Inmaculada García-González

Hospital Universitario Virgen del Rocío, Hispalis, Andalusia, Spain

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Publications (6)4.12 Total impact

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    ABSTRACT: Our aim was to safely and effectively reduce adverse gastrointestinal (GI) events resulting from the use of mycophenolate mofetil (MMF) in liver transplant patients by switching to enteric-coated mycophenolate sodium (EC-MPS). We studied 19 patients on maintenance therapy presenting with GI intolerance to MMF whose therapy was switched to EC-MPS. The variables recorded were: calcineurin inhibitor (CNI) dose levels, MMF/EC-MPS dose levels, lipid profile, hematology, renal and hepatic function markers, and rejection episodes. These variables were recorded at the visit prior to the day of conversion, on the day of conversion, and 1, 3, 6, and 9 months thereafter. Of the 19 patients, 16 were men (mean age, 56.6 +/- 15.9 years) and 3 were women (58.3 +/- 12.1 years). While 31.6% were on MMF monotherapy, 52.6% were on combined therapy with tacrolimus and 15.8% with cyclosporine. On the day of conversion, 21% were not on MMF, 36.8% were on 1000 mg/d, 26.3% were on 1500 mg/d, 5.3% were on 750 mg/d, and 10.6% were on 500 mg/d. The starting daily doses of EC-MPS were: 360 mg (26.3%), 720 mg (31.6%), 540 mg (26.3%), 1080 mg (10.5%), and 1440 mg (5.3%). GI complications were significantly reduced from the first month postconversion (P < .01), as 57.2% of patients did not display any symptoms; however, at 9 months, this incidence rose by 12% relative to month 1 (P < .05). There were no changes in the other variables and there were no reported rejection episodes. Treatment was suspended in 2 patients due to dyspnea and nervousness. In liver transplant patients with GI complications from chronic MMF use, the use of EC-MPS was safe and efficacious, as it significantly reduced their incidence.
    Transplantation Proceedings 01/2009; 41(6):2192-4. · 0.95 Impact Factor
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    ABSTRACT: Summary Background: Aneurysm of the hepatic artery is relatively infrequent, representing 16-20% of aneurysms of the visceral arteries. Clinical presentation is nonspecific and may include abdominal pain, upper digestive system hemorrhage, or obstructive jaundice, as in the case presented here. Clinical case: We present the case of a 47-year-old patient referred to our service due to obstructive jaundice, verifying that the pathology was caused by an aneurysm of >7 cm in diameter in the hepatic artery. Despite elective treatment and intensive collaboration of different surgical specialists, the patient's evolution was poor. Conclusions: These types of aneurysms occur infrequently and with an uncertain prognosis. Therefore, individualized treatment for each case is necessary. We must carefully select the approach that fits the needs of our patient. The endovascular approach is often currently used. However, because of the complexity of the location of the injury, in some cases it is impossible and surgical intervention is necessary with trained hepatobiliary and vascular surgeons.
    01/2008;
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    ABSTRACT: Aneurysm of the hepatic artery is relatively infrequent, representing 16-20% of aneurysms of the visceral arteries. Clinical presentation is nonspecific and may include abdominal pain, upper digestive system hemorrhage, or obstructive jaundice, as in the case presented here. We present the case of a 47-year-old patient referred to our service due to obstructive jaundice, verifying that the pathology was caused by an aneurysm of >7 cm in diameter in the hepatic artery. Despite elective treatment and intensive collaboration of different surgical specialists, the patient's prognosis was poor. These types of aneurysms occur infrequently and with an uncertain prognosis. Therefore, individualized treatment for each case is necessary. We must carefully select the approach that fits the needs of our patient. The endovascular route is often currently used. However, because of the complexity of the location of the injury, in some cases it is impossible and surgical intervention is necessary with trained hepatobiliary and vascular surgeons.
    Cirugia y cirujanos 01/2008; 76(3):253-6. · 0.32 Impact Factor
