Author: "De Carlis L." / Topic: humans - Searchworks@Jio Institute Digital Library Search Results

Your search keyword '"De Carlis L."' showing total 201 results

Start Over Author "De Carlis L." Topic humans

201 results on '"De Carlis L."'

1. Targeting CXCR1/2 Does Not Improve Insulin Secretion After Pancreatic Islet Transplantation: A Phase 3, Double-Blind, Randomized, Placebo-Controlled Trial in Type 1 Diabetes

Author: Maffi P., Lundgren T., Tufveson G., Rafael E., Shaw J. A. M., Liew A., Saudek F., Witkowski P., Golab K., Bertuzzi F., Gustafsson B., Daffonchio L., Ruffini P. A., Piemonti L., Nano R., Mercalli A., Lampasona V., Magistretti P., Sordi V., Antonio S., Antonioli B., Galuzzi M., Tosca M. C., De Carlis L., Colussi G., Korsgren O., Pollard H., Maffi, Paola, Lundgren, Torbjörn, Tufveson, Gunnar, Rafael, Ehab, Shaw, James A M, Liew, Aaron, Saudek, Frantisek, Witkowski, Piotr, Golab, Karolina, Bertuzzi, Federico, Gustafsson, Bengt, Daffonchio, Luisa, Ruffini, Pier Adelchi, Piemonti, Lorenzo, Maffi, P, Lundgren, T, Tufveson, G, Rafael, E, Shaw, J, Liew, A, Saudek, F, Witkowski, P, Golab, K, Bertuzzi, F, Gustafsson, B, Daffonchio, L, Ruffini, P, Piemonti, L, Nano, R, Mercalli, A, Lampasona, V, Magistretti, P, Sordi, V, Antonio, S, Antonioli, B, Galuzzi, M, Tosca, M, De Carlis, L, Colussi, G, Korsgren, O, and Pollard, H
Subjects: Male, Time Factors, Endocrinology, Diabetes and Metabolism, Islets of Langerhans Transplantation, Placebo-controlled study, Gastroenterology, Receptors, Interleukin-8B, Receptors, Interleukin-8A, law.invention, Placebos, 0302 clinical medicine, Randomized controlled trial, law, Insulin Secretion, Postoperative Period, 030212 general & internal medicine, Sulfonamides, geography.geographical_feature_category, Clinical Care/Education/Nutrition/Psychosocial Research, Area under the curve, Middle Aged, Islet, Combined Modality Therapy, Female, Immunosuppressive Agents, Adult, medicine.medical_specialty, Adolescent, 030209 endocrinology & metabolism, Placebo, Drug Administration Schedule, Young Adult, Islets of Langerhans, 03 medical and health sciences, Double-Blind Method, Internal medicine, CXCR1/2, insulin secretion, pancreatic islet transplantation, Internal Medicine, medicine, Humans, Aged, Advanced and Specialized Nursing, geography, Type 1 diabetes, business.industry, medicine.disease, Transplantation, Diabetes Mellitus, Type 1, Pancreatic islet transplantation, business
Abstract: OBJECTIVE Reparixin is an inhibitor of CXCR1/2 chemokine receptor shown to be an effective anti-inflammatory adjuvant in a pilot clinical trial in allotransplant recipients. RESEARCH DESIGN AND METHODS A phase 3, multicenter, randomized, double-blind, parallel-assignment study (NCT01817959) was conducted in recipients of islet allotransplants randomized (2:1) to reparixin or placebo in addition to immunosuppression. Primary outcome was the area under the curve (AUC) for C-peptide during the mixed-meal tolerance test at day 75 ± 5 after the first and day 365 ± 14 after the last transplant. Secondary end points included insulin independence and standard measures of glycemic control. RESULTS The intention-to-treat analysis did not show a significant difference in C-peptide AUC at both day 75 (27 on reparixin vs. 18 on placebo, P = 0.99) and day 365 (24 on reparixin vs. 15 on placebo, P = 0.71). There was no statistically significant difference between treatment groups at any time point for any secondary variable. Analysis of patient subsets showed a trend for a higher percentage of subjects retaining insulin independence for 1 year after a single islet infusion in patients receiving reparixin as compared with patients receiving placebo (26.7% vs. 0%, P = 0.09) when antithymocyte globulin was used as induction immunosuppression. CONCLUSIONS In this first double-blind randomized trial, islet transplantation data obtained with reparixin do not support a role of CXCR1/2 inhibition in preventing islet inflammation-mediated damage.
Published: 2020
Full Text: View/download PDF

2. Variations in risk-adjusted outcomes following 4318 laparoscopic liver resections

Author: Cucchetti, A., Aldrighetti, L., Ratti, F., Ferrero, A., Guglielmi, A., Giuliante, F., Cillo, U., Mazzaferro, V., De Carlis, L., Ercolani, G., Ettorre, G. M., di Benedetto, F., Valle, R. D., Gruttadauria, S., Jovine, E., Boggi, U., Vincenti, L., Santambrogio, R., Giuliani, A., Torzilli, G., Zimmiti, G., Brolese, A., Belli, A., Ravaioli, M., Frena, A., Rossi, G. E., Grazi, G. L., Zamboni, F., Berti, S., Calise, F., Massani, M., Morelli, L., Filauro, M., Tisone, G., Coratti, A., Navarra, G., Romito, R., Ceccarelli, G., Belli, G., Griseri, G., Antonucci, A., Mezzatesta, P., Veneroni, L., Schiavo, M., Colledan, M., Parisi, A., Guerriero, S., Spada, M., Batignani, G., Sgroi, G., Floridi, P., Boni, L., Maida, P., Ribero, D., La Barba, G., Cucchetti, A, Aldrighetti, L, Ratti, F, Ferrero, A, Guglielmi, A, Giuliante, F, Cillo, U, Mazzaferro, V, De Carlis, L, Ercolani, G, Ettorre, G, di Benedetto, F, Valle, R, Gruttadauria, S, Jovine, E, Boggi, U, Vincenti, L, Santambrogio, R, Giuliani, A, Torzilli, G, Zimmiti, G, Brolese, A, Belli, A, Ravaioli, M, Frena, A, Rossi, G, Grazi, G, Zamboni, F, Berti, S, Calise, F, Massani, M, Morelli, L, Filauro, M, Tisone, G, Coratti, A, Navarra, G, Romito, R, Ceccarelli, G, Belli, G, Griseri, G, Antonucci, A, Mezzatesta, P, Veneroni, L, Schiavo, M, Colledan, M, Parisi, A, Guerriero, S, Spada, M, Batignani, G, Sgroi, G, Floridi, P, Boni, L, Maida, P, Ribero, D, La Barba, G, Cucchetti, Alessandro, Aldrighetti, Luca, Ratti, Francesca, Ferrero, Alessandro, Guglielmi, Alfredo, Giuliante, Felice, Cillo, Umberto, Mazzaferro, Vincenzo, De Carlis, Luciano, and Ercolani, Giorgio
Subjects: Hepatology, mortality, morbidity, Liver Neoplasms, risk-adjustment, morbidity, laparoscopic liver resection, Length of Stay, mortality, Settore MED/18, Hepatectomy, Humans, Surgery, Laparoscopy, Prospective Studies, heterogeneity
Abstract: Background/Purpose: Quality measures in surgery are important to establish appropriate levels of care and to develop improvement strategies. The purpose of this study was to provide risk-adjusted outcome measures after laparoscopic liver resection (LLR). Methods: Data from a prospective, multicenter database involving 4318 patients submitted to LLRs in 41 hospitals from an intention-to-treat approach (2014–2020) were used to analyze heterogeneity (I2) among centers and to develop a risk-adjustment model on outcome measures through multivariable mixed-effect models to account for confounding due to case-mix. Results: Involved hospitals operated on very different patients: the largest heterogeneity was observed for operating in the presence of previous abdominal surgery (I2:79.1%), in cirrhotic patients (I2:89.3%) suffering from hepatocellular carcinoma (I2:88.6%) or requiring associated intestinal resections (I2:82.8%) and in regard to technical complexity (I2 for the most complex LLRs: 84.1%). These aspects determined substantial or large heterogeneity in overall morbidity (I2:84.9%), in prolonged in-hospital stay (I2:86.9%) and in conversion rate (I2:73.4%). Major complication had medium heterogeneity (I2:46.5%). The heterogeneity of mortality was null. Risk-adjustment accounted for all of this variability and the final risk-standardized conversion rate was 8.9%, overall morbidity was 22.1%, major morbidity was 5.1% and prolonged in-hospital stay was 26.0%. There were no outliers among the 41 participating centers. An online tool was provided. Conclusions: A benchmark for LLRs including all eligible patients was provided, suggesting that surgeons can act accordingly in the interest of the patient, modifying their approach in relation to different indications and different experience, but finally providing the same quality of care.
Published: 2022

3. Current practice of normothermic regional perfusion and machine perfusion in donation after circulatory death liver transplants in Italy

Author: De Carlis, R., Lauterio, A., Centonze, L., Buscemi, V., Schlegel, A., Muiesan, P., De Carlis, L., Carraro, A., Ghinolfi, D., De Simone, P., Ravaioli, M., Cescon, M., Dondossola, D., Bongini, M., Mazzaferro, V., Pagano, D., Gruttadauria, S., Gringeri, E., Cillo, U., Patrono, D., Romagnoli, R., Camagni, S., Colledan, M., Olivieri, T., Di Benedetto, F., Vennarecci, G., Baccarani, U., Lai, Q., Rossi, M., Manzia, T. M., Tisone, G., Vivarelli, M., Scalera, I., Lupo, L. G., Andorno, E., Meniconi, R. L., Ettorre, G. M., Avolio, A. W., Agnes, S., Pellegrino, R. A., Zamboni, F., De Carlis, R, Lauterio, A, Centonze, L, Buscemi, V, Schlegel, A, Muiesan, P, De Carlis, L, Carraro, A, Ghinolfi, D, De Simone, P, Ravaioli, M, Cescon, M, Dondossola, D, Bongini, M, Mazzaferro, V, Pagano, D, Gruttadauria, S, Gringeri, E, Cillo, U, Patrono, D, Romagnoli, R, Camagni, S, Colledan, M, Olivieri, T, Di Benedetto, F, Vennarecci, G, Baccarani, U, Lai, Q, Rossi, M, Manzia, T, Tisone, G, Vivarelli, M, Scalera, I, Lupo, L, Andorno, E, Meniconi, R, Ettorre, G, Avolio, A, Agnes, S, Pellegrino, R, and Zamboni, F
Subjects: Warm ischemia, Hypothermic oxygenated perfusion, Ischemic-type biliary lesions, Liver preservation, Liver utilization, Graft Survival, Organ Preservation, Ischemic-type biliary lesion, Tissue Donors, Settore MED/18, Liver Transplantation, Perfusion, Humans, Surgery
Abstract: Background: Normothermic regional perfusion (NRP) and machine perfusion (MP) are variously used in many European centers to improve the outcomes after liver transplantation from donation after circulatory death (DCD). In Italy, a combination of NRP and subsequent MP has been used since the start of the activity. While NRP is mandatory for every DCD recovery, the subsequent use of MP is left to each center. Methods: We have designed a national survey to investigate practices and policies of these techniques. The questionnaire included 46 questions and was distributed to all the 21 Italian centers using an online form between June and July 2021. Results: The overall response rate was 100%. A local NRP program for controlled Maastricht type 3 DCD was active in 11/21 (52.4%) centers. Organization and availability of personnel were perceived as the main difficulties in starting such a program. Between 2015 and 2020, 119 DCD livers were transplanted, with an overall utilization rate of 69.2%. Pump flow and gross aspect were considered the most reliable parameters in liver selection during NRP. Eight (72.7%) centers adopted subsequent hypothermic MP, 1 (9.1%) center normothermic MP, and the remaining 2 (18.2%) used both MP types. Conclusion: This first snapshot survey shows that NRP with subsequent MP is the most used protocol in Italy for DCD livers, although some heterogeneity exists in the type and purpose of MP between centers. Overall, this policy ensures a high utilization rate, considering the high risk of the DCD donor population in Italy. Graphical abstract: [Figure not available: see fulltext.]
Published: 2022

4. Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study

Author: Bracale, U., Podda, Maria Vittoria, Castiglioni, S., Peltrini, R., Sartori, Alessandra, Arezzo, A., Corcione, F., Agresta, F., Antonucci, A., Zanframundo, C., Cavallo, F., Mazzarolo, G., Agrusa, A., Di Buono, G., Aldrighetti, L., Fiorentini, G., Lucianetti, A., Magnone, S., Alfieri, Sergio, Rosa, Fausto, Altomare, D. F., Picciariello, A., Parisi, Carmelo Maria Antonio, Di Cintio, A., Amisano, M. F., Cravero, F., Ammendola, M., Ammerata, G., Anastasi, A., Canonico, G., Gattolin, A., Travaglio, E., De Palma, M., Angelini, P., Galante, F., Benevento, A., Rausei, S., Serao, A., Abbatini, F., Annecchiarico, M., Varricchio, A., Annessi, V., Tumiati, D., Annicchiarico, A., Mirabella, A., Marino, M. V., Spinelli, A., Braun, A., Santi, H. T., Romano, L., Antoniutti, M., Armellino, M. F., Argenio, G., Verzelli, A., Budassi, A., Baiocchi, G., Alfano, M. S., Balani, A., Barone, M., Baldazzi, G., Cassini, D., Canger, R. C. B., Zabbialini, G., Belli, Andrea, Izzo, Filippo, Bertolino, F., Brunetti, Maria Mercede, Bianco, Flaviana, Cappiello, A., Boccia, L., Boffi, B., Perna, Francesco, Bonilauri, S., Frazzetta, G., Bordoni, P., Fleres, F., Borghi, F., Giraudo, G., Bottino, V., Canfora, A., Piccoli, F. B., Calligaris, L., Nipote, B., Nasti, A. G., Bufalari, A., Bettarini, F., Buononato, M., Greco, M., Calo, P. G., Medas, F., Cardamone, E., Castaldo, P., Carlini, M., Spoletini, D., De Nisco, C., Pulighe, F., Feo, C. V., Fabbri, N., Antropoli, C., Foroni, F., Carnazza, M., Ragazzi, S., Cassinotti, E., Boni, L., Catena, F., Giuffrida, M., Perrone, Giuseppe, Ccotsoglou, C., Granieri, S., Ceccarelli, G., Bugiantella, W., Cedolini, C., Seriau, L., Cesari, Matteo, Contine, A., Chiara, Osvaldo, Cimbanassi, S., Cocozza, E., Berselli, M., Fantini, C., Costi, R., Casali, L., Morini, A., Crafa, F., Vanela, S., Curro, G., Orsini, V., Da Lio, C., Biral, Maria Francesca, Danelli, P., Guerci, C., Scala, D., Marino, Giuseppe, De Carlis, L., Lauterio, A., De Giorgi, D., Sciannamea, G., De Manzini, N., Losurdo, P., Sangiuliano, N., Degiuli, M., Caterina, F., Del Rio, P., Bonati, E., Di Lernia, S., Ardizzone, M. V. R., Di Saverio, S., Franchi, C., Di Venere, B., Miglio, R., Cuccurullo, D., Sagnelli, C., Docimo, L., Tolone, S., Longoni, M., Faillace, G., Rondelli, F., Pennella, F. P., Colucci, V., Carfora, T., Muttillo, I. A., Picardi, B., Stefano, R., Campagnacci, R., Maurizi, A., Tricarico, F., Montagna, M., Amedeo, E., Scollica, M. C., Lauro, E., Laterza, E., Molinari, E., Berta, G., Bono, D., Fabozzi, Simone Michele, Romano, M., Facci, E., Parini, D., Farfaglia, R., Arizzi, V., Farsi, M., Miranda, E., Fei, L., Flavio, G., Pirozzi, F., Sciuto, A., Ferrero, A., Palisi, M., Filauro, M., Barberis, A., Azzinnaro, A., Fiscon, V., Vigna, S., D'Ambra, M., Pontecorvi, E., Anania, G., Bombardini, C., Galizia, G., Auricchio, Anna Maria, Cardella, F., Genna, M., Gentilli, S., Herald, N., Castagnoli, G., Bartoli, A., Gianotti, L., Garancini, M., Bellanova, G., Palazzo, P., De Palma, G., Milone, Maria, Ferrari, G., Magistro, C., Giuliani, Antonio, Di Natale, Maria Grazia, Brisinda, Giuseppe, Cavallaro, G., Sammarco, G., Gallo, Giuseppe, Goletti, O., Macchini, D., Greco, Viviana, Amoroso, V., Guercioni, G., Benedetti, M., Guzzo, G., Pata, F., Scandroglio, I., Roscio, F., Jovine, E., Lombardi, Roberto, La Rocca, F., Di Capua, F., Lanci, C., Leli, R., Borasi, A., Lepiane, P., Balla, A., Liberatore, E., Morelli, L., Di Franco, G., Lucchi, A., Vittori, L., Bonavina, L., Asti, Emilio Fabrizio, Maggioni, D., Martino, G., Manca, Gavina, Delvecchio, A., Tedesco, M., Gambardella, D., Marafioti, S., De Marco, M. L., Guicciardi, M. A., Motta, M., Calgaro, M., Adamo, V., Guerrieri, Maria Chiara, Coletta, P., Ortenzi, M., Martines, G., Lantone, G., Martinotti, M., Fassardi, G., Castriconi, M., Squillante, S., De Luca, M., Pavanello, M., Di Marco, C., Ronconi, M., Casiraghi, Maria Stella, Mazzaferro, V., Battiston, C., Perrotta, M., Ripa, C., Giancarlo, M., Panizzo, V., Millo, P., Contul, R. B., Ferraro, V., Molino, C., Crolla, E., Moretto, G., Bacchion, M., Morino, M., Allaix, M. E., Motterlini, E., Petracca, Martina, Muratore, A., Musella, Martina, Vitiello, A., Nardo, B., Crocco, V., Navarra, G., Lazzara, S., Navarra, G. G., Cuoghi, M., Olmi, S., Oldani, Alberto, Uccelli, M., Opocher, E., Giovenzana, M., De Paolis, P., Santarelli, M., Delrio, P., Carbone, F., Bianchi, P. P. G., Formisano, Capelli, P., Baldini, E., Festa, P., Mottola, Armando, Merola, G., Perrotta, N., Celiento, M., Personnettaz, E., Muzio, S., Petitti, T., Melchiorre, A., Piccoli, M., Pecchini, F., Frontali, A., Maffioli, A., Maida, P., Tammaro, P., Pignata, G., Andreuccetti, J., Pilone, V., Renzulli, M., Pintaldi, S., Ceretti, A. P., Mariani, N. M., Pisanu, A., Polastri, R., Maiello, F., Porcu, A., Perra, T., Mucilli, F., Troisi, R., Montalti, R., Scognamillo, F., Delogu, D., Galleano, R., Malerba, M., Salfi, R., Pisano, M., Sechi, R., Cillara, N., Ramuscello, S., De Leo, E., Restini, E., Tumolo, R., Cianci, P., Capuzzolo, S., Rizzo, M., Recordare, A., Santoro, Roberto, Amodio, P. M., Rocca, A., Cecere, G., Romito, R., Portigliotti, L., Rosati, R., Elmore, U., Russello, D., Latteri, S., Costarella, S. M., Massa, S., Capasso, L., Santangelo, M., Sodo, M., Sarro, G., Rivolta, U., Scabini, S., Pertile, D., Selvaggi, F., Rossi, S., Pellino, G., Sganga, Gabriele, Fransvea, P., Testa, S., De Rosa, Maria Cristina, Siquini, W., Trana, C., Solej, M., Bolzon, S., Guerra, Eliana, Stella, M., Ferrara, F., Stipa, F., Stringhi, E., Celotti, A., Taglietti, L., Del Giudice, R., Talarico, C. A., Ruggiero, Miriam, Tirone, G., Romario, U. F., Petz, W., Caracino, V., Rossetti, V., Verza, L. A., Vescovi, L., Marini, M., Vettoretto, N., Botteri, E., Vincenti, L., Giannandrea, G., Viora, T., Maganuco, L., Veronesi, P., Zani, B., Zanus, G., Brizzolari, M., Zanzi, F., Guariniello, A., Zappa, M. A., Galfrascoli, E., Zonta, S., Oragano, L., Zuliani, W., Chiari, D., Bracale, Umberto, Podda, Mauro, Castiglioni, Simone, Peltrini, Roberto, Sartori, Alberto, Arezzo, Alberto, Corcione, Francesco, Agresta, Ferdinando, Rosati, Riccardo, Umberto, Bracale, Mauro, Podda, Simone, Castiglioni, Roberto, Peltrini, Alberto, Sartori, Alberto, Arezzo, Francesco, Corcione, Ferdinando, Agresta, CLOUD-19 Collaborative Group Adelmo Antonucci, Claudia, Zanframundo, Fabio, Cavallo, Giorgio, Mazzarolo, Antonio, Agrusa, Giuseppe Di Buono, Luca, Aldrighetti, Guido, Fiorentini, Alessandro, Lucianetti, Stefano, Magnone, Sergio, Alfieri, Fausto, Rosa, Altomare, Donato F., Arcangelo, Picciariello, Amilcare, Parisi, Antonio Di Cintio, Marco Francesco Amisano, Francesca, Cravero, Michele, Ammendola, Giorgio, Ammerata, Alessandro, Anastasi, Giuseppe, Canonico, Andra, Gattolin, Elisabetta, Travaglio, Andrea, Sartori, Massimiliano De Palma, Pierluigi, Angelini, Francesco, Galante, Angelo, Benevento, Stefano, Rausei, Angelo, Serao, Francesca, Abbatini, Mario, Annecchiarico, Antonio, Varricchio, Valerio, Annessi, David, Tumiati, Alfredo, Annicchiarico, Antonello, Mirabella, Marino, Marco V., Antonino, Spinelli, Antonio, Braun, Hong Tham Santi, Lucia, Romano, Michele, Antoniutti, Mariano Fortunato Armellino, Giulio, Argenio, Augusto, Verzelli, Andrea, Budassi, Gianluca, Baiocchi, Marie Sophie Alfano, Alessandro, Balani, Marco, Barone, Gianandrea, Baldazzi, Diletta, Cassini, Ruben Carlo Balzarotti Canger, Gianpietro, Zabbialini, Andrea, Belli, Francesco, Izzo, Franco, Bertolino, Marco, Brunetti, Francesco, Bianco, Antonio, Cappiello, Luigi, Boccia, Bernardo, Boffi, Federico, Perna, Stefano, Bonilauri, Giuseppe, Frazzetta, Pierpaolo, Bordoni, Francesco, Flere, Felice, Borghi, Giorgio, Giraudo, Vincenzo, Bottino, Alfonso, Canfora, Fabrizio Briganti Piccoli, Luca, Calligari, Bruno, Nipote, Aniello Gennaro Nasti, Andrea, Bufalari, Francesca, Bettarini, Massimo, Buononato, Marco, Greco, Pietro Giorgio Calò, Fabio, Meda, Eugenia, Cardamone, Pasquale, Castaldo, Massimo, Carlini, Domenico, Spoletini, Carlo De Nisco, Fabio, Pulighe, Feo, Carlo V., Nicolò, Fabbri, Carmine, Antropoli, Fabrizio, Foroni, Maurizio, Carnazza, Salvatore, Ragazzi, Elisa, Cassinotti, Luigi, Boni, Fausto, Catena, Mario, Giuffrida, Gennaro, Perrone, Christian, Ccotsoglou, Stefano, Granieri, Graziano, Ceccarelli, Walter, Bugiantella, Carla, Cedolini, Luca, Seriau, Maurizio, Cesari, Alessandro, Contine, Osvaldo, Chiara, Stefania, Cimbanassi, Eugenio, Cocozza, Mattia, Berselli, Corrado, Fantini, Renato, Costi, Lorenzo, Casali, Andrea, Morini, Francesco, Crafa, Serafino, Vanela, Giuseppe, Currò, Vincenzo, Orsini, Corrado Da Lio, Mario, Biral, Piergiorgio, Danelli, Claudio, Guerci, Dario, Scala, Graziella, Marino, Luciano De Carlis, Andrea, Lauterio, Donato De Giorgi, Gianluca, Sciannamea, Nicolo De Manzini, Pasquale, Losurdo, Maurizio De Palma, Nicola, Sangiuliano, Maurizio, Degiuli, Franco, Caterina, Paolo Del Rio, Elena, Bonati, Stefano Di Lernia, Marco Vittorio Rossi Ardizzone, Salomone Di Saverio, Caterina, Franchi, Beatrice Di Venere, Rosanna, Miglio, Diego, Cuccurullo, Carlo, Sagnelli, Docimo, Ludovico, Tolone, Salvatore, Mauro, Longoni, Giuseppe, Faillace, Fabio, Rondelli, Francesca Pennetti Pennella, Vincenzo, Colucci, Teresa, Carfora, Irnerio Angelo Muttillo, Biagio, Picardi, Rossi, Stefano, Roberto, Campagnacci, Angela, Maurizi, Fausto, Tricarico, Marco, Montagna, Elio, Amedeo, Scollica, Michela C., Enrico, Lauro, Ernesto, Laterza, Enrico, Molinari, Berta, G., Dario, Bono, Massimiliano, Fabozzi, Mafalda, Romano, Enzo, Facci, Dario, Parini, Roberto, Farfaglia, Valeria, Arizzi, Marco, Farsi, Egidio, Miranda, Fei, Landino, Giordano, Flavio, Felice, Pirozzi, Antonio, Sciuto, Alessandro, Ferrero, Marco, Palisi, Marco, Filauro, Andrea, Barberi, Antonio, Azzinnaro, Valentino, Fiscon, Silvia, Vigna, Michele, D’Ambra, Emanuele, Pontecorvi, Gabriele, Anania, Cristina, Bombardini, Galizia, Gennaro, Auricchio, Annamaria, Cardella, Francesca, Michele, Genna, Sergio, Gentilli, Nikaj, Herald, Giampaolo, Castagnoli, Alberto, Bartoli, Luca, Gianotti, Mattia, Garancini, Giovanni, Bellanova, Paola, Palazzo, Giovanni De Palma, Marco, Milone, Giovanni, Ferrari, Carmelo, Magistro, Antonio, Giuliani, Giuseppe Di Natale, Giuseppe, Brisinda, Giuseppe, Cavallaro, Giuseppe, Sammarco, Gaetano, Gallo, Orlando, Goletti, Daniele, Macchini, Vincenzo, Greco, Vincenzo, Amoroso, Gianluca, Guercioni, Michele, Benedetti, Guglielmo, Guzzo, Francesco, Pata, Ildo, Scandroglio, Francesco, Roscio, Elio, Jovine, Raffaele, Lombardi, Francesco La Rocca, Francesca Di Capua, Carmine, Lanci, Renzo, Leli, Andrea, Borasi, Pasquale, Lepiane, Andrea, Balla, Edoardo, Liberatore, Luca, Morelli, Gregorio Di Franco, Andrea, Lucchi, Laura, Vittori, Luigi, Bonavina, Emanuele, Asti, Dario, Maggioni, Gerosa, Martino, Giuseppe, Manca, Antonella, Delvecchio, Manfredo, Tedesco, Denise, Gambardella, Salvatore, Marafioti, Maria Luisa De Marco, Marco Azzola Guicciardi, Massimo, Motta, Marco, Calgaro, Vincenzo, Adamo, Mario, Guerrieri, Pietro, Coletta, Monica, Ortenzi, Gennaro, Martine, Giuliano, Lantone, Mario, Martinotti, Giuseppe, Fassardi, Maurizio, Castriconi, Simone, Squillante, Maurizio De Luca, Maurizio, Pavanello, Carlo Di Marco, Maurizio, Ronconi, Silvia, Casiraghi, Vincenzo, Mazzaferro, Carlo, Battiston, Michele, Perrotta, Carmine, Ripa, Micheletto, Giancarlo, Valerio, Panizzo, Paolo, Millo, Riccardo Brachet Contul, Valentina, Ferraro, Carlo, Molino, Enrico, Crolla, Gianluigi, Moretto, Matilde, Bacchion, Mario, Morino, Marco Ettore Allaix, Enrico, Motterlini, Michele, Petracca, Andrea, Muratore, Mario, Musella, Antonio, Vitiello, Bruno, Nardo, Veronica, Crocco, Giuseppe, Navarra, Salvatore, Lazzara, Giuseppe Giovanni Navarra, Manuela, Cuoghi, Stefano, Olmi, Alberto, Oldani, Matteo, Uccelli, Enrico, Opocher, Marco, Giovenzana, Paolo De Paolis, Mauro, Santarelli, Paolo, Delrio, Fabio, Carbone, Paolo Pietro Giampaolo Bianchi, Formisano, Patrizio, Capelli, Edoardo, Baldini, Patrizio, Festa, Arianna, Mottola, Giovanni, Merola, Nicola, Perrotta, Marta, Celiento, Eraldo, Personnettaz, Stefania, Muzio, Tommaso, Petitti, Antonietta, Melchiorre, Micaela, Piccoli, Francesca, Pecchini, Alice, Frontali, Anna, Maffioli, Pietro, Maida, Pasquale, Tammaro, Giusto, Pignata, Jacopo, Andreuccetti, Vincenzo, Pilone, Michele, Renzulli, Salvatore, Pintaldi, Andrea Pisani Ceretti, Nicolò Maria Mariani, Adolfo, Pisanu, Roberto, Polastri, Fabio, Maiello, Alberto, Porcu, Teresa, Perra, Felice, Mucilli, Mirko, Barone, Roberto, Troisi, Roberto, Montalti, Fabrizio, Scognamillo, Daniele, Delogu, Raffaele, Galleano, Michele, Malerba, Raffaele, Salfi, Marcello, Pisano, Raffaele, Sechi, Nicola, Cillara, Salvatore, Ramuscello, Eugenio De Leo, Enrico, Restini, Rocco, Tumolo, Pasquale, Cianci, Sabino, Capuzzolo, Maurizio, Rizzo, Alfonso, Recordare, Roberto, Santoro, Pietro Maria Amodio, Aldo, Rocca, Giuseppe, Cecere, Raffaele, Romito, Luca, Portigliotti, Riccardo, Rosati, Ugo, Elmore, Domenico, Russello, Saverio, Latteri, Salvatore Maria Costarella, Salvatore, Massa, Lorenzo, Capasso, Michele, Santangelo, Maurizio, Sodo, Giuliano, Sarro, Umberto, Rivolta, Stefano, Scabini, Davide, Pertile, Federico, Selvaggi, Selene, Rossi, Selvaggi, Francesco, Pellino, Gianluca, Gabriele, Sganga, Pietro, Fransvea, Silvio, Testa, Clemente De Rosa, Walter, Siquini, Cristian, Tranà, Mario, Solej, Stefano, Bolzon, Enrico, Guerra, Marco, Stella, Francesco, Ferrara, Francesco, Stipa, Enrico, Stringhi, Andrea, Celotti, Lucio, Taglietti, Roberto Del Giudice, Carlo Alessandro Talarico, Michele, Ruggiero, Giuseppe, Tirone, Uberto Fumagalli Romario, Wanda, Petz, Valerio, Caracino, Valentina, Rossetti, Luca Andrea Verza, Lorenzo, Vescovi, Michele, Marini, Nereo, Vettoretto, Emanuele, Botteri, Leonardo, Vincenti, Giusy, Giannandrea, Tiziana, Viora, Lorenzo, Maganuco, Paolo, Veronesi, Bruno, Zani, Giacomo, Zanu, Marco, Brizzolari, Federico, Zanzi, Anna, Guariniello, Marco Antonio Zappa, Elisa, Galfrascoli, Sandro, Zonta, Luigi, Oragano, Walter Zuliani &amp, Damiano, Chiari, de Manzini, Nicolo', Agresta, Ferdinando, Agrusa, Antonino, Di Buono, Giuseppe, Bracale, U., Podda, M., Castiglioni, S., Peltrini, R., Sartori, A., Arezzo, A., Corcione, F., Agresta, F., Antonucci, A., Zanframundo, C., Cavallo, F., Mazzarolo, G., Agrusa, A., Di Buono, G., Aldrighetti, L., Fiorentini, G., Lucianetti, A., Magnone, S., Alfieri, S., Rosa, F., Altomare, D. F., Picciariello, A., Parisi, A., Di Cintio, A., Amisano, M. F., Cravero, F., Ammendola, M., Ammerata, G., Anastasi, A., Canonico, G., Gattolin, A., Travaglio, E., De Palma, M., Angelini, P., Galante, F., Benevento, A., Rausei, S., Serao, A., Abbatini, F., Annecchiarico, M., Varricchio, A., Annessi, V., Tumiati, D., Annicchiarico, A., Mirabella, A., Marino, M. V., Spinelli, A., Braun, A., Santi, H. T., Romano, L., Antoniutti, M., Armellino, M. F., Argenio, G., Verzelli, A., Budassi, A., Baiocchi, G., Alfano, M. S., Balani, A., Barone, M., Baldazzi, G., Cassini, D., Canger, R. C. B., Zabbialini, G., Belli, A., Izzo, F., Bertolino, F., Brunetti, M., Bianco, F., Cappiello, A., Boccia, L., Boffi, B., Perna, F., Bonilauri, S., Frazzetta, G., Bordoni, P., Fleres, F., Borghi, F., Giraudo, G., Bottino, V., Canfora, A., Piccoli, F. B., Calligaris, L., Nipote, B., Nasti, A. G., Bufalari, A., Bettarini, F., Buononato, M., Greco, M., Calo, P. G., Medas, F., Cardamone, E., Castaldo, P., Carlini, M., Spoletini, D., De Nisco, C., Pulighe, F., Feo, C. V., Fabbri, N., Antropoli, C., Foroni, F., Carnazza, M., Ragazzi, S., Cassinotti, E., Boni, L., Catena, F., Giuffrida, M., Perrone, G., Ccotsoglou, C., Granieri, S., Ceccarelli, G., Bugiantella, W., Cedolini, C., Seriau, L., Cesari, M., Contine, A., Chiara, O., Cimbanassi, S., Cocozza, E., Berselli, M., Fantini, C., Costi, R., Casali, L., Morini, A., Crafa, F., Vanela, S., Curro, G., Orsini, V., Da Lio, C., Biral, M., Danelli, P., Guerci, C., Scala, D., Marino, G., De Carlis, L., Lauterio, A., De Giorgi, D., Sciannamea, G., De Manzini, N., Losurdo, P., Sangiuliano, N., Degiuli, M., Caterina, F., Del Rio, P., Bonati, E., Di Lernia, S., Ardizzone, M. V. R., Di Saverio, S., Franchi, C., Di Venere, B., Miglio, R., Cuccurullo, D., Sagnelli, C., Docimo, L., Tolone, S., Longoni, M., Faillace, G., Rondelli, F., Pennella, F. P., Colucci, V., Carfora, T., Muttillo, I. A., Picardi, B., Stefano, R., Campagnacci, R., Maurizi, A., Tricarico, F., Montagna, M., Amedeo, E., Scollica, M. C., Lauro, E., Laterza, E., Molinari, E., Bono, D., Fabozzi, M., Romano, M., Facci, E., Parini, D., Farfaglia, R., Arizzi, V., Farsi, M., Miranda, E., Fei, L., Flavio, G., Pirozzi, F., Sciuto, A., Ferrero, A., Palisi, M., Filauro, M., Barberis, A., Azzinnaro, A., Fiscon, V., Vigna, S., D'Ambra, M., Pontecorvi, E., Anania, G., Bombardini, C., Galizia, G., Auricchio, A., Cardella, F., Genna, M., Gentilli, S., Herald, N., Castagnoli, G., Bartoli, A., Gianotti, L., Garancini, M., Bellanova, G., Palazzo, P., De Palma, G., Milone, M., Ferrari, G., Magistro, C., Giuliani, A., Di Natale, G., Brisinda, G., Cavallaro, G., Sammarco, G., Gallo, G., Goletti, O., Macchini, D., Greco, V., Amoroso, V., Guercioni, G., Benedetti, M., Guzzo, G., Pata, F., Scandroglio, I., Roscio, F., Jovine, E., Lombardi, R., La Rocca, F., Di Capua, F., Lanci, C., Leli, R., Borasi, A., Lepiane, P., Balla, A., Liberatore, E., Morelli, L., Di Franco, G., Lucchi, A., Vittori, L., Bonavina, L., Asti, E., Maggioni, D., Martino, G., Manca, G., Delvecchio, A., Tedesco, M., Gambardella, D., Marafioti, S., De Marco, M. L., Guicciardi, M. A., Motta, M., Calgaro, M., Adamo, V., Guerrieri, M., Coletta, P., Ortenzi, M., Martines, G., Lantone, G., Martinotti, M., Fassardi, G., Castriconi, M., Squillante, S., De Luca, M., Pavanello, M., Di Marco, C., Ronconi, M., Casiraghi, S., Mazzaferro, V., Battiston, C., Perrotta, M., Ripa, C., Giancarlo, M., Panizzo, V., Millo, P., Contul, R. B., Ferraro, V., Molino, C., Crolla, E., Moretto, G., Bacchion, M., Morino, M., Allaix, M. E., Motterlini, E., Petracca, M., Muratore, A., Musella, M., Vitiello, A., Nardo, B., Crocco, V., Navarra, G., Lazzara, S., Navarra, G. G., Cuoghi, M., Olmi, S., Oldani, A., Uccelli, M., Opocher, E., Giovenzana, M., De Paolis, P., Santarelli, M., Delrio, P., Carbone, F., Bianchi, P. P. G., Capelli, P., Baldini, E., Festa, P., Mottola, A., Merola, G., Perrotta, N., Celiento, M., Personnettaz, E., Muzio, S., Petitti, T., Melchiorre, A., Piccoli, M., Pecchini, F., Frontali, A., Maffioli, A., Maida, P., Tammaro, P., Pignata, G., Andreuccetti, J., Pilone, V., Renzulli, M., Pintaldi, S., Ceretti, A. P., Mariani, N. M., Pisanu, A., Polastri, R., Maiello, F., Porcu, A., Perra, T., Mucilli, F., Troisi, R., Montalti, R., Scognamillo, F., Delogu, D., Galleano, R., Malerba, M., Salfi, R., Pisano, M., Sechi, R., Cillara, N., Ramuscello, S., De Leo, E., Restini, E., Tumolo, R., Cianci, P., Capuzzolo, S., Rizzo, M., Recordare, A., Santoro, R., Amodio, P. M., Rocca, A., Cecere, G., Romito, R., Portigliotti, L., Rosati, R., Elmore, U., Russello, D., Latteri, S., Costarella, S. M., Massa, S., Capasso, L., Santangelo, M., Sodo, M., Sarro, G., Rivolta, U., Scabini, S., Pertile, D., Selvaggi, F., Rossi, S., Pellino, G., Sganga, G., Fransvea, P., Testa, S., De Rosa, C., Siquini, W., Trana, C., Solej, M., Bolzon, S., Guerra, E., Stella, M., Ferrara, F., Stipa, F., Stringhi, E., Celotti, A., Taglietti, L., Del Giudice, R., Talarico, C. A., Ruggiero, M., Tirone, G., Romario, U. F., Petz, W., Caracino, V., Rossetti, V., Verza, L. A., Vescovi, L., Marini, M., Vettoretto, N., Botteri, E., Vincenti, L., Giannandrea, G., Viora, T., Maganuco, L., Veronesi, P., Zani, B., Zanus, G., Brizzolari, M., Zanzi, F., Guariniello, A., Zappa, M. A., Galfrascoli, E., Zonta, S., Oragano, L., Zuliani, W., Chiari, D., Bracale, U, Podda, M, Castiglioni, S, Peltrini, R, Sartori, A, Arezzo, A, Corcione, F, Agresta, F, Antonucci, A, Zanframundo, C, Cavallo, F, Mazzarolo, G, Agrusa, A, Di Buono, G, Aldrighetti, L, Fiorentini, G, Lucianetti, A, Magnone, S, Alfieri, S, Rosa, F, Altomare, D, Picciariello, A, Parisi, A, Di Cintio, A, Amisano, M, Cravero, F, Ammendola, M, Ammerata, G, Anastasi, A, Canonico, G, Gattolin, A, Travaglio, E, De Palma, M, Angelini, P, Galante, F, Benevento, A, Rausei, S, Serao, A, Abbatini, F, Annecchiarico, M, Varricchio, A, Annessi, V, Tumiati, D, Annicchiarico, A, Mirabella, A, Marino, M, Spinelli, A, Braun, A, Santi, H, Romano, L, Antoniutti, M, Armellino, M, Argenio, G, Verzelli, A, Budassi, A, Baiocchi, G, Alfano, M, Balani, A, Barone, M, Baldazzi, G, Cassini, D, Canger, R, Zabbialini, G, Belli, A, Izzo, F, Bertolino, F, Brunetti, M, Bianco, F, Cappiello, A, Boccia, L, Boffi, B, Perna, F, Bonilauri, S, Frazzetta, G, Bordoni, P, Fleres, F, Borghi, F, Giraudo, G, Bottino, V, Canfora, A, Piccoli, F, Calligaris, L, Nipote, B, Nasti, A, Bufalari, A, Bettarini, F, Buononato, M, Greco, M, Calo, P, Medas, F, Cardamone, E, Castaldo, P, Carlini, M, Spoletini, D, De Nisco, C, Pulighe, F, Feo, C, Fabbri, N, Antropoli, C, Foroni, F, Carnazza, M, Ragazzi, S, Cassinotti, E, Boni, L, Catena, F, Giuffrida, M, Perrone, G, Ccotsoglou, C, Granieri, S, Ceccarelli, G, Bugiantella, W, Cedolini, C, Seriau, L, Cesari, M, Contine, A, Chiara, O, Cimbanassi, S, Cocozza, E, Berselli, M, Fantini, C, Costi, R, Casali, L, Morini, A, Crafa, F, Vanela, S, Curro, G, Orsini, V, Da Lio, C, Biral, M, Danelli, P, Guerci, C, Scala, D, Marino, G, De Carlis, L, Lauterio, A, De Giorgi, D, Sciannamea, G, De Manzini, N, Losurdo, P, Sangiuliano, N, Degiuli, M, Caterina, F, Del Rio, P, Bonati, E, Di Lernia, S, Ardizzone, M, Di Saverio, S, Franchi, C, Di Venere, B, Miglio, R, Cuccurullo, D, Sagnelli, C, Docimo, L, Tolone, S, Longoni, M, Faillace, G, Rondelli, F, Pennella, F, Colucci, V, Carfora, T, Muttillo, I, Picardi, B, Stefano, R, Campagnacci, R, Maurizi, A, Tricarico, F, Montagna, M, Amedeo, E, Scollica, M, Lauro, E, Laterza, E, Molinari, E, Berta, G, Bono, D, Fabozzi, M, Romano, M, Facci, E, Parini, D, Farfaglia, R, Arizzi, V, Farsi, M, Miranda, E, Fei, L, Flavio, G, Pirozzi, F, Sciuto, A, Ferrero, A, Palisi, M, Filauro, M, Barberis, A, Azzinnaro, A, Fiscon, V, Vigna, S, D'Ambra, M, Pontecorvi, E, Anania, G, Bombardini, C, Galizia, G, Auricchio, A, Cardella, F, Genna, M, Gentilli, S, Herald, N, Castagnoli, G, Bartoli, A, Gianotti, L, Garancini, M, Bellanova, G, Palazzo, P, De Palma, G, Milone, M, Ferrari, G, Magistro, C, Giuliani, A, Di Natale, G, Brisinda, G, Cavallaro, G, Sammarco, G, Gallo, G, Goletti, O, Macchini, D, Greco, V, Amoroso, V, Guercioni, G, Benedetti, M, Guzzo, G, Pata, F, Scandroglio, I, Roscio, F, Jovine, E, Lombardi, R, La Rocca, F, Di Capua, F, Lanci, C, Leli, R, Borasi, A, Lepiane, P, Balla, A, Liberatore, E, Morelli, L, Di Franco, G, Lucchi, A, Vittori, L, Bonavina, L, Asti, E, Maggioni, D, Martino, G, Manca, G, Delvecchio, A, Tedesco, M, Gambardella, D, Marafioti, S, De Marco, M, Guicciardi, M, Motta, M, Calgaro, M, Adamo, V, Guerrieri, M, Coletta, P, Ortenzi, M, Martines, G, Lantone, G, Martinotti, M, Fassardi, G, Castriconi, M, Squillante, S, De Luca, M, Pavanello, M, Di Marco, C, Ronconi, M, Casiraghi, S, Mazzaferro, V, Battiston, C, Perrotta, M, Ripa, C, Giancarlo, M, Panizzo, V, Millo, P, Contul, R, Ferraro, V, Molino, C, Crolla, E, Moretto, G, Bacchion, M, Morino, M, Allaix, M, Motterlini, E, Petracca, M, Muratore, A, Musella, M, Vitiello, A, Nardo, B, Crocco, V, Navarra, G, Lazzara, S, Cuoghi, M, Olmi, S, Oldani, A, Uccelli, M, Opocher, E, Giovenzana, M, De Paolis, P, Santarelli, M, Delrio, P, Carbone, F, Bianchi, P, Capelli, P, Baldini, E, Festa, P, Mottola, A, Merola, G, Perrotta, N, Celiento, M, Personnettaz, E, Muzio, S, Petitti, T, Melchiorre, A, Piccoli, M, Pecchini, F, Frontali, A, Maffioli, A, Maida, P, Tammaro, P, Pignata, G, Andreuccetti, J, Pilone, V, Renzulli, M, Pintaldi, S, Ceretti, A, Mariani, N, Pisanu, A, Polastri, R, Maiello, F, Porcu, A, Perra, T, Mucilli, F, Troisi, R, Montalti, R, Scognamillo, F, Delogu, D, Galleano, R, Malerba, M, Salfi, R, Pisano, M, Sechi, R, Cillara, N, Ramuscello, S, De Leo, E, Restini, E, Tumolo, R, Cianci, P, Capuzzolo, S, Rizzo, M, Recordare, A, Santoro, R, Amodio, P, Rocca, A, Cecere, G, Romito, R, Portigliotti, L, Rosati, R, Elmore, U, Russello, D, Latteri, S, Costarella, S, Massa, S, Capasso, L, Santangelo, M, Sodo, M, Sarro, G, Rivolta, U, Scabini, S, Pertile, D, Selvaggi, F, Rossi, S, Pellino, G, Sganga, G, Fransvea, P, Testa, S, De Rosa, C, Siquini, W, Trana, C, Solej, M, Bolzon, S, Guerra, E, Stella, M, Ferrara, F, Stipa, F, Stringhi, E, Celotti, A, Taglietti, L, Del Giudice, R, Talarico, C, Ruggiero, M, Tirone, G, Romario, U, Petz, W, Caracino, V, Rossetti, V, Verza, L, Vescovi, L, Marini, M, Vettoretto, N, Botteri, E, Vincenti, L, Giannandrea, G, Viora, T, Maganuco, L, Veronesi, P, Zani, B, Zanus, G, Brizzolari, M, Zanzi, F, Guariniello, A, Zappa, M, Galfrascoli, E, Zonta, S, Oragano, L, Zuliani, W, and Chiari, D
Subjects: Laparoscopic surgery, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, laparoscopy, COVID-19, Elective surgery, Emergency surgery, Survey, Oral Health, cross infection (MeSH), Surveys and Questionnaires, Epidemiology, Pandemic, Infection control, Practice Patterns, Physicians', emergency surgery, Laparoscopy, humans, medicine.diagnostic_test, General Commentary, laparoscopic surgery, infection control, Italy, physicians', Original Article, Elective Surgical Procedure, Human, heating ventilation air conditioning, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), fallow period, elective surgical procedures, pandemics, NO, aerosol generating procedures, elective surgery, survey, practice patterns, physicians', SARS-CoV-2, surveys and questionnaires, medicine, Infection Control, business.industry, General surgery, practice patterns, Surgery, business
Abstract: Background The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic. Methods The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March–May 2020), II (June–September 2020), and III (October–December 2020). Results Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (> 200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency ( Conclusion This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic.
Published: 2021

