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Morelli MC, Gambato M, Martini S, Carrai P, Toniutto P, Giannelli V, Donato F, Lenci I, Pasulo L, Mazzarelli C, Ferrarese A, Rendina M, Grieco A, Lanza AG, Baroni GS, De Maria N, Marenco S, Mameli L, Ponziani FR, Vitale G, Burra P, Viganò R, Fornasiere E, Catanzaro E, Marrone G, Milana M, Calleri A, Scorzoni C, Frassanito G, Lionetti R, Dibenedetto C. Trends in liver transplantation for primary sclerosing cholangitis. Dig Liver Dis 2024:S1590-8658(24)00194-4. [PMID: 38233315 DOI: 10.1016/j.dld.2024.01.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Primary sclerosing cholangitis is a cholestatic disease with a low prevalence in Italy. Indications for liver transplantation and the time of listing are not stated. AIM We performed a national survey to investigate the listing criteria, comorbidities, and outcomes. METHODS In April 2022, we surveyed liver transplantation in primary sclerosing cholangitis nationwide for the last 15 years. RESULTS From 2007 to 2021, 445 patients were included on waiting lists, and 411 had undergone liver transplants. The median age at transplantation was 46 years (males 63.9%); 262 patients (59%) presented an inflammatory bowel disease. Transplants increased over the years, from 1.8 % in 2007 to 3.0 % in 2021. Cholangitis (51%) and hepatic decompensation (45%) were the main indications for listing. The disease recurred in 81 patients (20%). Patient survival after the first transplant was 94 %, 86% and 84% at one, five, and ten years. Twenty-four died in the first year (50% surgical complications, 25% infections); 33 between one to five years (36% recurrence, 21% cholangiocarcinoma recurrence) and nine after five years (56% de novo cancer, 44% recurrence). CONCLUSIONS Primary sclerosing cholangitis has been an increasing indication for transplantation in Italy. Cholangitis and decompensation were the main indications for listing. Recurrence and cancer were the leading causes of death.
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Affiliation(s)
- Maria Cristina Morelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit for the treatment of Severe Organ Failure, Bologna, Italy
| | - Martina Gambato
- Multivisceral Transplant Unit, Padua University Hospital, Padova, Italy
| | - Silvia Martini
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paola Carrai
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School and Hospital, Pisa, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplant Unit, Department of Medical Area, Udine University Hospital, Udine, Italy
| | - Valerio Giannelli
- San Camillo Hospital, Department of Transplantation and General Surgery, Rome, Italy
| | - Francesca Donato
- Gastroenterology and Hepatology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Lenci
- Hepatology and Transplant Unit, Fondazione Policlinico Tor Vergata, Roma, Italy
| | - Luisa Pasulo
- Gastroenterology and Transplant Hepatology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Chiara Mazzarelli
- Gastroenterology and Hepatology Department, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Ferrarese
- Unit of Gastroenterology, Borgo Trento University Hospital of Verona, Verona, Italy
| | - Maria Rendina
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Antonio Grieco
- Liver Transplant Medicine Unit, Gastroenterological Area, Department of Gastroenterological, Endocrine and Metabolic Sciences, Fondazione Policlinico Universitario Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Nicola De Maria
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Simona Marenco
- Department of Internal Medicine, Gastroenterology Unit, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genova 16132, Italy
| | - Laura Mameli
- Liver and Pancreas Transplant Center, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Francesca Romana Ponziani
- Hepatology Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Giovanni Vitale
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit for the treatment of Severe Organ Failure, Bologna, Italy.
| | - Patrizia Burra
- Multivisceral Transplant Unit, Padua University Hospital, Padova, Italy
| | - Raffaella Viganò
- Gastroenterology and Hepatology Department, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ezio Fornasiere
- Hepatology and Liver Transplant Unit, Department of Medical Area, Udine University Hospital, Udine, Italy
| | - Elisa Catanzaro
- Multivisceral Transplant Unit, Padua University Hospital, Padova, Italy
| | - Giuseppe Marrone
- Liver Transplant Medicine Unit, Fondazione Policlinico Universitario Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Martina Milana
- Hepatology and Transplant Unit, Fondazione Policlinico Tor Vergata, Roma, Italy
| | - Alberto Calleri
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Scorzoni
- Liver Injury and Transplant Unit, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Gabriella Frassanito
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Raffaella Lionetti
- Infectious diseases and Hepatology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Clara Dibenedetto
- Gastroenterology and Hepatology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore, Policlinico, Milan, Italy
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Asmundo L, Rizzetto F, Sgrazzutti C, Carbonaro LA, Mazzarelli C, Centonze L, Rutanni D, De Carlis L, Vanzulli A. Computed Tomography and Magnetic Resonance Imaging Signs of Chronic Liver Rejection: A Case-Control Study. J Comput Assist Tomogr 2024; 48:26-34. [PMID: 37422693 DOI: 10.1097/rct.0000000000001511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
OBJECTIVE In liver transplantation, chronic rejection is still poorly studied. This study aimed to investigate the role of imaging in its recognition. METHODS This study is a retrospective observational case-control series. Patients with histologic diagnosis of chronic liver transplant rejection were selected; the last imaging examination (computed tomography or magnetic resonance imaging) before the diagnosis was evaluated. At least 3 controls were selected for each case; radiological signs indicative of altered liver function were analyzed. χ 2 Test with Yates correction was used to compare the rates of radiologic signs in the case and control groups, also considering whether patients suffered chronic rejection within or after 12 months. Statistical significance was set at P < 0.050. RESULTS A total of 118 patients were included in the study (27 in the case group and 91 in the control group). Periportal edema was appreciable in 19 of 27 cases (70%) and in 6 of 91 controls (4%) ( P < 0.001); ascites and hepatomegaly were present in 14 of 27 cases (52%) and 12 of 27 cases (44%), respectively, and in 1 of 91 controls (1%) ( P < 0.001); splenomegaly was present in 13 of 27 cases (48%) and in 8 of 91 controls (10%) ( P < 0.001); and biliary tract dilatation was present in 13 of 27 cases (48%) and in 11 of 91 patients controls (5%) ( P < 0.001). In the controls, periportal edema was significantly less frequent beyond 12 months after transplant (1% vs 11%; P = 0.020); the other signs after 12 months were not significant. CONCLUSIONS The identification of periportal edema, biliary dilatation, ascites, and hepatosplenomegaly can serve as potential warning signs of ongoing chronic liver rejection. It is especially important to investigate periportal edema if it is present 1 year or more after orthotopic liver transplantation.
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Affiliation(s)
- Luigi Asmundo
- From the Postgraduate School in Radiodiagnostic, University of Milan
| | | | | | | | - Chiara Mazzarelli
- Department of Hepatology and Gastroenterology Unit, ASST Grande Ospedale
| | | | - Davide Rutanni
- From the Postgraduate School in Radiodiagnostic, University of Milan
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3
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Carbone M, Della Penna A, Mazzarelli C, De Martin E, Villard C, Bergquist A, Line PD, Neuberger JM, Al-Shakhshir S, Trivedi PJ, Baumann U, Cristoferi L, Hov J, Fischler B, Hadzic NH, Debray D, D’Antiga L, Selzner N, Belli LS, Nadalin S. Liver Transplantation for Primary Sclerosing Cholangitis (PSC) With or Without Inflammatory Bowel Disease (IBD)-A European Society of Organ Transplantation (ESOT) Consensus Statement. Transpl Int 2023; 36:11729. [PMID: 37841645 PMCID: PMC10570452 DOI: 10.3389/ti.2023.11729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023]
Abstract
Primary sclerosing cholangitis (PSC) is the classical hepatobiliary manifestation of inflammatory bowel disease (IBD) and a lead indication for liver transplantation (LT) in the western world. In this article, we present a Consensus Statement on LT practice, developed by a dedicated Guidelines' Taskforce of the European Society of Organ Transplantation (ESOT). The overarching goal is to provide practical guidance on commonly debated topics, including indications and timing of LT, management of bile duct stenosis in patients on the transplant waiting list, technical aspects of transplantation, immunosuppressive strategies post-transplant, timing and extension of intestinal resection and futility criteria for re-transplantation.
