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LIVER TRANSPLANTATION: RECENT OUTCOMES AND IMMUNOLOGICAL PREDICTORS
Abstract: Background Liver transplantation remains the definitive treatment for end stage liver disease. Recent studies emphasize the impact of preservation techniques and de novo donor-specific HLA antibodies (DSA) on graft outcomes. Objective To review recent evidence on one-year graft survival after liver transplantation, and to assess the association of machine perfusion and de novo DSA with rejection and graft failure. Materials and Methods Systematic review and network meta-analysis comparing static cold storage (SCS) versus machine perfusion strategies (HOPE, NMP) in adult liver transplant recipients. Studies of de novo DSA and long-term graft survival were also included. Outcomes: early allograft dysfunction, biliary complications, graft and patient survival. Results In 12 RCTs (n≈1 628), hypothermic oxygenated perfusion (HOPE/dHOPE) versus SCS significantly reduced early allograft dysfunction (RR 0.53; 95 % CI 0.37–0.74), increased 1 year graft survival (RR 1.07; 95 % CI 1.01–1.14), and decreased biliary complications (RR 0.52; 95 % CI 0.43–0.75) and graft loss (RR 0.38; 95 % CI 0.16–0.90). Separately, pooled data (n≈2 016 DSA positive recipients) showed de novo DSA were associated with significantly increased risk of graft loss/rejection (OR approximately 3.6 to 6.4). Conclusion Machine perfusion, particularly HOPE, improves early graft function and 1 year survival compared to static cold storage. The emergence of de novo DSA is a strong predictor of graft failure, supporting routine immunologic surveillance. These findings suggest optimized preservation plus immunomonitoring are key to improving liver transplant outcomes.
Authors: JUAN PEKOLJ
Keywords: TRASPLANTE DE HÍGADO, ANTICUERPOS ESPECÍFICOS DEL DONANTE, PERFUSIÓN MECÁNICA, RECHAZO DEL INJERTO, SUPERVIVENCIA DEL INJERTO.
Submission Date: 6 Ago 2025
DownloadROUX EN Y GASTRIC BYPASS FOR OBESITY AND GERD OUTCOMES
Abstract: Abstract Background Roux en Y gastric bypass is considered the bariatric procedure of choice for patients with obesity and gastroesophageal reflux disease (GERD), due to its double impact on weight loss and reflux reduction. Objective To evaluate the impact of primary RYGB on GERD symptoms, acid suppressive therapy use, and incidence of de novo GERD in adult patients with obesity. Materials and Methods A systematic review and meta analysis including 14 studies and 28,027 patients undergoing primary RYGB for obesity. Outcomes assessed: proportion of symptomatic GERD improvement, new or worsening GERD, discontinuation of proton pump inhibitors (PPIs), and change in DeMeester score. Results Pooled analysis showed a 47 % improvement in GERD symptoms (95 % CI 34.0–59.0; p ≤ 0.005), while only 4.5 % developed de novo or worsening GERD (95 % CI 1.7–7.2; p ≤ 0.005). Average postoperative DeMeester score improved by 16.49 points (95 % CI 0.2–32.7; p ≤ 0.005), and 79.4 % of patients discontinued PPIs completely during follow up (95 % CI 68.7–90.1; p = 0.01). Conclusion Primary RYGB yields substantial and durable improvement in GERD symptoms in nearly half of the patients with obesity and pre existing reflux, with very low incidence of new or worsened GERD. The high rate of PPI discontinuation and significant reduction in esophageal acid exposure position RYGB as the preferred surgical option for obese patients with reflux-related comorbidity.
Authors: JOSÉ COOKE
Keywords: BYPASS GÁSTRICO EN Y DE ROUX OBESIDAD, ENFERMEDAD POR REFLUJO GASTROESOFÁGICO, CIRUGÍA BARIÁTRICA Y METABÓLICA.
Submission Date: 6 Ago 2025
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