Role of Transarterial Chemoembolization to Downstage Hepatocellular Carcinoma Within the Milan Criteria.

The practice of treating candidates for liver transplantation (LT) for hepatocellular carcinoma (HCC), with locoregional therapies, is common in most transplantation centers. We present our results using transarterial chemoembolization (TACE) as a neo-adjuvant treatment in our center between 2002 and 2013 to determine its effectiveness in downstaging (DS) HCC within the Milan criteria (MC). Clinical variables were recorded of both donors and recipients, such as diagnosis and treatment, variables related to its etiology, the use of TACE as a neo-adjuvant treatment, immunosuppressive therapy, toxicity, recurrence of disease, exitus, and others. Sixty-four patients were analyzed. Median age was 57 (range, 51-64) years. In this study, 84% (54) were male and 16% (10) were women. Etiology of HCC was viral in 47% (30), alcoholic in 25% (16), and other in 28% (18). TACE was conducted in 45 patients (70%). Every patient included in our study presented a T2 stage (of tumor-nodes-metastasis [TNM]) before surgery, thus within the MC. However, DS protocol was performed in 5 patients (7.8%). We performed a bivariate analysis, having assessed that the use of TACE decreases T2 stage into T1-T0 stage (P < .05). We have also calculated the recurrence-free survival, which reaches up to 80% to 125 months. Furthermore, even though the statistical differences are not consistent due to the simple size presented, we conclude that TACE is a safe and effective therapy to control HCC progression during the waiting list time.

Complications Associated With Liver Transplantation in Recipients With Body Mass Index >35 kg/m(2): Would It Be a Poor Prognosis Predictive Factor?

BACKGROUND: Obesity is a global epidemic that continues to increase in a great number of countries, and it has become a major public health problem in Spain. Unfortunately, the impact of obesity on survival in liver transplantation (LT) recipients is underestimated and controversial. The aim of this study was to determine if obesity is a risk factor for morbidity and mortality after LT. METHODS: In a retrospective cohort study of the records of 180 consecutive patients who had undergone to LT from 2007 to 2013, 11 obese patients with body mass index (BMI) >35 kg/m(2) were identified. Their data have been compared with recipients with BMI 20-25 kg/m(2). RESULTS: There were no differences in demographic data, Child-Pugh score, Model for End-Stage Liver Disease score, or cause of liver failure. BMI >35 kg/m(2) recipients had a significantly higher rate of portal vein thrombosis before LT, compared with the BMI 20-25 kg/m(2) group (36.5% vs 13.9%; P = .041). There were also no differences in development of post-reperfusion syndrome. The groups were also comparable concerning morbidity rate after LT, stay in the intensive care unit, and global hospital stay. However, the mortality rate was significantly higher in the obese group compared with the nonobese group (72.7% vs 38.9%; P = .032). CONCLUSIONS: The results of the study clearly demonstrate higher mortality rates in obese patients undergoing LT; thus, it is fair to consider obesity as a poor prognosis predictive factor concerning mortality rate.

Immunosuppression Strategies in the Treatment of Hepatocellular Carcinoma in Virgen de las Nieves University Hospital.

BACKGROUND: We describe an observational, retrospective study that included patients who underwent a liver transplantation (LT) for hepatocellular carcinoma (HCC) in our center between 2004 and 2012. METHODS: Clinical variables were recorded for donors and recipients as diagnosis and treatment, immunosuppressive therapy, toxicity, graft dysfunction, recurrence, and exitus. Fifty-eight patients were analyzed. The mean age was 57 ± 8 years. The viral etiology of HCC was 50% (n = 29), alcoholic 26% (n = 15), and others, 24% (n = 14). Regarding initial immunosuppressive strategy (IS), 51 patients (87.9%) were treated with standard regimen with corticosteroids (CS) and tacrolimus (TA), compared with 7 patients with impaired renal function (12.1%) who underwent a delayed therapy with calcineurin inhibitors (CNI) + mycophenolate mophetil (MMF) + CS. Concomitant use of anti-CD25 monoclonal antibodies was less than 10%. Regarding maintenance, 43 patients (74.1%) were treated with MMF + CNI versus 15 treated only with TA (25.9%). RESULTS: Recurrence of HCC was approximately 12%: 7 patients (2 hepatic only, 5 also extra-hepatic). Exitus was established in 19 patients (32.75%); only 3 patients (5.17%) were attributable to HCC. Bivariate studies were conducted according to the initial IS (standard regimen versus delayed therapy) and maintenance therapy (MMF + TA versus TA alone), with no differences in any of them in recurrence, treatment toxicity, graft rejection, and dysfunction. CONCLUSIONS: In our experience with the IS, we found no differences in the development of recurrent disease, treatment toxicity, development of graft dysfunction, or rejection. We believe that individualized immunosuppressive therapy in these patients is safe and effective.

[The intracoronary infusion of superoxide dismutase during the initial liberation of oxygen free radicals induced by reperfusion. The effect on the infarct size after 60 minutes of coronary occlusion in the pig model]. / Infusión intracoronaria de superóxido dismutasa durante la liberación inicial de radicales libres del oxígeno inducida por la reperfusión. Efecto sobre el tamaño del infarto tras 60 minutos de oclusión coronaria en el modelo porcino.

The role of oxygen free radicals (OFR) generated early during myocardial reperfusion in the genesis of myocardial necrosis was studied in 26 pigs submitted to transient coronary occlusion followed by one of three different reperfusion protocols. In group A, a selective intracoronary infusion of a Ringer solution was started after 60 min of coronary occlusion, and reperfusion was performed 4 min later. The infusion was maintained during the first 6 min of reperfusion at a rate of 3 ml/min. In group B, the Ringer solution administered during reperfusion contained a high concentration (2.778 U/ml) of superoxide dismutase (SOD). In group C, reperfusion was performed after 60 min of coronary occlusion with no intracoronary infusion. Twenty-four hours later the heart was excised and the area at risk and infarct size were measured by in vivo fluorescein injection and triphenyl-tetrazolium chloride staining respectively. The area at risk was similar in the 3 groups: 15.03 +/- 2.6%, 13.26 +/- 3.3% and 16.34 +/- 6.7% of ventricular mass in groups A, B, and C, respectively (p = 0.42). No differences between groups were observed in infarct size, either when measured as a percent of ventricular mass (10.04 +/- 3.8%, 9.31 +/- 3.8% and 10.1 +/- 2.4% in groups A, B, and C, p = 0.91) or as a percent of the area at risk (64.63 +/- 18.5%, 67.81 +/- 16.1%, and 61.35 +/- 6.7%, respectively, p = 0.72). Thus, the intracoronary administration of SOD during the early reperfusion has not beneficial effect on infarct size. This results suggest that the early burst of OFR is not a major determinant of infarct size in the pig.

Neuropsychological evaluation of everyday memory.

The evaluation of everyday memory (EM) was reviewed and reconceptualized. EM has established new objectives of study and the development of new methods to reach these objectives. At the basic level, this approach has already produced important discoveries and the development of new principles about memory and functioning. At the clinical level, this new area of investigation has resulted in evaluating deficits of EM, which is defined as what daily life functions remain impaired after a deficit pathology has occurred. A type of evaluation has evolved that is oriented toward treatment and extremely useful in designing rehabilitation programs for individuals with alterations in memory.