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Serenari M, Lenzi J, Ricci C, Odaldi F, Maroni L, Laurenzi A, Prosperi E, Bonatti C, Fallani G, Caputo F, Rottoli M, Ravaioli M, Cescon M. The Importance of Multiorgan Procurement in the Improvement of Residents' Open Surgical Skills. J Surg Res 2024; 296:441-446. [PMID: 38320363 DOI: 10.1016/j.jss.2024.01.012] [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] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION The multiorgan procurement (MOP) represents a chance for the general surgery resident to learn the fundamental steps of open abdominal surgery. The objective of this study was to evaluate the impact of MOP on the residents' open surgical skills. METHODS Residents' surgical skills were assessed during a 6-month transplant rotation (October 2020-March 2021) using a modified Objective Structured Assessment of Technical Skills with the global rating scale. The surgeries were self-assessed by residents and tutors based on 9 specific steps (SS) and 4 general skills (GS). Each item was rated from 1 (poor) to 5 (excellent) with a maximum score of 45 points for SS and 20 for GS. A crossed-effects linear regression analysis was performed both to evaluate any associations between GS/SS scores and some prespecified covariates, and to study differences in the assessments performed by residents and tutors. RESULTS Residents actively participated in a total of 59 procurements. In general, there were no significant differences in SS/GS mean scorings between residents (n = 15) and tutors (n = 5). There was a significantly positive association between mean GS/SS scorings and the number of donor surgeries performed (at least 5). Comparing the evaluations of the tutors with the residents, this significance was retained only when scorings were assigned by the tutors. CONCLUSIONS MOP was shown to improve basic open surgical skills among residents. Awareness of the utility of a clinical rotation in transplant surgery should be raised also on an institutional level.
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Affiliation(s)
- Matteo Serenari
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Claudio Ricci
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy; Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Federica Odaldi
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Maroni
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Laurenzi
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Prosperi
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Chiara Bonatti
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Guido Fallani
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Francesca Caputo
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Matteo Rottoli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy; Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Ravaioli
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Matteo Cescon
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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Dajti G, Germinario G, Prosperi E, Siniscalchi A, Vasuri F, Valente S, Odaldi F, Maroni L, Serenari M, Bertuzzo V, Laurenzi A, Del Gaudio M, Cescon M, Ravaioli M. The role of cold ischemia time and hypothermic perfusion in predicting early hepatocellular carcinoma recurrences after liver transplantation. Artif Organs 2024. [PMID: 38270476 DOI: 10.1111/aor.14715] [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] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/28/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
AIM The aim of the study was to identify predictors of early tumor recurrence in patients with hepatocellular carcinoma (HCC) after liver transplantation (LT). METHODS Retrospective cohort study in 237 consecutive liver recipients with HCC between 2016 and 2021. Multivariate logistic analysis was performed to identify predictors of early HCC recurrences. The impact of hypothermic-oxygenated perfusion (HOPE) on outcome was analyzed after propensity score weighting. RESULTS Early recurrences were observed in 15 cases. Microvascular invasion (OR 3.737, 95% CI 1.246-11.206, p = 0.019) and cold ischemia time (OR 1.155, 95% CI 1.001-1.333, p = 0.049) were independently associated with a lower risk of HCC recurrences. After balancing for relevant variables, patients in the HOPE group had lower rates of tumor recurrence (weighted OR 0.126, 95% CI 0.016-0.989, p = 0.049) and higher recurrence free survival (weighted HR 0.132, 95% CI 0.017-0.999, p = 0.050). CONCLUSION Reducing cold ischemia time and graft perfusion with HOPE can lead to lower rates of early HCC recurrences and higher recurrence-free survival.
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Affiliation(s)
- Gerti Dajti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Giuliana Germinario
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- General Surgery and Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Prosperi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- General Surgery and Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Siniscalchi
- Intensive Care Unit, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Vasuri
- Department of Specialized, Experimental and Diagnostic Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Sabrina Valente
- Department of Specialized, Experimental and Diagnostic Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Federica Odaldi
- General Surgery and Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Maroni
- General Surgery and Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Serenari
- General Surgery and Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valentina Bertuzzo
- General Surgery and Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Laurenzi
- General Surgery and Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Massimo Del Gaudio
- General Surgery and Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Cescon
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- General Surgery and Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Ravaioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- General Surgery and Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Di Sandro S, Sposito C, Ravaioli M, Lauterio A, Magistri P, Bongini M, Odaldi F, De Carlis R, Botta F, Centonze L, Maroni L, Citterio D, Guidetti C, Bagnardi V, De Carlis L, Cescon M, Mazzaferro V, Di Benedetto F. Surgical Treatment of Hepatocellular Carcinoma: Multicenter Competing-risk Analysis of Tumor-related Death Following Liver Resection and Transplantation Under an Intention-to-treat Perspective. Transplantation 2023; 107:1965-1975. [PMID: 37022089 DOI: 10.1097/tp.0000000000004593] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 04/07/2023]
Abstract
BACKGROUND Early-stage hepatocellular carcinoma could benefit from upfront liver resection (LR) or liver transplantation (LT), but the optimal strategy in terms of tumor-related outcomes is still debated. We compared the oncological outcomes of LR and LT for hepatocellular carcinoma, stratifying the study population into a low-, intermediate-, and high-risk class according to the risk of death at 5-y predicted by a previously developed prognostic model. The impact of tumor pathology on oncological outcomes of low- and intermediate-risk patients undergoing LR was investigated as a secondary outcome. METHODS We performed a retrospective multicentric cohort study involving 2640 patients consecutively treated by LR or LT from 4 tertiary hepatobiliary and transplant centers between 2005 and 2015, focusing on patients amenable to both treatments upfront. Tumor-related survival and overall survival were compared under an intention-to-treat perspective. RESULTS We identified 468 LR and 579 LT candidates: 512 LT candidates underwent LT, whereas 68 (11.7%) dropped-out for tumor progression. Ninety-nine high-risk patients were selected from each treatment cohort after propensity score matching. Three and 5-y cumulative incidence of tumor-related death were 29.7% and 39.5% versus 17.2% and 18.3% for LR and LT group ( P = 0.039), respectively. Low-risk and intermediate-risk patients treated by LR and presenting satellite nodules and microvascular invasion had a significantly higher 5-y incidence of tumor-related death (29.2% versus 12.5%; P < 0.001). CONCLUSIONS High-risk patients showed significantly better intention-to-treat tumor-related survival after upfront LT rather than LR. Cancer-specific survival of low- and intermediate-risk LR patients was significantly impaired by unfavorable pathology, suggesting the application of ab-initio salvage LT in such scenarios.