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Affiliation(s)
- M. Carbone
- Centre for Autoimmune Liver Diseases, Department of Medicina and Surgery, University of Milano-Bicocca, Milan, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), IRCCS San Gerardo dei Tintori, Monza, Italy
| | - A. Della Penna
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - C. Mazzarelli
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy
| | - E. De Martin
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Inserm Unité 1193, Université Paris-Saclay, FHU Hépatinov, Centre de Référence Maladies Inflammatoires des Voies Biliaires et Hépatites Auto-Immunes, Villejuif, France
| | - C. Villard
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), IRCCS San Gerardo dei Tintori, Monza, Italy
- Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - A. Bergquist
- Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - P. D. Line
- Norwegian PSC Research Center and Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - J. M. Neuberger
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - S. Al-Shakhshir
- National Institute for Health and Care Research (NIHR) Birmingham Liver Biomedical Research Centre, Centre for Liver and Gastrointestinal Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - P. J. Trivedi
- National Institute for Health and Care Research (NIHR) Birmingham Liver Biomedical Research Centre, Centre for Liver and Gastrointestinal Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - U. Baumann
- Division of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - L. Cristoferi
- Centre for Autoimmune Liver Diseases, Department of Medicina and Surgery, University of Milano-Bicocca, Milan, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), IRCCS San Gerardo dei Tintori, Monza, Italy
| | - J. Hov
- Norwegian PSC Research Center and Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - B. Fischler
- Department of Pediatrics, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - N. H. Hadzic
- Paediatric Centre for Hepatology, Gastroenterology and Nutrition, King’s College, London, United Kingdom
| | - D. Debray
- Unité d’Hépatologie Pédiatrique, Hôpital Necker-Enfants Malades, Centre de Référence Maladies Inflammatoires des Voies Biliaires et Hépatites Auto-Immunes, Filfoie, Paris, France
| | - L. D’Antiga
- Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - N. Selzner
- Multiorgan Transplant Program, University of Toronto, Toronto, ON, Canada
| | - L. S. Belli
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy
| | - S. Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
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Rossotti R, Merli M, Mazzarelli C, De Carlis RM, Travi G, Vecchi M, Viganò R, Lauterio A, Raimondi A, Belli LS, De Carlis LG, Puoti M. Similar survival but higher and delayed hepatocellular carcinoma recurrence in HIV-positive compared to negative cirrhotics undergoing liver transplantation. Dig Liver Dis 2023; 55:268-275. [PMID: 35644890 DOI: 10.1016/j.dld.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Liver transplantation (LT) represents the best therapeutic option for hepatocellular carcinoma (HCC) and end-stage liver disease (ESLD). Although HIV infection does not seem to lower survival rates, HCV and HCC recurrence appear more harmful. AIMS To compare the overall survival after LT; evaluate the impact of anti-HCV direct-acting agents (DAA); assess the rate of HCC recurrence in HIV-positive and negative patients. METHODS Subjects with HCV/HBV infection who underwent LT for HCC or ESLD from 2012 to 2019 were retrospectively evaluated. RESULTS Study population included 299 individuals, 31 (10.4%) were HIV-positive. Overall mortality was similar (16.1% versus 19.0%, p = 0.695). HCC recurrence was observed in 6 HIV-positive (19.4%) and in 17 negative subjects (6.3%, p = 0.022). Time to relapse was 831 days in HIV-positive and 315 days in negative patients (p = 0.046). Cox model found a significant role for HIV in univariate analysis but, after adjusting for variables, extra-hepatic tumor was the only factor associated to recurrence (aHR 56.379, p < 0.001). CONCLUSIONS Post-LT survival improved after DAA availability and HIV has no impact on mortality. A higher and delayed rate of HCC recurrence was observed in co-infected individuals: surveillance protocols should be strengthened along time in this population.
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Affiliation(s)
- Roberto Rossotti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Marco Merli
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Mazzarelli
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo Maria De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanna Travi
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marta Vecchi
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Raffaella Viganò
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Raimondi
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luca Saverio Belli
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luciano Gregorio De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; School of Medicine, University of Milan-Bicocca, Milan, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; School of Medicine, University of Milan-Bicocca, Milan, Italy
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5
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Bang K, Casadei‐Gardini A, Yoo C, Iavarone M, Ryu M, Park SR, Kim H, Yoon Y, Jung D, Park G, Ahn C, Moon D, Hwang S, Kim K, Song G, Mazzarelli C, Alimenti E, Chan SL, De Giorgio M, Ryoo B, Lee S. Efficacy and safety of lenvatinib in patients with recurrent hepatocellular carcinoma after liver transplantation. Cancer Med 2022; 12:2572-2579. [PMID: 36812124 PMCID: PMC9939097 DOI: 10.1002/cam4.5123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Lenvatinib is approved for the treatment of patients with metastatic or recurrent hepatocellular carcinoma (HCC); however, clinical outcomes of lenvatinib therapy in patients with post-liver transplantation (LT) HCC recurrence remain unclear. We investigated the efficacy and safety of lenvatinib in patients with post-LT HCC recurrence. METHODS This multinational, multicenter, retrospective study included 45 patients with recurrent HCC after LT who received lenvatinib at six institutions in three countries (Korea, Italy, and Hong Kong) from June 2017 to October 2021. RESULTS At the time of lenvatinib initiation, 95.6% (n = 43) of patients had Child-Pugh A status, and 35 (77.8%) and 10 (22.2%) participants were classified as having albumin-bilirubin (ALBI) grades 1 and 2, respectively. The objective response rate was 20.0%. With a median follow-up duration of 12.9 months (95% confidence interval [CI]: 11.2-14.7), the median progression-free survival and overall survival (OS) were 7.6 (95% CI: 5.3-9.8) months, and 14.5 (95% CI: 0.8-28.2) months, respectively. Patients with ALBI grade 1 showed significantly better OS (52.3 months, [95% CI: not assessable]) than patients with ALBI grade 2 (11.1 months [95% CI: 0.0-30.4 months], p = 0.003). The most common adverse events were hypertension (n = 25, 55.6%), fatigue (n = 17, 37.8%), and anorexia (n = 14, 31.1%). CONCLUSION Lenvatinib showed consistent efficacy and toxicity profiles in patients with post-LT HCC recurrence that were comparable to those reported from previous studies among non-LT HCC patients. The baseline ALBI grade correlated with better OS in post-LT lenvatinib-treated patients.
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Affiliation(s)
- Kyunghye Bang
- Department of Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea,Division of Hemato‐Oncology, Department of Internal MedicineChung‐Ang University Gwangmyeong HospitalGwangmyeongRepublic of Korea
| | - Andrea Casadei‐Gardini
- Department of Medical OncologyVita‐Salute San Raffaele University, IRCCS San Raffaele Scientific InstituteMilanItaly
| | - Changhoon Yoo
- Department of Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Massimo Iavarone
- Division of Gastroenterology and HepatologyFoundation IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Min‐Hee Ryu
- Department of Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Sook Ryun Park
- Department of Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Hyung‐Don Kim
- Department of Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Young‐In Yoon
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of Surgery, Asan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Dong‐Hwan Jung
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of Surgery, Asan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Gil‐Chun Park
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of Surgery, Asan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Chul‐Soo Ahn
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of Surgery, Asan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Deok‐Bog Moon
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of Surgery, Asan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Shin Hwang
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of Surgery, Asan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Ki‐Hun Kim
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of Surgery, Asan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Gi‐Won Song
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of Surgery, Asan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Chiara Mazzarelli
- Hepatology and Gastro‐Enterology UnitASST Ospedale NiguardaMilanItaly
| | - Eleonora Alimenti
- Division of Gastroenterology and HepatologyFoundation IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Stephen L. Chan
- State Key Laboratory of Translational OncologyDepartment of Clinical Oncology, Sir YK Pao Centre for Cancer, The Chinese University of Hong KongHong Kong
| | - Massimo De Giorgio
- Department of GastroenterologyHepatology and Liver Transplantation, Papa Giovanni XXIII HospitalBergamoItaly
| | - Baek‐Yeol Ryoo
- Department of Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Sung‐Gyu Lee
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of Surgery, Asan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
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Guarino M, Cossiga V, Capasso M, Mazzarelli C, Pelizzaro F, Sacco R, Russo FP, Vitale A, Trevisani F, Cabibbo G. Impact of SARS-CoV-2 Pandemic on the Management of Patients with Hepatocellular Carcinoma. J Clin Med 2022; 11:jcm11154475. [PMID: 35956091 PMCID: PMC9369221 DOI: 10.3390/jcm11154475] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 02/07/2023] Open
Abstract
Worldwide, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) significantly increases mortality and morbidity. The Coronavirus Disease 2019 (COVID-19) outbreak has had a considerable impact on healthcare systems all around the world, having a significant effect on planned patient activity and established care pathways, in order to meet the difficult task of the global pandemic. Patients with hepatocellular carcinoma (HCC) are considered a particularly susceptible population and conceivably at increased risk for severe COVID-19 because of two combined risk factors: chronic advanced liver disease and HCC itself. In these challenging times, it is mandatory to reshape clinical practice in a prompt way to preserve the highest standards of patient care and safety. However, due to the stay-at-home measures instituted to stop the spread of COVID-19, HCC surveillance has incurred a dramatic drop, and care for HCC patients has been rearranged by refining the algorithm for HCC treatment to the COVID-19 pandemic, permitting these patients to be safely managed by identifying those most at risk of neoplastic disease progression.
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Affiliation(s)
- Maria Guarino
- Gastroenterology and Hepatology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (V.C.); (M.C.)
- Correspondence:
| | - Valentina Cossiga
- Gastroenterology and Hepatology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (V.C.); (M.C.)
| | - Mario Capasso
- Gastroenterology and Hepatology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (V.C.); (M.C.)
| | - Chiara Mazzarelli
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Filippo Pelizzaro
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy; (F.P.); (F.P.R.)
- Gastroenterology Unit, Azienda Ospedale-Università di Padova, 35128 Padova, Italy
| | - Rodolfo Sacco
- Gastroenterology and Endoscopy Unit, Policlinico Riuniti, 71122 Foggia, Italy;
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy; (F.P.); (F.P.R.)
