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1. Temporal trends of waitlistings for liver transplantation in Italy: The ECALITA (Evolution of IndiCAtion in LIver transplantation in ITAly) registry study

Author

Manzia, T, Trapani, S, Nardi, A, Ricci, A, Lenci, I, Milana, M, Angelico, R, De Feo, T, Agnes, S, Andorno, E, Baccarani, U, Carraro, A, Cescon, M, Cillo, U, Colledan, M, De Carlis, L, De Simone, P, Di Benedetto, F, Ettorre, G, Gruttadauria, S, Lupo, L, Mazzaferro, V, Romagnoli, R, Rossi, G, Rossi, M, Spada, M, Vennarecci, G, Vivarelli, M, Zamboni, F, Tisone, G, Cardillo, M, Angelico, M, Manzia T. M., Trapani S., Nardi A., Ricci A., Lenci I., Milana M., Angelico R., De Feo T. M., Agnes S., Andorno E., Baccarani U., Carraro A., Cescon M., Cillo U., Colledan M., De Carlis L., De Simone P., Di Benedetto F., Ettorre G. M., Gruttadauria S., Lupo L. G., Mazzaferro V., Romagnoli R., Rossi G., Rossi M., Spada M., Vennarecci G., Vivarelli M., Zamboni F., Tisone G., Cardillo M., Angelico M., Manzia, T, Trapani, S, Nardi, A, Ricci, A, Lenci, I, Milana, M, Angelico, R, De Feo, T, Agnes, S, Andorno, E, Baccarani, U, Carraro, A, Cescon, M, Cillo, U, Colledan, M, De Carlis, L, De Simone, P, Di Benedetto, F, Ettorre, G, Gruttadauria, S, Lupo, L, Mazzaferro, V, Romagnoli, R, Rossi, G, Rossi, M, Spada, M, Vennarecci, G, Vivarelli, M, Zamboni, F, Tisone, G, Cardillo, M, Angelico, M, Manzia T. M., Trapani S., Nardi A., Ricci A., Lenci I., Milana M., Angelico R., De Feo T. M., Agnes S., Andorno E., Baccarani U., Carraro A., Cescon M., Cillo U., Colledan M., De Carlis L., De Simone P., Di Benedetto F., Ettorre G. M., Gruttadauria S., Lupo L. G., Mazzaferro V., Romagnoli R., Rossi G., Rossi M., Spada M., Vennarecci G., Vivarelli M., Zamboni F., Tisone G., Cardillo M., and Angelico M.

Abstract

Background: Over the last decades relevant epidemiological changes of liver diseases have occurred, together with greatly improved treatment opportunities. Aim: To investigate how the indications for elective adult liver transplantation and the underlying disease etiologies have evolved in Italy. Methods: We recruited from the National Transplant Registry a cohort comprising 17,317 adults patients waitlisted for primary liver transplantation from January-2004 to December-2020. Patients were divided into three Eras:1(2004–2011),2(2012–2014) and 3(2015–2020). Results: Waitlistings for cirrhosis decreased from 65.9% in Era 1 to 46.1% in Era 3, while those for HCC increased from 28.7% to 48.7%. Comparing Eras 1 and 3, waitlistings for HCV-related cirrhosis decreased from 35.9% to 12.1%, yet those for HCV-related HCC increased from 8.5% to 26.7%. Waitlistings for HBV-related cirrhosis remained almost unchanged (13.2% and 12.4%), while those for HBV-related HCC increased from 4.0% to 11.6%. ALD-related cirrhosis decreased from 16.9% to 12.9% while ALD-related HCC increased from 1.9% to 3.9%. Conclusions: A sharp increase in liver transplant waitlisting for HCC and a concomitant decrease of waitlisting for cirrhosis have occurred In Italy. Despite HCV infection has noticeably decreased, still remains the primary etiology of waitlisting for HCC, while ALD and HBV represent the main causes for cirrhosis.

Published
2022

2. Diagnostic approach to neonatal and infantile cholestasis: A position paper by the SIGENP liver disease working group

Author

Ranucci, G, Della Corte, C, Alberti, D, Bondioni, M, Boroni, G, Calvo, P, Cananzi, M, Candusso, M, Clemente, M, D'Antiga, L, Degrassi, I, De Ville De Goyet, J, Di Dato, F, Di Giorgio, A, Vici, C, Ferrari, F, Francalanci, P, Fuoti, M, Fusaro, F, Gaio, P, Grimaldi, C, Iascone, M, Indolfi, G, Iorio, R, Maggiore, G, Mandato, C, Matarazzo, L, Monti, L, Mosca, F, Nebbia, G, Nuti, F, Paolella, G, Pinon, M, Roggero, P, Sciveres, M, Serranti, D, Spada, M, Vajro, P, Nicastro, E, Ranucci G., Della Corte C., Alberti D., Bondioni M. P., Boroni G., Calvo P. L., Cananzi M., Candusso M., Clemente M. G., D'Antiga L., Degrassi I., De Ville De Goyet J., Di Dato F., Di Giorgio A., Vici C. D., Ferrari F., Francalanci P., Fuoti M., Fusaro F., Gaio P., Grimaldi C., Iascone M., Indolfi G., Iorio R., Maggiore G., Mandato C., Matarazzo L., Monti L., Mosca F., Nebbia G., Nuti F., Paolella G., Pinon M., Roggero P., Sciveres M., Serranti D., Spada M., Vajro P., Nicastro E., Ranucci, G, Della Corte, C, Alberti, D, Bondioni, M, Boroni, G, Calvo, P, Cananzi, M, Candusso, M, Clemente, M, D'Antiga, L, Degrassi, I, De Ville De Goyet, J, Di Dato, F, Di Giorgio, A, Vici, C, Ferrari, F, Francalanci, P, Fuoti, M, Fusaro, F, Gaio, P, Grimaldi, C, Iascone, M, Indolfi, G, Iorio, R, Maggiore, G, Mandato, C, Matarazzo, L, Monti, L, Mosca, F, Nebbia, G, Nuti, F, Paolella, G, Pinon, M, Roggero, P, Sciveres, M, Serranti, D, Spada, M, Vajro, P, Nicastro, E, Ranucci G., Della Corte C., Alberti D., Bondioni M. P., Boroni G., Calvo P. L., Cananzi M., Candusso M., Clemente M. G., D'Antiga L., Degrassi I., De Ville De Goyet J., Di Dato F., Di Giorgio A., Vici C. D., Ferrari F., Francalanci P., Fuoti M., Fusaro F., Gaio P., Grimaldi C., Iascone M., Indolfi G., Iorio R., Maggiore G., Mandato C., Matarazzo L., Monti L., Mosca F., Nebbia G., Nuti F., Paolella G., Pinon M., Roggero P., Sciveres M., Serranti D., Spada M., Vajro P., and Nicastro E.

Abstract

Neonatal and infantile cholestasis (NIC) can represent the onset of a surgically correctable disease and of a genetic or metabolic disorder worthy of medical treatment. Timely recognition of NIC and identification of the underlying etiology are paramount to improve outcomes. Upon invitation by the Italian National Institute of Health (ISS), an expert working grouped was formed to formulate evidence-based positions on current knowledge about the diagnosis of NIC. A systematic literature search was conducted to collect evidence about epidemiology, etiology, clinical aspects and accuracy of available diagnostic tests in NIC. Evidence was scored using the GRADE system. All recommendations were approved by a panel of experts upon agreement of at least 75% of the members. The final document was approved by all the panel components. This position document summarizes the collected statements and defines the best-evidence diagnostic approach to cholestasis in the first year of life.