5. Technical feasibility and short-term outcomes of laparoscopic isolated caudate lobe resection: an IgoMILS (Italian Group of Minimally Invasive Liver Surgery) registry-based study

Author: Ruzzenente A., Ciangherotti A., Aldrighetti L., Ettorre G. M., De Carlis L., Ferrero A., Dalla Valle R., Tisone G., Guglielmi A., Ratti F., Gringeri E., Russolillo N., Campagnaro T., Conci S., Sandri G. B. L., Ardito F., Boggi U., Gruttadauria S., Vigano L., Di Benedetto F., Rossi G. E., Berti S., Ceccarelli G., Vincenti L., Cillo U., Giuliante F., Mazzaferro V., Jovine E., Calise F., Belli G., Zamboni F., Coratti A., Mezzatesta P., Santambrogio R., Navarra G., Giuliani A., Ferla F., Pinna A. D., Parisi A., Colledan M., Slim A., Antonucci A., Grazi G. L., Frena A., Sgroi G., Brolese A., Morelli L., Floridi A., Patriti A., Veneroni L., Boni L., Maida P., Griseri G., Filauro M., Guerriero S., Romito R., Tedeschi U., Zimmitti G., Ruzzenente, A., Ciangherotti, A., Aldrighetti, L., Ettorre, G. M., De Carlis, L., Ferrero, A., Dalla Valle, R., Tisone, G., Guglielmi, A., Ratti, F., Gringeri, E., Russolillo, N., Campagnaro, T., Conci, S., Sandri, G. B. L., Ardito, F., Boggi, U., Gruttadauria, S., Vigano, L., Di Benedetto, F., Rossi, G. E., Berti, S., Ceccarelli, G., Vincenti, L., Cillo, U., Giuliante, F., Mazzaferro, V., Jovine, E., Calise, F., Belli, G., Zamboni, F., Coratti, A., Mezzatesta, P., Santambrogio, R., Navarra, G., Giuliani, A., Ferla, F., Pinna, A. D., Parisi, A., Colledan, M., Slim, A., Antonucci, A., Grazi, G. L., Frena, A., Sgroi, G., Brolese, A., Morelli, L., Floridi, A., Patriti, A., Veneroni, L., Boni, L., Maida, P., Griseri, G., Filauro, M., Guerriero, S., Romito, R., Tedeschi, U., Zimmitti, G., Ruzzenente, A, Ciangherotti, A, Aldrighetti, L, Ettorre, G, De Carlis, L, Ferrero, A, Dalla Valle, R, Tisone, G, Guglielmi, A, Ratti, F, Gringeri, E, Russolillo, N, Campagnaro, T, Conci, S, Sandri, G, Ardito, F, Boggi, U, Gruttadauria, S, Vigano, L, Di Benedetto, F, Rossi, G, Berti, S, Ceccarelli, G, Vincenti, L, Cillo, U, Giuliante, F, Mazzaferro, V, Jovine, E, Calise, F, Belli, G, Zamboni, F, Coratti, A, Mezzatesta, P, Santambrogio, R, Navarra, G, Giuliani, A, Ferla, F, Pinna, A, Parisi, A, Colledan, M, Slim, A, Antonucci, A, Grazi, G, Frena, A, Sgroi, G, Brolese, A, Morelli, L, Floridi, A, Patriti, A, Veneroni, L, Boni, L, Maida, P, Griseri, G, Filauro, M, Guerriero, S, Romito, R, Tedeschi, U, and Zimmitti, G
Subjects: medicine.medical_specialty, Carcinoma, Hepatocellular, Settore MED/18 - CHIRURGIA GENERALE, Article, NO, Cohort Studies, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Postoperative Complications, Caudate lobe, Open Resection, Internal medicine, medicine, Hepatectomy, Humans, Multi-institutional, Prospective Studies, Registries, Propensity Score, Contraindication, Retrospective Studies, LS7_4, Intrahepatic, business.industry, Carcinoma, Liver Neoplasms, Minimally invasive liver surgery, Hepatocellular, Perioperative, Hepatology, Length of Stay, medicine.disease, Surgery, Settore MED/18, Bile Ducts, Intrahepatic, Bile Duct Neoplasms, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Propensity score matching, Feasibility Studies, 030211 gastroenterology & hepatology, Laparoscopy, Bile Ducts, business, Propensity score matched, Abdominal surgery
Abstract: Background Although isolated caudate lobe (CL) liver resection is not a contraindication for minimally invasive liver surgery (MILS), feasibility and safety of the procedure are still poorly investigated. To address this gap, we evaluate data on the Italian prospective maintained database on laparoscopic liver surgery (IgoMILS) and compare outcomes between MILS and open group. Methods Perioperative data of patients with malignancies, as colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), non-colorectal liver metastases (NCRLM) and benign liver disease, were retrospectively analyzed. A propensity score matching (PSM) analysis was performed to balance the potential selection bias for MILS and open group. Results A total of 224 patients were included in the study, 47 and 177 patients underwent MILS and open isolated CL resection, respectively. The overall complication rate was comparable between the two groups; however, severe complication rate (Dindo–Clavien grade ≥ 3) was lower in the MILS group (0% versus 6.8%, P = ns). In-hospital mortality was 0% in both groups and mean hospital stay was significantly shorter in the MILS group (P = 0.01). After selection of 42 MILS and 43 open CL resections by PSM analysis, intraoperative and postoperative outcomes remained similar except for the hospital stay which was not significantly shorter in MILS group. Conclusions This multi-institutional cohort study shows that MILS CL resection is feasible and safe. The surgical procedure can be technically demanding compared to open resection, whereas good perioperative outcomes can be achieved in highly selected patients.
Published: 2021

6. Is minimally invasive liver surgery a reasonable option in recurrent HCC? A snapshot from the I Go MILS registry

Author: Levi Sandri, G. B., Colasanti, M., Aldrighetti, L., Guglielmi, A., Cillo, U., Mazzaferro, V., Dalla Valle, R., De Carlis, L., Salvatore, G., Di Benedetto, F., Ferrero, A., Ettorre, G. M., Antonucci, A., Batignani, G., Belli, G., Belli, A., Berti, S., Boggi, U., Bonsignore, P., Brolese, A., Calise, F., Ceccarelli, G., Cecconi, S., Colledan, M., Coratti, A., Ercolani, G., Ferla, F., Filauro, M., Floridi, A., Frena, A., Giuliani, A., Giuliante, F., Grazi, G. L., Gringeri, E., Griseri, G., Guerriero, S., Jovine, E., Magistri, P., Maida, P., Massani, M., Mezzatesta, P., Morelli, L., Russolillo, N., Navarra, G., Parisi, A., Patriti, A., Ravaioli, M., Ratti, F., Romito, R., Reggiani, P., Ruzzenente, A., Santambrogio, R., Berardi, G., Sgroi, G., Slim, A., Spada, M., Sposito, C., Tedeschi, U., Tisone, G., Torzilli, G., Veneroni, L., Vincenti, L., Zamboni, F., Zimmitti, G., Levi Sandri G.B., Colasanti M., Aldrighetti L., Guglielmi A., Cillo U., Mazzaferro V., Dalla Valle R., De Carlis L., Salvatore G., Di Benedetto F., Ferrero A., Ettorre G.M., Antonucci A., Batignani G., Belli G., Belli A., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Cecconi S., Colledan M., Coratti A., Ercolani G., Ferla F., Filauro M., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G.L., Gringeri E., Griseri G., Guerriero S., Jovine E., Magistri P., Maida P., Massani M., Mezzatesta P., Morelli L., Russolillo N., Navarra G., Parisi A., Patriti A., Ravaioli M., Ratti F., Romito R., Reggiani P., Ruzzenente A., Santambrogio R., Berardi G., Sgroi G., Slim A., Spada M., Sposito C., Tedeschi U., Tisone G., Torzilli G., Veneroni L., Vincenti L., Zamboni F., Zimmitti G., Levi Sandri, G, Colasanti, M, Aldrighetti, L, Guglielmi, A, Cillo, U, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Salvatore, G, Di Benedetto, F, Ferrero, A, Ettorre, G, Antonucci, A, Batignani, G, Belli, G, Belli, A, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Cecconi, S, Colledan, M, Coratti, A, Ercolani, G, Ferla, F, Filauro, M, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, G, Gringeri, E, Griseri, G, Guerriero, S, Jovine, E, Magistri, P, Maida, P, Massani, M, Mezzatesta, P, Morelli, L, Russolillo, N, Navarra, G, Parisi, A, Patriti, A, Ravaioli, M, Ratti, F, Romito, R, Reggiani, P, Ruzzenente, A, Santambrogio, R, Berardi, G, Sgroi, G, Slim, A, Spada, M, Sposito, C, Tedeschi, U, Tisone, G, Torzilli, G, Veneroni, L, Vincenti, L, Zamboni, F, Zimmitti, G, Levi Sandri, G. B., Colasanti, M., Aldrighetti, L., Guglielmi, A., Cillo, U., Mazzaferro, V., Dalla Valle, R., De Carlis, L., Salvatore, G., Di Benedetto, F., Ferrero, A., Ettorre, G. M., Antonucci, A., Batignani, G., Belli, G., Belli, A., Berti, S., Boggi, U., Bonsignore, P., Brolese, A., Calise, F., Ceccarelli, G., Cecconi, S., Colledan, M., Coratti, A., Ercolani, G., Ferla, F., Filauro, M., Floridi, A., Frena, A., Giuliani, A., Giuliante, F., Grazi, G. L., Gringeri, E., Griseri, G., Guerriero, S., Jovine, E., Magistri, P., Maida, P., Massani, M., Mezzatesta, P., Morelli, L., Russolillo, N., Navarra, G., Parisi, A., Patriti, A., Ravaioli, M., Ratti, F., Romito, R., Reggiani, P., Ruzzenente, A., Santambrogio, R., Berardi, G., Sgroi, G., Slim, A., Spada, M., Sposito, C., Tedeschi, U., Tisone, G., Torzilli, G., Veneroni, L., Vincenti, L., Zamboni, F., and Zimmitti, G.
Subjects: Liver surgery, Registrie, medicine.medical_specialty, Carcinoma, Hepatocellular, Subgroup analysis, IGoMILS, Laparoscopic HCC, Laparoscopic indications, Laparoscopic liver resection, Minimally invasive, Recurrence, Redo surgery, Robotic, NO, Resection, Postoperative Complications, Retrospective Studie, Clinical endpoint, Medicine, Humans, Hepatectomy, Registries, Propensity Score, LS7_4, Retrospective Studies, business.industry, Primary resection, Carcinoma, Liver Neoplasms, Hepatocellular, Length of Stay, medicine.disease, Surgery, Settore MED/18, Hepatocellular carcinoma, Cohort, Propensity score matching, Laparoscopy, Postoperative Complication, business, Laparoscopic indication, Human
Abstract: Laparoscopic liver resection (LLR) for Hepatocellular carcinoma (HCC) is a safe procedure. Repeat surgery is more often required, and the role of minimally invasive liver surgery (MILS) is not yet clearly defined. The present study analyzes data compiled by the Italian Group of Minimally Invasive Liver Surgery (IGoMILS) on LLR. To compare repeated LLR with the first LLR for HCC is the primary endpoint. The secondary endpoint was to evaluate the outcome of repeat LLR in the case of primary open versus primary MILS surgery. The data cohort is divided into two groups. Group 1: first liver resection and Group 2: Repeat LLR. To compare the two groups a 3:1 Propensity Score Matching is performed to analyze open versus MILS primary resection. Fifty-two centers were involved in the present study, and 1054 patients were enrolled. 80 patients underwent to a repeat LLR. The type of resection was different, with more major resections in the group 1 before matching the two groups. After propensity score matching 3:1, each group consisted of 222 and 74 patients. No difference between the two groups was observed. In the subgroup analysis, in 44 patients the first resection was performed by an open approach. The other 36 patients were resected with a MILS approach. We found no difference between these two subgroups of patients. The present study in repeat MILS for HCC using the IGoMILS Registry has observed the feasibility and safety of the MILS procedure.
Published: 2021

7. Surgical Management of Hepatic Benign Disease: Have the Number of Liver Resections Increased in the Era of Minimally Invasive Approach? Analysis from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery) Registry

Author: Ardito, Francesco, Aldrighetti, L, Guglielmi, A, Jovine, E, Cillo, U, Ferrero, A, De Carlis, L, Belli, G, Dalla Valle, R, Slim, A, Mazzaferro, V, Navarra, G, Ettorre, Gm, Calise, F, Pinna, Ad, Giuliante, Felice, Italian Group of Minimally Invasive Liver Surgery (I Go, MILS)., Ardito, F, Aldrighetti, L, Guglielmi, A, Jovine, E, Cillo, U, Ferrero, A, De Carlis, L, Belli, G, Dalla Valle, R, Slim, A, Mazzaferro, V, Navarra, G, Ettorre, G, Calise, F, Pinna, A, Giuliante, F, Ardito, F., Aldrighetti, L., Guglielmi, A., Jovine, E., Cillo, U., Ferrero, A., De Carlis, L., Belli, G., Dalla Valle, R., Slim, A., Mazzaferro, V., Navarra, G., Ettorre, G. M., Calise, F., Pinna, A. D., and Giuliante, F.
Subjects: Liver surgery, medicine.medical_specialty, Settore MED/18 - CHIRURGIA GENERALE, 030230 surgery, Liver resections, Benign liver tumors, Malignant disease, Resection, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, medicine, Hepatectomy, Humans, Minimally Invasive Surgical Procedures, Prospective Studies, Registries, Prospective cohort study, Benign disease, business.industry, Indications for resection, Liver Neoplasms, Gastroenterology, Minimally invasive liver surgery, Operative risk, Laparoscopic liver resection, Surgery, Benign liver disease, Italy, 030220 oncology & carcinogenesis, Period Analysis, Laparoscopy, business, Benign liver disease, Benign liver tumors, Indications for resection, Laparoscopic liver resection, Minimally invasive liver surgery, Operative risk, Benign liver tumor
Abstract: Background: Increased expertise with minimally invasive liver surgery (MILS) could cause an unjustified extension of indications to resect liver benign disease (BD). The aim of this study was to evaluate the operative risk of MILS for BD and if implementation and diffusion of MILS have widened indications for BD resection. Methods: A prospective study including centers with > 6 MILS for BD, enrolled in the I Go MILS registry from January 2015 to October 2016. Cysts fenestrations were excluded. Results: Eight hundred eighteen MILS were performed in 15 centers. One hundred seventy-three of these (21.1%) were for BD: conversion rate was 6.9%, postoperative mortality and morbidity rates were 0 and 13.9%. During the same period, 3713 liver resections (open + MILS) were performed and 407 (11.0%) were for BD. A time-trend analysis showed that the total number of MILS and the number of MILS for malignant disease significantly increased, but this increasing trend was not documented for the number of MILS for BD, which remained stable during the study period of time. This trend was confirmed for the overall rate of resected BD (open + MILS) that remained stable. Discussion: BD represents a valid indication for MILS. For BD, 21.1% of MILS was performed, rate significantly lower than that previously reported in Italy. Although an evident growth of the use of MILS was observed during the time period analysis in Italy, this trend did not correspond to an increased number of MILS for BD, and the overall rate of resected BD was comparable to that reported in previous large open series.
Published: 2019

8. 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 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, and Avolio, A
Subjects: Nephrology, Adult, Male, medicine.medical_specialty, Settore MED/18 - CHIRURGIA GENERALE, Renal function, lcsh:RC870-923, 03 medical and health sciences, 0302 clinical medicine, Calcineurin inhibitors, Calcineurin inhibitor, Internal medicine, Sex differences, Medicine, Humans, Meta-analysi, 030212 general & internal medicine, Longitudinal Studies, Renal insufficiency, Liver transplant, Aged, Retrospective Studies, Sex Characteristics, business.industry, Gender, Middle Aged, medicine.disease, lcsh:Diseases of the genitourinary system. Urology, Transplant Recipients, Liver Transplantation, Calcineurin, Transplantation, Meta-analysis, Clinical research, Cross-Sectional Studies, Italy, 030211 gastroenterology & hepatology, Observational study, Female, business, Research Article, Kidney disease, Follow-Up Studies, Glomerular Filtration Rate
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) 2 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 2 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

9. Surgical and oncological outcomes of hepatic resection for BCLC-B hepatocellular carcinoma: a retrospective multicenter analysis among 474 consecutive cases

Author: Di Sandro S., Centonze L., Pinotti E., Lauterio A., De Carlis R., Romano F., Gianotti L., De Carlis L., Cena T., Bagnardi V., Benuzzi L., Pezzoli I., Danieli M., Ciravegna A., Di Sandro, S, Centonze, L, Pinotti, E, Lauterio, A, De Carlis, R, Romano, F, Gianotti, L, De Carlis, L, Cena, T, Bagnardi, V, Benuzzi, L, Pezzoli, I, Danieli, M, and Ciravegna, A
Subjects: Adult, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Adolescent, Hepatocellular carcinoma, Hepatic resection, 030230 surgery, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Retrospective Studie, Medicine, Effective treatment, Hepatectomy, Humans, In patient, Stage (cooking), Liver surgery, Aged, Neoplasm Staging, Retrospective Studies, Liver resection, business.industry, Incidence (epidemiology), Liver Neoplasms, Perioperative, Middle Aged, medicine.disease, Surgery, BCLC, Survival Rate, Treatment Outcome, Liver Neoplasm, 030220 oncology & carcinogenesis, Female, Neoplasm Recurrence, Local, business, Liver cancer, Human
Abstract: The Barcelona clinic liver cancer (BCLC) algorithm is the most widely accepted staging system form hepatocellular carcinoma (HCC). Liver resection is traditionally proposed to early stage HCC (BCLC-0/A), even if recent reports have shown that surgical resection could provide a safe and effective treatment also for intermediate-stage HCC (BCLC-B). In this study, we focused on surgical and oncological outcomes of hepatic resection in BLCB-B patients. Patients who received hepatic resection for early- (BCLC-0/A) or intermediate-stage (BCLC-B) HCC in two tertiary hepatobiliary centers between January 2003 and December 2016 were included in study. Four-hundred and twenty-nine patients were included in the analysis. At the time of resection, 298 patients were classified as BCLC-A/0 and 131 as BCLC-B. Despite a higher complication rate in BCLC-B group (49.6% vs 32.9%; p = 0.001), the incidence of clinically relevant complications did not differ significantly between the two groups (16.0% vs 10.1%; p = 0.079); moreover, postoperative mortality (4.6% vs 2.7%; p = 0.309) and relapse-free survival (RFS) were similar between BCLC-0/A and BCLC-B group (1-, 3-, and 5-year RFS: 74, 43, and 31% vs 59, 38, and 34%; p = 0.180). Overall survival was slightly worse in BCLC-B group (1-, 3-, and 5-year overall survival of 89, 70, and 52% vs. 77, 51, and 44%; p = 0.004). Focusing on BCLC-B group, a Child–Pugh score B (HR 2.47; p = 0.003), growing number of nodules (HR 3.04; p = 0.003), and R1 resection (HR 2.43; p = 0.005) beard a higher risk of tumor recurrence, while overall survival was negatively affected by the presence of more than two nodules (HR 3.66; p = 0.0001) and R1 resection (HR 3.06; p = 0.0001); patients presenting single-large HCC experienced a better overall survival (HR 0.53; p = 0.014) and lower recurrence-rate (HR 0.60; p = 0.046). Hepatic resection for intermediate-stage HCC shows acceptable results in terms of perioperative morbidity and mortality, with better oncological outcomes in patients with lower number of lesions despite of their size.
Published: 2019

10. Use of Everolimus in Liver Transplantation: Recommendations from a Working Group

Author: De Simone P, Fagiuoli S, Cescon M, De Carlis L, Tisone G, Volpes R, Cillo U, Avolio AW, Burra P, Calise F, Di Benedetto F, Ettorre GM, Galeota Lanza A, Lupo L, Montin U, Reggiani P, Rendina M, Torre G, Bozzoli M, Ippoliti G, Sacchini D, Venturini F, De Simone, P, Fagiuoli, S, Cescon, M, De Carlis, L, Tisone, G, Volpes, R, Cillo, U, and De Simone P, Fagiuoli S, Cescon M, De Carlis L, Tisone G, Volpes R, Cillo U, Avolio AW, Burra P, Calise F, Di Benedetto F, Ettorre GM, Galeota Lanza A, Lupo L, Montin U, Reggiani P, Rendina M, Torre G, Bozzoli M, Ippoliti G, Sacchini D, Venturini F
Subjects: Graft Rejection, medicine.medical_specialty, Consensus, Time Factors, Time Factor, Delphi Technique, medicine.medical_treatment, Protein Kinase Inhibitor, Consensu, 030230 surgery, Liver transplantation, Nephrotoxicity, 03 medical and health sciences, Immunosuppressive Agent, 0302 clinical medicine, Internal medicine, medicine, Humans, Everolimus, Cooperative Behavior, Adverse effect, Protein Kinase Inhibitors, Transplantation, TOR Serine-Threonine Kinase, business.industry, TOR Serine-Threonine Kinases, Graft Survival, Immunosuppression, Evidence-based medicine, Surgery, Liver Transplantation, Settore MED/18, Calcineurin, Immunosuppressive Agents, Interdisciplinary Communication, Signal Transduction, Treatment Outcome, Everolimu, 030211 gastroenterology & hepatology, business, medicine.drug, Human
Abstract: Immunosuppression after liver transplantation (LT) is presently based on use of calcineurin inhibitors (CNI), although they are associated with an increased incidence of renal dysfunction, cardiovascular complications, and de novo and recurrent malignancies. Over the past decade, mammalian target of rapamycin inhibitors have received considerable attention as immunosuppressants because they are associated with a more favorable renal profile versus CNI, as well as antiproliferative activity in clinical studies. Comprehensive guidelines on use of everolimus (EVR) in LT are still lacking. In Italy, a project, named Everolimus: the road to long-term functioning, was initiated to collect the experience on EVR after LT with the aim of providing guidance for transplant clinicians. Herein, recommendations by this national consensus group, based on Delphi methodology, are presented. Consensus was reached on 20 of the 23 statements proposed, and their level of evidence, grade of recommendation, and percent of agreement are reported. Statements are grouped into 4 areas: (A) renal function; (B) time of EVR introduction, CNI reduction and elimination, and risk for graft rejection; (C) antiproliferative effects of EVR; and (D) management of EVR-related adverse events. The high level of consensus shows that there is good agreement on the routine use of EVR in predefined clinical scenarios, especially in light of posttransplant nephrotoxicity and other adverse events associated with long-term administration of CNIs.
Published: 2017

