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1. How useful is the machine perfusion in liver transplantation? An answer from a national survey

Author

Scalera, I, De Carlis, R, Patrono, D, Gringeri, E, Olivieri, T, Pagano, D, Lai, Q, Rossi, M, Gruttadauria, S, Di Benedetto, F, Cillo, U, Romagnoli, R, Lupo, L, De Carlis, L, Scalera I., De Carlis R., Patrono D., Gringeri E., Olivieri T., Pagano D., Lai Q., Rossi M., Gruttadauria S., Di Benedetto F., Cillo U., Romagnoli R., Lupo L. G., De Carlis L., Scalera, I, De Carlis, R, Patrono, D, Gringeri, E, Olivieri, T, Pagano, D, Lai, Q, Rossi, M, Gruttadauria, S, Di Benedetto, F, Cillo, U, Romagnoli, R, Lupo, L, De Carlis, L, Scalera I., De Carlis R., Patrono D., Gringeri E., Olivieri T., Pagano D., Lai Q., Rossi M., Gruttadauria S., Di Benedetto F., Cillo U., Romagnoli R., Lupo L. G., and De Carlis L.

Abstract

Machine perfusion (MP) has been shown worldwide to offer many advantages in liver transplantation, but it still has some gray areas. The purpose of the study is to evaluate the donor risk factors of grafts, perfused with any MP, that might predict an ineffective MP setting and those would trigger post-transplant early allograft dysfunction (EAD). Data from donors of all MP-perfused grafts at six liver transplant centers have been analyzed, whether implanted or discarded after perfusion. The first endpoint was the negative events after perfusion (NegE), which is the number of grafts discarded plus those that were implanted but lost after the transplant. A risk factor analysis for NegE was performed and marginal grafts for MP were identified. Finally, the risk of EAD was analyzed, considering only implanted grafts. From 2015 to September 2019, 158 grafts were perfused with MP: 151 grafts were implanted and 7 were discarded after the MP phase because they did not reach viability criteria. Of 151, 15 grafts were lost after transplant, so the NegE group consisted of 22 donors. In univariate analysis, the donor risk index >1.7, the presence of hypertension in the medical history, static cold ischemia time, and the moderate or severe macrovesicular steatosis were the significant factors for NegE. Multivariate analysis confirmed that macrosteatosis >30% was an independent risk factor for NegE (odd ratio 5.643, p = 0.023, 95% confidence interval, 1.27–24.98). Of 151 transplanted patients, 34% experienced EAD and had worse 1- and 3-year-survival, compared with those who did not face EAD (NoEAD), 96% and 96% for EAD vs. 89% and 71% for NoEAD, respectively (p = 0.03). None of the donor/graft characteristics was associated with EAD even if the graft was moderately steatotic or fibrotic or from an aged donor. For the first time, this study shows that macrovesicular steatosis >30% might be a warning factor involved in the risk of graft loss or a cause of graft discard aft

Published
2022

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

Author

De Carlis, R, Lauterio, A, Centonze, L, Buscemi, V, Schlegel, A, Muiesan, P, De Carlis, L, Carraro, A, Ghinolfi, D, De Simone, P, Ravaioli, M, Cescon, M, Dondossola, D, Bongini, M, Mazzaferro, V, Pagano, D, Gruttadauria, S, Gringeri, E, Cillo, U, Patrono, D, Romagnoli, R, Camagni, S, Colledan, M, Olivieri, T, Di Benedetto, F, Vennarecci, G, Baccarani, U, Lai, Q, Rossi, M, Manzia, T, 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

3. TIPS under-dilation strategy with new controlled expansion endoprosthesis: A hemodynamic and imaging confirmation of its feasibility

Author

Saltini, D., primary, Caporali, C., additional, Indulti, F., additional, Casari, F., additional, Prampolini, F., additional, Felaco, D., additional, Battinelli, G., additional, Bianchini, M., additional, Guasconi, T., additional, Cuffari, B., additional, Zanetto, A., additional, Olivieri, T., additional, Assirati, G., additional, Serra, V., additional, Catellani, B., additional, Guidetti, C., additional, Guerrini, G.P., additional, Ballarin, R., additional, Magistri, P., additional, De Maria, N., additional, Di Sandro, S., additional, Torricelli, P., additional, Girardis, M., additional, Villa, E., additional, Colecchia, A., additional, Di Benedetto, F., additional, and Schepis, F., additional

Published
2023
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4. How useful is the machine perfusion in liver transplantation? An answer from a national survey

Author

Scalera, Irene, primary, De Carlis, R., additional, Patrono, D., additional, Gringeri, E., additional, Olivieri, T., additional, Pagano, D., additional, Lai, Q., additional, Rossi, M., additional, Gruttadauria, S., additional, Di Benedetto, F., additional, Cillo, U., additional, Romagnoli, R., additional, Lupo, L. G., additional, and De Carlis, L., additional

Published
2022
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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. 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

7. How to preserve liver grafts from circulatory death with long warm ischemia? a retrospective italian cohort study with normothermic regional perfusion and hypothermic oxygenated perfusion

Author

De Carlis, R, Schlegel, A, Frassoni, S, Olivieri, T, Ravaioli, M, Camagni, S, Patrono, D, Bassi, D, Pagano, D, Di Sandro, S, Lauterio, A, Bagnardi, V, Gruttadauria, S, Cillo, U, Romagnoli, R, Colledan, M, Cescon, M, Di Benedetto, F, Muiesan, P, De Carlis, L, De Carlis R., Schlegel A., Frassoni S., Olivieri T., Ravaioli M., Camagni S., Patrono D., Bassi D., Pagano D., Di Sandro S., Lauterio A., Bagnardi V., Gruttadauria S., Cillo U., Romagnoli R., Colledan M., Cescon M., Di Benedetto F., Muiesan P., De Carlis L., De Carlis, R, Schlegel, A, Frassoni, S, Olivieri, T, Ravaioli, M, Camagni, S, Patrono, D, Bassi, D, Pagano, D, Di Sandro, S, Lauterio, A, Bagnardi, V, Gruttadauria, S, Cillo, U, Romagnoli, R, Colledan, M, Cescon, M, Di Benedetto, F, Muiesan, P, De Carlis, L, De Carlis R., Schlegel A., Frassoni S., Olivieri T., Ravaioli M., Camagni S., Patrono D., Bassi D., Pagano D., Di Sandro S., Lauterio A., Bagnardi V., Gruttadauria S., Cillo U., Romagnoli R., Colledan M., Cescon M., Di Benedetto F., Muiesan P., and De Carlis L.

Abstract

Background. Donation after circulatory death (DCD) in Italy, given its 20-min stand-off period, provides a unique bench test for normothermic regional perfusion (NRP) and dual hypothermic oxygenated machine perfusion (D-HOPE). Methods. We coordinated a multicenter retrospective Italian cohort study with 44 controlled DCD donors, who underwent NRP, to present transplant characteristics and results. To rank our results according to the high donor risk, we matched and compared a subgroup of 37 controlled DCD livers, preserved with NRP and D-HOPE, with static-preserved controlled DCD transplants from an established European program. Results. In the Italian cohort, D-HOPE was used in 84% of cases, and the primary nonfunction rate was 5%. Compared with the matched comparator group, the NRP + D-HOPE group showed a lower incidence of moderate and severe acute kidney injury (stage 2: 8% versus 27% and stage 3: 3% versus 27%; P = 0.001). Ischemic cholangiopathy remained low (2-y proportion free: 97% versus 92%; P = 0.317), despite the high-risk profile resulting from the longer donor warm ischemia in Italy (40 versus 18 min; P < 0.001). Conclusions. These data suggest that NRP and D-HOPE yield good results in DCD livers with prolonged warm ischemia.

