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1. The SURF (Italian observational study for renal insufficiency evaluation in liver transplant recipients): A post-hoc between-sex analysis

Author: Colombo, D, Zagni, E, Zullo, A, Simoni, L, Fagiuoli, S, De Simone, P, Donati, D, Salizzoni, M, Angeli, P, Burra, P, Cillo, U, Toniutto, P, Rossi, M, Vennarecci, G, De Carlis, L, Donato, F, Cescon, M, Di Leo, A, Di Costanzo, G, Avolio, A, Colombo D., Zagni E., Zullo A., Simoni L., Fagiuoli S., De Simone P., Donati D., Salizzoni M., Angeli P., Burra P., Cillo U., Toniutto P., Rossi M., Vennarecci G., De Carlis L., Donato F., Cescon M., Di Leo A., Di Costanzo G. G., Avolio A., Colombo, D, Zagni, E, Zullo, A, Simoni, L, Fagiuoli, S, De Simone, P, Donati, D, Salizzoni, M, Angeli, P, Burra, P, Cillo, U, Toniutto, P, Rossi, M, Vennarecci, G, De Carlis, L, Donato, F, Cescon, M, Di Leo, A, Di Costanzo, G, Avolio, A, Colombo D., Zagni E., Zullo A., Simoni L., Fagiuoli S., De Simone P., Donati D., Salizzoni M., Angeli P., Burra P., Cillo U., Toniutto P., Rossi M., Vennarecci G., De Carlis L., Donato F., Cescon M., Di Leo A., Di Costanzo G. G., and Avolio A.
Abstract: Background: Female sex has been reported as an independent predictor of severe post-liver transplantation (LT) chronic kidney disease. We performed a by sex post-hoc analysis of the SURF study, that investigated the prevalence of renal impairment following LT, aimed at exploring possible differences between sexes in the prevalence and course of post-LT renal damage. Methods: All patients enrolled in the SURF study were considered evaluable for this sex-based analysis, whose primary objective was to evaluate by sex the proportion of patients with estimated Glomerular Filtration Rate (eGFR) < 60 ml/min/1.73m2 at inclusion and follow-up visit. Results: Seven hundred thirty-eight patients were included in our analysis, 76% males. The proportion of patients with eGFR < 60 mL/min/1.73 m2 was significantly higher in females at initial study visit (33.3 vs 22.8%; p = 0.005), but also before, at time of transplantation (22.9 vs 14.7%; p = 0.0159), as analyzed retrospectively. At follow-up, such proportion increased more in males than in females (33.9 vs 26.0%, p = 0.04). Mean eGFR values decreased over the study in both sexes, with no significant differences. Statistically significant M/F differences in patient distribution by O'Riordan eGFR levels were observed at time of transplant and study initial visit (p = 0.0005 and 0.0299 respectively), but not at follow-up. Conclusions: Though the limitation of being performed post-hoc, this analysis suggests potential sex differences in the prevalence of renal impairment before and after LT, encouraging further clinical research to explore such differences more in depth.
Published: 2019

2. Very Early Introduction of Everolimus in De Novo Liver Transplantation: Results of a Multicenter, Prospective, Randomized Trial

Author: Cillo, U, Saracino, L, Vitale, A, Bertacco, A, Salizzoni, M, Lupo, F, Colledan, M, Corno, V, Rossi, G, Reggiani, P, Baccarani, U, Bresadola, V, De Carlis, L, Mangoni, I, Ramirez Morales, R, Agnes, S, Nure, E, Cillo U., Saracino L., Vitale A., Bertacco A., Salizzoni M., Lupo F., Colledan M., Corno V., Rossi G., Reggiani P., Baccarani U., Bresadola V., De Carlis L., Mangoni I., Ramirez Morales R., Agnes S., Nure E., Cillo, U, Saracino, L, Vitale, A, Bertacco, A, Salizzoni, M, Lupo, F, Colledan, M, Corno, V, Rossi, G, Reggiani, P, Baccarani, U, Bresadola, V, De Carlis, L, Mangoni, I, Ramirez Morales, R, Agnes, S, Nure, E, Cillo U., Saracino L., Vitale A., Bertacco A., Salizzoni M., Lupo F., Colledan M., Corno V., Rossi G., Reggiani P., Baccarani U., Bresadola V., De Carlis L., Mangoni I., Ramirez Morales R., Agnes S., and Nure E.
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.
Published: 2019

3. The SURF (Italian observational study for renal insufficiency evaluation in liver transplant recipients): A post-hoc between-sex analysis

Author: Colombo, D, Zagni, E, Zullo, A, Simoni, L, Fagiuoli, S, De Simone, P, Donati, D, Salizzoni, M, Angeli, P, Burra, P, Cillo, U, Toniutto, P, Rossi, M, Vennarecci, G, De Carlis, L, Donato, F, Cescon, M, Di Leo, A, Di Costanzo, G, Avolio, A, Colombo D., Zagni E., Zullo A., Simoni L., Fagiuoli S., De Simone P., Donati D., Salizzoni M., Angeli P., Burra P., Cillo U., Toniutto P., Rossi M., Vennarecci G., De Carlis L., Donato F., Cescon M., Di Leo A., Di Costanzo G. G., Avolio A., Colombo, D, Zagni, E, Zullo, A, Simoni, L, Fagiuoli, S, De Simone, P, Donati, D, Salizzoni, M, Angeli, P, Burra, P, Cillo, U, Toniutto, P, Rossi, M, Vennarecci, G, De Carlis, L, Donato, F, Cescon, M, Di Leo, A, Di Costanzo, G, Avolio, A, Colombo D., Zagni E., Zullo A., Simoni L., Fagiuoli S., De Simone P., Donati D., Salizzoni M., Angeli P., Burra P., Cillo U., Toniutto P., Rossi M., Vennarecci G., De Carlis L., Donato F., Cescon M., Di Leo A., Di Costanzo G. G., and Avolio A.
Abstract: Background: Female sex has been reported as an independent predictor of severe post-liver transplantation (LT) chronic kidney disease. We performed a by sex post-hoc analysis of the SURF study, that investigated the prevalence of renal impairment following LT, aimed at exploring possible differences between sexes in the prevalence and course of post-LT renal damage. Methods: All patients enrolled in the SURF study were considered evaluable for this sex-based analysis, whose primary objective was to evaluate by sex the proportion of patients with estimated Glomerular Filtration Rate (eGFR) < 60 ml/min/1.73m2 at inclusion and follow-up visit. Results: Seven hundred thirty-eight patients were included in our analysis, 76% males. The proportion of patients with eGFR < 60 mL/min/1.73 m2 was significantly higher in females at initial study visit (33.3 vs 22.8%; p = 0.005), but also before, at time of transplantation (22.9 vs 14.7%; p = 0.0159), as analyzed retrospectively. At follow-up, such proportion increased more in males than in females (33.9 vs 26.0%, p = 0.04). Mean eGFR values decreased over the study in both sexes, with no significant differences. Statistically significant M/F differences in patient distribution by O'Riordan eGFR levels were observed at time of transplant and study initial visit (p = 0.0005 and 0.0299 respectively), but not at follow-up. Conclusions: Though the limitation of being performed post-hoc, this analysis suggests potential sex differences in the prevalence of renal impairment before and after LT, encouraging further clinical research to explore such differences more in depth.
Published: 2019

4. A national mandatory-split liver policy: A report from the Italian experience

Author: Angelico, R, Trapani, S, Spada, M, Colledan, M, de Ville de Goyet, J, Salizzoni, M, De Carlis, L, Andorno, E, Gruttadauria, S, Ettorre, G, Cescon, M, Rossi, G, Risaliti, A, Tisone, G, Tedeschi, U, Vivarelli, M, Agnes, S, De Simone, P, Lupo, L, 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, Angelico R., Trapani S., Spada M., Colledan M., de Ville de Goyet J., Salizzoni M., De Carlis L., Andorno E., Gruttadauria S., Ettorre G. M., Cescon M., Rossi G., Risaliti A., Tisone G., Tedeschi U., Vivarelli M., Agnes S., De Simone P., Lupo L. G., 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., Angelico, R, Trapani, S, Spada, M, Colledan, M, de Ville de Goyet, J, Salizzoni, M, De Carlis, L, Andorno, E, Gruttadauria, S, Ettorre, G, Cescon, M, Rossi, G, Risaliti, A, Tisone, G, Tedeschi, U, Vivarelli, M, Agnes, S, De Simone, P, Lupo, L, 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, Angelico R., Trapani S., Spada M., Colledan M., de Ville de Goyet J., Salizzoni M., De Carlis L., Andorno E., Gruttadauria S., Ettorre G. M., Cescon M., Rossi G., Risaliti A., Tisone G., Tedeschi U., Vivarelli M., Agnes S., De Simone P., Lupo L. G., Di Benedetto F., Santaniello W., Zamboni F., Mazzaferro V., Rossi M., Puoti F., Camagni S., Grimaldi C., Gringeri E., Rizzato L., Nanni Costa A., and Cillo U.
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.
Published: 2019

5. Endo-therapies for biliary duct-to-duct anastomotic stricture after liver transplantation: Outcomes of a nationwide survey

Author: Cantu, 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, M, Lampertico, P, Maggi, U, Caccamo, L, Rossi, G, Vecchi, M, Penagini, R, Cantu 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 M. F., Lampertico P., Maggi U., Caccamo L., Rossi G., Vecchi M., Penagini R., Cantu, 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, M, Lampertico, P, Maggi, U, Caccamo, L, Rossi, G, Vecchi, M, Penagini, R, Cantu 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 M. F., Lampertico P., Maggi U., Caccamo L., Rossi G., Vecchi M., and Penagini R.
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.
Published: 2019

6. 2018 Annual Report of the European Liver Transplant Registry (ELTR) – 50-year evolution of liver transplantation

Author: Adam, R, Karam, V, Cailliez, V, O Grady, J, Mirza, D, Cherqui, D, Klempnauer, J, Salizzoni, M, Pratschke, J, Jamieson, N, Hidalgo, E, Paul, A, Andujar, R, Lerut, J, Fisher, L, Boudjema, K, Fondevila, C, Soubrane, O, Bachellier, P, Pinna, A, Berlakovich, G, Bennet, W, Pinzani, M, Schemmer, P, Zieniewicz, K, Romero, C, De Simone, P, Ericzon, B, Schneeberger, S, Wigmore, S, Prous, J, Colledan, M, Porte, R, Yilmaz, S, Azoulay, D, Pirenne, J, Line, P, Trunecka, P, Navarro, F, Lopez, A, De Carlis, L, Pena, S, Kochs, E, Duvoux, C, Adam R., Karam V., Cailliez V., O Grady J. G., Mirza D., Cherqui D., Klempnauer J., Salizzoni M., Pratschke J., Jamieson N., Hidalgo E., Paul A., Andujar R. L., Lerut J., Fisher L., Boudjema K., Fondevila C., Soubrane O., Bachellier P., Pinna A. D., Berlakovich G., Bennet W., Pinzani M., Schemmer P., Zieniewicz K., Romero C. J., De Simone P., Ericzon B. -G., Schneeberger S., Wigmore S. J., Prous J. F., Colledan M., Porte R. J., Yilmaz S., Azoulay D., Pirenne J., Line P. -D., Trunecka P., Navarro F., Lopez A. V., De Carlis L., Pena S. R., Kochs E., Duvoux C., Adam, R, Karam, V, Cailliez, V, O Grady, J, Mirza, D, Cherqui, D, Klempnauer, J, Salizzoni, M, Pratschke, J, Jamieson, N, Hidalgo, E, Paul, A, Andujar, R, Lerut, J, Fisher, L, Boudjema, K, Fondevila, C, Soubrane, O, Bachellier, P, Pinna, A, Berlakovich, G, Bennet, W, Pinzani, M, Schemmer, P, Zieniewicz, K, Romero, C, De Simone, P, Ericzon, B, Schneeberger, S, Wigmore, S, Prous, J, Colledan, M, Porte, R, Yilmaz, S, Azoulay, D, Pirenne, J, Line, P, Trunecka, P, Navarro, F, Lopez, A, De Carlis, L, Pena, S, Kochs, E, Duvoux, C, Adam R., Karam V., Cailliez V., O Grady J. G., Mirza D., Cherqui D., Klempnauer J., Salizzoni M., Pratschke J., Jamieson N., Hidalgo E., Paul A., Andujar R. L., Lerut J., Fisher L., Boudjema K., Fondevila C., Soubrane O., Bachellier P., Pinna A. D., Berlakovich G., Bennet W., Pinzani M., Schemmer P., Zieniewicz K., Romero C. J., De Simone P., Ericzon B. -G., Schneeberger S., Wigmore S. J., Prous J. F., Colledan M., Porte R. J., Yilmaz S., Azoulay D., Pirenne J., Line P. -D., Trunecka P., Navarro F., Lopez A. V., De Carlis L., Pena S. R., Kochs E., and Duvoux C.
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.
Published: 2018

7. Survival of children after liver transplantation for hepatocellular carcinoma

Author: Baumann, U, Adam, R, Duvoux, C, Mikolajczyk, R, Karam, V, D'Antiga, L, Chardot, C, Coker, A, Colledan, M, Ericzon, B, Line, P, Hadzic, N, Isoniemi, H, Klempnauer, J, Reding, R, Mckiernan, P, Mclin, V, Paul, A, Salizzoni, M, Furtado, E, Schneeberger, S, Karch, A, 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 ES, Schneeberger S, Karch A, Baumann, U, Adam, R, Duvoux, C, Mikolajczyk, R, Karam, V, D'Antiga, L, Chardot, C, Coker, A, Colledan, M, Ericzon, B, Line, P, Hadzic, N, Isoniemi, H, Klempnauer, J, Reding, R, Mckiernan, P, Mclin, V, Paul, A, Salizzoni, M, Furtado, E, Schneeberger, S, Karch, A, 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 ES, Schneeberger S, and Karch A
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.
Published: 2018

8. Recurrence of Hepatitis B Infection in Liver Transplant Patients Receiving Long-Term Hepatitis B Immunoglobulin Prophylaxis

Author: Beckebaum, S, Herzer, K, Bauhofer, A, Gelson, W, De Simone, P, de Man, R, Engelmann, C, Mullhaupt, B, Vionnet, J, Salizzoni, M, Volpes, R, Ercolani, G, De Carlis, L, Angeli, P, Burra, P, Dufour, J, Rossi, M, Cillo, U, Neumann, U, Fischer, L, Niemann, G, Toti, L, Tisone, G, Beckebaum S., Herzer K., Bauhofer A., Gelson W., De Simone P., de Man R., Engelmann C., Mullhaupt B., Vionnet J., Salizzoni M., Volpes R., Ercolani G., De Carlis L., Angeli P., Burra P., Dufour J. -F., Rossi M., Cillo U., Neumann U., Fischer L., Niemann G., Toti L., Tisone G., Beckebaum, S, Herzer, K, Bauhofer, A, Gelson, W, De Simone, P, de Man, R, Engelmann, C, Mullhaupt, B, Vionnet, J, Salizzoni, M, Volpes, R, Ercolani, G, De Carlis, L, Angeli, P, Burra, P, Dufour, J, Rossi, M, Cillo, U, Neumann, U, Fischer, L, Niemann, G, Toti, L, Tisone, G, Beckebaum S., Herzer K., Bauhofer A., Gelson W., De Simone P., de Man R., Engelmann C., Mullhaupt B., Vionnet J., Salizzoni M., Volpes R., Ercolani G., De Carlis L., Angeli P., Burra P., Dufour J. -F., Rossi M., Cillo U., Neumann U., Fischer L., Niemann G., Toti L., and Tisone G.
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.
Published: 2018

9. Liver transplantation in hepatocellular carcinoma after tumour downstaging (XXL): a randomised, controlled, phase 2b/3 trial

