Félix Cambra Molero

Research Institute Hospital 12 de Octubre

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Iago Justo

Universidad Complutense de Madrid

Jorge Calvo

Universidad Complutense de Madrid

Alejandro Manrique Municio

Hospital Universitario 12 De Octubre

ÓC

Óscar Caso Maestro

Hospital Universitario 12 De Octubre

Alberto Marcacuzco

Hospital Universitario 12 De Octubre

Carlos Jiménez Romero

Universidad Complutense de Madrid

Carmelo Loinaz Segurola

Hospital Universitario 12 De Octubre

Manuel Abradelo de Usera

Research Institute Hospital 12 de Octubre

ÁG

Álvaro García-Sesma Pérez-Fuentes

Universidad Complutense de Madrid

Luis Carlos Jiménez Romero

Hospital Universitario 12 De Octubre

Cooperative Institutions

Hospital Universitario 12 De Octubre

Research Institute Hospital 12 de Octubre

Universidad Complutense de Madrid

Centro de Investigación Biomédica en Red

Organización Nacional de Trasplantes

Instituto Nacional de la Salud

Universidad de Navarra

University of Puerto Rico System

Hospital General Universitario de Ciudad Real

Hospital Universitario HM Madrid

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Long Term Outcome of Patients with Portal Thrombosis Previous to Liver Transplantation

Transplantation (2018)

Isabel Lechuga Alonso S. Salamea Sarmiento M. Delgado Oana Anisa Nutu Pilar Del Pozo Elso

Introduction Portal vein thrombosis is a late consequence of advanced cirrhosis. Its development has been associated with worse long term patient and graft survival, as well as a higher risk of vascular complications after liver transplantation. Material and Methods We reviewed all patients over 18 years old who underwent liver transplantation (LT) at University Hospital “12 de Octubre” between January 2002 and January 2017. Pediatric recipients and cases of retransplantation were excluded. Patients were divided according to the presence of preoperative portal thrombosis (PT, 126 patients) or no PT (N-PT, 724 patients). Results Mean recipient age was 55.5±9 in PT vs 53.7±11 in N-PT (p 0.085), with a similar number of male patients in both groups (76.2% en PT vs 72.8% in N-PT; p 0.431). There was a 59,2% rate of HCV infection in the PT group (52.4% in N-PT; p 0.157), and 22.2% of patients in the same group had a diagnosis of hepatocellular carcinoma (vs 29,9% in N-PT group; p 0.080). Mean preoperative MELD score was 14.7 en TP vs 15.6 in N-PT (p 0.067). There were no significant differences found regarding preoperative BMI, haemoglobin, MELD-Na score and Child-Pugh score.16.7 % of patients in the PT group received a subobtimal graft for LT, vs 21.7% in the N-PT group (p 0.204). In relation to blood products transfusion, an average of 12.3 units of RBC was administered in the the PT group and 9.2 in the N-PT (p 0.084), with an average of 14.6 and 12.8 FFP units respectively (p 0.093) and no differences found when reviewing platelets and fibrinogen. Mean ICU stay was 9.2 days in PT vs 6.7 in N-PT (p 0.075), while mean ward stay was 17.7 days in PT vs 19.4 in N-PT (p 0.429). Portal thrombosis recurrence rate was 4% in patients with a previous diagnosis of PT, significantly higher than in those without said previous history (1.1% in N-PT; p 0.015). However, the rate of arterial thrombosis was 4.8% in the PT group vs 3.8% in the N-PT group with no statistical significance (p 0.890). Retransplantation rate was 4% in PT and 6.2% in N-PT (p 0.326). Actuarial survival at 1, 3 and 5 years was 86.5%, 79.1% and 76.2% respectively in the PT group, vs 84.5%, 78.3% y 74.3% in the N-PT group (p=0.489). Conclusion Pretransplant portal thrombosis is a diagnosis that has not been associated with a decreased survival after LT in our series; but seems to determine an increase in transfusion requirements and a higher risk of postoperative vascular complications.

