Author: Andrés, Amado ; Mazuecos, Auxiliadora ; Ontañón, Jesús ; Álvarez, Antonia ; Coll, Elisabeth ; Diekmann, Fritz ; Crespo, Marta ; Domínguez-Gil, Beatriz ; Bestard, Oriol ; González, M Francisca ; Vilches, Carlos ; Muro, Manuel ; Vega, Rocío ; Fernández, Constantino ; Segundo, David San ; Nieto, Antonio ; Caro, José L ; Paz-Artal, Estela ; Cruzado, Josep M ; Mancebo, Esther ; Palou, Eduard

Highly sensitized patients awaiting kidney transplantation face substantial challenges due to the presence of potential donor-specific anti-HLA antibodies (DSA). These antibodies increase the risk of antibody-mediated rejection (ABMR), but also complicate their access to HLA compatible transplantation. Although advancements in allocation priority programs, such as the Spanish Program for the Access of Highly Sensitized Patients to Kidney Transplantation (PATHI), have introduced virtual crossmatching (v-XM) to streamline compatibility assessments, patients with >99,5 % virtual panel reactive antibodies (vPRA) often remain on waiting lists for extended periods with minimal chances of receiving a transplant. This article summarizes Spanish guidelines for a harmonized and comprehensive framework for the management of highly sensitized patients. These guidelines focus on strategies to facilitate transplantation in the presence of DSA, including a stepwise approach to delist HLA antigens, prioritizing those recognized as "less deleterious" antibodies, to expand transplant options while minimizing immunological risks. Conventional desensitization techniques are discussed, alongside the innovative use of imlifidase to enable transplants in particularly complex cases. Post-transplant monitoring protocols are also exposed, with a focus on early detection of antibody rebound and effective management of ABMR. Ultimately, this resource offers clinicians a structured framework to navigate the intricate challenges of kidney transplantation in high-risk populations, aiming to enhance access to life-saving procedures and improve patient outcomes.

01 Jul 2025·European Journal of Surgical Oncology

“Complex segmentectomies: Comparison with simple and effect of experience on postoperative outcomes”

Article

Author: Galvez, Carlos ; Figueroa, Santiago ; Azcarate, Leire ; Córcoles, Juan Manuel ; Mongil, Roberto ; Blanco, Ana ; Viti, Andrea ; Lirio, Francisco ; Salcedo, José García ; Cabañero, Alberto ; Campo-Cañaveral, José Luis ; Socci, Laura ; Moldes, Milagros ; López, Iker ; Sánchez, David ; Rivo, Eduardo ; Genovés, Marta ; Hernando, Florentino ; Bolufer, Sergio ; Recuero, Jose Luis

OBJECTIVESWe compared simple and complex segmentectomies in terms of complications and mortality. We hypothesized which proportion of complex segmentectomies might improve postoperative outcomes.METHODSPatients from 18 hospitals operated since september 2018 to December 2019 were prospectively collected. Primary peripheral lung cancer or peripheral solitary nodules ≤2 cm, lung metastasis, carcinoids and benign lesions not amenable to wedge resection were included. Patients less than 18 years old, compromised patients, middle lobe lesions, preoperative induction or adjuvant treatment and patients without follow-up were excluded.RESULTS261 (72.5 %) and 99 (27.5 %) were simple and complex segmentectomies. Median operative time was 146.5 min being slightly higher in complex segmentectomies (p = 0.05) while mean chest tube duration was 1 day, higher in simple than in complex (p = 0.01). 102 patients presented complications (28 %), with pulmonary complications accounting 21 %, prolonged air leak (PAL) 9.7 % and pneumonia 8.3 % as the most common. Postoperative pneumonia was 3.4-fold higher in the simple segmentectomy group (p = 0.02) and the combined respiratory morbidity almost doubled that of the complex (p = 0.02). After propensity-score matching, only operative time was shorter in the simple group (p = 0.02). Centers performing at least 40 % complex segmentectomies, presented significantly lower rate of PAL and pulmonary complications.CONCLUSIONSComplex segmentectomies are safe but longer procedures compared to simple and there is no risk of higher rate of operative or postoperative complications. Centers experienced in complex segmentectomies accomplishing at least 40 % from the total, present better outcomes in terms of prolonged air leak and pulmonary complications.

01 Jun 2025·American Heart Journal

Occult cancer in patients with unprovoked venous thromboembolism: Rationale, design, and methods of the VaLRIETEs study and the SOME-RIETE trial

Article

Author: Andrade-Ruiz, Henry A ; Bikdeli, Behnood ; Mena-Muñoz, Elisabeth ; Mahe, Isabelle ; de la Red-Bellvis, Gloria ; Marchena-Yglesias, Pablo Javier ; Lopez-Miguel, Patricia ; Lopez-Nuñez, Juan Jose ; Del Molino-Sanz, Fatima ; Fernandez-Reyes, Jose Luis ; Meireles, Jose ; Jou-Segovia, Ines ; Imbalzano, Egidio ; Barca-Hernando, Maria ; Aibar-Gallizo, Jesus ; Lopez-Saez, Juan Bosco ; Portillo-Sanchez, Jose ; Elias-Hernandez, Teresa ; Marcos-Jubilar, Maria ; Marin-Romero, Samira ; Diaz-Brasero, Ana Maria ; Diaz-Pedroche, Carmen ; Mehdipour, Ghazaleh ; Pagan-Escribano, Javier ; Villalobos-Sanchez, Aurora ; Amado-Fernandez, Cristina ; Otalora-Valderrama, Sonia ; Agudo-de Blas, Paloma ; Jara-Palomares, Luis ; Lorenzo-Hernandez, Alicia ; Diaz-Peromingo, Jose Antonio

BACKGROUNDUnprovoked venous thromboembolism (VTE) is considered when no clear major provoking factor for VTE is identified. Although the 1-year risk of diagnosing new cancer in these patients can be as high as 5%, the benefits of extensive screening remain uncertain. It is possible that in a risk-enriched population of patients, screening yields benefit. Recently, the RIETE score, a composite score including sex, age, chronic pulmonary disease, anemia, platelet count and previous VTE, was found to improve risk prediction for identification of occult cancer in patients with unprovoked VTE. As for screening tests, whole body 18F-fluorodeoxyglucose Positron Emission/Computed Tomography (18F-FDG PET/CT) is a promising and sensitive tool for occult cancer screening.METHODSThis manuscript summarizes the rationale and design of 2 prospective studies in patients with unprovoked symptomatic VTE: (1) ValRIETE is an international, multicenter, prospective, adaptative, cohort study that plans to include 1,550 patients; the adaptive design permits a sample size increase depending on the results of the predefined interim analysis. This study will enable the external validation of the RIETE score, with several ancillary aims related to additional clinical and biomarker predictors. Recruitment began in December 2022. (2) SOME-RIETE is an open-label, randomized, multicenter clinical trial that plans to enroll 650 patients with a RIETE score ≥3 to compare limited screening with limited screening plus whole body 18F-FDG PET/CT. The primary outcome is cancer diagnosis within 3 months after VTE event. Secondary outcomes include cancer diagnosis and mortality at 12 months.CONCLUSIONSThis study provides clinically meaningful data on and the utility of extended screening of cancer by 18F-FDG PET/CT.STUDY REGISTRATIONVaLRIETE study: ethics committee of the Virgen del Rocio University Hospital, Sevilla (Spain). https://www.juntadeandalucia.es/salud/portaldeetica/xhtml/inicio/inicio.iface (1687-N-22).TRIAL REGISTRATIONSOME-RIETE:ClinicalTrials.gov (NCT03937583).

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