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Cussa D, Pino A, Catalano S, Montini C, Assanti F, Peruzzi L, Pinon M, Calvo PL, Spada M, Patrono D, Gennari F, Otte JB, Salizzoni M, Romagnoli R. Long-term outcomes and health-related quality of life 20 years after pediatric liver transplantation. Updates Surg 2023; 75:1549-1557. [PMID: 37535192 PMCID: PMC10435421 DOI: 10.1007/s13304-023-01608-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
Pediatric liver transplantation is a challenging surgical procedure requiring complex post-transplant patient management. Liver transplantation in children should ensure long-term survival and good health-related quality of life (HR-QOL), but data in the literature are conflicting. With the aim of investigating survival and psychosocial outcomes of patients transplanted during childhood, we identified 40 patients with ≥ 20-year follow-up after liver transplantation regularly followed up at our Institution. Clinical charts were reviewed to retrieve patients' data. Psychosocial aspects and HR-QOL were investigated by an in-person or telephonic interview and by administering the WHOQOL-BREF questionnaire through an online form. Ten- and 20-year patient survival was 97.5% (95% CI 92.8-100%), whereas 10- and 20-year graft survival was 77.5% (65.6-91.6%) and 74.8% (62.5-89.6%), respectively. At last follow-up visit, 31 patients (77.5%) were receiving a tacrolimus-based immunosuppression. Twelve (32.4%) patients obtained a university diploma or higher, whereas 19 (51.4%) successfully completed high school. 81.1% of patients were active workers or in education, 17.5% had children, and 35% regularly practiced sport. 25 patients answered to the WHOQOL-BREF questionnaire. More than 60% of respondents did not report any disability and the perceived physical status was invariably good or very good. Median scores for physical health, psychological health, social relationships, and environment were 16.6, 14.7, 16, and 15, respectively. Pediatric liver transplantation is associated with excellent long-term survival and good HR-QOL. Psychological health and environment represent areas in which support would be needed to further improve HR-QOL.
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Affiliation(s)
- Davide Cussa
- General Surgery 2U-Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Ospedale Molinette, Corso Bramante 88-90, 10126, Turin, Italy
| | - Angelica Pino
- General Surgery 2U-Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Ospedale Molinette, Corso Bramante 88-90, 10126, Turin, Italy
| | - Silvia Catalano
- General Surgery 2U-Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Ospedale Molinette, Corso Bramante 88-90, 10126, Turin, Italy
| | - Chiara Montini
- General Surgery 2U-Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Ospedale Molinette, Corso Bramante 88-90, 10126, Turin, Italy
| | - Federico Assanti
- General Surgery 2U-Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Ospedale Molinette, Corso Bramante 88-90, 10126, Turin, Italy
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Ospedale Infantile Regina Margherita, Turin, Italy
| | - Michele Pinon
- Pediatric Gastroenterology Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Ospedale Infantile Regina Margherita, Turin, Italy
| | - Pier Luigi Calvo
- Pediatric Gastroenterology Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Ospedale Infantile Regina Margherita, Turin, Italy
| | - Marco Spada
- Department of Pediatrics, University of Turin, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Ospedale Infantile Regina Margherita, Turin, Italy
| | - Damiano Patrono
- General Surgery 2U-Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Ospedale Molinette, Corso Bramante 88-90, 10126, Turin, Italy
| | - Fabrizio Gennari
- Pediatric Surgery Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Ospedale Infantile Regina Margherita, Turin, Italy
| | - Jean-Bernard Otte
- Abdominal Transplantation Unit-Service de Chirurgie Digestive et Transplantation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Mauro Salizzoni
- General Surgery 2U-Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Ospedale Molinette, Corso Bramante 88-90, 10126, Turin, Italy
| | - Renato Romagnoli
- General Surgery 2U-Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Ospedale Molinette, Corso Bramante 88-90, 10126, Turin, Italy.
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2
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Patrono D, Cussa D, Sciannameo V, Montanari E, Panconesi R, Berchialla P, Lepore M, Gambella A, Rizza G, Catalano G, Mirabella S, Tandoi F, Lupo F, Balagna R, Salizzoni M, Romagnoli R. Outcome of liver transplantation with grafts from brain-dead donors treated with dual hypothermic oxygenated machine perfusion, with particular reference to elderly donors. Am J Transplant 2022; 22:1382-1395. [PMID: 35150050 PMCID: PMC9303789 DOI: 10.1111/ajt.16996] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 01/25/2023]
Abstract
Prompted by the utilization of extended criteria donors, dual hypothermic oxygenated machine perfusion (D-HOPE) was introduced in liver transplantation to improve preservation. When donors after neurological determination of death (DBD) are used, D-HOPE effect on graft outcomes is unclear. To assess D-HOPE value in this setting and to identify ideal scenarios for its use, data on primary adult liver transplant recipients from January 2014 to April 2021 were analyzed using inverse probability of treatment weighting, comparing outcomes of D-HOPE-treated grafts (n = 121) with those preserved by static cold storage (n = 723). End-ischemic D-HOPE was systematically applied since November 2017 based on donor and recipient characteristics and transplant logistics. D-HOPE use was associated with a significant reduction of early allograft failure (OR: 0.24; 0.83; p = .024), grade ≥3 complications (OR: 0.57; p = .046), comprehensive complication index (-7.20 points; p = .003), and improved patient and graft survival. These results were confirmed in the subset of elderly donors (>75-year-old). Although D-HOPE did not reduce the incidence of biliary complications, its use was associated with a reduced severity of ischemic cholangiopathy. In conclusion, D-HOPE improves postoperative outcomes and reduces early allograft loss in extended criteria DBD grafts.
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Affiliation(s)
- Damiano Patrono
- General Surgery 2U ‐ Liver Transplant UnitA.O.U. Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
| | - Davide Cussa
- General Surgery 2U ‐ Liver Transplant UnitA.O.U. Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
| | | | - Elena Montanari
- General Surgery 2U ‐ Liver Transplant UnitA.O.U. Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
| | - Rebecca Panconesi
- General Surgery 2U ‐ Liver Transplant UnitA.O.U. Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
| | - Paola Berchialla
- Department of Clinical and Biological SciencesUniversity of TurinTurinItaly
| | - Mirella Lepore
- General Surgery 2U ‐ Liver Transplant UnitA.O.U. Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
| | | | - Giorgia Rizza
- General Surgery 2U ‐ Liver Transplant UnitA.O.U. Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
| | - Giorgia Catalano
- General Surgery 2U ‐ Liver Transplant UnitA.O.U. Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
| | - Stefano Mirabella
- General Surgery 2U ‐ Liver Transplant UnitA.O.U. Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
| | - Francesco Tandoi
- General Surgery 2U ‐ Liver Transplant UnitA.O.U. Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
| | - Francesco Lupo
- General Surgery 2U ‐ Liver Transplant UnitA.O.U. Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
| | - Roberto Balagna
- Anesthesia Department 2A.O.U. Città della Salute e della Scienza di TorinoTurinItaly
| | - Mauro Salizzoni
- General Surgery 2U ‐ Liver Transplant UnitA.O.U. Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
| | - Renato Romagnoli
- General Surgery 2U ‐ Liver Transplant UnitA.O.U. Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
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3
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Brüggenwirth IMA, Werner MJM, Adam R, Polak WG, Karam V, Heneghan MA, Mehrabi A, Klempnauer JL, Paul A, Mirza DF, Pratschke J, Salizzoni M, Cherqui D, Allison M, Soubrane O, Staffa SJ, Zurakowski D, Porte RJ, de Meijer VE. The Liver Retransplantation Risk Score: a prognostic model for survival after adult liver retransplantation. Transpl Int 2021; 34:1928-1937. [PMID: 34160850 PMCID: PMC8518385 DOI: 10.1111/tri.13956] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/27/2021] [Accepted: 06/18/2021] [Indexed: 01/10/2023]
Abstract
High‐risk combinations of recipient and graft characteristics are poorly defined for liver retransplantation (reLT) in the current era. We aimed to develop a risk model for survival after reLT using data from the European Liver Transplantation Registry, followed by internal and external validation. From 2006 to 2016, 85 067 liver transplants were recorded, including 5581 reLTs (6.6%). The final model included seven predictors of graft survival: recipient age, model for end‐stage liver disease score, indication for reLT, recipient hospitalization, time between primary liver transplantation and reLT, donor age, and cold ischemia time. By assigning points to each variable in proportion to their hazard ratio, a simplified risk score was created ranging 0–10. Low‐risk (0–3), medium‐risk (4–5), and high‐risk (6–10) groups were identified with significantly different 5‐year survival rates ranging 56.9% (95% CI 52.8–60.7%), 46.3% (95% CI 41.1–51.4%), and 32.1% (95% CI 23.5–41.0%), respectively (P < 0.001). External validation showed that the expected survival rates were closely aligned with the observed mortality probabilities. The Retransplantation Risk Score identifies high‐risk combinations of recipient‐ and graft‐related factors prognostic for long‐term graft survival after reLT. This tool may serve as a guidance for clinical decision‐making on liver acceptance for reLT.
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Affiliation(s)
- Isabel M A Brüggenwirth
- Division of HPB Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maureen J M Werner
- Division of HPB Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - René Adam
- Centre Hépato-Biliaire, Inserm U935, Hôpital Universitaire Paul Brousse, Villejuif, France
| | - Wojciech G Polak
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent Karam
- Centre Hépato-Biliaire, Inserm U935, Hôpital Universitaire Paul Brousse, Villejuif, France
| | | | - Arianeb Mehrabi
- Department of General, Visceral and Transplant Surgery, Medical University Heidelberg, University Hospital, Heidelberg, Germany
| | - Jürgen L Klempnauer
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Andreas Paul
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany
| | - Darius F Mirza
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Johann Pratschke
- Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mauro Salizzoni
- General Surgery 2U - Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Daniel Cherqui
- Department of Surgery, Centre Hépato-Biliare, Inserm, Unit 1193, Paul-Brousse Hospital, Villejuif, France
| | - Michael Allison
- Liver Unit, Department of Medicine, Cambridge Biomedical Research Centre, Cambridge, UK
| | - Olivier Soubrane
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Robert J Porte
- Division of HPB Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Vincent E de Meijer
- Division of HPB Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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4
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Ribaldone DG, Imperatore N, Le Grazie M, Furfaro F, Balestrieri P, De Blasio F, Fagoonee S, Mosso E, Boano V, Reggio D, Sarli E, Castiglione F, Milla M, Vecchi M, Saracco GM, Salizzoni M, Romagnoli R, Fiorino G, Astegiano M. Inflammatory bowel disease course in liver transplant versus non-liver transplant patients for primary sclerosing cholangitis: LIVIBD, an IG-IBD study. Dig Liver Dis 2021; 53:712-716. [PMID: 32972831 DOI: 10.1016/j.dld.2020.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data regarding the effect of orthotopic liver transplantation (OLT) for primary sclerosing cholangitis (PSC) on inflammatory bowel disease (IBD) course are scarce and conflicting. AIMS To compare the incidence of refractory IBD in two groups (OLT and non-OLT) of patients affected by IBD and PSC. METHODS An observational, multicentre, cohort retrospective study was conducted by the Italian Group for the study of IBD in Italy. The primary outcome was the need for biologic therapy or bowel resection for medically refractory IBD or hospitalization due to IBD relapse during the follow-up. Secondary outcomes were rate of colonic dysplasia, colorectal cancer, other solid tumours, lymphoma. RESULTS Eighty-four patients were included in the study. The primary outcome was not different between OLT and non-OLT groups (11/27, 40.7%, versus 20/57, 35.1%, respectively, p = 0.62). The lymphoma and other tumours (thyroid cancer, kidney cancer, ileal tumour, ovarian cancer, cervical cancer) rates were significantly higher in the OLT group (p = 0.04 and p = 0.005, respectively), at the limit of statistical significance for high-grade colonic dysplasia (p = 0.06). CONCLUSION OLT in patients affected by IBD and PSC is not a risk factor for a more severe IBD course, but it is associated with a higher occurrence of cancer.
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Affiliation(s)
| | - Nicola Imperatore
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy; Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli, Naples, Italy
| | - Marco Le Grazie
- IBD Referral Center, Gastroenterology Department, Careggi University Hospital, Florence, Italy
| | - Federica Furfaro
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | | | - Federico De Blasio
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | - Sharmila Fagoonee
- Institute of Biostructure and Bioimaging (CNR), Molecular Biotechnology Center, Turin, Italy
| | - Elena Mosso
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | - Valentina Boano
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | - Dario Reggio
- General Surgery 2U, Liver Transplant Center, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Ennio Sarli
- Italian Group for the study of Inflammatory Bowel Disease IG-IBD, Florence, Italy
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Monica Milla
- IBD Referral Center, Gastroenterology Department, Careggi University Hospital, Florence, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Giorgio Maria Saracco
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | - Mauro Salizzoni
- General Surgery 2U, Liver Transplant Center, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Renato Romagnoli
- General Surgery 2U, Liver Transplant Center, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Gionata Fiorino
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marco Astegiano
- Department of General and Specialist Medicine, Gastroenterologia-U, Città della Salute e della Scienza di Torino, Turin, Italy
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- Italian Group for the study of Inflammatory Bowel Disease IG-IBD, Florence, Italy
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Tandoi F, Cussa D, Peruzzi L, Catalano S, Camilla R, Mandrile G, Calvo PL, Pinon M, Dell'Olio D, Salizzoni M, Amoroso A, Romagnoli R. Combined liver kidney transplantation for primary hyperoxaluria type 1: Will there still be a future? Current transplantation strategies and monocentric experience. Pediatr Transplant 2021; 25:e14003. [PMID: 33742750 DOI: 10.1111/petr.14003] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
Combined liver-kidney transplantation is a therapeutic option for children affected by type 1 primary hyperoxaluria. Persistently high plasma oxalate levels may lead to kidney graft failure. It is debated whether pre-emptive liver transplantation, followed by kidney transplantation, might be a better strategy to reduce kidney graft loss. Our experience of 6 pediatric combined liver-kidney transplants for primary hyperoxaluria type 1 in pediatric recipients was retrospectively analyzed. Plasma oxalate levels were monitored before and after transplantation. All the recipients were on hemodialysis at transplantation. Median [IQR] recipient's age at transplantation was 11 [1-14] years; in all cases, a compatible graft from a pediatric brain-dead donor aged 8 [2-16] years was used. In a median follow-up of 7 [2-19] years after combined liver-kidney transplantation, no child died and no liver graft failure was observed; three kidney grafts were lost, due to chronic rejection, primary non-function, and early renal oxalate accumulation. Liver and kidney graft survival remained stable at 1, 3, and 5 years, at 100% and 85%, respectively. Kidney graft loss was the major complication in our series. Risk is higher with very young, low-weight donors. The impact of treatment with glyoxalate pathway enzyme inhibitors treatment in children with advanced disease as well as of donor kidney preservation by ex vivo machine perfusion needs to be evaluated. At present, a case-by-case discussion is needed to establish an optimal treatment strategy.
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Affiliation(s)
- Francesco Tandoi
- General Surgery 2U and Liver Transplant Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Torino, Torino, Italy
| | - Davide Cussa
- General Surgery 2U and Liver Transplant Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Torino, Torino, Italy
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Department of Pediatrics, A.O.U. Città della Salute e della Scienza, Regina Margherita Children's Hospital, University of Torino, Torino, Italy
| | - Silvia Catalano
- General Surgery 2U and Liver Transplant Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Torino, Torino, Italy
| | - Roberta Camilla
- Pediatric Nephrology Unit, Department of Pediatrics, A.O.U. Città della Salute e della Scienza, Regina Margherita Children's Hospital, University of Torino, Torino, Italy
| | - Giorgia Mandrile
- Medical Genetics Unit, Thalassemia Centre, A.O.U. San Luigi, Orbassano, Italy
| | - Pier Luigi Calvo
- Pediatric Gastroenterology Unit, Department of Pediatrics, A.O.U. Città della Salute e della Scienza, Regina Margherita Children's Hospital, University of Torino, Torino, Italy
| | - Michele Pinon
- Pediatric Gastroenterology Unit, Department of Pediatrics, A.O.U. Città della Salute e della Scienza, Regina Margherita Children's Hospital, University of Torino, Torino, Italy
| | - Dominic Dell'Olio
- Regional Transplant Centre, A.O.U. Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Mauro Salizzoni
- General Surgery 2U and Liver Transplant Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Torino, Torino, Italy
| | - Antonio Amoroso
- Regional Transplant Centre, A.O.U. Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Renato Romagnoli
- General Surgery 2U and Liver Transplant Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Torino, Torino, Italy
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6
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Sanlorenzo M, Ribero S, Osella Abate S, Mariani S, Strignano P, Salizzoni M, Savoia P, Fierro MT, Quaglino P. Genetic mutations in primary malignant melanoma of the esophagus: case report and literature review. GIORN ITAL DERMAT V 2020. [PMID: 33295742 DOI: 10.23736/s0392-0488.16.05174-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The most frequent genetic aberrations in mucosal melanoma are activating mutations of c-KIT. Primary malignant melanomas of esophagus (PMME) are uncommon entities, with aggressive biological behavior and poor prognosis. The better definition of their genotype could improve therapeutic options. We report a case of a 66 years old man with a PMME in the lower third of the esophagus. Analysis of c-kit, KRAS, NRAS and BRAF genes resulted negative for mutations. On the basis of a computerized (PuMed/Medline) bibliography search we retrieved a total of other 35 cases of PMME analyzed for genetic alterations in RAS, BRAF, and KIT. When we compared mutations frequency of PMME with those of other mucosal melanomas, it appeared that PMME are characterized by a relative higher percentage of NRAS mutations. PMME seem to show a specific pattern of genetic alterations suggesting that they could represent a distinct entity among mucosal melanomas.
