108 results on '"Federico Piñero"'
Search Results
2. From evidence to clinical practice: Bridging the gap of new liver cancer therapies in Latin America.
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Federico Piñero, Ezequiel Mauro, Paola Casciato, and Alejandro Forner
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Liver cancer ,Challenges ,Staging ,Clinical decision ,Cholangiocarcinoma ,Hepatocellular carcinoma ,Specialties of internal medicine ,RC581-951 - Abstract
The most common primary liver tumors are hepatocellular carcinoma and cholangiocarcinoma. They constitute the sixth most common neoplasia and the third cause of cancer-related deaths worldwide. Although both tumors may share etiologic factors, diagnosis, prognostic factors, and treatments, they differ substantially in determining distinctive clinical management. In recent years, significant advances have been made in the management of these neoplasms, particularly in advanced stages. In this review, we focus on the most relevant diagnostic, prognostic, and treatment aspects of both, hepatocellular carcinoma and cholangiocarcinoma, underlying their applicability in Latin America.
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- 2024
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3. The leading and key role of hepatologists in the multidisciplinary management of patients with hepatocellular carcinoma
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Juan Ignacio Marín, Margarita Anders, Aline Chagas, Josemaría Menéndez, Oscar Beltran, Enrique Carrera Estupiñan, Javier Diaz Ferrer, Angelo A. Mattos, and Federico Piñero
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Leadership ,Health policy makers ,Specialties of internal medicine ,RC581-951 - Published
- 2023
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4. Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC
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Federico Piñero, Margarita Anders, Carla Bermudez, Ezequiel Demirdjian, Adriana Varón, Ana Palazzo, Jorge Rodriguez, Oscar Beltrán, Leonardo Gomes da Fonseca, Ezequiel Ridruejo, Pablo Caballini, Norberto Tamagnone, Virginia Reggiardo, Hugo Cheinquer, Alexandre Araujo, Diego Arufe, Juan Ignacio Marín, Natalia Ratusnu, Estela Manero, Daniela Perez, Marina Villa, Federico Orozco, Dolores Murga, Sebastián Marciano, Fernando Bessone, Marcelo Silva, and Manuel Mendizabal
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Liver cancer ,Progression ,Outcomes ,Prognosis ,Real-world ,Specialties of internal medicine ,RC581-951 - Abstract
Introduction and Objectives: With the advent of new therapeutic options for patients with hepatocellular carcinoma (HCC) for intermediate or advanced stages of the Barcelona Clinic Liver Cancer (BCLC), regional real-world data regarding prognostic survival factors are of significant importance. Patients and Methods: A multicenter prospective cohort study was conducted in Latin America including BCLC B or C patients since 15th May 2018. We report here the second interim analysis focusing on prognostic variables and causes of treatment discontinuation. Cox proportional hazard survival analysis was performed, estimating hazard ratios (HR) and 95% confidence intervals (95% CI). Results: Overall, 390 patients were included, 55.1% and 44.9% were BCLC B and C at the time of study enrollment. Cirrhosis was present in 89.5% of the cohort. Among the BCLC-B group, 42.3% were treated with TACE with a median survival since the first session of 41.9 months. Liver decompensation before TACE was independently associated with increased mortality [HR 3.22 (CI 1.64;6.33); P
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- 2023
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5. O-10 SIMILAR RISK RECLASSIFICATION OF HCC RECURRENCE BETWEEN THE AFP SCORE AND METROTICKET 2.0 AT LISTING AND AT LAST REASSESSMENT
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Federico Piñero, Charlotte Costentin, Helena Degroote, Quirino Lai, Fernando Rubinstein, and Christophe Duvoux
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Specialties of internal medicine ,RC581-951 - Abstract
Introduction and Objectives: Recently, two composite models, the alpha-fetoprotein (AFP) score and the Metroticket 2.0, have been proposed to select patients with hepatocellular carcinoma (HCC) for liver transplantation (LT). This study aimed to compare both models in their predictive performance of post-LT outcomes and their net reclassification of risk of recurrence. Materials and Methods: This multicenter cohort study included 2444 adult patients who underwent LT for HCC in Europe and Latin America. The discrimination power of each model was estimated using adapted Harrell c-statistics and the NRI for recurrence was compared considering each model´s threshold assessed at listing and at last pre-LT reassessment. Results: At listing, although the Metroticket 2.0 showed a higher discrimination power for HCC recurrence compared to the AFP score, no differences were observed comparing each model's thresholds. At the last tumor evaluation, c-statistics did not significantly differ. Overall, predictive gaps and overlaps were observed between the model's thresholds. At listing and at last pre-LT reassessment, the Metroticket 2.0 did not show a significant gain on the NRI. Patients meeting both composite model´s thresholds either within or beyond the Milan criteria showed the lowest risk of HCC recurrence [SHR of 0.28 (95% CI 0.22-0.36; P
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- 2023
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6. O-12 CHARACTERIZATION AND UTILIZATION OF HCV-POSITIVE DONORS IN ARGENTINA
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Manuel Mendizabal, Margarita Anders, Ariel Antik, Federico Piñero, Gabriela Hidalgo, Daniela Hansen Krogh, Viviana Tagliafichi, Marcelo Silva, and Liliana Bisigniano
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Specialties of internal medicine ,RC581-951 - Abstract
Introduction and Objectives: Increased utilization of hepatitis C virus (HCV)-positive organ donors has been endorsed as one of several ways to combat organ shortages. However, HCV-positive donors remain poorly characterized. This study aimed to evaluate the prevalence and utilization of HCV antibody (Ab) positive donors in Argentina. Materials and Methods: We performed a cross-sectional study to analyze data from the INCUCAI in Argentina from January 2006 to December 2020. Demographic and allograft characteristics were evaluated, and utilization of HCV Ab-positive donors across Argentina was studied. Anti-HCV (ELISA), was performed on all donors during the procurement process. A stratified analysis according to the type of donor and HCV Ab was done. Results: Overall, 16,140 deceased donors were denounced. Of these, 8627 (53.5%) were organ donors (7802 [90.4%] were effective) and 7513 (46.5%) were tissue donors. Demographic characteristics were age 42 ± 18 years and male/female ratio was 1.59/1. HCV Ab-positive was reported in 0,92% (n=149). The prevalence ratio per period among HCV Ab-positive donors (see graphic 1) showed that the highest prevalence was observed in 2007 (1.3%) and the lowest prevalence was in 2020 (0.1%). Prevalence for HCV Ab-positive among the type of donors was significantly higher in non-effective donors at 5.81% (n=48/825), followed by tissue donors at only 1.01% (n=76/7513) and lower in effective donors at 0.32% (n=25/7802; P
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- 2023
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7. O-13 PERFORMANCE OF PRE-TRANSPLANT CRITERIA IN PREDICTION OF HEPATOCELLULAR CARCINOMA PROGRESSION AND WAITLIST DROPOUT
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Federico Piñero, Marcos Thompson, Ilka Boin, Aline Chagas, Emilio Quiñonez, Carla Bermúdez, Mario Vilatobá, Luisa Santos, Margarita Anders, Sergio Hoyos Duque, Agnaldo Soares Lima, MD, Josemaría Menendez, MD, Martín Padilla, MD, Jaime Poniachik, MD, Rodrigo Zapata, Martín Maraschio, Ricardo Chong Menéndez, Linda Muñoz, Diego Arufe, Rodrigo Figueroa, Adriana Varón, Sebastián Marciano, Juan Mattera, Flair Carrilho, and Marcelo Silva, MD
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Specialties of internal medicine ,RC581-951 - Abstract
Introduction and Objectives: Liver transplantation (LT) selection models for hepatocellular carcinoma (HCC) have not been proposed to predict waitlist dropout due to tumor progression. This study aimed to compare the alfa-fetoprotein (AFP) model and other pre-LT models in their prediction of HCC dropout. Materials and Methods: A multicenter cohort study was conducted in 20 Latin American transplant centers, including 994 listed patients for LT with HCC from 2012 to 2018. Longitudinal tumor characteristics and patterns of progression were recorded at the time of listing, after treatments and at last follow-up over the waitlist period. Competing risk regression models were performed, and the model's discrimination was compared by estimating Harrell's adapted c-statistics. Results: HCC dropout rate was significantly higher in patients beyond [24% (95% CI 16-28)] compared to those within Milan criteria [8% (95% IC 5-12%); P2 [adjusted SHR of 3.17 (CI 2.13-4.71)], c-index of 0.71 (95% CI 0.65-0.77; P=0.09 vs. Milan). Similar discrimination power for HCC dropout was observed between the AFP score and the Metroticket 2.0 model. In patients within Milan, an AFP score >2 points discriminated two populations with a higher risk of HCC dropout [SHR 1.68 (95% CI 1.08-2.61)]. Conclusions: Pre-transplant selection models similarly predicted HCC dropout. However, the AFP model can discriminate a higher risk of dropout among patients within Milan criteria.
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- 2023
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8. O-23 HEPATITIS B VIRUS STATUS OF ORGAN DONORS IN ARGENTINA
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Maria Anders, Ariel Antik, Manuel Mendizabal, Federico Piñero, Daniela Hansen Krogh, Federico Orozco, Viviana Tagliafichi, Julia Brutti, Marcelo Silva, Gabriela Hidalgo, and Liliana Bisignano
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Specialties of internal medicine ,RC581-951 - Abstract
Introduction and Objectives: Argentina is considered an area with a low prevalence of hepatitis B virus (HBV). However, the real prevalence of the disease is unknown. We aimed to study the prevalence of HBV in potential cadaveric donors. Materials and Methods: We performed a cross-sectional study to analyze data from the National Procurement of Transplantation in Argentina from all donors from 2006 to 2020. HBV serologic tests included hepatitis B virus antigen (HBsAg), core antigen-antibody (HBcIgG) and anti-HBs performed during the procurement process. HBV status was defined as 1) active HBV: donors with positive HBsAg; 2) Past HBV infection or false positive: isolated positive HBcIgG; 3) Cured infection anti-HBs+/HBcIgG+. Results: Overall, 16140 deceased donors were denounced. The prevalence of HBsAg was 0.37% (n=60) and of isolated HBcIgG+ was 3.6% (n=575). Among organ donors only, 328 (3.8%) presented isolated HBcIgG-positive serology. Of these, 252 (77%) were effective organ donors. Solid-organ transplants performed using isolated HBcIgG+ donors were 220 kidneys, 124 livers, and 27 intrathoracic organs. There was no significant 5-year graft and patient survival difference between HBcIgG+ receptor (kidney transplant 65% and 81%, and for liver 65% and 83% respectively) and the general population. Anti-HBs data were available in only 4455 donors, of which 19% (N=847) were anti-HBs+. In those patients with positive anti-HBs, HBcIgG was positive in 8.3% (n=369), reflecting past HBV infection. Of the remaining 4086 AntiS available, only 11.7% were positive; that is, they were effectively vaccinated. The Patagonia region presented the highest prevalence of HBsAg, especially in the provinces of La Pampa (2.3%), Santa Cruz (2.2.%), and Tierra del Fuego (2.1.%). Conclusions: The prevalence of HBsAg in deceased donors in Argentina is low. Since the probability of being a donor is random, the prevalence in this population could be close to the real one in the country.
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- 2023
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9. OP-4 IMPLEMENTATION OF A RE-LINKAGE TO CARE STRATEGY IN PATIENTS WITH CHRONIC HEPATITIS C WHO WERE LOST TO FOLLOW-UP IN LATIN AMERICA
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Manuel Mendizabal, Marcos Thompson, Esteban Gonzalez-Ballerga, Margarita Anders, Graciela E Castro-Narro, Mario G Pessoa, Hugo Cheinquer, Gabriel Mezzano, Ana Palazzo, Ezequiel Ridruejo, Valeria Descalzi, Jose A Velarde-Ruiz Velasco, Sebastian Marciano, Linda Muñoz, Maria I Schinoni, Jaime Poniachik, Rosalía Perazzo, Eira Cerda, Francisco Fuster, Adriana Varon, Sandro Ruiz García, Alejandro Soza, Cecilia Cabrera, Andres J Gomez-Aldana, Flor de María Beltrán, Solange Gerona, Daniel Cocozzella, Fernando Bessone, Nelia Hernández, Cristina Alonso, Melina Ferreiro, Florencia Antinucci, Aldo Torre, Bruna D Moutinho, Silvia Coelho Borges, Fernando Gomez, Maria Dolores Murga, Federico Piñero, Gisela F Sotera, Jhonier A Ocampo, Valeria A Cortés Mollinedo, Marcos Girala, Pedro Montes, Natalia Ratusnu, Claudia A Zuñagua, Lida Castillo, Mauricio Castillo Barradas, Rocío Chávez, Cláudia Ivantes, Julia Brutti, Laura Tenorio, Jorge Garavito, Katherine Zevallos, Fernando Contreras, Mirtha Infante, Emilia Vera-Pozo, Martín Tagle, Luis G Toro, Carlos A De La Rocha, Daniela Simian, and Marcelo O Silva
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Specialties of internal medicine ,RC581-951 - Abstract
Introduction and Objectives: To achieve WHO's goal of eliminating HCV, innovative strategies must be designed to diagnose and treat more patients. This study aimed to describe an implementation strategy to identify patients with HCV who were lost to follow-up (LTFU) and offer them re-linkage to Figure 1. Analysis of global DNA methylation. A) Representative dot blot using anti-5mC which recognizes global methylated DNA, anti-IgG as negative control and methylene blue staining as total DNA loading control. B) Graphs shows mean ± standard deviation of 5mC densitometry brand intensity of study groups. C) Graph that represents the percentage of global methylation of the DNA analyzed with ELISA.A one-way ANOVA statistical test and a Tukey post hoc test were performed. Group NT: only received vehicle; Group HCC: damage group induced by weekly administration of DEN and 2-AAF for 12 weeks; and Group HCC/PFD: which received the same treatment as Group HCC, plus PFD (300 mg/kg) (**p
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- 2023
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10. P-10 PATTERNS OF PROGRESSION AND TREATMENT DISCONTINUATION IN A REAL LIFE LATIN AMERICAN PROSPECTIVE COHORT STUDY OF INTERMEDIATE-ADVANCED HEPATOCELLULAR CARCINOMA: SECOND INTERIM ANALYSIS
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Federico Piñero, Margarita Anders, Carla Bermudez, Ezequiel Demirdjian, Adriana Varón, Ana Palazzo, Jorge Rodriguez, Oscar Beltrán, Leonardo Gomes da Fonseca, Ezequiel Ridruejo, Pablo Caballini, Norberto Tamagnone, Virginia Reggiardo, Hugo Cheinquer, Diego Arufe, Juan Ignacio Marín, Natalia Ratusnu, Estela Manero, Daniela Perez, Marina Villa, Federico Orozco, Dolores Murga, Sebastián Marciano, Fernando Bessone, Marcelo Silva, and Manuel Mendizabal
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Specialties of internal medicine ,RC581-951 - Abstract
Introduction and Objectives: Previously published regional real-world results of overall survival (OS) in Barcelona Clinic Liver Cancer (BCLC) B and C patients demanded a prospective cohort study nested in a systematic and continuous medical educational networking group. This study aimed to describe and evaluate the treatment decisions in patients with hepatocellular carcinoma (HCC) within BCLC B and C stages. Materials and Methods: A multicenter prospective cohort study, conducted in different Latin American centers from Argentina, Brazil and Colombia, started on 15th May 2018 (delayed recruitment during COVID locked-down period). Patients within BCLC B or C stages were included. Survival, tumor progression and patterns of treatment suspension were evaluated. Results: At this second interim analysis (projected final analysis March 2023), 390 HCC BCLC-B or C patients were included (n=15 excluded); mean age 65 years, 75.6% males and 89.5% cirrhotic. Median OS since HCC diagnosis was 27.2 months. Among BCLC-B patients, the most frequent therapy was transarterial chemoembolization (TACE, 42.3%); 51.8% using drug-eluting beads and 47.4% conventional TACE; with a median OS since 1st TACE of 41.9 months. Similar radiological responses after 1st TACE were observed between both modalities. Overall, 48.2% of the cohort received systemic therapy for HCC (n=188), 23.7% still on BCLC-B stage. The most frequent systemic treatments were Sorafenib (74.5%), atezolizumab bevacizumab (17.5%), and lenvatinib (12.2%), with a median OS since systemic therapy of 15.7 months. Lenvatinib or atezolizumab bevacizumab was used as the second line following sorafenib in 5 and 3 patients, respectively. The most common causes of systemic treatment discontinuation were tumor progression and liver function deterioration (15% to 36.4%). Patterns of tumor progression were not specifically associated with prognosis or treatment discontinuation. Conclusions: Liver function deterioration occurs in a third of patients following systemic therapies. The complexity of treatment decisions underly the need for a multidisciplinary team and the role of hepatologists.
