Sergio Hoyos

Efecto del consumo de alcohol al diagnóstico en la sobrevida de pacientes con cirrosis hepática en un Hospital Universitario de la ciudad de Medellín

Worldwide, alcohol consumption is a well-known risk factor for premature death, morbidity and disability. Records of mortality associated with alcohol consumption are not centralized. The aim of this study was to record the mortality rate associated with alcohol intake in patients with cirrhosis who were treated at a university hospital in the city of Medellin. Materials and methods: We included 163 patients who had been diagnosed with cirrhosis in the outpatient hepatology clinic of a 277 bed referral hospital in Medellin. Patients were monitored until 2016. Sociodemographic, paraclinical and clinical variables were measured. Alcohol consumption was considered at the beginning of the follow-up. Survival and complications associated with cirrhosis were described and recorded for patients who consumed alcohol as well as for those who did not, and then the two groups were compared. Results: One hundred sixty-three patients were followed until December 2016. The mortality rate among those who consumed alcohol was 51% while it was only 39% for those who did not consume alcohol (P = 0.19). Comparison of complications of cirrhosis showed that 68% of alcohol users developed ascites vs. 43% of non-consumers (P = 0.01); 40.6% of alcohol users developed encephalopathy vs. 13.5% of non-consumers (P = 0.00); and 29% of alcohol users developed hepatocellular carcinoma (HCC) vs. 17% of non-consumers (P = 0.08). In the subgroup analysis, patients with hepatitis C who consumed alcohol had a higher mortality rate than patients who did not consume alcohol (OR: 33, 95% CI: 1.06 to 1023). Conclusions: Although alcohol consumption was not related to increased mortality among patients with cirrhosis in this study, increased mortality was observed in the subgroup of patients with hepatitis C.

Polimorfismos en los genes alcohol deshidrogenasa (ADH1) y citocromo P450 2E1 (CYP2E1) en pacientes con diagnóstico de cirrosis y carcinoma hepatocelular

Introducción. Uno de los principales factores de riesgo del carcinoma hepatocelular es el consumo crónico de alcohol. En estudios en diferentes poblaciones, se sugiere que las variantes genéticas de las enzimas que participan en el metabolismo del alcohol, como la alcohol deshidrogenasa (ADH) y la citocromo P450 (CYP2E1), estarían asociadas con riesgo de enfermedades hepáticas terminales.Objetivo. Identificar y caracterizar las variantes alélicas de los genes ADH1B, ADH1C y CYP2E1 en pacientes colombianos con diagnóstico de cirrosis y carcinoma hepatocelular.Materiales y métodos. Se incluyeron muestras de pacientes atendidos entre el 2005 y el 2007, y entre el 2014 y el 2016, en la unidad de hepatología de un hospital de Medellín. La genotipificación de las muestras se hizo mediante reacción en cadena de la polimerasa (Polymerase Chain Reaction, PCR) con análisis de los polimorfismos en la longitud de los fragmentos de restricción (Restriction Fragment Length Polymorphism, RFLP). Los resultados se compararon con los de dos grupos de control y con lo reportado en la base de datos del 1000 Genomes Project.Resultados. Se recolectaron 97 muestras de pacientes con diagnóstico de cirrosis y carcinoma hepatocelular. Los dos factores de riesgo más frecuentes fueron el consumo crónico de alcohol (18,6 %) y las colangiopatías (17,5 %). Los genotipos más frecuentes en la población de estudio fueron el ADH1B*1/1 (82 %), el ADH1C*1/1 (59 %) y el CYP2E1*C/C (84 %).Conclusiones. En este primer estudio de los polimorfismos en pacientes colombianos con diagnóstico de cirrosis y carcinoma hepatocelular, los genotipos más frecuentes fueron el ADH1B*1/1, el ADH1C*1/1 y el CYP2E1*C/C. No se observaron diferencias estadísticamente significativas en la frecuencia de los genotipos entre los casos y los controles. Se requieren estudios adicionales en población colombiana para evaluar el riesgo de la enfermedad hepática terminal por consumo crónico de alcohol y laasociación con los polimorfismos.

Trasplante hepático en mayores de 65 años de edad: experiencia en el Hospital Pablo Tobón Uribe, Medellín, Colombia 2004-2010

Liver transplantation protocols have been extended to people over 65 years of age who had previously beenxa0excluded from protocols due to the increased morbidity and mortality rates associated with age. This studyaims to identify survival rates and complications in patients over 65 years who have undergone liver transplantation.xa0Medical records of patients older than 65 who underwent liver transplantation in the period betweenSeptember 2004 and November 2010 at the Hospital Pablo Tobon Uribe in Medellin, Colombia were analyzed.xa0We studied 27 patients with an average age of 67 years. The 30 day post-transplant survival rate was 85.2%,xa0at one year the survival rate was 70.4%, and at five years it was 63%. An evaluation of post-transplant complicationsxa0found that the most frequent complications were massive bleeding and nosocomial infections. Thexa0main causes of death were cardiovascular events. Conclusion: Proper patient selection allows those overxa065 years of age to become candidates for liver transplantation with a good actuarial 5-year survival rate andxa0better quality of life.

Hepatic transplantation in a child with giant multicystic tumor: Pathological and imaging findings

Castrillon GA, Sepúlveda E, Yepez NL, Hoyos S, Osorio G. Hepatic transplantation in a child with giant multicystic tumor: Pathological and imaging findings. Pediatr Transplantation 2010: 14:e58–e61.