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1. Systemic treatment for hepatocellular carcinoma beyond milan criteria on the waitlist: is it time for a neoadjuvant therapy?

Author

Magro, B, Triolo, M, Celsa, C, Pagano, D, Cabibbo, G, Cammà, C, Fagiuoli, S, Gruttadauria, S, Magro B., Triolo M., Celsa C., Pagano D., Cabibbo G., Cammà C., Fagiuoli S., Gruttadauria S., Magro, B, Triolo, M, Celsa, C, Pagano, D, Cabibbo, G, Cammà, C, Fagiuoli, S, Gruttadauria, S, Magro B., Triolo M., Celsa C., Pagano D., Cabibbo G., Cammà C., Fagiuoli S., and Gruttadauria S.

Published
2023

2. Impact of laparoscopic liver resection for access to the waiting list of a single regional liver transplant center in southern Italy: entry and dropout flows’ analysis

Author

Pagano, D., primary, Vella, R., additional, Calamia, S., additional, di Francesco, F., additional, Petri, S. Li, additional, Bonsignore, P., additional, Tropea, A., additional, Accardo, C., additional, Vella, I., additional, Magro, B., additional, Laquatra, N., additional, Lorenzo, N. Di, additional, Barbara, M., additional, and Gruttadauria, S., additional

Published
2023
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3. Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome

Author

Efe, C, Kulkarni, A, Terziroli Beretta-Piccoli, B, Magro, B, Friedrich Stattermayer, A, Cengiz, M, Clayton-Chubb, D, Lammert, C, Bernsmeier, C, Gul, O, la Tijera, F, Anders, M, Lytvyak, E, Akin, M, Purnak, T, Liberal, R, Peralta, M, Ebik, B, Duman, S, Demir, N, Balaban, Y, Urzua, A, Contreras, F, Venturelli, M, Bilgic, Y, Medina, A, Girala, M, Gunsar, F, Londono, M, Androutsakos, T, Kisch, A, Yurci, A, Guzelbult, F, Cagin, Y, Avci, E, Guzelbulut, M, Dindar-Demiray, E, Harputluoglu, M, Kumar, R, Satapathy, S, Mendizabal, M, Silva, M, Fagiuoli, S, Roberts, S, Soylu, N, Idilman, R, Yoshida, E, Montano-Loza, A, Dalekos, G, Ridruejo, E, Schiano, T, Wahlin, S, Efe C., Kulkarni A. V., Terziroli Beretta-Piccoli B., Magro B., Friedrich Stattermayer A., Cengiz M., Clayton-Chubb D., Lammert C., Bernsmeier C., Gul O., la Tijera F. H. -D., Anders M., Lytvyak E., Akin M., Purnak T., Liberal R., Peralta M., Ebik B., Duman S., Demir N., Balaban Y., Urzua A., Contreras F., Venturelli M. G., Bilgic Y., Medina A., Girala M., Gunsar F., Londono M. -C., Androutsakos T., Kisch A., Yurci A., Guzelbult F., Cagin Y. F., Avci E., Guzelbulut M., Dindar-Demiray E. K., Harputluoglu M., Kumar R., Satapathy S. K., Mendizabal M., Silva M., Fagiuoli S., Roberts S. K., Soylu N. K., Idilman R., Yoshida E. M., Montano-Loza A. J., Dalekos G. N., Ridruejo E., Schiano T. D., Wahlin S., Efe, C, Kulkarni, A, Terziroli Beretta-Piccoli, B, Magro, B, Friedrich Stattermayer, A, Cengiz, M, Clayton-Chubb, D, Lammert, C, Bernsmeier, C, Gul, O, la Tijera, F, Anders, M, Lytvyak, E, Akin, M, Purnak, T, Liberal, R, Peralta, M, Ebik, B, Duman, S, Demir, N, Balaban, Y, Urzua, A, Contreras, F, Venturelli, M, Bilgic, Y, Medina, A, Girala, M, Gunsar, F, Londono, M, Androutsakos, T, Kisch, A, Yurci, A, Guzelbult, F, Cagin, Y, Avci, E, Guzelbulut, M, Dindar-Demiray, E, Harputluoglu, M, Kumar, R, Satapathy, S, Mendizabal, M, Silva, M, Fagiuoli, S, Roberts, S, Soylu, N, Idilman, R, Yoshida, E, Montano-Loza, A, Dalekos, G, Ridruejo, E, Schiano, T, Wahlin, S, Efe C., Kulkarni A. V., Terziroli Beretta-Piccoli B., Magro B., Friedrich Stattermayer A., Cengiz M., Clayton-Chubb D., Lammert C., Bernsmeier C., Gul O., la Tijera F. H. -D., Anders M., Lytvyak E., Akin M., Purnak T., Liberal R., Peralta M., Ebik B., Duman S., Demir N., Balaban Y., Urzua A., Contreras F., Venturelli M. G., Bilgic Y., Medina A., Girala M., Gunsar F., Londono M. -C., Androutsakos T., Kisch A., Yurci A., Guzelbult F., Cagin Y. F., Avci E., Guzelbulut M., Dindar-Demiray E. K., Harputluoglu M., Kumar R., Satapathy S. K., Mendizabal M., Silva M., Fagiuoli S., Roberts S. K., Soylu N. K., Idilman R., Yoshida E. M., Montano-Loza A. J., Dalekos G. N., Ridruejo E., Schiano T. D., and Wahlin S.

Abstract

Background and Aims: A few case reports of autoimmune hepatitis–like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS-CoV-2 vaccination in a large case series. Approach and Results: We collected data from cases in 18 countries. The type of liver injury was assessed with the R-value. The study population was categorized according to features of immune-mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18–79) years at presentation. Liver injury was diagnosed a median 15 (range: 3–65) days after vaccination. Fifty-one cases (59%) were attributed to the Pfizer-BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford-AstraZeneca (ChAdOX1 nCoV-19) vaccine and 16 (18%) cases to the Moderna (mRNA-1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune-mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3–4 liver injury than for grade 1–2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune-mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow-up. Conclusions: SARS-CoV-2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune-mediated features or severe hepatitis. Outcome was generally favorable, but vaccine-associated liver injury led to fulminant liver failure in one patient.

Published
2022

4. Serum procalcitonin predicts mortality independently of the presence of ACLF in patients with cirrhosis and ascites hospitalized for suspicious infection and treated with empiric antibiotic therapy

Author

Bianchini, M., primary, Celsa, C., additional, Magro, B., additional, Cavani, G., additional, Giuffrida, P., additional, Battaglia, S., additional, Saltini, D., additional, Zanetto, A., additional, Indulti, F., additional, Guasconi, T., additional, Girardis, M., additional, Calvaruso, V., additional, Fagiuoli, S., additional, Colecchia, A., additional, Villa, E., additional, Cammà, C., additional, and Schepis, F., additional

Published
2023
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5. Pre-transplant alpha-fetoprotein > 25.5 and its dynamic on waitlist are predictors of HCC recurrence after liver transplantation for patients meeting milan criteria

Author

Magro, B, Pinelli, D, De Giorgio, M, Luca, M, Ghirardi, A, Carrobio, A, Baronio, G, Del Prete, L, Nounamo, F, Gianatti, A, Colledan, M, Fagiuoli, S, Magro B., Pinelli D., De Giorgio M., Luca M. G., Ghirardi A., Carrobio A., Baronio G., Del Prete L., Nounamo F., Gianatti A., Colledan M., Fagiuoli S., Magro, B, Pinelli, D, De Giorgio, M, Luca, M, Ghirardi, A, Carrobio, A, Baronio, G, Del Prete, L, Nounamo, F, Gianatti, A, Colledan, M, Fagiuoli, S, Magro B., Pinelli D., De Giorgio M., Luca M. G., Ghirardi A., Carrobio A., Baronio G., Del Prete L., Nounamo F., Gianatti A., Colledan M., and Fagiuoli S.

