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Hepatitis B virus recurrence after liver transplantation: An old tale or a clear and present danger?

World Journal of Gastroenterology 2020年第18期26卷 2166-2176页

作者： Ilaria Lenci Martina Milana giuseppe Grassi Tommaso M Manzia Carlo Gazia giuseppe tisone Roberta Angelico Leonardo Baiocchi Hepatology and Liver Transplant Unit University of Tor VergataRome 00133Italy Hepato-Pancreato-Biliary and Transplant Department of SurgeryUniversity of Rome Tor VergataRome 00133Italy

Hepatitis B virus(HBV) recurrence after liver transplantation(LT) has been described more than 50 years ago. Similarly, to other clinical conditions, in which impairment of host immune defense favors viral replication, early reports described in details recurrence and reactivation of HBV in liver transplant recipients. The evidence of a possible, severe, clinical evolution of HBV reappearance in a significant percentage of these patients, allowed to consider,for some years, HBV positivity a contraindication for LT. Moving from the old to the new millennium this picture has changed dramatically. Several studies contributed to establish efficient prophylactic protocols for HBV recurrence and with the advent of more potent anti-viral drugs an increased control of infection was achieved in transplanted patients as well as in the general immunecompetent HBV population. Success obtained in the last decade led some authors to the conclusion that HBV is now to consider just as a "mere nuisance".However, with regard to HBV and LT, outstanding issues are still on the table:(1)A standard HBV prophylaxis protocol after transplant has not yet been clearly defined;(2) The evidence of HBV resistant strains to the most potent antiviral agents is claiming for a new generation of drugs;and(3) The possibility of prophylaxis withdrawal in some patients has been demonstrated, but reliable methods for their selection are still lacking. The evolution of LT for HBV is examined in detail in this review together with the description of the strategies adopted to prevent HBV recurrence and their pros and cons.

关键词： Liver transplant Hepatitis B virus Viral recurrence Prophylaxis Minimization Antiviral drug

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Chronic rejection after liver transplantation:Opening the Pandora’s box

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World Journal of Gastroenterology 2021年第45期27卷 7771-7783页

作者： Roberta Angelico Bruno Sensi Tommaso M Manzia giuseppe tisone giuseppe Grassi Alessandro Signorello Martina Milana Ilaria Lenci Leonardo Baiocchi Department of Surgery Sciences HPB and Transplant UnitUniversity of Tor VergataRome 00100Italy Hepatology Unit University of Tor VergataRome 00100Italy

Chronic rejection(CR)of liver allografts causes damage to intrahepatic vessels and bile ducts and may lead to graft failure after liver transplantation.Although its prevalence has declined steadily with the introduction of potent immunosuppressive therapy,CR still represents an important cause of graft injury,which might be irreversible,leading to graft loss requiring re-transplantation.To date,we still do not fully appreciate the mechanisms underlying this process.In addition to T cell-mediated CR,which was initially the only recognized type of CR,recently a new form of liver allograft CR,antibody-mediated CR,has been identified.This has indeed opened an era of thriving research and renewed interest in the field.Liver biopsy is needed for a definitive diagnosis of CR,but current research is aiming to identify new non-invasive tools for predicting patients at risk for CR after liver transplantation.Moreover,the minimization or withdrawal of immunosuppressive therapy might influence the establishment of subclinical CR-related injury,which should not be disregarded.Therapies for CR may only be effective in the“early”phases,and a tailored management of the immunosuppression regimen is essential for preventing irreversible liver damage.Herein,we provide an overview of the current knowledge and research on CR,focusing on early detection,identification of non-invasive biomarkers,immunosuppressive management,re-transplantation and future perspectives of CR.

