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10. Consensus Statement on Hemostatic Management, Anticoagulation, and Antiplatelet Therapy in Liver Transplantation

Author

Montalvá E, Rodríguez-Perálvarez M, Blasi A, Bonanad S, Gavín O, Hierro L, Lladó L, Llop E, Pozo-Laderas JC, and Colmenero J

Subjects
PERIOPERATIVE MANAGEMENT, VENOUS THROMBOEMBOLISM, RISK-FACTOR, PORTAL-VEIN THROMBOSIS, HEPATIC-ARTERY THROMBOSIS, REBALANCED HEMOSTASIS, TRANSCATHETER THROMBOLYTIC THERAPY, INTRAHEPATIC PORTOSYSTEMIC SHUNT, BLOOD-CELL TRANSFUSION, EUROPEAN-SOCIETY
Abstract

Anticoagulation and antiplatelet therapies are increasingly used in liver transplant (LT) candidates and recipients due to cardiovascular comorbidities, portal vein thrombosis, or to manage posttransplant complications. The implementation of the new direct-acting oral anticoagulants and the recently developed antiplatelet drugs is a great challenge for transplant teams worldwide, as their activity must be monitored and their complications managed, in the absence of robust scientific evidence. In this changing and clinically heterogeneous scenario, the Spanish Society of Liver Transplantation and the Spanish Society of Thrombosis and Haemostasis aimed to achieve consensus regarding the indications, drugs, dosing, and timing of anticoagulation and antiplatelet therapies initiated from the inclusion of the patient on the waiting list to post-LT surveillance. A multidisciplinary group of experts composed by transplant hepatologists, surgeons, hematologists, transplant-specialized anesthesiologists, and intensivists performed a comprehensive review of the literature and identified 21 clinically relevant questions using the patient-intervention-comparison-outcome format. A preliminary list of recommendations was drafted and further validated using a modified Delphi approach by a panel of 24 transplant delegates, each representing a LT institution in Spain. The present consensus statement contains the key recommendations together with the core supporting scientific evidence, which will provide guidance for improved and more homogeneous clinical decision making.

Published
2022

11. The IMPROVEMENT project: first report of the global liver transplant activity

Author

Avolio, A.W., Pascale, M.M., Burra, P., Bhoori, S., De Maria, N., Donato, F., Fagiuoli, S., Lanza, A. Galeota, Giannelli, V., Ginanni Corradini, S, Lenci, I., Magro, B., Martini, S., Petruccelli, S., Piscaglia, F., Pompili, M., Rendina, M., Baroni, G.L. Svegliati, Violi, P., Barbier, L., Braun, F., Boin, I., Caccamo, L., Cicarelli, O., Cillo, U., Carraro, A., Cescon, M., De Carlis, L., De Carlis, R, De Simone, P., De Santibanes, M., Deng, F., Benedetto, F. Di, Ettorre, G.M., Fernandez, H., Gastaca, M., Gruttadauria, S., Guo, Z., Hammond, J., Lai, Q, Lesurtel, M., Llado, L., Martins, P., Mazzaferro, V., Mejia, G., Nadalin, S., Oniscu, G., Patel, M., Perera, T., Pinelli, D., Polak, W., Quintini, C., Ravaioli, M., Rela, M., Romagnoli, R., Salame, E, Subash, G., Tandoi, F., Takashi, I., Timucin, T., Tisone, G., Vennarecci, G., Vivarelli, M., Vorasittha, A., Zieniewicz, K., and Agopian, V.

Published
2024
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24. The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study

Author

Oriol, I, primary, Sabe, N, additional, Càmara, J, additional, Berbel, D, additional, Ballesteros, M A, additional, Escudero, R, additional, Lopez-Medrano, F, additional, Linares, L, additional, Len, O, additional, Silva, J T, additional, Oliver, E, additional, Soldevila, L, additional, Pérez-Recio, S, additional, Guillem, L L, additional, Camprubí, D, additional, LLadó, L, additional, Manonelles, A, additional, González-Costello, J, additional, Domínguez, M A, additional, Fariñas, M C, additional, Lavid, N, additional, González-Rico, C, additional, Garcia-Cuello, L, additional, Arnaiz de las Revillas, F, additional, Fortun, J, additional, Aguado, J M, additional, Jimenez-Romero, C, additional, Bodro, M, additional, Almela, M, additional, Paredes, D, additional, Moreno, A, additional, Pérez-Cameo, C, additional, Muñoz-Sanz, A, additional, Blanco-Fernández, G, additional, Cabo-González, J A, additional, García-López, J L, additional, Nuño, E, additional, and Carratalà, J, additional

