1
|
Morelli MC, Gambato M, Martini S, Carrai P, Toniutto P, Giannelli V, Donato F, Lenci I, Pasulo L, Mazzarelli C, Ferrarese A, Rendina M, Grieco A, Lanza AG, Baroni GS, De Maria N, Marenco S, Mameli L, Ponziani FR, Vitale G, Burra P, Viganò R, Fornasiere E, Catanzaro E, Marrone G, Milana M, Calleri A, Scorzoni C, Frassanito G, Lionetti R, Dibenedetto C. Trends in liver transplantation for primary sclerosing cholangitis. Dig Liver Dis 2024:S1590-8658(24)00194-4. [PMID: 38233315 DOI: 10.1016/j.dld.2024.01.175] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Primary sclerosing cholangitis is a cholestatic disease with a low prevalence in Italy. Indications for liver transplantation and the time of listing are not stated. AIM We performed a national survey to investigate the listing criteria, comorbidities, and outcomes. METHODS In April 2022, we surveyed liver transplantation in primary sclerosing cholangitis nationwide for the last 15 years. RESULTS From 2007 to 2021, 445 patients were included on waiting lists, and 411 had undergone liver transplants. The median age at transplantation was 46 years (males 63.9%); 262 patients (59%) presented an inflammatory bowel disease. Transplants increased over the years, from 1.8 % in 2007 to 3.0 % in 2021. Cholangitis (51%) and hepatic decompensation (45%) were the main indications for listing. The disease recurred in 81 patients (20%). Patient survival after the first transplant was 94 %, 86% and 84% at one, five, and ten years. Twenty-four died in the first year (50% surgical complications, 25% infections); 33 between one to five years (36% recurrence, 21% cholangiocarcinoma recurrence) and nine after five years (56% de novo cancer, 44% recurrence). CONCLUSIONS Primary sclerosing cholangitis has been an increasing indication for transplantation in Italy. Cholangitis and decompensation were the main indications for listing. Recurrence and cancer were the leading causes of death.
Collapse
Affiliation(s)
- Maria Cristina Morelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit for the treatment of Severe Organ Failure, Bologna, Italy
| | - Martina Gambato
- Multivisceral Transplant Unit, Padua University Hospital, Padova, Italy
| | - Silvia Martini
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paola Carrai
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School and Hospital, Pisa, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplant Unit, Department of Medical Area, Udine University Hospital, Udine, Italy
| | - Valerio Giannelli
- San Camillo Hospital, Department of Transplantation and General Surgery, Rome, Italy
| | - Francesca Donato
- Gastroenterology and Hepatology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Lenci
- Hepatology and Transplant Unit, Fondazione Policlinico Tor Vergata, Roma, Italy
| | - Luisa Pasulo
- Gastroenterology and Transplant Hepatology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Chiara Mazzarelli
- Gastroenterology and Hepatology Department, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Ferrarese
- Unit of Gastroenterology, Borgo Trento University Hospital of Verona, Verona, Italy
| | - Maria Rendina
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Antonio Grieco
- Liver Transplant Medicine Unit, Gastroenterological Area, Department of Gastroenterological, Endocrine and Metabolic Sciences, Fondazione Policlinico Universitario Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Nicola De Maria
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Simona Marenco
- Department of Internal Medicine, Gastroenterology Unit, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genova 16132, Italy
| | - Laura Mameli
- Liver and Pancreas Transplant Center, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Francesca Romana Ponziani
- Hepatology Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Giovanni Vitale
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit for the treatment of Severe Organ Failure, Bologna, Italy.
| | - Patrizia Burra
- Multivisceral Transplant Unit, Padua University Hospital, Padova, Italy
| | - Raffaella Viganò
- Gastroenterology and Hepatology Department, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ezio Fornasiere
- Hepatology and Liver Transplant Unit, Department of Medical Area, Udine University Hospital, Udine, Italy
| | - Elisa Catanzaro
- Multivisceral Transplant Unit, Padua University Hospital, Padova, Italy
| | - Giuseppe Marrone
- Liver Transplant Medicine Unit, Fondazione Policlinico Universitario Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Martina Milana
- Hepatology and Transplant Unit, Fondazione Policlinico Tor Vergata, Roma, Italy
| | - Alberto Calleri
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Scorzoni
- Liver Injury and Transplant Unit, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Gabriella Frassanito
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Raffaella Lionetti
- Infectious diseases and Hepatology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Clara Dibenedetto
- Gastroenterology and Hepatology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore, Policlinico, Milan, Italy
| |
Collapse
|
2
|
Stefanizzi P, Bianchi FP, Moscara L, Martinelli A, Di Lorenzo A, Gesualdo L, Simone S, Rendina M, Tafuri S. Determinants of compliance to influenza and COVID-19 vaccination in a cohort of solid organ transplant patients in Puglia, Southern Italy (2017-2022). Hum Vaccin Immunother 2023; 19:2266932. [PMID: 37842986 PMCID: PMC10580794 DOI: 10.1080/21645515.2023.2266932] [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: 07/30/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023] Open
Abstract
Influenza and Coronavirus Disease 2019 (COVID-19) vaccination are recommended in both solid organ transplant (SOT) candidates and recipients. In Puglia, Southern Italy, an active vaccination offer program has been activated targeting these patients. This study aims at investigating vaccination coverage (VC) for both vaccines in a SOT patients' cohort, as well as at identifying the vaccination compliance determinant. This is a retrospective, population-based study. The study population consists of the SOT patients who accessed Bari's "Policlinico" General Hospital during 2017-2022. Patients were contacted and, after providing their consent, asked their immunization status regarding influenza and COVID-19 and whether they had already undergone transplant or were waiting to do so. Regression models were fitted to investigate the determinants of VCs for influenza vaccination (2021/22 and 2022/23 seasons) and for COVID-19 vaccination (three-dose base cycle, first and second booster doses). Three-hundred and ten SOT patients were identified; 85.2% (264/310) had already undergone SOT. VCs were suboptimal, especially for constant yearly influenza vaccination (17.7%) and COVID-19 vaccination's second booster (1.94%). Logistic regression highlighted that influenza VCs are higher for SOT recipients than SOT candidates, as well as for older patients, although when considering both vaccination seasons only age significantly impact the vaccination uptake. Older age was the only influential variable for COVID-19 VC. VCs for SOT patients seem to be unsatisfying. Stronger interventions are required.
Collapse
Affiliation(s)
- Pasquale Stefanizzi
- Hygiene Unit – Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Paolo Bianchi
- Hygiene Unit – Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Lorenza Moscara
- Hygiene Unit – Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Martinelli
- Hygiene Unit – Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Di Lorenzo
- Hygiene Unit – Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Bari, Italy
| | - Simona Simone
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Bari, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Silvio Tafuri
- Hygiene Unit – Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| |
Collapse
|
3
|
Tedesco CC, Bonfiglio C, Notarnicola M, Rendina M, Castellaneta A, Di Leo A, Giannelli G, Fontana L. High Extra Virgin Olive Oil Consumption Is Linked to a Lower Prevalence of NAFLD with a Prominent Effect in Obese Subjects: Results from the MICOL Study. Nutrients 2023; 15:4673. [PMID: 37960329 PMCID: PMC10647576 DOI: 10.3390/nu15214673] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Extra virgin olive oil (EVOO) has healthy benefits for noncommunicable diseases (NCDs). However, limited evidence is available about the effects of liver disease and non-alcoholic fatty liver disease (NAFLD). We evaluate whether dose-increased consumption of EVOO is associated with a lower prevalence of NAFLD and if these effects vary based on body weight. The study included 2436 subjects with a 33% NAFLD prevalence. Daily EVOO was categorized into tertiles: low (0-24 g/day), moderate (25-37 g/day), and high consumption (>37 g/day). Subjects were also classified by body mass index (BMI) as normo-weight (18.5-24.9), overweight (25-29.9), and obese (≥30). Logistic regression analysis was applied to calculate odds ratios (ORs) for NAFLD, considering a 20-gram increment in EVOO intake and accounting for EVOO categories combined with BMI classes. The ORs were 0.83 (0.74;0.93) C.I. p = 0.0018 for continuous EVOO, 0.89 (0.69;1.15) C.I. p = 0.37, and 0.73 (0.55;0.97) C.I. p = 0.03 for moderate and high consumption, respectively, when compared to low consumption. Overall, the percent relative risk reductions (RRR) for NAFLD from low to high EVOO consumption were 18% (16.4%;19.2%) C.I. and 26% (25%;27.4%) C.I. in overweight and obese subjects. High EVOO consumption is associated with a reduced risk of NAFLD. This effect is amplified in overweight subjects and even more in obese subjects.
Collapse
Affiliation(s)
- Calogero Claudio. Tedesco
- Data Science Unit, National Institute of Gastroenterology, IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy
| | - Caterina Bonfiglio
- Laboratory of Epidemiology and Statistics, National Institute of Gastroenterology, IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy;
| | - Maria Notarnicola
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology, IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy;
| | - Maria Rendina
- Gastroenterology and Digestive Endoscopy, University Hospital, Policlinico of Bari, 70100 Bari, Italy;
| | - Antonino Castellaneta
- Gastroenterology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70100 Bari, Italy; (A.C.); (A.D.L.)
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70100 Bari, Italy; (A.C.); (A.D.L.)
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology, IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy;
| | - Luigi Fontana
- Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW 2006, Australia
| |
Collapse
|
4
|
Barone M, Iannone A, Mezzapesa M, Milella M, Di Gennaro F, Niro G, Cotugno R, Cozzolongo R, Mennea G, Rendina M, Di Leo A. Natural History and Hepatitis B Virus Surface Antigen (HBsAg) Spontaneous Seroclearance in Hepatitis B Virus e-Antigen (HBeAg)-Negative Patients with Inactive Chronic Infection: A Multicenter Regional Study from South Italy. Pathogens 2023; 12:1198. [PMID: 37887714 PMCID: PMC10609832 DOI: 10.3390/pathogens12101198] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Spontaneous HBsAg seroclearance has been mainly studied in populations from Asia, Australia, the Pacific Islands, and Polynesia. For the first time, we evaluated the spontaneous HBsAg seroclearance and its possible associated factors and the risk of disease progression in HBeAg-negative patients with inactive infection all coming from the same region in South Italy. In this multicenter retrospective study, 146 patients were selected after 18 months of observation and followed for a median of 82 months (IQR 60-107). For our analyses, they were divided into three groups based on their HBsAg levels: <100 IU/mL, 100-1000 IU/mL, and >1000 IU/mL. Crude and adjusted hazard ratios (HRs) for HBsAg seroclearance were determined. During the follow-up period, three patients (2.0%) showed a disease progression with an increased liver stiffness, whereas 17 (11.6%) cleared the HBsAg. Patients with HBsAg levels <100 IU/mL had the highest probability of HBsAg seroclearance compared to the other two groups (p = 0.009). In the multivariate analysis, the HBsAg level <100 IU/mL was the only parameter independently associated with HBsAg seroclearance (adjusted HR = 3.53; CI 1.29-9.69; p = 0.01). In patients with chronic HBV inactive infection, HBsAg levels <100 IU/mL predicted the highest probability of HBsAg seroclearance.
Collapse
Affiliation(s)
- Michele Barone
- Gastroenterology Unit, Department of Precision and Regenerative Medicine—Jonian Area—(DiMePRe-J), University of Bari “Aldo Moro”, Policlinic University Hospital, 70124 Bari, Italy;
| | - Andrea Iannone
- Gastroenterology Unit, Policlinic University Hospital, Piazza G. Cesare 11, 70124 Bari, Italy; (A.I.); (M.M.); (M.R.)
| | - Martino Mezzapesa
- Gastroenterology Unit, Policlinic University Hospital, Piazza G. Cesare 11, 70124 Bari, Italy; (A.I.); (M.M.); (M.R.)
| | - Michele Milella
- Clinic of Infectious Diseases, Policlinic University Hospital, 70124 Bari, Italy;
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine—Jonian Area—(DiMePRe-J), University of Bari “Aldo Moro”, Policlinic University Hospital, Piazza G. Cesare 11, 70124 Bari, Italy;
| | - Grazia Niro
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS ‘Casa Sollievo della Sofferenza’, Viale Cappuccini, snc, 71013 San Giovanni Rotondo, Italy; (G.N.); (R.C.)
| | - Rosa Cotugno
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS ‘Casa Sollievo della Sofferenza’, Viale Cappuccini, snc, 71013 San Giovanni Rotondo, Italy; (G.N.); (R.C.)
| | - Raffaele Cozzolongo
- Gastroenterology Unit, IRCCS “S. De Bellis”, Via Turi 27, 70013 Castellana Grotte, Italy;
| | - Giuseppe Mennea
- Internal Medicine Unit, “L. Bonomo” Hospital, Viale Istria, 76123 Andria, Italy;
| | - Maria Rendina
- Gastroenterology Unit, Policlinic University Hospital, Piazza G. Cesare 11, 70124 Bari, Italy; (A.I.); (M.M.); (M.R.)
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Precision and Regenerative Medicine—Jonian Area—(DiMePRe-J), University of Bari “Aldo Moro”, Policlinic University Hospital, 70124 Bari, Italy;
| |
Collapse
|
5
|
Rendina M, Barone M, Lillo C, Trapani S, Masiero L, Trerotoli P, Puoti F, Lupo LG, Tandoi F, Agnes S, Grieco A, Andorno E, Marenco S, Giannini EG, Baccarani U, Toniutto P, Carraro A, Colecchia A, Cescon M, Morelli MC, Cillo U, Burra P, Angeli P, Colledan M, Fagiuoli S, De Carlis L, Belli L, De Simone P, Carrai P, Di Benedetto F, De Maria N, Ettorre GM, Giannelli V, Gruttadauria S, Volpes R, Corsale S, Mazzaferro V, Bhoori S, Romagnoli R, Martini S, Rossi G, Caccamo L, Donato MF, Rossi M, Ginanni Corradini S, Spada M, Maggiore G, Tisone G, Lenci I, Vennarecci G, Tortora R, Vivarelli M, Svegliati Baroni G, Zamboni F, Mameli L, Tafuri S, Simone S, Gesualdo L, Cardillo M, Di Leo A. The Italian data on SARS-CoV-2 infection in transplanted patients support an organ specific immune response in liver recipients. Front Immunol 2023; 14:1203854. [PMID: 37469512 PMCID: PMC10352984 DOI: 10.3389/fimmu.2023.1203854] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/18/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction The study of immune response to SARSCoV-2 infection in different solid organ transplant settings represents an opportunity for clarifying the interplay between SARS-CoV-2 and the immune system. In our nationwide registry study from Italy, we specifically evaluated, during the first wave pandemic, i.e., in non-vaccinated patients, COVID-19 prevalence of infection, mortality, and lethality in liver transplant recipients (LTRs), using non-liver solid transplant recipients (NL-SOTRs) and the Italian general population (GP) as comparators. Methods Case collection started from February 21 to June 22, 2020, using the data from the National Institute of Health and National Transplant Center, whereas the data analysis was performed on September 30, 2020.To compare the sex- and age-adjusted distribution of infection, mortality, and lethality in LTRs, NL-SOTRs, and Italian GP we applied an indirect standardization method to determine the standardized rate. Results Among the 43,983 Italian SOTRs with a functioning graft, LTRs accounted for 14,168 patients, of whom 89 were SARS-CoV-2 infected. In the 29,815 NL-SOTRs, 361 cases of SARS-CoV-2 infection were observed. The geographical distribution of the disease was highly variable across the different Italian regions. The standardized rate of infection, mortality, and lethality rates in LTRs resulted lower compared to NL-SOTRs [1.02 (95%CI 0.81-1.23) vs. 2.01 (95%CI 1.8-2.2); 1.0 (95%CI 0.5-1.5) vs. 4.5 (95%CI 3.6-5.3); 1.6 (95%CI 0.7-2.4) vs. 2.8 (95%CI 2.2-3.3), respectively] and comparable to the Italian GP. Discussion According to the most recent studies on SOTRs and SARS-CoV-2 infection, our data strongly suggest that, in contrast to what was observed in NL-SOTRs receiving a similar immunosuppressive therapy, LTRs have the same risk of SARS-CoV-2 infection, mortality, and lethality observed in the general population. These results suggest an immune response to SARS-CoV-2 infection in LTRS that is different from NL-SOTRs, probably related to the ability of the grafted liver to induce immunotolerance.
