Role of proton pump inhibitors dosage and duration in Helicobacter pylori eradication treatment: Results from the European Registry on H. pylori management.

BACKGROUND: Management of Helicobacter pylori (H. pylori) infection requires co-treatment with proton pump inhibitors (PPIs) and the use of antibiotics to achieve successful eradication. AIM: To evaluate the role of dosage of PPIs and the duration of therapy in the effectiveness of H. pylori eradication treatments based on the 'European Registry on Helicobacter pylori management' (Hp-EuReg). METHODS: Hp-EuReg is a multicentre, prospective, non-interventionist, international registry on the routine clinical practice of H. pylori management by European gastroenterologists. All infected adult patients were systematically registered from 2013 to 2022. RESULTS: Overall, 36,579 patients from five countries with more than 1000 patients were analysed. Optimal (≥90%) first-line-modified intention-to-treat effectiveness was achieved with the following treatments: (1) 14-day therapies with clarithromycin-amoxicillin-bismuth and metronidazole-tetracycline-bismuth, both independently of the PPI dose prescribed; (2) All 10-day (except 10-day standard triple therapy) and 14-day therapies with high-dose PPIs; and (3) 10-day quadruple therapies with clarithromycin-amoxicillin-bismuth, metronidazole-tetracycline-bismuth, and clarithromycin-amoxicillin-metronidazole (sequential), all with standard-dose PPIs. In first-line treatment, optimal effectiveness was obtained with high-dose PPIs in all 14-day treatments, in 10- and 14-day bismuth quadruple therapies and in 10-day sequential with standard-dose PPIs. Optimal second-line effectiveness was achieved with (1) metronidazole-tetracycline-bismuth quadruple therapy for 14- and 10 days with standard and high-dose PPIs, respectively; and (2) levofloxacin-amoxicillin triple therapy for 14 days with high-dose PPIs. None of the 7-day therapies in both treatment lines achieved optimal effectiveness. CONCLUSIONS: We recommend, in first-line treatment, the use of high-dose PPIs in 14-day triple therapy and in 10-or 14-day quadruple concomitant therapy in first-line treatment, while standard-dose PPIs would be sufficient in 10-day bismuth quadruple therapies. On the other hand, in second-line treatment, high-dose PPIs would be more beneficial in 14-day triple therapy with levofloxacin and amoxicillin or in 10-day bismuth quadruple therapy either as a three-in-one single capsule or in the traditional scheme.

Bismuth quadruple three-in-one single capsule three times a day increases effectiveness compared with the usual four times a day schedule: results from the European Registry on Helicobacter pylori Management (Hp-EuReg).

BACKGROUND: The recommended schedule for single capsule bismuth quadruple therapy (scBQT, Pylera) includes a proton pump inhibitor (PPI) two times a day and three scBQT capsules four times a day. Four times a day treatments are inconvenient and reduce adherence. In contrast, adherence improves with three times a day schedules. In clinical practice, many gastroenterologists use four capsule scBQT three times a day. However, the effectiveness and safety of this latter approach remain uncertain. AIM: To assess the effectiveness and safety of scBQT administered three times a day in the patients included in the European Registry on Helicobacter pylori Management (Hp-EuReg). METHODS: All Spanish adult patients registered in the Asociación Española de Gastroenterología Research Electronic Data Capture (REDCap) database from June 2013 to March 2021 receiving 10-day scBQT were analysed. Modified intention-to-treat effectiveness, adherence and the safety of scBQT given three times a day were calculated and compared with the four times a day schedule. A multivariate analysis was performed to determine independent factors predicting cure of the infection. RESULTS: Of the 3712 cases, 2516 (68%) were four times a day and 1196 (32%) three times a day. Mean age was 51 years, 63% were women and 15% had a peptic ulcer. The three times a day schedule showed significantly better overall cure rates than four times a day (1047/1112, 94%; 95% CI 92.7 to 95.6 vs 2207/2423, 91%; 95% CI 89.9 to 92.2, respectively, p=0.002). Adherence and safety data were similar for both regimens. In the multivariate analysis, three times a day dosage, first-line therapy, use of standard or high-dose PPIs and adherence over 90% were significantly associated with cure of the infection. CONCLUSIONS: ScBQT prescribed three times a day was more effective than the traditional four times a day schedule. No differences were observed in treatment adherence or safety.

