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  1. Article: Development of a liver graft assessment expert machine-learning system: when the artificial intelligence helps liver transplant surgeons.

    Pontes Balanza, Beatriz / Castillo Tuñón, Juan M / Mateos García, Daniel / Padillo Ruiz, Javier / Riquelme Santos, José C / Álamo Martinez, José M / Bernal Bellido, Carmen / Suarez Artacho, Gonzalo / Cepeda Franco, Carmen / Gómez Bravo, Miguel A / Marín Gómez, Luis M

    Frontiers in surgery

    2023  Volume 10, Page(s) 1048451

    Abstract: Background: The complex process of liver graft assessment is one point for improvement in liver transplantation. The main objective of this study is to develop a tool that supports the surgeon who is responsible for liver donation in the decision-making ...

    Abstract Background: The complex process of liver graft assessment is one point for improvement in liver transplantation. The main objective of this study is to develop a tool that supports the surgeon who is responsible for liver donation in the decision-making process whether to accept a graft or not using the initial variables available to it.
    Material and method: Liver graft samples candidate for liver transplantation after donor brain death were studied. All of them were evaluated "
    Results: A total of 350 liver grafts that were evaluated for liver transplantation were studied. Steatosis was the most frequent reason for classifying grafts as no transplantable, and the main risk factors identified in the univariant study were age, dyslipidemia, personal medical history, personal surgical history, bilirubinemia, and the result of previous liver ultrasound (
    Conclusion: The tool presented in this study obtains a high accuracy in predicting whether a liver graft will be transplanted or deemed non-transplantable based on the initial variables assigned to it. The inherent capacity for improvement in the system causes the rate of correct predictions to increase as new data are entered. Therefore, we believe it is a tool that can help optimize the graft pool for liver transplantation.
    Language English
    Publishing date 2023-09-22
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2773823-1
    ISSN 2296-875X
    ISSN 2296-875X
    DOI 10.3389/fsurg.2023.1048451
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  2. Article ; Online: Impact of a Donor Age >75 Years on the Survival of Liver Transplant Recipients.

    Cuevas López, María José / Álvarez Aguilera, Miriam / Cepeda Franco, Carmen / Suárez Artacho, Gonzalo / Marín Gómez, Luis Miguel / Bernal Bellido, Carmen / Álamo Martínez, José María / Padillo Ruiz, Francisco Javier / Gómez Bravo, Miguel Ángel

    Transplantation proceedings

    2022  

    Abstract: Background: An organ shortage is the reason why it is necessary to expand the pool of donors, which can be achieved by using elderly donors. The main goal of this study is to analyze the outcomes of liver transplant (LT) when it is performed with donors ...

    Abstract Background: An organ shortage is the reason why it is necessary to expand the pool of donors, which can be achieved by using elderly donors. The main goal of this study is to analyze the outcomes of liver transplant (LT) when it is performed with donors older than 75 years.
    Methods: We carried out a retrospective case-control study (N = 212) that included LTs with donors older than 75 years (group A, n = 106 cases) that were performed in our center between the years 2010 and 2020. This cohort has been paired off with a similar control group (group B, n = 106) whose donors were significantly younger. A survival analysis using the Kaplan-Meier model was performed.
    Results: Average (SD) age of donors in group A was statistically greater than group B (A, 79.1 [3.0] years vs B, 54.4 [15.3], P < .001). There were no differences either in the average age of the recipients or in the Model for End-Stage Liver Disease score of both groups. Indications for LT were distributed equally in both groups: the most common was cellular hepatocarcinoma followed by alcohol-related cirrhosis. Survival rates for group A were 81%, 78%, and 67%, in 1, 3, and 5 years, respectively, while in group B they were 85%, 76%, and 71%, respectively, without differences found between the groups (P = .57).
    Conclusions: Using elderly liver donors is safe, achieving good outcomes in terms of short- and midterm rates of survival.
    Language English
    Publishing date 2022-10-30
    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.2022.10.009
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    Zs.A 835: Show issues Location:
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  3. Article ; Online: Risk Factors for No Valid Liver Graft. Multivariate Study Based on the Variables Included in the Donation Protocol of the National Trasplant Organisation.

    Castillo Tuñón, Juan Manuel / Marín Gómez, Luis Miguel / Suárez Artacho, Gonzalo / Cepeda Franco, Carmen / Bernal Bellido, Carmen / Álamo Martínez, José María / Padillo Ruiz, Francisco Javier / Gómez Bravo, Miguel Ángel

    Cirugia espanola

    2020  Volume 98, Issue 10, Page(s) 591–597

    Abstract: Introduction: Among the strategies designed to optimize the number of existing liver grafts for transplantation, the implementation of the graft assessment process is one of the least explored. The main objective is to identify the risk factors ... ...

