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Background: Liver transplantation (LT) is crucial for end-stage liver disease patients, but organ shortages persist. Donation after circulatory death (DCD) aims to broaden the donor pool but presents challenges. Complications like acute rejection, hepatic artery thrombosis, and biliary issues still impact posttransplant prognosis. Biomarkers, including extracellular vesicles (EVs) and microRNAs (miRNAs), show promise in understanding and monitoring posttransplant events. This study explores the role of EVs and their miRNA cargo in LT, including their potential as diagnostic tools., Methods: EVs from intrahepatic end-ischemic organ preservation solution (eiOPS) in 79 donated livers were detected using different techniques (nanosight tracking analysis, transmission electron microscopy, and flow cytometry). EV-derived miRNAs were identified by quantitative real time-polymerase chain reaction. Bioinformatics analysis was performed using the R platform., Results: Different-sized and origin-specific EVs were found in eiOPS, with significantly higher concentrations in DCD compared with donation after brain death organs. Additionally, several EV-associated miRNAs, including let-7d-5p , miR-28-5p , miR-200a-3p , miR-200b-3p , miR-200c-3p , and miR-429 , were overexpressed in DCD-derived eiOPS. These miRNAs also exhibited differential expression patterns in liver tissue biopsies. Pathway analysis revealed enrichment in signaling pathways involved in extracellular matrix organization and various cellular processes. Moreover, specific EVs and miRNAs correlated with clinical outcomes, including survival and early allograft dysfunction. A predictive model combining biomarkers and clinical variables showed promise in acute rejection detection after LT., Conclusions: These findings provide new insights into the use of EVs and miRNAs as biomarkers and their possible influence on posttransplantation outcomes, potentially contributing to improved diagnostic approaches and personalized treatment strategies in LT., Competing Interests: A.B.-M., P.P., and L.M.-A. are co-founders of Viva In Vitro Diagnostics SL, a company focused on utilizing the NLR Family Pyrin Domain Containing 3 inflammasome as a disease biomarker. A.B.-M. is also co-inventor listed on a provisional patent application for an in vitro method predicting organ transplant rejection. However, it is important to note that this research was conducted independently, without any commercial or financial associations that might be considered a conflict of interest. The other authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Innate immunity plays a fundamental role in solid organ transplantation. Myeloid cells can sense danger signals or DAMPs released after tissue or cell damage, such as during ischemia processes. This study aimed to identify DAMPs released during cold ischemia storage of human liver and analyze their ability to activate the inflammasome in myeloid cells and the possible implications in terms of short-term outcomes of liver transplantation., Methods: 79 samples of organ preservation solution (OPS) from 79 deceased donors were collected after cold static storage. We used different analytical methods to measure DAMPs in these end-ischemic OPS (eiOPS) samples. We also used eiOPS in the human macrophage THP-1 cell line and primary monocyte cultures to study inflammasome activation., Findings: Different DAMPs were identified in eiOPS, several of which induced both priming and activation of the NLRP3 inflammasome in human myeloid cells. Cold ischemia time and donation after circulatory death negatively influenced the DAMP signature. Moreover, the presence of oligomeric inflammasomes and interleukin-18 in eiOPS correlated with early allograft dysfunction in liver transplant patients., Interpretation: DAMPs released during cold ischemia storage prime and activate the NLRP3 inflammasome in liver macrophages after transplantation, inducing a pro-inflammatory environment that will complicate the outcome of the graft. The use of pharmacological blockers targeting DAMPs or the NLRP3 inflammasome in liver ischemia during static cold storage or through extracorporeal organ support could be a suitable strategy to increase the success of liver transplantation., Funding: Fundación Mutua Madrileña and Instituto de Salud Carlos III, Madrid, Spain., Competing Interests: Declaration of interests P.P. is scientific consultant of Glenmak Ltd, FirstThought, Donation and Transplantation Institute and Viva in vitro diagnostics. P.P. is co-inventor on patent application to use NLRP3 inflammasome as biomarker of disease, which have been licensed to Viva in vitro diagnostics S.L, a company co-funded by P.P., A.B.-M. and L.M-A. A.B-M. is co-inventor on provisional patent application of an in vitro method for predicting organ transplant rejection, but declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The rest of authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: Resilience is the ability to recover or adequately face adverse situations. It acts as a protective factor against negative events and/or complex stages of life, such as a chronic and complex disease requiring liver transplant. Age can also have an effect on a patient's ability to deal with liver transplant, resilience here being a predictor of well-being., Objective: To analyze the level of resilience and its relationship with health-related quality of life (HRQoL) in patients over 60 years of age who underwent an orthotopic liver transplant (OLT) more than 10 years ago., Materials and Methods: We conducted a cross-sectional descriptive study at the Hospital Clínico Virgen Arrixaca., Instrument: 1. To analyze resilience we used the Connor-Davidson Resilience Scale (CD-RISC 17) which measures 3 dimensions (tenacity/self-efficacy, personal control, and social competence). 2. To evaluate HRQoL, we used the Short Form-36 Health Survey (SF-36) questionnaire which covers 8 dimensions and produces 2 summary scores. Variables included age, sex, and post-OLT survival. Non-parametric statistical analysis was performed (P < .05)., Results: We analyzed 47 patients, 68% men (n = 32). The average age was 70.85 ± 0.98 years and average post-OLT survival was 15.79 ± 0.78 years. In terms of resilience, men had higher scores in tenacity/self-efficacy (90.82 ± 2.71 vs 84.79 ± 3.49; P = .029) and personal control (82.5 ± 3.79 vs 69.33 ± 5.23; P = .023). The longer the post-OLT period, the less personal control (R = -0.298; P = .042). Regarding HRQoL, the dimension of personal control is positively related: physical function (R = 0.388; P = .007); general health (R = 0.429; P = .003); vitality (R = 0.560; P = .000); social function (R = 0.402; P = .005); mental health (R = 0.311; P = .034); and physical summary (R = 0.381; P = .008). Like social competence, it is related to mental health (R = 0.360; P = .013) and mental summary (R = 0.384; P = .008)., Conclusion: These patients showed adequate levels of resilience. A greater resilience is related to greater general health, vitality, social functioning, and mental health., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: In liver transplantation, living donation shows better and better results. However, rates of living liver donation (LLD) are low., Objective: To analyze the attitude towards LLD among patients on the waiting list for liver transplantation., Method: Study population: Patients included in the waiting list for liver transplantation who are not in code 0 and do not present with encephalopathy above grade I., Protocol: After being included in the waiting list, they are informed of the study and they are cited in the Psychology Consultation., Instruments: attitude questionnaire towards LLD, carried out in the Psychological Care consultation., Results: Of the 147 patients included in the waiting list, 112 fulfilled the inclusion criteria in the study. After being cited in the consultation, 100% of respondents are in favor of living liver donation. However, when considering the related LLD, 80% of the respondents indicated that they would not accept a living donation from a family member and therefore did not want to complete the questionnaire. Of the remaining 20% who completed the study, 11% would accept it from any family member, 8% only from some family members (mainly excluding children and grandchildren), and the remaining 1% would accept it but excluded all their family members., Conclusion: Currently, there is a disconnect between patients' intentions in favor of living liver donation and the real attitude when they are on the waiting list and related living donation is raised., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Sarcopenia is defined as the loss of muscle mass and function. Our aim is to evaluate the degree of sarcopenia by measuring the patients on the waiting list for liver transplantation and its influence on the different post-liver transplant outcomes in our group., Methods: The psoas muscle index (PMI, cm 2 /m 2 ) was calculated (right psoas muscle area [cm 2 ]/the square of the body height [m 2 ]) in 57 patients on the waiting list for liver transplantation in our center, and the post-transplant variables relevant to our study were collected., Results: The 57 recipients had a mean age of 57 years (range, 35-73) and had a mean of 7.4 months (range, 0-39) on the liver transplant waiting list. The mean psoas muscle index was 2.39 (range, 1-4), and the mean body mass index was 28.01kg/m 2 (range, 22-36). After multivariate analysis we found a positive correlation between the PMI and the body mass index of the recipients (r = 0.320, P = .017), intensive care unit length of stay, and donor age (r = 0.319, P = .042), and between cold ischemia time and graft survival (r = 0.366, P = .009). We found no correlation in our sample between PMI and post-liver transplant complications either in terms of graft or patient survival., Conclusion: PMI is not representative of total muscle mass and sarcopenia and is not effective in adequately predicting the survival of patients on the waiting list for liver transplantation., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Orthotopic liver transplantation (OLT) represents an improvement in the quality of life (QoL) in the short to medium term. However, there is little information about QoL in the long-term post-transplant and its relation with psychological variables such as self-esteem., Objective: To analyze the perceived QoL in relation to the level of self-esteem in patients over 60 years of age who received an OLT more than 10 years ago., Materials and Methods: Cross-sectional descriptive study. Including patients from the Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA)., Instrument: to evaluate the QoL: EuroQol-5D questionnaire; to evaluate health status: 1. social transfer index and 2. visual analog scale (VAS); to measure self-esteem level: Rosenberg scale. Sociodemographic and clinical variables. Nonparametric analysis (P < .05)., Results: Analyzed 46 patients, 70% men (n = 32) and 30% women (n = 14); mean age of 70.85 ± 6.7 years and mean years of post-OLT survival of 15.91 ± 5.3 years. Average score in QoL: 0.8 ± 0.17 in the social transfer index and 77.07 ± 16.82 in the VAS. Average level of self-esteem: 34 ± 3.55 point. When analyzing the variables, there are no differences in age or post-OLT years. There are significant differences according to sex (P = .001). However, the diagnosis influences the patient's perception of QoL (P < .001). The post-OLT survival correlates negatively with social transfer index (P = .017) and self-esteem level (P = .045). In addition, those patients living in the city presented a higher level of self-esteem (P = .03)., Conclusion: Sex, diagnosis, post-OLT years, social environment, and place of residence have an influence on the QoL and self-esteem of patients., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Hepatic artery thrombosis is one of the most serious complications after liver transplant. Our objective is to evaluate the impact of arterial thrombosis on the postoperative evolution of a series of patients who received transplants because of hepatocellular carcinoma., Methods: A retrospective study of 100 consecutive hepatocellular carcinoma liver transplants was performed from January 2011 to November 2017., Results: Of the 100 transplant recipients, we have observed hepatic artery thrombosis in 4 of them, 3 premature and 1 delayed. All of them received retransplants after diagnosis by hepatic artery ultrasonography and arteriography. The descriptive analysis showed a significant relationship between the appearance of hepatic artery thrombosis with variables of postoperative severity, such as arrhythmias, atelectasis, pleural effusion, hemodialysis requirement, acute kidney failure, and respiratory failure. Although patients with hepatic artery thrombosis had a longer mean hospital stay, this was not statistically significant. There was decreased graft survival and overall survival of patients who experienced hepatic artery thrombosis., Conclusion: Although the incidence of hepatic artery thrombosis has been relatively low (4%), the early detection of risk factors, such as arterial anatomic anomalies that condition a complex anastomosis, should draw our attention, thus having at our disposal strict ultrasonography and arteriography surveillance protocols as well as prophylactic anticoagulation guidelines for receptors at risk., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: The attitude toward living liver donation (LLD) among the Spanish population is mostly positive; however, the reality is that liver transplants from live donations are currently minimal. Given this situation, studies that analyze these discrepancies should be carried out., Objective: Analyze the attitude toward LLD among family members of patients on the waiting list for liver transplantation., Method: Population under study. First-degree relatives of the patients included in the waiting list for liver transplantation., Inclusion Criteria: 1. Have the patient's authorization for family members to participate; 2. Accept, the relative, to participate in this investigation; and 3. Be over 18 years old. Opinion survey. The attitude toward LLD is assessed through a questionnaire on psychosocial aspects., Results: Patients who accepted family members' participation in the study were 21 of 112, of which 9 placed restrictions on family access, and 12 authorized family members without restrictions. The participants were 1. children: 52.2% (n = 24); 2. brothers: 30.5% (n = 14); and 3. partners: 17.3% (n = 14). Finally, the authorized relatives and participants in the study were 45. Of these, only 44% (n = 20) would accept to be donors., Conclusions: The access to the LLD of the relatives starts from the restriction and initial rejection of the patients themselves on the waiting list. The promotion of LDD is to initially sensitize patients., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Our main objective was to compare liver transplant (LT) results between donation after circulatory death (DCD) and donation after brainstem death (DBD) in our hospital and to analyze, within the DCD group, the influence of age on the results obtained with DCD donors aged >70 years and up to 80 years. All DCD-LTs performed were analyzed prospectively. The results of the DCD group were compared with those of a control group who received a DBD-LT immediately after each DCD-LT. Later, the results obtained within the DCD group were analyzed according to the age of the donors, considering 2 subgroups with a cut-off point at 70 years. Survival results for LT with DCD and super rapid recovery were not inferior to those obtained in a similar group of patients transplanted with DBD livers. However, the cost of DCD was a higher rate of biliary complications, including ischemic cholangiopathy. Donor age was not a negative factor., (© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Background: Numerous studies have emphasized the genetic and phenotypic profiles of tolerant transplant patients. Moreover, different groups have defined several biomarkers, trying to distinguish patients who are going to be tolerant from those who are going to reject. However, most of these biomarkers have not been validated by other groups or even established for clinical practice., Methods: We reanalyzed and stratified the predictive capacity of 20 previously described biomarkers for liver transplantation tolerance in a cohort of 17 liver transplant patients subjected to an independent, nonrandomized, prospective study of immunosuppression drug withdrawal., Results: Only 4 of the 20 studied biomarkers (expression of SENP6, FEM1C, miR31, and miR95) showed a strong predictive capacity in the present study. miR31 and FEM1C presented an area under the ROC curve of 96.7%, followed by SENP1 with 93.3%. Finally, miR95 had an area under the ROC curve value <86.7%., Conclusions: Even though this independent analysis seems to confirm the predictive strength of SENP6 and FEM1C in liver transplantation tolerance, there are also risks in establishing biomarkers for clinical phenotypes without an understanding of how they are biologically relevant. Future collaborations between groups should be promoted so that the most promising biomarkers can be validated and implemented in daily clinical practice.

