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Liver transplantation for intermediate hepatocellular carcinoma: An adaptive approach

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World Journal of Gastroenterology 2017年第18期23卷 3195-3204页

作者： Marco Biolato Giuseppe Marrone Luca Miele antonio Gasbarrini antonio grieco Liver Transplant Medicine Gastroenterological Area Gastroenterological and Endocrino Metabolical Sciences Department Fondazione Policlinico Universitario Gemelli Universita’ Cattolica del Sacro Cuore

Hepatocellular carcinoma is becoming an increasing indication for liver transplantation, but selection and allocation of patients are challenging because of organ shortages. Conventional Milan criteria are the reference for the selection of patients worldwide, but many expanded criteria, like University of California San Francisco criteria and up-to-7 criteria, have demonstrated that survival and recurrence results are lower than those for restricted indications. Correct staging is crucial and should include surrogate markers of biological aggressiveness(α-fetoprotein, response to loco-regional treatments). Successful down-staging can select between patients with tumor burden initially beyond transplantation criteria those with a more favorable biology, provided a 3-mo stability in meeting the transplantation criteria. Allocation rules are constantly adjusted to minimize the imbalance between the priorities of candidates with and without hepatocellular carcinoma, and take into account local donor rate and waitlist dynamics. Recently, Mazzaferro et al proposed a benefit-oriented "adaptive approach", in which the selection and allocation of patients are based on their response to non-transplantation treatments: low priority for transplantation in case of complete response, high priority in case of partial response or recurrence, and no listing in case of progression beyond transplantation criteria.

关键词： Milan criteria α-fetoprotein Down-staging Allocation Adaptive approach

Branched chain amino acids in hepatic encephalopathy and sarcopenia in liver cirrhosis:Evidence and uncertainties

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World Journal of Gastroenterology 2023年第19期29卷 2905-2915页

作者： Giuseppe Marrone Amato Serra Luca Miele Marco Biolato antonio Liguori antonio grieco antonio Gasbarrini Medical and Surgical Sciences Fondazione Policlinico Universitario A.Gemelli-IRCCSUniversita Cattolica del Sacro CuoreRome 00168Italy

Liver cirrhosis is commonly associated with nutritional alterations,reported in 20% of patients with compensated disease and over 60% of patients with decompensated *** disturbances are associated with a worse prognosis and increased risk of *** levels of branched-chain amino acids(BCAAs)are decreased in patients with liver *** imbalance of amino acids levels has been suggested to be associated with the development of complications,such as hepatic encephalopathy and sarcopenia,and to affect the clinical presentation and prognosis of these *** studies investigated the efficacy of BCAAs supplementation as a therapeutic option in liver cirrhosis,but uncertainties remain about the real efficacy,the best route of administration,and dosage.

关键词： Branched-chain amino acids Hepatic encephalopathy Sarcopenia Liver cirrhosis

Minimum platelet count threshold before invasive procedures in cirrhosis:Evolution of the guidelines

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World Journal of Gastrointestinal Surgery 2023年第2期15卷 127-141页

作者： Marco Biolato Federica Vitale Tiziano Galasso antonio Gasbarrini antonio grieco Department of Medical and Surgical Sciences CEMADFondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy Department of Internal Medicine Catholic University of Sacred HeartRome 00168Italy

Cirrhotic patients with severe thrombocytopenia are at increased risk of bleeding during invasive *** need for preprocedural prophylaxis aimed at reducing the risk of bleeding in cirrhotic patients with thrombocytopenia who undergo scheduled procedures is assessed via the platelet count;however,establishing a minimum threshold considered safe is challenging.A platelet count≥50000/μL is a frequent target,but levels vary by provider,procedure,and specific *** the years,this value has changed several times according to the different guidelines proposed in the *** to the latest guidelines,many procedures can be performed at any level of platelet count,which should not necessarily be checked before the *** this review,we aim to investigate and describe how the guidelines have evolved in recent years in the evaluation of the minimum platelet count threshold required to perform different invasive procedures,according to their bleeding risk.

关键词： Liver disease Thrombocytopenia Avatrombopag Lusutrombopag Transfusion

Two elective invasive procedures after a single avatrombopag treatment in a patient with liver cirrhosis and severe thrombocytopenia

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Gastroenterology Report 2022年第1期10卷 668-670页

作者： Marco Biolato Federica Vitale Giuseppe Marrone Luca Miele antonio grieco Internal and Liver Transplant Medicine Unit CEMADDepartment of Medical and Surgical SciencesFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly Institute of Internal Medicine Catholic University of the Sacred HeartRomeItaly

Introduction Severe thrombocytopenia(platelet count56×10^(9)/L[2].Observational studies found that severe thrombocytopenia may be predictive of post-procedure bleeding after liver biopsy,dental extractions,percutaneo... 详细信息

