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Toti L, Manzia TM, Sensi B, Blasi F, Baiocchi L, Lenci I, Angelico R, Tisone G. Towards tolerance in liver transplantation. Best Pract Res Clin Gastroenterol 2021; 54-55:101770. [PMID: 34874844 DOI: 10.1016/j.bpg.2021.101770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/08/2021] [Indexed: 02/08/2023]
Abstract
Life-long immunosuppression has always been considered the key in managing liver graft protection from recipient rejection. However, it is associated with severe adverse effects that lead to increased morbidity and mortality, including infections, cardiovascular diseases, kidney failure, metabolic disorders and de novo malignancies. This explains the great interest that has developed in the concept of tolerance in recent years. The liver, thanks to its marked tolerogenicity, is to be considered a privileged organ: up to 60% of selected patients undergoing liver transplantation could safely withdraw immunosuppression.
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Affiliation(s)
- L Toti
- Hepato-Pancreato-Biliary and Transplant Unit, Fondazione Policlinico Tor Vergata, Rome, Italy.
| | - T M Manzia
- University of Rome Tor Vergata, Department of Surgical Science, Italy
| | - B Sensi
- University of Rome Tor Vergata, Department of Surgical Science, Italy
| | - F Blasi
- University of Rome Tor Vergata, Department of Surgical Science, Italy
| | - L Baiocchi
- University of Rome Tor Vergata, Department of Surgical Science, Italy
| | - I Lenci
- Hepatology and Liver Transplant Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - R Angelico
- University of Rome Tor Vergata, Department of Surgical Science, Italy
| | - G Tisone
- University of Rome Tor Vergata, Department of Surgical Science, Italy
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2
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Manzia TM, Gazia C, Lenci I, Angelico R, Toti L, Monaco A, Anselmo A, Baiocchi L, Grossi P, Tisone G. Liver transplantation performed in a SARS-CoV-2 positive hospitalized recipient using a SARS-CoV-2 infected donor. Am J Transplant 2021; 21:2600-2604. [PMID: 33621393 PMCID: PMC8013325 DOI: 10.1111/ajt.16548] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 02/05/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 currently affected more than 108 million people worldwide with a fatality rate of 2.2%. Herein, we report the first case of liver transplantation (LT) performed with a liver procured from a SARS-CoV-2 positive donor. The recipient was a 35-year-old SARS-CoV-2 positive female patient affected by severe end-stage HBV-HDV-related liver disease (model of end-stage liver disease = 32) who had neutralizing SARS-CoV-2 antibodies (titers 1:320) at time of LT. The LT was successful, and the graft is functioning two months after surgery. The recipient cleared the SARS-CoV-2 infection 1 month after LT. The current case shows that the prompt use of SARS-CoV-2 infected liver donors offers an invaluable life-saving opportunity for SARS-CoV-2 positive wait-listed patients who developed neutralizing SARS-CoV-2 antibodies.
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Affiliation(s)
- Tommaso Maria Manzia
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
- Correspondence Tommaso Maria Manzia, Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome 00133, Italy.
| | - Carlo Gazia
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Ilaria Lenci
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - Roberta Angelico
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Luca Toti
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Monaco
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Anselmo
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Leonardo Baiocchi
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - Paolo Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Giuseppe Tisone
- Hepato-Pancreato-Biliary and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
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3
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Angelico R, Blasi F, Manzia TM, Toti L, Tisone G, Cacciola R. The Management of Immunosuppression in Kidney Transplant Recipients with COVID-19 Disease: An Update and Systematic Review of the Literature. Medicina (Kaunas) 2021; 57:medicina57050435. [PMID: 33946462 PMCID: PMC8147172 DOI: 10.3390/medicina57050435] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: In the era of the coronavirus disease 2019 (COVID-19) pandemic, the management of immunosuppressive (IS) therapy in kidney transplant (KT) recipients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires attention. It is not yet understood whether IS therapy may protect from the cytokine storm induced by SARS-CoV-2 infection or a temporary adjustment/withdrawal of IS therapy to restore the immune system may be necessary. We performed a systematic literature review to investigate the current management of IS therapy in KT recipients with COVID-1. Materials and Methods: Out of 71 articles published from 1 February 2020 until 30 October 2020, 554 KT recipients with SARS-CoV-2 infection were identified. Results: Modifications of IS therapy were based on the clinical conditions. For asymptomatic patients or those with mild COVID-19 symptoms, a "wait and see approach" was mostly used; a suspension of antimetabolites drugs (347/461, 75.27%) or mTOR inhibitors (38/48, 79.2%) was adopted in the majority of patients with symptomatic COVID-19 infections. For CNIs, the most frequent attitude was their maintenance (243/502, 48.4%) or dose-reduction (99/502, 19.72%) in patients asymptomatic or with mild COVID-19 symptoms, while drug withdrawal was the preferred choice in severely symptomatic patients (160/450, 31.87%). A discontinuation of all IS drugs was used only in severely symptomatic COVID-19 patients on invasive mechanical ventilation. Renal function remained stable in 422(76.17%) recipients, while 49(8.84%) patients experienced graft loss. Eight (1.44%) patients experienced a worsening of renal function. The overall mortality was 21.84%, and 53(9.56%) patients died with functioning grafts. Conclusion: A tailored approach to the patient has been the preferred strategy for the management of IS therapy in KT recipients, taking into account the clinical conditions of patients and the potential interactions between IS and antiviral drugs, in the attempt to balance the risks of COVID-19-related complications and those due to rejection or graft loss.
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Affiliation(s)
- Roberta Angelico
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, 00133 Rome, Italy; (R.A.); (F.B.); (L.T.); (G.T.); (R.C.)
| | - Francesca Blasi
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, 00133 Rome, Italy; (R.A.); (F.B.); (L.T.); (G.T.); (R.C.)
| | - Tommaso Maria Manzia
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, 00133 Rome, Italy; (R.A.); (F.B.); (L.T.); (G.T.); (R.C.)
- Correspondence:
| | - Luca Toti
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, 00133 Rome, Italy; (R.A.); (F.B.); (L.T.); (G.T.); (R.C.)
| | - Giuseppe Tisone
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, 00133 Rome, Italy; (R.A.); (F.B.); (L.T.); (G.T.); (R.C.)
| | - Roberto Cacciola
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, 00133 Rome, Italy; (R.A.); (F.B.); (L.T.); (G.T.); (R.C.)
- Department of Surgery, King Salman Armed Forces Hospital, Tabuk 47512, Saudi Arabia
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Shalaby S, Taborelli M, Zanetto A, Ferrarese A, D'Arcangelo F, Gambato M, Senzolo M, Russo FP, Germani G, Boccagni P, Ettorre GM, Baccarani U, Lauro A, Galatioto L, Rendina M, Petrara R, De Rossi A, Nudo F, Toti L, Fantola G, Vennarecci G, Risaliti A, Pinna AD, Gruttadauria S, Di Leo A, Rossi M, Tisone G, Zamboni F, Cillo U, Piselli P, Serraino D, Burra P. Hepatocellular carcinoma and the risk of de novo malignancies after liver transplantation - a multicenter cohort study. Transpl Int 2021; 34:743-753. [PMID: 33492715 DOI: 10.1111/tri.13831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/22/2020] [Accepted: 01/20/2021] [Indexed: 02/05/2023]
Abstract
Patients with hepatocellular carcinoma (HCC) are at high risk of second primary malignancies. As HCC has become the leading indication of liver transplant (LT), the aim of this study was to investigate whether the presence of HCC before LT could influence the onset of de novo malignancies (DNM). A cohort study was conducted on 2653 LT recipients. Hazard ratios (HR) of DNM development for patients transplanted for HCC (HCC patients) were compared with those of patients without any previous malignancy (non-HCC patients). All models were adjusted for sex, age, calendar year at transplant, and liver disease etiology. Throughout 17 903 person-years, 6.6% of HCC patients and 7.4% of non-HCC patients developed DNM (202 cases). The median time from LT to first DNM diagnosis was shorter for solid tumors in HCC patients (2.7 vs 4.5 years for HCC and non-HCC patients, respectively, P < 0.01). HCC patients were at a higher risk of bladder cancer and skin melanoma. There were no differences in cumulative DNM-specific mortality by HCC status. This study suggests that primary HCC could be a risk factor for DNM in LT recipients, allowing for risk stratification and screening individualization.
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Affiliation(s)
- Sarah Shalaby
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Martina Taborelli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Alberto Zanetto
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Alberto Ferrarese
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Francesca D'Arcangelo
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Martina Gambato
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Marco Senzolo
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Francesco Paolo Russo
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Giacomo Germani
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Patrizia Boccagni
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | | | | | - Augusto Lauro
- Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Laura Galatioto
- Department of Gastroenterology and Hepatology, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), University of Pittsburgh Medical Center, Palermo, Italy
| | - Maria Rendina
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University Hospital, Bari, Italy
| | - Raffaella Petrara
- Oncology and Immunology Section, AIDS Reference Center, Department of Oncology and Immunology, University of Padua, Padua, Italy
| | - Anita De Rossi
- Oncology and Immunology Section, AIDS Reference Center, Department of Oncology and Immunology, University of Padua, Padua, Italy
| | - Francesco Nudo
- Department of General Surgery and Organ Transplantation, Umberto I Policlinic, Sapienza University, Rome, Italy
| | - Luca Toti
- UOC Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Giovanni Fantola
- Department of Surgery, General and Hepatic Transplantation Surgery Unit, A.O.B. Brotzu, Cagliari, Italy
| | - Giovanni Vennarecci
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy
| | | | - Antonio Daniele Pinna
- Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Salvatore Gruttadauria
- Department of Gastroenterology and Hepatology, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), University of Pittsburgh Medical Center, Palermo, Italy
| | - Alfredo Di Leo
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University Hospital, Bari, Italy
| | - Massimo Rossi
- Department of General Surgery and Organ Transplantation, Umberto I Policlinic, Sapienza University, Rome, Italy
| | - Giuseppe Tisone
- UOC Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Fausto Zamboni
- Department of Surgery, General and Hepatic Transplantation Surgery Unit, A.O.B. Brotzu, Cagliari, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Pierluca Piselli
- Department of Epidemiology, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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5
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Manzia TM, Angelico R, Toti L, Pisani G, Vita G, Romano F, Pirozzi BM, Vinci D, Cacciola R, Iaria G, Tisone G. The hamletic dilemma of patients waiting for kidney transplantation during the COVID-19 pandemic: To accept or not to accept (an organ offer)? Transpl Infect Dis 2021; 23:e13560. [PMID: 33393172 PMCID: PMC7883127 DOI: 10.1111/tid.13560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 02/05/2023]
Abstract
The outbreak of COVID-19 led to a reduction in the number of organ transplant interventions in most Countries. In April 2020, at the Tor Vergata University in Rome, Italy, two patients on the waiting list for kidney transplantation (KT) declined a deceased donor's kidney offer. Therefore, between April 20 and 25, 2020, we conducted a telephone survey among our 247 KT waitlist patients. Our aim was to explore: (a) the COVID-19 diffusion among them and (b) their current willingness to be transplanted in case of a kidney offer from a deceased donor. Two hundred and forty-three patients participated in a phone interview. One patient had died from COVID-19. Eighty-five (35%) KT candidates would decline any kidney offer, in most cases until the end of the COVID-19 pandemic. Upon a multivariate analysis, female gender (OR = 2.25, 95% CI = 1.26-4.03, P = .006), high cardiovascular risk (OR = 2.33, 95% CI = 1.06-5.08, P = .034), a waiting list time <3 years (OR = 0.375, 95% CI = 0.15-0.95, P = .04), and the need to be transferred to another hospital for HD (OR = 2.56, 95% CI = 1.10-5.9, P = .03) were associated with such refusal. The COVID-19 pandemic led to a fear of transplantation in a third of the KT candidates. Proactive educational webinars could be a useful tool to remove, or at least lessen, any doubts on the part of KT candidates and to avoid losing the opportunity to quit dialysis.
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Affiliation(s)
- Tommaso M. Manzia
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Roberta Angelico
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Luca Toti
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Gennaro Pisani
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Giuseppe Vita
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Francesca Romano
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Brunella M. Pirozzi
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Danilo Vinci
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Roberto Cacciola
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Giuseppe Iaria
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
| | - Giuseppe Tisone
- Department of Surgery ScienceTransplant and HPB UnitUniversity of Rome Tor VergataRomeItaly
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Ghinolfi D, Lai Q, Dondossola D, De Carlis R, Zanierato M, Patrono D, Baroni S, Bassi D, Ferla F, Lauterio A, Lazzeri C, Magistri P, Melandro F, Pagano D, Pezzati D, Ravaioli M, Rreka E, Toti L, Zanella A, Burra P, Petta S, Rossi M, Dutkowski P, Jassem W, Muiesan P, Quintini C, Selzner M, Cillo U. Machine Perfusions in Liver Transplantation: The Evidence-Based Position Paper of the Italian Society of Organ and Tissue Transplantation. Liver Transpl 2020; 26:1298-1315. [PMID: 32519459 DOI: 10.1002/lt.25817] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/26/2020] [Accepted: 05/08/2020] [Indexed: 02/05/2023]
Abstract
The use of machine perfusion (MP) in liver transplantation (LT) is spreading worldwide. However, its efficacy has not been demonstrated, and its proper clinical use has far to go to be widely implemented. The Società Italiana Trapianti d'Organo (SITO) promoted the development of an evidence-based position paper. A 3-step approach has been adopted to develop this position paper. First, SITO appointed a chair and a cochair who then assembled a working group with specific experience of MP in LT. The Guideline Development Group framed the clinical questions into a patient, intervention, control, and outcome (PICO) format, extracted and analyzed the available literature, ranked the quality of the evidence, and prepared and graded the recommendations. Recommendations were then discussed by all the members of the SITO and were voted on via the Delphi method by an institutional review board. Finally, they were evaluated and scored by a panel of external reviewers. All available literature was analyzed, and its quality was ranked. A total of 18 recommendations regarding the use and the efficacy of ex situ hypothermic and normothermic machine perfusion and sequential normothermic regional perfusion and ex situ MP were prepared and graded according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. A critical and scientific approach is required for the safe implementation of this new technology.
