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1. The impact of the COVID-19 outbreak on liver transplantation programs in Northern Italy

Author

Maggi, Umberto, De Carlis, Luciano, Yiu, Daniel, Colledan, Michele, Regalia, Enrico, Rossi, Giorgio, Angrisani, Marco, Consonni, Dario, Fornoni, Gianluca, Piccolo, Giuseppe, DeFeo, T. Maria, Maggi, U, De Carlis, L, Yiu, D, Colledan, M, Regalia, E, Rossi, G, Angrisani, M, Consonni, D, Fornoni, G, Piccolo, G, and Defeo, T

Subjects
Male, Pediatrics, Basiliximab, medicine.medical_treatment, 030230 surgery, Liver transplantation, COVID-19 Testing, 0302 clinical medicine, Epidemiology, Immunology and Allergy, Pharmacology (medical), Young adult, Mortality rate, infection and infectious agents – viral, critical care/intensive care management, Middle Aged, Prognosis, Tissue Donors, Treatment Outcome, Italy, Female, epidemiology, Coronavirus Infections, medicine.drug, Adult, organ allocation, medicine.medical_specialty, Tissue and Organ Procurement, Adolescent, Pneumonia, Viral, Brief Communication, clinical research/practice, End Stage Liver Disease, Betacoronavirus, Young Adult, 03 medical and health sciences, medicine, Humans, Pandemics, Aged, Transplantation, Clinical Laboratory Techniques, SARS-CoV-2, business.industry, bronchoalveolar lavage (BAL), COVID-19, Outbreak, Postoperative complication, Liver Transplantation, COVID-19, Liver, Transplantation, business, liver transplantation/hepatology, Follow-Up Studies
Abstract

In January 2020, Novel Coronavirus Disease 2019 (COVID-19) resulted in a global pandemic, creating uncertainty towards the management of Liver Transplantation (LT) programmes. Lombardy has been the most affected region in Italy: The current mortality rate of COVID-19 patients is 18,3% (10022 deaths) (April 10th) with hospitals in Lombardy having to expand the total number of ICU beds from 724 to 1381 to accommodate infected patients. There has been a drastic decrease in liver donors. From February 23rd until April 10th, 17 LTs were performed in Lombardy. Mean donor age was 49 years (range 18-74) whereas mean recipient age was 55 (13-69); mean MELD Score was 12 (6-24). All donors underwent screening for SARS CoV-2 prior to LT. Two patients tested positive after LT, and one patient died for COVID on POD 30. 16 patients are alive after an average of 30 days post LT (range 3-46). 10 patients have been discharged. This study has found no specific reason concerning the safety of recipients, to stop liver transplantation programmes. Several Key-lessons from our experience are reported. However, due to the complex circumstances which surround the viral outbreak, the cessation or a reduction in LT activity is a pragmatic requirement.

Published
2020
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2. HCC recurrence in HCV‐infected patients after liver transplantation: SiLVER Study reveals benefits of sirolimus in combination with CNIs – a post‐hoc analysis