关键词： treatment cirrhosis liver

Disseminated intravascular coagulation after splenic artery aneurysm coils embolization:an unexpected surprise

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Gastroenterology Report 2023年第1期11卷 551-553页

作者： Marco Biolato Alessandro D’Errico Fiammetta Maria Rognoni Giuseppe Marrone Luca Laurenti Alessandro Cina antonio grieco Department of Medical and Surgical Sciences Fondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly Institute of Internal Medicine Catholic University of the Sacred HeartRomeItaly Department of Diagnostic imaging Radiation oncology and HematologyFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly Institute of Hematology Catholic University of the Sacred HeartRomeItaly Institute of Radiology Catholic University of the Sacred HeartRomeItaly

Introduction The Society for Vascular Surgery recommends treating nonruptured splenic artery aneurysms(SAAs)of>3 cm with a demonstrable increase in size or with associated symptoms[1].Percutaneous intervention with embolization coils or covered stents has become popular due to its high technical success rates and low morbidity[2,3].

关键词： Surgery artery coils

Intestinal permeability in the pathogenesis of liver damage: From non-alcoholic fatty liver disease to liver transplantation

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World Journal of Gastroenterology 2019年第33期25卷 4814-4834页

作者： Alberto Nicoletti Francesca Romana Ponziani Marco Biolato Venanzio Valenza Giuseppe Marrone Gabriele Sganga antonio Gasbarrini Luca Miele antonio grieco Fondazione Policlinico Universitario A Gemelli IRCCS Rome 00168Italy UniversitàCattolica del Sacro Cuore Rome 00168Italy

The intimate connection and the strict mutual cooperation between the gut and the liver realizes a functional entity called gut-liver *** integrity of intestinal barrier is crucial for the maintenance of liver *** this mutual relationship,the liver acts as a second firewall towards potentially harmful substances translocated from the gut,and is,in turn,is implicated in the regulation of the *** evidence has highlighted the relevance of increased intestinal permeability and consequent bacterial translocation in the development of liver *** particular,in patients with non-alcoholic fatty liver disease recent hypotheses are considering intestinal permeability impairment,diet and gut dysbiosis as the primary pathogenic *** advanced liver disease,intestinal permeability is enhanced by portal *** clinical consequence is an increased bacterial translocation that further worsens liver ***,this pathogenic mechanism is implicated in most of liver cirrhosis complications,such as spontaneous bacterial peritonitis,hepatorenal syndrome,portal vein thrombosis,hepatic encephalopathy,and hepatocellular *** liver transplantation,the decrease in portal pressure should determine beneficial effects on the gut-liver axis,although are incompletely understood data on the modifications of the intestinal permeability and gut microbiota composition are still *** the modulation of the intestinal permeability could prevent the initiation and progression of liver disease is still an uncovered area,which deserves further attention.

关键词： Bacterial translocation Gut microbiota Gut-liver axis Liver disease Cirrhosis Mediterranean diet Personalized medicine

Intestinal permeability after Mediterranean diet and low-fat diet in non-alcoholic fatty liver disease

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World Journal of Gastroenterology 2019年第4期25卷 509-520页

作者： Marco Biolato Fiorella Manca Giuseppe Marrone Consuelo Cefalo Simona Racco Giacinto A Miggiano Venanzio Valenza antonio Gasbarrini Luca Miele antonio grieco Department of Gastroenterological Endocrine-Metabolic and Nefro-Urological Sciences Fondazione Policlinico Universitario A. Gemelli IRCCS Institute of Special Medical Pathology and Medical Semeiotics Università Cattolica del Sacro Cuore Institute of Internal Medicine and Geriatrics Università Cattolica del Sacro Cuore Department of Image Diagnostics Oncological Radiotherapy and Hematology Sciences Fondazione Policlinico Universitario A. Gemelli IRCCS Nuclear Medicine Institute Università Cattolica del Sacro Cuore

