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2. Infections in liver and lung transplant recipients. A national prospective cohort
- Author
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Gagliotti, Carlo, Morsillo, Filomena, Moro, Maria Luisa, Masiero, Lucia, Procaccio, Francesco, Vespasiano, Francesca, Pantosti, Annalisa, Monaco, Monica, Errico, Giulia, Ricci, Andrea, Grossi, Paolo, Nanni Costa, Alessandro, Adorno, D., Ambretti, S., Amoroso, A., Arghittu, M., Berloco, P., Bertani, A., Bonizzoli, M., Cambieri, P., Canzonieri, M., Caprio, M., Carrara, E., Carrinola, R., Cibelli, E., Cillo, U., Colledan, M., Colombo, R., Coluccio, E., Conaldi, P. G., Cusi, M., D’Armini, A. M., da Riva, A., D’Auria, B., de Carlis, L., de Cillia, C., de Gasperi, A., Di Caro, A., Di Ciaccio, P., Dondossola, D., Farina, C., Feltrin, G., Finarelli, A. C., Fossati, L., Gaibani, P., Garcia Fernandez, A., Gesu, G., Giacometti, R., Gona, F., Gridelli, B., Henrici de Angelis, L., Landini, M. P., Maldarelli, F., Mancini, C., Marone, P., Mularoni, A., Paglialunga, G., Paladini, P., Palù, G., Parisi, S., Peris, A., Pinna, A. D., Platto, M., Pugliese, F., Puoti, F., Rago, C., Ravini, M., Rea, F., Rinaldi, M., Rossi, G., Rossi, L., Rossi, M., Salizzoni, M., Sangiorgi, G., Santambrogio, L., Spada, M., Sparacino, V., Stella, F., Torelli, R., Torresani, E., Tosi, D., Vailati, F., Valeri, M., Venuta, F., Vesconi, S., Viale, P., Vismara, C., Gagliotti, C, Morsillo, F, Moro, M, Masiero, L, Procaccio, F, Vespasiano, F, Pantosti, A, Monaco, M, Errico, G, Ricci, A, Grossi, P, Nanni Costa, A, Adorno, D, Ambretti, S, Amoroso, A, Arghittu, M, Berloco, P, Bertani, A, Bonizzoli, M, Cambieri, P, Canzonieri, M, Caprio, M, Carrara, E, Carrinola, R, Cibelli, E, Cillo, U, Colledan, M, Colombo, R, Coluccio, E, Conaldi, P, Cusi, M, D’Armini, A, da Riva, A, D’Auria, B, de Carlis, L, de Cillia, C, de Gasperi, A, Di Caro, A, Di Ciaccio, P, Dondossola, D, Farina, C, Feltrin, G, Finarelli, A, Fossati, L, Gaibani, P, Garcia Fernandez, A, Gesu, G, Giacometti, R, Gona, F, Gridelli, B, Henrici de Angelis, L, Landini, M, Maldarelli, F, Mancini, C, Marone, P, Mularoni, A, Paglialunga, G, Paladini, P, Palù, G, Parisi, S, Peris, A, Pinna, A, Platto, M, Pugliese, F, Puoti, F, Rago, C, Ravini, M, Rea, F, Rinaldi, M, Rossi, G, Rossi, L, Rossi, M, Salizzoni, M, Sangiorgi, G, Santambrogio, L, Spada, M, Sparacino, V, Stella, F, Torelli, R, Torresani, E, Tosi, D, Vailati, F, Valeri, M, Venuta, F, Vesconi, S, Viale, P, Vismara, C, Gagliotti, Carlo, Morsillo, Filomena, Moro, Maria Luisa, Masiero, Lucia, Procaccio, Francesco, Vespasiano, Francesca, Pantosti, Annalisa, Monaco, Monica, Errico, Giulia, Ricci, Andrea, Grossi, Paolo, Costa, Alessandro Nanni, Adorno, Domenico, Ambretti, Simone, Amoroso, Antonio, Arghittu, Milena, Berloco, Pasquale, Bertani, Alessandro, Bonizzoli, Manuela, Cambieri, Patrizia, Canzonieri, Marco, Caprio, Mario, Carrara, Elena, Carrinola, Rosaria, Cibelli, Eva, Cillo, Umberto, Colledan, Michele, Colombo, Rosaria, Coluccio, Elena, Conaldi, Pier Giulio, Cusi, Mariagrazia, D’Armini, Andrea Maria, Da Riva, Adelaide, D'Auria, Bianca, De Carlis, Luciano, De Cillia, Carlo, De Gasperi, Andrea, Di Caro, Antonino, Di Ciaccio, Paola, Dondossola, Daniele, Farina, Claudio, Feltrin, Giuseppe, Finarelli, Alba Carola, Fossati, Lucina, Gaibani, Paolo, Fernandez, Aurora Garcia, Gesu, Giovanni, Giacometti, Raffaella, Gona, Floriana, Gridelli, Bruno, De