Browsing by Autor "Alejandra Villamil"

Now showing 1 - 7 of 7

AMA-NEGATIVE PRIMARY BILIARY CHOLANGITIS IN LATIN AMERICA: A DISTINCT SUBSET WITH LOWER TREATMENT RESPONSE
(Elsevier BV, 2025) Cláudia Alves Couto; Guilherme Grossi Lopes Cançado; Maria Lúcia Gomes Ferraz; Débora Raquel Benedita Terrabuio; Alejandra Villamil; Lorena Castro Solari; Graciela Castro‐Narro; Ezequiel Ridruejo; Cristiane Alves Villela‐Nogueira; D. Guerrero
Primary biliary cholangitis (PBC) is an autoimmune cholestatic disease, typically diagnosed by the presence of anti-mitochondrial antibodies (AMA). Whether AMA-negative PBC represents a distinct clinical phenotype remains controversial. This study aimed to characterize the epidemiological profile of PBC according to AMA status in Latin America. This ongoing, retrospective, international multicenter cohort study, sponsored by ALEH, includes PBC patients from multiple Latin American countries. Patients were stratified by AMA status; those with autoimmune hepatitis-PBC overlap were excluded. Data from 1,204 patients were analyzed: Brazil (48.3%), Argentina (23.4%), Chile (10.8%), Mexico (7.4%), and others. Most were female (92.3%) with a mean age at diagnosis of 53±13 years; 22.2% had cirrhosis at baseline. Overlap syndrome was excluded. AMA were positive in 76.8%. AMA-positive and AMA-negative patients had similar rates of female sex (92.5% each, p=0.963), baseline cirrhosis (22.4% vs. 23.6%, p=0.706), and symptomatic presentation (77.5% vs. 79.4%, p=0.544). MASLD was more frequent among AMA-negative patients (7.5% vs. 3.8%, p=0.024), which also had higher rates of sp100 (9.1% vs 2.5%, p< 0.001) and gp210 (7.3 vs 3.3%, p< 0.001) positivity. Treatment with UDCA was performed in 95.2% of patients and, from those, 28.3% had second line treatment indicated due to incomplete response to UDCA. AMA-positive patients showed higher response to ursodeoxycholic acid (UDCA) at 12 months, including ALP normalization (29.7% vs. 21.2%, p=0.035) and deep response (17.5% vs. 8.6%, p=0.007). Similar findings were observed after 12 months of fibrate therapy (34.8% vs. 9.4%, p=0.005). No difference was found in transplant-free survival (p=0.213). AMA-negative PBC patients in Latin America present similar baseline features but have lower response rates to UDCA and fibrates, supporting the hypothesis of a biologically distinct disease subset.
AUTOIMMUNE HEPATITIS IN LATIN AMERICA: INSIGHTS FROM THE ALLATIN COHORT
(Elsevier BV, 2025) Ludmila Resende Guedes; Guilherme Grossi Lopes Cançado; Janaína Luz Narciso Schiavo; Luciana Costa Faria; Ezequiel Ridruejo; Maria Lúcia Gomes Ferraz; Margarita Anders; Lorena Castro Solari; Alejandra Villamil; Harlim Rodríguez Rodríguez
FIBRATES SEEM TO BE EQUALLY EFFECTIVE AS SECOND-LINE THERAPY IN PRIMARY BILIARY CHOLANGITIS, WITH BIOCHEMICAL RESPONSE PLATEAUING AT 6 MONTHS
(Elsevier BV, 2025) Guilherme Grossi Lopes Cançado; Maria Lúcia Gomes Ferraz; Débora Raquel Benedita Terrabuio; Alejandra Villamil; Lorena Castro Solari; Graciela Castro‐Narro; Ezequiel Ridruejo; Cristiane Alves Villela‐Nogueira; M Fernandes; Daniela Chiodi
Approximately 40% of patients with primary biliary cholangitis (PBC) exhibit an incomplete biochemical response to ursodeoxycholic acid (UDCA) and require second-line therapy. Fibrates are widely available in Latin America and commonly used off-label in this setting. We aimed to evaluate clinical and biochemical outcomes in PBC patients with incomplete UDCA response treated with different fibrates. This ongoing, retrospective, multicenter cohort study (ALLATIN), sponsored by ALEH, includes PBC patients from several Latin American countries. For this analysis, only patients with incomplete response (based on biochemical criteria or physician judgment), who received fibrates, were included. Among 1,204 patients, 342 received fibrates; 263 (76.7%) were treated for incomplete UDCA response (93.2% female; mean age: 50 ± 11 years; 76.5% AMA-positive; 19.6% with cirrhosis). Bezafibrate, fenofibrate, and ciprofibrate were used in 72.2%, 7.2%, and 17.9% of cases. Median ALP before fibrates was 1.9xULN (IQR 1.4-3.0); median time from UDCA start to fibrate use was 30 months (IQR 13-69). At 6 months (n = 153), ALP normalization occurred in 42.5%, while 67.3% and 50.3% met Toronto and POISE criteria, respectively; 30.9% achieved deep response (normal ALP and bilirubin <0.6×ULN). At 12 months (n=150), rates remained stable. No differences were observed across fibrate types (p>0.4). Liver transplantation or death occurred in 24 patients (9.1%) over 87 months (IQR 44-135), associated with cirrhosis at diagnosis (OR 9.9; 95%CI 3.3-29.9; p<0.001) and response at 6 months by Toronto criteria (OR 0.31; 95%CI 0.1-0.9; p=0.035). Discontinuation occurred in 13.7%; adverse events included renal injury (n=1), myalgia (n=4), liver injury (n=4), and abdominal pain (n=4). Fibrates showed high efficacy regardless of agent used. Biochemical response plateaued by 6 months and predicted long-term outcomes. These findings support early assessment and a pragmatic approach to second-line therapy in PBC, independent of fibrate type.
O-17 Are macroeconomic and health expenditure indicators correlated with the capacity for liver transplantation in Latin American Countries? THE ALEH Special Interest Group, international Survey 2020
(Elsevier BV, 2021) Rodrigo Zapata; Graciela Castro; Josefina Pagés; Fernando Cairo; Oscar Imventarza; Alejandra Villamil; Paulo Lisboa Bittencourt; Leonardo de Lucca Schiavon; J.R. Alfeu de Medeiros Fleck; Ricardo Villarroel
Latin America (LA), is a geographical region with 20 countries homing 652 million people (10% world population), with a huge cultural, economic and developmental diversity. The ALEH (Asociación Latinamericana para el Estudio del Hígado) has driven the formation of special interest groups (SIGs) to enhance the collaboration of health care professionals with common specialized interests in the field of hepatology. The gross domestic product (GDP) is a monetary measure of the market value of all the final goods and services produced in a specific time period by a country. The ratio of GDP to the total population of the region is the per capita GDP (Mean Standard of Living). It is often considered to be the "world's most powerful statistical indicator of national development and progress". On the other hand, Liver transplantation (LT) is considered a very expensive procedure requiring high-cost management with a lifelong immunosuppression, hence a possible barrier to some underdeveloped countries. In the different regions of the USA, there has been shown a strong correlation between GDP per capita and all organ donation rates, except heart donation (1988-2012). In LA countries, there is almost no data on the relation of macroeconomic indicators in relation to the capacity for LT. To study the influence of macroeconomic indicators with the LT capacity in LA. During 2020, LA countries, were invited to nominate representatives to this SIG and also from the STALYC. Online ZOOM meetings were arranged to discuss a survey of more than 70 questions in relation to different topics in LT including economic indicators of countries, barriers and access to LT. A database with all the information was built in an excel file. Scatter plot graphs were built to evaluate correlation and linear regression equations for different variables. 15 out of 20 countries completed the questionnaire by Jan/2021. During 2019 there were 3,354 DDLT performed in 13 out of the 15 countries (DDLT rate of 5.85 LT/pmp), and 483 LDLT in 7 countries. The mean costs of LT (hospitalization and first month) in our survey was 57,000 USD. After evaluating a few macroeconomic indicators, the higher GDP per capita and the higher health expenditure (as % of GDP) had a good positive correlation with the LT capacity in LA countries (scatter plot). There was no correlation with the gross GDP with LT (DDLT nor LDLT), nor with de number of active LT centers in each country. Our study shows a positive correlation between economic indicators of prosperity (GDP per capita and health expenditure) and LT rates. Chronic liver diseases are a very common cause of burden of disease in LA, and although LT is a high-cost procedure, it is. a lot less expensive than in other world regions. LA is still composed of countries with huge cultural, economic and developmental diversity and where at least 30% of the population lives in poverty, nevertheless, some countries have been able to perform LT with rates > 5 ppm with excellent results. There is need to improve education and investment in LT as a health priority, being saving life procedure making possible to return a chronic patient to a normal and productive life.
