Browsing by Author "Soza, Alejandro"
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Item A changing etiologic scenario in liver transplantation for hepatocellular carcinoma in a multicenter cohort study from Latin America(2018) Pinero, Federico; Costa, Paulo; Longatto Boteon, Yuri; Hoyos Duque, Sergio; Marciano, Sebastián; Anders, Margarita; Varóng, Adriana; Zerega, Alina; Poniachik, Jaime; Soza, Alejandro; Padilla Machaca, Martín; Menéndez, Josemaría; Zapata, Rodrigo; Vilatoba, Mario; Muñoz, Linda; Maraschio, Martín; Podestá, Luis G.; McCormack, Lucas; Gadano, Adrian; Boinc, Ilka S.F. Fatima; García, Parente; Silva, Marcelo; On behalf of the Latin American Liver Research, Education, Awareness Network (LALREAN)Background and aim: Non-alcoholic fatty liver disease (NAFLD) is an increasing cause of hepatocellular carcinoma (HCC) and liver transplantation (LT). Our study focused on changing trendsof liver related HCC etiologies during the last years in Latin America. Methods: From a cohort of 2761 consecutive adult LT patients between 2005 and 2012 in 17 different centers, 435 with HCC were included. Different periods including years 2005—2006, 2007—2008, 2009—2010 and 2011—2012 were considered. Etiology of liver disease was confirmed in the explant. Results: Participating LT centers per country included 2 from Brazil (n = 191), 5 transplant programs from Argentina (n = 98), 2 from Colombia (n = 65), 4 from Chile (n = 49), 2 from Mexico (n = 12), and 1 from Peru (n = 11) and Uruguay (n = 9). Chronic hepatitis C infection was the leading cause of HCC in the overall cohort (37%), followed by HBV (25%) and alcoholic liver disease (17%). NAFLD and cryptogenic cirrhosis accounted for 6% and 7%, respectively. While HCV decreased from 48% in 2005—06 to 26% in 2011—12, NAFLD increased from 1.8% to 12.8% during the same period, accounting for the third cause of HCC. This represented a 6-fold increase in NAFLD-HCC, whereas HCV had a 2-fold decrease. Patients with NAFLD were older, had lower pre-LT serum AFP values and similar 5-year survival and recurrence rates than non-NAFLD. Conclusion: There might be a global changing figure regarding etiologies of HCC in Latin America. This epidemiological change on the incidence of HCC in the world, although it has been reported, should still be confirmed in prospective studies.Item An update on the management of hepatitis C: Guidelines for protease inhibitor-based triple therapy from the Latin American Association for the Study of the Liver(2013) Chávez-Tapia, Norberto C.; Ridruejo, Ezequiel; Alves de Mattos, Angelo; Bessone, Fernando; Daruich, Jorge; Sánchez-Ávila, Juan F.; Cheinquer, Hugo; Zapata, Rodrigo; Uribe, Misael; Bosques-Padilla, Francisco; Gadano, Adrián; Soza, Alejandro; Dávalos-Moscol, Milagros; Marroni, Claudio; Muñoz-Espinoza, Linda; Castro-Narro, Graciela; Paraná, Raymundo; Méndez-Sánchez, NahumHepatitis C is a common cause of end-stage liver disease, and the main indication for liver transplantation in Latin America. Treatment of hepatitis C infected patients improves important long-term outcomes as mortality. Sustained viral response is reached in near 50% of patients with the previous management based in pegylated interferon and ribavirin. Recently new drugs were available increasing sustained viral response significantly, changing the standard of care to triple therapy. This guidelines provides a framework for practitioner in Latin America, to the management of patients with hepatitis C chronic infection.Item Infectious and non‑infectious diseases burden among Haitian immigrants in Chile: a cross‑sectional study(2020) Fuster, Francisco; Peirano, Felipe; Vargas, José Ignacio; Zamora, Francisco