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1. Graft factors as determinants of postoperative delirium after liver transplantation

Author: Patrono, D., Rigo, F., Bormida, S., Berchialla, P., Giordanengo, L., Skurzak, S., Balagna, R., and Romagnoli, R.
Published: 2020
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2. 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

3. 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

4. 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

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

Author: De Carlis, R, Lauterio, A, Centonze, L, Buscemi, V, Schlegel, A, Muiesan, P, De Carlis, L, Carraro, A, Ghinolfi, D, De Simone, P, Ravaioli, M, Cescon, M, Dondossola, D, Bongini, M, Mazzaferro, V, Pagano, D, Gruttadauria, S, Gringeri, E, Cillo, U, Patrono, D, Romagnoli, R, Camagni, S, Colledan, M, Olivieri, T, Di Benedetto, F, Vennarecci, G, Baccarani, U, Lai, Q, Rossi, M, Manzia, T, Tisone, G, Vivarelli, M, Scalera, I, Lupo, L, Andorno, E, Meniconi, R, Ettorre, G, Avolio, A, Agnes, S, Pellegrino, R, Zamboni, F, De Carlis R., Lauterio A., Centonze L., Buscemi V., Schlegel A., Muiesan P., De Carlis L., Carraro A., Ghinolfi D., De Simone P., Ravaioli M., Cescon M., Dondossola D., Bongini M., Mazzaferro V., Pagano D., Gruttadauria S., Gringeri E., Cillo U., Patrono D., Romagnoli R., Camagni S., Colledan M., Olivieri T., Di Benedetto F., Vennarecci G., Baccarani U., Lai Q., Rossi M., Manzia T. M., Tisone G., Vivarelli M., Scalera I., Lupo L. G., Andorno E., Meniconi R. L., Ettorre G. M., Avolio A. W., Agnes S., Pellegrino R. A., Zamboni F., De Carlis, R, Lauterio, A, Centonze, L, Buscemi, V, Schlegel, A, Muiesan, P, De Carlis, L, Carraro, A, Ghinolfi, D, De Simone, P, Ravaioli, M, Cescon, M, Dondossola, D, Bongini, M, Mazzaferro, V, Pagano, D, Gruttadauria, S, Gringeri, E, Cillo, U, Patrono, D, Romagnoli, R, Camagni, S, Colledan, M, Olivieri, T, Di Benedetto, F, Vennarecci, G, Baccarani, U, Lai, Q, Rossi, M, Manzia, T, Tisone, G, Vivarelli, M, Scalera, I, Lupo, L, Andorno, E, Meniconi, R, Ettorre, G, Avolio, A, Agnes, S, Pellegrino, R, Zamboni, F, De Carlis R., Lauterio A., Centonze L., Buscemi V., Schlegel A., Muiesan P., De Carlis L., Carraro A., Ghinolfi D., De Simone P., Ravaioli M., Cescon M., Dondossola D., Bongini M., Mazzaferro V., Pagano D., Gruttadauria S., Gringeri E., Cillo U., Patrono D., Romagnoli R., Camagni S., Colledan M., Olivieri T., Di Benedetto F., Vennarecci G., Baccarani U., Lai Q., Rossi M., Manzia T. M., Tisone G., Vivarelli M., Scalera I., Lupo L. G., Andorno E., Meniconi R. L., Ettorre G. M., Avolio A. W., Agnes S., Pellegrino R. A., and Zamboni F.
Abstract: Background: Normothermic regional perfusion (NRP) and machine perfusion (MP) are variously used in many European centers to improve the outcomes after liver transplantation from donation after circulatory death (DCD). In Italy, a combination of NRP and subsequent MP has been used since the start of the activity. While NRP is mandatory for every DCD recovery, the subsequent use of MP is left to each center. Methods: We have designed a national survey to investigate practices and policies of these techniques. The questionnaire included 46 questions and was distributed to all the 21 Italian centers using an online form between June and July 2021. Results: The overall response rate was 100%. A local NRP program for controlled Maastricht type 3 DCD was active in 11/21 (52.4%) centers. Organization and availability of personnel were perceived as the main difficulties in starting such a program. Between 2015 and 2020, 119 DCD livers were transplanted, with an overall utilization rate of 69.2%. Pump flow and gross aspect were considered the most reliable parameters in liver selection during NRP. Eight (72.7%) centers adopted subsequent hypothermic MP, 1 (9.1%) center normothermic MP, and the remaining 2 (18.2%) used both MP types. Conclusion: This first snapshot survey shows that NRP with subsequent MP is the most used protocol in Italy for DCD livers, although some heterogeneity exists in the type and purpose of MP between centers. Overall, this policy ensures a high utilization rate, considering the high risk of the DCD donor population in Italy. Graphical abstract: [Figure not available: see fulltext.]
Published: 2022

6. 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

7. 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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8. A Bayesian methodology to improve prediction of early graft loss after liver transplantation derived from the Liver Match study

Author: Angelico, M., Cillo, U., Fagiuoli, S., Strazzabosco, M., Caraceni, P., Toniutto, P.L., Nanni Costa, A., Salizzoni, Torino M., Romagnoli, R., Bertolotti, G., Patrono, D., De Carlis, L., Slim, A., Mangoni, J.M.E., Rossi, G., Caccamo, L., Antonelli, B., Mazzaferro, V., Regalia, E., Sposito, C., Colledan, M., Corno, V., Tagliabue, F., Marin, S., Vitale, A., Gringeri, E., Donataccio, M., Donataccio, D., Baccarani, U., Lorenzin, D., Bitetto, D., Valente, U., Gelli, M., Cupo, P., Gerunda, G.E., Rompianesi, G., Pinna, A.D., Grazi, G.L., Cucchetti, A., Zanfi, C., Risaliti, A., Faraci, M.G., Tisone, G., Anselmo, A., Lenci, I., Sforza, D., Agnes, S., Di Mugno, M., Avolio, A.W., Ettorre, G.M., Miglioresi, L., Vennarecci, G., Berloco, P., Rossi, M., Ginanni Corradini, S., Molinaro, A., Calise, F., Scuderi, V., Cuomo, O., Migliaccio, C., Lupo, L., Notarnicola, G., Gridelli, B., Volpes, R., Li Petri, S., Zamboni, F., Carbotta, G., Dedola, S., Nardi, A., Marianelli, T., Gavrila, C., Ricci, A., Vespasiano, F., Angelico, Mario, Nardi, Alessandra, Romagnoli, Renato, Marianelli, Tania, Corradini, Stefano Ginanni, Tandoi, Francesco, Gavrila, Caius, Salizzoni, Mauro, Pinna, Antonio D., Cillo, Umberto, Gridelli, Bruno, De Carlis, Luciano G., Colledan, Michele, Gerunda, Giorgio E., Costa, Alessandro Nanni, and Strazzabosco, Mario
Published: 2014
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9. Current practice of normothermic regional perfusion and machine perfusion in donation after circulatory death liver transplants in Italy

Author: De Carlis, R., Lauterio, A., Centonze, L., Buscemi, V., Schlegel, A., Muiesan, P., De Carlis, L., Carraro, A., Ghinolfi, D., De Simone, P., Ravaioli, M., Cescon, M., Dondossola, D., Bongini, M., Mazzaferro, V., Pagano, D., Gruttadauria, S., Gringeri, E., Cillo, U., Patrono, D., Romagnoli, R., Camagni, S., Colledan, M., Olivieri, T., Di Benedetto, F., Vennarecci, G., Baccarani, U., Lai, Q., Rossi, M., Manzia, T. M., Tisone, G., Vivarelli, M., Scalera, I., Lupo, L. G., Andorno, E., Meniconi, R. L., Ettorre, G. M., Avolio, A. W., Agnes, S., Pellegrino, R. A., Zamboni, F., De Carlis, R, Lauterio, A, Centonze, L, Buscemi, V, Schlegel, A, Muiesan, P, De Carlis, L, Carraro, A, Ghinolfi, D, De Simone, P, Ravaioli, M, Cescon, M, Dondossola, D, Bongini, M, Mazzaferro, V, Pagano, D, Gruttadauria, S, Gringeri, E, Cillo, U, Patrono, D, Romagnoli, R, Camagni, S, Colledan, M, Olivieri, T, Di Benedetto, F, Vennarecci, G, Baccarani, U, Lai, Q, Rossi, M, Manzia, T, Tisone, G, Vivarelli, M, Scalera, I, Lupo, L, Andorno, E, Meniconi, R, Ettorre, G, Avolio, A, Agnes, S, Pellegrino, R, and Zamboni, F
Subjects: Warm ischemia, Hypothermic oxygenated perfusion, Ischemic-type biliary lesions, Liver preservation, Liver utilization, Graft Survival, Organ Preservation, Ischemic-type biliary lesion, Tissue Donors, Settore MED/18, Liver Transplantation, Perfusion, Humans, Surgery
Abstract: Background: Normothermic regional perfusion (NRP) and machine perfusion (MP) are variously used in many European centers to improve the outcomes after liver transplantation from donation after circulatory death (DCD). In Italy, a combination of NRP and subsequent MP has been used since the start of the activity. While NRP is mandatory for every DCD recovery, the subsequent use of MP is left to each center. Methods: We have designed a national survey to investigate practices and policies of these techniques. The questionnaire included 46 questions and was distributed to all the 21 Italian centers using an online form between June and July 2021. Results: The overall response rate was 100%. A local NRP program for controlled Maastricht type 3 DCD was active in 11/21 (52.4%) centers. Organization and availability of personnel were perceived as the main difficulties in starting such a program. Between 2015 and 2020, 119 DCD livers were transplanted, with an overall utilization rate of 69.2%. Pump flow and gross aspect were considered the most reliable parameters in liver selection during NRP. Eight (72.7%) centers adopted subsequent hypothermic MP, 1 (9.1%) center normothermic MP, and the remaining 2 (18.2%) used both MP types. Conclusion: This first snapshot survey shows that NRP with subsequent MP is the most used protocol in Italy for DCD livers, although some heterogeneity exists in the type and purpose of MP between centers. Overall, this policy ensures a high utilization rate, considering the high risk of the DCD donor population in Italy. Graphical abstract: [Figure not available: see fulltext.]
Published: 2022

10. An Italian survey on the use of T-tube in liver transplantation: old habits die hard!

Author: Pravisani, R, De Simone, P, Patrono, D, Lauterio, A, Cescon, M, Gringeri, E, Colledan, M, Di Benedetto, F, di Francesco, F, Antonelli, B, Manzia, T, Carraro, A, Vivarelli, M, Regalia, E, Vennarecci, G, Guglielmo, N, Cesaretti, M, Avolio, A, Valentini, M, Lai, Q, Baccarani, U, Pravisani R, De Simone P, Patrono D, Lauterio A, Cescon M, Gringeri E, Colledan M, Di Benedetto F, di Francesco F, Antonelli B, Manzia TM, Carraro A, Vivarelli M, Regalia E, Vennarecci G, Guglielmo N, Cesaretti M, Avolio AW, Valentini MF, Lai QRO, Baccarani U, Pravisani, R, De Simone, P, Patrono, D, Lauterio, A, Cescon, M, Gringeri, E, Colledan, M, Di Benedetto, F, di Francesco, F, Antonelli, B, Manzia, T, Carraro, A, Vivarelli, M, Regalia, E, Vennarecci, G, Guglielmo, N, Cesaretti, M, Avolio, A, Valentini, M, Lai, Q, Baccarani, U, Pravisani R, De Simone P, Patrono D, Lauterio A, Cescon M, Gringeri E, Colledan M, Di Benedetto F, di Francesco F, Antonelli B, Manzia TM, Carraro A, Vivarelli M, Regalia E, Vennarecci G, Guglielmo N, Cesaretti M, Avolio AW, Valentini MF, Lai QRO, and Baccarani U
Abstract: There is enough clinical evidence that a T-tube use in biliary reconstruction at adult liver transplantation (LT) does not significantly modify the risk of biliary stricture/leak, and it may even sustain infective and metabolic complications. Thus, the policy on T-tube use has been globally changing, with progressive application of more restrictive selection criteria. However, there are no currently standardized indications in such change, and many LT Centers rely only on own experience and routine. A nation-wide survey was conducted among all the 20 Italian adult LT Centers to investigate the current policy on T-tube use. It was found that 20% of Centers completely discontinued the T-tube use, while 25% Centers used it routinely in all LT cases. The remaining 55% of Centers applied a selective policy, based on criteria of technical complexity of biliary reconstruction (72.7%), followed by low-quality graft (63.6%) and high-risk recipient (36.4%). A T-tube use > 50% of annual caseload was not associated with high-volume Center status (> 70 LT per year), an active pediatric or living-donor transplant program, or use of DCD grafts. Only 10/20 (50%) Centers identified T-tube as a potential risk factor for complications other than biliary stricture/leak. In these cases, the suspected pathogenic mechanism comprised bacterial colonization (70%), malabsorption (70%), interruption of the entero-hepatic bile-acid cycle (50%), biliary inflammation due to an indwelling catheter (40%) and gut microbiota changes (40%). In conclusion, the prevalence of T-tube use among the Italian LT Centers is still relatively high, compared to the European trend (33%), and the potential detrimental effect of T-tube, beyond biliary stricture/leak, seems to be somehow underestimated.
Published: 2021