O-19 INCIDENCE, PATTERN OF PRESENTATION AND RISK FACTORS FOR HEPATOCELLULAR CARCINOMA AFTER DIRECT ACTING ANTIVIRAL TREATMENT IN PATIENTS WITH HEPATITIS C VIRUS CIRRHOSIS
(Elsevier BV, 2021) Roseane Pôrto Medeiros; Oscar Imventarza; Alejandra Villamil; Pablo Felipe Bittencourt; Leonardo de Lucca Schiavon; Alfeu de Medeiros Fleck; Ricardo Villarroel; Oscar Varas; Juan Carlos Restrepo; Adriana Varón
Brazilian public health system currently provides universal free all oral direct-acting antiviral (DAA) therapy for patients with hepatitis C virus (HCV) infection. Despite high rates of sustained virological response (SVR), patients with cirrhosis remain at risk for hepatocellular carcinoma (HCC). The aim of this study was to investigate incidence, risk factors and tumor pattern at presentation in a cohort of Brazilian HCV-related cirrhotic patients treated with DAAs. This prospective cohort study included patients with HCV-related cirrhosis treated with DAAs and followed for at least 24 weeks after therapy at the Viral Hepatitis Outpatient Clinic of Hospital de Clinicas de Porto Alegre, Brazil, between August 2016 and November 2017. Ultrasound screening was performed within 24 weeks before DAA therapy and patients with presumed past or current HCC were excluded. Primary outcome was HCC incidence. Secondary outcomes were risk factors for HCC ocurrence and tumor pattern at presentation. Multivariate analysis was used to identify independent variables associated with HCC development. A total of 234 patients with HCV cirrhosis were included. Fifty-six percent were males with a mean age of 61.2±10.9 years. Overall SVR was 97.4%. Child-Turcotte-Pugh (CTP) A, B and C at baseline was found, respectively, in 89.3%, 9.4% and 1,3%. Mean Model for End Stage Liver Disease (MELD) score was 9.17 ± 2.82. Esophageal varices were found in 43.6% of the patients. Type 2 diabetes was present in 18.8%. De novo HCC was diagnosed in 9% (21/234) of the patients during follow-up. Tumor pattern at presentation according to BCLC staging was 0, A, B, C and D in 19,1%, 47.6%, 4.8%, 28.6% and 0%, respectively. Multivariate analysis showed significant relative risk (RR) for HCC occurrence associated with the following variables: baseline MELD score ≥10 (RR: 1.8; p=0.05); absence of SVR (RR: 6.9; p=0.04); baseline platelet count <120 × 109/L (RR: 5.0; p=0.04) and baseline albumin level <3.5 mg/dL (RR: 4.6. A high incidence of HCC was found after DAA therapy compared to the literature, particularly among patients with more advanced cirrhosis, particularly those with baseline albumin levels < 3.5 g/dL plus platelets < 120 × 109/L. Absence of SVR was also significantly associated with HCC development. The majority of patients presented with very early (BCLC 0) or early (BCLC A) HCC, although a significant proportion showed advanced stage (BCLC C) at presentation.
O-3 TRENDS IN DECEASED DONOR AND LIVING DONOR LIVER TRANSPLANTATION IN LATIN AMERICAN COUNTRIES DURING A DECADE (2010-2019) . THE ALEH SPECIAL INTEREST GROUP, INTERNATIONAL SURVEY 2020
(Elsevier BV, 2021) Rodrigo Zapata; Graciela Castro; Josefina Pagés; Cairo Fernando; Oscar Imventarza; Alejandra Villamil; Paulo Lisboa Bittencourt; Leonardo de Lucca Schiavon; Alfeu de Medeiros Fleck; Ricardo Villarroel
OP-4 Current status of Liver transplantation in Latin America: The Latin-American ALEH special interest group, international Survey 2020
(Elsevier BV, 2021) Rodrigo Zapata; Graciela Castro; Josefina Pagés; Fernando Cairo; Oscar Imventarza; Alejandra Villamil; Paulo Lisboa Bittencourt; Leonardo de Lucca Schiavon; Alfeu de Medeiros Fleck; Ricardo Villarroel