138 results on '"Miglioresi L"'
Search Results
102. CD81 expression on CD19+ peripheral blood lymphocytes is associated with chronic HCV disease and increased risk for HCV infection: A putative role for inflammatory cytokines
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D Agosto, G., elisabetta trento, Nosotti, L., Bordignon, V., Battista, M., Prignano, G., Pimpinelli, F., Biolcati, G., Macrí, A., Palamara, G., Miglioresi, L., Morrone, A., Di Carlo, A., Cordiali-Fei, P., and Ensoli, F.
103. RISK OF KAPOSI’S SARCOMA FOLLOWING SOLID ORGAN TRANSPLANTATION. A MULTICENTER STUDY IN 4767 RECIPIENTS:ITALY 1970-2006
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Pierluca Piselli, Busnach G, Citterio F, Frigerio M, Arbustini E, Burra P, Pinna A.D., Bresadola, V., Ettore G.M., Buda A, Baccarani, U., Lauro A, Cimaglia C, Spagnoletti G, Zanus G, Lenardon A, Agozzino M, Gambato M, Zanfi C, Miglioresi L, Di gioia P, Girardi E, and Serraino D.
104. RISK OF KAPOSI'S SARCOMA FOLLOWING SOLID ORGAN TRANSPLANTATION. A MULTICENTER STUDY IN 4767 RECIPIENTS: ITALY 1970-2006
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Pierluca Piselli, Busnach, G., Citterio, F., Frigerio, M., Arbustini, E., Burra, P., Pinna, A. D., Bresadola, V., Ettorre, G. M., Buda, A., Baccarani, U., Lauro, A., Cimaglia, C., Spagnoletti, G., Zanus, G., Lenardon, A., Agozzino, M., Gambato, M., Zanfi, C., Miglioresi, L., Di Gioia, P., Girardi, E., and Serraino, D.
105. HCV genotype 1a shows a better virological response to antiviral therapy than HCV genotype 1b
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Pellicelli Adriano M, Romano Mario, Stroffolini Tommaso, Mazzoni Ettore, Mecenate Fabrizio, Monarca Roberto, Picardi Antonio, Bonaventura Maria, Mastropietro Cristina, Vignally Pascal, Andreoli Arnaldo, Marignani Massimo, D’Ambrosio Cecilia, Miglioresi Lucia, Nosotti Lorenzo, Mitidieri Olga, Gentilucci Umberto, Puoti Claudio, Barbaro Giuseppe, Barlattani Angelo, Furlan Caterina, and Barbarini Giorgio
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Genotype 1a ,HCV genotype 1 subtypes ,Sustained virological response ,Antiviral therapy ,Pegylated interferon ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Abstract Background The impact of viral subtype on the rate of sustained virological response (SVR) to antiviral therapy in patients chronically infected with hepatitis C genotype 1 subtype 1a and 1b has not been extensively investigated. The aim of this study is to determine whether the HCV genotype 1 subtypes 1a and 1b respond differently to treatment with PEGylated interferon (PEG-IFN) plus ribavirin. Methods For 48 weeks, 388 “naïve”genotype 1 patients were treated weekly with PEG-IFN α-2a or PEG-INF α-2b combined with daily ribavirin (1000–1200 mg/day). The numbers of patients in whom HCV-RNA was undetectable were compared after 4 (rapid virological response, RVR), 12 (early virological response, EVR), and 48 (end treatment virological response, ETR) weeks of treatment as well as 24 weeks after the last treatment (sustained virological response, SVR). Results The rate of SVR was higher in subtype 1a patients than subtype 1b patients (55% vs. 43%; p 10 IU/ml (OR: 3.2; 95% CI: 2.7 to 6.9) and fibrosis score < S3 (OR: 3.8; 95% CI:3.2 to 7.4), were all independent predictors of SVR. Conclusion Dual antiviral therapy is more effective against HCV subtype 1a than against subtype 1b and this difference is independent of other factors that may favour viral clearance. Trial registration ClinicalTrials.gov Identifier: NCT01342003
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- 2012
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106. AFP score and metroticket 2.0 perform similarly and could be used in a 'within-ALL' clinical decision tool
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Federico Piñero, Charlotte Costentin, Helena Degroote, Andrea Notarpaolo, Ilka FSF. Boin, Karim Boudjema, Cinzia Baccaro, Aline Chagas, Philippe Bachellier, Giuseppe Maria Ettorre, Jaime Poniachik, Fabrice Muscari, Fabrizio Dibenedetto, Sergio Hoyos Duque, Ephrem Salame, Umberto Cillo, Sebastián Marciano, Claire Vanlemmens, Stefano Fagiuoli, Flair Carrilho, Daniel Cherqui, Patrizia Burra, Hans Van Vlierberghe, Quirino Lai, Marcelo Silva, Fernando Rubinstein, Christophe Duvoux, Filomena Conti, Olivier Scatton, Pierre Henri Bernard, Claire Francoz, Francois Durand, Sébastien Dharancy, Marie-lorraine Woehl, Alexis Laurent, Sylvie Radenne, Jérôme Dumortier, Armand Abergel, Louise Barbier, Pauline Houssel-Debry, Georges Philippe Pageaux, Laurence Chiche, Victor Deledinghen, Jean Hardwigsen, J. Gugenheim, M. altieri, Marie Noelle Hilleret, Thomas Decaens, Paulo Costa, Elaine Cristina de Ataide, Emilio Quiñones, Margarita Anders, Adriana Varón, Alina Zerega, Alejandro Soza, Martín Padilla Machaca, Diego Arufe, Josemaría Menéndez, Rodrigo Zapata, Mario Vilatoba, Linda Muñoz, Ricardo Chong Menéndez, Martín Maraschio, Luis G. Podestá, Lucas McCormack, Juan Mattera, Adrian Gadano, Jose Huygens Parente García, Giulia Magini, Lucia Miglioresi, Martina Gambato, Cecilia D’Ambrosio, Alessandro Vitale, Michele Colledan, Domenico Pinelli, Paolo Magistri, Giovanni Vennarecci, Marco Colasanti, Valerio Giannelli, Adriano Pellicelli, Callebout Eduard, Iesari Samuele, Dekervel Jeroen, Schreiber Jonas, Pirenne Jacques, Verslype Chris, Ysebaert Dirk, Michielsen Peter, Lucidi Valerio, Moreno Christophe, Detry Olivier, Delwaide Jean, Troisi Roberto, Lerut Jan Paul, Piñero, F, Costentin, C, Degroote, H, Notarpaolo, A, Boin, I, Boudjema, K, Baccaro, C, Chagas, A, Bachellier, P, Ettorre, G, Poniachik, J, Muscari, F, Dibenedetto, F, Duque, S, Salame, E, Cillo, U, Marciano, S, Vanlemmens, C, Fagiuoli, S, Carrilho, F, Cherqui, D, Burra, P, Van Vlierberghe, H, Lai, Q, Silva, M, Rubinstein, F, Duvoux, C, Conti, F, Scatton, O, Bernard, P, Francoz, C, Durand, F, Dharancy, S, Woehl, M, Laurent, A, Radenne, S, Dumortier, J, Abergel, A, Barbier, L, Houssel-Debry, P, Pageaux, G, Chiche, L, Deledinghen, V, Hardwigsen, J, Gugenheim, J, Altieri, M, Hilleret, M, Decaens, T, Costa, P, de Ataide, E, Quiñones, E, Anders, M, Varón, A, Zerega, A, Soza, A, Machaca, M, Arufe, D, Menéndez, J, Zapata, R, Vilatoba, M, Muñoz, L, Menéndez, R, Maraschio, M, Podestá, L, Mccormack, L, Mattera, J, Gadano, A, Parente García, J, Magini, G, Miglioresi, L, Gambato, M, D'Ambrosio, C, Vitale, A, Colledan, M, Pinelli, D, Magistri, P, Vennarecci, G, Colasanti, M, Giannelli, V, Pellicelli, A, Eduard, C, Samuele, I, Jeroen, D, Jonas, S, Jacques, P, Chris, V, Dirk, Y, Peter, M, Valerio, L, Christophe, M, Olivier, D, Jean, D, Roberto, T, and Paul, L
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recurrence ,Hepatology ,reclassification ,Gastroenterology ,Internal Medicine ,Immunology and Allergy ,Prediction ,transplantation - Abstract
Background & Aims: Two recently developed composite models, the alpha-fetoprotein (AFP) score and Metroticket 2.0, could be used to select patients with hepatocellular carcinoma (HCC) who are candidates for liver transplantation (LT). The aim of this study was to compare the predictive performance of both models and to evaluate the net risk reclassification of post-LT recurrence between them using each model's original thresholds. Methods: This multicenter cohort study included 2,444 adult patients who underwent LT for HCC in 47 centers from Europe and Latin America. A competing risk regression analysis estimating sub-distribution hazard ratios (SHRs) and 95% CIs for recurrence was used (Fine and Gray method). Harrell's adapted c-statistics were estimated. The net reclassification index for recurrence was compared based on each model's original thresholds. Results: During a median follow-up of 3.8 years, there were 310 recurrences and 496 competing events (20.3%). Both models predicted recurrence, HCC survival and survival better than Milan criteria (p
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- 2023
107. Liver Match, a prospective observational cohort study on liver transplantation in Italy: study design and current practice of donor-recipient matching
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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
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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.