11. COVID-19 in liver transplant candidates: Pretransplant and post-transplant outcomes - An ELITA/ELTR multicentre cohort study

Author: Belli, L, Duvoux, C, Cortesi, P, Facchetti, R, Iacob, S, Perricone, G, Radenne, S, Conti, S, Patrono, D, Berlakovich, G, Hann, A, Pasulo, L, Castells, L, Faitot, F, Detry, O, Invernizzi, F, Magini, G, De Simone, P, Kounis, I, Morelli, M, Diaz Fontenla, F, Ericzon, B, Loinaz, C, Johnston, C, Gheorghe, L, Lesurtel, M, Romagnoli, R, Kollmann, D, Perera, M, Fagiuoli, S, Mirza, D, Coilly, A, Toso, C, Zieniewicz, K, Elkrief, L, Karam, V, Adam, R, Den Hoed, C, Merli, M, Puoti, M, De Carlis, L, Oniscu, G, Piano, S, Angeli, P, Fondevila, C, Polak, W, Belli L. S., Duvoux C., Cortesi P. A., Facchetti R., Iacob S., Perricone G., Radenne S., Conti S., Patrono D., Berlakovich G., Hann A., Pasulo L., Castells L., Faitot F., Detry O., Invernizzi F., Magini G., De Simone P., Kounis I., Morelli M. C., Diaz Fontenla F., Ericzon B. -G., Loinaz C., Johnston C., Gheorghe L., Lesurtel M., Romagnoli R., Kollmann D., Perera M. T. P. R., Fagiuoli S., Mirza D., Coilly A., Toso C., Zieniewicz K., Elkrief L., Karam V., Adam R., Den Hoed C., Merli M., Puoti M., De Carlis L., Oniscu G. C., Piano S., Angeli P., Fondevila C., Polak W. G., Belli, L, Duvoux, C, Cortesi, P, Facchetti, R, Iacob, S, Perricone, G, Radenne, S, Conti, S, Patrono, D, Berlakovich, G, Hann, A, Pasulo, L, Castells, L, Faitot, F, Detry, O, Invernizzi, F, Magini, G, De Simone, P, Kounis, I, Morelli, M, Diaz Fontenla, F, Ericzon, B, Loinaz, C, Johnston, C, Gheorghe, L, Lesurtel, M, Romagnoli, R, Kollmann, D, Perera, M, Fagiuoli, S, Mirza, D, Coilly, A, Toso, C, Zieniewicz, K, Elkrief, L, Karam, V, Adam, R, Den Hoed, C, Merli, M, Puoti, M, De Carlis, L, Oniscu, G, Piano, S, Angeli, P, Fondevila, C, Polak, W, Belli L. S., Duvoux C., Cortesi P. A., Facchetti R., Iacob S., Perricone G., Radenne S., Conti S., Patrono D., Berlakovich G., Hann A., Pasulo L., Castells L., Faitot F., Detry O., Invernizzi F., Magini G., De Simone P., Kounis I., Morelli M. C., Diaz Fontenla F., Ericzon B. -G., Loinaz C., Johnston C., Gheorghe L., Lesurtel M., Romagnoli R., Kollmann D., Perera M. T. P. R., Fagiuoli S., Mirza D., Coilly A., Toso C., Zieniewicz K., Elkrief L., Karam V., Adam R., Den Hoed C., Merli M., Puoti M., De Carlis L., Oniscu G. C., Piano S., Angeli P., Fondevila C., and Polak W. G.
Abstract: Objective: Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course. Design: Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed. Results: From 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10-30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15-19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44-102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31-170). Conclusions: Increased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).
Published: 2021

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

Author: De Carlis, R, Schlegel, A, Frassoni, S, Olivieri, T, Ravaioli, M, Camagni, S, Patrono, D, Bassi, D, Pagano, D, Di Sandro, S, Lauterio, A, Bagnardi, V, Gruttadauria, S, Cillo, U, Romagnoli, R, Colledan, M, Cescon, M, Di Benedetto, F, Muiesan, P, De Carlis, L, De Carlis R., Schlegel A., Frassoni S., Olivieri T., Ravaioli M., Camagni S., Patrono D., Bassi D., Pagano D., Di Sandro S., Lauterio A., Bagnardi V., Gruttadauria S., Cillo U., Romagnoli R., Colledan M., Cescon M., Di Benedetto F., Muiesan P., De Carlis L., De Carlis, R, Schlegel, A, Frassoni, S, Olivieri, T, Ravaioli, M, Camagni, S, Patrono, D, Bassi, D, Pagano, D, Di Sandro, S, Lauterio, A, Bagnardi, V, Gruttadauria, S, Cillo, U, Romagnoli, R, Colledan, M, Cescon, M, Di Benedetto, F, Muiesan, P, De Carlis, L, De Carlis R., Schlegel A., Frassoni S., Olivieri T., Ravaioli M., Camagni S., Patrono D., Bassi D., Pagano D., Di Sandro S., Lauterio A., Bagnardi V., Gruttadauria S., Cillo U., Romagnoli R., Colledan M., Cescon M., Di Benedetto F., Muiesan P., and De Carlis L.
Abstract: Background. Donation after circulatory death (DCD) in Italy, given its 20-min stand-off period, provides a unique bench test for normothermic regional perfusion (NRP) and dual hypothermic oxygenated machine perfusion (D-HOPE). Methods. We coordinated a multicenter retrospective Italian cohort study with 44 controlled DCD donors, who underwent NRP, to present transplant characteristics and results. To rank our results according to the high donor risk, we matched and compared a subgroup of 37 controlled DCD livers, preserved with NRP and D-HOPE, with static-preserved controlled DCD transplants from an established European program. Results. In the Italian cohort, D-HOPE was used in 84% of cases, and the primary nonfunction rate was 5%. Compared with the matched comparator group, the NRP + D-HOPE group showed a lower incidence of moderate and severe acute kidney injury (stage 2: 8% versus 27% and stage 3: 3% versus 27%; P = 0.001). Ischemic cholangiopathy remained low (2-y proportion free: 97% versus 92%; P = 0.317), despite the high-risk profile resulting from the longer donor warm ischemia in Italy (40 versus 18 min; P < 0.001). Conclusions. These data suggest that NRP and D-HOPE yield good results in DCD livers with prolonged warm ischemia.
Published: 2021

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

Author: Avolio, A, Franco, A, Schlegel, A, Lai, Q, Meli, S, Burra, P, Patrono, D, Ravaioli, M, Bassi, D, Ferla, F, Pagano, D, Violi, P, Camagni, S, Dondossola, D, Montalti, R, Alrawashdeh, W, Vitale, A, Teofili, L, Spoletini, G, Magistri, P, Bongini, M, Rossi, M, Mazzaferro, V, Di Benedetto, F, Hammond, J, Vivarelli, M, Agnes, S, Colledan, M, Carraro, A, Cescon, M, De Carlis, L, Caccamo, L, Gruttadauria, S, Muiesan, P, Cillo, U, Romagnoli, R, De Simone, P, Avolio A. W., Franco A., Schlegel A., Lai Q., Meli S., Burra P., Patrono D., Ravaioli M., Bassi D., Ferla F., Pagano D., Violi P., Camagni S., Dondossola D., Montalti R., Alrawashdeh W., Vitale A., Teofili L., Spoletini G., Magistri P., Bongini M., Rossi M., Mazzaferro V., Di Benedetto F., Hammond J., Vivarelli M., Agnes S., Colledan M., Carraro A., Cescon M., De Carlis L., Caccamo L., Gruttadauria S., Muiesan P., Cillo U., Romagnoli R., De Simone P., Avolio, A, Franco, A, Schlegel, A, Lai, Q, Meli, S, Burra, P, Patrono, D, Ravaioli, M, Bassi, D, Ferla, F, Pagano, D, Violi, P, Camagni, S, Dondossola, D, Montalti, R, Alrawashdeh, W, Vitale, A, Teofili, L, Spoletini, G, Magistri, P, Bongini, M, Rossi, M, Mazzaferro, V, Di Benedetto, F, Hammond, J, Vivarelli, M, Agnes, S, Colledan, M, Carraro, A, Cescon, M, De Carlis, L, Caccamo, L, Gruttadauria, S, Muiesan, P, Cillo, U, Romagnoli, R, De Simone, P, Avolio A. W., Franco A., Schlegel A., Lai Q., Meli S., Burra P., Patrono D., Ravaioli M., Bassi D., Ferla F., Pagano D., Violi P., Camagni S., Dondossola D., Montalti R., Alrawashdeh W., Vitale A., Teofili L., Spoletini G., Magistri P., Bongini M., Rossi M., Mazzaferro V., Di Benedetto F., Hammond J., Vivarelli M., Agnes S., Colledan M., Carraro A., Cescon M., De Carlis L., Caccamo L., Gruttadauria S., Muiesan P., Cillo U., Romagnoli R., and De Simone P.
Abstract: Importance: Expansion of donor acceptance criteria for liver transplant increased the risk for early allograft failure (EAF), and although EAF prediction is pivotal to optimize transplant outcomes, there is no consensus on specific EAF indicators or timing to evaluate EAF. Recently, the Liver Graft Assessment Following Transplantation (L-GrAFT) algorithm, based on aspartate transaminase, bilirubin, platelet, and international normalized ratio kinetics, was developed from a single-center database gathered from 2002 to 2015. Objective: To develop and validate a simplified comprehensive model estimating at day 10 after liver transplant the EAF risk at day 90 (the Early Allograft Failure Simplified Estimation [EASE] score) and, secondarily, to identify early those patients with unsustainable EAF risk who are suitable for retransplant. Design, Setting, and Participants: This multicenter cohort study was designed to develop a score capturing a continuum from normal graft function to nonfunction after transplant. Both parenchymal and vascular factors, which provide an indication to list for retransplant, were included among the EAF determinants. The L-GrAFT kinetic approach was adopted and modified with fewer data entries and novel variables. The population included 1609 patients in Italy for the derivation set and 538 patients in the UK for the validation set; all were patients who underwent transplant in 2016 and 2017. Main Outcomes and Measures: Early allograft failure was defined as graft failure (codified by retransplant or death) for any reason within 90 days after transplant. Results: At day 90 after transplant, the incidence of EAF was 110 of 1609 patients (6.8%) in the derivation set and 41 of 538 patients (7.6%) in the external validation set. Median (interquartile range) ages were 57 (51-62) years in the derivation data set and 56 (49-62) years in the validation data set. The EASE score was developed through 17 entries derived from 8 variables, including the Mod
Published: 2020