Author: 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, M, 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, Mazzaferro, Vincenzo, Citterio, Davide, Bhoori, Sherrie, Bongini, Marco, Miceli, Rosalba, De Carlis, Luciano, Colledan, Michele, Salizzoni, Mauro, Romagnoli, Renato, Antonelli, Barbara, Vivarelli, Marco, Tisone, Giuseppe, Rossi, Massimo, Gruttadauria, Salvatore, Di Sandro, Stefano, De Carlis, Riccardo, Lucà, Maria Grazia, De Giorgio, Massimo, Mirabella, Stefano, Belli, Luca, Fagiuoli, Stefano, Martini, Silvia, Iavarone, Massimo, Svegliati Baroni, Gianluca, Angelico, Mario, Ginanni Corradini, Stefano, Volpes, Riccardo, Mariani, Luigi, Regalia, Enrico, Flores, Maria, Droz Dit Busset, Michele, Sposito, Carlo, 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, M, 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, Mazzaferro, Vincenzo, Citterio, Davide, Bhoori, Sherrie, Bongini, Marco, Miceli, Rosalba, De Carlis, Luciano, Colledan, Michele, Salizzoni, Mauro, Romagnoli, Renato, Antonelli, Barbara, Vivarelli, Marco, Tisone, Giuseppe, Rossi, Massimo, Gruttadauria, Salvatore, Di Sandro, Stefano, De Carlis, Riccardo, Lucà, Maria Grazia, De Giorgio, Massimo, Mirabella, Stefano, Belli, Luca, Fagiuoli, Stefano, Martini, Silvia, Iavarone, Massimo, Svegliati Baroni, Gianluca, Angelico, Mario, Ginanni Corradini, Stefano, Volpes, Riccardo, Mariani, Luigi, Regalia, Enrico, Flores, Maria, Droz Dit Busset, Michele, and Sposito, Carlo
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 downsta
Published: 2020

10. AISF position paper on HCV in immunocompromised patients

Author: Angelucci, E, Astegiano, M, Baratelli, C, Biancone, L, Bironzo, P, Brancaccio, G, Brunetto, M, Bruno, R, Burra, P, Cabras, M, l Caraceni, P, Chialà, C, Clemente, M, Colli, A, Daniele, B, De Gasperi, E, Di Marco, V, Ditto, M, Fagiuoli, S, Ferri, C, Gaeta, G, Grossi, P, Imperatrice, B, Lampertico, P, Macaluso, F, Madonia, S, Marignani, M, Mazzarelli, C, Mella, A, Missale, G, Parisi, S, Pasulo, L, Puoti, M, Rendina, M, Ribaldone, D, Rossi, G, Toniutto, P, Tucci, A, Vajro, P, Viganò, M, Volpes, R, Zignego, A, Giannini, E, Miele, L, Russo, F, Petta, S, Bonora, S, Brignardello, E, Busca, A, Cariti, G, Cavallo, F, Conforti, M, Coscia, M, Craxì, A, Curci, D, Cusinato, S, Di Maio, M, Valle, R, Fusaro, E, Giacardi, A, Giaccone, L, Lagget, M, Libertucci, D, Minutolo, R, Montrucchio, G, Orlando, A, Orsucci, L, Pasquina, C, Pera, A, Peroni, C, Pirisi, M, Racca, P, Riccardini, F, Rizzetto, M, Salizzoni, M, Salomone, M, Saracco, G, Scaglione, L, Torre, G, Tozzi, R, Vitolo, U, Verme, G, Brunetto, MR, Cabras, MG, Clemente, MG, Ditto, MC, Gaeta, GB, Grossi, PA, Macaluso, FS, Zignego, AL, Giannini, EG, Russo, FP, Valle, RD, Peroni, CL, Saracco, GM, Angelucci, E, Astegiano, M, Baratelli, C, Biancone, L, Bironzo, P, Brancaccio, G, Brunetto, M, Bruno, R, Burra, P, Cabras, M, l Caraceni, P, Chialà, C, Clemente, M, Colli, A, Daniele, B, De Gasperi, E, Di Marco, V, Ditto, M, Fagiuoli, S, Ferri, C, Gaeta, G, Grossi, P, Imperatrice, B, Lampertico, P, Macaluso, F, Madonia, S, Marignani, M, Mazzarelli, C, Mella, A, Missale, G, Parisi, S, Pasulo, L, Puoti, M, Rendina, M, Ribaldone, D, Rossi, G, Toniutto, P, Tucci, A, Vajro, P, Viganò, M, Volpes, R, Zignego, A, Giannini, E, Miele, L, Russo, F, Petta, S, Bonora, S, Brignardello, E, Busca, A, Cariti, G, Cavallo, F, Conforti, M, Coscia, M, Craxì, A, Curci, D, Cusinato, S, Di Maio, M, Valle, R, Fusaro, E, Giacardi, A, Giaccone, L, Lagget, M, Libertucci, D, Minutolo, R, Montrucchio, G, Orlando, A, Orsucci, L, Pasquina, C, Pera, A, Peroni, C, Pirisi, M, Racca, P, Riccardini, F, Rizzetto, M, Salizzoni, M, Salomone, M, Saracco, G, Scaglione, L, Torre, G, Tozzi, R, Vitolo, U, Verme, G, Brunetto, MR, Cabras, MG, Clemente, MG, Ditto, MC, Gaeta, GB, Grossi, PA, Macaluso, FS, Zignego, AL, Giannini, EG, Russo, FP, Valle, RD, Peroni, CL, and Saracco, GM
Abstract: This report summarizes the clinical features and the indications for treating HCV infection in immunocompromised and transplanted patients in the Direct Acting Antiviral drugs era.
Published: 2019

11. The SURF (Italian observational study for renal insufficiency evaluation in liver transplant recipients): A post-hoc between-sex analysis

Author: Colombo, D., Zagni, E., Zullo, A., Simoni, L., Fagiuoli, S., De Simone, P., Donati, D., Salizzoni, M., Angeli, P., Burra, P., Cillo, U., Toniutto, P., Rossi, M., Vennarecci, G., De Carlis, L., Donato, F., Cescon, M., Di Leo, A., Di Costanzo, G. G., Avolio, Alfonso Wolfango, Avolio A. (ORCID:0000-0003-2491-7625), Colombo, D., Zagni, E., Zullo, A., Simoni, L., Fagiuoli, S., De Simone, P., Donati, D., Salizzoni, M., Angeli, P., Burra, P., Cillo, U., Toniutto, P., Rossi, M., Vennarecci, G., De Carlis, L., Donato, F., Cescon, M., Di Leo, A., Di Costanzo, G. G., Avolio, Alfonso Wolfango, and Avolio A. (ORCID:0000-0003-2491-7625)
Abstract: Background: Female sex has been reported as an independent predictor of severe post-liver transplantation (LT) chronic kidney disease. We performed a by sex post-hoc analysis of the SURF study, that investigated the prevalence of renal impairment following LT, aimed at exploring possible differences between sexes in the prevalence and course of post-LT renal damage. Methods: All patients enrolled in the SURF study were considered evaluable for this sex-based analysis, whose primary objective was to evaluate by sex the proportion of patients with estimated Glomerular Filtration Rate (eGFR) < 60 ml/min/1.73m2 at inclusion and follow-up visit. Results: Seven hundred thirty-eight patients were included in our analysis, 76% males. The proportion of patients with eGFR < 60 mL/min/1.73 m2 was significantly higher in females at initial study visit (33.3 vs 22.8%; p = 0.005), but also before, at time of transplantation (22.9 vs 14.7%; p = 0.0159), as analyzed retrospectively. At follow-up, such proportion increased more in males than in females (33.9 vs 26.0%, p = 0.04). Mean eGFR values decreased over the study in both sexes, with no significant differences. Statistically significant M/F differences in patient distribution by O'Riordan eGFR levels were observed at time of transplant and study initial visit (p = 0.0005 and 0.0299 respectively), but not at follow-up. Conclusions: Though the limitation of being performed post-hoc, this analysis suggests potential sex differences in the prevalence of renal impairment before and after LT, encouraging further clinical research to explore such differences more in depth.
Published: 2019

12. Liver Transplantation for Hepatic Trauma: A Study From the European Liver Transplant Registry

Author: Krawczyk, M, Grat, M, Adam, R, Polak, W, Klempnauer, J, Pinna, A, Di Benedetto, F, Filipponi, F, Senninger, N, Foss, A, Rufian-Pena, S, Bennet, W, Pratschke, J, Paul, A, Settmacher, U, Rossi, G, Salizzoni, M, Fernandez-Selles, C, de Rituerto, S, Gomez-Bravo, M, Pirenne, J, Detry, O, Majno, P, Nemec, P, Bechstein, W, Bartels, M, Nadalin, S, Pruvot, F, Mirza, D, Lupo, L, Colledan, M, Tisone, G, Ringers, J, Daniel, J, Torra, R, Gonzalez, E, Canizares, R, Martinez, V, Rodriguez, F, Yilmaz, S, Remiszewski, P, Krawczyk M, Grat M, Adam R, Polak WG, Klempnauer J, Pinna A, Di Benedetto F, Filipponi F, Senninger N, Foss A, Rufian-Pena S, Bennet W, Pratschke J, Paul A, Settmacher U, Rossi G, Salizzoni M, Fernandez-Selles C, de Rituerto STM, Gomez-Bravo MA, Pirenne J, Detry O, Majno PE, Nemec P, Bechstein WO, Bartels M, Nadalin S, Pruvot FR, Mirza DF, Lupo L, Colledan M, Tisone G, Ringers J, Daniel J, Torra RC, Gonzalez EM, Canizares RB, Martinez VCM, Rodriguez FSJ, Yilmaz S, Remiszewski P, Krawczyk, M, Grat, M, Adam, R, Polak, W, Klempnauer, J, Pinna, A, Di Benedetto, F, Filipponi, F, Senninger, N, Foss, A, Rufian-Pena, S, Bennet, W, Pratschke, J, Paul, A, Settmacher, U, Rossi, G, Salizzoni, M, Fernandez-Selles, C, de Rituerto, S, Gomez-Bravo, M, Pirenne, J, Detry, O, Majno, P, Nemec, P, Bechstein, W, Bartels, M, Nadalin, S, Pruvot, F, Mirza, D, Lupo, L, Colledan, M, Tisone, G, Ringers, J, Daniel, J, Torra, R, Gonzalez, E, Canizares, R, Martinez, V, Rodriguez, F, Yilmaz, S, Remiszewski, P, Krawczyk M, Grat M, Adam R, Polak WG, Klempnauer J, Pinna A, Di Benedetto F, Filipponi F, Senninger N, Foss A, Rufian-Pena S, Bennet W, Pratschke J, Paul A, Settmacher U, Rossi G, Salizzoni M, Fernandez-Selles C, de Rituerto STM, Gomez-Bravo MA, Pirenne J, Detry O, Majno PE, Nemec P, Bechstein WO, Bartels M, Nadalin S, Pruvot FR, Mirza DF, Lupo L, Colledan M, Tisone G, Ringers J, Daniel J, Torra RC, Gonzalez EM, Canizares RB, Martinez VCM, Rodriguez FSJ, Yilmaz S, and Remiszewski P
Abstract: Background. Liver transplantation is the most extreme form of surgical management of patients with hepatic trauma, with very limited literature data supporting its use. The aim of this study was to assess the results of liver transplantation for hepatic trauma. Methods. This retrospective analysis based on European Liver Transplant Registry comprised data of 73 recipients of liver transplantation for hepatic trauma performed in 37 centers in the period between 1987 and 2013. Mortality and graft loss rates at 90 days were set as primary and secondary outcome measures, respectively. Results. Mortality and graft loss rates at 90 days were 42.5% and 46.6%, respectively. Regarding general variables, cross-clamping without extracorporeal veno-venous bypass was the only independent risk factor for both mortality (P = 0.031) and graft loss (P = 0.034). Regarding more detailed factors, grade of liver trauma exceeding IV increased the risk of mortality (P = 0.005) and graft loss (P = 0.018). Moreover, a tendency above the level of significance was observed for the negative impact of injury severity score (ISS) on mortality (P = 0.071). The optimal cutoff for ISS was 33, with sensitivity of 60.0%, specificity of 80.0%, positive predictive value of 75.0%, and negative predictive value of 66.7%. Conclusions. Liver transplantation seems to be justified in selected patients with otherwise fatal severe liver injuries, particularly in whom cross-clamping without extracorporeal bypass can be omitted. The ISS cutoff less than 33 may be useful in the selection process.
Published: 2016

13. Infections in liver and lung transplant recipients: a national prospective cohort

Author: Gagliotti, C, Morsillo, F, Moro, M, Masiero, L, Procaccio, F, Vespasiano, F, Pantosti, A, Monaco, M, Errico, G, Ricci, A, Grossi, P, Nanni Costa, A, Adorno, D, Ambretti, S, Amoroso, A, Arghittu, M, Berloco, P, Bertani, A, Bonizzoli, M, Cambieri, P, Canzonieri, M, Caprio, M, Carrara, E, Carrinola, R, Cibelli, E, Cillo, U, Colledan, M, Colombo, R, Coluccio, E, Conaldi, P, Cusi, M, D’Armini, A, da Riva, A, D’Auria, B, de Carlis, L, de Cillia, C, de Gasperi, A, Di Caro, A, Di Ciaccio, P, Dondossola, D, Farina, C, Feltrin, G, Finarelli, A, Fossati, L, Gaibani, P, Garcia Fernandez, A, Gesu, G, Giacometti, R, Gona, F, Gridelli, B, Henrici de Angelis, L, Landini, M, Maldarelli, F, Mancini, C, Marone, P, Mularoni, A, Paglialunga, G, Paladini, P, Palù, G, Parisi, S, Peris, A, Pinna, A, Platto, M, Pugliese, F, Puoti, F, Rago, C, Ravini, M, Rea, F, Rinaldi, M, Rossi, G, Rossi, L, Rossi, M, Salizzoni, M, Sangiorgi, G, Santambrogio, L, Spada, M, Sparacino, V, Stella, F, Torelli, R, Torresani, E, Tosi, D, Vailati, F, Valeri, M, Venuta, F, Vesconi, S, Viale, P, Vismara, C, Gagliotti, C, Morsillo, F, Moro, M, Masiero, L, Procaccio, F, Vespasiano, F, Pantosti, A, Monaco, M, Errico, G, Ricci, A, Grossi, P, Nanni Costa, A, Adorno, D, Ambretti, S, Amoroso, A, Arghittu, M, Berloco, P, Bertani, A, Bonizzoli, M, Cambieri, P, Canzonieri, M, Caprio, M, Carrara, E, Carrinola, R, Cibelli, E, Cillo, U, Colledan, M, Colombo, R, Coluccio, E, Conaldi, P, Cusi, M, D’Armini, A, da Riva, A, D’Auria, B, de Carlis, L, de Cillia, C, de Gasperi, A, Di Caro, A, Di Ciaccio, P, Dondossola, D, Farina, C, Feltrin, G, Finarelli, A, Fossati, L, Gaibani, P, Garcia Fernandez, A, Gesu, G, Giacometti, R, Gona, F, Gridelli, B, Henrici de Angelis, L, Landini, M, Maldarelli, F, Mancini, C, Marone, P, Mularoni, A, Paglialunga, G, Paladini, P, Palù, G, Parisi, S, Peris, A, Pinna, A, Platto, M, Pugliese, F, Puoti, F, Rago, C, Ravini, M, Rea, F, Rinaldi, M, Rossi, G, Rossi, L, Rossi, M, Salizzoni, M, Sangiorgi, G, Santambrogio, L, Spada, M, Sparacino, V, Stella, F, Torelli, R, Torresani, E, Tosi, D, Vailati, F, Valeri, M, Venuta, F, Vesconi, S, Viale, P, and Vismara, C
Abstract: Infections are a major complication of solid organ transplants (SOTs). This study aimed to describe recipients’ characteristics, and the frequency and etiology of infections and transplant outcome in liver and lung SOTs, and to investigate exposures associated to infection and death in liver transplant recipients. The study population included recipients of SOTs performed in Italy during a 1-year period in ten Italian lung transplant units and eight liver transplant units. Data on comorbidities, infections, retransplantation, and death were prospectively collected using a web-based system, with a 6-month follow-up. The cumulative incidence of infection was 31.7% and 47.8% in liver and lung transplants, respectively, with most infections occurring within the first month after transplantation. Gram-negatives, which were primarily multidrug-resistant, were the most frequent cause of infection. Death rates were 0.42 per 1000 recipient-days in liver transplants and 1.41 per 1000 recipient-days in lung transplants. Infection after SOT in adult liver recipients is associated to an increased risk of death (OR = 13.25; p-value < 0.001). Given the frequency of infection caused by multidrug-resistant microorganisms in SOT recipients in Italy and the heavy impact of infections on the transplant outcome, the reinforcement of surveillance and control activities to prevent the transmission of multidrug-resistant microorganisms in SOT recipients represents a priority. The implementation of the study protocol in liver and lung transplant units and the sharing of results have increased the awareness about the threat due to antimicrobial resistance in the country
Published: 2018

