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1. Dynamic surgical anatomy using 3D reconstruction technology in complex hepato-biliary surgery with vascular involvement. Results from an international multicentric survey

Author: Cotsoglou, C, Granieri, S, Bassetto, S, Bagnardi, V, Pugliese, R, Grazi, G, Guglielmi, A, Ruzzenente, A, Aldrighetti, L, Ratti, F, De Carlis, L, De Carlis, R, Centonze, L, De Angelis, N, Memeo, R, Delvecchio, A, Felli, E, Izzo, F, Belli, A, Patrone, R, Ettorre, G, Berardi, G, Di Benedetto, F, Di Sandro, S, Romano, F, Garancini, M, Scotti, M, Bianchi, G, Germini, A, Gjoni, E, Bonomi, A, Bruno, F, Paleino, S, Pugliese, G, Cotsoglou C., Granieri S., Bassetto S., Bagnardi V., Pugliese R., Grazi G. L., Guglielmi A., Ruzzenente A., Aldrighetti L., Ratti F., De Carlis L., De Carlis R., Centonze L., De Angelis N., Memeo R., Delvecchio A., Felli E., Izzo F., Belli A., Patrone R., Ettorre G. M., Berardi G., Di Benedetto F., Di Sandro S., Romano F., Garancini M., Scotti M. A., Bianchi G., Germini A., Gjoni E., Bonomi A., Bruno F., Paleino S., Pugliese G., Cotsoglou, C, Granieri, S, Bassetto, S, Bagnardi, V, Pugliese, R, Grazi, G, Guglielmi, A, Ruzzenente, A, Aldrighetti, L, Ratti, F, De Carlis, L, De Carlis, R, Centonze, L, De Angelis, N, Memeo, R, Delvecchio, A, Felli, E, Izzo, F, Belli, A, Patrone, R, Ettorre, G, Berardi, G, Di Benedetto, F, Di Sandro, S, Romano, F, Garancini, M, Scotti, M, Bianchi, G, Germini, A, Gjoni, E, Bonomi, A, Bruno, F, Paleino, S, Pugliese, G, Cotsoglou C., Granieri S., Bassetto S., Bagnardi V., Pugliese R., Grazi G. L., Guglielmi A., Ruzzenente A., Aldrighetti L., Ratti F., De Carlis L., De Carlis R., Centonze L., De Angelis N., Memeo R., Delvecchio A., Felli E., Izzo F., Belli A., Patrone R., Ettorre G. M., Berardi G., Di Benedetto F., Di Sandro S., Romano F., Garancini M., Scotti M. A., Bianchi G., Germini A., Gjoni E., Bonomi A., Bruno F., Paleino S., and Pugliese G.
Abstract: Introduction: Three-dimensional liver modeling can lead to substantial changes in choosing the type and extension of liver resection. This study aimed to explore whether 3D reconstruction helps to better understand the relationship between liver tumors and neighboring vascular structures compared to standard 2D CT scan images. Methods: Contrast-enhanced CT scan images of 11 patients suffering from primary and secondary hepatic tumors were selected. Twenty-three experienced HBP surgeons participated to the survey. A standardized questionnaire outlining 16 different vascular structures (items) having a potential relationship with the tumor was provided. Intraoperative and histopathological findings were used as the reference standard. The proper hypothesis was that 3D accuracy is greater than 2D. As a secondary endpoint, inter-raters’ agreement was explored. Results: The mean difference between 3D and 2D, was 2.6 points (SE: 0.40; 95 % CI: 1.7–3.5; p < 0.0001). After sensitivity analysis, the results favored 3D visualization as well (mean difference 1.7 points; SE: 0.32; 95 % CI: 1.0–2.5; p = 0.0004). The inter-raters’ agreement was moderate for both methods (2D: W = 0.45; 3D: W = 0.44). Conclusion: 3D reconstruction may give a significant contribution to better understanding liver vascular anatomy and the precise relationship between the tumor and the neighboring structures.
Published: 2024

2. Major hepatectomy for perihilar cholangiocarcinoma in elderly patients: is it reasonable?

Author: Ripamonti, L., De Carlis, R., Lauterio, A., Mangoni, I., Frassoni, S., Bagnardi, V., Centonze, L., Poli, C., Buscemi, V., Ferla, F., and De Carlis, L.
Published: 2022
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3. How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