Published
2022

3. Surviving COVID-19 in Bergamo province: a post-acute outpatient re-evaluation

Author

Venturelli, S, Benatti, S, Casati, M, Binda, F, Zuglian, G, Imeri, G, Conti, C, Biffi, A, Spada, M, Bondi, E, Camera, G, Severgnini, R, Giammarresi, A, Marinaro, C, Rossini, A, Bonaffini, P, Guerra, G, Bellasi, A, Cesa, S, Rizzi, M, Venturelli, Serena, Benatti, Simone Vasilij, Casati, Monica, Binda, Francesca, Zuglian, Gianluca, Imeri, Gianluca, Conti, Caterina, Biffi, Ave Maria, Spada, Maria Simonetta, Bondi, Emi, Camera, Giorgia, Severgnini, Roberta, Giammarresi, Andrea, Marinaro, Claudia, Rossini, Alessandro, Bonaffini, Pietro Andrea, Guerra, Giovanni, Bellasi, Antonio, Cesa, Simonetta, Rizzi, Marco, Venturelli, S, Benatti, S, Casati, M, Binda, F, Zuglian, G, Imeri, G, Conti, C, Biffi, A, Spada, M, Bondi, E, Camera, G, Severgnini, R, Giammarresi, A, Marinaro, C, Rossini, A, Bonaffini, P, Guerra, G, Bellasi, A, Cesa, S, Rizzi, M, Venturelli, Serena, Benatti, Simone Vasilij, Casati, Monica, Binda, Francesca, Zuglian, Gianluca, Imeri, Gianluca, Conti, Caterina, Biffi, Ave Maria, Spada, Maria Simonetta, Bondi, Emi, Camera, Giorgia, Severgnini, Roberta, Giammarresi, Andrea, Marinaro, Claudia, Rossini, Alessandro, Bonaffini, Pietro Andrea, Guerra, Giovanni, Bellasi, Antonio, Cesa, Simonetta, and Rizzi, Marco

Abstract

Bergamo province was badly hit by the coronavirus disease 2019 (COVID-19) epidemic. We organised a public-funded, multidisciplinary follow-up programme for COVID-19 patients discharged from the emergency department or from the inpatient wards of 'Papa Giovanni XXIII' Hospital, the largest public hospital in the area. As of 31 July, the first 767 patients had completed the first post-discharge multidisciplinary assessment. Patients entered our programme at a median time of 81 days after discharge. Among them, 51.4% still complained of symptoms, most commonly fatigue and exertional dyspnoea, and 30.5% were still experiencing post-traumatic psychological consequences. Impaired lung diffusion was found in 19%. Seventeen per cent had D-dimer values two times above the threshold for diagnosis of pulmonary embolism (two unexpected and clinically silent pulmonary thrombosis were discovered by investigating striking D-dimer elevation). Survivors of COVID-19 exhibit a complex array of symptoms, whose common underlying pathology, if any, has still to be elucidated: a multidisciplinary approach is fundamental, to address the different problems and to look for effective solutions.

Published
2021

4. The Role of Emotional Competence in Takotsubo Cardiomyopathy

Author

Compare, A, Brugnera, A, Spada, M, Zarbo, C, Tasca, G, Sassaroli, S, Caselli, G, Ruggiero, G, Wittstein, I, Compare, Angelo, Brugnera, Agostino, Spada, Marcantonio M., Zarbo, Cristina, Tasca, Giorgio A., Sassaroli, Sandra, Caselli, Gabriele, Ruggiero, Giovanni Maria, Wittstein, Ilan, Compare, A, Brugnera, A, Spada, M, Zarbo, C, Tasca, G, Sassaroli, S, Caselli, G, Ruggiero, G, Wittstein, I, Compare, Angelo, Brugnera, Agostino, Spada, Marcantonio M., Zarbo, Cristina, Tasca, Giorgio A., Sassaroli, Sandra, Caselli, Gabriele, Ruggiero, Giovanni Maria, and Wittstein, Ilan

Abstract

Objective The current study examined the role of emotional competences and depression in takotsubo cardiomyopathy (TTC). Methods We compared 37 TTC patients who experienced emotion triggers (TTC-t: M (SD) age = 66.4 (12.8) years, 33 women) with 37 TTC patients who did not experience emotion triggers (TTC-nt: M (SD) age = 65.8 (11.1) years, 33 women) and 37 patients with acute myocardial infarction who experienced an emotion trigger (AMI-t: M (SD) age = 66.1 (10.1) years, 33 women). Three aspects of emotional competence (emotional intelligence, metacognitive beliefs, and emotional processing deficits) were assessed using the Trait Meta-Mood Scale (TMMS), the Meta-Cognitions Questionnaire 30, and the Emotional Processing Scale. Differences between-group means were evaluated using multivariate analysis of covariance, adjusting for depressive symptom (Hamilton Rating Scale for Depression). Results Compared with the TTC-nt and AMI-t comparison groups, TTC-t patients had low scores on emotional intelligence (TMMS Attention: F(2, 184) = 23.10, p <.001; TMMS Repair: F(2, 184) = 11.98, p <.001) and high scores in metacognitive beliefs and emotional processing deficits (e.g., Meta-Cognitions Questionnaire 30 Negative Beliefs about Thoughts: F(2, 184) = 56.93, p <.001), independent of the levels of depressive symptom. TTC-nt patients also had significantly lower scores on the Hamilton Rating Scale for Depression scale compared with AMI-t (p =.021) and TTC-t (p =.004) patients. Conclusions TTC-t patients showed a specific dysfunctional profile of emotional competence, even after adjusting for depressive symptom. These results provided a better understanding of the psychological factors that contribute to TTC.

Published
2018

5. A Multistep, Consensus-Based Approach to Organ Allocation in Liver Transplantation: Toward a 'blended Principle Model'

Author

Cillo, U, Burra, P, Mazzaferro, V, Belli, L, Pinna, A, Spada, M, Nanni Costa, A, Toniutto, P, Avolio, A, Cescon, M, Regalia, E, Romagnoli, R, Santaniello, W, Rossi, M, Corno, V, Caraceni, P, Coco, B, Fraquelli, M, Rendina, M, Angelico, M, Fagiuoli, S, Bruno, R, Costa, A, De Feo, T, Ridolfi, L, Pretagostini, R, Amoroso, A, Biancofiore, G, De Gasperi, A, Della Rocca, G, Feltracco, P, Colli, A, Sacchini, D, Pegoraro, R, Gardini, I, Cillo U., Burra P., Mazzaferro V., Belli L., Pinna A. D., Spada M., Nanni Costa A., Toniutto P., Avolio A., Cescon M., Regalia E., Romagnoli R., Santaniello W., Rossi M., Corno V., Caraceni P., Coco B., Fraquelli M., Rendina M., Angelico M., Fagiuoli S., Bruno R., Costa A. N., De Feo T., Ridolfi L., Pretagostini R., Amoroso A., Biancofiore G., De Gasperi A., Della Rocca G., Feltracco P., Colli A., Sacchini D., Pegoraro R., Gardini I., Cillo, U, Burra, P, Mazzaferro, V, Belli, L, Pinna, A, Spada, M, Nanni Costa, A, Toniutto, P, Avolio, A, Cescon, M, Regalia, E, Romagnoli, R, Santaniello, W, Rossi, M, Corno, V, Caraceni, P, Coco, B, Fraquelli, M, Rendina, M, Angelico, M, Fagiuoli, S, Bruno, R, Costa, A, De Feo, T, Ridolfi, L, Pretagostini, R, Amoroso, A, Biancofiore, G, De Gasperi, A, Della Rocca, G, Feltracco, P, Colli, A, Sacchini, D, Pegoraro, R, Gardini, I, Cillo U., Burra P., Mazzaferro V., Belli L., Pinna A. D., Spada M., Nanni Costa A., Toniutto P., Avolio A., Cescon M., Regalia E., Romagnoli R., Santaniello W., Rossi M., Corno V., Caraceni P., Coco B., Fraquelli M., Rendina M., Angelico M., Fagiuoli S., Bruno R., Costa A. N., De Feo T., Ridolfi L., Pretagostini R., Amoroso A., Biancofiore G., De Gasperi A., Della Rocca G., Feltracco P., Colli A., Sacchini D., Pegoraro R., and Gardini I.

Abstract

Since Italian liver allocation policy was last revised (in 2012), relevant critical issues and conceptual advances have emerged, calling for significant improvements. We report the results of a national consensus conference process, promoted by the Italian College of Liver Transplant Surgeons (for the Italian Society for Organ Transplantation) and the Italian Association for the Study of the Liver, to review the best indicators for orienting organ allocation policies based on principles of urgency, utility, and transplant benefit in the light of current scientific evidence. MELD exceptions and hepatocellular carcinoma were analyzed to construct a transplantation priority algorithm, given the inequity of a purely MELD-based system for governing organ allocation. Working groups of transplant surgeons and hepatologists prepared a list of statements for each topic, scoring their quality of evidence and strength of recommendation using the Centers for Disease Control grading system. A jury of Italian transplant surgeons, hepatologists, intensivists, infectious disease specialists, epidemiologists, representatives of patients' associations and organ-sharing organizations, transplant coordinators, and ethicists voted on and validated the proposed statements. After carefully reviewing the statements, a critical proposal for revising Italy's current liver allocation policy was prepared jointly by transplant surgeons and hepatologists.