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- 2010
108. R3-AFP score is a new composite tool to refine prediction of hepatocellular carcinoma recurrence after liver transplantation
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Charlotte Costentin, Federico Piñero, Helena Degroote, Andrea Notarpaolo, Ilka F. Boin, Karim Boudjema, Cinzia Baccaro, Luis G. Podestá, Philippe Bachellier, Giuseppe Maria Ettorre, Jaime Poniachik, Fabrice Muscari, Fabrizio Dibenedetto, Sergio Hoyos Duque, Ephrem Salame, Umberto Cillo, Sebastian Marciano, Claire Vanlemmens, Stefano Fagiuoli, Patrizia Burra, Hans Van Vlierberghe, Daniel Cherqui, Quirino Lai, Marcelo Silva, Fernando Rubinstein, Christophe Duvoux, Filomena Conti, Olivier Scatton, Pierre Henri Bernard, Claire Francoz, Francois Durand, Sébastien Dharancy, Marie-lorraine Woehl, Alexis Laurent, Sylvie Radenne, Jérôme Dumortier, Armand Abergel, Louise Barbier, Pauline Houssel-Debry, Georges Philippe Pageaux, Laurence Chiche, Victor Deledinghen, Jean Hardwigsen, J. Gugenheim, M. Altieri, Marie Noelle Hilleret, Thomas Decaens, Aline Chagas, Paulo Costa, Elaine Cristina de Ataide, Emilio Quiñones, Sebastián Marciano, Margarita Anders, Adriana Varón, Alina Zerega, Alejandro Soza, Martín Padilla Machaca, Diego Arufe, Josemaría Menéndez, Rodrigo Zapata, Mario Vilatoba, Linda Muñoz, Ricardo Chong Menéndez, Martín Maraschio, Lucas McCormack, Juan Mattera, Adrian Gadano, Ilka S.F. Fatima Boin, Jose Huygens Parente García, Flair Carrilho, Giulia Magini, Lucia Miglioresi, Martina Gambato, Fabrizio Di Benedetto, Cecilia D’Ambrosio, Alessandro Vitale, Michele Colledan, Domenico Pinelli, Paolo Magistri, Giovanni Vennarecci, Marco Colasanti, Valerio Giannelli, Adriano Pellicelli, Cizia Baccaro, Callebout Eduard, Iesari Samuele, Dekervel Jeroen, Schreiber Jonas, Pirenne Jacques, Verslype Chris, Ysebaert Dirk, Michielsen Peter, Lucidi Valerio, Moreno Christophe, Detry Olivier, Delwaide Jean, Troisi Roberto, Lerut Jan Paul, Costentin, C, Piñero, F, Degroote, H, Notarpaolo, A, Boin, I, Boudjema, K, Baccaro, C, Podestá, L, Bachellier, P, Ettorre, G, Poniachik, J, Muscari, F, Dibenedetto, F, Hoyos Duque, S, Salame, E, Cillo, U, Marciano, S, Vanlemmens, C, Fagiuoli, S, Burra, P, Van Vlierberghe, H, Cherqui, D, Lai, Q, Silva, M, Rubinstein, F, Duvoux, C, Conti, F, Scatton, O, Bernard, P, Francoz, C, Durand, F, Dharancy, S, Woehl, M, Laurent, A, Radenne, S, Dumortier, J, Abergel, A, Barbier, L, Houssel-Debry, P, Pageaux, G, Chiche, L, Deledinghen, V, Hardwigsen, J, Gugenheim, J, Altieri, M, Hilleret, M, Decaens, T, Chagas, A, Costa, P, Cristina de Ataide, E, Quiñones, E, Duque, S, Anders, M, Varón, A, Zerega, A, Soza, A, Machaca, M, Arufe, D, Menéndez, J, Zapata, R, Vilatoba, M, Muñoz, L, Menéndez, R, Maraschio, M, Mccormack, L, Mattera, J, Gadano, A, Fatima Boin, I, Parente García, J, Carrilho, F, Magini, G, Miglioresi, L, Gambato, M, Benedetto, F, D’Ambrosio, C, Vitale, A, Colledan, M, Pinelli, D, Magistri, P, Vennarecci, G, Colasanti, M, Giannelli, V, Pellicelli, A, Vlierberghe, H, Eduard, C, Samuele, I, Jeroen, D, Jonas, S, Jacques, P, Chris, V, Dirk, Y, Peter, M, Valerio, L, Christophe, M, Olivier, D, Jean, D, Roberto, T, Paul, L, Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) (IAB), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Hôpital la Tronche, Universidad Austral de Chile, Ghent University Hospital, Arcispedale S Maria Nuova, Universidade Estadual de Campinas = University of Campinas (UNICAMP), CHU Pontchaillou [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES), CHU Strasbourg, Universidad de Chile = University of Chile [Santiago] (UCHILE), Hôpital Universitaire de Rangueil, Università degli Studi di Modena e Reggio Emilia = University of Modena and Reggio Emilia (UNIMORE), Universidad de Antioquia = University of Antioquia [Medellín, Colombia], CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Azienda Ospedale Università di Padova = Hospital-University of Padua (AOUP), Instituto Universitario del Hospital Italiano [Buenos Aires, Argentina], Hôpital JeanMinjoz, Hospital Papa Giovanni XXIII (Hosp P Giovanni XXIII), Hôpital Paul Brousse, Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome] (UNIROMA), CHU Henri Mondor, Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), None, French-Italian-Belgium and Latin American collaborative group for HCC and liver transplantation: Karim Boudjema, Philippe Bachellier, Filomena Conti, Olivier Scatton, Fabrice Muscari, Ephrem Salame, Pierre Henri Bernard, Claire Francoz, Francois Durand, Sébastien Dharancy, Marie-Lorraine Woehl, Claire Vanlemmens, Alexis Laurent, Sylvie Radenne, Jérôme Dumortier, Armand Abergel, Daniel Cherqui, Louise Barbier, Pauline Houssel-Debry, Georges Philippe Pageaux, Laurence Chiche, Victor Deledinghen, Jean Hardwigsen, J Gugenheim, M Altieri, Marie Noelle Hilleret, Thomas Decaens, Christophe Duvoux, Federico Piñero, Aline Chagas, Paulo Costa, Elaine Cristina de Ataide, Emilio Quiñones, Sergio Hoyos Duque, Sebastián Marciano, Margarita Anders, Adriana Varón, Alina Zerega, Jaime Poniachik, Alejandro Soza, Martín Padilla Machaca, Diego Arufe, Josemaría Menéndez, Rodrigo Zapata, Mario Vilatoba, Linda Muñoz, Ricardo Chong Menéndez, Martín Maraschio, Luis G Podestá, Lucas McCormack, Juan Mattera, Adrian Gadano, Ilka Sf Fatima Boin, Jose Huygens Parente García, Flair Carrilho, Marcelo Silva, Andrea Notarpaolo, Giulia Magini, Lucia Miglioresi, Martina Gambato, Fabrizio Di Benedetto, Cecilia D'Ambrosio, Giuseppe Maria Ettorre, Alessandro Vitale, Patrizia Burra, Stefano Fagiuoli, Umberto Cillo, Michele Colledan, Domenico Pinelli, Paolo Magistri, Giovanni Vennarecci, Marco Colasanti, Valerio Giannelli, Adriano Pellicelli, Cizia Baccaro, Quirino Lai, Helena Degroote, Hans Van Vlierberghe, Callebout Eduard, Iesari Samuele, Dekervel Jeroen, Schreiber Jonas, Pirenne Jacques, Verslype Chris, Ysebaert Dirk, Michielsen Peter, Lucidi Valerio, Moreno Christophe, Detry Olivier, Delwaide Jean, Troisi Roberto, Lerut Jan Paul, Université de Rennes (UR), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and CHU Henri Mondor [Créteil]
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TTR= time to recurrence ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Explants pathology ,Liver cancer ,Liver transplantation ,Prediction ,Recurrence ,MVI= microvascular invasion ,VC= validation cohort ,VALIDATION ,LT= liver transplantation ,RETREAT SCORE ,SHR= sub-distribution of hazard ratio ,R3= recurrence risk reassessment ,HBV= hepatitis B virus ,SIROLIMUS-BASED IMMUNOSUPPRESSION ,Internal Medicine ,HCV= hepatitis C virus ,Medicine and Health Sciences ,IMPROVES ,Immunology and Allergy ,Hepatology ,TC= test cohort ,Gastroenterology ,DEATH ,COMPETING RISKS ,MODEL ,AFP= alpha-foetoprotein ,SORAFENIB ,SURVIVAL ,HCC= hepatocellular carcinoma ,RETREAT= Risk Estimation of Tumour Recurrence After Transplant - Abstract
Background & Aims: Patients with hepatocellular carcinoma (HCC) are selected for liver transplantation (LT) based on pre-LT imaging +/- alpha-foetoprotein (AFP) level, but discrepancies between pre-LT tumour assessment and explant are frequent. Our aim was to design an explant-based recurrence risk reassessment score to refine prediction of recurrence after LT and provide a framework to guide post-LT management.Methods: Adult patients who underwent transplantation between 2000 and 2018 for HCC in 47 centres were included. A prediction model for recurrence was developed using competing-risk regression analysis in a European training cohort (TC; n = 1,359) and tested in a Latin American validation cohort (VC; n=1,085).Results: In the TC, 76.4% of patients with HCC met the Milan criteria, and 89.9% had an AFP score of -4 nodules (sub-distribution of hazard ratio [SHR] = 1.88, 1 point), size of largest nodule (3-6 cm: SHR = 1.83,1 point; >6 cm: SHR = 5.82, 5 points), presence of microvascular invasion (MVI; SHR = 2.69, 2 points), nuclear grade >II (SHR = 1.20, 1 point), and last pre-LT AFP value (101-1,000 ng/ml: SHR = 1.57, 1 point; >1,000 ng/ml: SHR = 2.83, 2 points). Wolber's c-index was 0.76 (95% CI 0.72-0.80), significantly superior to an R3 model without AFP (0.75; 95% CI 0.72-0.79; p = 0.01). Four 5-year recurrence risk categories were identified: very low (score = 0; 5.5%), low (1-2 points; 15.1%), high (3-6 points; 39.1%), and very high (>6 points; 73.9%). The R3-AFP score performed well in the VC (Wolber's c-index of 0.78; 95% CI 0.73-0.83). Conclusions: The R3 score including the last pre-LT AFP value (R3-AFP score) provides a user-friendly, standardised framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials for HCC not limited to the Milan criteria.Clinical Trials Registration: NCT03775863.Lay summary: Considering discrepancies between pre-LT tumour assessment and explant are frequent, reassessing the risk of recurrence after LT is critical to further refine the management of patients with HCC. In a large and international cohort of patients who underwent transplantation for HCC, we designed and validated the R3-AFP model based on variables inde-pendently associated with recurrence post-LT (number of nodules, size of largest nodule, presence of MVI, nuclear grade, and last pre-LT AFP value). The R3-AFP model including last available pre-LT AFP value outperformed the original R3 model only based on explant features. The final R3-AFP scoring system provides a robust framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials, irrespective of criteria used to select patients with HCC for LT. (c) 2022 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL).
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- 2022
109. Toward Zero Hepatitis C Virus-Related Mortality as a Prerequisite for the Release of Resources in a Center for Follow-up of Liver Transplant
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Luca Rinaldi, Tommaso Sgueglia, Giovanna Valente, Guido Piai, Lucia Miglioresi, Valente, G., Miglioresi, L., Sgueglia, T., Rinaldi, L., and Piai, G.
