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Biliary complications after liver transplantation:A computed tomography and magnetic resonance imaging pictorial review

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World Journal of Gastroenterology 2023年第21期29卷 3257-3268页

作者： Federica Vernuccio Irene Mercante Xiao-Xiao Tong Filippo Crimì umberto cillo Emilio Quaia Department of Radiology University Hospital of PadovaPadova 35128Italy Department of Radiology-DIMED University of PadovaPadova 35128Italy Department of Surgery Hepatobiliary Surgery and Liver Transplant CenterOncology and Gastroenterology(DISCOG)University of PadovaPadova 35128Italy

Biliary complications are the most common complications after liver *** tomography(CT)and magnetic resonance imaging(MRI)are cornerstones for timely diagnosis of biliary complications after liver *** diagnosis of these complications by CT and MRI requires expertise,mainly with respect to identifying subtle early signs to avoid missed or incorrect *** example,biliary strictures may be misdiagnosed on MRI due to size mismatch of the common ducts of the donor and recipient,postoperative edema,pneumobilia,or susceptibility artifacts caused by surgical *** and prompt diagnosis of biliary complications after transplantation allows the timely initiation of appropriate *** aim of this pictorial review is to illustrate various CT and MRI findings related to biliary complications after liver transplantation,based on time of presentation after surgery and frequency of occurrence.

关键词： Liver transplantation Biliary Complications Computed tomography Magnetic resonance imaging Hepatic imaging Biliary tract Cholangiopancreatography Stricture

Invasive fungal infection before and after liver transplantation

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World Journal of Gastroenterology 2020年第47期26卷 7485-7496页

作者： Alberto Ferrarese Annamaria Cattelan umberto cillo Enrico Gringeri Francesco Paolo Russo Giacomo Germani Martina Gambato Patrizia Burra Marco Senzolo Multivisceral Transplant Unit Padua University HospitalPadua 35128Italy Tropical and Infectious Disease Unit Padua University HospitalPadua 35128Italy Padua University Hospital Hepatobiliary Surgery and Liver Transplant CenterPadua 35128Italy

Invasive infections are a major complication before liver transplantation(LT)and in the early phase after *** has been an increasing prevalence of invasive fungal disease(IFD),especially among the sickest patients with decompensated cirrhosis and acute-on-chronic liver failure,who suffer from a profound state of immune dysfunction and receive intensive care *** such patients,who are listed for LT,development of an IFD often worsens hepatic and extra-hepatic organ dysfunction,requiring a careful evaluation before *** the post-transplant setting,the burden of IFD has been reduced after the clinical advent of antifungal prophylaxis,even if several major issues still remain,such as duration,target population and drug type(s).Nevertheless,the development of IFD in the early phase after surgery significantly impairs graft and patient *** review outlines presentation,prophylactic and therapeutic strategies,and outcomes of IFD in LT candidates and recipients,providing specific considerations for clinical practice.

关键词： Acute-on-chronic liver failure Sepsis Cirrhosis Candidemia Acute liver failure Invasive fungal infection

Long term follow-up and outcome of liver transplantation from hepatitis B surface antigen positive donors

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World Journal of Gastroenterology 2017年第12期23卷 2095-2105页

作者： Roberto Ballarin Alessandro Cucchetti Francesco Paolo Russo Paolo Magistri Matteo Cescon umberto cillo Patrizia Burra Antonio Daniele Pinna Fabrizio Di Benedetto Hepatopancreatobiliary Surgery and Liver Transplant Unit University Hospital "Policlinico" University of Modena and Reggio Emilia Department of Medical and Surgical Sciences DIMEC S. Orsola-Malpighi Hospital Alma Mater Studiorum University of Bologna Gastroenterology/Multivisceral Transplant Unit Department of Surgery Oncology and Gastroenterology Padua University Hospital Department of Medical and Surgical Sciences and Translational Medicine Sapienza University of Rome

