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1. Artificial Intelligence and liver: Opportunities and barriers

Author

Balsano, C, Burra, P, Duvoux, C, Alisi, A, Piscaglia, F, Gerussi, A, Brunetto, M, Bonino, F, Montalti, R, Campanile, S, Persico, M, Alvaro, D, Santini, S, Invernizzi, P, Carbone, M, Masarone, M, Eccher, A, Siciliano, B, Vento, M, Ficuciello, F, Cabitza, F, Penasa, S, Donatelli, P, Balsano C., Burra P., Duvoux C., Alisi A., Piscaglia F., Gerussi A., Brunetto M. R., Bonino F., Montalti R., Campanile S., Persico M., Alvaro D., Santini S., Invernizzi P., Carbone M., Masarone M., Eccher A., Siciliano B., Vento M., Ficuciello F., Cabitza F., Penasa S., Donatelli P., Balsano, C, Burra, P, Duvoux, C, Alisi, A, Piscaglia, F, Gerussi, A, Brunetto, M, Bonino, F, Montalti, R, Campanile, S, Persico, M, Alvaro, D, Santini, S, Invernizzi, P, Carbone, M, Masarone, M, Eccher, A, Siciliano, B, Vento, M, Ficuciello, F, Cabitza, F, Penasa, S, Donatelli, P, Balsano C., Burra P., Duvoux C., Alisi A., Piscaglia F., Gerussi A., Brunetto M. R., Bonino F., Montalti R., Campanile S., Persico M., Alvaro D., Santini S., Invernizzi P., Carbone M., Masarone M., Eccher A., Siciliano B., Vento M., Ficuciello F., Cabitza F., Penasa S., and Donatelli P.

Abstract

Artificial Intelligence (AI) has recently been shown as an excellent tool for the study of the liver; however, many obstacles still have to be overcome for the digitalization of real-world hepatology. The authors present an overview of the current state of the art on the use of innovative technologies in different areas (big data, translational hepatology, imaging, and transplant setting). In clinical practice, physicians must integrate a vast array of data modalities (medical history, clinical data, laboratory tests, imaging, and pathology slides) to achieve a diagnostic or therapeutic decision. Unfortunately, machine learning and deep learning are still far from really supporting clinicians in real life. In fact, the accuracy of any technological support has no value in medicine without the support of clinicians. To make better use of new technologies, it is essential to improve clinicians’ knowledge about them. To this end, the authors propose that collaborative networks for multidisciplinary approaches will improve the rapid implementation of AI systems for developing disease-customized AI-powered clinical decision support tools. The authors also discuss ethical, educational, and legal challenges that must be overcome to build robust bridges and deploy potentially effective AI in real-world clinical settings.

Published
2023

6. Italian association for the study of the liver position statement on SARS-CoV2 vaccination

Author

Russo, F, Piano, S, Bruno, R, Burra, P, Puoti, M, Masarone, M, Montagnese, S, Ponziani, F, Petta, S, Aghemo, A, Russo F. P., Piano S., Bruno R., Burra P., Puoti M., Masarone M., Montagnese S., Ponziani F. R., Petta S., Aghemo A., Russo, F, Piano, S, Bruno, R, Burra, P, Puoti, M, Masarone, M, Montagnese, S, Ponziani, F, Petta, S, Aghemo, A, Russo F. P., Piano S., Bruno R., Burra P., Puoti M., Masarone M., Montagnese S., Ponziani F. R., Petta S., and Aghemo A.

Abstract

The vaccination campaign against Sars-CoV-2 commenced in Italy at the end of December 2020. The first ones to receive the immunization against the virus were the health workers and the residents of nursing homes, following which the vaccine would be available for the entire population, beginning with the most vulnerable individuals. SARS-CoV2 vaccines have been demonstrated to be safe for the general population, although no data for patients with liver diseases or those having undergone liver transplantation are available so far. The present position statement AISF is an attempt to suggest, based on the published data on the impact of Sars-Cov-2 infection in patients with chronic liver disease, a possible priority for vaccination for this category of patients.

