Examinando por Autor "Gustavo Ayares"

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  • Miniatura
    Ítem
    Actualizaciones en el manejo general de pacientes postrasplante hepático y de sus complicaciones más frecuentes
    (2024) Luis Antonio Díaz; Alejandro Villalón; Gabriela Ochoa; Sergio García; Nicolás Severino; Gustavo Ayares; Francisco Idalsoaga; Martin Dib; Eduardo Briceño; Eduardo Viñuela; Jorge Martinez; Nicolás Jarufe; Ricardo Rabagliati; Luis Meneses; Pablo Muñoz-Schuffenegger; José Ignacio Vargas; Alberto Espino; María Magdalena Vera; Carlos Benítez; Rodrigo Wolff; Blanca Norero; Francisco Barrera; Alejandro Soza; Marco Arrese; Juan Pablo Arab
    El trasplante hepático (TH) es una terapia costo-efectiva para el tratamiento de las enfermedades hepáticas avanzadas. Aunque el TH mejora significativamente la supervivencia a largo plazo, requiere de un control estricto de la inmunosupresión y de las potenciales complicaciones. Entre los fármacos inmunosupresores destacan los corticoides, inhibidores de calcineurina, micofenolato, inhibidores de mTOR y los anticuerpos anti CD-25. Estos fármacos actúan especialmente sobre los linfocitos T, agotándolos, desviando su tráfico o bloqueando sus vías de respuesta. Las principales complicaciones post TH pueden ser renales, infecciosas, inmunológicas, biliares, vasculares, metabólicas, cardiovasculares y neoplásicas, especialmente los primeros meses post trasplante. Las infecciones son frecuentes y pueden ser causadas por bacterias, virus y hongos. Se debe considerar la profilaxis contra virus Herpes Simple, virus Varicela zoster, Citomegalovirus, Pneumocistys jirovecii, Candida spp. y Aspergillus spp. según la presencia de factores de riesgo. Entre las complicaciones inmunológicas, el rechazo celular agudo es frecuente (30% de los TH), pero habitualmente responde al tratamiento inmunosupresor. Asimismo, el rechazo crónico se presenta en el 3-17% de los TH y solo la mitad responde al incremento de inmunosupresión. El control de las etiologías de base es fundamental, especialmente en enfermedades autoinmunes e infecciones por virus hepatitis B y C. Se deben promover cambios de estilo de vida en todos los pacientes y evitar el consumo de alcohol (especialmente en trastorno por consumo de alcohol). Debido al mayor riesgo de cáncer, se debe vigilar activamente la aparición de neoplasias, así como de osteoporosis y otros trastornos metabólicos, en particular diabetes y enfermedad cardiovascular
  • Miniatura
    Ítem
    MELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis
    (2023) Luis Antonio Díaz; Eduardo Fuentes-López; Gustavo Ayares; Francisco Idalsoaga; Jorge Arnold; María Ayala Valverde; Diego Perez; Jaime Gómez; Rodrigo Escarate; Alejandro Villalón; Carolina A. Ramírez; Maria Hernandez-Tejero; Wei Zhang; Steve Qian; Douglas A. Simonetto; Joseph C. Ahn; Seth Buryska; Winston Dunn; Heer Mehta; Rohit Agrawal; Joaquín Cabezas; Inés García-Carrera; Berta Cuyàs; Maria Poca; German Soriano; Shiv K. Sarin; Rakhi Maiwall; Prasun K. Jalal; Saba Abdulsada; Fátima Higuera-de-la-Tijera; Anand V. Kulkarni; P. Nagaraja Rao; Patricia Guerra Salazar; Lubomir Skladaný; Natália Bystrianska; Ana Clemente-Sanchez; Clara Villaseca-Gómez; Tehseen Haider; Kristina R. Chacko; Gustavo A. Romero; Florencia D. Pollarsky; Juan Carlos Restrepo; Susana Castro-Sanchez; Luis G. Toro; Pamela Yaquich; Manuel Mendizabal; Maria Laura Garrido; Sebastián Marciano; Melisa Dirchwolf; Victor Vargas; César Jiménez; Alexandre Louvet; Guadalupe García-Tsao; Juan Pablo Roblero; Juan G. Abraldes; Vijay H. Shah; Patrick S. Kamath; Marco Arrese; Ashwani K. Singal; Ramon Bataller; Juan Pablo Arab
    Background & Aims: Model for End-Stage Liver Disease (MELD) score better predicts mortality in alcohol-associated hepatitis (AH) but could underestimate severity in women and malnourished patients. Using a global cohort, we assessed the ability of the MELD 3.0 score to predict short-term mortality in AH. Methods: This was a retrospective cohort study of patients admitted to hospital with AH from 2009 to 2019. The main outcome was all-cause 30-day mortality. We compared the AUC using DeLong’s method and also performed a timedependent AUC with competing risks analysis. Results: A total of 2,124 patients were included from 28 centres from 10 countries on three continents (median age 47.2 ± 11.2 years, 29.9% women, 71.3% with underlying cirrhosis). The median MELD 3.0 score at admission was 25 (20–33), with an estimated survival of 73.7% at 30 days. The MELD 3.0 score had a better performance in predicting 30-day mortality (AUC:0.761, 95%CI:0.732–0.791) compared with MELD sodium (MELD-Na; AUC: 0.744, 95% CI: 0.713–0.775; p = 0.042) and Maddrey’s discriminant function (mDF) (AUC: 0.724, 95% CI: 0.691–0.757; p = 0.013). However, MELD 3.0 did not perform better than traditional MELD (AUC: 0.753, 95% CI: 0.723–0.783; p = 0.300) and Age-Bilirubin-International Normalised Ratio- Creatinine (ABIC) (AUC:0.757, 95% CI: 0.727–0.788; p = 0.765). These results were consistent in competing-risk analysis, where MELD 3.0 (AUC: 0.757, 95% CI: 0.724–0.790) predicted better 30-day mortality compared with MELD-Na (AUC: 0.739, 95% CI: 0.708–0.770; p = 0.028) and mDF (AUC:0.717, 95% CI: 0.687–0.748; p = 0.042). The MELD 3.0 score was significantly better in predicting renal replacement therapy requirements during admission compared with the other scores (AUC: 0.844, 95% CI: 0.805–0.883). Conclusions: MELD 3.0 demonstrated better performance compared with MELD-Na and mDF in predicting 30-day and 90- day mortality, and was the best predictor of renal replacement therapy requirements during admission for AH. However, further prospective studies are needed to validate its extensive use in AH. Impact and implications: Severe AH has high short-term mortality. The establishment of treatments and liver transplantation depends on mortality prediction. We evaluated the performance of the new MELD 3.0 score to predict short-term mortality in AH in a large global cohort. MELD 3.0 performed better in predicting 30- and 90-day mortality compared with MELD-Na and mDF, but was similar to MELD and ABIC scores. MELD 3.0 was the best predictor of renal replacement therapy requirements. Thus, further prospective studies are needed to support the wide use of MELD 3.0 in AH. © 2023 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver