Fabio Vistoli

Publications (99) View all

• Article: Metabolic and cardiovascular effects of beta cell replacement in type 1 diabetes.

  Piero Marchetti, Margherita Occhipinti, Lorenzo Rondinini, Rita Mariotti, Gabriella Amorese, Massimiliano Barsotti, Fabio Vistoli, Ugo Boggi
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  ABSTRACT: Type 1 diabetes is associated with high morbidity and mortality, mostly due to the acute and chronic complications of the disease. Restoration of the lost beta cell mass by pancreas transplantation is the treatment of choice in selected type 1 diabetic patients. Growing data show that successful pancreas transplantation normalizes the metabolic alterations of diabetes, and can slow the progression, stabilize, and even favor the regression of secondary complications of the disease, including those at the cardiovascular level.
  Internal and Emergency Medicine 03/2013; · 2.06 Impact Factor
• Source

  Available from: Daniele Focosi

  Article: Transplantation of the pancreas.

  Ugo Boggi, Fabio Vistoli, Francesca Maria Egidi, Piero Marchetti, Nelide De Lio, Vittorio Perrone, Fabio Caniglia, Stefano Signori, Massimiliano Barsotti, Matteo Bernini, Margherita Occhipinti, Daniele Focosi, Gabriella Amorese
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  ABSTRACT: Pancreas transplantation consistently induces insulin-independence in beta-cell-penic diabetic patients, but at the cost of major surgery and life-long immunosuppression. One year after grafting, patient survival rate now exceeds 95 % across recipient categories, while insulin independence is maintained in some 85 % of simultaneous pancreas and kidney recipients and in nearly 80 % of solitary pancreas transplant recipients. The half-life of the pancreas graft currently averages 16.7 years, being the longest among extrarenal grafts, and substantially matching the one of renal grafts from deceased donors. The difference between expected (100 %) and actual insulin-independence rate is mostly explained by technical failure in the postoperative phase, and rejection in the long-term period. Death with a functioning graft remains a further major issue, especially in uremic patients who have undergone prolonged periods of dialysis. Refinements in graft preservation, surgical techniques, immunosuppression, and prophylactic treatments are expected to further improve the results of pancreas transplantation.
  Current Diabetes Reports 07/2012; 12(5):568-79. · 2.50 Impact Factor
• Article: Central pancreatectomy with inframesocolic pancreatojejunostomy.

  Ugo Boggi, Gabriella Amorese, Nelide De Lio, Vittorio Perrone, Simone D'Imporzano, Chiara Croce, Fabio Vistoli, Stefano Signori, Carla Cappelli, Franco Mosca
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  ABSTRACT: Pancreatic fistula (PF) occurs frequently after central pancreatectomy (CP), but it is not clear from which pancreatic stump it arises and, consequently, which interventions can reduce its incidence and severity. The information could be obtained if the two pancreatic remnants were segregated into different body compartments. In eight consecutive patients, the cut end of the distal pancreatic stump after CP was brought in the inframesocolic compartment through a small defect created in the transverse mesocolon. Pancreatojejunostomy was hence constructed in the intraperitoneal compartment, being divided by the retroperitoneal right-sided pancreatic stump by the transverse mesocolon itself. Five patients were operated on open, and three by robot-assisted laparoscopy. PF was defined according to the criteria proposed by the International Study Group on Pancreatic Fistula. PF fistula developed in five out eight patients (three grade A and two grade B). Amylase concentration in the fluid obtained from surgical drains showed that the two pancreatic remnants were actually segregated into different body compartments and that four out of five PF originated from the right remnant. Mean hospital stay was 12.5 days. No patient was readmitted, developed peripancreatic fluid collections, required interventional radiology procedures, or underwent repeat surgery. In CP, interposing an anatomic barrier, such as the transverse mesocolon, between the two pancreatic remnants is a simple maneuver that, if on one hand, adds little to the complexity of the operation, on the other, provides insights into the origin of PF after CP.
  Langenbeck s Archives of Surgery 02/2012; 397(6):1013-21. · 1.81 Impact Factor
• Article: Long-term (5 years) efficacy and safety of pancreas transplantation alone in type 1 diabetic patients.

