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  1. Article: Liver transplant immunosuppression during the covid-19 pandemic.

    Forns, Xavier / Navasa, Miquel

    Gastroenterologia y hepatologia

    2020  Volume 43, Issue 8, Page(s) 457–463

    Abstract: SARS-CoV-2 infection has produced a pandemic with serious consequences for our health care system. Although liver transplant patients represent only a minority of the population, the hepatologists who follow these patients have tried to coordinate ... ...

    Title translation Inmunosupresión en el trasplante hepático en la era covid-19.
    Abstract SARS-CoV-2 infection has produced a pandemic with serious consequences for our health care system. Although liver transplant patients represent only a minority of the population, the hepatologists who follow these patients have tried to coordinate efforts to produce a protocol the management of immunosuppression during SARS-CoV-2 infection. Although there are no solid studies to support general recommendations, experiences with other viral infections (hepatitis C, cytomegalovirus) suggest that management of immunosuppression without mycophenolate mofetil or m-Tor inhibitors (drugs that are also associated with leukopenia and lymphopenia) may be beneficial. It is also important to pay attention to possible drug interactions, especially in the case of tacrolimus, with some of the treatments with antiviral effect given in the context of COVID 19 (lopinavir/ritonavir, azithromycin). Finally, the immunosuppressive effect of immunomodulating drugs (tocilizumab and similar) administered to patients with severe lung disease should be taken into account. The mechanisms of action of the different immunosuppressive drugs are reviewed in this article, as well as their potential effect on SARS-CoV-2 infection, and suggests guidelines for the management of immunosuppression.
    MeSH term(s) Adaptive Immunity ; Antiviral Agents/pharmacology ; Betacoronavirus/immunology ; Betacoronavirus/physiology ; COVID-19 ; Calcineurin Inhibitors/adverse effects ; Calcineurin Inhibitors/pharmacology ; Calcineurin Inhibitors/therapeutic use ; Contraindications, Drug ; Coronavirus Infections/drug therapy ; Coronavirus Infections/epidemiology ; Coronavirus Infections/immunology ; Disease Susceptibility ; Drug Interactions ; Everolimus/adverse effects ; Everolimus/pharmacology ; Everolimus/therapeutic use ; Glucocorticoids/adverse effects ; Glucocorticoids/pharmacology ; Glucocorticoids/therapeutic use ; Humans ; Immunity, Innate ; Immunocompromised Host ; Immunosuppression/adverse effects ; Immunosuppression/methods ; Immunosuppressive Agents/adverse effects ; Immunosuppressive Agents/pharmacology ; Immunosuppressive Agents/therapeutic use ; Liver Transplantation ; Mycophenolic Acid/adverse effects ; Mycophenolic Acid/pharmacology ; Mycophenolic Acid/therapeutic use ; Pandemics ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/immunology ; Postoperative Complications/immunology ; Postoperative Complications/prevention & control ; SARS-CoV-2 ; Sirolimus/adverse effects ; Sirolimus/pharmacology ; Sirolimus/therapeutic use ; TOR Serine-Threonine Kinases/antagonists & inhibitors
    Chemical Substances Antiviral Agents ; Calcineurin Inhibitors ; Glucocorticoids ; Immunosuppressive Agents ; Everolimus (9HW64Q8G6G) ; MTOR protein, human (EC 2.7.1.1) ; TOR Serine-Threonine Kinases (EC 2.7.1.1) ; Mycophenolic Acid (HU9DX48N0T) ; Sirolimus (W36ZG6FT64)
    Keywords covid19
    Language Spanish
    Publishing date 2020-06-12
    Publishing country Spain
    Document type Journal Article ; Review
    ZDB-ID 632502-6
    ISSN 0210-5705
    ISSN 0210-5705
    DOI 10.1016/j.gastrohep.2020.06.003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

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  2. Article ; Online: Posttransplant Hepatocellular Carcinoma Surveillance: A Cost-effectiveness and Cost-utility Analysis.

    Hessheimer, Amelia J / Vargas-Martínez, Ana Magdalena / Trapero-Bertrán, Marta / Navasa, Miquel / Fondevila, Constantino

    Annals of surgery

    2023  Volume 277, Issue 2, Page(s) e359–e365

    Abstract: Objective: Assess cost-effectiveness and -utility associated with posttransplant HCC surveillance compared to standard follow-up.: Summary of background data: Despite lack of prospective clinical data, expert consensus recommends posttransplant ... ...