Portal vein thrombosis

10.1097/01.tp.0000543972.18815.74

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Liver Transplantation from Donor after Cardiac Death (DCD) Maastricht type IIA, our Experience after 10 years

Transplantation (2018)

M. Delgado Iago Justo Oana Anisa Nutu Marina Pérez‐Flecha González Pilar Del Pozo Elso

Introduction Ten years after the beginning of the donation after cardic death (DCD) programme in the University Hospital 12 de Octubre, we study the evolution of the results of said programme over time. Objectives To compare the results of liver transplantation (LT) using grafts obtained from donors after cardiac death (DCD type Maastricht IIA) performed during the first period (A) of the programme (January 2006 to December 2010) versus those performed during a later period defined from January 2011 to December 2016 (B). Materials and Methods Retrospective analysis of the DCD liver transplantation series in the University Hospital 12 de Octubre. Results 75 LT from DCD type IIA have been reviewed, 44 performed during period A and 31 during period B. Mean recipient ages were 59+8 y 58+6 (NS) respectively, with a similar number of male patients (79,5% vs. 71% NS). There were no statistically significant differences found regarding other recipient characteristics such as MELD score, hepatocellular carcinoma or HCV infection. Mean donor age was 38+9 years in group A and 46+7 in group B (p 0.000). When reviewing ischemia times (IT), cold IT was shorter in group B (A 7:00 vs. B 6:05; p 0.046) as was warm IT (A 1:08 vs. B 0:58, p 0.025). However NECMO time was significantly shorter during the first period (3:16 vs. 3:37 min, p 0.027). Recipient survival during period A at 1, 3 and 5 years was 77.3%, 61.4% and 59.1% while during period B it was 87.1%, 83.7% and 83.7% (p 0.039). Graft survival after period A was significantly lower as well (63.6%, 50% and 47.7% vs. 83.9%, 80.5% and 80.5% in group B; p 0.008). The incidence of ischemic cholangiopathy was higher in group A (43.2% vs. 13.3%; p 0.006), as well as the retransplantation rate (A 18.2% vs. B 3.2%; p 0.05). There were non-statistically significant differences found regarding the incidence of primary graft non-function (A 11.4% vs. 3.3% in group B; p 0.214). Conclusions The study shows a significant improvement in the results of DCD liver transplantation through time, possibly related to graft ischemia time optimization.

10.1097/01.tp.0000543151.82018.be

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DR-MELD

Transplantation (2018)

Óscar Caso Maestro Iago Justo Carlos Muñoz Alberto Marcacuzco María García‐Conde

Introduction The use of old grafts is one of the main sources to increase the number of available grafts for liver transplantation (LT). D-MELD seems to be the best graft survival predictor to date, but if we combine D-MELD with other variables maybe we can get a better score to predict survival. The aim of this study is analyse our experience in LT with donors >70 years, identify independent predictors of graft survival, and then, try to combine these predictors in an attempt to find a new score to predict graft survival. Materials and Methods We present a longitudinal and retrospective study of all LT performed in our department using grafts >70 years. Donor, recipient, LT complications, and short, medium and long-term follow-up variables were analyzed. Results From April 1986 to May 2016, 1848 LT were performed in 1659 patients. We performed 232 LT with grafts from donors >70 years, 20 cases were excluded, so 212 cases were included in the analysis. Donor median age was 76 years and 125 (59%) donors were females. We found hypertension in 122 (57,5%) donors and diabetes in 43 (20,3%). A biopsy was taken from all grafts during the procurement process, diffuse microsteatosis was described in 41 (19,5%) patients and mild steatosis in 56 (26,7%). Recipient median age was 59 years and 167 (78,8%) patients were males. The indication for LT was alcohol in 95 (44,8%) patients and HCV in 72 (34%) patients. Hepatocellular carcinoma (HCC) was diagnosed in 84 (39,3%) patients. Median recipient MELD score was 13 and median recipient D-MELD was 1051. Mean CIT was 445 minutes. After a mean follow-up of 64 months, PNF was present in 3,3%, acute rejection in 25%, vascular complications, in 6,6% biliary complications in 7,5% and liver re-transplantation was necessary in 12 (5,7%) patients. Finally, patient and graft survival at 5 years was 69% and 64.5%, respectively. In the multivariate analysis we identified as independent risk factors for a worse graft survival HCV, donor age, recipient age and D-MELD. Searching a new score to predict old livers surival, we multiply the D-MELD value and the recipient age (DR-MELD) and we applied the Kaplan-Meier method with the Log-Rank test to study the influence of this parameter on the graft survival. Mean DR-MELD value was 50.286 (range 4752-234.000). Graft survival at 5 years was 100% for DR-MELD <25.000, 76,2% for DR-MELD 25.000-50.000, 767,8% for DR-MELD 50.000-75.000, 52,1% for DR-MELD 75.000-100.000 and 49% for DR-MELD >100.000 (p<0,00). Conclusion DR-MELD seems to be a good predictor of graft survival after LT with donors >70 years and very easy to use in daily clinical practice.

