Early Outcomes of Liver Transplantation Using Donors After Circulatory Death in Patients With Hepatocellular Carcinoma: A Comparative Study.

INTRODUCTION: Donation after circulatory death (DCD) has increased in the last decade, although a slight increase in surgical complications has been reported in liver transplantation (LT). Therefore, DCD is not overall recommended because it entails an added risk. However, DCD in selected patients shows acceptable results. OBJECTIVE: The objective was to analyze the characteristics, early outcomes, and survival at 1 year post-LT from a single institute (January 2015 to May 2017). MATERIALS AND METHODS: We included 18 DCD-LTs and compared them with a control group of 18 donation after brain death (DBD) LTs. We analyzed pre- and posttransplant variables related to donors, recipients, and intraoperative early outcomes within patients transplanted due to hepatocellular carcinoma (HCC). A descriptive analysis, Mann-Whitney U test, χ2, or Fisher test was performed when appropriate, as well as multivariate analysis in case of statistical significance. A variable is considered as statistically significant when it reaches a value of P < .05. RESULTS: In DBD, we found a lower length of stay in the intensive care unit before retrieval and a higher rate of alcoholism and diabetes mellitus, Model for End-Stage Liver Disease score, and Child B and C score (P < .05). Most of the DCD were originally from the same LT recipient center, and a higher donor mean post-LT alanine aminotransferase level was found (P < .05). Survival for the DBD group was 88% and 75% in the DCD group at 1 year post-LT, being not significant (NS). CONCLUSION: HCC recipients who are transplanted with good quality DCD livers do no worse than those transplanted with livers from DBD donors, although a good selection of them is crucial.

Outcomes of Liver Transplantation Using Older Donors After Circulatory Death and the Super-Rapid Technique: 14 Cases.

INTRODUCTION: Donation after circulatory death (DCD) has increased in the last decade, although a slight increase in surgical complications has been reported in liver transplantation (LT). Therefore, DCD is not recommended with donors aged 60 years or more because it entails an added risk. However, donation after brain death (DBD)-LT with donors aged 70 years or more shows acceptable results. OBJECTIVE: The objective was to analyze the characteristics and complications of DCD-LT with donors aged 70 years or more (DCD-70). MATERIALS AND METHODS: We included 14 DCD-70-LT and compared them with a control group of 28 DBD-LT aged 70 years or more. STATISTICAL ANALYSIS: A descriptive analysis, Mann-Whitney U test, and Pearson chi-square or Fisher test were performed when appropriate. RESULTS: Significant differences were found in aminotransferase peak at 24 hours, with an increase in the DCD-70 group (aspartate aminotransferease [AST] 1038 vs 507, P = .013; alanine aminotransferase [ALT] 750 vs 399, P = .014). The cold ischemia time was lower in DCD-70 although without significant differences (4.8 vs 6.7 hours). Biliary complications (28.6% vs 31.7%) and vascular complications (7.1% vs 7.1%) were similar. A single transplant with DCD-70 required a retransplantation due to arterial thrombosis. Mortality was the same in both cases (14.3%). CONCLUSION: LT results with DCD-70 are similar to those of DBD-70, so the age criteria could also be extended in this type of donation.

Benefits of Group Psychotherapy in Cirrhotic Patients on the Liver Transplant Waiting List.

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

Risk of Respiratory Complications in Obese Liver Transplant Patients: A Study of 343 Patients.

