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1. Tailoring allocation policies and improving access to pediatric liver transplantation over a 16-year period

Author

Spada, Marco, primary, Angelico, Roberta, additional, Trapani, Silvia, additional, Masiero, Lucia, additional, Puoti, Francesca, additional, Colledan, Michele, additional, Cintorino, Davide, additional, Romagnoli, Renato, additional, Cillo, Umberto, additional, Cardillo, Massimo, additional, Agnes, S., additional, Andorno, E., additional, Baccarani, U., additional, Caccamo, L., additional, Rossi, G., additional, Carraro, A., additional, Cescon, M., additional, Simone, P.De, additional, Carlis, L.De, additional, Benedetto, F.Di, additional, Ettorre, G.M., additional, Gruttadauria, S., additional, Lupo, L.G., additional, Tandoi, F., additional, Mazzaferro, V., additional, Rossi, M., additional, Tisone, G., additional, Vennarecci, G., additional, Vivarelli, M., additional, and Zamboni, F., additional

Published
2023
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2. Improving outcomes of in situ split liver transplantation in Italy over the last 25 years

Author

Lauterio, A, Cillo, U, Spada, M, Trapani, S, De Carlis, R, Bottino, G, Bernasconi, D, Scalamogna, C, Pinelli, D, Cintorino, D, D'Amico, F, Spagnoletti, G, Miggino, M, Romagnoli, R, Centonze, L, Caccamo, L, Baccarani, U, Carraro, A, Cescon, M, Vivarelli, M, Mazaferro, V, Ettorre, G, Rossi, M, Vennarecci, G, De Simone, P, Angelico, R, Agnes, S, Di Benedetto, F, Lupo, L, Zamboni, F, Zefelippo, A, Patrono, D, Diviacco, P, Laureiro, Z, Gringeri, E, Di Francesco, F, Lucianetti, A, Valsecchi, M, Gruttadauria, S, De Feo, T, Cardillo, M, De Carlis, L, Colledan, M, Andorno, E, Lauterio A., Cillo U., Spada M., Trapani S., De Carlis R., Bottino G., Bernasconi D., Scalamogna C., Pinelli D., Cintorino D., D'Amico F. E., Spagnoletti G., Miggino M., Romagnoli R., Centonze L., Caccamo L., Baccarani U., Carraro A., Cescon M., Vivarelli M., Mazaferro V., Ettorre G. M., Rossi M., Vennarecci G., De Simone P., Angelico R., Agnes S., Di Benedetto F., Lupo L. G., Zamboni F., Zefelippo A., Patrono D., Diviacco P., Laureiro Z. L., Gringeri E., Di Francesco F., Lucianetti A., Valsecchi M. G., Gruttadauria S., De Feo T., Cardillo M., De Carlis L., Colledan M., Andorno E., Lauterio, A, Cillo, U, Spada, M, Trapani, S, De Carlis, R, Bottino, G, Bernasconi, D, Scalamogna, C, Pinelli, D, Cintorino, D, D'Amico, F, Spagnoletti, G, Miggino, M, Romagnoli, R, Centonze, L, Caccamo, L, Baccarani, U, Carraro, A, Cescon, M, Vivarelli, M, Mazaferro, V, Ettorre, G, Rossi, M, Vennarecci, G, De Simone, P, Angelico, R, Agnes, S, Di Benedetto, F, Lupo, L, Zamboni, F, Zefelippo, A, Patrono, D, Diviacco, P, Laureiro, Z, Gringeri, E, Di Francesco, F, Lucianetti, A, Valsecchi, M, Gruttadauria, S, De Feo, T, Cardillo, M, De Carlis, L, Colledan, M, Andorno, E, Lauterio A., Cillo U., Spada M., Trapani S., De Carlis R., Bottino G., Bernasconi D., Scalamogna C., Pinelli D., Cintorino D., D'Amico F. E., Spagnoletti G., Miggino M., Romagnoli R., Centonze L., Caccamo L., Baccarani U., Carraro A., Cescon M., Vivarelli M., Mazaferro V., Ettorre G. M., Rossi M., Vennarecci G., De Simone P., Angelico R., Agnes S., Di Benedetto F., Lupo L. G., Zamboni F., Zefelippo A., Patrono D., Diviacco P., Laureiro Z. L., Gringeri E., Di Francesco F., Lucianetti A., Valsecchi M. G., Gruttadauria S., De Feo T., Cardillo M., De Carlis L., Colledan M., and Andorno E.

Abstract

Background & Aims: Split liver transplant(ation) (SLT) is still considered a challenging procedure that is by no means widely accepted. We aimed to present data on 25-year trends in SLT in Italy, and to investigate if, and to what extent, outcomes have improved nationwide during this time. Methods: The study included all consecutive SLTs performed from May 1993 to December 2019, divided into three consecutive periods: 1993–2005, 2006–2014, and 2015–2019, which match changes in national allocation policies. Primary outcomes were patient and graft survival, and the relative impact of each study period. Results: SLT accounted for 8.9% of all liver transplants performed in Italy. A total of 1,715 in situ split liver grafts were included in the analysis: 868 left lateral segments (LLSs) and 847 extended right grafts (ERGs). A significant improvement in patient and graft survival (p <0.001) was observed with ERGs over the three periods. Predictors of graft survival were cold ischaemia time (CIT) <6 h (p = 0.009), UNOS status 2b (p <0.001), UNOS status 3 (p = 0.009), and transplant centre volumes: 25–50 cases vs. <25 cases (p = 0.003). Patient survival was significantly higher with LLS grafts in period 2 vs. period 1 (p = 0.008). No significant improvement in graft survival was seen over the three periods, where predictors of graft survival were CIT <6 h (p = 0.007), CIT <6 h vs. ≥10 h (p = 0.019), UNOS status 2b (p = 0.038), and UNOS status 3 (p = 0.009). Retransplantation was a risk factor in split liver graft recipients, with significantly worse graft and patient survival for both types of graft (p <0.001). Conclusions: Our analysis showed Italian SLT outcomes to have improved over the last 25 years. These results could help to dispel reservations regarding the use of this procedure. Impact and implications: Split liver transplant(ation) (SLT) is still considered a challenging procedure and is by no means widely accepted. This study included all

Published
2023

3. The Italian data on SARS-CoV-2 infection in transplanted patients support an organ specific immune response in liver recipients

