Browsing by Author "Benitez, Carlos"

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    Accuracy of the BAR score in the prediction of survival after liver transplantation
    (2019) Martinez Castillo, Jorge Arturo; Pacheco, Sergio; Bachler, J.; Jarufe Cassis, Nicolás; Briceño, Eduardo; Guerra Castro, Juan Francisco; Benitez, Carlos; Wolff, Rodrigo; Barrera Martínez, Francisco José; Arrese Jiménez, Marco
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    Assessing the impact of COVID-19 on liver cancer management (CERO-19)
    (2021) Munoz-Martinez, Sergio; Sapena, Victor; Forner, Alejandro; Nault, Jean-Charles; Sapisochin, Gonzalo; Rimassa, Lorenza; Sangro, Bruno; Bruix, Jordi; Sanduzzi-Zamparelli, Marco; Holowko, Waclaw; El Kassas, Mohamed; Mocan, Tudor; Bouattour, Mohamed; Merle, Philippe; Hoogwater, Frederik J. H.; Alqahtani, Saleh A.; Reeves, Helen L.; Pinato, David J.; Giorgakis, Emmanouil; Meyer, Tim; Villadsen, Gerda Elisabeth; Wege, Henning; Salati, Massimiliano; Minguez, Beatriz; Di Costanzo, Giovan Giuseppe; Roderburg, Christoph; Tacke, Frank; Varela, Maria; Galle, Peter R.; Alvares-da-Silva, Mario Reis; Trojan, Joerg; Bridgewater, John; Cabibbo, Giuseppe; Toso, Christian; Lachenmayer, Anja; Casadei-Gardini, Andrea; Toyoda, Hidenori; Luedde, Tom; Villani, Rosanna; Matilla Pena, Ana Maria; Guedes Leal, Cassia Regina; Ronzoni, Monica; Delgado, Manuel; Perello, Christie; Pascual, Sonia; Luis Lledo, Jose; Argemi, Josepmaria; Basu, Bristi; da Fonseca, Leonardo; Acevedo, Juan; Siebenhuener, Alexander R.; Braconi, Chiara; Meyers, Brandon M.; Granito, Alessandro; Sala, Margarita; Rodriguez-Lope, Carlos; Blaise, Lorraine; Romero-Gomez, Manuel; Pinero, Federico; Gomez, Dhanny; Mello, Vivianne; Pinheiro Alves, Rogerio Camargo; Franca, Alex; Branco, Fernanda; Brandi, Giovanni; Pereira, Gustavo; Coll, Susanna; Guarino, Maria; Benitez, Carlos; Margarita Anders, Maria; Bandi, Juan C.; Vergara, Mercedes; Calvo, Mariona; Peck-Radosavljevic, Markus; Garcia-Juarez, Ignacio; Cardinale, Vincenzo; Lozano, Mar; Gambato, Martina; Okolicsanyi, Stefano; Morales-Arraez, Dalia; Elvevi, Alessandra; Munoz, Alberto E.; Lue, Alberto; Iavarone, Massimo; Reig, Maria
    Background & Aims: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). Herein, we evaluated whether the schedule of LC screening or procedures has been interrupted or delayed because of the COVID-19 pandemic.