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Affiliation(s)
- Davide Ghinolfi
- Division of Hepatic Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Quirino Lai
- Hepatobiliary and Organ Transplantation Unit, Sapienza University of Rome, Rome, Italy
| | - Daniele Dondossola
- General and Liver Transplantation Unit, Fondazione IRCCS Ca'Granda, University of Milan Medical School Hospital, Milan, Italy
| | - Riccardo De Carlis
- Department of General Surgery and Abdominal Transplantation, Niguarda Hospital, Milan, Italy
| | - Marinella Zanierato
- General Surgery and Liver Transplantation, University of Turin Medical School Hospital, Turin, Italy
| | - Damiano Patrono
- Department of Anesthesiology, University of Turin Medical School Hospital, Turin, Italy
| | - Stefano Baroni
- Department of Anesthesiology, University of Modena Medical School Hospital, Modena, Italy
| | - Domenico Bassi
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Padua Medical School Hospital, Padua, Italy
| | - Fabio Ferla
- Department of General Surgery and Abdominal Transplantation, Niguarda Hospital, Milan, Italy
| | - Andrea Lauterio
- Department of General Surgery and Abdominal Transplantation, Niguarda Hospital, Milan, Italy
| | - Chiara Lazzeri
- Intensive Care Unit and Regional ECMO Referral Centre, University of Florence Medical School Hospital, Florence, Italy
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver, Transplantation Unit, University of Modena Medical School Hospital, Modena, Italy
| | - Fabio Melandro
- Division of Hepatic Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Duilio Pagano
- Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione and University of Pittsburgh Medical Center, Palermo, Italy
| | - Daniele Pezzati
- Division of Hepatic Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Matteo Ravaioli
- Department of Organ Insufficiency and Transplantation, General Surgery and Transplantation, University of Bologna Medical School Hospital, Bologna, Italy
| | - Erion Rreka
- Division of Hepatic Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Luca Toti
- HPB and Transplant Unit, Department of Surgery, University of Tor Vergata, Rome, Italy
| | - Alberto Zanella
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, University of Milan Medical School Hospital, Milan, Italy
| | - Patrizia Burra
- Department of Surgery, Oncology, and Gastroenterology, University of Padua Medical School Hospital, Padua, Italy
| | - Salvatore Petta
- Division of Gastroenterology and Hepatology, University of Palermo Medical School Hospital, Palermo, Italy
| | - Massimo Rossi
- Hepatobiliary and Organ Transplantation Unit, Sapienza University of Rome, Rome, Italy
| | - Philippe Dutkowski
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Wayel Jassem
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Paolo Muiesan
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Markus Selzner
- Multi-Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Padua Medical School Hospital, Padua, Italy
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7
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Manzia TM, Quaranta C, Filingeri V, Toti L, Anselmo A, Tariciotti L, De Carolis G, Cacciola R, Di Lorenzo N, Sorge R, Angelico R, Monteleone G, Tisone G. Feasibility and cost effectiveness of ambulatory laparoscopic cholecystectomy. A retrospective cohort study. Ann Med Surg (Lond) 2020; 55:56-61. [PMID: 32461804 PMCID: PMC7240280 DOI: 10.1016/j.amsu.2020.04.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 02/08/2023] Open
Abstract
Ambulatory surgery is an efficient, safe and widely performed procedure; this study would shows the advantages of the ambulatory laparoscopic cholecystectomy procedure from the point of view of patients and the Hospital/National Health System. Materials and Methods: Single-center retrospective cohort study including 288 patients who underwent laparoscopic-cholecystectomy at **** from January 2016 to July 2018. Ambulatory LC were compared to well-matched inpatient procedures performed in the same study period. The primary endpoints was the 30-day readmission rate. Secondary endpoints were the discharge rate in the ambulatory group, the post-operative complications rate and cost effectiveness. Results: 120/288 (41.7%) patients underwent ambulatory laparoscopic cholecystectomy. Thirty-two (26.7%) patients who underwent ambulatory laparoscopic cholecystectomy had major preoperative comorbidities and 35 (29.2%) had undergone prior abdominal surgery. The readmission rates for ambulatory patients and inpatients were 0.8% and 1.7% (p = 0.56), respectively; 104 (86.7%) ambulatory patients were discharged successfully on the same day. The two groups showed the same post-operative complication rate (p = 0.40). Ambulatory procedures resulted in related cost savings of more than 300% for the hospital and a remarkable financial benefit for the National Italian Healthcare System, accounting for savings exceeding € 27 000 per year. Conclusions: Ambulatory laparoscopic cholecystectomy is safe and cost effective. Since a third of ambulatory patients showed comorbidity or previous abdominal surgery, we believe that this procedure may be performed safely in a tertiary HPB centre, even in complex patients.
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Affiliation(s)
- Tommaso Maria Manzia
- Department of Surgery, HPB and Transplant Unit, Fondazione PTV, Tor Vergata University of Rome, Italy
| | - Claudia Quaranta
- Department of Surgery, HPB and Transplant Unit, Fondazione PTV, Tor Vergata University of Rome, Italy
| | - Vincenzino Filingeri
- Department of Surgery, HPB and Transplant Unit, Fondazione PTV, Tor Vergata University of Rome, Italy
| | - Luca Toti
- Department of Surgery, HPB and Transplant Unit, Fondazione PTV, Tor Vergata University of Rome, Italy
| | - Alessandro Anselmo
- Department of Surgery, HPB and Transplant Unit, Fondazione PTV, Tor Vergata University of Rome, Italy
| | - Laura Tariciotti
- Department of Surgery, HPB and Transplant Unit, Fondazione PTV, Tor Vergata University of Rome, Italy
| | | | - Roberto Cacciola
- Department of Surgery, HPB and Transplant Unit, Fondazione PTV, Tor Vergata University of Rome, Italy
| | - Nicola Di Lorenzo
- Department of Surgery, HPB and Transplant Unit, Fondazione PTV, Tor Vergata University of Rome, Italy
| | - Roberto Sorge
- Laboratory of Biometry, Department of Systems Medicine, Tor Vergata University of Rome, Italy
| | - Roberta Angelico
- Department of Surgery, HPB and Transplant Unit, Fondazione PTV, Tor Vergata University of Rome, Italy
| | | | - Giuseppe Tisone
- Department of Surgery, HPB and Transplant Unit, Fondazione PTV, Tor Vergata University of Rome, Italy
- Corresponding author. Liver Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy. ,
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Fiume D, Lenci I, Milana M, Manzia TM, Massoud R, Tariciotti L, Russo C, Toti L, Baiocchi L. Serum Levels of Granulocyte-Macrophage-colony-stimulating Factor and Stem-cell Factor During Liver Regeneration after Partial Hepatectomy in Humans. Rev Recent Clin Trials 2020; 15:131-136. [PMID: 31971114 DOI: 10.2174/1574887115666200123113623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/01/2020] [Accepted: 01/03/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Multiple biological functions have been recognized regarding Granulocyte Macrophage-Colony Stimulating Factor (GM-CSF) and Stem Cell Factor (SCF). AIM To evaluate the serum changes of GM-CSF and SCF in patients undergoing surgical resection for liver tumor, in the regenerative phase after surgery in order to identify the possible relationship with the patient, tumor or surgical variables. METHODS Thirty-two consecutive patients (50% male, median age 66), undergoing hepatic resection of liver neoplasm, were evaluated. The liver tumor was Hepatocellular Carcinoma (HCC) in 44% of cases. Other tumors were cholangiocarcinoma and metastasis. Serum levels of GM-CSF and SCF were assessed at baseline and 2 days, 7 days and 4 weeks after surgery. Personal and clinical patient data were also recorded. The statistical analysis was carried out using t-test for unpaired data or ANOVA (repeated measure) for continuous variables and Fisher test for discrete variables. RESULTS GM-CSF levels remained constant after surgery and were compared to baseline values. SCF levels, on the other hand, increased during the time, after surgery. The evaluation of SCF levels (fold increase) according to surgical, patient and tumor variables evidenced some differences. At day 7 and week 4, SCF levels were statistically increased: i) in patients undergoing a large resection in comparison with others (p<0.05); ii) in patients non-cirrhotic in comparison with cirrhotic ones (p=0.02) and finally; iii) in patients with non-HCC tumor in comparison with HCC ones (p=0.02). CONCLUSION During liver regeneration in humans, SCF serum levels are increased allowing to hypothesize a possible role of this chemokine during tissue growth and remodeling.
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Affiliation(s)
- Diego Fiume
- Department of Experimental Medicine Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Martina Milana
- Hepatology Unit, Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Tommaso M Manzia
- Unit of Transplant Surgery, Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Renato Massoud
- Department of Experimental Medicine Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Laura Tariciotti
- Unit of Transplant Surgery, Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Carmelo Russo
- Department of Experimental Medicine Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Luca Toti
- Hepatology Unit, Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Leonardo Baiocchi
- Hepatology Unit, Tor Vergata Policlinic, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
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Manzia TM, Angelico R, Gazia C, Lenci I, Milana M, Ademoyero OT, Pedini D, Toti L, Spada M, Tisone G, Baiocchi L. De novo malignancies after liver transplantation: The effect of immunosuppression-personal data and review of literature. World J Gastroenterol 2019; 25:5356-5375. [PMID: 31558879 PMCID: PMC6761240 DOI: 10.3748/wjg.v25.i35.5356] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/08/2019] [Accepted: 08/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Immunosuppression has undoubtedly raised the overall positive outcomes in the post-operative management of solid organ transplantation. However, long-term exposure to immunosuppression is associated with critical systemic morbidities. De novo malignancies following orthotopic liver transplants (OLTs) are a serious threat in pediatric and adult transplant individuals. Data from different experiences were reported and compared to assess the connection between immunosuppression and de novo malignancies in liver transplant patients.
AIM To study the role of immunosuppression on the incidence of de novo malignancies in liver transplant recipients.
METHODS A systematic literature examination about de novo malignancies and immunosuppression weaning in adult and pediatric OLT recipients was described in the present review. Worldwide data were collected from highly qualified institutions performing OLTs. Patient follow-up, immunosuppression discontinuation and incidence of de novo malignancies were reported. Likewise, the review assesses the differences in adult and pediatric recipients by describing the adopted immunosuppression regimens and the different type of diagnosed solid and blood malignancy.
RESULTS Emerging evidence suggests that the liver is an immunologically privileged organ able to support immunosuppression discontinuation in carefully selected recipients. Malignancies are often detected in liver transplant patients undergoing daily immunosuppression regimens. Post-transplant lymphoproliferative diseases and skin tumors are the most detected de novo malignancies in the pediatric and adult OLT population, respectively. To date, immunosuppression withdrawal has been achieved in up to 40% and 60% of well-selected adult and pediatric recipients, respectively. In both populations, a clear benefit of immunosuppression weaning protocols on de novo malignancies is difficult to ascertain because data have not been specified in most of the clinical experiences.
CONCLUSION The selected populations of tolerant pediatric and adult liver transplant recipients greatly benefit from immunosuppression weaning. There is still no strong clinical evidence on the usefulness of immunosuppression withdrawal in OLT recipients on malignancies. An interesting focus is represented by the complete reconstitution of the immunological pathways that could help in decreasing the incidence of de novo malignancies and may also help in treating liver transplant patients suffering from cancer.
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Affiliation(s)
- Tommaso Maria Manzia
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Roberta Angelico
- Division of Abdominal Transplantation and HPB Surgery, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Carlo Gazia
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC 27101, United States
| | - Ilaria Lenci
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome 00133, Italy
| | - Martina Milana
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome 00133, Italy
| | | | - Domiziana Pedini
- Division of Abdominal Transplantation and HPB Surgery, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Luca Toti
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Marco Spada
- Division of Abdominal Transplantation and HPB Surgery, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Giuseppe Tisone
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Leonardo Baiocchi
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome 00133, Italy
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10
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Toti L, Manzia TM, Roma S, Meucci R, Blasi F, Ferlosio A, Tisone G, Orlacchio A. Rare malignant glomus tumor of the stomach with liver metastases. Radiol Case Rep 2019; 14:463-467. [PMID: 30766648 PMCID: PMC6360248 DOI: 10.1016/j.radcr.2019.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 02/08/2023] Open
Abstract
We report a case of a 72-year-old male admitted in our Unit with anemia and a 10 cm liver neoplasm. Computed tomography scan showed 2 lesions respectively in the II, III and, VIII segment of the liver. Surgical resection of the larger liver mass was performed and the tumor appeared as a solid-cystic mass and a diagnosis of malignant mesenchymal tumor not otherwise specified, was made. One month later a Computed tomography scan detected a dishomogeneous gastric mass, 6 cm in diameter, in the greater curvature, confirmed by esophagogastroduodenoscopy. The pathological diagnosis from endoscopic biopsy revealed a mesenchymal tumor requiring surgical removal for accurate diagnosis. The patient underwent relaparotomy and gastric resection and the pathological findings gave a diagnosis of a rare malignant glomic tumor of the stomach confirmed by the revision of previously performed hepatic resection classified as secondary lesion.
