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1. Living Donor Lung Transplantation After Hematopoietic Stem Cell Transplantation From the Same Donor: A Risk Worth Taking

Author

Camagni, S, D'Antiga, L, Di Marco, F, Grazioli, L, Bonanomi, E, Pinelli, D, Beretta, M, Tintori, V, Lucianetti, A, Colledan, M, Camagni S., D'Antiga L., Di Marco F., Grazioli L., Bonanomi E., Pinelli D., Beretta M., Tintori V., Lucianetti A., Colledan M., Camagni, S, D'Antiga, L, Di Marco, F, Grazioli, L, Bonanomi, E, Pinelli, D, Beretta, M, Tintori, V, Lucianetti, A, Colledan, M, Camagni S., D'Antiga L., Di Marco F., Grazioli L., Bonanomi E., Pinelli D., Beretta M., Tintori V., Lucianetti A., and Colledan M.

Abstract

Living donor (LD) lung transplantation (LT) represents an exceptional procedure in Western countries. However, in selected situations, it could be a source of unique advantages, besides addressing organ shortage. We report a successful case of father-to-child single-lobe LT, because of the complications of hematopoietic stem cell transplantation from the same donor, with initial low-dose immunosuppressive therapy and subsequent early discontinuation. Full donor chimerism was hypothesized to be a mechanism of transplant tolerance, and this postulated immunological benefit was deemed to outweigh the risks of living donation and the possible drawbacks of single compared with bilateral LT. Favorable size matching and donor's anatomy, accurate surgical planning, and specific expertise in pediatric transplantation also contributed to the optimal recipient and donor outcomes. Ten months after LD LT, the patient's steadily good lung function after withdrawal of immunosuppressive therapy seems to confirm the original hypothesis.

Published
2024

2. Portal vein thrombosis and liver transplantation: management, matching, and outcomes: a retrospective multicenter cohort study

Author

Di Benedetto, F, Magistri, P, Di Sandro, S, Boetto, R, Tandoi, F, Camagni, S, Lauterio, A, Pagano, D, Nicolini, D, Violi, P, Dondossola, D, Guglielmo, N, Cherchi, V, Lai, Q, Toti, L, Bongini, M, Frassoni, S, Bagnardi, V, Mazzaferro, V, Tisone, G, Rossi, M, Baccarani, U, Ettorre, G, Caccamo, L, Carraro, A, Vivarelli, M, Gruttadauria, S, De Carlis, L, Colledan, M, Romagnoli, R, Cillo, U, Di Benedetto, Fabrizio, Magistri, Paolo, Di Sandro, Stefano, Boetto, Riccardo, Tandoi, Francesco, Camagni, Stefania, Lauterio, Andrea, Pagano, Duilio, Nicolini, Daniele, Violi, Paola, Dondossola, Daniele, Guglielmo, Nicola, Cherchi, Vittorio, Lai, Quirino, Toti, Luca, Bongini, Marco, Frassoni, Samuele, Bagnardi, Vincenzo, Mazzaferro, Vincenzo, Tisone, Giuseppe, Rossi, Massimo, Baccarani, Umberto, Ettorre, Giuseppe Maria, Caccamo, Lucio, Carraro, Amedeo, Vivarelli, Marco, Gruttadauria, Salvatore, De Carlis, Luciano, Colledan, Michele, Romagnoli, Renato, Cillo, Umberto, Di Benedetto, F, Magistri, P, Di Sandro, S, Boetto, R, Tandoi, F, Camagni, S, Lauterio, A, Pagano, D, Nicolini, D, Violi, P, Dondossola, D, Guglielmo, N, Cherchi, V, Lai, Q, Toti, L, Bongini, M, Frassoni, S, Bagnardi, V, Mazzaferro, V, Tisone, G, Rossi, M, Baccarani, U, Ettorre, G, Caccamo, L, Carraro, A, Vivarelli, M, Gruttadauria, S, De Carlis, L, Colledan, M, Romagnoli, R, Cillo, U, Di Benedetto, Fabrizio, Magistri, Paolo, Di Sandro, Stefano, Boetto, Riccardo, Tandoi, Francesco, Camagni, Stefania, Lauterio, Andrea, Pagano, Duilio, Nicolini, Daniele, Violi, Paola, Dondossola, Daniele, Guglielmo, Nicola, Cherchi, Vittorio, Lai, Quirino, Toti, Luca, Bongini, Marco, Frassoni, Samuele, Bagnardi, Vincenzo, Mazzaferro, Vincenzo, Tisone, Giuseppe, Rossi, Massimo, Baccarani, Umberto, Ettorre, Giuseppe Maria, Caccamo, Lucio, Carraro, Amedeo, Vivarelli, Marco, Gruttadauria, Salvatore, De Carlis, Luciano, Colledan, Michele, Romagnoli, Renato, and Cillo, Umberto

Abstract

Background and aims: Besides the increased risk of perioperative morbidity, graft failure, and mortality, the majority of PVT are diagnosed at liver transplantation (LT). Improving preoperative management and patient selection may lead to better short-term and long-term outcomes and reduce the risk of a futile LT. The authors aimed to identify predictors of adverse outcomes after LT in patients with nonmalignant portal vein thrombosis (PVT) and improve donor to recipient matching by analyzing the results of the Italian cohort of LT recipients. Methods: Adult patients who underwent LT in Italy between January 2000 and February 2020 diagnosed with PVT pre-LT or at time of LT were considered eligible for inclusion. Based on a survey encompassing all 26 surgeons participating in the study, a binary composite outcome was defined. Patients were classified as having the composite event if at least one of these conditions occurred: operative time more than 600 min, estimated blood loss greater than 5000 ml, more than 20 ICU days, 90 days mortality, 90 days retransplant. Results: Seven hundred fourteen patients were screened and 698 met the inclusion criteria. The analysis reports the results of 568 patients that fulfilled the criteria to enter the composite outcome analysis.Overall, 156 patients (27.5%) developed the composite outcome. PVT stage 3/4 at transplant and need for any surgical correction of PVT are independent predictors of the composite outcome occurrence. When stratified by PVT grade, overall survival at 1-year ranges from 89.0% with PVT grade 0/1 to 67.4% in patients with PVT grade 3/4 at LT (P<0.001). Nevertheless, patients with severe PVT can improve their survival when identified risk factors are not present. Conclusions: Potential LT candidates affected by PVT have a benefit from LT that should be adequately balanced on liver function and type of inflow reconstruction needed to mitigate the incidence of adverse events. Nonetheless, the absenc

Published
2024

3. Extended criteria liver donation after circulatory death with prolonged warm ischemia: a pilot experience of normothermic regional perfusion and no subsequent ex-situ machine perfusion

Author

Camagni, S, Amaduzzi, A, Grazioli, L, Ghitti, D, Pasulo, L, Pinelli, D, Fagiuoli, S, Colledan, M, Camagni S., Amaduzzi A., Grazioli L., Ghitti D., Pasulo L., Pinelli D., Fagiuoli S., Colledan M., Camagni, S, Amaduzzi, A, Grazioli, L, Ghitti, D, Pasulo, L, Pinelli, D, Fagiuoli, S, Colledan, M, Camagni S., Amaduzzi A., Grazioli L., Ghitti D., Pasulo L., Pinelli D., Fagiuoli S., and Colledan M.

Abstract

Background: Livers from controlled donation after circulatory death (cDCD) with very prolonged warm ischemic time (WIT) are regularly transplanted after abdominal normothermic regional perfusion (aNRP) plus ex-situ machine perfusion (MP). Considering aNRP as in-situ MP, we investigated whether the results of a pilot experience of extended criteria cDCD liver transplantation (LT) with prolonged WIT, with aNRP alone, were comparable to the best possible outcomes in low-risk cDCD LT. Methods: Prospectively collected data on 24 cDCD LT, with aNRP alone, were analyzed. Results: The median total and asystolic WIT were 51 and 25 min. Measures within benchmark cut-offs were: median duration of surgery (5.9 h); median intraoperative transfusions (3 units of red blood cells); need for renal replacement therapy (2/24 patients); median intensive care stay (3 days); key complications; overall morbidity, graft loss, and retransplantation up to 12 months; 12-month mortality (2/21 patients). The median hospital stay (33 days, due to logistics) and mortality up to 6 months (2/24 patients, due to graft-unrelated causes) exceeded benchmark thresholds. Conclusions: This pilot experience suggests that livers from cDCD with very prolonged WIT that appear viable during adequate quality aNRP may be safely transplanted, with no need for ex-situ MP, with considerable resource savings.

Published
2023

4. Vaccination Recommendations in Solid Organ Transplant Adult Candidates and Recipients

Author

Vigano, M, Beretta, M, Lepore, M, Abete, R, Benatti, S, Grassini, M, Camagni, S, Chiodini, G, Vargiu, S, Vittori, C, Iachini, M, Terzi, A, Neri, F, Pinelli, D, Casotti, V, Di Marco, F, Ruggenenti, P, Rizzi, M, Colledan, M, Fagiuoli, S, Vigano M., Beretta M., Lepore M., Abete R., Benatti S. V., Grassini M. V., Camagni S., Chiodini G., Vargiu S., Vittori C., Iachini M., Terzi A., Neri F., Pinelli D., Casotti V., Di Marco F., Ruggenenti P., Rizzi M., Colledan M., Fagiuoli S., Vigano, M, Beretta, M, Lepore, M, Abete, R, Benatti, S, Grassini, M, Camagni, S, Chiodini, G, Vargiu, S, Vittori, C, Iachini, M, Terzi, A, Neri, F, Pinelli, D, Casotti, V, Di Marco, F, Ruggenenti, P, Rizzi, M, Colledan, M, Fagiuoli, S, Vigano M., Beretta M., Lepore M., Abete R., Benatti S. V., Grassini M. V., Camagni S., Chiodini G., Vargiu S., Vittori C., Iachini M., Terzi A., Neri F., Pinelli D., Casotti V., Di Marco F., Ruggenenti P., Rizzi M., Colledan M., and Fagiuoli S.

Abstract

Prevention of infections is crucial in solid organ transplant (SOT) candidates and recipients. These patients are exposed to an increased infectious risk due to previous organ insufficiency and to pharmacologic immunosuppression. Besides infectious-related morbidity and mortality, this vulnerable group of patients is also exposed to the risk of acute decompensation and organ rejection or failure in the pre- and post-transplant period, respectively, since antimicrobial treatments are less effective than in the immunocompetent patients. Vaccination represents a major preventive measure against specific infectious risks in this population but as responses to vaccines are reduced, especially in the early post-transplant period or after treatment for rejection, an optimal vaccination status should be obtained prior to transplantation whenever possible. This review reports the currently available data on the indications and protocols of vaccination in SOT adult candidates and recipients.

Published
2023

5. Current practice of normothermic regional perfusion and machine perfusion in donation after circulatory death liver transplants in Italy

Author

De Carlis, R, Lauterio, A, Centonze, L, Buscemi, V, Schlegel, A, Muiesan, P, De Carlis, L, Carraro, A, Ghinolfi, D, De Simone, P, Ravaioli, M, Cescon, M, Dondossola, D, Bongini, M, Mazzaferro, V, Pagano, D, Gruttadauria, S, Gringeri, E, Cillo, U, Patrono, D, Romagnoli, R, Camagni, S, Colledan, M, Olivieri, T, Di Benedetto, F, Vennarecci, G, Baccarani, U, Lai, Q, Rossi, M, Manzia, T, Tisone, G, Vivarelli, M, Scalera, I, Lupo, L, Andorno, E, Meniconi, R, Ettorre, G, Avolio, A, Agnes, S, Pellegrino, R, Zamboni, F, De Carlis R., Lauterio A., Centonze L., Buscemi V., Schlegel A., Muiesan P., De Carlis L., Carraro A., Ghinolfi D., De Simone P., Ravaioli M., Cescon M., Dondossola D., Bongini M., Mazzaferro V., Pagano D., Gruttadauria S., Gringeri E., Cillo U., Patrono D., Romagnoli R., Camagni S., Colledan M., Olivieri T., Di Benedetto F., Vennarecci G., Baccarani U., Lai Q., Rossi M., Manzia T. M., Tisone G., Vivarelli M., Scalera I., Lupo L. G., Andorno E., Meniconi R. L., Ettorre G. M., Avolio A. W., Agnes S., Pellegrino R. A., Zamboni F., De Carlis, R, Lauterio, A, Centonze, L, Buscemi, V, Schlegel, A, Muiesan, P, De Carlis, L, Carraro, A, Ghinolfi, D, De Simone, P, Ravaioli, M, Cescon, M, Dondossola, D, Bongini, M, Mazzaferro, V, Pagano, D, Gruttadauria, S, Gringeri, E, Cillo, U, Patrono, D, Romagnoli, R, Camagni, S, Colledan, M, Olivieri, T, Di Benedetto, F, Vennarecci, G, Baccarani, U, Lai, Q, Rossi, M, Manzia, T, Tisone, G, Vivarelli, M, Scalera, I, Lupo, L, Andorno, E, Meniconi, R, Ettorre, G, Avolio, A, Agnes, S, Pellegrino, R, Zamboni, F, De Carlis R., Lauterio A., Centonze L., Buscemi V., Schlegel A., Muiesan P., De Carlis L., Carraro A., Ghinolfi D., De Simone P., Ravaioli M., Cescon M., Dondossola D., Bongini M., Mazzaferro V., Pagano D., Gruttadauria S., Gringeri E., Cillo U., Patrono D., Romagnoli R., Camagni S., Colledan M., Olivieri T., Di Benedetto F., Vennarecci G., Baccarani U., Lai Q., Rossi M., Manzia T. M., Tisone G., Vivarelli M., Scalera I., Lupo L. G., Andorno E., Meniconi R. L., Ettorre G. M., Avolio A. W., Agnes S., Pellegrino R. A., and Zamboni F.

Abstract

Background: Normothermic regional perfusion (NRP) and machine perfusion (MP) are variously used in many European centers to improve the outcomes after liver transplantation from donation after circulatory death (DCD). In Italy, a combination of NRP and subsequent MP has been used since the start of the activity. While NRP is mandatory for every DCD recovery, the subsequent use of MP is left to each center. Methods: We have designed a national survey to investigate practices and policies of these techniques. The questionnaire included 46 questions and was distributed to all the 21 Italian centers using an online form between June and July 2021. Results: The overall response rate was 100%. A local NRP program for controlled Maastricht type 3 DCD was active in 11/21 (52.4%) centers. Organization and availability of personnel were perceived as the main difficulties in starting such a program. Between 2015 and 2020, 119 DCD livers were transplanted, with an overall utilization rate of 69.2%. Pump flow and gross aspect were considered the most reliable parameters in liver selection during NRP. Eight (72.7%) centers adopted subsequent hypothermic MP, 1 (9.1%) center normothermic MP, and the remaining 2 (18.2%) used both MP types. Conclusion: This first snapshot survey shows that NRP with subsequent MP is the most used protocol in Italy for DCD livers, although some heterogeneity exists in the type and purpose of MP between centers. Overall, this policy ensures a high utilization rate, considering the high risk of the DCD donor population in Italy. Graphical abstract: [Figure not available: see fulltext.]