Published
2021

8. Robotic liver resection versus percutaneous ablation for early hcc: Short-and long-term results

Author

Magistri, P, Catellani, B, Frassoni, S, Guidetti, C, Olivieri, T, Assirati, G, Caporali, C, Pecchi, A, Serra, V, Ballarin, R, Guerrini, G, Bagnardi, V, Di Sandro, S, Di Benedetto, F, Magistri P., Catellani B., Frassoni S., Guidetti C., Olivieri T., Assirati G., Caporali C., Pecchi A., Serra V., Ballarin R., Guerrini G. P., Bagnardi V., Di Sandro S., Di Benedetto F., Magistri, P, Catellani, B, Frassoni, S, Guidetti, C, Olivieri, T, Assirati, G, Caporali, C, Pecchi, A, Serra, V, Ballarin, R, Guerrini, G, Bagnardi, V, Di Sandro, S, Di Benedetto, F, Magistri P., Catellani B., Frassoni S., Guidetti C., Olivieri T., Assirati G., Caporali C., Pecchi A., Serra V., Ballarin R., Guerrini G. P., Bagnardi V., Di Sandro S., and Di Benedetto F.

Abstract

Background: The correct approach for early hepatocellular carcinoma (HCC) is debatable, since multiple options are currently available. Percutaneous ablation (PA) is associated in some series to reduced morbidity compared to liver resection (LR); therefore, minimally invasive surgery may play a significant role in this setting. Methods: All consecutive patients treated by robotic liver resection (RLR) or PA between January 2014 and October 2019 for a newly diagnosed single HCC, less than 3 cm in size (very early/early stages according to the Barcelona Clinic Liver Cancer (BCLC)) on chronic liver disease or liver cirrhosis, were enrolled in this retrospective study. The aim of this study was to compare short-and long-term outcomes to define the best approach in this specific cohort. Results: 60 patients fulfilled the inclusion criteria: 24 RLR and 36 PA. The two populations were homogeneous in terms of baseline characteristics. There were no statistically significant differences regarding the incidence of postoperative morbidity (RLR 38% vs. PA 19%, p = 0.15). The cumulative incidence of recurrence (CIR) was significantly higher in patients who underwent PA, with the one, two, and three years of CIR being 42%, 69%, and 73% in the PA group and 17%, 27%, and 27% in the RLR group, respectively. Conclusions: RLR provides a significantly higher potential of cure and tumor-related free survival in cases of newly diagnosed single HCCs smaller than 3 cm. Therefore, it can be considered as a first-line approach for the treatment of patients with those characteristics in high-volume centers with extensive experience in the field of hepatobiliary surgery and minimally invasive approaches.

Published
2020

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

Author

Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Schlegel, Andrea, van Reeven, Marjolein, Croome, Kristopher, Parente, Alessandro, Dolcet, Annalisa, Widmer, Jeannette, Meurisse, Nicolas, De Carlis, Riccardo, Hessheimer, Amelia, Jochmans, Ina, Mueller, Matteo, van Leeuwen, Otto B, Nair, Amit, Tomiyama, Koji, Sherif, Ahmed, Elsharif, Mohamed, Kron, Philipp, van der Helm, Danny, Borja-Cacho, Daniel, Bohorquez, Humberto, Germanova, Desislava, Dondossola, Daniele, Olivieri, Tiziana, Camagni, Stefania, Gorgen, Andre, Patrono, Damiano, Cescon, Matteo, Croome, Sarah, Panconesi, Rebecca, Flores Carvalho, Mauricio, Ravaioli, Matteo, Caicedo, Juan Carlos, Loss, George, Lucidi, Valerio, Sapisochin, Gonzalo, Romagnoli, Renato, Jassem, Wayel, Colledan, Michele, De Carlis, Luciano, Rossi, Giorgio, Di Benedetto, Fabrizio, Miller, Charles M, van Hoek, Bart, Attia, Magdy, Lodge, Peter, Hernandez-Alejandro, Roberto, Detry, Olivier, Quintini, Cristiano, Oniscu, Gabriel C, Fondevila, Constantino, Malagó, Massimo, Pirenne, Jacques, IJzermans, Jan Nm, Porte, Robert J, Dutkowski, Philipp, Taner, C Burcin, Heaton, Nigel, Clavien, Pierre-Alain, Polak, Wojciech G, Muiesan, Paolo, Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Schlegel, Andrea, van Reeven, Marjolein, Croome, Kristopher, Parente, Alessandro, Dolcet, Annalisa, Widmer, Jeannette, Meurisse, Nicolas, De Carlis, Riccardo, Hessheimer, Amelia, Jochmans, Ina, Mueller, Matteo, van Leeuwen, Otto B, Nair, Amit, Tomiyama, Koji, Sherif, Ahmed, Elsharif, Mohamed, Kron, Philipp, van der Helm, Danny, Borja-Cacho, Daniel, Bohorquez, Humberto, Germanova, Desislava, Dondossola, Daniele, Olivieri, Tiziana, Camagni, Stefania, Gorgen, Andre, Patrono, Damiano, Cescon, Matteo, Croome, Sarah, Panconesi, Rebecca, Flores Carvalho, Mauricio, Ravaioli, Matteo, Caicedo, Juan Carlos, Loss, George, Lucidi, Valerio, Sapisochin, Gonzalo, Romagnoli, Renato, Jassem, Wayel, Colledan, Michele, De Carlis, Luciano, Rossi, Giorgio, Di Benedetto, Fabrizio, Miller, Charles M, van Hoek, Bart, Attia, Magdy, Lodge, Peter, Hernandez-Alejandro, Roberto, Detry, Olivier, Quintini, Cristiano, Oniscu, Gabriel C, Fondevila, Constantino, Malagó, Massimo, Pirenne, Jacques, IJzermans, Jan Nm, Porte, Robert J, Dutkowski, Philipp, Taner, C Burcin, Heaton, Nigel, Clavien, Pierre-Alain, Polak, Wojciech G, and Muiesan, Paolo

Abstract

Background & Aims: The concept of benchmarking is established in the field of transplant surgery; however, benchmark values for donation after circulatory death (DCD) liver transplantation are not available. Thus, we aimed to identify the best possible outcomes in DCD liver transplantation and to propose outcome reference values. Methods: Based on 2,219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1,012 low-risk, primary, adult liver transplantations with a laboratory MELD score of ≤20 points, receiving a DCD liver with a total donor warm ischemia time of ≤30 minutes and asystolic donor warm ischemia time of ≤15 minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the comprehensive complication index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered. Results: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centres. The 1-year retransplant and mortality rates were 4.5% and 8.4% in the benchmark group, respectively. Within the first year of follow-up, 51.1% of recipients developed at least 1 major complication (≥Clavien-Dindo-Grade III). Benchmark cut-offs were ≤3 days and ≤16 days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade III), ≤16.8% for ischemic cholangiopathy, and ≤38.9 CCI points 1 year after transplant. Comparisons with higher risk groups showed more complications and impaired graft survival outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk. Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk grou