Published
2021

34. 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

40. Management of infections in cirrhotic patients: report of a consensus conference

Author

Fagiuoli, S, Colli, A, Bruno, R, Burra, P, Craxì, A, Gaeta, G, Grossi, P, Mondelli, M, Puoti, M, Sagnelli, E, Stefani, S, Toniutto, P, Fagiuoli S, Colli A, Bruno R, Burra P, Craxì A, Gaeta GB, Grossi P, Mondelli MU, Puoti M, Sagnelli E, Stefani S, Toniutto P., Fagiuoli, S, Colli, A, Bruno, R, Burra, P, Craxì, A, Gaeta, G, Grossi, P, Mondelli, M, Puoti, M, Sagnelli, E, Stefani, S, Toniutto, P, Fagiuoli S, Colli A, Bruno R, Burra P, Craxì A, Gaeta GB, Grossi P, Mondelli MU, Puoti M, Sagnelli E, Stefani S, and Toniutto P.

Abstract

The statements produced by the consensus conference on infection in end-stage liver disease promoted by the Italian Association for the Study of the Liver, are here reported.The topics of epidemiology, risk factors, diagnosis, prophylaxis, and treatment of infections in patient with compensated and decompensated liver cirrhosis were reviewed by a scientific board of experts who proposed 26 statements that were graded according to level of evidence and strength of recommendation, and approved by an independent jury. Each topic was explored focusing on the more relevant clinical questions. By systematic literature search of available evidence, comparison and discussion of expert opinions, pertinent statements answering specific questions were presented and approved. Short comments were added to explain the basis for grading evidence particularly on case of controversial areas.

Published
2014

45. Skills and requirements of a transplant hepatologist: board certification of the Italian Association for the Study of the Liver (AISF)

Author

Burra, P, Belli, L, Fagiuoli, S, Angelico, M, Costa, A, Caraceni, P, Toniutto, P, Burra P, Belli L, Fagiuoli S, Angelico M, Costa AN, Caraceni P, Toniutto P., Burra, P, Belli, L, Fagiuoli, S, Angelico, M, Costa, A, Caraceni, P, Toniutto, P, Burra P, Belli L, Fagiuoli S, Angelico M, Costa AN, Caraceni P, and Toniutto P.

Abstract

Liver transplantation has indeed evolved from an experimental procedure in the early 1980s to the most effective treatmentfor patients with advanced liver cirrhosis and for selected patients with hepatocellular carcinoma and fulminant hepatic failure. In this new scenario, the transplant hepatologist plays a crucial clinical role, withessentialduties andskills tomanage the complexities encounteredin waitlistedpatients or transplant recipients. The clinical tasks of the transplant hepatologist include the management of patients with end-stage liver disease who are candidates for liver transplantation and/or on the waiting list, as well as the care of transplant recipients, in both the in- and outpatient setting. Starting in 2013, the Italian Association of the Study of the Liver, with the endorsement of the National Transplant Centre, will be offering a formal certification process for transplant hepatologists, implemented in accordance to Union Européenne des Médecins Spécialistes-European Board of Transplant Medicine procedures. The Special Article outlines the requirements for board certification of the Italian Association for the Study of the Liver transplant hepatologist

Published
2013

46. Management of hepatitis C virus infection recurrence after liver transplantation: an overview

Author

Ponziani, F, Gasbarrini, A, Pompili, M, Burra, P, Fagiuoli, S, Ponziani FR, Gasbarrini A, Pompili M, Burra P, Fagiuoli S, Ponziani, F, Gasbarrini, A, Pompili, M, Burra, P, Fagiuoli, S, Ponziani FR, Gasbarrini A, Pompili M, Burra P, and Fagiuoli S

Abstract

Hepatitis C virus (HCV) infection is the major indication for liver transplantation worldwide. Its recurrence is virtually universal. Once reinfection is established, progression to cirrhosis occurs in 25%-30% of recipients within 5 years. Several studies have attempted to identify the ideal antiviral treatment for liver transplant recipients. At present, the management of recurrent HCV infection in liver transplant recipients is based on widely accepted indications, which represent a reliable guide to identify the "ideal" candidate for therapy, when therapy should be started, and what is to be expected in terms of side effects and response to treatment

Published
2011

47. Practice guidelines for the treatment of hepatitis C: recommendations from an AISF/SIMIT/SIMAST Expert Opinion Meeting.