Author

Rendina, M, Barone, M, Lillo, C, Trapani, S, Masiero, L, Trerotoli, P, Puoti, F, Lupo, L, Tandoi, F, Agnes, S, Grieco, A, Andorno, E, Marenco, S, Giannini, E, Baccarani, U, Toniutto, P, Carraro, A, Colecchia, A, Cescon, M, Morelli, M, Cillo, U, Burra, P, Angeli, P, Colledan, M, Fagiuoli, S, De Carlis, L, Belli, L, De Simone, P, Carrai, P, Di Benedetto, F, De Maria, N, Ettorre, G, Giannelli, V, Gruttadauria, S, Volpes, R, Corsale, S, Mazzaferro, V, Bhoori, S, Romagnoli, R, Martini, S, Rossi, G, Caccamo, L, Donato, M, Rossi, M, Ginanni Corradini, S, Spada, M, Maggiore, G, Tisone, G, Lenci, I, Vennarecci, G, Tortora, R, Vivarelli, M, Svegliati Baroni, G, Zamboni, F, Mameli, L, Tafuri, S, Simone, S, Gesualdo, L, Cardillo, M, Di Leo, A, Rendina M., Barone M., Lillo C., Trapani S., Masiero L., Trerotoli P., Puoti F., Lupo L. G., Tandoi F., Agnes S., Grieco A., Andorno E., Marenco S., Giannini E. G., Baccarani U., Toniutto P., Carraro A., Colecchia A., Cescon M., Morelli M. C., Cillo U., Burra P., Angeli P., Colledan M., Fagiuoli S., De Carlis L., Belli L., De Simone P., Carrai P., Di Benedetto F., De Maria N., Ettorre G. M., Giannelli V., Gruttadauria S., Volpes R., Corsale S., Mazzaferro V., Bhoori S., Romagnoli R., Martini S., Rossi G., Caccamo L., Donato M. F., Rossi M., Ginanni Corradini S., Spada M., Maggiore G., Tisone G., Lenci I., Vennarecci G., Tortora R., Vivarelli M., Svegliati Baroni G., Zamboni F., Mameli L., Tafuri S., Simone S., Gesualdo L., Cardillo M., Di Leo A., Rendina, M, Barone, M, Lillo, C, Trapani, S, Masiero, L, Trerotoli, P, Puoti, F, Lupo, L, Tandoi, F, Agnes, S, Grieco, A, Andorno, E, Marenco, S, Giannini, E, Baccarani, U, Toniutto, P, Carraro, A, Colecchia, A, Cescon, M, Morelli, M, Cillo, U, Burra, P, Angeli, P, Colledan, M, Fagiuoli, S, De Carlis, L, Belli, L, De Simone, P, Carrai, P, Di Benedetto, F, De Maria, N, Ettorre, G, Giannelli, V, Gruttadauria, S, Volpes, R, Corsale, S, Mazzaferro, V, Bhoori, S, Romagnoli, R, Martini, S, Rossi, G, Caccamo, L, Donato, M, Rossi, M, Ginanni Corradini, S, Spada, M, Maggiore, G, Tisone, G, Lenci, I, Vennarecci, G, Tortora, R, Vivarelli, M, Svegliati Baroni, G, Zamboni, F, Mameli, L, Tafuri, S, Simone, S, Gesualdo, L, Cardillo, M, Di Leo, A, Rendina M., Barone M., Lillo C., Trapani S., Masiero L., Trerotoli P., Puoti F., Lupo L. G., Tandoi F., Agnes S., Grieco A., Andorno E., Marenco S., Giannini E. G., Baccarani U., Toniutto P., Carraro A., Colecchia A., Cescon M., Morelli M. C., Cillo U., Burra P., Angeli P., Colledan M., Fagiuoli S., De Carlis L., Belli L., De Simone P., Carrai P., Di Benedetto F., De Maria N., Ettorre G. M., Giannelli V., Gruttadauria S., Volpes R., Corsale S., Mazzaferro V., Bhoori S., Romagnoli R., Martini S., Rossi G., Caccamo L., Donato M. F., Rossi M., Ginanni Corradini S., Spada M., Maggiore G., Tisone G., Lenci I., Vennarecci G., Tortora R., Vivarelli M., Svegliati Baroni G., Zamboni F., Mameli L., Tafuri S., Simone S., Gesualdo L., Cardillo M., and Di Leo A.

Abstract

Introduction: The study of immune response to SARSCoV-2 infection in different solid organ transplant settings represents an opportunity for clarifying the interplay between SARS-CoV-2 and the immune system. In our nationwide registry study from Italy, we specifically evaluated, during the first wave pandemic, i.e., in non-vaccinated patients, COVID-19 prevalence of infection, mortality, and lethality in liver transplant recipients (LTRs), using non-liver solid transplant recipients (NL-SOTRs) and the Italian general population (GP) as comparators. Methods: Case collection started from February 21 to June 22, 2020, using the data from the National Institute of Health and National Transplant Center, whereas the data analysis was performed on September 30, 2020.To compare the sex- and age-adjusted distribution of infection, mortality, and lethality in LTRs, NL-SOTRs, and Italian GP we applied an indirect standardization method to determine the standardized rate. Results: Among the 43,983 Italian SOTRs with a functioning graft, LTRs accounted for 14,168 patients, of whom 89 were SARS-CoV-2 infected. In the 29,815 NL-SOTRs, 361 cases of SARS-CoV-2 infection were observed. The geographical distribution of the disease was highly variable across the different Italian regions. The standardized rate of infection, mortality, and lethality rates in LTRs resulted lower compared to NL-SOTRs [1.02 (95%CI 0.81-1.23) vs. 2.01 (95%CI 1.8-2.2); 1.0 (95%CI 0.5-1.5) vs. 4.5 (95%CI 3.6-5.3); 1.6 (95%CI 0.7-2.4) vs. 2.8 (95%CI 2.2-3.3), respectively] and comparable to the Italian GP. Discussion: According to the most recent studies on SOTRs and SARS-CoV-2 infection, our data strongly suggest that, in contrast to what was observed in NL-SOTRs receiving a similar immunosuppressive therapy, LTRs have the same risk of SARS-CoV-2 infection, mortality, and lethality observed in the general population. These results suggest an immune response to SARS-CoV-2 infection in LTRS that is different fr

Published
2023

4. Temporal trends of waitlistings for liver transplantation in Italy: The ECALITA (Evolution of IndiCAtion in LIver transplantation in ITAly) registry study

Author

Manzia, T, Trapani, S, Nardi, A, Ricci, A, Lenci, I, Milana, M, Angelico, R, De Feo, T, Agnes, S, Andorno, E, Baccarani, U, Carraro, A, Cescon, M, Cillo, U, Colledan, M, De Carlis, L, De Simone, P, Di Benedetto, F, Ettorre, G, Gruttadauria, S, Lupo, L, Mazzaferro, V, Romagnoli, R, Rossi, G, Rossi, M, Spada, M, Vennarecci, G, Vivarelli, M, Zamboni, F, Tisone, G, Cardillo, M, Angelico, M, Manzia T. M., Trapani S., Nardi A., Ricci A., Lenci I., Milana M., Angelico R., De Feo T. M., Agnes S., Andorno E., Baccarani U., Carraro A., Cescon M., Cillo U., Colledan M., De Carlis L., De Simone P., Di Benedetto F., Ettorre G. M., Gruttadauria S., Lupo L. G., Mazzaferro V., Romagnoli R., Rossi G., Rossi M., Spada M., Vennarecci G., Vivarelli M., Zamboni F., Tisone G., Cardillo M., Angelico M., Manzia, T, Trapani, S, Nardi, A, Ricci, A, Lenci, I, Milana, M, Angelico, R, De Feo, T, Agnes, S, Andorno, E, Baccarani, U, Carraro, A, Cescon, M, Cillo, U, Colledan, M, De Carlis, L, De Simone, P, Di Benedetto, F, Ettorre, G, Gruttadauria, S, Lupo, L, Mazzaferro, V, Romagnoli, R, Rossi, G, Rossi, M, Spada, M, Vennarecci, G, Vivarelli, M, Zamboni, F, Tisone, G, Cardillo, M, Angelico, M, Manzia T. M., Trapani S., Nardi A., Ricci A., Lenci I., Milana M., Angelico R., De Feo T. M., Agnes S., Andorno E., Baccarani U., Carraro A., Cescon M., Cillo U., Colledan M., De Carlis L., De Simone P., Di Benedetto F., Ettorre G. M., Gruttadauria S., Lupo L. G., Mazzaferro V., Romagnoli R., Rossi G., Rossi M., Spada M., Vennarecci G., Vivarelli M., Zamboni F., Tisone G., Cardillo M., and Angelico M.

