P.Martin Padilla-Machaca
@unmsm.edu.pe
Universidad Nacional Mayor de San Marcos Facultad de Medicina de San Fernando
Scopus Publications
Scopus Publications
Alberto Queiroz Farias, Anna Curto Vilalta, Patricia Momoyo Zitelli, Gustavo Pereira, Luciana L. Goncalves, Aldo Torre, Juan Manuel Diaz, Adrian C. Gadano, Angelo Z. Mattos, Liliana S.C. Mendes,et al.
Elsevier BV
BACKGROUND & AIMS
Genetic ancestry or racial differences in health outcomes exist in diseases associated with systemic inflammation (e.g., Covid-19). This study aimed to investigate the association of genetic ancestry and race with acute-on-chronic liver failure (ACLF), which is characterized by acute systemic inflammation, multi-organ failure and high risk of short-term death.
METHODS
This prospective cohort study analyzed a comprehensive set of data including genetic ancestry and race, among several others, in 1274 patients with acutely decompensated cirrhosis (ADC) who were nonelectively admitted to 44 hospitals from 7 Latin American countries.
RESULTS
395 (31.0%) had ACLF of any grade at enrollment. Patients with ACLF had higher median percentage of Native American genetic ancestry and lower median percentage of European ancestry than patients without ACLF (22.6% vs 12.9% and 53.4% vs 59.6%, respectively). The median percentage of African genetic ancestry was low among patients with ACLF and among those without. In terms of race, a higher percentage of patients with ACLF than patients without ACLF were Native Americans and a lower percentage of patients with ACLF than patients without were European Americans or African Americans. In multivariable analyses that adjusted for differences in sociodemographic and clinical characteristics, the odds ratio for ACLF at enrollment was 1.08 (95% confidence interval [CI], 1.03-1.13) with Native American genetic ancestry and 2.57 (95% CI, 1.84-3.58) for Native American race vs. European American race.
CONCLUSIONS
In a large cohort of Latin American patients with ADC, increasing percentages of Native American ancestry and Native American race were factors independently associated with ACLF at enrollment.
Jeffrey V. Lazarus, Henry E. Mark, Alina M. Allen, Juan Pablo Arab, Patrizia Carrieri, Mazen Noureddin, William Alazawi, Naim Alkhouri, Saleh A. Alqahtani, Quentin M. Anstee,et al.
Ovid Technologies (Wolters Kluwer Health)
Background and Aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care. Approach and Results: We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over 2 rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities using Qualtrics XM, indicating agreement using a 4-point Likert-scale and providing written feedback. Priorities were revised between rounds, and in R2, panelists also ranked the priorities within 6 domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2, the mean percentage of “agree” responses was 82.4%, with all individual priorities having at least a super-majority of agreement (> 66.7% “agree”). The highest-ranked action priorities included collaboration between liver specialists and primary care doctors on early diagnosis, action to address the needs of people living with multiple morbidities, and the incorporation of fatty liver disease into relevant non-communicable disease strategies and guidance. Conclusions: This consensus-driven multidisciplinary fatty liver disease action agenda developed by care providers, clinical researchers, and public health and policy experts provides a path to reduce fatty liver disease prevalence and improve health outcomes. To implement this agenda, concerted efforts will be needed at the global, regional, and national levels.
P. Martin Padilla-Machaca, Eduardo Luna-Victoria, Ada Cabrera, Juan-Carlos Gómez-De la Torre, Rocio Galloso, and Pedro Montes
Elsevier BV
Nahum Méndez-Sánchez, Elisabetta Bugianesi, Robert G Gish, Frank Lammert, Herbert Tilg, Mindie H Nguyen, Shiv K Sarin, Núria Fabrellas, Shira Zelber-Sagi, Jian-Gao Fan,et al.
Elsevier BV
Carmen Ana Cerron Cabezas, Rosa Luz Lopez Martinez, Gino Salcedo Bermudez, Pedro Martin Padilla Machaca, Bertha Eliana Cardenas Ramirez, Wilmer Bacilio Calderon, Omar Mantilla Cruzatti, Jose Rivera Romani, Alfonso Solar Peche, Augudberto Montufar Valer,et al.