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Male ,medicine.medical_specialty ,Sustained Virologic Response ,medicine.medical_treatment ,Hepacivirus ,Hepatitis C virus ,Population ,medicine.disease_cause ,Antiviral Agents ,Follow-Up Studie ,Retrospective Studie ,Internal medicine ,Humans ,Medicine ,education ,Retrospective Studies ,Antiviral Agent ,Excess mortality ,Transplantation ,education.field_of_study ,Hepaciviru ,biology ,business.industry ,Immunosuppression ,Retrospective cohort study ,Hepatitis C ,Hepatitis C, Chronic ,medicine.disease ,biology.organism_classification ,Liver Transplantation ,Virologic response ,Female ,Surgery ,business ,Follow-Up Studies ,Human - Abstract
Taking charge of a liver transplanted (LT) patient implies not only to follow up the transplanted organ (eg, immunosuppression and cancer risk) but also to deal with the prevailing patient’s active problems. The recurrence of hepatitis C on the graft has historically been one of the main active problems to be addressed, leading to 30% to 40% mortality per se in these patients and has involved many resources in the hepatological centers responsible for the follow-up. We verified how much the availability of the new drugs with direct-acting antiviral agents (DAAs) against hepatitis C virus (HCV) has impacted the mortality within the assisted population, changing its characteristics and addressing new clinical issues in the LT-patients. We performed a retrospective comparison between 230 LT patients followed up during pre-DAA era (group 1, with 88 HCV RNA-positive) and 244 patients observed from 2014 onward when DAAs became available (group 2, with 79 HCV RNA-positive). Fifty-two antiviral therapies were performed in group 1 with 18 sustained virologic response (SVR) (35%) and 53 treatments, of which 37 were retreatments, in group 2 with 51 SVR (96%), P = .0001. Deaths for HCV-related causes were 19 of 33 (57%) in group 1 and 7 of 24 (24%) in group 2, P = .01. The Kaplan-Meier showed a dramatic reduction in excess mortality in HCV-LT patients after the availability of DAAs. These results suggest that HCV is no longer the main active problem of follow-up in liver transplants, therefore the resources can be relocated to take care of other clinical aspects.
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- 2019
110. Incidence and risk factors of early HCC occurrence in HCV patients treated with direct acting antivirals: a prospective multicentre study
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Maria Guarino, Nicola Coppola, Luigi Elio Adinolfi, Guido Piai, Massimo De Luca, Antonio Izzi, Morena Fasano, Luca Rinaldi, Fortunato Ciardiello, Ferdinando Carlo Sasso, Riccardo Nevola, Filomena Morisco, Giovanna Valente, Alessandro Perrella, Caterina Monari, Pia Clara Pafundi, Lucia Miglioresi, Erika Martinelli, Barbara Guerrera, Massimiliano Berretta, Rinaldi, Luca, Perrella, Alessandro, Guarino, Maria, De Luca, Massimo, Piai, Guido, Coppola, Nicola, Pafundi, Pia Clara, Ciardiello, Fortunato, Fasano, Morena, Martinelli, Erika, Valente, Giovanna, Nevola, Riccardo, Monari, Caterina, Miglioresi, Lucia, Guerrera, Barbara, Berretta, Massimiliano, Sasso, Ferdinando Carlo, Morisco, Filomena, Izzi, Antonio, Adinolfi, Luigi Elio, Rinaldi, L., Perrella, A., Guarino, M., De Luca, M., Piai, G., Coppola, N., Pafundi, P. C., Ciardiello, F., Fasano, M., Martinelli, E., Valente, G., Nevola, R., Monari, C., Miglioresi, L., Guerrera, B., Berretta, M., Sasso, F. C., Morisco, F., Izzi, A., and Adinolfi, L. E.
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Liver Cirrhosis ,Male ,0301 basic medicine ,Cirrhosis ,Sustained Virologic Response ,Sofosbuvir ,lcsh:Medicine ,Gastroenterology ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,Medicine ,Cumulative incidence ,Prospective Studies ,HCC ,Incidence ,Incidence (epidemiology) ,HCV cirrhosis ,Liver Neoplasms ,General Medicine ,Middle Aged ,030220 oncology & carcinogenesis ,Female ,Immune-surveillance ,Off Treatment ,medicine.drug ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Antiviral Agents ,General Biochemistry, Genetics and Molecular Biology ,Direct acting antivirals ,03 medical and health sciences ,Diabetes mellitus ,Internal medicine ,Humans ,Aged ,business.industry ,Research ,Ribavirin ,lcsh:R ,Hepatitis C, Chronic ,medicine.disease ,digestive system diseases ,Regimen ,HCV cirrhosi ,Logistic Models ,030104 developmental biology ,chemistry ,Multivariate Analysis ,Direct acting antiviral ,business - Abstract
Background An unexpected increased HCC recurrence and occurrence rate among HCV patients treated with direct acting antivirals combination has been reported. Aim of the study was the evaluation of early HCC occurrence rate and its risk factors in a HCV infected population, treated with direct-acting-antivirals. Methods According to the Italian ministerial guidelines for direct-acting-antivirals treatment, 1022 consecutive HCV patients treated with direct-acting-antivirals were enrolled. Patients either with active HCC at imaging or history of previous treated HCC, HBV or HIV co-infection, or liver transplant recipients were excluded. The SVR, defined as the persistent absence of detectable serum HCV-RNA 12 weeks after the end of treatment (SVR12), was assessed for all enrolled patients. Abdominal ultrasound was performed before starting antiviral therapy, and repeated every 6 months. HCC was diagnosed according to the international guidelines. Patients showing either nodular patterns suggestive of HCC or with uncertain dynamic vascular behaviour were excluded from a further follow-up. Results Nine hundred and eighty-five patients completed the 48 weeks follow-up after the end of treatment. A Sofosbuvir-based regimen was administered in the 74.9% of patients, among whom, the 71.6% underwent a simultaneous Ribavirin administration. A sustained virological response at 12 weeks off treatment was documented in 966 patients (98.2%). During the post treatment follow-up HCC was detected in 35 patients, with a cumulative incidence rate of the 3.55%. At multivariate analysis, four variables resulted independently associated with HCC development, both in a cirrhosis based and a class B Child based model, respectively: cirrhosis/class B Child, therapeutic schedule including Sofosbuvir without Ribavirin, liver stiffness values, male gender and presence of diabetes. A multivariate analysis performed on Child A cirrhotic patients, showed that Sofosbuvir based therapeutic treatment without Ribavirin had a HCC occurrence 5.7 higher than Ribavirin-based schedules with or without Sofosbuvir (p
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- 2019
111. A Bayesian methodology to improve prediction of early graft loss after liver transplantation derived from the Liver Match study
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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
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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.
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- 2014
112. Treatment of recurrent genotype 4 hepatitis C after liver transplantation: early virological response is predictive of sustained virological response. An AISF RECOLT-C group study
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Luisa Pasulo, Stefano Fagiuoli, L. Miglioresi, Maria Rendina, Maria Marino, Pierluigi Toniutto, Maria Cristina Morelli, Raffaella Viganò, A. Milani, Maria Francesca Donato, Antonio Gasbarrini, Francesca Romana Ponziani, Maurizio Pompili, Raffaella Zaccaria, Daniele Di Paolo, Ponziani, F, Milani, A, Gasbarrini, A, Zaccaria, R, Viganò, R, Donato, M, Morelli, M, Miglioresi, L, Pasulo, L, Rendina, M, Paolo, D, Marino, M, Toniutto, P, Fagiuoli, S, and Pompili, M
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Adult ,Male ,medicine.medical_specialty ,Genotype ,medicine.medical_treatment ,Specialties of internal medicine ,Hepacivirus ,Liver transplantation ,Antiviral Agents ,Gastroenterology ,Polyethylene Glycols ,Cohort Studies ,Virological response ,chemistry.chemical_compound ,Hepatitis B, Chronic ,Recurrence ,Interferon ,Internal medicine ,Ribavirin ,medicine ,Humans ,Retrospective Studies ,Hepatology ,Group study ,business.industry ,Settore MED/09 - MEDICINA INTERNA ,Interferon-alpha ,Genotype 4 ,General Medicine ,Hepatitis C ,Middle Aged ,medicine.disease ,Recombinant Proteins ,Transplantation ,Treatment Outcome ,Italy ,chemistry ,RC581-951 ,Immunology ,HCV treatment ,Drug Therapy, Combination ,Female ,business ,EVR ,medicine.drug ,HCV recurrence - Abstract
Introduction. Hepatitis C virus genotype 4 is predominant in the Middle East and Northern Africa, even if it has recently spread to Southern Europe. Data about the treatment of post-liver transplantation (LT) genotype 4 hepatitis C recurrence are scarce. We report a retrospective analysis of post-LT genotype 4 hepatitis C treatment in 9 Italian transplant centres, focusing on the overall survival rates and treatment outcome. Results. Among 452 recipients, we identified 17 HCV genotype 4 patients (16 males, 1 female) transplanted between 1998 and 2007. All patients received combined antiviral treatment with conventional doses of interferon (recombinant or pegylated) and ribavirin after histological diagnosis of hepatitis C recurrence. The observed overall survival after LT was 100% at 1 year and 83.3% at 5 years. More than 1/3 (35.3%) of patients achieved a sustained virological response (SVR) and 40% (data available in 15 subjects) an early virological response (EVR), which was significantly associated with the achievement of SVR (overall accuracy: 85.7%; predictive values of EVR absence/presence 80/88.8%; chi-square p < 0.05). Conclusion. In conclusion, in post-LT genotype 4 hepatitis C treatment, SVR rates are similar to genotype 1. Patients who don't show an EVR are not likely to achieve a SVR.
