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Longo UG, Franceschetti E, Carnevale A, Schena E, Cozza G, Perricone G, Cardinale ME, Papalia R. Influence of Lateralization and Distalization on Joint Function after Primary Reverse Total Shoulder Arthroplasty. Bioengineering (Basel) 2023; 10:1409. [PMID: 38136000 PMCID: PMC10740542 DOI: 10.3390/bioengineering10121409] [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: 10/16/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
The purpose of this study was to investigate how lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) are related to clinical and kinematic outcomes after reverse total shoulder arthroplasty. Thirty-three patients were evaluated at least six months postoperatively. The Single Assessment Numeric Evaluation (SANE), Constant Murley Score (CMS), Simple Shoulder Test (SST), and Visual Analogue Scale (VAS) were used. Shoulder kinematics was evaluated with a stereophotogrammetric system. LSA and DSA inter-rater reliability was analysed through the interclass correlation coefficient (ICC). Stepwise forward linear regression analysis was conducted between LSA and DSA with clinical scales and kinematic measures, between which a correlation analysis was conducted. The inter-rater reliability for LSA (mean ICC = 0.93) and DSA (mean ICC = 0.97) results were good to excellent. Greater LSA values were associated with higher peaks of internal rotation (p = 0.012, R2 = 0.188) and range of motion (ROM) (p = 0.037, R2 = 0.133). SANE (p = 0.009), CMS (p = 0.031), and SST (0.026) were positively correlated to external rotation, while VAS (p = 0.020) was negatively related. Abduction peaks were positively related to CMS (p = 0.011) and SANE (p = 0.037), as well as abduction ROM (SANE, p = 0.031; CMS, p = 0.014).
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Edoardo Franceschetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Arianna Carnevale
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
| | - Emiliano Schena
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Laboratory of Measurement and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Giulia Cozza
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
| | - Giovanni Perricone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Marco Edoardo Cardinale
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
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Mehta G, Riva A, Ballester MP, Uson E, Pujadas M, Carvalho-Gomes Â, Sahuco I, Bono A, D’Amico F, Viganò R, Diago E, Lanseros BT, Inglese E, Vazquez DM, Sharma R, Tsou HLP, Harris N, Broekhoven A, Kikkert M, Morales SPT, Myeni SK, Riveiro-Barciela M, Palom A, Zeni N, Brocca A, Cussigh A, Cmet S, Escudero-García D, Stocco M, Natola LA, Ieluzzi D, Paon V, Sangiovanni A, Farina E, di Benedetto C, Sánchez-Torrijos Y, Lucena-Varela A, Román E, Sánchez E, Sánchez-Aldehuelo R, López-Cardona J, Canas-Perez I, Eastgate C, Jeyanesan D, Morocho AE, Di Cola S, Lapenna L, Zaccherini G, Bongiovanni D, Zanaga P, Sayaf K, Hossain S, Crespo J, Robles-Díaz M, Madejón A, Degroote H, Fernández J, Korenjak M, Verhelst X, García-Samaniego J, Andrade RJ, Iruzubieta P, Wright G, Caraceni P, Merli M, Patel VC, Gander A, Albillos A, Soriano G, Donato MF, Sacerdoti D, Toniutto P, Buti M, Duvoux C, Grossi PA, Berg T, Polak WG, Puoti M, Bosch-Comas A, Belli L, Burra P, Russo FP, Coenraad M, Calleja JL, Perricone G, Berenguer M, Claria J, Moreau R, Arroyo V, Angeli P, Sánchez C, Ampuero J, Piano S, Chokshi S, Jalan R. Serological response and breakthrough infection after COVID-19 vaccination in patients with cirrhosis and post-liver transplant. Hepatol Commun 2023; 7:e0273. [PMID: 37870985 PMCID: PMC10586829 DOI: 10.1097/hc9.0000000000000273] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/21/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Vaccine hesitancy and lack of access remain major issues in disseminating COVID-19 vaccination to liver patients globally. Factors predicting poor response to vaccination and risk of breakthrough infection are important data to target booster vaccine programs. The primary aim of the current study was to measure humoral responses to 2 doses of COVID-19 vaccine. Secondary aims included the determination of factors predicting breakthrough infection. METHODS COVID-19 vaccination and Biomarkers in cirrhosis And post-Liver Transplantation is a prospective, multicenter, observational case-control study. Participants were recruited at 4-10 weeks following first and second vaccine doses in cirrhosis [n = 325; 94% messenger RNA (mRNA) and 6% viral vaccine], autoimmune liver disease (AILD) (n = 120; 77% mRNA and 23% viral vaccine), post-liver transplant (LT) (n = 146; 96% mRNA and 3% viral vaccine), and healthy controls (n = 51; 72% mRNA, 24% viral and 4% heterologous combination). Serological end points were measured, and data regarding breakthrough SARS-CoV-2 infection were collected. RESULTS After adjusting by age, sex, and time of sample collection, anti-Spike IgG levels were the lowest in post-LT patients compared to cirrhosis (p < 0.0001), AILD (p < 0.0001), and control (p = 0.002). Factors predicting reduced responses included older age, Child-Turcotte-Pugh B/C, and elevated IL-6 in cirrhosis; non-mRNA vaccine in AILD; and coronary artery disease, use of mycophenolate and dysregulated B-call activating factor, and lymphotoxin-α levels in LT. Incident infection occurred in 6.6%, 10.6%, 7.4%, and 15.6% of cirrhosis, AILD, post-LT, and control, respectively. The only independent factor predicting infection in cirrhosis was low albumin level. CONCLUSIONS LT patients present the lowest response to the SARS-CoV-2 vaccine. In cirrhosis, the reduced response is associated with older age, stage of liver disease and systemic inflammation, and breakthrough infection with low albumin level.
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Affiliation(s)
- Gautam Mehta
- Institute for Liver and Digestive Heath, University College London, London, UK
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Antonio Riva
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Maria Pilar Ballester
- Department of Gastroenterology and Hepatology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Eva Uson
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Montserrat Pujadas
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Ângela Carvalho-Gomes
- Hepatology, HBP Surgery and Transplantation, Hepatology & Liver Transplant Unit, La Fe University Hospital, Valencia, Spain
- Ciberehd, Universidad de Valencia, Valencia, Spain
| | - Ivan Sahuco
- Hepatology, HBP Surgery and Transplantation, Hepatology & Liver Transplant Unit, La Fe University Hospital, Valencia, Spain
- Ciberehd, Universidad de Valencia, Valencia, Spain
| | - Ariadna Bono
- Hepatology, HBP Surgery and Transplantation, Hepatology & Liver Transplant Unit, La Fe University Hospital, Valencia, Spain
- Ciberehd, Universidad de Valencia, Valencia, Spain
| | - Federico D’Amico
- ASST Grande Ospedale Metropolitano Niguarda, Infectious Diseases Unit, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy
| | - Raffaela Viganò
- ASST Grande Ospedale Metropolitano Niguarda, Hepatology and Gastroenterology Unit, Milan, Italy
| | - Elena Diago
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain
- Central Unit of Clinical Research and Clinical Trials, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBERehd, Madrid, Spain
| | - Beatriz Tormo Lanseros
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain
- CIBERehd, Madrid, Spain
| | - Elvira Inglese
- ASST Grande Ospedale Metropolitano Niguarda, Hepatology and Gastroenterology Unit, Milan, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Rajni Sharma
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
| | - Hio Lam Phoebe Tsou
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
| | - Nicola Harris
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
| | - Annelotte Broekhoven
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, RC Leiden, the Netherlands
| | - Marjolein Kikkert
- Department of Medical Microbiology, Leiden University Medical Center, RC Leiden, the Netherlands
| | - Shessy P. Torres Morales
- Department of Medical Microbiology, Leiden University Medical Center, RC Leiden, the Netherlands
| | - Sebenzile K. Myeni
- Department of Medical Microbiology, Leiden University Medical Center, RC Leiden, the Netherlands
| | | | - Adriana Palom
- Liver Unit, Hospital Universitario Valle de Hebron, Barcelona, Spain
| | - Nicola Zeni
- Department of Medicine - DIMED, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Alessandra Brocca
- Department of Medicine - DIMED, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Annarosa Cussigh
- Hepatology and Liver Transplantation Unit, Azienda Sanitaria Universitaria Integrata, University of Udine, Udine, Italy
| | - Sara Cmet
- Hepatology and Liver Transplantation Unit, Azienda Sanitaria Universitaria Integrata, University of Udine, Udine, Italy
| | | | - Matteo Stocco
- Department of Gastroenterology and Hepatology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | | | - Veronica Paon
- Azienda Ospedaiera Universitaria Integrata Verona, Verona Italy
| | - Angelo Sangiovanni
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Elisa Farina
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Clara di Benedetto
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Yolanda Sánchez-Torrijos
- Hospital Universitario Virgen del Rocio, Sevilla. Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Sevilla, Spain
| | - Ana Lucena-Varela
- Hospital Universitario Virgen del Rocio, Sevilla. Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Sevilla, Spain
| | - Eva Román
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- EUI-Sant Pau School of Nursing, Barcelona, Spain
| | - Elisabet Sánchez
- CIBERehd, Madrid, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rubén Sánchez-Aldehuelo
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - Julia López-Cardona
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, Spain
| | | | | | - Dhaarica Jeyanesan
- Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, UK
| | | | - Simone Di Cola
- Department of Translational and Precision Medicine, University of Rome Sapienza, Roma, Italy
| | - Lucia Lapenna
- Department of Translational and Precision Medicine, University of Rome Sapienza, Roma, Italy
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Deborah Bongiovanni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paola Zanaga
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Units, Azienda Ospedale Università’ di Padova, Padova, Italy
| | - Katia Sayaf
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Units, Azienda Ospedale Università’ di Padova, Padova, Italy
| | - Sabir Hossain
- Mid & South Essex NHS Foundation Trust, Basildon, UK
| | - Javier Crespo
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, Santander, Spain
- Clinical and Traslational Digestive Research Group, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Mercedes Robles-Díaz
- CIBERehd, Madrid, Spain
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Antonio Madejón
- Liver Unit, Hospital Universitario La Paz, CIBERehd, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Helena Degroote
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Belgium
- Liver Research Center Ghent, Ghent University, Belgium
- European Reference Network (ERN)RARE-LIVER
| | - Javier Fernández
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
- Liver Unit, Hospital Clínic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS) and Centro de Investigación Biomèdica en Red (CIBEREHD), Barcelona, Spain
| | | | - Xavier Verhelst
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Belgium
- Liver Research Center Ghent, Ghent University, Belgium
- European Reference Network (ERN)RARE-LIVER
| | - Javier García-Samaniego
- Liver Unit, Hospital Universitario La Paz, CIBERehd, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Raúl J. Andrade
- CIBERehd, Madrid, Spain
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Paula Iruzubieta
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, Santander, Spain
- Clinical and Traslational Digestive Research Group, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Gavin Wright
- Mid & South Essex NHS Foundation Trust, Basildon, UK
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-related Diseases, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Manuela Merli
- Department of Translational and Precision Medicine, University of Rome Sapienza, Roma, Italy
| | - Vishal C Patel
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, UK
| | - Amir Gander
- Royal Free London NHS Foundation Trust, London, UK
| | - Agustín Albillos
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, Spain
| | - Germán Soriano
- CIBERehd, Madrid, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Francesca Donato
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - David Sacerdoti
- Azienda Ospedaiera Universitaria Integrata Verona, Verona Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplantation Unit, Azienda Sanitaria Universitaria Integrata, University of Udine, Udine, Italy
| | - Maria Buti
- Liver Unit, Hospital Universitario Valle de Hebron, Barcelona, Spain
| | - Christophe Duvoux
- Department of Hepatogy-Liver Transplant Unit, Henri Mondor Hospital-APHP, Paris Est University, Paris, France
| | - Paolo Antonio Grossi
- Department of Medicine and Surgery, University of Insubria, Infectious and Tropical Diseases Unit, ASST Sette Laghim, Varese, Italy
| | - Thomas Berg
- European Association for the Study of the Liver (EASL)
| | - Wojciech G. Polak
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Massimo Puoti
- University of Milano Bicocca, Infectious Diseases Niguarda Great Metropolitan Hospital, Milan, Italy
| | - Anna Bosch-Comas
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Luca Belli
- ASST Grande Ospedale Metropolitano Niguarda, Hepatology and Gastroenterology Unit, Milan, Italy
| | - Patrizia Burra
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Units, Azienda Ospedale Università’ di Padova, Padova, Italy
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Units, Azienda Ospedale Università’ di Padova, Padova, Italy
| | - Minneke Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, RC Leiden, the Netherlands
| | - José Luis Calleja
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain
- CIBERehd, Madrid, Spain
| | - Giovanni Perricone
- ASST Grande Ospedale Metropolitano Niguarda, Hepatology and Gastroenterology Unit, Milan, Italy
| | - Marina Berenguer
- Hepatology, HBP Surgery and Transplantation, Hepatology & Liver Transplant Unit, La Fe University Hospital, Valencia, Spain
- Ciberehd, Universidad de Valencia, Valencia, Spain
| | - Joan Claria
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
- Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBERehd) and Universitat de Barcelona, Barcelona, Spain
| | - Richard Moreau
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
- INSERM and Université Paris Cité, Centre de Recherche sur l’inflammation (CRI), Paris, France
- APHP, Service d’hépatologie, Hôpital Beaujon, Clichy, France
| | - Vicente Arroyo
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Paolo Angeli
- Department of Medicine - DIMED, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Cristina Sánchez
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Javier Ampuero
- Hospital Universitario Virgen del Rocio, Sevilla. Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Sevilla, Spain
| | - Salvatore Piano
- Department of Medicine - DIMED, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Shilpa Chokshi
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Rajiv Jalan
- Institute for Liver and Digestive Heath, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
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Gregori P, Perricone G, Franceschetti E, Giurazza G, Papalia GF, Zà P, Papalia R. Allograft Prosthesis Composite (APC) for Proximal Humeral Bone Loss: Outcomes and Perspectives. J Pers Med 2023; 13:1301. [PMID: 37763069 PMCID: PMC10532464 DOI: 10.3390/jpm13091301] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Allograft prosthetic composite (APC) represents one of the techniques used for reconstruction in large proximal humeral bone deficits. The present systematic review aimed at summarizing the state of the art of the technique and analyzing its outcomes. (2) Methods: The PRISMA guidelines were followed to perform this systematic review. A systematic electronic search was performed using PubMed (MEDLINE), EMBASE, and the Cochrane Library databases. All the studies analyzing the rates of allograft prosthesis composite were pooled, and the data were extracted and analyzed. (3) Results: A total of 10 studies were eligible for inclusion in this systematic review for a total of 239 patients. The rate of patient satisfaction with surgery was reported in 7 studies with a mean of 86.4% ± 13.64. The mean constant score was 45.7 ± 3.51, the mean ASES score was 63.58 ± 8.37, and the mean SST was 4.6 ± 1.04. The mean revision rate observed was 10.32% ± 3.63 and the mean implant survival was 83.66% ± 14.98. (4) Conclusions: Based on the currently available data, allograft prosthesis composite represents a valuable option for the reconstruction of proximal humeral deficits. All studies analyzed showed the favorable impact of this surgical technique on clinical outcomes and patient satisfaction.
