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3 results on '"Zeno Ballarini"'

1. Outcomes in AB0 Incompatible Living Donor Kidney Transplantation: A Case – Control Study

Author

Martina Cozzi, Paola Donato, Gabriele Ugolini, Rostand Emmanuel Nguefouet Momo, Francesco Nacchia, Zeno Ballarini, Pierluigi Piccoli, Maurizio Cantini, Chiara Caletti, Stefano Andreola, Giorgio Gandini, Giovanni Gambaro, and Luigino Boschiero

Subjects
AB0 incompatible, living donor kidney transplantation, desensitization, isoagglutinin titer, kidney transplant, Medicine (General), R5-920
Abstract

BackgroundPatients waiting for a kidney transplant by far exceed available organs. AB0 incompatible living donor kidney transplantation (AB0i LDKT) represents an additional therapeutic strategy, but with higher risk for complications. We aimed at evaluating outcomes of AB0i LDKTs compared to compatible (AB0c) controls at our Institution.MethodsRetrospective matched case – control study (1:2) comparing AB0i vs. AB0c LDKTs from March 2012 to September 2021. Considered outcomes: graft function, acute rejection, sepsis, CMV infection, BK virus reactivation, death-censored graft survival, patient survival.ResultsSeventeen AB0i LDKTs matched to 34 AB0c controls. We found excellent graft function, comparable in the two groups, at all considered intervals, with an eGFR (ml/min/1.73 m2) of 67 vs. 66 at 1 year (p = 0.41), 63 vs. 64 at 3 years (p = 0.53). AB0i recipients had a statistically significant higher incidence of acute rejection, acute antibody-mediated rejection and sepsis within 30 days (p = 0.016; p = 0.02; p = 0.001), 1 year (p = 0.012; p = 0.02; p = 0.0004) and 3 years (p = 0.004; p = 0.006; p = 0.012) after surgery. There was no difference in CMV infection, BK virus reactivation, death-censored graft survival between the two groups. Patient survival was inferior in AB0i group at 1 and 3 years (88.2 vs. 100%; log-rank p = 0.03) due to early death for opportunistic infections. AB0i LDKTs spent longer time on dialysis (p = 0.04) and 82.3 vs. 38.3% controls had blood group 0 (p = 0.003).ConclusionsAB0i LDKT is an effective therapeutic strategy with graft function and survival comparable to AB0c LDKTs, despite higher rates of acute rejection and sepsis. It is an additional opportunity for patients with less chances of being transplanted, as blood group 0 individuals.

Published
2022
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2. Development and validation of a preoperative 'difficulty score' for laparoscopic transabdominal adrenalectomy: a multicenter retrospective study

Author

Alessandro M. Paganini, Andrea Balla, Carlo Ingaldi, Guido A. M. Tiberio, Giovanni Casole, Silvia Quaresima, Riccardo Casadei, Claudio Ricci, Zeno Ballarini, Marie Sophie Alfano, Guido Di Dalmazi, Laura Alberici, Giovanni Lezoche, Francesco Minni, Monica Ortenzi, Saverio Selva, Pietro Ursi, Mario Guerrieri, Alberici L., Paganini A.M., Ricci C., Balla A., Ballarini Z., Ortenzi M., Casole G., Quaresima S., Di Dalmazi G., Ursi P., Alfano M.S., Selva S., Casadei R., Ingaldi C., Lezoche G., Guerrieri M., Minni F., and Tiberio G.A.M.