Collapse
Affiliation(s)
- Maria Rendina
- Gastroenterology Unit, University Hospital Policlinico of Bari, Bari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
| | - Chiara Lillo
- Gastroenterology Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
| | - Silvia Trapani
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Lucia Masiero
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Paolo Trerotoli
- Section of Statistics, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Francesca Puoti
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Luigi Giovanni Lupo
- General Surgery and Liver Transplantation Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari, Bari, Italy
| | - Francesco Tandoi
- General Surgery and Liver Transplantation Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari, Bari, Italy
| | - Salvatore Agnes
- U.O.C. Chirurgia Generale e Trapianti di Organo, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Grieco
- U.O.C. Medicina Interna e del Trapianto di Fegato, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Enzo Andorno
- Chirurgia dei Trapianti di Fegato, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Simona Marenco
- Gastroenterology Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | | | - Umberto Baccarani
- Centro Trapianto di Fegato, A.O.U.I. Udine, Università degli Studi di Udine, Udine, Italy
| | - Pierluigi Toniutto
- U.S.D. Epatologia e Trapianto di Fegato, A.O.U.I. Udine, Università degli Studi di Udine, Udine, Italy
| | | | - Antonio Colecchia
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, Modena, Italy
| | - Matteo Cescon
- Chirurgia Epatobiliare e dei Trapianti, IRCCS, A.O.U. di Bologna, University of Bologna, Bologna, Italy
| | - Maria Cristina Morelli
- Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS, A.O.U. di Bologna, Bologna, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation, University-Teaching Hospital of Padova, Padova, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, University-Teaching Hospital of Padova, Padova, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology (UIMH), University-Teaching Hospital of Padova, Padova, Italy
| | - Michele Colledan
- U.O.C. Chirurgia Generale III, Centro Trapianti Fegato, A.S.S.T. Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation Unit, A.S.S.T. Ospedale Papa Giovanni XXIII, Bergamo, Italy
- Gastroenterologia, Department of Medicine University of Milan Bicocca, Milano, Italy
| | - Luciano De Carlis
- Chirurgia Generale dei Trapianti, Azienda Ospedaliera Niguarda Ca’Granda, University of Milano-Bicocca, Milano, Italy
| | - Luca Belli
- U.O.C. Epatologia e Gastroenterologia, Azienda Ospedaliera Niguarda Ca’Granda, Milano, Italy
| | - Paolo De Simone
- U.O.C. Chirurgia Epatica e Trapianti di Fegato, A.O.U. Pisana, University of Pisa, Pisa, Italy
| | - Paola Carrai
- U.O. Chirurgia Epatica e del Trapianto di Fegato, A.O.U. Pisana, Pisa, Italy
| | - Fabrizio Di Benedetto
- U.O.C. di Chirurgia Oncologica Epatobiliopancreatica e Chirurgia dei Trapianti di Fegato, Azienda Ospedaliera Policlinico, Università di Modena, Modena, Italy
| | - Nicola De Maria
- U.O.C. Chirurgia Generale e Trapianti, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | | | - Valerio Giannelli
- Hepatology Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | | | - Riccardo Volpes
- Unità di Gastroenterologia ed Epatologia, IRCCS-ISMETT-UPMCI, Palermo, Italy
| | - Sveva Corsale
- Unità di Gastroenterologia ed Epatologia, IRCCS-ISMETT-UPMCI, Palermo, Italy
| | - Vincenzo Mazzaferro
- Hepato-pancreatic-biliary surgery and Liver transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Department of Oncology, University of Milan, Milan, Italy
| | - Sherrie Bhoori
- Hepato-pancreatic-biliary surgery and Liver transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Renato Romagnoli
- Chirurgia Generale 2, Centro Trapianto Fegato A.O.U Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Silvia Martini
- Gastroenteroly Unit, A.O.U Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Giorgio Rossi
- Division of General and Liver Transplant Surgery, Ospedale Maggiore Policlinico, Milano, Italy
| | - Lucio Caccamo
- Division of General and Liver Transplant Surgery, Ospedale Maggiore Policlinico, Milano, Italy
| | - Maria Francesca Donato
- Division of Gastroenterology and Hepatology, Ospedale Maggiore Policlinico, Milano, Italy
| | - Massimo Rossi
- U.O.C. di Chirurgia Generale e Trapianti di Organo, Policlinico Umberto I, Sapienza Università di Roma, Rome, Italy
| | | | - Marco Spada
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giuseppe Maggiore
- Hepatogastroenterology, Digestive Endoscopy, Nutrition and Liver Transplantation Unit, Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giuseppe Tisone
- Liver Transplant Unit, A.O.U. Policlinico Tor Vergata, University of Tor Vergata Rome, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, A.O.U. Policlinico Tor Vergata, University of Tor Vergata Rome, Rome, Italy
| | - Giovanni Vennarecci
- Hepatobiliary and Liver Tranplantation Surgery, A.O.R.N. “A. CARDARELLI”, Naples, Italy
| | | | - Marco Vivarelli
- Chirurgia Epatobiliare, Pancreatica e dei Trapianti, A.O.U., Ospedali Riuniti, Ancona, Italy
| | | | - Fausto Zamboni
- General and Hepatic Transplantation Surgery Unit, AO.B. G. Brotzu, Cagliari, Italy
| | - Laura Mameli
- General and Hepatic Transplantation Surgery Unit, AO.B. G. Brotzu, Cagliari, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Simona Simone
- Dialysis and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
| | - Loreto Gesualdo
- Dialysis and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
| | - Massimo Cardillo
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
| |
Collapse
|
6
|
Losurdo G, Di Leo M, Rizzi S, Lacavalla I, Celiberto F, Iannone A, Rendina M, Ierardi E, Iabichino G, De Luca L, Di Leo A. Familial intestinal polyposis and device assisted enteroscopy: where do we stand? Expert Rev Gastroenterol Hepatol 2023; 17:811-816. [PMID: 37515779 DOI: 10.1080/17474124.2023.2242240] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Hereditary polyposis syndromes are a group of inherited disorders associated with a high risk of developing colorectal cancer. The best known ones are familial adenomatous polyposis (FAP), Peutz-Jeghers (PJS), juvenile polyposis and Cowden syndromes, as well as conditions predisposing to cancer, such as Lynch syndrome. Some of them are characterized by an increased risk of small bowel polyps occurrence. AREAS COVERED Literature search in PubMed was performed in November 2022 and a narrative review was carried out. Since performing small bowel polypectomy is important in such patients, device assisted enteroscopy (DAE) is the key for this procedure. A screening strategy for small bowel polyps is recommended only for PJS. Guidelines endorse either magnetic resonance imaging (MRI) or videocapsule endoscopy (VCE) every 1-3 years, according to the phenotype of the disease. Enteroscopy should be considered for therapeutic purpose in patients with a positive VCE or MRI. DAE has a central role in the resection of polyps larger than mm or causing symptoms of subocclusion or intussusception. Both single (SBE) and double balloon enteroscopy (DBE) are indicated and able to resect polyps up to 6-10 cm. American guidelines have restricted the indications to small bowel enteroscopy only to FAP patients with grade IV Spiegelman. EXPERT OPINION Only some groups of patients (PJS, FAP with demonstrated small bowel polyp burden) may benefit from DAE.
Collapse
Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Milena Di Leo
- Digestive Endoscopy Unit, ASST Santi Paolo E Carlo, Milano, Italy
| | - Salvatore Rizzi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Ilaria Lacavalla
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Francesca Celiberto
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | | | - Luca De Luca
- Digestive Endoscopy Unit, ASST Santi Paolo E Carlo, Milano, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| |
Collapse
|
7
|
Simone S, Pesce F, Fontò G, Pronzo V, Pontrelli P, Conserva F, Schirinzi A, Casanova A, Gallo P, Rossini M, Lucarelli G, Spilotros M, Rendina M, Stallone G, Di Serio F, Di Leo A, Tafuri S, Ditonno P, Gesualdo L. Kinetics of humoral immune response and severity of infection after three doses of SARS-CoV-2 mRNA vaccine in a large cohort of kidney transplant recipients. J Nephrol 2023; 36:1663-1671. [PMID: 37458909 PMCID: PMC10393874 DOI: 10.1007/s40620-023-01650-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/15/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND COVID-19 in kidney transplant recipients is associated with high morbidity and mortality. In this study we aimed to evaluate: (i) the seroconversion rate after BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine, (ii) factors associated with humoral response, (iii) clinical outcome of COVID-19 in kidney transplanted patients. METHODS We enrolled a cohort of 743 kidney transplant recipients followed up from March 2020 until April 2022. A subset of 336 patients, who received three-doses of SARS-CoV-2 vaccine, was analyzed in terms of kinetics of humoral immune response and compared to a control group of 94 healthcare workers. Antibody response was tested before vaccination (T0), 15 and 90 days after the second dose (T1 and T2), on the day of the third dose (T3) and one month after the third dose (T4). RESULTS We observed that 66 out of 743 subjects had COVID-19 infection pre-vaccination: 65.2% had severe symptoms, 27.3% were hospitalized (9 deaths), none were asymptomatic. After three doses, 51 patients had COVID-19 infection, 60.8% were asymptomatic, 27.5% reported mild symptoms, 3.9% showed severe symptoms, 7.8% were hospitalized (2 deaths). In the subset of 336 vaccinated patients, an antibody level > 0.8 U/ml was detected at T1, that increased at T2 and T3, peaking at T4. Independent factors associated with a negative antibody titer at T4 were decreasing estimated glomerular filtration rate, time from transplantation, and antimetabolites (all p < 0.001) and age (p = 0.007). CONCLUSIONS The kinetics of humoral response after three doses of vaccine in kidney transplant patients is characterized by a late but effective immune response against SARS-CoV-2, reducing morbidity and mortality.
Collapse
Affiliation(s)
- Simona Simone
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Pesce
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Giulia Fontò
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Virginia Pronzo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Paola Pontrelli
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Francesca Conserva
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | | | - Annalisa Casanova
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Pasquale Gallo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Michele Rossini
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, 70124, Bari, Italy
| | - Marco Spilotros
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, 70124, Bari, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Giovanni Stallone
- Department of Medical and Surgical Sciences, Renal Unit, University of Foggia, Foggia, Italy
| | | | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Pasquale Ditonno
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, 70124, Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy.
| |
Collapse
|
8
|
Iannone A, Natale P, Palmer SC, Nicolucci A, Rendina M, Giorgino F, Laviola L, Di Leo A, Strippoli GFM. Clinical outcomes associated with drugs for obesity and overweight: A systematic review and network meta-analysis of randomized controlled trials. Diabetes Obes Metab 2023. [PMID: 37254688 DOI: 10.1111/dom.15138] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/27/2023] [Accepted: 05/08/2023] [Indexed: 06/01/2023]
Abstract
AIM To compare the benefits and harms of drugs approved for weight management in adults with obesity or overweight. MATERIALS AND METHODS We performed a systematic review of drugs approved for treating obesity and overweight. We searched MEDLINE, Embase and CENTRAL through 26 February 2023. Random-effects network meta-analysis was applied. RESULTS A total of 168 trials (97 938 patients) were included. There was no evidence that drugs approved for weight management had different associations with cardiovascular death (69 trials, 59 037 participants). Naltrexone/bupropion was associated with lower cardiovascular mortality than placebo (odds ratio [OR], 0.62 [95% CI: 0.39, 0.99]; low certainty evidence). All drugs were associated with greater weight loss at 12 months than placebo (33 trials, 37 616 participants), mainly semaglutide (mean difference [MD], -9.02 kg [95% CI: -10.42, -7.63]; moderate certainty) and phentermine/topiramate (MD, -8.10 kg [95% CI: -10.14, -6.05]; high certainty); and with greater waist circumference reduction at 12 months than placebo (24 trials, 35 733 participants), mainly semaglutide (MD, -7.84 cm [95% CI: -9.34, -6.34]; moderate certainty) and phentermine/topiramate (MD, -6.20 cm [95% CI: -7.46, -4.94]; high certainty). Semaglutide and phentermine/topiramate were associated with lower or no difference in the odds of treatment withdrawal compared with all other drugs (87 trials, 70 860 participants). CONCLUSIONS Among adults with obesity or overweight, semaglutide and phentermine/topiramate were associated with greater body weight loss and waist circumference reduction at 12 months than all other drugs, and lower or no significant difference in risks of withdrawal. There was no evidence that drugs approved for weight management had different associations with cardiovascular death.
