Sandra García Aroz

University of Illinois Chicago

Author Statistics

Papers

Citation

H-Index

i-10 index

Research Trends

Author Order

Document Type

Co-Authors

Ivo Tzvetanov

University of Illinois Chicago

José Oberholzer

University Hospital of Zurich

Enrico Benedetti

University of Illinois Chicago

Manuel Abradelo de Usera

Research Institute Hospital 12 de Octubre

Carlos Jiménez Romero

Universidad Complutense de Madrid

Rebeca Sanabria Mateos

King's College Hospital

C. Alegre

Hospital Universitario 12 De Octubre

Mario Spaggiari

University of Illinois Chicago

ÁG

Álvaro García‐Sesma

Hospital Universitario 12 De Octubre

Alejandro Manrique Municio

Hospital Universitario 12 De Octubre

Cooperative Institutions

Research Institute Hospital 12 de Octubre

Hospital Universitario 12 De Octubre

University of Illinois Chicago

Universidad Complutense de Madrid

University of Illinois Hospital & Health Sciences System

Illinois College

NHS Blood and Transplant

Centro de Investigación Biomédica en Red

University of Illinois Urbana-Champaign

University of Chicago Medical Center

Author Statistics

Papers

Citation

H-Index

i-10 index

Research Field

Sirolimus Monotherapy in Liver Transplantation

Transplantation (2012)

C. Alegre Carlos Jiménez Romero Manuel Abradelo de Usera Alejandro Manrique Municio Elfrid Cifuentes

Background: Sirolimus is an antibiotic with antifungal, antifibrotic and immunosuppressant properties that has been used in orthotopic liver transplantation (OLT) as substitute of calcineurin inhibitors (CNI) in cases of de novo tumors, patients subjected to OLT for hepatocellular carcinoma (HCC) and nephrotoxicity due to CNI. We present our experience with sirolimus monotherapy in OLT Patients and methods: Between April 1986 and December 2010 we performed 1500 OLT, of whom 57 patients are receiving immunosuppressive treatment with sirolimus, and 39 of them are currently in monotherapy. We analized the clinical characteristics of patients, associated side effects, rejection rate, renal function and lipid profile, in patients treated with sirolimus monotherapy. Results: There were 31 males (79.5%), and 8 females (20.5%) with a mean age at OLT of 50.5 ±10.5 years. The mean follow-up period was 89.8 months. The main indications for OLT was alcoholic cirrhosis in 10 patients (25.6%), HCV cirrhosis in 5 (12.8%), and HCV cirrhosis+HCC in 5 (12.8%). Other causes were HBV cirrhosis, acute liver failure, autoimmune hepatitis. The most frequently immusosuppressive therapy used at discharge was tacrolimus+prednisone in 25 patients (64.1%). Premonotherapy immunosuppression most frequently used was tacrolimus+sirolimus in 21 patients (53.9%), and mycophenolate+sirolimus in 15 (38.5%). The mean time from OLT to sirolimus monotherapy treatment initiation was 65.3 months, and the mean follow-up after switching to sirolimus monotherapy was 22.8 months. Only 1 patient (2.6%) presented acute rejection, being with adequate drug levels, and treated with reintroduction of tacrolimus. The indications for conversion to sirolimus monotherapy were: de novo aerodigestive tract tumors in 11 patients (28.3%), HCC in 10 (25.6%), nephrotoxicity due to CNI in 5 (12.8%), skin malignacies in 4 (10.3%), lymphoproliferative disorders in 3 (7.7%), urologic tract tumors in 3 (7.7%), central nervous system tumors in 2 (5%) and gynecological in 1 patient (2.6%). Adverse effects developed in 35 patients (89.7%) and the most frequent were: dyslipidemia in 24 patients (61.5%), edemas in 8 (20.5%), and cytopenias in 8 (20.5%). The mean creatinine clearance rate (CCL) before sirolimus therapy was 69.9 ml/min (normal kidney function in 30.8% of patients, mild renal insufficiency in 48.7%, and moderate in 20.5%); and after monotherapy was 75.3 ml/min (normal kidney function in 38.5% of patients, mild renal insufficiency in 41%, moderate in 18%, and severe in 2.6%) (p=0.0001). Total cholesterol and trigliceride values increased significantly after switching: cholesterol 171 mg/dl vs 208 mg/dl (p=0.002); and trigliceride 108 mg/dl vs 158 mg/dl (p=0.015). Seventeen patients were treated with hypolipemiant drugs. Conclusions: Sirolimus monotherapy is a good immunosuppressive option in patients who underwent OLT for HCC or those who develop de novo tumors or nephrotoxicity due to CNI. Monotherapy is well tolerated and is associated with low rejection rate. Renal function improves after conversion to sirolimus monotherapy and dyslipidemia is pharmacologically well controlled.

