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Risk factors for autoimmune liver disease recurrence after liver transplantation
(Baishideng Publishing Group Inc., 2025)
Salgado-de la Mora, Moisés
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Mendez-Guerrero, Osvely
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Torre, Aldo
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Vilatoba, Mario
;
Castro Narro, Graciela E
Background: Autoimmune liver disease (AILD) recurrence is common after liver transplantation (LT). While several risk factors for recurrence have been identified, their combined predictive value has yet to be thoroughly investigated. Aim: To evaluate the combined predictive value of clinical and laboratory risk factors for AILD recurrence after LT. Methods: This retrospective cohort study included 79 patients with AILD who underwent LT at a single liver transplant center. We compared clinical and laboratory variables between patients with and without recurrent disease and assessed the predictive performance of these factors using four logistic regression models and their corresponding area under the receiver operating characteristic curve (AUC). Results: Recurrent AILD occurred in 26.58% of patients (95%CI: 17-38), the median time to recurrence was 28 months (interquartile range: 16-38). Patients with recurrent AILD had significantly higher pre-transplant Child-Pugh scores [11.61 ± 1.16 vs 10.58 ± 1.96 points; odds ratio (OR) = 1.43, 95%CI: 1.03-2.00; P = 0.032] and model for end-stage liver disease score (MELD) (22.76 ± 5.47 vs 18.81 ± 7.24 points; OR = 1.08, 95%CI: 1.01-1.16; P = 0.032), compared to those without recurrence. Additionally, baseline alanine aminotransferase (ALT) > 2 times the upper limit of normal (ULN) was significantly associated with recurrence (31% vs 57.1%; OR = 2.96, 95%CI: 1.06-8.28; P = 0.038). Our models, incorporating several risk variables, demonstrated moderate predictive ability for AILD recurrence. The AUCs were as follows: (1) Model 1 (AUC = 0.75, 95%CI: 0.58-0.87); (2) Model 2 (AUC = 0.74, 95%CI: 0.59-0.90); (3) Model 3 (AUC = 0.72, 95%CI: 0.58-0.88); and (4) Model 4 (AUC = 0.63, 95%CI: 0.40-0.76), with no statistically significant difference between the models (P = 0.488). Conclusion: Higher pre-transplant Child-Pugh and MELD scores, as well as ALT > 2 ULN, were associated with an increased risk of AILD recurrence. ©The authors ©Baishideng Publishing Group Inc.
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Optimizing nutrition in hepatic cirrhosis: A comprehensive assessment and care approach
(Baishideng Publishing Group, 2024)
Mendez-Guerrero, Osvely
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Carranza-Carrasco, Anaisa
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Chi-Cervera, Luis Alberto
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Torre, Aldo
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Navarro-Alvarez, Nalu
Cirrhosis is considered a growing cause of morbidity and mortality, which represents a significant public health problem. Currently, there is no effective treatment to reverse cirrhosis. Treatment primarily centers on addressing the underlying liver condition, monitoring, and managing portal hypertension-related complications, and evaluating the potential for liver transplantation in cases of decompensated cirrhosis, marked by rapid progression and the emergence of complications like variceal bleeding, hepatic encephalopathy, ascites, malnutrition, and more. Malnutrition, a prevalent complication across all disease stages, is often underdiagnosed in cirrhosis due to the complexities of nutritional assessment in patients with fluid retention and/or obesity, despite its crucial impact on prognosis. Increasing emphasis has been placed on the collaboration of nutritionists within hepatology and Liver transplant teams to deliver comprehensive care, a practice that has shown to improve outcomes. This review covers appropriate screening and assessment methods for evaluating the nutritional status of this population, diagnostic approaches for malnutrition, and context-specific nutrition treatments. It also discusses evidence-based recommendations for supplementation and physical exercise, both essential elements of the standard care provided to cirrhotic patients. © Baishideng Publishing Group
Scopus© Citations 3 7 1
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Galectin-3 as a Biomarker of Disease Severity in Acute-on-Chronic Liver Failure
(2020)
Cervantes-Álvarez, Eduardo
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Limón-de la Rosa, Nathaly
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Vilatoba, Mario
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Pérez-Monter, Carlos
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Hurtado-Gómez, Sahara
*Purpose: A matter of great importance is the discovery of alternative diagnostic measures that can detect liver disease at an early stage, especially when at risk of developing acute on chronic liver failure (ACLF), to optimize outcome and survival. Galectin-3 (Gal-3) is a lectin that binds to β-galactosides and can be secreted to the systemic circulation, regulating inflammation and fibrosis. Due to its direct role in inflammation and fibrosis, levels of this lectin can reflect the progression of liver damage and the possible consequent multiorgan failure, which is a distinctive characteristic of ACLF. The purpose of this study is to determine if liver Gal-3 expression is a useful biomarker of disease progression. *Methods: Liver samples from cirrhotic patients with compensated, decompensated cirrhosis and ACLF were collected at the time of liver transplant. The liver from donors was used as controls. RNA was extracted and liver Gal-3 expression was analyzed by quantitative polymerase chain reaction (qPCR). The values obtained were correlated with clinical and biochemical parameters using Pearson’s and Spearman’s correlation coefficients. A comparison among 3 different groups was performed using the Kruskal-Wallis test with Dunn’s multiple comparisons test.