  Ugo Boggi, Fabio Vistoli, Gabriella Amorese, Rosa Giannarelli, Alberto Coppelli, Rita Mariotti, Lorenzo Rondinini, Massimiliamo Barsotti, Stefano Signori, Nelide De Lio, Margherita Occhipinti, Emanuela Mangione, Diego Cantarovich, Stefano Del Prato, Franco Mosca, Piero Marchetti
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  ABSTRACT: Although combined pancreas and kidney transplantation is an established procedure for the treatment of type 1 diabetes (T1D) in patients with end-stage renal disease, the role of pancreas transplant alone (PTA) in the therapy of T1D subjects with preserved kidney function is still matter of debate. We report our single-center experience of PTA in 71 consecutive T1D patients all with a posttransplant follow-up of 5 years. Patient and pancreas (normoglycemia in the absence of any antidiabetic therapy) survivals were determined, and several clinical parameters (including risk factors for cardiovascular diseases) were assessed. Cardiac evaluation and Doppler echocardiographic examination were also performed, and renal function and proteinuria were evaluated. Actual patient and pancreas survivals at 5 years were 98.6% and 73.2%, respectively. Relaparotomy was needed in 18.3% of cases. Restoration of endogenous insulin secretion was accompanied by sustained normalization of fasting plasma glucose concentrations and HbA1c levels as well as significant improvement of total cholesterol, low-density lipoprotein-cholesterol, and blood pressure. An improvement of left ventricular ejection fraction was also observed. Proteinuria (24 hours) decreased significantly after transplantation. One patient developed end-stage renal disease. In the 51 patients with sustained pancreas graft function, kidney function (serum creatinine and glomerular filtration rate) decreased over time with a slower decline in recipients with pretransplant glomerular filtration rate less than 90 mL/min. PTA was an effective and reasonably safe procedure in this single-center cohort of T1D patients.
  Transplantation 02/2012; 93(8):842-6. · 4.00 Impact Factor
• Source

  Available from: Daniele Focosi

  Article: Laparoscopic robot-assisted pancreas transplantation: first world experience.

  Ugo Boggi, Stefano Signori, Fabio Vistoli, Simone D'Imporzano, Gabriella Amorese, Giovanni Consani, Fabio Guarracino, Piero Marchetti, Daniele Focosi, Franco Mosca
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  ABSTRACT: Surgical complications are a major disincentive to pancreas transplantation, despite the undisputed benefits of restored insulin independence. The da Vinci surgical system, a computer-assisted electromechanical device, provides the unique opportunity to test whether laparoscopy can reduce the morbidity of pancreas transplantation. Pancreas transplantation was performed by robot-assisted laparoscopy in three patients. The first patient received a pancreas after kidney transplant, the second a simultaneous pancreas kidney transplantation, and the third a pancreas transplant alone. Operations were carried out through an 11-mm optic port, two 8-mm operative ports, and a 7-cm midline incision. The latter was used to introduce the grafts, enable vascular cross-clamping, and create exocrine drainage into the jejunum. The two solitary pancreas transplants required an operating time of 3 and 5 hr, respectively; the simultaneous pancreas kidney transplantation took 8 hr. Mean warm ischemia time of the pancreas graft was 34 min. All pancreatic transplants functioned immediately, and all recipients became insulin independent. The kidney graft, revascularized after 35 min of warm ischemia, also functioned immediately. No patient had complications during or after surgery. At the longer follow-up of 10, 8, and 6 months, respectively, all recipients are alive with normal graft function. We have shown the feasibility of laparoscopic robot-assisted solitary pancreas and simultaneous pancreas and kidney transplantation. If the safety and feasibility of this procedure can be confirmed by larger series, laparoscopic robot-assisted pancreas transplantation could become a new option for diabetic patients needing beta-cell replacement.
  Transplantation 01/2012; 93(2):201-6. · 4.00 Impact Factor