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Stefano DI SANDRO

Professore Associato
Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa

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Pubblicazioni

2024 - ASO Visual Abstract: Clinical Outcomes of Robotic Resection for Perihilar Cholangiocarcinoma: A First Multicenter Trans-Atlantic Expert Center Collaborative Study [Articolo su rivista]
Sucandy, I.; Marques, H. P.; Lippert, T.; Magistri, P.; Coelho, J. S.; Ross, S. B.; Chumbinho, B.; Di Sandro, S.; Dibenedetto, F.
abstract

2023 - ASO Author Reflections: Robotic Perihilar Cholangiocarcinoma Beyond Technical Feasibility [Articolo su rivista]
Di Benedetto, F; Magistri, P; Di Sandro, S
abstract

2023 - From Listing to Recovery: A Review of Nutritional Status Assessment and Management in Liver Transplant Patients [Articolo su rivista]
Ravaioli, F.; De Maria, N.; Di Marco, L.; Pivetti, A.; Casciola, R.; Ceraso, C.; Frassanito, G.; Pambianco, M.; Pecchini, M.; Sicuro, C.; Leoni, L.; Di Sandro, S.; Magistri, P.; Menozzi, R.; Di Benedetto, F.; Colecchia, A.
abstract

Liver transplantation (LT) is a complex surgical procedure requiring thorough pre- and post-operative planning and care. The nutritional status of the patient before, during, and after LT is crucial to surgical success and long-term prognosis. This review aims to assess nutritional status assessment and management before, during, and after LT, with a focus on patients who have undergone bariatric surgery. We performed a comprehensive topic search on MEDLINE, Ovid, In-Process, Cochrane Library, EMBASE, and PubMed up to March 2023. It identifies key factors influencing the nutritional status of liver transplant patients, such as pre-existing malnutrition, the type and severity of liver disease, comorbidities, and immunosuppressive medications. The review highlights the importance of pre-operative nutritional assessment and intervention, close nutritional status monitoring, individualised nutrition care plans, and ongoing nutritional support and monitoring after LT. The review concludes by examining the effect of bariatric surgery on the nutritional status of liver transplant recipients. The review offers valuable insights into the challenges and opportunities for optimising nutritional status before, during, and after LT.

2023 - Liver transplantation for iatrogenic injuries secondary to cholecystectomy: a systematic review [Articolo su rivista]
Guidetti, C.; Pang, N. Q.; Catellani, B.; Magistri, P.; Caracciolo, D.; Guerrini, G. P.; Pecchi, A.; Di Sandro, S.; Di Benedetto, F.
abstract

INTRODUCTION: Iatrogenic injury to the liver hilum during cholecystectomy is a severe surgical complication, with liver transplantation (LT) as the final drastic solution. The authors report the experience of our center and conduct a review of the literature on the outcomes of LT performed in this setting. METHODS: Data sources included MEDLINE, EMBASE, and CENTRAL from inception to 19 June 2022. Studies reporting on patients treated with LT for liver hilar injuries following cholecystectomy were included. Incidence, clinical outcomes, and survival data were synthesized through a narrative review. RESULTS: Twenty-seven articles were identified, including 213 patients. Eleven (40.7%) articles highlighted deaths within 90-days post-LT. Post-LT mortality was reported in 28 (13.1%) patients. Severe complications (≥Clavien III) occurred in at least 25.8% ( n =55) of patients. Within larger cohorts, 1-year overall survival (OS) was 76.5-84.3%, and 5-year OS was 67.2-83.0%. The authors also highlight our own experience managing 14 patients with liver hilar injury secondary to cholecystectomy, of which two required LT. CONCLUSION: While short-term morbidity and mortality is significant, available long-term data suggests reasonable OS in these patients following LT. Future studies are necessary to better understand the relationship between different types of liver hilar injury, transplant indication, and outcomes of LT in this setting.

2023 - Pneumocystis jirovecii pneumonia in patients with decompensated cirrhosis: a case series [Articolo su rivista]
Franceschini, Erica; Dolci, Giovanni; Santoro, Antonella; Meschiari, Marianna; Riccò, Alice; Menozzi, Marianna; Burastero, Giulia Jole; Cuffari, Biagio; De Maria, Nicola; Serio, Lucia; Biagioni, Emanuela; Catellani, Barbara; Sandro, Stefano Di; Colecchia, Antonio; Girardis, Massimo; Benedetto, Fabrizio Di; Mussini, Cristina
abstract

Objectives: Pneumocystis jirovecii pneumonia (PCP) incidence is increasing in people without HIV. Decompensated liver cirrhosis is not currently considered a risk factor for PCP. The aim of this paper is to describe a case series of patients with decompensated liver cirrhosis and PCP. Methods: All consecutive patients hospitalized with decompensated cirrhosis and microbiology-confirmed PCP at Policlinico Modena University Hospital from January 1, 2016 to December 31, 2021 were included in our series. Results: Eight patients were included. All patients had advanced-stage liver disease with a model for end-stage liver disease score above 15 (6/8 above 20). Four were on an active orthotopic liver transplant waiting list at the time of PCP diagnosis. Five patients did not have any traditional risk factor for PCP, whereas the other three were on glucocorticoid treatment for acute-on-chronic liver failure. All patients were treated with cotrimoxazole, except two who died before the diagnosis. Five patients died (62.5%), four of them within 30 days from PCP diagnosis. Of the remaining three, one patient underwent liver transplantation. Conclusion: Although further studies are needed, liver cirrhosis can be an independent risk factor for PCP in patients with decompensated cirrhosis that is mainly due to severe alcoholic hepatitis and who are on corticosteroids therapy, and primary prophylaxis for PCP should be considered.

2023 - Successful living donor liver transplantation from an HIV and HCV positive donor: report from the first case in the world [Articolo su rivista]
Di Sandro, Stefano; Catellani, Barbara; Guidetti, Cristiano; Magistri, Paolo; Ballarin, Roberto; Pecchi, Annarita; Caracciolo, Daniela; Guaraldi, Giovanni; Guerrini, Gian Piero; Di Benedetto, Fabrizio
abstract

: HIV (human-immunodeficiency-virus) and HCV (hepatitis-C-virus) infections cause millions of deaths across the world every year. Since the introduction of effective therapies for HIV, in the middle of 1990 s, and HCV, after 2013, those two untreatable infections became completely controlled. Donor safety is the main goal in living donor liver transplantation (LDLT). An accurate pre-donation screening is mandatory for excluding risk factors related with any increase of donors' short-term and long-term morbidity. We present the first LDLT from a donor with both HIV and HCV previous infections. Donor and recipient did not experience any complication. Individuals with well controlled HIV/HCV infections and without any risk factors may be suitable for donation of a part of their healthy liver. An infographic is available for this article at:http://links.lww.com/QAD/C833.

2023 - The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma [Articolo su rivista]
Lai, Quirino; De Matthaeis, Nicoletta; Finotti, Michele; Galati, Giovanni; Marrone, Giuseppe; Melandro, Fabio; Morisco, Filomena; Nicolini, Daniele; Pravisani, Riccardo; Giannini, Edoardo G; di sandro, S
abstract

To evaluate the impact of antiplatelet therapy (APT)on the incidence of hepatocellular carcinoma (HCC) and mortality following its treatment.

2022 - De Novo Skin Neoplasms in Liver-Transplanted Patients: Single-Center Prospective Evaluation of 105 Cases [Articolo su rivista]
Paganelli, Alessia; Magistri, Paolo; Kaleci, Shaniko; Chester, Johanna; Pezzini, Claudia; Catellani, Barbara; Ciardo, Silvana; Casari, Alice; Giusti, Francesca; Bassoli, Sara; Di Sandro, Stefano; Pellacani, Giovanni; Farnetani, Francesca; Di Benedetto, Fabrizio
abstract

Background and Objectives: Solid-organ transplant recipients (SOTRs) are notably considered at risk for developing cutaneous malignancies. However, most of the existing literature is focused on kidney transplant-related non-melanoma skin cancers (NMSCs). Conflicting data have been published so far on NMSC incidence among liver transplant recipients (LTRs), and whether LTRs really should be considered at lower risk remains controversial. The aim of the present study was to prospectively collect data on the incidence of cutaneous neoplasms in an LTR cohort. Materials and Methods: All LTRs transplanted at the Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit of Modena University Hospital from October 2015 to June 2021 underwent a post-transplant periodic skin check at the Dermatology Unit according to our institutional integrated care pathway. Data on the presence of cutaneous malignant and premalignant lesions were collected at every timepoint. Results: A total of 105 patients were enrolled in the present study. Nearly 15% of the patients developed cutaneous cancerous and/or precancerous lesions during the follow-up period. Almost half of the skin cancerous lesions were basal cell carcinomas. Actinic keratoses (AKs) were observed in six patients. Four patients developed in situ squamous cell carcinomas, and one patient was diagnosed with stage I malignant melanoma. Otherwise, well-established risk factors for the occurrence of skin tumors, such as skin phototype, cumulative sun exposure, and familial history of cutaneous neoplasms, seemed to have no direct impact on skin cancer occurrence in our cohort, as well as an immunosuppressive regimen and the occurrence of non-cutaneous neoplasms. Conclusions: Close dermatological follow-up is crucial for LTRs, and shared protocols of regular skin checks in this particular subset of patients are needed in transplant centers.

2022 - Impact of MELD 30-allocation policy on liver transplant outcomes in Italy [Articolo su rivista]
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.
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 model for end-stage liver disease (MELD) score ≥30 (i.e. very sick patients). This policy has led to more liver transplants, fewer dropouts, and shorter waiting times for patients with MELD ≥30. However, a higher risk of graft loss still burdens these cases. Transplant center volumes and competition among centers may have a role in recipient prioritization and outcomes.

2022 - Perihilar-cholangiocarcinoma: what really matters? [Articolo su rivista]
Di Benedetto, Fabrizio; Magistri, Paolo; Di Sandro, Stefano
abstract

2022 - Predictors of solid extra-hepatic non-skin cancer in liver transplant recipients and analysis of survival: a long-term follow-up study [Articolo su rivista]
Gitto, Stefano; Magistri, Paolo; Marzi, Luca; Mannelli, Nicolò; De Maria, Nicola; Mega, Andrea; Vitale, Giovanni; Valente, Giovanna; Vizzutti, Francesco; Villa, Erica; Marra, Fabio; Andreone, Pietro; Di Benedetto, Fabrizio; Falcini, Margherita; Catellani, Barbara; Guerrini, Gian Piero; Serra, Valentina; Di Sandro, Stefano; Ballarin, Roberto; Piai, Guido; Schepis, Filippo; Margotti, Marzia; Cursaro, Carmela; De Simone, Paolo; Petruccelli, Stefania; Carrai, Paola; Forte, Paolo; Campani, Claudia; Zoller, Heinz
abstract

Introduction and objectives: De novo malignancies represent an important cause of death for liver transplant recipients. Our aim was to analyze predictors of extra-hepatic non-skin cancer (ESNSC) and the impact of ESNSC on the long-term outcome. Patients: We examined data from patients transplanted between 2000 and 2005 and followed-up in five Italian transplant clinics with a retrospective observational cohort study. Cox Regression was performed to identify predictors of ESNSC. A 1:2 cohort sub-study was developed to analyze the impact of ESNSC on 10-year survival. Results: We analyzed data from 367 subjects (median follow-up: 15 years). Patients with ESNSC (n=47) more often developed post-LT diabetes mellitus (DM) (57,4% versus 35,9%, p=0,004). At multivariate analysis, post-LT DM independently predicted ESNSC (HR 1.929, CI 1.029-3.616, p=0.040). Recipients with ESNSC showed a lower 10-year survival than matched controls (46,8% versus 68,1%, p=0,023). Conclusions: Post-LT DM seems to be a relevant risk factor for post-LT ESNSC. ESNSC could have a noteworthy impact on the long-term survival of LT recipients.

2022 - Robotic liver partition and portal vein embolization for staged hepatectomy for perihilar cholangiocarcinoma [Articolo su rivista]
Di Benedetto, F.; Magistri, P.; Guerrini, G. P.; Di Sandro, S.
abstract

Perihilar cholangiocarcinoma (pCCA) is one of the most complex challenges for hepatobiliary surgeons. Poor results and high incidence of morbidity after Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) for pCCA discouraged this indication. It has been proposed that minimally invasive approach for ALPPS first stage, as well as combination of surgical liver partition and radiologic portal vein embolization (PVE), may improve outcomes reducing interstage morbidity. We report a case of right trisectionectomy with enbloc&nbsp;caudatectomy ALPPS scheduled for pCCA with robotic approach at stage-1, the full video is provided as supplementary material. Due to intraoperative presence of portal vein tumor infiltration during hilar dissection (no evidence in the pre-operative work-up), a radiologic right PVE was performed after stage-1 instead of portal vein ligation, followed by portal vein resection and biductal hepatico-jejunostomy at stage-2 with open approach. The patient was a 74-year-old female diagnosed with 3-cm mass-forming pCCA. The total clean liver volume was 1231&nbsp;cc, with future liver remnant (FLR) volume of 25.1% (segments II and III). She was discharged in the interstage interval on postoperative day (POD) 4; CT scan on POD 12 showed that FLR increased up to 33% (369&nbsp;cc) (Fig. 1). ALPPS was completed on POD 17, the postoperative course was uneventful, and the patient was discharged in good general condition on POD 19 after stage-2. Besides the already demonstrated advantages in terms of reduced interstage morbidity, robotic ALPPS represents a promising strategy to expand surgical indication in patients with pCCA. The combination of liver partition and PVE may increase the opportunities to perform radical resections in selected patients with pCCA and portal vein infiltration.

2022 - Salvage versus Primary Liver Transplantation for Hepatocellular Carcinoma: A Twenty-Year Experience Meta-Analysis [Articolo su rivista]
Guerrini, G. P.; Esposito, G.; Olivieri, T.; Magistri, P.; Ballarin, R.; Di Sandro, S.; Di Benedetto, F.
abstract

(1) Background: Primary liver transplantation (PLT) for HCC represents the ideal treatment. However, since organ shortage increases the risk of drop-out from the waiting list for tumor progression, a new surgical strategy has been developed: Salvage Liver Transplantation (SLT) can be offered as an additional curative strategy for HCC recurrence after liver resection. The aim of this updated meta-analysis is to compare surgical and long-term outcomes of SLT versus PLT for HCC. (2) Materials and Methods: A systematic review and meta-analysis was conducted using the published papers comparing SLT and PLT up to January 2022. (3) Results: 25 studies describing 11,275 patients met the inclusion criteria. The meta-analysis revealed no statistical difference in intraoperative blood loss, overall vascular complications, retransplantation rate, and hospital stay in the SLT group compared with the PLT group. However, the SLT group showed a slightly significant lower 5-year OS rate and 5-year disease-free survival rate. (4) Conclusion: meta-analysis advocates the relative safety and feasibility of both Salvage LT and Primary LT strategies. Specifically, SLT seems to have comparable surgical outcomes but slightly poorer long-term survival than PLT.

