weight and that of the recipient of 1.11. Fifteen recipients (50%) presented biliary leaks and nine of these (30%) required reintervention. There were no graft losses for technical reasons. Four patients died. With a median follow-up of 14 months, actuarial survival at 18 months was 92.9%. CONCLUSION ALDLT is an effective method for reducing the number of patients on the waiting list. The probability of survival is similar to that of cadaveric transplantation. Biliary complications in the recipient constitute a problem, the long-term repercussions of which remain to be resolved.
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Affiliation(s)
- J C García-Valdecasas
- Sección de Cirugía Hepática y Trasplante, Institut de Malalties Digestives, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
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García-Valdecasas JC, Fuster J, Grande L, Fondevila C, Rimola A, Navasa M, Bombuy E, Ferrer J, Visa J. Adult living donor liver transplantation: initial results of a starting program. Transplant Proc 2002; 34:237-8. [PMID: 11959262 DOI: 10.1016/s0041-1345(01)02740-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J C García-Valdecasas
- Department of Surgery and Liver Transplant Unit, Institut de Malalties Digestives, Hospital Clinic, University of Barcelona, Barcelona, Spain.
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García-Valdecasas JC, Fuster J, Grande L, Fondevila C, Rimola A, Navasa M, Cirera I, Bombuy E, Visa J. [Living donor liver transplantation in adults. Initial results]. Gastroenterol Hepatol 2001; 24:275-80. [PMID: 11459562 DOI: 10.1016/s0210-5705(01)70174-4] [Citation(s) in RCA: 5] [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: 10/27/2022]
Abstract
AIM To analyze the preliminary results of the implementation of a living donor liver transplantation program. PATIENTS AND METHOD Between March and September 2000 we performed 7 living donor liver transplantations using the right hepatic lobe. The donors were 5 men and 2 women with a mean age of 39.3 11.5 years. Three donors were genetically related (daughter, mother, son). The mean relative liver volume transplanted was 58.8 2.5%. The mean age of the recipients was 50.4 16.5 years. Six patients presented hepatitis C virus-induced cirrhosis and one presented familial amyloidotic polyneuropathy. RESULTS Three complications occurred in the donors: 1 slight infection and 2 biliary fistulae. Graft function was adequate in all recipients and there were three acute rejections. Four biliary leakages occurred of which two required reoperation. None of the patients developed vascular thrombosis. Two recipients died, 53 and 72 days after the operation, with a correctly functioning graft. CONCLUSION Living donor liver transplantation constitutes a necessary complement to the current cadaveric donor program to increase the number of patients who can benefit from this treatment, which may represent 10% of the activity of our center. The technical complexity of this procedure is much greater than that of cadaveric transplantation. The right hepatic lobe provides sufficient hepatic mass for most adult recipients.
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Affiliation(s)
- J C García-Valdecasas
- Unidad de Cirugía Hepática y Trasplante Hepático. IMD. Hospital Clínico. Universidad de Barcelona
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Fondevila C, Real MI, Fuster J, Navasa M, Grande L. Images in hepatology. Postoperative biliary fistula treated with percutaneous microcoil embolization. J Hepatol 2001; 34:351. [PMID: 11281570 DOI: 10.1016/s0168-8278(00)00079-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- C Fondevila
- Surgery Department, IMD Hospital Clínic, University of Barcelona, Spain
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Fondevila C, Mans E, Fuster J, Grande L, García-Valdecasas J, Ferrer J, Visa J. Tumor de Klatskin con invasión de la vena porta. Utilización de injertos vasculares criopreservados tras la resección quirúrgica radical. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71878-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
We studied major bleeding complications, death related to hemorrhage, and tried to identify predisposing factors for bleeding in outpatients treated with acenocoumarol. We evaluated 811 outpatients attending a specialized anticoagulant therapy unit. The intended INR range was 3.5-4.5 for mechanical heart valve replacement (N= 384) and 2.0-3.0 for other indications (N= 427). The variability of INR for the total follow-up and the 2 months before the hemorrhage was calculated. The total follow-up was 1,963.26 years with 27,321 control tests. We observed 47 major bleeding episodes, including 2 fatal (central nervous system hemorrhages), in 37 patients. 49.5% of the patients had underlying diseases. The rate of major and fatal hemorrhage was 2.39 and 0.10 episodes per 100 patients year, respectively. Hemorrhagic complications were more frequently observed in patients with a more intense intended range (8.2% in the INR 3.5-4.5 group vs. 1.5% in the 2.0-3.0 INR group). The risk of major bleeding increased in patients with an achieved INR higher than 6 and in those with higher INR variability during follow-up. The estimated probability of bleeding also increased with time: it was 0.102% at 78 months, and at the beginning of therapy it was 0.006% and 0.007% at 1 and 4 months, respectively. The intensity of anticoagulation and the deviation of the INR from the target are the most important risk factors for bleeding in patients taking acenocoumarol. Monitoring the variability of INR can help identifying patients predisposed to bleeding. However, the screening for underlying disease should always be performed.
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Affiliation(s)
- P Casais
- Departamento de Hemostasia y Trombosis, Instituto de Investigaciones Hematológicas "Mariano R. Castex," Academia Nacional de Medicina de Buenos Aires, Argentina
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