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Liver transplantation for hepatocellular carcinoma on cirrhosis:Strategies to avoid tumor recurrence

World Journal of Gastroenterology 2011年第43期17卷 4741-4746页

作者： Marco Vivarelli andrea risaliti Department of Surgery and Transplantation University of BolognaS Orsola Hospital Department of Hepatobiliopancreatic and Transplantation Surgery Polytechnic University of MarcheOspedali Riuniti

Hepatocellular carcinoma(HCC) is one of the most frequent neoplasms worldwide and in most cases it is associated with chronic liver *** transplantation(LT) is potentially the optimal treatment for those patients with HCC who have a poor functional hepatic reserve due to their underlying chronic liver ***,due to the limited availability of donors,only those patients whose oncologic profile is favorable can be considered for *** the careful selection of candidates based on strict rules,10 to 20%of liver transplant recipients who have HCC in the native cirrhotic liver develop tumor recurrence after *** selection criteria presently employed to minimize the risk of recurrence are based on gross tumor characteristics defined by imaging techniques;unfortunately,the accuracy of imaging is far from being ***,microscopic tumor features that are strictly linked with prognosis can not be assessed prior to ***-transplantation tumor downstaging may allow transplantation in patients initially outside the selection criteria and seems to improve the prognosis;it also provides information on tumor *** peculiarity of the transplantation setting,when this is compared with other modalities of treatment,is the need for pharmacological immunosuppression:this is based on drugs that have been demonstrated to increase the risk of tumor *** HCC is an aggressive malignancy,immunosuppression has to be handled carefully in patients who have HCC at the time of transplantation and new categories of immunosuppressive agents should be *** chemotherapy following transplantation has failed to show any significant *** aim of the present study is to review the possible strategies to avoid recurrence of HCC after liver transplantation based on the current clinical evidence and the more recent developments and to discuss possible future directions.

关键词： Chemotherapy Hepatocellular carcinoma Immunosuppression Liver transplantation Tumor recurrence

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Multimodal treatment of hepatocellular carcinoma on cirrhosis: An update

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World Journal of Gastroenterology 2013年第42期19卷 7316-7326页

作者： Marco Vivarelli Roberto Montalti andrea risaliti Hepatobiliary and Abdominal Transplantation Surgery Department of Gastroenterology and TransplantationPolytechnic University of Marche60129 AnconaItaly Department of Surgery and Transplantation University of Udine33100 UdineItaly

Hepatocellular carcinoma(HCC)is the most frequent primary liver tumor,and overall,it is one of the most frequent *** association of HCC with chronic liver disease,and cirrhosis in particular,is well known,making treatment complex and *** treatment of HCC must take into account the presence and stage of chronic liver disease,with the aim of preserving hepatic function that is often already impaired,the stage of HCC and the clinical condition of the *** different treatment options include surgical resection,transplantation,local ablation,chemoembolization,radioembolization and molecular targeted therapies;these treatments can be combined in various ways to achieve different ***,liver transplantation is best treatment for early stage HCC on cirrhosis because it removes both the tumor and the chronic disease that produced it;however,the application of this powerful tool is limited by the scarcity of *** and bridging are different strategies for the management of HCC patients who will undergo liver *** professionals,including gastroenterologists,radiologists and surgeons,are involved in the choice of the most appropriate treatment for a single case,and a multidisciplinary approach is necessary to optimize the *** purpose of this review is to provide a comprehensive description of the current treatment options for patients with HCC by analyzing the advantages,disadvantages and rationale for their use.

关键词： Hepatocellular carcinoma Multimodal treatment Locoregional treatments Molecular targeted therapies Liver resection Liver transplantation

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Evolution of incidental branch-duct intraductal papillary mucinous neoplasms of the pancreas: A study with magnetic resonance imaging cholangiopancreatography

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World Journal of Gastroenterology 2016年第43期22卷 9562-9570页

作者： Rossano Girometti Riccardo Pravisani Sergio Giuseppe Intini Miriam Isola Lorenzo Cereser andrea risaliti Chiara Zuiani Institute of Diagnostic Radiology Department of Medical and Biological Sciences University of Udine University Hospital "S. Maria della Misericordia" Clinical Surgery Department of Medical and Biological Sciences University of Udine University Hospital "S. Maria della Misericordia" Department of Medical and Biological Sciences University of Udine

