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Article ; Conference proceedings: FEASIBILITY AND OUTCOMES OF EUS-GUIDED MAGNETIC COMPRESSION ANASTOMOSIS (EUS-MCA) TO REPAIR DISCONNECTED BILE DUCTS (DBDS): A PILOT STUDY

Dura-Gil, M. / de Benito, M. / Sanchez-Ocana, R. / Carbajo-Lopez, A.Y / Sciarretta, M. / Estradas-Trujillo, J.A. / Almohalla, C. / Penas-Herrero, I. / de la Serna, C. / Perez-Miranda, M.

Endoscopy

2022 Volume 54, Issue S 01

Event/congress	ESGE Days 2022, Prague, Czech Republic, 2022-04-28
Language	English
Publishing date	2022-04-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article ; Conference proceedings
ZDB-ID	80120-3
ISSN	1438-8812 ; 0013-726X
ISSN (online)	1438-8812
ISSN	0013-726X
DOI	10.1055/s-0042-1744691
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Zs.A 669: 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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Article ; Online: Antimigration versus conventional fully covered metal stents in the endoscopic treatment of anastomotic biliary strictures after deceased-donor liver transplantation.

Fuentes-Valenzuela, Esteban / de Benito Sanz, Marina / García-Pajares, Félix / Estradas, José / Peñas-Herrero, Irene / Durá-Gil, Miguel / Carbajo, Ana Yaiza / de la Serna-Higuera, Carlos / Sanchez-Ocana, Ramon / Alonso-Martín, Carmen / Almohalla, Carolina / Sánchez-Antolín, Gloria / Perez-Miranda, Manuel

Surgical endoscopy

2023 Volume 37, Issue 9, Page(s) 6975–6982

Abstract: Introduction: Migration of fully covered metal stents (FCMS) remains a limitation of the endoscopic treatment of anastomotic biliary strictures (ABS) following orthotopic liver transplantation (OLT). The use of antimigration FCMS (A-FCMS) might enhance ... ...

Abstract	Introduction: Migration of fully covered metal stents (FCMS) remains a limitation of the endoscopic treatment of anastomotic biliary strictures (ABS) following orthotopic liver transplantation (OLT). The use of antimigration FCMS (A-FCMS) might enhance endoscopic treatment outcomes for ABS. Methods: Single center retrospective study. Consecutive patients with ABS following OLT who underwent ERCP with FCMS placement between January 2005 and December 2020 were eligible. Subjects were grouped into conventional-FCMS (C-FCMS) and A-FCMS. The primary outcome was stent migration rates. Secondary outcomes were stricture resolution, adverse event, and recurrence rates. Results: A total of 102 (40 C-FCMS; 62 A-FCMS) patients were included. Stent migration was identified at the first revision in 24 C-FCMS patients (63.2%) and in 21 A-FCMS patients (36.2%) (p = 0.01). The overall migration rate, including the first and subsequent endoscopic revisions, was 65.8% in C-FCMS and 37.3% in A-FCMS (p = 0.006). The stricture resolution rate at the first endoscopic revision was similar in both groups (60.0 vs 61.3%, p = 0.87). Final stricture resolution was achieved in 95 patients (93.1%), with no difference across groups (92.5 vs 93.5%; p = 0.84). Adverse events were identified in 13 patients (12.1%) with no difference across groups. At a median follow-up of 52 (IQR: 19-85.5) months after stricture resolution, 25 patients (24.5%) developed recurrences, with no difference across groups (C-FCMS 30% vs A-FCMS 21%; p = 0.28). Conclusions: The use of A-FCMS during ERCP for ABS following OLT results in significantly lower stent migration rates compared to C-FCMS. However, the clinical benefit of reduced stent migration is unclear. Larger studies focusing on stricture resolution and recurrence rates are needed.
MeSH term(s)	Humans ; Liver Transplantation/adverse effects ; Constriction, Pathologic/etiology ; Constriction, Pathologic/surgery ; Cholangiopancreatography, Endoscopic Retrograde/methods ; Retrospective Studies ; Living Donors ; Neoplasm Recurrence, Local/etiology ; Cholestasis/etiology ; Cholestasis/surgery ; Stents ; Treatment Outcome
Language	English
Publishing date	2023-06-21
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-023-10199-3
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Article ; Conference proceedings: CONVENTIONAL VS ANTIMIGRATION FULLY COVERED METAL STENT (FCMS) FOR ENDOTHERAPY OF BILIARY ANASTOMOTIC STRICTURE (BAS) FOLLOWING DECEASED-DONOR LIVER TRANSPLANTATION (LT)

Fuentes-Valenzuela, E. / De Benito Sanz, M. / Estradas, J. / Dura Gil, M. / Carbajo Lopez, A.Y. / Alonso-Martín, C. / Sanchez-Ocana, R. / Peñas-Herrero, I. / Almohalla, C. / García Pajares, F. / De la Serna Higuera, C. / Pérez-Miranda, M.