Author: Siragusa, L, Angelico, R, Angrisani, M, Zampogna, B, Materazzo, M, Sorge, R, Giordano, L, Meniconi, R, Coppola, A, Marino, A, Giraudo, G, Esposito, S, Urbani, A, De Pastena, M, Mastrapasqua, R, Garancini, M, Frontal, A, Pascal, G, Martellucc, J, Falb, F, Boscarelli, A, Bertoglio, P, Trecca, E, Galassi, L, Vento, V, Chiappini, A, Antonelli, A, Bennardo, F, Familiari, F, Giannaccare, G, Zappia, A, Giuliani, G, Falcone, F, Sebastiani, S, Montuori, M, Rossi, S, Sagnotta, A, Giuliani, B, Imbriani, G, Restaino, S, Andreani, L, Di Maria, F, Lagana, A, Vitiello, L, Berton, F, Virgilio, E, Palisi, M, Portigliotti, L, Calussi, M, Conti, L, Mauriello, C, Barone, M, Saladino, E, Giaquinta, A, Zerb, D, Frazzetta, G, Merola, G, Chierici, A, Bini, R, Centonze, L, De Carlis, R, Ferrario, L, Giani, A, Lauterio, A, Tamini, N, Corti, S, Botteri, E, Andreuccetti, J, D'Alessio, R, Cestaro, G, Clarizia, G, Spolini, A, Carboni, A, Benzoni, E, Galiffa, G, Perotti, B, Veroux, M, Randazzo, V, Topa, D, Pranteda, C, Contini, G, Iacusso, C, Voglino, V, Vita, P, Carrano, F, Ambrosio, L, Cammarata, R, Capolupo, G, Caputo, D, Carannante, F, Cascone, C, Esperto, F, Farolfi, T, Frasca, L, Gallo, I, Gibin, G, Giurazza, G, Improta, L, La Vaccara, V, Luffarelli, P, Luvero, D, Marangi, G, Masciana, G, Mazzola, A, Mazzotta, E, Miligi, C, Montelione, N, Nenna, A, Orsaria, P, Papalia, R, Papalia, G, Parisi, F, Prata, F, Salzillo, R, Santini, S, Sofo, F, Zampoli, A, Tanda, C, Altieri, G, Ardito, F, Belia, F, Bianchi, V, Biondi, A, Brisinda, G, Chiappetta, M, Ciolli, G, Ciolli, A, Ferracci, F, Ferri, L, Fico, V, Fiorillo, C, Fransvea, P, Galiandro, F, Giovinazzo, F, La Greca, A, Litta, F, Mele, C, Pafundi, D, Panettieri, E, Papa, V, Patini, R, Perrotta, G, Puccioni, C, Santocchi, P, Armatura, G, Olmi, S, Casoni Pattacini, G, Salgarello, S, Trompetto, M, Bombardini, C, La Rocca, R, Celentano, G, Micalef, A, Mazzella, A, Settembrini, A, Zoia, C, Degrate, L, Musumeci, G, Palopoli, C, Montori, G, Bonati, E, Dinuzzi, V, Velluti, F, Balla, A, Bonasia, D, Coletta, D, Berardi, G, Colasanti, M, Ferretti, S, Gasparoli, C, Mariano, G, Avenia, S, Cianci, P, Cestino, L, Festa, F, Fazio, F, Ascari, F, Desio, M, Arroyo Murillo, G, Cereda, M, Galleano, R, David, G, Pansini, A, Gazia, C, Atzori, G, Desideri, L, Famularo, S, Galvanin, J, Giudici, V, Mangiameli, G, Mei, S, Milana, F, Pansa, A, Sacchi, M, Testori, A, Di Carlo, G, Paratore, M, Perrone, U, Vagge, A, Vigano, J, Torre, B, Scotti, M, Carbone, G, Cerchione, R, De Nardi, P, Gozzini, L, Ottaviani, L, Senni, C, Piccin, O, Pio, L, Colombo, F, Avantifiori, R, Baldassarri, V, Caronna, R, Cicerchia, P, Corallino, D, Crocetti, D, Gallo, G, Giovanardi, F, Giovannetti, F, Hassan, R, Iossa, A, Lai, Q, Lancellotti, F, Lucarini, A, Lucchese, S, Mazzarella, G, Melandro, F, Minervini, A, Muttillo, E, Palmieri, L, Pasqua, R, Rosiello, F, Salina, G, Sibio, S, Sirignano, P, Tarallo, M, Usai, S, Vanni, C, Viglietta, E, Zambon, M, Conversano, N, Epifani, A, Milano, V, Sacco, L, Nava, M, Maffioli, A, Giuratrabocchetta, S, Baracchi, F, Zuolo, M, Ceresoli, M, Verdi, D, Belli, A, Pata, F, Piovano, E, Pastore, G, Bernabei, F, Deiana, S, Arceri, A, D'Agostino, C, Marafante, C, Moggia, E, Parini, S, Moretti, M, Uggeri, F, Pontarolo, N, Fontana, T, Palmisano, G, Giuffrida, M, Guaitoli, E, Ferretti, C, Iacopino, G, Gioco, R, Roscitano, G, Montanelli, P, Pinotti, E, Monati, E, Fazio, G, Di Pietro, F, Damarco, F, Barberis, A, Razzore, A, Pascale, A, Loi, S, Ferrara, F, Rossi, M, Lisi, G, Viel, G, Sasia, D, Bono, D, Cordaro, E, Giacomelli, E, Giani, I, Seriau, L, Pellino, G, Sparavigna, M, Trigiante, G, D'Ambrogio, R, Cardella, F, Guzzetti, S, Luzzi, A, Carganico, G, Drago, B, Micheletto, G, Orlandi, R, Cutolo, C, Gibello, U, Mistrangelo, M, Forcignano, E, D'Ugo, S, Losurdo, P, Manitto, M, Caroli, G, Franco, M, Tilocca, P, Mendogni, P, Sena, G, Sambucci, D, Luciani, C, Atelli, P, Guida, A, Marino, F, Morini, A, Sibilla, M, Longo, F, Giaccari, S, Vigorita, V, Balduzzi, A, Barra, F, Delogu, D, Milone, E, Bencini, L, Aprile, V, Papini, P, Montemurro, N, Cavallo, M, Picciariello, A, Tomasicchio, G, Fittipaldi, A, Maruccia, M, Gerardi, S, Cillara, N, Deidda, S, Demarinis, G, Peiretti, E, Tatti, F, Iovino, C, Isola, G, Progno, V, Migliore, M, Badessi, G, Barilla, C, Calleri, G, Cianci, S, Fama, F, Fleres, F, Mazzeo, C, Visaloco, M, Marchetto, C, Bolognesi, F, Benuzzi, L, Bracchetti, G, Brucchi, F, Manzo, C, Scaravilli, L, Ferrari, C, Rocca, A, Napolitano, P, Anoldo, P, Caricato, C, Manigrasso, M, Milone, M, Napolitano, L, Palomba, G, Schiavone, V, Vetrella, M, Grossi, U, Moletta, L, Annicchiarico, A, Vella, I, Talesa, G, Boggi, U, Aiello, F, Anselmo, A, Bacchiocchi, G, Beati, F, Bellato, V, Billeci, F, Blasi, F, Buonomo, O, Campanelli, M, Coco, G, Contadini, A, Conte, L, D'Ippolito, G, Di Marcantonio, A, Spicchiale, C, Afflitto, G, Gismondi, A, Gorgolini, G, Granai, A, Grande, S, Gravina, A, Ingallinella, S, Keci, L, Latini, E, Marino, D, Oddi, F, Orecchia, L, Don, C, Pellicciaro, M, Petagna, L, Pirozzi, B, Quaranta, C, Rho, M, Rosina, A, Santicchia, M, Saraceno, F, Schiavone, A, Sensi, B, Spina, A, Sullo, L, Tacconi, F, Taje, R, Vanni, G, Vinci, D, Vita, G, Alba, G, Badalucco, S, Carbone, L, Samorani, O, Chisci, G, Cuomo, R, Francia, A, Fusario, D, Gargiulo, B, Pasqui, E, Pasquetti, L, Puoti, P, Resca, L, Cumbo, J, Ganio, S, Vizzielli, G, Anastasi, M, Guerra, D, Romanzi, A, Vannelli, A, Baia, M, Siragusa L., Angelico R., Angrisani M., Zampogna B., Materazzo M., Sorge R., Giordano L., Meniconi R., Coppola A., Marino A., Giraudo G., Esposito S., Urbani A., De Pastena M., Mastrapasqua R., Garancini M., Frontal A., Pascal G., Martellucc J., Falb F., Boscarelli A., Bertoglio P., Trecca E., Galassi L., Vento V., Chiappini A., Antonelli A., Bennardo F., Familiari F., Giannaccare G., Zappia A. S., Giuliani G., Falcone F., Sebastiani S., Montuori M., Rossi S., Sagnotta A., Giuliani B., Imbriani G. C., Restaino S., Andreani L., Di Maria F., Lagana A. S., Vitiello L., Berton F., Virgilio E., Palisi M., Portigliotti L., Calussi M., Conti L., Mauriello C., Barone M., Saladino E., Giaquinta A., Zerb D., Frazzetta G., Merola G., Chierici A., Bini R., Centonze L., De Carlis R., Ferrario L., Giani A., Lauterio A., Tamini N., Corti S., Botteri E., Andreuccetti J., D'Alessio R., Cestaro G., Clarizia G., Spolini A., Carboni A. S., Benzoni E., Galiffa G., Perotti B., Veroux M., Randazzo V., Topa D., Pranteda C., Contini G., Iacusso C., Voglino V., Vita P., Carrano F. M., Ambrosio L., Cammarata R., Capolupo G. T., Caputo D., Carannante F., Cascone C., Esperto F., Farolfi T., Frasca L., Gallo I. F., Gibin G., Giurazza G., Improta L., La Vaccara V., Luffarelli P., Luvero D., Marangi G., Masciana G., Mazzola A., Mazzotta E., Miligi C. I., Montelione N., Nenna A., Orsaria P., Papalia R., Papalia G. F., Parisi F. R., Prata F., Salzillo R., Santini S., Sofo F., Zampoli A., Tanda C., Altieri G., Ardito F., Belia F., Bianchi V., Biondi A., Brisinda G., Chiappetta M., Ciolli G., Ciolli A., Ferracci F., Ferri L., Fico V., Fiorillo C., Fransvea P., Galiandro F., Giovinazzo F., La Greca A., Litta F., Mele C., Pafundi D. P., Panettieri E., Papa V., Patini R., Perrotta G., Puccioni C., Santocchi P., Armatura G., Olmi S., Casoni Pattacini G., Salgarello S., Trompetto M., Bombardini C., La Rocca R., Celentano G., Micalef A., Mazzella A., Settembrini A., Zoia C., Degrate L., Musumeci G., Palopoli C. A. M., Montori G., Bonati E., Dinuzzi V. P., Velluti F., Balla A., Bonasia D. E., Coletta D., Berardi G., Colasanti M., Ferretti S., Gasparoli C., Mariano G., Avenia S., Cianci P., Cestino L., Festa F., Fazio F., Ascari F., Desio M., Arroyo Murillo G. A., Cereda M., Galleano R., David G., Pansini A., Gazia C., Atzori G., Desideri L. F., Famularo S., Galvanin J., Giudici V. M., Mangiameli G., Mei S., Milana F., Pansa A., Sacchi M., Testori A., Di Carlo G., Paratore M., Perrone U., Vagge A., Vigano J., Torre B., Scotti M. A., Carbone G., Cerchione R., De Nardi P., Gozzini L., Ottaviani L., Senni C., Piccin O., Pio L., Colombo F., Avantifiori R., Baldassarri V., Caronna R., Cicerchia P. M., Corallino D., Crocetti D., Gallo G., Giovanardi F., Giovannetti F., Hassan R., Iossa A., Lai Q., Lancellotti F., Lucarini A., Lucchese S., Mazzarella G., Melandro F., Minervini A., Muttillo E. M., Palmieri L., Pasqua R., Rosiello F., Salina G., Sibio S., Sirignano P., Tarallo M., Usai S., Vanni C., Viglietta E., Zambon M., Conversano N. I., Epifani A. G., Milano V., Sacco L., Nava M., Maffioli A., Giuratrabocchetta S., Baracchi F., Zuolo M., Ceresoli M., Verdi D., Belli A., Pata F., Piovano E., Pastore G., Bernabei F., Deiana S., Arceri A., D'Agostino C., Marafante C., Moggia E., Parini S., Moretti M., Uggeri F., Pontarolo N., Fontana T., Palmisano G., Giuffrida M., Guaitoli E., Ferretti C., Iacopino G., Gioco R., Roscitano G., Montanelli P., Chiappetta M. F., Pinotti E., Monati E., Fazio G., Di Pietro F., Damarco F., Barberis A., Razzore A., Pascale A., Loi S., Ferrara F., Rossi M., Lisi G., Viel G., Sasia D., Bono D., Cordaro E. R., Giacomelli E., Giani I., Seriau L., Pellino G., Sparavigna M., Trigiante G., D'Ambrogio R. G., Cardella F., Guzzetti S., Luzzi A. -P., Carganico G., Drago B., Micheletto G., Orlandi R., Cutolo C., Gibello U., Mistrangelo M., Forcignano E., D'Ugo S., Losurdo P., Manitto M., Caroli G., Franco M., Tilocca P. L., Mendogni P., Sena G., Sambucci D., Luciani C., Atelli P., Guida A., Marino F., Morini A., Sibilla M. G., Longo F., Giaccari S., Vigorita V., Balduzzi A., Barra F., Delogu D., Milone E., Bencini L., Aprile V., Papini P., Montemurro N., Cavallo M., Picciariello A., Tomasicchio G., Fittipaldi A., Maruccia M., Gerardi S., Cillara N., Deidda S., Demarinis G., Peiretti E., Tatti F., Iovino C., Isola G., Progno V. C., Migliore M., Badessi G., Barilla C., Calleri G. S., Cianci S., Fama F., Fleres F., Mazzeo C., Visaloco M. G., Marchetto C., Bolognesi F., Benuzzi L., Bracchetti G., Brucchi F., Manzo C. A., Scaravilli L., Ferrari C., Rocca A., Napolitano P., Anoldo P., Caricato C., Manigrasso M., Milone M., Napolitano L., Palomba G., Schiavone V., Vetrella M., Grossi U., Moletta L., Annicchiarico A., Vella I., Talesa G., Boggi U., Aiello F., Anselmo A., Bacchiocchi G., Beati F., Bellato V., Billeci F., Blasi F., Buonomo O. C., Campanelli M., Coco G., Contadini A., Conte L. E., D'Ippolito G., Di Marcantonio A., Spicchiale C. F., Afflitto G. G., Gismondi A., Gorgolini G., Granai A. V., Grande S., Gravina A., Guida A. M., Ingallinella S., Keci L., Latini E., Marino D., Oddi F. M., Orecchia L., Don C. B. P., Pellicciaro M., Petagna L., Pirozzi B. M., Quaranta C., Rho M., Rosina A., Santicchia M. S., Saraceno F., Schiavone A., Sensi B., Spina A., Sullo L., Tacconi F., Taje R., Vanni G., Vinci D., Vita G., Alba G., Badalucco S., Carbone L., Samorani O. C., Chisci G., Cuomo R., Francia A., Fusario D., Gargiulo B., Pasqui E., Pasquetti L., Puoti P., Resca L., Cumbo J., Ganio S., Vizzielli G., Anastasi M., Guerra D., Romanzi A., Vannelli A., Baia M., Siragusa, L, Angelico, R, Angrisani, M, Zampogna, B, Materazzo, M, Sorge, R, Giordano, L, Meniconi, R, Coppola, A, Marino, A, Giraudo, G, Esposito, S, Urbani, A, De Pastena, M, Mastrapasqua, R, Garancini, M, Frontal, A, Pascal, G, Martellucc, J, Falb, F, Boscarelli, A, Bertoglio, P, Trecca, E, Galassi, L, Vento, V, Chiappini, A, Antonelli, A, Bennardo, F, Familiari, F, Giannaccare, G, Zappia, A, Giuliani, G, Falcone, F, Sebastiani, S, Montuori, M, Rossi, S, Sagnotta, A, Giuliani, B, Imbriani, G, Restaino, S, Andreani, L, Di Maria, F, Lagana, A, Vitiello, L, Berton, F, Virgilio, E, Palisi, M, Portigliotti, L, Calussi, M, Conti, L, Mauriello, C, Barone, M, Saladino, E, Giaquinta, A, Zerb, D, Frazzetta, G, Merola, G, Chierici, A, Bini, R, Centonze, L, De Carlis, R, Ferrario, L, Giani, A, Lauterio, A, Tamini, N, Corti, S, Botteri, E, Andreuccetti, J, D'Alessio, R, Cestaro, G, Clarizia, G, Spolini, A, Carboni, A, Benzoni, E, Galiffa, G, Perotti, B, Veroux, M, Randazzo, V, Topa, D, Pranteda, C, Contini, G, Iacusso, C, Voglino, V, Vita, P, Carrano, F, Ambrosio, L, Cammarata, R, Capolupo, G, Caputo, D, Carannante, F, Cascone, C, Esperto, F, Farolfi, T, Frasca, L, Gallo, I, Gibin, G, Giurazza, G, Improta, L, La Vaccara, V, Luffarelli, P, Luvero, D, Marangi, G, Masciana, G, Mazzola, A, Mazzotta, E, Miligi, C, Montelione, N, Nenna, A, Orsaria, P, Papalia, R, Papalia, G, Parisi, F, Prata, F, Salzillo, R, Santini, S, Sofo, F, Zampoli, A, Tanda, C, Altieri, G, Ardito, F, Belia, F, Bianchi, V, Biondi, A, Brisinda, G, Chiappetta, M, Ciolli, G, Ciolli, A, Ferracci, F, Ferri, L, Fico, V, Fiorillo, C, Fransvea, P, Galiandro, F, Giovinazzo, F, La Greca, A, Litta, F, Mele, C, Pafundi, D, Panettieri, E, Papa, V, Patini, R, Perrotta, G, Puccioni, C, Santocchi, P, Armatura, G, Olmi, S, Casoni Pattacini, G, Salgarello, S, Trompetto, M, Bombardini, C, La Rocca, R, Celentano, G, Micalef, A, Mazzella, A, Settembrini, A, Zoia, C, Degrate, L, Musumeci, G, Palopoli, C, Montori, G, Bonati, E, Dinuzzi, V, Velluti, F, Balla, A, Bonasia, D, Coletta, D, Berardi, G, Colasanti, M, Ferretti, S, Gasparoli, C, Mariano, G, Avenia, S, Cianci, P, Cestino, L, Festa, F, Fazio, F, Ascari, F, Desio, M, Arroyo Murillo, G, Cereda, M, Galleano, R, David, G, Pansini, A, Gazia, C, Atzori, G, Desideri, L, Famularo, S, Galvanin, J, Giudici, V, Mangiameli, G, Mei, S, Milana, F, Pansa, A, Sacchi, M, Testori, A, Di Carlo, G, Paratore, M, Perrone, U, Vagge, A, Vigano, J, Torre, B, Scotti, M, Carbone, G, Cerchione, R, De Nardi, P, Gozzini, L, Ottaviani, L, Senni, C, Piccin, O, Pio, L, Colombo, F, Avantifiori, R, Baldassarri, V, Caronna, R, Cicerchia, P, Corallino, D, Crocetti, D, Gallo, G, Giovanardi, F, Giovannetti, F, Hassan, R, Iossa, A, Lai, Q, Lancellotti, F, Lucarini, A, Lucchese, S, Mazzarella, G, Melandro, F, Minervini, A, Muttillo, E, Palmieri, L, Pasqua, R, Rosiello, F, Salina, G, Sibio, S, Sirignano, P, Tarallo, M, Usai, S, Vanni, C, Viglietta, E, Zambon, M, Conversano, N, Epifani, A, Milano, V, Sacco, L, Nava, M, Maffioli, A, Giuratrabocchetta, S, Baracchi, F, Zuolo, M, Ceresoli, M, Verdi, D, Belli, A, Pata, F, Piovano, E, Pastore, G, Bernabei, F, Deiana, S, Arceri, A, D'Agostino, C, Marafante, C, Moggia, E, Parini, S, Moretti, M, Uggeri, F, Pontarolo, N, Fontana, T, Palmisano, G, Giuffrida, M, Guaitoli, E, Ferretti, C, Iacopino, G, Gioco, R, Roscitano, G, Montanelli, P, Pinotti, E, Monati, E, Fazio, G, Di Pietro, F, Damarco, F, Barberis, A, Razzore, A, Pascale, A, Loi, S, Ferrara, F, Rossi, M, Lisi, G, Viel, G, Sasia, D, Bono, D, Cordaro, E, Giacomelli, E, Giani, I, Seriau, L, Pellino, G, Sparavigna, M, Trigiante, G, D'Ambrogio, R, Cardella, F, Guzzetti, S, Luzzi, A, Carganico, G, Drago, B, Micheletto, G, Orlandi, R, Cutolo, C, Gibello, U, Mistrangelo, M, Forcignano, E, D'Ugo, S, Losurdo, P, Manitto, M, Caroli, G, Franco, M, Tilocca, P, Mendogni, P, Sena, G, Sambucci, D, Luciani, C, Atelli, P, Guida, A, Marino, F, Morini, A, Sibilla, M, Longo, F, Giaccari, S, Vigorita, V, Balduzzi, A, Barra, F, Delogu, D, Milone, E, Bencini, L, Aprile, V, Papini, P, Montemurro, N, Cavallo, M, Picciariello, A, Tomasicchio, G, Fittipaldi, A, Maruccia, M, Gerardi, S, Cillara, N, Deidda, S, Demarinis, G, Peiretti, E, Tatti, F, Iovino, C, Isola, G, Progno, V, Migliore, M, Badessi, G, Barilla, C, Calleri, G, Cianci, S, Fama, F, Fleres, F, Mazzeo, C, Visaloco, M, Marchetto, C, Bolognesi, F, Benuzzi, L, Bracchetti, G, Brucchi, F, Manzo, C, Scaravilli, L, Ferrari, C, Rocca, A, Napolitano, P, Anoldo, P, Caricato, C, Manigrasso, M, Milone, M, Napolitano, L, Palomba, G, Schiavone, V, Vetrella, M, Grossi, U, Moletta, L, Annicchiarico, A, Vella, I, Talesa, G, Boggi, U, Aiello, F, Anselmo, A, Bacchiocchi, G, Beati, F, Bellato, V, Billeci, F, Blasi, F, Buonomo, O, Campanelli, M, Coco, G, Contadini, A, Conte, L, D'Ippolito, G, Di Marcantonio, A, Spicchiale, C, Afflitto, G, Gismondi, A, Gorgolini, G, Granai, A, Grande, S, Gravina, A, Ingallinella, S, Keci, L, Latini, E, Marino, D, Oddi, F, Orecchia, L, Don, C, Pellicciaro, M, Petagna, L, Pirozzi, B, Quaranta, C, Rho, M, Rosina, A, Santicchia, M, Saraceno, F, Schiavone, A, Sensi, B, Spina, A, Sullo, L, Tacconi, F, Taje, R, Vanni, G, Vinci, D, Vita, G, Alba, G, Badalucco, S, Carbone, L, Samorani, O, Chisci, G, Cuomo, R, Francia, A, Fusario, D, Gargiulo, B, Pasqui, E, Pasquetti, L, Puoti, P, Resca, L, Cumbo, J, Ganio, S, Vizzielli, G, Anastasi, M, Guerra, D, Romanzi, A, Vannelli, A, Baia, M, Siragusa L., Angelico R., Angrisani M., Zampogna B., Materazzo M., Sorge R., Giordano L., Meniconi R., Coppola A., Marino A., Giraudo G., Esposito S., Urbani A., De Pastena M., Mastrapasqua R., Garancini M., Frontal A., Pascal G., Martellucc J., Falb F., Boscarelli A., Bertoglio P., Trecca E., Galassi L., Vento V., Chiappini A., Antonelli A., Bennardo F., Familiari F., Giannaccare G., Zappia A. S., Giuliani G., Falcone F., Sebastiani S., Montuori M., Rossi S., Sagnotta A., Giuliani B., Imbriani G. C., Restaino S., Andreani L., Di Maria F., Lagana A. S., Vitiello L., Berton F., Virgilio E., Palisi M., Portigliotti L., Calussi M., Conti L., Mauriello C., Barone M., Saladino E., Giaquinta A., Zerb D., Frazzetta G., Merola G., Chierici A., Bini R., Centonze L., De Carlis R., Ferrario L., Giani A., Lauterio A., Tamini N., Corti S., Botteri E., Andreuccetti J., D'Alessio R., Cestaro G., Clarizia G., Spolini A., Carboni A. S., Benzoni E., Galiffa G., Perotti B., Veroux M., Randazzo V., Topa D., Pranteda C., Contini G., Iacusso C., Voglino V., Vita P., Carrano F. M., Ambrosio L., Cammarata R., Capolupo G. T., Caputo D., Carannante F., Cascone C., Esperto F., Farolfi T., Frasca L., Gallo I. F., Gibin G., Giurazza G., Improta L., La Vaccara V., Luffarelli P., Luvero D., Marangi G., Masciana G., Mazzola A., Mazzotta E., Miligi C. I., Montelione N., Nenna A., Orsaria P., Papalia R., Papalia G. F., Parisi F. R., Prata F., Salzillo R., Santini S., Sofo F., Zampoli A., Tanda C., Altieri G., Ardito F., Belia F., Bianchi V., Biondi A., Brisinda G., Chiappetta M., Ciolli G., Ciolli A., Ferracci F., Ferri L., Fico V., Fiorillo C., Fransvea P., Galiandro F., Giovinazzo F., La Greca A., Litta F., Mele C., Pafundi D. P., Panettieri E., Papa V., Patini R., Perrotta G., Puccioni C., Santocchi P., Armatura G., Olmi S., Casoni Pattacini G., Salgarello S., Trompetto M., Bombardini C., La Rocca R., Celentano G., Micalef A., Mazzella A., Settembrini A., Zoia C., Degrate L., Musumeci G., Palopoli C. A. M., Montori G., Bonati E., Dinuzzi V. P., Velluti F., Balla A., Bonasia D. E., Coletta D., Berardi G., Colasanti M., Ferretti S., Gasparoli C., Mariano G., Avenia S., Cianci P., Cestino L., Festa F., Fazio F., Ascari F., Desio M., Arroyo Murillo G. A., Cereda M., Galleano R., David G., Pansini A., Gazia C., Atzori G., Desideri L. F., Famularo S., Galvanin J., Giudici V. M., Mangiameli G., Mei S., Milana F., Pansa A., Sacchi M., Testori A., Di Carlo G., Paratore M., Perrone U., Vagge A., Vigano J., Torre B., Scotti M. A., Carbone G., Cerchione R., De Nardi P., Gozzini L., Ottaviani L., Senni C., Piccin O., Pio L., Colombo F., Avantifiori R., Baldassarri V., Caronna R., Cicerchia P. M., Corallino D., Crocetti D., Gallo G., Giovanardi F., Giovannetti F., Hassan R., Iossa A., Lai Q., Lancellotti F., Lucarini A., Lucchese S., Mazzarella G., Melandro F., Minervini A., Muttillo E. M., Palmieri L., Pasqua R., Rosiello F., Salina G., Sibio S., Sirignano P., Tarallo M., Usai S., Vanni C., Viglietta E., Zambon M., Conversano N. I., Epifani A. G., Milano V., Sacco L., Nava M., Maffioli A., Giuratrabocchetta S., Baracchi F., Zuolo M., Ceresoli M., Verdi D., Belli A., Pata F., Piovano E., Pastore G., Bernabei F., Deiana S., Arceri A., D'Agostino C., Marafante C., Moggia E., Parini S., Moretti M., Uggeri F., Pontarolo N., Fontana T., Palmisano G., Giuffrida M., Guaitoli E., Ferretti C., Iacopino G., Gioco R., Roscitano G., Montanelli P., Chiappetta M. F., Pinotti E., Monati E., Fazio G., Di Pietro F., Damarco F., Barberis A., Razzore A., Pascale A., Loi S., Ferrara F., Rossi M., Lisi G., Viel G., Sasia D., Bono D., Cordaro E. R., Giacomelli E., Giani I., Seriau L., Pellino G., Sparavigna M., Trigiante G., D'Ambrogio R. G., Cardella F., Guzzetti S., Luzzi A. -P., Carganico G., Drago B., Micheletto G., Orlandi R., Cutolo C., Gibello U., Mistrangelo M., Forcignano E., D'Ugo S., Losurdo P., Manitto M., Caroli G., Franco M., Tilocca P. L., Mendogni P., Sena G., Sambucci D., Luciani C., Atelli P., Guida A., Marino F., Morini A., Sibilla M. G., Longo F., Giaccari S., Vigorita V., Balduzzi A., Barra F., Delogu D., Milone E., Bencini L., Aprile V., Papini P., Montemurro N., Cavallo M., Picciariello A., Tomasicchio G., Fittipaldi A., Maruccia M., Gerardi S., Cillara N., Deidda S., Demarinis G., Peiretti E., Tatti F., Iovino C., Isola G., Progno V. C., Migliore M., Badessi G., Barilla C., Calleri G. S., Cianci S., Fama F., Fleres F., Mazzeo C., Visaloco M. G., Marchetto C., Bolognesi F., Benuzzi L., Bracchetti G., Brucchi F., Manzo C. A., Scaravilli L., Ferrari C., Rocca A., Napolitano P., Anoldo P., Caricato C., Manigrasso M., Milone M., Napolitano L., Palomba G., Schiavone V., Vetrella M., Grossi U., Moletta L., Annicchiarico A., Vella I., Talesa G., Boggi U., Aiello F., Anselmo A., Bacchiocchi G., Beati F., Bellato V., Billeci F., Blasi F., Buonomo O. C., Campanelli M., Coco G., Contadini A., Conte L. E., D'Ippolito G., Di Marcantonio A., Spicchiale C. F., Afflitto G. G., Gismondi A., Gorgolini G., Granai A. V., Grande S., Gravina A., Guida A. M., Ingallinella S., Keci L., Latini E., Marino D., Oddi F. M., Orecchia L., Don C. B. P., Pellicciaro M., Petagna L., Pirozzi B. M., Quaranta C., Rho M., Rosina A., Santicchia M. S., Saraceno F., Schiavone A., Sensi B., Spina A., Sullo L., Tacconi F., Taje R., Vanni G., Vinci D., Vita G., Alba G., Badalucco S., Carbone L., Samorani O. C., Chisci G., Cuomo R., Francia A., Fusario D., Gargiulo B., Pasqui E., Pasquetti L., Puoti P., Resca L., Cumbo J., Ganio S., Vizzielli G., Anastasi M., Guerra D., Romanzi A., Vannelli A., and Baia M.
Abstract: COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March–April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients’ management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons’ personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon–patient/family communication. From the Italian surgeons’ perspective, COVID-related measures will continue to influence
Published: 2023