Characterization and Classification of Spanish Honeydew and Blossom Honeys Based on Their Antioxidant Capacity.

Honey is a very appreciated product for its nutritional characteristics and its benefits for human health, comprising antioxidant, anti-inflammatory, antifungal, and antibacterial activities. These attributes depend on the specific composition of each honey variety, with the botanical origin as one of the distinctive features. Indeed, honeydew and blossom honeys show different physicochemical properties, being the antioxidant capacity, mainly relying on the phenolic compound content, one of the most important. In this work, Folin-Ciocalteu (FC) index, total flavonoid content (TFC), and the antioxidant capacity based on the ferric reducing antioxidant power (FRAP) assay were determined for a total of 73 honeys (50 blossom honeys and 23 honeydew honeys). Mean content of oxidizable species (FC index) ranges from 0.17 to 0.7 mg eq. gallic acid g-1, with honeydew honeys being the ones with higher values. Regarding TFC, mean values above 1.5 mg eq. quercetin g-1 (method applied in the absence of NaNO2) were obtained for honeydew honeys and heather honey. Lower and not discriminatory values (below 0.3 mg eq. epicatechin g-1) were obtained in the presence of NaNO2. The maximum antioxidant capacity was observed for thyme honeys (2.2 mg eq. Trolox g-1) followed by honeydew and heather honeys. Individually, only the FC index was able to discriminate between honeydew and blossom honeys, while the other spectroscopic indexes tested allowed the differentiation of some honey types according to the botanical origin. Thus, a holistic treatment of the results was performed using partial least square discriminant analysis (PLS-DA) for classification purposes using FC, TFC, and FRAP results as data. Honeydew and blossom honey were satisfactorily discriminated (error 5%). In addition, blossom honeys can be perfectly classified according to their botanical origin based on two-class PLS-DA classification models.

Liquid Chromatography-High-Resolution Mass Spectrometry (LC-HRMS) Fingerprinting and Chemometrics for Coffee Classification and Authentication.

Nowadays, the quality of natural products is an issue of great interest in our society due to the increase in adulteration cases in recent decades. Coffee, one of the most popular beverages worldwide, is a food product that is easily adulterated. To prevent fraudulent practices, it is necessary to develop feasible methodologies to authenticate and guarantee not only the coffee's origin but also its variety, as well as its roasting degree. In the present study, a C18 reversed-phase liquid chromatography (LC) technique coupled to high-resolution mass spectrometry (HRMS) was applied to address the characterization and classification of Arabica and Robusta coffee samples from different production regions using chemometrics. The proposed non-targeted LC-HRMS method using electrospray ionization in negative mode was applied to the analysis of 306 coffee samples belonging to different groups depending on the variety (Arabica and Robusta), the growing region (e.g., Ethiopia, Colombia, Nicaragua, Indonesia, India, Uganda, Brazil, Cambodia and Vietnam), and the roasting degree. Analytes were recovered with hot water as the extracting solvent (coffee brewing). The data obtained were considered the source of potential descriptors to be exploited for the characterization and classification of the samples using principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA). In addition, different adulteration cases, involving nearby production regions and different varieties, were evaluated by pairs (e.g., Vietnam Arabica-Vietnam Robusta, Vietnam Arabica-Cambodia and Vietnam Robusta-Cambodia). The coffee adulteration studies carried out with partial least squares (PLS) regression demonstrated the good capability of the proposed methodology to quantify adulterant levels down to 15%, accomplishing calibration and prediction errors below 2.7% and 11.6%, respectively.

Total Polyphenol Content in Food Samples and Nutraceuticals: Antioxidant Indices versus High Performance Liquid Chromatography.

Total polyphenol content and antioxidant capacity were estimated in various food and nutraceutical samples, including cranberries, raspberries, artichokes, grapevines, green tea, coffee, turmeric, and other medicinal plant extracts. Samples were analyzed by using two antioxidant assays-ferric reducing antioxidant power (FRAP) and Folin-Ciocalteu (FC)-and a reversed-phase high-performance liquid chromatography (HPLC), with a focus on providing compositional fingerprints dealing with polyphenolic compounds. A preliminary data exploration via principal component analysis (PCA) revealed that HPLC fingerprints were suitable chemical descriptors to classify the analyzed samples according to their nature. Moreover, chromatographic data were correlated with antioxidant data using partial least squares (PLS) regression. Regression models have shown good prediction capacities in estimating the antioxidant activity from chromatographic data, with determination coefficients (R2) of 0.971 and 0.983 for FRAP and FC assays, respectively.