Angelis, Lucia Henrici, Landini, Maria Paola, Maldarelli, Federica, Mancini, Carlo, Marone, Piero, Mularoni, Alessandra, Paglialunga, Giulia, Paladini, Piero, Palù, Giorgio, Parisi, Saverio, Peris, Adriano, Pinna, Antonio Daniele, Platto, Marco, Pugliese, Francesco, Puoti, Francesca, Rago, Claudio, Ravini, Mario, Rea, Federico, Rinaldi, Mauro, Rossi, Giorgio, Rossi, Lucia, Rossi, Massimo, Salizzoni, Mauro, Sangiorgi, Gabriela, Santambrogio, Luigi, Spada, Marco, Sparacino, Vito, Stella, Franco, Torelli, Rosanna, Torresani, Erminio, Tosi, Davide, Vailati, Francesca, Valeri, Maurizio, Venuta, Federico, Vesconi, Sergio, Viale, Pierluigi, and Vismara, Chiara
- Subjects
Microbiology (medical) ,Infectious Diseases ,Male ,0301 basic medicine ,medicine.medical_treatment ,Drug Resistance ,Transplant Recipient ,030230 surgery ,Liver transplantation ,Postoperative Complications ,0302 clinical medicine ,Drug Resistance, Multiple, Bacterial ,Medicine ,Cumulative incidence ,Prospective Studies ,Prospective cohort study ,Incidence ,Incidence (epidemiology) ,Mortality rate ,Bacterial ,Bacterial Infections ,General Medicine ,Middle Aged ,lung transplant ,Anti-Bacterial Agents ,infectious ,Italy ,Female ,Multiple ,Adult ,Bacteria ,Humans ,Transplant Recipients ,Liver Transplantation ,Lung Transplantation ,Human ,medicine.medical_specialty ,030106 microbiology ,Bacterial Infection ,Infectious Diseases, transplantation ,03 medical and health sciences ,Internal medicine ,Anti-Bacterial Agent ,Lung transplantation ,business.industry ,lung transplant, liver transplant, infectious ,Transplantation ,Prospective Studie ,liver transplant ,Etiology ,Postoperative Complication ,business ,transplantation - Abstract
Infections are a major complication of solid organ transplants (SOTs). This study aimed to describe recipients’ characteristics, and the frequency and etiology of infections and transplant outcome in liver and lung SOTs, and to investigate exposures associated to infection and death in liver transplant recipients. The study population included recipients of SOTs performed in Italy during a 1-year period in ten Italian lung transplant units and eight liver transplant units. Data on comorbidities, infections, retransplantation, and death were prospectively collected using a web-based system, with a 6-month follow-up. The cumulative incidence of infection was 31.7% and 47.8% in liver and lung transplants, respectively, with most infections occurring within the first month after transplantation. Gram-negatives, which were primarily multidrug-resistant, were the most frequent cause of infection. Death rates were 0.42 per 1000 recipient-days in liver transplants and 1.41 per 1000 recipient-days in lung transplants. Infection after SOT in adult liver recipients is associated to an increased risk of death (OR = 13.25; p-value < 0.001). Given the frequency of infection caused by multidrug-resistant microorganisms in SOT recipients in Italy and the heavy impact of infections on the transplant outcome, the reinforcement of surveillance and control activities to prevent the transmission of multidrug-resistant microorganisms in SOT recipients represents a priority. The implementation of the study protocol in liver and lung transplant units and the sharing of results have increased the awareness about the threat due to antimicrobial resistance in the country.