11. Intramuscular islet allotransplantation in type 1 diabetes mellitus

Author: Bertuzzi, F, Colussi, G, Lauterio, A, De Carlis, L, Bertuzzi, F, Colussi, G, Lauterio, A, and De Carlis, L
Subjects: Adult, Male, Islets of Langerhans Transplantation, Middle Aged, Islets of Langerhans, Diabetes Mellitus, Type 1, Treatment Outcome, Animals, Feasibility Studies, Humans, Transplantation, Homologous, Female, Dm1, Muscle, Skeletal
Abstract: OBJECTIVE: Alternative sites to the liver for islet transplantation have been studied for a long time. Intramuscular islet transplantation appears to be an alternative site to the liver because of the ease of access. First islet autotransplantations were reported in patients after total pancreatectomies. The transplanted islets showed a proper revascularization and their function was observed for up to 2 years after the implant. However, only a few cases of autotransplantation and no allotransplantation have been performed. The aim of this study was to verify the feasibility of islet allotransplantation into muscles. PATIENTS AND METHODS: In four patients affected by type 1 diabetes mellitus in which liver islet allotransplantation was contraindicated, human islets were transplanted into patients' arm muscle with local anesthesia. RESULTS: The surgery was minimally invasive, without complications. In one patient a moderate local inflammatory reaction was observed at the site of the implant, which resolved spontaneously within 4 days. Islet graft function was observed after transplantation in all patients, but it progressively disappeared in 3 out 4 patients within a short time. CONCLUSIONS: In this first ever-reported intramuscular pancreatic islet allotransplantation, the procedure appears feasible but new strategies must be envisaged to significantly improve islet engraftment and the long-term graft function
Published: 2018
Full Text: View/download PDF

12. 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

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

Author: Donato, M. F., Morelli, C., Romagnoli, R., Invernizzi, F., Mazzarelli, C., Iemmolo, R. M., Montalbano, M., Lenci, I., Bhoori, S., Pieri, G., Berardi, S., Caraceni, P., Martini, S., Angeli, P., Belli, L. S., Bernabucci, V., Malinverno, F., Monico, S., Ottobrelli, A., Romano, A., Strona, S., Tame, M. R., Visco-Comandini, U., Cavenago, M., De Carlis, L., Di Benedetto, F., Dondossola, D., Ettorre, G. M., Mazzaferro, V., Montin, U., Pinna, A. D., 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, 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, and Tisone, G
Subjects: Liver Cirrhosis, Male, Sofosbuvir, Sustained Virologic Response, Hepatocellular carcinoma, medicine.medical_treatment, Hepacivirus, Liver transplantation, medicine.disease_cause, hepatitis C, hepatocellular carcinoma, liver transplant, sofosbuvir therapy, virological response, Adult, Aged, Antiviral Agents, Carcinoma, Hepatocellular, Drug Therapy, Combination, Female, Hepatitis C, Humans, Italy, Liver Neoplasms, Middle Aged, Postoperative Period, Preoperative Period, Recurrence, Retrospective Studies, Ribavirin, Liver Transplantation, Gastroenterology, chemistry.chemical_compound, 0302 clinical medicine, Sofosbuvir therapy, Retrospective Studie, Liver transplant, Virological response, Liver Neoplasm, 030220 oncology & carcinogenesis, Combination, 030211 gastroenterology & hepatology, Viral hepatitis, Human, medicine.drug, medicine.medical_specialty, Liver Cirrhosi, Hepatitis C virus, 03 medical and health sciences, Hepatology, Drug Therapy, Internal medicine, medicine, Antiviral Agent, Hepaciviru, business.industry, Carcinoma, Hepatocellular, medicine.disease, Settore MED/18, Surgery, Regimen, chemistry, business
Abstract: Background and aims Hepatitis C virus (HCV) reinfection following liver transplant (LT) is associated with reduced graft and patients 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 week HCV-RNA undetectability at the time of transplant. Material and 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 were transplanted and 31 patients (31%) treated by SOF/R bridging therapy were studied Results LT 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 4 recipients. On September 2016, 30 recipients (97%) are 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. This article is protected by copyright. All rights reserved.
Published: 2017

14. Everolimus With Reduced Tacrolimus Improves Renal Function in De Novo Liver Transplant Recipients: A Randomized Controlled Trial

Author: De Simone, P, Nevens, Frederik, De Carlis, L, Metselaar, HJ, Beckebaum, S, Saliba, F, Jonas, S, Sudan, D, Fung, J, Fischer, L, Duvoux, C, Chavin, KD, Koneru, B, Huang, MA, Chapman, WC, Foltys, D, Witte, S, Jiang, H, Hexham, JM, Junge, G, for the H2304 Study Group, De Simone, P, Nevens, F, DE CARLIS, L, Metselaar, H, Beckebaum, S, Saliba, F, Jonas, S, Sudan, D, Fung, J, Fischer, L, Duvoux, C, Chavin, K, Koneru, B, Huang, M, Chapman, W, Foltys, D, Witte, S, Jiang, H, Hexham, J, Junge, G, and Gastroenterology & Hepatology
Subjects: Graft Rejection, CHRONIC KIDNEY-DISEASE, Male, Time Factors, medicine.medical_treatment, Medizin, Kaplan-Meier Estimate, Liver transplantation, Kidney, Kidney Function Tests, GLOMERULAR-FILTRATION-RATE, Immunosuppressive Agent, HEPATOCELLULAR-CARCINOMA, SIROLIMUS-BASED IMMUNOSUPPRESSION, Immunology and Allergy, Sirolimu, Pharmacology (medical), Prospective Studies, tacrolimus, MYCOPHENOLATE-MOFETIL, COMPLICATIONS, Cross-Over Studies, liver transplantation, withdrawal, Graft Survival, Cross-Over Studie, Middle Aged, Treatment Outcome, surgical procedures, operative, Survival Analysi, reduced, Life Sciences & Biomedicine, Immunosuppressive Agents, Human, Glomerular Filtration Rate, medicine.drug, Adult, medicine.medical_specialty, Randomization, Time Factor, Adolescent, Efficacy, Urology, Renal function, chemical and pharmacologic phenomena, CALCINEURIN INHIBITOR, Risk Assessment, Drug Administration Schedule, Follow-Up Studie, Young Adult, stomatognathic system, Transplantation Immunology, DOSE TACROLIMUS, Confidence Intervals, medicine, Humans, METAANALYSIS, Aged, Sirolimus, Transplantation, Kidney Function Test, Science & Technology, Everolimus, Dose-Response Relationship, Drug, business.industry, everolimu, tacrolimu, Original Articles, everolimus, Survival Analysis, Crossover study, Tacrolimus, Surgery, Prospective Studie, CONVERSION, stomatognathic diseases, business, Confidence Interval, Liver Failure, Follow-Up Studies
Abstract: In a prospective, multicenter, open-label study, de novo liver transplant patients were randomized at day 30±5 to (i) everolimus initiation with tacrolimus elimination (TAC Elimination) (ii) everolimus initiation with reduced-exposure tacrolimus (EVR+Reduced TAC) or (iii) standard-exposure tacrolimus (TAC Control). Randomization to TAC Elimination was terminated prematurely due to a higher rate of treated biopsy-proven acute rejection (tBPAR). EVR+Reduced TAC was noninferior to TAC Control for the primary efficacy endpoint (tBPAR, graft loss or death at 12 months posttransplantation): 6.7% versus 9.7% (-3.0%; 95% CI -8.7, 2.6%; p
Published: 2012

15. 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, LUCIANO GREGORIO, 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., Avolio A.W., Cillo U., Salizzoni M., De Carlis L., Colledan M., Gerunda G.E., 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.C., Miele L., Pompili M., Siciliano M., Perilli V., Gaspari R., Castagneto M., Tandoi F., Mangoni I., Belli L., Pinna A.D., 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., Brotzu G., Ettorre G.M., Vennarecci G., Bresadola F., Baccarani U., Toniutto P.L., 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 J., Monti L., Avolio, A W, Cillo, U, Salizzoni, M, De Carlis, L, Colledan, M, Gerunda, G E, Mazzaferro, Mariapia, Tisone, G, Romagnoli, R, Caccamo, L, Rossi, M, Vitale, A, Cucchetti, A, Lupo, L, Gruttadauria, S, Nicolotti, N, Burra, P, Gasbarrini, A, Agnes, S, Montalti, Roberto, Avolio, A, DE CARLIS, L, Gerunda, G, Mazzaferro, V, Lirosi, M, Miele, L, Pompili, M, Siciliano, M, Perilli, V, Gaspari, R, Castagneto, M, Lupo, F, Tandoi, F, 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, and De Waure, C
Subjects: Graft Rejection, Male, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, Hepacivirus, Liver transplantation, Gastroenterology, Liver disease, Postoperative Complications, Retrospective Studie, UNSUSTAINABLE MATCH, Models, Risk Factors, Immunology and Allergy, Health Status Indicators, Age Factor, PROGNOSTIC INDICES, Pharmacology (medical), Health Status Indicator, D-MELD, Liver Transplantation, liver transplantation, Hazard ratio, Graft Survival, donor-recipient match, outcome, prognosis, risk factors, Age Factors, Trapianto epatico, Hepatitis C, Hepatitis B, Statistical, Middle Aged, Prognosis, Tissue Donors, Survival Rate, Italy, HCV, Female, Human, Adult, medicine.medical_specialty, Prognosi, Donor Selection, End Stage Liver Disease, Young Adult, Internal medicine, medicine, Humans, fattori di rischio, Aged, Retrospective Studies, Transplantation, Hepaciviru, Models, Statistical, business.industry, Donor selection, Risk Factor, Settore MED/09 - MEDICINA INTERNA, Odds ratio, medicine.disease, Settore MED/18, Surgery, body regions, Postoperative Complication, business
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 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
Published: 2011

16. A method for establishing allocation equity among patients with and without hepatocellular carcinoma on a common liver transplant waiting list

Author: Vitale, A, Volk, Ml, De Feo TM, Burra, P, Frigo, Ac, Ramirez Morales, R, De Carlis, L, Belli, L, Colledan, M, Fagiuoli, S, Rossi, G, Andorno, E, Baccarani, U, Regalia, E, Vivarelli, M, Donataccio, M, Russo, Fp, Angeli, P, for Liver Transplantation North Italy Transplant program (NITp) working group, Cillo, U., Vitale, A, Volk, M, De Feo, T, Burra, P, Frigo, A, Ramirez Morales, R, DE CARLIS, L, Belli, L, Colledan, M, Fagiuoli, S, Rossi, G, Andorno, E, Baccarani, U, Regalia, E, Vivarelli, M, Donataccio, M, and Cillo, U
Subjects: Adult, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Tissue and Organ Procurement, Waiting Lists, Hepatocellular carcinoma, medicine.medical_treatment, Liver transplantation, Gastroenterology, Severity of Illness Index, End Stage Liver Disease, Liver disease, Model for End-Stage Liver Disease, Interquartile range, Internal medicine, Medicine, Humans, Proportional Hazards Models, Cirrhosi, Hepatology, Surgical oncology, Cirrhosis, Clinical decision making, business.industry, Proportional hazards model, Hazard ratio, Liver Neoplasms, Transplant Waiting List, Middle Aged, medicine.disease, digestive system diseases, Markov Chains, Italy, Female, business, Monte Carlo Method
Abstract: Background & Aims:The current organ allocation system for liver transplantation (LT) creates an imbalance between patients with and without hepatocellular carcinoma (HCC). We describe a model designed to re-establish allocation equity among patient groups using transplant benefit as the common endpoint. Methods:We enrolled consecutive adult patients entering the waiting list (WL group, n = 2697) and undergoing LT (LT group, n = 1702) during the period 2004‐2009 in the North Italy Transplant program area. Independent multivariable regressions (WL and LT models) were created for patients without HCC and for those with stage T2 HCC. Monte Carlo simulation was used to create distributions of transplant benefit, and covariates such as Model for End-stage Liver Disease (MELD) and alpha-fetoprotein (AFP) were combined in regression equations. These equations were then calibrated to create an ‘‘MELD equivalent’’ which matches HCC patients to non-HCC patients having the same numerical MELD score. Results:Median 5 year transplant benefit was 15.12 months (8.75‐25.35) for the non-HCC patients, and 28.18 months (15.11‐36.38) for the T2-HCC patients (p
Published: 2014

17. Evolution of robotic nephrectomy for living donation: From hand-assisted to totally robotic technique

Author: Giacomoni, A, Di Sandro, S, Lauterio, A, Concone, G, Mangoni, I, Mihaylov, P, Tripepi, M, De Carlis, L., Giacomoni, A, Di Sandro, S, Lauterio, A, Concone, G, Mangoni, I, Mihaylov, P, Tripepi, M, and DE CARLIS, L
Subjects: Adult, Male, Living Donor, Robotic Surgical Procedure, Intraoperative Complication, Operative Time, Nephrectomy, Robotic-assisted nephrectomy, Kidney transplantation, Robotic Surgical Procedures, Ischemia, Living Donors, Living donation, Humans, Postoperative Period, Intraoperative Complications, Aged, Medicine (all), Computer Science Applications1707 Computer Vision and Pattern Recognition, Middle Aged, Kidney Transplantation, Biophysic, Tissue and Organ Harvesting, Female, Laparoscopy, Surgery, Human
Abstract: Background: The application of robotic-assisted surgery offers EndoWrist instruments and 3-D visualization of the operative field, which are improvements over traditional laparoscopy. The results of the few studies published so far have shown that living donor nephrectomy using the robot-assisted technique is safe, feasible, and offers advantages to patients. Materials and methods: Since November 2009, 16 patients have undergone robotic-assisted living donor nephrectomy at our Institute. Patients were divided into two groups according to the surgical technique adopted for the procedure: Group A, hand-assisted robotic nephrectomy (eight patients); Group B, totally robotic nephrectomy (eight patients). Results: Intra-operative bleeding was similar in the two groups (90 vs 100mL for Group A and B, respectively). Median warm ischemia time was significantly shorter in Group A (2.3 vs 5.1min for Group A and B, respectively, P-value=0.05). Switching to the open procedure was never required. Median operative time was not significantly longer in Group A than Group B (275min vs 250min, respectively). Conclusion: Robotic assisted living kidney recovery is a safe and effective procedure. Considering the overall technical, clinical, and feasibility aspects of living kidney donation, we believe that the robotic assisted technique is the method of choice for surgeon's comfort and donors' safety
Published: 2014

18. Residual right portal branch flow after first-step ALPPS: Artifact or homeostatic response?

Author: De Carlis L, Sguinzi R, De Carlis R, Di Sandro S, Mangoni J, Aseni P, Giacomoni A, Angelo Vanzulli, DE CARLIS, L, Sguinzi, R, De Carlis, R, Di Sandro, S, Mangoni, J, Aseni, P, Giacomoni, A, and Vanzulli, A
Subjects: Male, Time Factors, Time Factor, Portal Vein, Liver Neoplasms, Ultrasonography, Doppler, Phlebography, Middle Aged, Liver Regeneration, Hepatic Artery, Bile Duct Neoplasms, Liver Neoplasm, Artifact, Homeostasi, Homeostasis, Humans, Hepatectomy, Female, Artifacts, Tomography, X-Ray Computed, Bile Duct Neoplasm, Ligation, Aged, Human, Liver Circulation
Abstract: Background/Aims: Mutual interactions between portal vein and hepatic artery can be documented during hepatobiliary surgery. Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a recently introduced surgical technique which can also represent a unique living human model to investigate intrahepatic blood circulation. We report three consecutive cases in which a residual right portal branch flow was clearly detectable after first-step ALPPS, and try to further investigate this unexpected finding with intraoperative clamping tests. Methodology: Every patient was evaluated with CT scan 7 days after first-step ALPPS and Intraoperative Doppler Ultrasonography (IOUS) at both steps of the procedure. Results: In every patient, CT scan and second-step IOUS demonstrated a clear hepatopetal flow distally to the divided right portal branch. The flow was present after right biliary duct clamping and stopped after right total hilar clamping as well as after right hepatic artery occlusion. Conclusions: Neither cross-portal circulation between the two hemilivers nor trans-sinusoidal backflow from the hepatic veins can explain these findings, which are rather consistent with a refilling of the occluded portal branch through the opening of intrahepatic arterioportal shunts (APS). APS could represent the simplest homeostatic mechanism that regulate intrahepatic blood flow
Published: 2014

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

Author: Mazzaferro, V, Llovet, Jm, Miceli, R, Bhoori, S, Schiavo, M, Mariani, L, Camerini, T, Roayaie, S, Schwartz, Me, Grazi, Gl, Adam, R, Neuhaus, P, Salizzoni, M, Bruix, J, Forner, A, De Carlis, L, Cillo, U, Burroughs, Ak, Troisi, R, Rossi, M, Gerunda, Ge, Lerut, J, Belghiti, J, Boin, I, Gugenheim, J, Rochling, F, Van Hoek, B, Majno, P, Graziadei, I, Vogel, W, Lucidi, V, de Hemptinne, B, Leopardi, L, Cotsoglou, C, Iannelli, A, Staccini, A, Koenigsrainer, A, Steurer, W, Cautero, N, Risaliti, A, Lupo, L, Colledan, M, De Giorgio, M, Fagiuoli, S, Pinna, Ad, Ravaioli, M, Battiston, C, Coppa, J, Regalia, E, Romito, R, Giacomoni, A, Mangoni, J, Maggi, U, Rossi, G, Masetti, M, Montalti, R, Calise, F, Cuomo, O, Scuderi, E, Bridda, A, Vitale, A, Tisone, G, Berloco, P, Paraluppi, G, Patrono, D, Adani, Gl, Baccarani, U, Lorenzin, D, Zieniewicz, K, Ribeiro, V, Soderdahl, G, Giostra, E, Mentha, G, Morel, P, Marelli, L, Patch, D, Muiesan, P, Heaton, N, Schwartz, M, Rossaro, L, Khatri, V, Hsieh, Cb., 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 V., Llovet J.M., Miceli R., Bhoori S., Schiavo M., Mariani L., Camerini T., Roayaie S., Schwartz M.E., Grazi G.L., Adam R., Neuhaus P., Salizzoni M., Bruix J., Forner A., De Carlis L., Cillo U., Burroughs A.K., Troisi R., Rossi M., Gerunda G.E., Lerut J., Belghiti J., Boin I., Gugenheim J., Rochling F., Van Hoek B., Majno P., Graziadei I., Vogel W., Lucidi V., de Hemptinne B., Leopardi L., Cotsoglou C., Iannelli A., Staccini A., Koenigsrainer A., Steurer W., Cautero N., Risaliti A., Lupo L., Colledan M., De Giorgio M., Fagiuoli S., Pinna A.D., Ravaioli M., Battiston C., Coppa J., Regalia E., Romito R., Giacomoni A., Mangoni J., Maggi U., Rossi G., Masetti M., Montalti R., Calise F., Cuomo O., Scuderi E., Bridda A., Vitale A., Tisone G., Berloco P., Paraluppi G., Patrono D., Adani G.L., Baccarani U, Lorenzin D, Zieniewicz K, Ribeiro V, Soderdahl G., Giostra E., Mentha G., Morel P., Marelli L., Patch D., Muiesan P., Heaton N., Rossaro L., Khatri V., Hsieh C.B., 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, Jacque, Boin, Ilka, Gugenheim, Jean, Rochling, Fedja, Van Hoek, Bart, and Majno, Pietro
Subjects: Oncology, Adult, medicine.medical_specialty, Carcinoma, Hepatocellular, Adolescent, medicine.medical_treatment, education, Liver transplantation, Milan criteria, Retrospective Studie, Liver Neoplasms/mortality/*surgery, Internal medicine, Liver Transplantation, Carcinoma, medicine, Humans, HEPATOCELLULAR CARCINOMA, Child, Aged, Retrospective Studies, mortality/surgery, ddc:617, Proportional hazards model, business.industry, Hazard ratio, Liver Neoplasms, SELECTION CRITERIA, Retrospective cohort study, Hepatocellular, Middle Aged, medicine.disease, digestive system diseases, Surgery, Carcinoma, Hepatocellular/mortality/*surgery, Transplantation, Settore MED/18 - Chirurgia Generale, Liver Neoplasm, Hepatocellular carcinoma, Adolescent, Adult, Aged, Carcinoma, mortality/surgery, Child, Humans, Liver Neoplasms, mortality/surgery, Liver Transplantation, Middle Aged, Retrospective Studies, business, Human
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 patients had hepatocellular carcinoma exceeding Milan criteria and 444 patients had hepatocellular carcinoma shown not to exceed Milan criteria at post-transplant pathology review. In the group of patients with hepatocellular carcinomas exceeding the criteria, the median size of the largest nodule was 40 mm (range 4-200) and the median number of nodules was four (1-20). 454 of 1112 patients (41%) had microvascular invasion and, for those transplanted outside the Milan criteria, 5-year overall survival was 53·6% (95% CI 50·1-57·0), compared with 73·3% (68·2-77·7) for those that met the criteria. Hazard ratios (HR) associated with increasing values of size and number were 1·34 (1·25-1·44) and 1·51 (1·21-1·88), respectively. The effect was linear for size, whereas for number of tumours, the effect tended to plateau above three tumours. The effect of tumour size and number on survival was mediated by recurrence (b=0·08, SE=0·12, p=0·476). The presence of microvascular invasion doubled HRs in all scenarios. The 283 patients without microvascular invasion, but who fell within the Up-to-seven criteria (hepatocellular carcinomas with seven as the sum of the size of the largest tumour [in cm] and the number of tumours) achieved a 5-year overall survival of 71·2% (64·3-77·0). Interpretation: More patients with hepatocellular carcinoma could be candidates for transplantation if the current dual (yes/no) approach to candidacy, based on the strict Milan criteria, were replaced with a more precise estimation of survival contouring individual tumour characteristics and use of the up-to-seven criteria. Funding: Specific funding was not used to do this study. © 2009 Elsevier Ltd. All rights reserved
Published: 2009

