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Article: Periprocedural management of hemostatic alterations in patients with cirrhosis and vascular liver disorders: a step forward of the American Association for the Study of Liver Diseases.

Fortea, José Ignacio / Puente, Ángela / Crespo, Javier / Fábrega, Emilio

2023 Volume 12, Issue 1, Page(s) 105–109

Language	English
Publishing date	2023-01-16
Publishing country	China (Republic : 1949- )
Document type	Editorial ; Comment
ZDB-ID	2812398-0
ISSN	2304-389X ; 2304-3881
ISSN (online)	2304-389X
ISSN	2304-3881
DOI	10.21037/hbsn-22-556
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Article: Protective measures against Omicron could be more effective than Evusheld in liver transplant recipients.

Odriozola Herrán, Aitor / Fortea Ormaechea, José Ignacio / Cuadrado, Antonio / Puente Sánchez, Ángela / Lazarus, Jeffrey V. / Crespo, Javier / Fábrega, Emilio

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

2022

Abstract: Evusheld (the combination of cilgavimab and tixagevimab, two long-lasting monoclonal antibodies against SARS-CoV-2) has been approved by the FDA as a pre-exposure treatment for COVID-19 in immunocompromised patients older than 12 years. However, this ... ...

Abstract	Evusheld (the combination of cilgavimab and tixagevimab, two long-lasting monoclonal antibodies against SARS-CoV-2) has been approved by the FDA as a pre-exposure treatment for COVID-19 in immunocompromised patients older than 12 years. However, this monoclonal antibody has been developed from SARS-CoV-2 variants that were predominant at the beginning of the pandemic, when Ómicron was not prevalent. Compared with other solid organ transplant recipients, liver transplant recipients have shown an excellent immune response to standard vaccination with three doses of the SARS-CoV-2 vaccine. In addition, this population has shown very good adherence to protective measures for the transmission of COVID-19 infection. Several studies have shown that the use of Evusheld is less effective against Ómicron than against other variants of SARS-CoV-2. In addition, in the post-hoc analysis, it appears to be a drug that increases cardiovascular risk. For these reasons, we believe that in liver transplant recipients is essential to prioritize vaccination and protective measures, rather than the use of Evusheld as pre-exposure prophylaxis.
Language	English
Publishing date	2022-08-31
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.2022.9058/2022
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Article ; Online: Fatty Liver Disease, Metabolism and Alcohol Interplay: A Comprehensive Review.

Odriozola, Aitor / Santos-Laso, Alvaro / Del Barrio, María / Cabezas, Joaquín / Iruzubieta, Paula / Arias-Loste, María Teresa / Rivas, Coral / Duque, Juan Carlos Rodríguez / Antón, Ángela / Fábrega, Emilio / Crespo, Javier

International journal of molecular sciences

2023 Volume 24, Issue 9

Abstract: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide, and its incidence has been increasing in recent years because of the high prevalence of obesity and metabolic syndrome in the Western population. ... ...

Abstract	Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide, and its incidence has been increasing in recent years because of the high prevalence of obesity and metabolic syndrome in the Western population. Alcohol-related liver disease (ArLD) is the most common cause of cirrhosis and constitutes the leading cause of cirrhosis-related deaths worldwide. Both NAFLD and ArLD constitute well-known causes of liver damage, with some similarities in their pathophysiology. For this reason, they can lead to the progression of liver disease, being responsible for a high proportion of liver-related events and liver-related deaths. Whether ArLD impacts the prognosis and progression of liver damage in patients with NAFLD is still a matter of debate. Nowadays, the synergistic deleterious effect of obesity and diabetes is clearly established in patients with ArLD and heavy alcohol consumption. However, it is still unknown whether low to moderate amounts of alcohol are good or bad for liver health. The measurement and identification of the possible synergistic deleterious effect of alcohol consumption in the assessment of patients with NAFLD is crucial for clinicians, since early intervention, advising abstinence and controlling cardiovascular risk factors would improve the prognosis of patients with both comorbidities. This article seeks to perform a comprehensive review of the pathophysiology of both disorders and measure the impact of alcohol consumption in patients with NAFLD.
MeSH term(s)	Humans ; Non-alcoholic Fatty Liver Disease ; Liver Cirrhosis/epidemiology ; Metabolic Syndrome ; Obesity/complications ; Obesity/epidemiology
Language	English
Publishing date	2023-04-24
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms24097791
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Article ; Online: High accuracy of spleen stiffness measurement in diagnosing clinically significant portal hypertension in metabolic-associated fatty liver disease.