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Affiliation(s)
- Stefano Di Sandro
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Sposito
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Matteo Ravaioli
- Department of General Surgery and Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Bongini
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Federica Odaldi
- Department of General Surgery and Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
- PhD Course in Clinical and Experimental Sciences, Univeristy of Padua, Padua, Italy
| | - Francesca Botta
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Leonardo Centonze
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Maroni
- Department of General Surgery and Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Citterio
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Cristiano Guidetti
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, 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
| | - Matteo Cescon
- Department of General Surgery and Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Vincenzo Mazzaferro
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
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4
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Fallani G, Maroni L, Bonatti C, Comai G, Buzzi M, Cuna V, Vasuri F, Caputo F, Prosperi E, Pisani F, Pisillo B, Maurino L, Odaldi F, Bertuzzo VR, Tondolo F, Busutti M, Zanfi C, Del Gaudio M, La Manna G, Ravaioli M. Renal Vessel Extension With Cryopreserved Vascular Grafts: Overcoming Surgical Pitfalls in Living Donor Kidney Transplant. Transpl Int 2023; 36:11060. [PMID: 36846603 PMCID: PMC9950096 DOI: 10.3389/ti.2023.11060] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/26/2023] [Indexed: 02/12/2023]
Abstract
In LDKT, right kidneys and kidneys with anomalous vascularization are often deferred because of concerns on complications and vascular reconstructions. To date, only few reports have examined renal vessel extension with cryopreserved vascular grafts in LDKT. The aim of this study is to investigate the effect of renal vessel extension on short-term outcomes and ischemia times in LDKT. From 2012 to 2020, recipients of LDKT with renal vessels extension were compared with standard LDKT recipients. Subset analysis of rights grafts and grafts with anomalous vascularization, with or without renal vessel extension, was performed. Recipients of LDKT with (n = 54) and without (n = 91) vascular extension experienced similar hospital stays, surgical complications and DGF rates. For grafts with multiple vessels, renal vessel extension granted a faster implantation time (44±5 vs. 72±14 min), which resulted comparable to that of standard anatomy grafts. Right kidney grafts with vascular extension had a faster implantation time compared to right kidney grafts without vascular lengthening (43±5 vs. 58±9 min), and a comparable implantation time to left kidney grafts. Renal vessel extension with cryopreserved vascular grafts allows faster implantation time in right kidney grafts or grafts with anomalous vascularization, maintaining similar surgical and functional outcomes.
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Affiliation(s)
- Guido Fallani
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Maroni
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Chiara Bonatti
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giorgia Comai
- Department of Nephrology, Dialysis and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marina Buzzi
- Tissue Bank, Department of Immunohematology and Transfusion Medicine, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vania Cuna
- Department of Nephrology, Dialysis and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Vasuri
- Department of Pathology, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesca Caputo
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Prosperi
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federico Pisani
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Beatrice Pisillo
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ludovica Maurino
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federica Odaldi
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valentina Rosa Bertuzzo
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Tondolo
- Department of Nephrology, Dialysis and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Busutti
- Department of Nephrology, Dialysis and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Chiara Zanfi
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Massimo Del Gaudio
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gaetano La Manna
- Department of Nephrology, Dialysis and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Matteo Ravaioli
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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5
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Ravaioli M, Germinario G, Dajti G, Sessa M, Vasuri F, Siniscalchi A, Morelli MC, Serenari M, Del Gaudio M, Zanfi C, Odaldi F, Bertuzzo VR, Maroni L, Laurenzi A, Cescon M. Hypothermic oxygenated perfusion in extended criteria donor liver transplantation-A randomized clinical trial. Am J Transplant 2022; 22:2401-2408. [PMID: 35671067 PMCID: PMC9796786 DOI: 10.1111/ajt.17115] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [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: 01/18/2022] [Revised: 05/12/2022] [Accepted: 06/03/2022] [Indexed: 01/25/2023]
Abstract
Hypothermic Oxygenated Perfusion (HOPE) of the liver can reduce the incidence of early allograft dysfunction (EAD) and failure in extended criteria donors (ECD) grafts, although data from prospective studies are very limited. In this monocentric, open-label study, from December 2018 to January 2021, 110 patients undergoing transplantation of an ECD liver graft were randomized to receive a liver after HOPE or after static cold storage (SCS) alone. The primary endpoint was the incidence of EAD. The secondary endpoints included graft and patient survival, the EASE risk score, and the rate of graft or other graft-related complications. Patients in the HOPE group had a significantly lower rate of EAD (13% vs. 35%, p = .007) and were more frequently allocated to the intermediate or higher risk group according to the EASE score (2% vs. 11%, p = .05). The survival analysis confirmed that patients in the HOPE group were associated with higher graft survival one year after LT (p = .03, log-rank test). In addition, patients in the SCS group had a higher re-admission and overall complication rate at six months, in particular cardio-vascular adverse events (p = .04 and p = .03, respectively). HOPE of ECD grafts compared to the traditional SCS preservation method is associated with lower dysfunction rates and better graft survival.
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Affiliation(s)
- Matteo Ravaioli
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly,Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Giuliana Germinario
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly,Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Gerti Dajti
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Maurizio Sessa
- Department of Drug Design and PharmacologyUniversity of CopenhagenCopenhagenDenmark
| | - Francesco Vasuri
- Department of Specialized, Experimental and Diagnostic Medicine, Pathology UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Antonio Siniscalchi
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Maria Cristina Morelli
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Matteo Serenari
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Massimo Del Gaudio
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Chiara Zanfi
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Federica Odaldi
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Valentina Rosa Bertuzzo
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Lorenzo Maroni
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly,Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Andrea Laurenzi
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Matteo Cescon
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly,Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
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6
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Ravaioli M, Lai Q, Sessa M, Ghinolfi D, Fallani G, Patrono D, Di Sandro S, Avolio A, Odaldi F, Bronzoni J, Tandoi F, De Carlis R, Pascale MM, Mennini G, Germinario G, Rossi M, Agnes S, De Carlis L, Cescon M, Romagnoli R, De Simone P. Impact of MELD 30-allocation policy on liver transplant outcomes in Italy. J Hepatol 2022; 76:619-627. [PMID: 34774638 DOI: 10.1016/j.jhep.2021.10.024] [Citation(s) in RCA: 6] [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: 09/01/2020] [Revised: 10/04/2021] [Accepted: 10/15/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS In Italy, since August 2014, liver transplant (LT) candidates with model for end-stage liver disease (MELD) scores ≥30 receive national allocation priority. This multicenter cohort study aims to evaluate time on the waiting list, dropout rate, and graft survival before and after introducing the macro-area sharing policy. METHODS A total of 4,238 patients registered from 2010 to 2018 were enrolled and categorized into an ERA-1 Group (n = 2,013; before August 2014) and an ERA-2 Group (n = 2,225; during and after August 2014). A Cox proportional hazards model was used to estimate the hazard ratio (HR) of receiving a LT or death between the two eras. The Fine-Gray model was used to estimate the HR for dropout from the waiting list and graft loss, considering death as a competing risk event. A Fine-Gray model was also used to estimate risk factors of graft loss. RESULTS Patients with MELD ≥30 had a lower median time on the waiting list (4 vs.12 days, p <0.001) and a higher probability of being transplanted (HR 2.27; 95% CI 1.78-2.90; p = 0.001) in ERA-2 compared to ERA-1. The subgroup analysis on 3,515 LTs confirmed ERA-2 (odds ratio 0.56; 95% CI 0.46-0.68; p = 0.001) as a protective factor for better graft survival rate. The protective variables for lower dropouts on the waiting list were: ERA-2, high-volume centers, no competition centers, male recipients, and hepatocellular carcinoma. The protective variables for graft loss were high-volume center and ERA-2, while MELD ≥30 remained related to a higher risk of graft loss. CONCLUSIONS The national MELD ≥30 priority allocation was associated with improved patient outcomes, although MELD ≥30 was associated with a higher risk of graft loss. Transplant center volumes and competition among centers may have a role in recipient prioritization and outcomes. CLINICAL TRIAL NUMBER NCT04530240 LAY SUMMARY: Italy introduced a new policy in 2014 to give national allocation priority to patients with a model for end-stage liver disease (MELD) score ≥30 (i.e. very sick patients). This policy has led to more liver transplants, fewer dropouts, and shorter waiting times for patients with MELD ≥30. However, a higher risk of graft loss still burdens these cases. Transplant center volumes and competition among centers may have a role in recipient prioritization and outcomes.