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- 2023
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11. AFP score and metroticket 2.0 perform similarly and could be used in a 'within-ALL' clinical decision tool
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Federico Piñero, Charlotte Costentin, Helena Degroote, Andrea Notarpaolo, Ilka FSF. Boin, Karim Boudjema, Cinzia Baccaro, Aline Chagas, Philippe Bachellier, Giuseppe Maria Ettorre, Jaime Poniachik, Fabrice Muscari, Fabrizio Dibenedetto, Sergio Hoyos Duque, Ephrem Salame, Umberto Cillo, Sebastián Marciano, Claire Vanlemmens, Stefano Fagiuoli, Flair Carrilho, Daniel Cherqui, Patrizia Burra, Hans Van Vlierberghe, Quirino Lai, Marcelo Silva, Fernando Rubinstein, Christophe Duvoux, Filomena Conti, Olivier Scatton, Pierre Henri Bernard, Claire Francoz, Francois Durand, Sébastien Dharancy, Marie-lorraine Woehl, Alexis Laurent, Sylvie Radenne, Jérôme Dumortier, Armand Abergel, Louise Barbier, Pauline Houssel-Debry, Georges Philippe Pageaux, Laurence Chiche, Victor Deledinghen, Jean Hardwigsen, J. Gugenheim, M. altieri, Marie Noelle Hilleret, Thomas Decaens, Paulo Costa, Elaine Cristina de Ataide, Emilio Quiñones, Margarita Anders, Adriana Varón, Alina Zerega, Alejandro Soza, Martín Padilla Machaca, Diego Arufe, Josemaría Menéndez, Rodrigo Zapata, Mario Vilatoba, Linda Muñoz, Ricardo Chong Menéndez, Martín Maraschio, Luis G. Podestá, Lucas McCormack, Juan Mattera, Adrian Gadano, Jose Huygens Parente García, Giulia Magini, Lucia Miglioresi, Martina Gambato, Cecilia D’Ambrosio, Alessandro Vitale, Michele Colledan, Domenico Pinelli, Paolo Magistri, Giovanni Vennarecci, Marco Colasanti, Valerio Giannelli, Adriano Pellicelli, Callebout Eduard, Iesari Samuele, Dekervel Jeroen, Schreiber Jonas, Pirenne Jacques, Verslype Chris, Ysebaert Dirk, Michielsen Peter, Lucidi Valerio, Moreno Christophe, Detry Olivier, Delwaide Jean, Troisi Roberto, and Lerut Jan Paul
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Prediction ,reclassification ,recurrence ,transplantation ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Two recently developed composite models, the alpha-fetoprotein (AFP) score and Metroticket 2.0, could be used to select patients with hepatocellular carcinoma (HCC) who are candidates for liver transplantation (LT). The aim of this study was to compare the predictive performance of both models and to evaluate the net risk reclassification of post-LT recurrence between them using each model’s original thresholds. Methods: This multicenter cohort study included 2,444 adult patients who underwent LT for HCC in 47 centers from Europe and Latin America. A competing risk regression analysis estimating sub-distribution hazard ratios (SHRs) and 95% CIs for recurrence was used (Fine and Gray method). Harrell’s adapted c-statistics were estimated. The net reclassification index for recurrence was compared based on each model’s original thresholds. Results: During a median follow-up of 3.8 years, there were 310 recurrences and 496 competing events (20.3%). Both models predicted recurrence, HCC survival and survival better than Milan criteria (p
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- 2023
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12. R3-AFP score is a new composite tool to refine prediction of hepatocellular carcinoma recurrence after liver transplantation
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Charlotte Costentin, Federico Piñero, Helena Degroote, Andrea Notarpaolo, Ilka F. Boin, Karim Boudjema, Cinzia Baccaro, Luis G. Podestá, Philippe Bachellier, Giuseppe Maria Ettorre, Jaime Poniachik, Fabrice Muscari, Fabrizio Dibenedetto, Sergio Hoyos Duque, Ephrem Salame, Umberto Cillo, Sebastian Marciano, Claire Vanlemmens, Stefano Fagiuoli, Patrizia Burra, Hans Van Vlierberghe, Daniel Cherqui, Quirino Lai, Marcelo Silva, Fernando Rubinstein, Christophe Duvoux, Filomena Conti, Olivier Scatton, Pierre Henri Bernard, Claire Francoz, Francois Durand, Sébastien Dharancy, Marie-lorraine Woehl, Alexis Laurent, Sylvie Radenne, Jérôme Dumortier, Armand Abergel, Louise Barbier, Pauline Houssel-Debry, Georges Philippe Pageaux, Laurence Chiche, Victor Deledinghen, Jean Hardwigsen, J. Gugenheim, M. Altieri, Marie Noelle Hilleret, Thomas Decaens, Aline Chagas, Paulo Costa, Elaine Cristina de Ataide, Emilio Quiñones, Sebastián Marciano, Margarita Anders, Adriana Varón, Alina Zerega, Alejandro Soza, Martín Padilla Machaca, Diego Arufe, Josemaría Menéndez, Rodrigo Zapata, Mario Vilatoba, Linda Muñoz, Ricardo Chong Menéndez, Martín Maraschio, Lucas McCormack, Juan Mattera, Adrian Gadano, Ilka S.F. Fatima Boin, Jose Huygens Parente García, Flair Carrilho, Giulia Magini, Lucia Miglioresi, Martina Gambato, Fabrizio Di Benedetto, Cecilia D’Ambrosio, Alessandro Vitale, Michele Colledan, Domenico Pinelli, Paolo Magistri, Giovanni Vennarecci, Marco Colasanti, Valerio Giannelli, Adriano Pellicelli, Cizia Baccaro, Callebout Eduard, Iesari Samuele, Dekervel Jeroen, Schreiber Jonas, Pirenne Jacques, Verslype Chris, Ysebaert Dirk, Michielsen Peter, Lucidi Valerio, Moreno Christophe, Detry Olivier, Delwaide Jean, Troisi Roberto, and Lerut Jan Paul
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Liver transplantation ,Liver cancer ,Recurrence ,Explants pathology ,Prediction ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Patients with hepatocellular carcinoma (HCC) are selected for liver transplantation (LT) based on pre-LT imaging ± alpha-foetoprotein (AFP) level, but discrepancies between pre-LT tumour assessment and explant are frequent. Our aim was to design an explant-based recurrence risk reassessment score to refine prediction of recurrence after LT and provide a framework to guide post-LT management. Methods: Adult patients who underwent transplantation between 2000 and 2018 for HCC in 47 centres were included. A prediction model for recurrence was developed using competing-risk regression analysis in a European training cohort (TC; n = 1,359) and tested in a Latin American validation cohort (VC; n=1,085). Results: In the TC, 76.4% of patients with HCC met the Milan criteria, and 89.9% had an AFP score of ≤2 points. The recurrence risk reassessment (R3)-AFP model was designed based on variables independently associated with recurrence in the TC (with associated weights): ≥4 nodules (sub-distribution of hazard ratio [SHR] = 1.88, 1 point), size of largest nodule (3–6 cm: SHR = 1.83, 1 point; >6 cm: SHR = 5.82, 5 points), presence of microvascular invasion (MVI; SHR = 2.69, 2 points), nuclear grade >II (SHR = 1.20, 1 point), and last pre-LT AFP value (101–1,000 ng/ml: SHR = 1.57, 1 point; >1,000 ng/ml: SHR = 2.83, 2 points). Wolber’s c-index was 0.76 (95% CI 0.72–0.80), significantly superior to an R3 model without AFP (0.75; 95% CI 0.72–0.79; p = 0.01). Four 5-year recurrence risk categories were identified: very low (score = 0; 5.5%), low (1–2 points; 15.1%), high (3–6 points; 39.1%), and very high (>6 points; 73.9%). The R3-AFP score performed well in the VC (Wolber’s c-index of 0.78; 95% CI 0.73–0.83). Conclusions: The R3 score including the last pre-LT AFP value (R3-AFP score) provides a user-friendly, standardised framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials for HCC not limited to the Milan criteria. Clinical Trials Registration: NCT03775863. Lay summary: Considering discrepancies between pre-LT tumour assessment and explant are frequent, reassessing the risk of recurrence after LT is critical to further refine the management of patients with HCC. In a large and international cohort of patients who underwent transplantation for HCC, we designed and validated the R3-AFP model based on variables independently associated with recurrence post-LT (number of nodules, size of largest nodule, presence of MVI, nuclear grade, and last pre-LT AFP value). The R3-AFP model including last available pre-LT AFP value outperformed the original R3 model only based on explant features. The final R3-AFP scoring system provides a robust framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials, irrespective of criteria used to select patients with HCC for LT.
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- 2022
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13. LI-RADS 4 or 5 categorization may not be clinically relevant for decision-making processes: A prospective cohort study
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Federico Piñero, Marcos A. Thompson, Federico Diaz Telli, Juan Trentacoste, Carlos Padín, Manuel Mendizabal, Carla Colaci, Ariel Gonzalez Campaña, Josefina Pages, Silvina Montal, Mariano Barreiro, Martín Fauda, Gustavo Podestá, Juan Pablo Perotti, and Marcelo Silva
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Hepatocellular carcinoma ,LI-RADS ,Probability ,Liver transplant ,Histology ,Explant ,Specialties of internal medicine ,RC581-951 - Abstract
Introduction and objectives: The liver imaging reporting data system (LI-RADS) for hepatocellular carcinoma (HCC) was proposed to standardize and enhance consensus of reporting. However, clinical utility of LI-RADS has not been evaluated in Latin America. We therefore sought to compare LI-RADS categories with histopathology findings in liver transplant (LT) explants in a regional center. Materials and methods: Prospective cohort study conducted between 2012 and 2018 in a single center from Argentina including patients with HCC listed for LT. LI-RADS definitions were applied to magnetic resonance images (MRI) or computed tomography (CT) abdominal scans at time of listing and at final pre-LT reassessment and compared to explant pathology findings; specifically, major nodule (NOD1). Results: Of 130 patients with HCC listed for LT (96.1% with cirrhosis and 35.6% with hepatitis C virus infection), 72 underwent LT. Overall, 65% had imaging HCC diagnosis based on MRI (n = 84), 26% with CT (n = 34) and 9% (n = 12) with both methods. Among LT patients with pre-transplant imaging at our institution (n = 42/72), 69% of the NOD1 were LR-5, 21% LR-4 and 10% LR-3. Definite HCC diagnosis was 50% in LR-3 NOD1 (CI 18–90); none presented microvascular invasion. In LR-4 NOD1, HCC was confirmed in 89% (CI 59–98), of which 11% showed microvascular invasion; whereas in LR-5 NOD1 77% (CI 64–87) had confirmed HCC, 17% with microvascular invasion. Conclusions: LI-RADS was useful to standardize reports; however, no significant differences were observed between LR-4 and LR-5 HCC probability when compared to explant pathology.
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- 2020
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14. Liver transplant outcomes during the COVID-19 pandemic
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Manuel Mendizabal, Josefina Pages, Federico Piñero, Marcos Thompson, and Marcelo O Silva
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Specialties of internal medicine ,RC581-951 - Published
- 2022
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15. Argentinian clinical practice guideline for surveillance, diagnosis, staging and treatment of hepatocellular carcinoma
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Federico Piñero, Mario Tanno, Gabriel Aballay Soteras, Matías Tisi Baña, Melisa Dirchwolf, Eduardo Fassio, Andrés Ruf, Silvia Mengarelli, Silvia Borzi, Nora Fernández, Ezequiel Ridruejo, Valeria Descalzi, Margarita Anders, Guillermo Mazzolini, Virginia Reggiardo, Sebastián Marciano, Florencia Perazzo, Juan Carlos Spina, Lucas McCormack, Martín Maraschio, Cecilia Lagues, Adrián Gadano, Federico Villamil, Marcelo Silva, Fernando Cairo, and Beatriz Ameigeiras
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Liver cancer ,Practice guideline ,Latin America ,Argentina ,Specialties of internal medicine ,RC581-951 - Abstract
The A.A.E.E.H has developed this guideline for the best care of patients with hepatocellular carcinoma (HCC) from Argentina. It was done from May 2018 to March 2020. Specific clinical research questions were systematically searched. The quality of evidence and level of recommendations were organized according to GRADE. HCC surveillance is strongly recommended with abdominal ultrasound (US) every six months in the population at risk for HCC (cirrhosis, hepatitis B or hepatitis C); it is suggested to add alpha-feto protein (AFP) levels in case of inexeperienced sonographers. Imaging diagnosis in patients at risk for HCC has high specificity and tumor biopsy is not mandatory. The Barcelona Clinic Liver Cancer algorithm is strongly recommended for HCC staging and treatment-decision processes. Liver resection is strongly recommended for patients without portal hypertension and preserved liver function. Composite models are suggested for liver transplant selection criteria. Therapies for HCC with robust clinical evidence include transarterial chemoembolization (TACE) and first to second line systemic treatment options (sorafenib, lenvatinib, regorafenib, cabozantinib and ramucirumab). Immunotherapy with nivolumab and pembrolizumab has failed to show statistical benefit but the novel combination of atezolizumab plus bevacizumab has recently shown survival benefit over sorafenib in frontline.