Aim: To determine the psychological characteristics of patients on the liver transplant waiting list; to analye the implications of the patient's psychological profile on coping with the disease., Material and Methods: Study population: patients on the liver transplant waiting list. Psychological-profile: Socio-personal history; Mini Mental State Examination; Brief-Symptom Inventory of psychopathological problems; International Neuropsychiatric Interview; Family APGAR questionnaire; Social Support Questionnaire. Coping with the disease: A questionnaire about mental adaptation to the disease. Patients were recruited for the study at the time when they were included on the waiting list., Results: The patients (n=112) had the following characteristics: 68% of the patients had symptoms of emotional psychopathology, with 48% being of a depressive, anxious and obsessive-compulsive type, respectively. In terms of social and family support, 27% had the perception of being in a dysfunctional family (slight-23%; serious-4%). What is more, according to the Global Support Index, 21% had non-functional social and family support. Coping with the disease: 8% were well-adapted to the disease, the remaining 92% were poorly adapted; of which, 79% had a weaker fighting spirit, 51% expressed anxiety and concern about coping with the disease, 34% found they resorted to fatalism, 29% were in denial and 27% felt helpless., Conclusions: Once liver patients are included on the transplant waiting list, they poorly adapt to the disease, with important emotional implications that result in psychological alterations., (Copyright © 2019 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