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- 2018
3. Colonization and infection due to carbapenemase-producing Enterobacteriaceae in liver and lung transplant recipients and donor-derived transmission: a prospective cohort study conducted in Italy
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Errico, G., primary, Gagliotti, C., additional, Monaco, M., additional, Masiero, L., additional, Gaibani, P., additional, Ambretti, S., additional, Landini, M.P., additional, D’Arezzo, S., additional, Di Caro, A., additional, Parisi, S.G., additional, Palù, G., additional, Vespasiano, F., additional, Morsillo, F., additional, Moro, M.L., additional, Procaccio, F., additional, Ricci, A., additional, Grossi, P.A., additional, Pantosti, A., additional, Nanni Costa, A., additional, Farina, C., additional, Vailati, F., additional, Gesu, G., additional, Vismara, C., additional, Arghittu, M., additional, Colombo, R., additional, Torresani, E., additional, Rossi, L., additional, Conaldi, P.G., additional, Gona, F., additional, Cambieri, P., additional, Marone, P., additional, Venditti, C., additional, Fernandez, A. Garcia, additional, Mancini, C., additional, Cusi, M., additional, De Angelis, L. Henrici, additional, Fossati, L., additional, Finarelli, A.C., additional, De Cillia, C., additional, Sangiorgi, G., additional, Pinna, A.D., additional, Stella, F., additional, Viale, P., additional, Colledan, M., additional, Platto, M., additional, Bonizzoli, M., additional, Peris, A., additional, Torelli, R., additional, Vesconi, S., additional, Cibelli, E., additional, De Carlis, L., additional, De Gasperi, A., additional, Ravini, M., additional, Carrinola, R., additional, Coluccio, E., additional, Dondossola, D., additional, Rossi, G., additional, Santambrogio, L., additional, Tosi, D., additional, Feltrin, G., additional, Rago, C., additional, Cillo, U., additional, Da Riva, A., additional, Rea, F., additional, Sparacino, V., additional, Bertani, A., additional, Canzonieri, M., additional, Gridelli, B., additional, Mularoni, A., additional, Spada, M., additional, Carrara, E., additional, D’Armini, A. Maria, additional, Paladini, P., additional, Adorno, D., additional, Valeri, M., additional, Caprio, M., additional, Di Ciaccio, P., additional, Puoti, F., additional, Berloco, P., additional, D’Auria, B., additional, Maldarelli, F., additional, Paglialunga, G., additional, Pugliese, F., additional, Rossi, M., additional, Venuta, F., additional, Amoroso, A., additional, Giacometti, R., additional, Rinaldi, M., additional, and Salizzoni, M., additional
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- 2019
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4. Infections in liver and lung transplant recipients: a national prospective cohort
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Gagliotti, C, Morsillo, F, Moro, M, Masiero, L, Procaccio, F, Vespasiano, F, Pantosti, A, Monaco, M, Errico, G, Ricci, A, Grossi, P, Nanni Costa, A, Adorno, D, Ambretti, S, Amoroso, A, Arghittu, M, Berloco, P, Bertani, A, Bonizzoli, M, Cambieri, P, Canzonieri, M, Caprio, M, Carrara, E, Carrinola, R, Cibelli, E, Cillo, U, Colledan, M, Colombo, R, Coluccio, E, Conaldi, P, Cusi, M, D’Armini, A, da Riva, A, D’Auria, B, de Carlis, L, de Cillia, C, de Gasperi, A, Di Caro, A, Di Ciaccio, P, Dondossola, D, Farina, C, Feltrin, G, Finarelli, A, Fossati, L, Gaibani, P, Garcia Fernandez, A, Gesu, G, Giacometti, R, Gona, F, Gridelli, B, Henrici de Angelis, L, Landini, M, Maldarelli, F, Mancini, C, Marone, P, Mularoni, A, Paglialunga, G, Paladini, P, Palù, G, Parisi, S, Peris, A, Pinna, A, Platto, M, Pugliese, F, Puoti, F, Rago, C, Ravini, M, Rea, F, Rinaldi, M, Rossi, G, Rossi, L, Rossi, M, Salizzoni, M, Sangiorgi, G, Santambrogio, L, Spada, M, Sparacino, V, Stella, F, Torelli, R, Torresani, E, Tosi, D, Vailati, F, Valeri, M, Venuta, F, Vesconi, S, Viale, P, Vismara, C, Gagliotti, C, Morsillo, F, Moro, M, Masiero, L, Procaccio, F, Vespasiano, F, Pantosti, A, Monaco, M, Errico, G, Ricci, A, Grossi, P, Nanni Costa, A, Adorno, D, Ambretti, S, Amoroso, A, Arghittu, M, Berloco, P, Bertani, A, Bonizzoli, M, Cambieri, P, Canzonieri, M, Caprio, M, Carrara, E, Carrinola, R, Cibelli, E, Cillo, U, Colledan, M, Colombo, R, Coluccio, E, Conaldi, P, Cusi, M, D’Armini, A, da Riva, A, D’Auria, B, de Carlis, L, de Cillia, C, de Gasperi, A, Di Caro, A, Di Ciaccio, P, Dondossola, D, Farina, C, Feltrin, G, Finarelli, A, Fossati, L, Gaibani, P, Garcia Fernandez, A, Gesu, G, Giacometti, R, Gona, F, Gridelli, B, Henrici de Angelis, L, Landini, M, Maldarelli, F, Mancini, C, Marone, P, Mularoni, A, Paglialunga, G, Paladini, P, Palù, G, Parisi, S, Peris, A, Pinna, A, Platto, M, Pugliese, F, Puoti, F, Rago, C, Ravini, M, Rea, F, Rinaldi, M, Rossi, G, Rossi, L, Rossi, M, Salizzoni, M, Sangiorgi, G, Santambrogio, L, Spada, M, Sparacino, V, Stella, F, Torelli, R, Torresani, E, Tosi, D, Vailati, F, Valeri, M, Venuta, F, Vesconi, S, Viale, P, and Vismara, C