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Affiliation(s)
- Luca Toti
- Department of Surgery, Liver Unit also University Hospital Tor Vergata, Rome, Italy
| | - Tommaso Maria Manzia
- Department of Surgery, Liver Unit also University Hospital Tor Vergata, Rome, Italy
| | - Silvia Roma
- Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Rome 00133, Italy
| | - Rosaria Meucci
- Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Rome 00133, Italy
| | - Francesca Blasi
- Department of Surgery, Liver Unit also University Hospital Tor Vergata, Rome, Italy
| | - Amedeo Ferlosio
- Anatomic Pathology, University Hospital Tor Vergata, Rome, Italy
| | - Giuseppe Tisone
- Department of Surgery, Liver Unit also University Hospital Tor Vergata, Rome, Italy
| | - Antonio Orlacchio
- Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Rome 00133, Italy
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11
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Taborelli M, Toffolutti F, Del Zotto S, Clagnan E, Furian L, Piselli P, Citterio F, Zanier L, Boscutti G, Serraino D. Increased cancer risk in patients undergoing dialysis: a population-based cohort study in North-Eastern Italy. BMC Nephrol 2019; 20:107. [PMID: 30922296 PMCID: PMC6437907 DOI: 10.1186/s12882-019-1283-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/07/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In southern Europe, the risk of cancer in patients with end-stage kidney disease receiving dialysis has not been well quantified. The aim of this study was to assess the overall pattern of risk for de novo malignancies (DNMs) among dialysis patients in the Friuli Venezia Giulia region, north-eastern Italy. METHODS A population-based cohort study among 3407 dialysis patients was conducted through a record linkage between local healthcare databases and the cancer registry (1998-2013). Person-years (PYs) were calculated from 30 days after the date of first dialysis to the date of DNM diagnosis, kidney transplant, death, last follow-up or December 31, 2013, whichever came first. The risk of DNM, as compared to the general population, was estimated using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). RESULTS During 10,798 PYs, 357 DNMs were diagnosed in 330 dialysis patients. A higher than expected risk of 1.3-fold was found for all DNMs combined (95% CI: 1.15-1.43). The risk was particularly high in younger dialysis patients (SIR = 1.88, 95% CI: 1.42-2.45 for age 40-59 years), and it decreased with age. Moreover, significantly increased DNM risks emerged during the first 3 years since dialysis initiation, especially within the first year (SIR = 8.52, 95% CI: 6.89-10.41). Elevated excess risks were observed for kidney (SIR = 3.18; 95% CI: 2.06-4.69), skin non-melanoma (SIR = 1.81, 95% CI: 1.46-2.22), oral cavity (SIR = 2.42, 95% CI: 1.36-4.00), and Kaposi's sarcoma (SIR = 10.29, 95% CI: 1.25-37.16). CONCLUSIONS The elevated risk for DNM herein documented suggest the need to implement a targeted approach to cancer prevention and control in dialysis patients.
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Affiliation(s)
- Martina Taborelli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081 Aviano, (PN) Italy
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081 Aviano, (PN) Italy
| | - Stefania Del Zotto
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081 Aviano, (PN) Italy
| | - Elena Clagnan
- Azienda Regionale di Coordinamento per la Salute, Udine, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Pierluca Piselli
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases “L. Spallanzani”, Rome, Italy
| | - Franco Citterio
- Renal Transplantation Unit, Department of Surgical Science, Università Cattolica Sacro Cuore, Rome, Italy
| | - Loris Zanier
- Azienda Regionale di Coordinamento per la Salute, Udine, Italy
| | - Giuliano Boscutti
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081 Aviano, (PN) Italy
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12
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Taborelli M, Piselli P, Ettorre GM, Baccarani U, Burra P, Lauro A, Galatioto L, Rendina M, Shalaby S, Petrara R, Nudo F, Toti L, Fantola G, Cimaglia C, Agresta A, Vennarecci G, Pinna AD, Gruttadauria S, Risaliti A, Di Leo A, Rossi M, Tisone G, Zamboni F, Serraino D. Survival after the diagnosis of de novo malignancy in liver transplant recipients. Int J Cancer 2019; 144:232-239. [PMID: 30091809 DOI: 10.1002/ijc.31782] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/25/2018] [Indexed: 02/05/2023]
Abstract
In the setting of liver transplant (LT), the survival after the diagnosis of de novo malignancies (DNMs) has been poorly investigated. In this study, we assessed the impact of DNMs on survival of LT recipients as compared to corresponding LT recipients without DNM. A nested case-control study was conducted in a cohort of 2,818 LT recipients enrolled in nine Italian centres between 1985 and 2014. Cases were 244 LT recipients who developed DNMs after LT. For each case, two controls matched for gender, age, and year at transplant were selected by incidence density sampling among cohort members without DNM. The survival probabilities were estimated using the Kaplan-Meier method. Hazard ratios (HRs) of death and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models. The all-cancer 10-year survival was 43% in cases versus 70% in controls (HR = 4.66; 95% CI: 3.17-6.85). Survival was impaired in cases for all the most frequent cancer types, including lung (HR = 37.13; 95% CI: 4.98-276.74), non-Hodgkin lymphoma (HR = 6.57; 95% CI: 2.15-20.01), head and neck (HR = 4.65; 95% CI: 1.81-11.95), and colon-rectum (HR = 3.61; 95% CI: 1.08-12.07). The survival gap was observed for both early and late mortality, although the effect was more pronounced in the first year after cancer diagnosis. No significant differences in survival emerged for Kaposi's sarcoma and nonmelanoma skin cancers. The survival gap herein quantified included a broad range of malignancies following LT and prompts close monitoring during the post-transplant follow-up to ensure early cancer diagnosis and to improve survival.
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Affiliation(s)
- Martina Taborelli
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute IRCCS, Aviano, Italy
| | - Pierluca Piselli
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Rome, Italy
| | | | | | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Augusto Lauro
- Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Laura Galatioto
- Department of Gastroenterology and Hepatology, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), University of Pittsburgh Medical Center, Palermo, Italy
| | - Maria Rendina
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University Hospital, Bari, Italy
| | - Sarah Shalaby
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Raffaella Petrara
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Francesco Nudo
- Department of General Surgery and Organ Transplantation, Umberto I Policlinic, Sapienza University, Rome, Italy
| | - Luca Toti
- UOC Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Giovanni Fantola
- Department of Surgery, General and Hepatic Transplantation Surgery Unit, A.O.B. Brotzu, Cagliari, Italy
| | - Claudia Cimaglia
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Rome, Italy
| | - Alessandro Agresta
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Rome, Italy
| | - Giovanni Vennarecci
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy
| | - Antonio Daniele Pinna
- Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Salvatore Gruttadauria
- Department of Gastroenterology and Hepatology, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), University of Pittsburgh Medical Center, Palermo, Italy
| | | | - Alfredo Di Leo
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University Hospital, Bari, Italy
| | - Massimo Rossi
- Department of General Surgery and Organ Transplantation, Umberto I Policlinic, Sapienza University, Rome, Italy
| | - Giuseppe Tisone
- UOC Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Fausto Zamboni
- Department of Surgery, General and Hepatic Transplantation Surgery Unit, A.O.B. Brotzu, Cagliari, Italy
| | - Diego Serraino
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute IRCCS, Aviano, Italy
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Pace C, Nardone V, Roma S, Chegai F, Toti L, Manzia TM, Tisone G, Orlacchio A. Evaluation of Contrast-Enhanced Intraoperative Ultrasound in the Detection and Management of Liver Lesions in Patients with Hepatocellular Carcinoma. J Oncol 2019; 2019:6089340. [PMID: 31467539 PMCID: PMC6701365 DOI: 10.1155/2019/6089340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/04/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023]
Abstract
AIM To evaluate the role of contrast-enhanced intraoperative ultrasound (CE-IOUS) during liver surgery in the detection and management of liver lesions in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS From December 2016 to December 2017, 50 patients with HCC, who were candidates for liver resection, were evaluated with intraoperative ultrasound (IOUS). For all patients, MRI and/or CT were performed before surgery. During surgery, IOUS was performed after liver mobilization, and when nodules that had not been detected in the preoperative MRI and/or CT were observed, CE-IOUS scans were carried out with the dual purpose of better characterizing the unknown lesion and discovering new lesions. RESULTS In 12 patients, IOUS showed 14 nodules not detected by preoperative MRI and/or CT, before surgery. Out of the 12 lesions, five presented vascular features compatible with those of malignant HCC to the evaluation with CE-IOUS and four of these were simultaneously treated with intraoperative radiofrequency ablation (RFA). The fifth lesion was resected by the surgeon. The remaining nine lesions recognized by IOUS were evaluated as benign at CE-IOUS and considered regenerative nodules. The last diagnosis was confirmed during follow-up obtained by means of CT and/or MRI after 1, 3, 6, or 12 months. CONCLUSION In our experience, CE-IOUS is a useful diagnostic tool in both benign pathologies, such as regenerative nodules, and malignant liver lesions. The advantage of this approach is the possibility of intraoperatively characterizing, based on vascularization patterns, lesions that could not be diagnosed by preoperative imaging, resulting in modification of the surgical therapy decision and expansion of the resection or intraoperative ablation.
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Affiliation(s)
- Cristina Pace
- 1Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Vittorio Nardone
- 1Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Silvia Roma
- 1Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Fabrizio Chegai
- 1Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Luca Toti
- 2Department of Surgery, Liver Unit-University Hospital Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Tommaso Maria Manzia
- 2Department of Surgery, Liver Unit-University Hospital Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Giuseppe Tisone
- 2Department of Surgery, Liver Unit-University Hospital Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Antonio Orlacchio
- 1Department of Diagnostic and Interventional Radiology, University Hospital Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
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Manzia TM, Toti L, Quaranta C, Blasi F, Tisone G. Liver transplantation with a normothermic machine preserved fatty nonagenarian liver: A case report. Int J Surg Case Rep 2019; 57:163-166. [PMID: 30959367 PMCID: PMC6453798 DOI: 10.1016/j.ijscr.2019.03.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/12/2019] [Accepted: 03/21/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The use of organs from expanded criteria donors for Liver Transplantation (LT) represents a major challenge. In the current era of Normothermic Machine Perfusion (NMP), donor age boundaries are often overcome and may contribute to reduce the gap between supply and demand of organs suitable for transplantation. We report on a unique case of nonagenarian liver successfully transplanted after NMP. PRESENTATION OF CASE A fatty previously declined liver graft from nonagenarian male brain death donor underwent NMP (OrganOx Metra®, UK, Oxford) perfusion at University of Rome Tor Vergata on April 2018. The histology assessment showed 15% macro and 35% micro vescicular steatosis. Liver fulfilled viability criteria after NMP and was thus transplanted. The recipient was a 53 years old male with hepatocellular carcinoma who underwent two previous trans-arterial chemo-embolization. The post-LT AST peak was 1556 U/L; post operative course was characterized by hepatic artery thrombosis that required re-laparotomy and successful thrombectomy. Recipient experienced biliary stricture three months after discharge successfully treated by endoscopic retrograde cholangiopancreatography. At 7 months of follow-up patient has good clinical status and graft function. DISCUSSION NMP represents a safe approach in order to increase the usage of very old fatty livers, that otherwise would be declined because of the high risk of primary non function and death. CONCLUSION Nonagenarian liver recruitment after NMP seems to be feasible but a major attention is advisable on the manipulation and cannulation of hepatic artery in order to avoid intimal damage that can lead hepatic artery thrombosis.
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Affiliation(s)
- Tommaso Maria Manzia
- Department of Surgery, HPB and Transplant Unit, Tor Vergata University of Rome, Italy.
| | - Luca Toti
- Department of Surgery, HPB and Transplant Unit, Tor Vergata University of Rome, Italy
| | - Claudia Quaranta
- Department of Surgery, HPB and Transplant Unit, Tor Vergata University of Rome, Italy
| | - Francesca Blasi
- Department of Surgery, HPB and Transplant Unit, Tor Vergata University of Rome, Italy
| | - Giuseppe Tisone
- Department of Surgery, HPB and Transplant Unit, Tor Vergata University of Rome, Italy
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15
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Beckebaum S, Herzer K, Bauhofer A, Gelson W, De Simone P, de Man R, Engelmann C, Müllhaupt B, Vionnet J, Salizzoni M, Volpes R, Ercolani G, De Carlis L, Angeli P, Burra P, Dufour JF, Rossi M, Cillo U, Neumann U, Fischer L, Niemann G, Toti L, Tisone G. Recurrence of Hepatitis B Infection in Liver Transplant Patients Receiving Long-Term Hepatitis B Immunoglobulin Prophylaxis. Ann Transplant 2018; 23:789-801. [PMID: 30420590 PMCID: PMC6249983 DOI: 10.12659/aot.910176] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Long-term real-world data are relatively sparse regarding recurrence of chronic hepatitis B virus (HBV) infection after liver transplantation using hepatitis B immunoglobulin (HBIg) and nucleos(t)ide analogue (NUC) prophylaxis. MATERIAL AND METHODS Data from 371 adults transplanted for HBV-related disease at 20 European centers and given HBIg for ³12 months ± NUC therapy were analyzed retrospectively. RESULTS HBIg comprised Hepatect® (iv HBIgB; n=299), subcutaneous Zutectra® (sc HBIg, n=236), and other HBIg preparations (n=130); 93.5% received NUC therapy. Mean follow-up was 6.8±3.5 years. The primary efficacy variable, freedom from HBV recurrence, occurred in 95.7% of patients (95% CI [93.1%, 97.5%]). The observed incidence of recurrence was 16/371 (4.3%) (annual rate 0.65%); 5/16 patients with recurrence had discontinued HBIg and 7/16 had anti-HBs <100 IU/l. Excluding these 7 patients, the HBV recurrence rate was 2.4%. The recurrence rate while on HBIg therapy was 1 per 2069 months. In patients who discontinued HBIg, risk of HBV recurrence versus sc HBIg users was increased by 5.2-fold (1 per 1 603 versus 1 per 8379 treatment months). The annual rate of HBV-related hepatocellular carcinoma (HCC) recurrence was 1.7%. CONCLUSIONS These results support the long-term use of HBIg with NUC therapy as an effective management strategy to minimize risk of HBV recurrence and virus-related complications after liver transplantation.
