RESUMENIntroducción: La enfermedad por coronavirus (COVID-19) se ha propagado de forma rápida alrededor del mundo produciendo una pandemia.Con el objetivo de frenar su avance, se ha modificado la estructura asistencial de todos los hospitales, priorizando a los pacientes COVID y urgentes, y paralizando todas las actividades que puedan ser aplazadas.Uno de los principales elementos afectados han sido las consultas, habitualmente presenciales, dado que el objetivo es reducir la exposición de pacientes y personal médico al virus.Como el seguimiento de nuestros pacientes no puede abandonarse, la teleconsulta se presenta como una alternativa eficaz durante la pandemia.Material y métodos: En nuestro centro hemos optado por la consulta telefónica durante los meses de máxima incidencia de la pandemia (marzo-mayo).Esto nos ha permitido realizar el seguimiento de 2,120 pacientes que estaban citados en esas fechas.Resultados: Tras una primera llamada, dividimos a los pacientes en varios grupos según su prioridad para las consultas sucesivas: urgente (0.09%), preferente (10.61%) y sin prioridad (60.75%).Aquéllos que estaban asintomáticos fueron dados de alta (19.05%).Conclusiones: La consulta telefónica se ha mostrado como una forma eficaz de mantener el seguimiento de nuestros casos durante la pandemia.Más allá de este periodo, en el futuro, podría mostrarse como una alternativa eficaz para el seguimiento de ciertos pacientes y patologías seleccionados.

Over the past years, IR has competed with surgeons for many treatments because we are often substitutes for surgery; we provide a different service that, at least partly, satisfies the same needs, often with lower morbidity, cost and hospital stay. After surgeons denied their efficacy, they later adopted and dispensed our techniques, namely in vascular IR and neuro IR. In other fields, such as IO, where the adoption is more complex, namely due to the versatility in image guidance, which requires a thorough knowledge in imaging, our techniques remained mostly within the IR com munity and developed rapidly, albeit at a slower pace than expected.

community” is that living donor liver transplantation (LDLT) is justified since patients on liver transplantation (LT) waiting lists continue to die (1). Data from the Spanish Registry are telling on-list mortality has leveled out at 8% (it is up to 20% in some centers) whereas the odds of having a transplant (year 2008) never went beyond 50%. LDLT —as well as split (2,3), non-heart-beating donation (4), marginal organs, or domino transplants— represents an option for increasing the donors pool. As our country is a world leader in cadaver donation rates, LDLT has been (and still is) reasonably questioned with arguments for (5) and against (6). This is a simple supply and demand issue that forces complex decisions regarding ethics, equity, and justice. The paper published here by the Murcia University team (Martínez-Alarcón et al.) helps elucidate this controversy (7). Until January 2010, around 246 living-donor transplants had been performed in Spain (53% for adult recipients), with figures becoming more stable on a yearly basis, and representing 1-1.5% of the yearly total (8). When interannual percent growth rates for different organs were compared kidney transplants show a slight increase while the opposite is true for LDLT (9). The reported mortality of living liver donors is 0.15% (0.20% when causes potentially related to living donation are included) (6). To this day no donor deaths have occurred in Spain (5,6), and reoperation rates after donation are estimated around 10%. Survival rates for LDLT, according to data from the European Transplant Registry (10), are better for both patients (85% at 1 year and 76% at five years vs. 82 and 71%, respectively, for cadaver donation) and grafts (80% at 1 year and 70% at five years vs. 78 and 64%, respectively, for cadaver donation). The A2ALL study (11,12) described a higher incidence of grade-4 complications in living donor transplant recipients (16 vs. 9%); this percentage significantly decreases as team experience increases (> 20 transplants/year). Surveys of living donors confirm that only 3.7% are pressured into donation; reasons for donation include saving the recipient’s life for 60%, and personal satisfaction for 35% (13). Martínez-Alarcón et al. confirm that, should relatives be properly informed and hence considered living donation favorably, only 44% of recipients would rather stay indefinitely on their waiting list than choose a living donor transplant. Why then are we witnessing a sustained yearly decrease in absolute numbers? Living donation is a singular, complex option to gain access to an organ for transplantation. Some factors condition living donation for the adult (organ scarcity, recipient benefits, donor risks, emotional stress, altruism, autonomy, MELD, etc.). Various (regional) lists exist, and wait times vary from one region to the next. As a consequence, on-list mortality and the odds for transplantation differ between Liver transplantation from living donor as a sign of social intelligence 1130-0108/2011/103/3/111-114 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS Copyright © 2011 ARÁN EDICIONES, S. L. REV ESP ENFERM DIG (Madrid) Vol. 103, N.° 3, pp. 111-114, 2011