Odriozola, Aitor / Puente, Ángela / Cuadrado, Antonio / Iruzubieta, Paula / Arias-Loste, María T / Redondo, Carlos / Rivas, Coral / Fábrega, Emilio / Crespo, Javier / Fortea, José I

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

2023 Volume 43, Issue 7, Page(s) 1446–1457

Abstract: Background and aims: Spleen stiffness measurement (SSM) by vibration-controlled transient elastography (VCTE) has been tested in a limited number of studies versus hepatic venous pressure gradient (HVPG), especially with the 100 Hz spleen-specific ... ...

Abstract	Background and aims: Spleen stiffness measurement (SSM) by vibration-controlled transient elastography (VCTE) has been tested in a limited number of studies versus hepatic venous pressure gradient (HVPG), especially with the 100 Hz spleen-specific module. The current study aims to evaluate the diagnostic performance of this novel module for detecting clinically significant portal hypertension (CSPH) in a cohort of compensated patients with metabolic-associated fatty liver disease (MAFLD) as the main aetiology and to improve the performance of the Baveno VII criteria for CSPH diagnosis by including SSM. Methods: This is a retrospective single-centre study including patients with available measurements of HVPG, Liver stiffness measurement (LSM) and SSM by VCTE with the 100 Hz module. Area under the receiver operating characteristic (AUROC) curve analysis was conducted to identify dual cut-offs (rule-out and rule-in) associated with the absence/presence of CSPH. The diagnostic algorithms were adequate if negative predictive value (NPV) and positive predictive values (PPV) were >90%. Results: A total of 85 patients were included, 60 MAFLD and 25 non-MAFLD. SSM showed a good correlation with HVPG (MAFLD: r = .74; p < .0001; non-MAFLD: r = .62; p < .0011). In MAFLD patients, SSM had a high accuracy in discarding/diagnosing CSPH (cut-off values of <40.9 and >49.9 kPa, AUC 0.95). The addition of these cut-offs in a sequential or combined approach to the Baveno VII criteria significantly reduced the grey zone (60% vs. 15%-20%), while maintaining adequate NPV and PPV. Conclusions: Our findings support the utility of SSM for diagnosing CSPH in MAFLD patients and demonstrate that the addition of SSM to the Baveno VII criteria increases accuracy.
MeSH term(s)	Humans ; Liver/pathology ; Liver Cirrhosis/diagnosis ; Liver Cirrhosis/diagnostic imaging ; Spleen/diagnostic imaging ; Esophageal and Gastric Varices/complications ; Retrospective Studies ; Hypertension, Portal/etiology ; Hypertension, Portal/complications ; Non-alcoholic Fatty Liver Disease/diagnosis ; Non-alcoholic Fatty Liver Disease/diagnostic imaging ; Elasticity Imaging Techniques
Language	English
Publishing date	2023-03-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2102783-3
ISSN	1478-3231 ; 1478-3223
ISSN (online)	1478-3231
ISSN	1478-3223
DOI	10.1111/liv.15561
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Article: Risk of Recurrence of Hepatocarcinoma after Liver Transplantation: Performance of Recurrence Predictive Models in a Cohort of Transplant Patients.

Cuadrado, Antonio / Fortea, José Ignacio / Rodríguez-Lope, Carlos / Puente, Ángela / Fernández-Vilchez, Vanesa / Echavarria, Victor Jose / Castillo Suescun, Federico José / Fernández, Roberto / Echeverri, Juan Andrés / Achalandabaso, Mar / Toledo, Enrique / Pellón, Raúl / Rodríguez Sanjuan, Juan Carlos / Crespo, Javier / Fábrega, Emilio

Journal of clinical medicine

2023 Volume 12, Issue 17

Abstract: Liver transplantation (LT) is a curative treatment for early-stage hepatocellular carcinoma (HCC) unsuitable for surgical resection. However, tumor recurrence (TR) rates range from 8% to 20% despite strict selection criteria. The validation of new ... ...