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Affiliation(s)
- Susanne Beckebaum
- Department of Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Kerstin Herzer
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Artur Bauhofer
- Corporate Medical Affairs and Corporate Clinical Research and Development, Biotest AG, Dreieich, Germany
| | - William Gelson
- Cambridge Liver Unit, Addenbrooke’s Hospital, Cambridge, U.K
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation, Chirurgia Epatica e del Trapianto Fegato Pisa, Pisa, Italy
| | - Robert de Man
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cornelius Engelmann
- Department of Gastroenterology and Rheumatology, University of Leipzig, Leipzig, Germany
| | - Beat Müllhaupt
- Swiss HPB Center and Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Julien Vionnet
- Transplantation Centre and Service of Gastroenterology and Hepatology, Lausanne, Switzerland
| | - Mauro Salizzoni
- Chirurgia Generale 2U, Centro Trapianto Fegato, AO Città della Salute e della Scienza di Torino, Turin, Italy
| | - Riccardo Volpes
- Hepatology and Gastroenterology Unit, ISMETT-IRCCS, Palermo, Italy
| | - Giorgio Ercolani
- Department of General Surgery, Morgagni-Pierantoni General Hospital, University of Bologna, Bologna, Italy
| | - Luciano De Carlis
- Surgery and Abdominal Transplantation Division, Niguarda Ca’ Granda Hospital, Milan, Italy
| | - Paolo Angeli
- Multivisceral Transplant Unit, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Padua University Hospital, Padua, Italy
| | - Jean-François Dufour
- University Clinic for Visceral Surgery and Medicine, Inselspital, Bern, Switzerland
| | - Massimo Rossi
- Department of General Surgery and Organ Transplantation, Umberto I Policlinic, Sapienza University, Rome, Italy
| | - Umberto Cillo
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padova, Italy
| | - Ulf Neumann
- Department of Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Lutz Fischer
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele Niemann
- Corporate Medical Affairs and Corporate Clinical Research and Development, Biotest AG, Dreieich, Germany
| | - Luca Toti
- Transplant Centre, Faculty of Medicine, Azienda Ospedaliera Policlinico Tor Vergata, Rome, Italy
| | - Giuseppe Tisone
- Transplant Centre, Faculty of Medicine, Azienda Ospedaliera Policlinico Tor Vergata, Rome, Italy
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Taborelli M, Piselli P, Ettorre GM, Lauro A, Galatioto L, Baccarani U, Rendina M, Shalaby S, Petrara R, Nudo F, Toti L, Sforza D, Fantola G, Cimaglia C, Agresta A, Vennarecci G, Pinna AD, Gruttadauria S, Risaliti A, Di Leo A, Burra P, Rossi M, Tisone G, Zamboni F, Serraino D. Risk of virus and non-virus related malignancies following immunosuppression in a cohort of liver transplant recipients. Italy, 1985-2014. Int J Cancer 2018; 143:1588-1594. [PMID: 29693248 DOI: 10.1002/ijc.31552] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/19/2018] [Accepted: 04/06/2018] [Indexed: 02/05/2023]
Abstract
This cohort study assessed, in Italy, the overall pattern of risk of de novo malignancies following liver transplantation (LT). The study group included 2,832 individuals who underwent LT between 1985 and 2014 in nine centers all over Italy. Person-years (PYs) at cancer risk were computed from 30 days after LT to the date of cancer diagnosis, to the date of death or to the end of follow-up. Excess cancer risk, as compared to the general population, was estimated using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). During 18,642 PYs, 246 LT recipients developed 266 de novo malignancies, corresponding to a 1.8-fold higher cancer risk (95% CI: 1.6-2.0). SIRs were particularly elevated for virus-related malignancies, including Kaposi's sarcoma (SIR = 53.6, 95% CI: 30.0-88.5), non-Hodgkin lymphomas (SIR = 7.1, 95% CI: 4.8-10.1) and cervix uteri (SIR = 5.4, 95% CI: 1.1-15.8). Among virus-unrelated malignancies, elevated risks emerged for head and neck (SIR = 4.4, 95% CI: 3.1-6.2), esophagus (SIR = 6.7, 95% CI: 2.9-13.3) and adrenal gland (SIR = 22.9, 95% CI: 2.8-82.7). Borderline statistically significant elevated risks were found for lung cancer (SIR = 1.4, 95% CI: 1.0-2.1) and skin melanoma (SIR = 2.6, 95% CI: 1.0-5.3). A reduced risk emerged for prostate cancer (SIR = 0.1, 95% CI: 0.0-0.5). These findings underline the need of preventive interventions and early detection of malignancies, specifically tailored to LT recipients.
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Affiliation(s)
- Martina Taborelli
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Pierluca Piselli
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | | | - Augusto Lauro
- Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Laura Galatioto
- Department of Gastroenterology and Hepatology, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), University of Pittsburgh Medical Center, Palermo, Italy
| | | | - Maria Rendina
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University Hospital, Bari, Italy
| | - Sarah Shalaby
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Raffaella Petrara
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Francesco Nudo
- Department of General Surgery and Organ Transplantation, Umberto I Policlinic, Sapienza University, Rome, Italy
| | - Luca Toti
- UOC Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Daniele Sforza
- UOC Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Giovanni Fantola
- Department of Surgery, General and Hepatic Transplantation Surgery Unit, A.O.B. Brotzu, Cagliari, Italy
| | - Claudia Cimaglia
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Alessandro Agresta
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Giovanni Vennarecci
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy
| | - Antonio Daniele Pinna
- Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Salvatore Gruttadauria
- Department of Gastroenterology and Hepatology, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), University of Pittsburgh Medical Center, Palermo, Italy
| | | | - Alfredo Di Leo
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University Hospital, Bari, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Massimo Rossi
- Department of General Surgery and Organ Transplantation, Umberto I Policlinic, Sapienza University, Rome, Italy
| | - Giuseppe Tisone
- UOC Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Fausto Zamboni
- Department of Surgery, General and Hepatic Transplantation Surgery Unit, A.O.B. Brotzu, Cagliari, Italy
| | - Diego Serraino
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
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17
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Manzia TM, Angelico R, Toti L, Angelico C, Quaranta C, Parente A, Blasi F, Iesari S, Sforza D, Baiocchi L, Lerut J, Tisone G. Longterm Survival and Cost-Effectiveness of Immunosuppression Withdrawal After Liver Transplantation. Liver Transpl 2018; 24:1199-1208. [PMID: 30129171 DOI: 10.1002/lt.25293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/15/2018] [Indexed: 02/05/2023]
Abstract
Lifelong immunosuppression (IS) after liver transplantation is associated with severe adverse effects and increased recipients' morbidity and mortality. Clinical operational tolerance has been reported in up to 40% in very well-selected recipients. Longterm survival and cost savings within the Italian national health system in operational tolerant recipients is reported. Seventy-five liver recipients were enrolled for IS withdrawal at our institution during the period from April 1998 to December 2015. The study population comprised 32 (42.7%) tolerant patients; 41 (54.7%) nontolerant patients needing uptake of IS after clinical or biopsy-proven rejection; and 2 (2.7%) immediate nontolerant patients who developed early rejection after the first drug reduction. The primary endpoint of the study was to assess the longterm patients and graft outcome; the secondary endpoint was the assessment of cost savings in the context of IS withdrawal. The follow-up was 95.0 months (interquartile range, 22.5-108.5 months). IS withdrawal did not result in patient nor graft loss and resulted in a major cost savings reaching about €630,000. In conclusion, longterm IS withdrawal represents a remarkable cost savings in the health care of liver recipients without exposing them to graft loss.
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Affiliation(s)
- Tommaso Maria Manzia
- Transplant and Hepatobiliary Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Roberta Angelico
- Transplant and Hepatobiliary Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy
| | - Luca Toti
- Transplant and Hepatobiliary Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - Claudia Quaranta
- Transplant and Hepatobiliary Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Parente
- Transplant and Hepatobiliary Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Blasi
- Transplant and Hepatobiliary Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Samuele Iesari
- Department of Economics, Bocconi University, Milan, Italy
| | - Daniele Sforza
- Transplant and Hepatobiliary Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Leonardo Baiocchi
- Transplant and Hepatobiliary Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Jan Lerut
- Starzl Unit of Abdominal Transplantation, Université Catholique de Louvain, Brussels, Belgium
| | - Giuseppe Tisone
- Transplant and Hepatobiliary Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy
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18
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Lenci I, Milana M, Toti L, Palmieri G, Manzia TM, Angelico M, Tisone G, Baiocchi L. An unusual duodenal polyp causing anemia in a liver-transplanted patient. Am J Gastroenterol 2018; 113:918-919. [PMID: 29686271 DOI: 10.1038/s41395-018-0046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/28/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Ilaria Lenci
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Martina Milana
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Luca Toti
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Giampiero Palmieri
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Tommaso Maria Manzia
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Mario Angelico
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Giuseppe Tisone
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Leonardo Baiocchi
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
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19
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Marzano A, Andreone P, Boccagni P, Burra P, Caneschi F, Conoscitore PF, Coppola C, DE Carlis L, Fagiuoli S, Forte P, Gaeta GB, Iemmolo RM, Lotti Suffredini A, Mazzola M, Merli M, Parrilli G, Piai G, Piras MR, Salizzoni M, Tamè M, Tisone G, Toniutto P, Vennarecci G, Volpes R, Zamboni F, Caccamo L. Prevalent use of combined prophylaxis of hepatitis B after liver transplantation in Italy: results of a national survey in a large cohort. MINERVA GASTROENTERO 2018; 64:1-9. [PMID: 29307146 DOI: 10.23736/s1121-421x.17.02407-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Prophylaxis of hepatitis B after liver transplantation with antiviral(s) and immunoglobulins efficiently protect the majority of recipients; however recent experiences suggest a decline of HBsAg-positive candidates and the use of hepatitis B Immunoglobulin-free schedules. METHODS This national survey evaluated the epidemiology and clinical results of hepatitis B prophylaxis among 10,365 liver transplants performed in 25 years in 13 Italian centers. RESULTS With a percentage of 22, 2260 procedures were performed in HBsAg-positive recipients and 714 out of 1080 anti-HBc-positive grafts were used in HBsAg-negative recipients; a total of 2974 patients (29%) were considered at risk of hepatitis B after liver transplantation. Similar rates (18% of HBsAg-positive candidates and 15% of anti-HBc-positive grafts) were registered in the last collected year. Combined prophylaxis with Hepatitis B Immunoglobulins remained prevalent among centers and was effective in 96% of HBsAg-positive recipients and in 94% of HBsAg-negative recipients of anti-HBc-positive grafts. CONCLUSIONS Data from this survey confirm: the excellent results of combined prophylaxis; the past and persistent use of Hepatitis B Immunoglobulin-on and only rare -off prophylactic regimens, in contrast with the newest reports; the increasing use of anti-HBc-positive grafts; the past and present high prevalence of HBsAg-positive recipients, due to an increase in candidates with either hepatocellular carcinoma and Hepatitis Delta Virus coinfection in the last years.
