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3. ORTHOTOPIC LIVER TRANSPLANTATION FOR ALAGILLE SYNDROME

Author

Maldini, G, primary, Torri, E, additional, Guizzetti, M, additional, Corno, V, additional, Lucianetti, A, additional, Pinelli, D, additional, Bertani, A, additional, Giovanelli, M, additional, Zambelli, M, additional, Stroppa, P, additional, Alberti, D, additional, Torre, G, additional, Spada, M, additional, Gridelli, B, additional, and Colledan, M, additional

Published
2004
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7. ORTHOTOPIC LIVER TRANSPLANTATION FOR BYLER’S DISEASE

Author

Torri, E, primary, Lucianetti, A, additional, Pinelli, D, additional, Corno, V, additional, Guizzetti, M, additional, Maldini, G, additional, Zambelli, M, additional, Bertani, A, additional, Melzi, M L., additional, Alberti, D, additional, Doffria, E, additional, Torre, G, additional, Spada, M, additional, Gridelli, B, additional, and Colledan, M, additional

Published
2004
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8. ORTHOTOPIC LIVER TRANSPLANTATION FOR BILIARY ATRESIA

Author

Colledan, M, primary, Torri, E, additional, Bertani, A, additional, Corno, V, additional, Guizzetti, M, additional, Lucianetti, A, additional, Maldini, G, additional, Pinelli, D, additional, Zambelli, M, additional, Riva, S, additional, Alberti, D, additional, Torre, G, additional, Spada, M, additional, and Gridelli, B, additional

Published
2004
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12. A RANDOMIZED TRIAL FOR TACROLIMUS AND STEROIDS VS. TACROLIMUS AND BASILIXIMAB IN PEDIATRIC LIVER TRANSPLANTATION

Author

M Guizzetti, Giuliano Torre, M.L. Melzi, Elena Torri, Alessandro Lucianetti, Aurelio Sonzogni, W Petz, Marco Spada, Michele Colledan, A Bertani, Silvia Riva, B. Gridelli, Paola Stroppa, Spada, M, Bertani, A, Petz, W, Torri, E, Sonzogni, A, Guizzetti, M, Lucianetti, A, Riva, S, Melzi, M, Stroppa, P, Torre, G, Colledan, M, and Gridelli, B

Subjects
Transplantation, medicine.medical_specialty, Hepatology, business.industry, Basiliximab, medicine.medical_treatment, Gastroenterology, Immunosuppression, Liver transplantation, medicine.disease, Tacrolimus, Group B, Biliary atresia, Internal medicine, medicine, Cumulative incidence, business, medicine.drug
Abstract

Aims: Basiliximab is a monoclonal antibody against IL-2 receptor. A comparison between immunosuppression carried out with Tacrolimus (TAC) and Steroids (ST) VS. Tacrolimus and Basiliximab (BAS) was performed to evaluate the efficiency and safety of these two drugs association after pediatric liver transplantation. Methods: A randomized prospective trial was started in June 2001 at the Liver Transplantation Center in Bergamo, Italy. Patients receiving primary liver transplantation were enrolled in two groups: group A (TAC ST) or in group B (TAC BAS). A total of 64 patients were recruited in the study, 32 in group A and 32 in group B. Mean age was 3 yrs (0.5-16.9) and mean weight was 13.3 (4-65). The main indication for transplantation was biliary atresia. Primary endpoint of the study was the incidence of acute rejection (ACR) in the first three months. Secondary endpoints of the study were the cumulative incidence and severity of ACR, patient and graft survival, and incidence of adverse events. Tacrolimus was given at an initial dose of 0.08 mg/kg/die and then adjusted to obtain trough levels between 10 and 15 ng/ml during the first three months and of 5/10 ng/ml after the 3 month. ST were administered at the dose of 2 mg/kg and tapered before being stopped after three months. BAS was given at the dose of 20 mg iv on postoperative day 0 and 4. Results: Overall survival rate was 92%, 93% for patients in group A and 90% for patients in group B. 4 patients were excluded from the study (1 in group A and 3 in group B) for early death or discontinuation of immunosuppression. Rejection episodes were 7 in group A (22%) and 2 in group B (7%). Mean RAI score was 6 for group A, while the two patients in group B had a RAI of 4. Rejection occurred after 11 days (mean) in group A and after 20 and 223 days in the two cases in group B. One patient in group B had PTLD. Rates of EBV seroconversion were respectively (group A vs. group B) 25% and 17%. CMV infection rates were 19% vs. 13%. Sepsis occurred in 25% of patients in group A vs. 13% in group B. Conclusions: ACR seems to be less frequent in the BAS group and, even when it occurs, shows a delayed onset and a less severity. Severe infectious episodes are more rare without the use of steroids. Adverse effects of BAS were not observed in this study. Long term follow-up needs to clarify the effect of these results on the occurrence rate of late complications and chronic rejection.

Published
2004
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13. Split-liver transplantation eliminates the need for living-donor liver transplantation in children with end-stage cholestatic liver disease.

Author

Gridelli B, Spada M, Petz W, Bertani A, Lucianetti A, Colledan M, Altobelli M, Alberti D, Guizzetti M, Riva S, Melzi ML, Stroppa P, and Torre G

Subjects
Adolescent, Adult, Cadaver, Child, Child, Preschool, Female, Graft Rejection epidemiology, Graft Survival, Humans, Incidence, Infant, Liver Transplantation adverse effects, Liver Transplantation mortality, Male, Middle Aged, Reoperation, Survival Analysis, Transplantation, Homologous, Cholestasis, Intrahepatic complications, Liver Failure etiology, Liver Failure surgery, Liver Transplantation methods, Tissue and Organ Procurement methods
Abstract

Background: End-stage cholestatic liver disease (ESCLD) is the main indication for liver replacement in children. Pediatric cadaver-organ-donor shortage has prompted the most important evolutions in the technique of liver transplantation, in particular living-donor liver transplantation (LDLT) and split-liver transplantation (SLT)., Methods: Between November 1997 and June 2001, 127 children with ESCLD were evaluated for liver transplantation, and 124 underwent 138 liver transplantations after a median time of 40 days. Causes of liver disease were congenital biliary atresia (n=96), Alagille's syndrome (n=12), Byler's disease (n=8), and other cholestatic diseases (n=8)., Results: Ninety (73%) patients received a split-liver graft, 28 (23%) a whole liver, and 6 (4%) a reduced-size liver. Overall 2- and 4-year patient survival rates were 93% and 91%, respectively; the 2- and 4-year graft-survival rates were 84% and 80%, respectively. In split-liver recipients, 4-year patient and graft-survival rates were 91% and 83%, respectively; these were 93% and 78%, respectively, in whole-liver recipients and 67% and 63%, respectively, in reduced-size liver recipients. Retransplantation rate was 11%, whereas mortality rate was 8%. Overall incidence of vascular and biliary complication were 16% and 27%, respectively., Conclusions: SLT can provide liver grafts for children with ESCLD with an outcome similar to the one reported following LDLT, eliminating mortality while they are on a transplantation wait list. The need for pediatric LDLT should be reevaluated and programs of SLT strongly encouraged and supported at a national and international level.

Published
2003
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