Raúl López-Blasco

Background/Objectives: Weight gain after kidney transplantation is frequent but heterogeneous, often accompanied by changes in body composition that influence long-term outcomes. This study analysed one-year changes in body compartments and their demographic and clinical determinants. Methods: A prospective cohort of 112 adult kidney recipients transplanted between September 2020 and June 2022 at a Spanish tertiary hospital was followed. Body weight, muscle mass, fat mass, visceral fat and total body water were assessed by multi-frequency bioelectrical impedance at discharge, and at 3, 6 and 12 months. Associations with sociodemographic, clinical and comorbidity variables were examined using repeated-measures ANOVA and comparative tests. Results: At 12 months, mean weight gain was 3.6 ± 6.5 kg (5.1%). Increases were greater in men, younger patients, non-dialysis candidates, those with previous transplantation and living donor grafts. Muscle mass rose during the first three months and then stabilised, with greater gains in men and haemodialysis patients. Fat mass decreased initially and then increased, particularly in women, younger recipients and living donor transplants. Visceral fat progressively increased after three months, with higher levels in men and older patients. Total body water declined in women, younger recipients and first transplant patients. Patients with new-onset diabetes gained less weight, while smokers gained more. Conclusions: Post-transplant body composition is shaped by sex, age, BMI, comorbidities and donor type. Monitoring compartments beyond body weight may allow early detection of adverse metabolic trajectories. Tailored nutritional and lifestyle interventions are needed to optimise long-term outcomes.

Background and Objective: Over the past decade, prostate cancer (PCa) survival rates have increased, largely due to advancements in modern healthcare. As a result, the majority of PCa patients worldwide are now survivors, placing a considerable burden on healthcare systems. Specialists at Miguel Servet Hospital in Zaragoza, Spain, follow the European Association of Urology (EAU) guidelines in managing PCa patients; however, these recommendations do not specifically address the follow‐up of patients by nonspecialist medical staff. This study evaluates the safety of a follow‐up protocol that refers PCa survivors to primary care after undergoing radical prostatectomy (RP) as a curative treatment, with a particular focus on those diagnosed with pathologic high‐grade localized and locally advanced PCa. Methods: The study includes data from 579 patients diagnosed with high‐risk PCa—both localized and locally advanced—according to EAU criteria. These patients underwent RP between 1992 and 2018 at the Aragón Health Service (SALUD), Sector Zaragoza II—Hospital Universitario Miguel Servet. The follow‐up protocol involves initial monitoring by the urology department. Patients who remain free of biochemical recurrence (BCR) are subsequently followed up by primary care (PC) medical staff. To evaluate the short‐ and long‐term effectiveness of this protocol, we analyzed biochemical recurrence‐free survival, stratified by risk groups. Results: The BCR rate after referral to PC is under 20.5% in the overall high‐risk group. A more detailed analysis shows that the localized subgroup has a 14.5% BCR probability, while the locally advanced subgroup experiences a fourfold increase, reaching 41.98%. The risk of BCR is 2–5 times higher in the locally advanced group compared to the localized group. BCR patterns indicate that nearly half of all cases occur within 4 years post‐RP, though trends vary by risk group. In high‐risk localized PCa, almost half of BCRs occur between four and ten years post‐RP, whereas in locally advanced PCa, over 65% occur within the first 4 years, indicating earlier recurrence in this group. Kaplan–Meier survival curves confirm a significant difference ( p < 0.001): locally advanced PCa shows a threefold higher cumulative BCR risk at 10 years (2.78) and a fourfold higher risk at 5 years (4.41). Although the overall BCR rate after referral to PC is below 20.5% in the high‐risk group, recurrence risk varies significantly—14.5% in the localized subgroup versus 41.98% in the locally advanced subgroup. These findings underscore the earlier and more frequent recurrence in locally advanced PCa compared to high‐risk localized PCa. Conclusions: Referring PCa survivors for follow‐up in primary care has proven to be an effective and safe approach. The success of this protocol can be attributed to clear communication with the primary care team regarding the parameters for referring patients back to specialized care for recurrence assessment. As expected, the high‐risk localized group showed a lower incidence of BCR than the locally advanced group, consistent with known recurrence patterns. It is imperative that the Spanish healthcare system implement a public primary care program dedicated to cancer survivors, with the aim of reducing the substantial burden on specialized services.

Prior evidence has suggested the multisystem symptomatic manifestations of post-acute COVID-19 condition (PCC). Here we conducted a network cluster analysis of 24 WHO proposed symptoms to identify potential latent subclasses of PCC. Individuals with a positive test of or diagnosed with SARS-CoV-2 after 09/2020 and with at least one symptom within ≥ 90 to 365 days following infection were included. Sub-analyses were conducted among people with ≥ 3 different symptoms. Summary characteristics were provided for each cluster. All analyses were conducted separately in 9 databases from 7 countries, including data from primary care, hospitals, national health claims and national health registries, allowing to validate clusters across the different healthcare settings. 787,078 persons with PCC were included. Single-symptom clusters were common across all databases, particularly for joint pain, anxiety, depression and allergy. Complex clusters included anxiety-depression and abdominal-gastrointestinal symptoms. Substantial heterogeneity within and between PCC clusters was seen across healthcare settings. Current definitions of PCC should be critically reviewed to reflect this variety in clinical presentation.