INTRODUCTION: Obesity is a risk factor that increases the number of complications after orthotopic liver transplantation (LT). We sought to analyze the short-term respiratory complications in obese LT recipients and compare them with a control group of nonobese patients. MATERIAL AND METHODS: A retrospective analysis of LT patients in a hospital in the southeast of Spain (2007-2013), selecting the study cases using a body mass index (BMI) of >30 kg/m(2) and a control group (BMI < 30). Study variables were age, sex, indication for LT, demographic and clinical variables, respiratory complications during the first postoperative month, and mortality rate secondary to respiratory disease. RESULTS: Of the 343 LT recipients, 74 were obese (21.6%): 59 patients had a BMI between 30 and 35 (grade I obesity) and among them, 5% presented with respiratory complications, with a 33% mortality rate. Fifteen patients had a BMI of >35 (obesity grade II), and 20% presented with respiratory complications, with a 33% mortality rate. In the control group (n = 30), 17% experienced respiratory complications and there was a 20% mortality rate. There were no differences in respiratory complications between the obese and nonobese groups, or the different kinds of obesity (P > .05). CONCLUSIONS: There were no differences in short-term respiratory complications between obese LT recipients and those with a normal weight.

Prevalence of endometriosis in epithelial ovarian cancer. Analysis of the associated clinical features and study on molecular mechanisms involved in the possible causality.

PURPOSE OF INVESTIGATION: To determine the prevalence of endometriosis in patients with epithelial ovarian cancer and explore the differences between women with endometrioid and clear-cell histologic subtypes with and without associated endometriosis. MATERIALS AND METHODS: The medical charts of 496 patients with epithelial ovarian cancer at the Hospital Virgin de la Arrixaca (Murcia, Spain) between 1971 and 2010 were reviewed. RESULTS: Endometriosis was present in 27 (5.4%) of the 496 cases (p < 0001), and was associated with the endometrioid histotype in 13/45 cases (29%) and with the clear cell histotype in 7/22 (32%). The prevalence of an association with endometriosis according to histologic type was 28.8% (13/45) for endometrioid carcinoma and 31.8% (7/22) for clear-cell carcinoma. CONCLUSION: Both endometrioid and clear-cell ovarians tumours are associated with pelvic endometriosis. Patients with endometiosis associated ovarian cancer differ from non-endometiosis associated ovarian cancer in their clinical characteristics.

The evolution of therapeutic strategies for biliary tract complications after liver transplantation over a period of 20 years.

Despite the improved overall outcomes of liver transplantation as a result of advances in surgical techniques and improved immunosuppressive control, biliary complications (BCs) continue to be the most common cause of morbidity in liver transplant recipients. The objectives of this study were to analyze the incidence, type, and management of BCs over a 20-year period. We performed a comparative study of two groups of liver transplant patients in our unit operated on by the same surgical team: group I consists of the first 300 liver transplant patients (1989-1992), and group II is composed of the last 300 liver transplants (2007-2011). We found no significant differences in the number of cases of biliary leakage whether or not a Kehr T-tube was used. However, there was a significant relationship between a greater number of anastomotic strictures and less use of a Kehr T-tube. In our series, there has been a decrease over the years in the number of surgical interventions required to resolve these complications and an increase in radiologic and endoscopic treatment.

Thirteen cases of liver-kidney transplantation.

Combined kidney-liver transplantation is currently the best therapeutic option for patients with end-stage kidney and liver disease. We present our experience of kidney-liver transplantation in a series of 13 patients. The most frequent indications were familial amyloidotic polyneuropathy (FAP) and polycystosis of the liver and kidney. The 1- and 5-year survival rates of the liver grafts were 75% and 67%, respectively, with no kidney losses during follow-up.

Attitude of Scottish residents living in southeastern Spain toward organ donation.