Abstract

Background: Over the last decades relevant epidemiological changes of liver diseases have occurred, together with greatly improved treatment opportunities. Aim: To investigate how the indications for elective adult liver transplantation and the underlying disease etiologies have evolved in Italy. Methods: We recruited from the National Transplant Registry a cohort comprising 17,317 adults patients waitlisted for primary liver transplantation from January-2004 to December-2020. Patients were divided into three Eras:1(2004–2011),2(2012–2014) and 3(2015–2020). Results: Waitlistings for cirrhosis decreased from 65.9% in Era 1 to 46.1% in Era 3, while those for HCC increased from 28.7% to 48.7%. Comparing Eras 1 and 3, waitlistings for HCV-related cirrhosis decreased from 35.9% to 12.1%, yet those for HCV-related HCC increased from 8.5% to 26.7%. Waitlistings for HBV-related cirrhosis remained almost unchanged (13.2% and 12.4%), while those for HBV-related HCC increased from 4.0% to 11.6%. ALD-related cirrhosis decreased from 16.9% to 12.9% while ALD-related HCC increased from 1.9% to 3.9%. Conclusions: A sharp increase in liver transplant waitlisting for HCC and a concomitant decrease of waitlisting for cirrhosis have occurred In Italy. Despite HCV infection has noticeably decreased, still remains the primary etiology of waitlisting for HCC, while ALD and HBV represent the main causes for cirrhosis.

Published
2022

5. Migration rate using fully covered metal stent in anastomotic strictures after liver transplantation: Results from the BASALT study group

Author

Conigliaro, R, Pigo, F, Bertani, H, Greco, S, Burti, C, Indriolo, A, Di Sario, A, Ortolani, A, Maroni, L, Tringali, A, Barbaro, F, Costamagna, G, Magarotto, A, Masci, E, Mutignani, M, Forti, E, Parodi, M, Assandri, L, Marrone, C, Fantin, A, Penagini, R, Cantu, P, Di Benedetto, F, Ravelli, P, Vivarelli, M, Agnes, S, Mazzaferro, V, De Carlis, L, Andorno, E, Cillo, U, Rossi, G, Conigliaro R., Pigo F., Bertani H., Greco S., Burti C., Indriolo A., Di Sario A., Ortolani A., Maroni L., Tringali A., Barbaro F., Costamagna G., Magarotto A., Masci E., Mutignani M., Forti E., Parodi M. C., Assandri L., Marrone C., Fantin A., Penagini R., Cantu P., Di Benedetto F., Ravelli P., Vivarelli M., Agnes S., Mazzaferro V., De Carlis L., Andorno E., Cillo U., Rossi G., Conigliaro, R, Pigo, F, Bertani, H, Greco, S, Burti, C, Indriolo, A, Di Sario, A, Ortolani, A, Maroni, L, Tringali, A, Barbaro, F, Costamagna, G, Magarotto, A, Masci, E, Mutignani, M, Forti, E, Parodi, M, Assandri, L, Marrone, C, Fantin, A, Penagini, R, Cantu, P, Di Benedetto, F, Ravelli, P, Vivarelli, M, Agnes, S, Mazzaferro, V, De Carlis, L, Andorno, E, Cillo, U, Rossi, G, Conigliaro R., Pigo F., Bertani H., Greco S., Burti C., Indriolo A., Di Sario A., Ortolani A., Maroni L., Tringali A., Barbaro F., Costamagna G., Magarotto A., Masci E., Mutignani M., Forti E., Parodi M. C., Assandri L., Marrone C., Fantin A., Penagini R., Cantu P., Di Benedetto F., Ravelli P., Vivarelli M., Agnes S., Mazzaferro V., De Carlis L., Andorno E., Cillo U., and Rossi G.

Abstract

Background and Study Aim: The traditional endoscopic therapy of anastomotic strictures (AS) after orthotopic liver transplantation (OLT) is multiple ERCPs with the insertion of an increasing number of plastic stents side-by-side. Fully covered self-expanding metal stents (cSEMS) could be a valuable option to decrease the number of procedures needed or non-responders to plastic stents. This study aims to retrospectively analyse the results of AS endoscopic treatment by cSEMS and to identify any factors associated with its success. Patients and Methods: Ninety-one patients (mean age 55.9 ± 7.6 SD; 73 males) from nine Italian transplantation centres, had a cSEMS positioned for post-OLT-AS between 2007 and 2017. Forty-nine (54%) patients were treated with cSEMS as a second-line treatment. Results: All the procedures were successfully performed without immediate complications. After ERCP, adverse events occurred in 11% of cases (2 moderate pancreatitis and 8 cholangitis). In 49 patients (54%), cSEMSs migrated. After cSEMS removal, 46 patients (51%) needed further endoscopic (45 patients) or radiological (1 patient) treatments to solve the AS. Lastly, seven patients underwent surgery. Multivariable stepwise logistic regression showed that cSEMS migration was the only factor associated with further treatments (OR 2.6, 95% CI 1.0–6.6; p value 0.03); cSEMS implantation before 12 months from OLT was associated with stent migration (OR 5.2, 95% CI 1.7–16.0; p value 0.004). Conclusions: cSEMS appears to be a safe tool to treat AS. cSEMS migration is the main limitation to its routinary implantation and needs to be prevented, probably with the use of new generation anti-migration stents.

Published
2022

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

Author

De Carlis, R, Lauterio, A, Centonze, L, Buscemi, V, Schlegel, A, Muiesan, P, De Carlis, L, Carraro, A, Ghinolfi, D, De Simone, P, Ravaioli, M, Cescon, M, Dondossola, D, Bongini, M, Mazzaferro, V, Pagano, D, Gruttadauria, S, Gringeri, E, Cillo, U, Patrono, D, Romagnoli, R, Camagni, S, Colledan, M, Olivieri, T, Di Benedetto, F, Vennarecci, G, Baccarani, U, Lai, Q, Rossi, M, Manzia, T, Tisone, G, Vivarelli, M, Scalera, I, Lupo, L, Andorno, E, Meniconi, R, Ettorre, G, Avolio, A, Agnes, S, Pellegrino, R, Zamboni, F, De Carlis R., Lauterio A., Centonze L., Buscemi V., Schlegel A., Muiesan P., De Carlis L., Carraro A., Ghinolfi D., De Simone P., Ravaioli M., Cescon M., Dondossola D., Bongini M., Mazzaferro V., Pagano D., Gruttadauria S., Gringeri E., Cillo U., Patrono D., Romagnoli R., Camagni S., Colledan M., Olivieri T., Di Benedetto F., Vennarecci G., Baccarani U., Lai Q., Rossi M., Manzia T. M., Tisone G., Vivarelli M., Scalera I., Lupo L. G., Andorno E., Meniconi R. L., Ettorre G. M., Avolio A. W., Agnes S., Pellegrino R. A., Zamboni F., De Carlis, R, Lauterio, A, Centonze, L, Buscemi, V, Schlegel, A, Muiesan, P, De Carlis, L, Carraro, A, Ghinolfi, D, De Simone, P, Ravaioli, M, Cescon, M, Dondossola, D, Bongini, M, Mazzaferro, V, Pagano, D, Gruttadauria, S, Gringeri, E, Cillo, U, Patrono, D, Romagnoli, R, Camagni, S, Colledan, M, Olivieri, T, Di Benedetto, F, Vennarecci, G, Baccarani, U, Lai, Q, Rossi, M, Manzia, T, Tisone, G, Vivarelli, M, Scalera, I, Lupo, L, Andorno, E, Meniconi, R, Ettorre, G, Avolio, A, Agnes, S, Pellegrino, R, Zamboni, F, De Carlis R., Lauterio A., Centonze L., Buscemi V., Schlegel A., Muiesan P., De Carlis L., Carraro A., Ghinolfi D., De Simone P., Ravaioli M., Cescon M., Dondossola D., Bongini M., Mazzaferro V., Pagano D., Gruttadauria S., Gringeri E., Cillo U., Patrono D., Romagnoli R., Camagni S., Colledan M., Olivieri T., Di Benedetto F., Vennarecci G., Baccarani U., Lai Q., Rossi M., Manzia T. M., Tisone G., Vivarelli M., Scalera I., Lupo L. G., Andorno E., Meniconi R. L., Ettorre G. M., Avolio A. W., Agnes S., Pellegrino R. A., and Zamboni F.