Collapse
Affiliation(s)
- Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Patrizia Natale
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Suetonia C Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Antonio Nicolucci
- Centre for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Luigi Laviola
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giovanni F M Strippoli
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy
| |
Collapse
|
9
|
Bavaro DF, Diella L, Belati A, Metrangolo G, De Santis L, Spada V, Camporeale M, Dargenio A, Brindicci G, Balena F, Fiordelisi D, Signorile F, Loseto G, Pasciolla C, Minoia C, Attolico I, Perrone T, Simone S, Rendina M, Giovine N, Di Gennaro F, Musto P, Guarini A, Di Leo A, Gesualdo L, Dell'Aera M, Saracino A. Efficacy of Remdesivir and Neutralizing Monoclonal Antibodies in Monotherapy or Combination Therapy in Reducing the Risk of Disease Progression in Elderly or Immunocompromised Hosts Hospitalized for COVID-19: A Single Center Retrospective Study. Viruses 2023; 15:v15051199. [PMID: 37243285 DOI: 10.3390/v15051199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Remdesivir (REM) and monoclonal antibodies (mAbs) could alleviate severe COVID-19 in at-risk outpatients. However, data on their use in hospitalized patients, particularly in elderly or immunocompromised hosts, are lacking. METHODS All consecutive patients hospitalized with COVID-19 at our unit from 1 July 2021 to 15 March 2022 were retrospectively enrolled. The primary outcome was the progression to severe COVID-19 (P/F < 200). Descriptive statistics, a Cox univariate-multivariate model, and an inverse probability treatment-weighted (IPTW) analysis were performed. RESULTS Overall, 331 subjects were included; their median (q1-q3) age was 71 (51-80) years, and they were males in 52% of the cases. Of them, 78 (23%) developed severe COVID-19. All-cause in-hospital mortality was 14%; it was higher in those with disease progression (36% vs. 7%, p < 0.001). REM and mAbs resulted in a 7% (95%CI = 3-11%) and 14% (95%CI = 3-25%) reduction in the risk of severe COVID-19, respectively, after adjusting the analysis with the IPTW. In addition, by evaluating only immunocompromised hosts, the combination of REM and mAbs was associated with a significantly lower incidence of severe COVID-19 (aHR = 0.06, 95%CI = 0.02-0.77) when compared with monotherapy. CONCLUSIONS REM and mAbs may reduce the risk of COVID-19 progression in hospitalized patients. Importantly, in immunocompromised hosts, the combination of mAbs and REM may be beneficial.
Collapse
Affiliation(s)
- Davide Fiore Bavaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Lucia Diella
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Alessandra Belati
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giuliana Metrangolo
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Laura De Santis
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Vito Spada
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Michele Camporeale
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Angelo Dargenio
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Gaetano Brindicci
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Flavia Balena
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Deborah Fiordelisi
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Fabio Signorile
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giacomo Loseto
- Hematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | - Crescenza Pasciolla
- Hematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | - Carla Minoia
- Hematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | - Immacolata Attolico
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinic, 70124 Bari, Italy
| | - Tommasina Perrone
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinic, 70124 Bari, Italy
| | - Simona Simone
- Nephrology Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy
| | - Nicoletta Giovine
- Hospital Pharmacy Department, University Hospital of Bari, 70124 Bari, Italy
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Pellegrino Musto
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinic, 70124 Bari, Italy
- Department of Precision and Regenerative Medicine and Ionian Area University of Bari and Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, 70124 Bari, Italy
| | - Attilio Guarini
- Hematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy
| | - Loreto Gesualdo
- Nephrology Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Maria Dell'Aera
- Hospital Pharmacy Department, University Hospital of Bari, 70124 Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| |
Collapse
|
10
|
Ditonno I, Novielli D, Celiberto F, Rizzi S, Rendina M, Ierardi E, Di Leo A, Losurdo G. Molecular Pathways of Carcinogenesis in Familial Adenomatous Polyposis. Int J Mol Sci 2023; 24:ijms24065687. [PMID: 36982759 PMCID: PMC10056005 DOI: 10.3390/ijms24065687] [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] [Received: 02/27/2023] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Familial adenomatous polyposis (FAP) is a genetic syndrome characterized by the presence of multiple polyps in the gastrointestinal tract and a wide range of systemic extra-intestinal manifestations. Patients affected will inevitably undergo abdominal surgery due to the malignant transformation of one or more adenomas. The pathogenesis of the disease is based on a loss of function mutation in adenomatous polyposis coli (APC), a tumor-suppressor gene, inherited following a Mendelian pattern. This gene is a key component of multiple cell functions that cooperate for homeostasis; when mutated, it contributes to the progression of colorectal adenoma into cancer. Recent studies have demonstrated that several additional mechanisms may influence this process, such as alterations in gut microbiota composition and mucosal barrier immunity, interaction with the immune microenvironment and inflammation, the hormone estrogen, and other signaling pathways. These factors represent promising targets of future therapies and chemoprevention, aiming to alter the progressive nature of the disease and improve the quality of life of families affected. Therefore, we performed a narrative review about the current knowledge of the aforementioned pathways involved in colorectal cancer pathogenesis in FAP, exploring the genetic and environmental factors that may contribute to the development of CRC in FAP.
Collapse
Affiliation(s)
- Ilaria Ditonno
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Domenico Novielli
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Francesca Celiberto
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
- Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Precision Medicine Jonic Area, University “Aldo Moro” of Bari, 70124 Bari, Italy
| | - Salvatore Rizzi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
- Correspondence:
| |
Collapse
|
11
|
Borraccino AV, Celiberto F, Pricci M, Girardi B, Iannone A, Rendina M, Ierardi E, Di Leo A, Losurdo G. Rifabutin as salvage therapy for Helicobacter pylori eradication: Cornerstones and novelties. World J Gastroenterol 2022; 28:6356-6362. [PMID: 36533106 PMCID: PMC9753051 DOI: 10.3748/wjg.v28.i45.6356] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/25/2022] [Accepted: 11/17/2022] [Indexed: 12/02/2022] Open
Abstract
When several Helicobacter pylori eradication treatments fail, guidelines recommend a cultured guided approach; however, culture is not widely available. Therefore, a rifabutin based regimen could be the best solution. Rifabutin indeed shows a low rate of antibiotic resistance. Rifabutin is generally used in combination with amoxicillin in a triple therapy, with eradication rates about 80% in third-line regimens. The ideal duration of this therapy should range between 10 and 12 d. Combinations with antibiotics other than amoxicillin have demonstrated even better results, such as vonoprazan, which is a type of novel acid suppressor drug. Finally, a new formulation of triple therapy in a single capsule is under investigation, which is a field that deserves further investigation. Some notes of caution about rifabutin should be mentioned. This drug is used to treat tuberculosis or atypical mycobacteria; therefore, before starting a rifabutin-based eradication regimen, Mycobacterium tuberculosis infection should be thoroughly tested, since its use could promote the development of antibiotic resistance, thus affecting its effectiveness against Koch’s bacillus. Additionally, some serious side effects must be evaluated before starting any rifabutin-based therapy. Adverse effects include fever, nausea, vomiting and bone marrow suppression. For this reason, full blood count surveillance is required.
Collapse
Affiliation(s)
- Antonia Valeria Borraccino
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Francesca Celiberto
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | | | | | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| |
Collapse
|
12
|
Losurdo G, Pricci M, De Bellis M, Celiberto F, Russo F, Riezzo G, D'attoma B, Iannone A, Rendina M, Ierardi E, Di Leo A. Effect of metronidazole resistance on Helicobacter pylori eradication regimens. J Dig Dis 2022; 23:561-567. [PMID: 36321440 DOI: 10.1111/1751-2980.13142] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/14/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Guidelines suggest bismuth-containing quadruple therapy (BQT) or concomitant therapy (CT) as first-line therapy in our geographic area. Both schedules contain metronidazole. We aimed to evaluate the effect of metronidazole resistance to Helicobacter pylori (H. pylori) eradication therapy. METHODS We recruited treatment-naïve subjects with H. pylori infection who received either CT or BQT during January 2020 and December 2021. Before therapy, a fecal sample was collected using the THD fecal test device from each patient. H. pylori DNA was extracted and mutations of rdxA and frxA genes and A2143G for metronidazole and clarithromycin resistance were investigated using real-time polymerase chain reaction with a high-resolution melting curve. RESULTS Ninety-six patients were enrolled, including 29 received BQT and 67 received CT. The overall eradication rate was 94.8% (100% for BQT and 92.5% for CT). Metronidazole resistance was found in 18 (18.8%) subjects, while clarithromycin resistance was found in 19 (19.8%). All 18 patients with metronidazole resistance achieved successful eradication (five treated with BQT and 13 with CT). The eradication rate in metronidazole-sensitive strains was 93.6%. Of these, 24 received BQT with 100% success, and 54 had CT with five failures (successful eradication in 90.7%). Two patients with treatment failure were resistant to clarithromycin, and the remaining three were susceptible to both clarithromycin and metronidazole. No statistical significance was observed in the eradication rate between metronidazole-resistant and -sensitive strains (100% vs 93.6%, P = 0.58). CONCLUSION Metronidazole resistance does not influence the eradication rate of BQT and CT regimens in our geographical area, even if such results need to confirmed in a larger sample.
Collapse
Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy.,PhD Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | | | - Margherita De Bellis
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Francesca Celiberto
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy.,PhD Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Francesco Russo
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Giuseppe Riezzo
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Benedetta D'attoma
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| |
Collapse
|
13
|
Rendina M, Paoletti E, Labarile N, Marra A, Iannone A, Castellaneta A, Bussalino E, Ravera M, Schena A, Castellaneta NM, Barone M, Simone S, Gesualdo L, Di Leo A. HCV-positive kidney transplant patients treated with direct-acting antivirals maintain stable medium-term graft function despite persistent reduction in tacrolimus trough levels. Ther Adv Chronic Dis 2022; 13:20406223221117975. [PMID: 36147292 PMCID: PMC9486264 DOI: 10.1177/20406223221117975] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background/aim: Direct-acting antivirals (DAAs) have improved the treatment of HCV-positive
kidney transplant recipients (KTRs). However, their medium-term follow-up
effects on graft function are conflicting. This study aimed to analyze how
the interplay between DAAs, calcineurin inhibitors (CNI), and HCV
eradication impacts 12-month kidney graft function. Methods: This double-center retrospective study with a prospective follow-up enrolled
35 KTRs with HCV treated with DAAs for 12 weeks. We compared three
parameters: estimated glomerular filtration rate (eGFR), 24-h proteinuria,
and CNI trough levels at three time points: baseline, end of treatment
(EOT), and 12 months later. Results: Kidney allograft function remained stable when comparing baseline and
12-month post-treatment values of eGFR (60.7 versus
57.8 ml/min; p = 0.28) and 24-h proteinuria (0.3
versus 0.2 g/24 h; p = 0.15), while
tacrolimus (Tac) trough levels underwent a statistically significant decline
(6.9 versus 5.4 ng/ml; p = 0.004). Using
an ongoing triple Tac-based maintenance therapy as a conservative measure, a
dose escalation of Tac was applied only in seven patients. No variation in
CyA and mTOR levels was detected. Conclusion: DAA therapy is safe and effective in HCV-positive KTRs. It also produces a
persistent significant reduction in Tac trough levels that does not
influence graft function at 12 months.
Collapse
Affiliation(s)
- Maria Rendina
- Gastroenterology and Digestive Endoscopy, University Hospital, Bari, Italy
| | - Ernesto Paoletti
- Nephrology, Dialysis, and Transplantation, University of Genova and Policlinico San Martino, Genova, Italy
| | - Nunzia Labarile
- Gastroenterology Unit, National Institute of Gastroenterology IRCCS "Saverio de Bellis', Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Antonella Marra
- Gastroenterology and Digestive Endoscopy, University Hospital, Bari, Italy
| | - Andrea Iannone
- Gastroenterology and Digestive Endoscopy, University Hospital, Bari, Italy
| | | | - Elisabetta Bussalino
- Nephrology, Dialysis, and Transplantation, University of Genova and Policlinico San Martino, Genova, Italy
| | - Maura Ravera
- Nephrology, Dialysis, and Transplantation, University of Genova and Policlinico San Martino, Genova, Italy
| | - Antonio Schena
- Nephrology, Dialysis and Transplantation, University of Bari, Bari, Italy
| | | | - Michele Barone
- Gastroenterology and Digestive Endoscopy, University Hospital, Bari, Italy
| | - Simona Simone
- Nephrology, Dialysis and Transplantation, University of Bari, Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology and Digestive Endoscopy, University Hospital, Bari, Italy
| |
Collapse
|
14
|
Di Leo M, Iannone A, Arena M, Losurdo G, Palamara MA, Iabichino G, Consolo P, Rendina M, Luigiano C, Di Leo A. Novel frontiers of agents for bowel cleansing for colonoscopy. World J Gastroenterol 2021; 27:7748-7770. [PMID: 34963739 PMCID: PMC8661374 DOI: 10.3748/wjg.v27.i45.7748] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/23/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence of colorectal cancer (CRC) is characterized by rapid declines in the wake of widespread screening. Colonoscopy is the gold standard for CRC screening, but its accuracy is related to high quality of bowel preparation (BP). In this review, we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy. Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients’ acceptability. The role of the diet before colonoscopy was also changed, as well the contribution of educational intervention and the use of adjunctive drugs to improve patients’ tolerance and/or quality of BP. The review also described BP in special situations, as lower gastrointestinal bleeding, elderly people, patients with chronic kidney disease, patients with inflammatory bowel disease, patients with congestive heart failure, inpatient, patient with previous bowel resection, pregnant/lactating patients. The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales. Finally, the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota. Moreover, the study underlined several points needed to further investigations.
Collapse
Affiliation(s)
- Milena Di Leo
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Monica Arena
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | | | | | - Pierluigi Consolo
- Unit of Digestive Endoscopy, University of Messina, Hospital "G. Martino", Messina 98121, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Carmelo Luigiano
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| |
Collapse
|
15
|
Losurdo G, Brescia IV, Lillo C, Mezzapesa M, Barone M, Principi M, Ierardi E, Di Leo A, Rendina M. Liver involvement in inflammatory bowel disease: What should the clinician know? World J Hepatol 2021; 13:1534-1551. [PMID: 34904028 PMCID: PMC8637677 DOI: 10.4254/wjh.v13.i11.1534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/06/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) may show a wide range of extraintestinal manifestations. In this context, liver involvement is a focal point for both an adequate management of the disease and its prognosis, due to possible serious comorbidity. The association between IBD and primary sclerosing cholangitis is the most known example. This association is relevant because it implies an increased risk of both colorectal cancer and cholangiocarcinoma. Additionally, drugs such as thiopurines or biologic agents can cause drug-induced liver damage; therefore, this event should be considered when planning IBD treatment. Additionally, particular consideration should be given to the evidence that IBD patients may have concomitant chronic viral hepatitis, such as hepatitis B and hepatitis C. Chronic immunosuppressive regimens may cause a hepatitis flare or reactivation of a healthy carrier state, therefore careful monitoring of these patients is necessary. Finally, the spread of obesity has involved even IBD patients, thus increasing the risk of non-alcoholic fatty liver disease, which has already proven to be more common in IBD patients than in the non-IBD population. This phenomenon is considered an emerging issue, as it will become the leading cause of liver cirrhosis.