Published
2015

6. A Multicenter Italian Experience in Split-Liver Transplantation: 10 Year Follow-Up of a Case Control Study

Author

Spada, M, Pagano, D, Colledan, M, Cescon, M, Rossi, G, Baccarani, U, Tisone, G, Adorno, E, De Carlis, L, Cillo, U, Mazzaferro, V, Rossi, M, Gruttadauria, S, Gridelli, B, Spada M, Pagano D, Colledan M, Cescon M, Rossi G, Baccarani U, Tisone G, Adorno E, De Carlis L, Cillo U, Mazzaferro V, Rossi M, Gruttadauria S, Gridelli BG, Spada, M, Pagano, D, Colledan, M, Cescon, M, Rossi, G, Baccarani, U, Tisone, G, Adorno, E, De Carlis, L, Cillo, U, Mazzaferro, V, Rossi, M, Gruttadauria, S, Gridelli, B, Spada M, Pagano D, Colledan M, Cescon M, Rossi G, Baccarani U, Tisone G, Adorno E, De Carlis L, Cillo U, Mazzaferro V, Rossi M, Gruttadauria S, and Gridelli BG

Published
2010

8. Feasibility and limits of split liver transplantation from pediatric donors - An Italian multicenter experience

Author

Cescon, M, Spada, M, Colledan, M, Torre, G, Andorno, E, Valente, U, Rossi, G, Reggiani, P, Cillo, U, Baccarani, U, Grazi, G, Tisone, G, Filipponi, F, Rossi, M, Ettorre, G, Salizzoni, M, Cuomo, O, De Feo, T, Gridelli, B, Cescon M, Spada M, Colledan M, Torre G, Andorno E, Valente U, Rossi G, Reggiani P, Cillo U, Baccarani U, Grazi GL, Tisone G, Filipponi F, Rossi M, Ettorre GM, Salizzoni M, Cuomo O, De Feo T, Gridelli B, Cescon, M, Spada, M, Colledan, M, Torre, G, Andorno, E, Valente, U, Rossi, G, Reggiani, P, Cillo, U, Baccarani, U, Grazi, G, Tisone, G, Filipponi, F, Rossi, M, Ettorre, G, Salizzoni, M, Cuomo, O, De Feo, T, Gridelli, B, Cescon M, Spada M, Colledan M, Torre G, Andorno E, Valente U, Rossi G, Reggiani P, Cillo U, Baccarani U, Grazi GL, Tisone G, Filipponi F, Rossi M, Ettorre GM, Salizzoni M, Cuomo O, De Feo T, and Gridelli B

Abstract

Objective: To report the results of a multicenter experience of split liver transplantation (SLT) with pediatric donors.Summary Background Data: There are no reports in the literature regarding pediatric liver splitting; further; the use of donors weighing <40 kg for SLT is currently not recommended.Methods: From 1997 to 2004, 43 conventional split liver procedures from donors aged < 15 years were performed. Nineteen donors weighing <= 40 kg and 24 weighing >40 kg were used. Dimensional matching was based on donor-to-recipient weight ratio (DRWR) for left lateral segment (LLS) and on estimated graft-to-recipient weight ratio (eGRWR) for extended right grafts (ERG). In 3 cases, no recipient was found for an ERG. The celiac trunk was retained with the LLS in all but 1 case. Forty LLSs were transplanted into 39 children, while 39 ERGs were transplanted into 11 children and 28 adults.Results: Two-year patient and graft survival rates were not significantly different between recipients of donors <= 40 kg and >40 kg, between pediatric and adult recipients, and between recipients of LLSs and ERGs. Vascular complication rates were 12% in the <= 40 kg donor group and 6% in the >40 kg donor group (P = not significant). There were no differences in the incidence of other complications. Donor ICU stay >3 days and the use of an interposition arterial graft were associated with an increased risk of graft loss and arterial complications, respectively.Conclusions: Splitting of pediatric liver grafts is an effective strategy to increase organ availability, but a cautious evaluation of the use of donors <= 40 kg is necessary. Prolonged donor ICU stay is associated with poorer outcomes. The maintenance of the celiac trunk with LLS does not seem detrimental for right-sided grafts, whereas the use of interposition grafts for arterial reconstruction should be avoided.

Published
2006

9. Specific autologous cytotoxic T lymphocytes for chronic varicella in a liver transplanted child

Author

Melzi, M, Sonzogni, A, Comoli, P, Stroppa, P, Riva, S, Altobelli, M, Casati, A, Torre, G, Alberti, D, Guizzetti, M, Furione, M, Spada, M, Colledan, M, Gridelli, B, Melzi ML, Sonzogni A, Comoli P, Stroppa P, Riva S, Altobelli M, Casati A, Torre G, Alberti D, Guizzetti M, Furione M, Spada M, Colledan M, Gridelli B, Melzi, M, Sonzogni, A, Comoli, P, Stroppa, P, Riva, S, Altobelli, M, Casati, A, Torre, G, Alberti, D, Guizzetti, M, Furione, M, Spada, M, Colledan, M, Gridelli, B, Melzi ML, Sonzogni A, Comoli P, Stroppa P, Riva S, Altobelli M, Casati A, Torre G, Alberti D, Guizzetti M, Furione M, Spada M, Colledan M, and Gridelli B

Abstract

Infections by herpesviruses may have severe complications in liver transplant patients. Although prophylactic varicella zoster virus vaccination is strongly recommended and widely applied, severe infection may still occur. We report the case of systemic chronic varicella, which developed in a liver allograft recipient, unresponsive to antiviral drug treatment, successfully treated by varicella zooster-specific CTL. Graft failure ensued, likely, because of massive cytolysis of infected hepatocytes. The patient, who was re-transplanted in the absence of signs of varicella zooster reactivation, is now well and disease free 3 yr after second liver transplant.

Published
2006

10. Late graft dysfunction and autoantibodies after liver transplantation in children: Preliminary results of an Italian experience

Author

Riva, S, Sonzogni, A, Bravi, M, Bertani, A, Alessio, M, Candusso, M, Stroppa, P, Melzi, M, Spada, M, Gridelli, B, Colledan, M, Torre, G, Riva S, Sonzogni A, Bravi M, Bertani A, Alessio MG, Candusso M, Stroppa P, Melzi ML, Spada M, Gridelli B, Colledan M, Torre G, Riva, S, Sonzogni, A, Bravi, M, Bertani, A, Alessio, M, Candusso, M, Stroppa, P, Melzi, M, Spada, M, Gridelli, B, Colledan, M, Torre, G, Riva S, Sonzogni A, Bravi M, Bertani A, Alessio MG, Candusso M, Stroppa P, Melzi ML, Spada M, Gridelli B, Colledan M, and Torre G

Abstract

Late graft dysfunction (GD) associated with the development of autoantibodies is a common event after pediatric liver transplantation (OLTx) and can present in 2 clinicohistological subsets: de novo autoimmune hepatitis (DNAH) and early chronic rejection (ECR). Sixty out of 247 children developed autoantibodies after OLTx. GD was demonstrated in 22 (37%); based on histology, patients were divided in a DNAH and an ECR group. Portal/periportal inflammatory infiltrate with interface/lobular hepatitis was suggestive for DNAH. Pericentral hepatocytes; confluent dropout with a variable degree of central vein endothelitis, but not with ductopenia (loss of >50% of interlobular bile ducts), was diagnosed as ECR. Nine patients had DNAH and 13 ECR. Five out of 9 in the DNAH group were on cyclosporin (CsA) and 4/9 were on tacrolimus (Tac). In the ECR group, 11 children were treated with CsA and 2 with Tac. All DNAH patients had normal liver function tests on steroids and azathioprine (AZA). Five patients with ECR recovered by increasing calcineurin inhibitors (CNIs) dosage, but in 8/13, including 7 switched from CsA to Tac, AZA and steroids were added to obtain remission of disease. Two patients developed late chronic rejection. DNAH and ECR associated with autoantibodies are forms of late GD after OLTx. DNAH improves after standard treatment of autoimmune hepatitis. ECR has a good response to increased doses of CNIs, although ductopenic chronic rejection may occur. In conclusion, the early differential diagnosis of these conditions and an appropriate treatment seem to allow good overall results reflected by a graft survival of more than 90%.

Published
2006

11. Randomized trial of basiliximab induction versus steroid therapy in pediatric liver allograft recipients under tacrolimus immunosuppression

Author

Spada, M, Petz, W, Bertani, A, Riva, S, Sonzogni, A, Giovannelli, M, Torri, E, Torre, G, Colledan, M, Gridelli, B, Spada M, Petz W, Bertani A, Riva S, Sonzogni A, Giovannelli M, Torri E, Torre G, Colledan M, Gridelli B, Spada, M, Petz, W, Bertani, A, Riva, S, Sonzogni, A, Giovannelli, M, Torri, E, Torre, G, Colledan, M, Gridelli, B, Spada M, Petz W, Bertani A, Riva S, Sonzogni A, Giovannelli M, Torri E, Torre G, Colledan M, and Gridelli B

Abstract

Avoidance of corticosteroids could be beneficial after pediatric liver transplantation (LTx). To test this hypothesis, we performed a randomized prospective study to compare immunosuppression with tacrolimus (TAC) and steroids versus TAC and basiliximab (BAS) after pediatric LTx. Seventy-two patients were recruited, 36 receiving TAC and steroids and 36 TAC and BAS. The primary endpoint was the occurrence of the first rejection episode. Secondary endpoints were the cumulative incidence and severity of rejection, patient and graft survival, and incidence of adverse events. Overall 1-year patient and graft survival rates were 91.4% and 85.5% in the steroid group, and 88.6% and 80% in the BAS group (p = NS). Patients free from rejection were 87.7% in the BAS group and 67.7% in the steroid group (p = 0.036). The use of BAS was associated with a 63.6% reduction in incidence of acute rejection episodes. Overall incidence of infection was 72.3% in the steroid group and 50% in the BAS group (p = 0.035). We conclude that the combination of TAC with BAS is an alternative to TAC and steroid immunosuppression in pediatric LTx, which allows for a significant reduction in the incidence of acute rejection and infectious complications.