20. Simulect vs Steroids in de novo HCV+ liver transplant patients: A randomized trial

Author: Filipponi, F, Santaniello, W, DE CARLIS, L, Grazi, G, Castagneto, M, Burra, P, Salizzoni, M, Valente, Umberto, Bresadola, F, Rossi, M, and Fassati, L.
Subjects: Humans, Clinical Trials, Randomization, Liver Transplantation, Immunosuppression
Published: 2005

21. Split liver transplantation is effective in reducing in list mortality for patients with end stage liver disease

Author: Cardillo, M, DE FAZIO, N, Mazzaferro, V, RAINERO FASSATI, L, Colledan, M, Gridelli, B, DE CARLIS, L, Valente, Umberto, Cillo, U, Baccarani, U, Martini, C, and Scalamogna, M.
Subjects: Humans, Liver Transplantation, Split Liver Transplantation, Waiting Lists, Mortality
Published: 2005

22. Sandimmun-Neoral in liver transplantation: a remarkable improvement in long-term immunosuppression

Author: Belli, L. S., De Carlis, L., Rondinara, G. F., Alberti, A., Rossetti, O., Zurleni, F., Bellati, G., Fesce, E., Zoppi, F., Airoldi, A., Ideo, G., Belli, L., Belli, L, De Carlis, L, Rondinara, G, Alberti, A, Rossetti, O, Zurleni, F, Bellati, G, Fesce, E, Zoppi, F, Airoldi, A, and Ideo, G
Subjects: Adult, Liver Cirrhosis, Male, Transplantation, Intestinal Absorption, Cyclosporine, Administration, Oral, Humans, Surgery, Female, Middle Aged, Hepatitis C, Liver Transplantation
Published: 1994

23. Recurrence of HDV infection after liver transplantation

Author: Bettale, G., Alberti, A., Belli, L. S., Rondinara, G., De Carlis, L., Vai, C., Zavaglia, C., Belli, L., Ideo, G., Bettale, G, Alberti, A, Belli, L, Rondinara, G, De Carlis, L, Vai, C, Zavaglia, C, and Ideo, G
Subjects: Adult, Liver Cirrhosis, Male, Hepatitis B Surface Antigens, Medicine (all), Middle Aged, Hepatitis B, Hepatitis D, Liver Transplantation, Recurrence, Humans, Female, Hepatitis B Vaccines, Hepatitis Antibodies, Hepatitis B Antibodies, Hepatitis Delta Virus
Published: 1993

24. Surgical treatment of symptomatic giant hemangiomas of the liver

Author: Belli, L., De Carlis, L., Beati, C., Rondinara, G., Sansalone, V., Brambilla, G., Belli, L, De Carlis, L, Beati, C, Rondinara, G, Sansalone, V, and Brambilla, G
Subjects: Male, Hemangioma, Cavernous, Postoperative Complications, Time Factors, Liver Neoplasms, Obstetrics and Gynecology, Hepatectomy, Humans, Surgery, Female, Middle Aged, Follow-Up Studies, Retrospective Studies
Abstract: Cavernous hemangiomas are the most common benign tumors of the liver. Twenty-four patients who had hepatic resections for giant symptomatic hepatic hemangiomas during a six year period at a single institute were retrospectively reviewed to analyze indications for surgical treatment and evaluate operative mortality and morbidity. There were 18 women and six men varying in age from 41 to 69 years with an average age of 52.5 years. Moderate to severe pain, discomfort, feeling of fullness, bloating and sensation of an abdominal mass were the most commonly reported symptoms. Ten patients had moderate anemia and two had severe anemia. Tumors were visualized by ultrasonography in all patients and by computed tomography in 18. Angiography was performed in all patients with diagnostic confirmation of a benign hemangioma in all but one patient in whom an angiosarcoma was suspected. The resection was feasible in each patient: 20 minor hepatic resections (three wedge, 11 segmentectomies, six bisegmentectomies) and four right hepatic lobectomies were carried out. There were no surgical deaths. Two patients had postoperative complications: one patient had a pneumonia on the right side and one had wound infection. The benign nature of the tumors was confirmed in all. The lesions varied in size from 5.6 to 26 centimeters in diameter. Symptoms and hematologic disorders were relieved in all patients in the follow-up. The results of our experience confirm that resection for giant symptomatic hepatic hemangioma represents a safe radical curative procedure. Medical treatment is justified in smaller lesions or in asymptomatic patients.
Published: 1992

25. Massive hemorrhagic hepatic graft necrosis secondary to diversion of portal blood flow during a rejection reaction: Report of a case

Author: Del Favero, E., De Carlis, L., Rondinara, G. F., Belli, L. S., Sansalone, C. V., Romani, F., Tommasini, D. C., Brambilla, G., Rampoldi, A., De Gasperi, A., Belli, L., Del Favero, E, De Carlis, L, Rondinara, G, Belli, L, Sansalone, C, Romani, F, Tommasini, D, Brambilla, G, Rampoldi, A, and De Gasperi, A
Subjects: Adult, Graft Rejection, Male, Transplantation, Necrosis, Portal System, Carcinoma, Hepatocellular, Liver Neoplasms, Humans, Surgery, Hemorrhage, Liver Transplantation

26. Cyclosporin monotherapy (after 3 months) in liver transplant patients: A prospective randomized trial

Author: Romani, F., Belli, L. S., De Carlis, L., Rondinara, G. F., Alberti, A., Sansalone, C. V., Bellati, G., Zavaglia, C., Fesce, E., Ideo, G., Belli, L., Romani, F, Belli, L, De Carlis, L, Rondinara, G, Alberti, A, Sansalone, C, Bellati, G, Zavaglia, C, Fesce, E, and Ideo, G
Subjects: Adult, Graft Rejection, Immunosuppression Therapy, Male, Transplantation, Incidence, Middle Aged, Liver Transplantation, Survival Rate, Acute Disease, Chronic Disease, Cyclosporine, Humans, Female, Steroids, Surgery

27. Perspectives from Italy during the COVID-19 pandemic: nationwide survey-based focus on minimally invasive HPB surgery

Author: Aldrighetti, aEmail Author, L., Boggi, U. b., Falconi, M. c., Giuliante, F. d., Cipriani, F. a., Ratti, Torzilli, G. e., Abu, Hilal, Andrianello, Anselmo, Ardito, Gian, L. B., Banchini, Barabino, Barberis, Bassi, Batignani, Battiston, Belli, Berti, Bianco, Brolese, Brozzetti, Butturini, Calise, Carabott, Capretti, Casadei, Cescon, Cesaretti, Cillo, Cinardi, Colledan, Coppola, Cotsoglou, Crippa, Bona, E. D., Valle, R. D., Angelis, De, Carlis, De, Benedetto, Di, Sebastiano, Di, Dova, Ercolani, Esposito, Giuseppe, M. E., Fabris, Ferrero, Frena, Frigerio, Gianotti, Giuliani, Grazi, Gringeri, Griseri, Gruttadauria, Guglielmi, Izzo, Jovine, Lanza, Malleo, Manzini, Massani, Mazzaferro, Memeo, Minni, Morelli, Nappo, Nardo, Orlando, Partelli, Patriti, Patrone, Percivale, Piccolo, Ravaioli, Reggiani, Risaliti, Rocca, A, Romagnoli, Romano, Russolillo, Ruzzenente, Saladino, Salvia, Santambrogio, Tarchi, Troci, Troisi, Urbani, Veneroni, Vennarecci, Vigano, Viola, Vistoli, Vivarelli, Zanello, Zanus, Zerbi, Italian Association of HepatoBilioPancreatic Surgeons-AICEP, Aldrighetti, L., Boggi, U., Falconi, M., Giuliante, F., Cipriani, F., Ratti, F., Torzilli, G., Abu Hilal, M., Andrianello, S., Anselmo, A., Ardito, F., Gian, L. B., Banchini, F., Barabino, M., Barberis, A., Bassi, C., Batignani, G., Battiston, C., Belli, A., Berti, S., Bianco, P., Brolese, A., Brozzetti, S., Butturini, G., Calise, F., Carabott, K., Capretti, G., Casadei, R., Cescon, M., Cesaretti, M., Cillo, U., Cinardi, N., Colledan, M., Coppola, A., Cotsoglou, C., Crippa, S., Bona, E. D., Valle, R. D., De Angelis, M., De Carlis, L., Di Benedetto, F., Di Sebastiano, P., Dova, L., Ercolani, G., Esposito, A., Giuseppe, M. E., Fabris, A., Ferrero, A., Frena, A., Frigerio, I., Gianotti, L., Giuliani, A., Grazi, G., Gringeri, E., Griseri, G., Gruttadauria, S., Guglielmi, A., Izzo, F., Jovine, E., Lanza, E., Malleo, G., Manzini, L., Massani, M., Mazzaferro, V., Memeo, R., Minni, F., Morelli, L., Nappo, G., Nardo, B., Orlando, F., Partelli, S., Patriti, A., Patrone, R., Percivale, A., Piccolo, G., Ravaioli, M., Reggiani, P., Risaliti, M., Rocca, A., Romagnoli, R., Romano, F., Russolillo, N., Ruzzenente, A., Saladino, E., Salvia, R., Santambrogio, R., Tarchi, P., Troci, A., Troisi, R., Urbani, L., Veneroni, L., Vennarecci, G., Vigano, L., Viola, M., Vistoli, F., Vivarelli, M., Zanello, M., Zanus, G., Zerbi, A., Aldrighetti L., Boggi U., Falconi M., Giuliante F., Cipriani F., Ratti F., Torzilli G., Abu Hilal M., Andrianello S., Anselmo A., Ardito F., Gian L.B., Banchini F., Barabino M., Barberis A., Bassi C., Batignani G., Battiston C., Belli A., Berti S., Bianco P., Brolese A., Brozzetti S., Butturini G., Calise F., Carabott K., Capretti G., Casadei R., Cescon M., Cesaretti M., Cillo U., Cinardi N., Colledan M., Coppola A., Cotsoglou C., Crippa S., Bona E.D., Valle R.D., De Angelis M., De Carlis L., Di Benedetto F., Di Sebastiano P., Dova L., Ercolani G., Esposito A., Giuseppe M.E., Fabris A., Ferrero A., Frena A., Frigerio I., Gianotti L., Giuliani A., Grazi G., Gringeri E., Griseri G., Gruttadauria S., Guglielmi A., Izzo F., Jovine E., Lanza E., Malleo G., Manzini L., Massani M., Mazzaferro V., Memeo R., Minni F., Morelli L., Nappo G., Nardo B., Orlando F., Partelli S., Patriti A., Patrone R., Percivale A., Piccolo G., Ravaioli M., Reggiani P., Risaliti M., Rocca A., Romagnoli R., Romano F., Russolillo N., Ruzzenente A., Saladino E., Salvia R., Santambrogio R., Tarchi P., Troci A., Troisi R., Urbani L., Veneroni L., Vennarecci G., Vigano L., Viola M., Vistoli F., Vivarelli M., Zanello M., Zanus G., and Zerbi A.
Subjects: Future studies, Settore MED/18 - CHIRURGIA GENERALE, Crisis management, Nationwide survey, 0302 clinical medicine, Pandemic, Pancrea, Medicine, Viral, Minimally invasive procedures, Liver Disease, Liver Diseases, COVID-19, Liver, Minimally invasive, Pancreas, Biliary Tract Diseases, Health Care Surveys, Humans, Italy, Pancreatic Diseases, Coronavirus Infections, Minimally Invasive Surgical Procedures, Pandemics, Pneumonia, Viral, 030220 oncology & carcinogenesis, Esophagus Resection, Original Article, 030211 gastroenterology & hepatology, Biliary Tract Disease, Human, Prioritization, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), NO, 03 medical and health sciences, High Volume Hospital, Centralization, LS7_4, Coronavirus Infection, business.industry, Minimally Invasive Surgical Procedure, Pneumonia, Surgery, Health Care Survey, Invasive surgery, Pancreatic Disease, business
Abstract: The safety of minimally invasive procedures during COVID pandemic remains hotly debated, especially in a country, like Italy, where minimally invasive techniques have progressively and pervasively entered clinical practice, in both the hepatobiliary and pancreatic community. A nationwide snapshot of the management of HPB minimally invasive surgery activity during COVID-19 pandemic is provided: a survey was developed and conducted within AICEP (Italian Association of HepatoBilioPancreatic Surgeons) with the final aim of conveying the experience, knowledge, and opinions into a unitary report enabling more efficient crisis management. Results from the survey (81 respondents) show that, in Italian hospitals, minimally invasive surgery maintains its role despite the COVID-19 pandemic, with the registered reduction of cases being proportional to the overall reduction of the HPB surgical activity. Respondents agree that the switch from minimally invasive to open technique can be considered as a valid option for cases with a high technical complexity. Several issues merit specific attention: screening for virus positivity should be universally performed; only expert surgical teams should operate on positive patients and specific technical measures to lower the biological risk of contamination during surgery must be followed. Future studies specifically designed to establish the true risks in minimally invasive surgery are suggested. Furthermore, a standard and univocal process of prioritization of patients from Regional Healthcare Systems is advisable. Electronic supplementary material The online version of this article (10.1007/s13304-020-00815-5) contains supplementary material, which is available to authorized users.
Published: 2020
Full Text: View/download PDF

28. Impact of MELD 30-allocation policy on liver transplant outcomes in Italy

Author: Maurizio Sessa, Salvatore Agnes, Marco Maria Pascale, Matteo Ravaioli, Francesco Tandoi, Federica Odaldi, Paolo De Simone, Giuliana Germinario, Gianluca Mennini, Luciano De Carlis, Alfonso Wolfango Avolio, Massimo Rossi, Jessica Bronzoni, Quirino Lai, Guido Fallani, Renato Romagnoli, Stefano Di Sandro, Matteo Cescon, Davide Ghinolfi, Damiano Patrono, Riccardo De Carlis, Ravaioli M., Lai Q., Sessa M., Ghinolfi D., Fallani G., Patrono D., Di Sandro S., Avolio A., Odaldi F., Bronzoni J., Tandoi F., De Carlis R., Pascale M.M., Mennini G., Germinario G., Rossi M., Agnes S., De Carlis L., Cescon M., Romagnoli R., De Simone P., Ravaioli, M, Lai, Q, Sessa, M, Ghinolfi, D, Fallani, G, Patrono, D, Di Sandro, S, Avolio, A, Odaldi, F, Bronzoni, J, Tandoi, F, De Carlis, R, Pascale, M, Mennini, G, Germinario, G, Rossi, M, Agnes, S, De Carlis, L, Cescon, M, Romagnoli, R, and De Simone, P
Subjects: Waiting time, Prioritization, Male, medicine.medical_specialty, Time Factors, Tissue and Organ Procurement, Waiting Lists, medicine.medical_treatment, Liver transplantation, Cohort Studies, End Stage Liver Disease, Model for End-Stage Liver Disease, Risk Factors, Outcome Assessment, Health Care, medicine, Odds Ratio, Humans, In patient, ECD, HCC, Proportional Hazards Models, Hepatology, business.industry, Proportional hazards model, Health Policy, Patient Selection, Graft Survival, Liver Transplantation, MELD, Middle Aged, body regions, Clinical trial, Logistic Models, Italy, Emergency medicine, Female, business, Cohort study
Abstract: Background & Aims: In Italy, since August 2014, liver transplant (LT) candidates with model for end-stage liver disease (MELD) scores ≥30 receive national allocation priority. This multicenter cohort study aims to evaluate time on the waiting list, dropout rate, and graft survival before and after introducing the macro-area sharing policy. Methods: A total of 4,238 patients registered from 2010 to 2018 were enrolled and categorized into an ERA-1 Group (n = 2,013; before August 2014) and an ERA-2 Group (n = 2,225; during and after August 2014). A Cox proportional hazards model was used to estimate the hazard ratio (HR) of receiving a LT or death between the two eras. The Fine-Gray model was used to estimate the HR for dropout from the waiting list and graft loss, considering death as a competing risk event. A Fine-Gray model was also used to estimate risk factors of graft loss. Results: Patients with MELD ≥30 had a lower median time on the waiting list (4 vs.12 days, p
Published: 2022
Full Text: View/download PDF

29. Pure laparoscopic versus robotic liver resections: Multicentric propensity score-based analysis with stratification according to difficulty scores

Author: Federica Cipriani, Andrea Coratti, Andrea Fontani, Francesca Menonna, Fabrizio Di Benedetto, Mario Annecchiarico, Luca Aldrighetti, Andrea Lauterio, Ugo Boggi, Guido Fiorentini, Luciano De Carlis, Graziano Ceccarelli, Paolo Magistri, Cipriani, F., Fiorentini, G., Magistri, P., Fontani, A., Menonna, F., Annecchiarico, M., Lauterio, A., De Carlis, L., Coratti, A., Boggi, U., Ceccarelli, G., Di Benedetto, F., Aldrighetti, L., Cipriani, F, Fiorentini, G, Magistri, P, Fontani, A, Menonna, F, Annecchiarico, M, Lauterio, A, De Carlis, L, Coratti, A, Boggi, U, Ceccarelli, G, Di Benedetto, F, and Aldrighetti, L
Subjects: medicine.medical_specialty, medicine.medical_treatment, laparoscopy, Liver resections, Resection, Conversion to open surgery, conversion to open surgery, hepatectomy, propensity score, robotic surgical procedures, Postoperative Complications, Blood loss, MED/18 - CHIRURGIA GENERALE, Medicine, Humans, Laparoscopy, Retrospective Studies, Hepatology, medicine.diagnostic_test, business.industry, Open surgery, Liver Neoplasms, Robotics, Length of Stay, Surgery, Propensity score matching, Hepatectomy, business, robotic surgical procedure
Abstract: Background: The benefits of pure laparoscopic and robot-assisted liver resections (LLR and RALR) are known in comparison to open surgery. The aim of the present retrospective comparative study is to investigate the role of RALR and LLR according to different levels of difficulty. Methods: The institutional databases of six high-volume hepatobiliary centers were retrospectively reviewed. The study population was divided in two groups: LLR and RALR. The procedures were stratified for difficulty levels accordingly to three classifications. A propensity score matching was implemented to mitigate selection bias. Short-term outcomes were the object of comparison. Results: Nine hundred and thirty-six LLR and 403 RALR were collected. RALR exhibited fewer cases of intraoperative blood loss, lower transfusion and conversion rates (especially for oncological radicality) than LLR in the setting of highly difficult operations, whereas LLR had lower postoperative morbidity and fewer low-grade complications. For intermediate and low-difficulty resections, the intraoperative advantages of RALR gradually decreased to nonsignificant results and LLR remained associated with lower postoperative morbidity. Conclusion: Robot-assisted liver resections do not show operative nor clinically significant benefits over LLR for low- and intermediate-difficulty resections. By reducing conversion rates, RALR can favour the operative feasibility of difficult resections possibly extending the indications of minimally invasive approaches for liver resection.
Published: 2021

30. Liver resection for perihilar cholangiocarcinoma: Impact of biliary drainage failure on postoperative outcome. Results of an Italian multicenter study

Author: Salvatore Gruttadauria, Matteo Zanello, Matteo Cescon, Umberto Cillo, Edoardo Rosso, Nadia Russolillo, Alfredo Guglielmi, Andrea Ruzzenente, Felice Giuliante, Elio Jovine, Francesco Ardito, Alessandro Ferrero, Enrico Gringeri, Marco Massani, Stefano Di Sandro, Carlo Sposito, Luca Aldrighetti, Giuseppe Zimmitti, Vincenzo Mazzaferro, Giuseppe Maria Ettorre, Luciano De Carlis, Antonio Daniele Pinna, Nazario Portolani, Francesca Ratti, Marco Colasanti, Giuliante F., Ardito F., Aldrighetti L., Ferrero A., Pinna A.D., De Carlis L., Cillo U., Jovine E., Portolani N., Gruttadauria S., Mazzaferro V., Massani M., Rosso E., Ettorre G.M., Ratti F., Guglielmi A., Cescon M., Colasanti M., Di Sandro S., Gringeri E., Russolillo N., Ruzzenente A., Sposito C., Zanello M., Zimmitti G., Giuliante, F, Ardito, F, Aldrighetti, L, Ferrero, A, Pinna, A, De Carlis, L, Cillo, U, Jovine, E, Portolani, N, Gruttadauria, S, Mazzaferro, V, Massani, M, Rosso, E, Ettorre, G, Ratti, F, Guglielmi, A, Cescon, M, Colasanti, M, Di Sandro, S, Gringeri, E, Russolillo, N, Ruzzenente, A, Sposito, C, Zanello, M, Zimmitti, G, Giuliante, F., Ardito, F., Aldrighetti, L., Ferrero, A., Pinna, A. D., De Carlis, L., Cillo, U., Jovine, E., Portolani, N., Gruttadauria, S., Mazzaferro, V., Massani, M., Rosso, E., Ettorre, G. M., Ratti, F., Guglielmi, A., Cescon, M., Colasanti, M., Di Sandro, S., Gringeri, E., Russolillo, N., Ruzzenente, A., Sposito, C., Zanello, M., and Zimmitti, G.
Subjects: Male, Percutaneous, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, postoperative outcome, 030230 surgery, Postoperative Complications, 0302 clinical medicine, Risk Factors, Retrospective Studie, 80 and over, Risk of mortality, Clinical endpoint, Drainage, Referral and Consultation, Aged, 80 and over, medicine.diagnostic_test, Liver resection, Middle Aged, Treatment Outcome, Italy, 030220 oncology & carcinogenesis, Female, Human, Adult, medicine.medical_specialty, Preoperative care, 03 medical and health sciences, Preoperative Care, medicine, Humans, Hepatectomy, Bile Duct Neoplasm, Retrospective Studies, Aged, business.industry, Risk Factor, Retrospective cohort study, Endoscopy, biliary drainage, Surgery, Bile Duct Neoplasms, Postoperative Complication, business, perihilar cholangiocarcinoma, Liver Failure, Klatskin Tumor
Abstract: Background Preoperative biliary drainage may be essential to reduce the risk of postoperative liver failure after hepatectomy for perihilar cholangiocarcinoma. However, infectious complications related to preoperative biliary drainage may increase the risk of postoperative mortality. The strategy and optimal drainage method continues to be controversial. Methods This is a retrospective multicenter study including patients who underwent hepatectomy for perihilar cholangiocarcinoma between 2000 and 2016 at 14 Italian referral hepatobiliary centers. The primary end point was to evaluate independent predictors for postoperative outcome in patients undergoing liver resection for perihilar cholangiocarcinoma after preoperative biliary drainage. Results Of the 639 enrolled patients, 441 (69.0%) underwent preoperative biliary drainage. Postoperative mortality was 8.9% (12.5% after right-side hepatectomy versus 5.7% after left-side hepatectomy; P = .003). Of the patients, 40.5% underwent preoperative biliary drainage at the first admitting hospital, before evaluation at referral centers. Use of percutaneous preoperative biliary drainage was significantly more frequent at referral centers than at community hospitals where endoscopic preoperative biliary drainage was the most frequent type. The overall failure rate after preoperative biliary drainage was 43.3%, significantly higher at community hospitals than that at referral centers (52.7% v 36.9%; P = .002). Failure of the first preoperative biliary drainage was one of the strongest predictors for postoperative complications after right-side and left-side hepatectomies and for mortality after right-side hepatectomy. Type of preoperative biliary drainage (percutaneous versus endoscopic) was not associated with significantly different risk of mortality. Conclusion Failure of preoperative biliary drainage was significantly more frequent at community hospitals and it was an independent predictor for postoperative outcome. Centers’ experience in preoperative biliary drainage management is crucial to reduce the risk of failure that is closely associated with postoperative morbidity and mortality.
Published: 2021