Author

Werner, Jens M., Hornung, Matthias, Krah, Rubertha, Götz, Markus, Schnitzbauer, Andreas A., Schlitt, Hans J., Geissler, Edward K., Zülke, Carl, Lamby, Philipp E., Proneth, Andrea, Duvoux, Christophe, Burra, Patrizia, Jauch, Karl‐Walter, Rentsch, Markus, Ganten, Tom M., Schmidt, Jan, Settmacher, Utz, Heise, Michael, Rossi, Giorgio, Cillo, Umberto, Kneteman, Norman, Adam, René, Hoek, Bart, Bachellier, Philippe, Wolf, Philippe, Rostaing, Lionel, Bechstein, Wolf O., Rizell, Magnus, Powell, James, Hidalgo, Ernest, Gugenheim, Jean, Wolters, Heiner, Brockmann, Jens, Roy, André, Mutzbauer, Ingrid, Schlitt, Angela, Beckebaum, Susanne, Graeb, Christian, Nadalin, Silvio, Valente, Umberto, Turrión, Victor Sánchez, Jamieson, Neville, Scholz, Tim, Colledan, Michele, Fändrich, Fred, Becker, Thomas, Söderdahl, Gunnar, Chazouillères, Olivier, Mäkisalo, Heikki, Pageaux, Georges‐Philippe, Steininger, Rudolf, Soliman, Thomas, Jong, Koert P., Pirenne, Jacques, Margreiter, Raimund, Pratschke, Johann, Pinna, Antonio D., Hauss, Johann, Schreiber, Stefan, Strasser, Simone, Klempnauer, Jürgen, Troisi, Roberto I., Bhoori, Sherrie, Lerut, Jan, Bilbao, Itxarone, Klein, Christian G., Königsrainer, Alfred, Otto, Gerd, Mazzaferro, Vincenzo, Neuhaus, Peter, Werner, J, Hornung, M, Krah, R, Gotz, M, Schnitzbauer, A, Schlitt, H, Geissler, E, Zulke, C, Lamby, P, Proneth, A, Duvoux, C, Burra, P, Jauch, K, Rentsch, M, Ganten, T, Schmidt, J, Settmacher, U, Heise, M, Rossi, G, Cillo, U, Kneteman, N, Adam, R, Hoek, B, Bachellier, P, Wolf, P, Rostaing, L, Bechstein, W, Rizell, M, Powell, J, Hidalgo, E, Gugenheim, J, Wolters, H, Brockmann, J, Roy, A, Mutzbauer, I, Schlitt, A, Beckebaum, S, Graeb, C, Nadalin, S, Valente, U, Turrion, V, Jamieson, N, Scholz, T, Colledan, M, Fandrich, F, Becker, T, Soderdahl, G, Chazouilleres, O, Makisalo, H, Pageaux, G, Steininger, R, Soliman, T, Jong, K, Pirenne, J, Margreiter, R, Pratschke, J, Pinna, A, Hauss, J, Schreiber, S, Strasser, S, Klempnauer, J, Troisi, R, Bhoori, S, Lerut, J, Bilbao, I, Klein, C, Konigsrainer, A, Otto, G, Mazzaferro, V, and Neuhaus, P

Subjects
Silver Study, medicine.medical_specialty, Carcinoma, Hepatocellular, Silver, direct-acting antiviral agents, medicine.medical_treatment, 610 Medizin, Subgroup analysis, 030230 surgery, Liver transplantation, Gastroenterology, Group B, 03 medical and health sciences, HEPATOCELLULAR-CARCINOMA, hepatitis C virus infection, hepatocellular carcinoma, liver transplantation, 0302 clinical medicine, Internal medicine, Post-hoc analysis, medicine, Humans, Sirolimus, direct-acting antiviral agent, ddc:610, Transplantation, business.industry, Liver Neoplasms, Immunosuppression, medicine.disease, Hepatitis C, digestive system diseases, Calcineurin, Hepatocellular carcinoma, 030211 gastroenterology & hepatology, Neoplasm Recurrence, Local, business, medicine.drug
Abstract

Factors affecting outcomes in liver transplant (LTx) recipients with hepatocellular carcinoma (HCC) and hepatitis C viral (HCV) infection include the choice of immunosuppression. Here, we analyzed the HCV+ subgroup of patients from the randomized controlled, international SiLVER Study. We performed a post hoc analysis of 166 HCV+ SiLVER Study patients regarding HCC outcome after LTx. Control patients (group A: n=88) received mTOR inhibitor (mTORi)-free, calcineurin inhibitor (CNI)-based versus sirolimus-based immunosuppression (group B: n=78). We found no significant difference regarding HCV-RNA titers between group A and B. Since no effect in group B could be due to variable sirolimus dosing, we split group B into patients receiving sirolimus-based immunosuppression+CNIs for >50% (B1; n=44) or

Published
2020
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3. Koolen-de Vries Syndrome: Preliminary Observations of Topiramate Efficacy

Author

Mercuri Anna, Termine Cristiano, Piccinelli Paolo, Casalone Rosario, Ferri Matteo, Granata Paola, Rossi Giorgio, and Lipari Rossella