14. 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

15. Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Author: Manzia, T, Angelico, R, Parente, A, Muiesan, P, Tisone, G, Al Alawy, Y, Arif, A, Attia, M, Bhati, C, Battula R, N, Bonney, G, Brooke-Smith, M, Derosas, C, De Liguori Carino, N, Ferretti, S, Fiorani, C, Gherardi, D, Hegab, B, Hussain, Z, Ielpo, B, Iesari, S, Lai, Q, Lainas, P, Lauterio, A, Lazzaro, A, Marudanayagam, R, Nasralla, D, Nicolini, D, Orlando, G, Patrono, D, Pitchaimuthu, M, Polak, W, Quinto, A, Rai, R, Scalera, I, Schlegel, A, Shanmugam, V, Vitale, A, Widmer, J, Yannick, D, Manzia T. M., Angelico R., Parente A., Muiesan P., Tisone G., Al Alawy Y., Arif A. J., Attia M., Bhati C., Battula R N., Bonney G. K., Brooke-Smith M., Derosas C., De Liguori Carino N., Ferretti S., Fiorani C., Gherardi D., Hegab B., Hussain Z., Ielpo B., Iesari S., Lai Q., Lainas P., Lauterio A., Lazzaro A., Marudanayagam R., Nasralla D., Nicolini D., Orlando G., Patrono D., Pitchaimuthu M., Polak W., Quinto A. M., Rai R., Scalera I., Schlegel A., Shanmugam V., Vitale A., Widmer J., Yannick D., Manzia, T, Angelico, R, Parente, A, Muiesan, P, Tisone, G, Al Alawy, Y, Arif, A, Attia, M, Bhati, C, Battula R, N, Bonney, G, Brooke-Smith, M, Derosas, C, De Liguori Carino, N, Ferretti, S, Fiorani, C, Gherardi, D, Hegab, B, Hussain, Z, Ielpo, B, Iesari, S, Lai, Q, Lainas, P, Lauterio, A, Lazzaro, A, Marudanayagam, R, Nasralla, D, Nicolini, D, Orlando, G, Patrono, D, Pitchaimuthu, M, Polak, W, Quinto, A, Rai, R, Scalera, I, Schlegel, A, Shanmugam, V, Vitale, A, Widmer, J, Yannick, D, Manzia T. M., Angelico R., Parente A., Muiesan P., Tisone G., Al Alawy Y., Arif A. J., Attia M., Bhati C., Battula R N., Bonney G. K., Brooke-Smith M., Derosas C., De Liguori Carino N., Ferretti S., Fiorani C., Gherardi D., Hegab B., Hussain Z., Ielpo B., Iesari S., Lai Q., Lainas P., Lauterio A., Lazzaro A., Marudanayagam R., Nasralla D., Nicolini D., Orlando G., Patrono D., Pitchaimuthu M., Polak W., Quinto A. M., Rai R., Scalera I., Schlegel A., Shanmugam V., Vitale A., Widmer J., and Yannick D.
Abstract: Background: Since the Coronavirus disease-19(COVID-19) pandemic, the healthcare systems are reallocating their medical resources, with consequent narrowed access to elective surgery for benign conditions such as gallstone disease(GD). This survey represents an overview of the current policies regarding the surgical management of patients with GD during the COVID-19 pandemic. Methods: A Web-based survey was conducted among 36 Hepato-Prancreato-Biliary surgeons from 14 Countries. Through a 17-item questionnaire, participants were asked about the local management of patients with GD since the start of the COVID-19 pandemic. Results: The majority (n = 26,72.2%) of surgeons reported an alarming decrease in the cholecystectomy rate for GD since the start of the pandemic, regardless of the Country: 19(52.7%) didn't operate any GD, 7(19.4%) reduced their surgical activity by 50–75%, 10(27.8%) by 25–50%, 1(2.8%) maintained regular activity. Currently, only patients with GD complications are operated. Thirty-two (88.9%) participants expect these changes to last for at least 3 months. In 15(41.6%) Centers, patients are currently being screened for SARS-CoV-2 infection before cholecystectomy [in 10(27.8%) Centers only in the presence of suspected infection, in 5(13.9%) routinely]. The majority of surgeons (n = 29,80.6%) have adopted a laparoscopic approach as standard surgery, 5(13.9%) perform open cholecystectomy in patients with known/suspected SARS-CoV-2 infection, and 2(5.6%) in all patients. Conclusion: In the ongoing COVID-19 emergency, the surgical treatment of GD is postponed, resulting in a huge number of untreated patients who could develop severe morbidity. Updated guidelines and dedicated pathways for patients with benign disease awaiting elective surgery are mandatory to prevent further aggravation of the overloaded healthcare systems.
Published: 2020

16. Preoperative risk score for prediction of long-term outcomes after hepatectomy for intrahepatic cholangiocarcinoma: Report of a collaborative, international-based, external validation study

Author: Brustia, R, Langella, S, Kawai, T, Fonseca, G, Schielke, A, Colli, F, Resende, V, Fleres, F, Roulin, D, Leyman, P, Giacomoni, A, Granger, B, Fartoux, L, De Carlis, L, Demartines, N, Sommacale, D, Sanches, M, Patrono, D, Detry, O, Herman, P, Okumura, S, Ferrero, A, Scatton, O, Uemoto, S, Perdigao, F, Nolasco, F, Laroche, S, Romagnoli, R, Famularo, S, Brustia R., Langella S., Kawai T., Fonseca G. M., Schielke A., Colli F., Resende V., Fleres F., Roulin D., Leyman P., Giacomoni A., Granger B., Fartoux L., De Carlis L., Demartines N., Sommacale D., Sanches M. D., Patrono D., Detry O., Herman P., Okumura S., Ferrero A., Scatton O., Uemoto S., Perdigao F., Nolasco F., Laroche S., Romagnoli R., Famularo S., Brustia, R, Langella, S, Kawai, T, Fonseca, G, Schielke, A, Colli, F, Resende, V, Fleres, F, Roulin, D, Leyman, P, Giacomoni, A, Granger, B, Fartoux, L, De Carlis, L, Demartines, N, Sommacale, D, Sanches, M, Patrono, D, Detry, O, Herman, P, Okumura, S, Ferrero, A, Scatton, O, Uemoto, S, Perdigao, F, Nolasco, F, Laroche, S, Romagnoli, R, Famularo, S, Brustia R., Langella S., Kawai T., Fonseca G. M., Schielke A., Colli F., Resende V., Fleres F., Roulin D., Leyman P., Giacomoni A., Granger B., Fartoux L., De Carlis L., Demartines N., Sommacale D., Sanches M. D., Patrono D., Detry O., Herman P., Okumura S., Ferrero A., Scatton O., Uemoto S., Perdigao F., Nolasco F., Laroche S., Romagnoli R., and Famularo S.
Abstract: Purpose: A preoperative risk score (PRS) to predict outcome of patients with intrahepatic cholangiocarcinoma treated by liver surgery could be clinically relevant.To assess accuracy for broadly adoption, external validation of predictive models on independent datasets is crucial. The objective of this study was to externally validate the score for prediction of long-term outcomes after liver surgery for intrahepatic cholangiocarcinoma proposed by Sasaki et al. and based on preoperative albumin, neutrophil-to-lymphocytes-ratio, CA19-9 and tumor size. Methods: Patients treated by liver surgery for intrahepatic cholangiocarcinoma at 11 international HPB centers from 2001 to 2018 were included in the external validation cohort. Harrell's c-index and Hosmer-Lemeshow analyses were used to test PRS discrimination and calibration. Kaplan–Meier curve for risk groups as described in the original study were displayed. Results: A total of 355 patients with 174 deaths during the follow-up period (median = 41.7 months, IQR 32.8–50.6) were included. The median PRS value was 14.7 (IQR 10.7–20.6), with normal distribution across the cohort. A Cox regression on PRS covariates found coefficients similar to those of the derivation cohort, except for tumor size. Measures of discrimination estimated by Harrell's c-index was 0.61(95%CI:0.56–0.67) and Hosmer-Lemeshow p = 0.175. The Kaplan-Meyer estimation showed reasonable discrimination across risk groups, with 5years survival rate ranging from 20.1% to 0%. Conclusion: In this external validation cohort, the PRS had mild discrimination and poor calibration performance, similarly to the original publication. Nevertheless, its ability to identify different classes of risk is clinically useful, for a better tailoring of a therapeutic strategy.
Published: 2020

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

Author: Brüggenwirth, I, Mueller, M, Lantinga, V, Camagni, S, De Carlis, R, De Carlis, L, Colledan, M, Dondossola, D, Drefs, M, Eden, J, Ghinolfi, D, Koliogiannis, D, Lurje, G, Manzia, T, Monbaliu, D, Muiesan, P, Patrono, D, Pratschke, J, Romagnoli, R, Rayar, M, Roma, F, Schlegel, A, Dutkowski, P, Porte, R, de Meijer, V, Brüggenwirth, Isabel M A, Mueller, Matteo, Lantinga, Veerle A, Camagni, Stefania, De Carlis, Riccardo, De Carlis, Luciano, Colledan, Michele, Dondossola, Daniele, Drefs, Moritz, Eden, Janina, Ghinolfi, Davide, Koliogiannis, Dionysios, Lurje, Georg, Manzia, Tommaso M, Monbaliu, Diethard, Muiesan, Paolo, Patrono, Damiano, Pratschke, Johann, Romagnoli, Renato, Rayar, Michel, Roma, Federico, Schlegel, Andrea, Dutkowski, Philipp, Porte, Robert J, de Meijer, Vincent E, Brüggenwirth, I, Mueller, M, Lantinga, V, Camagni, S, De Carlis, R, De Carlis, L, Colledan, M, Dondossola, D, Drefs, M, Eden, J, Ghinolfi, D, Koliogiannis, D, Lurje, G, Manzia, T, Monbaliu, D, Muiesan, P, Patrono, D, Pratschke, J, Romagnoli, R, Rayar, M, Roma, F, Schlegel, A, Dutkowski, P, Porte, R, de Meijer, V, Brüggenwirth, Isabel M A, Mueller, Matteo, Lantinga, Veerle A, Camagni, Stefania, De Carlis, Riccardo, De Carlis, Luciano, Colledan, Michele, Dondossola, Daniele, Drefs, Moritz, Eden, Janina, Ghinolfi, Davide, Koliogiannis, Dionysios, Lurje, Georg, Manzia, Tommaso M, Monbaliu, Diethard, Muiesan, Paolo, Patrono, Damiano, Pratschke, Johann, Romagnoli, Renato, Rayar, Michel, Roma, Federico, Schlegel, Andrea, Dutkowski, Philipp, Porte, Robert J, and de Meijer, Vincent E
Abstract: A short period (1–2 h) of hypothermic oxygenated machine perfusion (HOPE) after static cold storage is safe and reduces ischemia-reperfusion injury-related complications after liver transplantation. Machine perfusion time is occasionally prolonged for logistical reasons, but it is unknown if prolonged HOPE is safe and compromises outcomes. We conducted a multicenter, observational cohort study of patients transplanted with a liver preserved by prolonged (≥4 h) HOPE. Postoperative biochemistry, complications, and survival were evaluated. The cohort included 93 recipients from 12 European transplant centers between 2014–2021. The most common reason to prolong HOPE was the lack of an available operating room to start the transplant procedure. Grafts underwent HOPE for a median (range) of 4:42 h (4:00–8:35 h) with a total preservation time of 10:50 h (5:50–20:50 h). Postoperative peak ALT was 675 IU/L (interquartile range 419–1378 IU/L). The incidence of postoperative complications was low, and 1-year graft and patient survival were 94% and 88%, respectively. To conclude, good outcomes are achieved after transplantation of donor livers preserved with prolonged (median 4:42 h) HOPE, leading to a total preservation time of almost 21 h. These results suggest that simple, end-ischemic HOPE may be utilized for safe extension of the preservation time to ease transplantation logistics.
Published: 2022

18. Location and allocation: inequity of access to liver transplantation for patients with severe acute‐on‐chronic liver failure in Europe