4. Survival benefit of second line therapies for recurrent hepatocellular carcinoma: repeated hepatectomy, thermoablation and second-line transplant referral in a real life national scenario

Author: Famularo, S, Cillo, U, Lauterio, A, Donadon, M, Vitale, A, Serenari, M, Cipriani, F, Fazio, F, Giuffrida, M, Ardito, F, Dominioni, T, Garancini, M, Lai, Q, Nicolini, D, Molfino, S, Perri, P, Pinotti, E, Conci, S, Ferrari, C, Zanello, M, Patauner, S, Zimmitti, G, Germani, P, Chiarelli, M, Romano, M, De Angelis, M, La Barba, G, Troci, A, Ferraro, V, Izzo, F, Antonucci, A, Belli, A, Memeo, R, Crespi, M, Ercolani, G, Boccia, L, Zanus, G, Tarchi, P, Hilal, M, Frena, A, Jovine, E, Griseri, G, Ruzzenente, A, Zago, M, Grazi, G, Baiocchi, G, Vivarelli, M, Rossi, M, Romano, F, Maestri, M, Giuliante, F, Valle, R, Ferrero, A, Aldrighetti, L, De Carlis, L, Cescon, M, Torzilli, G, Milana, F, Bertacco, A, De Carlis, R, Ratti, F, Russolillo, N, Iaria, M, Razionale, F, Tartaglia, G, Ciulli, C, Carissimi, F, Laureiro, Z, Marinelli, L, Depeppo, V, Montuori, M, Marchitelli, I, Franceschi, A, Notte, F, Manzoni, A, Cosola, D, Corleone, P, Fumagalli, L, Salvador, L, Mantovani, G, Cucchetti, A, Cammarata, F, Conticchio, M, Patrone, R, Bernasconi, D, Famularo S., Cillo U., Lauterio A., Donadon M., Vitale A., Serenari M., Cipriani F., Fazio F., Giuffrida M., Ardito F., Dominioni T., Garancini M., Lai Q., Nicolini D., Molfino S., Perri P., Pinotti E., Conci S., Ferrari C., Zanello M., Patauner S., Zimmitti G., Germani P., Chiarelli M., Romano M., De Angelis M., La Barba G., Troci A., Ferraro V., Izzo F., Antonucci A., Belli A., Memeo R., Crespi M., Ercolani G., Boccia L., Zanus G., Tarchi P., Hilal M. A., Frena A., Jovine E., Griseri G., Ruzzenente A., Zago M., Grazi G., Baiocchi G. L., Vivarelli M., Rossi M., Romano F., Maestri M., Giuliante F., Valle R. D., Ferrero A., Aldrighetti L., De Carlis L., Cescon M., Torzilli G., Milana F., Bertacco A., De Carlis R., Ratti F., Russolillo N., Iaria M., Razionale F., Tartaglia G., Ciulli C., Carissimi F., Laureiro Z. L., Marinelli L., DePeppo V., Montuori M., Marchitelli I., Franceschi A., Notte F., Manzoni A., Cosola D., Corleone P., Fumagalli L., Salvador L., Mantovani G., Cucchetti A., Cammarata F., Conticchio M., Patrone R., Bernasconi D. P., Famularo, S, Cillo, U, Lauterio, A, Donadon, M, Vitale, A, Serenari, M, Cipriani, F, Fazio, F, Giuffrida, M, Ardito, F, Dominioni, T, Garancini, M, Lai, Q, Nicolini, D, Molfino, S, Perri, P, Pinotti, E, Conci, S, Ferrari, C, Zanello, M, Patauner, S, Zimmitti, G, Germani, P, Chiarelli, M, Romano, M, De Angelis, M, La Barba, G, Troci, A, Ferraro, V, Izzo, F, Antonucci, A, Belli, A, Memeo, R, Crespi, M, Ercolani, G, Boccia, L, Zanus, G, Tarchi, P, Hilal, M, Frena, A, Jovine, E, Griseri, G, Ruzzenente, A, Zago, M, Grazi, G, Baiocchi, G, Vivarelli, M, Rossi, M, Romano, F, Maestri, M, Giuliante, F, Valle, R, Ferrero, A, Aldrighetti, L, De Carlis, L, Cescon, M, Torzilli, G, Milana, F, Bertacco, A, De Carlis, R, Ratti, F, Russolillo, N, Iaria, M, Razionale, F, Tartaglia, G, Ciulli, C, Carissimi, F, Laureiro, Z, Marinelli, L, Depeppo, V, Montuori, M, Marchitelli, I, Franceschi, A, Notte, F, Manzoni, A, Cosola, D, Corleone, P, Fumagalli, L, Salvador, L, Mantovani, G, Cucchetti, A, Cammarata, F, Conticchio, M, Patrone, R, Bernasconi, D, Famularo S., Cillo U., Lauterio A., Donadon M., Vitale A., Serenari M., Cipriani F., Fazio F., Giuffrida M., Ardito F., Dominioni T., Garancini M., Lai Q., Nicolini D., Molfino S., Perri P., Pinotti E., Conci S., Ferrari C., Zanello M., Patauner S., Zimmitti G., Germani P., Chiarelli M., Romano M., De Angelis M., La Barba G., Troci A., Ferraro V., Izzo F., Antonucci A., Belli A., Memeo R., Crespi M., Ercolani G., Boccia L., Zanus G., Tarchi P., Hilal M. A., Frena A., Jovine E., Griseri G., Ruzzenente A., Zago M., Grazi G., Baiocchi G. L., Vivarelli M., Rossi M., Romano F., Maestri M., Giuliante F., Valle R. D., Ferrero A., Aldrighetti L., De Carlis L., Cescon M., Torzilli G., Milana F., Bertacco A., De Carlis R., Ratti F., Russolillo N., Iaria M., Razionale F., Tartaglia G., Ciulli C., Carissimi F., Laureiro Z. L., Marinelli L., DePeppo V., Montuori M., Marchitelli I., Franceschi A., Notte F., Manzoni A., Cosola D., Corleone P., Fumagalli L., Salvador L., Mantovani G., Cucchetti A., Cammarata F., Conticchio M., Patrone R., and Bernasconi D. P.
Abstract: Background: Despite second-line transplant(SLT) for recurrent hepatocellular carcinoma(rHCC) leads to the longest survival after recurrence(SAR), its real applicability has never been reported. The aim was to compare the SAR of SLT versus repeated hepatectomy and thermoablation(CUR group). Methods: Patients were enrolled from the Italian register HE.RC.O.LE.S. between 2008 and 2021. Two groups were created: CUR versus SLT. A propensity score matching (PSM) was run to balance the groups. Results: 743 patients were enrolled, CUR = 611 and SLT = 132. Median age at recurrence was 71(IQR 6575) years old and 60(IQR 53-64, p < 0.001) for CUR and SLT respectively. After PSM, median SAR for CUR was 43 months(95%CI = 37 – 93) and not reached for SLT(p < 0.001). SLT patients gained a survival benefit of 9.4 months if compared with CUR. MilanCriteria(MC)-In patients were 82.7% of the CUR group. SLT(HR 0.386, 95%CI = 0.23 – 0.63, p < 0.001) and the MELD score(HR 1.169, 95%CI = 1.07 – 1.27, p < 0.001) were the only predictors of mortality. In case of MC-Out, the only predictor of mortality was the number of nodules at recurrence(HR 1.45, 95%CI= 1.09 – 1.93, p = 0.011). Conclusion: It emerged an important transplant under referral in favour of repeated hepatectomy or thermoablation. In patients with MC-Out relapse, the benefit of SLT over CUR was not observed.
Published: 2023

5. Improving outcomes of in situ split liver transplantation in Italy over the last 25 years

Author: Lauterio, A, Cillo, U, Spada, M, Trapani, S, De Carlis, R, Bottino, G, Bernasconi, D, Scalamogna, C, Pinelli, D, Cintorino, D, D'Amico, F, Spagnoletti, G, Miggino, M, Romagnoli, R, Centonze, L, Caccamo, L, Baccarani, U, Carraro, A, Cescon, M, Vivarelli, M, Mazaferro, V, Ettorre, G, Rossi, M, Vennarecci, G, De Simone, P, Angelico, R, Agnes, S, Di Benedetto, F, Lupo, L, Zamboni, F, Zefelippo, A, Patrono, D, Diviacco, P, Laureiro, Z, Gringeri, E, Di Francesco, F, Lucianetti, A, Valsecchi, M, Gruttadauria, S, De Feo, T, Cardillo, M, De Carlis, L, Colledan, M, Andorno, E, Lauterio A., Cillo U., Spada M., Trapani S., De Carlis R., Bottino G., Bernasconi D., Scalamogna C., Pinelli D., Cintorino D., D'Amico F. E., Spagnoletti G., Miggino M., Romagnoli R., Centonze L., Caccamo L., Baccarani U., Carraro A., Cescon M., Vivarelli M., Mazaferro V., Ettorre G. M., Rossi M., Vennarecci G., De Simone P., Angelico R., Agnes S., Di Benedetto F., Lupo L. G., Zamboni F., Zefelippo A., Patrono D., Diviacco P., Laureiro Z. L., Gringeri E., Di Francesco F., Lucianetti A., Valsecchi M. G., Gruttadauria S., De Feo T., Cardillo M., De Carlis L., Colledan M., Andorno E., Lauterio, A, Cillo, U, Spada, M, Trapani, S, De Carlis, R, Bottino, G, Bernasconi, D, Scalamogna, C, Pinelli, D, Cintorino, D, D'Amico, F, Spagnoletti, G, Miggino, M, Romagnoli, R, Centonze, L, Caccamo, L, Baccarani, U, Carraro, A, Cescon, M, Vivarelli, M, Mazaferro, V, Ettorre, G, Rossi, M, Vennarecci, G, De Simone, P, Angelico, R, Agnes, S, Di Benedetto, F, Lupo, L, Zamboni, F, Zefelippo, A, Patrono, D, Diviacco, P, Laureiro, Z, Gringeri, E, Di Francesco, F, Lucianetti, A, Valsecchi, M, Gruttadauria, S, De Feo, T, Cardillo, M, De Carlis, L, Colledan, M, Andorno, E, Lauterio A., Cillo U., Spada M., Trapani S., De Carlis R., Bottino G., Bernasconi D., Scalamogna C., Pinelli D., Cintorino D., D'Amico F. E., Spagnoletti G., Miggino M., Romagnoli R., Centonze L., Caccamo L., Baccarani U., Carraro A., Cescon M., Vivarelli M., Mazaferro V., Ettorre G. M., Rossi M., Vennarecci G., De Simone P., Angelico R., Agnes S., Di Benedetto F., Lupo L. G., Zamboni F., Zefelippo A., Patrono D., Diviacco P., Laureiro Z. L., Gringeri E., Di Francesco F., Lucianetti A., Valsecchi M. G., Gruttadauria S., De Feo T., Cardillo M., De Carlis L., Colledan M., and Andorno E.
Abstract: Background & Aims: Split liver transplant(ation) (SLT) is still considered a challenging procedure that is by no means widely accepted. We aimed to present data on 25-year trends in SLT in Italy, and to investigate if, and to what extent, outcomes have improved nationwide during this time. Methods: The study included all consecutive SLTs performed from May 1993 to December 2019, divided into three consecutive periods: 1993–2005, 2006–2014, and 2015–2019, which match changes in national allocation policies. Primary outcomes were patient and graft survival, and the relative impact of each study period. Results: SLT accounted for 8.9% of all liver transplants performed in Italy. A total of 1,715 in situ split liver grafts were included in the analysis: 868 left lateral segments (LLSs) and 847 extended right grafts (ERGs). A significant improvement in patient and graft survival (p <0.001) was observed with ERGs over the three periods. Predictors of graft survival were cold ischaemia time (CIT) <6 h (p = 0.009), UNOS status 2b (p <0.001), UNOS status 3 (p = 0.009), and transplant centre volumes: 25–50 cases vs. <25 cases (p = 0.003). Patient survival was significantly higher with LLS grafts in period 2 vs. period 1 (p = 0.008). No significant improvement in graft survival was seen over the three periods, where predictors of graft survival were CIT <6 h (p = 0.007), CIT <6 h vs. ≥10 h (p = 0.019), UNOS status 2b (p = 0.038), and UNOS status 3 (p = 0.009). Retransplantation was a risk factor in split liver graft recipients, with significantly worse graft and patient survival for both types of graft (p <0.001). Conclusions: Our analysis showed Italian SLT outcomes to have improved over the last 25 years. These results could help to dispel reservations regarding the use of this procedure. Impact and implications: Split liver transplant(ation) (SLT) is still considered a challenging procedure and is by no means widely accepted. This study included all
Published: 2023

6. The impact of postoperative complications on oncological outcomes of liver transplantation for hepatocellular carcinoma: A competing risk analysis

Author: Incarbone, N, De Carlis, R, Centonze, L, Bernasconi, D, Valsecchi, M, Lauterio, A, De Carlis, L, Incarbone N., De Carlis R., Centonze L., Bernasconi D. P., Valsecchi M. G., Lauterio A., De Carlis L., Incarbone, N, De Carlis, R, Centonze, L, Bernasconi, D, Valsecchi, M, Lauterio, A, De Carlis, L, Incarbone N., De Carlis R., Centonze L., Bernasconi D. P., Valsecchi M. G., Lauterio A., and De Carlis L.
Abstract: Objective: To investigate the influence of postoperative complications on tumor-related (TRD), disease-free survival (DFS) and overall survival (OS) in patients undergoing liver transplant (LT) for hepatocellular carcinoma (HCC). Methods: We retrospectively evaluated 425 LTs for HCC from 2010 to 2019. Postoperative complications were classified according to Comprehensive Complication Index (CCI) and the posttransplant risk of TRD assessed through Metroticket 2.0 calculator. The population was stratified into high-risk and low-risk cohorts based on the predicted TRD risk of 80%. In a second step, we re-evaluated TRD, DFS and OS of both cohorts according to a further stratification based on 47.3 points of CCI cut-off. Results: In the low-risk cohort, we observed a significantly better DFS (84% vs. 46%, p<0.001), TRD (3% vs. 26%, p<0.001) and OS (89% vs. 62%, p<0.001) in the group with CCI < 47.3. In the high-risk cohort, patients with CCI < 47.3 had significantly better DFS (50% vs. 23%, p = 0.003) and OS (68% vs. 42%, p = 0.02) and a comparable TRD (22% vs. 31%, p = 0.142). Conclusions: A complicated postoperative course negatively influenced long-term survival. This poorer oncological outcome associated with in-hospital postoperative complications suggests that every effort should be made to improve the early posttransplant course in HCC patients, including a careful donor-to recipient match and use of new perfusion technologies.
Published: 2023

7. Viability assessment and transplantation of fatty liver grafts using end-ischemic normothermic machine perfusion

Author: Patrono, D, De Carlis, R, Gambella, A, Farnesi, F, Podesta, A, Lauterio, A, Tandoi, F, De Carlis, L, Romagnoli, R, Patrono D., De Carlis R., Gambella A., Farnesi F., Podesta A., Lauterio A., Tandoi F., De Carlis L., Romagnoli R., Patrono, D, De Carlis, R, Gambella, A, Farnesi, F, Podesta, A, Lauterio, A, Tandoi, F, De Carlis, L, Romagnoli, R, Patrono D., De Carlis R., Gambella A., Farnesi F., Podesta A., Lauterio A., Tandoi F., De Carlis L., and Romagnoli R.
Abstract: End-ischemic viability testing by normothermic machine perfusion (NMP) represents an effective strategy to recover liver grafts having initially been discarded for liver transplantation (LT). However, its results in the setting of significant (≥30%) macrovesicular steatosis (MaS) have not been specifically assessed. Prospectively maintained databases at two high-volume LT centers in Northern Italy were searched to identify cases of end-ischemic NMP performed to test the viability of livers with MaS ≥ 30% in the period from January 2019 to January 2022. A total of 14 cases were retrieved, representing 57.9% of NMP and 5.7% of all machine perfusion procedures. Of those patients, 10 (71%) received transplants. Two patients developed primary nonfunction (PNF) and required urgent re-LT, and both were characterized by incomplete or suboptimal lactate clearance during NMP. PNF cases were also characterized by higher perfusate transaminases, lower hepatic artery and portal vein flows at 2 h, and a lack of glucose metabolism in one case. The remaining eight patients showed good liver function (Liver Graft Assessment Following Transplantation risk score, −1.9 [risk, 13.6%]; Early Allograft Failure Simplified Estimation score, −3.7 [risk, 2.6%]) and had a favorable postoperative course. Overall, NMP allowed successful transplantation of 57% of livers with moderate-to-severe MaS. Our findings suggest that prolonged observation (≥6 h) might be required for steatotic livers and that stable lactate clearance is a fundamental prerequisite for their use.
Published: 2023

8. Similar survival but higher and delayed hepatocellular carcinoma recurrence in HIV-positive compared to negative cirrhotics undergoing liver transplantation