2021 - A retrospective single-centre analysis of the oncological impact of LI-RADS classification applied to Metroticket 2.0 calculator in liver transplantation: every nodule matters [Articolo su rivista]
Centonze, L.; Di Sandro, S.; Lauterio, A.; De Carlis, R.; Sgrazzutti, C.; Ciulli, C.; Vella, I.; Vicentin, I.; Incarbone, N.; Bagnardi, V.; Vanzulli, A.; De Carlis, L.
abstract

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

2021 - Advanced donor age does not increase risk of hepatocellular carcinoma recurrence after liver transplantation: a retrospective two-centre analysis using competing risk analysis [Articolo su rivista]
Cusumano, C.; De Carlis, L.; Centonze, L.; Lesourd, R.; Levi Sandri, G. B.; Lauterio, A.; De Carlis, R.; Ferla, F.; Di Sandro, S.; Camus, C.; Jezequel, C.; Bardou-Jacquet, E.; Rayar, M.
abstract

The impact of donor age on the recurrence of hepatocellular carcinoma (HCC) after liver transplantation is still debated. Between 2002 and 2014, all patients transplanted for HCC in 2 European liver transplantation tertiary centres were retrospectively reviewed. Risk factors for HCC recurrence were assessed using competing risk analysis, and the impact of donor age &lt; or ≥65&nbsp;years and &lt; or ≥80&nbsp;years was specifically evaluated after propensity score matching. 728 patients transplanted with a median follow-up of 86&nbsp;months were analysed. The 1-, 3- and 5-year recurrence rates were 4.9%, 10.7% and 13.9%, respectively. In multivariable analysis, recipient age (sHR: 0.96 [0.93; 0.98], P&nbsp;&lt;&nbsp;0.01), number of lesions (sHR: 1.05 [1.04; 1.06], P&nbsp;&lt;&nbsp;0.001), maximum size of the lesions (sHR: 1.37 [1.27; 1.48], P&nbsp;&lt;&nbsp;0.01), presence of a hepatocholangiocarcinoma (sHR: 6.47 [2.91; 14.38], P&nbsp;&lt;&nbsp;0.01) and microvascular invasion (sHR: 3.48 [2.42; 5.02], P&nbsp;&lt;&nbsp;0.01) were significantly associated with HCC recurrence. After propensity score matching, neither donor age ≥65 (P&nbsp;=&nbsp;0.29) nor donor age ≥80 (P&nbsp;=&nbsp;0.84) years increased the risk of HCC recurrence. In conclusion, donor age was not found to be a risk factor for HCC recurrence. Patients listed for HCC can receive a graft from an elderly donor without compromising the outcome.

2021 - 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 [Articolo su rivista]
De Carlis, Riccardo; Schlegel, Andrea; Frassoni, Samuele; Olivieri, Tiziana; Ravaioli, Matteo; Camagni, Stefania; Patrono, Damiano; Bassi, Domenico; Pagano, Duilio; Di Sandro, Stefano; Lauterio, Andrea; Bagnardi, Vincenzo; Gruttadauria, Salvatore; Cillo, Umberto; Romagnoli, Renato; Colledan, Michele; Cescon, Matteo; Di Benedetto, Fabrizio; Muiesan, Paolo; De Carlis, Luciano
abstract

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).

2021 - Liver resection for perihilar cholangiocarcinoma: Impact of biliary drainage failure on postoperative outcome. Results of an Italian multicenter study [Articolo su rivista]
Giuliante, F.; Ardito, F.; Aldrighetti, L.; Ferrero, A.; Pinna, A. D.; De Carlis, L.; Cillo, U.; Jovine, E.; Portolani, N.; Gruttadauria, S.; Mazzaferro, V.; Massani, M.; Rosso, E.; Ettorre, G. M.; Ratti, F.; Guglielmi, A.; Cescon, M.; Colasanti, M.; Di Sandro, S.; Gringeri, E.; Russolillo, N.; Ruzzenente, A.; Sposito, C.; Zanello, M.; Zimmitti, G.
abstract

Background: Preoperative biliary drainage may be essential to reduce the risk of postoperative liver failure after hepatectomy for perihilar cholangiocarcinoma. However, infectious complications related to preoperative biliary drainage may increase the risk of postoperative mortality. The strategy and optimal drainage method continues to be controversial. Methods: This is a retrospective multicenter study including patients who underwent hepatectomy for perihilar cholangiocarcinoma between 2000 and 2016 at 14 Italian referral hepatobiliary centers. The primary end point was to evaluate independent predictors for postoperative outcome in patients undergoing liver resection for perihilar cholangiocarcinoma after preoperative biliary drainage. Results: Of the 639 enrolled patients, 441 (69.0%) underwent preoperative biliary drainage. Postoperative mortality was 8.9% (12.5% after right-side hepatectomy versus 5.7% after left-side hepatectomy; P = .003). Of the patients, 40.5% underwent preoperative biliary drainage at the first admitting hospital, before evaluation at referral centers. Use of percutaneous preoperative biliary drainage was significantly more frequent at referral centers than at community hospitals where endoscopic preoperative biliary drainage was the most frequent type. The overall failure rate after preoperative biliary drainage was 43.3%, significantly higher at community hospitals than that at referral centers (52.7% v 36.9%; P = .002). Failure of the first preoperative biliary drainage was one of the strongest predictors for postoperative complications after right-side and left-side hepatectomies and for mortality after right-side hepatectomy. Type of preoperative biliary drainage (percutaneous versus endoscopic) was not associated with significantly different risk of mortality. Conclusion: Failure of preoperative biliary drainage was significantly more frequent at community hospitals and it was an independent predictor for postoperative outcome. Centers’ experience in preoperative biliary drainage management is crucial to reduce the risk of failure that is closely associated with postoperative morbidity and mortality.

2021 - Liver transplantation for hcc in hiv‐infected patients: Long‐term single‐center experience [Articolo su rivista]
Guerrini, G. P.; Berretta, M.; Guaraldi, G.; Magistri, P.; Esposito, G.; Ballarin, R.; Serra, V.; Di Sandro, S.; Di Benedetto, F.
abstract

Background: HIV‐infected patients now have long life expectation since the introduction of the highly active antiretroviral therapy (HAART). Liver diseases, especially cirrhosis and hepatocellular carcinoma (HCC), currently represent a leading cause of death in this setting of patients. Aim: To address the results of liver transplantation (LT) for HCC in HIV‐infected patients. Methods: All patients with and without HIV infection who underwent LT for HCC (n = 420) between 2001 and 2021 in our center were analyzed with the intent of comparing graft and patient survival. Cox regression analysis was used to determine prognostic survival factors and logistic regression to determine the predictor factors of post‐LT recurrence. Results: Among 1010 LT, 32 were HIV‐infected recipients. With an average follow‐up of 62 ± 51 months, 5‐year overall survival in LT recipients with and without HIV‐infection was 71.6% and 69.9%, respectively (p = ns), whereas 5‐year graft survival in HIV‐infected and HIV‐non infected was 68.3% and 68.2%, respectively (p = ns). The independent predictive factor of survival in the study group was: HCV infection (HR 1.83 p = 0.024). There were no significant differences in the pathological characteristics of HCC between the two groups. The logistic regression analysis of the study population demonstrated that microvascular invasion (HR 5.18 p&lt; 0.001), HCC diameter (HR 1.16 p = 0.028), and number of HCC nodules (HR 1.26 p = 0.003) were predictors of recurrence post‐LT. Conclusion: Our study shows that HIV patients undergoing LT for HCC have comparable results in terms of post‐LT survival. Excellent results can be achieved for HIV-infected patients with HCC, as long as a strategy of close surveillance and precise treatment of the tumor is adopted while on the waiting list.

2021 - Major robotic hepatectomies: technical considerations [Articolo su rivista]
Magistri, P.; Assirati, G.; Ballarin, R.; Di Sandro, S.; Di Benedetto, F.
abstract

Robotic approach to the liver may allow to perform difficult resections with a minimally invasive strategy in an easier way as compared to standard laparoscopy. The aim of this study is to review our experience with robotic major hepatectomies, reporting technical considerations, and describing the outcomes of patients that underwent either left (LRH) or right robotic hepatectomy (RRH). Our prospectively maintained database was screened to identify all patients that received a major liver resection for benign or malignant disease. Preoperative data and postoperative short-term and long-term outcomes were reported. 261 robotic procedures were performed in our Center between May 2014 and October 2020. 12 patients underwent robotic left hepatectomy (RLH) and 10 patients were treated by robotic right hepatectomy (RRH). In the RLH group, median operative time (OT) was 383&nbsp;min, median estimated blood loss (EBL) was 300&nbsp;ml, and median in-hospital stay was of 3&nbsp;days. In the RRH group, median OT was 490&nbsp;min, median EBL 725&nbsp;ml, and median hospital stay was 5&nbsp;days. Although one of the advantages of minimally invasive surgery is to obtain radical resections with parenchyma sparing strategies, patients that need a major hepatectomy may benefit of a robotic resection with good postoperative outcomes. Team learning curve and growth instead of personal progression is crucial to expand the limits of novel surgical techniques.

2021 - Overview of prognostic systems for hepatocellular carcinoma and ITA.LI.CA external validation of MESH and CNLC classifications [Articolo su rivista]
Vitale, A.; Farinati, F.; Finotti, M.; Di Renzo, C.; Brancaccio, G.; Piscaglia, F.; Cabibbo, G.; Caturelli, E.; Missale, G.; Marra, F.; Sacco, R.; Giannini, E. G.; Trevisani, F.; Cillo, U.; Bhoori, S.; Borzio, M.; Burra, P.; Casadei Gardini, A.; Carrai, P.; Conti, F.; Cozzolongo, R.; Cucchetti, A.; D'Ambrosio, R.; Dell'Unto, C.; De Matthaeis, N.; Di Costanzo, G. G.; Di Sandro, S.; Famularo, S.; Foschi, F. G.; Fucilli, F.; Galati, G.; Gambato, M.; Gasbarrini, A.; Giuliante, F.; Ghinolfi, D.; Grieco, A.; Gruttadauria, S.; Guarino, M.; Iavarone, M.; Kostandini, A.; Lai, Q.; Lenci, I.; Levi Sandri, G. V.; Losito, F.; Lupo, L. G.; Marasco, G.; Manzia, T. M.; Mazzocato, S.; Masarone, M.; Melandro, F.; Mescoli, C.; Miele, L.; Morisco, F.; Muley, M.; Nicolini, D.; Pagano, D.; Persico, M.; Pompili, M.; Ponziani, F. R.; Pravisani, R.; Rapaccini, G. L.; Rendina, M.; Renzulli, M.; Romano, F.; Rossi, M.; Rreka, E.; Russo, F. P.; Sangiovanni, A.; Sessa, A.; Simonetti, N.; Sposito, C.; Tortora, R.; Vigano, L.; Vigano, M.; Villa, E.; Vincenzi, V.; Violi, P.; Azzaroli, F.; Brunetto, M. R.; Di Marco, A.; Gasbarrini, A.; Foschi, F. G.; Guarino, M.; Masotto, A.; Mega, A.; Morisco, F.; Nardone, G.; Oliveri, F.; Raimondo, G.; Rapaccini, G. L.; Svegliati Baroni, G.; Vidili, G.; Zoli, M.
abstract

Prognostic assessment in patients with HCC remains an extremely difficult clinical task due to the complexity of this cancer where tumour characteristics interact with degree of liver dysfunction, patient general health status, and a large span of available treatment options. Several prognostic systems have been proposed in the last three decades, both from the Asian and European/North American countries. Prognostic scores, such as the CLIP score and the recent MESH score, have been generated on a solid statistical basis from real life population data, while staging systems, such as the BCLC scheme and the recent CNLC classification, have been created by experts according to recent HCC prognostic evidences from the literature. A third category includes combined prognostic systems that can be used both as prognostic scores and staging systems. A recent example is the ITA.LI.CA prognostic system including either a prognostic score and a simplified staging system. This review focuses first on an overview of the main prognostic systems for HCC classified according to the above three categories, and, second, on a comprehensive description of the methodology required for a correct comparison between different systems in terms of prognostic performance. In this second section the main studies in the literature comparing different prognostic systems are described in detail. Lastly, a formal comparison between the last prognostic systems proposed for each of the above three categories is performed using a large Italian database including 6882 HCC patients in order to concretely apply the comparison rules previously described.

2021 - Surgical resection vs. Percutaneous ablation for single hepatocellular carcinoma: Exploring the impact of li‐rads classification on oncological outcomes [Articolo su rivista]
Centonze, L.; Di Sandro, S.; Lauterio, A.; De Carlis, R.; Frassoni, S.; Rampoldi, A.; Tuscano, B.; Bagnardi, V.; Vanzulli, A.; De Carlis, L.
abstract

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

2021 - The COVID-19 second wave risk and liver transplantation: lesson from the recent past and the unavoidable need of living donors [Articolo su rivista]
Di Sandro, S.; Magistri, P.; Bagnardi, V.; Catellani, B.; Guerrini, G. P.; Di Benedetto, F.
abstract

2021 - Total robotic ALPPS approach for hepatocellular carcinoma in cirrhotic liver [Articolo su rivista]
Fernandes, E. D. S. M.; de Barros, F.; Magistri, P.; Di Sandro, S.; Rezende de Carvalho, P.; Roza da Silva, F.; Andrade, R. O.; Pimentel, L. S.; Girao, C. L.; Pedreira de Mello, F.; Torres, O. J. M.; Di Benedetto, F.
abstract

Background: Hepatocellular carcinoma (HCC) is a common indication for associating liver partition with portal vein ligation for staged hepatectomy (ALPPS). Robotic liver resection has been done for HCC, but robotic ALPPS is a rare procedure. Methods: To present three cases of totally robotic ALPPS in cirrhotic patients with HCC. Results: Three cirrhotic male patients with HCC underwent ALPPS; the mean age was 54.3 years. MELD score was ≤9 and tumour size between 90 and 140&nbsp;mm. The mean hypertrophy of the future liver remnant after the first stage was 77.5% and no postoperative liver failure was reported. Mean operative time of stage 1 was 7:30&nbsp;h and of stage 2 was 4:37&nbsp;h, without blood transfusion. The mean hospital stay for the first stage was 10 days and for the second stage was 9.3 days. No postoperative complication was recorded. Conclusions: Robotic ALPPS in cirrhotic patients with HCC is safe and feasible.