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Affiliation(s)
- Alfredo Marzano
- Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pietro Andreone
- Department of Medical and Surgical Science, Research Center for the Study of Hepatitis, University of Bologna, Bologna, Italy
| | - Patrizia Boccagni
- Unit of Hepatobiliary Surgery and Liver Transplant, Department of Surgical Oncological and Gastrointestinal Sciences, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Unit of Multivisceral Transplant, Padua University Hospital, Padua, Italy
| | | | - Pasquale F Conoscitore
- Unit of Gastroenterology, "Casa Sollievo della Sofferenza" Hospital, IRCCS San Giovanni Rotondo, Foggia, Italy
| | - Carmine Coppola
- Unit of Hepatology and Interventional Ultrasonography, Department of Internal Medicine, OORR Area Stabiese, Plesso Nuovo Gragnano, Naples, Italy
| | - Luciano DE Carlis
- Department of Surgery and Transplantation, Niguarda Hospital, Milan, Italy
| | - Stefano Fagiuoli
- Unit of Gastroenterology Hepatology and Transplantology, Department of Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paolo Forte
- Division of Gastroenterology, University Hospital Careggi, Florence, Italy
| | - Giovanni B Gaeta
- Department of Internal and Experimental Medicine, Unit of Infectious Diseases, Second University of Naples, Naples, Italy
| | - Rosa M Iemmolo
- Unit of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, University of Modena, Modena, Italy
| | | | - Michele Mazzola
- Division of Infectious Disease, Vittorio Emanuele II Hospital, Bisceglie, Bari, Italy
| | - Manuela Merli
- Unit of Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Gianpaolo Parrilli
- Gastrointestinal Unit, AOU Sangiovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Guido Piai
- Unit of Hepatology, A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy
| | - Maria R Piras
- Department of Liver Transplant Coordination, AO Brotzu, Cagliari, Italy
| | - Mauro Salizzoni
- Unit of General Surgery, Liver Transplantation Center, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Mariarosa Tamè
- Division of Gastroenterology, Department of Medical and Surgical Sciences, AOU Bologna, Bologna, Italy
| | - Giuseppe Tisone
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Pierluigi Toniutto
- Medical Liver Transplant Section, Department of Medical Sciences Experimental and Clinical, University of Udine, Udine, Italy
| | | | - Riccardo Volpes
- Unit of Hepatology, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specialità, University of Pittsburgh Medical Center, Palermo, Italy
| | - Fausto Zamboni
- Department of General Surgery - Liver, Kidney and Pancreas Transplantation, AO Brotzu, Cagliari, Italy
| | - Lucio Caccamo
- Division of Hepato-Biliary-Pancreatic Surgery, IRCCS Ca' Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy -
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20
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Manzia TM, Angelico R, Toti L, Grimaldi C, Sforza D, Vella I, Tariciotti L, Lenci I, Breshanaj G, Baiocchi L, Tisone G. Ab initio Everolimus-based Versus Standard Calcineurin Inhibitor Immunosuppression Regimen in Liver Transplant Recipients. Transplant Proc 2018; 50:175-183. [PMID: 29407305 DOI: 10.1016/j.transproceed.2017.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/13/2017] [Accepted: 12/12/2017] [Indexed: 02/05/2023]
Abstract
AIM We designed a retrospective case-control study to determine the efficacy and feasibility of everolimus (EVR) combined with low-dose tacrolimus (Tac) ab initio versus standard-dose Tac after liver transplantation (LT). METHODS Seventy-one adult LT patients, receiving EVR and low-dose Tac without corticosteroids or induction therapy from postoperative day 1 (EVR group) were compared with a well-matched control group of 61 recipients treated with standard-dose Tac in association with antimetabolite. RESULTS Baseline characteristics for the two groups were comparable. The overall patient and graft survival rates were similar (P = .908). Liver function was stable during the follow-up. In the EVR group, biopsy-proven acute rejection occurred in two cases (2.8%), whereas chronic rejection occurred in one (1.4%). The EVR group experienced a better renal function already after 2 weeks (estimated glomerular filtration rate: 89.85 [36.46 to 115.3] mL/min/1.73 m2 vs. 68.77 [16.11 to 115.42] mL/min/1.73 m2; P = .013), which was also observed after a median time of 27 months (range, 0 to 82 months) from LT (estimated glomerular filtration rate: 80 [45 to 118.3] mL/min/1.73 m2 vs. 70.9 [45 to 88.4] mL/min/1.73 m2; P = .04). After a median time of 27 months, the EVR group showed lower incidence of arterial hypertension and insulin-dependent diabetes mellitus. CONCLUSION Ab initio EVR-based immunosuppression could be a valid option immediately after surgery in recipients at high-risk for post-LT renal impairment.
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Affiliation(s)
- T M Manzia
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy.
| | - R Angelico
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy; Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesu` Children's Research Hospital IRCCS, Rome, Italy
| | - L Toti
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy
| | - C Grimaldi
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesu` Children's Research Hospital IRCCS, Rome, Italy
| | - D Sforza
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy
| | - I Vella
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy
| | - L Tariciotti
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy
| | - I Lenci
- Department of Hepatology and Gastroenterology, Liver Unit, Tor Vergata University of Rome, Italy
| | - G Breshanaj
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy
| | - L Baiocchi
- Department of Hepatology and Gastroenterology, Liver Unit, Tor Vergata University of Rome, Italy
| | - G Tisone
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy
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21
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Garofalo V, Ventura A, Mazzilli S, Diluvio L, Bianchi L, Toti L, Tisone G, Milani M, Campione E. Treatment of Multiple Actinic Keratosis and Field of Cancerization with Topical Piroxicam 0.8% and Sunscreen 50+ in Organ Transplant Recipients: A Series of 10 Cases. Case Rep Dermatol 2017; 9:211-216. [PMID: 29282394 PMCID: PMC5731151 DOI: 10.1159/000481770] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/22/2017] [Indexed: 02/05/2023] Open
Abstract
Organ transplant recipient (OTR) subjects are at high risk of skin cancer such as squamous cell carcinoma and basal cell carcinoma. Actinic keratosis (AK) is considered the precursor of these non-melanoma skin cancers. Sun protection is mandatory in subjects with AK and this preventive strategy is very important in OTR. Treatment of the field of cancerization is also crucial to reduce the risk of recurrence of skin lesions in AK and non-melanoma skin cancer patients. Activation of cyclooxygenase 1 and 2 enzymes plays an important role in the pathogenesis of skin cancers. Topical application of cyclooxygenase inhibitors such as diclofenac and, more recently, piroxicam has shown to reduce AK lesions in immunocompetent subjects. A medical device containing piroxicam and SPF 50+ sunscreen filters (P+SS) has been demonstrated to be effective in reducing AK lesions and improving the field of cancerization. We report the effect of P+SS, applied for 16 weeks, in a case series of 10 OTR subjects with multiple AK lesions. P+SS treatment was associated with a relevant AK lesion reduction (>75%) in 7 patients (with a complete clearance in 3 subjects) with an improvement in the field of cancerization. This medical device could be considered a promising long-term curative and preventive treatment in OTR patients at high risk of non-melanoma skin cancers.
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Affiliation(s)
- Virginia Garofalo
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Alessandra Ventura
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Sara Mazzilli
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Laura Diluvio
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Luca Bianchi
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Luca Toti
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Tisone
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Milani
- Medical Department, Difa Cooper, IFC Group, Caronno Pertusella, Italy
- *Dr. Massimo Milani, MD, Medical Department, Difa Cooper, IFC Group, Via Milano 160, IT-21042 Caronno Pertusella (Italy), E-Mail
| | - Elena Campione
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Rome, Italy
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22
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Gandini R, Konda D, Toti L, Abrignani S, Merolla S, Tisone G, Floris R. Endovascular Mechanical Thromboaspiration of Right Hepatic Arterial Thrombosis After Liver Transplantation. Cardiovasc Intervent Radiol 2017; 40:621-624. [PMID: 28032131 DOI: 10.1007/s00270-016-1538-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/08/2016] [Indexed: 02/08/2023]
Abstract
A 56-year-old male Patient presented 27 days after a liver transplantation (LT) with fever and hyperbilirubinemia. He underwent CT examination resulting in a diagnosis of right hepatic artery (HA) occlusion with hepatic bilomas. Once placed a long right femoral 6F introducer at the origin of the HA, a 0.014" guidewire was advanced over the thrombus, in a segmental branch. A 4MAX (Penumbra, Alameda, USA) catheter was advanced and withdrawn under constant aspiration until complete clot removal was achieved. Follow-up CT and D-US assessments at 12 months demonstrated regular HA patency and bilomas reduction. Endovascular thromboaspiration is an effective strategy in cases of E-HAT after LT.
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Affiliation(s)
- Roberto Gandini
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, PTV Foundation, "Tor Vergata" Hospital, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Daniel Konda
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, PTV Foundation, "Tor Vergata" Hospital, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Luca Toti
- Department of Surgery, Section of Transplantation, PTV Foundation, "Tor Vergata" Hospital, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Sergio Abrignani
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, PTV Foundation, "Tor Vergata" Hospital, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.
| | - Stefano Merolla
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, PTV Foundation, "Tor Vergata" Hospital, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Giuseppe Tisone
- Department of Surgery, Section of Transplantation, PTV Foundation, "Tor Vergata" Hospital, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Roberto Floris
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, PTV Foundation, "Tor Vergata" Hospital, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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Lenci I, Baiocchi L, Tariciotti L, Di Paolo D, Milana M, Santopaolo F, Manzia TM, Toti L, Svicher V, Tisone G, Perno CF, Angelico M. Complete hepatitis B virus prophylaxis withdrawal in hepatitis B surface antigen-positive liver transplant recipients after longterm minimal immunosuppression. Liver Transpl 2016; 22:1205-13. [PMID: 27272189 DOI: 10.1002/lt.24493] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/03/2016] [Accepted: 05/05/2016] [Indexed: 02/05/2023]
Abstract
Tailored approaches have been attempted to prevent hepatitis B virus (HBV) reinfection in antibodies against hepatitis B surface antigen (HBsAg)-positive liver transplantation (LT) recipients in order to minimize the use of hepatitis B immune globulin (HBIG) and nucleoside analogues (NAs). We report the results of complete HBV prophylaxis withdrawal after a follow-up of at least 6 years in LT recipients with undetectable serum HBV DNA and intrahepatic total HBV DNA and covalently closed circular DNA at LT. We included 30 HBsAg positive, hepatitis B e antigen-negative recipients, 6 with hepatitis C virus and 7 with hepatitis D virus coinfection, who had received HBIG plus NA for at least 5 years after LT. Stepwise HBIG and NA withdrawal was performed in two 6-month periods under strict monitoring of HBV virology. All patients underwent a clinical, biochemical, and virological follow-up at 3-6 month intervals. HBV recurrence (HBsAg seroreversion ± detectable HBV DNA) occurred in 6 patients: in 1 patient after HBIG interruption and in 5 after both HBIG and NA cessation. Only 3 patients required reinstitution of HBV prophylaxis because of persistent HBV replication, and all achieved optimal control of HBV infection and did not experience clinical events. The other who recurred showed only short-lasting HBsAg positivity, with undetectable HBV DNA, followed by spontaneous anti-HBs seroconversion. An additional 15 patients mounted an anti-HBs titer, without previous serum HBsAg detectability. At the end of follow-up, 90% of patients were still prophylaxis-free, 93.3% were HBsAg negative, and 100% were HBV DNA negative; 60% had anti-HBs titers >10 IU/L (median, 143; range, 13-1000). This small series shows that complete prophylaxis withdrawal is safe in patients transplanted for HBV-related disease at low risk of recurrence and is often followed by spontaneous anti-HBs seroconversion. Further studies are needed to confirm this finding. Liver Transplantation 22 1205-1213 2016 AASLD.
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Affiliation(s)
- Ilaria Lenci
- Hepatology Unit, Tor Vergata University, Rome, Italy
| | | | | | | | | | | | | | - Luca Toti
- Liver Transplant Unit, Tor Vergata University, Rome, Italy
| | - Valentina Svicher
- Laboratory of Molecular Virology, Tor Vergata University, Rome, Italy
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Manzia TM, Angelico R, Toti L, Belardi C, Cillis A, Quaranta C, Tariciotti L, Katari R, Mogul A, Sforza D, Orlando G, Tisone G. The efficacy and safety of mammalian target of rapamycin inhibitors ab initio after liver transplantation without corticosteroids or induction therapy. Dig Liver Dis 2016; 48:315-20. [PMID: 26682720 DOI: 10.1016/j.dld.2015.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/23/2015] [Accepted: 11/09/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mammalian target of rapamycin inhibitors have been used along with corticosteroids and/or induction therapy immediately after liver transplantation. Our aim was to assess the safety and tolerability of everolimus ab initio after liver transplantation without corticosteroids or induction, as well as efficacy in terms of liver function, rejection and graft loss. METHODS A retrospective observational study of 50 adult patients (86% males, median age 54 years, range 25-68) who were liver transplanted between 2009 and 2013 and followed for 12 months. All recipients received everolimus plus low doses of calcineurin inhibitors (n=38) or mycophenolate (n=12) without corticosteroids and/or induction from the day of transplant. RESULTS The overall patient and graft survival was 80%. Liver function was stable during one year follow-up. No rejections or graft loss were observed. Only five patients (10%) required therapy for onset dyslipidemia. CONCLUSION Everolimus-based immunosuppression regimen without corticosteroids and/or induction immediately after liver transplantation seems to be safe and effective when administered with low doses of calcineurin-inhibitor or mycophenolate; although these findings require further investigation, these regimens could avoid adverse effects of standard immunosuppression regimens with higher doses.
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Affiliation(s)
- Tommaso Maria Manzia
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy.
| | - Roberta Angelico
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy
| | - Luca Toti
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy
| | - Chiara Belardi
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy
| | - Annagrazia Cillis
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy
| | - Claudia Quaranta
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy
| | - Laura Tariciotti
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy
| | - Ravi Katari
- Wake Forest School of Medicine, Winston Salem, USA
| | - Ashley Mogul
- Wake Forest School of Medicine, Winston Salem, USA
| | - Daniele Sforza
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy
| | | | - Giuseppe Tisone
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy
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Manzia TM, Tariciotti L, Angelico R, Toti L, Anselmo A, Tisone G. Side-to-side caval anastomosis in a patient receiving a liver graft from a marginal donor with situs inversus totalis. Int J Surg Case Rep 2015; 6C:222-5. [PMID: 25553527 PMCID: PMC4334491 DOI: 10.1016/j.ijscr.2014.10.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 10/05/2014] [Accepted: 10/10/2014] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The donor situs inversus totalis status was considered an absolute contraindication to liver transplantation due to the technical difficulties involved. Only in recent years has a very young deceased donor with situs inversus totalis been considered as a potential donor. PRESENTATION OF CASE We herein report a single case of 57-year-old male patient with hepatocellular carcinoma who received a liver transplantation from a 73-year-old woman with situs inversus totalis. Liver was implanted using a 1992-Belghiti piggyback technique positioning the larger hemiliver in the left upper quadrant and the left in the liver fossa. We assisted a good graft reperfusion without surgical or anesthetic problems. His hospital stay was relatively uneventful and he was discharged from hospital on postoperative day 7. At 8 months of follow-up the patient is alive and in good clinical condition. DISCUSSION The donor situs inversus totalis does not require any modification of transplant procedure if the donor-recipient size match permits a comfortable placement of the graft in a standard anatomical position. To the best of our knowledge, this is the first case of liver transplantation with a graft from a "marginal" donor with situs inversus totalis using a 1992-Belghiti piggyback technique. CONCLUSION The donor situs inversus totalis status should not be considered a contraindication for LT and the piggyback technique should be considered the surgery of choice.