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Affiliation(s)
- Pietro Gregori
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy; (P.G.); (G.P.); (G.G.); (G.F.P.); (P.Z.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Giovanni Perricone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy; (P.G.); (G.P.); (G.G.); (G.F.P.); (P.Z.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Edoardo Franceschetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy; (P.G.); (G.P.); (G.G.); (G.F.P.); (P.Z.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Giancarlo Giurazza
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy; (P.G.); (G.P.); (G.G.); (G.F.P.); (P.Z.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Giuseppe Francesco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy; (P.G.); (G.P.); (G.G.); (G.F.P.); (P.Z.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Pierangelo Zà
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy; (P.G.); (G.P.); (G.G.); (G.F.P.); (P.Z.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy; (P.G.); (G.P.); (G.G.); (G.F.P.); (P.Z.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
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4
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Perricone G, Artzner T, De Martin E, Jalan R, Wendon J, Carbone M. Intensive care management of acute-on-chronic liver failure. Intensive Care Med 2023; 49:903-921. [PMID: 37552333 DOI: 10.1007/s00134-023-07149-x] [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: 04/03/2023] [Accepted: 06/21/2023] [Indexed: 08/09/2023]
Abstract
Acute-on-chronic liver failure (ACLF) is a clinical syndrome defined by an acute deterioration of the liver function associated with extrahepatic organ failures requiring intensive care support and associated with a high short-term mortality. ACLF has emerged as a major cause of mortality in patients with cirrhosis and chronic liver disease. ACLF has a unique pathophysiology in which systemic inflammation plays a key role; this provides the basis of novel therapies, several of which are now in clinical trials. Intensive care unit (ICU) therapy parallels that applied in the general ICU population in some organ failures but has peculiar differential characteristics in others. Critical care management strategies and the option of liver transplantation (LT) should be balanced with futility considerations in those with a poor prognosis. Nowadays, LT is the only life-saving treatment that can radically improve the long-term prognosis of patients with ACLF. This narrative review will provide insights on the current understanding of ACLF with emphasis on intensive care management.
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Affiliation(s)
- Giovanni Perricone
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Thierry Artzner
- Hôpitaux Universitaires de Strasbourg, 67000, Strasbourg, France
| | - Eleonora De Martin
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris-Saclay, Villejuif, France
| | - Rajiv Jalan
- Liver Failure Group, Institute for Liver and Digestive Health, University College London, Royal Free Campus, London, UK
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
| | - Julia Wendon
- Liver Intensive Therapy Unit, Division of Inflammation Biology, King's College London, London, UK
| | - Marco Carbone
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- European Reference Network On Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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5
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Cortesi PA, Viganò R, Conti S, Lenci I, Volpes R, Martini S, Angelico M, Fung J, Buti M, Coilly A, Durand F, Fondevila C, Lebray P, Nevens F, Polak WG, Rizzetto M, Zoulim F, Perricone G, Berenguer M, Mantovani LG, Duvoux C, Belli LS. Economic Impact of European Liver and Intestine Transplantation Association (ELITA) Recommendations for Hepatitis B Prophylaxis After Liver Transplantation. Transpl Int 2023; 36:10954. [PMID: 36793896 PMCID: PMC9922709 DOI: 10.3389/ti.2023.10954] [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: 10/05/2022] [Accepted: 01/12/2023] [Indexed: 01/31/2023]
Abstract
The European Liver and Intestine Transplant Association, ELITA, promoted a Consensus Conference involving 20 experts across the world which generated updated guidelines on HBV prophylaxis in liver transplant candidates and recipients. This study explores the economic impact associated with the implementation of the new ELITA guidelines. To this aim, a condition-specific cohort simulation model has been developed to compare new and historical prophylaxis, including only pharmaceutical cost and using the European perspective. The target population simulated in the model included both prevalent and incident cases, and consisted of 6,133 patients after the first year, that increased to 7,442 and 8,743 patents after 5 and 10 years from its implementation. The ELITA protocols allowed a cost saving of around € 235.65 million after 5 years and € 540.73 million after 10 years; which was mainly due to early HIBG withdrawal either after the first 4 weeks or after the first year post Liver Transplantation (LT) depending on the virological risk at transplantation. Results were confirmed by sensitivity analyses. The money saved by the implementation of the ELITA guidelines would allow healthcare decision makers and budget holders to understand where costs could be reduced and resources re-allocated to different needs.
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Affiliation(s)
- Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy,*Correspondence: Paolo Angelo Cortesi,
| | - Raffaella Viganò
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Ilaria Lenci
- Unit of Hepatology and Liver Transplant Unit, Tor Vergata University, Rome, Italy
| | - Riccardo Volpes
- Hepatology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapia ad Alta Specializzazione), Palermo, Italy
| | - Silvia Martini
- Gastro-hepatology Unit, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Mario Angelico
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - James Fung
- Department of Medicine, School of Clinical Medicine, Queen Mary Hospital, State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Maria Buti
- Liver Unit, Hospital Universitario Valld’Hebron, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Audrey Coilly
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France,Unité INSERM 1193, Université Paris-Saclay, Paris, France
| | - Francois Durand
- Hepatology and Liver Intensive care, Hospital Beaujon, Clichy, France,Service d’Hépatologie et Transplantation Hépatique, APHP, Hôpital Beaujon, Université Paris Diderot, INSERM U1149, Clichy, France
| | - Constantino Fondevila
- HPB Surgery and Transplantation, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), CIBERehd, Madrid, Spain
| | - Pascal Lebray
- Médecine Sorbonne Université, Service d’Hépato-gastroentérologie, Hôpitaux Universitaires Pitié Salpêtrière—Charles Foix, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Frederik Nevens
- Division of Hepatology and Liver Transplantation, European Reference Network on Hepatological Diseases (ERN Rare-Liver), University Hospitals KU, Leuven, Belgium
| | - Wojciech G. Polak
- Erasmus MC, Transplant Institute, University Medical Center Rotterdam, Department of Surgery, Division of HPB and Transplant Surgery, Rotterdam, Netherlands
| | - Mario Rizzetto
- Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Fabien Zoulim
- INSERM U1052—Cancer Research Center of Lyon (CRCL), Lyon University, Hospices Civils de Lyon, Lyon, France
| | | | - Marina Berenguer
- Hepatology and Liver Transplantation Unit, Ciberehd; Faculty of Medicine, La Fe University Hospital, Valencia, Spain
| | | | - Christophe Duvoux
- Service d'Hépatologie, Hôpitaux Universitaires Henri Mondor, Créteil, France
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6
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Artzner T, Bernal W, Belli LS, Conti S, Cortesi PA, Sacleux SC, Pageaux GP, Radenne S, Trebicka J, Fernandez J, Perricone G, Piano S, Nadalin S, Morelli MC, Martini S, Polak WG, Zieniewicz K, Toso C, Berenguer M, Iegri C, Invernizzi F, Volpes R, Karam V, Adam R, Faitot F, Rabinowich L, Saliba F, Meunier L, Lesurtel M, Uschner FE, Michard B, Coilly A, Meszaros M, Poinsot D, Besch C, Schnitzbauer A, De Carlis LG, Fumagalli R, Angeli P, Arroyo V, Fondevila C, Duvoux C, Jalan R. Location and allocation: Inequity of access to liver transplantation for patients with severe acute-on-chronic liver failure in Europe. Liver Transpl 2022; 28:1429-1440. [PMID: 35544360 DOI: 10.1002/lt.26499] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 03/10/2022] [Accepted: 03/29/2022] [Indexed: 01/13/2023]
Abstract
There is growing evidence that liver transplantation (LT) is the most effective treatment for acute-on-chronic liver failure grade-3 (ACLF-3). This study examines whether and how this evidence translates into practice by analyzing the variability in intensive care unit (ICU) admissions, listing strategies, and LT activity for patients with ACLF-3 across transplantation centers in Europe. Consecutive patients who were admitted to the ICU with ACLF-3, whether or not they were listed and/or transplanted with ACLF-3, between 2018 and 2019 were included across 20 transplantation centers. A total of 351 patients with ACLF-3 were included: 33 had been listed prior to developing ACLF-3 and 318 had not been listed at the time of admission to the ICU. There was no correlation between the number of unlisted patients with ACLF-3 admitted to the ICU and the number listed or transplanted while in ACLF-3 across centers. By contrast, there was a correlation between the number of patients listed and the number transplanted while in ACLF-3. About 21% of patients who were listed while in ACLF-3 died on the waiting list or were delisted. The percentage of LT for patients with ACLF-3 varied from 0% to 29% for those transplanted with decompensated cirrhosis across centers (average = 8%), with an I2 index of 68% (95% confidence interval, 49%-80%), showing substantial heterogeneity among centers. The 1-year survival for all patients with ACLF-3 was significantly higher in centers that listed and transplanted more patients with ACLF-3 (>10 patients) than in centers that listed and transplanted fewer: 36% versus 20%, respectively (p = 0.012). Patients with ACLF-3 face inequity of access to LT across Europe. Waitlisting strategies for patients with ACLF-3 influence their access to LT and, ultimately, their survival.
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Affiliation(s)
- Thierry Artzner
- Service de Réanimation Médicale, Hôpital de Hautepierre, Strasbourg, France
| | - William Bernal
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK
| | - Luca S Belli
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy
| | - Sara Conti
- Value-Based Healthcare Unit, IRCCS Multi Medica, Sesto San Giovanni, Italy.,Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Paolo A Cortesi
- Value-Based Healthcare Unit, IRCCS Multi Medica, Sesto San Giovanni, Italy.,Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Sophie-Caroline Sacleux
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Unité INSERM 1193, Université Paris-Saclay, Villejuif, France
| | - George-Philippe Pageaux
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
| | - Sylvie Radenne
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, HCL Hôpital de la Croix-Rousse, Lyon, France
| | - Jonel Trebicka
- Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany.,European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain
| | - Javier Fernandez
- Liver ICU, Liver Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, IDIBAPS and CIBERehd, Barcelona, Spain.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Salvatore Piano
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine, University of Padova, Padova, Italy
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Germany
| | - Maria C Morelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Martini
- Gastro-hepatology Unit, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Wojciech G Polak
- University Medical Center Rotterdam Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, Transplant Institute, Rotterdam, the Netherlands
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Christian Toso
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Marina Berenguer
- Hepatology and Liver Transplantation Unit, CIBEREHD, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain.,Faculty of Medicine, La Fe University Hospital, Valencia, Spain
| | - Claudia Iegri
- Gastroenterology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Federica Invernizzi
- Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Volpes
- Hepatology and Gastroenterology Unit, ISMETT-IRCCS, Palermo, Italy
| | - Vincent Karam
- European Liver Transplant Registry, Centre Hépato-Biliaire Hôpital Universitaire Paul-Brousse, Villejuif, France
| | - René Adam
- European Liver Transplant Registry, Centre Hépato-Biliaire Hôpital Universitaire Paul-Brousse, Villejuif, France
| | - François Faitot
- Service de Chirurgie Hépato-Biliaire et Transplantation Hépatique, Hôpital de Hautepierre, Strasbourg, France
| | - Liane Rabinowich
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK
| | - Faouzi Saliba
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Unité INSERM 1193, Université Paris-Saclay, Villejuif, France
| | - Lucy Meunier
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
| | - Mickael Lesurtel
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Frank E Uschner
- Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany
| | - Baptiste Michard
- Service de Chirurgie Hépato-Biliaire et Transplantation Hépatique, Hôpital de Hautepierre, Strasbourg, France
| | - Audrey Coilly
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Unité INSERM 1193, Université Paris-Saclay, Villejuif, France
| | - Magdalena Meszaros
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
| | - Domitille Poinsot
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, HCL Hôpital de la Croix-Rousse, Lyon, France
| | - Camille Besch
- Service de Chirurgie Hépato-Biliaire et Transplantation Hépatique, Hôpital de Hautepierre, Strasbourg, France
| | - Andreas Schnitzbauer
- Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany
| | - Luciano G De Carlis
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,General Surgery and Transplantation Unit, ASST GOM Niguarda, Milan, Italy
| | - Roberto Fumagalli
- Department of Anesthesia, Critical Care, ASST GOM Niguarda, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine, University of Padova, Padova, Italy
| | - Vincente Arroyo
- European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain
| | | | | | - Rajiv Jalan
- European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain.,Liver Failure Group, Institute for Liver and Digestive Health, UCL Medical School, London, UK
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7
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Belli LS, Perricone G, Jalan R. Reply to: "Sarcopenia should be evaluated in patients with acute-on-chronic liver failure and candidates to liver transplantation". J Hepatol 2022; 76:986. [PMID: 34971636 DOI: 10.1016/j.jhep.2021.12.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/11/2021] [Accepted: 12/17/2021] [Indexed: 12/04/2022]
Affiliation(s)
| | | | - Rajiv Jalan
- European Foundation for the Study of Chronic Liver Failure (EF Clif), 08021 Barcelona, Spain; Liver Failure Group, Institute for Liver and Digestive Health, UCL Medical School, London, UK
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8
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Simonetti RG, Perricone G, Gluud C. Albumin for people with liver cirrhosis and bacterial infections. Hippokratia 2021. [DOI: 10.1002/14651858.cd014636] [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: 11/11/2022]
Affiliation(s)
- Rosa G Simonetti
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research; Capital Region, Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | | | - Christian Gluud
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research; Capital Region, Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
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9
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D'Amico G, Maruzzelli L, Airoldi A, Petridis I, Tosetti G, Rampoldi A, D'Amico M, Miraglia R, De Nicola S, La Mura V, Solcia M, Volpes R, Perricone G, Sgrazzutti C, Vanzulli A, Primignani M, Luca A, Malizia G, Federico A, Dallio M, Andriulli A, Iacobellis A, Addario L, Garcovich M, Gasbarrini A, Chessa L, Salerno F, Gobbo G, Merli M, Ridola L, Baroni GS, Tarantino G, Caporaso N, Morisco F, Pozzoni P, Colli A, Belli LS. Performance of the model for end-stage liver disease score for mortality prediction and the potential role of etiology. J Hepatol 2021; 75:1355-1366. [PMID: 34333100 DOI: 10.1016/j.jhep.2021.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/17/2021] [Revised: 07/02/2021] [Accepted: 07/16/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIMS Although the discriminative ability of the model for end-stage liver disease (MELD) score is generally considered acceptable, its calibration is still unclear. In a validation study, we assessed the discriminative performance and calibration of 3 versions of the model: original MELD-TIPS, used to predict survival after transjugular intrahepatic portosystemic shunt (TIPS); classic MELD-Mayo; and MELD-UNOS, used by the United Network for Organ Sharing (UNOS). We also explored recalibrating and updating the model. METHODS In total, 776 patients who underwent elective TIPS (TIPS cohort) and 445 unselected patients (non-TIPS cohort) were included. Three, 6 and 12-month mortality predictions were calculated by the 3 MELD versions: discrimination was assessed by c-statistics and calibration by comparing deciles of predicted and observed risks. Cox and Fine and Grey models were used for recalibration and prognostic analyses. RESULTS In the TIPS/non-TIPS cohorts, the etiology of liver disease was viral in 402/188, alcoholic in 185/130, and non-alcoholic steatohepatitis in 65/33; mean follow-up±SD was 25±9/19±21 months; and the number of deaths at 3-6-12 months was 57-102-142/31-47-99, respectively. C-statistics ranged from 0.66 to 0.72 in TIPS and 0.66 to 0.76 in non-TIPS cohorts across prediction times and scores. A post hoc analysis revealed worse c-statistics in non-viral cirrhosis with more pronounced and significant worsening in the non-TIPS cohort. Calibration was acceptable with MELD-TIPS but largely unsatisfactory with MELD-Mayo and -UNOS whose performance improved much after recalibration. A prognostic analysis showed that age, albumin, and TIPS indication might be used to update the MELD. CONCLUSIONS In this validation study, the performance of the MELD score was largely unsatisfactory, particularly in non-viral cirrhosis. MELD recalibration and candidate variables for an update to the MELD score are proposed. LAY SUMMARY While the discriminative performance of the model for end-stage liver disease (MELD) score is credited to be fair to good, its calibration, the correspondence of observed to predicted mortality, is still unsettled. We found that application of 3 different versions of the MELD in 2 independent cirrhosis cohorts yielded largely imprecise mortality predictions particularly in non-viral cirrhosis. Thus, we propose a recalibration and suggest candidate variables for an update to the model.