Subjects
medicine.medical_specialty, medicine.medical_treatment, Operative Time, Population, Adrenal Gland Neoplasms, Laparoscopic adrenalectomy, Difficulty score, Logistic regression, Cohort Studies, Postoperative Complications, Internal medicine, laparoscopic adrenalectomy, postoperative complications, Humans, Medicine, education, Retrospective Studies, education.field_of_study, business.industry, Adrenalectomy, Area under the curve, Retrospective cohort study, Odds ratio, Cohort, Laparoscopy, Surgery, business, Abdominal surgery
Abstract

Background A difficulty score for laparoscopic adrenalectomy (LA) is lacking in the literature. A retrospective cohort study was designed to develop a preoperative “difficulty score” for LA. Methods A multicenter study was conducted involving four Italian tertiary centers for adrenal disease. The population was randomly divided into two subsets: training group and validation one. A multicenter study was undertaken, including 964 patients. Patient, adrenal lesion, surgeon’s characteristics, and the type of procedure were studied as potential predictors of target events. The operative time (pOT), conversion rate (cLA), or both were used as indicators of the difficulty in three multivariate models. All models were developed in a training cohort (70% of the sample) and validated using 30% of patients. For all models, the ability to predict complicated postoperative course was reported describing the area under the curve (AUCs). Logistic regression, reporting odds ratio (OR) with p-value, was used. Results In model A, gender (OR 2.04, p = 0.001), BMI (OR 1.07, p = 0.002), previous surgery (OR 1.29, p = 0.048), site (OR 21.8, p p = 0.002), cumulative sum of procedures (OR 0.99, p p p = 0.015) increased the pOT. In model B, ASA (OR 2.86, p = 0.001), lesion size (OR 1.20, p = 0.005), and extended resection (OR 8.85, p = 0.007) increased the cLA risk. Model C had similar results to model A. All scores obtained predicted the target events in validation cohort (OR 1.99, p p = 0.007; OR 1.70, p Conclusion A difficulty score based on both pOT and cLA (Model C) was developed using 70% of the sample. The score was validated using a second cohort. Finally, the score was tested, and its results are able to predict a complicated postoperative course.

Published
2021

3. Hyperthermic Intraperitoneal Chemotherapy for Primary or Recurrent Adrenocortical Carcinoma. A Single Center Study

Author

Zeno Ballarini, Arianna Coniglio, Vittorio Ferrari, Guido A. M. Tiberio, Salvatore Grisanti, Elisa Arici, Giovanni Casole, Alfredo Berruti, Riccardo Nascimbeni, Marta Laganà, Michele Gritti, and Sandra Sigala

Subjects
safety, Cancer Research, medicine.medical_specialty, Intra peritoneal, medicine.medical_treatment, adrenocortical carcinoma, hyperthermic intraperitoneal chemotherapy, survival analysis, tumor recurrence, Single Center, lcsh:RC254-282, Article, 03 medical and health sciences, 0302 clinical medicine, Recurrent Adrenocortical Carcinoma, medicine, Adrenocortical carcinoma, Survival analysis, Chemotherapy, business.industry, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, Surgery, Oncology, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Hyperthermic intraperitoneal chemotherapy, business, Rare disease
Abstract

Background. This study explores the impact of Hypertermic Intra PEritoneal Chemotherapy (HIPEC) on adrenocortical carcinoma (ACC) management through a safety analysis completed by a preliminary evaluation of survival performances. Methods. Retrospective chart review of 27 patients submitted to surgical treatment completed by HIPEC for primary (SP, 13 patients) or recurrent (SR, 14 patients, 17 treatments) ACC. Safety was evaluated by means of procedural morbidity and mortality. Survival performances included multiple end points: local/peritoneal disease-free survival (l/pDFS), overall progression-free survival (OPFS), and overall survival (OS). Results. In the SP group, mortality was nil and morbidity was 46% (major 23%). At a median follow-up of 25 months, the median value for all the different survival measures had not been reached. Mortality was also nil in the SR group. However, morbidity was 77% (major 18%). Median l/pDFS and OPFS were 12 &plusmn, 4 and 8 &plusmn, 2 months, respectively. At a median follow-up of 30 months, median OS had not been reached. Conclusion. Surgery and HIPEC is an invasive procedure. Its employment in the surgery for primary setting deserves attention as it may affect oncologic outcomes positively. Its value in the management of recurrences seems less appreciable, albeit it may find its place in the multimodal management of a rare disease for which multiple therapeutic options do not yet exist.

Published
2020

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