Published
2022

10. Robotic Liver Resection Versus Percutaneous Ablation for Early HCC: Short- and Long-Term Results

Author

Magistri, P., Catellani, B., Frassoni, S., Guidetti, C., Olivieri, T., Assirati, G., Caporali, C., Pecchi, A., Serra, V., Ballarin, R., Guerrini, G. P., Bagnardi, V., Di Sandro, S., Di Benedetto, F., Magistri, P, Catellani, B, Frassoni, S, Guidetti, C, Olivieri, T, Assirati, G, Caporali, C, Pecchi, A, Serra, V, Ballarin, R, Guerrini, G, Bagnardi, V, Di Sandro, S, and Di Benedetto, F

Subjects
RFA, recurrence, robotic surgery, minimally invasive, hepatocellular carcinoma, Hepatocellular carcinoma, Minimally invasive, Recurrence, Robotic surgery, Survival, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, survival, lcsh:RC254-282, Article, digestive system diseases
Abstract

Background: The correct approach for early hepatocellular carcinoma (HCC) is debatable, since multiple options are currently available. Percutaneous ablation (PA) is associated in some series to reduced morbidity compared to liver resection (LR), therefore, minimally invasive surgery may play a significant role in this setting. Methods: All consecutive patients treated by robotic liver resection (RLR) or PA between January 2014 and October 2019 for a newly diagnosed single HCC, less than 3 cm in size (very early/early stages according to the Barcelona Clinic Liver Cancer (BCLC)) on chronic liver disease or liver cirrhosis, were enrolled in this retrospective study. The aim of this study was to compare short- and long-term outcomes to define the best approach in this specific cohort. Results: 60 patients fulfilled the inclusion criteria: 24 RLR and 36 PA. The two populations were homogeneous in terms of baseline characteristics. There were no statistically significant differences regarding the incidence of postoperative morbidity (RLR 38% vs. PA 19%, p = 0.15). The cumulative incidence of recurrence (CIR) was significantly higher in patients who underwent PA, with the one, two, and three years of CIR being 42%, 69%, and 73% in the PA group and 17%, 27%, and 27% in the RLR group, respectively. Conclusions: RLR provides a significantly higher potential of cure and tumor-related free survival in cases of newly diagnosed single HCCs smaller than 3 cm. Therefore, it can be considered as a first-line approach for the treatment of patients with those characteristics in high-volume centers with extensive experience in the field of hepatobiliary surgery and minimally invasive approaches.

Published
2020

15. Robotic ALPPS for intrahepatic cholangiocarcinoma

Author

Magistri, P., primary, Catellani, B., additional, Guidetti, C., additional, Olivieri, T., additional, Caracciolo, D., additional, Serra, V., additional, Assirati, G., additional, Ballarin, R., additional, Guerrini, G.P., additional, Di Sandro, S., additional, and Di Benedetto, F., additional

Published
2021
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16. Pilot-Scale Investigation of an Innovative Process for Biogas Upgrading with CO2 Capture and Storage

Author

Baciocchi, R, Carnevale, E, Corti, A, Costa, G, Lombardi, L, Olivieri, T, Paradisi, A, Zanchi, L, and Zingaretti, D

Subjects
Air pollution control residues, Aqueous solution, Calcium hydroxide, Settore ICAR/03 - Ingegneria Sanitaria-Ambientale, Waste management, Accelerated carbonation, Chemistry, Precipitation (chemistry), Carbon dioxide removal, chemistry.chemical_compound, Calcium carbonate, Biogas, Energy(all), Biogas upgrading, Alkali absorption, CO2 capture and storage, Absorption (chemistry), Alkali hydroxide
Abstract

In this work an innovative carbon dioxide removal method that, differently from the currently employed commercial techniques, allows also to capture and store the separated CO 2 is investigated. This process, Alkali absorption with Regeneration (AwR), consists in a first step in which CO 2 is separated from the biogas by chemical absorption with an alkali aqueous solution followed by a second step in which the spent absorption solution is regenerated for reuse in the first step and the captured CO 2 is stored in a solid and thermodynamically stable form. The latter process is carried out contacting the spent absorption solution, rich in carbonate and bicarbonate ions, with a waste material characterized by a high content of calcium hydroxide and leads to the precipitation of calcium carbonate and to the regeneration of the alkali hydroxide content of the solution. The proposed processes were first investigated by preliminary laboratory and simulation analysis. On the basis of the results of these tests, air pollution control (APC) residues from Waste-to-Energy plants were selected as the material to use for the regeneration step and a pilot-scale regeneration plant was designed, built and installed in a landfill site downstream of the already existing absorption column. In this paper the sizing and design of the regeneration plant and the results of the preliminary AwR pilot- plant tests are reported. This study was carried out within the framework of the UPGAS-LOWCO2 (LIFE08/ENV/IT/000429) Life+ project.

Published
2013
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20. Innovative Processes for Biogas Upgrading: Results from Pilot Plant Operation

Author

Lombardi, L., Baciocchi, R., Carnevale, E., Corti, A., Costa, G., Mostbauer, P., Olivieri, T., Paradisi, A., Zanchi, L., and Zingaretti, D.

Subjects
Biomass
Abstract

Biogas up-grading treatments aimed at producing biomethane to fuel vehicles or to inject into the gas grid, are applications that are gaining increasing interest throughout Europe. Several different commercial methods are available for separating carbon dioxide from biogas. In this work two innovative carbon dioxide removal methods that, differently from the currently employed commercial techniques, allow also to capture and store the separated carbon dioxide are investigated. The first investigated process, named alkali Absorption with Regeneration (AwR), consists in a first step in which carbon dioxide is separated from the biogas by chemical absorption, with an alkali aqueous solution, followed by a second step in which the spent absorption solution is regenerated for reuse in the first step of the upgrading process and the captured carbon dioxide is stored in a solid and thermodynamically stable form. The latter process is carried out contacting the spent absorption solution, rich in carbonate and bicarbonate ions, with a waste material characterized by a high content of calcium hydroxide and leads to the precipitation of calcium carbonate and to the regeneration of the alkali hydroxide content of the solution. The second investigated process is based on chemical reaction of carbon dioxide contained in the biogas directly with bottom ashes from municipal solid waste combustion. In this kind of process the gas containing the carbon dioxide and the solid residues come directly into contact, in an appropriate gas/solid reactor, with the result of an accelerated carbonation of the solid residues and carbon dioxide up-take. Both the proposed processes were first studied by preliminary laboratory analysis, then two small pilot plants were built in order to demonstrate the technical feasibility of the processes. The pilot plant operation results are reported in the paper. This study was conducted in the framework of the UPGAS-LOWCO2 (LIFE08/ENV/IT/000429) Life+ project., Proceedings of the 20th European Biomass Conference and Exhibition, 18-22 June 2012, Milan, Italy, pp. 1491-1498

Published
2012
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21. Biochemical Methane Potential of Organic Municipal Solid Waste Components

Author

Pecorini, I., Olivieri, T., Paradisi, A., Bacchi, D., Cenni, G., Burberi, L., Lombardi, L., and Corti, A.

