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  1. Article ; Online: Unusual early post-transplant hepatic dysfunction.

    Díaz-Fontenla, Fernando / Caballero-Marcos, Aránzazu / Peligros, Isabel / Vicario Moreno, Jose Luis / Salcedo, Magdalena

    Journal of hepatology

    2024  Volume 80, Issue 1, Page(s) e11–e13

    Language English
    Publishing date 2024-01-04
    Publishing country Netherlands
    Document type Case Reports
    ZDB-ID 605953-3
    ISSN 1600-0641 ; 0168-8278
    ISSN (online) 1600-0641
    ISSN 0168-8278
    DOI 10.1016/j.jhep.2023.10.005
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  2. Article: Implementation and impact of an antibiotic control program and multidrug-resistant bacterial colonization in a liver transplant unit.

    Fernández, Ainhoa / Díez-Picazo, Clara / Iglesias Sobrino, Carmen / Trueba Collado, Celia / Romero Cristóbal, Mario / Díaz Fontenla, Fernando / Caballero Marcos, Aránzazu / Valerio, Maricela / Olmedo, María / Vicente Rangel, Teresa / Padilla Ortega, Belén / Ramos, Rafael / López Baena, José Ángel / Muñoz, Patricia / Bañares, Rafael / Salcedo, Magdalena

    Revista espanola de enfermedades digestivas

    2022  Volume 115, Issue 7, Page(s) 357–361

    Abstract: Introduction: infections by multidrug-resistant bacteria are a major cause of morbidity and mortality in transplant patients.: Objective: a retrospective single-center study was performed to evaluate the implementation of an Antimicrobial Treatment ... ...

    Abstract Introduction: infections by multidrug-resistant bacteria are a major cause of morbidity and mortality in transplant patients.
    Objective: a retrospective single-center study was performed to evaluate the implementation of an Antimicrobial Treatment Optimization Program (PROA) on multidrug-resistant bacteria colonization and infection after liver transplant (LT).
    Methods: colonization by multidrug-resistant bacteria and infections during the first year after a liver transplant were analyzed in a group of 76 transplanted patients in two stages, before and after PROA (2016-2019). Clinical variables related to infection, readmissions and survival one year after the liver transplant were analyzed.
    Results: there was good adherence to the PROA. Infection was the most frequent cause for readmission during the first year after the liver transplant. Incidence of infections was similar during both periods (mean of 1.25 and 1.5 episodes of bacterial infection per patient/year, respectively) with 19 bacterial infectious episodes, six by hospital-acquired multidrug-resistant and extensively drug-resistant (MDR-XDR) bacteria in the pre-PROA stage, and 18 bacterial infectious episodes, five by MDR-XDR in the post-PROA stage. A 37 % decrease of post-TH of rectal colonization by MDR-XDR after liver transplant was observed during 2019.
    Conclusions: epidemiological surveillance policies and antibiotic optimization are key to control the increase of colonization and infection by multidrug-resistant bacteria in liver transplant units. Long-term studies are needed to better evaluate the impact of these programs.
    MeSH term(s) Humans ; Anti-Bacterial Agents/therapeutic use ; Liver Transplantation/adverse effects ; Retrospective Studies ; Bacterial Infections/drug therapy ; Bacterial Infections/epidemiology ; Bacterial Infections/prevention & control ; Bacteria
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2022-05-27
    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.2022.8810/2022
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  3. Article: Long-term outcomes and clinical impact of anti-HLA donor-specific antibodies (DSA) after liver transplantation: a prospective study in a pilot cohort.

    Caballero Marcos, Aranzazu / Díaz Ruiz, Raquel / Romero Cristóbal, Mario / Fernández Yunquera, Ainhoa / Díaz-Fontenla, Fernando / Pérez Carazo, Leticia / Peligros Gómez, María Isabel / Vicario Moreno, José Luis / Salcedo Plaza, Magdalena / Bañares Cañizares, Rafael

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

    2020  Volume 113, Issue 8, Page(s) 557–562

    Abstract: Introduction: the presence of donor-specific antibodies (DSA) is thought to affect survival of the allograft and patient after liver transplantation (LT). However, their significance is not well understood.: Patients and methods: a prospective study ... ...