Sociedad de Gastroenterologia del Peru
Liver transplantation is the major treatment for end-stage liver disease. Postoperative care is a great challenge to reduce morbidity and mortality in patients. In this sense, management in the liver ICU allows hemodynamic management, coagulation monitoring, renal support, electrolyte disturbances, respiratory support and early weaning from mechanical ventilation and evaluation of the liver graft. Objective: The present study shows the results of the management of liver transplant patients in 20 years of experience in a transplant center in a low- to middle-income country. Materials and methods: The medical records of 273 adult patients in the ICU in the immediate postoperative liver transplant were reviewed, from March 20, 2000 to November 30, 2020, including the effect of the pandemic caused by COVID-19. Liver-kidney, retransplanted, SPLIT, and domino transplant patients were excluded. Results: The most frequent etiology for LTx was NASH (35%), the mean age was 49 years, MELD Score ranged 15 - 20 (47.5%), 21 - 30 (46%) > 30 (6.2%). ICU pre transplant stay 7%, average ICU stay: 7.8 days. APACHE average admission: 14.9 points. Weaning extubation of 91.8% patients in ICU and Fast Track in 8.2%. The most frequent respiratory complication was atelectasis 56.3%, pneumonia (31.3%); AKI 1 (60.9%), and 11.1% with hemodyalisis support (AKI3). Immunosuppression: Tacrolimus (8.9%). Post-operative ICU mortality was 6.2%. Conclusions: The management of liver transplantation in the ICU is essential to achieve optimal results in patients who present advanced liver disease and require advanced life support in the immediate postoperative period and thus optimize graft survival.
Claudia Maccali, Aline L. Chagas, Ilka Boin, Emilio Quiñonez, Sebastián Marciano, Mario Vilatobá, Adriana Varón, Margarita Anders, Sergio Hoyos Duque, Agnaldo S. Lima,et al.
Wiley
BACKGROUND & AIM
Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) has a poor prognosis, and the adjusted effect of different treatments on post-recurrence survival (PRS) has not been well defined. This study aims to evaluate prognostic and predictive variables associated with PRS.
METHODS
This Latin American multicenter retrospective cohort study included HCC patients who underwent LT between the years 2005-2018. We evaluated the effect of baseline characteristics at time of HCC recurrence diagnosis and PRS (Cox regression analysis). Early recurrences were those occurring within 12 months of LT. To evaluate the adjusted treatment effect for HCC recurrence, a propensity score matching analysis was performed to assess the probability of having received any specific treatment for recurrence.
RESULTS
From a total of 1,085 transplanted HCC patients, the cumulative incidence of recurrence was 16.6% (CI 13.5-20.3), with median time to recurrence of 13.0 months (IQR 6.0-26.0). Factors independently associated with PRS were early recurrence (47.6%), treatment with sorafenib and surgery/TACE. Patients who underwent any treatment presented "early recurrences" less frequently, and more extrahepatic metastasis. This unbalanced distribution was included in the propensity score matching, with correct calibration and discrimination [ROC of 0.81 (CI 0.72;0.88)]. After matching, the adjusted effect on PRS for any treatment was HR of 0.2 (0.10;0.33); P<0.0001, for sorafenib therapy HR of 0.4 (0.27;0.77); P=0.003, and for surgery/TACE HR of 0.4 (0.18;0.78); P=0.009.
CONCLUSION
Although early recurrence was associated with worse outcome, even in this population, systemic or locoregional treatments were associated with better PRS. Word Count: 246.
Juan Pablo Arab, Melisa Dirchwolf, Mário Reis Álvares-da-Silva, Francisco Barrera, Carlos Benítez, Marlene Castellanos-Fernandez, Graciela Castro-Narro, Norberto Chavez-Tapia, Daniela Chiodi, Helma Cotrim,et al.