Collapse
Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Irene Vita Brescia
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Chiara Lillo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Martino Mezzapesa
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| |
Collapse
|
16
|
Losurdo G, Di Leo M, Santamato E, Arena M, Rendina M, Luigiano C, Ierardi E, Di Leo A. Serologic diagnosis of celiac disease: May it be suitable for adults? World J Gastroenterol 2021; 27:7233-7239. [PMID: 34876785 PMCID: PMC8611199 DOI: 10.3748/wjg.v27.i42.7233] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/02/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
The diagnosis of coeliac disease (CD) in adult patients requires the simultaneous assessment of clinical presentation, serology, and typical histological picture of villous atrophy. However, several years ago, the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines approved new criteria for the diagnosis in children: Biopsy could be avoided when anti-transglutaminase antibody (TGA) values exceed the cut-off of × 10 upper limit of normal (ULN) and anti-endomysium antibodies are positive, independently from value. This “no biopsy” approach is a decisive need for pediatric population, allowing to avoid stressful endoscopic procedures in children, if unnecessary. This approach relies on the correlation existing in children between TGA levels and assessment of mucosal atrophy according to Marsh’s classification. Several lines of evidence have shown that patients with villous atrophy have markedly elevated TGA levels. Therefore, we aim to perform a narrative review on the topic in adults. Despite that some studies confirmed that the × 10 ULN threshold value has a very good diagnostic performance, several lines of evidence in adults suggest that TGA cut off should be different from that of pediatric population for reaching a good correlation with histological picture. In conclusion, the heterogeneity of study reports as well as some conditions, which may hamper the serological diagnosis of CD (such as seronegative CD and non-celiac villous atrophy) and are much more common in adults than in children, could represent a limitation for the “no biopsy” approach to CD diagnosis in patients outside the pediatric age.
Collapse
Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Milena Di Leo
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Edoardo Santamato
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Monica Arena
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Carmelo Luigiano
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| |
Collapse
|
17
|
Losurdo G, Di Leo M, Santamato E, Giangaspero A, Rendina M, Luigiano C, Ierardi E, Di Leo A. May Antitransglutaminase Levels Predict Severity of Duodenal Lesions in Adults with Celiac Disease? Medicina (B Aires) 2021; 57:medicina57111212. [PMID: 34833430 PMCID: PMC8622174 DOI: 10.3390/medicina57111212] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 01/11/2023] Open
Abstract
Background and Objective: Pediatric guidelines on celiac disease (CD) state that children with anti-transglutaminase antibodies (TGAs) >×10 upper limit of normal (ULN) may avoid endoscopy and biopsy. We aimed to evaluate whether these criteria may be suitable for villous atrophy diagnosis in CD adults. Materials and Methods: We retrospectively enrolled patients with CD aged >18 years. TGAs were expressed as xULN. Duodenal lesions were classified as atrophic or non-atrophic according to Marsh-Oberhuber. Fisher’s exact and t-test were used for variables comparison. Receiver operating characteristics (ROC) curve analysis was performed with estimation of area under the curve (AUC), sensitivity, specificity, and positive and negative predictive value (PPV/NPV). Results: One hundred and twenty-one patients were recruited. Sixty patients (49.6%) had TGA >×10 ULN, and 93 (76.8%) had villous atrophy. The cut-off of >×10 ULN had sensitivity = 53.7%, specificity = 64.3%, PPV = 83.3%, and NPV = 29.5% to predict atrophy. Therefore, considering pediatric criteria, in 50 (41.3%) patients, biopsy could have been avoided. Patient subgroup with atrophy had higher TGA levels despite being not significant (37.2 ± 15.3 vs. 8.0 ± 1.3 ULN, p = 0.06). In adults, a slightly better diagnostic performance was obtained using a cut-off of TGA >×6.2 ULN (sensitivity = 57.1%, specificity = 65.6%, and AUC = 0.62). Conclusions: Despite our confirmation that villous atrophy is linked to high TGA levels, CD and atrophy diagnosis based only on serology is not reliable in adults.
Collapse
Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (E.S.); (A.G.); (M.R.); (E.I.); (A.D.L.)
- Ph.D. Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-080-559-4430
| | - Milena Di Leo
- Unit of Digestive Endoscopy, San Paolo Hospital, 20142 Milano, Italy; (M.D.L.); (C.L.)
| | - Edoardo Santamato
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (E.S.); (A.G.); (M.R.); (E.I.); (A.D.L.)
| | - Antonio Giangaspero
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (E.S.); (A.G.); (M.R.); (E.I.); (A.D.L.)
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (E.S.); (A.G.); (M.R.); (E.I.); (A.D.L.)
| | - Carmelo Luigiano
- Unit of Digestive Endoscopy, San Paolo Hospital, 20142 Milano, Italy; (M.D.L.); (C.L.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (E.S.); (A.G.); (M.R.); (E.I.); (A.D.L.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (E.S.); (A.G.); (M.R.); (E.I.); (A.D.L.)
| |
Collapse
|
18
|
Morelli MC, Rendina M, La Manna G, Alessandria C, Pasulo L, Lenci I, Bhoori S, Messa P, Biancone L, Gesualdo L, Russo FP, Petta S, Burra P. Position paper on liver and kidney diseases from the Italian Association for the Study of Liver (AISF), in collaboration with the Italian Society of Nephrology (SIN). Dig Liver Dis 2021; 53 Suppl 2:S49-S86. [PMID: 34074490 DOI: 10.1016/j.dld.2021.03.035] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 02/07/2023]
Abstract
Liver and kidney are strictly connected in a reciprocal manner, in both the physiological and pathological condition. The Italian Association for the Study of Liver, in collaboration with the Italian Society of Nephrology, with this position paper aims to provide an up-to-date overview on the principal relationships between these two important organs. A panel of well-recognized international expert hepatologists and nephrologists identified five relevant topics: 1) The diagnosis of kidney damage in patients with chronic liver disease; 2) Acute kidney injury in liver cirrhosis; 3) Association between chronic liver disease and chronic kidney disease; 4) Kidney damage according to different etiology of liver disease; 5) Polycystic kidney and liver disease. The discussion process started with a review of the literature relating to each of the five major topics and clinical questions and related statements were subsequently formulated. The quality of evidence and strength of recommendations were graded according to the GRADE system. The statements presented here highlight the importance of strong collaboration between hepatologists and nephrologists for the management of critically ill patients, such as those with combined liver and kidney impairment.
Collapse
Affiliation(s)
- Maria Cristina Morelli
- Internal Medicine Unit for the treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di S.Orsola, Bologna, Italy, Via Albertoni 15, 40138, Bologna, Italy
| | - Maria Rendina
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Policlinic Hospital, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Carlo Alessandria
- Division of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital, University of Torino, Corso Bramante 88, 10126, Torino, Italy
| | - Luisa Pasulo
- Gastroenterology and Transplant Hepatology, "Papa Giovanni XXIII" Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Ilaria Lenci
- Department of Internal Medicine, Hepatology Unit, Tor Vergata University, Rome Viale Oxford 81, 00133, Rome, Italy
| | - Sherrie Bhoori
- Hepatology and Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS, Istituto Nazionale Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Piergiorgio Messa
- Unit of Nephrology, Università degli Studi di Milano, Via Commenda 15, 20122, Milano, Italy; Nephrology, Dialysis and Renal Transplant Unit-Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via Commenda 15, 20122 Milano, Italy
| | - Luigi Biancone
- Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e della Scienza Hospital, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Loreto Gesualdo
- Nephrology Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, Università degli Studi di Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Francesco Paolo Russo
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Salvatore Petta
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Piazza delle Cliniche, 2 90127, Palermo, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy.
| | | |
Collapse
|
19
|
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.
Collapse
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
| | | |
Collapse
|
20
|
Rendina M, Viggiani MT, Di Leo A, Barone M. Malnutrition, sarcopenia, and refractory ascites in end stage liver diseases: is there a way to climb back up? Dig Liver Dis 2019; 51:1513-1514. [PMID: 31278015 DOI: 10.1016/j.dld.2019.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/23/2019] [Revised: 05/30/2019] [Accepted: 06/02/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Maria Rendina
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Policlinic Hospital, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Maria Teresa Viggiani
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Policlinic Hospital, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Policlinic Hospital, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Policlinic Hospital, Piazza G. Cesare 11, 70124 Bari, Italy.
| |
Collapse
|
21
|
Giannini EG, Aglitti A, Borzio M, Gambato M, Guarino M, Iavarone M, Lai Q, Levi Sandri GB, Melandro F, Morisco F, Ponziani FR, Rendina M, Russo FP, Sacco R, Viganò M, Vitale A, Trevisani F. Overview of Immune Checkpoint Inhibitors Therapy for Hepatocellular Carcinoma, and The ITA.LI.CA Cohort Derived Estimate of Amenability Rate to Immune Checkpoint Inhibitors in Clinical Practice. Cancers (Basel) 2019; 11:cancers11111689. [PMID: 31671581 PMCID: PMC6896125 DOI: 10.3390/cancers11111689] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/24/2019] [Indexed: 12/24/2022] Open
Abstract
Despite progress in our understanding of the biology of hepatocellular carcinoma (HCC), this tumour remains difficult-to-cure for several reasons, starting from the particular disease environment where it arises—advanced chronic liver disease—to its heterogeneous clinical and biological behaviour. The advent, and good results, of immunotherapy for cancer called for the evaluation of its potential application also in HCC, where there is evidence of intra-hepatic immune response activation. Several studies advanced our knowledge of immune checkpoints expression in HCC, thus suggesting that immune checkpoint blockade may have a strong rationale even in the treatment of HCC. According to this background, initial studies with tremelimumab, a cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitor, and nivolumab, a programmed cell death protein 1 (PD-1) antibody, showed promising results, and further studies exploring the effects of other immune checkpoint inhibitors, alone or with other drugs, are currently underway. However, we are still far from the identification of the correct setting, and sequence, where these drugs might be used in clinical practice, and their actual applicability in real-life is unknown. This review focuses on HCC immunobiology and on the potential of immune checkpoint blockade therapy for this tumour, with a critical evaluation of the available trials on immune checkpoint blocking antibodies treatment for HCC. Moreover, it assesses the potential applicability of immune checkpoint inhibitors in the real-life setting, by analysing a large, multicentre cohort of Italian patients with HCC.
Collapse
Affiliation(s)
- Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, Università di Genova, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico)-Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Andrea Aglitti
- Department of Medicine and Surgery, Internal Medicine and Hepatology Unit, University of Salerno, 84084 Fisciano, Italy.
| | - Mauro Borzio
- Unità Operativa Complessa (UOC) Gastroenterologia ed Endoscopia Digestiva, ASST (Azienda Socio Sanitaria Territoriale) Melegnano Martesana, 20063 Milan, Italy.
| | - Martina Gambato
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35124 Padua, Italy.
| | - Maria Guarino
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy.
| | - Massimo Iavarone
- CRC "A. M. and A. Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy.
| | - Quirino Lai
- Liver Transplantation Program, Sapienza University, 00185 Rome, Italy.
| | | | - Fabio Melandro
- Dipartimento Assistenziale Integrato di Chirurgia Generale, Unità Operativa Complessa Epatica e Trapianto Fegato, Azienda Ospedaliera Universitaria Pisana, 56126 Pisa, Italy.
| | - Filomena Morisco
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy.
| | - Francesca Romana Ponziani
- Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
| | - Maria Rendina
- UOC Gastroenterologia Universitaria, Dipartimento Emergenza e trapianti di organo, Azienda Policlinico-Universita' di Bari, 70124 Bari, Italy.
| | - Francesco Paolo Russo
- Gastroenterology and Multivisceral Transplant Unit, Padua University Hospital, 35124 Padua, Italy.
| | - Rodolfo Sacco
- UOC Gastroenterologia ed Endoscopia Digestiva, Azienda Ospedaliera Universitaria "Ospedali Riuniti", 71122 Foggia, Italy.
| | - Mauro Viganò
- Division of Hepatology, Ospedale San Giuseppe, University of Milan, 20122 Milan, Italy.
| | - Alessandro Vitale
- UOC di Chirurgia Epatobiliare, Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche, Azienda Università di Padova, 35124 Padua, Italy.
| | - Franco Trevisani
- Dipartimento di Scienze Mediche e Chirurgiche Alma Mater Studiorum, Università di Bologna, 40126 Bologna, Italy.
| |
Collapse
|
22
|
Bussalino E, Rendina M, Parodi A, Marra A, Mocka S, Marenco S, Panaro L, Gesualdo L, Di Leo A, Paoletti E. FP758Direct acting antivirals are effective and safe in HCV positive kidney transplant recipients (KTRs), even with advanced liver fibrosis. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
23
|
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.
Collapse
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
| | | |
Collapse
|
24
|
Minutolo R, Aghemo A, Chirianni A, Fabrizi F, Gesualdo L, Giannini EG, Maggi P, Montinaro V, Paoletti E, Persico M, Perticone F, Petta S, Puoti M, Raimondo G, Rendina M, Zignego AL. Management of hepatitis C virus infection in patients with chronic kidney disease: position statement of the joint committee of Italian association for the study of the liver (AISF), Italian society of internal medicine (SIMI), Italian society of infectious and tropical disease (SIMIT) and Italian society of nephrology (SIN). Intern Emerg Med 2018; 13:1139-1166. [PMID: 30255464 DOI: 10.1007/s11739-018-1940-9] [Citation(s) in RCA: 2] [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: 03/28/2018] [Accepted: 08/09/2018] [Indexed: 12/14/2022]
Abstract
Hepatitis C virus (HCV) infection is now considered a systemic disease due to the occurrence of extra-hepatic manifestations. Among these, the renal involvement is frequent. HCV infection, in fact, is strongly associated with proteinuria and chronic kidney disease (CKD) and negatively affects the prognosis of renal patients. In the last few years, availability of more specific and effective drugs against HCV has dramatically changed the clinical course of this disease. These drugs may provide further advantages in the CKD population as a whole by reducing progression of renal disease, mortality rate and by increasing the survival of graft in renal transplant recipients. The strict pathogenetic and prognostic link between HCV infection and CKD requires an ongoing relationship among the healthcare professionals involved in the treatment of both HCV infection and CKD. Therefore, Scientific Societies involved in the care of this high-risk population in Italy have organized a joint expert panel. The aim of the panel is to produce a position statement that can be used in daily clinical practice for the management of HCV infected patients across the whole spectrum of renal disease, from the conservative phase to renal replacement treatments (dialysis and transplantation). Sharing specific evidence-based expertise of different professional healthcare is the first step to obtain a common ground of knowledge on which to instate a model for multidisciplinary management of this high-risk population. Statements cover seven areas including epidemiology of CKD, HCV-induced glomerular damage, HCV-related renal risk, staging of liver disease in patients with CKD, prevention of transmission of HCV in hemodialysis units, treatment of HCV infection and management of HCV in kidney transplantation.
Collapse
Affiliation(s)
- Roberto Minutolo
- Division of Nephrology, Department of Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell'Invecchiamento, University of Campania "Luigi Vanvitelli", Via M. Longo 50, 80138, Naples, Italy.