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Affiliation(s)
- Gennaro D'Amico
- Gatroenterology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy; Gastroenterology Unit, Clinica La Maddalena, Palermo, Italy.
| | - Luigi Maruzzelli
- Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Aldo Airoldi
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy
| | - Ioannis Petridis
- Hepatology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Giulia Tosetti
- Gastroenterology and Hepatology Unit Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | | | - Mario D'Amico
- Radiology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy; Radiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Miraglia
- Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Stella De Nicola
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy
| | - Vincenzo La Mura
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Luigi Villa, Milan, Italy
| | - Marco Solcia
- Interventional Radiology Unit, ASST GOM Niguarda, Milan, Italy
| | - Riccardo Volpes
- Hepatology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
| | | | - Cristiano Sgrazzutti
- University of Milan, Department of Oncology and Hemato-oncology and Radiology, Department ASST Niguarda, Milan, Italy
| | - Angelo Vanzulli
- University of Milan, Department of Oncology and Hemato-oncology and Radiology, Department ASST Niguarda, Milan, Italy
| | - Massimo Primignani
- Gastroenterology and Hepatology Unit Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | - Angelo Luca
- Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Giuseppe Malizia
- Gatroenterology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Alessandro Federico
- Hepato-Gastroenterology Unit, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marcello Dallio
- Hepato-Gastroenterology Unit, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Angelo Andriulli
- Department of Gastroenterology and Endoscopy, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Angelo Iacobellis
- Department of Gastroenterology and Endoscopy, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Matteo Garcovich
- Department of Internal Medicine and Gastroenterology, Policlinico Gemelli, Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine and Gastroenterology, Policlinico Gemelli, Rome, Italy
| | - Luchino Chessa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Giulia Gobbo
- Internal Medicine Unit, IRCCS Policlinico San Donato, Milano, Italy
| | - Manuela Merli
- Gastroenterology and Hepatology Unit, Department of Translational and Precision Medicine, Università Sapienza, Roma, Italy
| | - Lorenzo Ridola
- Gastroenterology Unit, ASL Latina, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Italy
| | | | - Giuseppe Tarantino
- Liver Injury and Transplant Unit, Polytechnic University of Marche, Ancona, Italy
| | - Nicola Caporaso
- Gastroenterology Unit, Federico II University, Naples, Italy
| | | | - Pietro Pozzoni
- General Medicine Unit,Presidio Ospedaliero, Azienda Socio Sanitaria Territoriale di Lecco, Lecco, Italy
| | - Agostino Colli
- General Medicine Unit,Presidio Ospedaliero, Azienda Socio Sanitaria Territoriale di Lecco, Lecco, Italy
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10
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Lauterio A, Bottiroli M, Cannata A, DE Carlis R, Valsecchi M, Perricone G, Colombo S, Buscemi V, Zaniboni M, Pedrazzini G, Mondino M, Russo C, Fumagalli R, DE Carlis L. Successful recovery from severe inverted Takotsubo cardiomyopathy after liver transplantation: the efficacy of extracorporeal membrane oxygenation (ECMO). Minerva Anestesiol 2021; 88:199-201. [PMID: 34636225 DOI: 10.23736/s0375-9393.21.16140-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Andrea Lauterio
- Division of General Surgery and Transplantation, Department of Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy -
| | - Maurizio Bottiroli
- Cardiothoracic Anesthesiology Unit, Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Aldo Cannata
- Department of Cardiac Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo DE Carlis
- Division of General Surgery and Transplantation, Department of Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mila Valsecchi
- Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Perricone
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefania Colombo
- Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Vincenzo Buscemi
- Division of General Surgery and Transplantation, Department of Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Zaniboni
- Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanna Pedrazzini
- Cardiothoracic Anesthesiology Unit, Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michele Mondino
- Cardiothoracic Anesthesiology Unit, Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Claudio Russo
- Department of Cardiac Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Roberto Fumagalli
- Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Luciano DE Carlis
- Division of General Surgery and Transplantation, Department of Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,International Center for Digestive Health, University of Milano-Bicocca, Milan, Italy
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11
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Belli LS, Duvoux C, Cortesi PA, Facchetti R, Iacob S, Perricone G, Radenne S, Conti S, Patrono D, Berlakovich G, Hann A, Pasulo L, Castells L, Faitot F, Detry O, Invernizzi F, Magini G, De Simone P, Kounis I, Morelli MC, Díaz Fontenla F, Ericzon BG, Loinaz C, Johnston C, Gheorghe L, Lesurtel M, Romagnoli R, Kollmann D, Perera MTP, Fagiuoli S, Mirza D, Coilly A, Toso C, Zieniewicz K, Elkrief L, Karam V, Adam R, den Hoed C, Merli M, Puoti M, De Carlis L, Oniscu GC, Piano S, Angeli P, Fondevila C, Polak WG. COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study. Gut 2021; 70:1914-1924. [PMID: 34281984 PMCID: PMC8300535 DOI: 10.1136/gutjnl-2021-324879] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course. DESIGN Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed. RESULTS From 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10-30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15-19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44-102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31-170). CONCLUSIONS Increased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).
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Affiliation(s)
- Luca Saverio Belli
- Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), Universita degli Studi di Milano-Bicocca Scuola di Medicina e Chirurgia, Monza, Italy
| | - Rita Facchetti
- Research Centre on Public Health (CESP), Universita degli Studi di Milano-Bicocca Scuola di Medicina e Chirurgia, Monza, Italy
| | - Speranta Iacob
- Digestive Diseases and Liver Transplantation Center, Institutul Clinic Fundeni, Bucharest, Romania
| | - Giovanni Perricone
- Epatologia e Gastroenterologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Sylvie Radenne
- Service Hépatologie et Gastro-Entérologie, Hospital Croix-Rousse, Lyon, France
| | - Sara Conti
- Research Centre on Public Health (CESP), Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Damiano Patrono
- Liver Transplantation Unit, Ospedale Molinette, Torino, Italy
| | - Gabriela Berlakovich
- Division of Transplantation, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Angus Hann
- Department of Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Luisa Pasulo
- Gastroenterology and Transplant Hepatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Lluis Castells
- Liver Transplant Unit, HPB Surgery and Transplants, Hospital Vall d'Hebron, Barcelona, Spain
| | - Francois Faitot
- Service de Chirurgie Hepatobiliare and Transplantation, Hôpital de Hautepierre, Strasbourg, France
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege, Liege, Belgium
| | - Federica Invernizzi
- Division of Gastroenterology and Hepatology, Policlinico di Milano, Milan, Italy
| | - Giulia Magini
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, Geneve, Switzerland
| | - Paolo De Simone
- Trapiantologia Epatica Universitaria, Ospedale Cisanello, Pisa, Italy
| | - Ilias Kounis
- Centre Hépatobiliaire, Hospital Paul Brousse, Villejuif, France
| | - Maria Cristina Morelli
- Department of Organ Failures and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fernando Díaz Fontenla
- Liver Transplantation Unit, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Bo-Göran Ericzon
- Transplantation Surgery, Karolinska Institute, Stockholm, Sweden
| | - Carmelo Loinaz
- HBP and Transplant Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Chris Johnston
- Liver Transplantation Unit, Edinburgh Royal Infirmary, Edinburgh, Edinburgh, UK
| | - Liliana Gheorghe
- Digestive Diseases and Liver Transplantation Center, Clinical Institute Fundeni, Bucuresti, Romania
| | - Mickael Lesurtel
- Department of Surgery and Transplanattion, Hospital Croix-Rousse, Lyon, Rhône-Alpes, France
| | | | - Dagmar Kollmann
- Division of Transplantation, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Stefano Fagiuoli
- Department of Gastroenterology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Darius Mirza
- Department of Surgery, Queen Elizabeth Hospital, Birmingham, Birmingham, UK
| | - Audrey Coilly
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, Île-de-France, France
- UMR-S1193, INSERM, Villejuif, Île-de-France, France
| | - Christian Toso
- Department of Surgery, Geneva University Hospitals, Geneve, Switzerland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Faculty of Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Laure Elkrief
- Hepatogastroenterology Unit, Hopital Trousseau, Chambray-les-Tours, France
| | - Vincent Karam
- Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France
| | - Rene Adam
- Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France
| | | | - Marco Merli
- Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Massimo Puoti
- Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Luciano De Carlis
- Chirurgia Generale e dei Trapianti, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Gabriel C Oniscu
- Transplantation Surgery, Karolinska Institute, Stockholm, Sweden
| | - Salvatore Piano
- Department of Medicine, Faculty of Medicine and Surgery, University of Padua, Padova, Italy
| | - Paolo Angeli
- Department of Medicine, Faculty of Medicine and Surgery, University of Padua, Padova, Italy
| | | | - Wojciech G Polak
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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12
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Belli LS, Duvoux C, Artzner T, Bernal W, Conti S, Cortesi PA, Sacleux SC, Pageaux GP, Radenne S, Trebicka J, Fernandez J, Perricone G, Piano S, Nadalin S, Morelli MC, Martini S, Polak WG, Zieniewicz K, Toso C, Berenguer M, Iegri C, Invernizzi F, Volpes R, Karam V, Adam R, Faitot F, Rabinovich L, Saliba F, Meunier L, Lesurtel M, Uschner FE, Fondevila C, Michard B, Coilly A, Meszaros M, Poinsot D, Schnitzbauer A, De Carlis LG, Fumagalli R, Angeli P, Arroyo V, Jalan R. Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: Results of the ELITA/EF-CLIF collaborative study (ECLIS). J Hepatol 2021; 75:610-622. [PMID: 33951535 DOI: 10.1016/j.jhep.2021.03.030] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [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: 12/23/2020] [Revised: 03/13/2021] [Accepted: 03/26/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Liver transplantation (LT) has been proposed as an effective salvage therapy even for the sickest patients with acute-on-chronic liver failure (ACLF). This large collaborative study was designed to assess the current clinical practice and outcomes of patients with ACLF who are wait-listed for LT in Europe. METHODS This was a retrospective study including 308 consecutive patients with ACLF, listed in 20 centres across 8 European countries, from January 2018 to June 2019. RESULTS A total of 2,677 patients received a LT: 1,216 (45.4%) for decompensated cirrhosis. Of these, 234 (19.2%) had ACLF at LT: 58 (4.8%) had ACLF-1, 78 (6.4%) had ACLF-2, and 98 (8.1%) had ACLF-3. Wide variations were observed amongst countries: France and Germany had high rates of ACLF-2/3 (27-41%); Italy, Switzerland, Poland and the Netherlands had medium rates (9-15%); and the United Kingdom and Spain had low rates (3-5%) (p <0.0001). The 1-year probability of survival after LT for patients with ACLF was 81% (95% CI 74-87). Pre-LT arterial lactate levels >4 mmol/L (hazard ratio [HR] 3.14; 95% CI 1.37-7.19), recent infection from multidrug resistant organisms (HR 3.67; 95% CI 1.63-8.28), and renal replacement therapy (HR 2.74; 95% CI 1.37-5.51) were independent predictors of post-LT mortality. During the same period, 74 patients with ACLF died on the waiting list. In an intention-to-treat analysis, 1-year survival of patients with ACLF on the LT waiting list was 73% for ACLF-1 or -2 and 50% for ACLF-3. CONCLUSION The results reveal wide variations in the listing of patients with ACLF in Europe despite favourable post-LT survival. Risk factors for mortality were identified, enabling a more precise prognostic assessment of patients with ACLF. LAY SUMMARY Acute-on-chronic liver failure (ACLF) is a severe clinical condition for which liver transplantation is an effective therapeutic option. This study has demonstrated that in Europe, referral and access to liver transplantation (LT) for patients with ACLF needs to be harmonised to avoid inequities. Post-LT survival for patients with ACLF was >80% after 1 year and some factors have been identified to help select patients with favourable outcomes.
