Análisis de 500 trasplantes hepáticos en el Hospital de Bellvitge

Jaurrieta, Eduardo; Casais, L; Figueras, Juan; Ramos, Emilio; Lama, Carmen; Rafecas, A; Taltavull, Teresa Casanovas; Fabregat, J.; Xiol, Xavier; Torras, Jaume; Baliellas, Carme; Sabaté, A.; Rufí, Gabriel; Benasco, C; Casanovas, T; Serrano, Teresa; Gil-Vernet, S.; Sabaté, I; Busquets, Juli

doi:10.1016/s0025-7753(00)71614-9

Cited by 21 publications

(7 citation statements)

References 12 publications

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“…In our study, based on a large cohort of liver transplant recipients, the incidence of de novo internal neoplasms was 5.3%. This frequency is higher than that observed in the general population matched for age (1–1.7%) (10), and is similar to that reported in previous studies on LT recipients where skin cancers were also excluded (2–17%) (1–3,7,8,11–22) (Table 7).…”

Section: Discussionsupporting

confidence: 89%

De Novo Internal Neoplasms after Liver Transplantation: Increased Risk and Aggressive Behavior in Recent Years?

Benlloch

Berenguer

Prieto

et al. 2004

American Journal of Transplantation

123

129

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The goal of the study was to determine the incidence and variables associated with post-liver transplantation (LT) de novo internal neoplasms development, excluding skin tumors and hepatocellular carcinoma. Medical records were reviewed for recipient/donor demographics, viral serology, cause of liver disease, interval from LT to tumor diagnosis, predisposing factors, immunosuppression and survival. Forty-one neoplasms (31 solid and 10 hematologic) developed in 772 recipients (5.3%) transplanted between 1991 and 2001. Time to tumor diagnosis was longer in patients transplanted before 1995 than in those transplanted afterwards (58 vs. 22 months; p < < 0.05). Hematologic neoplasms (HN) appeared earlier than solid (2 vs. 21 months; p < < 0.001), were more prevalent in those transplanted after 1995 than before (32% vs. 12.5%), and had lower survival than solid (2 vs. 21 months, p < < 0.001). While HCV was the most frequent indication in HN (70%), alcohol was that of solid tumors (71%). Overall, risk factors for de novo neoplasms included alcohol and immunosuppression (p < < 0.01). In patients undergoing LT in recent years, there is a higher incidence of HN with de novo internal neoplasms developing at earlier time-points than in those transplanted years ago. Risk factors for tumor development include alcohol, HCV and possibly strong immunosuppression.

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Section: Discussionsupporting

confidence: 89%

De Novo Internal Neoplasms after Liver Transplantation: Increased Risk and Aggressive Behavior in Recent Years?

Benlloch

Berenguer

Prieto

et al. 2004

American Journal of Transplantation

123

129

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“…On the other hand, the development of noncutaneous neoplasia has a poor prognosis and noncutaneous malignancy was independently related to mortality. In this series, the incidence of noncutaneous neoplasia (14.4%) was higher than in most series of neoplasia in liver transplant recipients previously published 1, 4, 7–23. Only Bellamy et al17 had a higher incidence (17%).…”

Section: Discussioncontrasting

confidence: 50%

De Novo neoplasia after liver transplantation: An analysis of risk factors and influence on survival

