V. Aguilera

Hospital Universitari i Politècnic la Fe, Valenza, Valencia, Spain

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Publications (108)540.99 Total impact

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    ABSTRACT: Conclusions: HIV infection had no impact on recurrence of HCC or survival after LT. Our results support the indication of LT in HIV-infected patients with HCC. This article is protected by copyright. All rights reserved.
    Hepatology 10/2015; DOI:10.1002/hep.28321 · 11.06 Impact Factor
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    ABSTRACT: Introduction. To assess the clinical profile and management of patients with hepatitis C (HCV) infection in an observational study in Spanish hospitals. Methods. The study included an initial cross-sectional phase (study phase I), in which investigators at 48 hospitals from 14 Spanish regions collected data from approximately 20 consecutive patients each (a total of 1,000 patients) to assess the general features of HCV-infected patients of any genotype. During the second phase (study phase II), data from 878 patients that were infected exclusively with genotype 1 HCV were assessed retrospectively. Eight pre-defined clinical profiles were established, in order to assess clinical and previous treatments characteristics. Results. Among the HCV-infected individuals that were analysed during the first part, HCV genotype 1 was found to be predominant (with a prevalence of 76.6%), prevailing the subtype 1b (69.8%), with other significant groups infected by genotype 3 (12.3%) and 4 (7.4%). In the second part of the study, 44% of the HCV genotype 1-infected patients were at a F3/F4 fibrosis stage. 15.9% had never been treated, and previously unsuccessfully treated patients that were no longer receiving anti-HCV treatment accounted for 50.8% of cases. Individuals with a sustained virologic response (SVR) to previous dual therapies (based on Interferon and Ribavirin) were only 14.5% and patients under treatment during the study accounted for the remaining 18.8%. A total of 713 patients (81.2%) in the second phase were not receiving any type of therapy over the period analysed, mainly due to the anticipation of new anti-HCV drugs (41.8%), SVR achievement (17.8%) and unresponsiveness to therapies available at the time of the study (9.5%). Conclusions. HCV genotype 1, predominately 1b, is the most prevalent type in Spain. Advanced fibrosis or cirrhosis is frequent in this group, mainly patients not yet cured.
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    ABSTRACT: Background & Aims: Cardiovascular (CV) events represent major impediments to liver transplant (LT) long-term survival. The aim was to assess whether the Framingham risk score (FRS) at transplantation can predict the development of post-LT CV events.Methods: Patients transplanted between 2006 and 2008 were included. Baseline features, CV risk factors and CV events occurring post-LT (ischemic heart disease, stroke, heart failure, de novo arrhythmias, peripheral arterial disease) were recorded.Results: 250 patients, 69.5% men, median age 56 (range 18-68) yrs were included. At transplantation, 34.5%, 32.5% and 33% of patients respectively had a low, moderate and high FRS, with a median FRS of 15 (range: .09 – 30). 14% of LT recipients developed at least one CV event at a median of 2.5 (range: 0.005 - 7) yrs. In the univariate analysis, factors associated with the development of CV events were continuous-FRS at LT (p= .003), age (p= .007), creatinine clearance (eGFR) (p= .020) and MMF use at discharge (p=.011). In the multivariate analysis, only the eGFR (HR: .98, 95/CI: .97-1.00; p= .009) and FRS (HR: 1.06, 95/CI: 1.02-1.10, p= .002) remained in the model. Moreover, an association was also found between the FRS and overall survival (p= .014) with a 5 yr-survival rate of 82.5%, 78% and 61.5% in the low, moderate and high-risk groups, respectively. Continuous-FRS, eGFR and HCV infection were independent risk factors of overall mortality.Conclusions: In our series, the FRS and eGFR at LT were able to predict the development of post-LT CV events and poor outcome. This article is protected by copyright. All rights reserved.
    Liver Transplantation 03/2015; 21(6). DOI:10.1002/lt.24128 · 4.24 Impact Factor
  • V Aguilera ·
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    ABSTRACT: Chronic hepatitis C (CHC) is an important cause of cirrhosis and hepatocellular carcinoma and a common indication of liver transplantation (LT). Recurrence of hepatitis C occurs universally after LT with an accelerated course of the natural history of CHC in the graft. Treatment of hepatitis C before transplantation is the most effective strategy because it prevents graft reinfection, but applicability is low with pegylated interferon regimens. Treatment after LT is the strategy more frequently used. A sustained viral response (SVR) is achieved by one-third of those treated with dual therapy and is associated with better outcomes after LT. Triple therapy with protease inhibitors after LT has efficacy to 60%-70% of SVR but is associated with higher rates of secondary effects and drug-drug interactions that require an intensified and frequent monitoring of calcineurin inhibitors during treatment. In the near future, interferon-free regimens with new oral antiviral drugs will likely prevent viral reinfection before or after LT, and shorter treatment regimens and less toxicity are expected.
    Transplantation Proceedings 11/2014; 46(9):3100-3. DOI:10.1016/j.transproceed.2014.09.177 · 0.98 Impact Factor
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    ABSTRACT: To evaluate the results of the treatment with pegylated interferon and ribavirin for recurrence of hepatitis C after liver transplantation in HCV/HIV-coinfected patients.
    Journal of Hepatology 08/2014; DOI:10.1016/j.jhep.2014.07.034 · 11.34 Impact Factor