Author

Prati, D, Gasbarrini, A, Mazzotta, F, Sagnelli, E, Carosi, G, Abrescia, N, Alberti, A, Ambu, S, Andreone, P, Andriulli, A, Angelico, M, Antonucci, G, Ascione, A, Belli, L, Bruno, R, Bruno, S, Burra, P, Cammà, C, Caporaso, N, Cariti, G, Cillo, U, Coppola, N, Craxì, A, De Luca, A, De Martin, E, Di Marco, V, Fagiuoli, S, Ferrari, C, Gaeta, G, Galli, M, Grieco, A, Grossi, P, Licata, A, Maida, I, Mangia, A, Marino, N, Maserati, R, Missale, G, Mondelli, M, Nasta, P, Niro, G, Persico, M, Petrelli, E, Picciotto, A, Piscaglia, F, Pollicino, T, Puoti, C, Puoti, M, Raimondo, G, Rumi, M, Santantonio, T, Smedile, A, Squadrito, G, Baroni, G, Taliani, G, Tavio, M, Toti, M, Bonino, F, Brunetto, M, Cacopardo, B, Caremani, M, Cauda, R, Colombo, M, Di Perri, G, Donato, F, Farci, P, Fattovich, G, Filice, G, Ghinelli, F, Guadagnino, V, Lazzarin, A, Levrero, M, Licata, G, Orani, A, Paffetti, A, Pastore, G, Piccinino, F, Pizzigallo, E, Pontisso, P, Portelli, V, Rizzetto, M, Rossi, A, Stroffolini, T, Ubaldi, E, Prati D, Gasbarrini A, Mazzotta F, Sagnelli E, Carosi G, Abrescia N, Alberti A, Ambu S, Andreone P, Andriulli A, Angelico M, Antonucci GF, Ascione A, Belli LS, Bruno R, Bruno S, Burra P, Cammà C, Caporaso N, Cariti G, Cillo U, Coppola N, Craxì A, De Luca A, De Martin E, Di Marco V, Fagiuoli S, Ferrari C, Gaeta GB, Galli M, Grieco A, Grossi P, Licata A, Maida I, Mangia A, Marino N, Maserati R, Missale G, Mondelli M, Nasta P, Niro G, Persico M, Petrelli E, Picciotto A, Piscaglia F, Pollicino T, Puoti C, Puoti M, Raimondo G, Rumi MG, Santantonio T, Smedile A, Squadrito G, Baroni GS, Taliani G, Tavio M, Toti M, Bonino F, Brunetto MR, Cacopardo B, Caremani M, Cauda R, Colombo M, Di Perri G, Donato F, Farci P, Fattovich G, Filice G, Ghinelli F, Guadagnino V, Lazzarin A, Levrero M, Licata G, Orani A, Paffetti A, Pastore G, Piccinino F, Pizzigallo E, Pontisso P, Portelli V, Rizzetto M, Rossi A, Stroffolini T, Ubaldi E., Prati, D, Gasbarrini, A, Mazzotta, F, Sagnelli, E, Carosi, G, Abrescia, N, Alberti, A, Ambu, S, Andreone, P, Andriulli, A, Angelico, M, Antonucci, G, Ascione, A, Belli, L, Bruno, R, Bruno, S, Burra, P, Cammà, C, Caporaso, N, Cariti, G, Cillo, U, Coppola, N, Craxì, A, De Luca, A, De Martin, E, Di Marco, V, Fagiuoli, S, Ferrari, C, Gaeta, G, Galli, M, Grieco, A, Grossi, P, Licata, A, Maida, I, Mangia, A, Marino, N, Maserati, R, Missale, G, Mondelli, M, Nasta, P, Niro, G, Persico, M, Petrelli, E, Picciotto, A, Piscaglia, F, Pollicino, T, Puoti, C, Puoti, M, Raimondo, G, Rumi, M, Santantonio, T, Smedile, A, Squadrito, G, Baroni, G, Taliani, G, Tavio, M, Toti, M, Bonino, F, Brunetto, M, Cacopardo, B, Caremani, M, Cauda, R, Colombo, M, Di Perri, G, Donato, F, Farci, P, Fattovich, G, Filice, G, Ghinelli, F, Guadagnino, V, Lazzarin, A, Levrero, M, Licata, G, Orani, A, Paffetti, A, Pastore, G, Piccinino, F, Pizzigallo, E, Pontisso, P, Portelli, V, Rizzetto, M, Rossi, A, Stroffolini, T, Ubaldi, E, Prati D, Gasbarrini A, Mazzotta F, Sagnelli E, Carosi G, Abrescia N, Alberti A, Ambu S, Andreone P, Andriulli A, Angelico M, Antonucci GF, Ascione A, Belli LS, Bruno R, Bruno S, Burra P, Cammà C, Caporaso N, Cariti G, Cillo U, Coppola N, Craxì A, De Luca A, De Martin E, Di Marco V, Fagiuoli S, Ferrari C, Gaeta GB, Galli M, Grieco A, Grossi P, Licata A, Maida I, Mangia A, Marino N, Maserati R, Missale G, Mondelli M, Nasta P, Niro G, Persico M, Petrelli E, Picciotto A, Piscaglia F, Pollicino T, Puoti C, Puoti M, Raimondo G, Rumi MG, Santantonio T, Smedile A, Squadrito G, Baroni GS, Taliani G, Tavio M, Toti M, Bonino F, Brunetto MR, Cacopardo B, Caremani M, Cauda R, Colombo M, Di Perri G, Donato F, Farci P, Fattovich G, Filice G, Ghinelli F, Guadagnino V, Lazzarin A, Levrero M, Licata G, Orani A, Paffetti A, Pastore G, Piccinino F, Pizzigallo E, Pontisso P, Portelli V, Rizzetto M, Rossi A, Stroffolini T, and Ubaldi E.

