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1. Antithrombotic strategies in the catheterization laboratory for patients with acute coronary syndromes undergoing percutaneous coronary interventions: insights from the EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units Registry

Author

De Luca, L., Musumeci, G., Leonardi, S., Gonzini, L., Cavallini, C., Calabro, P., Mauro, C., Cacciavillani, L., Savonitto, S., De Servi, S., Caporale, R., Ceravolo, R., Formigli, D., Lupi, A., Rakar, S., Smecca, I. M., Maggioni, A. P., Lucci, D., Lorimer, A., Orsini, G., Fabbri, G., Bianchini, E., Abrignani, M. G., Bonura, F., Trimarco, B., Galasso, G., Misuraca, G., Manes, M. T., Tuccillo, B., Irace, L., Olivari, Z., Totis, O., Ledda, A., Boccalatte, M., Iliceto, S., Tortorella, G., Esposito, L., De Rosa, P., Bianchi, R., Napoletano, C., Piccioni, L. L., Pavesi, P. C., Bovenzi, F. M., Boni, A., Merenda, R., Wolff, S., De Ferrari, G. M., Camporotondo, R., Gambino, P., Cutaia, A., Picariello, C., Cemin, R., Chiarella, F., Gauthier, L. G., Mircoli, L., Del Pinto, M., Finocchiaro, M. L., Scioli, R., Farina, R., Naddeo, C., Scherillo, M., Santopietro, S., Metra, M., Costa, F., Calculli, G., Troito, G., Pennisi, V., Adornato, E. M. F., Pirelli, S., Fadin, B. M., DI Biase, M., Ieva, R., Zuin, G., Sanfilippo, N., Mancuso, L., Pani, A., Serra, E., Marenzi, G., Assanelli, E. M., Ansalone, G., Cacciotti, L., Morocutti, G., Fresco, C., Berti, S., Paradossi, U., Bozzano, A., Mauro, A., Noussan, P., Zanini, P., Bolognese, L., Falsini, G., Costa, P., Manca, G., Caldarola, P., Locuratolo, N., Cipolla, T., Becchina, M., Cocco, G., Scalera, G., Stefanelli, S., Giunta, N., Sinagra, G., Meloni, L., Lai, O., Chiaranda, G., Luca, G., Helou, J. S., Biscottini, E., Magliari, F., Callerame, M., Uguccioni, M., Pugliese, M., Sanchez, F., Tartaglione, S., Ignone, G., Mavilio, G., Mantovan, R., Bini, R., Caico, S. I., Demolli, V., Proietti, F., Michisanti, M., Musmeci, G., Cantamessa, P., Sicuso, G., Micalef, S. S., Accogli, M., Zaccaria, M., Caputo, M., DI Paolo, G., Piatti, L., Farina, A., Vicinelli, P., Paloscia, L., DI Clemente, D., Felis, S., Castini, D., Rota, C., Casu, G., Bonano, S., Margheri, M., Lucchi, G. R., Serdoz, R., Proietti, P., Autore, C., Conti, E., Russo, V., Orlando, P., Ramondo, A. B., Bontorin, M., Marcolongo, M., Santagostino, M., Maestroni, A., Vitti, P., Rodella, P., Bonetti, P., Elia, M., Lumare, R., Politi, A., Gritti, S., Poletti, F., Mafrici, A., Fusco, R., Bongo, A. S., Bacchini, S., Gasparetto, V., Ferraiuolo, G., De Luca, M., Campana, C., Bonatti, R., Gaita, F., Bergerone, S., Bonmassari, R., Zeni, P., Langialonga, T., Scarcia, A., Caravita, L., Musacchio, E., Augello, G., Usmiani, T., Stomaci, B., Cirino, D., Pierini, S., Bottiglieri, G., Liso, A., Mussardo, M., Tosi, P., Sala, R., Belloni, A., Blengino, S., Lisi, E., Delfino, P., Auguadro, C., Brunazzi, M. C., Pacchioni, E., Fattore, L., Bosco, B., Blandizzi, S., Pajes, G., Patruno, N., Perna, G. P., Francioni, M., Favale, S., Vestito, D., Lombardi, A., Capecchi, A., Ferrero, P., De