Herrero

Lorenzo²,

Quiroga³

et al. 2004

Liver Transpl

135

125

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Immunosuppression increases the risk of posttransplant malignancy and it may increase posttransplant mortality. The finding of factors related to the development of posttransplant malignancy may serve as a guide to avoid those risk factors and to develop strategies of posttransplant surveillance. The incidence and risk factors of malignancy were studied in 187 consecutive liver transplant recipients surviving more than 3 months. None of the 12 patients surviving less than 3 months had de novo neoplasia. The impact of malignancy on survival was studied in a casecontrol study. After a median follow-up of 65 months, 49 patients developed 63 malignancies: 25 patients had 35 cutaneous neoplasias and 27 patients had 28 noncutaneous malignancies. The 5-and 10-year actuarial rates of cutaneous neoplasia were 14 and 24% and the rates of noncutaneous neoplasia were 11 and 22%, respectively. Risk factors for the development of cutaneous malignancy were older age and Child-Turcotte-Pugh A status. Risk factors for the development of noncutaneous malignancy were older age, alcoholism, and smoking. Cutaneous neoplasia had no effect on survival, whereas patients with noncutaneous malignancy had a significant reduction of survival. The overall relative risk of cutaneous and noncutaneous neoplasia, as compared with the general population were 16.91 (95% confidence interval: 11.78-23.51) and 3.23 (95% confidence interval: 2.15-4.67), respectively. The relative risk of cancer-related mortality (after excluding recurrent malignancy) was 2.93 (95% confidence interval: 1.56-5.02). Multivariate analysis showed that noncutaneous malignancy was an independent risk factor for posttransplant mortality. In conclusion, liver transplant recipients have a higher risk of cancer-related mortality than the general population. This increased risk is due to the development of noncutaneous neoplasia. Older age, alcoholism, and smoking increase the risk of de novo noncutaneous neoplasia. (Liver Transpl 2005;11: 89-97.)

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“…Therefore, minimizing the need for blood product transfusion should be an important objective. We, 3 as well as others, [4][5][6] have experienced a progressive reduction in the use of most blood components during the last decade. This trend is caused by several factors, such as earlier patient selection, better preservation of grafts, more experienced surgical and anesthesiology teams, implementation of new techniques, 7 and use of drugs to improve hemostasis.…”

mentioning

confidence: 99%

Intraoperative red blood cell transfusion in liver transplantation: Influence on patient outcome, prediction of requirements, and measures to reduce them

Ramos

Dalmau

Sabaté

et al. 2003

Liver Transplantation

Self Cite

245

171

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Objectives of this study are to quantify the need for blood transfusion during liver transplantation (LT) and confirm the importance of intraoperative blood transfusion as an independent prognostic factor for postoperative outcome. Furthermore, we try to detect useful variables for the preoperative identification of patients likely to require transfusion of packed red blood cell units (PRCUs) and identify measures to reduce transfusion needs. Data were collected prospectively between September 1998 and November 2000. One hundred twenty-two LTs were included in the study. Forty-two patients (34%) did not require transfusion of PRCUs. In multivariate analysis, transfusion of more than three PRCUs was found to be the only significant variable associated with prolonged hospital stay. In addition, excluding perioperative deaths, PRCU transfusion, using a cutoff value of six units, was the only variable to reach statistical significance (P ‫؍‬ .008; risk ratio, 4.93; 95% confidence interval, 15 to 15.9) to predict survival in a multivariate analysis that also included Child's class and United Network for Organ Sharing (UNOS) classification. Moreover, only preoperative hemoglobin (Hb) level was found to significantly predict the need for transfusion of one or more PCRUs. Finally, only UNOS classification and placement of an intraoperative portacaval shunt were found to be statistically significant to predict the need to transfuse more than six PRCUs. We found the requirement of even a moderate number of blood transfusions is associated with longer hospital stay, and transfusion of more than six PRCUs is associated with diminished survival. Preoperative normalization of Hb levels and placement of an intraoperative portacaval shunt can diminish the number of blood transfusions during LT. (Liver Transpl 2003;9:1320-1327.)

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Análisis de 500 trasplantes hepáticos en el Hospital de Bellvitge

Cited by 21 publications

References 12 publications

De Novo Internal Neoplasms after Liver Transplantation: Increased Risk and Aggressive Behavior in Recent Years?

De Novo Internal Neoplasms after Liver Transplantation: Increased Risk and Aggressive Behavior in Recent Years?

De Novo neoplasia after liver transplantation: An analysis of risk factors and influence on survival

Intraoperative red blood cell transfusion in liver transplantation: Influence on patient outcome, prediction of requirements, and measures to reduce them

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