High frequency of central memory regulatory T cells allows detection of liver recipients at risk of early acute rejection within the first month after transplantation.

Several studies have analyzed the potential of T regulatory cells (Treg cells) as biomarkers of acute rejection (AR). The aim of the present multicenter study was to correlate the percentage of peripheral Treg cells in liver graft recipients drawn at baseline up to 12 months after transplantation with the presence of AR. The percentage of central memory (cm) Treg cells (CD4(+)CD25(high)CD45RO(+)CD62L(+)) was monitored at pre-transplant and at 1 and 2 weeks, and 1, 2, 3 and 6 months and 1 year post-transplantation. The same validation standard operating procedures were used in all participating centers. Fifteen patients developed AR (23.4%). Hepatitis C virus recurrence was observed in 16 recipients, who displayed low peripheral blood cmTreg levels compared with patients who did not. A steady increase of cmTregs was observed during the first month after transplantation with statistically significant differences between AR and non-AR patients. The high frequency of memory Treg cells allowed us to monitor rejection episodes during the first month post-transplantation. On the basis of these data, we developed a prediction model for assessing risk of AR that can provide clinicians with useful information for managing patients individually and customizing immunosuppressive therapies.

Control of blood pressure in liver transplant recipients.

BACKGROUND: Increased blood pressure (BP) is common after liver transplantation. However, there is scarce information on its control. METHODS: In this prospective, cross-sectional, multicenter study, we determined BP according to the recommended international standards in 921 liver transplant patients during one routine outpatient visit to assess their grade of control of BP. At the time of the study, 490 patients had been previously diagnosed with arterial hypertension and were receiving antihypertensive treatment, and 431 were not previously diagnosed as hypertensive. RESULTS: In the hypertensive group, arterial hypertension was uncontrolled (BP >140/90 mm Hg [>130/80 in diabetics]) in 158 (32%) patients and controlled in 332 (68%) patients. In a multivariate analysis, only diabetes was identified as a significant predictor of uncontrolled hypertension. Among patients not previously diagnosed as hypertensive, BP was increased in 106 (25%) and normal in 325 (75%). On multivariate analysis, the only variable independently associated with increased BP in this group was metabolic syndrome. CONCLUSION: BP is not adequately controlled in a noticeable percentage of liver transplant patients, especially in subjects with diabetes or metabolic syndrome.

Trasplante hepático en pacientes con infección por VIH / Liver transplantation in patients with HIV infection

En los últimos años, tras la introducción del tratamiento antirretroviral de gran actividad, las hepatopatías, especialmente las relacionadas con VHC, han emergido como una de las causas de muerte más frecuentes en los pacientes con infección por VIH (VIH+). Ello ha llevado a la creciente indicación de trasplante hepático en esta población. La supervivencia postrasplante de los pacientes VIH+ con hepatopatías no asociadas a VHC es correcta y similar a la de pacientes VIH−. En cambio, la supervivencia en pacientes coinfectados VIH-VHC es modesta (aproximadamente, 50% a 5 años del trasplante). La principal causa de muerte en estos pacientes es la recidiva de hepatitis C. La infección por VIH se mantiene adecuadamente controlada con tratamiento antirretroviral de gran actividad después del trasplante en la práctica totalidad de pacientes. Otros aspectos de interés son la selección de candidatos para trasplante y la interacción entre el tratamiento antirretroviral de gran actividad y los inmunosupresores (AU)

During the few last years, after the introduction of high activity antiretroviral therapy (HAART), liver diseases, particularly those related to HCV infection, have emerged as one of the most important causes of mortality in patients with HIV infection. Consequently, liver transplantation is increasingly indicated in this population. Post-transplantation survival in HIV-positive patients with non-hepatitis C virus (HCV) liver diseases is adequate and similar to that in HIV-negative patients. In contrast, survival in patients coinfected with HIV and HCV is only moderate (around 50% at 5 years after transplantation). The main cause of mortality in these patients is HCV recurrence. In almost all patients, HIV infection remains controlled with HAART after liver transplantation. Other issues of interest in this setting are the selection of liver transplantation candidates and the frequent interactions between HAART and immunosuppressive drugs (AU)

[Liver transplantation in patients with HIV infection]. / Trasplante hepático en pacientes con infección por VIH.

During the few last years, after the introduction of high activity antiretroviral therapy (HAART), liver diseases, particularly those related to HCV infection, have emerged as one of the most important causes of mortality in patients with HIV infection. Consequently, liver transplantation is increasingly indicated in this population. Post-transplantation survival in HIV-positive patients with non-hepatitis C virus (HCV) liver diseases is adequate and similar to that in HIV-negative patients. In contrast, survival in patients coinfected with HIV and HCV is only moderate (around 50% at 5 years after transplantation). The main cause of mortality in these patients is HCV recurrence. In almost all patients, HIV infection remains controlled with HAART after liver transplantation. Other issues of interest in this setting are the selection of liver transplantation candidates and the frequent interactions between HAART and immunosuppressive drugs.