14. Recurrence of Hepatitis B Infection in Liver Transplant Patients Receiving Long-Term Hepatitis B Immunoglobulin Prophylaxis

Author: Beckebaum, S., Herzer, K. (Kerstin), Bauhofer, A. (Artur), Gelson, W. (William), De Simone, P. (Paolo), Man, R.A. (Robert) de, Engelmann, C. (Cornelius), Müllhaupt, B. (Beat), Vionnet, J. (Julien), Salizzoni, M. (Mauro), Volpes, R. (Riccardo), Ercolani, G. (Giorgio), Carlis, L. (Luciano) de, Angeli, V., Burra, P. (Patrizia), Dufour, J.-F. (Jean-François), Rossi, M. (Massimo), Cillo, U. (Umberto), Neumann, U., Fischer, L. (Lutz), Niemann, G. (Gabriele), Toti, L. (Luca), Tisone, G. (Guiseppe), Beckebaum, S., Herzer, K. (Kerstin), Bauhofer, A. (Artur), Gelson, W. (William), De Simone, P. (Paolo), Man, R.A. (Robert) de, Engelmann, C. (Cornelius), Müllhaupt, B. (Beat), Vionnet, J. (Julien), Salizzoni, M. (Mauro), Volpes, R. (Riccardo), Ercolani, G. (Giorgio), Carlis, L. (Luciano) de, Angeli, V., Burra, P. (Patrizia), Dufour, J.-F. (Jean-François), Rossi, M. (Massimo), Cillo, U. (Umberto), Neumann, U., Fischer, L. (Lutz), Niemann, G. (Gabriele), Toti, L. (Luca), and Tisone, G. (Guiseppe)
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.
Published: 2018
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15. Impact of DAAs on liver transplantation: Major effects on the evolution of indications and results. An ELITA study based on the ELTR registry

Author: Belli, L, Perricone, G, Adam, R, Cortesi, P, Strazzabosco, M, Facchetti, R, Karam, V, Salizzoni, M, Andujar, R, 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, Belli, Luca Saverio, Perricone, Giovanni, Adam, Rene, Cortesi, Paolo A, Strazzabosco, Mario, Facchetti, Rita, Karam, Vincent, Salizzoni, Mauro, Andujar, Rafael Lopez, Fondevila, Costantino, De Simone, Paolo, Morelli, Cristina, Fabregat-Prous, Joan, Samuel, Didier, Agarwaal, Kosh, Moreno Gonzales, Enrique, Charco, Ramon, Zieniewicz, Krzysztof, De Carlis, Luciano, Duvoux, Christophe, Belli, L, Perricone, G, Adam, R, Cortesi, P, Strazzabosco, M, Facchetti, R, Karam, V, Salizzoni, M, Andujar, R, 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, Belli, Luca Saverio, Perricone, Giovanni, Adam, Rene, Cortesi, Paolo A, Strazzabosco, Mario, Facchetti, Rita, Karam, Vincent, Salizzoni, Mauro, Andujar, Rafael Lopez, Fondevila, Costantino, De Simone, Paolo, Morelli, Cristina, Fabregat-Prous, Joan, Samuel, Didier, Agarwaal, Kosh, Moreno Gonzales, Enrique, Charco, Ramon, Zieniewicz, Krzysztof, De Carlis, Luciano, and Duvoux, Christophe
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
Published: 2018

16. Prevalent use of Combined Prophylaxis of Hepatitis B after liver transplantation in Italy: Results of a national survey in a large cohort

Author: Marzano, A, Andreone, P, Boccagni, P, Burra, P, Caneschi, F, Conoscitore, P, Coppola, C, De Carlis, L, Fagiuoli, S, Forte, P, Gaeta, G, Iemmolo, R, Suffredini, A, Mazzola, M, Merli, M, Parrilli, G, Piai, G, Piras, M, Salizzoni, M, Tamè, M, Tisone, G, Toniutto, P, Vennarecci, G, Volpes, R, Zamboni, F, Caccamo, L, Bertuzzo, V, Bongiovanni, A, Brin-Dicci, G, Cocchis, D, Ettorre, G, Gianni, E, Giusto, M, Lenisa, I, Lucà, M, Mameli, L, Mangoni, I, Manini, M, Paoli, S, Russo, F, Staiano, L, Stornaiuolo, G, Toti, L, Valente, G, Vukotic, R, Marzano, Alfredo, Andreone, Pietro, Boccagni, Patrizia, Burra, Patrizia, Caneschi, Francesco, Conoscitore, Pasquale F., Coppola, Carmine, De Carlis, Luciano, Fagiuoli, Stefano, Forte, Paolo, Gaeta, Giovanni B., Iemmolo, Rosa M., Suffredini, Anna Lotti, Mazzola, Michele, Merli, Manuela, Parrilli, Gianpaolo, Piai, Guido, Piras, Maria R., Salizzoni, Mauro, Tamè, Mariarosa, Tisone, Giuseppe, Toniutto, Pierluigi, Vennarecci, Giovanni, Volpes, Riccardo, Zamboni, Fausto, Caccamo, Lucio, Bertuzzo, Valentina R., Bongiovanni, Assunta S., Brin-Dicci, Gaetano, Cocchis, Donatella, Ettorre, Giuseppe M., Gianni, Elena, Giusto, Michela, Lenisa, Ilaria, Lucà, Maria G., Mameli, Laura, Mangoni, Iacopo, Manini, Matteo A., Paoli, Serena, Russo, Francesco P., Staiano, Laura, Stornaiuolo, Gianfranca, Toti, Luca, Valente, Giovanna, Vukotic, Ranka, Marzano, A, Andreone, P, Boccagni, P, Burra, P, Caneschi, F, Conoscitore, P, Coppola, C, De Carlis, L, Fagiuoli, S, Forte, P, Gaeta, G, Iemmolo, R, Suffredini, A, Mazzola, M, Merli, M, Parrilli, G, Piai, G, Piras, M, Salizzoni, M, Tamè, M, Tisone, G, Toniutto, P, Vennarecci, G, Volpes, R, Zamboni, F, Caccamo, L, Bertuzzo, V, Bongiovanni, A, Brin-Dicci, G, Cocchis, D, Ettorre, G, Gianni, E, Giusto, M, Lenisa, I, Lucà, M, Mameli, L, Mangoni, I, Manini, M, Paoli, S, Russo, F, Staiano, L, Stornaiuolo, G, Toti, L, Valente, G, Vukotic, R, Marzano, Alfredo, Andreone, Pietro, Boccagni, Patrizia, Burra, Patrizia, Caneschi, Francesco, Conoscitore, Pasquale F., Coppola, Carmine, De Carlis, Luciano, Fagiuoli, Stefano, Forte, Paolo, Gaeta, Giovanni B., Iemmolo, Rosa M., Suffredini, Anna Lotti, Mazzola, Michele, Merli, Manuela, Parrilli, Gianpaolo, Piai, Guido, Piras, Maria R., Salizzoni, Mauro, Tamè, Mariarosa, Tisone, Giuseppe, Toniutto, Pierluigi, Vennarecci, Giovanni, Volpes, Riccardo, Zamboni, Fausto, Caccamo, Lucio, Bertuzzo, Valentina R., Bongiovanni, Assunta S., Brin-Dicci, Gaetano, Cocchis, Donatella, Ettorre, Giuseppe M., Gianni, Elena, Giusto, Michela, Lenisa, Ilaria, Lucà, Maria G., Mameli, Laura, Mangoni, Iacopo, Manini, Matteo A., Paoli, Serena, Russo, Francesco P., Staiano, Laura, Stornaiuolo, Gianfranca, Toti, Luca, Valente, Giovanna, and Vukotic, Ranka
Abstract: BACKGROUND: Prophylaxis of hepatitis B after liver transplantation with antiviral(s) and immunoglobulins effciently 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 confrm: 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
Published: 2018

17. Recurrence of Hepatitis B Infection in Liver Transplant Patients Receiving Long-Term Hepatitis B Immunoglobulin Prophylaxis

Author: Beckebaum, S, Herzer, K, Bauhofer, A, Gelson, W, De Simone, P, de Man, Rob, Engelmann, C, Mullhaupt, 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, Beckebaum, S, Herzer, K, Bauhofer, A, Gelson, W, De Simone, P, de Man, Rob, Engelmann, C, Mullhaupt, 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, and Tisone, G
Published: 2018

18. Prevention of hepatitis C recurrence by bridging sofosbuvir/ribavirin from pre- to post-liver transplant: A real-life strategy

Author: Donato, M, Morelli, C, Romagnoli, R, Invernizzi, F, Mazzarelli, C, Iemmolo, R, Montalbano, M, Lenci, I, Bhoori, S, Pieri, G, Berardi, S, Caraceni, P, Martini, S, Angeli, P, Belli, L, Bernabucci, V, Malinverno, F, Monico, S, Ottobrelli, A, Romano, A, Strona, S, Tamè, M, Visco-Comandini, U, Cavenago, M, De Carlis, L, Di Benedetto, F, Dondossola, D, Ettorre, G, Mazzaferro, V, Montin, U, Pinna, A, Rossi, G, Salizzoni, M, Tisone, G, Donato, Maria Francesca, Morelli, Cristina, Romagnoli, Renato, Invernizzi, Federica, Mazzarelli, Chiara, Iemmolo, Rosa Maria, Montalbano, Marzia, Lenci, Ilaria, Bhoori, Sherrie, Pieri, Giulia, Berardi, Sonia, Caraceni, Paolo, Martini, Silvia, Angeli, Paolo, Belli, Luca Saverio, Bernabucci, Veronica, Malinverno, Federica, Monico, Sara, Ottobrelli, Antonio, Romano, Antonietta, Strona, Silvia, Tamè, Maria Rosa, Visco-Comandini, Ubaldo, Cavenago, Margherita, De Carlis, Luciano, Di Benedetto, Fabrizio, Dondossola, Daniele, Ettorre, Giuseppe Maria, Mazzaferro, Vincenzo, Montin, Umberto, Pinna, Antonio Daniele, Rossi, Giorgio, Salizzoni, Mauro, Tisone, Giuseppe, Donato, M, Morelli, C, Romagnoli, R, Invernizzi, F, Mazzarelli, C, Iemmolo, R, Montalbano, M, Lenci, I, Bhoori, S, Pieri, G, Berardi, S, Caraceni, P, Martini, S, Angeli, P, Belli, L, Bernabucci, V, Malinverno, F, Monico, S, Ottobrelli, A, Romano, A, Strona, S, Tamè, M, Visco-Comandini, U, Cavenago, M, De Carlis, L, Di Benedetto, F, Dondossola, D, Ettorre, G, Mazzaferro, V, Montin, U, Pinna, A, Rossi, G, Salizzoni, M, Tisone, G, Donato, Maria Francesca, Morelli, Cristina, Romagnoli, Renato, Invernizzi, Federica, Mazzarelli, Chiara, Iemmolo, Rosa Maria, Montalbano, Marzia, Lenci, Ilaria, Bhoori, Sherrie, Pieri, Giulia, Berardi, Sonia, Caraceni, Paolo, Martini, Silvia, Angeli, Paolo, Belli, Luca Saverio, Bernabucci, Veronica, Malinverno, Federica, Monico, Sara, Ottobrelli, Antonio, Romano, Antonietta, Strona, Silvia, Tamè, Maria Rosa, Visco-Comandini, Ubaldo, Cavenago, Margherita, De Carlis, Luciano, Di Benedetto, Fabrizio, Dondossola, Daniele, Ettorre, Giuseppe Maria, Mazzaferro, Vincenzo, Montin, Umberto, Pinna, Antonio Daniele, Rossi, Giorgio, Salizzoni, Mauro, and Tisone, Giuseppe
Abstract: Background & Aims: Hepatitis C virus (HCV) re-infection following liver transplant (LT) is associated with reduced graft and patient survival. Before transplant, Sofosbuvir/ Ribavirin (SOF/R) treatment prevents recurrent HCV in 96% of those patients achieving viral suppression for at least 4 weeks before transplant. We evaluated whether a bridging SOF-regimen from pre- to post-transplant is safe and effective to prevent HCV recurrence in those patients with less than 4 weeks of HCV-RNA undetectability at the time of transplant. Methods: From July 2014 SOF/R was given in 233 waitlisted HCV cirrhotics with/ without hepatocellular carcinoma (HCC) within an Italian Compassionate Program. One hundred patients were transplanted and 31 patients (31%) treated with SOF/R bridging therapy were studied. Results: Liver transplant indication in bridge subgroup was HCC in 22 and decompensated cirrhosis in 9. HCV-genotype was 1/4 in 18 patients. SOF 400 mg/day and R (median dosage 800 mg/day) were given for a median of 35 days before LT. At transplant time, 19 patients were still HCV-RNA positive (median HCV-RNA 58 IU/mL). One recipient had a virological breakthrough at week 4 post-transplant; one died, on treatment, 1-month post-transplant for sepsis and 29/31 achieved a 12-week sustained virological response (94%). Acute cellular rejection occurred in three recipients. On September 2016, 30 recipients (97%) were alive with a median follow-up of 18 months (range 13-25). Conclusions: In patients with suboptimal virological response at LT, a bridging SOF/R regimen helps avoiding post-transplant graft reinfection.
Published: 2017

19. D-MELD, a Powerful Instrument To Optimize Donor-2-Recipient Match. Differences between US and Italy

Author: Avolio, A, Halldorson, J, Lirosi, M, Agnes, S, Salizzoni, M, Pinna, A, Spada, M, De Carlis, L, Colledan, M, Gerunda, G, Andorno, E, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Rossi, M, Tisone, G, Zamboni, F, Vivarelli, M, Lupo, L, Cuomo, O, Calise, F, Nicolotti, N, Vitale, A, Romagnoli, R, Cucchetti, A, Bonsignore, P, Mangoni, I, Pinelli, D, Montalti, R, Caccamo, L, Vennarecci, G, Nicolini, D, Regalia, E, Baccarani, U, Lai, Q, Manzia, T, Tondolo, E, Rendina, M, Perrella, A, Santaniello, W, Bottino, G, Spagnoletti, G, Mariano, G, Gasbarrini, A, Burra, P, Cillo, U, Avolio A, Halldorson J, Lirosi M, Agnes S, Salizzoni M, Pinna A, Spada M, De Carlis L, Colledan M, Gerunda G, Andorno E, Rossi G, Ettorre G, Risaliti A, Mazzaferro V, Rossi M, Tisone G, Zamboni F, Vivarelli M, Lupo L, Cuomo O, Calise F, Nicolotti N, Vitale A, Romagnoli R, Cucchetti A, Bonsignore P, Mangoni I, Pinelli D, Montalti R, Caccamo L, Vennarecci G, Nicolini D, Regalia E, Baccarani U, Lai Q, Manzia T, Tondolo E, Rendina M, Perrella A, Santaniello W, Bottino G, Spagnoletti G, Mariano G, Gasbarrini A, Burra P, Cillo U, Avolio, A, Halldorson, J, Lirosi, M, Agnes, S, Salizzoni, M, Pinna, A, Spada, M, De Carlis, L, Colledan, M, Gerunda, G, Andorno, E, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Rossi, M, Tisone, G, Zamboni, F, Vivarelli, M, Lupo, L, Cuomo, O, Calise, F, Nicolotti, N, Vitale, A, Romagnoli, R, Cucchetti, A, Bonsignore, P, Mangoni, I, Pinelli, D, Montalti, R, Caccamo, L, Vennarecci, G, Nicolini, D, Regalia, E, Baccarani, U, Lai, Q, Manzia, T, Tondolo, E, Rendina, M, Perrella, A, Santaniello, W, Bottino, G, Spagnoletti, G, Mariano, G, Gasbarrini, A, Burra, P, Cillo, U, Avolio A, Halldorson J, Lirosi M, Agnes S, Salizzoni M, Pinna A, Spada M, De Carlis L, Colledan M, Gerunda G, Andorno E, Rossi G, Ettorre G, Risaliti A, Mazzaferro V, Rossi M, Tisone G, Zamboni F, Vivarelli M, Lupo L, Cuomo O, Calise F, Nicolotti N, Vitale A, Romagnoli R, Cucchetti A, Bonsignore P, Mangoni I, Pinelli D, Montalti R, Caccamo L, Vennarecci G, Nicolini D, Regalia E, Baccarani U, Lai Q, Manzia T, Tondolo E, Rendina M, Perrella A, Santaniello W, Bottino G, Spagnoletti G, Mariano G, Gasbarrini A, Burra P, and Cillo U
Published: 2013