Published
2006

12. Can donor selection criteria for split liver transplantation he safely expanded? A multicenter, multivariate analysis

Author

Spada, M, Cescon, N, Colledan, M, Andorno, E, Valente, U, De Carlis, L, Abdallah, S, Reggiani, P, Rossi, G, Zanus, G, Cillo, U, Baccarani, U, Gerunda, G, Mazzaferro, V, Grazi, G, Tisone, G, Rossi, R, Ettorre, G, Calise, F, De Feo, T, Gridelli, B, Spada M, Cescon N, Colledan M, Andorno E, Valente U, De Carlis L, Abdallah S, Reggiani P, Rossi G, Zanus G, Cillo U, Baccarani U, Gerunda GE, Mazzaferro V, Grazi GL, Tisone G, Rossi R, Ettorre GM, Calise F, De Feo T, Gridelli B, Spada, M, Cescon, N, Colledan, M, Andorno, E, Valente, U, De Carlis, L, Abdallah, S, Reggiani, P, Rossi, G, Zanus, G, Cillo, U, Baccarani, U, Gerunda, G, Mazzaferro, V, Grazi, G, Tisone, G, Rossi, R, Ettorre, G, Calise, F, De Feo, T, Gridelli, B, Spada M, Cescon N, Colledan M, Andorno E, Valente U, De Carlis L, Abdallah S, Reggiani P, Rossi G, Zanus G, Cillo U, Baccarani U, Gerunda GE, Mazzaferro V, Grazi GL, Tisone G, Rossi R, Ettorre GM, Calise F, De Feo T, and Gridelli B

Published
2006

13. Liver transplantation in children weighting less than 6 kg: The Bergamo experience

Author

Lucianetti, A, Guizzetti, M, Bertani, A, Corno, V, Maldini, G, Pinelli, D, Aluffi, A, Codazzi, D, Spotti, A, Spada, M, Gridelli, B, Torre, G, Colledan, M, Lucianetti A, Guizzetti M, Bertani A, Corno V, Maldini G, Pinelli D, Aluffi A, Codazzi D, Spotti A, Spada M, Gridelli B, Torre G, Colledan M, Lucianetti, A, Guizzetti, M, Bertani, A, Corno, V, Maldini, G, Pinelli, D, Aluffi, A, Codazzi, D, Spotti, A, Spada, M, Gridelli, B, Torre, G, Colledan, M, Lucianetti A, Guizzetti M, Bertani A, Corno V, Maldini G, Pinelli D, Aluffi A, Codazzi D, Spotti A, Spada M, Gridelli B, Torre G, and Colledan M

Abstract

Liver transpantation (OLT) remains a major medical and surgical challenge in small patients. From October 1997 through July 2004, 17 babies less than 6 kg underwent 18 OLTs. Median age and weight were 3 months (range = 1 to 9) and 4.7 kg (range = 2.2 to 5.8). Two whole, one reduced, and 15 split-liver grafts (left lateral segments) were obtained from donors of median age and weight of 11.6 years (range = 0.5 to 62) and 50 kg (range = 7 to 63). Donor-to-recipient median weight ratio (D/R) was 9.1 kg (range = 1.3 to 17.6) and median graft-to-recipient weight ratio (GRWR) was 5% (range = 3.1 to 10). The incidence of biliary complications was 23%. The only vascular complication was a portal vein thrombosis (6%). Fourteen patients (79%) are alive with good graft function at a median follow-up of 39 months (range = 0.5 to 74). Three patients (all status 1) died on postoperative day 285 (brain death), 17 (multiorgan failure), and 229 (cardiovascular failure during retransplantation). Actuarial patient survivals at 6 months and 6 years are 94% and 78% while graft survivals are 89% and 74%, respectively. Currently all the patients listed as UNOS status 2 and 3 (73%) at the time of transplant are alive. During the same period one premature neonate (1.8 kg) who presented with fulminant hepatic failure died on the waiting list after 12 days. Our data confirm that the extensive use of a split-liver technique from small adult or pediatric cadaveric donors can offer the benefits of liver transplantation to small pediatric candidates with excellent results.

Published
2005

14. Orthotopic liver transplantation for biliary atresia

Author

Colledan, M, Torri, E, Bertani, A, Corno, V, Guizzetti, M, Lucianetti, A, Maldini, G, Pinelli, D, Zambelli, M, Giovanelli, M, Carrara, B, Riva, S, Alberti, D, Passoni, M, Spada, M, Gridelli, B, Torre, G, Colledan M, Torri E, Bertani A, Corno V, Guizzetti M, Lucianetti A, Maldini G, Pinelli D, Zambelli M, Giovanelli M, Carrara B, Riva S, Alberti D, Passoni M, Spada M, Gridelli B, Torre G, Colledan, M, Torri, E, Bertani, A, Corno, V, Guizzetti, M, Lucianetti, A, Maldini, G, Pinelli, D, Zambelli, M, Giovanelli, M, Carrara, B, Riva, S, Alberti, D, Passoni, M, Spada, M, Gridelli, B, Torre, G, Colledan M, Torri E, Bertani A, Corno V, Guizzetti M, Lucianetti A, Maldini G, Pinelli D, Zambelli M, Giovanelli M, Carrara B, Riva S, Alberti D, Passoni M, Spada M, Gridelli B, and Torre G

Abstract

Biliary atresia (BA) represents the most frequent indication for liver transplantation (OLTX) in the pediatric population. The aim of this paper was to present a series collected over the last 7 years from October 1997 through July 2004, including 260 pediatric OLTX in 231 patients. BA was the indication in 137 patients. There were 69 boys and 68 girls of mean weight 10.68 kg and median age 0.9 years. As a primary transplant, 99 patients received a LLS graft; 27 a whole graft; four a I+IV-VIII segment, and two a I-IV segment. Mean follow up was 1047 days (range, 1-2496 day). Infections were diagnosed in 45 patients, vascular complications in 27 patients. Surgical complications that required reintervention occurred in 25 patients. In 41 cases biliary complications occurred, 11 requiring reintervention. 16 patients were retransplanted. In two cases another re-OLTx was performed. Currently 126 patients are alive, showing an actuarial 1 year survival of 92% and 5 year 91%, with actuarial graft survivals of 85% at 1 year and 82% at 3 and 5 years. Our results confirm the effectiveness of OLTx for the treatment of children with BA and a failed Kasai procedure. Split liver grafts represent an excellent organ supply for these patients, achieving optimal results with no mortality on the waiting list.

Published
2005

15. Orthotopic liver transplantation for Alagille syndrome

Author

Maldini, G, Torri, E, Lucianetti, A, Guizzetti, M, Pinelli, D, Bertani, A, Corno, V, Giovanelli, M, Zambelli, M, Stroppa, P, Alberti, D, Torre, G, Spada, M, Gridelli, B, Colledan, M, Maldini G, Torri E, Lucianetti A, Guizzetti M, Pinelli D, Bertani A, Corno V, Giovanelli M, Zambelli M, Stroppa P, Alberti D, Torre G, Spada M, Gridelli B, Colledan M, Maldini, G, Torri, E, Lucianetti, A, Guizzetti, M, Pinelli, D, Bertani, A, Corno, V, Giovanelli, M, Zambelli, M, Stroppa, P, Alberti, D, Torre, G, Spada, M, Gridelli, B, Colledan, M, Maldini G, Torri E, Lucianetti A, Guizzetti M, Pinelli D, Bertani A, Corno V, Giovanelli M, Zambelli M, Stroppa P, Alberti D, Torre G, Spada M, Gridelli B, and Colledan M

Abstract

Alagille syndrome (AS) is a dominantly inherited, multisystem disorder involving the liver, heart, eyes, face, and skeleton. From October 1997 through July 2004, 260 pediatric orthotopic liver transplantations (OLTx) were performed in 231 patients. This report describes 21 patients of median age 1.95 years (range, 0.7-16.7) who had alagille syndrome. We present the technical features of the OLTx, incidence and type of complications, medical conditions related to the syndrome, need for retransplantation, as well as patient and graft survival rates. A split liver technique was used in 16 patients (76%) who received a left lateral segment (LLS) graft whereas 7 patients (33%) received a whole liver. Only cadaveric donors were used. The major surgical complications requiring reintervention in 11 patients (52%) included biliary problems (19%) and vascular complications (17%). One case of hepatic artery thrombosis required retransplantation. Three recipients (14%) died. All other patients are alive with an actuarial survival rate of 90% at 1 year and 80% at 5 years. The actuarial graft survival rate is 85% at 1 year and 75% at 5 years. Patients with AS, despite the associated cardiovascular anomalies, can be treated successfully by a combined approach between cardiologist, radiologist, cardiothoracic, and liver transplant surgeons. With careful planning and operative management, the results are comparable with those obtained with other more common cholestatic diseases.