Sirolimus

Immunosuppression

10.1097/00007890-201211271-00081

Cite

Citations (0)

Robotic Surgery in Organ Transplantation

Springer eBooks (2017)

Ivo Tzvetanov Sandra García Aroz Mario Spaggiari E. Benedetti

Invasive surgery

Pancreas transplantation

10.1007/978-3-319-62142-5_5

Cite

Citations (0)

Sirolimus Monotherapy in Liver Transplant Recipients with De Novo Tumors

Transplantation (2012)

C. Alegre Carlos Jiménez Romero Alejandro Manrique Municio Elfrid Cifuentes Félix Cambra Molero

Background: Sirolimus is a macrocyclic antibiotic with antifungal, antifibrotic and immunosuppressive properties that can inhibit metastatic tumor growth and angiogenesis in vivo mouse models. It can be used as a substitute for calcineurin inhibitors (CNI) because it may reduces the likelihood of recurrent hepatocellular carcinoma (HCC) or the rate of de novo tumors in high risk transplant patients. Sirolimus protects allografts from rejection while simultaneously inhibits tumor growth. Patients and methods: Between April 1986 and December 2010 we performed 1500 orthotopic liver transplants (OLT). Fifty-seven patients received immunosuppressive treatment with sirolimus, and 26 patients of them due to de novo tumors. Currently, 20 of these patients are with sirolimus monotherapy. We analyze the outcome of liver transplant recipients who developed de novo tumors and were treated with sirolimus monotherapy. Results: There were 20 patients (18 males and 2 females), with a mean age at OLT of 50.3±12.1 years, and mean follow-up of 111.5 months. The main indications for OLT were alcoholic cirrhosis (40%), and HCV cirrhosis (15%). The most frequently immunosuppressive therapy used at discharge was tacrolimus+prednisone (55%). Premonoterapy immunosuppression most frequently used was tacrolimus+sirolimus (50%), and mycophenolate+sirolimus (40%). The mean time from OLT to sirolimus treatment was 74.6 months, and from then until the beginning of monotherapy was 9.5 months with a mean time of 24.7 months in monotherapy. The location of de novo tumors was: aerodigestive tract (45%), skin (20%), lymphoproliferative disorders (15%), urologic tract (10%), gynecological (5%), and central nervous system (5%). There was only one case of rejection (5%) in the presence of adequate drug levels, successfully treated with reintroduction of tacrolimus. Adverse effects were seen in 80% of patients, and the most frequent were: dyslipidemia (11 patients), edema (5 patients), and oral thrush (4 patients). Regarding lipid profile, mean cholesterol value before sirolimus was 168 mg/dl, and postmonotherapy was 211 mg/dl (p =0.0001). Seven patients are treated with hypolipemiant. Mean value of pre-sirolimus triglycerides was 104 mg/dl and post-monotherapy was 130 mg/dl (p=0.071). Regarding renal function, mean creatinine clearance pre-sirolimus was 70.6 ml/min and post-monotherapy was 75.6 ml/min (p>0.05). Conclusions: Sirolimus is a potent immunosuppressant with antitumoral properties, with low rate of rejection, which represents a good option OLT with de novo malignancies. More than half of the patients presented side effects, but they were well tolerated or controlled with medical treatment (dyslipidemia as the most frequent). There was an improvement of renal function showing an increase in creatinine clearance.

Sirolimus

Immunosuppression

10.1097/00007890-201211271-00083

Cite

Citations (1)

Long‐term outcomes of living‐related small intestinal transplantation in children: A single‐center experience

Pediatric Transplantation (2017)

Sandra García Aroz Ivo Tzvetanov E. Hetterman Hoonbae Jeon José Oberholzer

Abstract Pediatric patients with irreversible intestinal failure present a significant challenge to meet the nutritional needs that promote growth. From 2002 to 2013, 13 living‐related small intestinal transplantations were performed in 10 children, with a median age of 18 months. Grafts included isolated living‐related intestinal transplantation (n=7), and living‐related liver and small intestine (n=6). The immunosuppression protocol consisted of induction with thymoglobulin and maintenance therapy with tacrolimus and steroids. Seven of 10 children are currently alive with a functioning graft and good quality of life. Six of the seven children who are alive have a follow‐up longer than 10 years. The average time to initiation of oral diet was 32 days (range, 13‐202 days). The median day for ileostomy takedown was 77 (range, 18‐224 days). Seven children are on an oral diet, and one of them is on supplements at night through a g‐tube. We observed an improvement in growth during the first 3 years post‐transplant and progressive weight gain throughout the first year post‐transplantation. Growth catch‐up and weight gain plateaued after these time periods. We concluded that living donor intestinal transplantation potentially offers a feasible, alternative strategy for long‐term treatment of irreversible intestinal failure in children.

Thymoglobulin

Immunosuppression

Single Center

Ileostomy

Intestinal Failure

10.1111/petr.12910

Cite

Citations (9)

The use of bovine pericardial patch for vascular reconstruction in infected fields for transplant recipients

Journal of Vascular Surgery Cases and Innovative Techniques (2017)

Sandra García Aroz Mario Spaggiari Hoonbae Jeon José Oberholzer Enrico Benedetti

Infectious vascular complications affecting transplant recipients may lead to severe morbidity and graft loss. This is a retrospective review of vascular repair with bovine pericardial patch (BPP) in infected fields for immunosuppressed patients. BPP was used as either a patch or an interposition graft. Five cases of arterial reconstruction in infected fields using BPP were performed. There were no complications related to bleeding, thrombosis, or recurrent infection. In our limited experience, the use of BPP as a vascular patch is successful, and it represents an alternative when vascular reconstruction is needed in the context of infected fields.

Vascular graft

10.1016/j.jvscit.2016.10.006

Cite

Citations (12)

Robotic kidney transplantation in class lll obesity

Journal of the American College of Surgeons (2015)

Raquel Garcı́a-Roca Ivo Tzvetanov Sandra García Aroz Carlos Parra Hoombae Jeon

10.1016/j.jamcollsurg.2015.08.390

Cite

Citations (0)

Bocio amiloide en paciente con fibrosis quística

Medicina Clínica (2014)

Irene Osorio Silla José Ignacio Martínez Pueyo Sandra García Aroz Felipe de la Cruz Vigó

10.1016/j.medcli.2014.02.010

Cite

Citations (0)