The involvement of health professionals from their training period is important for the promotion of living liver donation. There are data that indicate that the awareness of living donation is lower in areas with high rates of deceased donation., Objective: To analyze the attitude toward living liver donation among Spanish medical students, according to donation rates of their regions., Method: Population under study: Medical students in Spanish universities. Database of the Collaborative International Donor Project, stratified by geographic area and academic course. The completion was anonymous and self-administered. Groups under study: group 1 (n = 1136): students in universities of regions with >50 donors per million population (pmp); group 2 (n = 2018): students in region universities with <40 donors pmp. Assessment instrument: the attitude questionnaire for living liver donation Proyecto Colaborativo Internacional Donante sobre Donación de Vivo Hepático-Ríos (PCID-DVH Ríos)., Results: The attitude toward related liver donation is more favorable among the students of regions with <40 donors pmp than among those of >50 donors pmp. Thus, in group 1, a total of 88% (n = 1002) of students are in favor compared with 91% (n = 1831) of group 2 (P=.02). The psychosocial profile of each study group about their attitude toward living related liver donation is analyzed. There is a similar profile between the 2 groups, although there are differences in some variables such as age, a belief that one might need a transplant, family discussion about donation and transplantation, discussion with friends about donation and transplantation, and knowing about a donor., Conclusions: The awareness of living related donation among Spanish medical students is greater among the regions with lower organ donation rates., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: It is well-known that there is a high incidence of depression in patients on the liver transplant (LT) waiting list. However, there have been few studies of psychological intervention on these patients., Objectives: To determine symptoms of depression in patients on the LT waiting list and the impact of group psychotherapy., Methods: Study population: patients on the LT waiting list who received group psychotherapy (n = 15)., Control Group: patients who did not receive psychotherapy (n = 10). Measurement instrument: Beck's depression test, which was provided before psychotherapy was initiated and after it was completed (after 6 months). The control group was given the questionnaire at the same 2 points in time as the study group. The psychotherapeutic method consisted of discussing patients' feelings, which dealt with several matters related to transplantation. Different coping strategies were considered., Results: More than half of those surveyed initially had depressive symptoms. When the second survey was administered to the study population, all the patients improved in their psychopathological assessment. When the survey was administered to the control group, a worse psychopathological assessment was obtained in all cases., Conclusions: Our data suggest an improvement in depressive symptoms in patients on the LT waiting list after receiving group psychotherapy., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The artificial induction of tolerance in transplantation is gaining strength. In mice, a differential role of extracellular adenosine (eADO) for regulatory and effector T cells (Tregs and Teffs, respectively) has been proposed: inhibiting Teffs and inducing Tregs. The aim of this study was to analyze the action of extracellular nucleotides in human T cells and, moreover, to examine the influence of CD39 and CD73 ectonucleotidases and subsequent adenosine signaling through adenosine 2 receptor (A 2 R) in the induction of clinical tolerance after liver transplant. The action of extracellular nucleotides in human T cells was analyzed by in vitro experiments with isolated T cells. Additionally, 17 liver transplant patients were enrolled in an immunosuppression withdrawal trial, and the differences in the CD39-CD73-A 2 R axis were compared between tolerant and nontolerant patients. In contrast to the mice, the activation of human Tregs was inhibited similarly to Teffs in the presence of eADO. Moreover, the expression of the enzyme responsible for the degradation of ADO, adenosine deaminase, was higher in tolerant patients with respect to the nontolerant group along the immunosuppression withdrawal. Our data support the idea that eADO signaling and its degradation may play a role in the complex system of regulation of liver transplant tolerance., (© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Background: The patients on the liver transplant (LT) waiting list usually present with deterioration in their quality of life. Previous studies on psychological intervention have shown how the quality of life can be improved., Objective: To analyze preliminary results of the influence of group psychotherapy on the quality of life of patients on the LT waiting list., Method: Fifteen patients on the LT waiting list who accepted receiving group psychotherapy were selected. The development of each 1 of these sessions was carried out at fortnightly periods for 6 months (12 sessions). Those patients who received a transplant and those patients who did not attend more than 6 group psychotherapy sessions were excluded. The Nottingham Health Profile was used to assess the quality of life. It consists of 38 items belonging to 6 health dimensions: energy, pain, physical mobility, emotional reaction, sleep, and social isolation. The study population was given a questionnaire before starting group psychotherapy and after it was finished., Results: Of the 15 patients selected from the study population, 3 patients were given a transplant before the psychotherapy had finished, and 5 patients were excluded for not having attended more than 50% of the sessions. Therefore, the study was completed on 7 patients (n = 7). Overall, a better assessment can be seen in the second questionnaire., Conclusions: Group psychotherapy might favorably influence the quality of life of patients on the LT waiting list; therefore, it might be interesting to carry out studies on a larger scale in order to confirm these results., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: The immunorejection in xenotransplantation has mostly been studied from the host's immune system activation point of view and there is very little information about the graft-vs-host reaction., Objectives: To validate an enzyme-linked immunosorbent assay (ELISA) test for porcine IgM and IgG quantitation, the assessment of porcine IgG and IgM in sera samples from baboons after liver orthotopic xenotransplantation or in human plasma after xenotransfusion through pig organs, and to assess the presence of porcine immunoglobulin in a baboon after plasmapheresis to a complete change of plasma after 4 passages through pig liver., Materials and Methods: Two commercial ELISA kits for pig IgG and IgM quantitation were evaluated for cross reactivity with samples from baboons, Rhesus monkeys, squirrel monkeys, and humans. Then, samples from 18 baboons after orthotopic liver xenotransplantation were studied for porcine IgG and IgM. To understand the phenomenon, human plasma samples after xenotransfusion 1, 2, 3, or 4 times through liver or kidney were assessed for porcine IgG presence and finally, the porcine IgG were quantified in sera samples obtained during more than 4 years from a baboon after plasmapheresis with baboon plasma after xenotransfusion 4 times through a pig liver., Results: Porcine IgG and IgM were found in samples from xenotransplanted baboon during all survival. The quantity of porcine IgG in plasma after xenotransfusion correlated with the number of passages through the pig liver, and the IgG were completely cleared from the baboon 16 days after plasmapheresis and complete substitution of plasma after 4 xenotransfusions through a pig liver., (Copyright © 2018. Published by Elsevier Inc.)