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Affiliation(s)
- Matteo Ravaioli
- Dipartimento di Chirurgia Generale e Trapianti, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), University of Bologna, Bologna, Italy.
| | - Quirino Lai
- Unità di Chirurgia Generale e Trapianti d'Organo, Dipartimento di Chirurgia Generale e Specialistica, Sapienza Università di Roma, Azienda Ospedaliero-Universitaria Policlinico Umberto I di Roma, Italy
| | - Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Davide Ghinolfi
- Chirurgia epatobiliare e trapianto di fegato, Ospedale della Scuola medica dell'Università di Pisa, Italy
| | - Guido Fallani
- Dipartimento di Chirurgia Generale e Trapianti, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Damiano Patrono
- Centro trapianti di fegato, Chirurgia Generale 2U, Università di Torino, AOU Città della Salute e della Scienza, Torino, Italy
| | - Stefano Di Sandro
- Dipartimento di Chirurgia Generale e Trapianti, Ospedale Niguarda Ca 'Granda, Milano, Italy
| | - Alfonso Avolio
- Dipartimento di Chirurgia - Servizio Trapianti, Università Cattolica "A. Gemelli" di Roma, Italy
| | - Federica Odaldi
- Dipartimento di Chirurgia Generale e Trapianti, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jessica Bronzoni
- Chirurgia epatobiliare e trapianto di fegato, Ospedale della Scuola medica dell'Università di Pisa, Italy
| | - Francesco Tandoi
- Centro trapianti di fegato, Chirurgia Generale 2U, Università di Torino, AOU Città della Salute e della Scienza, Torino, Italy
| | - Riccardo De Carlis
- Dipartimento di Chirurgia Generale e Trapianti, Ospedale Niguarda Ca 'Granda, Milano, Italy
| | - Marco Maria Pascale
- Unità di Chirurgia Generale e Trapianti d'Organo, Dipartimento di Chirurgia Generale e Specialistica, Sapienza Università di Roma, Azienda Ospedaliero-Universitaria Policlinico Umberto I di Roma, Italy
| | - Gianluca Mennini
- Unità di Chirurgia Generale e Trapianti d'Organo, Dipartimento di Chirurgia Generale e Specialistica, Sapienza Università di Roma, Azienda Ospedaliero-Universitaria Policlinico Umberto I di Roma, Italy
| | - Giuliana Germinario
- Dipartimento di Chirurgia Generale e Trapianti, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), University of Bologna, Bologna, Italy
| | - Massimo Rossi
- Unità di Chirurgia Generale e Trapianti d'Organo, Dipartimento di Chirurgia Generale e Specialistica, Sapienza Università di Roma, Azienda Ospedaliero-Universitaria Policlinico Umberto I di Roma, Italy
| | - Salvatore Agnes
- Dipartimento di Chirurgia - Servizio Trapianti, Università Cattolica "A. Gemelli" di Roma, Italy
| | - Luciano De Carlis
- Dipartimento di Chirurgia Generale e Trapianti, Ospedale Niguarda Ca 'Granda, Milano, Italy
| | - Matteo Cescon
- Dipartimento di Chirurgia Generale e Trapianti, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), University of Bologna, Bologna, Italy
| | - Renato Romagnoli
- Centro trapianti di fegato, Chirurgia Generale 2U, Università di Torino, AOU Città della Salute e della Scienza, Torino, Italy
| | - Paolo De Simone
- Chirurgia epatobiliare e trapianto di fegato, Ospedale della Scuola medica dell'Università di Pisa, Italy
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7
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Rampino T, Gregorini M, Germinario G, Pattonieri EF, Erasmi F, Grignano MA, Bruno S, Alomari E, Bettati S, Asti A, Ramus M, De Amici M, Testa G, Bruno S, Ceccarelli G, Serpieri N, Libetta C, Sepe V, Blasevich F, Odaldi F, Maroni L, Vasuri F, La Manna G, Ravaioli M. Extracellular Vesicles Derived from Mesenchymal Stromal Cells Delivered during Hypothermic Oxygenated Machine Perfusion Repair Ischemic/Reperfusion Damage of Kidneys from Extended Criteria Donors. Biology (Basel) 2022; 11:biology11030350. [PMID: 35336724 PMCID: PMC8945029 DOI: 10.3390/biology11030350] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
Simple Summary In this study, we explore for the first time an innovative tool for organ preservation aimed to preventing ischemia reperfusion injury (IRI) in marginal kidneys from expanded criteria donors (ECD) unsuitable for transplantation. Ex vivo hypothermic oxygenated perfusion (HOPE) with and without MSC-derived EV and normothermic reperfusion (NR) with artificial blood composed of bovine hemoglobin were applied on kidneys to evaluate global renal ischemic damage score, renal ultrastructure, mitochondrial distress, apoptosis, cell proliferation index, and the mediators of energy metabolism. Our study demonstrates that kidney conditioning with HOPE+EV arrests the ischemic damage, prevents reoxygenation-dependent injury, and preserves tissue integrity. EV delivery during HOPE can be considered a new organ preservation strategy to increase the donor pool and improving transplant outcome. The originality of our study lies an EV and HOPE combined novel setting use in kidneys from ECD, but also in any condition for graft dysfunction such as ischemia/reperfusion. Abstract The poor availability of kidney for transplantation has led to a search for new strategies to increase the donor pool. The main option is the use of organs from extended criteria donors. We evaluated the effects of hypothermic oxygenated perfusion (HOPE) with and without extracellular vesicles (EV) derived from mesenchymal stromal cells on ischemic/reperfusion injury of marginal kidneys unsuitable for transplantation. For normothermic reperfusion (NR), we used artificial blood as a substitute for red blood cells. We evaluated the global renal ischemic dam-age score (GRS), analyzed the renal ultrastructure (RU), cytochrome c oxidase (COX) IV-1 (a mitochondrial distress marker), and caspase-3 renal expression, the tubular cell proliferation index, hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF) tissue levels, and effluent lactate and glucose levels. HOPE+EV kidneys had lower GRS and better RU, higher COX IV-1 expression and HGF and VEGF levels and lower caspase-3 expression than HOPE kidneys. During NR, HOPE+EV renal effluent had lower lactate release and higher glucose levels than HOPE renal effluent, suggesting that the gluconeogenesis system in HOPE+EV group was pre-served. In conclusion, EV delivery during HOPE can be considered a new organ preservation strategy for increasing the donor pool and improving transplant outcome.