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    Effect of acute on chronic liver failure over post-transplant survival
    (2023) Benitez, Carlos; Arnold, Jorge; Cambindo, Veronica; Schoenfeldt, Fernanda; Cancino, Alejandra; Ibanez, Samuel; Grandy, Catalina; Hunfan, Paola; Gonzalez, Jorge; Guerra, Catalina; Godoy, Esteban; Araneda, Veronica; Mollo, Constanza; Poniachik, Jaime; Urzua, Alvaro; Cattaneo, Maximo; Roblero, Juan Pablo; Oppenheimer, Ilan; Pizarro, Vicente
    Introduction and Objectives: Acute-on-chronic liver failure (ACLF) is associated with reduced short-term sur-vival, and liver transplantation is frequently the only therapeutic option. Nonetheless, the post-transplanta-tion prognosis seems to be worse in ACLF patients.Materials and Methods: The databases of two university centers were retrospectively evaluated, and adult patients with cirrhosis who underwent transplantation between 2013 and 2020 were included. One-year survival of patients with ACLF was compared to that of patients without ACLF. Variables associated with mor-tality were identified.Results: A total of 428 patients were evaluated, and 303 met the inclusion criteria; 57.1% were male, the mean age was 57.1 +/- 10.2 years, 75 patients had ACLF, and 228 did not. The main etiologies of ACLF were NASH (36.6%), alcoholic liver disease (13.9%), primary biliary cholangitis (8.6%) and autoimmune hepatitis (7.9%). Mechanical ventilation, renal replacement therapy, the use of vasopressors and the requirement of blood product transfusion during liver transplantation were significantly more frequent in ACLF patients. Among those recipients without and with ACLF, survival at 1, 3 and 5 years was 91.2% vs. 74.7%, 89.1% vs. 72.6% and 88.3% vs. 72.6%, respectively (p=0.001). Among pre-transplantation variables, only the presence of ACLF was independently associated with survival (HR 3.2, 95% CI: 1.46-7.11). Post-transplantation variables indepen-dently associated with survival were renal replacement therapy (HR 2.8, 95% CI: 1.1-6.8) and fungal infec-tions (HR 3.26, 95% CI: 1.07-9.9).Conclusions: ACLF is an independent predictor of one-year post-transplantation survival. Importantly, trans-plant recipients with ACLF require the use of more resources than patients without ACLF. (c) 2023 Fundacion Clinica Medica Sur, A.C. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
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    Embolization of spontaneous portosystemic shunts as treatment for refractory hepatic encephalopathy
    (2022) Benitez, Carlos; Munoz, Ana; Poniachik, Jaime; Ramirez, Felipe; Munoz, Claudia; Cermenati, Tomas; Martinez, Nicolas; Diaz, Pia; Meneses, Luis
    Background: Hepatic encephalopathy (HE) is a common complication of cirrhosis associated with a reduced survival. The presence of high-flux spontaneous porto-systemic shunts can induce HE even in patients with preserved liver function. Aim: To evaluate the effect of spontaneous porto-systemic shunt embolization (SPSE) over HE and its long-term evolution. Material and Methods: Retrospective analysis of 11 patients (91% males) with severe HE non-responsive to medical treatment in whom a SPSE was performed. The grade of HE (employing West Haven score), survival, MELD and Child-Pugh score, ammonia levels, degree of disability (employing the modified Rankin scale (mRs)) were evaluated before and at thirty days after procedure. Results: The most common etiology found was non-alcoholic steatohepatitis (63.6%). A reduction of at least two score points of HE was observed in all patients after thirty days. There was a significant reduction on median (IQR) West Haven score from 3 (2-3) at baseline to 1 (0-1) after the procedure (p < 0.01). Twelve months survival was 63.6%. There was a decrease in median ammonia level from 106.5 (79-165) (ug/dL) to 56 (43-61) after SPSE (p = 0.006). The median mRS score before and after the procedure was 3 (3-5) and 1 (1-2.5), respectively (p < 0.01). Conclusions: According to our experience, SPSE is a feasible and effective alternative to improve HE and functionality of patients with refractory EH.
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    Frailty and reduced gait speed are independently related to mortality of cirrhotic patients in long-term follow-up
    (2021) Soto, Ruben; Antonio Diaz, Luis; Rivas, Violeta; Fuentes-Lopez, Eduardo; Zalaquett, Macarena; Jose Bruera, Maria; Gonzalez, Cecilia; Mezzano, Gabriel; Benitez, Carlos
    Introduction and objectives: Frailty is characterized by a poor restoration of homeostasis after a stressor event. Although it is not usually diagnosed, it has been associated with decreased survival in cirrhotic patients. We aimed to evaluate the impact of frailty and decreased gait speed over survival in cirrhotic patients at long-term follow-up.