Published
2005

16. Orthotopic liver transplantation for Byler's disease

Author

Torri, E, Lucianetti, A, Pinelli, D, Corno, V, Guizzetti, M, Maldini, G, Zambelli, M, Bertani, A, Melzi, M, Alberti, D, Doffria, E, Giovanelli, M, Torre, G, Spada, M, Gridelli, B, Colledan, M, Torri E, Lucianetti A, Pinelli D, Corno V, Guizzetti M, Maldini G, Zambelli M, Bertani A, Melzi ML, Alberti D, Doffria E, Giovanelli M, Torre G, Spada M, Gridelli B, Colledan M, Torri, E, Lucianetti, A, Pinelli, D, Corno, V, Guizzetti, M, Maldini, G, Zambelli, M, Bertani, A, Melzi, M, Alberti, D, Doffria, E, Giovanelli, M, Torre, G, Spada, M, Gridelli, B, Colledan, M, Torri E, Lucianetti A, Pinelli D, Corno V, Guizzetti M, Maldini G, Zambelli M, Bertani A, Melzi ML, Alberti D, Doffria E, Giovanelli M, Torre G, Spada M, Gridelli B, and Colledan M

Abstract

In this study we analyzed the features of 12 patients who underwent liver transplantation for progressive familial intrahepatic cholestasis (Byler's disease [BD]) in view of the technical features of the OLTx, incidence and type of complications, need for retransplantation, as well as patient and graft survivals. BD was the indication in 12 patients of median age 1.32 years and median weight 10 kg. Median follow-up was 670 days. Major surgical complications requiring reintervention occurred in three patients. No thrombosis of the hepatic artery was observed. Infections with positive blood cultures were diagnosed in four patients. One patient had a biliary anastomotic stenosis successfully treated by percutaneous techniques. Four patients had episodes of acute rejection treated with steroids. Two patients were retransplanted, both of whom died in the early postoperative period due to hepatic vein thrombosis and venoenteric fistula. The actuarial patient and graft survival was 83% at 1 year and 83% at 5 years. Split-liver grafts represent an excellent organ supply for these patients, achieving good results with no mortality on the waiting list.

Published
2005

17. Split-liver transplantation with pediatric donors: A multicenter experience

Author

Cescon, M, Spada, M, Colledan, M, Andorno, E, Valente, U, Rossi, G, Reggiani, P, Grazi, G, Tisone, G, Majno, P, Rogiers, X, Santamaria, M, Baccarani, U, Ettorre, G, Cillo, U, Rossi, M, Scalamogna, M, Gridelli, B, Cescon M, Spada M, Colledan M, Andorno E, Valente U, Rossi G, Reggiani P, Grazi GL, Tisone G, Majno P, Rogiers X, Santamaria ML, Baccarani U, Ettorre GM, Cillo U, Rossi M, Scalamogna M, Gridelli B, Cescon, M, Spada, M, Colledan, M, Andorno, E, Valente, U, Rossi, G, Reggiani, P, Grazi, G, Tisone, G, Majno, P, Rogiers, X, Santamaria, M, Baccarani, U, Ettorre, G, Cillo, U, Rossi, M, Scalamogna, M, Gridelli, B, Cescon M, Spada M, Colledan M, Andorno E, Valente U, Rossi G, Reggiani P, Grazi GL, Tisone G, Majno P, Rogiers X, Santamaria ML, Baccarani U, Ettorre GM, Cillo U, Rossi M, Scalamogna M, and Gridelli B

Abstract

Background. Outcomes of split-liver transplantation (SLT) with pediatric donors have never been specifically reported. Methods. A prospective multicenter study on SLT using donors younger than 15 years was conducted. Thirty-nine split-liver procedures generating a left lateral segment (LLS) and an extended right graft (ERG) were performed. In three cases, no recipient was found for ERG. In all but one case, the celiac trunk was maintained with LLS. Data were available for 67 grafts (90% of the total): 38 LLSs and 9 ERGs transplanted into 46 children and 20 ERGs transplanted into 20 adults. Sixty-two (93%) grafts were used for primary transplants and five (7%) for retransplantation. SLT were performed with 15 donors 10 years of age and less and with 24 between 11 and 15 years. Results. Median follow-up was 24 months. Two-year patient and graft survival were 87% and 82%. Patient and graft survivals were not significantly different between pediatric and adult recipients, between recipients from donors 10 years of age and less and those between 11 and 15 years, and between recipients of LLS and ERG. Arterial complications occurred in 6% of cases (8% in the ≤10 year donors group, 5% in the 11-15 year donors group). The incidence of other complications was similar between groups. Conclusions. SLT with pediatric donors, even younger than 10 years, provided results comparable with those achievable using adult donors. The similar incidence of arterial complications among patients receiving LLS or ERG suggests that maintenance of the celiac trunk with LLS is not detrimental for right-sided grafts.

Published
2005

18. Transplantation for acute liver failure in children

Author

Pinelli, D, Spada, M, Lucianetti, A, Riva, S, Guizzetti, M, Giovanelli, M, Maldini, G, Corno, V, Sonzogni, V, Vedovati, S, Bertani, A, Zambelli, M, Gridelli, B, Colledan, M, Pinelli D, Spada M, Lucianetti A, Riva S, Guizzetti M, Giovanelli M, Maldini G, Corno V, Sonzogni V, Vedovati S, Bertani A, Zambelli M, Gridelli B, Colledan M, Pinelli, D, Spada, M, Lucianetti, A, Riva, S, Guizzetti, M, Giovanelli, M, Maldini, G, Corno, V, Sonzogni, V, Vedovati, S, Bertani, A, Zambelli, M, Gridelli, B, Colledan, M, Pinelli D, Spada M, Lucianetti A, Riva S, Guizzetti M, Giovanelli M, Maldini G, Corno V, Sonzogni V, Vedovati S, Bertani A, Zambelli M, Gridelli B, and Colledan M

Abstract

We reviewed the clinical data of 30 children-hospitalized for acute liver failure in the last 6 years. Ten patients were not listed for liver transplantation OLTX. Their clinical conditions gradually improved and they are all alive without deficit. Among 20 patients listed, 15 underwent urgent OLTX. Two children died on the waiting list and three were suspended from waiting list after few days because of improvement. Survival according to age class was analyzed dividing the patients into two groups: A, age 1 year or less versus B, age between 1 and 16 years. The patient survival was 86% at 6 months and 61% both at 1 and 2 years. Survival at 6 months and 1 and 2 years was 88%, 67%, and 45% for the patients in group A and 83%, 83%, and 83% for the patients in group B (P = NS). Observing graft-to-recipient weight ratio and donor-to-recipient weight ratio most patients received an optimal sized graft. The split-liver technique is considered the preferred method of liver transplantation even in the pediatric patients with acute liver failure; especially in the setting of a cooperative system in which all livers that are suitable for split-liver transplantation are shared between centers. In order to have the best chance for survival, children with acute liver failure should be referred as soon as possible to an highly specialized pediatric liver transplantation center that can offer all the treatment modalities that are currently available.

Published
2005

19. Early portal vein thrombosis after pediatric split liver transplantation with left lateral segment graft

Author

Corno, V, Torri, E, Bertani, A, Guizzetti, M, Lucianetti, A, Maldini, G, Pinelli, D, Zambelli, M, Aluffi, A, Alberti, D, Spada, M, Gridelli, B, Torre, G, Colledan, M, Corno V, Torri E, Bertani A, Guizzetti M, Lucianetti A, Maldini G, Pinelli D, Zambelli M, Aluffi A, Alberti D, Spada M, Gridelli B, Torre G, Colledan M, Corno, V, Torri, E, Bertani, A, Guizzetti, M, Lucianetti, A, Maldini, G, Pinelli, D, Zambelli, M, Aluffi, A, Alberti, D, Spada, M, Gridelli, B, Torre, G, Colledan, M, Corno V, Torri E, Bertani A, Guizzetti M, Lucianetti A, Maldini G, Pinelli D, Zambelli M, Aluffi A, Alberti D, Spada M, Gridelli B, Torre G, and Colledan M

Abstract

Early portal vein thrombosis (PVT) represents a serious complication after liver transplantation (OLTx). From October 1997 through July 2004, 260 OLTx were performed in 231 children, including 189 of left lateral segments (LLS). We retrospectively analyzed the incidence and the outcome of early PVT in this group. A daily doppler US scan was performed during the first week after transplantation. Early PVT occurred in 14 patients (8%), 10 males and four females of median age 0.77 years. The main indication for primary transplantation was biliary atresia (10), followed by Byler's disease (2), acute liver failure on cryptogenetic cirrhosis (1), and Alagille syndrome (1). Four children underwent retransplantation; three cases of thrombectomy and revision of the anastomosis, two children were treated with beta blockers, one of whom had a later failed attempt at percutaneous revascularization and eventually a meso-caval shunt. Five patients were followed with observation and no treatment. Among the four patients who died, three were in the retransplantation group and one in the thrombectomy and revision of the anastomosis group; the overall mortality was 28%. With a median follow up of 399 days, 10 patients are alive with an actuarial survival at 1 and 5 years of 72%, and graft survival rates at 1 and 5 years of 64%. PVT represents a serious complication after pediatric OLTx with LLS grafts. Prompt detection and aggressive surgical treatment in selected cases are required to reduce the mortality and graft loss.