Vincenzo, C., Magri, G., Indolfi, C., De Rosa, S., Rossi, M., Collarini, L., Agnelli, D., Conti, G., Tonelli, C., Spadaro, C., Negroni, S., DI Noto, G., Lanari, A., Casolo, G., Del Meglio, J., Negrini, M., Celentano, A., Sifola, C., Rellini, G., Mattia, A. D., Molero, U., Piovaccari, G., Grosseto, D., Callegarin, L., Fiasconaro, G., Crivello, R., Thiebat, B., Leone, G., Tamburino, C., Caruso, G., Cassadonte, F., Sassone, B., Fuca, G., Sormani, L., Percoco, G. F., Mazzucco, R., Cazzani, E., Gianni, M., Limido, A., Luvini, M., Guglielmi, R., Mannarini, A., Moruzzi, P., Pastori, P., Golia, B., Marzano, A., Orazi, S., Marchese, I., Anselmi, M., Girardi, P., Nassiacos, D., Meloni, S., Busacca, P., Generali, C. A., Corda, S., Costanza, G., Montalto, S., Argenziano, L., Tommasini, P., Emdin, M., Pasanisi, E. M., Colivicchi, F., Tubaro, M., Azzolini, P., Luciani, C., Doronzo, B., Coppolino, A., Dellavesa, P., Zenone, F., DI Marco, A., De Conti, F., Piccinni, G. C., Gualtieri, M. R., Bisignani, G., Leone, A., Arcuri, G. M., Marinacci, L., Rossi, P., Perotti, S., Cometti, V. C., Arcidiacono, S., Tramontana, M., Bazzucchi, M., Mezzetti, P., Romano, M., Villani, R., DI Giovambattista, R., Volpe, B., Tedesco, L., Carini, M., Vinci, S., Paolini, E. A., Busoni, F., Piergentili, C., Navazio, A., Manca, F., Cocco, F., Pennetta, C. A., Maggiolini, S., Galbiati, R., Bruna, C., Ferrero, L., Brigido, S., Barducci, E., Musacchio, D., Manduca, B., Marchese, D., Patrassi, L. A., Pattarino, F. A., Rocchi, M., Briglia, S., Fanelli, R., Villella, M., Gronda, E., Massa, D., Lenti, V., DI Gregorio, L., Bottero, M., Bazzanini, F., Braggion, G., Antoniceli, R., Caraceni, D., Guzzo, V., DI Giovanni, P., Scarpini, S., Severgnini, B., Musolino, M. F., Casa, S. D., Gobbi, M., Arena, G., Bonizzato, S., Agnoletto, V., Sansoni, S., Pes, R. A. M., Denti, S., Polizzi, G. M., Pino, R., Commisso, B., Merlino, A., DI Lorenzo, L., Porchetta, I., Del Furia, F., Colombi, E., Covini, D., Cavalieri, F., Antonaci, S., Rubino, G., Ciulla, A., Bui, F., Casorelli, E., Caliendo, L., Laezza, A., Americo, L., Schillaci, A. M., Cordoni, M., Barsotti, L., Gaudio, C., Barilla, F., Cannone, M., Memeo, R., Truncellito, L., Andriani, A., Salituri, S., Verrina, F., Pafi, M., Sebastiani, M. L., Amico, A. F., Scolozzi, D., Lupi, G., D'Alea, A., Catanzariti, D., Angheben, C., Ottaviano, A., Levantesi, G., de Luca, Leonardo, Musumeci, Giuseppe, Leonardi, Sergio, Gonzini, Lucio, Cavallini, Claudio, Calabrò, Paolo, Mauro, Ciro, Cacciavillani, Luisa, Savonitto, Stefano, de Servi, Stefano, Caporale, Roberto, Ceravolo, Roberto, Formigli, Dario, Lupi, Alessandro, Rakar, Sadir, Smecca, Ivan, Maggioni, Aldo Pietro, Lucci, Donata, Lorimer, Andrea, Orsini, Giampietro, Fabbri, Gianna, Bianchini, Elisa, Abrignani, Maurizio Giuseppe, Bonura, Francesc, Trimarco, Bruno, Galasso, Gennaro, Misuraca, Gianfranco, Manes, Maria Teresa, Tuccillo, Bernardino, and Irace, Luigi.