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Affiliation(s)
- Martina Sanlorenzo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy -
| | - Simone Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simona Osella Abate
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy.,Section of Surgical Pathology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Sara Mariani
- Section of Surgical Pathology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Strignano
- General Surgery and Liver Transplant Center, Città della Salute e della Scienza, Turin, Italy
| | - Mauro Salizzoni
- General Surgery and Liver Transplant Center, Città della Salute e della Scienza, Turin, Italy
| | - Paola Savoia
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maria T Fierro
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
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7
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Pommergaard HC, Rostved AA, Adam R, Rasmussen A, Salizzoni M, Bravo MAG, Cherqui D, De Simone P, Houssel-Debry P, Mazzaferro V, Soubrane O, García-Valdecasas JC, Prous JF, Pinna AD, O'Grady J, Karam V, Duvoux C, Thygesen LC. Mortality after Transplantation for Hepatocellular Carcinoma: A Study from the European Liver Transplant Registry. Liver Cancer 2020; 9:455-467. [PMID: 32999871 PMCID: PMC7506266 DOI: 10.1159/000507397] [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: 11/20/2019] [Accepted: 02/17/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIMS Prognosis after liver transplantation differs between hepatocellular carcinoma (HCC) arising in cirrhotic and non-cirrhotic livers and aetiology is poorly understood. The aim was to investigate differences in mortality after liver transplantation between these patients. METHODS We included patients from the European Liver Transplant Registry transplanted due to HCC from 1990 to November 2016 and compared cirrhotic and non-cirrhotic patients using propensity score (PS) calibration of Cox regression estimates to adjust for unmeasured confounding. RESULTS We included 22,787 patients, of whom 96.5% had cirrhosis. In the unadjusted analysis, non-cirrhotic patients had an increased risk of overall mortality with a hazard ratio (HR) of 1.37 (95% confidence interval [CI] 1.23-1.52). However, the HR approached unity with increasing adjustment and was 1.11 (95% CI 0.99-1.25) when adjusted for unmeasured confounding. Unadjusted, non-cirrhotic patients had an increased risk of HCC-specific mortality (HR 2.62, 95% CI 2.21-3.12). After adjustment for unmeasured confounding, the risk remained significantly increased (HR 1.62, 95% CI 1.31-2.00). CONCLUSIONS Using PS calibration, we showed that HCC in non-cirrhotic liver has similar overall mortality, but higher HCC-specific mortality. This may be a result of a more aggressive cancer form in the non-cirrhotic liver as higher mortality could not be explained by tumour characteristics or other prognostic variables.
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Affiliation(s)
- Hans-Christian Pommergaard
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,*Hans-Christian Pommergaard, Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK–2100 Copenhagen (Denmark),
| | - Andreas Arendtsen Rostved
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - René Adam
- Department of Hepatobiliary Surgery, Cancer, and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, France
| | - Allan Rasmussen
- Department of Hepatobiliary Surgery, Cancer, and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, France
| | - Mauro Salizzoni
- Liver Transplant Centre and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | | | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Cancer, and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, France
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School Hospital, Pisa, Italy
| | - Pauline Houssel-Debry
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Université de Rennes 1, and INSERM, UMR991, Foie, Métabolisme et Cancer, Université de Rennes 1, Rennes, France
| | - Vincenzo Mazzaferro
- University of Milan and Division of Gastrointestinal Surgery and Liver Transplantation, Istituto Nazionale Tumori, Fondazione IRCCS, Milan, Italy
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, University Denis Diderot, Paris, France
| | | | - Joan Fabregat Prous
- Unitat de Cirurgia Hepato-bilio-pancreàtica, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Antonio D. Pinna
- General Surgery and Transplant Division, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - John O'Grady
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Vincent Karam
- Department of Hepatobiliary Surgery, Cancer, and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, France
| | - Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Paris Est University, Créteil, France
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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8
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Germani G, Zeni N, Zanetto A, Adam R, Karam V, Belli LS, O'Grady J, Mirza D, Klempnauer J, Cherqui D, Pratschke J, Jamieson N, Salizzoni M, Hidalgo E, Lerut J, Paul A, Garcia-Valdecasas JC, Rodríguez FSJ, Villa E, Burra P. Influence of donor and recipient gender on liver transplantation outcomes in Europe. Liver Int 2020; 40:1961-1971. [PMID: 32418358 DOI: 10.1111/liv.14510] [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: 03/05/2020] [Revised: 04/21/2020] [Accepted: 05/06/2020] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS The impact of gender and donor/recipient gender mismatch on LT outcomes is controversial. The aim of this study was to compare outcomes of LT in Europe, using the ELTR database, between male and female recipients, including donor/recipient gender mismatch. METHODS Recipient, donor and transplant characteristics were compared between male and female patients. Patient survival was compared between groups, and the impact of donor/recipient gender matching as well as donor and recipient anthropometric characteristics were evaluated as potential risk factors for post-LT death/graft loss. RESULTS A total of 46,334 LT patients were evaluated (70.5% men and 29.5% women). Ten-year survival rate was significantly higher in female than in male recipients (66% vs 59%, P < .0001). At multivariate analysis, adjusted for indication to LT and type of graft, donor/recipient gender mismatch (HR 1.12, 95% CI 1.04-1.2; P = .003), donor age > 60 years (HR 1.09, 95% CI 1.01-1.18; P = .027) and recipient age (HR 1.02, 95% CI 1.1-1.02; P < .0001) were significantly associated with post-LT lower survival rate in men. Conversely in female recipients, donor BMI > 30 (HR 1.32, 95% CI 1.09-1.6; P = .005), donor age > 60 years (HR 1.15, 95% CI 1.01-1.32; P = .027) and recipient age (HR 1.02, 95% CI 1.01-1.02; P < .0001) were significantly associated with lower post-LT survival rate. CONCLUSIONS Donor/recipient gender mismatch in male recipients and the use of obese donor in female recipients are associated with reduced survival after LT. Therefore, the incorporation of donor and recipient anthropometric quantities in the allocation process should be a matter of further studies, as their matching can significantly influence long-term outcomes.
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Affiliation(s)
- Giacomo Germani
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Nicola Zeni
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Alberto Zanetto
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - René Adam
- ELTR, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Centre Hepato-Biliaire, Universite´Paris-Sud, Villejuif, France
| | - Vincent Karam
- ELTR, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Centre Hepato-Biliaire, Universite´Paris-Sud, Villejuif, France
| | - Luca S Belli
- Gastroenterology and Hepatology, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | | | | | | | | | | | | | - Jan Lerut
- Universitè Catholique Louvain, Brussels, Belgium
| | | | | | | | - Erica Villa
- Department of Gastroenterology, Policlinico of Modena University Hospital of Modena, Modena, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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9
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Mazza E, Strignano P, Fop F, Patrono D, Catalano G, Salizzoni M, Romagnoli R. Semimechanical anastomosis during oesophagectomy reduces leaks and stenosis: a propensity score matched analysis. Interact Cardiovasc Thorac Surg 2020; 31:182-190. [PMID: 32530036 DOI: 10.1093/icvts/ivaa065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/04/2020] [Accepted: 03/12/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Several techniques for oesophageal anastomosis during oesophagectomy have been described, all of which are associated with variable leakage and stricture rates. Given the notable morbidity of oesophageal fistula, reducing its incidence is of paramount importance. We report our single-centre experience with the semimechanical (SM) technique as compared to a totally manual (TM) technique. METHODS Three hundred and twelve partial and subtotal oesophagectomies performed between January 1998 and April 2018 were analysed. The series was split into a training period (January 1998-September 2015), when both TM and SM techniques were used, and a validation period (October 2015-April 2018), during which SM technique became standard practice. Propensity score matching was used to reduce confounding. RESULTS The training period included 212 oesophagectomies (90 TM, 122 SM); SM technique was initially used in the neck and afterwards also in the thorax, mainly with gastric conduits (92%), whereas the TM group contained a prevalence of jejunal loops (48%). SM anastomosis was associated with a significant reduction in both leak (0.8% vs 12%; P < 0.001) and stricture rate (0% vs 7%; P = 0.005). After propensity score matching, the difference in leak (0% vs 14%; P = 0.013) and stricture rate (0% vs 10%; P = 0.022) was confirmed. During the validation period, which included 100 oesophagectomies performed with SM anastomosis, 1 leak (1%) and 1 stricture (1%) were observed. CONCLUSIONS SM technique for oesophageal anastomosis outperforms TM technique and allows achieving very low complication rates.
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Affiliation(s)
- Elena Mazza
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Paolo Strignano
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Fabrizio Fop
- Renal Transplant Unit, Nephrology, Dialysis and Renal Transplant Division, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Damiano Patrono
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Giorgia Catalano
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Mauro Salizzoni
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Renato Romagnoli
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
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10
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Mazzaferro V, Citterio D, Bhoori S, Bongini M, Miceli R, De Carlis L, Colledan M, Salizzoni M, Romagnoli R, Antonelli B, Vivarelli M, Tisone G, Rossi M, Gruttadauria S, Di Sandro S, De Carlis R, Lucà MG, De Giorgio M, Mirabella S, Belli L, Fagiuoli S, Martini S, Iavarone M, Svegliati Baroni G, Angelico M, Ginanni Corradini S, Volpes R, Mariani L, Regalia E, Flores M, Droz Dit Busset M, Sposito C. Liver transplantation in hepatocellular carcinoma after tumour downstaging (XXL): a randomised, controlled, phase 2b/3 trial. Lancet Oncol 2020; 21:947-956. [PMID: 32615109 DOI: 10.1016/s1470-2045(20)30224-2] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/25/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Indications for liver transplantation for hepatocellular carcinoma are evolving and so-called expanded criteria remain debated. Locoregional therapies are able to downstage hepatocellular carcinoma from beyond to within the Milan criteria. We aimed to investigate the efficacy of liver transplantation after successful hepatocellular carcinoma downstaging. METHODS We did an open-label, multicentre, randomised, controlled trial designed in two phases, 2b and 3, at nine Italian tertiary care and transplantation centres. Patients aged 18-65 years with hepatocellular carcinoma beyond the Milan criteria, absence of macrovascular invasion or extrahepatic spread, 5-year estimated post-transplantation survival of at least 50%, and good liver function (Child-Pugh A-B7) were recruited and underwent tumour downstaging with locoregional, surgical, or systemic therapies according to multidisciplinary decision. After an observation period of 3 months, during which sorafenib was allowed, patients with partial or complete responses according to modified Response Evaluation Criteria in Solid Tumors were randomly assigned (1:1) by an interactive web-response system to liver transplantation or non-transplantation therapies (control group). A block randomisation (block size of 2), stratified by centre and compliance to sorafenib treatment, was applied. Liver transplantation was done with whole or split organs procured from brain-dead donors. The control group received sequences of locoregional and systemic treatment at the time of demonstrated tumour progression. The primary outcomes were 5-year tumour event-free survival for phase 2b and overall survival for phase 3. Analyses were by intention to treat. Organ allocation policy changed during the course of the study and restricted patient accrual to 4 years. This trial is registered with ClinicalTrials.gov, NCT01387503. FINDINGS Between March 1, 2011, and March 31, 2015, 74 patients were enrolled. Median duration of downstaging was 6 months (IQR 4-11). 29 patients dropped out before randomisation and 45 were randomly assigned: 23 to the transplantation group versus 22 to the control group. At data cutoff on July 31, 2019, median follow-up was 71 months (IQR 60-85). 5-year tumour event-free survival was 76·8% (95% CI 60·8-96·9) in the transplantation group versus 18·3% (7·1-47·0) in the control group (hazard ratio [HR] 0·20, 95% CI 0·07-0·57; p=0·003). 5-year overall survival was 77·5% (95% CI 61·9-97·1) in the transplantation group versus 31·2% (16·6-58·5) in the control group (HR 0·32, 95% CI 0·11-0·92; p=0·035). The most common registered grade 3-4 serious adverse events were hepatitis C virus recurrence (three [13%] of 23 patients) and acute transplant rejection (two [9%]) in the transplantation group, and post-embolisation syndrome (two [9%] of 22 patients) in the control group. Treatment-related deaths occurred in four patients: two (8%) of 23 patients in the transplantation group (myocardial infarction and multi-organ failure) versus two (9%) of 22 patients in the control group (liver decompensation). INTERPRETATION Although results must be interpreted with caution owing to the early closing of the trial, after effective and sustained downstaging of eligible hepatocellular carcinomas beyond the Milan criteria, liver transplantation improved tumour event-free survival and overall survival compared with non-transplantation therapies Post-downstaging tumour response could contribute to the expansion of hepatocellular carcinoma transplantation criteria. FUNDING Italian Ministry of Health.
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Affiliation(s)
- Vincenzo Mazzaferro
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy.
| | - Davide Citterio
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Sherrie Bhoori
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Marco Bongini
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Rosalba Miceli
- Clinical Epidemiology and Trial Organization, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Luciano De Carlis
- General Surgery and Abdominal Transplantation Unit, Hepatology, University of Milano-Bicocca andNiguarda-CàGranda Hospital, Milan, Italy
| | - Michele Colledan
- Department of Organ Failure and Transplantation, Gastroenterology, Hepatology and Liver Transplantation, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Mauro Salizzoni
- General Surgery 2U and Liver Transplantation Center, University of Turin, AOU Cittàdella Salute e della Scienza di Torino, Turin, Italy
| | - Renato Romagnoli
- General Surgery 2U and Liver Transplantation Center, University of Turin, AOU Cittàdella Salute e della Scienza di Torino, Turin, Italy
| | - Barbara Antonelli
- General and Liver Transplant Surgery Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Vivarelli
- Hepatobiliary and Abdominal Transplantation Surgery, Hepatology, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Giuseppe Tisone
- Department of Surgical Sciences and Medical Sciences University of Rome-Tor Vergata, Rome, Italy
| | - Massimo Rossi
- Department of General Surgery and Organ Transplantation, Sapienza University, Rome, Italy
| | - Salvatore Gruttadauria
- Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, ISMETT, Palermo, Italy
| | - Stefano Di Sandro
- General Surgery and Abdominal Transplantation Unit, Hepatology, University of Milano-Bicocca andNiguarda-CàGranda Hospital, Milan, Italy
| | - Riccardo De Carlis
- General Surgery and Abdominal Transplantation Unit, Hepatology, University of Milano-Bicocca andNiguarda-CàGranda Hospital, Milan, Italy
| | - Maria Grazia Lucà
- Department of Organ Failure and Transplantation, Gastroenterology, Hepatology and Liver Transplantation, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Massimo De Giorgio
- Department of Organ Failure and Transplantation, Gastroenterology, Hepatology and Liver Transplantation, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Mirabella
- General Surgery 2U and Liver Transplantation Center, University of Turin, AOU Cittàdella Salute e della Scienza di Torino, Turin, Italy
| | - Luca Belli
- General Surgery and Abdominal Transplantation Unit, Hepatology, University of Milano-Bicocca andNiguarda-CàGranda Hospital, Milan, Italy
| | - Stefano Fagiuoli
- Department of Organ Failure and Transplantation, Gastroenterology, Hepatology and Liver Transplantation, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Martini
- General Surgery 2U and Liver Transplantation Center, University of Turin, AOU Cittàdella Salute e della Scienza di Torino, Turin, Italy
| | - Massimo Iavarone
- Division of Gastroenterology and Hepatology, CRC A M and A Migliavacca Center for Liver Disease, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca Svegliati Baroni
- Hepatobiliary and Abdominal Transplantation Surgery, Hepatology, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Mario Angelico
- Department of Surgical Sciences and Medical Sciences University of Rome-Tor Vergata, Rome, Italy
| | | | - Riccardo Volpes
- Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, ISMETT, Palermo, Italy
| | - Luigi Mariani
- Clinical Epidemiology and Trial Organization, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Enrico Regalia
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Maria Flores
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Michele Droz Dit Busset
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Carlo Sposito
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
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11
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Angelico R, Trapani S, Spada M, Colledan M, de Ville de Goyet J, Salizzoni M, De Carlis L, Andorno E, Gruttadauria S, Ettorre GM, Cescon M, Rossi G, Risaliti A, Tisone G, Tedeschi U, Vivarelli M, Agnes S, De Simone P, Lupo LG, Di Benedetto F, Santaniello W, Zamboni F, Mazzaferro V, Rossi M, Puoti F, Camagni S, Grimaldi C, Gringeri E, Rizzato L, Nanni Costa A, Cillo U. A national mandatory-split liver policy: A report from the Italian experience. Am J Transplant 2019; 19:2029-2043. [PMID: 30748091 DOI: 10.1111/ajt.15300] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/13/2019] [Accepted: 01/26/2019] [Indexed: 01/25/2023]
Abstract
To implement split liver transplantation (SLT) a mandatory-split policy has been adopted in Italy since August 2015: donors aged 18-50 years at standard risk are offered for SLT, resulting in a left-lateral segment (LLS) graft for children and an extended-right graft (ERG) for adults. We aim to analyze the impact of the new mandatory-split policy on liver transplantation (LT)-waiting list and SLT outcomes, compared to old allocation policy. Between August 2015 and December 2016 out of 413 potentially "splittable" donors, 252 (61%) were proposed for SLT, of whom 53 (21%) donors were accepted for SLT whereas 101 (40.1%) were excluded because of donor characteristics and 98 (38.9%) for absence of suitable pediatric recipients. The SLT rate augmented from 6% to 8.4%. Children undergoing SLT increased from 49.3% to 65.8% (P = .009) and the pediatric LT-waiting list time dropped (229 [10-2121] vs 80 [12-2503] days [P = .045]). The pediatric (4.5% vs 2.5% [P = .398]) and adult (9.7% to 5.2% [P < .001]) LT-waiting list mortality reduced; SLT outcomes remained stable. Retransplantation (HR = 2.641, P = .035) and recipient weight >20 kg (HR = 5.113, P = .048) in LLS, and ischemic time >8 hours (HR = 2.475, P = .048) in ERG were identified as predictors of graft failure. A national mandatory-split policy maximizes the SLT donor resources, whose selection criteria can be safely expanded, providing favorable impact on the pediatric LT-waiting list and priority for adult sick LT candidates.