    Abstract Objective: Assess cost-effectiveness and -utility associated with posttransplant HCC surveillance compared to standard follow-up.
    Summary of background data: Despite lack of prospective clinical data, expert consensus recommends posttransplant surveillance to detect HCC recurrence in a latent phase, while it might be amenable to curative-intent therapy.
    Methods: A Markov-based transition model was created to estimate life expectancy and quality-of-life among liver transplant patients undergoing HCC surveillance. Models were built for 2 cohorts: 1 undergoing HCC surveillance with contrast-enhanced computed tomography of chest and abdomen and serum alpha-fetoprotein analysis and the other receiving standard posttransplant follow-up. Primary model outputs included LY and QALY gains, incremental cost-effectiveness ratio, and incremental cost-utility ratio. Willingness-to-pay for a QALY gain (cost-effectiveness threshold) was used to estimate efficiency.
    Results: Surveillance was marginally more effective versus no surveillance, resulting in means of 0.069 LYs and 0.026 QALYs gained. Costs for surveillance were increased by an average of 988.32€, resulting in incremental cost-effectiveness ratio 14,410.15€/LY and incremental cost-utility ratio 37,547.97€/QALY. Surveillance did not seem cost-effective in our setting, considering willingness-to-pay threshold of 25,000€/QALY. Probabilistic sensitivity analysis indicated surveillance might be cost-effective in 42% of cases, but degree of uncertainty in the analysis was high.
    Conclusions: Performing posttransplant HCC surveillance offers marginal clinical benefits and increases costs. Although expert consensus supports surveillance, results of this decision analysis raise doubt regarding the utility of such recommendations and support ongoing need for prospective clinical trials.
    MeSH term(s) Humans ; Carcinoma, Hepatocellular/surgery ; Carcinoma, Hepatocellular/diagnosis ; Cost-Benefit Analysis ; Liver Neoplasms/surgery ; Liver Neoplasms/diagnosis ; Prospective Studies ; Liver Transplantation
    Language English
    Publishing date 2023-01-10
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000005295
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  3. Article ; Online: Liver transplant immunosuppression during the COVID-19 pandemic

    Forns, Xavier / Navasa, Miquel

    Gastroenterología y Hepatología (English Edition)

    2020  Volume 43, Issue 8, Page(s) 457–463

    Keywords covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ISSN 2444-3824
    DOI 10.1016/j.gastre.2020.10.001
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Inmunosupresión en el trasplante hepático en la era covid-19

    Forns, Xavier / Navasa, Miquel

    Gastroenterología y Hepatología

    2020  Volume 43, Issue 8, Page(s) 457–463

    Keywords Hepatology ; Gastroenterology ; covid19
    Language Spanish
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 632502-6
    ISSN 0210-5705
    ISSN 0210-5705
    DOI 10.1016/j.gastrohep.2020.06.003
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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    Zs.A 2044: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  5. Article ; Online: Inmunosupresión en el trasplante hepático en la era Covid-19

    Forns, Xavier / Navasa, Miquel

    Gastroenterol Hepatol

    Abstract: Abstract SARS CoV-2 infection has produced a pandemic with serious consequences for our health care system. Although liver transplant patients represent only a minority of the population, the hepatologists who follow these patients have tried to ... ...

    Abstract Abstract SARS CoV-2 infection has produced a pandemic with serious consequences for our health care system. Although liver transplant patients represent only a minority of the population, the hepatologists who follow these patients have tried to coordinate efforts to produce a protocol the management of immunosuppression during SARS Cov-2 infection. Although there are no solid studies to support general recommendations, experiences with other viral infections (hepatitis C, cytomegalovirus) suggest that management of immunosuppression without mycophenolate mofetil or m-Tor inhibitors (drugs that are also associated with leukopenia and lymphopenia) may be beneficial. It is also important to pay attention to possible drug interactions, especially in the case of tacrolimus, with some of the treatments with antiviral effect given in the context of COVID 19 (lopinavir/ritonavir, azithromycin). Finally, the immunosuppressive effect of immunomodulating drugs (tocilizumab and similar) administered to patients with severe lung disease should be taken into account. The mechanisms of action of the different immunosuppressive drugs are reviewed in this article, as well as their potential effect on Cov-2 SARS infection, and suggests guidelines for the management of immunosuppression.
    Keywords covid19
    Publisher Elsevier; PMC; WHO
    Document type Article ; Online
    Note WHO #Covidence: #597417
    DOI 10.1016/j.gastrohep.2020.06.003
    Database COVID19

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  6. Article: Inmunosupresión en el trasplante hepático en la era covid-19./ Inmunosupresión en el trasplante hepático en la era covid-19./ Liver transplant immunosuppression during the covid-19 pandemic

    Forns, Xavier / Navasa, Miquel

    Gastroenterol Hepatol

    Abstract: SARS-CoV-2 infection has produced a pandemic with serious consequences for our health care system. Although liver transplant patients represent only a minority of the population, the hepatologists who follow these patients have tried to coordinate ... ...

