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Abenavoli L, Gambardella ML, Scarlata GGM, Lenci I, Baiocchi L, Luzza F. The Many Faces of Metabolic Dysfunction-Associated Fatty Liver Disease Treatment: From the Mediterranean Diet to Fecal Microbiota Transplantation. Medicina (Kaunas) 2024; 60:563. [PMID: 38674209 DOI: 10.3390/medicina60040563] [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] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
The gastrointestinal tract is inhabited by the gut microbiota. The main phyla are Firmicutes and Bacteroidetes. In non-alcoholic fatty liver disease, now renamed metabolic dysfunction-associated fatty liver disease (MAFLD), an alteration in Firmicutes and Bacteroidetes abundance promotes its pathogenesis and evolution into non-alcoholic steatohepatitis, liver cirrhosis, and hepatocellular carcinoma. For this reason, early treatment is necessary to counteract its progression. The aim of the present narrative review is to evaluate the different therapeutic approaches to MAFLD. The most important treatment for MAFLD is lifestyle changes. In this regard, the Mediterranean diet could be considered the gold standard in the prevention and treatment of MAFLD. In contrast, a Western diet should be discouraged. Probiotics and fecal microbiota transplantation seem to be valid, safe, and effective alternatives for MAFLD treatment. However, more studies with a longer follow-up and with a larger cohort of patients are needed to underline the more effective approaches to contrasting MAFLD.
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Affiliation(s)
- Ludovico Abenavoli
- Department of Health Sciences, University "Magna Graecia", Viale Europa, 88100 Catanzaro, Italy
| | - Maria Luisa Gambardella
- Department of Health Sciences, University "Magna Graecia", Viale Europa, 88100 Catanzaro, Italy
| | | | - Ilaria Lenci
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Via Montpellier, 00133 Rome, Italy
| | - Leonardo Baiocchi
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Via Montpellier, 00133 Rome, Italy
| | - Francesco Luzza
- Department of Health Sciences, University "Magna Graecia", Viale Europa, 88100 Catanzaro, Italy
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Morelli MC, Gambato M, Martini S, Carrai P, Toniutto P, Giannelli V, Donato F, Lenci I, Pasulo L, Mazzarelli C, Ferrarese A, Rendina M, Grieco A, Lanza AG, Baroni GS, De Maria N, Marenco S, Mameli L, Ponziani FR, Vitale G, Burra P, Viganò R, Fornasiere E, Catanzaro E, Marrone G, Milana M, Calleri A, Scorzoni C, Frassanito G, Lionetti R, Dibenedetto C. Trends in liver transplantation for primary sclerosing cholangitis. Dig Liver Dis 2024:S1590-8658(24)00194-4. [PMID: 38233315 DOI: 10.1016/j.dld.2024.01.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Primary sclerosing cholangitis is a cholestatic disease with a low prevalence in Italy. Indications for liver transplantation and the time of listing are not stated. AIM We performed a national survey to investigate the listing criteria, comorbidities, and outcomes. METHODS In April 2022, we surveyed liver transplantation in primary sclerosing cholangitis nationwide for the last 15 years. RESULTS From 2007 to 2021, 445 patients were included on waiting lists, and 411 had undergone liver transplants. The median age at transplantation was 46 years (males 63.9%); 262 patients (59%) presented an inflammatory bowel disease. Transplants increased over the years, from 1.8 % in 2007 to 3.0 % in 2021. Cholangitis (51%) and hepatic decompensation (45%) were the main indications for listing. The disease recurred in 81 patients (20%). Patient survival after the first transplant was 94 %, 86% and 84% at one, five, and ten years. Twenty-four died in the first year (50% surgical complications, 25% infections); 33 between one to five years (36% recurrence, 21% cholangiocarcinoma recurrence) and nine after five years (56% de novo cancer, 44% recurrence). CONCLUSIONS Primary sclerosing cholangitis has been an increasing indication for transplantation in Italy. Cholangitis and decompensation were the main indications for listing. Recurrence and cancer were the leading causes of death.
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Affiliation(s)
- Maria Cristina Morelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit for the treatment of Severe Organ Failure, Bologna, Italy
| | - Martina Gambato
- Multivisceral Transplant Unit, Padua University Hospital, Padova, Italy
| | - Silvia Martini
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paola Carrai
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School and Hospital, Pisa, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplant Unit, Department of Medical Area, Udine University Hospital, Udine, Italy
| | - Valerio Giannelli
- San Camillo Hospital, Department of Transplantation and General Surgery, Rome, Italy
| | - Francesca Donato
- Gastroenterology and Hepatology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Lenci
- Hepatology and Transplant Unit, Fondazione Policlinico Tor Vergata, Roma, Italy
| | - Luisa Pasulo
- Gastroenterology and Transplant Hepatology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Chiara Mazzarelli
- Gastroenterology and Hepatology Department, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Ferrarese
- Unit of Gastroenterology, Borgo Trento University Hospital of Verona, Verona, Italy
| | - Maria Rendina
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Antonio Grieco
- Liver Transplant Medicine Unit, Gastroenterological Area, Department of Gastroenterological, Endocrine and Metabolic Sciences, Fondazione Policlinico Universitario Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Nicola De Maria
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Simona Marenco
- Department of Internal Medicine, Gastroenterology Unit, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genova 16132, Italy
| | - Laura Mameli
- Liver and Pancreas Transplant Center, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Francesca Romana Ponziani
- Hepatology Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Giovanni Vitale
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit for the treatment of Severe Organ Failure, Bologna, Italy.
| | - Patrizia Burra
- Multivisceral Transplant Unit, Padua University Hospital, Padova, Italy
| | - Raffaella Viganò
- Gastroenterology and Hepatology Department, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ezio Fornasiere
- Hepatology and Liver Transplant Unit, Department of Medical Area, Udine University Hospital, Udine, Italy
| | - Elisa Catanzaro
- Multivisceral Transplant Unit, Padua University Hospital, Padova, Italy
| | - Giuseppe Marrone
- Liver Transplant Medicine Unit, Fondazione Policlinico Universitario Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Martina Milana
- Hepatology and Transplant Unit, Fondazione Policlinico Tor Vergata, Roma, Italy
| | - Alberto Calleri
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Scorzoni
- Liver Injury and Transplant Unit, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Gabriella Frassanito
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Raffaella Lionetti
- Infectious diseases and Hepatology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Clara Dibenedetto
- Gastroenterology and Hepatology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore, Policlinico, Milan, Italy
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Marrone G, Giannelli V, Agnes S, Avolio AW, Baiocchi L, Berardi G, Ettorre GM, Ferri F, Corradini SG, Grieco A, Guglielmo N, Lenci I, Lionetti R, Mennini G, Milana M, Rossi M, Spoletini G, Tisone G, Manzia TM, Lai Q. Superiority of the new sex-adjusted models to remove the female disadvantage restoring equity in liver transplant allocation. Liver Int 2024; 44:103-112. [PMID: 37752798 DOI: 10.1111/liv.15735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/10/2023] [Accepted: 09/02/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND AND AIMS Model for End-stage Liver Disease (MELD) and MELDNa are used worldwide to guide graft allocation in liver transplantation (LT). Evidence exists that females are penalized in the present allocation systems. Recently, new sex-adjusted scores have been proposed with improved performance respect to MELD and MELDNa. GEMA-Na, MELD 3.0, and sex-adjusted MELDNa were developed to improve the 90-day dropout prediction from the list. The present study aimed at evaluating the accuracy and calibration of these scores in an Italian setting. METHODS The primary outcome of the present study was the dropout from the list up to 90 days because of death or clinical deterioration. We retrospectively analysed data from 855 adults enlisted for liver transplantation in the Lazio region (Italy) (2012-2018). Ninety-day prediction of GEMA-Na, MELD 3.0 and sex-adjusted MELDNa with respect to MELD and MELDNa was analysed. Brier score and Brier Skill score were used for accuracy, and the Greenwood-Nam-D'Agostino test was used to evaluate the calibration of the models. RESULTS GEMA-Na (concordance = .82, 95% CI = .75-.89), MELD 3.0 (concordance = .81, 95% CI = .74-.87) and sex-adjusted MELDNa (concordance = .81, 95% CI = .74-.88) showed the best 90-day dropout prediction. GEMA-Na showed a higher increase in accuracy with respect to MELD (p = .03). No superiority was shown with respect to MELDNa. All the tested scores showed a good calibration of the models. Using GEMA-Na instead of MELD would potentially save one in nine dropouts and could save one dropout per 285 patients listed. CONCLUSIONS Validation and reclassification of the sex-adjusted score GEMA-Na confirm its superiority in predicting short-term dropout also in an Italian setting when compared with MELD.
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Affiliation(s)
- Giuseppe Marrone
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Salvatore Agnes
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfonso Wolfango Avolio
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | | | | | - Antonio Grieco
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Raffaella Lionetti
- Istituto Nazionale Malattie Infettive Lazzaro Spallanzani-IRCCS, Rome, Italy
| | | | | | | | - Gabriele Spoletini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Salpini R, Piermatteo L, Torre G, D'Anna S, Khan S, Duca L, Bertoli A, La Frazia S, Malagnino V, Teti E, Iannetta M, Paba P, Ciotti M, Lenci I, Francioso S, Paquazzi C, Lichtner M, Mastroianni C, Santopaolo F, De Sanctis G, Pellicelli A, Galati G, Moretti A, Casinelli K, Caterini L, Iapadre N, Parruti G, Vecchiet I, Paoloni M, Marignani M, Ceccherini-Silberstein F, Baiocchi L, Grelli S, Sarmati L, Svicher V. Prevalence of hepatitis D virus infection in Central Italy has remained stable across the last 2 decades with dominance of subgenotypes 1 and characterized by elevated viral replication. Int J Infect Dis 2024; 138:1-9. [PMID: 37944585 DOI: 10.1016/j.ijid.2023.11.005] [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: 08/01/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES Here we investigate Hepatitis D virus (HDV)-prevalence in Italy and its fluctuations over time and we provide an extensive characterization of HDV-infected patients. METHODS The rate of HDV seroprevalence and HDV chronicity was assessed in 1579 hepatitis B surface antigen (HBsAg)+ patients collected from 2005 to 2022 in Central Italy. RESULTS In total, 45.3% of HBsAg+ patients received HDV screening with an increasing temporal trend: 15.6% (2005-2010), 45.0% (2011-2014), 49.4% (2015-2018), 71.8% (2019-2022). By multivariable model, factors correlated with the lack of HDV screening were alanine-aminotransferase (ALT) less than two times of upper limit of normality (<2ULN) and previous time windows (P <0.002). Furthermore, 13.4% of HDV-screened patients resulted anti-HDV+ with a stable temporal trend. Among them, 80.8% had detectable HDV-ribonucleic acid (RNA) (median [IQR]:4.6 [3.6-5.6] log copies/ml) with altered ALT in 89.3% (median [IQR]:92 [62-177] U/L). Anti-HDV+ patients from Eastern/South-eastern Europe were younger than Italians (44 [37-54] vs 53 [47-62] years, P <0.0001), less frequently nucleos(t)ide analogs (NUC)-treated (58.5% vs 80%, P = 0.026) with higher HDV-RNA (4.8 [3.6-5.8] vs 3.9 [1.4-4.9] log copies/ml, P = 0.016) and HBsAg (9461 [4159-24,532] vs 4447 [737-13,336] IU/ml, P = 0.032). Phylogenetic analysis revealed the circulation of HDV subgenotype 1e (47.4%) and -1c (52.6%). Notably, subgenotype 1e correlated with higher ALT than 1c (168 [89-190] vs 58 [54-88] U/l, P = 0.015) despite comparable HDV-RNA. CONCLUSIONS HDV-screening awareness is increasing over time even if some gaps persist to achieve HDV screening in all HBsAg+ patients. HDV prevalence in tertiary care centers tend to scarcely decline in native/non-native patients. Detection of subgenotypes, triggering variable inflammatory stimuli, supports the need to expand HDV molecular characterization.
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Affiliation(s)
- Romina Salpini
- Tor Vergata University, Department of Biology, Rome, Italy
| | | | - Giulia Torre
- Tor Vergata University, Department of Biology, Rome, Italy
| | - Stefano D'Anna
- Tor Vergata University, Department of Experimental Medicine, Rome, Italy
| | - Sohaib Khan
- Tor Vergata University, Department of Experimental Medicine, Rome, Italy
| | - Leonardo Duca
- Tor Vergata University, Department of Experimental Medicine, Rome, Italy
| | - Ada Bertoli
- Tor Vergata University, Department of Experimental Medicine, Rome, Italy; Tor Vergata University Hospital, Virology Unit, Rome, Italy
| | | | | | - Elisabetta Teti
- Tor Vergata University Hospital, Infectious Diseases Unit, Rome, Italy
| | - Marco Iannetta
- Tor Vergata University Hospital, Infectious Diseases Unit, Rome, Italy
| | - Pierpaolo Paba
- Tor Vergata University Hospital, Virology Unit, Rome, Italy
| | - Marco Ciotti
- Tor Vergata University Hospital, Virology Unit, Rome, Italy
| | - Ilaria Lenci
- Tor Vergata University Hospital, Hepatology Unit, Rome, Italy
| | | | | | - Miriam Lichtner
- La Sapienza University, Department of Public Health and Infectious Disease, Rome, Italy
| | - Claudio Mastroianni
- La Sapienza University, Department of Public Health and Infectious Disease, Rome, Italy
| | - Francesco Santopaolo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Internal Medicine and Gastroenterology-Hepatology Unit, Rome, Italy
| | | | | | - Giovanni Galati
- University Campus Bio-Medico, Internal Medicine and Hepatology Unit, Rome, Italy
| | | | - Katia Casinelli
- Spaziani Hospital, Infectious Disease Unit, Frosinone, Italy
| | | | - Nerio Iapadre
- San Salvatore Hospital, Infectious Diseases Unit, L'Aquila, Italy
| | - Giustino Parruti
- Pescara General Hospital, Infectious Disesases Unit, Pescara, Italy
| | - Iacopo Vecchiet
- University "G. d'Annunzio" Chieti-Pescara, Clinic of Infectious Diseases, Department of Medicine and Science of Aging, Chieti, Italy
| | - Maurizio Paoloni
- Avezzano General Hospital, Infectious Diseases Unit, Avezzano, Italy
| | - Massimo Marignani
- Regina Apostolorum Hospital, Department of Gastroenterology and Hepatology, Albano Laziale, Italy
| | | | | | - Sandro Grelli
- Tor Vergata University Hospital, Virology Unit, Rome, Italy
| | - Loredana Sarmati
- Tor Vergata University Hospital, Infectious Diseases Unit, Rome, Italy
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Lenci I, Carnì P, Milana M, Bicaj A, Signorello A, Baiocchi L. Sequence of events leading to primary biliary cholangitis. World J Gastroenterol 2023; 29:5305-5312. [PMID: 37899786 PMCID: PMC10600805 DOI: 10.3748/wjg.v29.i37.5305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/22/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023] Open
Abstract
Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease that is observed more frequently in middle-aged women. This disorder is considered an autoimmune disease, since liver injury is sustained by the presence of self-directed antimitochondrial antibodies targeting the bile duct cells. The prognosis may vary depending on an early diagnosis and response to therapy. However, nearly a third of patients can progress to liver cirrhosis, thus requiring a liver transplant. Traditional immunosuppressive therapies, commonly employed for other autoimmune diseases, have limited effects on PBC. In fact, dramatic functional changes that occur in the biliary epithelium in the course of inflammation play a major role in perpetuating the injury. In this minireview, after a background on the disease and possible predisposing factors, the sequential cooperation of cellular/molecular events leading to end-stage PBC is discussed in detail. The rise and maintenance of the autoimmune process, as well as the response of the biliary epithelia during inflammatory injury, are key factors in the progression of the disease. The so-called "ductular reaction (DR)", intended as a reactive expansion of cells with biliary phenotype, is a process frequently observed in PBC and partially understood. However, recent findings suggest a strict relationship between this pathological picture and the progression to liver fibrosis, cell senescence, and loss of biliary ducts. All these issues (onset of chronic inflammation, changes in secretive and proliferative biliary functions, DR, and its relationship with other pathological events) are discussed in this manuscript in an attempt to provide a snapshot, for clinicians and researchers, of the most relevant and sequential contributors to the progression of this human cholestatic disease. We believe that interpreting this disorder as a multistep process may help identify possible therapeutic targets to prevent evolution to severe disease.