Author: Rossotti, R, Merli, M, Mazzarelli, C, De Carlis, R, Travi, G, Vecchi, M, Vigano, R, Lauterio, A, Raimondi, A, Belli, L, De Carlis, L, Puoti, M, Rossotti R., Merli M., Mazzarelli C., De Carlis R. M., Travi G., Vecchi M., Vigano R., Lauterio A., Raimondi A., Belli L. S., De Carlis L. G., Puoti M., Rossotti, R, Merli, M, Mazzarelli, C, De Carlis, R, Travi, G, Vecchi, M, Vigano, R, Lauterio, A, Raimondi, A, Belli, L, De Carlis, L, Puoti, M, Rossotti R., Merli M., Mazzarelli C., De Carlis R. M., Travi G., Vecchi M., Vigano R., Lauterio A., Raimondi A., Belli L. S., De Carlis L. G., and Puoti M.
Abstract: Background: Liver transplantation (LT) represents the best therapeutic option for hepatocellular carcinoma (HCC) and end-stage liver disease (ESLD). Although HIV infection does not seem to lower survival rates, HCV and HCC recurrence appear more harmful. Aims: To compare the overall survival after LT; evaluate the impact of anti-HCV direct-acting agents (DAA); assess the rate of HCC recurrence in HIV-positive and negative patients. Methods: Subjects with HCV/HBV infection who underwent LT for HCC or ESLD from 2012 to 2019 were retrospectively evaluated. Results: Study population included 299 individuals, 31 (10.4%) were HIV-positive. Overall mortality was similar (16.1% versus 19.0%, p = 0.695). HCC recurrence was observed in 6 HIV-positive (19.4%) and in 17 negative subjects (6.3%, p = 0.022). Time to relapse was 831 days in HIV-positive and 315 days in negative patients (p = 0.046). Cox model found a significant role for HIV in univariate analysis but, after adjusting for variables, extra-hepatic tumor was the only factor associated to recurrence (aHR 56.379, p < 0.001). Conclusions: Post-LT survival improved after DAA availability and HIV has no impact on mortality. A higher and delayed rate of HCC recurrence was observed in co-infected individuals: surveillance protocols should be strengthened along time in this population.
Published: 2023

9. Surgical Treatment of Hepatocellular Carcinoma: Multicenter Competing-risk Analysis of Tumor-related Death Following Liver Resection and Transplantation Under an Intention-to-treat Perspective

Author: Di Sandro, S, Sposito, C, Ravaioli, M, Lauterio, A, Magistri, P, Bongini, M, Odaldi, F, De Carlis, R, Botta, F, Centonze, L, Maroni, L, Citterio, D, Guidetti, C, Bagnardi, V, De Carlis, L, Cescon, M, Mazzaferro, V, Di Benedetto, F, Catellani, B, Piero Guerrini, G, Danieli, M, Frassoni, S, Virdis, M, Bhoori, S, Serenari, M, Laurenzi, A, Di Sandro S., Sposito C., Ravaioli M., Lauterio A., Magistri P., Bongini M., Odaldi F., De Carlis R., Botta F., Centonze L., Maroni L., Citterio D., Guidetti C., Bagnardi V., De Carlis L., Cescon M., Mazzaferro V., Di Benedetto F., Catellani B., Piero Guerrini G., Danieli M., Frassoni S., Virdis M., Bhoori S., Serenari M., Laurenzi A., Di Sandro, S, Sposito, C, Ravaioli, M, Lauterio, A, Magistri, P, Bongini, M, Odaldi, F, De Carlis, R, Botta, F, Centonze, L, Maroni, L, Citterio, D, Guidetti, C, Bagnardi, V, De Carlis, L, Cescon, M, Mazzaferro, V, Di Benedetto, F, Catellani, B, Piero Guerrini, G, Danieli, M, Frassoni, S, Virdis, M, Bhoori, S, Serenari, M, Laurenzi, A, Di Sandro S., Sposito C., Ravaioli M., Lauterio A., Magistri P., Bongini M., Odaldi F., De Carlis R., Botta F., Centonze L., Maroni L., Citterio D., Guidetti C., Bagnardi V., De Carlis L., Cescon M., Mazzaferro V., Di Benedetto F., Catellani B., Piero Guerrini G., Danieli M., Frassoni S., Virdis M., Bhoori S., Serenari M., and Laurenzi A.
Abstract: Background. Early-stage hepatocellular carcinoma could benefit from upfront liver resection (LR) or liver transplantation (LT), but the optimal strategy in terms of tumor-related outcomes is still debated. We compared the oncological outcomes of LR and LT for hepatocellular carcinoma, stratifying the study population into a low-, intermediate-, and high-risk class according to the risk of death at 5-y predicted by a previously developed prognostic model. The impact of tumor pathology on oncological outcomes of low- and intermediate-risk patients undergoing LR was investigated as a secondary outcome. Methods. We performed a retrospective multicentric cohort study involving 2640 patients consecutively treated by LR or LT from 4 tertiary hepatobiliary and transplant centers between 2005 and 2015, focusing on patients amenable to both treatments upfront. Tumor-related survival and overall survival were compared under an intention-to-treat perspective. Results. We identified 468 LR and 579 LT candidates: 512 LT candidates underwent LT, whereas 68 (11.7%) dropped-out for tumor progression. Ninety-nine high-risk patients were selected from each treatment cohort after propensity score matching. Three and 5-y cumulative incidence of tumor-related death were 29.7% and 39.5% versus 17.2% and 18.3% for LR and LT group (P = 0.039), respectively. Low-risk and intermediate-risk patients treated by LR and presenting satellite nodules and microvascular invasion had a significantly higher 5-y incidence of tumor-related death (29.2% versus 12.5%; P < 0.001). Conclusions. High-risk patients showed significantly better intention-to-treat tumor-related survival after upfront LT rather than LR. Cancer-specific survival of low- and intermediate-risk LR patients was significantly impaired by unfavorable pathology, suggesting the application of ab-initio salvage LT in such scenarios.
Published: 2023

10. Single Hepatocellular Carcinoma approached by curative-intent treatment: A propensity score analysis comparing radiofrequency ablation and liver resection

Author: Di Sandro, S., Benuzzi, L., Lauterio, A., Botta, F., De Carlis, R., Najjar, M., Centonze, L., Danieli, M., Pezzoli, I., Rampoldi, A., Bagnardi, V., and De Carlis, L.
Published: 2019
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11. Successful recovery from severe inverted Takotsubo cardiomyopathy after liver transplantation: The efficacy of extracorporeal membrane oxygenation (ECMO)

Author: Lauterio, A, Bottiroli, M, Cannata, A, de Carlis, R, Valsecchi, M, Perricone, G, Colombo, S, Buscemi, V, Zaniboni, M, Pedrazzini, G, Mondino, M, Russo, C, Fumagalli, R, de Carlis, L, Lauterio A., Bottiroli M., Cannata A., de Carlis R., Valsecchi M., Perricone G., Colombo S., Buscemi V., Zaniboni M., Pedrazzini G., Mondino M., Russo C., Fumagalli R., de Carlis L., Lauterio, A, Bottiroli, M, Cannata, A, de Carlis, R, Valsecchi, M, Perricone, G, Colombo, S, Buscemi, V, Zaniboni, M, Pedrazzini, G, Mondino, M, Russo, C, Fumagalli, R, de Carlis, L, Lauterio A., Bottiroli M., Cannata A., de Carlis R., Valsecchi M., Perricone G., Colombo S., Buscemi V., Zaniboni M., Pedrazzini G., Mondino M., Russo C., Fumagalli R., and de Carlis L.
Published: 2022

12. How useful is the machine perfusion in liver transplantation? An answer from a national survey

Author: Scalera, I, De Carlis, R, Patrono, D, Gringeri, E, Olivieri, T, Pagano, D, Lai, Q, Rossi, M, Gruttadauria, S, Di Benedetto, F, Cillo, U, Romagnoli, R, Lupo, L, De Carlis, L, Scalera I., De Carlis R., Patrono D., Gringeri E., Olivieri T., Pagano D., Lai Q., Rossi M., Gruttadauria S., Di Benedetto F., Cillo U., Romagnoli R., Lupo L. G., De Carlis L., Scalera, I, De Carlis, R, Patrono, D, Gringeri, E, Olivieri, T, Pagano, D, Lai, Q, Rossi, M, Gruttadauria, S, Di Benedetto, F, Cillo, U, Romagnoli, R, Lupo, L, De Carlis, L, Scalera I., De Carlis R., Patrono D., Gringeri E., Olivieri T., Pagano D., Lai Q., Rossi M., Gruttadauria S., Di Benedetto F., Cillo U., Romagnoli R., Lupo L. G., and De Carlis L.
Abstract: Machine perfusion (MP) has been shown worldwide to offer many advantages in liver transplantation, but it still has some gray areas. The purpose of the study is to evaluate the donor risk factors of grafts, perfused with any MP, that might predict an ineffective MP setting and those would trigger post-transplant early allograft dysfunction (EAD). Data from donors of all MP-perfused grafts at six liver transplant centers have been analyzed, whether implanted or discarded after perfusion. The first endpoint was the negative events after perfusion (NegE), which is the number of grafts discarded plus those that were implanted but lost after the transplant. A risk factor analysis for NegE was performed and marginal grafts for MP were identified. Finally, the risk of EAD was analyzed, considering only implanted grafts. From 2015 to September 2019, 158 grafts were perfused with MP: 151 grafts were implanted and 7 were discarded after the MP phase because they did not reach viability criteria. Of 151, 15 grafts were lost after transplant, so the NegE group consisted of 22 donors. In univariate analysis, the donor risk index >1.7, the presence of hypertension in the medical history, static cold ischemia time, and the moderate or severe macrovesicular steatosis were the significant factors for NegE. Multivariate analysis confirmed that macrosteatosis >30% was an independent risk factor for NegE (odd ratio 5.643, p = 0.023, 95% confidence interval, 1.27–24.98). Of 151 transplanted patients, 34% experienced EAD and had worse 1- and 3-year-survival, compared with those who did not face EAD (NoEAD), 96% and 96% for EAD vs. 89% and 71% for NoEAD, respectively (p = 0.03). None of the donor/graft characteristics was associated with EAD even if the graft was moderately steatotic or fibrotic or from an aged donor. For the first time, this study shows that macrovesicular steatosis >30% might be a warning factor involved in the risk of graft loss or a cause of graft discard aft
Published: 2022

13. 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

14. Extremely rare presentation of primary nonfunctioning hepatic paraganglioma

Author: Vella, I, De Carlis, R, Lauterio, A, De Carlis, L, Vella I., De Carlis R., Lauterio A., De Carlis L., Vella, I, De Carlis, R, Lauterio, A, De Carlis, L, Vella I., De Carlis R., Lauterio A., and De Carlis L.
Published: 2022

15. Impact of MELD 30-allocation policy on liver transplant outcomes in Italy

Author: Ravaioli, M, Lai, Q, Sessa, M, Ghinolfi, D, Fallani, G, Patrono, D, Di Sandro, S, Avolio, A, Odaldi, F, Bronzoni, J, Tandoi, F, De Carlis, R, Pascale, M, Mennini, G, Germinario, G, Rossi, M, Agnes, S, De Carlis, L, Cescon, M, Romagnoli, R, De Simone, P, Ravaioli M., Lai Q., Sessa M., Ghinolfi D., Fallani G., Patrono D., Di Sandro S., Avolio A., Odaldi F., Bronzoni J., Tandoi F., De Carlis R., Pascale M. M., Mennini G., Germinario G., Rossi M., Agnes S., De Carlis L., Cescon M., Romagnoli R., De Simone P., Ravaioli, M, Lai, Q, Sessa, M, Ghinolfi, D, Fallani, G, Patrono, D, Di Sandro, S, Avolio, A, Odaldi, F, Bronzoni, J, Tandoi, F, De Carlis, R, Pascale, M, Mennini, G, Germinario, G, Rossi, M, Agnes, S, De Carlis, L, Cescon, M, Romagnoli, R, De Simone, P, Ravaioli M., Lai Q., Sessa M., Ghinolfi D., Fallani G., Patrono D., Di Sandro S., Avolio A., Odaldi F., Bronzoni J., Tandoi F., De Carlis R., Pascale M. M., Mennini G., Germinario G., Rossi M., Agnes S., De Carlis L., Cescon M., Romagnoli R., and De Simone P.
Abstract: Background & Aims: In Italy, since August 2014, liver transplant (LT) candidates with model for end-stage liver disease (MELD) scores ≥30 receive national allocation priority. This multicenter cohort study aims to evaluate time on the waiting list, dropout rate, and graft survival before and after introducing the macro-area sharing policy. Methods: A total of 4,238 patients registered from 2010 to 2018 were enrolled and categorized into an ERA-1 Group (n = 2,013; before August 2014) and an ERA-2 Group (n = 2,225; during and after August 2014). A Cox proportional hazards model was used to estimate the hazard ratio (HR) of receiving a LT or death between the two eras. The Fine-Gray model was used to estimate the HR for dropout from the waiting list and graft loss, considering death as a competing risk event. A Fine-Gray model was also used to estimate risk factors of graft loss. Results: Patients with MELD ≥30 had a lower median time on the waiting list (4 vs.12 days, p <0.001) and a higher probability of being transplanted (HR 2.27; 95% CI 1.78–2.90; p = 0.001) in ERA-2 compared to ERA-1. The subgroup analysis on 3,515 LTs confirmed ERA-2 (odds ratio 0.56; 95% CI 0.46–0.68; p = 0.001) as a protective factor for better graft survival rate. The protective variables for lower dropouts on the waiting list were: ERA-2, high-volume centers, no competition centers, male recipients, and hepatocellular carcinoma. The protective variables for graft loss were high-volume center and ERA-2, while MELD ≥30 remained related to a higher risk of graft loss. Conclusions: The national MELD ≥30 priority allocation was associated with improved patient outcomes, although MELD ≥30 was associated with a higher risk of graft loss. Transplant center volumes and competition among centers may have a role in recipient prioritization and outcomes. Clinical trial number: NCT04530240 Lay summary: Italy introduced a new policy in 2014 to give national allocation priority to patients with a mo
Published: 2022

16. New-Onset Antibodies to Platelet Factor 4 Following Liver Transplantation From a Donor With Vaccine-Induced Thrombotic Thrombocytopenia

Author: Valsecchi, M, Lauterio, A, Crocchiolo, R, De Carlis, R, Pugliano, M, Centonze, L, Ferla, F, Zaniboni, M, Veronese, S, Podda, G, Belli, L, Rossini, S, De Carlis, L, Fumagalli, R, Valsecchi M., Lauterio A., Crocchiolo R., De Carlis R., Pugliano M., Centonze L., Ferla F., Zaniboni M., Veronese S., Podda G. M., Belli L., Rossini S., De Carlis L., Fumagalli R., Valsecchi, M, Lauterio, A, Crocchiolo, R, De Carlis, R, Pugliano, M, Centonze, L, Ferla, F, Zaniboni, M, Veronese, S, Podda, G, Belli, L, Rossini, S, De Carlis, L, Fumagalli, R, Valsecchi M., Lauterio A., Crocchiolo R., De Carlis R., Pugliano M., Centonze L., Ferla F., Zaniboni M., Veronese S., Podda G. M., Belli L., Rossini S., De Carlis L., and Fumagalli R.
Published: 2022

17. Portal Steal Syndrome From a Large Linton’s Splenorenal Shunt after Liver Transplantation: Successful Endovascular Management Through Off-Label Application of a 30 mm Amplatzer Cardiac Plug

Author: Centonze, L, Vella, I, Morelli, F, Checchini, G, De Carlis, R, Rampoldi, A, Lauterio, A, Andorno, E, De Carlis, L, Centonze L., Vella I., Morelli F., Checchini G., De Carlis R., Rampoldi A., Lauterio A., Andorno E., De Carlis L., Centonze, L, Vella, I, Morelli, F, Checchini, G, De Carlis, R, Rampoldi, A, Lauterio, A, Andorno, E, De Carlis, L, Centonze L., Vella I., Morelli F., Checchini G., De Carlis R., Rampoldi A., Lauterio A., Andorno E., and De Carlis L.
Abstract: A 34-year-old patient underwent liver transplantation for progressive hepatic failure in the setting of congenital hepatic fibrosis. In past medical history, the patient had undergone splenectomy with proximal Linton’s splenorenal surgical shunt creation for symptomatic portal hypertension with hypersplenism. The patient developed an early allograft dysfunction, with radiologic evidence of a reduced portal flow associated to portal steal from the patent surgical shunt. The patient was successfully treated through endovascular placement of a 30 mm Amplatzer cardiac plug at the origin of the splenic vein.
Published: 2022