Published
2022

6. Liver transplantation in patients with non-neoplastic portal vein thrombosis: 20 years of experience in a single center

Author

Pinelli, D, Camagni, S, Amaduzzi, A, Frosio, F, Fontanella, L, Carioli, G, Guizzetti, M, Zambelli, M, Giovanelli, M, Fagiuoli, S, Colledan, M, Pinelli D., Camagni S., Amaduzzi A., Frosio F., Fontanella L., Carioli G., Guizzetti M., Zambelli M. F., Giovanelli M., Fagiuoli S., Colledan M., Pinelli, D, Camagni, S, Amaduzzi, A, Frosio, F, Fontanella, L, Carioli, G, Guizzetti, M, Zambelli, M, Giovanelli, M, Fagiuoli, S, Colledan, M, Pinelli D., Camagni S., Amaduzzi A., Frosio F., Fontanella L., Carioli G., Guizzetti M., Zambelli M. F., Giovanelli M., Fagiuoli S., and Colledan M.

Abstract

Background: The Yerdel classification is widely used for describing the severity of portal vein thrombosis (PVT) in liver transplant (LT) candidates, but might not accurately predict transplant outcome. Methods: We retrospectively analyzed data regarding 97 adult patients with PVT who underwent LT, investigating whether the complexity of portal reconstruction could better correlate with transplant outcome than the site and extent of the thrombosis. Results: 79/97 (80%) patients underwent thrombectomy and anatomical anastomosis (TAA), 18/97 (20%) patients underwent non-anatomical physiological reconstructions (non-TAA). PVT Yerdel grade was 1–2 in 72/97 (74%) patients, and 3–4 in 25/97 (26%) patients. Univariate analysis revealed higher 30-day mortality, 90-day mortality, 1-year mortality, and a higher rate of severe early complications in the non-TAA group than in the TAA group (p =.018,.001,.014,.009, respectively). In the model adjusted for PVT Yerdel grade, non-TAA remained independently associated with higher 30-day, 90-day, and 1-year mortality (p =.021,.007, and.015, respectively). The portal vein re-thrombosis and overall patient and graft survival rates were similar. Discussion: In our experience, the complexity of portal reconstruction better correlated with transplant outcome than the Yerdel classification, which did not even appear to be a reliable predictor of the surgical complexity and technique.

Published
2022

7. Successful Lung Transplantation From a Donor With Previous Severe COVID-19 Pneumonia

Author

Camagni, S, Di Marco, F, Sani, E, Beretta, M, Legittimo, F, Pinelli, D, Colledan, M, Camagni, Stefania, Di Marco, Fabiano, Sani, Emanuele, Beretta, Marta, Legittimo, Francesco, Pinelli, Domenico, Colledan, Michele, Camagni, S, Di Marco, F, Sani, E, Beretta, M, Legittimo, F, Pinelli, D, Colledan, M, Camagni, Stefania, Di Marco, Fabiano, Sani, Emanuele, Beretta, Marta, Legittimo, Francesco, Pinelli, Domenico, and Colledan, Michele

Abstract

Lungs from donors with previous COVID-19 could become a precious resource if proved safe. So far, only 3 successful lung transplantations from donors with previous mild COVID-19 have been reported. We describe a successful bilateral sequential lung transplantation from a donor who, 10 months before, had developed severe COVID-19 acute respiratory distress syndrome. No donor-derived viral transmission occurred, and 12 months after transplantation, the recipient's lung function is normal. In the presence of normal results of bronchoalveolar lavage and adequate functional and morphologic parameters, even a history of severe COVID-19 acute respiratory distress syndrome might not be considered a contraindication to lung donation.

Published
2023

8. Venous outflow obstruction in pediatric left lateral segment split liver transplantation

Author

Pinelli, D, Sansotta, N, Cavallin, F, Marra, P, Deiro, G, Camagni, S, Bonanomi, E, Sironi, S, Antiga, L, Colledan, M, Pinelli, Domenico, Sansotta, Naire, Cavallin, Francesco, Marra, Paolo, Deiro, Giacomo, Camagni, Stefania, Bonanomi, Ezio, Sironi, Sandro, Antiga, Lorenzo D', Colledan, Michele, Pinelli, D, Sansotta, N, Cavallin, F, Marra, P, Deiro, G, Camagni, S, Bonanomi, E, Sironi, S, Antiga, L, Colledan, M, Pinelli, Domenico, Sansotta, Naire, Cavallin, Francesco, Marra, Paolo, Deiro, Giacomo, Camagni, Stefania, Bonanomi, Ezio, Sironi, Sandro, Antiga, Lorenzo D', and Colledan, Michele

Abstract

Background: Venous outflow obstruction (VOO) is a known cause of graft and patient loss after pediatric liver transplantation (LT). We analyzed the incidence, risk factors, diagnosis, management, and outcome of VOO in a large, consecutive series of left lateral segment (LLS) split LT with end-to-side triangular venous anastomosis. Methods: We evaluated data collected in our prospective databases relative to all consecutive pediatric liver transplants performed from January 2006 to December 2021. We included in this study children undergoing LLS split liver transplant with end-to-side triangular anastomosis. Diagnosis of VOO was based on clinical suspicion and radiological confirmation. Results: VOO occurred in 24/279 transplants (8.6%), and it was associated with lower graft weight (p = .04), re-transplantation (p = .008), and presence of two hepatic veins (p < .0001). In presence of two segmental veins' orifices, the type of reconstruction (single anastomosis after venoplasty or double anastomosis) was not significantly related to VOO (p = .87). Multivariable analysis indicated VOO as a risk factor for graft lost (hazard ratio 3.21, 95% confidence interval 1.22-8.46; p = .01). Percutaneous Transluminal Angioplasty (PTA) was effective in 17/22 (77%) transplants. Surgical anastomosis was redone in one case. Overall six grafts (25%) were lost. Conclusion: VOO after LLS split LT with end-to-side triangular anastomosis is an unusual but critical complication leading to graft loss in a quarter of cases. The occurrence of VOO was associated with lower graft weight, re-transplantation, and presence of two hepatic veins. PTA was safe and effective to restore proper venous outflow in most cases.

Published
2023

9. Current practice of normothermic regional perfusion and machine perfusion in donation after circulatory death liver transplants in Italy

Author

De Carlis, R., Lauterio, A., Centonze, L., Buscemi, V., Schlegel, A., Muiesan, P., De Carlis, L., Carraro, A., Ghinolfi, D., De Simone, P., Ravaioli, M., Cescon, M., Dondossola, D., Bongini, M., Mazzaferro, V., Pagano, D., Gruttadauria, S., Gringeri, E., Cillo, U., Patrono, D., Romagnoli, R., Camagni, S., Colledan, M., Olivieri, T., Di Benedetto, F., Vennarecci, G., Baccarani, U., Lai, Q., Rossi, M., Manzia, T. M., Tisone, G., Vivarelli, M., Scalera, I., Lupo, L. G., Andorno, E., Meniconi, R. L., Ettorre, G. M., Avolio, A. W., Agnes, S., Pellegrino, R. A., Zamboni, F., De Carlis, R, Lauterio, A, Centonze, L, Buscemi, V, Schlegel, A, Muiesan, P, De Carlis, L, Carraro, A, Ghinolfi, D, De Simone, P, Ravaioli, M, Cescon, M, Dondossola, D, Bongini, M, Mazzaferro, V, Pagano, D, Gruttadauria, S, Gringeri, E, Cillo, U, Patrono, D, Romagnoli, R, Camagni, S, Colledan, M, Olivieri, T, Di Benedetto, F, Vennarecci, G, Baccarani, U, Lai, Q, Rossi, M, Manzia, T, Tisone, G, Vivarelli, M, Scalera, I, Lupo, L, Andorno, E, Meniconi, R, Ettorre, G, Avolio, A, Agnes, S, Pellegrino, R, and Zamboni, F

Subjects
Warm ischemia, Hypothermic oxygenated perfusion, Ischemic-type biliary lesions, Liver preservation, Liver utilization, Graft Survival, Organ Preservation, Ischemic-type biliary lesion, Tissue Donors, Settore MED/18, Liver Transplantation, Perfusion, Humans, Surgery
Abstract

Background: Normothermic regional perfusion (NRP) and machine perfusion (MP) are variously used in many European centers to improve the outcomes after liver transplantation from donation after circulatory death (DCD). In Italy, a combination of NRP and subsequent MP has been used since the start of the activity. While NRP is mandatory for every DCD recovery, the subsequent use of MP is left to each center. Methods: We have designed a national survey to investigate practices and policies of these techniques. The questionnaire included 46 questions and was distributed to all the 21 Italian centers using an online form between June and July 2021. Results: The overall response rate was 100%. A local NRP program for controlled Maastricht type 3 DCD was active in 11/21 (52.4%) centers. Organization and availability of personnel were perceived as the main difficulties in starting such a program. Between 2015 and 2020, 119 DCD livers were transplanted, with an overall utilization rate of 69.2%. Pump flow and gross aspect were considered the most reliable parameters in liver selection during NRP. Eight (72.7%) centers adopted subsequent hypothermic MP, 1 (9.1%) center normothermic MP, and the remaining 2 (18.2%) used both MP types. Conclusion: This first snapshot survey shows that NRP with subsequent MP is the most used protocol in Italy for DCD livers, although some heterogeneity exists in the type and purpose of MP between centers. Overall, this policy ensures a high utilization rate, considering the high risk of the DCD donor population in Italy. Graphical abstract: [Figure not available: see fulltext.]

Published
2022

10. A Multicentric Evaluation of Pediatric Lung Transplantation in Italy

Author

Schiavon, M, Camagni, S, Venuta, F, Rosso, L, Boffini, M, Parisi, F, Bertani, A, Meloni, F, Paladini, P, Faccioli, E, Colledan, M, Diso, D, Cattaneo, M, Scalini, F, Alfieri, S, Morosini, M, Luzzi, L, Lorenzoni, G, Dell'Amore, A, Rea, F, Schiavon M, Camagni S, Venuta F, Rosso L, Boffini M, Parisi F, Bertani A, Meloni F, Paladini P, Faccioli E, Colledan M, Diso D, Cattaneo M, Scalini F, Alfieri S, Morosini M, Luzzi L, Lorenzoni G, Dell'Amore A, Rea F, Schiavon, M, Camagni, S, Venuta, F, Rosso, L, Boffini, M, Parisi, F, Bertani, A, Meloni, F, Paladini, P, Faccioli, E, Colledan, M, Diso, D, Cattaneo, M, Scalini, F, Alfieri, S, Morosini, M, Luzzi, L, Lorenzoni, G, Dell'Amore, A, Rea, F, Schiavon M, Camagni S, Venuta F, Rosso L, Boffini M, Parisi F, Bertani A, Meloni F, Paladini P, Faccioli E, Colledan M, Diso D, Cattaneo M, Scalini F, Alfieri S, Morosini M, Luzzi L, Lorenzoni G, Dell'Amore A, and Rea F

Published
2021

11. Third-party bone marrow-derived mesenchymal stromal cell infusion before liver transplantation: A randomized controlled trial

Author

Casiraghi, F, Perico, N, Podesta, M, Todeschini, M, Zambelli, M, Colledan, M, Camagni, S, Fagiuoli, S, Pinna, A, Cescon, M, Bertuzzo, V, Maroni, L, Introna, M, Capelli, C, Golay, J, Buzzi, M, Mister, M, Ordonez, P, Breno, M, Mele, C, Villa, A, Remuzzi, G, Casiraghi F, Perico N, Podesta MA, Todeschini M, Zambelli M, Colledan M, Camagni S, Fagiuoli S, Pinna AD, Cescon M, Bertuzzo V, Maroni L, Introna M, Capelli C, Golay JT, Buzzi M, Mister M, Ordonez PYR, Breno M, Mele C, Villa A, Remuzzi G, Casiraghi, F, Perico, N, Podesta, M, Todeschini, M, Zambelli, M, Colledan, M, Camagni, S, Fagiuoli, S, Pinna, A, Cescon, M, Bertuzzo, V, Maroni, L, Introna, M, Capelli, C, Golay, J, Buzzi, M, Mister, M, Ordonez, P, Breno, M, Mele, C, Villa, A, Remuzzi, G, Casiraghi F, Perico N, Podesta MA, Todeschini M, Zambelli M, Colledan M, Camagni S, Fagiuoli S, Pinna AD, Cescon M, Bertuzzo V, Maroni L, Introna M, Capelli C, Golay JT, Buzzi M, Mister M, Ordonez PYR, Breno M, Mele C, Villa A, and Remuzzi G

Abstract

Mesenchymal stromal cells (MSC) have emerged as a promising therapy to minimize the immunosuppressive regimen or induce tolerance in solid organ transplantation. In this randomized open-label phase Ib/IIa clinical trial, 20 liver transplant patients were randomly allocated (1:1) to receive a single pretransplant intravenous infusion of third-party bone marrow-derived MSC or standard of care alone. The primary endpoint was the safety profile of MSC administration during the 1-year follow-up. In all, 19 patients completed the study, and none of those who received MSC experienced infusion-related complications. The incidence of serious and non-serious adverse events was similar in the two groups. Circulating Treg/memory Treg and tolerant NK subset of CD56(bright) NK cells increased slightly over baseline, albeit not to a statistically significant extent, in MSC-treated patients but not in the control group. Graft function and survival, as well as histologic parameters and intragraft expression of tolerance-associated transcripts in 1-year protocol biopsies were similar in the two groups. In conclusion, pretransplant MSC infusion in liver transplant recipients was safe and induced mild positive changes in immunoregulatory T and NK cells in the peripheral blood. This study opens the way for a trial on possible tolerogenic efficacy of MSC in liver transplantation. ClinicalTrials.gov identifier: NCT02260375.

Published
2021

12. How to preserve liver grafts from circulatory death with long warm ischemia? a retrospective italian cohort study with normothermic regional perfusion and hypothermic oxygenated perfusion

Author

De Carlis, R, Schlegel, A, Frassoni, S, Olivieri, T, Ravaioli, M, Camagni, S, Patrono, D, Bassi, D, Pagano, D, Di Sandro, S, Lauterio, A, Bagnardi, V, Gruttadauria, S, Cillo, U, Romagnoli, R, Colledan, M, Cescon, M, Di Benedetto, F, Muiesan, P, De Carlis, L, De Carlis R., Schlegel A., Frassoni S., Olivieri T., Ravaioli M., Camagni S., Patrono D., Bassi D., Pagano D., Di Sandro S., Lauterio A., Bagnardi V., Gruttadauria S., Cillo U., Romagnoli R., Colledan M., Cescon M., Di Benedetto F., Muiesan P., De Carlis L., De Carlis, R, Schlegel, A, Frassoni, S, Olivieri, T, Ravaioli, M, Camagni, S, Patrono, D, Bassi, D, Pagano, D, Di Sandro, S, Lauterio, A, Bagnardi, V, Gruttadauria, S, Cillo, U, Romagnoli, R, Colledan, M, Cescon, M, Di Benedetto, F, Muiesan, P, De Carlis, L, De Carlis R., Schlegel A., Frassoni S., Olivieri T., Ravaioli M., Camagni S., Patrono D., Bassi D., Pagano D., Di Sandro S., Lauterio A., Bagnardi V., Gruttadauria S., Cillo U., Romagnoli R., Colledan M., Cescon M., Di Benedetto F., Muiesan P., and De Carlis L.