    Title translation Factores de riesgo para injertos hepáticos no válidos. Estudio multivariante a partir de las variables recogidas en el protocolo de donación de la Organización Nacional de Trasplantes.
    Abstract Introduction: Among the strategies designed to optimize the number of existing liver grafts for transplantation, the implementation of the graft assessment process is one of the least explored. The main objective is to identify the risk factors presented by liver donors for «NO validity». Secondly, we analyzed the coincidence between the surgeon's assessment and that of the anatomo-pathologist in the invalid donors.
    Material and method: Retrospective study conducted from a prospective database that analyzes 190 liver donors, 95 valid and 95 NOT valid. The variables of each of them corresponding to the donation protocol of the National Transplant Organization are studied. Through a multivariate study we determine the independent risk factors of NO validity. We checked the causes of NO validity argued with the histopathological findings of these grafts.
    Results: The independent risk factors of non-validity in the multivariate study (P < .05) were: dyslipidemia, personal medical history other than cardiovascular and abdominal surgical risk factors, GGT, BrT, and the result of previous liver ultrasound. The 3 most frequent causes of NO validity were: steatosis, fibrosis and macroscopic appearance of the organ. 78% of the biopsies confirmed the NO validity of the graft (in 57.9% of the cases the histological findings coincided with those described by the surgeon). The 22.1% of the biopsies hadńt pathological findings.
    Conclusions: The determination of the risk factors of NO validity will contribute to the design of future assessment scores that are useful tools in the process of liver graft assessment.).
    MeSH term(s) Adult ; Aged ; Biopsy/methods ; Donor Selection/methods ; Dyslipidemias/diagnosis ; Dyslipidemias/epidemiology ; Fatty Liver/diagnosis ; Fatty Liver/epidemiology ; Female ; Humans ; Liver/pathology ; Liver Cirrhosis/diagnosis ; Liver Cirrhosis/epidemiology ; Liver Transplantation/standards ; Liver Transplantation/statistics & numerical data ; Male ; Middle Aged ; Multivariate Analysis ; Patient Selection ; Retrospective Studies ; Risk Factors ; Tissue Donors/statistics & numerical data ; Tissue Donors/supply & distribution ; Tissue and Organ Procurement/standards ; Ultrasonography/methods ; Ultrasonography/statistics & numerical data
    Language Spanish
    Publishing date 2020-06-02
    Publishing country Spain
    Document type Comparative Study ; Journal Article
    ISSN 2173-5077
    ISSN (online) 2173-5077
    DOI 10.1016/j.ciresp.2020.03.021
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  4. 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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    Zs.A 5542: Show issues Location:
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  5. Article ; Online: Intrahepatic Masson tumor (intravascular papillary endothelial hyperplasia).

    Ramallo Solís, Irene / Tinoco González, José / Senent Boza, Ana / Bernal Bellido, Carmen / Gómez Bravo, Miguel Ángel

    Cirugia espanola

    2017  Volume 95, Issue 4, Page(s) 235–237

    Title translation Tumor de Masson intrahepático (hiperplasia endotelial papilar intravascular).
    Language Spanish
    Publishing date 2017-04
    Publishing country Spain
    Document type Journal Article
    ZDB-ID 730701-9
    ISSN 1578-147X ; 0009-739X
    ISSN (online) 1578-147X
    ISSN 0009-739X
    DOI 10.1016/j.ciresp.2016.07.009
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    Zs.B 96: Show issues Location:
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  6. Article ; Online: 1000 consecutive liver transplants. Descriptive analysis and evolution of a single center.

    Tinoco González, José / Álamo Martínez, Jose María / Bernal Bellido, Carmen / Suárez Artacho, Gonzalo / Marín Gómez, Luis Miguel / Barrera-Pulido, Lydia / Padillo Ruíz, Javier / Gómez Bravo, Miguel Ángel

    Cirugia espanola

    2018  Volume 96, Issue 5, Page(s) 268–275

    Abstract: Between 1991 and 2013, 1,000 liver transplantations were performed at Virgen del Rocio Hospital (Seville, Spain). A retrospective study was conducted, analyzing the characteristics of recipients and donors, indications, surgical technique, complications ... ...