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    ABSTRACT: Our objective was establish a scoring system that allows a donor to be evaluated quickly and easily using a set of variables that are evaluated prior to the donation and another set that are evaluated during surgery. Prior to the donation we analyzed age, medication requirements, natremia, hepatic biochemistry, gas levels, days in ICU, history of hypertension, and weight. A value of 40% was allocated to this group of factors. During the transplant we assessed the characteristics of the organ-shine, consistency, surface, edge, color, presence of steatosis, and atheromatosis. A value of 60% was allocated to this set. We established a scale of 1 to 10, only accepting organs scoring 5 or more points. Those grafts that received a score between 5 and 7.5 points were called suboptimal and those with over 7.5 points, optimal. We prospectively analyzed 133 donors whose organs were implanted. The survival rate at 1 year was 85%, and the rejection rate was 12%. The incidence of primary graft dysfunction was 8.2% (n = 11) and that of primary graft nonfunction 2.2% (n = 3). The incidence of primary graft dysfunction was greater within the group with fewer points (suboptimal). There were no differences between the optimal and suboptimal groups in terms of primary malfunction, survival, or rejection rate. The score provided a guide to decide whether to accept viable organs for implantation, given that the point system was obtained quickly and easily. When greater than 5, it correlated with low rates of primary nonfunction (<3%) and of primary graft dysfunction (<15%), with acceptable survival at 1 year (>80%) and acute rejections rate (<15%).
    Transplantation Proceedings 11/2006; 38(8):2382-4. · 0.95 Impact Factor
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    ABSTRACT: Hepaticojejunostomy is a good alternative technique for biliary reconstruction in liver transplantation. Among 517 liver transplants performed between March 1992 and July 2005, 33 involved hepaticojejunostomy, namely, 18 men and 12 women of average age: 44.8 years. The main cause for this technique was retransplant (n = 10), secondary biliary cirrhosis (n = 5), alcoholic cirrhosis (n = 5), HCV cirrhosis (n = 2), primary biliary cirrhosis (n = 1), cryptogenic cirrhosis (n = 1), sclerosing cholangitis (n = 3), fulminant liver failure (n = 1), autoimmune cirrhosis (n = 1), and insulinoma metastasis (n = 1). Choledochojejunostomy was performed for all Roux-en-Y loops, with an average cold ischemia time of 361.16 minutes (180-780). The biliary complications were biliary fistula in four cases (13.3%), including two who required surgery; stenosis of the anastomosis in two cases (6.6%) including one diagnosed by HIDA that resolved with medical treatment and the other, diagnosed by cholangio-MRI, requiring a new hepaticojejunostomy; and biliary peritonitis in three cases (10%), all of whom required surgery. The vascular complications were thrombosis of the hepatic artery (n = 1), which required retransplantation, and pseudoaneurysm of hepatic artery (n = 1). No biliary complications occurred. The 6-month patient survival was 80% and the 6-month graft survival was 77%; no patient died due to biliary complications. Hepaticojejunostomy is a technique with higher morbidity than choledocho-choledochostomy, but it is the best alternative when the latter is not possible.
    Transplantation Proceedings 11/2006; 38(8):2471-2. · 0.95 Impact Factor
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    ABSTRACT: To report our experience with mycophenolate mofetil (MMF) for induction and maintenance therapy to prevent acute liver transplant rejection. A retrospective analysis of 66 elective, noncombined liver transplant patients treated beginning de novo MMF and follow for a minimum of 2 years. Thirty-nine of the 66 cases received MMF, calcineurin inhibitors, and steroids. In 11 cases daclizumab was added; in 16 daclizumab was added without steroids. The global survival rate was 91% at 6 months, 89.4% at 1 year, and 87.9% after 2 years. Acute rejection episodes were observed in six patients (9.1%). All episodes responded to corticoids. Toxicity possibly, probably, or partially related to MMF was observed in 35 patients (53%) with definitive suspension required in 13 cases (20%), with dose reduction or temporary suspension in 22 (33%). Hematological toxicity associated with MMF was observed in 12 patients (18%), leading to definitive suspension in two patients (3.03%), temporary suspension in two cases (3.03%), and dose reduction in eight cases (12%). Opportunistic infection was observed in seven cases (10%). Gastrointestinal toxicity was mild and infrequent (five cases, 7.5%). Regimens containing MMF reduce rejection episodes with high survival rates and low toxicity.
    Transplantation Proceedings 12/2005; 37(9):3926-9. · 0.95 Impact Factor