BACKGROUND: Southeastern Spain is a habitual area of residence for the native population of Scotland. OBJECTIVE: To assess the attitude toward donation in the immigrant population in our regional community who were born in Scotland and to analyze the variables that influence this attitude. MATERIALS AND METHODS: A random sample was taken (n = 350) of the population group born in Scotland and living in southeastern Spain. The instrument used to measure attitude was a previously validated questionnaire, which was self-administered and completed anonymously between December 2005 and March 2006. For a control group, we used a sample of the autochthonous population (n = 2000). Statistical analysis included Student t test, the chi(2) test, Fisher exact test, and logistical regression analysis. RESULTS: The attitude toward donation was favorable among 73% of respondents (n = 237), with 7% (n = 22) against and 21% (n = 68) undecided. The attitude was more favorable than among the Spanish control group (73% vs 63%; P = .002). The following variables were related to this attitude: an understanding of the concept of brain death (P = .025); having discussed the matter within the family unit (P < .001); a partner's attitude toward donation (P < .001); being in favor of donating a family member's organs (P < .001); attitude toward cremation (P < .001); attitude toward autopsy (P = .002); and concern about mutilation after donation (P < .001). CONCLUSIONS: The attitude of Scottish residents in southeastern Spain is more favorable than that of the Spanish population. It is mainly affected by factors related to the family and to the attitude toward manipulation of the cadaver.

Irish residents in southeastern Spain: in search of favorable groups to encourage living kidney donation in Spain.

INTRODUCTION: There has been an increase in the population resident in southeast Spain originating from the British Isles, among them Irish citizens. Living kidney donation rates are currently low in Spain. In an attempt to increase these rates, a search is underway to find groups who are favorable toward this type of donation especially from those countries with high levels of living kidney donation. The objective of this study was to analyze the attitudes toward living kidney donation among the population group originating from Ireland (including Northern Ireland) and who live in southeast Spain. MATERIALS AND METHODS: A random sample (n = 325) of the population in southeast Spain (Autonomous Community of Murcia) who were born in Ireland completed a validated questionnaire to measure attitudes. The questionnaire was self-administered and was completed anonymously between November 2005 and March 2006. Spanish citizens from an urban and a rural area were used as control groups (n = 500). RESULTS: The questionnaire completion rate was 81% (n = 262) including 87% (n = 229) of respondents in favor of living related donation and 13% (n = 94) against it. The attitude was similar to that of the urban Spanish control group (87% vs 89%; P = .5832) and more favorable than that of the rural area (87% vs 29%; P < 0.001). With respect to living donation for monetary incentives, 7% (n = 16) reported that they would donate an organ while alive for money, although this would depend on the quantity of money offered; 4% (n = 10) would need to think about it; while the vast majority (81%; n = 212) would never donate an organ in life for money. The following variables influenced attitudes toward living kidney donation: respondent sex (P = .023); previous experience with the donation and transplantation process (P = .004); participation in prosocial activities (P = .016); religion (P = .003); partner's attitude toward the matter (P = .020); concern about "mutilation" after donation (P < .001); and belief that living kidney donation is a risk for the patient (P = .003). CONCLUSION: Irish citizens living in southeast Spain showed a favorable attitude toward related living kidney donation. Therefore, they are a priority group to whom the option of living kidney donation should be offered when a kidney transplant is needed by an Irish person.

Hospital personnel in surgical services in a transplant hospital faced with living liver donation: an attitudinal survey.

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

Emigration from the British Isles to southeastern Spain: a study of attitudes toward organ donation.

Southeastern Spain is a cosmopolitan area where there is a growing British and Irish population. The objective is to analyze the attitude toward organ donation among British and Irish citizens living in southeastern Spain. A sample was taken stratified according to a respondent's country of origin (n = 1700) between November 2005 and April 2006. Attitude was evaluated using a validated questionnaire, which was self-administered and completed anonymously. A sample of 2000 Spanish citizens was used as a control group. The survey completion rate was 95% (n = 1611). Attitude toward donation is favorable in 72% (n = 1155) of respondents with 8% (n = 122) against and 20% (n = 334) undecided. Attitude is more favorable than in the control group (72% vs. 63%; p < 0.0001). The following factors influence this attitude: (1) attitude toward the donation of a family member's organs (OR = 4.891); (2) having discussed the matter of organ donation within the family (OR = 2.513); (3) a willingness to accept an autopsy if it were necessary (OR = 1.706); (4) having no concern about the mutilation of the deceased donor (OR = 3.294); (5) having a partner who is in favor of donation (OR = 2.786) and (6) a respondent's belief that he or she might need a transplant in the future (OR = 2.243). The attitude of this population is more positive than in the native Spanish population and is determined by many psychosocial factors.