Liver transplant for hepatitis B virus(HBV) currently yields excellent outcomes: it allows to rescue patients with an HBV-related advanced liver disease, resulting in a demographical modification of the waiting list for liver transplant. In an age of patient-tailored treatments, in liver transplantation as well the aim is to offer the best suitable graft to the patient who can benefit from it, also expanding the criteria for organ acceptance and allocation. With the intent of developing strategies to increase the donor pool, we set-up a multicenter study involving 3 Liver Transplant Centers in Italy: patients undergoing liver transplantation between March 03, 2004, and May 21, 2010, were retrospectively evaluated. 1408 patients underwent liver transplantation during the study period, 28(2%) received the graft from hepatitis B surface antigen positive(HBs Ag)-positive deceased donors. The average follow-up after liver transplantation was 63.7 mo [range: 0.1-119.4; SD ± 35.8]. None Primary nonfunction, re-liver transplantation, early or late hepatic artery thrombosis occurred. The 1-, 3-and 5-year graft and patient survival resulted of 85.7%, 82.1%, 78.4%. Our results suggest that the use of HBs Agpositive donors liver grafts is feasible, since HBV can be controlled without affecting graft stability. However, the selection of grafts and the postoperative antiviral therapy should be managed appropriately.

关键词： Liver transplantation Hepatitis B virus Hepatitis B surface antigen Hepatocellular carcinoma Organ allocation Organ procurement Multicenter study

Hepatitis C virus related cirrhosis decreased as indication to liver transplantation since the introduction of direct-acting antivirals: A single-center study

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World Journal of Gastroenterology 2018年第38期24卷 4403-4411页

作者： Alberto Ferrarese Giacomo Germani Martina Gambato Francesco Paolo Russo Marco Senzolo Alberto Zanetto Sarah Shalaby umberto cillo Giacomo Zanus Paolo Angeli Patrizia Burra Multivisceral Transplant Unit Department of Surgery Oncology and Gastroenterology Padua University Hospital Hepatobiliary Surgery and Liver Transplant Unit Department of Surgery Oncology and Gastroenterology Padua University Hospital Internal Medicine Department of Medicine Padua University Hospital

AIM To evaluate waiting list(WL) registration and liver transplantation(LT) rates in patients with hepatitis C virus(HCV)-related cirrhosis since the introduction of direct-acting antivirals(DAAs).METHODS All adult patients with cirrhosis listed for LT at Padua University Hospital between 2006-2017 were retrospectively collected using a prospectivelyupdated database; patients with HCV-related cirrhosis were divided by indication for LT [dec-HCV vs HCV/hepatocellular carcinoma(HCC)] and into two interval times(2006-2013 and 2014-2017) according to the introduction of DAAs. For each patient, indications to LT, severity of liver dysfunction and the outcome in the WL were assessed and compared between the two different time periods. For patients receiving DAA-based regimens, the achievement of viral eradication and the outcome were also evaluated. RESULTS One thousand one hundred and ninty-four [male(M)/female(F): 925/269] patients were included. Considering the whole cohort, HCV-related cirrhosis was the main etiology at the time of WL registration(490/1194 patients, 41%). HCV-related cirrhosis significantly decreased as indication to WL registration after DAA introduction(from 43.3% in 2006-2013 to 37.2% in 2014-2017, P = 0.05), especially amongst decHCV(from 24.2% in 2006-2013 to 15.9% in 2014-2017, P = 0.007). Even HCV remained the most common indication to LT over time(289/666, 43.4%), there was a trend towards a decrease after DAAs introduction(from 46.3% in 2006-2013 to 39% in 2014-2017, P = 0.06). HCV patients(M/F: 43/11, mean age: 57.7 ± 8 years) who achieved viral eradication in the WL had better transplant-free survival(log-rank test P = 0.02) and delisting rate(P = 0.002) than untreated HCV patients. CONCLUSION Introduction of DAAs significantly reduced WL registrations for HCV related cirrhosis, especially in the setting of decompensated cirrhosis.

关键词： Liver transplantation Hepatitis C Cirrhosis Sustained virological response

Perioperative thrombotic complications in liver transplantation

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World Journal of Gastroenterology 2015年第26期21卷 8004-8013页

作者： Paolo Feltracco Stefania Barbieri umberto cillo Giacomo Zanus Marco Senzolo Carlo Ori Department of Medicine UO Anaesthesia and Intensive CarePadua University Hospital Hepatobiliary Surgery and Liver Transplant Unit Department of SurgeryOncology and GastroenterologyUniversity Hospital of Padua Multivisceral Transplant Unit Department of SurgeryOncology and GastroenterologyUniversity Hospital of Padua