  • Journal of Hepatology 04/2014; 60(1):S378. DOI:10.1016/S0168-8278(14)61071-0 · 11.34 Impact Factor

  • Journal of Hepatology 04/2014; 60(1):S372. DOI:10.1016/S0168-8278(14)61055-2 · 11.34 Impact Factor

  • Journal of Hepatology 04/2014; 60(1):S490. DOI:10.1016/S0168-8278(14)61367-2 · 11.34 Impact Factor

  • Journal of Hepatology 04/2014; 60(1):S463. DOI:10.1016/S0168-8278(14)61303-9 · 11.34 Impact Factor
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    ABSTRACT: Hepatitis C virus (HCV) is associated with renal complications. We aimed to determine whether sustained viral response (SVR) is associated with improvement in renal function in HCV-treated liver transplant (LT) recipients. Methods: Changes in renal function were compared 1, 3 and 5 years post-therapy as a function of pre-treatment stage of chronic kidney disease (CKD). In addition, variables associated with renal dysfunction (RD, MDRD-4 ≤ 60 mL/min/1.73 m(2) ) at last follow-up were evaluated in all treated LT patients with a minimum follow up of at least one year since end-of-treatment (n=175). Results: Of 99 patients with pre-treatment CKD stage 2 (MDRD-4 60 - 90 mL/min/1.73 m(2) ), improvement in renal function was observed in SVR patients more frequently than in non-responders. Median pre-treatment, 1, 3 and 5 years post-treatment MDRD-4 values were 71.8, 70,4, 79.4 and 82.1 in SVRs vs 76.2, 72.2, 73.9 and 66.1 in NRs (p=0.17, 0.61, 0.15 and 0.005, respectively). The median changes in MDRD-4 from pre-treatment to 1, 3 and 5 years post-treatment were -0.5, 4.5 and 9.4 in SVR vs -1, -0.3 and -1.5 in NR (p=0.61, 0.06 and 0.004, respectively). RD was present in 54 out of the 175 (31%) patients at last follow up, at a median of 3.8 years since end of therapy (range: 1-9 years). Follow up did not differ between SVR and NR. RD was present at last follow-up in 19% of SVR vs 40% of NR (p=.002). In the multivariate analysis, RD (MDRD-4 ≤ 60 mL/minute/1.73 m(2) ) at last follow up was associated with non-response (RR: 3.8, 95% CI: 1.3-11.23; p=.014), end-of-treatment MDRD-4 (RR: 1.022, 95% CI: 1.001-1.04; p=.044) and female gender (RR: 5.6; 95% CI: 1.84-17.5; p=.002). Conclusions: SVR leads to improved renal function in HCV-infected LT recipients with pre-treatment stage 2 CKD This improvement is not immediate following therapy. Liver Transpl , 2013. © 2013 AASLD.
    Liver Transplantation 01/2014; 20(1). DOI:10.1002/lt.23756 · 4.24 Impact Factor
  • Carmen Vinaixa · Victoria Aguilera · Marina Berenguer ·
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    ABSTRACT: Recent approval of new protease inhibitors (boceprevir and telaprevir) for the treatment of chronic hepatitis C, genotype 1, has meant a significant increase in the sustained viral response both in naive and previously treated patients. However, such efficacy increase has been accompanied by an increase in adverse events, sometimes serious, and new practical issues including different approaches to stop treatment and drug interactions that recommend a close follow-up of patients. The efficacy and safety of triple therapy in special populations such as cirrhotic and transplanted patients is less known and has some particulars, meaning that its administration requires an exhaustive monitoring.
    Medicina Clínica 11/2013; 141(10):447–452. DOI:10.1016/j.medcli.2013.01.041 · 1.42 Impact Factor
