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Background: As literature largely focuses on long-term outcomes, this study aimed at elucidating the perioperative outcomes of liver transplant patients receiving a graft from two groups of unconventional expanded criteria donors: brain dead aged > 80 years and cardiac dead. Methods: Data of 247 cirrhotic patients transplanted at two high volume liver transplant centers were analysed. Confounders were balanced using a stabilized inverse probability therapy weighting and a propensity score for each patient on the original population was generated. The score was created using a multivariate logistic regression model considering a Comprehensive Complication Index ≥ 42 (no versus yes) as the dependent variable and 11 possible clinically relevant confounders as covariate. Results: Forty-four patients received the graft from a cardiac-dead donor and 203 from a brain-dead donor aged > 80 years. Intraoperatively, cardiac-dead donors liver transplant cases required more fresh frozen plasma units (P < 0.0001) with similar reduced need of fibrinogen to old brain-dead donors cases. The incidence of reperfusion syndrome was similar (P = 0.80). In the Intensive Care Unit, both the groups presented a comparable low need for blood transfusions, renal replacement therapy and inotropes. Cardiac-dead donors liver transplantations required more time to tracheal extubation (P < 0.0001) and scored higher Comprehensive Complication Index (P < 0.0001) however the incidence of a severe complication status (Comprehensive Complication Index ≥ 42) was similar (P = 0.52). ICU stay (P = 0.97), total hospital stay (P = 0.57), in hospital (P = 1.00) and 6 months (P = 1.00) death were similar. Conclusion: Selected octogenarian and cardiac-dead donors can be used safely for liver transplantation.

Background and aims: In patients with hepatocellular carcinoma (HCC), macrovascular invasion (MaVI) limits treatment options and decreases survival. Detailed data on the relationship between MaVI extension and patients' characteristics, and its impact on patients' outcome are limited. We evaluated the prevalence and extension of MaVI in a large cohort of consecutive HCC patients, analysing its association with liver disease and tumour characteristics, as well as with treatments performed and patients' survival. Methods: We analysed data of 4774 patients diagnosed with HCC recorded in the Italian Liver Cancer (ITA.LI.CA) database (2008-2018). Recursive partition analysis (RPA) was performed to evaluate interactions between MaVI, clinical variables and treatment, exploring the inter-relationship determining overall survival. Results: MaVI prevalence was 11.1%, and median survival of these patients was 6.0 months (95% CI, 5.1-7.1). MaVI was associated with younger age at diagnosis, presence of symptoms, worse Performance Status (PS) and liver function, high alphafetoprotein levels and large HCCs. MaVI extension was associated with worse PS, ascites and greater impairment in liver function. RPA identified patients' categories with different treatment indications and survival, ranging from 2.4 months in those with PS > 1 and ascites, regardless of MaVI extension (receiving best supportive care in 90.3% of cases), to 14.1 months in patients with PS 0-1, no ascites and Vp1-Vp2 MaVI (treated with surgery in 19.1% of cases). Conclusions: MaVI presence and extension, together with PS and ascites, significantly affect patients' survival and treatment selection. The decision tree based on these parameters may help assess patients' prognosis and inform therapeutic decisions.

BACKGROUND & AIMS: According to the Barcelona Clinic Liver Cancer (BCLC) staging system, monofocal hepatocellular carcinoma (HCC) is classified as early (BCLC A) irrespective of its size, even though controversies still exist regarding staging and treatment of large tumours. We aimed at evaluating the appropriate staging and treatment for large (>5 cm) monofocal (HCC). METHODS: From the Italian Liver Cancer database, we selected 924 patients with small early monofocal HCC (2-5 cm; SEM-HCC), 163 patients with larger tumours (>5 cm; LEM-HCC) and 1048 intermediate stage patients (BCLC B). RESULTS: LEM-HCC patients had a worse overall survival (OS) than SEM-HCC (31.0 vs 49.0 months; P < .0001), and this was confirmed at multivariate analysis (HR 1.63, 95% CI 1.29-2.05; P < .0001). The small difference in OS between LEM-HCC and BCLC B patients (31.0 vs 27.0 months; P = .03) disappeared in the multivariate model (HR 0.98, 95% CI 0.77-1.25; P = .89). In all monofocal tumours, treatment was the strongest independent predictor of survival, with a progressively decreasing survival benefit moving from "curative" to "palliative" therapies. The survival of resected patients with LEM-HCC was significantly shorter than that of SEM-HCC (44.0 vs 78.0 months; P = .002), but liver resection provided the highest survival benefit in both groups compared to other treatments. CONCLUSIONS: Monofocal HCC larger than 5 cm should not be staged as BCLC A and either a different staging system or a different subgrouping of patients (e.g. BCLC AB) should be used. Liver resection, if feasible, remains the recommended treatment for all these patients.