Although the perioperative bleeding complications and the major side effects of blood transfusion have always been the primary concern in liver transplantation(OLT),the possible cohesion of an underestimated intrinsic hypercoagulative state during and after the transplant procedure may pose a major threat to both patient and graft *** during OLT is characterized not only by a complex aetiology,but also by unpredictable onset and evolution of the *** initiation of a procoagulant process may be triggered by various factors,such as inflammation,venous stasis,ischemia-reperfusion injury,vascular clamping,anatomical and technical abnormalities,genetic factors,deficiency of profibrinolytic activity,and platelet *** involvement of the arterial system,intracardiac thrombosis,pulmonary emboli,portal vein thrombosis,and deep vein thrombosis,are among the most serious thrombotic events in the perioperative *** rapid detection of occlusive vascular events is of paramount importance as it heavily influences the prognosis,particularly when these events occur intraoperatively or early after *** of the lack of studies and guidelines on anticoagulant prophylaxis in this setting,many institutions recommend such an approach especially in the subset of patients at high ***,the decision of when,how and in what doses to use the various chemical anticoagulants is still a difficult task,since there is no common consensus,even for highrisk *** risk of postoperative thromboembolism causing severe hemodynamic events,or even loss of graft function,must be weighed and compared with the risk of an important *** this article we briefly review the risk factors and the possible predictors of major thrombotic complications occurringin the perioperative period,as well as their incidence and clinical ***,the indications to pharmacological prophylaxis and the current treatment strategies are also summarized.

关键词： Vascular complications Thromboembolicphenomena Liver transplantation Hepatic arteryocclusion Postoperative complications Pulmonaryemboli

Covert hepatic encephalopathy: Agreement and predictive validity of different indices

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World Journal of Gastroenterology 2014年第42期20卷 15756-15762页

作者： Sara Montagnese Esmeralda Balistreri Sami Schiff Michele De Rui Paolo Angeli Giacomo Zanus umberto cillo Giancarlo Bombonato Massimo Bolognesi David Sacerdoti Angelo Gatta Carlo Merkel Piero Amodio Department of Medicine University of Padova Department of Surgical Oncological and Gastroenterological Sciences University of Padova

AIM: To investigate the agreement and prognostic value of different measures of covert hepatic encephalopathy (CHE).

关键词： Hepatic encephalopathy Electroencephalography Psychometry Ammonia Liver cirrhosis

Prediction of hepatocellular carcinoma biological behaviorin patient selection for liver transplantation

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World Journal of Gastroenterology 2016年第1期22卷 232-252页

作者： umberto cillo Tommaso Giuliani Marina Polacco Luz Maria Herrero Manley Gino Crivellari Alessandro Vitale Hepatobiliary Surgery and Liver Transplantation Unit Department of General Surgery and Organ TransplantationUniversity Hospital of Padua35128 PadovaItaly UnitàOperativa di Oncologia Medica Istituto Oncologico Veneto(IOV)IRCCS35128 PadovaItaly

Morphological criteria have always been considered the benchmark for selecting hepatocellular carcinoma(HCC)patients for liver transplantation(LT).These criteria,which are often inappropriate to express the tumor’s biological behavior and aggressiveness,offer only a static view of the disease burden and are frequently unable to correctly stratify the tumor recurrence risk after ***-fetoprotein(AFP)and its progression as well as AFP-m RNA,AFP-L3%,des-γ-carboxyprothrombin,inflammatory markers and other serological tests appear to be correlated with post-transplant *** other markers for patient selection including functional imaging studies such as18F-FDG-PET imaging,histological evaluation of tumor grade,tissue-specific biomarkers,and molecular signatures have been outlined in the *** growth rate and response to pre-transplant therapies can further contribute to the transplant evaluation process of HCC *** AFP,its progression,and HCC response to pretransplant therapy have already been used as a part of an integrated prognostic model for selecting patients,the utility of other markers in the transplant setting is still under *** article intends to review the data in the literature concerning predictors that could be included in an integrated LT selection model and to evaluate the importance of biological aggressiveness in the evaluation process of these patients.