18. Major hepatectomy for perihilar cholangiocarcinoma in elderly patients: is it reasonable?

Author: Ripamonti, L, De Carlis, R, Lauterio, A, Mangoni, I, Frassoni, S, Bagnardi, V, Centonze, L, Poli, C, Buscemi, V, Ferla, F, De Carlis, L, Ripamonti L., De Carlis R., Lauterio A., Mangoni I., Frassoni S., Bagnardi V., Centonze L., Poli C., Buscemi V., Ferla F., De Carlis L., Ripamonti, L, De Carlis, R, Lauterio, A, Mangoni, I, Frassoni, S, Bagnardi, V, Centonze, L, Poli, C, Buscemi, V, Ferla, F, De Carlis, L, Ripamonti L., De Carlis R., Lauterio A., Mangoni I., Frassoni S., Bagnardi V., Centonze L., Poli C., Buscemi V., Ferla F., and De Carlis L.
Abstract: Introduction: We sought to evaluate the effect of age on postoperative outcomes among patients undergoing major liver surgery for perihilar cholangiocarcinoma (PHCC). Methods: 77 patients were included. Patients were categorized into two groups: the “< 70-year-olds” group (n = 54) and the “≥ 70-year-olds” group (n = 23). Results: Median LOS was 19 both for < 70-year-old group and ≥ 70-year-old group (P = 0.72). No differences in terms of severe complication were detected (44.4% Clavien–Dindo 3–4–5 in < 70-year-old group vs 47.8% in ≥ 70-year-old group, P = 0.60). Within 90 postoperative days, 11 patients died, 6 in < 70-year-old group (11.3%) and 5 in ≥ 70-year-old group (21.7%), P = 0.29. The median follow‐up was 20 months. The death rate was 72.2% and 78.3% among patients < 70 years old and ≥ 70 years old. The OS at 2 and 5 years was significantly higher among the < 70 years old (57.0% and 27.7%) compared to the ≥ 70 years old (27.1% and 13.6%), P = 0.043. Adjusting for hypertension and Charlson comorbidity index in a multivariate analysis, the HR for age was 1.93 (95% CI 0.84–4.44), P = 0.12. Relapse occurred in 43 (81.1%) patients in the < 70-year-old group and in 19 (82.6%) patients in the ≥ 70-year-old group. DFS at 12, 24, and 36 months was, respectively, 59.6, 34.2, and 23.2 for the < 70 -year-old group and 32.5, 20.3, and 13.5 for the ≥ 70-year-old group (P = 0.26). Adjusting for hypertension and Charlson comorbidity index in a Cox model, the HR for age was 1.52 (95% CI 0.67–3.46), with P = 0.32. Conclusions: ≥ 70-year-old patients with PHCC can still be eligible for major liver resection with acceptable complication rates and should not be precluded a priori from a radical treatment.
Published: 2022

19. Robotic Versus Laparoscopic Donor Nephrectomy: A Retrospective Bicentric Comparison of Learning Curves and Surgical Outcomes From 2 High-volume European Centers

Author: Centonze, L, Di Bella, C, Giacomoni, A, Silvestre, C, De Carlis, R, Frassoni, S, Franchin, B, Angrisani, M, Tuci, F, Di Bello, M, Bagnardi, V, Lauterio, A, Furian, L, De Carlis, L, Centonze, Leonardo, Di Bella, Caterina, Giacomoni, Alessandro, Silvestre, Cristina, De Carlis, Riccardo, Frassoni, Samuele, Franchin, Barbara, Angrisani, Marco, Tuci, Francesco, Di Bello, Marianna, Bagnardi, Vincenzo, Lauterio, Andrea, Furian, Lucrezia, De Carlis, Luciano, Centonze, L, Di Bella, C, Giacomoni, A, Silvestre, C, De Carlis, R, Frassoni, S, Franchin, B, Angrisani, M, Tuci, F, Di Bello, M, Bagnardi, V, Lauterio, A, Furian, L, De Carlis, L, Centonze, Leonardo, Di Bella, Caterina, Giacomoni, Alessandro, Silvestre, Cristina, De Carlis, Riccardo, Frassoni, Samuele, Franchin, Barbara, Angrisani, Marco, Tuci, Francesco, Di Bello, Marianna, Bagnardi, Vincenzo, Lauterio, Andrea, Furian, Lucrezia, and De Carlis, Luciano
Abstract: Background. Although laparoscopic donor nephrectomy (LDN) represents the gold-standard technique for kidney living donation, robotic donor nephrectomy (RDN) settled as another appealing minimally invasive technique over the past decades. A comparison between LDN and RDN outcomes was performed. Methods. RDN and LDN outcomes were compared, focusing on operative time and perioperative risk factors affecting surgery duration. Learning curves for both techniques were compared through spline regression and cumulative sum models. Results. The study analyzed 512 procedures (154 RDN and 358 LDN procedures) performed between 2010 and 2021 in 2 different high-volume transplant centers. The RDN group presented a higher prevalence of arterial variations (36.2 versus 22.4%; P = 0.001) compared with the LDN cohort. No open conversions occurred; operative time (210 versus 195 min; P = 0.011) and warm ischemia time (WIT; 230 versus 180 s; P < 0.001) were longer in RDN. Postoperative complication rate was similar (8.4% versus 11.5%; P = 0.49); the RDN group showed shorter hospital stay (4 versus 5 d; P < 0.001). Spline regression models depicted a faster learning curve in the RDN group (P = 0.0002). Accordingly, cumulative sum analysis highlighted a turning point after about 50 procedures among the RDN cohort and after about 100 procedures among the LDN group. Higher body mass index resulted as an independent risk factor for longer operative time for both techniques; multiple arteries significantly prolonged operative time in LDN, whereas RDN was longer in right kidney procurements; both procedures were equally shortened by growing surgical experience. Conclusions. RDN grants a faster learning curve and improves multiple vessel handling. Incidence of postoperative complications was low for both techniques.
Published: 2023

20. The role of intravenous immunoglobulin in the treatment of community-acquired West Nile virus encephalitis after liver transplantation

Author: Lauterio, A, De Carlis, R, Centonze, L, Merli, M, Valsecchi, M, Monti, G, Puoti, M, Fumagalli, R, De Carlis, L, Lauterio, Andrea, De Carlis, Riccardo, Centonze, Leonardo, Merli, Marco, Valsecchi, Mila, Monti, Gianpaola, Puoti, Massimo, Fumagalli, Roberto, De Carlis, Luciano, Lauterio, A, De Carlis, R, Centonze, L, Merli, M, Valsecchi, M, Monti, G, Puoti, M, Fumagalli, R, De Carlis, L, Lauterio, Andrea, De Carlis, Riccardo, Centonze, Leonardo, Merli, Marco, Valsecchi, Mila, Monti, Gianpaola, Puoti, Massimo, Fumagalli, Roberto, and De Carlis, Luciano
Published: 2023

21. Clinical Impact of Spontaneous Portosystemic Shunts in Liver Transplantation: A Comprehensive Assessment Through Total Shunt Area Measurement

Author: Centonze, L, Gorga, G, De Carlis, R, Bernasconi, D, Lauterio, A, Carbonaro, L, Vella, I, Sgrazzutti, C, Incarbone, N, Rizzetto, F, Valsecchi, M, Vanzulli, A, De Carlis, L, Centonze, Leonardo, Gorga, Giovanna, De Carlis, Riccardo, Bernasconi, Davide, Lauterio, Andrea, Carbonaro, Luca, Vella, Ivan, Sgrazzutti, Cristiano, Incarbone, Niccolò, Rizzetto, Francesco, Valsecchi, Maria Grazia, Vanzulli, Angelo, De Carlis, Luciano, Centonze, L, Gorga, G, De Carlis, R, Bernasconi, D, Lauterio, A, Carbonaro, L, Vella, I, Sgrazzutti, C, Incarbone, N, Rizzetto, F, Valsecchi, M, Vanzulli, A, De Carlis, L, Centonze, Leonardo, Gorga, Giovanna, De Carlis, Riccardo, Bernasconi, Davide, Lauterio, Andrea, Carbonaro, Luca, Vella, Ivan, Sgrazzutti, Cristiano, Incarbone, Niccolò, Rizzetto, Francesco, Valsecchi, Maria Grazia, Vanzulli, Angelo, and De Carlis, Luciano
Abstract: Background. The impact of spontaneous portosystemic shunts (SPSSs) on natural history of cirrhotic patients was recently evaluated through the measurement of total shunt area (TSA), a novel tool that allows a comprehensive assessment of SPSSs extension, identifying a direct correlation of higher TSA with lower patient survival. The role of SPSSs in liver transplant (LT) is still debated: we sought to investigate the clinical impact of TSA on the development of early allograft dysfunction (EAD), acute kidney injury (AKI), postoperative complications, and graft and patient survival following LT. Methods. Preoperative imaging of 346 cirrhotic patients undergoing primary LT between 2015 and 2020 were retrospectively revised, recording the size and anatomy of each SPSS to calculate TSA. The impact of TSA and selected patient and donor characteristics on the development of EAD, AKI, and clinically relevant complications was evaluated through univariate and multivariate logistic regression, whereas their effect on graft and patient survival was investigated through Cox regression analysis. Results. A TSA exceeding 78.54 mm2resulted as an independent risk factor for the development of EAD (odds ratio [OR]: 2.327; P = 0.003), grade 3 AKI (OR: 2.093; P = 0.041), and clinically relevant complications (OR: 1.962; P = 0.015). Moreover, higher TSA was significantly related to early graft and patient survivals, emerging as an independent risk factor for 12-mo graft loss (hazard ratio: 3.877; P = 0.007) and patient death (hazard ratio: 2.682; P = 0.018). Conclusions. Higher TSA emerged as a significant risk factor for worse postoperative outcomes following LT, supporting the need for careful hemodynamic assessment and management of patients presenting multiple/larger shunts.
Published: 2023

22. Utilization of livers donated after circulatory death for transplantation - An international comparison

Author: Eden, J, Da Silva, R, Cortes-Cerisuelo, M, Croome, K, De Carlis, R, Hessheimer, A, Muller, X, de Goeij, F, Banz, V, Magini, G, Compagnon, P, Elmer, A, Lauterio, A, Panconesi, R, Widmer, J, Dondossola, D, Muiesan, P, Monbaliu, D, de Rosner van Rosmalen, M, Detry, O, Fondevila, C, Jochmans, I, Pirenne, J, Immer, F, Oniscu, G, de Jonge, J, Lesurtel, M, De Carlis, L, Taner, C, Heaton, N, Schlegel, A, Dutkowski, P, Eden, Janina, Da Silva, Richard Sousa, Cortes-Cerisuelo, Miriam, Croome, Kristopher, De Carlis, Riccardo, Hessheimer, Amelia J, Muller, Xavier, de Goeij, Femke, Banz, Vanessa, Magini, Giulia, Compagnon, Philippe, Elmer, Andreas, Lauterio, Andrea, Panconesi, Rebecca, Widmer, Jeannette, Dondossola, Daniele, Muiesan, Paolo, Monbaliu, Diethard, de Rosner van Rosmalen, Marieke, Detry, Olivier, Fondevila, Constantino, Jochmans, Ina, Pirenne, Jacques, Immer, Franz, Oniscu, Gabriel C, de Jonge, Jeroen, Lesurtel, Mickaël, De Carlis, Luciano G, Taner, C Burcin, Heaton, Nigel, Schlegel, Andrea, Dutkowski, Philipp, Eden, J, Da Silva, R, Cortes-Cerisuelo, M, Croome, K, De Carlis, R, Hessheimer, A, Muller, X, de Goeij, F, Banz, V, Magini, G, Compagnon, P, Elmer, A, Lauterio, A, Panconesi, R, Widmer, J, Dondossola, D, Muiesan, P, Monbaliu, D, de Rosner van Rosmalen, M, Detry, O, Fondevila, C, Jochmans, I, Pirenne, J, Immer, F, Oniscu, G, de Jonge, J, Lesurtel, M, De Carlis, L, Taner, C, Heaton, N, Schlegel, A, Dutkowski, P, Eden, Janina, Da Silva, Richard Sousa, Cortes-Cerisuelo, Miriam, Croome, Kristopher, De Carlis, Riccardo, Hessheimer, Amelia J, Muller, Xavier, de Goeij, Femke, Banz, Vanessa, Magini, Giulia, Compagnon, Philippe, Elmer, Andreas, Lauterio, Andrea, Panconesi, Rebecca, Widmer, Jeannette, Dondossola, Daniele, Muiesan, Paolo, Monbaliu, Diethard, de Rosner van Rosmalen, Marieke, Detry, Olivier, Fondevila, Constantino, Jochmans, Ina, Pirenne, Jacques, Immer, Franz, Oniscu, Gabriel C, de Jonge, Jeroen, Lesurtel, Mickaël, De Carlis, Luciano G, Taner, C Burcin, Heaton, Nigel, Schlegel, Andrea, and Dutkowski, Philipp
Abstract: Background and aim: Liver graft utilization rates are a hot topic due to the worldwide organ shortage and an increasing number of transplant candidates on waiting lists. Liver perfusion techniques have been introduced in several countries, and may help to increase the organ supply, as they potentially allow the assessment of livers before use. Methods: Liver offers were counted from donation after circulatory death (DCD) donors (Maastricht-type-III) arising during the past decade in eight countries, including Belgium, France, Italy, the Netherlands, Spain, Switzerland, UK, and US. Initial DCD-type-III liver offers were correlated with accepted, recovered and implanted livers. Results: A total number of 34`269 DCD livers were offered, resulting in 9`780 liver transplants (28.5%). The discard rates were highest in UK and US, ranging between 70 and 80%. In contrast, much lower DCD liver discard rates, e.g., between 30-40%, were found in Belgium, France, Italy, Spain and Switzerland. In addition, large differences were recognized in the use of various machine perfusion techniques, and in terms of risk factors in the cohorts of implanted livers. For example, the median donor age and functional donor warm ischemia were highest in Italy, e.g., >40minutes, followed by Switzerland, France, and the Netherlands. Importantly, such varying risk profiles of accepted DCD livers between countries did not translate into large differences in five-year graft survival rates, which ranged between 60-82% in this analysis. Conclusions: We highlight a significant number of discarded and consequently unused DCD liver offers. Countries with more routine use of in- and ex-situ machine perfusion strategies showed better DCD utilization rates without compromised outcome. Impact and implications: A significant number of Maastricht type III DCD livers are discarded across Europe and North America today. The overall utilization rate among eight Western countries is 28.5%, but varies significant
Published: 2023