Subjects
Male, Prasugrel, medicine.medical_treatment, Myocardial Infarction, antithrombotic therapy, 030204 cardiovascular system & hematology, acute coronary syndromes, bivalirudin, heparins, percutaneous coronary intervention, prasugrel, ticagrelor, 0302 clinical medicine, Antithrombotic, 80 and over, Bivalirudin, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Registries, Aged, 80 and over, General Medicine, Hirudins, Middle Aged, Recombinant Proteins, Italy, Female, Cardiology and Cardiovascular Medicine, Ticagrelor, medicine.drug, medicine.medical_specialty, Platelet Glycoprotein GPIIb-IIIa Complex, NO, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, medicine, Humans, Acute Coronary Syndrome, Aged, Aspirin, business.industry, Heparin, Percutaneous coronary intervention, Anticoagulants, medicine.disease, Peptide Fragments, Clinical trial, Cross-Sectional Studies, Logistic Models, Conventional PCI, Multivariate Analysis, business
Abstract

Aims In the last decades, several new therapies have emerged for the treatment of acute coronary syndromes (ACS). We sought to describe real-world patterns of use of antithrombotic treatments in the catheterization laboratory for ACS patients undergoing percutaneous coronary interventions (PCI). Methods EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units was a nationwide, prospective registry aimed to evaluate antithrombotic strategies employed in ACS patients in Italy. Results Over a 3-week period, a total of 2585 consecutive ACS patients have been enrolled in 203 cardiac care units across Italy. Among these patients, 1755 underwent PCI (923 with ST-elevation myocardial infarction and 832 with non-ST-elevation ACS). In the catheterization laboratory, unfractioned heparin was the most used antithrombotic drug in both ST-elevation myocardial infarction (64.7%) and non-ST-elevation ACS (77.5%) undergoing PCI and, as aspirin, bivalirudin and glycoprotein IIb/IIIa inhibitors (GPIs) more frequently employed before or during PCI compared with the postprocedural period. Any crossover of heparin therapy occurred in 36.0% of cases, whereas switching from one P2Y12 inhibitor to another occurred in 3.7% of patients. Multivariable analysis yielded several independent predictors of GPIs and of bivalirudin use in the catheterization laboratory, mainly related to clinical presentation, PCI complexity and presence of complications during the procedure. Conclusion In our contemporary, nationwide, all-comers cohort of ACS patients undergoing PCI, antithrombotic therapies were commonly initiated before the catheterization laboratory. In the periprocedural period, the most frequently employed drugs were unfractioned heparin, leading to a high rate of crossover, followed by GPIs and bivalirudin, mainly used during complex PCI. Clinical trial registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02015624.

Published
2017

2. Varespladib and cardiovascular events in patients with an acute coronary syndrome: the VISTA-16 randomized clinical trial