- Abstract
Infections are a major complication of solid organ transplants (SOTs). This study aimed to describe recipients’ characteristics, and the frequency and etiology of infections and transplant outcome in liver and lung SOTs, and to investigate exposures associated to infection and death in liver transplant recipients. The study population included recipients of SOTs performed in Italy during a 1-year period in ten Italian lung transplant units and eight liver transplant units. Data on comorbidities, infections, retransplantation, and death were prospectively collected using a web-based system, with a 6-month follow-up. The cumulative incidence of infection was 31.7% and 47.8% in liver and lung transplants, respectively, with most infections occurring within the first month after transplantation. Gram-negatives, which were primarily multidrug-resistant, were the most frequent cause of infection. Death rates were 0.42 per 1000 recipient-days in liver transplants and 1.41 per 1000 recipient-days in lung transplants. Infection after SOT in adult liver recipients is associated to an increased risk of death (OR = 13.25; p-value < 0.001). Given the frequency of infection caused by multidrug-resistant microorganisms in SOT recipients in Italy and the heavy impact of infections on the transplant outcome, the reinforcement of surveillance and control activities to prevent the transmission of multidrug-resistant microorganisms in SOT recipients represents a priority. The implementation of the study protocol in liver and lung transplant units and the sharing of results have increased the awareness about the threat due to antimicrobial resistance in the country
- Published
- 2018
5. Colonization and infection due to carbapenemase-producing Enterobacteriaceae in liver and lung transplant recipients and donor-derived transmission: a prospective cohort study conducted in Italy
- Author
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Rosaria Carrinola, P. Paladini, A. Garcia Fernandez, M. Bonizzoli, E. Coluccio, Marco Spada, L. Henrici De Angelis, Alessandro Bertani, M. Valeri, Mauro Rinaldi, P. Di Ciaccio, Simone Ambretti, A. Ricci, Paolo Gaibani, Claudio Farina, L. De Carlis, Giulia Errico, S. D’Arezzo, F. Vailati, M. Canzonieri, M. Caprio, Antonio Daniele Pinna, E. Carrara, Giorgio Palù, G. Feltrin, Francesco Pugliese, C. Rago, M. Ravini, G. Sangiorgi, R. Colombo, P. Cambieri, C. De Cillia, Pier Giulio Conaldi, B. D’Auria, Erminio Torresani, G. P. Gesu, Alessandra Mularoni, A De Gasperi, Giorgio Rossi, A. Peris, Bruno Gridelli, Milena Arghittu, Mauro Salizzoni, Saverio Giuseppe Parisi, Paolo Grossi, M. Platto, V. Sparacino, P. Viale, Lucia Masiero, A. Nanni Costa, M. P. Landini, A. Da Riva, Daniele Dondossola, Antonio Amoroso, Carlo Gagliotti, R. Torelli, D. Adorno, M. Cusi, Floriana Gona, Luigia Rossi, P.B. Berloco, G. Paglialunga, Federico Venuta, Piero Marone, U. Cillo, Francesca Vespasiano, A C Finarelli, L. Fossati, Davide Tosi, A. Maria D’Armini, Federica Maldarelli, Massimiliano Rossi, Federico Rea, Francesco Procaccio, Michele Colledan, Annalisa Pantosti, Filomena Morsillo, C. Vismara, R. Giacometti, Sergio Vesconi, C. Mancini, C. Venditti, Francesca Puoti, Luigi Santambrogio, A. Di Caro, Maria Luisa Moro, F. Stella, E. Cibelli, Monica Monaco, Errico G., Gagliotti C., Monaco M., Masiero L., Gaibani P., Ambretti S., Landini M.P., D'Arezzo S., Di Caro A., Parisi S.G., Palu G., Vespasiano F., Morsillo F., Moro M.L., Procaccio F., Ricci A., Grossi P.A., Pantosti A., Nanni Costa A., Farina C., Vailati F., Gesu G., Vismara C., Arghittu M., Colombo R., Torresani E., Rossi L., Conaldi P.G., Gona F., Cambieri P., Marone P., Venditti C., Fernandez A.G., Mancini C., Cusi M., De Angelis L.H., Fossati L., Finarelli A.C., De Cillia C., Sangiorgi G., Pinna A.D., Stella F., Viale P., Colledan M., Platto M., Bonizzoli M., Peris A., Torelli R., Vesconi S., Cibelli E., De Carlis L., De Gasperi A., Ravini M., Carrinola R., Coluccio E., Dondossola D., Rossi G., Santambrogio L., Tosi D., Feltrin G., Rago C., Cillo U., Da Riva A., Rea F., Sparacino V., Bertani A., Canzonieri M., Gridelli B., Mularoni A., Spada