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Affiliation(s)
- Tommaso Maria Manzia
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
| | - Laura Tariciotti
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Roberta Angelico
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Luca Toti
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Alessandro Anselmo
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Giuseppe Tisone
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
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Orlando G, Manzia TM, Sorge R, Iaria G, Angelico R, Sforza D, Toti L, Peloso A, Patel T, Katari R, Zambon JP, Maida A, Salerno MP, Clemente K, Di Cocco P, De Luca L, Tariciotti L, Famulari A, Citterio F, Tisone G, Pisani F, Romagnoli J. One-shot versus multidose perioperative antibiotic prophylaxis after kidney transplantation: a randomized, controlled clinical trial. Surgery 2015; 157:104-10. [PMID: 25304836 DOI: 10.1016/j.surg.2014.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 06/12/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is no consensus on the optimal perioperative antibiotic prophylaxis regimen for renal transplant recipients. Some studies have reported that irrigation of the wound at the time of closure without systemic antibiotics may suffice to minimize the risk for surgical site infection (SSI), but many centers still use long-term, multidose regimens in which antibiotics are administered until removal of foreign bodies occur, such as the urethral catheter, drain and central line. METHODS We designed a prospective, randomized, multicenter, controlled trial to compare a single dose versus a multidose regimen of systemic antibiotic prophylaxis in adult, nondiabetic, non-morbidly obese patients undergoing renal transplantation. The primary endpoint was the incidence of SSI; the assessment of other infection in the first postoperative month was the secondary endpoint. RESULTS Two hundred five patients were enrolled and randomized to receive either a single (n = 103) or multidose antibiotic regimen (n = 102) for prophylaxis. The incidences of SSI and urinary tract infection were similar in both groups. CONCLUSION As the dramatic increase in antibiotic resistance has mandated the implementation of global programs to optimize the use of antibiotic agents in humans, we believe that the single dose regimen is preferred, at least in nondiabetic, non-morbidly obese, adult renal transplant recipients.
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Affiliation(s)
| | - Tommaso Maria Manzia
- Department of Surgery, Section of Transplantation, Tor Vergata University of Rome, Rome, Italy
| | - Roberto Sorge
- Biometrics Laboratory, Tor Vergata University of Rome, Rome, Italy
| | - Giuseppe Iaria
- Department of Surgery, Section of Transplantation, Tor Vergata University of Rome, Rome, Italy
| | - Roberta Angelico
- Department of Surgery, Section of Transplantation, Tor Vergata University of Rome, Rome, Italy
| | - Daniele Sforza
- Department of Surgery, Section of Transplantation, Tor Vergata University of Rome, Rome, Italy
| | - Luca Toti
- Department of Surgery, Section of Transplantation, Tor Vergata University of Rome, Rome, Italy
| | | | - Timil Patel
- Wake Forest School of Medicine, Winston Salem, NC
| | - Ravi Katari
- Wake Forest School of Medicine, Winston Salem, NC
| | | | - Andrea Maida
- Department of Surgery, Renal Transplantation Unit, Catholic University, Rome, Italy
| | - Maria Paola Salerno
- Department of Surgery, Section of Transplantation, Tor Vergata University of Rome, Rome, Italy
| | - Katia Clemente
- Department of Surgery, Section of Transplantation, University of L'Aquila, L'Aquila, Italy
| | - Pierpaolo Di Cocco
- Department of Surgery, Section of Transplantation, University of L'Aquila, L'Aquila, Italy
| | - Linda De Luca
- Department of Surgery, Section of Transplantation, University of L'Aquila, L'Aquila, Italy
| | - Laura Tariciotti
- Department of Surgery, Section of Transplantation, University of L'Aquila, L'Aquila, Italy
| | - Antonio Famulari
- Department of Surgery, Section of Transplantation, University of L'Aquila, L'Aquila, Italy
| | - Franco Citterio
- Department of Surgery, Renal Transplantation Unit, Catholic University, Rome, Italy
| | - Giuseppe Tisone
- Department of Surgery, Section of Transplantation, Tor Vergata University of Rome, Rome, Italy
| | - Francesco Pisani
- Department of Surgery, Section of Transplantation, University of L'Aquila, L'Aquila, Italy
| | - Jacopo Romagnoli
- Department of Surgery, Renal Transplantation Unit, Catholic University, Rome, Italy
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Manzia TM, Angelico R, Ciano P, Mugweru J, Owusu K, Sforza D, Toti L, Tisone G. Impact of immunosuppression minimization and withdrawal in long-term hepatitis C virus liver transplant recipients. World J Gastroenterol 2014; 20:12217-12225. [PMID: 25232255 PMCID: PMC4161806 DOI: 10.3748/wjg.v20.i34.12217] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 02/17/2014] [Accepted: 05/14/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effects of different immunosuppressive regimens and avoidance on fibrosis progression in hepatitis C virus (HCV) liver transplant (LT) recipients.
METHODS: We retrospectively compared the liver biopsies of well-matched HCV LT recipients under calcineurin inhibitors (CNI group, n = 21) and mycophenolate (MMF group, n = 15) monotherapy, with those patients who successfully withdrawn immunosuppression (IS) therapy from at least 3 years (TOL group, n = 10). To perform the well-matched analysis, all HCV transplanted patients from December 1993 were screened. Only those HCV patients who reached the following criteria were considered for the analysis: (1) at least 3 years of post-operative follow-up; (2) patients with normal liver graft function under low dose CNI monotherapy (CNI group); (3) patients with normal liver graft function under antimetabolite (Micophenolate Mofetil or coated mycophenolate sodium) monotherapy (MMF group); and (4) recipients with normal liver function without any IS. We excluded from the analysis recipients who were IS free or under monotherapy for < 36 mo, recipients with cirrhosis or with unstable liver function tests.
RESULTS: Thirty six recipients were enrolled in the study. Demographics, clinical data, time after LT and baseline liver biopsies were comparable in the three groups. After six years of follow-up, there was no worsening of hepatic fibrosis in the MMF group (2.5 ± 1.5 Ishak Units vs 2.9 ± 1.7 Ishak Units, P = 0.5) and TOL group (2.7 ± 10.7 vs 2.5 ± 1.2, P = 0.2). In contrast, a significant increase in the fibrosis score was observed in the CNI group (2.2 ± 1.7 vs 3.9 ± 1.6, P = 0.008). The yearly fibrosis progression rate was significantly worse in the CNI group (0.32 ± 0.35) vs MMF group (0.03 ± 0.31, P = 0.03), and TOL group (-0.02 ± 0.27, P = 0.02). No differences have been reported in grading scores for CNI group (2.79 ± 1.9, P = 0.7), MMF group (3.2 ± 1.5, P = 0.9) and TOL group (3.1 ± 1.4, P = 0.2). Twenty four patients were treated with low dose ribavirin (8 TOL, 7 MMF, 9 CNI). The hepatitis C titers were comparable in the three groups. No episodes of rejection have been reported despite differences of liver function test in the three groups during the observational period.
CONCLUSION: IS withdrawal and MMF monotherapy is safe and seems to be associated with the slowest fibrosis progression in HCV LT recipients.
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Sforza D, Iaria G, Tariciotti L, Manuelli M, Anselmo A, Ciano P, Manzia TM, Toti L, Tisone G. Deep vein thrombosis as debut of cytomegalovirus infection associated with type II cryoglobulinemia, with antierythrocyte specificity in a kidney transplant recipient: a case report. Transplant Proc 2013; 45:2782-4. [PMID: 24034048 DOI: 10.1016/j.transproceed.2013.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Immunologic alterations, such as cryoglobulinemia, have been described in the acute phase of primary cytomegalovirus (CMV) infections in immunocompetent patients. There are few references about these influences of a primary CMV infection in an at-risk kidney transplant recipient (donor positive/recipient negative-D(+)/R(-)). Herein we have described the case of a 46-year-old man, who was naive for CMV and underwent renal transplantation from a CMV+ cadaveric donor, thereby at high risk for disease transmission. The immunosuppression consisted of basiliximab, tacrolimus, mycophenolate mofetil, and steroids. The recipient was not treated with CMV prophylaxis, but rather regularly screened for possible pre-emptive treatment. At 35 days after transplantation, he was admitted because of deep vein thrombosis (DVT) in the transplant ipsilateral lower limb accompanied by oliguria, fever, and epigastric pain accompanied by type II cryoglobulinemia and acute CMV infection. The direct antiglobulin test (DAT) for C3d was positive. The cryoglobulins displayed anti-red blood cell specificity, with maximum activity at 4°C. The DVT was successfully treated with locoregional thrombolysis in combination with anticoagulant therapy. The DAT improved with CMV treatment and increased steroid therapy. The urine output and renal function tests improved with resolution of the thrombosis, achieving complete recovery without sequelae. Our hypothesis was that CMV infection triggered cryoglobulinemia. The blood disorder caused hyperviscosity, inducing DVT. This case, of CMV infection showed associated cryoglobulinemia presenting with antierythrocyte specificity in a kidney transplant recipient.
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Affiliation(s)
- D Sforza
- U.O.C. Chirurgia dei Trapianti, Fondazione Policlinico Tor Vergata, University of Rome "Tor Vergata", Rome, Italy
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Manzia TM, Angelico R, Baiocchi L, Toti L, Ciano P, Palmieri G, Angelico M, Orlando G, Tisone G. The Tor Vergata weaning of immunosuppression protocols in stable hepatitis C virus liver transplant patients: the 10-year follow-up. Transpl Int 2013; 26:259-66. [PMID: 23278973 DOI: 10.1111/tri.12023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 06/18/2012] [Accepted: 10/30/2012] [Indexed: 02/05/2023]
Abstract
We report herein the 10-year outcome of the Tor Vergata weaning off immunosuppression protocol in hepatitis C virus (HCV) liver transplant patients. Thirty-four patients who had received a liver graft for HCV-related cirrhosis were enrolled in a prospective study in which they were progressively weaned off immunosuppression. The primary endpoints were feasibility and safety of the weaning; the second aim was to assess fibrosis progression. At the 10-year follow-up, of the eight original tolerant patients, six remained IS-free. Of the 26 individuals who could not be weaned, 22 were alive. When the baseline biopsies were compared with the 10-year biopsies, the tolerant group showed no differences in staging, whereas the nontolerant group showed a significant increase in staging. The fibrosis progression rates calculated for the tolerant and the nontolerant groups were -0.06 ± 0.12 and 0.1 ± 0.2, respectively (P = 0.04). Furthermore, with the last taken biopsies, nine nontolerant patients were showing frank cirrhosis versus no cirrhosis among the tolerant patients. After a 10-year follow-up of a Tor Vergata weaning protocol, 6/34 patients completed follow-up without reinstitution of immunosuppression and this appeared beneficial regarding a reduction in fibrosis progression.
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Manzia TM, Angelico R, Toti L, Lai Q, Ciano P, Angelico M, Tisone G. Hepatitis C virus recurrence and immunosuppression-free state after liver transplantation. Expert Rev Clin Immunol 2012; 8:635-44. [PMID: 23078061 DOI: 10.1586/eci.12.66] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
HCV-related disease is the most common indication for liver transplantation (LT). HCV recurrence, which is almost universal, has a significant impact on patient and graft survival after LT and still represents a great unsolved issue for the liver transplant community. Several treatment strategies have been proposed. Since antiviral therapy has limited efficacy and can be administrated only in selected transplant recipients and additionally that immunosuppressive drugs have a negative impact on HCV re-infection, the achievement of an immunosuppression-free state after LT could play a central role in the avoidance of rapid HCV recurrence.
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Manzia TM, Sforza D, Angelico R, Bellini MI, Ciano P, Manuelli M, Toti L, Tisone G. Everolimus and enteric-coated mycophenolate sodium ab initio after liver transplantation: midterm results. Transplant Proc 2012; 44:1942-5. [PMID: 22974878 DOI: 10.1016/j.transproceed.2012.06.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Everolimus (EVR) use in liver transplantation (OLT) has been prescribed with calcineurin inhibitors (CNIs), steroids, and monoclonal antibodies. The aim of our study was to evaluate the safety, feasibility, and impact on renal function of EVR ab initio, in combination with enteric-coated mycophenolate sodium (EC-MPS) without the use of induction treatment, steroids, or CNIs. PATIENTS AND METHODS We retrospective analyzed nine consecutive patients who underwent OLT at our institution. The initial dose of EVR (1.5 mg/d) was adjusted to achieve trough levels of 8 to 12 ng/mL. EC-MPS introduced at 1080 mg/d was maintained at the same dose over time. RESULTS At a mean follow-up of 21.48 (standard deviation [SD] 1.4) months from OLT, 7/9 recipients were alive with stable graft function. The 2-year patient and graft survivals were 77%. One recipient died due to cerebral hemorrhage and one, lung failure. No clinical evidence of an acute rejection episode was observed. Mean estimated glomerular filtration rate value, according to the Modification of Diet in Renal Disease formula increased from 59.5 (SD 9.89) mL/min/1.73 m(2) at OLT to 100.2 (SD 47.5) mL/min/1.73 m(2) (P = .03) after 12 months and 98.71 (SD 33.74) mL/min/1.73 m(2) (P = .03) after 24 months' follow-up. CONCLUSION A double immunosuppression therapy with EVR and EC-MPS ab initio seemed to be efficacions and safe, representing a valid alternative to CNIs to prevent renal failure after OLT.