AIM To investigate the type and timing of evolution of incidentally found branch-duct intraductal papillary mucinous neoplasms(bd-IPMN) of the pancreas addressed to magnetic resonance imaging cholangiopancreatography(MRCP) *** We retrospectively evaluated 72 patients who underwent, over the period 2006-2016, a total of 318 MRCPs(mean 4.4) to follow-up incidental, presumed bdIPMN without signs of malignancy, found or confirmedat a baseline MRCP examination. Median follow-up time was 48.5 mo(range 13-95 mo). MRCPs were acquired on 1.5T and/or 3.0T systems using 2D and/or 3D technique. Image analysis assessed the rates of occurrence over the follow-up of the following outcomes:(1) imaging evolution, defined as any change in cysts number and/or size and/or appearance; and(2) alert findings, defined as worrisome features and/or high risk stigmata(e.g., thick septa, parietal thickening, mural nodules and involvement of the main pancreatic duct). Time to outcomes was described with the Kaplan-Meir approach. Cox regression model was used to investigate clinical or initial MRCP findings predicting cysts *** We found a total of 343 cysts(per-patient mean 5.1) with average size of 8.5 mm(range 5-25 mm). Imaging evolution was observed in 32/72 patients(44.4%; 95%CI: 32-9-56.6), involving 47/343 cysts(13.7%). There was a main trend towards small( 0.01).CONCLUSION Changes in MRCP appearance of incidental bd-IPNM were frequent over the follow-up(44.4%), with relatively rare(8.3%) occurrence of non-malignant alert findings that prompted further diagnostic steps. Cha

关键词： Pancreas Cysts Branch-duct intraductal papillary mucinous neoplasm Magnetic resonance cholangiopancreatography Follow-up

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Pros and cons of liver transplantation in human immunodeficiency virus infected recipients

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World Journal of Gastroenterology 2014年第18期20卷 5353-5362页

作者： Umberto Baccarani Elda Righi Gian Luigi Adani Dario Lorenzin Alberto Pasqualucci Matteo Bassetti andrea risaliti Liver Transplant Unit Department of Medical and Biological SciencesUniversity Hospital of Udine33100 UdineItaly Division of Infectious Disease University Hospital of Udine33100 UdineItaly Department of Anaesthesiology University of Perugia33100 UdineItaly

Before the introduction of combined highly active antiretroviral therapy, a positive human immunodeficiency virus (HIV) serological status represented an absolute contraindication for solid organ transplant (SOT). The advent of highly effective combined antiretroviral therapy in 1996 largely contributed to the increased demand for SOT in HIV-positive individuals due to increased patients’ life expectancy associated with the increasing prevalence of end-stage liver disease (ESLD). Nowadays, liver failure represents a frequent cause of mortality in the HIV-infected population mainly due to coinfection with hepatitis viruses sharing the same way of transmission. Thus, liver transplantation (LT) represents a reasonable approach in HIV patients with stable infection and ESLD. Available data presently supports with good evidence the practice of LT in the HIV-positive population. Thus, the issue is no longer “whether it is correct to transplant HIV-infected patients”, but “who are the patients who can be safely transplanted” and “when is the best time to perform LT”. Indeed, the benefits of LT in HIV-infected patients, especially in terms of mid- and long-term patient and graft survivals, are strictly related to the patients’ selection and to the correct timing for transplantation, especially when hepatitis C virus coinfection is present. Aim of this article is to review the pros and cons of LT in the cohort of HIV infected recipients.

关键词： Liver transplantation Human immunodeficiency virus/hepatitis C virus coinfection Hepatocellular carcinoma Immunosuppression

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Doxorubicin-eluting bead vs conventional transcatheter arterial chemoembolization for hepatocellular carcinoma before liver transplantation

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World Journal of Gastroenterology 2013年第34期19卷 5622-5632页

作者： Daniele Nicolini Gianluca Svegliati-Baroni Roberto Candelari Cinzia Mincarelli Alessandra Mandolesi Italo Bearzi Federico Mocchegiani andrea Vecchi Roberto Montalti Antonio Benedetti andrea risaliti Marco Vivarelli Division of Hepatobiliary and Transplant Surgery Department of Gastroenterology and TransplantationPolytechnic University of Marche Division of Gastroenterology Department of Gastroenterology and TransplantationPolytechnic University of Marche Division of Interventional Radiology Department of Radiological SciencesPolytechnic University of Marche Division of Pathology Department of PathologyPolytechnic University of Marche Division of Hepatobiliary and Transplant Surgery Department of Medical and Biological SciencesUniversityof Udine