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Affiliation(s)
- Luca S Belli
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy.
| | | | - Thierry Artzner
- C.H.R.U. De Strasbourg, Hôpital Hautepierre, Strasbourg, France
| | - William Bernal
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London UK
| | - Sara Conti
- Value-Based Healthcare Unit, IRCCS Multi Medica, Sesto San Giovanni, Italy; Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Paolo A Cortesi
- Value-Based Healthcare Unit, IRCCS Multi Medica, Sesto San Giovanni, Italy; Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Sophie-Caroline Sacleux
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France; Unité INSERM 1193, Université Paris-Saclay, France
| | - George-Philippe Pageaux
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
| | - Sylvie Radenne
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, HCL Hopital de la Croix-Rousse, Lyon, France
| | - Jonel Trebicka
- Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany; European Foundation for the Study of Chronic Liver Failure (EF Clif), 08021 Barcelona, Spain
| | - Javier Fernandez
- Liver ICU, Liver Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, IDIBAPS and CIBERehd, Barcelona, Spain
| | | | - Salvatore Piano
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine, University of Padova, Italy
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Germany
| | - Maria C Morelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Martini
- Gastro-hepatology Unit, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Wojciech G Polak
- Erasmus MC, Transplant Institute, University Medical Center Rotterdam Department of Surgery, Division of HPB and Transplant Surgery, Rotterdam, Rotterdam, the Netherlands
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Christian Toso
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Marina Berenguer
- Hepatology and Liver Transplantation Unit, Ciberehd, and Facultad de Medicina, La Fe University Hospital, Valencia, Spain
| | - Claudia Iegri
- Gastroenterology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Federica Invernizzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | - Riccardo Volpes
- Hepatology and Gastroenterology Unit, ISMETT-IRCCS, Palermo, Italy
| | - Vincent Karam
- European Liver Transplant Registry, Centre Hépatobiliaire Hôpital Universitaire Paul Brousse, Villejuif, France
| | - René Adam
- European Liver Transplant Registry, Centre Hépatobiliaire Hôpital Universitaire Paul Brousse, Villejuif, France
| | - François Faitot
- C.H.R.U. De Strasbourg, Hôpital Hautepierre, Strasbourg, France
| | - Liane Rabinovich
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London UK
| | - Faouzi Saliba
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France; Unité INSERM 1193, Université Paris-Saclay, France
| | - Lucy Meunier
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
| | - Mickael Lesurtel
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, HCL Hopital de la Croix-Rousse, Lyon, France
| | - Frank E Uschner
- Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany
| | - Costantino Fondevila
- Liver ICU, Liver Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, IDIBAPS and CIBERehd, Barcelona, Spain
| | | | - Audrey Coilly
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France; Unité INSERM 1193, Université Paris-Saclay, France
| | - Magdalena Meszaros
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
| | - Domitille Poinsot
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, HCL Hopital de la Croix-Rousse, Lyon, France
| | - Andreas Schnitzbauer
- Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany
| | - Luciano G De Carlis
- General Surgery and Transplantation Unit, ASST GOM Niguarda, Milan, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Roberto Fumagalli
- Department of Anesthesia, Critical Care, ASST GOM Niguarda, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine, University of Padova, Italy
| | - Vincente Arroyo
- European Foundation for the Study of Chronic Liver Failure (EF Clif), 08021 Barcelona, Spain
| | - Rajiv Jalan
- European Foundation for the Study of Chronic Liver Failure (EF Clif), 08021 Barcelona, Spain; Liver Failure Group, Institute for Liver and Digestive Health, UCL Medical School, London, UK
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13
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Simonetti RG, Perricone G, Gluud C. Vasoactive drugs for adults with cirrhosis and large ascites treated with paracentesis. Hippokratia 2021. [DOI: 10.1002/14651858.cd014637] [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: 11/09/2022]
Affiliation(s)
- Rosa G Simonetti
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research; Capital Region, Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - Giovanni Perricone
- S.C. Epatologia e Gastroenterologia; Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Christian Gluud
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research; Capital Region, Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
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14
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Belli LS, Fondevila C, Cortesi PA, Conti S, Karam V, Adam R, Coilly A, Ericzon BG, Loinaz C, Cuervas-Mons V, Zambelli M, Llado L, Diaz-Fontenla F, Invernizzi F, Patrono D, Faitot F, Bhooori S, Pirenne J, Perricone G, Magini G, Castells L, Detry O, Cruchaga PM, Colmenero J, Berrevoet F, Rodriguez G, Ysebaert D, Radenne S, Metselaar H, Morelli C, De Carlis LG, Polak WG, Duvoux C. Protective Role of Tacrolimus, Deleterious Role of Age and Comorbidities in Liver Transplant Recipients With Covid-19: Results From the ELITA/ELTR Multi-center European Study. Gastroenterology 2021; 160:1151-1163.e3. [PMID: 33307029 PMCID: PMC7724463 DOI: 10.1053/j.gastro.2020.11.045] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking. METHODS Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis. RESULTS Between March 1 and June 27, 2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39 of 204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10-23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age >70 (HR, 4.16; 95% CI, 1.78-9.73) had a negative effect and tacrolimus (TAC) use (HR, 0.55; 95% CI, 0.31-0.99) had a positive independent effect on survival. The role of co-morbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR, 1.95; 95% CI, 1.06-3.58) and chronic kidney disease (HR, 1.97; 95% CI, 1.05-3.67) emerged as associated with death CONCLUSIONS: Twenty-five percent of patients requiring hospitalization for COVID-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose.
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Affiliation(s)
- Luca S. Belli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy,Correspondence Address correspondence to: Luca S. Belli, Department of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Constantino Fondevila
- Department of General and Digestive Surgery, Hospital Clínic, Institut d’Investigacion Biomediques August Pi-Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Paolo A. Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Vincent Karam
- European Liver Transplant Registry, Centre Hépatobiliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul-Brousse, Paris-Saclay University, Villejuif, France
| | - Rene Adam
- European Liver Transplant Registry, Centre Hépatobiliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul-Brousse, Paris-Saclay University, Villejuif, France
| | - Audrey Coilly
- Centre Hepato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul-Brousse, Paris-Sud Saclay University, Villejuif, France
| | - Bo Goran Ericzon
- Division of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Carmelo Loinaz
- Chirugía General, Doce de Octubre Universidad Complutense de Madrid, Madrid, Spain
| | - Valentin Cuervas-Mons
- Departimento de Medicina, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marco Zambelli
- Department of Surgery, “Papa Giovanni XXIII” Hospital, Bergamo, Lombardia, Italy
| | - Laura Llado
- Liver Transplant Unit, Hospital Uniersitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Fernando Diaz-Fontenla
- Unidad de Trasplante Hepático, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Federica Invernizzi
- Division of Gastroenterology and Hepatology, University of Milan, Milan, Italy
| | - Damiano Patrono
- Liver Transplantation Center, Molinette Hospital, Turin, Italy
| | - Francois Faitot
- Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Strasbourg, France
| | - Sherrie Bhooori
- Department of Surgery and Oncology, Istituto Nazionale Tumori, Milan, Italy
| | - Jacques Pirenne
- Department of Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Giovanni Perricone
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - Giulia Magini
- Service de Transplantation, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Lluis Castells
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Oliver Detry
- Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire Liege, University of Liege, Liege, Belgium
| | - Pablo Mart Cruchaga
- Cirugía General y Digestiva, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jordi Colmenero
- Department of General and Digestive Surgery, Hospital Clínic, Institut d’Investigacion Biomediques August Pi-Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Frederick Berrevoet
- Department of General and Hepatobiliary Surgery, Ghent University, Ghent, Belgium
| | - Gonzalo Rodriguez
- Department of General & Digestive Surgery, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
| | - Dirk Ysebaert
- Department of Surgery, Antwerp University Hospital, Antwerp University, Edegem, Belgium
| | - Sylvie Radenne
- Service d’Hépato-Gastroentérologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Herold Metselaar
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Cristina Morelli
- Liver and Multi-organ Transplantation, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luciano G. De Carlis
- General Surgery and Abdominal Transplantation Unit, Niguarda-Cà Granda Hospital, and School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Wojciech G. Polak
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Christophe Duvoux
- Department of Hepatology and Medical Liver Transplant Unit, Henri Mondor Hospital Assistance Publique-Hôpitaux de Paris, Paris-Est University, Creteil, France
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15
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Merli M, Alteri C, Colagrossi L, Perricone G, Chiappetta S, Travi G, Campisi D, Pugliano MT, Vecchi M, Orcese C, Rossini S, De Carlis L, Vismara C, Belli L, Perno CF, Puoti M. Mild Course of SARS-CoV-2 Infection in a Liver Transplant Recipient Undergoing Plasma Exchange and Defibrotide for Acute Graft Rejection. Transplantation 2021; 105:e22-e24. [PMID: 33492115 DOI: 10.1097/tp.0000000000003592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Marco Merli
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Claudia Alteri
- Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Luna Colagrossi
- Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Giovanni Perricone
- Division of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefania Chiappetta
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanna Travi
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Daniela Campisi
- Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Teresa Pugliano
- Division of Immunohaematology and Transfusion Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marta Vecchi
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carloandrea Orcese
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvano Rossini
- Division of Immunohaematology and Transfusion Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luciano De Carlis
- Division of General and Transplantation Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Chiara Vismara
- Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luca Belli
- Division of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carlo Federico Perno
- Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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16
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D'Amico G, Perricone G, Morabito A, Latteri F, Filì D, Affronti A, Pietrosi G, Maida M, Rizzo GEM, Bronte F, Petridis I, Bavetta MG, Volpes R, Malizia G, Luca A. Model for end stage liver disease for prediction of mortality in people with cirrhosis. Hippokratia 2021. [DOI: 10.1002/14651858.cd013849] [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: 11/10/2022]
Affiliation(s)
| | - Giovanni Perricone
- S.C. Epatologia e Gastroenterologia; Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Alberto Morabito
- Istituto di Statistica Medica e Biometria; Universita di Milano; Milano Italy
| | | | | | | | | | - Marcello Maida
- Gastroenterology and Endoscopy Unit; S Elia - Raimondi Hospital - Caltanissetta; Caltanissetta Italy
| | | | | | | | | | | | | | - Angelo Luca
- Hepatology; CEO, IRCCS-ISMETT; Palermo Italy
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17
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Sundaram V, Mahmud N, Perricone G, Katarey D, Wong RJ, Karvellas CJ, Fortune BE, Rahimi RS, Maddur H, Jou JH, Kriss M, Stein LL, Lee M, Jalan R. Longterm Outcomes of Patients Undergoing Liver Transplantation for Acute-on-Chronic Liver Failure. Liver Transpl 2020; 26:1594-1602. [PMID: 32574423 DOI: 10.1002/lt.25831] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/13/2020] [Accepted: 06/03/2020] [Indexed: 12/18/2022]
Abstract
Recent data have demonstrated >80% 1-year survival probability after liver transplantation (LT) for patients with severe acute-on-chronic liver failure (ACLF). However, longterm outcomes and complications are still unknown for this population. Our aim was to compare longterm patient and graft survival among patients transplanted across all grades of ACLF. We analyzed the United Network for Organ Sharing database for the years 2004-2017. Patients with ACLF were identified using the European Association for the Study of the Liver-Chronic Liver Failure criteria. Kaplan-Meier and Cox regression methods were used to determine patient and graft survival and associated predictors of mortality in adjusted models. A total of 56,801 patients underwent transplantation of which 31,024 (54.6%) had no ACLF, 8757 (15.4%) had ACLF grade 1, 9039 (15.9%) had ACLF grade 2, and 7891 (14.1%) had ACLF grade 3. The 5-year patient survival after LT was lower in the ACLF grade 3 patients compared with the other groups (67.7%; P < 0.001), although after year 1, the percentage decrease in survival was similar among all groups. Infection was the primary cause of death among all patient groups in the first year. Infection was the primary cause of death among all patient groups in the first year. After the first year, infection was the main cause of death in patients transplanted with ACLF grade 1 (32.1%), ACLF grade 2 (33.9%), and ACLF grade 3 (37.6%), whereas malignancy was the predominant cause of death in those transplanted with no ACLF (28.5%). In conclusion, patients transplanted with ACLF grade 3 had lower 5-year survival as compared with patients with ACLF grades 0-2, but mortality rates were not significantly different after the first year following LT. Graft survival was excellent across all ACLF groups.