Published
2005

20. A randomized trial for tacrolimus and steroids vs. tacrolimus and basiliximab in pediatric liver transplantation

Author

Spada, M, Bertani, A, Colledan, M, Sonzogni, A, Guizzetti, M, Lucianetti, A, Riva, S, Torre, G, Gridelli, B, Spada M, Bertani A, Colledan M, Sonzogni A, Guizzetti M, Lucianetti A, Riva S, Torre G, Gridelli B, Spada, M, Bertani, A, Colledan, M, Sonzogni, A, Guizzetti, M, Lucianetti, A, Riva, S, Torre, G, Gridelli, B, Spada M, Bertani A, Colledan M, Sonzogni A, Guizzetti M, Lucianetti A, Riva S, Torre G, and Gridelli B

Published
2005

21. Can donor selection criteria for split liver transplantation be safely expanded? A multicenter, multivariate analysis

Author

Spada, M, Bertani, A, Guizzetti, M, Lucianetti, A, Cintorino, D, Torre, G, Gridelli, B, Colledan, M, Spada M, Bertani A, Guizzetti M, Lucianetti A, Cintorino D, Torre G, Gridelli B, Colledan M, Spada, M, Bertani, A, Guizzetti, M, Lucianetti, A, Cintorino, D, Torre, G, Gridelli, B, Colledan, M, Spada M, Bertani A, Guizzetti M, Lucianetti A, Cintorino D, Torre G, Gridelli B, and Colledan M

Published
2005

22. Pediatric in situ split liver transplantation for Langerhans' cell histiocytosis - Acute rejection and disease recurrence

Author

Spada, M, Arico, M, Cintorino, D, Clarizia, S, Guizzetti, M, Lucianetti, A, Melzi, M, Minervini, M, Riva, S, Sonzogni, A, Stroppa, P, Torre, G, Colledan, M, Gridelli, B, Spada M, Arico M, Cintorino D, Clarizia S, Guizzetti M, Lucianetti A, Melzi ML, Minervini M, Riva S, Sonzogni A, Stroppa P, Torre G, Colledan M, Gridelli B, Spada, M, Arico, M, Cintorino, D, Clarizia, S, Guizzetti, M, Lucianetti, A, Melzi, M, Minervini, M, Riva, S, Sonzogni, A, Stroppa, P, Torre, G, Colledan, M, Gridelli, B, Spada M, Arico M, Cintorino D, Clarizia S, Guizzetti M, Lucianetti A, Melzi ML, Minervini M, Riva S, Sonzogni A, Stroppa P, Torre G, Colledan M, and Gridelli B

Published
2005

23. Use of extended right split grafts for adult and pediatric primary liver transplantation

Author

Corno, V, Lucianetti, A, Zambelli, M, Pinelli, D, Guizzetti, M, Maldini, G, Gridelli, B, Spada, M, Torri, E, Giovanelli, M, Dezza, M, Strazzabosco, M, Torre, G, Colledan, M, Corno V, Lucianetti A, Zambelli M, Pinelli D, Guizzetti M, Maldini G, Gridelli B, Spada M, Torri E, Giovanelli M, Dezza MC, Strazzabosco M, Torre G, Colledan M, Corno, V, Lucianetti, A, Zambelli, M, Pinelli, D, Guizzetti, M, Maldini, G, Gridelli, B, Spada, M, Torri, E, Giovanelli, M, Dezza, M, Strazzabosco, M, Torre, G, Colledan, M, Corno V, Lucianetti A, Zambelli M, Pinelli D, Guizzetti M, Maldini G, Gridelli B, Spada M, Torri E, Giovanelli M, Dezza MC, Strazzabosco M, Torre G, and Colledan M

Published
2005

24. Split liver transplantation with pediatric donors: Results of a multicentric experience

Author

Cescon, M, Spada, M, Aluffi, A, Zambelli, M, Guizzetti, M, Lucianetti, A, Pinelli, D, Torre, G, Strazzabosco, M, Andorno, E, Fassati, L, Gridelli, B, Colledan, M, Cescon M, Spada M, Aluffi A, Zambelli M, Guizzetti M, Lucianetti A, Pinelli D, Torre G, Strazzabosco M, Andorno E, Fassati LR, Gridelli B, Colledan M, Cescon, M, Spada, M, Aluffi, A, Zambelli, M, Guizzetti, M, Lucianetti, A, Pinelli, D, Torre, G, Strazzabosco, M, Andorno, E, Fassati, L, Gridelli, B, Colledan, M, Cescon M, Spada M, Aluffi A, Zambelli M, Guizzetti M, Lucianetti A, Pinelli D, Torre G, Strazzabosco M, Andorno E, Fassati LR, Gridelli B, and Colledan M

Published
2004

25. A randomized trial for Tacrolimus and Steroids vs. Tacrolimus and Basiliximab in pediatric liver transplantation

Author

Spada, M, Bertani, A, Petz, W, Torri, E, Sonzogni, A, Guizzetti, M, Lucianetti, A, Riva, S, Melzi, M, Stroppa, P, Torre, G, Colledan, M, Gridelli, B, Spada M, Bertani A, Petz W, Torri E, Sonzogni A, Guizzetti M, Lucianetti A, Riva S, Melzi ML, Stroppa P, Torre G, Colledan M, Gridelli B, Spada, M, Bertani, A, Petz, W, Torri, E, Sonzogni, A, Guizzetti, M, Lucianetti, A, Riva, S, Melzi, M, Stroppa, P, Torre, G, Colledan, M, Gridelli, B, Spada M, Bertani A, Petz W, Torri E, Sonzogni A, Guizzetti M, Lucianetti A, Riva S, Melzi ML, Stroppa P, Torre G, Colledan M, and Gridelli B

Published
2004

26. Impact of graft size mismatching on outcome in pediatric split liver transplantation

Author

Spada, M, Aluffi, A, Cescon, M, Guizzetti, M, Lucianetti, A, Pinelli, D, Torre, G, Gridelli, B, Colledan, M, Spada M, Aluffi A, Cescon M, Guizzetti M, Lucianetti A, Pinelli D, Torre G, Gridelli B, Colledan M, Spada, M, Aluffi, A, Cescon, M, Guizzetti, M, Lucianetti, A, Pinelli, D, Torre, G, Gridelli, B, Colledan, M, Spada M, Aluffi A, Cescon M, Guizzetti M, Lucianetti A, Pinelli D, Torre G, Gridelli B, and Colledan M

Published
2004

27. Split liver transplantation from pediatric donors: Results of a multicentric experience

Author

Cescon, M, Spada, M, Aluffi, A, Zambelli, M, Guizzetti, M, Lucianetti, A, Pinelli, D, Torre, G, Strazzabosco, M, Andorno, E, Fassati, L, Gridelli, B, Colledan, M, Cescon M, Spada M, Aluffi A, Zambelli M, Guizzetti M, Lucianetti A, Pinelli D, Torre G, Strazzabosco M, Andorno E, Fassati LR, Gridelli B, Colledan M, Cescon, M, Spada, M, Aluffi, A, Zambelli, M, Guizzetti, M, Lucianetti, A, Pinelli, D, Torre, G, Strazzabosco, M, Andorno, E, Fassati, L, Gridelli, B, Colledan, M, Cescon M, Spada M, Aluffi A, Zambelli M, Guizzetti M, Lucianetti A, Pinelli D, Torre G, Strazzabosco M, Andorno E, Fassati LR, Gridelli B, and Colledan M

Published
2004

28. Impact of graft size mismatching on graft prognosis in pediatric split liver transplantation

Author

Spada, M, Cescon, M, Aluffi, A, Guizzetti, M, Zambelli, M, Pinelli, D, Altobelli, M, Torre, G, Gridelli, B, Colledan, M, Spada M, Cescon M, Aluffi A, Guizzetti M, Zambelli M, Pinelli D, Altobelli M, Torre G, Gridelli B, Colledan M, Spada, M, Cescon, M, Aluffi, A, Guizzetti, M, Zambelli, M, Pinelli, D, Altobelli, M, Torre, G, Gridelli, B, Colledan, M, Spada M, Cescon M, Aluffi A, Guizzetti M, Zambelli M, Pinelli D, Altobelli M, Torre G, Gridelli B, and Colledan M