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Affiliation(s)
- Roberta Angelico
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Silvia Trapani
- Italian National Transplant Center, Italian National Institute of Health, Rome, Italy
| | - Marco Spada
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Michele Colledan
- Department of Organ Failure and Transplantation - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Jean de Ville de Goyet
- Department of Pediatrics for the Study of Abdominal Diseases and Abdominal Transplantation, ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), IRCCS -UPMC (University of Pittsburgh Medical Center), Palermo, Italy
| | - Mauro Salizzoni
- General Surgery 2U, Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Luciano De Carlis
- Division of General Surgery & Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Enzo Andorno
- Department of Hepatobiliarypancreatic Surgery and Liver Transplantation Unit, Ospedale San Martino, Genoa, Italy
| | - Salvatore Gruttadauria
- Department for the Study of Abdominal Diseases and Abdominal Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), University of Pittsburgh Medical Center, Palermo, Italy
| | | | - Matteo Cescon
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giorgio Rossi
- Division of General Surgery and Liver Transplantation, IRCCS Foundation, Ca' Granda Maggiore Hospital, University of Milan, Milan, Italy
| | | | - Giuseppe Tisone
- Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Umberto Tedeschi
- Liver Transplant Unit, Department of Surgical Science, University and Hospital Trust of Verona, Verona, Italy
| | - Marco Vivarelli
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Salvatore Agnes
- Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Foundation A. Gemelli Hospital, Rome, Italy
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Luigi Giovanni Lupo
- Sezione Chirurgia Generale e Trapianti di Fegato, Policlinico di Bari, Bari, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Walter Santaniello
- Unit of Hepatobiliary Surgery and Liver Transplant Center, Department of Gastroenterology and Transplantation, "A. Cardarelli" Hospital, Naples, Italy
| | - Fausto Zamboni
- Department of Surgery, General and Hepatic Transplantation Surgery Unit, A.O.B. Brotzu, Cagliari, Italy
| | - Vincenzo Mazzaferro
- Hepatology and Liver Transplantation Unit, Department of Surgery, University of Milan and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Massimo Rossi
- Department of General Surgery and Organ Transplantation, Umberto I Policlinic, Sapienza University, Rome, Italy
| | - Francesca Puoti
- Italian National Transplant Center, Italian National Institute of Health, Rome, Italy
| | - Stefania Camagni
- Department of Organ Failure and Transplantation - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Grimaldi
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Enrico Gringeri
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Padova, Padova, Italy
| | - Lucia Rizzato
- Italian National Transplant Center, Italian National Institute of Health, Rome, Italy
| | | | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Padova, Padova, Italy
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12
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Cantù P, Tarantino I, Baldan A, Mutignani M, Tringali A, Lombardi G, Cerofolini A, Di Sario A, Catalano G, Bertani H, Ghinolfi D, Boarino V, Masci E, Bulajic M, Pisani A, Fantin A, Ligresti D, Barresi L, Traina M, Ravelli P, Forti E, Barbaro F, Costamagna G, Rodella L, Maroni L, Salizzoni M, Conigliaro R, Filipponi F, Merighi A, Staiano T, Monteleone M, Mazzaferro V, Zucchi E, Zilli M, Nadal E, Rosa R, Santi G, Parzanese I, De Carlis L, Donato MF, Lampertico P, Maggi U, Caccamo L, Rossi G, Vecchi M, Penagini R. Endo-therapies for biliary duct-to-duct anastomotic stricture after liver transplantation: Outcomes of a nationwide survey. Liver Int 2019; 39:1355-1362. [PMID: 30500104 DOI: 10.1111/liv.14010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/03/2018] [Accepted: 11/14/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND The most appropriate endo-therapeutic approach to biliary anastomotic strictures is yet to be defined. AIM To retrospectively report on the endo-therapy of duct-to-duct anastomotic strictures during 2013 in Italy. METHODS Data were collected from 16 Endoscopy Units at the Italian Liver Transplantation Centers (BASALT study group). RESULTS Complete endo-therapy and follow-up data are available for 181 patients: 101 treated with plastic multistenting, 26 with fully covered self-expandable metal stenting and 54 with single stenting. Radiological success was achieved for 145 patients (80%), that is, 88% of plastic multistenting, 88% of self-expandable metal stenting and 61% of single stenting (P < 0.001 vs plastic multistenting; P < 0.05 vs self-expandable metal stenting). After first-line endo-therapy failure, the patients underwent a second-line endo-therapy with plastic multistenting for 25%, fully covered self-expandable metal stenting for 53% and single stenting for 22% of cases, and radiological success was achieved for 84%, that is, 100%, 85% and 63% with plastic multistenting, self-expandable metal stenting and single stenting (P < 0.05 vs plastic multistenting or self-expandable metal stenting) respectively. Procedure-related complications occurred in 7.8% of endoscopic retrograde cholangiopancreatographies. Overall, clinical success was achieved in 87% of patients after a median follow-up of 25 months. CONCLUSION Plastic multistenting is confirmed as the preferred first-line treatment, while fully covered self-expandable metal stenting as rescue option for biliary anastomotic strictures. Single stenting has sub-optimal results and should be abandoned.
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Affiliation(s)
- Paolo Cantù
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Anna Baldan
- Digestive Endoscopy Unit, Department of Gastroenterology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Massimiliano Mutignani
- Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Andrea Tringali
- Digestive Endoscopy Unit, Gemelli University Hospital, Catholic University, Rome, Italy
| | | | | | - Antonio Di Sario
- Department of Gastroenterology and Transplantation, Gastroenterology Clinic, Polytechnic Marche University - United Hospitals of Ancona, Ancona, Italy
| | - Giorgia Catalano
- Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - Helga Bertani
- U.O.C. Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy
| | - Davide Ghinolfi
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Oncology, Transplants and Advances in Medicine, University of Pisa Medical School Hospital, Pisa, Italy
| | - Valentina Boarino
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Enzo Masci
- Diagnostic and Therapeutic Endoscopy Unit, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Milutin Bulajic
- University Clinical Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Antonio Pisani
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Alberto Fantin
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, Azienda Ospedaliera - Università di Padova, Padova, Italy
| | - Dario Ligresti
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Luca Barresi
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Mario Traina
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Paolo Ravelli
- Digestive Endoscopy Unit, Department of Gastroenterology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Edoardo Forti
- Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Federico Barbaro
- Digestive Endoscopy Unit, Gemelli University Hospital, Catholic University, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Gemelli University Hospital, Catholic University, Rome, Italy
| | - Luca Rodella
- Emergency Endoscopy Unit, Borgo Trento Hospital, Verona, Italy
| | - Luca Maroni
- Department of Gastroenterology and Transplantation, Gastroenterology Clinic, Polytechnic Marche University - United Hospitals of Ancona, Ancona, Italy
| | - Mauro Salizzoni
- Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - Rita Conigliaro
- U.O.C. Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy
| | - Franco Filipponi
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Oncology, Transplants and Advances in Medicine, University of Pisa Medical School Hospital, Pisa, Italy
| | - Alberto Merighi
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Teresa Staiano
- Diagnostic and Therapeutic Endoscopy Unit, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michela Monteleone
- Liver Surgery, Transplantation and Gastroenterology, University of Milan and Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Vincenzo Mazzaferro
- Liver Surgery, Transplantation and Gastroenterology, University of Milan and Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elena Zucchi
- University Clinical Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Maurizio Zilli
- University Clinical Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Elena Nadal
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, Azienda Ospedaliera - Università di Padova, Padova, Italy
| | - Roberto Rosa
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi, Milan, Italy
| | - Giulio Santi
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi, Milan, Italy
| | - Ilaria Parzanese
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi, Milan, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Università degli Studi Milano-Bicocca, Milan, Italy
| | - Maria Francesca Donato
- Gastroenterology and Hepatology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Pietro Lampertico
- Università degli Studi, Milan, Italy.,Gastroenterology and Hepatology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Umberto Maggi
- General Surgery and Liver Transplantation Unit, Department of Pathophysiology and Transplantation, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucio Caccamo
- General Surgery and Liver Transplantation Unit, Department of Pathophysiology and Transplantation, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Rossi
- Università degli Studi, Milan, Italy.,General Surgery and Liver Transplantation Unit, Department of Pathophysiology and Transplantation, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi, Milan, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi, Milan, Italy
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Patrono D, Surra A, Catalano G, Rizza G, Berchialla P, Martini S, Tandoi F, Lupo F, Mirabella S, Stratta C, Salizzoni M, Romagnoli R. Hypothermic Oxygenated Machine Perfusion of Liver Grafts from Brain-Dead Donors. Sci Rep 2019; 9:9337. [PMID: 31249370 PMCID: PMC6597580 DOI: 10.1038/s41598-019-45843-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [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: 02/18/2019] [Accepted: 06/06/2019] [Indexed: 02/08/2023] Open
Abstract
Hypothermic oxygenated machine perfusion (HOPE) was introduced in liver transplantation (LT) to mitigate ischemia-reperfusion injury. Available clinical data mainly concern LT with donors after circulatory-determined death, whereas data on brain-dead donors (DBD) are scarce. To assess the impact of end-ischemic HOPE in DBD LT, data on primary adult LTs performed between March 2016 and June 2018 were analyzed. HOPE was used in selected cases of donor age >80 years, apparent severe graft steatosis, or ischemia time ≥10 hours. Outcomes of HOPE-treated cases were compared with those after static cold storage. Propensity score matching (1:2) and Bayesian model averaging were used to overcome selection bias. During the study period, 25 (8.5%) out of 294 grafts were treated with HOPE. After matching, HOPE was associated with a lower severe post-reperfusion syndrome (PRS) rate (4% versus 20%, p = 0.13) and stage 2–3 acute kidney injury (AKI) (16% versus 42%, p = 0.046). Furthermore, Bayesian model averaging showed lower transaminases peak and a lower early allograft dysfunction (EAD) rate after HOPE. A steeper decline in arterial graft resistance throughout perfusion was associated with lower EAD rate. HOPE determines a significant reduction of ischemia reperfusion injury in DBD LT.
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Affiliation(s)
- Damiano Patrono
- General Surgery 2U - Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Astrid Surra
- General Surgery 2U - Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Giorgia Catalano
- General Surgery 2U - Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Giorgia Rizza
- General Surgery 2U - Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Silvia Martini
- Gastrohepatology Unit, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Tandoi
- General Surgery 2U - Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesco Lupo
- General Surgery 2U - Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Stefano Mirabella
- General Surgery 2U - Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Chiara Stratta
- Anesthesia Department 2, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mauro Salizzoni
- General Surgery 2U - Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Renato Romagnoli
- General Surgery 2U - Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
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14
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Patrono D, Franchi E, Guarasci F, Bartoli G, Nada E, Rigo F, Ottobrelli A, Fonio P, Salizzoni M, Romagnoli R. Vascular Remodeling of Visceral Arteries Following Interruption of the Splenic Artery During Liver Transplantation. Liver Transpl 2019; 25:934-945. [PMID: 30882994 DOI: 10.1002/lt.25447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/01/2019] [Indexed: 02/07/2023]
Abstract
Splenic artery (SA) ligation can be performed during liver transplantation (LT) to avoid portal hyperperfusion, which is involved in the pathogenesis of both small-for-size and SA syndrome. The SA can also be used as an inflow for arterial reconstruction. Exceptionally, SA interruption or agenesis has been associated with positive remodeling of collateral arteries supplying the spleen via the left gastric artery (LGA), short gastric vessels, and the gastroepiploic arcade (GEA), with subsequent severe upper gastrointestinal (GI) bleeding. To determine incidence, magnitude, predictors, and clinical implications of vascular remodeling after SA interruption during LT, we identified 465 patients transplanted in the period 2007-2017 who had the SA ligated or interrupted at LT. Among them, 88 had a computed tomography angiography suitable for evaluation of vascular remodeling after LT. The presence of prominent gastric arterial collaterals and the increase in LGA and GEA diameter were evaluated on 2-dimensional axial images and multiplanar reconstructions. Of the 88 patients, 28 (31.8%), 32 (36.4%), and 22 (25.0%) developed gastric collateralization graded as mild, moderate, or severe. Of the patients for whom comparison with pre-LT imaging was possible (n = 54), 51 (94.4%) presented a median 37% and 55% increase in LGA and GEA diameter, respectively. Severe gastric collateralization was associated with lower body mass index (odds ratio, 0.84; 95% confidence interval [CI], 0.71-0.98; P = 0.03), whereas a GEA caliper measurement increase was positively correlated with Model for End-Stage Liver Disease score (r2 = 0.12; 95% CI, 0.65-4.15; P = 0.008). Out of 465 patients, 2 (0.43%) had severe episodes of arterial upper GI bleeding, possibly exacerbated by vascular remodeling. In conclusion, vascular remodeling after SA interruption during LT is frequent and can aggravate GI bleeding during follow-up.
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Affiliation(s)
- Damiano Patrono
- Liver Transplant Center, General Surgery 2U, University of Torino, A.O.U. Città Della Salute e Della Scienza, Torino, Italy
| | - Eloisa Franchi
- Liver Transplant Center, General Surgery 2U, University of Torino, A.O.U. Città Della Salute e Della Scienza, Torino, Italy
| | - Fabio Guarasci
- Radiology Department, University of Torino, A.O.U. Città Della Salute e Della Scienza, Torino, Italy
| | - Germana Bartoli
- Radiology Department, University of Torino, A.O.U. Città Della Salute e Della Scienza, Torino, Italy
| | - Elisabetta Nada
- Liver Transplant Center, General Surgery 2U, University of Torino, A.O.U. Città Della Salute e Della Scienza, Torino, Italy
| | - Federica Rigo
- Liver Transplant Center, General Surgery 2U, University of Torino, A.O.U. Città Della Salute e Della Scienza, Torino, Italy
| | - Antonio Ottobrelli
- Gastrohepatology Unit, A.O.U. Città Della Salute e Della Scienza, Torino, Italy
| | - Paolo Fonio
- Radiology Department, University of Torino, A.O.U. Città Della Salute e Della Scienza, Torino, Italy
| | - Mauro Salizzoni
- Liver Transplant Center, General Surgery 2U, University of Torino, A.O.U. Città Della Salute e Della Scienza, Torino, Italy
| | - Renato Romagnoli
- Liver Transplant Center, General Surgery 2U, University of Torino, A.O.U. Città Della Salute e Della Scienza, Torino, Italy
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15
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De Simone P, Salizzoni M, Cillo U, Benedetto FD, Woodward MK, Barceló M, Páez A. Efficacy and safety of Niuliva ® immune globulin to prevent hepatitis B reinfection in de novo orthotopic liver transplant. Future Virol 2019. [DOI: 10.2217/fvl-2018-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aims: To determine efficacy and safety of intravenous hepatitis B immune globulin (Niuliva®, Grifols) to prevent reinfection in de novo orthotopic liver transplantation. Patients & methods: In a nonrandomized, noncontrolled and Phase III clinical trial, 15 adult patients (12 men) were treated with Niuliva from the anhepatic phase (10,000 IU/daily 1 week postsurgery) up to 6 or 12 months (5000 IU/weekly 1 month; 5000 IU/monthly thereafter). Results: No patients showed reinfection throughout the study. Niuliva was effective in maintaining antibody titers above the thresholds recommended by the European Medicines Agency (EMA) to prevent reinfection (100–150 IU/l). Four serious adverse events were reported in three patients (none related to the study product). There were no seroconversions and no deaths. Conclusion: Long-term, high-dose Niuliva administration was safe and effective to prevent graft reinfection in the tested patients.
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Affiliation(s)
- Paolo De Simone
- UO Chirurgia Epatica e Trapianto di Fegato, Az. Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Mauro Salizzoni
- Chirurgia Generale 2 – Centro Trapianto di Fegato A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Umberto Cillo
- U.O. Chirurgia Epatobiliare e dei Trapianti Epatici. Az. Ospedaliera Universitaria di Padova, Padova, Italy
| | - Fabrizio Di Benedetto
- Chirurgia Oncologica, Epatobiliopancreatica e dei Trapianti di Fegato. A.O.U. Policlinico Università di Modena e Reggio Emilia, Modena, Italy
| | | | - Miquel Barceló
- Clinical Development, Instituto Grifols S.A., Barcelona, Spain
| | - Antonio Páez
- Clinical Development, Instituto Grifols S.A., Barcelona, Spain
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16
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Cillo U, Saracino L, Vitale A, Bertacco A, Salizzoni M, Lupo F, Colledan M, Corno V, Rossi G, Reggiani P, Baccarani U, Bresàdola V, De Carlis L, Mangoni I, Ramirez Morales R, Agnes S, Nure E. Very Early Introduction of Everolimus in De Novo Liver Transplantation: Results of a Multicenter, Prospective, Randomized Trial. Liver Transpl 2019; 25:242-251. [PMID: 30592371 DOI: 10.1002/lt.25400] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/05/2018] [Indexed: 02/07/2023]
Abstract
Early everolimus (EVR) introduction and tacrolimus (TAC) minimization after liver transplantation may represent a novel immunosuppressant approach. This phase 2, multicenter, randomized, open-label trial evaluated the safety and efficacy of early EVR initiation. Patients treated with corticosteroids, TAC, and basiliximab were randomized (2:1) to receive EVR (1.5 mg twice daily) on day 8 and to gradually minimize or withdraw TAC when EVR was stable at >5 ng/mL or to continue TAC at 6-12 ng/mL. The primary endpoint was the proportion of treated biopsy-proven acute rejection (tBPAR)-free patients at 3 months after transplant. As secondary endpoints, composite tBPAR plus graft/patient loss rate, renal function, TAC discontinuation rate, and adverse events were assessed. A total of 93 patients were treated with EVR, and 47 were controls. After 3 months from transplantation, 87.1% of patients with EVR and 95.7% of controls were tBPAR-free (P = 0.09); composite endpoint-free patients with EVR were 85% (versus 94%; P = 0.15). Also at 3 months, 37.6% patients were in monotherapy with EVR, and the tBPAR rate was 11.4%. Estimated glomerular filtration rate was significantly higher with EVR, as early as 2 weeks after randomization. In the study group, higher rates of dyslipidemia (15% versus 6.4%), wound complication (18.32% versus 0%), and incisional hernia (25.8% versus 6.4%) were observed, whereas neurological disorders were more frequent in the control group (13.9% versus 31.9%; P < 0.05). In conclusion, an early EVR introduction and TAC minimization may represent a suitable approach when immediate preservation of renal function is crucial.