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Affiliation(s)
- Ilaria Lenci
- Hepatology Unit, University of Tor Vergata, Rome 00133, Italy
| | - Paola Carnì
- Hepatology Unit, University of Tor Vergata, Rome 00133, Italy
- Postgraduate School in Hepato/Gastroenterology, Catholic University Our Lady of Good Counsel, Tirana 1004, Albania
| | - Martina Milana
- Hepatology Unit, University of Tor Vergata, Rome 00133, Italy
| | - Agreta Bicaj
- Hepatology Unit, University of Tor Vergata, Rome 00133, Italy
- Postgraduate School in Hepato/Gastroenterology, Catholic University Our Lady of Good Counsel, Tirana 1004, Albania
| | | | - Leonardo Baiocchi
- Hepatology Unit, University of Tor Vergata, Rome 00133, Italy
- Postgraduate School in Hepato/Gastroenterology, Catholic University Our Lady of Good Counsel, Tirana 1004, Albania
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Lai Q, Lenci I, Giannelli V, Marrone G. Response to: Importance of gender differences in body composition for liver transplantation and the 'Sarco-Model' study. Liver Int 2023; 43:2328-2329. [PMID: 37592871 DOI: 10.1111/liv.15704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Quirino Lai
- General Surgery and Organ Transplantation Unit, Department of General and Specialty Surgery, Sapienza University, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Tor Vergata University, Rome, Italy
| | | | - Giuseppe Marrone
- Internal Medicine and Transplant Hepatology Unit, Università Cattolica - Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
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Lai Q, Lenci I, Giannelli V, Marrone G. Response to: Letter to the Editor "Child-Turcotte-Pugh score as a model for organ allocation in liver transplantation, perhaps old is still gold". Liver Int 2023; 43:2332-2333. [PMID: 37665132 DOI: 10.1111/liv.15721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Quirino Lai
- General Surgery and Organ Transplantation Unit, Sapienza University, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Tor Vergata University, Rome, Italy
| | | | - Giuseppe Marrone
- Internal Medicine and Transplant Hepatology Unit, Università Cattolica-Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
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8
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Rendina M, Barone M, Lillo C, Trapani S, Masiero L, Trerotoli P, Puoti F, Lupo LG, Tandoi F, Agnes S, Grieco A, Andorno E, Marenco S, Giannini EG, Baccarani U, Toniutto P, Carraro A, Colecchia A, Cescon M, Morelli MC, Cillo U, Burra P, Angeli P, Colledan M, Fagiuoli S, De Carlis L, Belli L, De Simone P, Carrai P, Di Benedetto F, De Maria N, Ettorre GM, Giannelli V, Gruttadauria S, Volpes R, Corsale S, Mazzaferro V, Bhoori S, Romagnoli R, Martini S, Rossi G, Caccamo L, Donato MF, Rossi M, Ginanni Corradini S, Spada M, Maggiore G, Tisone G, Lenci I, Vennarecci G, Tortora R, Vivarelli M, Svegliati Baroni G, Zamboni F, Mameli L, Tafuri S, Simone S, Gesualdo L, Cardillo M, Di Leo A. The Italian data on SARS-CoV-2 infection in transplanted patients support an organ specific immune response in liver recipients. Front Immunol 2023; 14:1203854. [PMID: 37469512 PMCID: PMC10352984 DOI: 10.3389/fimmu.2023.1203854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/18/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction The study of immune response to SARSCoV-2 infection in different solid organ transplant settings represents an opportunity for clarifying the interplay between SARS-CoV-2 and the immune system. In our nationwide registry study from Italy, we specifically evaluated, during the first wave pandemic, i.e., in non-vaccinated patients, COVID-19 prevalence of infection, mortality, and lethality in liver transplant recipients (LTRs), using non-liver solid transplant recipients (NL-SOTRs) and the Italian general population (GP) as comparators. Methods Case collection started from February 21 to June 22, 2020, using the data from the National Institute of Health and National Transplant Center, whereas the data analysis was performed on September 30, 2020.To compare the sex- and age-adjusted distribution of infection, mortality, and lethality in LTRs, NL-SOTRs, and Italian GP we applied an indirect standardization method to determine the standardized rate. Results Among the 43,983 Italian SOTRs with a functioning graft, LTRs accounted for 14,168 patients, of whom 89 were SARS-CoV-2 infected. In the 29,815 NL-SOTRs, 361 cases of SARS-CoV-2 infection were observed. The geographical distribution of the disease was highly variable across the different Italian regions. The standardized rate of infection, mortality, and lethality rates in LTRs resulted lower compared to NL-SOTRs [1.02 (95%CI 0.81-1.23) vs. 2.01 (95%CI 1.8-2.2); 1.0 (95%CI 0.5-1.5) vs. 4.5 (95%CI 3.6-5.3); 1.6 (95%CI 0.7-2.4) vs. 2.8 (95%CI 2.2-3.3), respectively] and comparable to the Italian GP. Discussion According to the most recent studies on SOTRs and SARS-CoV-2 infection, our data strongly suggest that, in contrast to what was observed in NL-SOTRs receiving a similar immunosuppressive therapy, LTRs have the same risk of SARS-CoV-2 infection, mortality, and lethality observed in the general population. These results suggest an immune response to SARS-CoV-2 infection in LTRS that is different from NL-SOTRs, probably related to the ability of the grafted liver to induce immunotolerance.
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Affiliation(s)
- Maria Rendina
- Gastroenterology Unit, University Hospital Policlinico of Bari, Bari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
| | - Chiara Lillo
- Gastroenterology Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
| | - Silvia Trapani
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Lucia Masiero
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Paolo Trerotoli
- Section of Statistics, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Francesca Puoti
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Luigi Giovanni Lupo
- General Surgery and Liver Transplantation Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari, Bari, Italy
| | - Francesco Tandoi
- General Surgery and Liver Transplantation Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari, Bari, Italy
| | - Salvatore Agnes
- U.O.C. Chirurgia Generale e Trapianti di Organo, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Grieco
- U.O.C. Medicina Interna e del Trapianto di Fegato, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Enzo Andorno
- Chirurgia dei Trapianti di Fegato, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Simona Marenco
- Gastroenterology Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | | | - Umberto Baccarani
- Centro Trapianto di Fegato, A.O.U.I. Udine, Università degli Studi di Udine, Udine, Italy
| | - Pierluigi Toniutto
- U.S.D. Epatologia e Trapianto di Fegato, A.O.U.I. Udine, Università degli Studi di Udine, Udine, Italy
| | | | - Antonio Colecchia
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, Modena, Italy
| | - Matteo Cescon
- Chirurgia Epatobiliare e dei Trapianti, IRCCS, A.O.U. di Bologna, University of Bologna, Bologna, Italy
| | - Maria Cristina Morelli
- Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS, A.O.U. di Bologna, Bologna, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation, University-Teaching Hospital of Padova, Padova, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, University-Teaching Hospital of Padova, Padova, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology (UIMH), University-Teaching Hospital of Padova, Padova, Italy
| | - Michele Colledan
- U.O.C. Chirurgia Generale III, Centro Trapianti Fegato, A.S.S.T. Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation Unit, A.S.S.T. Ospedale Papa Giovanni XXIII, Bergamo, Italy
- Gastroenterologia, Department of Medicine University of Milan Bicocca, Milano, Italy
| | - Luciano De Carlis
- Chirurgia Generale dei Trapianti, Azienda Ospedaliera Niguarda Ca’Granda, University of Milano-Bicocca, Milano, Italy
| | - Luca Belli
- U.O.C. Epatologia e Gastroenterologia, Azienda Ospedaliera Niguarda Ca’Granda, Milano, Italy
| | - Paolo De Simone
- U.O.C. Chirurgia Epatica e Trapianti di Fegato, A.O.U. Pisana, University of Pisa, Pisa, Italy
| | - Paola Carrai
- U.O. Chirurgia Epatica e del Trapianto di Fegato, A.O.U. Pisana, Pisa, Italy
| | - Fabrizio Di Benedetto
- U.O.C. di Chirurgia Oncologica Epatobiliopancreatica e Chirurgia dei Trapianti di Fegato, Azienda Ospedaliera Policlinico, Università di Modena, Modena, Italy
| | - Nicola De Maria
- U.O.C. Chirurgia Generale e Trapianti, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | | | - Valerio Giannelli
- Hepatology Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | | | - Riccardo Volpes
- Unità di Gastroenterologia ed Epatologia, IRCCS-ISMETT-UPMCI, Palermo, Italy
| | - Sveva Corsale
- Unità di Gastroenterologia ed Epatologia, IRCCS-ISMETT-UPMCI, Palermo, Italy
| | - Vincenzo Mazzaferro
- Hepato-pancreatic-biliary surgery and Liver transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Department of Oncology, University of Milan, Milan, Italy
| | - Sherrie Bhoori
- Hepato-pancreatic-biliary surgery and Liver transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Renato Romagnoli
- Chirurgia Generale 2, Centro Trapianto Fegato A.O.U Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Silvia Martini
- Gastroenteroly Unit, A.O.U Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Giorgio Rossi
- Division of General and Liver Transplant Surgery, Ospedale Maggiore Policlinico, Milano, Italy
| | - Lucio Caccamo
- Division of General and Liver Transplant Surgery, Ospedale Maggiore Policlinico, Milano, Italy
| | - Maria Francesca Donato
- Division of Gastroenterology and Hepatology, Ospedale Maggiore Policlinico, Milano, Italy
| | - Massimo Rossi
- U.O.C. di Chirurgia Generale e Trapianti di Organo, Policlinico Umberto I, Sapienza Università di Roma, Rome, Italy
| | | | - Marco Spada
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giuseppe Maggiore
- Hepatogastroenterology, Digestive Endoscopy, Nutrition and Liver Transplantation Unit, Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giuseppe Tisone
- Liver Transplant Unit, A.O.U. Policlinico Tor Vergata, University of Tor Vergata Rome, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, A.O.U. Policlinico Tor Vergata, University of Tor Vergata Rome, Rome, Italy
| | - Giovanni Vennarecci
- Hepatobiliary and Liver Tranplantation Surgery, A.O.R.N. “A. CARDARELLI”, Naples, Italy
| | | | - Marco Vivarelli
- Chirurgia Epatobiliare, Pancreatica e dei Trapianti, A.O.U., Ospedali Riuniti, Ancona, Italy
| | | | - Fausto Zamboni
- General and Hepatic Transplantation Surgery Unit, AO.B. G. Brotzu, Cagliari, Italy
| | - Laura Mameli
- General and Hepatic Transplantation Surgery Unit, AO.B. G. Brotzu, Cagliari, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Simona Simone
- Dialysis and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
| | - Loreto Gesualdo
- Dialysis and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
| | - Massimo Cardillo
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
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9
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Lenci I, Tariciotti L, Angelico R, Milana M, Signorello A, Manzia TM, Toti L, Tisone G, Angelico M, Baiocchi L. Successful clinical and virological outcomes of liver transplantation for HDV/HBV-related disease after long-term discontinuation of hepatitis B immunoglobulins. Clin Transplant 2023:e14971. [PMID: 36928864 DOI: 10.1111/ctr.14971] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/21/2022] [Accepted: 03/05/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Indefinite, long-term administration of hepatitis B immunoglobulins (HBIg), together with a third generation nucleos(t)ide analog (NA), is the currently recommended prophylactic strategy to prevent viral recurrence after liver transplantation (LT) for Hepatitis Delta virus (HDV)/Hepatitis B virus (HBV)-related disease. METHODS We retrospectively analyzed the safety and long-term clinical and virological outcomes of a consecutive cohort of 16 patients (10 males, median age 64.5, range 41-75) transplanted for HDV/HBV-related cirrhosis at our Institution, who discontinued HBIg after a median of 24.5 months (range 15-116) after transplant. All patients continued prophylaxis with same NA used before LT. Recurrence of HDV/HBV infection was defined as reappearance of serum HDV-RNA with detectable serum HBsAg and/or HBV-DNA. RESULTS The median follow-up after LT was 138 months (range 73-316) and 110 months (range 52-200) after HBIg withdrawal. All patients were HBsAg-positive, HBV-DNA negative, and anti-HDV positive at the time of LT and without coinfections with HCV or HIV. Patients were followed with biochemical and virological tests every 3-6 months after HBIg withdrawal. No recurrences of HDV/HBV infection or disease were observed during monoprophylaxis with NA. In addition, eight patients (50%) spontaneously developed anti-HBs titers above 10 IU/L at a median of 74 months (range 58-140) following HBIG discontinuation. CONCLUSIONS HBIg withdrawal after LT is a safe and efficacious strategy in patients transplanted for HDV/HBV disease and is frequently associated with the spontaneous development of serological immunity against HBV. These data call for a revision of current prophylactic recommendations in this setting.
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Affiliation(s)
- Ilaria Lenci
- Hepatology Unit, Tor Vergata University, Rome, Italy
| | | | | | | | | | | | - Luca Toti
- Liver Transplant Unit, Tor Vergata University, Rome, Italy
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10
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Cortesi PA, Viganò R, Conti S, Lenci I, Volpes R, Martini S, Angelico M, Fung J, Buti M, Coilly A, Durand F, Fondevila C, Lebray P, Nevens F, Polak WG, Rizzetto M, Zoulim F, Perricone G, Berenguer M, Mantovani LG, Duvoux C, Belli LS. Economic Impact of European Liver and Intestine Transplantation Association (ELITA) Recommendations for Hepatitis B Prophylaxis After Liver Transplantation. Transpl Int 2023; 36:10954. [PMID: 36793896 PMCID: PMC9922709 DOI: 10.3389/ti.2023.10954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/12/2023] [Indexed: 01/31/2023]
Abstract
The European Liver and Intestine Transplant Association, ELITA, promoted a Consensus Conference involving 20 experts across the world which generated updated guidelines on HBV prophylaxis in liver transplant candidates and recipients. This study explores the economic impact associated with the implementation of the new ELITA guidelines. To this aim, a condition-specific cohort simulation model has been developed to compare new and historical prophylaxis, including only pharmaceutical cost and using the European perspective. The target population simulated in the model included both prevalent and incident cases, and consisted of 6,133 patients after the first year, that increased to 7,442 and 8,743 patents after 5 and 10 years from its implementation. The ELITA protocols allowed a cost saving of around € 235.65 million after 5 years and € 540.73 million after 10 years; which was mainly due to early HIBG withdrawal either after the first 4 weeks or after the first year post Liver Transplantation (LT) depending on the virological risk at transplantation. Results were confirmed by sensitivity analyses. The money saved by the implementation of the ELITA guidelines would allow healthcare decision makers and budget holders to understand where costs could be reduced and resources re-allocated to different needs.
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Affiliation(s)
- Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy,*Correspondence: Paolo Angelo Cortesi,
| | - Raffaella Viganò
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Ilaria Lenci
- Unit of Hepatology and Liver Transplant Unit, Tor Vergata University, Rome, Italy
| | - Riccardo Volpes
- Hepatology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapia ad Alta Specializzazione), Palermo, Italy
| | - Silvia Martini
- Gastro-hepatology Unit, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Mario Angelico
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - James Fung
- Department of Medicine, School of Clinical Medicine, Queen Mary Hospital, State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Maria Buti
- Liver Unit, Hospital Universitario Valld’Hebron, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Audrey Coilly
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France,Unité INSERM 1193, Université Paris-Saclay, Paris, France
| | - Francois Durand
- Hepatology and Liver Intensive care, Hospital Beaujon, Clichy, France,Service d’Hépatologie et Transplantation Hépatique, APHP, Hôpital Beaujon, Université Paris Diderot, INSERM U1149, Clichy, France
| | - Constantino Fondevila
- HPB Surgery and Transplantation, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), CIBERehd, Madrid, Spain
| | - Pascal Lebray
- Médecine Sorbonne Université, Service d’Hépato-gastroentérologie, Hôpitaux Universitaires Pitié Salpêtrière—Charles Foix, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Frederik Nevens
- Division of Hepatology and Liver Transplantation, European Reference Network on Hepatological Diseases (ERN Rare-Liver), University Hospitals KU, Leuven, Belgium
| | - Wojciech G. Polak
- Erasmus MC, Transplant Institute, University Medical Center Rotterdam, Department of Surgery, Division of HPB and Transplant Surgery, Rotterdam, Netherlands
| | - Mario Rizzetto
- Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Fabien Zoulim
- INSERM U1052—Cancer Research Center of Lyon (CRCL), Lyon University, Hospices Civils de Lyon, Lyon, France
| | | | - Marina Berenguer
- Hepatology and Liver Transplantation Unit, Ciberehd; Faculty of Medicine, La Fe University Hospital, Valencia, Spain
| | | | - Christophe Duvoux
- Service d'Hépatologie, Hôpitaux Universitaires Henri Mondor, Créteil, France
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11
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Lenci I, Milana M, Signorello A, Grassi G, Baiocchi L. Secondary bile acids and the biliary epithelia: The good and the bad. World J Gastroenterol 2023; 29:357-366. [PMID: 36687129 PMCID: PMC9846939 DOI: 10.3748/wjg.v29.i2.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/12/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023] Open
Abstract
The biliary tract has been considered for several decades a passive system just leading the hepatic bile to the intestine. Nowadays several researches demonstrated an important role of biliary epithelia (i.e. cholangiocytes) in bile formation. The study of biliary processes therefore maintains a continuous interest since the possible important implications regarding chronic cholestatic human diseases, such as primary biliary cholangitis or primary sclerosing cholangitis. Bile acids (BAs), produced by the liver, are the most represented organic molecules in bile. The physiologic importance of BAs was initially attributed to their behavior as natural detergents but several studies now demonstrate they are also important signaling molecules. In this minireview the effect of BAs on the biliary epithelia are reported focusing in particular on secondary (deriving by bacterial manipulation of primary molecules) ones. This class of BAs is demonstrated to have relevant biological effects, ranging from toxic to therapeutic ones. In this family ursodeoxycholic and lithocholic acid present the most interesting features. The molecular mechanisms linking ursodeoxycholic acid to its beneficial effects on the biliary tract are discussed in details as well as data on the processes leading to lithocholic damage. These findings suggest that expansion of research in the field of BAs/cholangiocytes interaction may increase our understanding of cholestatic diseases and should be helpful in designing more effective therapies for biliary disorders.
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Affiliation(s)
- Ilaria Lenci
- Hepatology Unit, Policlinico Tor Vergata, Rome 00133, Italy
| | - Martina Milana
- Hepatology Unit, Policlinico Tor Vergata, Rome 00133, Italy
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12
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Toti L, Manzia TM, Blasi F, Lenci I, Baiocchi L, Toschi N, Tisone G. Renal Function, Adherence and Quality of Life Improvement After Conversion From Immediate to Prolonged-Release Tacrolimus in Liver Transplantation: Prospective Ten-Year Follow-Up Study. Transpl Int 2022; 35:10384. [PMID: 36601628 PMCID: PMC9806113 DOI: 10.3389/ti.2022.10384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
Immunosuppression non-adherence is a major cause of graft failure after liver transplantation. The aim of this study was to evaluate practice surrounding conversion from immediate-release to prolonged-release Tacrolimus formulation and to assess patient adherence and quality of life (QoL). One hundred and seven adult liver transplant recipients, receiving immediate-release Tacrolimus for a minimum of 6 months, were converted to prolonged-release formulation, based on a dose ratio of one (1:1). The median follow-up was 120 [IQR, 120-123] months. Tacrolimus dosage and blood level, liver and renal function, lipid and glucose profiles were recorded. In addition, questionnaires were submitted to evaluate adherence and QoL following conversion. No rejection was recorded. The median serum Tacrolimus blood level decreased over 1 month (5.80, [IQR, 2.0-10.8] vs. 3.8 [IQR, 1.4-8.7]; p < 0.0005). Significant improvement in renal function was noted (median GFR was 81.7 [IQR, 43.4-128.6] vs. 73.9 [IQR, 27.1-130.2]; p = 0.0002). At the end of the follow-up, conversion resulted in an overall decrease in non-adherence of 53.3% (p = 0.0001) and an improvement in QoL was reported by 76.2% of patients. Thus, 1:1 conversion from immediate to prolonged-release Tacrolimus is safe, feasible and efficient, avoiding under-therapeutic and toxic peak concentrations, improving renal function, adherence to immunosuppression and overall patient QoL.