关键词： Liver transplantation Chronic rejection Immunosuppression T cell-mediated rejection Antibody-mediated rejection Donor-specific antibody Re-transplantation Graft loss Complications Outcomes

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Moving forward in the treatment of cholangiocarcinoma

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World Journal of Gastrointestinal Oncology 2021年第12期13卷 1939-1955页

作者： Tommaso M Manzia Alessandro Parente Ilaria Lenci Bruno Sensi Martina Milana Carlo Gazia Alessandro Signorello Roberta Angelico giuseppe Grassi giuseppe tisone Leonardo Baiocchi Hepato-Pancreato-Biliary and Transplant Department of SurgeryUniversity of Rome Tor VergataRome 00133Italy The Liver Unit Queen Elizabeth Hospital BirminghamBirmingham B152THUnited Kingdom Hepatology Unit University of Tor VergataRome 00133Italy

Despite being the second most frequent primary liver tumor in humans,early diagnosis and treatment of cholangiocarcinoma(CCA)are still unsatisfactory.In fact,survival after 5 years is expected in less than one fourth of patients diagnosed with this disease.Rare incidence,late appearance of symptoms and heterogeneous biology are all factors contributing to our limited knowledge of this cancer and determining its poor prognosis in the clinical setting.Several efforts have been made in the last decades in order to achieve an improved classification/understanding with regard to the diverse CCA forms.Location within the biliary tree has helped to distinguish between intrahepatic,perihilar and distal CCA types.Sequence analysis contributed to identifying several characteristic genetic aberrations in CCA that may also serve as possible targets for therapy.Novel findings are expected to significantly improve the management of this malignancy in the near future.In this changing scenario our review focuses on the current and future strategies for CCA treatment.Both systemic and surgical treatments are discussed in detail.The results of the main studies in this field are reported,together with the ongoing trials.The current findings suggest that an integrated multidisciplinary approach to this malignancy would be helpful to improve its outcome.

关键词： Cholangiocarcinoma Treatment Genetic aberration Immunotherapy Liver resection Liver transplantation

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Development and validation of an artificial intelligence model for predicting post-transplant hepatocellular cancer recurrence

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Cancer Communications 2023年第12期43卷 1381-1385页

作者： Quirino Lai Carmine De Stefano Jean Emond Prashant Bhangui Toru Ikegami Benedikt Schaefer Maria Hoppe-Lotichius Anna Mrzljak Takashi Ito Marco Vivarelli giuseppe tisone Salvatore Agnes giuseppe Maria Ettorre Massimo Rossi Emmanuel Tsochatzis Chung Mau Lo Chao-Long Chen Umberto Cillo Matteo Ravaioli Jan Paul Lerut the EurHeCaLT and the West-East LT Study Group General Surgery and Organ Transplantation Unit AOU Policlinico Umberto I Sapienza University of Rome Rome Italy Data Science and Engineering Polytechnic of Turin Turin Italy Division of Liver Transplantation and Hepatobiliary Surgery Department of Surgery Weill Cornell Medicine-Columbia University New York US Medanta Institute of Liver Transplantation and Regenerative Medicine Medanta-The Medicity Gurgaon India Department of Surgery and Science Kyushu University Fukuoka Japan Department of Medicine I Gastroenterology Hepatology and Endocrinology Medical University of Innsbruck Innsbruck Austria Klinik für Allgemein- Viszeral- und Transplantationschirurgie Universitätsmedizin Mainz Mainz Germany Liver Transplant Centre Merkur University of Zagreb Zagreb Croatia Division of Hepato-Biliary-Pancreatic and Transplant Surgery Department of Surgery Graduate School of Medicine Kyoto Japan Unit of Hepatobiliary Surgery and Transplantation AOU Ospedali Riuniti Polytechnic University of Marche Ancona Italy Department of Surgical Sciences and Medical Sciences University of Rome-Tor Vergata Rome Italy Liver Unit Department of Surgery Catholic University-Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy Department of Transplantation and General Surgery San Camillo Hospital Rome Italy UCL Institute for Liver and Digestive Health and Royal Free Sheila Sherlock Liver Centre Royal Free Hospital London UK Hong Kong University–Department of Surgery Queen Mary Hospital University of Hong Kong Hong Kong P. R. China Department of Surgery Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Kaohsiung Taiwan P. R. China Department of Surgery Oncology and Gastroenterology University of Padua Padua Italy Department of General Surgery and Transplantation IRCCS Azienda Ospedaliero-Universitaria di Bologna Bologna University Bologna Italy Institut de Recherche Clinique Université catholique de Louvain Brussels Belgium 不详

Dear Editor,In recent years,criteria based on the combinationof morphology and biology have been proposed forimproving the selection of hepatocellular cancer(HCC)patients waiting for liver transplantation(LT)[1,2].Since all the proposed models showed suboptimalresults in predicting the risk of postLT recurrence,aprediction model constructed using artificial intelligence(Al)could be an attractive way to surpass this limit[3,4].Therefore,the Time_Radiological-response_Alpha-fetoproteIN_Artificial-Intelligence(TRAIN-AI)modelwas developed,combining morphology and biology tumorvariables.