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- 2012
113. Hepatitis B-core Antibody Positive Donors in Liver Transplantation and Their Impact on Graft Survival: Evidence From The Liver Match Cohort Study
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Angelico M, Nardi A, Marianelli T, Caccamo L, Romagnoli R, Tisone G, Pinna AD, Avolio AW, Fagiuoli S, Burra P, Strazzabosco M, Nanni Costa A, U Cillo, P Caraceni, P L Toniutto, M Salizzoni, G Bertolotti, D Patrono, L De Carlis, A Slim, J M E Mangoni, G Rossi, 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, G L Grazi, A Cucchetti, C Zanfi, A Risaliti, M G Faraci, A Anselmo, I Lenci, D Sforza, S Agnes, M Di Mugno, G M Ettorre, L Miglioresi, G Vennarecci, Roma Sapienza, 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, C Gavrila, A Ricci, F Vespasiano, Angelico, M, Nardi, A, Marianelli, T, Caccamo, L, Romagnoli, R, Tisone, G, Pinna, A, Avolio, A, Fagiuoli, S, Burra, P, Strazzabosco, M, Costa, A, M, Angelico, A, Nardi, T, Marianelli, L, Caccamo, R, Romagnoli, G, Tisone, Ad, Pinna, Aw, Avolio, S, Fagiuoli, P, Burra, M, Strazzabosco, A, Nanni Costa, Cillo, U, Caraceni, P, L Toniutto, P, Salizzoni, M, Bertolotti, G, Patrono, D, De Carlis, L, Slim, A, E Mangoni, J M, Rossi, G, Antonelli, B, Mazzaferro, V, Regalia, E, Sposito, C, Colledan, M, Corno, V, Tagliabue, F, Marin, S, Vitale, A, Gringeri, E, Donataccio, M, Donataccio, D, Baccarani, U, Lorenzin, D, Bitetto, D, Valente, U, Gelli, M, Cupo, P, E Gerunda, G, Rompianesi, G, L Grazi, G, Cucchetti, A, Zanfi, C, Risaliti, A, G Faraci, M, Anselmo, A, Lenci, I, Sforza, D, Agnes, S, Di Mugno, M, M Ettorre, G, Miglioresi, L, Vennarecci, G, Sapienza, Roma, Berloco, P, Rossi, M, Ginanni-Corradini, S, Molinaro, A, Calise, F, Scuderi, V, Cuomo, O, Migliaccio, C, Lupo, L, Notarnicola, G, Gridelli, B, Volpes, R, Li Petri, S, Zamboni, F, Carbotta, G, Dedola, S, Gavrila, C, Ricci, A, Vespasiano, F, Mario Angelico, Alessandra Nardi, Tania Marianelli, Lucio Caccamo, Renato Romagnoli, Giuseppe Tisone, Antonio D. Pinna, Alfonso W. Avolio, Stefano Fagiuoli, Patrizia Burra, Mario Strazzabosco, Alessandro Nanni Costa, For the Liver Match Investigators [.., Paolo Caraceni, and ]
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Male ,HBsAg ,medicine.medical_treatment ,Settore MED/18 - CHIRURGIA GENERALE ,graft survival ,De novo HBV infection ,Donor Risk Index ,Donor-recipient matching ,HBcAb positive donors ,Liver transplantation ,medicine.disease_cause ,Gastroenterology ,Cohort Studies ,Model for End-Stage Liver Disease ,MED/12 - GASTROENTEROLOGIA ,HBcAb positive donor ,liver transplantation ,Prospective Studies ,Prospective cohort study ,Settore MED/12 - Gastroenterologia ,Hepatitis B Core Antigen ,Hazard ratio ,Middle Aged ,Hepatitis B ,Hepatitis B Core Antigens ,Tissue Donors ,Italy ,Hepatocellular carcinoma ,HCV ,outcome ,Female ,Human ,hbcab positive donors ,Adult ,medicine.medical_specialty ,donor risk index ,HBcAb positive ,Tissue Donor ,survival ,donor-recipient matching ,Donor Selection ,Hepatitis B Antibodie ,HBV, liver transplantation ,Internal medicine ,medicine ,Humans ,de novo hbv infection ,Hepatitis B Antibodies ,Donor-recipient matching, HBcAb positive donors, De novo HBV infection, Donor Risk Index ,Aged ,Hepatitis B virus ,Hepatitis ,Hepatology ,business.industry ,LIVER TRANSPLANTATION ,medicine.disease ,Surgery ,Prospective Studie ,Liver Transplantation ,Graft Survival ,Cohort Studie ,business - Abstract
Background & Aims: The appropriate allocation of grafts from HBcAb positive donors in liver transplantation is crucial, yet a consensus is still lacking. Methods: We evaluated this issue within Liver Match, a prospective observational Italian study. Data from 1437 consecutive, first transplants performed in 2007-2009 using grafts from deceased heart beating donors were analyzed (median follow-up: 1040 days). Of these, 219 (15.2%) were HBcAb positive. Sixty-six HBcAb positive grafts were allocated to HBsAg positive and 153 to HBsAg negative recipients. Results: 329 graft losses occurred (22.9%): 66 (30.1%) among 219 recipients of HBcAb positive grafts, and 263 (21.6%) among 1218 recipients of HBcAb negative grafts. Graft survival was lower in recipients of HBcAb positive compared to HBcAb negative donors, with unadjusted 3-year graft survival of 0.69 (s.e. 0.032) and 0.77 (0.013), respectively (log-rank, p = 0.0047). After stratifying for recipient HBsAg status, this difference was only observed among HBsAg negative recipients (log rank, p = 0.0007), 3-year graft survival being excellent (0.88, s.e. 0.020) among HBsAg positive recipients, regardless of the HBcAb donor status (log rank, p = 0.4478). Graft loss due to de novo HBV hepatitis occurred only in one patient. At Cox regression, hazard ratios for graft loss were: MELD (1.30 per 10 units, p = 0.0002), donor HBcAb positivity (1.56, p = 0.0015), recipient HBsAg positivity (0.43, p
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- 2012
114. Acute and Chronic Rejection during Interferon Therapy in HCV Recurrent Transplant Patients: Results from the AISF-RECOLT-C Group
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M. Rendina, N. M. Castellaneta, S. Fagiuoli, F. Ponziani, R. Vigano, R. M. Iemmolo, M. F. Donato, P. Toniutto, L. Pasulo, M. C. Morelli, P. Burra, L. Miglioresi, V. Giannelli, D. D. Paolo, A. D. Leo, Rendina, M, Castellaneta, N, Fagiuoli, S, Ponziani, F, Vigano, R, Iemmolo, R, Donato, M, Toniutto, P, Pasulo, L, Morelli, M, Burra, P, Miglioresi, L, Giannelli, V, Paolo, D, and Leo, A
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Acute and chronic rejection, HCV, liver transplant - Published
- 2011
115. Svr To Antiviral Therapy Is Highly Protective Against Liver-related Death In Patients With Hcv Recurrence On the Graft After Liver Transplantation (lt)
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M. Rendina, N. M. Castellaneta, S. Fagiuoli, P. Burra, R. Vigano, R. M. Iemmolo, M. F. Donato, P. Toniutto, L. Pasulo, M. C. Morelli, L. Miglioresi, M. Merli, M. Angelico, A. Gasbarrini, A. D. Leo, Rendina, M, Castellaneta, N, Fagiuoli, S, Burra, P, Vigano, R, Iemmolo, R, Donato, M, Toniutto, P, Pasulo, L, Morelli, M, Miglioresi, L, Merli, M, Angelico, M, Gasbarrini, A, and Leo, A
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Svr ,Antiviral Therapy ,Hcv ,Liver-related Death ,Liver Transplantation - Published
- 2010
116. Impact of COVID-19 Pandemic on Colorectal Cancer Screening Program.
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D'Ovidio V, Lucidi C, Bruno G, Lisi D, Miglioresi L, and Bazuro ME
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- Aged, Colorectal Neoplasms pathology, Female, Humans, Male, Middle Aged, Patient Safety, Retrospective Studies, COVID-19 epidemiology, Colonoscopy, Colorectal Neoplasms diagnosis, Early Detection of Cancer, SARS-CoV-2
- Abstract
Introduction: One of the main clusters of coronavirus disease-2019 (COVID-19) has been identified in Italy. Following European and local guidelines, Italian endoscopy units modulated their activity. We aimed at analyzing the need and safety to continue selective colorectal cancer screening (CRCS) colonoscopies during the COVID-19 pandemic., Patients and Methods: We carried out a retrospective controlled cohort study in our "COVID-free" hospital to compare data of the CRCS colonoscopies of the lockdown period (March 9 to May 4, 2020) with those of the same period of 2019 (control group). A pre/post endoscopic sanitary surveillance for COVID-19 infection was organized for patients and sanitary staff., Results: In the lockdown group, 60 of 137 invited patients underwent endoscopy, whereas in the control group, 238 CRCS colonoscopies (3.9-fold) were performed. In the lower number of examinations during the lockdown, we found more colorectal cancers (5 cases; 8% vs. 3 cases; 1%; P = .002). The "high-risk" adenomas detection rate was also significantly higher in the "lockdown group" than in controls (47% vs. 25%; P = .001). A multiple regression analysis selected relevant symptoms (hazard ratio [HR], 3.1), familiarity (HR, 1.99), and lockdown period (HR, 2.2) as independent predictors of high-risk lesions (high-risk adenomas and colorectal cancer). No COVID-19 infections were reported among staff and patients., Conclusions: The overall adherence to CRCS decreased during the pandemic, but the continuation of CRCS colonoscopies was efficacious and safe., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2021
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117. Toward Zero Hepatitis C Virus-Related Mortality as a Prerequisite for the Release of Resources in a Center for Follow-up of Liver Transplant.
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Valente G, Miglioresi L, Sgueglia T, Rinaldi L, and Piai G
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- Female, Follow-Up Studies, Hepacivirus, Hepatitis C, Chronic mortality, Humans, Male, Retrospective Studies, Antiviral Agents therapeutic use, Hepatitis C, Chronic drug therapy, Liver Transplantation mortality, Sustained Virologic Response
- Abstract
Taking charge of a liver transplanted (LT) patient implies not only to follow up the transplanted organ (eg, immunosuppression and cancer risk) but also to deal with the prevailing patient's active problems. The recurrence of hepatitis C on the graft has historically been one of the main active problems to be addressed, leading to 30% to 40% mortality per se in these patients and has involved many resources in the hepatological centers responsible for the follow-up. We verified how much the availability of the new drugs with direct-acting antiviral agents (DAAs) against hepatitis C virus (HCV) has impacted the mortality within the assisted population, changing its characteristics and addressing new clinical issues in the LT-patients. We performed a retrospective comparison between 230 LT patients followed up during pre-DAA era (group 1, with 88 HCV RNA-positive) and 244 patients observed from 2014 onward when DAAs became available (group 2, with 79 HCV RNA-positive). Fifty-two antiviral therapies were performed in group 1 with 18 sustained virologic response (SVR) (35%) and 53 treatments, of which 37 were retreatments, in group 2 with 51 SVR (96%), P = .0001. Deaths for HCV-related causes were 19 of 33 (57%) in group 1 and 7 of 24 (24%) in group 2, P = .01. The Kaplan-Meier showed a dramatic reduction in excess mortality in HCV-LT patients after the availability of DAAs. These results suggest that HCV is no longer the main active problem of follow-up in liver transplants, therefore the resources can be relocated to take care of other clinical aspects., (Copyright © 2019. Published by Elsevier Inc.)
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- 2019
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118. Incidence and risk factors of early HCC occurrence in HCV patients treated with direct acting antivirals: a prospective multicentre study.