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Internal Medicine and Hepatology, Humanitas Clinical and Research Center, Milan, Italy
| | - Antonio Chirianni
- Third Department of Infectious Diseases Azienda Ospedaliera Ospedali dei Colli, Naples, Italy
| | - Fabrizio Fabrizi
- Division of Nephrology, Maggiore Hospital and IRCCS Foundation, Milan, Italy
| | - Loreto Gesualdo
- Division of Nephrology, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paolo Maggi
- Infectious Disease Clinic, University of Bari, Bari, Italy
| | - Vincenzo Montinaro
- Division of Nephrology, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Ernesto Paoletti
- Nephrology, Dialysis, and Transplantation, University of Genoa and Policlinico San Martino, Genoa, Italy
| | - Marcello Persico
- Internal Medicine and Hepatology Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia, Catanzaro, Italy
| | - Salvatore Petta
- Gastroenterology and Hepatology Unit, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, Niguarda Cà Granda Hospital, Milan, Italy
| | - Giovanni Raimondo
- Department of Medicina Clinica e Sperimentale, University of Messina, Messina, Italy
| | - Maria Rendina
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University Hospital, Bari, Italy
| | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Hepatology Center MaSVE, University of Florence, Florence, Italy
| |
Collapse
|
25
|
Minutolo R, Aghemo A, Chirianni A, Fabrizi F, Gesualdo L, Giannini EG, Maggi P, Montinaro V, Paoletti E, Persico M, Perticone F, Petta S, Puoti M, Raimondo G, Rendina M, Zignego AL. Management of hepatitis C virus infection in patients with chronic kidney disease: position statement of the joint committee of Italian association for the study of the liver (AISF), Italian society of internal medicine (SIMI), Italian society of infectious and tropical disease (SIMIT) and Italian society of nephrology (SIN). Dig Liver Dis 2018; 50:1133-1152. [PMID: 30266305 DOI: 10.1016/j.dld.2018.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/09/2018] [Indexed: 12/11/2022]
Abstract
Hepatitis C virus (HCV) infection is now considered a systemic disease due to the occurrence of extra-hepatic manifestations. Among these, the renal involvement is frequent. HCV infection, in fact, is strongly associated with proteinuria and chronic kidney disease (CKD) and negatively affects the prognosis of renal patients. In the last few years, availability of more specific and effective drugs against HCV has dramatically changed the clinical course of this disease. These drugs may provide further advantages in the CKD population as a whole by reducing progression of renal disease, mortality rate and by increasing the survival of graft in renal transplant recipients. The strict pathogenetic and prognostic link between HCV infection and CKD requires an ongoing relationship among the healthcare professionals involved in the treatment of both HCV infection and CKD. Therefore, Scientific Societies involved in the care of this high-risk population in Italy have organized a joint expert panel. The aim of the panel is to produce a position statement that can be used in daily clinical practice for the management of HCV infected patients across the whole spectrum of renal disease, from the conservative phase to renal replacement treatments (dialysis and transplantation). Sharing specific evidence-based expertise of different professional healthcare is the first step to obtain a common ground of knowledge on which to instate a model for multidisciplinary management of this high-risk population. Statements cover seven areas including epidemiology of CKD, HCV-induced glomerular damage, HCV-related renal risk, staging of liver disease in patients with CKD, prevention of transmission of HCV in hemodialysis units, treatment of HCV infection and management of HCV in kidney transplantation.
Collapse
Affiliation(s)
- Roberto Minutolo
- Division of Nephrology, Department of Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dvecchiamento, University of Campania "Luigi Vanvitelli", Via M. Longo 50, 80138 Naples, Italy.
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Division of Internal Medicine and Hepatology, Humanitas Clinical and Research Center, Milan, Italy
| | - Antonio Chirianni
- Third Department of Infectious Diseases Azienda Ospedaliera Ospedali dei Colli, Naples, Italy
| | - Fabrizio Fabrizi
- Division of Nephrology, Maggiore Hospital and IRCCS Foundation, Milan, Italy
| | - Loreto Gesualdo
- Division of Nephrology, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paolo Maggi
- Infectious Disease Clinic, University of Bari, Bari, Italy
| | - Vincenzo Montinaro
- Division of Nephrology, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Ernesto Paoletti
- Nephrology, Dialysis, and Transplantation, University of Genoa and Policlinico San Martino, Genoa, Italy
| | - Marcello Persico
- Internal Medicine and Hepatology Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia, Catanzaro, Italy
| | - Salvatore Petta
- Gastroenterology and Hepatology Unit, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, Niguarda Cà Granda Hospital, Milan, Italy
| | - Giovanni Raimondo
- Department of Medicina Clinica e Sperimentale, University of Messina, Messina, Italy
| | - Maria Rendina
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University Hospital, Bari, Italy
| | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Hepatology Center MaSVE, University of Florence, Florence, Italy
| | | |
Collapse
|
26
|
Guarino M, Viganò L, Ponziani FR, Giannini EG, Lai Q, Morisco F, Russo FP, Cillo U, Burra P, Mescoli C, Gambato M, Sessa A, Cabibbo G, Viganò M, Galati G, Villa E, Iavarone M, Brancaccio G, Rendina M, Lupo LG, Losito F, Fucilli F, Persico M, D’Ambrosio R, Sangiovanni A, Cucchetti A, Trevisani e Matteo Renzulli F, Miele L, Grieco A, Lodovico Rapaccini G, Pompili M, Gasbarrini A, Battista Levi Sandri G, Melandro F, Rossi M, Lenci I, Manzia TM, Tortora R, Di Costanzo GG, Sacco R, Ghinolfi D, Rreka E, Carrai P, Simonetti N, Sposito C, Bhoori S, di Sandro S, Foschi FG, Casadei Gardini A, Nicolini D, Mazzocato S, Kostandini A, Violi P, Baccarani U, Pravisani R, Vincenzi V. Recurrence of hepatocellular carcinoma after direct acting antiviral treatment for hepatitis C virus infection: Literature review and risk analysis. Dig Liver Dis 2018; 50:1105-1114. [PMID: 30170908 DOI: 10.1016/j.dld.2018.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023]
Abstract
Although studies suggest decreased incident hepatocellular carcinoma (HCC) after treatment with direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection, data are conflicting regarding risk and aggressiveness of recurrence in patients who have a history of treated HCC. This review analyses data available in literature in order to elucidate the impact of DAAs on the risk of HCC recurrence after successful treatment of the tumor. Overall 24 papers were identified. The available data cannot be considered definitive, but the initial alarmist data indicating an increased risk of recurrence have not been confirmed by most subsequent studies. The suggested aggressive pattern (rapid growth and vascular invasion) of tumor recurrence after DAAs still remains to be confirmed. Several limitations of the available studies were highlighted, and should drive future researches. The time-to-recurrence should be computed since the last HCC treatment and results stratified for cirrhosis and sustained viral response. Any comparison with historical series is of limited interest because of a number of biases affecting these studies and differences between enrolled patients. Prospective intention-to-treat analyses will be probably the best contribution to drive clinical practice, provided that a randomized trial can be difficult to design.
Collapse
Affiliation(s)
- Maria Guarino
- Dept. of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", Naples, Italy
| | - Luca Viganò
- Dept. of Surgery, Division of Hepatobiliary and General Surgery, Humanitas Clinical and Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Francesca Romana Ponziani
- Division of Internal Medicine, Gastroenterology and Hepatology Unit, Polyclinic Foundation "Agostino Gemelli", IRCCS, Catholic University of Rome, Rome, Italy.
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Polyclinic Hospital "San Martino", Genoa, Italy.
| | - Quirino Lai
- Hepato-bilio-pancreatic and Liver Transplant Unit, Dept. of Surgery, Sapienza University of Rome, Rome, Italy
| | - Filomena Morisco
- Dept. of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", Naples, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
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.
Collapse
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
| | | |
Collapse
|
28
|
Minutolo R, Aghemo A, Chirianni A, Fabrizi F, Gesualdo L, Giannini EG, Maggi P, Montinaro V, Paoletti E, Persico M, Perticone F, Petta S, Puoti M, Raimondo G, Rendina M, Zignego AL. Management of hepatitis C virus infection in patients with chronic kidney disease: position statement of the joint committee of Italian association for the study of the liver (AISF), Italian society of internal medicine (SIMI), Italian society of infectious and tropical disease (SIMIT) and Italian society of nephrology (SIN). Infection 2018; 47:141-168. [PMID: 30255389 DOI: 10.1007/s15010-018-1209-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
Hepatitis C virus (HCV) infection is now considered a systemic disease due to the occurrence of extra-hepatic manifestations. Among these, the renal involvement is frequent. HCV infection, in fact, is strongly associated with proteinuria and chronic kidney disease (CKD) and negatively affects the prognosis of renal patients. In the last few years, availability of more specific and effective drugs against HCV has dramatically changed the clinical course of this disease. These drugs may provide further advantages in the CKD population as a whole by reducing progression of renal disease, mortality rate and by increasing the survival of graft in renal transplant recipients. The strict pathogenetic and prognostic link between HCV infection and CKD requires an ongoing relationship among the healthcare professionals involved in the treatment of both HCV infection and CKD. Therefore, Scientific Societies involved in the care of this high-risk population in Italy have organized a joint expert panel. The aim of the panel is to produce a position statement that can be used in daily clinical practice for the management of HCV infected patients across the whole spectrum of renal disease, from the conservative phase to renal replacement treatments (dialysis and transplantation). Sharing specific evidence-based expertise of different professional healthcare is the first step to obtain a common ground of knowledge on which to instate a model for multidisciplinary management of this high-risk population. Statements cover seven areas including epidemiology of CKD, HCV-induced glomerular damage, HCV-related renal risk, staging of liver disease in patients with CKD, prevention of transmission of HCV in hemodialysis units, treatment of HCV infection and management of HCV in kidney transplantation.
Collapse
Affiliation(s)
- Roberto Minutolo
- Division of Nephrology, Department of Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell'Invecchiamento, University of Campania "Luigi Vanvitelli", Via M. Longo 50, 80138, Naples, Italy.
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Division of Internal Medicine and Hepatology, Humanitas Clinical and Research Center, Milan, Italy
| | - Antonio Chirianni
- Third Department of Infectious Diseases Azienda Ospedaliera Ospedali dei Colli, Naples, Italy
| | - Fabrizio Fabrizi
- Division of Nephrology, Maggiore Hospital and IRCCS Foundation, Milan, Italy
| | - Loreto Gesualdo
- Division of Nephrology, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paolo Maggi
- Infectious Disease Clinic, University of Bari, Bari, Italy
| | - Vincenzo Montinaro
- Division of Nephrology, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Ernesto Paoletti
- Nephrology, Dialysis, and Transplantation, University of Genoa and Policlinico San Martino, Genoa, Italy
| | - Marcello Persico
- Internal Medicine and Hepatology Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia, Catanzaro, Italy
| | - Salvatore Petta
- Gastroenterology and Hepatology Unit, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, Niguarda Cà Granda Hospital, Milan, Italy
| | - Giovanni Raimondo
- Department of Medicina Clinica e Sperimentale, University of Messina, Messina, Italy
| | - Maria Rendina
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University Hospital, Bari, Italy
| | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Hepatology Center MaSVE, University of Florence, Florence, Italy
| | | | | | | | | |
Collapse
|
29
|
Burra P, Giannini EG, Caraceni P, Ginanni Corradini S, Rendina M, Volpes R, Toniutto P. Specific issues concerning the management of patients on the waiting list and after liver transplantation. Liver Int 2018; 38:1338-1362. [PMID: 29637743 DOI: 10.1111/liv.13755] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/27/2018] [Indexed: 02/06/2023]
Abstract
The present document is a second contribution collecting the recommendations of an expert panel of transplant hepatologists appointed by the Italian Association for the Study of the Liver (AISF) concerning the management of certain aspects of liver transplantation, including: the issue of prompt referral; the management of difficult candidates; malnutrition; living related liver transplants; hepatocellular carcinoma; and the role of direct acting antiviral agents before and after transplantation. The statements on each topic were approved by participants at the AISF Transplant Hepatology Expert Meeting organized by the Permanent Liver Transplant Commission in Mondello on 12-13 May 2017. They are graded according to the GRADE grading system.
Collapse
Affiliation(s)
- Patrizia Burra
- Multivisceral Transplant Unit, University Hospital, Padova, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | | | - Riccardo Volpes
- Hepatology and Gastroenterology Unit, ISMETT-IRCCS, Palermo, Italy
| | | |
Collapse
|
30
|
Caraceni P, Riggio O, Angeli P, Alessandria C, Neri S, Foschi FG, Levantesi F, Airoldi A, Boccia S, Svegliati-Baroni G, Fagiuoli S, Romanelli RG, Cozzolongo R, Di Marco V, Sangiovanni V, Morisco F, Toniutto P, Tortora A, De Marco R, Angelico M, Cacciola I, Elia G, Federico A, Massironi S, Guarisco R, Galioto A, Ballardini G, Rendina M, Nardelli S, Piano S, Elia C, Prestianni L, Cappa FM, Cesarini L, Simone L, Pasquale C, Cavallin M, Andrealli A, Fidone F, Ruggeri M, Roncadori A, Baldassarre M, Tufoni M, Zaccherini G, Bernardi M. Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial. Lancet 2018; 391:2417-2429. [PMID: 29861076 DOI: 10.1016/s0140-6736(18)30840-7] [Citation(s) in RCA: 265] [Impact Index Per Article: 44.2] [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: 01/25/2018] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Evidence is scarce on the efficacy of long-term human albumin (HA) administration in patients with decompensated cirrhosis. The human Albumin for the treatmeNt of aScites in patients With hEpatic ciRrhosis (ANSWER) study was designed to clarify this issue. METHODS We did an investigator-initiated multicentre randomised, parallel, open-label, pragmatic trial in 33 academic and non-academic Italian hospitals. We randomly assigned patients with cirrhosis and uncomplicated ascites who were treated with anti-aldosteronic drugs (≥200 mg/day) and furosemide (≥25 mg/day) to receive either standard medical treatment (SMT) or SMT plus HA (40 g twice weekly for 2 weeks, and then 40 g weekly) for up to 18 months. The primary endpoint was 18-month mortality, evaluated as difference of events and analysis of survival time in patients included in the modified intention-to-treat and per-protocol populations. This study is registered with EudraCT, number 2008-000625-19, and ClinicalTrials.gov, number NCT01288794. FINDINGS From April 2, 2011, to May 27, 2015, 440 patients were randomly assigned and 431 were included in the modified intention-to-treat analysis. 38 of 218 patients died in the SMT plus HA group and 46 of 213 in the SMT group. Overall 18-month survival was significantly higher in the SMT plus HA than in the SMT group (Kaplan-Meier estimates 77% vs 66%; p=0·028), resulting in a 38% reduction in the mortality hazard ratio (0·62 [95% CI 0·40-0·95]). 46 (22%) patients in the SMT group and 49 (22%) in the SMT plus HA group had grade 3-4 non-liver related adverse events. INTERPRETATION In this trial, long-term HA administration prolongs overall survival and might act as a disease modifying treatment in patients with decompensated cirrhosis. FUNDING Italian Medicine Agency.