FIA-HRMS fingerprinting subjected to chemometrics as a valuable tool to address food classification and authentication: Application to red wine, paprika, and vegetable oil samples.

The rise of food fraud practices, affecting a wide variety of goods and their specific characteristics (e.g., quality or geographical origin), demands rapid high-throughput analytical approaches to ensure consumers protection. In this context, this study assesses flow injection analysis coupled to high-resolution mass spectrometry (FIA-HRMS), using a fingerprinting approach and combined with chemometrics, to address four food authentication issues: (i) the geographical origin of three Spanish red wines, (ii) the geographical origin of three European paprikas, (iii) the distinction of olive oil from other vegetable oils and (iv) the assessment of its quality category. In each case, negative and positive ionisation FIA-HRMS fingerprints, and two different data fusion strategies, were evaluated. After external validation, excellent classification accuracies were reached. Moreover, high-resolution mass spectrometry (HRMS) allowed sample matrices characterisation by the putative identification of the most common ions.

Characterization, Classification and Authentication of Turmeric and Curry Samples by Targeted LC-HRMS Polyphenolic and Curcuminoid Profiling and Chemometrics.

The importance of monitoring bioactive substances as food features to address sample classification and authentication is increasing. In this work, targeted liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS) polyphenolic and curcuminoid profiles were evaluated as chemical descriptors to deal with the characterization and classification of turmeric and curry samples. The profiles corresponding to bioactive substances were obtained by TraceFinderTM software using accurate mass databases with 53 and 24 polyphenolic and curcuminoid related compounds, respectively. For that purpose, 21 turmeric and 9 curry samples commercially available were analyzed in triplicate by a simple liquid-solid extraction procedure using dimethyl sulfoxide as extracting solvent. The obtained results demonstrate that the proposed profiles were excellent chemical descriptors for sample characterization and classification by principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA), achieving 100% classification rates. Curcuminoids and some specific phenolic acids such as trans-cinnamic, ferulic and sinapic acids, helped on the discrimination of turmeric samples; polyphenols, in general, were responsible for the curry sample distinction. Besides, the combination of both polyphenolic and curcuminoid profiles was necessary for the simultaneous characterization and classification of turmeric and curry samples. Discrimination among turmeric species such as Curcuma longa vs. Curcuma zedoaria, as well as among different Curcuma longa varieties (Alleppey, Madras and Erode) was also accomplished.

Determination of Phenolic Compounds in Paprika by Ultrahigh Performance Liquid Chromatography-Tandem Mass Spectrometry: Application to Product Designation of Origin Authentication by Chemometrics.

An ultrahigh performance liquid chromatography-electrospray-tandem mass spectrometry method was developed for the determination of 36 phenolic compounds in paprika. The proposed method showed good method performance with limits of quantitation between 0.03 and 50 µg/L for 16 compounds and between 50 µg/L and 1 mg/L for 12 compounds. Good linearity (R2 > 0.995), run-to-run and day-to-day precisions (%RSD values < 12.3 and < 19.2%, respectively), and trueness (relative errors < 15.0%) were obtained. The proposed method was applied to the analysis of 111 paprika samples from different production regions: Spain (La Vera PDO and Murcia PDO) and Czech Republic, each one including different flavor varieties (sweet, bittersweet, and spicy). Phenolic profiles and concentration levels showed to be good chemical descriptors to achieve paprika classification and authentication according to the production region by principal component analysis and partial least squares regression-discriminant analysis. In addition, perfect classification among flavor varieties for Murcia PDO and Czech Republic samples was also obtained.

Determination of HPLC-UV Fingerprints of Spanish Paprika (Capsicum annuum L.) for Its Classification by Linear Discriminant Analysis.