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    ABSTRACT: Haemophagocytic syndrome (HS) is a rare disease that is often fatal despite treatment. HS is characterized by fevers, lymphadenopathy, hepatosplenomegaly, cytopenias and hyperferritinaemia due to deregulated activation and proliferation of macrophages, leading to uncontrolled phagocytosis of platelets, erythrocytes, lymphocytes, and their hematopoietic precursors throughout the reticuloendothelial system. Mycobacterium tuberculosis-associated HS is a rare and underdiagnosed association with only 39 cases reported. We describe a case of HS associated with disseminated Mycobacterium tuberculosis in the setting of post-liver transplantation anti-hepatitis C therapy with pegylated interferon (pegIFN), ribavirin (RBV) and telaprevir (TVR). Despite the delay in the etiologic diagnosis, the patient was treated properly with corticosteroids, cyclosporine and tuberculostatic agents. It is unknown whether telaprevir, a drug that only recently has been started off-label in liver transplant recipients, may have contributed to the development of the HS. Unfortunately, as in many reported cases of HS, the outcome was unfavourable resulting in the death of the patient.
    Annals of hepatology: official journal of the Mexican Association of Hepatology 11/2013; 12(6):974-978. · 2.07 Impact Factor
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    ABSTRACT: There are few studies focusing on long-term complications in liver transplant (LT) recipients. The aim of this study was to define the outcome of LT recipients having survived at least 10 years from LT. Of 323 adult LT done between 1991 and 1997, the 167(52%) alive >10 years post-LT (baseline time) formed the study population. Long-term outcome measures included the following: immunosuppression, metabolic complications [obesity, arterial hypertension (AH), diabetes, dislypidemia], cardiovascular events (CVE), chronic renal dysfunction-CRD, and de novo tumors. Median age at LT was 50 years. Most common indication was postnecrotic cirrhosis (89%), mostly because of HCV (46%). At study-baseline (10 years post-LT), 29% were obese and AH, diabetes, dislypidemia, and CRD were present in 75%, 30%, 42%, and 36%, respectively. In most cases, these complications were already present 1 year post-LT; less than one quarter developed them onward. The 6 year cumulative survival since baseline reached 84% (n = 24 deaths), with most deaths related to recurrent graft diseases (mostly HCV) followed by de novo tumors or CVE. 1, 3, 5 and 10 years cumulative rates of CVE and de novo tumors since baseline were 2%, 5%, 10% and 17%, and 1%, 3%, 6% and 13%, respectively. Chronic renal impairment was independently associated with survival and development of CVE since baseline. The medium-term survival of 'long-term survivors', i.e. patients alive 10 years after LT is good, but metabolic complications and CRD are common and continue to increase afterwards. Cardiovascular events and de novo tumors increase gradually over time and represent a major cause of late mortality.
    Transplant International 04/2013; DOI:10.1111/tri.12118 · 2.60 Impact Factor

  • Journal of Hepatology 04/2013; 58:S497. DOI:10.1016/S0168-8278(13)61226-X · 11.34 Impact Factor

  • Journal of Hepatology 04/2013; 58:S377. DOI:10.1016/S0168-8278(13)60917-4 · 11.34 Impact Factor