Abstract	Liver transplantation (LT) is a curative treatment for early-stage hepatocellular carcinoma (HCC) unsuitable for surgical resection. However, tumor recurrence (TR) rates range from 8% to 20% despite strict selection criteria. The validation of new prognostic tools, such as pre-MORAL or RETREAT risks, is necessary to improve recurrence prediction. A retrospective study was conducted at Marqués de Valdecilla University Hospital in Cantabria, Spain, between 2010 and 2019 to determine the rate of TR in LT patients and identify associated factors. Patients with liver-kidney transplantation, re-transplantation, HIV infection, survival less than 90 days, or incidental HCC were excluded. Data on demographic, liver disease-related, LT, and tumor-related variables, as well as follow-up records, including TR and death, were collected. TR was analyzed using the Log-Rank test, and a multivariate Cox regression analysis was performed. The study was approved by the IRB of Cantabria. TR occurred in 13.6% of LT patients (95% CI = 7.3-23.9), primarily as extrahepatic recurrence (67%) within the first 5 years (75%). Increased TR was significantly associated with higher Body Mass Index (BMI) (HR = 1.3 [95% CI = 1.1-1.5]), vascular micro-invasion (HR = 8.8 [1.6-48.0]), and medium (HR = 20.4 [3.0-140.4]) and high pre-MORAL risk (HR = 30.2 [1.6-568.6]). TR also showed a significant correlation with increased mortality. Conclusions: LT for HCC results in a 13.6% rate of tumor recurrence. Factors such as BMI, vascular micro-invasion, and medium/high pre-MORAL risk are strongly associated with TR following LT.
Language	English
Publishing date	2023-08-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12175457
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Article ; Online: No evidence of association between inherited thrombophilia and increased risk of liver fibrosis.

Ezcurra, Iranzu / Puente, Ángela / Cuadrado, Antonio / Tamayo, Ibai / Iruzubieta, Paula / Arias-Loste, María Teresa / González, Francisco José / Pellón, Raúl / Sánchez, Sara / Crespo, Juan / Acebo, Mercedes / López-Hoyos, Marcos / Pérez, Rocío / Cuesta, Amalia / Antón, Ángela / Echavarría, Víctor / Fábrega, Emilio / Crespo, Javier / Fortea, Jose Ignacio

United European gastroenterology journal

2023 Volume 11, Issue 10, Page(s) 1010–1020

Abstract: Background: Preliminary evidence suggests that inherited hypercoagulable disorders can lead to an increased risk of significant liver fibrosis.: Objective: We aimed to investigate the prevalence of significant fibrosis in patients with inherited ... ...

Abstract	Background: Preliminary evidence suggests that inherited hypercoagulable disorders can lead to an increased risk of significant liver fibrosis. Objective: We aimed to investigate the prevalence of significant fibrosis in patients with inherited thrombophilia, assessed by using liver stiffness (LS), and to compare this prevalence to that found in a large population-based cohort from the same region. Methods: This was a single-center, cross-sectional study. A complete laboratory analysis for liver disease, LS by transient elastography and an abdominal ultrasound were performed in patients with inherited thrombophilia diagnosed between May 2013-February 2017. These patients were propensity score matched (ratio 1:4) with a population-based cohort from the same region (PREVHEP-ETHON study; NCT02749864; N = 5988). Results: Of 241 patients with inherited thrombophilia, eight patients (3.3%) had significant fibrosis (LS ≥8 kPa). All of them had risk factors for liver disease and met diagnostic criteria for different liver diseases. After matching 221 patients with thrombophilia with 884 patients of the PREVHEP-ETHON cohort, the prevalence of significant fibrosis was similar between both cohorts (1.8% vs. 3.6%, p = 0.488). Multivariate analysis showed that age and liver disease risk factors, but not belonging to the thrombophilia cohort, were associated with the presence of significant fibrosis. The magnitude of the increased risk of significant fibrosis in patients with risk factors for liver disease was also similar in both cohorts. Conclusions: Our findings do not provide evidence supporting an association between inherited thrombophilia and an increased risk of significant liver fibrosis, independent of the presence of liver-related causes of fibrosis.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Liver Cirrhosis/diagnosis ; Liver Diseases/complications ; Thrombophilia/complications ; Thrombophilia/epidemiology ; Thrombophilia/genetics
Language	English
Publishing date	2023-11-28
Publishing country	England
Document type	Clinical Study ; Journal Article
ZDB-ID	2728585-6
ISSN	2050-6414 ; 2050-6406
ISSN (online)	2050-6414
ISSN	2050-6406
DOI	10.1002/ueg2.12500
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Article: Portal Vein Thrombosis in the Setting of Cirrhosis: A Comprehensive Review.