Abstract

Background. Donation after circulatory death (DCD) in Italy, given its 20-min stand-off period, provides a unique bench test for normothermic regional perfusion (NRP) and dual hypothermic oxygenated machine perfusion (D-HOPE). Methods. We coordinated a multicenter retrospective Italian cohort study with 44 controlled DCD donors, who underwent NRP, to present transplant characteristics and results. To rank our results according to the high donor risk, we matched and compared a subgroup of 37 controlled DCD livers, preserved with NRP and D-HOPE, with static-preserved controlled DCD transplants from an established European program. Results. In the Italian cohort, D-HOPE was used in 84% of cases, and the primary nonfunction rate was 5%. Compared with the matched comparator group, the NRP + D-HOPE group showed a lower incidence of moderate and severe acute kidney injury (stage 2: 8% versus 27% and stage 3: 3% versus 27%; P = 0.001). Ischemic cholangiopathy remained low (2-y proportion free: 97% versus 92%; P = 0.317), despite the high-risk profile resulting from the longer donor warm ischemia in Italy (40 versus 18 min; P < 0.001). Conclusions. These data suggest that NRP and D-HOPE yield good results in DCD livers with prolonged warm ischemia.

Published
2021

13. Development and Validation of a Comprehensive Model to Estimate Early Allograft Failure among Patients Requiring Early Liver Retransplant

Author

Avolio, A, Franco, A, Schlegel, A, Lai, Q, Meli, S, Burra, P, Patrono, D, Ravaioli, M, Bassi, D, Ferla, F, Pagano, D, Violi, P, Camagni, S, Dondossola, D, Montalti, R, Alrawashdeh, W, Vitale, A, Teofili, L, Spoletini, G, Magistri, P, Bongini, M, Rossi, M, Mazzaferro, V, Di Benedetto, F, Hammond, J, Vivarelli, M, Agnes, S, Colledan, M, Carraro, A, Cescon, M, De Carlis, L, Caccamo, L, Gruttadauria, S, Muiesan, P, Cillo, U, Romagnoli, R, De Simone, P, Avolio A. W., Franco A., Schlegel A., Lai Q., Meli S., Burra P., Patrono D., Ravaioli M., Bassi D., Ferla F., Pagano D., Violi P., Camagni S., Dondossola D., Montalti R., Alrawashdeh W., Vitale A., Teofili L., Spoletini G., Magistri P., Bongini M., Rossi M., Mazzaferro V., Di Benedetto F., Hammond J., Vivarelli M., Agnes S., Colledan M., Carraro A., Cescon M., De Carlis L., Caccamo L., Gruttadauria S., Muiesan P., Cillo U., Romagnoli R., De Simone P., Avolio, A, Franco, A, Schlegel, A, Lai, Q, Meli, S, Burra, P, Patrono, D, Ravaioli, M, Bassi, D, Ferla, F, Pagano, D, Violi, P, Camagni, S, Dondossola, D, Montalti, R, Alrawashdeh, W, Vitale, A, Teofili, L, Spoletini, G, Magistri, P, Bongini, M, Rossi, M, Mazzaferro, V, Di Benedetto, F, Hammond, J, Vivarelli, M, Agnes, S, Colledan, M, Carraro, A, Cescon, M, De Carlis, L, Caccamo, L, Gruttadauria, S, Muiesan, P, Cillo, U, Romagnoli, R, De Simone, P, Avolio A. W., Franco A., Schlegel A., Lai Q., Meli S., Burra P., Patrono D., Ravaioli M., Bassi D., Ferla F., Pagano D., Violi P., Camagni S., Dondossola D., Montalti R., Alrawashdeh W., Vitale A., Teofili L., Spoletini G., Magistri P., Bongini M., Rossi M., Mazzaferro V., Di Benedetto F., Hammond J., Vivarelli M., Agnes S., Colledan M., Carraro A., Cescon M., De Carlis L., Caccamo L., Gruttadauria S., Muiesan P., Cillo U., Romagnoli R., and De Simone P.

Abstract

Importance: Expansion of donor acceptance criteria for liver transplant increased the risk for early allograft failure (EAF), and although EAF prediction is pivotal to optimize transplant outcomes, there is no consensus on specific EAF indicators or timing to evaluate EAF. Recently, the Liver Graft Assessment Following Transplantation (L-GrAFT) algorithm, based on aspartate transaminase, bilirubin, platelet, and international normalized ratio kinetics, was developed from a single-center database gathered from 2002 to 2015. Objective: To develop and validate a simplified comprehensive model estimating at day 10 after liver transplant the EAF risk at day 90 (the Early Allograft Failure Simplified Estimation [EASE] score) and, secondarily, to identify early those patients with unsustainable EAF risk who are suitable for retransplant. Design, Setting, and Participants: This multicenter cohort study was designed to develop a score capturing a continuum from normal graft function to nonfunction after transplant. Both parenchymal and vascular factors, which provide an indication to list for retransplant, were included among the EAF determinants. The L-GrAFT kinetic approach was adopted and modified with fewer data entries and novel variables. The population included 1609 patients in Italy for the derivation set and 538 patients in the UK for the validation set; all were patients who underwent transplant in 2016 and 2017. Main Outcomes and Measures: Early allograft failure was defined as graft failure (codified by retransplant or death) for any reason within 90 days after transplant. Results: At day 90 after transplant, the incidence of EAF was 110 of 1609 patients (6.8%) in the derivation set and 41 of 538 patients (7.6%) in the external validation set. Median (interquartile range) ages were 57 (51-62) years in the derivation data set and 56 (49-62) years in the validation data set. The EASE score was developed through 17 entries derived from 8 variables, including the Mod

Published
2020

14. Full-Left Full-Right Split Liver Transplantation

Author

Cillo, U, DeCarlis, L, Camagni, S, Colledan, M, Camagni S, Colledan M, Cillo, U, DeCarlis, L, Camagni, S, Colledan, M, Camagni S, and Colledan M

Abstract

Full-left full-right split liver transplantation (FLFR SLT) is the division of a deceased donor liver into two similarly sized grafts and the subsequent transplantation of each of them into two adult-sized recipients. It may be considered an evolution from conventional SLT aiming at expanding the number of adult transplants and providing otherwise hardly available size-matched grafts for large children and adolescents. Its development has been supported by both growing experience in adult-to-adult living donor liver transplantation (LDLT) and advances in resectional liver surgery. Controversial outcomes have been reported so far, but most of the largest series worldwide have shown comparable results to those achieved by the most common approaches, namely whole liver transplantation (WLT) in Europe and the United States and LDLT in Asia. Actually, FLFR SLT is extremely demanding and its possible success is multifactorial. Not only optimal organs from the best donors should be used, but the most favorable donor-to-recipient matching should be pursued. Moreover, FLFR SLT requires high levels of technical skills and expertise in liver transplantation, usually typical of high-volume transplant and hepatobiliary surgery centers. Finally, a split liver-oriented allocation policy encouraging graft sharing appears crucial for its implementation. So, in the presence of the above-mentioned conditions, FLFR SLT may become a safe and effective strategy to increase the number of adult transplants and to facilitate transplantation of large children and adolescents.

Published
2020

15. Airway complications after lung transplantation: risk factors and survival

Author

Sanfilippo, C, Tarantini, F, Imeri, G, Conti, C, Camagni, S, Consonni, F, Ciaravino, G, Comandini, S, Parigi, P, Raimondi, F, Vedovati, S, Colledan, M, Di Marco, F, Sanfilippo CM, Tarantini F, Imeri G, Conti C, Camagni S, Consonni F, Ciaravino G, Comandini S, Parigi P, Raimondi F, Vedovati S, Colledan M, Di Marco F, Sanfilippo, C, Tarantini, F, Imeri, G, Conti, C, Camagni, S, Consonni, F, Ciaravino, G, Comandini, S, Parigi, P, Raimondi, F, Vedovati, S, Colledan, M, Di Marco, F, Sanfilippo CM, Tarantini F, Imeri G, Conti C, Camagni S, Consonni F, Ciaravino G, Comandini S, Parigi P, Raimondi F, Vedovati S, Colledan M, and Di Marco F

Published
2020

16. Outcome of lung retransplantation: from graft survival to patients' perspective

Author

Comandini, S, Di Marco, F, Imeri, G, Novelli, L, Camagni, S, Colledan, M, Sanfilippo, C, Parigi, P, Lucianetti, A, Pugliese, C, Comandini S, Di Marco F, Imeri G, Novelli L, Camagni S, Colledan M, Sanfilippo CM, Parigi P, Lucianetti A, Pugliese C, Comandini, S, Di Marco, F, Imeri, G, Novelli, L, Camagni, S, Colledan, M, Sanfilippo, C, Parigi, P, Lucianetti, A, Pugliese, C, Comandini S, Di Marco F, Imeri G, Novelli L, Camagni S, Colledan M, Sanfilippo CM, Parigi P, Lucianetti A, and Pugliese C

Published
2020

17. Prolonged preservation by hypothermic machine perfusion facilitates logistics in liver transplantation: a European observational cohort study

Author

Brüggenwirth, I, Mueller, M, Lantinga, V, Camagni, S, De Carlis, R, De Carlis, L, Colledan, M, Dondossola, D, Drefs, M, Eden, J, Ghinolfi, D, Koliogiannis, D, Lurje, G, Manzia, T, Monbaliu, D, Muiesan, P, Patrono, D, Pratschke, J, Romagnoli, R, Rayar, M, Roma, F, Schlegel, A, Dutkowski, P, Porte, R, de Meijer, V, Brüggenwirth, Isabel M A, Mueller, Matteo, Lantinga, Veerle A, Camagni, Stefania, De Carlis, Riccardo, De Carlis, Luciano, Colledan, Michele, Dondossola, Daniele, Drefs, Moritz, Eden, Janina, Ghinolfi, Davide, Koliogiannis, Dionysios, Lurje, Georg, Manzia, Tommaso M, Monbaliu, Diethard, Muiesan, Paolo, Patrono, Damiano, Pratschke, Johann, Romagnoli, Renato, Rayar, Michel, Roma, Federico, Schlegel, Andrea, Dutkowski, Philipp, Porte, Robert J, de Meijer, Vincent E, Brüggenwirth, I, Mueller, M, Lantinga, V, Camagni, S, De Carlis, R, De Carlis, L, Colledan, M, Dondossola, D, Drefs, M, Eden, J, Ghinolfi, D, Koliogiannis, D, Lurje, G, Manzia, T, Monbaliu, D, Muiesan, P, Patrono, D, Pratschke, J, Romagnoli, R, Rayar, M, Roma, F, Schlegel, A, Dutkowski, P, Porte, R, de Meijer, V, Brüggenwirth, Isabel M A, Mueller, Matteo, Lantinga, Veerle A, Camagni, Stefania, De Carlis, Riccardo, De Carlis, Luciano, Colledan, Michele, Dondossola, Daniele, Drefs, Moritz, Eden, Janina, Ghinolfi, Davide, Koliogiannis, Dionysios, Lurje, Georg, Manzia, Tommaso M, Monbaliu, Diethard, Muiesan, Paolo, Patrono, Damiano, Pratschke, Johann, Romagnoli, Renato, Rayar, Michel, Roma, Federico, Schlegel, Andrea, Dutkowski, Philipp, Porte, Robert J, and de Meijer, Vincent E

Abstract

A short period (1–2 h) of hypothermic oxygenated machine perfusion (HOPE) after static cold storage is safe and reduces ischemia-reperfusion injury-related complications after liver transplantation. Machine perfusion time is occasionally prolonged for logistical reasons, but it is unknown if prolonged HOPE is safe and compromises outcomes. We conducted a multicenter, observational cohort study of patients transplanted with a liver preserved by prolonged (≥4 h) HOPE. Postoperative biochemistry, complications, and survival were evaluated. The cohort included 93 recipients from 12 European transplant centers between 2014–2021. The most common reason to prolong HOPE was the lack of an available operating room to start the transplant procedure. Grafts underwent HOPE for a median (range) of 4:42 h (4:00–8:35 h) with a total preservation time of 10:50 h (5:50–20:50 h). Postoperative peak ALT was 675 IU/L (interquartile range 419–1378 IU/L). The incidence of postoperative complications was low, and 1-year graft and patient survival were 94% and 88%, respectively. To conclude, good outcomes are achieved after transplantation of donor livers preserved with prolonged (median 4:42 h) HOPE, leading to a total preservation time of almost 21 h. These results suggest that simple, end-ischemic HOPE may be utilized for safe extension of the preservation time to ease transplantation logistics.

Published
2022

18. Physiological reno-portal bypass in liver transplantation with non-tumorous portal vein thrombosis

Author

Pinelli, D, Neri, F, Tornese, S, Amaduzzi, A, Camagni, S, D'Antiga, L, Fagiuoli, S, Colledan, M, Pinelli, Domenico, Neri, Flavia, Tornese, Stefania, Amaduzzi, Annalisa, Camagni, Stefania, D'Antiga, Lorenzo, Fagiuoli, Stefano, Colledan, Michele, Pinelli, D, Neri, F, Tornese, S, Amaduzzi, A, Camagni, S, D'Antiga, L, Fagiuoli, S, Colledan, M, Pinelli, Domenico, Neri, Flavia, Tornese, Stefania, Amaduzzi, Annalisa, Camagni, Stefania, D'Antiga, Lorenzo, Fagiuoli, Stefano, and Colledan, Michele

Abstract

Reno-portal anastomosis (RPA) in presence of spleno-renal shunts (SRS) is a physiological option to restore blood flow in liver transplantation with portal vein thrombosis (PVT). Diffuse splanchnic venous system thrombosis (complex PVT) is its main indication but RPA proved to be useful in selected cases of less extensive thrombosis (non-complex PVT). Up until now only two monocentric and one multicentric case series has been published on this topic in addition to few anecdotal reports. After 2014, we introduced RPA in our institution to manage some cases of complex PVT in presence of SRS. Here, we present the evolution of indication to RPA. From 2014 to 2020, we performed ten RPA: nine patients presented non-complex and one complex PVT. Overall early and late complication rates were 66.6% and 50%, respectively. Two patients developed RPA stenosis, treated by interventional radiology. Self-resolving acute kidney injury (AKI) was observed in three cases. No re-transplantation was necessary. RPA was patent in all patients, with a mean follow-up of 41.9 months. The overall patient survival was 70% at 1 year and 60% at 3 and 5 years. Four patients died at 1, 2, 3 and 20 months from LT. Causes of deaths were, respectively, stroke, cerebral infection, sepsis (MOF) and sudden variceal bleeding in sinusoidal obstruction syndrome. The relative simplicity and effectiveness of RPA in presence of SRS allowed us to rely more and more often on this technique in liver transplantation with challenging non-complex PVT.