20. THE UN-SUSTAINABLE MATCH IN HCV LIVER TRANSPLANT PATIENTS

Author: Avolio, A, Agnes, S, Lirosi, M, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Valente, U, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Bresadola, F, Rossi, M, Tisone, G, Zamboni, F, Lupo, L, Cuomo, O, Calise, F, Vitale, A, Nicolotti, N, Romagnoli, R, Cucchetti, A, Gruttadauria, S, Mangoni, I, Pinelli, D, Montalti, R, Gelli, M, Caccamo, L, Vennarecci, G, Nicolini, D, Regalia, E, Baccarani, U, Lai, Q, Manzia, T, Tondolo, E, Rendina, M, Perrella, A, Scuderi, E, Antonelli, B, de Waure, C, Angelico, M, Burra, P, Gasbarrini, A, Cillo, U, Avolio AW, Agnes S, Lirosi MC, Salizzoni M, Pinna A, Gridelli B, De Carlis L, Colledan M, Gerunda G, Valente U, Rossi G, Ettorre G, Risaliti A, Mazzaferro V, Bresadola F, Rossi M, Tisone G, Zamboni F, Lupo L, Cuomo O, Calise F, Vitale A, Nicolotti N, Romagnoli R, Cucchetti A, Gruttadauria S, Mangoni I, Pinelli D, Montalti R, Gelli M, Caccamo L, Vennarecci G, Nicolini D, Regalia E, Baccarani U, Lai Q, Manzia T, Tondolo E, Rendina M, Perrella A, Scuderi E, Antonelli B, de Waure C, Angelico M, Burra P, Gasbarrini A, Cillo U, Avolio, A, Agnes, S, Lirosi, M, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Valente, U, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Bresadola, F, Rossi, M, Tisone, G, Zamboni, F, Lupo, L, Cuomo, O, Calise, F, Vitale, A, Nicolotti, N, Romagnoli, R, Cucchetti, A, Gruttadauria, S, Mangoni, I, Pinelli, D, Montalti, R, Gelli, M, Caccamo, L, Vennarecci, G, Nicolini, D, Regalia, E, Baccarani, U, Lai, Q, Manzia, T, Tondolo, E, Rendina, M, Perrella, A, Scuderi, E, Antonelli, B, de Waure, C, Angelico, M, Burra, P, Gasbarrini, A, Cillo, U, Avolio AW, Agnes S, Lirosi MC, Salizzoni M, Pinna A, Gridelli B, De Carlis L, Colledan M, Gerunda G, Valente U, Rossi G, Ettorre G, Risaliti A, Mazzaferro V, Bresadola F, Rossi M, Tisone G, Zamboni F, Lupo L, Cuomo O, Calise F, Vitale A, Nicolotti N, Romagnoli R, Cucchetti A, Gruttadauria S, Mangoni I, Pinelli D, Montalti R, Gelli M, Caccamo L, Vennarecci G, Nicolini D, Regalia E, Baccarani U, Lai Q, Manzia T, Tondolo E, Rendina M, Perrella A, Scuderi E, Antonelli B, de Waure C, Angelico M, Burra P, Gasbarrini A, and Cillo U
Published: 2012

21. The UN-SUSTAINABLE Match in HCV Recipients. Evidences from the Italian D-MELD Study on Balancing Donor-Recipient Risk Factors

Author: Avolio, A, Agnes, S, Lirosi, M, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Rossi, M, Tisone, G, Zamboni, F, Lupo, L, Cuomo, O, Calise, F, Donataccio, M, Nicolotti, N, Romagnoli, R, Vitale, A, Cucchetti, A, Gruttadauria, S, Baccarani, U, Caccamo, L, Mangoni, I, Pinelli, D, Montalti, R, Morelli, N, Vennarecci, G, Nicolini, D, Regalia, E, Lai, Q, Anselmo, A, Tondolo, E, Perrella, A, Burra, P, Cillo, U, Avolio AW, Agnes S, Lirosi M, Salizzoni M, Pinna A, Gridelli B, De Carlis L, Colledan M, Gerunda G, Rossi G, Ettorre G, Risaliti A, Mazzaferro V, Rossi M, Tisone G, Zamboni F, Lupo L, Cuomo O, Calise F, Donataccio M, Nicolotti N, Romagnoli R, Vitale A, Cucchetti A, Gruttadauria S, Baccarani U, Caccamo L, Mangoni I, Pinelli D, Montalti R, Morelli N, Vennarecci G, Nicolini D, Regalia E, Lai Q, Anselmo A, Tondolo E, Perrella A, Burra P, Cillo U, Avolio, A, Agnes, S, Lirosi, M, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Rossi, M, Tisone, G, Zamboni, F, Lupo, L, Cuomo, O, Calise, F, Donataccio, M, Nicolotti, N, Romagnoli, R, Vitale, A, Cucchetti, A, Gruttadauria, S, Baccarani, U, Caccamo, L, Mangoni, I, Pinelli, D, Montalti, R, Morelli, N, Vennarecci, G, Nicolini, D, Regalia, E, Lai, Q, Anselmo, A, Tondolo, E, Perrella, A, Burra, P, Cillo, U, Avolio AW, Agnes S, Lirosi M, Salizzoni M, Pinna A, Gridelli B, De Carlis L, Colledan M, Gerunda G, Rossi G, Ettorre G, Risaliti A, Mazzaferro V, Rossi M, Tisone G, Zamboni F, Lupo L, Cuomo O, Calise F, Donataccio M, Nicolotti N, Romagnoli R, Vitale A, Cucchetti A, Gruttadauria S, Baccarani U, Caccamo L, Mangoni I, Pinelli D, Montalti R, Morelli N, Vennarecci G, Nicolini D, Regalia E, Lai Q, Anselmo A, Tondolo E, Perrella A, Burra P, and Cillo U
Published: 2012

22. Behind D-MELD: The Role of Primary Indication (HCV or HBV) as Significant Covariate in the Outcome Prediction after Liver Transplants

Author: Avolio, A, Agnes, S, Lirosi, M, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Valente, U, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Rossi, M, Tisone, G, Zamboni, F, Lupo, L, Cuomo, O, Calise, F, Nicolotti, N, Vitale, A, Romagnoli, R, Cucchetti, A, Gruttadauria, S, Mangoni, I, Pinelli, D, Montalti, R, Gelli, M, Caccamo, L, Vennarecci, G, Nicolini, D, Regalia, E, Baccarani, U, Lai, Q, Manzia, T, Tondolo, E, Rendina, M, Perrella, A, Scuderi, E, Burra, P, Gasbarrini, A, Cillo, U, Avolio AW, Agnes S, Lirosi MC, Salizzoni M, Pinna A, Gridelli B, De Carlis L, Colledan M, Gerunda G, Valente U, Rossi G, Ettorre G, Risaliti A, Mazzaferro V, Rossi M, Tisone G, Zamboni F, Lupo L, Cuomo O, Calise F, Nicolotti N, Vitale A, Romagnoli R, Cucchetti A, Gruttadauria S, Mangoni I, Pinelli D, Montalti R, Gelli M, Caccamo L, Vennarecci G, Nicolini D, Regalia E, Baccarani U, Lai Q, Manzia T, Tondolo E, Rendina M, Perrella A, Scuderi E, Burra P, Gasbarrini A, Cillo U, Avolio, A, Agnes, S, Lirosi, M, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Valente, U, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Rossi, M, Tisone, G, Zamboni, F, Lupo, L, Cuomo, O, Calise, F, Nicolotti, N, Vitale, A, Romagnoli, R, Cucchetti, A, Gruttadauria, S, Mangoni, I, Pinelli, D, Montalti, R, Gelli, M, Caccamo, L, Vennarecci, G, Nicolini, D, Regalia, E, Baccarani, U, Lai, Q, Manzia, T, Tondolo, E, Rendina, M, Perrella, A, Scuderi, E, Burra, P, Gasbarrini, A, Cillo, U, Avolio AW, Agnes S, Lirosi MC, Salizzoni M, Pinna A, Gridelli B, De Carlis L, Colledan M, Gerunda G, Valente U, Rossi G, Ettorre G, Risaliti A, Mazzaferro V, Rossi M, Tisone G, Zamboni F, Lupo L, Cuomo O, Calise F, Nicolotti N, Vitale A, Romagnoli R, Cucchetti A, Gruttadauria S, Mangoni I, Pinelli D, Montalti R, Gelli M, Caccamo L, Vennarecci G, Nicolini D, Regalia E, Baccarani U, Lai Q, Manzia T, Tondolo E, Rendina M, Perrella A, Scuderi E, Burra P, Gasbarrini A, and Cillo U
Published: 2012

23. Use of HBcAb Positive Liver Grafts. Medium Term Results According to Donor-Recipient Risk Factors

Author: Avolio, A, Agnes, S, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Valente, U, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Bresadola, F, Rossi, M, Tisone, G, Zamboni, F, Lupo, L, Cuomo, O, Calise, F, Lirosi, M, Vitale, A, Nicolotti, N, Romagnoli, R, Cucchetti, A, Gruttadauria, S, Mangoni, I, Pinelli, D, Montalti, R, Gelli, M, Caccamo, L, Vennarecci, G, Nicolini, D, Regalia, E, Baccarani, U, Lai, Q, Manzia, T, Tondolo, E, Rendina, M, Perrella, A, Scudieri, E, Antonelli, B, de Waure, C, De Feo, T, Burra, P, Gasbarrini, A, Cillo, U, Avolio A, Agnes S, Salizzoni M, Pinna A, Gridelli B, De Carlis L, Colledan M, Gerunda G, Valente U, Rossi G, Ettorre G, Risaliti A, Mazzaferro V, Bresadola F, Rossi M, Tisone G, Zamboni F, Lupo L, Cuomo O, Calise F, Lirosi M, Vitale A, Nicolotti N, Romagnoli R, Cucchetti A, Gruttadauria S, Mangoni I, Pinelli D, Montalti R, Gelli M, Caccamo L, Vennarecci G, Nicolini D, Regalia E, Baccarani U, Lai Q, Manzia T, Tondolo E, Rendina M, Perrella A, Scudieri E, Antonelli B, de Waure C, De Feo T, Burra P, Gasbarrini A, Cillo U, Avolio, A, Agnes, S, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Valente, U, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Bresadola, F, Rossi, M, Tisone, G, Zamboni, F, Lupo, L, Cuomo, O, Calise, F, Lirosi, M, Vitale, A, Nicolotti, N, Romagnoli, R, Cucchetti, A, Gruttadauria, S, Mangoni, I, Pinelli, D, Montalti, R, Gelli, M, Caccamo, L, Vennarecci, G, Nicolini, D, Regalia, E, Baccarani, U, Lai, Q, Manzia, T, Tondolo, E, Rendina, M, Perrella, A, Scudieri, E, Antonelli, B, de Waure, C, De Feo, T, Burra, P, Gasbarrini, A, Cillo, U, Avolio A, Agnes S, Salizzoni M, Pinna A, Gridelli B, De Carlis L, Colledan M, Gerunda G, Valente U, Rossi G, Ettorre G, Risaliti A, Mazzaferro V, Bresadola F, Rossi M, Tisone G, Zamboni F, Lupo L, Cuomo O, Calise F, Lirosi M, Vitale A, Nicolotti N, Romagnoli R, Cucchetti A, Gruttadauria S, Mangoni I, Pinelli D, Montalti R, Gelli M, Caccamo L, Vennarecci G, Nicolini D, Regalia E, Baccarani U, Lai Q, Manzia T, Tondolo E, Rendina M, Perrella A, Scudieri E, Antonelli B, de Waure C, De Feo T, Burra P, Gasbarrini A, and Cillo U
Published: 2011

24. www.D-MELD.com. The online prognostic calculator to optimize donor-recipient match

Author: Avolio, A, Agnes, S, Lirosi, M, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Valente, U, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Bresadola, F, Rossi, M, Tisone, G, Zamboni, F, Lupo, L, Cuomo, O, Calise, F, Donataccio, M, Nicolotti, N, Vitale, A, Romagnoli, R, Lupo, F, Cucchetti, A, Gruttadauria, S, Mangoni, I, Pinelli, D, Montalti, R, Gelli, M, Caccamo, L, Vennarecci, G, Nicolini, D, Regalia, E, Baccarani, U, Lai, Q, Manzia, T, Tondolo, E, Rendina, M, Perrella, A, Scuderi, E, Antonelli, B, de Waure, C, De Feo, T, Burra, P, Gasbarrini, A, Cillo, U, Avolio AW, Agnes S, Lirosi MC, Salizzoni M, Pinna AD, Gridelli B, De Carlis L, Colledan M, Gerunda GE, Valente U, Rossi G, Ettorre GM, Risaliti A, Mazzaferro V, Bresadola F, Rossi M, Tisone G, Zamboni F, Lupo L, Cuomo O, Calise F, Donataccio M, Nicolotti N, Vitale A, Romagnoli R, Lupo F, Cucchetti A, Gruttadauria S, Mangoni I, Pinelli D, Montalti R, Gelli M, Caccamo L, Vennarecci G, Nicolini D, Regalia E, Baccarani U, Lai Q, Manzia T, Tondolo E, Rendina M, Perrella A, Scuderi E, Antonelli B, de Waure C, De Feo T, Burra P, Gasbarrini A, Cillo U, Avolio, A, Agnes, S, Lirosi, M, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Valente, U, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Bresadola, F, Rossi, M, Tisone, G, Zamboni, F, Lupo, L, Cuomo, O, Calise, F, Donataccio, M, Nicolotti, N, Vitale, A, Romagnoli, R, Lupo, F, Cucchetti, A, Gruttadauria, S, Mangoni, I, Pinelli, D, Montalti, R, Gelli, M, Caccamo, L, Vennarecci, G, Nicolini, D, Regalia, E, Baccarani, U, Lai, Q, Manzia, T, Tondolo, E, Rendina, M, Perrella, A, Scuderi, E, Antonelli, B, de Waure, C, De Feo, T, Burra, P, Gasbarrini, A, Cillo, U, Avolio AW, Agnes S, Lirosi MC, Salizzoni M, Pinna AD, Gridelli B, De Carlis L, Colledan M, Gerunda GE, Valente U, Rossi G, Ettorre GM, Risaliti A, Mazzaferro V, Bresadola F, Rossi M, Tisone G, Zamboni F, Lupo L, Cuomo O, Calise F, Donataccio M, Nicolotti N, Vitale A, Romagnoli R, Lupo F, Cucchetti A, Gruttadauria S, Mangoni I, Pinelli D, Montalti R, Gelli M, Caccamo L, Vennarecci G, Nicolini D, Regalia E, Baccarani U, Lai Q, Manzia T, Tondolo E, Rendina M, Perrella A, Scuderi E, Antonelli B, de Waure C, De Feo T, Burra P, Gasbarrini A, and Cillo U
Published: 2011

25. OPTIMIZATION OF DONOR-RECIPIENT MATCH AND IDENTIFICATION OF THE FUTILE MATCH CUTOFF. A NATIONAL ITALIAN STUDY ON LIVER TRANSPLANTATION