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Rinaldi L, Perrella A, Guarino M, De Luca M, Piai G, Coppola N, Pafundi PC, Ciardiello F, Fasano M, Martinelli E, Valente G, Nevola R, Monari C, Miglioresi L, Guerrera B, Berretta M, Sasso FC, Morisco F, Izzi A, and Adinolfi LE
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- Aged, Female, Humans, Incidence, Liver Cirrhosis complications, Logistic Models, Male, Middle Aged, Multivariate Analysis, Prospective Studies, Risk Factors, Sustained Virologic Response, Antiviral Agents therapeutic use, Carcinoma, Hepatocellular epidemiology, Carcinoma, Hepatocellular virology, Hepatitis C, Chronic complications, Hepatitis C, Chronic drug therapy, Liver Neoplasms epidemiology, Liver Neoplasms virology
- Abstract
Background: An unexpected increased HCC recurrence and occurrence rate among HCV patients treated with direct acting antivirals combination has been reported. Aim of the study was the evaluation of early HCC occurrence rate and its risk factors in a HCV infected population, treated with direct-acting-antivirals., Methods: According to the Italian ministerial guidelines for direct-acting-antivirals treatment, 1022 consecutive HCV patients treated with direct-acting-antivirals were enrolled. Patients either with active HCC at imaging or history of previous treated HCC, HBV or HIV co-infection, or liver transplant recipients were excluded. The SVR, defined as the persistent absence of detectable serum HCV-RNA 12 weeks after the end of treatment (SVR12), was assessed for all enrolled patients. Abdominal ultrasound was performed before starting antiviral therapy, and repeated every 6 months. HCC was diagnosed according to the international guidelines. Patients showing either nodular patterns suggestive of HCC or with uncertain dynamic vascular behaviour were excluded from a further follow-up., Results: Nine hundred and eighty-five patients completed the 48 weeks follow-up after the end of treatment. A Sofosbuvir-based regimen was administered in the 74.9% of patients, among whom, the 71.6% underwent a simultaneous Ribavirin administration. A sustained virological response at 12 weeks off treatment was documented in 966 patients (98.2%). During the post treatment follow-up HCC was detected in 35 patients, with a cumulative incidence rate of the 3.55%. At multivariate analysis, four variables resulted independently associated with HCC development, both in a cirrhosis based and a class B Child based model, respectively: cirrhosis/class B Child, therapeutic schedule including Sofosbuvir without Ribavirin, liver stiffness values, male gender and presence of diabetes. A multivariate analysis performed on Child A cirrhotic patients, showed that Sofosbuvir based therapeutic treatment without Ribavirin had a HCC occurrence 5.7 higher than Ribavirin-based schedules with or without Sofosbuvir (p < 0.0001, OR: 5.686, 95% CI 2.455-13.169)., Conclusions: Our data suggest that early HCC occurrence appears more frequently related to Sofosbuvir-based therapy without Ribavirin which, indeed, seems to play a protective role on HCC onset. Therefore, a careful follow-up should be mandatory, especially in those regimens including Sofosbuvir without Ribavirin.
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- 2019
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119. How to Improve Compliance With Dermatologic Screening in Liver Transplant Recipients: Experience in a (Spoke) Peripheral Center for Follow-up.
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Piai G, Battarra VC, Miglioresi L, Nacca M, and Valente G
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- Adult, Female, Follow-Up Studies, Humans, Male, Middle Aged, Liver Transplantation adverse effects, Mass Screening methods, Patient Compliance, Skin Neoplasms diagnosis, Skin Neoplasms etiology, Transplant Recipients
- Abstract
Annual dermatologic examination is required in all transplant recipients because of the high risk of skin cancers. Nevertheless, if the transplant recipient is merely advised to have a dermatologic consultation, the adherence usually appears to be poor. We analyzed our population of liver transplant recipients in 2 periods: in 2014 (group 1) and in 2016 (group 2), when we had organized the presence of a dermatologist at scheduled intervals to annually examine the entire liver transplant population we actively follow-up. The adherence to dermatologic screening during period 1 was significantly lower (50/179; 28% of patients) than during period 2 (198/200; 99% of patients) (P < .0001). In group 1 and 2, respectively, we found cutaneous lesions in 3 of 50 (6%) and in 13 of 198 (7%) examined patients and in 3 of 179 (1.7%) and in 13 of 200 (6.5%) of the whole groups of patients in follow-up (P = .02). The type of neoplastic lesions found at dermatologic visits were similar in group 1 (1 squamous cell carcinoma, 1 basal cell carcinoma) and group 2 (2 squamous cell carcinoma, 3 basal cell carcinoma) (P = .45), but with this intensive protocol of surveillance we discovered more preneoplastic lesions (1 leukoplakia in group 1 vs 7 actinic keratosis and 1 dysplastic nevus in group 2; P = .03). These results suggest that the planned presence of a dermatologist is mandatory among the many aspects of a well-organized transplant follow-up team., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2019
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120. Sarcopenia is associated with reduced survival in patients with advanced hepatocellular carcinoma undergoing sorafenib treatment.
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Antonelli G, Gigante E, Iavarone M, Begini P, Sangiovanni A, Iannicelli E, Biondetti P, Pellicelli AM, Miglioresi L, Marchetti P, Lampertico P, and Marignani M
- Abstract
Background: Sarcopenia has been associated with poor outcomes in patients with cirrhosis and solid tumours., Objective: Analyse the influence of sarcopenia on survival and treatment duration in patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib., Methods: We conducted a multicentre, retrospective study on 96 patients with advanced HCC treated with sorafenib, all with available abdominal computed tomography (CT) scan within 30 days from treatment start. Anthropometric, laboratory, treatment and follow-up data were collected. Sarcopenia was defined by reduced skeletal muscle index calculated from an L3 section CT image., Results: Sarcopenia was present in 49% of patients. Patients were divided into two groups according to sarcopenia: age was significantly higher in the sarcopenic group (SG) (66 years (31-87) versus 72 years (30-84), p = 0.04], with no difference in other baseline characteristics. The SG showed shorter overall survival (OS) (39 (95% confidence interval (CI) 26-50) versus 61 (95% CI 47-77) weeks ( p = 0,01)) and shorter time on treatment (12.3 (95% CI 8-19) versus 25.9 (95% CI 15-33) weeks ( p = 0.0044)). At multivariate analysis, sarcopenia was independently associated to reduced OS ( p = 0.03) and reduced time on treatment ( p = 0.001)., Conclusion: Sarcopenia is present in almost half of patients with advanced HCC, and is associated with reduced survival and reduced duration of oral chemotherapy.
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- 2018
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121. Distribution of IL28B Polymorphism in a Cohort of Italians and Immigrants with HCV Infection: Association with Viraemia, Stage of Fibrosis and Response to Treatment.
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Nosotti L, Petrelli A, Genovese D, Catone S, Argentini C, Vella S, Rossi A, Costanzo G, Fortino A, Chessa L, Miglioresi L, and Mirisola C
- Subjects
- Adult, Antiviral Agents therapeutic use, Black People statistics & numerical data, Cohort Studies, Female, Genotype, Hepatitis C, Chronic complications, Hepatitis C, Chronic drug therapy, Humans, Interferons, Italy epidemiology, Liver Cirrhosis etiology, Liver Cirrhosis genetics, Male, Middle Aged, Polymorphism, Single Nucleotide, Socioeconomic Factors, Viremia genetics, White People statistics & numerical data, Emigrants and Immigrants statistics & numerical data, Hepatitis C, Chronic ethnology, Hepatitis C, Chronic genetics, Interleukins genetics
- Abstract
Aims of the study are to investigate, in a cohort of patients affected by HCV chronic hepatitis with genotypes 1 and 4, the prevalence of interleukin 28B (IL28B) genotypes, the possible association between IL28B polymorphism and severity of liver damage, the role of IL28B CC as a predictor of outcome. 365 patients with HCV infection were observed between 2013 and 2014. Demographic, virological, biochemical, and genetic characteristics of each patient were investigated. Liver fibrosis was assessed by transient elastometry. Mean age of the patients (72.9 % males, 27.1 % females) is 50 years. 91.5 % % of patients are Caucasian, 8.5 % African. In the patients with HCV1 and HCV4 a higher frequency of IL28B CT is observed with a prevalence of 52.1 and 61.8 % respectively. As regards ethnic group, African people have a prevalence of 35.5 % for CC, while Caucasians have a prevalence of 23.8 % for CC. In our cohort, IL28B polymorphism does not show significant differences among ethnic groups and in HCV1 and HCV4 genotypes. As described in literature, IL28B CC genotype is confirmed as predictor of sustained virological response in both Caucasians and Africans. A significant correlation between liver fibrosis and IL28B polymorphism emerges.
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- 2017
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122. Liver Transplant in a Patient With Acquired Epidermolysis Bullosa and Associated End-Stage Liver Disease.
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Vennarecci G, Miglioresi L, Guglielmo N, Pelle F, Santoro R, Andreuccetti J, Ceribelli C, Stella P, Angelo C, and Ettorre GM
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- End Stage Liver Disease diagnosis, End Stage Liver Disease immunology, End Stage Liver Disease virology, Epidermolysis Bullosa Acquisita diagnosis, Epidermolysis Bullosa Acquisita immunology, Female, Hepatitis B diagnosis, Hepatitis B immunology, Hepatitis B virology, Hepatitis D diagnosis, Hepatitis D immunology, Hepatitis D virology, Humans, Immunosuppressive Agents therapeutic use, Middle Aged, Risk Factors, Treatment Outcome, End Stage Liver Disease surgery, Epidermolysis Bullosa Acquisita complications, Hepatitis B complications, Hepatitis D complications, Liver Transplantation adverse effects
- Abstract
We report the first case of a liver transplant in a patient with epidermolysis bullosa acquisita and associated hepatitis B virus-hepatitis D virus cirrhosis and its inherent technical issues. Epidermolysis bullosa acquisita is an autoimmune multisystem disorder involving skin and mucosa characterized by the appearing of blisters and erosions. The more severe forms may result in nutritional compromise, anemia, osteopenia, dilated cardiomyopathy, laryngeal mucosal involvement, esophageal strictures, bladder, and kidney involvement requiring surgical intervention. Epidermolysis bullosa acquisita has become recognized as a multisystem disorder that poses several surgical challenges. This case shows that liver transplant is a feasible procedure in patients affected by epidermolysis bullosa acquisita. Patients with epidermolysis bullosa acquisita require a particular pretransplant assessment and a dedicated intra- and postoperative management of every invasive procedure that can traumatize the skin and mucosal epithelium to achieve an uneventful liver transplant. Epidermolysis bullosa acquisita does not represent a contraindication to liver transplant, and immunosuppression after transplant may favor a good systemic control of this immunologic disorder.
