Publications by authors named "Pablo Gámez"

17 Publications

  • Page 1 of 1

Gastroesophageal Reflux and Esophageal Motility Disorder After Lung Transplant: Influence on the Transplanted Graft.

Transplant Proc 2021 May 13. Epub 2021 May 13.

Pneumology Unit, University Hospital 12 de Octubre, Madrid, Spain; Center of Net Biomedical Investigation on Respiratory Diseases (CIBERES), Madrid, Spain.

Background: Esophageal pathology has been identified as a bad prognostic factor in lung transplantation (LTx). This study aims to assess the esophageal disorders present post-LTx, under treatment with proton pump inhibitors, and their putative impact on the graft.

Methods: Prospective, observational study of LTx patients. Digestive factors were assessed by manometry and pH-metry at 6 months post-LTx and under proton pump inhibitor treatment. We assessed the association between esophageal disorders and graft function and acute rejection (AR) and chronic lung allograft dysfunction (CLAD).

Results: Out of 76 post-LTx patients, 27% showed gastroesophageal reflux disease (GERD), 55% showed inadequate gastric inhibition, and 59% showed esophageal motility disorders (EMDs). We observed a greater incidence of AR from 3 months post-LTx in the presence of EMD (P ≤ .05). No significant differences were observed in GERD or EMD prevalence or in survival between patients with or without CLAD. The maximum forced expiratory volume in 1 second (FEV1) achieved after bilateral LTx was significantly (P = .022) lower in patients with EMD vs without EMD.

Conclusion: At 6 months post-LTx, there is a high percentage of esophageal disorders (GERD and EMDs). No esophageal disorder is associated with CLAD or with survival, although EMDs are associated with a greater incidence of AR and lower graft function.
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http://dx.doi.org/10.1016/j.transproceed.2021.03.035DOI Listing
May 2021

Prospective Clinical Integration of an Amplicon-Based Next-Generation Sequencing Method to Select Advanced Non-Small-Cell Lung Cancer Patients for Genotype-Tailored Treatments.

Clin Lung Cancer 2018 01 23;19(1):65-73.e7. Epub 2017 Jun 23.

Medical Oncology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación i+12, Madrid, Spain; Lung Cancer Group, Clinical Research Program, CNIO (Centro Nacional de Investigaciones Oncológicas) and Instituto de Investigación i+12, Madrid, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.

Introduction: A substantial fraction of non-small-cell lung cancers (NSCLCs) harbor targetable genetic alterations. In this study, we analyzed the feasibility and clinical utility of integrating a next-generation sequencing (NGS) panel into our routine lung cancer molecular subtyping algorithm.

Patients And Methods: After routine pathologic and molecular subtyping, we implemented an amplicon-based gene panel for DNA analysis covering mutational hot spots in 22 cancer genes in consecutive advanced-stage NSCLCs.

Results: We analyzed 109 tumors using NGS between December 2014 and January 2016. Fifty-six patients (51%) were treatment-naive and 82 (75%) had lung adenocarcinomas. In 89 cases (82%), we used samples derived from lung cancer diagnostic procedures. We obtained successful sequencing results in 95 cases (87%). As part of our routine lung cancer molecular subtyping protocol, single-gene testing for EGFR, ALK, and ROS1 was attempted in nonsquamous and 3 squamous-cell cancers (n = 92). Sixty-nine of 92 samples (75%) had sufficient tissue to complete ALK and ROS1 immunohistochemistry (IHC) and NGS. With the integration of the gene panel, 40 NSCLCs (37%) in the entire cohort and 30 NSCLCs (40%) fully tested for ALK and ROS1 IHC and NGS had actionable mutations. KRAS (24%) and EGFR (10%) were the most frequently mutated actionable genes. Ten patients (9%) received matched targeted therapies, 6 (5%) in clinical trials.

Conclusion: The combination of IHC tests for ALK and ROS1 and amplicon-based NGS is applicable in routine clinical practice, enabling patient selection for genotype-tailored treatments.
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http://dx.doi.org/10.1016/j.cllc.2017.06.008DOI Listing
January 2018

Agreement Between Computed Tomography and Pathologic Nodule Counts in Colorectal Lung Metastases.

Ann Thorac Surg 2016 Jan 25;101(1):259-65. Epub 2015 Aug 25.

Clinical Research Unit-CIBERESP, "12 Octubre" University Hospital, Madrid, Spain.