2020 - Common bile duct lesions - how cholangioscopy helps rule out intraductal papillary neoplasms of the bile duct: A case report [Articolo su rivista]
Cocca, Silvia; Grande, Giuseppe; Reggiani Bonetti, Luca; Magistri, Paolo; Di Sandro, Stefano; Di Benedetto, Fabrizio; Conigliaro, Rita; Bertani, Helga
abstract

BACKGROUNDIntraductal papillary neoplasm of the bile duct (IPNB) is a rare variant of bile duct tumors, characterized by an exophytic growth exhibiting a papillary mass within the bile duct lumen and it can be localized anywhere along the biliary tree, with morphological variations and occasional invasion.CASE SUMMARYWe present a patient with obstructive jaundice who was diagnosed with IPNB using cholangioscopy during endoscopic retrograde cholangio-pancreatography. Using the SpyGlass DS II technology, we were able to define tumor extension and obtain targeted Spy-byte biopsies. After multidisciplinary evaluation, the patient was scheduled for surgical resection of the tumor, which was radically removed.CONCLUSIONCholangioscopy appears to be crucial for the rapid and clear diagnosis of lesions in the bile duct to achieve radical surgical resection.

2020 - Endovascular Treatment of Acute Posttransplant Portal Vein Thrombosis Due to Portal Steal From Mesocaval And Coronary Portosystemic Shunts [Articolo su rivista]
Centonze, Leonardo; Di Sandro, Stefano; Cereda, Marco; Lauterio, Andrea; De Carlis, Riccardo; Migliorisi, Carmelo; Morelli, Francesco; Rampoldi, Antonio; De Carlis, Luciano
abstract

The management of portosystemic shunts in liver transplant recipients relies on appropriate perioperative study. There are several strategies for shunt handling, ranging from preoperative interventional procedures to intraoperative surgical interruption or embolization. Appropriate management often results in a successful outcome, although wrong decisions could lead to serious consequences. Here, we report a liver transplant recipient with grade 2 portal vein thrombosis associated with 2 large portosystemic shunts (coronary and mesocaval), which were managed intraoperatively via thrombectomy without shunt ligation. Acute portal vein thrombosis developed early after transplant due to portal steal syndrome. The patient underwent a successful endovascular shunt embolization, with prompt restoration of hepatopetal portal flow and resolution of the portal steal. Use of interventional radiology in perioperative management of transplant patients has recently gained wider importance; our case reported here is particularly suggestive of the good outcomes of a multidisciplinary approach to a threatening complication such as postoperative acute portal vein thrombosis.

2020 - Hepatocellular carcinoma and liver transplant: beyond the Milan criteria and the risk of "short-blanket" syndrome [Articolo su rivista]
Gitto, Stefano; Di Sandro, Stefano; Magistri, Paolo; Andreone, Pietro; Di Benedetto, Fabrizio
abstract

2020 - Including mRECIST in the Metroticket 2.0 criteria improves prediction of hepatocellular carcinoma-related death after liver transplant [Articolo su rivista]
Cucchetti, Alessandro; Serenari, Matteo; Sposito, Carlo; Di Sandro, Stefano; Mosconi, Cristina; Vicentin, Ilaria; Garanzini, Enrico; Mazzaferro, Vincenzo; De Carlis, Luciano; Golfieri, Rita; Spreafico, Carlo; Vanzulli, Angelo; Buscemi, Vincenzo; Ravaioli, Matteo; Ercolani, Giorgio; Pinna, Antonio Daniele; Cescon, Matteo
abstract

S AIMS: The weight of response to neo-adjuvant therapies, to select candidates with hepatocellular carcinoma (HCC) for liver transplantation (LT) at acceptable risk of recurrence, remains partially unsolved for most of post-LT prediction models. Aim of this study was to embed radiological response in the Metroticket 2.0 model for post-LT prediction of "HCC-related death" to provide more usefulness in the modern clinical scenario.

2020 - Liver transplantation in hepatocellular carcinoma after tumour downstaging (XXL): a randomised, controlled, phase 2b/3 trial [Articolo su rivista]
Mazzaferro, V.; Citterio, D.; Bhoori, S.; Bongini, M.; Miceli, R.; De Carlis, L.; Colledan, M.; Salizzoni, M.; Romagnoli, R.; Antonelli, B.; Vivarelli, M.; Tisone, G.; Rossi, M.; Gruttadauria, S.; Di Sandro, S.; De Carlis, R.; Luca, M. G.; De Giorgio, M.; Mirabella, S.; Belli, L.; Fagiuoli, S.; Martini, S.; Iavarone, M.; Svegliati Baroni, G.; Angelico, M.; Ginanni Corradini, S.; Volpes, R.; Mariani, L.; Regalia, E.; Flores, M.; Droz dit Busset, M.; Sposito, C.
abstract

Background: Indications for liver transplantation for hepatocellular carcinoma are evolving and so-called expanded criteria remain debated. Locoregional therapies are able to downstage hepatocellular carcinoma from beyond to within the Milan criteria. We aimed to investigate the efficacy of liver transplantation after successful hepatocellular carcinoma downstaging. Methods: We did an open-label, multicentre, randomised, controlled trial designed in two phases, 2b and 3, at nine Italian tertiary care and transplantation centres. Patients aged 18–65 years with hepatocellular carcinoma beyond the Milan criteria, absence of macrovascular invasion or extrahepatic spread, 5-year estimated post-transplantation survival of at least 50%, and good liver function (Child-Pugh A-B7) were recruited and underwent tumour downstaging with locoregional, surgical, or systemic therapies according to multidisciplinary decision. After an observation period of 3 months, during which sorafenib was allowed, patients with partial or complete responses according to modified Response Evaluation Criteria in Solid Tumors were randomly assigned (1:1) by an interactive web-response system to liver transplantation or non-transplantation therapies (control group). A block randomisation (block size of 2), stratified by centre and compliance to sorafenib treatment, was applied. Liver transplantation was done with whole or split organs procured from brain-dead donors. The control group received sequences of locoregional and systemic treatment at the time of demonstrated tumour progression. The primary outcomes were 5-year tumour event-free survival for phase 2b and overall survival for phase 3. Analyses were by intention to treat. Organ allocation policy changed during the course of the study and restricted patient accrual to 4 years. This trial is registered with ClinicalTrials.gov, NCT01387503. Findings: Between March 1, 2011, and March 31, 2015, 74 patients were enrolled. Median duration of downstaging was 6 months (IQR 4–11). 29 patients dropped out before randomisation and 45 were randomly assigned: 23 to the transplantation group versus 22 to the control group. At data cutoff on July 31, 2019, median follow-up was 71 months (IQR 60–85). 5-year tumour event-free survival was 76·8% (95% CI 60·8–96·9) in the transplantation group versus 18·3% (7·1–47·0) in the control group (hazard ratio [HR] 0·20, 95% CI 0·07–0·57; p=0·003). 5-year overall survival was 77·5% (95% CI 61·9–97·1) in the transplantation group versus 31·2% (16·6–58·5) in the control group (HR 0·32, 95% CI 0·11–0·92; p=0·035). The most common registered grade 3–4 serious adverse events were hepatitis C virus recurrence (three [13%] of 23 patients) and acute transplant rejection (two [9%]) in the transplantation group, and post-embolisation syndrome (two [9%] of 22 patients) in the control group. Treatment-related deaths occurred in four patients: two (8%) of 23 patients in the transplantation group (myocardial infarction and multi-organ failure) versus two (9%) of 22 patients in the control group (liver decompensation). Interpretation: Although results must be interpreted with caution owing to the early closing of the trial, after effective and sustained downstaging of eligible hepatocellular carcinomas beyond the Milan criteria, liver transplantation improved tumour event-free survival and overall survival compared with non-transplantation therapies Post-downstaging tumour response could contribute to the expansion of hepatocellular carcinoma transplantation criteria. Funding: Italian Ministry of Health.

2020 - Pre-transplant diabetes predicts atherosclerotic vascular events and cardiovascular mortality in liver transplant recipients: a long-term follow-up study [Articolo su rivista]
Gitto, S.; De Maria, N.; Marzi, L.; Magistri, P.; Falcini, M.; Vitale, G.; Olivieri, T.; Guerrini, G. P.; Serra, V.; Forte, P.; Carrai, P.; De Simone, P.; Mega, A.; Zoller, H.; Piai, G.; Schepis, F.; Marocchi, M.; Villa, E.; Marra, F.; Andreone, P.; Di Benedetto, F.; Vizzutti, F.; Laffi, G.; Borelli, E.; Ballarin, R.; Tarantino, G.; Di Sandro, S.; Puntili, R.; Petruccelli, S.; Valente, G.; Turco, L.
abstract

Background Early after surgery, liver transplant (LT) recipients often develop weight gain. Metabolic disorders and cardiovascular disease represent main drivers of morbidity and mortality. Our aim was to identify predictors of atherosclerotic vascular events (AVE) and to assess the impact of AVE on the long-term outcome. Methods We retrospectively analyzed data from patients transplanted between 2000 and 2005 and followed-up in five Italian transplant clinics. Cox Regression analysis was performed to identify predictors of AVE, global mortality, and cardiovascular mortality. Survival analysis was performed using the Kaplan-Meier method. Results We analyzed data from 367 subjects during a median follow-up of 14 years. Thirty-seven post-LT AVE were registered. Patients with AVE more frequently showed pre-LT diabetes mellitus (DM) (48.6 vs 13.9%, p=0.000). In the post-LT period, patients with AVE satisfied criteria of metabolic syndrome in 83.8% vs. 36.7% of subjects without AVE (p=0.000). At multivariate analysis, pre-LT DM independently predicted AVE (HR 2.250, CI 4.848-10.440, p=0.038). Moreover, both pre-LT DM and AVE strongly predicted cardiovascular mortality (HR 5.418, CI 1.060-29.183, p=0.049, and HR 86.097, CI 9.510-779.480, p=0.000, respectively). Conclusions Pre-LT DM is the main risk factor for post-LT AVE. Pre-LT DM and post-LT AVE are strong, long-term predictors of cardiovascular mortality. Patients with pre-LT DM should obtain a personalized follow-up for prevention or early diagnosis of AVE.

2020 - Robotic liver resection versus percutaneous ablation for early hcc: Short-and long-term results [Articolo su rivista]
Magistri, P.; Catellani, B.; Frassoni, S.; Guidetti, C.; Olivieri, T.; Assirati, G.; Caporali, C.; Pecchi, A.; Serra, V.; Ballarin, R.; Guerrini, G. P.; Bagnardi, V.; Di Sandro, S.; Di Benedetto, F.
abstract

Background: The correct approach for early hepatocellular carcinoma (HCC) is debatable, since multiple options are currently available. Percutaneous ablation (PA) is associated in some series to reduced morbidity compared to liver resection (LR); therefore, minimally invasive surgery may play a significant role in this setting. Methods: All consecutive patients treated by robotic liver resection (RLR) or PA between January 2014 and October 2019 for a newly diagnosed single HCC, less than 3 cm in size (very early/early stages according to the Barcelona Clinic Liver Cancer (BCLC)) on chronic liver disease or liver cirrhosis, were enrolled in this retrospective study. The aim of this study was to compare short-and long-term outcomes to define the best approach in this specific cohort. Results: 60 patients fulfilled the inclusion criteria: 24 RLR and 36 PA. The two populations were homogeneous in terms of baseline characteristics. There were no statistically significant differences regarding the incidence of postoperative morbidity (RLR 38% vs. PA 19%, p = 0.15). The cumulative incidence of recurrence (CIR) was significantly higher in patients who underwent PA, with the one, two, and three years of CIR being 42%, 69%, and 73% in the PA group and 17%, 27%, and 27% in the RLR group, respectively. Conclusions: RLR provides a significantly higher potential of cure and tumor-related free survival in cases of newly diagnosed single HCCs smaller than 3 cm. Therefore, it can be considered as a first-line approach for the treatment of patients with those characteristics in high-volume centers with extensive experience in the field of hepatobiliary surgery and minimally invasive approaches.

2020 - Robotic versus laparoscopic gastrectomy for gastric cancer: The largest meta-analysis [Articolo su rivista]
Guerrini, G. P.; Esposito, G.; Magistri, P.; Serra, V.; Guidetti, C.; Olivieri, T.; Catellani, B.; Assirati, G.; Ballarin, R.; Di Sandro, S.; Di Benedetto, F.
abstract

Background: Minimally invasive surgery (MIS) has been increasingly used in the treatment of gastric cancer (GC). Laparoscopic gastrectomy (LG) has shown several advantages over open surgery in dealing with GC, although it is still considered a demanding procedure. Robotic gastrectomy (RG) is now being employed with increased frequency worldwide and has been reported to overcome some limitations of conventional LG. The aim of this updated meta-analysis is to compare surgical and oncological outcomes of RG versus LG for gastric cancer. Materials and methods: A systematic review and meta-analysis was conducted using the PubMed, MEDLINE and Cochrane library database of published studies comparing RG and LG up to March 2020. The evaluated end-points were intra-operative, post-operative and oncological outcomes. Dichotomous data were calculated by odds ratio (OR) and continuous data were calculated by mean difference (MD) with 95% confidence intervals (95% CI), and a random-effect model was always applied. Results: Forty retrospective studies describing 17,712 patients met the inclusion criteria. With respect to surgical outcomes, robotic compared with laparoscopic gastrectomy was associated with higher operating time [MD 44.73, (95%CI 36.01, 53.45) p &lt; 0.00001] and less intraoperative blood loss [MD -18.24, (95%CI -25.21, −11.26) p &lt; 0.00001] and lower rate of surgical complication in terms of Dindo-Clavien ≥ 3 classification [OR 0.66, (95%CI 0.49, 0.88) p = 0.005]. With respect to oncological outcomes, the RG group showed a significantly increased mean number of retrieved lymph nodes [MD 1.84, (95%CI 0.84, 2.84) p = 0.0003], but mean proximal and distal resection margin distance and the recurrence rate were not significantly different between the two approaches. Conclusions: With respect to safety, technical feasibility and oncological adequacy, robotic and laparoscopic groups were comparable, although the robotic approach seems to achieve better short-term surgical outcomes. Moreover, a higher rate of retrieved lymph nodes was observed in the RG group.

2020 - Successful Transplant of a Liver Graft After Giant Hepatic Artery Aneurysm Resection and Reconstruction [Articolo su rivista]
De Carlis, Riccardo; Andorno, Enzo; Buscemi, Vincenzo; Lauterio, Andrea; Diviacco, Pietro; Di Sandro, Stefano; De Carlis, Luciano
abstract

The shortage of organs has pushed transplant surgeons to accept liver grafts with extended criteria, but severe vascular abnormalities may still discourage the use of otherwise acceptable organs. We report herein the case of a liver graft with a 64-mm aneurysm of the proper hepatic artery extended to the origin of the right and left hepatic branches. The graft was deemed unsuitable for transplant by all other centers in the region. However, liver function tests were normal, and there was no evidence of compromised arterial supply. At back table, we resected the aneurysm and anastomosed the right and left hepatic arteries to a vascular graft obtained from the distal tract of the donor's superior mesenteric artery. After portal reperfusion, we anastomosed the mesenteric graft to the recipient's hepatic artery at the origin of the gastroduodenal artery. The postoperative course and the subsequent 6-month follow-up were uneventful. In conclusion, the presence of a hepatic artery aneurysm should not be an absolute contraindication to the use of a liver graft. The present case emphasizes the possibility to utilize an organ that would have been otherwise discarded.