M., Carrara E., D'Armini A.M., Paladini P., Adorno D., Valeri M., Caprio M., Di Ciaccio P., Puoti F., Berloco P., D'Auria B., Maldarelli F., Paglialunga G., Pugliese F., Rossi M., Venuta F., Amoroso A., Giacometti R., Rinaldi M., Salizzoni M., Errico, G, Gagliotti, C, Monaco, M, Masiero, L, Gaibani, P, Ambretti, S, Landini, M, D'Arezzo, S, Di Caro, A, Parisi, S, Palu, G, Vespasiano, F, Morsillo, F, Moro, M, Procaccio, F, Ricci, A, Grossi, P, Pantosti, A, Nanni Costa, A, Farina, C, Vailati, F, Gesu, G, Vismara, C, Arghittu, M, Colombo, R, Torresani, E, Rossi, L, Conaldi, P, Gona, F, Cambieri, P, Marone, P, Venditti, C, Fernandez, A, Mancini, C, Cusi, M, De Angelis, L, Fossati, L, Finarelli, A, De Cillia, C, Sangiorgi, G, Pinna, A, Stella, F, Viale, P, Colledan, M, Platto, M, Bonizzoli, M, Peris, A, Torelli, R, Vesconi, S, Cibelli, E, De Carlis, L, De Gasperi, A, Ravini, M, Carrinola, R, Coluccio, E, Dondossola, D, Rossi, G, Santambrogio, L, Tosi, D, Feltrin, G, Rago, C, Cillo, U, Da Riva, A, Rea, F, Sparacino, V, Bertani, A, Canzonieri, M, Gridelli, B, Mularoni, A, Spada, M, Carrara, E, D'Armini, A, Paladini, P, Adorno, D, Valeri, M, Caprio, M, Di Ciaccio, P, Puoti, F, Berloco, P, D'Auria, B, Maldarelli, F, Paglialunga, G, Pugliese, F, Rossi, M, Venuta, F, Amoroso, A, Giacometti, R, Rinaldi, M, and Salizzoni, M
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0301 basic medicine ,Male ,Colonization ,Klebsiella pneumoniae ,medicine.medical_treatment ,Drug Resistance ,Transplant Recipient ,Liver transplantation ,beta-Lactamase ,Cohort Studies ,0302 clinical medicine ,80 and over ,030212 general & internal medicine ,Prospective Studies ,Screening cultures ,Prospective cohort study ,Child ,Aged, 80 and over ,biology ,Bacterial ,Enterobacteriaceae Infections ,General Medicine ,Middle Aged ,Tissue Donors ,Infectious Diseases ,Italy ,Child, Preschool ,Female ,Infection ,Human ,Lung Transplantation ,Adult ,Microbiology (medical) ,medicine.medical_specialty ,Adolescent ,030106 microbiology ,Tissue Donor ,Bacterial Protein ,beta-Lactamases ,03 medical and health sciences ,Young Adult ,Bacterial Proteins ,Internal medicine ,Drug Resistance, Bacterial ,medicine ,Humans ,Preschool ,Genotyping ,Contraindication ,Donor–recipient transmission ,Aged ,business.industry ,CPE ,Solid organ transplant ,Infant ,Liver Transplantation ,Transplant Recipients ,Carbapenem-Resistant Enterobacteriaceae ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,Enterobacteriaceae Infection ,Transplantation ,Prospective Studie ,Multilocus sequence typing ,Cohort Studie ,business - Abstract
Objectives A prospective cohort study was conducted in Italy in order to describe the microbiologic aspects of colonization/infection by carbapenemase-producing Enterobacteriaceae (CPE) in donors and recipients of lung and liver transplants and the possible CPE transmission from donors to recipients. Methods Between 15 January 2014 and 14 January 2015, all recipients of solid organ transplants (SOT) at ten lung and eight liver transplantation centres and the corresponding donors were enrolled. Screening cultures to detect CPE were performed in donors, and screening and clinical cultures in recipients with a 28-day microbiologic follow-up after receipt of SOT. Detection of carbapenemase genes by PCR, genotyping by multilocus sequence typing, and pulsed-field gel electrophoresis and whole-genome sequencing were performed. Results Of 588 screened donors, 3.4% were colonized with CPE. Of the liver first transplant recipients (n = 521), 2.5% were colonized before receipt of SOT and 5% acquired CPE during follow-up. CPE colonization was higher in lung first transplant recipients (n = 111, 2.7% before SOT and 14.4% after SOT). CPE infections occurred in 1.9% and 5.3% of liver or lung recipients, respectively. CPE isolates were mostly Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae belonging to CG258. Three events of donor–recipient CPE transmission, confirmed by whole-genome sequencing and/or pulsed-field gel electrophoresis, occurred in lung recipients: two involving K. pneumoniae sequence type 512 and one Verona integron-encoded metallo-β-lactamase (VIM)-producing Enterobacter aerogenes. Conclusions This study showed a low risk of donor–recipient CPE transmission, indicating that donor CPE colonization does not necessarily represent a contraindication for donation unless colonization regards the organ to be transplanted. Donor and recipient screening remains essential to prevent CPE transmission and cross-infection in transplantation centres.