Author

Nicholls, Stephen J., Kastelein, John J. P., Schwartz, Gregory G., Bash, Dianna, Rosenson, Robert S., Cavender, Matthew A., Brennan, Danielle M., Koenig, Wolfgang, Jukema, J. Wouter, Nambi, Vijay, Wright, R. Scott, Menon, Venu, Lincoff, A. Michael, Nissen, Hennekens C, Steven E., Brown, Wv, Demets, D, Pfeffer, M, Roleau, J, Abraham, J, Gebel, J, Huff, C, Katzan, I, Shishehbor, M, Rassi, A, Uchino, K, Vest, A, Zishiri, E, Heckman, Mj, Balog, C, Dart, A, Amerena, J, Prasad, C, Farshid, A, Gunalingam, B, Thompson, P, Collins, N, Arstall, M, van Gaal, W, Aroney, C, Mahar, L, Youssef, G, Horowitz, J, Anand, D, Rodes-Cabau, J, Polasek, P, Lai, C, Huynh, T, Hubacek, J, Kokis, A, Paradis, Jm, Mukherjee, A, Senaratne, M, Constance, C, Gosselin, G, Lavi, S, Parker, J, Zadra, R, Abramson, B, Della-Siega, A, Spinar, J, Pudil, R, Motovska, Z, Maly, M, Hutyra, M, Pleva, L, Mayer, O, Semenka, J, Klimovic, T, Horak, D, Cervinka, P, Klimsa, Z, Hulinsky, V, Reichert, P, Monhart, Z, Rotterova, H, Kobulia, B, Shaburishvili, T, Mamatsashvili, M, Chapidze, G, Chumburidze, V, Megreladze, I, Khintibidze, I, Leithäuser, B, Voehringer, Hf, Wachter, R, Nogai, K, Lapp, H, Haltern, G, Gielen, S, Dorsel, T, Möllmann, H, Stellbrink, C, Hengstenberg, C, Dengler, T, Heuer, H, Kreuzer, J, Leschke, M, Mudra, H, Werner, N, Braun-Dullaeus, R, Rosenberg, M, Frey, N, Koenig, W, Strasser, R, Genth-Zotz, S, Kiss, R, Nagy, A, Kovacs, Z, Csapo, K, Edes, I, Sereg, M, Vertes, A, Ronaszeki, A, Kancz, S, Benczur, B, Polgar, P, Muller, G, Simonyi, G, Dezsi, C, Merkely, B, Dinnyes, J, Lupkovics, G, Kahali, D, Banker, D, Trivedi, S, Rajput, R, Premchand, R, Dani, S, Vadaganelli, P, Gupta, S, Chandra, S, Fulwani, M, Chawla, K, Parikh, K, Prati, F, Speciale, G, Valgimigli, M, Suriano, P, Sangiorgi, G, Fineschi, M, Merenda, R, Marenzi, G, Berti, S, Corrada, E, Cuccia, C, Testa, R, Moretti, L, Mennuni, M, Biasucci, Lm, Lioy, E, Auguadro, C, Magagnini, E, Fedele, F, Piscione, F, Azar, R, Trip, Md, Liem, A, den Hartoog, M, Lenderink, T, van de Wetering ML, Lok, D, Oei, F, Tans, Jg, Ilmer, B, Keijzers, M, Monraats, P, Kedhi, E, Breedveld, Rw, Herrman, J, van Wijk, L, Ronner, E, Nierop, P, Bosschaert, M, Hermans, W, Doevendans, P, Troquay, R, van der Heijden, R, Veen, G, Bokern, Mj, Bronzwaer, Pn, Kie, Sh, Den Hartog, F, Elliott, J, Wilkins, G, Hart, H, Devlin, G, Harding, S, Ponikowski, P, Madej, A, Kochmanski, M, Witkowski, A, Pluta, W, Bronisz, M, Kornacewicz-Jach, Z, Wysokinski, A, Ujda, M, Drozdz, J, Derlaga, B, Gessek, J, Dabrowski, M, Miekus, P, Kozlowski, A, Gniot, J, Musial, W, Dobrzycki, S, Rynkiewicz, A, Psuja, P, Rekosz, J, Drzewiecki, A, Kuznetsov, V, Gordeev, I, Goloshchekin, B, Markov, V, Barbarich, V, Belenky, D, Mikhin, V, Volkova, E, Timofeev, A, Ermoshkina, L, Barbarash, O, Klein, G, Libis, R, Vishnevsky, A, Linev, K, Khaisheva, L, Ruda, M, Dovgalevskiy, Y, Shvarts, Y, Zateyshchikov, D, Kostenko, V, Shalnev, V, Simanenkov, V, Arkhipov, M, Ovcharenko, E, Guseva, G, Akhunova, S, Ortiz, Ai, Navarro, Mj, Romero, Aj, Goya, Il, Peñaranda, As, Cendon, Aa, Rubio, Am, Zubiri, Jj, Soriano, Fr, Sanz, Rr, Genís, Ab, Lago, Vn, Fernández, Jd, Romo, Ai, Franco, Sn, Martin, Ih, Montero, Js, Martin Mde, M, González, Mj, Antolin, Jm, Areses, El, Miranda, Jm, Alonso-Pulpón, L, Esquivias, Gb, Jarne, Ef, Cortés, Jm, Pérez, Mb, Gormaz, Cl, Alegret, Jm, Nava, Js, Ingelmo, Jm, Urbano, Rh, Sanmartín, M, Katerenchuk, O, Vakaliuk, I, Karpenko, O, Prokhorov, O, Koval, O, Faynyk, A, Kopytsya, M, Karpenko, Y, Kraiz, I, Feskov, O, Rudenko, L, Kozhukhov, S, Goloborodko, B, Rivera, E, Broadwater, S, Crowley, S, Vijay, N, Goswami, R, Ferrier, L, Blanchard, A, Mccullum, K, Chernick, R, Bertolet, B, Battaglia, J, Richardson, J, Lochridge, S, Lieberman, S, Amkieh, A, Cavender, Jb, Denning, S, Treasure, C, Kmetzo, J, Stillabower, M, Brilakis, E, Schwartz, G, Acheatel, R, Kukuy, E, Ashchi, M, Skelding, K, Martin, L, Gillespie, E, French, W, Pollock, S, Polk, D, Black, R, Drenning, D, Anderson, J, Sanz, M, Korban, E, Wiley, M, Rezkalla, S, Minisi, A, Shah, A, Silverman, P, Amlani, M, Eaton, G, Brown, A, Jay, D, Loussararian, A, Lamas, G, Lauer, M, Williams, J, Asfour, A, Runquist, L, Robertson, R, Blonder, R, Davies, C, Downes, T, Chronos, N, Marso, S, Haldis, T, Eich, D, Ahmed, M, East, C, Macdonald, L, Seigel, P, White, M, Camp, A, Kleiman, N, Burtt, D, Strain, J, Go, B, Henry, P, Sultan, P, Delafontaine, P, Kashou, H, Lambert, C, Movahed, M, Saucedo, J, Thadani, U, Chandrashekhar, Y, Lu, D, Chandna, H, Mann, J, Ramaswamy, G, Browne, K, Janik, M, Cannon, K, Tolerico, P., Berni, Andrea, ACS - Amsterdam Cardiovascular Sciences, Vascular Medicine, and Cardiology

Subjects
Male, Indoles, Acetates, Acute Coronary Syndrome, Aged, Angina, Unstable, Atherosclerosis, Double-Blind Method, Early Termination of Clinical Trials, Female, Heptanoic Acids, Humans, Middle Aged, Phospholipases A, Phospholipases A2, Secretory, Pyrroles, Risk, Stroke, Survival Analysis, Treatment Outcome, Myocardial Infarction, law.invention, chemistry.chemical_compound, Randomized controlled trial, law, Atorvastatin, Clinical endpoint, Medicine (all), General Medicine, Angina, Keto Acids, medicine.medical_specialty, Acute coronary syndrome, Placebo, Unstable, Internal medicine, Multicenter trial, medicine, Atorvastatin Calcium, Unstable angina, business.industry, Secretory, medicine.disease, Interim analysis, Surgery, Phospholipases A2, chemistry, Varespladib, business
Abstract