Author: Avolio, A, Agnes, S, Lirosi, M, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Valente, U, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Bresadola, F, Rossi, M, Tisone, G, Zamboni, F, Lupo, L, Cuomo, O, Calise, F, Donataccio, M, Nicolotti, N, Vitale, A, Romagnoli, R, Lupo, F, Cucchetti, A, Gruttadauria, S, Mangoni, I, Pinelli, D, Montalti, R, Gelli, M, Caccamo, L, Vennarecci, G, Nicolini, D, Regalia, E, Baccarani, U, Lai, Q, Manzia, T, Tondolo, E, Rendina, M, Barone, M, Perrella, A, Romano, M, de Waure, C, Burra, P, Gasbarrini, A, Cillo, U, Avolio AW, Agnes S, Lirosi MC, Salizzoni M, Pinna AD, Gridelli B, De Carlis L, Colledan M, Gerunda GE, Valente U, Rossi G, Ettorre GM, Risaliti A, Mazzaferro V, Bresadola F, Rossi M, Tisone G, Zamboni F, Lupo L, Cuomo O, Calise F, Donataccio M, Nicolotti N, Vitale A, Romagnoli R, Lupo F, Cucchetti A, Gruttadauria S, Mangoni I, Pinelli D, Montalti R, Gelli M, Caccamo L, Vennarecci G, Nicolini D, Regalia E, Baccarani U, Lai Q, Manzia T, Tondolo E, Rendina M, Barone M, Perrella A, Romano M, de Waure C, Burra P, Gasbarrini A, Cillo U, Avolio, A, Agnes, S, Lirosi, M, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Valente, U, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Bresadola, F, Rossi, M, Tisone, G, Zamboni, F, Lupo, L, Cuomo, O, Calise, F, Donataccio, M, Nicolotti, N, Vitale, A, Romagnoli, R, Lupo, F, Cucchetti, A, Gruttadauria, S, Mangoni, I, Pinelli, D, Montalti, R, Gelli, M, Caccamo, L, Vennarecci, G, Nicolini, D, Regalia, E, Baccarani, U, Lai, Q, Manzia, T, Tondolo, E, Rendina, M, Barone, M, Perrella, A, Romano, M, de Waure, C, Burra, P, Gasbarrini, A, Cillo, U, Avolio AW, Agnes S, Lirosi MC, Salizzoni M, Pinna AD, Gridelli B, De Carlis L, Colledan M, Gerunda GE, Valente U, Rossi G, Ettorre GM, Risaliti A, Mazzaferro V, Bresadola F, Rossi M, Tisone G, Zamboni F, Lupo L, Cuomo O, Calise F, Donataccio M, Nicolotti N, Vitale A, Romagnoli R, Lupo F, Cucchetti A, Gruttadauria S, Mangoni I, Pinelli D, Montalti R, Gelli M, Caccamo L, Vennarecci G, Nicolini D, Regalia E, Baccarani U, Lai Q, Manzia T, Tondolo E, Rendina M, Barone M, Perrella A, Romano M, de Waure C, Burra P, Gasbarrini A, and Cillo U
Published: 2011

26. WWW.D-MELD.COM THE PROGNOSTIC CALCULATOR TO BALANCE DONOR AND RECIPIENT LIVER TRANSPLANT FACTORS USING D-MELD AND COVARIATES

Author: Avolio, A, Agnes, S, Lirosi, M, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Valente, U, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Rossi, M, Tisone, G, Zamboni, F, Cuomo, O, Calise, F, Nicolotti, N, Vitale, A, Romagnoli, R, Cucchetti, A, Gruttadauria, S, Montalti, R, Caccamo, L, Vennarecci, G, Nicolini, D, Baccarani, U, Lai, Q, Manzia, T, Tondolo, V, Rendina, M, Scuderi, V, Perrella, A, Angelico, M, Burra, P, Fagiuoli, S, Gasbarrini, A, Cillo, U, Avolio AW, Agnes S, Lirosi MC, Salizzoni M, Pinna AD, Gridelli B, De Carlis L, Colledan M, Gerunda GE, Valente U, Rossi G, Ettorre GM, Risaliti A, Mazzaferro V, Rossi M, Tisone G, Zamboni F, Cuomo O, Calise F, Nicolotti N, Vitale A, Romagnoli R, Cucchetti A, Gruttadauria S, Montalti R, Caccamo L, Vennarecci G, Nicolini D, Baccarani U, Lai Q, Manzia TM, Tondolo V, Rendina M, Scuderi V, Perrella A, Angelico M, Burra P, Fagiuoli S, Gasbarrini A, Cillo U, Avolio, A, Agnes, S, Lirosi, M, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Valente, U, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Rossi, M, Tisone, G, Zamboni, F, Cuomo, O, Calise, F, Nicolotti, N, Vitale, A, Romagnoli, R, Cucchetti, A, Gruttadauria, S, Montalti, R, Caccamo, L, Vennarecci, G, Nicolini, D, Baccarani, U, Lai, Q, Manzia, T, Tondolo, V, Rendina, M, Scuderi, V, Perrella, A, Angelico, M, Burra, P, Fagiuoli, S, Gasbarrini, A, Cillo, U, Avolio AW, Agnes S, Lirosi MC, Salizzoni M, Pinna AD, Gridelli B, De Carlis L, Colledan M, Gerunda GE, Valente U, Rossi G, Ettorre GM, Risaliti A, Mazzaferro V, Rossi M, Tisone G, Zamboni F, Cuomo O, Calise F, Nicolotti N, Vitale A, Romagnoli R, Cucchetti A, Gruttadauria S, Montalti R, Caccamo L, Vennarecci G, Nicolini D, Baccarani U, Lai Q, Manzia TM, Tondolo V, Rendina M, Scuderi V, Perrella A, Angelico M, Burra P, Fagiuoli S, Gasbarrini A, and Cillo U
Published: 2011

27. Long term follow-up of liver transplantation (OLT) for cholestatic and autoimmune end stage liver diseases

Author: Blasone, L, Fagiuoli, S, Colledan, M, Strazzabosco, M, Lenzi, M, Floreani, A, Burra, P, Cillo, U, Merenda, R, Donato, M, Rossi, G, Salizzoni, M, Franchello, A, Rizzetto, M, Pinzello, G, De Carlis, L, Toniutto, P, Andorno, E, Blasone L, Fagiuoli S, Colledan M, Strazzabosco M, Lenzi M, Floreani A, Burra P, Cillo U, Merenda R, Donato MF, Rossi G, Salizzoni M, Franchello A, Rizzetto M, Pinzello G, De Carlis L, Toniutto P, Andorno E, Blasone, L, Fagiuoli, S, Colledan, M, Strazzabosco, M, Lenzi, M, Floreani, A, Burra, P, Cillo, U, Merenda, R, Donato, M, Rossi, G, Salizzoni, M, Franchello, A, Rizzetto, M, Pinzello, G, De Carlis, L, Toniutto, P, Andorno, E, Blasone L, Fagiuoli S, Colledan M, Strazzabosco M, Lenzi M, Floreani A, Burra P, Cillo U, Merenda R, Donato MF, Rossi G, Salizzoni M, Franchello A, Rizzetto M, Pinzello G, De Carlis L, Toniutto P, and Andorno E
Published: 2007

28. The place of liver transplantation (LT) in the treatment of hepatic epitheloid haemangioendothelioma (HEHE): Report of the european liver transplant registry

Author: Lerut, J, Orlando, G, Adam, R, Schiavo, M, Klempnauer, J, Mirza, D, Boleslawski, E, Burroughs, A, Selles, C, Jaeck, D, Pfitzmann, R, Salizzoni, M, Soderdahl, G, Steininger, R, Wettergren, A, Baccarani, U, Berenguer, M, Calise, F, Colledan, M, Figueras, J, Graziadei, I, Halkic, N, Holscher, A, Metselaar, H, Urbina, J, Pisarski, P, Kobori, L, Pirenne, J, Rossi, M, Valdecassas, J, Benvenuto, E, Karam, V, Delvart, V, Mazzaferro, V, Lerut J, Orlando G, Adam R, Schiavo M, Klempnauer J, Mirza D, Boleslawski E, Burroughs A, Selles CF, Jaeck D, Pfitzmann R, Salizzoni M, Soderdahl G, Steininger R, Wettergren A, Baccarani U, Berenguer M, Calise F, Colledan M, Figueras J, Graziadei I, Halkic N, Holscher A, Metselaar H, Urbina JOD, Pisarski P, Kobori L, Pirenne J, Rossi M, Valdecassas JCG, Benvenuto E, Karam V, Delvart V, Mazzaferro V, Lerut, J, Orlando, G, Adam, R, Schiavo, M, Klempnauer, J, Mirza, D, Boleslawski, E, Burroughs, A, Selles, C, Jaeck, D, Pfitzmann, R, Salizzoni, M, Soderdahl, G, Steininger, R, Wettergren, A, Baccarani, U, Berenguer, M, Calise, F, Colledan, M, Figueras, J, Graziadei, I, Halkic, N, Holscher, A, Metselaar, H, Urbina, J, Pisarski, P, Kobori, L, Pirenne, J, Rossi, M, Valdecassas, J, Benvenuto, E, Karam, V, Delvart, V, Mazzaferro, V, Lerut J, Orlando G, Adam R, Schiavo M, Klempnauer J, Mirza D, Boleslawski E, Burroughs A, Selles CF, Jaeck D, Pfitzmann R, Salizzoni M, Soderdahl G, Steininger R, Wettergren A, Baccarani U, Berenguer M, Calise F, Colledan M, Figueras J, Graziadei I, Halkic N, Holscher A, Metselaar H, Urbina JOD, Pisarski P, Kobori L, Pirenne J, Rossi M, Valdecassas JCG, Benvenuto E, Karam V, Delvart V, and Mazzaferro V
Published: 2007

29. Feasibility and limits of split liver transplantation from pediatric donors - An Italian multicenter experience

Author: Cescon, M, Spada, M, Colledan, M, Torre, G, Andorno, E, Valente, U, Rossi, G, Reggiani, P, Cillo, U, Baccarani, U, Grazi, G, Tisone, G, Filipponi, F, Rossi, M, Ettorre, G, Salizzoni, M, Cuomo, O, De Feo, T, Gridelli, B, Cescon M, Spada M, Colledan M, Torre G, Andorno E, Valente U, Rossi G, Reggiani P, Cillo U, Baccarani U, Grazi GL, Tisone G, Filipponi F, Rossi M, Ettorre GM, Salizzoni M, Cuomo O, De Feo T, Gridelli B, Cescon, M, Spada, M, Colledan, M, Torre, G, Andorno, E, Valente, U, Rossi, G, Reggiani, P, Cillo, U, Baccarani, U, Grazi, G, Tisone, G, Filipponi, F, Rossi, M, Ettorre, G, Salizzoni, M, Cuomo, O, De Feo, T, Gridelli, B, Cescon M, Spada M, Colledan M, Torre G, Andorno E, Valente U, Rossi G, Reggiani P, Cillo U, Baccarani U, Grazi GL, Tisone G, Filipponi F, Rossi M, Ettorre GM, Salizzoni M, Cuomo O, De Feo T, and Gridelli B
Abstract: Objective: To report the results of a multicenter experience of split liver transplantation (SLT) with pediatric donors.Summary Background Data: There are no reports in the literature regarding pediatric liver splitting; further; the use of donors weighing <40 kg for SLT is currently not recommended.Methods: From 1997 to 2004, 43 conventional split liver procedures from donors aged < 15 years were performed. Nineteen donors weighing <= 40 kg and 24 weighing >40 kg were used. Dimensional matching was based on donor-to-recipient weight ratio (DRWR) for left lateral segment (LLS) and on estimated graft-to-recipient weight ratio (eGRWR) for extended right grafts (ERG). In 3 cases, no recipient was found for an ERG. The celiac trunk was retained with the LLS in all but 1 case. Forty LLSs were transplanted into 39 children, while 39 ERGs were transplanted into 11 children and 28 adults.Results: Two-year patient and graft survival rates were not significantly different between recipients of donors <= 40 kg and >40 kg, between pediatric and adult recipients, and between recipients of LLSs and ERGs. Vascular complication rates were 12% in the <= 40 kg donor group and 6% in the >40 kg donor group (P = not significant). There were no differences in the incidence of other complications. Donor ICU stay >3 days and the use of an interposition arterial graft were associated with an increased risk of graft loss and arterial complications, respectively.Conclusions: Splitting of pediatric liver grafts is an effective strategy to increase organ availability, but a cautious evaluation of the use of donors <= 40 kg is necessary. Prolonged donor ICU stay is associated with poorer outcomes. The maintenance of the celiac trunk with LLS does not seem detrimental for right-sided grafts, whereas the use of interposition grafts for arterial reconstruction should be avoided.
Published: 2006

30. A Bayesian methodology to improve prediction of early graft loss after liver transplantation derived from the Liver Match study

Author: Angelico, M, Nardi, A, Romagnoli, R, Marianelli, T, Corradini, S, Tandoi, F, Gavrila, C, Salizzoni, M, Pinna, A, Cillo, U, Gridelli, B, DE CARLIS, L, Colledan, M, Gerunda, G, Costa, A, Strazzabosco, M, Fagiuoli, S, DE CARLIS, LUCIANO GREGORIO, STRAZZABOSCO, MARIO, FAGIUOLI, STEFANO, Angelico, M, Nardi, A, Romagnoli, R, Marianelli, T, Corradini, S, Tandoi, F, Gavrila, C, Salizzoni, M, Pinna, A, Cillo, U, Gridelli, B, DE CARLIS, L, Colledan, M, Gerunda, G, Costa, A, Strazzabosco, M, Fagiuoli, S, DE CARLIS, LUCIANO GREGORIO, STRAZZABOSCO, MARIO, and FAGIUOLI, STEFANO
Abstract: Background: To generate a robust predictive model of Early (3 months) Graft Loss after liver transplantation, we used a Bayesian approach to combine evidence from a prospective European cohort (Liver-Match) and the United Network for Organ Sharing registry. Methods: Liver-Match included 1480 consecutive primary liver transplants performed from 2007 to 2009 and the United Network for Organ Sharing a time-matched series of 9740 transplants. There were 173 and 706 Early Graft Loss, respectively. Multivariate analysis identified as significant predictors of Early Graft Loss: donor age, donation after cardiac death, cold ischaemia time, donor body mass index and height, recipient creatinine, bilirubin, disease aetiology, prior upper abdominal surgery and portal thrombosis. Results: A Bayesian Cox model was fitted to Liver-Match data using the United Network for Organ Sharing findings as prior information, allowing to generate an Early Graft Loss-Donor Risk Index and an Early Graft Loss-Recipient Risk Index. A Donor-Recipient Allocation Model, obtained by adding Early Graft Loss-Donor Risk Index to Early Graft Loss-Recipient Risk Index, was then validated in a distinct United Network for Organ Sharing (year 2010) cohort including 2964 transplants. Donor-Recipient Allocation Model updating using the independent Turin Transplant Centre dataset, allowed to predict Early Graft Loss with good accuracy (c-statistic: 0.76). Conclusion: Donor-Recipient Allocation Model allows a reliable donor and recipient-based Early Graft Loss prediction. The Bayesian approach permits to adapt the original Donor-Recipient Allocation Model by incorporating evidence from other cohorts, resulting in significantly improved predictive capability. © 2013 Editrice Gastroenterologica Italiana S.r.l.
Published: 2014

31. A Bayesian methodology to improve prediction of early graft loss after liver transplantation derived from the Liver Match study

Author: Angelico, M, Nardi, A, Romagnoli, R, Marianelli, T, Corradini, Sg, Agnes, Salvatore, Gavrila, C, Salizzoni, M, Pinna, Ad, Cillo, U, Gridelli, B, De Carlis, Lg, Colledan, M, Gerunda, Ge, Costa, An, Strazzabosco, M., Agnes, Salvatore (ORCID:0000-0002-3341-4221), Angelico, M, Nardi, A, Romagnoli, R, Marianelli, T, Corradini, Sg, Agnes, Salvatore, Gavrila, C, Salizzoni, M, Pinna, Ad, Cillo, U, Gridelli, B, De Carlis, Lg, Colledan, M, Gerunda, Ge, Costa, An, Strazzabosco, M., and Agnes, Salvatore (ORCID:0000-0002-3341-4221)
Abstract: To generate a robust predictive model of Early (3 months) Graft Loss after liver transplantation, we used a Bayesian approach to combine evidence from a prospective European cohort (Liver-Match) and the United Network for Organ Sharing registry.
Published: 2014