Annals of Hepatology Elsevier BV
Alfonso Solar Peche, P. Martin Padilla-Machaca, Carmen Cerron Cabezas, Bertha Cárdenas Ramírez, José Rivera Romaní, Omar Mantilla Cruzatti, Carlos Rondón Leyva, and José-Carlos Chaman Ortiz
Sociedad de Gastroenterologia del Peru
Introducción: La no función primaria del injerto (NFPI) después del trasplante hepático es la falla aguda del injerto, en ausencia de algún factor causal, como trombosis aguda de arteria hepática o vena porta. Objetivos: Describir las características perioperatorias de los pacientes trasplantados de Hígado que presentaron NFPI en el Departamento de Trasplantes del Hospital Guillermo Almenara Irigoyen. Materiales y métodos: Estudio retrospectivo, descriptivo y transversal. Desde marzo del 2000 a marzo del 2018 se realizaron 249 Trasplantes de hígado. La NFPI fue definida con los criterios de OPTN/UNOS, se manifiesta por aumento de transaminasas (>3 000 UI/ml), coagulopatía (INR >2,5), niveles altos de lactato (>4 mEq/l), PH en acidosis: PH arterial ≤7,30 y/o PH venoso ≤7,25 e inestabilidad hemodinámica que requiere soporte con drogas vasoactivas; puede llevar a la muerte sin retrasplante de emergencia. Resultados: Se diagnosticaron 8 pacientes con NFPI siendo una prevalencia de 3,7% de 216 trasplantes de hígado en adultos, la edad de los receptores fue 51,5±8,45 años, score de MELD basal 13,13±3,8 (rango 6-18). Las características de los donantes, la edad fue 38,5±14,48, todos ABO idénticos al receptor, la distribución geográfica: 7 de Lima metropolitana y 1 en Tacna. La causa de muerte encefálica 75% ACV Hemorrágico y 25% TEC grave. Respecto a factores transoperatorios el TIF 431±143 min [265 - 645 min], y TIC 81,8±46 min [57- 195 min], La estancia en UCI hasta el deceso del paciente fue 11,13±9,3 días (rango 2-31 días), el 12,5% fue retrasplantado. Conclusiones: La prevalencia de NFPI en nuestro centro después del trasplant a las series reportadas por otros centros, y se asocia con mortalidad alta sin retrasplante hepático.
Federico Piñero, Ilka Boin, Aline Chagas, Emilio Quiñonez, Sebastián Marciano, Mario Vilatobá, Luisa Santos, Margarita Anders, Sergio Hoyos Duque, Agnaldo Soares Lima,et al.
Wiley
The association between direct‐acting antivirals (DAAs) and hepatocellular carcinoma (HCC) wait‐list progression or its recurrence following liver transplantation (LT) remains uncertain. We evaluated the impact of DAAs on HCC wait‐list progression and post‐LT recurrence. This Latin American multicenter retrospective cohort study included HCC patients listed for LT between 2012 and 2018. Patients were grouped according to etiology of liver disease: hepatitis C virus (HCV) negative, HCV+ never treated with DAAs, and HCV+ treated with DAAs either before or after transplantation. Multivariate competing risks models were conducted for both HCC wait‐list progression adjusted by a propensity score matching (pre‐LT DAA effect) and for post‐LT HCC recurrence (pre‐ or post‐LT DAA effect). From 994 included patients, 50.6% were HCV−, 32.9% were HCV+ never treated with DAAs, and 16.5% were HCV+ treated with DAAs either before (n = 66) or after LT (n = 98). Patients treated with DAAs before LT presented similar cumulative incidence of wait‐list tumor progression when compared with those patients who were HCV+ without DAAs (26.2% versus 26.9%; P = 0.47) and a similar HCC‐related dropout rate (12.1% [95% CI, 0.4%‐8.1%] versus 12.9% [95% CI, 3.8%‐27.2%]), adjusted for baseline tumor burden, alpha‐fetoprotein values, HCC diagnosis after listing, bridging therapies, and by the probability of having received or not received DAAs through propensity score matching (subhazard ratio [SHR], 0.9; 95% CI, 0.6‐1.6; P = 0.95). A lower incidence of posttransplant HCC recurrence among HCV+ patients who were treated with pre‐ or post‐LT DAAs was observed (SHR, 0.7%; 95% CI, 0.2%‐4.0%). However, this effect was confounded by the time to DAA initiation after LT. In conclusion, in this multicenter cohort, HCV treatment with DAAs did not appear to be associated with an increased wait‐list tumor progression and HCC recurrence after LT.