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- 2019
6. Crucial Role of Extended Criteria Donors in Deceased Donor Single Kidney Transplantation to Face Chronic Shortage in the Heart of the Mediterranean Basin: A Single-Center Experience
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Sergio Calamia, Duilio Pagano, Giuliana Checchini, Pasquale Bonsignore, Davide Cintorino, Paola Salis, Fabrizio di Francesco, Antonio Arcadipane, Calogero Ricotta, Alessandro Tropea, Marco Canzonieri, Sergio Li Petri, Salvatore Piazza, Salvatore Gruttadauria, Rosa Liotta, Bonsignore P., Pagano D., Piazza S., Ricotta C., di Francesco F., Cintorino D., Li Petri S., Canzonieri M., Tropea A., Calamia S., Checchini G., Salis P., Arcadipane A., Liotta R., and Gruttadauria S.
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Adult ,Male ,medicine.medical_specialty ,Tissue and Organ Procurement ,Delayed Graft Function ,Single Center ,Medicine ,Humans ,Survival analysis ,Kidney transplantation ,Retrospective Studies ,Transplantation ,Kidney ,Continental Population Groups ,business.industry ,Incidence (epidemiology) ,Incidence ,Graft Survival ,Racial Groups ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Survival Analysis ,Tissue Donors ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,Treatment Outcome ,Female ,business ,Body mass index - Abstract
Background: The gap between organ availability and patients on the waiting list for deceased donor kidney transplants has resulted in the wide use of extended criteria donors (ECDs).We aimed to compare the surgical outcomes of single kidney transplantation (KT) performed at our institute with standard criteria donor (SCD) or ECD grafts, according to the Organ Procurement and Transplantation Network definition. Patients and methods. Our retrospective analysis studied 115 adult recipients of KT from January 2016 to July 2018, with kidney grafts procured from adult donors after brain or circulatory death, performed at our institute. Among the 2 recipients’ groups, we compared the incidence of early graft loss, delayed graft function, hospitalization, and surgical complications. We compared the evaluation of time to early graft loss with Kaplan-Meier estimators and curves; the hypothesis of no difference in time to graft loss between the 2 groups was tested using the log-rank statistics. Results: Of the 103 deceased donor kidney transplants during the study period, 129 grafts were used after the regional network sharing allocation. More frequently, ECDs had a greater body mass index than SCDs (25.2 ± 3.9 vs 27.7 ± 5.0, P = .005) and type II diabetes mellitus (0% vs 18%, P = .002). KT recipients who received an ECD graft (73, 63.5%) were older (59.8 ± 9.8 vs 45.2 ± 15.4, P < .001) and presented a higher rate of delayed graft function (56% vs 24%, P = .001). Post-transplant graft loss did not differ among the 2 groups. Conclusion: Based on clinical experience in a single transplant center, ECD use for KTs is crucial in facing the organ shortage, without impairing post-deceased donor kidney transplant outcomes.
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- 2019
7. Impact of Italian Score for Organ Allocation System on Deceased Donor Liver Transplantation: A Monocentric Competing Risk Time-to-Event Analysis
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Sergio Calamia, Simone Khouzam, Pasquale Bonsignore, Salvatore Gruttadauria, Duilio Pagano, Alessandro Tropea, Marco Canzonieri, Marco Barbara, Fabrizio di Francesco, Davide Cintorino, Aurelio Seidita, Sergio Li Petri, Calogero Ricotta, Khouzam S., Pagano D., Barbara M., Cintorino D., Li Petri S., di Francesco F., Ricotta C., Bonsignore P., Seidita A., Calamia S., Canzonieri M., Tropea A., and Gruttadauria S.