[Hyponatremia as a possible mortality factor in cirrhotic patients hospitalised in the Guillermo Almenara Irigoyen State Hospital, 2003- 2005]. / Hiponatremia como factor pronóstico de mortalidad en pacientes cirróticos internados en el Hospital Nacional Guillermo Almenara Irigoyen. 2003 - 2005.

INTRODUCTION: In the decompensated hepatic cirrhosis the development of complications such as bleeding in the digestive tracts, encephalopathy, ascites and spontaneous bacterial peritonitis is well-known; another important complication is the development of dilutional hyponatremia resulting from severe circulatory and renal dysfunction and which different papers have linked to a higher mortality rate. The main purpose of the present study is to determine if hyponatremia is an independent prognosis factor in the mortality of cirrhotic patients. MATERIAL AND METHODS: A retrospective study of cases and controls was carried out. Cirrhotic patients hospitalized in the Guillermo Almenara Irigoyen Hospital from January 2003 to June 2005 were evaluated; the patients who died with MELD10 were defined as cirrhotic; the controls were living cirrhotic patients with MELDor=10 was 28.13%. Hyponatremia, previous ascites and linked infection are independent prognosis factors for mortality of cirrhotic patients.

Hiponatremia como factor pronóstico de mortalidad en pacientes cirróticos internados en el Hospital Nacional Guillermo Almenara Irigoyen. 2003-2005 / Hyponatremia like prognosis factor of mortality in committed cirrhotic patients in the Guillermo Almenara Irigoyen Nacional Hospital. 2003-2005

Introducción: En la cirrosis hepática descompensada es conocido el desarrollo de complicaciones como hemorragia digestiva, encefalopatía, ascitis, peritonitis bacteriana espontánea. Otra alteración importante es el desarrollo de hiponatremia dilucional como resultado de una disfunción circulatoria y renal severa y que en diferentes trabajos se ha asociado a mayor mortalidad. El presente estudio tiene como objetivo fundamental determinar si la hiponatremia es un factor pronóstico independiente de mortalidad en los cirróticos. Material y métodos: Se realizó un estudio retrospectivo de casos y controles. Se evaluó a pacientes cirróticos internados en el Hospital Guillermo Almenara Irigoyen desde enero del 2003 hasta junio del 2005; los casos fueron definidos como cirróticos fallecidos con MELD (Modelo de Enfermedad Hepática Terminal) mayor o igual que 10; los controles fueron cirróticos vivos con MELD mayor o igual que 10; adicionalmente se les clasificó de acuerdo a la presencia o no de hiponatremia. Para cada grupo se determinó las características clínicas, analíticas, el grado de disfunción hepática y sodio sérico. Para la comparación entre grupos se utilizó la prueba de t de student y para determinar si la hiponatremia fue un factor pronóstico independiente de mortalidad se calculó el OR crudo y el ajustado, este último a través de un modelo de regresión logística. Resultados: Se contó con 40 casos y 56 controles. Se encontró hiponatremia en el 28.13 por ciento del total de cirróticos y en el 50 por ciento de los cirróticos que fallecieron. Al comparar los grupos de cirróticos vivos y fallecidos, se encontró diferencia significativa en la edad (p=0,013), Child (p=0,0001), MELD (p=0,004), bilirrubina (p=0,009), albúmina (p=0,0001), creatinina (p=0,019) y sodio sérico (p=0,002)...

Introduction: In the decompensated hepatic cirrhosis the development of complications such as bleeding in the digestive tracts, encephalopathy, ascites and spontaneous bacterial peritonitis is well-known; another important complication is the development of dilutional hyponatremia resulting from severe circulatory and renal dysfunction and which different papers have linked to a higher mortality rate. The main purpose of the present study is to determine if hyponatremia is an independent prognosis factor in the mortality of cirrhotic patients. Material and Methods: A retrospective study of cases and controls was carried out. Cirrhotic patients hospitalized in the Guillermo Almenara Irigoyen Hospital from January 2003 to June 2005 were evaluated; the patients who died with MELD10 were defined as cirrhotic; the controls were living cirrhotic patients with MELD menor o igual10. They further were classified according to the presence or not of hyponatremia. For each group the clinical and analytical characteristics, the extent of the hepatic dysfunction and the seric levels of sodium were established. In order to compare the groups the student t test was used; to determine if hyponatremia was an independent prognosis factor of mortality the raw OR and the adjusted OR were calculated, the latter through a model of logistic regression. Results: Forty (40) test patients and 56 controls were used. Hyponatremia was found in 28.13 per cent of the total of cirrhotic patients and in 50 per cent of the deceased cirrhotic patients. Upon comparing the groups of alive and deceased cirrhotic patients a significant difference was found in terms of the age (p=0.0013), Child (p=0.000), MELD (p=0.004), bilirrubin (p=0.009), albumin (p=0.000), creatinine (p=0.019) and seric sodium (p=0.002)...