31. Inter-center agreement of mRECIST in transplanted patients for hepatocellular carcinoma

Author: Carlo Spreafico, Giorgio Ercolani, Matteo Cescon, Vincenzo Buscemi, Vincenzo Mazzaferro, Martina Verna, Cristina Mosconi, Rita Golfieri, Alessandro Cucchetti, Matteo Serenari, Enrico Garanzini, Angelo Vanzulli, Carlo Sposito, Ilaria Vicentin, Luciano De Carlis, Vicentin I., Mosconi C., Garanzini E., Sposito C., Serenari M., Buscemi V., Verna M., Spreafico C., Golfieri R., Mazzaferro V., De Carlis L., Cescon M., Ercolani G., Vanzulli A., Cucchetti A., Vicentin, I, Mosconi, C, Garanzini, E, Sposito, C, Serenari, M, Buscemi, V, Verna, M, Spreafico, C, Golfieri, R, Mazzaferro, V, De Carlis, L, Cescon, M, Ercolani, G, Vanzulli, A, and Cucchetti, A
Subjects: medicine.medical_specialty, Carcinoma, Hepatocellular, Intraclass correlation, Concordance, medicine.medical_treatment, Response Evaluation Criteria in Solid Tumor, Reproducibility of Result, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Retrospective Studie, medicine, Humans, Predictive value of test, Radiology, Nuclear Medicine and imaging, Chemoembolization, Therapeutic, Response Evaluation Criteria in Solid Tumors, Neoadjuvant therapy, Retrospective Studies, Neuroradiology, medicine.diagnostic_test, business.industry, Liver Neoplasms, Reproducibility of Results, Magnetic resonance imaging, General Medicine, medicine.disease, Liver Transplantation, Liver Neoplasm, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Predictive value of tests, Radiology, business, Human
Abstract: Objectives: To evaluate the inter-observer reliability of modified Response Evaluation Criteria In Solid Tumours (mRECIST) of patients with hepatocellular carcinoma (HCC) undergoing neo-adjuvant treatments before liver transplant (LT). The agreement of tumor number, size, transplant criteria, and the radiological-pathological concordance were also assessed. Methods: A total of 180 radiological studies before/after neo-adjuvant therapies performed on 90 patients prior to LT were reviewed from three expert centers. Kappa-statistic and intraclass correlation (ICC) were evaluated on mRECIST and on tumoral features. Complete radiological response (CR) was compared with complete pathological response (CPR). Results: Before neo-adjuvant therapies, the agreement on tumor number, size, and transplant criteria ranged from moderate (defined as ICC of 0.41–0.60) to almost perfect (ICC of 0.81–0.99), being higher with magnetic resonance imaging (MRI) than CT (0.657–0.899 and 0.422–0.776, respectively). After neo-adjuvant therapies, the agreement decreased, as ICCs ranged between 0.518 and 0.663 with MRI and between 0.508 and 0.677 with CT. Concordant mRECIST pairs were 201 of 270 reviews (76.3%) with a kappa of 0.648 indicating substantial agreement. When the three observers completely agreed on CR, the positive predictive value for CPR was 51.6%. The negative predictive value was 94.2% with a kappa of 0.512 indicating fair agreement between radiology and pathology. Conclusions: mRECIST agreement was substantial among the three observers involved. The agreement on tumor number, size, and transplant criteria ranged from moderate to almost perfect, with the highest ICCs obtained with MRI before neo-adjuvant therapies. Finally, the predictive value of mRECIST in the diagnosis of CPR was only fair. Key Points: • The review of 180 radiological exams of patients with hepatocellular carcinoma before and after neo-adjuvant therapies showed that the concordance among three different raters on mRECIST diagnosis was substantial. • The inter-observer reliability on fulfilment of transplant criteria slightly decreased when evaluated through CT and after loco-regional therapies. • The radiological diagnosis of complete response after neo-adjuvant therapies was predictive of complete pathological response in only 51.6% of cases.
Published: 2021

32. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation

Author: Bart van Hoek, Riccardo De Carlis, Philipp Dutkowski, Gonzalo Sapisochin, Luciano De Carlis, Danny van der Helm, Juan Carlos Caicedo, Erin Winter, Wojciech G. Polak, Humberto Bohorquez, Gabriel C. Oniscu, Fabrizio Di Benedetto, Amna Daud, Paolo Muiesan, V. Lucidi, Daniel Borja-Cacho, C. Burcin Taner, Nicolas Meurisse, Jacques Pirenne, Jeannette Widmer, Amelia J. Hessheimer, Matteo Ravaioli, Wayel Jassem, Mauricio Flores Carvalho, Aad P. van der Berg, Ahmed Sherif, Michele Colledan, Amit Nair, Renato Romagnoli, Diethard Monbaliu, Desislava Germanova, Cristiano Quintini, Andre Gorgen, Matteo Cescon, Sofie Vets, Marco P. A. W. Claasen, Massimo Malagó, Peter Lodge, Stefania Camagni, Kristopher P. Croome, Giorgio Rossi, Robert J. Porte, Ian P.J. Alwayn, Rebecca Panconesi, Maite Paolucci, Philipp Kron, Andrea Schlegel, Vincent E de Meijer, Annalisa Dolcet, Ina Jochmans, Charles Miller, Margherita Carbonaro, Pierre-Alain Clavien, Jan Nm Ijzermans, Constantino Fondevila, Damiano Patrono, Daniele Dondossola, Olivier Detry, Mohamed Elsharif, Koji Tomiyama, Alessandro Parente, Nigel Heaton, Herold J. Metselaar, Matteo Mueller, Tiziana Olivieri, George E. Loss, Marjolein van Reeven, Sarah Croome, Magdy Attia, Roberto Hernandez-Alejandro, Otto B. van Leeuwen, Groningen Institute for Organ Transplantation (GIOT), Center for Liver, Digestive and Metabolic Diseases (CLDM), Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Surgery, Gastroenterology & Hepatology, Schlegel A., van Reeven M., Croome K., Parente A., Dolcet A., Widmer J., Meurisse N., De Carlis R., Hessheimer A., Jochmans I., Mueller M., van Leeuwen O.B., Nair A., Tomiyama K., Sherif A., Elsharif M., Kron P., van der Helm D., Borja-Cacho D., Bohorquez H., Germanova D., Dondossola D., Olivieri T., Camagni S., Gorgen A., Patrono D., Cescon M., Croome S., Panconesi R., Carvalho M.F., Ravaioli M., Caicedo J.C., Loss G., Lucidi V., Sapisochin G., Romagnoli R., Jassem W., Colledan M., De Carlis L., Rossi G., Di Benedetto F., Miller C.M., van Hoek B., Attia M., Lodge P., Hernandez-Alejandro R., Detry O., Quintini C., Oniscu G.C., Fondevila C., Malago M., Pirenne J., IJzermans J.N.M., Porte R.J., Dutkowski P., Taner C.B., Heaton N., Clavien P.-A., Polak W.G., Muiesan P., Alwayn I.P.J., van der Berg A.P., Carbonaro M., Claasen M., Daud A., de Meijer V.E., Metselaar H.J., Monbaliu D., Paolucci M., Vets S., and Winter E.
Subjects: Male, Organ Dysfunction Scores, benchmarking, Donation after circulatory death, liver transplantation, morbidity, organ perfusion, risk analysis, IMPACT, medicine.medical_treatment, Kaplan-Meier Estimate, Liver transplantation, GUIDELINES, ALLOCATION, law.invention, Cohort Studies, Postoperative Complications, PROPOSAL, Interquartile range, law, Outcome Assessment, Health Care, risk analysi, Mortality rate, EXTENDED-CRITERIA DONORS, Shock, Middle Aged, Editorial from the ACHBPT, Intensive care unit, CARDIAC DEATH, Area Under Curve, Cohort, Female, medicine.medical_specialty, Tissue and Organ Procurement, BILIARY COMPLICATIONS, Cold storage, CLASSIFICATION, Internal medicine, SCORE, medicine, Humans, Renal replacement therapy, Aged, Proportional Hazards Models, GRAFT-SURVIVAL, Hepatology, business.industry, ROC Curve, Complication, business
Abstract: BACKGROUND: To identify the best possible outcomes in liver transplantation from donation after circulatory death donors (DCD) and to propose outcome values, which serve as reference for individual liver recipients or patient groups.METHODS: Based on 2219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1012 low-risk, primary, adult liver transplantations with a laboratory MELD of ≤20points, receiving a DCD liver with a total donor warm ischemia time of ≤30minutes and asystolic donor warm ischemia time of ≤15minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the Comprehensive Complication Index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered.RESULTS: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centers. The one-year retransplant and mortality rate was 5.23% and 9.01%, respectively. Within the first year of follow-up, 51.1% of recipients developed at least one major complication (≥Clavien-Dindo-Grade-III). Benchmark cut-offs were ≤3days and ≤16days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade-III), ≤16.8% for ischemic cholangiopathy, and ≤38.9CCI points at one-year posttransplant. Comparisons with higher risk groups showed more complications and impaired graft survival, outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk.CONCLUSIONS: Despite excellent 1-year survival, morbidity in benchmark cases remains high with more than half of recipients developing severe complications during 1-year follow-up. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk groups, and provide a valid comparator cohort for future clinical trials.LAY SUMMARY: The best possible outcomes after liver transplantation of grafts donated after circulatory death (DCD) were defined using the concept of benchmarking. These were based on 2219 liver transplantations following controlled DCD donation in 17 centres worldwide. The following benchmark cut-offs for the most relevant outcome parameters were developed: ICU and hospital stay: ≤3 and ≤16 days; primary non function: ≤2.5%; renal replacement therapy: ≤9.6%; ischemic cholangiopathy: ≤16.8% and anastomotic strictures ≤28.4%. One-year graft loss and mortality were defined as ≤14.4% and 9.6%, respectively. Donor and recipient combinations with higher risk had significantly worse outcomes. The use of novel organ perfusion technology achieved similar, good results in this high-risk group with prolonged donor warm ischemia time, when compared to the benchmark cohort.
Published: 2021

33. The Role of Salvage Transplantation in Patients Initially Treated With Open Versus Minimally Invasive Liver Surgery: An Intention-to-Treat Analysis

Author: Fabrizio Di Benedetto, Cristiano Guidetti, Gianluca Mennini, Matteo Cescon, Paolo Magistri, Fabio Ferla, Marco Colasanti, Salvatore Gruttadauria, E Balzano, Giovanni Battista Levi Sandri, Matteo Ravaioli, Fabrizio di Francesco, Quirino Lai, Matteo Serenari, Massimo Rossi, Luciano De Carlis, Giovanni Tincani, Stefano Di Sandro, Duilio Pagano, Paolo De Simone, Giuseppe Maria Ettorre, Levi Sandri G.B., Lai Q., Ravaioli M., Di Sandro S., Balzano E., Pagano D., Magistri P., Di Benedetto F., Rossi M., Gruttadauria S., De Simone P., Ettorre G.M., De Carlis L., Cescon M., Colasanti M., Mennini G., Serenari M., Ferla F., Tincani G., Francesco F.D., Guidetti C., Levi Sandri, G, Lai, Q, Ravaioli, M, DI Sandro, S, Balzano, E, Pagano, D, Magistri, P, DI Benedetto, F, Rossi, M, Gruttadauria, S, DE Simone, P, Ettorre, G, DE Carlis, L, and Cescon, M
Subjects: medicine.medical_specialty, Carcinoma, Hepatocellular, recurrence, medicine.medical_treatment, Liver, HCC, laparoscopy, laparoscopy, Salvage therapy, Liver transplantation, dropout, propensity score match, Carcinoma, Medicine, Hepatectomy, Humans, Prospective Studies, HCC, Prospective cohort study, Retrospective Studies, Salvage Therapy, Transplantation, Intention-to-treat analysis, Hepatology, business.industry, Liver Neoplasms, Retrospective cohort study, liver resection, medicine.disease, Surgery, Intention to Treat Analysis, Liver Transplantation, Liver, Italy, Liver function, Neoplasm Recurrence, Local, business
Abstract: Despite gaining wide consensus in the management of hepatocellular carcinoma (HCC), minimally invasive liver surgery (MILS) has been poorly investigated for its role in the setting of salvage liver transplantation (SLT). A multicenter retrospective analysis was carried out in 6 Italian centers on 211 patients with HCC who were initially resected with open (n=167) versus MILS (n=44) and eventually wait-listed for SLT. The secondary endpoint was identification of risk factors for posttransplant death and tumor recurrence. The enrolled patients included 211 HCC patients resected with open surgery (n=167) versus MILS (n=44) and wait-listed for SLT between January 2007 and December 2017. We analyzed the intention-to-treat survival of these patients. MILS was the most important protective factor for the composite risk of delisting, posttransplant patient death, and HCC recurrence (OR, 0.26; 95% confidence interval [CI], 0.11-0.63; P=0.003). MILS was also the only independent protective factor for the risk of post-SLT patient death (OR, 0.29; 95% CI, 0.09-0.93; P=0.04). After propensity score matching, MILS was the only independent protective factor against the risk of delisting, posttransplant death, and HCC recurrence (OR, 0.22; 95% CI, 0.07-0.75; P=0.02). On the basis of the current analysis, MILS seems protective over open surgery for the risk of delisting, posttransplant patient death, and tumor recurrence. Larger prospective studies balancing liver function and tumor stage are strongly favored to better clarify the beneficial effect of MILS for HCC patients eventually referred to SLT.
Published: 2020

34. Multicentre evaluation of case volume in minimally invasive hepatectomy

Author: L Viganò, M Cimino, L Aldrighetti, A Ferrero, U Cillo, A Guglielmi, G M Ettorre, F Giuliante, R Dalla Valle, V Mazzaferro, E Jovine, L De Carlis, F Calise, G Torzilli, F Ratti, E Gringeri, N Russolillo, G B Levi Sandri, F Ardito, U Boggi, S Gruttadauria, F Di Benedetto, G E Rossi, S Berti, G Ceccarelli, L Vincenti, G Belli, F Zamboni, A Coratti, P Mezzatesta, R Santambrogio, G Navarra, A Giuliani, A D Pinna, A Parisi, M Colledan, A Slim, A Antonucci, G L Grazi, A Frena, G Sgroi, A Brolese, L Morelli, A Floridi, A Patriti, L Veneroni, L Boni, P Maida, G Griseri, M Filauro, S Guerriero, G Tisone, R Romito, U Tedeschi, G Zimmitti, Vigano L., Cimino M., Aldrighetti L., Ferrero A., Cillo U., Guglielmi A., Ettorre G.M., Giuliante F., Dalla Valle R., Mazzaferro V., Jovine E., De Carlis L., Calise F., Torzilli G., Ratti F., Gringeri E., Russolillo N., Levi Sandri G.B., Ardito F., Boggi U., Gruttadauria S., Di Benedetto F., Rossi G.E., Berti S., Ceccarelli G., Vincenti L., Belli G., Zamboni F., Coratti A., Mezzatesta P., Santambrogio R., Navarra G., Giuliani A., Pinna A.D., Parisi A., Colledan M., Slim A., Antonucci A., Grazi G.L., Frena A., Sgroi G., Brolese A., Morelli L., Floridi A., Patriti A., Veneroni L., Boni L., Maida P., Griseri G., Filauro M., Guerriero S., Tisone G., Romito R., Tedeschi U., Zimmitti G., Vigano, L, Cimino, M, Aldrighetti, L, Ferrero, A, Cillo, U, Guglielmi, A, Ettorre, G, Giuliante, F, Dalla Valle, R, Mazzaferro, V, Jovine, E, De Carlis, L, Calise, F, Torzilli, G, Ratti, F, Gringeri, E, Russolillo, N, Levi Sandri, G, Ardito, F, Boggi, U, Gruttadauria, S, Di Benedetto, F, Rossi, G, Berti, S, Ceccarelli, G, Vincenti, L, Belli, G, Zamboni, F, Coratti, A, Mezzatesta, P, Santambrogio, R, Navarra, G, Giuliani, A, Pinna, A, Parisi, A, Colledan, M, Slim, A, Antonucci, A, Grazi, G, Frena, A, Sgroi, G, Brolese, A, Morelli, L, Floridi, A, Patriti, A, Veneroni, L, Boni, L, Maida, P, Griseri, G, Filauro, M, Guerriero, S, Tisone, G, Romito, R, Tedeschi, U, Zimmitti, G, Vigano, L., Cimino, M., Aldrighetti, L., Ferrero, A., Cillo, U., Guglielmi, A., Ettorre, G. M., Giuliante, F., Dalla Valle, R., Mazzaferro, V., Jovine, E., De Carlis, L., Calise, F., Torzilli, G., Ratti, F., Gringeri, E., Russolillo, N., Levi Sandri, G. B., Ardito, F., Boggi, U., Gruttadauria, S., Di Benedetto, F., Rossi, G. E., Berti, S., Ceccarelli, G., Vincenti, L., Belli, G., Zamboni, F., Coratti, A., Mezzatesta, P., Santambrogio, R., Navarra, G., Giuliani, A., Pinna, A. D., Parisi, A., Colledan, M., Slim, A., Antonucci, A., Grazi, G. L., Frena, A., Sgroi, G., Brolese, A., Morelli, L., Floridi, A., Patriti, A., Veneroni, L., Boni, L., Maida, P., Griseri, G., Filauro, M., Guerriero, S., Tisone, G., Romito, R., Tedeschi, U., and Zimmitti, G.
Subjects: Aged, Female, Hepatectomy, Humans, Italy, Liver Neoplasms, Male, Minimally Invasive Surgical Procedures, Registries, Retrospective Studies, Treatment Outcome, Liver surgery, Hepatic resection, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, Proposal, laparoscopy, Metastases, Liver resections, 0302 clinical medicine, minimally invasive liver surgery, case volume, Case volume, Laparascopic Liver Resection, minimally invasive hepatectomy, liver resections, 030220 oncology & carcinogenesis, high-volume centres, 030211 gastroenterology & hepatology, hepatectomy, laparoscopy, liver resections, Hepatocellular-Carcinome, medicine.medical_specialty, Outcomes, NO, 03 medical and health sciences, Hospital volume, medicine, minimally invasive, hepatectomy, LS7_4, business.industry, Retrospective cohort study, Laparascopic Liver Resection, Hepatocellular-Carcinome, Surgery, Outcomes, Metastases, Difficulty, Proposal, hepatectomy, Surgery, Severe morbidity, business, Difficulty
Abstract: Surgical outcomes may be associated with hospital volume and the influence of volume on minimally invasive liver surgery (MILS) is not known.Patients entered into the prospective registry of the Italian Group of MILS from 2014 to 2018 were considered. Only centres with an accrual period of at least 12 months and stable MILS activity during the enrolment period were included. Case volume was defined by the mean number of minimally invasive liver resections performed per month (MILS/month).A total of 2225 MILS operations were undertaken by 46 centres; nine centres performed more than two MILS/month (1376 patients) and 37 centres carried out two or fewer MILS/month (849 patients). The proportion of resections of anterolateral segments decreased with case volume, whereas that of major hepatectomies increased. Left lateral sectionectomies and resections of anterolateral segments had similar outcome in the two groups. Resections of posterosuperior segments and major hepatectomies had higher overall and severe morbidity rates in centres performing two or fewer MILS/month than in those undertaking a larger number (posterosuperior segments resections: overall morbidity 30·4 versus 18·7 per cent respectively, and severe morbidity 9·9 versus 4·0 per cent; left hepatectomy: 46 versus 22 per cent, and 19 versus 5 per cent; right hepatectomy: 42 versus 34 per cent, and 25 versus 15 per cent).A volume-outcome association existed for minimally invasive hepatectomy. Complex and major resections may be best managed in high-volume centres.Los resultados quirúrgicos pueden estar relacionados con el volumen de casos del hospital, pero no se conoce la influencia en la cirugía mínimamente invasiva del hígado (minimally‐invasive liver surgery, MILS). MÉTODOS: Se incluyeron los pacientes registrados en el registro prospectivo del grupo italiano de MILS desde 2014 a 2018. Solo se consideraron centros con extensión de ≥ 12 meses y actividad estable de MILS durante el periodo de reclutamiento. El volumen de casos se definió como el número de MILS efectuado por mes.Se llevaron a cabo un total de 2.225 MILS en 46 centros, 9 de ellos con 2 MILS/mes (n = 1.376 pacientes) y 37 centros con ≤ 2 MILS/mes (n = 849). La proporción de resecciones de segmentos anterolaterales disminuyó con el volumen de casos, mientras que la proporción de hepatectomías mayores aumentó. Los resultados para ambos grupos fueron similares en las seccionectomías lateral izquierda y en las resecciones del segmento anterolateral. Las resecciones del segmento posterosuperior y las hepatectomías mayores presentaron tasas más altas de morbilidad global y morbilidad grave en centros que realizaban ≤ 2 MILS/mes que en los que realizaban 2 MILS/mes (resecciones del segmento posterosuperior, morbilidad global 30,4 versus 18,7%, morbilidad grave 9,9 versus 4,0%; hepatectomía izquierda, 46,2 versus 22,0%, 19,2 versus 5,5%; hepatectomía derecha, 41,7 versus 33,8%, 25,0 versus 14.9%). CONCLUSIÓN: Se observó una asociación volumen‐resultado para la resección hepática mínimamente invasiva. Las resecciones complejas y mayores se pueden manejar mejor en centros de gran volumen.
Published: 2020

35. Colonization and infection due to carbapenemase-producing Enterobacteriaceae in liver and lung transplant recipients and donor-derived transmission: a prospective cohort study conducted in Italy

