Browsing by Subject "Human clinical toxicology"

Now showing 1 - 5 of 5
  • Thumbnail Image
    Publication
    Open Access
    Causes of death and survival in alcoholic cirrhosis patients undergoing liver transplantation: influence of the patient’s clinical variables and transplant outcome complications
    (MDPI, 2021-05-27) Bolarín, J. M.; Pérez Cárceles, María Dolores; Hernández del Rincón, J. P.; Luna, A.; Minguela, A.; Muro, Manuel; Legaz Pérez, Isabel; Ciencias Sociosanitarias
    Background. Clinical and molecular mechanisms involved in the cause and time of death of alcoholic cirrhosis (AC) patients undergoing liver transplantation (LT) are not entirely understood. In sudden death cases, judicial autopsy practice is mandatory for determining the cause and circumstances of death. The medico-legal autopsy data are essential for helping health authorities to guide future public health activities, assess the effectiveness of health systems, and adopt the necessary preventive measures to improve and adapt the treatments in order to increase these patients’ survival. Objective. Our study aimed to determine the different clinical and sociodemographic causes that influence the different causes of death and the short- and long-term survival of AC patients undergoing liver transplantation. Methods. A total of 122 deceased AC patients undergoing LT were analyzed at different times post-transplantation. The main pre- and post-transplant complications were analyzed in relation to the cause of death and the patient’s survival, as well as the causes and time at which the patient’s death occurred. Results. A total of 53.3% of non-sudden death was observed. A large number of the deaths of AC patients undergoing transplantation were due to non-sudden death, sepsis, and graft failure (GF), the main causes of death in the sample being similar in both sexes. In non-sudden deaths, there were no significant differences between the death rates either related or not related to the liver transplant. Sepsis was the main cause, with the highest percentage (21.3%) of mortality, followed by GF (18.9%) and multiorgan failure (15.6%) at ten years. Furthermore, our results showed how pre-transplant clinical complications, such as viral infections and encephalopathy, influence the age at which multiorgan failure occurs in the transplanted patient. Conclusion. Multiorgan failure is the leading cause of sudden death, with higher mortality during the first year after transplantation, followed by sepsis and GF. Our results show the vulnerability of AC patients, both in the hospital period after the transplant and outside.
  • Thumbnail Image
    Publication
    Embargo
    Genetic susceptibility to nicotine and/or alcohol addiction: a systematic review
    (Taylor and Francis Group, 2019-05-23) Legaz Pérez, Isabel; Pérez Cárceles, María D.; Calle, Irene de la; Arjona, Fuensanta; Roca, Miriam; Cejudo, Pablo; Luna, Aurelio; Osuna, Eduardo; Ciencias Sociosanitarias
    Recent studies have confirmed the wide consumption of tobacco and alcohol in our society and the strong addiction generated by these substances, which is responsible for high public health expenditure. Understanding the biological mechanisms of nicotine and/or alcohol dependence should have huge public health repercussions in the future. The aim of this review was to analyze the main human genes and polymorphisms related to nicotine and/or alcohol addiction, to help understand the biological mechanisms involved and which may be useful for developing new treatments in the future.
  • Thumbnail Image
    Publication
    Open Access
    Is the development of ascites in alcoholic liver patients influenced by specific KIR/HLA Gene profiles?
    (MDPI, 2023-08-28) Legaz Pérez, Isabel; Morales, Raquel; Bolarín, José Miguel; Collados Ros, Aurelia; Pons, José Antonio; Muro, Manuel; Ciencias Sociosanitarias
    Decompensated cirrhosis is the most common cause of ascites due to hemodynamic and renal alteration by continuous fluid leakage from the hepatic sinusoids and splanchnic capillaries into the interstitial space. Then, fluid leakage exceeds lymphatic return, leading to progressive fluid accumulation directly into the peritoneal cavity. Alcohol consumption is one of the main risks of developing alcoholic cirrhosis (AC), but not all AC patients develop ascites. Avoiding the development of ascites is crucial, given that it deteriorates prognosis and increases the patient mortality patient. The innate immune system plays a crucial role in cirrhosis through natural killer cells, which are abundant in the liver. The aim of this study was to analyze the KIR/HLA-C genetic profile in AC patients with and without ascites to understand this pathology and find predictive clinical susceptibility biomarkers that can help to establish risks and prevent the development of ascites in AC patients. A total of 281 AC patients with and without ascites were analyzed and compared with 319 healthy controls. Genomic DNA was extracted from peripheral blood in all groups. A PCR-SSO assay was performed for KIR/HLA genotyping analysis. A total of 16 activating and inhibitor KIR genes and their corresponding known ligands, epitopes of HLA-C, and their genotypes were analyzed. According to our analysis, C1 epitopes were statistically significantly decreased in AC patients with and without ascites. When comparing AC patients with ascites and healthy controls, a significant decrease in C1 epitope frequency was also observed. A statistically significant decrease was also found when comparing the C1C2 genotype in AC patients without ascites with controls. In conclusion, the absence of KIR2DL2 and KIR3DL1 genes may be a predisposing factor for the development of ascites in AC patients. The KIR2DS2/KIR2DL2 may could be involved in grade I ascites development, and the presence of the C1+ epitope and the homozygous C2C2 genotype may be protective genetic factors against ascites development in AC patients.