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Affiliation(s)
- T M Manzia
- Transplant Unit, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
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Manzia TM, Gravante G, Di Paolo D, Orlando G, Toti L, Bellini MI, Ciano P, Angelico M, Tisone G. Liver transplantation for the treatment of nodular regenerative hyperplasia. Dig Liver Dis 2011; 43:929-34. [PMID: 21601542 DOI: 10.1016/j.dld.2011.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 03/28/2011] [Accepted: 04/04/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Nodular regenerative hyperplasia (NRH) is the leading cause of non-cirrhotic portal hypertension in Western countries. Although some patients are successfully managed medically or with shunting procedures, others require liver transplantation. The aim of this review was to assess the overall results obtained with liver transplantation and to better define its role in this setting. METHODS Systematic review of all published studies on liver transplantation for NRH without language restrictions, in Medline, Embase and Cochrane Library databases through March 2010. RESULTS 17 studies including a total of 73 patients were identified; 47 (64.3%) were excluded due to lacking inclusion criteria or clinical data and 26 (35.7%) were analysed. Before liver transplantation, the most frequent clinical presentation was gastroesophageal bleeding (65.3%) followed by ascites (61.5%), hepatic encephalopathy (30.7%) and liver failure (11.5%). The mean follow-up reported after liver transplantation was 30.6±27.6 months and patient and graft survival rate was 78.3%. Only one case reported a NRH recurrence 7 years after liver transplantation (LT). CONCLUSIONS Although there are no hard data supporting the role of liver transplantation in symptomatic NRH, onset of severe portal hypertension in this setting may represent a valid indication.
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Anselmo A, Rossi P, De Mayo A, Manzia TM, Iaria G, Toti L, Tisone G. Radiofrequency-assisted right hemihepatectomy by using a new incremental bipolar generator combined with liver hanging maneuver. MINERVA CHIR 2011; 66:495-9. [PMID: 22117214 DOI: pmid/22117214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In order to reduce bleeding, various surgical maneuvers and devices have been used and radiofrequency (RF)-assisted liver resections have been recently advocated by many authors. We performed a right hemihepatectomy for colorectal liver metastases by using new radiofrequency generator (Surtron SB®) combined with hanging maneuver to facilitate the application of the probe and avoid injuries of the interior vena cava (IVC). Operative time was 245 minutes, intraoperative blood loss was 120 ml, transection blood loss was 70 mL. No blood units were administered at any time. After a regular postoperative (PO) course patient was discharged on 11th PO day with normal liver function tests. In conclusion combined use of a RF generator and hanging maneuver in right hemihepatectomy provide bloodless parenchymal transection. The enhanced exposure contributes to better hemostasis and permits the best allocation of the comb with protection of the IVC from injuries.
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Affiliation(s)
- A Anselmo
- Department of Transplantation, Tor Vergata University, Fondazione Policlinico Tor Vergata, Rome, Italy.
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Manzia TM, Bellini MI, Corona L, Toti L, Fratoni S, Cillis A, Orlando G, Tisone G. Successful treatment of systemic de novo sarcoidosis with cyclosporine discontinuation and provision of rapamune after liver transplantation. Transpl Int 2011; 24:e69-70. [PMID: 21504488 DOI: 10.1111/j.1432-2277.2011.01256.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Iaria G, Sforza D, Angelico R, Toti L, de Luca L, Manuelli M, Bellini I, Manzia TM, Anselmo A, Tisone G. Switch from twice-daily tacrolimus (Prograf) to once-daily prolonged-release tacrolimus (Advagraf) in kidney transplantation. Transplant Proc 2011; 43:1028-9. [PMID: 21620043 DOI: 10.1016/j.transproceed.2011.01.130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Advagraf is a new modified-release once-daily formulation of tacrolimus. The aim of this study was to define the efficacy and safety of switching from Prograf to Advagraf immunosuppression in kidney transplant recipients. The switched dose ratio of Prograf to Advagraf was 1:1. Forty-one patients (34 men and 7 women) were switched at 36.6 ± 16.1 months after kidney transplantation. All patients maintained stable renal function and the conversion. In 16 subjects it was possible to withdraw steroid administration after obtaining adequate Advagraf blood levels, among whom 14 remained steroid free. Adverse events, including dizziness and tinnitus, were reported in 1 patient, who was reverted to Prograf. One patient who was receiving triple therapy with low tacrolimus blood levels experienced are acute rejection episode. The switch to Advagraf was safe and efficacious in kidney transplant recipients with or without steroid administration. Moreover, interruption of steroid was possible and well tolerated after achieving adequate stable blood levels with Advagraf.
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Affiliation(s)
- G Iaria
- Transplant Unit, S. Eugenio Hospital, Tor Vergata University, Rome, Italy.
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Manzia TM, Angelico R, Toti L, Bellini MI, Sforza D, Palmieri G, Orlando G, Tariciotti L, Angelico M, Tisone G. Long-term, maintenance MMF monotherapy improves the fibrosis progression in liver transplant recipients with recurrent hepatitis C. Transpl Int 2011; 24:461-8. [PMID: 21294787 DOI: 10.1111/j.1432-2277.2011.01228.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (LT) is universal. We designed a retrospective case-control study to evaluate the effect of mycophenolate mofetil (MMF) monotherapy in patients with recurrent hepatitis C. Fifteen patients with histologically proven hepatitis C recurrence after LT were switched from calcineurin inhibitors (CNIs) to MMF monotherapy because of impairment of kidney function and/or metabolic side effects, and treated for 48 months (MMF group). Fifteen well-matched LT recipients who continued to receive CNIs therapy over the same period served as control group. Demographics, clinical data, time after LT, and baseline liver biopsies were similar in the two groups. There was no worsening of hepatic fibrosis during the study in the MMF group [2.6 ± 1.5 (baseline) Ishak Units vs. 2.7 ± 1.8 (after 48 months of MMF treatment), P = 0.6]. In contrast, a significant increase in the fibrosis score [2 ± 1.1 (baseline) vs. 3.2 ± 1.7 (after 48 months of CNI treatment), P = 0.0002] was observed in the control group. The yearly fibrosis progression rate was of 0.05 ± 0.44 in the MMF group and 0.33 ± 0.24 in the CNI group (P = 0.04). MMF monotherapy is associated with a favourable effect on hepatic fibrosis progression in HCV liver transplant recipients.
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Affiliation(s)
- Tommaso Maria Manzia
- UOC Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy.
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Manzia TM, Angelico R, Toti L, Cillis A, Ciano P, Orlando G, Anselmo A, Angelico M, Tisone G. Glycogen storage disease type Ia and VI associated with hepatocellular carcinoma: two case reports. Transplant Proc 2011; 43:1181-3. [PMID: 21620082 DOI: 10.1016/j.transproceed.2011.01.129] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Glycogen storage diseases (GSD) are inherited metabolic disorders of glycogen metabolism due to intracellular enzyme deficiency resulting in abnormal storage of glycogen in tissues. GSD represents an indication for liver transplantation (OLT) when medical treatment fails to control the metabolic dysfunction and/or there is an high risk of malignant transformation of hepatocellular adenomas (HCA). Herein we have reported two cases of GSD, type Ia and type VI, which were both associated with rapidly growing HCA, and underwent OLT because of suspect changes in their radiological features. Final histological findings in the explanted liver showed the presence of hepatocellular carcinoma (HCC) in both cases. In GSD type Ia and VI, OLT is considered to be the treatment of choice when a liver neoplasm is suspected. While the association of HCC with GSD type Ia is well known, this is the first case of HCC in GSD type VI so far reported to the best of our knowledge.
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Affiliation(s)
- T M Manzia
- U.O.C. Chirurgia dei Trapianti, Fondazione PTV, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
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Abstract
BACKGROUND This randomized study compared results obtained with the Ferguson's technique for the treatment of hemorrhoids performed with a radiofrequency (RF) scalpel and traditional diathermy. METHODS 28 patients affected by grade IV hemorrhoids were randomized to receive either the Ferguson operation with the RF scalpel (group A) or traditional diathermy (group B). The operating time, intra- and postoperative bleeding, postoperative pain, and overall patient satisfaction were all recorded. RESULTS Six patients (three for each group) did not attend follow-up controls. Group A showed a significant reduction of the surgical time (23 vs. 33 min; p < .01), pain at first postoperative day (Visual Analog Scale [VAS] score 3.4 vs. 4.8; p < .05), and at the first evacuation (3.4 vs. 5.0; p < .05). No significant differences were observed for the pain score at the seventh postoperative day, or overall satisfaction scores at the 7th postoperative day, and six months postoperatively (p = NS). No severe complications were recorded. Two patients in group A (18.2%) and four patients in group B (36.4%) reported transitory gas incontinence that spontaneously resolved within one month (p = NS). Three patients in group A (27.3%) and four patients in group B (36.4%) required postoperative catheterization due to urinary retention (p = NS). CONCLUSIONS RF scalpel shortens the operating time of the Ferguson operation and is less painful in the early postoperative period.
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Manzia TM, Gravante G, Toti L, Iaria G, Anselmo A, Fratoni S, Angelico R, Sforza D, Manuelli M, Tisone G. Management of spermatic cord liposarcoma in renal transplant recipients: case report. Transplant Proc 2010; 42:1355-7. [PMID: 20534300 DOI: 10.1016/j.transproceed.2010.03.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Herein, we report the case of a 52-year-old man with a spermatic cord liposarcoma that developed 4 years after renal transplantation. The patient was admitted with a diagnosis of inguinal hernia. During surgical exploration, a solid mass was found arising from the spermatic cord. Histologic analysis demonstrated a well-differentiated sclerosing liposarcoma.
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Affiliation(s)
- T M Manzia
- UOC Trapianti d'Organo, Sant' Eugenio Hospital, University Tor Vergata, Rome, Italy.
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Manzia TM, Toti L, Angelico R, Di Cocco P, Orlando G, Tisone G. Steroid-free immunosuppression after liver transplantation does not increase the risk of graft fibrosis. Transplant Proc 2010; 42:1237-9. [PMID: 20534270 DOI: 10.1016/j.transproceed.2010.03.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Steroid-free immunosuppression after liver transplantation (OLT) is effective and safe in the short and mid terms. However, research has shown a higher risk for late fibrosis among pediatric liver transplant recipients who have steroids withdrawn. Our aim was to test this hypothesis in the adult population. PATIENTS AND METHODS The study involved 27 adults, 14 of whom were on a regimen of cyclosporine, azathioprine, and steroid (group A) and 13 cyclosporine and azathioprine steroid-free immunosuppression (group B). The main end point of the study was liver graft histology in the late stage after OLT, with emphasis on the evolution of fibrosis, which was scored according to Ishak. The secondary end points were patient and graft survivals, liver and kidney functions, rejection rates, infections, and tumors, as well as the incidences of cardiovascular and metabolic complications. RESULTS After a mean follow-up of 89.3 +/- 21 months, the mean fibrosis scores did not differ between the 2 groups (2.2 +/- 1.5 vs 1.9 +/- 1.2; P = NS). One group A patient developed a severe acute rejection episode. The 7-year patient and graft survivals, as well as liver and kidney functions, incidence of infections, and cardiovascular and metabolic complications were comparable. Patients receiving steroids showed a trend toward an higher rate of de novo malignancies. CONCLUSION Steroid-free immunosuppression did not increase the risk of graft fibrosis in the long term.
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Affiliation(s)
- T M Manzia
- Transplant Unit, Surgical Clinic, Department of Surgery, Tor Vergata University of Rome, S Eugenio Hospital, Rome, Italy.
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Manzia TM, Toti L, Lenci I, Attia M, Tariciotti L, Bramhall SR, Buckels JAC, Mirza DF. Benign disease and unexpected histological findings after pancreaticoduodenectomy: the role of endoscopic ultrasound fine needle aspiration. Ann R Coll Surg Engl 2010; 92:295-301. [PMID: 20385044 PMCID: PMC3025206 DOI: 10.1308/003588410x12628812458374] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION We assessed the incidence and outcome of pancreaticoduodenectomy for patients with a pre-operative benign diagnosis and in patients who had an unexpected diagnosis of benign disease following resection. We have also compared how the introduction of endoscopic ultrasound fine needle aspiration (EUS-FNA) has altered our pre-operative assessment. PATIENTS AND METHODS Between January 1997 and April 2006, 499 patients underwent pancreaticoduodenectomy at the Queen Elizabeth Hospital. Data were collected prospectively. A further 85 patients between 2006 and 2008 had a different diagnostic approach (after imaging these patients have been also studied by EUS-FNA). RESULTS Overall, 78 (15.6%) patients had no malignant disease on final histology. Out of 459 patients who underwent pancreaticoduodenectomy for presumed malignancy, 49 (10.6%) had benign disease (sensitivity, 97%; positive predictive value, 89%). In a further 40 patients with a pre-operative benign diagnosis, we found 11 cases (27%) of malignancy (sensitivity, 37%; negative predictive value, 72%). Following the introduction of EUS-FNA, the sensitivity and specificity of the diagnostic work were 92% and 75%, respectively (positive predictive value, 93%; negative predictive value, 63%). The median follow-up was 35 months (range, 1-116 months). CONCLUSIONS Prior to the introduction of EUS-FNA, a significant number of patients, in whom pancreaticoduodenectomy is carried out for suspected benign disease, turn out to have an underlying malignancy. The use of EUS-FNA has improved the specificity of diagnostic work-up.