The development of a simple HPLC-UV method towards the evaluation of Spanish paprika's phenolic profile and their discrimination based on the former is reported herein. The approach is based on C18 reversed-phase chromatography to generate characteristic fingerprints, in combination with linear discriminant analysis (LDA) to achieve their classification. To this aim, chromatographic conditions were optimized so as to achieve the separation of major phenolic compounds already identified in paprika. Paprika samples were subjected to a sample extraction stage by sonication and centrifugation; extracting procedure and conditions were optimized to maximize the generation of enough discriminant fingerprints. Finally, chromatograms were baseline corrected, compressed employing fast Fourier transform (FFT), and then analyzed by means of principal component analysis (PCA) and LDA to carry out the classification of paprika samples. Under the developed procedure, a total of 96 paprika samples were analyzed, achieving a classification rate of 100% for the test subset (n = 25).

Detection and Quantitation of Frauds in the Authentication of Cranberry-Based Extracts by UHPLC-HRMS (Orbitrap) Polyphenolic Profiling and Multivariate Calibration Methods.

UHPLC-HRMS (Orbitrap) polyphenolic profiling was applied to the characterization, classification, and authentication of cranberry-based natural and pharmaceutical products. Fifty three polyphenolic standards were characterized to build a user-accurate mass database which was then proposed to obtain UHPLC-HRMS polyphenolic profiles by means of ExactFinder software. Principal component analysis results showed a good sample discrimination according to the fruit employed. Regarding cranberry-based pharmaceuticals, discrimination according to the presentation format (syrup, sachets, capsules, etc.) was also observed due to the enhancement of some polyphenols by purification and preconcentration procedures. Procyanidin A2 and homogentisic, sinapic, veratric, cryptochlorogenic, and caffeic acids showed to be important polyphenols to achieve cranberry-based products discrimination against the other studied fruits. Partial least-squares regression allowed the determination of adulterant percentages in cranberry-fruit samples. Very satisfactory results with adulteration quantification errors lower than 6.0% were obtained even at low adulteration levels.

Determination of flavanols by liquid chromatography with fluorescence detection. Application to the characterization of cranberry-based pharmaceuticals through profiling and fingerprinting approaches.

In this work, a new method based on reversed-phase high-performance liquid chromatography (HPLC) with fluorescence detection (FLD) was established for the determination of catechins and related oligomeric proanthocyanidins (PACs) in cranberry-based pharmaceuticals. Compounds were recovered by liquid extraction using methanol/water/hydrochloric acid (60:39:1, v:v:v) as the extraction solvent. The chromatographic separation was carried out using a core-shell C18 column under an elution program based on 0.1% formic acid in water and methanol as the components of the mobile phase. The flow rate was 0.4 mL min-1 and the injection volume was 5 µL. Chromatograms were acquired at 280 nm by UV-vis absorption and at λex 280 nm and λem 347 nm by fluorescence spectroscopy. Compared to UV detection, FLD demonstrated both increased sensitivity and selectivity to avoid interfering signals from other phenolic compounds present in the samples. Data resulting from the analysis of cranberry-based products was exploited to tackle an exploratory characterization and classification using principal component analysis. Samples were clustered according to their compositions and those enriched with PACs with antibacterial activity were clearly distinguished from the others.

Characterization, classification and authentication of fruit-based extracts by means of HPLC-UV chromatographic fingerprints, polyphenolic profiles and chemometric methods.

HPLC-UV was applied to the analysis and characterization of fruit-based and fruit-processed products. A Kinetex C18 reversed-phase column was proposed under gradient elution for the determination of 17 polyphenols. Acceptable sensitivity (LODs below 0.16mg/L), and good linearity (r2 higher than 0.995), precision (RSD below 6.8%), and method trueness (relative errors below 11%) were obtained. Data corresponding to polyphenolic peak areas and HPLC-UV chromatographic fingerprints were then analyzed by exploratory principal component analysis (PCA) to extract information of the most significant variables contributing to characterization and classification of analyzed samples regarding the fruit of origin. HPLC-UV chromatographic data was further treated by partial least square (PLS) regression to determine the percentages of adulteration in cranberry-fruit extracts. It was found that even mixture samples containing low percentages of adulterants could be distinguished from genuine cranberry extracts. Highly satisfactory results were obtained, with overall errors in the quantification of adulterations below 4.3%.

Transcriptomic and metabolomic profiling of ionic liquid stimuli unveils enhanced secondary metabolism in Aspergillus nidulans.

