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1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. A Multistep, Consensus-Based Approach to Organ Allocation in Liver Transplantation: Toward a 'Blended Principle Model'

Author

Cillo, U, Burra, P, Mazzaferro, V, Belli, L, Pinna, Ad, Spada, M, Nanni Costa, A, Toniutto, P, Avolio, A, Cescon, M, Romagnoli, Renato, Santaniello, W, Rossi, M, Corno, V, Caraceni, P, Coco, B, Fraquelli, M, Rendina, M, Angelico, M, Fagiuoli, S, Bruno, R, Costa, An, Ridolfi, L, R, Pretagostini, R, Amoroso, Antonio, Biancofiore, G, De Gasperi, A, Rocca, Gd, Feltracco, P, Colli, A, Sacchini, D, Pegoraro, R, Gardini, I, Pipit, P, Maffeo, C, Rossellini, S. r., Cillo, U, Burra, P, Mazzaferro, V, Belli, L, Pinna, A, Spada, M, Nanni Costa, A, Toniutto, P, Avolio, A, Cescon, M, Regalia, E, Romagnoli, R, Santaniello, W, Rossi, M, Corno, V, Caraceni, P, Coco, B, Fraquelli, M, Rendina, M, Angelico, M, Fagiuoli, S, Bruno, R, Costa, A, De Feo, T, Ridolfi, L, Pretagostini, R, Amoroso, A, Biancofiore, G, De Gasperi, A, Della Rocca, G, Feltracco, P, Colli, A, Sacchini, D, Pegoraro, R, Gardini, I, Cillo U, Burra P, Mazzaferro V, Belli L, Pinna AD, Spada M, Nanni Costa A, Toniutto P, Avolio A, Cescon M, Romagnoli R, Santaniello W, Rossi M, Corno V, Caraceni P, Coco B, Fraquelli M, Rendina M, Angelico M, Fagiuoli S, Bruno R, Costa AN, Ridolfi L, Pretagostini R, Amoroso A, Biancofiore G, De Gasperi A, Rocca GD, Feltracco P, Colli A, Sacchini D, Pegoraro R, Gardini I, Pipit P, Maffeo C, and Rossellini SR

Subjects
medicine.medical_specialty, organ allocation, medicine.medical_treatment, media_common.quotation_subject, MEDLINE, Liver transplantation, allocation, consensus, Liver transplantation, Severity of Illness Index, Organ transplantation, Scientific evidence, Decision Support Techniques, Health care rationing, Jury, medicine, Algorithms, Health Care Rationing, Humans, Italy, Liver Diseases, Liver Transplantation, Patient Selection, Immunology and Allergy, Pharmacology (medical), media_common, Settore MED/12 - Gastroenterologia, Transplantation, liver transplantation, business.industry, liver transplantation, organ allocation, Surgery, Settore MED/18 - Chirurgia Generale, surgical procedures, operative, Family medicine, business, Working group
Abstract

Since Italian liver allocation policy was last revised (in 2012), relevant critical issues and conceptual advances have emerged, calling for significant improvements. We report the results of a national consensus conference process, promoted by the Italian College of Liver Transplant Surgeons (for the Italian Society for Organ Transplantation) and the Italian Association for the Study of the Liver, to review the best indicators for orienting organ allocation policies based on principles of urgency, utility, and transplant benefit in the light of current scientific evidence. MELD exceptions and hepatocellular carcinoma were analyzed to construct a transplantation priority algorithm, given the inequity of a purely MELD-based system for governing organ allocation. Working groups of transplant surgeons and hepatologists prepared a list of statements for each topic, scoring their quality of evidence and strength of recommendation using the Centers for Disease Control grading system. A jury of Italian transplant surgeons, hepatologists, intensivists, infectious disease specialists, epidemiologists, representatives of patients' associations and organ-sharing organizations, transplant coordinators, and ethicists voted on and validated the proposed statements. After carefully reviewing the statements, a critical proposal for revising Italy's current liver allocation policy was prepared jointly by transplant surgeons and hepatologists.

Published
2015

8. 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

9. 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

10. A prospective policy development to increase split-liver transplantation for 2 adult recipients: results of a 12-year multicenter collaborative study

Author

Aseni, P, De Feo, T, Valente, U, Colledan, M, Cillo, U, Rossi, G, Mazzaferro, V, Donataccio, M, De Fazio, N, Andorno, E, Burra, P, Giacomoni, A, Slim, A, Sposito, C, De Gasperi, A, Antonelli, B, Zanus, G, Pinelli, D, Zambelli, M, Morelli, N, Valente, R, Grosso, G, Mantovani, M, Piccolo, G., DE CARLIS, LUCIANO GREGORIO, Aseni, P, De Feo, T, DE CARLIS, L, Valente, U, Colledan, M, Cillo, U, Rossi, G, Mazzaferro, V, Donataccio, M, De Fazio, N, Andorno, E, Burra, P, Giacomoni, A, Slim, A, Sposito, C, De Gasperi, A, Antonelli, B, Zanus, G, Pinelli, D, Zambelli, M, Morelli, N, Valente, R, Grosso, G, Mantovani, M, and Piccolo, G

Subjects
Adult, Male, medicine.medical_specialty, Policy development, Adolescent, segmental liver transplantation, medicine.medical_treatment, Transplants, Transplant, Liver transplantation, surgical technique, Young Adult, Postoperative Complications, Retrospective Studie, Surgical complication, medicine, Humans, Prospective Studies, Young adult, Intensive care medicine, Prospective cohort study, Policy Making, Retrospective Studies, business.industry, Graft Survival, Retrospective cohort study, Middle Aged, liver transplantation, split-liver transplantation, surgical complications, Liver Transplantation, Algorithm, Transplantation, Prospective Studie, Multicenter study, Split liver transplantation, Surgery, Female, Postoperative Complication, business, Algorithms, Human
Abstract

OBJECTIVE: To analyze in a multicenter study the potential benefit of a new prospective policy development to increase split-liver procedures for 2 adult recipients. BACKGROUND: Split-liver transplantation is an important means of overcoming organ shortages. Division of the donor liver for 1 adult and 1 pediatric recipient has reduced the mortality of children waiting for liver transplantation but the benefits or disadvantages to survival when the liver is divided for 2 adults (adult-to-adult split-liver transplant, AASLT) compared with recipients of a whole graft have not been fully investigated. METHODS: We developed a computerized algorithm in selected donors for 2 adult recipients and applied it prospectively over a 12-year period among 7 collaborative centers. Patient and graft outcomes of this cohort receiving AASLT either as full right grafts or full left grafts were analyzed and retrospectively compared with a matched cohort of adults who received a conventional whole-liver transplant (WLT). Univariate and multivariate analysis was done for selected clinical variables in the AASLT group to assess the impact on the patient outcome. RESULTS: Sixty-four patients who received the AASLT had a high postoperative complication rate (64.1% grade III and IV) and a lower 5-year survival rate than recipients of a WLT (63.3% and 83.1%) CONCLUSIONS: AASLT should be considered a surgical option for selected smaller-sized adults only in experimental clinical studies in experienced centers. Copyright © 2013 by Lippincott Williams & Wilkins.

Published
2013

11. D-MELD, a Powerful Instrument To Optimize Donor-2-Recipient Match. Differences between US and Italy

Author

Avolio A, Halldorson J, Lirosi M, Agnes S, Salizzoni M, Pinna A, Spada M, De Carlis L, Colledan M, Gerunda G, Andorno E, Rossi G, Ettorre G, Risaliti A, Mazzaferro V, Rossi M, Tisone G, Zamboni F, Vivarelli M, Lupo L, Cuomo O, Calise F, Nicolotti N, Vitale A, Romagnoli R, Cucchetti A, Bonsignore P, Mangoni I, Pinelli D, Montalti R, Caccamo L, Vennarecci G, Nicolini D, Regalia E, Baccarani U, Lai Q, Manzia T, Tondolo E, Rendina M, Perrella A, Santaniello W, Bottino G, Spagnoletti G, Mariano G, Gasbarrini A, Burra P, Cillo U, Avolio, A, Halldorson, J, Lirosi, M, Agnes, S, Salizzoni, M, Pinna, A, Spada, M, De Carlis, L, Colledan, M, Gerunda, G, Andorno, E, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Rossi, M, Tisone, G, Zamboni, F, Vivarelli, M, Lupo, L, Cuomo, O, Calise, F, Nicolotti, N, Vitale, A, Romagnoli, R, Cucchetti, A, Bonsignore, P, Mangoni, I, Pinelli, D, Montalti, R, Caccamo, L, Vennarecci, G, Nicolini, D, Regalia, E, Baccarani, U, Lai, Q, Manzia, T, Tondolo, E, Rendina, M, Perrella, A, Santaniello, W, Bottino, G, Spagnoletti, G, Mariano, G, Gasbarrini, A, Burra, P, and Cillo, U

Subjects
Transplantation, Surgery
Published
2013

12. High MELD vs High Donor Age: Two Different Approaches, Similar Results. Evidences from US and Italy

Author

Avolio, A. W., Cillo, U., Lirosi, M. C., Perkins, J., Pinna, A. D., Romagnoli, R., Humar, A., Spada, M., Marc Melcher, Carlis, L., Zamboni, F., Colledan, M., Mazzaferro, V., Ettorre, G., Rossi, M., Tisone, G., Vivarelli, M., Burra, P., Agnes, S., Halldorson, J. B., Avolio, A, Cillo, U, Lirosi, M, Perkins, J, Pinna, A, Romagnoli, R, Humar, A, Spada, M, Melcher, M, De Carlis, L, Zamboni, F, Colledan, M, Mazzaferro, V, Ettorre, G, Rossi, M, Tisone, G, Vivarelli, M, Burra, P, Agnes, S, and Halldorson, J

Subjects
Transplantation, Hepatology, Gastroenterology, Surgery
Published
2013

13. Position paper of the Italian Association for the Study of the Liver (AISF): The multidisciplinary clinical approach to hepatocellular carcinoma

Author

Italian Association for the Study of the Liver, AISF Expert Panel, AISF Coordinating Committee, Bolondi, L, Cillo, U, Colombo, M, Craxì, A, Farinati, F, Giannini, Eg, Golfieri, R, Levrero, M, Pinna, Ad, Piscaglia, F, Raimondo, G, Trevisani, F, Bruno, R, Caraceni, P, Ciancio, Alessia, Coco, B, Fraquelli, M, Rendina, M, Squadrito, G, Toniutto, P., Bolondi L, Cillo U, Colombo M, Craxì A, Farinati F, Giannini EG, Golfieri R, Levrero M, Pinna AD, Piscaglia F, Raimondo G, Trevisani F, Bruno R, Caraceni P, Ciancio A, Coco B, Fraquelli M, Rendina M, Squadrito G, and Toniutto P

Subjects
Liver Cirrhosis, medicine.medical_specialty, Reference Document, Carcinoma, Hepatocellular, Association (object-oriented programming), medicine.medical_treatment, Liver transplantation, Risk Assessment, Scientific evidence, Percutaneous ablation, Liver disease, Multidisciplinary approach, medicine, Hepatectomy, Humans, HEPATOCELLULAR CARCINOMA, Intensive care medicine, Trans-arterial chemoembolisation, Tomography, Early Detection of Cancer, Ultrasonography, Neoplasm Staging, Cirrhosis, Hepatic resection, Hepatocellular carcinoma, Liver transplantation, Percutaneous ablation, Trans-arterial chemoembolisation, Hepatology, business.industry, Carcinoma, Liver Neoplasms, Gastroenterology, Cirrhosis, Hepatic resection, Hepatocellular carcinoma, Catheter Ablation, Italy, Liver Transplantation, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Liver, Hepatocellular, medicine.disease, Surgery, X-Ray Computed, Position paper, business
Abstract

Patients with hepatocellular carcinoma should be managed with a multidisciplinary approach framed in a network where all the diagnostic techniques and therapeutic resources are available in order to provide the optimal level of care.Given this assumption, the Coordinating Committee of the Italian Association for the Study of the Liver nominated a panel of experts to elaborate practical recommendations for the multidisciplinary management of hepatocellular carcinoma aiming to provide: (1) homogeneous and efficacious diagnostic and staging work-up, and (2) the best treatment choice tailored to patient status and tumour stage at diagnosis.The 2010 updated American Association for the Study of Liver Disease Guidelines for hepatocellular carcinoma were selected as the reference document. For each management issue, the American Association for the Study of Liver Disease recommendations were briefly summarised and discussed, according to both the scientific evidence published after their release and the clinical expertise of the Italian centres taking care of these patients. The Italian Association for the Study of the Liver expert panel recommendations are finally reported.

Published
2013

15. Worse Graft Survival in HCV-Infected Transplanted Females Receiving a Male Donor Graft. The Liver Match Study

Author

Romagnoli, R., Rossi, M., Gerunda, G. E., Pinna, A. D., Agnes, S., Marco Spada, Colledan, M., Tisone, G., Carlis, L., Baccarani, U., Ettorre, G. M., Cillo, U., Calise, F., Caccamo, L., Cuomo, O., Lupo, L., Corradini, S., Zamboni, F., Marianelli, T., Risaliti, A., Patrono, D., Petri, S. Li, Tagliabue, F., Mangoni, J. M. E., Antonelli, B., Sposito, C., Gringeri, E., Rompianesi, G., Sforza, D., Cucchetti, A., Miglioresi, L., Donataccio, M., Gelli, M., Gavrila, C., Nardi, A., Angelico, M., Romagnoli, R, Rossi, M, Gerunda, G, Pinna, A, Agnes, S, Spada, M, Colledan, M, Tisone, G, De Carlis, L, Baccarani, U, Ettorre, G, Cillo, U, Calise, F, Caccamo, L, Cuomo, O, Lupo, L, Corradini, S, Zamboni, F, Marianelli, T, Risaliti, A, Patrono, D, Petri, S, Tagliabue, F, Mangoni, J, Antonelli, B, Sposito, C, Gringeri, E, Rompianesi, G, Sforza, D, Cucchetti, A, Miglioresi, L, Donataccio, M, Gelli, M, Gavrila, C, Nardi, A, and Angelico, M

Subjects
HCV infection, liver transplantation, Transplantation, Hepatology, HCV-infected transplanted females, Gastroenterology, Surgery
Published
2012

16. The UN-SUSTAINABLE Match in HCV Recipients. Evidences from the Italian D-MELD Study on Balancing Donor-Recipient Risk Factors

Author

Avolio, A. W., Agnes, S., Lirosi, M., Salizzoni, M., Pinna, A., Gridelli, B., Carlis, L., Colledan, M., Gerunda, G., Rossi, G., Ettorre, G., Risaliti, A., Mazzaferro, V., Rossi, M., Tisone, G., Zamboni, F., Lupo, L., Cuomo, O., Calise, F., Donataccio, M., Nicolotti, N., Romagnoli, R., Vitale, A., Cucchetti, A., Gruttadauria, S., Baccarani, U., Caccamo, L., Mangoni, I., Pinelli, D., Montalti, R., Morelli, N., Vennarecci, G., Nicolini, D., Regalia, E., Lai, Q., Alessandro Anselmo, Tondolo, E., Perrella, A., Burra, P., Cillo, U., Avolio, A, Agnes, S, Lirosi, M, Salizzoni, M, Pinna, A, Gridelli, B, De Carlis, L, Colledan, M, Gerunda, G, Rossi, G, Ettorre, G, Risaliti, A, Mazzaferro, V, Rossi, M, Tisone, G, Zamboni, F, Lupo, L, Cuomo, O, Calise, F, Donataccio, M, Nicolotti, N, Romagnoli, R, Vitale, A, Cucchetti, A, Gruttadauria, S, Baccarani, U, Caccamo, L, Mangoni, I, Pinelli, D, Montalti, R, Morelli, N, Vennarecci, G, Nicolini, D, Regalia, E, Lai, Q, Anselmo, A, Tondolo, E, Perrella, A, Burra, P, and Cillo, U

