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Article ; Online: First Case of Successful Urgent Liver Retransplantation Using a Graft From a Donor After Uncontrolled Circulatory Death.

Justo, Iago / Caso, Óscar / Marcacuzco, Alberto / García-Conde, María / Jiménez-Romero, Carlos

2021 Volume 105, Issue 9, Page(s) e109–e110

MeSH term(s)	Adult ; Arterial Occlusive Diseases/diagnostic imaging ; Arterial Occlusive Diseases/etiology ; Arterial Occlusive Diseases/surgery ; Donor Selection ; Female ; Hepatic Artery/diagnostic imaging ; Hepatic Artery/surgery ; Humans ; Liver Transplantation/adverse effects ; Male ; Reoperation ; Thrombosis/diagnostic imaging ; Thrombosis/etiology ; Thrombosis/surgery ; Treatment Outcome
Language	English
Publishing date	2021-11-02
Publishing country	United States
Document type	Case Reports ; Letter
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000003796
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Article ; Online: Risk factors indicating the need for surgical therapy in patients with pyogenic liver abscesses.

Justo, Iago / Vega, Viviana / Marcacuzco, Alberto / Caso, Óscar / García-Conde, María / Manrique, Alejandro / Calvo, Jorge / García-Sesma, Álvaro / San Juan, Rafael / Fernández-Ruiz, Mario / Rivas, Cristina / Calero, María Rosa / Jiménez-Romero, Carlos

Langenbeck's archives of surgery

2023 Volume 408, Issue 1, Page(s) 97

Abstract: Background: Percutaneous drainage (PD) and antibiotics are the therapy of choice (non-surgical therapy [non-ST]) for pyogenic liver abscesses (PLA), reserving surgical therapy (ST) for PD failure. The aim of this retrospective study was to identify risk ...

Abstract	Background: Percutaneous drainage (PD) and antibiotics are the therapy of choice (non-surgical therapy [non-ST]) for pyogenic liver abscesses (PLA), reserving surgical therapy (ST) for PD failure. The aim of this retrospective study was to identify risk factors that indicate the need for ST. Methods: We reviewed the medical charts of all of our institution's adult patients with a diagnosis of PLA between January 2000 and November 2020. A series of 296 patients with PLA was divided into two groups according to the therapy used: ST (n = 41 patients) and non-ST (n = 255). A comparison between groups was performed. Results: The overall median age was 68 years. Demographics, clinical history, underlying pathology, and laboratory variables were similar in both groups, except for the duration of PLA symptoms < 10 days and leukocyte count which were significantly higher in the ST group. The in-hospital mortality rate in the ST group was 12.2% vs. 10.2% in the non-ST group (p = 0.783), with biliary sepsis and tumor-related abscesses as the most frequent causes of death. Hospital stay and PLA recurrence were statistically insignificant between groups. One-year actuarial patient survival was 80.2% in the ST group vs. 84.6% in the non-ST (p = 0.625) group. The presence of underlying biliary disease, intra-abdominal tumor, and duration of symptoms for less than 10 days on presentation comprised the risk factors that indicated the need to perform ST. Conclusions: There is little evidence regarding the decision to perform ST, but according to this study, the presence of underlying biliary disease or an intra-abdominal tumor and the duration of PLA symptoms < 10 days upon presentation are risk factors that should sway the surgeons to perform ST instead of PD.
MeSH term(s)	Aged ; Humans ; Abdominal Neoplasms/complications ; Abdominal Neoplasms/drug therapy ; Anti-Bacterial Agents/therapeutic use ; Gallbladder Diseases ; Liver Abscess, Pyogenic/diagnosis ; Liver Abscess, Pyogenic/etiology ; Liver Abscess, Pyogenic/therapy ; Polyesters ; Retrospective Studies ; Risk Factors
Chemical Substances	Anti-Bacterial Agents ; Polyesters
Language	English
Publishing date	2023-02-21
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-023-02837-0
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Article ; Online: Use of Nonvascularized Fascia in Liver Transplantation.

