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12 results on '"Miglioresi, L"'

1. Graft survival is worse in HCV positive females transplanted with male donor grafts L

Author

Belli, Romagnoli, R., Rossi, M., Gerunda, G. E., Pinna, A. D., Agnes, S., Spada, M., Colledan, M., Tisone, G., De Carlis, L., Baccarani, U., Mazzaferro, V., Ettorre, G. M., Cillo, Umberto, Calise, F., Cuomo, O., Lupo, L., Ginanni Corradini, S., Zamboni, F., Marianelli, T., Risaliti, A., Patrono, D., Li Petri, S., Tagliabue, F., Mangoni, J. M. E., Antonelli, B., Sposito, C., Gringeri, Enrico, Rompianesi, G., Sforza, D., Cucchetti, A., Miglioresi, L., Donataccio, M., Gelli, M., Gavrila, C., Nardi, A., Angelico, M., Italian Liver Ctrs, for the Liver Match i. n. v. e. s. t. i. g. a. t. o. r. s., Italian Association for the Study of the Liver, Dept, Mathematics, Tor Vergata Univ, and Rome

Published
2012

5. De Novo Malignancies after Organ Transplantation: Focus on Viral Infections

Author

Piselli, P1, Busnach, G, Fratino, L, Citterio, F, Ettorre, Gm, De Paoli, P, Serraino, D, Dal Maso, L, Di Maso, M, Zucchetto, A, Agresta, A, Cimaglia, C, Puro, V, Ippolito, G, Miglioresi, L, Vennarecci, G, Santoro, R, Famulari, A, Delreno, F, Grandaliano, G, Fiorentino, M, Stefoni, S, Todeschini, P, Panicali, L, Valentini, C, Valerio, F, Bossini, N, Setti, G, Michittu, Mb, Murgia, Mg, Onano, B, Veroux, Pierfrancesco, Giuffrida, G, Giaquinta, A, Zerbo, D, Di Leo, L, Perrino, Ml, Colombo, V, Sghirlanzoni, Mc, Leoni, A, Buscemi, B, Lazzarin, M, Zanini, S, Spagnoletti, G, Salerno, Mp, Favi, E, De Luca, L, Lavacca, A, Cascone, C, Virgilio, B, Dossi, F, Fontanella, A, Ambrosini, A, Di Cicco, M., Piselli P, Busnach G, Fratino L, Citterio F, Ettorre GM, De Paoli P, Serraino D, Todeschini P, and Immunosuppression and Cancer Study Group

Subjects
SOLID ORGAN TRANSPLANT, Herpesvirus 4, Human, medicine.medical_specialty, Skin Neoplasms, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, Lymphoproliferative disorders, cancer risk, medicine.disease_cause, Biochemistry, Organ transplantation, Virus, medicine, Humans, Sarcoma, Kaposi, Molecular Biology, solid organ transplantation, Immunosuppression Therapy, business.industry, ORGAN, Cancer, Kaposi sarcoma, Immunosuppression, KAPOSI'S SARCOMA, General Medicine, renal transplantation, medicine.disease, iatrogenic immunosuppression, Kidney Transplantation, neoplasia, VIRAL INFECTIONS, Herpesvirus 8, Human, Immunology, Molecular Medicine, POST-TRANSPLANT MALIGNANCY, Sarcoma, viral infection, Carcinogenesis, business, Oncovirus
Abstract

Organ transplantation is an increasingly used medical procedure for treating otherwise fatal end stage organ diseases with 107,000 transplants performed worldwide in 2010. Newly developed anti-rejection drugs greatly helped to prolong long-term survival of both the individual and the transplanted organ, and they facilitate the diffusion of organ transplantation. Presently, 5-year patient survival rates are around 90% after kidney transplant and 70% after liver transplant. However, the prolonged chronic use of immunosuppressive drugs is well known to increase the risks of opportunistic diseases, particularly infections and virus-related malignancies. Although transplant recipients experience a nearly 2-fold elevated risk for all types of de-novo cancers, persistent infections with oncogenic viruses - such as Kaposi sarcoma herpes virus, high-risk human papillomaviruses, and Epstein-Barr virus - are associated with up to 100-fold increased cancer risks. This review, focusing on kidney and liver transplants, highlights updated evidences linking iatrogenic immunosuppression, persistent infections with oncogenic viruses and cancer risk. The implicit capacity of oncogenic viruses to immortalise infected cells by disrupting the cell-cycle control can lead, in a setting of induced lowered immune surveillance, to tumorigenesis and this ability is thought to closely correlate with cumulative exposure to immunosuppressive drugs. Mechanisms underlying the relationship between viral infections, immunosuppressive drugs and the risk of skin cancers, post-transplant lymphoproliferative disorders, Kaposi sarcoma, cervical and other ano-genital cancers are reviewed in details.