Subjects
Transplantation, D-MELD, donor-recipient match, liver transplantation, Hepatology, Gastroenterology, Surgery
Published
2012

17. Prediction of Outcome after Liver Transplantation by D-MELD. Stratification of Graft Survival According to Donor Recipient Match in the Italian Multicenter Study

Author

Avolio AW, Cillo U, Rossi M, Colledan M, Tisone G, Rossi G, Gerunda G, Valente U, Lupo L, Ettorre G, Risaliti A, Bresadola V, Gridelli B, Vitale A, Lai Q, Pinelli D, Anselmo A, Caccamo L, Montalti R, Morelli N, Rendina M, Vennarecci G, Boscarino G, Nicolotti N, Nicolini D, Baccarani U, Gruttadauria S, Regalia E, Angelico M, Gasbarrini A, Agnes S, Avolio, A, Cillo, U, Rossi, M, Colledan, M, Tisone, G, Rossi, G, Gerunda, G, Valente, U, Lupo, L, Ettorre, G, Risaliti, A, Bresadola, V, Gridelli, B, Vitale, A, Lai, Q, Pinelli, D, Anselmo, A, Caccamo, L, Montalti, R, Morelli, N, Rendina, M, Vennarecci, G, Boscarino, G, Nicolotti, N, Nicolini, D, Baccarani, U, Gruttadauria, S, Regalia, E, Angelico, M, Gasbarrini, A, and Agnes, S

Subjects
Transplantation, Donor Recipient Match in the Italian Multicenter Study, D-MELD, Surgery
Published
2010

18. D-MELD, a Powerful Predictor of Graft Survival after Liver Transplantation. Long-Term Results of a Multicenter Italian Study

Author

Avolio, A. W., Cillo, U., Rossi, M., Colledan, M., Tisone, G., Rossi, G., Gerunda, G., Valente, U., Lupo, L., Ettorre, G., Grieco, A., Vitale, A., Lai, Q., Pinelli, D., Alessandro Anselmo, Caccamo, L., Montalti, R., Morelli, N., Rendina, M., Vennarecci, G., Angeli, P., Corno, V., Antonelli, B., Gaspari, R., Gelli, M., Boscarino, G., Nicolotti, N., Costa, R., Angelico, M., Corradini, S. Ginanni, Gasbarrini, A., Di Leo, A., Agnes, S., Avolio, A, Cillo, U, Rossi, M, Colledan, M, Tisone, G, Rossi, G, Gerunda, G, Valente, U, Lupo, L, Ettorre, G, Grieco, A, Vitale, A, Lai, Q, Pinelli, D, Anselmo, A, Caccamo, L, Montalti, R, Morelli, N, Rendina, M, Vennarecci, G, Angeli, P, Corno, V, Antonelli, B, Gaspari, R, Gelli, M, Boscarino, G, Nicolotti, N, Costa, R, Angelico, M, Corradini, S, Gasbarrini, A, Di Leo, A, and Agnes, S

Subjects
Transplantation, Hepatology, Gastroenterology, Surgery
Published
2010

19. FIBROSIS PROGRESSION AFTER ANTIVIRAL TREATMENT (AT) FOR HCV RECURRENCE FOLLOWING LIVER TRANSPLANTATION

Author

De Martin E, Masier A, Senzolo M, Boninsegna S, Ponziani FR, Vigano R, Belli L, Pinzello G, Colledan M, Donato FC, Di Paolo D, Angelico M, Rendina M, Pompili M, Gasbarrini A, Russo FP, Cillo U, Fagiuoli S, Burra P, De Martin, E, Masier, A, Senzolo, M, Boninsegna, S, Ponziani, F, Vigano, R, Belli, L, Pinzello, G, Colledan, M, Donato, F, Di Paolo, D, Angelico, M, Rendina, M, Pompili, M, Gasbarrini, A, Russo, F, Cillo, U, Fagiuoli, S, and Burra, P

Subjects
Transplantation, Hepatology, Gastroenterology, Surgery
Published
2009

20. Split-liver activity in an Italian transplant program: An update

Author

De Feo TM, Colledan M, Andorno E, De Carlis LG, Cillo U, Rossi G, Baccarani U, Regalia E, Donataccio M, Risaliti A, Di Silvestre A, Scalamogna M, De Feo, T, Colledan, M, Andorno, E, DE CARLIS, L, Cillo, U, Rossi, G, Baccarani, U, Regalia, E, Donataccio, M, Risaliti, A, Di Silvestre, A, and Scalamogna, M

Subjects
Transplantation, Surgery
Published
2007

23. Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients

Author

Nuzzo G, Giuliante F, Ardito F, Giovannini I, Aldrighetti L, Belli G, Bresadola F, Calise F, Dalla Valle R, D'Amico DF, Gennari L, Giulini SM, Guglielmi A, Jovine E, Pellicci R, Pernthaler H, Pinna AD, Puleo S, Torzilli G, Capussotti L, Italian Chapter of the International Hepato-Pancreato-Biliary Association, Cillo U, Ercolani G, Ferrucci M, Mastrangelo L, Portolani N, Pulitanò C, Ribero D, Ruzzenente A, Scuderi V, Federico B, Nuzzo, Gennaro, Giuliante, Felice, Ardito, Francesco, Giovannini, Ivo, Aldrighetti, Luca, Belli, Giulio, Bresadola, Fabrizio, Calise, Fulvio, Dalla Valle, Raffaele, D'Amico, Davide F., Gennari, Leandro, Giulini, Stefano M., Guglielmi, Alfredo, Jovine, Elio, Pellicci, Riccardo, Pernthaler, Heinrich, Pinna, Antonio D., Puleo, Stefano, Torzilli, Guido, Capussotti, Lorenzo, Cillo, Umberto, Ercolani, Giorgio, Ferrucci, Massimo, Mastrangelo, Laura, Portolani, Nazario, Pulitanò, Carlo, Ribero, Dario, Ruzzenente, Andrea, Scuderi, Vincenzo, Federico, Bruno, Nuzzo, G, Giuliante, F, Ardito, F, Giovannini, I, Aldrighetti, L, Belli, G, Bresadola, F, Calise, F, Dalla Valle, R, D'Amico, Df, Gennari, L, Giulini, Sm, Guglielmi, A, Jovine, E, Pellicci, R, Pernthaler, H, Pinna, Ad, Puleo, S, Torzilli, G, and Capussotti, L

Subjects
Male, Blood transfusion, Time Factors, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, Adult Aged Aged, Cholangiocarcinoma, Klatskin tumor, Retrospective Studie, 80 and over, Improved results, Main biliary confluence excision, Intrahepatic Cholangiocarcinoma, Outcome, Intrahepatic, Aged, 80 and over, Liver resection, 80 and over Bile Duct Neoplasms/surgery* Bile Ducts, Intrahepatic* Cholangiocarcinoma/surgery* Female Humans Italy Male Middle Aged Retrospective Studies Time Factors Treatment Outcome, Jaundice, Middle Aged, Treatment Outcome, Italy, Female, medicine.symptom, Human, Adult, medicine.medical_specialty, Time Factor, Preoperative care, medicine, Humans, Results, Bile Duct Neoplasm, Adult, Aged, Aged, 80 and over, Bile Duct Neoplasms, surgery, Bile Ducts, Intrahepatic, Cholangiocarcinoma, surgery, Female, Humans, Italy, Male, Middle Aged, Retrospective Studies, Time Factors, Treatment Outcome, Retrospective Studies, Aged, business.industry, Retrospective cohort study, Perioperative, Hilar cholangiocarcinoma, medicine.disease, Surgery, Bile Ducts, Intrahepatic, Bile Duct Neoplasms, Bile Ducts, Hepatectomy, business
Abstract

Objective: To evaluate improvements in operative and long-term results following surgery for hilar cholangiocarcinoma. Design: Retrospective multicenter study including 17 Italian hepatobiliary surgery units. Patients: A total of 440 patients who underwent resection for hilar cholangiocarcinoma from January 1, 1992, through December 31, 2007. Main Outcome Measures: Postoperative mortality, morbidity, overall survival, and disease-free survival. Results: Postoperative mortality and morbidity after liver resection were 10.1% and 47.6%, respectively. At multivariate logistic regression, extent of resection (rightor right extended hepatectomy) and intraoperative blood transfusion were independent predictors of postoperative mortality (P =. 03 and P =. 006, respectively); in patients with jaundice, mortality was also higher without preoperative biliary drainage than with biliary drainage (14.3% vs 10.7%). During the study period, there was an increasingly aggressive approach, with more frequent caudate lobectomies, vascular resections, and resections for advanced tumors (T stage of 3 or greater and tumors with poor differentiation). Despite the aggressive approach, the blood transfusion rate decreased from 81.0% to 53.2%, and mortality slightly decreased from 13.6% to 10.8%. Median overall survival significantly increased from 16 to 30 months (P =. 05). At multivariate analysis, R1 resection, lymph node metastases, and T stage of 3 or greater independently predicted overall and disease-free survival. Conclusions: Surgery for hilar cholangiocarcinoma has improved with decreased operative risk despite a more aggressive surgical policy. Long-term survival after liver resection has also increased, despite the inclusion of cases with more advanced hilar cholangiocarcinoma. Preoperative biliary drainage was a safe strategy before right or right extended hepatectomy in patients with jaundice. Pathologic factors independently predicted overall and disease-free survival at multivariate analysis. Arch Surg. 2012; 147(1): 26-34

Published
2012

24. Erratum to 'A method for establishing allocation equity among patients with and without hepatocellular carcinoma on a common liver transplant waiting list' [J Hepatol 2013;60:290–297]

Author

Vitale, A., Volk, M. L., De Feo, T. M., Burra, P, Frigo, A. C., 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, F. P., Cillo, U., and Liver Transplantation North Italy Transplant program working group

Subjects
medicine.medical_specialty, Hepatology, business.industry, General surgery, medicine.medical_treatment, Equity (finance), Transplant Waiting List, Liver transplantation, medicine.disease, Surgery, Hepatocellular carcinoma, medicine, Regalia, business
Abstract

Erratum to ‘‘A method for establishing allocation equity among patients with and without hepatocellular carcinoma on a common liver transplant waiting list’’ [J Hepatol 2013;60:290–297] Alessandro Vitale, Michael L. Volk, Tullia Maria De Feo, Patrizia Burra1,⇑, Anna Chiara Frigo, Rafael Ramirez Morales, Luciano De Carlis, Luca Belli, Michele Colledan, Stefano Fagiuoli, Giorgio Rossi, Enzo Andorno, Umberto Baccarani, Enrico Regalia, Marco Vivarelli, Matteo Donataccio, Umberto Cillo, on behalf of the Liver Transplantation North Italy Transplant program (NITp) working group

Published
2014

25. Cystadenoma and laparoscopic surgery for hepatic cystic disease: a need for laparotomy?

Author

Veroux, M., Fiamingo, P., Cillo, U., Tedeschi, U., Brolese, A., Veroux, P., Basso, S., Buffone, A., and D'Amico, D. F.

Subjects
LIVER tumors, LIVER surgery, CYSTS (Pathology), SURGERY, ABDOMINAL surgery, LAPAROSCOPIC surgery, LIVER disease diagnosis, ALGORITHMS, LAPAROSCOPY, LIVER diseases, DISEASE incidence, CYSTADENOMA, DISEASE complications, DIAGNOSIS
Abstract

Background: This study aimed to evaluate the incidence of cystadenoma diagnosis in a series of laparoscopic treatments for nonparasitic liver cysts, as well as its management.Methods: From 1996 to 2004, 26 patients with a nonparasitic cyst of the liver were selected for laparoscopic liver surgery. Solitary nonparasitic liver cysts were, whenever feasible, completely enucleated.Results: In four patients, the histopathologic examination showed a cystadenoma. Three patients with 13, 9, and 12-cm cysts, respectively, had undergone complete enucleation of the lesion, with no evidence of recurrence in the follow-up visit. One patient with multicystic liver experienced a recurrence and required an open hepatic resection.Conclusions: When a complete laparoscopic enucleation of the cyst can be ensured, a strict follow-up assessment should be considered as the definitive treatment, with surgical intervention demanded only in the case of recurrence or high suspicion for malignancy. [ABSTRACT FROM AUTHOR]

Published
2005
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26. Laparoscopic treatment of simple hepatic cysts and polycystic liver disease.

Author

Fiamingo, P., Tedeschi, U., Veroux, M., Cillo, U., Brolese, A., Da Rold, A., Madia, C., Zanus, G., and D'Amico, D.F.

Subjects
LIVER surgery, CYSTS (Pathology), LIVER diseases, DIARRHEA, SURGERY
Abstract

Background: The authors present their experience in the laparoscopic management of hepatic cysts and polycystic liver disease (PLD). Methods: Between January 1996 and January 2002, 16 patients underwent laparoscopic liver surgery. Indications were solitary giant cysts (n = 10) and PLD (n = 6). Data were collected retrospectively. Results: Laparoscopic fenestration was completed in 15 patients. Median operative time was 80 min. There was no deaths. Complications occurred in four patients: one patient with a solitary liver cyst experienced diarrhea, while a pleural effusion, a bleeding from the trocar-insertion site, and ascites occurred in three patients with PLD. Median follow-up was 34 months. There was one asymptomatic recurrence (11%) in one patient with a solitary cyst. Two patients with PLD had a symptomatic recurrence of a liver cyst. Conclusion: Laparoscopic fenestration could be the preferred treatment of solitary liver cysts and PLD. Adequate selection of patients and type of cystic liver together with a meticulous surgical technique are recommended. [ABSTRACT FROM AUTHOR]

Published
2003
Full Text
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27. Can donor selection criteria for split liver transplantation he safely expanded? A multicenter, multivariate analysis

Author

Marco Spada, Cescon, N., Colledan, M., Andorno, E., Valente, U., Carlis, L., Abdallah, S., Reggiani, P., Rossi, G., Zanus, G., Cillo, U., Baccarani, U., Gerunda, Ge, Mazzaferro, V., Grazi, Gl, Tisone, G., Rossi, R., Ettorre, Gm, Calise, F., Feo, T., Gridelli, B., Spada, M, Cescon, N, Colledan, M, Andorno, E, Valente, U, De Carlis, L, Abdallah, S, Reggiani, P, Rossi, G, Zanus, G, Cillo, U, Baccarani, U, Gerunda, G, Mazzaferro, V, Grazi, G, Tisone, G, Rossi, R, Ettorre, G, Calise, F, De Feo, T, and Gridelli, B

Subjects
Transplantation, Hepatology, Gastroenterology, Surgery

28. Machine Perfusions in Liver Transplantation: The Evidence‐Based Position Paper of the Italian Society of Organ and Tissue Transplantation

Author

Paolo Muiesan, Massimo Rossi, Damiano Patrono, F. Melandro, Daniele Pezzati, Markus Selzner, Alberto Zanella, Andrea Lauterio, Riccardo De Carlis, Cristiano Quintini, Stefano Baroni, Domenico Bassi, Davide Ghinolfi, Paolo Magistri, Fabio Ferla, Luca Toti, Marinella Zanierato, Matteo Ravaioli, Quirino Lai, Chiara Lazzeri, Wayel Jassem, Patrizia Burra, Daniele Dondossola, Duilio Pagano, Philippe Dutkowski, Umberto Cillo, Erion Rreka, Salvatore Petta, University of Zurich, Ghinolfi, Davide, Ghinolfi, D, Lai, Q, Dondossola, D, De Carlis, R, Zanierato, M, Patrono, D, Baroni, S, Bassi, D, Ferla, F, Lauterio, A, Lazzeri, C, Magistri, P, Melandro, F, Pagano, D, Pezzati, D, Ravaioli, M, Rreka, E, Toti, L, Zanella, A, Burra, P, Petta, S, Rossi, M, Dutkowski, P, Jassem, W, Muiesan, P, Quintini, C, Selzner, M, Cillo, U, Ghinolfi D., Lai Q., Dondossola D., De Carlis R., Zanierato M., Patrono D., Baroni S., Bassi D., Ferla F., Lauterio A., Lazzeri C., Magistri P., Melandro F., Pagano D., Pezzati D., Ravaioli M., Rreka E., Toti L., Zanella A., Burra P., Petta S., Rossi M., Dutkowski P., Jassem W., Muiesan P., Quintini C., Selzner M., and Cillo U.