Endoscopy

2022 Volume 54, Issue S 01

Event/congress	ESGE Days 2022, Prague, Czech Republic, 2022-04-28
Language	English
Publishing date	2022-04-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article ; Conference proceedings
ZDB-ID	80120-3
ISSN	1438-8812 ; 0013-726X
ISSN (online)	1438-8812
ISSN	0013-726X
DOI	10.1055/s-0042-1744686
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Article ; Online: Cumulative exposure to tacrolimus and incidence of cancer after liver transplantation.

Rodríguez-Perálvarez, Manuel / Colmenero, Jordi / González, Antonio / Gastaca, Mikel / Curell, Anna / Caballero-Marcos, Aránzazu / Sánchez-Martínez, Ana / Di Maira, Tommaso / Herrero, José Ignacio / Almohalla, Carolina / Lorente, Sara / Cuadrado-Lavín, Antonio / Pascual, Sonia / López-Garrido, María Ángeles / González-Grande, Rocío / Gómez-Orellana, Antonio / Alejandre, Rafael / Zamora-Olaya, Javier / Bernal-Bellido, Carmen

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2022 Volume 22, Issue 6, Page(s) 1671–1682

Abstract: Cancer is the leading cause of death after liver transplantation (LT). This multicenter case-control nested study aimed to evaluate the effect of maintenance immunosuppression on post-LT malignancy. The eligible cohort included 2495 LT patients who ... ...

Abstract	Cancer is the leading cause of death after liver transplantation (LT). This multicenter case-control nested study aimed to evaluate the effect of maintenance immunosuppression on post-LT malignancy. The eligible cohort included 2495 LT patients who received tacrolimus-based immunosuppression. After 13 922 person/years follow-up, 425 patients (19.7%) developed malignancy (cases) and were matched with 425 controls by propensity score based on age, gender, smoking habit, etiology of liver disease, and hepatocellular carcinoma (HCC) before LT. The independent predictors of post-LT malignancy were older age (HR = 1.06 [95% CI 1.05-1.07]; p < .001), male sex (HR = 1.50 [95% CI 1.14-1.99]), smoking habit (HR = 1.96 [95% CI 1.42-2.66]), and alcoholic liver disease (HR = 1.53 [95% CI 1.19-1.97]). In selected cases and controls (n = 850), the immunosuppression protocol was similar (p = .51). An increased cumulative exposure to tacrolimus (CET), calculated by the area under curve of trough concentrations, was the only immunosuppression-related predictor of post-LT malignancy after controlling for clinical features and baseline HCC (CET at 3 months p = .001 and CET at 12 months p = .004). This effect was consistent for de novo malignancy (after excluding HCC recurrence) and for internal neoplasms (after excluding non-melanoma skin cancer). Therefore, tacrolimus minimization, as monitored by CET, is the key to modulate immunosuppression in order to prevent cancer after LT.
MeSH term(s)	Carcinoma, Hepatocellular/epidemiology ; Carcinoma, Hepatocellular/etiology ; Carcinoma, Hepatocellular/surgery ; Humans ; Incidence ; Liver Neoplasms/epidemiology ; Liver Neoplasms/etiology ; Liver Neoplasms/surgery ; Liver Transplantation/adverse effects ; Male ; Neoplasm Recurrence, Local/pathology ; Retrospective Studies ; Risk Factors ; Tacrolimus/adverse effects
Chemical Substances	Tacrolimus (WM0HAQ4WNM)
Language	English
Publishing date	2022-03-31
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1111/ajt.17021
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Article ; Conference proceedings: COMBINED RETROGRADE/ANTEGRADE ENDOSCOPIC APPROACH TO DISCONNECTED BILE-DUCT (DBD) AS A RESULT OF SEVERE POSTOPERATIVE INJURY

de Benito, M / Carbajo, AY / Peñas-Herrero, I / García-Alonso, FJ / Bazaga, S / Tejedor-Tejeda, J / Sánchez-Ocaña, R / De la Serna, C / García-Pajares, F / Almohalla, C / Sánchez-Antolín, G / Pérez-Miranda, M

Endoscopy

2019 Volume 51, Issue 04

Event/congress	ESGE Days 2019, Prague, Czech Republic, 2019-04-04
Language	English
Publishing date	2019-03-18
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article ; Conference proceedings
ZDB-ID	80120-3
ISSN	1438-8812 ; 0013-726X
ISSN (online)	1438-8812
ISSN	0013-726X
DOI	10.1055/s-0039-1681526
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Zs.A 669: 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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Article ; Online: Severe anemia, gastric ulcer, pneumonitis and cholangitis in a liver transplant patient: multiple organic dysfunction and one etiology: a case report.