Author: Artzner, T, Bernal, W, Belli, L, Conti, S, Cortesi, P, Sacleux, S, Pageaux, G, Radenne, S, Trebicka, J, Fernandez, J, Perricone, G, Piano, S, Nadalin, S, Morelli, M, Martini, S, Polak, W, Zieniewicz, K, Toso, C, Berenguer, M, Iegri, C, Invernizzi, F, Volpes, R, Karam, V, Adam, R, Faitot, F, Rabinowich, L, Saliba, F, Meunier, L, Lesurtel, M, Uschner, F, Michard, B, Coilly, A, Meszaros, M, Poinsot, D, Besch, C, Schnitzbauer, A, De Carlis, L, Fumagalli, R, Angeli, P, Arroyo, V, Fondevila, C, Duvoux, C, Jalan, R, Viganò, R, Mazzarelli, C, Lauterio, A, Giacomoni, A, Donato, F, Lampertico, P, Pasulo, L, Fagiuoli, S, Colledan, M, Cristina Morelli, M, Vitale, G, Ottobrelli, A, Patrono, D, Romagnoli, R, Petridis, I, Cillo, U, Germani, G, Burra, P, Bachellier, P, Schneider, F, Castelain, V, Addeo, P, Deridder, M, Caroline Sacleux Audrey Coilly, S, Faouzi, S, Samuel, D, Guichon, C, Faure, S, Ursic‐bedoya, J, Colmenero, J, Toapanta, D, Hernández‐tejero, M, Vinaixa, C, den Hoed, C, Haan, J, Della Penna, A, Erhard Uschner, F, Welker, M, Zeuzem, S, Bechstein, W, Goossens, N, Raszeja‐wyszomirska, J, Rabinovich, L, Katarey, D, Agarwal, B, Artzner, Thierry, Bernal, William, Belli, Luca S, Conti, Sara, Cortesi, Paolo A, Sacleux, Sophie‐Caroline, Pageaux, George‐Philippe, Radenne, Sylvie, Trebicka, Jonel, Fernandez, Javier, Perricone, Giovanni, Piano, Salvatore, Nadalin, Silvio, Morelli, Maria C, Martini, Silvia, Polak, Wojciech G, Zieniewicz, Krzysztof, Toso, Christian, Berenguer, Marina, Iegri, Claudia, Invernizzi, Federica, Volpes, Riccardo, Karam, Vincent, Adam, René, Faitot, François, Rabinowich, Liane, Saliba, Faouzi, Meunier, Lucy, Lesurtel, Mickael, Uschner, Frank E, Michard, Baptiste, Coilly, Audrey, Meszaros, Magdalena, Poinsot, Domitille, Besch, Camille, Schnitzbauer, Andreas, De Carlis, Luciano G, Fumagalli, Roberto, Angeli, Paolo, Arroyo, Vincente, Fondevila, Constantino, Duvoux, Christophe, Jalan, Rajiv, Viganò, Raffaella, Mazzarelli, Chiara, Lauterio, Andrea, Giacomoni, Alessandro, Donato, Francesca, Lampertico, Pietro, Pasulo, Luisa, Fagiuoli, Stefano, Colledan, Michele, Cristina Morelli, Maria, Vitale, Giovanni, Ottobrelli, Antonio, Patrono, Damiano, Romagnoli, Renato, Petridis, Ioannis, Cillo, Umberto, Germani, Giacomo, Burra, Patrizia, Bachellier, Philippe, Schneider, Francis, Castelain, Vincent, Addeo, Pietro, Deridder, Mathilde, Caroline Sacleux Audrey Coilly, Sophie, Faouzi, Saliba, Adam, Rene, Samuel, Didier, Guichon, Celine, Faure, Stéfanie, Ursic‐Bedoya, Josè, Fondevila, Costantino, Colmenero, Jorde, Toapanta, David, Hernández‐Tejero, María, Vinaixa, Carmen, Polak, Wojciech G., den Hoed, Caroline, Haan, Jubi E., Della Penna, Andrea, Erhard Uschner, Frank, Welker, Martin, Zeuzem, Stefan, Bechstein, Wolf, Goossens, Nicolas, Raszeja‐Wyszomirska, Joanna, Rabinovich, Liane, Katarey, Dev, Agarwal, Banwari, Artzner, T, Bernal, W, Belli, L, Conti, S, Cortesi, P, Sacleux, S, Pageaux, G, Radenne, S, Trebicka, J, Fernandez, J, Perricone, G, Piano, S, Nadalin, S, Morelli, M, Martini, S, Polak, W, Zieniewicz, K, Toso, C, Berenguer, M, Iegri, C, Invernizzi, F, Volpes, R, Karam, V, Adam, R, Faitot, F, Rabinowich, L, Saliba, F, Meunier, L, Lesurtel, M, Uschner, F, Michard, B, Coilly, A, Meszaros, M, Poinsot, D, Besch, C, Schnitzbauer, A, De Carlis, L, Fumagalli, R, Angeli, P, Arroyo, V, Fondevila, C, Duvoux, C, Jalan, R, Viganò, R, Mazzarelli, C, Lauterio, A, Giacomoni, A, Donato, F, Lampertico, P, Pasulo, L, Fagiuoli, S, Colledan, M, Cristina Morelli, M, Vitale, G, Ottobrelli, A, Patrono, D, Romagnoli, R, Petridis, I, Cillo, U, Germani, G, Burra, P, Bachellier, P, Schneider, F, Castelain, V, Addeo, P, Deridder, M, Caroline Sacleux Audrey Coilly, S, Faouzi, S, Samuel, D, Guichon, C, Faure, S, Ursic‐bedoya, J, Colmenero, J, Toapanta, D, Hernández‐tejero, M, Vinaixa, C, den Hoed, C, Haan, J, Della Penna, A, Erhard Uschner, F, Welker, M, Zeuzem, S, Bechstein, W, Goossens, N, Raszeja‐wyszomirska, J, Rabinovich, L, Katarey, D, Agarwal, B, Artzner, Thierry, Bernal, William, Belli, Luca S, Conti, Sara, Cortesi, Paolo A, Sacleux, Sophie‐Caroline, Pageaux, George‐Philippe, Radenne, Sylvie, Trebicka, Jonel, Fernandez, Javier, Perricone, Giovanni, Piano, Salvatore, Nadalin, Silvio, Morelli, Maria C, Martini, Silvia, Polak, Wojciech G, Zieniewicz, Krzysztof, Toso, Christian, Berenguer, Marina, Iegri, Claudia, Invernizzi, Federica, Volpes, Riccardo, Karam, Vincent, Adam, René, Faitot, François, Rabinowich, Liane, Saliba, Faouzi, Meunier, Lucy, Lesurtel, Mickael, Uschner, Frank E, Michard, Baptiste, Coilly, Audrey, Meszaros, Magdalena, Poinsot, Domitille, Besch, Camille, Schnitzbauer, Andreas, De Carlis, Luciano G, Fumagalli, Roberto, Angeli, Paolo, Arroyo, Vincente, Fondevila, Constantino, Duvoux, Christophe, Jalan, Rajiv, Viganò, Raffaella, Mazzarelli, Chiara, Lauterio, Andrea, Giacomoni, Alessandro, Donato, Francesca, Lampertico, Pietro, Pasulo, Luisa, Fagiuoli, Stefano, Colledan, Michele, Cristina Morelli, Maria, Vitale, Giovanni, Ottobrelli, Antonio, Patrono, Damiano, Romagnoli, Renato, Petridis, Ioannis, Cillo, Umberto, Germani, Giacomo, Burra, Patrizia, Bachellier, Philippe, Schneider, Francis, Castelain, Vincent, Addeo, Pietro, Deridder, Mathilde, Caroline Sacleux Audrey Coilly, Sophie, Faouzi, Saliba, Adam, Rene, Samuel, Didier, Guichon, Celine, Faure, Stéfanie, Ursic‐Bedoya, Josè, Fondevila, Costantino, Colmenero, Jorde, Toapanta, David, Hernández‐Tejero, María, Vinaixa, Carmen, Polak, Wojciech G., den Hoed, Caroline, Haan, Jubi E., Della Penna, Andrea, Erhard Uschner, Frank, Welker, Martin, Zeuzem, Stefan, Bechstein, Wolf, Goossens, Nicolas, Raszeja‐Wyszomirska, Joanna, Rabinovich, Liane, Katarey, Dev, and Agarwal, Banwari
Abstract: Background: There is growing evidence that liver transplantation (LT) is the most effective treatment for acute-on-chronic liver failure grade-3 (ACLF-3). This study examines whether and how this evidence translates into practice by analyzing the variability in intensive care unit (ICU) admissions, listing strategies and LT activity for ACLF-3 patients across transplant centers in Europe. Methods: Consecutive patients who were admitted to the ICU with ACLF-3, whether or not they were listed and/or transplanted with ACLF-3 between 2018 and 2019 were included across 20 transplantation centers. Results: 351 patients with ACLF-3 were included: 33 had been listed prior to developing ACLF-3 and 318 had not been listed at the time of admission to the ICU. There was no correlation between the number of unlisted ACLF-3 patients admitted to the ICU and the number listed or transplanted whilst in ACLF-3 across centers. In contrast, there was a correlation between the number of patients listed and the number transplanted whilst in ACLF-3. 21% of patients who were listed whilst in ACLF-3 died on the waiting list or were delisted. The percentage of LT for ACLF-3 patients varied from 0%-29% of patients transplanted with decompensated cirrhosis across centers (average = 8%), with an I2 index of 68% (95% CI: 49%-80%), showing substantial heterogeneity among centers. The one-year survival for all patients with ACLF-3 was significantly higher in centers that listed and transplanted more ACLF-3 patients (>10 patients) than in centers that listed and transplanted fewer: respectively 36% vs. 20%, p = 0.012. Conclusion: Patients with ACLF-3 face inequity of access to LT across Europe. Wait-listing strategies for ACLF-3 patients influence their access to LT and, ultimately, their survival.
Published: 2022

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

Author: Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Schlegel, Andrea, van Reeven, Marjolein, Croome, Kristopher, Parente, Alessandro, Dolcet, Annalisa, Widmer, Jeannette, Meurisse, Nicolas, De Carlis, Riccardo, Hessheimer, Amelia, Jochmans, Ina, Mueller, Matteo, van Leeuwen, Otto B, Nair, Amit, Tomiyama, Koji, Sherif, Ahmed, Elsharif, Mohamed, Kron, Philipp, van der Helm, Danny, Borja-Cacho, Daniel, Bohorquez, Humberto, Germanova, Desislava, Dondossola, Daniele, Olivieri, Tiziana, Camagni, Stefania, Gorgen, Andre, Patrono, Damiano, Cescon, Matteo, Croome, Sarah, Panconesi, Rebecca, Flores Carvalho, Mauricio, Ravaioli, Matteo, Caicedo, Juan Carlos, Loss, George, Lucidi, Valerio, Sapisochin, Gonzalo, Romagnoli, Renato, Jassem, Wayel, Colledan, Michele, De Carlis, Luciano, Rossi, Giorgio, Di Benedetto, Fabrizio, Miller, Charles M, van Hoek, Bart, Attia, Magdy, Lodge, Peter, Hernandez-Alejandro, Roberto, Detry, Olivier, Quintini, Cristiano, Oniscu, Gabriel C, Fondevila, Constantino, Malagó, Massimo, Pirenne, Jacques, IJzermans, Jan Nm, Porte, Robert J, Dutkowski, Philipp, Taner, C Burcin, Heaton, Nigel, Clavien, Pierre-Alain, Polak, Wojciech G, Muiesan, Paolo, Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Schlegel, Andrea, van Reeven, Marjolein, Croome, Kristopher, Parente, Alessandro, Dolcet, Annalisa, Widmer, Jeannette, Meurisse, Nicolas, De Carlis, Riccardo, Hessheimer, Amelia, Jochmans, Ina, Mueller, Matteo, van Leeuwen, Otto B, Nair, Amit, Tomiyama, Koji, Sherif, Ahmed, Elsharif, Mohamed, Kron, Philipp, van der Helm, Danny, Borja-Cacho, Daniel, Bohorquez, Humberto, Germanova, Desislava, Dondossola, Daniele, Olivieri, Tiziana, Camagni, Stefania, Gorgen, Andre, Patrono, Damiano, Cescon, Matteo, Croome, Sarah, Panconesi, Rebecca, Flores Carvalho, Mauricio, Ravaioli, Matteo, Caicedo, Juan Carlos, Loss, George, Lucidi, Valerio, Sapisochin, Gonzalo, Romagnoli, Renato, Jassem, Wayel, Colledan, Michele, De Carlis, Luciano, Rossi, Giorgio, Di Benedetto, Fabrizio, Miller, Charles M, van Hoek, Bart, Attia, Magdy, Lodge, Peter, Hernandez-Alejandro, Roberto, Detry, Olivier, Quintini, Cristiano, Oniscu, Gabriel C, Fondevila, Constantino, Malagó, Massimo, Pirenne, Jacques, IJzermans, Jan Nm, Porte, Robert J, Dutkowski, Philipp, Taner, C Burcin, Heaton, Nigel, Clavien, Pierre-Alain, Polak, Wojciech G, and Muiesan, Paolo
Abstract: Background & Aims: The concept of benchmarking is established in the field of transplant surgery; however, benchmark values for donation after circulatory death (DCD) liver transplantation are not available. Thus, we aimed to identify the best possible outcomes in DCD liver transplantation and to propose outcome reference values. Methods: Based on 2,219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1,012 low-risk, primary, adult liver transplantations with a laboratory MELD score of ≤20 points, receiving a DCD liver with a total donor warm ischemia time of ≤30 minutes and asystolic donor warm ischemia time of ≤15 minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the comprehensive complication index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered. Results: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centres. The 1-year retransplant and mortality rates were 4.5% and 8.4% in the benchmark group, respectively. Within the first year of follow-up, 51.1% of recipients developed at least 1 major complication (≥Clavien-Dindo-Grade III). Benchmark cut-offs were ≤3 days and ≤16 days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade III), ≤16.8% for ischemic cholangiopathy, and ≤38.9 CCI points 1 year after transplant. Comparisons with higher risk groups showed more complications and impaired graft survival outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk. Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk grou
Published: 2022

