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

Author

Ravaioli, M, Lai, Q, Sessa, M, Ghinolfi, D, Fallani, G, Patrono, D, Di Sandro, S, Avolio, A, Odaldi, F, Bronzoni, J, Tandoi, F, De Carlis, R, Pascale, M, Mennini, G, Germinario, G, Rossi, M, Agnes, S, De Carlis, L, Cescon, M, Romagnoli, R, De Simone, P, Ravaioli M., Lai Q., Sessa M., Ghinolfi D., Fallani G., Patrono D., Di Sandro S., Avolio A., Odaldi F., Bronzoni J., Tandoi F., De Carlis R., Pascale M. M., Mennini G., Germinario G., Rossi M., Agnes S., De Carlis L., Cescon M., Romagnoli R., De Simone P., Ravaioli, M, Lai, Q, Sessa, M, Ghinolfi, D, Fallani, G, Patrono, D, Di Sandro, S, Avolio, A, Odaldi, F, Bronzoni, J, Tandoi, F, De Carlis, R, Pascale, M, Mennini, G, Germinario, G, Rossi, M, Agnes, S, De Carlis, L, Cescon, M, Romagnoli, R, De Simone, P, Ravaioli M., Lai Q., Sessa M., Ghinolfi D., Fallani G., Patrono D., Di Sandro S., Avolio A., Odaldi F., Bronzoni J., Tandoi F., De Carlis R., Pascale M. M., Mennini G., Germinario G., Rossi M., Agnes S., De Carlis L., Cescon M., Romagnoli R., and De Simone P.

Abstract

Background & Aims: In Italy, since August 2014, liver transplant (LT) candidates with model for end-stage liver disease (MELD) scores ≥30 receive national allocation priority. This multicenter cohort study aims to evaluate time on the waiting list, dropout rate, and graft survival before and after introducing the macro-area sharing policy. Methods: A total of 4,238 patients registered from 2010 to 2018 were enrolled and categorized into an ERA-1 Group (n = 2,013; before August 2014) and an ERA-2 Group (n = 2,225; during and after August 2014). A Cox proportional hazards model was used to estimate the hazard ratio (HR) of receiving a LT or death between the two eras. The Fine-Gray model was used to estimate the HR for dropout from the waiting list and graft loss, considering death as a competing risk event. A Fine-Gray model was also used to estimate risk factors of graft loss. Results: Patients with MELD ≥30 had a lower median time on the waiting list (4 vs.12 days, p <0.001) and a higher probability of being transplanted (HR 2.27; 95% CI 1.78–2.90; p = 0.001) in ERA-2 compared to ERA-1. The subgroup analysis on 3,515 LTs confirmed ERA-2 (odds ratio 0.56; 95% CI 0.46–0.68; p = 0.001) as a protective factor for better graft survival rate. The protective variables for lower dropouts on the waiting list were: ERA-2, high-volume centers, no competition centers, male recipients, and hepatocellular carcinoma. The protective variables for graft loss were high-volume center and ERA-2, while MELD ≥30 remained related to a higher risk of graft loss. Conclusions: The national MELD ≥30 priority allocation was associated with improved patient outcomes, although MELD ≥30 was associated with a higher risk of graft loss. Transplant center volumes and competition among centers may have a role in recipient prioritization and outcomes. Clinical trial number: NCT04530240 Lay summary: Italy introduced a new policy in 2014 to give national allocation priority to patients with a mo

Published
2022

2. Minimally Invasive Treatment of Colorectal Liver Metastases: Does Robotic Surgery Provide any Technical Advantages over Laparoscopy? A Multicenter Analysis from the IGoMILS (Italian Group of Minimally Invasive Liver Surgery) Registry

Author

Masetti, M., primary, Fallani, G., additional, Ratti, F., additional, Ferrero, A., additional, Giuliante, F., additional, Cillo, U., additional, Guglielmi, A., additional, Ettorre, G.M., additional, Torzilli, G., additional, Vincenti, L., additional, Ercolani, G., additional, Cipressi, C., additional, Lombardi, R., additional, Aldrighetti, L., additional, and Jovine, E., additional

Published
2022
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5. Long term results of down-staging and liver transplantation for patients with hepatocellular carcinoma beyond the conventional criteria

Author

Ravaioli, M, Odaldi, F, Cucchetti, A, Trevisani, F, Piscaglia, F, De, P, V, Bertuzzo, V, Neri, F, Golfieri, R, Cappelli, A, D’Errico, A, Cescon, M, Del, G, M, Fallani, G, Siniscalchi, A, Morelli, M, Ciccarese, F, Di Marco, M, Farinati, F, Giannini, E, Pinna, A, De Pace, Bertuzzo, VR, Del Gaudio, Morelli, MC, Giannini, EG, Pinna, AD, Ravaioli, M, Odaldi, F, Cucchetti, A, Trevisani, F, Piscaglia, F, De, P, V, Bertuzzo, V, Neri, F, Golfieri, R, Cappelli, A, D’Errico, A, Cescon, M, Del, G, M, Fallani, G, Siniscalchi, A, Morelli, M, Ciccarese, F, Di Marco, M, Farinati, F, Giannini, E, Pinna, A, De Pace, Bertuzzo, VR, Del Gaudio, Morelli, MC, Giannini, EG, and Pinna, AD

Abstract

The objective of the study is to evaluate 10 years of down-staging strategy for liver transplantation (LT) with a median follow-up of 5 years. Data on long-term results are poor and less information is available for hepatocellular carcinoma (HCC) non-responder patients or those ineligible for down-staging. The outcome of 308 HCC candidates and the long-term results of 231 LTs for HCC performed between 2003 and 2013 were analyzed. HCCs were divided according to tumor stage and response to therapy: 145 patients were T2 (metering Milan Criteria, MC), 43 were T3 successfully down-staged to T2 (Down-Achieved), 20 were T3 not fully down-staged to T2 (Down-not Achieved), and 23 patients were T3 not receiving down-staging treatments (No-Down). The average treatment effect (ATE) of LT for T3 tumors was estimated using the outcome of 535 T3 patients undergoing non-LT therapies, using inverse probability weighting regression adjustment. The 24-month drop-out rate during waiting time was significantly higher in the down-staging groups: 27.6% vs. 9.2%, p < 0.005. After LT, the tumor recurrence rate was significantly different: MC 7.6%, Down-Achieved 20.9%, Down-not Achieved 31.6%, and No-Down 30.4% (p < 0.001). The survival rates at 5 years were: 63% in Down-Achieved, 62% in Down-not Achieved, 63% in No-Down, and 77% in MC (p = n.s.). The only variable related to a better outcome was the effective down-staging to T2 at the histological evaluation of the explanted liver: recurrence rate = 7.8% vs. 26% (p < 0.001) and 5-year patient survival = 76% vs. 67% (p < 0.05). The ATE estimation showed that the mean survival of T3-LT candidates was significantly better than that of T3 patients ineligible for LT [83.3 vs 39.2 months (+44.6 months); p < 0.001]. Long term outcome of T3 down-staged candidates was poorer than that of MC candidates, particularly for cases not achieving down-staging. However, their survival outcome was significantly better than that achieved with no

Published
2019

7. Environmental indicators in EpiAir2 project: Air quality data for epidemiological surveillance [Indicatori ambientali nello studio EpiAir2: I dati di qualità dell'aria per la sorveglianza epidemiologica]

Author

Gandini, M., Berti, G., Cattani, G., Faustini, A., Scarinzi, C., Donato, F., Accetta, G., Angiuli, L., Caldara, S., Carreras, G., Casale, P., Di Biagio, K., Giannini, S., Iuzzolino, C., Lanzani, G., Lauriola, P., Leuci, P., Mariuz, M., Marchesi, S., Nocioni, A., Pistollato, S., Pizzi, L., Ranzi, A., Serinelli, M., Stagnaro, E., Vianello, L., Vigotti, M., Zauli-Sajani, S., Cadum, E., Alessandrini, E. R., Angelini, P., Antonelli, A., Arena, P., Assennato, G., Baccini, M., Baldacchini, F., Baldacci, S., Baldini, M., Baldo, V., Ballarino, G., Balzi, D., Barban, I., Barbati, G., Barbone, F., Barchielli, A., Baroni, S., Barontini, R., Bartolacci, S., Bellodi, S., Berico, M., Biggeri, A., Bisanti, L., Bonfanti, M., Bonomolo, A., Bonvicini, L., Bovenzi, M., Brescianini, C., Broccoli, S., Bruni, A., Calzolari, R., Canossa, E., Canova, C., Caramia, G., Casale, G., Casella, C., Casetta, A., Cernigliaro, A., Cerrai, S., Cervino, M., Cestari, L., Chellini, E., Chiusolo, M., Ciaccia, G., Cibella, F., Cocchio, S., Crosetto, L., Cuccaro, F., Daris, F., Girolamo, G., Togni, A., Di Leo, A., Di Lonardo, S., Dessì, M. P., Evangelista, A., Faccini, F., Fallani, G., Forastiere, F., Fruzzetti, R., Galassi, C., Gallo, G., Gallo, L., Ganzi, A., Garrone, E., Gatti, G., Gherardi, B., Gianicolo, E. A. L., Giua, R., Goldoni, C. A., Grechi, D., Grosa, M., Guerrini, N., Impallomeni, M., La Torretta, T., Luberto, F., Lupi, A., Madonia, G., Maio, S., Malaguti, A., Mangia, C., Mariottini, M., Marotta, A., Martini, A., Menegotto, M., Merlo, F., Migliore, E., Minerba, S., Minichilli, F., Mircea, M., Morassuto, C., Nuvolone, D., Onorati, R. N. G., Padolecchia, G., Palazzi, B., Pandolfi, P., Parodi, S., Pasetti, P., Pensato, A., Piersanti, A., Piovesan, C., Pizzuti, R., Addario, S. P., Porcaro, L., Protti, M., Puppo, A., Raciti, M., Randi, G., Rosa, M., Rubini, G., Sacco, F., Santoro, M., Sarno, G., Scala, D., Scondotto, S., Selle, V., Simeoni, R., Simonato, L., Simoni, M., Spagnolo, G., Massimo Stafoggia, Starnino, G., Stivanello, E., Tominz, R., Troiano, F., Vercelli, M., Viegi, G., Vigotti, M. A., Volta, C., Zanini, G., and Zero, F.