- Gastroenterology Unit, Azienda Ospedale-Università di Padova, 35128 Padova, Italy
| | - Alessandro Vitale
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy;
| | - Franco Trevisani
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE)-University of Palermo, 90133 Palermo, Italy;
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7
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Corradi M, Mazzarelli C, Cesari M, Viganò R, Belli LS. Implementation of the frailty assessment to improve liver transplant outcomes. Aging Clin Exp Res 2022; 34:1919-1923. [PMID: 35380349 PMCID: PMC8981198 DOI: 10.1007/s40520-022-02111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/07/2022] [Indexed: 11/26/2022]
Abstract
The majority of patients undergoing Orthotopic Liver Transplantation (OLT) have increased in age, therefore chronological age may have become an unreliable parameter for supporting clinical decisions. The age-related deficit accumulation model measuring frailty proposed by Rockwood et al., may propose an alternative in providing an estimate of an individual’s biological age. No Frailty Index (FI) tailored specifically for OLT patients exists to date. Forty-three consecutive OLT patients with ≥ 20 years of survival with a functioning graft were included in our study. The FI was computed taking to account 39 items (FI-39), meeting the standard criteria for internal validation. Endpoints were polypharmacy, and recent Emergency Room admission. The mean age of our population was 69 (sd 9) years. The mean FI-39 was 0.23 (sd 0.1). The FI-39 was associated with polypharmacy [odds ratio (OR) 1.13; Confidence interval (95%CI) 1.03–1.24; p = 0.01], and recent Emergency Room admission [beta coefficient + 1.98; 95%CI + 0.26, + 3.70; p = 0.03], independent for age and sex. This study demonstrates that an FI can be derived from data collected during routine clinical follow-up and allows for improved differentiation related to the OLT clinical complexity in OLT patients, independent of chronological age. This may lead to the adoption of FI-39 to improve personalized OLT patient care.
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Affiliation(s)
- Mattia Corradi
- Scuola di Specializzazione in Malattie dell'Apparato Digerente, University of Milan, Milan, Italy.
| | - Chiara Mazzarelli
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Raffaella Viganò
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luca Saverio Belli
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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8
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Germani G, Angrisani D, Addolorato G, Merli M, Mazzarelli C, Tarli C, Lattanzi B, Panariello A, Prandoni P, Craxì L, Forza G, Feltrin A, Ronzan A, Feltracco P, Grieco A, Agnes S, Gasbarrini A, Rossi M, De Carlis L, Francesco D, Cillo U, Belli LS, Burra P. Liver transplantation for severe alcoholic hepatitis: A multicenter Italian study. Am J Transplant 2022; 22:1191-1200. [PMID: 34954874 DOI: 10.1111/ajt.16936] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 01/25/2023]
Abstract
There is increasing evidence that early liver transplantation (eLT), performed within standardized protocols can improve survival in severe alcoholic hepatitis (sAH). The aim of the study was to assess outcomes after eLT for sAH in four Italian LT centers and to compare them with non-responders to medical therapy excluded from eLT. Patients admitted for sAH (2013-2019), according to NIAAA criteria, were included. Patients not responding to medical therapy were placed on the waiting list for eLT after a strict selection. Histological features of explanted livers were evaluated. Posttransplant survival and alcohol relapse were evaluated. Ninety-three patients with severe AH were evaluated (65.6% male, median [IQR] age: 47 [42-56] years). Forty-five of 93 patients received corticosteroids, 52 of 93 were non-responders and among these, 20 patients were waitlisted. Sixteen patients underwent LT. Overall, 6-, 12-, and 24-month survival rates were 100% significantly higher compared with non-responders to medical therapy who were denied LT (45%, 45%, and 36%; p < .001). 2/16 patients resumed alcohol intake, one at 164 days and one at 184 days. Early LT significantly improves survival in sAH non-responding to medical therapy, when a strict selection process is applied. Further studies are needed to properly assess alcohol relapse rates.
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Affiliation(s)
- Giacomo Germani
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Debora Angrisani
- Department of Hepatology and Gastroenterology, ASST GOM Niguarda Hospital, Milan, Italy
| | - Giovanni Addolorato
- Alcohol Use Disorders Unit, Department of Internal Medicine, Institute of Internal Medicine, Gemelli Hospital, Catholic University of Rome, Rome, Italy.,Internal Medicine, Gastroenterology and Hepatology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Manuela Merli
- Gastroenterology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Chiara Mazzarelli
- Department of Hepatology and Gastroenterology, ASST GOM Niguarda Hospital, Milan, Italy
| | - Claudia Tarli
- Alcohol Use Disorders Unit, Department of Internal Medicine, Institute of Internal Medicine, Gemelli Hospital, Catholic University of Rome, Rome, Italy
| | - Barbara Lattanzi
- Gastroenterology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Adelaide Panariello
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Paola Prandoni
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Lucia Craxì
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo, Italy
| | - Giovanni Forza
- Department of Legal and Occupational Medicine, Toxicology and Public Health, Padua University Hospital, Padua, Italy
| | | | - Andrea Ronzan
- Psychiatry Unit, Padua University Hospital, Padua, Italy
| | - Paolo Feltracco
- Anesthesia and Intensive Care, Department of Medicine, Padua University Hospital, Padua, Italy
| | - Antonio Grieco
- Liver Transplant Medicine Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Salvatore Agnes
- General Surgery and Liver Transplant Unit, Università Cattolica - Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- Internal Medicine, Gastroenterology and Hepatology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Massimo Rossi
- General Surgery and Organ Transplantation Unit, Department of General 3 Surgery and Organ Transplantation, Sapienza University of Rome, Rome, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.,School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - D'Amico Francesco
- Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Luca S Belli
- Department of Hepatology and Gastroenterology, ASST GOM Niguarda Hospital, Milan, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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9
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Mazzarelli C, Viganò R, Vangeli M, Vanzulli A. An atypical presentation of biliary cast syndrome (BCS). Dig Liver Dis 2021; 53:1050. [PMID: 32819859 DOI: 10.1016/j.dld.2020.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Chiara Mazzarelli
- Hepatology and Gastroenterology Unit, ASST Ospedale Niguarda, P.za Ospedale Maggiore 3, 20100 Milan, Italy.
| | - Raffaella Viganò
- Hepatology and Gastroenterology Unit, ASST Ospedale Niguarda, P.za Ospedale Maggiore 3, 20100 Milan, Italy
| | - Marcello Vangeli
- Hepatology and Gastroenterology Unit, ASST Ospedale Niguarda, P.za Ospedale Maggiore 3, 20100 Milan, Italy
| | - Angelo Vanzulli
- Radiology Unit, ASST Ospedale Niguarda, P.za Ospedale Maggiore 3, 20100 Milan, Italy
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10
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Mazzarelli C, Angrisani D, Viganò R. The Rising Tide of Nonalcoholic Fatty Liver Disease: How Much Time Until the Flood Reaches Our Coast? Clin Gastroenterol Hepatol 2021; 19:1299. [PMID: 33248075 DOI: 10.1016/j.cgh.2020.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Chiara Mazzarelli
- Hepatology Unit and Gastroenterology, Aziensa Sociosanitaria Territoriale Ospedale Metropolitano Niguarda, Milan, Italy
| | - Debora Angrisani
- Hepatology Unit and Gastroenterology, Aziensa Sociosanitaria Territoriale Ospedale Metropolitano Niguarda, Milan, Italy
| | - Raffaella Viganò
- Hepatology Unit and Gastroenterology, Aziensa Sociosanitaria Territoriale Ospedale Metropolitano Niguarda, Milan, Italy
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11
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Manini MA, Bruce M, Whitehouse G, Mazzarelli C, Considine A, Agarwal K, Suddle A, Fagiuoli S, Heaton N, Heneghan M. A Very Short Course of HBIg+NA Followed by Entecavir or Tenofovir Monotherapy Prevents HBV Recurrence in Low-Risk Liver Transplant Recipients. Transplant Proc 2020; 53:207-214. [PMID: 32605776 DOI: 10.1016/j.transproceed.2020.04.1822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/20/2020] [Accepted: 04/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Monoprophylaxis with third-generation nucleos(t)ide analogues (NAs) can be safely adopted in hepatitis B virus (HBV)-positive, liver transplantation (LT) patients after at least 6 months of HBV immunoglobulin (HBIg)+NA. We investigated the efficacy of earlier initiation of post-LT entecavir (ETV) or tenofovir (TDF) monoprophylaxis. METHODS Between September 2011 and January 2017, all consecutive hepatitis B surface antigen (HBsAg)-positive transplanted patients were scheduled to receive HBIg with ETV or TDF for a period related to the risk for HBV reinfection: 1. low-risk patients (HBeAg-negative and HBV DNA < 12 IU/mL before LT) were due to withdraw from HBIg once HBsAg had become negative after a minimum of 7 days of HBIg+NA; 2. high-risk patients were due to receive HBIg for at least 6 months, after which they continued with third-generation NA monotherapy, only. RESULTS Twenty patients with a median interquartile range (IQR) follow-up of 46 (64-39) months were enrolled in the study (40% receiving ETV, 60% receiving TDF). Two low-risk patients refused early HBIg withdrawal and were therefore treated and analyzed along with the high-risk group. Eventually, there were 2 groups: group A, which included 12 low-risk patients, and group B, which included 8 patients (six high-risk, 2 low-risk). After transplantation, group A and B patients received HBIg+NA for a median (IQR) time of 7 (9-7) days and 9 (13-5) months, respectively. All 20 recipients demonstrated HBV DNA < 12 IU/mL and stable graft function during follow-up. Two patients (10%), 1 from each group, had HBsAg relapse. Notably, both patients who relapsed had hepatocellular carcinoma (HCC) diagnosed before LT and showed very low levels (< 0.25 IU/mL) of HBsAg after recurrence. CONCLUSION In low-risk HBsAg-positive recipients, HBIg may be safely discontinued within 2 weeks of LT and replaced by ETV or TDF monotherapy.