关键词： hepatocellular cancer artificial

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De novo malignancies after liver transplantation: The effect of immunosuppression-personal data and review of literature

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World Journal of Gastroenterology 2019年第35期25卷 5356-5375页

作者： Tommaso Maria Manzia Roberta Angelico Carlo Gazia Ilaria Lenci Martina Milana Oludamilola T Ademoyero Domiziana Pedini Luca Toti Marco Spada giuseppe tisone Leonardo Baiocchi HPB and Transplant Unit Department of Surgery University of Rome Tor Vergata Rome 00133 Italy Division of Abdominal Transplantation and HPB Surgery Bambino Gesù Children's Hospital IRCCS Rome 00165 Italy Wake Forest Institute for Regenerative Medicine Winston-Salem NC 27101 United States Hepatology and Liver Transplant Unit University of Tor Vergata Rome 00133 Italy

BACKGROUND Immunosuppression has undoubtedly raised the overall positive outcomes in the post-operative management of solid organ transplantation. However, long-term exposure to immunosuppression is associated with critical systemic morbidities. De novo malignancies following orthotopic liver transplants (OLTs) are a serious threat in pediatric and adult transplant individuals. Data from different experiences were reported and compared to assess the connection between immunosuppression and de novo malignancies in liver transplant patients. AIM To study the role of immunosuppression on the incidence of de novo malignancies in liver transplant recipients. METHODS A systematic literature examination about de novo malignancies and immunosuppression weaning in adult and pediatric OLT recipients was described in the present review. Worldwide data were collected from highly qualified institutions performing OLTs. Patient follow-up, immunosuppression discontinuation and incidence of de novo malignancies were reported. Likewise, the review assesses the differences in adult and pediatric recipients by describing the adopted immunosuppression regimens and the different type of diagnosed solid and blood malignancy.RESULTS Emerging evidence suggests that the liver is an immunologically privileged organ able to support immunosuppression discontinuation in carefully selected recipients. Malignancies are often detected in liver transplant patients undergoing daily immunosuppression regimens. Post-transplant lymphoproliferative diseases and skin tumors are the most detected de novo malignancies in the pediatric and adult OLT population, respectively. To date, immunosuppression withdrawal has been achieved in up to 40% and 60% of well-selected adult and pediatric recipients, respectively. In both populations, a clear benefit of immunosuppression weaning protocols on de novo malignancies is difficult to ascertain because data have not been specified in most of the clinical experiences. CONCLUSION The selected populations of toleran

关键词： Pediatric liver transplant Immunosuppression weaning Clinical operational tolerance Adult liver transplant Graft rejection Immune system De novo malignancies Immunosuppression minimization Cancer

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Impact of immunosuppression minimization and withdrawal in long-term hepatitis C virus liver transplant recipients

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World Journal of Gastroenterology 2014年第34期20卷 12217-12225页

作者： Tommaso Maria Manzia Roberta Angelico Paolo Ciano Jon Mugweru Kofi Owusu Daniele Sforza Luca Toti giuseppe tisone Department of Experimental Medicine and Surgery Section of TransplantationTor Vergata University of Rome00133 RomeItaly Wake Forest School of Medicine Winston-SalemNC 27106United States