51 2
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Liver transplantation is beneficial regardless of cirrhosis stage or acute-on-chronic liver failure grade: A single-center experience
(2022)
Cervantes-Álvarez, Eduardo
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Vilatoba, Mario
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Limón-de la Rosa, Nathaly
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Méndez-Guerrero, Osvely
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Kershenobich, David
Background: Liver transplantation for the most critically ill remains controversial; however, it is currently the only curative treatment option. Aim: To assess immediate posttransplant outcomes and compare the short (1 year) and long-term (6 years) posttransplant survival among cirrhotic patients stratified by disease severity. Methods: We included cirrhotic patients undergoing liver transplantation between 2015 and 2019 and categorized them into compensated cirrhosis (CC), decompensated cirrhosis (DC), and acute-on-chronic liver failure (ACLF). ACLF was further divided into severity grades. Our primary outcomes of interest were total days of intensive care unit (ICU) and hospital stay, development of complications and posttransplant survival at 1 and 6 years. ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Scopus© Citations 5 30 2
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Galectin‐3 is overexpressed in advanced cirrhosis and predicts post‐liver transplant infectious complications
(2022)
Cervantes‐Alvarez, Eduardo
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Limón-de la Rosa, Nathaly
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Vilatoba, Mario
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Pérez Nicomedes, Carlos
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Hurtado‐Gomez, Sahara
Background & aims: Patients with advanced cirrhosis often have immune dysfunction and are more susceptible to infections. Galectin-3 is a β-galactoside-binding lectin implicated in inflammation, immune regulation and liver fibrosis. We aim to investigate galectin-3 expression in advanced cirrhosis and its ability to predict post-transplant infectious complications. Methods: We collected sera and liver samples from 129 cirrhotic patients at the time of liver transplantation and from an external cohort of 37 patients with alcoholic liver disease including alcoholic hepatitis (AH) at the time of diagnosis. Galectin-3 was assessed by ELISA, real-time PCR, immunohistochemistry and RNA-seq. Receiver operating characteristic curves and Cox proportional-hazards regression analysis were performed to assess the predictive power of galectin-3 for disease severity and post-transplant infections.
Scopus© Citations 14 23 1
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Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit
(2021)
Méndez-Guerrero, Osvely
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Calle-Rodas, Daniel A.
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Cervantes-Álvarez, Eduardo
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Alatorre-Arenas, Elisa
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Pérez-Escobar, Juanita
Introduction and objectives: Acute on Chronic Liver Failure (ACLF) is characterized by organ failure and high 28-day mortality. Identifying clinical predictors associated with early mortality could have implications for the treatment of patients with ACLF. Patients and methods: Patients diagnosed with chronic liver failure that developed ACLF based on the EASL-CLIF Consortium definition admitted to the Intensive care unit of a tertiary hospital between 2012-2018 were included. Bivariate and multivariate Cox regression analyses were performed to identify factors associated with mortality. Copyright © 2020 Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U. All rights reserved.
Scopus© Citations 19 10 2

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