Subjects
medicine.medical_specialty, Evidence-based practice, 2747 Transplantation, GRADE, donor after circulatory death, donor brain death, hypothermic machine, liver transplant, machine perfusion, normothermic machine, normothermic regional perfusion, position paper, medicine.medical_treatment, Delphi method, MEDLINE, 610 Medicine & health, liver, perfusion machine, 030230 surgery, Liver transplantation, liver, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, Medical physics, 10217 Clinic for Visceral and Transplantation Surgery, HumansItaly, Transplantation, Machine perfusion, Hepatology, business.industry, Organ Preservation, perfusion machine, Institutional review board, Liver Transplantation, 2746 Surgery, Perfusion, Italy, Position paper, 2721 Hepatology, 030211 gastroenterology & hepatology, Surgery, business, Human
Abstract

The use of machine perfusion (MP) in liver transplantation (LT) is spreading worldwide. However, its efficacy has not been demonstrated, and its proper clinical use has far to go to be widely implemented. The Società Italiana Trapianti d’Organo (SITO) promoted the development of an evidence-based position paper. A 3-step approach has been adopted to develop this position paper. First, SITO appointed a chair and a cochair who then assembled a working group with specific experience of MP in LT. The Guideline Development Group framed the clinical questions into a patient, intervention, control, and outcome (PICO) format, extracted and analyzed the available literature, ranked the quality of the evidence, and prepared and graded the recommendations. Recommendations were then discussed by all the members of the SITO and were voted on via the Delphi method by an institutional review board. Finally, they were evaluated and scored by a panel of external reviewers. All available literature was analyzed, and its quality was ranked. A total of 18 recommendations regarding the use and the efficacy of ex situ hypothermic and normothermic machine perfusion and sequential normothermic regional perfusion and ex situ MP were prepared and graded according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. A critical and scientific approach is required for the safe implementation of this new technology.

Published
2020

29. 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

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. The Italian Consensus on minimally invasive simultaneous resections for synchronous liver metastasis and primary colorectal cancer: A Delphi methodology

Author

Antonino Spinelli, Gaya Spolverato, Ugo Elmore, S. Berti, Giorgio Ercolani, Nadia Russolillo, Ugo Boggi, L. Vincenti, Simone Nicosia, Andrea Laurenzi, Paolo De Paolis, Giuseppe Maria Ettorre, Agostino Maria De Rose, Luca Aldrighetti, Giovanni Vennarecci, Pierluigi Marini, Matteo Cescon, Michela Mineccia, Umberto Cillo, Francesco Marchegiani, Aldo Rocca, Francesco Minni, Luciano De Carlis, Alfredo Guglielmi, Paolo Delrio, Salvatore Gruttadauria, Riccardo Rosati, Francesco Izzo, Domenico D'Ugo, Vincenzo Bottino, Maurizio Degiuli, Giulio Belli, Fulvio Calise, Vincenzo Mazzaferro, Luca Viganò, Francesco Corcione, Fabrizio Di Benedetto, Riccardo Pellicci, Marco Filauro, Alessandro Ferrero, Andrea Muratore, Marco Massani, Federica Cipriani, Guido Torzilli, Matteo Cimino, Felice Giuliante, Elio Jovine, Rocca, A, Cipriani, F, Belli, G, Berti, S, Boggi, U, Bottino, V, Cillo, U, Cescon, M, Cimino, M, Corcione, F, De Carlis, L, Degiuli, M, De Paolis, P, De Rose, A, D'Ugo, D, Di Benedetto, F, Elmore, U, Ercolani, G, Ettorre, G, Ferrero, A, Filauro, M, Giuliante, F, Gruttadauria, S, Guglielmi, A, Izzo, F, Jovine, E, Laurenzi, A, Marchegiani, F, Marini, P, Massani, M, Mazzaferro, V, Mineccia, M, Minni, F, Muratore, A, Nicosia, S, Pellicci, R, Rosati, R, Russolillo, N, Spinelli, A, Spolverato, G, Torzilli, G, Vennarecci, G, Vigano, L, Vincenti, L, Delrio, P, Calise, F, Aldrighetti, L, Rocca, Aldo, Cipriani, Federica, Belli, Giulio, Berti, Stefano, Boggi, Ugo, Bottino, Vincenzo, Cillo, Umberto, Cescon, Matteo, Cimino, Matteo, Corcione, Francesco, De Carlis, Luciano, Degiuli, Maurizio, De Paolis, Paolo, De Rose, Agostino Maria, D’Ugo, Domenico, Di Benedetto, Fabrizio, Elmore, Ugo, Ercolani, Giorgio, Ettorre, Giuseppe M., Ferrero, Alessandro, Filauro, Marco, Giuliante, Felice, Gruttadauria, Salvatore, Guglielmi, Alfredo, Izzo, Francesco, Jovine, Elio, Laurenzi, Andrea, Marchegiani, Francesco, Marini, Pierluigi, Massani, Marco, Mazzaferro, Vincenzo, Mineccia, Michela, Minni, Francesco, Muratore, Andrea, Nicosia, Simone, Pellicci, Riccardo, Rosati, Riccardo, Russolillo, Nadia, Spinelli, Antonino, Spolverato, Gaya, Torzilli, Guido, Vennarecci, Giovanni, Viganò, Luca, Vincenti, Leonardo, Delrio, Paolo, Calise, Fulvio, Aldrighetti, Luca, Rocca A., Cipriani F., Belli G., Berti S., Boggi U., Bottino V., Cillo U., Cescon M., Cimino M., Corcione F., De Carlis L., Degiuli M., De Paolis P., De Rose A.M., D'Ugo D., Di Benedetto F., Elmore U., Ercolani G., Ettorre G.M., Ferrero A., Filauro M., Giuliante F., Gruttadauria S., Guglielmi A., Izzo F., Jovine E., Laurenzi A., Marchegiani F., Marini P., Massani M., Mazzaferro V., Mineccia M., Minni F., Muratore A., Nicosia S., Pellicci R., Rosati R., Russolillo N., Spinelli A., Spolverato G., Torzilli G., Vennarecci G., Vigano L., Vincenti L., Delrio P., Calise F., and Aldrighetti L.

Subjects
Synchronous colorectal liver metastases, medicine.medical_specialty, Consensus, Colorectal cancer, Delphi method, Consensu, Colorectal Neoplasm, 030230 surgery, law.invention, Metastasis, Standard procedure, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Minimally invasive surgery, medicine, Hepatectomy, Humans, Italy, Colorectal Neoplasms, Liver Neoplasms, computer.programming_language, business.industry, General surgery, medicine.disease, Chemotherapy regimen, Surgery, Systematic review, 030220 oncology & carcinogenesis, business, computer, Delphi, Synchronous colorectal liver metastase, Human
Abstract

At the time of diagnosis synchronous colorectal cancer, liver metastases (SCRLM) account for 15–25% of patients. If primary tumour and synchronous liver metastases are resectable, good results may be achieved performing surgical treatment incorporated into the chemotherapy regimen. So far, the possibility of simultaneous minimally invasive (MI) surgery for SCRLM has not been extensively investigated. The Italian surgical community has captured the need and undertaken the effort to establish a National Consensus on this topic. Four main areas of interest have been analysed: patients’ selection, procedures, techniques, and implementations. To establish consensus, an adapted Delphi method was used through as many reiterative rounds were needed. Systematic literature reviews were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses instructions. The Consensus took place between February 2019 and July 2020. Twenty-six Italian centres participated. Eighteen clinically relevant items were identified. After a total of three Delphi rounds, 30-tree recommendations reached expert consensus establishing the herein presented guidelines. The Italian Consensus on MI surgery for SCRLM indicates possible pathways to optimise the treatment for these patients as consensus papers express a trend that is likely to become shortly a standard procedure for clinical pictures still on debate. As matter of fact, no RCT or relevant case series on simultaneous treatment of SCRLM are available in the literature to suggest guidelines. It remains to be investigated whether the MI technique for the simultaneous treatment of SCRLM maintain the already documented benefit of the two separate surgeries.

Published
2021

32. Infrarenal versus supraceliac aorto-hepatic arterial revascularisation in adult liver transplantation: multicentre retrospective study

Author

Roberto Troisi, Michele Colledan, J. Lambrechts, Jan Lerut, Giacomo Zanus, Federico Mocchegiani, Kevin Ackenine, G. Conte, Roberto Montalti, Marco Vivarelli, Andrea Risaliti, Umberto Baccarani, A. Benedetti Cacciaguerra, J. Lanari, Samuele Iesari, Riccardo Pravisani, Daniele Nicolini, Xavier Rogiers, Umberto Cillo, Vivarelli, M., Benedetti Cacciaguerra, A., Lerut, J., Lanari, J., Conte, G., Pravisani, R., Lambrechts, J., Iesari, S., Ackenine, K., Nicolini, D., Cillo, U., Zanus, G., Colledan, M., Risaliti, A., Baccarani, U., Rogiers, X., Troisi, R. I., Montalti, R., Mocchegiani, F., UCL - SSS/IREC - Institut de recherche expérimentale et clinique, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Vivarelli, M, Cacciaguerra, A, Lerut, J, Lanari, J, Conte, G, Pravisani, R, Lambrechts, J, Iesari, S, Ackenine, K, Nicolini, D, Cillo, U, Zanus, G, Colledan, M, Risaliti, A, Baccarani, U, Rogiers, X, Troisi, R, Montalti, R, and Mocchegiani, F

Subjects
Male, medicine.medical_treatment, Aorto-hepatic arterial reconstruction, Hepatic artery, Hepatic artery thrombosis, Iliac conduit, Liver transplantation, Vessel graft, Postoperative Complications, 0302 clinical medicine, Risk Factors, Surgical, Aorta, Abdominal, Aorta, Incidence, Incidence (epidemiology), Anastomosis, Surgical, Middle Aged, Hepatic artery thrombosi, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Vascular Surgical Procedures, Adult, medicine.medical_specialty, Anastomosis, Young Adult, 03 medical and health sciences, medicine.artery, medicine, Humans, Abdominal, Reconstructive Surgical Procedures, Risk factor, Aged, Retrospective Studies, business.industry, Thrombosis, Retrospective cohort study, Plastic Surgery Procedures, Surgery, Transplantation, Hepatic Artery, Liver Transplantation, business
Abstract

When the standard arterial reconstruction is not feasible during liver transplantation (LT), aorto-hepatic arterial reconstruction (AHAR) can be the only solution to save the graft. AHAR can be performed on the infrarenal (IR) or supraceliac (SC) tract of the aorta, but the possible effect on outcome of selecting SC versus IR reconstruction is still unclear. One hundred and twenty consecutive patients who underwent liver transplantation with AHAR in six European centres between January 2003 and December 2018 were retrospectively analysed to ascertain whether the incidence of hepatic artery thrombosis (HAT) was influenced by the type of AHAR (IR-AHAR vs. SC-AHAR). In 56/120 (46.6%) cases, an IR anastomosis was performed, always using an interposition arterial conduit. In the other 64/120 (53.4%) cases, an SC anastomosis was performed; an arterial conduit was used in 45/64 (70.3%) cases. Incidence of early (

Published
2020

33. 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

34. Minimally Invasive Stage 1 to Protect against the Risk of Liver Failure: Results from the Hepatocellular Carcinoma Series of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Italian Registry

Author

Francesca Ratti, Matteo Cescon, Luca Aldrighetti, Umberto Cillo, Raffaele Dalla Valle, Federico Mocchegiani, Michele Colledan, Marco Colasanti, Fabrizio Di Benedetto, Bruno Nardo, Matteo Serenari, Nicola Guglielmo, Marco Massani, Vincenzo Mazzaferro, Giuseppe Maria Ettorre, Elio Jovine, Marco Vivarelli, Matteo Zanello, Serenari, M., Ratti, F., Zanello, M., Guglielmo, N., Mocchegiani, F., Di Benedetto, F., Nardo, B., Mazzaferro, V., Cillo, U., Massani, M., Colledan, M., Dalla Valle, R., Cescon, M., Vivarelli, M., Colasanti, M., Ettorre, G. M., Aldrighetti, L., Jovine, E., Serenari, M, Ratti, F, Zanello, M, Guglielmo, N, Mocchegiani, F, Di Benedetto, F, Nardo, B, Mazzaferro, V, Cillo, U, Massani, M, Colledan, M, Dalla Valle, R, Cescon, M, Vivarelli, M, Colasanti, M, Ettorre, G, Aldrighetti, L, and Jovine, E

Subjects
Male, medicine.medical_specialty, Carcinoma, Hepatocellular, medicine.medical_treatment, Treatment outcome, Portal vein, laparoscopy, Portal vein ligation, 03 medical and health sciences, 0302 clinical medicine, ALPPS, hepatocellular carcinoma, liver failure, Aged, Female, Hepatectomy, Humans, Italy, Ligation, Liver Failure, Liver Neoplasms, Middle Aged, Minimally Invasive Surgical Procedures, Portal Vein, Registries, Treatment Outcome, Medicine, Laparoscopy, medicine.diagnostic_test, business.industry, Carcinoma, Liver failure, Hepatocellular, medicine.disease, digestive system diseases, Surgery, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, 030211 gastroenterology & hepatology, business
Abstract

Introduction: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been described to treat hepatocellular carcinoma (HCC) but burdened, in its pioneering phase, by high morbidity and mortality. With the advent of minimally invasive (MI) techniques in liver surgery, surgical complications, including posthepatectomy liver failure (PHLF), have been dramatically reduced. The primary endpoint of this study was to compare the short-term outcomes of MI-versus open-ALPPS for HCC, with specific focus on PHLF. Methods: Data of patients submitted to ALPPS for HCC between 2012 and 2020 were identified from the ALPPS Italian Registry. Patients receiving an MI Stage 1 (MI-ALPPS) constituted the study group, whereas the patients who received an open Stage 1 (open-ALPPS) constituted the control group. Results: Sixty-six patients were enrolled from 12 Italian centers. Stage 1 of ALPPS was performed in 14 patients using an MI approach (21.2%). MI-ALPPS patients were discharged after Stage 1 at a significantly higher rate compared with open-ALPPS (78.6% versus 9.6%, P < .001). After Stage 2, major morbidity after MI-ALPPS was 8.3% compared with 28.6% reported after open-ALPPS. Mortality was nil after MI-ALPPS. Length of hospital stay was significantly shorter in MI-ALPPS (12 days versus 22 days, P < .001). Univariate logistic regression analysis (Firth method) found that both MI-ALPPS (odds ratio [OR] = 0.05, P = .040) and partial parenchymal transection (OR = 0.04, P = .027) were protective against PHLF. Conclusion: This national multicenter study showed that a less invasive approach to ALPPS first stage was associated with a lower overall risk of PHLF.