Importance Secretory phospholipase A 2 (sPLA 2 ) generates bioactive phospholipid products implicated in atherosclerosis. The sPLA 2 inhibitor varespladib has favorable effects on lipid and inflammatory markers; however, its effect on cardiovascular outcomes is unknown. Objective To determine the effects of sPLA 2 inhibition with varespladib on cardiovascular outcomes. Design, Setting, and Participants A double-blind, randomized, multicenter trial at 362 academic and community hospitals in Europe, Australia, New Zealand, India, and North America of 5145 patients randomized within 96 hours of presentation of an acute coronary syndrome (ACS) to either varespladib (n = 2572) or placebo (n = 2573) with enrollment between June 1, 2010, and March 7, 2012 (study termination on March 9, 2012). Interventions Participants were randomized to receive varespladib (500 mg) or placebo daily for 16 weeks, in addition to atorvastatin and other established therapies. Main Outcomes and Measures The primary efficacy measure was a composite of cardiovascular mortality, nonfatal myocardial infarction (MI), nonfatal stroke, or unstable angina with evidence of ischemia requiring hospitalization at 16 weeks. Six-month survival status was also evaluated. Results At a prespecified interim analysis, including 212 primary end point events, the independent data and safety monitoring board recommended termination of the trial for futility and possible harm. The primary end point occurred in 136 patients (6.1%) treated with varespladib compared with 109 patients (5.1%) treated with placebo (hazard ratio [HR], 1.25; 95% CI, 0.97-1.61; log-rank P = .08). Varespladib was associated with a greater risk of MI (78 [3.4%] vs 47 [2.2%]; HR, 1.66; 95% CI, 1.16-2.39; log-rank P = .005). The composite secondary end point of cardiovascular mortality, MI, and stroke was observed in 107 patients (4.6%) in the varespladib group and 79 patients (3.8%) in the placebo group (HR, 1.36; 95% CI, 1.02-1.82; P = .04). Conclusions and Relevance In patients with recent ACS, varespladib did not reduce the risk of recurrent cardiovascular events and significantly increased the risk of MI. The sPLA 2 inhibition with varespladib may be harmful and is not a useful strategy to reduce adverse cardiovascular outcomes after ACS. Trial Registration clinicaltrials.gov Identifier:NCT01130246

Published
2014

3. Change in portal flow after liver transplantation: effect on hepatic arterial resistance indices and role of spleen size

Author

Bolognesi, Massimo, Sacerdoti, David, Bombonato, G, Merkel, Carlo, Sartori, G, Merenda, R, Nava, V, Angeli, Paolo, Feltracco, P, and Gatta, Angelo

Subjects
Adult, Liver Cirrhosis, Male, Liver Failure, Acute, Middle Aged, Liver Transplantation, Portal System, Hepatic Artery, Regional Blood Flow, Humans, Female, Ultrasonics, Vascular Resistance, Cardiac Output, Blood Flow Velocity, Spleen
Abstract

Information on changes in splanchnic hemodynamics after liver transplantation is incomplete. In particular, data on long-term changes are lacking, and the relationship between changes in arterial and portal parameters is still under debate. The effect of liver transplantation on splanchnic hemodynamics was analyzed with echo-Doppler in 41 patients with cirrhosis who were followed for up to 4 years. Doppler parameters were also evaluated in 7 patients transplanted for acute liver failure and in 35 controls. In cirrhotics, portal blood velocity and flow increased immediately after transplantation (from 9.1 plus minus 3.7 cm/sec to 38.3 plus minus 14.6 and from 808 plus minus 479 mL/min to 2,817 plus minus 1,153, respectively, P.001). Hepatic arterial resistance index (pulsatility index) also augmented (from 1.36 plus minus 0.32 to 2.34 plus minus 1.29, P.001) and was correlated with portal blood velocity and flow. The early changes in these parameters were related, in agreement with the hepatic buffer response theory. Portal flow returned to normal values after 2 years. Superior mesenteric artery flow normalized after 3 to 6 months. Splenomegaly persisted after 4 years, when spleen size was related to portal blood flow. In 7 patients transplanted for acute liver failure, portal flow, and hepatic arterial resistance index were normal after transplantation. In conclusion, a high portal flow was present in cirrhotics until 2 years after transplantation, probably because of maintenance of elevated splenic flow. An early increase in hepatic arterial resistance indices is a common finding, but it is transient and is related to the increase in portal blood flow. A normal time course of portal-hepatic hemodynamics was detected in patients transplanted for acute liver failure.