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- 2020
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16. Comparison of different prognostic scores for patients with cirrhosis hospitalized with SARS-CoV-2 infection
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Manuel Mendizabal, Ezequiel Ridruejo, Federico Piñero, Margarita Anders, Martín Padilla, Luis G. Toro, Aldo Torre, Pedro Montes, Alvaro Urzúa, Esteban Gonzalez Ballerga, María Dolores Silveyra, Douglas Michelato, Javier Díaz, Mirta Peralta, Josefina Pages, Sandro Ruiz García, Isabel Gutierrez Lozano, Yuridia Macias, Daniel Cocozzella, Norberto Chavez-Tapia, Martín Tagle, Alejandra Dominguez, Adriana Varón, Emilia Vera Pozo, Fátima Higuera-de la Tijera, Carla Bustios, Damián Conte, Nataly Escajadillo, Andrés J Gómez, Laura Tenorio, Mauricio Castillo Barradas, Maria Isabel Schinoni, Fernando Bessone, Fernando Contreras, Leyla Nazal, Abel Sanchez, Matías García, Julia Brutti, María Cecilia Cabrera, Godolfino Miranda-Zazueta, German Rojas, Maximo Cattaneo, Graciela Castro-Narro, Fernando Rubinstein, and Marcelo O. Silva
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COVID-19 ,Death ,Pandemic ,Acute-on-chronic liver failure ,Coronavirus ,Cirrhosis ,Specialties of internal medicine ,RC581-951 - Abstract
Introduction and Objectives: Viral infections have been described to increase the risk of decompensation in patients with cirrhosis. We aimed to determine the effect of SARS-CoV-2 infection on outcome of hospitalized patients with cirrhosis and to compare the performance of different prognostic models for predicting mortality. Patients: We performed a prospective cohort study including 2211 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through October 1, 2020 in 38 Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters of patients with and without cirrhosis. All patients were followed until discharge or death. We evaluated the prognostic performance of different scoring systems to predict mortality in patients with cirrhosis using ROC curves. Results: Overall, 4.6% (CI 3.7–5.6) subjects had cirrhosis (n = 96). Baseline Child-Turcotte-Pugh (CTP) class was assessed: CTP-A (23%), CTP-B (45%) and CTP-C (32%); median MELD-Na score was 19 (IQR 14−25). Mortality was 47% in patients with cirrhosis and 16% in patients without cirrhosis (P 30. The areas under the ROC curves for performance evaluation in predicting 28-days mortality for Chronic Liver Failure Consortium (CLIF-C), North American Consortium for the Study of End-Stage Liver Disease (NACSELD), CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P
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- 2021
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17. International study on the outcome of locoregional therapy for liver transplant in hepatocellular carcinoma beyond Milan criteria
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Helena Degroote, Federico Piñero, Charlotte Costentin, Andrea Notarpaolo, Ilka F. Boin, Karim Boudjema, Cinzia Baccaro, Aline Lopes Chagas, Philippe Bachellier, Giuseppe Maria Ettorre, Jaime Poniachik, Fabrice Muscari, Fabrio Di Benedetto, Sergio Hoyos Duque, Ephrem Salame, Umberto Cillo, Adrián Gadano, Claire Vanlemmens, Stefano Fagiuoli, Fernando Rubinstein, Patrizia Burra, Daniel Cherqui, Marcelo Silva, Hans Van Vlierberghe, Christophe Duvoux, Filomena Conti, Olivier Scatton, Pierre Henri Bernard, Claire Francoz, Francois Durand, Sébastien Dharancy, Marie-lorraine Woehl, Alexis Laurent, Sylvie Radenne, Jérôme Dumortier, Armand Abergel, Louise Barbier, Pauline Houssel-Debry, Georges Philippe Pageaux, Laurence Chiche, Victor Deledinghen, Jean Hardwigsen, J. Gugenheim, M. Altieri, Marie Noelle Hilleret, Thomas Decaens, Aline Chagas, Paulo Costa, Elaine Cristina de Ataide, Emilio Quiñones, Sebastián Marciano, Margarita Anders, Adriana Varón, Alina Zerega, Alejandro Soza, Martín Padilla Machaca, Diego Arufe, Josemaría Menéndez, Rodrigo Zapata, Mario Vilatoba, Linda Muñoz, Ricardo Chong Menéndez, Martín Maraschio, Luis G. Podestá, M. Fauda, A. Gonzalez Campaña, Lucas McCormack, Juan Mattera, Adrian Gadano, Ilka S.F. Fatima Boin, Jose Huygens Parente García, Flair Carrilho, Giulia Magini, Lucia Miglioresi, Martina Gambato, Fabrizio Di Benedetto, Cecilia D’Ambrosio, Alessandro Vitale, Michele Colledan, Domenico Pinelli, Paolo Magistri, Giovanni Vennarecci, Marco Colasanti, Valerio Giannelli, Adriano Pellicelli, Cizia Baccaro, Callebout Eduard, Iesari Samuele, Dekervel Jeroen, Schreiber Jonas, Pirenne Jacques, Verslype Chris, Ysebaert Dirk, Michielsen Peter, Lucidi Valerio, Moreno Christophe, Detry Olivier, Delwaide Jean, Troisi Roberto, and Lerut Jan Paul
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Hepatocellular carcinoma ,Downstaging ,UCSF downstaging protocol ,All-comers ,Alpha-foetoprotein ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Good outcomes after liver transplantation (LT) have been reported after successfully downstaging to Milan criteria in more advanced hepatocellular carcinoma (HCC). We aimed to compare post-LT outcomes in patients receiving locoregional therapies (LRT) before LT according to Milan criteria and University of California San Francisco downstaging (UCSF-DS) protocol and ‘all-comers’. Methods: This multicentre cohort study included patients who received any LRT before LT from Europe and Latin America (2000–2018). We excluded patients with alpha-foetoprotein (AFP) above 1,000 ng/ml. Competing risk regression analysis for HCC recurrence was conducted, estimating subdistribution hazard ratios (SHRs) and corresponding 95% CIs. Results: From 2,441 LT patients, 70.1% received LRT before LT (n = 1,711). Of these, 80.6% were within Milan, 12.0% within UCSF-DS, and 7.4% all-comers. Successful downstaging was achieved in 45.2% (CI 34.8–55.8) and 38.2% (CI 25.4–52.3) of the UCSF-DS group and all-comers, respectively. The risk of recurrence was higher for all-comers (SHR 6.01 [p
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- 2021
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18. P-13 COMPARISON OFF DIFFERENT PROGNOSTIC SCORES FOR PATIENTS WITH CIRRHOSIS HOSPITALIZED WITH SARS – COV 2 INFECTION
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Manuel Mendizabal, Ezequiel Ridruejo, Federico Piñero, Margarita Anders, Martín Padilla, Luis G. Toro, Aldo Torre, Pedro Montes, Alvaro Urzúa, Esteban Gonzalez Ballerga, María Dolores Silveyra, Douglas Michelato, Javier Díaz, Mirta Peralta, Josefina Pages, Sandro Ruiz García, Isabel Gutierrez Lozano, Yuridia Macias, Daniel Cocozzella, Norberto Chavez-Tapia, Martín Tagle, Alejandra Dominguez, Adriana Varón, Emilia Vera Pozo, Fátima Higuera-de la Tijera, Carla Bustios, Damiá Conte, Nataly Escajadillo, Andrés J Gómez, Laura Tenorio, Mauricio Castillo Barradas, Maria Isabel Schinoni, Fernando Bessone, Fernando Contreras, Leyla Nazal, Abel Sanchez, Matías García, Julia Brutti, María Cecilia Cabrera, Godolfino Miranda-Zazueta, German Rojas, Maximo Cattaneo, Graciela Castro-Narro, Fernando Rubinstein, and Marcelo O. Silva
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Specialties of internal medicine ,RC581-951 - Abstract
Introduction and Objectives: Viral infections have been described to increase the risk of decompensation in patients with cirrhosis. We aimed to determine the impact of SARS-CoV-2 infection on clinical outcome of hospitalized patients with cirrhosis and to compare the performance of different prognostic models for predicting mortality. Patients: We performed a prospective cohort study including 2211 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through October 1, 2020 in 38 Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters of patients with and without cirrhosis. All patients were followed until discharge or death. We evaluated the prognostic performance of different scoring systems to predict mortality in patients with cirrhosis using ROC curves. Results: Overall, 4.6%(CI 3.7-5.6) subjects had cirrhosis (n=96). Baseline Child-Turcotte-Pugh (CTP) class was assessed: CTP-A (23%), CTP-B (45%) and CTP-C (32%); median MELD-Na score was 19 (IQR 14-25). Mortality was 47% in patients with cirrhosis compared to 16% in those without cirrhosis (P30. The areas under the ROC curves for performance evaluation in predicting 28-days mortality for Chronic Liver Failure Consortium (CLIF-C), North American Consortium for the Study of End-Stage Liver Disease (NACSELD), CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P
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- 2021
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19. P-101 IMPACT OF COMPLETE AND PREVENTIVE LOCKED–DOWN BEFORE COVID 19 OUTBREAK IN ORGAN PROCUREMENT AND SOLID TRANSPLANTATION IN ARGENTINA: THE WORST HAS NOT YET ARRIVED.
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Josefina Pages, Federico Piñero, Margarita Anders, Marcos Thompson, Ariel Gonzalez Campaña, Manuel Mendizabal, Martín Fauda, Florencia Antinucci, Federico Orozco Ganem, Nadia Grigera, Lucas McCormack, Gustavo Podesta, and Marcelo Silva
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Specialties of internal medicine ,RC581-951 - Abstract
Introduction: Early preventive strict quarantine due to COVID-19 pandemic was implemented in Argentina since March 20th, 2020. Transplant societies and organ procurement organizations were challenged to face this complex scenario and sustain organ donation and transplantation activity. Objectives: We evaluated the impact of complete and preventive lockdown in organ procurement and transplantation before the COVID-19 peak onset. Materials and Methods: We analyzed prospectively collected data from the National Report Agency (INCUCAI). By constructing time series, we compared donation and transplant rates from the years 2010 to 2020, during a same monthly-period between March 3rd and July 20th. We evaluated the effect of preventive lockdown before the peak of COVID-19 curve. Donation rates per million population in these months were also registered for each year. Transplant accessibility was calculated, dividing the total number of transplants and the total number of listed patients. Results: The preventive lockdown was associated with a 34.5% relative reduction (95% CI 26.9-43.2) in organ procurement when compared to 2010-2019 and significantly reduced comparing 2019 [53.3% (CI 44.6-61.6)]. This scenario was even worse in Buenos Aires city and its surroundings, the region most affected by COVID-19. During this period, donation per million population rates decreased from 7.8 in 2019 to 3.3 in 2020. This reduction was even higher in the number of deceased and living donor transplants performed comparing 2019 vs. 2020, with a relative reduction of 62.0% (CI 30.8-89.1) and 68.8% (CI 65.7-71.7), respectively. Conclusions: During this short observation period of 120 days of preventive quarantine, not yet having reached the ''peak'' incidence of COVID-19, a marked reduction in procurement and transplantation rates were observed. Although waiting list mortality was not significantly modified, transplant access has been significantly reduced, showing a future negative trend on waitlist mortality.
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- 2021
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20. Assessing the impact of COVID-19 on liver cancer management (CERO-19)
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Sergio Muñoz-Martínez, Victor Sapena, Alejandro Forner, Jean-Charles Nault, Gonzalo Sapisochin, Lorenza Rimassa, Bruno Sangro, Jordi Bruix, Marco Sanduzzi-Zamparelli, Wacław Hołówko, Mohamed El Kassas, Tudor Mocan, Mohamed Bouattour, Philippe Merle, Frederik J.H. Hoogwater, Saleh A. Alqahtani, Helen L. Reeves, David J. Pinato, Emmanouil Giorgakis, Tim Meyer, Gerda Elisabeth Villadsen, Henning Wege, Massimiliano Salati, Beatriz Mínguez, Giovan Giuseppe Di Costanzo, Christoph Roderburg, Frank Tacke, María Varela, Peter R. Galle, Mario Reis Alvares-da-Silva, Jörg Trojan, John Bridgewater, Giuseppe Cabibbo, Christian Toso, Anja Lachenmayer, Andrea Casadei-Gardini, Hidenori Toyoda, Tom Lüdde, Rosanna Villani, Ana María Matilla Peña, Cassia Regina Guedes Leal, Monica Ronzoni, Manuel Delgado, Christie Perelló, Sonia Pascual, José Luis Lledó, Josepmaria Argemi, Bristi Basu, Leonardo da Fonseca, Juan Acevedo, Alexander R. Siebenhüner, Chiara Braconi, Brandon M. Meyers, Alessandro Granito, Margarita Sala, Carlos Rodríguez-Lope, Lorraine Blaise, Manuel Romero-Gómez, Federico Piñero, Dhanny Gomez, Vivianne Mello, Rogerio Camargo Pinheiro Alves, Alex França, Fernanda Branco, Giovanni Brandi, Gustavo Pereira, Susanna Coll, Maria Guarino, Carlos Benítez, Maria Margarita Anders, Juan C. Bandi, Mercedes Vergara, Mariona Calvo, Markus Peck-Radosavljevic, Ignacio García-Juárez, Vincenzo Cardinale, Mar Lozano, Martina Gambato, Stefano Okolicsanyi, Dalia Morales-Arraez, Alessandra Elvevi, Alberto E. Muñoz, Alberto Lué, Massimo Iavarone, and Maria Reig
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COVID-19 ,Hepatocellular carcinoma ,Cholangiocarcinoma ,Liver cancer ,Management ,Clinical trials ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). Herein, we evaluated whether the schedule of LC screening or procedures has been interrupted or delayed because of the COVID-19 pandemic. Methods: An international survey evaluated the impact of the COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international, and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave. Results: Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia, and Africa (73.7%, 17.1%, 5.3%, 2.6%, and 1.3% per continent, respectively). Eighty-seven percent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening programme, 50% cancelled curative and/or palliative treatments for LC, and 41.7% modified the liver transplantation programme. Forty-five out of 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service before the COVID-19 pandemic (n = 19/37). Conclusions: The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with liver cancer. Modifications in screening, diagnostic, and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision-making. Lay summary: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems globally. Herein, we assessed the impact of the first wave pandemic on patients with liver cancer and found that routine care for these patients has been majorly disrupted, which could have a significant impact on outcomes.
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- 2021
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21. A different gut microbiome linked to inflammation found in cirrhotic patients with and without hepatocellular carcinoma
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Federico Piñero, Martín Vazquez, Patricia Baré, Cristian Rohr, Manuel Mendizabal, Mariela Sciara, Cristina Alonso, Fabián Fay, and Marcelo Silva
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Liver cancer ,Microbiota ,Inflammatory pathways ,Specialties of internal medicine ,RC581-951 - Abstract
Introduction and aim: A pro-oncogenic intestinal microbiome was observed in murine models; however, no specific microbiome in patients with hepatocellular carcinoma (HCC) has been reported. We aimed to compare the gut microbiome found in cirrhotic patients with or without HCC. Materials and methods: From 407 patients with Child Pugh A/B cirrhosis prospectively followed, 25 with HCC (cases) were matched with 25 without HCC (wo-HCC) in a 1:1 ratio according to age, gender, etiology, Child Pugh and severity of portal hypertension. In addition, results were also compared with 25 healthy subjects. Fecal stool samples were sequenced for the V3–V4 region of the microbial 16S rRNA (Illumina MiSeq Platform). Plasma cytokines were quantified including interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α). Results: We found a differential abundance in family members of Firmicutes with a 3-fold increase of Erysipelotrichaceae and a 5-fold decrease in family Leuconostocaceae in HCC when compared to wo-HCC controls. Genus Fusobacterium was found to be 5-fold decreased in HCC vs wo-HCC. The ratio bacteriodes/prevotella was increased in HCC. Three operational taxonomic units (OTUs), genus Odoribacter and Butyricimonas were more abundant in HCC, whereas a decreased abundance in Lachnospiraceae family genus Dorea was observed in HCC patients. A Random Forest model trained with differential abundant taxa correctly classified HCC individuals. This pattern was associated with an inflammatory milieu with a putative increased activation of NOD-like receptor pathways. Conclusion: We found a pattern of microbiome linked to inflammation that could be potentially useful as HCC biomarker after follow-up validation studies.