Veterinarians often hold decision-making positions in the public health care system, and therefore can influence public opinion about organ donation. The objective is to analyze the attitude of Spanish veterinarian students toward living liver donation (LLD) and to establish which factors have an influence on this attitude., Methods: A sociological, interdisciplinary, multicenter, and observational study was carried out in the veterinarian students enrolled in Spain (n = 9000) (university academic year 2010-2011). A sample of 2854 students was stratified by geographic area and academic year. A validated questionnaire (PCID-DVH RIOS) was self-administered and completed anonymously. The questionnaire was applied to each academic year at compulsory sessions at randomly selected veterinary schools. Statistical analysis included t test, χ 2 test, and logistic regression analysis., Results: Completion rate was 94% (n = 2683); 89% (n = 2345) were in favor of related LLD, and 40% (n = 1053) supported unrelated LLD. The following variables were associated with a more favorable attitude: (1) age (P < .001), (2) sex (P < .001), (3) academic year (P < .001), (4) believing in the possibility of needing a transplant oneself in the future (P < .001), (5) attitude toward deceased donation (P < .001), (6) attitude toward living kidney donation (P < .001), (7) acceptance of a donated liver segment from a family member if one were needed (P < .001), (8) having discussed the subject with one's family (P = .009) and friends (P < .001), (9) a partner's opinion about the subject (P = .002), and (10) fear of the possible mutilation of the body after donation (P < .001)., Conclusion: Spanish veterinary students have a favorable attitude toward LLD., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Living kidney related donations (LKRD) should be promoted because of the current deficit of organs for transplantation. The objective of the study was to analyze the attitude of Spanish veterinary students toward LKRD, because they may influence public opinion in the future, and to determine the factors that condition it., Methods: A sociological, interdisciplinary, multicenter, and observational study was carried out in the veterinary students enrolled in Spain (n = 9000) in the university academic year 2010-2011. A sample of 2815 students was stratified by geographical area and academic year. The students' attitude toward LKRD was assessed using a psychosocial validated questionnaire (PCID-DVR Rios), was self-administered, and was completed anonymously. Veterinary schools were randomly selected. The questionnaire was applied to each academic year at compulsory sessions. Statistical analysis was preformed using t test, χ 2 test, and logistic regression analysis., Results: The completion rate was 95% (n = 2683); 93% (n = 2504) were in favor of LKRD and 36% (n = 945) supported unrelated living kidney donation. The following variables were associated with having a more favorable attitude: (1) sex (P < .001), (2) being a student of southern universities (P = .03), (3) attitude toward deceased donation (P < .001), (4) having a father (P < .001) or a mother (P < .001) in favor of organ donation, and (5) having discussed the subject with friends (P = .03) or family (P = .02). However, only 60% would accept a kidney from a relative., Conclusion: Spanish veterinary students have a favorable attitude toward LKRD. However, only 60% would accept a kidney from a relative., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Regulatory T cells (Tregs) play a potential role in operational tolerance in liver transplantation (LT) patients, and microRNAs (miRNAs) are known to be involved in immunological responses and tolerance. Thus, we analyzed the implication of different peripheral blood Treg subsets and miRNAs on LT tolerance in 24 tolerant (Tol) and 23 non-tolerant (non-Tol) LT recipients by cellular, genetic, and epigenetic approximation. Non-Tol patients had a lower demethylation rate of the forkhead box P3 (FOXP3) regulatory T cell-specific demethylated region (TSDR) than Tol patients that correlated with the frequency of circulating Tregs. Tol patients presented a different signature of Treg subset markers compared with non-Tol patients with increased expression of HELIOS and FOXP3 and a higher proportion of latency-associated peptide (LAP) + Tregs and CD45RA - human leukocyte antigen D related (HLA-DR) + activated effector-memory Tregs. The expression of miR95, miR24, miR31, miR146a, and miR155 was higher in Tol than in non-Tol patients and was positively correlated with activated Treg markers. In conclusion, these data suggest that activated effector-memory Tregs and a TSDR-demethylation state of Tregs may play a role in the complex system of regulation of LT tolerance. In addition, we describe a set of miRNAs differentially expressed in human LT Tol patients providing suggestive evidence that miRNAs are implied in the preservation of self-tolerance as mediated by Tregs. Liver Transplantation 23 933-945 2017 AASLD., (© 2016 by the American Association for the Study of Liver Diseases.)

Transplantation is the optimal treatment for end-stage organ failure, and modern immunosuppression has allowed important progress in short-term outcomes. However, immunosuppression poorly influences chronic rejection and elicits chronic toxicity in current clinical practice. Thus, a major goal in transplantation is to understand and induce tolerance. It is well established that human regulatory T cells expressing the transcription factor FoxP3 play important roles in the maintenance of immunological self-tolerance and immune homeostasis. The major regulatory T cell subsets and mechanisms of expansion that are critical for induction and long-term maintenance of graft tolerance and survival are being actively investigated. Likewise, other immune cells, such as dendritic cells, monocyte/macrophages or natural killer cells, have been described as part of the process known as "operational tolerance". However, translation of these results towards clinical practice needs solid tools to identify accurately and reliably patients who are going to be tolerant. In this way, a plethora of genetic and cellular biomarkers is raising and being validated worldwide in large multi-center clinical trials. Few of the studies performed so far have provided a detailed analysis of the impact of immunosuppression withdrawal on pre-existing complications derived from the long-term administration of immunosuppressive drugs and the side effects associated with them. The future of liver transplantation is aimed to develop new therapies which increase the actual low tolerant vs non-tolerant recipients ratio., Competing Interests: Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.

Aim: To analyze the attitude of Spanish medical students toward living liver donation (LLD) and to establish which factors have an influence on this attitude., Study Type: A sociological, interdisciplinary, multicenter and observational study., Study Population: Medical students enrolled in Spain (n = 34000) in the university academic year 2010-2011., Sample Size: A sample of 9598 students stratified by geographical area and academic year. Instrument used to measure attitude: A validated questionnaire (PCID-DVH RIOS) was self-administered and completed anonymously. Data collection procedure: Randomly selected medical schools. The questionnaire was applied to each academic year at compulsory sessions., Statistical Analysis: Student´s t test, χ(2) test and logistic regression analysis., Results: The completion rate was 95.7% (n = 9275). 89% (n = 8258) were in favor of related LLD, and 32% (n = 2937) supported unrelated LLD. The following variables were associated with having a more favorable attitude: (1) age (P = 0.008); (2) sex (P < 0.001); (3) academic year (P < 0.001); (4) geographical area (P = 0.013); (5) believing in the possibility of needing a transplant oneself in the future (P < 0.001); (6) attitude toward deceased donation (P < 0.001); (7) attitude toward living kidney donation (P < 0.001); (8) acceptance of a donated liver segment from a family member if one were needed (P < 0.001); (9) having discussed the subject with one's family (P < 0.001) and friends (P < 0.001); (10) a partner's opinion about the subject (P < 0.001); (11) carrying out activities of an altruistic nature; and (12) fear of the possible mutilation of the body after donation (P < 0.001)., Conclusion: Spanish medical students have a favorable attitude toward LLD.

