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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 candidates.AIM To assess the ineligibility rate for liver transplantation and its motivations.METHODS A single-center retrospective study was conducted on adult patients which entailed a formal multidisciplinary assessment for liver transplantation eligibility.The predictors for listing were evaluated using multivariable logistic regression.RESULTS In our center,314 patients underwent multidisciplinary work-up before liver transplantation enlisting over a three-year period.The 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 cohort.Two hundred and five motivations for ineligibility were collected.The most common contraindications were psychological(9.3%),cardiovascular(6.8%),and surgical(5.9%).Inappropriate or premature referral accounted for 76(37.1%)cases.On multivariable analysis,a referral from another hospital(OR:2.113;95%CI:1.259–3.548)served as an independent predictor of non-listing.CONCLUSION A non-listing decision occurred in half of our cohort and was based on an inappropriate or premature referral in one case out of three.The referral from another hospital was taken as a strong predictor of non-listing.

关键词： Controindication Eligibility Evaluation Referral Personalized medicine

Transjugular intrahepatic portosystemic shunt with accidental diagnosis of persistence of the left superior vena cava

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World Journal of Gastroenterology 2010年第9期16卷 1158-1160页

作者： Ioannis Petridis Roberto Miraglia Gianluca marrone salvatore Gruttadauria Angelo Luca Giovanni Battista Vizzini Bruno Gridelli Department of Gastroenterology and Hepatology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT)University of Pittsburgh Medical Center Department of Diagnostic and Interventional Radiology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT)University of Pittsburgh Medical Center Department of Abdominal Surgery and Organ Transplantation Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT)University of Pittsburgh Medical Center

Transjugular intrahepatic portosystemic shunt (TIPSS) is considered a valid therapeutic option for the treatment of portal hypertension and its complications.The guidelines for this procedure have already been established on the basis of the normal vascular anatomy and of various technical radiological aspects.In some few rare cases,diagnosis of a congenital vascular anomaly can be made accidentally by interventional radiologists,making the procedure of the TIPSS placement extremely difficult or in some cases technically impossible.This report describes a rare vascular malformation characterized by the absence of the right superior vena cava and persistence of the left superior vena cava in a patient with a diagnosis of advanced liver cirrhosis who needed a TIPSS placement in order to control refractory ascites.

关键词： Left superior vena cava persistence Liver cirrhosis Refractory ascites Transjugular intrahepatic portosystemic shunt

Multidisciplinary imaging of liver hydatidosis

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World Journal of Gastroenterology 2012年第13期18卷 1438-1447页

作者： Gianluca marrone Francesca Crino' Settimo Caruso Giuseppe Mamone Vincenzo Carollo Mariapina Milazzo salvatore Gruttadauria Angelo Luca Bruno Gridelli Department of Diagnostic and Interventional Radiology Mediterranean Institute for Transplantation and Advanced Specialized TherapiesUniversity of Pittsburgh Medical Center Italy90127 PalermoItaly Department of Transplantation Surgery Mediterranean Institute for Transplantation and Advanced Specialized TherapiesUniversity of Pittsburgh Medical Center Italy90127 PalermoItaly

Liver hydatidosis is a parasitic endemic disease affecting extensive areas in our planet,a significant stigma within medicine to manage because of its incidence,possible complications,and diagnostic involvements.The diagnosis of liver hydatidosis should be as fast as possible because of the relevant complications that may arise with disease progression,involving multiple organs and neighboring structures causing disruption,migration,contamination.The aim of this essay is to illustrate the role of imaging as ultrasonography(US),multi detector row computed tomography,and magnetic resonance imaging(MRI)in the evaluation of liver hydatidosis:the diagnosis,the assessment of extension,the identification of possible complications and the monitoring the response to therapy.US is the screening method of choice.Computed tomography(CT)is indicated in cases in which US is inadequate and has high sensitivity and specificity for calcified hydatid cysts.Magnetic resonance is the best imaging procedure to demonstrate a cystic component and to show a biliary tree involvement.Diagnostic tests such as CT and MRI are mandatory in liver hydatidosis because they allow thorough knowledge regarding lesion size,location,and relations to intrahepatic vascular and biliary structures,providing useful information for effective treatment and decrease in post-operative morbidity.Hydatid disease is classified into four types on the basis of their radiologic appearance.