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Affiliation(s)
- Umberto Cillo
- Centro Trapianti di Fegato, Azienda Università di Padova, Padua, Italy
| | - Laura Saracino
- Centro Trapianti di Fegato, Azienda Università di Padova, Padua, Italy
| | - Alessandro Vitale
- Centro Trapianti di Fegato, Azienda Università di Padova, Padua, Italy
| | | | - Mauro Salizzoni
- Dipartimento Chirurgia Generale, Azienda Ospedaliera-Universitaria S. Giovanni Battista di Torino Ospedale Molinette, Turin, Italy
| | - Francesco Lupo
- Dipartimento Chirurgia Generale, Azienda Ospedaliera-Universitaria S. Giovanni Battista di Torino Ospedale Molinette, Turin, Italy
| | - Michele Colledan
- Dipartimento di Chirurgia, ASST Giovanni XXIII Bergamo, Bergamo, Italy
| | - Vittorio Corno
- Dipartimento di Chirurgia, ASST Giovanni XXIII Bergamo, Bergamo, Italy
| | - Giorgio Rossi
- Centro Trapianti di Fegato, Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Paolo Reggiani
- Centro Trapianti di Fegato, Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Umberto Baccarani
- Dipartimento di Chirurgia Generale, Azienda Ospedaliera "S.M. Misericordia", Udine, Italy
| | - Vittorio Bresàdola
- Dipartimento di Chirurgia Generale, Azienda Ospedaliera "S.M. Misericordia", Udine, Italy
| | - Luciano De Carlis
- Dipartimento di Chirurgia Generale e dei Trapianti, Ospedale Niguarda-Ca' Granda, Milan, Italy
| | - Iacopo Mangoni
- Dipartimento di Chirurgia Generale e dei Trapianti, Ospedale Niguarda-Ca' Granda, Milan, Italy
| | | | - Salvatore Agnes
- Dipartimento di Chirurgia Generale e Trapianti d'Organo, Policlinico, Universitario Agostino Gemelli, Rome, Italy
| | - Erida Nure
- Dipartimento di Chirurgia Generale e Trapianti d'Organo, Policlinico, Universitario Agostino Gemelli, Rome, Italy
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17
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Adam R, Karam V, Cailliez V, O Grady JG, Mirza D, Cherqui D, Klempnauer J, Salizzoni M, Pratschke J, Jamieson N, Hidalgo E, Paul A, Andujar RL, Lerut J, Fisher L, Boudjema K, Fondevila C, Soubrane O, Bachellier P, Pinna AD, Berlakovich G, Bennet W, Pinzani M, Schemmer P, Zieniewicz K, Romero CJ, De Simone P, Ericzon BG, Schneeberger S, Wigmore SJ, Prous JF, Colledan M, Porte RJ, Yilmaz S, Azoulay D, Pirenne J, Line PD, Trunecka P, Navarro F, Lopez AV, De Carlis L, Pena SR, Kochs E, Duvoux C. 2018 Annual Report of the European Liver Transplant Registry (ELTR) - 50-year evolution of liver transplantation. Transpl Int 2019; 31:1293-1317. [PMID: 30259574 DOI: 10.1111/tri.13358] [Citation(s) in RCA: 272] [Impact Index Per Article: 54.4] [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: 05/18/2018] [Revised: 06/19/2018] [Accepted: 09/22/2018] [Indexed: 02/07/2023]
Abstract
The purpose of this registry study was to provide an overview of trends and results of liver transplantation (LT) in Europe from 1968 to 2016. These data on LT were collected prospectively from 169 centers from 32 countries, in the European Liver Transplant Registry (ELTR) beginning in 1968. This overview provides epidemiological data, as well as information on evolution of techniques, and outcomes in LT in Europe over more than five decades; something that cannot be obtained from only a single center experience.
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Affiliation(s)
- René Adam
- Paul Brousse Hospital, Univ Paris-Sud, Inserm U935, Villejuif, France
| | - Vincent Karam
- Paul Brousse Hospital, Univ Paris-Sud, Inserm U935, Villejuif, France
| | - Valérie Cailliez
- Paul Brousse Hospital, Univ Paris-Sud, Inserm U935, Villejuif, France
| | | | | | - Daniel Cherqui
- Paul Brousse Hospital, Univ Paris-Sud, Inserm U935, Villejuif, France
| | | | | | | | | | | | | | | | - Jan Lerut
- Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Lutz Fisher
- Universitatsklinikum Hamburg Eppendorf, Hamburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Robert J Porte
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | | | - Pavel Trunecka
- Transplant Center, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | | | | | | | - Eberhard Kochs
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Munich, Germany
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18
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Beckebaum S, Herzer K, Bauhofer A, Gelson W, De Simone P, de Man R, Engelmann C, Müllhaupt B, Vionnet J, Salizzoni M, Volpes R, Ercolani G, De Carlis L, Angeli P, Burra P, Dufour JF, Rossi M, Cillo U, Neumann U, Fischer L, Niemann G, Toti L, Tisone G. Recurrence of Hepatitis B Infection in Liver Transplant Patients Receiving Long-Term Hepatitis B Immunoglobulin Prophylaxis. Ann Transplant 2018; 23:789-801. [PMID: 30420590 PMCID: PMC6249983 DOI: 10.12659/aot.910176] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Long-term real-world data are relatively sparse regarding recurrence of chronic hepatitis B virus (HBV) infection after liver transplantation using hepatitis B immunoglobulin (HBIg) and nucleos(t)ide analogue (NUC) prophylaxis. MATERIAL AND METHODS Data from 371 adults transplanted for HBV-related disease at 20 European centers and given HBIg for ³12 months ± NUC therapy were analyzed retrospectively. RESULTS HBIg comprised Hepatect® (iv HBIgB; n=299), subcutaneous Zutectra® (sc HBIg, n=236), and other HBIg preparations (n=130); 93.5% received NUC therapy. Mean follow-up was 6.8±3.5 years. The primary efficacy variable, freedom from HBV recurrence, occurred in 95.7% of patients (95% CI [93.1%, 97.5%]). The observed incidence of recurrence was 16/371 (4.3%) (annual rate 0.65%); 5/16 patients with recurrence had discontinued HBIg and 7/16 had anti-HBs <100 IU/l. Excluding these 7 patients, the HBV recurrence rate was 2.4%. The recurrence rate while on HBIg therapy was 1 per 2069 months. In patients who discontinued HBIg, risk of HBV recurrence versus sc HBIg users was increased by 5.2-fold (1 per 1 603 versus 1 per 8379 treatment months). The annual rate of HBV-related hepatocellular carcinoma (HCC) recurrence was 1.7%. CONCLUSIONS These results support the long-term use of HBIg with NUC therapy as an effective management strategy to minimize risk of HBV recurrence and virus-related complications after liver transplantation.
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Affiliation(s)
- Susanne Beckebaum
- Department of Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Kerstin Herzer
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Artur Bauhofer
- Corporate Medical Affairs and Corporate Clinical Research and Development, Biotest AG, Dreieich, Germany
| | - William Gelson
- Cambridge Liver Unit, Addenbrooke’s Hospital, Cambridge, U.K
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation, Chirurgia Epatica e del Trapianto Fegato Pisa, Pisa, Italy
| | - Robert de Man
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cornelius Engelmann
- Department of Gastroenterology and Rheumatology, University of Leipzig, Leipzig, Germany
| | - Beat Müllhaupt
- Swiss HPB Center and Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Julien Vionnet
- Transplantation Centre and Service of Gastroenterology and Hepatology, Lausanne, Switzerland
| | - Mauro Salizzoni
- Chirurgia Generale 2U, Centro Trapianto Fegato, AO Città della Salute e della Scienza di Torino, Turin, Italy
| | - Riccardo Volpes
- Hepatology and Gastroenterology Unit, ISMETT-IRCCS, Palermo, Italy
| | - Giorgio Ercolani
- Department of General Surgery, Morgagni-Pierantoni General Hospital, University of Bologna, Bologna, Italy
| | - Luciano De Carlis
- Surgery and Abdominal Transplantation Division, Niguarda Ca’ Granda Hospital, Milan, Italy
| | - Paolo Angeli
- Multivisceral Transplant Unit, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Padua University Hospital, Padua, Italy
| | - Jean-François Dufour
- University Clinic for Visceral Surgery and Medicine, Inselspital, Bern, Switzerland
| | - Massimo Rossi
- Department of General Surgery and Organ Transplantation, Umberto I Policlinic, Sapienza University, Rome, Italy
| | - Umberto Cillo
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padova, Italy
| | - Ulf Neumann
- Department of Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Lutz Fischer
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele Niemann
- Corporate Medical Affairs and Corporate Clinical Research and Development, Biotest AG, Dreieich, Germany
| | - Luca Toti
- Transplant Centre, Faculty of Medicine, Azienda Ospedaliera Policlinico Tor Vergata, Rome, Italy
| | - Giuseppe Tisone
- Transplant Centre, Faculty of Medicine, Azienda Ospedaliera Policlinico Tor Vergata, Rome, Italy
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19
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Fanelli V, Costamagna A, Carosso F, Rotondo G, Pivetta EE, Panio A, Cappello P, Mazzeo AT, Del Sorbo L, Grasso S, Mascia L, Brazzi L, Romagnoli R, Salizzoni M, Ranieri MV. Effects of liver ischemia-reperfusion injury on respiratory mechanics and driving pressure during orthotopic liver transplantation. Minerva Anestesiol 2018; 85:494-504. [PMID: 30394062 DOI: 10.23736/s0375-9393.18.12890-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND During orthotopic liver transplantation (OLT), liver graft ischemia-reperfusion injury (IRI) triggers a cytokine-mediated systemic inflammatory response, which impairs graft function and disrupts distal organ homeostasis. The objective of this prospective, observational trial was to assess the effects of IRI on lung and chest wall mechanics in the intraoperative period of patients undergoing OLT. METHODS In 26 patients undergoing OLT, we measured elastance of the respiratory system (ERS), partitioned into lung (EL) and chest wall (ECW), hemodynamics, and fluid and blood product intake before laparotomy (T1), after portal/caval surgical clamp (T2), and immediately (T3) and, at 90 and 180 minutes post-reperfusion (T4 and T5, respectively). Interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), IL-1β and tumor necrosis factor-α plasma concentrations were assessed at T1, T4 and T5. RESULTS EL significantly decreased from T1 to T2 (13.5±4.4 vs 9.7±4.8 cmH2O/L, P<0.05), remained stable at T3, while at T4 (12.3±4.4 cmH2O/L, P<0.05) was well above levels recorded at T2, reaching its highest value at T5 (15±3.9 cmH2O/L, P<0.05). Variations in ERS, EL, driving pressure (∆P) and trans-pulmonary pressure (∆PL) significantly correlated with changes in IL-6 and MCP-1 plasma concentrations, but not with changes in wedge pressure, fluid amounts, and red blood cells and platelets administered. No correlation was found between changes in cytokine concentrations and ECW. CONCLUSIONS We found that EL, ECW, ∆P and ∆PL underwent significant variations during the OLT procedure. Further, we documented a significant association between the respiratory mechanics changes and the inflammatory response following liver graft reperfusion.
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Affiliation(s)
- Vito Fanelli
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy - .,Department of Surgical Science, University of Turin, Turin, Italy -
| | - Andrea Costamagna
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Fabio Carosso
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Giuseppe Rotondo
- Department of Surgical Science, University of Turin, Turin, Italy
| | | | - Angelo Panio
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paola Cappello
- Laboratory of Tumor Immunology, Experimental Medicine Research Center (CeRMS), University of Turin, Turin, Italy
| | - Anna T Mazzeo
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.,Department of Surgical Science, University of Turin, Turin, Italy
| | - Lorenzo Del Sorbo
- Division of Respirology and Critical Care Medicine, Department of Medicine, Toronto General Hospital, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | - Salvatore Grasso
- Unit of Anesthesia and Intensive Care, Department of Emergency Medicine and Organ Transplant (DETO), University of Bari, Bari, Italy
| | - Luciana Mascia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Luca Brazzi
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.,Department of Surgical Science, University of Turin, Turin, Italy
| | - Renato Romagnoli
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Mauro Salizzoni
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Marco V Ranieri
- Department of Anesthesia and Intensive Care Medicine, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
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20
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Patrono D, Marola S, David E, Chiusa L, Martini S, Mirabella S, Lupo F, Salizzoni M, Romagnoli R. Long-Term Outcome of Veno-Occlusive Disease After Liver Transplant: A Retrospective Single-Center Experience. EXP CLIN TRANSPLANT 2018; 17:214-221. [PMID: 30381049 DOI: 10.6002/ect.2017.0315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Veno-occlusive disease after liver transplant has been sporadically reported, and significant uncertainty exists concerning the best treatment and the long-term outcomes. Here, we reviewed our experience to evaluate clinical presentation, treatment, and the long-term outcomes of these patients. MATERIALS AND METHODS Between 2000 and 2015, 2165 patients underwent liver transplant at our center. The incidence of veno-occlusive disease was 0.3% (7/2165). RESULTS Timing of veno-occlusive disease onset (median 4.7 mo; interquartile range, 2.5-11.1 mo) varied widely as did clinical presentation, which was characterized by a variable association of liver failure and portal hypertension and different disease pro-gression rates. In all cases, diagnosis of veno-occlusive disease was confirmed by liver biopsy. Six patients (85.7%) presented with veno-occlusive disease after a previous episode of acute cellular rejection. Three patients died due to veno-occlusive disease (n = 2) or due to hepatocellular carcinoma recurrence (n = 1). Two patients were treated by increasing immunosuppression and with interventional procedures (pleurodesis and transjugular intrahepatic portosystemic shunt, respectively), and 2 had successful retransplants. 5-year patient and graft survival rates were 57.1% and 28.6%, respectively. CONCLUSIONS A tailored approach based on clinical features and including retransplant can achieve acceptable long-term survival in patients with veno-occlusive disease after liver transplant.
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Affiliation(s)
- Damiano Patrono
- From the Department of General Surgery, Liver Transplant Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
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21
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Belli LS, Perricone G, Adam R, Cortesi PA, Strazzabosco M, Facchetti R, Karam V, Salizzoni M, Andujar RL, Fondevila C, De Simone P, Morelli C, Fabregat-Prous J, Samuel D, Agarwaal K, Moreno Gonzales E, Charco R, Zieniewicz K, De Carlis L, Duvoux C. Impact of DAAs on liver transplantation: Major effects on the evolution of indications and results. An ELITA study based on the ELTR registry. J Hepatol 2018; 69:810-817. [PMID: 29940268 DOI: 10.1016/j.jhep.2018.06.010] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [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: 04/11/2018] [Revised: 06/05/2018] [Accepted: 06/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Direct-acting antivirals (DAAs) have dramatically improved the outcome of patients with hepatitis C virus (HCV) infection including those with decompensated cirrhosis (DC). We analyzed the evolution of indications and results of liver transplantation (LT) in the past 10 years in Europe, focusing on the changes induced by the advent of DAAs. METHODS This is a cohort study based on data from the European Liver Transplant Registry (ELTR). Data of adult LTs performed between January 2007 to June 2017 for HCV, hepatitis B virus (HBV), alcohol (EtOH) and non-alcoholic steatohepatitis (NASH) were analyzed. The period was divided into different eras: interferon (IFN/RBV; 2007-2010), protease inhibitor (PI; 2011-2013) and second generation DAA (DAA; 2014-June 2017). RESULTS Out of a total number of 60,527 LTs, 36,382 were performed in patients with HCV, HBV, EtOH and NASH. The percentage of LTs due to HCV-related liver disease varied significantly over time (p <0.0001), decreasing from 22.8% in the IFN/RBV era to 17.4% in the DAA era, while those performed for NASH increased significantly (p <0.0001). In the DAA era, the percentage of LTs for HCV decreased significantly (p <0.0001) from 21.1% (first semester 2014) to 10.6% (first semester 2017). This decline was more evident in patients with DC (HCV-DC, -58.0%) than in those with hepatocellular carcinoma (HCC) associated with HCV (HCV-HCC, -41.2%). Conversely, three-year survival of LT recipients with HCV-related liver disease improved from 65.1% in the IFN/RBV era to 76.9% in the DAA era, and is now comparable to the survival of recipients with HBV infection (p = 0.3807). CONCLUSIONS In Europe, the number of LTs due to HCV infection is rapidly declining for both HCV-DC and HCV-HCC indications and post-LT survival has dramatically improved over the last three years. This is the first comprehensive study of the overall impact of DAA treatment for HCV on liver transplantation in Europe. LAY SUMMARY After the advent of direct-acting antivirals in 2014, a dramatic decline was observed in the number of liver transplants performed both in patients with decompensated cirrhosis due to hepatitis C virus (HCV), minus 60%, and in those with hepatocellular carcinoma associated with HCV, minus 41%. Furthermore, this is the first large-scale study demonstrating that the survival of liver transplant recipients with HCV-related liver disease has dramatically improved over the last three years and is now comparable to the survival of recipients with hepatitis B virus infection. The reduction in HCV-related indications for LT means that there is a greater availability of livers, at least 600 every year, which can be allocated to patients with indications other than HCV.
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Affiliation(s)
- Luca Saverio Belli
- Gastroenterology and Hepatology, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Giovanni Perricone
- Gastroenterology and Hepatology, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Rene Adam
- Centre Hépatobiliaire, Université Paris-Sud, Hôpital Paul Brousse, F-94804 Villejuif, France
| | - Paolo A Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | | | - Rita Facchetti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Vincent Karam
- Centre Hépatobiliaire, Université Paris-Sud, Hôpital Paul Brousse, F-94804 Villejuif, France
| | - Mauro Salizzoni
- Centro trapianti di fegato, AO San Giovanni Battista, Torino, Italy
| | - Rafael Lopez Andujar
- Hospital Universitario y Politecnico La Fe, Unidad de Chirurgia HPB y TX, Valencia, Spain
| | - Costantino Fondevila
- Hospital Clinic de Barcelona, Dep. of Surgery, University of Barcelona Villaroel, Barcelona, Spain
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Cristina Morelli
- Liver and Multiorgan Transplantation, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Joan Fabregat-Prous
- Hospital Universitari de Bellvitge, Unidad de Transplante Hepatico, Barcelona, Spain
| | - Didier Samuel
- Centre Hépatobiliaire, Université Paris-Sud, Hôpital Paul Brousse, F-94804 Villejuif, France
| | - Kosh Agarwaal
- Institute of Liver Diseases, King's College Hospital, Liver Unit, London, UK
| | | | - Ramon Charco
- Hospital Universitario Vall D Hebron HBP, Surgery & Transplant Department, Barcelona, Spain
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland
| | - Luciano De Carlis
- Chirurgia generale 2 e Trapianti, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, AssistancePublique-Hôpitaux de Paris, Paris-Est University, Creteil, France
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22
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Pommergaard HC, Rostved AA, Adam R, Thygesen LC, Salizzoni M, Gómez Bravo MA, Cherqui D, Filipponi F, Boudjema K, Mazzaferro V, Soubrane O, García-Valdecasas JC, Prous JF, Pinna AD, O'Grady J, Karam V, Duvoux C, Rasmussen A. Vascular invasion and survival after liver transplantation for hepatocellular carcinoma: a study from the European Liver Transplant Registry. HPB (Oxford) 2018; 20:768-775. [PMID: 29622402 DOI: 10.1016/j.hpb.2018.03.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/18/2018] [Accepted: 03/03/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Studies suggest that vascular invasion may be a superior prognostic marker compared with traditional selection criteria, e.g. Milan criteria. This study aimed to investigate the prognostic value of micro and macrovascular invasion in a large database material. METHODS Patients liver transplanted for HCC and cirrhosis registered in the European Liver Transplant Registry (ELTR) database were included. The association between the Milan criteria, Up-to-seven criteria and vascular invasion with overall survival and HCC specific survival was investigated with univariate and multivariate Cox regression analyses. RESULTS Of 23,124 patients transplanted for HCC, 9324 had cirrhosis and data on explant pathology. Patients without microvascular invasion, regardless of number and size of HCC nodules, had a five-year overall survival of 73.2%, which was comparable with patients inside both Milan and Up-to-seven criteria. Patients without macrovascular invasion had an only marginally reduced survival of 70.7% after five years. Patients outside both Milan and Up-to-seven criteria without micro or macrovascular invasion still had a five-year overall survival of 65.8%. CONCLUSION Vascular invasion as a prognostic indicator remains superior to criteria based on size and number of nodules. With continuously improving imaging studies, microvascular invasion may be used for selecting patients for transplantation in the future.