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Affiliation(s)
- Vinay Sundaram
- Karsh Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Nadim Mahmud
- Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA.,Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Giovanni Perricone
- Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, United Kingdom.,Hepatology and Gastroenterology Unit, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Dev Katarey
- Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, United Kingdom
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine and Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA
| | - Constantine J Karvellas
- Department of Critical Care and Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
| | - Brett E Fortune
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY
| | - Robert S Rahimi
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Baylor Scott and White, Dallas, TX
| | - Harapriya Maddur
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL
| | - Janice H Jou
- Division of Gastroenterology and Hepatology, Oregon Health and Sciences University, Portland, OR
| | - Michael Kriss
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, CO
| | - Lance L Stein
- Piedmont Transplant Institute, Piedmont Healthcare, Atlanta, GA
| | - Moses Lee
- Department of Medicine, Western University College of Medicine, Pomona, CA
| | - Rajiv Jalan
- Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, United Kingdom
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18
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Merli M, Perricone G, Lauterio A, Prosperi M, Travi G, Roselli E, Petrò L, De Carlis L, Belli L, Puoti M. Coronaviruses and Immunosuppressed Patients: The Facts During the Third Epidemic. Liver Transpl 2020; 26:1543-1544. [PMID: 32475054 PMCID: PMC7300680 DOI: 10.1002/lt.25806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Marco Merli
- Infectious Diseases UnitASST Grande Ospedale Metropolitano NiguardaMilanoItaly
| | - Giovanni Perricone
- Hepatology and Gastroenterology UnitASST Grande Ospedale Metropolitano NiguardaMilanoItaly
| | - Andrea Lauterio
- Department of General Surgery and TransplantationASST Grande Ospedale Metropolitano NiguardaMilanoItaly
| | - Manlio Prosperi
- Department of Anesthesia and ResuscitationASST Grande Ospedale Metropolitano NiguardaMilanoItaly
| | - Giovanna Travi
- Infectious Diseases UnitASST Grande Ospedale Metropolitano NiguardaMilanoItaly
| | - Elena Roselli
- Department of Anesthesia and ResuscitationASST Grande Ospedale Metropolitano NiguardaMilanoItaly
| | - Laura Petrò
- Department of Anesthesia and ResuscitationASST Grande Ospedale Metropolitano NiguardaMilanoItaly
| | - Luciano De Carlis
- Department of General Surgery and TransplantationASST Grande Ospedale Metropolitano NiguardaMilanoItaly,Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
| | - Luca Belli
- Hepatology and Gastroenterology UnitASST Grande Ospedale Metropolitano NiguardaMilanoItaly
| | - Massimo Puoti
- Infectious Diseases UnitASST Grande Ospedale Metropolitano NiguardaMilanoItaly
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19
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Iavarone M, D'Ambrosio R, Soria A, Triolo M, Pugliese N, Del Poggio P, Perricone G, Massironi S, Spinetti A, Buscarini E, Viganò M, Carriero C, Fagiuoli S, Aghemo A, Belli LS, Lucà M, Pedaci M, Rimondi A, Rumi MG, Invernizzi P, Bonfanti P, Lampertico P. High rates of 30-day mortality in patients with cirrhosis and COVID-19. J Hepatol 2020; 73:1063-1071. [PMID: 32526252 PMCID: PMC7280108 DOI: 10.1016/j.jhep.2020.06.001] [Citation(s) in RCA: 250] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/27/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities, but its impact on patients with cirrhosis is currently unknown. Herein, we aimed to evaluate the impact of COVID-19 on the clinical outcome of patients with cirrhosis. METHODS In this multicentre retrospective study, patients with cirrhosis and a confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were enrolled between 1st and 31th March 2020. Clinical and biochemical data at diagnosis of COVID-19 and at the last outpatient visit were obtained through review of medical records. RESULTS Fifty patients with cirrhosis and confirmed SARS-CoV-2 infection were enrolled (age 67 years, 70% men, 38% virus-related, 52% previously compensated cirrhosis). At diagnosis, 64% of patients presented fever, 42% shortness of breath/polypnea, 22% encephalopathy, 96% needed hospitalization or a prolonged stay if already in hospital. Respiratory support was necessary in 71%, 52% received antivirals, 80% heparin. Serum albumin significantly decreased, while bilirubin, creatinine and prothrombin time significantly increased at COVID-19 diagnosis compared to last available data. The proportion of patients with a model for end-stage liver disease (MELD) score ≥15 increased from 13% to 26% (p = 0.037), acute-on-chronic liver failure and de novo acute liver injury occurred in 14 (28%) and 10 patients, respectively. Seventeen patients died after a median of 10 (4-13) days from COVID-19 diagnosis, with a 30-day-mortality rate of 34%. The severity of lung and liver (according to CLIF-C, CLIF-OF and MELD scores) diseases independently predicted mortality. In patients with cirrhosis, mortality was significantly higher in those with COVID-19 than in those hospitalized for bacterial infections. CONCLUSION COVID-19 is associated with liver function deterioration and elevated mortality in patients with cirrhosis. LAY SUMMARY Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities. Herein, we assessed its impact on patients with cirrhosis. Infection with COVID-19 was associated with liver function deterioration and elevated mortality in patients with cirrhosis.
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Affiliation(s)
- Massimo Iavarone
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy.
| | - Roberta D'Ambrosio
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | - Alessandro Soria
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza, University of Milano - Bicocca School of Medicine, Monza, Italy
| | - Michela Triolo
- Gastroenterology 1 - Hepatology & Transplantology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Nicola Pugliese
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Paolo Del Poggio
- UO Gastroenterologia. Policlinico S. Marco, Zingonia-Bergamo, Italy
| | | | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Angiola Spinetti
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Elisabetta Buscarini
- UOC Gastroenterologia ed Endoscopia Digestiva, ASST Ospedale Maggiore, Crema, Italy
| | - Mauro Viganò
- Division of Hepatology, Ospedale San Giuseppe, Italy
| | - Canio Carriero
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Stefano Fagiuoli
- Gastroenterology 1 - Hepatology & Transplantology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Luca S Belli
- Hepatology and Gastroenterology Unit, Niguarda Hospital, Milan, Italy
| | - Martina Lucà
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marianna Pedaci
- UOC Gastroenterologia ed Endoscopia Digestiva, ASST Ospedale Maggiore, Crema, Italy; University of Milan, Milan, Italy
| | - Alessandro Rimondi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy; University of Milan, Milan, Italy
| | - Maria Grazia Rumi
- Division of Hepatology, Ospedale San Giuseppe, Italy; University of Milan, Milan, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Paolo Bonfanti
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza, University of Milano - Bicocca School of Medicine, Monza, Italy
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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20
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Merli M, Pasulo L, Perricone G, Travi G, Rossotti R, Colombo VG, De Carlis R, Chiappetta S, Moioli MC, Minetti E, Frigerio M, De Carlis LG, Belli L, Fagiuoli S, Puoti M. Impact of immunosuppressive therapy on the severity of COVID-19 in solid organ transplant recipients. J Infect 2020; 82:414-451. [PMID: 33127455 PMCID: PMC7590634 DOI: 10.1016/j.jinf.2020.10.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 10/24/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Marco Merli
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
| | - Luisa Pasulo
- Division of Gastroenterology, Hepatology and Transplantation, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Giovanna Travi
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | | | - Stefania Chiappetta
- Division of Gastroenterology, Hepatology and Transplantation, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Enrico Minetti
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Maria Frigerio
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Luca Belli
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Massimo Puoti
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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21
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Simonetti RG, Perricone G, Robbins HL, Battula NR, Weickert MO, Sutton R, Khan S. Portosystemic shunts versus endoscopic intervention with or without medical treatment for prevention of rebleeding in people with cirrhosis. Cochrane Database Syst Rev 2020; 10:CD000553. [PMID: 33089892 PMCID: PMC8095029 DOI: 10.1002/14651858.cd000553.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND People with liver cirrhosis who have had one episode of variceal bleeding are at risk for repeated episodes of bleeding. Endoscopic intervention and portosystemic shunts are used to prevent further bleeding, but there is no consensus as to which approach is preferable. OBJECTIVES To compare the benefits and harms of shunts (surgical shunts (total shunt (TS), distal splenorenal shunt (DSRS), or transjugular intrahepatic portosystemic shunt (TIPS)) versus endoscopic intervention (endoscopic sclerotherapy or banding, or both) with or without medical treatment (non-selective beta blockers or nitrates, or both) for prevention of variceal rebleeding in people with liver cirrhosis. SEARCH METHODS We searched the CHBG Controlled Trials Register; CENTRAL, in the Cochrane Library; MEDLINE Ovid; Embase Ovid; LILACS (Bireme); Science Citation Index - Expanded (Web of Science); and Conference Proceedings Citation Index - Science (Web of Science); as well as conference proceedings and the references of trials identified until 22 June 2020. We contacted study investigators and industry researchers. SELECTION CRITERIA Randomised clinical trials comparing shunts versus endoscopic interventions with or without medical treatment in people with cirrhosis who had recovered from a variceal haemorrhage. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. When possible, we collected data to allow intention-to-treat analysis. For each outcome, we estimated a meta-analysed estimate of treatment effect across trials (risk ratio for binary outcomes). We used random-effects model meta-analysis as our main analysis and as a means of presenting results. We reported differences in means for continuous outcomes without a meta-analytic estimate due to high variability in their assessment among all trials. We assessed the certainty of evidence using GRADE. MAIN RESULTS We identified 27 randomised trials with 1828 participants. Three trials assessed TSs, five assessed DSRSs, and 19 trials assessed TIPSs. The endoscopic intervention was sclerotherapy in 16 trials, band ligation in eight trials, and a combination of band ligation and either sclerotherapy or glue injection in three trials. In eight trials, endoscopy was combined with beta blockers (in one trial plus isosorbide mononitrate). We judged all trials to be at high risk of bias. We assessed the certainty of evidence for all the outcome review results as very low (i.e. the true effects of the results are likely to be substantially different from the results of estimated effects). The very low evidence grading is due to the overall high risk of bias for all trials, and to imprecision and publication bias for some outcomes. Therefore, we are very uncertain whether portosystemic shunts versus endoscopy interventions with or without medical treatment have effects on all-cause mortality (RR 0.99, 95% CI 0.86 to 1.13; 1828 participants; 27 trials), on rebleeding (RR 0.40, 95% CI 0.33 to 0.50; 1769 participants; 26 trials), on mortality due to rebleeding (RR 0.51, 95% CI 0.34 to 0.76; 1779 participants; 26 trials), and on occurrence of hepatic encephalopathy, both acute (RR 1.60, 95% CI 1.33 to 1.92; 1649 participants; 24 trials) and chronic (RR 2.51, 95% CI 1.38 to 4.55; 956 participants; 13 trials). No data were available regarding health-related quality of life. Analysing each modality of portosystemic shunts individually (i.e. TS, DSRS, and TIPS) versus endoscopic interventions with or without medical treatment, we are very uncertain if each type of shunt has effect on all-cause mortality: TS, RR 0.46, 95% CI 0.19 to 1.13; 164 participants; 3 trials; DSRS, RR 0.93, 95% CI 0.65 to 1.33; 352 participants; 4 trials; and TIPS, RR 1.10, 95% CI 0.92 to 1.31; 1312 participants; 19 trial; on rebleeding: TS, RR 0.28, 95% CI 0.14 to 0.56; 127 participants; 2 trials; DSRS, RR 0.26, 95% CI 0.11 to 0.65; 330 participants; 5 trials; and TIPS, RR 0.44, 95% CI 0.36 to 0.55; 1312 participants; 19 trials; on mortality due to rebleeding: TS, RR 0.25, 95% CI 0.06 to 0.96; 164 participants; 3 trials; DSRS, RR 0.31, 95% CI 0.13 to 0.74; 352 participants; 5 trials; and TIPS, RR 0.65, 95% CI 0.40 to 1.04; 1263 participants; 18 trials; on acute hepatic encephalopathy: TS, RR 1.66, 95% CI 0.70 to 3.92; 115 participants; 2 trials; DSRS, RR 1.70, 95% CI 0.94 to 3.08; 287 participants; 4 trials, TIPS, RR 1.61, 95% CI 1.29 to 1.99; 1247 participants; 18 trials; and chronic hepatic encephalopathy: TS, Fisher's exact test P = 0.11; 69 participants; 1 trial; DSRS, RR 4.87, 95% CI 1.46 to 16.23; 170 participants; 2 trials; and TIPS, RR 1.88, 95% CI 0.93 to 3.80; 717 participants; 10 trials. The proportion of participants with shunt occlusion or dysfunction was overall 37% (95% CI 33% to 40%). It was 3% (95% CI 0.8% to 10%) following TS, 7% (95% CI 3% to 13%) following DSRS, and 47.1% (95% CI 43% to 51%) following TIPS. Shunt dysfunction in trials utilising polytetrafluoroethylene-covered stents was 17% (95% CI 11% to 24%). Length of inpatient hospital stay and cost were not comparable across trials. Funding was unclear in 16 trials; 11 trials were funded by government, local hospitals, or universities. AUTHORS' CONCLUSIONS Evidence on whether portosystemic shunts versus endoscopy interventions with or without medical treatment in people with cirrhosis and previous hypertensive portal bleeding have little or no effect on all-cause mortality is very uncertain. Evidence on whether portosystemic shunts may reduce bleeding and mortality due to bleeding while increasing hepatic encephalopathy is also very uncertain. We need properly conducted trials to assess effects of these interventions not only on assessed outcomes, but also on quality of life, costs, and length of hospital stay.
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Affiliation(s)
- Rosa G Simonetti
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Giovanni Perricone
- S.C. Epatologia e Gastroenterologia, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Helen L Robbins
- Department of Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Narendra R Battula
- Division of Hepatobiliary and Abdominal Transplant surgery, University of Florida, Gainesville, Florida, USA
| | - Martin O Weickert
- The ARDEN NET Centre, ENETS Centre of Excellence, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Robert Sutton
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Saboor Khan
- Surgery, University Hosptial Coventry and Warwickshire, Coventry, UK
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22
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Travi G, Rossotti R, Merli M, Sacco A, Perricone G, Lauterio A, Colombo VG, De Carlis L, Frigerio M, Minetti E, Belli LS, Puoti M. Clinical outcome in solid organ transplant recipients with COVID-19: A single-center experience. Am J Transplant 2020; 20:2628-2629. [PMID: 32436646 PMCID: PMC7280581 DOI: 10.1111/ajt.16069] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Giovanna Travi
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy,Correspondence Giovanna Travi
| | - Roberto Rossotti
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Merli
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alice Sacco
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Perricone
- Division of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Lauterio
- Department of Transplantation, Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Valeriana G. Colombo
- Division of Nephrology, Dialysis and Renal Transplantatation, University of Milano-Bicocca, Milan, Italy
| | - Luciano De Carlis
- Department of Transplantation, Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,International Center for Digestive Health, University of Milano-Bicocca, Milan, Italy
| | - Maria Frigerio
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Enrico Minetti
- Division of Nephrology, Dialysis and Renal Transplantatation, University of Milano-Bicocca, Milan, Italy
| | - Luca S. Belli
- Division of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Puoti
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Airoldi A, Perricone G, De Nicola S, Molisano C, Tarsia P, Belli L. COVID-19-related thrombotic microangiopathy in a cirrhotic patient. Dig Liver Dis 2020; 52:946. [PMID: 32641274 PMCID: PMC7294259 DOI: 10.1016/j.dld.2020.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022]
Affiliation(s)
- A. Airoldi
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milano Italy
| | - G. Perricone
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milano Italy
| | - S. De Nicola
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milano Italy,Corresponding author.
| | - C. Molisano
- Internal Medicine Unit, Università di Milano Bicocca, Italy
| | - P. Tarsia
- Pneumology Unit, ASST GOM Niguarda, Milano Italy
| | - L.S. Belli
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milano Italy
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Motta I, Perricone G. Ulcerative pyoderma gangrenosum in inflammatory bowel disease. Lancet Gastroenterol Hepatol 2020; 4:488. [PMID: 31070128 DOI: 10.1016/s2468-1253(19)30038-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Ilaria Motta
- Infectious Diseases Unit, Department of Medical Sciences, University of Turin, Italy
| | - Giovanni Perricone
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK.