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Affiliation(s)
- Matteo A Manini
- Institute of Liver Studies, King's College Hospital, London, United Kingdom; Gastroenterology, Hepatology, and Transplant Unit, Department of Specialty and Transplant Medicine, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy.
| | - Matthew Bruce
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Gavin Whitehouse
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Chiara Mazzarelli
- Institute of Liver Studies, King's College Hospital, London, United Kingdom; Gastroenterology and Hepatology, ASST Ospedale Metropolitano Niguarda, Milano, Italy
| | - Aisling Considine
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Abid Suddle
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Stefano Fagiuoli
- Gastroenterology, Hepatology, and Transplant Unit, Department of Specialty and Transplant Medicine, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Nigel Heaton
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Michael Heneghan
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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12
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Mazzarelli C, Vangeli M, Airoldi A. Harmful and Beneficial Effects of Anticoagulants in Patients With Cirrhosis and Portal Vein Thrombosis. Clin Gastroenterol Hepatol 2019; 17:797-798. [PMID: 30099107 DOI: 10.1016/j.cgh.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/01/2018] [Accepted: 08/04/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Chiara Mazzarelli
- Hepatology Unit and Gastroenterology, Azienda Socio-Sanitaria Territoriale "ASST" Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marcello Vangeli
- Hepatology Unit and Gastroenterology, Azienda Socio-Sanitaria Territoriale "ASST" Ospedale Metropolitano Niguarda, Milan, Italy
| | - Aldo Airoldi
- Hepatology Unit and Gastroenterology, Azienda Socio-Sanitaria Territoriale "ASST" Ospedale Metropolitano Niguarda, Milan, Italy
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13
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Mazzarelli C, Cannon MD, Hudson M, Heaton N, Sarker D, Kane P, Quaglia A, Suddle A. Hepatocellular Carcinoma as a Complication of Vascular Disease of the Liver After Fontan Procedure. Hepatology 2019; 69:911-913. [PMID: 30055116 DOI: 10.1002/hep.30194] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/25/2018] [Indexed: 12/07/2022]
Affiliation(s)
- Chiara Mazzarelli
- Institute of Liver Studies, King's College Hospital, London, United Kingdom.,Hepatology and Gastroenterology Unit, ASST Ospedale Niguarda, Milan, Italy
| | - Mary D Cannon
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Mark Hudson
- Liver Transplantation Unit, Freeman Hospital, Newcastle, United Kingdom
| | - Nigel Heaton
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Debashis Sarker
- Department of Research Oncology, Division of Cancer Studies, King's College London, United Kingdom
| | - Pauline Kane
- Department of Radiology, King's College Hospital, London, United Kingdom
| | - Alberto Quaglia
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Abid Suddle
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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14
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Calvaruso V, Mazzarelli C, Milazzo L, Badia L, Pasulo L, Guaraldi G, Lionetti R, Villa E, Borghi V, Carrai P, Alberti A, Biolato M, Piai G, Persico M, Santantonio T, Felder M, Angelico M, Montalbano M, Mancusi RL, Grieco A, Angeli E, D'Offizi G, Fagiuoli S, Belli L, Verucchi G, Puoti M, Craxì A. Daclatasvir-based regimens in HCV cirrhosis: experience from the Italian early access program. Sci Rep 2019; 9:585. [PMID: 30679515 PMCID: PMC6345835 DOI: 10.1038/s41598-018-36734-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/06/2018] [Indexed: 12/13/2022] Open
Abstract
We reported the efficacy and safety data for daclatasvir (DCV)-based all-oral antiviral therapy in patients treated in the Italian compassionate-use program. 275 patients were included (202 male-73.5%, mean age: 57.4 years, 62 HIV-coinfected, 94 with recurrence of hepatitis C post-OLT). Forty-nine patients (17.8%) had Child-Pugh B, Genotype(G) distribution was: G1a:72 patients (26.2%), G1b:137 (49.8%); G3:40 (14.5%) and G4:26 (9.5%). Patients received DCV with sofosbuvir(SOF) (n = 221, 129 with ribavirin(RBV) or with simeprevir (SMV) or asunaprevir (ASU) (n = 54, 19 with RBV) for up to 24 weeks. Logistic regression was used to identify baseline characteristics associated with sustained virological response at week 12 post-treatment (SVR12). Liver function changes between baseline and follow up were assessed in 228 patients. 240 patients achieved SVR12 (87.3%), post transplant and HIV co-infected patients were equally distributed among SVR and no SVR (35% vs 34.3%; p = 0.56 and 24.2% vs 11.4%, p = 0.13, respectively). SVR rate was significantly higher with the combination DCV + SOF compared with DCV + SIM or ASU (93.2% vs 63.0%, p < 0.0001). Bilirubin value (OR: 0.69, CI95%: 0.54–0.87, p = 0.002) and regimen containing SOF (OR: 9.99, CI95%: 4.09–24.40; p < 0.001) were independently related with SVR. Mean albumin and bilirubin values significantly improved between baseline and follow-up week 12. DCV-based antiviral therapy was well tolerated and resulted in a high SVR when combined with SOF either in pre-transplant and in OLT patients and in “difficult to treat” HCV genotypes. Regimens containing DCV in combination with NS3 protease inhibitors obtained suboptimal results.
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Affiliation(s)
- Vincenza Calvaruso
- Gastroenterology and Hepatology Unit, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy.
| | | | - Laura Milazzo
- Section of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Lorenzo Badia
- Infectious Diseases Unit - Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Luisa Pasulo
- Gastroenterology and Liver unit, San giovanni XXIII Hospital, Bergamo, Italy
| | - Giovanni Guaraldi
- Infectious Disease Unit - Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | - Erica Villa
- Gastroenterology Unit Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Vanni Borghi
- Infectious Disease Unit - Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | - Alfredo Alberti
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Marco Biolato
- Liver Transplant Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Guido Piai
- Azienda Ospedaliera San Sebastiano-Caserta, Caserta, Italy
| | | | | | - Martina Felder
- Gastroenterology Unit, Ospedale Centrale Bolzano, Bolzano, Italy
| | | | | | | | - Antonio Grieco
- Liver Transplant Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Elena Angeli
- Section of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | | | - Stefano Fagiuoli
- Gastroenterology and Liver unit, San giovanni XXIII Hospital, Bergamo, Italy
| | - Luca Belli
- Gastroenterology and Liver unit, Niguarda Ca' granda, Milan, Italy
| | - Gabriella Verucchi
- Infectious Diseases Unit - Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Massimo Puoti
- Section of Infectious Diseases, Niguarda Ca' granda, Milan, Italy
| | - Antonio Craxì
- Gastroenterology and Hepatology Unit, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
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15
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Perricone G, Duvoux C, Berenguer M, Cortesi PA, Vinaixa C, Facchetti R, Mazzarelli C, Rockenschaub SR, Martini S, Morelli C, Monico S, Volpes R, Pageaux GP, Fagiuoli S, Belli LS. Delisting HCV-infected liver transplant candidates who improved after viral eradication: Outcome 2 years after delisting. Liver Int 2018; 38:2170-2177. [PMID: 29750389 DOI: 10.1111/liv.13878] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUNDS & AIMS Treating patients with decompensated cirrhosis with direct-acting antiviral (DAA) therapy while on the waiting list for liver transplantation results in substantial improvement of liver function allowing 1 in 4 patients to be removed from the waiting list or delisted, as reported in a previous study promoted by the European Liver and Intestine Transplant Association (ELITA). The aim of this study was to report on clinical outcomes of delisted patients, including mortality risk, hepatocellular carcinoma development and clinical decompensation requiring relisting. METHODS One hundred and forty-two HCV-positive patients on the liver transplant waiting list for decompensated cirrhosis, negative for hepatocellular carcinoma, between February 2014 and June 2015 were treated with DAA therapy and were prospectively followed up. RESULTS Forty-four patients (30.9%) were delisted following clinical improvement. This percentage was higher than in the original study because of a number of patients being delisted long after starting DAAs. The median Child-Pugh and MELD score of delisted patients was 5.5 and 9 respectively. Four patients were relisted, because of HCC diagnosis in 1 case and 3 patients developed ascites. One further patient died (2.4%) because of rapidly progressing hepatocellular carcinoma twenty-two months after delisting. Of the 70 patients who received a liver graft, 9 died (13%). CONCLUSIONS Antiviral therapy allows for a long-term improvement of liver function and the delisting of one-third of treated patients with risk of liver-related complications after delisting being very low.