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    Genetic Ancestry, Race, and Severity of Acutely Decompensated Cirrhosis in Latin America
    (2023) Farias, Alberto Queiroz; Vilalta, Anna Curto; Zitelli, Patricia Momoyo; Pereira, Gustavo; Goncalves, Luciana L.; Torre, Aldo; Diaz, Juan Manuel; Gadano, Adrian C.; Mattos, Angelo Z.; Mendes, Liliana S. C.; Alvares-da-Silva, Mario R.; Bittencourt, Paulo L.; Benitez, Carlos; Couto, Claudia Alves; Mendizabal, Manuel; Toledo, Claudio L.; Mazo, Daniel F. C.; Barradas, Mauricio Castillo; Raposo, Eva M. Uson; Padilla-Machaca, P. Martin; Miranda, Adelina Zarela Lozano; Male-Velazquez, Rene; Lyra, Andre Castro; Davalos-Moscol, Milagros B.; Hernandez, Jose L. Perez; Ximenes, Rafael O.; Silva, Giovanni Faria; Beltran-Galvis, Oscar A.; Huezo, Maria S. Gonzalez; Bessone, Fernando; Rocha, Tarciso D. S.; Fassio, Eduardo; Terra, Carlos; Marin, Juan I.; Casas, Patricia Sierra; de la Pena-Ramirez, Carlos; Parera, Ferran Aguilar; Fernandes, Flavia; Zago-Gomes, Maria da Penha; Mendez-Guerrero, Osvely; Marciano, Sebastian; Mattos, Angelo A.; Oliveira, Joao C.; Guerreiro, Gabriel T. S.; Codes, Liana; Arrese, Marco; Nardelli, Mateus J.; Silva, Marcelo O.; Palma-Fernandez, Renato; Alcantara, Camila; Garrido, Cristina Sanchez; Trebicka, Jonel; Gustot, Thierry; Fernandez, Javier; Claria, Joan; Jalan, Rajiv; Angeli, Paolo; Arroyo, Vicente; Moreau, Richard; ACLARA Study Collaborators
    BACKGROUND & AIMS: Genetic ancestry or racial differences in health outcomes exist in diseases associated with systemic inflammation (eg, 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 who were nonelectively admitted to 44 hospitals from 7 Latin American countries. RESULTS: Three hundred ninety-five patients (31.0%) had ACLF of any grade at enrollment. Patients with ACLF had a 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 ACLF. In terms of race, a higher percentage of patients with ACLF than patients without ACLF were Native American and a lower percentage of patients with ACLF than patients without ACLF were European American or African American. In multivariable analyses that adjusted for differences in sociodemographic and clinical characteristics, the odds ratio for ACLF at enrollment was 1.08 (95% 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 acutely decompensated cirrhosis, increasing percentages of Native American ancestry and Native American race were factors independently associated with ACLF at enrollment.
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    High prevalence of undiagnosed liver cirrhosis and advanced fibrosis in type 2 diabetic patients
    (2016) Arab Verdugo, Juan Pablo; Barrera Martínez, Francisco José; Gallego C.; Valderas Igor, Juan Patricio; Uribe Arancibia, Sergio A.; Tejos Núñez, Cristián Andrés; Serrano, C.; Huete, Isidro; Liberona, J.; Labbé P.; Quiroga, T.; Benitez, Carlos; Irarrázaval Mena, Pablo; Riquelme, A.; Arrese Jiménez, Marco
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    Mycobacterium abscessus pulmonary infection during hepatitis C treatment with telaprevir, peginterferon and ribavirin
    (2015) Soza, Alejandro; Labbe, Pilar; Arrese, Marco; Riquelme, Arnoldo; Barrera, Francisco; Benitez, Carlos; Huete, Alvaro; Elvira Balcells, M.; Labarca, Jaime
    The first generation protease inhibitors has been the mainstay of hepatitis C treatment for the last couple of years, showing marked improvement in sustained virological response, but also increased side effects. Infection has emerged as a common complication of telaprevir and boceprevir in combination with peginterferon and ribavirin, usually caused by common pathogens. We present the case of a 65 years old man who developed a Mycobacterium abscessus pulmonary infection during treatment with telaprevir, peginterferon and ribavirin. The patient was successfully treated with amikacin, imipenem and chlarithro-mycin. The present case is relevant for increasing awareness for recognition of opportunistic-infections and particularly nontuberculous mycobacterial infections in patients receiving triple therapy for chronic hepatitis C, especially in cirrhotic subjects who develop significant lymphopenia.