Abstract

Background and Aim: Hepatocellular carcinoma (HCC) recurrence rates after liver transplantation (LT) range between 8 and 20%. Alpha-fetoprotein (AFP) levels at transplant can predict HCC recurrence, however a defined cut-off value is needed to better stratify patients. The aim of this study was to evaluate the rate of HCC recurrence at our centre and to identify predictors, focusing on AFP. Methods: We retrospectively analysed 236 consecutive patients that were waitlisted for HCC who all met the Milan criteria from January 2001 to December 2017 at our liver transplant centre. A total of twenty-nine patients dropped out while they were waitlisted, and 207 patients were included in the final analysis. All survival analyses included the competing-risk model. Results: The mean age was 56.8 ± 6.8 years. A total of 14% were female (n = 29/207). The median MELD (model for end-stage liver disease) at LT was 12 (9-16). The median time on the waitlist was 92 (41-170) days. The HCC recurrence rate was 16.4% (n = 34/208). The mean time to recurrence was 3.3 ± 2.8 years. The median AFP levels at transplant were higher in patients with HCC recurrence (p < 0.001). At multivariate analysis, the AFP value at transplant that was greater than 25.5 ng/mL (AUC 0.69) was a strong predictor of HCC recurrence after LT [sHR 3.3 (1.6-6.81); p = 0.001]. The HCC cumulative incidence function (CIF) of recurrence at 10 years from LT was significantly higher in patients with AFP > 25.5 ng/mL [34.3% vs. 11.5% (p = 0.001)]. Moreover, an increase in AFP > 20.8%, was significantly associated with HCC recurrence (p = 0.034). Conclusions: In conclusion, in our retrospective study, the AFP level at transplant > 25.5 ng/mL and its increase greater than 20.8% on the waitlist were strong predictors of HCC recurrence after LT in a cohort of patients that were waitlisted within the Milan criteria. However further studies are needed to validate these data.

Published
2021

6. Successful treatment of suspected donor-derived human herpesvirus-8 infection in a liver transplant patient with coronavirus disease-19

Author

Peri, A, Magro, B, Van Den Bogaart, L, Pria, A, Giuffrida, P, Gianatti, A, Fabretti, F, Barbui, A, Tebaldi, A, Rizzi, M, Fagiuoli, S, Peri A. M., Magro B., Van Den Bogaart L., Pria A. D., Giuffrida P., Gianatti A., Fabretti F., BArbui A. M., Tebaldi A., Rizzi M., Fagiuoli S., Peri, A, Magro, B, Van Den Bogaart, L, Pria, A, Giuffrida, P, Gianatti, A, Fabretti, F, Barbui, A, Tebaldi, A, Rizzi, M, Fagiuoli, S, Peri A. M., Magro B., Van Den Bogaart L., Pria A. D., Giuffrida P., Gianatti A., Fabretti F., BArbui A. M., Tebaldi A., Rizzi M., and Fagiuoli S.

Published
2021

7. AFP at transplant is associated with a higher risk of HCC recurrence after liver transplantation for patients meeting Milano criteria

Author

Magro, B, Pinelli, D, De Giorgio, M, Ghirardi, A, Giuseppe, B, Del Prete, L, Colledan, M, Fagiuoli, S, Magro B, Pinelli D, De Giorgio M, Ghirardi A, Giuseppe B, Del Prete L, Colledan M, Fagiuoli S, Magro, B, Pinelli, D, De Giorgio, M, Ghirardi, A, Giuseppe, B, Del Prete, L, Colledan, M, Fagiuoli, S, Magro B, Pinelli D, De Giorgio M, Ghirardi A, Giuseppe B, Del Prete L, Colledan M, and Fagiuoli S

Published
2021

8. Predicting in-hospital mortality from Coronavirus Disease 2019: A simple validated app for clinical use

Author

Magro, B, Zuccaro, V, Novelli, L, Zileri, L, Celsa, C, Raimondi, F, Gori, M, Cammà, G, Battaglia, S, Genova, V, Paris, L, Tacelli, M, Mancarella, F, Enea, M, Attanasio, M, Senni, M, Di Marco, F, Lorini, L, Fagiuoli, S, Bruno, R, Cammà, C, Gasbarrini, A, Magro B, Zuccaro V, Novelli L, Zileri L, Celsa C, Raimondi F, Gori M, Cammà G, Battaglia S, Genova VG, Paris L, Tacelli M, Mancarella FA, Enea M, Attanasio M, Senni M, Di Marco F, Lorini LF, Fagiuoli S, Bruno R, Cammà C, Gasbarrini A, Magro, B, Zuccaro, V, Novelli, L, Zileri, L, Celsa, C, Raimondi, F, Gori, M, Cammà, G, Battaglia, S, Genova, V, Paris, L, Tacelli, M, Mancarella, F, Enea, M, Attanasio, M, Senni, M, Di Marco, F, Lorini, L, Fagiuoli, S, Bruno, R, Cammà, C, Gasbarrini, A, Magro B, Zuccaro V, Novelli L, Zileri L, Celsa C, Raimondi F, Gori M, Cammà G, Battaglia S, Genova VG, Paris L, Tacelli M, Mancarella FA, Enea M, Attanasio M, Senni M, Di Marco F, Lorini LF, Fagiuoli S, Bruno R, Cammà C, and Gasbarrini A

Abstract

Backgrounds Validated tools for predicting individual in-hospital mortality of COVID-19 are lacking. We aimed to develop and to validate a simple clinical prediction rule for early identification of in-hospital mortality of patients with COVID-19. Methods and findings We enrolled 2191 consecutive hospitalized patients with COVID-19 from three Italian dedicated units (derivation cohort: 1810 consecutive patients from Bergamo and Pavia units; validation cohort: 381 consecutive patients from Rome unit). The outcome was in-hospital mortality. Fine and Gray competing risks multivariate model (with discharge as a competing event) was used to develop a prediction rule for in-hospital mortality. Discrimination and calibration were assessed by the area under the receiver operating characteristic curve (AUC) and by Brier score in both the derivation and validation cohorts. Seven variables were independent risk factors for in-hospital mortality: age (Hazard Ratio [HR] 1.08, 95% Confidence Interval [CI] 1.07–1.09), male sex (HR 1.62, 95%CI 1.30–2.00), duration of symptoms before hospital admission <10 days (HR 1.72, 95%CI 1.39–2.12), diabetes (HR 1.21, 95% CI 1.02–1.45), coronary heart disease (HR 1.40 95% CI 1.09–1.80), chronic liver disease (HR 1.78, 95%CI 1.16–2.72), and lactate dehydrogenase levels at admission (HR 1.0003, 95%CI 1.0002–1.0005). The AUC was 0.822 (95%CI 0.722–0.922) in the derivation cohort and 0.820 (95%CI 0.724–0.920) in the validation cohort with good calibration. The prediction rule is freely available as a web-app (COVID-CALC: https://sites.google.com/community. unipa.it/covid-19riskpredictions/c19-rp). Conclusions A validated simple clinical prediction rule can promptly and accurately assess the risk for in-hospital mortality, improving triage and the management of patients with COVID-19.