Collapse
Affiliation(s)
- Paolo Caraceni
- Department of Medical and Surgical Sciences, and Center for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Oliviero Riggio
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padua, Padua, Italy
| | - Carlo Alessandria
- Division of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Sergio Neri
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Francesco G Foschi
- Internal Medicine, Hospital of Faenza, Azienda Unità Sanitaria Locale of Romagna, Faenza, Italy
| | - Fabio Levantesi
- Internal Medicine, Hospital of Bentivoglio, AUSL of Bologna, Bologna, Italy
| | - Aldo Airoldi
- Liver Unit, Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - Sergio Boccia
- Gastroenterology Unit, University Hospital, Ferrara, Italy
| | | | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Roberto G Romanelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Raffaele Cozzolongo
- Division of Gastroenterology, National Institute of Gastroenterology S De Bellis, Castellana Grotte (Bari), Italy
| | - Vito Di Marco
- Unit of Gastroenterology and Hepatology, Biomedical Department of Internal and Specialistic Medicine, University of Palermo, Palermo, Italy
| | - Vincenzo Sangiovanni
- Azienda Ospedaliera di Rilievo Nazionale dei Colli, Cotugno Hospital of Naples, Naples, Italy
| | - Filomena Morisco
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Pierluigi Toniutto
- Internal Medicine, Department of Medical Area, University of Udine, Udine, Italy
| | - Annalisa Tortora
- Gastroenterology, Gemelli Foundation, Catholic University, Rome, Italy
| | | | | | - Irene Cacciola
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy
| | - Gianfranco Elia
- Infectious Diseases and Hepatology, University Hospital of Parma, Parma, Italy
| | - Alessandro Federico
- Department of Clinical and Experimental Internal Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Sara Massironi
- Gastroenterology and Endoscopy Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Guarisco
- Internal Medicine, S Sebastiano General Hospital, Frascati (Rome), Italy
| | - Alessandra Galioto
- Internal Medicine, Hospital of Dolo, Azienda Unità Locale Socio-sanitaria Serenissima, Mestre, Italy
| | | | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Silvia Nardelli
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Salvatore Piano
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padua, Padua, Italy
| | - Chiara Elia
- Division of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Loredana Prestianni
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Federica Mirici Cappa
- Internal Medicine, Hospital of Faenza, Azienda Unità Sanitaria Locale of Romagna, Faenza, Italy
| | - Lucia Cesarini
- Liver Unit, Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | | | - Chiara Pasquale
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Marta Cavallin
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padua, Padua, Italy
| | - Alida Andrealli
- Division of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Federica Fidone
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Matteo Ruggeri
- Graduate School of Health Economics and Management, Catholic University, Rome, Italy
| | | | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, and Center for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Manuel Tufoni
- Department of Medical and Surgical Sciences, and Center for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, and Center for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences, and Center for Applied Biomedical Research, University of Bologna, Bologna, Italy.
| |
Collapse
|
31
|
Rendina M, Castellaneta NM, Losurdo G, Castellaneta A, Cazzolla A, Chialà C, D’Errico F, Di Leo A. Primary biliary cholangitis triggered by DAAs-induced HCV clearance: a biological proof of concept. Ther Adv Chronic Dis 2018; 9:121-123. [PMID: 29854373 PMCID: PMC5956644 DOI: 10.1177/2040622318755651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 01/08/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Hospital, Bari, Italy
| | - Nicola Maurizio Castellaneta
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Hospital, Bari, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Hospital, Bari, Italy
| | - Antonino Castellaneta
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Hospital, Bari, Italy
| | - Annamaria Cazzolla
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Hospital, Bari, Italy
| | - Claudia Chialà
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Hospital, Bari, Italy
| | - Francesca D’Errico
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Hospital, Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, Bari, 70124, Italy
| |
Collapse
|
32
|
Persico M, Aglitti A, Aghemo A, Rendina M, Lleo A, Ciancio A, Di Marco V, Lampertico P, Brunetto MR, Zuin M, Andreone P, Villa E, Troshina G, Calvaruso V, Degasperi E, Coco B, Giorgini A, Conti F, Di Leo A, Marzi L, Boccaccio V, Bollani S, Maisonneuve P, Bruno S. High efficacy of direct-acting anti-viral agents in hepatitis C virus-infected cirrhotic patients with successfully treated hepatocellular carcinoma. Aliment Pharmacol Ther 2018; 47:1705-1712. [PMID: 29722439 DOI: 10.1111/apt.14685] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/17/2018] [Accepted: 04/03/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The efficacy of direct-acting anti-viral (DAA) therapy in patients with a history of hepatocellular carcinoma (HCC) is unknown. AIM We prospectively evaluated whether previously treated HCC affects DAA efficacy in a large real-life cohort of cirrhotic patients. METHODS From January to December 2015 all consecutive HCV mono-infected patients with cirrhosis and/or history of HCC attending 10 Italian tertiary liver centres were enrolled. Baseline characteristics and response to therapy were recorded. 1927 patients were enrolled (mean age: 62.1 ± 10.9 years; 1.205 males). Genotype 1 was the most frequent (67.9%) followed by genotypes 3 (12.4%), 2 (11.2%) and 4 (8.6%). 88.4% and 10.9% of cases were classified Child A and B, respectively, and 14 (<1%) cases were classified Child C. Ascites and hepatic encephalopathy occurred in 10.7% and 3.2% of patients, respectively. Varices were detected in 39.3% of patients. Suboptimal and optimal treatment was prescribed: 15.9% of patients received sofosbuvir/simeprevir, 33.4% sofosbuvir/ledipasvir, 20.2% a Viekirax + Exviera regimen, 15.7% sofosbuvir/ribavirin, 9.9% sofosbuvir/daclatasvir and 3.4% Viekirax; 1.3% of patients received an interferon-based regimen. RESULTS The sustained virologic response (SVR) rate at intention-to-treat analysis was 95.1%. It differed significantly across Child classes, that is, 96.3%, 86.1% and 71.4% Child A, B and C, respectively (P < 0.0001) and across genotypes (P = 0.002). The SVR rate did not differ between patients with (95.0%) and those without previous HCC (95.1%). At multivariable analysis, SVR was significantly associated with HCV genotype, Child class. CONCLUSION This large real-life study proves that the efficacy of DAA in cirrhotic patients is not impaired by successfully treated HCC.
Collapse
|
33
|
Martini S, Donato MF, Mazzarelli C, Rendina M, Visco-Comandini U, Filì D, Gianstefani A, Fagiuoli S, Melazzini M, Montilla S, Pani L, Petraglia S, Russo P, Trotta MP, Carrai P, Caraceni P. The Italian compassionate use of sofosbuvir in HCV patients waitlisted for liver transplantation: A national real-life experience. Liver Int 2018; 38:733-741. [PMID: 28921807 DOI: 10.1111/liv.13588] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/08/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS This study aimed to assess the real-life clinical and virological outcomes of HCV waitlisted patients for liver transplantation (LT) who received sofosbuvir/ribavirin (SOF/R) within the Italian compassionate use program. METHODS Clinical and virological data were collected in 224 patients with decompensated cirrhosis and/or hepatocellular carcinoma (HCC) receiving daily SOF/R until LT or up a maximum of 48 weeks. RESULTS Of 100 transplanted patients, 51 were HCV-RNA negative for >4 weeks before LT (SVR12: 88%) and 49 negative for <4 weeks or still viraemic at transplant: 34 patients continued treatment after LT (bridging therapy) (SVR12: 88%), while 15 stopped treatment (SVR12: 53%). 98 patients completed SOF/R without LT (SVR12: 73%). In patients with advanced decompensated cirrhosis (basal MELD ≥15 and/or C-P ≥B8), a marked improvement of the scores occurred in about 50% of cases and almost 20% of decompensated patients without HCC reached a condition suitable for inactivation and delisting. CONCLUSIONS These real-life data indicate that in waitlisted patients: (i) bridging antiviral therapy can be an option for patients still viraemic or negative <4 weeks at LT; and (ii) clinical improvement to a condition suitable for delisting can occur even in patients with advanced decompensated cirrhosis.
Collapse
Affiliation(s)
- Silvia Martini
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Maria Francesca Donato
- First Division of Gastroenterology, IRCCS Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy
| | - Chiara Mazzarelli
- Hepatology and Gastroenterology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Maria Rendina
- Gastroenterology and Digestive Endoscopy, University Hospital, Bari, Italy
| | - Ubaldo Visco-Comandini
- Infectious Diseases - Hepatology Division, National Institute for Infectious Diseases Spallanzani IRCSS, Rome, Italy
| | - Daniela Filì
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Hepatology Unit, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Alice Gianstefani
- Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Ospedale Papa Giovanni XXIII di Bergamo, Bergamo, Italy
| | | | | | - Luca Pani
- Italian Medicines Agency (AIFA), Rome, Italy
| | | | | | | | - Paola Carrai
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa, Pisa, Italy
| | - Paolo Caraceni
- Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | | |
Collapse
|
34
|
Losurdo G, Castellaneta A, Rendina M, Carparelli S, Leandro G, Di Leo A. Systematic review with meta-analysis: de novo non-alcoholic fatty liver disease in liver-transplanted patients. Aliment Pharmacol Ther 2018; 47:704-714. [PMID: 29359341 DOI: 10.1111/apt.14521] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 08/26/2017] [Accepted: 12/25/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND De novo non-alcoholic fatty liver disease (NAFLD) in liver-transplanted patients for cirrhosis not due to non-alcoholic steatohepatitis (NASH) is becoming a growing phenomenon. AIMS We performed a systematic review and evaluated the prevalence of this event and possible associated factors. METHODS A literature search in medical databases (PubMed, MEDLINE/OVIDSP, Science Direct and EMBASE) was performed in March 2017. Relevant publications were identified in most important databases. We estimated the pooled prevalence of NAFLD and NASH in patients with liver transplant. The data have been expressed as proportions/percentages, and 95% confidence intervals (CI) were calculated, using the inverse variance method. Odd ratios (OR) and 95% confidence intervals (95% CI) were estimated. RESULTS Twelve studies were selected, enrolling 2166 subjects overall undergoing post-liver transplant biopsy. The pooled weighted prevalence of de novo NAFLD was 26% (95% CI 20%-31%). The pooled weighted prevalence of NASH was 2% (95% CI 0%-3%). The highest prevalences of de novo NAFLD were found for patients transplanted for alcoholic cirrhosis (37%) and cryptogenic cirrhosis (35%) and for patients taking tacrolimus (26%). Tacrolimus showed a risk of NAFLD similar to ciclosporin (OR = 1.02, 95% CI 0.3-3.51). CONCLUSIONS Patients undergoing liver transplant are more prone to experience diabetes, hypertension or dyslipidaemia, and NAFLD may be an important element in this context. In this study, we show how the prevalence of NASH tends to remain significant and similar to the general population. Moreover, this study suggests a possible association with specific transplant indications. Further studies are required to confirm these findings.
Collapse
Affiliation(s)
- G Losurdo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - A Castellaneta
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - M Rendina
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - S Carparelli
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - G Leandro
- Gastroenterology Unit, IRCCS "Saverio De Bellis", Castellana Grotte, BA, Italy
| | - A Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| |
Collapse
|
35
|
Vukotic R, Conti F, Fagiuoli S, Morelli MC, Pasulo L, Colpani M, Foschi FG, Berardi S, Pianta P, Mangano M, Donato MF, Malinverno F, Monico S, Tamè M, Mazzella G, Belli LS, Viganò R, Carrai P, Burra P, Russo FP, Lenci I, Toniutto P, Merli M, Loiacono L, Iemmolo R, Degli Antoni AM, Romano A, Picciotto A, Rendina M, Andreone P. Long-term outcomes of direct acting antivirals in post-transplant advanced hepatitis C virus recurrence and fibrosing cholestatic hepatitis. J Viral Hepat 2017; 24:858-864. [PMID: 28370880 DOI: 10.1111/jvh.12712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/22/2017] [Indexed: 12/14/2022]
Abstract
Long-term functional outcomes of sofosbuvir-based antiviral treatment were evaluated in a cohort study involving 16 Italian centres within the international compassionate use programme for post-transplant hepatitis C virus (HCV) recurrence. Seventy-three patients with cirrhosis (n=52) or fibrosing cholestatic hepatitis (FCH, n=21) received 24-week sofosbuvir with ribavirin±pegylated interferon or interferon-free sofosbuvir-based regimen with daclatasvir/simeprevir+ribavirin. The patients were observed for a median time of 103 (82-112) weeks. Twelve of 73 (16.4%) died (10 non-FCH, 2 FCH) and two underwent re-LT. Sustained virological response was achieved in 46 of 66 (69.7%): 31 of 47 (66%) non-FCH and 15 of 19 (79%) FCH patients. All relapsers were successfully retreated. Comparing the data of baseline with last follow-up, MELD and Child-Turcotte-Pugh scores improved both in non-FCH (15.3±6.5 vs 10.5±3.8, P<.0001 and 8.4±2.1 vs 5.7±1.3, P<.0001, respectively) and FCH (17.3±5.9 vs 10.1±2.8, P=.001 and 8.2±1.6 vs 5.5±1, P=.001, respectively). Short-treatment mortality was higher in patients with baseline MELD≥25 than in those with MELD<25 (42.9% vs 4.8%, P=.011). Long-term mortality was 53.3% among patients with baseline MELD≥20 and 7.5% among those with MELD<20 (P<.0001). Among deceased patients 75% were Child-Turcotte-Pugh class C at baseline, while among survivors 83.9% were class A or B (P<.0001). Direct acting antivirals-based treatments for severe post-transplant hepatitis C recurrence, comprising fibrosing cholestatic hepatitis, significantly improve liver function, even without viral clearance and permit an excellent long-term survival. The setting of severe HCV recurrence may require the identification of "too-sick-to-treat patients" to avoid futile treatments.