Federico Piñero, Paulo Costa, Yuri Longatto Boteon, Sergio Hoyos Duque, Sebastian Marciano, Margarita Anders, Adriana Varón, Alina Zerega, Jaime Poniachik, Alejandro Soza,et al.
Elsevier BV
BACKGROUND AND AIM
Non-alcoholic fatty liver disease (NAFLD) is an increasing cause of hepatocellular carcinoma (HCC) and liver transplantation (LT). Our study focused on changing trends of liver related HCC etiologies during the last years in Latin America.
METHODS
From a cohort of 2761 consecutive adult LT patients between 2005 and 2012 in 17 different centers, 435 with HCC were included. Different periods including years 2005-2006, 2007-2008, 2009-2010 and 2011-2012 were considered. Etiology of liver disease was confirmed in the explant.
RESULTS
Participating LT centers per country included 2 from Brazil (n=191), 5 transplant programs from Argentina (n=98), 2 from Colombia (n=65), 4 from Chile (n=49), 2 from Mexico (n=12), and 1 from Peru (n=11) and Uruguay (n=9). Chronic hepatitis C infection was the leading cause of HCC in the overall cohort (37%), followed by HBV (25%) and alcoholic liver disease (17%). NAFLD and cryptogenic cirrhosis accounted for 6% and 7%, respectively. While HCV decreased from 48% in 2005-06 to 26% in 2011-12, NAFLD increased from 1.8% to 12.8% during the same period, accounting for the third cause of HCC. This represented a 6-fold increase in NAFLD-HCC, whereas HCV had a 2-fold decrease. Patients with NAFLD were older, had lower pre-LT serum AFP values and similar 5-year survival and recurrence rates than non-NAFLD.
CONCLUSION
There might be a global changing figure regarding etiologies of HCC in Latin America. This epidemiological change on the incidence of HCC in the world, although it has been reported, should still be confirmed in prospective studies.
Federico Piñero, Matías Tisi Baña, Elaine Cristina de Ataide, Sergio Hoyos Duque, Sebastian Marciano, Adriana Varón, Margarita Anders, Alina Zerega, Josemaría Menéndez, Rodrigo Zapata,et al.
Wiley
The French alpha‐fetoprotein (AFP) model has recently shown superior results compared to Milan criteria (MC) for prediction of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) in European populations. The aim of this study was to explore the predictive capacity of the AFP model for HCC recurrence in a Latin‐American cohort.
Nahum Méndez-Sánchez, Raymundo Paraná, Hugo Cheinquer, Angelo Alves de Mattos, Adrian Gadano, Marcelo Silva, Mario G. Pessôa, Maria L. Gomes-Ferraz, Alejandro Soza, M. Cassia Mendes-Correa,et al.
Elsevier BV
Martín Padilla, Rosario Mayorga, Félix Carrasco, Tayana Bedregal, Fernando Bobadilla, Carlos Rondón, and José Chaman
Elsevier BV
BACKGROUND
Liver transplantation is the only therapy for end-stage liver disease. Cirrhosis secondary to autoimmune hepatitis (AIH) is an indication in 4-6% of adult transplants.
AIMS
To describe the outcomes and recurrence of AIH in liver transplant patients.
MATERIAL AND METHODS
Twenty patients were retrospectively studied.
RESULTS
The female/male ratio was 3:1, the median age was 36.7 years (range, 16 to 39 years), and the median MELD score was 18.5. According to serological analysis, 19 patients were AIH type 1 and one patient was AIH type 2. AIH was associated with human leukocyte antigen (HLA) DR13+ and DR4+. The overall 5-year patient and graft survival rates were 94 and 85%, respectively. Three (15.7%) cases of recurrent AIH were diagnosed based on histological evidence. Clinical and histological features of acute and chronic rejection were present in four (20%) and three (16.6%) patients, respectively.
CONCLUSION
AIH frequently affected young women, was the most frequent indication for liver transplantation. Rejection and recurrence were commonly associated with AIH, but did not affect patient survival. No significant relationship between HLA-DR type and recurrence was found. Rapid progression to cirrhosis should be considered in severe recurrences.