Published
2021

10. Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis

Author

Efe, C., Lammert, C., Taşçılar, K., Dhanasekaran, R., Ebik, B., Higuera-de la Tijera, F., Calışkan, A.R., Peralta, M., Gerussi, A., Massoumi, H., Catana, A.M., Purnak, T., Rigamonti, C., Aldana, A.J. Gomez, Khakoo, N., Nazal, L., Frager, S., Demir, N., Irak, K., Melekoğlu-Ellik, Z., Kacmaz, H., Balaban, Y., Atay, K., Eren, F., Alvares-da-Silva, M.R., Cristoferi, L., Urzua, Á., Eşkazan, T., Magro, B., Snijders, R.J.A.L.M., Barutçu, S., Lytvyak, E., Zazueta, G.M., Demirezer-Bolat, A., Aydın, M., Heurgue-Berlot, A., Martin, E., Ekin, N., Yıldırım, S., Yavuz, A., Bıyık, M., Narro, G.C., Kıyıcı, M., Akyıldız, M., Kahramanoğlu-Aksoy, E., Vincent, M., Carr, R.M., Günşar, F., Reyes, E.C., Harputluoğlu, M., Aloman, C., Gatselis, N.K., Üstündağ, Y., Brahm, J., Vargas, N.C.E., Güzelbulut, F., Garcia, S.R., Aguirre, J., Anders, M., Ratusnu, N., Hatemi, I., Mendizabal, M., Floreani, A., Fagiuoli, S., Silva, M., Idilman, R., Satapathy, S.K., Silveira, M., Drenth, J.P.H., Dalekos, G.N., Assis, D.N., Björnsson, E., Boyer, J.L., Yoshida, E.M., Invernizzi, P., Levy, C., Montano-Loza, A.J., Schiano, T.D., Ridruejo, E., Wahlin, S., Efe, C., Lammert, C., Taşçılar, K., Dhanasekaran, R., Ebik, B., Higuera-de la Tijera, F., Calışkan, A.R., Peralta, M., Gerussi, A., Massoumi, H., Catana, A.M., Purnak, T., Rigamonti, C., Aldana, A.J. Gomez, Khakoo, N., Nazal, L., Frager, S., Demir, N., Irak, K., Melekoğlu-Ellik, Z., Kacmaz, H., Balaban, Y., Atay, K., Eren, F., Alvares-da-Silva, M.R., Cristoferi, L., Urzua, Á., Eşkazan, T., Magro, B., Snijders, R.J.A.L.M., Barutçu, S., Lytvyak, E., Zazueta, G.M., Demirezer-Bolat, A., Aydın, M., Heurgue-Berlot, A., Martin, E., Ekin, N., Yıldırım, S., Yavuz, A., Bıyık, M., Narro, G.C., Kıyıcı, M., Akyıldız, M., Kahramanoğlu-Aksoy, E., Vincent, M., Carr, R.M., Günşar, F., Reyes, E.C., Harputluoğlu, M., Aloman, C., Gatselis, N.K., Üstündağ, Y., Brahm, J., Vargas, N.C.E., Güzelbulut, F., Garcia, S.R., Aguirre, J., Anders, M., Ratusnu, N., Hatemi, I., Mendizabal, M., Floreani, A., Fagiuoli, S., Silva, M., Idilman, R., Satapathy, S.K., Silveira, M., Drenth, J.P.H., Dalekos, G.N., Assis, D.N., Björnsson, E., Boyer, J.L., Yoshida, E.M., Invernizzi, P., Levy, C., Montano-Loza, A.J., Schiano, T.D., Ridruejo, E., and Wahlin, S.

Abstract

Item does not contain fulltext, BACKGROUND: We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). PATIENTS AND METHODS: Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. RESULTS: We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. CONCLUSION: Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH.

Published
2022

11. Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis

Author

Efe, C, Lammert, C, Tascilar, K, Dhanasekaran, R, Ebik, B, Higuera-de la Tijera, F, Caliskan, A, Peralta, M, Gerussi, A, Massoumi, H, Catana, A, Purnak, T, Rigamonti, C, Aldana, A, Khakoo, N, Nazal, L, Frager, S, Demir, N, Irak, K, Melekoglu-Ellik, Z, Kacmaz, H, Balaban, Y, Atay, K, Eren, F, Alvares-da-Silva, M, Cristoferi, L, Urzua, A, Eskazan, T, Magro, B, Snijders, R, Barutcu, S, Lytvyak, E, Zazueta, G, Demirezer-Bolat, A, Aydin, M, Heurgue-Berlot, A, De Martin, E, Ekin, N, Yildirim, S, Yavuz, A, Biyik, M, Narro, G, Kiyici, M, Akyildiz, M, Kahramanoglu-Aksoy, E, Vincent, M, Carr, R, Gunsar, F, Reyes, E, Harputluoglu, M, Aloman, C, Gatselis, N, Ustundag, Y, Brahm, J, Vargas, N, Guzelbulut, F, Garcia, S, Aguirre, J, Anders, M, Ratusnu, N, Hatemi, I, Mendizabal, M, Floreani, A, Fagiuoli, S, Silva, M, Idilman, R, Satapathy, S, Silveira, M, Drenth, J, Dalekos, G, Assis, D, Bjornsson, E, Boyer, J, Yoshida, E, Invernizzi, P, Levy, C, Montano-Loza, A, Schiano, T, Ridruejo, E, Wahlin, S, Caliskan, AR, Catana, AM, Aldana, AJG, Alvares-da-Silva, MR, Zazueta, GM, Narro, GC, Carr, RM, Reyes, EC, Gatselis, NK, Vargas, NCE, Garcia, SR, Satapathy, SK, Drenth, JPH, Dalekos, GN, Assis, DN, Boyer, JL, Yoshida, EM, Montano-Loza, AJ, Schiano, TD, Efe, C, Lammert, C, Tascilar, K, Dhanasekaran, R, Ebik, B, Higuera-de la Tijera, F, Caliskan, A, Peralta, M, Gerussi, A, Massoumi, H, Catana, A, Purnak, T, Rigamonti, C, Aldana, A, Khakoo, N, Nazal, L, Frager, S, Demir, N, Irak, K, Melekoglu-Ellik, Z, Kacmaz, H, Balaban, Y, Atay, K, Eren, F, Alvares-da-Silva, M, Cristoferi, L, Urzua, A, Eskazan, T, Magro, B, Snijders, R, Barutcu, S, Lytvyak, E, Zazueta, G, Demirezer-Bolat, A, Aydin, M, Heurgue-Berlot, A, De Martin, E, Ekin, N, Yildirim, S, Yavuz, A, Biyik, M, Narro, G, Kiyici, M, Akyildiz, M, Kahramanoglu-Aksoy, E, Vincent, M, Carr, R, Gunsar, F, Reyes, E, Harputluoglu, M, Aloman, C, Gatselis, N, Ustundag, Y, Brahm, J, Vargas, N, Guzelbulut, F, Garcia, S, Aguirre, J, Anders, M, Ratusnu, N, Hatemi, I, Mendizabal, M, Floreani, A, Fagiuoli, S, Silva, M, Idilman, R, Satapathy, S, Silveira, M, Drenth, J, Dalekos, G, Assis, D, Bjornsson, E, Boyer, J, Yoshida, E, Invernizzi, P, Levy, C, Montano-Loza, A, Schiano, T, Ridruejo, E, Wahlin, S, Caliskan, AR, Catana, AM, Aldana, AJG, Alvares-da-Silva, MR, Zazueta, GM, Narro, GC, Carr, RM, Reyes, EC, Gatselis, NK, Vargas, NCE, Garcia, SR, Satapathy, SK, Drenth, JPH, Dalekos, GN, Assis, DN, Boyer, JL, Yoshida, EM, Montano-Loza, AJ, and Schiano, TD

Abstract

Background: We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). Patients and methods: Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. Results: We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. Conclusion: Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH.