Published
2020

35. Risk-adjusted benchmarks in laparoscopic liver surgery in a national cohort

Author

Nadia Russolillo, L. Vincenti, M. Iaria, R. Lo Tesoriere, Giulio Belli, R. Dalla Valle, Enrico Gringeri, Alberto Brolese, Roberto Santambrogio, Luca Aldrighetti, F. Di Benedetto, Fausto Zamboni, L. De Carlis, Giuseppe Zimmitti, Felice Giuliante, Vincenzo Mazzaferro, Elio Jovine, Graziano Ceccarelli, G.B. Levi Sandri, Alfredo Guglielmi, Fabio Ferla, P. Mezzatesta, Matteo Virdis, S. Berti, Fulvio Calise, Giuseppe Navarra, Salvatore Gruttadauria, Annamaria Ferrero, Francesco Ardito, Umberto Cillo, E. Rossi, A. Coratti, R. Lombardi, Francesca Ratti, Guido Torzilli, Ugo Boggi, Matteo Ravaioli, Andrea Ruzzenente, Giuseppe Maria Ettorre, Russolillo, N, Aldrighetti, L, Cillo, U, Guglielmi, A, Ettorre, G, Giuliante, F, Mazzaferro, V, Dalla Valle, R, De Carlis, L, Jovine, E, Ferrero, A, Russolillo N., Aldrighetti L., Cillo U., Guglielmi A., Ettorre G.M., Giuliante F., Mazzaferro V., Dalla Valle R., De Carlis L., Jovine E., Ferrero A., Ratti F., Lo Tesoriere R., Gringeri E., Ruzzenente A., Levi Sandri G.B., Ardito F., Virdis M., Iaria M., Ferla F., Lombardi R., Di Benedetto F., Gruttadauria S., Boggi U., Torzilli G., Rossi E., Vincenti L., Berti S., Ceccarelli G., Belli G., Zamboni F., Calise F., Coratti A., Santambrogio R., Brolese A., Navarra G., Mezzatesta P., Zimmitti G., Ravaioli M., Russolillo, N., Aldrighetti, L., Cillo, U., Guglielmi, A., Ettorre, G. M., Giuliante, F., Mazzaferro, V., Dalla Valle, R., De Carlis, L., Jovine, E., Ferrero, A., Ratti, F., Lo Tesoriere, R., Gringeri, E., Ruzzenente, A., Levi Sandri, G. B., Ardito, F., Virdis, M., Iaria, M., Ferla, F., Lombardi, R., Di Benedetto, F., Gruttadauria, S., Boggi, U., Torzilli, G., Rossi, E., Vincenti, L., Berti, S., Ceccarelli, G., Belli, G., Zamboni, F., Calise, F., Coratti, A., Santambrogio, R., Brolese, A., Navarra, G., Mezzatesta, P., Zimmitti, G., and Ravaioli, M.

Subjects
Liver surgery, Male, ACHIEVABLE BENCHMARKS, Cirrhosis, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, ESTABLISHING BENCHMARKS, CARE, COMPLICATIONS, PROPOSAL, 030230 surgery, 0302 clinical medicine, Postoperative Complications, Risk Factors, benchmarks, Registries, Laparoscopy, liver surgery, medicine.diagnostic_test, Bowel resection, Benchmarking, Treatment Outcome, Italy, liver resection, 030211 gastroenterology & hepatology, Female, medicine.medical_specialty, National cohort, Coronavirus, SARS-CoV-2COVID-19Pandemic, Obesity, Bariatric surgery, 03 medical and health sciences, Internal medicine, medicine, Hepatectomy, Humans, Obesity, Quality of Health Care, Bariatric surgery, major morbidity, business.industry, Minimally Invasive Liver Surgery, laparoscopic liver surgery, Odds ratio, Risk adjustment, medicine.disease, Coronavirus, benchmarks, laparoscopic, SARS-CoV-2COVID-19Pandemic, Surgery, business
Abstract

This study aimed to assess the best achievable outcomes in laparoscopic liver resection (LLR) after risk adjustment based on surgical technical difficulty using a national registry.LLRs registered in the Italian Group of Minimally Invasive Liver Surgery registry from November 2014 to March 2018 were considered. Benchmarks were calculated according to the Achievable Benchmark of Care (ABC™). LLRs at each centre were divided into three clusters (groups I, II and III) based on the Kawaguchi classification. ABCs for overall and major morbidity were calculated in each cluster. Multivariable analysis was used to identify independent risk factors for overall and major morbidity. Significant variables were used in further risk adjustment.A total of 1752 of 2263 patients fulfilled the inclusion criteria: 1096 (62·6 per cent) in group I, 435 (24·8 per cent) in group II and 221 (12·6 per cent) in group III. The ABCs for overall morbidity (7·8, 14·2 and 26·4 per cent for grades I, II and II respectively) and major morbidity (1·4, 2·2 and 5·7 per cent) increased with the difficulty of LLR. Multivariable analysis showed an increased risk of overall morbidity associated with multiple LLRs (odds ratio (OR) 1·35), simultaneous intestinal resection (OR 3·76) and cirrhosis (OR 1·83), and an increased risk of major morbidity with intestinal resection (OR 4·61). ABCs for overall and major morbidity were 14·4 and 3·2 per cent respectively for multiple LLRs, 30 and 11·1 per cent for intestinal resection, and 14·9 and 4·8 per cent for cirrhosis.Overall morbidity benchmarks for LLR ranged from 7·8 to 26·4 per cent, and those for major morbidity from 1·4 to 5·7 per cent, depending on complexity. Benchmark values should be adjusted according to multiple LLRs or simultaneous intestinal resection and cirrhosis.Este estudio tuvo como objetivo evaluar los mejores resultados que se pueden conseguir en la resección hepática laparoscópica (laparoscopic liver resection, LLR) después del ajuste por riesgos basado en la dificultad de la técnica quirúrgica utilizando un registro nacional. MÉTODOS: Se consideraron las LLRs incluidas en el Registro del Grupo Italiano de Cirugía Hepática Mínimamente Invasiva desde 11/2014 a 03/2018. Los resultados de referencia (benchmarks) se calcularon de acuerdo con el Achievable Benchmark of Care (ABC™). Las LLRs de cada uno de los centros se dividieron en 3 grupos (Grupo I, II y III) en base a la clasificación de Kawaguchi. Se calculó el ABC de la morbilidad global y de la morbilidad mayor para cada grupo. Se realizó un análisis multivariable para identificar los factores independientes de riesgos para la morbilidad global y morbilidad mayor. Se utilizaron variables significativas para realizar ajustes de riesgo adicionales.Un total de 1.752 pacientes de los 2.263 cumplían los criterios de inclusión, de los cuales 1.096 (62,6%) se incluyeron en el Grupo I, 435 (24,8%) en el Grupo II y 221 (12,6%) en el Grupo III. El ABC de la morbilidad global (7,8%, 14,2%, 26,4%) y de la morbilidad mayor (1,4%, 2,2%, 5,7%) aumentó del Grupo I al Grupo III. El análisis multivariable mostró un incremento del riesgo para la morbilidad global asociada con múltiples LLRs (razón de oportunidades, odds ratio, OR 1,349), resección intestinal simultánea (OR 3,760) y cirrosis (OR 1,825), y para la morbilidad mayor con la resección intestinal (OR 4,606). Los ABC de la morbilidad global y morbilidad mayor fueron 14,4% y 3,2% para las LLR múltiples, 30% y 11% para la resección intestinal, y 14,9% y 4,8% para la cirrosis, respectivamente. CONCLUSIÓN: Los resultados de referencia (benchmark) para la morbilidad global y morbilidad mayor en la LLR variaron entre un 8% y un 26% y entre un 1,4% y un 5,7%, dependiendo de la complejidad. Los valores de referencia deberían ajustarse de acuerdo con la práctica de LLRs múltiples o resección intestinal simultánea y cirrosis.

Published
2020

36. Development and Validation of a Comprehensive Model to Estimate Early Allograft Failure among Patients Requiring Early Liver Retransplant

Author

Fabio Ferla, Damiano Patrono, Patrizia Burra, Roberto Montalti, Paolo Muiesan, Amedeo Carraro, Vincenzo Mazzaferro, S Meli, Fabrizio Di Benedetto, Matteo Cescon, Alessandro Vitale, Salvatore Agnes, Paolo Magistri, Umberto Cillo, Stefania Camagni, Lucio Caccamo, Duilio Pagano, Wasfi Alrawashdeh, Alfonso Wolfango Avolio, Andrea Schlegel, Salvatore Gruttadauria, Luciana Teofili, Luciano De Carlis, Gabriele Spoletini, Michele Colledan, A Franco, Massimo Rossi, Marco Vivarelli, Paolo De Simone, Quirino Lai, Daniele Dondossola, John Hammond, Marco Bongini, Renato Romagnoli, Matteo Ravaioli, P Violi, Domenico Bassi, Avolio, A. W., Franco, A., Schlegel, A., Lai, Q., Meli, S., Burra, P., Patrono, D., Ravaioli, M., Bassi, D., Ferla, F., Pagano, D., Violi, P., Camagni, S., Dondossola, D., Montalti, R., Alrawashdeh, W., Vitale, A., Teofili, L., Spoletini, G., Magistri, P., Bongini, M., Rossi, M., Mazzaferro, V., Di Benedetto, F., Hammond, J., Vivarelli, M., Agnes, S., Colledan, M., Carraro, A., Cescon, M., De Carlis, L., Caccamo, L., Gruttadauria, S., Muiesan, P., Cillo, U., Romagnoli, R., De Simone, P., Avolio A.W., Franco A., Schlegel A., Lai Q., Meli S., Burra P., Patrono D., Ravaioli M., Bassi D., Ferla F., Pagano D., Violi P., Camagni S., Dondossola D., Montalti R., Alrawashdeh W., Vitale A., Teofili L., Spoletini G., Magistri P., Bongini M., Rossi M., Mazzaferro V., Di Benedetto F., Hammond J., Vivarelli M., Agnes S., Colledan M., Carraro A., Cescon M., De Carlis L., Caccamo L., Gruttadauria S., Muiesan P., Cillo U., Romagnoli R., De Simone P., Avolio, A, Franco, A, Schlegel, A, Lai, Q, Meli, S, Burra, P, Patrono, D, Ravaioli, M, Bassi, D, Ferla, F, Pagano, D, Violi, P, Camagni, S, Dondossola, D, Montalti, R, Alrawashdeh, W, Vitale, A, Teofili, L, Spoletini, G, Magistri, P, Bongini, M, Rossi, M, Mazzaferro, V, Di Benedetto, F, Hammond, J, Vivarelli, M, Agnes, S, Colledan, M, Carraro, A, Cescon, M, De Carlis, L, Caccamo, L, Gruttadauria, S, Muiesan, P, Cillo, U, Romagnoli, R, and De Simone, P

Subjects
Male, Time Factors, li, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, 030230 surgery, Liver transplantation, Liver disease, 0302 clinical medicine, Retrospective Studie, Interquartile range, Risk Factors, LIVER TRANSPLANTATION, EARLY ALLOGRAFT FAILURE, OUTCOME, RISK QUANTIFICATION, EARLY ALLOGRAFT FAILURE, Original Investigation, Aged, 80 and over, education.field_of_study, RISK QUANTIFICATION, Graft Survival, Middle Aged, Allografts, Algorithm, Online Only, 030220 oncology & carcinogenesis, Female, Algorithms, Human, Cohort study, medicine.medical_specialty, Logistic Model, liver retransplantation, Population, Reproducibility of Result, 03 medical and health sciences, Internal medicine, medicine, Online First, Humans, education, Aged, Retrospective Studies, OUTCOME, Receiver operating characteristic, business.industry, Risk Factor, Research, Reproducibility of Results, Correction, Retrospective cohort study, LIVER TRANSPLANTATION, medicine.disease, TRAPIANTO DI FEGATO, SOPRAVVIVENZA, QUANTIFICAZIONE DEL RISCHIO, Transplantation, Logistic Models, ROC Curve, Surgery, Primary Graft Dysfunction, business, Liver Failure
Abstract

Key Points Question Can the individual risk estimation for early allograft failure (EAF) be improved in view of liver retransplant? Findings In this multicenter cohort study investigating the association between donor-recipient factors and EAF, a novel Early Allograft Failure Simplified Estimation (EASE) score was developed. The score includes Model for End-stage Liver Disease score, transfused packed red blood cells, and hepatic vessel early thrombosis as well as transaminases, platelet, and bilirubin kinetics as variables on day 10 after transplant. The EASE score outperformed previous model scores, estimating EAF risk with 87% accuracy on day 90 after transplant; EASE was developed on a multicenter Italian database (1609 recipients) and validated on an external UK database (538 recipients). Meaning In this study, the EASE score rated the EAF risk (0%-100%) and identified cases at unsustainable risk to be listed for retransplant., Importance Expansion of donor acceptance criteria for liver transplant increased the risk for early allograft failure (EAF), and although EAF prediction is pivotal to optimize transplant outcomes, there is no consensus on specific EAF indicators or timing to evaluate EAF. Recently, the Liver Graft Assessment Following Transplantation (L-GrAFT) algorithm, based on aspartate transaminase, bilirubin, platelet, and international normalized ratio kinetics, was developed from a single-center database gathered from 2002 to 2015. Objective To develop and validate a simplified comprehensive model estimating at day 10 after liver transplant the EAF risk at day 90 (the Early Allograft Failure Simplified Estimation [EASE] score) and, secondarily, to identify early those patients with unsustainable EAF risk who are suitable for retransplant. Design, Setting, and Participants This multicenter cohort study was designed to develop a score capturing a continuum from normal graft function to nonfunction after transplant. Both parenchymal and vascular factors, which provide an indication to list for retransplant, were included among the EAF determinants. The L-GrAFT kinetic approach was adopted and modified with fewer data entries and novel variables. The population included 1609 patients in Italy for the derivation set and 538 patients in the UK for the validation set; all were patients who underwent transplant in 2016 and 2017. Main Outcomes and Measures Early allograft failure was defined as graft failure (codified by retransplant or death) for any reason within 90 days after transplant. Results At day 90 after transplant, the incidence of EAF was 110 of 1609 patients (6.8%) in the derivation set and 41 of 538 patients (7.6%) in the external validation set. Median (interquartile range) ages were 57 (51-62) years in the derivation data set and 56 (49-62) years in the validation data set. The EASE score was developed through 17 entries derived from 8 variables, including the Model for End-stage Liver Disease score, blood transfusion, early thrombosis of hepatic vessels, and kinetic parameters of transaminases, platelet count, and bilirubin. Donor parameters (age, donation after cardiac death, and machine perfusion) were not associated with EAF risk. Results were adjusted for transplant center volume. In receiver operating characteristic curve analyses, the EASE score outperformed L-GrAFT, Model for Early Allograft Function, Early Allograft Dysfunction, Eurotransplant Donor Risk Index, donor age × Model for End-stage Liver Disease, and Donor Risk Index scores, estimating day 90 EAF in 87% (95% CI, 83%-91%) of cases in both the derivation data set and the internal validation data set. Patients could be stratified in 5 classes, with those in the highest class exhibiting unsustainable EAF risk. Conclusions and Relevance This study found that the developed EASE score reliably estimated EAF risk. Knowledge of contributing factors may help clinicians to mitigate risk factors and guide them through the challenging clinical decision to allocate patients to early liver retransplant. The EASE score may be used in translational research across transplant centers., This multicenter cohort study develops and validates a simplified comprehensive model that estimates on day 10 after liver transplant the risk of early allograft failure with 90 days among patients who undergo liver transplant.