Background: Computed tomography is the most common technique used to estimate the number of pulmonary metastases and their resectability. A lack of agreement between radiologic and surgical pathologic findings could potentially lead to incomplete resection or to rejection of patients for potentially curative treatments. The objective of this study was to estimate the disagreement between the number of radiologic lesions and the number of histologically confirmed malignant lesions excised from patients with pulmonary metastases from colorectal cancer.

Methods: This was a multicenter longitudinal study using a national registry. All patients underwent open surgery for pulmonary metastasectomy.

Results: Radiologic unilateral involvement was documented in 345 of 404 patients (85%); 253 (73%) presented with single nodules. The radiologic and malignant pathologic findings were concordant in 316 (78%) patients. The two independent predictors of discordance between computed tomography and the number of pathologic metastases were the bilateral involvement and the number of radiologic nodules. This model explained 28% of the variability in the disagreement frequency and discriminated between agreement and disagreement in 85% of the patients. Discrepancies increased with the nodule count with an odds ratio of 6.17 (95% confidence interval, 4.08 to 9.33) per additional nodule. For similar nodule counts, a lower disagreement frequency was observed among bilateral cases (odds ratio, 0.2; 95% confidence interval, 0.07 to 0.55).

Conclusions: Differences between the radiologic and pathologic findings were documented in 1 of every 5 patients. The correlation was very accurate in patients with single radiologic nodules. However, half of the patients with more nodules showed discrepancies.
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http://dx.doi.org/10.1016/j.athoracsur.2015.06.022DOI Listing
January 2016

[Treatment of non-small cell lung carcinoma in early stages].

Cir Esp 2013 Dec 3;91(10):625-32. Epub 2013 Jul 3.

Servicio de Cirugía Torácica, Hospital Universitario 12 de Octubre de Madrid, Madrid, España. Electronic address:

Treatment of lung carcinoma is multidisciplinary. There are different therapeutic strategies available, although surgery shows the best results in those patients with lung carcinoma in early stages. Other options such as stereotactic radiation therapy are relegated to patients with small tumors and poor cardiopulmonary reserve or to those who reject surgery. Adjuvant chemotherapy is not justified in patients with stage i of the disease and so double adjuvant chemotherapy should be considered. This adjuvant chemotherapy should be based on cisplatin after surgery in those patients with stages ii and IIIA.
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http://dx.doi.org/10.1016/j.ciresp.2013.01.007DOI Listing
December 2013

The Spanish Lung Transplant Registry: first report of results (2006-2010).

Arch Bronconeumol 2013 Feb 28;49(2):70-8. Epub 2012 Aug 28.

Organización Nacional de Trasplantes, Madrid, España.

The Spanish Lung Transplant Registry (SLTR) began its activities in 2006 with the participation of all the lung transplantation (LT) groups with active programs in Spain. This report presents for the first time an overall description and results of the patients who received lung transplants in Spain from 2006 to 2010. LT activity has grown progressively, and in this time period 951 adults and 31 children underwent lung transplantation. The mean age of the recipients was 48.2, while the mean age among the lung donors was 41.7. In adult LT, the most frequent cause for lung transplantation was emphysema/COPD, followed by idiopathic pulmonary fibrosis, both representing more than 60% the total number of indications. The probability for survival after adult LT to one and three years was 72% and 60%, respectively, although in patients who survived until the third month post-transplantation, these survival rates reached 89.7% and 75.2%. The factors that most clearly influenced patient survival were the age of the recipient and the diagnosis that indicated the transplantation. Among the pediatric transplantations, cystic fibrosis was the main cause for transplantation (68%), with a one-year survival of 80% and a three-year survival of 70%. In adult as well as pediatric transplantations, the most frequent cause of death was infection. These data confirm the consolidated situation of LT in Spain as a therapeutic option for advanced chronic respiratory disease, both in children as well as in adults.
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http://dx.doi.org/10.1016/j.arbres.2012.06.001DOI Listing
February 2013

Development of a non-heart-beating lung donor program with «Bithermia Preservation», and results after one year of clinical experience.

Arch Bronconeumol 2012 Sep 13;48(9):338-41. Epub 2012 Jan 13.

Unidad de Trasplante Pulmonar, Servicio de Cirugía Torácica, Hospital Universitario 12 de Octubre, Madrid, España.