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25
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Ferrarese A, Morelli MC, Carrai P, Milana M, Angelico M, Perricone G, Belli LS, Marrone G, Grieco A, Martini S, Manini MA, Fagiuoli S, Toniutto P, Galeota Lanza A, Bhoori S, Petta S, Giannini EG, Burra P. Outcomes of Liver Transplant for Adults With Wilson's Disease. Liver Transpl 2020; 26:507-516. [PMID: 31901209 DOI: 10.1002/lt.25714] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 08/13/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022]
Abstract
Wilson's disease (WD) is a rare genetic disorder with protean manifestations. Even if liver transplantation (LT) could represent an effective therapeutic option for patients with end-stage liver disease, it has remained controversial in the presence of neuropsychiatric involvement. This study aimed to examine the frequency of adult LT for WD in Italy, focusing on the disease phenotype at the time of LT. A retrospective, observational, multicenter study was conducted across Italy exploring the frequency and characteristics of adults transplanted for WD between 2006 and 2016. A total of 29 adult WD patients underwent LT during the study period at 11 Italian LT centers (accounting for 0.4% of all LTs performed), and 27 of them were considered in this analysis (male/female, n = 9/18; age at LT, 29 years [19-60 years]; median Model for End-Stage Liver Disease score at LT, 27 [6-49]). Isolated hepatic phenotype was the indication for LT in 17 (63%) patients, whereas 2 (7%) patients underwent LT for neurological impairment on compensated liver disease. Overall 1- and 5-year patient survival was excellent (88% and 83%, respectively). Neuropsychiatric symptoms early after LT completely recovered in only a few patients. In conclusion, WD remains an uncommon, unusual indication for LT in Italy, displaying good post-LT graft and patient survival. Because isolated neuropsychiatric involvement represents a rare indication to LT, more data are needed to properly assess the value of LT for WD in this subset of patients.
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Affiliation(s)
- Alberto Ferrarese
- Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Maria Cristina Morelli
- Department for Care of Organ Failures and Transplants, Internal Medicine for the Treatment of Severe Organ Failures, University Hospital - Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Paola Carrai
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School and Hospital, Pisa, Italy
| | - Martina Milana
- Liver and Transplant Unit, Tor Vergata University Hospital, Rome, Italy
| | - Mario Angelico
- Liver and Transplant Unit, Tor Vergata University Hospital, Rome, Italy
| | - Giovanni Perricone
- Gastroenterology and Hepatology Department, Liver Unit, Azienda Socio Sanitaria Territoriale, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luca Saverio Belli
- Gastroenterology and Hepatology Department, Liver Unit, Azienda Socio Sanitaria Territoriale, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe Marrone
- 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
| | - 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
| | - Silvia Martini
- Gastrohepatology Unit, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Matteo Angelo Manini
- Gastroenterology and Transplant Hepatology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplant Unit, Department of Medical Area, Udine University Hospital, Udine, Italy
| | | | - Sherrie Bhoori
- Department of Surgery and Oncology, Istituto Nazionale Tumori Instituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Salvatore Petta
- Gastroenterology and Hepatology, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino, Instituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia, Genoa, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
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Jalan R, Perricone G, Moreau R, Arroyo V, Williams R. Acute-on-Chronic Liver Failure: A New Disease or an Old One Hiding in Plain Sight? Clin Liver Dis (Hoboken) 2020; 15:S45-S51. [PMID: 32140213 PMCID: PMC7050950 DOI: 10.1002/cld.859] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 02/04/2023] Open
Affiliation(s)
- Rajiv Jalan
- Liver Failure GroupUCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free HospitalLondonUnited Kingdom
| | - Giovanni Perricone
- Liver Failure GroupUCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free HospitalLondonUnited Kingdom,Hepatology and Gastroenterology UnitAzienda Socio‐Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Richard Moreau
- Inserm, U1149, Centre de Recherche sur l’InflammationUMRS1149, Université de Paris, Service d’Hépatologie, Hôpital Beaujon, Assistance Publique‐Hôpitaux de ParisClichyFrance
| | - Vicente Arroyo
- European Foundation for the Study of Chronic Liver FailureBarcelonaSpain
| | - Roger Williams
- Institute of HepatologyFoundation for Liver ResearchLondonUnited Kingdom,Faculty of Life Sciences and MedicineKing’s CollegeLondonUnited Kingdom
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Strazzabosco M, Cortesi PA, Conti S, Okolicsanyi S, Rota M, Ciaccio A, Cozzolino P, Fornari C, Gemma M, Scalone L, Cesana G, Fabris L, Colledan M, Fagiuoli S, Ideo G, Zavaglia C, Perricone G, Munari LM, Mantovani LG, Belli LS. Clinical outcome indicators in chronic hepatitis B and C: A primer for value-based medicine in hepatology. Liver Int 2020; 40:60-73. [PMID: 31654608 PMCID: PMC10916792 DOI: 10.1111/liv.14285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/03/2019] [Accepted: 10/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Chronic liver diseases (CLDs) are major health problems that require complex and costly treatments. Liver-specific clinical outcome indicators (COIs) able to assist both clinicians and administrators in improving the value of care are presently lacking. The Value-Based Medicine in Hepatology (VBMH) study aims to fill this gap, devising and testing a set of COIs for CLD, that could be easily collected during clinical practice. Here we report the COIs generated and recorded for patients with HBV or HCV infection at different stages of the disease. METHODS/RESULTS In the first phase of VBMH study, COIs were identified, based on current international guidelines and literature, using a modified Delphi method and a RAND 9-point appropriateness scale. In the second phase, COIs were tested in an observational, longitudinal, prospective, multicentre study based in Lombardy, Italy. Eighteen COIs were identified for HBV and HCV patients. Patients with CLD secondary to HBV (547) or HCV (1391) were enrolled over an 18-month period and followed for a median of 4 years. The estimation of the proposed COIs was feasible in the real-word clinical practice and COI values compared well with literature data. Further, the COIs were able to capture the impact of new effective treatments like direct-acting antivirals (DAAs) in the clinical practice. CONCLUSIONS The COIs efficiently measured clinical outcomes at different stages of CLDs. While specific clinical practice settings and related healthcare systems may modify their implementation, these indicators will represent an important component of the tools for a value-based approach in hepatology and will positively affect care delivery.
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Affiliation(s)
- Mario Strazzabosco
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Paolo A. Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Stefano Okolicsanyi
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
| | - Matteo Rota
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
- Department of Molecular and Traslational Medicine, University of Brescia, Brescia, Italy
| | - Antonio Ciaccio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
| | - Paolo Cozzolino
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Carla Fornari
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Marta Gemma
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
| | - Luciana Scalone
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Luca Fabris
- International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Molecular Medicine, University of Padua School of Medicine, Padua, Italy
| | - Michele Colledan
- Department of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Gastroenterology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Claudio Zavaglia
- Hepatology and Gastroenterology Unit - Liver Unit, ASST GOM Niguarda, Milan, Italy
| | - Giovanni Perricone
- Hepatology and Gastroenterology Unit - Liver Unit, ASST GOM Niguarda, Milan, Italy
| | | | - Lorenzo G. Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Luca S. Belli
- International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
- Hepatology and Gastroenterology Unit - Liver Unit, ASST GOM Niguarda, Milan, Italy
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Perricone G, Jalan R. Acute-on-Chronic Liver Failure: A Distinct Clinical Syndrome That Has Reclassified Cirrhosis. Clin Liver Dis (Hoboken) 2019; 14:171-175. [PMID: 31879558 PMCID: PMC6924966 DOI: 10.1002/cld.857] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/24/2019] [Indexed: 02/04/2023] Open
Affiliation(s)
- Giovanni Perricone
- Liver Failure GroupUCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free HospitalLondonUnited Kingdom,Hepatology and Gastroenterology UnitAzienda Socio‐Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Rajiv Jalan
- Liver Failure GroupUCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free HospitalLondonUnited Kingdom
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Simonetti RG, Perricone G, Nikolova D, Bjelakovic G, Gluud C. Plasma expanders for people with cirrhosis and large ascites treated with abdominal paracentesis. Cochrane Database Syst Rev 2019; 6:CD004039. [PMID: 31251387 PMCID: PMC6598734 DOI: 10.1002/14651858.cd004039.pub2] [Citation(s) in RCA: 10] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND Plasma volume expanders are used in connection to paracentesis in people with cirrhosis to prevent reduction of effective plasma volume, which may trigger deleterious effect on haemodynamic balance, and increase morbidity and mortality. Albumin is considered the standard product against which no plasma expansion or other plasma expanders, e.g. other colloids (polygeline , dextrans, hydroxyethyl starch solutions, fresh frozen plasma), intravenous infusion of ascitic fluid, crystalloids, or mannitol have been compared. However, the benefits and harms of these plasma expanders are not fully clear. OBJECTIVES To assess the benefits and harms of any plasma volume expanders such as albumin, other colloids (polygeline, dextrans, hydroxyethyl starch solutions, fresh frozen plasma), intravenous infusion of ascitic fluid, crystalloids, or mannitol versus no plasma volume expander or versus another plasma volume expander for paracentesis in people with cirrhosis and large ascites. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS, CNKI, VIP, Wanfang, Science Citation Index Expanded, and Conference Proceedings Citation Index until January 2019. Furthermore, we searched FDA, EMA, WHO (last search January 2019), www.clinicaltrials.gov/, and www.controlled-trials.com/ for ongoing trials. SELECTION CRITERIA Randomised clinical trials, no matter their design or year of publication, publication status, and language, assessing the use of any type of plasma expander versus placebo, no intervention, or a different plasma expander in connection with paracentesis for ascites in people with cirrhosis. We considered quasi-randomised, retrieved with the searches for randomised clinical trials only, for reports on harms. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We calculated the risk ratio (RR) or mean difference (MD) using the fixed-effect model and the random-effects model meta-analyses, based on the intention-to-treat principle, whenever possible. If the fixed-effect and random-effects models showed different results, then we made our conclusions based on the analysis with the highest P value (the more conservative result). We assessed risks of bias of the individual trials using predefined bias risk domains. We assessed the certainty of the evidence at an outcome level, using GRADE, and constructed 'Summary of Findings' tables for seven of our review outcomes. MAIN RESULTS We identified 27 randomised clinical trials for inclusion in this review (24 published as full-text articles and 3 as abstracts). Five of the trials, with 271 participants, assessed plasma expanders (albumin in four trials and ascitic fluid in one trial) versus no plasma expander. The remaining 22 trials, with 1321 participants, assessed one type of plasma expander, i.e. dextran, hydroxyethyl starch, polygeline, intravenous infusion of ascitic fluid, crystalloids, or mannitol versus another type of plasma expander, i.e. albumin in 20 of these trials and polygeline in one trial. Twenty-five trials provided data for quantitative meta-analysis. According to the Child-Pugh classification, most participants were at an intermediate to advanced stage of liver disease in the absence of hepatocellular carcinoma, recent gastrointestinal bleeding, infections, and hepatic encephalopathy. All trials were assessed as at overall high risk of bias. Ten trials seemed not to have been funded by industry; twelve trials were considered unclear about funding; and five trials were considered funded by industry or a for-profit institution.We found no evidence of a difference in effect between plasma expansion versus no plasma expansion on mortality (RR 0.52, 95% CI 0.06 to 4.83; 248 participants; 4 trials; very low certainty); renal impairment (RR 0.32, 95% CI 0.02 to 5.88; 181 participants; 4 trials; very low certainty); other liver-related complications (RR 1.61, 95% CI 0.79 to 3.27; 248 participants; 4 trials; very low certainty); and non-serious adverse events (RR 1.04, 95% CI 0.32 to 3.40; 158 participants; 3 trials; very low certainty). Two of the trials stated that no serious adverse events occurred while the remaining trials did not report on this outcome. No trial reported data on health-related quality of life.We found no evidence of a difference in effect between experimental plasma expanders versus albumin on mortality (RR 1.03, 95% CI 0.82 to 1.30; 1014 participants; 14 trials; very low certainty); serious adverse events (RR 0.89, 95% CI 0.10 to 8.30; 118 participants; 2 trials; very low certainty); renal impairment (RR 1.17, 95% CI 0.71 to 1.91; 1107 participants; 17 trials; very low certainty); other liver-related complications (RR 1.10, 95% CI 0.82 to 1.48; 1083 participants; 16 trials; very low certainty); and non-serious adverse events (RR 1.37, 95% CI 0.66 to 2.85; 977 participants; 14 trials; very low certainty). We found no data on heath-related quality of life and refractory ascites. AUTHORS' CONCLUSIONS Our systematic review and meta-analysis did not find any benefits or harms of plasma expanders versus no plasma expander or of one plasma expander such as polygeline, dextrans, hydroxyethyl starch, intravenous infusion of ascitic fluid, crystalloids, or mannitol versus albumin on primary or secondary outcomes. The data originated from few, small, mostly short-term trials at high risks of systematic errors (bias) and high risks of random errors (play of chance). GRADE assessments concluded that the evidence was of very low certainty. Therefore, we can neither demonstrate or discard any benefit of plasma expansion versus no plasma expansion, and differences between one plasma expander versus another plasma expander.Larger trials at low risks of bias are needed to assess the role of plasma expanders in connection with paracentesis. Such trials should be conducted according to the SPIRIT guidelines and reported according to the CONSORT guidelines.