Xavier; López‑Lastra, Marcelo; Núñez, Ruth; Soza, Jacinta; González, Katherine; Estay, Denisse; Barchiesi, Beatrice; Fuster, Antonieta; López, Ignacia; Utrera, Nicolás; Landeros, Jorge; Chandía, Javiera; Paredes, Angela; Reyes, Daniela; Arias, Rodrigo; Padilla, Luis; Suárez, Hernán; Farcas, Katia; Cannistra, Macarena; Muñoz, Geraldine; Rodríguez, Ignacio; Ormazábal, Ivana; Cortés, Josefina; Cornejo, Bárbara; Manzur, Franco; Reyes, Antonia; Leiva, Vicente; Raimann, María Victoria; Arrau, Catalina; Cox, Valentina; Soza, AlejandroChile has become a popular destination for migrants from South America and the Caribbean (lowand middle-income countries migration). Close to 200.000 Haitian migrants have arrived in Chile. Infectious and non-infectious disease burden among the Haitian adult population living in Chile is unknown. This study aimed to acquire the basic health information (selected transmissible and nontransmissible conditions) of the Haitian adult population living in Chile. A cross-sectional survey was performed, inviting Haitian-born residents in Chile older than 18 years old. Common conditions and risk factors for disease were assessed, as well as selected transmissible conditions (HIV, HBV, and HCV). 498 participants (60.4% female) from 10 communities in two regions of Chile were surveyed. Most subjects had never smoked (91.5%), and 80% drank less than one alcohol unit per month. The mean BMI was 25.6, with 45% of participants having a normal BMI (20–25). Hypertension was present in 31.5% (33% in the 25–44 age group). Prevalence of HIV was 2.4% (95 CI 1.3–4.2%), hepatitis B (HBsAg positive) was 3.4% (95 CI 2.1–5.5%), and hepatitis C was 0% (95 CI 0.0–0.9%). Quality of life showed a significant prevalence of depression and anxiety markers, particularly in those arriving in Chile less than 1 year ago. Low prevalence of obesity, diabetes, smoking, and drinking and estimated cardiovascular risk were found. Nonetheless, hypertension at a younger age, disproportionately higher prevalence of HIV and HBV infection and frequent markers of anxiety and depression were also found. Public policies for detecting and treating hypertension, HIV, and HBV screening, offering HBV vaccination, and organizing mental health programs for Haitian immigrants, are urgently needed.Item Liver transplantation for hepatocellular carcinoma: evaluation of the alpha-fetoprotein model in a multicenter cohort from Latin America(2016) Piñero, Federico; Tisi Baña, Matías; de Ataide, Elaine Cristina; Hoyos Duque, Sergio; Marciano, Sebastián; Varón, Adriana; Anders, Margarita; Zerega, Alina; Menéndez, Josemaría; Zapata, Rodrigo; Muñoz, Linda; Padilla Machaca, Martín; Soza, Alejandro; McCormack, Lucas; Poniachik, Jaime; Podestá, Luis G; Gadano, Adrián; Boin, Ilka S F Fatima; Duvoux, Christophe; Silva, Marcelo; Latin American Liver Research, Education and Awareness Network (LALREAN)Background & aims: The French alpha-fetoprotein (AFP) model has recently shown superior results compared to Milan criteria (MC) for prediction of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) in European populations. The aim of this study was to explore the predictive capacity of the AFP model for HCC recurrence in a Latin-American cohort. Methods: Three hundred twenty-seven patients with HCC were included from a total of 2018 patients transplanted at 15 centres. Serum AFP and imaging data were both recorded at listing. Predictability was assessed by the Net Reclassification Improvement (NRI) method. Results: Overall, 82 and 79% of the patients were within MC and the AFP model respectively. NRI showed a superior predictability of the AFP model against MC. Patients with an AFP score >2 points had higher risk of recurrence at 5 years Hazard Ratio (HR) of 