Collapse
Affiliation(s)
- R Vukotic
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - F Conti
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - S Fagiuoli
- Dipartimento di Medicina Specialistica e dei Trapianti, U.S.C. Gastroenterologia Epatologia e Trapiantologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - M C Morelli
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - L Pasulo
- Dipartimento di Medicina Specialistica e dei Trapianti, U.S.C. Gastroenterologia Epatologia e Trapiantologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - M Colpani
- Dipartimento di Medicina Specialistica e dei Trapianti, U.S.C. Gastroenterologia Epatologia e Trapiantologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - F G Foschi
- AUSL della Romagna, Presidio Ospedaliero di Faenza, Faenza, Italy
| | - S Berardi
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - P Pianta
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - M Mangano
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - M F Donato
- Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico ed Univerisità di Milano, Milan, Italy
| | - F Malinverno
- Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico ed Univerisità di Milano, Milan, Italy
| | - S Monico
- Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico ed Univerisità di Milano, Milan, Italy
| | - M Tamè
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - G Mazzella
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - L S Belli
- Dipartimento di Epatologia e Gastroenterologia, Ospedale Niguarda, Milan, Italy
| | - R Viganò
- Dipartimento di Epatologia e Gastroenterologia, Ospedale Niguarda, Milan, Italy
| | - P Carrai
- Chirurgia biliopancreatica e Trapianto di Fegato, Università di Pisa, Pisa, Italy
| | - P Burra
- Dipartimento di Chirurgia, Oncologia e Gastroenterologia, Unità di Trapianto Multiviscerale, Ospedale Universitario Padova, Padua, Italy
| | - F P Russo
- Dipartimento di Chirurgia, Oncologia e Gastroenterologia, Unità di Trapianto Multiviscerale, Ospedale Universitario Padova, Padua, Italy
| | - I Lenci
- Unità di Epatologia, Università Tor Vergata, Rome, Italy
| | - P Toniutto
- Medicina Interna Sezione di Trapianto di Fegato, Università di Udine, Udine, Italy
| | - M Merli
- Dipartimento di Medicina Clinica La Sapienza, Gastroenterologia, Università di Roma, Rome, Italy
| | | | - R Iemmolo
- Chirurgia Oncologica Epato-bilio-pancreatica e Chirurgia dei Trapianti di fegato, AOU di Modena, Modena, Italy
| | - A M Degli Antoni
- Unità di Malattie Infettive ed Epatologia, AOU di Parma, Parma, Italy
| | - A Romano
- Dipartimento di Medicina, Unità delle Emergenze epatologiche e dei Trapianti di fegato, Università di Padova, Padua, Italy
| | - A Picciotto
- Dipartimento di Medicina Interna, Università degli Studi di Genova, Genova, Italy
| | - M Rendina
- Unità Operativa Gastroenterologia ed Endoscopia Digestiva, Policlinico Universitario di Bari, Bari, Italy
| | - P Andreone
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | | |
Collapse
|
36
|
Barone M, Viggiani MT, Avolio AW, Iannone A, Rendina M, Di Leo A. Obesity as predictor of postoperative outcomes in liver transplant candidates: Review of the literature and future perspectives. Dig Liver Dis 2017; 49:957-966. [PMID: 28801180 DOI: 10.1016/j.dld.2017.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 02/14/2017] [Revised: 07/07/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current American and European guidelines consider a pre-transplant BMI ≥40kg/m2 as a relative contraindication for liver transplantation but this recommendation is graded as uncertain and requires further research. Moreover, conflicting results are reported on the predictive value of BMI 30-39.9kg/m2 on post-transplant complication and mortality risk. AIM This study analyzed the data of the literature on the effect of all three BMI classes of obesity on postoperative outcomes in liver transplantation. MATERIALS AND METHODS A PubMed and Cochrane Library search was conducted from inception to October 2015. RESULTS Analysis of the literature demonstrates that discrepancies among studies are mainly either due to limitations of BMI per se, the different BMI cut-offs used to select patients with obesity or reference group and the different outcomes considered. Moreover, the evaluation of visceral adipose tissue and the detrimental effect of muscle mass reduction in presence of obesity are never considered. CONCLUSIONS BMI assessment should be used as a preliminary method to evaluate obesity. Subsequently, the assessment of visceral adipose tissue and muscle mass should complete the preoperative evaluation of liver transplant candidates. This innovative approach could represent a new field of research in liver transplantation.
Collapse
Affiliation(s)
- Michele Barone
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy.
| | - Maria Teresa Viggiani
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Alfonso W Avolio
- Transplantation Service, Dept of Surgery, Catholic University, Rome, Italy
| | - Andrea Iannone
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Maria Rendina
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| |
Collapse
|
37
|
Petta S, Marzioni M, Russo P, Aghemo A, Alberti A, Ascione A, Antinori A, Bruno R, Bruno S, Chirianni A, Gaeta GB, Giannini EG, Merli M, Messina V, Montilla S, Perno CF, Puoti M, Raimondo G, Rendina M, Silberstein FC, Villa E, Zignego AL, Pani L, Craxì A. Ombitasvir, paritaprevir, and ritonavir, with or without dasabuvir, plus ribavirin for patients with hepatitis C virus genotype 1 or 4 infection with cirrhosis (ABACUS): a prospective observational study. Lancet Gastroenterol Hepatol 2017; 2:427-434. [PMID: 28497758 DOI: 10.1016/s2468-1253(17)30048-1] [Citation(s) in RCA: 14] [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: 09/18/2016] [Revised: 12/23/2016] [Accepted: 01/24/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND We ran a compassionate use nationwide programme (ABACUS) to provide access to ombitasvir, paritaprevir, and ritonavir, with dasabuvir, plus ribavirin for hepatitis C virus (HCV) genotype 1 infection and ombitasvir, paritaprevir, and ritonavir, plus ribavirin for HCV genotype 4 infection in patients with cirrhosis at high risk of decompensation while approval of these regimens was pending in Italy. METHODS In this prospective observational study, we collected data from a compassionate use nationwide programme from March 17, 2014, to May 28, 2015. Patients with HCV genotype 1 infection and cirrhosis at high risk of decompensation were given coformulated ombitasvir (25 mg), paritaprevir (150 mg), and ritonavir (100 mg) once daily and dasabuvir (250 mg) twice daily for 12 weeks (patients with HCV genotype 1b infection) or 24 weeks (patients with HCV genotype 1a infection). Patients with HCV genotype 4 infection were given coformulated ombitasvir (25 mg), paritaprevir (150 mg), and ritonavir (100 mg) once per day for 24 weeks. All patients were given weight-based ribavirin. The primary efficacy endpoint was sustained virological response at week 12 after the end of treatment (SVR12), analysed by intention-to-treat. Univariate and multivariate logistic regression analyses were used to identify baseline characteristics associated with SVR12. Adverse events were recorded throughout the study. FINDINGS 728 (96%) of 762 patients with cirrhosis who were given ombitasvir, paritaprevir, and ritonavir, with or without dasabuvir, plus ribavirin therapy for 12 or 24 weeks achieved SVR12. Logistic regression analyses identified that bilirubin concentrations of less than 2 mg/dL were associated with SVR12 (odds ratio [OR] 4·76 [95% CI 1·83-12·3]; p=0·001). 166 (23%) of 734 patients included in safety analyses had an adverse event. 25 (3%) patients discontinued treatment because of adverse events. Asthenia was the most commonly reported adverse event, occurring in 36 (5%) patients. INTERPRETATION Our findings suggest that the safety and effectiveness of ombitasvir, paritaprevir, and ritonavir, with or without dasabuvir, plus ribavirin in patients with HCV genotype 1 or 4 infection and cirrhosis at high risk of decompensation in a real-life setting are similar to those reported in clinical trials. The concordance with clinical trials provides reassurance that the reported efficacy of this treatment in clinical trials will translate to its use in routine clinical practice. FUNDING Dipartimento Biomedico di Medicina Interna e Specialistica dell'Universita di Palermo.
Collapse
Affiliation(s)
- Salvatore Petta
- Section of Gastroenterology and Hepatology, Biomedical Department of Internal and Specialized Medicine (DiBiMIS), University of Palermo, Palermo, Italy.
| | - Marco Marzioni
- Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche, Ancona, Italy
| | | | - Alessio Aghemo
- L'Unità Operativa Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Alfredo Alberti
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Antonio Ascione
- Centro per le malattie del Fegato, Ospedale Fatebenefratelli, Napoli, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases, "Lazzaro Spallanzani" Istituto di Ricovero e Cura a Carattere Scientific (IRCCS), Rome, Italy
| | - Raffaele Bruno
- Dipartimento Malattie Infettive, Fondazione IRCCS Policlinico San Matteo Pavia Italia, Università degli studi di Pavia, Pavia, Italy
| | - Savino Bruno
- Humanitas University and Humanitas Research Hospital Rozzano, Milan, Italy
| | - Antonio Chirianni
- UOC Infezioni sistemiche e dell'immunodepresso, AO Ospedali dei Colli Napoli, Napoli, Italy
| | | | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Manuela Merli
- Gastroenterology Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Messina
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | | | - Carlo Federico Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, AO Niguarda Ca' Granda, Milan, Italy
| | - Giovanni Raimondo
- Division of Clinical and Molecular Hepatology, Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Maria Rendina
- Gastroenterology and Digestive Endoscopy, University Hospital Policlinico Bari, Bari, Italy
| | | | - Erica Villa
- Division of Gastroenterology, Azienda Ospedaliero, Universitaria Policlinico di Modena, Italy Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Anna Linda Zignego
- Interdepartmental Centre MASVE, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luca Pani
- Italian Medicines Agency, Rome, Italy
| | - Antonio Craxì
- Section of Gastroenterology and Hepatology, Biomedical Department of Internal and Specialized Medicine (DiBiMIS), University of Palermo, Palermo, Italy
| | | | | |
Collapse
|
38
|
Barbano R, Pasculli B, Coco M, Fontana A, Copetti M, Rendina M, Valori V, Graziano P, Maiello E, Fazio V, Parrella P. Evaluation of pre-analytical procedures for the detection of BRAF V600 mutations in melanoma patients: comparison between Sanger sequencing and Competitive allele-specific TaqMan PCR (Cast-PCR). Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61452-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
39
|
Manna L, Picillo E, Esposito G, Rendina M, Campanile G, Varricchio E, Gravino A, Zicarelli L, Neglia G. Preliminary results on ghrelin mRNA quantification in buffalo calves during fasting and refeeding by real-time reverse transcription PCR assay. Italian Journal of Animal Science 2016. [DOI: 10.4081/ijas.2007.s2.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
40
|
Gasparrini B, Rendina M, Vecchio D, Baruselli P, Gazaneo M, Marchiello M, Balestrieri A, Campanile G. Effect of diet with different energy content in growing Murrah buffalo heifers. Italian Journal of Animal Science 2016. [DOI: 10.4081/ijas.2007.s2.540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
41
|
Campanile G, Vecchio D, Rendina M, Grassi C, Balestrieri A, Di Palo R, Zicarelli L. Ovary response and embryonic mortality in buffaloes treated with GnRH or hCG. Italian Journal of Animal Science 2016. [DOI: 10.4081/ijas.2007.s2.673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
42
|
Castellaneta A, Massaro A, Rendina M, D'Errico F, Carparelli S, Rizzi SF, Thomson AW, Di Leo A. Immunomodulating effects of the anti-viral agent Silibinin in liver transplant patients with HCV recurrence. Transplant Res 2016; 5:1. [PMID: 26798454 PMCID: PMC4721199 DOI: 10.1186/s13737-016-0030-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/25/2015] [Accepted: 01/05/2016] [Indexed: 01/27/2023] Open
Abstract
Background Silibinin has been shown to have anti-HCV activity and immune-modulating properties by regulating dendritic cell (DC) function. DCs are antigen-presenting cells that, together with regulatory T cells (Treg), play a pivotal role in controlling alloimmune, as well as anti-HCV immune responses. Methods Twelve liver transplant patients with HCV recurrence received iv infusion of Silibinin (iv-SIL) for 14 consecutive days. Using flow cytometry, before and at the end of treatment, we determined the frequencies of circulating myeloid (m) and plasmacytoid (p) DC and Treg and the expression of costimulatory/coregulatory molecules by the DC subsets and Treg. Statistical analysis was performed using the paired Student’s t test and Pearson correlation test. Results After iv-SIL treatment, we observed an elevated plasmacytoid dendritic cell (pDC)/myeloid dendritic cell (mDC) ratio, while pDC displayed lower HLA-DR and higher immunoglobulin-like transcript 4 (ILT4), CD39, and HLA-G expression compared to the pretreatment baseline. In addition, after iv-SIL, mDC showed increased inducible costimulator ligand (ICOSL) expression. No changes were detected in Treg frequency or programed death (PD)-1 expression by these cells. Moreover, several correlations between DC/Treg markers and clinical parameters were detected. Conclusions This descriptive study, in liver transplant patients with HCV recurrence, reveals the impact of iv-SIL on DC and Treg. The changes observed in circulating pDC and mDC that have previously been associated with tolerogenic conditions shed new light on how iv-SIL may regulate anti-viral and alloimmunity. We have also observed multiple clinical correlations that could improve the clinical management of liver transplant patients and that deserve further analysis.
Collapse
Affiliation(s)
- Antonino Castellaneta
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15261 USA
| | - Antonio Massaro
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15261 USA
| | - Maria Rendina
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15261 USA
| | - Francesca D'Errico
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15261 USA
| | - Sonia Carparelli
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15261 USA
| | - Salvatore Fabio Rizzi
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15261 USA
| | - Angus W Thomson
- Department of Emergency and Organ Transplantation, Unit of Gastroenterology, University Hospital, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Alfredo Di Leo
- Department of Emergency and Organ Transplantation, Unit of Gastroenterology, University Hospital, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| |
Collapse
|
43
|
Belli LS, Romagnoli R, Nardi A, Marianelli T, Donato F, Corradini SG, Iemmolo RM, Morelli C, Pasulo L, Rendina M, De Martin E, Ponziani FR, Volpes R, Strazzabosco M, Angelico M. Recipient female gender is a risk factor for graft loss after liver transplantation for chronic hepatitis C: Evidence from the prospective Liver Match cohort. Dig Liver Dis 2015; 47:689-94. [PMID: 26055490 DOI: 10.1016/j.dld.2015.04.006] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/28/2015] [Accepted: 04/08/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Female gender has been reported to be a risk factor for graft loss after liver transplantation for hepatitis C virus (HCV)-related cirrhosis but evidence is limited to retrospective studies. AIMS To investigate the impact of recipient gender and donor/recipient gender mismatch on graft outcome. METHODS We performed a survival analysis of a cohort of 1530 first adult transplants enrolled consecutively in Italy between 2007 and 2009 and followed prospectively. After excluding possible confounding factors (fulminant hepatitis, human immunodeficiency virus co-infection, non-viremic anti-HCV positive subjects), a total of 1394 transplant recipients (604 HCV-positive and 790 HCV-negative) were included. RESULTS Five-year graft survival was significantly reduced in HCV-positive patients (64% vs 76%, p=0.0002); Cox analysis identified recipient female gender (HR=1.44, 95% CI 1.03-2.00, p=0.0319), Mayo clinic End stage Liver Disease score (every 10 units, HR=1.25, 95% CI 1.03-1.50; p=0.022), portal thrombosis (HR=2.40, 95% CI 1.20-4.79, p=0.0134) and donor age (every 10 years, HR=1.14, 95% CI 1.05-1.24, p=0.0024) as independent determinants of graft loss. All additional mortality observed among female recipients was attributable to severe HCV recurrence. CONCLUSIONS This study unequivocally shows that recipient female gender unfavourably affects the outcome of HCV-infected liver grafts.