Published
2013

10. Air pollution and mortality in twenty-five Italian cities: Results of the EpiAir2 Project,Inquinamento atmosferico e mortalità in venticinque città Italiane: Risultati del progetto EpiAir2

Author

Alessandrini, E. R., Faustini, A., Chiusolo, M., Stafoggia, M., Gandini, M., Demaria, M., Antonelli, A., Arena, P., Biggeri, A., Canova, C., Casale, G., Cernigliaro, A., Garrone, E., Gherardi, B., Gianicolo, E. A. L., Giannini, S., Iuzzolino, C., Lauriola, P., Mariottini, M., Pasetti, P., Randi, G., Andrea Ranzi, Santoro, M., Selle, V., Serinelli, M., Stivanello, E., Tominz, R., Vigotti, M., Zauli-Sajani, S., Forastiere, F., Cadum, E., Accetta, G., Angelini, P., Angiuli, L., Assennato, G., Baccini, M., Baldacchini, F., Baldacci, S., Baldini, M., Baldo, V., Ballarino, G., Balzi, D., Barban, I., Barbati, G., Barbone, F., Barchielli, A., Baroni, S., Barontini, R., Bartolacci, S., Bellodi, S., Berico, M., Berti, G., Bisanti, L., Bonfanti, M., Bonomolo, A., Bonvicini, L., Bovenzi, M., Brescianini, C., Broccoli, S., Bruni, A., Caldara, S., Calzolari, R., Canossa, E., Caramia, G., Carreras, G., Casale, P., Casella, C., Casetta, A., Cattani, G., Cerrai, S., Cervino, M., Cestari, L., Chellini, E., Ciaccia, G., Cibella, F., Cocchio, S., Crosetto, L., Cuccaro, F., Daris, F., Donato, F., Girolamo, G., Togni, A., Di Biagio, K., Di Leo, A., Di Lonardo, S., Dessì, M. P., Evangelista, A., Faccini, F., Fallani, G., Fruzzetti, R., Galassi, C., Gallo, G., Gallo, L., Ganzi, A., Gatti, G., Giua, R., Goldoni, C. A., Grechi, D., Grosa, M., Guerrini, N., Impallomeni, M., La Torretta, T., Lanzani, G., Leuci, P., Luberto, F., Lupi, A., Madonia, G., Maio, S., Malaguti, A., Mangia, C., Marchesi, S., Mariuz, M., Marotta, A., Martini, A., Menegotto, M., Merlo, F., Migliore, E., Minerba, S., Minichilli, F., Mircea, M., Morassuto, C., Nocioni, A., Nuvolone, D., Nuzzi, R., Onorati, G., Padolecchia, G., Palazzi, B., Pandolfi, P., Parodi, S., Pensato, A., Piersanti, A., Piovesan, C., Pistollato, S., Pizzi, L., Pizzuti, R., Addario, S. P., Porcaro, L., Protti, M., Puppo, A., Raciti, M., Rosa, M., Rubini, G., Sacco, F., Sarno, G., Scala, D., Scarinzi, C., Scondotto, S., Simeoni, R., Simonato, L., Simoni, M., Spagnolo, G., Stagnaro, E., Starnino, G., Troiano, F., Vercelli, M., Vianello, L., Viegi, G., Vigotti, M. A., Volta, C., Zanini, G., and Zero, F.

11. Policies for the promotion of sustainable mobility and the reduction of traffic-related air pollution in the cities participating in the EpiAir2 project,Le politiche per la promozione della mobilità sostenibile e la riduzione dell'inquinamento atmosferico causato dal traffico veicolare nelle città partecipanti allo studio EpiAir2

Author

Di Lonardo, S., Nuvolone, D., Forastiere, F., Cadum, E., Barchielli, A., Accetta, G., Alessandrini, E. R., Angelini, P., Angiuli, L., Antonelli, A., Arena, P., Assennato, G., Baccini, M., FLAVIA BALDACCHINI, Baldacci, S., Baldini, M., Baldo, V., Ballarino, G., Balzi, D., Barban, I., Barbati, G., Barbone, F., Baroni, S., Barontini, R., Bartolacci, S., Bellodi, S., Berico, M., Berti, G., Biggeri, A., Bisanti, L., Bonfanti, M., Bonomolo, A., Bonvicini, L., Bovenzi, M., Brescianini, C., Broccoli, S., Bruni, A., Caldara, S., Calzolari, R., Canossa, E., Canova, C., Caramia, G., Carreras, G., Casale, G., Casale, P., Casella, C., Casetta, A., Cattani, G., Cernigliaro, A., Cerrai, S., Cervino, M., Cestari, L., Chellini, E., Chiusolo, M., Ciaccia, G., Cibella, F., Cocchio, S., Crosetto, L., Cuccaro, F., Daris, F., Donato, F., Girolamo, G., Togni, A., Di Biagio, K., Di Leo, A., Dessì, M. P., Evangelista, A., Faccini, F., Fallani, G., Faustini, A., Fruzzetti, R., Galassi, C., Gallo, G., Gallo, L., Gandini, M., Ganzi, A., Garrone, E., Gatti, G., Gherardi, B., Gianicolo, E. A. L., Giannini, S., Giua, R., Goldoni, C. A., Grechi, D., Grosa, M., Guerrini, N., Impallomeni, M., Iuzzolino, C., La Torretta, T., Lanzani, G., Lauriola, P., Leuci, P., Luberto, F., Lupi, A., Madonia, G., Maio, S., Malaguti, A., Mangia, C., Marchesi, S., Mariottini, M., Mariuz, M., Marotta, A., Martini, A., Menegotto, M., Merlo, F., Migliore, E., Minerba, S., Minichilli, F., Mircea, M., Morassuto, C., Nocioni, A., Nuzzi, R., Onorati, G., Padolecchia, G., Palazzi, B., Pandolfi, P., Parodi, S., Pasetti, P., Pensato, A., Piersanti, A., Piovesan, C., Pistollato, S., Pizzi, L., Pizzuti, R., Addario, S. P., Porcaro, L., Protti, M., Puppo, A., Raciti, M., Randi, G., Ranzi, A., Rosa, M., Rubini, G., Sacco, F., Santoro, M., Sarno, G., Scala, D., Scarinzi, C., Scondotto, S., Selle, V., Serinelli, M., Simeoni, R., Simonato, L., Simoni, M., Spagnolo, G., Stafoggia, M., Stagnaro, E., Starnino, G., Stivanello, E., Tominz, R., Troiano, F., Vercelli, M., Vianello, L., Viegi, G., Vigotti, M. A., Volta, C., Zanini, G., Zauli-Sajani, S., and Zero, F.

12. Air pollution and urgent hospital admissions in 25 Italian cities: Results from the EpiAir2 project,Inquinamento atmosferico e ricoveri ospedalieri urgenti in 25 città Italiane: Risultati del progetto EpiAir2

Author

Scarinzi, C., Alessandrini, E. R., Chiusolo, M., Galassi, C., Baldini, M., Serinelli, M., Pandolfi, P., Bruni, A., Biggeri, A., Togni, A., Carreras, G., Casella, C., Canova, C., Randi, G., Andrea Ranzi, Morassuto, C., Cernigliaro, A., Giannini, S., Lauriola, P., Minichilli, F., Gherardi, B., Zauli-Sajani, S., Stafoggia, M., Casale, P., Gianicolo, E. A. L., Piovesan, C., Tominz, R., Porcaro, L., Cadum, E., Accetta, G., Angelini, P., Angiuli, L., Antonelli, A., Arena, P., Assennato, G., Baccini, M., Baldacchini, F., Baldacci, S., Baldo, V., Ballarino, G., Balzi, D., Barban, I., Barbati, G., Barbone, F., Barchielli, A., Baroni, S., Barontini, R., Bartolacci, S., Bellodi, S., Berico, M., Berti, G., Bisanti, L., Bonfanti, M., Bonomolo, A., Bonvicini, L., Bovenzi, M., Brescianini, C., Broccoli, S., Caldara, S., Calzolari, R., Canossa, E., Caramia, G., Casale, G., Casetta, A., Cattani, G., Cerrai, S., Cervino, M., Cestari, L., Chellini, E., Ciaccia, G., Cibella, F., Cocchio, S., Crosetto, L., Cuccaro, F., Daris, F., Donato, F., Girolamo, G., Di Biagio, K., Di Leo, A., Di Lonardo, S., Dessì, M. P., Evangelista, A., Faccini, F., Fallani, G., Faustini, A., Forastiere, F., Fruzzetti, R., Gallo, G., Gallo, L., Gandini, M., Ganzi, A., Garrone, E., Gatti, G., Giua, R., Goldoni, C. A., Grechi, D., Grosa, M., Guerrini, N., Impallomeni, M., Iuzzolino, C., La Torretta, T., Lanzani, G., Leuci, P., Luberto, F., Lupi, A., Madonia, G., Maio, S., Malaguti, A., Mangia, C., Marchesi, S., Mariottini, M., Mariuz, M., Marotta, A., Martini, A., Menegotto, M., Merlo, F., Migliore, E., Minerba, S., Mircea, M., Nocioni, A., Nuvolone, D., Nuzzi, R., Onorati, G., Padolecchia, G., Palazzi, B., Parodi, S., Pasetti, P., Pensato, A., Piersanti, A., Pistollato, S., Pizzi, L., Pizzuti, R., Addario, S. P., Protti, M., Puppo, A., Raciti, M., Rosa, M., Rubini, G., Sacco, F., Santoro, M., Sarno, G., Scala, D., Scondotto, S., Selle, V., Simeoni, R., Simonato, L., Simoni, M., Spagnolo, G., Stagnaro, E., Starnino, G., Stivanello, E., Troiano, F., Vercelli, M., Vianello, L., Viegi, G., Vigotti, M. A., Volta, C., Zanini, G., and Zero, F.