3.15 (P = 0.0001) and lower patient survival (HR = 1.51; P = 0.03). Among patients exceeding MC, a score ≤2 points identified a subgroup of patients with lower recurrence (5% vs 42%; P = 0.013) and higher survival rates (84% vs 45%; P = 0.038). In cases treated with bridging procedures, following restaging, a score >2 points identified a higher recurrence (HR 2.2, P = 0.12) and lower survival rate (HR 2.25, P = 0.03). A comparative analysis between HBV and non-HBV patients showed that the AFP model performed better in non-HBV patients.Item Liver transplantation for hepatocellular carcinoma: impact of expansion criteria in a multicenter cohort study from a high waitlist mortality region(2021) Piñero, Federico; Anders, Margarita; Boin, Ilka F.; Chagas, Aline; Quiñonez, Emilio; Marciano, Sebastián; Vilatobá, Mario; Santos, Luisa; Hoyos Duque, Sergio; Soares Lima, Agnaldo; Menendez, Josemaría; Padilla, Martín; Poniachik, Jaime; Zapata, Rodrigo; Soza, Alejandro; Maraschio, Martín; Chong Menéndez, Ricardo; Muñoz, Linda; Arufe, Diego; Figueroa, Rodrigo; Ataide, Elaine Cristina de; Maccali, Claudia; Vergara Sandoval, Rodrigo; Bermudez, Carla; Podesta, Luis G.; McCormack, Lucas; Varón, Adriana; Gadano, Adrián; Mattera, Juan; Villamil, Federico; Rubinstein, Fernando; Carrilho, Flair; Silva, MarceloThis study aimed to compare liver transplantation (LT) outcomes and evaluate the potential rise in numbers of LT candidates with hepatocellular carcinoma (HCC) of different allocation policies in a high waitlist mortality region. Three policies were applied in two Latin American cohorts (1085 HCC transplanted patients and 917 listed patients for HCC): (i) Milan criteria with expansion according to UCSF downstaging (UCSF-DS), (ii) the AFP score, and (iii) restrictive policy or Double Eligibility Criteria (DEC; within Milan + AFP score ≤2). Increase in HCC patient numbers was evaluated in an Argentinian prospective validation set (INCUCAI; NCT03775863). Expansion criteria in policy A showed that UCSF-DS [28.4% (CI 12.8-56.2)] or "all-comers" [32.9% (CI 11.9-71.3)] had higher 5-year recurrence rates compared to Milan, with 10.9% increase in HCC patients for LT. The policy B showed lower recurrence rates for AFP scores ≤2 points, even expanding beyond Milan criteria, with a 3.3% increase. Patients within DEC had lower 5-year recurrence rates compared with those beyond DEC [13.3% (CI 10.1-17.3) vs 24.2% (CI 17.4-33.1; P = 0.0006], without significant HCC expansion. In conclusion, although the application of a stricter policy may optimize the selection process, this restrictive policy may lead to ethical concerns in organ allocation (NCT03775863).Item Management of nonalcoholic fatty liver disease: An evidence-based clinical practice review(WJG Press, 2014) Arab, Juan; Candia, Roberto; Zapata, Rodrigo; Muñoz, Cristián; Arancibia, Juan; Poniachik, Jaime; Soza, Alejandro; Fuster, Francisco; Brahm, Javier; Sanhueza, Edgar; Contreras, Jorge; Cuellar, Carolina; Arrese, Marco; Riquelme, ArnoldoAIM: To build a consensus among Chilean specialists on the appropriate management of patients with nonalcoholic fatty liver disease (NAFLD) in clinical practice. METHODS: NAFLD has now reached epidemic proportions worldwide. The optimal treatment for NAFLD has not been established due to a lack of evidence-based recommendations. An expert panel of members of the Chilean Gastroenterological Society and the Chilean Hepatology Association conducted a structured analysis of the current literature on NAFLD therapy. The quality of the evidence and the level of recommendations supporting each statement were assessed according to the recommendations of the United States Preventive Services Task Force. A modified three-round