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- 2019
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22. Prospective Latin American cohort evaluating outcomes of patients with COVID-19 and abnormal liver tests on admission
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Manuel Mendizabal, Federico Piñero, Ezequiel Ridruejo, Margarita Anders, María Dolores Silveyra, Aldo Torre, Pedro Montes, Alvaro Urzúa, Josefina Pages, Luis G. Toro, Javier Díaz, Esteban Gonzalez Ballerga, Godolfino Miranda-Zazueta, Mirta Peralta, Isabel Gutiérrez, Douglas Michelato, Maria Grazia Venturelli, Adriana Varón, Emilia Vera-Pozo, Martín Tagle, Matías García, Alfredo Tassara, Julia Brutti, Sandro Ruiz García, Carla Bustios, Nataly Escajadillo, Yuridia Macias, Fátima Higuera-de la Tijera, Andrés J Gómez, Alejandra Dominguez, Mauricio Castillo-Barradas, Fernando Contreras, Aldana Scarpin, Maria Isabel Schinoni, Claudio Toledo, Marcos Girala, Victoria Mainardi, Abel Sanchez, Fernando Bessone, Fernando Rubinstein, and Marcelo O Silva
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SARS-CoV-2 ,Death ,Pandemic ,Hepatitis ,Coronavirus ,Specialties of internal medicine ,RC581-951 - Abstract
Introduction & objectives: The independent effect of liver biochemistries as a prognostic factor in patients with COVID-19 has not been completely addressed. We aimed to evaluate the prognostic value of abnormal liver tests on admission of hospitalized patients with COVID-19. Materials & methods: We performed a prospective cohort study including 1611 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through July 31, 2020 in 38 different Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters, including liver function tests, on admission and during hospitalization. All patients were followed until discharge or death. We fit multivariable logistic regression models, further post-estimation effect through margins and inverse probability weighting. Results: Overall, 57.8% of the patients were male with a mean age of 52.3 years, 8.5% had chronic liver disease and 3.4% had cirrhosis. Abnormal liver tests on admission were present on 45.2% (CI 42.7–47.7) of the cohort (n = 726). Overall, 15.1% (CI 13.4–16.9) of patients died (n = 244). Patients with abnormal liver tests on admission presented higher mortality 18.7% (CI 15.9–21.7), compared to those with normal liver biochemistries 12.2% (CI 10.1–14.6); P 30. Conclusions: The presence of abnormal liver tests on admission is independently associated with mortality and severe COVID-19 in hospitalized patients with COVID-19 infection and may be used as surrogate marker of inflammation. Clinicaltrials.gov: NCT04358380.
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- 2021
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23. Isolated Intrapulmonary Vascular Dilatations and the Risk of Developing Hepatopulmonary Syndrome in Liver Transplant Candidates
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Manuel Mendizabal, David S. Goldberg, Federico Piñero, Diego T. Arufe, María José de la Fuente, Pablo Testa, Matías Coronel, Sergio Baratta, Luis G. Podestá, Michael B. Fallon, and Marcelo O. Silva
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Hepatopulmonary syndrome ,Intrapulmonary vascular dilatation ,Liver transplantation. ,Specialties of internal medicine ,RC581-951 - Abstract
Background: The natural history of intrapulmonary vascular dilations (IPVD) and their impact on patient outcomes in the setting of portal hypertension has only been described in small series. Aims: To assess the development of hepatopulmonary syndrome (HPS) in patients with isolated IPVD and to evaluate outcomes of IPVD and HPS among patients evaluated for liver transplantation (LT). Material and methods: Data from a prospective cohort of patients evaluated for LT with standardized screening for HPS were analyzed. IPVDs were defined as the presence of microbubbles in the left atrium > 3 cycles following right atrial opacification. HPS was defined as the presence of IPVD and hypoxemia (Alveolar-arterial gradient ≥ 15 mmHg) in the absence of concomitant cardiopulmonary disease. Results: A total of 104 patients with negative contrast-enhanced echocardiogram (CE) were compared to 63 patients with IPVD and 63 patients with HPS. Only four patients were categorized as ‘severe’ HPS based on degree of hypoxemia (defined as PaO2 < 60 mmHg). Twenty IPVD patients were followed with ABG over a mean duration of 21 months (range 9-43), of whom 7 (35%) subsequently met HPS criteria. Overall unadjusted survival from the time of LT evaluation using multistate survival models that accounted for pre- and post-LT time was not statistically different among the three groups (negative CE, IPVD, and HPS; p > 0.5). Conclusions: Patients with IPVD appear to have a substantial risk of developing oxygenation impairment over time and progress to HPS. In our cohort, survival in patients with HPS and isolated IPVD is not different when compared to those without IPVDs.
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- 2017
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24. Predicting early discharge from hospital after liver transplantation (ERDALT) at a single center: a new model
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Federico Piñero, Martín Fauda, Rodolfo Quiros, Manuel Mendizabal, Ariel González-Campaña, Demian Czerwonko, Mariano Barreiro, Silvina Montal, Ezequiel Silberman, Matías Coronel, Fernando Cacheiro, Pía Raffa, Oscar Andriani, Marcelo Silva, and Luis G. Podestá
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Health care ,Hospital stay ,Transplant ,Resources ,Specialties of internal medicine ,RC581-951 - Abstract
Background & rationale. Limited information related to Liver Transplantation (LT) costs in South America exists. Additionally, costs analysis from developed countries may not provide comparable models for those in emerging economies. We sought to evaluate a predictive model of Early Discharge from Hospital after LT (ERDALT = length of hospital stay ≤ 8 days). A predictive model was assessed based on the odds ratios (OR) from a multivariate regression analysis in a cohort of consecutively transplanted adult patients in a single center from Argentina and internally validated with bootstrapping technique.Results. ERDALT was applicable in 34 of 289 patients (11.8%). Variables independently associated with ERDALT were MELD exception points OR 1.9 (P = 0.04), surgery time < 4 h OR 3.8 (P = 0.013), < 5 units of blood products consumption (BPC) OR 3.5 (P = 0.001) and early weaning from mechanical intubation OR 6.3 (P = 0.006). Points in the predictive scoring model were allocated as follows: MELD exception points (absence = 0 points, presence = 1 point), surgery time < 4 h (0-2 points), < 5 units of BPC (0-2 points), and early weaning (0-3 points). Final scores ranged from 0 to 8 points with a c-statistic of 0.83 (95% CI 0.77-0.90; P < 0.0001). Transplant costs were significantly lower in patients with ERDALT (median $23,078 vs. $28,986; P < 0.0001). Neither lower patient and graft survival, nor higher rates of short-term re-hospitalization and acute rejection events after discharge were observed in patients with ERDALT. In conclusion, the ERDALT score identifies patients suitable for early discharge with excellent outcomes after transplantation. This score may provide applicable models particularly for emerging economies.
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- 2015
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25. Biomarkers in Hepatocellular Carcinoma: Diagnosis, Prognosis and Treatment Response Assessment
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Federico Piñero, Melisa Dirchwolf, and Mário G. Pessôa
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liver cancer ,biological ,markers ,Cytology ,QH573-671 - Abstract
Hepatocellular carcinoma (HCC) is one of the main cancer-related causes of death worldwide. Thus, there is a constant search for improvement in screening, diagnosis, and treatment strategies to improve the prognosis of this malignancy. The identification of useful biomarkers for surveillance and early HCC diagnosis is still deficient, with available serum biomarkers showing low sensitivity and heterogeneous specificity despite different cut-off points, even when assessed longitudinally, or with a combination of serum biomarkers. In contrast, HCC biomarkers used for prognostic (when associated with clinical outcomes) or predictive purposes (when associated with treatment response) may have an increased clinical role in the near future. Furthermore, some serum biomarkers are already implicated as a treatment selection tool, whether to provide access to certain therapies or to assess clinical benefit after treatment. In the present review we will discuss the clinical utility and foreseen future of HCC biomarkers implicated in surveillance, diagnosis, prognosis, and post-treatment assessment.
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- 2020
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26. Ultra-sensitive procalcitonin may help rule out bacterial infections in patients with cirrhosis
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Sebastián Marciano, M.D., Leila Haddad, Alfredo P. Martínez, María L. Posadas, Federico Piñero, Gonzalo J. Mora, Laura N. Guerrero, Ezequiel Ridruejo, Oscar G. Mandó, Diego H. Giunta, and Adrián C. Gadano
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End-stage liver disease ,Sepsis ,Antibiotics ,Surrogate markers ,Encephalopathy ,Specialties of internal medicine ,RC581-951 - Abstract
Background. Bacterial infections are frequent complications in patients with cirrhosis. Since they are associated with poor outcomes, antibiotics are frequently over-prescribed. Surrogate markers of bacterial infections, like procalcitonin, are needed to better discriminate between infected and not infected patients.Aims. To evaluated the diagnostic accuracy of an ultra-sensitive procalcitonin assay for the diagnosis of bacterial infections in patients with cirrhosis.Material and methods. In a single-center prospective study, we determined the basal levels of procalcitonin in 106 episodes of admissions to the emergency department in 84 cirrhotic patients. Patients were classified as infected or not infected by two independent hepatologists blinded to the procalcitonin result.Results. The prevalence of bacterial infection was 28% (29 episodes). The median procalcitonin was significantly higher in the infected group than in the not infected group (0.45 vs. 0.061 ng/mL, p < 0.001). The diagnostic accuracy of procalcitonin for bacterial infection estimated by the ROC curve was 0.95 (CI: 95%, 0.91-0.99). When selecting a cutoff value of 0.098 ng/mL a sensitivity of 97% and a negative predictive value 98% were found.Conclusions. The use of an ultra-sensitive procalcitonin assay identifies patients with cirrhosis at very low risk of bacterial infections.
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- 2014
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27. Successful orthotopic liver transplantation and delayed delivery of a healthy newborn in a woman with fulminant hepatic failure during the second trimester of pregnancy
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Manuel Mendizabal, Carlos Rowe, Federico Piñero, Ariel Gonzalez-Campaña, Martín Fauda, Diego Tomás Arufe, María Pía Raffa, Mariano Barreiro, Rodolfo Keller, Fernando Cacheiro, Ernesto Beruti, Oscar Andriani, Marcelo Oscar Silva, and Luis Gustavo Podestá
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Acute liver failure ,Liver transplantation ,High risk pregnancy ,Specialties of internal medicine ,RC581-951 - Abstract
Severe liver dysfunction during pregnancy implies a serious risk for both mother and fetus, and represents a technical and ethical challenge for treating physicians. We report a case of a previously healthy 32-year old woman who was admitted to our hospital with idiopathic fulminant hepatic failure and underwent successful orthotopic liver transplantation (OLT) at gestation week 21. Patient’s and fetus’ immediate postoperative course were relatively uneventful until week six after OLT, when the mother developed oligohydramnios and preeclampsia. At pregnancy week 27, after inducing baby’s lung maturation, a cesarean section was performed with the delivery of an otherwise healthy girl. After 3 years of follow-up, mother and child are leading normal lives with no complications related either to pregnancy or to OLT. We describe the case of a successful emergency liver transplant in a woman during the second trimester of pregnancy, demonstrating that OLT can be a viable option to preserve the life of the mother and an otherwise unviable fetus. Intrauterine baby’s growths until the attainment of a viable gestational age was feasible despite the mother’s fulminant hepatic failure and liver transplant surgery.
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- 2014
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28. Early predictors of renal dysfunction in cirrhotic patients after liver transplantation
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Federico Piñero, Juan Bandi, Matías Tisi Baña, Paola Casciato, Alejandra Villamil, Omar Galdame, Eduardo de Santibañés, and Adrián Gadano
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Diseases of the digestive system. Gastroenterology ,RC799-869 ,Medicine - Abstract
Introduction. La evaluación de la función renal al año post-trasplante hepático (TH) predice el desarrollo de injuria renal crónica y progresiva a largo plazo. Objetivo. Evaluar variables predictoras pre- y post-TH de desarrollo de disfun - ción renal (DR) en pacientes cirróticos luego del TH. Mé - todos. Entre junio de 2005 y junio de 2010, 104 pacientes cirróticos fueron incluidos de un total 268 pacientes adultos trasplantados de hígado. La DR se definió cuando la tasa de filtrado glomerular (TFG) era de
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- 2014
29. Implementation of a re-linkage to care strategy in patients with chronic hepatitis C who were lost to follow-up in Latin America
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Manuel Mendizabal, Marcos Thompson, Esteban Gonzalez‐Ballerga, Margarita Anders, Graciela E. Castro‐Narro, Mario G. Pessoa, Hugo Cheinquer, Gabriel Mezzano, Ana Palazzo, Ezequiel Ridruejo, Valeria Descalzi, Jose A. Velarde‐Ruiz Velasco, Sebastian Marciano, Linda Muñoz, Maria I. Schinoni, Jaime Poniachik, Rosalía Perazzo, Eira Cerda, Francisco Fuster, Adriana Varon, Sandro Ruiz García, Alejandro Soza, Cecilia Cabrera, Andres J. Gomez‐Aldana, Flor de María Beltrán, Solange Gerona, Daniel Cocozzella, Fernando Bessone, Nelia Hernández, Cristina Alonso, Melina Ferreiro, Florencia Antinucci, Aldo Torre, Bruna D. Moutinho, Silvia Coelho Borges, Fernando Gomez, Maria Dolores Murga, Federico Piñero, Gisela F. Sotera, Jhonier A. Ocampo, Valeria A. Cortés Mollinedo, Daniela Simian, and Marcelo O. Silva
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Infectious Diseases ,Hepatology ,Virology - Abstract
To achieve WHO's goal of eliminating hepatitis C virus (HCV), innovative strategies must be designed to diagnose and treat more patients. Therefore, we aimed to describe an implementation strategy to identify patients with HCV who were lost to follow-up (LTFU) and offer them re-linkage to HCV care. We conducted an implementation study utilizing a strategy to contact patients with HCV who were not under regular follow-up in 13 countries from Latin America. Patients with HCV were identified by the international classification of diseases (ICD-9/10) or equivalent. Medical records were then reviewed to confirm the diagnosis of chronic HCV infection defined by anti-HCV+ and detectable HCV-RNA. Identified patients who were not under follow-up by a liver specialist were contacted by telephone or email, and offered a medical reevaluation. A total of 10,364 patients were classified to have HCV. After reviewing their medical charts, 1349 (13%) had undetectable HCV-RNA or were wrongly coded. Overall, 9015 (86.9%) individuals were identified with chronic HCV infection. A total of 5096 (56.5%) patients were under routine HCV care and 3919 (43.5%) had been LTFU. We were able to contact 1617 (41.3%) of the 3919 patients who were LTFU at the primary medical institution, of which 427 (26.4%) were cured at a different institutions or were dead. Of the remaining patients, 906 (76.1%) were candidates for retrieval. In our cohort, about one out of four patients with chronic HCV who were LTFU were candidates to receive treatment. This strategy has the potential to be effective, accessible and significantly impacts on the HCV care cascade.