BACKGROUND: The inherent potential of filamentous fungi, especially of Ascomycota, for producing diverse bioactive metabolites remains largely silent under standard laboratory culture conditions. Innumerable strategies have been described to trigger their production, one of the simplest being manipulation of the growth media composition. Supplementing media with ionic liquids surprisingly enhanced the diversity of extracellular metabolites generated by penicillia. This finding led us to evaluate the impact of ionic liquids' stimuli on the fungal metabolism in Aspergillus nidulans and how it reflects on the biosynthesis of secondary metabolites (SMs). RESULTS: Whole transcriptional profiling showed that exposure to 0.7 M cholinium chloride or 1-ethyl-3-methylimidazolium chloride dramatically affected expression of genes encoding both primary and secondary metabolism. Both ionic liquids apparently induced stress responses and detoxification mechanisms but response profiles to each stimulus were unique. Primary metabolism was up-regulated by choline, but down-regulated by 1-ethyl-3-methylimidazolium chloride; both stimulated production of acetyl-CoA (key precursor to numerous SMs) and non proteinogenic amino acids (building blocks of bioactive classes of SMs). In total, twenty one of the sixty six described backbone genes underwent up-regulation. Accordingly, differential analysis of the fungal metabolome showed that supplementing growth media with ionic liquids resulted in ca. 40 differentially accumulated ion masses compared to control conditions. In particular, it stimulated production of monodictyphenone and orsellinic acid, otherwise cryptic. Expression levels of genes encoding corresponding polyketide biosynthetic enzymes (i.e. backbone genes) increased compared to control conditions. The corresponding metabolite extracts showed increased cell polarity modulation potential in an ex vivo whole tissue assay (The lial Live Targeted Epithelia; theLiTE™). CONCLUSIONS: Ionic liquids, a diverse class of chemicals composed solely of ions, can provide an unexpected means to further resolve the diversity of natural compounds, guiding discovery of fungal metabolites with clinical potential.

Effects of the Fruit Ripening Stage on Antioxidant Capacity, Total Phenolics, and Polyphenolic Composition of Crude Palm Oil from Interspecific Hybrid Elaeis oleifera × Elaeis guineensis.

In the present study, we assessed for the first time the changes in the antioxidant capacity, total phenolic content, and polyphenolic composition of interspecific hybrid palm oil extracted from Elaeis oleifera × Elaeis guineensis (O × G, Coari × La Mé cultivar) during the fruit ripening process 18, 20, 22, and 24 weeks after anthesis. A progressive decrease (p < 0.05) of phenolic content occurred during fruit development together with marked changes in polyphenol profiles. Significant negative correlations were established between antioxidant activity measured by TEAC (R = -0.954; p < 0.05) and ORAC (R = -0.745; p < 0.05) and the fruit ripening stage, while a positive correlation between total phenolic content was found using either the TEAC assay or the ORAC assay. The highest DPPH radical scavenging activity was also obtained with oils extracted at 18 WAA. These results highlight that O × G fruits of early ripeness represent a better source of phenolic compounds and may provide extracts with higher antioxidant activities when hybrid palm oil is aimed to be used as a functional ingredient for the development of food or food products with antioxidant properties.

Prunus persica var. platycarpa (Tabacchiera Peach): Bioactive Compounds and Antioxidant Activity of Pulp, Peel and Seed Ethanolic Extracts.

A comparative analysis of ethanol extracts from peel, pulp and seed of Prunus persica var. platycarpa (Tabacchiera peach) was done. The total phenol, flavonoid and carotenoid content as well as the antioxidant properties by using different in vitro assays (DPPH, ABTS, FRAP, Fe-chelating, ß-carotene bleaching test) were evaluated. Pulp extract was subjected to liquid chromatography-electrospray-tandem mass spectrometry (HPLC-ESI-MS/MS). Gallic acid, protocatechuic acid, protocatechualdehyde, chlorogenic acid, p-coumaric acid, and ferulic acid were identified as main constituents. Pulp extract was characterized by the highest total phytonutrients content and exhibited the highest antioxidant activity in all in vitro assays (IC(50) values of 2.2 µg/mL after 60 min of incubation by using ß-carotene bleaching test and 2.9 µg/mL by using Fe-chelating assay). Overall, the obtained results suggest that P. persica var. platycarpa displays a good antioxidant activity and its consumption could be promoted.

Determination of polyphenolic profiles by liquid chromatography-electrospray-tandem mass spectrometry for the authentication of fruit extracts.