Published
2022

19. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation

Author

Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Schlegel, Andrea, van Reeven, Marjolein, Croome, Kristopher, Parente, Alessandro, Dolcet, Annalisa, Widmer, Jeannette, Meurisse, Nicolas, De Carlis, Riccardo, Hessheimer, Amelia, Jochmans, Ina, Mueller, Matteo, van Leeuwen, Otto B, Nair, Amit, Tomiyama, Koji, Sherif, Ahmed, Elsharif, Mohamed, Kron, Philipp, van der Helm, Danny, Borja-Cacho, Daniel, Bohorquez, Humberto, Germanova, Desislava, Dondossola, Daniele, Olivieri, Tiziana, Camagni, Stefania, Gorgen, Andre, Patrono, Damiano, Cescon, Matteo, Croome, Sarah, Panconesi, Rebecca, Flores Carvalho, Mauricio, Ravaioli, Matteo, Caicedo, Juan Carlos, Loss, George, Lucidi, Valerio, Sapisochin, Gonzalo, Romagnoli, Renato, Jassem, Wayel, Colledan, Michele, De Carlis, Luciano, Rossi, Giorgio, Di Benedetto, Fabrizio, Miller, Charles M, van Hoek, Bart, Attia, Magdy, Lodge, Peter, Hernandez-Alejandro, Roberto, Detry, Olivier, Quintini, Cristiano, Oniscu, Gabriel C, Fondevila, Constantino, Malagó, Massimo, Pirenne, Jacques, IJzermans, Jan Nm, Porte, Robert J, Dutkowski, Philipp, Taner, C Burcin, Heaton, Nigel, Clavien, Pierre-Alain, Polak, Wojciech G, Muiesan, Paolo, Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Schlegel, Andrea, van Reeven, Marjolein, Croome, Kristopher, Parente, Alessandro, Dolcet, Annalisa, Widmer, Jeannette, Meurisse, Nicolas, De Carlis, Riccardo, Hessheimer, Amelia, Jochmans, Ina, Mueller, Matteo, van Leeuwen, Otto B, Nair, Amit, Tomiyama, Koji, Sherif, Ahmed, Elsharif, Mohamed, Kron, Philipp, van der Helm, Danny, Borja-Cacho, Daniel, Bohorquez, Humberto, Germanova, Desislava, Dondossola, Daniele, Olivieri, Tiziana, Camagni, Stefania, Gorgen, Andre, Patrono, Damiano, Cescon, Matteo, Croome, Sarah, Panconesi, Rebecca, Flores Carvalho, Mauricio, Ravaioli, Matteo, Caicedo, Juan Carlos, Loss, George, Lucidi, Valerio, Sapisochin, Gonzalo, Romagnoli, Renato, Jassem, Wayel, Colledan, Michele, De Carlis, Luciano, Rossi, Giorgio, Di Benedetto, Fabrizio, Miller, Charles M, van Hoek, Bart, Attia, Magdy, Lodge, Peter, Hernandez-Alejandro, Roberto, Detry, Olivier, Quintini, Cristiano, Oniscu, Gabriel C, Fondevila, Constantino, Malagó, Massimo, Pirenne, Jacques, IJzermans, Jan Nm, Porte, Robert J, Dutkowski, Philipp, Taner, C Burcin, Heaton, Nigel, Clavien, Pierre-Alain, Polak, Wojciech G, and Muiesan, Paolo

Abstract

Background & Aims: The concept of benchmarking is established in the field of transplant surgery; however, benchmark values for donation after circulatory death (DCD) liver transplantation are not available. Thus, we aimed to identify the best possible outcomes in DCD liver transplantation and to propose outcome reference values. Methods: Based on 2,219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1,012 low-risk, primary, adult liver transplantations with a laboratory MELD score of ≤20 points, receiving a DCD liver with a total donor warm ischemia time of ≤30 minutes and asystolic donor warm ischemia time of ≤15 minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the comprehensive complication index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered. Results: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centres. The 1-year retransplant and mortality rates were 4.5% and 8.4% in the benchmark group, respectively. Within the first year of follow-up, 51.1% of recipients developed at least 1 major complication (≥Clavien-Dindo-Grade III). Benchmark cut-offs were ≤3 days and ≤16 days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade III), ≤16.8% for ischemic cholangiopathy, and ≤38.9 CCI points 1 year after transplant. Comparisons with higher risk groups showed more complications and impaired graft survival outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk. Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk grou

Published
2022

20. Development of a model based on case-mix analysis to predict 6-month patient survival and identify futility after liver transplantation: a multicenter Italian study

Author

Avolio, A, Lai, Q, Franco, A, Gruttadauria, S, Bianco, G, Vivarelli, M, Montalti, R, Colledan, M, Camagni, S, Cescon, M, Maroni, L, De Carlis, L, Ferla, F, Rossi, G, Dondossola, D, Mazzaferro, V, Bongini, M, Di Benedetto, F, Magistri, P, Pagano, D, Agnes, S, Spoletini, G, Bassi, D, Rossi, M, Ghinolfi, D, Meli, S, Carraro, A, Violi, P, Patrono, D, Burra, P, De Simone, P, Romagnoli, R, Cillo, U, Avolio A, Lai Q, Franco A, Gruttadauria S, Bianco G, Vivarelli M, Montalti R, Colledan M, Camagni S, Cescon M, Maroni L, De Carlis L, Ferla F, Rossi G, Dondossola D, Mazzaferro V, Bongini M, Di Benedetto F, Magistri P, Pagano D, Agnes S, Spoletini G, Bassi D, Rossi M, Ghinolfi D, Meli S, Carraro A, Violi P, Patrono D, Burra P, De Simone P, Romagnoli R, Cillo U, Avolio, A, Lai, Q, Franco, A, Gruttadauria, S, Bianco, G, Vivarelli, M, Montalti, R, Colledan, M, Camagni, S, Cescon, M, Maroni, L, De Carlis, L, Ferla, F, Rossi, G, Dondossola, D, Mazzaferro, V, Bongini, M, Di Benedetto, F, Magistri, P, Pagano, D, Agnes, S, Spoletini, G, Bassi, D, Rossi, M, Ghinolfi, D, Meli, S, Carraro, A, Violi, P, Patrono, D, Burra, P, De Simone, P, Romagnoli, R, Cillo, U, Avolio A, Lai Q, Franco A, Gruttadauria S, Bianco G, Vivarelli M, Montalti R, Colledan M, Camagni S, Cescon M, Maroni L, De Carlis L, Ferla F, Rossi G, Dondossola D, Mazzaferro V, Bongini M, Di Benedetto F, Magistri P, Pagano D, Agnes S, Spoletini G, Bassi D, Rossi M, Ghinolfi D, Meli S, Carraro A, Violi P, Patrono D, Burra P, De Simone P, Romagnoli R, and Cillo U

Published
2019

21. EAF SCORE, A NOVEL ALGORITHM BASED ON KINETICS OF ALT, BILIRUBIN, PLATELETS AND RECIPIENT DATA TO PREDICT EARLY ALLOGRAFT FAILURE AT 30 AND 90 DAYS AFTER LIVER TRASPLANTATION. A MULTICENTRE ITALIAN STUDY WITH UK VALIDATION

Author

Avolio, A, Franco, A, Lai, Q, Gruttadauria, S, Caccamo, L, Colledan, M, Agnes, S, Vivarelli, M, Mazzaferro, V, Di Benedetto, F, Rossi, M, Tedeschi, U, De Carlis, L, Cescon, M, Meli, S, Spoletini, G, Ghinolfi, D, Patrono, D, Pagano, D, Dondossola, D, Tandoi, F, Camagni, S, Montalti, R, Bongini, M, Bassi, D, Violi, P, Magistri, P, Ferla, F, Ravaioli, M, Hammond, J, Alrawashdeh, W, Schlegel, A, Muiesan, P, Romagnoli, R, Cillo, U, De Simone, P, Avolio A, Franco A, Lai Q, Gruttadauria S, Caccamo L, Colledan M, Agnes S, Vivarelli M, Mazzaferro V, Di Benedetto F, Rossi M, Tedeschi U, De Carlis L, Cescon M, Meli S, Spoletini G, Ghinolfi D, Patrono D, Pagano D, Dondossola D, Tandoi F, Camagni S, Montalti R, Bongini M, Bassi D, Violi P, Magistri P, Ferla F, Ravaioli M, Hammond J, Alrawashdeh W, Schlegel A, Muiesan P, Romagnoli R, Cillo U, De Simone P, Avolio, A, Franco, A, Lai, Q, Gruttadauria, S, Caccamo, L, Colledan, M, Agnes, S, Vivarelli, M, Mazzaferro, V, Di Benedetto, F, Rossi, M, Tedeschi, U, De Carlis, L, Cescon, M, Meli, S, Spoletini, G, Ghinolfi, D, Patrono, D, Pagano, D, Dondossola, D, Tandoi, F, Camagni, S, Montalti, R, Bongini, M, Bassi, D, Violi, P, Magistri, P, Ferla, F, Ravaioli, M, Hammond, J, Alrawashdeh, W, Schlegel, A, Muiesan, P, Romagnoli, R, Cillo, U, De Simone, P, Avolio A, Franco A, Lai Q, Gruttadauria S, Caccamo L, Colledan M, Agnes S, Vivarelli M, Mazzaferro V, Di Benedetto F, Rossi M, Tedeschi U, De Carlis L, Cescon M, Meli S, Spoletini G, Ghinolfi D, Patrono D, Pagano D, Dondossola D, Tandoi F, Camagni S, Montalti R, Bongini M, Bassi D, Violi P, Magistri P, Ferla F, Ravaioli M, Hammond J, Alrawashdeh W, Schlegel A, Muiesan P, Romagnoli R, Cillo U, and De Simone P

Published
2019

22. EASE SCORE, NOVEL ALGORITHM BASED ON KINETICS OF AST, BILIRUBIN, PLATELETS AND RECIPIENT DATA TO PREDICT EARLY ALLOGRAFT FAILURE. AN ITALIAN MULTICENTER STUDY DESIGNED IN THE PERSPECTIVE OF LIVER RE-TRANSPLANTATION WITH UK VALIDATION

Author

Franco, A, De Simone, P, Schlegel, A, Lai, Q, Burra, P, Patrono, D, Meli, S, Ravaioli, M, Bassi, D, Ferla, F, Pagano, D, Violi, P, Camagni, S, Dondossola, D, Montalti, R, Alrawashdeh, W, Vitale, A, Teofili, L, Ghinolfi, D, Spoletini, G, Maroni, L, Nicolotti, N, Magistri, P, Pastena, D, Bongini, M, Rossi, M, Mazzaferro, V, Di Benedetto, F, Hammond, J, Vivarelli, M, Agnes, S, Colledan, M, Carraro, A, De Carlis, L, Cescon, M, Caccamo, L, Gruttadauria, S, Muiesan, P, Cillo, U, Romagnoli, R, Avolio, A, Franco A, De Simone P, Schlegel A, Lai Q, Burra P, Patrono D, Meli S, Ravaioli M, Bassi D, Ferla F, Pagano D, Violi P, Camagni S, Dondossola D, Montalti R, Alrawashdeh W, Vitale A, Teofili L, Ghinolfi D, Spoletini G, Maroni L, Nicolotti N, Magistri P, Pastena D, Bongini M, Rossi M, Mazzaferro V, Di Benedetto F, Hammond J, Vivarelli M, Agnes S, Colledan M, Carraro A, De Carlis L, Cescon M, Caccamo L, Gruttadauria S, Muiesan P, Cillo U, Romagnoli R, Avolio A, Franco, A, De Simone, P, Schlegel, A, Lai, Q, Burra, P, Patrono, D, Meli, S, Ravaioli, M, Bassi, D, Ferla, F, Pagano, D, Violi, P, Camagni, S, Dondossola, D, Montalti, R, Alrawashdeh, W, Vitale, A, Teofili, L, Ghinolfi, D, Spoletini, G, Maroni, L, Nicolotti, N, Magistri, P, Pastena, D, Bongini, M, Rossi, M, Mazzaferro, V, Di Benedetto, F, Hammond, J, Vivarelli, M, Agnes, S, Colledan, M, Carraro, A, De Carlis, L, Cescon, M, Caccamo, L, Gruttadauria, S, Muiesan, P, Cillo, U, Romagnoli, R, Avolio, A, Franco A, De Simone P, Schlegel A, Lai Q, Burra P, Patrono D, Meli S, Ravaioli M, Bassi D, Ferla F, Pagano D, Violi P, Camagni S, Dondossola D, Montalti R, Alrawashdeh W, Vitale A, Teofili L, Ghinolfi D, Spoletini G, Maroni L, Nicolotti N, Magistri P, Pastena D, Bongini M, Rossi M, Mazzaferro V, Di Benedetto F, Hammond J, Vivarelli M, Agnes S, Colledan M, Carraro A, De Carlis L, Cescon M, Caccamo L, Gruttadauria S, Muiesan P, Cillo U, Romagnoli R, and Avolio A

Published
2019

23. CASE-MIX MODELS TO PREDICT 6-MONTH PATIENT SURVIVAL AND IDENTIFY FUTILITY AFTER LIVER TRANSPLANTATION: A MULTICENTER ITALIAN STUDY

Author

Avolio, A, Lai, Q, Franco, A, Gruttadauria, S, Nure, E, Vivarelli, M, Montalti, R, Colledan, M, Camagni, S, Cescon, M, Maroni, M, De Carlis, L, Ferla, F, Rossi, G, Dondossola, D, Mazzaferro, V, Bongini, M, Morelli, M, Di Benedetto, F, Magistri, P, Pagano, D, Agnes, S, Pascale, M, Bassi, D, Rossi, M, Ghinolfi, D, Meli, S, Carraro, A, Violi, P, Patrono, P, Burra, P, De Simone, P, Romagnoli, R, Cillo, U, Avolio A, Lai Q, Franco A, Gruttadauria S, Nure E, Vivarelli M, Montalti R, Colledan M, Camagni S, Cescon M, Maroni M, De Carlis L, Ferla F, Rossi G, Dondossola D, Mazzaferro V, Bongini M, Morelli MC, Di Benedetto F, Magistri P, Pagano D, Agnes S, Pascale MM, Bassi D, Rossi M, Ghinolfi D, Meli S, Carraro A, Violi P, Patrono P, Burra P, De Simone P, Romagnoli R, Cillo U, Avolio, A, Lai, Q, Franco, A, Gruttadauria, S, Nure, E, Vivarelli, M, Montalti, R, Colledan, M, Camagni, S, Cescon, M, Maroni, M, De Carlis, L, Ferla, F, Rossi, G, Dondossola, D, Mazzaferro, V, Bongini, M, Morelli, M, Di Benedetto, F, Magistri, P, Pagano, D, Agnes, S, Pascale, M, Bassi, D, Rossi, M, Ghinolfi, D, Meli, S, Carraro, A, Violi, P, Patrono, P, Burra, P, De Simone, P, Romagnoli, R, Cillo, U, Avolio A, Lai Q, Franco A, Gruttadauria S, Nure E, Vivarelli M, Montalti R, Colledan M, Camagni S, Cescon M, Maroni M, De Carlis L, Ferla F, Rossi G, Dondossola D, Mazzaferro V, Bongini M, Morelli MC, Di Benedetto F, Magistri P, Pagano D, Agnes S, Pascale MM, Bassi D, Rossi M, Ghinolfi D, Meli S, Carraro A, Violi P, Patrono P, Burra P, De Simone P, Romagnoli R, and Cillo U