Subjects
Topiramate, Pediatrics, medicine.medical_specialty, Koolen De Vries syndrome, Case Report, Electroencephalography, RJ1-570, antiepileptic drugs, electroencephalography, epilepsy, genetics, quality of life, Epilepsy, Quality of life, medicine, Rare syndrome, RC346-429, medicine.diagnostic_test, business.industry, Low dose, General Medicine, medicine.disease, Levetiracetam, Neurology. Diseases of the nervous system, business, medicine.drug
Abstract

We describe the case of a baby-girl affected by the Koolen-de Vries syndrome (KdVS), with epilepsy. Our patient has microdeletions in the 17q21.31 region (array CGH). Therapy with Levetiracetam showed a relatively lack of efficacy, while adding a low dose of Topiramate in the therapy allowed the complete seizures control. KdVS is a rare syndrome and its epilepsy features and seizures treatment are not well known by pediatric neurologists. However, with broader use of array CGH, an increasing number of cases are likely to be identified and their description, including response to specific medications, can facilitate recognition and treatment. The complex treatment of epilepsy should be part of the global management and counseling in these composite patients.

Published
2021

5. Age level vs grade level for the diagnosis of ADHD and neurodevelopmental disorders

Author

Bonati, Maurizio, Cartabia, Massimo, Zanetti, Michele, Reale, Laura, Didoni, Anna, Costantino, Maria Antonella, Conte, Stefano, Renzetti, Valeria, Salvoni, Laura, Molteni, Massimo, Trabattoni, Sara, Effedri, Paola, Fazzi, Elisa, Filippini, Elena, Pedercini, Elisabetta, Zanetti, Edda, Fteita, Nadia, Arisi, Daniele, Mapelli, Roberta, Frassica, Simona, Oriani, Simonetta, Trevisan, Christian, Acquistapace, Susanna, Martinelli, Ottaviano, Villani, Davide, Binaghi, Emanuela, Deriu, Andrea, Vasile, Gabriella, Borchia, Arianna, Morosini, Paola, Breviglieri, Maddalena, Capovilla, Giuseppe, Segala, Roberto, Battaini, Chiara, Bissoli, Claudio, Canevini, Maria Paola, Cropanese, Isabella, Fornaro, Emiddio, Leonardi, Giorgio, Merati, Silvia, Saccani, Monica, Vaccari, Roberto, Valenti, Vera, Balottin, Umberto, Chiappedi, Matteo, Vlacos, Elena, Meraviglia, Corrado, Palmieri, Maria Grazia, Ruffoni, Gianpaolo, Rinaldi, Francesco, Soardi, Federica, Luoni, Chiara, and Rossi, Giorgio

Subjects
School, Male, Parents, medicine.medical_specialty, Pediatrics, Adolescent, Epidemiology, Comorbidity, behavioral disciplines and activities, 03 medical and health sciences, 0302 clinical medicine, Neurodevelopmental disorder, Age factors, Attention-deficit hyperactivity disorder, Children, Italy, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Incidence, Neurodevelopmental Disorders, Prevalence, Registries, Schools, Age Factors, Pediatrics, Perinatology and Child Health, Developmental and Educational Psychology, Psychiatry and Mental Health, mental disorders, medicine, Child and adolescent psychiatry, Attention deficit hyperactivity disorder, 0501 psychology and cognitive sciences, Cumulative incidence, 030212 general & internal medicine, business.industry, Incidence (epidemiology), 05 social sciences, General Medicine, Relative age effect, Perinatology and Child Health, medicine.disease, business, 050104 developmental & child psychology
Abstract

A number of worldwide studies have demonstrated that children born later in the school year are more likely to receive an ADHD diagnosis than their same school-year peers. There is, however, variation in findings between countries. We aimed to confirm whether relative age is associated with ADHD diagnosis, with or without comorbidities, and to investigate whether relative age is associated with ADHD type and severity, and if this age relationship is in common with other neurodevelopmental disorder. We used the Lombardy Region’s ADHD registry. Data on children aged 6 years and older from September 1, 2011 to December 31, 2017 were considered. We calculated incidence ratios to assess the inter-relations between relative age within the school year, using age at diagnosis of ADHD or of other psychiatric disorder, year of diagnosis, and total number of children born in Lombardy during the corresponding timeframe. Data on ADHD type, severity of diagnosed disorder clinical global impressions–severity scale, and repetition of a school-grade were also considered. 4081 children, 2856 of whom with ADHD, were identified. We confirmed that the cumulative incidence of ADHD diagnosis was greatest for younger children, in particular for boys, for whom the prevalence is greater. The relative age effect was not accounted for by ADHD comorbid disorders, ADHD of combined type or severity. The relative age effect was also observed for children with other neurodevelopmental disorders (without ADHD), with a similar profile as ADHD children: the incidence ratio was 1.78 (95% CI 1.07–2.97; p