32. Patterns of hepatitis delta virus reinfection and disease in liver transplantation

Author: Ottobrelli, A, Marzano, A, Smedile, A, Recchia, S, Salizzoni, M, Cornu, C, Lamy, M, Otte, J, Dehemptinne, B, Geubel, A, Grendele, M, Colledan, M, Galmarini, D, Marinucci, G, Digiacomo, C, Agnes, S, Bonino, F, Rizzetto, M, OTTOBRELLI A, MARZANO A, SMEDILE A, RECCHIA S, SALIZZONI M, CORNU C, LAMY ME, OTTE JB, DEHEMPTINNE B, GEUBEL A, GRENDELE M, COLLEDAN M, GALMARINI D, MARINUCCI G, DIGIACOMO C, AGNES S, BONINO F, RIZZETTO M, Ottobrelli, A, Marzano, A, Smedile, A, Recchia, S, Salizzoni, M, Cornu, C, Lamy, M, Otte, J, Dehemptinne, B, Geubel, A, Grendele, M, Colledan, M, Galmarini, D, Marinucci, G, Digiacomo, C, Agnes, S, Bonino, F, Rizzetto, M, OTTOBRELLI A, MARZANO A, SMEDILE A, RECCHIA S, SALIZZONI M, CORNU C, LAMY ME, OTTE JB, DEHEMPTINNE B, GEUBEL A, GRENDELE M, COLLEDAN M, GALMARINI D, MARINUCCI G, DIGIACOMO C, AGNES S, BONINO F, and RIZZETTO M
Abstract: Twenty-seven carriers of the hepatitis B surface antigen who underwent liver transplantation in Italy and Belgium for terminal Hepatitis delta virus (HDV) cirrhosis were investigated. In 22 of the patients, HDV infection recurred. Two patients died of coexisting HDV and hepatitis B virus (HBV) reactivation. Four patients who died of unrelated causes were found to have HDV without signs of HBV reactivation. Five patients (18%) cleared both HBV and HDV after transplantation with no evidence of hepatitis (mean follow-up, 29 months). In many surviving patients, HDV infection recurred early without signs of HBV reactivation. Disease returned in the 11 HDV-infected patients in whom HBV also recurred. Histological hepatitis did not recur during an interim of 12-33 months in the 5 HDV-infected patients in whom HBV did not return. The overall medium-term survival in patients with HDV who underwent transplantation was 77.7%. Liver transplantation offers patients with HDV a hope of cure from disease despite a high risk of reinfection. In the transplantation setting, HDV can cause subclinical infections without any apparent assistance from HBV; these infections become symptomatic only if and when HBV reactivates. Thus, HDV may not be in itself pathogenic but requires cooperation from HBV to cause the appearance of the disease.
Published: 1991

33. Balancing donor and recipient risk factors in liver transplantation: the value of D-MELD with particular reference to HCV recipients

Author: Avolio, Alfonso Wolfango, Salizzoni, M, De Carlis, L, Colledan, M, Gerunda, Ge, Mazzaferro, V, Tisone, G, Romagnoli, R, Caccamo, L, Rossi, M, Vitale, A, Cucchetti, A, Lupo, L, Gruttadauria, S, Nicolotti, Nicola, Burra, P, Gasbarrini, Antonio, Agnes, Salvatore, Avolio, Alfonso Wolfango (ORCID:0000-0003-2491-7625), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Agnes, Salvatore (ORCID:0000-0002-3341-4221), Avolio, Alfonso Wolfango, Salizzoni, M, De Carlis, L, Colledan, M, Gerunda, Ge, Mazzaferro, V, Tisone, G, Romagnoli, R, Caccamo, L, Rossi, M, Vitale, A, Cucchetti, A, Lupo, L, Gruttadauria, S, Nicolotti, Nicola, Burra, P, Gasbarrini, Antonio, Agnes, Salvatore, Avolio, Alfonso Wolfango (ORCID:0000-0003-2491-7625), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Agnes, Salvatore (ORCID:0000-0002-3341-4221)
Abstract: Donor–recipient match is a matter of debate in liver transplantation. D-MELD (donor age × recipient bio- chemical model for end-stage liver disease [MELD]) and other factors were analyzed on a national Ital- ian database recording 5946 liver transplants. Primary endpoint was to determine factors predictive of 3- year patient survival. D-MELD cutoff predictive of 5- year patient survival <50% (5yrsPS<50%) was in- vestigated. A prognosis calculator was implemented (www.D-MELD.com). Differences among D-MELD deciles allowed their regrouping into three D-MELD classes (A < 338, B 338–1628, C >1628). At 3 years, the odds ratio (OR) for death was 2.03 (95% confidence interval [CI], 1.44–2.85) in D-MELD class C versus B. The OR was 0.40 (95% CI, 0.24–0.66) in class A versus class B. Other predictors were hepatitis C virus (HCV; OR = 1.42; 95% CI, 1.11–1.81), hepatitis B virus (HBV; OR = 0.69; 95% CI, 0.51–0.93), retransplant (OR = 1.82; 95% CI, 1.16–2.87) and low-volume center (OR = 1.48; 95% CI, 1.11–1.99). Cox regressions up to 90 months confirmed results. The hazard ratio was 1.97 (95% CI, 1.59–2.43) for D-MELD class C versus class B and 0.42 (95% CI, 0.29–0.60) for D-MELD class A versus class B. Recipient age, HCV, HBV and retransplant were also significant. The 5yrsPS<50% cutoff was identified only in HCV patients (D-MELD ≥ 1750). The innovative ap- proach offered by D-MELD and covariates is helpful in predicting outcome after liver transplantation, espe- cially in HCV recipients.
Published: 2011

34. Balancing Donor and Recipient Risk Factors in Liver Transplantation: The Value of D-MELD With Particular Reference to HCV Recipients

Author: Avolio, Alfonso Wolfango, Cillo, U, Salizzoni, M, De Carlis, L, Colledan, M, Gerunda, Ge, Mazzaferro, V, Tisone, G, Romagnoli, R, Caccamo, L, Rossi, M, Vitale, A, Cucchetti, A, Lupo, L, Gruttadauria, S, Nicolotti, Nicola, Burra, P, Gasbarrini, Antonio, Agnes, Salvatore, Lirosi, Mc, Miele, Luca, Pompili, Maurizio, Siciliano, M, Perilli, Valter, Gaspari, Rita, Castagneto, M, Tandoi, F, Mangoni, I, Belli, L, Pinna, Ad, Cescon, M, Gridelli, B, Li Petri, S, Volpes, R, Pinelli, D, Fagiuoli, Stefano, Montalti, R, Regalia, E, Rossi, G, Antonelli, B, Berloco, P, Lai, Q, Risaliti, A, Nicolini, D, Valente, U, Gelli, M, Morelli, N, Zamboni, F, Tondolo, Vincenzo, Ettorre, Gm, Vennarecci, G, Bresadola, F, Baccarani, U, Toniutto, Pl, Manzia, T, Anselmo, A, Angelico, M, Calise, F, Scuderi, V, Romano, M, Rendina, M, Barone, M, Cuomo, O, Perrella, A, Santaniello, W, Donataccio, M, Dalle Ore, G, de Ville de Goyet, J, Monti, L, De Waure, Chiara, Avolio, AW (ORCID:0000-0003-2491-7625), Nicolotti, N, Gasbarrini, A (ORCID:0000-0002-7278-4823), Agnes, S (ORCID:0000-0002-3341-4221), Miele, L (ORCID:0000-0003-3464-0068), Pompili, M (ORCID:0000-0001-6699-7980), Perilli, V (ORCID:0000-0001-9655-4267), Gaspari, R (ORCID:0000-0003-0141-3686), Fagiuoli, S, Tondolo, V (ORCID:0000-0003-0256-3766), de Waure, C (ORCID:0000-0002-4346-1494), Avolio, Alfonso Wolfango, Cillo, U, Salizzoni, M, De Carlis, L, Colledan, M, Gerunda, Ge, Mazzaferro, V, Tisone, G, Romagnoli, R, Caccamo, L, Rossi, M, Vitale, A, Cucchetti, A, Lupo, L, Gruttadauria, S, Nicolotti, Nicola, Burra, P, Gasbarrini, Antonio, Agnes, Salvatore, Lirosi, Mc, Miele, Luca, Pompili, Maurizio, Siciliano, M, Perilli, Valter, Gaspari, Rita, Castagneto, M, Tandoi, F, Mangoni, I, Belli, L, Pinna, Ad, Cescon, M, Gridelli, B, Li Petri, S, Volpes, R, Pinelli, D, Fagiuoli, Stefano, Montalti, R, Regalia, E, Rossi, G, Antonelli, B, Berloco, P, Lai, Q, Risaliti, A, Nicolini, D, Valente, U, Gelli, M, Morelli, N, Zamboni, F, Tondolo, Vincenzo, Ettorre, Gm, Vennarecci, G, Bresadola, F, Baccarani, U, Toniutto, Pl, Manzia, T, Anselmo, A, Angelico, M, Calise, F, Scuderi, V, Romano, M, Rendina, M, Barone, M, Cuomo, O, Perrella, A, Santaniello, W, Donataccio, M, Dalle Ore, G, de Ville de Goyet, J, Monti, L, De Waure, Chiara, Avolio, AW (ORCID:0000-0003-2491-7625), Nicolotti, N, Gasbarrini, A (ORCID:0000-0002-7278-4823), Agnes, S (ORCID:0000-0002-3341-4221), Miele, L (ORCID:0000-0003-3464-0068), Pompili, M (ORCID:0000-0001-6699-7980), Perilli, V (ORCID:0000-0001-9655-4267), Gaspari, R (ORCID:0000-0003-0141-3686), Fagiuoli, S, Tondolo, V (ORCID:0000-0003-0256-3766), and de Waure, C (ORCID:0000-0002-4346-1494)
Abstract: Donorrecipient match is a matter of debate in liver transplantation. D-MELD (donor age x recipient biochemical model for end-stage liver disease [MELD]) and other factors were analyzed on a national Italian database recording 5946 liver transplants. Primary endpoint was to determine factors predictive of 3-year patient survival. D-MELD cutoff predictive of 5-year patient survival <50% (5yrsPS<50%) was investigated. A prognosis calculator was implemented (). Differences among D-MELD deciles allowed their regrouping into three D-MELD classes (A < 338, B 338-1628, C >1628). At 3 years, the odds ratio (OR) for death was 2.03 (95% confidence interval [CI], 1.442.85) in D-MELD class C versus B. The OR was 0.40 (95% CI, 0.24-0.66) in class A versus class B. Other predictors were hepatitis C virus (HCV; OR = 1.42; 95% CI, 1.11-1.81), hepatitis B virus (HBV; OR = 0.69; 95% CI, 0.51-0.93), retransplant (OR = 1.82; 95% CI, 1.16-2.87) and low-volume center (OR = 1.48; 95% CI, 1.1-11.99). Cox regressions up to 90 months confirmed results. The hazard ratio was 1.97 (95% CI, 1.592.43) for D-MELD class C versus class B and 0.42 (95% CI, 0.290.60) for D-MELD class A versus class B. Recipient age, HCV, HBV and retransplant were also significant. The 5yrsPS<50% cutoff was identified only in HCV patients (D-MELD = 1750). The innovative approach offered by D-MELD and covariates is helpful in predicting outcome after liver transplantation, especially in HCV recipients.
Published: 2011

35. Balancing donor and recipient risk factors in liver transplantation: The value of D-MELD with particular reference to HCV recipients

Author: Avolio, A, Cillo, U, Salizzoni, M, DE CARLIS, L, Colledan, M, Gerunda, G, Mazzaferro, V, Tisone, G, Romagnoli, R, Caccamo, L, Rossi, M, Vitale, A, Cucchetti, A, Lupo, L, Gruttadauria, S, Nicolotti, N, Burra, P, Gasbarrini, A, Agnes, S, Lirosi, M, Miele, L, Pompili, M, Siciliano, M, Perilli, V, Gaspari, R, Castagneto, M, Lupo, F, Tandoi, F, De Carlis, L, Mangoni, I, Belli, L, Pinna, A, Cescon, M, Gridelli, B, Li Petri, S, Volpes, R, Pinelli, D, Fagiuoli, S, Montalti, R, Regalia, E, Rossi, G, Antonelli, B, Berloco, P, Lai, Q, Risaliti, A, Nicolini, D, Valente, U, Gelli, M, Morelli, N, Zamboni, F, Tondolo, V, Ettorre, G, Vennarecci, G, Bresadola, F, Baccarani, U, Toniutto, P, Manzia, T, Anselmo, A, Angelico, M, Calise, F, Scuderi, V, Romano, M, Rendina, M, Barone, M, Cuomo, O, Perrella, A, Santaniello, W, Donataccio, M, Dalle Ore, G, De Ville De Goyet, J, Monti, L, De Waure, C, DE CARLIS, LUCIANO GREGORIO, De Waure, C., Avolio, A, Cillo, U, Salizzoni, M, DE CARLIS, L, Colledan, M, Gerunda, G, Mazzaferro, V, Tisone, G, Romagnoli, R, Caccamo, L, Rossi, M, Vitale, A, Cucchetti, A, Lupo, L, Gruttadauria, S, Nicolotti, N, Burra, P, Gasbarrini, A, Agnes, S, Lirosi, M, Miele, L, Pompili, M, Siciliano, M, Perilli, V, Gaspari, R, Castagneto, M, Lupo, F, Tandoi, F, De Carlis, L, Mangoni, I, Belli, L, Pinna, A, Cescon, M, Gridelli, B, Li Petri, S, Volpes, R, Pinelli, D, Fagiuoli, S, Montalti, R, Regalia, E, Rossi, G, Antonelli, B, Berloco, P, Lai, Q, Risaliti, A, Nicolini, D, Valente, U, Gelli, M, Morelli, N, Zamboni, F, Tondolo, V, Ettorre, G, Vennarecci, G, Bresadola, F, Baccarani, U, Toniutto, P, Manzia, T, Anselmo, A, Angelico, M, Calise, F, Scuderi, V, Romano, M, Rendina, M, Barone, M, Cuomo, O, Perrella, A, Santaniello, W, Donataccio, M, Dalle Ore, G, De Ville De Goyet, J, Monti, L, De Waure, C, DE CARLIS, LUCIANO GREGORIO, and De Waure, C.
Abstract: Donor-recipient match is a matter of debate in liver transplantation. D-MELD (donor age x recipient biochemical model for end-stage liver disease [MELD]) and other factors were analyzed on a national Italian database recording 5946 liver transplants. Primary endpoint was to determine factors predictive of 3-year patient survival. D-MELD cutoff predictive of 5-year patient survival <50% (5 yrs PS<50%) was investigated. A prognosis calculator was implemented (www.D-MELD.com). Differences among D-MELD deciles allowed their regrouping into three D-MELD classes (A < 338, B 338-1628, C >1628). At 3 years, the odds ratio (OR) for death was 2.03 (95% confidence interval [CI], 1.44-2.85) in D-MELD class C versus B. The OR was 0.40 (95% CI, 0.24-0.66) in class A versus class B. Other predictors were hepatitis C virus (HCV; OR = 1.42; 95% CI, 1.11-1.81), hepatitis B virus (HBV; OR = 0.69; 95% CI, 0.51-0.93), retransplant (OR = 1.82; 95% CI, 1.16-2.87) and low-volume center (OR = 1.48; 95% CI, 1.11-1.99). Cox regressions up to 90 months confirmed results. The hazard ratio was 1.97 (95% CI, 1.59-2.43) for D-MELD class C versus class B and 0.42 (95% CI, 0.29-0.60) for D-MELD class A versus class B. Recipient age, HCV, HBV and retransplant were also significant. The 5 yrs PS<50% cutoff was identified only in HCV patients (D-MELD ≥ 1750). The innovative approach offered by D-MELD and covariates is helpful in predicting outcome after liver transplantation, especially in HCV recipients
Published: 2011

36. Liver Match, a prospective observational cohort study on liver transplantation in Italy: study design and current practice of donor-recipient matching