    Abstract Introduction: the presence of donor-specific antibodies (DSA) is thought to affect survival of the allograft and patient after liver transplantation (LT). However, their significance is not well understood.
    Patients and methods: a prospective study was performed of 32 adult patients who underwent LT in 2011 to analyze the existence of DSA, associated risk factors and medium-term impact. Immunological determinations were performed immediately before LT and at three, six, 12 months and five years after LT.
    Results: eight patients (24.2 %) presented pre-formed DSA. However, titers were negative in all patients five years after LT and there were no associated events. Eight out of 24 patients (33.3 %) developed de novo DSA. After five years, only two remained positive; both were class II with high mean fluorescence intensity (MFI) values at diagnosis (over 15,000). No association was found between the development of DSA and the risk of rejection, graft loss or death. However, an increase in liver stiffness values was observed in patients with persistent DSA, and focal sinusoidal deposition of C4d and moderate liver fibrosis were reported.
    Conclusion: the incidence of DSA is high after LT. In addition, the persistence of de novo DSA could be associated with silent liver fibrosis with a potential impact on graft outcomes.
    MeSH term(s) Adult ; Graft Rejection/epidemiology ; HLA Antigens ; Humans ; Isoantibodies ; Liver Transplantation ; Prospective Studies ; Retrospective Studies
    Chemical Substances HLA Antigens ; Isoantibodies
    Language English
    Publishing date 2020-08-25
    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.2020.7337/2020
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  4. Article ; Online: Chronic Budd-Chiari syndrome in Behçet's disease successfully managed with transjugular intrahepatic portosystemic shunt: a case report and literature review.

    Oblitas, Crhistian-Mario / Toledo-Samaniego, Neera / Fernández-Yunquera, Ainhoa / Díaz-Fontenla, Fernando / Galeano-Valle, Francisco / Del-Toro-Cervera, Jorge / Bañares-Cañizares, Rafael / Demelo-Rodriguez, Pablo

    Clinical journal of gastroenterology

    2020  Volume 13, Issue 4, Page(s) 572–578

    Abstract: Budd-Chiari syndrome (BCS) is characterized by an obstruction of hepatic venous outflow from small hepatic veins to inferior vena cava, caused by acute thrombosis or its fibrous sequellae. An underlying myeloproliferative neoplasm is present in 50% of ... ...

    Abstract Budd-Chiari syndrome (BCS) is characterized by an obstruction of hepatic venous outflow from small hepatic veins to inferior vena cava, caused by acute thrombosis or its fibrous sequellae. An underlying myeloproliferative neoplasm is present in 50% of cases. Clinical manifestations are widely variable, from asymptomatic to fulminant episodes. Long-term complications range from cirrhosis to hepatocellular carcinoma. Behçet's disease (BD) is a rare recurrent inflammatory multisystemic disorder characterized by recurrent skin-mucosa lesions and systemic involvement. Vascular involvement is observed in up to 40% of the patients with BD, and it is one of the major causes of mortality and morbidity. BCS is a rare complication of BD with a frequency of < 5% among patients with vascular involvement. Immunosuppressive treatment is the cornerstone for the management of vascular involvement in BD, while anticoagulant therapy has been an issue of debate. Transjugular intrahepatic portosystemic shunt (TIPS) in severe cases of BCS-of all causes- improves survival. However, there is scarce evidence about the role of TIPS in the setting of BCS in BD. We present a case of a vascular Behçet's disease associated with chronic Budd-Chiari syndrome with progression of thrombosis despite adequate anticoagulant and immunosuppressive treatment, successfully managed with TIPS.
    MeSH term(s) Behcet Syndrome/complications ; Budd-Chiari Syndrome/etiology ; Budd-Chiari Syndrome/surgery ; Hepatic Veins ; Humans ; Portasystemic Shunt, Transjugular Intrahepatic ; Vena Cava, Inferior
    Language English
    Publishing date 2020-02-17
    Publishing country Japan
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 2429411-1
    ISSN 1865-7265 ; 1865-7257
    ISSN (online) 1865-7265
    ISSN 1865-7257
    DOI 10.1007/s12328-020-01106-7
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  5. Article ; Online: HCV eradication in recurrent hepatitis C after liver transplantation normalizes enhanced endothelial activation.

    Caballero-Marcos, Aránzazu / Romero-Cristóbal, Mario / Puerto, Marta / Fernández-Yunquera, Ainhoa / Dieguez, Lucia / Navarrete, Cristina / Clemente, Ana / Diaz-Fontenla, Fernando / Catalán, Pilar / Rincón, Diego / López-Baena, José-Ángel / Bañares Cañizares, Rafael / Salcedo, Magdalena

    Transplant international : official journal of the European Society for Organ Transplantation

    2021  Volume 34, Issue 11, Page(s) 2214–2225

    Abstract: The increased risk of cardiovascular disease (CVD) conferred by hepatitis C virus (HCV) is especially relevant after liver transplantation (LT), but its mechanism is still not well defined. This study aimed to evaluate the influence of HCV eradication in ...