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- 2017
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123. Validation of the AFP model as a predictor of HCC recurrence in patients with viral hepatitis-related cirrhosis who had received a liver transplant for HCC.
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Notarpaolo A, Layese R, Magistri P, Gambato M, Colledan M, Magini G, Miglioresi L, Vitale A, Vennarecci G, Ambrosio CD, Burra P, Di Benedetto F, Fagiuoli S, Colasanti M, Maria Ettorre G, Andreoli A, Cillo U, Laurent A, Katsahian S, Audureau E, Roudot-Thoraval F, and Duvoux C
- Subjects
- Adult, Carcinoma, Hepatocellular etiology, Female, Hepatitis B, Chronic complications, Hepatitis C, Chronic complications, Humans, Italy, Kaplan-Meier Estimate, Liver Cirrhosis complications, Liver Neoplasms etiology, Male, Middle Aged, Models, Biological, Neoplasm Recurrence, Local etiology, Predictive Value of Tests, Retrospective Studies, Risk Factors, Carcinoma, Hepatocellular blood, Carcinoma, Hepatocellular surgery, Liver Neoplasms blood, Liver Neoplasms surgery, Liver Transplantation, Neoplasm Recurrence, Local blood, Neoplasm Recurrence, Local surgery, alpha-Fetoproteins metabolism
- Abstract
Background & Aims: The AFP model was shown to be superior to the Milan criteria for predicting hepatocellular carcinoma (HCC) recurrence after liver transplantation in a French population. Our aim was to test the AFP model in a non-French, post-hepatitic cirrhosis-based population of HCC candidates., Methods: 574 patients transplanted for HCC in four Italian centers were studied. AFP score was assessed at the last evaluation before liver transplantation (LT). Probabilities of recurrence and survival were estimated by the log-rank test or competing risk analysis and compared according to the AFP model., Results: 24.7% patients were beyond Milan criteria. HCC complicated hepatitis C virus (HCV) and hepatitis B virus (HBV) cirrhosis in 58.7% and 24% of the cases, respectively. Five-year probabilities of recurrence differed according to AFP score ⩽2 vs. >2 in the whole population (13.2±1.8% vs. 49.8±8.7%, p<0.001, HR=4.98), in patients within Milan criteria (12.8±2.0% vs. 32.4±12.1%, p=0.009, HR=3.51), beyond Milan criteria (14.9±4.2% vs. 58.9±11.5%, p<0.001, HR=4.26), HCV patients (14.9±2.5% vs. 67.6±14.7%, p<0.001, HR=6.56) and HBV patients (11.6±3.4% vs. 34.3±12.5%, p=0.012, HR=3.49). By net reclassification improvement analysis AFP score significantly improved prediction of non-recurrence compared to Milan criteria. Overall five-year survival rates according to AFP score ⩽2 or >2 were 71.7±2.2% vs. 42.2±8.3% (p<0.001, HR=2.14)., Conclusions: The AFP model identifies HCC candidates at low risk of recurrence, otherwise excluded by Milan criteria in a population with a predominance of post-hepatitic-related HCC. The AFP score can be proposed for selection of HCC candidates in programs with a high proportion of viral/HCV-related cirrhosis., Lay Summary: Selection criteria for liver transplantation of patients affected with hepatocellular carcinoma (HCC) are based on the Milan criteria, which have been shown to be too restrictive, precluding access to liver transplantation for some patients who might be cured by this operation. Recently, a French group of researchers developed a new selection model called the AFP model, or AFP score, allowing some patients with HCC not meeting Milan criteria to be transplanted with excellent results. In the present work, the AFP score was tested in a population of non-French patients transplanted for HCC occurring mainly on post-hepatitic (HCV or HBV) cirrhosis. The results confirm that in this specific population, as in the original French population of patients, the AFP model better selects patients with HCC eligible for transplantation, compared to Milan criteria. We conclude that the AFP score, which has been officially adopted by the French organization for Organ Sharing for HCC patients, can also be implemented in countries with an important burden of HCC occurring on post-hepatitic cirrhosis., (Copyright © 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)
- Published
- 2017
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124. Cholestatic hepatitis C after chemotherapy containing rituximab in diffuse large B cell lymphoma.
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Pellicelli AM, D'Ambrosio C, Dessanti ML, Villani R, Fondacaro L, Miglioresi L, Grillo LR, and Andreoli A
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- Aged, Antiviral Agents therapeutic use, Biopsy, Cholestasis diagnosis, Cholestasis drug therapy, Cholestasis virology, Hepacivirus pathogenicity, Hepatitis C diagnosis, Hepatitis C drug therapy, Hepatitis C virology, Humans, Male, Time Factors, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols adverse effects, Cholestasis chemically induced, Hepacivirus drug effects, Hepatitis C chemically induced, Lymphoma, Large B-Cell, Diffuse drug therapy, Rituximab adverse effects, Virus Activation drug effects
- Abstract
Rituximab is a chimeric anti-CD20 monoclonal antibody that is a widely used for the treatment of B cells non-Hodgkin lymphoma. The use of chemotherapy regimens containing rituximab in HCV-positive patients with non-Hodgkin lymphoma has been associated with liver dysfunction, but no cases of cholestatic hepatitis C were described. To our knowledge, this is the first case of cholestatic hepatitis C in an HCV-positive patient with diffuse large B-cell lymphoma describes in the literature. We discuss the pathogenetic mechanisms underlying this severe form of hepatitis and describe its evolution after antiviral treatment.
- Published
- 2015
125. Long-term maintenance of sustained virological response in liver transplant recipients treated for recurrent hepatitis C.
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Ponziani FR, Viganò R, Iemmolo RM, Donato MF, Rendina M, Toniutto P, Pasulo L, Morelli MC, Burra P, Miglioresi L, Merli M, Di Paolo D, Fagiuoli S, Gasbarrini A, Pompili M, Belli L, Gerunda GE, Marino M, Montalti R, Di Benedetto F, De Ruvo N, Rigamonti C, Colombo M, Rossi G, Di Leo A, Lupo L, Memeo V, Bringiotti R, Zappimbulso M, Bitetto D, Vero V, Colpani M, Fornasiere E, Pinna AD, Morelli MC, Bertuzzo V, De Martin E, Senzolo M, Ettorre GM, Visco-Comandini U, Antonucci G, Angelico M, Tisone G, Giannelli V, and Giusto M
- Subjects
- Drug Therapy, Combination, Female, Follow-Up Studies, Genotype, Graft Survival, Hepatitis C, Chronic blood, Hepatitis C, Chronic mortality, Humans, Interferon-alpha therapeutic use, Interferons, Interleukins genetics, Maintenance Chemotherapy methods, Male, Middle Aged, Polyethylene Glycols therapeutic use, Recombinant Proteins therapeutic use, Recurrence, Retrospective Studies, Ribavirin therapeutic use, Survival Rate, Time Factors, Antiviral Agents therapeutic use, Hepacivirus genetics, Hepatitis C, Chronic drug therapy, Liver Transplantation mortality, RNA, Viral blood
- Abstract
Background: The recurrence of hepatitis C viral infection is common after liver transplant, and achieving a sustained virological response to antiviral treatment is desirable for reducing the risk of graft loss and improving patients' survival., Aim: To investigate the long-term maintenance of sustained virological response in liver transplant recipients with hepatitis C recurrence., Methods: 436 Liver transplant recipients (74.1% genotype 1) who underwent combined antiviral therapy for hepatitis C recurrence were retrospectively evaluated., Results: The overall sustained virological response rate was 40% (173/436 patients), and the mean follow-up after liver transplantation was 11±3.5 years (range, 5-24). Patients with a sustained virological response demonstrated a 5-year survival rate of 97% and a 10-year survival rate of 93%; all but 6 (3%) patients remained hepatitis C virus RNA-negative during follow-up. Genotype non-1 (p=0.007), treatment duration >80% of the scheduled period (p=0.027), and early virological response (p=0.002), were associated with the maintenance of sustained virological response as indicated by univariate analysis. Early virological response was the only independent predictor of sustained virological response maintenance (p=0.008)., Conclusions: Sustained virological response achieved after combined antiviral treatment is maintained in liver transplant patients with recurrent hepatitis C and is associated with an excellent 5-year survival., (Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)
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- 2014
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126. Treatment of genotype-1 hepatitis C recurrence after liver transplant improves survival in both sustained responders and relapsers.
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Ponziani FR, Milani A, Gasbarrini A, Zaccaria R, Viganò R, Iemmolo RM, Donato MF, Rendina M, Toniutto P, Pasulo L, Cescon M, Burra P, Miglioresi L, Merli M, Paolo DD, Fagiuoli S, and Pompili M
- Subjects
- Cohort Studies, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Follow-Up Studies, Graft Rejection, Graft Survival, Hepatitis C, Chronic mortality, Hepatitis C, Chronic pathology, Humans, Interferon-alpha administration & dosage, Italy, Kaplan-Meier Estimate, Liver Transplantation adverse effects, Liver Transplantation methods, Male, Middle Aged, Multivariate Analysis, Polyethylene Glycols administration & dosage, Predictive Value of Tests, Recombinant Proteins administration & dosage, Recurrence, Regression Analysis, Retreatment, Retrospective Studies, Ribavirin administration & dosage, Risk Assessment, Survival Analysis, Treatment Outcome, Antiviral Agents administration & dosage, Genotype, Hepatitis C, Chronic genetics, Hepatitis C, Chronic surgery, Liver Transplantation mortality
- Abstract
The aim of this study was to evaluate the factors affecting the response to treatment and how it could affect survival in a large series of genotype-1 HCV-transplanted patients. Three-hundred and twenty six genotype-1 HCV patients were enrolled. One hundred and ninety-six patients (60.1%) were nonresponders and 130 (39.9%) showed negative HCV-RNA at the end of treatment. Eighty-four of them (25.8%) achieved sustained virological response, while 46 (14.1%) showed viral relapse. Five-year cumulative survival was significantly worse in nonresponders (76.4%) compared with sustained viral response (93.2) or relapsers (94.9%). Sustained responders and relapsers were therefore considered as a single 'response group' in further analysis. Pretreatment variables significantly associated with virological response at multivariate regression analysis were the absence of ineffective pretransplant antiviral therapy, the recurrence of HCV-hepatitis more than 1 year after transplant, an histological grading ≥4 at pretreatment liver biopsy, a pretreatment HCV-RNA level <1.2 × 10(6 ) IU/ml, and the absence of diabetes. As expected, also on-treatment variables (rapid and early virological response) were significantly associated to the response to antiviral treatment. In conclusion, this study shows that postliver transplant antiviral treatment results in beneficial effect on survival not only in sustained responders but also in relapsers., (© 2012 The Authors Transplant International © 2012 European Society for Organ Transplantation. Published by Blackwell Publishing Ltd.)