Abstract

Background: Normothermic regional perfusion (NRP) and machine perfusion (MP) are variously used in many European centers to improve the outcomes after liver transplantation from donation after circulatory death (DCD). In Italy, a combination of NRP and subsequent MP has been used since the start of the activity. While NRP is mandatory for every DCD recovery, the subsequent use of MP is left to each center. Methods: We have designed a national survey to investigate practices and policies of these techniques. The questionnaire included 46 questions and was distributed to all the 21 Italian centers using an online form between June and July 2021. Results: The overall response rate was 100%. A local NRP program for controlled Maastricht type 3 DCD was active in 11/21 (52.4%) centers. Organization and availability of personnel were perceived as the main difficulties in starting such a program. Between 2015 and 2020, 119 DCD livers were transplanted, with an overall utilization rate of 69.2%. Pump flow and gross aspect were considered the most reliable parameters in liver selection during NRP. Eight (72.7%) centers adopted subsequent hypothermic MP, 1 (9.1%) center normothermic MP, and the remaining 2 (18.2%) used both MP types. Conclusion: This first snapshot survey shows that NRP with subsequent MP is the most used protocol in Italy for DCD livers, although some heterogeneity exists in the type and purpose of MP between centers. Overall, this policy ensures a high utilization rate, considering the high risk of the DCD donor population in Italy. Graphical abstract: [Figure not available: see fulltext.]

Published
2022

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

Author

Centonze, L, Vella, I, Morelli, F, Checchini, G, De Carlis, R, Rampoldi, A, Lauterio, A, Andorno, E, De Carlis, L, Centonze L., Vella I., Morelli F., Checchini G., De Carlis R., Rampoldi A., Lauterio A., Andorno E., De Carlis L., Centonze, L, Vella, I, Morelli, F, Checchini, G, De Carlis, R, Rampoldi, A, Lauterio, A, Andorno, E, De Carlis, L, Centonze L., Vella I., Morelli F., Checchini G., De Carlis R., Rampoldi A., Lauterio A., Andorno E., and De Carlis L.

Abstract

A 34-year-old patient underwent liver transplantation for progressive hepatic failure in the setting of congenital hepatic fibrosis. In past medical history, the patient had undergone splenectomy with proximal Linton’s splenorenal surgical shunt creation for symptomatic portal hypertension with hypersplenism. The patient developed an early allograft dysfunction, with radiologic evidence of a reduced portal flow associated to portal steal from the patent surgical shunt. The patient was successfully treated through endovascular placement of a 30 mm Amplatzer cardiac plug at the origin of the splenic vein.

Published
2022

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

Author

De Carlis, R., Lauterio, A., Centonze, L., Buscemi, V., Schlegel, A., Muiesan, P., De Carlis, L., Carraro, A., Ghinolfi, D., De Simone, P., Ravaioli, M., Cescon, M., Dondossola, D., Bongini, M., Mazzaferro, V., Pagano, D., Gruttadauria, S., Gringeri, E., Cillo, U., Patrono, D., Romagnoli, R., Camagni, S., Colledan, M., Olivieri, T., Di Benedetto, F., Vennarecci, G., Baccarani, U., Lai, Q., Rossi, M., Manzia, T. M., Tisone, G., Vivarelli, M., Scalera, I., Lupo, L. G., Andorno, E., Meniconi, R. L., Ettorre, G. M., Avolio, A. W., Agnes, S., Pellegrino, R. A., Zamboni, F., De Carlis, R, Lauterio, A, Centonze, L, Buscemi, V, Schlegel, A, Muiesan, P, De Carlis, L, Carraro, A, Ghinolfi, D, De Simone, P, Ravaioli, M, Cescon, M, Dondossola, D, Bongini, M, Mazzaferro, V, Pagano, D, Gruttadauria, S, Gringeri, E, Cillo, U, Patrono, D, Romagnoli, R, Camagni, S, Colledan, M, Olivieri, T, Di Benedetto, F, Vennarecci, G, Baccarani, U, Lai, Q, Rossi, M, Manzia, T, Tisone, G, Vivarelli, M, Scalera, I, Lupo, L, Andorno, E, Meniconi, R, Ettorre, G, Avolio, A, Agnes, S, Pellegrino, R, and Zamboni, F

Subjects
Warm ischemia, Hypothermic oxygenated perfusion, Ischemic-type biliary lesions, Liver preservation, Liver utilization, Graft Survival, Organ Preservation, Ischemic-type biliary lesion, Tissue Donors, Settore MED/18, Liver Transplantation, Perfusion, Humans, Surgery
Abstract

Background: Normothermic regional perfusion (NRP) and machine perfusion (MP) are variously used in many European centers to improve the outcomes after liver transplantation from donation after circulatory death (DCD). In Italy, a combination of NRP and subsequent MP has been used since the start of the activity. While NRP is mandatory for every DCD recovery, the subsequent use of MP is left to each center. Methods: We have designed a national survey to investigate practices and policies of these techniques. The questionnaire included 46 questions and was distributed to all the 21 Italian centers using an online form between June and July 2021. Results: The overall response rate was 100%. A local NRP program for controlled Maastricht type 3 DCD was active in 11/21 (52.4%) centers. Organization and availability of personnel were perceived as the main difficulties in starting such a program. Between 2015 and 2020, 119 DCD livers were transplanted, with an overall utilization rate of 69.2%. Pump flow and gross aspect were considered the most reliable parameters in liver selection during NRP. Eight (72.7%) centers adopted subsequent hypothermic MP, 1 (9.1%) center normothermic MP, and the remaining 2 (18.2%) used both MP types. Conclusion: This first snapshot survey shows that NRP with subsequent MP is the most used protocol in Italy for DCD livers, although some heterogeneity exists in the type and purpose of MP between centers. Overall, this policy ensures a high utilization rate, considering the high risk of the DCD donor population in Italy. Graphical abstract: [Figure not available: see fulltext.]