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

Author

Mario Angelico 1, Umberto Cillo, Stefano Fagiuoli, Antonio Gasbarrini, Caius Gavrila, Tania Marianelli, Alessandro Nanni Costa, Alessandra Nardi, Mario Strazzabosco, Patrizia Burra, Salvatore Agnes, Umberto Baccarani, Fulvio Calise, Michele Colledan, Oreste Cuomo, Luciano De Carlis, Matteo Donataccio, Giuseppe M Ettorre, Giorgio E Gerunda, Bruno Gridelli, Luigi Lupo, Vincenzo Mazzaferro, Antonio Pinna, Andrea Risaliti, Mauro Salizzoni, Giuseppe Tisone, Umberto Valente, Giorgio Rossi, Massimo Rossi, Fausto Zamboni, S Fagiuoli, A Gasbarrini, M Strazzabosco, D Prati, F Piscaglia, P G Toniutto, L Rizzato, S Venettoni, A Nardi, A Ricci, R Romagnoli, G Bertolotti, D Patrono, J M E Mangoni, L Caccamo, B Antonelli, E Regalia, C Sposito, V Corno, F Tagliabue, S Marin, E Gringeri, D Donataccio, F Bresadola, D Lorenzin, M Gelli, G Rompianesi, A Cucchetti, M G Faraci, D Sforza, S Agnes, M Di Mugno, L Miglioresi, M Rossi, S Ginanni Corradini, A Molinaro, V Scuderi, G Arenga, G Notarnicola, B Gridelli, S Li Petri, G Carbotta, S Dedola, C Gavrila, F Vespasiano, Angelico M, Cillo U, Fagiuoli S, Gasbarrini A, Costa AN, Strazzabosco M, Prati D, Piscaglia F, Toniutto PG, Burra P, Rizzato L, Venettoni S, Marianelli T, Salizzoni M, Romagnoli R, Bertolotti G, Patrono D, De Carolis L, Mangoni JM, Rossi G, Caccamo L, Antonelli B, Mazzaferro V, Regalia E, Sposito C, Colledan M, Corno V, Tagliabue F, Marin S, Gringeri E, Donataccio, Donataccio D, Bresadola F, Lorenzin D, Valente U, Gelli M, Gerunda GE, Rompianesi G, Pinna A, Grazi GL, Cucchetti A, Risaliti A, Faraci MG, Tisone G, Sforza D, Agnes S, Di Mugno M, Ettorre GM, Miglioresi L, Berloco P, Rossi M, Ginanni Corradini S, Molinaro A, Calise F, Scuderi V, Cuomo O, Arenga G, Lupo L, Notarnicola G, Gridelli B, Li Petri S, Zamboni F, Carbotta G, Dedola S, Nardi A, Gavrila C, Ricci A, Vespasiano F, Baccarani U, 1, Mario Angelico, Cillo, Umberto, Fagiuoli, Stefano, Gasbarrini, Antonio, Gavrila, Caiu, Marianelli, Tania, Nanni Costa, Alessandro, Nardi, Alessandra, Strazzabosco, Mario, Burra, Patrizia, Agnes, Salvatore, Baccarani, Umberto, Calise, Fulvio, Colledan, Michele, Cuomo, Oreste, De Carlis, Luciano, Donataccio, Matteo, M Ettorre, Giuseppe, E Gerunda, Giorgio, Gridelli, Bruno, Lupo, Luigi, Mazzaferro, Vincenzo, Pinna, Antonio, Risaliti, Andrea, Salizzoni, Mauro, Tisone, Giuseppe, Valente, Umberto, Rossi, Giorgio, Rossi, Massimo, Zamboni, Fausto, Fagiuoli, S, Gasbarrini, A, Strazzabosco, M, Prati, D, Piscaglia, F, G Toniutto, P, Rizzato, L, Venettoni, S, Nardi, A, Ricci, A, Romagnoli, R, Bertolotti, G, Patrono, D, E Mangoni, J M, Caccamo, L, Antonelli, B, Regalia, E, Sposito, C, Corno, V, Tagliabue, F, Marin, S, Gringeri, E, Donataccio, D, Bresadola, F, Lorenzin, D, Gelli, M, Rompianesi, G, Cucchetti, A, G Faraci, M, Sforza, D, Agnes, S, Di Mugno, M, Miglioresi, L, Rossi, M, Ginanni Corradini, S, Molinaro, A, Scuderi, V, Arenga, G, Notarnicola, G, Gridelli, B, Li Petri, S, Carbotta, G, Dedola, S, Gavrila, C, Vespasiano, F, Angelico, M, Cillo, U, Marianelli, T, Costa, A, Burra, P, Baccarani, U, Calise, F, Colledan, M, Cuomo, O, DE CARLIS, L, Donataccio, M, Ettorre, G, Gerunda, G, Lupo, L, Mazzaferro, V, Pinna, A, Risaliti, A, Salizzoni, M, Tisone, G, Valente, U, Rossi, G, Zamboni, F, and Liver Match, I