关键词： Hepatocellular carcinoma Liver Alphafetoprotein Transplantation Biomarkers Histopathology Recurrence Integrated prognostic tool

Protocol liver biopsies in long-term management of patients transplanted for hepatitis B-related liver disease

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World Journal of Gastroenterology 2006年第11期12卷 1706-1712页

作者： Stefano Targhetta Federico Villamil Paolo Inturri Patrizia Pontisso Stefano Fagiuoli umberto cillo Attilio Cecchetto Simona Gianni Remo Naccarato Patrizia Burra Gastroenterology Section Department of Surgical and Gastroenterological Sciences University of PadovaItaly Liver Unit Fundacion Favaloro Buenos AiresArgentina Gastroenterology Unit San Bonifacio Hospital VeronaItaly Clinica Medica 5 Department of Clinical and Experimental Medicine University of PadovaItaly Surgery Section Department of Surgical and Gastroenterological Sciences University of PadovaItaly Department of Pathology University of Padova Italy

AIM：To evaluate the long-term histological outcome of patients transplanted for HBV-related liver disease and given HBIg prophylaxis indefinitely after LT. METHODS： Forty-two consecutive patients transplanted for hepatitis B were prospectively studied. HBsAg, HBVDNA and liver function tests were evaluated in the serum 3, 6 and 12 mo after LT and then yearly. LB was obtained 6 and 12 mo after LT and yearly thereafter. Chronic hepatitis （CH） B after LT was classified as minimal, mild, moderate or severe. RESULTS： HBV recurred in 7/42 （16.6%） patients after 6-96 mo of follow-up. A hundred and eightyseven LB were evaluated. Four of 7 patients with graft reinfection, all with unknown HBV DNA status before LT, developed cirrhosis at 12-36 mo of follow-up. Of the 122 LB obtained from 28 HBsAg＋/HCV- recipients with no HBV recurrence after LT, all biopsies were completely normal in only 2 patients （7.1%）, minimal/non-specific changes were observed in 18 （64.2%）, and at least 1 biopsy showed CH in the remaining 8 （28.5%）. Twentynine LB obtained from 7 patients transplanted for HBVHCV cirrhosis and remaining HBsAg- after LT revealed recurrent CH-C. Actuarial survival was similar in patients with HBsAg＋ or HBsAg- liver ***： Though protocol biopsies may enable the detection of graft dysfunction at an early stage, the risk of progression and the clinical significance of these findings remains to be determined.

关键词： Liver transplantation Hepatitis B virus Liverbiopsy Anti-HBs Immunoglobulins

Role of blood AFP mRNA and tumor grade in the preoperative prognostic evaluation of patients with hepatoceiluiar carcinoma

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World Journal of Gastroenterology 2005年第44期11卷 6920-6925页

作者： umberto cillo Alessandro Vitale Filippo Navaglia Daniela Basso umberto Montin Marco Bassanello Francesco D'Amico Francesco Antonio Ciarleglio Alberto Brolese Giacomo Zanus Vito De Pascale Mario Plebani Davide Francesco D'Amico Clinica Chirurgica Ⅰ Dipartimento di Medicina di Laboratono Dipartimento Assistenziale di Chirurgia Generale ed Emergenze Chirurgiche Dipartimento di Medicina di Laboratorio Clinica Chirurgica I

AIM： To explore the potential prognostic role of preoperative tumor grade and blood AFP mRNA in a cohort of patients with hepatocellular carcinoma （HCC） eligible for radical therapies according to a well-defined treatment algorithm not including nodule size and number as absolute selection criteria. METHODS： Fifty patients with a diagnosis of HCC were prospectively enrolled in the study. Inclusion criteria were：（1） histological assessment of tumor grade by means of percutaneous biopsies; （2） determination of AFP mRNA status in the blood; （3） patient＇s eligibility for radical therapies. RESULTS： At preoperative evaluation, 54% of the study group had a well-differentiated HCC, 42% had AFP mRNA in the blood, 40% had a tumor larger than 5 cm and 56% had more than one nodule. Surgery （resection or liver transplantation） was performed in 29 patients, while 21 had percutaneous ablation procedures. After a median follow-up of 28 too, 12-, 24-, and 36-mo survival rates were 78%, 58%, and 51%, respectively. Surgical therapy, performance status and three tumor-related variables （AFP mRNA, HCC grade and gross vascular invasion） resulted as significant survival predictors at univariate analysis. Nodule size and number did not perform as significant prognosticators. Multivariate study selected only surgical therapy and a biologically early HCC profile （AFP mRNA negative and well-differentiated tumor without gross vascular invasion） as independent survival variables. CONCLUSION： The preoperative determination of tumor grade and blood AFP mRNA status may potentially refine the prognostic evaluation of HCC patients and improve the selection process for radical therapies.

关键词： Hepatocellular carcinoma Prognosis Treatment policy Biomarker Tumor biology