    Abstract SARS-CoV-2 infection has produced a pandemic with serious consequences for our health care system. Although liver transplant patients represent only a minority of the population, the hepatologists who follow these patients have tried to coordinate efforts to produce a protocol the management of immunosuppression during SARS-CoV-2 infection. Although there are no solid studies to support general recommendations, experiences with other viral infections (hepatitis C, cytomegalovirus) suggest that management of immunosuppression without mycophenolate mofetil or m-Tor inhibitors (drugs that are also associated with leukopenia and lymphopenia) may be beneficial. It is also important to pay attention to possible drug interactions, especially in the case of tacrolimus, with some of the treatments with antiviral effect given in the context of COVID 19 (lopinavir/ritonavir, azithromycin). Finally, the immunosuppressive effect of immunomodulating drugs (tocilizumab and similar) administered to patients with severe lung disease should be taken into account. The mechanisms of action of the different immunosuppressive drugs are reviewed in this article, as well as their potential effect on SARS-CoV-2 infection, and suggests guidelines for the management of immunosuppression.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #597417
    Database COVID19

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  7. Article ; Online: Implementation of a quality management system in a liver transplant programme.

    López-Púa, Yolanda / Navasa, Miquel / Trilla, Antoni / Colmenero, Jordi / García, Raquel / López, Eva / Durà, Anna / Guash, Ana / Ríos, José

    BMJ open quality

    2023  Volume 12, Issue 3

    Abstract: Background: The management of liver transplantation has become a complex process involving different healthcare professionals. Teamwork, standardisation and definition of the best practices are essential for success, patient satisfaction and society's ... ...

    Abstract Background: The management of liver transplantation has become a complex process involving different healthcare professionals. Teamwork, standardisation and definition of the best practices are essential for success, patient satisfaction and society's favourable perception of transplantation programmes.ISO 9001:2015 certification provides the necessary elements to help implement a quality management system (QMS) to ensure that patient care is performed with the highest guarantees of clinical quality and safety. The aim of this study is to describe the steps, strengths and limitations in the implementation of a QMS in a liver transplant programme (LTP).
    Project management method: This included analysing the starting point, setting up a working group, training, defining the scope of certification, preparing documentation, and conducting an internal and external audit, which culminated in the ISO 9001 quality certification award. The scope of QMS includes all the processes of LTP, from referral of candidates to long-term follow-up after transplantation.
    Results: The project was structured in seven phases that took place between 2008 and 2011. The implementation of QMS led to the generation of all the necessary documentation to meet the requirements of the standard, including internal and legal requirements related to the transplant activity. The establishment of indicators to measure the effectiveness of processes, risk management and the identification of incidents allows us to implement measures devoted to avoiding the deficiencies and to meet the established objectives.
    Conclusion: ISO 9001:2015 certification has contributed to the adaptation of a new quality and safety culture focused on the patient. All activities are protocolised, everything is recorded, measured, and verified, and all steps are taken as planned. Work is carried out in terms of continuous improvement. This has led to less variability in daily clinical practice and a better understanding of work dynamics.
    MeSH term(s) Humans ; Liver Transplantation ; Quality Assurance, Health Care
    Language English
    Publishing date 2023-09-25
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2399-6641
    ISSN (online) 2399-6641
    DOI 10.1136/bmjoq-2023-002440
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: A plasmatic score using a miRNA signature and CXCL-10 for accurate prediction and diagnosis of liver allograft rejection.

    Millán, Olga / Ruiz, Pablo / Julian, Judit / Lizana, Ana / Fundora, Yiliam / Crespo, Gonzalo / Colmenero, Jordi / Navasa, Miquel / Brunet, Mercè

    Frontiers in immunology

    2023  Volume 14, Page(s) 1196882

    Abstract: Introduction: The use of noninvasive biomarkers may avoid the need for liver biopsy (LB) and could guide immunosuppression adjustment in liver transplantation (LT). The aims of this study were: to confirm the predictive and diagnostic capacity of ... ...