Liquid chromatography-electrospray-tandem mass spectrometry (LC-ESI-MS/MS) was applied to the analysis and authentication of fruit-based products and fruit-based pharmaceutical preparations. A Kinetex C18 reversed-phase column under gradient elution with 0.1 % formic acid aqueous solution and methanol mobile phases was used for the simultaneous determination of 26 polyphenols, allowing an acceptable separation in less than 22 min. Instrumental quality parameters such as limits of detection (LOD, values between 12 and 14 µg/L for 19 of the 26 analyzed polyphenols), linearity (r (2) > 0.991), run-to-run and day-to-day precisions (relative standard deviation (RSD) values lower than 9.9 and 13.5 %, respectively), and accuracy (relative errors lower than 8 %) were established. A simple extraction method, consisting of a sample sonication with acetone/water/hydrochloric acid (70:29.9:0.1 v/v/v) and centrifugation, was proposed. Two calibration procedures, external calibration using standards prepared in water and standard addition, were evaluated for polyphenol quantification in several grape and cranberry fruits and processed fruit products. For a 95 % confidence level, no statistical differences were observed between the two calibration methods (p values between 0.06 and 0.95), denoting that external calibration was suitable enough for the quantitative analysis of polyphenols in fruit-based products. The proposed LC-ESI-MS/MS method was then applied to the analysis of polyphenols in 23 grape-based and cranberry-based natural products and pharmaceutical preparations. Polyphenolic concentration data was then analyzed by principal component analysis (PCA) to extract information of the most significant profile data contributing to authentication of natural extracts according to their fruit of origin.

Characterization of fruit products by capillary zone electrophoresis and liquid chromatography using the compositional profiles of polyphenols: application to authentication of natural extracts.

Capillary zone electrophoresis (CZE) and high performance liquid chromatography (HPLC) were applied to the authentication of fruit products based on the compositional profiles of polyphenols. Various sample treatments were used to maximize the overall recovery of polyphenols or specific fractions, such as phenolic acids or anthocyanins. The resulting CZE and HPLC data were treated with Principal Component Analysis (PCA) showing that samples were mainly clustered according to the fruit of origin, with cranberry- and grape-based products clearly separated in groups. A possible adulterated cranberry extract was analyzed more deeply by high resolution mass spectrometry (HRMS) in order to identify the presence of A-type proanthocyanidins, which are characteristic and more abundant in cranberry-based products. In accordance with PCA interpretation, HRMS results indicated that the suspicious sample was not a cranberry-based product, allowing us to validate and demonstrate the suitability of both CZE- and HPLC-proposed methods for the characterization of fruit-based products.

Influencia del tratamiento del hepatocarcinoma antes del trasplante hepático en la recurrencia tumoral y supervivencia postrasplante / Influence of treatment of hepatocellular carcinoma before liver transplantation on postransplant tumor recurrence and survival

ObjetivosEvaluar la efectividad del tratamiento del carcinoma hepatocelular (CHC) previo al trasplante hepático (TH) y su influencia sobre la supervivencia y recurrencia tumoral en pacientes trasplantados con CHC.Pacientes y métodosSe incluyeron 67 pacientes trasplantados con diagnóstico preoperatorio de CHC y confirmación en el explante entre enero del año 2000 y octubre del año 2007. Se realizó tratamiento pretrasplante en 46 pacientes (68,7%) (18 radiofrecuencia, 31 quimioembolización transarterial y 2 alcoholización).ResultadosLa mediana de tiempo entre la inclusión en lista y el TH fue de 4 meses, y fue similar en pacientes tratados y no tratados. El tiempo entre la realización del tratamiento y el TH fue menor de 6 meses en el 65,2%. Los pacientes tratados presentaban mejor función hepática (Child A: el 52,2 vs. el 19%; Child B: el 39,1 vs. el 33,3%; Child C: el 8,7 vs. el 47,6%; p=0,001) y una mayor proporción de tamaño tumoral total >3cm (59,1 vs. 30%; p=0,031). Se confirmó necrosis total del CHC en el 26,1% de los pacientes sin diferencias en el grado de necrosis según el tipo de tratamiento o tamaño tumoral. En 6 pacientes (9%) se produjo recurrencia del CHC. La mediana de tiempo entre el TH y la recurrencia fue de 26,5 meses con una supervivencia tras ésta de 6,6 meses. La supervivencia global fue del 83,5, el 69,9 y el 59,5% y la supervivencia libre de recurrencia tumoral fue del 83,5, el 68,3 y el 58% a 1, 3 y 5 años, respectivamente. El haber recibido tratamiento previo no influyó en la probabilidad de recurrencia o en la supervivencia. Asimismo, el grado de necrosis tampoco se relacionó con la supervivencia o la frecuencia de recurrencia.ConclusiónLa realización de tratamiento del CHC previo al TH en pacientes con un período en lista de espera menor de 6 meses no parece influir en la supervivencia o en la prevención de la recurrencia tumoral postrasplante (AU)