    Abstract The increased risk of cardiovascular disease (CVD) conferred by hepatitis C virus (HCV) is especially relevant after liver transplantation (LT), but its mechanism is still not well defined. This study aimed to evaluate the influence of HCV eradication in inflammatory and endothelial activation markers after LT. We evaluated inflammatory (TNF-alfa, IL-6, IL-8, and MCP-1) and endothelial activation (E-selectin, ICAM-1, VCAM-1, and MMP-9) markers before and after eradication in 45 LT recipients with HCV infection (LT+/HCV+) and 44 non-transplanted HCV-infected patients (LT-/HCV+). We also considered an additional group of 40 LT recipients without HCV infection (LT+/HCV-). LT+/HCV+ patients presented a higher endothelial activation status before eradication compared with LT+/HCV- patients. However, levels of E-selectin, ICAM-1, VCAM-1, and MMP-9 were comparable between LT+/HCV+ and LT-/HCV+ patients before eradication. HCV eradication decreased ICAM-1 (5466.55 pg/ml vs. 3354.88 pg/ml, P < 0.001) and VCAM-1 (10456.52 pg/ml vs. 6658.85 pg/ml, P < 0.001) levels in LT+/HCV+ and LT-/HCV+ patients. Remarkably, HCV eradication restored levels of endothelial activation markers of LT+/HCV+ patients compared with that of LT+/HCV- patients. HCV plays a major role in endothelial dysfunction after LT. Furthermore, HCV eradication restores endothelial activation despite the exposure to immunosuppressive therapy.
    MeSH term(s) Antiviral Agents/therapeutic use ; Hepacivirus ; Hepatitis C/complications ; Hepatitis C/drug therapy ; Hepatitis C, Chronic/drug therapy ; Humans ; Liver Transplantation
    Chemical Substances Antiviral Agents
    Language English
    Publishing date 2021-09-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 639435-8
    ISSN 1432-2277 ; 0934-0874
    ISSN (online) 1432-2277
    ISSN 0934-0874
    DOI 10.1111/tri.14000
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  6. Article ; Online: Noninvasive Prediction of Outcomes in Autoimmune Hepatitis-Related Cirrhosis.

    Llovet, Laura-Patricia / Gratacós-Ginès, Jordi / Téllez, Luis / Gómez-Outomuro, Ana / Navascués, Carmen A / Riveiro-Barciela, Mar / Vinuesa, Raquel / Gómez-Camarero, Judith / García-Retortillo, Montserrat / Díaz-Fontenla, Fernando / Salcedo, Magdalena / García-Eliz, María / Horta, Diana / Guerrero, Marta / Rodríguez-Perálvarez, Manuel / Fernández-Rodriguez, Conrado / Albillos, Agustín / G-Abraldes, Juan / Parés, Albert /
    Londoño, Maria-Carlota

    Hepatology communications

    2022  Volume 6, Issue 6, Page(s) 1392–1402

    Abstract: The value of noninvasive tools in the diagnosis of autoimmune hepatitis (AIH)-related cirrhosis and the prediction of clinical outcomes is largely unknown. We sought to evaluate (1) the utility of liver stiffness measurement (LSM) in the diagnosis of ... ...

    Abstract The value of noninvasive tools in the diagnosis of autoimmune hepatitis (AIH)-related cirrhosis and the prediction of clinical outcomes is largely unknown. We sought to evaluate (1) the utility of liver stiffness measurement (LSM) in the diagnosis of cirrhosis and (2) the performance of the Sixth Baveno Consensus on Portal Hypertension (Baveno VI), expanded Baveno VI, and the ANTICIPATE models in predicting the absence of varices needing treatment (VNT). A multicenter cohort of 132 patients with AIH-related cirrhosis was retrospectively analyzed. LSM and endoscopies performed at the time of cirrhosis diagnosis were recorded. Most of the patients were female (66%), with a median age of 54 years. Only 33%-49% of patients had a LSM above the cutoff points described for the diagnosis of AIH-related cirrhosis (12.5, 14, and 16 kPa). Patients with portal hypertension (PHT) had significantly higher LSM than those without PHT (15.7 vs. 11.7 kPa; P = 0.001), but 39%-52% of patients with PHT still had LSM below these limits. The time since AIH diagnosis negatively correlated with LSM, with longer time being significantly associated with a lower proportion of patients with LSM above these cutoffs. VNT was present in 12 endoscopies. The use of the Baveno VI, expanded Baveno VI criteria, and the ANTICIPATE model would have saved 46%-63% of endoscopies, but the latter underpredicted the risk of VNT. Conclusions: LSM cutoff points do not have a good discriminative capacity for the diagnosis of AIH-related cirrhosis, especially long-term after treatment initiation. Noninvasive tools are helpful to triage patients for endoscopy.
    MeSH term(s) Elasticity Imaging Techniques ; Esophageal and Gastric Varices/diagnosis ; Female ; Hepatitis, Autoimmune/complications ; Humans ; Hypertension, Portal/complications ; Liver Cirrhosis/complications ; Male ; Middle Aged ; Retrospective Studies ; Varicose Veins/complications
    Language English
    Publishing date 2022-01-06
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ISSN 2471-254X
    ISSN (online) 2471-254X
    DOI 10.1002/hep4.1889
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  7. Article ; Online: Tacrolimus as an Effective and Durable Second-Line Treatment for Chronic Autoimmune Hepatitis: A Multicentric Study.