BACKGROUND In non-alcoholic fatty liver disease(NAFLD), a high-fat or high-fructose diet increases intestinal permeability and promotes derangement of the gut-liver *** hypothesize that, diet could be able to modulate intestinal permeability in patients with *** To detect diet-induced modification of intestinal permeability in patients with NAFLD undergoing a Mediterranean diet or a low-fat *** The current study was a dietary intervention for non-diabetic, patients with biopsy-verified NAFLD and increased transaminases. A crossover design was employed: participants underwent 16 weeks of Mediterranean diet, 16 wk of free wash-out, and 16 weeks of low-fat diet. Both diets were hypocaloric and no consumption of supplements was allowed. All patients were followed bimonthly by a dietitian. Evaluations of clinical and metabolic parameters were completed at baseline and at the end of each dietary period. Intestinal permeability was assessed by chromium-51 ethylene diamine tetraacetate excretion testing(51 CrEDTA).RESULTS Twenty Caucasian patients, 90% male, median age 43 years, body mass index(BMI) 30.9, with biopsy-verified NAFLD were enrolled. At the end of 16 weeks of a Mediterranean diet, a significant reduction in mean body weight(-5.3 ± 4.1 kg,P = 0.003), mean waist circumference(-7.9 ± 4.9 cm, P = 0.001), and mean transaminase levels [alanine aminotransferase(ALT)-28.3 ± 11.9 IU/L, P =0.0001; aspartate aminotransferase(AST)-6.4 ± 56.3 IU/L, P = 0.01] were observed. These benefits were maintained after 16 wk of wash-out and also after16 wk of low-fat diet, without further improvements. Fourteen of the 20 patients had intestinal permeability alteration at baseline(mean percentage retention of51 Cr-EDTA = 5.4%), but no significant changes in intestinal permeability were observed at the end of the 16 wk of the Mediterranean diet or 16 wk of the low-fat *** Mediterranean diet is an effective strategy for treating overweight, visceral obesit

关键词： Liver steatosis Gut-liver axis Nutrition Personalized medicine Visceral obesity

Direct oral anticoagulant administration in cirrhotic patients with portal vein thrombosis:What is the evidence?

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World Journal of Hepatology 2022年第4期14卷 682-695页

作者： Marco Biolato Mattia Paratore Luca Di Gialleonardo Giuseppe Marrone antonio grieco Internal and Liver Transplant Medicine Unit CEMADDepartment of Medical and Surgical SciencesFondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy Institute of Internal Medicine Catholic University of Sacred HeartRome 00168Italy

In recent years,the traditional concept that cirrhosis-related coagulopathy is an acquired bleeding disorder has ***,it is known that in cirrhotic patients,the hemostatic system is rebalanced,which involves coagulation factors,fibrinolysis and *** alterations disrupt homeostasis,skewing it toward a procoagulant state,which can lead to thromboembolic manifestations,especially when hemodynamic and endothelial factors co-occur,such as in the portal vein system in *** vein thrombosis is a common complication of advanced liver cirrhosis that negatively affects the course of liver disease,prognosis of cirrhotic patients and success of liver *** is still debated whether portal vein thrombosis is the cause or the consequence of worsening liver *** therapy is the mainstay treatment for acute symptomatic portal vein *** chronic portal vein thrombosis,the role of anticoagulant therapy is still *** anticoagulants,vitamin K antagonists and low-molecular-weight heparin are standard-of-care treatments for portal vein *** the last ten years,direct oral anticoagulants have been approved for the prophylaxis and treatment of many thromboembolicrelated diseases,but evidence on their use in cirrhotic patients is very *** aim of this review was to summarize the evidence about the safety and effectiveness of direct oral anticoagulants for treating portal vein thrombosis in cirrhotic patients.

关键词： Dabigatran Rivaroxaban Apixaban Edoxaban Bleeding

Frequency of and reasons behind non-listing in adult patients referred for liver transplantation: Results from a retrospective study

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World Journal of Transplantation 2024年第2期14卷 99-106页

作者： Marco Biolato Luca Miele Giuseppe Marrone Claudia Tarli antonio Liguori Rosaria Calia Giovanni Addolorato Salvatore Agnes antonio Gasbarrini Maurizio Pompili antonio grieco Department of Medical and Surgical Sciences CEMADFondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy Department of Translational Medicine and Surgery Catholic University of Sacred HeartRome 00168Italy

BACKGROUND Few studies have evaluated the frequency of and the reasons behind the refusal of listing liver transplantation *** To assess the ineligibility rate for liver transplantation and its *** A single-center retrospective study was conducted on adult patients which entailed a formal multidisciplinary assessment for liver transplantation *** predictors for listing were evaluated using multivariable logistic *** In our center,314 patients underwent multidisciplinary work-up before liver transplantation enlisting over a three-year *** most frequent reasons for transplant evaluation were decompensated cirrhosis(51.6%)and hepatocellular carcinoma(35.7%).The non-listing rate was 53.8%and the transplant rate was 34.4%for the whole *** hundred and five motivations for ineligibility were *** most common contraindications were psychological(9.3%),cardiovascular(6.8%),and surgical(5.9%).Inappropriate or premature referral accounted for 76(37.1%)*** multivariable analysis,a referral from another hospital(OR:2.113;95%CI:1.259–3.548)served as an independent predictor of *** A non-listing decision occurred in half of our cohort and was based on an inappropriate or premature referral in one case out of *** referral from another hospital was taken as a strong predictor of non-listing.

关键词： Controindication Eligibility Evaluation Referral Personalized medicine