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Affiliation(s)
- Teresa Rampino
- Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (T.R.); (E.F.P.); (F.E.); (M.A.G.); (A.A.); (M.R.); (N.S.); (C.L.); (V.S.)
| | - Marilena Gregorini
- Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (T.R.); (E.F.P.); (F.E.); (M.A.G.); (A.A.); (M.R.); (N.S.); (C.L.); (V.S.)
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Correspondence: ; Tel.: +39-0382-503896
| | - Giuliana Germinario
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.G.); (F.O.); (L.M.); (M.R.)
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), University of Bologna, 40126 Bologna, Italy
| | - Eleonora Francesca Pattonieri
- Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (T.R.); (E.F.P.); (F.E.); (M.A.G.); (A.A.); (M.R.); (N.S.); (C.L.); (V.S.)
| | - Fulvia Erasmi
- Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (T.R.); (E.F.P.); (F.E.); (M.A.G.); (A.A.); (M.R.); (N.S.); (C.L.); (V.S.)
| | - Maria Antonietta Grignano
- Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (T.R.); (E.F.P.); (F.E.); (M.A.G.); (A.A.); (M.R.); (N.S.); (C.L.); (V.S.)
| | - Stefano Bruno
- Department of Food and Drug, University of Parma, 43124 Parma, Italy; (S.B.); (E.A.)
- Biopharmatec TEC, University of Parma, Tecnopolo Padiglione 33, 43124 Parma, Italy;
| | - Esra Alomari
- Department of Food and Drug, University of Parma, 43124 Parma, Italy; (S.B.); (E.A.)
| | - Stefano Bettati
- Biopharmatec TEC, University of Parma, Tecnopolo Padiglione 33, 43124 Parma, Italy;
- Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy
| | - Annalia Asti
- Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (T.R.); (E.F.P.); (F.E.); (M.A.G.); (A.A.); (M.R.); (N.S.); (C.L.); (V.S.)
| | - Marina Ramus
- Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (T.R.); (E.F.P.); (F.E.); (M.A.G.); (A.A.); (M.R.); (N.S.); (C.L.); (V.S.)
| | - Mara De Amici
- Laboratory of Immuno-Allergology of Clinical Chemistry and Pediatric Clinic, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy;
| | - Giorgia Testa
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy;
| | - Stefania Bruno
- Department of Medical Sciences and Molecular Biotechnology Center, University of Torino, 10126 Torino, Italy;
| | - Gabriele Ceccarelli
- Human Anatomy Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Nicoletta Serpieri
- Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (T.R.); (E.F.P.); (F.E.); (M.A.G.); (A.A.); (M.R.); (N.S.); (C.L.); (V.S.)
| | - Carmelo Libetta
- Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (T.R.); (E.F.P.); (F.E.); (M.A.G.); (A.A.); (M.R.); (N.S.); (C.L.); (V.S.)
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Vincenzo Sepe
- Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (T.R.); (E.F.P.); (F.E.); (M.A.G.); (A.A.); (M.R.); (N.S.); (C.L.); (V.S.)
| | - Flavia Blasevich
- Department of Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Neurological Institute Carlo Besta, 20133 Milan, Italy;
| | - Federica Odaldi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.G.); (F.O.); (L.M.); (M.R.)
| | - Lorenzo Maroni
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.G.); (F.O.); (L.M.); (M.R.)
| | - Francesco Vasuri
- “F. Addarii” Institute of Oncology and Transplantation Pathology, S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy;
| | - Gaetano La Manna
- Department of Nephrology, S.Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy;
| | - Matteo Ravaioli
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.G.); (F.O.); (L.M.); (M.R.)
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), University of Bologna, 40126 Bologna, Italy
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8
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Ravaioli M, Germinario G, Cerri M, Prosperi E, Fallani G, Vasuri F, Serenari M, Odaldi F, Maroni L, Siniscalchi A, Cescon M, Renzulli M. Venous outflow in partial heterotopic liver transplantation with spleen replacement: Evidence of no chronic venous hypertension. Am J Transplant 2022; 22:664-665. [PMID: 34387912 DOI: 10.1111/ajt.16800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/11/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Matteo Ravaioli
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Giuliana Germinario
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Matteo Cerri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Enrico Prosperi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Guido Fallani
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Francesco Vasuri
- Department of Pathology, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Serenari
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federica Odaldi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Maroni
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Siniscalchi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Cescon
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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9
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Odaldi F, Serenari M, Comai G, La Manna G, Bova R, Frascaroli G, Malvi D, Maroni L, Vasuri F, Germinario G, Baraldi O, Capelli I, Cuna V, Sangiorgi G, D'Errico A, Del Gaudio M, Bertuzzo VR, Zanfi C, Sessa M, Ravaioli M. The Relationship between Timing of Pretransplant Kidney Biopsy, Graft Loss, and Survival in Kidney Transplantation: An Italian Cohort Study. Nephron Clin Pract 2021; 146:22-31. [PMID: 34818242 DOI: 10.1159/000518610] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Kidney biopsy is performed to assess if an extended criteria graft can be used for transplantation. It may be performed before or after cross-clamping during organ procurement. This study aims to evaluate whether the timing of biopsy may modify cold ischemia times (CIT) and/or graft outcomes. METHODS Kidney transplants performed in our center from January 2007 to December 2017 were analyzed. Grafts with preimplantation kidney biopsy were included. Biopsies were performed during surgical back table (ex situ kidney biopsy [ESKB]) until 2012 and since then before the aortic cross-clamping (in situ kidney biopsy [ISKB]). To overcome biases owing to different distributions, a propensity score model was developed. The study population consists in 322 patients, 115 ESKB, and 207 ISKB. RESULTS CIT was significantly lower for ISKB (730 min ISKB vs. 840 min ESKB, p value = 0.001). In both crude (OR 0.27; 95% confidence interval, 95% CI 0.12-0.60; p value = 0.002) and adjusted analyses (OR 0.37; 95% CI 0.14-0.94; p value = 0.039), ISKB was associated with a reduced odd of graft loss when compared to ESKB. DISCUSSION/CONCLUSION Performing preimplantation kidney biopsy during the recovery, prior to the aortic cross-clamping, may be a strategy to reduce CIT and improve transplant outcomes.