13. Air pollution and urgent hospital admissions in 25 Italian cities: Results from the EpiAir2 project | Inquinamento atmosferico e ricoveri ospedalieri urgenti in 25 città Italiane: Risultati del progetto EpiAir2

Author

Scarinzi, C., Alessandrini, E. R., Chiusolo, M., Galassi, C., Baldini, M., Serinelli, M., Pandolfi, P., Bruni, A., Biggeri, A., Togni, A., Carreras, G., Casella, C., Canova, C., Randi, G., Ranzi, A., Morassuto, C., Cernigliaro, A., Giannini, S., Lauriola, P., Minichilli, F., Gherardi, B., Zauli-Sajani, S., Stafoggia, M., Casale, P., Gianicolo, E. A. L., Piovesan, C., Tominz, R., Porcaro, L., Cadum, E., Accetta, G., Angelini, P., Angiuli, L., Antonelli, A., Arena, P., Assennato, G., Baccini, M., Baldacchini, F., Baldacci, S., Baldo, V., Ballarino, G., Balzi, D., Barban, I., Barbati, G., Fabio Barbone, Barchielli, A., Baroni, S., Barontini, R., Bartolacci, S., Bellodi, S., Berico, M., Berti, G., Bisanti, L., Bonfanti, M., Bonomolo, A., Bonvicini, L., Bovenzi, M., Brescianini, C., Broccoli, S., Caldara, S., Calzolari, R., Canossa, E., Caramia, G., Casale, G., Casetta, A., Cattani, G., Cerrai, S., Cervino, M., Cestari, L., Chellini, E., Ciaccia, G., Cibella, F., Cocchio, S., Crosetto, L., Cuccaro, F., Daris, F., Donato, F., Girolamo, G., Di Biagio, K., Di Leo, A., Di Lonardo, S., Dessì, M. P., Evangelista, A., Faccini, F., Fallani, G., Faustini, A., Forastiere, F., Fruzzetti, R., Gallo, G., Gallo, L., Gandini, M., Ganzi, A., Garrone, E., Gatti, G., Giua, R., Goldoni, C. A., Grechi, D., Grosa, M., Guerrini, N., Impallomeni, M., Iuzzolino, C., La Torretta, T., Lanzani, G., Leuci, P., Luberto, F., Lupi, A., Madonia, G., Maio, S., Malaguti, A., Mangia, C., Marchesi, S., Mariottini, M., Mariuz, M., Marotta, A., Martini, A., Menegotto, M., Merlo, F., Migliore, E., Minerba, S., Mircea, M., Nocioni, A., Nuvolone, D., Nuzzi, R., Onorati, G., Padolecchia, G., Palazzi, B., Parodi, S., Pasetti, P., Pensato, A., Piersanti, A., Pistollato, S., Pizzi, L., Pizzuti, R., Addario, S. P., Protti, M., Puppo, A., Raciti, M., Rosa, M., Rubini, G., Sacco, F., Santoro, M., Sarno, G., Scala, D., Scondotto, S., Selle, V., Simeoni, R., Simonato, L., Simoni, M., Spagnolo, G., Stagnaro, E., Starnino, G., Stivanello, E., Troiano, F., Vercelli, M., Vianello, L., Viegi, G., Vigotti, M. A., Volta, C., Zanini, G., and Zero, F.

14. Environmental indicators in EpiAir2 project: Air quality data for epidemiological surveillance,Indicatori ambientali nello studio EpiAir2: I dati di qualità dell'aria per la sorveglianza epidemiologica

Author

Gandini, M., Berti, G., Cattani, G., Faustini, A., Scarinzi, C., Donato, F., Accetta, G., Angiuli, L., Caldara, S., Carreras, G., Casale, P., Di Biagio, K., Giannini, S., Iuzzolino, C., Lanzani, G., Lauriola, P., Leuci, P., Mariuz, M., Marchesi, S., Nocioni, A., Pistollato, S., Pizzi, L., Ranzi, A., Serinelli, M., Stagnaro, E., Vianello, L., Vigotti, M., Zauli-Sajani, S., Cadum, E., Alessandrini, E. R., Angelini, P., Antonelli, A., Arena, P., Assennato, G., Baccini, M., Baldacchini, F., Baldacci, S., Baldini, M., Baldo, V., Ballarino, G., Balzi, D., Barban, I., Barbati, G., Barbone, F., Barchielli, A., Baroni, S., Barontini, R., Bartolacci, S., Bellodi, S., Berico, M., Biggeri, A., Bisanti, L., Bonfanti, M., Bonomolo, A., Bonvicini, L., Bovenzi, M., Brescianini, C., Broccoli, S., Bruni, A., Calzolari, R., Canossa, E., Canova, C., Caramia, G., Casale, G., Casella, C., Casetta, A., Cernigliaro, A., Cerrai, S., Cervino, M., Cestari, L., Chellini, E., Chiusolo, M., Ciaccia, G., Cibella, F., Cocchio, S., Crosetto, L., Cuccaro, F., Daris, F., Girolamo, G., Togni, A., Di Leo, A., Di Lonardo, S., Dessì, M. P., Evangelista, A., Faccini, F., Fallani, G., Forastiere, F., Fruzzetti, R., Galassi, C., Gallo, G., Gallo, L., Ganzi, A., Garrone, E., Gatti, G., Gherardi, B., Gianicolo, E. A. L., Giua, R., Goldoni, C. A., Grechi, D., Grosa, M., Guerrini, N., Impallomeni, M., La Torretta, T., Ferdinando Luberto, Lupi, A., Madonia, G., Maio, S., Malaguti, A., Mangia, C., Mariottini, M., Marotta, A., Martini, A., Menegotto, M., Merlo, F., Migliore, E., Minerba, S., Minichilli, F., Mircea, M., Morassuto, C., Nuvolone, D., Onorati, R. N. G., Padolecchia, G., Palazzi, B., Pandolfi, P., Parodi, S., Pasetti, P., Pensato, A., Piersanti, A., Piovesan, C., Pizzuti, R., Addario, S. P., Porcaro, L., Protti, M., Puppo, A., Raciti, M., Randi, G., Rosa, M., Rubini, G., Sacco, F., Santoro, M., Sarno, G., Scala, D., Scondotto, S., Selle, V., Simeoni, R., Simonato, L., Simoni, M., Spagnolo, G., Stafoggia, M., Starnino, G., Stivanello, E., Tominz, R., Troiano, F., Vercelli, M., Viegi, G., Vigotti, M. A., Volta, C., Zanini, G., and Zero, F.

15. Short-term impact of air pollution among Italian cities covered by the EpiAir2 project,Impatto a breve termine dell'inquinamento dell'aria nelle città coperte dalla sorveglianza epidemiologica EpiAir2

Author

Baccini, M., Biggeri, A., Accetta, G., Alessandrini, E. R., Angelini, P., Angiuli, L., Antonelli, A., Arena, P., Assennato, G., Baldacchini, F., Baldacci, S., Baldini, M., Baldo, V., Ballarino, G., Balzi, D., Barban, I., Barbati, G., Barbone, F., Barchielli, A., Baroni, S., Barontini, R., Bartolacci, S., Bellodi, S., Berico, M., Berti, G., Bisanti, L., Bonfanti, M., Bonomolo, A., Bonvicini, L., Bovenzi, M., Brescianini, C., Broccoli, S., Bruni, A., Cadum, E., Caldara, S., Calzolari, R., Canossa, E., Canova, C., Caramia, G., Carreras, G., Casale, G., Casale, P., Casella, C., Casetta, A., Cattani, G., Cernigliaro, A., Cerrai, S., Cervino, M., Cestari, L., Chellini, E., Chiusolo, M., Ciaccia, G., Cibella, F., Cocchio, S., Crosetto, L., Cuccaro, F., Daris, F., Francesca K. de'Donato, Girolamo, G., Togni, A., Di Biagio, K., Di Leo, A., Di Lonardo, S., Dessì, M. P., Evangelista, A., Faccini, F., Fallani, G., Faustini, A., Forastiere, F., Fruzzetti, R., Galassi, C., Gallo, G., Gallo, L., Gandini, M., Ganzi, A., Garrone, E., Gatti, G., Gherardi, B., Gianicolo, E. A. L., Giannini, S., Giua, R., Goldoni, C. A., Grechi, D., Grosa, M., Guerrini, N., Impallomeni, M., Iuzzolino, C., La Torretta, T., Lanzani, G., Lauriola, P., Leuci, P., Luberto, F., Lupi, A., Madonia, G., Maio, S., Malaguti, A., Mangia, C., Marchesi, S., Mariottini, M., Mariuz, M., Marotta, A., Martini, A., Menegotto, M., Merlo, F., Migliore, E., Minerba, S., Minichilli, F., Mircea, M., Morassuto, C., Nocioni, A., Nuvolone, D., Nuzzi, R., Onorati, G., Padolecchia, G., Palazzi, B., Pandolfi, P., Parodi, S., Pasetti, P., Pensato, A., Piersanti, A., Piovesan, C., Pistollato, S., Pizzi, L., Pizzuti, R., Addario, S. P., Porcaro, L., Protti, M., Puppo, A., Raciti, M., Randi, G., Ranzi, A., Rosa, M., Rubini, G., Sacco, F., Santoro, M., Sarno, G., Scala, D., Scarinzi, C., Scondotto, S., Selle, V., Serinelli, M., Simeoni, R., Simonato, L., Simoni, M., Spagnolo, G., Stafoggia, M., Stagnaro, E., Starnino, G., Stivanello, E., Tominz, R., Troiano, F., Vercelli, M., Vianello, L., Viegi, G., Vigotti, M. A., Volta, C., Zanini, G., Zauli-Sajani, S., and Zero, F.