The number of lung transplantations that are performed in Spain continues to grow, with 235 transplant recipients 2010. Non-heart-beating donations have contributed to this upward progression. Our Lung Transplant Unit began its activity in October 2008 and during these last three years 97% of the transplant interventions performed have been successful. In order to increase the number of donations, we have developed a non-heart-beating donor program as part of the existing organs program in our hospital. In doing so, the development of a multi-organic preservation method (lung, liver and kidney), which we call «Bithermia Preservation», was necessary. This paper presents this methodology as well as the first year of clinical application experience. During this time, 3 patients have been transplanted using such non-heart-beating donations. None of them developed primary graft dysfunction; all the patients have been discharged and lead active lives without any evidence of bronchiolitis obliterans syndrome.
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http://dx.doi.org/10.1016/j.arbres.2011.11.006DOI Listing
September 2012

Guidelines for the selection of lung transplantation candidates.

Arch Bronconeumol 2011 Jun 4;47(6):303-9. Epub 2011 May 4.

Servicio de Neumología, Hospital Universitario Vall d'Hebron, Barcelona, España.

The present guidelines have been prepared with the consensus of at least one representative of each of the hospitals with lung transplantation programs in Spain. In addition, prior to their publication, these guidelines have been reviewed by a group of prominent reviewers who are recognized for their professional experience in the field of lung transplantation. Within the following pages, the reader will find the selection criteria for lung transplantation candidates, when and how to remit a patient to a transplantation center and, lastly, when to add the patient to the waiting list. A level of evidence has been identified for the most relevant questions. Our intention is for this document to be a practical guide for pulmonologists who do not directly participate in lung transplantations but who should consider this treatment for their patients. Finally, these guidelines also propose an information form in order to compile in an organized manner the patient data of the potential candidate for lung transplantation, which are relevant in order to be able to make the best decisions possible.
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http://dx.doi.org/10.1016/j.arbres.2011.03.007DOI Listing
June 2011

Graft pneumonectomy and delayed contralateral lung transplantation.

Ann Thorac Surg 2007 May;83(5):1891-3

Division of Thoracic Surgery, Hospital Universitario Puerta de Hierro, Madrid, Spain.

We believe that contralateral single lung transplantation after graft pneumonectomy has not been reported yet in the literature. We present the case of an emphysematous patient who received a unilateral left lung transplant and had severe stenosis in bronchial anastomosis and bronchiectasis develop. Four years after transplantation we decided to perform a left pneumonectomy and a delayed right lung transplantation. Nine months after the procedure the patient is ambulatory and is not dependent on oxygen support.
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http://dx.doi.org/10.1016/j.athoracsur.2006.11.041DOI Listing
May 2007

Results of clinical lung transplant from uncontrolled non-heart-beating donors.

J Heart Lung Transplant 2007 May;26(5):529-34

Lung Transplant Department, Hospital Universitario Puerta de Hierro, Madrid, Spain.

Background: The scarcity of grafts for lung transplant and the growing number of candidates expecting an organ has led to an increase of deaths in patients waiting for lung transplantation. Non-heart-beating donors (NHBD) represent a promising source of grafts for those who are involved in clinical lung transplantation. We present the results of our series of 17 out-of-hospital NHBD lung transplantations performed since 2002.

Methods: We have collected data from 17 donors and recipients involved in NHBD lung transplants since 2002, as well as data referring to the type of procedure and peri-operative events. We describe the incidence of post-operative complications with special attention to primary graft disfunction (PGD), bronchial healing, bronchiolitis obliterans syndrome (BOS), and survival. We used Kaplan-Meier method to obtain the survival curve.

Results: G2-G3 PGD was reported in 9 patients (53%), with a complete restoration of the partial pressure of arterial oxygen/fraction of inspired oxygen ratio in 170 hours for G2 and 168 hours for G3. There were no deaths directly related to PGD. Acute rejection was detected in 7 patients (41%), 4 of which exceeded grade 1. The incidence of BOS after transplantation was 1 (7%) of 14 patients during the first year, 2 (11%) of 9 in the second year, and 2 (50%) of 4 in the third year. Hospital mortality rate was 17%. The survival rates were 82% at 3 months, 69%, at 1 year, and 58% at 3 years.

Conclusions: Mid-term results confirm the adequacy of uncontrolled NHBD as a promising complementary source of lung donors for clinical transplant.
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http://dx.doi.org/10.1016/j.healun.2007.01.028DOI Listing
May 2007

[Is endoscopic treatment of bronchopleural fistula useful?].

Arch Bronconeumol 2006 Aug;42(8):394-8

Servicio de Neumología, Hospital Universitario Puerta de Hierro, Madrid, España.