关键词：磁共振成像包虫病多学科计算机断层扫描肝诊断测试并发症成像过程

Interventional radiology procedures in adult patients who underwent liver transplantation

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World Journal of Gastroenterology 2009年第6期15卷 684-693页

作者： Roberto Miraglia Luigi Maruzzelli Settimo Caruso Mariapina Milazzo Gianluca marrone Giuseppe Mamone Vincenzo Carollo salvatore Gruttadauria Angelo Luca Bruno Gridelli Department of Diagnostic and Interventional Radiology Mediterranean Institute for Transplantation and Advanced Specialized Therapies(IsMeTT) University of Pittsburgh Medical CenterVia Tricomi 1 Palermo 90127Italy Department of Transplantation Surgery Mediterranean Institute for Transplantation and Advanced Specialized Therapies(IsMeTT) University of Pittsburgh Medical CenterVia Tricomi 1 Palermo 90127Italy

Interventional radiology has acquired a key role in every liver transplantation(LT)program by treating the majority of vascular and non-vascular post-transplant complications,improving graft and patient survival and avoiding,in the majority of cases,surgical revision and/or re-transplantation.The aim of this paper is to review indications,technical consideration,results achievable and potential complications of interventional radiology procedures after deceased donor LT and living related adult LT.

关键词：肝移植 X光学射线并发症治疗效果

Reverse time-dependent effect of alphafetoprotein and disease control on survival of patients with Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma

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World Journal of Hepatology 2017年第36期9卷 1322-1331页

作者： Francesca Romana Ponziani Irene Spinelli Emanuele Rinninella Lucia Cerrito Antonio Saviano Alfonso Wolfango Avolio Michele Basso Luca Miele Laura Riccardi Maria Assunta Zocco Brigida Eleonora Annicchiarico Matteo Garcovich Marco Biolato Giuseppe marrone Anna Maria De Gaetano Roberto Iezzi Felice Giuliante Fabio Maria Vecchio salvatore Agnes Giovanni Addolorato Massimo Siciliano Gian Lodovico Rapaccini Antonio Grieco Antonio Gasbarrini Maurizio Pompili Department of Internal Medicine Gastroenterology and Hepatology Agostino Gemelli Hospital Department of Liver Transplant Surgery Agostino Gemelli Hospital Department of Oncology Gastroenterology and Hepatology Agostino Gemelli Hospital Department of Bioimaging and Radiological Sciences Agostino Gemelli Hospital Department of Hepatobiliary Surgery Agostino Gemelli Hospital Department of Pathology Agostino Gemelli Hospital

AIM To characterize the survival of cirrhotic patients with Barcelona Clinic Liver Cancer(BCLC) stage C hepatocellular carcinoma(HCC) and to ascertain the factors predicting the achievement of disease control(DC).METHODS The cirrhotic patients with BCLC stage C HCC evaluated by the Hepatocatt multidisciplinary group were subjected to the investigation. Demographic, clinical and tumor features, along with the best tumor response and overall survival were recorded. RESULTS One hundred and ten BCLC stage C patients were included in the analysis; the median overall survival was 13.4 mo(95%CI: 10.6-17.0). Only alphafetoprotein(AFP) serum level > 200 ng/m L and DC could independently predict survival but in a time dependent manner, the former was significantly associated with increased risk of mortality within the first 6 mo of follow-up(HR = 5.073, 95%CI: 2.159-11.916, P = 0.0002), whereas the latter showed a protective effect against death after one year(HR = 0.110, 95%CI: 0.038-0.314, P < 0.0001). Only patients showing microvascular invasion and/or extrahepatic spread recorded lower chances of achieving DC(OR = 0.263, 95%CI: 0.111-0.622, P = 0.002).CONCLUSION The BCLC stage C HCC includes a wide heterogeneous group of cirrhotic patients suitable for potentially curative treatments. The reverse and time dependent effect of AFP serum level and DC on patients' survival confers them as useful predictive tools for treatment management and clinical decisions.

关键词： Hepatocellular carcinoma Cirrhosis Barcelona Clinic Liver Cancer stage C Alphafetoprotein Disease control Performance status Survival