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    Latin American Association for the study of the liver (ALEH) practice guidance for the diagnosis and treatment of non-alcoholic fatty liver disease
    (2020) Pablo Arab, Juan; Dirchwolf, Melisa; Alvares-da-Silva, Mario Reis; Barrera, Francisco; Benitez, Carlos; Castellanos-Fernandez, Marlene; Castro-Narro, Graciela; Chavez-Tapia, Norberto; Chiodi, Daniela; Cotrim, Helma; Cusi, Kenneth; Marques Souza de Oliveira, Claudia Pinto; Diaz, Javier; Fassio, Eduardo; Gerona, Solange; Girala, Marcos; Hernandez, Nelia; Marciano, Sebastian; Masson, Walter; Mendez-Sanchez, Nahum; Leite, Nathalie; Lozano, Adelina; Padilla, Martin; Panduro, Arturo; Parana, Raymundo; Parise, Edison; Perez, Marlene; Poniachik, Jaime; Carlos Restrepo, Juan; Ruf, Andres; Silva, Marcelo; Tagle, Martin; Tapias, Monica; Torres, Kenia; Vilar-Gomez, Eduardo; Costa Gil, Jose Eduardo; Gadano, Adrian; Arrese, Marco
    Non-alcoholic fatty liver disease (NAFLD) currently represents an epidemic worldwide. NAFLD is the most frequently diagnosed chronic liver disease, affecting 20-30% of the general population. Furthermore, its prevalence is predicted to increase exponentially in the next decades, concomitantly with the global epidemic of obesity, type 2 diabetes mellitus (T2DM), and sedentary lifestyle. NAFLD is a clinical syndrome that encompasses a wide spectrum of associated diseases and hepatic complications such as hepatocellular carcinoma (HCC). Moreover, this disease is believed to become the main indication for liver transplantation in the near future. Since NAFLD management represents a growing challenge for primary care physicians, the Asociacion Latinoamericana para el Estudio del Higado (ALEH) has decided to organize this Practice Guidance for the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease, written by Latin-American specialists in different clinical areas, and destined to general practitioners, internal medicine specialists, endocrinologists, diabetologists, gastroenterologists, and hepatologists. The main purpose of this document is to improve patient care and awareness of NAFLD. The information provided in this guidance may also be useful in assisting stakeholders in the decision-making process related to NAFLD. Since new evidence is constantly emerging on different aspects of the disease, updates to this guideline will be required in future. (C) 2020 Published by Elsevier Espana, S.L.U. on behalf of Fundacion Cilnica Medica Sur, A.C.