Published
2019
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29. The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation : A Prospective Multicenter Cohort Study

Author

Oriol, I, Sabe, N, Càmara, J, Berbel, D, Ballesteros, M A, Escudero, R, Lopez-Medrano, F, Linares, L, Len, O, Silva, J T, Oliver, E, Soldevila, L, Pérez-Recio, S, Guillem, L L, Camprubí, D, LLadó, L, Manonelles, A, González-Costello, J, Domínguez, M A, Fariñas, M C, Lavid, N, González-Rico, C, Garcia-Cuello, L, Arnaiz de las Revillas, F, Fortun, J, Aguado, José María, Jimenez-Romero, C, Bodro, M, Almela, M, Paredes, D, Moreno Camacho, Asunción, Pérez-Cameo, C, Muñoz-Sanz, A, Blanco-Fernández, G, Cabo-González, J A, García-López, J L, Nuño, E, Carratalà, J, Oriol, I, Sabe, N, Càmara, J, Berbel, D, Ballesteros, M A, Escudero, R, Lopez-Medrano, F, Linares, L, Len, O, Silva, J T, Oliver, E, Soldevila, L, Pérez-Recio, S, Guillem, L L, Camprubí, D, LLadó, L, Manonelles, A, González-Costello, J, Domínguez, M A, Fariñas, M C, Lavid, N, González-Rico, C, Garcia-Cuello, L, Arnaiz de las Revillas, F, Fortun, J, Aguado, José María, Jimenez-Romero, C, Bodro, M, Almela, M, Paredes, D, Moreno Camacho, Asunción, Pérez-Cameo, C, Muñoz-Sanz, A, Blanco-Fernández, G, Cabo-González, J A, García-López, J L, Nuño, E, and Carratalà, J

Abstract

We analyzed the prevalence, etiology, and risk factors of culture-positive preservation fluid and their impact on the management of solid organ transplant recipients. From July 2015 to March 2017, 622 episodes of adult solid organ transplants at 7 university hospitals in Spain were prospectively included in the study. The prevalence of culture-positive preservation fluid was 62.5% (389/622). Nevertheless, in only 25.2% (98/389) of the cases were the isolates considered "high risk" for pathogenicity. After applying a multivariate regression analysis, advanced donor age was the main associated factor for having culture-positive preservation fluid for high-risk microorganisms. Preemptive antibiotic therapy was given to 19.8% (77/389) of the cases. The incidence rate of preservation fluid-related infection was 1.3% (5 recipients); none of these patients had received preemptive therapy. Solid organ transplant (SOT) recipients with high-risk culture-positive preservation fluid receiving preemptive antibiotic therapy presented both a lower cumulative incidence of infection and a lower rate of acute rejection and graft loss compared with those who did not have high-risk culture-positive preservation fluid. After adjusting for age, sex, type of transplant, and prior graft rejection, preemptive antibiotic therapy remained a significant protective factor for 90-day infection. The routine culture of preservation fluid may be considered a tool that provides information about the contamination of the transplanted organ. Preemptive therapy for SOT recipients with high-risk culture-positive preservation fluid may be useful to avoid preservation fluid-related infections and improve the outcomes of infection, graft loss, and graft rejection in transplant patients.

Published
2019

32. Rifabutin for treating tuberculosis in solid organ transplant recipients: A retrospective observational study and literature review.

Author

Gomila‐Grange, A., Pérez‐Recio, S., Camprubí‐Ferrer, D., Lladó, L., Fava, A., García‐Romero, E., Grijota‐Camino, M. D., Sabé, N., and Santin, M.