Subjects
Biomass
Abstract

With the aim of evaluating the possibility to estimate the biogas production of a real scale anaerobic digestion plant, the Biochemical Methane Potential (BMP) of several components of the Organic Fraction of the Municipal Solid Waste (OFMSW) were tested. In particular, five different fractions and a mixed food waste sample were tested. Both the BMP after 21 days (BMP21) and final BMP (BMPf) were measured in specific batch anaerobic digesters at 37°C. In particular, from the lab tests, it was found that the mixed food waste substrate is characterized by a BMP21 of about 405 NL/kgVS and a BMPf of 484 NL/kgVS and an average methane content of 57%., Proceedings of the 20th European Biomass Conference and Exhibition, 18-22 June 2012, Milan, Italy, pp. 1411-1414

Published
2012
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23. Innovative processes for biogas upgrading

Author

Lombardi, F, Baciocchi, R, Carnevale, E, Corti, A, Costa, G, Gabarell, X, Mostbauer, P, Olivieri, F, Olivieri, T, Paradisi, A, Starr, K, Villalba, G, and Zingaretti, D

Subjects
Settore ICAR/03 - Ingegneria Sanitaria-Ambientale
Published
2011

24. Innovative processes for biogas up-grading

Author

Lombardi, L., Baciocchi, R., Carnevale, E., Corti, Andrea, Costa, G., Gabarrell, X., Mostbauer, P., Olivieri, F., Olivieri, T., Paradisi, A., Starr, K., Villalba, G., and Zingaretti, D.

Subjects
biogas, upgrading, biomethane, industrial solid residues, accelerated carbonation
Published
2011

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

Author

Bart van Hoek, Riccardo De Carlis, Philipp Dutkowski, Gonzalo Sapisochin, Luciano De Carlis, Danny van der Helm, Juan Carlos Caicedo, Erin Winter, Wojciech G. Polak, Humberto Bohorquez, Gabriel C. Oniscu, Fabrizio Di Benedetto, Amna Daud, Paolo Muiesan, V. Lucidi, Daniel Borja-Cacho, C. Burcin Taner, Nicolas Meurisse, Jacques Pirenne, Jeannette Widmer, Amelia J. Hessheimer, Matteo Ravaioli, Wayel Jassem, Mauricio Flores Carvalho, Aad P. van der Berg, Ahmed Sherif, Michele Colledan, Amit Nair, Renato Romagnoli, Diethard Monbaliu, Desislava Germanova, Cristiano Quintini, Andre Gorgen, Matteo Cescon, Sofie Vets, Marco P. A. W. Claasen, Massimo Malagó, Peter Lodge, Stefania Camagni, Kristopher P. Croome, Giorgio Rossi, Robert J. Porte, Ian P.J. Alwayn, Rebecca Panconesi, Maite Paolucci, Philipp Kron, Andrea Schlegel, Vincent E de Meijer, Annalisa Dolcet, Ina Jochmans, Charles Miller, Margherita Carbonaro, Pierre-Alain Clavien, Jan Nm Ijzermans, Constantino Fondevila, Damiano Patrono, Daniele Dondossola, Olivier Detry, Mohamed Elsharif, Koji Tomiyama, Alessandro Parente, Nigel Heaton, Herold J. Metselaar, Matteo Mueller, Tiziana Olivieri, George E. Loss, Marjolein van Reeven, Sarah Croome, Magdy Attia, Roberto Hernandez-Alejandro, Otto B. van Leeuwen, Groningen Institute for Organ Transplantation (GIOT), Center for Liver, Digestive and Metabolic Diseases (CLDM), Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Surgery, Gastroenterology & Hepatology, Schlegel A., van Reeven M., Croome K., Parente A., Dolcet A., Widmer J., Meurisse N., De Carlis R., Hessheimer A., Jochmans I., Mueller M., van Leeuwen O.B., Nair A., Tomiyama K., Sherif A., Elsharif M., Kron P., van der Helm D., Borja-Cacho D., Bohorquez H., Germanova D., Dondossola D., Olivieri T., Camagni S., Gorgen A., Patrono D., Cescon M., Croome S., Panconesi R., Carvalho M.F., Ravaioli M., Caicedo J.C., Loss G., Lucidi V., Sapisochin G., Romagnoli R., Jassem W., Colledan M., De Carlis L., Rossi G., Di Benedetto F., Miller C.M., van Hoek B., Attia M., Lodge P., Hernandez-Alejandro R., Detry O., Quintini C., Oniscu G.C., Fondevila C., Malago M., Pirenne J., IJzermans J.N.M., Porte R.J., Dutkowski P., Taner C.B., Heaton N., Clavien P.-A., Polak W.G., Muiesan P., Alwayn I.P.J., van der Berg A.P., Carbonaro M., Claasen M., Daud A., de Meijer V.E., Metselaar H.J., Monbaliu D., Paolucci M., Vets S., and Winter E.

Subjects
Male, Organ Dysfunction Scores, benchmarking, Donation after circulatory death, liver transplantation, morbidity, organ perfusion, risk analysis, IMPACT, medicine.medical_treatment, Kaplan-Meier Estimate, Liver transplantation, GUIDELINES, ALLOCATION, law.invention, Cohort Studies, Postoperative Complications, PROPOSAL, Interquartile range, law, Outcome Assessment, Health Care, risk analysi, Mortality rate, EXTENDED-CRITERIA DONORS, Shock, Middle Aged, Editorial from the ACHBPT, Intensive care unit, CARDIAC DEATH, Area Under Curve, Cohort, Female, medicine.medical_specialty, Tissue and Organ Procurement, BILIARY COMPLICATIONS, Cold storage, CLASSIFICATION, Internal medicine, SCORE, medicine, Humans, Renal replacement therapy, Aged, Proportional Hazards Models, GRAFT-SURVIVAL, Hepatology, business.industry, ROC Curve, Complication, business
Abstract

BACKGROUND: To identify the best possible outcomes in liver transplantation from donation after circulatory death donors (DCD) and to propose outcome values, which serve as reference for individual liver recipients or patient groups.METHODS: Based on 2219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1012 low-risk, primary, adult liver transplantations with a laboratory MELD of ≤20points, receiving a DCD liver with a total donor warm ischemia time of ≤30minutes and asystolic donor warm ischemia time of ≤15minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the Comprehensive Complication Index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered.RESULTS: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centers. The one-year retransplant and mortality rate was 5.23% and 9.01%, respectively. Within the first year of follow-up, 51.1% of recipients developed at least one major complication (≥Clavien-Dindo-Grade-III). Benchmark cut-offs were ≤3days and ≤16days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade-III), ≤16.8% for ischemic cholangiopathy, and ≤38.9CCI points at one-year posttransplant. Comparisons with higher risk groups showed more complications and impaired graft survival, outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk.CONCLUSIONS: Despite excellent 1-year survival, morbidity in benchmark cases remains high with more than half of recipients developing severe complications during 1-year follow-up. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk groups, and provide a valid comparator cohort for future clinical trials.LAY SUMMARY: The best possible outcomes after liver transplantation of grafts donated after circulatory death (DCD) were defined using the concept of benchmarking. These were based on 2219 liver transplantations following controlled DCD donation in 17 centres worldwide. The following benchmark cut-offs for the most relevant outcome parameters were developed: ICU and hospital stay: ≤3 and ≤16 days; primary non function: ≤2.5%; renal replacement therapy: ≤9.6%; ischemic cholangiopathy: ≤16.8% and anastomotic strictures ≤28.4%. One-year graft loss and mortality were defined as ≤14.4% and 9.6%, respectively. Donor and recipient combinations with higher risk had significantly worse outcomes. The use of novel organ perfusion technology achieved similar, good results in this high-risk group with prolonged donor warm ischemia time, when compared to the benchmark cohort.