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    LDL particle size and antioxidant HDL function improve after sustained virological response in patients with chronic HCV
    (2022) Ignacio Vargas, Jose; Rivera, Katherine; Arrese, Marco; Benitez, Carlos; Barrera, Francisco; Hugo, Monrroy; Pablo Arab, Juan; Pino, Karla; Barrera, Aldo; Lopez-Lastra, Marcelo; Rigotti, Attilio; Soza, Alejandro
    HCV infection is associated with an increased incidence of cardiovascular (CV) events. Mechanisms underlying this association remain unknown. In our study, twenty HCV patients (median age 60.5 years, 65% male and 80% with cirrhosis) were evaluated prior, during and after direct-acting antiviral treatment. Ninety percent of patients achieved sustained virological response (SVR). Significant changes were observed in LDL particle size index, measured by LDL-C/apoB ratio, which increased after treatment (p = 0.023). In addition, HDL antioxidant capacity improved gradually from 34.4% at baseline to 42.4% at 4 weeks (p = 0.011), 65.9% at end of treatment EOT (p = 0.002) and remained elevated at 12-week (p = 0.001) after EOT compared to baseline values. Our findings suggest that a shift to a less atherogenic lipid profile may be a possible mechanism associated with CV risk reduction in patients with HCV infection achieving SVR. (c) 2021 Fundacion Clinica Medica Sur, A.C. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
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    Nuevas terapias orales de acción directa para tratamiento de virus de hepatitis C (VHC)
    (2017) Vargas Domínguez, José Ignacio; Arab Verdugo, Juan Pablo; Monrroy Bravo, Hugo Alfonso; Labbé, Pilar; Sarmiento, Valeska; Fuster, Felipe; Barrera Martínez, Francisco Javier; Benitez, Carlos; Arrese Jiménez, Marco; Soza, Alejandro; Fuster, Francisco
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    Operational tolerance after liver transplantation, more common than we think: A case report
    (MEXICAN ASSOC HEPATOLOGY, 2011) Benitez, Carlos; Pablo Arancibia, Juan; Arrese, Marco; Soza, Alejandro; Dominguez, Pilar; Jarufe, Nicolas; Martinez, Jorge; Maria Perez Ayuso, Rosa
    Operational tolerance after liver transplantation has been described in around 20% of the recipients. These patients are able to maintain a normal graft function in the absence of immunosuppressive drugs, thus being free of adverse effects that are common and frequently severe. Here we present a well-documented case of operational tolerance after liver transplantation and discuss current concepts on this topic with emphasis on recent findings that will potentially allow for identifying graft-tolerant patients.
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    Procedural-Related Bleeding in Hospitalized Patients With Liver Disease (PROC-BLeeD): An International, Prospective, Multicenter Observational Study
    (2023) Intagliata, Nicolas M.; Rahimi, Robert S.; Higuera-de-la-Tijera, Fatima; Simonetto, Douglas A.; Farias, Alberto Queiroz; Mazo, Daniel F.; Boike, Justin R.; Stine, Jonathan G.; Serper, Marina; Pereira, Gustavo; Mattos, Angelo Z.; Marciano, Sebastian; Davis, Jessica P. E.; Benitez, Carlos; Chadha, Ryan; Mendez-Sanchez, Nahum; deLemos, Andrew S.; Mohanty, Arpan; Dirchwolf, Melisa; Fortune, Brett E.; Northup, Patrick G.; Patrie, James T.; Caldwell, Stephen H.
    BACKGROUND & AIMS: Hospitalized patients with cirrhosis frequently undergo multiple procedures. The risk of procedural-related bleeding remains unclear, and management is not standardized. We conducted an international, prospective, multicenter study of hospitalized patients with cirrhosis undergoing nonsurgical procedures to establish the incidence of procedural-related bleeding and to identify bleeding risk factors. METHODS: Hospitalized patients were prospectively enrolled and monitored until surgery, transplantation, death, or 28 days from admission. The study enrolled 1187 patients undergoing 3006 nonsurgical procedures from 20 centers. RESULTS: A total of 93 procedural-related bleeding events were identified. Bleeding was reported in 6.9% of patient admissions and in 3.0% of the procedures. Major bleeding was reported in 2.3% of patient admissions and in 0.9% of the procedures. Patients with bleeding were more likely to have nonalcoholic steatohepatitis (43.9% vs 30%) and higher body mass index (BMI; 31.2 vs 29.5). Patients with bleeding had a higher Model for End-Stage Liver Disease score at admission (24.5 vs 18.5). A multivariable analysis controlling for center variation found that high-risk procedures (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.44-8.84), Model for End Stage Liver Disease score (OR, 2.37; 95% CI, 1.46-3.86), and higher BMI (OR, 1.40; 95% CI, 1.10-1.80) independently predicted bleeding. Preprocedure international normalized ratio, platelet level, and antithrombotic use were not predictive of bleeding. Bleeding prophylaxis was used more routinely in patients with bleeding (19.4% vs 7.4%). Patients with bleeding had a significantly higher 28-day risk of death (hazard ratio, 6.91; 95% CI, 4.22-11.31). CONCLUSIONS: Procedural-related bleeding occurs rarely in hospitalized patients with cirrhosis. Patients with elevated BMI and decompensated liver disease who undergo high-risk procedures may be at risk to bleed. Bleeding is not associated with conventional hemostasis tests, preprocedure prophylaxis, or recent antithrombotic therapy.