Purpose: We aimed at assessing the impact of surveillance on long-term survival in HCC patients. Methods: From the ITA.LI.CA database, we selected 1028 cases with long (≥5 years, LS group) and 2721 controls with short-term survival (<5 years, SS group). The association between surveillance and LS was adjusted for confounders by multivariable logistic regression analysis. Survival of surveilled patients was presented both as observed and corrected for the lead-time bias, and the comparison of survival between surveillance and no surveillance groups was also performed after balancing the baseline characteristics with inverse probability weights (IPW). Results: LS patients were more frequently diagnosed under surveillance (p < 0.0001), and had more favorable baseline characteristics. Surveillance was an independent predictor of LS (OR = 1.413, 95% CI 1.195– 1.671; p < 0.0001). The observed and the lead-time corrected survival of surveilled patients were significantly longer compared to the survival of not surveilled patients (p < 0.0001 and p = 0.0008, respectively). In IPW adjusted populations, no survival differences were demonstrated between the two groups (p = 0.30). Conclusions: Surveillance, increasing early-stage diagnosis and applicability of curative treatments, is a fundamental determinant of long-term survival in HCC patients. A wide implementation of surveillance programs should be pursued in order to improve HCC patients’ prognosis.

Introduzione: i disturbi psichiatrici subiscono frequentemente un ritardo nella diagnosi e nel trattamento e le cause che maggiormente influenzano tali variabili rimangono in gran parte sconosciute, non essendovi strumenti specificamente volti a indagare tale fenomeno (1) (2). A tal proposito, il nostro Dipartimento ha recentemente sviluppato un questionario focalizzato sull’esordio e sulla latenza ai trattamenti: il questionario sull’esordio psicopatologico (QEP). Scopo del presente studio è stato analizzare le principali variabili cliniche e socio-demografiche correlate all’esordio psicopatologico e alla latenza al trattamento, confrontandole tra gruppi diagnostici. Metodi: il questionario è stato somministrato a 256 pazienti, affetti da qualsiasi disturbo psichiatrico e suddivisi in: Disturbi dell’Umore (n=135), Disturbi d’Ansia (n=83), Disturbi Psicotici (n=38). Sono state successivamente effettuate analisi statistiche demografiche e di confronto tra gruppi tramite SPSS. Risultati: il campione di pazienti con Disturbi dell’Umore ha mostrato le seguenti variabili: età d’esordio 33.2 anni ±15.8, eventi stressanti precedenti l’esordio nel 67%, latenza alla prima visita>6 mesi nel 41% dei casi. Il campione dei Disturbi d’Ansia ha riportato invece: età d’esordio 29.6 anni ±14.7, eventi stressanti precedenti l’esordio nel 66%, una latenza alla prima visita>6 mesi nel 47%. Infine, i Disturbi Psicotici hanno mostrato: esordio 29.5 anni±12.9, eventi stressanti precedenti l’esordio nel 54, latenza alla prima visita>6 mesi nel 48% dei casi. Sono emerse differenze significative tra gruppi, in termini di motivazione alla prima visita: più della metà dei pazienti con Disturbi dell’umore (55%) e la maggior parte dei pazienti con Disturbi Psicotici (72%) sono stati inviati su consiglio dei familiari, percentuale ridotta al 39% nei pazienti con Disturbi d’Ansia, nei quali, invece, sembrerebbe prevalere una decisione autonoma. In tutti i gruppi, la familiarità psichiatrica

Introduzione: i disturbi psichiatrici subiscono frequentemente un ritardo nella diagnosi e nel trattamento e le cause che maggiormente influenzano tali variabili rimangono in gran parte sconosciute, non essendovi strumenti specificamente volti a indagare tale fenomeno (1) (2). A tal proposito, il nostro Dipartimento ha recentemente sviluppato un questionario focalizzato sull’esordio e sulla latenza ai trattamenti: il questionario sull’esordio psicopatologico (QEP). Scopo del presente studio è stato analizzare le principali variabili cliniche e socio-demografiche correlate all’esordio psicopatologico e alla latenza al trattamento, confrontandole tra gruppi diagnostici. Metodi: il questionario è stato somministrato a 256 pazienti, affetti da qualsiasi disturbo psichiatrico e suddivisi in: Disturbi dell’Umore (n=135), Disturbi d’Ansia (n=83), Disturbi Psicotici (n=38). Sono state successivamente effettuate analisi statistiche demografiche e di confronto tra gruppi tramite SPSS. Risultati: il campione di pazienti con Disturbi dell’Umore ha mostrato le seguenti variabili: età d’esordio 33.2 anni ±15.8, eventi stressanti precedenti l’esordio nel 67%, latenza alla prima visita>6 mesi nel 41% dei casi. Il campione dei Disturbi d’Ansia ha riportato invece: età d’esordio 29.6 anni ±14.7, eventi stressanti precedenti l’esordio nel 66%, una latenza alla prima visita>6 mesi nel 47%. Infine, i Disturbi Psicotici hanno mostrato: esordio 29.5 anni±12.9, eventi stressanti precedenti l’esordio nel 54, latenza alla prima visita>6 mesi nel 48% dei casi. Sono emerse differenze significative tra gruppi, in termini di motivazione alla prima visita: più della metà dei pazienti con Disturbi dell’umore (55%) e la maggior parte dei pazienti con Disturbi Psicotici (72%) sono stati inviati su consiglio dei familiari, percentuale ridotta al 39% nei pazienti con Disturbi d’Ansia, nei quali, invece, sembrerebbe prevalere una decisione autonoma. In tutti i gruppi, la familiarità psichiatrica