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Author: search.filters.author.Navarro-Alvarez, Nalu

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    Item type:Publication,
    Risk factors for autoimmune liver disease recurrence after liver transplantation
    (Baishideng Publishing Group Inc., 2025)
    Salgado-de la Mora, Moisés
    ;
    Mendez-Guerrero, Osvely
    ;
    Torre, Aldo
    ;
    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
    ;
    Carranza-Carrasco, Anaisa
    ;
    Chi-Cervera, Luis Alberto
    ;
    Torre, Aldo
    ;
    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