Published
2002

4. A COMPARATIVE PROSPECTIVE STUDY OF TWO AVAILABLE SOLUTIONS FOR KIDNEY AND LIVER PRESERVATION

Author

Paola, Pedotti, Massimo, Cardillo, Paolo, Rigotti, Giorgio, Gerunda, Roberto, Merenda, Umberto, Cillo, Giacomo, Zanus, Umberto, Baccarani, Maria Luisa, Berardinelli, Luigi, Boschiero, Lucio, Caccamo, Gilberto, Calconi, Stefano, Chiaramonte, Antonio, Dal Canton, Luciano, De Carlis, Valerio, Di Carlo, Donato, Donati, Domenico, Montanaro, Andrea, Pulvirenti, Giuseppe, Remuzzi, Silvio, Sandrini, Umberto, Valente, Mario, Scalamogna, Pedotti, P, Cardillo, M, Rigotti, P, Gerunda, G, Merenda, R, Cillo, U, Zanus, G, Baccarani, U, Berardinelli, M, Boschiero, L, Caccamo, L, Calconi, G, Chiaramonte, S, Dal Canton, A, De Carlis, L, Di Carlo, V, Donati, D, Pulvirenti, A, Remuzzi, G, Sandrini, S, Valente, U, and Scalamogna, M

Subjects
Adenosine, medicine.medical_treatment, Liver transplantation, Disaccharides, Kidney, HEPATOCYTES, Cohort Studies, Electrolytes, Glutamates, Insulin, Mannitol, Prospective Studies, Liver preservation, Kidney transplantation, liver transplantation, Graft Survival, UNIVERSITY-OF-WISCONSIN, Organ Preservation, Middle Aged, Clinical Trial, Glutathione, Multicenter Study, HTK, medicine.anatomical_structure, Liver, Randomized Controlled Trial, RCT, Adult, medicine.medical_specialty, University of Wisconsin solution, CELSIOR SOLUTION, Allopurinol, Urinary system, Organ Preservation Solutions, Urology, Cold storage, Raffinose, COLD-STORAGE, Comparative Study, Prospective Study, UW, Celsior, Transplantation, medicine, Humans, Histidine, Viaspan, Cryopreservation, business.industry, UNIVERSITY-OF-WISCONSIN, CELSIOR SOLUTION, ORGAN PRESERVATION, COLD-STORAGE, TRANSPLANTATION, UW, HTK, HEPATOCYTES, Bilirubin, medicine.disease, Kidney Transplantation, Survival Analysis, Liver Transplantation, Surgery, business
Abstract

BACKGROUND Viaspan (University of Wisconsin [UW]) solution is the gold standard for abdominal organ preservation. Celsior (CEL) is an extracellular-type, low-potassium, low-viscosity solution, initially used for heart and lung preservation. We have performed a prospective multicenter study to compare the role of these cold-storage solutions on kidney and liver recovery after transplantation. PATIENTS AND METHODS From March 15, 2000 to December 31, 2001, 441 (172 CEL and 269 UW) renal transplants (RT) and 175 (79 CEL and 96 UW) liver transplants (LT) were included in the study. RESULTS Perfusate volume used was significantly lower in the UW group, being 4,732 +/- 796 mL versus 5,826 + 834 mL in the CEL group (P < 0.001). In LT, median total bilirubin serum levels were significantly higher at 5 and 7 posttransplant days in the UW group (90.6 and 92.3 micromol/L, respectively) as compared with CEL (51.3 and 63.4 micromol/L, respectively). After LT, primary nonfunction (PNF) rates in the CEL and UW groups were 3.8% and 4.2% (P = NS) respectively, with 1-year graft and patient survival being 83.3% versus 85.4% (P = NS) and 89.9% versus 90.6% (P = NS). After RT, delayed graft function (DGF) rates were 23.2% and 22.7% (P = NS), respectively; PNF rates were 1.9% and 1.7% (P = NS) respectively, with 1-year graft and patient survival being 92.3% versus 94.2% (P = NS) and 99.4% versus 97.7% (P = NS). CONCLUSIONS CEL solution was shown to be as effective as UW in both liver and kidney preservation. In LT patients, biliary function recovery is significantly better in the CEL group. CEL solution represents an efficacious option in multiorgan harvesting.

Published
2004
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5. Influence of steroids on HCV recurrence after liver transplantation: A prospective study

Author

Giuliano La Barba, Gian Luca Grazi, Umberto Cillo, Federico Maria Giannini, Marco Vivarelli, Matteo Zanello, Antonia D'Errico, Alessandro Cucchetti, Roberto Merenda, Marco Senzolo, Daniele Neri, Maria Guido, D Canova, Antonio Daniele Pinna, Patrizia Burra, Vivarelli M, Burra P, Barba GL, Canova D, Senzolo M, Cucchetti A, D'Errico A, Guido M, Merenda R, Neri D, Zanello M, Giannini FM, Grazi GL, Cillo U, and Pinna AD.