Delphi technique was used to reach a consensus among the experts. RESULTS: A group of thirteen experts was established. The survey included 17 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 93.8% in the first round and 100% in the second and third rounds. The final recommendations support the indication of lifestyle changes, including diet and exercise, for all patients with NAFLD. Proven pharmacological therapies include only vitamin E and pioglitazone, which can be used in nondiabetic patients with biopsy-proven nonalcoholic steatohepatitis (the progressive form ofNAFLD), although the long-term safety and efficacy of these therapies have not yet been established. CONCLUSION: Current NAFLD management is rapidly evolving, and new pathophysiology-based therapies are expected to be introduced in the near future. All NAFLD patients should be evaluated using a three-focused approach that considers the risks of liver disease, diabetes and cardiovascular events.Publication Orientación técnica: manejo y tratamiento de la infección por virus de la hepatitis B (VHB) Chile, 3ra Edición. 2021(2021) Zapata, Rodrigo; Mezzano, Gabriel; Soza, Alejandro; Gómez, Fernando; Izquierdo, Giannina; Zamora, Francisco; Muñoz, María; Peña, AndreaIntroducción: Este protocolo describe en forma simple y actualizada el manejo de la hepatitis B (HB) aguda, crónica y en situación especiales. Se ha considerado en su desarrollo la importancia de los cambios epidemiológicos, nomenclaturas, avances en nuevas terapias, recomendaciones de tratamiento y las metas propuestas por la Organización Mundial de la Salud (OMS) para el año 2030. En particular, se hace hincapié en la importancia de la pesquisa activa de nuevos casos para perfilar esta enfermedad hacia las metas propuestas por la OMS, que refuerza la necesidad de lograr la reducción de la incidencia en un 90% y la mortalidad en un 65% para el 2030. En Chile desde el año 2010, la HB crónica es una patología GES, por lo que su atención está garantizada por ley. Objetivo: Entregar un protocolo del manejo clínico del paciente con infección aguda y crónica por VHB y una orientación terapéutica en poblaciones especiales con hepatitis B. Usuarios: Este documento está dirigido a los equipos tratantes, médicos y enfermeras, que atienden directamente al paciente con hepatitis B aguda y crónica. Además, permite dar una guía a los equipos externos que participan directa o indirectamente en la atención de los pacientes, como los tecnólogos médicos, químicos farmacéuticos, matronas/es, referentes de los Servicios de Salud y tomadores de decisiones.Item Recurrence of hepatocellular carcinoma after liver transplantation: Prognostic and predictive factors of survival in a Latin American cohort(2021) Maccali, Claudia; Chagas, Aline L; Boin, Ilka; Quiñonez, Emilio; Marciano, Sebastián; Vilatobá, Mario; Varón, Adriana; Anders, Margarita; Hoyos Duque, Sergio; Lima, Agnaldo S; Menendez, Josemaría; Padilla-Machaca, Martín; Poniachik, Jaime; Zapata, Rodrigo; Maraschio, Martín; Chong Menéndez, Ricardo; Muñoz, Linda; Arufe, Diego; Figueroa, Rodrigo; Soza, Alejandro; Fauda, Martín; Perales, Simone R; Vergara Sandoval, Rodrigo; Bermudez, Carla; Beltran, Oscar; Arenas Hoyos, Isabel; McCormack, Lucas; Mattera, Francisco Juan; Gadano, Adrián; Parente García, Jose H; Megumi Tani, Claudia; Carneiro D'Albuquerque, Luiz Augusto; Carrilho, Flair J; Silva, Marcelo; Piñero, FedericoBackground & aim: Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) has a poor prognosis, and the adjusted effect of different treatments on post-recurrence survival (PRS) has not been well defined. This study aims to evaluate prognostic and predictive variables associated with PRS. Methods: This Latin American