16. Short-term impact of air pollution among Italian cities covered by the EpiAir2 project | Impatto a breve termine dell'inquinamento dell'aria nelle città coperte dalla sorveglianza epidemiologica EpiAir2

Author

Baccini, M., Biggeri, A., Accetta, G., Alessandrini, E. R., Angelini, P., Angiuli, L., Antonelli, A., Arena, P., Assennato, G., Baldacchini, F., Baldacci, S., Baldini, M., Baldo, V., Ballarino, G., Balzi, D., Barban, I., Barbati, G., Barbone, F., Barchielli, A., Baroni, S., Barontini, R., Bartolacci, S., Bellodi, S., Berico, M., Berti, G., Bisanti, L., Bonfanti, M., Bonomolo, A., Bonvicini, L., Bovenzi, M., Brescianini, C., Broccoli, S., Bruni, A., Cadum, E., Caldara, S., Calzolari, R., Canossa, E., Canova, C., Caramia, G., Carreras, G., Casale, G., Casale, P., Casella, C., Casetta, A., Cattani, G., Cernigliaro, A., Cerrai, S., Cervino, M., Cestari, L., Chellini, E., Chiusolo, M., Ciaccia, G., Cibella, F., Cocchio, S., Crosetto, L., Cuccaro, F., Daris, F., Donato, F., Girolamo, G., Togni, A., Di Biagio, K., Di Leo, A., Di Lonardo, S., Dessì, M. P., Evangelista, A., Faccini, F., Fallani, G., Faustini, A., Forastiere, F., Fruzzetti, R., Galassi, C., Gallo, G., Gallo, L., Gandini, M., Ganzi, A., Garrone, E., Gatti, G., Gherardi, B., Gianicolo, E. A. L., Giannini, S., Giua, R., Goldoni, C. A., Grechi, D., Grosa, M., Guerrini, N., Impallomeni, M., Iuzzolino, C., La Torretta, T., Lanzani, G., Lauriola, P., Leuci, P., Luberto, F., Lupi, A., Madonia, G., Maio, S., Malaguti, A., Mangia, C., Marchesi, S., Mariottini, M., Mariuz, M., Marotta, A., Martini, A., Menegotto, M., Merlo, F., Migliore, E., Minerba, S., Fabrizio Minichilli, Mircea, M., Morassuto, C., Nocioni, A., Nuvolone, D., Nuzzi, R., Onorati, G., Padolecchia, G., Palazzi, B., Pandolfi, P., Parodi, S., Pasetti, P., Pensato, A., Piersanti, A., Piovesan, C., Pistollato, S., Pizzi, L., Pizzuti, R., Addario, S. P., Porcaro, L., Protti, M., Puppo, A., Raciti, M., Randi, G., Ranzi, A., Rosa, M., Rubini, G., Sacco, F., Santoro, M., Sarno, G., Scala, D., Scarinzi, C., Scondotto, S., Selle, V., Serinelli, M., Simeoni, R., Simonato, L., Simoni, M., Spagnolo, G., Stafoggia, M., Stagnaro, E., Starnino, G., Stivanello, E., Tominz, R., Troiano, F., Vercelli, M., Vianello, L., Viegi, G., Vigotti, M. A., Volta, C., Zanini, G., Zauli-Sajani, S., and Zero, F.

17. Policies for the promotion of sustainable mobility and the reduction of traffic-related air pollution in the cities participating in the EpiAir2 project | Le politiche per la promozione della mobilità sostenibile e la riduzione dell'inquinamento atmosferico causato dal traffico veicolare nelle città partecipanti allo studio EpiAir2

Author

Di Lonardo, S., Nuvolone, D., Forastiere, F., Cadum, E., Barchielli, A., Accetta, G., Alessandrini, E. R., Angelini, P., Angiuli, L., Antonelli, A., Arena, P., Assennato, G., Baccini, M., Baldacchini, F., Baldacci, S., Baldini, M., Baldo, V., Ballarino, G., Balzi, D., Barban, I., Barbati, G., Fabio Barbone, Baroni, S., Barontini, R., Bartolacci, S., Bellodi, S., Berico, M., Berti, G., Biggeri, A., Bisanti, L., Bonfanti, M., Bonomolo, A., Bonvicini, L., Bovenzi, M., Brescianini, C., Broccoli, S., Bruni, A., Caldara, S., Calzolari, R., Canossa, E., Canova, C., Caramia, G., Carreras, G., Casale, G., Casale, P., Casella, C., Casetta, A., Cattani, G., Cernigliaro, A., Cerrai, S., Cervino, M., Cestari, L., Chellini, E., Chiusolo, M., Ciaccia, G., Cibella, F., Cocchio, S., Crosetto, L., Cuccaro, F., Daris, F., Donato, F., Girolamo, G., Togni, A., Di Biagio, K., Di Leo, A., Dessì, M. P., Evangelista, A., Faccini, F., Fallani, G., Faustini, A., Fruzzetti, R., Galassi, C., Gallo, G., Gallo, L., Gandini, M., Ganzi, A., Garrone, E., Gatti, G., Gherardi, B., Gianicolo, E. A. L., Giannini, S., Giua, R., Goldoni, C. A., Grechi, D., Grosa, M., Guerrini, N., Impallomeni, M., Iuzzolino, C., La Torretta, T., Lanzani, G., Lauriola, P., Leuci, P., Luberto, F., Lupi, A., Madonia, G., Maio, S., Malaguti, A., Mangia, C., Marchesi, S., Mariottini, M., Mariuz, M., Marotta, A., Martini, A., Menegotto, M., Merlo, F., Migliore, E., Minerba, S., Minichilli, F., Mircea, M., Morassuto, C., Nocioni, A., Nuzzi, R., Onorati, G., Padolecchia, G., Palazzi, B., Pandolfi, P., Parodi, S., Pasetti, P., Pensato, A., Piersanti, A., Piovesan, C., Pistollato, S., Pizzi, L., Pizzuti, R., Addario, S. P., Porcaro, L., Protti, M., Puppo, A., Raciti, M., Randi, G., Ranzi, A., Rosa, M., Rubini, G., Sacco, F., Santoro, M., Sarno, G., Scala, D., Scarinzi, C., Scondotto, S., Selle, V., Serinelli, M., Simeoni, R., Simonato, L., Simoni, M., Spagnolo, G., Stafoggia, M., Stagnaro, E., Starnino, G., Stivanello, E., Tominz, R., Troiano, F., Vercelli, M., Vianello, L., Viegi, G., Vigotti, M. A., Volta, C., Zanini, G., Zauli-Sajani, S., and Zero, F.

18. Air pollution and mortality in twenty-five Italian cities: Results of the EpiAir2 Project | Inquinamento atmosferico e mortalità in venticinque città Italiane: Risultati del progetto EpiAir2

Author

Alessandrini, E. R., Faustini, A., Chiusolo, M., Stafoggia, M., Gandini, M., Demaria, M., Antonelli, A., Arena, P., Biggeri, A., Canova, C., Casale, G., Cernigliaro, A., Garrone, E., Gherardi, B., Gianicolo, E. A. L., Giannini, S., Iuzzolino, C., Lauriola, P., Mariottini, M., Pasetti, P., Randi, G., Ranzi, A., Santoro, M., Selle, V., Serinelli, M., Stivanello, E., Tominz, R., Vigotti, M., Stefano Zauli Sajani, Forastiere, F., Cadum, E., Accetta, G., Angelini, P., Angiuli, L., Assennato, G., Baccini, M., Baldacchini, F., Baldacci, S., Baldini, M., Baldo, V., Ballarino, G., Balzi, D., Barban, I., Barbati, G., Barbone, F., Barchielli, A., Baroni, S., Barontini, R., Bartolacci, S., Bellodi, S., Berico, M., Berti, G., Bisanti, L., Bonfanti, M., Bonomolo, A., Bonvicini, L., Bovenzi, M., Brescianini, C., Broccoli, S., Bruni, A., Caldara, S., Calzolari, R., Canossa, E., Caramia, G., Carreras, G., Casale, P., Casella, C., Casetta, A., Cattani, G., Cerrai, S., Cervino, M., Cestari, L., Chellini, E., Ciaccia, G., Cibella, F., Cocchio, S., Crosetto, L., Cuccaro, F., Daris, F., Donato, F., Girolamo, G., Togni, A., Di Biagio, K., Di Leo, A., Di Lonardo, S., Dessì, M. P., Evangelista, A., Faccini, F., Fallani, G., Fruzzetti, R., Galassi, C., Gallo, G., Gallo, L., Ganzi, A., Gatti, G., Giua, R., Goldoni, C. A., Grechi, D., Grosa, M., Guerrini, N., Impallomeni, M., La Torretta, T., Lanzani, G., Leuci, P., Luberto, F., Lupi, A., Madonia, G., Maio, S., Malaguti, A., Mangia, C., Marchesi, S., Mariuz, M., Marotta, A., Martini, A., Menegotto, M., Merlo, F., Migliore, E., Minerba, S., Minichilli, F., Mircea, M., Morassuto, C., Nocioni, A., Nuvolone, D., Nuzzi, R., Onorati, G., Padolecchia, G., Palazzi, B., Pandolfi, P., Parodi, S., Pensato, A., Piersanti, A., Piovesan, C., Pistollato, S., Pizzi, L., Pizzuti, R., Addario, S. P., Porcaro, L., Protti, M., Puppo, A., Raciti, M., Rosa, M., Rubini, G., Sacco, F., Sarno, G., Scala, D., Scarinzi, C., Scondotto, S., Simeoni, R., Simonato, L., Simoni, M., Spagnolo, G., Stagnaro, E., Starnino, G., Troiano, F., Vercelli, M., Vianello, L., Viegi, G., Vigotti, M. A., Volta, C., Zanini, G., and Zero, F.

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

Author

Maurizio Sessa, Salvatore Agnes, Marco Maria Pascale, Matteo Ravaioli, Francesco Tandoi, Federica Odaldi, Paolo De Simone, Giuliana Germinario, Gianluca Mennini, Luciano De Carlis, Alfonso Wolfango Avolio, Massimo Rossi, Jessica Bronzoni, Quirino Lai, Guido Fallani, Renato Romagnoli, Stefano Di Sandro, Matteo Cescon, Davide Ghinolfi, Damiano Patrono, Riccardo De Carlis, Ravaioli M., Lai Q., Sessa M., Ghinolfi D., Fallani G., Patrono D., Di Sandro S., Avolio A., Odaldi F., Bronzoni J., Tandoi F., De Carlis R., Pascale M.M., Mennini G., Germinario G., Rossi M., Agnes S., De Carlis L., Cescon M., Romagnoli R., De Simone P., Ravaioli, M, Lai, Q, Sessa, M, Ghinolfi, D, Fallani, G, Patrono, D, Di Sandro, S, Avolio, A, Odaldi, F, Bronzoni, J, Tandoi, F, De Carlis, R, Pascale, M, Mennini, G, Germinario, G, Rossi, M, Agnes, S, De Carlis, L, Cescon, M, Romagnoli, R, and De Simone, P

Subjects
Waiting time, Prioritization, Male, medicine.medical_specialty, Time Factors, Tissue and Organ Procurement, Waiting Lists, medicine.medical_treatment, Liver transplantation, Cohort Studies, End Stage Liver Disease, Model for End-Stage Liver Disease, Risk Factors, Outcome Assessment, Health Care, medicine, Odds Ratio, Humans, In patient, ECD, HCC, Proportional Hazards Models, Hepatology, business.industry, Proportional hazards model, Health Policy, Patient Selection, Graft Survival, Liver Transplantation, MELD, Middle Aged, body regions, Clinical trial, Logistic Models, Italy, Emergency medicine, Female, business, Cohort study
Abstract

Background & Aims: In Italy, since August 2014, liver transplant (LT) candidates with model for end-stage liver disease (MELD) scores ≥30 receive national allocation priority. This multicenter cohort study aims to evaluate time on the waiting list, dropout rate, and graft survival before and after introducing the macro-area sharing policy. Methods: A total of 4,238 patients registered from 2010 to 2018 were enrolled and categorized into an ERA-1 Group (n = 2,013; before August 2014) and an ERA-2 Group (n = 2,225; during and after August 2014). A Cox proportional hazards model was used to estimate the hazard ratio (HR) of receiving a LT or death between the two eras. The Fine-Gray model was used to estimate the HR for dropout from the waiting list and graft loss, considering death as a competing risk event. A Fine-Gray model was also used to estimate risk factors of graft loss. Results: Patients with MELD ≥30 had a lower median time on the waiting list (4 vs.12 days, p

Published
2022
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32. Technical and Immunological Challenges in Early Kidney Regrafting

Author

Massimo Del Gaudio, Gaetano La Manna, Matteo Ravaioli, Guido Fallani, Matteo Serenari, Giorgia Comai, Fallani G., Comai G., Serenari M., Del Gaudio M., La Manna G., and Ravaioli M.