Published
2020

37. mTOR Inhibition Is Most Beneficial After Liver Transplantation for Hepatocellular Carcinoma in Patients With Active Tumors

Author

Antonio Daniele Pinna, Natalie Filmann, Lionel Rostaing, Jens Brockmann, Michael Heise, Andreas A. Schnitzbauer, Simone I. Strasser, Giorgio Rossi, Silvio Nadalin, Jean Gugenheim, Tom M. Ganten, Umberto Cillo, Norman M. Kneteman, Koert P. de Jong, André Roy, Víctor Sánchez Turrión, Thomas Becker, Christoph Duvoux, Markus Rentsch, Jürgen Klempnauer, Utz Settmacher, George Philippe Pageaux, Christian Klein, Roberto Troisi, Edward K. Geissler, Darius F. Mirza, Gunnar Söderdahl, Peter Neuhaus, Jan Lerut, Hans J. Schlitt, Patrizia Burra, Vincenzo Mazzaferro, Johann Pratschke, T. Scholz, Neville V. Jamieson, Wolf O. Bechstein, James Powel, Thomas Soliman, Heikki Mäkisalo, Magnus Rizell, René Adam, Bart van Hoek, Michele Colledan, Itxarone Bilbao, Philippe Bachellier, Olivier Chazoullières, Sherrie Bhoori, Jaques Pirenne, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, Schnitzbauer, A, Filmann, N, Adam, R, Bachellier, P, Bechstein, W, Becker, T, Bhoori, S, Bilbao, I, Brockmann, J, Burra, P, Chazoullieres, O, Cillo, U, Colledan, M, Duvoux, C, Ganten, T, Gugenheim, J, Heise, M, van Hoek, B, Jamieson, N, de Jong, K, Klein, C, Klempnauer, J, Kneteman, N, Lerut, J, Makisalo, H, Mazzaferro, V, Mirza, D, Nadalin, S, Neuhaus, P, Pageaux, G, Pinna, A, Pirenne, J, Pratschke, J, Powel, J, Rentsch, M, Rizell, M, Rossi, G, Rostaing, L, Roy, A, Scholz, T, Settmacher, U, Soliman, T, Strasser, S, Soderdahl, G, Troisi, R, Turrion, V, Schlitt, H, Geissler, E, Universitätsklinikum Frankfurt, Centre Hépato-Biliaire [Hôpital Paul Brousse] (CHB), Hôpital Paul Brousse-Assistance Publique - Hôpitaux de Paris, Les Hôpitaux Universitaires de Strasbourg (HUS), University Medical Center of Schleswig–Holstein = Universitätsklinikum Schleswig-Holstein (UKSH), Kiel University, IRCCS Istituto Nazionale dei Tumori [Milano], Vall d'Hebron University Hospital [Barcelona], Universitätsklinikum Münster, Universita degli Studi di Padova, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Azienda Ospedaliera di Padova, Azienda Ospedaliera Ospedale Papa Giovanni XXIII [Bergamo, Italy], Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), UniversitätsKlinikum Heidelberg, Centre Hospitalier Universitaire de Nice (CHU Nice), Leiden University Medical Center (LUMC), Cambridge University Hospitals - NHS (CUH), University of Cambridge [UK] (CAM), Addenbrooke's Hospital, Cambridge University NHS Trust, University Medical Center Groningen [Groningen] (UMCG), University of Groningen [Groningen], Universitätsklinikum Essen [Universität Duisburg-Essen] (Uniklinik Essen), Medizinische Hochschule Hannover (MHH), University of Alberta, Université Catholique de Louvain = Catholic University of Louvain (UCL), Helsinki University Hospital, University Hospitals Birmingham [Birmingham, Royaume-Uni], Queens Elizabeth Hospital [Birmingham], Universitätsklinikum Tübingen - University Hospital of Tübingen, Eberhard Karls Universität Tübingen = Eberhard Karls University of Tuebingen, Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Policlinico S. Orsola-malpighi, Alma Mater Studiorum Università di Bologna [Bologna] (UNIBO)-Servizio sanitario regionale Emilia-Romagna, UZLeuven, Royal Infirmary of Edinburgh, Ludwig-Maximilians-Universität München (LMU), Sahlgrenska University Hospital [Gothenburg], Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, CHU Grenoble, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM), Uppsala University Hospital, Universitätsklinikum Jena [Jena], Medizinische Universität Wien = Medical University of Vienna, Royal Prince Alfred Hospital, Karolinska University Hospital [Stockholm], Ghent University Hospital, Hospital Universitario Puerta de Hierro-Majadahonda [Madrid, Spain], University Hospital Regensburg, Fraunhofer Institute for Toxicology and Experimental Medicine (Fraunhofer ITEM), Fraunhofer (Fraunhofer-Gesellschaft), Publica, Schnitzbauer, A. A., Filmann, N., Adam, R., Bachellier, P., Bechstein, W. O., Becker, T., Bhoori, S., Bilbao, I., Brockmann, J., Burra, P., Chazoullieres, O., Cillo, U., Colledan, M., Duvoux, C., Ganten, T. M., Gugenheim, J., Heise, M., van Hoek, B., Jamieson, N., de Jong, K. P., Klein, C. G., Klempnauer, J., Kneteman, N., Lerut, J., Makisalo, H., Mazzaferro, V., Mirza, D. F., Nadalin, S., Neuhaus, P., Pageaux, G. -P., Pinna, A. D., Pirenne, J., Pratschke, J., Powel, J., Rentsch, M., Rizell, M., Rossi, G., Rostaing, L., Roy, A., Scholz, T., Settmacher, U., Soliman, T., Strasser, S., Soderdahl, G., Troisi, R., Turrion, V. S., Schlitt, H. J., Geissler, E. K., Università degli Studi di Padova = University of Padua (Unipd), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Herrada, Anthony, Groningen Institute for Organ Transplantation (GIOT), and Guided Treatment in Optimal Selected Cancer Patients (GUTS)

Subjects
Male, Oncology, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, medicine.medical_treatment, Medizin, Liver transplantation, MESH: Intention to Treat Analysis, mTOR-inhibition, 0302 clinical medicine, MESH: Liver Neoplasms, Clinical endpoint, MESH: Carcinoma, Hepatocellular, Milan criteria, MESH: Aged, MESH: Middle Aged, Liver Neoplasms, Hazard ratio, Middle Aged, Intention to Treat Analysis, 3. Good health, Survival Rate, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, multivariate COX regression, Female, 030211 gastroenterology & hepatology, MESH: Immunosuppressive Agents, MESH: Neoplasm Recurrence, Local, Immunosuppressive Agents, medicine.drug, medicine.medical_specialty, MESH: Liver Transplantation, Carcinoma, Hepatocellular, MESH: Survival Rate, AFP, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 03 medical and health sciences, Internal medicine, medicine, Carcinoma, Humans, Survival rate, Aged, Sirolimus, MESH: Humans, business.industry, medicine.disease, digestive system diseases, MESH: Male, Liver Transplantation, Surgery, MESH: Sirolimus, Neoplasm Recurrence, Local, business, MESH: Female
Abstract

OBJECTIVE: The aim of this study was to evaluate the survival benefit of sirolimus in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC) (exploratory analysis of the SiLVER-trial). SUMMARY AND BACKGROUND DATA: Patients receiving LT) for HCC are at a high risk for tumor recurrence. Calcineurin inhibitors have shown evidence to promote cancer growth, whereas mammalian target of rapamycin (mTOR) inhibitors like sirolimus have anticancer effects. In the SiLVER-trial (Clinicaltrials.gov: NCT00355862), the effect of sirolimus on the recurrence of HCC after LT was investigated in a prospective randomized trial. Although the primary endpoint of improved disease-free survival (DFS) with sirolimus was not met, outcomes were improved for patients in the sirolimus-treatment arm in the first 3 to 5 years. To learn more about the key variables, a multivariate analysis was performed on the SiLVER-trial data. PATIENTS AND METHODS: Data from 508 patients of the intention-to-treat analysis were included in exploratory univariate and multivariate models for overall survival (OS), DFS and a competing risk analysis for HCC recurrence. RESULTS: Sirolimus use for ≥3 months after LT for HCC independently reduced the hazard for death in the multivariate analysis [hazard ratio (HR): 0.7 (95% confidence interval, CI: 0.52-0.96, P = 0.02). Most strikingly, patients with an alpha-fetoprotein (AFP) ≥10 ng/mL and having used sirolimus for ≥3 months, benefited most with regard to OS, DFS, and HCC-recurrence (HR: 0.49-0.59, P = 0.0079-0.0245). CONCLUSIONS: mTOR-inhibitor treatment with sirolimus for ≥3 months improves outcomes in LT for HCC, especially in patients with AFP-evidence of higher tumor activity, advocating particularly for mTOR inhibitor use in this subgroup of patients. CLINICAL TRIAL REGISTRATION: EudraCT: 2005-005362-36 CLINICALTRIALS.GOV:: NCT00355862. ispartof: ANNALS OF SURGERY vol:272 issue:5 pages:855-862 ispartof: location:United States status: published

Published
2020

38. Preoperative predictors of liver decompensation after mini-invasive liver resection

Author

Giorgio Rossi, M. Monteleone, Vincenzo Mazzaferro, Giuseppe Maria Ettorre, Umberto Cillo, Luca Aldrighetti, Raffaele Dalla Valle, Alessandro Ferrero, Felice Giuliante, Luciano De Carlis, Fabrizio Di Benedetto, Carlo Sposito, Alfredo Guglielmi, Sposito, C., Monteleone, M., Aldrighetti, L., Cillo, U., Dalla Valle, R., Guglielmi, A., Ettorre, G. M., Ferrero, A., Di Benedetto, F., Rossi, G. E., De Carlis, L., Giuliante, F., Mazzaferro, V., Sposito, C, Monteleone, M, Aldrighetti, L, Cillo, U, Dalla Valle, R, Guglielmi, A, Ettorre, G, Ferrero, A, Di Benedetto, F, Rossi, G, De Carlis, L, Giuliante, F, and Mazzaferro, V

Subjects
Male, medicine.medical_specialty, Cirrhosis, Carcinoma, Hepatocellular, Mini-invasive liver surgery, Post-hepatectomy liver failure, 030230 surgery, Chronic liver disease, Gastroenterology, Resection, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Ascites, medicine, Hepatectomy, Humans, Prospective Studies, Prospective cohort study, Aged, Retrospective Studies, business.industry, Liver Neoplasms, Hepatology, medicine.disease, Preoperative Period, 030211 gastroenterology & hepatology, Surgery, Female, medicine.symptom, Complication, business, Liver Failure, Abdominal surgery
Abstract

Background: Post-hepatectomy liver failure (PHLF) represents the most frequent complication after liver surgery, and the most common cause of morbidity and mortality. Aim of the study is to identify the predictors of PHLF after mini-invasive liver surgery in cirrhosis and chronic liver disease, and to develop a model for risk prediction. Methods: The present study is a multicentric prospective cohort study on 490 consecutive patients who underwent mini-invasive liver resection from the Italian Registry of Mini-invasive Liver Surgery (I go MILS). Retrospective additional biochemical and clinical data were collected. Results: On 490 patients (26.5% females), PHLF occurred in 89 patients (18.2%). The only independent predictors of PHLF were Albumin-Bilirubin (ALBI) score (OR 3.213; 95% CI 1.661–6.215; p

Published
2019

39. Outcomes of enhanced one-stage ultrasound-guided hepatectomy for bilobar colorectal liver metastases compared to those of ALPPS: a multicenter case-match analysis

Author

Matteo Cescon, Umberto Cillo, Luca Viganò, Claudia Benini, Alessandro Ferrero, Elio Jovine, Luca Aldrighetti, Marco Massani, Matteo Cimino, Guido Torzilli, Matteo Serenari, Giuseppe Maria Ettorre, Torzilli, G., Serenari, M., Vigano, L., Cimino, M., Benini, C., Massani, M., Ettorre, G. M., Cescon, M., Ferrero, A., Cillo, U., Aldrighetti, L., Jovine, E., Torzilli G., Serenari M., Vigano L., Cimino M., Benini C., Massani M., Ettorre G.M., Cescon M., Ferrero A., Cillo U., Aldrighetti L., and Jovine E.

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Portal vein ligation, 030230 surgery, Disease-Free Survival, 03 medical and health sciences, 0302 clinical medicine, medicine, Preoperative chemotherapy, Hepatectomy, Humans, Hospital Mortality, Aged, Retrospective Studies, Ultrasonography, Hepatology, business.industry, Patient Selection, Liver Neoplasms, Gastroenterology, One stage, Retrospective cohort study, Perioperative, Ultrasound guided, Surgery, Match analysis, Survival Rate, Treatment Outcome, colorectal liver metastases, liver failure, ALPPS, hepatectomy, Italy, Surgery, Computer-Assisted, 030220 oncology & carcinogenesis, Female, business, Colorectal Neoplasms, Follow-Up Studies
Abstract

Background In case of bilobar colorectal liver metastases (CLM) associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been proposed. Enhanced one-stage ultrasound-guided hepatectomy (e-OSH) may represent a further solution for these patients. Aim of this study was to compare by case-match analyses the outcome of ALPPS and e-OSH. Methods Between 2012 and 2017, patients undergoing ALPPS for bilobar CLM were matched 1:2 with patients receiving e-OSH. Patients were matched according to the Fong Score (1–3/4–5), the number of CLM (3–7/≥8), the number of CLM in the left liver (1–2/≥3) and preoperative chemotherapy. All the patients in the e-OSH group had a right -sided major vascular contact. The main endpoints of the study were perioperative outcomes, overall (OS) and disease-free survival (DFS). Results Seventy-eight patients were selected (26 ALPPS and 52 e-OSH) based on matching process. The two treatments differed significantly in major morbidity (26.9% ALPPS vs 7.7% e-OSH, p = 0.017). Median OS (31.7 vs 32.6 months) and DFS (10.6 vs 7.8 months) were comparable between the two groups. Conclusions This study demonstrates that ALPPS and e-OSH for bilobar CLM achieve comparable long-term results, despite higher morbidity reported after ALPPS. These findings should drive to reposition e-OSH in managing these patients.