Introduction: It is well-known that patients on the liver transplant (LT) waiting list experience a high rate of psychopathologic symptoms. However, few studies have been published about the use of group psychotherapy for these patients. We sought to assess (1) the psychopathologic data in patients on the LT waiting list and (2) the attitude toward a group psychotherapy procedure and its efficacy., Material and Methods: In the pretransplant consultation phase, group therapy was offered to 20 patients on the LT waiting list. Patients who received psychotherapy were assessed previously using the Beck Depression Inventory., Results: Fifteen patients were included in the study. Significant differences were found between the psychopathologic assessment and the level of hepatopathy. In the first session, we observed that patients with hepatocarcinoma were much more reluctant to participate in the group therapy. In the second session, the group showed a high level of anxiety connected with a fear of transplantation. In the third session, a transplant physician answered all their questions, and at the end of the session patient anxiety had decreased. During the following sessions, family bonds and sharing experiences with other transplant patients were emphasized., Conclusions: Patients were initially reluctant to participate in the group psychotherapy, although this changed as sessions proceeded. It is necessary to provide more information about the transplant procedure itself to decrease anxiety. Group therapy was valued positively by all patients who participated., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Introduction: Given the lack of a sufficient number of livers available for transplantation, living liver donation (LLD) is being developed in the Spanish-speaking world. To do this, it is essential that health workers in hospitals are in favor of such donation, given that they are a key component in this treatment and that their attitudes influence public opinion., Objective: To analyze attitude toward LLD among hospital personnel from healthcare centers in Spain and Latin America., Material and Method: Ten hospitals were selected from the «International Donor Collaborative Project»: 3 from Spain, 5 from Mexico and 2 from Cuba. Random sampling stratified by type of service and job category was used. Attitudes to LLD were evaluated through a validated questionnaire on psychosocial aspects. The questionnaire was anonymous and self-administered. Statistical tests consisted of Student's T test, the chi-square test and logistic regression analysis., Results: Of the 2,618 employees surveyed, 85% (n=2,231) were in favor of related LLD; of these, 31% (n=804) were in favor of unrelated LLD. No association was found between the country of the interviewed, personal-social variables or work-related variables. The following factors were associated with a favorable attitude toward related LLD donation: having had personal experience of donation and transplantation (P<.001); being in favor of deceased donation (P<.001); believing that one might need a possible transplant (P<.001); being in favor of living kidney donation (P<.001); being willing to accept a liver from a living donor (P<.001); having discussed the matter of donation and transplantation within the family (P<.001) and with one's partner (P<.001); carrying out pro-social type activities (P<.001); being Catholic (P=.040); believing that one's religion is in favor of donation and transplantation (P<.001); and not being concerned about the possible mutilation of the body after donation (P<.001)., Conclusions: Hospital personnel from Spain and Latin America had a favorable attitude toward LLD, which was associated with factors directly and indirectly related to donation and transplantation, family and religious factors, and attitudes toward the body., (Copyright © 2015 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.)

Introduction: Hospital professionals are an opinion group that influences the general population., Objective: To analyze attitudes to living donor liver transplantation (LDLT) among non-medical professionals working in Spanish and Latin American hospitals and to determine the variables that influence these attitudes., Material and Method: A random sample, stratified by department, was selected from non-medical staff in the "International Donor Collaborative Project": there were three hospitals in Spain, five in Mexico and two in Cuba. Attitudes were evaluated through a validated, anonymous, self-administered questionnaire., Results: There were 951 non-medical professionals: 277 from Spain, 632 from Mexico and 42 from Cuba. A total of 86% (n = 818) were in favor of related living donation and 31% (n = 299) were in favor of unrelated living donation. This attitude was associated with the following: country (Mexico 88%, Cuba 83%, Spain 81%) (p =0.016), female sex (p =0.026), having experience of donation and transplantation (p =0.001), having a favorable attitude to donation (P <0.001), considering the possibility of needing a transplant (P <0.001), being in favor of living kidney donation (P <0.001), being willing to accept a transplant from a living donor if necessary (P <0.001), discussing donation and transplantation with the family and partner (P <0.001), carrying out pro-social activities (P <0.001), believing that one's religion was in favor of donation and transplantation (P<0.001), and not worrying about bodily mutilation after donation (P <0.001)., Conclusions: Attitudes toward related LDLT among non-medical staff in various Spanish, Mexican and Cuban hospitals are favorable. In 86% of those surveyed, this attitude was not influenced by classical psychosocial factors., (Copyright © 2012 Elsevier España, S.L. and AEEH y AEG. All rights reserved.)

Introduction: Current liver donation rates are insufficient to cover transplant needs. Therefore, it is essential to promote living liver donation (LLD) given the ever decreasing morbidity and mortality in the donor and the improving results in the recipient. LLD is becoming increasingly accepted. However, in the health care system, a percentage of the personnel are not in favor., Objective: To analyze the attitude of personnel in surgical services in Spain and Latin-America hospitals toward LLD., Materials and Methods: As part of the "International Collaborative Donor Project," a random sample was taken and stratified according to surgical service and job category in 10 hospitals; three in Spain, five in Mexico, and two in Cuba (n = 496). Attitude was evaluated using a validated survey that was completed anonymously and self-administered., Results: Eighty-six percent (n = 425) of respondents were in favor of related living liver donation, and 30% (n = 147) were in favor if it were not related. According to country, 88% of the Mexican respondents were in favor of living liver donation, 85% of the Cubans, and 82% of the Spanish (P > .05). In the multivariate analysis of the variables with most weight affecting attitude toward LLD, the following significant associations were found: (1) a favourable attitude toward living kidney donation (odds ratio [OR] = 91; P < .001); (2) acceptance of a donated living liver if one were needed (OR = 11; P < .001); and (3) family discussion about donation and transplantation (OR = 2.581; P = .037)., Conclusions: Attitude toward related living liver donation was very favorable among hospital personnel in Spanish and Latin American surgical services., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Introduction: The infant and youth population constitutes a sector in which early awareness is important to increase favorable attitudes toward donation. Objectives were as follows: (1) to analyze the attitudes of adolescents toward living organ donation; and (2) to determine the psychosocial variables affecting them., Materials and Methods: In Southeast of Spain a random sample was stratified according to Compulsory Secondary Education (CSO) school. In the 10 selected schools we performed a random sampling of each of the classes from the first to the fourth year of CSO. Attitudes were evaluated using a validated questionnaire lowering psychosocial aspects of donation. The self-administered questionnaire was completed anonymously. Statistical analyses employed Student t test and the χ(2) test., Results: Regarding living kidney donation, 89% (n = 3146) of adolescents favored it, although only 29% (n = 1035) in unrelated cases. For living liver donation, 78% (n = 2753) were in favor of related donation, but only 19% (n = 668) were in favor if it was unrelated. The favorable attitude toward living donation was mainly associated with the following variables: (1) being a woman; (2) having previous experience with the donation-transplantation process; (3) having spoken about the matter of donation and transplantation with family and friends; (4) a favorable attitude of one's mother and father; (5) concern about possible bodily mutilation after donation; and (6) having performed pro-social type activities (P < .05)., Conclusions: Related living donation is well accepted among adolescents on the Southeast of Spain. There was a high acceptance of unrelated living donation compared with studies published in other geographic areas., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The liver is a privileged organ with a lower incidence of rejection than other organs. However, immunosuppressive regimens are still required to control the alloreactive T-lymphocyte response after transplantation. These treatments may lead to severe complications, such as infectious diseases, cancers, cardiovascular diseases, and chronic renal insufficiency. In clinical transplantation, there is increasing evidence that some liver transplant recipients who cease taking immunosuppressive drugs maintain allograft function, suggesting that tolerance is already present. This strategy is feasible in 25% to 33% of liver transplant recipients. Few of the studies performed so far have provided a detailed analysis of the impact of immunosuppression (IS) withdrawal on pre-existing complications derived from the long-term administration of immunosuppressive drugs and the side effects associated with it. In preliminary studies, IS withdrawal was safely achieved in selected liver transplant patients, and improved not only kidney function, but also other IS-associated side-effects such as hypercholesterolemia, hyperuricemia, hypertension, and diabetes control. However, longer follow-up periods are needed to confirm the benefits of IS withdrawal in liver transplant patients., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: The organ transplant deficit is leading to an increase in the importance of solid organ xenotransplantation. However, the use of animals for human transplantation causes a certain amount of opposition in patients and the general public. The objective of this study was to analyze the attitude of patients on the kidney and liver waiting list toward xenotransplantation and the variables affecting this attitude., Methods: Patients on the kidney and liver waiting list (January 2003 - December 2005) were surveyed. Attitude toward xenotransplantation was assessed using a psychosocial questionnaire about the donation of organs of animal origin administered by a healthcare professional from the Transplant Unit., Results: A total of 373 patients were interviewed (kidney [n=214] and liver patients [n=158]). In the case of kidney patients, if the results of xenotransplantation were as effective as those attained using human organs, 76% (n=162) would be in favor. If the results were worse, only 8% (n=17) would be in favor. Two factors affected this attitude: a high level of education (P=0.007) and a positive attitude toward organ donation upon death (P< 0.001). In the case of liver patients, 67% (n=106) would be in favor if the results of xenotransplantation were as effective as those attained using human organs, decreasing to 16% (n=25) if the results were worse. Attitude toward deceased organ donation also affected the attitude of these patients (P<0.043)., Conclusions: The attitude toward xenotransplantation of patients on the kidney and liver transplant waiting list was favorable and associated with a positive attitude toward human organ donation., (© 2011 John Wiley & Sons A/S.)

