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Cozzi M, Donato P, Ugolini G, Nguefouet Momo RE, Nacchia F, Ballarini Z, Piccoli P, Cantini M, Caletti C, Andreola S, Gandini G, Gambaro G, Boschiero L. Outcomes in AB0 Incompatible Living Donor Kidney Transplantation: A Case – Control Study. Front Med (Lausanne) 2022; 9:932171. [PMID: 35935799 PMCID: PMC9353324 DOI: 10.3389/fmed.2022.932171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients waiting for a kidney transplant by far exceed available organs. AB0 incompatible living donor kidney transplantation (AB0i LDKT) represents an additional therapeutic strategy, but with higher risk for complications. We aimed at evaluating outcomes of AB0i LDKTs compared to compatible (AB0c) controls at our Institution.MethodsRetrospective matched case – control study (1:2) comparing AB0i vs. AB0c LDKTs from March 2012 to September 2021. Considered outcomes: graft function, acute rejection, sepsis, CMV infection, BK virus reactivation, death-censored graft survival, patient survival.ResultsSeventeen AB0i LDKTs matched to 34 AB0c controls. We found excellent graft function, comparable in the two groups, at all considered intervals, with an eGFR (ml/min/1.73 m2) of 67 vs. 66 at 1 year (p = 0.41), 63 vs. 64 at 3 years (p = 0.53). AB0i recipients had a statistically significant higher incidence of acute rejection, acute antibody-mediated rejection and sepsis within 30 days (p = 0.016; p = 0.02; p = 0.001), 1 year (p = 0.012; p = 0.02; p = 0.0004) and 3 years (p = 0.004; p = 0.006; p = 0.012) after surgery. There was no difference in CMV infection, BK virus reactivation, death-censored graft survival between the two groups. Patient survival was inferior in AB0i group at 1 and 3 years (88.2 vs. 100%; log-rank p = 0.03) due to early death for opportunistic infections. AB0i LDKTs spent longer time on dialysis (p = 0.04) and 82.3 vs. 38.3% controls had blood group 0 (p = 0.003).ConclusionsAB0i LDKT is an effective therapeutic strategy with graft function and survival comparable to AB0c LDKTs, despite higher rates of acute rejection and sepsis. It is an additional opportunity for patients with less chances of being transplanted, as blood group 0 individuals.
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Affiliation(s)
- Martina Cozzi
- Kidney Transplant Center, Department of Surgical Sciences, University and Hospital Trust of Verona, Verona, Italy
- Nephrology Postgraduate School, Department of Medicine, University of Verona, Verona, Italy
- *Correspondence: Martina Cozzi
| | - Paola Donato
- Kidney Transplant Center, Department of Surgical Sciences, University and Hospital Trust of Verona, Verona, Italy
| | - Gabriele Ugolini
- Kidney Transplant Center, Department of Surgical Sciences, University and Hospital Trust of Verona, Verona, Italy
| | | | - Francesco Nacchia
- Kidney Transplant Center, Department of Surgical Sciences, University and Hospital Trust of Verona, Verona, Italy
| | - Zeno Ballarini
- Kidney Transplant Center, Department of Surgical Sciences, University and Hospital Trust of Verona, Verona, Italy
| | - Pierluigi Piccoli
- Transfusion Medicine Unit, Department of Pathology and Diagnostic Services, University and Hospital Trust of Verona, Verona, Italy
| | - Maurizio Cantini
- Transfusion Medicine Unit, Department of Pathology and Diagnostic Services, University and Hospital Trust of Verona, Verona, Italy
| | - Chiara Caletti
- Renal Unit, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Andreola
- Nephrology Postgraduate School, Department of Medicine, University of Verona, Verona, Italy
- Renal Unit, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Giorgio Gandini
- Transfusion Medicine Unit, Department of Pathology and Diagnostic Services, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Gambaro
- Nephrology Postgraduate School, Department of Medicine, University of Verona, Verona, Italy
- Renal Unit, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Luigino Boschiero
- Kidney Transplant Center, Department of Surgical Sciences, University and Hospital Trust of Verona, Verona, Italy
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Alberici L, Paganini AM, Ricci C, Balla A, Ballarini Z, Ortenzi M, Casole G, Quaresima S, Di Dalmazi G, Ursi P, Alfano MS, Selva S, Casadei R, Ingaldi C, Lezoche G, Guerrieri M, Minni F, Tiberio GAM. Development and validation of a preoperative "difficulty score" for laparoscopic transabdominal adrenalectomy: a multicenter retrospective study. Surg Endosc 2021; 36:3549-3557. [PMID: 34402981 PMCID: PMC9001553 DOI: 10.1007/s00464-021-08678-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/07/2021] [Indexed: 12/14/2022]
Abstract