    Title translation 1000 trasplantes hepáticos consecutivos. Análisis descriptivo y evolución de un centro.
    Abstract Between 1991 and 2013, 1,000 liver transplantations were performed at Virgen del Rocio Hospital (Seville, Spain). A retrospective study was conducted, analyzing the characteristics of recipients and donors, indications, surgical technique, complications and survival in 2 different stages (1991-2002 vs. 2003-2013) coinciding with the implementation of the MELD scale as a prioritization model. The most frequent indication were of hepatopathy of hepatocellular origin in 48.8%. There was a significant increase in the indications for hepatocarcinoma (8.6% and 24.1% P=0.03), and the rate of retransplantation (5.9% vs 9.6%, P=0.04). There was a change in the age of donation, going from 27.7 years in 1990 to 62.9 years in 2012 (P=0.001). The percentage of patients who did not require blood transfusion doubled (6.16 vs. 14.31%, P=.001). Survival of all patients after one, 5 and 10 years was 77, 63.5 and 51.3%, respectively.
    MeSH term(s) Adolescent ; Adult ; Female ; Humans ; Liver Diseases/surgery ; Liver Transplantation/methods ; Liver Transplantation/mortality ; Liver Transplantation/statistics & numerical data ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Young Adult
    Language Spanish
    Publishing date 2018-04-25
    Publishing country Spain
    Document type Journal Article ; Observational Study
    ISSN 2173-5077
    ISSN (online) 2173-5077
    DOI 10.1016/j.ciresp.2018.02.004
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  7. Article ; Online: Incidence and survival rate of de novo tumors in liver transplants.

    Bernal Bellido, Carmen / Suárez Artacho, Gonzalo / Álamo Martínez, José María / Marin Gómez, Luis Miguel / Cepeda Franco, Carmen / Barrera Pulido, Lydia / Praena Fernández, Juan Manuel / Padillo Ruiz, Javier / Gómez Bravo, Miguel Ángel

    Cirugia espanola

    2018  Volume 96, Issue 8, Page(s) 501–507

    Abstract: Introduction: The greater survival of transplanted patients is accompanied by an increase in the rate of de novo malignancies (NM), which are the most frequent late-onset complication. We can distinguish between non-melanoma skin cancers (NMSC), post- ... ...

    Title translation Incidencia y supervivencia de los tumores de novo en el trasplante hepático.
    Abstract Introduction: The greater survival of transplanted patients is accompanied by an increase in the rate of de novo malignancies (NM), which are the most frequent late-onset complication. We can distinguish between non-melanoma skin cancers (NMSC), post-transplant lymphoproliferative disorders (PTLD) and solid organ cancers (SOC). Our objective is to determine the incidence of the different types of NM, the time elapsed until diagnosis and survival rates in our setting.
    Methods: We conducted a retrospective study of 1071 liver transplant patients from 1990 to 2015 at our center. We analyzed the demographic variables, incidence of NM and survival.
    Results: 184 NM developed in 1071 transplant patients (17%), specifically 19% of the males and 13% of the females (P=.004). The most frequent NM were NMSC (29%), lung (18%), head and neck (16%), PTLD (10%) and gastrointestinal (8%). The median time of diagnosis was 7.9 years in NMSC, 3.9 years in PTLD and 9.8 years in SOC. Patients with NMSC had significantly better survival than those with PTLD or SOC. The incidence of de novo tumors (excluding NMSC) was 1889/100,000 transplants/year. By gender, lung cancer was the most common TOS in men and breast cancer in women.
    Conclusion: In our setting, excluding NMSC, the incidence is 8.8 times greater than estimations for the general population, with a high rate of lung cancer, so we should implement preventive and diagnostic strategies.
    MeSH term(s) Adolescent ; Adult ; Aged ; Female ; Humans ; Incidence ; Liver Transplantation ; Male ; Middle Aged ; Neoplasms/epidemiology ; Postoperative Complications/epidemiology ; Retrospective Studies ; Survival Rate ; Young Adult
    Language Spanish
    Publishing date 2018-07-13
    Publishing country Spain
    Document type Journal Article
    ISSN 2173-5077
    ISSN (online) 2173-5077
    DOI 10.1016/j.ciresp.2018.05.003
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  8. Article: Post-transplant lymphoproliferative disease in liver transplant recipients.