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Affiliation(s)
- Luca Toti
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy,*Correspondence: Luca Toti,
| | - Tommaso Maria Manzia
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Blasi
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Ilaria Lenci
- Hepatology and Liver Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Leonardo Baiocchi
- Hepatology and Liver Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy,Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, United States
| | - Giuseppe Tisone
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
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13
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Manzia TM, Trapani S, Nardi A, Ricci A, Lenci I, Milana M, Angelico R, De Feo TM, Agnes S, Andorno E, Baccarani U, Carraro A, Cescon M, Cillo U, Colledan M, De Carlis L, De Simone P, Di Benedetto F, Ettorre GM, Gruttadauria S, Lupo LG, Mazzaferro V, Romagnoli R, Rossi G, Rossi M, Spada M, Vennarecci G, Vivarelli M, Zamboni F, Tisone G, Cardillo M, Angelico M. Temporal trends of waitlistings for liver transplantation in Italy: The ECALITA (Evolution of IndiCAtion in LIver transplantation in ITAly) registry study. Dig Liver Dis 2022; 54:1664-1671. [PMID: 36096992 DOI: 10.1016/j.dld.2022.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/15/2022] [Accepted: 08/20/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Over the last decades relevant epidemiological changes of liver diseases have occurred, together with greatly improved treatment opportunities. AIM To investigate how the indications for elective adult liver transplantation and the underlying disease etiologies have evolved in Italy. METHODS We recruited from the National Transplant Registry a cohort comprising 17,317 adults patients waitlisted for primary liver transplantation from January-2004 to December-2020. Patients were divided into three Eras:1(2004-2011),2(2012-2014) and 3(2015-2020). RESULTS Waitlistings for cirrhosis decreased from 65.9% in Era 1 to 46.1% in Era 3, while those for HCC increased from 28.7% to 48.7%. Comparing Eras 1 and 3, waitlistings for HCV-related cirrhosis decreased from 35.9% to 12.1%, yet those for HCV-related HCC increased from 8.5% to 26.7%. Waitlistings for HBV-related cirrhosis remained almost unchanged (13.2% and 12.4%), while those for HBV-related HCC increased from 4.0% to 11.6%. ALD-related cirrhosis decreased from 16.9% to 12.9% while ALD-related HCC increased from 1.9% to 3.9%. CONCLUSIONS A sharp increase in liver transplant waitlisting for HCC and a concomitant decrease of waitlisting for cirrhosis have occurred In Italy. Despite HCV infection has noticeably decreased, still remains the primary etiology of waitlisting for HCC, while ALD and HBV represent the main causes for cirrhosis.
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Affiliation(s)
- Tommaso Maria Manzia
- Department of Surgery Science, University of Rome Tor Vergata, U.O.C. HepatoBiliary and Transplantation, Policlinico Tor Vergata, Rome, Italy
| | - Silvia Trapani
- Italian National Transplant Centre, National Institute of Health, Rome, Italy
| | - Alessandra Nardi
- Department of Mathematics, University of Rome Tor Vergata, Italy.
| | - Andrea Ricci
- Italian National Transplant Centre, National Institute of Health, Rome, Italy
| | - Ilaria Lenci
- Hepatology and Transplant Unit, Fondazione Policlinico Tor Vergata, Italy
| | - Martina Milana
- Hepatology and Transplant Unit, Fondazione Policlinico Tor Vergata, Italy
| | - Roberta Angelico
- Department of Surgery Science, University of Rome Tor Vergata, U.O.C. HepatoBiliary and Transplantation, Policlinico Tor Vergata, Rome, Italy
| | - Tullia Maria De Feo
- North Italy Transplant program (NITp), U.O.C. Coordinamento Trapianti, Fondazione IRCSS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Salvatore Agnes
- Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Foundation A. Gemelli Hospital, Rome, Italy
| | - Enzo Andorno
- Department of Hepatobiliarypancreatic Surgery and Liver Transplantation Unit, A.O.U. S. Martino, Genova, Italy
| | - Umberto Baccarani
- Department of Medicine, Università Degli Studi Di Udine, Udine, Italy
| | - Amedeo Carraro
- Liver Transplant Unit, Department of Surgical Science, University and Hospital Trust of Verona, Azienda Ospedaliera Verona, Verona, Italy
| | - Matteo Cescon
- Hepato-Biliary and Transplant Unit, AOU Sant'Orsola IRCCS, Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Padova, Padova, Italy
| | - Michele Colledan
- Department of Organ Failure and Transplantation, Ospedale Papa Giovanni XXIII, Bergamo, University of Milano-Bicocca, Milano, Italy
| | - Luciano De Carlis
- Division of General Surgery & Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, University of Milano-Bicocca, Milano, Italy
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation AOU Pisana, Pisa, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit Azienda Ospedaliera Policlinico, University of Modena and Reggio Emilia Modena, Italy
| | - Giuseppe Maria Ettorre
- Division of General Surgery and Liver Transplantation, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneoper i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy; Department of Surgery and Medical and Surgical Specialties, University of Catania, Catania, Italy
| | - Luigi Giovanni Lupo
- General Surgery and Liver transplantation Unit, University of Bari, Bari, Italy
| | - Vincenzo Mazzaferro
- HPB Surgery and Liver Transplantation Unit, Department of Oncology University of Milan and Department of Surgery, Fondazione IRCCS, Istituto Nazionale Tumori, IRCCS Milan, Italy
| | - Renato Romagnoli
- Liver Transplant Center, General Surgery 2U, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giorgio Rossi
- Division of General Surgery and Liver Transplantation, Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Massimo Rossi
- General Surgery and Organ Transplantation, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy
| | - Marco Spada
- Department of Specialized Surgery, Division of Hepatobiliopancreatic Surgery and of Liver and Kidney Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanni Vennarecci
- Unit of Hepatobiliary Surgery and Liver Transplant Center, Department of Gastroenterology and Transplantation, "A. Cardarelli" Hospital, Naples, Italy
| | - Marco Vivarelli
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Aou Ospedali Riuniti, Ancona, Italy
| | - Fausto Zamboni
- Department of Surgery, General and Hepatic Transplantation Surgery Unit, A.O.B. Brotzu, Cagliari, Italy
| | - Giuseppe Tisone
- Department of Surgery Science, University of Rome Tor Vergata, U.O.C. HepatoBiliary and Transplantation, Policlinico Tor Vergata, Rome, Italy
| | - Massimo Cardillo
- Italian National Transplant Centre, National Institute of Health, Rome, Italy
| | - Mario Angelico
- Hepatology and Transplant Unit, Fondazione Policlinico Tor Vergata, Italy
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14
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Guarino M, Cossiga V, Becchetti C, Invernizzi F, Lapenna L, Lavezzo B, Lenci I, Merli M, Pasulo L, Zanetto A, Burra P, Morisco F. Sarcopenia in chronic advanced liver diseases: A sex-oriented analysis of the literature. Dig Liver Dis 2022; 54:997-1006. [PMID: 34789397 DOI: 10.1016/j.dld.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/29/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022]
Abstract
Sarcopenia, defined as progressive and generalized loss of muscle mass and strength, is common in chronic liver disease. It significantly impacts the quality of life and increases the risk of liver-related complications and mortality in cirrhotic patients. Moreover, recent studies showed a negative impact of sarcopenia on patients awaiting liver transplantation (LT), on post-LT outcomes, and on response to hepatocellular carcinoma therapies. Data about the influence of sex on the incidence, prevalence, diagnosis and treatment of sarcopenia in chronic liver diseases are poor and conflicting. The aims of this review of the literature are to define sex differences in sarcopenic cirrhotic patients and to highlight the necessity of a sex stratified analysis in future studies. This analysis of the literature showed that most of the studies are retrospective, with a higher prevalence of sarcopenia in males, probably due to anatomical differences between the sexes. Moreover, diagnostic criteria for sarcopenia are different between studies, as there is not a defined cut-off and, as a consequence, no comparable results. In conclusion, sex seems to have an impact on sarcopenia, and future studies must accurately investigate its role in identifying and treating high-risk patients, reducing the negative impact of sarcopenia on the survival and quality of life of cirrhotic patients.
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Affiliation(s)
- Maria Guarino
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli Federico II", Via S. Pansini, 5, Napoli 80131, Italy
| | - Valentina Cossiga
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli Federico II", Via S. Pansini, 5, Napoli 80131, Italy.
| | - Chiara Becchetti
- Hepatology, Department of Biomedical Research, University of Bern, Switzerland; University Clinic for Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern, Switzerland; Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Federica Invernizzi
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucia Lapenna
- Department of Translational and Precision Medicine, Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy
| | - Bruna Lavezzo
- Anesthesia and Intensive Care Unit 2, Liver Transplant Center, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Ilaria Lenci
- Department of Surgery Science, Hepatology and Liver Transplant Unit, Tor Vergata University, Rome, Italy
| | - Manuela Merli
- Department of Translational and Precision Medicine, Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy
| | - Luisa Pasulo
- Department of Clinical Medicine, Gastroenterology-Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alberto Zanetto
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Filomena Morisco
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli Federico II", Via S. Pansini, 5, Napoli 80131, Italy
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Morosetti D, Lenci I, Argirò R, Milana M, Gasparrini F, Crociati S, Tisone G, Floris R, Baiocchi L. Use of Intravascular Ultrasound to Improve Diagnosis and Treatment of Transjugular Intrahepatic Portosystemic Shunt Dysfunction in Patients in the Long-term Follow-up. Euroasian J Hepatogastroenterol 2022; 12:50-56. [PMID: 35990871 PMCID: PMC9357521 DOI: 10.5005/jp-journals-10018-1374] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To evaluate the efficacy of intravascular ultrasound (IVUS) in transjugular intrahepatic portosystemic shunt (TIPS) revision associated with phlebography and invasive pressure measurement in patients with clinical or radiological signs of TIPS malfunction. Background Four patients underwent TIPS revision between February and August 2021. Right internal jugular vein access was achieved under ultrasonographic guidance, a catheter was advanced to achieve the Inferior Vena Cava (IVC) and afterward the Portal vein through the TIPS. Once the Portal vein was achieved, a phlebography was performed, followed by invasive pressure measurement and IVUS exam over the guidewire. Based on the combination of phlebography, invasive pressure measurement, and IVUS evaluations, TIPS dysfunction was treated either with angioplasty or stent apposition. Case description In all patients, we obtained the reduction of porto-systemic gradient. In three patients, angioplasty with a 10 mm diameter balloon catheter was performed. Anticoagulation therapy was added to one patient. In one patient, the Viatorr's proximal extremity in the suprahepatic vein wall was dislocated, so it was lengthened with a “Viabahn” covered stent. None of the patients developed hepatic encephalopathy after both TIPS placement and TIPS revision. No complications related to the procedure were observed during the follow-up. Clinical improvement in the immediate follow-up period was observed in all patients. In two patients, the abdominal ascites resolved. In another one, the abdominal pain disappeared, and a reduction of the longitudinal spleen diameter was recorded at 3 months follow-up. Conclusion The use of IVUS allowed us to correctly visualize the organic cause of TIPS malfunction and to obtain direct visualization of the results of endovascular treatment. How to cite this article Morosetti D, Lenci I, Argirò R, et al. Use of Intravascular Ultrasound to Improve Diagnosis and Treatment of Transjugular Intrahepatic Portosystemic Shunt Dysfunction in Patients in the Long-term Follow-up. Euroasian J Hepato-Gastroenterol 2022;12(1):50–56.
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Affiliation(s)
- Daniele Morosetti
- Department of Interventional Radiology Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Ilaria Lenci
- Department of Experimental Medicine and Surgery, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Renato Argirò
- Department of Interventional Radiology Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Martina Milana
- Department of Experimental Medicine and Surgery, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Fulvio Gasparrini
- Department of Interventional Radiology Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Sara Crociati
- Department of Interventional Radiology Unit, University of Rome Tor Vergata, Rome, Latium, Italy
- Sara Crociati, Department of Interventional Radiology Unit, University of Rome Tor Vergata, Rome, Latium, Italy, Phone: +39 3331579930, e-mail:
| | - Giuseppe Tisone
- Department of Experimental Medicine and Surgery, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Roberto Floris
- Department of Interventional Radiology Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Leonardo Baiocchi
- Department of Experimental Medicine and Surgery, Policlinico Universitario Tor Vergata, Rome, Italy
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16
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Ferri F, Milana M, Abbatecola A, Pintore A, Lenci I, Parisse S, Vitale A, Di Croce G, Mennini G, Lai Q, Rossi M, Angelico R, Tisone G, Anselmo A, Angelico M, Corradini SG. Electronic Outpatient Referral System for Liver Transplant Improves Appropriateness and Allows First Visit Triage. Clin Gastroenterol Hepatol 2022; 20:e1388-e1415. [PMID: 34648952 DOI: 10.1016/j.cgh.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/07/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Missed or inappropriate referrals of potential candidates for liver transplantation (LT) are common and traditional referral methods (tRs) do not allow for efficient triage. We investigated the effects of a website developed for electronic outpatient referral to LT (eRW-LT) on these issues. METHODS We prospectively collected data on all consecutive outpatient referrals to 2 Italian LT centers from January 2015 to December 2019. In the second half of the study, starting from July 2017, referring physicians had the option of using eRW-LT, quickly obtaining the judgment on the appropriateness and urgency of the visit from a transplant hepatologist. RESULTS In the second half of the study, there were 99 eRW-LTs and 96 traditional referrals (new tRs), representing a 17.4% increase over the 161 traditional referrals (old tRs) of the first half. With eRW-LT, 11.1% of referrals were judged inappropriate online without booking a visit. Appropriateness, judged at the time of the first visit, was 59.6%, 56.2%, and 94.3% with old tRs, new tRs, and eRW-LT, respectively. Considering the appropriate visits, the median waiting time in days between referral date and first visit appointment was significantly shorter for urgent visits referred with eRW-LT (5.0; 95% CI, 4.8-9.3) compared with nonurgent visits sent with the same system (17.0; 95% CI, 11.5-25.0; P < .0001), those referred with old tRs (14.0; 95% CI, 8.0-23.0; P < .001) and with new tRs (16.0; 95% CI, 10.0-23.0; P < .001). CONCLUSIONS eRW-LT allows an increase in the number of referrals for LT, ensuring effective triage and better appropriateness of visits.
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Affiliation(s)
- Flaminia Ferri
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| | - Martina Milana
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - Aurelio Abbatecola
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Pintore
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Ilaria Lenci
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - Simona Parisse
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | - Gianluca Mennini
- General Surgery and Organ Transplantation Unit, Department of Specialistic and Transplant Surgery "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Quirino Lai
- General Surgery and Organ Transplantation Unit, Department of Specialistic and Transplant Surgery "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Massimo Rossi
- General Surgery and Organ Transplantation Unit, Department of Specialistic and Transplant Surgery "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Roberta Angelico
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - Giuseppe Tisone
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - Alessandro Anselmo
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - Mario Angelico
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
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Sciarrone SS, Ferrarese A, Bizzaro D, Volpato S, Donato FM, Invernizzi F, Trespidi L, Ramezzana IG, Avolio AW, Nure E, Pascale MM, Fagiuoli S, Pasulo L, Merli M, Lapenna L, Toniutto P, Lenci I, Di Donato R, De Maria N, Villa E, Galeota Lanza A, Marenco S, Bhoori S, Mameli L, Cillo U, Boccagni P, Russo FP, Bo P, Cosmi E, Burra P. Safe pregnancy after liver transplantation: Evidence from a multicenter Italian collaborative study. Dig Liver Dis 2022; 54:669-675. [PMID: 34497039 DOI: 10.1016/j.dld.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Women who have undergone liver transplantation (LT) enjoy better health, and possibility of childbearing. However, maternal and graft risks, optimal immunosuppression, and fetal outcome is still to clarify. AIM Aim of the study was to assess outcomes of pregnancy after LT at national level. METHODS In 2019, under the auspices of the Permanent Transplant Committee of the Italian Association for the Study of the Liver, a multicenter survey including 14 Italian LT-centers was conducted aiming at evaluating the outcomes of recipients and newborns, and graft injury/function parameters during pregnancy in LT-recipients. RESULTS Sixty-two pregnancies occurred in 60 LT-recipients between 1990 and 2018. Median age at the time of pregnancy was 31-years and median time from transplantation to conception was 8-years. During pregnancy, 4 recipients experienced maternal complications with hospital admission. Live-birth-rate was 100%. Prematurity occurred in 25/62 newborns, and 8/62 newborns had low-birth-weight. Cyclosporine was used in 16 and Tacrolimus in 37 pregnancies, with no different maternal or newborn outcomes. Low-birth-weight was correlated to high values of AST, ALT and GGT. CONCLUSION Pregnancy after LT has good outcome; however, maternal complications and prematurity may occur. Compliance with the immunosuppression is fundamental to ensure the stability of graft function and prevent graft-deterioration.
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Affiliation(s)
- Salvatore Stefano Sciarrone
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy
| | - Alberto Ferrarese
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy
| | - Debora Bizzaro
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy
| | - Sofia Volpato
- Gynaecology and Obstetrics Unit, Department of Women's and Children's Health, University of Padua, Via Giustianini 3, Padua 35128, Italy
| | - Francesca Maria Donato
- Division of Gastroenterology, Maggiore Hospital and IRCCS Foundation, Via Francesco Sforza 35, Milan 20122, Italy
| | - Federica Invernizzi
- Division of Gastroenterology, Maggiore Hospital and IRCCS Foundation, Via Francesco Sforza 35, Milan 20122, Italy
| | - Laura Trespidi
- Gynaecology and Obstetrics Unit, Department of Women's and Children's Health, Fondazione Ospedale Maggiore, Via Francesco Sforza 35, Milan 20122, Italy
| | - Ilaria Giuditta Ramezzana
- Gynaecology and Obstetrics Unit, Department of Women's and Children's Health, Fondazione Ospedale Maggiore, Via Francesco Sforza 35, Milan 20122, Italy
| | - Alfonso Wolfango Avolio
- Liver Unit, Department of Surgery, Agostino Gemelli Hospital, Catholic University, Largo Agostino Gemelli 8, Rome 00168, Italy
| | - Erida Nure
- Liver Unit, Department of Surgery, Agostino Gemelli Hospital, Catholic University, Largo Agostino Gemelli 8, Rome 00168, Italy
| | - Marco Maria Pascale
- Liver Unit, Department of Surgery, Agostino Gemelli Hospital, Catholic University, Largo Agostino Gemelli 8, Rome 00168, Italy
| | - Stefano Fagiuoli
- Gastroenterology, Hepatology and Liver Transplantation Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy
| | - Luisa Pasulo
- Gastroenterology, Hepatology and Liver Transplantation Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy
| | - Manuela Merli
- Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Via di Grottarossa 1015, Rome 00189, Italy
| | - Lucia Lapenna
- Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Via di Grottarossa 1015, Rome 00189, Italy
| | - Pierluigi Toniutto
- Internal Medicine, Department of Medical Area, University of Udine, via Palladio 8, Udine 33100, Italy
| | - Ilaria Lenci
- Hepatology and Liver Transplant Unit, Department of Medicine, Policlinico Tor Vergata, Viale Oxford 81, Rome 00133, Italy
| | - Roberto Di Donato
- Department of Digestive Disease and Internal Medicine, Azienda Ospedaliero-Universitaria di Bologna Policlinico S.Orsola-Malpighi, Via Giuseppe Massarenti 11, Bologna 40138, Italy
| | - Nicola De Maria
- Department of Internal Medicine, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Largo del Pozzo 71, Modena 41124, Italy
| | - Erica Villa
- Department of Internal Medicine, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Largo del Pozzo 71, Modena 41124, Italy
| | | | - Simona Marenco
- Department of Internal Medicine, Gastroenterolgy Unit, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genova 16132, Italy
| | - Sherrie Bhoori
- Department of Surgery and Oncology, Istituto Nazionale Tumori IRCCS, Via Giacomo Venezian, 1, Milan 20133, Italy
| | - Laura Mameli
- Liver and Pancreas Transplant Center, Azienda Ospedaliera Brotzu Piazzale Ricchi 1, Cagliari 09134, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via Giustiniani 2, Padua 35128, Italy
| | - Patrizia Boccagni
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via Giustiniani 2, Padua 35128, Italy
| | - Francesco Paolo Russo
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy
| | - Patrizio Bo
- Gynaecology and Obstetrics Unit, Cittadella Hospital, Via Riva dell'Ospedale, Cittadella 35013, Italy
| | - Erich Cosmi
- Gynaecology and Obstetrics Unit, Department of Women's and Children's Health, University of Padua, Via Giustianini 3, Padua 35128, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy.