We evaluate the 5-year results of a single-centre prospective randomized trial that compared cyclosporine microemulsion (CyA-me) in triple therapy (plus steroids and azathioprine) and Tacrolimus (Tac) in double therapy (plus steroids) for primary immunosuppression. One hundred adult patients undergoing liver transplantation were randomized to receive Tac (n=51) or CyA-me (n=49). Ten patients in group A, and thirty-one patients in group B had their main immunosuppressive agent switched. The switch was much more frequent from CyA-me to Tac (n=31; 62.3%), mainly because of lack of efficacy (n=12; 38.7%). Six of 10 patients were shifted from Tac to CyA-me for side effects. The clinical course of the majority of patients converted from CyA-me to Tac improved clearly after conversion. Donor age and acute rejection (number, severity and rejection free days) had a significative association with lack of efficacy in group B. In these series, the conversion to Tac from CyA-me could be accomplished safely, with an excellent long-term outcome.

Because of the organ shortage, non-heart-beating donors have been proposed as a possible source of grafts for orthotopic liver transplantation (OLT). Despite the widespread use of controlled non-heart-beating donors, there are only a few published studies reporting the outcomes with uncontrolled non-heart-beating donors (UNHBDs). A prospective case-control study on adult patients undergoing OLT was designed. We used normothermic extracorporeal membrane oxygenation (NECMO) in all UNHBDs. Matching 2:1 ratio comparison was performed between a study group (UNHBDs) and a brain death donor (BDD) control group. Between January 2006 and March 2008, a total of 60 patients were included: 20 in the UNHBD group and 40 in the control group. The incidence of ischemic cholangiopathy was 5% (n = 1) for the UNHBD group and 0% for the BDD group (P = 0.15). The rate of primary nonfunction was 10% (n = 2) in UNHBD recipients and 2.5% (n = 1) in BDD recipients (P = 0.21), with graft loss in all of them. Three patients were retransplanted in the UNHBD group (15%), 2 of them because of primary nonfunction and 1 because of ischemic cholangiopathy; no patient was retransplanted in the control group (P = 0.012). After a mean follow-up of 330.4 +/- 224.9 days, 1-year cumulative patient survival was 85.5% for the UNHBD group and 87.5% for the BDD group (P = 0.768). One-year cumulative graft survival was 80% in the UNHBD group and 87.5% in the BDD group (P = 0.774). In conclusion, UNHBDs under NECMO are a potential source of organs for OLT with encouraging outcomes potentially comparable to those obtained with BDDs.

Nocardiosis is an infrequent disease that affects patients who display a cellular immunodeficiency, such as transplant recipients on immunosuppressive treatment, but uncommonly associated with high morbidity and mortality rates. Disseminated Nocardiosis affecting the central nervous system (CNS), abdomen, skin, and lungs has been described in bone marrow, lung, and kidney transplant recipients. However, to our knowledge, no cases involving all of these structures have been reported in liver transplant recipients. Herein, we have reported a case of CNS, pulmonary, and cutaneous nocardiosis in a liver transplant recipient who experienced hepatitis C virus-related cirrhosis and hepatocellular carcinoma and received the organ from a non-heart-beating donor. At posttransplantation month 7 the patient was admitted to the emergency department with poor general health status, fever, edema, and subcutaneous nodules in the legs. A computed tomography scan revealed multiple nodules disseminated through both lungs, abdomen, brain, and subcutaneous tissue. A needle biopsy was performed into one of the subcutaneous nodules. Cultures of the material tested positive for Nocardia farcinica. Thus, we started treatment with intravenous sulfamethoxazole-trimethoprim (SMZ-TMP), shifting after 1 month to oral therapy. Radiological examination performed after 2 weeks of treatment showed a 70% reduction in subcutaneous, pulmonary, and cerebral lesions. After 6 months of SMZ-TMP treatment, the patient remained free of the symptoms with involution of the subcutaneous nodules and significant radiological improvement. Among opportunistic infections appearing in liver transplant recipients, Nocardia species should have special consideration according to the success of early treatment and the bad prognosis in cases of delayed diagnosis.

BACKGROUND/AIMS:To assess the efficacy of the Molecular Adsorbent Recirculating System MARS (GAMBRO LUNDIA AB, Europe) in patients with acute liver failure waiting for liver transplantation.METHODOLOGY:Case-control study in a medical-surgical ICU of a referral hospital. Patients admitted to ICU with severe acute liver failure of any etiology were included. Conventional treatment was applied in all cases according to patient's clinical condition. Patients were treated with MARS after the implementation of this therapy in the ICU. Patients without this treatment were the control group.RESULTS:Were included 45 patients (control group: 26, MARS group: 19). Comparison between groups showed only differences in plasma bilirrubin levels in the first 24 hours. ICU mortality was 52.63% in the treatment group and 42.3% in the control group (p = 0.49). In the control group 17 patients (65.4%) received a liver transplant and 11 (57.9%) in the MARS group. ICU mortality was lower for transplanted patients in the study group (27.27% vs. 87.5%) (p = 0.019). Kaplan-Meier survival curves indicate that MARS-treated patients before liver transplantation had better survival.CONCLUSIONS:Combination therapy with MARS and liver transplantation seems to be the more effective therapeutic option for patients with severe ALF.