Published
2022

9. Preliminary Analysis of the Impact of COVID-19 Outbreak on Italian Liver Transplant Programs

Author

Agnes, S, Andorno, E, Avolio, A, Baccarani, U, Carraro, A, Cescon, M, Cillo, U, Colledan, M, De Carlis, L, De Simone, P, De Ville De Goyet, J, Di Benedetto, F, Ettorre, G, Gringeri, E, Gruttadauria, S, Lupo, L, Mazzaferro, V, Regalia, E, Romagnoli, R, Rossi, G, Rossi, M, Spada, M, Tisone, G, Vennarecci, G, Vivarelli, M, Zamboni, F, Boggi, U, Agnes S., Andorno E., Avolio A. W., Baccarani U., Carraro A., Cescon M., Cillo U., Colledan M., De Carlis L., De Simone P., De Ville De Goyet J., Di Benedetto F., Ettorre G. M., Gringeri E., Gruttadauria S., Lupo L. G., Mazzaferro V., Regalia E., Romagnoli R., Rossi G. E., Rossi M., Spada M., Tisone G., Vennarecci G., Vivarelli M., Zamboni F., Boggi U., Agnes, S, Andorno, E, Avolio, A, Baccarani, U, Carraro, A, Cescon, M, Cillo, U, Colledan, M, De Carlis, L, De Simone, P, De Ville De Goyet, J, Di Benedetto, F, Ettorre, G, Gringeri, E, Gruttadauria, S, Lupo, L, Mazzaferro, V, Regalia, E, Romagnoli, R, Rossi, G, Rossi, M, Spada, M, Tisone, G, Vennarecci, G, Vivarelli, M, Zamboni, F, Boggi, U, Agnes S., Andorno E., Avolio A. W., Baccarani U., Carraro A., Cescon M., Cillo U., Colledan M., De Carlis L., De Simone P., De Ville De Goyet J., Di Benedetto F., Ettorre G. M., Gringeri E., Gruttadauria S., Lupo L. G., Mazzaferro V., Regalia E., Romagnoli R., Rossi G. E., Rossi M., Spada M., Tisone G., Vennarecci G., Vivarelli M., Zamboni F., and Boggi U.

Abstract

Liver Transplant Programs in Italy have faced a sequela of management and clinical decision-making problems due to the high incidence in some regions of the country of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). The Italian Society for Organ Transplantation (SITO) and the Board of Liver Transplant Program Directors issued a survey to assess the initial impact of this pandemic event on the routine activity of 22 Italian Liver Transplant Programs. One hundred percent of participants completed the survey within a few days. The analysis is presented dividing the centers in two macro-areas: north-central Italy and south-central Italy. The reason for this is that the two areas had a different incidence of the infection and because they have distinctive rates of cadaveric donation. Overall, all centers remained open although a reduction in the activity was noted. Transplant Programs reduced their outpatient activity both in terms of pre-transplant evaluation (68% of the centers) and transplant recipient follow-up (100%); a reduction in transplant activity was observed in the first two weeks of March only in the north-central macro area (23 LTs vs 39 in 2018 and 60 in 2019); overall, SARS-CoV-2 infection was registered for 24 liver transplant recipients and 37 health care providers in liver transplant units. In the perspective of the increasing magnitude of the epidemic, more data will be required to define appropriate strategies for the increasingly complex management of liver transplant patients.

Published
2020

11. SARS-CoV-2 infection in liver transplantation is associated with favorable outcomes: an Italian transplant registry study

Author

Rendina, M., primary, Barone, M., additional, Trapani, S., additional, Masiero, L., additional, Trerotoli, P., additional, Puoti, F., additional, Lupo, L.G., additional, Agnes, S., additional, Grieco, A., additional, Andorno, E., additional, Marenco, S., additional, Baccarani, U., additional, Toniutto, P., additional, Carraro, A., additional, Colecchia, A., additional, Cescon, M., additional, Morelli, M.C., additional, Cillo, U., additional, Burra, P., additional, Angeli, P., additional, Colledan, M., additional, Fagiuoli, S., additional, De Carlis, L., additional, Belli, L., additional, De Simone, P., additional, Carrai, P., additional, Di Benedetto, F., additional, De Maria, N., additional, Ettorre, G.M., additional, Giannelli, V., additional, Gruttadauria, S., additional, Volpes, R., additional, Mazzaferro, V., additional, Bhoori, S., additional, Romagnoli, R., additional, Martini, S., additional, Rossi, G., additional, Donato, F., additional, Rossi, M., additional, Ginanni Corradini, S., additional, Spada, M., additional, Maggiore, G., additional, Tisone, G., additional, Lenci, I., additional, Vennarecci, G., additional, Di Costanzo, G.G., additional, Vivarelli, M., additional, Svegliati Baroni, G., additional, Zamboni, F. o, additional, Mameli, L., additional, Tafuri, S., additional, Simone, S., additional, Gesualdo, L., additional, Cardillo, M., additional, and Di Leo, A., additional

Published
2022
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13. A national mandatory-split liver policy: A report from the Italian experience

Author

Angelico, R, Trapani, S, Spada, M, Colledan, M, de Ville de Goyet, J, Salizzoni, M, De Carlis, L, Andorno, E, Gruttadauria, S, Ettorre, G, Cescon, M, Rossi, G, Risaliti, A, Tisone, G, Tedeschi, U, Vivarelli, M, Agnes, S, De Simone, P, Lupo, L, Di Benedetto, F, Santaniello, W, Zamboni, F, Mazzaferro, V, Rossi, M, Puoti, F, Camagni, S, Grimaldi, C, Gringeri, E, Rizzato, L, Nanni Costa, A, Cillo, U, Angelico R., Trapani S., Spada M., Colledan M., de Ville de Goyet J., Salizzoni M., De Carlis L., Andorno E., Gruttadauria S., Ettorre G. M., Cescon M., Rossi G., Risaliti A., Tisone G., Tedeschi U., Vivarelli M., Agnes S., De Simone P., Lupo L. G., Di Benedetto F., Santaniello W., Zamboni F., Mazzaferro V., Rossi M., Puoti F., Camagni S., Grimaldi C., Gringeri E., Rizzato L., Nanni Costa A., Cillo U., Angelico, R, Trapani, S, Spada, M, Colledan, M, de Ville de Goyet, J, Salizzoni, M, De Carlis, L, Andorno, E, Gruttadauria, S, Ettorre, G, Cescon, M, Rossi, G, Risaliti, A, Tisone, G, Tedeschi, U, Vivarelli, M, Agnes, S, De Simone, P, Lupo, L, Di Benedetto, F, Santaniello, W, Zamboni, F, Mazzaferro, V, Rossi, M, Puoti, F, Camagni, S, Grimaldi, C, Gringeri, E, Rizzato, L, Nanni Costa, A, Cillo, U, Angelico R., Trapani S., Spada M., Colledan M., de Ville de Goyet J., Salizzoni M., De Carlis L., Andorno E., Gruttadauria S., Ettorre G. M., Cescon M., Rossi G., Risaliti A., Tisone G., Tedeschi U., Vivarelli M., Agnes S., De Simone P., Lupo L. G., Di Benedetto F., Santaniello W., Zamboni F., Mazzaferro V., Rossi M., Puoti F., Camagni S., Grimaldi C., Gringeri E., Rizzato L., Nanni Costa A., and Cillo U.

Abstract

To implement split liver transplantation (SLT) a mandatory-split policy has been adopted in Italy since August 2015: donors aged 18-50 years at standard risk are offered for SLT, resulting in a left-lateral segment (LLS) graft for children and an extended-right graft (ERG) for adults. We aim to analyze the impact of the new mandatory-split policy on liver transplantation (LT)-waiting list and SLT outcomes, compared to old allocation policy. Between August 2015 and December 2016 out of 413 potentially “splittable” donors, 252 (61%) were proposed for SLT, of whom 53 (21%) donors were accepted for SLT whereas 101 (40.1%) were excluded because of donor characteristics and 98 (38.9%) for absence of suitable pediatric recipients. The SLT rate augmented from 6% to 8.4%. Children undergoing SLT increased from 49.3% to 65.8% (P =.009) and the pediatric LT-waiting list time dropped (229 [10-2121] vs 80 [12-2503] days [P =.045]). The pediatric (4.5% vs 2.5% [P =.398]) and adult (9.7% to 5.2% [P <.001]) LT-waiting list mortality reduced; SLT outcomes remained stable. Retransplantation (HR = 2.641, P =.035) and recipient weight >20 kg (HR = 5.113, P =.048) in LLS, and ischemic time >8 hours (HR = 2.475, P =.048) in ERG were identified as predictors of graft failure. A national mandatory-split policy maximizes the SLT donor resources, whose selection criteria can be safely expanded, providing favorable impact on the pediatric LT-waiting list and priority for adult sick LT candidates.