Published
2004

29. Use of extended right grafts from in-situ split liver in adults liver trasplantation: A comparison with whole liver transplants

Author

Spada, M, Cescon, M, Aluffi, A, Zambelli, M, Guizzetti, M, Lucianetti, A, Pinelli, D, Strazzabosco, M, Gridelli, B, Colledan, M, Spada M, Cescon M, Aluffi A, Zambelli M, Guizzetti M, Lucianetti A, Pinelli D, Strazzabosco M, Gridelli B, Colledan M, Spada, M, Cescon, M, Aluffi, A, Zambelli, M, Guizzetti, M, Lucianetti, A, Pinelli, D, Strazzabosco, M, Gridelli, B, Colledan, M, Spada M, Cescon M, Aluffi A, Zambelli M, Guizzetti M, Lucianetti A, Pinelli D, Strazzabosco M, Gridelli B, and Colledan M

Published
2004

30. Split-liver transplantation eliminates the need for living-donor liver transplantation in children with end-stage cholestatic liver disease

Author

Gridelli, B, Spada, M, Petz, W, Bertani, A, Lucianetti, A, Colledan, M, Altobelli, M, Alberti, D, Guizzetti, M, Riva, S, Melzi, M, Stroppa, P, Torre, G, Gridelli B, Spada M, Petz W, Bertani A, Lucianetti A, Colledan M, Altobelli M, Alberti D, Guizzetti M, Riva S, Melzi ML, Stroppa P, Torre G, Gridelli, B, Spada, M, Petz, W, Bertani, A, Lucianetti, A, Colledan, M, Altobelli, M, Alberti, D, Guizzetti, M, Riva, S, Melzi, M, Stroppa, P, Torre, G, Gridelli B, Spada M, Petz W, Bertani A, Lucianetti A, Colledan M, Altobelli M, Alberti D, Guizzetti M, Riva S, Melzi ML, Stroppa P, and Torre G

Abstract

Background. End-stage cholestatic liver disease (ESCLD) is the main indication for liver replacement in children. Pediatric cadaver-organ-donor shortage has prompted the most important evolutions in the technique of liver transplantation, in particular living-donor liver transplantation (LDLT) and split-liver transplantation (SLT). Methods. Between November 1997 and June 2001, 127 children with ESCLD were evaluated for liver transplantation, and 124 underwent 138 liver transplantations after a median time of 40 days. Causes of liver disease were congenital biliary atresia (n=96), Alagille's syndrome (n=12), Byler's disease (n=8), and other cholestatic diseases (n=8). Results. Ninety (73%) patients received a split-liver graft, 28 (23%) a whole liver, and 6 (4%) a reduced-size liver. Overall 2- and 4-year patient survival rates were 93% and 91%, respectively; the 2- and 4-year graft-survival rates were 84% and 80%, respectively. In split-liver recipients, 4-year patient and graft-survival rates were 91% and 83%, respectively; these were 93% and 78%, respectively, in whole-liver recipients and 67% and 63%, respectively, in reduced-size liver recipients. Retransplantation rate was 11%, whereas mortality rate was 8%. Overall incidence of vascular and biliary complication were 16% and 27%, respectively. Conclusions. SLT can provide liver grafts for children with ESCLD with an outcome similar to the one reported following LDLT, eliminating mortality while they are on a transplantation wait list. The need for pediatric LDLT should be reevaluated and programs of SLT strongly encouraged and supported at a national and international level.

Published
2003

31. Pediatric and adult liver transplantation: The Bergamo experience

Author

Bertani, A, Lucianetti, A, Segalin, A, Spada, M, Peloni, G, Guizzetti, M, Petz, W, Corno, V, Gridelli, B, Colledan, M, Bertani A, Lucianetti A, Segalin A, Spada M, Peloni G, Guizzetti M, Petz W, Corno V, Gridelli B, Colledan M, Bertani, A, Lucianetti, A, Segalin, A, Spada, M, Peloni, G, Guizzetti, M, Petz, W, Corno, V, Gridelli, B, Colledan, M, Bertani A, Lucianetti A, Segalin A, Spada M, Peloni G, Guizzetti M, Petz W, Corno V, Gridelli B, and Colledan M

Published
2002

33. A cause of late graft dysfunction after liver transplantation in children: De-novo autoimmune hepatitis

Author

Spada, M, Bertani, A, Sonzogni, A, Petz, W, Riva, S, Torre, G, Melzi, M, Alberti, D, Colledan, M, Segalin, A, Lucianetti, A, Gridelli, B, Spada M, Bertani A, Sonzogni A, Petz W, Riva S, Torre G, Melzi ML, Alberti D, Colledan M, Segalin A, Lucianetti A, Gridelli B, Spada, M, Bertani, A, Sonzogni, A, Petz, W, Riva, S, Torre, G, Melzi, M, Alberti, D, Colledan, M, Segalin, A, Lucianetti, A, Gridelli, B, Spada M, Bertani A, Sonzogni A, Petz W, Riva S, Torre G, Melzi ML, Alberti D, Colledan M, Segalin A, Lucianetti A, and Gridelli B

Published
2001

34. Pediatric split liver transplantation using elderly donors

Author

Petz, W, Spada, M, Sonzogni, A, Colledan, M, Segalin, A, Lucianetti, A, Bertani, A, Guizzetti, M, Peloni, G, Gridelli, B, Petz W, Spada M, Sonzogni A, Colledan M, Segalin A, Lucianetti A, Bertani A, Guizzetti M, Peloni G, Gridelli B, Petz, W, Spada, M, Sonzogni, A, Colledan, M, Segalin, A, Lucianetti, A, Bertani, A, Guizzetti, M, Peloni, G, Gridelli, B, Petz W, Spada M, Sonzogni A, Colledan M, Segalin A, Lucianetti A, Bertani A, Guizzetti M, Peloni G, and Gridelli B

Published
2001

35. Alternative split liver technique: The equal size split

Author

Colledan, M, Andorno, E, Segalin, A, Lucianetti, A, Spada, M, Corno, V, Valente, U, Antonucci, A, Gridelli, B, Colledan M, Andorno E, Segalin A, Lucianetti A, Spada M, Corno V, Valente U, Antonucci A, Gridelli B, Colledan, M, Andorno, E, Segalin, A, Lucianetti, A, Spada, M, Corno, V, Valente, U, Antonucci, A, Gridelli, B, Colledan M, Andorno E, Segalin A, Lucianetti A, Spada M, Corno V, Valente U, Antonucci A, and Gridelli B

Published
2001

36. Circulating EBV-DNA in the monitoring of EBV infection in pediatric liver transplant recipients

Author

Spada, M, Guizzetti, M, Petz, W, Colledan, M, Segalin, A, Lucianetti, A, Bertani, A, Peloni, G, Sonzogni, A, Alberti, D, Riva, S, Melzi, M, Gridelli, B, Spada M, Guizzetti M, Petz W, Colledan M, Segalin A, Lucianetti A, Bertani A, Peloni G, Sonzogni A, Alberti D, Riva S, Melzi M, Gridelli B, Spada, M, Guizzetti, M, Petz, W, Colledan, M, Segalin, A, Lucianetti, A, Bertani, A, Peloni, G, Sonzogni, A, Alberti, D, Riva, S, Melzi, M, Gridelli, B, Spada M, Guizzetti M, Petz W, Colledan M, Segalin A, Lucianetti A, Bertani A, Peloni G, Sonzogni A, Alberti D, Riva S, Melzi M, and Gridelli B

Published
2001

37. De-novo autoimmune hepatitis as a cause of graft dysfunction after liver transplantation in children

Author

Riva, S, Torre, G, Migliazza, L, Melzi, M, Alberti, D, Colledan, M, Segalin, A, Lucianetti, A, Spada, M, Corno, V, Gridelli, B, Riva S, Torre G, Migliazza L, Melzi ML, Alberti D, Colledan M, Segalin A, Lucianetti A, Spada M, Corno V, Gridelli B, Riva, S, Torre, G, Migliazza, L, Melzi, M, Alberti, D, Colledan, M, Segalin, A, Lucianetti, A, Spada, M, Corno, V, Gridelli, B, Riva S, Torre G, Migliazza L, Melzi ML, Alberti D, Colledan M, Segalin A, Lucianetti A, Spada M, Corno V, and Gridelli B

Published
2000

39. The management of biliary complications after split liver pediatric transplantation

Author

Lucianetti, A, Bertani, A, Colledan, M, Segalin, A, Spada, M, Corno, V, Peloni, G, Petz, W, Gridelli, B, Lucianetti A, Bertani A, Colledan M, Segalin A, Spada M, Corno V, Peloni G, Petz W, Gridelli B, Lucianetti, A, Bertani, A, Colledan, M, Segalin, A, Spada, M, Corno, V, Peloni, G, Petz, W, Gridelli, B, Lucianetti A, Bertani A, Colledan M, Segalin A, Spada M, Corno V, Peloni G, Petz W, and Gridelli B