AIM:To assess the possible effect of two different types of preoperative transcatheter arterial chemoembolization(TACE)on recurrence-free survival after liver transplantation(LT)in patients with hepatocellular carcinoma(HCC)and to analyze the effects of TACE on tumor ***:We retrospectively analyzed the histological features of 130 HCC nodules in 63 native livers removed at *** who received any other type of treatment such as radiofrequency tumor ablation,percutaneous ethanol ablation or who were not treated at all were *** patients in the present study were within the Milan Criteria at the last imaging findings before *** bead TACE(DEB-TACE)was performed in 22patients(38 nodules),and conventional TACE(c-TACE)in 16(25 nodules).Patients’and tumors’characteristics were retrospectively *** performed a pernodule analysis of the explanted livers to establish the mean percentage of necrosis of any nodule treated by TACE(conventional or DEB)and a per-patient analysis to establish the percentage of necrosis in the cumulative tumor area,including 21 nodules not reached by *** and fibrotic changes in the tissue surrounding the tumor nodule were analyzed and categorized as poor/absent,moderate and enhanced ***-and multivariate analysis of risk factors for HCC-recurrence were ***:The number and diameter of the nodules,the time spent on the waiting list and the number of treatments were similar in the two groups.A trend towards higher appropriate response rates(necrosis≥90%)was observed in the DEB-TACE group(44.7%vs32.0%,P=0.2834).The mean percentage of necrosis in the cumulative tumor area was 58.8%±36.6%in the DEB-TACE group and 50.2%±38.1%in the c-TACE group(P=0.4856).Fibrotic and inflammatory reactions surrounding the tumor nodule were markedly more common in the DEB-TACE group(P<0.0001,for both the parameters).The three-year recurrence-free survival was hig

关键词： Liver transplantation Hepatocellular carcinoma Transcatheter arterial chemoembolization Doxorubicin-eluting bead Tumor histology Recurrence-free survival Locoregional therapies

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Combined approach for spontaneous rupture of hepatocellular carcinoma

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World Journal of Hepatology 2010年第1期2卷 49-51页

作者： Anna Rossetto Gian Luigi Adani andrea risaliti Umberto Baccarani Vittorio Bresadola Dario Lorenzin Giovanni Terrosu Department of Surgery & Transplantation University HospitalP.Le S.M.della Misericordia

Ruptured hepatocellular carcinoma is a rare,emergency occurrence in western countries with high mortality risk.A number of hypotheses have been formulated in order to explain the precise mechanism that leads to hepatocellular carcinoma(HCC) rupture:sub-capsular location,dimensions,portal hypertension,tumour necrosis,local increase of venous pressure due to the outflow reduction caused by neoplastic invasion,and the presence of a previous vascular injury which might predispose to HCC *** is still a debate in the literature concerning the best approach in cases of HCC *** is the first option for treatment of acute abdominal *** the advent of endovascular treatments widens the range of possible therapies for acute bleeding control and subsequent ablation *** report a case of hemoperitoneum from spontaneous rupture of undiagnosed HCC,that was treated successfully by emergency surgical resection followed by transarterial chemo-embolizationfor local recurrence.

关键词： Hemoperitoneum Acute abdominal bleeding Bleeding hepatocellular carcinoma

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Abdominal cross-sectional imaging of the associating liver partition and portal vein ligation for staged hepatectomy procedure

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World Journal of Hepatology 2017年第16期9卷 733-745页

作者： Michele Zerial Dario Lorenzin andrea risaliti Chiara Zuiani Rossano Girometti Institute of Diagnostic Radiology Department of MedicineUniversity of UdineUniversity Hospital 'S. Maria della Misericordia' Clinical Surgery Department of MedicineUniversity of UdineUniversity Hospital 'S. Maria della Misericordia'

Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) is a recently introduced technique aimed to perform two-stage hepatectomy in patients with a variety of primary or secondary neoplastic lesions. ALPSS is based on a preliminary liver resection associated with ligation of the portal branch directed to the diseased hemiliver(DH), followed by hepatectomy after an interval of time in which the future liver remnant(FLR) hypertrophied adequately(partly because of preserved arterialization of the DH). Multidetector computed tomography(MDCT) and magnetic resonance imaging(MRI) play a pivotal role in patients' selection and FLR assessment before and after the procedure, as well as in monitoring early and late complications, as we aim to review in this paper. Moreover, we illustrate main abdominal MDCT and MRI findings related to ALPPS.