Objective: New endoscopic techniques have been developed as an alternative to surgical treatment of bronchopleural fistula. The objective of this study was to analyze our experience with endoscopic treatment of such fistulas.

Material And Methods: We conducted a retrospective study of patients with bronchopleural fistula diagnosed by fiberoptic bronchoscopy. Patient characteristics, underlying disease, fistula size, and outcome of endoscopic treatment were analyzed. The endoscopic technique consisted of injection of fibrin sealants (Histoacryl and/or Tissucol) through the catheter of the fiberoptic bronchoscope.

Results: Between 1997 and 2004, 18 patients were diagnosed with bronchopleural fistula by fiberoptic bronchoscopy. All were men with a mean (SD) age of 62 (12) years. Bronchopleural fistula was diagnosed after neoplastic surgery in 16 patients, in the bronchial suture after lung transplantation in 1 patient, and concurrently with pleural effusion due to hydatidosis in the remaining patient. The size of the fistula ranged from 1 mm to 10 mm (mean 3.6 [2.7] mm). Fibrin sealants were applied in 14 patients, 2 underwent direct surgery after diagnosis, and the bronchopleural fistula closed spontaneously in the remaining 2. The fibrin sealant used was Histoacryl in 12 patients and Tissucol in 2. Pleural drainage was employed simultaneously and antibiotic therapy was administered at the discretion of the surgeon. The 4 patients whose bronchopleural fistula was associated with empyema also underwent pleural lavage. In 12 patients the fistulas closed as a result of the endoscopic technique (85.7%), and no complications were observed. For 85.7%, fewer than 3 applications of fibrin sealant were necessary.

Conclusions: The success rate of closure of bronchopleural fistula with fibrin sealants injected under guidance with fiberoptic bronchoscopy is high and there are no complications. This technique can render surgery unnecessary.
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http://dx.doi.org/10.1016/s1579-2129(06)60553-3DOI Listing
August 2006

Results of surgery in small cell carcinoma of the lung.

Lung Cancer 2006 Jun 29;52(3):299-304. Epub 2006 Mar 29.

Hospital Universitario Puerta de Hierro, c/San Martin de Porres, 4 28035, Madrid, Spain.

Objective: The experiences published by various groups have re-opened the debate on the role of surgery in the management of patients with small cell lung cancer, especially in those with early stage disease (T1-T2 N0). Our study reports the survival rate of 47 patients with small cell lung cancer treated surgically.

Patients And Methods: Ours is a prospective study that selected patients with lung cancer recommended for surgery (n=2994) between 1993 and 1997 based on operability criteria accepted by the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery. We report the clinical as well as pathological stages of the patients with small cell lung cancer (n=47), later analysing the 5-year survival rate after surgery using the Kaplan-Meier method.

Results: In 31 patients (66%), resection was complete; 3 patients (6%) received induction treatment and 30 (64%) adjuvant treatment. Five years later, 26% (95% CI 12-40%) of the patients that received surgical treatment were still alive. When we analysed the patients that underwent complete resection, 31% (95% CI 13-49%) survived 5 years or more. In patients at stage Ip (n=15), 36% (95% CI 11-61%) were still living after 5 years.

Conclusion: Until future studies compare surgery plus chemotherapy versus chemotherapy and radiotherapy, it seems reasonable to offer surgical treatment to those patients with early stage small cell lung cancer (T1-T2-N0).
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http://dx.doi.org/10.1016/j.lungcan.2006.01.012DOI Listing
June 2006

Lung transplantation from out-of-hospital non-heart-beating lung donors. one-year experience and results.

J Heart Lung Transplant 2005 Aug;24(8):1098-102

Thoracic Surgery Service, Hospital Universitario Puerta de Hierro, Madrid, Spain.

There is currently no method for preservation and functional evaluation of clinical out-of-hospital non-heart-beating lung donors (NHBLD) that can be applied practically and systematically in clinical lung transplantation programs. A new method of preservation and functional evaluation of the lung has been developed in NHBLD that is based on the knowledge of various experimental studies. Initially, the viability of lungs harvested this way was proved from preliminary functional and histologic tests. In November 2002, we started using lung allografts from non-heart-beating donors. Five lung transplantations (4 bipulmonary and 1 unipulmonary) were performed successfully. The short and mid-term results have been excellent and all recipients are alive. We report our initial experience, which we hope will be of help to those involved in clinical lung transplantation programs worldwide.
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http://dx.doi.org/10.1016/j.healun.2004.06.002DOI Listing
August 2005