  • Journal of Hepatology 04/2013; 58:S101-S102. DOI:10.1016/S0168-8278(13)60238-X · 11.34 Impact Factor
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    ABSTRACT: BACKGROUND: Chronic renal impairment is an emerging problem in the management of patients after liver transplantation (LT). METHODS: We prospectively analyzed predictors of chronic kidney disease (CKD) after LT in 179 patients followed for a median of 63 months. Diagnosis of CKD was based on an estimated glomerular filtration rate (GFR) of less than 60 mL/min according to the current position statement from the Kidney Disease Improving Global Outcome. Pretransplantation risk factors were evaluated. A Cox regression analysis, with time-dependent variables evaluated during follow-up, was applied to realize a prognostic model for CKD, and a prognostic index was also calculated. The validity of the model was tested in 149 independent LT patients with a median follow-up of 46 months. RESULTS: The cumulative incidence of CKD was 45% at 5 years after LT. Estimated GFR at LT was the only pretransplantation independent risk factor (beta, 0.33; standard error (beta), 0.07; 95% confidence interval, 0.95-0.98). Development of arterial hypertension (hazards ratio [HR], 1.83), episodes of severe infection (HR, 2.15), and estimated GFR (HR, 0.89) after LT were identified as independent prognostic factors at the Cox regression time-dependent analysis. The model was able to identify the patients at higher risk for the development of CKD in the validation set. CONCLUSIONS: Lower renal function at transplantation is associated with a higher risk of CKD after transplantation. A predictive model based on the variation of posttransplantation variables during the course of follow-up can help the clinicians to estimate the probability of CKD in the next 12 months.
    Transplantation 03/2013; 95(9). DOI:10.1097/TP.0b013e3182884890 · 3.83 Impact Factor
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    Carmen Vinaixa · Angel Rubín · Victoria Aguilera · Marina Berenguer ·
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    ABSTRACT: Recurrence of hepatitis C virus (HCV) infection following liver transplantation is a major source of morbidity and mortality. The natural history of hepatitis C in the transplant setting is shortened. Overall, one third of HCV-infected recipients have developed allograft cirrhosis due to HCV recurrence by the 5(th)-7(th) year post-transplantation. The most significant variables which determine disease progression are the use of organs from old donors, the use of an inadequate immunosuppression (too low, inducing treatment rejection episodes, too potent or too rapidly changing), and the presence of comorbid conditions that also impact the quality of the graft (biliary complications, metabolic syndrome). The only factor consistently shown to modify the natural history of recurrent disease is antiviral therapy. A sustained viral response, achieved by one third of those treated with dual therapy, is associated with improved histology, reduced liver-related complications and increased survival. Variables associated with enhanced viral response with dual therapy include an adequate genetic background (IL28B C/C of both donor and recipient), good treatment adherence (full doses of ribavirin, treatment duration), lack of graft cirrhosis at baseline, and viral genotype non-1. Data with triple therapy are encouraging. Response rates of about 60% at end-of-therapy have been described. Drug-drug interactions with calcineurin inhibitors are present but easily manageable with strict trough levels monitoring. Side effects are frequent and severe, particularly anemia, infections and acute renal insufficiency. In the future new oral antivirals will likely prevent viral reinfection. In this review, we will cover the most significant but also controversial aspects regarding recurrent HCV infection, including the natural history, retransplantation, antiviral therapy, and outcome in HIV-HCV patients.
    Annals of Gastroenterology 03/2013; 26(4):304-313.