Background A difficulty score for laparoscopic adrenalectomy (LA) is lacking in the literature. A retrospective cohort study was designed to develop a preoperative “difficulty score” for LA. Methods A multicenter study was conducted involving four Italian tertiary centers for adrenal disease. The population was randomly divided into two subsets: training group and validation one. A multicenter study was undertaken, including 964 patients. Patient, adrenal lesion, surgeon’s characteristics, and the type of procedure were studied as potential predictors of target events. The operative time (pOT), conversion rate (cLA), or both were used as indicators of the difficulty in three multivariate models. All models were developed in a training cohort (70% of the sample) and validated using 30% of patients. For all models, the ability to predict complicated postoperative course was reported describing the area under the curve (AUCs). Logistic regression, reporting odds ratio (OR) with p-value, was used. Results In model A, gender (OR 2.04, p = 0.001), BMI (OR 1.07, p = 0.002), previous surgery (OR 1.29, p = 0.048), site (OR 21.8, p < 0.001) and size of the lesion (OR 1.16, p = 0.002), cumulative sum of procedures (OR 0.99, p < 0.001), extended (OR 26.72, p < 0.001) or associated procedures (OR 4.32, p = 0.015) increased the pOT. In model B, ASA (OR 2.86, p = 0.001), lesion size (OR 1.20, p = 0.005), and extended resection (OR 8.85, p = 0.007) increased the cLA risk. Model C had similar results to model A. All scores obtained predicted the target events in validation cohort (OR 1.99, p < 0.001; OR 1.37, p = 0.007; OR 1.70, p < 0.001, score A, B, and C, respectively). The AUCs in predicting complications were 0.740, 0.686, and 0.763 for model A, B, and C, respectively. Conclusion A difficulty score based on both pOT and cLA (Model C) was developed using 70% of the sample. The score was validated using a second cohort. Finally, the score was tested, and its results are able to predict a complicated postoperative course. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08678-6.
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Affiliation(s)
- Laura Alberici
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Alessandro M Paganini
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Claudio Ricci
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
- Policlinico S.Orsola-Malpighi, Alma Mater Studiorum-Università di Bologna, Via Massarenti n.9, 40138, Bologna, Italy.
| | - Andrea Balla
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Zeno Ballarini
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
| | - Monica Ortenzi
- Clinica Chirurgica Generale e d'Urgenza, AOU Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Giovanni Casole
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
| | - Silvia Quaresima
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Guido Di Dalmazi
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Pietro Ursi
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marie Sophie Alfano
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
| | - Saverio Selva
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Riccardo Casadei
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Carlo Ingaldi
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Giovanni Lezoche
- Clinica Chirurgica Generale e d'Urgenza, AOU Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Mario Guerrieri
- Clinica Chirurgica Generale e d'Urgenza, AOU Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Francesco Minni
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Guido Alberto Massimo Tiberio
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
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Tiberio GAM, Ferrari V, Ballarini Z, Casole G, Laganà M, Gritti M, Arici E, Grisanti S, Nascimbeni R, Sigala S, Berruti A, Coniglio A. Hyperthermic Intraperitoneal Chemotherapy for Primary or Recurrent Adrenocortical Carcinoma. A Single Center Study. Cancers (Basel) 2020; 12:E969. [PMID: 32295220 PMCID: PMC7226100 DOI: 10.3390/cancers12040969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/30/2020] [Accepted: 04/10/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study explores the impact of Hypertermic Intra PEritoneal Chemotherapy (HIPEC) on adrenocortical carcinoma (ACC) management through a safety analysis completed by a preliminary evaluation of survival performances. METHODS Retrospective chart review of 27 patients submitted to surgical treatment completed by HIPEC for primary (SP, 13 patients) or recurrent (SR, 14 patients, 17 treatments) ACC. Safety was evaluated by means of procedural morbidity and mortality. Survival performances included multiple end points: local/peritoneal disease-free survival (l/pDFS), overall progression-free survival (OPFS), and overall survival (OS). RESULTS In the SP group, mortality was nil and morbidity was 46% (major 23%). At a median follow-up of 25 months, the median value for all the different survival measures had not been reached. Mortality was also nil in the SR group. However, morbidity was 77% (major 18%). Median l/pDFS and OPFS were 12 ± 4 and 8 ± 2 months, respectively. At a median follow-up of 30 months, median OS had not been reached. CONCLUSION Surgery and HIPEC is an invasive procedure. Its employment in the surgery for primary setting deserves attention as it may affect oncologic outcomes positively. Its value in the management of recurrences seems less appreciable, albeit it may find its place in the multimodal management of a rare disease for which multiple therapeutic options do not yet exist.