Published
2019

18. Successful Transplant of a Liver Graft After Giant Hepatic Artery Aneurysm Resection and Reconstruction

Author

De Carlis, R, Andorno, E, Buscemi, V, Lauterio, A, Diviacco, P, Di Sandro, S, De Carlis, L, De Carlis, Riccardo, Andorno, Enzo, Buscemi, Vincenzo, Lauterio, Andrea, Diviacco, Pietro, Di Sandro, Stefano, De Carlis, Luciano, De Carlis, R, Andorno, E, Buscemi, V, Lauterio, A, Diviacco, P, Di Sandro, S, De Carlis, L, De Carlis, Riccardo, Andorno, Enzo, Buscemi, Vincenzo, Lauterio, Andrea, Diviacco, Pietro, Di Sandro, Stefano, and De Carlis, Luciano

Abstract

The shortage of organs has pushed transplant surgeons to accept liver grafts with extended criteria, but severe vascular abnormalities may still discourage the use of otherwise acceptable organs. We report herein the case of a liver graft with a 64-mm aneurysm of the proper hepatic artery extended to the origin of the right and left hepatic branches. The graft was deemed unsuitable for transplant by all other centers in the region. However, liver function tests were normal, and there was no evidence of compromised arterial supply. At back table, we resected the aneurysm and anastomosed the right and left hepatic arteries to a vascular graft obtained from the distal tract of the donor's superior mesenteric artery. After portal reperfusion, we anastomosed the mesenteric graft to the recipient's hepatic artery at the origin of the gastroduodenal artery. The postoperative course and the subsequent 6-month follow-up were uneventful. In conclusion, the presence of a hepatic artery aneurysm should not be an absolute contraindication to the use of a liver graft. The present case emphasizes the possibility to utilize an organ that would have been otherwise discarded.

Published
2020

19. Preliminary Analysis of the Impact of COVID-19 Outbreak on Italian Liver Transplant Programs.

Author

Agnes, Salvatore, Andorno, E, Avolio, Alfonso Wolfango, Baccarani, U, Carraro, A, Cescon, M, Cillo, U, Colledan, M, De Carlis, L, De Simone, P, De Ville De Goyet, J, Di Benedetto, F, Ettorre, Gm, Gringeri, E, Gruttadauria, S, Lupo, Lg, Mazzaferro, V, Regalia, E, Romagnoli, R, Rossi, Ge, Rossi, M, Spada, M, Tisone, G, Vennarecci, G, Vivarelli, M, Zamboni, F, Boggi, U., Agnes S (ORCID:0000-0002-3341-4221), Avolio AW (ORCID:0000-0003-2491-7625), Agnes, Salvatore, Andorno, E, Avolio, Alfonso Wolfango, Baccarani, U, Carraro, A, Cescon, M, Cillo, U, Colledan, M, De Carlis, L, De Simone, P, De Ville De Goyet, J, Di Benedetto, F, Ettorre, Gm, Gringeri, E, Gruttadauria, S, Lupo, Lg, Mazzaferro, V, Regalia, E, Romagnoli, R, Rossi, Ge, Rossi, M, Spada, M, Tisone, G, Vennarecci, G, Vivarelli, M, Zamboni, F, Boggi, U., Agnes S (ORCID:0000-0002-3341-4221), and Avolio AW (ORCID:0000-0003-2491-7625)

Abstract

Liver Transplant Programs in Italy have faced a sequela of management and clinical decisionmaking problems due to the high incidence in some regions of the country of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). The Italian Society for Organ Transplantation (SITO) and the Board of Liver Transplant Program Directors issued a survey to assess the initial impact of this pandemic event on the routine activity of 22 Italian Liver Transplant Programs. One hundred percent of participants completed the survey within a few days. The analysis is presented dividing the centers in two macro-areas: north-central Italy and south-central Italy. The reason for this is that the two areas had a different incidence of the infection and because they have distinctive rates of cadaveric donation. Overall, all centers remained open although a reduction in the activity was noted. Transplant Programs reduced their outpatient activity both in terms of pre-transplant evaluation (68% of the centers) and transplant recipient follow-up (100%); a reduction in transplant activity was observed in the first two weeks of March only in the north-central macro area (23 LTs vs 39 in 2018 and 60 in 2019); overall, SARS-CoV-2 infection was registered for 24 liver transplant recipients and 37 health care providers in liver transplant units. In the perspective of the increasing magnitude of the epidemic, more data will be required to define appropriate strategies for the increasingly complex management of liver transplant patients.

Published
2020

30. Liver Grafts From Donors After Circulatory Death on Regional Perfusion With Extended Warm Ischemia Compared With Donors After Brain Death

Author

De Carlis, R, Di Sandro, S, Lauterio, A, Botta, F, Ferla, F, Andorno, E, Bagnardi, V, De Carlis, L, De Carlis, Riccardo, Di Sandro, Stefano, Lauterio, Andrea, Botta, Francesca, Ferla, Fabio, Andorno, Enzo, Bagnardi, Vincenzo, De Carlis, Luciano, De Carlis, R, Di Sandro, S, Lauterio, A, Botta, F, Ferla, F, Andorno, E, Bagnardi, V, De Carlis, L, De Carlis, Riccardo, Di Sandro, Stefano, Lauterio, Andrea, Botta, Francesca, Ferla, Fabio, Andorno, Enzo, Bagnardi, Vincenzo, and De Carlis, Luciano

Abstract

Donation after circulatory death (DCD) in Italy constitutes a relatively unique population because of the requirement of a no-touch period of 20 minutes. The first aim of this study was to compare liver transplantations from donors who were maintained on normothermic regional perfusion after circulatory death and suffered extended warm ischemia (DCD group, n = 20) with those from donors who were maintained on extracorporeal membrane oxygenation (ECMO) and succumbed to brain death (ECMO group, n = 17) and those from standard donors after brain death (donation after brain death [DBD] group, n = 52). Second, we conducted an explorative analysis on the DCD group to identify relationships between the donor characteristics and the transplant outcomes. The 1-year patient survival for the DCD group (95%) was not significantly different from that of the ECMO group (87%; P = 0.47) or the DBD group (94%; P = 0.94). Graft survival was slightly inferior in the DCD group (85%) because of a high rate of primary nonfunction (10%) and retransplantation (15%) but was not significantly different from the ECMO group (87%; P = 0.76) or the DBD group (91%; P = 0.20). Although ischemic cholangiopathy was more frequent in the DCD group (10%), this issue did not adversely impact graft survival because none of the recipients underwent retransplantation due to biliary complications. Moreover, the DCD recipients were more likely to develop posttransplant renal dysfunction with the need for renal replacement therapy. Further analysis of the DCD group showed that warm ischemia >125 minutes and an Ishak fibrosis score of 1 at liver biopsy negatively impacted serum creatinine and alanine transaminase levels in the first posttransplant week, respectively. In conclusion, our findings encourage the use of liver grafts from DCD donors maintained by regional perfusion after proper selection.