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

Author: Avolio, A, Lai, Q, Franco, A, Gruttadauria, S, Bianco, G, Vivarelli, M, Montalti, R, Colledan, M, Camagni, S, Cescon, M, Maroni, L, De Carlis, L, Ferla, F, Rossi, G, Dondossola, D, Mazzaferro, V, Bongini, M, Di Benedetto, F, Magistri, P, Pagano, D, Agnes, S, Spoletini, G, Bassi, D, Rossi, M, Ghinolfi, D, Meli, S, Carraro, A, Violi, P, Patrono, D, Burra, P, De Simone, P, Romagnoli, R, Cillo, U, Avolio A, Lai Q, Franco A, Gruttadauria S, Bianco G, Vivarelli M, Montalti R, Colledan M, Camagni S, Cescon M, Maroni L, De Carlis L, Ferla F, Rossi G, Dondossola D, Mazzaferro V, Bongini M, Di Benedetto F, Magistri P, Pagano D, Agnes S, Spoletini G, Bassi D, Rossi M, Ghinolfi D, Meli S, Carraro A, Violi P, Patrono D, Burra P, De Simone P, Romagnoli R, Cillo U, Avolio, A, Lai, Q, Franco, A, Gruttadauria, S, Bianco, G, Vivarelli, M, Montalti, R, Colledan, M, Camagni, S, Cescon, M, Maroni, L, De Carlis, L, Ferla, F, Rossi, G, Dondossola, D, Mazzaferro, V, Bongini, M, Di Benedetto, F, Magistri, P, Pagano, D, Agnes, S, Spoletini, G, Bassi, D, Rossi, M, Ghinolfi, D, Meli, S, Carraro, A, Violi, P, Patrono, D, Burra, P, De Simone, P, Romagnoli, R, Cillo, U, Avolio A, Lai Q, Franco A, Gruttadauria S, Bianco G, Vivarelli M, Montalti R, Colledan M, Camagni S, Cescon M, Maroni L, De Carlis L, Ferla F, Rossi G, Dondossola D, Mazzaferro V, Bongini M, Di Benedetto F, Magistri P, Pagano D, Agnes S, Spoletini G, Bassi D, Rossi M, Ghinolfi D, Meli S, Carraro A, Violi P, Patrono D, Burra P, De Simone P, Romagnoli R, and Cillo U
Published: 2019

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

Author: Avolio, A, Franco, A, Lai, Q, Gruttadauria, S, Caccamo, L, Colledan, M, Agnes, S, Vivarelli, M, Mazzaferro, V, Di Benedetto, F, Rossi, M, Tedeschi, U, De Carlis, L, Cescon, M, Meli, S, Spoletini, G, Ghinolfi, D, Patrono, D, Pagano, D, Dondossola, D, Tandoi, F, Camagni, S, Montalti, R, Bongini, M, Bassi, D, Violi, P, Magistri, P, Ferla, F, Ravaioli, M, Hammond, J, Alrawashdeh, W, Schlegel, A, Muiesan, P, Romagnoli, R, Cillo, U, De Simone, P, Avolio A, Franco A, Lai Q, Gruttadauria S, Caccamo L, Colledan M, Agnes S, Vivarelli M, Mazzaferro V, Di Benedetto F, Rossi M, Tedeschi U, De Carlis L, Cescon M, Meli S, Spoletini G, Ghinolfi D, Patrono D, Pagano D, Dondossola D, Tandoi F, Camagni S, Montalti R, Bongini M, Bassi D, Violi P, Magistri P, Ferla F, Ravaioli M, Hammond J, Alrawashdeh W, Schlegel A, Muiesan P, Romagnoli R, Cillo U, De Simone P, Avolio, A, Franco, A, Lai, Q, Gruttadauria, S, Caccamo, L, Colledan, M, Agnes, S, Vivarelli, M, Mazzaferro, V, Di Benedetto, F, Rossi, M, Tedeschi, U, De Carlis, L, Cescon, M, Meli, S, Spoletini, G, Ghinolfi, D, Patrono, D, Pagano, D, Dondossola, D, Tandoi, F, Camagni, S, Montalti, R, Bongini, M, Bassi, D, Violi, P, Magistri, P, Ferla, F, Ravaioli, M, Hammond, J, Alrawashdeh, W, Schlegel, A, Muiesan, P, Romagnoli, R, Cillo, U, De Simone, P, Avolio A, Franco A, Lai Q, Gruttadauria S, Caccamo L, Colledan M, Agnes S, Vivarelli M, Mazzaferro V, Di Benedetto F, Rossi M, Tedeschi U, De Carlis L, Cescon M, Meli S, Spoletini G, Ghinolfi D, Patrono D, Pagano D, Dondossola D, Tandoi F, Camagni S, Montalti R, Bongini M, Bassi D, Violi P, Magistri P, Ferla F, Ravaioli M, Hammond J, Alrawashdeh W, Schlegel A, Muiesan P, Romagnoli R, Cillo U, and De Simone P
Published: 2019

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

Author: Franco, A, De Simone, P, Schlegel, A, Lai, Q, Burra, P, Patrono, D, Meli, S, Ravaioli, M, Bassi, D, Ferla, F, Pagano, D, Violi, P, Camagni, S, Dondossola, D, Montalti, R, Alrawashdeh, W, Vitale, A, Teofili, L, Ghinolfi, D, Spoletini, G, Maroni, L, Nicolotti, N, Magistri, P, Pastena, D, Bongini, M, Rossi, M, Mazzaferro, V, Di Benedetto, F, Hammond, J, Vivarelli, M, Agnes, S, Colledan, M, Carraro, A, De Carlis, L, Cescon, M, Caccamo, L, Gruttadauria, S, Muiesan, P, Cillo, U, Romagnoli, R, Avolio, A, Franco A, De Simone P, Schlegel A, Lai Q, Burra P, Patrono D, Meli S, Ravaioli M, Bassi D, Ferla F, Pagano D, Violi P, Camagni S, Dondossola D, Montalti R, Alrawashdeh W, Vitale A, Teofili L, Ghinolfi D, Spoletini G, Maroni L, Nicolotti N, Magistri P, Pastena D, Bongini M, Rossi M, Mazzaferro V, Di Benedetto F, Hammond J, Vivarelli M, Agnes S, Colledan M, Carraro A, De Carlis L, Cescon M, Caccamo L, Gruttadauria S, Muiesan P, Cillo U, Romagnoli R, Avolio A, Franco, A, De Simone, P, Schlegel, A, Lai, Q, Burra, P, Patrono, D, Meli, S, Ravaioli, M, Bassi, D, Ferla, F, Pagano, D, Violi, P, Camagni, S, Dondossola, D, Montalti, R, Alrawashdeh, W, Vitale, A, Teofili, L, Ghinolfi, D, Spoletini, G, Maroni, L, Nicolotti, N, Magistri, P, Pastena, D, Bongini, M, Rossi, M, Mazzaferro, V, Di Benedetto, F, Hammond, J, Vivarelli, M, Agnes, S, Colledan, M, Carraro, A, De Carlis, L, Cescon, M, Caccamo, L, Gruttadauria, S, Muiesan, P, Cillo, U, Romagnoli, R, Avolio, A, Franco A, De Simone P, Schlegel A, Lai Q, Burra P, Patrono D, Meli S, Ravaioli M, Bassi D, Ferla F, Pagano D, Violi P, Camagni S, Dondossola D, Montalti R, Alrawashdeh W, Vitale A, Teofili L, Ghinolfi D, Spoletini G, Maroni L, Nicolotti N, Magistri P, Pastena D, Bongini M, Rossi M, Mazzaferro V, Di Benedetto F, Hammond J, Vivarelli M, Agnes S, Colledan M, Carraro A, De Carlis L, Cescon M, Caccamo L, Gruttadauria S, Muiesan P, Cillo U, Romagnoli R, and Avolio A
Published: 2019

23. Presentation and management of mycotic pseudoaneurysm after kidney transplantation

Author: Patrono, D., Verhelst, R., Buemi, A., Darius, T., Godefroid, N., and Mourad, M.
Published: 2015
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24. Protective role of tacrolimus, deleterious role of age and comorbidities in liver transplant recipients with Covid-19: results from the ELITA/ELTR multi-center European study

Author: Belli LS, Fondevila C, Cortesi PA, Conti S, Karam V, Adam R, Coilly A, Ericzon BG, Loinaz C, Cuervas-Mons V, Zambelli M, Llado L, Diaz F, Invernizzi F, Patrono D, Faitot F, Bhooori S, Pirenne J, Perricone G, Magini G, Castells L, Detry O, Cruchaga PM, Colmenero J, Berrevoet F, Rodriguez G, Ysebaert D, Radenne S, Metselaar H, Morelli C, De Carlis L, Polak WG, Duvoux C, and ELITA-ELTR COVID-19 Registry
Subjects: Liver transplantation, COVID-19, Tacrolimus, Outcome
Abstract: BACKGROUND AND AIMS: Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking. METHODS: Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis. RESULTS: Between March 1st and June 27th2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39/204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10-23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age >70 (HR, 4.16; 95% CI, 1.78-9.73) had a negative effect and tacrolimus (TAC) use (HR, 0.55; 95% CI, 0.31-0.99) had a positive independent effect on survival. The role of co-morbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR, 1.95; 95% CI, 1.06-3.58) and chronic kidney disease (HR, 1.97; 95% CI, 1.05-3.67) emerged as associated with death CONCLUSIONS: Twenty-five per cent of patients requiring hospitalization for Covid-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose.
Published: 2021

25. Liver transplantation as last-resort treatment for patients with bile duct injuries following cholecystectomy: A multicenter analysis

Author: Tsaparas, P. Machairas, N. Ardiles, V. Krawczyk, M. Patrono, D. Baccarani, U. Cillo, U. Aandahl, E.M. Cotsoglou, C. Espinoza, J.L. Claría, R.S. Kostakis, I.D. Foss, A. Mazzaferro, V. De Santibañes, E. Sotiropoulos, G.C.
Subjects: education
Abstract: Background Liver transplantation (LT) has been used as a last resort in patients with end-stage liver disease due to bile duct injuries (BDI) following cholecystectomy. Our study aimed to identify and evaluate factors that cause or contribute to an extended liver disease that requires LT as ultimate solution, after BDI during cholecystectomy. Methods Data from 8 high-volume LT centers relating to patients who underwent LT after suffering BDI during cholecystectomy were prospectively collected and retrospectively analyzed. Results Thirty-four patients (16 men, 18 women) with a median age of 45 (range 22-69) years were included in this study. Thirty of them (88.2%) underwent LT because of liver failure, most commonly as a result of secondary biliary cirrhosis. The median time interval between BDI and LT was 63 (range 0-336) months. There were 23 cases (67.6%) of postoperative morbidity, 6 cases (17.6%) of post-transplant 30-day mortality, and 10 deaths (29.4%) in total after LT. There was a higher probability that patients with concomitant vascular injury (hazard ratio 10.69, P=0.039) would be referred sooner for LT. Overall survival following LT at 1, 3, 5 and 10 years was 82.4%, 76.5%, 73.5% and 70.6%, respectively. Conclusion LT for selected patients with otherwise unmanageable BDI following cholecystectomy yields acceptable long-term outcomes. © 2021 Hellenic Society of Gastroenterology.
Published: 2021