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Affiliation(s)
- Guido Alberto Massimo Tiberio
- Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (Z.B.); (G.C.); (M.G.); (E.A.); (R.N.); (A.C.)
| | - Vittorio Ferrari
- Clinical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and public Health, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (V.F.); (M.L.); (S.G.); (A.B.)
| | - Zeno Ballarini
- Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (Z.B.); (G.C.); (M.G.); (E.A.); (R.N.); (A.C.)
| | - Giovanni Casole
- Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (Z.B.); (G.C.); (M.G.); (E.A.); (R.N.); (A.C.)
| | - Marta Laganà
- Clinical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and public Health, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (V.F.); (M.L.); (S.G.); (A.B.)
| | - Michele Gritti
- Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (Z.B.); (G.C.); (M.G.); (E.A.); (R.N.); (A.C.)
| | - Elisa Arici
- Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (Z.B.); (G.C.); (M.G.); (E.A.); (R.N.); (A.C.)
| | - Salvatore Grisanti
- Clinical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and public Health, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (V.F.); (M.L.); (S.G.); (A.B.)
| | - Riccardo Nascimbeni
- Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (Z.B.); (G.C.); (M.G.); (E.A.); (R.N.); (A.C.)
| | - Sandra Sigala
- Clinical Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy;
| | - Alfredo Berruti
- Clinical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and public Health, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (V.F.); (M.L.); (S.G.); (A.B.)
| | - Arianna Coniglio
- Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (Z.B.); (G.C.); (M.G.); (E.A.); (R.N.); (A.C.)
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Molfino S, Ballarini Z, Gheza F, Portolani N, Baiocchi GL. Is there a role for treatment-oriented surgery in stage IV gastric cancer? A systematic review. Updates Surg 2018; 71:21-27. [PMID: 30039281 DOI: 10.1007/s13304-018-0571-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 06/30/2018] [Indexed: 12/19/2022]
Abstract
To analyze the available evidence on the role of treatment-oriented surgery in stage IV gastric cancer (metastatic disease), a systematic literature search was undertaken using Medline, Embase, Cochrane, and Web-of-Science libraries. The search was not restricted to articles published within a given year range. Articles written in English language (or with abstracts written in English) were considered. All references in the chosen articles were further screened to find additional relevant publications. Both clinical series and literature reviews were included. Stage IV gastric cancer is classified into four subcategories: positive peritoneal cytology without clear macroscopic peritoneal involvement (surgery is usually performed in these cases); gross appearance peritoneal carcinomatosis [surgery, eventually with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) may be considered in very selected cases with limited PCI]; nodal metastases outside the loco-regional nodes (surgery may not be denied for metastatic nodes in stations 13 and 16); and hematogenous metastases (surgery should be performed in selected cases with liver metastases suitable to R0 resection). The analysis incorporated the new biological classification of stage IV gastric cancer recently proposed by Japanese researchers (Yoshida et al. in Gastric Cancer 19:329-338. https://doi.org/10.1007/s10120-015-0575-z , 2015) into the four aforementioned subcategories to make the comparison of the issues discussed meaningful. The take home message from the existing literature is that treatment-oriented surgery may be performed in a significant proportion of patients with stage IV gastric cancer.
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Affiliation(s)
- Sarah Molfino
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Zeno Ballarini
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy. .,Chirurgia Generale 3, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Federico Gheza
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
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