    Ferre-Aracil, Carlos / Riveiro-Barciela, Mar / Trapero-Marugán, María / Rodríguez-Perálvarez, Manuel / Llovet, Laura-Patricia / Téllez, Luis / Sánchez-Torrijos, Yolanda / Díaz-Fontenla, Fernando / Salcedo-Plaza, Magdalena / Álvarez-López, Patricia / de la Mata, Manuel / Londoño, María-Carlota / Bañares-Cañizares, Rafael / Calleja, José Luis

    Digestive diseases and sciences

    2020  Volume 66, Issue 8, Page(s) 2826–2832

    Abstract: Background: Autoimmune hepatitis (AIH) is a chronic liver disease able to progress to acute liver failure, cirrhosis, and liver cancer. A significant proportion of patients fail to first-line therapy or develop severe toxicity.: Aims: To assess ... ...

    Abstract Background: Autoimmune hepatitis (AIH) is a chronic liver disease able to progress to acute liver failure, cirrhosis, and liver cancer. A significant proportion of patients fail to first-line therapy or develop severe toxicity.
    Aims: To assess safety and effectiveness of tacrolimus as a second-line therapy in AIH patients.
    Methods: Multicentric retrospective study of AIH patients treated with tacrolimus for at least 3 months as a second-line therapy. Effectiveness was defined as complete normalization of transaminases and IgG.
    Results: A total of 23 AIH patients were included in the final analysis. In 13% of patients tacrolimus was initiated because of toxicity to previous first-line treatments and the rest were switched because of previous non-efficacy. Tacrolimus was effective in 18 patients (78%; 95%CI: 55.20-91.92%). The median time receiving tacrolimus was 16 months (IQR 20). There was a sustained response with a significant improvement in all liver enzymes and IgG on last follow-up. Only one patient discontinued tacrolimus at the third month because of severe neuropathy, and ototoxicity. Responders were significantly older at diagnosis of AIH (41 ± 13 vs. 27 ± 10 years old; p = 0.0496).
    Conclusion: Tacrolimus is effective and well tolerated as a second-line therapy in patients with AIH.
    MeSH term(s) Adult ; Chronic Disease ; Female ; Hepatitis, Autoimmune/drug therapy ; Humans ; Immunoglobulin G/blood ; Immunosuppressive Agents/therapeutic use ; Liver/drug effects ; Liver/enzymology ; Liver/metabolism ; Male ; Middle Aged ; Retrospective Studies ; Tacrolimus/therapeutic use
    Chemical Substances Immunoglobulin G ; Immunosuppressive Agents ; Tacrolimus (WM0HAQ4WNM)
    Language English
    Publishing date 2020-08-29
    Publishing country United States
    Document type Journal Article ; Multicenter Study
    ZDB-ID 304250-9
    ISSN 1573-2568 ; 0163-2116
    ISSN (online) 1573-2568
    ISSN 0163-2116
    DOI 10.1007/s10620-020-06569-9
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  8. Article ; Online: Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study.

    Téllez, Luis / Sánchez Rodríguez, Eugenia / Rodríguez de Santiago, Enrique / Llovet, Laura / Gómez-Outomuro, Ana / Díaz-Fontenla, Fernando / Álvarez López, Patricia / García-Eliz, María / Amaral, Carla / Sánchez-Torrijos, Yolanda / Fortea, José Ignacio / Ferre-Aracil, Carlos / Rodríguez-Perálvarez, Manuel / Abadía, Marta / Gómez-Camarero, Judith / Olveira, Antonio / Calleja, José Luis / Crespo, Javier / Romero, Manuel /
    Hernández-Guerra, Manuel / Berenguer, Marina / Riveiro-Barciela, Mar / Salcedo, Magdalena / Rodríguez, Manuel / Londoño, María Carlota / Albillos, Agustín

    Alimentary pharmacology & therapeutics

    2022  Volume 56, Issue 1, Page(s) 131–143

    Abstract: Background and aims: To assess whether corticosteroids improve prognosis in patients with AS-AIH, and to identify factors at therapy initiation and during therapy predictive of the response to corticosteroids.: Methods: This was a retrospective ... ...