Published
2018

6. Italian regional health service costs for diagnosis and 1-year treatment of ADHD in children and adolescents

Author

Casadei, Gianluigi, Cartabia, Massimo, Reale, Laura, Costantino, Maria Antonella, Bonati, Maurizio, Conte, Stefano, Renzetti, Valeria, Salvoni, Laura, Molteni, Massimo, Trabattoni, Sara, Effedri, Paola, Filippini, Elena, Pedercini, Elisabetta, Zanetti, Edda, Fteita, Nadia, Arisi, Daniele, Mapelli, Roberta, Frassica, Simona, Oriani, Simonetta, Trevisan, Christian, Acquistapace, Susanna, Martinelli, Ottaviano, Villani, Davide, Binaghi, Emanuela, Deriu, Andrea, Ricotta, Ernesta, Borchia, Arianna, Morosini, Paola, Breviglieri, Maddalena, Capovilla, Giuseppe, Segala, Roberto, Bissoli, Claudio, Canevini, Maria Paola, Costantino, Antonella, Cropanese, Isabella, Didoni, Anna, Fornaro, Emiddio, Merati, Silvia, Ottolini, Alberto, Saccani, Monica, Vaccari, Roberto, Valenti, Vera, Valentino, Alessandra, Balottin, Umberto, Chiappedi, Matteo, Vlacos, Elena, Meraviglia, Corrado, Palmieri, Maria Grazia, Ruffoni, Gianpaolo, Rinaldi, Francesco, Soardi, Federica, Luoni, Chiara, Pavone, Francesca, Rossi, Giorgio, Zanetti, Michele, Casadei, G, Cartabia, M, Reale, L, Costantino, M, Bonati, M, Conte, S, Renzetti, V, Salvoni, L, Molteni, M, Trabattoni, S, Effedri, P, Filippini, E, Pedercini, E, Zanetti, E, Fteita, N, Arisi, D, Mapelli, R, Frassica, S, Oriani, S, Trevisan, C, Acquistapace, S, Martinelli, O, Villani, D, Binaghi, E, Deriu, A, Ricotta, E, Borchia, A, Morosini, P, Breviglieri, M, Capovilla, G, Segala, R, Bissoli, C, Canevini, M, Costantino, A, Cropanese, I, Didoni, A, Fornaro, E, Merati, S, Ottolini, A, Saccani, M, Vaccari, R, Valenti, V, Valentino, A, Balottin, U, Chiappedi, M, Vlacos, E, Meraviglia, C, Palmieri, M, Ruffoni, G, Rinaldi, F, Soardi, F, Luoni, C, Pavone, F, Rossi, G, and Zanetti, M

Subjects
medicine.medical_specialty, Psychological intervention, Ambulatory/outpatient care, Child and adolescent health, Health care cost, Health administration, lcsh:RC321-571, 03 medical and health sciences, Health services, 0302 clinical medicine, medicine, 030212 general & internal medicine, Treatment costs, Psychiatry, Psychiatric Mental Health, lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry, Health policy, business.industry, Research, Health Policy, Environmental and Occupational Health, Public Health, Environmental and Occupational Health, Mental health, Cost driver, Psychiatry and Mental Health, Public Health, Pshychiatric Mental Health, Health care costs, business, 030217 neurology & neurosurgery, Time to diagnosis
Abstract