García-Pajares, F / Santos-Santamarta, F / Fernández-Fontecha, E / Sánchez-Ocaña, R / Amo-Alonso, R / Loza-Vargas, A / Madrigal, B / Pérez-Saborido, B / Almohalla, C / Sánchez-Antolín, G

Transplantation proceedings

2015 Volume 47, Issue 1, Page(s) 136–138

Abstract: Cytomegalovirus (CMV) is the most common viral pathogen that negatively affects the outcome of liver transplantation. CMV causes febrile illness often accompanied by bone marrow suppression, and in some cases it invades tissues, including the ... ...

Abstract	Cytomegalovirus (CMV) is the most common viral pathogen that negatively affects the outcome of liver transplantation. CMV causes febrile illness often accompanied by bone marrow suppression, and in some cases it invades tissues, including the transplanted allograft. In addition, CMV has been significantly associated with an increased predisposition to allograft rejection, accelerated hepatitis C recurrence, and other opportunistic infections, as well as reduced overall patient and allograft survivals. We carried out a study on a Spanish adult liver transplant recipient who rapidly presented anemia and was diagnosed as having Coomb negative (nonimmune) hemolytic anemia, gastric ulcer, pneumonitis, and cholangitis associated with a CMV infection.
MeSH term(s)	Anemia/complications ; Cholangitis/complications ; Cytomegalovirus Infections/complications ; Graft Rejection/etiology ; Humans ; Liver Transplantation/adverse effects ; Male ; Middle Aged ; Opportunistic Infections/complications ; Pneumonia/complications ; Stomach Ulcer/complications ; Transplantation, Homologous/adverse effects
Language	English
Publishing date	2015-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2014.11.019
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Article ; Online: Indications and effectiveness of the mammalian target of rapamycin in liver transplantation.

Sanchez Antolín, G / Garcia Pajares, F / Lorenzo Pelayo, S / Herranz Bachiller, M T / Almohalla, C / Velicia, R / Caro Paton, A

Transplantation proceedings

2011 Volume 43, Issue 3, Page(s) 714–717

Abstract: Background: The mammalian target of rapamycin (mTOR) inhibitors are new immunosuppressive drugs for organ transplantation. They are interesting for liver transplantation because of their absence of nephrotoxicity and potential antitumor effects, because ...

Abstract	Background: The mammalian target of rapamycin (mTOR) inhibitors are new immunosuppressive drugs for organ transplantation. They are interesting for liver transplantation because of their absence of nephrotoxicity and potential antitumor effects, because calcineurin inhibitors (CNI) are associated with renal dysfunction post-CNI and tumors. We sought to analyze the indications, safety, and efficacy of mTOR among liver transplant patients at our center. Methods: We retrospectively identified patients who were treated with mTOR for their indications for liver transplantation, type of immunosuppressive therapy, acute rejection episodes, and evolution of kidney function. Results: We identified 43 (19.02%) patients treated with mTOR including 35 (81.4%) males and 8 (18.6%) females of overall average age of 56.7 (range, 44-68). In 30% of patients, the drug was introduced for kidney failure, and in 23% for actual or a high risk of hepatocellular carcinoma (HCC) recurrence. The average time to introduction of the mTOR was 6.4 months (range, 1-46). The final immunosuppressive regimen was mTOR alone (73%), or mTOR plus CNI (23%), or mTOR plus mycophenolate mofetil (4%). The average values of creatinine and urea were lower after conversion to mTOR (P < .05) with a 6.9% incidence of acute rejection episodes. Conclusion: The mTOR immunosuppressive drugs are safe for liver transplant patients, effectively controlling renal dysfunction. They can be used in other indications, such as neurotoxicity, de novo tumors, and high risk of HCC recurrence. More studies are needed to clarify their long-term effectiveness.
MeSH term(s)	Adult ; Aged ; Blood Urea Nitrogen ; Creatinine/blood ; Female ; Humans ; Immunosuppressive Agents/therapeutic use ; Kidney/physiopathology ; Liver Transplantation ; Male ; Middle Aged ; TOR Serine-Threonine Kinases/antagonists & inhibitors
Chemical Substances	Immunosuppressive Agents ; Creatinine (AYI8EX34EU) ; MTOR protein, human (EC 2.7.1.1) ; TOR Serine-Threonine Kinases (EC 2.7.1.1)
Language	English
Publishing date	2011-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2011.01.105
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Article: Significant heterogeneity in the diagnosis and long-term management of Wilson disease: Results from a large multicenter Spanish study.