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Affiliation(s)
- Federica Odaldi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Serenari
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine, Nephrology, Dialysis and Renal Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine, Nephrology, Dialysis and Renal Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Raffaele Bova
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giacomo Frascaroli
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Deborah Malvi
- Department of Specialized, Experimental and Diagnostic Medicine, Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Maroni
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Francesco Vasuri
- Department of Specialized, Experimental and Diagnostic Medicine, Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giuliana Germinario
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Olga Baraldi
- Department of Experimental Diagnostic and Specialty Medicine, Nephrology, Dialysis and Renal Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Irene Capelli
- Department of Experimental Diagnostic and Specialty Medicine, Nephrology, Dialysis and Renal Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vania Cuna
- Department of Experimental Diagnostic and Specialty Medicine, Nephrology, Dialysis and Renal Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gabriela Sangiorgi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonietta D'Errico
- Department of Specialized, Experimental and Diagnostic Medicine, Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Massimo Del Gaudio
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valentina Rosa Bertuzzo
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Chiara Zanfi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Matteo Ravaioli
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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10
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Loforte A, Odaldi F, Berardi M, Boschi S, Potena L, Gliozzi G, Cavalli GG, Ravaioli M, Cescon M, Pacini D. Multiple organ retrieval in a brain dead left ventricular assist device donor. J Artif Organs 2021; 25:155-157. [PMID: 34652561 PMCID: PMC8517934 DOI: 10.1007/s10047-021-01298-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/06/2021] [Indexed: 11/27/2022]
Abstract
Left ventricular assist device (LVAD) support in donors may contribute in preserving proper haemodynamics and systemic perfusion during organ retrieval thus decreasing the risk of multiple organ injury. This is an option to expand the current organ supply. We report on intra-abdominal organs procurement strategy in a selected LVAD recipient who suffered a fatal cerebrovascular accident at the time of COVID-19 pandemic outbreak. The liver and kidneys grafts have been successfully transplanted.
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Affiliation(s)
- Antonio Loforte
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy.
| | - Federica Odaldi
- General Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Marianna Berardi
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
| | - Silvia Boschi
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
| | - Luciano Potena
- Cardiology Division, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Gregorio Gliozzi
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
| | - Giulio Giovanni Cavalli
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
| | - Matteo Ravaioli
- General Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Matteo Cescon
- General Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
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11
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Dondossola D, Ravaioli M, Lonati C, Maroni L, Pini A, Accardo C, Germinario G, Antonelli B, Odaldi F, Zanella A, Siniscalchi A, Cescon M, Rossi G. The Role of Ex Situ Hypothermic Oxygenated Machine Perfusion and Cold Preservation Time in Extended Criteria Donation After Circulatory Death and Donation After Brain Death. Liver Transpl 2021; 27:1130-1143. [PMID: 33835695 DOI: 10.1002/lt.26067] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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] [Revised: 03/08/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023]
Abstract
Hypothermic oxygenated machine perfusion (HOPE) has the potential to counterbalance the detrimental consequences of cold and warm ischemia time (WIT) in both donation after brain death (DBD) and donation after circulatory death (DCD). Herein we investigated the protective effects of HOPE in extended criteria donor (ECD) DBD and overextended WIT DCD grafts. The present retrospective case series included 50 livers subjected to end-ischemic HOPE or dual DHOPE in 2 liver transplantation (LT) centers from January 2018 to December 2019. All DCD donors were subjected to normothermic regional perfusion before organ procurement. Results are expressed as median (interquartile range [IQR]). In the study period, 21 grafts were derived from overextended WIT DCD donors (total WIT 54 [IQR, 40-60] minutes and 75% classified as futile), whereas 29 were from ECD DBD. A total of 3 biliary complications and 1 case of ischemia-type biliary lesion were diagnosed. The rate of early allograft dysfunction (EAD) was 20%, and those patients had higher Comprehensive Complication Index scores. Through a changing point analysis, cold preservation time >9 hours was associated with prolonged hospital stays (P = 0.02), higher rates of EAD (P = 0.009), and worst post-LT complications (P = 0.02). Logistic regression analyses indicated a significant relationship between cold preservation time and EAD. No differences were shown in terms of the early post-LT results between LTs performed with DCD and DBD. Overall, our data are fully comparable with benchmark criteria in LT. In conclusion, the application of DHOPE obtained satisfactory and promising results using ECD-DBD and overextended DCD grafts. Our findings indicate the need to reduce cold preservation time also in the setting of DHOPE, particularly for grafts showing poor quality.
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Affiliation(s)
- Daniele Dondossola
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Matteo Ravaioli
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Caterina Lonati
- Center for Preclinical Research, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Maroni
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessia Pini
- Department of Statistical Sciences, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Caterina Accardo
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuliana Germinario
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Barbara Antonelli
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Odaldi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberto Zanella
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Siniscalchi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Cescon
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giorgio Rossi
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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12
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Ravaioli M, Prosperi E, Pinna A, Siniscalchi A, Fallani G, Frascaroli G, Maroni L, Odaldi F, Serenari M, Cescon M. Restoration of portal flow with varix in liver transplantation for patients with total portal vein thrombosis: An effective strategy in the largest center experience. Clin Transplant 2021; 35:e14303. [PMID: 33797802 DOI: 10.1111/ctr.14303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Postoperative complications and worse prognosis still burden liver transplantations (LT) with complex portal vein thrombosis (CPVT). When an engorged left gastric vein (LGV) is present, the portal inflow is restorable with an anastomosis between the graft portal vein and the LGV of the recipient. We analyzed short- and long-term results of this procedure in 12 LT with CPVT. METHODS Between 2005 and 2019, 55 patients with CPVT underwent LT. We applied this technique in 12 patients. In six cases, we placed a vascular graft to obtain a tension-free structure. We evaluated patency, short- and long-term results. RESULTS No intraoperative complication was observed. The median duration of LT, blood transfusion, deceased donor age, and MELD score of the recipients were 7 h, 1250 mL, 72 years, and 19. Seven patients were affected by hepatocellular carcinoma. No major complications or PVT recurrence were observed. One patient required a liver re-transplantation for primary non-functioning syndrome. The mean hospital stay was 20 days. The actuarial patient survival was 85% with a mean FU of 4 years. The two late deaths were due to hepatocellular carcinoma recurrence and sepsis for cholangitis. CONCLUSIONS This technique in presence of both CPVT and engorged LGV is feasible and safe for patients, with good short- and long-term results.