2020 - The Impact of Sarcopenia on Postoperative Course following Pancreatoduodenectomy: Single-Center Experience of 110 Consecutive Cases [Articolo su rivista]
Centonze, L.; Di Sandro, S.; Lauterio, A.; De Carlis, R.; Botta, F.; Mariani, A.; Bagnardi, V.; De Carlis, L.
abstract

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

2020 - The role of salvage transplantation in patients initially treated with open vs minimally invasive liver surgery: an intention-to-treat analysis [Articolo su rivista]
Levi Sandri, Giovanni B; Lai, Quirino; Ravaioli, Matteo; DI Sandro, Stefano; Balzano, Emanuele; Pagano, Duilio; Magistri, Paolo; DI Benedetto, Fabrizio; Rossi, Massimo; Gruttadauria, Salvatore; DE Simone, Paolo; Ettorre, Giuseppe M; DE Carlis, Luciano; Cescon, Matteo
abstract

Recently, minimally invasive liver surgery (MILS) has gained wide consensus in the management of hepatocellular carcinoma (HCC). However, its role in the setting of a salvage liver transplantation (SLT) has been poorly investigated. We analyzed the intention-to-treat survival of HCC patients treated with MILS vs. the open approach and eventually waitlisted for SLT. The secondary end-point was identification of risk factors for post-transplant death and tumor recurrence.

2020 - Treatment of hepatocarcinoma beyond the milan criteria. A weighted comparative study of surgical resection versus chemoembolization [Articolo su rivista]
Famularo, S.; Di Sandro, S.; Giani, A.; Bernasconi, D. P.; Lauterio, A.; Ciulli, C.; Rampoldi, A. G.; Corso, R.; De Carlis, R.; Romano, F.; Braga, M.; Gianotti, L.; De Carlis, L.
abstract

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

2019 - Comment on the article “Age and liver transplantation” [Articolo su rivista]
Ferla, F; Lauterio, A; De Carlis, R; Di Sandro, S; Petrucciani, N; Benuzzi, L; De Carlis, L.
abstract

2019 - Delayed kidney transplantation in combined liver–kidney transplantation for polycystic liver and kidney disease [Articolo su rivista]
Lauterio, A; De Carlis, R; Di Sandro, S; Buscemi, V; Andorno, E; De Carlis, L.
abstract

2019 - Early post-liver transplant surgical morbidity in HIV-infected recipients: risk factor for overall survival? A nationwide retrospective study [Articolo su rivista]
Baccarani, U; Pravisani, R; Isola, M; Mocchegiani, F; Lauterio, A; Righi, E; Magistri, P; Corno, V; Adani, G; Lorenzin, D; Di Sandro, S; Pagano, D; Bassetti, M; Gruttadauria, S; De Carlis, L; Vivarelli, M; Di Benedetto, F; Risaliti, A.
abstract

The aim of the study was to analyse the risk factors for early surgical complications requiring relaparotomy and the related impact on overall survival (OS) in HIV-infected patients submitted to liver transplantation. Thus a retrospective investigation was conducted on a nationwide multicentre cohort of 157 HIV patients submitted to liver transplantation in six Italian Transplant Units between 2004 and 2014. An early relaparotomy was performed in 24.8% of cases and the underlying clinical causes were biliary leak (8.2%), bleeding (8.2%), intestinal perforation (4.5%) and suspect of vascular complications(3.8%). No differences in terms of prevalence for either overall or cause-specific early relaparotomies were noted when compared with a non-HIV control group, matched for MELD, recipient age, HCV-RNA positivity and HBV prevalence. While in the control group an early relaparotomy appeared a negative prognostic factor, such impact on OS was not noted in HIV recipients. Nonetheless increasing number of relaparotomies were associated with decreased survival. In multivariate analysis, preoperative refractory ascites and Roux-en-Y choledochojejunostomy reconstruction were significant risk factors for early relaparotomy. To conclude, in HIV liver transplanted patients, an increasing number of early relaparotomies because of surgical complications does negatively affect the OS. Preoperative refractory ascites reflecting a severe portal hypertension and a difficult biliary tract reconstruction requiring a Roux-en-Y choledochojejunostomy are associated with increased risk of early relaparotomy.

2019 - Emergency Intraoperative Implantation of ECMO for Refractory Cardiogenic Shock Arising During Liver Transplantation as a Bridge to Myocardial Surgical Revascularization [Articolo su rivista]
Lauterio, A; De Carlis, R; Cannata, A; Di Sandro, S; De Gasperi, A; Russo, C; De Carlis, L
abstract

2019 - From a philosophical framework to a valid prognostic staging system of the new “comprehensive assessment” for transplantable hepatocellular carcinoma [Articolo su rivista]
Di Sandro, Stefano; Bagnardi, Vincenzo; Cucchetti, Alessandro; Lauterio, Andrea; De Carlis, Riccardo; Benuzzi, Laura; Danieli, Maria; Botta, Francesca; Centonze, Leonardo; Carlis., Marc Najjar and Luciano De
abstract

2019 - HIV-positive to HIV-positive liver transplantation: To be continued [Articolo su rivista]
Lauterio, A; Moioli, Mc; Di Sandro, S; Travi, G; De Carlis, R; Merli, M; Ferla, F; Puoti, M; De Carlis, L.
abstract

2019 - Hyper-Urgent Liver Transplantation for Posttraumatic and Surgical Iatrogenic Acute Liver Failure [Capitolo/Saggio]
Lauterio, A.; Di Sandro, S.; De Carlis, R.; Ciravegna, A.; Aseni, P.; De Carlis, L.
abstract

2019 - Platelets and Hepatocellular Cancer: Bridging the Bench to the Clinics [Articolo su rivista]
Lai, ; Q., aEmail Author; Vitale, ; A., bEmail Author; Manzia, ; T. M., cEmail Author; Foschi, ; F. G., dEmail Author; Sandri, ; G. B. L., eEmail Author; Gambato, ; M., bEmail Author; Melandro, ; F., fEmail Author; Russo, ; F. P., bEmail Author; Miele, ; L., gEmail Author; Viganò, ; L., hEmail Author; Burra, ; P., bEmail Author; Giannini, ; E. G., iEmail Author; Aliberti, C.; Baccarani, U.; Bhoori, S.; Borzio, M.; Brancaccio, G.; Cabibbo, G.; Casadei, Gardini; A., Carrai; P., Cillo; U., Conti; F., Cucchetti; A., D’Ambrosio; R., Dell’Unto; C., Dematthaeis; Di, Costanzo; G., G.; Di Sandro, S.; Fucilli, F.; Galati, G.; Gasbarrini, A.; Giuliante, F.; Ghinolfi, D.; Grieco, A.; Gruttaduria, S.; Guarino, M.; Kostandini, A.; Iavarone, M.; Lenci, I.; Losito, F.; Lupo, L. G.; Mazzocato, S.; Mescoli, C.; Miele, L.; Morisco, F.; Muley, M.; Nicolini, D.; Persico, M.; Pompili, M.; Ponziani, F. R.; Pravisani, R.; Rapaccini, G. L.; Rendina, M.; Renzulli, M.; Rossi, M.; Rreka, E.; Sacco, R.; Sangiovanni, A.; Sessa, A.; Simonetti, N.; Sposito, C.; Tortora, R.; Trevisani, F.; Viganò, M.; Villa, E.; Vincenzi, V.; Violi, P.; Associazione Italiana per lo Studio del Fegato (AISF) HCC Special Interest, Group
abstract

Growing interest is recently being focused on the role played by the platelets in favoring hepatocellular cancer (HCC) growth and dissemination. The present review reports in detail both the experimental and clinical evidence published on this topic. Several growth factors and angiogenic molecules specifically secreted by platelets are directly connected with tumor progression and neo-angiogenesis. Among them, we can list the platelet-derived growth factor, the vascular endothelial growth factor, the endothelial growth factor, and serotonin. Platelets are also involved in tumor spread, favoring endothelium permeabilization and tumor cells' extravasation and survival in the bloodstream. From the bench to the clinics, all of these aspects were also investigated in clinical series, showing an evident correlation between platelet count and size of HCC, tumor biological behavior, metastatic spread, and overall survival rates. Moreover, a better understanding of the mechanisms involved in the platelet-tumor axis represents a paramount aspect for optimizing both current tumor treatment and development of new therapeutic strategies against HCC.

2019 - Single Hepatocellular Carcinoma approached by curative-intent treatment: A propensity score analysis comparing radiofrequency ablation and liver resection [Articolo su rivista]
Di Sandro, S.; Benuzzi, L.; Lauterio, A.; Botta, F.; De Carlis, R.; Najjar, M.; M., Danieli; I., Pezzoli; A., Rampoldi; V., Bagnardi.; De Carlis, L.
abstract

2019 - Surgical and oncological outcomes of hepatic resection for BCLC-B hepatocellular carcinoma: a retrospective multicenter analysis among 474 consecutive cases [Articolo su rivista]
Di Sandro, S; Centonze, L; Pinotti, E; Lauterio, A; De Carlis, R; Romano, F; Gianotti, L; De Carlis, L
abstract

2019 - Surgical Complications Requiring an Early Relaparotomy in HIV-Infected Liver Transplant Recipients: Risk Factors and Impact on Survival [Articolo su rivista]
Pravisani, R.; Baccarani, U.; Isola, M.; Mocchegiani, F.; Lauterio, A.; Righi, E.; Magistri, P.; Corno, V.; Adani, G. L.; Lorenzin, D.; Di Sandro, S.; Pagano, D.; Bassetti, M.; Gruttadauria, S.; De Carlis, L.; Vivarelli, M.; Di Benedetto, F.; Risaliti, A.
abstract

Aim: We aimed to analyze the risk factors for early surgical complications requiring relaparotomy and the related impact on overall survival (OS) in HIV-infected patients submitted to liver transplantation. Methods: We performed a retrospective study on a nationwide multicenter cohort of 157 HIV-infected patients submitted to liver transplantation in 6 Italian transplant units between 2004 to 2014. Results: The median preoperative model for end-stage liver disease score was 18 (interquartile range 12-26.5). An early relaparotomy was performed in 24.8% of patients, and the underlying clinical causes were biliary leak (8.2%), bleeding (8.2%), intestinal perforation (4.5%), and suspected vascular complications (3.8%). The OS at 1, 3, and 5 years was 74.3%, 68.0%, and 60.0%, respectively, and an early relaparotomy was not a prognostic factor itself, but an increasing number of relaparotomies was associated with decreased survival (hazard ratio = 1.40, 95% confidence interval [CI] 1.07-1.81, P = .01). In the multivariate analysis, preoperative refractory ascites (odds ratio 3.32, 95% CI 1.18-6.47, P = .02) and Roux-en-Y choledochojejunostomy reconstruction (odds ratio 12.712, 95% CI 2.47-65.38, P ≤ .01) were identified as significant risk factors for early relaparotomy. Conclusions: In HIV-infected liver transplant recipients, an increasing number of early relaparotomies due to surgical complications did negatively affect the OS. Preoperative refractory ascites reflecting a severe portal hypertension and a difficult biliary tract reconstruction requiring a Roux-en-Y choledochojejunostomy were associated with an increased risk of early relaparotomy.

2019 - The impact of age and ageing on hepatocarcinoma surgery: Short- and long-term outcomes in a multicentre propensity-matched cohort [Articolo su rivista]
Famularo, S; Di Sandro, S; Giani, A; Angrisani, M; Lauterio, A; Romano, F; Gianotti, L; De Carlis, L
abstract

2018 - Direct-acting antivirals and hepatocellular carcinoma in chronic hepatitis C: A few lights and many shadows [Articolo su rivista]
Guarino, Maria; Sessa, Anna; Cossiga, Valentina; Morando, Federica; Caporaso, Nicola; Morisco, Filomena; Luca, Viganó; Romana, Ponziani Francesca; Maurizio, Pompili; Cillo, Umberto; Burra, Patrizia; Mescoli, Claudia; Gambato, Martina; Paolo, Russo Francesco; Alessandro, Vitale; Giuseppe, Cabibbo; Mauro, Vigano'; Giovanni, Galati; Villa, Erica; Lupo, Luigi G.; Maria, Rendina; Losito, Francesco; Fucilli, Fabio; Persico, Marcello; D'Ambrosio, Roberta; Sangiovanni, Angelo; Massimo, Iavarone; Giuseppina, Brancaccio; Cucchetti, Alessandro; Renzulli, Matteo; Franco, Trevisani; Miele, Luca; Grieco, Antonio; Rapaccini, Gianlodovico; Gasbarrini, Antonio; Sandri, Giovanni Battisa Levi; Melandro, Fabio; Rossi, Massimo; Quirino, Lai; Lenci, Ilaria; Manzia, Tommaso Maria; Tortora, Raffaella; Di Costanzo, Giovan Giuseppe; Ghinolfi, Davide; Rreka, Erion; Carrai, Paola; Simonetti, Natalia; Rodolfo, Sacco; Sposito, Carlo; Bhoori, Sherrie; Di Sandro, Stefano; Foschi, Francesco Giuseppe; Gardini, Andrea Casadei; Nicolini, Daniele; Mazzocato, Susanna; Alba, Kostandini; Violi, Paola; Baccarani, Umberto; Pravisani, Riccardo; Vincenzi, Valter
abstract

With the introduction of direct-acting antiviral agents (DAA), the rate of sustained virological response (SVR) in the treatment of hepatitis C virus (HCV) has radically improved to over 95%. Robust scientific evidence supports a beneficial role of SVR after interferon therapy in the progression of cirrhosis, resulting in a decreased incidence of hepatocellular carcinoma (HCC). However, a debate on the impact of DAAs on the development of HCC is ongoing. This review aimed to analyse the scientific literature regarding the risk of HCC in terms of its recurrence and occurrence after the use of DAAs to eradicate HCV infection. Among 11 studies examining HCC occurrence, the de novo incidence rate ranged from 0 to 7.4% (maximum follow-up: 18 mo). Among 18 studies regarding HCC recurrence, the rate ranged from 0 to 54.4% (maximum "not well-defined" followup: 32 mo). This review highlights the major difficulties in interpreting data and reconciling the results of the included studies. These difficulties include heterogeneous cohorts, potential misclassifications of HCC prior to DAA therapy, the absence of an adequate control group, short follow-up times and different kinds of follow-up. Moreover, no clinical feature-based scoring system accounts for the molecular characteristics and pathobiology of the tumours. Nonetheless, this review does not suggest that there is a higher rate of de novo HCC occurrence or recurrence after DAA therapy in patients with previous HCV infection.