Berenguer, Marina / Vergara, Mercedes / Almohalla, Carolina / Hernandez, Alicia / Blanco, Sonia / Testillano, Milagros / Girona, Eva / Casado, Marta / García, Miren / Catalina, Maria-Vega / Muñoz, Carolina / Gutierrez, Maria Luisa / Molina, Esther / Romero, Miriam / Otero, Alejandra / Hernáez-Alsina, Tania / Bernal-Monterde, Vanessa / Lorente, Sara / Masnou, Helena /

Bonet, Lucia / Soto, Susana / Gisbert, Concha / Valer, María-Paz / Gomez, Judith / Pacheco, Gemma / Morillas, Julia / Gonzalez, Martha / Dominguez, Nuria / Lazaro, Maria / Pascual, Sonia / Castelló, Immaculada / Gonzalez, Rocio

Gastroenterologia y hepatologia

2022 Volume 46, Issue 8, Page(s) 577–584

Abstract: There is uncertainty regarding Wilson's disease (WD) management.: Objectives: To assess, in a multicenter Spanish retrospective cohort study, whether the approach to WD is homogeneous among centers.: Methods: Data on WD patients followed at 32 ... ...

Abstract	There is uncertainty regarding Wilson's disease (WD) management. Objectives: To assess, in a multicenter Spanish retrospective cohort study, whether the approach to WD is homogeneous among centers. Methods: Data on WD patients followed at 32 Spanish hospitals were collected. Results: 153 cases, 58% men, 20.6 years at diagnosis, 69.1% hepatic presentation, were followed for 15.5 years. Discordant results in non-invasive laboratory parameters were present in 39.8%. Intrahepatic copper concentration was pathologic in 82.4%. Genetic testing was only done in 56.6% with positive results in 83.9%. A definite WD diagnosis (Leipzig score ≥4) was retrospectively confirmed in 92.5% of cases. Chelating agents were standard initial therapy (75.2%) with frequent modifications (57%), particularly to maintenance zinc. Enzyme normalization was not achieved by one third, most commonly in the setting of poor compliance, lack of genetic mutations and/or presence of cardiometabolic risk factors. Although not statistically significant, there were trends for sex differences in number of diagnosed cases, age at diagnosis and biochemical response. Conclusions: Significant heterogeneity in diagnosis and management of WD patients emerges from this multicenter study that includes both small and large reference centers. The incorporation of genetic testing will likely improve diagnosis. Sex differences need to be further explored.
MeSH term(s)	Humans ; Female ; Male ; Hepatolenticular Degeneration/diagnosis ; Hepatolenticular Degeneration/genetics ; Retrospective Studies ; Chelating Agents/therapeutic use ; Zinc ; Copper ; Penicillamine/therapeutic use
Chemical Substances	Chelating Agents ; Zinc (J41CSQ7QDS) ; Copper (789U1901C5) ; Penicillamine (GNN1DV99GX)
Language	Spanish
Publishing date	2022-11-11
Publishing country	Spain
Document type	Multicenter Study ; Journal Article
ZDB-ID	632502-6
ISSN	0210-5705
ISSN	0210-5705
DOI	10.1016/j.gastrohep.2022.10.018
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Article ; Online: Early and extended therapy for recurrent hepatitis C after liver transplantation.

García-Pajares, F / Almohalla, C / Lorenzo Pelayo, S / Ruiz Zorrilla, R / Pinto, P / Ramos, C / Sanchez Antolin, G / Paton, A C

Transplantation proceedings

2012 Volume 44, Issue 6, Page(s) 1571–1573

Abstract: Background: End-stage cirrhosis due to hepatitis C virus (HCV) is one of the most common indications for orthotopic liver transplantation (OLT). Recurrence is universal and more aggressive than before OLT. The aim of this study was to evaluate the ... ...