Published
2019

40. Laparoscopic liver resection of hepatocellular carcinoma located in unfavorable segments: a propensity score-matched analysis from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery) Registry

Author

G.L. Grazi, Fausto Zamboni, Fulvio Calise, Giovanni Sgroi, Giorgio Rossi, Antonio Giuliani, G.B. Levi Sandri, S. Berti, Abdallah Slim, Antonio Floridi, Roberto Santambrogio, P. Mezzatesta, Felice Giuliante, Giulio Belli, Giovanni Vennarecci, Salvatore Gruttadauria, Vincenzo Mazzaferro, R. Dalla Valle, Alberto Brolese, Alessandro Ferrero, A. Coratti, Francesca Ratti, Nadia Russolillo, Andrea Ruzzenente, Giuseppe Maria Ettorre, A. Antonucci, Giuseppe Navarra, M. Iaria, L. Vincenti, P. Bonsignore, P. Maida, Ugo Boggi, G. Griseri, A. Parisi, Alfredo Guglielmi, Elio Jovine, Enrico Gringeri, Guido Torzilli, Umberto Cillo, Michele Colledan, F. Di Benedetto, Paolo Magistri, A. Frena, Fabio Ferla, Andrea Scotti, Matteo Virdis, A.D. Pinna, Luca Aldrighetti, L. De Carlis, Graziano Ceccarelli, Sandri, Gbl, Ettorre, Gm, Aldrighetti, L, Cillo, U, Dalla Valle, R, Guglielmi, A, Mazzaferro, V, Ferrero, A, Di Benedetto, F, Gruttadauria, S, De Carlis, L, Vennarecci, G, Antonucci, A, Belli, G, Berti, S, Boggi, U, Bonsignore, P, Brolese, A, Calise, F, Ceccarelli, G, Colledan, M, Coratti, A, Ferla, F, Floridi, A, Frena, A, Giuliani, A, Giuliante, F, Grazi, Gl, Gringeri, E, Griseri, G, Iaria, M, Jovine, E, Paolo, M, Maida, P, Mezzatesta, P, Russolillo, N, Navarra, G, Parisi, A, Pinna, Ad, Ratti, F, Rossi, Ge, Ruzzenente, A, Santambrogio, R, Scotti, A, Sgroi, G, Slim, A, Torzilli, G, Vincenti, L, Virdis, M, Zamboni, F, Levi Sandri G.B., Ettorre G.M., Aldrighetti L., Cillo U., Dalla Valle R., Guglielmi A., Mazzaferro V., Ferrero A., Di Benedetto F., Gruttadauria S., De Carlis L., Vennarecci G., Antonucci A., Belli G., Berti S., Boggi U., Bonsignore P., Brolese A., Calise F., Ceccarelli G., Colledan M., Coratti A., Ferla F., Floridi A., Frena A., Giuliani A., Giuliante F., Grazi G.L., Gringeri E., Griseri G., Iaria M., Jovine E., Magistri P., Maida P., Mezzatesta P., Russolillo N., Navarra G., Parisi A., Pinna A.D., Ratti F., Rossi G.E., Ruzzenente A., Santambrogio R., Scotti A., Sgroi G., Slim A., Torzilli G., Vincenti L., Virdis M., Zamboni F., Levi Sandri, G, Ettorre, G, Grazi, G, Magistri, P, Pinna, A, and Rossi, G

Subjects
Laparoscopic surgery, Registrie, Male, Hepatocellular carcinoma, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, Laparoscopic HCC, Posterior segment, Hepatocellular carcinoma, IGoMILS, Child B, Laparoscopic liver resection, 0302 clinical medicine, Postoperative Complications, Prospective Studies, Registries, Laparoscopy, Prospective cohort study, medicine.diagnostic_test, Laparoscopic HCC, Liver Neoplasms, Margins of Excision, IGoMILS, Middle Aged, Laparoscopic liver resection, Child B, Italy, Liver Neoplasm, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, Human, medicine.medical_specialty, Carcinoma, Hepatocellular, Matched-Pair Analysis, Operative Time, NO, 03 medical and health sciences, medicine, Humans, Hepatectomy, Blood Transfusion, Matched-Pair Analysi, Posterior segment, Aged, Postoperative Care, LS7_4, Surgery, business.industry, Carcinoma, Hepatocellular, Perioperative, medicine.disease, digestive system diseases, Child B, Hepatocellular carcinoma, IGoMILS, Laparoscopic HCC, Laparoscopic liver resection, Posterior segment, Aged, Blood Transfusion, Carcinoma, Hepatocellular, Female, Humans, Italy, Liver Neoplasms, Male, Margins of Excision, Matched-Pair Analysis, Middle Aged, Operative Time, Postoperative Care, Postoperative Complications, Prospective Studies, Registries, Hepatectomy, Laparoscopy, Prospective Studie, Propensity score matching, Postoperative Complication, business, Abdominal surgery
Abstract

Objective: Laparoscopic liver resection (LLR) for Hepatocellular Carcinoma (HCC) is one of the most important indications for the minimally invasive approach. Our study aims to analyze the experience of the Italian Group of Minimally Invasive Liver Surgery with laparoscopic surgical treatment of HCC, with a focus on tumor location and how it affects morbidity and mortality. Methods: 38 centers participated in this study; 372 cases of LLR for HCC were prospectively enrolled. Patients were divided into two groups according to the HCC nodule location. Group 1 favorable location and group 2 unfavorable location. Perioperative outcomes were compared between the two groups before and after a propensity score match (PS) 1:1. Results: Before PS in group 2 surgical time was longer; conversion rate was higher; postoperative transfusion and comprehensive complication index were also higher. PS was performed with a cohort of 298 patients (from 18 centers), with 66 and 232 patients with HCC in unfavorable and favorable locations, respectively. After PS matching, 62 patients from group 1 and group 2 each were compared. Operative and postoperative course were similar in patients with HCC in favorable and unfavorable LLR locations. Surgical margins were found to be identical before and after PS. Conclusions: These results show that LLR in patients with HCC can be safely performed in all segments because of the extensive experience of all surgeons from multiple centers in performing traditional open liver surgery as well as laparoscopic surgery.

Published
2019

41. 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

42. Location and allocation

Author

Artzner, Thierry, Bernal, William, Belli, Luca S, Conti, Sara, Cortesi, Paolo A, Sacleux, Sophie‐Caroline, Pageaux, George‐Philippe, Radenne, Sylvie, Trebicka, Jonel, Fernandez, Javier, Perricone, Giovanni, Piano, Salvatore, Nadalin, Silvio, Morelli, Maria C, Martini, Silvia, Polak, Wojciech G, Zieniewicz, Krzysztof, Toso, Christian, Berenguer, Marina, Iegri, Claudia, Invernizzi, Federica, Volpes, Riccardo, Karam, Vincent, Adam, René, Faitot, François, Rabinowich, Liane, Saliba, Faouzi, Meunier, Lucy, Lesurtel, Mickael, Uschner, Frank E, Michard, Baptiste, Coilly, Audrey, Meszaros, Magdalena, Poinsot, Domitille, Besch, Camille, Schnitzbauer, Andreas, De Carlis, Luciano G, Fumagalli, Roberto, Angeli, Paolo, Arroyo, Vincente, Fondevila, Constantino, Duvoux, Christophe, Jalan, Rajiv, Viganò, Raffaella, Mazzarelli, Chiara, Lauterio, Andrea, Giacomoni, Alessandro, Donato, Francesca, Lampertico, Pietro, Pasulo, Luisa, Fagiuoli, Stefano, Colledan, Michele, Cristina Morelli, Maria, Vitale, Giovanni, Ottobrelli, Antonio, Patrono, Damiano, Romagnoli, Renato, Petridis, Ioannis, Cillo, Umberto, Germani, Giacomo, Burra, Patrizia, Bachellier, Philippe, Schneider, Francis, Castelain, Vincent, Addeo, Pietro, Deridder, Mathilde, Caroline Sacleux Audrey Coilly, Sophie, Faouzi, Saliba, Adam, Rene, Samuel, Didier, Guichon, Celine, Faure, Stéfanie, Ursic‐Bedoya, Josè, Fondevila, Costantino, Colmenero, Jorde, Toapanta, David, Hernández‐Tejero, María, Vinaixa, Carmen, Polak, Wojciech G., den Hoed, Caroline, Haan, Jubi E., Della Penna, Andrea, Erhard Uschner, Frank, Welker, Martin, Zeuzem, Stefan, Bechstein, Wolf, Goossens, Nicolas, Raszeja‐Wyszomirska, Joanna, Rabinovich, Liane, Katarey, Dev, Agarwal, Banwari, Surgery, Gastroenterology & Hepatology, Intensive Care, Biomatériaux et Bioingénierie (BB), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Interface de Recherche Fondamentale et Appliquée en Cancérologie (IRFAC - Inserm U1113), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Paul Strauss : Centre Régional de Lutte contre le Cancer (CRLCC)-Fédération de Médecine Translationelle de Strasbourg (FMTS), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA), the ELITA/EF-CLIF Working Group, Artzner, T, Bernal, W, Belli, L, Conti, S, Cortesi, P, Sacleux, S, Pageaux, G, Radenne, S, Trebicka, J, Fernandez, J, Perricone, G, Piano, S, Nadalin, S, Morelli, M, Martini, S, Polak, W, Zieniewicz, K, Toso, C, Berenguer, M, Iegri, C, Invernizzi, F, Volpes, R, Karam, V, Adam, R, Faitot, F, Rabinowich, L, Saliba, F, Meunier, L, Lesurtel, M, Uschner, F, Michard, B, Coilly, A, Meszaros, M, Poinsot, D, Besch, C, Schnitzbauer, A, De Carlis, L, Fumagalli, R, Angeli, P, Arroyo, V, Fondevila, C, Duvoux, C, Jalan, R, Viganò, R, Mazzarelli, C, Lauterio, A, Giacomoni, A, Donato, F, Lampertico, P, Pasulo, L, Fagiuoli, S, Colledan, M, Cristina Morelli, M, Vitale, G, Ottobrelli, A, Patrono, D, Romagnoli, R, Petridis, I, Cillo, U, Germani, G, Burra, P, Bachellier, P, Schneider, F, Castelain, V, Addeo, P, Deridder, M, Caroline Sacleux Audrey Coilly, S, Faouzi, S, Samuel, D, Guichon, C, Faure, S, Ursic‐bedoya, J, Colmenero, J, Toapanta, D, Hernández‐tejero, M, Vinaixa, C, den Hoed, C, Haan, J, Della Penna, A, Erhard Uschner, F, Welker, M, Zeuzem, S, Bechstein, W, Goossens, N, Raszeja‐wyszomirska, J, Rabinovich, L, Katarey, D, and Agarwal, B

Subjects
Transplantation, ILL CIRRHOTIC-PATIENTS, Liver transplantation, Hepatology, Intensive care, Waiting list, Surgery, Acute-on-Chronic Liver Failure, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

There is growing evidence that liver transplantation (LT) is the most effective treatment for acute-on-chronic liver failure grade-3 (ACLF-3). This study examines whether and how this evidence translates into practice by analyzing the variability in intensive care unit (ICU) admissions, listing strategies, and LT activity for patients with ACLF-3 across transplantation centers in Europe. Consecutive patients who were admitted to the ICU with ACLF-3, whether or not they were listed and/or transplanted with ACLF-3, between 2018 and 2019 were included across 20 transplantation centers. A total of 351 patients with ACLF-3 were included: 33 had been listed prior to developing ACLF-3 and 318 had not been listed at the time of admission to the ICU. There was no correlation between the number of unlisted patients with ACLF-3 admitted to the ICU and the number listed or transplanted while in ACLF-3 across centers. By contrast, there was a correlation between the number of patients listed and the number transplanted while in ACLF-3. About 21% of patients who were listed while in ACLF-3 died on the waiting list or were delisted. The percentage of LT for patients with ACLF-3 varied from 0% to 29% for those transplanted with decompensated cirrhosis across centers (average = 8%), with an I(2) index of 68% (95% confidence interval, 49%-80%), showing substantial heterogeneity among centers. The 1-year survival for all patients with ACLF-3 was significantly higher in centers that listed and transplanted more patients with ACLF-3 (>10 patients) than in centers that listed and transplanted fewer: 36% versus 20%, respectively (p = 0.012). Patients with ACLF-3 face inequity of access to LT across Europe. Waitlisting strategies for patients with ACLF-3 influence their access to LT and, ultimately, their survival.

Published
2022

43. Importance of primary indication and liver function between stages: results of a multicenter Italian audit of ALPPS 2012-2014

Author

Michele Masetti, Fabio Forchino, Elena Toschi, Elio Jovine, Roberto Montalti, Marco Vivarelli, Enrico Gringeri, Antonio Daniele Pinna, Giuseppe Maria Ettorre, Matteo Serenari, Luca Aldrighetti, Vincenzo Mazzaferro, Salvatore Gruttadauria, Erik Schadde, Gian Luca Grazi, Umberto Cillo, Christian Cotsoglou, Giorgio Ercolani, Marco Massani, Francesca Ratti, Bruno Nardo, Nicolò Bassi, Giovanni Vennarecci, Alessandro Ferrero, Matteo Zanello, Serenari, M., Zanello, M., Schadde, E., Toschi, E., Ratti, F., Gringeri, E., Masetti, M., Cillo, U., Aldrighetti, L., Jovine, E., Montalti, R., Vivarelli, M., Grazi, G. L., Vennarecci, G., Ettorre, G. M., Massani, M., Bassi, N., Cotsoglou, C., Mazzaferro, V., Nardo, B., Forchino, F., Ferrero, A., Gruttadauria, S., Ercolani, G., Pinna, A. D., Serenari, Matteo, Zanello, Matteo, Schadde, Erik, Toschi, Elena, Ratti, Francesca, Gringeri, Enrico, Masetti, Michele, Cillo, Umberto, Aldrighetti, Luca, Jovine, Elio, Montalti, Roberto, Vivarelli, Marco, Grazi, GIAN LUCA, Vennarecci, Giovanni, Ettorre, Giuseppe Maria, Massani, Marco, Bassi, Nicolò, Cotsoglou, Christian, Mazzaferro, Vincenzo, Nardo, Bruno, Forchino, Fabio, Ferrero, Alessandro, Gruttadauria, Salvatore, Ercolani, Giorgio, Pinna, ANTONIO DANIELE, Serenari, M, Zanello, M, Schadde, E, Toschi, E, Ratti, F, Gringeri, E, Masetti, M, Cillo, U, Aldrighetti, L, and Jovine, E

Subjects
Male, hepatocellular carcinoma, hepatic resection, metastases, Time Factors, medicine.medical_treatment, 030230 surgery, Muscle hypertrophy, Cholangiocarcinoma, 0302 clinical medicine, Liver Function Tests, Risk Factors, Medicine, Registries, Medical Audit, medicine.diagnostic_test, Portal Vein, Gastroenterology, Organ Size, hepatocellular carcinoma, Middle Aged, Liver regeneration, Treatment Outcome, Italy, Liver, Hepatology, 030220 oncology & carcinogenesis, Female, Original Article, Adult, medicine.medical_specialty, hepatic resection, NO, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, Hepatectomy, Humans, metastases, Ligation, Aged, Proportional Hazards Models, business.industry, Bilirubin, Hypertrophy, Liver Regeneration, Surgery, Logistic Models, Bile Duct Neoplasms, Multivariate Analysis, Liver function, Complication, business, Liver function tests, Biomarkers, Hospitals, High-Volume, Liver Failure
Abstract

Background: Posthepatectomy liver failure is one of the most feared complications in extended hepatic resections. In 2012, a novel two-stage liver resection was developed, able to induce rapid and extensive hypertrophy by portal vein ligation and in situ liver splitting - Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS). The technique became more widely employed but its use remained controversial due to reporting of high complication and mortality rates. Method: A national audit was performed to gather information about the safety of the procedure and to better understand the complications. The audit was offered to all high-volume hepatobiliary centers in Italy. Results: Of all Italian centers approached in January 2012, 12 centers with experience in ALPPS enrolled and participated in collection of data. Fifty patients underwent ALPPS between 2012 and 2014. In 48/50 patients completion of hepatectomy was performed successfully. Major morbidity occurred in 54% with a 20% 90-day mortality. Uni- and multivariate analysis showed that ALPPS for cholangiocarcinoma and a peak of bilirubin over 5 mg/dl between stages was associated with increase of 90 day mortality and worse survival. Discussion: It is proposed that a moratorium be introduced for classic ALPPS in cholangiocarcinoma and to abort ALPPS in patients who develop an interstage increase in bilirubin, due to the high risk of liver failure and mortality.