23. How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

Author: Siragusa, L., Angelico, R., Angrisani, M., Zampogna, B., Materazzo, M., Sorge, R., Giordano, Lucia, Meniconi, R., Coppola, A., Marino, A., Giraudo, G., Esposito, S., Urbani, A., De Pastena, M., Mastrapasqua, R., Garancini, M., Frontal, A., Pascal, G., Martellucc, J., Falb, F., Boscarelli, A., Bertoglio, P., Trecca, E., Galassi, L., Vento, V., Chiappini, A., Antonelli, A., Bennardo, F., Familiari, F., Giannaccare, G., Zappia, A. S., Giuliani, G., Falcone, F., Sebastiani, S., Montuori, M., Rossi, S., Sagnotta, A., Giuliani, B., Imbriani, G. C., Restaino, S., Andreani, L., Di Maria, F., Lagana, A. S., Vitiello, L., Berton, F., Virgilio, E., Palisi, M., Portigliotti, L., Calussi, M., Conti, L., Mauriello, C., Barone, Alessia Maria Addolorata, Saladino, E., Giaquinta, A., Zerb, D., Frazzetta, G., Merola, G., Chierici, A., Bini, R., Centonze, L., De Carlis, R., Ferrario, L., Giani, A., Lauterio, A., Tamini, N., Corti, Serafino, Botteri, E., Andreuccetti, J., D'Alessio, R., Cestaro, G., Clarizia, G., Spolini, A., Carboni, A. S., Benzoni, E., Galiffa, G., Perotti, B., Veroux, M., Randazzo, V., Topa, D., Pranteda, C., Contini, G., Iacusso, C., Voglino, V., Vita, P., Carrano, F. M., Ambrosio, L., Cammarata, R., Capolupo, G. T., Caputo, D., Carannante, F., Cascone, C., Esperto, F., Farolfi, T., Frasca, L., Gallo, I. F., Gibin, G., Giurazza, G., Improta, L., La Vaccara, V., Luffarelli, P., Luvero, D., Marangi, Giuseppe, Masciana, G., Mazzola, A., Mazzotta, E., Miligi, C. I., Montelione, N., Nenna, A., Orsaria, P., Papalia, R., Papalia, G. F., Parisi, F. R., Prata, F., Salzillo, R., Santini, Stefano Angelo, Sofo, F., Zampoli, A., Tanda, C., Altieri, G., Ardito, Francesco, Belia, Francesco, Bianchi, V., Biondi, Alberto, Brisinda, Giuseppe, Chiappetta, M., Ciolli, G., Ciolli, Alessandro, Ferracci, Federica, Ferri, L., Fico, V., Fiorillo, Claudio, Fransvea, Pietro, Galiandro, F., Giovinazzo, F., La Greca, Antonio, Litta, Francesco, Mele, C., Pafundi, D. P., Panettieri, Elena, Papa, Valerio, Patini, Romeo, Perrotta, Generoso, Puccioni, Caterina, Santocchi, P., Armatura, G., Olmi, S., Casoni Pattacini, G., Salgarello, S., Trompetto, M., Bombardini, C., La Rocca, R., Celentano, G., Micalef, A., Mazzella, A., Settembrini, A., Zoia, C., Degrate, L., Musumeci, Giampaolo, Palopoli, C. A. M., Montori, G., Bonati, E., Dinuzzi, V. P., Velluti, F., Balla, A., Bonasia, D. E., Coletta, D., Berardi, Giulia, Colasanti, M., Ferretti, Serena, Gasparoli, C., Mariano, Giuseppantonio, Avenia, S., Cianci, P., Cestino, L., Festa, F., Fazio, F., Ascari, F., Desio, M., Arroyo Murillo, G. A., Cereda, M., Galleano, R., David, G., Pansini, A., Gazia, C., Atzori, G., Desideri, L. F., Famularo, S., Galvanin, J., Giudici, V. M., Mangiameli, Gaetano, Mei, S., Milana, F., Pansa, A., Sacchi, Dario Marco, Testori, A., Di Carlo, Giampiero, Paratore, Mattia, Perrone, U., Vagge, A., Vigano, J., Torre, B., Scotti, M. A., Carbone, G., Cerchione, R., De Nardi, P., Gozzini, L., Ottaviani, Letizia, Senni, C., Piccin, O., Pio, L., Colombo, F., Avantifiori, R., Baldassarri, V., Caronna, R., Cicerchia, P. M., Corallino, D., Crocetti, D., Gallo, Giuseppe, Giovanardi, F., Giovannetti, F., Hassan, R., Iossa, A., Lai, Q., Lancellotti, F., Lucarini, A., Lucchese, S., Mazzarella, Giulio, Melandro, F., Minervini, A., Muttillo, E. M., Palmieri, L., Pasqua, R., Rosiello, F., Salina, Giulia, Sibio, S., Sirignano, P., Tarallo, M., Usai, S., Vanni, C., Viglietta, E., Zambon, M., Conversano, N. I., Epifani, A. G., Milano, Valentina, Sacco, L., Nava, Bruna Maria, Maffioli, A., Giuratrabocchetta, S., Baracchi, F., Zuolo, M., Ceresoli, M., Verdi, D., Belli, Andrea, Pata, F., Piovano, E., Pastore, G., Bernabei, F., Deiana, S., Arceri, A., D'Agostino, Cinzia, Marafante, C., Moggia, E., Parini, S., Moretti, M., Uggeri, F., Pontarolo, N., Fontana, T., Palmisano, Gerardo, Giuffrida, M., Guaitoli, E., Ferretti, C., Iacopino, G., Gioco, R., Roscitano, G., Montanelli, P., Chiappetta, M. F., Pinotti, E., Monati, E., Fazio, G., Di Pietro, F., Damarco, F., Barberis, A., Razzore, A., Pascale, A., Loi, S., Ferrara, F., Rossi, Marco, Lisi, G., Viel, G., Sasia, D., Bono, D., Cordaro, E. R., Giacomelli, E., Giani, I., Seriau, L., Pellino, Giuseppe, Sparavigna, M., Trigiante, G., D'Ambrogio, R. G., Cardella, F., Guzzetti, S., Luzzi, A. -P., Carganico, G., Drago, B., Micheletto, G., Orlandi, R., Cutolo, C., Gibello, U., Mistrangelo, M., Forcignano, E., D'Ugo, S., Losurdo, P., Manitto, M., Caroli, G., Franco, Manuela, Tilocca, P. L., Mendogni, P., Sena, G., Sambucci, D., Luciani, C., Atelli, P., Guida, Maria Antonietta, Marino, Filippo, Morini, A., Sibilla, M. G., Longo, Fabio, Giaccari, S., Vigorita, V., Balduzzi, A., Barra, F., Delogu, D., Milone, E., Bencini, L., Aprile, V., Papini, P., Montemurro, N., Cavallo, Michele, Picciariello, A., Tomasicchio, G., Fittipaldi, A., Maruccia, M., Gerardi, S., Cillara, N., Deidda, Silvia, Demarinis, G., Peiretti, E., Tatti, F., Iovino, C., Isola, G., Progno, V. C., Migliore, M., Badessi, G., Barilla, C., Calleri, G. S., Cianci, Stefano, Fama, F., Fleres, F., Mazzeo, C., Visaloco, M. G., Marchetto, C., Bolognesi, F., Benuzzi, L., Bracchetti, G., Brucchi, F., Manzo, C. A., Scaravilli, L., Ferrari, C., Rocca, A., Napolitano, Paola, Anoldo, P., Caricato, Chiara, Manigrasso, M., Milone, Maria, Napolitano, L., Palomba, G., Schiavone, V., Vetrella, M., Grossi, U., Moletta, L., Annicchiarico, A., Vella, I., Talesa, G., Boggi, U., Aiello, F., Anselmo, Anna, Bacchiocchi, G., Beati, F., Bellato, V., Billeci, F., Blasi, F., Buonomo, O. C., Campanelli, M., Coco, G., Contadini, A., Conte, L. E., D'Ippolito, G., Di Marcantonio, A., Spicchiale, C. F., Afflitto, G. G., Gismondi, A., Gorgolini, G., Granai, A. V., Grande, S., Gravina, A., Guida, A. M., Ingallinella, S., Keci, L., Latini, E., Marino, D., Oddi, F. M., Orecchia, L., Don, C. B. P., Pellicciaro, M., Petagna, L., Pirozzi, B. M., Quaranta, Caterina, Rho, M., Rosina, Alessandro, Santicchia, M. S., Saraceno, F., Schiavone, A., Sensi, B., Spina, A., Sullo, L., Tacconi, F., Taje, R., Vanni, G., Vinci, D., Vita, G., Alba, G., Badalucco, S., Carbone, Luigi, Samorani, O. C., Chisci, G., Cuomo, Rosa, Francia, A., Fusario, D., Gargiulo, B., Pasqui, E., Pasquetti, L., Puoti, P., Resca, L., Cumbo, J., Ganio, S., Vizzielli, Giuseppe, Anastasi, M., Guerra, D., Romanzi, A., Vannelli, A., Baia, M., Giordano L., Barone M., Corti S., Marangi G. (ORCID:0000-0002-6898-8882), Santini S. (ORCID:0000-0003-1956-5899), Ardito F. (ORCID:0000-0003-1596-2862), Belia F., Biondi A. (ORCID:0000-0002-2470-7858), Brisinda G. (ORCID:0000-0001-8820-9471), Ciolli A., Ferracci F., Fiorillo C. (ORCID:0000-0001-7681-3567), Fransvea P. (ORCID:0000-0003-4969-3373), La Greca A. (ORCID:0000-0002-7587-7427), Litta F., Panettieri E., Papa V. (ORCID:0000-0002-3709-8924), Patini R. (ORCID:0000-0001-7358-8763), Perrotta G., Puccioni C., Musumeci G., Berardi G., Ferretti S., Mariano G., Mangiameli G., Sacchi M. (ORCID:0000-0003-2826-8431), Di Carlo G., Paratore M., Ottaviani L. (ORCID:0009-0001-0967-8809), Gallo G., Mazzarella G., Salina G., Milano V., Nava M., Belli A., D'Agostino C., Palmisano G., Rossi M. (ORCID:0000-0002-4539-5670), Pellino G., Franco M., Guida A., Marino F., Longo F., Cavallo M., Deidda S., Cianci S., Napolitano P., Caricato C., Milone M., Anselmo A., Quaranta C., Rosina A. (ORCID:0000-0002-0158-0583), Carbone L., Cuomo R., Vizzielli G., Siragusa, L., Angelico, R., Angrisani, M., Zampogna, B., Materazzo, M., Sorge, R., Giordano, Lucia, Meniconi, R., Coppola, A., Marino, A., Giraudo, G., Esposito, S., Urbani, A., De Pastena, M., Mastrapasqua, R., Garancini, M., Frontal, A., Pascal, G., Martellucc, J., Falb, F., Boscarelli, A., Bertoglio, P., Trecca, E., Galassi, L., Vento, V., Chiappini, A., Antonelli, A., Bennardo, F., Familiari, F., Giannaccare, G., Zappia, A. S., Giuliani, G., Falcone, F., Sebastiani, S., Montuori, M., Rossi, S., Sagnotta, A., Giuliani, B., Imbriani, G. C., Restaino, S., Andreani, L., Di Maria, F., Lagana, A. S., Vitiello, L., Berton, F., Virgilio, E., Palisi, M., Portigliotti, L., Calussi, M., Conti, L., Mauriello, C., Barone, Alessia Maria Addolorata, Saladino, E., Giaquinta, A., Zerb, D., Frazzetta, G., Merola, G., Chierici, A., Bini, R., Centonze, L., De Carlis, R., Ferrario, L., Giani, A., Lauterio, A., Tamini, N., Corti, Serafino, Botteri, E., Andreuccetti, J., D'Alessio, R., Cestaro, G., Clarizia, G., Spolini, A., Carboni, A. S., Benzoni, E., Galiffa, G., Perotti, B., Veroux, M., Randazzo, V., Topa, D., Pranteda, C., Contini, G., Iacusso, C., Voglino, V., Vita, P., Carrano, F. M., Ambrosio, L., Cammarata, R., Capolupo, G. T., Caputo, D., Carannante, F., Cascone, C., Esperto, F., Farolfi, T., Frasca, L., Gallo, I. F., Gibin, G., Giurazza, G., Improta, L., La Vaccara, V., Luffarelli, P., Luvero, D., Marangi, Giuseppe, Masciana, G., Mazzola, A., Mazzotta, E., Miligi, C. I., Montelione, N., Nenna, A., Orsaria, P., Papalia, R., Papalia, G. F., Parisi, F. R., Prata, F., Salzillo, R., Santini, Stefano Angelo, Sofo, F., Zampoli, A., Tanda, C., Altieri, G., Ardito, Francesco, Belia, Francesco, Bianchi, V., Biondi, Alberto, Brisinda, Giuseppe, Chiappetta, M., Ciolli, G., Ciolli, Alessandro, Ferracci, Federica, Ferri, L., Fico, V., Fiorillo, Claudio, Fransvea, Pietro, Galiandro, F., Giovinazzo, F., La Greca, Antonio, Litta, Francesco, Mele, C., Pafundi, D. P., Panettieri, Elena, Papa, Valerio, Patini, Romeo, Perrotta, Generoso, Puccioni, Caterina, Santocchi, P., Armatura, G., Olmi, S., Casoni Pattacini, G., Salgarello, S., Trompetto, M., Bombardini, C., La Rocca, R., Celentano, G., Micalef, A., Mazzella, A., Settembrini, A., Zoia, C., Degrate, L., Musumeci, Giampaolo, Palopoli, C. A. M., Montori, G., Bonati, E., Dinuzzi, V. P., Velluti, F., Balla, A., Bonasia, D. E., Coletta, D., Berardi, Giulia, Colasanti, M., Ferretti, Serena, Gasparoli, C., Mariano, Giuseppantonio, Avenia, S., Cianci, P., Cestino, L., Festa, F., Fazio, F., Ascari, F., Desio, M., Arroyo Murillo, G. A., Cereda, M., Galleano, R., David, G., Pansini, A., Gazia, C., Atzori, G., Desideri, L. F., Famularo, S., Galvanin, J., Giudici, V. M., Mangiameli, Gaetano, Mei, S., Milana, F., Pansa, A., Sacchi, Dario Marco, Testori, A., Di Carlo, Giampiero, Paratore, Mattia, Perrone, U., Vagge, A., Vigano, J., Torre, B., Scotti, M. A., Carbone, G., Cerchione, R., De Nardi, P., Gozzini, L., Ottaviani, Letizia, Senni, C., Piccin, O., Pio, L., Colombo, F., Avantifiori, R., Baldassarri, V., Caronna, R., Cicerchia, P. M., Corallino, D., Crocetti, D., Gallo, Giuseppe, Giovanardi, F., Giovannetti, F., Hassan, R., Iossa, A., Lai, Q., Lancellotti, F., Lucarini, A., Lucchese, S., Mazzarella, Giulio, Melandro, F., Minervini, A., Muttillo, E. M., Palmieri, L., Pasqua, R., Rosiello, F., Salina, Giulia, Sibio, S., Sirignano, P., Tarallo, M., Usai, S., Vanni, C., Viglietta, E., Zambon, M., Conversano, N. I., Epifani, A. G., Milano, Valentina, Sacco, L., Nava, Bruna Maria, Maffioli, A., Giuratrabocchetta, S., Baracchi, F., Zuolo, M., Ceresoli, M., Verdi, D., Belli, Andrea, Pata, F., Piovano, E., Pastore, G., Bernabei, F., Deiana, S., Arceri, A., D'Agostino, Cinzia, Marafante, C., Moggia, E., Parini, S., Moretti, M., Uggeri, F., Pontarolo, N., Fontana, T., Palmisano, Gerardo, Giuffrida, M., Guaitoli, E., Ferretti, C., Iacopino, G., Gioco, R., Roscitano, G., Montanelli, P., Chiappetta, M. F., Pinotti, E., Monati, E., Fazio, G., Di Pietro, F., Damarco, F., Barberis, A., Razzore, A., Pascale, A., Loi, S., Ferrara, F., Rossi, Marco, Lisi, G., Viel, G., Sasia, D., Bono, D., Cordaro, E. R., Giacomelli, E., Giani, I., Seriau, L., Pellino, Giuseppe, Sparavigna, M., Trigiante, G., D'Ambrogio, R. G., Cardella, F., Guzzetti, S., Luzzi, A. -P., Carganico, G., Drago, B., Micheletto, G., Orlandi, R., Cutolo, C., Gibello, U., Mistrangelo, M., Forcignano, E., D'Ugo, S., Losurdo, P., Manitto, M., Caroli, G., Franco, Manuela, Tilocca, P. L., Mendogni, P., Sena, G., Sambucci, D., Luciani, C., Atelli, P., Guida, Maria Antonietta, Marino, Filippo, Morini, A., Sibilla, M. G., Longo, Fabio, Giaccari, S., Vigorita, V., Balduzzi, A., Barra, F., Delogu, D., Milone, E., Bencini, L., Aprile, V., Papini, P., Montemurro, N., Cavallo, Michele, Picciariello, A., Tomasicchio, G., Fittipaldi, A., Maruccia, M., Gerardi, S., Cillara, N., Deidda, Silvia, Demarinis, G., Peiretti, E., Tatti, F., Iovino, C., Isola, G., Progno, V. C., Migliore, M., Badessi, G., Barilla, C., Calleri, G. S., Cianci, Stefano, Fama, F., Fleres, F., Mazzeo, C., Visaloco, M. G., Marchetto, C., Bolognesi, F., Benuzzi, L., Bracchetti, G., Brucchi, F., Manzo, C. A., Scaravilli, L., Ferrari, C., Rocca, A., Napolitano, Paola, Anoldo, P., Caricato, Chiara, Manigrasso, M., Milone, Maria, Napolitano, L., Palomba, G., Schiavone, V., Vetrella, M., Grossi, U., Moletta, L., Annicchiarico, A., Vella, I., Talesa, G., Boggi, U., Aiello, F., Anselmo, Anna, Bacchiocchi, G., Beati, F., Bellato, V., Billeci, F., Blasi, F., Buonomo, O. C., Campanelli, M., Coco, G., Contadini, A., Conte, L. E., D'Ippolito, G., Di Marcantonio, A., Spicchiale, C. F., Afflitto, G. G., Gismondi, A., Gorgolini, G., Granai, A. V., Grande, S., Gravina, A., Guida, A. M., Ingallinella, S., Keci, L., Latini, E., Marino, D., Oddi, F. M., Orecchia, L., Don, C. B. P., Pellicciaro, M., Petagna, L., Pirozzi, B. M., Quaranta, Caterina, Rho, M., Rosina, Alessandro, Santicchia, M. S., Saraceno, F., Schiavone, A., Sensi, B., Spina, A., Sullo, L., Tacconi, F., Taje, R., Vanni, G., Vinci, D., Vita, G., Alba, G., Badalucco, S., Carbone, Luigi, Samorani, O. C., Chisci, G., Cuomo, Rosa, Francia, A., Fusario, D., Gargiulo, B., Pasqui, E., Pasquetti, L., Puoti, P., Resca, L., Cumbo, J., Ganio, S., Vizzielli, Giuseppe, Anastasi, M., Guerra, D., Romanzi, A., Vannelli, A., Baia, M., Giordano L., Barone M., Corti S., Marangi G. (ORCID:0000-0002-6898-8882), Santini S. (ORCID:0000-0003-1956-5899), Ardito F. (ORCID:0000-0003-1596-2862), Belia F., Biondi A. (ORCID:0000-0002-2470-7858), Brisinda G. (ORCID:0000-0001-8820-9471), Ciolli A., Ferracci F., Fiorillo C. (ORCID:0000-0001-7681-3567), Fransvea P. (ORCID:0000-0003-4969-3373), La Greca A. (ORCID:0000-0002-7587-7427), Litta F., Panettieri E., Papa V. (ORCID:0000-0002-3709-8924), Patini R. (ORCID:0000-0001-7358-8763), Perrotta G., Puccioni C., Musumeci G., Berardi G., Ferretti S., Mariano G., Mangiameli G., Sacchi M. (ORCID:0000-0003-2826-8431), Di Carlo G., Paratore M., Ottaviani L. (ORCID:0009-0001-0967-8809), Gallo G., Mazzarella G., Salina G., Milano V., Nava M., Belli A., D'Agostino C., Palmisano G., Rossi M. (ORCID:0000-0002-4539-5670), Pellino G., Franco M., Guida A., Marino F., Longo F., Cavallo M., Deidda S., Cianci S., Napolitano P., Caricato C., Milone M., Anselmo A., Quaranta C., Rosina A. (ORCID:0000-0002-0158-0583), Carbone L., Cuomo R., and Vizzielli G.
Abstract: COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March–April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients’ management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons’ personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon–patient/family communication. From the Italian surgeons’ perspective, COVID-related measures will continue to influence
Published: 2023