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Affiliation(s)
- Hans-Christian Pommergaard
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Andreas A Rostved
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - René Adam
- Department of Hepatobiliary Surgery, Cancer and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U 935, Univ Paris-Sud, Villejuif, France
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Mauro Salizzoni
- Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Miguel A Gómez Bravo
- Department of Surgery - Liver Transplant Unit, Hospital Virgen Del Rocio, Sevilla, Spain
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Cancer and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U 935, Univ Paris-Sud, Villejuif, France
| | - Franco Filipponi
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School Hospital, 56124, Pisa, Italy
| | - Karim Boudjema
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Université de Rennes 1, Rennes, France
| | - Vincenzo Mazzaferro
- University of Milan and Division of Gastrointestinal Surgery and Liver Transplantataion, Istituto Nazionale Tumori, Fondazione IRCCS, Milan, Italy
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, University Denis Diderot, Paris, France
| | | | - Joan F Prous
- Unitat de Cirurgia Hepato-bilio-pancreàtica, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Antonio D Pinna
- General Surgery and Transplant Division, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - John O'Grady
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Vincent Karam
- Department of Hepatobiliary Surgery, Cancer and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U 935, Univ Paris-Sud, Villejuif, France
| | - Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Paris Est University (UPEC), Créteil, France
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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23
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Patrono D, Salizzoni M, Romagnoli R. Normothermic Machine Perfusion of Donor Livers Without the Need for Human Blood Products. Liver Transpl 2018; 24:1147-1148. [PMID: 29694701 DOI: 10.1002/lt.25184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/27/2018] [Accepted: 04/15/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Damiano Patrono
- Liver Transplant Unit, General Surgery 2U, University of Turin, Turin, Italy
| | - Mauro Salizzoni
- Liver Transplant Unit, General Surgery 2U, University of Turin, Turin, Italy
| | - Renato Romagnoli
- Liver Transplant Unit, General Surgery 2U, University of Turin, Turin, Italy
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24
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Caviglia GP, Abate ML, Tandoi F, Ciancio A, Amoroso A, Salizzoni M, Saracco GM, Rizzetto M, Romagnoli R, Smedile A. Quantitation of HBV cccDNA in anti-HBc-positive liver donors by droplet digital PCR: A new tool to detect occult infection. J Hepatol 2018; 69:301-307. [PMID: 29621551 DOI: 10.1016/j.jhep.2018.03.021] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [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: 11/14/2017] [Revised: 03/10/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The accurate diagnosis of occult hepatitis B virus (HBV) infection (OBI) requires the demonstration of HBV DNA in liver biopsies of hepatitis B surface antigen-negative individuals. However, in clinical practice a latent OBI is deduced by the finding of the antibody to the hepatitis B core antigen (anti-HBc). We investigated the true prevalence of OBI and the molecular features of intrahepatic HBV in anti-HBc-positive individuals. METHODS The livers of 100 transplant donors (median age 68.2 years; 64 males, 36 females) positive for anti-HBc at standard serologic testing, were examined for total HBV DNA by nested-PCR and for the HBV covalently closed circular DNA (HBV cccDNA) with an in-house droplet digital PCR assay (ddPCR) (Linearity: R2 = 0.9998; lower limit of quantitation and detection of 2.4 and 0.8 copies/105 cells, respectively). RESULTS A total of 52% (52/100) of the individuals studied were found to have OBI. cccDNA was found in 52% (27/52) of the OBI-positive, with a median 13 copies/105 cells (95% CI 5-25). Using an assay specific for anti-HBc of IgG class, the median antibody level was significantly higher in HBV cccDNA-positive than negative donors (17.0 [7.0-39.2] vs. 5.7 [3.6-9.7] cut-off index [COI], respectively, p = 0.007). By multivariate analysis, an anti-HBc IgG value above 4.4 COI was associated with the finding of intrahepatic HBV cccDNA (odds ratio 8.516, p = 0.009); a lower value ruled out its presence with a negative predictive value of 94.6%. CONCLUSIONS With a new in-house ddPCR-based method, intrahepatic HBV cccDNA was detectable in quantifiable levels in about half of the OBI cases examined. The titer of anti-HBc IgG may be a useful surrogate to predict the risk of OBI reactivation in immunosuppressed patients. LAY SUMMARY The covalently closed circular DNA (cccDNA) form of the hepatitis B virus (HBV) sustains the persistence of the virus even decades after resolution of the symptomatic infection (occult HBV infection). In the present study we developed a highly sensitive method based on droplet digital PCR technology for the detection and quantitation of HBV cccDNA in the liver of individuals with occult HBV infection. We observed that the amount of HBV cccDNA may be inferred from the titer in serum of the IgG class antibody to the hepatitis B core antigen. The quantitation of this antibody may represent a surrogate to determine which patients are at the highest risk of HBV reactivation following immunosuppressive therapies.
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Affiliation(s)
- Gian Paolo Caviglia
- Department of Medical Sciences, University of Turin, Gastroenterology Division of Città della Salute e della Scienza of Turin, University Hospital, Turin, Italy.
| | - Maria Lorena Abate
- Department of Medical Sciences, University of Turin, Gastroenterology Division of Città della Salute e della Scienza of Turin, University Hospital, Turin, Italy
| | - Francesco Tandoi
- General Surgery 2U, Liver Transplant Center - A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alessia Ciancio
- Department of Medical Sciences, University of Turin, Gastroenterology Division of Città della Salute e della Scienza of Turin, University Hospital, Turin, Italy
| | - Antonio Amoroso
- Regional Transplant Center, Piedmont, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Mauro Salizzoni
- General Surgery 2U, Liver Transplant Center - A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Giorgio Maria Saracco
- Department of Medical Sciences, University of Turin, Gastroenterology Division of Città della Salute e della Scienza of Turin, University Hospital, Turin, Italy
| | - Mario Rizzetto
- Department of Medical Sciences, University of Turin, Gastroenterology Division of Città della Salute e della Scienza of Turin, University Hospital, Turin, Italy
| | - Renato Romagnoli
- General Surgery 2U, Liver Transplant Center - A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Antonina Smedile
- Department of Medical Sciences, University of Turin, Gastroenterology Division of Città della Salute e della Scienza of Turin, University Hospital, Turin, Italy
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Lavezzo B, Patrono D, Tandoi F, Martini S, Fop F, Ballerini V, Stratta C, Skurzak S, Lupo F, Strignano P, Donadio PP, Salizzoni M, Romagnoli R, De Rosa FG. A simplified regimen of targeted antifungal prophylaxis in liver transplant recipients: A single-center experience. Transpl Infect Dis 2018; 20:e12859. [PMID: 29427394 DOI: 10.1111/tid.12859] [Citation(s) in RCA: 12] [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: 07/09/2017] [Revised: 09/17/2017] [Accepted: 11/12/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Invasive fungal infection (IFI) is a severe complication of liver transplantation burdened by high mortality. Guidelines recommend targeted rather than universal antifungal prophylaxis based on tiers of risk. METHODS We aimed to evaluate IFI incidence, risk factors, and outcome after implementation of a simplified two-tiered targeted prophylaxis regimen based on a single broad-spectrum antifungal drug (amphotericin B). Patients presenting 1 or more risk factors according to literature were administered prophylaxis. Prospectively collected data on all adult patients transplanted in Turin from January 2011 to December 2015 were reviewed. RESULTS Patients re-transplanted before postoperative day 7 were considered once, yielding a study cohort of 581 cases. Prophylaxis was administered to 299 (51.4%) patients; adherence to protocol was 94.1%. Sixteen patients developed 18 IFIs for an overall rate of 2.8%. All IFI cases were in targeted prophylaxis group; none of the non-prophylaxis group developed IFI. Most cases (81.3%) presented within 30 days after transplantation during prophylaxis; predominant pathogens were molds (94.4%). Only 1 case of candidemia was observed. One-year mortality in IFI patients was 33.3% vs 6.4% in patients without IFI (P = .001); IFI attributable mortality was 6.3%. At multivariate analysis, significant risk factors for IFI were renal replacement therapy (OR = 8.1) and re-operation (OR = 5.2). CONCLUSIONS The implementation of a simplified targeted prophylaxis regimen appeared to be safe and applicable and was associated with low IFI incidence and mortality. Association of IFI with re-operation and renal replacement therapy calls for further studies to identify optimal prophylaxis in this subset of patients.
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Affiliation(s)
- B Lavezzo
- Anesthesia and Intensive Care Unit 2, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - D Patrono
- Liver Transplant Center, General Surgery 2U, University of Torino, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - F Tandoi
- Liver Transplant Center, General Surgery 2U, University of Torino, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - S Martini
- Gastrohepatology Unit, AOU Città della Salute e della Scienza, Torino, Italy
| | - F Fop
- Nephrology, Dialysis and Transplantation Unit, University of Torino, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - V Ballerini
- Anesthesia and Intensive Care Unit 2, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - C Stratta
- Anesthesia and Intensive Care Unit 2, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - S Skurzak
- Anesthesia and Intensive Care Unit 2, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - F Lupo
- Liver Transplant Center, General Surgery 2U, University of Torino, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - P Strignano
- Liver Transplant Center, General Surgery 2U, University of Torino, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - P P Donadio
- Anesthesia and Intensive Care Unit 2, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - M Salizzoni
- Liver Transplant Center, General Surgery 2U, University of Torino, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - R Romagnoli
- Liver Transplant Center, General Surgery 2U, University of Torino, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - F G De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Torino, A.O.U. Città della Salute e della Scienza, Torino, Italy
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26
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Marzano A, Andreone P, Boccagni P, Burra P, Caneschi F, Conoscitore PF, Coppola C, DE Carlis L, Fagiuoli S, Forte P, Gaeta GB, Iemmolo RM, Lotti Suffredini A, Mazzola M, Merli M, Parrilli G, Piai G, Piras MR, Salizzoni M, Tamè M, Tisone G, Toniutto P, Vennarecci G, Volpes R, Zamboni F, Caccamo L. Prevalent use of combined prophylaxis of hepatitis B after liver transplantation in Italy: results of a national survey in a large cohort. MINERVA GASTROENTERO 2018; 64:1-9. [PMID: 29307146 DOI: 10.23736/s1121-421x.17.02407-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Prophylaxis of hepatitis B after liver transplantation with antiviral(s) and immunoglobulins efficiently protect the majority of recipients; however recent experiences suggest a decline of HBsAg-positive candidates and the use of hepatitis B Immunoglobulin-free schedules. METHODS This national survey evaluated the epidemiology and clinical results of hepatitis B prophylaxis among 10,365 liver transplants performed in 25 years in 13 Italian centers. RESULTS With a percentage of 22, 2260 procedures were performed in HBsAg-positive recipients and 714 out of 1080 anti-HBc-positive grafts were used in HBsAg-negative recipients; a total of 2974 patients (29%) were considered at risk of hepatitis B after liver transplantation. Similar rates (18% of HBsAg-positive candidates and 15% of anti-HBc-positive grafts) were registered in the last collected year. Combined prophylaxis with Hepatitis B Immunoglobulins remained prevalent among centers and was effective in 96% of HBsAg-positive recipients and in 94% of HBsAg-negative recipients of anti-HBc-positive grafts. CONCLUSIONS Data from this survey confirm: the excellent results of combined prophylaxis; the past and persistent use of Hepatitis B Immunoglobulin-on and only rare -off prophylactic regimens, in contrast with the newest reports; the increasing use of anti-HBc-positive grafts; the past and present high prevalence of HBsAg-positive recipients, due to an increase in candidates with either hepatocellular carcinoma and Hepatitis Delta Virus coinfection in the last years.
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Affiliation(s)
- Alfredo Marzano
- Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pietro Andreone
- Department of Medical and Surgical Science, Research Center for the Study of Hepatitis, University of Bologna, Bologna, Italy
| | - Patrizia Boccagni
- Unit of Hepatobiliary Surgery and Liver Transplant, Department of Surgical Oncological and Gastrointestinal Sciences, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Unit of Multivisceral Transplant, Padua University Hospital, Padua, Italy
| | | | - Pasquale F Conoscitore
- Unit of Gastroenterology, "Casa Sollievo della Sofferenza" Hospital, IRCCS San Giovanni Rotondo, Foggia, Italy
| | - Carmine Coppola
- Unit of Hepatology and Interventional Ultrasonography, Department of Internal Medicine, OORR Area Stabiese, Plesso Nuovo Gragnano, Naples, Italy
| | - Luciano DE Carlis
- Department of Surgery and Transplantation, Niguarda Hospital, Milan, Italy
| | - Stefano Fagiuoli
- Unit of Gastroenterology Hepatology and Transplantology, Department of Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paolo Forte
- Division of Gastroenterology, University Hospital Careggi, Florence, Italy
| | - Giovanni B Gaeta
- Department of Internal and Experimental Medicine, Unit of Infectious Diseases, Second University of Naples, Naples, Italy
| | - Rosa M Iemmolo
- Unit of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, University of Modena, Modena, Italy
| | | | - Michele Mazzola
- Division of Infectious Disease, Vittorio Emanuele II Hospital, Bisceglie, Bari, Italy
| | - Manuela Merli
- Unit of Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Gianpaolo Parrilli
- Gastrointestinal Unit, AOU Sangiovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Guido Piai
- Unit of Hepatology, A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy
| | - Maria R Piras
- Department of Liver Transplant Coordination, AO Brotzu, Cagliari, Italy
| | - Mauro Salizzoni
- Unit of General Surgery, Liver Transplantation Center, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Mariarosa Tamè
- Division of Gastroenterology, Department of Medical and Surgical Sciences, AOU Bologna, Bologna, Italy
| | - Giuseppe Tisone
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Pierluigi Toniutto
- Medical Liver Transplant Section, Department of Medical Sciences Experimental and Clinical, University of Udine, Udine, Italy
| | | | - Riccardo Volpes
- Unit of Hepatology, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specialità, University of Pittsburgh Medical Center, Palermo, Italy
| | - Fausto Zamboni
- Department of General Surgery - Liver, Kidney and Pancreas Transplantation, AO Brotzu, Cagliari, Italy
| | - Lucio Caccamo
- Division of Hepato-Biliary-Pancreatic Surgery, IRCCS Ca' Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy -
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27
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Di Stefano C, Vanni E, Mirabella S, Younes R, Boano V, Mosso E, Nada E, Milazzo V, Maule S, Romagnoli R, Salizzoni M, Veglio F, Milan A. Risk factors for arterial hypertension after liver transplantation. J Am Soc Hypertens 2018; 12:220-229. [PMID: 29366595 DOI: 10.1016/j.jash.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 04/18/2017] [Revised: 12/29/2017] [Accepted: 01/01/2018] [Indexed: 12/11/2022]
Abstract
Arterial hypertension represents a common complication of immunosuppressive therapy after liver transplantation (LT). The aim of the study is to evaluate the prevalence and risk factors associated with hypertension after LT. From a cohort of 323 cirrhotic patients who underwent LT from 2008 to 2012, 270 patients were retrospectively evaluated, whereas 53 (16.4%) patients deceased. Hypertension was defined as blood pressure ≥140/90 mm Hg in at least two visits and/or the need for antihypertensive therapy. The prevalence of hypertension was 15% before LT and significantly increased up to 53% after LT (P < .001). Mean follow-up was 43 ± 19 months. In normotensive (NT) subjects at baseline, 35.9% developed sustained hypertension after LT, whereas 15.2% developed transient hypertension within the first month after LT, and then returned NT. The development of sustained hypertension after LT was related to the mammalian target of rapamycin inhibitor treatment (odds ratio [OR], 4.02; 95% confidence interval [CI], 1.26-13.48; P = .02), alcoholic cirrhosis before LT (OR, 3.38; 95% CI, 1.44-8.09; P = .005), and new-onset hepatic steatosis after LT (OR, 2.13; 95% CI, 1.10-4.11; P = .02). Tacrolimus, the etiology and severity of liver disease, and other immunosuppressive regimens were not related to the development of hypertension after LT. In our cohort, the prevalence of arterial hypertension has increased up to 53% after LT, and metabolic comorbidities and immunosuppressive treatment with mammalian target of rapamycin inhibitors are the risk factors for the development of hypertension after LT.
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Affiliation(s)
- Cristina Di Stefano
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy.
| | - Ester Vanni
- Division of Gastroenterology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Stefano Mirabella
- Liver Transplant Center, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Ramy Younes
- Division of Gastroenterology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Valentina Boano
- Division of Gastroenterology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Elena Mosso
- Division of Gastroenterology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Elisabetta Nada
- Liver Transplant Center, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Valeria Milazzo
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Simona Maule
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Renato Romagnoli
- Liver Transplant Center, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Mauro Salizzoni
- Liver Transplant Center, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Franco Veglio
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Alberto Milan
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy
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28
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Vinciguerra T, Brunati A, David E, Longo F, Pinon M, Ricceri F, Castellino L, Piga A, Giraudo MT, Tandoi F, Cisarò F, Dell Olio D, Isolato G, Romagnoli R, Salizzoni M, Calvo PL. Transient elastography for non-invasive evaluation of post-transplant liver graft fibrosis in children. Pediatr Transplant 2018; 22. [PMID: 29369488 DOI: 10.1111/petr.13125] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 12/15/2022]
Abstract
As graft survival in pediatric LT is often affected by progressive fibrosis, numerous centers carry out protocol liver biopsies. Follow-up biopsy protocols differ from center to center, but all biopsies are progressively spaced out, as time from transplant increases. Therefore, there is a need for non-invasive techniques to evaluate graft fibrosis progression in those children who have no clinical or serological signs of liver damage. Indirect markers, such as the APRI, should be relied on with caution because their sensitivity in predicting fibrosis can be strongly influenced by the etiology of liver disease, severity of fibrosis, and patient age. A valid alternative could be TE, a non-invasive technique already validated in adults, which estimates the stiffness of the cylindrical volume of liver tissue, 100-fold the size of a standard needle biopsy sample. The aims of this study were to evaluate the reliability of TE in children after LT and to compare both the TE and the APRI index results with the histological scores of fibrosis on liver biopsies. A total of 36 pediatric LT recipients were studied. All patients underwent both TE and biopsy within a year (median interval -0.012 months) at an interval from LT of 0.36 to 19.47 years (median 3.02 years). Fibrosis was assessed on the biopsy specimens at histology and staged according to METAVIR. There was a statistically significant correlation between TE stiffness values and METAVIR scores (P = .005). The diagnostic accuracy of TE for the diagnosis of significant fibrosis (F ≥ 2) was measured as the area under the curve (AUROC = 0.865), and it demonstrated that the method had a good diagnostic performance. APRI was not so accurate in assessing graft fibrosis when compared to METAVIR (AUROC = 0.592). A liver stiffness cutoff value of 5.6 kPa at TE was identified as the best predictor for a significant graft fibrosis (METAVIR F ≥ 2) on liver biopsy, with a 75% sensitivity, a 95.8% specificity, a 90% positive predictive value, and an 88.5% negative predictive value. These data suggest that TE may represent a non-invasive, reliable tool for the assessment of graft fibrosis in the follow-up of LT children, alerting the clinicians to the indication for a liver biopsy, with the aim of reducing the number of protocol liver biopsies.