Abstract

It is increasingly clear that a tailored therapeutic approach to patients with hepatitis C virus infection is needed. Success rates in difficult to treat and low-responsive hepatitis C virus patients are not completely satisfactory, and there is the need to optimise treatment duration and intensity in patients with the highest likelihood of response. In addition, the management of special patient categories originally excluded from phase III registration trials needs to be critically re-evaluated. This article reports the recommendations for the treatment of hepatitis C virus infection on an individual basis, drafted by experts of three scientific societies.

Published
2010

48. Genotype 2 and 3 Reccurent Hepatitis C After Liver Transplantation: Excellent Results with Suboptimal Doses of Antiviral Therapy

Author

Vigano, R, Ponziani, F, Belli, L, Vangeli, M, Pinzello, G, Gasbarrini, A, Pasulo, L, De Martin, E, Burra, P, Pompili, M, Colledan, M, Cillo, U, Fagiuoli, S, Vigano R, Ponziani FR, Belli LS, Vangeli M, Pinzello G, Gasbarrini A, Pasulo L, De Martin E, Burra P, Pompili M, Colledan M, Cillo U, Fagiuoli S, Vigano, R, Ponziani, F, Belli, L, Vangeli, M, Pinzello, G, Gasbarrini, A, Pasulo, L, De Martin, E, Burra, P, Pompili, M, Colledan, M, Cillo, U, Fagiuoli, S, Vigano R, Ponziani FR, Belli LS, Vangeli M, Pinzello G, Gasbarrini A, Pasulo L, De Martin E, Burra P, Pompili M, Colledan M, Cillo U, and Fagiuoli S

Published
2009

49. Prophylaxis and treatment of hepatitis B in immunocompromised patients

Author

Marzano, A, Angelucci, E, Andreone, P, Brunetto, M, Bruno, R, Burra, P, Caraceni, P, Daniele, B, Di Marco, V, Fabrizi, F, Fagiuoli, S, Grossi, P, Lampertico, P, Meliconi, R, Mangia, A, Puoti, M, Raimondo, G, Smedile, A, Marzano A, Angelucci E, Andreone P, Brunetto M, Bruno R, Burra P, Caraceni P, Daniele B, Di Marco V, Fabrizi F, Fagiuoli S, Grossi P, Lampertico P, Meliconi R, Mangia A, Puoti M, Raimondo G, Smedile A, Marzano, A, Angelucci, E, Andreone, P, Brunetto, M, Bruno, R, Burra, P, Caraceni, P, Daniele, B, Di Marco, V, Fabrizi, F, Fagiuoli, S, Grossi, P, Lampertico, P, Meliconi, R, Mangia, A, Puoti, M, Raimondo, G, Smedile, A, Marzano A, Angelucci E, Andreone P, Brunetto M, Bruno R, Burra P, Caraceni P, Daniele B, Di Marco V, Fabrizi F, Fagiuoli S, Grossi P, Lampertico P, Meliconi R, Mangia A, Puoti M, Raimondo G, and Smedile A