Published
2021

31. Are there any benefits of prolonged hypothermic oxygenated perfusion?: Results from a national retrospective study.

Author

De Carlis R, Lauterio A, Schlegel A, Gringeri E, Patrono D, Camagni S, Dondossola D, Pezzati D, Olivieri T, Pagano D, Bongini M, Montanelli P, Ravaioli M, Bernasconi D, Valsecchi MG, Baccarani U, Cescon M, Andorno E, Mazzaferro V, Gruttadauria S, Di Benedetto F, Ghinolfi D, Caccamo L, Pinelli D, Romagnoli R, Cillo U, and De Carlis L

Abstract

Dual hypothermic oxygenated perfusion (DHOPE) is increasingly being used to extend liver preservation to improve transplant logistics. However, little is known about its benefits in high-risk liver grafts. This study aimed to investigate whether prolonged DHOPE provides benefits other than improved logistics in all liver types. We performed a national retrospective cohort study of 177 liver transplants from 12 Italian centers preserved with DHOPE for ≥4 hours between 2015 and 2022. A control group of 177 DHOPEs of <4 hours during the same period was created using 1:1 propensity score matching. The impact of risk profiles and preservation times on the outcomes was assessed using univariable and multivariable regression models. No significant differences in posttransplant outcomes were found between prolonged and short DHOPEs. However, the prolonged group had a significantly lower incidence of posttransplant acute kidney injury (AKI) compared to the short group (30.5% vs. 44.6%, p = 0.008). Among prolonged DHOPEs, no differences in transplant outcomes were observed according to donor risk index, Eurotransplant definition for marginal grafts, and balance of risk score. DHOPE duration was associated with a lower risk of AKI in multivariable models adjusted for donor risk index, Eutrotransplant marginal grafts, and balance of risk score. Prolonged hypothermic oxygenated perfusion confirmed its protective effect against AKI in a multivariable model adjusted for donor and recipient risk factors [OR: 0.412, 95% CI: 0.200-0.850, p = 0.016]. Prolonged DHOPE is widely used to improve transplant logistics, provides good results with high-risk grafts, and appears to be associated with a lower risk of posttransplant AKI. These results provide further insight into the important role of DHOPE in preventing posttransplant complications., (Copyright © 2024 American Association for the Study of Liver Diseases.)

Published
2024
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32. Salvage versus Primary Liver Transplantation for Hepatocellular Carcinoma: A Twenty-Year Experience Meta-Analysis.

Author

Guerrini GP, Esposito G, Olivieri T, Magistri P, Ballarin R, Di Sandro S, and Di Benedetto F

Abstract

(1) Background: Primary liver transplantation (PLT) for HCC represents the ideal treatment. However, since organ shortage increases the risk of drop-out from the waiting list for tumor progression, a new surgical strategy has been developed: Salvage Liver Transplantation (SLT) can be offered as an additional curative strategy for HCC recurrence after liver resection. The aim of this updated meta-analysis is to compare surgical and long-term outcomes of SLT versus PLT for HCC. (2) Materials and Methods: A systematic review and meta-analysis was conducted using the published papers comparing SLT and PLT up to January 2022. (3) Results: 25 studies describing 11,275 patients met the inclusion criteria. The meta-analysis revealed no statistical difference in intraoperative blood loss, overall vascular complications, retransplantation rate, and hospital stay in the SLT group compared with the PLT group. However, the SLT group showed a slightly significant lower 5-year OS rate and 5-year disease-free survival rate. (4) Conclusion: meta-analysis advocates the relative safety and feasibility of both Salvage LT and Primary LT strategies. Specifically, SLT seems to have comparable surgical outcomes but slightly poorer long-term survival than PLT.

Published
2022
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33. Cytokine mass balance levels in donation after circulatory death donors using hemoadsorption: Case series report.

Author

Baroni S, Marudi A, Rinaldi S, Ghedini S, Magistri P, Piero Guerrini G, Olivieri T, Dallai C, Talamonti M, Maccieri J, Benedetto FD, and Bertellini E

Subjects
Cytokines, Death, Graft Survival, Humans, Middle Aged, Perfusion, Tissue Donors, Kidney Transplantation, Tissue and Organ Procurement
Abstract

The use of hemadsorption has been purposed to reduce cytokine levels during the reperfusion phase during donation after circulatory death (DCD) programs. This paper aims to describe a cases series of the inflammatory cytokine levels before and after hemadsorption during normothermic reperfusion in DCD donors of liver and kidneys. In this observational pilot paper, we describe 8 DCD donors of liver or kidneys in our center from the year 2018 to 2019. All DCD donor subjects had similar age, were younger than 60 years, without evident critical conditions, no liver or kidney dysfunction known, and they presented with poor neurological outcomes instrumentally and clinically documented. We observed in our patients an interesting reduction of IL-10 and TNF-α levels during the normothermic reperfusion with hemadsorption. We transplanted all livers and kidneys from DCD donors without significant compliances.

Published
2022
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34. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation.

Author

Schlegel A, van Reeven M, Croome K, Parente A, Dolcet A, Widmer J, Meurisse N, De Carlis R, Hessheimer A, Jochmans I, Mueller M, van Leeuwen OB, Nair A, Tomiyama K, Sherif A, Elsharif M, Kron P, van der Helm D, Borja-Cacho D, Bohorquez H, Germanova D, Dondossola D, Olivieri T, Camagni S, Gorgen A, Patrono D, Cescon M, Croome S, Panconesi R, Carvalho MF, Ravaioli M, Caicedo JC, Loss G, Lucidi V, Sapisochin G, Romagnoli R, Jassem W, Colledan M, De Carlis L, Rossi G, Di Benedetto F, Miller CM, van Hoek B, Attia M, Lodge P, Hernandez-Alejandro R, Detry O, Quintini C, Oniscu GC, Fondevila C, Malagó M, Pirenne J, IJzermans JNM, Porte RJ, Dutkowski P, Taner CB, Heaton N, Clavien PA, Polak WG, and Muiesan P

Subjects
Aged, Area Under Curve, Benchmarking methods, Benchmarking statistics & numerical data, Cohort Studies, Female, Humans, Kaplan-Meier Estimate, Liver Transplantation methods, Liver Transplantation statistics & numerical data, Male, Middle Aged, Organ Dysfunction Scores, Outcome Assessment, Health Care methods, Postoperative Complications epidemiology, Postoperative Complications etiology, Proportional Hazards Models, ROC Curve, Shock epidemiology, Tissue and Organ Procurement methods, Tissue and Organ Procurement statistics & numerical data, Liver Transplantation adverse effects, Outcome Assessment, Health Care statistics & numerical data, Shock etiology
Abstract