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Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Time Factors ,Waiting Lists ,medicine.medical_treatment ,Liver transplantation ,Competing risks ,Logistic regression ,Severity of Illness Index ,Group B ,End Stage Liver Disease ,Liver disease ,Risk Factors ,Internal medicine ,medicine ,Humans ,Cumulative incidence ,Survival analysis ,Retrospective Studies ,Transplantation ,business.industry ,Liver Neoplasms ,Middle Aged ,medicine.disease ,Liver Transplantation ,Italy ,Hepatocellular carcinoma ,Surgery ,Female ,business - Abstract
Background: Liver transplantation (LT) is the only definitive and curative treatment for patients with end-stage liver disease and hepatocellular carcinoma. We aimed to evaluate the impact of the Italian score for organ allocation (ISO) in terms of the waiting-list mortality, probability of LT, and patient survival after LT. Patient and methods: All of the adult patients on the waiting list for LT at our institute from January 2014 to December 2017 were included in the study. The probabilities of death while on the waiting list, dropout from the list, and LT were compared by means of cumulative incidence functions, in a competing risk time-to-event analysis setting. Uni- and multivariable logistic regression models were used to estimate and compare the probability of death and to find potential risk factors for waiting-list death. Results: There were 286 patients on the waiting list for LT during the study period, 122 of whom entered the waiting list prior to the implementation of ISO (Group A) and 164 afterward (Group B). Group A had 62 transplants, and Group B had 116 transplants. Group B showed a lesser probability of death (P = .005) and a greater probability of transplant (P < .001) compared to Group A. In the 2 groups, post-transplant survival was similar. Conclusion: Based on preliminary clinical experience from a single transplant center, the ISO allocation system demonstrated an overall reduced probability of patient death while on the waiting list without impairing post-LT survival, suggesting that the ISO system might represent an improved method of organ allocation, with a more beneficial distribution of livers.
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- 2019
8. How important is the role of iterative liver direct surgery in patients with hepatocellular carcinoma for a transplant center located in an area with a low rate of deceased donation?
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Pagano D, Khouzam S, Magro B, Barbara M, Cintorino D, di Francesco F, Li Petri S, Bonsignore P, Calamia S, Deiro G, Cammà C, Canzonieri M, and Gruttadauria S
- Abstract
Introduction: Hepatocellular carcinoma (HCC) accounts for nearly 90% of primary liver cancers, with estimates of over 1 million people affected by 2025. We aimed to explore the impacting role of an iterative surgical treatment approach in a cohort of HCC patients within the Milan criteria, associated with clinical risk factors for tumor recurrence (RHCC) after liver transplant (LT) and loco-regional therapies (LRT), as well as liver resection (LR) and/or microwave thermal ablation (MWTA)., Methods: We retrospectively analyzed our experience performed during an 8-year period between January 2013 and December 2021 in patients treated for HCC, focusing on describing the impact on preoperative end-stage liver disease severity, oncologic staging, tumor characteristics, and surgical treatments. The Cox model was used to evaluate variables that could predict relapse risks. Relapse risk curves were calculated according to the Kaplan-Meier method, and the log-rank test was used to compare them., Results: There were 557 HCC patients treated with a first-line approach of LR and/or LRTs ( n = 335) or LT ( n = 222). The median age at initial transplantation was 59 versus 68 for those whose first surgical approach was LR and/or LRT. In univariate analysis with the Cox model, nodule size was the single predictor of recurrence of HCC in the posttreatment setting (HR: 1.61, 95% CI: 1.05-2.47, p = 0.030). For the LRT group, we have enlightened the following clinical characteristics as significantly associated with RHCC: hepatitis B virus infection (which has a protective role with HR: 0.34, 95% CI: 0.13-0.94, p = 0.038), number of HCC nodules (HR: 1.54, 95% CI: 1.22-1.94, p < 0.001), size of the largest nodule (HR: 1.06, 95% CI: 1.01-1.12, p = 0.023), serum bilirubin (HR: 1.57, 95% CI: 1.03-2.40, p = 0.038), and international normalized ratio (HR: 16.40, 95% CI: 2.30-118.0, p = 0.006). Among the overall 111 patients with RHCC in the LRT group, 33 were iteratively treated with further curative treatment (12 were treated with LR, two with MWTA, three with a combined LR-MWTA treatment, and 16 underwent LT). Only one of 18 recurrent patients previously treated with LT underwent LR. For these RHCC patients, multivariable analysis showed the protective roles of LT for primary RHCC after IDLS (HR: 0.06, 95% CI: 0.01-0.36, p = 0.002), of the time relapsed between the first and second IDLS treatments (HR: 0.97, 95% CI: 0.94-0.99, p = 0.044), and the impact of previous minimally invasive treatment (HR: 0.28, 95% CI: 0.08-1.00, p = 0.051)., Conclusion: The coexistence of RHCC with underlying cirrhosis increases the complexity of assessing the net health benefit of ILDS before LT. Minimally invasive surgical therapies and time to HCC relapse should be considered an outcome in randomized clinical trials because they have a relevant impact on tumor-free survival., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Pagano, Khouzam, Magro, Barbara, Cintorino, di Francesco, Li Petri, Bonsignore, Calamia, Deiro, Cammà, Canzonieri and Gruttadauria.)