Subjects
Adult, Liver Cirrhosis, medicine.medical_specialty, medicine.medical_treatment, Liver transplantation, Gastroenterology, Group B, law.invention, Randomized controlled trial, law, Internal medicine, Biopsy, Secondary Prevention, medicine, Humans, Prospective cohort study, Aged, Aged, 80 and over, IMMUNOSUPPRESSION, Hepatology, medicine.diagnostic_test, business.industry, STEROIDS, Immunosuppression, LIVER TRANSPLANTATION, Middle Aged, Hepatitis C, Surgery, Treatment Outcome, Liver biopsy, HCV, Prednisone, Complication, business
Abstract

Background/Aims To assess the effect of long-term maintenance of steroids on HCV recurrence after liver transplantation (LT), that is still controversial, a prospective multicentre trial was conducted at the centres of Bologna and Padua, Italy. Methods From September 2002, 47 eligible HCV positive LT recipients were randomized to receive 2 different steroid schedules in association with tacrolimus: group A: rapid tapering and withdrawal 91 days after LT group B: slow tapering and withdrawal 25 months after LT. Thirty-nine patients were assessable: 23 in group A and 16 in group B. Donor and recipient characteristics were similar in the two groups. Median follow-up was 841 days (130–1376). One hundred liver biopsies were performed, and every patient had a biopsy at month 12. Results Twenty-two out of 23 (95, 65%) patients in group A and 15 out of 16 (93, 75%) in group B had histologically-confirmed HCV recurrence. Twelve-month histology showed advanced fibrosis (score 3 or 4) in 42.1% of the patients in group A versus 7.6% in group B ( P =0.03). One-and 2-year advanced fibrosis-free survival were 65.2 and 60.8 in group A and 93.7% in group B ( P =0.03 and=0.02, respectively). Conclusions Slow tapering of steroids reduced the progression of recurrent hepatitis C after LT.

Published
2007

6. Comparison between two high-dose methylprednisolone schedules in the treatment of acute hepatic cellular rejection in liver transplant recipients: a controlled clinical trial

Author

Roberto Merenda, Angelo Gatta, Mario Strazzabosco, Antonietta Sticca, Carlo Merkel, Daniele Neri, Paolo Feltracco, Roberta Volpin, Silvano Fasolato, F. Casagrande, Franco Del Piccolo, Giorgio Enrico Gerunda, Alessandra Galioto, Paolo Angeli, Franco Barbazza, Volpin, R, Angeli, P, Galioto, A, Fasolato, S, Neri, D, Barbazza, F, Merenda, R, Del Piccolo, F, Strazzabosco, M, Casagrande, F, Feltracco, P, Sticca, A, Merkel, C, Gerunda, G, and Gatta, A

Subjects
Graft Rejection, Male, methylprednisone, hacute rejection, liver transplantation, medicine.medical_specialty, medicine.medical_treatment, Liver transplantation, Gastroenterology, Methylprednisolone, Group B, law.invention, Randomized controlled trial, MED/12 - GASTROENTEROLOGIA, law, Internal medicine, medicine, Humans, Transplantation, Homologous, Glucocorticoids, Aged, Transplantation, Analysis of Variance, Hepatology, medicine.diagnostic_test, business.industry, Alanine Transaminase, Bilirubin, Middle Aged, Surgery, Liver Transplantation, Clinical trial, Regimen, Liver biopsy, Female, business, medicine.drug
Abstract

Intravenous methylprednisolone is used in most liver transplant centers as first-line therapy of acute hepatic cellular rejection in patients who undergo liver transplant. However, no controlled study has been performed to date to define the optimal dose and duration of the steroid regimen. The schedules that actually are used in most transplant centers are drawn from those that were developed empirically for the treatment of acute renal graft rejection. Thus, the aim of the study was to compare two schedules of steroid treatment of acute hepatic cellular rejection among those most widely used. Thirty-eight eligible patients with grade II or III acute hepatic cellular rejection were randomized to receive two different high-dose methylprednisolone schedules. Eighteen patients were randomized in group A (intravenous dose of 1,000 mg of methylprednisolone followed by a 6-day taper from 200 to 20 mg/d). Twenty patients were randomized in group B (intravenous dose of 1,000 mg of methylprednisolone for three consecutive days). The response to treatment was evaluated by means of a second liver biopsy. The treatment of group A proved to be more effective than treatment of group B. The resolution of acute hepatic cellular rejection was observed in 83.3% of cases in group A and 50.0% of cases in group B (P