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Manzia TM, Di Paolo D, Sforza D, Toti L, Angelico R, Brega A, Angelico M, Tisone G. Liver transplantation for hepatitis B and C virus-related cirrhosis: mid-term results. Transplant Proc 2010; 42:1200-3. [PMID: 20534261 DOI: 10.1016/j.transproceed.2010.03.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) is almost universal; cirrhosis develops in up to 30% of cases. Currently there is interest in the midterm outcomes of HCV patients with concomitant hepatitis B virus (HBV) infection among OLT recipients. We therefore retrospectively analyzed our database of patients who underwent OLT for HCV-HBV-related cirrhosis. Between April 1992 and December 2008, 350 patients underwent OLT, including 20 (5.7%) transplanted for HBV-HCV cirrhosis. We assessed patient and graft survivals at 1 and 5 years, as well as the progression of fibrosis. Protocol liver biopsies were available yearly after OLT. The survival curves were analyzed by the Kaplan-Meier approach and chronic hepatitis evaluated according to the Ishak scoring system. At a median follow-up of 68.4 +/- 53 months, the 1- and 5-year patient and graft survival rates were 80% and 70%, respectively. The 5-year fibrosis progression rate was 0.17 +/- 0.08 units of fibrosis. The only patient who developed histologic cirrhosis within 10 years of follow-up showed a lamivudine-resistant HBV recurrence. Patients transplanted for HBV-HCV coinfection showed a lower fibrosis progression rate compared with HCV monoinfected subjects.
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Affiliation(s)
- T M Manzia
- Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy.
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Toti L, Attia M, Manzia TM, Lenci I, Gunson B, Buckels JAC, Mirza DF, Mayer AD, Bramhall SR, Wigmore SJ. Reduction in bile leaks following adult split liver transplant using a fibrin-collagen sponge: A pilot study. Dig Liver Dis 2010; 42:205-9. [PMID: 19913466 DOI: 10.1016/j.dld.2009.06.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 06/15/2009] [Accepted: 06/17/2009] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Bile leaks are a frequent complication of adult split liver transplantation. We compared surgical complications in patients who had the cut surface of the donor liver treated with a patch to those in whom the cut surface of the liver was treated with fibrin glue. MATERIAL AND METHODS Two consecutive cohorts of 16 patients undergoing adult right lobe split liver transplant were compared. In the first cohort, the liver surface was treated with fibrin glue and in the second the liver surface was treated with TachoSil fibrinogen-thrombin-collagen patches. Post-operative complications were analyzed. RESULTS Bile leaks were significantly fewer among patients in whom the cut surface of the liver was treated with fibrin-collagen sponge compared to those where fibrin glue was used on the cut surface: 1/16 (6.25%) vs. 7/16 (43.75%), respectively; p=0.03. There were some differences in biliary anastomotic techniques used in the two groups but 7/8 leaks (87.5%) arose from the cut surface, and only one was from the anastomosis. CONCLUSION Using a fibrinogen-thrombin-collagen sponge patch may reduce bile leaks from the cut surface of the liver during adult right lobe split liver transplants.
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Affiliation(s)
- Luca Toti
- Queen Elizabeth Hospital, Birmingham, UK.
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Toti L, Manzia TM, Romano P, Lenci I, Baiocchi L, Anselmo A, Sforza D, Manuelli M, Tisone G. Successful management of a same-day emergency delivery and liver transplant in a 27 weeks pregnant woman with fulminant hepatic failure. Transpl Int 2010; 23:114-5. [PMID: 19619174 DOI: 10.1111/j.1432-2277.2009.00908.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Lenci I, Alvior A, Manzia TM, Toti L, Neuberger J, Steeds R. Saline contrast echocardiography in patients with hepatopulmonary syndrome awaiting liver transplantation. J Am Soc Echocardiogr 2009; 22:89-94. [PMID: 19022621 DOI: 10.1016/j.echo.2008.09.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with hepatopulmonary syndrome (HPS) with end-stage liver disease (ESLD) have higher cardiorespiratory mortality than those without. The aims of this study were to determine whether echocardiography could distinguish patients with ESLD with and without HPS and whether the diagnosis of HPS by contrast echocardiography (CE) was altered by the performance of the test in a supine or standing position. METHODS Subjects were recruited prospectively from patients with end-stage liver disease undergoing assessment for liver transplantation. Hepatopulmonary syndrome was diagnosed on the basis of arterial blood gas analysis, lung function testing and agitated saline contrast echocardiography in the absence of primary cardiac or pulmonary disease. Bubble contrast injections were performed supine or standing in a randomised order and read by a blinded observer. RESULTS CE showed late right-to-left shunting in 13 of 50 consecutive patients with cirrhosis (26%). Eight patients (16%) had definite diagnoses of HPS. CE in the standing position consistently increased both the number and the size of shunts compared with supine injection. CE detected intrapulmonary shunting before a change in arterial blood gases. Standard echocardiographic parameters did not distinguish between those with and without HPS. CONCLUSION This study suggests that screening for HPS in patients with advanced cirrhosis should be done using CE with patients in the upright position.
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Affiliation(s)
- Ilaria Lenci
- Liver Unit, Queen Elizabeth University Hospital, Birmingham, UK
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Baiocchi L, Tisone G, Russo MA, Longhi C, Palmieri G, Volpe A, Almerighi C, Telesca C, Carbone M, Toti L, De Leonardis F, Angelico M. TUDCA prevents cholestasis and canalicular damage induced by ischemia-reperfusion injury in the rat, modulating PKCalpha-ezrin pathway. Transpl Int 2008; 21:792-800. [PMID: 18435680 DOI: 10.1111/j.1432-2277.2008.00682.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cholestasis, induced by liver ischemia-reperfusion injury (IRI), is characterized by dilatation of bile canaliculi and loss of microvilli. Tauroursodeoxycholic acid (TUDCA) is an anti-cholestatic agent, modulating protein kinase C (PKC) alpha pathway. PKC reduces ischemic damage in several organs, its isoform alpha modulates ezrin, a key protein in the maintenance of cell lamellipoidal extensions. We evaluated the effects of TUDCA on cholestasis, canalicular changes and PKCalpha-ezrin expression in a rat model of liver IRI. Livers flushed and stored with Belzer solution or Belzer + 10 mm TUDCA (4 degrees C for 6 h) were reperfused (37 degrees C with O(2)) with Krebs-Ringer bicarbonate + 2.5 micromol/min of Taurocholate or TUDCA. Bile was harvested for bile flow assessment. Liver tissue was employed for Electron Microscopy (EM) and for PKCalpha and ezrin immunoblot and immunofluorescence. The same experiments were conducted with the PKCalpha inhibitor Go-6976. TUDCA-treated livers showed increased bile flow (0.25+/-0.17 vs. 0.042+/-0.02 microl/min/g liver, P<0.05) and better preservation of microvilli and bile canalicular area at EM. These effects were associated with increased PKCalpha and ezrin expression (P=0.03 and P=0.04 vs. control respectively), as also confirmed by immunofluorescence data. PKCalpha inhibition abolished these TUDCA effects. TUDCA administration during IRI reduces cholestasis and canalicular damage in the liver modulating PKCalpha-ezrin pathway.
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Lenci I, Tariciotti L, Baiocchi L, Manzia TM, Toti L, Craboledda P, Callea F, Angelico M, Tisone G. Primary yolk sac tumor of the liver: incidental finding in a patient transplanted for hepatocellular carcinoma. Transpl Int 2008; 21:598-601. [PMID: 18363574 DOI: 10.1111/j.1432-2277.2008.00667.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 64-year-old man with HBV-related cirrhosis presented with a liver nodule measuring 2.8 cm revealed by a routine ultrasound and concomitant increased alpha-fetoprotein (AFP) up to 400 UI/l. Contrast-enhanced CT was suggestive of hepatocellular carcinoma (HCC) and the patient underwent laser ablation procedure. Five months later, because of raised AFP up to 1600 UI/l, ultrasonography and abdominal CT were repeated, showing an increased diameter of liver nodule, measuring 3.8 cm. The patient underwent down-staged trans-arterial chemoembolization (TACE) and then was entered into the active liver transplant (LT) list. Lamivudine was already started and the patient underwent LT showing HBV-DNA serum levels <10(3) log/copies at the time of surgery. Pathological analysis performed on the explanted liver showed, instead of the suspected HCC, hepatic yolk sac tumor with the presence of typical 'Schiller-Duval bodies'. The first 12 months of postoperative follow-up were excellent, with no evidence of tumor recurrence.
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Affiliation(s)
- Ilaria Lenci
- Department of Internal Medicine, Liver Transplant Centre, Tor Vergata University, Rome, Italy.
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Tisone G, Orlando G, Cardillo A, Palmieri G, Manzia TM, Baiocchi L, Lionetti R, Anselmo A, Toti L, Angelico M. Complete weaning off immunosuppression in HCV liver transplant recipients is feasible and favourably impacts on the progression of disease recurrence. J Hepatol 2006; 44:702-9. [PMID: 16473433 DOI: 10.1016/j.jhep.2005.11.047] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Revised: 11/05/2005] [Accepted: 11/09/2005] [Indexed: 02/05/2023]
Abstract
BACKGROUND/AIMS HCV-related disease recurrence progresses rapidly after liver transplantation. We hypothesised that withdrawal of immunosuppression might favourably impact on disease progression. METHODS Weaning off immunosuppression was attempted in 34 HCV-RNA positive patients (mean age 62+/-6.4 years) transplanted 63.5+/-20.1 months earlier, under cyclosporine A monotherapy. Patients were followed for 3 years including yearly protocol liver biopsies. Primary endpoints were feasibility of weaning off immunosuppression and its impact on disease progression. Secondary endpoint was to identify predictors of an immunosuppression-free state and fibrosis progression. RESULTS Complete and permanent immunosuppression withdrawal was achieved in 8 patients (23.4%), whereas 14 (41.2%) developed rejection within eight months despite an initial response and 12 (35.2%) rejected during tapering. After a mean follow-up 45.5+/-5.8 months weaned patients showed stabilisation/improvement of histological fibrosis (P<0.01), lower necro-inflammation (P<0.02) and improved liver function (P<0.05) compared to weaning-intolerants. Multiple logistic regression identified low blood cyclosporine A trough levels during the first post-transplant week (P=0.004) and initial steroid-free immunosuppression (P<0.008) as independent predictors of sustained weaning. Achievement of immunosoppression freedom (P=0.02) and baseline staging score (P<0.0001) were independently associated with stabilisation/improvement of histological fibrosis. CONCLUSIONS Reconstitution of immune-competence in the host improves the natural history of HCV recurrence in the graft.
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Affiliation(s)
- Giuseppe Tisone
- Liver Transplant Unit, Surgical Clinic, University of Rome Tor Vergata, S. Eugenio Hospital, Viale dell'Umanesimo 10, 00144, Rome, Italy.
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Manzia TM, De Liguori Carino N, Orlando G, Toti L, De Luca L, D'Andria D, Cardillo A, Anselmo A, Casciani CU, Tisone G. Use of mycophenolate mofetil in liver transplantation: a literature review. Transplant Proc 2005; 37:2616-7. [PMID: 16182764 DOI: 10.1016/j.transproceed.2005.06.073] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mycophenolate mofetil (MMF) is an immunosuppressive drug, exhibiting its effect through inhibition of proliferation of T and B lymphocytes. Standard primary immunosuppressive therapy after orthotopic liver transplantation (OLT) is based on a calcineurin-inhibitor (CNI): cyclosporine or tacrolimus. Renal failure with arterial hypertension, due to CNI side-effects, is a major cause of morbidity and mortality after OLT. Several studies have shown the efficacy of MMF to improve CNI-induced nephrotoxicity, blood pressure, and uric acid concentration in liver transplant patients with concomitant reduction or withdrawal of CNI. Predose plasma mycophenolic acid concentrations (MPA) are related to adverse events, drug dose, and clinical status. Blood level values outside the suggested MPA therapeutic range are associated with acute rejection episodes and side effects, which have been described in about half of the patients treated with MMF. Most authors have described gastrointestinal and hematological side-effects, whereas these appear usually dose related, responding quickly to reduction. MMF is potent and safe immunosuppressive agent, and replacement of CNI by MMF in liver transplant patients with renal dysfunction may improve not only kidney function but also other CNI-associated side-effects, such as hypertension and hyperuricemia, with a low risk of rejection.
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Affiliation(s)
- T M Manzia
- Liver Transplant Unit, Surgical Clinic, Tor Vergata University of Rome S. Eugenio Hospital Rome, Italy
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Orlando G, Cardillo A, Anselmo A, De Luca L, Toti L, Muzi F, Ielpo B, Angelico M, Tisone G. Interposition of the right colic angle between the liver and thoracic wall: an unusual cause of massive rectal bleeding following percutaneous biopsy in a liver transplant recipient. Transplant Proc 2005; 37:2629-31. [PMID: 16182768 DOI: 10.1016/j.transproceed.2005.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A 37-year-old male liver transplant recipient developed hemorrhagic shock from massive rectal bleeding a few hours after a protocol liver biopsy. Conservative treatment was not possible and the patient underwent a radiological investigation of the celiac and mesenteric arterial trunks, which showed active bleeding from a branch of the middle colic artery. Embolization with Tabotamp (Ethicon, Neuchatel, CH Switzerland) particles led to successful hemostasis. We thus discuss the possible mechanisms of injury. To our knowledge, no other cases of major rectal bleeding following percutaneous liver biopsy have been reported in the literature. We emphasize the need for Doppler ultrasound assistance, in terms of either preoperative examination with or without marking or guidance. The latter is the safest and most reliable technique, given the low risk of puncture of other organs and the low probability of obtaining an inadequate sample.
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Affiliation(s)
- G Orlando
- Liver Transplant Unit, Tor Vergata University of Rome, Surgical Clinic, S. Eugenio Hospital, Rome, Italy.
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