Subjects
TRANSPLANTATION of organs, tissues, etc., TUBERCULOSIS, LITERATURE reviews, MYCOBACTERIUM tuberculosis, GRAFT rejection
Abstract

Background: The treatment of tuberculosis (TB) in solid organ transplant (SOT) recipients is challenging owing to interactions between rifampin and immunosuppressive drugs. Rifabutin, a rifamycin with excellent activity against Mycobacterium tuberculosis and that induces cytochrome p450 less, may facilitate treatment. We report our experience with rifabutin for treating TB in SOT recipients and review the available literature. Methods: A retrospective observational study of all SOT recipients with TB between January 2000 and December 2019. The clinical characteristics and outcomes of patients treated with and without rifabutin‐containing regimens were compared and a literature review was conducted. Results: We included 31 SOT recipients with TB, among whom 22 (71%) were men and the median age was 62 years (interquartile range 50‐20). There were no significant differences between patients treated with rifabutin (n = 12), rifampin (n = 14), and non‐rifamycins (n = 5) in clinical cure rates (83.3%, 64.3%, and 100%, respectively; P =.21), side effects (25%, 37.5%, and 20%, respectively; P =.74), or mortality (16.7%, 35.7%, and 0%, respectively; P =.21). Only one patient, treated with rifampin, suffered graft rejection. The literature review identified 59 SOT recipients with TB treated with rifabutin‐containing regimens from 8 publications. Overall, the clinical cure, graft rejection, and mortality rates were 93.2%, 5.1%, and 6.8%, respectively. Conclusions: Rifabutin‐containing regimens offer a reliable alternative to rifampin when treating TB in SOT recipients. [ABSTRACT FROM AUTHOR]

Published
2021
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33. P-153 Safety and effectiveness of sorafenib in elderly patients diagnosed with advanced hepatocellular carcinoma in a monographic oncologic center

Author

Vidales Sepulveda, Z., Gómez Serra, N., Laquente Saez, B., Navarro Pérez, V., Sánchez, C., î Serra Solé, Ruiz Osuna, S., Rota Roca, M., Ramos Rubio, E., Joudanin Seijo, J., Galán Guzmán, M., Leiva, D., Amador Navarrete, A., Lladó, L., Serrano, T., García Guix, M., Martínez Carnicero, L., Mils Julià, K., Iglesias Míguez, C., del Carpio, L., Xiol Quingles, X., and Calvo Campos, M.

Published
2021
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38. Differences on metabolic behavior between intra and extrahepatic cholangiocarcinomas at 18F-FDG-PET/CT: prognostic implication of metabolic parameters and tumor markers.

Author

Sabaté-Llobera, A., Gràcia-Sánchez, L., Reynés-Llompart, G., Ramos, E., Lladó, L., Robles, J., Serrano, T., Mestres-Martí, J., and Gámez-Cenzano, C.

Abstract

Background and purpose: Cholangiocarcinoma is an infrequent neoplasm barely studied with 18F-FDG-PET/CT. We evaluated the metabolic behavior of cholangiocarcinoma in PET/CT according to its location (intra or extrahepatic) and analyzed the relationship between metabolic parameters of the primary tumor and tumor markers (CA19-9 and CEA), determining their prognostic significance.Methods: Retrospective study of PET/CT of 60 patients with untreated cholangiocarcinoma, divided into two groups according to tumor location. FDG uptake was evaluated visually and semiquantitatively [SUVmax and tumor-to-liver ratio (TLR)], and differences between intra and extrahepatic cholangiocarcinomas were tested, both for FDG uptake in the primary tumor and for the presence of regional or distant disease (per-patient), as well as regarding tumor marker levels. A correlation between metabolic parameters and tumor markers was performed, and prognostic value of these factors was determined (univariate and multivariate analyses).Results: Intrahepatic cholangiocarcinomas were significantly more FDG-avid than extrahepatic ones (p = 0.006 for SUVmax; p = 0.002 for TLR). There were differences neither between both groups considering the capacity of PET/CT to detect regional (p = 0.261) and distant involvement (p = 0.876), nor regarding the levels of tumor markers (p = 0.160 for CA19-9; p = 0.708 for CEA). Metabolic parameters and tumor markers showed a weak positive correlation (R2 0.22-0.27). At the multivariate analysis, advanced stage (p = 0.024), increased CEA (p = 0.022), and higher TLR (p = 0.003) were significantly related with shorter overall survival.Conclusions: Intra and extrahepatic cholangiocarcinomas behave differently on PET/CT, though no differences between both groups exist in its capacity to detect regional or distant disease. Metabolic parameters and levels of tumor markers seem to relate with tumor burden, impacting in prognosis. [ABSTRACT FROM AUTHOR]

