N Cuende

Hospital Virgen del Camino, Cádiz, Andalusia, Spain

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Publications (28)63.49 Total impact

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    ABSTRACT: To evaluate the results of liver transplantation (OLT) performed for hepatocellular carcinoma (HCC) among a multicenter cohort of patients with predefined common inclusion and priorization criteria. Over a 5-year period (January 2002-December 2006), 199 HCC patients underwent OLT in four centers in Andalusia. The morphological (Milan) inclusion criteria were priorized in two consecutive periods, according to the Model for End-stage Liver Disease score: group I, 53 patients (HCC < 2 cm = 24 points; > or = 2 cm or multinodular = 29 points) and group II, 146 cases (HCC < 3 cm without priorization; HCC > or = 3 cm or multinodular = 18 points). Among the 199 HCCs, 186 (93.5%) subjects were transplanted and 13 (6.5%) were excluded. There were 18 cases (9.7%) where the diagnosis was incidental and 168 were known HCC cases; 144 (85.7%) complied with the Milan criteria (Milan+); 24 (14.3%) exceeded there criteria (Milan-). According to preoperative imaging, the number of nodules and tumor mean sizes among the excluded-Milan+ and Milan- groups-were 1.8/5.3 cm, 1.4/3.5 cm, and 2.3/6.7 cm, respectively (P < .001). Percutaneous treatment during listing was delivered to 55% of the excluded cases: 49% of Milan+ and 96% of Milan-. The median time on the list was 88 days for known HCC (53 days for group I, and 97 days for group II), and 172 days for the incidental HCCs. Staging (pTNM) was correct in 64% of cases: 23% were understaged and 13% were overstaged. Overall mortality within the first 90 days was 9%, and transplant patient survival at 5 years was 61%. No differences were observed in survival rates between both study periods, although there were differences between the Milan+ (65%) and Milan- (23%) groups (P < .04). In addition, the difference in the recurrence rates was also significant between the Milan+ (7%), Milan- (24%), and the incidental (25%) groups (P < .02). A common priorization policy of HCC for OLT based on morphological criteria results in a low exclusion rate on the waiting lists (6.5%). The Milan criteria are still a good cutoff to stratify the risk of recurrence, despite preoperative tumor staging being correct in only two-thirds of cases.
    Transplantation Proceedings 04/2009; 41(3):1009-11. · 0.95 Impact Factor
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    N Cuende, M Alonso
    American Journal of Transplantation 10/2007; 7(9):2212-3. · 6.19 Impact Factor
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    ABSTRACT: This study analyzed the effect of population aging on organ donation for transplants in 43 countries and on the effectiveness of the donation process by comparing the results between Spain and the United States. The percentage of the population aged 65 or over accounted for 33% of the difference in the donation rates between the countries and for 91% of the variation in the rates after age adjustment. However, the level of aging of the Spanish (16.5%) and American (12.3%) populations failed to account for the percentages of deceased donors 65 or over (28% vs. 10%), due to the different age-specific donation rates, much higher in Spain above 50 years. These differences lead to a higher effectiveness of the process in the United States (3.1 transplanted organs per donor vs. 2.5 in Spain), though at lower rates of transplant per million population (73 vs. 87). We conclude that older populations have a greater donation potential as donation rates are strongly associated with population aging. It should therefore be mandatory to adjust donation rates for age before making comparisons. Additionally, effectiveness decreases with older donors, so age should be considered when establishing standards relating to organ donation and effectiveness of the process.
    American Journal of Transplantation 07/2007; 7(6):1526-35. · 6.19 Impact Factor
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    ABSTRACT: Prioritizing the liver transplant waiting list (WL) is subject to great variability. We present the experience of four transplant centers in Andalusia (Southern Spain) with a new consensus model of WL management based on the Model for End-Stage Liver Disease (MELD) score. The initial criteria for local prioritizing were: a) cirrhosis with MELD score > or =24, and b) all hepatocellular carcinoma (HCC) admitted to the WL. Fourteen months later new criteria were established: a) cirrhosis with MELD score > or =18, and b) uninodular HCC between 3-5 cm or multinodular HCC (2-3 nodules <3 cm). Access to regional priority was scheduled after three months for patients with cirrhosis or six months for patients with HCC. We analyzed the WL mortality rate, posttransplant survival rate, and overall survival rate over three 14-month periods: A (before implementation of priority criteria), B (initial criteria), and C (current criteria). Priority was given to 36% of recipients in period B and 47% in period C. The WL mortality rate (including removals from WL) was 12.9%, 12.9%, and 10.7% in periods A, B, and C, respectively. One-year graft survival was 79.7%, 72.6%, and 81.2% in the same periods. The overall one-year survival rate for new cases on the WL was 74.9% in period A, 68.6% in period B, and 82.2% in period C. The allocation system and WL management with the current criteria resulted in lower waiting list mortality without reducing posttransplant survival, leading to better survival for all patients listed.
    Transplantation 01/2007; 82(11):1429-35. · 3.78 Impact Factor
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    ABSTRACT: The 2 main indications for emergency liver transplantation are severe acute hepatic insufficiency and emergency retransplantation. In Spain, since the creation of the National Transplant Organisation (NTO), known as "the Spanish model," there have been high rates of donation, with a mean of 33.9 donors per million inhabitants in 2003 and 34.6 donors per million inhabitants in 2004. According to data provided by the NTO, there were 169 liver emergencies in the 2-year period 2003-2004. The time on the waiting list in an emergency situation was limited; 82.8% of cases were resolved in less than 48 hours. During this 2-year period, there were 2077 liver transplantations, including 128 emergence patients, which accounted for 6.1% of transplantations.
    Transplantation Proceedings 12/2005; 37(9):3878-80. · 0.95 Impact Factor