Collapse
Affiliation(s)
- Luca Saverio Belli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy.
| | - Renato Romagnoli
- Liver Transplant Center, Azienda Ospedaliera Città della Salute e della Scienza, University of Turin, Italy
| | - Alessandra Nardi
- Department of Mathematics, Tor Vergata University Hospital, Rome, Italy
| | - Tania Marianelli
- Department of Mathematics, Tor Vergata University Hospital, Rome, Italy
| | - Francesca Donato
- Division of Digestive Diseases, "Maggiore" University Hospital, Milan, Italy
| | | | | | | | - Luisa Pasulo
- Gastroenterology and Transplant Hepatology, San Giovanni XXIII Hospital, Bergamo, Italy
| | - Maria Rendina
- Department of Emergency and Organ Transplantation, University Hospital, Bari, Italy
| | | | | | | | - Mario Strazzabosco
- Digestive Disease Section, University Hospital Milano Bicocca and Yale University Center, New Haven, USA
| | | |
Collapse
|
44
|
Piselli P, Burra P, Lauro A, Baccarani U, Ettorre GM, Vizzini GB, Rendina M, Rossi M, Tisone G, Zamboni F, Bortoluzzi I, Pinna AD, Risaliti A, Galatioto L, Vennarecci G, Di Leo A, Nudo F, Sforza D, Fantola G, Cimaglia C, Verdirosi D, Virdone S, Serraino D. Head and neck and esophageal cancers after liver transplant: results from a multicenter cohort study. Italy, 1997-2010. Transpl Int 2015; 28:841-8. [PMID: 25778395 DOI: 10.1111/tri.12555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/03/2014] [Accepted: 02/27/2015] [Indexed: 12/20/2022]
Abstract
This study quantified the risk of head and neck (HN) and esophageal cancers in 2770 Italian liver transplant (LT) recipients. A total of 186 post-transplant cancers were diagnosed-including 32 cases of HN cancers and nine cases of esophageal carcinoma. The 10-year cumulative risk for HN and esophageal carcinoma was 2.59%. Overall, HN cancers were nearly fivefold more frequent in LT recipients than expected (standardized incidence ratios - SIR=4.7, 95% CI: 3.2-6.6), while esophageal carcinoma was ninefold more frequent (SIR=9.1, 95% CI: 4.1-17.2). SIRs ranged from 11.8 in LT with alcoholic liver disease (ALD) to 1.8 for LT without ALD for HN cancers, and from 23.7 to 2.9, respectively, for esophageal carcinoma. Particularly elevated SIRs in LT with ALD were noted for carcinomas of tongue (23.0) or larynx (13.7). Our findings confirmed and quantified the large cancer excess risk in LT recipients with ALD. The risk magnitude and the prevalence of ALD herein documented stress the need of timely and specifically organized programs for the early diagnosis of cancer among LT recipients, particularly for high-risk recipients like those with ALD.
Collapse
Affiliation(s)
- Pierluca Piselli
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", 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
| | - Umberto Baccarani
- Liver Transplant Unit, Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Giuseppe M Ettorre
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy
| | - Giovanni B Vizzini
- 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
| | - 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
| | - Ilaria Bortoluzzi
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Antonio D Pinna
- Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Andrea Risaliti
- Liver Transplant Unit, Department of Medical and Biological Sciences, University of Udine, Udine, 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
| | - Giovanni Vennarecci
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy
| | - Alfredo Di Leo
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University Hospital, Bari, Italy
| | - Francesco Nudo
- Department of General Surgery and Organ Transplantation, Umberto I Policlinic, Sapienza 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
| | - Diana Verdirosi
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Saverio Virdone
- Epidemiology and Biostatistics Unit, Centro di Riferimento Oncologico IRCCS, Aviano, Pordenone, Italy
| | - Diego Serraino
- Epidemiology and Biostatistics Unit, Centro di Riferimento Oncologico IRCCS, Aviano, Pordenone, Italy
| | | |
Collapse
|
45
|
Rendina M, D'Amato M, Castellaneta A, Castellaneta NM, Brambilla N, Giacovelli G, Rovati L, Rizzi SF, Zappimbulso M, Bringiotti RS, Di Leo A. Antiviral activity and safety profile of silibinin in HCV patients with advanced fibrosis after liver transplantation: a randomized clinical trial. Transpl Int 2014; 27:696-704. [PMID: 24673819 DOI: 10.1111/tri.12324] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 02/17/2014] [Accepted: 03/24/2014] [Indexed: 12/30/2022]
Abstract
Response to interferon-based therapies in HCV recurrence after liver transplantation (LT) is unsatisfactory, and major safety issues aroused in preliminary experience with boceprevir and telaprevir. As transplant community identified HCV viral clearance as a critical matter, efficacious and safe anti-HCV therapies are awaited. The aim of this study was to assess efficacy and safety of intravenous silibinin monotherapy in patients with established HCV recurrence after LT, nonresponders to pegylated interferon and ribavirin. This is a single center, prospective, randomized, parallel-group, double-blind, placebo-controlled, phase 2 trial including 20 patients randomly assigned (3:1) to receive daily 20 mg/kg of intravenous silibinin or saline as placebo, for 14 consecutive days. On day 14 of treatment, viral load decreased by 2.30 ± 1.32 in silibinin group versus no change in the placebo group (P = 0.0002). Sixteen days after the end of the treatment, viral load mean values were similar to baseline. Treatment resulted well tolerated apart from a transient and reversible increase in bilirubin. Neither changes in immunosuppressant through levels nor dosage adjustments were necessary. Silibinin monotherapy has a significant antiviral activity in patients with established HCV recurrence on the graft not responding to standard therapy and confirms safety and tolerability without interaction with immunosuppressive drugs (ClinicalTrials.gov number: NCT01518933).
Collapse
Affiliation(s)
- Maria Rendina
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University Hospital, Bari, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Ponziani FR, Viganò R, Iemmolo RM, Donato MF, Rendina M, Toniutto P, Pasulo L, Morelli MC, Burra P, Miglioresi L, Merli M, Di Paolo D, Fagiuoli S, Gasbarrini A, Pompili M, Belli L, Gerunda GE, Marino M, Montalti R, Di Benedetto F, De Ruvo N, Rigamonti C, Colombo M, Rossi G, Di Leo A, Lupo L, Memeo V, Bringiotti R, Zappimbulso M, Bitetto D, Vero V, Colpani M, Fornasiere E, Pinna AD, Morelli MC, Bertuzzo V, De Martin E, Senzolo M, Ettorre GM, Visco-Comandini U, Antonucci G, Angelico M, Tisone G, Giannelli V, Giusto M. Long-term maintenance of sustained virological response in liver transplant recipients treated for recurrent hepatitis C. Dig Liver Dis 2014; 46:440-5. [PMID: 24635906 DOI: 10.1016/j.dld.2014.01.157] [Citation(s) in RCA: 3] [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: 07/31/2013] [Revised: 01/13/2014] [Accepted: 01/25/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The recurrence of hepatitis C viral infection is common after liver transplant, and achieving a sustained virological response to antiviral treatment is desirable for reducing the risk of graft loss and improving patients' survival. AIM To investigate the long-term maintenance of sustained virological response in liver transplant recipients with hepatitis C recurrence. METHODS 436 Liver transplant recipients (74.1% genotype 1) who underwent combined antiviral therapy for hepatitis C recurrence were retrospectively evaluated. RESULTS The overall sustained virological response rate was 40% (173/436 patients), and the mean follow-up after liver transplantation was 11±3.5 years (range, 5-24). Patients with a sustained virological response demonstrated a 5-year survival rate of 97% and a 10-year survival rate of 93%; all but 6 (3%) patients remained hepatitis C virus RNA-negative during follow-up. Genotype non-1 (p=0.007), treatment duration >80% of the scheduled period (p=0.027), and early virological response (p=0.002), were associated with the maintenance of sustained virological response as indicated by univariate analysis. Early virological response was the only independent predictor of sustained virological response maintenance (p=0.008). CONCLUSIONS Sustained virological response achieved after combined antiviral treatment is maintained in liver transplant patients with recurrent hepatitis C and is associated with an excellent 5-year survival.
Collapse
|
47
|
Coco B, Caraceni P, Aghemo A, Bitetto D, Bruno R, Ciancio A, Marzioni M, Petta S, Rendina M, Valenti L. Triple therapy with first-generation protease inhibitors for patients with genotype 1 chronic hepatitis C: recommendations of the Italian association for the study of the liver (AISF). Dig Liver Dis 2014; 46:18-24. [PMID: 24119482 DOI: 10.1016/j.dld.2013.08.243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/03/2013] [Accepted: 08/27/2013] [Indexed: 12/11/2022]
Abstract
The first-generation Protease Inhibitors Boceprevir and Telaprevir administered in triple therapy regimens with Peg-interferon alpha and Ribavirin have been proven effective in increasing the rate of Sustained Virological Response in both naive and treatment-experienced patients with chronic genotype-1 hepatitis C. However, at the individual level, the therapeutic advantage of triple therapy is highly variable and results from the combination of multiple factors related to the characteristics of patient, viral status and liver disease. The recommendations presented are promoted by the Italian Association for the Study of the Liver, with the aim to help the physician in the decision-making process as well as to manage patients during treatment with triple therapy.
Collapse
Affiliation(s)
| | | | | | - Alessio Aghemo
- AISF Consulting Committee on the New Antiviral Hepatitis C Drugs
| | - Davide Bitetto
- AISF Consulting Committee on the New Antiviral Hepatitis C Drugs
| | - Raffaele Bruno
- AISF Consulting Committee on the New Antiviral Hepatitis C Drugs
| | | | | | - Salvatore Petta
- AISF Consulting Committee on the New Antiviral Hepatitis C Drugs
| | | | | | | |
Collapse
|
48
|
Bolondi L, Cillo U, Colombo M, Craxì A, Farinati F, Giannini EG, Golfieri R, Levrero M, Pinna AD, Piscaglia F, Raimondo G, Trevisani F, Bruno R, Caraceni P, Ciancio A, Coco B, Fraquelli M, Rendina M, Squadrito G, Toniutto P. Position paper of the Italian Association for the Study of the Liver (AISF): the multidisciplinary clinical approach to hepatocellular carcinoma. Dig Liver Dis 2013; 45:712-23. [PMID: 23769756 DOI: 10.1016/j.dld.2013.01.012] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/16/2013] [Indexed: 12/11/2022]
Abstract
Patients with hepatocellular carcinoma should be managed with a multidisciplinary approach framed in a network where all the diagnostic techniques and therapeutic resources are available in order to provide the optimal level of care. Given this assumption, the Coordinating Committee of the Italian Association for the Study of the Liver nominated a panel of experts to elaborate practical recommendations for the multidisciplinary management of hepatocellular carcinoma aiming to provide: (1) homogeneous and efficacious diagnostic and staging work-up, and (2) the best treatment choice tailored to patient status and tumour stage at diagnosis. The 2010 updated American Association for the Study of Liver Disease Guidelines for hepatocellular carcinoma were selected as the reference document. For each management issue, the American Association for the Study of Liver Disease recommendations were briefly summarised and discussed, according to both the scientific evidence published after their release and the clinical expertise of the Italian centres taking care of these patients. The Italian Association for the Study of the Liver expert panel recommendations are finally reported.
Collapse
|
49
|
Ponziani FR, Milani A, Gasbarrini A, Zaccaria R, Viganò R, Iemmolo RM, Donato MF, Rendina M, Toniutto P, Pasulo L, Cescon M, Burra P, Miglioresi L, Merli M, Paolo DD, Fagiuoli S, Pompili M. Treatment of genotype-1 hepatitis C recurrence after liver transplant improves survival in both sustained responders and relapsers. Transpl Int 2012; 26:281-9. [PMID: 23230956 DOI: 10.1111/tri.12027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 07/17/2012] [Accepted: 11/01/2012] [Indexed: 12/16/2022]
Abstract
The aim of this study was to evaluate the factors affecting the response to treatment and how it could affect survival in a large series of genotype-1 HCV-transplanted patients. Three-hundred and twenty six genotype-1 HCV patients were enrolled. One hundred and ninety-six patients (60.1%) were nonresponders and 130 (39.9%) showed negative HCV-RNA at the end of treatment. Eighty-four of them (25.8%) achieved sustained virological response, while 46 (14.1%) showed viral relapse. Five-year cumulative survival was significantly worse in nonresponders (76.4%) compared with sustained viral response (93.2) or relapsers (94.9%). Sustained responders and relapsers were therefore considered as a single 'response group' in further analysis. Pretreatment variables significantly associated with virological response at multivariate regression analysis were the absence of ineffective pretransplant antiviral therapy, the recurrence of HCV-hepatitis more than 1 year after transplant, an histological grading ≥4 at pretreatment liver biopsy, a pretreatment HCV-RNA level <1.2 × 10(6 ) IU/ml, and the absence of diabetes. As expected, also on-treatment variables (rapid and early virological response) were significantly associated to the response to antiviral treatment. In conclusion, this study shows that postliver transplant antiviral treatment results in beneficial effect on survival not only in sustained responders but also in relapsers.
Collapse
|
50
|
Villa E, Vukotic R, Cammà C, Petta S, Di Leo A, Gitto S, Turola E, Karampatou A, Losi L, Bernabucci V, Cenci A, Tagliavini S, Baraldi E, De Maria N, Gelmini R, Bertolini E, Rendina M, Francavilla A. Reproductive status is associated with the severity of fibrosis in women with hepatitis C. PLoS One 2012; 7:e44624. [PMID: 22970270 PMCID: PMC3438179 DOI: 10.1371/journal.pone.0044624] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 08/06/2012] [Indexed: 01/05/2023] Open
Abstract
Introduction Chronic hepatitis C is the main cause of death in patients with end-stage liver disease. Prognosis depends on the increase of fibrosis, whose progression is twice as rapid in men as in women. Aim of the study was to evaluate the effects of reproductive stage on fibrosis severity in women and to compare these findings with age-matched men. Materials and Methods A retrospective study of 710 consecutive patients with biopsy-proven chronic hepatitis C was conducted, using data from a clinical database of two tertiary Italian care centers. Four age-matched groups of men served as controls. Data about demographics, biochemistry, liver biopsy and ultrasonography were analyzed. Contributing factors were assessed by multivariate logistic regression analysis. Results Liver fibrosis was more advanced in the early menopausal than in the fully reproductive (P<0.0001) or premenopausal (P = 0.042) group. Late menopausal women had higher liver fibrosis compared with the other groups (fully reproductive, P<0.0001; premenopausal, P = <0.0001; early menopausal, P = 0.052). Multivariate analyses showed that male sex was independently associated with more severe fibrosis in the groups corresponding to premenopausal (P = 0.048) and early menopausal (P = 0.004) but not late menopausal pairs. In women, estradiol/testosterone ratio decreased markedly in early (vs. reproductive age: P = 0.002 and vs. premenopausal: P<0.0001) and late menopause (vs. reproductive age: P = 0.001; vs. premenopausal: P<0.0001). In men age-matched with menopausal women, estradiol/testosterone ratio instead increased (reproductive age group vs. early: P = 0.002 and vs. late M: P = 0.001). Conclusions The severity of fibrosis in women worsens in parallel with increasing estrogen deprivation and estradiol/testosterone ratio decrease. Our data provide evidence why fibrosis progression is discontinuous in women and more linear and severe in men, in whom aging-associated estradiol/testosterone ratio increase occurs too late to noticeably influence the inflammatory process leading to fibrosis.
Collapse
Affiliation(s)
- Erica Villa
- Department of Gastroenterology, Azienda Ospedaliero-Universitaria & University of Modena and Reggio Emilia, Modena, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|