Published
2019

24. A national mandatory-split liver policy: A report from the Italian experience

Author

Angelico, R, Trapani, S, Spada, M, Colledan, M, de Ville de Goyet, J, Salizzoni, M, De Carlis, L, Andorno, E, Gruttadauria, S, Ettorre, G, Cescon, M, Rossi, G, Risaliti, A, Tisone, G, Tedeschi, U, Vivarelli, M, Agnes, S, De Simone, P, Lupo, L, Di Benedetto, F, Santaniello, W, Zamboni, F, Mazzaferro, V, Rossi, M, Puoti, F, Camagni, S, Grimaldi, C, Gringeri, E, Rizzato, L, Nanni Costa, A, Cillo, U, Angelico R., Trapani S., Spada M., Colledan M., de Ville de Goyet J., Salizzoni M., De Carlis L., Andorno E., Gruttadauria S., Ettorre G. M., Cescon M., Rossi G., Risaliti A., Tisone G., Tedeschi U., Vivarelli M., Agnes S., De Simone P., Lupo L. G., Di Benedetto F., Santaniello W., Zamboni F., Mazzaferro V., Rossi M., Puoti F., Camagni S., Grimaldi C., Gringeri E., Rizzato L., Nanni Costa A., Cillo U., Angelico, R, Trapani, S, Spada, M, Colledan, M, de Ville de Goyet, J, Salizzoni, M, De Carlis, L, Andorno, E, Gruttadauria, S, Ettorre, G, Cescon, M, Rossi, G, Risaliti, A, Tisone, G, Tedeschi, U, Vivarelli, M, Agnes, S, De Simone, P, Lupo, L, Di Benedetto, F, Santaniello, W, Zamboni, F, Mazzaferro, V, Rossi, M, Puoti, F, Camagni, S, Grimaldi, C, Gringeri, E, Rizzato, L, Nanni Costa, A, Cillo, U, Angelico R., Trapani S., Spada M., Colledan M., de Ville de Goyet J., Salizzoni M., De Carlis L., Andorno E., Gruttadauria S., Ettorre G. M., Cescon M., Rossi G., Risaliti A., Tisone G., Tedeschi U., Vivarelli M., Agnes S., De Simone P., Lupo L. G., Di Benedetto F., Santaniello W., Zamboni F., Mazzaferro V., Rossi M., Puoti F., Camagni S., Grimaldi C., Gringeri E., Rizzato L., Nanni Costa A., and Cillo U.

Abstract

To implement split liver transplantation (SLT) a mandatory-split policy has been adopted in Italy since August 2015: donors aged 18-50 years at standard risk are offered for SLT, resulting in a left-lateral segment (LLS) graft for children and an extended-right graft (ERG) for adults. We aim to analyze the impact of the new mandatory-split policy on liver transplantation (LT)-waiting list and SLT outcomes, compared to old allocation policy. Between August 2015 and December 2016 out of 413 potentially “splittable” donors, 252 (61%) were proposed for SLT, of whom 53 (21%) donors were accepted for SLT whereas 101 (40.1%) were excluded because of donor characteristics and 98 (38.9%) for absence of suitable pediatric recipients. The SLT rate augmented from 6% to 8.4%. Children undergoing SLT increased from 49.3% to 65.8% (P =.009) and the pediatric LT-waiting list time dropped (229 [10-2121] vs 80 [12-2503] days [P =.045]). The pediatric (4.5% vs 2.5% [P =.398]) and adult (9.7% to 5.2% [P <.001]) LT-waiting list mortality reduced; SLT outcomes remained stable. Retransplantation (HR = 2.641, P =.035) and recipient weight >20 kg (HR = 5.113, P =.048) in LLS, and ischemic time >8 hours (HR = 2.475, P =.048) in ERG were identified as predictors of graft failure. A national mandatory-split policy maximizes the SLT donor resources, whose selection criteria can be safely expanded, providing favorable impact on the pediatric LT-waiting list and priority for adult sick LT candidates.

Published
2019

27. Mycotic aneurysm of the hepatic artery in pediatric liver transplantation: A case series and literature review

Author

Camagni, S, Stroppa, P, Tebaldi, A, Lucianetti, A, Pinelli, D, Pellicioli, I, D'Antiga, L, Colledan, M, Camagni S, Stroppa P, Tebaldi A, Lucianetti A, Pinelli D, Pellicioli I, D'Antiga L, Colledan M, Camagni, S, Stroppa, P, Tebaldi, A, Lucianetti, A, Pinelli, D, Pellicioli, I, D'Antiga, L, Colledan, M, Camagni S, Stroppa P, Tebaldi A, Lucianetti A, Pinelli D, Pellicioli I, D'Antiga L, and Colledan M

Abstract

Mycotic aneurysm of the hepatic artery (HA) is a rare, unpredictable, and potentially lethal complication of liver transplantation (LT). Pediatric LT is not exempt from it but the related literature is rather scanty. We present our experience with post-LT mycotic aneurysm of the HA in pediatric age, describing four cases occurred with a special focus on the possible risk factors for its development and a proposal for the management of high-risk recipients.

Published
2018

29. Development and Validation of a Comprehensive Model to Estimate Early Allograft Failure Among Patients Requiring Early Liver Retransplant

Author

Avolio, Alfonso Wolfango, Franco, A, Schlegel, A, Lai, Q, Meli, S, Burra, P, Patrono, D, Ravaioli, M, Bassi, D, Ferla, F, Pagano, D, Violi, P, Camagni, S, Dondossola, D, Montalti, R, Alrawashdeh, W, Vitale, A, Teofili, Luciana, Spoletini, Gabriele, Magistri, P, Bongini, P, Rossi, M, Mazzaferro, V, Di Benedetto, F, Hammond, J, Vivarelli, M, Agnes, Salvatore, Colledan, M, Carraro, A, Cescon, M, De Carlis, L, Caccamo, L, Gruttadauria, S, Muiesan, P, Cillo, U, Romagnoli, R, De Simone, P, Avolio AW (ORCID:0000-0003-2491-7625), Teofili L (ORCID:0000-0002-7214-1561), Spoletini G (ORCID:0000-0002-6855-4515), Agnes S (ORCID:0000-0002-3341-4221), Avolio, Alfonso Wolfango, Franco, A, Schlegel, A, Lai, Q, Meli, S, Burra, P, Patrono, D, Ravaioli, M, Bassi, D, Ferla, F, Pagano, D, Violi, P, Camagni, S, Dondossola, D, Montalti, R, Alrawashdeh, W, Vitale, A, Teofili, Luciana, Spoletini, Gabriele, Magistri, P, Bongini, P, Rossi, M, Mazzaferro, V, Di Benedetto, F, Hammond, J, Vivarelli, M, Agnes, Salvatore, Colledan, M, Carraro, A, Cescon, M, De Carlis, L, Caccamo, L, Gruttadauria, S, Muiesan, P, Cillo, U, Romagnoli, R, De Simone, P, Avolio AW (ORCID:0000-0003-2491-7625), Teofili L (ORCID:0000-0002-7214-1561), Spoletini G (ORCID:0000-0002-6855-4515), and Agnes S (ORCID:0000-0002-3341-4221)

Abstract

BACKGROUND Expansion of donor acceptance criteria for liver transplantation increased the risk for early allograft failure (EAF). Though EAF prediction is pivotal to optimize transplant outcomes, there is no consensus on specific EAF indicators or timing to evaluate EAF. Recently, the Liver Graft Assessment following Transplantation (L-GrAFT) algorithm, based on aspartate transaminase, bilirubin, platelets, and INR kinetics, has been developed from a single-center database gathered from 2002 to 2015. OBJECTIVE To develop and validate a simplified comprehensive model estimating the EAF risk at day 10 after liver transplantation (the Early Allograft failure Simplified Estimation, EASE score), and, secondarily, to early identify patients with unsustainable EAF risk, suitable for re-transplant. DESIGN This multicenter study was designed to elaborate a score catching the continuum from normal graft function to non-function after transplant. We included among EAF determinants both parenchymal and vascular factors, which provide an indication to list for re-transplant. The L-GrAFT kinetic approach was adopted and modified with less data-entries and novel variables. ClinicalTrials.gov Identifier: NCT03858088. SETTING The patient population included 1,609 Italian patients in the derivation set and 570 UK patients in the validation set, all transplanted in 2016 and 2017. MAIN OUTCOME and MEASURE EAF was defined as graft failure (codified by re-transplant or death) for any reason within day 90 after transplant. RESULTS The EAF incidence was 6.8%. The EASE score was developed through 17 entries derived from 8 variables: MELD, blood transfusions, early thrombosis of hepatic vessels, kinetic parameters of transaminases, platelets and bilirubin. Donor parameters (age, DCD, machine perfusion) were not predictive. Results were adjusted for Center-volume. At ROC curve analysis, the EASE score outperformed L-GrAFT, MEAF, EAD, ET-DRI, DMELD, and DRI scores, predicting day-90 E

Published
2020

31. ALPHA-FETOPROTEIN PROGRESSION SLOPE AS A DISCRIMINANT FACTOR OF RECURRENCE AFTER LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA IN CIRRHOTIC PATIENTS WITHIN MILAN CRITERIA

Author

Nounamo, F, Pinelli, D, Ghirardi, A, Iegri, C, Camagni, S, Magini, G, Licini, L, Fagiuoli, S, Colledan, M, Nounamo F, Pinelli D, Ghirardi A, Iegri C, Camagni S, Magini G, Licini L, Fagiuoli S, Colledan M, Nounamo, F, Pinelli, D, Ghirardi, A, Iegri, C, Camagni, S, Magini, G, Licini, L, Fagiuoli, S, Colledan, M, Nounamo F, Pinelli D, Ghirardi A, Iegri C, Camagni S, Magini G, Licini L, Fagiuoli S, and Colledan M

Published
2017

32. Surgical techniques

Author

D'Antiga, L, Colledan, M, Camagni, S, D'Antiga, L, Colledan, M, and Camagni, S

Published
2019

33. The successful management of a Bronchoesophageal fistula after lung transplantation: a case report

Author

Camagni, S, Lucianetti, A, Ravelli, P, Di Dedda, G, Bonanomi, E, Corno, V, Aluffi, A, Pinelli, D, Zambelli, M, Guizzetti, M, Parigi, P, Colledan, M, Camagni S, Lucianetti A, Ravelli P, Di Dedda GB, Bonanomi E, Corno V, Aluffi A, Pinelli D, Zambelli MF, Guizzetti M, Parigi P, Colledan M, Camagni, S, Lucianetti, A, Ravelli, P, Di Dedda, G, Bonanomi, E, Corno, V, Aluffi, A, Pinelli, D, Zambelli, M, Guizzetti, M, Parigi, P, Colledan, M, Camagni S, Lucianetti A, Ravelli P, Di Dedda GB, Bonanomi E, Corno V, Aluffi A, Pinelli D, Zambelli MF, Guizzetti M, Parigi P, and Colledan M

Abstract

We describe an unprecedented, disastrous complication after bilateral lung transplantation (BLT), a bilateral bronchial dehiscence with a right bronchoesophageal fistula leading to life-threatening septic shock. We also report the successful endoscopic management of this complication by double stenting and stress the efficacy of the multidisciplinary approach to this critical case.

Published
2015

34. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation

Author

Bart van Hoek, Riccardo De Carlis, Philipp Dutkowski, Gonzalo Sapisochin, Luciano De Carlis, Danny van der Helm, Juan Carlos Caicedo, Erin Winter, Wojciech G. Polak, Humberto Bohorquez, Gabriel C. Oniscu, Fabrizio Di Benedetto, Amna Daud, Paolo Muiesan, V. Lucidi, Daniel Borja-Cacho, C. Burcin Taner, Nicolas Meurisse, Jacques Pirenne, Jeannette Widmer, Amelia J. Hessheimer, Matteo Ravaioli, Wayel Jassem, Mauricio Flores Carvalho, Aad P. van der Berg, Ahmed Sherif, Michele Colledan, Amit Nair, Renato Romagnoli, Diethard Monbaliu, Desislava Germanova, Cristiano Quintini, Andre Gorgen, Matteo Cescon, Sofie Vets, Marco P. A. W. Claasen, Massimo Malagó, Peter Lodge, Stefania Camagni, Kristopher P. Croome, Giorgio Rossi, Robert J. Porte, Ian P.J. Alwayn, Rebecca Panconesi, Maite Paolucci, Philipp Kron, Andrea Schlegel, Vincent E de Meijer, Annalisa Dolcet, Ina Jochmans, Charles Miller, Margherita Carbonaro, Pierre-Alain Clavien, Jan Nm Ijzermans, Constantino Fondevila, Damiano Patrono, Daniele Dondossola, Olivier Detry, Mohamed Elsharif, Koji Tomiyama, Alessandro Parente, Nigel Heaton, Herold J. Metselaar, Matteo Mueller, Tiziana Olivieri, George E. Loss, Marjolein van Reeven, Sarah Croome, Magdy Attia, Roberto Hernandez-Alejandro, Otto B. van Leeuwen, Groningen Institute for Organ Transplantation (GIOT), Center for Liver, Digestive and Metabolic Diseases (CLDM), Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Surgery, Gastroenterology & Hepatology, Schlegel A., van Reeven M., Croome K., Parente A., Dolcet A., Widmer J., Meurisse N., De Carlis R., Hessheimer A., Jochmans I., Mueller M., van Leeuwen O.B., Nair A., Tomiyama K., Sherif A., Elsharif M., Kron P., van der Helm D., Borja-Cacho D., Bohorquez H., Germanova D., Dondossola D., Olivieri T., Camagni S., Gorgen A., Patrono D., Cescon M., Croome S., Panconesi R., Carvalho M.F., Ravaioli M., Caicedo J.C., Loss G., Lucidi V., Sapisochin G., Romagnoli R., Jassem W., Colledan M., De Carlis L., Rossi G., Di Benedetto F., Miller C.M., van Hoek B., Attia M., Lodge P., Hernandez-Alejandro R., Detry O., Quintini C., Oniscu G.C., Fondevila C., Malago M., Pirenne J., IJzermans J.N.M., Porte R.J., Dutkowski P., Taner C.B., Heaton N., Clavien P.-A., Polak W.G., Muiesan P., Alwayn I.P.J., van der Berg A.P., Carbonaro M., Claasen M., Daud A., de Meijer V.E., Metselaar H.J., Monbaliu D., Paolucci M., Vets S., and Winter E.