    Abstract Background and aims: To assess whether corticosteroids improve prognosis in patients with AS-AIH, and to identify factors at therapy initiation and during therapy predictive of the response to corticosteroids.
    Methods: This was a retrospective cohort study including all patients with AS-AIH admitted to 13 tertiary centres from January 2002 to January 2019. The composite primary outcome was death or liver transplantation within 90 days of admission. Kaplan-Meier and Cox regression methods were used for data analysis.
    Results: Of 242 consecutive patients enrolled (mean age [SD] 49.7 [16.8] years), 203 received corticosteroids. Overall 90-day transplant-free survival was 61.6% (95% confidence interval [CI] 55.4-67.7). Corticosteroids reduced the risk of a poor outcome (adjusted hazard ratio [HR] 0.25; 95% CI 0.2-0.4), but this treatment failed in 30.5%. An internally validated nomogram composed of older age, MELD, encephalopathy and ascites at the initiation of corticosteroids accurately predicted the response (C-index 0.82; [95% CI 0.8-0.9]). In responders, MELD significantly improved from days 3 to 14 but remained unchanged in non-responders. MELD on day 7 with a cut-off of 25 (sensitivity 62.5%[95% CI: 47.0-75.8]; specificity 95.2% [95% CI: 89.9-97.8]) was the best univariate predictor of the response. Prolonging corticosteroids did not increase the overall infection risk (adjusted HR 0.75; 95% CI 0.3-2.1).
    Conclusion: Older patients with high MELD, encephalopathy or ascites at steroid therapy initiation and during treatment are unlikely to show a favourable response and so prolonged therapy in these patients, especially if they are transplantation candidates, should be avoided.
    MeSH term(s) Acute Disease ; Adolescent ; Adrenal Cortex Hormones/therapeutic use ; Ascites ; Brain Diseases ; Hepatitis, Autoimmune/diagnosis ; Hepatitis, Autoimmune/drug therapy ; Humans ; Prognosis ; Retrospective Studies ; Severity of Illness Index
    Chemical Substances Adrenal Cortex Hormones
    Language English
    Publishing date 2022-04-25
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 639012-2
    ISSN 1365-2036 ; 0269-2813 ; 0953-0673
    ISSN (online) 1365-2036
    ISSN 0269-2813 ; 0953-0673
    DOI 10.1111/apt.16926
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  9. Article: Gastric and duodenal pseudomelanosis: a propos of two cases.

    Ochoa-Palominos, Alejandra / Díaz-Fontenla, Fernando / González-Asanza, Cecilia / Merino-Rodríguez, Beatriz / Nogales-Rincón, Óscar / Menchén-Fernández-Pacheco, Pedro

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

    2014  Volume 106, Issue 5, Page(s) 346–347

    MeSH term(s) Aged ; Duodenal Diseases/pathology ; Humans ; Male ; Melanosis/pathology ; Middle Aged ; Stomach Diseases/pathology
    Language English
    Publishing date 2014-05
    Publishing country Spain
    Document type Case Reports ; Journal Article
    ZDB-ID 1070381-0
    ISSN 1130-0108 ; 0212-7512
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  10. Article: Tuberculosis pancreática: presentación en forma de pancreatitis con desarrollo de hipertensión portal.

    Díaz Fontenla, Fernando / Miranda-Bautista, José / Hernando Alonso, Ana / Urizar Gorosarri, Maite / Jiménez Pérez, José María / Senosiáin Labiano, María

    Gastroenterologia y hepatologia

    2014  Volume 37, Issue 7, Page(s) 417–420

    Title translation Pancreatic tuberculosis: presentation in the form of pancreatitis with portal hypertension.
    MeSH term(s) Adult ; Humans ; Hypertension, Portal/microbiology ; Male ; Pancreatitis/drug therapy ; Pancreatitis/microbiology ; Tuberculosis/diagnosis ; Tuberculosis/drug therapy
    Language Spanish
    Publishing date 2014-08
    Publishing country Spain
    Document type Case Reports ; Letter
    ZDB-ID 632502-6
    ISSN 0210-5705
    ISSN 0210-5705
    DOI 10.1016/j.gastrohep.2013.11.002
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