The main aim of this study was to estimate the costs associated with diagnostic assessment and 1-year therapy in children and adolescents enrolled in 18 ADHD reference centres. Data concerning 1887 children and adolescents from the mandatory ADHD registry database during the 2012–2014 period were analysed. The overall diagnostic and treatment costs per patient amounts to €574 and €830, respectively. The ADHD centre, the school as sender, and the time to diagnosis constitute cost drivers. Non-pharmacological therapy resulted as being more expensive for patients concomitantly treated with drugs (€929) compared to those treated with psychological interventions alone (€590; p = 0.006). This study gives the first and reliable estimate of the costs associated with both diagnosis and treatment of ADHD in Italy. Although costs associated with mental disorders are difficult to estimate, continuing efforts are need to define costs and resources to guarantee appropriate care, also for ADHD. Electronic supplementary material The online version of this article (doi:10.1186/s13033-017-0140-8) contains supplementary material, which is available to authorized users.

Published
2017

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

Author

Krawczyk, Marek, Grat, Michal, Adam, Rene, Polak, Wojciech G, Klempnauer, Jurgen, Pinna, Antonio, Di Benedetto, Fabrizio, Filipponi, Franco, Senninger, Norbert, Foss, Aksel, Rufián-Peña, Sebastian, Bennet, William, Pratschke, Johann, Paul, Andreas, Settmacher, Utz, Rossi, Giorgio, Salizzoni, Mauro, Fernandez-Selles, Carlos, Martínez de Rituerto, Santiago T, Gómez-Bravo, Miguel A, Pirenne, Jacques, Detry, Olivier, Majno, Pietro E, Nemec, Petr, Bechstein, Wolf O, Bartels, Michael, Nadalin, Silvio, Pruvot, Francois R, Mirza, Darius F, Lupo, Luigi, Colledan, Michele, Tisone, Giuseppe, Ringers, Jan, Daniel, Jorge, Charco Torra, Ramón, Moreno González, Enrique, Bañares Cañizares, Rafael, Cuervas-Mons Martinez, Valentin, San Juan Rodríguez, Fernando, Yilmaz, Sezai, Remiszewski, Piotr, Remiszweski, Piotr, Deschans, Bruno, Hans, Marie France, Meyer, Stephanie Hauss, Rutarova, Jana, Siems, Martina, Knochel, Cornelia Swillus, Wilhelm, Dietmar, Hecker, Sandy, Harms, Simone, Sakirow, Larissa, Eissing, Elvira, Schenk, Martin, Poli, Elisabetta, Guizzetti, Michela, Grazi, Gian Luca, Maggi, Umberto, Montalti, Roberto, Arenga, Giuseppe, Sforza, Daniele, Cibelli, Alessandra, Foss, Stein, Caetano, Rosario, Ispir, Mukadder, 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, and Surgery

Subjects
Registrie, Graft Rejection, Male, medicine.medical_specialty, medicine.medical_treatment, Medizin, 030230 surgery, Liver transplantation, Extracorporeal, Female, Humans, Injury Severity Score, Liver, Registries, Retrospective Studies, Liver Transplantation, 03 medical and health sciences, 0302 clinical medicine, Statistical significance, Risk of mortality, Medicine, Risk factor, Transplantation, ddc:617, business.industry, 030208 emergency & critical care medicine, Retrospective cohort study, Surgery, Settore MED/18, business, Human
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 cut-off 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

8. A Pilot Study on Circadian Activity Rhythm in Pediatric Attention-Deficit Hyperactivity Disorder

Author

Lorenzo Tonetti, Umberto Balottin, M. Zoppello, Monica Martoni, Giorgio Rossi, Vincenzo Natale, Marco Filardi, Marco Fabbri, Tonetti, Lorenzo, Zoppello, Marina, Rossi, Giorgio, Balottin, Umberto, Fabbri, Marco, Filardi, Marco, Martoni, Monica, and Natale, Vincenzo

Subjects
medicine.medical_specialty, pediatrics, Activity rhythms, Case Report, circadian activity rhythm, Audiology, 03 medical and health sciences, 0302 clinical medicine, Time windows, attention-deficit hyperactivity disorder, medicine, Attention deficit hyperactivity disorder, Circadian rhythm, Motor activity, General Environmental Science, business.industry, motor activity, Monitor sleep, Actigraphy, Mean age, medicine.disease, 030227 psychiatry, General Earth and Planetary Sciences, functional linear modeling, business, human activities, 030217 neurology & neurosurgery, actigraphy
Abstract