Subjects
Male, Organ Dysfunction Scores, benchmarking, Donation after circulatory death, liver transplantation, morbidity, organ perfusion, risk analysis, IMPACT, medicine.medical_treatment, Kaplan-Meier Estimate, Liver transplantation, GUIDELINES, ALLOCATION, law.invention, Cohort Studies, Postoperative Complications, PROPOSAL, Interquartile range, law, Outcome Assessment, Health Care, risk analysi, Mortality rate, EXTENDED-CRITERIA DONORS, Shock, Middle Aged, Editorial from the ACHBPT, Intensive care unit, CARDIAC DEATH, Area Under Curve, Cohort, Female, medicine.medical_specialty, Tissue and Organ Procurement, BILIARY COMPLICATIONS, Cold storage, CLASSIFICATION, Internal medicine, SCORE, medicine, Humans, Renal replacement therapy, Aged, Proportional Hazards Models, GRAFT-SURVIVAL, Hepatology, business.industry, ROC Curve, Complication, business
Abstract

BACKGROUND: To identify the best possible outcomes in liver transplantation from donation after circulatory death donors (DCD) and to propose outcome values, which serve as reference for individual liver recipients or patient groups.METHODS: Based on 2219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1012 low-risk, primary, adult liver transplantations with a laboratory MELD of ≤20points, receiving a DCD liver with a total donor warm ischemia time of ≤30minutes and asystolic donor warm ischemia time of ≤15minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the Comprehensive Complication Index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered.RESULTS: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centers. The one-year retransplant and mortality rate was 5.23% and 9.01%, respectively. Within the first year of follow-up, 51.1% of recipients developed at least one major complication (≥Clavien-Dindo-Grade-III). Benchmark cut-offs were ≤3days and ≤16days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade-III), ≤16.8% for ischemic cholangiopathy, and ≤38.9CCI points at one-year posttransplant. Comparisons with higher risk groups showed more complications and impaired graft survival, outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk.CONCLUSIONS: Despite excellent 1-year survival, morbidity in benchmark cases remains high with more than half of recipients developing severe complications during 1-year follow-up. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk groups, and provide a valid comparator cohort for future clinical trials.LAY SUMMARY: The best possible outcomes after liver transplantation of grafts donated after circulatory death (DCD) were defined using the concept of benchmarking. These were based on 2219 liver transplantations following controlled DCD donation in 17 centres worldwide. The following benchmark cut-offs for the most relevant outcome parameters were developed: ICU and hospital stay: ≤3 and ≤16 days; primary non function: ≤2.5%; renal replacement therapy: ≤9.6%; ischemic cholangiopathy: ≤16.8% and anastomotic strictures ≤28.4%. One-year graft loss and mortality were defined as ≤14.4% and 9.6%, respectively. Donor and recipient combinations with higher risk had significantly worse outcomes. The use of novel organ perfusion technology achieved similar, good results in this high-risk group with prolonged donor warm ischemia time, when compared to the benchmark cohort.

Published
2021

35. Development and Validation of a Comprehensive Model to Estimate Early Allograft Failure among Patients Requiring Early Liver Retransplant

Author

Fabio Ferla, Damiano Patrono, Patrizia Burra, Roberto Montalti, Paolo Muiesan, Amedeo Carraro, Vincenzo Mazzaferro, S Meli, Fabrizio Di Benedetto, Matteo Cescon, Alessandro Vitale, Salvatore Agnes, Paolo Magistri, Umberto Cillo, Stefania Camagni, Lucio Caccamo, Duilio Pagano, Wasfi Alrawashdeh, Alfonso Wolfango Avolio, Andrea Schlegel, Salvatore Gruttadauria, Luciana Teofili, Luciano De Carlis, Gabriele Spoletini, Michele Colledan, A Franco, Massimo Rossi, Marco Vivarelli, Paolo De Simone, Quirino Lai, Daniele Dondossola, John Hammond, Marco Bongini, Renato Romagnoli, Matteo Ravaioli, P Violi, Domenico Bassi, Avolio, A. W., Franco, A., Schlegel, A., Lai, Q., Meli, S., Burra, P., Patrono, D., Ravaioli, M., Bassi, D., Ferla, F., Pagano, D., Violi, P., Camagni, S., Dondossola, D., Montalti, R., Alrawashdeh, W., Vitale, A., Teofili, L., Spoletini, G., Magistri, P., Bongini, M., Rossi, M., Mazzaferro, V., Di Benedetto, F., Hammond, J., Vivarelli, M., Agnes, S., Colledan, M., Carraro, A., Cescon, M., De Carlis, L., Caccamo, L., Gruttadauria, S., Muiesan, P., Cillo, U., Romagnoli, R., De Simone, P., Avolio A.W., Franco A., Schlegel A., Lai Q., Meli S., Burra P., Patrono D., Ravaioli M., Bassi D., Ferla F., Pagano D., Violi P., Camagni S., Dondossola D., Montalti R., Alrawashdeh W., Vitale A., Teofili L., Spoletini G., Magistri P., Bongini M., Rossi M., Mazzaferro V., Di Benedetto F., Hammond J., Vivarelli M., Agnes S., Colledan M., Carraro A., Cescon M., De Carlis L., Caccamo L., Gruttadauria S., Muiesan P., Cillo U., Romagnoli R., De Simone P., Avolio, A, Franco, A, Schlegel, A, Lai, Q, Meli, S, Burra, P, Patrono, D, Ravaioli, M, Bassi, D, Ferla, F, Pagano, D, Violi, P, Camagni, S, Dondossola, D, Montalti, R, Alrawashdeh, W, Vitale, A, Teofili, L, Spoletini, G, Magistri, P, Bongini, M, Rossi, M, Mazzaferro, V, Di Benedetto, F, Hammond, J, Vivarelli, M, Agnes, S, Colledan, M, Carraro, A, Cescon, M, De Carlis, L, Caccamo, L, Gruttadauria, S, Muiesan, P, Cillo, U, Romagnoli, R, and De Simone, P

Subjects
Male, Time Factors, li, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, 030230 surgery, Liver transplantation, Liver disease, 0302 clinical medicine, Retrospective Studie, Interquartile range, Risk Factors, LIVER TRANSPLANTATION, EARLY ALLOGRAFT FAILURE, OUTCOME, RISK QUANTIFICATION, EARLY ALLOGRAFT FAILURE, Original Investigation, Aged, 80 and over, education.field_of_study, RISK QUANTIFICATION, Graft Survival, Middle Aged, Allografts, Algorithm, Online Only, 030220 oncology & carcinogenesis, Female, Algorithms, Human, Cohort study, medicine.medical_specialty, Logistic Model, liver retransplantation, Population, Reproducibility of Result, 03 medical and health sciences, Internal medicine, medicine, Online First, Humans, education, Aged, Retrospective Studies, OUTCOME, Receiver operating characteristic, business.industry, Risk Factor, Research, Reproducibility of Results, Correction, Retrospective cohort study, LIVER TRANSPLANTATION, medicine.disease, TRAPIANTO DI FEGATO, SOPRAVVIVENZA, QUANTIFICAZIONE DEL RISCHIO, Transplantation, Logistic Models, ROC Curve, Surgery, Primary Graft Dysfunction, business, Liver Failure
Abstract

Key Points Question Can the individual risk estimation for early allograft failure (EAF) be improved in view of liver retransplant? Findings In this multicenter cohort study investigating the association between donor-recipient factors and EAF, a novel Early Allograft Failure Simplified Estimation (EASE) score was developed. The score includes Model for End-stage Liver Disease score, transfused packed red blood cells, and hepatic vessel early thrombosis as well as transaminases, platelet, and bilirubin kinetics as variables on day 10 after transplant. The EASE score outperformed previous model scores, estimating EAF risk with 87% accuracy on day 90 after transplant; EASE was developed on a multicenter Italian database (1609 recipients) and validated on an external UK database (538 recipients). Meaning In this study, the EASE score rated the EAF risk (0%-100%) and identified cases at unsustainable risk to be listed for retransplant., Importance Expansion of donor acceptance criteria for liver transplant increased the risk for early allograft failure (EAF), and although EAF prediction is pivotal to optimize transplant outcomes, there is no consensus on specific EAF indicators or timing to evaluate EAF. Recently, the Liver Graft Assessment Following Transplantation (L-GrAFT) algorithm, based on aspartate transaminase, bilirubin, platelet, and international normalized ratio kinetics, was developed from a single-center database gathered from 2002 to 2015. Objective To develop and validate a simplified comprehensive model estimating at day 10 after liver transplant the EAF risk at day 90 (the Early Allograft Failure Simplified Estimation [EASE] score) and, secondarily, to identify early those patients with unsustainable EAF risk who are suitable for retransplant. Design, Setting, and Participants This multicenter cohort study was designed to develop a score capturing a continuum from normal graft function to nonfunction after transplant. Both parenchymal and vascular factors, which provide an indication to list for retransplant, were included among the EAF determinants. The L-GrAFT kinetic approach was adopted and modified with fewer data entries and novel variables. The population included 1609 patients in Italy for the derivation set and 538 patients in the UK for the validation set; all were patients who underwent transplant in 2016 and 2017. Main Outcomes and Measures Early allograft failure was defined as graft failure (codified by retransplant or death) for any reason within 90 days after transplant. Results At day 90 after transplant, the incidence of EAF was 110 of 1609 patients (6.8%) in the derivation set and 41 of 538 patients (7.6%) in the external validation set. Median (interquartile range) ages were 57 (51-62) years in the derivation data set and 56 (49-62) years in the validation data set. The EASE score was developed through 17 entries derived from 8 variables, including the Model for End-stage Liver Disease score, blood transfusion, early thrombosis of hepatic vessels, and kinetic parameters of transaminases, platelet count, and bilirubin. Donor parameters (age, donation after cardiac death, and machine perfusion) were not associated with EAF risk. Results were adjusted for transplant center volume. In receiver operating characteristic curve analyses, the EASE score outperformed L-GrAFT, Model for Early Allograft Function, Early Allograft Dysfunction, Eurotransplant Donor Risk Index, donor age × Model for End-stage Liver Disease, and Donor Risk Index scores, estimating day 90 EAF in 87% (95% CI, 83%-91%) of cases in both the derivation data set and the internal validation data set. Patients could be stratified in 5 classes, with those in the highest class exhibiting unsustainable EAF risk. Conclusions and Relevance This study found that the developed EASE score reliably estimated EAF risk. Knowledge of contributing factors may help clinicians to mitigate risk factors and guide them through the challenging clinical decision to allocate patients to early liver retransplant. The EASE score may be used in translational research across transplant centers., This multicenter cohort study develops and validates a simplified comprehensive model that estimates on day 10 after liver transplant the risk of early allograft failure with 90 days among patients who undergo liver transplant.

Published
2020

36. A national mandatory-split liver policy: A report from the Italian experience

Author

Mauro Salizzoni, Marco Spada, Vincenzo Mazzaferro, Matteo Cescon, Umberto Tedeschi, Umberto Cillo, Luciano De Carlis, Andrea Risaliti, Stefania Camagni, Fausto Zamboni, S. Trapani, Massimo Rossi, Luigi Lupo, Giuseppe Maria Ettorre, Alessandro Nanni Costa, W. Santaniello, Paolo De Simone, Giuseppe Tisone, Giorgio Rossi, Michele Colledan, Enzo Andorno, L. Rizzato, Enrico Gringeri, Roberta Angelico, Salvatore Agnes, Chiara Grimaldi, Salvatore Gruttadauria, Francesca Puoti, Fabrizio Di Benedetto, Jean de Ville de Goyet, Marco Vivarelli, Angelico, R, Trapani, S, Spada, M, Colledan, M, de Ville de Goyet, J, Salizzoni, M, De Carlis, L, Andorno, E, Gruttadauria, S, Ettorre, G, Cescon, M, Rossi, G, Risaliti, A, Tisone, G, Tedeschi, U, Vivarelli, M, Agnes, S, De Simone, P, Lupo, L, Di Benedetto, F, Santaniello, W, Zamboni, F, Mazzaferro, V, Rossi, M, Puoti, F, Camagni, S, Grimaldi, C, Gringeri, E, Rizzato, L, Nanni Costa, A, Cillo, U, Angelico R., Trapani S., Spada M., Colledan M., de Ville de Goyet J., Salizzoni M., De Carlis L., Andorno E., Gruttadauria S., Ettorre G.M., Cescon M., Rossi G., Risaliti A., Tisone G., Tedeschi U., Vivarelli M., Agnes S., De Simone P., Lupo L.G., Di Benedetto F., Santaniello W., Zamboni F., Mazzaferro V., Rossi M., Puoti F., Camagni S., Grimaldi C., Gringeri E., Rizzato L., Nanni Costa A., and Cillo U.

Subjects
Adult, Male, medicine.medical_specialty, organ allocation, Graft failure, Tissue and Organ Procurement, genetic structures, pediatrics, Adolescent, donors and donation, clinical research/practice, health services and outcomes research, liver transplantation/hepatology, liver transplantation: split, organ procurement and allocation, waitlist management, medicine.medical_treatment, split, Female, Follow-Up Studies, Hepatectomy, Humans, Liver Diseases, Liver Transplantation, Middle Aged, Patient Selection, Prospective Studies, Retrospective Studies, Tissue Donors, Treatment Outcome, Young Adult, Graft Survival [clinical research/practice, liver transplantation], Ischemic time, Liver transplantation, Immunology and Allergy, Transplantation, Pharmacology (medical), Standard Risk, Internal medicine, medicine, split [liver transplantation], business.industry, Graft Survival, Settore MED/18, pediatric, Split liver transplantation, business, Erg
Abstract

To implement split liver transplantation (SLT) a mandatory-split policy has been adopted in Italy since August 2015: donors aged 18-50years at standard risk are offered for SLT, resulting in a left-lateral segment (LLS) graft for children and an extended-right graft (ERG) for adults. We aim to analyze the impact of the new mandatory-split policy on liver transplantation (LT)-waiting list and SLT outcomes, compared to old allocation policy. Between August 2015 and December 2016 out of 413 potentially “splittable” donors, 252 (61%) were proposed for SLT, of whom 53 (21%) donors were accepted for SLT whereas 101 (40.1%) were excluded because of donor characteristics and 98 (38.9%) for absence of suitable pediatric recipients. The SLT rate augmented from 6% to 8.4%. Children undergoing SLT increased from 49.3% to 65.8% (P=.009) and the pediatric LT-waiting list time dropped (229 [10-2121] vs 80 [12-2503] days [P=.045]). The pediatric (4.5% vs 2.5% [P=.398]) and adult (9.7% to 5.2% [P20kg (HR=5.113, P=.048) in LLS, and ischemic time >8hours (HR=2.475, P=.048) in ERG were identified as predictors of graft failure. A national mandatory-split policy maximizes the SLT donor resources, whose selection criteria can be safely expanded, providing favorable impact on the pediatric LT-waiting list and priority for adult sick LT candidates.