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Affiliation(s)
- Giovanni Perricone
- Gastroenterology and Hepatology Unit, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, AssistancePublique-Hôpitaux de Paris, Paris-Est University, Creteil, France
| | - Marina Berenguer
- Hepatology & Liver Transplantation Unit, Hospital Universitari I Politècnic La Fe, University of Valencia & Ciberhed, Valencia, Spain
| | - Paolo A Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Carmen Vinaixa
- Division of Transplantation, Department of Surgery, University of Vienna, Vienna, Austria
| | - Rita Facchetti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Chiara Mazzarelli
- Gastroenterology and Hepatology Unit, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Silvia Martini
- Liver Transplantation Center, Gastro-Hepatology Unit, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Cristina Morelli
- Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Sara Monico
- Division of Digestive Diseases, 'Maggiore' University Hospital, Milan, Italy
| | - Riccardo Volpes
- Hepatology and Gastroenterology Unit, ISMETT, Palermo, Italy
| | - Georges-Philippe Pageaux
- Department of Hepatology, Gastroenterology, and Liver Transplantation, Centre HospitalierUniversitaire (CHU) Saint Eloi, Montpellier, France
| | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luca S Belli
- Gastroenterology and Hepatology Unit, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,International Center for Disease Health (ICDH), University of Milan-Bicocca, Monza, Italy
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16
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Cortesi PA, Belli LS, Facchetti R, Mazzarelli C, Perricone G, De Nicola S, Cesana G, Duvoux C, Mantovani LG, Strazzabosco M. The optimal timing of hepatitis C therapy in liver transplant-eligible patients: Cost-effectiveness analysis of new opportunities. J Viral Hepat 2018; 25:791-801. [PMID: 29406608 DOI: 10.1111/jvh.12877] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023]
Abstract
Different strategies of DAAs treatment are currently possible both pre- and postliver transplantation (LT). Clinical and economic consequences of these strategies still need to be adequately investigated; this study aims at assessing their cost-effectiveness. A decision analytical model was created to simulate the progression of HCV-infected patients listed for decompensated cirrhosis (DCC) or for hepatocellular carcinoma (HCC). Three DAAs treatment strategies were compared: (i) a 12-week course of DAAs prior to transplantation (PRE-LT), (ii) a 4-week course of DAAs starting at the time of transplantation (PERI-LT) and (iii) a 12-week course of DAAs administered at disease recurrence (POST-LT). The population was substratified according to HCC presence and, in those without HCC, according to the MELD score at listing. Data on DAAs effectiveness were estimated using a cohort of patients still followed by 11 transplant centres of the European Liver and Intestine Transplant Association and by data available in the literature. In this study, PRE-LT treatment strategy was dominant for DCC patients with MELD<16 and cost-effective for those with MELD16-20, while POST-LT strategy emerged as cost-effective for DCC patients with MELD>20 and for those with HCC. Sensitivity analyses confirmed PRE-LT as the cost-effective strategy for patients with MELD≤20. In conclusion, PRE-LT treatment is cost-effective for patients with MELD≤20 without HCC, while treatments after LT are cost-effective in cirrhotic patients with MELD>20 and in those with HCC. It is worth reminding, though, that the final choice of a specific regimen at the patient level will have to be personalized based on clinical, social and transplant-related factors.
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Affiliation(s)
- P A Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - L S Belli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy.,International Center for Disease Health (ICDH), University of Milan-Bicocca, Monza, Italy
| | - R Facchetti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - C Mazzarelli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - G Perricone
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - S De Nicola
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - G Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - C Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Paris-Est University, Creteil, France
| | - L G Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy.,International Center for Disease Health (ICDH), University of Milan-Bicocca, Monza, Italy
| | - M Strazzabosco
- International Center for Disease Health (ICDH), University of Milan-Bicocca, Monza, Italy.,Department of Internal Medicine, Liver Center, Yale University, New Haven, CT, USA
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17
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Mazzarelli C, Prentice WM, Heneghan MA, Belli LS, Agarwal K, Cannon MD. Palliative care in end-stage liver disease: Time to do better? Liver Transpl 2018; 24:961-968. [PMID: 29729119 DOI: 10.1002/lt.25193] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/28/2018] [Accepted: 04/08/2018] [Indexed: 12/12/2022]
Abstract
Optimal involvement of palliative care (PC) services in the management of patients with decompensated cirrhosis and end-stage liver disease (ESLD) is limited. This may result from both ignorance and the failure to recognize the spectrum and unpredictability of the underlying liver condition. Palliative care is a branch of medicine that focuses on quality of life (QoL) by optimizing symptom management and providing psychosocial, spiritual, and practical support for both patients and their caregivers. Historically, palliative care has been underutilized for patients with decompensated liver disease. This review provides an evidence-based analysis of the benefits of the integration of palliative care into the management of patients with ESLD. Liver Transplantation 24 961-968 2018 AASLD.
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Affiliation(s)
- Chiara Mazzarelli
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom.,Hepatology and Gastroenterology Unit, ASST Ospedale Niguarda, Milan, Italy
| | - Wendy M Prentice
- Cicely Saunders Institute, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Luca S Belli
- Hepatology and Gastroenterology Unit, ASST Ospedale Niguarda, Milan, Italy
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Mary D Cannon
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom
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18
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Mazzarelli C, Considine A, Childs K, Carey I, Manini MA, Suddle A, Dusheiko G, Agarwal K, Cannon MD. Efficacy and Tolerability of Direct-Acting Antivirals for Hepatitis C in Older Adults. J Am Geriatr Soc 2018; 66:1339-1345. [PMID: 29799112 DOI: 10.1111/jgs.15392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the efficacy and tolerability of direct-acting antiviral (DAA) therapy in individuals aged 65 and older. DESIGN Retrospective review between June 2014 and January 2017. SETTING Viral hepatitis outpatient clinic. PARTICIPANTS Individuals aged 65 and older treated with DAA therapy for hepatitis C virus (HCV) during the study period (N=113) divided into 2 cohorts: aged 65 to 74 (n=88) and aged 75 and older (n=25). MEASUREMENTS Drug-drug interactions (DDIs), adverse events (AEs), and rates of sustained virologic response with DAA therapy were assessed. RESULTS Sustained virologic response rate was 97.7% in individuals aged 65 to 74 and 95.8% in those aged 75 and older. Individuals aged 75 and older were more likely to be taking more than 2 medications per day for chronic conditions (84% vs 62%, p=.02) and more likely to have clinically significant DDIs necessitating cessation or adjustment of medications before commencement of DAA therapy (80% vs 36%, p=.001). Moreover, individuals aged 75 and older were more likely to experience an AE during therapy (50% vs 26%, p=.03) and were more susceptible to developing anemia secondary to ribavirin (60% vs 20%, p=.02). CONCLUSION DAA therapy is highly efficacious for the treatment of HCV in older adults, but those aged 75 and older are more likely to have clinically significant pretreatment DDIs and experience AEs, including ribavirin-induced anemia, during therapy.
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Affiliation(s)
- Chiara Mazzarelli
- Institute of Liver Studies, King's College Hospital, London, United Kingdom.,Hepatology and Gastroenterology Unit, ASST Ospedale Niguarda, Milan, Italy
| | - Aisling Considine
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Kate Childs
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Ivana Carey
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | | | - Abid Suddle
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Geoffrey Dusheiko
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Mary D Cannon
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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19
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Martini S, Donato MF, Mazzarelli C, Rendina M, Visco-Comandini U, Filì D, Gianstefani A, Fagiuoli S, Melazzini M, Montilla S, Pani L, Petraglia S, Russo P, Trotta MP, Carrai P, Caraceni P. The Italian compassionate use of sofosbuvir in HCV patients waitlisted for liver transplantation: A national real-life experience. Liver Int 2018; 38:733-741. [PMID: 28921807 DOI: 10.1111/liv.13588] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/08/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS This study aimed to assess the real-life clinical and virological outcomes of HCV waitlisted patients for liver transplantation (LT) who received sofosbuvir/ribavirin (SOF/R) within the Italian compassionate use program. METHODS Clinical and virological data were collected in 224 patients with decompensated cirrhosis and/or hepatocellular carcinoma (HCC) receiving daily SOF/R until LT or up a maximum of 48 weeks. RESULTS Of 100 transplanted patients, 51 were HCV-RNA negative for >4 weeks before LT (SVR12: 88%) and 49 negative for <4 weeks or still viraemic at transplant: 34 patients continued treatment after LT (bridging therapy) (SVR12: 88%), while 15 stopped treatment (SVR12: 53%). 98 patients completed SOF/R without LT (SVR12: 73%). In patients with advanced decompensated cirrhosis (basal MELD ≥15 and/or C-P ≥B8), a marked improvement of the scores occurred in about 50% of cases and almost 20% of decompensated patients without HCC reached a condition suitable for inactivation and delisting. CONCLUSIONS These real-life data indicate that in waitlisted patients: (i) bridging antiviral therapy can be an option for patients still viraemic or negative <4 weeks at LT; and (ii) clinical improvement to a condition suitable for delisting can occur even in patients with advanced decompensated cirrhosis.
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Affiliation(s)
- Silvia Martini
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Maria Francesca Donato
- First Division of Gastroenterology, IRCCS Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy
| | - Chiara Mazzarelli
- Hepatology and Gastroenterology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Maria Rendina
- Gastroenterology and Digestive Endoscopy, University Hospital, Bari, Italy
| | - Ubaldo Visco-Comandini
- Infectious Diseases - Hepatology Division, National Institute for Infectious Diseases Spallanzani IRCSS, Rome, Italy
| | - Daniela Filì
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Hepatology Unit, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Alice Gianstefani
- Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Ospedale Papa Giovanni XXIII di Bergamo, Bergamo, Italy
| | | | | | - Luca Pani
- Italian Medicines Agency (AIFA), Rome, Italy
| | | | | | | | - Paola Carrai
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa, Pisa, Italy
| | - Paolo Caraceni
- Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
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20
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Lionetti R, Calvaruso V, Piccolo P, Mancusi RL, Mazzarelli C, Fagiuoli S, Montalbano M, Lenci I, Carrai P, Guaraldi G, Visco-Comandini U, Milana M, Biolato M, Loiacono L, Valente G, Craxì A, Angelico M, D'offizi G. Sofosbuvir plus daclatasvir with or without ribavirin is safe and effective for post-transplant hepatitis C recurrence and severe fibrosis and cirrhosis: A prospective study. Clin Transplant 2017; 32. [PMID: 29193356 DOI: 10.1111/ctr.13165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND In 2012, an Italian Named Patient Program began for hepatitis C virus (HCV)-infected liver transplant (LT) recipients with advanced fibrosis, before approval of direct antiviral agents (DAA), to benefit severely ill patients. The aim of this "real-life" study was to assess treatment efficacy and safety with an extended course of daclatasvir (DCV) plus sofosbuvir (SOF) with or without ribavirin (RBV). METHODS All HCV LT recipients with severe fibrosis in 15 Italian transplant centers were treated with DCV+SOF±RBV for 24 weeks; sustained virological response was assessed at 12 weeks post-treatment (SVR12). RESULTS Eighty-seven patients were enrolled (75.9% males, mean age 58.4 ± 7.2 years, 83.9% genotype 1, 81.6% cirrhosis); 52 (59.8%) received RBV. Overall, 79 obtained SVR12 (90.8%): 100% in F3 and 88.7% in cirrhotics (91.5% in Child-Pugh A, 83.3% in Child-Pugh B and C). According to the treatment group, SVR was 80% in DCV + SOF group and 98.1% in SOF + DCV + RBV. Two virological relapses occurred during follow-up in cirrhotic patients who received DCV + SOF. Four cirrhotic patients in DCV + SOF group and 1 in DCV + SOF + RBV group died on treatment. CONCLUSION An extended course of SOF plus DCV for 24 weeks, with or without RBV, is effective and well tolerated for the treatment of post-LT HCV recurrence with severe fibrosis.