Introduction: In patients awaiting a transplant, the help received from friends and/or family members is considered to be an important factor in the transplantation process. Our objective was to determine the level of social/family support for patients on the liver transplant waiting list and to determine the relationship between clinical psychopathology and the level of social/family support., Materials and Methods: The study population consisted of 70 patients on the liver transplant waiting list. We used the following instruments: (1) Medical Outcomes Study-Social Support Survey (MOS) Questionnaire. For size of the social network, four support dimensions and a global support index for emotional support, material/instrumental support, leisure/free time activities, and love/care; (2) Family Apgar Questionnaire for personal perception of family function; (3) SA-45 questionnaire of psychopathologic symptoms for somatizations, obsessive-compulsivity, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism., Results: The MOS showed that the mean size of the social network of these patients was 12 people. In these patients, social/family support was nonfunctional in 20% of the cases. By dimensions, the patients had the following percentage of nonfunctional support: 24% in emotional support; 10% material/instrumental support; 23% social relations of leisure/free-time activities; and 11% compassionate love/care support. The patients with nonfunctional support had the following associated psychopathologic symptoms (SA-45): depression (79% vs 39%; P = .008), anxiety (86% vs 46%; P = .008), hostility (43% vs 12%; P = .009), and psychoticism (14% vs 2%; P = .039) compared to functional patients. The Family Apgar showed that 27% of patients perceived a family dysfunction. These patients had greater interpersonal sensitivity-type emotional symptoms (32% vs 8%; P = .012), depression (79% vs 35%; P = .001), anxiety (79% vs 45%; P = .011), and hostility (42% vs 10%; P = .002) compared to normally functioning patients., Conclusions: Nearly a quarter of patients on the liver transplant waiting list have social/family support that is nonfunctional, which leads to greater emotional psychopathologic symptoms that would need to be treated., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To analyze attitude of patients on the liver transplant waiting list toward living donation (LD)., Design and Patients: Patients on the transplant waiting list -2003-2005 (n = 164)- were selected. Attitude was evaluated using a validated questionnaire, completed by an independent healthcare professional., Results: The questionnaire completion rate was 97% (n = 159). A total of 87% (n = 138) of patients stated that they would donate an organ while alive if a family member needed one. However, only 39% (n = 61) would be prepared to receive a liver donation from a living relative and 50% would prefer to wait on the list (n = 80). 90% accepted that living liver donation involves a certain amount of risk. This assumption was not associated with a willingness to accept related LD (p = 0.170). A willingness to accept LD was related to patient's knowledge of his or her family's attitude toward donating an organ to the patient (p = 0.027)., Conclusions: Patients had a favorable attitude toward living liv-er donation. When there was a family base that is in favor of LD then this encouraged acceptance, and therefore, it is essential to carry out family screening of patients to detect those cases in which this type of LD can be successfully requested.