Background & Aims: The concept of benchmarking is established in the field of transplant surgery; however, benchmark values for donation after circulatory death (DCD) liver transplantation are not available. Thus, we aimed to identify the best possible outcomes in DCD liver transplantation and to propose outcome reference values., Methods: Based on 2,219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1,012 low-risk, primary, adult liver transplantations with a laboratory MELD score of ≤20 points, receiving a DCD liver with a total donor warm ischemia time of ≤30 minutes and asystolic donor warm ischemia time of ≤15 minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the comprehensive complication index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75 th -percentile was considered., Results: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centres. The 1-year retransplant and mortality rates were 4.5% and 8.4% in the benchmark group, respectively. Within the first year of follow-up, 51.1% of recipients developed at least 1 major complication (≥Clavien-Dindo-Grade III). Benchmark cut-offs were ≤3 days and ≤16 days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade III), ≤16.8% for ischemic cholangiopathy, and ≤38.9 CCI points 1 year after transplant. Comparisons with higher risk groups showed more complications and impaired graft survival outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk., Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk groups and to provide a valid comparator cohort for future clinical trials., Lay Summary: The best possible outcomes after liver transplantation of grafts donated after circulatory death (DCD) were defined using the concept of benchmarking. These were based on 2,219 liver transplantations following controlled DCD donation in 17 centres worldwide. Donor and recipient combinations with higher risk had significantly worse outcomes. However, the use of novel organ perfusion technology helped high-risk patients achieve similar outcomes as the benchmark cohort., Competing Interests: Conflict of interest The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details., (Copyright © 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Published
2022
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35. How to Preserve Liver Grafts From Circulatory Death With Long Warm Ischemia? A Retrospective Italian Cohort Study With Normothermic Regional Perfusion and Hypothermic Oxygenated Perfusion.

Author

De Carlis R, Schlegel A, Frassoni S, Olivieri T, Ravaioli M, Camagni S, Patrono D, Bassi D, Pagano D, Di Sandro S, Lauterio A, Bagnardi V, Gruttadauria S, Cillo U, Romagnoli R, Colledan M, Cescon M, Di Benedetto F, Muiesan P, and De Carlis L

Subjects
Cohort Studies, Graft Survival, Humans, Liver, Organ Preservation adverse effects, Organ Preservation methods, Perfusion adverse effects, Perfusion methods, Retrospective Studies, Tissue Donors, Liver Transplantation adverse effects, Liver Transplantation methods, Warm Ischemia adverse effects
Abstract

Background: Donation after circulatory death (DCD) in Italy, given its 20-min stand-off period, provides a unique bench test for normothermic regional perfusion (NRP) and dual hypothermic oxygenated machine perfusion (D-HOPE)., Methods: We coordinated a multicenter retrospective Italian cohort study with 44 controlled DCD donors, who underwent NRP, to present transplant characteristics and results. To rank our results according to the high donor risk, we matched and compared a subgroup of 37 controlled DCD livers, preserved with NRP and D-HOPE, with static-preserved controlled DCD transplants from an established European program., Results: In the Italian cohort, D-HOPE was used in 84% of cases, and the primary nonfunction rate was 5%. Compared with the matched comparator group, the NRP + D-HOPE group showed a lower incidence of moderate and severe acute kidney injury (stage 2: 8% versus 27% and stage 3: 3% versus 27%; P = 0.001). Ischemic cholangiopathy remained low (2-y proportion free: 97% versus 92%; P = 0.317), despite the high-risk profile resulting from the longer donor warm ischemia in Italy (40 versus 18 min; P < 0.001)., Conclusions: These data suggest that NRP and D-HOPE yield good results in DCD livers with prolonged warm ischemia., Competing Interests: The authors declare no funding or conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2021
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37. Robotic versus laparoscopic gastrectomy for gastric cancer: The largest meta-analysis.

Author

Guerrini GP, Esposito G, Magistri P, Serra V, Guidetti C, Olivieri T, Catellani B, Assirati G, Ballarin R, Di Sandro S, and Di Benedetto F

Subjects
Gastrectomy adverse effects, Humans, Laparoscopy adverse effects, Length of Stay, Postoperative Complications epidemiology, Reoperation statistics & numerical data, Robotic Surgical Procedures adverse effects, Stomach Neoplasms mortality, Gastrectomy methods, Laparoscopy methods, Robotic Surgical Procedures methods, Stomach Neoplasms surgery
Abstract

Background: Minimally invasive surgery (MIS) has been increasingly used in the treatment of gastric cancer (GC). Laparoscopic gastrectomy (LG) has shown several advantages over open surgery in dealing with GC, although it is still considered a demanding procedure. Robotic gastrectomy (RG) is now being employed with increased frequency worldwide and has been reported to overcome some limitations of conventional LG. The aim of this updated meta-analysis is to compare surgical and oncological outcomes of RG versus LG for gastric cancer., Materials and Methods: A systematic review and meta-analysis was conducted using the PubMed, MEDLINE and Cochrane library database of published studies comparing RG and LG up to March 2020. The evaluated end-points were intra-operative, post-operative and oncological outcomes. Dichotomous data were calculated by odds ratio (OR) and continuous data were calculated by mean difference (MD) with 95% confidence intervals (95% CI), and a random-effect model was always applied., Results: Forty retrospective studies describing 17,712 patients met the inclusion criteria. With respect to surgical outcomes, robotic compared with laparoscopic gastrectomy was associated with higher operating time [MD 44.73, (95%CI 36.01, 53.45) p < 0.00001] and less intraoperative blood loss [MD -18.24, (95%CI -25.21, -11.26) p < 0.00001] and lower rate of surgical complication in terms of Dindo-Clavien ≥ 3 classification [OR 0.66, (95%CI 0.49, 0.88) p = 0.005]. With respect to oncological outcomes, the RG group showed a significantly increased mean number of retrieved lymph nodes [MD 1.84, (95%CI 0.84, 2.84) p = 0.0003], but mean proximal and distal resection margin distance and the recurrence rate were not significantly different between the two approaches., Conclusions: With respect to safety, technical feasibility and oncological adequacy, robotic and laparoscopic groups were comparable, although the robotic approach seems to achieve better short-term surgical outcomes. Moreover, a higher rate of retrieved lymph nodes was observed in the RG group., (Copyright © 2020 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

Published
2020
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38. Pre-transplant diabetes predicts atherosclerotic vascular events and cardiovascular mortality in liver transplant recipients: a long-term follow-up study.

Author

Gitto S, De Maria N, Marzi L, Magistri P, Falcini M, Vitale G, Olivieri T, Guerrini GP, Serra V, Forte P, Carrai P, De Simone P, Mega A, Zoller H, Piai G, Schepis F, Marocchi M, Villa E, Marra F, Andreone P, and Di Benedetto F

Subjects
Follow-Up Studies, Humans, Retrospective Studies, Risk Factors, Cardiovascular Diseases, Diabetes Mellitus epidemiology, Liver Transplantation
Abstract

Background Early after surgery, liver transplant (LT) recipients often develop weight gain. Metabolic disorders and cardiovascular disease represent main drivers of morbidity and mortality. Our aim was to identify predictors of atherosclerotic vascular events (AVE) and to assess the impact of AVE on the long-term outcome. Methods We retrospectively analyzed data from patients transplanted between 2000 and 2005 and followed-up in five Italian transplant clinics. Cox Regression analysis was performed to identify predictors of AVE, global mortality, and cardiovascular mortality. Survival analysis was performed using the Kaplan-Meier method. Results We analyzed data from 367 subjects during a median follow-up of 14 years. Thirty-seven post-LT AVE were registered. Patients with AVE more frequently showed pre-LT diabetes mellitus (DM) (48.6 vs 13.9%, p=0.000). In the post-LT period, patients with AVE satisfied criteria of metabolic syndrome in 83.8% vs. 36.7% of subjects without AVE (p=0.000). At multivariate analysis, pre-LT DM independently predicted AVE (HR 2.250, CI 4.848-10.440, p=0.038). Moreover, both pre-LT DM and AVE strongly predicted cardiovascular mortality (HR 5.418, CI 1.060-29.183, p=0.049, and HR 86.097, CI 9.510-779.480, p=0.000, respectively). Conclusions Pre-LT DM is the main risk factor for post-LT AVE. Pre-LT DM and post-LT AVE are strong, long-term predictors of cardiovascular mortality. Patients with pre-LT DM should obtain a personalized follow-up for prevention or early diagnosis of AVE., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Published
2020
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39. Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: the first meta-analysis.