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Affiliation(s)
- Raffaella Lionetti
- Infectious and Liver Diseases, Lazzaro Spallanzani National Infectious Disease Institute, Rome, Italy
| | | | - Paola Piccolo
- Department of Internal Medicine, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy.,Hepatology Unit, Tor Vergata University, Rome, Italy
| | | | - Chiara Mazzarelli
- Gastroenterology and Liver Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Stefano Fagiuoli
- Gastroenterology and Liver Unit, San Giovanni XXIII Hospital, Bergamo, Italy
| | - Marzia Montalbano
- Infectious and Liver Diseases, Lazzaro Spallanzani National Infectious Disease Institute, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Tor Vergata University, Rome, Italy
| | - Paola Carrai
- Liver Transplantation Unit, Pisa Hospital, Pisa, Italy
| | | | - Ubaldo Visco-Comandini
- Infectious and Liver Diseases, Lazzaro Spallanzani National Infectious Disease Institute, Rome, Italy
| | | | - Marco Biolato
- Liver Transplant Medicine, Fondazione Policlinico Gemelli Catholic University, Rome, Italy
| | - Laura Loiacono
- Infectious and Liver Diseases, Lazzaro Spallanzani National Infectious Disease Institute, Rome, Italy
| | | | - Antonio Craxì
- Gastroenterology Unit, University of Palermo, Palermo, Italy
| | | | - Gianpiero D'offizi
- Infectious and Liver Diseases, Lazzaro Spallanzani National Infectious Disease Institute, Rome, Italy
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21
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Belli LS, Facchetti R, Mazzarelli C, Perricone G, De Nicola S, Cesana G, Duvoux C, Strazzabosco M, Mantovani LG, Cortesi PA. The optimal timing of HCV therapy in liver transplant: cost and effectiveness of new opportunities. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- LS Belli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - R Facchetti
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - C Mazzarelli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - G Perricone
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - S De Nicola
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - G Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - C Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Paris-Est University, Creteil, France
| | - M Strazzabosco
- Liver Center, Department of Internal Medicine, Yale University, New Haven, United States
| | - LG Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - PA Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
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22
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Mazzarelli C, Cannon MD, Belli LS, Agarwal K. Direct-acting antiviral therapy in patients with hepatocellular cancer: The timing of treatment is everything. J Hepatol 2017; 68:S0168-8278(17)32265-1. [PMID: 28870675 DOI: 10.1016/j.jhep.2017.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 01/26/2023]
Affiliation(s)
- Chiara Mazzarelli
- Institute of Liver Studies, King's College Hospital, London SE5 9RS, United Kingdom; Hepatology Unit and Gastroenterology, ASST Ospedale Metropolitano Niguarda, P.za dell'ospedale Maggiore 3, 20100 Milan, Italy.
| | - Mary D Cannon
- Institute of Liver Studies, King's College Hospital, London SE5 9RS, United Kingdom
| | - Luca S Belli
- Hepatology Unit and Gastroenterology, ASST Ospedale Metropolitano Niguarda, P.za dell'ospedale Maggiore 3, 20100 Milan, Italy
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital, London SE5 9RS, United Kingdom
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23
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Donato MF, Morelli C, Romagnoli R, Invernizzi F, Mazzarelli C, Iemmolo RM, Montalbano M, Lenci I, Bhoori S, Pieri G, Berardi S, Caraceni P, Martini S. Prevention of hepatitis C recurrence by bridging sofosbuvir/ribavirin from pre- to post-liver transplant: a real-life strategy. Liver Int 2017; 37:678-683. [PMID: 27865034 DOI: 10.1111/liv.13322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/12/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) re-infection following liver transplant (LT) is associated with reduced graft and patient survival. Before transplant, Sofosbuvir/Ribavirin (SOF/R) treatment prevents recurrent HCV in 96% of those patients achieving viral suppression for at least 4 weeks before transplant. We evaluated whether a bridging SOF-regimen from pre- to post-transplant is safe and effective to prevent HCV recurrence in those patients with less than 4 weeks of HCV-RNA undetectability at the time of transplant. METHODS From July 2014 SOF/R was given in 233 waitlisted HCV cirrhotics with/without hepatocellular carcinoma (HCC) within an Italian Compassionate Program. One hundred patients were transplanted and 31 patients (31%) treated with SOF/R bridging therapy were studied. RESULTS Liver transplant indication in bridge subgroup was HCC in 22 and decompensated cirrhosis in 9. HCV-genotype was 1/4 in 18 patients. SOF 400 mg/day and R (median dosage 800 mg/day) were given for a median of 35 days before LT. At transplant time, 19 patients were still HCV-RNA positive (median HCV-RNA 58 IU/mL). One recipient had a virological breakthrough at week 4 post-transplant; one died, on treatment, 1-month post-transplant for sepsis and 29/31 achieved a 12-week sustained virological response (94%). Acute cellular rejection occurred in three recipients. On September 2016, 30 recipients (97%) were alive with a median follow-up of 18 months (range 13-25). CONCLUSIONS In patients with suboptimal virological response at LT, a bridging SOF/R regimen helps avoiding post-transplant graft reinfection.
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Affiliation(s)
- Maria Francesca Donato
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Cristina Morelli
- U.O. Medicina Interna e delle Insufficienze d'Organo-Azienda Ospedaliera-Universitaria, Policlinico S. Orsola-Malpighi di Bologna, Bologna, Italy
| | - Renato Romagnoli
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Federica Invernizzi
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Chiara Mazzarelli
- Hepatology Unit and Liver Transplantation Surgery, Niguarda Hospital, Milan, Italy
| | - Rosa Maria Iemmolo
- Liver and Multivisceral Transplant Center, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Marzia Montalbano
- Infectious Diseases and General Surgery, National Institute for Infectious Diseases Spallanzani, Rome, Italy
| | - Ilaria Lenci
- Gastroenterology Unit and Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy
| | - Sherrie Bhoori
- Surgery and Liver Transplantation Unit, IRCCS National Institute of Cancer, Milan, Italy
| | - Giulia Pieri
- Division of Hepatology, IRCCS AO San Martino IST, Genova, Italy
| | - Sonia Berardi
- U.O. Medicina Interna e delle Insufficienze d'Organo-Azienda Ospedaliera-Universitaria, Policlinico S. Orsola-Malpighi di Bologna, Bologna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Silvia Martini
- Liver Transplantation Center, Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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24
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Viganò R, Mazzarelli C, Alberti AB, Perricone G. Change of liver transplantation list composition: Pre versus post direct-acting antivirals era. The Niguarda Hospital experience. Dig Liver Dis 2017; 49:317. [PMID: 28174002 DOI: 10.1016/j.dld.2017.01.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/10/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Raffaella Viganò
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Mazzarelli
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Giovanni Perricone
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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25
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Zavaglia C, Okolicsanyi S, Cesarini L, Mazzarelli C, Pontecorvi V, Ciaccio A, Strazzabosco M, Belli LS. Is the risk of neoplastic recurrence increased after prescribing direct-acting antivirals for HCV patients whose HCC was previously cured? J Hepatol 2017; 66:236-237. [PMID: 27592303 DOI: 10.1016/j.jhep.2016.08.016] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/07/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Claudio Zavaglia
- Department of Hepatology and Gastroenterology, Liver Unit, Niguarda Hospital, Milan, Italy.
| | - Stefano Okolicsanyi
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy; International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
| | - Lucia Cesarini
- Department of Hepatology and Gastroenterology, Liver Unit, Niguarda Hospital, Milan, Italy
| | - Chiara Mazzarelli
- Department of Hepatology and Gastroenterology, Liver Unit, Niguarda Hospital, Milan, Italy
| | - Valerio Pontecorvi
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy; International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
| | - Antonio Ciaccio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy; International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
| | - Mario Strazzabosco
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy; International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
| | - Luca Saverio Belli
- Department of Hepatology and Gastroenterology, Liver Unit, Niguarda Hospital, Milan, Italy; International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
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26
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Cortesi PA, Mantovani LG, Ciaccio A, Rota M, Mazzarelli C, Cesana G, Strazzabosco M, Belli LS. Cost-Effectiveness of New Direct-Acting Antivirals to Prevent Post-Liver Transplant Recurrent Hepatitis. Am J Transplant 2015; 15:1817-26. [PMID: 26086300 PMCID: PMC4946849 DOI: 10.1111/ajt.13320] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/02/2015] [Accepted: 01/14/2015] [Indexed: 01/25/2023]
Abstract
Preliminary studies on HCV-cirrhotics listed for transplant suggest that sofosbuvir in combination with ribavirin is very effective in promoting viral clearance and preventing disease recurrence. Unfortunately, the high cost of such treatment (€46 500 per 12 weeks of treatment) makes its cost-effectiveness questionable. A semi-Markov model was developed to assess the cost-effectiveness of sofosbuvir/ribavirin treatment in cirrhotic patients without HCC (HCV-CIRRH) and with HCC (HCV-HCC) listed for transplant. In the base-case analysis, the incremental cost-effectiveness ratio for 24 weeks of sofosbuvir/ribavirin was €44 875 per quality-adjusted life-year gained in HCV-CIRRH and €60 380 in HCV-HCC patients. Both results were above the willingness to pay threshold of €37 000 per quality-adjusted life-year. Our data also show that in order to remain cost-effective (with a 24-week treatment), any novel interferon-free treatment endowed with ideal efficacy should cost less than €67 224 or €95 712 in HCV-cirrhotics with and without HCC, respectively. The results shows that sofosbuvir/ribavirin therapy, given to patients listed for transplant, is not cost-effective at current prices despite being very effective, and new, more effective treatments will have little economic margins to remain cost-effective. New interferon-free combinations have the potential to revolutionize the treatment and prognosis of HCV-positive patients listed for transplant; however, without sustainable prices, this revolution is unlikely to happen.