Manejo del nódulo en cicatriz de Pfannenstiel en régimen de CMA: diagnóstico diferencial y actitud terapéutica / No disponible

Introducción: Un nódulo descubierto en torno a una cicatriz de tipo Pfannenstiel es un reto diagnóstico por su múltiple y variada etiología. Se debe considerar la posibilidad de que se trate de una endometriosis cicatricial. Pacientes y método: Se estudiaron de forma retrospectiva 17 pacientes que consultaron por nódulo doloroso pericicatricial. Se analizaron las variables: edad, antecedentes médicos, sintomatología, estudios de imagen, diagnóstico preoperatorio y postoperatorio, tratamiento realizado y estudios posteriores. El procedimiento quirúrgico se realizó en régimen ambulatorio. Resultados: La edad media de las pacientes fue de 33,7 años (rango 25-44), con una mediana de 33. En 14 casos la cirugía previa fue cesárea y en 3 fueron histerectomías. El motivo de consulta en todos los casos fue la existencia de un nódulo o masa sobre la antigua cicatriz, con un dolor cíclico en 6 de ellos. El diagnóstico preoperatorio fue de hernia (5 casos); granuloma a cuerpo extraño (7 casos); y endometrioma (5 casos). El diagnóstico anatomopatológico de endometrioma se dio en 9 casos. El tratamiento fue la exéresis de los endometriomas y granulomas, y la hernioplastia con prótesis en los casos de hernia laparotómica. No hubo morbilidad asociada. El seguimiento de los casos de endometriosis incluyó los controles ginecológicos, descubriéndose afectación ovárica con posterioridad en 7 de los 9 casos estudiados. Discusión: Una buena anamnesis junto con las pruebas de imagen pertinentes facilita el diagnóstico diferencial del nódulo pericicatricial. Es posible realizar con éxito el procedimiento quirúrgico en régimen ambulatorio. En los casos de endometriosis es indispensable el seguimiento ginecológico posterior (AU)

Introduction: A nodule discovered around a scar of Pfannenstiel type raises diagnostics doubts to the facultative. We must consider the possibility in question of a cicatricial endometriosis. Patients and method: 17 patients were studied in a retrospective form who consulted by pericicatricial painful nodule. The age of the patients, medical antecedents, sintomatology, studies of image, preoperating diagnosis, postoperating diagnosis, later treatment and studies were analyzed. The surgical procedure was made in ambulatory regime. Results: The average age of the patients was 33,7 years (rank 25-44), median of 33. In 14 cases the previous surgery was caesarean and 3 were hysterectomies. The reason for consultation in all the cases was nodule or mass on the old scar, related to cyclical pain in 6 them. The preoperating diagnosis was hernia (5 cases); granuloma to strange body (7 cases); and endometrioma (5 cases). The pathologic diagnosis of endometrioma occurred in 9 cases. The treatment was the exeresis of endometriomas and granulomas, and hernioplastia with prothesis in the cases laparotomic of hernia. There was no morbidity. The pursuit of the cases of endometriosis included the gynaecological controls, being discovered ovarian affectation later in 7 of the 9 studied cases. Discussion: A good anamnesis along with the pertinent tests of image facilitates the differential diagnosis of the pericicatricial nodule. The later gynaecological pursuit is possible successfully to make intervention surgical in ambulatory regime. In the cases of endometriosis is indispensable (AU)

Prevention of hyperacute rejection in a model of orthotopic liver xenotransplantation from pig to baboon using polytransgenic pig livers (CD55, CD59, and H-transferase).