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    Steatotic livers. Can we use them in OLTX? Outcome data from a prospective baseline liver biopsy study
    (MEXICAN ASSOC HEPATOLOGY, 2012) Gabriel, Mauricio; Moisan, Fabrizio; Vidal, Marcela; Duarte, Ignacio; Jimenez, Macarena; Izquierdo, Guillermo; Dominguez, Pilar; Mendez, Javier; Soza, Alejandro; Benitez, Carlos; Perez, Rosa; Arrese, Marco; Guerra, Juan; Jarufe, Nicolas; Martinez, Jorge
    Introduction. Steatotic livers have been associated with greater risk of allograft dysfunction in liver transplantation. Our aim was to determinate the prevalence of steatosis in grafts from deceased donors in Chile and to assess the utility of a protocol-bench biopsy as an outcome predictor of steatotic grafts in our transplant program. Material and methods. We prospectively performed protocol-bench graft biopsies from March 2004 to January 2009. Biopsies were analyzed and classified by two independent pathologists. Steatosis severity was graded as normal from absent to < 6%; grade 1: 6-33%; grade 2: > 33-66% and grade 3: > 66%. Results. We analyzed 58 liver grafts from deceased donors. Twenty-nine grafts (50%) were steatotic; 9 of them (16%) with grade 3. Donor age (p < 0.001) and BMI over 25 kg/m(2) (p = 0.012) were significantly associated with the presence of steatosis. There were two primary non-functions (PNF); both in a grade 3 steatotic graft. The 3-year overall survival was lower among recipients with macrovesicular steatotic graft (57%) than recipients with microvesicular (85%) or non-steatotic grafts (95%) (p = 0.026). Conclusion. Macrovesicular steatosis was associated with a poor outcome in this series. A protocol bench-biopsy would be useful to identify these grafts.
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    Sublingual tacrolimus administration provides similar drug exposure to per-oral route employing lower doses in liver transplantation: a pilot study
    (2017) Solari Gajardo, Sandra; Cancino, Alejandra; Wolff, Rodrigo; Norero, Blanca; Vargas, J. I.; Barrera Martínez, Francisco José; Guerra Castro, Juan Francisco; Martínez Castillo, Jorge; Jarufe Cassis, Nicolás; Soza, Alejandro; Arrese Jiménez, Marco; Benitez, Carlos
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    Successful treatment of severe hepatopulmonary syndrome with a sequential use of TIPS placement and liver transplantation
    (2009) Benitez, Carlos; Arrese, Marco; Jorquera, Jorge; Godoy, Ivan; Contreras, Andrea; Loyola, Soledad; Pilar Dominguez, P.; Jarufe, Nicolas; Martinez, Jorge; Perez-Ayuso, Rosa Maria
    Hepatopulmonary syndrome (HPS) is a complication of portal hypertension (PH) defined by the presence of liver disease, abnormal pulmonary gas exchange and evidence of intrapulmonary vascular dilatations (IPVD) producing a right to left intrapulmonary shunt. Liver transplantation (LT) is the treatment of choice; however, severe hypoxemia may contraindicate LT. The use of transjugular intrahepatic portosystemic shunts (TIPS) could be effective in HPS, although available data is limited. Aim: To report a clinical case of severe HPS treated sequentially with TIPS and LT. Case report: A 46 year old female cirrhotic patient presented with rapidly progressive dyspnea, hypoxemia (PaO2 60 mmHg, SaO(2) 92%) and increased alveolar-arterial oxygen gradient (A-a) (46 mmHg). She also had orthodeoxia (SaO(2) 87% in sitting position, but 91% in a prone position). A CT scan and pulmonary angiography were normal. Spirometric assessment showed a mild restrictive pattern and a desaturation was observed