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Affiliation(s)
- Tiziana Vinciguerra
- Gastroenterologia e Epatologia Pediatrica, Department of Pediatrics, Azienda Ospedaliera-Universitaria Citta`della Salute e della Scienza, Turin, Italy
| | - Andrea Brunati
- Liver Transplantation Center, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Ezio David
- Department of Pathology, Azienda Ospedaliera-Universitaria Citta`della Salute e della Scienza, Turin, Italy
| | - Filomena Longo
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Michele Pinon
- Gastroenterologia e Epatologia Pediatrica, Department of Pediatrics, Azienda Ospedaliera-Universitaria Citta`della Salute e della Scienza, Turin, Italy
| | - Fulvio Ricceri
- Epidemiology Unit, Regional Health Services ASL TO3, Grugliasco, Italy.,Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luisa Castellino
- Department of Mathematics "G. Peano", University of Turin, Turin, Italy
| | - Antonio Piga
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Francesco Tandoi
- Liver Transplantation Center, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fabio Cisarò
- Gastroenterologia e Epatologia Pediatrica, Department of Pediatrics, Azienda Ospedaliera-Universitaria Citta`della Salute e della Scienza, Turin, Italy
| | - Dominic Dell Olio
- Regional Transplant Center, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Giuseppe Isolato
- Institute of Diagnostic and Interventional Radiology, Azienda Ospedaliera-Universitaria Citta`della Salute e della Scienza, Turin, Italy
| | - Renato Romagnoli
- Liver Transplantation Center, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Mauro Salizzoni
- Liver Transplantation Center, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pier Luigi Calvo
- Gastroenterologia e Epatologia Pediatrica, Department of Pediatrics, Azienda Ospedaliera-Universitaria Citta`della Salute e della Scienza, Turin, Italy
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29
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Pommergaard HC, Rostved AA, Adam R, Thygesen LC, Salizzoni M, Gómez Bravo MA, Cherqui D, De Simone P, Boudjema K, Mazzaferro V, Soubrane O, García-Valdecasas JC, Fabregat Prous J, Pinna AD, O'Grady J, Karam V, Duvoux C, Rasmussen A. Locoregional treatments before liver transplantation for hepatocellular carcinoma: a study from the European Liver Transplant Registry. Transpl Int 2018; 31:531-539. [PMID: 29380442 DOI: 10.1111/tri.13123] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 10/25/2017] [Revised: 11/20/2017] [Accepted: 01/23/2018] [Indexed: 12/15/2022]
Abstract
Locoregional treatment while on the waiting list for liver transplantation (Ltx) for hepatocellular carcinoma (HCC) has been shown to improve survival. However, the effect of treatment type has not been investigated. We investigate the effect of locoregional treatment type on survival after Ltx for HCC. We investigated patients registered in the European Liver Transplant Registry database using multivariate Cox regression survival analysis. Information on locoregional therapy was registered for 4978 of 23 124 patients and was associated with improved overall survival [hazard ratio (HR) 0.84 (0.73-0.96)] and HCC-specific survival [HR 0.76 (0.59-0.98)]. Radiofrequency ablation (RFA) was the one monotherapy associated with improved overall survival [HR 0.51 (0.40-0.65)]. In addition, the combination of RFA and transarterial chemoembolization also improved survival [HR 0.74 (0.55-0.99)]. Adjusting for factors related to prognosis, disease severity, and tumor aggressiveness, RFA was highly beneficial for overall and HCC-specific survival. The effect may represent a selection of patients with favorable tumor biology; however, the treatment may be effective per se by halting tumor progression. Clinicaltrials.gov number: NCT02995096.
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Affiliation(s)
- Hans-Christian Pommergaard
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Arendtsen Rostved
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - René Adam
- Department of Hepatobiliary Surgery, Cancer and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U 935, University Paris-Sud, Villejuif, France
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Mauro Salizzoni
- Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | | | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Cancer and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U 935, University Paris-Sud, Villejuif, France
| | - Paolo De Simone
- Liver Transplantation Unit, Hepatobiliary Surgery, University of Pisa Medical School Hospital, Pisa, Italy
| | - Karim Boudjema
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Université de Rennes 1, Rennes, France.,INSERM, UMR991, Foie, Métabolisme et Cancer, Université de Rennes 1, Rennes, France
| | - Vincenzo Mazzaferro
- Division of Gastrointestinal Surgery and Liver Transplantation, Istituto Nazionale Tumori, Fondazione IRCCS, University of Milan, Milan, Italy
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, University Denis Diderot, Paris, France
| | | | - Joan Fabregat Prous
- Unitat de Cirurgia Hepato-Bilio-Pancreàtica, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Antonio D Pinna
- General Surgery and Transplant Division, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - John O'Grady
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Vincent Karam
- Department of Hepatobiliary Surgery, Cancer and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U 935, University Paris-Sud, Villejuif, France
| | - Christophe Duvoux
- Liver Transplant Unit, Department of Hepatology, Henri Mondor Hospital, Paris Est University (UPEC), Créteil, France
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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30
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Baumann U, Adam R, Duvoux C, Mikolajczyk R, Karam V, D'Antiga L, Chardot C, Coker A, Colledan M, Ericzon BG, Line PD, Hadzic N, Isoniemi H, Klempnauer JL, Reding R, McKiernan PJ, McLin V, Paul A, Salizzoni M, Furtado ESB, Schneeberger S, Karch A. Survival of children after liver transplantation for hepatocellular carcinoma. Liver Transpl 2018; 24:246-255. [PMID: 29222922 DOI: 10.1002/lt.24994] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/06/2017] [Accepted: 11/06/2017] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma (HCC) in childhood differs from adult HCC because it is often associated with inherited liver disease. It is, however, unclear whether liver transplantation (LT) for HCC in childhood with or without associated inherited disease has a comparable outcome to adult HCC. On the basis of data from the European Liver Transplant Registry (ELTR), we aimed to investigate if there are differences in patient and graft survival after LT for HCC between children and adults and between patients with underlying inherited versus noninherited liver disease, respectively. We included all 175 children who underwent LT for HCC and were enrolled in ELTR between 1985 and 2012. Of these, 38 had an associated inherited liver disease. Adult HCC patients with (n = 79) and without (n = 316, matched by age, sex, and LT date) inherited liver disease served as an adult comparison population. We used multivariable piecewise Cox regression models with shared frailty terms (for LT center) to compare patient and graft survival between the different HCC groups. Survival analyses demonstrated a superior longterm survival of children with inherited liver disease when compared with children with HCC without inherited liver disease (hazard ratio [HR], 0.29; 95% CI, 0.10-0.90; P = 0.03) and adults with HCC with inherited liver disease (HR, 0.27; 95% CI, 0.06-1.25; P = 0.09). There was no survival difference between adults with and without inherited disease (HR, 1.05; 95% CI, 0.66-1.66; P = 0.84). In conclusion, the potential survival advantage of children with an HCC based on inherited disease should be acknowledged when considering transplantation and prioritization for these patients. Further prospective studies accounting for tumor size and extension at LT are necessary to fully interpret our findings. Liver Transplantation 24 246-255 2018 AASLD.
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Affiliation(s)
- Ulrich Baumann
- Department for Pediatric Kidney, Liver, and Metabolic Diseases, Division of Pediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany
| | - René Adam
- European Liver Transplant Registry, INSERM U 935, AP-HP Hôpital Paul Brousse, Université Paris-Sud, Villejuif, France
| | - Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital AP-HP, Paris Est University, Créteil, France
| | - Rafael Mikolajczyk
- Research Group Epidemiological and Statistical Methods, Helmholtz Centre for Infection Research, Braunschweig, Germany.,German Center for Infection Research, Hannover-Braunschweig Site, Braunschweig, Germany
| | - Vincent Karam
- European Liver Transplant Registry, INSERM U 935, AP-HP Hôpital Paul Brousse, Université Paris-Sud, Villejuif, France
| | - Lorenzo D'Antiga
- Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Christophe Chardot
- Hopital Necker Enfants Malades, Service de Chirurgie Pediatrique, Paris, France
| | - Ahmet Coker
- Division of Hepatobiliary and Liver Transplantation, Department of Surgery Division, Ege University Medical School, Izmir, Turkey
| | - Michele Colledan
- Papa Giovanni 23 Hospital, Chirurgia III e Centro Trapianti di Fegato, Bergamo, Italy
| | - Bo-Goran Ericzon
- Department of Transplantation Surgery, Huddinge Hospital, Huddinge, Sweden
| | - Pål Dag Line
- Radiumhospitalet Medical Center Liver Transplant Unit, Rikshospitalet, Oslo, Norway
| | | | - Helena Isoniemi
- Transplantation and Liver Surgery Clinic, U.C.Helsingfors, Helsinki, Finland
| | - Jürgen L Klempnauer
- Klinik für Viszeral und Transplantationschirurgie, Hannover Medical School, Hannover, Germany
| | - Raymond Reding
- Cliniques Universitaires Saint Luc, Catholic University of Louvain, Brussels, Belgium
| | | | - Valérie McLin
- Swiss Center for Liver Disease in Children, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Andreas Paul
- Klinik für allgemeine und Transplantationschirurgie, C.U.K. GHS Essen, Essen, Germany
| | - Mauro Salizzoni
- Centro de Trapianti de Fegato, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy
| | - Emanuel San Bento Furtado
- Gabinete de Coordenacao de Colheita de Orgaos e Transplantacao, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - Stefan Schneeberger
- Department of General and Transplant Surgery, University Hospital, Innsbruck, Austria
| | - André Karch
- Research Group Epidemiological and Statistical Methods, Helmholtz Centre for Infection Research, Braunschweig, Germany.,German Center for Infection Research, Hannover-Braunschweig Site, Braunschweig, Germany
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Martini S, David E, Tandoi F, Dell Olio D, Salizzoni M, Saracco GM, Romagnoli R. HCV viremic donors with hepatic bridging fibrosis: Are we ready to use their livers in the era of direct-acting antivirals? Am J Transplant 2017; 17:2986-2987. [PMID: 28742943 DOI: 10.1111/ajt.14447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/07/2017] [Accepted: 07/17/2017] [Indexed: 01/25/2023]
Affiliation(s)
- S Martini
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | - E David
- Pathology Unit, AOU Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | - F Tandoi
- Liver Transplantation Center and General Surgery 2U, AOU Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | - D Dell Olio
- Regional Transplantation Center, Piedmont, AOU Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | - M Salizzoni
- Liver Transplantation Center and General Surgery 2U, AOU Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | - G M Saracco
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | - R Romagnoli
- Liver Transplantation Center and General Surgery 2U, AOU Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
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Patrono D, Lavezzo B, Molinaro L, Rizza G, Catalano G, Gonella F, Salizzoni M, Romagnoli R. Hypothermic Oxygenated Machine Perfusion for Liver Transplantation: An Initial Experience. EXP CLIN TRANSPLANT 2017; 16:172-176. [PMID: 29108514 DOI: 10.6002/ect.2016.0347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Due to widespread exploitation of extended criteria donors, machine perfusion is emerging as an alternative to static cold storage for organ preservation. Hypothermic oxygenated machine perfusion has been associated with improved outcomes after liver transplant, both in laboratory and clinical settings. Here, we present our initial experience with hypothermic oxygenated machine perfusion, evaluating incidence of postreperfusion syndrome, early allograft dysfunction, and long-term biliary complications. MATERIALS AND METHODS End-ischemic dual (hepatic artery and portal vein) hypothermic oxygenated machine perfusion was carried out for 150 to 200 minutes before organ implantation in 4 liver transplants considered at increased risk due to donor, recipient, or matching issues. RESULTS No device malfunction occurred. Theatre logistics were minimally affected. Incidences of post-reperfusion syndrome and early allograft dysfunction were 25% and 50%. At 6-month follow-up, all patients were alive with normal hepatic function and no evidence of ischemic cholangiopathy. CONCLUSIONS In our experience, hypothermic oxygenated machine perfusion appeared safe and logistically simple. Further studies are needed to assess the real value of this technique and to identify which subset of patients would benefit from its implementation.
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Affiliation(s)
- Damiano Patrono
- From the Department of General Surgery, Liver Transplant Center, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
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Herrera Sanchez MB, Previdi S, Bruno S, Fonsato V, Deregibus MC, Kholia S, Petrillo S, Tolosano E, Critelli R, Spada M, Romagnoli R, Salizzoni M, Tetta C, Camussi G. Extracellular vesicles from human liver stem cells restore argininosuccinate synthase deficiency. Stem Cell Res Ther 2017; 8:176. [PMID: 28750687 PMCID: PMC5531104 DOI: 10.1186/s13287-017-0628-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 03/07/2017] [Revised: 06/16/2017] [Accepted: 07/10/2017] [Indexed: 11/25/2022] Open
Abstract
Background Argininosuccinate synthase (ASS)1 is a urea cycle enzyme that catalyzes the conversion of citrulline and aspartate to argininosuccinate. Mutations in the ASS1 gene cause citrullinemia type I, a rare autosomal recessive disorder characterized by neonatal hyperammonemia, elevated citrulline levels, and early neonatal death. Treatment for this disease is currently restricted to liver transplantation; however, due to limited organ availability, substitute therapies are required. Recently, extracellular vesicles (EVs) have been reported to act as intercellular transporters carrying genetic information responsible for cell reprogramming. In previous studies, we isolated a population of stem cell-like cells known as human liver stem cells (HLSCs) from healthy liver tissue. Moreover, EVs derived from HLSCs were reported to exhibit regenerative effects on the liver parenchyma in models of acute liver injury. The aim of this study was to evaluate whether EVs derived from normal HLSCs restored ASS1 enzymatic activity and urea production in hepatocytes differentiated from HLSCs derived from a patient with type I citrullinemia. Methods HLSCs were isolated from the liver of a patient with type I citrullinemia (ASS1-HLSCs) and characterized by fluorescence-activated cell sorting (FACS), immunofluorescence, and DNA sequencing analysis. Furthermore, their differentiation capabilities in vitro were also assessed. Hepatocytes differentiated from ASS1-HLSCs were evaluated by the production of urea and ASS enzymatic activity. EVs derived from normal HLSCs were purified by differential ultracentrifugation followed by floating density gradient. The EV content was analyzed to identify the presence of ASS1 protein, mRNA, and ASS1 gene. In order to obtain ASS1-depleted EVs, a knockdown of the ASS1 gene in HLSCs was performed followed by EV isolation from these cells. Results Treating ASS1-HLSCs with EVs from HLSCs restored both ASS1 activity and urea production mainly through the transfer of ASS1 enzyme and mRNA. In fact, EVs from ASS1-knockdown HLSCs contained low amounts of ASS1 mRNA and protein, and were unable to restore urea production in hepatocytes differentiated from ASS1-HLSCs. Conclusions Collectively, these results suggest that EVs derived from normal HLSCs may compensate the loss of ASS1 enzyme activity in hepatocytes differentiated from ASS1-HLSCs. Electronic supplementary material The online version of this article (doi:10.1186/s13287-017-0628-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Beatriz Herrera Sanchez
- 2i3T, Società per la gestione dell'incubatore di imprese e per il trasferimento tecnologico, Scarl University of Torino, Torino, Italy.,Molecular Biotechnology Center, University of Torino, Torino, Italy
| | | | - Stefania Bruno
- Department of Molecular Biotechnology and Health Science, University of Torino, Torino, Italy
| | - Valentina Fonsato
- 2i3T, Società per la gestione dell'incubatore di imprese e per il trasferimento tecnologico, Scarl University of Torino, Torino, Italy.,Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Maria Chiara Deregibus
- 2i3T, Società per la gestione dell'incubatore di imprese e per il trasferimento tecnologico, Scarl University of Torino, Torino, Italy.,Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Sharad Kholia
- Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Sara Petrillo
- Department of Molecular Biotechnology and Health Science, University of Torino, Torino, Italy
| | - Emanuela Tolosano
- Department of Molecular Biotechnology and Health Science, University of Torino, Torino, Italy
| | - Rossana Critelli
- Molecular and Genetic Epidemiology Unit, Human Genetics Foundation, Torino, Italy
| | - Marco Spada
- Department of Pediatrics, Regina Margherita Children's Hospital, University of Torino, Torino, Italy
| | - Renato Romagnoli
- Liver Transplantation Center, University of Torino, Torino, Italy
| | - Mauro Salizzoni
- Liver Transplantation Center, University of Torino, Torino, Italy
| | | | - Giovanni Camussi
- Department of Medical Sciences, University of Torino, Corso Dogliotti 14, I-10126, Torino, Italy.