Abstract

The literature on hepatitis B virus (HBV) in immunocompromised patients is heterogeneous and referred mainly to the pre-antivirals era. Today a rational approach to the problem of hepatitis B in these patients provides for: (a) the evaluation of HBV markers and of liver condition in all subjects starting immunosuppressive therapies (baseline), (b) the treatment with antivirals (therapy) of active carriers, (c) the pre-emptive use of antivirals (prophylaxis) in inactive carriers, especially if they are undergoing immunosuppressive therapies judged to be at high risk, (d) the biochemical and hepatitis B surface antigen (HBsAg) monitoring (or universal prophylaxis, in case of high risk immunosuppression) in subjects with markers of previous contact with HBV (HBsAg negative and anti-HBc positive), in order to prevent reverse seroconversion. Moreover it is suggested a strict adherence to criteria of allocation based on the virological characteristics of both recipients and donors in the general setting of transplants and in liver transplantation the universal prophylaxis with nucleos(t)ides analogues (frequently combined with specific anti-HBV immunoglobulins) in HBsAg positive candidates and in HBsAg negative recipients of anti-HBc positive grafts.

Published
2007

50. Neuropsychological and neurophysiological evaluation in cirrhotic patients with minimal hepatic encephalopathy undergoing liver transplantation.

Author

Senzolo, M, Amodio, P, D'Aloiso, M, Fagiuoli, S, Del Piccolo, F, Canova, D, Masier, A, Bassanello, M, Zanus, G, Burra, P, Senzolo M, Amodio P, D'Aloiso MC, Fagiuoli S, Del Piccolo F, Canova D, Masier A, Bassanello M, Zanus G, Burra P, Senzolo, M, Amodio, P, D'Aloiso, M, Fagiuoli, S, Del Piccolo, F, Canova, D, Masier, A, Bassanello, M, Zanus, G, Burra, P, Senzolo M, Amodio P, D'Aloiso MC, Fagiuoli S, Del Piccolo F, Canova D, Masier A, Bassanello M, Zanus G, and Burra P

Abstract

Background. Cirrhotic patients without overt hepatic encephalopathy may have cerebral function alterations called minimal hepatic encephalopathy (MHE). Our goal was to evaluate the role of partial pressure of ammonia (pNH 3), neuropsychological, and neurophysiological assessment in detecting cognitive changes in cirrhotic patients awaiting liver transplantation. Materials and Methods. Fourteen cirrhotic patients listed for liver transplant were studied. All patients underwent the neuropsychological battery called PSE. Neurophysiological assessment including spectral EEG (sEEG), evoked potential P300 and pNH3 and venous and arterial ammonia levels was performed in all patients. Four patients were transplanted. Results. Liver disease etiology was alcoholic in four patients, viral in six mixed in two, and cryptogenic in two. PSE scores revealed MHE in 8 patients; sEEG was altered in 6, and P300 in 1. No correlations were detected between P300, sEEG, and PSE. pNH3 and arterial ammonia levels were significantly higher in the subgroup of patients with altered sEEG and were correlated with theta band increase in sEEG but not with pathological PSE scores or P300 wave abnormalities. Conclusions. The combination of sEEG and PSE, and possibly also pNH3 and arterial ammonia, is useful in detecting cerebral function alterations in cirrhotic patients with no apparent encephalopathy, whereas P300 is not. The diagnosis of MHE obtained using the multimodal approach adopted in this study may enable the adequate treatment of these patients prior to surgery, which includes advising them not to drive and adjusting their priority on the waiting list for OLTx in the light of a condition that cannot be evaluated by Child Pugh score and MELD score.

Published
2005

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