La mayoria de los autores ha catalogado al donante a corazon parado (DCP) o donante en asistolia (DA) como una fuente mas de injertos suboptimos. En nuestra opinion, deberia considerarse como un tipo de trasplante no convencional, tal como la Organizacion Nacional de Trasplantes refiere en sus diferentes memorias anuales 1. En realidad, su utilizacion no se fundamenta en una ampliacion de los criterios de seleccion del potencial donante idoneo fallecido por muerte encefalica, sino mas bien obedece al uso de criterios cardiorrespiratorios para diagnosticar el fallecimiento del posible donante, por lo que la donacion, y eventualmente el trasplante hepatico (TH), presenta una serie de peculiaridades. Al margen de esto, probablemente constituye el recurso menos desarrollado de todas las estrategias encaminadas a incrementar el numero de injertos disponibles para TH.

The significance of human leukocyte antigen (HLA) compatibility and preformed antibodies in liver transplantation remains unclear. The objectives of this study were to evaluate, in a single-center cohort comprising 896 liver transplants, whether the degree of donor-recipient compatibility and preformed antibodies modified graft survival. Univariate Kaplan-Meier analysis demonstrated that donor-recipient HLA compatibility had a marginal impact on allograft survival. As for compatibility at individual antigen loci, 2 mismatches at HLA-A conferred a survival advantage in retransplanted allografts (P = 0.011). HLA-B and HLA-DR loci did not play a significant role in outcome in any pathology. The concordance of results on preformed antibodies detected by complement-dependent cytotoxicity (CDC) and a multiple bead assay (Luminex xMAP) showed a strong correlation between both techniques (P < 0.0001). Both CDC-detected and Luminex-detected antibodies were associated with shorter graft survival within the first year post-transplant (P = 0.01 and P = 0.016, respectively). Positive CDC T crossmatches and Luminex-detected HLA class II antibodies played a significant role in decreasing graft survival (P = 0.043 and P = 0.0019 at 1 year, respectively, and P = 0.005 and P = 0.038 at 5 years, respectively). A correlation was also observed between the presence of preformed Luminex-detected class II or Luminex I and II antibodies and allograft rejection (P = 0.001 and P = 0.042, respectively). In conclusion, although HLA typing is not a prerequisite for transplantation, screening of HLA antibodies with Luminex techniques and CDC crossmatch may be useful in the detection of at-risk patients that could benefit from increased surveillance and tailored therapy following transplantation.

BACKGROUNDNeurocysticercosis (NCC) is a disorder caused by the Taenia solium larva. It is the most common parasitosis of the central nervous system (CNS). Its distribution is universal, but it is endemic in many developing countries and in the third world. In Spain most patients come from countries where the condition is endemic. However, sporadic cases occur among the population of rural regions. NCC in transplant recipients is uncommon. One renal transplant recipient developed NCC but responded to treatment with praziquantel. Recently, it has been reported to complicate a liver transplantation.CASE REPORTThe patient was a 49-year-old Ecuatorian man who received a cadaveric donor liver graft in June 2001 due to acute liver failure induced by toadstool and was under treatment with FK506. In January 2006, the patient presented with a generalized onset of a tonic-clonic seizure for 1 minute without sphincter incontinence, headache, fever, or previous brain trauma. Neurological evaluation did not show evidence of organic brain dysfunction. The neuroimaging findings (brain) computed tomography scan, magnetic resonance imaging were compatible with NCC: many cystic lesions intra- and extraparenchymatous with a scolex visible in three of them. Serology for cysticercosis in plasma was initially indeterminate but positive afterward. The patient was treated with anticonvulsivants (valproic acid) and albendazole. Systemic steroids were added in order to reduce the edema produced upon death of the cyst. Treatment lasted 3 weeks and it was completed without complications or neurological symptoms. Liver function was not affected. One year later the patient remained asymptomatic.CONCLUSIONNCC is a condition that must be included in the differential diagnosis of patients with CNS involvement and cystic lesions on neuroimaging investigations in transplant recipients, especially patients originating from or traveling to endemic areas. First-line therapy for active cysts includes antiparasitic drugs (albendazole or praziquantel) as well as steroids and anticonvulsivants. In our patient, this therapy was effective.