- Published
- 2013
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127. Treatment of recurrent genotype 4 hepatitis C after liver transplantation: early virological response is predictive of sustained virological response. An AISF RECOLT-C group study.
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Ponziani FR, Milani A, Gasbarrini A, Zaccaria R, Viganò R, Donato MF, Morelli MC, Miglioresi L, Pasulo L, Rendina M, Paolo DD, Marino M, Toniutto P, Fagiuoli S, and Pompili M
- Subjects
- Adult, Cohort Studies, Drug Therapy, Combination, Female, Humans, Interferon-alpha therapeutic use, Italy, Male, Middle Aged, Polyethylene Glycols therapeutic use, Recombinant Proteins therapeutic use, Recurrence, Retrospective Studies, Ribavirin therapeutic use, Treatment Outcome, Antiviral Agents therapeutic use, Genotype, Hepacivirus genetics, Hepatitis B, Chronic epidemiology, Hepatitis B, Chronic therapy, Liver Transplantation
- Abstract
Introduction: Hepatitis C virus genotype 4 is predominant in the Middle East and Northern Africa, even if it has recently spread to Southern Europe. Data about the treatment of post-liver transplantation (LT) genotype 4 hepatitis C recurrence are scarce. We report a retrospective analysis of post-LT genotype 4 hepatitis C treatment in 9 Italian transplant centres, focusing on the overall survival rates and treatment outcome., Results: Among 452 recipients, we identified 17 HCV genotype 4 patients (16 males, 1 female) transplanted between 1998 and 2007. All patients received combined antiviral treatment with conventional doses of interferon (recombinant or pegylated) and ribavirin after histological diagnosis of hepatitis C recurrence. The observed overall survival after LT was 100% at 1 year and 83.3% at 5 years. More than 1/3 (35.3%) of patients achieved a sustained virological response (SVR) and 40% (data available in 15 subjects) an early virological response (EVR), which was significantly associated with the achievement of SVR (overall accuracy: 85.7%; predictive values of EVR absence/presence 80/88.8%; chi-square p < 0.05)., Conclusion: In conclusion, in post-LT genotype 4 hepatitis C treatment, SVR rates are similar to genotype 1. Patients who don't show an EVR are not likely to achieve a SVR.
- Published
- 2012
128. Treatment of hepatitis C recurrence is less successful in female than in male liver transplant recipients.
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Giannelli V, Giusto M, Farcomeni A, Ponziani FR, Pompili M, Viganò R, Iemmolo RM, Donato MF, Rendina M, Toniutto P, Pasulo L, Morelli MC, De Martin E, Miglioresi L, Di Paolo D, Fagiuoli S, and Merli M
- Subjects
- Adult, Aged, Female, Hepacivirus genetics, Humans, Male, Middle Aged, Patient Compliance, RNA, Viral blood, Recurrence, Retrospective Studies, Sex Factors, Treatment Outcome, Viral Load, Antiviral Agents therapeutic use, Hepatitis C, Chronic virology, Interferon-alpha therapeutic use, Liver Transplantation, Polyethylene Glycols therapeutic use, Ribavirin therapeutic use
- Abstract
It has been recently suggested that the risk of graft loss after liver transplantation (LT) may increase in female HCV patients. The aim of the study was to examine gender differences in HCV therapy tolerance and outcome in LT patients treated for HCV recurrence. A retrospective study was conducted on liver recipients with HCV recurrence, who were given antiviral therapy from 2001 to 2009 in 12 transplant centers in Italy. Sustained virological response (SVR), adherence-to-therapy, and side effects were evaluated. A multivariate logistic regression model was used after adjusting for possible confounders. The data regarding 342 treated patients were analyzed. SVR was reported in 38.8% of patients. At baseline, male and female did not differ in HCV viral load, histology, or rate of diabetes. SVR was lower in females than in males (29.5% vs. 42.1%; P=0.03). Adherence-to-therapy was also lower in females than in males 43.4% vs. 23.8%; P=0.001); anemia was the main reason for lower adherence. In a multivariate analysis in patients Genotype1, female gender (P<0.04), early virological response (P<0.0001), and adherence to therapy (P<0.0001) were independent predictors for SVR. In conclusion, female gender represents an independent negative prognostic factor for the outcome of HCV antiviral therapy after LT., (© 2012 The Authors. Transplant International © 2012 European Society for Organ Transplantation.)
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- 2012
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129. Gas exchanges and pulmonary vascular abnormalities at different stages of chronic liver disease.
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Scarlata S, Conte ME, Cesari M, Gentilucci UV, Miglioresi L, Pedone C, Picardi A, Ricci GL, and Incalzi RA
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- Analysis of Variance, Chronic Disease, Female, Humans, Immunoenzyme Techniques, Liver Cirrhosis complications, Liver Diseases complications, Lung abnormalities, Male, Middle Aged, Respiratory Function Tests, Capillaries physiopathology, Liver Cirrhosis physiopathology, Liver Diseases physiopathology, Lung blood supply, Pulmonary Gas Exchange physiology
- Abstract
Background: It is unclear whether and to which extent respiratory function abnormalities may complicate the earliest stages of chronic liver disease (CLD). Aim of this study was to compare pulmonary capillary volumes and gas exchange efficiency of CLD patients with and without cirrhosis., Methods: Sixty-seven participants (mean age 56.5 years; women 22.4%) were divided into three groups (matched by age, sex, smoking) according to the baseline CLD stage as follows: (a) healthy controls (Group A, n=20); (b) non-cirrhotic CLD patients (Group B; n=23); (c) cirrhotic CLD patients (Group C; n=24). All participants underwent clinical assessment, respiratory function tests, gas exchange estimation by the alveolar diffusion of carbon monoxide (TLCO) measurement and 6-min walking test. Groups were compared by chi-square and one-way anova tests., Results: Chronic liver disease patients had significantly lower levels of TLCO (Group B=17.7 ml/min mmHg, and Group C=14.2 ml/min mmHg) compared with healthy controls (Group A=24.4 ml/min mmHg). Consistent results were obtained when analyses were performed using TLCO expressed as percentage of the predicted value. TLCO adjusted for the alveolar volume was lower in cirrhotic patients compared with both controls and non-cirrhotic CLD patients (P<0.001 and P=0.035 respectively). Group C participants presented blood gas parameters tending to a compensated chronic respiratory alkalosis status compared with the other groups., Conclusions: Pulmonary microvascular and gas exchange modifications are present at early stages of CLD. Future studies should be focused at evaluating the pathophysiological mechanisms underlying this relationship., (© 2011 John Wiley & Sons A/S.)
- Published
- 2011
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130. Short-term follow-up of radioembolization with yttrium-90 microspheres before liver transplantation: new perspectives in advanced hepatocellular carcinoma.
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Ettorre GM, Santoro R, Puoti C, Sciuto R, Carpanese L, Antonini M, Antonucci G, Maini CL, Miglioresi L, and Vennarecci G
- Subjects
- Humans, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular surgery, Embolization, Therapeutic statistics & numerical data, Liver Neoplasms pathology, Liver Neoplasms surgery, Liver Transplantation methods, Yttrium Radioisotopes therapeutic use
- Published
- 2010
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131. The controversial role of lamivudine prophylaxis in occult HBV carriers treated with chemo-immune therapy.
- Author
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D'Andrea M, Nosotti L, Pimpinelli F, Dessanti ML, Paviglianiti A, Miglioresi L, Morrone A, and Petti MC
- Subjects
- Chemoprevention, Drug-Related Side Effects and Adverse Reactions, Hepatitis B Antibodies blood, Hepatitis B Core Antigens immunology, Humans, Lymphoma drug therapy, Retrospective Studies, Antiviral Agents therapeutic use, Carrier State drug therapy, Hepatitis B drug therapy, Lamivudine therapeutic use
- Published
- 2009
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132. CD81 expression on CD19+ peripheral blood lymphocytes is associated with chronic HCV disease and increased risk for HCV infection: a putative role for inflammatory cytokines.
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D'Agosto G, Trento E, Nosotti L, Bordignon V, Battista M, Prignano G, Pimpinelli F, Biolcati G, Macrì A, Palamara G, Miglioresi L, Morrone A, Di Carlo A, Cordiali-Fei P, and Ensoli F
- Subjects
- Adult, Aged, Aged, 80 and over, B-Lymphocytes immunology, B-Lymphocytes virology, CD3 Complex immunology, Case-Control Studies, Dose-Response Relationship, Immunologic, Female, Hepatitis C, Chronic immunology, Hepatitis C, Chronic virology, Humans, Lymphocyte Subsets immunology, Lymphocyte Subsets virology, Lymphocytes virology, Male, Middle Aged, Risk Factors, T-Lymphocytes immunology, T-Lymphocytes virology, Tetraspanin 28, Antigens, CD immunology, Antigens, CD19 immunology, Cytokines immunology, Hepacivirus immunology, Hepatitis C, Chronic blood, Inflammation Mediators immunology, Lymphocytes immunology
- Abstract
The level of CD81 cell surface expression, a cellular co-receptor for hepatitis C virus (HCV), is critical for productive HCV infection of host cells. In addition, the cross-linking of HCV-E2 protein to CD81 can alter the function of T and B lymphocytes as well as that of NK cells by interfering with the activation signalling pathway. The down-regulation of CD81 expression on peripheral blood lymphocytes (PBL) has been associated to effective therapy of HCV infection. The aim of the present study is to quantitatively assess the levels of CD81 expression in PBL from HCV-infected patients compared to subjects at high risk for HCV infection such as HIV-infected individuals or patients with Porphyria Cutanea Tarda (PCT). The expression of CD81 was quantified by flow-cytometry using Phycoerythrin-labelled standard beads. Determination of CD81 was performed on CD3+ and CD19+ lymphocytes from 34 healthy controls, 51 patients with HCV infection and different clinical outcomes [these included HCV-RNA-negative subjects (8), patients with chronic active hepatitis (16), recipients of liver transplantation under immunosuppressive therapy (12), a subgroup with concomitant HIV infection (9) or concomitant PCT (6)]. In addition, 60 HIV-infected subjects and 4 patients with PCT were studied. The putative role of inflammatory cytokines in modulating CD81 was explored in vitro by assessing the effect of IL-6 or IFN-gamma on cultured human hepatocytes. A significant increase of the CD81 expression was found on CD19+ lymphocytes in association with either HIV or HCV infection, as compared to the control group. Immunosuppressive therapy with FK506, subsequent to liver transplantation, restored CD81 expression at normal levels. Data gathered in vitro using the WRL 68 hepatocytic cell line confirmed that inflammatory cytokines can up-regulate CD81 expression in liver cell inclusion. Our data suggest that CD81 up-regulation can increase the risk of HCV infection, particularly in HIV-infected subjects. In addition, the results strongly suggest that the cytokines released by activated lymphocytes at sites of inflammation may play a part in up-regulating CD81 expression.