Published
2022

12. Antecedent use of renin-angiotensin system inhibitors is associated with reduced mortality in elderly hypertensive Covid-19 patients

Author

Gori, M, Berzuini, C, D'Elia, E, Ghirardi, A, Bernardinelli, L, Gavazzi, A, Balestrieri, G, Giammarresi, A, Trevisan, R, Di Marco, F, Bellasi, A, Amoroso, M, Raimondi, F, Novelli, L, Magro, B, Mangia, G, Lorini, F, Guagliumi, G, Fagiuoli, S, Parati, G, Senni, M, Gori, Mauro, Berzuini, Carlo, D'Elia, Emilia, Ghirardi, Arianna, Bernardinelli, Luisa, Gavazzi, Antonello, Balestrieri, Giulio, Giammarresi, Andrea, Trevisan, Roberto, Di Marco, Fabiano, Bellasi, Antonio, Amoroso, Mariangela, Raimondi, Federico, Novelli, Luca, Magro, Bianca, Mangia, Gianpaolo, Lorini, Ferdinando L, Guagliumi, Giulio, Fagiuoli, Stefano, Parati, Gianfranco, Senni, Michele, Gori, M, Berzuini, C, D'Elia, E, Ghirardi, A, Bernardinelli, L, Gavazzi, A, Balestrieri, G, Giammarresi, A, Trevisan, R, Di Marco, F, Bellasi, A, Amoroso, M, Raimondi, F, Novelli, L, Magro, B, Mangia, G, Lorini, F, Guagliumi, G, Fagiuoli, S, Parati, G, Senni, M, Gori, Mauro, Berzuini, Carlo, D'Elia, Emilia, Ghirardi, Arianna, Bernardinelli, Luisa, Gavazzi, Antonello, Balestrieri, Giulio, Giammarresi, Andrea, Trevisan, Roberto, Di Marco, Fabiano, Bellasi, Antonio, Amoroso, Mariangela, Raimondi, Federico, Novelli, Luca, Magro, Bianca, Mangia, Gianpaolo, Lorini, Ferdinando L, Guagliumi, Giulio, Fagiuoli, Stefano, Parati, Gianfranco, and Senni, Michele

Abstract

Objectives:The effect of renin-angiotensin system inhibitors (RASIs) on mortality in patients with coronavirus disease (Covid-19) is debated. From a cohort of 1352 consecutive patients admitted with Covid-19 to Papa Giovanni XXIII Hospital in Bergamo, Italy, between February and April 2020, we selected and studied hypertensive patients to assess whether antecedent (prior to hospitalization) use of RASIs might affect mortality from Covid-19 according to age.Methods and results:Arterial hypertension was present in 688 patients. Overall mortality (in-hospital or shortly after discharge) was 35% (N = 240). After adjusting for 26 medical history variables via propensity score matching, antecedent use of RASIs (N = 459, 67%) was associated with a lower mortality in older hypertensive patients (age above the median of 68 years in the whole series), whereas no evidence of a significant effect was found in the younger group of the same population (P interaction = 0.001). In an analysis of the subgroup of 432 hypertensive patients older than 68 years, we considered two RASI drug subclasses, angiotensin-converting enzyme inhibitors (ACEIs, N = 156) and angiotensin receptor blockers (ARBs, N = 140), and assessed their respective effects by taking no-antecedent-use of RASIs as reference. This analysis showed that both antecedent use of ACEIs and antecedent use of ARBs were associated with a lower Covid-19 mortality (odds ratioACEI = 0.57, 95% confidence interval 0.36 - 0.91, P = 0.018) (odds ratioARB = 0.49, 95% confidence interval 0.29 - 0.82, P = 0.006).Conclusion:In the population of over-68 hypertensive Covid-19 patients, antecedent use of ACEIs or ARBs was associated with a lower all-cause mortality, whether in-hospital or shortly after discharge, compared with no-antecedent-use of RASIs.

Published
2022

13. Association between inhibitors of the renin-angiotensin system and lung function in elderly patients recovered from severe COVID-19

Author

Gori, M, Ghirardi, A, D'Elia, E, Imeri, G, Di Marco, F, Gavazzi, A, Carobbio, A, Balestrieri, G, Giammarresi, A, Trevisan, R, Amoroso, M, Raimondi, F, Novelli, L, Magro, B, Mangia, G, Lorini, F, Fagiuoli, S, Barbui, T, Rizzi, M, Cosentini, R, Sironi, S, Senni, M, Gori, Mauro, Ghirardi, Arianna, D'Elia, Emilia, Imeri, Gianluca, Di Marco, Fabiano, Gavazzi, Antonello, Carobbio, Alessandra, Balestrieri, Giulio, Giammarresi, Andrea, Trevisan, Roberto, Amoroso, Mariangela, Raimondi, Federico, Novelli, Luca, Magro, Bianca, Mangia, Gianpaolo, Lorini, Ferdinando L, Fagiuoli, Stefano, Barbui, Tiziano, Rizzi, Marco, Cosentini, Roberto, Sironi, Sandro, Senni, Michele, Gori, M, Ghirardi, A, D'Elia, E, Imeri, G, Di Marco, F, Gavazzi, A, Carobbio, A, Balestrieri, G, Giammarresi, A, Trevisan, R, Amoroso, M, Raimondi, F, Novelli, L, Magro, B, Mangia, G, Lorini, F, Fagiuoli, S, Barbui, T, Rizzi, M, Cosentini, R, Sironi, S, Senni, M, Gori, Mauro, Ghirardi, Arianna, D'Elia, Emilia, Imeri, Gianluca, Di Marco, Fabiano, Gavazzi, Antonello, Carobbio, Alessandra, Balestrieri, Giulio, Giammarresi, Andrea, Trevisan, Roberto, Amoroso, Mariangela, Raimondi, Federico, Novelli, Luca, Magro, Bianca, Mangia, Gianpaolo, Lorini, Ferdinando L, Fagiuoli, Stefano, Barbui, Tiziano, Rizzi, Marco, Cosentini, Roberto, Sironi, Sandro, and Senni, Michele

Published
2022

14. Clinical features of patients with new onset of autoimmune hepatitis following SARS-CoV-2 vaccination

Author

Rigamonti, C., primary, Coco, B., additional, Brunetto, M., additional, Labanca, S., additional, Giannini, E.G., additional, Magro, B., additional, Fagiuoli, S., additional, Baroni, G. Svegliati, additional, Sgamato, C., additional, Miele, L., additional, Grieco, A., additional, Giuli, L., additional, Manfredi, G.F., additional, and Pirisi, M., additional

Published
2022
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15. Health status of patients with autoimmune liver disease during SARS-CoV-2 outbreak in northern Italy

Author

Di Giorgio, A, Nicastro, E, Speziani, C, De Giorgio, M, Pasulo, L, Magro, B, Fagiuoli, S, D' Antiga, L, Di Giorgio A., Nicastro E., Speziani C., De Giorgio M., Pasulo L., Magro B., Fagiuoli S., D' Antiga L., Di Giorgio, A, Nicastro, E, Speziani, C, De Giorgio, M, Pasulo, L, Magro, B, Fagiuoli, S, D' Antiga, L, Di Giorgio A., Nicastro E., Speziani C., De Giorgio M., Pasulo L., Magro B., Fagiuoli S., and D' Antiga L.

Published
2020

16. AFP AT TRANSPLANT IS ASSOCIATED WITH A HIGHER RISK OF HCC RECURRENCE AFTER LIVER TRANSPLANTATION FOR PATIENTS MEETING MILANO CRITERIA

Author

Magro, B, Pinelli, D, De Giorgio, M, Del Prete, L, Baronio, G, Ghirardi, A, Colledan, M, Fagiuoli, S, Magro B, Pinelli D, De Giorgio M, Del Prete L, Baronio G, Ghirardi A, Colledan M, Fagiuoli S, Magro, B, Pinelli, D, De Giorgio, M, Del Prete, L, Baronio, G, Ghirardi, A, Colledan, M, Fagiuoli, S, Magro B, Pinelli D, De Giorgio M, Del Prete L, Baronio G, Ghirardi A, Colledan M, and Fagiuoli S

Published
2020

19. The IMPROVEMENT project: first report of the global liver transplant activity

Author

Avolio, A.W., Pascale, M.M., Burra, P., Bhoori, S., De Maria, N., Donato, F., Fagiuoli, S., Lanza, A. Galeota, Giannelli, V., Ginanni Corradini, S, Lenci, I., Magro, B., Martini, S., Petruccelli, S., Piscaglia, F., Pompili, M., Rendina, M., Baroni, G.L. Svegliati, Violi, P., Barbier, L., Braun, F., Boin, I., Caccamo, L., Cicarelli, O., Cillo, U., Carraro, A., Cescon, M., De Carlis, L., De Carlis, R, De Simone, P., De Santibanes, M., Deng, F., Benedetto, F. Di, Ettorre, G.M., Fernandez, H., Gastaca, M., Gruttadauria, S., Guo, Z., Hammond, J., Lai, Q, Lesurtel, M., Llado, L., Martins, P., Mazzaferro, V., Mejia, G., Nadalin, S., Oniscu, G., Patel, M., Perera, T., Pinelli, D., Polak, W., Quintini, C., Ravaioli, M., Rela, M., Romagnoli, R., Salame, E, Subash, G., Tandoi, F., Takashi, I., Timucin, T., Tisone, G., Vennarecci, G., Vivarelli, M., Vorasittha, A., Zieniewicz, K., and Agopian, V.