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Affiliation(s)
- Matteo Ravaioli
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of General Surgery and Transplantation, University of Bologna, Bologna, Italy
| | - Enrico Prosperi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Pinna
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Siniscalchi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Guido Fallani
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giacomo Frascaroli
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Maroni
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federica Odaldi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Serenari
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Cescon
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of General Surgery and Transplantation, University of Bologna, Bologna, Italy
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13
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Buscemi V, Checchini G, De Carlis R, Lauterio A, Loforte A, Pacini D, Odaldi F, Cescon M, De Carlis L. A Successful Urgent Liver Retransplant From a Donor With a Left Ventricular Assist Device. EXP CLIN TRANSPLANT 2021; 19:493-496. [PMID: 33797358 DOI: 10.6002/ect.2020.0472] [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] [Indexed: 11/05/2022]
Abstract
Organ shortage is one of the major limitations in the field of liver transplantation, which has led to the consideration of extended criteria donors as a way to expand the donor pool. The use of extended criteria donors in cases of high Model for End-Stage Liver Disease scores or urgent recipients could be complicated by increased postoperative mortality. Donors on left ventricular assist devices could be considered extended criteria donors because of the mechanical circulatory support itself and the potential of chronic liver damage due to right ventricular failure, but experiences in the literature are limited. Here, we report the first case of an urgent liver retransplant procured from a left ventricular assist device donor.
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Affiliation(s)
- Vincenzo Buscemi
- From the the Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Giuliana Checchini
- From the the Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan
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14
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Ravaioli M, Fallani G, Cerri M, Prosperi E, Serra C, D'Errico A, Serenari M, Germinario G, Renzulli M, Contedini F, Odaldi F, Maroni L, Siniscalchi A, Cescon M, Azoulay D. Two surgical techniques are better than one: RAVAS and RAPID are answers for the same issue. Am J Transplant 2021; 21:905-906. [PMID: 32886855 DOI: 10.1111/ajt.16301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Matteo Ravaioli
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of General Surgery and Transplantation, Alma Mater, Bologna, Italy
| | - Guido Fallani
- Department of General Surgery and Transplantation, Alma Mater, Bologna, Italy
| | - Matteo Cerri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Enrico Prosperi
- Department of General Surgery and Transplantation, Alma Mater, Bologna, Italy
| | - Carla Serra
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonia D'Errico
- Department of Pathology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Matteo Serenari
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giuliana Germinario
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Renzulli
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Federico Contedini
- Department of Plastic Surgery, S.Orsola- Malpighi Hospital, Bologna, Italy
| | - Federica Odaldi
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of General Surgery and Transplantation, Alma Mater, Bologna, Italy
| | - Lorenzo Maroni
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of General Surgery and Transplantation, Alma Mater, Bologna, Italy
| | - Antonio Siniscalchi
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Cescon
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of General Surgery and Transplantation, Alma Mater, Bologna, Italy
| | - Daniel Azoulay
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
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15
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Rocco G, Siniscalchi A, Serenari M, Fallani G, Germinario G, Maroni L, Prosperi E, Del Gaudio M, Odaldi F, Cescon M, Ravaioli M. Complex Liver Transplantation Using Venovenous Bypass With an Atypical Placement of the Portal Vein Cannula. Liver Transpl 2021; 27:231-235. [PMID: 37160012 DOI: 10.1002/lt.25878] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/06/2020] [Accepted: 07/01/2020] [Indexed: 01/13/2023]
Abstract
In liver transplantation (LT) medical literature, venovenous bypass (VVB) with the interposition of a venous graft attached to the inferior mesenteric vein (IMV) or to the splenic vein (SV) has not been reported previously. Here, we report the decompression of the portomesenteric compartment in 2 patients with complex cases of orthotopic LT. A femoroaxillary percutaneous VVB was installed prior to abdominal opening to decompress massive collateral veins in the abdominal wall. In the first patient, the IMV was connected to a donor vein graft with a lateroterminal anastomosis, and the distal part of the vein graft was cannulated and connected to the VVB. In the second patient, because of the excessive size of the spleen, it was necessary to perform a splenectomy to gain sufficient space in the abdomen to implant the new liver. The SV was connected to a donor vein graft with a terminoterminal anastomosis, and the distal part of the vein graft was cannulated and connected to the VVB. In both patients, the decompression of the portomesenteric compartment was crucial to reduce portal hypertension and to access the hepatic hilum, where the dissection was very complex due to previous major surgeries. In conclusion, VVB with the interposition of a venous graft attached to the IMV or to the SV during LT is a safe and simple technique, and it may be useful for patients needing VVB with no standard access to the portal compartment, particularly in the case of severe portal hypertension and re-LTs.
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Affiliation(s)
- Giuseppe Rocco
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Antonio Siniscalchi
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Matteo Serenari
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Guido Fallani
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Giuliana Germinario
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Lorenzo Maroni
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Enrico Prosperi
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Massimo Del Gaudio
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Federica Odaldi
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Matteo Cescon
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Matteo Ravaioli
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
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16
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Ravaioli M, Brandi G, Siniscalchi A, Renzulli M, Bonatti C, Fallani G, Prosperi E, Serenari M, Germinario G, Del Gaudio M, Zanfi C, Odaldi F, Bertuzzo VR, Pasqualini E, Maroni L, Frascaroli G, Rossetto A, Morelli MC, Vizioli L, Serra C, Sangiorgi G, D'Errico A, Contedini F, Cescon M. Heterotopic segmental liver transplantation on splenic vessels after splenectomy with delayed native hepatectomy after graft regeneration: A new technique to enhance liver transplantation. Am J Transplant 2021; 21:870-875. [PMID: 32715576 DOI: 10.1111/ajt.16222] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 01/25/2023]
Abstract
We describe a patient with liver metastases from colorectal cancer treated with chemotherapy and hepatic resection, who developed unresectable multifocal liver recurrence and who received liver transplantation using a novel planned technique: heterotopic transplantation of segment 2-3 in the splenic fossa with splenectomy and delayed hepatectomy after regeneration of the transplanted graft. We transplanted a segmental liver graft after in-situ splitting without any impact on the waiting list, as it was previously rejected for pediatric and adult transplantation. The volume of the graft was insufficient to provide liver function to the recipient, so we performed this novel operation. The graft was anastomosed to the splenic vessels after splenectomy, and the native liver portal flow was modulated to enhance graft regeneration, leaving the native recipient liver intact. The volume of the graft doubled during the next 2 weeks and the native liver was removed. After 8 months, the patient lives with a functioning liver in the splenic fossa and without abdominal tumor recurrence. This is the first case reported of a segmental graft transplanted replacing the spleen and modulating the portal flow to favor graft growth, with delayed native hepatectomy.