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Ceci L, Zhou T, Lenci I, Meadows V, Kennedy L, Li P, Ekser B, Milana M, Zhang W, Wu C, Sato K, Chakraborty S, Glaser SS, Francis H, Alpini G, Baiocchi L. Molecular Mechanisms Linking Risk Factors to Cholangiocarcinoma Development. Cancers (Basel) 2022; 14:1442. [PMID: 35326593 PMCID: PMC8945938 DOI: 10.3390/cancers14061442] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023] Open
Abstract
The poor prognosis of cholangiocarcinoma in humans is related to several factors, such as (i) the heterogeneity of the disease, (ii) the late onset of symptoms and (iii) the limited comprehension of the carcinogenic pathways determining neoplastic changes, which all limit the pursuit of appropriate treatment. Several risk factors have been recognized, including different infective, immune-mediated, and dysmorphogenic disorders of the biliary tree. In this review, we report the details of possible mechanisms that lead a specific premalignant pathological condition to become cholangiocarcinoma. For instance, during liver fluke infection, factors secreted from the worms may play a major role in pathogenesis. In primary sclerosing cholangitis, deregulation of histamine and bile-acid signaling may determine important changes in cellular pathways. The study of these molecular events may also shed some light on the pathogenesis of sporadic (unrelated to risk factors) forms of cholangiocarcinoma, which represent the majority (nearly 75%) of cases.
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Affiliation(s)
- Ludovica Ceci
- Hepatology and Gastroenterology Division, Department of Medicine, Indiana University, Indianapolis, IN 46202, USA; (L.C.); (T.Z.); (V.M.); (L.K.); (K.S.); (H.F.)
| | - Tianhao Zhou
- Hepatology and Gastroenterology Division, Department of Medicine, Indiana University, Indianapolis, IN 46202, USA; (L.C.); (T.Z.); (V.M.); (L.K.); (K.S.); (H.F.)
| | - Ilaria Lenci
- Unit of Hepatology, Tor Vergata University, 00133 Rome, Italy; (I.L.); (M.M.)
| | - Vik Meadows
- Hepatology and Gastroenterology Division, Department of Medicine, Indiana University, Indianapolis, IN 46202, USA; (L.C.); (T.Z.); (V.M.); (L.K.); (K.S.); (H.F.)
| | - Lindsey Kennedy
- Hepatology and Gastroenterology Division, Department of Medicine, Indiana University, Indianapolis, IN 46202, USA; (L.C.); (T.Z.); (V.M.); (L.K.); (K.S.); (H.F.)
- Department of Research, Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | - Ping Li
- Department of Surgery, Division of Transplant Surgery, Indiana University, Indianapolis, IN 46202, USA; (P.L.); (B.E.); (W.Z.)
| | - Burcin Ekser
- Department of Surgery, Division of Transplant Surgery, Indiana University, Indianapolis, IN 46202, USA; (P.L.); (B.E.); (W.Z.)
| | - Martina Milana
- Unit of Hepatology, Tor Vergata University, 00133 Rome, Italy; (I.L.); (M.M.)
| | - Wenjun Zhang
- Department of Surgery, Division of Transplant Surgery, Indiana University, Indianapolis, IN 46202, USA; (P.L.); (B.E.); (W.Z.)
| | - Chaodong Wu
- Department of Nutrition, Texas A&M University, College Station, TX 77843, USA;
| | - Keisaku Sato
- Hepatology and Gastroenterology Division, Department of Medicine, Indiana University, Indianapolis, IN 46202, USA; (L.C.); (T.Z.); (V.M.); (L.K.); (K.S.); (H.F.)
| | - Sanjukta Chakraborty
- Department of Medical Physiology, Texas A&M University College of Medicine, Bryan, TX 77807, USA; (S.C.); (S.S.G.)
| | - Shannon S. Glaser
- Department of Medical Physiology, Texas A&M University College of Medicine, Bryan, TX 77807, USA; (S.C.); (S.S.G.)
| | - Heather Francis
- Hepatology and Gastroenterology Division, Department of Medicine, Indiana University, Indianapolis, IN 46202, USA; (L.C.); (T.Z.); (V.M.); (L.K.); (K.S.); (H.F.)
- Department of Research, Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | - Gianfranco Alpini
- Hepatology and Gastroenterology Division, Department of Medicine, Indiana University, Indianapolis, IN 46202, USA; (L.C.); (T.Z.); (V.M.); (L.K.); (K.S.); (H.F.)
- Department of Research, Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | - Leonardo Baiocchi
- Unit of Hepatology, Tor Vergata University, 00133 Rome, Italy; (I.L.); (M.M.)
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19
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Lucidi C, Biolato M, Lai Q, Lattanzi B, Lenci I, Milana M, Lionetti R, Liguori A, Angelico M, Tisone G, Avolio AW, Agnes S, Rossi M, Grieco A, Merli M. Cumulative incidence of solid and hematological De novo malignancy after liver transplantation in a multicentre cohort. Ann Hepatol 2022; 24:100309. [PMID: 33482364 DOI: 10.1016/j.aohep.2021.100309] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent innovations in the field of liver transplantation have led to a wealth of new treatment regimes, with potential impact on the onset of de novo malignancies (DNM). The aim of this multicenter cohort study was to provide contemporary figures for the cumulative incidences of solid and hematological DNM after liver transplantation. METHODS We designed a retrospective cohort study including patients undergoing LT between 2000 and 2015 in three Italian transplant centers. Cumulative incidence was calculated by Kaplan-Meyer analysis. RESULTS The study included 789 LT patients with a median follow-up of 81 months (IQR: 38-124). The cumulative incidence of non-cutaneous DNM was 6.2% at 5-years, 11.6% at 10-years and 16.3% at 15-years. Post-Transplant Lymphoproliferative Disorders (PTLD) were demonstrated to have a cumulative incidence of 1.0% at 5-years, 1.6% at 10-years and 2.2% at 15-years. Solid Organ Tumors (SOT) demonstrated higher cumulative incidences - 5.3% at 5-years, 10.3% at 10-years and 14.4% at 15-years. The most frequently observed classifications of SOT were lung (rate 1.0% at 5-years, 2.5% at 10-years) and head & neck tumors (rate 1.3% at 5-years, 1.9% at 10-years). CONCLUSIONS Lung tumors and head & neck tumors are the most frequently observed SOT after LT.
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Affiliation(s)
- Cristina Lucidi
- Gastroenterology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marco Biolato
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Quirino Lai
- Hepato-biliopancreatic and Liver Transplant Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Barbara Lattanzi
- Gastroenterology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Department of Experimental Medicine and Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Martina Milana
- Hepatology Unit, Department of Experimental Medicine and Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Raffaella Lionetti
- Infectious and Liver Diseases, Lazzaro Spallanzani National Infectious Disease Institute, Rome, Italy
| | | | - Mario Angelico
- Hepatology Unit, Department of Experimental Medicine and Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Giuseppe Tisone
- Surgery Unit, Department of Experimental Medicine and Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Alfonso Wolfango Avolio
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Salvatore Agnes
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Rossi
- Hepato-biliopancreatic and Liver Transplant Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Antonio Grieco
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Manuela Merli
- Gastroenterology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
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Manzia TM, Parente A, Lenci I, Sensi B, Milana M, Gazia C, Signorello A, Angelico R, Grassi G, Tisone G, Baiocchi L. Moving forward in the treatment of cholangiocarcinoma. World J Gastrointest Oncol 2021; 13:1939-1955. [PMID: 35070034 PMCID: PMC8713313 DOI: 10.4251/wjgo.v13.i12.1939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/14/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
Despite being the second most frequent primary liver tumor in humans, early diagnosis and treatment of cholangiocarcinoma (CCA) are still unsatisfactory. In fact, survival after 5 years is expected in less than one fourth of patients diagnosed with this disease. Rare incidence, late appearance of symptoms and heterogeneous biology are all factors contributing to our limited knowledge of this cancer and determining its poor prognosis in the clinical setting. Several efforts have been made in the last decades in order to achieve an improved classification/understanding with regard to the diverse CCA forms. Location within the biliary tree has helped to distinguish between intrahepatic, perihilar and distal CCA types. Sequence analysis contributed to identifying several characteristic genetic aberrations in CCA that may also serve as possible targets for therapy. Novel findings are expected to significantly improve the management of this malignancy in the near future. In this changing scenario our review focuses on the current and future strategies for CCA treatment. Both systemic and surgical treatments are discussed in detail. The results of the main studies in this field are reported, together with the ongoing trials. The current findings suggest that an integrated multidisciplinary approach to this malignancy would be helpful to improve its outcome.
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Affiliation(s)
- Tommaso M Manzia
- Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Alessandro Parente
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
| | - Ilaria Lenci
- Hepatology Unit, University of Tor Vergata, Rome 00133, Italy
| | - Bruno Sensi
- Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Martina Milana
- Hepatology Unit, University of Tor Vergata, Rome 00133, Italy
| | - Carlo Gazia
- Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | | | - Roberta Angelico
- Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Giuseppe Grassi
- Hepatology Unit, University of Tor Vergata, Rome 00133, Italy
| | - Giuseppe Tisone
- Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
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21
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Angelico R, Sensi B, Manzia TM, Tisone G, Grassi G, Signorello A, Milana M, Lenci I, Baiocchi L. Chronic rejection after liver transplantation: Opening the Pandora’s box. World J Gastroenterol 2021; 27:7771-7783. [PMID: 34963740 PMCID: PMC8661381 DOI: 10.3748/wjg.v27.i45.7771] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/25/2021] [Accepted: 11/21/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic rejection (CR) of liver allografts causes damage to intrahepatic vessels and bile ducts and may lead to graft failure after liver transplantation. Although its prevalence has declined steadily with the introduction of potent immunosuppressive therapy, CR still represents an important cause of graft injury, which might be irreversible, leading to graft loss requiring re-transplantation. To date, we still do not fully appreciate the mechanisms underlying this process. In addition to T cell-mediated CR, which was initially the only recognized type of CR, recently a new form of liver allograft CR, antibody-mediated CR, has been identified. This has indeed opened an era of thriving research and renewed interest in the field. Liver biopsy is needed for a definitive diagnosis of CR, but current research is aiming to identify new non-invasive tools for predicting patients at risk for CR after liver transplantation. Moreover, the minimization or withdrawal of immunosuppressive therapy might influence the establishment of subclinical CR-related injury, which should not be disregarded. Therapies for CR may only be effective in the “early” phases, and a tailored management of the immunosuppression regimen is essential for preventing irreversible liver damage. Herein, we provide an overview of the current knowledge and research on CR, focusing on early detection, identification of non-invasive biomarkers, immunosuppressive management, re-transplantation and future perspectives of CR.
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Affiliation(s)
- Roberta Angelico
- Department of Surgery Sciences, HPB and Transplant Unit, University of Tor Vergata, Rome 00100, Italy
| | - Bruno Sensi
- Department of Surgery Sciences, HPB and Transplant Unit, University of Tor Vergata, Rome 00100, Italy
| | - Tommaso M Manzia
- Department of Surgery Sciences, HPB and Transplant Unit, University of Tor Vergata, Rome 00100, Italy
| | - Giuseppe Tisone
- Department of Surgery Sciences, HPB and Transplant Unit, University of Tor Vergata, Rome 00100, Italy
| | - Giuseppe Grassi
- Hepatology Unit, University of Tor Vergata, Rome 00100, Italy
| | | | - Martina Milana
- Hepatology Unit, University of Tor Vergata, Rome 00100, Italy
| | - Ilaria Lenci
- Hepatology Unit, University of Tor Vergata, Rome 00100, Italy
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22
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Toti L, Manzia TM, Sensi B, Blasi F, Baiocchi L, Lenci I, Angelico R, Tisone G. Towards tolerance in liver transplantation. Best Pract Res Clin Gastroenterol 2021; 54-55:101770. [PMID: 34874844 DOI: 10.1016/j.bpg.2021.101770] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/08/2021] [Indexed: 02/08/2023]
Abstract
Life-long immunosuppression has always been considered the key in managing liver graft protection from recipient rejection. However, it is associated with severe adverse effects that lead to increased morbidity and mortality, including infections, cardiovascular diseases, kidney failure, metabolic disorders and de novo malignancies. This explains the great interest that has developed in the concept of tolerance in recent years. The liver, thanks to its marked tolerogenicity, is to be considered a privileged organ: up to 60% of selected patients undergoing liver transplantation could safely withdraw immunosuppression.
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Affiliation(s)
- L Toti
- Hepato-Pancreato-Biliary and Transplant Unit, Fondazione Policlinico Tor Vergata, Rome, Italy.
| | - T M Manzia
- University of Rome Tor Vergata, Department of Surgical Science, Italy
| | - B Sensi
- University of Rome Tor Vergata, Department of Surgical Science, Italy
| | - F Blasi
- University of Rome Tor Vergata, Department of Surgical Science, Italy
| | - L Baiocchi
- University of Rome Tor Vergata, Department of Surgical Science, Italy
| | - I Lenci
- Hepatology and Liver Transplant Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - R Angelico
- University of Rome Tor Vergata, Department of Surgical Science, Italy
| | - G Tisone
- University of Rome Tor Vergata, Department of Surgical Science, Italy
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23
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Di Maio VC, Barbaliscia S, Teti E, Fiorentino G, Milana M, Paolucci S, Pollicino T, Morsica G, Starace M, Bruzzone B, Gennari W, Micheli V, Yu La Rosa K, Foroghi L, Calvaruso V, Lenci I, Polilli E, Babudieri S, Aghemo A, Raimondo G, Sarmati L, Coppola N, Pasquazzi C, Baldanti F, Parruti G, Perno CF, Angelico M, Craxì A, Andreoni M, Ceccherini-Silberstein F. Resistance analysis and treatment outcomes in hepatitis C virus genotype 3-infected patients within the Italian network VIRONET-C. Liver Int 2021; 41:1802-1814. [PMID: 33497016 DOI: 10.1111/liv.14797] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/29/2020] [Accepted: 01/14/2021] [Indexed: 12/20/2022]
Abstract
AIM This study aimed to investigate the role of resistance-associated substitutions (RASs) to direct-acting-antivirals (DAAs) in HCV genotype 3 (GT3). METHODS Within the Italian VIRONET-C network, a total of 539 GT3-infected patients (417 DAA-naïve and 135 DAA-failures, of them, 13 at both baseline and failure) were analysed. Sanger sequencing of NS3/NS5A/NS5B was performed following home-made protocols. RESULTS The majority of patients were male (79.4%), 91.4% were injection drug users, 49.3% were cirrhotic and 13.9% were HIV co-infected. Phylogenetic analysis classified sequences as GT3a-b-g-h (98%-0.4%-0.2%-1.2%) respectively. Overall, 135 patients failed a DAA regimen: sofosbuvir (SOF)/daclatasvir (DCV) or velpatasvir (VEL)±ribavirin (RBV) (N = 91/15) and glecaprevir (G)/pibrentasvir (P) (N = 9). Moreover, 14.8% of patients were treated with suboptimal regimens for GT3: 3D ± RBV (Paritaprevir/r + Ombitasvir+Dasabuvir, N = 15), SOF + Simeprevir (SIM) (N = 1) or SOF/Ledipasvir (LDV) ± RBV (N = 4). RAS prevalence was 15.8% in DAA-naïve patients. At failure, 81.5% patients showed at least one RAS: 11/25 (44.0%) in NS3, 109/135 (80.7%) in NS5A, 7/111 (6.3%) in NS5B SOF-failures. In NS5A-failures, Y93H RAS was the most prevalent (68.5% vs 5.1% DAA-naïve, P < .001) followed by A30K (12.7% vs 2.8% in DAA-naïve, P < .001). Analysing baseline samples, a higher prevalence of NS5A-RASs was observed before treatment in DAA-failures (5/13, 38.5%) vs DAA-naïves (61/393, 15.5%, P = .04). Regarding 228 DAA-naïve patients with an available outcome, 93.9% achieved a SVR. Interestingly, patients with baseline Y93H and/or A30K had SVR rate of 72.2% vs 95.7% for patients without NS5A-RASs (P = .002). CONCLUSIONS In this real-life GT3 cohort, the majority of failures harboured resistant variants carrying NS5A-RASs, the most frequent being Y93H. The presence of natural NS5A-RASs before treatment was associated with failure. Further analyses are needed to confirm this observation, particularly for the new current regimens.