multicenter retrospective cohort study included HCC patients who underwent LT between the years 2005-2018. We evaluated the effect of baseline characteristics at time of HCC recurrence diagnosis and PRS (Cox regression analysis). Early recurrences were those occurring within 12 months of LT. To evaluate the adjusted treatment effect for HCC recurrence, a propensity score matching analysis was performed to assess the probability of having received any specific treatment for recurrence. Results: From a total of 1085 transplanted HCC patients, the cumulative incidence of recurrence was 16.6% (CI 13.5-20.3), with median time to recurrence of 13.0 months (IQR 6.0-26.0). Factors independently associated with PRS were early recurrence (47.6%), treatment with sorafenib and surgery/trans-arterial chemoembolization (TACE). Patients who underwent any treatment presented "early recurrences" less frequently, and more extrahepatic metastasis. This unbalanced distribution was included in the propensity score matching, with correct calibration and discrimination (receiving operator curve of 0.81 [CI 0.72;0.88]). After matching, the adjusted effect on PRS for any treatment was HR of 0.2 (0.10;0.33); P < .0001, for sorafenib therapy HR of 0.4 (0.27;0.77); P = .003, and for surgery/TACE HR of 0.4 (0.18;0.78); P = .009. Conclusion: Although early recurrence was associated with worse outcome, even in this population, systemic or locoregional treatments were associated with better PRS.Item Results of Liver Transplantation for Hepatocellular Carcinoma in a Multicenter Latin American Cohort Study(2018) Piñero, Federico; Costa, Paulo; Boteon, Yuri L.; Hoyos Duque, Sergio; Marciano, Sebastián; Anders, Margarita; Varón, Adriana; Zerega, Alina; Poniachik, Jaime; Soza, Alejandro; Padilla Machaca, Martín; Menéndez, Josemaría; Zapata, Rodrigo; Vilatoba, Mario; Muñoz, Linda; Maraschio, Martín; Fauda, Martín; McCormack, Lucas; Gadano, Adrián; Boin, Ilka S.F.; Parente García, José H.; Silva, MarceloBackground and aims. Heterogeneous data has been reported regarding liver transplantation (LT) for hepatocellular carcinoma (HCC) in Latin America. We aimed to describe treatment during waiting list, survival and recurrence of HCC after LT in a multicenter study from Latin America. Material and methods. Patients with HCC diagnosed prior to transplant (cHCC) and incidentally found in the explanted liver (iHCC) were included. Imaging-explanted features were compared in cHCC (non-discordant if pre and post-LT were within Milan, discordant if pre-LT was within and post-LT exceeding Milan). Results. Overall, 435 patients with cHCC and 92 with iHCC were included. At listing, 81% and 91% of cHCC patients were within Milan and San Francisco criteria (UCSF), respectively. Five-year survival and recurrence rates for cHCC within Milan, exceeding Milan/within UCSF and beyond UCSF were 71% and 16%; 66% and 26%; 46% and 55%, respectively. Locoregional treatment prior to LT was performed in 39% of cHCC within Milan, in 53% beyond Milan/within UCSF and in 83% exceeding UCSF (p < 0.0001). This treatment difference was not observed according to AFP values (d100, 44%; 101-1,000, 39%, and > 1,000 ng/mL 64%; p = 0.12). Discordant imaging-explanted data was observed in 29% of cHCC, showing lower survival HR 2.02 (CI 1.29; 3.15) and higher recurrence rates HR 2.34 when compared to AFP <100 ng/mL. Serum AFP > 1,000 ng/mL at listing was independently associated with a higher 5-year recurrence rate and a HR of 3.24 when compared to AFP <100 ng/mL. Conclusion. Although overall results are comparable to other regions worldwide, pre-LT treatment not only considering imaging data but also AFP values should be contemplated during the next years