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Martini S, Tandoi F, Terzi di Bergamo L, Strona S, Lavezzo B, Sacco M, Maione F, Gonella F, Strignano P, Dell Olio D, Salizzoni M, Saracco GM, Romagnoli R. Negativization of viremia prior to liver transplant reduces early allograft dysfunction in hepatitis C-positive recipients. Liver Transpl 2017; 23:915-924. [PMID: 28422425 DOI: 10.1002/lt.24772] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/15/2017] [Accepted: 04/07/2017] [Indexed: 12/13/2022]
Abstract
Although early allograft dysfunction (EAD) negatively impacts survival from the first months following liver transplantation (LT), direct-acting antiviral agents (DAAs) have revolutionized hepatitis C virus (HCV) therapy. We investigated the EAD definition best predicting 90-day graft loss and identified EAD risk factors in HCV-positive recipients. From November 2002 to June 2016, 603 HCV-positive patients (hepatocellular carcinoma, 53.4%) underwent a first LT with HCV-negative donors. The median recipient Model for End-Stage Liver Disease (MELD) score was 15, and the median donor age was 63 years. At LT, 77 (12.8%) patients were HCV RNA negative; negativization was achieved and maintained by pre-LT antiviral therapy (61 patients) or pre-LT plus a pre-emptive post-LT course (16 patients); 60 (77.9%) patients received DAAs and 17 (22.1%) interferon. We compared 3 different EAD definitions: (1) bilirubin ≥ 10 mg/dL or international normalized ratio ≥ 1.6 on day 7 after LT or aspartate aminotransferase or alanine aminotransferase > 2000 IU/L within 7 days of LT; (2) bilirubin > 10 mg/dL on days 2-7 after LT; and (3) MELD ≥ 19 on day 5 after LT. EAD defined by MELD ≥ 19 on day 5 after LT had the lowest negative (0.1) and the highest positive (1.9) likelihood ratio to predict 90-day graft loss. At 90 days after LT, 9.2% of recipients with EAD lost their graft as opposed to 0.7% of those without EAD (P < 0.001). At multivariate analysis, considering variables available at LT, MELD at LT of >25 (OR = 7.4) or 15-25 (OR = 3.2), graft macrovesicular steatosis ≥ 30% (OR = 6.7), HCV RNA positive at LT (OR = 2.7), donor age > 70 years (OR = 2.0), earlier LT era (OR = 1.8), and cold ischemia time ≥ 8 hours (OR = 1.8) were significant risk factors for EAD. In conclusion, in HCV-positive patients, MELD ≥ 19 on day 5 after LT best predicts 90-day graft loss. Preventing graft infection by pre-/peri-LT antiviral therapy reduces EAD incidence and could be most beneficial in high-MELD patients and recipients of suboptimal grafts. Liver Transplantation 23 915-924 2017 AASLD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Dominic Dell Olio
- Regional Transplant Center, Piedmont, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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35
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Martini S, Salizzoni M, David E, Tandoi F, Fonio P, Delsedime L, Strona S, Dell Olio D, Saracco GM, Romagnoli R. Favorable short-term outcome of hepatitis C virus-positive liver graft with bridging fibrosis: A plea for very early viral eradication. Hepatology 2017; 65:2116-2118. [PMID: 27981614 DOI: 10.1002/hep.28978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/29/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Silvia Martini
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mauro Salizzoni
- Liver Transplantation Center and General Surgery 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Ezio David
- Pathology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesco Tandoi
- Liver Transplantation Center and General Surgery 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paolo Fonio
- Radiology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Luisa Delsedime
- Pathology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Silvia Strona
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Dominic Dell Olio
- Regional Transplantation Center, Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Giorgio Maria Saracco
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Renato Romagnoli
- Liver Transplantation Center and General Surgery 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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36
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Patrono D, Tandoi F, Rizza G, Catalano G, Mirabella S, Celoria P, Corcione S, De Rosa FG, Salizzoni M, Romagnoli R. Liver transplantation with an uncommon full right hemiliver graft after hydatid cysts resection: Case report and review of the literature. Transpl Infect Dis 2017; 19. [PMID: 28244199 DOI: 10.1111/tid.12685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/04/2016] [Revised: 11/23/2016] [Accepted: 12/04/2016] [Indexed: 11/28/2022]
Abstract
Because of widespread organ shortage, the transplant community has been exploiting more and more so-called "extended criteria" donors. In this scenario, liver grafts harboring benign tumors or large cysts represent an infrequent but potentially valuable source of viable grafts. We depict a challenging case of liver transplantation performed using a graft harboring two large Echinococcus granulosus hydatid cysts in close proximity with the hilar plate and complicated by cystobiliary communication. Although liver transplantation using grafts with hydatid cyst has been rarely reported (three published cases), our case was peculiar as one of the cysts was located close to the hilum and was ruptured into the left hepatic duct. The graft was finally accepted taking into account the low risk profile of the recipient, the good quality and size of the remnant liver parenchyma, and only after complete resection of the cysts was achieved. Although the recipient had a complication due to biliary confluence necrosis, at 10-months follow-up he is in good health with normal hepatic function, and a graft that could have been otherwise discarded was successfully used. The decision process along with technical and management issues are discussed.
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Affiliation(s)
- Damiano Patrono
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Tandoi
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giorgia Rizza
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giorgia Catalano
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Mirabella
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Piero Celoria
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Silvia Corcione
- Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Mauro Salizzoni
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Renato Romagnoli
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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Cantù P, Parzanese I, Balassone V, Di Sario A, Soggiu F, Lombardi G, Barbaro F, Pisani A, Baldan A, Cariani G, Boarino V, Fasoli A, Bertani H, Forti E, Bulajic M, Ghinolfi D, Nadal E, Cerofolini A, Barresi L, Catalano G, Stroppa I, Traini S, Mazzaferro V, Cipolletta L, Tringali A, Costamagna G, Ravelli P, Bazzoli F, Merighi A, Parodi MC, Conigliaro R, Mutignani M, Zilli M, Filipponi F, Fantin A, Rodella L, Tarantino I, Traina M, Salizzoni M, Rosa R, Malinverno F, Invernizzi F, Manini MA, Donato MF, Colombo M, Conte D, Rossi G, Penagini R. Management of biliary anastomotic strictures after liver transplantation (BASALT study): A nationwide Italian survey. Liver Transpl 2017; 23:257-261. [PMID: 28006872 DOI: 10.1002/lt.24701] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/30/2016] [Indexed: 02/07/2023]
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Calvo PL, Serpe L, Brunati A, Nonnato A, Bongioanni D, Olio DD, Pinon M, Ferretti C, Tandoi F, Carbonaro G, Salizzoni M, Amoroso A, Romagnoli R, Canaparo R. Donor CYP3A5 genotype influences tacrolimus disposition on the first day after paediatric liver transplantation. Br J Clin Pharmacol 2017; 83:1252-1262. [PMID: 28044353 DOI: 10.1111/bcp.13219] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/05/2016] [Accepted: 12/18/2016] [Indexed: 12/12/2022] Open
Abstract
AIM The aim of the present study was to investigate the influence of the cytochrome P450 (CYP) 3A4/5 genotype in paediatric liver transplant recipients and donors, and the contribution of age and gender to tacrolimus disposition on the first day after transplantation. METHODS The contribution of the CYP3A4/5 genotype in paediatric liver transplant recipients and donors to the tacrolimus blood trough concentrations (C0 ) and the tacrolimus concentration/weight-adjusted dose ratio on day 1 was evaluated in 67 liver-transplanted children: 33 boys and 34 girls, mean age 4.5 years. RESULTS Donor CYP3A5 genotype appears to be significantly associated with tacrolimus disposition on the first day after liver transplantation (P < 0.0002). Other physiological factors, such as recipient age and donor gender may also play a role and lead to significant differences in tacrolimus C0 and tacrolimus concentration/weight-adjusted dose ratio on day 1. However, according to the general linear model, only recipient age appears to be independently associated with tacrolimus disposition on the first day after liver transplantation (P < 0.03). Indeed, there was a faster tacrolimus metabolism in children under 6 years of age (P < 0.02). CONCLUSIONS Donor CYP3A5 genotype, recipient age and, to a lesser extent, donor gender appear to be associated with tacrolimus disposition on day 1 after transplant. This suggests that increasing the starting tacrolimus doses in paediatric patients under 6 years of age who receive a graft from a male extensive metabolizer may enhance the possibility of their tacrolimus levels reaching the therapeutic range sooner.
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Affiliation(s)
- Pier Luigi Calvo
- Department of Pediatrics and Public Health Sciences, Division of Pediatric Gastroenterology, A.O.U. Città della Salute e della Scienza of Torino, University of Torino, Torino, Italy
| | - Loredana Serpe
- Department of Drug Science and Technology, University of Torino, Torino, Italy
| | - Andrea Brunati
- Department of Surgical Sciences, Liver Transplantation Center, A.O.U. Città della Salute e della Scienza of Torino, University of Torino, Torino, Italy
| | - Antonello Nonnato
- Clinical Biochemistry Unit, A.O.U. Città della Salute e della Scienza of Torino, Torino, Italy
| | - Daniela Bongioanni
- Department of Medical Sciences, Regional Transplantation Center, A.O.U. Città della Salute e della Scienza of Torino, University of Torino, Torino, Italy
| | - Dominic Dell' Olio
- Department of Medical Sciences, Regional Transplantation Center, A.O.U. Città della Salute e della Scienza of Torino, University of Torino, Torino, Italy
| | - Michele Pinon
- Department of Pediatrics and Public Health Sciences, Division of Pediatric Gastroenterology, A.O.U. Città della Salute e della Scienza of Torino, University of Torino, Torino, Italy
| | - Carlo Ferretti
- Department of Drug Science and Technology, University of Torino, Torino, Italy
| | - Francesco Tandoi
- Department of Surgical Sciences, Liver Transplantation Center, A.O.U. Città della Salute e della Scienza of Torino, University of Torino, Torino, Italy
| | - Giulia Carbonaro
- Department of Surgical Sciences, Liver Transplantation Center, A.O.U. Città della Salute e della Scienza of Torino, University of Torino, Torino, Italy
| | - Mauro Salizzoni
- Department of Surgical Sciences, Liver Transplantation Center, A.O.U. Città della Salute e della Scienza of Torino, University of Torino, Torino, Italy
| | - Antonio Amoroso
- Department of Medical Sciences, Regional Transplantation Center, A.O.U. Città della Salute e della Scienza of Torino, University of Torino, Torino, Italy
| | - Renato Romagnoli
- Department of Surgical Sciences, Liver Transplantation Center, A.O.U. Città della Salute e della Scienza of Torino, University of Torino, Torino, Italy
| | - Roberto Canaparo
- Department of Drug Science and Technology, University of Torino, Torino, Italy
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39
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Martini S, Sacco M, Strona S, Arese D, Tandoi F, Dell Olio D, Stradella D, Cocchis D, Mirabella S, Rizza G, Magistroni P, Moschini P, Ottobrelli A, Amoroso A, Rizzetto M, Salizzoni M, Saracco GM, Romagnoli R. Impact of viral eradication with sofosbuvir-based therapy on the outcome of post-transplant hepatitis C with severe fibrosis. Liver Int 2017; 37:62-70. [PMID: 27344058 DOI: 10.1111/liv.13193] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 04/05/2016] [Accepted: 06/23/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Several studies have shown that new direct-acting antivirals maintain their efficacy in liver transplant (LT) recipients with severe hepatitis C virus (HCV) recurrence. We determined the clinical impact of sofosbuvir/ribavirin in LT through the changes in liver function and fibrosis state at 24 and 48 weeks after treatment. METHODS Between June 2014 and July 2015, 126 patients (30 F3, 96 F4 Metavir stage) were enrolled to receive sofosbuvir + ribavirin (24 weeks, 118 patients) or sofosbuvir + simeprevir + ribavirin (12 weeks, 8 patients); treatment was initiated at a median time of 4.3 years from LT. Median follow-up after therapy completion was 461 days. RESULTS All 30 F3 patients achieved a sustained virological response at week 24 after treatment (SVR24) and showed a distinct amelioration of the AST-to-platelet ratio index (APRI), FIB-4 and liver stiffness at elastography by week 24 post-therapy, which were maintained at week 48. Of the 96 F4 cirrhotic patients, 72 (75%) achieved SVR24 accompanied by significant improvement of liver function, which was maintained at week 48 (Child B-C 22% baseline, 11% week 24, 7% week 48); APRI, FIB-4 and liver stiffness further improved significantly between weeks 24 and 48 of follow-up. Among the 77 responders (27 F3, 50 F4) who underwent elastography at baseline and at the end of follow-up, 39 (50.6%; 18 F3, 21 F4) exhibited a regression in fibrosis stage. CONCLUSION At about 1 year from the completion of successful sofosbuvir-based therapy, patients with post-LT HCV and severe fibrosis experienced a long-term liver function improvement accompanied by a regression of fibrosis stage in half of them.
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Affiliation(s)
- Silvia Martini
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Marco Sacco
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Silvia Strona
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Daniele Arese
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesco Tandoi
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Dominic Dell Olio
- Regional Transplantation Center, Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Davide Stradella
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Donatella Cocchis
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Stefano Mirabella
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Giorgia Rizza
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paola Magistroni
- Regional Transplantation Center, Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Pamela Moschini
- Regional Transplantation Center, Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio Ottobrelli
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio Amoroso
- Regional Transplantation Center, Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mario Rizzetto
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mauro Salizzoni
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Giorgio M Saracco
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Renato Romagnoli
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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40
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Garbarini A, Reggio D, Arolfo S, Bruno M, Passera R, Catalano G, Barletti C, Salizzoni M, Morino M, Petruzzelli L, Arezzo A. Cost analysis of laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis. Surg Endosc 2016; 31:3291-3296. [DOI: 10.1007/s00464-016-5361-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/13/2016] [Indexed: 01/15/2023]
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Gilbo N, Catalano G, Salizzoni M, Romagnoli R. Liver graft preconditioning, preservation and reconditioning. Dig Liver Dis 2016; 48:1265-1274. [PMID: 27448845 DOI: 10.1016/j.dld.2016.06.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 01/18/2016] [Revised: 05/02/2016] [Accepted: 06/27/2016] [Indexed: 12/11/2022]
Abstract
Liver transplantation is the successful treatment of end-stage liver disease; however, the ischaemia-reperfusion injury still jeopardizes early and long-term post-transplant outcomes. In fact, ischaemia-reperfusion is associated with increased morbidity and graft dysfunction, especially when suboptimal donors are utilized. Strategies to reduce the severity of ischaemia-reperfusion can be applied at different steps of the transplantation process: organ procurement, preservation phase or before revascularization. During the donor procedure, preconditioning consists of pre-treating the graft prior to a sustained ischaemia either by a transient period of ischaemia-reperfusion or administration of anti-ischaemic medication, although a multi-pharmacological approach seems more promising. Different preservation solutions were developed to maintain graft viability during static cold storage, achieving substantial results in terms of liver function and survival in good quality organs but not in suboptimal ones. Indeed, preservation solutions do not prevent dysfunction of poor quality organs and are burdened with inadequate preservation of the biliary epithelium. Advantages derived from either hypo- or normothermic machine perfusion are currently investigated in experimental and clinical settings, suggesting a reconditioning effect possibly improving hepatocyte and biliary preservation and resuscitating graft function prior to transplantation. In this review, we highlight acquired knowledge and recent advances in liver graft preconditioning, preservation and reconditioning.
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Affiliation(s)
- Nicholas Gilbo
- Liver Transplantation Center, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Giorgia Catalano
- Liver Transplantation Center, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mauro Salizzoni
- Liver Transplantation Center, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Renato Romagnoli
- Liver Transplantation Center, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
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Romagnoli R, Martini S, Tandoi F, Dell Olio D, Magistroni P, Bertinetto FE, Dametto E, Rizzetto M, Salizzoni M, Amoroso A. Early reduced liver graft survival in hepatitis C recipients identified by two combined genetic markers. Transpl Int 2016; 29:1070-84. [PMID: 27172242 DOI: 10.1111/tri.12795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/23/2016] [Accepted: 05/09/2016] [Indexed: 01/08/2023]
Abstract
HLA and IL-28B genes were independently associated with severity of HCV-related liver disease. We investigated the effects of these combined genetic factors on post-transplant survival in HCV-infected recipients, aiming to provide new data to define the optimal timing of novel antiviral therapies in the transplant setting. HLA-A/B/DRB1 alleles and IL-28B rs12979860 (C > T) polymorphism frequencies were determined in 449 HCV viremic recipients and in their donors. Median follow-up was 10 years; study outcome was graft survival. HLA-DRB1*11 phenotype and IL-28B C/C genotype were significantly less frequent in recipients than donors (27.8% vs. 45.9% and 27.4% vs. 44.9%, respectively, P < 0.00001). Ten-year graft survival was better in patients with HLA-DRB1*11 (P = 0.0183) or IL-28B C/C (P = 0.0436). Conversely, concomitant absence of HLA-DRB1*11 and IL-28B C/C in 228 (50.8%) predicted worse survival (P = 0.0006), which was already evident at the first post-transplant year (P = 0.0370). In multivariable Cox analysis, absence of both markers ranked second as risk factor for survival (HR = 1.74), following donor age ≥ 70 years (HR = 1.77). In the current era of direct-acting antiviral agents, the negative effects of this common immunogenetic profile in HCV-infected recipients could be most effectively neutralized by peri-transplant treatment. This should be particularly relevant in countries where elderly donors represent an unavoidable resource.
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Affiliation(s)
- Renato Romagnoli
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Silvia Martini
- Liver Transplantation Center, Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesco Tandoi
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Dominic Dell Olio
- Regional Transplantation Center - Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paola Magistroni
- Regional Transplantation Center - Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
- Immunogenetics Laboratory, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesca E Bertinetto
- Regional Transplantation Center - Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
- Immunogenetics Laboratory, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Ennia Dametto
- Regional Transplantation Center - Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
- Immunogenetics Laboratory, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mario Rizzetto
- Liver Transplantation Center, Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mauro Salizzoni
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio Amoroso
- Regional Transplantation Center - Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
- Immunogenetics Laboratory, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
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43
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Guarneri A, Franco P, Romagnoli R, Trino E, Mirabella S, Molinaro L, Rizza G, Filippi AR, Carucci P, Salizzoni M, Ricardi U. Stereotactic ablative radiation therapy prior to liver transplantation in hepatocellular carcinoma. Radiol Med 2016; 121:873-881. [DOI: 10.1007/s11547-016-0670-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/12/2016] [Indexed: 12/31/2022]
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44
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Romagnoli R, Martini S, Giacometti R, David E, Martina MC, D'Errico A, Grigioni WF, Strignano P, Rizza G, Mirabella S, Amoroso A, Salizzoni M. Successful Urgent Liver Retransplantation for Donor-Transmitted Hepatocellular Carcinoma. Am J Transplant 2016; 16:1938-9. [PMID: 26752588 DOI: 10.1111/ajt.13712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- R Romagnoli
- Liver Transplantation Center, General Surgery Unit 2U, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - S Martini
- Liver Transplantation Center, Gastrohepatology Unit, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - R Giacometti
- Regional Transplantation Center, Piedmont, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - E David
- Pathology Unit, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - M C Martina
- Radiology Unit 3U, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - A D'Errico
- Department of Specialty, Diagnostic and Experimental Medicine (DIMES), "F. Addarii" Institute of Oncology and Transplant Pathology, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - W F Grigioni
- Department of Specialty, Diagnostic and Experimental Medicine (DIMES), "F. Addarii" Institute of Oncology and Transplant Pathology, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - P Strignano
- Liver Transplantation Center, General Surgery Unit 2U, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - G Rizza
- Liver Transplantation Center, General Surgery Unit 2U, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - S Mirabella
- Liver Transplantation Center, General Surgery Unit 2U, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - A Amoroso
- Regional Transplantation Center, Piedmont, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - M Salizzoni
- Liver Transplantation Center, General Surgery Unit 2U, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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45
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Catalano G, Tandoi F, Mazza E, Simonato F, Tognarelli G, Biancone L, Lupo F, Romagnoli R, Salizzoni M. Simultaneous Liver-Kidney Transplantation in Adults: A Single-center Experience Comparing Results With Isolated Liver Transplantation. Transplant Proc 2016; 47:2156-8. [PMID: 26361666 DOI: 10.1016/j.transproceed.2014.11.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 11/19/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND After introduction of the Model for End-Stage Liver Disease (MELD) score in 2002, a worldwide increasing number of simultaneous liver-kidney transplantations (SLKTx) has been observed. However, organ shortage puts into question the allocation of 2 grafts to 1 recipient. This retrospective, single-center study compared SLKTx results with isolated liver transplantation (LTx). METHODS Between 1995 and 2013, 37 SLKTx were performed in adult recipients. Every SLKTx was matched by donor age (±5 years) and transplantation date with 2 LTx (n = 74). Pretransplant, intraoperative, and post-transplant variables were collected; liver graft and patient survivals were calculated. RESULTS As expected, donor age was similar in the 2 groups (median, 39.7 years), whereas serum creatinine level, glomerular filtration rate, and MELD and D-MELD (donor age*MELD) scores were significantly higher in the SLKTx group. SLKTx had longer waiting list time (P = .0034) as well as higher surgical difficulty, testified by more blood transfusions (P = .0083), increased use of classic caval reconstruction (P = .0024), and more frequent need of abdominal packing for bleeding control (P = .0003). In addition, duration of hospital stay (P < .0001), second-look surgery (P = .0082), post-transplant dialysis (P < .0001), and post-transplant infections (P = .04) were significantly greater in SLKTx group. Acute rejection episodes involving the liver were significantly less in SLKTx than in LTx (14% vs 41%; P = .0045). Liver graft and patient survival at 10 years after transplantation was similar in the 2 groups (liver graft: SLKTx, 80% vs LTx, 77% [P = .85]; patient: SLKTx, 86% vs LTx, 79% [P = .56]). CONCLUSIONS Despite being technically challenging, SLKTx provided excellent long-term results and was shown to be an effective use of liver grafts.