AIM:To investigate the effects of different immunosuppressive regimens and avoidance on fibrosis progression in hepatitis C virus(HCV)liver transplant(LT)recipients.METHODS:We retrospectively compared the liver biopsies of well-matched HCV LT recipients under calcineurin inhibitors(CNI group,n=21)and mycophenolate(MMF group,n=15)monotherapy,with those patients who successfully withdrawn immunosuppression(IS)therapy from at least 3 years(TOL group,n=10).To perform the well-matched analysis,all HCV transplanted patients from December 1993 were screened.Only those HCV patients who reached the following criteria were considered for the analysis:(1)at least3 years of post-operative follow-up;(2)patients with normal liver graft function under low dose CNI monotherapy(CNI group);(3)patients with normal liver graft function under antimetabolite(Micophenolate Mofetil or coated mycophenolate sodium)monotherapy(MMF group);and(4)recipients with normal liver function without any IS.We excluded from the analysis recipients who were IS free or under monotherapy for<36 mo,recipients with cirrhosis or with unstable liver function tests.RESULTS:Thirty six recipients were enrolled in the study.Demographics,clinical data,time after LT and baseline liver biopsies were comparable in the three groups.After six years of follow-up,there was no worsening of hepatic fibrosis in the MMF group(2.5±1.5Ishak Units vs 2.9±1.7 Ishak Units,P=0.5)and TOL group(2.7±10.7 vs 2.5±1.2,P=0.2).In contrast,a significant increase in the fibrosis score was observed in the CNI group(2.2±1.7 vs 3.9±1.6,P=0.008).The yearly fibrosis progression rate was significantly worse in the CNI group(0.32±0.35)vs MMF group(0.03±0.31,P=0.03),and TOL group(-0.02±0.27,P=0.02).No differences have been reported in grading scores for CNI group(2.79±1.9,P=0.7),MMF group(3.2±1.5,P=0.9)and TOL group(3.1±1.4,P=0.2).Twenty four patients were treated with low dose ribavirin(8TOL,7 MMF,9 CNI).The hepatitis C titers were comparable in the three groups.No episodes of rejection have been

关键词： Liver transplantation Hepatitis C virus recurrence

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Downstaging disease in patients with hepatocellular carcinoma outside up-to-seven criteria: Strategies using degradable starch microspheres transcatheter arterial chemo-embolization

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World Journal of Hepatology 2015年第12期7卷 1694-1700页

作者： Antonio Orlacchio Fabrizio Chegai Stefano Merolla Simona Francioso Costantino Del Giudice Mario Angelico giuseppe tisone Giovanni Simonetti Department of Diagnostic and Molecular Imaging Radiation Therapy and Interventional Radiology University Hospital Tor Vergata Liver Unit University Hospital Tor Vergata Organ Transplantation Unit University Hospital Tor Vergata

AIM: To evaluate the downstaging rates in hepatitis C virus-patients with hepatocellular carcinoma(HCC), treated with degradable starch microspheres transcatheter arterial chemoembolization(DSM-TACE), to reach new-Milan-criteria(nM C) for transplantation. METHODS: This study was approved by the Ethics Committee of our institution. From September 2013 to March 2014 eight patients(5 men and 3 women) with liver cirrhosis and multinodular HCC, that did not meet n MC at baseline, were enrolled in this study. Patients who received any other type of treatment such as termal ablation or percutaneous ethanol injection were excluded. DSM-TACE was performed in all patients using Embo Cept? S and doxorubicin. Baseline and follow-up computed tomography or magnetic resonance imaging was assessed measuring the longest enhancing axial dimension of each tumor according to the modified Response Evaluation Criteria In Solid Tumors measure-ments, and medical records were reviewed.RESULTS: DSM-TACE was successfully performed in all patients without major complication. We treated 35 lesions(mean 4.3 per patient). Six of eight patients(75%) had their HCC downstaged to meet nM C. Every patient whose disease was downstaged eventually underwent transplantation. The six patients who received transplant were still living at the time of this writing, without recurrence of HCC. Baseline age(P = 0.25), Model for End-stage Liver Disease score(P = 0. 77), and α-fetoprotein level(P = 1.00) were similar between patients with and without downstaged HCC. CONCLUSION: DSM-TACE represents a safely and effective treatment option with similar safety and efficacy of conventional chemoembolization and could be successfully performed also for downstaging disease in patients without n MC, allowing them to reach liver transplantation.

关键词： Hepatocellular carcinoma Transcatheterarterial chemoembolization Liver transplantation Degradable starch microspheres New-Milan-criteria Recurrence-free survival Locoregional therapies

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