Published
2019

37. Successful Lung Transplantation From a Donor With Previous Severe COVID-19 Pneumonia

Author

Stefania Camagni, Fabiano Di Marco, Emanuele Sani, Marta Beretta, Francesco Legittimo, Domenico Pinelli, Michele Colledan, Camagni, S, Di Marco, F, Sani, E, Beretta, M, Legittimo, F, Pinelli, D, and Colledan, M

Subjects
lung transplantation, covid 19
Abstract

Lungs from donors with previous COVID-19 could become a precious resource if proved safe. So far, only 3 successful lung transplantations from donors with previous mild COVID-19 have been reported. We describe a successful bilateral sequential lung transplantation from a donor who, 10 months before, had developed severe COVID-19 acute respiratory distress syndrome. No donor-derived viral transmission occurred, and 12 months after transplantation, the recipient's lung function is normal. In the presence of normal results of bronchoalveolar lavage and adequate functional and morphologic parameters, even a history of severe COVID-19 acute respiratory distress syndrome might not be considered a contraindication to lung donation.

Published
2023

38. Prolonged preservation by hypothermic machine perfusion facilitates logistics in liver transplantation

Author

Isabel M.A. Brüggenwirth, Matteo Mueller, Veerle A. Lantinga, Stefania Camagni, Riccardo De Carlis, Luciano De Carlis, Michele Colledan, Daniele Dondossola, Moritz Drefs, Janina Eden, Davide Ghinolfi, Dionysios Koliogiannis, Georg Lurje, Tommaso M. Manzia, Diethard Monbaliu, Paolo Muiesan, Damiano Patrono, Johann Pratschke, Renato Romagnoli, Michel Rayar, Federico Roma, Andrea Schlegel, Philipp Dutkowski, Robert J. Porte, Vincent E. de Meijer, Brüggenwirth, I, Mueller, M, Lantinga, V, Camagni, S, De Carlis, R, De Carlis, L, Colledan, M, Dondossola, D, Drefs, M, Eden, J, Ghinolfi, D, Koliogiannis, D, Lurje, G, Manzia, T, Monbaliu, D, Muiesan, P, Patrono, D, Pratschke, J, Romagnoli, R, Rayar, M, Roma, F, Schlegel, A, Dutkowski, P, Porte, R, de Meijer, V, Groningen Institute for Organ Transplantation (GIOT), Center for Liver, Digestive and Metabolic Diseases (CLDM), and Faculteit Medische Wetenschappen/UMCG

Subjects
liver allograft function, liver allograft function/dysfunction, graft survival, organ procurement and allocation, Hypothermia, GUIDELINES, clinical research/practice, Cohort Studies, Immunology and Allergy, Humans, Pharmacology (medical), solid organ transplantation, Transplantation, Science & Technology, dysfunction, liver transplantation, organ perfusion and preservation, DEATH, Organ Preservation, practice, Liver Transplantation, Settore MED/18, Perfusion, ischemia reperfusion injury (IRI), liver transplantation/hepatology, organ acceptance, DEFINITION, Liver, clinical research, hepatology, Surgery, DONATION, Life Sciences & Biomedicine, STORAGE
Abstract

A short period (1-2 h) of hypothermic oxygenated machine perfusion (HOPE) after static cold storage is safe and reduces ischemia-reperfusion injury-related complications after liver transplantation. Machine perfusion time is occasionally prolonged for logistical reasons, but it is unknown if prolonged HOPE is safe and compromises outcomes. We conducted a multicenter, observational cohort study of patients transplanted with a liver preserved by prolonged (≥4 h) HOPE. Postoperative biochemistry, complications, and survival were evaluated. The cohort included 93 recipients from 12 European transplant centers between 2014-2021. The most common reason to prolong HOPE was the lack of an available operating room to start the transplant procedure. Grafts underwent HOPE for a median (range) of 4:42 h (4:00-8:35 h) with a total preservation time of 10:50 h (5:50-20:50 h). Postoperative peak ALT was 675 IU/L (interquartile range 419-1378 IU/L). The incidence of postoperative complications was low, and 1-year graft and patient survival were 94% and 88%, respectively. To conclude, good outcomes are achieved after transplantation of donor livers preserved with prolonged (median 4:42 h) HOPE, leading to a total preservation time of almost 21 h. These results suggest that simple, end-ischemic HOPE may be utilized for safe extension of the preservation time to ease transplantation logistics. ispartof: AMERICAN JOURNAL OF TRANSPLANTATION vol:22 issue:7 pages:1842-1851 ispartof: location:United States status: published

Published
2022

39. Third-party bone marrow–derived mesenchymal stromal cell infusion before liver transplantation: A randomized controlled trial

Author

Stefania Camagni, Giuseppe Remuzzi, Caterina Mele, Michele Colledan, M. Zambelli, Matteo Breno, Stefano Fagiuoli, Josée Golay, Marilena Mister, Norberto Perico, Marina Buzzi, Pamela Yossenaidy Rodriguez Ordonez, Chiara Capelli, Manuel Alfredo Podestà, Federica Casiraghi, Matteo Cescon, Lorenzo Maroni, Valentina Rosa Bertuzzo, Alessandro Villa, Marta Todeschini, Antonio Daniele Pinna, Martino Introna, Casiraghi, F, Perico, N, Podesta, M, Todeschini, M, Zambelli, M, Colledan, M, Camagni, S, Fagiuoli, S, Pinna, A, Cescon, M, Bertuzzo, V, Maroni, L, Introna, M, Capelli, C, Golay, J, Buzzi, M, Mister, M, Ordonez, P, Breno, M, Mele, C, Villa, A, Remuzzi, G, Casiraghi, Federica, Perico, Norberto, Podestà, Manuel A, Todeschini, Marta, Zambelli, Marco, Colledan, Michele, Camagni, Stefania, Fagiuoli, Stefano, Pinna, Antonio D, Cescon, Matteo, Bertuzzo, Valentina, Maroni, Lorenzo, Introna, Martino, Capelli, Chiara, Golay, Josee T, Buzzi, Marina, Mister, Marilena, Ordonez, Pamela Y R, Breno, Matteo, Mele, Caterina, Villa, Alessandro, and Remuzzi, Giuseppe, Matteo Ravaioli

Subjects
medicine.medical_specialty, Stromal cell, medicine.medical_treatment, Liver transplantation, clinical research/practice, Mesenchymal Stem Cell Transplantation, Gastroenterology, law.invention, Randomized controlled trial, Bone Marrow, law, Internal medicine, medicine, Humans, Immunology and Allergy, Pharmacology (medical), Transplantation, tolerance, liver transplantation, business.industry, Mesenchymal stem cell, Mesenchymal Stem Cells, Hepatology, practice, stem cell, Clinical trial, medicine.anatomical_structure, clinical research, hepatology, Bone marrow, Stem cell, business, liver transplantation/hepatology, Immunosuppressive Agents
Abstract

Mesenchymal stromal cells (MSC) have emerged as a promising therapy to minimize the immunosuppressive regimen or induce tolerance in solid organ transplantation. In this randomized open-label phase Ib/IIa clinical trial, 20 liver transplant patients were randomly allocated (1:1) to receive a single pre-transplant intravenous infusion of third-party bone marrow-derived MSC or standard of care alone. The primary end-point was the safety profile of MSC administration during the one-year follow-up. Nineteen patients completed the study, and none of those who received MSC experienced infusion-related complications. The incidence of serious and non-serious adverse events was similar in the two groups. Circulating Treg/memory Treg and tolerant NK subset of CD56bright NK cells increased slightly over baseline, albeit not to a statistically significant extent, in MSC-treated patients but not in the control group. Graft function and survival, as well as histologic parameters and intragraft expression of tolerance-associated transcripts in 1-year protocol biopsies were similar in the two groups. In conclusion, pre-transplant MSC infusion in liver transplant recipients was safe and induced mild positive changes in immunoregulatory T and NK cells in the peripheral blood. This study opens the way for a trial on possible tolerogenic efficacy of MSC in liver transplantation. ClinicalTrials.gov identifier: NCT02260375.

Published
2021

40. COVID-19 in an international European liver transplant recipient cohort

Author

Becchetti, C., Zambelli, M. F., Pasulo, L., Donato, M. F., Invernizzi, F., Detry, O., Dahlqvist, G., Ciccarelli, O., Morelli, M. C., Fraga, M., Svegliati-Baroni, G., Van Vlierberghe, H., Coenraad, M. J., Romero, M. C., De Gottardi, A., Toniutto, P., Del Prete, L., Abbati, C., D'Alessandro, Samuel, Pirenne, J., Nevens, F., Dufour J., -F, and COVID-LT group, Burra, Patrizia, Becchetti, C, Zambelli, M, Pasulo, L, Donato, M, Invernizzi, F, Detry, O, Dahlqvist, G, Ciccarelli, O, Morelli, M, Fraga, M, Svegliati-Baroni, G, van Vlierberghe, H, Coenraad, M, Romero, M, de Gottardi, A, Toniutto, P, Del Prete, L, Abbati, C, Samuel, D, Pirenne, J, Nevens, F, Dufour, J, Fagiuoli, S, COVID-LT group, Colledan, M., Fagiuoli, S., Camagni, S., Delwaide, J., Vitale, G., Moradpour, D., Pascual, M., Allegrini, G., Tarsetti, F., Giustizieri, U., Rota, L., Artru, F., Saouli, A.C., Burra, P., Gambato, M., Scalera, I., Petridis, I., Marques, H.P., Welker, M.W., UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de gastro-entérologie, and UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie

Subjects
myalgia, Male, medicine.medical_specialty, medicine.medical_treatment, infectious disease, Pneumonia, Viral, 030230 surgery, Liver transplantation, Chronic liver disease, Cohort Studies, 03 medical and health sciences, Betacoronavirus, chronic liver disease, orthotopic liver transplantation, 0302 clinical medicine, Internal medicine, Case fatality rate, medicine, Humans, Prospective Studies, Prospective cohort study, 610 Medicine & health, Survival rate, Pandemics, Aged, Hepatology, business.industry, SARS-CoV-2, Liver Diseases, Gastroenterology, COVID-19, Middle Aged, medicine.disease, Liver Transplantation, Europe, Hospitalization, Survival Rate, Coronavirus Infections/diagnosis, Coronavirus Infections/epidemiology, Coronavirus Infections/therapy, Female, Liver Diseases/mortality, Liver Diseases/surgery, Liver Diseases/virology, Pneumonia, Viral/diagnosis, Pneumonia, Viral/epidemiology, Pneumonia, Viral/therapy, Cohort, 030211 gastroenterology & hepatology, medicine.symptom, business, Coronavirus Infections, Cohort study
Abstract

ObjectiveKnowledge on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in liver transplant recipients is lacking, particularly in terms of severity of the disease. The aim of this study was to describe the demographic, baseline clinical characteristics and early outcomes of a European cohort of liver transplant recipients with SARS-CoV-2 infection.DesignWe conducted an international prospective study across Europe on liver transplant recipients with SARS-CoV-2 infection confirmed by microbiological assay during the first outbreak of COVID-19 pandemic. Baseline characteristics, clinical presentation, management of immunosuppressive therapy and outcomes were collected.Results57 patients were included (70% male, median (IQR) age at diagnosis 65 (57–70) years). 21 (37%), 32 (56%) and 21 (37%) patients had one cardiovascular disease, arterial hypertension and diabetes mellitus, respectively. The most common symptoms were fever (79%), cough (55%), dyspnoea (46%), fatigue or myalgia (56%) and GI symptoms (33%). Immunosuppression was reduced in 22 recipients (37%) and discontinued in 4 (7%). With this regard, no impact on outcome was observed. Forty-one (72%) subjects were hospitalised and 11 (19%) developed acute respiratory distress syndrome. Overall, we estimated a case fatality rate of 12% (95% CI 5% to 24%), which increased to 17% (95% CI 7% to 32%) among hospitalised patients. Five out of the seven patients who died had a history of cancer.ConclusionIn this European multicentre prospective study of liver transplant recipients, COVID-19 was associated with an overall and in-hospital fatality rate of 12% (95% CI 5% to 24%) and 17% (95% CI 7% to 32%), respectively. A history of cancer was more frequent in patients with poorer outcome.

Published
2020

41. Metabolic-Dysfunction-Associated Steatotic Liver Disease (MASLD) after Liver Transplantation: A Narrative Review of an Emerging Issue.

Author

Savino A, Loglio A, Neri F, Camagni S, Pasulo L, Lucà MG, Trevisan R, Fagiuoli S, and Viganò M

Abstract

The development of steatotic liver disease after liver transplant (LT) is widely described, and epidemiological data have revealed an increased incidence in recent times. Its evolution runs from simple steatosis to steatohepatitis and, in a small proportion of patients, to significant fibrosis and cirrhosis. Apparently, post-LT steatotic disease has no impact on the recipient's overall survival; however, a higher cardiovascular and malignancy burden has been reported. Many donors' and recipients' risk factors have been associated with this occurrence, although the recipient-related ones seem of greater impact. Particularly, pre- and post-LT metabolic alterations are strictly associated with steatotic graft disease, sharing common pathophysiologic mechanisms that converge on insulin resistance. Other relevant risk factors include genetic variants, sex, age, baseline liver diseases, and immunosuppressive drugs. Diagnostic evaluation relies on liver biopsy, although non-invasive methods are being increasingly used to detect and monitor both steatosis and fibrosis stages. Management requires a multifaceted approach focusing on lifestyle modifications, the optimization of immunosuppressive therapy, and the management of metabolic complications. This review aims to synthesize the current knowledge of post-LT steatotic liver disease, focusing on the recent definition of metabolic-dysfunction-associated steatotic liver disease (MASLD) and its metabolic and multisystemic concerns.

Published
2024
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42. Portal vein thrombosis and liver transplantation: management, matching, and outcomes. A retrospective multicenter cohort study.