Published
2024
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20. Predicting in-hospital mortality from Coronavirus Disease 2019: A simple validated app for clinical use

Author

Magro, B., Zuccaro, V., Novelli, L., Zileri, L., Celsa, C., Raimondi, F., Gori, Mario, Camma, Giulia, Battaglia, Laura Silvia Carmen Irene, Genova, V. G., Paris, Leonardo, Tacelli, M., Mancarella, Francesco Antonio, Enea, M., Attanasio, M., Senni, M., Marco, F. D., Lorini, L. F., Fagiuoli, Stefano, Bruno, Rosa Anna, Camma, C., Gasbarrini, Antonio, Gori M., Camma G., Battaglia S., Paris L., Mancarella F. A., Fagiuoli S., Bruno R., Gasbarrini A. (ORCID:0000-0002-7278-4823), Magro, B., Zuccaro, V., Novelli, L., Zileri, L., Celsa, C., Raimondi, F., Gori, Mario, Camma, Giulia, Battaglia, Laura Silvia Carmen Irene, Genova, V. G., Paris, Leonardo, Tacelli, M., Mancarella, Francesco Antonio, Enea, M., Attanasio, M., Senni, M., Marco, F. D., Lorini, L. F., Fagiuoli, Stefano, Bruno, Rosa Anna, Camma, C., Gasbarrini, Antonio, Gori M., Camma G., Battaglia S., Paris L., Mancarella F. A., Fagiuoli S., Bruno R., and Gasbarrini A. (ORCID:0000-0002-7278-4823)

Abstract

Backgrounds Validated tools for predicting individual in-hospital mortality of COVID-19 are lacking. We aimed to develop and to validate a simple clinical prediction rule for early identification of in-hospital mortality of patients with COVID-19. Methods and findings We enrolled 2191 consecutive hospitalized patients with COVID-19 from three Italian dedicated units (derivation cohort: 1810 consecutive patients from Bergamo and Pavia units; validation cohort: 381 consecutive patients from Rome unit). The outcome was in-hospital mortality. Fine and Gray competing risks multivariate model (with discharge as a competing event) was used to develop a prediction rule for in-hospital mortality. Discrimination and calibration were assessed by the area under the receiver operating characteristic curve (AUC) and by Brier score in both the derivation and validation cohorts. Seven variables were independent risk factors for in-hospital mortality: age (Hazard Ratio [HR] 1.08, 95% Confidence Interval [CI] 1.07–1.09), male sex (HR 1.62, 95%CI 1.30–2.00), duration of symptoms before hospital admission <10 days (HR 1.72, 95%CI 1.39–2.12), diabetes (HR 1.21, 95% CI 1.02–1.45), coronary heart disease (HR 1.40 95% CI 1.09–1.80), chronic liver disease (HR 1.78, 95%CI 1.16–2.72), and lactate dehydrogenase levels at admission (HR 1.0003, 95%CI 1.0002–1.0005). The AUC was 0.822 (95%CI 0.722–0.922) in the derivation cohort and 0.820 (95%CI 0.724–0.920) in the validation cohort with good calibration. The prediction rule is freely available as a web-app (COVID-CALC: https://sites.google.com/community. unipa.it/covid-19riskpredictions/c19-rp). Conclusions A validated simple clinical prediction rule can promptly and accurately assess the risk for in-hospital mortality, improving triage and the management of patients with COVID-19.

Published
2021

28. Developmental programming: intrauterine caloric restriction promotes upregulation of mitochondrial sirtuin with mild effects on oxidative parameters in the ovaries and testes of offspring

Author

Dal Magro, B. M., primary, Stone, V., additional, Klein, C. P., additional, Maurmann, R. M., additional, Saccomori, A. B., additional, dos Santos, B. G., additional, August, P. M., additional, Rodrigues, K. S., additional, Conrado, L., additional, de Sousa, F. A. B., additional, Dreimeier, D., additional, Mello, F., additional, and Matté, C., additional

Published
2020
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32. PC.01.10 LIVER AND CARDIOVASCULAR MORTALITY AFTER DAAS: DATA FROM THE RESIST-HCV COHORT

Author

Magro, B., primary, Calvaruso, V., additional, Petta, S., additional, Cacciola, I., additional, Cabibbo, G., additional, Cartabellotta, F., additional, Di Rosolini, A., additional, Davì, A., additional, Cannavò, M., additional, Russello, M., additional, Di Stefano, M., additional, Scifo, G., additional, Di Lorenzo, F., additional, Prestileo, T., additional, Rocca, L. La, additional, Montineri, A., additional, Fuduli, G., additional, Digiacomo, A., additional, Cannizzaro, M., additional, Madonia, S., additional, Licata, A., additional, Malizia, G., additional, Alaimo, G., additional, Bertino, G., additional, Cacopardo, B., additional, Iacobello, C., additional, Averna, A., additional, Guarneri, L., additional, Scalisi, I., additional, Mazzola, G., additional, Mondello, L., additional, Portelli, V., additional, Squadrito, G., additional, Cammà, C., additional, Raimondo, G., additional, Craxì, A., additional, and Di Marco, V., additional

Published
2019
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34. OC.07.1 DIRECT ACTING ANTIVIRALS AFTER SUCCESSFUL TREATMENT OF EARLY HEPATOCELLULAR CARCINOMA IMPROVE SURVIVAL AND REDUCE HEPATIC DECOMPENSATION IN HCV-CIRRHOTIC PATIENTS

Author

Celsa, C., primary, Cabibbo, G., additional, Calvaruso, V., additional, Petta, S., additional, Cacciola, I., additional, Cannavò, M.R., additional, Madonia, S., additional, Rossi, M., additional, Magro, B., additional, Rini, F., additional, Distefano, M., additional, Larocca, L., additional, Prestileo, T., additional, Malizia, G., additional, Bertino, G., additional, Benanti, F., additional, Licata, A., additional, Scalisi, I., additional, Mazzola, G., additional, Di Rosolini, M.A., additional, Alaimo, G., additional, Averna, A., additional, Cartabellotta, F., additional, Alessi, N., additional, Guastella, S., additional, Russello, M., additional, Scifo, G., additional, Squadrito, G., additional, Raimondo, G., additional, Craxì, A., additional, Di Marco, V., additional, and Cammà, C., additional

Published
2019
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35. AA genotype of deSNP rs6726639 of MERTK gene is associated with development of Hepatocellular Carcinoma after eradication of Hepatitis C Virus infection

Author

Di Marco, L., primary, Calvaruso, V., additional, Grimaudo, S., additional, Petta, S., additional, Pipitone, M.R., additional, Cabibbo, G., additional, Conte, E., additional, Magro, B., additional, Rini, F., additional, Celsa, C., additional, Cammà, C., additional, Craxì, A., additional, and Di Marco, V., additional

Published
2019
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36. Direct acting antivirals after successful treatment of early hepatocellular carcinoma improve survival in HCV-cirrhotic patients

Author

Cabibbo, G., primary, Celsa, C., additional, Calvaruso, V., additional, Petta, S., additional, Cacciola, I., additional, Cannavò, M.R., additional, Madonia, S., additional, Rossi, M., additional, Magro, B., additional, Rini, F., additional, Distefano, M., additional, Larocca, L., additional, Prestileo, T., additional, Malizia, G., additional, Bertino, G., additional, Benanti, F., additional, Licata, A., additional, Scalisi, I., additional, Mazzola, G., additional, Di Rosolini, M.A., additional, Alaimo, G., additional, Averna, A., additional, Cartabellotta, F., additional, Alessi, N., additional, Guastella, S., additional, Russello, M., additional, Scifo, G., additional, Squadrito, G., additional, Raimondo, G., additional, Craxì, A., additional, Di Marco, V., additional, and Cammà, C., additional

Published
2019
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43. Transesophageal echocardiography and intracardiac echocardiography differently predict potential technical challenges or failures of interatrial shunts catheter-based closure.