2018 - Does the Pringle maneuver affect survival and recurrence following surgical resection for hepatocellular carcinoma? A western series of 441 patients [Articolo su rivista]
Famularo, S; Giani, A; Di Sandro, S; Sandini, M; Giacomoni, A; Pinotti, E; Lauterio, A; Gianotti, L; De Carlis, L; Romano, F
abstract

Background: The impact of the Pringle maneuver (PM) on long-term outcome after curative resection for hepatocellular carcinoma (HCC) is controversial, with eastern series reporting conflicting results. We aim to evaluate the impact of the PM in a western cohort. Methods: We retrospectively analyzed patients with HCC who underwent liver resection between January 2001 and August 2015. Patients were divided in two groups based the use of the PM during resection. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Results: A total of 441 patients were analyzed. Of these, 176 patients (39.9%) underwent PM. Median OS was 46.4 months (95%CI: 34.1-58.7) for the PM group and 56.5 months (95%CI: 37.1-75.9) for the no-PM group (P = 0.188), with a median DFS of 26.7 months (95%CI: 15.7-37.7) and 24.9 months (95%CI: 18.1-31.7), respectively (P = 0.883). Conclusions: These results suggest that PM does not increase the risk of tumor recurrence or decrease long-term survival.

2018 - Effect of direct-acting antivirals on future occurrence of hepatocellular carcinoma in compensated cirrhotic patients [Articolo su rivista]
Cucchetti, Alessandro; D’Amico, Gennaro; Trevisani, Franco; Morelli, Maria Cristina; Vitale, Alessandro; Pinna, Antonio Daniele; Cescon, Matteo; Cillo, Umberto; Burra, Patrizia; Russo, Francesco P.; Mescoli, Claudia; Rendina, Maria; Lupo, Luigi G.; Losito, Francesco; Fucilli, Fabio; Brancaccio, Giusep-Pina; Persico, Marcello; Viganò, Luca; Iavarone, Massimo; D’Ambrosio, Roberta; Sangiovanni, Angelo; Renzulli, Matteo; Galati, Giovanni; Ponziani, Francesca Romana; Pompili, Maurizio; Miele, Luca; Grieco, Antonio; Rapaccini, Gianlodovico; Gasbarrini, Antonio; Sandri, Giovanni Battisa Levi; Lai, Quirino; Melandro, Fabio; Rossi, Massimo; Lenci, Ilaria; Manzia, Tommaso Maria; Tortora, Raffaella; Di Costanzo, Giovan Giuseppe; Sacco, Rodolfo; Simonetti, Natalia; Morisco, Filomena; Guarino, Maria; Cabibbo, Giuseppe; Bhoori, Carlo Sposito Sherrie; Di Sandro, Stefano; Foschi, Francesco Giuseppe; Gardini, Andrea Casadei; Nicolini, Daniele; Mazzocato, Susanna; Alba, Kostandini; Violi, Paola; Baccarani, Umberto; Pravisani, Riccardo
abstract

Background: The achievement of high rates of sustained virological response (SVR) with direct-acting antivirals (DAAs) in hepatitis C virus (HCV) infected patients will reduce decompensating terminal events. Aims: To investigate whether hepatocellular carcinoma (HCC) occurrence could change due to the DAA-induced increase in life-expectancy. Methods: A Markov model was built on clinical data of 494 cirrhotic patients and available literature to estimate probabilities of “death before HCC” and of “HCC occurrence” without and with DAA. Results: In comparison to untreated patients, DAA therapy reduced the 20-year mortality before HCC by 21.9% in patients without varices and by 21.5% in those with varices, considering an SVR of 95% and no direct effect on hepatocarcinogenesis. Tumour occurrence increased by 5%–8.2% and the proportion of HCCs diagnosed in compensated stages increased to &gt;98%. If we consider DAA as having “anti-tumoral” effects, the benefit becomes greater, achieving a 20-year survival of 81.5% in patients without varices, and 52.2% in patients with varices. Instead, if we consider DAA as having a “pro-tumoral” effect, then, the increased incidence of HCC nullifies the survival benefits. Conclusion: DAAs drastically reduce the mortality caused by the liver function worsening, increasing the proportion of HCCs diagnosed in compensated stages. Knowledge of the DAA effect on hepatocarcinogenesis remains pivotal.

2018 - Every Liver Graft Should Be Evaluated for Transplantation [Articolo su rivista]
Lauterio, A; Di Sandro, S; De Carlis, R; Ferla, F; Pinotti, E; De Carlis, L.
abstract

2018 - Liver Grafts From Donors After Circulatory Death on Regional Perfusion With Extended Warm Ischemia Compared With Donors After Brain Death [Articolo su rivista]
De Carlis, R; Di Sandro, S; Lauterio, A; Botta, F; Ferla, F; Andorno, E; Bagnardi, V; De Carlis, L.
abstract

2018 - Liver transplantation and hepatic resection can achieve cure for hepatocellular carcinoma [Articolo su rivista]
Pinna, Ad; Yang, T; Mazzaferro, V; De Carlis, L; Zhou, J; Roayaie, S; Shen, F; Sposito, C; Cescon, M; Di Sandro, S; Yi-Feng, H; Johnson, P; Cucchetti, A.
abstract

OBJECTIVE: The aim of this study was to estimate probabilities of achieving the statistical cure from hepatocellular carcinoma (HCC) with hepatic resection (HR) and liver transplantation (LT). BACKGROUND: Statistical cure occurs when the mortality of a specific population returns to values of that of general population. Resection and transplantation are considered potentially curative therapies for HCC, but their effect on the residual entire life-expectancy has never been investigated. METHODS: Data from 3286 HCC patients treated with LT (n = 1218) or HR (n = 2068) were used to estimate statistical cure. Disease-free survival (DFS) was the primary survival measure to estimate cure fractions through a nonmixture model. Overall survival (OS) was a secondary measure. In both, patients were matched with general population by age, sex, year, and race/ethnicity. Cure variations after LT were also adjusted for different waiting-list drop-outs. RESULTS: Considering DFS, the cure fraction after LT was 74.1% and after HR was 24.1% (effect size &gt;0.8). LT outperformed HR within all transplant criteria considered (effect size &gt;0.8), especially for multiple tumors (&gt;0.9) and even in presence of a drop-out up to 20% (&gt;0.5). Considering OS, the cure fraction after LT marginally increased to 75.8%, and after that HR increased to 40.5%. The effect size of LT over HR in terms of cure decreased for oligonodular tumors (&lt;0.5), became small for drop-out up to ∼20% (&lt;0.2), and negligible for single tumors &lt;5 cm (∼0.1). CONCLUSION: As other malignancies, statistical cure can occur for HCC, primarily with LT and secondarily with HR, depending on waiting-list capabilities and efficacy of tumor recurrence therapies after resection.

2018 - Long-term oncologic results of anatomic vs. parenchyma-sparing resection for hepatocellular carcinoma. A propensity score-matching analysis [Articolo su rivista]
Famularo, S; Di Sandro, S; Giani, A; Lauterio, A; Sandini, M; De Carlis, R; Buscemi, V; Romano, F; Gianotti, L; De Carlis, L.
abstract

2018 - Metroticket 2.0 Model for Analysis of Competing Risks of Death After Liver Transplantation for Hepatocellular Carcinoma [Articolo su rivista]
Mazzaferro, V; Sposito, C; Zhou, J; Pinna, Ad; De Carlis, L; Fan, J; Cescon, M; Di Sandro, S; Yi-Feng, H; Lauterio, A; Bongini, M; Cucchetti, A
abstract

2018 - Minor laparoscopic liver resection for Hepatocellular Carcinoma is safer than minor open resection, especially for less compensated cirrhotic patients: Propensity score analysis [Articolo su rivista]
Di Sandro, S; Bagnardi, V; Najjar, M; Buscemi, V; Lauterio, A; De Carlis, R; Danieli, M; Pinotti, E; Benuzzi, L; De Carlis, L
abstract

2018 - Proposal of Prognostic Survival Models before and after Liver Resection for Hepatocellular Carcinoma in Potentially Transplantable Patients [Articolo su rivista]
Di Sandro, S; Sposito, C; Lauterio, A; Najjar, M; Droz Dit Busset, M; Buscemi, V; Flores Reyes, M; De Carlis, R; Mazzaferro, V; De Carlis, L.
abstract

2018 - Recurrence of hepatocellular carcinoma after direct acting antiviral treatment for hepatitis C virus infection: Literature review and risk analysis [Articolo su rivista]
Guarino, Maria; Viganò, Luca; Ponziani, Francesca Romana; Giannini, Edoardo Giovanni; Lai, Quirino; Morisco, Filomena; Vitale, Alessandro; Russo, Francesco Paolo; Cillo, Umberto; Burra, Patrizia; Mescoli, Claudia; Gambato, Martina; Sessa, Anna; Cabibbo, Giuseppe; Viganò, Mauro; Galati, Giovanni; Villa, Erica; Iavarone, Massimo; Brancaccio, Giuseppina; Rendina, Maria; Lupo, Luigi G.; Losito, Francesco; Fucilli, Fabio; Persico, Marcello; D'Ambrosio, Roberta; Sangiovanni, Angelo; Cucchetti, Alessandro; Trevisani e Matteo Renzulli, Franco; Miele, Luca; Grieco, Antonio; Lodovico Rapaccini, Gian; Pompili, Maurizio; Gasbarrini, Antonio; Battisa Levi Sandri, Giovanni; Melandro, Fabio; Rossi, Massimo; Lenci, Ilaria; Manzia, Tommaso Maria; Tortora, Raffaella; Di Costanzo, Giovan Giuseppe; Sacco, Rodolfo; Ghinolfi, Davide; Rreka, Erion; Carrai, Paola; Simonetti, Natalia; Sposito, Carlo; Bhoori, Sherrie; di Sandro, Stefano; Foschi, Francesco Giuseppe; CASADEI GARDINI, Andrea; Nicolini, Daniele; Mazzocato, Susanna; Kostandini, Alba; Violi, Paola; Baccarani, Umberto; Pravisani, Riccardo; Vincenzi, Valter
abstract

Although studies suggest decreased incident hepatocellular carcinoma (HCC) after treatment with direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection, data are conflicting regarding risk and aggressiveness of recurrence in patients who have a history of treated HCC. This review analyses data available in literature in order to elucidate the impact of DAAs on the risk of HCC recurrence after successful treatment of the tumor. Overall 24 papers were identified. The available data cannot be considered definitive, but the initial alarmist data indicating an increased risk of recurrence have not been confirmed by most subsequent studies. The suggested aggressive pattern (rapid growth and vascular invasion) of tumor recurrence after DAAs still remains to be confirmed. Several limitations of the available studies were highlighted, and should drive future researches. The time-to-recurrence should be computed since the last HCC treatment and results stratified for cirrhosis and sustained viral response. Any comparison with historical series is of limited interest because of a number of biases affecting these studies and differences between enrolled patients. Prospective intention-to-treat analyses will be probably the best contribution to drive clinical practice, provided that a randomized trial can be difficult to design.

2018 - Recurrence Patterns After Anatomic or Parenchyma-Sparing Liver Resection for Hepatocarcinoma in a Western Population of Cirrhotic Patients [Articolo su rivista]
Famularo, S; Di Sandro, S; Giani, A; Lauterio, A; Sandini, M; De Carlis, R; Buscemi, V; Uggeri, F; Romano, F; Gianotti, L; De Carlis, L.
abstract

2018 - The current role of laparoscopic resection for HCC: A systematic review of past ten years [Articolo su rivista]
Di Sandro, S; Danieli, M; Ferla, F; Lauterio, A; De Carlis, R; Benuzzi, L; Buscemi, V; Pezzoli, I; De Carlis, L.
abstract

2017 - Bovine pericardium for multiple artery reconstruction in kidney transplantation [Articolo su rivista]
Lauterio, A; De Carlis, R; Di Sandro, S; Ferla, F; Giacomoni, A; Rossetti, O; De Carlis, L
abstract

2017 - Consequences of Increases in Antibiotic Resistance Pattern on Outcome of Pancreatic Resection for Cancer [Articolo su rivista]
Gianotti, L; Tamini, N; Gavazzi, F; Mariani, A; Sandini, M; Ferla, F; Cereda, M; Capretti, G; Di Sandro, S; Bernasconi, Dp; De Carlis, L; Zerbi, A.
abstract

2017 - Donor safety in living donor liver donation: An Italian multicenter survey [Articolo su rivista]
Lauterio, A; Di Sandro, S; Gruttadauria, S; Spada, M; Di Benedetto, F; Baccarani, U; Regalia, E; Melada, E; Giacomoni, A; Cescon, M; Cintorino, D; Ercolani, G; Rota, M; Rossi, G; Mazzaferro, V; Risaliti, A; Pinna, Ad; Gridelli, B; De Carlis, L
abstract

2017 - Hypothermic Machine Perfusion of Liver Grafts Can Safely Extend Cold Ischemia for Up to 20 Hours in Cases of Necessity [Articolo su rivista]
De Carlis, R; Lauterio, A; Ferla, F; Di Sandro, S; Sguinzi, R; De Carlis, L.
abstract

2017 - Liver transplantation in the treatment of severe iatrogenic liver injuries [Articolo su rivista]
Lauterio, A; De Carlis, R; Di Sandro, S; Ferla, F; Buscemi, V; De Carlis, L.
abstract

2017 - Robot-Assisted Harvesting of Kidneys for Transplantation and Global Complications for the Donor [Articolo su rivista]
Giacomoni, A.; Centonze, L.; Di Sandro, S.; Lauterio, A.; Ciravegna, A. L.; Buscemi, V.; Ferla, F.; Tripepi, M.; Concone, G.; De Carlis, R.; Colussi, G.; Gregorini, M.; De Carlis, L.
abstract

Introduction Robot-assisted kidney harvesting from living donors is feasible and safe. We report the results of a mono-centric experience relative to 98 consecutive robotic nephrectomies with emphasis on global donor complications. Materials and Methods This is a retrospective cohort study. Donors underwent robot-assisted kidney harvesting. The preferred kidney was the left one even in the presence of vascular anomalies. In the first cases we used a robotic hand–assisted technique, then the totally robotic technique, and finally the modified totally robot-assisted technique. Postoperative complications were ranked according to the five-grade Clavien-Dindo classification. Results Between November 2009 and November 2016, 98 living donors underwent nephrectomy. We experienced 14 complications. The 3 intraoperative ones (3.06%) were 1&nbsp;pneumothorax and 2 acute bleedings, 1 of them requiring transfusion. The 11 postoperative complications (11.22%) were as follows: 5 wound seromas, 1 rhabdomyolisis (Clavien I), 1 paretic ileum, 1 anemia requiring transfusion, 1 hypertensive crisis (Clavien II), and 2 chylus collections drained by interventional radiologists (Clavien III). Transfusion rate was 2.1%; conversions, reoperations, and mortality were nil. No statistically significant difference was observed between the patients with complications and without in terms of gender, age, anatomical anomalies, body mass index (BMI), and learning curve. We observed a longer global operation length of time in patients with complications. Conclusion Robotic assistance results in shorter and simpler learning curves for the harvesting of kidneys from living donors. It enables an easier and more efficient management of possible intraoperative complications. The rate of postoperative complications is comparable with the rate of complications encountered in traditional laparoscopic series with high numbers of harvestings.