关键词： Hepatectomy Computed tomography Magnetic resonance imaging Associating liver partition and portal vein ligation for staged hepatectomy Liver surgery

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Is there any correlation between Iiver graft regeneration and recipient's pretransplant skeletal muscle mass?-a study in extended Ieft Iobe graft Iiving-donor Iiver transplantation

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Hepatobiliary Surgery and Nutrition 2020年第2期9卷 183-194页

作者： Riccardo Pravisani Akihiko Soyama Shinichiro Ono Umberto Baccarani Miriam Isola Mitsuhisa Takatsuki Masaaki Hidaka Tomohiko Adachi Takanobu Hara Takashi Hamada Florian Pecquenard andrea risaliti Susumu Eguchi Department of Surgery Nagasaki University Graduate School of Biomedical SciencesNagasakiJapan Liver-Kidney Transplant Unit Department of MedicineUniversity of UdineUdineItaly Division of Medical Statistic Department of MedicineUniversity of UdineUdineItaly

Background:The end-stage liver disease causes a metabolic dysfunction whose most prominent clinical feature is the loss of skeletal muscle mass(SMM).In living-donor liver transplantation(LDLT),liver graft regeneration(GR)represents a crucial process to normalize the portal hypertension and to meet the metabolic demand of the *** data are available on the correlation between pre-LDLT low SMM and ***:Retrospective study on a cohort of 106 LDLT patients receiving an extended left liver lobe *** skeletal muscle index(SMI)at L3 level was used for muscle mass measurement,and the recommended cut-off values of the Japanese Society of Hepatology guidelines were used as criteria for defining low *** was evaluated as rate of volume increase at 1 month post-LT[graft regeneration rate(GRR)].Results:The median GRR at 1 month post-LT was 91%(IQR,65-128%)and a significant correlation with graft volume-to-recipient standard liver volume ratio(GV/SLV)(rho-0.467,P<0.001),graft-to-recipient weight ratio(GRWR)(rho-0.414,P<0.001),donor age(rho-0.306,P=0.001),1 month post-LT cholinesterase serum levels(rho 0.397,P=0.002)and pre-LT low muscularity[absent *** GRR 97.5%(73.1-130%)vs.83.5%(45.2-110.9%),P=0.041]was *** in male recipients,but not in women,it was shown a direct correlation with pre-LT SMI(rho 0.352,P=0.020)and inverse correlation with 1 month post-LT SMI variation(rho-0.301,P=0.049).A low GRR was identified as an independent prognostic factor for recipient overall survival(HR 6.045,P<0.001).Conclusions:Additionally to the hemodynamic factors of portal circulation and the quality of the graft,the metabolic status of the recipients has a significant role in the GR process.A pre-LT low SMM is associated with impaired GRR and this negative impact is more evident in male recipients.

关键词： Liver regeneration living-donor liver transplantation(LDLT) skeletal muscle mass index sarcopenia malnutrition

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Glial response in the midcingulate cortex in Huntington’s disease

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Neural Regeneration Research 2025年第1期20卷 207-208页

作者： Thulani H.Palpagama andrea Kwakowsky Center for Brain Research and Department of Anatomy and Medical Imaging Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand Pharmacology and Therapeutics School of MedicineGalway Neuroscience CenterUniversity of GalwayGalwayIreland

Huntington’s disease(HD)is a genetic disease characterized by the progressive degeneration of the striatum and *** can present with a variety of symptoms that can broadly be classified into motor symptoms,inclusive of choreatic movements and rigidity,mood and psychiatric symptoms,such as depression and apathy,and cognitive symptoms,such as cognitive *** causal mutation underlying HD results from an expansion of a CAG repeat sequence on the IT15 gene,resulting in the formation and accumulation of a mutant huntingtin protein.

关键词： Huntington degeneration cortex

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Neuroinflammation as a therapeutic target in Huntington's disease

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Neural Regeneration Research 2025年第3期20卷 817-818页

作者： andrea Kwakowsky Thulani H.Palpagama Center for Brain Research and Department of Anatomy and Medical Imaging Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand Pharmacology and Therapeutics School of MedicineGalway Neuroscience CentreUniversity of GalwayGalwayIreland

In 1872, George Huntington presented his essay “On Chorea” to the Meigs and Mason Academy of Medicine and, in doing so, detailed a disease that would later bear his name. Huntington's disease(HD) is a genetic, neurodegenerative disease that manifests as the loss of motor control,cognitive impairment,and mood and psychiatric changes in paents.

关键词： Huntington inflammation Medicine

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