    Abstract Introduction: The use of noninvasive biomarkers may avoid the need for liver biopsy (LB) and could guide immunosuppression adjustment in liver transplantation (LT). The aims of this study were: to confirm the predictive and diagnostic capacity of plasmatic expression of miR-155-5p, miR-181a-5p, miR-122-5p and CXCL-10 for assessing T-cell mediated rejection (TCMR) risk; to develop a score based on a panel of noninvasive biomarkers to predict graft rejection risk and to validate this score in a separate cohort.
    Methods: A prospective, observational study was conducted with a cohort of 79 patients followed during the first year after LT. Plasma samples were collected at predetermined time points for the analysis of miRNAs and the CXCL-10. Patients with LFTs abnormalities were submitted to a LB to rule out rejection, assessing previous and concurrent expression of the biomarkers to evaluate their predictive and diagnostic ability. Information from 86 patients included in a previous study was collected and used as a validation cohort.
    Results: Twenty-four rejection episodes were diagnosed in 22 patients. Plasmatic CXCL-10 concentration and the expression of the three miRNAs were significantly elevated prior to and at the moment of the diagnosis of rejection. We developed a logistic model for rejection prediction and diagnosis, which included CXCL-10, miR-155-5p and miR-181a-5p. The area under the ROC curve (AUROC) for rejection prediction was 0.975 (79.6% sensitivity, 99.1% specificity, 90,7% PPV; 97.7% NPV; 97.1% correctly classified) and 0.99 for diagnosis (87.5% sensitivity, 99.5% specificity, 91.3% PPV; 99.3% NPV; 98.9% correctly classified). In the validation cohort (n=86; 14 rejections), the same cut-off points were used obtaining AUROCs for rejection prediction and diagnosis of 0.89 and 0.92 respectively. In patients with graft dysfunction in both cohorts the score could discriminate those with rejection regarding other causes with an AUROC of 0.98 (97.3% sensitivity, 94.1%specificity).
    Conclusion: These results suggest that the clinical implementation of the monitoring of this noninvasive plasmatic score may allow the prediction and diagnosis of rejection and identify patients with graft dysfunction due to rejection, helping with a more efficient guide for immunosuppressive therapy adjustment. This finding warrants the development of prospective biomarker-guided clinical trials.
    MeSH term(s) Humans ; MicroRNAs/genetics ; Liver ; Transplantation, Homologous ; Biomarkers ; Allografts
    Chemical Substances MicroRNAs ; Biomarkers
    Language English
    Publishing date 2023-05-30
    Publishing country Switzerland
    Document type Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2606827-8
    ISSN 1664-3224 ; 1664-3224
    ISSN (online) 1664-3224
    ISSN 1664-3224
    DOI 10.3389/fimmu.2023.1196882
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  9. Article ; Online: Delta-MELD and survival after liver transplantation: the slope matters.

    Colmenero, Jordi / Navasa, Miquel

    Liver international : official journal of the International Association for the Study of the Liver

    2016  Volume 36, Issue 7, Page(s) 949–951

    Language English
    Publishing date 2016-07
    Publishing country United States
    Document type Editorial
    ZDB-ID 2102783-3
    ISSN 1478-3231 ; 1478-3223
    ISSN (online) 1478-3231
    ISSN 1478-3223
    DOI 10.1111/liv.13112
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    Zs.A 1632: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  10. Article ; Online: Implementation of a quality management system in a liver transplant programme

    Jose Rios / Raquel Garcia / Jordi Colmenero / Eva López / Yolanda López-Púa / Miquel Navasa / Antoni Trilla / Anna Durà / Ana Guash

    BMJ Open Quality, Vol 12, Iss

    2023  Volume 3

    Abstract: Background The management of liver transplantation has become a complex process involving different healthcare professionals. Teamwork, standardisation and definition of the best practices are essential for success, patient satisfaction and society’s ... ...

    Abstract Background The management of liver transplantation has become a complex process involving different healthcare professionals. Teamwork, standardisation and definition of the best practices are essential for success, patient satisfaction and society’s favourable perception of transplantation programmes.ISO 9001:2015 certification provides the necessary elements to help implement a quality management system (QMS) to ensure that patient care is performed with the highest guarantees of clinical quality and safety. The aim of this study is to describe the steps, strengths and limitations in the implementation of a QMS in a liver transplant programme (LTP).Project management method This included analysing the starting point, setting up a working group, training, defining the scope of certification, preparing documentation, and conducting an internal and external audit, which culminated in the ISO 9001 quality certification award. The scope of QMS includes all the processes of LTP, from referral of candidates to long-term follow-up after transplantation.Results The project was structured in seven phases that took place between 2008 and 2011. The implementation of QMS led to the generation of all the necessary documentation to meet the requirements of the standard, including internal and legal requirements related to the transplant activity. The establishment of indicators to measure the effectiveness of processes, risk management and the identification of incidents allows us to implement measures devoted to avoiding the deficiencies and to meet the established objectives.Conclusion ISO 9001:2015 certification has contributed to the adaptation of a new quality and safety culture focused on the patient. All activities are protocolised, everything is recorded, measured, and verified, and all steps are taken as planned. Work is carried out in terms of continuous improvement. This has led to less variability in daily clinical practice and a better understanding of work dynamics.
    Keywords Medicine (General) ; R5-920
    Subject code 650
    Language English
    Publishing date 2023-08-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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