26. Protective role of tacrolimus, deleterious role of age and comorbidities in liver transplant recipients with Covid-19: results from the ELITA/ELTR multi-center European study

Author: Belli, L, Fondevila, C, Cortesi, P, Conti, S, Karam, V, Adam, R, Coilly, A, Ericzon, B, Loinaz, C, Cuervas-Mons, V, Zambelli, M, Llado, L, Diaz, F, Invernizzi, F, Patrono, D, Faitot, F, Bhooori, S, Pirenne, J, Perricone, G, Magini, G, Castells, L, Detry, O, Cruchaga, P, Colmenero, J, Berrevoet, F, Rodriguez, G, Ysebaert, D, Radenne, S, Metselaar, H, Morelli, C, De Carlis, L, Polak, W, Duvoux, C, Belli, Luca S, Fondevila, Constantino, Cortesi, Paolo A, Conti, Sara, Karam, Vincent, Adam, Rene, Coilly, Audrey, Ericzon, Bo Goran, Loinaz, Carmelo, Cuervas-Mons, Valentin, Zambelli, Marco, Llado, Laura, Diaz, Fernando, Invernizzi, Federica, Patrono, Damiano, Faitot, Francois, Bhooori, Sherrie, Pirenne, Jacques, Perricone, Giovanni, Magini, Giulia, Castells, Lluis, Detry, Oliver, Cruchaga, Pablo Mart, Colmenero, Jordi, Berrevoet, Frederick, Rodriguez, Gonzalo, Ysebaert, Dirk, Radenne, Sylvie, Metselaar, Herold, Morelli, Cristina, De Carlis, Luciano, Polak, Wojciech G, Duvoux, Christophe, Belli, L, Fondevila, C, Cortesi, P, Conti, S, Karam, V, Adam, R, Coilly, A, Ericzon, B, Loinaz, C, Cuervas-Mons, V, Zambelli, M, Llado, L, Diaz, F, Invernizzi, F, Patrono, D, Faitot, F, Bhooori, S, Pirenne, J, Perricone, G, Magini, G, Castells, L, Detry, O, Cruchaga, P, Colmenero, J, Berrevoet, F, Rodriguez, G, Ysebaert, D, Radenne, S, Metselaar, H, Morelli, C, De Carlis, L, Polak, W, Duvoux, C, Belli, Luca S, Fondevila, Constantino, Cortesi, Paolo A, Conti, Sara, Karam, Vincent, Adam, Rene, Coilly, Audrey, Ericzon, Bo Goran, Loinaz, Carmelo, Cuervas-Mons, Valentin, Zambelli, Marco, Llado, Laura, Diaz, Fernando, Invernizzi, Federica, Patrono, Damiano, Faitot, Francois, Bhooori, Sherrie, Pirenne, Jacques, Perricone, Giovanni, Magini, Giulia, Castells, Lluis, Detry, Oliver, Cruchaga, Pablo Mart, Colmenero, Jordi, Berrevoet, Frederick, Rodriguez, Gonzalo, Ysebaert, Dirk, Radenne, Sylvie, Metselaar, Herold, Morelli, Cristina, De Carlis, Luciano, Polak, Wojciech G, and Duvoux, Christophe
Abstract: BACKGROUND AND AIMS: Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking.METHODS: Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis.RESULTS: Between March 1st and June 27th2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39/204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10-23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age >70 (HR, 4.16; 95% CI, 1.78-9.73) had a negative effect and tacrolimus (TAC) use (HR, 0.55; 95% CI, 0.31-0.99) had a positive independent effect on survival. The role of co-morbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR, 1.95; 95% CI, 1.06-3.58) and chronic kidney disease (HR, 1.97; 95% CI, 1.05-3.67) emerged as associated with death CONCLUSIONS: Twenty-five per cent of patients requiring hospitalization for Covid-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose.
Published: 2021

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

Author: Avolio, A., Lai, Q., Franco, A., Gruttadauria, S., Bianco, G., Vivarelli, M., Montalti, R., Colledan, M., Camagni, S., Cescon, M., Maroni, L., Carlis, L., Ferla, F., Rossi, G., Dondossola, D., Mazzaferro, V., Bongini, M., Di Benedetto, F., Magistri, P., Pagano, D., Agnes, S., Spoletini, G., Bassi, D., Rossi, M., Ghinolfi, D., Meli, S., Carraro, A., Violi, P., Patrono, D., Burra, P., Paolo De Simone, Romagnoli, R., Cillo, U., Avolio, A, Lai, Q, Franco, A, Gruttadauria, S, Bianco, G, Vivarelli, M, Montalti, R, Colledan, M, Camagni, S, Cescon, M, Maroni, L, De Carlis, L, Ferla, F, Rossi, G, Dondossola, D, Mazzaferro, V, Bongini, M, Di Benedetto, F, Magistri, P, Pagano, D, Agnes, S, Spoletini, G, Bassi, D, Rossi, M, Ghinolfi, D, Meli, S, Carraro, A, Violi, P, Patrono, D, Burra, P, De Simone, P, Romagnoli, R, and Cillo, U
Subjects: liver transplantation
Published: 2019

28. Liver transplant recipients with Covid-19: results from an Italian multicenter cohort

Author: Mazzarelli, C., primary, Viganò, R., additional, Perricone, G., additional, Merli, M., additional, Pasulo, L., additional, Invernizzi, F., additional, Bhoori, S., additional, Morelli, M.C., additional, Patrono, D., additional, Sandro, S. Di, additional, Cortesi, P., additional, Angrisani, D., additional, De Nicola, S., additional, Vangeli, M., additional, and Belli, L.S., additional
Published: 2021
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29. Liver transplant candidates and SARS-CoV-2 infection: Results from an Italian multicenter cohort

Author: Perricone, G., primary, Vigano, R., additional, Mazzarelli, C., additional, Travi, G., additional, Pasulo, L., additional, Invernizzi, F., additional, Morelli, M.C., additional, Patrono, D., additional, Sandro, S. Di, additional, De Simone, P., additional, Facchetti, R., additional, Angrisani, D., additional, De Nicola, S., additional, Airoldi, A., additional, Vangeli, M., additional, and Belli, e L.S., additional
Published: 2021
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30. Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Author: Manzia, T.M. (Tommaso Maria), Angelico, R. (Roberta), Parente, A. (Alessandro), Muiesan, P. (Paolo), Tisone, G. (Giuseppe), Al Alawy, Y. (Yousef), Arif, A.J. (Abdul Jabba), Attia, M. (Magdy), Bhati, C. (Chandra), Battula R, N. (Narendra), Bonney, G.K. (Glenn Kunnath), Brooke-Smith, M. (Mark), Derosas, C. (Carlos), De Liguori Carino, N. (Nicola), Ferretti, S. (Stefano), Fiorani, C. (Cristina), Gherardi, D. (Dario), Hegab, B. (Bassem), Hussain, Z. (Zaki), Ielpo, B. (Benedetto), Iesari, S. (Samuele), Lai, Q. (Quirino), Lainas, P. (Panagiotis), Lauterio, A. (Andrea), Lazzaro, A. (Alessandra), Marudanayagam, R. (Ravi), Nasralla, D. (David), Nicolini, D. (Daniele), Orlando, G. (Giuseppe), Patrono, D. (Damiano), Pitchaimuthu, M. (Maheswaran), Polak, W.G. (Wojciech), Quinto, A.M. (Alberto Marcacuzco), Rai, R. (Rakesh), Scalera, I. (Irene), Schlegel, A. (Andrea), Shanmugam, V. (Vivek), Vitale, A. (Alessandro), Widmer, J. (Jeannette), Yannick, D. (Deswysen), Manzia, T.M. (Tommaso Maria), Angelico, R. (Roberta), Parente, A. (Alessandro), Muiesan, P. (Paolo), Tisone, G. (Giuseppe), Al Alawy, Y. (Yousef), Arif, A.J. (Abdul Jabba), Attia, M. (Magdy), Bhati, C. (Chandra), Battula R, N. (Narendra), Bonney, G.K. (Glenn Kunnath), Brooke-Smith, M. (Mark), Derosas, C. (Carlos), De Liguori Carino, N. (Nicola), Ferretti, S. (Stefano), Fiorani, C. (Cristina), Gherardi, D. (Dario), Hegab, B. (Bassem), Hussain, Z. (Zaki), Ielpo, B. (Benedetto), Iesari, S. (Samuele), Lai, Q. (Quirino), Lainas, P. (Panagiotis), Lauterio, A. (Andrea), Lazzaro, A. (Alessandra), Marudanayagam, R. (Ravi), Nasralla, D. (David), Nicolini, D. (Daniele), Orlando, G. (Giuseppe), Patrono, D. (Damiano), Pitchaimuthu, M. (Maheswaran), Polak, W.G. (Wojciech), Quinto, A.M. (Alberto Marcacuzco), Rai, R. (Rakesh), Scalera, I. (Irene), Schlegel, A. (Andrea), Shanmugam, V. (Vivek), Vitale, A. (Alessandro), Widmer, J. (Jeannette), and Yannick, D. (Deswysen)
Abstract: Background: Since the Coronavirus disease-19(COVID-19) pandemic, the healthcare systems are reallocating their medical resources, with consequent narrowed access to elective surgery for benign conditions such as gallstone disease(GD). This survey represents an overview of the current policies regarding the surgical management of patients with GD during the COVID-19 pandemic. Methods: A Web-based survey was conducted among 36 Hepato-Prancreato-Biliary surgeons from 14 Countries. Through a 17-item questionnaire, participants were asked about the local management of patients with GD since the start of the COVID-19 pandemic. Results: The majority (n = 26,72.2%) of surgeons reported an alarming decrease in the cholecystectomy rate for GD since the start of the pandemic, regardless of the Country: 19(52.7%) didn't operate any GD, 7(19.4%) reduced their surgical activity by 50–75%, 10(27.8%) by 25–50%, 1(2.8%) maintained regular activity. Currently, only patients with GD complications are operated. Thirty-two (88.9%) participants expect these changes to last for at least 3 months. In 15(41.6%) Centers, patients are currently being screened for SARS-CoV-2 infection before cholecystectomy [in 10(27.8%) Centers only in the presence of suspected infection, in 5(13.9%) routinely]. The majority of surgeons (n = 29,80.6%) have adopted a laparoscopic approach as standard surgery, 5(13.9%) perform open cholecystectomy in patients with known/suspected SARS-CoV-2 infection, and 2(5.6%) in all patients. Conclusion
Published: 2020
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31. COVID-19 in liver transplant recipients: preliminary data from the ELITA/ELTR registry

Author: Belli, L, Duvoux, C, Karam, V, Adam, R, Cuervas-Mons, V, Pasulo, L, Loinaz, C, Invernizzi, F, Patrono, D, Bhoori, S, Ciccarelli, O, Morelli, M, Castells, L, Lopez-Lopez, V, Conti, S, Fondevila, C, Polak, W, Belli, Luca S, Duvoux, Christophe, Karam, Vincent, Adam, Rene, Cuervas-Mons, Valentin, Pasulo, Luisa, Loinaz, Carmelo, Invernizzi, Federica, Patrono, Damiano, Bhoori, Sherrie, Ciccarelli, Olga, Morelli, Maria Cristina, Castells, Lluis, Lopez-Lopez, Victor, Conti, Sara, Fondevila, Costantino, Polak, Wojchiech, Belli, L, Duvoux, C, Karam, V, Adam, R, Cuervas-Mons, V, Pasulo, L, Loinaz, C, Invernizzi, F, Patrono, D, Bhoori, S, Ciccarelli, O, Morelli, M, Castells, L, Lopez-Lopez, V, Conti, S, Fondevila, C, Polak, W, Belli, Luca S, Duvoux, Christophe, Karam, Vincent, Adam, Rene, Cuervas-Mons, Valentin, Pasulo, Luisa, Loinaz, Carmelo, Invernizzi, Federica, Patrono, Damiano, Bhoori, Sherrie, Ciccarelli, Olga, Morelli, Maria Cristina, Castells, Lluis, Lopez-Lopez, Victor, Conti, Sara, Fondevila, Costantino, and Polak, Wojchiech
Published: 2020

32. Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Author: Manzia, TM, Angelico, R, Parente, A, Muiesan, P, Tisone, G, Al Alawy, Y, Arif, AJ, Attia, M, Bhati, C, Battula, RN, Bonney, GK, Brooke-Smith, M, Derosas, C, Carino, ND, Ferretti, S, Fiorani, C, Gherardi, D, Hegab, B, Hussain, Z, Ielpo, B, Iesari, S, Lai, Q, Lainas, P, Lauterio, A, Lazzaro, A, Marudanayagam, R, Nasralla, D, Nicolini, D, Orlando, G, Patrono, D, Pitchaimuthu, M, Polak, Wojtek, Quinto, AM, Rai, R, Scalera, I, Schlegel, A, Shanmugam, V, Vitale, A, Widmer, J, Yannick, D, Manzia, TM, Angelico, R, Parente, A, Muiesan, P, Tisone, G, Al Alawy, Y, Arif, AJ, Attia, M, Bhati, C, Battula, RN, Bonney, GK, Brooke-Smith, M, Derosas, C, Carino, ND, Ferretti, S, Fiorani, C, Gherardi, D, Hegab, B, Hussain, Z, Ielpo, B, Iesari, S, Lai, Q, Lainas, P, Lauterio, A, Lazzaro, A, Marudanayagam, R, Nasralla, D, Nicolini, D, Orlando, G, Patrono, D, Pitchaimuthu, M, Polak, Wojtek, Quinto, AM, Rai, R, Scalera, I, Schlegel, A, Shanmugam, V, Vitale, A, Widmer, J, and Yannick, D
Published: 2020

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

Author: Avolio, Alfonso Wolfango, Franco, A, Schlegel, A, Lai, Q, Meli, S, Burra, P, Patrono, D, Ravaioli, M, Bassi, D, Ferla, F, Pagano, D, Violi, P, Camagni, S, Dondossola, D, Montalti, R, Alrawashdeh, W, Vitale, A, Teofili, Luciana, Spoletini, Gabriele, Magistri, P, Bongini, P, Rossi, M, Mazzaferro, V, Di Benedetto, F, Hammond, J, Vivarelli, M, Agnes, Salvatore, Colledan, M, Carraro, A, Cescon, M, De Carlis, L, Caccamo, L, Gruttadauria, S, Muiesan, P, Cillo, U, Romagnoli, R, De Simone, P, Avolio AW (ORCID:0000-0003-2491-7625), Teofili L (ORCID:0000-0002-7214-1561), Spoletini G (ORCID:0000-0002-6855-4515), Agnes S (ORCID:0000-0002-3341-4221), Avolio, Alfonso Wolfango, Franco, A, Schlegel, A, Lai, Q, Meli, S, Burra, P, Patrono, D, Ravaioli, M, Bassi, D, Ferla, F, Pagano, D, Violi, P, Camagni, S, Dondossola, D, Montalti, R, Alrawashdeh, W, Vitale, A, Teofili, Luciana, Spoletini, Gabriele, Magistri, P, Bongini, P, Rossi, M, Mazzaferro, V, Di Benedetto, F, Hammond, J, Vivarelli, M, Agnes, Salvatore, Colledan, M, Carraro, A, Cescon, M, De Carlis, L, Caccamo, L, Gruttadauria, S, Muiesan, P, Cillo, U, Romagnoli, R, De Simone, P, Avolio AW (ORCID:0000-0003-2491-7625), Teofili L (ORCID:0000-0002-7214-1561), Spoletini G (ORCID:0000-0002-6855-4515), and Agnes S (ORCID:0000-0002-3341-4221)
Abstract: BACKGROUND Expansion of donor acceptance criteria for liver transplantation increased the risk for early allograft failure (EAF). Though EAF prediction is pivotal to optimize transplant outcomes, there is no consensus on specific EAF indicators or timing to evaluate EAF. Recently, the Liver Graft Assessment following Transplantation (L-GrAFT) algorithm, based on aspartate transaminase, bilirubin, platelets, and INR kinetics, has been developed from a single-center database gathered from 2002 to 2015. OBJECTIVE To develop and validate a simplified comprehensive model estimating the EAF risk at day 10 after liver transplantation (the Early Allograft failure Simplified Estimation, EASE score), and, secondarily, to early identify patients with unsustainable EAF risk, suitable for re-transplant. DESIGN This multicenter study was designed to elaborate a score catching the continuum from normal graft function to non-function after transplant. We included among EAF determinants both parenchymal and vascular factors, which provide an indication to list for re-transplant. The L-GrAFT kinetic approach was adopted and modified with less data-entries and novel variables. ClinicalTrials.gov Identifier: NCT03858088. SETTING The patient population included 1,609 Italian patients in the derivation set and 570 UK patients in the validation set, all transplanted in 2016 and 2017. MAIN OUTCOME and MEASURE EAF was defined as graft failure (codified by re-transplant or death) for any reason within day 90 after transplant. RESULTS The EAF incidence was 6.8%. The EASE score was developed through 17 entries derived from 8 variables: MELD, blood transfusions, early thrombosis of hepatic vessels, kinetic parameters of transaminases, platelets and bilirubin. Donor parameters (age, DCD, machine perfusion) were not predictive. Results were adjusted for Center-volume. At ROC curve analysis, the EASE score outperformed L-GrAFT, MEAF, EAD, ET-DRI, DMELD, and DRI scores, predicting day-90 E
Published: 2020

34. Worse Graft Survival in HCV-Infected Transplanted Females Receiving a Male Donor Graft. The Liver Match Study.: Abstract# O-164

Author: Romagnoli, R., Rossi, M., Gerunda, G. E., Pinna, A. D., Agnes, S., Spada, M., Colledan, M., Tisone, G., De Carlis, L., Baccarani, U., Ettorre, G. M., Cillo, U., Calise, F., Caccamo, L., Cuomo, O., Lupo, L., Corradini, S., Zamboni, F, Marianelli, T., Risaliti, A., Patrono, D., Petri, S. Li, Tagliabue, F., Mangoni, J. M.E., Antonelli, B., Sposito, C., Gringeri, E., Rompianesi, G., Sforza, D., Cucchetti, A., Miglioresi, L., Donataccio, M., Gelli, M., Gavrila, C., Nardi, A., and Angelico, M.
Published: 2012

35. Implantation of a Renal Artery Allograft on an Iliac Vascular Graft: Early Complications and Long-Term Results.: Abstract# 1734: Poster Board #-Session: P296-IV

Author: Patrono, D., Verhelst, R., De Meyer, M., Fusaro, F., De Pauw, L., and Mourad, M.
Published: 2012

36. L’abord cœlioscopique n’est plus une contre-indication pour la résection des cholangiocarcinomes intrahépatiques (CCAi) : étude de cohorte internationale

Author: Brustia, R., primary, Laurent, A., additional, Goumard, C., additional, Langella, S., additional, Soubrane, O., additional, Kaway, T., additional, Sommacale, D., additional, Patrono, D., additional, Salamé, E., additional, Fuks, D., additional, Boleslawski, E., additional, Regimbeau, J.M., additional, Vibert, E., additional, and Scatton, O., additional
Published: 2020
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37. Preoperative risk score for prediction of long-term outcomes after hepatectomy for intrahepatic cholangiocarcinoma: Report of a collaborative, international-based, external validation study

Author: Brustia, R., primary, Langella, S., additional, Kawai, T., additional, Fonseca, G Marques, additional, Schielke, A., additional, Fartoux, L., additional, Colli, F., additional, Fleres, F., additional, Famularo, S., additional, Giacomoni, A., additional, Sommacale, D., additional, Patrono, D., additional, Detry, O., additional, Hermann, P., additional, Okumura, S., additional, and Scatton, O., additional
Published: 2020
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38. Molecular adsorbent recirculating system (MARS) application in liver failure: Clinical and hemodepurative results in 22 patients

Author: STEFONI, S., COLÌ, L., BOLONDI, L., DONATI, G., RUGGERI, G., FELICIANGELI, G., PISCAGLIA, F., SILVAGNI, E., SIRRI, M., BARALDI, O., SOVERINI, M. L., CIANCIOLO, G., BONI, P., PATRONO, D., RAMAZZOTTI, E., MOTTA, R., RODA, A., SIMONI, P., MAGLIULO, M., BORGNINO, L. C., RICCI, D., MEZZOPANE, D., and CAPPUCCILLI, M. L.
Published: 2006

39. Validation of biochemical laboratory results using the DNSev expert system

Author: Storari, S, Lamma, E, Mancini, R, Mello, P, Motta, R, Patrono, D, and Canova, G
Published: 2003
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40. P67 SEMIMECHANICAL ANASTOMOSIS DURING ESOPHAGECTOMY: A NEW GOLD STANDARD?

Author: Mazza, E, primary, Strignano, P, additional, Fop, F, additional, Patrono, D, additional, Catalano, G, additional, Salizzoni, M, additional, and Romagnoli, R, additional
Published: 2019
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41. Preemptive direct-acting antiviral therapy in naive or NS5A-relapser liver transplant recipients: a single centre experience

Author: Martini, S., primary, Chialà, C., additional, Calvo, F., additional, Tandoi, F., additional, Patrono, D., additional, Cocchis, D., additional, Ottobrelli, A., additional, Salizzoni, M., additional, Maria Saracco, G., additional, and Romagnoli, R., additional
Published: 2018
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42. A simplified regimen of targeted antifungal prophylaxis in liver transplant recipients: A single-center experience

Author: Lavezzo, B., primary, Patrono, D., additional, Tandoi, F., additional, Martini, S., additional, Fop, F., additional, Ballerini, V., additional, Stratta, C., additional, Skurzak, S., additional, Lupo, F., additional, Strignano, P., additional, Donadio, P.P., additional, Salizzoni, M., additional, Romagnoli, R., additional, and De Rosa, F.G., additional
Published: 2018
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43. Direct-acting antiviral therapy immediately after liver transplant in naïve or NS5A-relapser recipients

Author: Martini, S., primary, Chialà, C., additional, Calvo, F., additional, Tandoi, F., additional, Patrono, D., additional, Cocchis, D., additional, Ottobrelli, A., additional, Salizzoni, M., additional, Saracco, G.M., additional, and Romagnoli, R., additional
Published: 2018
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44. Worse Graft Survival in HCV-Infected Transplanted Females Receiving a Male Donor Graft. The Liver Match Study

Author: Romagnoli, R, Rossi, M, Gerunda, G, Pinna, A, Agnes, S, Spada, M, Colledan, M, Tisone, G, De Carlis, L, Baccarani, U, Ettorre, G, Cillo, U, Calise, F, Caccamo, L, Cuomo, O, Lupo, L, Corradini, S, Zamboni, F, Marianelli, T, Risaliti, A, Patrono, D, Petri, S, Tagliabue, F, Mangoni, J, Antonelli, B, Sposito, C, Gringeri, E, Rompianesi, G, Sforza, D, Cucchetti, A, Miglioresi, L, Donataccio, M, Gelli, M, Gavrila, C, Nardi, A, Angelico, M, Romagnoli R, Rossi M, Gerunda GE, Pinna AD, Agnes S, Spada M, Colledan M, Tisone G, De Carlis L, Baccarani U, Ettorre GM, Cillo U, Calise F, Caccamo L, Cuomo O, Lupo L, Corradini S, Zamboni F, Marianelli T, Risaliti A, Patrono D, Petri SL, Tagliabue F, Mangoni JME, Antonelli B, Sposito C, Gringeri E, Rompianesi G, Sforza D, Cucchetti A, Miglioresi L, Donataccio M, Gelli M, Gavrila C, Nardi A, Angelico M, Romagnoli, R, Rossi, M, Gerunda, G, Pinna, A, Agnes, S, Spada, M, Colledan, M, Tisone, G, De Carlis, L, Baccarani, U, Ettorre, G, Cillo, U, Calise, F, Caccamo, L, Cuomo, O, Lupo, L, Corradini, S, Zamboni, F, Marianelli, T, Risaliti, A, Patrono, D, Petri, S, Tagliabue, F, Mangoni, J, Antonelli, B, Sposito, C, Gringeri, E, Rompianesi, G, Sforza, D, Cucchetti, A, Miglioresi, L, Donataccio, M, Gelli, M, Gavrila, C, Nardi, A, Angelico, M, Romagnoli R, Rossi M, Gerunda GE, Pinna AD, Agnes S, Spada M, Colledan M, Tisone G, De Carlis L, Baccarani U, Ettorre GM, Cillo U, Calise F, Caccamo L, Cuomo O, Lupo L, Corradini S, Zamboni F, Marianelli T, Risaliti A, Patrono D, Petri SL, Tagliabue F, Mangoni JME, Antonelli B, Sposito C, Gringeri E, Rompianesi G, Sforza D, Cucchetti A, Miglioresi L, Donataccio M, Gelli M, Gavrila C, Nardi A, and Angelico M
Published: 2012