Published
2018

31. Split liver technique with middle hepatic vein reconstruction on livers from transplant hepatectomies: a useful tool for surgical improvement

Author

Sguinzi, R, Ferla, F, De Carlis, R, Andorno, E, Aseni, P, De Carlis, L, Sguinzi, R, Ferla, F, De Carlis, R, Andorno, E, Aseni, P, and De Carlis, L

Abstract

Livers removed during transplant hepatectomies could represent a useful anatomic ex vivo resource for surgical training, since they are intact and not altered by post-mortem changes yet. The aim of this study is to investigate the effectiveness of such kind of surgical training applied on some hepatic surgery techniques. In the present paper, we focused on split liver operation and middle hepatic vein (MHV) bipartition/reconstruction, since these procedures have a quite long learning curve. Seven native livers were submitted to split liver procedure by a senior resident assisted by a fully trained hepatic surgeon. Pre-splitting ultrasound mapping was compared to pre-operative CT scan. The whole graft was divided into two hemi-livers and the MHV into two hemi-confluents and reconstructed by venous or arterial patches obtained by deceased donor iliac homograft. Water tightness of the anastomosis was confirmed by hydro-pneumatic test and bench portal perfusion. Reduction in operating time was considered an indirect indicator of surgical skill improvement. In all cases, the US confirmed the anatomical distribution of MHV tributaries observed by pre-transplant CT scan. The "ex situ" splitting procedures and MHV bipartition and reconstruction were performed in all native livers in the usual time required for liver transplantation bench surgery (range 50-75 min). Liver grafts removed during hepatectomy could represent a useful resource of intact organs to perform surgical training and boost surgical confidence. In our initial experience, the study of venous drainage of the MHV and application of liver splitting technique and MHV reconstruction resulted technically feasible

Published
2018

34. Split-liver full-left full-right: Proposal for an operative protocol (Transplantation Proceedings (2014) 46:7 (2279-2282)) Erratum

Author

Ferla, F, Lauterio, A, Di Sandro, S, Mangoni, I, Poli, C, Concone, G, Cusumano, C, Giacomoni, A, Andorno, E, De Carlis, L, Ferla, F., Lauterio, A., Di Sandro, S., Mangoni, I., Poli, C., Concone, G., Cusumano, C., Giacomoni, A., Andorno, E., De Carlis, L., Ferla, F, Lauterio, A, Di Sandro, S, Mangoni, I, Poli, C, Concone, G, Cusumano, C, Giacomoni, A, Andorno, E, De Carlis, L, Ferla, F., Lauterio, A., Di Sandro, S., Mangoni, I., Poli, C., Concone, G., Cusumano, C., Giacomoni, A., Andorno, E., and De Carlis, L.

Published
2014

35. Split-liver full-left full-right: Proposal for an operative protocol (Transplantation Proceedings (2014) 46:7 (2279-2282)) Erratum

Author

Ferla, F., Ferla, F, Lauterio, A, Di Sandro, S, Mangoni, I, Poli, C, Concone, G, Cusumano, C, Giacomoni, A, Andorno, E, De Carlis, L, Ferla, F., Lauterio, A., Di Sandro, S., Mangoni, I., Poli, C., Concone, G., Cusumano, C., Giacomoni, A., Andorno, E., De Carlis, L., Ferla, F., Ferla, F, Lauterio, A, Di Sandro, S, Mangoni, I, Poli, C, Concone, G, Cusumano, C, Giacomoni, A, Andorno, E, De Carlis, L, Ferla, F., Lauterio, A., Di Sandro, S., Mangoni, I., Poli, C., Concone, G., Cusumano, C., Giacomoni, A., Andorno, E., and De Carlis, L.

Published
2014

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

Author

Ross, M, Cescon, M, Angelico, R, Andorno, E, Rossi, G, Pinna, A, De Carlis, L, Baccarani, U, Cillo, U, Colledan, M, Mazzaferro, V, Tisone, G, Rossi, M, Tuzzolino, F, Pagano, D, Gruttadauria, S, Mazariegos, G, Gridelli, B, Spada, M, Ross, MW, Ross, M, Cescon, M, Angelico, R, Andorno, E, Rossi, G, Pinna, A, De Carlis, L, Baccarani, U, Cillo, U, Colledan, M, Mazzaferro, V, Tisone, G, Rossi, M, Tuzzolino, F, Pagano, D, Gruttadauria, S, Mazariegos, G, Gridelli, B, Spada, M, and Ross, MW

Abstract

Split-liver transplantation has been proposed as an alternative to whole liver (WL) transplantation to expand the donor pool, but studies comparing adult longterm outcomes between the 2 methods are conflicting and limited. This is the first Italian multicenter study that retrospectively analyzed 119 matched-pair recipients of whole and extended right grafts (ERGs) for longterm survival outcomes. In the overall population, WL recipients showed higher patient survival at 1 (93% versus 73%), 5 (87% versus 65%), and 10 years (83% versus 60%) after transplantation compared with split-liver recipients (P < 0.001); graft survivals of WL recipients were also superior at 1 (90% versus 76%), 5 (84% versus 57%), and 10 years (81% versus 52%) posttransplant (P < 0.001). However, among the 81 matched pairs that survived the first posttransplant year, 5- and 10-year patient survivals were 90% and 81% for split recipients and 99% and 96% for whole recipients, respectively (P = 0.34). The 5- and 10-year graft survivals were also comparable: 87% and 77% for split recipients, and 86% and 82% for whole recipients (P = 0.86). Cox regression analysis identified donor age >50, donor-to-recipient weight ratio < 1, retransplantation status, and United Network for Organ Sharing I-IIA status as risk factors for partial graft use. There were no significant differences in 5-year outcomes based on center volume. In conclusion, we demonstrate that adult liver transplantation with ERGs can achieve longterm success comparable with that of whole grafts in appropriate patients but should be selectively used in patients with risk factors. Liver Transplantation 23 1384–1395 2017 AASLD.

Published
2017

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

Author

Vitale, A, Volk, Ml, De Feo TM, Burra, P, Frigo, Ac, Ramirez Morales, R, De Carlis, L, Belli, L, Colledan, M, Fagiuoli, S, Rossi, G, Andorno, E, Baccarani, U, Regalia, E, Vivarelli, M, Donataccio, M, Russo, Fp, Angeli, P, for Liver Transplantation North Italy Transplant program (NITp) working group, Cillo, U., Vitale, A, Volk, M, De Feo, T, Burra, P, Frigo, A, Ramirez Morales, R, DE CARLIS, L, Belli, L, Colledan, M, Fagiuoli, S, Rossi, G, Andorno, E, Baccarani, U, Regalia, E, Vivarelli, M, Donataccio, M, and Cillo, U

Subjects
Adult, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Tissue and Organ Procurement, Waiting Lists, Hepatocellular carcinoma, medicine.medical_treatment, Liver transplantation, Gastroenterology, Severity of Illness Index, End Stage Liver Disease, Liver disease, Model for End-Stage Liver Disease, Interquartile range, Internal medicine, Medicine, Humans, Proportional Hazards Models, Cirrhosi, Hepatology, Surgical oncology, Cirrhosis, Clinical decision making, business.industry, Proportional hazards model, Hazard ratio, Liver Neoplasms, Transplant Waiting List, Middle Aged, medicine.disease, digestive system diseases, Markov Chains, Italy, Female, business, Monte Carlo Method
Abstract

Background & Aims:The current organ allocation system for liver transplantation (LT) creates an imbalance between patients with and without hepatocellular carcinoma (HCC). We describe a model designed to re-establish allocation equity among patient groups using transplant benefit as the common endpoint. Methods:We enrolled consecutive adult patients entering the waiting list (WL group, n = 2697) and undergoing LT (LT group, n = 1702) during the period 2004‐2009 in the North Italy Transplant program area. Independent multivariable regressions (WL and LT models) were created for patients without HCC and for those with stage T2 HCC. Monte Carlo simulation was used to create distributions of transplant benefit, and covariates such as Model for End-stage Liver Disease (MELD) and alpha-fetoprotein (AFP) were combined in regression equations. These equations were then calibrated to create an ‘‘MELD equivalent’’ which matches HCC patients to non-HCC patients having the same numerical MELD score. Results:Median 5 year transplant benefit was 15.12 months (8.75‐25.35) for the non-HCC patients, and 28.18 months (15.11‐36.38) for the T2-HCC patients (p