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Affiliation(s)
- G Catalano
- Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy.
| | - F Tandoi
- Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - E Mazza
- Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - F Simonato
- Kidney Transplant Center and Nephrology, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - G Tognarelli
- Kidney Transplant Center and Nephrology, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - L Biancone
- Kidney Transplant Center and Nephrology, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - F Lupo
- Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - R Romagnoli
- Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - M Salizzoni
- Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
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46
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Hosokawa I, Allard MA, Nitta H, Lapointe RW, Mirza D, Nuzzo G, Barroso E, Kaiser G, Hubert C, Capussotti L, Poston GJ, Popescu I, Lopezben S, IJzermans JN, Ouellet JF, Salizzoni M, Oreilly D, Skipenko O, Adam R. Oncological benefit of parenchyma-preserving hepatectomy for colorectal liver metastasis. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Isamu Hosokawa
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France
| | | | - Hidetoshi Nitta
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France
| | | | - Darius Mirza
- Birmingham Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Gennaro Nuzzo
- Catholic University, Hepatobiliary Surgery Unit, Rome, Italy
| | - Eduardo Barroso
- Centro Hepato-Bilio-Pancreatico e de Transplantacao do Hospital de Curry Cabral, Lisbon, Portugal
| | | | - Catherine Hubert
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Lorenzo Capussotti
- S.C. Chirurgia Generale ed Oncologica, Ospedale Mauriziano, Torino, Italy
| | | | - Irinel Popescu
- Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation, Bucharest, Romania
| | | | | | | | - Mauro Salizzoni
- General Surgery 2U and Liver Transplantation Center, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Derek Oreilly
- North Manchester General Hospital, Manchester, United Kingdom
| | - Oleg Skipenko
- LIVER & Biliary Tracts in the Russian Research Cen, Moscow, Russia
| | - René Adam
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France
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47
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Coppo R, Bonaudo R, Peruzzi RL, Amore A, Brunati A, Romagnoli R, Salizzoni M, Galbusera M, Gotti E, Daina E, Noris M, Remuzzi G. Liver transplantation for aHUS: still needed in the eculizumab era? Pediatr Nephrol 2016; 31:759-68. [PMID: 26604087 DOI: 10.1007/s00467-015-3278-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/28/2015] [Accepted: 10/28/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND The risk of disease recurrence after a kidney transplant is high in patients with atypical hemolytic uremic syndrome (aHUS) and mutations in the complement factor H (FH) gene (CFH). Since FH is mostly produced by the liver, a kidney transplant does not correct the genetic defect. The anti-C5 antibody eculizumab prevents post-transplant aHUS recurrence, but it does not cure the disease. Combined liver-kidney transplantation has been performed in few patients with CFH mutations based on the rationale that liver replacement provides a source of normal FH. METHODS We report the 9-year follow-up of a child with aHUS and a CFH mutation, including clinical data, extensive genetic characterization, and complement profile in the circulation and at endothelial level. The outcome of kidney and liver transplants performed separately 3 years apart are reported. RESULTS The patient showed incomplete response to plasma, with relapsing episodes, progression to end-stage renal disease, and endothelial-restricted complement dysregulation. Eculizumab prophylaxis post-kidney transplant did not achieve sustained remission, leaving the child at risk of disease recurrence. A liver graft given 3 years after the kidney transplant completely abrogated endothelial complement activation and allowed eculizumab withdrawal. CONCLUSIONS Liver transplant may definitely cure aHUS and represents an option for patients with suboptimal response to eculizumab.
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Affiliation(s)
- Rosanna Coppo
- Nephrology Dialysis and Transplantation, AOU Città della Salute e della Scienza di Torino, Turin and Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Roberto Bonaudo
- Nephrology Dialysis and Transplantation, AOU Città della Salute e della Scienza di Torino, Turin and Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - R Licia Peruzzi
- Nephrology Dialysis and Transplantation, AOU Città della Salute e della Scienza di Torino, Turin and Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Alessandro Amore
- Nephrology Dialysis and Transplantation, AOU Città della Salute e della Scienza di Torino, Turin and Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Andrea Brunati
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin , Turin, Italy
| | - Renato Romagnoli
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin , Turin, Italy
| | - Mauro Salizzoni
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin , Turin, Italy
| | - Miriam Galbusera
- Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Villa Camozzi, 3-24020, Ranica (Bergamo), Italy.,Centro Anna Maria Astori, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Eliana Gotti
- Unit of Nephrology and Dialysis, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Erica Daina
- Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Villa Camozzi, 3-24020, Ranica (Bergamo), Italy
| | - Marina Noris
- Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Villa Camozzi, 3-24020, Ranica (Bergamo), Italy.
| | - Giuseppe Remuzzi
- Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Villa Camozzi, 3-24020, Ranica (Bergamo), Italy.,Centro Anna Maria Astori, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Science and Technology Park Kilometro Rosso, Bergamo, Italy.,Unit of Nephrology and Dialysis, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.,Department of Biomedical Sciences of Health, University of Milan, Milan, Italy
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48
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Tandoi F, Salizzoni M, Brunati A, Lupo F, Romagnoli R. Excellent outcomes of liver transplantation using severely steatotic grafts from brain-dead donors. Liver Transpl 2016; 22:377-8. [PMID: 26492164 DOI: 10.1002/lt.24362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 10/19/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Francesco Tandoi
- General Surgery 2U, Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Mauro Salizzoni
- General Surgery 2U, Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Andrea Brunati
- General Surgery 2U, Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Francesco Lupo
- General Surgery 2U, Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Renato Romagnoli
- General Surgery 2U, Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
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49
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Bertotti A, Papp E, Jones S, Adleff V, Anagnostou V, Lupo B, Sausen M, Phallen J, Hruban CA, Tokheim C, Niknafs N, Nesselbush M, Lytle K, Sassi F, Cottino F, Migliardi G, Zanella ER, Ribero D, Russolillo N, Mellano A, Muratore A, Paraluppi G, Salizzoni M, Marsoni S, Kragh M, Lantto J, Cassingena A, Li QK, Karchin R, Scharpf R, Sartore-Bianchi A, Siena S, Diaz LA, Trusolino L, Velculescu VE. The genomic landscape of response to EGFR blockade in colorectal cancer. Nature 2015; 526:263-7. [PMID: 26416732 PMCID: PMC4878148 DOI: 10.1038/nature14969] [Citation(s) in RCA: 342] [Impact Index Per Article: 38.0] [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: 11/17/2014] [Accepted: 07/22/2015] [Indexed: 11/09/2022]
Abstract
Colorectal cancer is the third most common cancer worldwide, with 1.2 million patients diagnosed annually. In late-stage colorectal cancer, the most commonly used targeted therapies are the monoclonal antibodies cetuximab and panitumumab, which prevent epidermal growth factor receptor (EGFR) activation. Recent studies have identified alterations in KRAS and other genes as likely mechanisms of primary and secondary resistance to anti-EGFR antibody therapy. Despite these efforts, additional mechanisms of resistance to EGFR blockade are thought to be present in colorectal cancer and little is known about determinants of sensitivity to this therapy. To examine the effect of somatic genetic changes in colorectal cancer on response to anti-EGFR antibody therapy, here we perform complete exome sequence and copy number analyses of 129 patient-derived tumour grafts and targeted genomic analyses of 55 patient tumours, all of which were KRAS wild-type. We analysed the response of tumours to anti-EGFR antibody blockade in tumour graft models and in clinical settings and functionally linked therapeutic responses to mutational data. In addition to previously identified genes, we detected mutations in ERBB2, EGFR, FGFR1, PDGFRA, and MAP2K1 as potential mechanisms of primary resistance to this therapy. Novel alterations in the ectodomain of EGFR were identified in patients with acquired resistance to EGFR blockade. Amplifications and sequence changes in the tyrosine kinase receptor adaptor gene IRS2 were identified in tumours with increased sensitivity to anti-EGFR therapy. Therapeutic resistance to EGFR blockade could be overcome in tumour graft models through combinatorial therapies targeting actionable genes. These analyses provide a systematic approach to evaluating response to targeted therapies in human cancer, highlight new mechanisms of responsiveness to anti-EGFR therapies, and delineate new avenues for intervention in managing colorectal cancer.
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Affiliation(s)
- Andrea Bertotti
- Department of Oncology, University of Turin Medical School, 10060 Candiolo, Turin, Italy.,Translational Cancer Medicine, Surgical Oncology, and Clinical Trials Coordination, Candiolo Cancer Institute - Fondazione del Piemonte per l'Oncologia IRCCS, 10060 Candiolo, Turin, Italy.,National Institute of Biostructures and Biosystems (INBB), 00136 Rome, Italy
| | - Eniko Papp
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Siân Jones
- Personal Genome Diagnostics, Baltimore, Maryland 21224, USA
| | - Vilmos Adleff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Valsamo Anagnostou
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Barbara Lupo
- Department of Oncology, University of Turin Medical School, 10060 Candiolo, Turin, Italy.,Translational Cancer Medicine, Surgical Oncology, and Clinical Trials Coordination, Candiolo Cancer Institute - Fondazione del Piemonte per l'Oncologia IRCCS, 10060 Candiolo, Turin, Italy
| | - Mark Sausen
- Personal Genome Diagnostics, Baltimore, Maryland 21224, USA
| | - Jillian Phallen
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Carolyn A Hruban
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Collin Tokheim
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland 21204, USA
| | - Noushin Niknafs
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland 21204, USA
| | | | - Karli Lytle
- Personal Genome Diagnostics, Baltimore, Maryland 21224, USA
| | - Francesco Sassi
- Translational Cancer Medicine, Surgical Oncology, and Clinical Trials Coordination, Candiolo Cancer Institute - Fondazione del Piemonte per l'Oncologia IRCCS, 10060 Candiolo, Turin, Italy
| | - Francesca Cottino
- Translational Cancer Medicine, Surgical Oncology, and Clinical Trials Coordination, Candiolo Cancer Institute - Fondazione del Piemonte per l'Oncologia IRCCS, 10060 Candiolo, Turin, Italy
| | - Giorgia Migliardi
- Department of Oncology, University of Turin Medical School, 10060 Candiolo, Turin, Italy.,Translational Cancer Medicine, Surgical Oncology, and Clinical Trials Coordination, Candiolo Cancer Institute - Fondazione del Piemonte per l'Oncologia IRCCS, 10060 Candiolo, Turin, Italy
| | - Eugenia R Zanella
- Department of Oncology, University of Turin Medical School, 10060 Candiolo, Turin, Italy.,Translational Cancer Medicine, Surgical Oncology, and Clinical Trials Coordination, Candiolo Cancer Institute - Fondazione del Piemonte per l'Oncologia IRCCS, 10060 Candiolo, Turin, Italy
| | - Dario Ribero
- Department of Surgery, Mauriziano Umberto I Hospital, 10128 Turin, Italy
| | - Nadia Russolillo
- Department of Surgery, Mauriziano Umberto I Hospital, 10128 Turin, Italy
| | - Alfredo Mellano
- Translational Cancer Medicine, Surgical Oncology, and Clinical Trials Coordination, Candiolo Cancer Institute - Fondazione del Piemonte per l'Oncologia IRCCS, 10060 Candiolo, Turin, Italy
| | - Andrea Muratore
- Translational Cancer Medicine, Surgical Oncology, and Clinical Trials Coordination, Candiolo Cancer Institute - Fondazione del Piemonte per l'Oncologia IRCCS, 10060 Candiolo, Turin, Italy
| | - Gianluca Paraluppi
- Liver Transplantation Center, San Giovanni Battista Hospital, 10126 Turin, Italy
| | - Mauro Salizzoni
- Liver Transplantation Center, San Giovanni Battista Hospital, 10126 Turin, Italy.,Department of Surgical Sciences, University of Turin Medical School, 10126 Turin, Italy
| | - Silvia Marsoni
- Translational Cancer Medicine, Surgical Oncology, and Clinical Trials Coordination, Candiolo Cancer Institute - Fondazione del Piemonte per l'Oncologia IRCCS, 10060 Candiolo, Turin, Italy
| | | | | | - Andrea Cassingena
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, 20162 Milan, Italy
| | - Qing Kay Li
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Rachel Karchin
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.,Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland 21204, USA
| | - Robert Scharpf
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | | | - Salvatore Siena
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, 20162 Milan, Italy.,University of Milan Medical School, 20162 Milan, Italy
| | - Luis A Diaz
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.,Swim Across America Laboratory, The Ludwig Center for Cancer Genetics and Therapeutics at Johns Hopkins, Baltimore, Maryland 21287, USA
| | - Livio Trusolino
- Department of Oncology, University of Turin Medical School, 10060 Candiolo, Turin, Italy.,Translational Cancer Medicine, Surgical Oncology, and Clinical Trials Coordination, Candiolo Cancer Institute - Fondazione del Piemonte per l'Oncologia IRCCS, 10060 Candiolo, Turin, Italy
| | - Victor E Velculescu
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Viganò L, Conci S, Cescon M, Fava C, Capelli P, D'Errico A, Torzilli G, Di Tommaso L, Giuliante F, Vecchio FM, Salizzoni M, David E, Pinna AD, Guglielmi A, Capussotti L. Liver resection for hepatocellular carcinoma in patients with metabolic syndrome: A multicenter matched analysis with HCV-related HCC. J Hepatol 2015; 63:93-101. [PMID: 25646890 DOI: 10.1016/j.jhep.2015.01.024] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [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: 08/02/2014] [Revised: 01/10/2015] [Accepted: 01/19/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS The incidence of metabolic syndrome-related hepatocellular carcinoma (MS-HCC) is increasing worldwide. High resection risks are anticipated because of underlying steatohepatitis, but long-term results are unknown. To clarify the outcomes following liver resection in patients with MS-HCC and to compare the outcomes of MS-HCC to HCV-related HCC (HCV-HCC). METHODS All the consecutive patients undergoing liver resection for HCC in six high-volume HPB units between 2000 and 2012 were retrospectively considered. The patients with MS-HCC were identified and matched one-to-one with HCV-HCC patients without metabolic syndrome. Matching was based on age, cirrhosis, Child-Pugh class, portal hypertension, HCC number and diameter and liver resection extension. RESULTS Among 1563 patients undergoing liver resection for HCC in the study period, 96 (6.1%) had MS-HCC. They were matched with 96 HCV-HCC patients. All patients were Child-Pugh class A, 22.9% had cirrhosis. Forty-one patients per group (42.7%) required major hepatectomy. The MS-HCC group had a higher prevalence of steatohepatitis (25.0% vs. 9.4%, p=0.004). Operative mortality was 2.1% (1 MS-HCC, 3 HCV-HCC, p=0.621). Morbidity and liver failure rates were similar between the two groups. In the multivariate analysis, cirrhosis, major hepatectomy, and MELD >8, but not steatohepatitis, impacted severe morbidity and liver failure rates. The MS-HCC group had better 5-year overall survival (65.6% vs. 61.4%, p=0.031) and recurrence-free survival (37.0% vs. 27.5%, p=0.077). Independent negative prognostic factors were HCV-HCC, multiple HCC, microvascular invasion, and satellite nodules. CONCLUSIONS Liver resection is safe for MS-HCC, as for HCV-HCC. Cirrhosis, but not steatohepatitis, affects short-term outcomes. MS-HCC is associated with excellent long-term outcomes, better than HCV-HCC.
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Affiliation(s)
- Luca Viganò
- Department of Hepatobiliary & General Surgery, Humanitas Clinical and Research Center, Rozzano (MI), Italy; Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Torino, Italy.
| | - Simone Conci
- Department of Surgery, Unit of HPB Surgery, GB Rossi University Hospital, Verona, Italy
| | - Matteo Cescon
- Liver and Multiorgan Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Cristina Fava
- Department of Pathology, Ospedale Mauriziano Umberto I, Torino, Italy
| | - Paola Capelli
- Department of Pathology, University Hospital, Verona, Italy
| | - Antonietta D'Errico
- Department of Pathology, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Guido Torzilli
- Department of Hepatobiliary & General Surgery, Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Luca Di Tommaso
- Department of Pathology, Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Felice Giuliante
- Hepatobiliary Unit, Department of Surgery, Catholic University of the Sacred Heart, Roma, Italy
| | - Fabio Maria Vecchio
- Department of Pathology, Catholic University of the Sacred Heart, Roma, Italy
| | - Mauro Salizzoni
- Department of Surgery and Liver Transplantation, A.O. Città della Salute e della Scienza, Torino, Italy
| | - Ezio David
- Department of Pathology, A.O. Città della Salute e della Scienza, Torino, Italy
| | - Antonio Daniele Pinna
- Liver and Multiorgan Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Alfredo Guglielmi
- Department of Surgery, Unit of HPB Surgery, GB Rossi University Hospital, Verona, Italy
| | - Lorenzo Capussotti
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Torino, Italy
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