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- 2022
30. Lenvatinib as first-line therapy for recurrent hepatocellular carcinoma after liver transplantation: Is the current evidence applicable to these patients?
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Juan Ignacio Marín, Federico Piñero, Marcos Thompson, and Marcelo Silva
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Opinion Review ,Oncology ,medicine.medical_specialty ,Hepatocellular carcinoma ,medicine.medical_treatment ,030232 urology & nephrology ,030230 surgery ,Liver transplantation ,Systemic therapy ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Recurrence ,Internal medicine ,Medicine ,Contraindication ,Cause of death ,Transplantation ,business.industry ,Systemic therapies ,Retrospective cohort study ,medicine.disease ,digestive system diseases ,Recurrent Hepatocellular Carcinoma ,chemistry ,business ,Lenvatinib - Abstract
Liver transplantation (LT) is one of the leading curative therapies for hepatocellular carcinoma (HCC). Despite recent optimization of transplant selection criteria, including alpha-feto protein, HCC recurrence after LT is still the leading cause of death in these patients. During the last decades, effective systemic treatments for HCC, including tyrosine kinase inhibitors and immunotherapy, have been approved. We describe the clinical scenario of a patient with recurrence of HCC five years after LT, who received lenvatinib as first-line systemic therapy to introduce systemic treatment options in this clinical setting. In this opinion review, we detail first and second-line systemic treatment options, focusing on those feasible for patients with recurrent HCC after LT. Several trials have evaluated new drugs to treat HCC patients in first and second-line therapy, but patients with recurrent HCC after LT have been excluded from these trials. Consequently, most of the evidence comes from observational retrospective studies. Whether tyrosine kinase inhibitors will remain the primary therapeutic approach in these patients, due to a relative contraindication for immunotherapy, may be clarified in the near future.
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- 2020
31. Performance of pre-transplant criteria in prediction of hepatocellular carcinoma progression and waitlist dropout
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Federico Piñero, Marcos Thompson, Ilka Boin, Aline Chagas, Emilio Quiñonez, Carla Bermúdez, Mario Vilatobá, Luisa Santos, Margarita Anders, Sergio Hoyos Duque, Agnaldo Soares Lima, Josemaría Menendez, Martín Padilla, Jaime Poniachik, Rodrigo Zapata, Martín Maraschio, Ricardo Chong Menéndez, Linda Muñoz, Diego Arufe, Rodrigo Figueroa, Simone R. Perales, Claudia Maccali, Rodrigo Vergara Sandoval, Lucas McCormack, Adriana Varón, Sebastián Marciano, Juan Mattera, Flair Carrilho, and Marcelo Silva
- Subjects
Cohort Studies ,Carcinoma, Hepatocellular ,Patient Dropouts ,Hepatology ,Waiting Lists ,Patient Selection ,Liver Neoplasms ,Health Status Indicators ,Humans ,alpha-Fetoproteins ,Liver Transplantation ,Retrospective Studies - Abstract
Liver transplantation (LT) selection models for hepatocellular carcinoma (HCC) have not been proposed to predict waitlist dropout because of tumour progression. The aim of this study was to compare the alpha-foetoprotein (AFP) model and other pre-LT models in their prediction of HCC dropout.A multicentre cohort study was conducted in 20 Latin American transplant centres, including 994 listed patients for LT with HCC from 2012 to 2018. Longitudinal tumour characteristics, and patterns of progression were recorded at time of listing, after treatments and at last follow-up over the waitlist period. Competing risk regression models were performed, and model's discrimination was compared estimating Harrell's adapted c-statistics.HCC dropout rate was significantly higher in patients beyond (24% [95% CI 16-28]) compared to those within Milan criteria (8% [95% IC 5%-12%]; p .0001), with a SHR of 3.01 [95% CI 2.03-4.47]), adjusted for waiting list time and bridging therapies (c-index 0.63 [95% CI 0.57; 0.69). HCC dropout rates were higher in patients with AFP scores2 (adjusted SHR of 3.17 [CI 2.13-4.71]), c-index of 0.71 (95% CI 0.65-0.77; p = .09 vs Milan). Similar discrimination power for HCC dropout was observed between the AFP score and the Metroticket 2.0 model. In patients within Milan, an AFP score 2 points discriminated two populations with a higher risk of HCC dropout (SHR 1.68 [95% CI 1.08-2.61]).Pre-transplant selection models similarly predicted HCC dropout. However, the AFP model can discriminate a higher risk of dropout among patients within Milan criteria.
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- 2022
32. Pilot study using the ECHO model to enhance linkage to care for patients with hepatitis C in the custodial setting
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Carolina Dunn, Soledad Olguín, Marcelo Silva, Federico Piñero, Fernando Rubinstein, Mercedes Zirpoli, Pablo Testa, Solana Elías, Mariano Barreiro, Mercedes Rojas, Manuel Mendizabal, Sanjeev Arora, Carla Colaci, Claudio Ronchi, Paula Nicolini, and Martin O´Flaherty
- Subjects
Male ,Sexually transmitted disease ,medicine.medical_specialty ,Population ,Pilot Projects ,Hepacivirus ,Logistic regression ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Virology ,Internal medicine ,Prevalence ,medicine ,Humans ,In patient ,030212 general & internal medicine ,education ,Linkage (software) ,education.field_of_study ,Hepatology ,business.industry ,Prisoners ,Echo (computing) ,virus diseases ,Hepatitis C ,Hepatitis C Antibodies ,medicine.disease ,Dried blood spot ,Infectious Diseases ,Prisons ,Female ,030211 gastroenterology & hepatology ,business - Abstract
Prisoners in most countries have a higher prevalence of HCV than the general population, but their access to treatment is very limited. Our aim was to evaluate a pilot programme using the ECHO model to enhance linkage to care in patients with HCV in 3 Argentinean prisons between October 2018 and January 2020. All inmates were invited to participate, and data were collected through a personal interview. We then estimated HCV prevalence with dried blood spot and performed a logistic regression analysis to identify risk behaviours associated with HCV infection. Finally, HCV management was assessed and monitored through ECHO. Overall, 1141 inmates agreed to participate, representing 39.7% of the total prison population. Anti-HCV prevalence was estimated at 1.58% (CI 0.93; 2.48), being significantly higher in women 2.98% (CI 1.4;5.6) than in men 1.07% (CI 0.5; 2.0); P = .03. Patients with anti-HCV were significantly older than those who tested negative, 42.3 years (CI 37.6;47.1) vs 30.1 years (CI 30.6;31.2), P < .001, respectively. Multiple logistic regression analysis, identified age OR 1.07 (CI 1.03;1.12, P = .001), history of sexually transmitted disease OR 3.08 (CI 0.97;9.82, P = .057) and intravenous drug use OR 12.6 (CI 3.31;48.53, P < .001) as risk factors associated with anti-HCV. Treatment was initiated in all the patients with specialist physician support utilizing ECHO model. In conclusion, our pilot study reported a low prevalence of anti-HCV in the studied population. Incarceration provides an ideal opportunity for testing and treating HCV. ECHO model arises as a useful tool to support assessment and treatment for inmates with chronic HCV.
- Published
- 2020
33. Argentinian clinical practice guideline for surveillance, diagnosis, staging and treatment of hepatocellular carcinoma
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Juan Carlos Spina, Mario Tanno, Cecilia Lagues, Ezequiel Ridruejo, Margarita Anders, Silvia Borzi, Matías Tisi Baña, Adrián Gadano, Andrés Ruf, Melisa Dirchwolf, Federico Piñero, Marcelo Silva, Guillermo Mazzolini, Nora Fernández, Eduardo Fassio, Martín Maraschio, Florencia Perazzo, Beatriz Ameigeiras, Lucas McCormack, Valeria Descalzi, Gabriel Aballay Soteras, Sebastián Marciano, Silvia Mengarelli, Virginia Reggiardo, Federico G. Villamil, and Fernando Cairo
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Oncology ,Biopsy ,Specialties of internal medicine ,Medical Oncology ,0302 clinical medicine ,Risk Factors ,purl.org/becyt/ford/3.2 [https] ,LIVER CANCER ,Ultrasonography ,ARGENTINA ,Evidence-Based Medicine ,Liver Neoplasms ,General Medicine ,Hepatitis C ,Treatment Outcome ,RC581-951 ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,030211 gastroenterology & hepatology ,purl.org/becyt/ford/3 [https] ,Liver cancer ,Algorithms ,medicine.drug ,Sorafenib ,medicine.medical_specialty ,Practice guideline ,Carcinoma, Hepatocellular ,Consensus ,Clinical Decision-Making ,Argentina ,Risk Assessment ,LATIN AMERICA ,Ramucirumab ,Decision Support Techniques ,03 medical and health sciences ,Atezolizumab ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,neoplasms ,Neoplasm Staging ,Hepatology ,business.industry ,Guideline ,medicine.disease ,digestive system diseases ,Latin America ,PRACTICE GUIDELINE ,Liver function ,business - Abstract
The A.A.E.E.H has developed this guideline for the best care of patients with hepatocellular carcinoma (HCC) from Argentina. It was done from May 2018 to March 2020. Specific clinical research questions were systematically searched. The quality of evidence and level of recommendations were organized according to GRADE. HCC surveillance is strongly recommended with abdominal ultrasound (US) every six months in the population at risk for HCC (cirrhosis, hepatitis B or hepatitis C); it is suggested to add alpha-feto protein (AFP) levels in case of inexeperienced sonographers. Imaging diagnosis in patients at risk for HCC has high specificity and tumor biopsy is not mandatory. The Barcelona Clinic Liver Cancer algorithm is strongly recommended for HCC staging and treatment-decision processes. Liver resection is strongly recommended for patients without portal hypertension and preserved liver function. Composite models are suggested for liver transplant selection criteria. Therapies for HCC with robust clinical evidence include transarterial chemoembolization (TACE) and first to second line systemic treatment options (sorafenib, lenvatinib, regorafenib, cabozantinib and ramucirumab). Immunotherapy with nivolumab and pembrolizumab has failed to show statistical benefit but the novel combination of atezolizumab plus bevacizumab has recently shown survival benefit over sorafenib in frontline. Fil: Piñero, Federico. Universidad Austral. Hospital Universitario Austral; Argentina Fil: Tanno, Mario. Universidad Nacional de Rosario. Facultad de Ciencias Médicas. Hospital Nacional del Centenario; Argentina Fil: Aballay Soteras, Gabriel. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; Argentina Fil: Tisi Baña, Matías. Universidad Austral. Hospital Universitario Austral; Argentina Fil: Dirchwolf, Melisa. Hospital Privado de Rosario; Argentina Fil: Fassio, Eduardo. Hospital Nacional Profesor Alejandro Posadas.; Argentina Fil: Ruf, Andrés. Hospital Privado de Rosario; Argentina Fil: Mengarelli, Silvia Estela. Gobierno de la Provincia de Entre Rios. Hospital San Roque.; Argentina Fil: Borzi, Silvia. Hospital Privado de Cordoba; Argentina Fil: Fernández, Nora. Hospital Británico de Buenos Aires; Argentina Fil: Ridruejo, Ezequiel. Universidad Austral. Hospital Universitario Austral; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Descalzi, Valeria. Fundación Favaloro; Argentina Fil: Anders, Margarita. Hospital Alemán; Argentina Fil: Mazzolini, Guillermo. Universidad Austral; Argentina Fil: Reggiardo, Virginia. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Doctor Cosme Argerich; Argentina Fil: Marciano, Sebastian. Hospital Italiano. Departamento de Medicina.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Perazzo, Florencia. Hospital Británico de Buenos Aires; Argentina Fil: Spina, Juan Carlos. Hospital Italiano; Argentina Fil: McCormack, Lucas. Hospital Alemán; Argentina Fil: Maraschio, Martín Alejandro. Hospital Privado de Cordoba; Argentina Fil: Lagues, Cecilia. Universidad Austral; Argentina Fil: Gadano, Adrián Carlos. Hospital Italiano. Departamento de Medicina.; Argentina Fil: Villamil, Federico. Hospital Italiano. Departamento de Medicina.; Argentina. Hospital Británico de Buenos Aires; Argentina Fil: Silva, Marcelo. Universidad Austral. Hospital Universitario Austral; Argentina Fil: Cairo, Fernando. Hospital Británico de Buenos Aires; Argentina Fil: Ameigeiras, Beatriz. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina
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- 2020
34. Sequencing of systemic treatment for hepatocellular carcinoma: Second line competitors
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Massimo Iavarone, Marcelo Silva, and Federico Piñero
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Oncology ,Sorafenib ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Cabozantinib ,Bevacizumab ,Hepatocellular carcinoma ,Options ,medicine.medical_treatment ,Ramucirumab ,03 medical and health sciences ,chemistry.chemical_compound ,Antineoplastic Agents, Immunological ,0302 clinical medicine ,Atezolizumab ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Sequencing ,Medicine ,Molecular Targeted Therapy ,Protein Kinase Inhibitors ,Future ,neoplasms ,Neoplasm Staging ,Randomized Controlled Trials as Topic ,business.industry ,Liver Neoplasms ,Systemic ,Gastroenterology ,Minireviews ,General Medicine ,Immunotherapy ,Prognosis ,medicine.disease ,Progression-Free Survival ,digestive system diseases ,chemistry ,030220 oncology & carcinogenesis ,Advanced ,030211 gastroenterology & hepatology ,business ,Lenvatinib ,medicine.drug - Abstract
During the last decades, further knowledge of hepatocellular carcinoma (HCC) molecular mechanisms has led to development of effective systemic treatments including tyrosine kinase inhibitors (TKIs) and immunotherapy. In this review, we describe first and second line systemic treatment options for advanced HCC. Several trials have evaluated new drugs for the treatment of HCC patients: In first line, lenvatinib resulted non-inferior to sorafenib and it can be used as alternative, even in the lack of evidence for sequential treatment options in second line after lenvatinib. Recently, atezolizumab plus bevacizumab have shown superiority over sorafenib in first-line. Sorafenib-regorafenib sequential administration in selected patients has opened a new paradigm of treatment in advanced HCC with a life expectancy exceeding two years. Other TKIs for second line treatment include cabozantinib and ramucirumab (specifically for patients with Alpha-fetoprotein values ≥ 400 ng/mL). The combination of TKIs with immunotherapy may represent a big step forward for these patients in the near future.