Author: Rosaria Carrinola, P. Paladini, A. Garcia Fernandez, M. Bonizzoli, E. Coluccio, Marco Spada, L. Henrici De Angelis, Alessandro Bertani, M. Valeri, Mauro Rinaldi, P. Di Ciaccio, Simone Ambretti, A. Ricci, Paolo Gaibani, Claudio Farina, L. De Carlis, Giulia Errico, S. D’Arezzo, F. Vailati, M. Canzonieri, M. Caprio, Antonio Daniele Pinna, E. Carrara, Giorgio Palù, G. Feltrin, Francesco Pugliese, C. Rago, M. Ravini, G. Sangiorgi, R. Colombo, P. Cambieri, C. De Cillia, Pier Giulio Conaldi, B. D’Auria, Erminio Torresani, G. P. Gesu, Alessandra Mularoni, A De Gasperi, Giorgio Rossi, A. Peris, Bruno Gridelli, Milena Arghittu, Mauro Salizzoni, Saverio Giuseppe Parisi, Paolo Grossi, M. Platto, V. Sparacino, P. Viale, Lucia Masiero, A. Nanni Costa, M. P. Landini, A. Da Riva, Daniele Dondossola, Antonio Amoroso, Carlo Gagliotti, R. Torelli, D. Adorno, M. Cusi, Floriana Gona, Luigia Rossi, P.B. Berloco, G. Paglialunga, Federico Venuta, Piero Marone, U. Cillo, Francesca Vespasiano, A C Finarelli, L. Fossati, Davide Tosi, A. Maria D’Armini, Federica Maldarelli, Massimiliano Rossi, Federico Rea, Francesco Procaccio, Michele Colledan, Annalisa Pantosti, Filomena Morsillo, C. Vismara, R. Giacometti, Sergio Vesconi, C. Mancini, C. Venditti, Francesca Puoti, Luigi Santambrogio, A. Di Caro, Maria Luisa Moro, F. Stella, E. Cibelli, Monica Monaco, Errico G., Gagliotti C., Monaco M., Masiero L., Gaibani P., Ambretti S., Landini M.P., D'Arezzo S., Di Caro A., Parisi S.G., Palu G., Vespasiano F., Morsillo F., Moro M.L., Procaccio F., Ricci A., Grossi P.A., Pantosti A., Nanni Costa A., Farina C., Vailati F., Gesu G., Vismara C., Arghittu M., Colombo R., Torresani E., Rossi L., Conaldi P.G., Gona F., Cambieri P., Marone P., Venditti C., Fernandez A.G., Mancini C., Cusi M., De Angelis L.H., Fossati L., Finarelli A.C., De Cillia C., Sangiorgi G., Pinna A.D., Stella F., Viale P., Colledan M., Platto M., Bonizzoli M., Peris A., Torelli R., Vesconi S., Cibelli E., De Carlis L., De Gasperi A., Ravini M., Carrinola R., Coluccio E., Dondossola D., Rossi G., Santambrogio L., Tosi D., Feltrin G., Rago C., Cillo U., Da Riva A., Rea F., Sparacino V., Bertani A., Canzonieri M., Gridelli B., Mularoni A., Spada M., Carrara E., D'Armini A.M., Paladini P., Adorno D., Valeri M., Caprio M., Di Ciaccio P., Puoti F., Berloco P., D'Auria B., Maldarelli F., Paglialunga G., Pugliese F., Rossi M., Venuta F., Amoroso A., Giacometti R., Rinaldi M., Salizzoni M., Errico, G, Gagliotti, C, Monaco, M, Masiero, L, Gaibani, P, Ambretti, S, Landini, M, D'Arezzo, S, Di Caro, A, Parisi, S, Palu, G, Vespasiano, F, Morsillo, F, Moro, M, Procaccio, F, Ricci, A, Grossi, P, Pantosti, A, Nanni Costa, A, Farina, C, Vailati, F, Gesu, G, Vismara, C, Arghittu, M, Colombo, R, Torresani, E, Rossi, L, Conaldi, P, Gona, F, Cambieri, P, Marone, P, Venditti, C, Fernandez, A, Mancini, C, Cusi, M, De Angelis, L, Fossati, L, Finarelli, A, De Cillia, C, Sangiorgi, G, Pinna, A, Stella, F, Viale, P, Colledan, M, Platto, M, Bonizzoli, M, Peris, A, Torelli, R, Vesconi, S, Cibelli, E, De Carlis, L, De Gasperi, A, Ravini, M, Carrinola, R, Coluccio, E, Dondossola, D, Rossi, G, Santambrogio, L, Tosi, D, Feltrin, G, Rago, C, Cillo, U, Da Riva, A, Rea, F, Sparacino, V, Bertani, A, Canzonieri, M, Gridelli, B, Mularoni, A, Spada, M, Carrara, E, D'Armini, A, Paladini, P, Adorno, D, Valeri, M, Caprio, M, Di Ciaccio, P, Puoti, F, Berloco, P, D'Auria, B, Maldarelli, F, Paglialunga, G, Pugliese, F, Rossi, M, Venuta, F, Amoroso, A, Giacometti, R, Rinaldi, M, and Salizzoni, M
Subjects: 0301 basic medicine, Male, Colonization, Klebsiella pneumoniae, medicine.medical_treatment, Drug Resistance, Transplant Recipient, Liver transplantation, beta-Lactamase, Cohort Studies, 0302 clinical medicine, 80 and over, 030212 general & internal medicine, Prospective Studies, Screening cultures, Prospective cohort study, Child, Aged, 80 and over, biology, Bacterial, Enterobacteriaceae Infections, General Medicine, Middle Aged, Tissue Donors, Infectious Diseases, Italy, Child, Preschool, Female, Infection, Human, Lung Transplantation, Adult, Microbiology (medical), medicine.medical_specialty, Adolescent, 030106 microbiology, Tissue Donor, Bacterial Protein, beta-Lactamases, 03 medical and health sciences, Young Adult, Bacterial Proteins, Internal medicine, Drug Resistance, Bacterial, medicine, Humans, Preschool, Genotyping, Contraindication, Donor–recipient transmission, Aged, business.industry, CPE, Solid organ transplant, Infant, Liver Transplantation, Transplant Recipients, Carbapenem-Resistant Enterobacteriaceae, biochemical phenomena, metabolism, and nutrition, biology.organism_classification, Enterobacteriaceae Infection, Transplantation, Prospective Studie, Multilocus sequence typing, Cohort Studie, business
Abstract: Objectives A prospective cohort study was conducted in Italy in order to describe the microbiologic aspects of colonization/infection by carbapenemase-producing Enterobacteriaceae (CPE) in donors and recipients of lung and liver transplants and the possible CPE transmission from donors to recipients. Methods Between 15 January 2014 and 14 January 2015, all recipients of solid organ transplants (SOT) at ten lung and eight liver transplantation centres and the corresponding donors were enrolled. Screening cultures to detect CPE were performed in donors, and screening and clinical cultures in recipients with a 28-day microbiologic follow-up after receipt of SOT. Detection of carbapenemase genes by PCR, genotyping by multilocus sequence typing, and pulsed-field gel electrophoresis and whole-genome sequencing were performed. Results Of 588 screened donors, 3.4% were colonized with CPE. Of the liver first transplant recipients (n = 521), 2.5% were colonized before receipt of SOT and 5% acquired CPE during follow-up. CPE colonization was higher in lung first transplant recipients (n = 111, 2.7% before SOT and 14.4% after SOT). CPE infections occurred in 1.9% and 5.3% of liver or lung recipients, respectively. CPE isolates were mostly Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae belonging to CG258. Three events of donor–recipient CPE transmission, confirmed by whole-genome sequencing and/or pulsed-field gel electrophoresis, occurred in lung recipients: two involving K. pneumoniae sequence type 512 and one Verona integron-encoded metallo-β-lactamase (VIM)-producing Enterobacter aerogenes. Conclusions This study showed a low risk of donor–recipient CPE transmission, indicating that donor CPE colonization does not necessarily represent a contraindication for donation unless colonization regards the organ to be transplanted. Donor and recipient screening remains essential to prevent CPE transmission and cross-infection in transplantation centres.
Published: 2019

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

Author: Mauro Salizzoni, Marco Spada, Vincenzo Mazzaferro, Matteo Cescon, Umberto Tedeschi, Umberto Cillo, Luciano De Carlis, Andrea Risaliti, Stefania Camagni, Fausto Zamboni, S. Trapani, Massimo Rossi, Luigi Lupo, Giuseppe Maria Ettorre, Alessandro Nanni Costa, W. Santaniello, Paolo De Simone, Giuseppe Tisone, Giorgio Rossi, Michele Colledan, Enzo Andorno, L. Rizzato, Enrico Gringeri, Roberta Angelico, Salvatore Agnes, Chiara Grimaldi, Salvatore Gruttadauria, Francesca Puoti, Fabrizio Di Benedetto, Jean de Ville de Goyet, Marco Vivarelli, 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.
Subjects: Adult, Male, medicine.medical_specialty, organ allocation, Graft failure, Tissue and Organ Procurement, genetic structures, pediatrics, Adolescent, donors and donation, clinical research/practice, health services and outcomes research, liver transplantation/hepatology, liver transplantation: split, organ procurement and allocation, waitlist management, medicine.medical_treatment, split, Female, Follow-Up Studies, Hepatectomy, Humans, Liver Diseases, Liver Transplantation, Middle Aged, Patient Selection, Prospective Studies, Retrospective Studies, Tissue Donors, Treatment Outcome, Young Adult, Graft Survival [clinical research/practice, liver transplantation], Ischemic time, Liver transplantation, Immunology and Allergy, Transplantation, Pharmacology (medical), Standard Risk, Internal medicine, medicine, split [liver transplantation], business.industry, Graft Survival, Settore MED/18, pediatric, Split liver transplantation, business, Erg
Abstract: To implement split liver transplantation (SLT) a mandatory-split policy has been adopted in Italy since August 2015: donors aged 18-50years 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% [P20kg (HR=5.113, P=.048) in LLS, and ischemic time >8hours (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

37. A matched pair analysis of multicenter longterm follow-up after split-liver transplantation with extended right grafts

Author: Enzo Andorno, Mitchell W. Ross, Luciano De Carlis, Marco Spada, Michele Colledan, Vincenzo Mazzaferro, Roberta Angelico, Duilio Pagano, Massimo Rossi, Fabio Tuzzolino, George V. Mazariegos, Matteo Cescon, Giorgio Rossi, Bruno Gridelli, Umberto Cillo, Salvatore Gruttadauria, Giuseppe Tisone, Umberto Baccarani, Antonio Daniele Pinna, Ross MW, Cescon M, Angelico R, Andorno E, Rossi G, Pinna A, De Carlis L, Baccarani U, Cillo U, Colledan M, Mazzaferro V, Tisone G, Rossi M, Tuzzolino F, Pagano D, Gruttadauria S, Mazariegos G, Gridelli B, Spada M, Ross, M, Cescon, M, Angelico, R, Andorno, E, Rossi, G, Pinna, A, De Carlis, L, Baccarani, U, Cillo, U, Colledan, M, Mazzaferro, V, Tisone, G, Rossi, M, Tuzzolino, F, Pagano, D, Gruttadauria, S, Mazariegos, G, Gridelli, B, and Spada, M
Subjects: Male, Time Factors, medicine.medical_treatment, 030230 surgery, Liver transplantation, 0302 clinical medicine, Risk Factors, Retrospective Studie, education.field_of_study, Graft Survival, whole liver transplantation, Middle Aged, Adolescent, Adult, End Stage Liver Disease, Female, Follow-Up Studies, Humans, Italy, Liver Transplantation, Matched-Pair Analysis, Patient Selection, Reoperation, Retrospective Studies, Survival Analysis, Treatment Outcome, Young Adult, 030211 gastroenterology & hepatology, Survival Analysi, Human, long-term outcome, medicine.medical_specialty, extended right graft, Time Factor, Population, Follow-Up Studie, Split liver transplantation, 03 medical and health sciences, Internal medicine, medicine, Risk factor, education, Matched-Pair Analysi, Survival rate, Survival analysis, posttransplant, organ sharing, Transplantation, Hepatology, business.industry, Risk Factor, Retrospective cohort study, Settore MED/18, Surgery, business
Abstract: Split-liver transplantation has been proposed as an alternative to whole liver (WL) transplantation to expand the donor pool, but studies comparing adult longterm outcomes between the 2 methods are conflicting and limited. This is the first Italian multicenter study that retrospectively analyzed 119 matched-pair recipients of whole and extended right grafts (ERGs) for longterm survival outcomes. In the overall population, WL recipients showed higher patient survival at 1 (93% versus 73%), 5 (87% versus 65%), and 10 years (83% versus 60%) after transplantation compared with split-liver recipients (P < 0.001); graft survivals of WL recipients were also superior at 1 (90% versus 76%), 5 (84% versus 57%), and 10 years (81% versus 52%) posttransplant (P < 0.001). However, among the 81 matched pairs that survived the first posttransplant year, 5- and 10-year patient survivals were 90% and 81% for split recipients and 99% and 96% for whole recipients, respectively (P = 0.34). The 5- and 10-year graft survivals were also comparable: 87% and 77% for split recipients, and 86% and 82% for whole recipients (P = 0.86). Cox regression analysis identified donor age >50, donor-to-recipient weight ratio < 1, retransplantation status, and United Network for Organ Sharing I-IIA status as risk factors for partial graft use. There were no significant differences in 5-year outcomes based on center volume. In conclusion, we demonstrate that adult liver transplantation with ERGs can achieve longterm success comparable with that of whole grafts in appropriate patients but should be selectively used in patients with risk factors. Liver Transplantation 23 1384–1395 2017 AASLD.
Published: 2017

38. [Surgical overview on kidney and pancreas transplantation]

Author: Capocasale, Enzo, Berardinelli, Luisa, Beretta, Claudio, Berloco, Pasquale, UGO BOGGI, Boschiero, Luigino, Bretto, Piero, Carmellini, Mario, Citterio, Franco, Concone, Giacomo, Carlis, Luciano, Rosa, Paride, Del Gaudio, Massimo, Di Sandro, Stefano, Di Tonno, Pasquale, Faenza, Alessandro, Famulari, Antonio, Giacomoni, Alessandro, Giovannoni, Massimo, Iaria, Maurizio, Lauterio, Andrea, Lasaponara, Fedele, Mazzoni, Maria Patrizia, Nicita, Giulio, Orsenigo, Elena, Parolini, Danilo Carlo, Pietrabissa, Andrea, Pinna, Antonio Daniele, Pisani, Franco, Ravaioli, Matteo, Rigotti, Paolo, Romagnoli, Jacopo, Rossetti, Ornella, Secchi, Antonio, Socci, Carlo, FABIO VISTOLI, Capocasale, E., Berardinelli, L., Beretta, C., Berloco, P., Boggi, U., Boschiero, L., Bretto, P., Carmellini, M., Citterio, F., Concone, G., De Carlis, L., De Rosa, P., Del Gaudio, M., Di Sandro, S., Di Tonno, P., Faenza, A., Famulari, A., Giacomoni, A., Giovannoni, M., Iaria, M., Lauterio, A., Lasaponara, F., Mazzoni, M. P., Nicita, G., Orsenigo, E., Parolini, D. C., Pietrabissa, A., Pinna, A. D., Pisani, F., Ravaioli, M., Rigotti, P., Romagnoli, J., Rossetti, O., Secchi, A., Socci, C., Vistoli, F., Capocasale, E, Berardinelli, L, Beretta, C, Berloco, P, Boggi, U, Boschiero, L, Bretto, P, Carmellini, M, Citterio, F, Concone, G, De Carlis, L, De Rosa, P, Del Gaudio, M, Di Sandro, S, Di Tonno, P, Faenza, A, Famulari, A, Giacomoni, A, Giovannoni, M, Iaria, M, Lauterio, A, Lasaponara, F, Mazzoni, M, Nicita, G, Orsenigo, E, Parolini, D, Pietrabissa, A, Pinna, A, Pisani, F, Ravaioli, M, Rigotti, P, Romagnoli, J, Rossetti, O, Secchi, A, Socci, C, and Vistoli, F
Subjects: Settore MED/18 - CHIRURGIA GENERALE, Medicine (all), Patient Selection, Pancreatic Diseases, Humans, Kidney Diseases, Nephrectomy, Pancreatectomy, Perioperative Care, Postoperative Complications, Practice Guidelines as Topic, Tissue and Organ Harvesting, Kidney Transplantation, Pancreas Transplantation
Abstract: The main purpose of this paper, written by a group of Italian expert transplant surgeons, is to provide clinical support and to help through the decision-making process over pre-transplant surgical procedures in potential kidney recipients, as well as selection of pancreas transplant candidates and perioperative management of kidney recipient. Current topics such as different approaches in minimally invasive donor nephrectomy, methods of graft preservation and treatment of failed allograft were addressed.
Published: 2016

39. Prolonged preservation by hypothermic machine perfusion facilitates logistics in liver transplantation

Author: Isabel M.A. Brüggenwirth, Matteo Mueller, Veerle A. Lantinga, Stefania Camagni, Riccardo De Carlis, Luciano De Carlis, Michele Colledan, Daniele Dondossola, Moritz Drefs, Janina Eden, Davide Ghinolfi, Dionysios Koliogiannis, Georg Lurje, Tommaso M. Manzia, Diethard Monbaliu, Paolo Muiesan, Damiano Patrono, Johann Pratschke, Renato Romagnoli, Michel Rayar, Federico Roma, Andrea Schlegel, Philipp Dutkowski, Robert J. Porte, Vincent E. de Meijer, Brüggenwirth, I, Mueller, M, Lantinga, V, Camagni, S, De Carlis, R, De Carlis, L, Colledan, M, Dondossola, D, Drefs, M, Eden, J, Ghinolfi, D, Koliogiannis, D, Lurje, G, Manzia, T, Monbaliu, D, Muiesan, P, Patrono, D, Pratschke, J, Romagnoli, R, Rayar, M, Roma, F, Schlegel, A, Dutkowski, P, Porte, R, de Meijer, V, Groningen Institute for Organ Transplantation (GIOT), Center for Liver, Digestive and Metabolic Diseases (CLDM), and Faculteit Medische Wetenschappen/UMCG
Subjects: liver allograft function, liver allograft function/dysfunction, graft survival, organ procurement and allocation, Hypothermia, GUIDELINES, clinical research/practice, Cohort Studies, Immunology and Allergy, Humans, Pharmacology (medical), solid organ transplantation, Transplantation, Science & Technology, dysfunction, liver transplantation, organ perfusion and preservation, DEATH, Organ Preservation, practice, Liver Transplantation, Settore MED/18, Perfusion, ischemia reperfusion injury (IRI), liver transplantation/hepatology, organ acceptance, DEFINITION, Liver, clinical research, hepatology, Surgery, DONATION, Life Sciences & Biomedicine, STORAGE
Abstract: A short period (1-2 h) of hypothermic oxygenated machine perfusion (HOPE) after static cold storage is safe and reduces ischemia-reperfusion injury-related complications after liver transplantation. Machine perfusion time is occasionally prolonged for logistical reasons, but it is unknown if prolonged HOPE is safe and compromises outcomes. We conducted a multicenter, observational cohort study of patients transplanted with a liver preserved by prolonged (≥4 h) HOPE. Postoperative biochemistry, complications, and survival were evaluated. The cohort included 93 recipients from 12 European transplant centers between 2014-2021. The most common reason to prolong HOPE was the lack of an available operating room to start the transplant procedure. Grafts underwent HOPE for a median (range) of 4:42 h (4:00-8:35 h) with a total preservation time of 10:50 h (5:50-20:50 h). Postoperative peak ALT was 675 IU/L (interquartile range 419-1378 IU/L). The incidence of postoperative complications was low, and 1-year graft and patient survival were 94% and 88%, respectively. To conclude, good outcomes are achieved after transplantation of donor livers preserved with prolonged (median 4:42 h) HOPE, leading to a total preservation time of almost 21 h. These results suggest that simple, end-ischemic HOPE may be utilized for safe extension of the preservation time to ease transplantation logistics. ispartof: AMERICAN JOURNAL OF TRANSPLANTATION vol:22 issue:7 pages:1842-1851 ispartof: location:United States status: published
Published: 2022
Full Text: View/download PDF

40. Hepatitis C virus recurrence after liver transplantation: a 10-year evaluation

Author: Roberto Di Donato, Mauro Bernardi, Marcello Vangeli, Antonio Daniele Pinna, Luciano De Carlis, Luca S. Belli, Stefania Lorenzini, Ranka Vukotic, Arrigo F G Cicero, Matteo Cescon, Arianna Martello Panno, Pietro Andreone, Gian Luca Grazi, Stefano Gitto, Aldo Airoldi, Lucia Brodosi, Gitto S, Belli LS, Vukotic R, Lorenzini S, Airoldi A, Cicero AF, Vangeli M, Brodosi L, Martello Panno A, Di Donato R, Cescon M, Grazi GL, De Carlis L, Pinna AD, Bernardi M, Andreone P., Gitto, S, Belli, L, Vukotic, R, Lorenzini, S, Airoldi, A, Cicero, A, Vangeli, M, Brodosi, L, Panno, A, Di Donato, R, Cescon, M, Grazi, G, De Carlis, L, Pinna, A, Bernardi, M, and Andreone, P
Subjects: Male, Time Factors, medicine.medical_treatment, Hepacivirus, Kaplan-Meier Estimate, Liver transplantation, Ten-year survival, Gastroenterology, Risk Factors, Recurrence, Retrospective Studie, Odds Ratio, Multivariate Analysi, General Medicine, Hepatitis C, Middle Aged, Exact test, Treatment Outcome, Italy, ANTIVIRAL TERAPHY, HEPATITIS C, SURVIVAL, Drug Therapy, Combination, Female, Viral hepatitis, LIVER TRANSPLANTATION, HEPATITIS C RECURRENCE, Human, Adult, medicine.medical_specialty, Logistic Model, Time Factor, Antiviral treatment, Hepatitis C virus recurrence, Antiviral Agents, NO, Hepatitis C, Liver transplantation, hepatitis C virus recurrence, Antiviral treatment, Ten-year survival, End Stage Liver Disease, Internal medicine, medicine, Humans, Retrospective Cohort Study, Survival rate, Survival analysis, Proportional Hazards Models, Retrospective Studies, Antiviral Agent, Chi-Square Distribution, Hepaciviru, Proportional hazards model, business.industry, Risk Factor, medicine.disease, Surgery, Transplantation, Logistic Models, Multivariate Analysis, Proportional Hazards Model, Virus Activation, business
Abstract: AIM: To evaluate the predictors of 10-year survival of patients with hepatitis C recurrence. /// METHODS: Data from 358 patients transplanted between 1989 and 2010 in two Italian transplant centers and with evidence of hepatitis C recurrence were analyzed. A χ 2, Fisher's exact test and Kruskal Wallis' test were used for categorical and continuous variables, respectively. Survival analysis was performed at 10 years after transplant using the Kaplan-Meier method, and a log-rank test was used to compare groups. A p level less than 0.05 was considered significant for all tests. Multivariate analysis of the predictive role of different variables on 10-year survival was performed by a stepwise Cox logistic regression./// RESULTS: The ten-year survival of the entire popu lation was 61.2%. Five groups of patients were identified according to the virological response or lack of a response to antiviral treatment and, among those who were not treated, according to the clinical status (mild hepatitis C recurrence, "too sick to be treated" and patients with comorbidities contraindicating the treatment). While the 10-year survival of treated and untreated patients was not different (59.1% vs 64.7%, p = 0.192), patients with a sustained virological response had a higher 10-year survival rate than both the "non-responders" (84.7% vs 39.8%, p < 0.0001) and too sick to be treated (84.7% vs 0%, p < 0.0001). Sustained virological responders had a survival rate comparable to patients untreated with mild recurrence (84.7% vs 89.3%). A sustained virological response and young donor age were independent predictors of 10-year survival./// CONCLUSION: Sustained virological response significantly increased long-term survival. Awaiting the interferon-free regimen global availability, antiviral treatment might be questionable in selected subjects with mild hepatitis C recurrence.
Published: 2015