Justo, I / Marcacuzco, A / Caso, O / Manrique, A / Calvo, J / García-Sesma, A / Nutu, A / García-Conde, M / Cambra, F / Loinaz, C / Jiménez-Romero, C

Transplantation proceedings

2020 Volume 52, Issue 5, Page(s) 1468–1471

Abstract: Abdominal wall transplant is developed in the context of intestinal and multivisceral transplant, in which it is often impossible to perform a primary wall closure. Despite the fact that abdominal wall closure is not as consequential in liver transplant, ...

Abstract	Abdominal wall transplant is developed in the context of intestinal and multivisceral transplant, in which it is often impossible to perform a primary wall closure. Despite the fact that abdominal wall closure is not as consequential in liver transplant, there are circumstances in which it might determine the success of the liver graft, especially in situations that compromise the abdominal cavity and facilitate an abdominal compartment syndrome. CASE 1: A 14-year-old girl suffering from cryptogenic cirrhosis with severe portal hypertension that causes ascites and severe malnutrition. Uneventful liver transplant, with a graft procured from a 14-year-old donor. At the time of wall closure it was decided to implant a nonvascularized fascia graft to supplement the right side of the transverse incision, with a 17 x 7 cm defect. This required reintervention after 4 months for biliary stricture. At that point, the wall graft was almost completely integrated into the native tissue. CASE 2: A 63-year-old man, transplanted for hepatitis C virus+ hepatocellular carcinoma+ nonocclusive portal thrombosis. Thirty-six hours after transplant the patient developed portal thrombosis. Thrombectomy and closure with biological mesh were performed. After 24 hours he was reoperated on for abdominal compartment syndrome and temporary closure with a Bogotá bag. Six days later he underwent omentectomy, intestinal decompression, and left components separation, identifying a 25 x 20 cm defect. For definitive closure, a nonvascularized fascia graft procured from a different donor was used, accomplishing a reduction in intra-abdominal pressure. Nonvascularized fascia transplantation is an interesting alternative in liver transplant recipients with abdominal wall closure difficulties.
MeSH term(s)	Abdominal Wall/surgery ; Abdominal Wound Closure Techniques ; Adolescent ; Fascia/transplantation ; Female ; Humans ; Liver Transplantation/methods ; Male ; Middle Aged ; Reconstructive Surgical Procedures/methods ; Retrospective Studies
Language	English
Publishing date	2020-03-21
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.2020.01.081
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Article: Quistes aracnoideos: embriología y anatomía patológica.

García-Conde, Mario / Martín-Viota, Lucia

Neurocirugia (Asturias, Spain)

2015 Volume 26, Issue 3, Page(s) 137–142

Abstract: There is still great controversy surrounding the origin of the arachnoid cyst. The most accepted theory in the case of congenital cysts explains how they are formed from an anomalous development of the arachnoid membrane, which is unfolded allowing the ... ...

Title translation	Arachnoid cysts: Embriology and pathology.
Abstract	There is still great controversy surrounding the origin of the arachnoid cyst. The most accepted theory in the case of congenital cysts explains how they are formed from an anomalous development of the arachnoid membrane, which is unfolded allowing the accumulation of cerebrospinal fluid inside and creating a cyst. This theory seems to explain the origin of convexity and sylvian cistern arachnoid cysts, whereas those in other locations might be due to other mechanisms. In the anatomopathological analysis, the arachnoid cyst wall can be seen as having few differences from normal, although thickened due to an increase quantity of collagenous material. A description of the embryological development of the arachnoid layer and cyst formation is presented, describing the main anatomopathological findings.
MeSH term(s)	Arachnoid Cysts/embryology ; Arachnoid Cysts/pathology ; Humans
Language	Spanish
Publishing date	2015-05
Publishing country	Spain
Document type	English Abstract ; Journal Article ; Review
ZDB-ID	2151282-6
ISSN	1130-1473
ISSN	1130-1473
DOI	10.1016/j.neucir.2015.02.003
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Article ; Online: Liver Transplantation in Sexagenarian Patients Using Grafts From Uncontrolled Circulatory Death Versus Grafts From Brain Death Donation.