in a six-minute walking test. Contrast-enhanced echocardiography (CEE) showed intrapulmonary shunting. A HPS was diagnosed and liver transplantation was disregarded due to severe hypoxemia. The patient underwent TIPS placement. After four weeks, a significant improvement of dyspnea and a complete remission of orthodeoxia were seen. One year later, the patient was successfully transplanted. Interestingly, six months after LT, and in the absence of dyspnea, a new CEE showed persistent passing of bubbles to the left cavities. Comments/Conclusion: Persistent right-to-left shunt after TIPS placement and liver transplantation in spite of the improvement of pulmonary function tests suggests long-term persistence of structural changes in the pulmonary vascular tree after liver transplantation. Because of lack of data, it is not possible to recommend the routine use of TIPS as a part of the conventional management of HPS. However, in patients with severe hypoxemia TIPS placement can reasonably be used as a bridge towards transplantation.
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    Trasplante hepático por insuficiencia cardíaca secundaria a telangiectasia hemorrágica hereditaria o enfermedad de Rendu Osler Weber. Caso clínico
    (2017) Ahumada, V.; Tejos, R.; Moraga, F.; Achurra Tirado, Pablo; Godoy, I.; Loyola, S.; Torres Montes, Paula Javiera; Kolbach Rengifo, Marianne Helene; Benitez, Carlos; Guerra, J.; Jarufe Cassis, Nicolás; Martinez, J.
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    Trasplante hepático: Evolución, curva de aprendizaje y resultados después de los primeros 300 casos
    (2019) Francisco Guerra, Juan; Luis Quezada, Jose; Cancino, Alejandra; Arrese, Marco; Wolff, Rodrigo; Benitez, Carlos; Carlos Pattillo, Juan; Cristobal Gana, Juan; Concha, Mario; Cortinez, Luis; Vera, Magdalena; Miranda, Paula; Rubilar, Francisco; Troncoso, Andres; Briceno, Eduardo; Dib, Martin; Jarufe, Nicolas; Martinez, Jorge
    Background: Liver transplantation (LT) is an option for people with liver failure who cannot be cured with other therapies and for some people with liver cancer. Aim: To describe, and analyze the first 300 LT clinical results, and to establish our learning curve. Material and Methods: Retrospective cohort study with data obtained from a prospectively collected LT Program database. We included all LT performed at a single center from March 1994 to September 2017. The database gathered demographics, diagnosis, indications for LT, surgical aspects and postoperative courses. We constructed a cumulative summation test for learning curve (LC-CUSUM) using 30-day post-LT mortality. Mortality at 30 days, and actuarial 1-, and 5-year survival rate were analyzed. Results: A total of 281 patients aged 54 (0-71) years (129 women) underwent 300 LT. Ten percent of patients were younger than 18 years old. The first, second and third indications for LT were non-alcoholic steatohepatitis, chronic autoimmune hepatitis and alcoholic liver cirrhosis, respectively. Acute liver failure was the LT indication in 51 cases (17%). The overall complication rate was 71%. Infectious and biliary complications were the most common of them (47 and 31% respectively). The LC-CUSUM curve shows that the first 30 patients corresponded to the learning curve. The peri-operative mortality was 8%. Actuarial 1 and 5-year survival rates were 82 and 71.4%, respectively. Conclusions: Outcome improvement of a LT program depends on the accumulation of experience after the first 30 transplants and the peri-operative mortality directly impacted long-term survival.