Author: Angelico, M, Cillo, U, Fagiuoli, S, Gasbarrini, A, Gavrila, C, Marianelli, T, Costa, A, Nardi, A, Strazzabosco, M, Burra, P, Agnes, S, Baccarani, U, Calise, F, Colledan, M, Cuomo, O, DE CARLIS, L, Donataccio, M, Ettorre, G, Gerunda, G, Gridelli, B, Lupo, L, Mazzaferro, V, Pinna, A, Risaliti, A, Salizzoni, M, Tisone, G, Valente, U, Rossi, G, Rossi, M, Zamboni, F, Liver Match, I, Costa, AN, DE CARLIS, LUCIANO GREGORIO, Ettorre, GM, Gerunda, GE, Liver Match Investigators, STRAZZABOSCO, MARIO, Angelico, M, Cillo, U, Fagiuoli, S, Gasbarrini, A, Gavrila, C, Marianelli, T, Costa, A, Nardi, A, Strazzabosco, M, Burra, P, Agnes, S, Baccarani, U, Calise, F, Colledan, M, Cuomo, O, DE CARLIS, L, Donataccio, M, Ettorre, G, Gerunda, G, Gridelli, B, Lupo, L, Mazzaferro, V, Pinna, A, Risaliti, A, Salizzoni, M, Tisone, G, Valente, U, Rossi, G, Rossi, M, Zamboni, F, Liver Match, I, Costa, AN, DE CARLIS, LUCIANO GREGORIO, Ettorre, GM, Gerunda, GE, Liver Match Investigators, and STRAZZABOSCO, MARIO
Abstract: BACKGROUND: The Liver Match is an observational cohort study that prospectively enrolled liver transplantations performed at 20 out of 21 Italian Transplant Centres between June 2007 and May 2009. Aim of the study is to investigate the impact of donor/recipient matching on outcomes. In this report we describe the study methodology and provide a cross-sectional description of donor and recipient characteristics and of graft allocation. METHODS: Adult primary transplants performed with deceased heart-beating donors were included. Relevant information on donors and recipients, organ procurement and allocation were prospectively entered in an ad hoc database within the National Transplant Centre web-based Network. Data were blindly analysed by an independent Biostatistical Board. RESULTS: The study enrolled 1530 donor/recipient matches. Median donor age was 56 years. Female donors (n = 681, median 58, range 12-92 years) were older than males (n = 849, median 53, range 2-97 years, p < 0.0001). Donors older than 60 years were 42.2%, including 4.2% octogenarians. Brain death was due to non-traumatic causes in 1126 (73.6%) cases. Half of the donor population was overweight, 10.1% was obese and 7.6% diabetic. Hepatitis B core antibody (HBcAb) was present in 245 (16.0%) donors. The median Donor Risk Index (DRI) was 1.57 (>1.7 in 35.8%). The median cold ischaemia time was 7.3h (≥ 10 in 10.6%). Median age of recipients was 54 years, and 77.7% were males. Hepatocellular carcinoma (HCC) was the most frequent indication overall (44.4%), being a coindication in roughly 1/3 of cases, followed by viral cirrhosis without HCC (28.2%) and alcoholic cirrhosis without HCC (10.2%). Hepatitis C virus infection (with or without HCC) was the most frequent etiologic factor (45.9% of the whole population and 71.4% of viral-related cirrhosis), yet hepatitis B virus infection accounted for 28.6% of viral-related cirrhosis, and HBcAb positivity was found in 49.7% of recipients. The median Model fo
Published: 2011

37. Balancing donor and recipient risk factors in liver transplantation: the value of D-MELD with particular reference to HCV recipients

Author: Avolio, Aw, Cillo, U, Salizzoni, M, De Carlis, L, Colledan, M, Gerunda, Ge, Mazzaferro, V, Tisone, G, Romagnoli, R, Caccamo, L, Rossi, Marianna, Vitale, A, Cucchetti, A, Lupo, L, Gruttadauria, S, Nicolotti, Nicola, Burra, P, Gasbarrini, Antonio, Agnes, Salvatore, Avolio, Aw (ORCID:0000-0003-2491-7625), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Agnes, Salvatore (ORCID:0000-0002-3341-4221), Avolio, Aw, Cillo, U, Salizzoni, M, De Carlis, L, Colledan, M, Gerunda, Ge, Mazzaferro, V, Tisone, G, Romagnoli, R, Caccamo, L, Rossi, Marianna, Vitale, A, Cucchetti, A, Lupo, L, Gruttadauria, S, Nicolotti, Nicola, Burra, P, Gasbarrini, Antonio, Agnes, Salvatore, Avolio, Aw (ORCID:0000-0003-2491-7625), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Agnes, Salvatore (ORCID:0000-0002-3341-4221)
Abstract: Donor-recipient match is a matter of debate in liver transplantation. D-MELD (donor age × recipient biochemical model for end-stage liver disease [MELD]) and other factors were analyzed on a national Italian database recording 5946 liver transplants. Primary endpoint was to determine factors predictive of 3-year patient survival. D-MELD cutoff predictive of 5-year patient survival <50% (5yrsPS<50%) was investigated. A prognosis calculator was implemented (http://www.D-MELD.com). Differences among D-MELD deciles allowed their regrouping into three D-MELD classes (A < 338, B 338-1628, C >1628). At 3 years, the odds ratio (OR) for death was 2.03 (95% confidence interval [CI], 1.44-2.85) in D-MELD class C versus B. The OR was 0.40 (95% CI, 0.24-0.66) in class A versus class B. Other predictors were hepatitis C virus (HCV; OR = 1.42; 95% CI, 1.11-1.81), hepatitis B virus (HBV; OR = 0.69; 95% CI, 0.51-0.93), retransplant (OR = 1.82; 95% CI, 1.16-2.87) and low-volume center (OR = 1.48; 95% CI, 1.11-1.99). Cox regressions up to 90 months confirmed results. The hazard ratio was 1.97 (95% CI, 1.59-2.43) for D-MELD class C versus class B and 0.42 (95% CI, 0.29-0.60) for D-MELD class A versus class B. Recipient age, HCV, HBV and retransplant were also significant. The 5yrsPS<50% cutoff was identified only in HCV patients (D-MELD ≥ 1750). The innovative approach offered by D-MELD and covariates is helpful in predicting outcome after liver transplantation, especially in HCV recipients.
Published: 2011

38. Liver Match, a prospective observational cohort study on liver transplantation in Italy: study design and current practice of donor-recipient matching

Author: Angelico, M, Cillo, U, Fagiuoli, S, Gasbarrini, Antonio, Gavrila, C, Marianelli, T, Costa, Antonio, Nardi, Anna, Strazzabosco, M, Burra, P, Agnes, Salvatore, Baccarani, U, Calise, F, Colledan, M, Cuomo, O, De Carlis, L, Donataccio, M, Ettorre, Gm, Gerunda, Ge, Gridelli, B, Lupo, L, Mazzaferro, V, Pinna, Anna Rita, Risaliti, A, Salizzoni, M, Tisone, G, Valente, U, Rossi, Gabriella, Rossi, Marianna, Zamboni, F., Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Agnes, Salvatore (ORCID:0000-0002-3341-4221), Angelico, M, Cillo, U, Fagiuoli, S, Gasbarrini, Antonio, Gavrila, C, Marianelli, T, Costa, Antonio, Nardi, Anna, Strazzabosco, M, Burra, P, Agnes, Salvatore, Baccarani, U, Calise, F, Colledan, M, Cuomo, O, De Carlis, L, Donataccio, M, Ettorre, Gm, Gerunda, Ge, Gridelli, B, Lupo, L, Mazzaferro, V, Pinna, Anna Rita, Risaliti, A, Salizzoni, M, Tisone, G, Valente, U, Rossi, Gabriella, Rossi, Marianna, Zamboni, F., Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Agnes, Salvatore (ORCID:0000-0002-3341-4221)
Abstract: The Liver Match is an observational cohort study that prospectively enrolled liver transplantations performed at 20 out of 21 Italian Transplant Centres between June 2007 and May 2009. Aim of the study is to investigate the impact of donor/recipient matching on outcomes. In this report we describe the study methodology and provide a cross-sectional description of donor and recipient characteristics and of graft allocation.
Published: 2011

39. Liver Match, a prospective observational cohort study on liver transplantation in Italy: study design and current practice of donor-recipient matching

Author: Angelico, M, Cillo, U, Fagiuoli, S, Gasbarrini, Antonio, Gavrila, C, Marianelli, T, Costa, Antonio, Nardi, Anna, Strazzabosco, M, Burra, P, Agnes, Salvatore, Baccarani, U, Calise, F, Colledan, M, Cuomo, O, De Carlis, L, Donataccio, M, Ettorre, Gm, Gerunda, Ge, Gridelli, B, Lupo, L, Mazzaferro, V, Pinna, Anna Rita, Risaliti, A, Salizzoni, M, Tisone, G, Valente, U, Rossi, Gabriella, Rossi, Marianna, Zamboni, F., Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Agnes, Salvatore (ORCID:0000-0002-3341-4221), Angelico, M, Cillo, U, Fagiuoli, S, Gasbarrini, Antonio, Gavrila, C, Marianelli, T, Costa, Antonio, Nardi, Anna, Strazzabosco, M, Burra, P, Agnes, Salvatore, Baccarani, U, Calise, F, Colledan, M, Cuomo, O, De Carlis, L, Donataccio, M, Ettorre, Gm, Gerunda, Ge, Gridelli, B, Lupo, L, Mazzaferro, V, Pinna, Anna Rita, Risaliti, A, Salizzoni, M, Tisone, G, Valente, U, Rossi, Gabriella, Rossi, Marianna, Zamboni, F., Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Agnes, Salvatore (ORCID:0000-0002-3341-4221)
Abstract: The Liver Match is an observational cohort study that prospectively enrolled liver transplantations performed at 20 out of 21 Italian Transplant Centres between June 2007 and May 2009. Aim of the study is to investigate the impact of donor/recipient matching on outcomes. In this report we describe the study methodology and provide a cross-sectional description of donor and recipient characteristics and of graft allocation.
Published: 2011

40. Liver Transplantation for Recipients >= 70 Years. Is It Worthwile?

Author: UCL - Cliniques universitaires Saint-Luc, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, Adam, R., Lerut, Jan, Karam, V., Delvart, V., Buckels, J., O'Grady, J., Castaing, D., Jamieson, N., Neuhaus, P., Pollard, S., Salizzoni, M., UCL - Cliniques universitaires Saint-Luc, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, Adam, R., Lerut, Jan, Karam, V., Delvart, V., Buckels, J., O'Grady, J., Castaing, D., Jamieson, N., Neuhaus, P., Pollard, S., and Salizzoni, M.
Published: 2010

41. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis

Author: Mazzaferro, V, Llovet, J, Miceli, R, Bhoori, S, Schiavo, M, Mariani, L, Camerini, T, Roayaie, S, Schwartz, M, Grazi, G, Adam, R, Neuhaus, P, Salizzoni, M, Bruix, J, Forner, A, De Carlis, L, Cillo, U, Burroughs, A, Troisi, R, Rossi, M, Gerunda, G, Lerut, J, Belghiti, J, Boin, I, Gugenheim, J, Rochling, F, Van Hoek, B, Majno, P, Colledan, M, Fagiuoli, S, Mazzaferro, Vincenzo, Llovet, Josep M, Miceli, Rosalba, Bhoori, Sherrie, Schiavo, Marcello, Mariani, Luigi, Camerini, Tiziana, Roayaie, Sasan, Schwartz, Myron E, Grazi, Gian Luca, Adam, René, Neuhaus, Peter, Salizzoni, Mauro, Bruix, Jordi, Forner, Alejandro, De Carlis, Luciano, Cillo, Umberto, Burroughs, Andrew K, Troisi, Roberto, ROSSI, MASSIMO, Gerunda, Giorgio E, Lerut, Jan, Belghiti, Jacques, Boin, Ilka, Gugenheim, Jean, Rochling, Fedja, Van Hoek, Bart, Majno, Pietro, COLLEDAN, MICHELE, FAGIUOLI, STEFANO, Mazzaferro, V, Llovet, J, Miceli, R, Bhoori, S, Schiavo, M, Mariani, L, Camerini, T, Roayaie, S, Schwartz, M, Grazi, G, Adam, R, Neuhaus, P, Salizzoni, M, Bruix, J, Forner, A, De Carlis, L, Cillo, U, Burroughs, A, Troisi, R, Rossi, M, Gerunda, G, Lerut, J, Belghiti, J, Boin, I, Gugenheim, J, Rochling, F, Van Hoek, B, Majno, P, Colledan, M, Fagiuoli, S, Mazzaferro, Vincenzo, Llovet, Josep M, Miceli, Rosalba, Bhoori, Sherrie, Schiavo, Marcello, Mariani, Luigi, Camerini, Tiziana, Roayaie, Sasan, Schwartz, Myron E, Grazi, Gian Luca, Adam, René, Neuhaus, Peter, Salizzoni, Mauro, Bruix, Jordi, Forner, Alejandro, De Carlis, Luciano, Cillo, Umberto, Burroughs, Andrew K, Troisi, Roberto, ROSSI, MASSIMO, Gerunda, Giorgio E, Lerut, Jan, Belghiti, Jacques, Boin, Ilka, Gugenheim, Jean, Rochling, Fedja, Van Hoek, Bart, Majno, Pietro, COLLEDAN, MICHELE, and FAGIUOLI, STEFANO
Abstract: Background: Patients undergoing liver transplantation for hepatocellular carcinoma within the Milan criteria (single tumour ≤5 cm in size or ≤3 tumours each ≤3 cm in size, and no macrovascular invasion) have an excellent outcome. However, survival for patients with cancers that exceed these criteria remains unpredictable and access to transplantation is a balance of maximising patients' chances of cure and organ availability. The aim of this study was to explore the survival of patients with tumours that exceed the Milan criteria, to assess whether the criteria could be less restrictive, enabling more patients to qualify as transplant candidates, and to derive a prognostic model based on objective tumour characteristics, to see whether the Milan criteria could be expanded. Methods: Data on patients who underwent transplantation for hepatocellular carcinoma despite exceeding Milan criteria at different centres were recorded via a web-based survey completed by specialists from each centre. The survival of these patients was correlated retrospectively with the size of the largest tumour nodule, number of nodules, and presence or absence of microvascular invasion detected at pathology. Contoured multivariable regression Cox models produced survival estimates by means of different combinations of the covariates. The primary aim of this study was to derive a prognostic model of overall survival based on tumour characteristics, according to the main parameters used in the Tumour Node Metastasis classification. The secondary aim was the identification of a subgroup of patients with hepatocellular carcinoma exceeding the Milan criteria, who achieved a 5-year overall survival of at least 70%-ie, similar to the outcome expected for patients who meet the Milan criteria. Findings: Over a 10-month period, between June 25, 2006, and April 3, 2007, data for 1556 patients who underwent transplantation for hepatocellular carcinoma were entered on the database by 36 centres. 1112 pati
Published: 2009

42. 15-year Evolution of Liver Transplantation in Europe.

Author: UCL - Cliniques universitaires Saint-Luc, UCL, Adam, R., Lerut, Jan, Karam, V. H., Buckels, J., O'Grady, J., Castaing, D., Klempnauer, J., Jamieson, N., Neuhaus, P., Pollard, S., Salizzoni, M., Burra, P., Joint International Congress of the ILTS, ELITA, AND LICAGE, UCL - Cliniques universitaires Saint-Luc, UCL, Adam, R., Lerut, Jan, Karam, V. H., Buckels, J., O'Grady, J., Castaing, D., Klempnauer, J., Jamieson, N., Neuhaus, P., Pollard, S., Salizzoni, M., Burra, P., and Joint International Congress of the ILTS, ELITA, AND LICAGE
Published: 2008

43. 3-month and 12-month mortality after first liver transplant in adults in Europe: predictive models for outcome

Author: UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - MD/CHIR - Département de chirurgie, Burroughs, AK, Sabin, CA, Rolles, K, Delvart, V., Karam, V., Buckels, J., O'Grady, JG, Castaing, D., Klempnauer, J., Jamieson, N., Neuhaus, P., Lerut, Jan, de Ville de Goyet, J., Pollard, S., Salizzoni, M., Rogiers, X, Muhlbacher, F, Valdecasas, JCG, Broelsch, C, Jaeck, D, Berenguer, J, Gonzalez, EM, Adam, R., UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - MD/CHIR - Département de chirurgie, Burroughs, AK, Sabin, CA, Rolles, K, Delvart, V., Karam, V., Buckels, J., O'Grady, JG, Castaing, D., Klempnauer, J., Jamieson, N., Neuhaus, P., Lerut, Jan, de Ville de Goyet, J., Pollard, S., Salizzoni, M., Rogiers, X, Muhlbacher, F, Valdecasas, JCG, Broelsch, C, Jaeck, D, Berenguer, J, Gonzalez, EM, and Adam, R.
Abstract: Background Mortality after liver transplantation depends on heterogeneous recipient and donor factors. Our aim was to assess risk of death and to develop models to help predict mortality after liver transplantation. Methods We analysed data from 34 664 first adult liver transplants from the European Liver Transplant Registry to identify factors associated with mortality at 3-months (n=21 605 in training dataset) and 12-months (n=18 852 in training dataset) after transplantation. We used multivariable logistic regression models to generate mortality scores for each individual, and assessed model discrimination and calibration on an independent validation dataset (n=9489 for 3-month model and n=8313 for 12-month model). Findings 2540 of 21 605 (12%) individuals in the 3-month training sample had died by 3 months. Compared with those transplanted in 2000-03, those transplanted earlier had a higher risk of death. increased mortality at 3-months post- transplantation was associated with acute liver failure (adjusted odds ratio 1.61), donor age older than 60 years (1.16), compatible (1.22) or incompatible (2.07) donor-recipient blood group, older recipient age (1.12 per 5 years), split or reduced graft (1.96), total ischaemia time of longer than 13 h (1.38), and low United Network for Organ Sharing score (score 1: 2.43; score 2: 1.67). However, cirrhosis with hepatocellular carcinoma, alcohol cirrhosis, hepatitis C or primary biliary cirrhosis, donor age 40 years or younger, or less, hepatitis B, and larger size of transplant Centre (>= 70 transplants per year) were associated with improved early outcomes. The 3-month mortality score discriminated well between those who did and did not die in the validation sample (C statistic=0.688). We noted similar findings for 12-month mortality, although deaths were generally underestimated at this timepoint. Interpretation The 3-month and 12-month mortality models can be effectively used to assess outcomes both within and between ce
Published: 2006