Introduction: Untreated psychiatric morbidity can worsen the quality of life in the posttransplantation stage. Therefore, it is important to detect and treat alterations associated with depression in transplantation patients from the beginning of the process. The objective of this study was to determine the psychological characteristics of patients on the liver transplantation waiting list with emotionally depressed symptoms., Material and Methods: We evaluated 70 patients on the liver transplantation waiting list for psychopathological symptoms of depression using the Symptom Assessment-45 Questionnaire (González and Cuevas) using chi-squared tests, Student t tests, and logistic regression analysis., Results: Forty-seven percent of the patients on the liver transplantation waiting list showed relevant depressive-type psychopathological symptoms. The presence of the following factors were associated with the emotionally depressed characteristics of these patients: psychiatric mental disorders (P = .015); no partner (P = .009); and alcohol abuse (P = .050). Other related factors included the following: obsessive-compulsive-type emotional alterations (P = .001); interpersonal sensitivity (P < .001); anxiety (P < .001); hostility (P = .017); phobic anxiety (P = .017); and paranoid ideation (P = .029). With regard to coping strategies, these patients used defenselessness (P < .001) and anxious preoccupation (P = .016). With regard to the social-family setting, emotionally depressed patients had nonfunctional family and/or social support, according to the global MOS (Medical Outcomes Study-Social Support Survey) index (P = .008) and the total Apgar Family Score (P < .001)., Conclusions: Almost half of the patients on the liver transplantation waiting list showed emotionally depressed-type symptoms. Other emotional-type alterations were related to this psychological profile: coping strategies of defenselessness and anxious preoccupation as well as nonfunctional social and/or family support., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Introduction: Patients on the liver transplant waiting list have increased emotional and clinical symptoms. The presence of psychopathologic symptoms associated with obsession-compulsion as a reflection of alterations due to anxiety disorders is common in these patients., Objective: To evaluate obsessive-compulsive psychopathological symptoms in patients on the liver transplant waiting list., Materials and Methods: The study included 50 patients on the liver transplant waiting list. The instrument was the SA-45 questionnaire (Derogatis, 75), whose Spanish version was adapted by González Rivera and De las Cuevas (1988). This dimension was evaluated using five statements., Results: Among of the patients on the liver transplant waiting list, 46% had no relevant obsessive-compulsive symptoms. Of these, 28% had no symptoms and 18% had some symptoms, but the overall evaluation in these patients was no greater than the cutoff point. The remaining 54% had relevant obsessive-compulsive clinical symptoms, most commonly (1) "Having difficulty making decisions" (P<3.45·10(-9)); (2) "Having difficulty concentrating" (P<1.70·10(-8)); (3) "One's mind goes blank" (P<3.04·10(-4)); (4) "Having to repeatedly check everything being done" (P<1.37·10(-1)); and (5) "Having to do things slowly to make sure they are done properly" (P<5.02·10(-1))., Conclusions: Many patients on the liver transplant waiting list have obsessive-compulsive psychopathologic symptoms. Their detection and application of adequate psychological treatment are important to minimize the effects of emotional changes onward from the pretransplant phase., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Introduction: Research into xenotransplantation is centered on the fields of organs, tissues, and cells. However, the use of animals in this therapy is creating social rejection among the general public as well as among patients on the transplant waiting list., Objective: The objective of this study was to analyze the attitudes of patients on the waiting list toward a possible transplantation of cells or tissues of animal origin., Materials and Methods: The study included patients on the kidney and liver transplant waiting lists from January 2003 until December 2005 (N=373). Attitudes toward xenotransplantation were assessed using a psychosocial questionnaire about the donation of animal organs. The questionnaire was administered through a direct personal interview., Results: With regard to the xenotransplantation of tissues and cells, 83% of kidney patients (n=177) were in favor and 17% (n=37) were not in favor of both options. Patients who were more in favor for tissues and also for cells were young respondents (P=.016; age P=.006) and those with a formal education (P=.002; education P=.001). Among liver patients, 85% (n=134) were in favor and 15% (n=24) were not in favor. Those who were more in favor for tissues included elderly patients (P=.028) and those with descendents (P=.001); for cells, those who were more in favor were those who were married (P=.011), were older (P=.009), and had children (P<.000). No significant differences were observed between the groups., Conclusion: Patients on the solid organ transplant waiting lists showed favorable attitudes toward tissue and cell xenotransplantation., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Introduction: Chronic end-stage liver disease is a difficult situation for the patient., Objective: The objective of this study was to analyze the disease coping styles of patients on the liver transplant waiting list., Materials and Methods: The study included 50 patients on the liver transplant waiting list. The instrument used was the Mental Adjustment to Cancer Scale (Ferrero, 94). Coping scales were as follows: fighting spirit, hopelessness, anxious preoccupation, fatalism, and negation., Results: Only 6% of subjects adapted well, whereas 94% adapted badly: 89% poor fighting spirit, 32% hopelessness, 50% anxious preoccupation, 28% fatalism, and 30% negation. Of those who had a poor fighting spirit, 88% also used another type of maladaptive style. The associated statements were (P<.05) as follows: "I value my life more"; "I don't think about the disease"; "I think about people who are worse off." Regarding hopelessness, 100% of those who confessed hopelessness also showed maladaptive signs. The associated statements were (P<.05) as follows: "I cannot cheer myself up"; "I cannot help myself"; "I've given up." Regarding anxious preoccupation, nearly all of these patients (96%) provided dysfunctional answers. The most associated were (P<.05) as follows: "I don't have any plans"; "I feel a lot of anxiety"; "I'm very angry." Regarding fatalism, all of the patients also had maladaptive behavior. The main types were (P<.05) as follows: "Nothing will change things"; "I cannot control the situation"; "I don't need information." Regarding negation, Only 14% used this style, and in 86% negation was associated with other inadequate coping styles., Conclusions: Patients on the liver transplant waiting list were maladaptive to their disease. It is important to establish adequate psychological care for these patients, given the important repercussions in the posttransplantation phase., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: Psychological changes in terminally ill patients with liver disease are underestimated. Therefore, a psychological care unit was introduced in the liver transplantation unit in a transplantation hospital in Spain., Objectives: To describe the establishment of the psychological care unit in a liver transplantation unit and to review its operation, and to evaluate and diagnose psychological changes in patients on the waiting list for liver transplantation., Materials and Methods: Variables evaluated included consultations, interviews, level of care provided, appointments postponed, difficulties, and cost-effectiveness. Psychopathologic symptoms were evaluated using the Symptom Assessment-45 questionnaire (Derogatis, 1975), examining 9 psychopathologic dimensions., Results: Thirty-eight patients were given an appointment, and 28 were interviewed. Twelve postponed the appointment. The level of support provided to patients on the waiting list was 70%. The hospital structure was used to develop the care unit, which is why it was only necessary to employ 1 professional psychologist. Of patients assessed, 54% exhibited relevant clinical symptoms of depression, and 47 demonstrated anxiety. Patients with symptoms of depression reported "loss of interest"; those with anxiety reported feeling "worried and tense." Of these patients, an increased presence of symptoms was associated with various emotional problems such as hostility (33%), somatization (60%), obsession/compulsion (73%), interpersonal sensitivity (40%), phobic anxiety (20%), paranoid ideation (20%), and psychosis (6%)., Conclusions: Patients on the waiting list for liver transplantation demonstrate increased clinical symptoms of depression and anxiety. Therefore, it is of great importance to introduce a psychological care unit to detect and treat these conditions. Introduction of the liver transplant unit program has improved multidisciplinary care and is cost-effective.

Background: Human liver allografts do sometimes survive in a recipient after withdrawal of immunosuppression (IS), commonly referred to as "operational tolerance." Preliminary clinical data have suggested an increase in the frequency of regulatory T cells (Treg) CD4+CD25 high and FoxP3 expression in operationally tolerant liver transplant recipients (Gr-T). In the context of human liver transplantation, the dynamics of Treg have not been studied. We designed a prospective study to ascertain the profile of the Treg population and FoxP3 expression during IS withdrawal., Methods: To identify such parameters, we analyzed peripheral blood mononuclear cell populations and FoxP3 mRNA expression in 12 liver allograft recipients under cyclosporine A-based IS, who showed stable function of the allograft for more than 2 years., Results: An increase was observed in the frequency of CD4+CD25 high cells when the IS was withdrawn in Gr-T patients (n=5). These patients exhibited a 3.5-fold increase for relative mRNA FoxP3 expression before the complete IS withdrawal and this continued when IS therapy was stopped. In patients who suffered rejection (n=7) there was no increase in the CD4+CD25 high cells or FoxP3 expression., Conclusions: With the present study, the first evidence is provided that the increase of CD4+CD25 high T cells and FoxP3 transcripts is associated with operational tolerance in liver transplanted patients during IS withdrawal.

Unlabelled: Living liver donation is becoming a more widely accepted practice given the decrease in donor morbidity and mortality and the beneficial results in the recipient. Use of this technique is unusual in Spain. There are a number of workers against its use within the health care system. The objective of this study was to analyze attitudes toward and the variables that affect them concerning living liver donation among surgical services in a transplant hospital., Materials and Methods: A random survey was stratified by surgical area and job category in a Spanish third-level hospital with an ongoing solid organ transplant program. Attitudes toward living liver donation were assessed using a questionnaire about organ donation and transplantation that evaluated various psychosocial variables. Student's t test and the chi square test were used., Results: A total of 263 workers were surveyed (mean age as 40 +/- 9 years). Regarding attitudes toward living liver donation, the level of acceptance was 80% (n = 211) of respondents, whereas 10% were undecided (n = 26), and another 10% were against (n = 26), assuming that the donations were related. When we asked about unrelated living donation, the percentage in favor decreased to 10% (n = 27). No differences were found with respect to job category or type of service. The variables that are related to such an attitude are the following: (1) possibility of respondent needing an organ (P = .001); (2) favorable attitude toward living kidney donation (P < .000); and (3) a belief that medical errors exist (P = .004). An important finding was that attitudes toward living liver donation were not more favorable according to whether the respondent was in favor or against cadaveric organ donation (P = .175)., Conclusion: There was a highly favorable attitude toward living liver donation among hospital personnel in surgical services, which is an important factor to take into account if this type of donation is to be encouraged in Spain.