Published
2002

7. Cerebral aspergillosis in a liver transplant recipient: a case report of long-term survival after combined treatment with liposomal amphotericin B and surgery

Author

Mario Strazzabosco, Gioacchino Mattisi, Andrea Rossanese, Rosa Maria Iemmolo, Roberto Merenda, Daniele Neri, Gaetano Crepaldi, Andrea Rotilio, Giorgio Enrico Gerunda, Iemmolo, R, Rossanese, A, Rotilio, A, Mattisi, G, Gerunda, G, Merenda, R, Neri, D, Crepaldi, G, and Strazzabosco, M

Subjects
Male, medicine.medical_specialty, Antifungal Agents, Time Factors, medicine.medical_treatment, Liver transplantation, Aspergillosis, Aspergillus fumigatus, Cerebrospinal fluid, Postoperative Complications, MED/12 - GASTROENTEROLOGIA, Amphotericin B, Medicine, Humans, liposomal amphotericin B, Mycosis, Brain Diseases, Drug Carriers, Hepatology, biology, business.industry, Brain, Middle Aged, medicine.disease, biology.organism_classification, Magnetic Resonance Imaging, Surgery, Liver Transplantation, Transplantation, cerebral aspergillosi, Liposomes, business, Complication, Tomography, X-Ray Computed, medicine.drug
Abstract

Cerebral aspergillosis is a life-threatening complication in liver transplant recipients, with mortality rates approaching 100%; treatment with amphotericin B is of limited efficacy because of its poor distribution in the cerebrospinal fluid and its systemic side effects. We report the case of a liver transplant recipient who developed recurrent cerebral Aspergillus fumigatus infection, and was successfully treated by combined surgical excision of the lesion and administration of liposomal amphotericin B. This first report of long-term complication-free survival in a liver transplant recipient suggests that therapy with liposomal amphotericin B may reduce the risk of recurrence of cerebral aspergillosis in these immunocompromised patients.

Published
1998

8. Epstein-Barr virus-associated post-transplant lympho-proliferative disease of donor origin in liver transplant recipients

Author

Chiara Menin, Rosa Maria Iemmolo, Emma D'Andrea, Alvise Maffei Faccioli, Mario Strazzabosco, Alessandro Poletti, Roberto Merenda, Annarosa Del Mistro, Laura Bonaldi, Daniele Neri, M. Montagna, Giorgio Enrico Gerunda, Barbara Corneo, Strazzabosco, M, Corneo, B, Iemmolo, R, Menin, C, Gerunda, G, Bonaldi, L, Merenda, R, Neri, D, Poletti, A, Montagna, M, Del Mistro, A, Faccioli, A, and D'Andrea, E

Subjects
Male, Herpesvirus 4, Human, Pathology, medicine.medical_specialty, medicine.medical_treatment, In situ hybridization, Liver transplantation, medicine.disease_cause, Herpesviridae, Virus, Cell Line, MED/12 - GASTROENTEROLOGIA, medicine, liver transpantation, epstein-barr virus, Humans, Gammaherpesvirinae, Southern blot, B-Lymphocytes, Hepatology, biology, business.industry, Herpesviridae Infections, Middle Aged, biology.organism_classification, Epstein–Barr virus, Lymphoproliferative Disorders, Tissue Donors, Liver Transplantation, Transplantation, Tumor Virus Infections, Immunology, Tomography, X-Ray Computed, business, Microsatellite Repeats
Abstract

Background/Aims: Post-transplant lymphoproliferative disease, a potential complication of solid organ transplantation, occurs in about 3% of orthotopic liver transplant recipients. We report the genetic and virological characterization of two cases of post-transplant lymphoproliferative disease that occurred early (4 and 6 months) after orthotopic liver transplant as large-cell non-Hodgkin's lymphomas located at the hepatic hilum. Methods: Lymphomatous tissues were analyzed for clonality and presence of Epstein-Barr virus (EBV) sequences by Southern blot, polymerase chain reaction, and in situ hybridization techniques. Results: The tumors in both cases were sustained by a clonal proliferation of B lymphocytes containing type A EBV DNA. Moreover, in situ hybridization with a digoxigenin-labeled EBV-specific probe evidenced a strong nuclear signal in most of the neoplastic cells. DNA microsatellite analysis at three different loci detected alleles of donor origin in both tumor samples, suggesting that the neoplastic B cells were of donor origin. Conclusions: EBV-infected donor B lymphocytes might be responsible for intragraft post-transplant lymphoproliferative disease in orthotopic liver transplant recipients. As 20 to 30% of post-transplant lymphomas involve the graft itself, donor-derived post-transplant lymphoproliferative disease might be more frequent than present appreciated. Prospective studies are needed to assess its real incidence and identify possible risk factors.

Published
1997

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