A recent study has applied a novel statistical framework (functional linear modeling: FLM) to the study of circadian activity rhythm (CAR) in adult attention-deficit hyperactivity disorder (ADHD), pointing out the absence of the physiological post-lunch dip. The aim of the present study was to apply FLM to explore the features of CAR in pediatric ADHD. To this end, a secondary analysis of previously collected data was carried out. Twenty-four ADHD children (four females, mean age 8.67 ± 1.74) and 107 controls (C, 60 females, mean age 10.25 ± 0.48) were examined. The actigraph model Actiwatch AW64 was used to objectively monitor sleep/wake behavior and CAR. In the original study each participant wore the actigraph on the non-dominant wrist for one week. FLM was applied to examine the differences between groups in CAR. Compared with C, the CAR of ADHD children was distinguished by a higher motor activity during the whole of the daytime and within a reduced time window during the nighttime.

Published
2019

9. Infections in liver and lung transplant recipients. A national prospective cohort

Author

Gagliotti, Carlo, Morsillo, Filomena, Moro, Maria Luisa, Masiero, Lucia, Procaccio, Francesco, Vespasiano, Francesca, Pantosti, Annalisa, Monaco, Monica, Errico, Giulia, Ricci, Andrea, Grossi, Paolo, Nanni Costa, Alessandro, 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. G., Cusi, M., D’Armini, A. M., 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. C., Fossati, L., Gaibani, P., Garcia Fernandez, A., Gesu, G., Giacometti, R., Gona, F., Gridelli, B., Henrici de Angelis, L., Landini, M. P., Maldarelli, F., Mancini, C., Marone, P., Mularoni, A., Paglialunga, G., Paladini, P., Palù, G., Parisi, S., Peris, A., Pinna, A. D., 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, Vismara, C, Gagliotti, Carlo, Morsillo, Filomena, Moro, Maria Luisa, Masiero, Lucia, Procaccio, Francesco, Vespasiano, Francesca, Pantosti, Annalisa, Monaco, Monica, Errico, Giulia, Ricci, Andrea, Grossi, Paolo, Costa, Alessandro Nanni, Adorno, Domenico, Ambretti, Simone, Amoroso, Antonio, Arghittu, Milena, Berloco, Pasquale, Bertani, Alessandro, Bonizzoli, Manuela, Cambieri, Patrizia, Canzonieri, Marco, Caprio, Mario, Carrara, Elena, Carrinola, Rosaria, Cibelli, Eva, Cillo, Umberto, Colledan, Michele, Colombo, Rosaria, Coluccio, Elena, Conaldi, Pier Giulio, Cusi, Mariagrazia, D’Armini, Andrea Maria, Da Riva, Adelaide, D'Auria, Bianca, De Carlis, Luciano, De Cillia, Carlo, De Gasperi, Andrea, Di Caro, Antonino, Di Ciaccio, Paola, Dondossola, Daniele, Farina, Claudio, Feltrin, Giuseppe, Finarelli, Alba Carola, Fossati, Lucina, Gaibani, Paolo, Fernandez, Aurora Garcia, Gesu, Giovanni, Giacometti, Raffaella, Gona, Floriana, Gridelli, Bruno, De Angelis, Lucia Henrici, Landini, Maria Paola, Maldarelli, Federica, Mancini, Carlo, Marone, Piero, Mularoni, Alessandra, Paglialunga, Giulia, Paladini, Piero, Palù, Giorgio, Parisi, Saverio, Peris, Adriano, Pinna, Antonio Daniele, Platto, Marco, Pugliese, Francesco, Puoti, Francesca, Rago, Claudio, Ravini, Mario, Rea, Federico, Rinaldi, Mauro, Rossi, Giorgio, Rossi, Lucia, Rossi, Massimo, Salizzoni, Mauro, Sangiorgi, Gabriela, Santambrogio, Luigi, Spada, Marco, Sparacino, Vito, Stella, Franco, Torelli, Rosanna, Torresani, Erminio, Tosi, Davide, Vailati, Francesca, Valeri, Maurizio, Venuta, Federico, Vesconi, Sergio, Viale, Pierluigi, and Vismara, Chiara