Introduction: The deficit in transplant organs is encouraging research into stem cells and xenotransplantation. However, many studies have shown that using animals for human transplantation could be rejected by society. The objective here was to analyze the attitude of patients on the waiting list toward a possible transplant of an organ of animal origin., Materials and Methods: Patients on the waiting list for kidney and liver transplants including last year (n = 96) underwent a direct interview by an independent health professional from the transplant unit. Using a psychosocial survey, an evaluation was made of attitudes toward donation of organs of animal origin and its various options. Student t test and the chi-square test were used for analysis., Results: If results from xenotransplantation could be superimposed onto those of human transplantation, 71% would accept such an organ. In the case of the kidney, 83% would accept, 4% would not, and 13% have doubts; as opposed to 60%, 12%, and 28%, respectively, of liver cases (P < .05). Supposing that the results were worse than in human organs, only 26% would accept an animal organ. Thus, for kidney, 33% would accept it, 48% would not, and 20% would have doubts; and for liver, it would be 20%, 50%, and 30%, respectively. In a life-threatening situation 98% would accept an animal organ as a bridge of hope in the wait for a human organ. In addition, if the organ functioned correctly, 98% would keep the animal organ, thus avoiding an intervention to substitute a human organ., Conclusion: If xenotransplantation became a clinical reality, acceptance of an animal organ by patients on the waiting list would be low, especially if the results could not be superimposed onto human ones. Only its use as a bridge until the arrival of a human organ would increase its acceptance.

Abstract: Objective: Using a percutaneous ecoguided injection system to obtain chimeric piglets through a less invasive and traumatic technique than previously reported. Materials and methods: The two types of human cells included umbilical cord blood mononuclear elements and mesenchymal stem cells cultured from bone marrow. Four sows at gestational day 50 were anesthetized. A needle was inserted through the skin and uterine wall to reach the peritoneal cavity of the fetuses under continuous ultrasound guidance. Fourteen piglets were injected with various cell concentrations. Results: All sows carried pregnancies to term yielding 69 piglets, among which 67 were alive and two mummified. Two piglets died during the first 48 hours of life. Chimerism was detected using flow cytometry and by quantitative polymerase chain reaction (q-PCR) to detect Alu gene in blood or tissues samples. The analysis detected blood chimerism in 13 piglets (21%) by flow cytometry and the presence of the human Alu gene in 33 (51%) by q-PCR. The results suggest cell trafficking between littermates after in utero injection. Conclusions: Transcutaneous echo-guided injection succeeded to produce chimeric piglets without disadvantages to the sow or the fetuses and avoiding abortions or fetal death. [Copyright &y& Elsevier]

Abstract: Background: “Anxious preoccupation” is a maladaptive coping strategy for patients with terminal chronic liver pathology causing psychopathologic emotional responses. The aim of this study was to identify “anxious preoccupation” as a coping strategy when faced with this disease and to investigate its relationship with emotional-type psychopathologic symptoms in patients awaiting a liver transplant (LT). Methods: A total of 63 patients awaiting an LT were evaluated. The instrument used to evaluate coping style was the Mental Adjustment to Cancer questionnaire. One of the coping scales of this questionnaire is “anxious preoccupation” (9 items). An Instrument for psychopathologic assessment was used, the SA-45 questionnaire, which assessed 9 psychopathologic dimensions: somatizations, obsessions-compulsions, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. Results: “Anxious preoccupation” was used as an inadequate coping style by 51% of patients when faced with the disease. Five psychopathologic dimensions were associated with this coping strategy: 1) obsessive-compulsivity: 75% of patients with “anxious preoccupation” had obsessive-compulsivity symptoms compared with 29% of patients with other coping strategies (P < .001); 2) interpersonal sensitivity: 25% vs 6%, respectively (P = .044); 3) depression: 59% vs 29% (P = .015); 4) anxiety: 75% vs 32% (P = .001); and 5) phobic anxiety: 19% vs 3% (P = .050). Conclusions: More than one-half of the patients on the LT waiting list used “anxious preoccupation” as a coping style for this disease. This strategy was associated with a greater presence of emotional-type psychopathologic symptoms in these patients. [Copyright &y& Elsevier]

Abstract: Background: Transplantation hospitals have played a key role in developing deceased organ donation and transplantation (ODT). To reduce the number of deaths on the transplant waiting list, it is essential to encourage living liver donation (LLD). Involvement of personnel in these hospitals is crucial. Purpose: We analyzed the attitudes toward LLD among hospital personnel in Spain, Mexico, and Cuba. Materials and methods: Data were obtained from 5 transplant hospitals in Spain, Mexico, and Cuba. The sample was stratified according to job category and type of service (n = 2273). A validated questionnaire about living donation was used as the instrument. Results: Most respondents (82%) were in favor of related LLD. If the LLD was not related, acceptance fell to 21%. A total of 85% of physicians, 79% of nursing personnel, 74% of nursing assistants, and 83% of auxiliary staff were in favor (p < .001). A favorable attitude toward LLD was associated (P < .05) with age (37 ± 10 y vs 39 ± 10 y), a favorable attitude toward deceased donation, a belief that a possible transplant is needed, acceptance of LLD if necessary, a favorable attitude toward living kidney donation, family discussion about ODT, a partner''s favorable attitude toward ODT, an intention to participate in prosocial activities, being a Catholic, and a belief that one''s religion is in favor of ODT. Conclusions: Personnel from Spanish, Mexican, and Cuban transplantation hospitals have favorable attitudes toward LLD. This suggests that there may be an increase in LLD in the future, provided that there is the necessary sociopolitical and economic support. [Copyright &y& Elsevier]

Abstract: Introduction: Patients with toxic substance abuse syndrome, such as alcohol abuse, have elevated psychopathologic morbidity and mortality such as mood disorders. Objective: To evaluate the emotional-type psychopathologic symptoms in patients with alcohol-induced hepatic cirrhosis on the liver transplant waiting list. Materials and methods: Patients with alcoholic liver cirrhosis who were candidates for liver transplant (n = 41) completed the SA-45 questionnaire (González y Cuevas; 88), which assesses nine dimensions: somatizations, obsessive-compulsivity, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. A control group consisted of patients with chronic nonalcoholic terminal hepatopathies (n = 22). Results: Seventy-six percent of patients had some kind of psychopathologic symptom compared to 68% of the patients in the control group with other nonalcoholic etiologies (P > .05). The emotional-type clinical symptoms were: (1) somatizations: 37% of patients with alcoholic cirrhosis had this type of clinical symptoms compared to 32% of the control group (P > .05); (2) obsessive-compulsivity: 56% versus 46%, respectively (P > .05); (3) interpersonal sensitivity: 19% versus 9%, respectively (P > .05); (4) depression: 54% versus 27%, respectively (P = .045); (5) anxiety: 59% versus 46%, respectively (P > .05); (6) hostility: 29% versus 5%, respectively (P = .021); (7) phobic anxiety: 10% versus 14%, respectively (P > .05); (8) paranoid Ideation: 7% versus 5%, respectively (P > .05); (9) psychoticism: 5% versus 4%, respectively (P > .05). Conclusions: The patients with alcoholic liver cirrhosis on the liver transplant waiting list had elevated psychopathologic symptoms. Depressive- and hostile-type emotional alterations were most frequent in this type of patients. [Copyright &y& Elsevier]