44. Isolated liver transplantation in an infant with ultrashort gut

Author: UCL - MD/CHIR - Département de chirurgie, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Lezo, A., Gennari, F., Santini, B., Calvo, P., Baldi, M., Salizzoni, M., Barbera, C., Otte, Jean-Bernard, de Goyet, J. de Ville, 10th International Symposium on Small Bowel Transplantation, UCL - MD/CHIR - Département de chirurgie, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Lezo, A., Gennari, F., Santini, B., Calvo, P., Baldi, M., Salizzoni, M., Barbera, C., Otte, Jean-Bernard, de Goyet, J. de Ville, and 10th International Symposium on Small Bowel Transplantation
Abstract: Intestinal function in children with very short bowel syndrome and related intestinal failure may improve after isolated liver transplantation. An infant with an ultrashort gut, ileo-cecal valve, and whole colon received total parenteral nutrition from the first days of life. Enteral feeding failed because of the progressive dilatation of the jejunal portion and motility disorders. He developed early severe cholestatic liver disease (aspartate transferase 186, alanine transferase 103 U/L, serum bilirubin 8.4 mg/dL) and subsequent liver failure. At 8 months of age, he benefited from isolated liver transplantation (left segment graft from living donor). His early posttransplant evolution was characterized by recovery of oral alimentation, improvement of digestive and absorption functions, but he did not achieve TPN-independence. At 20 months, 50% to 60% of his energy needs were covered by parenteral. nutrition and he has satisfactory growth indices (3rd percentile for weight and height), reduced stool volume, and frequency. Isolated liver transplantation allowed, in this particular case, time for further intestinal adaptation thereby avoiding the need for intestinal transplantation early in life.
Published: 2006

45. Oesophageal and gastric bile exposure after gastroduodenal surgery with Henley's interposition or a Roux-en-Y loop

Author: UCL - MD/CHIR - Département de chirurgie, Mabrut, JY, Collard, Jean-Marie, Romagnoli, R., Gutschow, C, Salizzoni, M., UCL - MD/CHIR - Département de chirurgie, Mabrut, JY, Collard, Jean-Marie, Romagnoli, R., Gutschow, C, and Salizzoni, M.
Abstract: Background: The degree which the various reconstruction techniques prevent bile reflux after gastroduodenal surgery has been poorly studied. Methods: Bile exposure in the intestinal tract just proximal to the jejunal loop was measured with the Bilitec 2000(R) device for 24 h after gastroduodenal surgery in three groups of patients. Group 1 comprised 24 patients,with a 60-cm Henley's loop after total gastrectomy. Group 2 included 31 patients with a 60-cm Roux-en-Y loop after total (22 patients) or subtotal (nine) gastrectomy. Group 3 contained 21 patients with a 60-cm Roux-en-Y loop anastomosed to the proximal duodenum as part of a duodenal switch operation for pathological transpyloric duodenogastric reflux. Bile exposure, measured as the percentage time with bile absorbance greater than 0.25, was classified as nil, within the range of a control population of healthy subjects, or pathological (above the 95th percentile for the control population). Reflux symptoms were scored and all patients had upper gastrointestinal endoscopy. Results: Bile was detected in the intestine proximal to the loop in none of 24 patients in group 1, eight of 31 in group 2 and 12 of 21 in group 3 (P < 0.001). The mean reflux symptom score increased with the degree of bile exposure, and the proportion of patients with oesophagitis or gastritis correlated well with the extent of bile exposure (P < 0.001). Conclusion: A long Henley's loop was more effective in preventing bile reflux than a long Roux-en-Y loop. Bilitec(R) data correlated well with the severity of reflux symptoms and the presence of mucosal lesions.
Published: 2004

46. Double-blind comparison of hepatitis C histological recurrence rate in HCV+ Liver Transplant Recipients Given Basiliximab+Steroids or Basiliximab+Placebo, in addition to Cyclosporine and Azathioprine

Author: Filipponi, F, Callea, F, Salizzoni, M, Grazi, G, Fassati, L, Rossi, M, Risaliti, A, Burra, P, Agnes, S, De Carlis, L, Valente, U, Ferrara, R, Pisati, R, Filipponi, Franco, Callea, Francesco, Salizzoni, Mauro, Grazi, Gian Luca, Fassati, Luigi Rainero, Rossi, Massimo, Risaliti, Andrea, Burra, Patrizia, Agnes, Salvatore, De Carlis, Luciano, Valente, Umberto, Ferrara, Roberto, Pisati, Roberto, Filipponi, F, Callea, F, Salizzoni, M, Grazi, G, Fassati, L, Rossi, M, Risaliti, A, Burra, P, Agnes, S, De Carlis, L, Valente, U, Ferrara, R, Pisati, R, Filipponi, Franco, Callea, Francesco, Salizzoni, Mauro, Grazi, Gian Luca, Fassati, Luigi Rainero, Rossi, Massimo, Risaliti, Andrea, Burra, Patrizia, Agnes, Salvatore, De Carlis, Luciano, Valente, Umberto, Ferrara, Roberto, and Pisati, Roberto
Abstract: Background. Hepatitis C virus (HCV) recurrence in HCV+liver transplant recipients is almost inevitable and may be promoted by immunosuppression. We compared the amount of liver damage with regard to usage of steroids and basiliximab. Methods. A total of 140 HCV+ adult liver transplant recipients were randomly allocated to basiliximab+steroids or basiliximab+placebo (plus cyclosporine and azathioprine). Primary endpoint: hepatitis C histological recurrence (liver damage as for Ishak grading score ≥8 by biopsy at 12 months); secondary endpoints: treatment failure (death, graft loss, patient withdrawal), biopsy proven acute rejection (BPAR), treated acute rejection (tAR), allograft and patient survival rates at 12 months. Results. Any significant difference has been observed in the 12-month hepatitis C histological recurrence rate (41.2% basiliximab+steroids, 37.5% basiliximab+placebo, P=0.354). The treatment failure rate was significantly higher in basiliximab+steroids (28.8%) than in basiliximab+placebo (15.6%), P=0.03; the combination test for the evaluation of the joint hypothesis resulted in a borderline nonsignificant overall result (P=0.059). BPAR rate was significantly lower in the group treated with steroids (24.3% basiliximab+steroids, 39.4% basiliximab+placebo, P=0.04), while the tAR rate was similar (29.7% basiliximab+steroids and 37.9% basiliximab+placebo). Any significant differences in 1-year graft and patient survival rates have been observed (72.9% and 84.8% basiliximab+steroids; 81.5% and 89.0% basiliximab+placebo). Conclusions. Results suggest that steroid-free therapy is associated with a significantly lower treatment failure rate, although histological recurrence rate of hepatitis C is similar in the two groups. This benefit is not offset by an evident increase in graft rejection rate requiring treatment
Published: 2004

47. Outcomes of dysplasia arising in Barrett's esophagus: A dynamic view

Author: UCL - MD/CHIR - Département de chirurgie, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Romagnoli, R., Collard, Jean-Marie, Gutschow, C, Yamusah, N, Salizzoni, M., UCL - MD/CHIR - Département de chirurgie, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Romagnoli, R., Collard, Jean-Marie, Gutschow, C, Yamusah, N, and Salizzoni, M.
Abstract: BACKGROUND: The management of dysplasia arising in Barrett's esophagus is controversial. STUDY DESIGN: Twenty patients (group 1, prompt attitude) underwent operation as soon as high-grade dysplasia (HGD) was discovered (n = 8) or just after either the presence of HGD was confirmed (n = 9) or invasive carcinoma (IC) was found (n = 3) in a second set of biopsy samples taken soon after HGD had been discovered. In contrast, esophagectomy in 13 patients (group 2, expectant attitude) was performed only because HGD persisted (n 4) or turned into IC (n = 4) at endoscopic followup (7 to 23 months) (subgroup 2a, n 8) or because HGD (n = 2) or low-grade dysplasia (LGD) (n = 3) was disregarded until dysphagia and IC developed (12 to 70 months) (subgroup 2b, n = 5). Skeletonizing en-bloc esophagectomy was performed in 29 patients and four patients (three with HGD and one with mucosal IC in the resected specimen) underwent vagus-sparing esophagectomy. RESULTS: Invasive carcinoma was found in 11 of 24 patients (45.8%) supposed. to have only HGD (in repeat biopsies in 3 patients from group 1 and in the resected specimen in eight of 21 patients (38%) operated on for HGD. Metastatic lymph nodes were found in the resected specimen of seven patients (group 1: one of 20 or 5%, versus subgroup 2a: two of eight or 25%, versus subgroup 2b: four of five or 80%; p = 0.001). Unlike none of the 26 patients (0%) with an intramural process, five of the seven patients (71.4%) with an extramural process (one had had disregarded LGD) developed neoplastic recurrence at followup (p < 0.0001). Cancer-related survival in the long term was 100% in group 1 versus 52.5% in group 2 (p = 0.0094). CONCLUSIONS: Invasive carcinoma is present in almost one half of patients with HGD within a Barrett's area. Promptness in the decision regarding an esophageal resection as soon as HGD is found is much safer than expectant observation. Not enrolling a patient with LGD in an endoscopic surveillance program can lead t
Published: 2003

48. Evolution of liver transplantation in Europe: Report of the European liver transplant registry

Author: UCL - MD/CHIR - Département de chirurgie, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Adam, René, Lerut, Jan, McMaster, P, O'Grady, JG, Castaing, D., Klempnauer, JL, Jamieson, N., Neuhaus, P., Salizzoni, M., Pollard, S., Muhlbacher, F, Rogiers, X, Valdecasas, JCG, Berenguer, J, Jaeck, D, Gonzalez, EM, UCL - MD/CHIR - Département de chirurgie, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Adam, René, Lerut, Jan, McMaster, P, O'Grady, JG, Castaing, D., Klempnauer, JL, Jamieson, N., Neuhaus, P., Salizzoni, M., Pollard, S., Muhlbacher, F, Rogiers, X, Valdecasas, JCG, Berenguer, J, Jaeck, D, and Gonzalez, EM
Abstract: The European Liver Transplant Registry (ELTR) currently allows for the analysis of 44,286 liver transplantations (LTs) performed on 39,196 patients in a 13-year period. After an exponential increase, the number of Us is plateauing due to a lack of organs. To cope with this, alternatives to cadaveric LT, such as split LT, domino LT, or living-related LT (LRLT) are being used increasingly. They now account for 11% of all procedures. One of the most important findings in the evolution of LT is the considerable improvement of results along time with, for the mean time, a one-year survival of 83%, all indications confounded. The improvement is particularly significant for cancers. This improvement is mainly represented by hepatocellular carcinoma, with a gain of 17% for 5-year survival rate from 1990 to 2000. Increasingly, older donors are used to augment the donor pool and older recipients are transplanted due to improved results and a better selection of patients. More than two thirds of deaths and three quarters of retransplantations occurred within the first year of transplantation. Retransplantation is associated with much less optimal results than first LT. One of the prominent features of recent years is the development of LRLT. LRLT is now performed by almost half of the European centers. As with split LT or domino LT, LRLT aims to provide more patients to be transplanted. Special attention is paid to reducing the risk for the donor, which is now estimated to be 0.5% mortality and 21% postoperative morbidity.
Published: 2003

49. Gastric symptoms and duodenogastric reflux in patients referred for gastroesophageal reflux symptoms and endoscopic esophagitis

Author: UCL, Romagnoli, R., Collard, Jean-Marie, Bechi, P, Salizzoni, M., UCL, Romagnoli, R., Collard, Jean-Marie, Bechi, P, and Salizzoni, M.
Abstract: Background. The role of excessive duodenogastric reflux (DRG) in the genesis of gastric symptoms in patients primarily referred for both gastroesophageal reflux (GER) symptoms and esophagitis is poorly understood. Methods. The study is based on the clinical, endoscopic, histologic, and 24-hour gastric data from the Bilitec optoelectronic device (Prodotec, Florence, Italy, licensed by Synectics Medical, Stockholm, Sweden) from 49 patients having both typical GER symptoms and gastric symptoms suggestive of excessive DGR (ie, epigastric pain, nausea, or bilious vomiting) in the absence of previous esophageal or gastric surgery (group I). Helicobacter pylori organisms were searched for on antral biopsy specimens with use of the Giemsa method. The percentages of total, upright, and supine time during which absorbance exceeded various thresholds through all the working range of the Bilitec device were calculated. Bilitec data from group 1 were compared with those from 16 patients with endoscopic esophagitis and GER symptoms only (group 2) and 25 healthy subjects (group 3). Results. The prevalence of an abnormal Bilitec test result in group 1 increased from 27% (13/49) at the 0.25 absorbance threshold to 36% (18/49) at thresholds ranging from 0.40 to 0.60 and to 41% (20/49) when multiple thresholds ranging from 0.25 to 0.30 threshold, whereas the other 15 patients had a normal test result. H pylori antral infection was present in 14 group 1 patients. None of these had an abnormal Bilitec test result, whereas the test was positive in 40% of the H pylori-negative patients without endoscopic gastritis and in 70% of H pylori-negative patients with endoscopic gastritis (P = .001). Conclusions. Twenty-four-hour intragastric bile monitoring provides the clinician with unequivocal evidence of excessive DGR in 41% of patients with an intact stomach having endoscopic esophagitis, GER symptoms, and gastric symptoms suggestive of DGR. The most dependable data are obtained when absorba
Published: 1999

50. Combined 24-hour intraluminal pH and bile monitoring of the denervated whole stomach as an esophageal substitute

Author: UCL, Romagnoli, R., Bechi, P, Salizzoni, M., Collard, Jean-Marie, UCL, Romagnoli, R., Bechi, P, Salizzoni, M., and Collard, Jean-Marie
Abstract: BACKGROUND/AIMS: The study aims to evaluate the pH and the presence of bile in the denervated whole stomach pulled up to the neck after subtotal esophagectomy METHODOLOGY: The pH and the presence of bile in the gastric cavity were monitored by combined 24-hour pH and bilimetry in 16 patients having their whole stomach as an esophageal substitute (i.e., 8 with and 8 without a gastric drainage procedure) and in 25 healthy control subjects. The percentage of time during which pH was <2 as well as the percentage of time during which bile absorbance was >0.25 for the total, upright, and supine periods of recording were considered for each subject studied. Seven patients underwent a gastroscopy with biopsies. RESULTS: Intragastric acidity was normal in 50% of patients while it was reduced in the other 50%. Ten of the 16 patients (62.5%), i.e., 4 with (50%) and 6 without (75%) a drainage procedure, had excessive exposure of the gastric mucosa to bile. No significant correlation was found between the existence of a high intraluminal pH profile and excessive bile exposure (p=0.9163). Bile exposure was significantly higher in whole stomach patients than in controls in both the upright and supine positions, irrespective of the existence or absence of a drainage procedure (p ranging from 0.0272-0.0001). Bile exposure in the supine position tended to be longer in patients without than in those with a drainage procedure (p =0.0929). Helicobacter pylori-negative chemical gastritis was present in 3 of the 7 patients who underwent a gastroscopy, all 3 having excessive bile exposure and no food retention in the transplant lumen. CONCLUSIONS: Gastric denervation and transposition up to the neck increased exposure of the gastric mucosa to bile, irrespective of the patient's position and of the presence of a gastric drainage procedure. The absence of gastric drainage procedure tends to ensure exposure to bile prolongeLow gastric acidity, if present, is due to a reduction in acid secreti
Published: 1999

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