- Published
- 2009
133. Risk of Kaposi sarcoma after solid-organ transplantation: multicenter study in 4,767 recipients in Italy, 1970-2006.
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Piselli P, Busnach G, Citterio F, Frigerio M, Arbustini E, Burra P, Pinna AD, Bresadola V, Ettorre GM, Baccarani U, Buda A, Lauro A, Zanus G, Cimaglia C, Spagnoletti G, Lenardon A, Agozzino M, Gambato M, Zanfi C, Miglioresi L, Di Gioia P, Mei L, Ippolito G, and Serraino D
- Subjects
- Adult, Aged, Female, Herpesvirus 8, Human, Humans, Italy epidemiology, Longitudinal Studies, Male, Middle Aged, Prevalence, Risk Factors, Sarcoma, Kaposi epidemiology, Sarcoma, Kaposi virology, Organ Transplantation, Postoperative Complications epidemiology
- Abstract
Given the high prevalence of infection with human herpesvirus type 8, Italy is an area of utmost interest for studying Kaposi sarcoma (KS). We investigated the risk of KS in transplant recipients compared with the general population. A longitudinal study was performed from 1970 to 2006 in 4767 kidney, heart, liver, and lung transplant recipients from 7 Italian transplantation centers. The sample included 72.3% male patients with an overall patient median age of 48 years. Patient-years (PYs) at risk for KS were computed from 30 days posttransplantation to the date of KS, death, last follow-up, or study closure (December 31, 2007). Standardized incidence ratios (SIRs) and 95% confidence intervals were computed to quantify the risk of KS in transplant recipients compared with the general Italian population. Incidence rate ratios were computed to identify risk factors using adjusted Poisson regression. Based on 33,621 PYs, KS was diagnosed in 73 patients (62 men): 31 in kidney recipients, 27 in heart recipients, 8 in liver recipients, and 7 in lung recipients. The overall incidence was 217 cases per 10(5) PYs, with a significantly increased SIR of 125. SIR was particularly high in women (n = 34) and lung recipients (n = 428) but decreased significantly with time posttransplantation. The primary predictors of increased risk of KS were male sex, older age, and lung transplantation. A 5-fold reduction was observed after 18 months posttransplantation. After adjustment, patients born in southern Italy compared with northern Italy demonstrated a significant 2.2-fold increased risk. Our findings confirm that in the early posttransplantation period, Italian patients who have undergone solid-organ transplantation, particularly those from southern Italy and those who are lung recipients, are at greater risk of KS compared with the general population. These findings underscore the need for appropriate models for monitoring transplant recipients for KS, especially those at greater risk and, in particular, in the early postoperative period.
- Published
- 2009
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- View/download PDF
134. Consensus interferon versus interferon-alpha 2b plus ribavirin in patients with relapsing HCV infection.
- Author
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Miglioresi L, Bacosi M, Russo F, Patrizi F, Saccenti P, Ursitti A, Angelis AD, and Ricci GL
- Abstract
Management of HCV infection and related liver disease with treatment currently available lead to a sustained virological response in 20% of patients using interferon (IFN)-alpha mono-therapy and approximately 40-45% in those on combination therapy with ribavirin.The aim of the present investigation was to compare the effect of consensus interferon alphacon-1 (C-IFN), and IFN-alpha 2b plus ribavirin, in patients relapsing after treatment with interferon alone. A total of 112 randomised patients with relapsing HCV infection (M/F=53/59), were treated for 24 weeks with: (A) IFN-alpha 2b starting with 5/6MU/day till negativity of HCV-RNA followed by 3MU every other day, plus ribavirin 15mg/kg/day (n=34); (B) C-IFN 9microg/day (n=40); (C) ursodeoxycholic acid (UDCA; sodium salt) 450mg/day (n=37). At the end of treatment, patients were observed at follow-up for 24 weeks.Clearance of HCV-RNA was achieved by the end of treatment in 23 patients (68%) in Group A and 21 also showed a biochemical response with normal ALT; in Group B, 33 patients (82%) had both a virological and a biochemical response; in Group C, one patient cleared HCV-RNA. At the end of follow-up (sustained-response), 29% of patients in Group A (n=10/34) had negative PCR (seven patients relapsed at the 4th week, six at the 12th); in Group B, a sustained response was achieved in 58% (p<0.03; two patients relapsed at the 4th week, three at the 12th and five at the 24th).MAJOR SIDE EFFECTS COMPRISED: neutropenia (n=17) and decrease in Hb>1.5g/dl (n=33) in Group A, recurrence of psoriasis in two patients in Group B and abdominal discomfort and diarrhoea in 11 patients in Group C.Rapid clearance of circulating HCV-RNA was induced by C-IFN (66% at three weeks, 71% at six weeks): this was a good prognostic index both for end of treatment and sustained response. Treatment with C-IFN lead to a higher response rate compared to that of recombinant IFN-alpha 2b in association with ribavirin. The action of C-IFN is superior in the time taken to reach the maximal response rate during treatment and in the lower prevalence of relapse of the infection.
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- 2003
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135. Localization of hepatitis C virus in gastrointestinal mucosa: a possible reservoir for relapse.
- Author
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Miglioresi L, Riva E, Antonelli G, Russo F, and Ricci GL
- Subjects
- Hepatitis C, Humans, Recurrence, Gastric Mucosa virology, Hepacivirus isolation & purification, Intestinal Mucosa virology
- Published
- 2003
- Full Text
- View/download PDF
136. Amantadine and interferon in the combined treatment of hepatitis C virus in elderly patients.
- Author
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Bacosi M, Russo F, D'innocenzo S, Santolamazza M, Miglioresi L, Ursitti A, De Angelis A, Patrizi F, and Ricci GL
- Abstract
Background: Treatment of hepatitis C virus (HCV) infection with interferon (IFN) in older patients may not be feasible on account of side effects: we, therefore, attempted combined treatment with amantadine hydrochloride (AH) in order to improve not only the flu-like symptoms associated with IFN but also the anti-viral effect. Methods: Patients over 65 years of age, (n=165), who had failed to eradicate HCV infection after previous treatment with IFN were randomized into three groups and treated for 12 months, group A received AH 100 mg twice per day; group B received IFNalpha-n(3) 6 M units every other day for 3 months followed by 3 MU and group C the same dose of IFNalpha-n(3), as in B, and AH 200 mg per day. Results: Group A, 42 patients agreed to undergo treatment (genotype 1b n=39); at the end of treatment 21 patients (50%) had normal ALT and seven (17%) negative polymerase chain reaction (PCR). HCV-RNA was not detectable in seven patients at the sixth month follow-up and in six (14%) after 23plus minus2 months. Group B, 39 patients accepted the treatment (genotype 1b n=31); at the end of treatment, 17 patients (44%) had normal ALT and 13 negative PCR (13%). HCV-RNA was not detectable in nine patients (23%) at the sixth month of follow-up and in eight (21%) after 22plus minus4 months. Group C, 38 patients accepted the treatment (genotype 1b n=32); at the end of treatment, 20 (53%) patients had normal ALT and 15 negative PCR (39%). HCV-RNA was not detectable in 15 patients at the sixth month follow-up and in 11 after 21plus minus4 months (29%). Forty-six patients did not accept the scheme of treatment and 26 of them had a follow-up of 20plus minus3 months. HCV-RNA copies and prevalence of genotype 1b were comparable to the treated groups: HCV-RNA was fluctuating or unchanged during the entire follow-up. Conclusions: AH associated with IFN was able to improve the negativization of HCV-RNA and sustained response to IFN and decreased the malaise associated with IFN; an increase in viral copies was observed under AH in about 40%.
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- 2002
- Full Text
- View/download PDF
137. Leucopenia is a side effect of combination therapy for hepatitis C infection.
- Author
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Russo F, Bacosi M, Miglioresi L, and Ricci GL
- Subjects
- Adult, Antiviral Agents administration & dosage, Drug Therapy, Combination, Female, Humans, Interferon alpha-2, Interferon-alpha administration & dosage, Leukocyte Count drug effects, Male, Recombinant Proteins, Ribavirin administration & dosage, Antiviral Agents adverse effects, Hepatitis C, Chronic drug therapy, Interferon-alpha adverse effects, Leukopenia chemically induced, Ribavirin adverse effects
- Published
- 2000
- Full Text
- View/download PDF
138. Elevated alanine aminotransferase in blood donors: role of different factors and multiple viral infections.
- Author
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Delle Monache M, Miceli M, Santolamazza M, Mannella E, Mercurio G, Di Lorenzo A, Bacosi M, Gerardi R, Berardo C, Bruno G, Russo F, Miglioresi L, and Ricci GL
- Subjects
- Antibodies, Viral blood, Humans, Retrospective Studies, Virus Diseases blood, Alanine Transaminase blood, Blood Donors
- Abstract
Many different aetiological agents stimulate alanine aminotransferase (ALT) production. Viral markers and other aetiologies were investigated in 2166 individuals, randomly selected from 10,000 consecutive blood donors. Elevation of ALT was found in 10.8% of subjects. Grouping donors according to ALT level and correlating with, respectively, hepatitis B core antibody (HBcAb), cytomegalovirus antibody alone, or associated with HBcAb, showed similar findings (high ALT 11.1%, normal 11.6%; high 85.4%, normal 81.4%; high 10.2%, normal 11.0%, respectively). Hepatitis C virus (HCV) antibody was found to be significantly associated with elevated ALT levels (high 1.7%, normal 0.26%). Other causes of ALT elevation were alcohol abuse (17%), obesity (25%) and dyslipidaemia (38%), but in 11% there was no obvious aetiology. Although HCV is a rare cause of elevated ALT in blood donors, it seems to be the only virus, among those tested, to account for liver damage. This may be due to the non-protective role of HCV antibody, the low specificity of ALT, or the pathogenic role of uninvestigated viruses.
- Published
- 1999
- Full Text
- View/download PDF
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