Subjects
Microbiology (medical), Infectious Diseases, Male, 0301 basic medicine, medicine.medical_treatment, Drug Resistance, Transplant Recipient, 030230 surgery, Liver transplantation, Postoperative Complications, 0302 clinical medicine, Drug Resistance, Multiple, Bacterial, Medicine, Cumulative incidence, Prospective Studies, Prospective cohort study, Incidence, Incidence (epidemiology), Mortality rate, Bacterial, Bacterial Infections, General Medicine, Middle Aged, lung transplant, Anti-Bacterial Agents, infectious, Italy, Female, Multiple, Adult, Bacteria, Humans, Transplant Recipients, Liver Transplantation, Lung Transplantation, Human, medicine.medical_specialty, 030106 microbiology, Bacterial Infection, Infectious Diseases, transplantation, 03 medical and health sciences, Internal medicine, Anti-Bacterial Agent, Lung transplantation, business.industry, lung transplant, liver transplant, infectious, Transplantation, Prospective Studie, liver transplant, Etiology, Postoperative Complication, business, transplantation
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

10. Management of biliary anastomotic strictures after liver transplantation (BASALT study): A nationwide Italian survey

Author

Roberto Penagini, Rita Conigliaro, Mauro Salizzoni, Dario Conte, Maria Francesca Donato, Federico Barbaro, Giorgia Catalano, Giovanni Lombardi, Davide Ghinolfi, Helga Bertani, Guido Costamagna, Livio Cipolletta, Elena Nadal, Roberto Rosa, Antonio Pisani, Antonio Di Sario, Andrea Tringali, Luca Rodella, Massimo Colombo, Massimiliano Mutignani, Milutin Bulajic, Ilaria Parzanese, Valentina Boarino, Angelo Cerofolini, Matteo Angelo Manini, Federica Malinverno, Giulio Cariani, Franco Filipponi, Luca Barresi, Edoardo Forti, Alberto Fasoli, Franco Bazzoli, Ilaria Tarantino, Sara Traini, Vincenzo Mazzaferro, Valerio Balassone, Mario Traina, Alberto Fantin, Paolo Cantù, Fiammetta Soggiu, Giorgio Rossi, Italo Stroppa, Maurizio Zilli, Federica Invernizzi, Alberto Merighi, Maria Caterina Parodi, Paolo Ravelli, Anna Baldan, Cantù, Paolo, Parzanese, Ilaria, Balassone, Valerio, Di Sario, Antonio, Soggiu, Fiammetta, Lombardi, Giovanni, Barbaro, Federico, Pisani, Antonio, Baldan, Anna, Cariani, Giulio, Boarino, Valentina, Fasoli, Alberto, Bertani, Helga, Forti, Edoardo, Bulajic, Milutin, Ghinolfi, Davide, Nadal, Elena, Cerofolini, Angelo, Barresi, Luca, Catalano, Giorgia, Stroppa, Italo, Traini, Sara, Mazzaferro, Vincenzo, Cipolletta, Livio, Tringali, Andrea, Costamagna, Guido, Ravelli, Paolo, Bazzoli, Franco, Merighi, Alberto, Parodi, Maria Caterina, Conigliaro, Rita, Mutignani, Massimiliano, Zilli, Maurizio, Filipponi, Franco, Fantin, Alberto, Rodella, Luca, Tarantino, Ilaria, Traina, Mario, Salizzoni, Mauro, Rosa, Roberto, Malinverno, Federica, Invernizzi, Federica, Angelo Manini, Matteo, Donato, Maria Francesca, Colombo, Massimo, Conte, Dario, Rossi, Giorgio, and Penagini, Roberto