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Affiliation(s)
- Velia Chiara Di Maio
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Barbaliscia
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elisabetta Teti
- Infectious Diseases, University Hospital of Rome Tor Vergata, Rome, Italy
| | | | - Martina Milana
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Stefania Paolucci
- Molecular Virology Unit, Microbiology and Virology Department, IRCCS Policlinic Foundation San Matteo, Pavia, Italy
| | - Teresa Pollicino
- Department of Internal Medicine, University Hospital of Messina, Messina, Italy
| | - Giulia Morsica
- Division of Infectious Diseases, IRCCS, Ospedale San Raffaele, Milan, Italy
| | - Mario Starace
- Laboratory for the identification of prognostic factors of response to the treatment against infectious diseases, University of Campania "L. Vanvitelli", Napoli, Italy
| | | | - William Gennari
- Microbiology Unit, University Hospital of Modena, Modena, Italy
| | - Valeria Micheli
- Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Katia Yu La Rosa
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luca Foroghi
- Infectious Diseases, University Hospital of Rome Tor Vergata, Rome, Italy
| | | | - Ilaria Lenci
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Ennio Polilli
- Infectious Disease Unit, Pescara General Hospital, Pescara, Italy
| | - Sergio Babudieri
- Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Giovanni Raimondo
- Department of Internal Medicine, University Hospital of Messina, Messina, Italy
| | - Loredana Sarmati
- Infectious Diseases, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Nicola Coppola
- Laboratory for the identification of prognostic factors of response to the treatment against infectious diseases, University of Campania "L. Vanvitelli", Napoli, Italy.,Department of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Fausto Baldanti
- Molecular Virology Unit, Microbiology and Virology Department, IRCCS Policlinic Foundation San Matteo, Pavia, Italy
| | - Giustino Parruti
- Infectious Disease Unit, Pescara General Hospital, Pescara, Italy
| | | | - Mario Angelico
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Antonio Craxì
- Gastroenterology, "P. Giaccone" University Hospital, Palermo, Italy
| | - Massimo Andreoni
- Infectious Diseases, University Hospital of Rome Tor Vergata, Rome, Italy
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24
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Gazia C, Lenci I, Manzia TM, Martina M, Tisone G, Angelico R, Abenavoli L, Grassi G, Signorello A, Baiocchi L. Current Strategies to Minimize Ischemia-Reperfusion Injury in Liver Transplantation: A Systematic Review. Rev Recent Clin Trials 2021; 16:372-380. [PMID: 34376136 DOI: 10.2174/1574887116666210729112932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/26/2020] [Revised: 03/31/2021] [Accepted: 04/29/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hepatic ischemia reperfusion injury (IRI) is a serious threat that characterizes the liver but also other transplantable organs. The worst effect of long-term IRI on an impaired graft could lead to irreversible damage and organ failure. Several events characterize the cascade that ultimately leads to organ failure. Among all, multiple strategies have been attempted to identify early phenomena of IRI with divergent results, and biomarkers might represent a novel approach to early detect ischemic damage. METHODS A literature review of the current state-of-the-art on IRI was conducted in the present manuscript. Information was collected from worldwide clinical trials conducted in highly specialized institutions. Experiments conducted on IRI animal models and clinical studies were screened. The final outcomes were analyzed and reported in the present review. RESULTS Matrix Metalloproteinases (MMPs) represent an interesting example of the early detector of neutrophil invasion after acute and chronic hepatic IRI. Neutrophil gelatinase-associated lipocalin (NGAL) is another biomarker that seems more predictable of the IRI gravity phase. Mitochondrial flavin mononucleotide (FMN) was recently discovered and might become a reliable biomarker of hepatic IRI during hypothermic oxygenation machine perfusion (HOPE). CONCLUSION The available strategies to avoid IRI, despite constantly improving, are still lacking of a gold standard method. Further studies are still needed to explore new options in the IRI diagnosis and treatment, and to this purpose regenerative medicine and tissue engineering surely can play a pivotal role in the transplantation field.
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Affiliation(s)
- Carlo Gazia
- Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Ilaria Lenci
- Hepatology and Liver Transplant Unit, University of Tor Vergata, 00133, Rome, Italy
| | - Tommaso M Manzia
- Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Milana Martina
- Hepatology and Liver Transplant Unit, University of Tor Vergata, 00133, Rome, Italy
| | - Giuseppe Tisone
- Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Roberta Angelico
- Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, University Magna Graecia, Campus "Salvatore Venuta", 88100 Catanzaro, Italy
| | - Giuseppe Grassi
- Hepatology and Liver Transplant Unit, University of Tor Vergata, 00133, Rome, Italy
| | | | - Leonardo Baiocchi
- Hepatology and Liver Transplant Unit, University of Tor Vergata, 00133, Rome, Italy
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25
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Grassi G, Lenci I, Signorello A, Milana M, Baiocchi L. Gastrointestinal endoscopy in cirrhotic patient: Issues on the table. World J Gastrointest Endosc 2021; 13:210-220. [PMID: 34326942 PMCID: PMC8311468 DOI: 10.4253/wjge.v13.i7.210] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Patients with liver cirrhosis are fragile and present specific clinical hallmarks. When undergoing to gastrointestinal (GI) endoscopy, these subjects require an individual pre evaluation, taking into account: Level of haemostasis impairment, the individual risk of infection, the impact of sedation on hepatic encephalopathy and other factors. The overall assessment of liver function, employing common scoring systems, should be also assessed in the preprocedural phase. Beside some common general problems, regarding GI endoscopy in cirrhotic subjects, also specific issues are present for some frequent indications or procedures. For instance, despite an increased incidence of adenomas in cirrhosis, colon cancer screening remains suboptimal in subjects with this disease. Several studies in fact demonstrated liver cirrhosis as a negative factor for an adequate colon cleansing before colonoscopy. On the other hand, also the routine assessment of gastroesophageal varices during upper GI endoscopy presents some concern, since important inter-observer variability or incomplete description of endoscopic findings has been reported in some studies. In this review we discussed in details the most relevant issues that may be considered while performing general GI endoscopic practice, in patient with cirrhosis. For most of these issues there are no guidelines or clear indications. Moreover until now, few studies focused on these aspects. We believe that targeting these issues with corrective measures may be helpful to develop a tailored endoscopic approach for cirrhosis, in the future.
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Affiliation(s)
- Giuseppe Grassi
- Hepatology Unit, University of Tor Vergata, Rome 00100, Italy
| | - Ilaria Lenci
- Hepatology Unit, University of Tor Vergata, Rome 00100, Italy
| | | | - Martina Milana
- Hepatology Unit, University of Tor Vergata, Rome 00100, Italy
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Gasparrini F, Lenci I, Gagliardi MG, Spada M, Salimei F, Orlacchio A. Repeated TACE in HCC after Fontan surgery and situs viscerum inversus: A case report. Radiol Case Rep 2021; 16:2564-2569. [PMID: 34306288 PMCID: PMC8283149 DOI: 10.1016/j.radcr.2021.06.031] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 12/12/2022] Open
Abstract
We describe the case of a 32-year-old man who developed a liver neoplasm due to previous Fontan surgery (FS) for a single ventricle anomaly and situs viscerum inversus. He was admitted to our hospital for suspected hepatocellular carcinoma during an Ultrasound (US) follow up. Computed tomography (CT) showed features of chronic liver disease and 7 cm hepatic nodule with arterial enhancement. Laboratory analyses documented preserved liver function and increased levels of alpha-fetoprotein. Trans-arterial-chemoembolization (TACE) was performed obtaining complete necrosis at 4 weeks of follow up and significant reduction of alpha-fetoprotein. The patient is currently in follow-up, being evaluated for further treatments and/or combined liver-heart transplantation. TACE is a therapeutic option for the treatment of patients with unresectable hepatocellular carcinoma (HCC) and with severe heart disease, like those submitted to FS and with also other vascular abnormalities like those correlated to situs viscerum inversus.
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Key Words
- CM, Contrast Medium
- CT, Computed Tomography, EDVi, End- Diastolic Volume index, EF, Ejection Fraction
- Cardiac cirrhosis
- Congenital heart disease
- FALD, Fontan-associated liver disease
- Fontan surgery
- HCC, hepatocellular carcinoma
- HR, Heart Rate
- IVC-PA, Inferior Vena Cava-Pulmonary Artery
- MRI, Magnetic Resonance Imaging
- SI, Situs inversus
- SMA, Superior Mesenteric Artery
- Situs viscerum inversus
- TACE, Trans Arterial ChemoEmbolization
- TACE, trans-arterial-chemoembolization
- US, Ultrasound
- bpm, beats per minute
- ceCT, Contrast Enhanced CT
- ceCT, contrast enhanced Computed Tomography
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Affiliation(s)
- Fulvio Gasparrini
- Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Rome, Italy
| | - Ilaria Lenci
- Liver Unit, University Hospital Tor Vergata, Rome, Italy
| | - Maria Giulia Gagliardi
- Department of Cardiology, Division of Grow Up Congenital Heart, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marco Spada
- Department of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Fabio Salimei
- Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Rome, Italy
| | - Antonio Orlacchio
- Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Rome, Italy
- Corresponding author: Viale Oxford, 81 - 00133 Rome, Italy.
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27
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Manzia TM, Gazia C, Lenci I, Angelico R, Toti L, Monaco A, Anselmo A, Baiocchi L, Grossi P, Tisone G. Liver transplantation performed in a SARS-CoV-2 positive hospitalized recipient using a SARS-CoV-2 infected donor. Am J Transplant 2021; 21:2600-2604. [PMID: 33621393 PMCID: PMC8013325 DOI: 10.1111/ajt.16548] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 02/05/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 currently affected more than 108 million people worldwide with a fatality rate of 2.2%. Herein, we report the first case of liver transplantation (LT) performed with a liver procured from a SARS-CoV-2 positive donor. The recipient was a 35-year-old SARS-CoV-2 positive female patient affected by severe end-stage HBV-HDV-related liver disease (model of end-stage liver disease = 32) who had neutralizing SARS-CoV-2 antibodies (titers 1:320) at time of LT. The LT was successful, and the graft is functioning two months after surgery. The recipient cleared the SARS-CoV-2 infection 1 month after LT. The current case shows that the prompt use of SARS-CoV-2 infected liver donors offers an invaluable life-saving opportunity for SARS-CoV-2 positive wait-listed patients who developed neutralizing SARS-CoV-2 antibodies.
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Affiliation(s)
- Tommaso Maria Manzia
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
- Correspondence Tommaso Maria Manzia, Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome 00133, Italy.
| | - Carlo Gazia
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Ilaria Lenci
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - Roberta Angelico
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Luca Toti
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Monaco
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Anselmo
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Leonardo Baiocchi
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - Paolo Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Giuseppe Tisone
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
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28
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Lai Q, Magistri P, Lionetti R, Avolio AW, Lenci I, Giannelli V, Pecchi A, Ferri F, Marrone G, Angelico M, Milana M, Schinniná V, Menozzi R, Di Martino M, Grieco A, Manzia TM, Tisone G, Agnes S, Rossi M, Di Benedetto F, Ettorre GM. Sarco-Model: A score to predict the dropout risk in the perspective of organ allocation in patients awaiting liver transplantation. Liver Int 2021; 41:1629-1640. [PMID: 33793054 DOI: 10.1111/liv.14889] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Sarcopenia in liver transplantation (LT) cirrhotic candidates has been connected with higher dropouts and graft losses after transplant. The study aims to create an 'urgency' model combining sarcopenia and Model for End-stage Liver Disease Sodium (MELDNa) to predict the risk of dropout and identify an appropriate threshold of post-LT futility. METHODS A total of 1087 adult cirrhotic patients were listed for a first LT during January 2012 to December 2018. The study population was split into a training (n = 855) and a validation set (n = 232). RESULTS Using a competing-risk analysis of cause-specific hazards, we created the Sarco-Model2 . According to the model, one extra point of MELDNa was added for each 0.5 cm2 /m2 reduction of total psoas area (TPA) < 6.0 cm2 /m2 . At external validation, the Sarco-Model2 showed the best diagnostic ability for predicting the risk of 3-month dropout in patients with MELDNa < 20 (area under the curve [AUC] = 0.93; P = .003). Using the net reclassification improvement, 14.3% of dropped-out patients were correctly reclassified using the Sarco-Model2 . As for the futility threshold, transplanted patients with TPA < 6.0 cm2 /m2 and MELDNa 35-40 (n = 16/833, 1.9%) had the worse results (6-month graft loss = 25.5%). CONCLUSIONS In sarcopenic patients with MELDNa < 20, the 'urgency' Sarco-Model2 should be used to prioritize the list, while MELDNa value should be preferred in patients with MELDNa ≥ 20. The Sarco-Model2 played a role in more than 30% of the cases in the investigated allocation scenario. In sarcopenic patients with a MELDNa value of 35-40, 'futile' transplantation should be considered.
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Affiliation(s)
- Quirino Lai
- General Surgery and Organ Transplantation Unit, Sapienza University, Rome, Italy
| | - Paolo Magistri
- Hepato-biliopancreatic and Transplant Surgery Unit, University of Modena, Modena, Italy
| | - Raffaella Lionetti
- Infectious Diseases - Hepatology Unit, Istituto Nazionale Malattie Infettive Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Alfonso W Avolio
- General Surgery and Liver Transplant Unit, Università Cattolica - Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Tor Vergata University, Rome, Italy
| | | | | | | | - Giuseppe Marrone
- Internal Medicine and Transplant Hepatology Unit, Università Cattolica - Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | | | | | - Vincenzo Schinniná
- Diagnostic imaging Unit, Istituto Nazionale Malattie Infettive Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Renata Menozzi
- Metabolic Disease and Clinical Nutrition Unit, University of Modena, Modena, Italy
| | | | - Antonio Grieco
- Internal Medicine and Transplant Hepatology Unit, Università Cattolica - Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Tommaso M Manzia
- Hepatobiliary and Transplant Surgery Unit, Tor Vergata University, Rome, Italy
| | - Giuseppe Tisone
- Hepatobiliary and Transplant Surgery Unit, Tor Vergata University, Rome, Italy
| | - Salvatore Agnes
- General Surgery and Liver Transplant Unit, Università Cattolica - Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Massimo Rossi
- General Surgery and Organ Transplantation Unit, Sapienza University, Rome, Italy
| | - Fabrizio Di Benedetto
- Hepato-biliopancreatic and Transplant Surgery Unit, University of Modena, Modena, Italy
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Morelli MC, Rendina M, La Manna G, Alessandria C, Pasulo L, Lenci I, Bhoori S, Messa P, Biancone L, Gesualdo L, Russo FP, Petta S, Burra P. Position paper on liver and kidney diseases from the Italian Association for the Study of Liver (AISF), in collaboration with the Italian Society of Nephrology (SIN). Dig Liver Dis 2021; 53 Suppl 2:S49-S86. [PMID: 34074490 DOI: 10.1016/j.dld.2021.03.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 02/07/2023]
Abstract
Liver and kidney are strictly connected in a reciprocal manner, in both the physiological and pathological condition. The Italian Association for the Study of Liver, in collaboration with the Italian Society of Nephrology, with this position paper aims to provide an up-to-date overview on the principal relationships between these two important organs. A panel of well-recognized international expert hepatologists and nephrologists identified five relevant topics: 1) The diagnosis of kidney damage in patients with chronic liver disease; 2) Acute kidney injury in liver cirrhosis; 3) Association between chronic liver disease and chronic kidney disease; 4) Kidney damage according to different etiology of liver disease; 5) Polycystic kidney and liver disease. The discussion process started with a review of the literature relating to each of the five major topics and clinical questions and related statements were subsequently formulated. The quality of evidence and strength of recommendations were graded according to the GRADE system. The statements presented here highlight the importance of strong collaboration between hepatologists and nephrologists for the management of critically ill patients, such as those with combined liver and kidney impairment.
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Affiliation(s)
- Maria Cristina Morelli
- Internal Medicine Unit for the treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di S.Orsola, Bologna, Italy, Via Albertoni 15, 40138, Bologna, Italy
| | - Maria Rendina
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Policlinic Hospital, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Carlo Alessandria
- Division of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital, University of Torino, Corso Bramante 88, 10126, Torino, Italy
| | - Luisa Pasulo
- Gastroenterology and Transplant Hepatology, "Papa Giovanni XXIII" Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Ilaria Lenci
- Department of Internal Medicine, Hepatology Unit, Tor Vergata University, Rome Viale Oxford 81, 00133, Rome, Italy
| | - Sherrie Bhoori
- Hepatology and Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS, Istituto Nazionale Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Piergiorgio Messa
- Unit of Nephrology, Università degli Studi di Milano, Via Commenda 15, 20122, Milano, Italy; Nephrology, Dialysis and Renal Transplant Unit-Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via Commenda 15, 20122 Milano, Italy
| | - Luigi Biancone
- Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e della Scienza Hospital, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Loreto Gesualdo
- Nephrology Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, Università degli Studi di Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Francesco Paolo Russo
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Salvatore Petta
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Piazza delle Cliniche, 2 90127, Palermo, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy.
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30
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Signorello A, Lenci I, Milana M, Grassi G, Baiocchi L. COVID-19 in normal, diseased and transplanted liver. World J Gastroenterol 2021; 27:2576-2585. [PMID: 34092976 PMCID: PMC8160629 DOI: 10.3748/wjg.v27.i20.2576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/18/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
Starting from December 2019 the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has extended in the entire world giving origin to a pandemic. Although the respiratory system is the main apparatus involved by the infection, several other organs may suffer coronavirus disease 2019 (COVID-19)-related injuries. The human tissues expressing angiotensin-converting enzyme 2 (ACE2) are all possible targets of viral damage. In fact myocarditis, meningo-encephalitis, acute kidney injury and other complications have been described with regard to SARS-CoV-2 infection. The liver has a central role in the body homeostasis contributing to detoxification, catabolism and also synthesis of important factor such as plasma proteins. ACE2 is significantly expressed just by cholangiocytes within the liver, however transaminases are increased in more than one third of COVID-19 patients, at hospital admission. The reasons for liver impairment in the course of this infection are not completely clear at present and multiple factors such as: Direct viral effect, release of cytokines, ischemic damage, use of hepatotoxic drugs, sepsis, and others, may contribute to damage. While COVID-19 seems to elicit just a transient alteration of liver function tests in subjects with normal hepatic function, of concern, more severe sequelae are frequently observed in patients with a reduced hepatic reserve. In this review we report data regarding SARS-CoV-2 infection in subjects with normal or diseased liver. In addition the risks of COVID-19 in immunosuppressed patients (either transplanted or suffering for autoimmune liver diseases) are also described.
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Affiliation(s)
- Alessandro Signorello
- Hepatology Unit, Department of Medicine, University of Tor Vergata, Rome 00133, Italy
| | - Ilaria Lenci
- Hepatology Unit, Department of Medicine, University of Tor Vergata, Rome 00133, Italy
| | - Martina Milana
- Hepatology Unit, Department of Medicine, University of Tor Vergata, Rome 00133, Italy
| | - Giuseppe Grassi
- Hepatology Unit, Department of Medicine, University of Tor Vergata, Rome 00133, Italy
| | - Leonardo Baiocchi
- Hepatology Unit, Department of Medicine, University of Tor Vergata, Rome 00133, Italy
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Alkhatib M, Di Maio VC, De Murtas V, Polilli E, Milana M, Teti E, Fiorentino G, Calvaruso V, Barbaliscia S, Bertoli A, Scutari R, Carioti L, Cento V, Santoro MM, Orro A, Maida I, Lenci I, Sarmati L, Craxì A, Pasquazzi C, Parruti G, Babudieri S, Milanesi L, Andreoni M, Angelico M, Perno CF, Ceccherini-Silberstein F, Svicher V, Salpini R. Genetic Determinants in a Critical Domain of NS5A Correlate with Hepatocellular Carcinoma in Cirrhotic Patients Infected with HCV Genotype 1b. Viruses 2021; 13:v13050743. [PMID: 33922732 PMCID: PMC8146897 DOI: 10.3390/v13050743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 12/05/2022] Open
Abstract
HCV is an important cause of hepatocellular carcinoma (HCC). HCV NS5A domain-1 interacts with cellular proteins inducing pro-oncogenic pathways. Thus, we explore genetic variations in NS5A domain-1 and their association with HCC, by analyzing 188 NS5A sequences from HCV genotype-1b infected DAA-naïve cirrhotic patients: 34 with HCC and 154 without HCC. Specific NS5A mutations significantly correlate with HCC: S3T (8.8% vs. 1.3%, p = 0.01), T122M (8.8% vs. 0.0%, p < 0.001), M133I (20.6% vs. 3.9%, p < 0.001), and Q181E (11.8% vs. 0.6%, p < 0.001). By multivariable analysis, the presence of ≥1 of them independently correlates with HCC (OR (95%CI): 21.8 (5.7–82.3); p < 0.001). Focusing on HCC-group, the presence of these mutations correlates with higher viremia (median (IQR): 5.7 (5.4–6.2) log IU/mL vs. 5.3 (4.4–5.6) log IU/mL, p = 0.02) and lower ALT (35 (30–71) vs. 83 (48–108) U/L, p = 0.004), suggesting a role in enhancing viral fitness without affecting necroinflammation. Notably, these mutations reside in NS5A regions known to interact with cellular proteins crucial for cell-cycle regulation (p53, p85-PIK3, and β-catenin), and introduce additional phosphorylation sites, a phenomenon known to ameliorate NS5A interaction with cellular proteins. Overall, these results provide a focus for further investigations on molecular bases of HCV-mediated oncogenesis. The role of these NS5A domain-1 mutations in triggering pro-oncogenic stimuli that can persist also despite achievement of sustained virological response deserves further investigation.