    Rubio-Manzanares Dorado, Mercedes / Álamo Martínez, José María / Bernal Bellido, Carmen / Marín Gómez, Luis Miguel / Suárez Artacho, Gonzalo / Cepeda Franco, Carmen / Wang, Jize / Gómez Bravo, Miguel Ángel / Padillo, Francisco Javier

    Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva

    2017  Volume 109, Issue 6, Page(s) 406–413

    Abstract: Introduction: Post-transplant lymphoproliferative syndrome (PTLD) is a rare and potentially life-threatening complication after liver transplantation. The aim of this study was to analyze the clinicopathologic features related to PTLD in a single ... ...

    Abstract Introduction: Post-transplant lymphoproliferative syndrome (PTLD) is a rare and potentially life-threatening complication after liver transplantation. The aim of this study was to analyze the clinicopathologic features related to PTLD in a single institution after liver transplantation.
    Methods: Observational study where we have retrospectively analyzed 851 cases who underwent liver transplantation. Ten cases have developed PTLD. Their clinical-pathological characteristics and the treatment received have been analyzed.
    Results: PTLD incidence was 1.2% (10/851). The mean time from liver transplantation to PTLD diagnosis was 36 months (range 1.2 to 144 months). PTLD localization was extranodal in all cases, the most frequent location being intestinal. Seven cases showed a monomorphic lymphoma which in all cases was differentiated B cell lymphomas. Fifty per cent of the series were seropositive for Epstein-Barr virus. Five patients were alive at the time of the review. Among these patients, we observed three cases of complete remission and two cases of disease stabilization. The death rate was higher in the first year after diagnosis of PTLD.
    Conclusion: PTLD is a rare complication after liver transplantation, but it may pose a threat to the life of a liver transplant recipient. It is essential to identify patients at risk, to establish an early diagnosis and treatment that can change the outcome of the disease.
    Language English
    Publishing date 2017-06
    Publishing country Spain
    Document type Journal Article
    ZDB-ID 1070381-0
    ISSN 1130-0108 ; 0212-7512
    ISSN 1130-0108 ; 0212-7512
    DOI 10.17235/reed.2017.4228/2016
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    Zs.B 199: Show issues Location:
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  9. Article ; Online: Alternative outflow reconstruction in domino liver transplantation.

    Cepeda-Franco, Carmen / Marín-Gómez, Luis Miguel / Bernal-Bellido, Carmen / Suárez-Artacho, Gonzalo / Álamo-Martínez, Jose María / Padillo-Ruiz, Francisco Javier / Gómez-Bravo, Miguel Ángel

    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

    2017  Volume 23, Issue 9, Page(s) 1226–1228

    MeSH term(s) Budd-Chiari Syndrome/etiology ; Budd-Chiari Syndrome/prevention & control ; Hepatic Veins/transplantation ; Humans ; Iliac Vein/transplantation ; Liver/blood supply ; Liver/surgery ; Liver Transplantation/adverse effects ; Liver Transplantation/methods ; Living Donors ; Tissue and Organ Harvesting/methods ; Vascular Grafting/methods
    Language English
    Publishing date 2017-07-11
    Publishing country United States
    Document type Case Reports ; Letter
    ZDB-ID 2006866-9
    ISSN 1527-6473 ; 1527-6465
    ISSN (online) 1527-6473
    ISSN 1527-6465
    DOI 10.1002/lt.24816
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    Zs.A 4702: Show issues Location:
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  10. Article: Neumonitis asociada a everolimus en un receptor de trasplante hepático.

    Marín-Gómez, Luis Miguel / Cordero-Matía, Elisa / Gómez-Bravo, Miguel Ángel / Bernal-Bellido, Carmen

    Medicina clinica

    2010  Volume 135, Issue 9, Page(s) 431–432

    Title translation Everolimus-associated pneumonitis in adult liver transplant recipient.
    MeSH term(s) Everolimus ; Humans ; Immunosuppressive Agents/adverse effects ; Liver Transplantation ; Male ; Middle Aged ; Pneumonia/chemically induced ; Postoperative Complications/chemically induced ; Sirolimus/adverse effects ; Sirolimus/analogs & derivatives
    Chemical Substances Immunosuppressive Agents ; Everolimus (9HW64Q8G6G) ; Sirolimus (W36ZG6FT64)
    Language Spanish
    Publishing date 2010-09-18
    Publishing country Spain
    Document type Case Reports ; Letter
    ZDB-ID 411607-0
    ISSN 1578-8989 ; 0025-7753
    ISSN (online) 1578-8989
    ISSN 0025-7753
    DOI 10.1016/j.medcli.2009.07.005
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