ObjectivesTo evaluate the effectiveness of treatment of hepatocellular carcinoma (HCC) before liver transplantation (LT) and its influence on survival and tumor recurrence in patients transplanted for HCC.Patients and methodsWe included 67 liver transplant patients with a preoperative diagnosis of HCC and pathological confirmation in the native liver between January 2000 and October 2007. Treatment before LT was performed in 46 (68.7%) patients [radiofrequency ablation in 18, transarterial chemoembolization in 31 and percutaneous ethanol injection in two].ResultsThe median time between inclusion on the waiting list and LT was 4 months and was similar in treated and untreated patients. The median time between pre-transplantation locoregional therapy and LT was less than 6 months in 65.2% of the patients. Treated patients had better liver function (Child A 52.2 vs 19%; Child B 39.1 vs 33.3%; Child C 8.7 vs. 47.6%; p=0.001) and a higher proportion of total tumor size >3cm (59.1% vs 30%; p=0.031). Total tumor necrosis was observed in 26.1% of the patients, with no differences according to treatment modality or tumor size. Tumor recurrence occurred in six patients (9%). The median time between LT and tumor recurrence was 26.5 months with a subsequent median survival of 6.6 months. Overall survival was 83.5%, 69.9% and 59.5%, and tumor recurrence-free survival was 83.5%, 68.3% and 58% at 1, 3 and 5 years, respectively. Previous HCC treatment showed no influence on survival or tumor recurrence. Likewise, the grade of tumor necrosis was unrelated to overall survival or the probability of recurrence.ConclusionTreatment of HCC before LT in patients with a waiting list time of less than 6 months does not appear to influence survival or tumor recurrence(AU)

[Influence of treatment of hepatocellular carcinoma before liver transplantation on post transplant tumor recurrence and survival]. / Influencia del tratamiento del hepatocarcinoma antes del trasplante hepático en la recurrencia tumoral y supervivencia postrasplante.

OBJECTIVES: To evaluate the effectiveness of treatment of hepatocellular carcinoma (HCC) before liver transplantation (LT) and its influence on survival and tumor recurrence in patients transplanted for HCC. PATIENTS AND METHODS: We included 67 liver transplant patients with a preoperative diagnosis of HCC and pathological confirmation in the native liver between January 2000 and October 2007. Treatment before LT was performed in 46 (68.7%) patients [radiofrequency ablation in 18, transarterial chemoembolization in 31 and percutaneous ethanol injection in two]. RESULTS: The median time between inclusion on the waiting list and LT was 4 months and was similar in treated and untreated patients. The median time between pre-transplantation locoregional therapy and LT was less than 6 months in 65.2% of the patients. Treated patients had better liver function (Child A 52.2 vs 19%; Child B 39.1 vs 33.3%; Child C 8.7 vs. 47.6%; p=0.001) and a higher proportion of total tumor size > 3 cm (59.1% vs 30%; p=0.031). Total tumor necrosis was observed in 26.1% of the patients, with no differences according to treatment modality or tumor size. Tumor recurrence occurred in six patients (9%). The median time between LT and tumor recurrence was 26.5 months with a subsequent median survival of 6.6 months. Overall survival was 83.5%, 69.9% and 59.5%, and tumor recurrence-free survival was 83.5%, 68.3% and 58% at 1, 3 and 5 years, respectively. Previous HCC treatment showed no influence on survival or tumor recurrence. Likewise, the grade of tumor necrosis was unrelated to overall survival or the probability of recurrence. CONCLUSION: Treatment of HCC before LT in patients with a waiting list time of less than 6 months does not appear to influence survival or tumor recurrence.