Published
2019
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39. Contribution of Population Pharmacokinetics to Dose Optimization of Ganciclovir-Valganciclovir in Solid-Organ Transplant Patients

Author

Padullés, A., primary, Colom, H., additional, Bestard, O., additional, Melilli, E., additional, Sabé, N., additional, Rigo, R., additional, Niubó, J., additional, Torras, J., additional, Lladó, L., additional, Manito, N., additional, Caldés, A., additional, Cruzado, J. M., additional, Grinyó, J. M., additional, and Lloberas, N., additional

Published
2016
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42. P0040 : Long-term cardiovascular mortality after liver transplantation: Analysis of risk factors

Author

D’Avola, D., primary, Cuervas-Mons, V., additional, Martí, J., additional, Ortiz de Urbina, J., additional, Lladó, L., additional, Jimenez, C., additional, Otero, E., additional, Suarez, F., additional, Rodrigo, J.M., additional, Gomez, M.A., additional, Fraga, E., additional, Lopez, P., additional, Serrano, T., additional, Rios, A., additional, Fabrega, E., additional, and Herrero, J.I., additional

Published
2015
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45. Current preventive strategies and management of Epstein–Barr virus-related post-transplant lymphoproliferative disease in solid organ transplantation in Europe. Results of the ESGICH Questionnaire-based Cross-sectional Survey

Author

San Juan, R, Manuel, O, Hirsch, Hh, Fernández Ruiz, M, López Medrano, F, Comoli, P, Caillard, S, Grossi, P, Aguado, Jm, Álamo Martínez JM, Anaya, F, Anttila, Vj, Arnol, M, Avolio, Aw, Baccarani, U, Castello, Ib, Boletis, I, Bonofiglio, R, Viamigliori, A, Bressollette, C, Brockmann, J, Pulido, Jc, Catalán, P, Christiansen, C, Cofan, F, Cordero, E, Leiro, Mc, Dantal, J, D'Armini, A, Delgado, Jf, Dello Strologo, L, Gesu, B, DI RAIMONDO, Francesco, Dierickx, D, Eis Hübinger, A, Kremer, Sf, Faggian, G, Fariñas, Mc, Folgueira, Md, Fontana, I, Franco, A, Furian, L, Garzoni, C, Ghirardo, G, Ginevri, F, Grinyó, J, Grossi, Pa, Gupte, G, Hansson, L, Helanterä, I, Herrero, Ji, Hobin, D, Hoffmann, D, Jan, L, Jarque, I, Jespersen, B, Kaczmarek, I, Klin, G, Kevin, P, Koneth, I, Kovac, D, Lacaille, F, Lautenschlager, I, Len, O, Lladó, L, Loy, M, Maeso, Ma, Marianne, Lv, Marsh, J, Meylan, P, Miñambres, E, Montejo, M, Mueller, N, Muñoz, P, Nadalin, S, Kamar, N, Nicolas, B, Olivier, D, Palomo, J, Pascual, M, Peter, J, Pierre, F, Portero, Mf, Provot, F, Boluda, Er, Regalia, E, Reina, G, Reuter, S, Ricart, Mj, García, Mr, Rollag, H, Russo, Fp, Sabé, N, Salcedo, M, Santambrogio, L, Seeman, T, Serra, N, Sgarabotto, D, Simonek, J, Thierry, Y, Thomsen, Mk, Tihic, N, Torre Cisneros, J, Travi, G, Tulissi, P, Moal, V, Veroux, Massimiliano, Santandreu, Av, Vizzini, G, Zibar, L., Clinicum, Department of Medicine, Infektiosairauksien yksikkö, Department of Virology, and Medicum