Author

Rigatelli G, Cardaioli P, Braggion G, Aaggio S, Giordan M, Magro B, Nascimben A, Favaro A, Rincon L, Rigatelli, Gianluca, Rigateli, Gianluca, Cardaioli, Paolo, Braggion, Gabriele, Aggio, Silvio, Giordan, Massimo, Magro, Beatrice, Nascimben, Alberto, Favaro, Alberto, Roncon, Loris, and Rincon, Loris

Abstract

We sought to prospectively assess the role of transesophageal (TEE) and intracardiac echocardiography (ICE) in detecting potential technical difficulties or failures in patients submitted to interatrial shunts percutaneous closure. We prospectively enrolled 46 consecutive patients (mean age 35+/-28, 8 years, 30 female) referred to our center for catheter-based closure of interatrial shunts. All patients were screened with TEE before the intervention. Patients who met the inclusion criteria underwent ICE study before the closure attempt (40 patients). TEE detected potential technical difficulties in 22.5% (9/40) patients, whereas ICE detected technical difficulties in 32.5% (13/40 patients). In patients with positive TEE/ICE the procedural success (92.4% versus 100% and, P = ns) and follow-up failure rate (7.7% versus 0%, P = ns) were similar to patients with negative TEE/ICE, whereas the fluoroscopy time (7 +/- 1.2 versus 5 +/- 0.7 minutes, P < 0.03), the procedural time (41 +/- 4.1 versus 30 +/- 8.2 minutes, P +/- 0.03), and technical difficulties rate (23.1% versus 0%, P = 0.013) were higher. Differences between ICE and TEE in the evaluation of rims, measurement of ASD or fossa ovalis, and detection of venous valve and embryonic septal membrane remnants impacted on technical challenges and on procedural and fluoroscopy times but did not influence the success rate and follow-up failure rate. [ABSTRACT FROM AUTHOR]

Published
2007

45. Liver injury after SARS‐CoV‐2 vaccination: Features of immune‐mediated hepatitis, role of corticosteroid therapy and outcome

Author

Cumali Efe, Anand V. Kulkarni, Benedetta Terziroli Beretta‐Piccoli, Bianca Magro, Albert Stättermayer, Mustafa Cengiz, Daniel Clayton‐Chubb, Craig Lammert, Christine Bernsmeier, Özlem Gül, Fatima Higuera‐de la Tijera, Margarita Anders, Ellina Lytvyak, Mete Akın, Tugrul Purnak, Rodrigo Liberal, Mirta Peralta, Berat Ebik, Serkan Duman, Nurhan Demir, Yasemin Balaban, Álvaro Urzua, Fernando Contreras, Maria Grazia Venturelli, Yılmaz Bilgiç, Adriana Medina, Marcos Girala, Fulya Günşar, Maria‐Carlota Londoño, Theodoros Androutsakos, Ayelen Kisch, Alper Yurci, Fatih Güzelbulut, Yasir Furkan Çağın, Enver Avcı, Murat Akyıldız, Emine Kübra Dindar‐Demiray, Murat Harputluoğlu, Rahul Kumar, Sanjaya K. Satapathy, Manuel Mendizabal, Marcelo Silva, Stefano Fagiuoli, Stuart K. Roberts, Neşe Karadağ Soylu, Ramazan Idilman, Eric M. Yoshida, Aldo J. Montano‐Loza, George N. Dalekos, Ezequiel Ridruejo, Thomas D. Schiano, Staffan Wahlin, Efe, C, Kulkarni, A, Terziroli Beretta-Piccoli, B, Magro, B, Friedrich Stattermayer, A, Cengiz, M, Clayton-Chubb, D, Lammert, C, Bernsmeier, C, Gul, O, la Tijera, F, Anders, M, Lytvyak, E, Akin, M, Purnak, T, Liberal, R, Peralta, M, Ebik, B, Duman, S, Demir, N, Balaban, Y, Urzua, A, Contreras, F, Venturelli, M, Bilgic, Y, Medina, A, Girala, M, Gunsar, F, Londono, M, Androutsakos, T, Kisch, A, Yurci, A, Guzelbult, F, Cagin, Y, Avci, E, Guzelbulut, M, Dindar-Demiray, E, Harputluoglu, M, Kumar, R, Satapathy, S, Mendizabal, M, Silva, M, Fagiuoli, S, Roberts, S, Soylu, N, Idilman, R, Yoshida, E, Montano-Loza, A, Dalekos, G, Ridruejo, E, Schiano, T, and Wahlin, S

Subjects
Male, COVID-19 Vaccines, Hepatology, SARS-CoV-2, Vaccination, VACCINE, COVID-19, Middle Aged, Hepatitis A, Hepatitis, Autoimmune, ChAdOx1 nCoV-19, Humans, Disease, Female, Idiopathic Autoimmune Hepatitis, BNT162 Vaccine
Abstract

© 2022 American Association for the Study of Liver Diseases.Background and Aims: A few case reports of autoimmune hepatitis–like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS-CoV-2 vaccination in a large case series. Approach and Results: We collected data from cases in 18 countries. The type of liver injury was assessed with the R-value. The study population was categorized according to features of immune-mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18–79) years at presentation. Liver injury was diagnosed a median 15 (range: 3–65) days after vaccination. Fifty-one cases (59%) were attributed to the Pfizer-BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford-AstraZeneca (ChAdOX1 nCoV-19) vaccine and 16 (18%) cases to the Moderna (mRNA-1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune-mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3–4 liver injury than for grade 1–2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune-mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow-up. Conclusions: SARS-CoV-2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune-mediated features or severe hepatitis. Outcome was generally favorable, but vaccine-associated liver injury led to fulminant liver failure in one patient.