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Affiliation(s)
- Mohammad Alkhatib
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; mohammad-- (M.A.); (V.C.D.M.); (S.B.); (A.B.); (R.S.); (L.C.); (M.M.S.); (F.C.-S.); (R.S.)
| | - Velia Chiara Di Maio
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; mohammad-- (M.A.); (V.C.D.M.); (S.B.); (A.B.); (R.S.); (L.C.); (M.M.S.); (F.C.-S.); (R.S.)
| | - Valentina De Murtas
- Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (V.D.M.); (I.M.); (S.B.)
| | - Ennio Polilli
- Infectious Diseases Unit, Pescara General Hospital, 65124 Pescara, Italy; (E.P.); (G.P.)
| | - Martina Milana
- Hepatology Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy; (M.M.); (I.L.); (M.A.)
| | - Elisabetta Teti
- Infectious Diseases Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy; (E.T.); (L.S.); (M.A.)
| | - Gianluca Fiorentino
- Infectious Diseases Unit, Sant’Andrea Hospital—“Sapienza” University, 00189 Rome, Italy; (G.F.); (C.P.)
| | - Vincenza Calvaruso
- Gastroenterology, “P. Giaccone” University Hospital, 90127 Palermo, Italy; (V.C.); (A.C.)
| | - Silvia Barbaliscia
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; mohammad-- (M.A.); (V.C.D.M.); (S.B.); (A.B.); (R.S.); (L.C.); (M.M.S.); (F.C.-S.); (R.S.)
| | - Ada Bertoli
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; mohammad-- (M.A.); (V.C.D.M.); (S.B.); (A.B.); (R.S.); (L.C.); (M.M.S.); (F.C.-S.); (R.S.)
- Laboratory of Clinical Microbiology and Virology, Polyclinic Tor Vergata Foundation, 00133 Rome, Italy
| | - Rossana Scutari
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; mohammad-- (M.A.); (V.C.D.M.); (S.B.); (A.B.); (R.S.); (L.C.); (M.M.S.); (F.C.-S.); (R.S.)
| | - Luca Carioti
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; mohammad-- (M.A.); (V.C.D.M.); (S.B.); (A.B.); (R.S.); (L.C.); (M.M.S.); (F.C.-S.); (R.S.)
| | - Valeria Cento
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Maria Mercedes Santoro
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; mohammad-- (M.A.); (V.C.D.M.); (S.B.); (A.B.); (R.S.); (L.C.); (M.M.S.); (F.C.-S.); (R.S.)
| | - Alessandro Orro
- ITB-CNR, Institute of Biomedical Technologies, National Research Council of Italy, 20090 Milan, Italy; (A.O.); (L.M.)
| | - Ivana Maida
- Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (V.D.M.); (I.M.); (S.B.)
| | - Ilaria Lenci
- Hepatology Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy; (M.M.); (I.L.); (M.A.)
| | - Loredana Sarmati
- Infectious Diseases Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy; (E.T.); (L.S.); (M.A.)
| | - Antonio Craxì
- Gastroenterology, “P. Giaccone” University Hospital, 90127 Palermo, Italy; (V.C.); (A.C.)
| | - Caterina Pasquazzi
- Infectious Diseases Unit, Sant’Andrea Hospital—“Sapienza” University, 00189 Rome, Italy; (G.F.); (C.P.)
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, 65124 Pescara, Italy; (E.P.); (G.P.)
| | - Sergio Babudieri
- Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (V.D.M.); (I.M.); (S.B.)
| | - Luciano Milanesi
- ITB-CNR, Institute of Biomedical Technologies, National Research Council of Italy, 20090 Milan, Italy; (A.O.); (L.M.)
| | - Massimo Andreoni
- Infectious Diseases Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy; (E.T.); (L.S.); (M.A.)
| | - Mario Angelico
- Hepatology Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy; (M.M.); (I.L.); (M.A.)
| | - Carlo Federico Perno
- Department of Diagnostic and Laboratory Medicine, IRCCS Bambino Gesu’, Pediatric Hospital, 60165 Rome, Italy;
| | - Francesca Ceccherini-Silberstein
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; mohammad-- (M.A.); (V.C.D.M.); (S.B.); (A.B.); (R.S.); (L.C.); (M.M.S.); (F.C.-S.); (R.S.)
| | - Valentina Svicher
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; mohammad-- (M.A.); (V.C.D.M.); (S.B.); (A.B.); (R.S.); (L.C.); (M.M.S.); (F.C.-S.); (R.S.)
- Correspondence: ; Tel.: +39-06-72596564
| | - Romina Salpini
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; mohammad-- (M.A.); (V.C.D.M.); (S.B.); (A.B.); (R.S.); (L.C.); (M.M.S.); (F.C.-S.); (R.S.)
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Baiocchi L, Sato K, Ekser B, Kennedy L, Francis H, Ceci L, Lenci I, Alvaro D, Franchitto A, Onori P, Gaudio E, Wu C, Chakraborty S, Glaser S, Alpini G. Cholangiocarcinoma: bridging the translational gap from preclinical to clinical development and implications for future therapy. Expert Opin Investig Drugs 2021; 30:365-375. [PMID: 33226854 PMCID: PMC8441992 DOI: 10.1080/13543784.2021.1854725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/19/2020] [Indexed: 12/17/2022]
Abstract
Introduction: Cholangiocarcinoma (CCA) is a devastating liver tumor with a poor prognosis. While less than 50% of the patients with CCA may benefit from surgical resection, the rest undergoes chemotherapy with disappointing results (mean survival <2 years). Alternative pharmacological treatments are needed to improve the outcomes in patients with CCA.Areas covered: In this review, we discuss CCA-related (1) experimental systems used in preclinical studies; (2) pharmacological targets identified by genetic analysis; (3) results obtained in preliminary trials in human with their pros and cons; and (4) possible targeting of endocrinal modulation. A PubMed bibliographic search matching the term 'cholangiocarcinoma' with 'experimental model', 'preclinical model', 'genetic target', 'targeted therapy', 'clinical trial', or 'translational research' was conducted and manuscripts published between 2010 and 2020 were retrieved for reading and reviewing.Expert opinion: Several factors contribute to the translational gap between bench research and clinical practice in CCA. The tumor heterogeneity, lack of a preclinical model recapitulating the different features of CCA, and difficult patient enrollment in clinical trials are elements to consider for basic and clinical research in CCA. Establishment of international networks formed by experts in the field of CCA may improve future research and its translational findings on patients.
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Affiliation(s)
- Leonardo Baiocchi
- Liver Unit, Department of Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Keisaku Sato
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN
| | - Burcin Ekser
- Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Lindsey Kennedy
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN
- Richard L. Roudebush VA Medical Center, Indianapolis, IN
| | - Heather Francis
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN
- Richard L. Roudebush VA Medical Center, Indianapolis, IN
| | - Ludovica Ceci
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN
| | - Ilaria Lenci
- Liver Unit, Department of Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Domenico Alvaro
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Antonio Franchitto
- Eleonora Lorillard Spencer Cenci Foundation, Rome, Italy
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Onori
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Eugenio Gaudio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Chaodong Wu
- Department of Nutrition, Texas A&M University, College Station, TX
| | | | - Shannon Glaser
- Department of Medical Physiology, Texas A&M University, Bryan, TX
| | - Gianfranco Alpini
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN
- Richard L. Roudebush VA Medical Center, Indianapolis, IN
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Wu N, Baiocchi L, Zhou T, Kennedy L, Ceci L, Meng F, Sato K, Wu C, Ekser B, Kyritsi K, Kundu D, Chen L, Meadows V, Franchitto A, Alvaro D, Onori P, Gaudio E, Lenci I, Francis H, Glaser S, Alpinis G. Functional Role of the Secretin/Secretin Receptor Signaling During Cholestatic Liver Injury. Hepatology 2020; 72:2219-2227. [PMID: 32737904 PMCID: PMC8957864 DOI: 10.1002/hep.31484] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022]
Abstract
The gastrointestinal peptide, secretin (Sct) is an important homeostatic regulator of pancreatic and liver secretory function. With regard to the liver, discoveries have been made, in the last decades, indicating a key role for the secretin/secretin receptor axis during normal or cholestatic conditions. Since large cholangiocytes are the only cells to express secretin receptor in the liver, research on secretin also expanded our knowledge on biliary epithelia. In this review we examined in detail the role of the secretin/secretin receptor axis, not only on biliary secretion, but also on cholangiocyte proliferation and senescence, as well as in prompting fibrotic processes involving biliary epithelia. Relevant data on human chronic cholestatic liver diseases, such as primary biliary cholangitis or primary sclerosing cholangitis, and obtained in animal models mimicking the diseases or in correlative studies on human are also reported. The aim of this review is to provide an update on the progress regarding the interactions between secretin and the biliary epithelia in normal and pathological conditions, underlining the aspects that suggests modulation of secretin pathway as a possible therapeutic approach for chronic cholestatic human liver disease.
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Affiliation(s)
- Nan Wu
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN
| | - Leonardo Baiocchi
- Liver Unit, Department of Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Tianhao Zhou
- Department of Medical Physiology, Texas A&M University, Bryan, TX
| | - Lindsey Kennedy
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN
| | - Ludovica Ceci
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN
| | - Fanyin Meng
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN,Richard L. Roudebush VA Medical Center, Indianapolis, IN
| | - Keisaku Sato
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN
| | - Chaodong Wu
- Department of Nutrition, Texas A&M University, College Station, TX
| | - Burcin Ekser
- Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Konstantina Kyritsi
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN
| | - Debjyoti Kundu
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN
| | - Lixian Chen
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN
| | - Vik Meadows
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN
| | | | - Domenico Alvaro
- Department of Internal Medicine and Medical Specialties and Sapienza University of Rome, Rome, Italy
| | - Paolo Onori
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Eugenio Gaudio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Ilaria Lenci
- Liver Unit, Department of Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Heather Francis
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN,Richard L. Roudebush VA Medical Center, Indianapolis, IN
| | - Shannon Glaser
- Department of Medical Physiology, Texas A&M University, Bryan, TX
| | - Gianfranco Alpinis
- Hepatology and Gastroenterology, Medicine, Indiana University, Indianapolis, IN,Richard L. Roudebush VA Medical Center, Indianapolis, IN
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Lenci I, Milana M, Grassi G, Signorello A, Aglitti A, Baiocchi L. Natremia and liver transplantation: The right amount of salt for a good recipe. World J Hepatol 2020; 12:919-930. [PMID: 33312419 PMCID: PMC7701977 DOI: 10.4254/wjh.v12.i11.919] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/19/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
An adequate balance between electrolytes and clear water is of paramount importance to maintaining physiologic homeostasis. Natremia imbalance and, in particular, hyponatremia is the most frequent electrolyte abnormality observed in hospitalized subjects, involving approximately one-fourth of them. Pathological changes occurring during liver cirrhosis predispose patients to an increased risk of sodium imbalance, and hypervolemic hyponatremia has been reported in nearly 50% of subjects with severe liver disease and ascites. Splanchnic vasodilatation, portal-systemic collaterals’ opening and increased excretion of vasoactive modulators are all factors impairing clear water handling during liver cirrhosis. Of concern, sodium imbalance has been consistently reported to be associated with increased risk of complications and reduced survival in liver disease patients. In the last decades clinical interest in sodium levels has been also extended in the field of liver transplantation. Evidence that [Na+] in blood is an independent risk factor for in-list mortality led to the incorporation of sodium value in prognostic scores employed for transplant priority, such as model for end-stage liver disease-Na and UKELD. On the other hand, severe hyponatremic cirrhotic patients are frequently delisted by transplant centers due to the elevated risk of mortality after grafting. In this review, we describe in detail the relationship between sodium imbalance and liver cirrhosis, focusing on its impact on peritransplant phases. The possible therapeutic approaches, in order to improve transplant outcome, are also discussed.
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Affiliation(s)
- Ilaria Lenci
- Department of Internal Medicine, Hepatology Unit, Tor Vergata University, Rome 00133, Italy
| | - Martina Milana
- Department of Internal Medicine, Hepatology Unit, Tor Vergata University, Rome 00133, Italy
| | - Giuseppe Grassi
- Department of Internal Medicine, Hepatology Unit, Tor Vergata University, Rome 00133, Italy
| | - Alessandro Signorello
- Department of Internal Medicine, Hepatology Unit, Tor Vergata University, Rome 00133, Italy
| | - Andrea Aglitti
- Department of Internal Medicine, Hepatology Unit, Tor Vergata University, Rome 00133, Italy
| | - Leonardo Baiocchi
- Department of Internal Medicine, Hepatology Unit, Tor Vergata University, Rome 00133, Italy
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Orlacchio A, Gasparrini F, Lenci I, Gagliardi MG, Spada M, Guazzaroni M, Ciccarese G, Angelico M. Transarterial chemoembolization for hepatocellular carcinoma in Fontan surgery patient. Radiol Case Rep 2020; 15:2602-2606. [PMID: 33088372 PMCID: PMC7557894 DOI: 10.1016/j.radcr.2020.09.056] [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: 08/18/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/17/2022] Open
Abstract
We describe the case of a 41‐year‐old woman who developed a liver neoplasm due to previous Fontan surgery for a single ventricle anomaly and pacemaker implantation. She was admitted to our hospital for moderate ascites and she was affected by hepatocellular carcinoma treated by trans-arterial chemoembolization (TACE). Computed tomography showed features of chronic liver disease and 4 cm hepatic nodules with arterial enhancement. Laboratory analyses documented preserved liver function and increased levels of alpha-fetoprotein. TACE was performed obtaining complete necrosis at 4 weeks of follow up and significant reduction of alpha-fetoprotein after 2 months. The patient is currently in follow-up, being evaluated for further treatments and/or combined liver/heart transplantation. TACE is a therapeutic option for the treatment of patients with unresectable HCC and with severe heart disease, like those submitted to FS.
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Affiliation(s)
- Antonio Orlacchio
- Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Rome, Italy
- Corresponding author.
| | - Fulvio Gasparrini
- Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Rome, Italy
| | - Ilaria Lenci
- Liver Unit, University Hospital Tor Vergata, Rome, Italy
| | - Maria Giulia Gagliardi
- Department of Cardiology, Division of Grow Up Congenital Heart, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marco Spada
- Department of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Manlio Guazzaroni
- Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Rome, Italy
| | - Giorgio Ciccarese
- Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Rome, Italy
| | - Mario Angelico
- Liver Unit, University Hospital Tor Vergata, Rome, Italy
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Lionetti R, Piccolo P, Lenci I, Siciliano M, Visco-Comandini U, De Santis A, Pompili M, Milana M, Taibi C, Dell'Isola S, Montalbano M, Mastroianni C, Begini P, Garbuglia AR, Angelico M, D'Offizi G. Daclatasvir, sofosbuvir with or without ribavirin for 24 weeks in hepatitis C genotype 3 cirrhosis: A real-life study. Ann Hepatol 2020; 18:434-438. [PMID: 31023614 DOI: 10.1016/j.aohep.2018.09.005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/02/2018] [Accepted: 09/05/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM Cirrhotic patients with hepatitis C virus genotype 3 infection show unsatisfactory outcomes after 12 weeks' treatment with direct antiviral agents. The National Italian Drug Agency allows 24 weeks of therapy in difficult-to-treat patients, including genotype 3 cirrhotics. Aim of this study was to evaluate efficacy and safety of a 24-week course of sofosbuvir plus daclatasvir±ribavirin in this population. MATERIALS AND METHODS 106 consecutive cirrhotics (70.8% males, mean age 55.3±7.6 years) in 8 tertiary hepatology centers received sofosbuvir plus daclatasvir for 24 weeks. Ribavirin was administered in 85 (80.2%) based expected tolerability, at a mean dose of 964±202mg/day. Baseline Child-Pugh class was A 91.5%, B 6.6%, C 1.9%; mean baseline MELD was 8.5±2.7. RESULTS All patients completed 12-week follow-up post-treatment, and 104 (98.1%) obtained sustained virological response (100% in ribavirin -treated patients vs. 90.4% without ribavirin; p=0.04). No worsening in renal and liver function was observed, no serious adverse events occurred. Two virological failures showed resistance associated variants (Y93H and S282T). CONCLUSION An extended 24-week treatment with sofosbuvir plus daclatasvir+ribavirin obtained 100% efficacy in genotype 3 hepatitis C cirrhosis, with very limited side effects. The role of ribavirin seems crucial in this setting and should be administered if clinically feasible.