Subjects
Transplantation, medicine.medical_specialty, Kidney, business.industry, Human leukocyte antigen typing, Ischemia, Multiorgan donation, Anastomosis, medicine.disease, Living donor, Surgery, Organ procurement, Renal transplant, medicine.anatomical_structure, Human Leukocyte Antigen Matching, Donation, medicine, business
Abstract

Few reports concerning early organ regrafting are available in the literature, and those dedicated to kidney regrafting do not focus on allocation policies or retrieval surgical strategies. This report describes an unsuccessful living donor kidney transplant, where a 12-year-old female recipient who had received a kidney from her mother died on postoperative day 2 due to cerebral ischemia and became a brain-dead donor. The family agreed to a multiorgan donation since the previously transplanted kidney was highly performing. The organ had initially been allocated according to the blood group of the recipient (AB), although the donor’s (her mother) blood group was B; however, human leukocyte antigen matching was performed considering the donor’s human leukocyte antigen typing. The new recipient of the kidney was a 53-year-old man. Organ procurement was performed with adjunctive cannulation of the iliac vessels, to flush the transplanted kidney with preservation solution; the graft was then procured, including the previous vascular anastomoses. Implantation of the graft was performed on the iliac vessels of the recipient, which were anastomosed to the iliac vessels of the donor, leaving the previous vascular anastomoses untouched. Two years after the transplant, the patient is alive with a functioning graft. Early kidney regrafting is a safeand feasible procedure, on both the surgical and immunological sides. Although kidney recipients who experience brain death in the early postoperative period are few, they should be considered as viable organ donors. Also, allocating and retrieving such organs require few precautions compared with standard allocation and retrieval processes.

Published
2021
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33. Urgent and emergency surgery for secondary peritonitis during the COVID-19 outbreak: an unseen burden of a healthcare crisis

Author

Giampaolo Ugolini, Michele Grassia, Stefano Bonilauri, Mario Chisari, Simone Nicosia, Nicola Zanini, Claudia Benini, Gaetano Vetrone, Federico Zanzi, Luca Di Donato, Michele Masetti, Enrico Guerra, Raffaele Lombardi, Andrea Lucchi, Francesco Pasini, Gaetano Maria Cattaneo, Mauro Filosa, Guido Fallani, Gianluca Garulli, Elio Jovine, Fallani G., Lombardi R., Masetti M., Chisari M., Zanini N., Cattaneo G.M., Filosa M., Zanzi F., Guerra E., Bonilauri S., Di Donato L., Garulli G., Lucchi A., Grassia M., Ugolini G., Pasini F., Vetrone G., Benini C., Nicosia S., and Jovine E.

Subjects
Subset Analysis, Adult, Male, medicine.medical_specialty, Pneumonia, Viral, Peritonitis, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Health care, Clinical endpoint, Medicine, Humans, Prospective Studies, Pandemics, Emergencie, Pandemic, Peritoniti, business.industry, SARS-CoV-2, Outbreak, COVID-19, Middle Aged, medicine.disease, Appendicitis, Surgery, Prospective Studie, Italy, 030220 oncology & carcinogenesis, Emergency medicine, Emergency surgery, 030211 gastroenterology & hepatology, Observational study, Original Article, Female, Postoperative Complication, Emergencies, business, Human
Abstract

The COVID-19 pandemic has raised concerns about the negative impact of the fear of contagion on people’s willingness to seek medical care and the subsequent effects on patients’ prognosis. To date, not much is known about the outcomes of acute surgical diseases in this scenario. The aim of this multicenter observational study is to explore the effects of COVID-19 outbreak on the outcomes of patients who underwent surgery for peritonitis. Patients undergoing surgery for secondary peritonitis during the first COVID-19 surge in Italy (March 23–May 4, 2020—COVID period group) were compared with patients who underwent surgery during the same time interval of year 2019 (no-COVID period group). The primary endpoint was the development of postoperative complications. Logistic regression analysis was conducted to identify predictors of complications. Of the 332 patients studied, 149 were in the COVID period group and 183 were in the no-COVID period group. Patients in the COVID period group had an increased frequency of late presentations to the emergency departments (43% vs. 31.1%; P = 0.026) and a higher rate of postoperative complications (35.6% vs. 18%; P < 0.001). The same results were found in the subset analysis of patients with severe peritonitis at surgical exploration. The ASA score, severity of peritonitis, qSOFA score, diagnosis other than appendicitis, and COVID period resulted independent predictors of complications. During the COVID-19 pandemic patients with peritonitis had a higher rate of complicated postoperative courses, weighing on hospital costs and assistance efforts already pressured by the ongoing sanitary crisis.

Published
2021

34. Venous outflow in partial heterotopic liver transplantation with spleen replacement: Evidence of no chronic venous hypertension

Author

Matteo Ravaioli, Matteo Serenari, Francesco Vasuri, Matteo Renzulli, Enrico Prosperi, Guido Fallani, Antonio Siniscalchi, Lorenzo Maroni, Federica Odaldi, Matteo Cerri, Giuliana Germinario, Matteo Cescon, Ravaioli M., Germinario G., Cerri M., Prosperi E., Fallani G., Vasuri F., Serenari M., Odaldi F., Maroni L., Siniscalchi A., Cescon M., and Renzulli M.

Subjects
medicine.medical_specialty, Transplantation, Heterotopic, medicine.medical_treatment, Spleen, Economic shortage, Liver transplantation, clinical research/practice, Liver disease, liver transplantation: auxiliary, medicine, Humans, Immunology and Allergy, Pharmacology (medical), Venous hypertension, Transplantation, business.industry, medicine.disease, Liver Transplantation, Surgery, medicine.anatomical_structure, Liver, Hypertension, Hepatectomy, liver disease, business, liver transplantation/hepatology
Abstract

We recently described the first case of partial heterotopic liver transplantation replacing the spleen with delayed recipient hepatectomy to overcome the problem of organ shortage and to make possible debated indications for liver transplantation.1,2 The surgical technique of the RAVAS procedure was described in different steps: before planning the operation1 and after the first procedure performed, with a case report and video of the technique.

Published
2022
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35. Restoration of portal flow with varix in liver transplantation for patients with total portal vein thrombosis: An effective strategy in the largest center experience

Author

Antonio Daniele Pinna, Matteo Cescon, Antonio Siniscalchi, Giacomo Frascaroli, Lorenzo Maroni, Enrico Prosperi, Federica Odaldi, Guido Fallani, Matteo Ravaioli, Matteo Serenari, Ravaioli M., Prosperi E., Pinna A., Siniscalchi A., Fallani G., Frascaroli G., Maroni L., Odaldi F., Serenari M., and Cescon M.

Subjects
medicine.medical_specialty, Blood transfusion, Left gastric vein, medicine.medical_treatment, portal reconstruction, 030230 surgery, Anastomosis, Liver transplantation, Varicose Veins, gastric varix, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, portal vein thrombosi, Venous Thrombosis, Transplantation, Varix, liver transplantation, Portal Vein, business.industry, Liver Neoplasms, portal hypertension, Gastric varices, medicine.disease, coronary-portal anastomosi, Portal vein thrombosis, Surgery, Liver Neoplasm, Portal hypertension, 030211 gastroenterology & hepatology, Neoplasm Recurrence, Local, business, Human, Varicose Vein
Abstract

Introduction: Postoperative complications and worse prognosis still burden liver transplantations (LT) with complex portal vein thrombosis (CPVT). When an engorged left gastric vein (LGV) is present, the portal inflow is restorable with an anastomosis between the graft portal vein and the LGV of the recipient. We analyzed short- and long-term results of this procedure in 12 LT with CPVT. Methods: Between 2005 and 2019, 55 patients with CPVT underwent LT. We applied this technique in 12 patients. In six cases, we placed a vascular graft to obtain a tension-free structure. We evaluated patency, short- and long-term results. Results: No intraoperative complication was observed. The median duration of LT, blood transfusion, deceased donor age, and MELD score of the recipients were 7h, 1250mL, 72years, and 19. Seven patients were affected by hepatocellular carcinoma. No major complications or PVT recurrence were observed. One patient required a liver re-transplantation for primary non-functioning syndrome. The mean hospital stay was 20days. The actuarial patient survival was 85% with a mean FU of 4years. The two late deaths were due to hepatocellular carcinoma recurrence and sepsis for cholangitis. Conclusions: This technique in presence of both CPVT and engorged LGV is feasible and safe for patients, with good short- and long-term results.

Published
2021
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36. Two surgical techniques are better than one: RAVAS and RAPID are answers for the same issue

Author

Antonia D'Errico, Matteo Ravaioli, Antonio Siniscalchi, Matteo Serenari, Daniel Azoulay, Federico Contedini, Giuliana Germinario, Carla Serra, Enrico Prosperi, Guido Fallani, Matteo Cerri, Matteo Cescon, Federica Odaldi, Matteo Renzulli, Lorenzo Maroni, Ravaioli M., Fallani G., Cerri M., Prosperi E., Serra C., D'Errico A., Serenari M., Germinario G., Renzulli M., Contedini F., Odaldi F., Maroni L., Siniscalchi A., Cescon M., and Azoulay D.