2017 - Successful donation after cardiac death liver transplants with prolonged warm ischemia time using normothermic regional perfusion [Articolo su rivista]
De Carlis, R; Di Sandro, S; Lauterio, A; Ferla, F; Dell'Acqua, A; Zanierato, M; De Carlis, L.
abstract

2017 - The European policy for liver allocation in patients affected by hepatocellular carcinoma [Articolo su rivista]
Sandro, Di; S., and Ferla; F., and Lauterio; A., and Mangoni; I., and De Carlis; R., and Buscemi; V., and De Carlis
abstract

2016 - Development of a prognostic scoring system for resectable hepatocellular carcinoma [Articolo su rivista]
Sposito, C; Di Sandro, S; Brunero, F; Buscemi, V; Battiston, C; Lauterio, A; Bongini, M; De Carlis, L; Mazzaferro, V
abstract

2016 - Do Older Liver Grafts Have Worse Survival? the Niguarda Experience [Articolo su rivista]
Ferla, F; Mariani, A; Di Sandro, S; Buscemi, V; Lauterio, A; Mangoni, J; Covucci, E; Giacomoni, A; De Carlis, L
abstract

2016 - Donation after cardiac death liver transplantation after more than 20 minutes of circulatory arrest and normothermic regional perfusion [Articolo su rivista]
De Carlis, L; Lauterio, A; De Carlis, R; Ferla, F; Di Sandro, S.
abstract

2016 - Liver transplantation for adenomatosis: European experience [Articolo su rivista]
Chiche, L; David, A; Adam, R; Oliverius, Mm; Klempnauer, J; Vibert, E; Colledan, M; Lerut, J; Mazzafero, Vv; Di Sandro, S; Laurent, C; Scuderi, V; Suc, B; Troisi, R; Bachelier, P; Dumortier, J; Gugenheim, J; Mabrut, Jy; Gonzalez-Pinto, I; Pruvot, Fr; Le-Treut, Yp; Navarro, F; Ortiz-de-Urbina, J; Salamé, E; Spada, M; Bioulac-Sage, P.
abstract

2016 - Liver-allocation policies for patients affected by HCC in Europe [Articolo su rivista]
De Carlis, Luciano; Di Sandro, Stefano; Centonze, Leonardo; Lauterio, Andrea; Buscemi, Vincenzo; De Carlis, Riccardo; Ferla, Fabio; Sguinzi, Raffaella; Okolicsanyi, Stefano; Belli, Luca; Strazzabosco, Mario
abstract

The main goal of organ allocation systems is to guarantee an equal access to the limited resource of liver grafts for every patients on the waiting list, balancing between the ethical principles of equity, utility, benefit, need, and fairness. The European heath care scenario is very complex, as it is essentially decentralized and each Nation and Regions inside the nation, operate on a significant degree of autonomy. Furthermore the epidemiology of liver diseases and HCC, which is different among European countries, clearly inpacts on indications and priorities. The aims of this review are to analyze liver allocation policies for hepatocellular carcinoma, among different European. The European area considered for this analysis included 5 macro-areas or countries, which have similar policies for liver sharing and allocation: Centro Nazionale Trapianti (CNT) in Italy; Eurotransplant (Germany, the Netherlands, Belgium, Luxembourg, Austria, Hungary, Slovenia, and Croatia); Organizacion Nacional de Transplantes (ONT) in Spain; Etablissement français des Greffes (EfG) in France; NHS Blood &amp; Transplant (NHSBT) in the United Kingdom and Ireland; Scandiatransplant (Sweden, Norway, Finland, Denmark, and Iceland). Each identified area, as network for organ sharing in Europe, adopts an allocation system based either on a policy center oriented or on a policy patient oriented. Priorization of patients affected by HCC in the waiting list for deceased donors liver transplant worldwide is dominated by 2 main principles: urgency and utility. Despite the absence of a common organs allocation policy over the Eurpean countries, long-term survival patients listed for transplant due to HCC are comparable to the long-term survival reported in the UNOS register. However, as the principles of allocation are being re-discussed and new proposals emerge, and the epidemiology of liver disease changes, an effort toward a common system is highly advisable.

2016 - Right hemihepatectomy for living donor liver transplantation in adults (open technique) [Capitolo/Saggio]
De Carlis, L.; Aseni, P.; Di Sandro, S.; Mangoni, I.; Sguinzi, R.; Lauterio, A.
abstract

2016 - Robotic nephrectomy for living donation: Surgical technique and literature systematic review [Articolo su rivista]
Giacomoni, A; Di Sandro, S; Lauterio, A; Concone, G; Buscemi, V; Rossetti, O; De Carlis, L.
abstract

2016 - Sequential Use of Normothermic Regional Perfusion and Hypothermic Machine Perfusion in Donation after Cardiac Death Liver Transplantation with Extended Warm Ischemia Time [Articolo su rivista]
De Carlis, L; De Carlis, R; Lauterio, A; Di Sandro, S; Ferla, F; Zanierato, M.
abstract

2016 - Surgical overview on kidney and pancreas transplantation [Problemi chirurgici nel trapianto di rene e di pancreas - Position paper] [Articolo su rivista]
Capocasale, E; Berardinelli, L; Beretta, C; Berloco, P; Boggi, U; Boschiero, L; Bretto, P; Carmellini, M; Citterio, F; Concone, G; De Carlis, L; De Rosa, P; Del Gaudio, M; Di Sandro, S; Di Tonno, P; Faenza, A; Famulari, A; Giacomoni, A; Giovannoni, M; Iaria, M; Lauterio, A; Lasaponara, F; Mazzoni, Mp; Nicita, G; Orsenigo, E; Parolini, Dc; Pietrabissa, A; Pinna, Ad; Pisani, F; Ravaioli, M; Rigotti, P; Romagnoli, J; Rossetti, O; Secchi, A; Socci, C; Vistoli, F.
abstract

2015 - Current status and perspectives in split liver transplantation [Articolo su rivista]
Lauterio, A; Di Sandro, S; Concone, G; De Carlis, R; Giacomoni, A; De Carlis, L.
abstract

2015 - Hepatocellular Carcinoma Progression while on Waiting List for Liver Transplantation [Articolo su rivista]
Giacomoni, A; Concone, G; Di Sandro, S; Lauterio, A; De Carlis, L.
abstract

2015 - Italian experience in minimally invasive liver surgery: a national survey [Abstract in Rivista]
Aldrighetti, L.; Belli, G.; Boni, L.; Cillo, U.; Ettorre, G.; De Carlis, L.; Pinna, A.; Casciola, L.; Calise, F.; Corrado, F.; Federica, C.; Francesca, R.; Elisa, C.; Enrico, G.; Roberto, S.; Di Sandro, S; Antonio, G.; Paolo, R.; Roberto, S.; Marcello, S.; Mario, M.; Marco, F.; Giuseppe, N.; Giorgio, E.; Alberto, P.; Lorenzo, C.; Marco, C.; Gennaro, N.; Mario, G.; Nicolo, B.; Maria di Ca, S.; Alberto, B.; Giovanni, S.; Maurizio, B.; Maurizio, B.; Jovine, Elio; Marco, S.; Francesco, C.; Francesco, C.; Valle Raffaele, D.; Michele, C.; Riuniti, O.; Riuniti, O.; Pietro, M.; Carmine Gianfranco, D.; Virgili, Alfredo; Isidoro, D.; Salvatore, G.; Benassi, Adelmo; Goffredo, C.; Vincenzo, S.; Carlo, D.; Piero, M.
abstract

This survey provides an overview about current spread of Minimally Invasive Liver Resection (MILR) in Italy. Primary endpoint was to assess evolution of MILR in recent years and its degree of application among centres with different experience in laparoscopic and hepatic surgery. A questionnaire with items describing activity MILR was sent to Italian surgical centers. Diagnosis, technical approaches, resection extent, devices and vascular control, reasons for conversion, morbidity and mortality were recorded. Level of expertise per centre was analysed in terms of learning curve acquisition and relationship with hepatobiliary background. 1497 MILRs from 39 centers (median 27 patients/center, range 1–145, period 1995–2012) were collected. Conversion rate was 10.7&nbsp;% (180 patients out of 1677, excluded from subsequent analysis), with bleeding representing most frequent cause of conversion (34.4&nbsp;%). Eleven centers completed learning curve, performing &gt;60 MILR. Benign lesions were 27.5&nbsp;% and malignant 72.5&nbsp;%, with hepatocellular carcinoma being the most frequent indication. 92.6&nbsp;% of cases were performed with a totally laparoscopic technique (1.3&nbsp;% were hand-assisted, 1.9&nbsp;% single-port and 4.2&nbsp;% robotic). Minor resections accounted for 92.9&nbsp;% (left lateral sectionectomy resulted the most frequent procedure; 23.8&nbsp;%), while major resections represented 7.1&nbsp;%. Overall mortality was 0.2&nbsp;% (3 of 1497 patients) and morbidity 22.8&nbsp;%. Mean length of stay was 5&nbsp;days. Correlation between MILR activity and a hepatobiliary background was not clear comparing MILR cases and liver resection volumes per center. MILR has been significantly widespread in Italy in recent years, with several centers having definitely completed the learning curve as attested by clinical results consistent with major series from the Western and Eastern countries. MILR programs in Italy seem to arise from both centers with specific hepatobiliary expertise and centers performing advanced general laparoscopic surgery.

2015 - Repeat Hepatectomy for Recurrent Colorectal Liver Metastases: Is it Worth the Challenge? [Articolo su rivista]
Ali, Ma; Di Sandro, S; Lauterio, A; Concone, G; Mangoni, I; Ferla, F; Rotiroti, V; Cusumano, C; Giacomoni, A; De Carlis, L
abstract

2015 - Salvage liver transplantation after laparoscopic resection for hepatocellular carcinoma: a multicenter experience [Articolo su rivista]
Felli, E; Cillo, U; Pinna, Ad; De Carlis, L; Ercolani, G; Santoro, R; Gringeri, E; Di Sandro, S; Di Laudo, M; Di Giunta, M; Lauterio, A; Colasanti, M; Lepiane, P; Vennarecci, G; Ettorre, Gm.
abstract

2015 - Survival after Liver Transplant: Influence of Progression of Disease and of Restoration of the "Milan" Criteria in Patients with Hepato-cellular Carcinoma undergoing Down-staging Procedures [Articolo su rivista]
Giacomoni, A; Di Sandro, S; Donadon, M; Lauterio, A; Belli, L; Mangoni, I; Mihaylov, P; Concone, G; De Carlis, L.
abstract

2015 - The role of adult living donor liver transplantation and recent advances [Articolo su rivista]
Lauterio, A; Di Sandro, S; Giacomoni, A; De Carlis, L.
abstract

2014 - Evolution of robotic nephrectomy for living donation: From hand-assisted to totally robotic technique [Articolo su rivista]
Giacomoni, A; Di Sandro, S; Lauterio, A; Concone, G; Mangoni, I; Mihaylov, P; Tripepi, M; De Carlis, L.
abstract

2014 - Pancreatico-duodenectomy and postoperative pancreatic fistula: Risk factors and technical considerations in a specialized HPB center [Articolo su rivista]
De Carlis, L; Ferla, F; Di Sandro, S; Giacomoni, A; De Carlis, R; Sguinzi, R.
abstract

2014 - Pancreatoduodenectomy: Risk Factors of Postoperative Pancreatic Fistula [Articolo su rivista]
De Carlis, Lg; Sguinzi, R; Ferla, F; Di Sandro, S; Dorobantu, Bm; De Carlis, R; Cusumano, C; Giacomoni, A; Ferrari, C.
abstract

2014 - Residual right portal branch flow after first-step ALPPS: Artifact or homeostatic response? [Articolo su rivista]
De Carlis, L; Sguinzi, R; De Carlis, R; Di Sandro, S; Mangoni, J; Aseni, P; Giacomoni, A; Vanzulli, A.
abstract

2014 - Split-liver full-left full-right: Proposal for an operative protocol [Articolo su rivista]
Ferla, F; Lauterio, A; Di Sandro, S; Mangoni, I; Poli, C; Concone, G; Cusumano, C; Giacomoni, A; Andorno, E; De Carlis, L.
abstract

2014 - Split-liver full-left full-right: Proposal for an operative protocol (Transplantation Proceedings (2014) 46:7 (2279-2282)) [Articolo su rivista]
Ferla, F.; Lauterio, A.; Di Sandro, S.; Mangoni, I.; Poli, C.; Concone, G.; Cusumano, C.; Giacomoni, A.; Andorno, E.; De Carlis, L.
abstract

2014 - The meaning of surgeon's comfort in robotic surgery [Articolo su rivista]
Giacomoni, A; Concone, G; Di Sandro, S; Lauterio, A; De Carlis, L.
abstract

2014 - Totally robotic liver resection for hepatocellular carcinoma in cirrhotic patients: safety and feasibility [Articolo su rivista]
Sandro, Di; S., and Lauterio; A., and Giacomoni; A., and Concone; G., and Mangoni; I., and Mihaylov; P., and De Carlis
abstract

2013 - Colorectal liver metastases: Hepatic pedicle clamping during hepatectomy reduces the incidence of tumor recurrence in selected patients. Case-matched analysis [Articolo su rivista]
De Carlis, L; Di Sandro, S; Giacomoni, A; Mihaylov, P; Lauterio, A; Mangoni, I; Cusumano, C; Poli, C; Tripepi, M; Bencardino, K.
abstract

2013 - Initial experience with robot-assisted nephrectomy for living-donor kidney transplantation: Feasibility and technical notes [Articolo su rivista]
Giacomoni, A; Di Sandro, S; Lauterio, A; Mangoni, I; Mihaylov, P; Concone, G; Tripepi, M; Poli, C; Cusumano, C; De Carlis, L.
abstract

2013 - Liver transplantation for hepatocellular carcinoma recurrence after liver resection: Why Deny this chance of cure? [Articolo su rivista]
De Carlis, L; Di Sandro, S; Giacomoni, A; Mangoni, I; Lauterio, A; Mihaylov, P; Cusumano, C; Rampoldi, A.
abstract

2013 - Living-donor liver transplantation: Donor selection criteria and postoperative outcomes. A single-center experience with a 10-year follow-up [Articolo su rivista]
Lauterio, A; Poli, C; Cusumano, C; Di Sandro, S; Tripepi, M; Mangoni, I; Mihaylov, P; Concone, G; Giacomoni, A; De Carlis, Lg.
abstract

2012 - Beyond the Milan criteria: What risks for patients with hepatocellular carcinoma progression before liver transplantation? [Articolo su rivista]
De Carlis, L; Di Sandro, S; Giacomoni, A; Slim, A; Lauterio, A; Mangoni, I; Mihaylov, P; Pirotta, V; Aseni, P; Rampoldi, A.
abstract

2012 - Laparoscopic radiofrequency ablation in the caudate lobe for hepatocellular carcinoma before liver transplantation [Articolo su rivista]
Di Benedetto, F; Tarantino, G; Montalti, R; Ballarin, R; D'Amico, G; Di Sandro, S; Gerunda, Ge.
abstract

The caudate lobe, because of its location and its highly unpredictable vascular anatomy, is one of the most surgical challenging segment of the liver. Hepatocellular carcinoma (HCC) of the caudate lobe in cirrhotic patients is not easily amenable to surgical resection. In order to treat HCC and to down-stage these patients within accepted criteria for liver transplantation (LT), laparoscopic radiofrequency ablation (RFA) can be performed.We present three cases of laparoscopic RFA for caudate lobe HCC. All three patients were successfully treated with laparoscopic RFA. The computed tomography scans 1 month postsurgery revealed complete necrosis of the lesion. No postoperative complications occurred, and all patients had a short postoperative stay. All three patients underwent, thereafter, LT from a deceased donor.Laparoscopic RFA is the treatment of choice in patients with HCC who could be scheduled for LT. Furthermore, a laparoscopic technique with an accurate ultrasound examination of liver parenchyma can allow for a complete exclusion of hepatic lesions undetectable at the preoperative imaging and provides the minimal onset of adhesions, both approaches that are extremely useful in patients undergoing liver transplantation.