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- 2020
35. International and multicenter real‐world study of sorafenib‐treated patients with hepatocellular carcinoma under dialysis
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Aline Lopes Chagas, Gabriel Aballay Soteras, Margarita Sala, Adolfo Gallego, Yolanda Sánchez-Torrijos, Marcus-Alexander Wörns, Carlos Huertas, Leonardo Gomes da Fonseca, Carlos Rodríguez de Lope, Margarita Anders, M. Varela, Manuel Hernández-Guerra, Rogerio Alves, Maria Reig, Sonia Pascual, Marco Sanduzzi-Zamparelli, Tania Hernáez, Lorenza Rimassa, Mário Reis Álvares-da-Silva, Alessandro Granito, Juan Arenas, Beatriz Minguez, Cassia Leal, Ana Matilla, Jordi Bruix, Morten Ladekarl, Alberto Lué, Alex Vianey Callado França, Christie Perelló, Rodolfo Sacco, José Luis Lledó, Álvaro Díaz-González, Matthias Pinter, Juan Ignacio Marín, Gustavo Pereira, Susanna Coll, Giovan Giuseppe Di Costanzo, Massimo Iavarone, Ángela Rojas, Federico Piñero, Mercedes Vergara, Edoardo G. Giannini, Jean-Charles Nault, Mar Lozano, Bruno Sangro, Ignacio Garcia Juarez, Vivianne Mello, Josemaría Menéndez, Manuel Delgado, Diaz-Gonzalez A., Sanduzzi-Zamparelli M., da Fonseca L.G., Di Costanzo G.G., Alves R., Iavarone M., Leal C., Sacco R., Matilla A.M., Hernandez-Guerra M., Aballay Soteras G., Worns M.-A., Pinter M., Varela M., Ladekarl M., Chagas A.L., Minguez B., Arenas J.I., Granito A., Sanchez-Torrijos Y., Rojas A., Rodriguez de Lope C., Alvares-da-Silva M.R., Pascual S., Rimassa L., Lledo J.L., Huertas C., Sangro B., Giannini E.G., Delgado M., Vergara M., Perello C., Lue A., Sala M., Gallego A., Coll S., Hernaez T., Pinero F., Pereira G., Franca A., Marin J., Anders M., Mello V., Lozano M., Nault J.C., Menendez J., Garcia Juarez I., Bruix J., and Reig M.
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Niacinamide ,safety ,Sorafenib ,dialysi ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Hepatocellular carcinoma ,medicine.medical_treatment ,Population ,adverse event ,Antineoplastic Agents ,survival ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Interquartile range ,Internal medicine ,adverse events ,dialysis ,sorafenib ,medicine ,Humans ,education ,Dialysis ,Aged ,education.field_of_study ,Hepatology ,business.industry ,Phenylurea Compounds ,Liver Neoplasms ,Retrospective cohort study ,Hepatitis C ,medicine.disease ,Europe ,Treatment Outcome ,Tolerability ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business ,medicine.drug - Abstract
Background & Aims: Information on safety and efficacy of systemic treatment in patients with hepatocellular carcinoma (HCC) under dialysis are limited due to patient exclusion from clinical trials. Thus, we aimed to evaluate the rate, prevalence, tolerability, and outcome of sorafenib in this population. Methods: We report a multicenter study comprising patients from Latin America and Europe. Patients treated with sorafenib were enrolled; demographics, dose modifications, adverse events (AEs), treatment duration, and outcome of patients undergoing dialysis were recorded. Results: As of March 2018, 6156 HCC patients were treated in 44 centres and 22 patients were concomitantly under dialysis (0.36%). The median age was 65.5years, 40.9% had hepatitis C, 75% had Child-Pugh A, and 85% were Barcelona Clinic Liver Cancer-C. The median time to first dose modification, treatment duration and overall survival rate were 2.4months (interquartile ranges [IQR], 0.8-3.8), 10.8months (IQR, 4.5-16.9), and 17.5months (95% CI, 7.2-24.5), respectively. Seventeen patients required at least 1 dose modification. The main causes of first dose modification were asthenia/worsening of Eastern Cooperative Oncology Group-Performance Status and diarrhoea. At the time of death or last follow-up, four patients were still on treatment and 18 had discontinued sorafenib: 14 were due to tumour progression, 2 were sorafenib-related, and 2 were non-sorafenib-related AE. Conclusions: The outcomes observed in this cohort seem comparable to those in the non-dialysis population. Thus, to the best of our knowledge, this is the largest and most informative dataset regarding systemic treatment outcomes in HCC patients undergoing dialysis.
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- 2020
36. Regorafenib Efficacy After Sorafenib in Patients With Recurrent Hepatocellular Carcinoma After Liver Transplantation:A Retrospective Study
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Matthias Pinter, Pietro Lampertico, Ainhoa Fernandez Yunquera, Gabriel Aballay Soteras, Miguel Fraile-López, Tommy Ivanics, Maria Reig, Massimo Iavarone, Álvaro Díaz-González, Maria Varela, Lucia Cesarini, Vincenzo Mazzaferro, Gerda Elisabeth Villadsen, Federica Invernizzi, Matteo Angelo Manini, Marcus A. Wörns, Maria Jose Blanco Rodríguez, Mario Romero Cristóbal, Helene Regnault, Giovanni Giuseppe Di Costanzo, Jordi Bruix, Sherrie Bhoori, Peter Daechul Yoon, Arndt Weinmann, Marco Sanduzzi-Zamparelli, Luigia Scudeller, Maria Francesca Donato, Gonzalo Sapisochin, Giuliana Amaddeo, Stefano Mazza, Carolin Czauderna, Gonzalo Crespo, Claudio Zavaglia, Massimo De Giorgio, Margarita Anders, María Luisa González-Diéguez, Rebecca Prince, R. Tortora, and Federico Piñero
- Subjects
Oncology ,Sorafenib ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Pyridines ,medicine.medical_treatment ,Antineoplastic Agents ,Liver transplantation ,chemistry.chemical_compound ,Regorafenib ,Internal medicine ,Clinical endpoint ,medicine ,Humans ,Retrospective Studies ,Transplantation ,Hepatology ,business.industry ,Phenylurea Compounds ,Liver Neoplasms ,Retrospective cohort study ,medicine.disease ,Recurrent Hepatocellular Carcinoma ,digestive system diseases ,Liver Transplantation ,Discontinuation ,chemistry ,Hepatocellular carcinoma ,Surgery ,business ,medicine.drug - Abstract
Background and aim Safety of regorafenib in hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) has been recently demonstrated. We aimed to assess the survival benefit of regorafenib compared to best supportive care (BSC) in LT-patients after sorafenib discontinuation. Methods This observational multicenter retrospective study included LT-patients with HCC-recurrence who discontinued first-line sorafenib. Group-1 was constituted by regorafenib-treated patients, while control group was selected among patients treated with best supportive care (BSC) due to unavailability of second-line options at the time of sorafenib discontinuation and who were sorafenib-tolerant progressors (group-2). Primary endpoint was overall survival (OS) of group-1 compared to group-2. Secondary endpoints were safety and OS of sequential treatment sorafenib+regorafenib/BSC. Results Among 132 LT-patients who discontinued sorafenib included in the study, 81 patients were sorafenib-tolerant: 36 received regorafenib (group-1) and 45 (group-2) received BSC. Overall, 24 (67%) patients died in group-1 and 40 (89%) in group-2: the median OS was significantly longer in group-1 than in group-2 (13.1 vs 5.5 months; p=0.002). Regorafenib treatment was an independent predictor of reduced mortality (HR 0.37, 95%CI 0.16-0.89, p=0.02). Median treatment duration with regorafenib was 7.0 (95%CI 5.5-8.5) months; regorafenib dose was reduced in 22 (61%) patients for adverse events and discontinued for tumor progression in 93%. The median OS calculated from sorafenib start was 28.8 months (95%CI: 17.6-40.1) in group-1 vs 15.3 months (95%CI: 8.8-21.7) in group-2 (p=0.002). Conclusions Regorafenib is an effective second-line treatment after sorafenib in patients with HCC-recurrence after LT.
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- 2021
37. 348.3: Prevalence of Chagas Disease in Deceased Donors From Argentina
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Ariel Antik, Gabriela Hidalgo, Margarita Anders, Federico Piñero, Daniela Hansen Krogh, Viviana Tagliafichi, Marcelo Silva, Manuel Mendizabal, Florencia Antinucci, Julia Brutti, and Liliana Bisigniano
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Transplantation - Published
- 2022
38. 211.4: Characterization and Utilization of HCV-positive Donors in Argentina
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Manuel Mendizabal, Margarita Anders, Ariel Antik, Federico Piñero, Gabriela Hidalgo, Daniela Hansen Krogh, Viviana Tagliafichi, Florencia Antinucci, Federico Orozco Ganem, Marcelo O Silva, and Liliana Bisigniano
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Transplantation - Published
- 2022
39. 248.1: Hepatitis B virus Status of Organ Donors in Argentina
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Maria Anders, Ariel Antik, Manuel Mendizabal, Federico Piñero, Daniela Hansen Krogh, Federico Orozco, Viviana Tagliafichi, Julia Brutti, Marcelo Silva, Gabriela Hidalgo, and Liliana Bisignano
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Transplantation - Published
- 2022
40. Assessing the impact of COVID-19 on liver cancer management (CERO-19)
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Manuel Delgado, Mar Lozano, Alejandro Forner, Bruno Sangro, Alessandro Granito, Margarita Sala, Monica Ronzoni, Giuseppe Cabibbo, Frederik J H Hoogwater, José Luis Lledó, Rosanna Villani, Alessandra Elvevi, Lorenza Rimassa, Juan Acevedo, Mariona Calvo, Mercedes Vergara, Sergio Muñoz-Martínez, Jean-Charles Nault, Juan C. Bandi, Markus Peck-Radosavljevic, Brandon M. Meyers, Marco Sanduzzi-Zamparelli, Rogerio Alves, Saleh A. Alqahtani, Alberto E. Muñoz, Sonia Pascual, Alberto Lué, Josepmaria Argemi, Beatriz Minguez, Henning Wege, Giovan Giuseppe Di Costanzo, David J. Pinato, Victor Sapena, Maria Guarino, Stefano Okolicsanyi, Vivianne Mello, Martina Gambato, Susanna Coll, Carlos Benítez, Dhanny Gomez, Christoph Roderburg, Peter R. Galle, Bristi Basu, Federico Piñero, Cassia Leal, Frank Tacke, Christie Perelló, Tudor Mocan, Massimiliano Salati, Helen L. Reeves, Jörg Trojan, Vincenzo Cardinale, Mohamed El Kassas, Tom Lüdde, John Bridgewater, Mário Reis Álvares-da-Silva, Anja Lachenmayer, Giovanni Brandi, Alex Vianey Callado França, Mohamed Bouattour, Tim Meyer, Gerda Elisabeth Villadsen, M. Varela, Jordi Bruix, Dalia Morales-Arraez, Carlos Rodríguez-Lope, Christian Toso, Wacław Hołówko, Philippe Merle, Manuel Romero-Gómez, Ignacio García-Juárez, Fernanda Branco, Gonzalo Sapisochin, Chiara Braconi, Emmanouil Giorgakis, Hidenori Toyoda, Lorraine Blaise, Ana María Matilla Peña, Andrea Casadei-Gardini, Leonardo G Da Fonseca, Alexander Siebenhüner, Maria Reig, Gustavo Pereira, Massimo Iavarone, Maria Margarita Anders, Munoz-Martinez S., Sapena V., Forner A., Nault J.-C., Sapisochin G., Rimassa L., Sangro B., Bruix J., Sanduzzi-Zamparelli M., Holowko W., El Kassas M., Mocan T., Bouattour M., Merle P., Hoogwater F.J.H., Alqahtani S.A., Reeves H.L., Pinato D.J., Giorgakis E., Meyer T., Villadsen G.E., Wege H., Salati M., Minguez B., Di Costanzo G.G., Roderburg C., Tacke F., Varela M., Galle P.R., Alvares-da-Silva M.R., Trojan J., Bridgewater J., Cabibbo G., Toso C., Lachenmayer A., Casadei-Gardini A., Toyoda H., Ludde T., Villani R., Matilla Pena A.M., Guedes Leal C.R., Ronzoni M., Delgado M., Perello C., Pascual S., Lledo J.L., Argemi J., Basu B., da Fonseca L., Acevedo J., Siebenhuner A.R., Braconi C., Meyers B.M., Granito A., Sala M., Rodriguez-Lope C., Blaise L., Romero-Gomez M., Pinero F., Gomez D., Mello V., Pinheiro Alves R.C., Franca A., Branco F., Brandi G., Pereira G., Coll S., Guarino M., Benitez C., Anders M.M., Bandi J.C., Vergara M., Calvo M., Peck-Radosavljevic M., Garcia-Juarez I., Cardinale V., Lozano M., Gambato M., Okolicsanyi S., Morales-Arraez D., Elvevi A., Munoz A.E., Lue A., Iavarone M., Reig M., Basu, Bristi [0000-0002-3562-2868], Apollo - University of Cambridge Repository, Institut Català de la Salut, [Muñoz-Martínez S, Sapena V, Forner A] BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain. [Nault JC] Service d’hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France. Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris, France. Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France. [Sapisochin G] Abdominal Transplant & HPB Surgical Oncology, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Canada. [Rimassa L] Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy. Department of Biomedical Sciences, Humanitas University, Milan, Italy. [Mínguez B] Unitat del Fetge, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca en Malalties hepàtiques, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain, and Vall d'Hebron Barcelona Hospital Campus
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Hepatocellular carcinoma ,LC ,medicine.medical_treatment ,diagnóstico::toma de decisiones clínicas [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Nurses ,RC799-869 ,Liver transplantation ,Cholangiocarcinoma ,Clinical trials ,ENS-CCA ,Interquartile range ,Decisió, Presa de ,Pandemic ,Other subheadings::/diagnosis [Other subheadings] ,virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES] ,CERO-19 ,Pandèmia de COVID-19, 2020 ,Immunology and Allergy ,iCCA, intrahepatic cholangiocarcinoma ,COVID-19, coronavirus disease 2019 ,Liver Cancer Outcome in the COVID-19-pandemic Project ,Settore MED/12 - Gastroenterologia ,ddc:617 ,IQR ,Gastroenterology ,BCLC, Barcelona Clinic Liver Cancer ,Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES] ,neoplasias::neoplasias por localización::neoplasias del sistema digestivo::neoplasias hepáticas [ENFERMEDADES] ,Diseases of the digestive system. Gastroenterology ,Management ,Clinical Practice ,Clinical trial ,European Network for the Study of Cholangiocarcinoma ,Diagnosis::Clinical Decision-Making [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,Fetge - Malalties - Diagnòstic ,Liver cancer ,PROGRESSION-FREE SURVIVAL ,Liver Cancer ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Otros calificadores::/diagnóstico [Otros calificadores] ,610 Medicine & health ,Neoplasms::Neoplasms by Site::Digestive System Neoplasms::Liver Neoplasms [DISEASES] ,LT, liver transplantation ,Article ,Barcelona Clinic Liver Cancer ,Internal Medicine ,medicine ,ENS-CCA, European Network for the Study of Cholangiocarcinoma ,Hepatology ,business.industry ,CERO-19, Liver Cancer Outcome in the COVID-19-pandemic Project ,COVID-19 ,IQR, Interquartile range ,medicine.disease ,BCLC ,Emergency medicine ,Observational study ,610 Medizin und Gesundheit ,business ,HCC, hepatocellular carcinoma ,LC, liver cancer ,SARS-CoV-2, severe acute respiratory syndrome coronavirus-2 - Abstract
[Background & Aims] The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). Herein, we evaluated whether the schedule of LC screening or procedures has been interrupted or delayed because of the COVID-19 pandemic., [Methods] An international survey evaluated the impact of the COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international, and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave., [Results] Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia, and Africa (73.7%, 17.1%, 5.3%, 2.6%, and 1.3% per continent, respectively). Eighty-seven percent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening programme, 50% cancelled curative and/or palliative treatments for LC, and 41.7% modified the liver transplantation programme. Forty-five out of 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service before the COVID-19 pandemic (n = 19/37)., [Conclusions] The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with liver cancer. Modifications in screening, diagnostic, and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision-making., [Lay summary] The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems globally. Herein, we assessed the impact of the first wave pandemic on patients with liver cancer and found that routine care for these patients has been majorly disrupted, which could have a significant impact on outcomes.