Published
2022
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46. Diagnostic performance of endoscopic ultrasound through‐the‐needle microforceps biopsy of pancreatic cystic lesions: Systematic review with meta‐analysis

Author

M Barchiesi, Calogero Cammà, G Capurso, Bianca Magro, Ciro Celsa, Matteo Tacelli, PG Arcidiacono, Stefano Francesco Crinò, Luca Barresi, Tacelli M., Celsa C., Magro B., Barchiesi M., Barresi L., Capurso G., Arcidiacono P.G., Camma C., Crino S.F., Tacelli, Matteo, Celsa, Ciro, Magro, Bianca, Barchiesi, Marco, Barresi, Luca, Capurso, Gabriele, Arcidiacono, Paolo Giorgio, Cammà, Calogero, and Crinò, Stefano Francesco

Subjects
Endoscopic ultrasound, medicine.medical_specialty, serous cystadenoma, Endosonography, histology, Cystic lesion, 03 medical and health sciences, 0302 clinical medicine, Biopsy, medicine, Humans, Radiology, Nuclear Medicine and imaging, Cyst, Adverse effect, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Pancreas, Intraductal papillary mucinous neoplasm, medicine.diagnostic_test, business.industry, IPMN, intraductal papillary mucinous neoplasm, Gastroenterology, medicine.disease, digestive system diseases, Confidence interval, Pancreatic Neoplasms, FNA, 030220 oncology & carcinogenesis, Meta-analysis, 030211 gastroenterology & hepatology, Radiology, Pancreatic Cyst, Differential diagnosis, business
Abstract

Objectives Endoscopic ultrasound through-the-needle biopsy (EUS-TTNB) is a useful tool for differential diagnosis among pancreatic cystic lesions (PCLs). Cystic fluid cytology (CFC) is recommended by guidelines, but its diagnostic accuracy is about 50%. The aim of this meta-analysis is to assess the clinical impact of EUS-TTNB in terms of technical success (TS), histological accuracy (HA) and diagnostic yield (DY). Methods Original studies in English language on EUS-TTNB were searched in MEDLINE and EMBASE until October 2019. Diagnostic accuracy of EUS-TTNB for identification of mucinous PCLs was calculated using individual diagnostic data of patients who underwent CFC and surgery. Results Nine studies, including 454 patients who underwent EUS-TTNB, met the inclusion criteria for the meta-analysis. TS and HA of EUS-TTNB were, respectively, 98.5% (95% Confidence Interval [CI] 97.3%-99.6%) and 86.7% (95%CI 80.1-93.4). DY was 69.5% (95%CI 59.2-79.7) for EUS-TTNB and 28.7% (95%CI 15.7-41.6) for CFC. Heterogeneity persisted significantly high in most of subgroup analyses. In the multivariate meta-regression, cyst size was independently associated with higher DY. Sensitivity and specificity for mucinous PCLs were 88.6 and 94.7% for EUS-TTNB, and 40 and 100% for CFC. Adverse events rate was 8.6% (95%CI 4.0-13.1). Conclusions This meta-analysis shows that EUS-TTNB is a feasible technique that allows a high rate of adequate specimens to be obtained for histology; in about two-thirds of patients a specific histotype diagnosis could be assessed. The number of adverse events is slightly higher respect to standard EUS-FNA, but complications are very rarely severe.

Published
2020
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47. Successful Treatment of Suspected Donor-derived Human Herpesvirus-8 Infection in a Liver Transplant Patient With Coronavirus Disease-19

Author

Lorena van den Bogaart, Marco Rizzi, Alessandra Tebaldi, Andrea Gianatti, Alessia Dalla Pria, Fabrizio Fabretti, Paolo Giuffrida, And Stefano Fagiuoli, Bianca Magro, Anna Maria Barbui, Anna Maria Peri, Peri, A, Magro, B, Van Den Bogaart, L, Pria, A, Giuffrida, P, Gianatti, A, Fabretti, F, Barbui, A, Tebaldi, A, Rizzi, M, and Fagiuoli, S

Subjects
Transplantation, business.industry, medicine.medical_treatment, coronavirus disease-19, Disease, Liver transplantation, medicine.disease_cause, medicine.disease, Virology, liver transplant, Herpesviridae Infections, Cytokine release syndrome, human herpesvirus-8, Carcinoma, Medicine, Rituximab, Transplant patient, business, medicine.drug, Coronavirus
Published
2021
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48. Association between inhibitors of the renin-angiotensin system and lung function in elderly patients recovered from severe COVID-19

Author

Marco Rizzi, Stefano Fagiuoli, Sandro Sironi, Tiziano Barbui, Alessandra Carobbio, Emilia D'Elia, Roberto Trevisan, Gianpaolo Mangia, Antonello Gavazzi, Michele Senni, Luca Novelli, Arianna Ghirardi, Gianluca Imeri, Roberto Cosentini, Bianca Magro, Federico Raimondi, Ferdinando Luca Lorini, Andrea Giammarresi, Giulio Balestrieri, Mariangela Amoroso, Mauro Gori, Fabiano Di Marco, Gori, M, Ghirardi, A, D'Elia, E, Imeri, G, Di Marco, F, Gavazzi, A, Carobbio, A, Balestrieri, G, Giammarresi, A, Trevisan, R, Amoroso, M, Raimondi, F, Novelli, L, Magro, B, Mangia, G, Lorini, F, Fagiuoli, S, Barbui, T, Rizzi, M, Cosentini, R, Sironi, S, and Senni, M

Subjects
2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Epidemiology, business.industry, SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19, Angiotensin-Converting Enzyme Inhibitors, Renin-Angiotensin System, Renin–angiotensin system, Immunology, Hypertension, Medicine, Humans, COVID 19, renin–angiotensin system inhibitors, angiotensin-converting enzyme 2 (ACE2) receptor, Cardiology and Cardiovascular Medicine, business, Lung, Lung function, Aged
Published
2022

49. Pre-Transplant Alpha-Fetoprotein > 25.5 and Its Dynamic on Waitlist Are Predictors of HCC Recurrence after Liver Transplantation for Patients Meeting Milan Criteria

Author

Andrea Gianatti, Maria Grazia Lucà, Domenico Pinelli, Giuseppe Baronio, Massimo De Giorgio, Stefano Fagiuoli, Alessandra Carrobio, Michele Colledan, Bianca Magro, Arianna Ghirardi, Franck Nounamo, Luca Del Prete, Magro, B, Pinelli, D, De Giorgio, M, Luca, M, Ghirardi, A, Carrobio, A, Baronio, G, Del Prete, L, Nounamo, F, Gianatti, A, Colledan, M, and Fagiuoli, S

Subjects
Cancer Research, medicine.medical_specialty, Cirrhosis, medicine.medical_treatment, Liver transplantation, Milan criteria, Gastroenterology, Article, Liver disease, Recurrence, Internal medicine, medicine, HCC, neoplasms, RC254-282, Alpha fetoprotein, Cirrhosi, business.industry, cirrhosis, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Retrospective cohort study, alpha fetoprotein, liver transplantation, recurrence, medicine.disease, digestive system diseases, Oncology, Hepatocellular carcinoma, Cohort, Alpha-fetoprotein, business
Abstract

Simple Summary In the setting of liver transplantation, prediction of hepatocellular carcinoma (HCC) recurrence persists as a fundamental issue, and few tools are available during the waitlist. Biological features such as alpha-fetoprotein values are strong predictors, but it is necessary to understand how we can use them. In this study, an AFP cut-off value was individuated and also its dynamic increase on the waitlist was defined as a predictor. Abstract Background and Aim: Hepatocellular carcinoma (HCC) recurrence rates after liver transplantation (LT) range between 8 and 20%. Alpha-fetoprotein (AFP) levels at transplant can predict HCC recurrence, however a defined cut-off value is needed to better stratify patients. The aim of this study was to evaluate the rate of HCC recurrence at our centre and to identify predictors, focusing on AFP. Methods: We retrospectively analysed 236 consecutive patients that were waitlisted for HCC who all met the Milan criteria from January 2001 to December 2017 at our liver transplant centre. A total of twenty-nine patients dropped out while they were waitlisted, and 207 patients were included in the final analysis. All survival analyses included the competing-risk model. Results: The mean age was 56.8 ± 6.8 years. A total of 14% were female (n = 29/207). The median MELD (model for end-stage liver disease) at LT was 12 (9–16). The median time on the waitlist was 92 (41–170) days. The HCC recurrence rate was 16.4% (n = 34/208). The mean time to recurrence was 3.3 ± 2.8 years. The median AFP levels at transplant were higher in patients with HCC recurrence (p < 0.001). At multivariate analysis, the AFP value at transplant that was greater than 25.5 ng/mL (AUC 0.69) was a strong predictor of HCC recurrence after LT [sHR 3.3 (1.6–6.81); p = 0.001]. The HCC cumulative incidence function (CIF) of recurrence at 10 years from LT was significantly higher in patients with AFP > 25.5 ng/mL [34.3% vs. 11.5% (p = 0.001)]. Moreover, an increase in AFP > 20.8%, was significantly associated with HCC recurrence (p = 0.034). Conclusions: In conclusion, in our retrospective study, the AFP level at transplant > 25.5 ng/mL and its increase greater than 20.8% on the waitlist were strong predictors of HCC recurrence after LT in a cohort of patients that were waitlisted within the Milan criteria. However further studies are needed to validate these data.