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Affiliation(s)
- P. A. Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - L. G. Mantovani
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - A. Ciaccio
- Department of Surgical and Interdisciplinary Medicine, University of Milan-Bicocca, Monza, Italy
| | - M. Rota
- Department of Health Sciences, Centre of Biostatistics for Clinical Epidemiology, University of Milan-Bicocca, Monza, Italy
| | - C. Mazzarelli
- Department of Hepatology and Liver Unit, Niguarda Hospital, Milan, Italy
| | - G. Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - M. Strazzabosco
- Department of Surgical and Interdisciplinary Medicine, University of Milan-Bicocca, Monza, Italy
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - L. S. Belli
- Department of Hepatology and Liver Unit, Niguarda Hospital, Milan, Italy
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27
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Vespasiani-Gentilucci U, Carotti S, Perrone G, Mazzarelli C, Galati G, Onetti-Muda A, Picardi A, Morini S. Hepatic toll-like receptor 4 expression is associated with portal inflammation and fibrosis in patients with NAFLD. Liver Int 2015; 35:569-81. [PMID: 24649857 DOI: 10.1111/liv.12531] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 03/09/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Notwithstanding evidences implicating the lipopolysaccharides (LPS)/toll-like receptor-4 (TLR4) axis in the pathogenesis of NAFLD, there are no studies aimed to characterize hepatic TLR4 expression in NAFLD patients. We aimed to analyse hepatic TLR4 expression and to verify its relationship with disease activity/evolution in NAFLD patients. METHODS Liver tissue from 74 patients with NAFLD and 12 controls was analysed by immunohistochemistry (IHC) for TLR4, α-smooth muscle actin (α-SMA) and cytokeratin-7. IHC for α-SMA was used to evaluate activation of fibrogenic cells (hepatic stellate cells and portal/septal myofibroblasts), that for cytokeratin-7 to count hepatic progenitor cells and bile ducts/ductules, and that for CD68, in a subgroup of 27 patients, for detecting macrophages. Serum LPS-binding protein (LBP), a sensitive marker of LPS activity, was determined in 36 patients and 32 controls. RESULTS As confirmed by double-labelling experiments, the highest level of TLR4 expression was observed in hepatic progenitor cells, biliary cells and portal/septal macrophages. TLR4-positive hepatic progenitor cells and bile ducts/ductules correlated with portal/interface inflammation, activity of fibrogenic cells and fibrosis (P < 0.001). Also the score of TLR4 positivity of porto-septal inflammatory infiltrate correlated with number of hepatic progenitor cells and bile ducts/ductules, activity of fibrogenic cells and fibrosis (P < 0.01). Serum LBP was increased in patients compared to controls (P < 0.001), and correlated with portal/interface inflammation, activity of portal/septal myofibroblasts and fibrosis (all P < 0.05). CONCLUSIONS TLR4 expression by regenerating and inflammatory cells at the porto-septal and interface level, favoured by increased LPS activity, is associated with activation of fibrogenic cells and the degree of fibrosis.
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Foschi A, Zavaglia CA, Fanti D, Mazzarelli C, Perricone G, Vangeli M, Viganò R, Belli LS. Autoimmunity after liver transplantation: a frequent event but a rare clinical problem. Clin Transplant 2015; 29:161-6. [PMID: 25522890 DOI: 10.1111/ctr.12498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 12/22/2022]
Abstract
Autoantibodies are frequently detected after liver transplantation (LT), but their role is unclear. This study was designed to address three points: autoantibody prevalence pre-LT and over time up to five yr after LT, identification of possible predictors of autoantibody formation, and correlation between autoantibodies and graft dysfunction. To these aims, we retrospectively evaluated 92 consecutive LT recipients for whom prospectively stored frozen sera were available for autoantibodies assessment by immunofluorescence. The overall autoantibody prevalence resulted significantly higher after LT than before LT (64% vs. 27%, p < 0.001 and 35.9% vs. 8.7%, p < 0.001 considering cutoff titer of ≥ 1:80 and ≥ 1:160, respectively). Recipient gender, donor age and gender, and indication for LT and main immunosuppressant (cyclosporine vs. tacrolimus) were not associated with the presence of autoantibodies. Patients with graft dysfunction had a significantly higher autoantibody prevalence irrespective of the etiology of liver injury as compared to those patients with persistently normal liver biochemistry, but only for cutoff titers ≥ 1:160 (p = 0.004). No cases of de novo autoimmune hepatitis were observed. In conclusion, autoantibodies are very frequently detected after LT also at high titers and their association with graft dysfunction likely represents an aspecific indicator of liver injury.
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Affiliation(s)
- Antonella Foschi
- Struttura Complessa di Gastroenterologia ed Epatologia, Ospedale Niguarda Ca' Granda, Milano, Italy
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Zavaglia C, Silini E, Mangia A, Airoldi A, Piazzolla V, Vangeli M, Stigliano R, Foschi A, Mazzarelli C, Tinelli C. Prognostic factors of hepatic decompensation and hepatocellular carcinoma in patients with transfusion-acquired HCV infection. Liver Int 2014; 34:e308-16. [PMID: 24529078 DOI: 10.1111/liv.12502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 02/08/2014] [Indexed: 12/20/2022]
Abstract
AIMS Aim of this study was to assess if host (immunogenetic traits, age, sex), exogenous (alcohol) or viral factors (viral type, past HBV infection) might affect the progression of chronic hepatitis C to liver decompensation or the development of HCC in a cohort of patients exposed to a single blood transfusion prior to the introduction of anti-HCV screening. METHODS Two hundred and forty-eight patients with a history of a single exposure to blood or blood products prior to 1990 were retrospectively considered. Patients were devoid of other risk factors of liver disease or immunosuppression and naïve to antiviral therapies. Eight baseline variables were assessed: age at transfusion, sex, HBV core antibody, immunogenetic profile (DRB1*11, DRB1*1104, DRB1*07), HCV genotype and alcohol consumption. RESULTS The follow-up was 22 (SD: 11) years. Sixty-eight patients (27%) progressed to hepatic decompensation over a median period of 22.5 years (IQR: 14-30) and 41 patients (16%) developed HCC over a median period of 31 years (IQR: 24-38). The cumulative incidence of liver failure was 0.4% (95% CI: 0.1-3.1), 4.9% (95% CI: 2.6-9.3) and 16.2% (95% CI: 10.4-24.7) at 10, 20 and 30 years after blood transfusion respectively. By univariate analysis, only age at transfusion was correlated with the risk of decompensation. Stratifying the age of transfusion by tertiles, the incidence of hepatic decompensation was 0.7% per year in patients transfused at ≤24 years of age as compared to 1.2% and 1.9% per year in those transfused at 25-35 and >36 years of age respectively (HR: 5.5, 95% CI: 2.78-10.7, P<0.001). The risk of HCC development was correlated by univariate analysis with age at transfusion (as continuous variable, HR: 1.12, 95% CI: 1.08-1.16 per year of age, P<0.001, >36 compared to ≤24 years, HR: 10.3, 95% CI: 3.9-26.9, P<0.001) and male sex (HR: 4.2, 95% CI: 1.7-10, P=0.001). Multivariate analysis confirmed age at transfusion and male sex as independent predictors of HCC development [HR: 1.12 per year (95% CI: 1.08-1.16), P<0.001 and HR: 5.4 (95% CI: 2.2-13.2), P<0.001 respectively]. CONCLUSIONS In patients with transfusion-acquired HCV infection, age at transfusion affects the risk for hepatic decompensation. Age at transfusion and male sex are independent risk factors for HCC development.