Odriozola, Aitor / Puente, Ángela / Cuadrado, Antonio / Rivas, Coral / Anton, Ángela / González, Francisco José / Pellón, Raúl / Fábrega, Emilio / Crespo, Javier / Fortea, José Ignacio

Journal of clinical medicine

2022 Volume 11, Issue 21

Abstract: Portal vein thrombosis constitutes the most common thrombotic event in patients with cirrhosis, with increased rates in the setting of advanced liver disease. Despite being a well-known complication of cirrhosis, the contribution of portal vein ... ...

Abstract	Portal vein thrombosis constitutes the most common thrombotic event in patients with cirrhosis, with increased rates in the setting of advanced liver disease. Despite being a well-known complication of cirrhosis, the contribution of portal vein thrombosis to hepatic decompensation and overall mortality is still a matter of debate. The incorporation of direct oral anticoagulants and new radiological techniques for portal vein recanalization have expanded our therapeutic arsenal. However, the lack of large prospective observational studies and randomized trials explain the heterogenous diagnostic and therapeutic recommendations of current guidelines. This article seeks to make a comprehensive review of the pathophysiology, clinical features, diagnosis, and treatment of portal vein thrombosis in patients with cirrhosis.
Language	English
Publishing date	2022-10-30
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11216435
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Article ; Online: SARS-CoV-2 and Liver Transplant: How Has It Behaved in This Sixth Wave?

Odriozola, Aitor / San Segundo, David / Cuadrado, Antonio / Hernáez, Tania / Escrich, Víctor / Fortea, José Ignacio / Martínez, Ángela / Puente, Ángela / Lapeña, Berta / Del Barrio, María / López-Hoyos, Marcos / Crespo, Javier / Fábrega, Emilio

Transplantation

2022 Volume 106, Issue 7, Page(s) 1445–1449

Abstract: Background: Since the declaration of a new variant of concern (VOC), Omicron, by the World Health Organization in November 2021, a quick spread has been documented worldwide, being the main VOC in the sixth wave in Spain. The Omicron variant has more ... ...

Abstract	Background: Since the declaration of a new variant of concern (VOC), Omicron, by the World Health Organization in November 2021, a quick spread has been documented worldwide, being the main VOC in the sixth wave in Spain. The Omicron variant has more transmissibility, lower virulence, and less risk of severe disease than previously described VOC. Here we analyze the current wave of severe acute respiratory syndrome coronavirus 2 infection in liver transplant recipients (LTRs). Methods: A retrospective observational study of 355 LTRs was conducted in La Rioja and Cantabria regions of Spain. Epidemiological and clinical parameters were gathered on the basis of clinical records and telephone interviews. Results: In the current wave of infection, a higher number of LTRs have been found to be infected than the sum of the previous 5 waves (30 versus 16 LTRs). Of the 30 infected LTRs, 29 (96.6%) had received 3 vaccine doses (mRNA based), in a median of 93 d (interquartile range, 86-108) before infection. Eight of 30 LTRs (24.0%) were asymptomatic and 21 LTRs (67.8%) were with mild symptoms with a mean duration of 4.6 d (interquartile range, 2.5-7), whereas in the unvaccinated LTRs, the symptoms were fever, nausea, vomiting, and diarrhea. Moreover, in the sixth wave, intrafamiliar transmission was the main route of infection (17/30; 56.6%), and nosocomial transmission was confirmed in 2 LTRs (6.6%). Conclusions: In our series, increased transmissibility of the Omicron variant was confirmed, including nosocomial infection, with a lower risk of severe disease in LTRs. These findings could be supported by the universal vaccination of LTRs and less virulence of the Omicron variant.
MeSH term(s)	COVID-19/epidemiology ; COVID-19/transmission ; COVID-19 Vaccines/administration & dosage ; Humans ; Liver Transplantation ; SARS-CoV-2 ; Spain/epidemiology ; Vaccination
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-04-08
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000004157
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Article ; Online: Bone mineral density and trabecular bone score in treatment-naïve patients with non-cirrhotic hepatitis C virus infection.