Subjects
Epstein-Barr Virus Infections, Cross-sectional study, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, Medizin, Epstein-Barr virus, Europe, Post-transplant lymphoproliferative disease, Pre-emptive treatment, Survey, Microbiology (medical), Infectious Diseases, medicine.disease_cause, Organ transplantation, Epstein–Barr virus, Surveys and Questionnaires, hemic and lymphatic diseases, Medicine, Tomography, TOR Serine-Threonine Kinases, Immunosuppression, General Medicine, Viral Load, pre-emptive treatment, X-Ray Computed, 3. Good health, Cross-Sectional Studies, Humans, Immunosuppressive Agents, Lymphoproliferative Disorders, Positron-Emission Tomography, Rituximab, Tomography, X-Ray Computed, Viremia, Organ Transplantation, Transplant Recipients, post-transplant lymphoproliferative disease, Viral load, medicine.drug, medicine.medical_specialty, survey, Internal medicine, business.industry, Immunology, 3111 Biomedicine, business, Solid organ transplantation, Serostatus
Abstract

There is limited clinical evidence on the utility of the monitoring of Epstein–Barr virus (EBV) DNAemia in the pre-emptive management of post-transplant lymphoproliferative disease (PTLD) in solid organ transplant (SOT) recipients. We investigated current preventive measures against EBV-related PTLD through a web-based questionnaire sent to 669 SOT programmes in 35 European countries. This study was performed on behalf of the ESGICH study group from the European Society of Clinical Microbiology and Infectious Diseases. A total of 71 SOT programmes from 15 European countries participated in the study. EBV serostatus of the recipient is routinely obtained in 69/71 centres (97%) and 64 (90%) have access to EBV DNAemia assays. EBV monitoring is routinely used in 85.9% of the programmes and 77.4% reported performing pre-emptive treatment for patients with significant EBV DNAemia levels. Pre-emptive treatment for EBV DNAemia included reduction of immunosuppression in 50.9%, switch to mammalian target of rapamycin inhibitors in 30.9%, and use of rituximab in 14.5% of programmes. Imaging by whole-body 18-fluoro-deoxyglucose positron emission tomography (FDG-PET) is used in 60.9% of centres to rule out PTLD and complemented computer tomography is used in 50%. In 10.9% of centres, FDG-PET is included in the first-line diagnostic workup in patients with high-risk EBV DNAemia. Despite the lack of definitive evidence, EBV load measurements are frequently used in Europe to guide diagnostic workup and pre-emptive reduction of immunosuppression. We need prospective and controlled studies to define the impact of EBV monitoring in reducing the risk of PTLD in SOT recipients.

Published
2015
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49. Direct‐acting antivirals are effective and safe in HCV/HIV‐coinfected liver transplant recipients who experience recurrence of hepatitis C: A prospective nationwide cohort study