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Affiliation(s)
- Raffaella Lionetti
- Liver and Infectious Diseases, Lazzaro Spallanzani National Institute for Infectious Disease, Rome, Italy.
| | - Paola Piccolo
- Internal Medicine Unit, Fatebenefratelli Hospital Isola Tiberina, Rome, Italy; Liver Unit, Tor Vergata University Hospital, Rome, Italy
| | - Ilaria Lenci
- Liver Unit, Tor Vergata University Hospital, Rome, Italy
| | - Massimo Siciliano
- Gastroenterology and Liver Unit, Policlinico Gemelli, Catholic University, Rome, Italy
| | - Ubaldo Visco-Comandini
- Liver and Infectious Diseases, Lazzaro Spallanzani National Institute for Infectious Disease, Rome, Italy
| | - Adriano De Santis
- Gastroenterology and Liver Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Maurizio Pompili
- Gastroenterology and Liver Unit, Policlinico Gemelli, Catholic University, Rome, Italy
| | - Martina Milana
- Liver Unit, Tor Vergata University Hospital, Rome, Italy
| | - Chiara Taibi
- Liver and Infectious Diseases, Lazzaro Spallanzani National Institute for Infectious Disease, Rome, Italy
| | - Serena Dell'Isola
- Medicina Protetta-Infectious Diseases, Belcolle Hospital, Viterbo, Italy
| | - Marzia Montalbano
- Liver and Infectious Diseases, Lazzaro Spallanzani National Institute for Infectious Disease, Rome, Italy
| | - Claudio Mastroianni
- Infectious Diseases, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Paola Begini
- Liver Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Anna Rosa Garbuglia
- Laboratory of Virology, Lazzaro Spallanzani National Institute for Infectious Disease, Rome, Italy
| | - Mario Angelico
- Liver Unit, Tor Vergata University Hospital, Rome, Italy
| | - Gianpiero D'Offizi
- Liver and Infectious Diseases, Lazzaro Spallanzani National Institute for Infectious Disease, Rome, Italy
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Glaser T, Baiocchi L, Zhou T, Francis H, Lenci I, Grassi G, Kennedy L, Liangpunsakul S, Glaser S, Alpini G, Meng F. Pro-inflammatory signalling and gut-liver axis in non-alcoholic and alcoholic steatohepatitis: Differences and similarities along the path. J Cell Mol Med 2020; 24:5955-5965. [PMID: 32314869 PMCID: PMC7294142 DOI: 10.1111/jcmm.15182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/25/2020] [Accepted: 03/01/2020] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) and alcohol-associated liver disease (ALD) represent a spectrum of injury, ranging from simple steatosis to steatohepatitis and cirrhosis. In humans, in fact, fatty changes in the liver, possibly leading to end-stage disease, were observed after chronic alcohol intake or in conditions of metabolic impairment. In this article, we examined the features and the pro-inflammatory pathways leading to non-alcoholic and alcoholic steatohepatitis. The involvement of several events (hits) and multiple inter-related pathways in the pathogenesis of these diseases suggest that a single therapeutic agent is unlikely to be an effective treatment strategy. Hence, a combination treatment towards multiple pro-inflammatory targets would eventually be required. Gut-liver crosstalk is involved not only in the impairment of lipid and glucose homoeostasis leading to steatogenesis, but also in the initiation of inflammation and fibrogenesis in both NAFLD and ALD. Modulation of the gut-liver axis has been suggested as a possible therapeutic approach since gut-derived components are likely to be involved in both the onset and the progression of liver damage. This review summarizes the translational mechanisms underlying pro-inflammatory signalling and gut-liver axis in non-alcoholic and alcoholic steatohepatitis. With a multitude of people being affected by liver diseases, identification of possible treatments and the elucidation of pathogenic mechanisms are elements of paramount importance.
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Affiliation(s)
- Trenton Glaser
- Texas A&M University College of MedicineCollege StationTXUSA
| | - Leonardo Baiocchi
- Liver UnitDepartment of MedicineUniversity of Rome Tor VergataRomeItaly
| | - Tianhao Zhou
- Department of Medical PhysiologyTexas A&M University College of MedicineBryanTXUSA
| | - Heather Francis
- Richard L. Roudebush VA Medical CenterIndianapolisINUSA
- Division of Gastroenterology and HepatologyDepartment of MedicineIndiana University School of MedicineIndianapolisINUSA
| | - Ilaria Lenci
- Liver UnitDepartment of MedicineUniversity of Rome Tor VergataRomeItaly
| | - Giuseppe Grassi
- Liver UnitDepartment of MedicineUniversity of Rome Tor VergataRomeItaly
| | | | - Suthat Liangpunsakul
- Richard L. Roudebush VA Medical CenterIndianapolisINUSA
- Division of Gastroenterology and HepatologyDepartment of MedicineIndiana University School of MedicineIndianapolisINUSA
| | - Shannon Glaser
- Department of Medical PhysiologyTexas A&M University College of MedicineBryanTXUSA
| | - Gianfranco Alpini
- Richard L. Roudebush VA Medical CenterIndianapolisINUSA
- Division of Gastroenterology and HepatologyDepartment of MedicineIndiana University School of MedicineIndianapolisINUSA
| | - Fanyin Meng
- Richard L. Roudebush VA Medical CenterIndianapolisINUSA
- Division of Gastroenterology and HepatologyDepartment of MedicineIndiana University School of MedicineIndianapolisINUSA
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Lenci I, Milana M, Grassi G, Manzia TM, Gazia C, Tisone G, Angelico R, Baiocchi L. Hepatitis B virus recurrence after liver transplantation: An old tale or a clear and present danger? World J Gastroenterol 2020; 26:2166-2176. [PMID: 32476783 PMCID: PMC7235198 DOI: 10.3748/wjg.v26.i18.2166] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/12/2020] [Accepted: 04/30/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) recurrence after liver transplantation (LT) has been described more than 50 years ago. Similarly, to other clinical conditions, in which impairment of host immune defense favors viral replication, early reports described in details recurrence and reactivation of HBV in liver transplant recipients. The evidence of a possible, severe, clinical evolution of HBV reappearance in a significant percentage of these patients, allowed to consider, for some years, HBV positivity a contraindication for LT. Moving from the old to the new millennium this picture has changed dramatically. Several studies contributed to establish efficient prophylactic protocols for HBV recurrence and with the advent of more potent anti-viral drugs an increased control of infection was achieved in transplanted patients as well as in the general immune-competent HBV population. Success obtained in the last decade led some authors to the conclusion that HBV is now to consider just as a “mere nuisance”. However, with regard to HBV and LT, outstanding issues are still on the table: (1) A standard HBV prophylaxis protocol after transplant has not yet been clearly defined; (2) The evidence of HBV resistant strains to the most potent antiviral agents is claiming for a new generation of drugs; and (3) The possibility of prophylaxis withdrawal in some patients has been demonstrated, but reliable methods for their selection are still lacking. The evolution of LT for HBV is examined in detail in this review together with the description of the strategies adopted to prevent HBV recurrence and their pros and cons.
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Affiliation(s)
- Ilaria Lenci
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome 00133, Italy
| | - Martina Milana
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome 00133, Italy
| | - Giuseppe Grassi
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome 00133, Italy
| | - Tommaso M Manzia
- Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Carlo Gazia
- Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Giuseppe Tisone
- Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Roberta Angelico
- Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Leonardo Baiocchi
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome 00133, Italy
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Santopaolo F, Lenci I, Bosa A, Angelico M, Milana M, Baiocchi L. Domino Liver Transplantation: Where are we Now? Rev Recent Clin Trials 2020; 14:183-188. [PMID: 30894112 DOI: 10.2174/1574887114666190320123824] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/04/2019] [Accepted: 03/15/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Domino transplant occurs when a recipient explanted graft is used for a second recipient. INTRODUCTION The first experience came from thoracic surgery by the observation that many patients during heart-lung transplantation actually showed a functional heart that could be employed in other subjects with a good result. RESULTS This concept was then extended to the field of liver transplantation. At present, some patients transplanted for an inborn metabolic disease may be considered as excellent domino liver donors. CONCLUSION The results, limitations, clinical challenges and the donor and recipient features of domino liver transplantation are discussed in this manuscript.
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Affiliation(s)
- Francesco Santopaolo
- Unita Operativa di Epatologia, Policlinico Universitario di "Tor Vergata"; Viale Oxford 81, 00133 Rome, Italy
| | - Ilaria Lenci
- Unita Operativa di Epatologia, Policlinico Universitario di "Tor Vergata"; Viale Oxford 81, 00133 Rome, Italy
| | - Alessandra Bosa
- Unita Operativa di Epatologia, Policlinico Universitario di "Tor Vergata"; Viale Oxford 81, 00133 Rome, Italy
| | - Mario Angelico
- Unita Operativa di Epatologia, Policlinico Universitario di "Tor Vergata"; Viale Oxford 81, 00133 Rome, Italy
| | - Martina Milana
- Unita Operativa di Epatologia, Policlinico Universitario di "Tor Vergata"; Viale Oxford 81, 00133 Rome, Italy
| | - Leonardo Baiocchi
- Unita Operativa di Epatologia, Policlinico Universitario di "Tor Vergata"; Viale Oxford 81, 00133 Rome, Italy
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40
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Aragri M, Milana M, Di Maio VC, Lenci I, Carioti L, Perno CF, Svicher V, Angelico M, Ceccherini-Silberstein F. Successful ongoing retreatment with glecaprevir/pibrentasvir + sofosbuvir + ribavirin in a patient with HCV genotype 3 who failed glecaprevir/pibrentasvir with both NS3 and NS5A resistance. Clin Microbiol Infect 2020; 26:1266-1268. [PMID: 32240711 DOI: 10.1016/j.cmi.2020.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 01/26/2023]
Affiliation(s)
- M Aragri
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - M Milana
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - V C Di Maio
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - I Lenci
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - L Carioti
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - C F Perno
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
| | - V Svicher
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - M Angelico
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
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Fiume D, Lenci I, Milana M, Manzia TM, Massoud R, Tariciotti L, Russo C, Toti L, Baiocchi L. Serum Levels of Granulocyte-Macrophage-colony-stimulating Factor and Stem-cell Factor During Liver Regeneration after Partial Hepatectomy in Humans. Rev Recent Clin Trials 2020; 15:131-136. [PMID: 31971114 DOI: 10.2174/1574887115666200123113623] [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: 10/23/2019] [Revised: 01/01/2020] [Accepted: 01/03/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Multiple biological functions have been recognized regarding Granulocyte Macrophage-Colony Stimulating Factor (GM-CSF) and Stem Cell Factor (SCF). AIM To evaluate the serum changes of GM-CSF and SCF in patients undergoing surgical resection for liver tumor, in the regenerative phase after surgery in order to identify the possible relationship with the patient, tumor or surgical variables. METHODS Thirty-two consecutive patients (50% male, median age 66), undergoing hepatic resection of liver neoplasm, were evaluated. The liver tumor was Hepatocellular Carcinoma (HCC) in 44% of cases. Other tumors were cholangiocarcinoma and metastasis. Serum levels of GM-CSF and SCF were assessed at baseline and 2 days, 7 days and 4 weeks after surgery. Personal and clinical patient data were also recorded. The statistical analysis was carried out using t-test for unpaired data or ANOVA (repeated measure) for continuous variables and Fisher test for discrete variables. RESULTS GM-CSF levels remained constant after surgery and were compared to baseline values. SCF levels, on the other hand, increased during the time, after surgery. The evaluation of SCF levels (fold increase) according to surgical, patient and tumor variables evidenced some differences. At day 7 and week 4, SCF levels were statistically increased: i) in patients undergoing a large resection in comparison with others (p<0.05); ii) in patients non-cirrhotic in comparison with cirrhotic ones (p=0.02) and finally; iii) in patients with non-HCC tumor in comparison with HCC ones (p=0.02). CONCLUSION During liver regeneration in humans, SCF serum levels are increased allowing to hypothesize a possible role of this chemokine during tissue growth and remodeling.
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Affiliation(s)
- Diego Fiume
- Department of Experimental Medicine Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Martina Milana
- Hepatology Unit, Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Tommaso M Manzia
- Unit of Transplant Surgery, Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Renato Massoud
- Department of Experimental Medicine Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Laura Tariciotti
- Unit of Transplant Surgery, Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Carmelo Russo
- Department of Experimental Medicine Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Luca Toti
- Hepatology Unit, Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Leonardo Baiocchi
- Hepatology Unit, Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
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Sorbo MC, Carioti L, Bellocchi MC, Antonucci F, Sforza D, Lenci I, Ciancio Manuelli M, Armenia D, De Leonardis F, Milana M, Manzia TM, Angelico M, Tisone G, Cento V, Perno CF, Ceccherini-Silberstein F. HCV resistance compartmentalization within tumoral and non-tumoral liver in transplanted patients with hepatocellular carcinoma. Liver Int 2019; 39:1986-1998. [PMID: 31172639 DOI: 10.1111/liv.14168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS We investigated the HCV-RNA amount, variability and prevalence of resistance-associated substitutions (RASs), in plasma, hepatic tumoral and non-tumoral tissue samples in patients undergoing liver-transplant/hepatic-resection (LT/HR), because of hepatocellular carcinoma and/or cirrhosis. METHODS Eighteen HCV-infected patients undergoing LT/HR, 94.0% naïve to direct-acting antivirals (DAAs), were analysed. HCV-RNA was quantified in all compartments. NS3/NS5A/NS5B in plasma and/or in tumoral/non-tumoral tissues were analysed using Sanger and Ultra-deep pyrosequencing (UDPS, 9/18 patients). RASs prevalence, genetic-variability and phylogenetic analysis were evaluated. RESULTS At the time of LT/HR, HCV-RNA was quantifiable in all compartments of DAA-naïve patients and was generally lower in tumoral than in non-tumoral tissues (median [IQR] = 4.0 [1.2-4.3] vs 4.3[3.1-4.9] LogIU/µg RNA; P = 0.193). The one patient treated with sofosbuvir + ribavirin represented an exception with HCV-RNA quantifiable exclusively in the liver, but with higher level in tumoral than in non-tumoral tissues (51 vs 7 IU/µg RNA). RASs compartmentalization was found by Sanger in 4/18 infected-patients, and by UDPS in other two patients. HCV-compartmentalization resulted to be associated with HBcAb-positivity (P = 0.013). UDPS showed approximately higher genetic-variability in NS3/NS5A sequences in all compartments. Phylogenetic-analysis showed defined and intermixed HCV-clusters among/within all compartments, and were strongly evident in the only non-cirrhotic patient, with plasma and non-tumoral sequences generally more closely related. CONCLUSIONS Hepatic compartments showed differences in HCV-RNA amount, RASs and genetic variability, with a higher segregation within the tumoral compartment. HBV coinfection influenced the HCV compartmentalization. These results highlight HCV-strain diversifications within the liver, which could explain some of the failures occurring even today in the era of DAAs.
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Affiliation(s)
- Maria C Sorbo
- Chair of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luca Carioti
- Chair of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Maria C Bellocchi
- Chair of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - FrancescoPaolo Antonucci
- Chair of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Sforza
- Hepatobiliary and Transplant Unit, Department of Surgery, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Department of Systems Medicine, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Matteo Ciancio Manuelli
- Hepatobiliary and Transplant Unit, Department of Surgery, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Daniele Armenia
- Chair of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesco De Leonardis
- Hepatology Unit, Department of Systems Medicine, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Martina Milana
- Hepatology Unit, Department of Systems Medicine, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Tommaso M Manzia
- Hepatobiliary and Transplant Unit, Department of Surgery, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Mario Angelico
- Hepatology Unit, Department of Systems Medicine, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Giuseppe Tisone
- Hepatobiliary and Transplant Unit, Department of Surgery, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Valeria Cento
- Chair of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carlo F Perno
- Chair of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
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Manzia TM, Angelico R, Gazia C, Lenci I, Milana M, Ademoyero OT, Pedini D, Toti L, Spada M, Tisone G, Baiocchi L. De novo malignancies after liver transplantation: The effect of immunosuppression-personal data and review of literature. World J Gastroenterol 2019; 25:5356-5375. [PMID: 31558879 PMCID: PMC6761240 DOI: 10.3748/wjg.v25.i35.5356] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/08/2019] [Accepted: 08/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Immunosuppression has undoubtedly raised the overall positive outcomes in the post-operative management of solid organ transplantation. However, long-term exposure to immunosuppression is associated with critical systemic morbidities. De novo malignancies following orthotopic liver transplants (OLTs) are a serious threat in pediatric and adult transplant individuals. Data from different experiences were reported and compared to assess the connection between immunosuppression and de novo malignancies in liver transplant patients.
AIM To study the role of immunosuppression on the incidence of de novo malignancies in liver transplant recipients.
METHODS A systematic literature examination about de novo malignancies and immunosuppression weaning in adult and pediatric OLT recipients was described in the present review. Worldwide data were collected from highly qualified institutions performing OLTs. Patient follow-up, immunosuppression discontinuation and incidence of de novo malignancies were reported. Likewise, the review assesses the differences in adult and pediatric recipients by describing the adopted immunosuppression regimens and the different type of diagnosed solid and blood malignancy.
RESULTS Emerging evidence suggests that the liver is an immunologically privileged organ able to support immunosuppression discontinuation in carefully selected recipients. Malignancies are often detected in liver transplant patients undergoing daily immunosuppression regimens. Post-transplant lymphoproliferative diseases and skin tumors are the most detected de novo malignancies in the pediatric and adult OLT population, respectively. To date, immunosuppression withdrawal has been achieved in up to 40% and 60% of well-selected adult and pediatric recipients, respectively. In both populations, a clear benefit of immunosuppression weaning protocols on de novo malignancies is difficult to ascertain because data have not been specified in most of the clinical experiences.
CONCLUSION The selected populations of tolerant pediatric and adult liver transplant recipients greatly benefit from immunosuppression weaning. There is still no strong clinical evidence on the usefulness of immunosuppression withdrawal in OLT recipients on malignancies. An interesting focus is represented by the complete reconstitution of the immunological pathways that could help in decreasing the incidence of de novo malignancies and may also help in treating liver transplant patients suffering from cancer.
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Affiliation(s)
- Tommaso Maria Manzia
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Roberta Angelico
- Division of Abdominal Transplantation and HPB Surgery, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Carlo Gazia
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC 27101, United States
| | - Ilaria Lenci
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome 00133, Italy
| | - Martina Milana
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome 00133, Italy
| | | | - Domiziana Pedini
- Division of Abdominal Transplantation and HPB Surgery, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Luca Toti
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Marco Spada
- Division of Abdominal Transplantation and HPB Surgery, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Giuseppe Tisone
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Leonardo Baiocchi
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome 00133, Italy
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Santopaolo F, Lenci I, Milana M, Manzia TM, Baiocchi L. Liver transplantation for hepatocellular carcinoma: Where do we stand? World J Gastroenterol 2019; 25:2591-2602. [PMID: 31210712 PMCID: PMC6558441 DOI: 10.3748/wjg.v25.i21.2591] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/09/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma represents an important cause of morbidity and mortality worldwide. It is the sixth most common cancer and the fourth leading cause of cancer death. Liver transplantation is a key tool for the treatment of this disease in human therefore hepatocellular carcinoma is increasing as primary indication for grafting. Although liver transplantation represents an outstanding therapy for hepatocellular carcinoma, due to organ shortage, the careful selection and management of patients who may have a major survival benefit after grafting remains a fundamental question. In fact, only some stages of the disease seem amenable of this therapeutic option, stimulating the debate on the appropriate criteria to select candidates. In this review we focused on current criteria to select patients with hepatocellular carcinoma for liver transplantation as well as on the strategies (bridging) to avoid disease progression and exclusion from grafting during the stay on wait list. The treatments used to bring patients within acceptable criteria (down-staging), when their tumor burden exceeds the standard criteria for transplant, are also reported. Finally, we examined tumor reappearance following liver transplantation. This occurrence is estimated to be approximately 8%-20% in different studies. The possible approaches to prevent this outcome after transplant are reported with the corresponding results.