Published
2016

44. A new prognostic model to predict dropout from the waiting list in cirrhotic candidates for liver transplantation with MELD score <18

Author

Maurizio Biselli, Roberto Montalti, Martina Gambato, Umberto Cillo, Marco Dall’Agata, Pietro Andreone, Patrizia Burra, Matteo Ravaioli, Caterina Liberati, Annagiulia Gramenzi, Lucia Brodosi, Mauro Bernardi, Giorgio Enrico Gerunda, Antonio Daniele Pinna, Stefano Gitto, Biselli, Maurizio, Dall'Agata, Marco, Gramenzi, Annagiulia, Gitto, Stefano, Liberati, Caterina, Brodosi, Lucia, Ravaioli, Matteo, Gambato, Martina, Montalti, Roberto, Pinna, Antonio D, Burra, Patrizia, Gerunda, Giorgio E, Cillo, Umberto, Andreone, Pietro, Bernardi, Mauro, Biselli M, Dall’Agata M, Gramenzi A, Gitto S, Liberati C, Brodosi L, Ravaioli M, Gambato M, Montalti R, Pinna AD, Burra P, Gerunda GE, Cillo U, Andreone P, Bernardi M., Biselli, M, Dall'Agata, M, Gramenzi, A, Gitto, S, Liberati, C, Brodosi, L, Ravaioli, M, Gambato, M, Montalti, R, Pinna, A, Burra, P, Gerunda, G, Cillo, U, Andreone, P, and Bernardi, M

Subjects
Liver Cirrhosis, Multivariate analysis, medicine.medical_treatment, Predictive Value of Test, Liver transplantation, Severity of Illness Index, survival analysis, Cohort Studies, Liver disease, Ascites, Dropout (neural networks), Competing risk, Organ allocation, Prognosis, Scoring system, Survival analysis, Wait list, liver transplantation, COMPETING RISKS, Waiting List, SECS-S/01 - STATISTICA, survival analysi, Ascite, Regression Analysis, medicine.symptom, Human, Glomerular Filtration Rate, medicine.medical_specialty, Prognostic variable, organ allocation, Waiting Lists, Prognosi, Liver Cirrhosi, Renal function, competing risk, Risk Assessment, Regression Analysi, End Stage Liver Disease, Predictive Value of Tests, Internal medicine, prognosis, scoring system, wait list, medicine, Humans, MED/01 - STATISTICA MEDICA, Serum Albumin, Hepatology, business.industry, Sodium, Bilirubin, Models, Theoretical, medicine.disease, Confidence interval, Surgery, MED/09 - MEDICINA INTERNA, Cohort Studie, business
Abstract

Background & Aims The model for end-stage liver disease (MELD) is used for organ allocation in liver transplantation (LT), but its prognostic performance is less accurate in patients with low score. We assess the outcome of patients with MELD 15.9. Conclusions In patients with low MELD (

Published
2015

45. 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

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

Author

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

Subjects
impact of donor/recipient matching on outcomes, Male, Alcoholic liver disease, Cirrhosis, Multicenter Study, Humans, Prospective Study, Liver Transplantation, Donor Risk Index, Hepatocellular Carcinoma, Italy, Donor Liver transplant Recipient, donor match, liver transplantation, donor, recipient, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, liver-match, liver transplant, Liver transplantation, Model for End-Stage Liver Disease, MED/12 - GASTROENTEROLOGIA, Prospective Studies, Prospective cohort study, Child, Liver transplant, donor, Aged, 80 and over, Settore MED/12 - Gastroenterologia, education.field_of_study, liver transplantation, Histocompatibility Testing, Graft Survival, Liver Neoplasms, Gastroenterology, Middle Aged, liver transplantations, liver transplant, information on donors and recipients, recipient, Tissue Donors, Treatment Outcome, Donor, Recipient, Hepatocellular carcinoma, Female, Cohort study, Adult, medicine.medical_specialty, Tissue and Organ Procurement, Adolescent, Waiting Lists, Population, NO, Internal medicine, medicine, education, donor match, Aged, Hepatology, business.industry, Patient Selection, Settore MED/09 - MEDICINA INTERNA, medicine.disease, Fibrosis, Surgery, business
Abstract

BACKGROUND: The Liver Match is an observational cohort study that prospectively enrolled liver transplantations performed at 20 out of 21 Italian Transplant Centres between June 2007 and May 2009. Aim of the study is to investigate the impact of donor/recipient matching on outcomes. In this report we describe the study methodology and provide a cross-sectional description of donor and recipient characteristics and of graft allocation. METHODS: Adult primary transplants performed with deceased heart-beating donors were included. Relevant information on donors and recipients, organ procurement and allocation were prospectively entered in an ad hoc database within the National Transplant Centre web-based Network. Data were blindly analysed by an independent Biostatistical Board. RESULTS: The study enrolled 1530 donor/recipient matches. Median donor age was 56 years. Female donors (n = 681, median 58, range 12-92 years) were older than males (n = 849, median 53, range 2-97 years, p < 0.0001). Donors older than 60 years were 42.2%, including 4.2% octogenarians. Brain death was due to non-traumatic causes in 1126 (73.6%) cases. Half of the donor population was overweight, 10.1% was obese and 7.6% diabetic. Hepatitis B core antibody (HBcAb) was present in 245 (16.0%) donors. The median Donor Risk Index (DRI) was 1.57 (>1.7 in 35.8%). The median cold ischaemia time was 7.3h (≥ 10 in 10.6%). Median age of recipients was 54 years, and 77.7% were males. Hepatocellular carcinoma (HCC) was the most frequent indication overall (44.4%), being a coindication in roughly 1/3 of cases, followed by viral cirrhosis without HCC (28.2%) and alcoholic cirrhosis without HCC (10.2%). Hepatitis C virus infection (with or without HCC) was the most frequent etiologic factor (45.9% of the whole population and 71.4% of viral-related cirrhosis), yet hepatitis B virus infection accounted for 28.6% of viral-related cirrhosis, and HBcAb positivity was found in 49.7% of recipients. The median Model for End Stage Liver Disease (MELD) at transplant was 12 in patients with HCC and 18 in those without. Multivariate analysis showed a slight but significant inverse association between DRI and MELD at transplant. CONCLUSIONS: The deceased donor population in Italy has a high-risk profile compared to other countries, mainly due to older donor age. Almost half of the grafts are transplanted in recipients with HCC. Higher risk donors tend to be preferentially allocated to recipients with HCC, who are usually less ill and older. No other relevant allocation strategy is currently adopted at national level.

Published
2010

47. A prospective randomised, open-labeled, trial comparing sirolimus-containing versus mTOR-inhibitor-free immunosuppression in patients undergoing liver transplantation for hepatocellular carcinoma

Author

Johann Hauss, Peter Neuhaus, Gerd Otto, Koert P. de Jong, Jan Schmidt, Jean Gugenheim, Hans J. Schlitt, Justine Rochon, Simone I. Strasser, Victor Sanchez Turrion, Giorgio Rossi, Michele Colledan, Ernest Hidalgo, Itxarone Bilbao, Thomas Becker, Darius F. Mirza, Ingrid Mutzbauer, Jan Lerut, Michael Heise, Karl-Walter Jauch, Edward K Geissler, Neville V. Jamieson, Umberto Valente, Christophe Duvoux, Susanne Beckebaum, Bart van Hoek, Magnus Rizell, Philippe Wolf, Olivier Chazouillères, Christian Graeb, Gunnar Söderdahl, Rudolf Steininger, Andreas A. Schnitzbauer, Wolf O. Bechstein, Jacques Pirenne, Lionel Rostaing, Umberto Cillo, Norman M. Kneteman, T. Scholz, Vincenzo Mazzaferro, Raimund Margreiter, André Roy, P. Lamby, Roberto Troisi, Heikki Mäkisalo, Antonio Daniele Pinna, Georges-Philippe Pageaux, Patrizia Burra, René Adam, Carl Zuelke, Heiner Wolters, Alfred Königsrainer, Fred Fändrich, Schnitzbauer A.A., Zuelke C., Graeb C., Rochon J., Bilbao I., Burra P., de Jong K.P., Duvoux C., Kneteman N.M., Adam R., Bechstein W.O., Becker T., Beckebaum S., Chazouillères O., Cillo U., Colledan M., Fändrich F., Gugenheim J., Hauss J.P., Heise M., Hidalgo E., Jamieson N., Königsrainer A., Lamby P.E., Lerut J.P., Mäkisalo H., Margreiter R., Mazzaferro V., Mutzbauer I., Otto G., Pageaux G.P., Pinna A.D., Pirenne J., Rizell M., Rossi G., Rostaing L., Roy A., Turrion V.S., Schmidt J., Troisi R.I., van Hoek B., Valente U., Wolf P., Wolters H., Mirza D.F., Scholz T., Steininger R., Soderdahl G., Strasser S.I., Jauch K.W., Neuhaus P., Schlitt H.J., Geissler E.K., Schnitzbauer, A, Zuelke, C, Graeb, C, Rochon, J, Bilbao, I, Burra, P, de Jong, K, Duvoux, C, Kneteman, N, Adam, R, Bechstein, W, Becker, T, Beckebaum, S, Chazouilleres, O, Cillo, U, Colledan, M, Fandrich, F, Gugenheim, J, Hauss, J, Heise, M, Hidalgo, E, Jamieson, N, Konigsrainer, A, Lamby, P, Lerut, J, Makisalo, H, Margreiter, R, Mazzaferro, V, Mutzbauer, I, Otto, G, Pageaux, G, Pinna, A, Pirenne, J, Rizell, M, Rossi, G, Rostaing, L, Roy, A, Turrion, V, Schmidt, J, Troisi, R, van Hoek, B, Valente, U, Wolf, P, Wolters, H, Mirza, D, Scholz, T, Steininger, R, Soderdahl, G, Strasser, S, Jauch, K, Neuhaus, P, Schlitt, H, Geissler, E, IV kirurgian klinikka, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, and UCL - (SLuc) Service de chirurgie et transplantation abdominale

Subjects
Oncology, Cancer Research, Time Factors, medicine.medical_treatment, Medizin, Intracellular Signaling Peptides and Proteins - antagonists & inhibitors, metabolism, Kaplan-Meier Estimate, 312 Clinical medicine, Protein-Serine-Threonine Kinase, Liver transplantation, THERAPY, Study Protocol, Immunosuppressive Agent, endothelial growth-factor renal-cell carcinoma tumor progression rapamycin cancer cyclosporine efficacy therapy target model, 0302 clinical medicine, RENAL-CELL CARCINOMA, Risk Factors, Recurrence, Surgical oncology, Medicine and Health Sciences, Liver Neoplasms - drug therapy, enzymology, mortality, surgery, Sirolimu, Prospective Studies, TUMOR PROGRESSION, Transplantation, Homologou, education.field_of_study, liver transplantation, TOR Serine-Threonine Kinases, Liver Neoplasms, Intracellular Signaling Peptides and Proteins, Immunosuppression, hepatocellular carcinoma, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, CANCER, 3. Good health, Europe, Multicenter Study, Treatment Outcome, TARGET, sirolimus, Liver Neoplasm, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Randomized Controlled Trial, mTOR, Carcinoma, Hepatocellular - drug therapy, enzymology, mortality, surgery, 030211 gastroenterology & hepatology, Immunosuppressive Agents, RCT, Human, medicine.drug, Canada, medicine.medical_specialty, Carcinoma, Hepatocellular, Time Factor, education, Population, Liver Transplantation - adverse effects, mortality, Protein Serine-Threonine Kinases, lcsh:RC254-282, Disease-Free Survival, 03 medical and health sciences, Internal medicine, Genetics, medicine, Transplantation, Homologous, Humans, Comparative Study, Rapamycin, ddc:610, Protein-Serine-Threonine Kinases - antagonists & inhibitors, metabolism, Kaplan-Meiers Estimate, business.industry, Risk Factor, Australia, Immunosuppressive Agents - therapeutic use, Sirolimus - therapeutic use, EFFICACY, Liver Transplantation, Hepatocellular Carcinoma, Sirolimus, medicine.disease, Surgery, MODEL, Transplantation, Clinical trial, Prospective Studie, Intracellular Signaling Peptides and Protein, ENDOTHELIAL GROWTH-FACTOR, CYCLOSPORINE, RAPAMYCIN, business
Abstract

Background The potential anti-cancer effects of mammalian target of rapamycin (mTOR) inhibitors are being intensively studied. To date, however, few randomised clinical trials (RCT) have been performed to demonstrate anti-neoplastic effects in the pure oncology setting, and at present, no oncology endpoint-directed RCT has been reported in the high-malignancy risk population of immunosuppressed transplant recipients. Interestingly, since mTOR inhibitors have both immunosuppressive and anti-cancer effects, they have the potential to simultaneously protect against immunologic graft loss and tumour development. Therefore, we designed a prospective RCT to determine if the mTOR inhibitor sirolimus can improve hepatocellular carcinoma (HCC)-free patient survival in liver transplant (LT) recipients with a pre-transplant diagnosis of HCC. Methods/Design The study is an open-labelled, randomised, RCT comparing sirolimus-containing versus mTOR-inhibitor-free immunosuppression in patients undergoing LT for HCC. Patients with a histologically confirmed HCC diagnosis are randomised into 2 groups within 4-6 weeks after LT; one arm is maintained on a centre-specific mTOR-inhibitor-free immunosuppressive protocol and the second arm is maintained on a centre-specific mTOR-inhibitor-free immunosuppressive protocol for the first 4-6 weeks, at which time sirolimus is initiated. A 21/2 -year recruitment phase is planned with a 5-year follow-up, testing HCC-free survival as the primary endpoint. Our hypothesis is that sirolimus use in the second arm of the study will improve HCC-free survival. The study is a non-commercial investigator-initiated trial (IIT) sponsored by the University Hospital Regensburg and is endorsed by the European Liver and Intestine Transplant Association; 13 countries within Europe, Canada and Australia are participating. Discussion If our hypothesis is correct that mTOR inhibition can reduce HCC tumour growth while simultaneously providing immunosuppression to protect the liver allograft from rejection, patients should experience less post-transplant problems with HCC recurrence, and therefore could expect a longer and better quality of life. A positive outcome will likely change the standard of posttransplant immunosuppressive care for LT patients with HCC. Trial Register Trial registered at http://www.clinicaltrials.gov: NCT00355862 (EudraCT Number: 2005-005362-36)

Published
2010

48. Feasibility and limits of split liver transplantation from pediatric donors: an italian multicenter experience

Author

Matteo, Cescon, Marco, Spada, M. D., Michele, Colledan, Giuliano, Torre, Enzo, Andorno, Umberto, Valente, Giorgio, Rossi, Paolo, Reggiani, Umberto, Cillo, Umberto, Baccarani, GIAN LUCA GRAZI, Giuseppe, Tisone, Franco, Filipponi, Rossi, Massimo, GIUSEPPE MARIA ETTORRE, Mauro, Salizzoni, Oreste, Cuomo, TULLIA DE FEO, Bruno, Gridelli, Cescon, M, Spada, M, Colledan, M, Torre, G, Andorno, E, Valente, U, Rossi, G, Reggiani, P, Cillo, U, Baccarani, U, Grazi, G, Tisone, G, Filipponi, F, Rossi, M, Ettorre, G, Salizzoni, M, Cuomo, O, De Feo, T, Gridelli, B, Cescon M, Spada M, Colledan M, Torre G, Andorno E, Valente U, Rossi G, Reggiani P, Cillo U, Baccarani U, Grazi GL, Tisone G, Filipponi F, Rossi M, Ettorre GM, Salizzoni M, Cuomo O, De Feo T, and Gridelli B.