  • Thumbnail Image
    Publication
    Open Access
    Patient sex in the setting of liver transplant in alcoholic liver disease
    (Baskent University, 2019-06) Legaz Pérez, Isabel; Navarro Noguera, Elena; Bolarín, Jose Miguel; Campillo, Jose Antonio; Moya, Rosa; Luna, Aurelio; Miras, Manuel; Minguela, Alfredo; Álvarez López, María Rocio; Muro, Manuel; Ciencias Sociosanitarias
    Objectives: The aim of this study was to analyze alcoholic cirrhosis in women who were to undergo liver transplant, including their biochemical and clinical characteristics, main complications, survival rates, and main causes of death compared with men with alcoholic cirrhosis. Materials and Methods: Our study included 400 patients with alcoholic cirrhosis, which we divided according to sex and viral infections. Biochemical parameters and the presence and degree of ascites and encephalopathy, liver function status, and liver rejection and survivalrates were analyzed from 1 to 10 years and the main cause of death at 10 years. Results: Patients with nonviral alcoholic cirrhosis and liver transplant had significantly better survival rates (84.1%) at 1 year versus those with viral alcoholic cirrhosis (74.5%; P = .036). Men with nonviral alcoholic cirrhosis (14%) and women with hepatitis C virus (29%) had the lowest short-term survival rates. In long-term survival analysis, the lowest rate was observed in women with nonviral alcoholic cirrhosis (26.1%), and the highest rate was observed in women with hepatitis C virus (42.9%). Liver graft failure was one of the main causes of death in male patients (19.5%). Conclusions: Women with alcoholic cirrhosis showed a higher rate of ascites and encephalopathy but lower liver graft rejection than men with alcoholic cirrhosis. Survival rates were similar between men and women, although slightly lowerin women who had hepatitis C virus.
  • Thumbnail Image
    Publication
    Open Access
    Pretransplant ascites and encephalopathy and their influence on survival and liver graft rejection in alcoholic cirrhosis disease
    (Termedia Publishing, 2021-05-06) Legaz Pérez, Isabel; Bolarín, Jose Miguel; Campillo, Jose Antonio; Moya, Rosa M.; Luna, Aurelio; Osuna, Eduardo; Minguela, Alfredo; Sánchez Bueno, Francisco; Alvarez, María Rocio; Muro, Manuel; Ciencias Sociosanitarias
    Introduction The Child-Pugh and model for end-stage liver disease (MELD) scores are widely used to predict the outcomes of liver transplant (LT). Both have similar prognostic values in most cases, although their benefits might differ in some specific conditions. The aim of our study was to analyze the influence of pre-transplant ascites and encephalopathy in post-transplant liver rejection development and survival in alcohol cirrhosis (AC) patients undergoing LT to determine the usefulness of the Child-Pugh score for the assessment of prognosis in such patients. Material and methods Two hundred and eighty-one AC patients, classified according to viral infections and pre-transplant complications, were analyzed. Acute (AR) and chronic (CR) liver rejections and Child-Pugh, MELD and albumin-bilirubin (ALBI) scores were studied in all cases. Results Similar AC rejection percentages were observed in ascites or encephalopathy groups (18.5% and 16.5%, p = 0.735), although a higher but not statistically significant AC rate was observed in patients with grade III ascites (p = 0.777) and with grade II encephalopathy (p = 0.089). Chronic rejection was only developed by 9.1% of AC patients, regardless of the presence of ascites (6.2%) or encephalopathy (5.5%). The presence of ascites and encephalopathy complications did not seem to influence post-transplant survival. Neither the Child-Pugh nor the ALBI score can be considered the best for predicting patient survival in the short or long term. Conclusions Ascites and encephalopathy do not seem to influence AC or CR in patient survival, regardless of the presence of viral infections, so in our study neither the Child-Pugh nor ALBI score seems to be the best score to predict the outcomes of these patients.