Abstract	Background: End-stage cirrhosis due to hepatitis C virus (HCV) is one of the most common indications for orthotopic liver transplantation (OLT). Recurrence is universal and more aggressive than before OLT. The aim of this study was to evaluate the efficacy and tolerability of antiviral therapy in recurrent HCV after OLT. Therapy was started even with mild fibrosis (F < 2) and extended until 72 weeks, if it was possible. Methods: Between November 2001 and December 2010, 279 OLTs were performed in 262 patients in our hospital; 81 (31%) for HCV-related cirrhosis. Nineteen patients were excluded because they died in the first 6 months. We treated 28 of 62 HVC patients. Results: Twenty-eight patients met the indication for antiviral therapy: 21 male (75%) and 7 female (25%), with a mean age of 56 years (range, 40 to 68 years). All the patients had histologically proven recurrence liver disease: F1, 19 patients (68%); F2, 4 patients (14%), and F3, 45 patients (18%). The mean time to recurrence was 23 months, with a range of 3 to 90 months. Adverse effects (leukopenia in 82% and anemia in 79%) were treated with granulocyte colony-stimulating factor (GCSF) and erythropoietin (EPO), and dose reduction. Four patients (14%) were withdrawn from the treatment because of adverse effects. Nineteen patients achieved early virologic response (68%), and the sustained virologic response was 54% (15 of 28 patients). Five patients died (18%). Conclusion: Improving sustained virologic response in HCV liver transplant patients is a key goal. Antiviral therapy is safe and effective treating HCV recurrence after OLT. Starting this therapy in an early stage of hepatitis C recurrence, extending antiviral therapy (72 weeks), and avoiding dose reduction of antiviral drugs could help to achieve higher rates of sustained virological response.
MeSH term(s)	Adult ; Aged ; Antiviral Agents/administration & dosage ; Antiviral Agents/adverse effects ; Drug Administration Schedule ; Female ; Hepatitis C/complications ; Hepatitis C/diagnosis ; Hepatitis C/drug therapy ; Hepatitis C/mortality ; Humans ; Interferon-alpha/administration & dosage ; Interferon-alpha/adverse effects ; Liver Cirrhosis/diagnosis ; Liver Cirrhosis/mortality ; Liver Cirrhosis/surgery ; Liver Cirrhosis/virology ; Liver Transplantation/adverse effects ; Liver Transplantation/mortality ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Polyethylene Glycols/administration & dosage ; Polyethylene Glycols/adverse effects ; Recombinant Proteins/administration & dosage ; Recombinant Proteins/adverse effects ; Recurrence ; Ribavirin/administration & dosage ; Ribavirin/adverse effects ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Spain ; Time Factors ; Treatment Outcome ; Virus Activation
Chemical Substances	Antiviral Agents ; Interferon-alpha ; Recombinant Proteins ; Polyethylene Glycols (30IQX730WE) ; Ribavirin (49717AWG6K) ; peginterferon alfa-2a (Q46947FE7K)
Language	English
Publishing date	2012-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2012.05.027
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Article: Sobrecrecimiento bacteriano intestinal en las hepatopatías crónicas.

Casafont, F / Almohalla, C / Garcia Pajares, F / Pons Romero, F

Revista de medicina de la Universidad de Navarra

1998 Volume 42, Issue 4, Page(s) 183–187

Abstract: Intestinal bacterial overgrowth (IBD) is very frequent in patients with chronic hepatopathies. Causes of IBO, although not entirely known, principally are: the hepatopathy, the alcoholism and the alterations produced by these two factors, such as achylia ...

Title translation	Intestinal bacteria overgrowth in chronic hepatopathies.
Abstract	Intestinal bacterial overgrowth (IBD) is very frequent in patients with chronic hepatopathies. Causes of IBO, although not entirely known, principally are: the hepatopathy, the alcoholism and the alterations produced by these two factors, such as achylia (and above all hypochlorhydria), decrease in the secretion of IgA, and malnutrition. On the other hand, the IBO increases the severity of the hepatopathy and frequently produces a bacterial peritonitis. All these data suggest that the IBO play an important role increasing the hepatopathy severity and consequently is a factor to bear in mind.
MeSH term(s)	Achlorhydria/microbiology ; Animals ; Enterobacteriaceae/growth & development ; Enterobacteriaceae/isolation & purification ; Humans ; Intestines/microbiology ; Liver Cirrhosis, Experimental/complications ; Liver Cirrhosis, Experimental/microbiology ; Liver Diseases/microbiology ; Liver Diseases, Alcoholic/microbiology ; Nutrition Disorders/complications ; Peritonitis/etiology ; Rats ; Risk Factors
Language	Spanish
Publishing date	1998-10
Publishing country	Spain
Document type	English Abstract ; Journal Article ; Review
ZDB-ID	123617-9
ISSN	0556-6177
ISSN	0556-6177
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