Subjects
Male, Pediatrics, IMPACT, medicine.medical_treatment, 40+kg+donor+group+%28P+=+not+significant%29%2E+There+were+no+differences+in+the+incidence+of+other+complications%2E+Donor+ICU+stay+>3+days+and+the+use+of+an+interposition+arterial+graft+were+associated+with+an+increased+risk+of+graft+loss+and+arterial+complications%22">and between recipients of LLSs and ERGs. Vascular complication rates were 12% in the < or =40 kg donor group and 6% in the >40 kg donor group (P = not significant). There were no differences in the incidence of other complications. Donor ICU stay >3 days and the use of an interposition arterial graft were associated with an increased risk of graft loss and arterial complications, HEPATIC-ARTERY THROMBOSIS, SINGLE-CENTER EXPERIENCE, ADULT, CHILDREN, RECIPIENTS, SURVIVAL, GRAFTS, IMPACT, RISK, NEED, CHILDREN, Liver transplantation, pediatric donor, 40+kg+were+used%2E+Dimensional+matching+was+based+on+donor-to-recipient+weight+ratio+%28DRWR%29+for+left+lateral+segment+%28LLS%29+and+on+estimated+graft-to-recipient+weight+ratio+%28eGRWR%29+for+extended+right+grafts+%28ERG%29%2E+In+3+cases%22">43 conventional split liver procedures from donors aged <15 years were performed. Nineteen donors weighing < or =40 kg and 24 weighing >40 kg were used. Dimensional matching was based on donor-to-recipient weight ratio (DRWR) for left lateral segment (LLS) and on estimated graft-to-recipient weight ratio (eGRWR) for extended right grafts (ERG). In 3 cases, law.invention, law, Retrospective Studie, SLT, HEPATIC-ARTERY THROMBOSIS, Child, Pediatric Donors, RISK, Liver Diseases, Liver Disease, Graft Survival, no recipient was found for an ERG. The celiac trunk was retained with the LLS in all but 1 case. Forty LLSs were transplanted into 39 children, between pediatric and adult recipients, Middle Aged, Intensive care unit, Tissue Donors, SINGLE-CENTER EXPERIENCE, Multicenter Study, Survival Rate, Treatment Outcome, Italy, ERG, Child, Preschool, SURVIVAL, GRAFTS, Female, Human, DRWR, Adult, medicine.medical_specialty, the use of donors weighing <40 kg for SLT is currently not recommended. METHODS: From 1997 to 2004, Adolescent, multicentric study, Tissue Donor, further, Liver transplantation, split transplantation, pediatric donor, multicentric study, LLS, NO, Follow-Up Studie, respectively. CONCLUSIONS: Splitting of pediatric liver grafts is an effective strategy to increase organ availability, Humans, Liver Transplantation, Split Liver Transplantation, Body Weight, Retrospective Studies, ICU, To report the results of a multicenter experience of split liver transplantation (SLT) with pediatric donors. SUMMARY BACKGROUND DATA: There are no reports in the literature regarding pediatric liver splitting, 40+kg+were+used%2E+Dimensional+matching+was+based+on+donor-to-recipient+weight+ratio+%28DRWR%29+for+left+lateral+segment+%28LLS%29+and+on+estimated+graft-to-recipient+weight+ratio+%28eGRWR%29+for+extended+right+grafts+%28ERG%29%2E+In+3+cases%2C+no+recipient+was+found+for+an+ERG%2E+The+celiac+trunk+was+retained+with+the+LLS+in+all+but+1+case%2E+Forty+LLSs+were+transplanted+into+39+children%2C+while+39+ERGs+were+transplanted+into+11+children+and+28+adults%2E+RESULTS%3A+Two-year+patient+and+graft+survival+rates+were+not+significantly+different+between+recipients+of+donors+<+or+=40+kg+and+>40+kg%2C+between+pediatric+and+adult+recipients%2C+and+between+recipients+of+LLSs+and+ERGs%2E+Vascular+complication+rates+were+12%25+in+the+<+or+=40+kg+donor+group+and+6%25+in+the+>40+kg+donor+group+%28P+=+not+significant%29%2E+There+were+no+differences+in+the+incidence+of+other+complications%2E+Donor+ICU+stay+>3+days+and+the+use+of+an+interposition+arterial+graft+were+associated+with+an+increased+risk+of+graft+loss+and+arterial+complications%2C+respectively%2E+CONCLUSIONS%3A+Splitting+of+pediatric+liver+grafts+is+an+effective+strategy+to+increase+organ+availability%2C+but+a+cautious+evaluation+of+the+use+of+donors+<+or+=40+kg+is+necessary%2E+Prolonged+donor+ICU+stay+is+associated+with+poorer+outcomes%2E+The+maintenance+of+the+celiac+trunk+with+LLS+does+not+seem+detrimental+for+right-sided+grafts%2C+whereas+the+use+of+interposition+grafts+for+arterial+reconstruction+should+be+avoided%22">the use of donors weighing <40 kg for SLT is currently not recommended. METHODS: From 1997 to 2004, 43 conventional split liver procedures from donors aged <15 years were performed. Nineteen donors weighing < or =40 kg and 24 weighing >40 kg were used. Dimensional matching was based on donor-to-recipient weight ratio (DRWR) for left lateral segment (LLS) and on estimated graft-to-recipient weight ratio (eGRWR) for extended right grafts (ERG). In 3 cases, no recipient was found for an ERG. The celiac trunk was retained with the LLS in all but 1 case. Forty LLSs were transplanted into 39 children, while 39 ERGs were transplanted into 11 children and 28 adults. RESULTS: Two-year patient and graft survival rates were not significantly different between recipients of donors < or =40 kg and >40 kg, between pediatric and adult recipients, and between recipients of LLSs and ERGs. Vascular complication rates were 12% in the < or =40 kg donor group and 6% in the >40 kg donor group (P = not significant). There were no differences in the incidence of other complications. Donor ICU stay >3 days and the use of an interposition arterial graft were associated with an increased risk of graft loss and arterial complications, respectively. CONCLUSIONS: Splitting of pediatric liver grafts is an effective strategy to increase organ availability, but a cautious evaluation of the use of donors < or =40 kg is necessary. Prolonged donor ICU stay is associated with poorer outcomes. The maintenance of the celiac trunk with LLS does not seem detrimental for right-sided grafts, whereas the use of interposition grafts for arterial reconstruction should be avoided, medicine, split transplantation, 40+kg%22">while 39 ERGs were transplanted into 11 children and 28 adults. RESULTS: Two-year patient and graft survival rates were not significantly different between recipients of donors < or =40 kg and >40 kg, Pediatric donor, business.industry, Infant, Newborn, Infant, NEED, Original Articles, Surgery, SPLIT LIVER TRANSPLANTATION, whereas the use of interposition grafts for arterial reconstruction should be avoided, Transplantation, Feasibility Studie, Settore MED/18 - Chirurgia Generale, RECIPIENTS, Multicenter study, El Niño, Split liver transplantation, Feasibility Studies, Liver function, business, but a cautious evaluation of the use of donors < or =40 kg is necessary. Prolonged donor ICU stay is associated with poorer outcomes. The maintenance of the celiac trunk with LLS does not seem detrimental for right-sided grafts, Follow-Up Studies
Abstract

Despite the worldwide acceptance of split liver transplantation (SLT) as a strategy to expand a limited donor pool, problems still exist in its widespread application.1 The technique of “conventional” SLT divides the liver of a heart-beating donor into an extended right graft (ERG) and a left lateral segment graft (LLS), including Couinaud segments I, IV–VIII, and segments II–III, respectively.2,3 Recent single-center series of either in situ or ex situ SLT reported results comparable to whole liver transplantation (WLT).3–16 The ideal split liver donor should be between 14 and 50 years of age, with good liver function, serum sodium level

Published
2006

49. Split-liver transplantation with pediatric donors: a multicenter experience

Author

Xavier Rogiers, Matteo Cescon, Umberto Valente, Umberto Cillo, Giuseppe Maria Ettorre, Enzo Andorno, Gian Luca Grazi, Giorgio Rossi, Marco Spada, Mario Scalamogna, Massimo Rossi, Pietro Majno, Umberto Baccarani, Michele Colledan, Paolo Reggiani, Manuel Lopez Santamaria, Bruno Gridelli, Giuseppe Tisone, Cescon M, Spada M, Colledan M, Andorno E, Valente U, Rossi G, Reggiani P, Grazi GL, Tisone G, Majno P, Rogiers X, Santamaria ML, Baccarani U, Ettorre GM, Cillo U, Rossi M, Scalamogna M, Gridelli B., Cescon, M, Spada, M, Colledan, M, Andorno, E, Valente, U, Rossi, G, Reggiani, P, Grazi, G, Tisone, G, Majno, P, Rogiers, X, Santamaria, M, Baccarani, U, Ettorre, G, Cillo, U, Rossi, M, Scalamogna, M, and Gridelli, B

Subjects
Male, genetic structures, Split Liver Transplantation, medicine.medical_treatment, Humans, Liver Transplantation, Prospective Study, Multicenter Study, Pediatric Donors, Outcome, Liver transplantation, Medicine, Child, Pediatric, ddc:617, Incidence (epidemiology), Split, Graft Survival, PEDIATRIC TRANSPLANTATION, Liver transplantation, Split, Pediatric, Donors, Tissue Donors, Tissue Donors/statistics & numerical data, donors, liver transplantation, pediatric, pediatric donors, split, split liver transplantation, surgical procedures, operative, Treatment Outcome, Child, Preschool, Tissue and Organ Harvesting, Tissue and Organ Harvesting/methods, Female, Hepatectomy/methods, Donor, Erg, Adult, medicine.medical_specialty, Adolescent, Donors, NO, Hepatectomy, SPLIT LIVER, Liver Transplantation/methods/mortality/physiology, Survival analysis, Retrospective Studies, Transplantation, business.industry, Infant, Retrospective cohort study, Survival Analysis, Surgery, Settore MED/18 - Chirurgia Generale, El Niño, business
Abstract

BACKGROUND: Outcomes of split-liver transplantation (SLT) with pediatric donors have never been specifically reported. METHODS: A prospective multicenter study on SLT using donors younger than 15 years was conducted. Thirty-nine split-liver procedures generating a left lateral segment (LLS) and an extended right graft (ERG) were performed. In three cases, no recipient was found for ERG. In all but one case, the celiac trunk was maintained with LLS. Data were available for 67 grafts (90% of the total): 38 LLSs and 9 ERGs transplanted into 46 children and 20 ERGs transplanted into 20 adults. Sixty-two (93%) grafts were used for primary transplants and five (7%) for retransplantation. SLT were performed with 15 donors 10 years of age and less and with 24 between 11 and 15 years. RESULTS: Median follow-up was 24 months. Two-year patient and graft survival were 87% and 82%. Patient and graft survivals were not significantly different between pediatric and adult recipients, between recipients from donors 10 years of age and less and those between 11 and 15 years, and between recipients of LLS and ERG. Arterial complications occurred in 6% of cases (8% in the < or = 10 year donors group, 5% in the 11-15 year donors group). The incidence of other complications was similar between groups. CONCLUSIONS: SLT with pediatric donors, even younger than 10 years, provided results comparable with those achievable using adult donors. The similar incidence of arterial complications among patients receiving LLS or ERG suggests that maintenance of the celiac trunk with LLS is not detrimental for right-sided grafts

Published
2005

50. Outcome of major hepatectomy in cirrhotic patients; does surgical approach matter? A propensity score matched analysis

Author

Luca Aldrighetti, Santiago López-Ben, Nadia Russolillo, Andrea Ruzzenente, Burak Görgec, Alessandro Ferrero, Marco Vivarelli, Bjørn Edwin, David Fuks, Giuseppe Zimmitti, D'Hondt Mathieu, Umberto Cillo, Adnan Alseidi, Federico Mocchegiani, Felice Giuliante, Andrea Benedetti Cacciaguerra, Mohammed Abu Hilal, Marc G. Besselink, J. Lanari, Fernando Rotellar, Federica Cipriani, Benedetti Cacciaguerra, A., Gorgec, B., Lanari, J., Cipriani, F., Russolillo, N., Mocchegiani, F., Zimmitti, G., Alseidi, A., Ruzzenente, A., Edwin, B., D'Hondt, M., Besselink, M. G., Giuliante, F., Fuks, D., Rotellar, F., Lopez-Ben, S., Ferrero, A., Aldrighetti, L., Cillo, U., Vivarelli, M., Abu Hilal, M., Graduate School, Radiology and Nuclear Medicine, Surgery, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Liver Cirrhosis, laparoscopic liver resection, liver cirrhosis, major liver resection, open liver resection, surgical oncology, medicine.medical_specialty, Carcinoma, Hepatocellular, medicine.medical_treatment, Subgroup analysis, Chronic liver disease, medicine, Humans, Hepatectomy, Laparoscopy, Propensity Score, Retrospective Studies, Hepatology, medicine.diagnostic_test, business.industry, Liver Neoplasms, Retrospective cohort study, Perioperative, Length of Stay, medicine.disease, Surgery, Treatment Outcome, Hepatocellular carcinoma, Propensity score matching, business
Abstract

Objective: Major hepatectomy in cirrhotic patients still represents a great challenge for liver surgeons. Hence, the aim in the present study is to investigate the clinical impact of major hepatectomy and to assess whether the surgical approach influences the outcome of cirrhotic patients. Methods: Multicenter retrospective study including cirrhotic patients undergoing major laparoscopic (mjLLR) and open liver resection (mjOLR) in 14 Western liver centers was performed (2009–2020). Clinical, demographic, and perioperative data were compared using propensity score matching (PSM). Long-term outcome after resection for hepatocellular carcinoma was analyzed. Results: Overall, 352 patients were included; 108 after mjLLR and 244 after mjOLR. After PSM, 88 patients were matched in each group. In the mjLLR group, compared to mjOLR, less blood loss (P=.042), lower overall and severe complication (P&nbsp

Published
2021

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