Subjects
medicine.medical_specialty, liver allograft function/dysfunction, medicine.medical_treatment, Splenectomy, Liver transplantation, clinical research/practice, Liver disease, liver transplantation: auxiliary, medicine, Immunology and Allergy, Hepatectomy, Regeneration, Pharmacology (medical), Transplantation, business.industry, Regeneration (biology), medicine.disease, Surgery, Liver Transplantation, Liver, liver (native) function/dysfunction, business, liver disease, liver transplantation/hepatology
Published
2021

37. Complex Liver Transplantation Using Venovenous Bypass With an Atypical Placement of the Portal Vein Cannula

Author

Federica Odaldi, Guido Fallani, Lorenzo Maroni, Enrico Prosperi, Matteo Cescon, Massimo Del Gaudio, Matteo Ravaioli, Matteo Serenari, Giuseppe Rocco, Antonio Siniscalchi, Giuliana Germinario, Rocco G., Siniscalchi A., Serenari M., Fallani G., Germinario G., Maroni L., Prosperi E., Del Gaudio M., Odaldi F., Cescon M., and Ravaioli M.

Subjects
medicine.medical_specialty, medicine.medical_treatment, Dissection (medical), 030230 surgery, Anastomosis, Liver transplantation, Abdominal wall, 03 medical and health sciences, Mesenteric Veins, 0302 clinical medicine, medicine, Cannula, Humans, Transplantation, Hepatology, liver transplantation, Portal Vein, business.industry, medicine.disease, Surgery, medicine.anatomical_structure, Splenic Vein, Splenic vein, Portal hypertension, Inferior mesenteric vein, 030211 gastroenterology & hepatology, business
Abstract

In liver transplantation (LT) medical literature, venovenous bypass (VVB) with the interposition of a venous graft attached to the inferior mesenteric vein (IMV) or to the splenic vein (SV) has not been reported previously. Here, we report the decompression of the portomesenteric compartment in 2 patients with complex cases of orthotopic LT. A femoroaxillary percutaneous VVB was installed prior to abdominal opening to decompress massive collateral veins in the abdominal wall. In the first patient, the IMV was connected to a donor vein graft with a lateroterminal anastomosis, and the distal part of the vein graft was cannulated and connected to the VVB. In the second patient, because of the excessive size of the spleen, it was necessary to perform a splenectomy to gain sufficient space in the abdomen to implant the new liver. The SV was connected to a donor vein graft with a terminoterminal anastomosis, and the distal part of the vein graft was cannulated and connected to the VVB. In both patients, the decompression of the portomesenteric compartment was crucial to reduce portal hypertension and to access the hepatic hilum, where the dissection was very complex due to previous major surgeries. In conclusion, VVB with the interposition of a venous graft attached to the IMV or to the SV during LT is a safe and simple technique, and it may be useful for patients needing VVB with no standard access to the portal compartment, particularly in the case of severe portal hypertension and re-LTs.

Published
2021

38. Hypothermic Oxygenated New Machine Perfusion System in Liver and Kidney Transplantation of Extended Criteria Donors:First Italian Clinical Trial

Author

Federica Odaldi, Massimo Del Gaudio, Maurizio Baldassarre, Guido Fallani, Vito Marco Ranieri, Antonietta D'Errico, Deborah Malvi, Lorenzo Maroni, Gianandrea Pasquinelli, Vanessa De Pace, Gaetano La Manna, Matteo Cescon, Paolo Caraceni, Matteo Ravaioli, Giuliana Germinario, Valentina Rosa Bertuzzo, Giorgia Comai, Francesco Vasuri, Antonio Daniele Pinna, Andrea Angeletti, Antonio Siniscalchi, Maria Cristina Morelli, Chiara Donadei, Ravaioli M., De Pace V., Angeletti A., Comai G., Vasuri F., Baldassarre M., Maroni L., Odaldi F., Fallani G., Caraceni P., Germinario G., Donadei C., Malvi D., Del Gaudio M., Bertuzzo V.R., Siniscalchi A., Ranieri V.M., D'Errico A., Pasquinelli G., Morelli M.C., Pinna A.D., Cescon M., and La Manna G.

Subjects
medicine.medical_specialty, medicine.medical_treatment, Urology, lcsh:Medicine, Cold storage, 030230 surgery, Liver transplantation, Kidney, Article, Kidney transplantation, 03 medical and health sciences, 0302 clinical medicine, Extended Criteria Donor, Hypothermic oxygenated machine perfusion, Medicine, lcsh:Science, Machine perfusion, Kidney diseases, Multidisciplinary, integumentary system, business.industry, lcsh:R, Kidney metabolism, medicine.disease, Clinical trial design, Transplantation, Clinical trial, nervous system, lcsh:Q, 030211 gastroenterology & hepatology, business, tissues, Perfusion
Abstract

With the aim to explore innovative tools for organ preservation, especially in marginal organs, we hereby describe a clinical trial of ex-vivo hypothermic oxygenated perfusion (HOPE) in the field of liver (LT) and kidney transplantation (KT) from Extended Criteria Donors (ECD) after brain death. A matched-case analysis of donor and recipient variables was developed: 10 HOPE-ECD livers and kidneys (HOPE-L and HOPE-K) were matched 1:3 with livers and kidneys preserved with static cold storage (SCS-L and SCS-K). HOPE and SCS groups resulted with similar basal characteristics, both for recipients and donors. Cumulative liver and kidney graft dysfunction were 10% (HOPE L-K) vs. 31.7%, in SCS group (p = 0.05). Primary non-function was 3.3% for SCS-L vs. 0% for HOPE-L. No primary non-function was reported in HOPE-K and SCS-K. Median peak aspartate aminotransferase within 7-days post-LT was significantly higher in SCS-L when compared to HOPE-L (637 vs.344 U/L, p = 0.007). Graft survival at 1-year post-transplant was 93.3% for SCS-L vs. 100% of HOPE-L and 90% for SCS-K vs. 100% of HOPE-K. Clinical outcomes support our hypothesis of machine perfusion being a safe and effective system to reduce ischemic preservation injuries in KT and in LT.

Published
2020
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39. Normothermic and hypothermic oxygenated perfusion for donation after circulatory death in kidney transplantation: Do we pay higher risk of severe infection after transplantation?: A case report

Author

Matteo Ravaioli, Anna Paola Pezzuto, Claudia Bini, Matteo Renzulli, Giorgia Comai, Lorenzo Maroni, Gaetano La Manna, Raffaele Bova, Daniele Parlanti, Guido Fallani, Giuliana Germinario, Valeria Corradetti, Federica Odaldi, Ravaioli M., Corradetti V., Renzulli M., Germinario G., Maroni L., Odaldi F., Fallani G., Pezzuto A.P., Parlanti D., Bova R., Bini C., La Manna G., and Comai G.

Subjects
Male, 030232 urology & nephrology, Delayed Graft Function, Case Report, 030230 surgery, Transplant, Infections, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, 0302 clinical medicine, Extracorporeal Membrane Oxygenation, Renal Artery, medicine.artery, Candida krusei, Risk of mortality, Medicine, Humans, lcsh:RC109-216, Arteritis, Warm Ischemia, Renal artery, Kidney transplantation, Warm Ischemia Time, business.industry, Cold Ischemia, Graft Survival, Organ Preservation, Middle Aged, medicine.disease, Kidney Transplantation, Arteriti, Tissue Donors, Transplantation, Perfusion, Infectious Diseases, Treatment Outcome, Italy, Mycoses, Anesthesia, Pseudomonas aeruginosa, business, Complication, Infection, Follow-Up Studies
Abstract

Background Normothermic and hypothermic oxygenated perfusion for donation after circulatory death in kidney transplantation are becoming popular in Italy, with the purpose of reducing the risk of primary non function and delayed graft function due to the prolonged warm ischemia time. Potential complications related to these procedures are currently under investigation and are continuously emerging with the increasing experience. Post-operative infections - in particular graft arteritis - are a rare complication but determine high risk of mortality and of graft loss. The acute onset of the arterial complications makes it very difficult to find an effective treatment, and early diagnosis is crucial for saving both patient and graft. Prevention of such infections in this particular setting are advisable. Case presentation We present a patient with an acute arterial rupture after transplantation of a DCD graft treated in-vivo hypothermic oxygenated perfusion. The cause was a severe arteritis of the renal artery caused by Candida krusei and Pseudomonas aeruginosa. We discussed our treatment and we compared it to the other reported series. Conclusion Fungal infections in DCD transplant may be treacherous and strategies to prevent them should be advocated.

Published
2020

40. Hypothermic Oxygenated Perfusion Versus Static Cold Storage for Expanded Criteria Donors in Liver and Kidney Transplantation: Protocol for a Single-Center Randomized Controlled Trial

Author

Matteo Ravaioli, Francesco Vasuri, Maria Cristina Morelli, Valeria Corradetti, Massimo Del Gaudio, Vanessa De Pace, Chiara Zanfi, Antonia D'Errico, Andrea Angeletti, Guido Fallani, Valentina Rosa Bertuzzo, Maurizio Baldassarre, Giorgia Comai, Lorenzo Maroni, Antonio Siniscalchi, Federica Odaldi, Paolo Caraceni, Anna Rossetto, Vito Marco Ranieri, Gabriela Sangiorgi, Gaetano La Manna, Matteo Cescon, Giuliana Germinario, Ravaioli M., Maroni L., Angeletti A., Fallani G., De Pace V., Germinario G., Odaldi F., Corradetti V., Caraceni P., Baldassarre M., Vasuri F., D'Errico A., Sangiorgi G., Siniscalchi A., Morelli M.C., Rossetto A., Ranieri V.M., Cescon M., Del Gaudio M., Zanfi C., Bertuzzo V., Comai G., and La Manna G.