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Affiliation(s)
- Rosa G Simonetti
- Cochrane Hepato‐Biliary GroupBlegdamsvej 9, 7811CopenhagenDenmark2100
| | - Giovanni Perricone
- Azienda Socio‐Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaS.C. Epatologia e GastroenterologiaPiazza Ospedale Maggiore, 3MilanItaly20162
- UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free HospitalLiver Failure GroupLondonUK
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Goran Bjelakovic
- Medical Faculty, University of NisDepartment of Internal MedicineZorana Djindjica 81NisSerbia18000
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
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Biselli M, Gramenzi A, Lenzi B, Dall'Agata M, Pierro ML, Perricone G, Tonon M, Bellettato L, D'Amico G, Angeli P, Boffelli S, Bonavita ME, Domenicali M, Caraceni P, Bernardi M, Trevisani F. Development and Validation of a Scoring System That Includes Corrected QT Interval for Risk Analysis of Patients With Cirrhosis and Gastrointestinal Bleeding. Clin Gastroenterol Hepatol 2019; 17:1388-1397.e1. [PMID: 30557740 DOI: 10.1016/j.cgh.2018.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/08/2018] [Revised: 11/29/2018] [Accepted: 12/07/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The electrocardiographic QT interval frequently is prolonged in patients with cirrhosis. Acute gastrointestinal bleeding further prolongs corrected QT (QTc) in patients with cirrhosis, which has been associated with an increased risk of death within 6 weeks. We aimed to confirm these findings and develop a mortality risk index that incorporates QTc. METHODS We collected data from 274 patients with cirrhosis and acute gastrointestinal bleeding from any cause admitted to a hospital in Bologna, Italy, from January 2001 through December 2012 (training set). We used logistic regression analysis to identify patient factors associated with death within 6 weeks (6-week mortality). We validated our findings by using data from 200 patients with cirrhosis and gastrointestinal bleeding treated at 2 separate hospitals in Italy, from 2001 through 2016 and 2007 through 2012. Our primary aim was to confirm the prognostic effects of prolonged QTc in a large population of patients and develop a 6-week mortality risk score for acute gastrointestinal bleeding from any cause that incorporates the QTc interval. RESULTS In the training set, QTc greater than 456 ms, the model for end-stage liver disease-sodium (MELD-Na) score, previous bleeding, and serum albumin concentration were associated independently with 6-week mortality. We combined these parameters to create a risk scoring system that we named MELD-Na acute gastrointestinal bleeding (MELDNa-AGIB). In the validation set, the MELDNa-AGIB identified patients who died within 6 weeks with an area under the receiver operating characteristic curve (AUROC) of 0.888; this value was higher than that of the MELD score (AUROC, 0.838; P = .031), MELD score with updated calibration (AUROC, 0.837; P = .029), Child-Turcotte-Pugh score (AUROC, 0.789; P = .004), D'Amico score (AUROC, 0.761; P = .003), and Augustin score (AUROC, 0.792; P = .001), with a net reclassification improvement better than the MELD-Na score (0.266; P = .045). In calibration, the MELDNa-AGIB produced a high score in the Hosmer-Lemeshow test (P = .947), which was superior to that of MELD-Na (P = .146). In the training set, only 6.3% of patients with MELDNa-AGIB scores of 4 or less died within 6 weeks. Among patients with a scores of 9, 16, and 25 or higher, 15.5%, 41.5%, and 81% or more patients died within 6 weeks, respectively. The probability of survival progressively and significantly decreased with increasing scores in the training and validation sets. CONCLUSIONS We confirmed QTc as an independent predictor of 6-week mortality in a large population of patients with cirrhosis and acute gastrointestinal bleeding. The combination of QTc, MELD-Na, previous bleeding, and serum albumin (the MELDNa-AGIB score) accurately determines the risk of 6-week mortality, providing timely identification of patients at very high risk of death.
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Affiliation(s)
- Maurizio Biselli
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Annagiulia Gramenzi
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Barbara Lenzi
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marco Dall'Agata
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Monica Loreta Pierro
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giovanni Perricone
- Gastroenterology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy; Gastroenterology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy; Hepatology and Gastroenterology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marta Tonon
- Clinica Medica, Dipartimento di Medicina, University of Padua, Padua, Italy
| | - Luca Bellettato
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Gennaro D'Amico
- Gastroenterology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Paolo Angeli
- Clinica Medica, Dipartimento di Medicina, University of Padua, Padua, Italy
| | - Silvia Boffelli
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Maria Elena Bonavita
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marco Domenicali
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paolo Caraceni
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mauro Bernardi
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Franco Trevisani
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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Perricone G, Simonetti RG. An unusual cause of acute mesenteric ischaemia. Frontline Gastroenterol 2019; 11:253-254. [PMID: 32419918 PMCID: PMC7223461 DOI: 10.1136/flgastro-2019-101229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/15/2019] [Accepted: 04/25/2019] [Indexed: 02/04/2023] Open
Affiliation(s)
- Giovanni Perricone
- Hepatology and Gastroenterology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy,Liver Failure Group, University College London, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK
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Perricone G, Duvoux C, Berenguer M, Cortesi PA, Vinaixa C, Facchetti R, Mazzarelli C, Rockenschaub SR, Martini S, Morelli C, Monico S, Volpes R, Pageaux GP, Fagiuoli S, Belli LS. Delisting HCV-infected liver transplant candidates who improved after viral eradication: Outcome 2 years after delisting. Liver Int 2018; 38:2170-2177. [PMID: 29750389 DOI: 10.1111/liv.13878] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 02/27/2018] [Accepted: 04/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUNDS & AIMS Treating patients with decompensated cirrhosis with direct-acting antiviral (DAA) therapy while on the waiting list for liver transplantation results in substantial improvement of liver function allowing 1 in 4 patients to be removed from the waiting list or delisted, as reported in a previous study promoted by the European Liver and Intestine Transplant Association (ELITA). The aim of this study was to report on clinical outcomes of delisted patients, including mortality risk, hepatocellular carcinoma development and clinical decompensation requiring relisting. METHODS One hundred and forty-two HCV-positive patients on the liver transplant waiting list for decompensated cirrhosis, negative for hepatocellular carcinoma, between February 2014 and June 2015 were treated with DAA therapy and were prospectively followed up. RESULTS Forty-four patients (30.9%) were delisted following clinical improvement. This percentage was higher than in the original study because of a number of patients being delisted long after starting DAAs. The median Child-Pugh and MELD score of delisted patients was 5.5 and 9 respectively. Four patients were relisted, because of HCC diagnosis in 1 case and 3 patients developed ascites. One further patient died (2.4%) because of rapidly progressing hepatocellular carcinoma twenty-two months after delisting. Of the 70 patients who received a liver graft, 9 died (13%). CONCLUSIONS Antiviral therapy allows for a long-term improvement of liver function and the delisting of one-third of treated patients with risk of liver-related complications after delisting being very low.
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Affiliation(s)
- Giovanni Perricone
- Gastroenterology and Hepatology Unit, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, AssistancePublique-Hôpitaux de Paris, Paris-Est University, Creteil, France
| | - Marina Berenguer
- Hepatology & Liver Transplantation Unit, Hospital Universitari I Politècnic La Fe, University of Valencia & Ciberhed, Valencia, Spain
| | - Paolo A Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Carmen Vinaixa
- Division of Transplantation, Department of Surgery, University of Vienna, Vienna, Austria
| | - Rita Facchetti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Chiara Mazzarelli
- Gastroenterology and Hepatology Unit, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Silvia Martini
- Liver Transplantation Center, Gastro-Hepatology Unit, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Cristina Morelli
- Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Sara Monico
- Division of Digestive Diseases, 'Maggiore' University Hospital, Milan, Italy
| | - Riccardo Volpes
- Hepatology and Gastroenterology Unit, ISMETT, Palermo, Italy
| | - Georges-Philippe Pageaux
- Department of Hepatology, Gastroenterology, and Liver Transplantation, Centre HospitalierUniversitaire (CHU) Saint Eloi, Montpellier, France
| | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luca S Belli
- Gastroenterology and Hepatology Unit, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,International Center for Disease Health (ICDH), University of Milan-Bicocca, Monza, Italy
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Cortesi PA, Belli LS, Perricone G, Adam R, Strazzabosco M, Facchetti R, Karam V, Duvoux C. Impact of new HCV therapies on liver transplantation: the European Liver Transplant Registry study. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.372] [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: 11/12/2022] Open
Affiliation(s)
- PA Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - LS Belli
- Department of Gastroenterology and Hepatology. Liver Unit. Niguarda Hospital, Milan, Italy
| | - G Perricone
- Department of Gastroenterology and Hepatology. Liver Unit. Niguarda Hospital, Milan, Italy
| | - R Adam
- Centre Hépatobiliaire, Université Paris-Sud, Hôpital Paul Brousse, Villejuif, France
| | - M Strazzabosco
- Yale University Liver Center, Department of Medicine, New Haven, USA
| | - R Facchetti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - V Karam
- Centre Hépatobiliaire, Université Paris-Sud, Hôpital Paul Brousse, Villejuif, France
| | - C Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est University, Creteil, France
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Belli LS, Perricone G, Adam R, Cortesi PA, Strazzabosco M, Facchetti R, Karam V, Salizzoni M, Andujar RL, Fondevila C, De Simone P, Morelli C, Fabregat-Prous J, Samuel D, Agarwaal K, Moreno Gonzales E, Charco R, Zieniewicz K, De Carlis L, Duvoux C. Impact of DAAs on liver transplantation: Major effects on the evolution of indications and results. An ELITA study based on the ELTR registry. J Hepatol 2018; 69:810-817. [PMID: 29940268 DOI: 10.1016/j.jhep.2018.06.010] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [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: 04/11/2018] [Revised: 06/05/2018] [Accepted: 06/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Direct-acting antivirals (DAAs) have dramatically improved the outcome of patients with hepatitis C virus (HCV) infection including those with decompensated cirrhosis (DC). We analyzed the evolution of indications and results of liver transplantation (LT) in the past 10 years in Europe, focusing on the changes induced by the advent of DAAs. METHODS This is a cohort study based on data from the European Liver Transplant Registry (ELTR). Data of adult LTs performed between January 2007 to June 2017 for HCV, hepatitis B virus (HBV), alcohol (EtOH) and non-alcoholic steatohepatitis (NASH) were analyzed. The period was divided into different eras: interferon (IFN/RBV; 2007-2010), protease inhibitor (PI; 2011-2013) and second generation DAA (DAA; 2014-June 2017). RESULTS Out of a total number of 60,527 LTs, 36,382 were performed in patients with HCV, HBV, EtOH and NASH. The percentage of LTs due to HCV-related liver disease varied significantly over time (p <0.0001), decreasing from 22.8% in the IFN/RBV era to 17.4% in the DAA era, while those performed for NASH increased significantly (p <0.0001). In the DAA era, the percentage of LTs for HCV decreased significantly (p <0.0001) from 21.1% (first semester 2014) to 10.6% (first semester 2017). This decline was more evident in patients with DC (HCV-DC, -58.0%) than in those with hepatocellular carcinoma (HCC) associated with HCV (HCV-HCC, -41.2%). Conversely, three-year survival of LT recipients with HCV-related liver disease improved from 65.1% in the IFN/RBV era to 76.9% in the DAA era, and is now comparable to the survival of recipients with HBV infection (p = 0.3807). CONCLUSIONS In Europe, the number of LTs due to HCV infection is rapidly declining for both HCV-DC and HCV-HCC indications and post-LT survival has dramatically improved over the last three years. This is the first comprehensive study of the overall impact of DAA treatment for HCV on liver transplantation in Europe. LAY SUMMARY After the advent of direct-acting antivirals in 2014, a dramatic decline was observed in the number of liver transplants performed both in patients with decompensated cirrhosis due to hepatitis C virus (HCV), minus 60%, and in those with hepatocellular carcinoma associated with HCV, minus 41%. Furthermore, this is the first large-scale study demonstrating that the survival of liver transplant recipients with HCV-related liver disease has dramatically improved over the last three years and is now comparable to the survival of recipients with hepatitis B virus infection. The reduction in HCV-related indications for LT means that there is a greater availability of livers, at least 600 every year, which can be allocated to patients with indications other than HCV.
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Affiliation(s)
- Luca Saverio Belli
- Gastroenterology and Hepatology, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Giovanni Perricone
- Gastroenterology and Hepatology, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Rene Adam
- Centre Hépatobiliaire, Université Paris-Sud, Hôpital Paul Brousse, F-94804 Villejuif, France
| | - Paolo A Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | | | - Rita Facchetti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Vincent Karam
- Centre Hépatobiliaire, Université Paris-Sud, Hôpital Paul Brousse, F-94804 Villejuif, France
| | - Mauro Salizzoni
- Centro trapianti di fegato, AO San Giovanni Battista, Torino, Italy
| | - Rafael Lopez Andujar
- Hospital Universitario y Politecnico La Fe, Unidad de Chirurgia HPB y TX, Valencia, Spain
| | - Costantino Fondevila
- Hospital Clinic de Barcelona, Dep. of Surgery, University of Barcelona Villaroel, Barcelona, Spain
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Cristina Morelli
- Liver and Multiorgan Transplantation, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Joan Fabregat-Prous
- Hospital Universitari de Bellvitge, Unidad de Transplante Hepatico, Barcelona, Spain
| | - Didier Samuel
- Centre Hépatobiliaire, Université Paris-Sud, Hôpital Paul Brousse, F-94804 Villejuif, France
| | - Kosh Agarwaal
- Institute of Liver Diseases, King's College Hospital, Liver Unit, London, UK
| | | | - Ramon Charco
- Hospital Universitario Vall D Hebron HBP, Surgery & Transplant Department, Barcelona, Spain
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland
| | - Luciano De Carlis
- Chirurgia generale 2 e Trapianti, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, AssistancePublique-Hôpitaux de Paris, Paris-Est University, Creteil, France
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Affiliation(s)
- Giovanni Perricone
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marcello Vangeli
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Cortesi PA, Belli LS, Facchetti R, Mazzarelli C, Perricone G, De Nicola S, Cesana G, Duvoux C, Mantovani LG, Strazzabosco M. The optimal timing of hepatitis C therapy in liver transplant-eligible patients: Cost-effectiveness analysis of new opportunities. J Viral Hepat 2018; 25:791-801. [PMID: 29406608 DOI: 10.1111/jvh.12877] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023]
Abstract
Different strategies of DAAs treatment are currently possible both pre- and postliver transplantation (LT). Clinical and economic consequences of these strategies still need to be adequately investigated; this study aims at assessing their cost-effectiveness. A decision analytical model was created to simulate the progression of HCV-infected patients listed for decompensated cirrhosis (DCC) or for hepatocellular carcinoma (HCC). Three DAAs treatment strategies were compared: (i) a 12-week course of DAAs prior to transplantation (PRE-LT), (ii) a 4-week course of DAAs starting at the time of transplantation (PERI-LT) and (iii) a 12-week course of DAAs administered at disease recurrence (POST-LT). The population was substratified according to HCC presence and, in those without HCC, according to the MELD score at listing. Data on DAAs effectiveness were estimated using a cohort of patients still followed by 11 transplant centres of the European Liver and Intestine Transplant Association and by data available in the literature. In this study, PRE-LT treatment strategy was dominant for DCC patients with MELD<16 and cost-effective for those with MELD16-20, while POST-LT strategy emerged as cost-effective for DCC patients with MELD>20 and for those with HCC. Sensitivity analyses confirmed PRE-LT as the cost-effective strategy for patients with MELD≤20. In conclusion, PRE-LT treatment is cost-effective for patients with MELD≤20 without HCC, while treatments after LT are cost-effective in cirrhotic patients with MELD>20 and in those with HCC. It is worth reminding, though, that the final choice of a specific regimen at the patient level will have to be personalized based on clinical, social and transplant-related factors.