Published
2000

40. Renal dysfunction after liver transplantation in children

Author

Melzi, M, Riva, S, Migliazza, L, Torre, G, Ulla, L, Alberti, D, Colledan, M, Segalin, A, Lucianetti, A, Spada, M, Corno, V, Gridelli, B, Melzi ML, Riva S, Migliazza L, Torre G, Ulla L, Alberti D, Colledan M, Segalin A, Lucianetti A, Spada M, Corno V, Gridelli B, Melzi, M, Riva, S, Migliazza, L, Torre, G, Ulla, L, Alberti, D, Colledan, M, Segalin, A, Lucianetti, A, Spada, M, Corno, V, Gridelli, B, Melzi ML, Riva S, Migliazza L, Torre G, Ulla L, Alberti D, Colledan M, Segalin A, Lucianetti A, Spada M, Corno V, and Gridelli B

Published
2000

41. Treatment of pediatric hepatic malignancies with liver transplantation

Author

Corno, V, Bertani, A, Colledan, M, Spada, M, Segalin, A, Lucianetti, A, Sonzogni, A, Cornelli, P, Peloni, G, Perz, W, Guizzetti, M, Gridelli, B, Corno V, Bertani A, Colledan M, Spada M, Segalin A, Lucianetti A, Sonzogni A, Cornelli PE, Peloni G, Perz W, Guizzetti M, Gridelli B, Corno, V, Bertani, A, Colledan, M, Spada, M, Segalin, A, Lucianetti, A, Sonzogni, A, Cornelli, P, Peloni, G, Perz, W, Guizzetti, M, Gridelli, B, Corno V, Bertani A, Colledan M, Spada M, Segalin A, Lucianetti A, Sonzogni A, Cornelli PE, Peloni G, Perz W, Guizzetti M, and Gridelli B

Published
2000

42. Results of liver transplantation in recipients less than one year of age

Author

Bertani, A, Corno, V, Spada, M, Segalin, A, Lucianetti, A, Peloni, G, Guizzetti, M, Colledan, M, Gridelli, B, Bertani A, Corno V, Spada M, Segalin A, Lucianetti A, Peloni G, Guizzetti M, Colledan M, Gridelli B, Bertani, A, Corno, V, Spada, M, Segalin, A, Lucianetti, A, Peloni, G, Guizzetti, M, Colledan, M, Gridelli, B, Bertani A, Corno V, Spada M, Segalin A, Lucianetti A, Peloni G, Guizzetti M, Colledan M, and Gridelli B

Published
2000

43. Extensive use of split liver for pediatric liver transplantation: A single-center experience

Author

Spada, M, Gridelli, B, Colledan, M, Segalin, A, Lucianetti, A, Petz, W, Riva, S, Spada M, Gridelli B, Colledan M, Segalin A, Lucianetti A, Petz W, Riva S, Spada, M, Gridelli, B, Colledan, M, Segalin, A, Lucianetti, A, Petz, W, Riva, S, Spada M, Gridelli B, Colledan M, Segalin A, Lucianetti A, Petz W, and Riva S

Abstract

The results of the extensive use of in situ liver splitting in a pediatric liver transplant program are presented. All referred donors were considered for split liver, and when the donor-recipient body weight ratio (DRWR) was greater than 2, the grafts were split. A modified split-liver technique was adopted when the DRWR was 2 or less. Eighty liver procurements were attempted and 72 (90%) were performed, enabling 65 children to receive 42 split, 22 whole, and 8 reduced-size livers. The right portions of the grafts were transplanted by other centers into adults. Median patient waiting time was 22 days, with no mortality on the waiting list. After a median follow-up of 14 months, overall patient and graft survival rates were 85% and 81%, respectively. Fifty-eight children received a single allograft, whereas 7 children required retransplantation. Two-year actuarial survival rates were 85% for split-liver recipients, 84% for whole-liver recipients, and 67% for reduced-size liver recipients. Vascular complications developed in 18% of the patients, with no difference among the 3 groups with different technique. Biliary complications developed in 25% of the children, mainly in reduced-size and split-liver recipients. Patient and graft survival rates for right split-liver grafts were 84% and 79%, respectively. Adopting a liberal policy of liver splitting provides allografts of optimal quality for pediatric transplantation, allowing a dramatic decrease in the waiting list time. The in situ split-liver technique should be considered the method of choice for expanding the cadaveric liver donor pool.

Published
2000

44. Alternative split liver technique: The equal-size split

Author

Colledan, M, Andorno, E, Segalin, A, Lucianetti, A, Spada, M, Valente, U, Antonucci, A, Gridelli, B, Colledan M, Andorno E, Segalin A, Lucianetti A, Spada M, Valente U, Antonucci A, Gridelli B, Colledan, M, Andorno, E, Segalin, A, Lucianetti, A, Spada, M, Valente, U, Antonucci, A, Gridelli, B, Colledan M, Andorno E, Segalin A, Lucianetti A, Spada M, Valente U, Antonucci A, and Gridelli B

Published
2000

45. Pediatric split liver transplantation using elderly donors

Author

Spada, M, Petz, W, Colledan, M, Segalin, A, Lucianetti, A, Bertani, A, Gridelli, B, Spada M, Petz W, Colledan M, Segalin A, Lucianetti A, Bertani A, Gridelli B, Spada, M, Petz, W, Colledan, M, Segalin, A, Lucianetti, A, Bertani, A, Gridelli, B, Spada M, Petz W, Colledan M, Segalin A, Lucianetti A, Bertani A, and Gridelli B

Published
2000

48. Split liver transplantation in a child with an angiosarcoma of the liver

Author

Corno, V, Colledan, M, Cornelli, P, Sonzogni, A, Segalin, A, Lucianetti, A, Spada, M, Riva, S, Gridelli, B, Corno V, Colledan M, Cornelli P, Sonzogni A, Segalin A, Lucianetti A, Spada M, Riva S, Gridelli B, Corno, V, Colledan, M, Cornelli, P, Sonzogni, A, Segalin, A, Lucianetti, A, Spada, M, Riva, S, Gridelli, B, Corno V, Colledan M, Cornelli P, Sonzogni A, Segalin A, Lucianetti A, Spada M, Riva S, and Gridelli B

Published
1999

49. Preliminary results with an alternative split liver technique: The equal-size split

Author

Colledan, M, Andorno, E, Segalin, A, Lucianetti, A, Spada, M, Valente, U, Antonucci, A, Gridelli, B, Colledan M, Andorno E, Segalin A, Lucianetti A, Spada M, Valente U, Antonucci A, Gridelli B, Colledan, M, Andorno, E, Segalin, A, Lucianetti, A, Spada, M, Valente, U, Antonucci, A, Gridelli, B, Colledan M, Andorno E, Segalin A, Lucianetti A, Spada M, Valente U, Antonucci A, and Gridelli B

Published
1999

50. Spatial neglect and perseveration in visuomotor exploration

Author

Ronchi, R, Algeri, L, Chiapella, L, Spada, M, Vallar, G, RONCHI, ROBERTA, VALLAR, GIUSEPPE, Ronchi, R, Algeri, L, Chiapella, L, Spada, M, Vallar, G, RONCHI, ROBERTA, and VALLAR, GIUSEPPE

Abstract

Objective: Right-brain-damaged patients with left spatial neglect make perseveration errors in target cancellation tasks. A recent study (Ronchi, Posteraro, Fortis, Bricolo, & Vallar, 2009) showed that perseveration occurred more frequently in star than in letter cancellation, possibly due to different stimulus disposition. In this study we investigated the role of the spatial organization of targets (scattered vs. arranged) of the star and letter cancellation tasks in eliciting omission and perseveration errors; the role of impairments of divided attentional resources; and the lesion correlates of perseveration. Method: Thirty-three right-brain-damaged patients (27 with neglect, and six without neglect; 17 showing perseveration, 16 of them with spatial neglect) were given two versions of the star and letter cancellation tasks (with stimuli scattered or in rows), and a dual task. Results: A scattered target disposition increased omission and perseveration errors. Target type modulated differently omission and perseveration, with the former being more elicited by verbal targets, and the latter occurring more frequently in the star cancellation task, with scattered stimuli. Perseveration behavior was unrelated to deficits of divided attention, as assessed by the dual task. Lesion analysis indicated damage to the right insula as a neural correlate of perseveration. Conclusions: A display including nonverbal (star) and scattered targets brings about more perseveration errors. Target type and organization modulate in a different fashion omission and perseveration, suggesting the involvement of independent pathological mechanisms, which, however, do not implicate deficits of divided attention. The role of insular damage in motor perseveration in spatial neglect is discussed.

Published
2012

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