Subjects
medicine.medical_specialty, medicine.medical_treatment, Cold storage, kidney transplantation, 030230 surgery, Liver transplantation, Organ graft, Cold Ischemia Time, perfusion, 03 medical and health sciences, 0302 clinical medicine, organ transplants, Protocol, Medicine, Kidney transplantation, Kidney, Machine perfusion, clinical trials, liver transplantation, business.industry, temperature, General Medicine, medicine.disease, organ grafts, Organ transplant, Surgery, Clinical trial, Transplantation, medicine.anatomical_structure, randomized, 030211 gastroenterology & hepatology, business, hypothermia
Abstract

Background Extended criteria donors (ECD) are widely utilized due to organ shortage, but they may increase the risk of graft dysfunction and poorer outcomes. Hypothermic oxygenated perfusion (HOPE) is a recent organ preservation strategy for marginal kidney and liver grafts, allowing a redirect from anaerobic metabolism to aerobic metabolism under hypothermic conditions and protecting grafts from oxidative species–related damage. These mechanisms may improve graft function and survival. Objective With this study, we will evaluate the benefit of end-ischemic HOPE on ECD grafts for livers and kidneys as compared to static cold storage (SCS). The aim of the study is to demonstrate the ability of HOPE to improve graft function and postoperative outcomes of ECD kidney and liver recipients. Methods This is an open-label, single-center randomized clinical trial with the aim of comparing HOPE with SCS in ECD kidney and liver transplantation. In the study protocol, which has been approved by the ethics committee, 220 patients (110 liver recipients and 110 kidney recipients) will be enrolled. Livers and kidneys assigned to the HOPE group undergo machine perfusion with cold Belzer solution (4-10°C) and continuous oxygenation (partial pressure of oxygen of 500-600 mm Hg). In the control group, livers and kidneys undergoing SCS are steeped in Celsior solution and stored on ice. Using the same perfusion machine for both liver and kidney grafts, organs are perfused from the start of the back-table procedure until implantation, without increasing the cold ischemia time. For each group, we will evaluate clinical outcomes, graft function tests, histologic findings, perfusate, and the number of allocated organs. Publication of the results is expected to begin in 2021. Results Dynamic preservation methods for organs from high-risk donors should improve graft dysfunction after transplantation. To date, we have recruited 108 participants. The study is ongoing, and recruitment of participants will continue until January 2020. Conclusions The proposed preservation method should improve ECD graft function and consequently the postoperative patient outcomes. Trial Registration ClinicalTrials.gov NCT03837197; https://clinicaltrials.gov/ct2/show/NCT03837197 ; Archived by WebCite® at http://www.webcitation.org/76fSutT3R International Registered Report Identifier (IRRID) DERR1-10.2196/13922

Published
2019

41. The impact of extent of pancreatic and venous resection on survival for patients with pancreatic cancer

Author

Matteo Cescon, Enrico Prosperi, Giorgio Ercolani, Raffaele Lombardi, Guido Fallani, Matteo Serenari, Elio Jovine, Michele Masetti, Matteo Zanello, Alessandro Cucchetti, and Serenari M, Ercolani G, Cucchetti A, Zanello M, Prosperi E, Fallani G, Masetti M, Lombardi R, Cescon M, Jovine E

Subjects
Male, Multivariate analysis, Time Factors, Databases, Factual, medicine.medical_treatment, Mesenteric Vein, 030230 surgery, Gastroenterology, 0302 clinical medicine, Retrospective Studie, Risk Factors, Portal Vein, Pancreatic Neoplasm, Pancreatic cancer surgery, Margins of Excision, Middle Aged, Pancreaticoduodenectomy, Vascular resection, Treatment Outcome, Adenocarcinoma, 030211 gastroenterology & hepatology, Female, Human, Carcinoma, Pancreatic Ductal, medicine.medical_specialty, Time Factor, Pancreatic resection, Risk Assessment, 03 medical and health sciences, Mesenteric Veins, Pancreatectomy, Internal medicine, Pancreatic cancer, medicine, Humans, Superior mesenteric vein, Aged, Retrospective Studies, Hepatology, Proportional hazards model, business.industry, Risk Factor, Retrospective cohort study, Perioperative, medicine.disease, digestive system diseases, Pancreatic Neoplasms, business
Abstract

Background Borderline resectable pancreatic cancer may require extended resections in order to achieve tumor-free margins, especially in the case of up-front resections, but it is important to know the limits of surgical therapy in this disease. This study aimed to investigate the impact of extent of pancreatic and venous resection on short- and long-term outcomes in patients with pancreatic adenocarcinoma (PDAC). Methods This was a retrospective study from a prospectively maintained database of pancreatic resections for PDAC. Short- and long-term outcomes were analyzed in patients having borderline resectable PDAC submitted to up-front total pancreatectomy (TP) or pancreaticoduodenectomy (PD) with simultaneous portal vein (PV) and/or superior mesenteric vein (SMV) resection. Venous resections were carried out as tangential venous resection (TVR) or segmental venous resection (SVR). Patients were divided into 4 groups: (1) PD + TVR, (2) PD + SVR, (3) TP + TVR, (4) TP + SVR. Uni- and multivariate Cox regression analysis were performed to identify factors associated with survival. Results Ninety-nine patients were submitted to simultaneous pancreatic and venous resection for PDAC. Among them, 25 were submitted to PD + TVR (25.3%), 12 to PD + SVR (12.1%), 23 to TP + TVR (23.2%), and 39 to TP + SVR (39.4%). Overall, major morbidity (Clavien-Dindo grade ≥ IIIA) was 26.3%. Thirty- and 90-day mortality were 3% and 11.1%, respectively. There were no significant differences among groups in terms of short-term outcomes. Median overall survival of patients submitted to PD + TVR was significantly higher than those to TP+SVR (29.5 vs 7.9 months, P = 0.001). Multivariate analysis identified TP (HR = 2.11; 95% CI: 1.31–3.44; P = 0.002) and SVR (HR = 2.01; 95% CI: 1.27–3.15; P = 0.003) as the only independent prognostic factors for overall survival. Conclusions Up-front TP associated to SVR was predictive of worse survival in borderline resectable PDAC. Perioperative treatments in high-risk surgical groups may improve such poor outcomes.

Published
2019

42. Burnout and psychological distress between surgical and non-surgical residents

Author

Alessandro Cucchetti, Katia Mattarozzi, Matteo Cescon, Valentina Colonnello, Guido Fallani, Gilberto Poggioli, Matteo Serenari, Paolo Maria Russo, Antonio Daniele Pinna, Serenari M., Cucchetti A., Russo P.M., Fallani G., Mattarozzi K., Pinna A.D., Colonnello V., Poggioli G., and Cescon M.

Subjects
Adult, Male, medicine.medical_specialty, Students, Medical, Depression scale, education, 030230 surgery, Burnout, Burnout, Psychological, Stress, Psychological Distress, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Depersonalization, medicine, Prevalence, Humans, Emotional exhaustion, Depression (differential diagnoses), Resident, business.industry, Psychological distress, Internship and Residency, Surgical training, Surgery, Education, Medical, Graduate, 030220 oncology & carcinogenesis, General Surgery, Female, medicine.symptom, business, Clinical psychology
Abstract

Surgical training is considered to be very stressful among residents and medical students choose less often surgery for their career. Our aim was to assess the prevalence of burnout and psychological distress in residents attending surgical specialties (SS) compared to non-surgical specialties (NSS). Residents from the University of Bologna were asked to participate in an anonymous online survey. The residents completed a set of questions regarding their training schedule and three standardized questionnaires: (1) the Maslach Burnout Inventory, assessing the three dimensions of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA); (2) the Zung Self-Rating Depression Scale; (3) the Psychosomatic Problems Scale. One-hundred and ninety residents completed the survey. Overall, the prevalence of burnout was 73% in the SS group and 56.3% in the NSS group (P = 0.026). More specifically, SS reported higher levels of EE and DP compared to NSS. No significant differences between SS and NSS emerged for PA, depression, or somatic problems. The present findings indicate that burnout is more prevalent in surgical residents than in residents attending non-surgical specialties. ClinicalTrials.gov identifier: NCT03668080.

Published
2018

43. Achievement of textbook outcome after hepatectomy combined with thermal ablation for colorectal liver metastases.

Author

Serenari M, Ratti F, Stocco A, De Cobelli F, Serra C, Santangelo D, Fallani G, Della Corte A, Marino R, Ravaioli M, Aldrighetti L, and Cescon M

Subjects
Humans, Female, Male, Middle Aged, Aged, Treatment Outcome, Radiofrequency Ablation methods, Retrospective Studies, Catheter Ablation methods, Microwaves therapeutic use, Liver Neoplasms secondary, Liver Neoplasms surgery, Hepatectomy methods, Colorectal Neoplasms pathology, Colorectal Neoplasms surgery
Abstract

Background: Hepatic resection combined with intraoperative ablation has been described as a technical solution potentially widening the resectability rate of patients with colorectal liver metastases (CRLM). Nevertheless, the perioperative and oncological benefit provided by this combined approach remains unclear. We hypothesized that textbook outcome (TO), which is a composite measure achieved for patients for whom some desired health indicators are met, may help to refine the indications of this approach., Methods: Patients submitted to hepatectomy with curative intent in combination with radiofrequency ablation or microwave ablation for CRLM ≤ 3 cm in two tertiary referral centers were included. TO was defined according to a recent definition for liver surgery based on a Delphi process including also the achievement of complete radiological response of the ablated lesion/s at 4 weeks., Results: Between 2015 and 2022, 112 patients were enrolled. Among them, 63 (56.2%) achieved a TO. According to multivariate analysis, minimally invasive (MI) approach (OR 2.72, 95% CI 0.99-7.48, p = 0.050), simultaneous CR resection (OR 0.28, 95% CI 0.11-0.70, p = 0.007), tumor burden score (OR 0.89, 95% CI 0.82-0.96, p = 0.004), and major hepatectomy (OR 0.12, 95% CI 0.03-0.52, p = 0.004) were significantly associated with the achievement of TO. Median overall survival was longer in those patients who were able to achieve a TO compared to those who did not., Conclusions: The combination of hepatectomy and ablation constitutes a valuable solution in patients affected by multiple CRLM and it may provide, also using a MI approach, adequate perioperative and oncological outcomes, allowing to achieve TO, however, in a selected number of patients and depending on several factors including the burden of disease., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Published
2024
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44. The Importance of Multiorgan Procurement in the Improvement of Residents' Open Surgical Skills.