Author

Guerrini GP, Esposito G, Tarantino G, Serra V, Olivieri T, Catellani B, Assirati G, Guidetti C, Ballarin R, Magistri P, and Di Benedetto F

Subjects
Bile Duct Neoplasms pathology, Cholangiocarcinoma pathology, Humans, Bile Duct Neoplasms surgery, Cholangiocarcinoma surgery, Hepatectomy, Laparoscopy
Abstract

Background: Laparoscopic liver resection (LLR) has gained increasing acceptance for surgical treatment of malignant and benign liver tumors. LLR for intrahepatic cholangiocarcinoma (ICC) is not commonly performed because of the concern for the frequent need for major hepatectomy, vascular-biliary reconstructions, and lymph node dissection (LND). The aim of this present meta-analysis is to compare surgical and oncological outcomes of laparoscopic (LLR) versus open liver resection (OLR) for ICC., Materials and Methods: A systematic review was conducted using the PubMed, MEDLINE, and Cochrane library database of published studies comparing LLR and OLR up to October 2019. Two reviewers independently assessed the eligibility and quality of the studies. Dichotomous data were calculated by odds ratio (OR), and continuous data were calculated by mean difference (MD) with 95% confidence intervals (95% CI)., Results: Four retrospective observational studies describing 204 patients met the inclusion criteria. With respect to surgical outcomes, laparoscopic compared with open liver resection was associated with lower blood loss [MD - 173.86, (95% CI - 254.82, -92.91) p < 0.0001], less requirement of blood transfusion [OR 0.34, (95% CI 0.14, 0.82) p = 0.02], less need for Pringle maneuver [OR 0.17, (95% CI 0.07, 0.43) p = 0.0002], shorter hospital stay [MD - 3.77, (95% CI - 5.09, - 2.44; p < 0.0001], and less morbidity [OR 0.44, (95% CI 0.21, 0.94) p = 0.03]. With respect to oncological outcomes, the LLR group was prone to lower rates of lymphadenectomy [OR 0.12, (95% CI 0.06, 0.25) p < 0.0001], but surgical margins R0 and recurrence rate were not significantly different., Conclusion: Laparoscopic liver resection for ICC seems to achieve better surgical outcomes, providing short-term benefits without negatively affecting oncologic adequacy in terms of R0 resections and disease recurrence. However, a higher LND rate was observed in the open group. Due to the risk of bias and the statistical heterogeneity between the studies included in this review, further RCTs are needed to reach stronger scientific conclusions.

Published
2020
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40. University of Modena Experience With Liver Grafts From Donation After Circulatory Death: What Really Matters in Organ Selection?

Author

Olivieri T, Magistri P, Guidetti C, Baroni S, Rinaldi S, Assirati G, Catellani B, Chierego G, Cantaroni C, Bondi F, Campagna A, Sangiorgi G, Pecchi A, Serra V, Tarantino G, Ballarin R, Guerrini GP, Girardis M, Bertellini E, and Di Benedetto F

Subjects
Adult, Female, Humans, Italy, Male, Middle Aged, Retrospective Studies, Warm Ischemia, Graft Survival, Liver Transplantation methods, Tissue and Organ Procurement methods, Transplants
Abstract

Introduction: The use of grafts from donation after circulatory death (DCD) is an important additional source to implement within the donor pool. We herein report the outcomes of our early experience with DCD grafts for liver transplantation (LT)., Methods: Ten patients successfully underwent LT with grafts from DCD donors between August 2017 and January 2019 at the Hepato-Pancreato-Biliary Surgery and Liver Transplant Unit of University of Modena and Reggio Emilia. All donors underwent normothermic regional perfusion after death declaration and, after the procurement, all the suitable grafts underwent ex situ hypothermic perfusion prior to transplantation., Results: Mean postoperative hospital stay after transplant was 12.7 days (range, 5-26), and in 5 cases we placed a biliary drainage (Kehr tube) during surgery. Primary graft nonfunction did not occur after LT in this cohort, although, we registered one case of biliary anastomosis stricture that was managed endoscopically by endoscopic retrograde cholangiopancreatography. All patients are alive and none required retransplantation., Conclusions: In our experience with controlled DCD donors, the demonstration of: (1) a negative trend of lactate during normothermic regional perfusion; (2) an aspartate aminotransferase and alanine aminotransferase level lower than 2000 mU/dL; and (3) less than 1 hour of functional warm ischemia time along with no signs of microscopic or macroscopic ischemia of the grafts, are related to positive outcomes in the first year after transplant. A DCD risk score based on Italian population characteristics and regulations on death observation may improve donor-recipient match and avoid futile transplants., (Copyright © 2019. Published by Elsevier Inc.)

Published
2019
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41. Vacuum-assisted management of surgical site infections after liver transplantation: 15-year experience in a tertiary hepatobiliary center.

Author

Magistri P, Olivieri T, Serra V, Tarantino G, Assirati G, Pecchi A, Ballarin R, and Di Benedetto F

Subjects
Female, Humans, Length of Stay statistics & numerical data, Male, Retrospective Studies, Tertiary Care Centers statistics & numerical data, Liver Transplantation adverse effects, Negative-Pressure Wound Therapy, Surgical Wound Infection therapy
Abstract

Immune compromised as well as critically ill patients are at higher risk of surgical wound infection and dehiscence. Wound infections critically influence the outcomes after liver transplantation. In particular, it was shown that they significantly reduce the overall survival rate when compared to patients with uneventful wound healing, and their occurrence is associated with death or graft loss within 1-year post-transplantation. From January 2001 through December 2017, 763 patients underwent liver transplantation in our Institution, the Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, "Policlinico" University Hospital, University of Modena and Reggio Emilia, Modena, Italy. We retrospectively analyzed data from our prospectively maintained database of patients treated with a negative pressure therapy device due to wound or abdominal infections. 13 patients underwent negative pressure treatments for surgical site infection after liver transplantation in our institution. Ten superficial "supra-fascial" applications (SF group) and three deeper abdominal (Ab group) were reported. Mean in-hospital stay for the SF group was 42.6 days, ranging from 8 to 80, while for the Ab group was 62 days (range 23-133), with an overall survival of 34 and 4.6 months, respectively. A multifactorial multidisciplinary approach is needed in the prevention of surgical site infections instead of mere antimicrobial prophylaxis The application of negative pressure wound therapy may help in controlling the diffusion of the infection and preventing sepsis.