24. How useful is the machine perfusion in liver transplantation? An answer from a national survey

Author: Scalera, Irene, primary, De Carlis, R., additional, Patrono, D., additional, Gringeri, E., additional, Olivieri, T., additional, Pagano, D., additional, Lai, Q., additional, Rossi, M., additional, Gruttadauria, S., additional, Di Benedetto, F., additional, Cillo, U., additional, Romagnoli, R., additional, Lupo, L. G., additional, and De Carlis, L., additional
Published: 2022
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25. 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

26. A retrospective single-centre analysis of the oncological impact of LI-RADS classification applied to Metroticket 2.0 calculator in liver transplantation : every nodule matters

Author: Centonze, L, Di Sandro, S, Lauterio, A, De Carlis, R, Sgrazzutti, C, Ciulli, C, Vella, I, Vicentin, I, Incarbone, N, Bagnardi, V, Vanzulli, A, De Carlis, L, Centonze L., Di Sandro S., Lauterio A., De Carlis R., Sgrazzutti C., Ciulli C., Vella I., Vicentin I., Incarbone N., Bagnardi V., Vanzulli A., De Carlis L., Centonze, L, Di Sandro, S, Lauterio, A, De Carlis, R, Sgrazzutti, C, Ciulli, C, Vella, I, Vicentin, I, Incarbone, N, Bagnardi, V, Vanzulli, A, De Carlis, L, Centonze L., Di Sandro S., Lauterio A., De Carlis R., Sgrazzutti C., Ciulli C., Vella I., Vicentin I., Incarbone N., Bagnardi V., Vanzulli A., and De Carlis L.
Abstract: Although the diagnostic value of Liver Imaging Reporting and Data System (LI-RADS) protocol is well recognized in clinical practice, its role in liver transplant (LT) setting is under-explored. We sought to evaluate the oncological impact of LI-RADS classification applied to Metroticket 2.0 calculator in a single-centre retrospective cohort of transplanted hepatocellular carcinoma (HCC) patients, exploring which LI-RADS subclasses need to be considered in order to grant the best Metroticket 2.0 performance. The most recent pre-LT imaging of 245 patients undergoing LT for HCC between 2005 and 2015 was retrospectively and blindly reviewed, classifying all nodules according to LI-RADS protocol. Metroticket 2.0 accuracy was subsequently tested incorporating all vital nodules identified during multi-disciplinary team (MDT) meetings attended before LI-RADS reclassification of the latest pre-LT imaging, LR-5 and LR-treatment-viable (LR-TR-V), LR-4/5 and LR-TR-V, and LR-3/4/5 and LR-TR-V nodules respectively. Considering their extremely low probability for harbouring HCC, LR-1 and LR-2 nodules were not considered in this analysis. Incorporation of all HCCs identified during MDT meetings attended before LI-RADS reclassification of the latest pre-LT imaging resulted in a Metroticket 2.0 c-index of 0.72, [95% confidence interval (CI) 0.64–0.80]. Metroticket 2.0 c-index dropped to 0.60 [95% CI: 0.48–0.72] when LI-RADS-5 and LI-RADS-TR-V (P = 0.0089) or LI-RADS-5, LI-RADS-4 and LI-RADS-TR-V (P = 0.0068) nodules were entered in the calculator. Conversely, addition of LI-RADS-3 HCCs raised the Metroticket 2.0 c-index to 0.65 [95% CI: 0.54–0.86], resulting in a not statistically significant diversion from the original performance (0.72 vs. 0.65; P = 0.08). Exclusion of LR-3 and LR-4 nodules from Metroticket 2.0 calculator resulted in a significant drop in its accuracy. Every nodule with an intermediate-to-high probability of harbouring HCC according to
Published: 2021

27. Impact of immunosuppressive therapy on the severity of COVID-19 in solid organ transplant recipients

Author: Merli, M, Pasulo, L, Perricone, G, Travi, G, Rossotti, R, Colombo, V, De Carlis, R, Chiappetta, S, Moioli, M, Minetti, E, Frigerio, M, De Carlis, L, Belli, L, Fagiuoli, S, Puoti, M, Merli M., Pasulo L., Perricone G., Travi G., Rossotti R., Colombo V. G., De Carlis R., Chiappetta S., Moioli M. C., Minetti E., Frigerio M., De Carlis L. G., Belli L., Fagiuoli S., Puoti M., Merli, M, Pasulo, L, Perricone, G, Travi, G, Rossotti, R, Colombo, V, De Carlis, R, Chiappetta, S, Moioli, M, Minetti, E, Frigerio, M, De Carlis, L, Belli, L, Fagiuoli, S, Puoti, M, Merli M., Pasulo L., Perricone G., Travi G., Rossotti R., Colombo V. G., De Carlis R., Chiappetta S., Moioli M. C., Minetti E., Frigerio M., De Carlis L. G., Belli L., Fagiuoli S., and Puoti M.
Published: 2021

28. Does interval time between liver transplant and COVID-19 infection make the difference?

Author: Buscemi, V, De Carlis, R, Lauterio, A, Merli, M, Puoti, M, De Carlis, L, Buscemi V, De Carlis R, Lauterio A, Merli M, Puoti M, De Carlis L., Buscemi, V, De Carlis, R, Lauterio, A, Merli, M, Puoti, M, De Carlis, L, Buscemi V, De Carlis R, Lauterio A, Merli M, Puoti M, and De Carlis L.
Published: 2021

29. Advanced donor age does not increase risk of hepatocellular carcinoma recurrence after liver transplantation: a retrospective two-centre analysis using competing risk analysis

Author: Cusumano, C, De Carlis, L, Centonze, L, Lesourd, R, Levi Sandri, G, Lauterio, A, De Carlis, R, Ferla, F, Di Sandro, S, Camus, C, Jezequel, C, Bardou-Jacquet, E, Rayar, M, Cusumano C., De Carlis L., Centonze L., Lesourd R., Levi Sandri G. B., Lauterio A., De Carlis R., Ferla F., Di Sandro S., Camus C., Jezequel C., Bardou-Jacquet E., Rayar M., Cusumano, C, De Carlis, L, Centonze, L, Lesourd, R, Levi Sandri, G, Lauterio, A, De Carlis, R, Ferla, F, Di Sandro, S, Camus, C, Jezequel, C, Bardou-Jacquet, E, Rayar, M, Cusumano C., De Carlis L., Centonze L., Lesourd R., Levi Sandri G. B., Lauterio A., De Carlis R., Ferla F., Di Sandro S., Camus C., Jezequel C., Bardou-Jacquet E., and Rayar M.
Abstract: The impact of donor age on the recurrence of hepatocellular carcinoma (HCC) after liver transplantation is still debated. Between 2002 and 2014, all patients transplanted for HCC in 2 European liver transplantation tertiary centres were retrospectively reviewed. Risk factors for HCC recurrence were assessed using competing risk analysis, and the impact of donor age < or ≥65 years and < or ≥80 years was specifically evaluated after propensity score matching. 728 patients transplanted with a median follow-up of 86 months were analysed. The 1-, 3- and 5-year recurrence rates were 4.9%, 10.7% and 13.9%, respectively. In multivariable analysis, recipient age (sHR: 0.96 [0.93; 0.98], P < 0.01), number of lesions (sHR: 1.05 [1.04; 1.06], P < 0.001), maximum size of the lesions (sHR: 1.37 [1.27; 1.48], P < 0.01), presence of a hepatocholangiocarcinoma (sHR: 6.47 [2.91; 14.38], P < 0.01) and microvascular invasion (sHR: 3.48 [2.42; 5.02], P < 0.01) were significantly associated with HCC recurrence. After propensity score matching, neither donor age ≥65 (P = 0.29) nor donor age ≥80 (P = 0.84) years increased the risk of HCC recurrence. In conclusion, donor age was not found to be a risk factor for HCC recurrence. Patients listed for HCC can receive a graft from an elderly donor without compromising the outcome.
Published: 2021

30. Discovery of a Rare Variant of the Arc of Bühler During Liver Procurement

Author: Incarbone, N, De Carlis, R, Centonze, L, Lauterio, A, De Carlis, L, Incarbone N., De Carlis R., Centonze L., Lauterio A., De Carlis L., Incarbone, N, De Carlis, R, Centonze, L, Lauterio, A, De Carlis, L, Incarbone N., De Carlis R., Centonze L., Lauterio A., and De Carlis L.
Abstract: We report a rare variant of the hepatic arterial supply observed during liver procurement from a 71-year-old female donor for whom an ischemic stroke caused brain death. Preoperative computed tomography showed a partially obliterated celiac trunk and an atypical arterial branch that coursed in a retropancreatic plane away from its origin at the superior mesenteric artery to anastomose with the common hepatic artery at the origin of the proper hepatic artery. The gastroduodenal artery and the dorsal pancreatic artery are the 2 conventional anastomotic arcades between the celiac trunk and the superior mesenteric artery. However, another potential anastomotic route is a rare physiological phenomenon known as the arc of Bühler, which, if present, connects the superior mesenteric artery with the celiac trunk or one of its branches. Although the arc of Bühler is known to occur in less than 3% of the general population, it could serve as a crucial anastomotic option in the case of median arcuate ligament syndrome or atheromatous obliteration of the celiac trunk. In our case, we were able to dissect and preserve the entire anastomotic arc from the donor. For arterial reconstruction during liver transplant, we anastomosed the arc of Bühler to the recipient’s hepatic artery at the origin of the gastroduodenal artery. The postoperative course was uneventful, and the recipient was in good health at the 6-month follow-up. The arc of Bühler, when present, is an important anastomotic option in hepatobiliary surgery to avoid potential damage to the arterial supply of the liver.
Published: 2021

31. Impact of the COVID-19 pandemic on liver donation and transplantation: A review of the literature

Author: de Carlis, R, Vella, I, Incarbone, N, Centonze, L, Buscemi, V, Lauterio, A, de Carlis, L, de Carlis R., Vella I., Incarbone N., Centonze L., Buscemi V., Lauterio A., de Carlis L., de Carlis, R, Vella, I, Incarbone, N, Centonze, L, Buscemi, V, Lauterio, A, de Carlis, L, de Carlis R., Vella I., Incarbone N., Centonze L., Buscemi V., Lauterio A., and de Carlis L.
Abstract: The coronavirus disease 2019 (COVID-19) pandemic has upended healthcare systems worldwide and led to an inevitable decrease in liver transplantation (LT) activity. During the first pandemic wave, administrators and clinicians were obliged to make the difficult decision of whether to suspend or continue a lifesaving procedure based on the scarce available evidence regarding the risk of transmission and mortality in immunosuppressed patients. Those centers where the activity continued or was heavily restricted were obliged to screen donors and recipients, design COVID-safe clinical pathways, and promote telehealth to prevent nosocomial transmission. Despite the ever-growing literature on COVID-19, the amount of high-quality literature on LT remains limited. This review will provide an updated view of the impact of the pandemic on LT programs worldwide. Donor and recipient screening, strategies for waitlist prioritization, and posttransplant risk of infection and mortality are discussed. Moreover, a particular focus is given to the possibility of donor-to-recipient transmission and immunosuppression management in COVID-positive recipients.
Published: 2021

32. Liver transplantation during the COVID-19 pandemic: A 2020 year-end report from Lombardy, northern Italy

Author: Lauterio, A, De Carlis, R, Valsecchi, M, Vella, I, Zaniboni, M, Fumagalli, R, De Carlis, L, Lauterio A., De Carlis R., Valsecchi M., Vella I., Zaniboni M., Fumagalli R., De Carlis L., Lauterio, A, De Carlis, R, Valsecchi, M, Vella, I, Zaniboni, M, Fumagalli, R, De Carlis, L, Lauterio A., De Carlis R., Valsecchi M., Vella I., Zaniboni M., Fumagalli R., and De Carlis L.
Published: 2021

33. Liver Transplantation from a Donor with Noonan Syndrome: Caveat Emptor

Author: Buscemi, V, De Carlis, R, Lauterio, A, Camozzi, M, De Carlis, L, Buscemi V., De Carlis R., Lauterio A., Camozzi M. L., De Carlis L., Buscemi, V, De Carlis, R, Lauterio, A, Camozzi, M, De Carlis, L, Buscemi V., De Carlis R., Lauterio A., Camozzi M. L., and De Carlis L.
Published: 2021

34. Machine perfusion for kidneys with multiple arteries: An unusual reconstruction with an iliac arterial graft

Author: De Carlis, R, Mangoni, I, Lauterio, A, Incarbone, N, De Carlis, L, De Carlis R., Mangoni I., Lauterio A., Incarbone N., De Carlis L., De Carlis, R, Mangoni, I, Lauterio, A, Incarbone, N, De Carlis, L, De Carlis R., Mangoni I., Lauterio A., Incarbone N., and De Carlis L.
Published: 2021

35. Current surgical management of peri-hilar and intra-hepatic cholangiocarcinoma

Author: Lauterio, A, De Carlis, R, Centonze, L, Buscemi, V, Incarbone, N, Vella, I, De Carlis, L, Lauterio A., De Carlis R., Centonze L., Buscemi V., Incarbone N., Vella I., De Carlis L., Lauterio, A, De Carlis, R, Centonze, L, Buscemi, V, Incarbone, N, Vella, I, De Carlis, L, Lauterio A., De Carlis R., Centonze L., Buscemi V., Incarbone N., Vella I., and De Carlis L.
Abstract: Cholangiocarcinoma accounts for approximately 10% of all hepatobiliary tumors and represents 3% of all new-diagnosed malignancies worldwide. Intrahepatic cholangiocarcinoma (i-CCA) accounts for 10% of all cases, perihilar (h-CCA) cholangiocarcinoma represents two-thirds of the cases, while distal cholangiocarcinoma accounts for the remaining quarter. Originally described by Klatskin in 1965, h-CCA represents one of the most challenging tumors for hepatobiliary surgeons, mainly because of the anatomical vascular relationships of the biliary confluence at the hepatic hilum. Surgery is the only curative option, with the goal of a radical, margin-negative (R0) tumor resection. Continuous efforts have been made by hepatobiliary surgeons in order to achieve R0 resections, leading to the progressive development of aggressive approaches that include extended hepatectomies, associating liver partition, and portal vein ligation for staged hepatectomy, preoperative portal vein embolization, and vascular resections. i-CCA is an aggressive biliary cancer that arises from the biliary epithelium proximal to the second-degree bile ducts. The incidence of i-CCA is dramatically increasing worldwide, and surgical resection is the only potentially curative therapy. An aggressive surgical approach, including extended liver resection and vascular reconstruction, and a greater application of systemic therapy and locoregional treatments could lead to an increase in the resection rate and the overall survival in selected i-CCA patients. Improvements achieved over the last two decades and the encouraging results recently reported have led to liver transplantation now being considered an appropriate indication for CCA patients.
Published: 2021

36. Liver transplantation from active COVID-19 donors: A lifesaving opportunity worth grasping?

Author: Romagnoli, R, Gruttadauria, S, Tisone, G, Maria Ettorre, G, De Carlis, L, Martini, S, Tandoi, F, Trapani, S, Saracco, M, Luca, A, Manzia, T, Visco Comandini, U, De Carlis, R, Ghisetti, V, Cavallo, R, Cardillo, M, Grossi, P, Romagnoli R., Gruttadauria S., Tisone G., Maria Ettorre G., De Carlis L., Martini S., Tandoi F., Trapani S., Saracco M., Luca A., Manzia T. M., Visco Comandini U., De Carlis R., Ghisetti V., Cavallo R., Cardillo M., Grossi P. A., Romagnoli, R, Gruttadauria, S, Tisone, G, Maria Ettorre, G, De Carlis, L, Martini, S, Tandoi, F, Trapani, S, Saracco, M, Luca, A, Manzia, T, Visco Comandini, U, De Carlis, R, Ghisetti, V, Cavallo, R, Cardillo, M, Grossi, P, Romagnoli R., Gruttadauria S., Tisone G., Maria Ettorre G., De Carlis L., Martini S., Tandoi F., Trapani S., Saracco M., Luca A., Manzia T. M., Visco Comandini U., De Carlis R., Ghisetti V., Cavallo R., Cardillo M., and Grossi P. A.
Abstract: COVID-19 pandemic dramatically impacted transplantation landscape. Scientific societies recommend against the use of donors with active SARS-CoV-2 infection. Italian Transplant Authority recommended to test recipients/donors for SARS-CoV-2-RNA immediately before liver transplant (LT) and, starting from November 2020, grafts from deceased donors with active SARS-CoV-2 infection were allowed to be considered for urgent-need transplant candidates with active/resolved COVID-19. We present the results of the first 10 LTs with active COVID-19 donors within an Italian multicenter series. Only two recipients had a positive molecular test at LT and one of them remained positive up to 21 days post-LT. None of the other eight recipients was found to be SARS-CoV-2 positive during follow-up. IgG against SARS-CoV-2 at LT were positive in 80% (8/10) of recipients, and 71% (5/7) showed neutralizing antibodies, expression of protective immunity related to recent COVID-19. In addition, testing for SARS-CoV-2 RNA on donors’ liver biopsy at transplantation was negative in 100% (9/9), suggesting a very low risk of transmission with LT. Immunosuppression regimen remained unchanged, according to standard protocol. Despite the small number of cases, these data suggest that transplanting livers from donors with active COVID-19 in informed candidates with SARS-CoV-2 immunity, might contribute to safely increase the donor pool.
Published: 2021