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- 2021
41. Comparison of different prognostic scores for patients with cirrhosis hospitalized with SARS-CoV-2 infection
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Ezequiel Ridruejo, Isabel Gutierrez Lozano, Godolfino Miranda-Zazueta, Daniel Cocozzella, Adriana Varón, Federico Piñero, María Cecilia Cabrera, Martín Padilla, Margarita Anders, Maria Isabel Schinoni, Graciela Castro-Narro, Martín Tagle, Yuridia Macias, María Dolores Silveyra, Fernando Bessone, Luis Guillermo Toro, Aldo Torre, Manuel Mendizabal, Fernando Rubinstein, Emilia Vera Pozo, Mirta Peralta, Pedro Montes, Mauricio Castillo Barradas, German Rojas, Leyla Nazal, Matías García, Alvaro Urzúa, Marcelo Silva, Esteban Gonzalez Ballerga, Laura Tenorio, Fernando Contreras, Abel Sanchez, Julia Brutti, Carla Bustios, Fátima Higuera-de la Tijera, Nataly Escajadillo, Norberto C. Chávez-Tapia, Andrés J Gómez, Javier Diaz, Sandro Ruiz García, Douglas Michelato, Alejandra Dominguez, Maximo Cattaneo, Damián Conte, and Josefina Pages
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Liver Cirrhosis ,medicine.medical_specialty ,Cirrhosis ,ACUTE-ON-CHRONIC LIVER FAILURE ,viruses ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,coronavirus ,Specialties of internal medicine ,CORONAVIRUS ,PANDEMIC ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Risk Factors ,Chronic liver failure ,Internal medicine ,death ,purl.org/becyt/ford/3.2 [https] ,Medicine ,Humans ,Decompensation ,Prospective cohort study ,CIRRHOSIS ,Prognostic models ,Hepatology ,Receiver operating characteristic ,business.industry ,SARS-CoV-2 ,pandemic ,cirrhosis ,DEATH ,COVID-19 ,General Medicine ,medicine.disease ,Prognosis ,RC581-951 ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,purl.org/becyt/ford/3 [https] ,Original Article ,acute-on-chronic liver failure ,business - Abstract
Introduction and Objectives: Viral infections have been described to increase the risk of decompensation in patients with cirrhosis. We aimed to determine the effect of SARS-CoV-2 infection on outcome of hospitalized patients with cirrhosis and to compare the performance of different prognostic models for predicting mortality. Patients: We performed a prospective cohort study including 2211 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through October 1, 2020 in 38 Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters of patients with and without cirrhosis. All patients were followed until discharge or death. We evaluated the prognostic performance of different scoring systems to predict mortality in patients with cirrhosis using ROC curves. Results: Overall, 4.6% (CI 3.7–5.6) subjects had cirrhosis (n = 96). Baseline Child-Turcotte-Pugh (CTP) class was assessed: CTP-A (23%), CTP-B (45%) and CTP-C (32%); median MELD-Na score was 19 (IQR 14−25). Mortality was 47% in patients with cirrhosis and 16% in patients without cirrhosis (P < .0001). Cirrhosis was independently associated with death [OR 3.1 (CI 1.9−4.8); P < .0001], adjusted by age, gender, and body mass index >30. The areas under the ROC curves for performance evaluation in predicting 28-days mortality for Chronic Liver Failure Consortium (CLIF-C), North American Consortium for the Study of End-Stage Liver Disease (NACSELD), CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P < .0001). Conclusions: SARS-CoV-2 infection is associated with elevated mortality in patients with cirrhosis. CLIFC had better performance in predicting mortality than NACSELD, CTP and MELD-Na in patients with cirrhosis and SARS-CoV-2 infection. Clinicaltrials.gov:NCT04358380. Fil: Mendizabal, Manuel. Universidad Austral; Argentina. Red Latinoamericana de Concientización y Educación en Investigación del Hígado; Argentina Fil: Ridruejo, Ezequiel. Red Latinoamericana de Concientización y Educación en Investigación del Hígado; Argentina. Centro de Educación Médica e Investigaciones Clínicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Piñero, Federico. Universidad Austral; Argentina. Red Latinoamericana de Concientización y Educación en Investigación del Hígado; Argentina Fil: Anders, Margarita. Hospital Alemán; Argentina. Red Latinoamericana de Concientización y Educación en Investigación del Hígado; Argentina Fil: Padilla, Martín Jesus. Hospital Nacional Guillermo Almenara Irigoyen; Perú Fil: Toro, Luis G.. Fundación de Medellín y Rionegro; Colombia Fil: Torre, Aldo. Instituto Nacional de Ciencias Médicas y Nutrición; México Fil: Montes, Pedro. Hospital Nacional Daniel A. Carrión; Argentina Fil: Urzúa, Alvaro. Universidad de Chile; Chile Fil: Gonzalez Ballerga, Esteban. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentina Fil: Silveyra, María Dolores. Sanatorio Anchorena; Argentina Fil: Michelato, Douglas. Hospital Especializado en Enfermedades Infecciosas Instituto Couto Maia; Brasil Fil: Díaz, Javier. Hospital Nacional Edgardo Rebagliati Martins; Perú Fil: Peralta, Mirta. Red Latinoamericana de Concientización y Educación en Investigación del Hígado; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Pages, Josefina. Universidad Austral; Argentina. Red Latinoamericana de Concientización y Educación en Investigación del Hígado; Argentina Fil: García, Sandro Ruiz. Hospital de Víctor Lazarte Echegaray; Perú Fil: Gutierrez Lozano, Isabel. Centro Médico ABC; México Fil: Macias, Yuridia. IMSS Hospital General Regional No. 1 “Dr. Carlos Mc Gregor Sánchez”; México Fil: Cocozzella, Daniel. Red Latinoamericana de Concientización y Educación en Investigación del Hígado; Argentina. Hospital Italiano de La Plata; Argentina Fil: Chavez Tapia, Norberto. Medica Sur Clinic & Foundation; México Fil: Tagle, Martín. Clínica Anglo-Americana; Perú Fil: Dominguez, Alejandra. Hospital Padre Hurtado; Chile Fil: Varón, Adriana. Red Latinoamericana de Concientización y Educación en Investigación del Hígado; Argentina. Fundación Cardio Infantil; Colombia Fil: Vera Pozo, Emilia. Hospital Regional Dr. Teodoro Maldonado Carbo del IESS; Ecuador Fil: Higuera de la Tijera, Fátima. Hospital General de México “Dr. Eduardo Liceaga”; México Fil: Bustios, Carla. Fundación Cardio Infantil; Colombia Fil: Conte, Damián. Hospital Privado de Córdoba; Argentina Fil: Escajadillo, Nataly. Universidad Austral; Argentina Fil: Rubinstein, Fernando Adrian. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Especializado en Enfermedades Infecciosas Instituto Couto Maia; Brasil Fil: Tenorio, Laura. Hospital Nacional Edgardo Rebagliati Martins; Perú
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- 2021
42. Intermediate-advanced hepatocellular carcinoma in Argentina: Treatment and survival analysis
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Luis Gaite, Gustavo Romero, Sebastián Marciano, Carla Bermudez, Federico Piñero, Margarita Anders, Marcelo Silva, Claudia D'Amico, Adrián Gadano, Ezequiel Ridruejo, Nora Fernández, Virginia Reggiardo, Alina Zerega, Jorge da Silva, Beatriz Ameigeiras, and Luis Colombato
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Sorafenib ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Survival ,Hepatocellular carcinoma ,Argentina ,Therapeutics ,Kaplan-Meier Estimate ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Retrospective Cohort Study ,Humans ,Longitudinal Studies ,Prospective Studies ,Stage (cooking) ,Chemoembolization, Therapeutic ,Survival analysis ,Aged ,Neoplasm Staging ,Retrospective Studies ,Proportional hazards model ,business.industry ,Phenylurea Compounds ,Hazard ratio ,Liver Neoplasms ,Real-life ,General Medicine ,Middle Aged ,medicine.disease ,BCLC Stage ,Treatment Outcome ,030220 oncology & carcinogenesis ,Disease Progression ,Quinolines ,030211 gastroenterology & hepatology ,Female ,Liver cancer ,business ,medicine.drug ,Follow-Up Studies - Abstract
BACKGROUND Hepatocellular carcinoma (HCC) represents the sixteenth most frequent cancer in Argentina. The rise of new therapeutic modalities in intermediate-advanced HCC opens up a new paradigm for the treatment of HCC. AIM To describe real-life treatments performed in patients with intermediate-advanced HCC before the approval of new systemic options. METHODS This longitudinal observational cohort study was conducted between 2009 and 2016 in 14 different regional hospitals from Argentina. Included subjects had intermediate-advanced Barcelona Clinic Liver Cancer (BCLC) HCC stages (BCLC B to D). Primary end point analyzed was survival, which was assessed for each BCLC stage from the date of treatment until last patient follow-up or death. Kaplan Meier survival curves and Cox regression analysis were performed, with hazard ratios (HR) calculations and 95% confidence intervals (95%CI). RESULTS From 327 HCC patients, 41% were BCLC stage B, 20% stage C and 39% stage D. Corresponding median survival were 15 mo (IQR 5-26 mo), 5 mo (IQR 2-13 mo) and 3 mo (IQR 1-13 mo) (P < 0.0001), respectively. Among BCLC-B patients (n = 135), 57% received TACE with a median number of 2 sessions (IQR 1-3 sessions). Survival was significantly better in BCLC-B patients treated with TACE HR = 0.29 (CI: 0.21-0.40) than those without TACE. After tumor reassessment by RECIST 1.1 criteria following the first TACE, patients with complete response achieved longer survival [HR = 0.15 (CI: 0.04-0.56, P = 0.005)]. Eighty-two patients were treated with sorafenib, mostly BCLC-B and C (87.8%). However, 12.2% were BCLC-D. Median survival with sorafenib was 4.5 mo (IQR 2.3-11.7 mo); which was lower among BCLC-D patients 3.2 mo (IQR 2.0-14.1 mo). A total of 36 BCLC-B patients presented tumor progression after TACE. In these patients, treatment with sorafenib presented better survival when compared to those patients who received sorafenib without prior TACE [HR = 0.26 (CI: 0.09-0.71); P = 0.013]. CONCLUSION In this real setting, our results were lower than expected. This highlights unmet needs in Argentina, prior to the introduction of new treatments for HCC.
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- 2019
43. Looking for the Best Model to Predict Hepatocellular Carcinoma Recurrence After Liver Transplantation in Latin America
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Aline Lopes Chagas, Federico Piñero, and Ilka de Fátima Santana Ferreira Boin
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Oncology ,medicine.medical_specialty ,Latin Americans ,Hepatology ,business.industry ,medicine.medical_treatment ,Hepatocellular carcinoma ,Internal medicine ,medicine ,MEDLINE ,Liver transplantation ,medicine.disease ,business - Published
- 2019
44. Hepatocellular carcinoma in Latin America: Diagnosis and treatment challenges
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Marcelo Silva, Federico Piñero, Ezequiel Ridruejo, and Jaime Poniachik
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LIMITATIONS ,medicine.medical_specialty ,CIENCIAS MÉDICAS Y DE LA SALUD ,Carcinoma, Hepatocellular ,Latin Americans ,Decision Making ,Population ,Medicina Clínica ,Health Services Accessibility ,LATIN AMERICA ,World health ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,parasitic diseases ,purl.org/becyt/ford/3.2 [https] ,Health care ,medicine ,Humans ,Gastroenterología y Hepatología ,Challenge ,LIVER CANCER ,education ,Quality of Health Care ,education.field_of_study ,business.industry ,Liver Neoplasms ,Gastroenterology ,Retrospective cohort study ,General Medicine ,medicine.disease ,Editorial ,Latin America ,Social Class ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Family medicine ,Limitations ,Medical training ,purl.org/becyt/ford/3 [https] ,030211 gastroenterology & hepatology ,Public Health ,CHALLENGE ,business ,Liver cancer ,Developed country - Abstract
Latin America, a region with a population greater than 600000000 individuals, is well known due to its wide geographic, socio-cultural and economic heterogeneity. Access to health care remains as the main barrier that challenges routine screening, early diagnosis and proper treatment of hepatocellular carcinoma (HCC). Therefore, identification of population at risk, implementation of surveillance programs and access to curative treatments has been poorly obtained in the region. Different retrospective cohort studies from the region have shown flaws in the implementation process of routine surveillance and early HCC diagnosis. Furthermore, adherence to clinical practice guidelines recommendations assessed in two studies from Brazil and Argentina demonstrated that there is also room for improvement in this field, similarly than the one observed in Europe and the United States. In summary, Latin America shares difficulties in HCC decision-making processes similar to those from developed countries. However, a transversal limitation in the region is the poor access to health care with the consequent limitation to standard treatments for overall population. Specifically, universal health care access to the different World Health Organization levels is crucial, including improvement in research, education and continuous medical training in order to expand knowledge and generation of data promoting a continuous improvement in the care of HCC patients. Fil: Piñero, Federico. Educational And Awareness Network; Argentina. Hospital Universitario Austral; Argentina Fil: Poniachik, Jaime. Hospital Clinico de la Universidad de Chile; Chile. Clinica Santa Maria; Chile Fil: Ridruejo, Ezequiel. Hospital Universitario Austral; Argentina. Educational And Awareness Network; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Silva, Marcelo. Hospital Universitario Austral; Argentina. Educational And Awareness Network; Argentina
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- 2018
45. Comment on 'Shadows Behind Using Simple Risk Models in Selection of Hepatocellular Carcinoma Patients for Liver Transplantation'
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Marcelo Silva, Fernando Rubinstein, Christophe Duvoux, Daniel Cherqui, Federico Piñero, and Alexis Laurent
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medicine.medical_specialty ,Carcinoma, Hepatocellular ,business.industry ,medicine.medical_treatment ,Patient Selection ,Liver Neoplasms ,MEDLINE ,Liver transplantation ,medicine.disease ,Liver Transplantation ,Hepatocellular carcinoma ,medicine ,Humans ,Surgery ,Radiology ,Neoplasm Recurrence, Local ,business ,Selection (genetic algorithm) ,Simple (philosophy) - Published
- 2020
46. Liver transplantation for hepatocellular carcinoma: impact of expansion criteria in a multicenter cohort study from a high waitlist mortality region
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Alejandro Soza, Mario Vilatobá, Fernando Rubinstein, Rodrigo Zapata, Carla Bermudez, Ricardo Chong Menéndez, Rodrigo Figueroa, Federico G. Villamil, Josemaría Menéndez, Luisa Santos, Diego Arufe, Aline Lopes Chagas, Martín Padilla, Elaine Cristina de Ataide, Claudia Maccali, Flair José Carrilho, Agnaldo Soares Lima, J Mattera, Luis G. Podesta, Sergio Iván Hoyos Duque, Marcelo Silva, Martín Maraschio, Sebastián Marciano, Adriana Varón, Ilka de Fátima Santana Ferreira Boin, Federico Piñero, Margarita Anders, Adrián Gadano, Emilio Quiñonez, Jaime Poniachik, Linda Muñoz, Rodrigo Vergara Sandoval, and Lucas McCormack
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medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,education ,030230 surgery ,Liver transplantation ,Milan criteria ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Retrospective Studies ,Transplantation ,business.industry ,Patient Selection ,Liver Neoplasms ,medicine.disease ,digestive system diseases ,Liver Transplantation ,Hepatocellular carcinoma ,Ethical concerns ,030211 gastroenterology & hepatology ,Waitlist mortality ,Neoplasm Recurrence, Local ,business ,Cohort study - Abstract
This study aimed to compare liver transplantation (LT) outcomes and evaluate the potential rise in numbers of LT candidates with hepatocellular carcinoma (HCC) of different allocation policies in a high waitlist mortality region. Three policies were applied in two Latin American cohorts (1085 HCC transplanted patients and 917 listed patients for HCC): (i) Milan criteria with expansion according to UCSF downstaging (UCSF-DS), (ii) the AFP score, and (iii) restrictive policy or Double Eligibility Criteria (DEC; within Milan + AFP score ≤2). Increase in HCC patient numbers was evaluated in an Argentinian prospective validation set (INCUCAI; NCT03775863). Expansion criteria in policy A showed that UCSF-DS [28.4% (CI 12.8-56.2)] or "all-comers" [32.9% (CI 11.9-71.3)] had higher 5-year recurrence rates compared to Milan, with 10.9% increase in HCC patients for LT. The policy B showed lower recurrence rates for AFP scores ≤2 points, even expanding beyond Milan criteria, with a 3.3% increase. Patients within DEC had lower 5-year recurrence rates compared with those beyond DEC [13.3% (CI 10.1-17.3) vs 24.2% (CI 17.4-33.1; P = 0.0006], without significant HCC expansion. In conclusion, although the application of a stricter policy may optimize the selection process, this restrictive policy may lead to ethical concerns in organ allocation (NCT03775863).