Published
2014

40. Extended Right Grafts from Split Livers: Are They Still Marginal Grafts?

Author

Maggi, U, De Feo, T, Andorno, E, Cillo, U, De Carlis, L, Colledan, M, De Fazio, N, Rossi, G, Maggi U, De Feo T, Andorno E, Cillo U, De Carlis L, Colledan M, De Fazio N, Rossi G, Maggi, U, De Feo, T, Andorno, E, Cillo, U, De Carlis, L, Colledan, M, De Fazio, N, Rossi, G, Maggi U, De Feo T, Andorno E, Cillo U, De Carlis L, Colledan M, De Fazio N, and Rossi G

Published
2013

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

Author

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

Published
2013

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

Author

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

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

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

Published
2013

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

Author

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

Subjects
Transplantation, Surgery
Published
2013

45. LIVER TRANSPLANTATION IN PATIENTS IN UNOS STATUS 1: OUTCOME OF 419 TRANSPLANTATIONS IN THE NORTH ITALY TRANSPLANT PROGRAM

Author

De Feo, T, De Fazio, N, Andorno, E, Baccarani, U, Cillo, U, Colledan, M, De Carlis, L, Donataccio, M, Regalia, E, Risaliti, A, Rossi, G, Procaccio, F, Scalamogna, M, De Feo TM, De Fazio N, Andorno E, Baccarani U, Cillo U, Colledan M, De Carlis L, Donataccio M, Regalia E, Risaliti A, Rossi G, Procaccio F, Scalamogna M, De Feo, T, De Fazio, N, Andorno, E, Baccarani, U, Cillo, U, Colledan, M, De Carlis, L, Donataccio, M, Regalia, E, Risaliti, A, Rossi, G, Procaccio, F, Scalamogna, M, De Feo TM, De Fazio N, Andorno E, Baccarani U, Cillo U, Colledan M, De Carlis L, Donataccio M, Regalia E, Risaliti A, Rossi G, Procaccio F, and Scalamogna M

Published
2009

46. Results of a 10-year multicenter experience in split-liver transplantation in an Italian transplant program

Author

De Feo, T, Colledan, M, Andorno, E, DE CARLIS, L, Cillo, U, Rossi, G, Baccarani, U, Regalia, E, Donataccio, M, Risaliti, A, Guizzetti, M, Pinelli, D, Slim, A, Brolese, A, Testasecca, D, Torelli, R, Scalamogna, M, De Feo TM, Colledan M, Andorno E, De Carlis LG, Cillo U, Rossi G, Baccarani U, Regalia E, Donataccio M, Risaliti A, Guizzetti M, Pinelli D, Slim A, Brolese A, Testasecca D, Torelli R, Scalamogna M, De Feo, T, Colledan, M, Andorno, E, DE CARLIS, L, Cillo, U, Rossi, G, Baccarani, U, Regalia, E, Donataccio, M, Risaliti, A, Guizzetti, M, Pinelli, D, Slim, A, Brolese, A, Testasecca, D, Torelli, R, Scalamogna, M, De Feo TM, Colledan M, Andorno E, De Carlis LG, Cillo U, Rossi G, Baccarani U, Regalia E, Donataccio M, Risaliti A, Guizzetti M, Pinelli D, Slim A, Brolese A, Testasecca D, Torelli R, and Scalamogna M

Published
2008

47. Cadaver and living donor split liver transplantation from cadaver and living donor in HCV plus recipients: A multicenter experience of an Italian transplant agency

Author

De Feo, T, De Fazio, N, Brolese, A, Slim, A, Rossi, G, Colledan, M, Andorno, E, Baccarani, U, Regalia, E, Donataccio, M, Risaliti, A, Cima, M, Burra, P, Scalamogna, M, De Feo TM, De Fazio N, Brolese A, Slim A, Rossi G, Colledan M, Andorno E, Baccarani U, Regalia E, Donataccio M, Risaliti A, Cima M, Burra P, Scalamogna M, De Feo, T, De Fazio, N, Brolese, A, Slim, A, Rossi, G, Colledan, M, Andorno, E, Baccarani, U, Regalia, E, Donataccio, M, Risaliti, A, Cima, M, Burra, P, Scalamogna, M, De Feo TM, De Fazio N, Brolese A, Slim A, Rossi G, Colledan M, Andorno E, Baccarani U, Regalia E, Donataccio M, Risaliti A, Cima M, Burra P, and Scalamogna M

Published
2008

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

Author

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

Published
2007

49. Long term follow-up of liver transplantation (OLT) for cholestatic and autoimmune end stage liver diseases

Author

Blasone, L, Fagiuoli, S, Colledan, M, Strazzabosco, M, Lenzi, M, Floreani, A, Burra, P, Cillo, U, Merenda, R, Donato, M, Rossi, G, Salizzoni, M, Franchello, A, Rizzetto, M, Pinzello, G, De Carlis, L, Toniutto, P, Andorno, E, Blasone L, Fagiuoli S, Colledan M, Strazzabosco M, Lenzi M, Floreani A, Burra P, Cillo U, Merenda R, Donato MF, Rossi G, Salizzoni M, Franchello A, Rizzetto M, Pinzello G, De Carlis L, Toniutto P, Andorno E, Blasone, L, Fagiuoli, S, Colledan, M, Strazzabosco, M, Lenzi, M, Floreani, A, Burra, P, Cillo, U, Merenda, R, Donato, M, Rossi, G, Salizzoni, M, Franchello, A, Rizzetto, M, Pinzello, G, De Carlis, L, Toniutto, P, Andorno, E, Blasone L, Fagiuoli S, Colledan M, Strazzabosco M, Lenzi M, Floreani A, Burra P, Cillo U, Merenda R, Donato MF, Rossi G, Salizzoni M, Franchello A, Rizzetto M, Pinzello G, De Carlis L, Toniutto P, and Andorno E

Published
2007

50. Split-liver transplantation: A 10-year multicentre experience in an italian transplant programme

Author

De Feo, T, De Fazio, N, Colledan, M, Andorno, E, DE CARLIS, L, Cillo, U, Rossi, G, Baccarani, U, Regalia, E, Donataccio, M, Risaliti, A, Zambelli, M, Corno, V, Lauterio, A, Zanus, G, Cossolini, M, Scalamogna, M, De Feo TM, De Fazio N, Colledan M, Andorno E, De Carlis LG, Cillo U, Rossi G, Baccarani U, Regalia E, Donataccio M, Risaliti A, Zambelli M, Corno V, Lauterio A, Zanus G, Cossolini M, Scalamogna M, De Feo, T, De Fazio, N, Colledan, M, Andorno, E, DE CARLIS, L, Cillo, U, Rossi, G, Baccarani, U, Regalia, E, Donataccio, M, Risaliti, A, Zambelli, M, Corno, V, Lauterio, A, Zanus, G, Cossolini, M, Scalamogna, M, De Feo TM, De Fazio N, Colledan M, Andorno E, De Carlis LG, Cillo U, Rossi G, Baccarani U, Regalia E, Donataccio M, Risaliti A, Zambelli M, Corno V, Lauterio A, Zanus G, Cossolini M, and Scalamogna M

Published
2007

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