Justo, Iago / Marcacuzco, Alberto / García-Conde, María / Caso, Oscar / Cobo, Cristina / Nutu, Anisa / Manrique, Alejandro / Calvo, Jorge / García-Sesma, Alvaro / Rivas, Cristina / Loinaz, Carmelo / Jiménez-Romero, Carlos

Transplantation proceedings

2022 Volume 54, Issue 7, Page(s) 1839–1846

Abstract: Background: An increased number of older recipients underwent liver transplantation in recent years, and consequently needing to obtain more liver grafts. In order to increase this pool, in 2006, we initiated the use of livers from uncontrolled ... ...

Abstract	Background: An increased number of older recipients underwent liver transplantation in recent years, and consequently needing to obtain more liver grafts. In order to increase this pool, in 2006, we initiated the use of livers from uncontrolled circulatory death (uDCD). We analyzed the use of uDCD livers in sexagenarian recipients and their effect on overall survival. Methods: A retrospective and comparative study was performed among 4 groups according to recipient age (less or greater than 60 years) and donor type (donor brain death [DBD] or uDCD): Group A: DBD livers in recipients aged <60 years (n = 169); Group B: uDCD livers in recipients aged <60 years (n = 36); Group C: DBD livers in recipients aged >60 years (n = 96); and Group D: uDCD livers in recipients aged >60 years(n = 39). Results: Intraoperative transfusion, biliary complications, primary non-function, acute rejection, chronic renal dysfunction, retransplantation, and mortality during follow-up (cardiovascular diseases in 3 patients, hepatitis C virus recurrence in 4 patients, and de novo malignancies in 3 patients) were significantly higher, and 5-year patient and graft survival was significantly lower in sexagenarian recipients. Bilirubin and packed red blood cells transfusion were risk factors for patient survival, whereas hepatocelular carcinoma, creatinine, and packed red blood cells transfusion were risk factors for patient survival. Recipient age (<60 years) was confirmed as protective factor for patient and graft survival, whereas the use of uDCD was not a risk factor for patient or graft survival. Conclusions: Use of a uDCD liver did not demonstrate as a risk factor for patient and graft survival, and recipient age (<60 years) was a protective factor for patient and graft survival.
MeSH term(s)	Humans ; Brain Death ; Liver Transplantation/adverse effects ; Retrospective Studies ; Tissue Donors ; Graft Survival ; Death
Language	English
Publishing date	2022-07-29
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.2022.05.037
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Article ; Online: Liver transplantation for hepatocellular carcinoma using grafts from uncontrolled circulatory death donation.

Nutu, Anisa / Justo, Iago / Marcacuzco, Alberto / Caso, Óscar / Manrique, Alejandro / Calvo, Jorge / García-Sesma, Álvaro / García-Conde, María / Gallego, María Santos / Jiménez-Romero, Carlos

Scientific reports

2021 Volume 11, Issue 1, Page(s) 13520

Abstract: Controversy exists regarding whether the rate of hepatocellular carcinoma (HCC) recurrence after orthotopic liver transplantation (OLT) differs when using livers from donation after controlled circulatory death (DCD) versus livers from donation after ... ...

Abstract	Controversy exists regarding whether the rate of hepatocellular carcinoma (HCC) recurrence after orthotopic liver transplantation (OLT) differs when using livers from donation after controlled circulatory death (DCD) versus livers from donation after brain death (DBD). The aim of this cohort study was to analyze rates of HCC recurrence, patient survival, and graft survival after OLT for HCC, comparing recipients of DBD livers (n = 103) with recipients of uncontrolled DCD livers (uDCD; n = 41). No significant differences in tumor size, tumor number, serum alpha-fetoprotein, proportion of patients within Milan criteria, or pre-OLT bridging therapies were identified between groups, although the waitlist period was significantly shorter in the uDCD group (p = 0.040). HCC recurrence was similar between groups. Patient survival was similar between groups, but graft survival was lower in the uDCD group. Multivariate analysis identified recipient age (p = 0.031), pre-OLT bridging therapy (p = 0.024), and HCC recurrence (p = 0.048) as independent risk factors for patient survival and pre-OLT transarterial chemoembolization (p = 0.045) as the single risk factor for HCC recurrence. In conclusion, similar patient survival and lower graft survival were observed in the uDCD group. However, the use of uDCD livers appears to be justified due to a shorter waitlist time, and lower waitlist dropout and HCC recurrence rates.
MeSH term(s)	Adult ; Age Factors ; Brain Death ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/surgery ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Liver Neoplasms/mortality ; Liver Neoplasms/surgery ; Liver Transplantation ; Male ; Middle Aged ; Neoplasm Recurrence, Local/metabolism ; Retrospective Studies ; Risk Factors ; Tissue Donors
Language	English
Publishing date	2021-06-29
Publishing country	England
Document type	Clinical Trial ; Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-92976-5
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Article ; Online: Validation of McCluskey Index for Massive Blood Transfusion Prediction in Liver Transplantation.