2012 - Laparoscopic versus open liver surgery: A single center analysis of post-operative in-hospital and post-discharge results [Articolo su rivista]
Slim, A; Garancini, M; Di Sandro, S; Mangoni, I; Lauterio, A; Giacomoni, A; De Carlis, L.
abstract

2012 - Living donor liver transplantation for hepatocellular carcinoma: The impact of neo-adjuvant treatments on the long term results [Articolo su rivista]
Di Sandro, S; Giacomoni, A; Slim, A; Lauterio, A; Mangoni, I; Mihaylov, P; Pirotta, V; Aseni, P; De Carlis, L.
abstract

2011 - Liver resection for colorectal metastases in older adults: A paired matched analysis [Articolo su rivista]
Di Benedetto, F.; Berretta, M.; D'Amico, G.; Montalti, R.; Ruvo, N. D.; Cautero, N.; Guerrini, G. P.; Ballarin, R.; Spaggiari, M.; Tarantino, G.; Di Sandro, Stefano; Pecchi, A.; Luppi, G.; Gerunda, G.
abstract

To assess the safety and long-term results of hepatic resection of colorectal liver metastases (CLM) in older adults.Case-control.Single liver and multivisceral transplant center.Individuals with CLM: 32 aged 70 and older (older group) and 32 younger than 70 (younger group) matched in a 1:1 ratio according to sex, primary tumor site, liver metastases at diagnosis, number of metastases, maximum tumor size, infiltration of cut margin, type of hepatic resection, and hepatic resection timing.Postoperative complications and survival rates.There was no significant difference in preoperative clinical findings between the two study groups. The incidence of cumulative postoperative complications was similar in the older (28.1%) and younger (34.4%) groups (P&nbsp;=&nbsp;.10). One-, 3-, and 5-year disease-free survival rates were 57.6%, 32.9%, and 16.4%, respectively, in the younger group and 67.9%, 29.2%, and 19.5%, respectively, in the older group (P&nbsp;=&nbsp;.72). One-, 3-, and 5-year participant survival rates were 84.1%, 51.9%, and 33.3%, respectively, in the older group and 93.6%, 63%, and 28%, respectively, in the younger group (P&nbsp;=&nbsp;.50).Resection of colorectal liver metastases in older adults can be performed with low mortality and morbidity and offers a long-time survival advantage to many of these individuals. Based on the results of this case-control study, older adults should be considered for surgical treatment whenever possible.

2011 - Role of chemoembolization as a rescue treatment for recurrence of resected hepatoblastoma in adult patients [Articolo su rivista]
Di Benedetto, F; Di Sandro, S; D’Amico, G; De Santis, M; Gerunda, Ge.
abstract

2010 - First report on a series of HIV patients undergoing rapamycin monotherapy after liver transplantation [Articolo su rivista]
Di Benedetto, F; Di Sandro, S; De Ruvo, N; Montalti, R; Ballarin, R; Guerrini, Gp; Spaggiari, M; Guaraldi, G; Gerunda, G
abstract

Some experimental trials have demonstrated that rapamycin (RAPA) is able to inhibit HIV-1 progression in three different ways: (1) reducing CCR5-gene transcription, (2) blocking interleukin-2 intracellular secondary messenger (mammalian target of rapamycin), and (3) up-regulating the beta-chemokine macrophage inflammatory protein (MIP; MIP-1alpha and MIP-1beta). We present the preliminary results of a prospective nonrandomized trial concerning the first HIV patient series receiving RAPA monotherapy after liver transplantation (LT).Since June 2003, 14 HIV patients have received cadaveric donor LT due to end-stage liver disease (ESLD) associated or not associated with hepatocellular carcinoma, scored by the model for ESLD system. Patients were assessed using the following criteria for HIV characterization: CD4 T-cell count more than 100/mL and HIV-RNA levels less than 50 copies/mL. Primary immunosuppression was based on calcineurin inhibitors (CI), whereas switch to RAPA monotherapy occurred in cases of CI complications or Kaposi's sarcoma.Mean overall post-LT follow-up was 14.8 months (range: 0.5-52.6). Six of 14 patients were administered RAPA monotherapy. Mean preswitch period from CI to RAPA was 67 days (range: 10-225 days). Mean postswitch follow-up was 11.9 months (range: 2-31 months). All patients were affected by ESLD, which was associated with hepatocellular carcinoma in seven patients. ESLD occurred due to hepatitis C virus (HCV)-related hepatopathy for nine patients, hepatitis B virus-related hepatopathy for one patient, and hepatitis B virus-HCV hepatopathy for four patients. Significantly better control of HIV and HCV replication was found among patients taking RAPA monotherapy (P=0.0001 and 0.03, respectively).After in vitro and in vivo experimental evidence of RAPA antiviral proprieties, to our knowledge, this is the first clinical report of several significant benefits in long-term immunosuppression maintenance and HIV-1 control among HIV positive patients who underwent LT.

2010 - Hepatocellular Carcinoma in Unrelated Viral Cirrhosis: Long-Term Results After Liver Transplantation [Articolo su rivista]
Lauterio, A; Di Sandro, S; Slim, A; Giacomoni, A; Mangoni, I; Mihaylov, P; Pirotta, V; Aseni, P; De Carlis, L.
abstract

2010 - Rapamycin and HIV Replication in Liver Transplant Recipients [Articolo su rivista]
Di Benedetto, F.; Di Sandro, S.; Ballarin, R.; Guaraldi, G.; Gerunda, G.
abstract

not available

2009 - Cystic pancreatic neuroendocrine neoplasms with uncertain malignant potential: Report of two cases [Articolo su rivista]
Ballarin, R; Masetti, M; Losi, L; Di Benedetto, F; Di Sandro, S; De Ruvo, N; Montalti, R; Romano, A; Guerrini, Gp; DE BLASIIS, Maria Grazia; Spaggiari, M; Gerunda, Ge.
abstract

Neuroendocrine tumors of the pancreas (NETP) represent only 1%-2% of all pancreatic neoplasms. They can be classified as functioning or non-functioning, respectively, according to the presence or absence of paraneoplastic syndrome. Case 1 concerned a 70-year-old woman with a cystic lesion of the pancreatic head and body. All tumor markers were negative. The patient underwent a distal pancreatectomy. The histology revealed a well-differentiated endocrine tumor with uncertain malignant potential. Case 2 was a 61-year-old man with chronic polyserositis. The serum tumor markers were negative, while he was strongly positive for intracystic tumor markers carcinoembryonic antigen, carbohydrate antigen (CA) 19-9, and CA 125. The patient underwent a cephalo-pancreatic duodenectomy. The preoperative differential diagnosis of cystic NETP is still a challenge due to the high rate of the nonfunctional variant. Although cystic NETPs are well differentiated, they are still tumors with a malignant potential, and therefore an early diagnosis and radical surgical resection could be associated with a better long-term survival.

2009 - Immunosuppressive Switch to Sirolimus in Renal Dysfunction After Liver Transplantation [Articolo su rivista]
DI BENEDETTO, Fabrizio; Di Sandro, S; De Ruvo, N; Montalti, R; Guerrini, Gp; Ballarin, R; Spaggiari, Mario; Mimmo, A; D'Amico, G; Cautero, N; Iemmolo, Rm; Gerunda Giorgio, Enrico.
abstract

OBJECTIVE: Nephrotoxicity is a serious adverse effect after liver transplantation often related to calcineurin inhibitors (CNI) with a incidence of 18.1% at 5 years. Sirolimus (SRL) is a new immunosuppressive drug that was introduced into solid organ transplant management in 1999. Herein we have performed a retrospective review of patients who developed renal insufficiency owing to CNI therapy after orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Thirty-one patients were switched to SRL monotherapy because of nephrotoxicity as evidenced by serum creatinine levels (SCr) &gt; 1.8 mg/dL and estimated glomerular filtration rates (eGFR) &lt; 45 mL/min/1.73 m(2). The dosage was adjusted to achieve trough levels between 8 and 10 ng/mL. RESULTS: The patients were followed for a mean of 52 months (range 2-88 months) after OLT. Mean follow-up after the switch was 27.5 months (range, 2-71.2 months). Immunosuppression was switched after a mean of 35.2 months (range, 0.2-43.4 months). Renal function was significantly improved, as shown by the improved SCr, urea, and eGFR after the switch. CONCLUSIONS: CNIs may be associated with significant nephrotoxicity and chronic kidney damage. Patients who develop renal dysfunction after OLT may be successfully treated by an early switch from CNIs to SRL, stopping the progression toward chronic renal damage and preserving allograft survival.

2009 - Liver Adenomatosis: A Rare Indication for Living Donor Liver Transplantation [Articolo su rivista]
Di Sandro, S; Slim, Ao; Lauterio, A; Giacomoni, A; Mangoni, I; Aseni, P; Pirotta, V; Aldumour, A; Mihaylov, P; De Carlis, L.
abstract

2009 - Living Donor Liver Transplantation for Hepatocellular Carcinoma: Long-Term Results Compared With Deceased Donor Liver Transplantation [Articolo su rivista]
Sandro, Di; S., and Slim; A. O., and Giacomoni; A., and Lauterio; A., and Mangoni; I., and Aseni; P., and Pirotta; V., and Aldumour; A., and Mihaylov; P., and De Carlis
abstract

2009 - Percutaneous Transhepatic Bile Duct Ablation with n-Butyl Cyanoacrylate in the Treatment of a Biliary Complication after Split Liver Transplantation [Articolo su rivista]
Lauterio, Andrea; Slim, Abdallah; Aseni, Paolo; Giacomoni, Alessandro; Di Sandro, Stefano; Corso, Rocco; Mangoni, Iacopo; Mihaylov, Plamen; Al Kofahi, Mohammed; Pirotta, Vincenzo; De Carlis, Luciano
abstract

Biliary complications continue to be a major cause of morbidity after split-liver transplantation (SLT). In this report we describe an uncommon late biliary complication. One year after SLT the patient showed an intrahepatic bile dicy dilatation with severe cholangitis episodes. The segmentary bile duct of hepatic segment VI-VII draining in the left duct was unidentified and tied at the time of the in situ split-liver procedure. We perform a permanent obliteration of the dilated intrahepatic ducts by a percutaneous embolization using an n-butyl cyanoacrylate (NABC). The management of biliary complications after SLT requires a multidisciplinary approach. The use of NBCA in obliteration of a dilated bile duct seems to be a safe procedure with good results providing a less invasive option than hepatic resection and decreasing the morbidity associated with chronic external biliary drainage. Further studies are needed to determine whether this approach is effective and safe and whether it could reduce hospital stay and cost.

2009 - Sirolimus monotherapy effectiveness in liver transplant recipients with renal dysfunction due to calcineurin inhibitors [Articolo su rivista]
Di Benedetto, F; Di Sandro, S; De Ruvo, N; Spaggiari, M; Montalti, R; Ballarin, R; Cappelli, G; Gerunda, Ge.
abstract

INTRODUCTION: Among the adverse effects of different calcineurin inhibitors (CIs), nephrotoxicity is the most common (incidence: 18.1% at 13 y from liver transplantation) and depends on a variable degree of tubular-interstitial injury accompanied by focal glomerular sclerosis. A new immunosuppressive drug was introduced in solid organ transplant management, Sirolimus (SRL). It is a nonnephrotoxic immunosuppressor. METHODS: Twenty-six patients who developed nephrotoxicity owing to CIs, showing an increment of serum creatinine levels (&gt;1.8 mg/dL) were switched to SRL monotherapy, initially at a dosage between 3 and 5 mg/d, and subsequently adapted to achieve trough level between 8 to 10 ng/mL. RESULTS: Patients were followed-up for a mean period of 40.3 months (range, 8.4 to 76.7) from liver transplantation. Mean follow-up after switch was 27.5 months (range, 2 to 71.2). Immunosuppression therapy was converted after a mean period of 12.8 months (range, 0.2 to 43.4). Serum creatinine, urea, and estimated glomerular filtration rate were significantly improved. DISCUSSION: Patients developing renal dysfunction after liver transplantation may be successfully treated by conversion from CI to SRL. Hypertriglyceridemia and hypercholesterolemia represent the principal side effects from SRL, but are treatable. Furthermore, SRL can significantly improve glucose tolerance.

2008 - Atypical presentation of pioderma gangrenosum complicating ulcerative colitis: Rapid disappearance with methylpredinsolone [Articolo su rivista]
Aseni, P; Di Sandro, S; Mihaylov, P; Lamperti, L; De Carlis, LG.
abstract

2008 - Diaphragmatic hernia occurring 15 months after percutaneous radiofrequency ablation of a hepatocellular cancer [Articolo su rivista]
di Francesco, F; Di Sandro, S; Doria, C; Ramirez, C; Iaria, M; Navarro, V; Silvestry, S; Needleman, L; Frank, A
abstract

2008 - Hepatocellular carcinoma in HIV patients treated by liver transplantation. [Articolo su rivista]
Di Benedetto, F.; De Ruvo, N.; Berretta, M.; Masetti, M.; Montalti, R.; Di Sandro, S.; Ballarin, R.; Codeluppi, M.; Guaraldi, G.; Gerunda, GE.
abstract

Several reports have shown the effectiveness of liver transplantation (LT) as a therapeutic option in HIV-patients affected by end-stage liver disease. HCC on cirrhosis is another major indication for LT. However, no reports, to our knowledge, have been published as yet addressing the important questions of indications and outcome of LT in HIV-patients with HCC, mainly because of concerns regarding a more aggressive course of HCC with respect to HCC seen in HIV-negative individuals. METHODS: The aim of this report is to focus on indications, preliminary results and complications of LT in a group of 7 HIV-patients who underwent LT at our department for HCC on cirrhosis. RESULTS: Indications to listing HIV-patients were HCC using the internationally accepted Milan criteria. All patients were HBV-and/or HCV-infected. The mean CD4+ cell-count was 249 (range 144-353), and the HIV-RNA load was undetectable in all but one case. After a mean follow-up period of 232days (range 33-774), no recurrence of HCC was seen; one patient died. CONCLUSION: Characteristics of the study protocol, the patients, virological and immunological features, tumor stage and pre-transplantation treatment, complications and survival are herein described in an effort to provide new insights into methodology for an aggressive management of HCC in HIV patients, and possibly give a greater chance of cure.