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    ABSTRACT: Organ availability is affecting the development of liver transplantation in its entirety, leading to transplant teams expanding the criteria for accepting organ donors. In these circumstances, analysis of the impact of the donor's characteristics on graft survival becomes mandatory. Fifty-two donor variables from 5,150 liver transplants performed in Spain between 1994 and 2001 were analyzed through a univariate analysis. Those with statistically significant impact on graft survival were entered in a Cox regression model with the recipients' characteristics and other factors linked to the graft technique. Several donor factors negatively affect graft survival: donor age, cause of death, body mass index, vasoactive drug administration, prolonged intensive care unit (ICU) stay, increased alkaline phosphatase and liver enzyme levels, low bicarbonate level, and antecedents of hypertension. However, only four can be mentioned as representing a risk for losing the graft when donor variables are controlled with recipient or technique variables in a Cox regression model: donor age, antecedents of hypertension, prolonged ICU stay, and low bicarbonate level. In the same analysis, norepinephrine administration has a relative risk less than 1. The multivariate analysis of the impact of 52 donor characteristics on liver graft survival showed the negative effect of an elderly donor, with hypertension combined with the presence of metabolic acidosis, or a prolonged ICU donor stay. The administration of norepinephrine alone during donor management showed a protective effect.
    Transplantation 06/2005; 79(10):1445-52. · 3.78 Impact Factor
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    ABSTRACT: The maintenance of an equitable system for access to transplantation is a matter of concern to all professionals involved in this field. Any national system must ensure equity. The rates of indication for liver transplantation have been reviewed for all Spanish regions. The time to transplantation was evaluated with respect to different recipient characteristics and donor rates. The indication rates for liver transplantation are similar in the different countries with liver transplant programs but are far from similar among different regions in Spain. This suggests that there is not equity in the access to liver transplantation. A review of the factors affecting the waiting times to transplantation after being registered for the waiting list shows that some groups of patients are currently waiting less time than others. Shorter waiting times occur in patients of the AB group, children, patients with hepatocarcinoma, and patients living in the zone of Valencia, despite similar organ donation rates in all transplant zones. Neither the rate nor the probability of liver transplantation is affected exclusively by the organ donation rate in Spain but also depends on the number of patients admitted to the waiting list. Despite the existence of an organ allocation system that is center-oriented, liver patients are receiving grafts mainly based on the severity of the illness, because clearance rates from the waiting list of both dead patients and grafted patients are the same.
    Transplantation 12/2003; 76(9):1398-403. · 3.78 Impact Factor
  • Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2003; 23 Suppl 5:32-41. · 1.27 Impact Factor
  • J F Cañón, N Cuende, B Miranda
    Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2003; 23 Suppl 5:42-9. · 1.27 Impact Factor
  • Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2003; 23 Suppl 5:1-5. · 1.27 Impact Factor
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    ABSTRACT: During recent years organ donation in Spain has increased by 100%, with important changes seen in the donor profile. Mean age has increased by more than 10 years, being nowadays more than 33% of our donors over 60 years. Ten years ago road traffic trauma was the main cause of death, while now most of our donors die due to stroke and only 21% die in a traffic accident. This changes lead to an increase in the number of kidneys discarded for transplantation every year. Among the 2517 kidneys retrieved during 2001, 567 were discarded, mainly due to different glomerular, interstitial or vascular pathologic damage. The older is the donor the higher is the percentage of kidneys discarded. It has to be underlined that an increased number of livers from donors, whose kidneys could not be used, are being grafted (141 in 2001 over 281 donors from whom no kidney could be grafted and over a total number of 1335 donors). Only 5% of kidneys were discarded due to technical problems. An important number of kidneys were discarded due to malignancy suspicion or diagnosis (12.3%). Organ donation has improved but kidney transplantation did not in parallel, due to the increasing number of kidneys discarded for transplantation in close relation with the evolution of donor's characteristics. Organ donation rate is around 33 donors per million population while efficient organ donation rate is around 30 donors per million. Only from 67% of donors both kidneys can be grafted and from 20% of donors no kidney can be used. These data will not change our policy, at least by the moment, we will continue to evaluate every potential brain death donor with the aim of studying if organs can be used. It is true that in 50% of cases over 70 years no organ can be used after retrieval and microscopic exam, but in the other 50% we can proceed.
    Annals of transplantation: quarterly of the Polish Transplantation Society 02/2003; 8(2):9-16. · 0.82 Impact Factor
  • Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2003; 23 Suppl 5:28-31. · 1.27 Impact Factor
  • Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2003; 23 Suppl 5:50-62. · 1.27 Impact Factor
  • J F Cañón, N Cuende, B Miranda
    Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2003; 23 Suppl 5:63-7. · 1.27 Impact Factor
  • Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2003; 23 Suppl 5:68-72. · 1.27 Impact Factor
  • Gastroenterología y Hepatología 01/2003; 26(6):355-75. · 0.57 Impact Factor
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    Gastroenterología y Hepatología 01/2003; 26(6). · 0.57 Impact Factor
  • Transplantation 05/2002; 73(8):1360. · 3.78 Impact Factor
  • Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2001; 21 Suppl 4:111-8. · 1.27 Impact Factor
  • Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2001; 21 Suppl 4:65-76. · 1.27 Impact Factor

Publication Stats

248 Citations
63.49 Total Impact Points

Institutions

  • 2007–2009
    • Hospital Virgen del Camino
      Cádiz, Andalusia, Spain
  • 2001–2005
    • Organización Nacional de Trasplantes (O.N.T)
      Madrid, Madrid, Spain
  • 2003
    • Hospital Universitario Reina Sofía
      Cordoue, Andalusia, Spain