Milan criteria

10.1097/01.tp.0000543989.10299.43

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Influence of immunocomplexes in vascular thrombosis in liver transplantation

HPB (2018)

S. Salamea Sarmiento Isabel Lechuga Alonso Iago Justo Dolores Pérez Méndez A. Serrano Hernández

Etiology

Group A

Portal vein thrombosis

10.1016/j.hpb.2018.06.2425

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Indications and Long-Term Outcomes of Using Mycophenolate Mofetil Monotherapy in Substitution for Calcineurin Inhibitors in Liver Transplantation

Transplant International (2025)

Carlos Jiménez‐Romero Iago Justo Óscar Caso Maestro Alejandro Manrique Municio Álvaro García‐Sesma

Mycophenolate

Substitution (logic)

10.3389/ti.2025.13790

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P.415: Tobacco influence on short-term outcomes of liver transplantation.

Transplantation (2024)

Alba Gómez Barrena Iago Justo Alberto Marcacuzco Óscar Caso Maestro Félix Cambra Molero

10.1097/01.tp.0001068412.32924.65

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Influence of Graft Steatosis on the Outcome of Liver Transplantation

Transplantation (2018)

Oana Anisa Nutu María García Conde Delgado Iago Justo Alberto Marcacuzco Jorge Calvo

Introduction Steatotic liver grafts represent the most common type of extended criteria of liver grafts organ that have been introduced in the last decade due to the disparity between liver transplant candidates and the number of available organs. The aim of this study was to determine the effect of donor graft steatosis on the outcomes of liver transplantation (LT). Material and Methods We performed a retrospective study during the period between 2006-2016. Excluding HIV positive recipients, split grafts, simultaneos liver-kidney transplantation, donors eldier than 70 years, we analyzed 172 patients. The sample divided into 3 groups: normal histology (steatosis<10%), mild steatosis (10-30%), and moderate steatosis (30-60%). Factors such as mortality, overall survival, graft surgical complications, graft rejection were analyzed following the degrees of steatosis. Results Among the existing pathology reports of the 172 cases we found 94 (54%) with normal pathology (steatosis less than 10%), 74 (43%) with mild steatosis (10-30%) and 4 (3%) patients with moderate steatosis (30-60%). If we compare the MELD score before transplantation or the transfusional requierements using the McCluskey index, no differences were seen among the three groups. Mean ICU stay were also similar: 6.7 days in the non steatosis group, 7.6 days in mild steatosis and 3,5 in moderate steatosis (p=0.6). No difference was observed between the three groups for the incidence of complications such as acute graft rejection (p=0,1), ischemic cholangiopathy (p=0,1), hepatic artery thrombosis or chronic rejection (p=0,2). Regarding the early allograft disfunction (EAD) and primary non function (PNF), no differences were observed: 8 EAD (8,5%) in no steatosis group and 6 (8,1%) in the mild steatosis. No difference was found on the actuarial survival (AS) at 1,3 and 5 years, being for each group: steatosis<10%, the AS was 87%, 82% and respectively 81%. In mild steatosis group the AS was 85%, 83% and respectively 82% (p=0,5). If we take a look to the early mortality, during the hospitalization stay, 3 (3%) died in the non steatosis group and 6 (8%) in the mild steatosis. Conclusion Though we need a larger sample size, we did not find differences in terms of overall survival or complications after LT using grafts with middle to moderate steatosis (<60%).

Steatosis

10.1097/01.tp.0000543967.44365.e5

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Aortic Graft Mycotic Pseudoaneurysm as a Severe Complication After Multivisceral Transplantation: A Case Report

Transplantation Proceedings (2016)

Jorge Calvo M. Manrique Municio Carmelo Loinaz Segurola Iago Justo Óscar Caso Maestro

Pseudoaneurysm

10.1016/j.transproceed.2015.10.083

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Citations (2)

Trombosis arterial con afectación del tronco celiaco como complicación del trasplante hepático.

Dykinson eBooks (2020)

Óscar Caso Maestro Félix Cambra Molero Iago Justo Alberto Marcacuzco C. Loinaz Segurola

10.2307/j.ctv102bm0k.35

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