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Affiliation(s)
- Claudio Zavaglia
- Struttura Complessa di Gastroenterologia ed Epatologia 'Crespi', Ospedale Niguarda, piazza Ospedale Maggiore 3, 20162, Milano, Italy
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Galati G, De Vincentis A, Ripetti V, La Vaccara V, Vespasiani-Gentilucci U, Mazzarelli C, Gallo P, Luppi G, Grasso RF, Picardi A. Haemorrhoidal disease in severe portal hypertension: a combined approach with transjugular intrahepatic portosystemic shunt (TIPS) and transanal haemorrhoidal dearterialization (THD). Arch Med Sci 2014; 10:195-6. [PMID: 24701234 PMCID: PMC3953988 DOI: 10.5114/aoms.2014.40746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 12/19/2022] Open
Affiliation(s)
- Giovanni Galati
- Department of Clinical Medicine and Hepatology, Campus Bio-Medico University of Rome, Italy
| | - Antonio De Vincentis
- Department of Clinical Medicine and Hepatology, Campus Bio-Medico University of Rome, Italy
| | - Valter Ripetti
- Department of General Surgery, Campus Bio-Medico University of Rome, Italy
| | | | | | - Chiara Mazzarelli
- Department of Clinical Medicine and Hepatology, Campus Bio-Medico University of Rome, Italy
| | - Paolo Gallo
- Department of Clinical Medicine and Hepatology, Campus Bio-Medico University of Rome, Italy
| | - Giacomo Luppi
- Department of Interventional Radiology, Campus Bio-Medico University of Rome, Italy
| | | | - Antonio Picardi
- Department of Clinical Medicine and Hepatology, Campus Bio-Medico University of Rome, Italy
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Riva E, Scagnolari C, Monteleone K, Selvaggi C, Picardi A, Mazzarelli C, Pizzigallo E, Vincenzi B, Carducci A, Antonaci S, Giannelli G, Antonelli G. Interleukin-28B (IL-28B) single-nucleotide polymorphisms and interferon plus ribavirin treatment outcome in Italian chronically HCV-infected patients. J Viral Hepat 2012; 19:650-3. [PMID: 22863269 DOI: 10.1111/j.1365-2893.2012.01606.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
To determine the single or combined effect of both rs12979860 and rs8099917 SNPs on HCV treatment response, these variants were genotyped in samples from a cohort of 170 patients infected with different HCV genotypes (HCVGT). The favourable rs12979860 CC genotype was found only in patients with sustained or rapid virological responses (SVR/RVR) and at significantly high proportions in HCVGT1/4 SVR patients. A significant association was also found between the rs8099917 TT genotype and SVR in both HCVGT1/4 and HCVGT2/3 groups of patients. In contrast, we found that there was significantly more of the rs8099917 GG genotype in nonresponders (NR) than in SVR patients which suggests a good association of the minor homozygote GG with the lack of treatment response. The combination of rs12979860/rs8099917 CC/TT favourable genotypes was found only in SVR patients and matched the frequency observed for their rs12979860 CC genotypes alone. By contrast, the inverse unfavourable correlate rs12979860/rs8099917 TT/GG genotype was seen more in NR than in SVR patients as observed for the single GG genotype. This study confirms the impact of both rs12979860 and/or rs8099917 IL-28B SNPs on treatment-induced clearance of HCV-RNA and demonstrates that the rs12979860 CC genotype is stronger than rs8099917 TT genotype in predicting a positive treatment response in HCVGT1/4 patients. The unfavourable rs8099917 GG genotype seems to be more important in predicting the failure of treatment response independently from HCV genotype.
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Affiliation(s)
- E Riva
- Virology Section, Campus Bio-Medico University, Rome, Italy.
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Casale M, Mazzarelli C, Vespasiani Gentilucci U, Potena M, Pappacena M, Faiella F, Galati G, Salvinelli F, Picardi A. Distortion-product otoacoustic emissions: a useful test for monitoring ototoxicity induced by pegylated interferon and ribavirin treatment in patients with chronic hepatitis C. Int J Immunopathol Pharmacol 2012; 25:551-6. [PMID: 22697091 DOI: 10.1177/039463201202500229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pegylated-interferon (peg-IFN) and ribavirin combination therapy for the treatment of hepatitis C virus (HCV) infection is well known to be associated with significant adverse effects. Several studies have investigated a possible auditory pathway involvement during IFN therapy, but a method to monitor the potential auditory involvement during treatment has not yet been described. The aim of this study is to evaluate possible modifications of the outer hair cell (OHC) function in HCV patients receiving peg-IFN and ribavirin combination therapy. Thirteen adult HCV patients (8 F/5 M, mean age 52∓12 years) treated with peg-IFN and ribavirin combination therapy underwent Pure Tone Audiogram and Distortion Product Otoacoustic Emission (DPOAE) tests. We compared mean auditory thresholds (PTA) and mean DPOAE amplitude before, at month 3 during, and at the end of treatment (T0, T3, and Tend, respectively), and 3 months after treatment discontinuation (Tfu). No significant differences were found in hearing levels at the different time points analyzed. During treatment, three patients developed tinnitus, which in 2 cases resolved spontaneously after the end of therapy. Compared to T0 (19.5±0.83), a statistically significant DPOAE increase at T3 (30±1,26) and Tend (28.6±2.16) was found (p<0.05 at both time points), while DPOAEs returned to pre-treatment levels at Tfu (19.3±1.3). In our group, none of the patients reported a permanent auditory impairment, excluding one patient with persistent tinnitus. Peg-IFN could produce an increase of motility of the OHCs by means of intracellular pathways. DPOAE test could be considered a new method for monitoring ototoxicity induced by IFN. On the basis of recent literature and our audiological results, physicians should be aware of the possible ototoxic effects of peg-IFN, requiring appropriate surveillance, and the patient should be informed of the potential side effects of IFN therapy on the auditory pathway.
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MESH Headings
- Acoustic Stimulation
- Adult
- Antiviral Agents/adverse effects
- Audiometry, Pure-Tone
- Auditory Threshold/drug effects
- Drug Therapy, Combination
- Female
- Hair Cells, Auditory, Outer/drug effects
- Hair Cells, Auditory, Outer/pathology
- Hearing Disorders/chemically induced
- Hearing Disorders/diagnosis
- Hearing Disorders/physiopathology
- Hearing Loss, Sensorineural/chemically induced
- Hearing Loss, Sensorineural/diagnosis
- Hearing Loss, Sensorineural/physiopathology
- Hepatitis C, Chronic/drug therapy
- Humans
- Interferon alpha-2
- Interferon-alpha/adverse effects
- Male
- Middle Aged
- Otoacoustic Emissions, Spontaneous/drug effects
- Polyethylene Glycols/adverse effects
- Predictive Value of Tests
- Recombinant Proteins/adverse effects
- Ribavirin/adverse effects
- Rome
- Time Factors
- Tinnitus/chemically induced
- Tinnitus/diagnosis
- Tinnitus/physiopathology
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Gentilucci UV, Gallo P, Perrone G, Vescovo RD, Galati G, Spataro S, Mazzarelli C, Pellicelli A, Afeltra A, Picardi A. Non-cirrhotic portal hypertension with large regenerative nodules: A diagnostic challenge. World J Gastroenterol 2011; 17:2580-4. [PMID: 21633664 PMCID: PMC3103817 DOI: 10.3748/wjg.v17.i20.2580] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 02/15/2011] [Accepted: 02/22/2011] [Indexed: 02/06/2023] Open
Abstract
Non-cirrhotic portal hypertension is a poorly understood condition characterized by portal hypertension in the absence of conventional hepatic cirrhosis and described in association with blood coagulation disorders, myeloproliferative and immunological diseases and with exposure to toxic drugs. Very recently, precise classification criteria have been proposed in order to define four distinct subcategories. The present case highlights how the clinical presentation, the confounding results from imaging studies, and the difficulties in the histological evaluation often render cases of non-cirrhotic portal hypertension a real diagnostic challenge. It also underscores the classification problems which can be faced once this diagnosis is performed. Indeed, the different subcategories proposed result from the prevalent subtypes in a spectrum of hepatic regenerative responses to a variety of injuries determining microcirculatory disturbances. More flexibility in classification should derive from this etiopathogenic background.
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Vespasiani-Gentilucci U, Galati G, Mazzarelli C, D'Avola D, Spataro S, Gallo P, Rigon A, Pellicelli A, Dicuonzo G, Afeltra A, Picardi A. Angiogenic cytokines in patients undergoing antiviral treatment for chronic hepatitis C virus infection. J Interferon Cytokine Res 2010; 31:207-10. [PMID: 20874229 DOI: 10.1089/jir.2010.0040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
During chronic liver disease (CLD), angiogenesis participates in the fibrogenic process. Herein, we aimed at verifying the on-treatment kinetics of serum vascular endothelial growth factor (VEGF) and angiopoietin-2 (Ang-2) in hepatitis C virus (HCV) patients undergoing antiviral therapy. Forty-three HCV patients treated with pegylated-interferon/ribavirin and 26 controls were studied. Serum VEGF and Ang-2 were determined before treatment, at different time points during treatment, and at follow-up after treatment. Thirty and 13 patients were sustained virological responder (SVR) and No-SVR, respectively. Patients showed increased Ang-2 levels [504 (368-720) versus 449 (389-483) pg/mL, P < 0.05], and equivalent VEGF levels [271 (193-377) versus 274 (199-324) pg/mL, P = 0.6], with respect to controls. By univariate analysis, stage of fibrosis was associated with Ang-2 levels (odds ratio 4.25, P < 0.05). In SVR patients VEGF levels showed a progressive reduction (P < 0.05) but returned to pretherapy levels at follow-up, and Ang-2 levels showed an opposite progressive increase, being significantly reduced at follow-up (P < 0.01). No significant modifications in VEGF and Ang-2 levels were observed in No-SVR. We conclude that, in patients with HCV-CLD, Ang-2 serum levels are associated with fibrosis and reduced at follow-up in SVR patients. On-treatment, VEGF and Ang-2 serum levels undergo different-sided modifications only in SVR patients, possibly expressing the vascular remodeling occurring early after viral clearance.
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Picardi A, Gentilucci UV, Bambacioni F, Galati G, Spataro S, Mazzarelli C, D'Avola D, Fiori E, Riva E. Lower schooling, higher hepatitis C virus prevalence in Italy: an association dependent on age. J Clin Virol 2007; 40:168-70. [PMID: 17804289 DOI: 10.1016/j.jcv.2007.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 07/23/2007] [Indexed: 10/22/2022]
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