Author

Serenari M, Lenzi J, Ricci C, Odaldi F, Maroni L, Laurenzi A, Prosperi E, Bonatti C, Fallani G, Caputo F, Rottoli M, Ravaioli M, and Cescon M

Subjects
Clinical Competence, Abdomen, Learning, Internship and Residency, Transplants, General Surgery education
Abstract

Introduction: The multiorgan procurement (MOP) represents a chance for the general surgery resident to learn the fundamental steps of open abdominal surgery. The objective of this study was to evaluate the impact of MOP on the residents' open surgical skills., Methods: Residents' surgical skills were assessed during a 6-month transplant rotation (October 2020-March 2021) using a modified Objective Structured Assessment of Technical Skills with the global rating scale. The surgeries were self-assessed by residents and tutors based on 9 specific steps (SS) and 4 general skills (GS). Each item was rated from 1 (poor) to 5 (excellent) with a maximum score of 45 points for SS and 20 for GS. A crossed-effects linear regression analysis was performed both to evaluate any associations between GS/SS scores and some prespecified covariates, and to study differences in the assessments performed by residents and tutors., Results: Residents actively participated in a total of 59 procurements. In general, there were no significant differences in SS/GS mean scorings between residents (n = 15) and tutors (n = 5). There was a significantly positive association between mean GS/SS scorings and the number of donor surgeries performed (at least 5). Comparing the evaluations of the tutors with the residents, this significance was retained only when scorings were assigned by the tutors., Conclusions: MOP was shown to improve basic open surgical skills among residents. Awareness of the utility of a clinical rotation in transplant surgery should be raised also on an institutional level., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Published
2024
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45. Beyond the Concepts of Elder and Marginal in DCD Liver Transplantation: A Prospective Observational Matched-Cohort Study in the Italian Clinical Setting.

Author

Fallani G, Stocco A, Siniscalchi A, Antonini MV, Stella AP, Amato A, Prosperi E, Turco L, Morelli MC, Cescon M, and Ravaioli M

Subjects
Aged, Humans, Cohort Studies, Prospective Studies, Living Donors, Death, Liver Transplantation
Abstract

Donation after circulatory determination of death (DCD) is a valuable strategy to increase the availability of grafts for liver transplantation (LT). As the average age of populations rises, the donor pool is likely to be affected by a potential increase in DCD donor age in the near future. We conducted a prospective cohort study to evaluate post-transplantation outcomes in recipients of grafts from elderly DCD donors compared with younger DCD donors, and elderly donors after brainstem determination of death (DBD). From August 2020 to May 2022, consecutive recipients of deceased donor liver-only transplants were enrolled in the study. DCD recipients were propensity score matched 1:3 to DBD recipients. One-hundred fifty-seven patients were included, 26 of whom (16.6%) were transplanted with a DCD liver graft. After propensity score matching and stratification, three groups were obtained: 15 recipients of DCD donors ≥75 years, 11 recipients of DCD donors <75 years, and 28 recipients of DBD donors ≥75 years. Short-term outcomes, as well as 12 months graft survival rates (93.3%, 100%, and 89.3% respectively), were comparable among the groups. LT involving grafts retrieved from very elderly DCD donors was feasible and safe in an experienced high-volume center, with outcomes comparable to LTs from younger DCD donors and age-matched DBD donors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Fallani, Stocco, Siniscalchi, Antonini, Stella, Amato, Prosperi, Turco, Morelli, Cescon and Ravaioli.)

Published
2023
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46. VA-ECMO Cardiac Support During Liver Transplant: A Case Report.

Author

Siniscalchi A, Laici C, Facciotto L, Vitale G, Fallani G, Ravaioli M, and Bianchini A

Subjects
Humans, Tricuspid Valve, Retrospective Studies, Extracorporeal Membrane Oxygenation, Liver Transplantation, Cardiac Surgical Procedures, Heart Failure surgery
Abstract

Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for cardiovascular collapse during and after liver transplantation (LT). According to the most recent guidelines, patients with severe cardiomyopathy are excluded from LT because of high-mortality risk during surgery. Intraoperative ECMO support could give these patients the opportunity to undergo LT by reducing the risk of heart failure and reperfusion syndrome. In this case report, we present a case of veno-arterial ECMO (VA-ECMO) support started before LT surgery in a patient with severe pulmonary hypertension, mitral valve steno-insufficiency, and right heart dysfunction. The presence of severe heart disease would have contraindicated LT, but simultaneous liver cirrhosis contraindicated mitral valve surgery, leaving the patient locked in a "Catch-22" state. The best solution was to perform LT with VA-ECMO support before, during, and after the surgery to reduce cardiac load and possible heart failure. LT was performed with good hemodynamic stability and the patient was successfully weaned from ECMO a few hours after surgery. At the 6 month follow-up, normal liver and kidney functions were recorded as well as an overall improvement of heart function; the patient successfully underwent mitral valve replacement and tricuspid annuloplasty 10 months after transplant and is now in good condition., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © ASAIO 2023.)

Published
2023
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47. Renal Vessel Extension With Cryopreserved Vascular Grafts: Overcoming Surgical Pitfalls in Living Donor Kidney Transplant.

Author

Fallani G, Maroni L, Bonatti C, Comai G, Buzzi M, Cuna V, Vasuri F, Caputo F, Prosperi E, Pisani F, Pisillo B, Maurino L, Odaldi F, Bertuzzo VR, Tondolo F, Busutti M, Zanfi C, Del Gaudio M, La Manna G, and Ravaioli M

Subjects
Humans, Living Donors, Graft Survival, Kidney surgery, Nephrectomy methods, Kidney Transplantation methods
Abstract

In LDKT, right kidneys and kidneys with anomalous vascularization are often deferred because of concerns on complications and vascular reconstructions. To date, only few reports have examined renal vessel extension with cryopreserved vascular grafts in LDKT. The aim of this study is to investigate the effect of renal vessel extension on short-term outcomes and ischemia times in LDKT. From 2012 to 2020, recipients of LDKT with renal vessels extension were compared with standard LDKT recipients. Subset analysis of rights grafts and grafts with anomalous vascularization, with or without renal vessel extension, was performed. Recipients of LDKT with ( n = 54) and without ( n = 91) vascular extension experienced similar hospital stays, surgical complications and DGF rates. For grafts with multiple vessels, renal vessel extension granted a faster implantation time (44±5 vs. 72±14 min), which resulted comparable to that of standard anatomy grafts. Right kidney grafts with vascular extension had a faster implantation time compared to right kidney grafts without vascular lengthening (43±5 vs. 58±9 min), and a comparable implantation time to left kidney grafts. Renal vessel extension with cryopreserved vascular grafts allows faster implantation time in right kidney grafts or grafts with anomalous vascularization, maintaining similar surgical and functional outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Fallani, Maroni, Bonatti, Comai, Buzzi, Cuna, Vasuri, Caputo, Prosperi, Pisani, Pisillo, Maurino, Odaldi, Bertuzzo, Tondolo, Busutti, Zanfi, Del Gaudio, La Manna and Ravaioli.)

Published
2023
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48. Planned Extracorporeal Life Support Employment during Liver Transplantation: The Potential of ECMO and CRRT as Preventive Therapies-Case Reports and Literature Review.

Author

Laici C, Bianchini A, Miglionico N, Bambagiotti N, Vitale G, Fallani G, Ravaioli M, and Siniscalchi A

Abstract

Liver Transplantation (LT) has become the gold standard treatment for End-Stage Liver Disease (ESLD). One of the main strategies to manage life-threatening complications, such as cardio-respiratory failure, is Extracorporeal Membrane Oxygenation (ECMO) in the peri-transplantation period, with different configurations of the technique and in combination with other extracorporeal care devices such as Continuous Renal Replacement Therapy (CRRT). This retrospective study includes three clinical cases of planned ECMO support strategies in LT and evaluates their application compared with current literature exploring PubMed/Medline. The three LT supported with ECMO and CRRT were performed at IRCCS Polyclinic S. Orsola-Malpighi, Bologna. All three cases of patients with compromised organ function analysed produced positive outcomes. The planned use of ECMO and CRRT support in peri-transplantation has allowed the patients to overcome contraindications and successfully undergo LT. In recent years, only a few reports have documented successful LT outcomes performed with intraoperative ECMO in critically ESLD patients. However, the management of LT with ECMO and/or CRRT assistance is an emerging challenge, with the need for more published evidence on this topic to guide treatment choices in patients with severe, acute and reversible respiratory and cardiovascular failure after LT.

Published
2023
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50. Minimally invasive treatment of colorectal liver metastases: does robotic surgery provide any technical advantages over laparoscopy? A multicenter analysis from the IGoMILS (Italian Group of Minimally Invasive Liver Surgery) registry.

Author

Masetti M, Fallani G, Ratti F, Ferrero A, Giuliante F, Cillo U, Guglielmi A, Ettorre GM, Torzilli G, Vincenti L, Ercolani G, Cipressi C, Lombardi R, Aldrighetti L, and Jovine E

Subjects
Humans, Length of Stay, Margins of Excision, Minimally Invasive Surgical Procedures, Postoperative Complications epidemiology, Postoperative Complications surgery, Registries, Retrospective Studies, Treatment Outcome, Colorectal Neoplasms surgery, Laparoscopy, Liver Neoplasms secondary, Liver Neoplasms surgery, Robotic Surgical Procedures
Abstract

Surgery has been the mainstay treatment for colorectal liver metastases (CRLM). Although the benefits of a laparoscopic approach have been evidenced by several comparative studies, the comparison between robotic and laparoscopic liver surgery has not been elucidated. Thus, in this study, we aim to analyze the short-term outcomes of a multicenter population that underwent robotic versus laparoscopic liver resection for CRLM. Consecutive patients with CRLM who were enrolled in the IGoMILS registry between November 2014 and June 2019 were retrospectively evaluated to compare robot-assisted procedures with laparoscopic procedures. Primary outcomes were postoperative morbidity and mortality, while secondary outcomes were length of hospital stay, operative time, and histological features of the surgical specimen. The effect size of surgical technique on resection margins was quantified using Hedges' g. In total, 1030 patients underwent minimally invasive liver surgery (MILS) for CRLM; of these, 77 (7.5%) underwent a robot-assisted approach (R-MILS), whereas 953 (92.5%) underwent a laparoscopic approach (L-MILS). Laparoscopy and robot-assisted surgery were comparable in terms of postoperative outcomes: specifically, complication rates, Comprehensive Complication Index (CCI ® ), intraoperative blood loss, conversion rate, operative time, and length of hospital stay did not differ significantly between the two groups. R-MILS showed a reduced rate of R1 resection margins (19.9 vs. 28.8%, p = 0.025) and wider surgical margins compared with L-MILS (8 vs. 3 mm, p < 0.001). The effect size of robot-assisted surgery was increased for posterosuperior lesions (g = 0.78) and difficult procedures (g = 1.92). As per our findings, it was determined that robot-assisted liver surgery offers some technical advantages over conventional laparoscopy, maintaining the benefits of minimally invasive surgery on short-term outcomes., (© 2022. Italian Society of Surgery (SIC).)

Published
2022
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