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Affiliation(s)
- Matteo Ravaioli
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giovanni Brandi
- Department of Experimental, Diagnostic and Specialty Medicine, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Antonio Siniscalchi
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Matteo Renzulli
- Department of Experimental, Diagnostic and Specialty Medicine, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Chiara Bonatti
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Guido Fallani
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Enrico Prosperi
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Matteo Serenari
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giuliana Germinario
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Massimo Del Gaudio
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Chiara Zanfi
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Federica Odaldi
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Valentina Rosa Bertuzzo
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Eddi Pasqualini
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Lorenzo Maroni
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giacomo Frascaroli
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Anna Rossetto
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Cristina Morelli
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luca Vizioli
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carla Serra
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Gabriela Sangiorgi
- Emilia-Romagna Transplant Reference Centre, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonia D'Errico
- Department of Pathology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Federico Contedini
- Department of Medical and Surgical Sciences, Plastic Surgery Unit, S.Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Matteo Cescon
- Department of General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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17
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Ravaioli M, De Pace V, Angeletti A, Comai G, Vasuri F, Baldassarre M, Maroni L, Odaldi F, Fallani G, Caraceni P, Germinario G, Donadei C, Malvi D, Del Gaudio M, Bertuzzo VR, Siniscalchi A, Ranieri VM, D'Errico A, Pasquinelli G, Morelli MC, Pinna AD, Cescon M, La Manna G. Author Correction: Hypothermic Oxygenated New Machine Perfusion System in Liver and Kidney Transplantation of Extended Criteria Donors: First Italian Clinical Trial. Sci Rep 2020; 10:14658. [PMID: 32868780 PMCID: PMC7459282 DOI: 10.1038/s41598-020-70620-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Matteo Ravaioli
- Department of General Surgery and Tran splantation, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy.
| | - Vanessa De Pace
- Department of General Surgery and Tran splantation, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Andrea Angeletti
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna Sant'Orsola- Malpighi Hospital, Bologna, Italy
| | - Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna Sant'Orsola- Malpighi Hospital, Bologna, Italy
| | - Francesco Vasuri
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna Sant'Orsola- Malpighi Hospital, Bologna, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Science, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Lorenzo Maroni
- Department of General Surgery and Tran splantation, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Federica Odaldi
- Department of General Surgery and Tran splantation, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Guido Fallani
- Department of General Surgery and Tran splantation, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Science, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Giuliana Germinario
- Department of General Surgery and Tran splantation, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Chiara Donadei
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna Sant'Orsola- Malpighi Hospital, Bologna, Italy
| | - Deborah Malvi
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna Sant'Orsola- Malpighi Hospital, Bologna, Italy
| | - Massimo Del Gaudio
- Department of General Surgery and Tran splantation, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Valentina Rosa Bertuzzo
- Department of General Surgery and Tran splantation, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Antonio Siniscalchi
- Department of General Surgery and Tran splantation, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Vito Marco Ranieri
- Department of General Surgery and Tran splantation, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Antonietta D'Errico
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna Sant'Orsola- Malpighi Hospital, Bologna, Italy
| | - Gianandrea Pasquinelli
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna Sant'Orsola- Malpighi Hospital, Bologna, Italy
| | - Maria Cristina Morelli
- Department of General Surgery and Tran splantation, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Antonio Daniele Pinna
- Department of General Surgery and Tran splantation, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Matteo Cescon
- Department of General Surgery and Tran splantation, University of Bologna Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna Sant'Orsola- Malpighi Hospital, Bologna, Italy
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18
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Ravaioli M, Maroni L, Angeletti A, Fallani G, De Pace V, Germinario G, Odaldi F, Corradetti V, Caraceni P, Baldassarre M, Vasuri F, D'Errico A, Sangiorgi G, Siniscalchi A, Morelli MC, Rossetto A, Ranieri VM, Cescon M, Del Gaudio M, Zanfi C, Bertuzzo V, Comai G, La Manna G. Hypothermic Oxygenated Perfusion Versus Static Cold Storage for Expanded Criteria Donors in Liver and Kidney Transplantation: Protocol for a Single-Center Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e13922. [PMID: 32191209 PMCID: PMC7118551 DOI: 10.2196/13922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/24/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 12/24/2022] Open
Abstract
Background Extended criteria donors (ECD) are widely utilized due to organ shortage, but they may increase the risk of graft dysfunction and poorer outcomes. Hypothermic oxygenated perfusion (HOPE) is a recent organ preservation strategy for marginal kidney and liver grafts, allowing a redirect from anaerobic metabolism to aerobic metabolism under hypothermic conditions and protecting grafts from oxidative species–related damage. These mechanisms may improve graft function and survival. Objective With this study, we will evaluate the benefit of end-ischemic HOPE on ECD grafts for livers and kidneys as compared to static cold storage (SCS). The aim of the study is to demonstrate the ability of HOPE to improve graft function and postoperative outcomes of ECD kidney and liver recipients. Methods This is an open-label, single-center randomized clinical trial with the aim of comparing HOPE with SCS in ECD kidney and liver transplantation. In the study protocol, which has been approved by the ethics committee, 220 patients (110 liver recipients and 110 kidney recipients) will be enrolled. Livers and kidneys assigned to the HOPE group undergo machine perfusion with cold Belzer solution (4-10°C) and continuous oxygenation (partial pressure of oxygen of 500-600 mm Hg). In the control group, livers and kidneys undergoing SCS are steeped in Celsior solution and stored on ice. Using the same perfusion machine for both liver and kidney grafts, organs are perfused from the start of the back-table procedure until implantation, without increasing the cold ischemia time. For each group, we will evaluate clinical outcomes, graft function tests, histologic findings, perfusate, and the number of allocated organs. Publication of the results is expected to begin in 2021. Results Dynamic preservation methods for organs from high-risk donors should improve graft dysfunction after transplantation. To date, we have recruited 108 participants. The study is ongoing, and recruitment of participants will continue until January 2020. Conclusions The proposed preservation method should improve ECD graft function and consequently the postoperative patient outcomes. Trial Registration ClinicalTrials.gov NCT03837197; https://clinicaltrials.gov/ct2/show/NCT03837197 ; Archived by WebCite® at http://www.webcitation.org/76fSutT3R International Registered Report Identifier (IRRID) DERR1-10.2196/13922