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- 2020
47. Decompensated cirrhosis and liver transplantation negatively impact in DAA treatment response: Real-world experience from HCV-LALREAN cohort
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Claudio Estepo, Ana Palazzo, Virginia Reggiardo, Margarita Anders, Federico Piñero, Raúl Adrover, Alejandro Soza, Maria Isabel Schinoni, Alexandre de Araujo, Andres Bruno, Marcela Sixto, Silvia Borzi, Mirta Peralta, Ezequiel Ridruejo, Daniela Perez, Luisa Santos, Adriana Varón, Daniel Cocozzella, María Grazia Videla Zuain, Valeria Descalzi, Manuel Mendizabal, Alina Zerega, Nelia Hernández, Nora Fernández, Beatriz Ameigeiras, Marcelo Silva, Federico Tanno, Fernando Herz Wolff, Cristina Alonso, Sebastián Figueroa, Cecilia Vistarini, and Hugo Cheinquer
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medicine.medical_specialty ,Cirrhosis ,business.industry ,Ribavirin ,medicine.medical_treatment ,Odds ratio ,Hepatitis C ,Liver transplantation ,medicine.disease ,Virology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Infectious Diseases ,chemistry ,Internal medicine ,Cohort ,medicine ,030211 gastroenterology & hepatology ,030212 general & internal medicine ,Liver function ,business ,Cohort study - Abstract
INTRODUCTION Although the effectiveness of direct-acting antivirals (DAAs) for the treatment of chronic hepatitis C virus (HCV) has been reported in real-world settings, predictive factors of treatment failure are lacking. Therefore, we sought to explore the baseline predictors of treatment response to DAAs. METHODS This was a prospective multicenter cohort study from the Latin American Liver Research Educational and Awareness Network (LALREAN) including patients who received DAA treatment from May 2016 to April 2019. A multivariate logistic regression model was conducted to identify variables associated with unachieved sustained virological response (SVR), defined as treatment failure (odds ratios [OR] and 95% confidence intervals [CIs]). RESULTS From 2167 patients (55.2% with cirrhosis) who initiated DAA therapy, 89.4% completed a full-course treatment (n = 1938). Median treatment duration was 12 weeks, and 50% received ribavirin. Definitive suspension due to intolerance or other causes was observed in only 1.0% cases (n = 20). Overall non-SVR12 was 4.5% (95% CI, 3.5-5.7). There were no significant differences in treatment failure according to HCV genotypes and the degree of fibrosis. Independently associated variables with DAA failure were liver function impairment according to the Child-Pugh score B OR, 2.09 (P = .06), Child-Pugh C OR, 11.7 (P
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- 2020
48. Disease Progression in Patients With Hepatitis C Virus Infection Treated With Direct-Acting Antiviral Agents
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Adriana Varón, Cristina Alonso, Daniela Perez, Mirta Peralta, Maria Isabel Schinoni, Alejandro Soza, Margarita Anders, Sebastián Figueroa, Manuel Mendizabal, Alina Zerega, Alexandre de Araujo, Andres Bruno, Marcela Sixto, Nelia Hernández, Nora Fernández, Federico Piñero, Ana Palazzo, María Grazia Videla Zuain, Claudio Estepo, Luisa Santos, Valeria Descalzi, Silvia Borzi, Cecilia Vistarini, Ezequiel Ridruejo, Daniel Cocozzella, Raúl Adrover, Beatriz Ameigeiras, Fernando Herz Wolff, Federico Tanno, Virginia Reggiardo, Marcelo Silva, Fernando Rubinstein, and Hugo Cheinquer
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Liver Cirrhosis ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Sustained Virologic Response ,medicine.medical_treatment ,Hepatitis C virus ,Hepacivirus ,Liver transplantation ,medicine.disease_cause ,Gastroenterology ,Antiviral Agents ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Risk Factors ,Internal medicine ,medicine ,Humans ,Cumulative incidence ,Prospective Studies ,Hepatology ,business.industry ,Hazard ratio ,Liver Neoplasms ,Hepatitis C, Chronic ,medicine.disease ,Transplantation ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Cohort ,Disease Progression ,030211 gastroenterology & hepatology ,business - Abstract
Background & Aims Little is known about how a sustained virologic response (SVR) to treatment of hepatitis C virus infection with direct-acting antivirals (DAAs) affects patient mortality and development of new liver-related events. We aimed to evaluate the incidence of disease progression in patients treated with DAAs. Methods We performed a prospective multicenter cohort study of 1760 patients who received DAA treatment at 23 hospitals in Latin America, from May 1, 2016, through November 21, 2019. We excluded patients with a history of liver decompensation, hepatocellular carcinoma (HCC), or solid-organ transplantation. Disease progression after initiation of DAA therapy included any of the following new events: liver decompensation, HCC, liver transplantation, or death. Evaluation of variables associated with the primary outcome was conducted using a time-dependent Cox proportional hazards models. Results During a median follow-up period of 26.2 months (interquartile range, 15.3–37.5 mo), the overall cumulative incidence of disease progression was 4.1% (95% CI, 3.2%–5.1%), and after SVR assessment was 3.6% (95% CI, 2.7%–4.7%). Baseline variables associated with disease progression were advanced liver fibrosis (hazard ratio [HR], 3.4; 95% CI, 1.2–9.6), clinically significant portal hypertension (HR, 2.1; 95% CI, 1.2–3.8), and level of albumin less than 3.5 mg/dL (HR, 4.1; 95% CI, 2.3–7.6), adjusted for SVR achievement as a time covariable. Attaining an SVR reduced the risk of liver decompensation (HR, 0.3; 95% CI, 0.1–0.8; P = .016) and de novo HCC (HR, 0.2; 95% CI, 0.1%–0.8%; P = .02) in the overall cohort. Conclusions Treatment of hepatitis C virus infection with DAAs significantly reduces the risk of new liver-related complications and should be offered to all patients, regardless of disease stage. Clinicaltrials.gov: NCT03775798 .
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- 2019
49. Characteristics of Liver Transplantation in Argentina: A Multicenter Study
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Federico Piñero, Ricardo Mastai, Valeria Descalzi, Sebastián Marciano, G Braslavsky, Manuel Mendizabal, Alina Zerega, Leila Haddad, M. Cleres, Oscar Imventarza, O. Gil, M. Silva, Gabriel Gondolesi, Adrián Gadano, and Federico Orozco
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,CIENCIAS MÉDICAS Y DE LA SALUD ,Cirrhosis ,Waiting Lists ,medicine.medical_treatment ,Argentina ,Medicina Clínica ,Liver transplantation ,Cohort Studies ,End Stage Liver Disease ,Liver disease ,Postoperative Complications ,Interquartile range ,Internal medicine ,medicine ,Humans ,Aged ,ARGENTINA ,Transplantation ,business.industry ,LIVER TRANSPLANTATION ,Hepatitis C ,Middle Aged ,medicine.disease ,COHORT STUDY ,Liver Transplantation ,Hepatocellular carcinoma ,Etiology ,Female ,Surgery ,business ,Transplantes ,Cohort study - Abstract
Introduction: There is a lack of information regarding outcomes after liver transplant in Latin America. Objectives: This study sought to describe outcomes after liver transplant in adult patients from Argentina. Methods: We performed an ambispective cohort study of adult patients transplanted between June 2010 and October 2012 in 6 centers from Argentina. Only patients who survived after the first 48 hours postransplantation were included. Pretransplantation and posttransplantation data were collected. Results: A total of 200 patients were included in the study. Median age at time of transplant was 50 (interquartile range [IQR] 26 to 54) years. In total, 173 (86%) patients had cirrhosis, and the most frequent etiology in these patients was hepatitis C (32%). A total of 35 (17%) patients were transplanted with hepatocellular carcinoma. In patients with cirrhosis, the median Model for End-Stage Liver Disease (MELD) score at time of liver transplant was 25 (IQR 19 to 30). Median time on the waiting list for elective patients was 101 (IQR 27 to 295) days, and 3 (IQR 2 to 4) days for urgent patients. Almost 40% of the patients were readmitted during the first 6 months after liver transplant. Acute rejection occurred in 27% of the patients. Biliary and vascular complications were reported in 39 (19%) and 19 (9%) patients, respectively. Renal failure, diabetes, and dyslipidemia were present in 40 (26%), 87 (57%), and 77 (50%) at 2 years, respectively. Conclusions: We believe the information contained in this article might be of value for reviewing current practices and developing local policies. Fil: Haddad, L.. Instituto Universitario del Hospital Italiano de Buenos Aires; Argentina Fil: Marciano, S.. Instituto Universitario del Hospital Italiano de Buenos Aires; Argentina Fil: Cleres, M.. Fundación Favaloro; Argentina Fil: Zerega, A.. Sanatorio Allende; Argentina Fil: Piñero, F.. Hospital Universitario Austral; Argentina Fil: Orozco, F.. Hospital Aleman; Argentina Fil: Braslavsky, G.. Hospital General de Agudos Cosme Argerich; Argentina Fil: Mendizabal, M.. Hospital Universitario Austral; Argentina Fil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina Fil: Gil, O.. Sanatorio Allende; Argentina Fil: Silva, M.. Hospital Universitario Austral; Argentina Fil: Mastai, Ricardo. Hospital Aleman; Argentina Fil: Imvertaza, O.. Hospital General de Agudos Cosme Argerich; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina Fil: Descalzi, V.. Fundación Favaloro; Argentina Fil: Gadano, A.. Instituto Universitario del Hospital Italiano de Buenos Aires; Argentina
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- 2018
50. Results of Liver Transplantation for Hepatocellular Carcinoma in a Multicenter Latin American Cohort Study
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Yuri L. Boteon, Josemaría Menéndez, Sergio Iván Hoyos Duque, Alina Zerega, Margarita Anders, Martín Maraschio, Adrián Gadano, Jaime Poniachik, Adriana Varón, Lucas McCormack, Martín Padilla Machaca, Sebastián Marciano, Marcelo Silva, Martín Fauda, Ilka S. F. Fatima Boin, Linda Muñoz, Paulo Henrique Alves da Costa, José Huygens Parente Garcia, Mario Vilatobá, Alejandro Soza, Federico Piñero, and Rodrigo Zapata
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Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Time Factors ,Neoplasias Hepáticas ,Waiting Lists ,medicine.medical_treatment ,education ,Specialties of internal medicine ,030230 surgery ,Liver transplantation ,Imaging data ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Aged ,Trasplante de Hígado ,Hepatology ,Treatment difference ,business.industry ,Liver Neoplasms ,General Medicine ,Middle Aged ,medicine.disease ,Liver Transplantation ,Latin America ,Treatment Outcome ,RC581-951 ,Multicenter study ,Waiting list ,Hepatocellular carcinoma ,Female ,030211 gastroenterology & hepatology ,Neoplasm Recurrence, Local ,Candidate selection ,Prediction ,business ,Liver cancer ,Cohort study - Abstract
Background and aims. Background and aims. Heter Background and aims. ogeneous data has been reported regarding liver transplantation (LT) for hepatocellular carcinoma (HCC) in Latin America. We aimed to describe treatment during waiting list, survival and recurrence of HCC after LT in a multicenter study from Latin America. Material and methods. Material and methods. Patients with Material and methods. HCC diagnosed prior to transplant (cHCC) and incidentally found in the explanted liver (iHCC) were included. Imaging-explanted features were compared in cHCC (non-discordant if pre and post-LT were within Milan, discordant if pre-LT was within and post-LT exceeding Milan). Results. Overall, Results.Results. 435 patients with cHCC and 92 with iHCC were included. At listing, 81% and 91% of cHCC patients were within Milan and San Francisco criteria (UCSF), respectively. Five-year survival and recurrence rates for cHCC within Milan, exceeding Milan/within UCSF and beyond UCSF were 71% and 16%; 66% and 26%; 46% and 55%, respectively. Locoregional treatment prior to LT was performed in 39% of cHCC within Milan, in 53% beyond Milan/within UCSF and in 83% exceeding UCSF (p < 0.0001). This treatment difference was not observed according to AFP values (d100, 44%; 101-1,000, 39%, and > 1,000 ng/mL 64%; p = 0.12). Discordant imaging-explanted data was observed in 29% of cHCC, showing lower survival HR 2.02 (CI 1.29; 3.15) and higher recurrence rates HR 2.34 when compared to AFP 1,000 ng/mL at listing was independently associated with a higher 5-year recurrence rate and a HR of 3.24 when compared to AFP
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- 2018
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