INTRODUCTION: The search for alternative sources for transplant organs leads us to the search for animals as an inexhaustible source of organs. The objective of this study was to analyze whether livers from polytransgenic pigs expressing the human complement regulatory proteins CD55 (hDAF), CD59, and alfa alpha1,2-fucosyltransferase (H-transferase), protected against hyperacute rejection after orthotopic liver xenotransplantation to a baboon and also to study pig liver function in a nonhuman primate. MATERIALS AND METHODS: Nine liver transplants from pig to baboon were divided into two groups: a control group (n = 4) of genetically unmodified pigs and an experimental group (n = 5) of pigs transgenic for CD55, CD59, and H-transferase as donors. All the donating piglets obtained through hysterectomy were maintained in specific pathogen-free conditions. The selection of transgenic pig donors followed demonstration of transgene expression using monoclonal antibodies (antiCD55, antiCD59) and immunohistological studies on liver biopsies. RESULTS: All animals in the control group developed hyperacute rejection with survival rates less than 16 hours without function of transplanted livers. In the experimental group none of the animals suffered hyperacute rejection. Survival in this group was between 13 and 24 hours. The livers were functional, producing bile and maintaining above 35% prothrombin activity. Only in one case was there primary dysfunction of the xenograft. CONCLUSION: Polytransgenic livers for complement regulatory proteins prevent hyperacute rejection when xenotransplanted into a baboon.

Adaptaciones metabólicas en la gestación / Metabolic adaptations in pregnancy

Los factores que influyen en el metabolismo hidrocarbonado de la mujer gestante se originan simultáneamente en el organismo materno, en el feto y en la placenta. En la primera mitad del embarazo, predominan las alteraciones metabólicas debidas al hiperinsulimo sobre la resistencia insulínica. Esto se traduce en una mejor utilización periférica de la glucosa, con aumento de la glucogenolisis e inhibición de la glucogenolisis y neoglucogénesis hepáticas. En la segunda mitad del embarazo, predomina una marcada resistencia a la insulina que provoca un aumento en la glucogenolisis y en la neoglucogénesis, que se traduce en una tendencia a la hiperglucemia postprandial. Podemos considerar que estos cambios están encaminados en la primera fase del embarazo a favorecer el anabolismo materno con depósitos energéticos, mientras que en al segunda mitad de la gestación predomina el catabolismo materno y el anabolismo fetal (AU)

Complicaciones crónicas de la diabetes mellitus durante la gestación: nefropatía, retinopatía y neuropatía / Chronic complications of diabetes mellitus during prenancy: nephropathy, retinopathy and neuropathy

La presencia de complicaciones crónicas sitúa a la mujer diabética embarazada en una categoría de riesgo superior en cuanto a morbimortalidad tanto materna como fetal. La gestación no ejerce ningún efecto adverso a largo plazo sobre la función renal o la supervivencia. Sin embargo, la nefropatía establecida se asocia con diversas complicaciones del embarazo, entre ellas retraso del crecimiento intrauterino, sufrimiento y mortalidad fetal. La nefropatía diabética incipiente parece incrementar la incidencia de preeclampsia. Lo ideal es que el tratamiento de la nefropatía diabética se inicie antes de la gestación, con un adecuado control de la glucemia y de la presión arterial. Si se produce una insuficiencia renal en el curso del embarazo, se puede utilizar diálisis peritoneal o hemodiálisis. El embarazo en sí mismo constituye un factor de riesgo para la progresión de la retinopatía diabética. El deterioro de la retinopatía es más ostensible en diabetes de larga evolución o en aquellas pacientes que presentan lesiones retinianas importantes antes de la gestación. Incluso puede empeorar con un control glucémico exhaustivo instaurado previamente. En caso de que progrese hacia la retinopatía proliferativa es necesario la fotocoagulación con láser. El examen de fondo de ojo debe realizarse antes del embarazo para descartar contraindicación del mismo, de forma trimestral durante el mismo y en el primer año postparto. La neuropatía diabética no siempre mejora con el riguroso control metabólico obtenido durante la gestación (AU)