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Affiliation(s)
- Matteo Ravaioli
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Lorenzo Maroni
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Andrea Angeletti
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Guido Fallani
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Vanessa De Pace
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Giuliana Germinario
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Federica Odaldi
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Valeria Corradetti
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesco Vasuri
- Pathology Division, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Antonia D'Errico
- Pathology Division, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Antonio Siniscalchi
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Cristina Morelli
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Anna Rossetto
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Vito Marco Ranieri
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Matteo Cescon
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Massimo Del Gaudio
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Chiara Zanfi
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Valentina Bertuzzo
- Department of Medical and Surgical Sciences, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
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Corradetti V, Comai G, Ravaioli M, Cuna V, Aiello V, Odaldi F, Angeletti A, Capelli I, La Manna G. Iloprost in Acute Post-kidney Transplant Atheroembolism: A Case Report of Two Successful Treatments. Front Med (Lausanne) 2020; 7:41. [PMID: 32181252 PMCID: PMC7059607 DOI: 10.3389/fmed.2020.00041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/15/2019] [Accepted: 01/28/2020] [Indexed: 11/13/2022] Open
Abstract
Cholesterol embolization (CE) is a rare and alarming post-transplant complication, responsible for primary non-function (PNF) or delayed graft function (DGF). Its incidence is expected to rise due to increasingly old donors and recipients and the extended criteria for donation. Therapy with statins and steroids has not been shown to be effective, while agonism of prostaglandin I2 has been reported to be useful in systemic CE. We report two cases of acute post-transplant CE in which intravenous iloprost (0.05 mg/kg/day) was added to standard statin and steroid therapy. In the first instance, CE was due to embolization from the kidney artery resulting in embolization of the small vessels; after a long DGF and 15 days of iloprost therapy, renal function recovered. The second instance is a case of embolization from the iliac artery of the recipient, where CE manifested as a partial renal infarction. After 5 days of iloprost administration, creatinine levels improved. Iloprost acts on vasodilation and on different inflammatory pathways, improving the anti-inflammatory profile. Post-transplant CE is difficult to diagnose and, if not treated, can lead to loss of function. Iloprost added to standard therapy could be beneficial in accelerating renal function recovery immediately after transplant.
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Affiliation(s)
- Valeria Corradetti
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Matteo Ravaioli
- Unit of General and Transplant Surgery, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola Malpighi Hospital Bologna, Bologna, Italy
| | - Vania Cuna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Valeria Aiello
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Federica Odaldi
- Unit of General and Transplant Surgery, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola Malpighi Hospital Bologna, Bologna, Italy
| | - Andrea Angeletti
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Irene Capelli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
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Serenari M, Pettinato C, Bonatti C, Zanoni L, Odaldi F, Cucchetti A, Ravaioli M, Fanti S, Pinna A, Cescon M. Hepatobiliary Scintigraphy in the Preoperative Evaluation of Potential Living Liver Donors. Transplant Proc 2019; 51:167-170. [DOI: 10.1016/j.transproceed.2018.04.087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/13/2018] [Indexed: 12/12/2022]
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Cescon M, Bertuzzo VR, Ercolani G, Ravaioli M, Odaldi F, Pinna AD. Liver transplantation for hepatocellular carcinoma: Role of inflammatory and immunological state on recurrence and prognosis. World J Gastroenterol 2013; 19:9174-9182. [PMID: 24409045 PMCID: PMC3882391 DOI: 10.3748/wjg.v19.i48.9174] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/13/2013] [Indexed: 02/06/2023] Open
Abstract
Criteria for liver transplantation (LT) for hepatocellular carcinoma (HCC) and post-LT indicators of prognosis are historically based on the measurement of the tumor mass. Recently, high throughput technologies have increased the prediction of recurrence, but these tools are not yet routinely available. The interaction between HCC and the immune system has revealed an imbalance of lymphocyte phenotypes in the peritumoral tissue, and the increase of regulatory T cells with respect to cytotoxic lymphocytes has been linked to a higher rate of post-LT HCC recurrence. Moreover, some inflammatory markers have shown good reliability in predicting cancer reappearance after surgery, as a result of either a systemic inflammatory response or a decreased capacity of the organism to control the tumor growth. Among these markers, the neutrophil-to-lymphocyte ratio appears to be the most promising and easily available serum parameter able to predict HCC recurrence after LT and following other types of treatment, although the exact mechanisms determining its elevation have not been clarified. Post-LT immunosuppression may impact on cancer control, and the exposure to high levels of calcineurin inhibitors or other immunusuppressants has recently emerged as a negative prognostic factor for HCC recurrence and patient survival. Despite the absence of prospective randomized trials, inhibitors of the mammalian target of rapamycin have been shown to be associated with lower rates of tumor recurrence compared to other immunosuppressors, suggesting their use especially in patients with HCC exceeding the conventional indication criteria for LT.
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Giannini EG, Cucchetti A, Erroi V, Garuti F, Odaldi F, Trevisani F. Surveillance for early diagnosis of hepatocellular carcinoma: How best to do it? World J Gastroenterol 2013; 19:8808-8821. [PMID: 24379604 PMCID: PMC3870532 DOI: 10.3748/wjg.v19.i47.8808] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 10/31/2013] [Accepted: 11/19/2013] [Indexed: 02/06/2023] Open
Abstract
Surveillance for hepatocellular carcinoma (HCC) is considered a standard of care for patients with chronic liver disease who are at risk of developing this malignancy. Several studies have shown that surveillance can improve the prognosis of patients diagnosed with HCC through an increased likelihood of application of curative or effective treatments. Repetition of liver ultrasonography (US) every 6 mo is the recommended surveillance program to detect early HCCs, and a positive US has to entrain a well-defined recall policy based on contrast-enhanced, dynamic radiological imaging or biopsy for the diagnosis of HCC. Although HCC fulfills the accepted criteria regarding cost-effective cancer screening and surveillance, the implementation of surveillance in clinical practice is defective and this has a negative impact on the cost-effectiveness of the procedure. Education of both physicians and patients is of paramount importance in order to improve the surveillance application and its benefits in patients at risk of HCC. The promotion of specific educational programs for practitioners, clinicians and patients is instrumental in order to expand the correct use of surveillance in clinical practice and eventually improve HCC prognosis.
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