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Affiliation(s)
- Francesco Santopaolo
- Hepatology Unit, Department of Medicine, Policlinico Universitario Tor Vergata, Rome 00133, Italy
| | - Ilaria Lenci
- Hepatology Unit, Department of Medicine, Policlinico Universitario Tor Vergata, Rome 00133, Italy
| | - Martina Milana
- Hepatology Unit, Department of Medicine, Policlinico Universitario Tor Vergata, Rome 00133, Italy
| | - Tommaso Maria Manzia
- Transplant Surgery Unit, Department of Surgery, Policlinico Universitario Tor Vergata, Rome 00133, Italy
| | - Leonardo Baiocchi
- Hepatology Unit, Department of Medicine, Policlinico Universitario Tor Vergata, Rome 00133, Italy
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Baiocchi L, Zhou T, Liangpunsakul S, Lenci I, Santopaolo F, Meng F, Kennedy L, Glaser S, Francis H, Alpini G. Dual Role of Bile Acids on the Biliary Epithelium: Friend or Foe? Int J Mol Sci 2019; 20:ijms20081869. [PMID: 31014010 PMCID: PMC6514722 DOI: 10.3390/ijms20081869] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/11/2019] [Accepted: 04/13/2019] [Indexed: 12/12/2022] Open
Abstract
Bile acids are a family of amphipathic compounds predominantly known for their role in solubilizing and absorbing hydrophobic compounds (including liposoluble vitamins) in the intestine. Bile acids also are key signaling molecules and inflammatory agents that activate transcriptional factors and cell signaling pathways that regulate lipid, glucose, and energy metabolism in various human disorders, including chronic liver diseases. However, in the last decade increased awareness has been founded on the physiological and chemical heterogeneity of this category of compounds and their possible beneficial or injurious effects on the biliary tree. In this review, we provide an update on the current understanding of the molecular mechanism involving bile acid and biliary epithelium. The last achievements of the research in this field are summarized, focusing on the molecular aspects and the elements with relevance regarding human liver diseases.
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Affiliation(s)
- Leonardo Baiocchi
- Liver Unit, Department of Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy.
| | - Tianhao Zhou
- Department of Medical Physiology, Texas A&M University, College of Medicine 702 SW HK Dodgen Loop, Temple, TX 76504, USA.
| | - Suthat Liangpunsakul
- Richard L. Roudebush VA Medical Center and Indiana University, Gastroenterology, Medicine 1481 W 10th street, Dedication Wing⁻Room C-7151, Indianapolis, IN 46202, USA.
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, 1481 W 10th street, Indianapolis, IN 46202, USA.
| | - Ilaria Lenci
- Liver Unit, Department of Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy.
| | - Francesco Santopaolo
- Liver Unit, Department of Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy.
| | - Fanyin Meng
- Richard L. Roudebush VA Medical Center and Indiana University, Gastroenterology, Medicine 1481 W 10th street, Dedication Wing⁻Room C-7151, Indianapolis, IN 46202, USA.
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, 1481 W 10th street, Indianapolis, IN 46202, USA.
| | - Lindsey Kennedy
- Richard L. Roudebush VA Medical Center and Indiana University, Gastroenterology, Medicine 1481 W 10th street, Dedication Wing⁻Room C-7151, Indianapolis, IN 46202, USA.
| | - Shannon Glaser
- Department of Medical Physiology, Texas A&M University, College of Medicine 702 SW HK Dodgen Loop, Temple, TX 76504, USA.
| | - Heather Francis
- Richard L. Roudebush VA Medical Center and Indiana University, Gastroenterology, Medicine 1481 W 10th street, Dedication Wing⁻Room C-7151, Indianapolis, IN 46202, USA.
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, 1481 W 10th street, Indianapolis, IN 46202, USA.
| | - Gianfranco Alpini
- Richard L. Roudebush VA Medical Center and Indiana University, Gastroenterology, Medicine 1481 W 10th street, Dedication Wing⁻Room C-7151, Indianapolis, IN 46202, USA.
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, 1481 W 10th street, Indianapolis, IN 46202, USA.
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Cucchiarelli S, Santopaolo F, Lamazza A, Lionetti R, Lenci I, Manzia TM, Angelico M, Milana M, Baiocchi L. Pitfalls in the reporting of upper endoscopy features in cirrhotic patients. Dig Liver Dis 2019; 51:382-385. [PMID: 30219669 DOI: 10.1016/j.dld.2018.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/08/2018] [Accepted: 08/10/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Upper endoscopy is the main tool for the accurate assessment of the risk of bleeding in cirrhotic patients. AIM To evaluate the diagnostic accuracy of upper endoscopy, in cirrhotic subjects, during common clinical practice. METHODS 120 endoscopic reports produced in different hospitals in our region were retrospectively and randomly selected. After a general evaluation, aimed at assessing the description of various endoscopic features, reports were evaluated by four expert endoscopists and four expert hepatologists. Experts were asked to fill in a questionnaire for each single endoscopic procedure, regarding the diagnostic accuracy of the report. RESULTS Endoscopic reports lacked descriptions of the size of esophageal varices and red signs in 14% and 29% of cases respectively. Presence (or absence) of gastric varices or portal hypertensive gastropathy were not reported in 62% and 34% of cases respectively. According to expert endoscopists 41% of the reports were incomplete, while, according to hepatologists, reports were incomplete and inadequate for clinical purposes in 36% of cases. CONCLUSION Our study clearly evidenced a significant lack of information in reports on upper endoscopy in cirrhotic patients, and supports the prompt adoption of corrective strategies.
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Affiliation(s)
| | | | | | - Raffaella Lionetti
- Infectious disease and Hepatology Unit, Lazzaro Spallanzani Hospital, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Tor Vergata University Hospital, Rome, Italy
| | | | - Mario Angelico
- Hepatology Unit, Tor Vergata University Hospital, Rome, Italy
| | - Martina Milana
- Hepatology Unit, Tor Vergata University Hospital, Rome, Italy
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47
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Manzia TM, Gazia C, Baiocchi L, Lenci I, Milana M, Santopaolo F, Angelico R, Tisone G. Clinical Operational Tolerance and Immunosuppression Minimization in Kidney Transplantation: Where Do We Stand? Rev Recent Clin Trials 2019; 14:189-202. [PMID: 30868959 DOI: 10.2174/1574887114666190313170205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/05/2019] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The 20th century represents a breakthrough in the transplantation era, since the first kidney transplantation between identical twins was performed. This was the first case of tolerance, since the recipient did not need immunosuppression. However, as transplantation became possible, an immunosuppression-free status became the ultimate goal, since the first tolerance case was a clear exception from the hard reality nowadays represented by rejection. METHODS A plethora of studies was described over the past decades to understand the molecular mechanisms responsible for rejection. This review focuses on the most relevant studies found in the literature where renal tolerance cases are claimed. Contrasting, and at the same time, encouraging outcomes are herein discussed and a glimpse on the main renal biomarkers analyzed in this field is provided. RESULTS The activation of the immune system has been shown to play a central role in organ failure, but also it seems to induce a tolerance status when an allograft is performed, despite tolerance is still rare to register. Although there are still overwhelming challenges to overcome and various immune pathways remain arcane; the immunosuppression minimization might be more attainable than previously believed. CONCLUSION . Multiple biomarkers and tolerance mechanisms suspected to be involved in renal transplantation have been investigated to understand their real role, with still no clear answers on the topic. Thus, the actual knowledge provided necessarily leads to more in-depth investigations, although many questions in the past have been answered, there are still many issues on renal tolerance that need to be addressed.
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Affiliation(s)
- Tommaso Maria Manzia
- Transplant and Hepatobiliary Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Gazia
- Transplant and Hepatobiliary Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
- Department of Surgery, Abdominal Organ Transplant Program, Wake Forest Baptist Medical Center, Winston Salem, NC, United States
- Wake Forest Institute for Regenerative Medicine, Department of Surgery, Winston-Salem, NC, United States
| | - Leonardo Baiocchi
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - Ilaria Lenci
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - Martina Milana
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | | | - Roberta Angelico
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giuseppe Tisone
- Transplant and Hepatobiliary Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
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Greco L, Chegai F, Pensabene MC, De Corato L, Pampana E, Lenci I, Garaci F, Floris R, Melis M. Early detection of hepatic encephalopathy after transjugular intrahepatic portsystemic shunt using multiparametric magnetic resonance with spectroscopy. Eur J Radiol Open 2019; 6:350-357. [PMID: 31886319 PMCID: PMC6909044 DOI: 10.1016/j.ejro.2019.09.002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 12/01/2022] Open
Abstract
Background Hepatic encephalopathy (HE) is a complication of transjugular intrahepatic portosystemic shunt (TIPS). Aims Extend the knowledge about the early detection of multiple brain metabolic abnormalities following TIPS; these abnormalities can be detected and managed prior to the clinical manifestation of HE with use of Multiparametric Magnetic Resonance with Spectroscopy. Methods 12 cirrhotic Patients underwent TIPS; each Patient underwent a 3 T MRI evaluation before and after TIPS. The spectroscopic images were processed measuring the values of the metabolites N-acetylaspartate (NAA) - Glutamine / Glutamate (Glx) - Colina (Cho) - Myinositol (mI) at the level of the nuclei of the base. Results Spectroscopic examination performed before the TIPS procedure showed low values of Cho and Mi, instead following the procedure: an increase in the Glx value, a mean reduction in the values of Cho and mI, a statistically significant reduction in the Cho / Creatine ratio, in the mI / Creatine ratio and an increase of the Glx / Creatine ratio. Conclusions Our study demonstrated the efficacy of spectroscopy in Patient subjected to TIPS. MR 3 T with spectroscopy can become a valid tool for monitor the dynamics of changes in brain metabolism after TIPS and to provide an early diagnosis of HE allowing an early treatment.
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Guarino M, Viganò L, Ponziani FR, Giannini EG, Lai Q, Morisco F, Russo FP, Cillo U, Burra P, Mescoli C, Gambato M, Sessa A, Cabibbo G, Viganò M, Galati G, Villa E, Iavarone M, Brancaccio G, Rendina M, Lupo LG, Losito F, Fucilli F, Persico M, D’Ambrosio R, Sangiovanni A, Cucchetti A, Trevisani e Matteo Renzulli F, Miele L, Grieco A, Lodovico Rapaccini G, Pompili M, Gasbarrini A, Battista Levi Sandri G, Melandro F, Rossi M, Lenci I, Manzia TM, Tortora R, Di Costanzo GG, Sacco R, Ghinolfi D, Rreka E, Carrai P, Simonetti N, Sposito C, Bhoori S, di Sandro S, Foschi FG, Casadei Gardini A, Nicolini D, Mazzocato S, Kostandini A, Violi P, Baccarani U, Pravisani R, Vincenzi V. Recurrence of hepatocellular carcinoma after direct acting antiviral treatment for hepatitis C virus infection: Literature review and risk analysis. Dig Liver Dis 2018; 50:1105-1114. [PMID: 30170908 DOI: 10.1016/j.dld.2018.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023]
Abstract
Although studies suggest decreased incident hepatocellular carcinoma (HCC) after treatment with direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection, data are conflicting regarding risk and aggressiveness of recurrence in patients who have a history of treated HCC. This review analyses data available in literature in order to elucidate the impact of DAAs on the risk of HCC recurrence after successful treatment of the tumor. Overall 24 papers were identified. The available data cannot be considered definitive, but the initial alarmist data indicating an increased risk of recurrence have not been confirmed by most subsequent studies. The suggested aggressive pattern (rapid growth and vascular invasion) of tumor recurrence after DAAs still remains to be confirmed. Several limitations of the available studies were highlighted, and should drive future researches. The time-to-recurrence should be computed since the last HCC treatment and results stratified for cirrhosis and sustained viral response. Any comparison with historical series is of limited interest because of a number of biases affecting these studies and differences between enrolled patients. Prospective intention-to-treat analyses will be probably the best contribution to drive clinical practice, provided that a randomized trial can be difficult to design.
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Affiliation(s)
- Maria Guarino
- Dept. of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", Naples, Italy
| | - Luca Viganò
- Dept. of Surgery, Division of Hepatobiliary and General Surgery, Humanitas Clinical and Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Francesca Romana Ponziani
- Division of Internal Medicine, Gastroenterology and Hepatology Unit, Polyclinic Foundation "Agostino Gemelli", IRCCS, Catholic University of Rome, Rome, Italy.
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Polyclinic Hospital "San Martino", Genoa, Italy.
| | - Quirino Lai
- Hepato-bilio-pancreatic and Liver Transplant Unit, Dept. of Surgery, Sapienza University of Rome, Rome, Italy
| | - Filomena Morisco
- Dept. of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", Naples, Italy
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50
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Colagrossi L, Salpini R, Scutari R, Carioti L, Battisti A, Piermatteo L, Bertoli A, Fabeni L, Minichini C, Trimoulet P, Fleury H, Nebuloso E, De Cristofaro M, Cappiello G, Spanò A, Malagnino V, Mari T, Barlattani A, Iapadre N, Lichtner M, Mastroianni C, Lenci I, Pasquazzi C, De Sanctis GM, Galeota Lanza A, Stanzione M, Stornaiuolo G, Marignani M, Sarmati L, Andreoni M, Angelico M, Ceccherini-Silberstein F, Perno CF, Coppola N, Svicher V. HDV Can Constrain HBV Genetic Evolution in HBsAg: Implications for the Identification of Innovative Pharmacological Targets. Viruses 2018; 10:v10070363. [PMID: 29987240 PMCID: PMC6071122 DOI: 10.3390/v10070363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 02/07/2023] Open
Abstract
Chronic HBV + HDV infection is associated with greater risk of liver fibrosis, earlier hepatic decompensation, and liver cirrhosis hepatocellular carcinoma compared to HBV mono-infection. However, to-date no direct anti-HDV drugs are available in clinical practice. Here, we identified conserved and variable regions in HBsAg and HDAg domains in HBV + HDV infection, a critical finding for the design of innovative therapeutic agents. The extent of amino-acid variability was measured by Shannon-Entropy (Sn) in HBsAg genotype-d sequences from 31 HBV + HDV infected and 62 HBV mono-infected patients (comparable for demographics and virological-parameters), and in 47 HDAg genotype-1 sequences. Positions with Sn = 0 were defined as conserved. The percentage of conserved HBsAg-positions was significantly higher in HBV + HDV infection than HBV mono-infection (p = 0.001). Results were confirmed after stratification for HBeAg-status and patients’ age. A Sn = 0 at specific positions in the C-terminus HBsAg were correlated with higher HDV-RNA, suggesting that conservation of these positions can preserve HDV-fitness. Conversely, HDAg was characterized by a lower percentage of conserved-residues than HBsAg (p < 0.001), indicating higher functional plasticity. Furthermore, specific HDAg-mutations were significantly correlated with higher HDV-RNA, suggesting a role in conferring HDV replicative-advantage. Among HDAg-domains, only the virus-assembly signal exhibited a high genetic conservation (75% of conserved-residues). In conclusion, HDV can constrain HBsAg genetic evolution to preserve its fitness. The identification of conserved regions in HDAg poses the basis for designing innovative targets against HDV-infection.
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Affiliation(s)
- Luna Colagrossi
- Department of Experimental Medicine and Surgery, Tor Vergata University, 00133 Rome, Italy.
| | - Romina Salpini
- Department of Experimental Medicine and Surgery, Tor Vergata University, 00133 Rome, Italy.
| | - Rossana Scutari
- Department of Experimental Medicine and Surgery, Tor Vergata University, 00133 Rome, Italy.
| | - Luca Carioti
- Department of Experimental Medicine and Surgery, Tor Vergata University, 00133 Rome, Italy.
| | - Arianna Battisti
- Department of Experimental Medicine and Surgery, Tor Vergata University, 00133 Rome, Italy.
| | - Lorenzo Piermatteo
- Department of Experimental Medicine and Surgery, Tor Vergata University, 00133 Rome, Italy.
| | - Ada Bertoli
- Department of Experimental Medicine and Surgery, Tor Vergata University, 00133 Rome, Italy.
| | - Lavinia Fabeni
- Department of Experimental Medicine and Surgery, Tor Vergata University, 00133 Rome, Italy.
| | - Carmine Minichini
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania L. Vanvitelli, 81100 Naples, Italy.
| | - Pascale Trimoulet
- Laboratoire de Virologie, Hôpital Pellegrin tripode, 33076 Bordeaux, France.
| | - Hervé Fleury
- Laboratoire de Virologie, Hôpital Pellegrin tripode, 33076 Bordeaux, France.
| | - Elena Nebuloso
- Unit of Microbiology, Sandro Pertini Hospital, 00157 Rome, Italy.
| | | | | | - Alberto Spanò
- Unit of Microbiology, Sandro Pertini Hospital, 00157 Rome, Italy.
| | - Vincenzo Malagnino
- Infectious Diseases Unit, Tor Vergata University Hospital, 00133 Rome, Italy.
| | - Terenzio Mari
- Hepatology Unit, Nuovo Regina Margherita Hospital, 00153 Rome, Italy.
| | - Angelo Barlattani
- Hepatology Unit, Nuovo Regina Margherita Hospital, 00153 Rome, Italy.
| | - Nerio Iapadre
- Infectious Diseases Unit, San Salvatore Hospital, 67100 L'Aquila, Italy.
| | - Miriam Lichtner
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy.
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy.
| | - Ilaria Lenci
- Hepatology Unit, Tor Vergata University Hospital, 00133 Rome, Italy.
| | | | | | | | - Maria Stanzione
- Department of Internal Medicine, University of Campania L. Vanvitelli, Viral Unit, 81100 Naples, Italy.
| | - Gianfranca Stornaiuolo
- Department of Internal Medicine, University of Campania L. Vanvitelli, Viral Unit, 81100 Naples, Italy.
| | | | - Loredana Sarmati
- Infectious Diseases Unit, Tor Vergata University Hospital, 00133 Rome, Italy.
| | - Massimo Andreoni
- Infectious Diseases Unit, Tor Vergata University Hospital, 00133 Rome, Italy.
| | - Mario Angelico
- Hepatology Unit, Tor Vergata University Hospital, 00133 Rome, Italy.
| | | | - Carlo-Federico Perno
- Department of Experimental Medicine and Surgery, Tor Vergata University, 00133 Rome, Italy.
- Haematology and Oncohematology, University of Milan, 20122 Milan, Italy.
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania L. Vanvitelli, 81100 Naples, Italy.
| | - Valentina Svicher
- Department of Experimental Medicine and Surgery, Tor Vergata University, 00133 Rome, Italy.
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