2008 - Human Immunodeficiency Virus and Liver Transplantation: Our Point of View [Articolo su rivista]
Di Benedetto, F.; Di Sandro, S.; De Ruvo, N.; Berretta, M.; Montalti, R.; Guerrini, G. P.; Ballarin, Roberto; De Blasiis, M. G.; Spaggiari, M.; Smerieri, Nazareno; Iemmolo, R. M.; Guaraldi, G.; Gerunda, G. E.
abstract

INTRODUCTION: Highly active antiretroviral therapy (HAART) has been able to improve the immune system function and survival of HIV patients with a consequent increase in the number of HIV patients affected by end-stage liver disease (ESLD). Between June 2003 and October 2006, 10 HIV-positive patients underwent liver transplantations in our center. METHODS: All patients were treated with HAART before transplantation; treatment was interrupted on transplantation day and was restarted once the patients' conditions stabilized. Five patients were hepatitis C virus (HCV)-positive, 3 were hepatitis B virus (HBV)-positive, and 2 were HBV-HCV coinfected. HIV viral load before transplantation was &lt;50 copies/mL in all cases. CD4+ cell count before transplantation ranged between 144 and 530 c/microL. Immunosuppression was based on Cyclosporine (CyA) and steroid weaning for 8 patients, and on Tacrolimus and steroid weaning for 2 patients. RESULTS: Five patients were cytomegalovirus (CMV)-positive pp65 antigenemia posttransplantation, and 1 patient was EBV-positive; 2 patients had a coinfection with HHV6. Four patients suffered from a cholestatic HCV recurrent hepatitis treated with antiviral therapy (peginterferon and Ribavirin). Three patients died after transplantation. DISCUSSION: The outcome of liver transplantation in HIV patients was influenced by infections (HCV, CMV, and EBV) and Kaposi's Sarcoma. HCV recurrence was more aggressive, showing a faster progression in this patient population. Drug interaction between HAART and immunosuppressants occurs; longer follow-up and better experience may improve the management of these drug interactions.

2008 - Kaposi's sarcoma after liver transplantation [Articolo su rivista]
DI BENEDETTO, Fabrizio; Di Sandro, S; De Ruvo, N; Berretta, M; Masetti, Michele; Montalti, R; Ballarin, Roberto; Cocchi, S; Potenza, Leonardo; Luppi, Mario; Gerunda, Giorgio Enrico
abstract

INTRODUCTION: Kaposi's Sarcoma (KS) is a malignant neoplasm arising from endothelial cells. HHV8-infection represents a key pathogenic determinant for the development of KS. There are no standard criteria to treat KS in immunosuppressed-individuals. Six cases (2.1%) of KS occurred in our Center among 285-recipients who underwent liver transplantation (LT) between October 2000 and November 2006. METHODS: Patients were four males and two females. Mean age was 57 years (range 44-65). Indication for LT was ESLD associated/non-associated with hepatocellular carcinoma (HCC). The immunosuppressive regimen consisted of cyclosporine/tacrolimus associated with steroids or daclizumab. HHV8-detection was performed by the serological method before LT, and by polymerase chain reaction (PCR)-analysis after KS. RESULTS: One patient had HCV-related cirrhosis and coinfection from HIV, three had HBV-related cirrhosis, two of these with coexistent HCC. The last two patients had alcoholic-cirrhosis, one with coexistent HCC. Mean time from transplantation to KS was 6.2 months (range 3.8-8.8). Three patients were treated with doxorubicin and three with switch from calcineurin-inhibitors to sirolimus. Three patients expired after 11.5, 8.8, and 7.4 months from KS diagnosis. DISCUSSION: KS should be treated by a multidisciplinary approach to obtain an early diagnosis and best management. Effective treatment with immunosuppression reduction or switch to sirolimus is mandatory and can induce complete regression.

2008 - Temporary porto-caval shunt utility during orthotopic liver transplantation. [Articolo su rivista]
Arzu, Gd; Deruvon, ; Montalti, R; Masetti, Michele; Begliomini, Bruno; DI BENEDETTO, Fabrizio; Rompianesi, Gianluca; Disandro, S; Smerieri, Nazareno; D'Amico, Giuseppe; Vezzelli, Elena; Iemmolo, Rm; Romano, Antonio; Ballarin, Roberto; Guerrini, Gian Piero; Deblasiis, Mg; Spaggiari, Mario; Gerunda, Giorgio Enrico
abstract

INTRODUCTION: In liver transplantation (OLT) a porto-caval shunt is a well-defined technique practiced by many surgeons in several centers. METHODS: We considered 186 cadaveric OLT patients who underwent a cavo-cavostomy-type reconstruction; they were divided into two groups: those in whom we performed a porto-caval shunt (group A) and those in whose we did not (group B). We evaluated several variables: warm and total ischemia time, intraoperative blood and fresh frozen plasma transfusions, crystalloid and colloid requirements, blood loss, operative duration, hemodynamic intraoperative changes and diuresis, length of hospital stay, and creatinine values at days 1 and 2, and at discharge day. RESULTS: Total and warm ischemic time differed significantly between the two groups. Infusion of blood, fresh frozen plasma, colloid, and crystalloid did not significantly differ. Blood loss was lower, and intraoperative diuresis was not significantly increased in group A subjects. Postoperative hospitalizations were 16.5 and 17.8 days and operative times, 504 and 611 minutes in the two groups. Both cardiac index and ejection fraction values during the anhepatic phase were significantly greater among group A than group B patients. PAD at the two phases was greater in group B. The PAS was significantly different only at reperfusion time. Creatinine values were significantly different at discharge. Better survival was shown for group A patients over group B subjects. CONCLUSION: The results presented herein confirmed that a porto-caval shunt during OLT was a safe, useful expedient contributing to an improved hemodynamic status and a better time distribution in the various phases of liver transplantation.

2007 - Different dose adjustments of immunosuppresants are necessary after initiating boosted or unboosted first protease inhibitors regimen post-liver transplantation [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Cocchi, S.; Ciaffi, S.; Motta, A.; Pinetti, D.; Codeluppi, M.; Bonora, S.; DI BENEDETTO, Fabrizio; Masetti, M.; Di Sandro, S.; Nardini, Giulia; Bertolini, A.; Gerunda, Giorgio Enrico; Esposito, Roberto
abstract

Antiretroviral (ARV) drug interactions in HIV-infected liver transplant (LTx) recipients can lead to increased levels of immunosuppressive agents (Is) which are responsible to induce acute renal failure and other major toxicities.

2007 - Does change of the liver change the metabolism? Assessment of atazanavir pharmacokinetic profile in 7 HIV-infected patients pre- and post-liver transplantation [Abstract in Atti di Convegno]
Cocchi, S.; Guaraldi, Giovanni; Ciaffi, S.; Motta, A.; Pinetti, D.; Codeluppi, M.; Bonora, S.; DI BENEDETTO, Fabrizio; Masetti, M.; Di Sandro, S.; Nardini, Giulia; Zona, S.; Bertolini, A.; Gerunda, Giorgio Enrico; Esposito, Roberto
abstract

Liver Transplantation (LTx) is a rational therapeutic option for selected HIV-infected patients who have concomitant end-stage liver disease (ESLD). In particular, the use of atazanavir (ATV) in the setting of patients with HIV infection suffering from ESLD is actually controindicated.

2007 - Intestinal autotransplantation for adenocarcinoma of pancreas involving the mesenteric root: our experience and literature review. [Articolo su rivista]
Quintini, C; Di Benedetto, F; Diago, T; Lauro, A; Cautero, N; De Ruvo, N; Romano, A; Di Sandro, S; Ramacciato, G; Pinna, Ad.
abstract

Ductal adenocarcinoma of pancreas represents one of the most aggressive tumor as demonstrated by 3- and 5-year survival rates. Involvement of mesenteric pedicle affects both the possibility to perform a tumor-free margin resection and accounts for most exploratory laparotomy for locally advanced disease. The ex vivo resection of the tumor (autotransplantation) after total exenteration and perfusion of the intestine might have a role to overcome some technical obstacles. So far, only 5 patients have been reported to have undergone small-bowel autotransplantation for tumor involving the mesenteric root. We describe 2 cases of adenocarcinoma of pancreas involving mesenteric root treated by small-bowel autotransplantation. Both patients survived from the procedure and were discharged home on postoperative days 16 and 29, respectively. The tumor was resected with free surgical margins, and both patients underwent adjuvant treatment. Intestinal autotransplantation can represent a significant technical advance for increasing the resectability rate and, ultimately, the survival rate for advanced adenocarcinoma of the pancreas in highly selected patients.

2007 - Liver Transplantation From a Donor Affected by Marfan's Syndrome. [Articolo su rivista]
Benedetto, F. D.; Di Sandro, S.; Ruvo, N.; Masetti, M.; Quintini, C.; Montalti, R.; Ballarin, R.; Gerunda, G. E.
abstract

liver transplantation from a Donor Affected by Marfan's Syndrome.

2007 - Pancreatic schwannoma of the body involving the splenic vein: Case report and review of the literature [Articolo su rivista]
Di Benedetto, F.; Spaggiari, M.; De Ruvo, N.; Masetti, M.; Montalti, R.; Quintini, C.; Ballarin, R.; Di Sandro, S.; Costantini, M.; Gerunda, Giorgio Enrico
abstract

Pancreatic schwannoma is a rare, benign tumour originating from the Schwann cell. The Schwann cells line the nerve sheath and can give rise to two types of tumours: schwannomas and neurofibromas.

2007 - Sirolimus Monotherapy in Liver Transplantation [Articolo su rivista]
Benedetto, F. D.; Di Sandro, S.; Ruvo, N. D.; Masetti, M.; Montalti, R.; Romano, A.; Guerrini, G. P.; Ballarin, R.; De Blasiis, M. G.; Gerunda, G. E.
abstract

INTRODUCTION: Since 1999, a new immunosuppressive drug was administered to renal transplant patients. The SRL molecule acts by blocking post-receptor signal transduction of interleukin-2 (IL-2) interacting with a family of intracellular binding proteins termed immunophilins FKBPs. Among these FKBPs, FK506 12-kd binding protein is the most relevant. SRL is an immunosuppressive drug. Therefore it can inhibit the immune system; at the same time the drug is not nephrotoxic, neurotoxic, and without diabetogenic effects. METHODS: Among 285 patients who underwent liver transplantation, 27 took Sirolimus as monotherapy. Immunosuppressive treatment upto cyclosporine (CsA) or tacrolimus (FK) associated with steroids (methylprednisolone) and mycophenolate Mofetil (MMF) was initiated among subjects with pre-transplant renal failure. SRL was administered as monotherapy for patients who developed nephrotoxicity, or neurotoxicity, or diabetes. Moreover, patients affected by multifocal HCC who did not meet the Milan criteria or patients who developed Kaposi's Sarcoma were prescribed SRL monotherapy. RESULTS: Nephrotoxicity occurred in 14 patients with mean serum creatinine level 2.2 mg/dl. Eleven patients with real failure showed significant improvements after a mean period of 28 days of SRL monotherapy (range: 6-45 days). The mean creatinine serum level after treatment with SRL monotherapy was 1.0 mg/dl (range: 0.7-1.2 mg/dl). Neurotoxicity occurred in 4 patients with tremor, confusion, and agitation. Each patient had complete improvement of symptoms after a few days of Sirolimus monotherapy. Among Three patients who developed Kaposi's Sarcoma, two underwent remission. One patient had diabetes due to calcineurin inhibitors, and one showed arterial hypertension not treatable with drugs. After the switch, we treated these patients with medications. Another important indication was HCC not meeting the Milan criteria. CONCLUSION: SRL monotherapy may be used to manage complication of calcineurin inhibitors or Kaposi's Sarcoma.

2007 - Successful liver transplantation using a severely injured graft. [Articolo su rivista]
Benedetto, F. D.; Quintini, C.; Ruvo, N. D.; Masetti, M.; Cautero, N.; Lauro, A.; Uso', T. D.; Guerrini, G.; Di Sandro, S.; Miller, C. M.; Pinna, A. D.; Gerunda, G. E.
abstract

No abstract available.

2006 - Don't deny liver transplantation to HIV patients with hepatocellular carcinoma in the highly active antiretroviral therapy era. [Articolo su rivista]
Benedetto, F. D.; Ruvo, N. D.; Berretta, M.; Masetti, M.; Montalti, R.; Di Sandro, Stefano; Quintini, C.; Codeluppi, M.; Tirelli, U.; Gerunda, G. E.
abstract

In an era of highly active antiretroviral therapy(HAART), liver transplantation is becoming an effective therapy inHIV patients suffering from hepatitis C virus (HCV)/hepatitis B virus(HBV) cirrhosis.1 The increase in survival of patients with HIV infection,attributed to HAART, has prompted the medical community toconsider therapeutic strategies including the possibility of major surgeryand solid organ transplantation to contrast the clinical picture ofend organ failure.In this clinical setting, several studies have consistently associatedan increased risk of death as a result of hepatocellular carcinoma(HCC) with HIV infection.2 In a large French survey, HCC-relateddeath in HIV patients rose from 11% in 1997 to 25% in 2001.3 Moreover,some reports have emphasized a more aggressive course ofHCCwith respect to HCC seen in HIV-negative individuals.4,5 In particular,the HCC is diagnosed at a younger age, and is generally more advanced(infiltrating ormetastatic) at diagnosis.6 Recent evidences suggesta crucial role of the HIV TAT protein to drive hepatocarcinogenesis inpatients with virus- or alcohol-mediated cirrhosis7,8; a coexistent weakerantitumor response because of a chronically low CD4 and CD8 lymphocytecounts must also be kept in due consideration. Consequently, amorefrequentscreeningthanevery6monthshasbeenwarrantedbecauseof the swifter course of HCC

2006 - Hepatic hilum management in 250 liver-multivisceral procurements [Articolo su rivista]
Di Benedetto, F; De, RUVO N; Masetti, M; Cautero, N; Lauro, A; Montalti, R; Quintini, C; Di Francesco, F; Romano, A; Guerrini, G; Ballarin, R; Molteni, G; Spaggiari, M; Sandro, Di; Gerunda, G.
abstract

An accurate in vivo preparation of the hepatic hihim is a fundamental prerequisite for a successful multiorgan transplantation. Our preferred technique in this surgical setting is in vivo procurement in the heart-beating donor. This technique allows an effective exposition of the hilum structures and recognition of anatomical vascular variants, particularly those of the hepatic artery. Also, the cold ischemia time is drastically reduced, and the back-table preparation is left to a minimum. In this article we show the results of a consecutive series of 250 procurements.