Published
2019
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42. Robotic liver resection for hepatocellular carcinoma: A systematic review.

Author

Magistri P, Tarantino G, Assirati G, Olivieri T, Catellani B, Guerrini GP, Ballarin R, and Di Benedetto F

Subjects
Blood Loss, Surgical, Disease-Free Survival, Humans, Laparoscopy, Length of Stay, Liver surgery, Operative Time, Postoperative Complications, Reproducibility of Results, Treatment Outcome, Carcinoma, Hepatocellular surgery, Hepatectomy methods, Liver Cirrhosis surgery, Liver Neoplasms surgery, Robotic Surgical Procedures methods
Abstract

Background: Hepatocellular carcinoma (HCC) represents a leading cause of death in patients with cirrhosis. This review attempts to clarify the role of robotic surgery for HCC in terms of oncologic outcomes., Materials and Methods: A systematic literature search was performed according to the PRISMA statement including papers comparing open, robotic, and laparoscopic approach for liver surgery. If more than one study was reported by the same institute, only the most recent or the highest quality study was included., Results: The literature search yielded 302 articles; titles and abstracts were reviewed for inclusion. Ten papers were finally included in this review for a total of 307 patients who underwent robotic resection for HCC., Conclusions: Robotic liver resection for HCC is effective in terms of oncological results as compared with open and laparoscopic approach when performed in experienced centers and is accurate in terms of R0 rates and disease-free surgical margin., (© 2019 John Wiley & Sons, Ltd.)

Published
2019
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43. Robotic Liver Resection Expands the Opportunities of Bridging Before Liver Transplantation.

Author

Magistri P, Olivieri T, Assirati G, Guerrini GP, Ballarin R, Tarantino G, and Di Benedetto F

Subjects
Humans, Liver pathology, Liver surgery, Liver Cirrhosis diagnosis, Liver Cirrhosis pathology, Male, Middle Aged, Preoperative Care methods, Severity of Illness Index, Treatment Outcome, Hepatectomy methods, Liver Cirrhosis surgery, Liver Transplantation, Robotic Surgical Procedures methods
Published
2019
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44. Extra-Anatomic Jump Graft from the Right Colic Vein: A Novel Technique to Manage Portal Vein Thrombosis in Liver Transplantation.

Author

Magistri P, Tarantino G, Olivieri T, Pecchi A, Ballarin R, and Di Benedetto F

Abstract

Background: In the context of cirrhosis, portal vein thrombosis (PVT) is present in 2.1% to 26% of patients. PVT is no longer considered an absolute contraindication for liver transplantation, and nowadays, surgical strategies depend on the extent of PVT. Complete PVT is associated with higher morbidity rates and poor prognosis, while comparable long-term outcomes can be achieved as long as physiological portal inflow is restored., Materials and Methods: We report our experience with a 45-year-old patient undergoing liver transplant with a PVT (stage III-b). To restore portal vein inflow to the liver, an extra-anatomic jump graft from the right colic vein with donor iliac vein interposition was constructed., Results: The patient recovered well, with a progressive improvement of the general conditions, and was finally discharged on p.o.d. 14. No anastomotic defects were found at the postoperative CT scan 10 months after the surgery., Conclusion: Our technical innovation represents a valid and safe alternative to the cavoportal hemitransposition, providing a proper flow restoration and reproducing a physiological setting, while avoiding the complications related to the cavoportal shunt. We believe that the reconstitution of liver portal inflow should be obtained with the most physiological approach possible and considering long-term liver function.

Published
2018
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45. Laparoscopic versus robotic surgery for hepatocellular carcinoma: the first 46 consecutive cases.

Author

Magistri P, Tarantino G, Guidetti C, Assirati G, Olivieri T, Ballarin R, Coratti A, and Di Benedetto F

Subjects
Aged, Female, Hepatectomy methods, Humans, Italy epidemiology, Male, Middle Aged, Postoperative Complications epidemiology, Retrospective Studies, Carcinoma, Hepatocellular surgery, Hepatectomy statistics & numerical data, Laparoscopy statistics & numerical data, Liver Neoplasms surgery, Robotics statistics & numerical data
Abstract

Background: Hepatocellular carcinoma has a growing incidence worldwide, and represents a leading cause of death in patients with cirrhosis. Nowadays, minimally invasive approaches are spreading in every field of surgery and in liver surgery as well., Materials and Methods: We retrospectively reviewed demographics, clinical, and pathologic characteristics and short-term outcomes of patients who had undergone minimally invasive resections for hepatocellular carcinoma at our institution between June 2012 and May 2016., Results: No significant differences in demographics and comorbidities were found between patients in the laparoscopic (n = 24) and robotic (n = 22) groups, except for the rates of cirrhotic patients (91.7% and 68.2%, respectively, P = 0.046). Perioperative data analysis showed that the operative time (mean, 211 and 318 min, respectively, P < 0.001) was the only parameter in favor of laparoscopy. Conversely, robotic-assisted resections were related to less Clavien I-II postoperative complications (22 cases versus 13 cases; P = 0.03). As regards resection margins, the two groups were similar with no statistically significant differences in rates of disease-free resection margins., Conclusions: A modern hepatobiliary center should offer both open and minimally invasive approaches to liver disease to provide the best care for each patient, according to the individual comorbidities, risk factors, and personal quality of life expectations. Our results show that the robotic approach is a reliable tool for accurate oncologic surgery, comparable to the laparoscopic approach. Robotic surgery also allows the surgeon to safely approach liver segments that are difficult to resect in laparoscopy, namely segments I-VII-VIII., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Published
2017
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46. Performance of a biogas upgrading process based on alkali absorption with regeneration using air pollution control residues.

Author

Baciocchi R, Carnevale E, Costa G, Gavasci R, Lombardi L, Olivieri T, Zanchi L, and Zingaretti D

Subjects
Adsorption, Biofuels, Calcium Carbonate chemical synthesis, Carbon Dioxide isolation & purification, Hydroxides chemistry, Potassium Compounds chemistry, Sodium Hydroxide chemistry
Abstract

This work analyzes the performance of an innovative biogas upgrading method, Alkali absorption with Regeneration (AwR) that employs industrial residues and allows to permanently store the separated CO2. This process consists in a first stage in which CO2 is removed from the biogas by means of chemical absorption with KOH or NaOH solutions followed by a second stage in which the spent absorption solution is contacted with waste incineration Air Pollution Control (APC) residues. The latter reaction leads to the regeneration of the alkali reagent in the solution and to the precipitation of calcium carbonate and hence allows to reuse the regenerated solution in the absorption process and to permanently store the separated CO2 in solid form. In addition, the final solid product is characterized by an improved environmental behavior compared to the untreated residues. In this paper the results obtained by AwR tests carried out in purposely designed demonstrative units installed in a landfill site are presented and discussed with the aim of verifying the feasibility of this process at pilot-scale and of identifying the conditions that allow to achieve all of the goals targeted by the proposed treatment. Specifically, the CO2 removal efficiency achieved in the absorption stage, the yield of alkali regeneration and CO2 uptake resulting for the regeneration stage, as well as the leaching behavior of the solid product are analyzed as a function of the type and concentration of the alkali reagent employed for the absorption reaction., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Published
2013
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