Author

Manzardo, Christian, Londoño, Maria C., Castells, LLuís, Testillano, Milagros, Luis Montero, José, Peñafiel, Judit, Subirana, Marta, Moreno, Ana, Aguilera, Victoria, Luisa González‐Diéguez, María, Calvo‐Pulido, Jorge, Xiol, Xavier, Salcedo, Magdalena, Cuervas‐Mons, Valentin, Manuel Sousa, José, Suarez, Francisco, Serrano, Trinidad, Ignacio Herrero, Jose, Jiménez, Miguel, Fernandez, José R., Giménez, Carlos, del Campo, Santos, Esteban‐Mur, Juan I., Crespo, Gonzalo, Moreno, Asunción, de la Rosa, Gloria, Rimola, Antoni, Miro, Jose M., Suárez, F., Castro, M.A., López, S., Pedreira, J.D., Vázquez, P., Agüero, F., Blanch, J., Brunet, M., Calatayud, D., Cervera, C., Lazzari, E., Fondevila, C., Forner, A., Fuster, J., Forns, X., Gil, A., Gatell, J.M., Laguno, M., Lligoña, A., Mallolas, J., Murillas, J., Navasa, M., Paredes, D., Pérez, I., Torres, F., Tural, C., Tuset, M., Antela, A., Losada, E., Molina, E., Otero, E., Varo, E., Araiz, J.J, Barrao, E., Larraga, J., Letona, S., Lozano, R., Luque, P., Navarro, A., Sanjoaquín, I., Tejero, E., Bañares, R., Berenguer, J., Clemente, G., Cosín, J., Ferreiroa, J.P, García‐Sabrido, J.L., Gutiérrez, I., López, J.C., Miralles, P., Ramírez, M., Rincón, D., Sánchez, M., Cruz, J., Fernández, J.L., Lozano, J.M., Santoyo, J., Rodrigo, J.M., Suárez, M.A., Rodríguez, M., Alonso, M.P., Asensi, V., González‐Pinto, I., Rafecas, A., Baliellas, C., Carratalá, J., Fabregat, J., Fernández, N., Jorba, R., Lladó, L., Montejo, M., Bustamante, J., Fernández, J.R., Gastaca, M., González, J., Montejo, E., Ortiz de Urbina, J., Ruiz, P., Suárez, M.J., Valdivieso, A., Ventoso, A., Abradelo, M., Calvo, J., Costa, J.R., García‐Sesma, A., Jiménez, C., Manrique, A., Meneu, J.C., Moreno, E., Moreno, V., Olivares, S.P., Pulido, F., Rubio, R., Blanes, M., Berenguer, M., López, J., López, R., Prieto, M., Fariñas, M.C., Casafont, F., Echevarria, S., Fábrega, E., Gomez‐Fleitas, M., Armiñanzas, C., Herrera‐Noreña, J.L., Moreno, S., Barcena, R., Fortún, J., Moreno, A.M., Martín‐Dávila, P., Torre‐Cisneros, J., Barrera, P., Briceño, J., Caston, J.J., Costan, G., Mata, M., Lara, R., López‐Cillero, P., Rivero, A., Rufian, S., Sánchez‐Antolín, G., García Pajares, F., Bachiller, P., Almohalla, C., Barrera, A., Conde, R., Bilbao, I., Campos‐Varela, I., Charco, R., Esteban, J.I., Gavaldá, J., Len, O., Pahissa, A., Ribera, E., Vargas, V., Pons, J.A., Cordero, E., Bernal, C., Cisneros, J.M., Gómez, M.A., Pascasio, J.M., Rodríguez, M.J., Sayago, M., Suárez, G., González‐García, J., Aznar, E., Esteban, H., Moyano, B., Garrido, G., Mahillo, B., Matesanz, R., Guerra, L., Manzanera, M., and Samuel, D.

Abstract

Direct‐acting antivirals have proved to be highly efficacious and safe in monoinfected liver transplant (LT) recipients who experience recurrence of hepatitis C virus (HCV) infection. However, there is a lack of data on effectiveness and tolerability of these regimens in HCV/HIV‐coinfected patients who experience recurrence of HCV infection after LT. In this prospective, multicenter cohort study, the outcomes of 47 HCV/HIV‐coinfected LT patients who received DAA therapy (with or without ribavirin [RBV]) were compared with those of a matched cohort of 148 HCV‐monoinfected LT recipients who received similar treatment. Baseline characteristics were similar in both groups. HCV/HIV‐coinfected patients had a median (IQR) CD4 T‐cell count of 366 (256‐467) cells/µL. HIV‐RNA was <50 copies/mL in 96% of patients. The DAA regimens administered were SOF + LDV ± RBV (34%), SOF + SMV ± RBV (31%), SOF + DCV ± RBV (27%), SMV + DCV ± RBV (5%), and 3D (3%), with no differences between the groups. Treatment was well tolerated in both groups. Rates of SVR (negative serum HCV‐RNA at 12 weeks after the end of treatment) were high and similar for coinfected and monoinfected patients (95% and 94%, respectively; P= .239). Albeit not significant, a trend toward lower SVR rates among patients with advanced fibrosis (P= .093) and genotype 4 (P= .088) was observed. In conclusion, interferon‐free regimens with DAAs for post‐LT recurrence of HCV infection in HIV‐infected individuals were highly effective and well tolerated, with results comparable to those of HCV‐monoinfected patients. Direct‐acting antivirals against HCV offer a very high and similar efficacy and safety in HIV‐positive and HIV‐negative liver transplant recipients.

Published
2018
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