Subjects
medicine.medical_specialty, Settore MED/12 - GASTROENTEROLOGIA, medicine.medical_treatment, Treatment outcome, Constriction, Pathologic, 030230 surgery, Anastomosis, Liver transplantation, Follow-Up Studie, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Surgery, Hepatology, Transplantation, Retrospective Studie, Internal medicine, Surveys and Questionnaires, medicine, Stent, Humans, Surveys and Questionnaire, Retrospective Studies, Cholangiopancreatography, Endoscopic Retrograde, Cholestasis, business.industry, Patient Selection, Follow up studies, biliary anastomotic strictures, Bile Duct, Retrospective cohort study, Liver Transplantation, Treatment Outcome, Multicenter study, Italy, Cholestasi, 030211 gastroenterology & hepatology, Stents, Bile Ducts, Postoperative Complication, business, Hospitals, High-Volume, Magnetic Resonance Angiography, Follow-Up Studies, Human
Abstract

n/a

Published
2017

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. Mismatch repair system (MMR) status correlates with response and survival in non-small cell lung cancer (NSCLC) patients

Author

Vittorio Franciosi, Nicoletta Campanini, Alfredo Santinelli, Roberta Camisa, Giulio Rossi, Rosa Rita Silva, Stefano Cascinu, Fausto Barbieri, Rossana Berardi, Mario Scartozzi, Guido Rindi, Lucio Crinò, Giovanni Benedetti, Andrea Ardizzoni, Scartozzi, M, Franciosi, V, Campanini, N, Benedetti, G, Barbieri, F, Rossi, Giorgio, Berardi, R, Camisa, R, Silva, Rr, Santineelli, A, Ardizzoni, A, Crino, L, Rindi, G, Cascinu, Stefano, Scartozzi M, Franciosi V, Campanini N, Benedetti G, Barbieri F, Rossi G, Berardi R, Camisa R, Silva RR, Santineelli A, Ardizzoni A, Crino L, Rindi G, and Cascinu S

Subjects
Male, Oncology, Cancer Research, Pathology, Lung Neoplasms, predictive factors, Organoplatinum Compounds, Base Pair Mismatch, non-small cell lung cancer (NSCLC), Deoxycytidine, Immunoenzyme Techniques, chemistry.chemical_compound, Carcinoma, Non-Small-Cell Lung, Antineoplastic Combined Chemotherapy Protocols, Aged, 80 and over, education.field_of_study, NSCLC, mismatch repair system, Nuclear Proteins, Middle Aged, Neoplasm Proteins, Oxaliplatin, Survival Rate, Female, MutL Protein Homolog 1, medicine.drug, Adult, Pulmonary and Respiratory Medicine, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Population, mismatch repair system, Internal medicine, medicine, Humans, Lung cancer, education, neoplasms, Survival rate, Adaptor Proteins, Signal Transducing, Aged, Retrospective Studies, Cisplatin, business.industry, nutritional and metabolic diseases, medicine.disease, Gemcitabine, digestive system diseases, Carboplatin, lung cancer, MutL Proteins, chemistry, Carrier Proteins, business
Abstract

Pre-clinical data suggested a relationship between inactivation of hMLH1 and hMSH2 and resistance to drugs like cisplatin and carboplatin, but not oxaliplatin. We then hypothesised that NSCLC showing loss of expression of the mismatch repair system (MMR), could be refractory to cisplatin-based, but not to oxaliplatin-based chemotherapy. Immunoistochemical. expression of hMLH1 and hMSH2 was analysed on tumour samples from 93 advanced NSCLC, receiving chemotherapy with either cisplatin or oxaliplatin in combination with gemcitabine. Patients showing loss of hMLH1 or hMSH2 expression in >= 50% of tumour cells were deemed MMR-negative (Group A), whereas cases with a normal, hMLH1 or hMSH2 expression in > 50% of the tumour cells were defined MMR-positive (Group B). No differences in the response and progression rate were found in the whole patients population and in the gemcitabine/cisplatin group for both hMLH1 and hMSH2. In the gemcitabine/oxaliplatin group response rate was 38% and 0% (p = 0.04) for patients with or without loss of hMSH2 expression. Median survival according to MMR status in Groups A and B, respectively was: 17 months versus 9 months for hMLH1 (p=0.031) and 10 months versus 9 months for hMSH2 (p=0.8330). Both the difference in response rate and in median survival observed according to MMR status seem to confirm what has been suggested by preclinical studies. (c) 2006 Elsevier Ireland Ltd. All rights reserved. RI Rossi, Giulio/C-5576-2011

Published
2006

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