Author

Di Benedetto F, Magistri P, Di Sandro S, Boetto R, Tandoi F, Camagni S, Lauterio A, Pagano D, Nicolini D, Violi P, Dondossola D, Guglielmo N, Cherchi V, Lai Q, Toti L, Bongini M, Frassoni S, Bagnardi V, Mazzaferro V, Tisone G, Rossi M, Baccarani U, Ettorre GM, Caccamo L, Carraro A, Vivarelli M, Gruttadauria S, De Carlis L, Colledan M, Romagnoli R, and Cillo U

Subjects
Humans, Male, Female, Retrospective Studies, Middle Aged, Adult, Italy epidemiology, Postoperative Complications epidemiology, Aged, Patient Selection, Treatment Outcome, Liver Transplantation adverse effects, Portal Vein surgery, Venous Thrombosis surgery
Abstract

Background and Aims: Besides the increased risk of perioperative morbidity, graft failure, and mortality, the majority of PVT are diagnosed at liver transplantation (LT). Improving preoperative management and patient selection may lead to better short-term and long-term outcomes and reduce the risk of a futile LT. The authors aimed to identify predictors of adverse outcomes after LT in patients with nonmalignant portal vein thrombosis (PVT) and improve donor to recipient matching by analyzing the results of the Italian cohort of LT recipients., Methods: Adult patients who underwent LT in Italy between January 2000 and February 2020 diagnosed with PVT pre-LT or at time of LT were considered eligible for inclusion. Based on a survey encompassing all 26 surgeons participating in the study, a binary composite outcome was defined. Patients were classified as having the composite event if at least one of these conditions occurred: operative time more than 600 min, estimated blood loss greater than 5000 ml, more than 20 ICU days, 90 days mortality, 90 days retransplant., Results: Seven hundred fourteen patients were screened and 698 met the inclusion criteria. The analysis reports the results of 568 patients that fulfilled the criteria to enter the composite outcome analysis.Overall, 156 patients (27.5%) developed the composite outcome. PVT stage 3/4 at transplant and need for any surgical correction of PVT are independent predictors of the composite outcome occurrence. When stratified by PVT grade, overall survival at 1-year ranges from 89.0% with PVT grade 0/1 to 67.4% in patients with PVT grade 3/4 at LT ( P <0.001). Nevertheless, patients with severe PVT can improve their survival when identified risk factors are not present., Conclusions: Potential LT candidates affected by PVT have a benefit from LT that should be adequately balanced on liver function and type of inflow reconstruction needed to mitigate the incidence of adverse events. Nonetheless, the absence of specific risk factors may improve the outcomes even in patients with PVT grades 3-4., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Published
2024
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43. Vaccination Recommendations in Solid Organ Transplant Adult Candidates and Recipients.

Author

Viganò M, Beretta M, Lepore M, Abete R, Benatti SV, Grassini MV, Camagni S, Chiodini G, Vargiu S, Vittori C, Iachini M, Terzi A, Neri F, Pinelli D, Casotti V, Di Marco F, Ruggenenti P, Rizzi M, Colledan M, and Fagiuoli S

Abstract

Prevention of infections is crucial in solid organ transplant (SOT) candidates and recipients. These patients are exposed to an increased infectious risk due to previous organ insufficiency and to pharmacologic immunosuppression. Besides infectious-related morbidity and mortality, this vulnerable group of patients is also exposed to the risk of acute decompensation and organ rejection or failure in the pre- and post-transplant period, respectively, since antimicrobial treatments are less effective than in the immunocompetent patients. Vaccination represents a major preventive measure against specific infectious risks in this population but as responses to vaccines are reduced, especially in the early post-transplant period or after treatment for rejection, an optimal vaccination status should be obtained prior to transplantation whenever possible. This review reports the currently available data on the indications and protocols of vaccination in SOT adult candidates and recipients.

Published
2023
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44. Successful Lung Transplantation From a Donor With Previous Severe COVID-19 Pneumonia.

Author

Camagni S, Di Marco F, Sani E, Beretta M, Legittimo F, Pinelli D, and Colledan M

Abstract

Lungs from donors with previous COVID-19 could become a precious resource if proved safe. So far, only 3 successful lung transplantations from donors with previous mild COVID-19 have been reported. We describe a successful bilateral sequential lung transplantation from a donor who, 10 months before, had developed severe COVID-19 acute respiratory distress syndrome. No donor-derived viral transmission occurred, and 12 months after transplantation, the recipient's lung function is normal. In the presence of normal results of bronchoalveolar lavage and adequate functional and morphologic parameters, even a history of severe COVID-19 acute respiratory distress syndrome might not be considered a contraindication to lung donation., (© 2022 The Authors.)

Published
2023
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45. Pancreatic ductal adenocarcinoma complete regression after preoperative chemotherapy: Surgical results in a small series.

Author

Pinelli D, Micalef A, Merelli B, Trezzi R, Amaduzzi A, Agnesi S, Guizzetti M, Camagni S, Fedele V, and Colledan M

Subjects
Female, Humans, Combined Modality Therapy, Prognosis, Neoadjuvant Therapy, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms genetics, Pancreatic Neoplasms surgery, Carcinoma, Pancreatic Ductal drug therapy, Carcinoma, Pancreatic Ductal surgery
Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) becomes a systemic disease from an early stage. Complete surgical resection remains the only validated and potentially curative treatment; disappointingly only 20% of patients present with a resectable tumour. Although a complete pathological regression (pCR) after the preoperative chemotherapy could intuitively lead to better outcomes and prolonged survival some reports highlighted significant rates of recurrence., Cases Presentation: We describe three cases of pCR following preoperative chemotherapy for PDAC. The first two cases received neoadjuvant mFOLFIRINOX and PAX-G scheme for borderline resectable PDAC. Recurrence appeared 9 and 12 months after surgery. Although both patients started adjuvant therapy straight after the diagnosis of recurrence, the disease rapidly progressed and led them to death 12 and 15 months after surgery. The third case was characterized by germline BRCA2 mutation. The patient presented with PDAC of the body, intrapancreatic biliary stenosis and suspected peritoneal metastasis. One year later, after first and second-line chemotherapy, she underwent explorative laparoscopy and total spleno-pancreatectomy without evidence of viable tumour cells in the surgical specimen. At six months she is recurrence-free., Conclusions: Very few reports describe a complete pathological response following preoperative chemotherapy in pancreatic cancer. We observed three cases in the last three years with disappointing oncological results. Further investigations are needed to predict PDAC prognosis in pCR after chemotherapy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Published
2023
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46. Prolonged preservation by hypothermic machine perfusion facilitates logistics in liver transplantation: A European observational cohort study.

Author

Brüggenwirth IMA, Mueller M, Lantinga VA, Camagni S, De Carlis R, De Carlis L, Colledan M, Dondossola D, Drefs M, Eden J, Ghinolfi D, Koliogiannis D, Lurje G, Manzia TM, Monbaliu D, Muiesan P, Patrono D, Pratschke J, Romagnoli R, Rayar M, Roma F, Schlegel A, Dutkowski P, Porte RJ, and de Meijer VE

Subjects
Cohort Studies, Graft Survival, Humans, Liver, Organ Preservation methods, Perfusion methods, Hypothermia, Liver Transplantation methods
Abstract

A short period (1-2 h) of hypothermic oxygenated machine perfusion (HOPE) after static cold storage is safe and reduces ischemia-reperfusion injury-related complications after liver transplantation. Machine perfusion time is occasionally prolonged for logistical reasons, but it is unknown if prolonged HOPE is safe and compromises outcomes. We conducted a multicenter, observational cohort study of patients transplanted with a liver preserved by prolonged (≥4 h) HOPE. Postoperative biochemistry, complications, and survival were evaluated. The cohort included 93 recipients from 12 European transplant centers between 2014-2021. The most common reason to prolong HOPE was the lack of an available operating room to start the transplant procedure. Grafts underwent HOPE for a median (range) of 4:42 h (4:00-8:35 h) with a total preservation time of 10:50 h (5:50-20:50 h). Postoperative peak ALT was 675 IU/L (interquartile range 419-1378 IU/L). The incidence of postoperative complications was low, and 1-year graft and patient survival were 94% and 88%, respectively. To conclude, good outcomes are achieved after transplantation of donor livers preserved with prolonged (median 4:42 h) HOPE, leading to a total preservation time of almost 21 h. These results suggest that simple, end-ischemic HOPE may be utilized for safe extension of the preservation time to ease transplantation logistics., (© 2022 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.)

Published
2022
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47. Third-party bone marrow-derived mesenchymal stromal cell infusion before liver transplantation: A randomized controlled trial.

Author

Casiraghi F, Perico N, Podestà MA, Todeschini M, Zambelli M, Colledan M, Camagni S, Fagiuoli S, Pinna AD, Cescon M, Bertuzzo V, Maroni L, Introna M, Capelli C, Golay JT, Buzzi M, Mister M, Ordonez PYR, Breno M, Mele C, Villa A, and Remuzzi G

Subjects
Bone Marrow, Humans, Immunosuppressive Agents, Liver Transplantation, Mesenchymal Stem Cell Transplantation, Mesenchymal Stem Cells
Abstract

Mesenchymal stromal cells (MSC) have emerged as a promising therapy to minimize the immunosuppressive regimen or induce tolerance in solid organ transplantation. In this randomized open-label phase Ib/IIa clinical trial, 20 liver transplant patients were randomly allocated (1:1) to receive a single pretransplant intravenous infusion of third-party bone marrow-derived MSC or standard of care alone. The primary endpoint was the safety profile of MSC administration during the 1-year follow-up. In all, 19 patients completed the study, and none of those who received MSC experienced infusion-related complications. The incidence of serious and non-serious adverse events was similar in the two groups. Circulating Treg/memory Treg and tolerant NK subset of CD56 bright NK cells increased slightly over baseline, albeit not to a statistically significant extent, in MSC-treated patients but not in the control group. Graft function and survival, as well as histologic parameters and intragraft expression of tolerance-associated transcripts in 1-year protocol biopsies were similar in the two groups. In conclusion, pretransplant MSC infusion in liver transplant recipients was safe and induced mild positive changes in immunoregulatory T and NK cells in the peripheral blood. This study opens the way for a trial on possible tolerogenic efficacy of MSC in liver transplantation. ClinicalTrials.gov identifier: NCT02260375., (© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Published
2021
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48. A national mandatory-split liver policy: A report from the Italian experience.

Author

Angelico R, Trapani S, Spada M, Colledan M, de Ville de Goyet J, Salizzoni M, De Carlis L, Andorno E, Gruttadauria S, Ettorre GM, Cescon M, Rossi G, Risaliti A, Tisone G, Tedeschi U, Vivarelli M, Agnes S, De Simone P, Lupo LG, Di Benedetto F, Santaniello W, Zamboni F, Mazzaferro V, Rossi M, Puoti F, Camagni S, Grimaldi C, Gringeri E, Rizzato L, Nanni Costa A, and Cillo U

Subjects
Adolescent, Adult, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Selection, Prospective Studies, Retrospective Studies, Treatment Outcome, Young Adult, Graft Survival, Hepatectomy methods, Liver Diseases surgery, Liver Transplantation methods, Tissue Donors supply & distribution, Tissue and Organ Procurement methods, Tissue and Organ Procurement statistics & numerical data
Abstract

To implement split liver transplantation (SLT) a mandatory-split policy has been adopted in Italy since August 2015: donors aged 18-50 years at standard risk are offered for SLT, resulting in a left-lateral segment (LLS) graft for children and an extended-right graft (ERG) for adults. We aim to analyze the impact of the new mandatory-split policy on liver transplantation (LT)-waiting list and SLT outcomes, compared to old allocation policy. Between August 2015 and December 2016 out of 413 potentially "splittable" donors, 252 (61%) were proposed for SLT, of whom 53 (21%) donors were accepted for SLT whereas 101 (40.1%) were excluded because of donor characteristics and 98 (38.9%) for absence of suitable pediatric recipients. The SLT rate augmented from 6% to 8.4%. Children undergoing SLT increased from 49.3% to 65.8% (P = .009) and the pediatric LT-waiting list time dropped (229 [10-2121] vs 80 [12-2503] days [P = .045]). The pediatric (4.5% vs 2.5% [P = .398]) and adult (9.7% to 5.2% [P < .001]) LT-waiting list mortality reduced; SLT outcomes remained stable. Retransplantation (HR = 2.641, P = .035) and recipient weight >20 kg (HR = 5.113, P = .048) in LLS, and ischemic time >8 hours (HR = 2.475, P = .048) in ERG were identified as predictors of graft failure. A national mandatory-split policy maximizes the SLT donor resources, whose selection criteria can be safely expanded, providing favorable impact on the pediatric LT-waiting list and priority for adult sick LT candidates., (© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Published
2019
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49. The successful management of a Bronchoesophageal fistula after lung transplantation: a case report.

Author

Camagni S, Lucianetti A, Ravelli P, Di Dedda GB, Bonanomi E, Corno V, Aluffi A, Pinelli D, Zambelli MF, Guizzetti M, Parigi P, and Colledan M

Subjects
Bronchial Fistula etiology, Esophageal Fistula etiology, Female, Humans, Young Adult, Bronchial Fistula therapy, Bronchoscopy, Esophageal Fistula therapy, Esophagoscopy, Lung Transplantation, Postoperative Complications therapy, Self Expandable Metallic Stents
Abstract

We describe an unprecedented, disastrous complication after bilateral lung transplantation (BLT), a bilateral bronchial dehiscence with a right bronchoesophageal fistula leading to life-threatening septic shock. We also report the successful endoscopic management of this complication by double stenting and stress the efficacy of the multidisciplinary approach to this critical case., (© 2015 Steunstichting ESOT.)

Published
2015
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50. Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology -Section of Vascular and Interventional Radiology- and the World Society of Emergency Surgery).

Author

Magnone S, Coccolini F, Manfredi R, Piazzalunga D, Agazzi R, Arici C, Barozzi M, Bellanova G, Belluati A, Berlot G, Biffl W, Camagni S, Campanati L, Castelli CC, Catena F, Chiara O, Colaianni N, De Masi S, Di Saverio S, Dodi G, Fabbri A, Faustinelli G, Gambale G, Capponi MG, Lotti M, Marchesi G, Massè A, Mastropietro T, Nardi G, Niola R, Nita GE, Pisano M, Poiasina E, Poletti E, Rampoldi A, Ribaldi S, Rispoli G, Rizzi L, Sonzogni V, Tugnoli G, and Ansaloni L

Abstract

Hemodynamically Unstable Pelvic Trauma is a major problem in blunt traumatic injury. No cosensus has been reached in literature on the optimal treatment of this condition. We present the results of the First Italian Consensus Conference on Pelvic Trauma which took place in Bergamo on April 13 2013. An extensive review of the literature has been undertaken by the Organizing Committee (OC) and forwarded to the Scientific Committee (SC) and the Panel (JP). Members of them were appointed by surgery, critical care, radiology, emergency medicine and orthopedics Italian and International societies: the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology, Section of Vascular and Interventional Radiology and the World Society of Emergency Surgery. From November 2012 to January 2013 the SC undertook the critical revision and prepared the presentation to the audience and the Panel on the day of the Conference. Then 3 recommendations were presented according to the 3 submitted questions. The Panel voted the recommendations after discussion and amendments with the audience. Later on a email debate took place until December 2013 to reach a unanimous consent. We present results on the 3 following questions: which hemodynamically unstable patient needs an extraperitoneal pelvic packing? Which hemodynamically unstable patient needs an external fixation? Which hemodynamically unstable patient needs emergent angiography? No longer angiography is considered the first therapeutic maneuver in such a patient. Preperitoneal pelvic packing and external fixation, preceded by pelvic binder have a pivotal role in the management of these patients.Hemodynamically Unstable Pelvic Trauma is a frequent death cause among people who sustain blunt trauma. We present the results of the First Italian Consensus Conference.

Published
2014
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