37. A successful urgent liver retransplant from a donor with a left ventricular assist device

Author: Emanuele Buscemi, V, Checchini, G, De Carlis, R, Lauterio, A, Loforte, A, Pacini, D, Odaldi, F, Cescon, M, De Carlis, L, Emanuele Buscemi V., Checchini G., De Carlis R., Lauterio A., Loforte A., Pacini D., Odaldi F., Cescon M., De Carlis L., Emanuele Buscemi, V, Checchini, G, De Carlis, R, Lauterio, A, Loforte, A, Pacini, D, Odaldi, F, Cescon, M, De Carlis, L, Emanuele Buscemi V., Checchini G., De Carlis R., Lauterio A., Loforte A., Pacini D., Odaldi F., Cescon M., and De Carlis L.
Abstract: Organ shortage is one of the major limitations in the field of liver transplantation, which has led to the consideration of extended criteria donors as a way to expand the donor pool. The use of extended criteria donors in cases of high Model for End-Stage Liver Disease scores or urgent recipients could be complicated by increased postoperative mortality. Donors on left ventricular assist devices could be considered extended criteria donors because of the mechanical circulatory support itself and the potential of chronic liver damage due to right ventricular failure, but experiences in the literature are limited. Here, we report the first case of an urgent liver retransplant procured from a left ventricular assist device donor.
Published: 2021

38. Complete resolution of a cutaneous grade 2 graft-versus-host disease after liver transplantation using ruxolitinib

Author: Lauterio, A, De Carlis, R, Pugliano, M, Vella, I, Bonoldi, E, Grillo, G, De Carlis, L, Lauterio A., De Carlis R., Pugliano M. T., Vella I., Bonoldi E., Grillo G., De Carlis L., Lauterio, A, De Carlis, R, Pugliano, M, Vella, I, Bonoldi, E, Grillo, G, De Carlis, L, Lauterio A., De Carlis R., Pugliano M. T., Vella I., Bonoldi E., Grillo G., and De Carlis L.
Published: 2021

39. Successful Liver Transplantation from a Deceased Donor with Vaccine-Induced Thrombotic Thrombocytopenia Causing Cerebral Venous Sinus and Hepatic Veins Thrombosis after ChAdOx1 nCov-19 Vaccination

Author: Centonze, L, Lauterio, A, De Carlis, R, Ferla, F, De Carlis, L, Centonze L., Lauterio A., De Carlis R., Ferla F., De Carlis L., Centonze, L, Lauterio, A, De Carlis, R, Ferla, F, De Carlis, L, Centonze L., Lauterio A., De Carlis R., Ferla F., and De Carlis L.
Published: 2021

40. Surgical resection vs. Percutaneous ablation for single hepatocellular carcinoma: Exploring the impact of li‐rads classification on oncological outcomes

Author: Centonze, L, Di Sandro, S, Lauterio, A, De Carlis, R, Frassoni, S, Rampoldi, A, Tuscano, B, Bagnardi, V, Vanzulli, A, De Carlis, L, Centonze L., Di Sandro S., Lauterio A., De Carlis R., Frassoni S., Rampoldi A., Tuscano B., Bagnardi V., Vanzulli A., De Carlis L., Centonze, L, Di Sandro, S, Lauterio, A, De Carlis, R, Frassoni, S, Rampoldi, A, Tuscano, B, Bagnardi, V, Vanzulli, A, De Carlis, L, Centonze L., Di Sandro S., Lauterio A., De Carlis R., Frassoni S., Rampoldi A., Tuscano B., Bagnardi V., Vanzulli A., and De Carlis L.
Abstract: Background: Single hepatocellular carcinoma (HCC) benefits from surgical resection (SR) or US‐guided percutaneous ablation (PA), although the best approach is still debated. We evaluated the impact of Li‐RADS classification on the oncological outcomes of SR vs. PA as single HCC first-line treatment. Methods: We retrospectively and blindly classified treatment‐naïve single HCC that underwent SR or PA between 2010 and 2016 according to Li‐RADS protocol. Overall survival (OS), recurrence free survival (RFS) and local recurrence after SR and PA were compared for each Li‐ RADS subclass before and after propensity‐score matching (PS‐M). Results: Considering the general population, SR showed better 5‐year OS (68.3% vs. 52.2%; p = 0.049) and RFS (42.5% vs. 29.8%; p = 0.002), with lower incidence of local recurrence (8.2% vs. 44.4%; p < 0.001), despite a significantly higher frequency of clinically‐relevant complications (12.8% vs. 1.9%; p = 0.002) and a higher Comprehensive Complication Index (12.1 vs. 2.2; p < 0.001). Focusing on different Li‐RADS subclasses, we highlighted better 5‐year OS (67.1% vs. 46.2%; p = 0.035), RFS (45.0% vs. 27.0% RFS; p < 0.001) and lower incidence of local recurrence (9.7% vs. 48.6%; p < 0.001) after SR for Li‐RADS‐5 HCCs, while these outcomes did not differ for Li‐RADS‐3/4 subclasses; such results were confirmed after PS‐M. Conclusions: Our analysis suggests a potential prognostic role of Li‐RADS classification, sup-porting SR over PA especially for Li‐RADS‐5 single HCC.
Published: 2021

41. An unexpected giant omental pseudocyst during a liver transplant

Author: De Carlis, R, Buscemi, V, Lauterio, A, De Carlis, L, De Carlis R., Buscemi V., Lauterio A., De Carlis L., De Carlis, R, Buscemi, V, Lauterio, A, De Carlis, L, De Carlis R., Buscemi V., Lauterio A., and De Carlis L.
Published: 2021

42. 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

43. How to guarantee liver transplantation in the north of Italy during the COVID-19 pandemic: A sound transplant protection strategy

Author: Lauterio, A, De Carlis, R, Belli, L, Fumagalli, R, De Carlis, L, Lauterio A., De Carlis R., Belli L., Fumagalli R., De Carlis L., Lauterio, A, De Carlis, R, Belli, L, Fumagalli, R, De Carlis, L, Lauterio A., De Carlis R., Belli L., Fumagalli R., and De Carlis L.
Published: 2020

44. Machine Perfusions in Liver Transplantation: The Evidence-Based Position Paper of the Italian Society of Organ and Tissue Transplantation

Author: Ghinolfi, D, Lai, Q, Dondossola, D, De Carlis, R, Zanierato, M, Patrono, D, Baroni, S, Bassi, D, Ferla, F, Lauterio, A, Lazzeri, C, Magistri, P, Melandro, F, Pagano, D, Pezzati, D, Ravaioli, M, Rreka, E, Toti, L, Zanella, A, Burra, P, Petta, S, Rossi, M, Dutkowski, P, Jassem, W, Muiesan, P, Quintini, C, Selzner, M, Cillo, U, Ghinolfi D., Lai Q., Dondossola D., De Carlis R., Zanierato M., Patrono D., Baroni S., Bassi D., Ferla F., Lauterio A., Lazzeri C., Magistri P., Melandro F., Pagano D., Pezzati D., Ravaioli M., Rreka E., Toti L., Zanella A., Burra P., Petta S., Rossi M., Dutkowski P., Jassem W., Muiesan P., Quintini C., Selzner M., Cillo U., Ghinolfi, D, Lai, Q, Dondossola, D, De Carlis, R, Zanierato, M, Patrono, D, Baroni, S, Bassi, D, Ferla, F, Lauterio, A, Lazzeri, C, Magistri, P, Melandro, F, Pagano, D, Pezzati, D, Ravaioli, M, Rreka, E, Toti, L, Zanella, A, Burra, P, Petta, S, Rossi, M, Dutkowski, P, Jassem, W, Muiesan, P, Quintini, C, Selzner, M, Cillo, U, Ghinolfi D., Lai Q., Dondossola D., De Carlis R., Zanierato M., Patrono D., Baroni S., Bassi D., Ferla F., Lauterio A., Lazzeri C., Magistri P., Melandro F., Pagano D., Pezzati D., Ravaioli M., Rreka E., Toti L., Zanella A., Burra P., Petta S., Rossi M., Dutkowski P., Jassem W., Muiesan P., Quintini C., Selzner M., and Cillo U.
Abstract: The use of machine perfusion (MP) in liver transplantation (LT) is spreading worldwide. However, its efficacy has not been demonstrated, and its proper clinical use has far to go to be widely implemented. The Società Italiana Trapianti d’Organo (SITO) promoted the development of an evidence-based position paper. A 3-step approach has been adopted to develop this position paper. First, SITO appointed a chair and a cochair who then assembled a working group with specific experience of MP in LT. The Guideline Development Group framed the clinical questions into a patient, intervention, control, and outcome (PICO) format, extracted and analyzed the available literature, ranked the quality of the evidence, and prepared and graded the recommendations. Recommendations were then discussed by all the members of the SITO and were voted on via the Delphi method by an institutional review board. Finally, they were evaluated and scored by a panel of external reviewers. All available literature was analyzed, and its quality was ranked. A total of 18 recommendations regarding the use and the efficacy of ex situ hypothermic and normothermic machine perfusion and sequential normothermic regional perfusion and ex situ MP were prepared and graded according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. A critical and scientific approach is required for the safe implementation of this new technology.
Published: 2020

45. Treatment of hepatocarcinoma beyond the milan criteria. A weighted comparative study of surgical resection versus chemoembolization

Author: Famularo, S, Di Sandro, S, Giani, A, Bernasconi, D, Lauterio, A, Ciulli, C, Rampoldi, A, Corso, R, De Carlis, R, Romano, F, Braga, M, Gianotti, L, De Carlis, L, Famularo S., Di Sandro S., Giani A., Bernasconi D. P., Lauterio A., Ciulli C., Rampoldi A. G., Corso R., De Carlis R., Romano F., Braga M., Gianotti L., De Carlis L., Famularo, S, Di Sandro, S, Giani, A, Bernasconi, D, Lauterio, A, Ciulli, C, Rampoldi, A, Corso, R, De Carlis, R, Romano, F, Braga, M, Gianotti, L, De Carlis, L, Famularo S., Di Sandro S., Giani A., Bernasconi D. P., Lauterio A., Ciulli C., Rampoldi A. G., Corso R., De Carlis R., Romano F., Braga M., Gianotti L., and De Carlis L.
Abstract: Background: Optimal treatment of hepatocellular carcinoma (HCC) beyond the Milan criteria (MC) is debated. The aim of the study was to assess overall-survival (OS) and disease-free-survival (DFS) for HCC beyond MC when treated by trans-arterial-chemoembolization (TACE) or surgical resection (SR). Method: between 2005 and 2015, all patients with a first diagnosis of HCC beyond MC(1 nodule>5 cm, or 3 nodules>3 cm without macrovascular invasion) were evaluated. Analyses were carried out through Kaplan–Meier, Cox models and the inverse probability weighting (IPW) method to reduce allocation bias. Sub-analyses have been performed for multinodular and single large tumors compared with a MC-IN cohort. Results: 226 consecutive patients were evaluated: 118 in SR group and 108 in TACE group. After IPW, the two pseudo-populations were comparable for tumor burden and liver function. In the SR group, 1–5 years OS rates were 72.3% and 35% respectively and 92.7% and 39.3% for TACE (p = 0.500). The median DFS was 8 months (95%CI:8–9) for TACE, and 11 months (95%CI:9–12) for SR (p < 0.001). TACE was an independent predictor for recurrence (HR 1.5; 95%CI: 1.1–2.1; p = 0.015). Solitary tumors > 5 cm and multinodular disease had comparable OS and DFS as Milan-IN group (p > 0.05). Conclusion: Surgery allowed a better control than TACE in patient bearing HCC beyond MC. This translated into a significant benefit in terms of DFS but not OS.
Published: 2020

46. The Impact of Sarcopenia on Postoperative Course following Pancreatoduodenectomy: Single-Center Experience of 110 Consecutive Cases

Author: Centonze, L, Di Sandro, S, Lauterio, A, De Carlis, R, Botta, F, Mariani, A, Bagnardi, V, De Carlis, L, Centonze L., Di Sandro S., Lauterio A., De Carlis R., Botta F., Mariani A., Bagnardi V., De Carlis L., Centonze, L, Di Sandro, S, Lauterio, A, De Carlis, R, Botta, F, Mariani, A, Bagnardi, V, De Carlis, L, Centonze L., Di Sandro S., Lauterio A., De Carlis R., Botta F., Mariani A., Bagnardi V., and De Carlis L.
Abstract: Despite that mortality following pancreatoduodenectomy (PD) has gradually dropped during the past few decades, the incidence of postoperative complications remains high, ranging from 30-60%. Many studies have been focused on identification of perioperative risk factors for morbidity, and in recent years, sarcopenia has been pointed out as a valid predictor of postoperative complication. Materials and methods: Perioperative data from 110 consecutive patients who underwent PD were retrieved, and the presence of sarcopenia was assessed by the measurement of Hounsfield unit average calculation on preoperative CT scans. Postoperative complications were graded according to Clavien-Dindo classification, and the morbidity burden was assessed by comprehensive complication index (CCI) calculation. Results: Sarcopenia was associated with advanced age (72 vs. 66 years; p = 0.014) and lower preoperative albumin levels (3.5 vs. 3.7 g/dL; p = 0.010); it represented an independent risk factor for clinically relevant complications (relative risk: 1.71; p = 0.015) and was related to a higher rate of Grade C postoperative pancreatic fistula (50.0 vs. 11.4%; p = 0.005) and a higher CCI (47.6 vs. 29.6; p = 0.001). Conclusions: Sarcopenia represents a valid indicator of increased morbidity risk and may play a central role in preoperative risk stratification, allowing the selection of patients who may benefit from prehabilitation programs.
Published: 2020

47. 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

48. Viability Criteria during Liver Ex-Situ Normothermic and Hypothermic Perfusion

Author: Melandro, F, De Carlis, R, Torri, F, Lauterio, A, De Simone, P, De Carlis, L, Ghinolfi, D, Melandro, Fabio, De Carlis, Riccardo, Torri, Francesco, Lauterio, Andrea, De Simone, Paolo, De Carlis, Luciano, Ghinolfi, Davide, Melandro, F, De Carlis, R, Torri, F, Lauterio, A, De Simone, P, De Carlis, L, Ghinolfi, D, Melandro, Fabio, De Carlis, Riccardo, Torri, Francesco, Lauterio, Andrea, De Simone, Paolo, De Carlis, Luciano, and Ghinolfi, Davide
Abstract: With the increased use of extended-criteria donors, machine perfusion became a beneficial alternative to cold storage in preservation strategy for donor livers with the intent to expand donor pool. Both normothermic and hypothermic approach achieved good results in terms of mid- and long-term outcome in liver transplantation. Many markers and molecules have been proposed for the assessment of liver, but no definitive criteria for graft viability have been validated in large clinical trials and key parameters during perfusion still require optimization.In this review, we address the current literature of viability criteria during normothermic and hypothermic machine perfusion and discuss about future steps and evolution of these technologies.
Published: 2022

49. The perioperative period of liver transplantation from unconventional extended criteria donors: data from two high-volume centres

Author: Pescarissi, C, Penzo, B, Ghinolfi, D, Lai, Q, Bindi, L, De Carlis, R, Melandro, F, Balzano, E, Desimone, P, De Carlis, L, Degasperi, A, Biancofiore, G, Pescarissi, Claudia, Penzo, Beatrice, Ghinolfi, Davide, Lai, Quirino, Bindi, Lucia, De Carlis, Riccardo, Melandro, Fabio, Balzano, Emanuele, DeSimone, Paolo, De Carlis, Luciano, DeGasperi, Andrea, Biancofiore, Giandomenico L, Pescarissi, C, Penzo, B, Ghinolfi, D, Lai, Q, Bindi, L, De Carlis, R, Melandro, F, Balzano, E, Desimone, P, De Carlis, L, Degasperi, A, Biancofiore, G, Pescarissi, Claudia, Penzo, Beatrice, Ghinolfi, Davide, Lai, Quirino, Bindi, Lucia, De Carlis, Riccardo, Melandro, Fabio, Balzano, Emanuele, DeSimone, Paolo, De Carlis, Luciano, DeGasperi, Andrea, and Biancofiore, Giandomenico L
Abstract: Background: As literature largely focuses on long-term outcomes, this study aimed at elucidating the perioperative outcomes of liver transplant patients receiving a graft from two groups of unconventional expanded criteria donors: brain dead aged > 80 years and cardiac dead. Methods: Data of 247 cirrhotic patients transplanted at two high volume liver transplant centers were analysed. Confounders were balanced using a stabilized inverse probability therapy weighting and a propensity score for each patient on the original population was generated. The score was created using a multivariate logistic regression model considering a Comprehensive Complication Index ≥ 42 (no versus yes) as the dependent variable and 11 possible clinically relevant confounders as covariate. Results: Forty-four patients received the graft from a cardiac-dead donor and 203 from a brain-dead donor aged > 80 years. Intraoperatively, cardiac-dead donors liver transplant cases required more fresh frozen plasma units (P < 0.0001) with similar reduced need of fibrinogen to old brain-dead donors cases. The incidence of reperfusion syndrome was similar (P = 0.80). In the Intensive Care Unit, both the groups presented a comparable low need for blood transfusions, renal replacement therapy and inotropes. Cardiac-dead donors liver transplantations required more time to tracheal extubation (P < 0.0001) and scored higher Comprehensive Complication Index (P < 0.0001) however the incidence of a severe complication status (Comprehensive Complication Index ≥ 42) was similar (P = 0.52). ICU stay (P = 0.97), total hospital stay (P = 0.57), in hospital (P = 1.00) and 6 months (P = 1.00) death were similar. Conclusion: Selected octogenarian and cardiac-dead donors can be used safely for liver transplantation.
Published: 2022

50. 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

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