Justo, Iago / Marcacuzco, Alberto / Caso, Oscar / García-Conde, María / Nutu, Anisa / Lechuga, Isabel / Manrique, Alejandro / Calvo, Jorge / García-Sesma, Alvaro / Loinaz, Carmelo / Jiménez-Romero, Carlos

Transplantation proceedings

2021 Volume 53, Issue 9, Page(s) 2698–2701

Abstract: Background: The McCluskey index has been used as a tool to predict massive bleeding (>6 red blood cells units) during orthotropic liver transplantation. The objective of this study is to verify its efficacy at our institution.: Materials and methods: ...

Abstract	Background: The McCluskey index has been used as a tool to predict massive bleeding (>6 red blood cells units) during orthotropic liver transplantation. The objective of this study is to verify its efficacy at our institution. Materials and methods: Between May 1998 and December 2017, we performed 1216 orthotropic liver transplantations, of which 1016 had sufficient data registered with respect to hemoderivative transfusion. We divided these patients into groups based on the original study of McCluskey. This study was approved by the ethical committee of our Institution and was performed in accordance with the Declaration of Helsinki. Results: The mean Model for End-Stage Liver Disease score in the 4 groups was 7.5 (range, 7-8) for low risk; 13 (range, 3-32) for medium risk, 17 (range, 8-41) for high risk, and 25 (range, 11-36) for very high risk (P < .001). No significant differences were observed regarding body mass index or hospital stay. No differences have been found in the number of suboptimal donors among the groups. With respect to hemoderivative transfusions, we observed the following for red blood cells: 7 (range, 6-8) units for low risk; 5.5 (range, 0-74) for medium risk; 7 (range, 0-73) for high risk, and 12 (range, 5-30) for very high risk (P < .001) and transfusion of plasma: 12 (range, 10-15) units for low risk; 11 (range, 0-89) for medium risk; 14 (range, 0-76) for high risk, and 13 (range, 3-30) for very high risk (P = .001). Conclusions: The McCluskey index is a good indicator of the risk of hemorrhage and hence the necessity of transfusion.
MeSH term(s)	Blood Transfusion ; End Stage Liver Disease ; Humans ; Liver Transplantation ; Retrospective Studies ; Severity of Illness Index
Language	English
Publishing date	2021-09-29
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.2021.04.022
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Article ; Online: Hemoderivative Transfusion in Liver Transplantation: Comparison Between Recipients of Grafts From Brain Death Donors and Recipients of Uncontrolled Donors After Circulatory Death.

Justo, Iago / Marcacuzco, Alberto / Caso, Oscar / García-Conde, María / Manrique, Alejandro / Calvo, Jorge / García-Sesma, Alvaro / Cambra, Félix / García, Adolfo / Cortés, Manuel / Loinaz, Carmelo / Jiménez-Romero, Carlos

Transplantation proceedings

2021 Volume 53, Issue 7, Page(s) 2298–2304

Abstract: Introduction: Intraoperative bleeding during liver transplantation has been correlated with a higher risk of morbidity and mortality and decrease in patient and graft survival.: Materials and methods: Between January 2006 and December 2016 we ... ...