Published
2021
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50. Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis

Author

George N. Dalekos, Cristina Rigamonti, Godolfino Miranda Zazueta, Ali Rıza Calışkan, Annarosa Floreani, Berat Ebik, Kadri Atay, Aylin Demirezer Bolat, Nazım Ekin, Eric M. Yoshida, Graciela Castro Narro, Fatih Güzelbulut, Murat Biyik, Manuel Mendizabal, Renumathy Dhanasekaran, Stefano Fagiuoli, Thomas D. Schiano, Ellina Lytvyak, Shalom Frager, Nataly Chris Escajadillo Vargas, Yucel Ustundag, Ramazan Idilman, Andreea M. Catana, Alvaro Urzúa, Ahmet Yavuz, Staffan Wahlin, Mesut Aydin, Cumali Efe, Laura Cristoferi, Hatef Massoumi, Maria Vincent, Sandro Ruiz Garcia, Evrim Kahramanoğlu-Aksoy, Natalia Ratusnu, Craig Lammert, Sümeyra Yıldırım, Mário Reis Álvares-da-Silva, Murat Harputoğlu, Marina Silveira, Murat Kiyici, Fátima Higuera-de la Tijera, Nurhan Demir, Cynthia Levy, Einar Bjornsson, Javier Brahm, Rotonya M. Carr, Nidah S. Khakoo, Andres Jose Gomez Aldana, Murat Akyildiz, Leyla Nazal, Alessio Gerussi, Tuğçe Eşkazan, Zeynep Ellik, Pietro Invernizzi, Fulya Gunsar, Ezequiel Ridruejo, Eleonora De Martin, Tugrul Purnak, Fatih Eren, Hüseyin Kaçmaz, Margarita Anders, Nikolaos K. Gatselis, Romee Snijders, Sezgin Barutçu, Costica Aloman, Alexandra Heurgue-Berlot, Bianca Magro, Jonathan Aguirre, Kader Irak, Koray Tascilar, Aldo J. Montano-Loza, Marcelo Silva, David N. Assis, Joost P.H. Drenth, Eira Cerda Reyes, Ibrahim Hatemi, Mirta Peralta, Sanjaya K. Satapathy, James L. Boyer, Yasemin H. Balaban, Efe, C, Lammert, C, Tascilar, K, Dhanasekaran, R, Ebik, B, Higuera-de la Tijera, F, Caliskan, A, Peralta, M, Gerussi, A, Massoumi, H, Catana, A, Purnak, T, Rigamonti, C, Aldana, A, Khakoo, N, Nazal, L, Frager, S, Demir, N, Irak, K, Melekoglu-Ellik, Z, Kacmaz, H, Balaban, Y, Atay, K, Eren, F, Alvares-da-Silva, M, Cristoferi, L, Urzua, A, Eskazan, T, Magro, B, Snijders, R, Barutcu, S, Lytvyak, E, Zazueta, G, Demirezer-Bolat, A, Aydin, M, Heurgue-Berlot, A, De Martin, E, Ekin, N, Yildirim, S, Yavuz, A, Biyik, M, Narro, G, Kiyici, M, Akyildiz, M, Kahramanoglu-Aksoy, E, Vincent, M, Carr, R, Gunsar, F, Reyes, E, Harputluoglu, M, Aloman, C, Gatselis, N, Ustundag, Y, Brahm, J, Vargas, N, Guzelbulut, F, Garcia, S, Aguirre, J, Anders, M, Ratusnu, N, Hatemi, I, Mendizabal, M, Floreani, A, Fagiuoli, S, Silva, M, Idilman, R, Satapathy, S, Silveira, M, Drenth, J, Dalekos, G, Assis, D, Bjornsson, E, Boyer, J, Yoshida, E, Invernizzi, P, Levy, C, Montano-Loza, A, Schiano, T, Ridruejo, E, Wahlin, S, Akyıldız, Murat (ORCID 0000-0002-2080-7528 & YÖK ID 123080), Efe, Cumalı, Lammert, Craig, Taşçılar, Koray, Dhanasekaran, Renumathy, Ebik, Berat, Higuera-de la Tijera, Fatima, Çalışkan, Ali R., Peralta, Mirta, Gerussi, Alessio, Massoumi, Hatef, Catana, Andreea M., Purnak, Tuğrul, Rigamonti, Cristina, Aldana, Andres J. G., Khakoo, Nidah, Nazal, Leyla, Frager, Shalom, Demir, Nurhan, Irak, Kader, Melekoğlu-Ellik, Zeynep, Kaçmaz, Hüseyin, Balaban, Yasemin, Atay, Kadri, Eren, Fatih, Alvares-da-Silva, Mario R., Cristoferi, Laura, Urzua, Alvaro, Eskazan, Tugce, Magro, Bianca, Snijders, Romee, Barutçu, Sezgin, Lytvyak, Ellina, Zazueta, Godolfino M., Demirezer-Bolat, Aylin, Aydın, Mesut, Heurgue-Berlot, Alexandra, De Martin, Eleonora, Ekin, Nazım, Yıldırım, Sumeyra, Yavuz, Ahmet, Bıyık, Murat, Narro, Graciela C., Kıyıcı, Murat, Kahramanoğlu-Aksoy, Evrim, Vincent, Maria, Carr, Rotonya M., Günsar, Fulya, Reyes, Eira C., Harputluoğlu, Murat, Aloman, Costica, Gatselis, Nikolaos K., Üstündağ, Yücel, Brahm, Javier, Vargas, Nataly C. E., Güzelbulut, Fatih, Garcia, Sandro R., Aguirre, Jonathan, Anders, Margarita, Ratusnu, Natalia, Hatemi, İbrahim, Mendizabal, Manuel, Floreani, Annarosa, Fagiuoli, Stefano, Silva, Marcelo, İdilman, Ramazan, Satapathy, Sanjaya K., Silveira, Marina, Drenth, Joost P. H., Dalekos, George N., Assis, David N., Bjornsson, Einar, Boyer, James L., Yoshida, Eric M., Invernizzi, Pietro, Levy, Cynthia, Montano-Loza, Aldo J., Schiano, Thomas D., Ridruejo, Ezequiel, Wahlin, Staffan, and School of Medicine

Subjects
Adult, Male, medicine.medical_specialty, budesonide, Cirrhosis, Adolescent, Gastroenterology and hepatology, medicine.medical_treatment, Azathioprine, Autoimmune hepatitis, mercaptopurine, Liver transplantation, Gastroenterology, Young Adult, Sars-Cov-2 Infection, Internal medicine, medicine, Humans, Autoimmunity, Budesonide, Mercaptopurine, SARS-CoV-2, Aged, Retrospective Studies, Mechanical ventilation, Aged, 80 and over, azathioprine, liver transplantation, Hepatology, business.industry, autoimmunity, COVID-19, Immunosuppression, Odds ratio, Middle Aged, medicine.disease, Tacrolimus, Liver-Transplant Recipients, Hospitalization, Hepatitis, Autoimmune, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Pharmaceutical Preparations, Female, business, medicine.drug
Abstract

Background We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). Patients and methods Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. Results We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. Conclusion Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH., Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic), A. Gerussi, L. Cristoferi, and P. Invernizzi acknowledge that this research was partially supported by the Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic).

Published
2021

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