Subjects
impact of donor/recipient matching on outcomes, Male, Alcoholic liver disease, Cirrhosis, Multicenter Study, Humans, Prospective Study, Liver Transplantation, Donor Risk Index, Hepatocellular Carcinoma, Italy, Donor Liver transplant Recipient, donor match, liver transplantation, donor, recipient, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, liver-match, liver transplant, Liver transplantation, Model for End-Stage Liver Disease, MED/12 - GASTROENTEROLOGIA, Prospective Studies, Prospective cohort study, Child, Liver transplant, donor, Aged, 80 and over, Settore MED/12 - Gastroenterologia, education.field_of_study, liver transplantation, Histocompatibility Testing, Graft Survival, Liver Neoplasms, Gastroenterology, Middle Aged, liver transplantations, liver transplant, information on donors and recipients, recipient, Tissue Donors, Treatment Outcome, Donor, Recipient, Hepatocellular carcinoma, Female, Cohort study, Adult, medicine.medical_specialty, Tissue and Organ Procurement, Adolescent, Waiting Lists, Population, NO, Internal medicine, medicine, education, donor match, Aged, Hepatology, business.industry, Patient Selection, Settore MED/09 - MEDICINA INTERNA, medicine.disease, Fibrosis, Surgery, business
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 for End Stage Liver Disease (MELD) at transplant was 12 in patients with HCC and 18 in those without. Multivariate analysis showed a slight but significant inverse association between DRI and MELD at transplant. CONCLUSIONS: The deceased donor population in Italy has a high-risk profile compared to other countries, mainly due to older donor age. Almost half of the grafts are transplanted in recipients with HCC. Higher risk donors tend to be preferentially allocated to recipients with HCC, who are usually less ill and older. No other relevant allocation strategy is currently adopted at national level.

Published
2010

12. Toward Zero Hepatitis C Virus-Related Mortality as a Prerequisite for the Release of Resources in a Center for Follow-up of Liver Transplant

Author

Luca Rinaldi, Tommaso Sgueglia, Giovanna Valente, Guido Piai, Lucia Miglioresi, Valente, G., Miglioresi, L., Sgueglia, T., Rinaldi, L., and Piai, G.

Subjects
Male, medicine.medical_specialty, Sustained Virologic Response, medicine.medical_treatment, Hepacivirus, Hepatitis C virus, Population, medicine.disease_cause, Antiviral Agents, Follow-Up Studie, Retrospective Studie, Internal medicine, Humans, Medicine, education, Retrospective Studies, Antiviral Agent, Excess mortality, Transplantation, education.field_of_study, Hepaciviru, biology, business.industry, Immunosuppression, Retrospective cohort study, Hepatitis C, Hepatitis C, Chronic, medicine.disease, biology.organism_classification, Liver Transplantation, Virologic response, Female, Surgery, business, Follow-Up Studies, Human
Abstract

Taking charge of a liver transplanted (LT) patient implies not only to follow up the transplanted organ (eg, immunosuppression and cancer risk) but also to deal with the prevailing patient’s active problems. The recurrence of hepatitis C on the graft has historically been one of the main active problems to be addressed, leading to 30% to 40% mortality per se in these patients and has involved many resources in the hepatological centers responsible for the follow-up. We verified how much the availability of the new drugs with direct-acting antiviral agents (DAAs) against hepatitis C virus (HCV) has impacted the mortality within the assisted population, changing its characteristics and addressing new clinical issues in the LT-patients. We performed a retrospective comparison between 230 LT patients followed up during pre-DAA era (group 1, with 88 HCV RNA-positive) and 244 patients observed from 2014 onward when DAAs became available (group 2, with 79 HCV RNA-positive). Fifty-two antiviral therapies were performed in group 1 with 18 sustained virologic response (SVR) (35%) and 53 treatments, of which 37 were retreatments, in group 2 with 51 SVR (96%), P = .0001. Deaths for HCV-related causes were 19 of 33 (57%) in group 1 and 7 of 24 (24%) in group 2, P = .01. The Kaplan-Meier showed a dramatic reduction in excess mortality in HCV-LT patients after the availability of DAAs. These results suggest that HCV is no longer the main active problem of follow-up in liver transplants, therefore the resources can be relocated to take care of other clinical aspects.

Published
2019

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