Abstract	Introduction: Intraoperative bleeding during liver transplantation has been correlated with a higher risk of morbidity and mortality and decrease in patient and graft survival. Materials and methods: Between January 2006 and December 2016 we performed 783 orthotopic liver transplants. After applying exclusion criteria, we found liver grafts from donors after circulatory death (DCD, group A) were used in 69 patients and liver grafts from donors after brain death (group B) were used in 265 patients. Results: No difference was found in terms of sex, body mass index, Model for End-Stage Liver Disease score, indication for transplantation, intensive care unit stay, and Child-Pugh score. The mean transfusion of hemoderivates was as follows: red blood cell 9 (0-28) units in group A vs 6 (0-20) units in group B (P = .004) and fresh frozen plasma 10 (0-29) units in group A vs 9.5 (0-23) in group B (P = .000). The only 2 factors related to massive blood transfusion (>6 units of red blood cell) were uncontrolled DCD condition (odds ratio = 2.38; 95% confidence interval, 1.32-4.31; P = .004), and higher Model for End-Stage Liver Disease score (odds ratio = 2.63; 95% confidence interval, 1.53-4.55; P = .001). Survival at 1, 3, and 5 years was 81.3%, 70.2%, and 68.9% in group A vs 89%, 83.7%, and 78% in group B (P = .070). Conclusion: The use of liver grafts from DCDs is associated with increased necessity of transfusion of hemoderivates in comparison with the use of liver grafts from donors after brain death.
MeSH term(s)	Blood Transfusion ; Brain Death ; Death ; End Stage Liver Disease/surgery ; Graft Survival ; Humans ; Liver Transplantation/adverse effects ; Retrospective Studies ; Severity of Illness Index ; Tissue Donors
Language	English
Publishing date	2021-08-19
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.2021.07.009
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Article ; Online: Short series regarding uncontrolled donor after cardiac death: A call for caution.

Justo, Iago / Nutu, Anisa / García-Conde, María / Marcacuzco, Alberto / Manrique, Alejandro / Calvo, Jorge / García-Sesma, Álvaro / Caso, Óscar / Martín-Arriscado, Carmen / Andrés, Amado / Paz, Estela / Jiménez-Romero, Carlos

Clinical transplantation

2021 Volume 36, Issue 1, Page(s) e14508

Abstract: The authors did not receive any funding for this work. ...

Abstract	The authors did not receive any funding for this work.
MeSH term(s)	Death ; Humans ; Tissue Donors ; Tissue and Organ Procurement
Language	English
Publishing date	2021-10-26
Publishing country	Denmark
Document type	Letter ; Comment
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.14508
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Article ; Online: New technique for abdominal wall procurement. Initial experience.

Justo, Iago / Marcacuzco, Alberto / Caso, Óscar / Manrique, Alejandro / García-Sesma, Álvaro / Calvo, Jorge / García-Conde, María / Fernández, Clara / Del Pozo, Pilar / Rodríguez, Yolanda / Jiménez-Romero, Carlos

Clinical transplantation

2021 Volume 36, Issue 2, Page(s) e14535

Abstract: Difficulty in obtaining adequate abdominal wall closure due to loss of the abdominal domain is a frequent complication of multivisceral, isolated intestinal transplantation and in some cases of liver transplantation. Various methods for primary closure ... ...

Abstract	Difficulty in obtaining adequate abdominal wall closure due to loss of the abdominal domain is a frequent complication of multivisceral, isolated intestinal transplantation and in some cases of liver transplantation. Various methods for primary closure have been proposed, including the use of synthetic and biological meshes, as well as full-thickness abdominal wall and non-vascularized rectus fascia grafts. We describe a novel technique for abdominal wall procurement in which the graft is perfused synchronously with the abdominal organs and can be transplanted as a full-thickness wall or as a non-vascularized rectus fascia graft. We performed six transplants of non-vascularized rectus fascia in three intestinal transplants, one multivisceral transplant, and two liver transplants. The size of the covered abdominal wall defects ranged from 17 cm × 7 cm to 25 cm × 20 cm. Only one patient developed graft infection secondary to enterocutaneous fistula requiring surgical correction and removal of the fascia graft. This patient, as well as two other patients, died due to sepsis. Our procurement technique allows removal of the rectus fascia graft to cover the abdominal wall defect, providing a feasible solution for treatment of abdominal wall defects in recipients after abdominal organ transplantation.
MeSH term(s)	Abdominal Muscles ; Abdominal Wall/surgery ; Fascia/transplantation ; Humans ; Liver Transplantation/methods ; Organ Transplantation
Language	English
Publishing date	2021-11-29
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.14535
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