45. Worse Graft Survival in HCV-Infected Transplanted Females Receiving a Male Donor Graft. The Liver Match Study

Author: Romagnoli, R., Rossi, M., Gerunda, G. E., Pinna, A. D., Agnes, S., Marco Spada, Colledan, M., Tisone, G., Carlis, L., Baccarani, U., Ettorre, G. M., Cillo, U., Calise, F., Caccamo, L., Cuomo, O., Lupo, L., Corradini, S., Zamboni, F., Marianelli, T., Risaliti, A., Patrono, D., Petri, S. Li, Tagliabue, F., Mangoni, J. M. E., Antonelli, B., Sposito, C., Gringeri, E., Rompianesi, G., Sforza, D., Cucchetti, A., Miglioresi, L., Donataccio, M., Gelli, M., Gavrila, C., Nardi, A., Angelico, M., Romagnoli, R, Rossi, M, Gerunda, G, Pinna, A, Agnes, S, Spada, M, Colledan, M, Tisone, G, De Carlis, L, Baccarani, U, Ettorre, G, Cillo, U, Calise, F, Caccamo, L, Cuomo, O, Lupo, L, Corradini, S, Zamboni, F, Marianelli, T, Risaliti, A, Patrono, D, Petri, S, Tagliabue, F, Mangoni, J, Antonelli, B, Sposito, C, Gringeri, E, Rompianesi, G, Sforza, D, Cucchetti, A, Miglioresi, L, Donataccio, M, Gelli, M, Gavrila, C, Nardi, A, and Angelico, M
Subjects: HCV infection, liver transplantation, Transplantation, Hepatology, HCV-infected transplanted females, Gastroenterology, Surgery
Published: 2012

46. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis

Author: Mazzaferro, V, Llovet, Jm, Miceli, R, Bhoori, S, Schiavo, M, Mariani, L, Camerini, T, Roayaie, S, Schwartz, Me, Grazi, Gl, Adam, R, Neuhaus, P, Salizzoni, M, Bruix, J, Forner, A, De Carlis, L, Cillo, U, Burroughs, Ak, Troisi, R, Rossi, M, Gerunda, Ge, Lerut, J, Belghiti, J, Boin, I, Gugenheim, J, Rochling, F, Van Hoek, B, Majno, P, Graziadei, I, Vogel, W, Lucidi, V, de Hemptinne, B, Leopardi, L, Cotsoglou, C, Iannelli, A, Staccini, A, Koenigsrainer, A, Steurer, W, Cautero, N, Risaliti, A, Lupo, L, Colledan, M, De Giorgio, M, Fagiuoli, S, Pinna, Ad, Ravaioli, M, Battiston, C, Coppa, J, Regalia, E, Romito, R, Giacomoni, A, Mangoni, J, Maggi, U, Rossi, G, Masetti, M, Montalti, R, Calise, F, Cuomo, O, Scuderi, E, Bridda, A, Vitale, A, Tisone, G, Berloco, P, Paraluppi, G, Patrono, D, Adani, Gl, Baccarani, U, Lorenzin, D, Zieniewicz, K, Ribeiro, V, Soderdahl, G, Giostra, E, Mentha, G, Morel, P, Marelli, L, Patch, D, Muiesan, P, Heaton, N, Schwartz, M, Rossaro, L, Khatri, V, Hsieh, Cb., Mazzaferro, V, Llovet, J, Miceli, R, Bhoori, S, Schiavo, M, Mariani, L, Camerini, T, Roayaie, S, Schwartz, M, Grazi, G, Adam, R, Neuhaus, P, Salizzoni, M, Bruix, J, Forner, A, De Carlis, L, Cillo, U, Burroughs, A, Troisi, R, Rossi, M, Gerunda, G, Lerut, J, Belghiti, J, Boin, I, Gugenheim, J, Rochling, F, Van Hoek, B, Majno, P, Colledan, M, Fagiuoli, S, Mazzaferro V., Llovet J.M., Miceli R., Bhoori S., Schiavo M., Mariani L., Camerini T., Roayaie S., Schwartz M.E., Grazi G.L., Adam R., Neuhaus P., Salizzoni M., Bruix J., Forner A., De Carlis L., Cillo U., Burroughs A.K., Troisi R., Rossi M., Gerunda G.E., Lerut J., Belghiti J., Boin I., Gugenheim J., Rochling F., Van Hoek B., Majno P., Graziadei I., Vogel W., Lucidi V., de Hemptinne B., Leopardi L., Cotsoglou C., Iannelli A., Staccini A., Koenigsrainer A., Steurer W., Cautero N., Risaliti A., Lupo L., Colledan M., De Giorgio M., Fagiuoli S., Pinna A.D., Ravaioli M., Battiston C., Coppa J., Regalia E., Romito R., Giacomoni A., Mangoni J., Maggi U., Rossi G., Masetti M., Montalti R., Calise F., Cuomo O., Scuderi E., Bridda A., Vitale A., Tisone G., Berloco P., Paraluppi G., Patrono D., Adani G.L., Baccarani U, Lorenzin D, Zieniewicz K, Ribeiro V, Soderdahl G., Giostra E., Mentha G., Morel P., Marelli L., Patch D., Muiesan P., Heaton N., Rossaro L., Khatri V., Hsieh C.B., Mazzaferro, Vincenzo, Llovet, Josep M, Miceli, Rosalba, Bhoori, Sherrie, Schiavo, Marcello, Mariani, Luigi, Camerini, Tiziana, Roayaie, Sasan, Schwartz, Myron E, Grazi, Gian Luca, Adam, René, Neuhaus, Peter, Salizzoni, Mauro, Bruix, Jordi, Forner, Alejandro, De Carlis, Luciano, Cillo, Umberto, Burroughs, Andrew K, Troisi, Roberto, Rossi, Massimo, Gerunda, Giorgio E, Lerut, Jan, Belghiti, Jacque, Boin, Ilka, Gugenheim, Jean, Rochling, Fedja, Van Hoek, Bart, and Majno, Pietro
Subjects: Oncology, Adult, medicine.medical_specialty, Carcinoma, Hepatocellular, Adolescent, medicine.medical_treatment, education, Liver transplantation, Milan criteria, Retrospective Studie, Liver Neoplasms/mortality/*surgery, Internal medicine, Liver Transplantation, Carcinoma, medicine, Humans, HEPATOCELLULAR CARCINOMA, Child, Aged, Retrospective Studies, mortality/surgery, ddc:617, Proportional hazards model, business.industry, Hazard ratio, Liver Neoplasms, SELECTION CRITERIA, Retrospective cohort study, Hepatocellular, Middle Aged, medicine.disease, digestive system diseases, Surgery, Carcinoma, Hepatocellular/mortality/*surgery, Transplantation, Settore MED/18 - Chirurgia Generale, Liver Neoplasm, Hepatocellular carcinoma, Adolescent, Adult, Aged, Carcinoma, mortality/surgery, Child, Humans, Liver Neoplasms, mortality/surgery, Liver Transplantation, Middle Aged, Retrospective Studies, business, Human
Abstract: Background: Patients undergoing liver transplantation for hepatocellular carcinoma within the Milan criteria (single tumour ≤5 cm in size or ≤3 tumours each ≤3 cm in size, and no macrovascular invasion) have an excellent outcome. However, survival for patients with cancers that exceed these criteria remains unpredictable and access to transplantation is a balance of maximising patients' chances of cure and organ availability. The aim of this study was to explore the survival of patients with tumours that exceed the Milan criteria, to assess whether the criteria could be less restrictive, enabling more patients to qualify as transplant candidates, and to derive a prognostic model based on objective tumour characteristics, to see whether the Milan criteria could be expanded. Methods: Data on patients who underwent transplantation for hepatocellular carcinoma despite exceeding Milan criteria at different centres were recorded via a web-based survey completed by specialists from each centre. The survival of these patients was correlated retrospectively with the size of the largest tumour nodule, number of nodules, and presence or absence of microvascular invasion detected at pathology. Contoured multivariable regression Cox models produced survival estimates by means of different combinations of the covariates. The primary aim of this study was to derive a prognostic model of overall survival based on tumour characteristics, according to the main parameters used in the Tumour Node Metastasis classification. The secondary aim was the identification of a subgroup of patients with hepatocellular carcinoma exceeding the Milan criteria, who achieved a 5-year overall survival of at least 70%-ie, similar to the outcome expected for patients who meet the Milan criteria. Findings: Over a 10-month period, between June 25, 2006, and April 3, 2007, data for 1556 patients who underwent transplantation for hepatocellular carcinoma were entered on the database by 36 centres. 1112 patients had hepatocellular carcinoma exceeding Milan criteria and 444 patients had hepatocellular carcinoma shown not to exceed Milan criteria at post-transplant pathology review. In the group of patients with hepatocellular carcinomas exceeding the criteria, the median size of the largest nodule was 40 mm (range 4-200) and the median number of nodules was four (1-20). 454 of 1112 patients (41%) had microvascular invasion and, for those transplanted outside the Milan criteria, 5-year overall survival was 53·6% (95% CI 50·1-57·0), compared with 73·3% (68·2-77·7) for those that met the criteria. Hazard ratios (HR) associated with increasing values of size and number were 1·34 (1·25-1·44) and 1·51 (1·21-1·88), respectively. The effect was linear for size, whereas for number of tumours, the effect tended to plateau above three tumours. The effect of tumour size and number on survival was mediated by recurrence (b=0·08, SE=0·12, p=0·476). The presence of microvascular invasion doubled HRs in all scenarios. The 283 patients without microvascular invasion, but who fell within the Up-to-seven criteria (hepatocellular carcinomas with seven as the sum of the size of the largest tumour [in cm] and the number of tumours) achieved a 5-year overall survival of 71·2% (64·3-77·0). Interpretation: More patients with hepatocellular carcinoma could be candidates for transplantation if the current dual (yes/no) approach to candidacy, based on the strict Milan criteria, were replaced with a more precise estimation of survival contouring individual tumour characteristics and use of the up-to-seven criteria. Funding: Specific funding was not used to do this study. © 2009 Elsevier Ltd. All rights reserved
Published: 2009

47. Standard fortification of human milk (HM) does not allow an optimal nutritional management of preterm newborn

Author: ACETI, ARIANNA, CORVAGLIA, LUIGI TOMMASO, BATTISTINI, BARBARA, PAOLETTI, VITTORIA, FALDELLA, GIACOMO, Mariani E, Patrono D, Aceti A, Corvaglia L, Mariani E, Battistini B, Paoletti V, Patrono D, and Faldella G
Subjects: PRETERM INFANTS, nutritional management, standard human milk fortification
Published: 2009

48. SUN-P103: Evaluation of Three Different Antibiotic Lock-Therapies in Combination with Urokinase for the Treatment of Central Venous Catheter-Related Bloodstream Infections

Author: Bruno, L., primary, Piro, F., additional, Conti, M., additional, Tumietto, F., additional, Forchielli, M., additional, Stancari, A., additional, Guarguaglini, A., additional, Piazza, G., additional, Patrono, D., additional, Puggioli, C., additional, and Bersani, G., additional
Published: 2016
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49. FRI-022 - Preemptive direct-acting antiviral therapy in naive or NS5A-relapser liver transplant recipients: a single centre experience

Author: Martini, S., Chialà, C., Calvo, F., Tandoi, F., Patrono, D., Cocchis, D., Ottobrelli, A., Salizzoni, M., Maria Saracco, G., and Romagnoli, R.
Published: 2018
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50. Sex hormones in obese premenopausal women and their relationships to body fat mass and distribution, B cell function and diet composition

Author: Pasquali, R., Antenucci, D., Melchionda, N., Fabbri, R., Venturoli, S., Patrono, D., and Capelli, M.
Published: 1987
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