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    ABSTRACT: Introduction. Combined liver-kidney transplantation (LKT) is the best therapeutic option for patients with end-stage liver and kidney disease. Objectives. To analyze baseline characteristics and clinical outcome of LKT compared to isolated liver transplantation (LT). Material and methods. The study included 16 LKT performed between 1998 and 2006 and 32 LT matched by age, sex, date and indication for transplantation. Demographic, pretransplant, post-transplant and survival variables were analyzed. Results. As planned by the study design, mean age, distribution by sex and indication for LT were similar between groups. The most common indication for LT was HCV- and/or alcohol-induced cirrhosis. The most common indication for KT was renal failure, in most cases secondary to glomerulonephritis. Twelve patients (69%) were on dialysis before LKT. Hepatocellular carcinoma and diabetes mellitus pre-transplantation were similar between groups. However pretransplant arterial hypertension (AHT) was higher in LKT than LT (50% vs. 19%; p = 0.02). In the post-transplant: reoperation due to bleeding, bacterial infections, liver rejection, AHT and median creatinine levels at 1st and 3rd years were similar in LKT and LT. In contrast, early post-transplant dialysis was higher in LKT than LT (31% vs. 3%; p = 0.01). Survival rates at 1st, 3rd, 5th and 7th years were similar in both groups (87.5%, 74%, 74% and 66% vs. 81%, 75%, 75% and 75% in LT and LKT, respectively). Conclusions. LKT is an effective therapeutic option in patients with end-stage liver and kidney disease. Most early and late complications and long-term survival are similar to those observed with LT.
    Annals of hepatology: official journal of the Mexican Association of Hepatology 03/2013; 12(2):274-81. · 2.07 Impact Factor
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    ABSTRACT: AbstractA sustained virological response (SVR) is achieved by 30% of naive liver transplantation (LT) recipients treated with pegylated interferon (PEG‐IFN) and ribavirin (RBV). Almost no data are available about retreatment. The aim of this study was to assess the efficacy, tolerability, and SVR predictors of retreatment. Data were collected from 4 centers on the retreatment of prior nonresponders to standard therapy or PEG‐IFN (with or without RBV) and relapsers. Seventy‐nine of 301 treatment‐experienced LT patients (26%), who had a median age of 59 years (range = 35‐77 years) and were mostly male (72%) and infected with genotype 1 (87%), were retreated with PEG‐IFN and RBV at a median of 6.9 years after LT. During the first course of therapy, 35% were treated with interferon, 49% received tacrolimus, 52% received steroids, and 49.5% were relapsers. Retreatment was started at a median of 1.9 years (range = 45 days to 8.2 years) after the end of the first course. The proportion of patients with cirrhosis increased from 10% to 37% (P P = 0.03), growth factors [erythropoietin (P P = 0.048)], and transfusions (P = 0.03) were used more frequently, and the treatment duration was longer (P = 0.03). An end‐of‐treatment response was achieved in 61%, whereas SVR, which was associated with improved survival, occurred in 28 (35%). The variables predicting SVR were age (P = 0.04), disease severity [fibrosis (50% with F0‐F2 versus 26% with F3‐4), P = 0.03; bilirubin, P = 0.006; platelet count, P = 0.03], adherence, and viral kinetics. None of the patients without an early virological response achieved SVR. There was a trend of prior relapsers achieving higher SVR rates than prior nonresponders. In conclusion, SVR, which was achieved by approximately one‐third of the retreated patients, can be predicted with the same variables used for naive LT recipients (age, disease severity, adherence, and viral kinetics) and is associated with enhanced survival. Liver Transpl 19:69–77, 2013. © 2012 AASLD.
    Liver Transplantation 01/2013; 19(1). DOI:10.1002/lt.23555 · 4.24 Impact Factor

Publication Stats

1k Citations
540.99 Total Impact Points


  • 2000-2015
    • Hospital Universitari i Politècnic la Fe
      • • Department of Hepatogastroenterology
      • • HepatoGastroenterology Service
      • • Servicio de Medicina Digestiva
      Valenza, Valencia, Spain
    • Colegio Oficial de Médicos de Valencia
      Valenza, Valencia, Spain
  • 2010-2013
    • Instituto de Salud Carlos III
      Madrid, Madrid, Spain
    • University of Concepción
      • Facultad de Medicina
      Ciudad de Concepcion, Biobío, Chile
  • 2009-2012
    • Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas
      Barcino, Catalonia, Spain
  • 2011
    • University of Antofagasta
      • Facultad de Ciencias Básicas
      Antofagasta, Antofagasta, Chile
  • 2008
    • University of Valencia
      Valenza, Valencia, Spain