Olmos-Martínez, José M / Hernández, José L / Fábrega, Emilio / Olmos, José M / Crespo, Javier / González-Macías, Jesús

Archives of osteoporosis

2020 Volume 15, Issue 1, Page(s) 72

Abstract: We studied 112 treatment-naïve chronic HCV patients without cirrhosis, and we found that, especially HCV+ postmenopausal women, they had lower TBS and BMD values than healthy controls. This suggests that HCV infection is an independent risk factor for ... ...

Abstract	We studied 112 treatment-naïve chronic HCV patients without cirrhosis, and we found that, especially HCV+ postmenopausal women, they had lower TBS and BMD values than healthy controls. This suggests that HCV infection is an independent risk factor for osteoporosis, and therefore, screening for osteoporosis in postmenopausal HCV+ women should be considered. Purpose: To know whether patients in earlier stages of chronic HCV infection are at increased risk of developing low bone mass and bone microarchitectural changes and whether there is an association between bone metabolism and the severity of the liver disease. Methods: We studied 112 treatment-naïve chronic HCV outpatients and 233 healthy age- and sex-matched controls. Bone mineral density (BMD) and trabecular bone score (TBS) were assessed by DXA. Serum 25(OH)D, PTH, P1NP, and CTX were determined by electrochemiluminescence. Results: TBS values were significantly lower in HCV patients than in controls, both considering the population as a whole (1.337 ± 0.119 vs. 1.377 ± 0.122; p < 0.005) and after stratifying by sex (1.347 ± 0.12 vs. 1.381 ± 0.13 in men and 1.314 ± 0.10 vs. 1.369 ± 0.11 in women). The difference remained significant (p < 0.0001 in all cases) after adjusting for confounders. BMD was also lower in HCV patients (lumbar spine, 0.935 ± 0.151 vs. 0.991 ± 0.143 g/cm Conclusions: Our findings suggest that HCV infection is an independent risk factor for osteoporosis, especially among postmenopausal women. Therefore, the appropriateness of screening for osteoporosis in postmenopausal HCV-positive women should be considered.
MeSH term(s)	Absorptiometry, Photon ; Bone Density ; Cancellous Bone ; Female ; Hepacivirus ; Hepatitis C ; Humans ; Lumbar Vertebrae/diagnostic imaging ; Male ; Osteoporosis, Postmenopausal
Language	English
Publishing date	2020-05-12
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2253231-6
ISSN	1862-3514 ; 1862-3522
ISSN (online)	1862-3514
ISSN	1862-3522
DOI	10.1007/s11657-020-00752-1
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Article ; Online: An Elusive Diagnosis in Noncirrhotic Chronic Portal Vein Thrombosis.

Fortea, José Ignacio / Puente, Angela / Cuadrado, Antonio / Del Pozo, Carmen / García, Inés / Pellon, Raul / Cagigal, Maria Luisa / Fábrega, Emilio / Crespo, Javier

The American journal of medicine

2020 Volume 134, Issue 3, Page(s) e199–e200

MeSH term(s)	Aged ; Chronic Disease ; Humans ; Male ; Portal Vein ; Venous Thrombosis/diagnosis
Language	English
Publishing date	2020-09-18
Publishing country	United States
Document type	Case Reports ; Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2020.07.039
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