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Affiliation(s)
- P A Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - L S Belli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy.,International Center for Disease Health (ICDH), University of Milan-Bicocca, Monza, Italy
| | - R Facchetti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - C Mazzarelli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - G Perricone
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - S De Nicola
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - G Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - C Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Paris-Est University, Creteil, France
| | - L G Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy.,International Center for Disease Health (ICDH), University of Milan-Bicocca, Monza, Italy
| | - M Strazzabosco
- International Center for Disease Health (ICDH), University of Milan-Bicocca, Monza, Italy.,Department of Internal Medicine, Liver Center, Yale University, New Haven, CT, USA
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Belli LS, Facchetti R, Mazzarelli C, Perricone G, De Nicola S, Cesana G, Duvoux C, Strazzabosco M, Mantovani LG, Cortesi PA. The optimal timing of HCV therapy in liver transplant: cost and effectiveness of new opportunities. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.290] [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: 11/15/2022] Open
Affiliation(s)
- LS Belli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - R Facchetti
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - C Mazzarelli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - G Perricone
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - S De Nicola
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - G Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - C Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Paris-Est University, Creteil, France
| | - M Strazzabosco
- Liver Center, Department of Internal Medicine, Yale University, New Haven, United States
| | - LG Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - PA Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
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Perricone G, Vangeli M, De Nicola S, Airoldi A, Belli LS. Adding embolization to TIPS implantation: A better therapy to control bleeding from ectopic varices? J Hepatol 2017; 67:200-201. [PMID: 28347802 DOI: 10.1016/j.jhep.2017.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Giovanni Perricone
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Marcello Vangeli
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stella De Nicola
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Aldo Airoldi
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luca Saverio Belli
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Viganò R, Mazzarelli C, Alberti AB, Perricone G. Change of liver transplantation list composition: Pre versus post direct-acting antivirals era. The Niguarda Hospital experience. Dig Liver Dis 2017; 49:317. [PMID: 28174002 DOI: 10.1016/j.dld.2017.01.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/10/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Raffaella Viganò
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Mazzarelli
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Giovanni Perricone
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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Belli LS, Berenguer M, Cortesi PA, Strazzabosco M, Rockenschaub SR, Martini S, Morelli C, Donato F, Volpes R, Pageaux GP, Coilly A, Fagiuoli S, Amaddeo G, Perricone G, Vinaixa C, Berlakovich G, Facchetti R, Polak W, Muiesan P, Duvoux C. Delisting of liver transplant candidates with chronic hepatitis C after viral eradication: A European study. J Hepatol 2016; 65:524-31. [PMID: 27212241 DOI: 10.1016/j.jhep.2016.05.010] [Citation(s) in RCA: 230] [Impact Index Per Article: 28.8] [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: 11/16/2015] [Revised: 04/30/2016] [Accepted: 05/04/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS All oral direct acting antivirals (DAA) have been shown to improve the liver function of patients with decompensated cirrhosis but it is presently unknown whether this clinical improvement may lead to the delisting of some patients. The aim of this study was to assess if and which patients can be first inactivated due to clinically improvement and subsequently delisted in a real life setting. METHODS 103 consecutive listed patients without hepatocellular carcinoma were treated with different DAA combinations in 11 European centres between February 2014 and February 2015. RESULTS The cumulative incidence of inactivated and delisted patients by competing risk analysis was 15.5% and 0% at 24weeks, 27.6% and 10.3% at 48weeks, 33.3% and 19.2% at 60weeks. The 34 patients who were inactivated showed a median improvement of 3.4 points for MELD (delta MELD, p<0.0001) and 2 points for Child-Pugh (CP) (delta-CP, p<0.0001). Three variables emerged from the most parsimonious multivariate competing risk model as predictors of inactivation for clinical improvement, namely, baseline MELD classes (MELD 16-20: HR=0.120; p=0.0005, MELD >20:HR=0.042; p<0.0001), delta MELD (HR=1.349; p<0.0001) and delta albumin (HR=0.307; p=0.0069) both assessed after 12weeks of DAA therapy. CONCLUSIONS This study showed that all oral DAAs were able to reverse liver dysfunction and favoured the inactivation and delisting of about one patient out-of-three and one patient out-of-five in 60weeks, respectively. Patients with lower MELD scores had higher chances to be delisted. The longer term benefits of therapy need to be ascertained. LAY SUMMARY The excellent efficacy and safety profile of the new drugs against Hepatitis C virus, "direct acting antivirals" or DAAs, have made antiviral therapy possible also for patients with advanced liver disease and for those on the waiting list for liver transplantation (LT). This study shows for the first time that the DAAs may lead to a remarkable clinical improvement allowing the delisting of one patient out of 5.
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Affiliation(s)
- Luca Saverio Belli
- Department of Gastroenterology and Hepatology, Liver Unit, Niguarda Hospital, Milan, Italy.
| | - Marina Berenguer
- Hepatology & Liver Transplantation Unit, Hospital Universitari I Politècnic La Fe, University of Valencia & Ciberhed, Valencia, Spain
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Mario Strazzabosco
- Digestive Disease Section and International Centre for Digestive Health, School of Medicine and Surgery, University of Milano Bicocca and Yale University Liver Center, Department of Medicine, New Haven, USA
| | | | - Silvia Martini
- LiverTransplantation Center, Gastrohepatology Unit, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Cristina Morelli
- Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesca Donato
- Division of Digestive Diseases, 'Maggiore' University Hospital, Milan, Italy
| | | | - Georges-Philippe Pageaux
- Department of Hepatology, Gastroenterology, and Liver Transplantation, Centre Hospitalier Universitaire (CHU) Saint Eloi, Montpellier, France
| | - Audrey Coilly
- Centre Hepato-Biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, Villejuif, France
| | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giuliana Amaddeo
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est University, Creteil, France
| | - Giovanni Perricone
- Department of Gastroenterology and Hepatology, Liver Unit, Niguarda Hospital, Milan, Italy
| | - Carmen Vinaixa
- Hepatology & Liver Transplantation Unit, Hospital Universitari I Politècnic La Fe, University of Valencia & Ciberhed, Valencia, Spain
| | - Gabriela Berlakovich
- Division of Transplantation, Department of Surgery, University of Vienna, Vienna, Austria
| | - Rita Facchetti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Wojciech Polak
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Paolo Muiesan
- Department of HPB Surgery & Liver Transplantation, University of Birmingham, UK
| | - Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est University, Creteil, France
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Mancuso A, Perricone G. Time to resize the role of everolimus as treatment of hepatocellular carcinoma recurrence after liver transplant. Transpl Int 2015; 28:502-502. [DOI: 10.1111/tri.12477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Andrea Mancuso
- Epatologia e Gastroenterologia; Ospedale Niguarda Ca' Granda; Milano Italy
- Medicina Interna 1; ARNAS Civico - Di Cristina - Benfratelli; Palermo Italy
| | - Giovanni Perricone
- Epatologia e Gastroenterologia; Ospedale Niguarda Ca' Granda; Milano Italy
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Mancuso A, Mazzola A, Cabibbo G, Perricone G, Enea M, Galvano A, Zavaglia C, Belli L, Cammà C. Survival of patients treated with sorafenib for hepatocellular carcinoma recurrence after liver transplantation: a systematic review and meta-analysis. Dig Liver Dis 2015; 47:324-30. [PMID: 25641331 DOI: 10.1016/j.dld.2015.01.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 10/25/2014] [Revised: 12/24/2014] [Accepted: 01/04/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data on survival and safety of sorafenib for hepatocellular carcinoma recurrence after liver transplant are still equivocal. AIM We performed a meta-analysis of published studies, with the aim of estimating the 1-year rates of survival, analysing the variability in survival rates and, finally, identifying the factors associated with a longer survival. METHODS Data from 8 of the 17 selected studies were pooled, while the other 9 were excluded because survival rates were missing. All included studies were retrospective. RESULTS Overall, the 1-year survival ranged from 18% to 90%. Tumour progression was the main cause of death. The second cause was bleeding, reported only in patients undergoing m-Tor inhibitor therapy. The pooled estimate of 1-year survival was 63%. There was a significant heterogeneity among studies (P < 0.0001). Among the 34 variables assessed by univariate meta-regression, 5 were associated with an increase in the 1-year survival rate: (1) male gender (P = 0.001); (2) Time to progression (P = 0.038); and adverse drug events, divided in (3) gastrointestinal (P = 0.038), (4) cardiovascular (P = 0.029), and (5) dermatological (P = 0.014). CONCLUSIONS Additional data from multicentre prospective studies are required to clearly determine if sorafenib is a safe and acceptable treatment in hepatocellular carcinoma recurrence after liver transplant. Nevertheless, its association with m-Tor inhibitors should be discouraged.
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Affiliation(s)
- Andrea Mancuso
- Hepatology and Gastroenterology Department, Ospedale Niguarda Ca' Granda, Milano, Italy; Internal Medicine Department, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico - Di Cristina - Benfratelli, Palermo, Italy
| | - Alessandra Mazzola
- Gastroenterology Unit, Internal Medicine Department, University of Palermo, Palermo, Italy
| | - Giuseppe Cabibbo
- Gastroenterology Unit, Internal Medicine Department, University of Palermo, Palermo, Italy
| | - Giovanni Perricone
- Hepatology and Gastroenterology Department, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Marco Enea
- "S Vianelli" Department, University of Palermo, Italy
| | | | - Claudio Zavaglia
- Hepatology and Gastroenterology Department, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Luca Belli
- Hepatology and Gastroenterology Department, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Calogero Cammà
- Gastroenterology Unit, Internal Medicine Department, University of Palermo, Palermo, Italy.
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Affiliation(s)
- G Perricone
- Hepatology and Gastroenterology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
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Foschi A, Zavaglia CA, Fanti D, Mazzarelli C, Perricone G, Vangeli M, Viganò R, Belli LS. Autoimmunity after liver transplantation: a frequent event but a rare clinical problem. Clin Transplant 2015; 29:161-6. [PMID: 25522890 DOI: 10.1111/ctr.12498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 12/22/2022]
Abstract
Autoantibodies are frequently detected after liver transplantation (LT), but their role is unclear. This study was designed to address three points: autoantibody prevalence pre-LT and over time up to five yr after LT, identification of possible predictors of autoantibody formation, and correlation between autoantibodies and graft dysfunction. To these aims, we retrospectively evaluated 92 consecutive LT recipients for whom prospectively stored frozen sera were available for autoantibodies assessment by immunofluorescence. The overall autoantibody prevalence resulted significantly higher after LT than before LT (64% vs. 27%, p < 0.001 and 35.9% vs. 8.7%, p < 0.001 considering cutoff titer of ≥ 1:80 and ≥ 1:160, respectively). Recipient gender, donor age and gender, and indication for LT and main immunosuppressant (cyclosporine vs. tacrolimus) were not associated with the presence of autoantibodies. Patients with graft dysfunction had a significantly higher autoantibody prevalence irrespective of the etiology of liver injury as compared to those patients with persistently normal liver biochemistry, but only for cutoff titers ≥ 1:160 (p = 0.004). No cases of de novo autoimmune hepatitis were observed. In conclusion, autoantibodies are very frequently detected after LT also at high titers and their association with graft dysfunction likely represents an aspecific indicator of liver injury.
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Affiliation(s)
- Antonella Foschi
- Struttura Complessa di Gastroenterologia ed Epatologia, Ospedale Niguarda Ca' Granda, Milano, Italy
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Affiliation(s)
- G Perricone
- Hepatology and Gastroenterology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
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Mancuso A, Perricone G. Hepatocellular Carcinoma and Liver Transplantation: State of the Art. J Clin Transl Hepatol 2014; 2:176-81. [PMID: 26357625 PMCID: PMC4521243 DOI: 10.14218/jcth.2014.00013] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in chronic liver disease and cirrhosis. The incidence of HCC is growing worldwide. With respect to any other available treatment for liver cancer, liver transplantation (LT) has the highest potential to cure. LT allows for removal at once of both the tumor ("seed") and the damaged-hepatic tissue ("soil") where cancerogenesis and chronic liver disorders have progressed together. The Milan criteria (MC) have been applied worldwide to select patients with HCC for LT, yielding a 4-year survival rate of 75%. These criteria represent the benchmark for patient selection and are the basis for comparison with any other suggested criteria. However, MC are often considered to be too restrictive, and recent data show that between 25% and 50% of patients with HCC are currently transplanted beyond conventional indications. Consequently, any unrestricted expansion of selection criteria will increase the need for donor organs, lengthen waiting periods, increase drop-out rates, and impair outcomes on intention-to-treat analysis. Management of HCC recurrence after LT is challenging. There are a few reports available regarding the safety and efficacy of sorafenib for HCC recurrence after LT, but the data are heterogeneous. A multi-center prospective randomized controlled trial comparing placebo with sorafenib is advised. Alternatively, a meta-analysis of patient survival with sorafenib for HCC recurrence after LT could be helpful to characterize the therapeutic benefit and safety of sorafenib. Here, we review the use of LT for HCC, with particular emphasis on the selection criteria for transplantation in patients with HCC and management of HCC recurrence after LT.
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Affiliation(s)
- Andrea Mancuso
- Epatologia e Gastroenterologia, Ospedale Niguarda Ca' Granda, Milano, Italy
- Medicina Interna 1, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico - Di Cristina – Benfratelli, Palermo, Italy
- Correspondence to: Andrea Mancuso, Medicina Interna 1, A.R.N.A.S. Civico, Piazzale Liotti 4, Palermo 90100, Italy. Tel: +39-329-899-7893, Fax: +39-091-609-0252. E-mail:
| | - Giovanni Perricone
- Epatologia e Gastroenterologia, Ospedale Niguarda Ca' Granda, Milano, Italy
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Affiliation(s)
- Andrea Mancuso
- Epatologia e Gastroenterologia; Ospedale Niguarda Ca' Granda; Milano Italy
- Medicina Interna 1; Azienda di Rilievo Nazionale ad Alta Specializzazione Civico - Di Cristina - Benfratelli; Palermo Italy
| | - Giovanni Perricone
- Epatologia e Gastroenterologia; Ospedale Niguarda Ca' Granda; Milano Italy
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