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- 2022
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9. Crucial Role of Extended Criteria Donors in Deceased Donor Single Kidney Transplantation to Face Chronic Shortage in the Heart of the Mediterranean Basin: A Single-Center Experience.
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Bonsignore P, Pagano D, Piazza S, Ricotta C, di Francesco F, Cintorino D, Li Petri S, Canzonieri M, Tropea A, Calamia S, Checchini G, Salis P, Arcadipane A, Liotta R, and Gruttadauria S
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- Adult, Delayed Graft Function epidemiology, Female, Graft Survival, Humans, Incidence, Male, Middle Aged, Racial Groups, Retrospective Studies, Survival Analysis, Treatment Outcome, Kidney Transplantation methods, Tissue Donors supply & distribution, Tissue and Organ Procurement methods
- Abstract
Background: The gap between organ availability and patients on the waiting list for deceased donor kidney transplants has resulted in the wide use of extended criteria donors (ECDs).We aimed to compare the surgical outcomes of single kidney transplantation (KT) performed at our institute with standard criteria donor (SCD) or ECD grafts, according to the Organ Procurement and Transplantation Network definition., Patients and Methods: Our retrospective analysis studied 115 adult recipients of KT from January 2016 to July 2018, with kidney grafts procured from adult donors after brain or circulatory death, performed at our institute. Among the 2 recipients' groups, we compared the incidence of early graft loss, delayed graft function, hospitalization, and surgical complications. We compared the evaluation of time to early graft loss with Kaplan-Meier estimators and curves; the hypothesis of no difference in time to graft loss between the 2 groups was tested using the log-rank statistics., Results: Of the 103 deceased donor kidney transplants during the study period, 129 grafts were used after the regional network sharing allocation. More frequently, ECDs had a greater body mass index than SCDs (25.2 ± 3.9 vs 27.7 ± 5.0, P = .005) and type II diabetes mellitus (0% vs 18%, P = .002). KT recipients who received an ECD graft (73, 63.5%) were older (59.8 ± 9.8 vs 45.2 ± 15.4, P < .001) and presented a higher rate of delayed graft function (56% vs 24%, P = .001). Post-transplant graft loss did not differ among the 2 groups., Conclusion: Based on clinical experience in a single transplant center, ECD use for KTs is crucial in facing the organ shortage, without impairing post-deceased donor kidney transplant outcomes., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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10. Impact of Italian Score for Organ Allocation System on Deceased Donor Liver Transplantation: A Monocentric Competing Risk Time-to-Event Analysis.
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Khouzam S, Pagano D, Barbàra M, Cintorino D, Li Petri S, di Francesco F, Ricotta C, Bonsignore P, Seidita A, Calamia S, Canzonieri M, Tropea A, and Gruttadauria S
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- Adult, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular surgery, End Stage Liver Disease mortality, End Stage Liver Disease surgery, Female, Humans, Italy, Liver Neoplasms mortality, Liver Neoplasms surgery, Male, Middle Aged, Retrospective Studies, Risk Factors, Time Factors, Liver Transplantation, Severity of Illness Index, Waiting Lists mortality
- Abstract
Background: Liver transplantation (LT) is the only definitive and curative treatment for patients with end-stage liver disease and hepatocellular carcinoma. We aimed to evaluate the impact of the Italian score for organ allocation (ISO) in terms of the waiting-list mortality, probability of LT, and patient survival after LT., Patient and Methods: All of the adult patients on the waiting list for LT at our institute from January 2014 to December 2017 were included in the study. The probabilities of death while on the waiting list, dropout from the list, and LT were compared by means of cumulative incidence functions, in a competing risk time-to-event analysis setting. Uni- and multivariable logistic regression models were used to estimate and compare the probability of death and to find potential risk factors for waiting-list death., Results: There were 286 patients on the waiting list for LT during the study period, 122 of whom entered the waiting list prior to the implementation of ISO (Group A) and 164 afterward (Group B). Group A had 62 transplants, and Group B had 116 transplants. Group B showed a lesser probability of death (P = .005) and a greater probability of transplant (P < .001) compared to Group A. In the 2 groups, post-transplant survival was similar., Conclusion: Based on preliminary clinical experience from a single transplant center, the ISO allocation system demonstrated an overall reduced probability of patient death while on the waiting list without impairing post-LT survival, suggesting that the ISO system might represent an improved method of organ allocation, with a more beneficial distribution of livers., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
- Full Text
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