41. Liver transplantation for severe alcoholic hepatitis: A multicenter Italian study

Author: Giacomo Germani, Debora Angrisani, Giovanni Addolorato, Manuela Merli, Chiara Mazzarelli, Claudia Tarli, Barbara Lattanzi, Adelaide Panariello, Paola Prandoni, Lucia Craxì, Giovanni Forza, Alessandra Feltrin, Andrea Ronzan, Paolo Feltracco, Antonio Grieco, Salvatore Agnes, Antonio Gasbarrini, Massimo Rossi, Luciano De Carlis, Francesco D’Amico, Umberto Cillo, Luca S. Belli, Patrizia Burra, Germani Giacomo, Belli Luca Saverio, Addolorato Giovanni, Merli Manuela, Mazzelli Chiara, Tarli Claudia, Lattanzi Barbara, Angrisani Debora, Panariello Adelaide, Craxì Lucia, Forza Giovanni, Feltrin Alessandra, Ronza Andrea, Feltracco Paolo, Cillo Umberto, Burra Patrizia, Germani, G, Angrisani, D, Addolorato, G, Merli, M, Mazzarelli, C, Tarli, C, Lattanzi, B, Panariello, A, Prandoni, P, Craxi, L, Forza, G, Feltrin, A, Ronzan, A, Feltracco, P, Grieco, A, Agnes, S, Gasbarrini, A, Rossi, M, De Carlis, L, Francesco, D, Cillo, U, Belli, L, and Burra, P
Subjects: Male, clinical decision-making, Transplantation, Waiting Lists, alcoholism and substance abuse, Hepatitis, Alcoholic, Patient Selection, alllocation, Settore MED/09 - MEDICINA INTERNA, clinical research/practice, liver transplantation/hepatology, alcoholic hepatiti, Middle Aged, Liver Transplantation, Recurrence, MED/18 - CHIRURGIA GENERALE, Humans, Immunology and Allergy, Female, ethic, Pharmacology (medical), Liver transplant
Abstract: There is increasing evidence that early liver transplantation (eLT), performed within standardized protocols can improve survival in severe alcoholic hepatitis (sAH). The aim of the study was to assess outcomes after eLT for sAH in four Italian LT centers and to compare them with non-responders to medical therapy excluded from eLT. Patients admitted for sAH (2013–2019), according to NIAAA criteria, were included. Patients not responding to medical therapy were placed on the waiting list for eLT after a strict selection. Histological features of explanted livers were evaluated. Posttransplant survival and alcohol relapse were evaluated. Ninety-three patients with severe AH were evaluated (65.6% male, median [IQR] age: 47 [42–56] years). Forty-five of 93 patients received corticosteroids, 52 of 93 were non-responders and among these, 20 patients were waitlisted. Sixteen patients underwent LT. Overall, 6-, 12-, and 24-month survival rates were 100% significantly higher compared with non-responders to medical therapy who were denied LT (45%, 45%, and 36%; p&nbsp
Published: 2022
Full Text: View/download PDF

42. Portal Steal Syndrome From a Large Linton’s Splenorenal Shunt after Liver Transplantation: Successful Endovascular Management Through Off-Label Application of a 30 mm Amplatzer Cardiac Plug

Author: Leonardo Centonze, Ivan Vella, Francesco Morelli, Giuliana Checchini, Riccardo De Carlis, Antonio Rampoldi, Andrea Lauterio, Enzo Andorno, Luciano De Carlis, Centonze, L, Vella, I, Morelli, F, Checchini, G, De Carlis, R, Rampoldi, A, Lauterio, A, Andorno, E, and De Carlis, L
Subjects: Adult, surgical portosystemic shunt, Liver transplantation, Portal Vein, Endovascular Procedures, Off-Label Use, General Medicine, Amplatzer cardiac plug, Treatment Outcome, portal steal syndrome, MED/18 - CHIRURGIA GENERALE, Humans, Surgery, Cardiology and Cardiovascular Medicine, Splenorenal Shunt, Surgical
Abstract: A 34-year-old patient underwent liver transplantation for progressive hepatic failure in the setting of congenital hepatic fibrosis. In past medical history, the patient had undergone splenectomy with proximal Linton’s splenorenal surgical shunt creation for symptomatic portal hypertension with hypersplenism. The patient developed an early allograft dysfunction, with radiologic evidence of a reduced portal flow associated to portal steal from the patent surgical shunt. The patient was successfully treated through endovascular placement of a 30 mm Amplatzer cardiac plug at the origin of the splenic vein.
Published: 2022
Full Text: View/download PDF

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

Author: Mario Angelico, Alessandra Nardi, Renato Romagnoli, Tania Marianelli, Stefano Ginanni Corradini, Francesco Tandoi, Caius Gavrila, Mauro Salizzoni, Antonio D. Pinna, Umberto Cillo, Bruno Gridelli, Luciano G. De Carlis, Michele Colledan, Giorgio E. Gerunda, Alessandro Nanni Costa, Mario Strazzabosco, M. Angelico, U. Cillo, S. Fagiuoli, M. Strazzabosco, P. Caraceni, P.L. Toniutto, A. Nanni Costa, Torino M. Salizzoni, R. Romagnoli, G. Bertolotti, D. Patrono, L. De Carlis, A. Slim, J.M.E. Mangoni, G. Rossi, L. Caccamo, B. Antonelli, V. Mazzaferro, E. Regalia, C. Sposito, M. Colledan, V. Corno, F. Tagliabue, S. Marin, A. Vitale, E. Gringeri, M. Donataccio, D. Donataccio, U. Baccarani, D. Lorenzin, D. Bitetto, U. Valente, M. Gelli, P. Cupo, G.E. Gerunda, G. Rompianesi, A.D. Pinna, G.L. Grazi, A. Cucchetti, C. Zanfi, A. Risaliti, M.G. Faraci, G. Tisone, A. Anselmo, I. Lenci, D. Sforza, S. Agnes, M. Di Mugno, A.W. Avolio, G.M. Ettorre, L. Miglioresi, G. Vennarecci, P. Berloco, M. Rossi, S. Ginanni Corradini, A. Molinaro, F. Calise, V. Scuderi, O. Cuomo, C. Migliaccio, L. Lupo, G. Notarnicola, B. Gridelli, R. Volpes, S. Li Petri, F. Zamboni, G. Carbotta, S. Dedola, A. Nardi, T. Marianelli, C. Gavrila, A. Ricci, F. Vespasiano, Angelico, M., Nardi, A., Romagnoli, R., Marianelli, T., Corradini, S. G., Tandoi, F., Gavrila, C., Salizzoni, M., Pinna, A. D., Cillo, U., Gridelli, B., De Carlis, L. G., Colledan, M., Gerunda, G. E., Costa, A. N., Strazzabosco, M., Fagiuoli, S., Caraceni, P., Toniutto, P. L., Sal-izzoni, T. M., Bertolotti, G., Patrono, D., Decarlis, L., Slim, A., Mangoni, J. M. E., Rossi, G., Caccamo, L., Antonelli, B., Mazzaferro, V., Regalia, E., Sposito, C., Corno, V., Marin, S., Vitale, A., Gringeri, E., Donataccio, M., Donataccio, D., Baccarani, U., Lorenzin, D., Bitetto, D., Valente, U., Gelli, M., Cupo, P., Rompianesi, G., Grazi, G. L., Cucchetti, A., Zanfi, C., Risaliti, A., Faraci, M. G., Tisone, G., Anselmo, A., Lenci, I., Sforza, D., Agnes, S., Di Mugno, M., Avolio, A. M., Ettorre, G. M., Miglioresi, L., Vennarecci, G., Berloco, P., Rossi, M., Corradini, G., Molinaro, A., Calise, F., Scuderi, V., Cuomo, O., Migliaccio, C., Lupo, L., Notarnicola, G., Volpes, R., Lipetri, S., Zamboni, G., Carbotta, G., Dedola, S., 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, and Fagiuoli, S
Subjects: Graft Rejection, Male, liver match, Multivariate analysis, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, Disease, Liver transplantation, Body Mass Index, Cohort Studies, MED/12 - GASTROENTEROLOGIA, Risk Factors, liver transplantation, early graft loss, Age Factor, Prospective Studies, Multivariate Analysi, hepatitis c, donor risk index, donor-recipient match, graft failure, transplantation outcome, risk factors, Donor Risk Index, Donor-recipient match, Graft failure, Hepatitis C, Risk factors, Transplantation outcome, Settore MED/12 - Gastroenterologia, Cold Ischemia, Graft Survival, Age Factors, Gastroenterology, Middle Aged, Tissue Donors, Treatment Outcome, Italy, Cohort, Female, Human, Adult, United Network for Organ Sharing, medicine.medical_specialty, Tissue Donor, Delayed Graft Function, Bayesan methodology, Risk Assessment, End Stage Liver Disease, medicine, Humans, Aged, Proportional Hazards Models, Hepatology, business.industry, Proportional hazards model, Risk Factor, Bayes Theorem, medicine.disease, Surgery, Prospective Studie, Multivariate Analysis, Proportional Hazards Model, Cohort Studie, Primary Graft Dysfunction, business, Body mass index, Transplantation Outcome
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

44. COVID-19 in liver transplant candidates

Author: Belli, Luca Saverio, Duvoux, Christophe, Cortesi, Paolo Angelo, Facchetti, Rita, Iacob, Speranta, Perricone, Giovanni, Radenne, Sylvie, Conti, Sara, Patrono, Damiano, Berlakovich, Gabriela, Hann, Angus, Pasulo, Luisa, Castells, Lluis, Faitot, Francois, Detry, Olivier, Invernizzi, Federica, Magini, Giulia, De Simone, Paolo, Kounis, Ilias, Morelli, Maria Cristina, Díaz Fontenla, Fernando, Ericzon, Bo-Göran, Loinaz, Carmelo, Johnston, Chris, Gheorghe, Liliana, Lesurtel, Mickael, Romagnoli, Renato, Kollmann, Dagmar, Perera, M Thamara Pr, Fagiuoli, Stefano, Mirza, Darius, Coilly, Audrey, Toso, Christian, Zieniewicz, Krzysztof, Elkrief, Laure, Karam, Vincent, Adam, Rene, den Hoed, Caroline, Merli, Marco, Puoti, Massimo, De Carlis, Luciano, Oniscu, Gabriel C, Piano, Salvatore, Angeli, Paolo, Fondevila, Constantino, Polak, Wojciech G, ELITA-ELTR COVID-19 Registry, Gastroenterology & Hepatology, Surgery, Belli, L, Duvoux, C, Cortesi, P, Facchetti, R, Iacob, S, Perricone, G, Radenne, S, Conti, S, Patrono, D, Berlakovich, G, Hann, A, Pasulo, L, Castells, L, Faitot, F, Detry, O, Invernizzi, F, Magini, G, De Simone, P, Kounis, I, Morelli, M, Diaz Fontenla, F, Ericzon, B, Loinaz, C, Johnston, C, Gheorghe, L, Lesurtel, M, Romagnoli, R, Kollmann, D, Perera, M, Fagiuoli, S, Mirza, D, Coilly, A, Toso, C, Zieniewicz, K, Elkrief, L, Karam, V, Adam, R, Den Hoed, C, Merli, M, Puoti, M, De Carlis, L, Oniscu, G, Piano, S, Angeli, P, Fondevila, C, and Polak, W
Subjects: 0301 basic medicine, Male, medicine.medical_specialty, Waiting Lists, medicine.medical_treatment, liver cirrhosis, Pneumonia, Viral, Population, Liver transplantation, 03 medical and health sciences, Liver disease, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Risk Factors, Internal medicine, Cause of Death, Medicine, Humans, Viral, Registries, education, Cause of death, education.field_of_study, ddc:617, liver transplantation, liver cirrhosi, Proportional hazards model, business.industry, SARS-CoV-2, Gastroenterology, COVID-19, Pneumonia, Middle Aged, medicine.disease, Transplant Recipients, Transplantation, Europe, 030104 developmental biology, Respiratory failure, Liver cirrhosis, 030211 gastroenterology & hepatology, Female, Liver Transplantation, business, Cohort study
Abstract: ObjectiveExplore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course.DesignData from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed.ResultsFrom 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10–30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15–19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44–102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31–170).ConclusionsIncreased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).
Published: 2021

45. Panitumumab in combination with infusional oxaliplatin and oral capecitabine for conversion therapy in patients with colon cancer and advanced liver metastases. The MetaPan study

Author: Luisa Gioeni, Carmine Pinto, Stefano Cascinu, Salvatore Siena, Giuseppe Fornarini, Raffaele Pugliese, Francesco Leone, Donatella Marino, Andrea Sartore-Bianchi, Massimo Aglietta, Francesca Di Fabio, Luciano De Carlis, Salvatore Artale, Lorenzo Capussotti, Celeste Cagnazzo, Marco Tampellini, Leone, F, Artale, S, Marino, D, Cagnazzo, C, Cascinu, S, Pinto, C, Fornarini, G, Tampellini, M, Di Fabio, F, Sartore Bianchi, A, De Carlis, L, Pugliese, R, Capussotti, L, Gioeni, L, Siena, S, Aglietta, M., DE CARLIS, L, and Aglietta, M
Subjects: Oncology, Male, Cancer Research, Organoplatinum Compounds, Colorectal cancer, medicine.disease_cause, Deoxycytidine, Metastasis, capecitabine plus oxaliplatin (XELOX) chemotherapy, Antineoplastic Combined Chemotherapy Protocols, education.field_of_study, Colonic Neoplasm, Panitumumab, Liver Neoplasms, Antibodies, Monoclonal, Middle Aged, Oxaliplatin, Treatment Outcome, colon cancer, Liver Neoplasm, liver resection, Colonic Neoplasms, Drug Therapy, Combination, Female, KRAS, Fluorouracil, medicine.drug, Human, Adult, medicine.medical_specialty, Population, liver metastasis, panitumumab, Disease-Free Survival, Capecitabine, Internal medicine, medicine, Humans, liver metastasi, education, Aged, Antineoplastic Combined Chemotherapy Protocol, business.industry, Organoplatinum Compound, Cancer, medicine.disease, business
Abstract: BACKGROUND Preoperative chemotherapy improves the outcome in patients with colorectal cancer with liver metastases. In the current study, the authors evaluated the activity of a conversion treatment with the combination of capecitabine plus oxaliplatin (XELOX) used in association with panitumumab in patients with unresectable, liver-only, metastatic colon cancer. METHODS Chemotherapy-naive patients with unresectable liver metastases from colon cancer with no other metastatic disease sites were enrolled. All patients received upfront therapy with XELOX plus panitumumab (P-XELOX) and were reevaluated for resectability every 4 cycles. The primary endpoint was the objective response rate (ORR). Secondary endpoints were overall survival (OS), progression-free survival, the percentage of patients whose disease became radically resectable, and the safety of the P-XELOX combination. RESULTS A total of 49 patients were recruited, 35 of whom had wild-type KRAS (wtKRAS) and 14 of whom (who were enrolled before study amendment) had unknown (9 patients) or mutated (5 patients) KRAS mutational status. Forty-six patients were evaluable for response. After conversion P-XELOX therapy, the ORR in the general population was 54%, with 2 complete responses, 23 partial responses, and 14 cases of stable disease. In patients with wtKRAS, the ORR of the patients reached 65% (2 CRs and 19 PRs), which allowed 15 patients with initial unresectable liver metastasis to be reclassified as having resectable disease. Survival analysis demonstrated a median progression-free survival of 8.5 months and a median OS of 21.9 months. Patients who underwent surgery were found to have a significantly better OS when compared with those who did not undergo surgery (P
Published: 2013

46. Recommendations for Donor and Recipient Selection and Risk Prediction: Working Group Report From the ILTS Consensus Conference in DCD Liver Transplantation

Author: Eric Savier, David P. Foley, Mauricio Flores Carvalho, Andrea Schlegel, Nigel Heaton, C. Burcin Taner, Luciano De Carlis, Schlegel, A, Foley, D, Savier, E, Flores Carvalho, M, De Carlis, L, Heaton, N, and Taner, C
Subjects: medicine.medical_specialty, Consensus, media_common.quotation_subject, medicine.medical_treatment, Clinical Decision-Making, Liver transplantation, Risk Assessment, Donor Selection, End Stage Liver Disease, Postoperative Complications, Jury, Risk Factors, medicine, DCD, Humans, media_common, Transplantation, Evidence-Based Medicine, business.industry, Consensus conference, Grade system, Circulatory death, Tissue Donors, Liver Transplantation, Clinical Practice, Treatment Outcome, Donation, Family medicine, Working group, business
Abstract: Although the utilization of donation after circulatory death donors (DCDs) for liver transplantation (LT) has increased steadily, much controversy remains, and no common acceptance criteria exist with regard to donor and recipient risk factors and prediction models. A consensus conference was organized by International Liver Transplantation Society on January 31, 2020, in Venice, Italy, to review the current clinical practice worldwide regarding DCD-LT and to develop internationally accepted guidelines. The format of the conference was based on the grade system. International experts in this field were allocated to 6 working groups and prepared evidence-based recommendations to answer-specific questions considering the currently available literature. Working group members and conference attendees served as jury to edit and confirm the final recommendations presented at the end of the conference by each working group separately. This report presents the final statements and recommendations provided by working group 2, covering the entire spectrum of donor and recipient risk factors and prediction models in DCD-LT.
Published: 2021
Full Text: View/download PDF

47. Successful recovery from severe inverted Takotsubo cardiomyopathy after liver transplantation: the efficacy of extracorporeal membrane oxygenation (ECMO)

Author: Luciano De Carlis, Michele Mondino, Aldo Cannata, Matteo Zaniboni, Vincenzo Buscemi, Mila Valsecchi, Stefania Colombo, Claudio Russo, Giovanni Perricone, Andrea Lauterio, Riccardo De Carlis, Maurizio Bottiroli, Giovanna Pedrazzini, Roberto Fumagalli, Lauterio, A, Bottiroli, M, Cannata, A, de Carlis, R, Valsecchi, M, Perricone, G, Colombo, S, Buscemi, V, Zaniboni, M, Pedrazzini, G, Mondino, M, Russo, C, Fumagalli, R, and de Carlis, L
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Shock, Cardiogenic, Cardiomyopathy, Liver transplantation, medicine.disease, Liver Transplantation, Extracorporeal Membrane Oxygenation, Treatment Outcome, Anesthesiology and Pain Medicine, Takotsubo Cardiomyopathy, Internal medicine, medicine, Extracorporeal membrane oxygenation, Cardiology, Humans, Takotsubo, ECMO, Liver transplant, business, Retrospective Studies
Published: 2022
Full Text: View/download PDF

48. 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: Gian Luca Grazi, Patrizia Burra, Salvatore Agnes, Massimo Rossi, Francesco Callea, L. R. Fassati, Luciano De Carlis, Roberto Ferrara, Andrea Risaliti, Roberto Pisati, Umberto Valente, Franco Filipponi, Mauro Salizzoni, Filipponi F, Callea F, Salizzoni M, Grazi GL, Fassati LR, Rossi M, Risaliti A, Burra P, Agnes S, De Carlis L, Valente U, Ferrara R, Pisati R., 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, and Pisati, R
Subjects: Male, Time Factors, Basiliximab, Settore MED/18 - CHIRURGIA GENERALE, Liver Damage, medicine.medical_treatment, Azathioprine, Hepacivirus, Liver transplantation, Virus Replication, Gastroenterology, Placebos, Adrenal Cortex Hormones, Recurrence, Liver transplant, IMMUNOSUPPRESSION, Graft Survival, Hepatitis C recurrence, Antibodies, Monoclonal, Immunosuppression, Hepatitis C, Middle Aged, Clinical Trial, Multicenter Study, HCV, HEPATITIS C, Drug Therapy, Combination, Female, Steroids, Humans, Liver Transplantation, Hepatitis C Virus, Comparative Study, Immunosuppressive Agents, medicine.drug, Adult, medicine.medical_specialty, Recombinant Fusion Proteins, Placebo, NO, Double-Blind Method, Internal medicine, medicine, Steroid, Aged, Transplantation, business.industry, LIVER TRANSPLANTATION, medicine.disease, Ciclosporin, Immunology, CYCLOSPORINE, Liver transplant, Hepatitis C recurrence, HCV, Basiliximab, Steroids, business
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 >or=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

49. Immunosuppressive regimens for adult liver transplant recipients in real-life practice: consensus recommendations from an Italian Working Group

Author: Massimo Del Gaudio, Francesco Lupo, Paolo De Simone, Stefano Fagiuoli, Luciano De Carlis, Umberto Cillo, Riccardo Volpes, Giuseppe Tisone, Cillo, U, De Carlis, L, Del Gaudio, M, De Simone, P, Fagiuoli, S, Lupo, F, Tisone, G, and Volpes, R
Subjects: Adult, medicine.medical_specialty, Carcinoma, Hepatocellular, Consensus, mTOR inhibitor, Hepatocellular carcinoma, medicine.medical_treatment, Population, MEDLINE, Guidelines, 030230 surgery, Liver transplantation, Tacrolimus, 03 medical and health sciences, Consensus recommendation, 0302 clinical medicine, Calcineurin inhibitor, Chronic kidney disease, Internal medicine, medicine, Humans, Sirolimu, Consensus recommendations, Everolimus, Intensive care medicine, education, Sirolimus, education.field_of_study, Hepatology, business.industry, Liver Neoplasms, Correction, Immunosuppression, Transplant Recipients, Liver Transplantation, Transplantation, Everolimu, Italy, Tacrolimu, Solid-organ transplantation, 030211 gastroenterology & hepatology, business, Immunosuppressive Agents, medicine.drug
Abstract: It is a well-recognized fact that implementing new guidelines in clinical practice may be difficult; therefore the Italian Society for Organ and Tissue Transplantation (SITO) set out to define practical immunosuppression tools for the management of liver transplantation patients. In 2017, an Italian Working Group of liver transplant experts and hepatologists issued a set of consensus statements along with evidence-based recommendations on the use of everolimus after liver transplantation. This article presents the evidence- and consensus-based algorithms developed within the Italian Working Group, which are aimed towards guiding clinicians in the selection of immunosuppressive regimens for the management of adult liver transplant recipients in real-life practice. The liver transplant recipient population, typically managed in clinical practice, was divided into the following categories: (1) standard patients; (2) critically ill patients; (3) patients with a specific etiology; (4) patients with hepatocellular carcinoma; (5) and patients with de novo malignancies. The algorithms are divided into two parts, according to the time from transplantation (0–3 months and > 3 months) and are discussed here along with relevant supporting literature, when available. Ultimately, it is hoped that the evidence- and consensus-based algorithms developed within the Italian Working Group, and presented here, contribute to simplify, personalize, and optimize immunosuppression of liver transplantation recipients in clinical practice.
Published: 2020
Full Text: View/download PDF

50. 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
Full Text: View/download PDF

Catalog

Books, media, physical & digital resources

See catalog results

Searchworks

Select search scope, currently: Articles Catalog books, media & more in Jio Institute collections Articles journal articles & other e-resources

Search

Search Constraints

Refine your results

Search Limiters

Topic

Publication Year Range

Language

Journal

Database

Publisher

201 results on '"De Carlis L."'

Search Results

Catalog

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources