Browsing by Author "Dib Marambio, Martín Javier"

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    Actualizaciones en el manejo general de pacientes postrasplante hepático y de sus complicaciones más frecuentes
    (2024) Díaz Piga, Luis Antonio; Villalón Friedrich, Alejandro Andrés; Ochoa, Gabriela; García Castillo, Sergio Adrián Nicolas; Severino Cuevas, Nicolás Felipe; Ayares Campos, Gustavo Ignacio; Idalsoaga Ferrer, Francisco Javier; Dib Marambio, Martín Javier; Briceño Valenzuela, Eduardo Andrés; Viñuela Fawaz, Eduardo Andrés; Martínez Castillo, Jorge Arturo; Jarufe Cassis, Nicolás Patricio; Rabagliati Borie, Ricardo Miguel; Meneses Quiroz, Luis Andrés; Muñoz Schuffenegger, Pablo; Vargas Domínguez, José Ignacio; Espino Espino, Alberto Antonio; Vera Alarcón, María Magdalena; Benítez Gajardo, Carlos Esteban; Wolff Rojas, Rodrigo Mauricio; Norero Muñoz, Blanca Gabriela; Barrera Álvarez, Francisco Benjamín; Soza Ried, Alejandro; Arrese Jiménez, Marco Antonio; Arab Verdugo, Juan Pablo
    Liver transplantation (LT) is a cost-effective therapy for advanced liver disease. Although LT significantly improves long-term survival, it requires strict control of immunosuppressants and their potential complications. Several available immunosuppressive drugs include glucocorticoids, calcineurin inhibitors, mycophenolate, mTOR inhibitors, and anti-CD25 antibodies. These drugs act particularly in T lymphocytes, depleting them, deviating their traffic, or blocking their response pathways. The main complications after LT include renal failure and infectious, immunological, biliary, vascular adverse events, metabolic, cardiovascular, and neoplastic diseases, especially during the first months. Bacteria, viruses, and fungi can cause infections in these patients. Prophylaxis against Herpes simplex virus, Varicella zoster virus, Cytomegalovirus, Pneumocystis jirovecii, Candida spp., and Aspergillus spp. should be considered according to the presence of risk factors. Among immunological complications, acute cellular rejection is common (30% of LT) but usually responds to immunosuppressive escalation. Also, chronic rejection appears in 3-17% of LT, but only half of the recipients respond to increased immunosuppressants. Appropriate treatment of the underlying etiology is essential, especially in autoimmune diseases, hepatitis B and C virus infection. Lifestyle changes must be encouraged in all patients, and alcohol consumption avoided (especially in alcohol use disorder). Due to the increased risk of cancer, neoplasms must be actively monitored, as well as osteoporosis and other metabolic disorders such as diabetes and cardiovascular disease.
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    Factores asociados a mayor sobrevida en pacientes con cáncer de páncreas tratados mediante pancreatoduodenectomía
    (2020) Troncoso T., Andrés; Briceño, Eduardo; Guerra, Juan Francisco; Dib Marambio, Martín Javier; Cerda, Jaime; Jarufe Cassis, Nicolás; Martínez Castillo, Jorge; Pontificia Universidad Católica de Chile. Escuela de Medicina
    Introducción: El adenocarcinoma de páncreas (ADP) mantiene un pronóstico ominoso a pesar de los avances en técnica quirúrgica y cuidados peri y postoperatorios. El objetivo del trabajo es identificar factores asociados a mayor sobrevida en pacientes con ADP tratados mediante pancreatoduodenectomía (PDD) en nuestra institución. Material y Método: Estudio de casos y controles de pacientes con ADP tratados mediante PPD en el Hospital Clínico de la Universidad Católica entre 2002 – 2015. Se definió como caso aquel paciente con sobrevida mayor a 3 años y control al paciente son sobrevida menor a 3 años. Se compararon entre casos y controles datos biodemográficos, clínicos, histopatológicos y morbimortalidad mediante regresión logística. Resultados: Se analizaron 70 pacientes, con una edad media de 62 ± 11 años; 40 (57%) mujeres. Se observó morbilidad en 26 enfermos (37,1%); Clavien-Dindo ≥ IIIa en 8 (11,4%). La mediana (rango) de ganglios resecados y días de hospitalización fue 17 (1-40) ganglios y 12 (7-84) días. La sobrevida actuarial al primer, tercer y quinto año fue de 77%, 32% y 22% repectivamente. Se identificaron 21 casos (30%) y 49 controles (70%). En el análisis univariable se objetivaron como variables asociadas asobrevida mayor a 3 años (p < 0,05): Resección R0; ausencia de ganglios positivos; ausencia de infiltración perineural; estadios más precoces (IA, IB y IIA) y ausencia de diabetes mellitus. En cambio, la presencia de hipoalbuminemia (< 3 mg/dL), el CA 19-9 (> 100 U/mL), la presencia de permeaciones vasculares, los tratamientos complementarios y la morbilidad (Clavien – Dindo ≥ IIIa) no alcanzaron significancia estadística. En el análisis multivariable, incluyendo solamente las variables estadísticamente significativas (excluyendo a los ganglios positivos), se identificó a la ausencia DM2 (OR ajustado: 12; IC95% 1,7 – 84,3), ausencia de infiltración perineural (OR ajustado: 7; IC95% 1,3 – 36,3) y a los estadios precoces IA, IB y IIA (OR ajustado: 10,3; IC95% 2,1 –49,1) como factores independientes asociados a sobrevida mayor a 3 años. Conclusión: Etapas precoces de la enfermedad, la ausencia de diabetes mellitus y la ausencia de infiltración perineural fueron identificados como factores asociados a una sobrevida mayor a 3 años.
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    SARS-CoV-2 vaccine booster in solid organ transplant recipients previously immunised with inactivated versus mRNA vaccines: A prospective cohort study
    (2022) Dib Marambio, Martín Javier; Le Corre Pérez, Monique Nicole; Ortiz Koh, Catalina Alejandra; García, Daniel; Ferrés, Marcela; Martínez Valdebenito, Constanza; Ruiz-Tagle, Cinthya; Ojeda Valenzuela, María José; Espinoza Sepúlveda, Manuel Antonio; Jara Contreras, Aquiles; Arab Verdugo, Juan Pablo; Rabagliati B., Ricardo; Vizcaya Altamirano, Cecilia; Ceballos, María Elena; Sarmiento Maldonado, Mauricio; Mondaca Contreras, Sebastián Patricio; Viñuela Morales, Macarena Rocío; Pastore Thomson, Antonia; Szwarcfiter Neiman, Vania; Galdames Lavín, Elizabeth Alejandra; Barrera Vásquez, Aldo Vincent; Castro Gálvez, Pablo Federico; Gálvez Arriagada, Nicolás Marcelo Salvador; Soto Ramírez, Jorge Andrés; Bueno Ramírez, Susan; Kalergis Parra, Alexis Mikes; Nervi Nattero, Bruno; Balcells Marty, María Elvira
    Solid-organ transplant (SOT) recipients have worse COVID-19 outcomes than general population and effective immunisation in these patients is essential but more difficult to reach. We aimed to determine the immunogenicity of an mRNA SARS-CoV-2 vaccine booster in SOT recipients previously immunised with either inactivated or homologous SARS-CoV-2 mRNA vaccine. Methods: Prospective cohort study of SOT recipients under medical care at Red de Salud UC-CHRISTUS, Chile, previously vaccinated with either CoronaVac or BNT162b2. All participants received a BNT162b2 vaccine booster. The primary study end point was anti-SARS-CoV-2 total IgG antibodies (TAb) seropositivity at 8-12 weeks (56-84 days) post booster. Secondary end points included neutralising antibodies (NAb) and specific T-cell responses. Findings: A total of 140 (50% kidney, 38% liver, 6% heart) SOT recipients (mean age 54 [13.6] years; 64 [46%] women) were included. Of them, 62 had homologous (three doses of BNT162b2) and 78 heterologous vaccine schedules (two doses of CoronaVac followed by BNT162b2 booster). Boosters were received at a median of 21.3 weeks after primary vaccination. The proportion achieving TAb seropositivity (82.3% vs 65.4%, P = 0.035) and NAb positivity (77.4% vs 55.1%, P = 0.007) were higher for the homologous versus the heterologous group. On the other hand, the number of IFN-γ and IL-2 secreting SARS-CoV-2-specific T-cells did not differ significantly between groups. Interpretation: This cohort study shows that homologous mRNA vaccine priming plus boosting in SOT recipients, reaches a significantly higher humoral immune response than inactivated SARS-CoV-2 vaccine priming followed by heterologous mRNA booster.
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    Telemedicine for postoperative follow-up, virtual surgical clinics during COVID-19 pandemic
    (2020) Inzunza A., Martín; Muñoz Claro, Rodrigo Edgardo; Quezada Sanhueza, Nicolás; Gabrielli Nervi, Mauricio; Dib Marambio, Martín Javier; Urrejola Schmied, Gonzalo Ignacio; Varas, Julián; Valderrama Chang, Sebastián Matías; Crovari Eulufi, Fernando; Achurra Tirado, Pablo; Irarrázaval Llona, Manuel José; Brañes A.; Soto P.; Inzunza Agüero, Martín Alejandro; Muñoz Claro, Rodrigo; Quezada Sanhueza, Nicolás; Gabrielli Nervi, Mauricio; Dib Marambio, Martín Javier; Urrejola Schmied, Gonzalo Ignacio; Varas, Julián; Valderrama Chang, Sebastián Matías; Crovari Eulufi, Fernando; Achurra Tirado, Pablo; Irarrázaval Llona, Manuel José; Brañes A.; Soto P.
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    Unusual indications for liver transplantation. Results
    (2020) Briceño, Eduardo; Soriano Brucher, Humberto Eduardo; Gana Ansaldo, Juan Cristóbal; Benítez, Carlos; Barrera Martínez, Francisco José; Montaña Rodríguez, Rodrigo; Concha P., Mario; Jarufe Cassis, Nicolás; Guerra Castro, Juan Francisco; Dib Marambio, Martín Javier; Martínez Castillo, Jorge; Troncoso T., Andrés; Cancino M., Alejandra; Dellepiane M., Paulina; Wolff R., Rodrigo; Pattillo Silva, Juan Carlos