A. Dazzi

Publications (70)44.55 Total impact

• Article: Hepatocellular carcinoma on cirrhosis: Liver resection, liver transplantation or both surgical treatments?

  M. Del Gaudio, M. Cescon, G. Ercolani, M. Ravaioli, A. Cucchetti, A. Lauro, M. Zanello, A. Dazzi, C. Zanfi, V. Bertuzzo, P. Di Gioia, C. Morelli, A.D. Pinna
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  ABSTRACT: Background: The management of patients with cirrhosis and early hepatocellular carcinoma (HCC) is controversial, especially due to low availability of cadaveric liver donors. Methods: From January 1996 to December 2010, 503 patients with transplantable HCC according to Milan criteria were treated by liver resection (LR) (n=180) or liver transplantation (LT) (n=323 of 512 listed for LT at our institution). Results: Among 180 patients elegible for transplantation who underwent LR, 72 (40%) developped HCC recurrence and 53/72 (74%) of these, presented HCC recurrence into Milan criteria. Only 30 of the 72 patients underwent LT as a salvage procedure, with a transplantation rate of 41% of patients with HCC recurrence. According to intention to treat analysis of transplantable HCC patients who underwent LR (n=180), compared to all those listed for LT (n=512), 5-year overall survival was 71% in the LR group versus 62% in patients listed for LT, respectively (p=NS); 5-year disease-free survival was 41% in the
  Transplant International. 01/2011; 24:3.
• Article: Donor risk factors and correlation with meld score in liver transplant recipients

  M. Del Gaudio, G. Ercolani, M. Cescon, A. Lauro, M. Ravaioli, A. Cucchetti, M. Zanello, A. Dazzi, C. Zanfi, C. Morelli, A.D. Pinna
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  ABSTRACT: Background: We evaluated the effect of donor risk factors and model for endstage liver disease (MELD) score on liver transplant (LT) recipients. Methods: Prospectively, data of patients transplanted at University of Bologna between January 2003 and December 2010 were included (n=628). Outcomes included the impact on graft survival of the following variables: recipient liver disease (HCC 43.9%, HCV+ 20.4%, cholestatic 8.4%, alchool 6.7%, HBV+ 5.7%), donor cause of death (Stroke 65.3%, Trauma 25%, Anoxia 9.6%), donor age > 60 yrs (n=305), HBcAb positive donor (n=130), HCV positive (n=38), HBsAg positive (n=20), organ sharing (Region 76.8%, extra-Region 20.6%, extra Nation 2.6%), split liver graft (n=23). The recipients characteristics were: sex (M/F) 73.2%/26.8%, mean age 51.07(plus or minus)0.42 (11-67), MELD at the time of LT 20.86(plus or minus)0.36 (6-51). Outcomes of LT on patients categorized into low (<15), intermediate (15-25), and high (>25) MELD categories were analyzed. Results: Post-operative
  Transplant International. 01/2011; 24:215.
• Article: Conversion from twice-daily tacrolimus (prograf(registered trademark)) to once-daily prolonged release tacrolimus (ADVAGRAF(registered trademark)) in liver transplant recipients

  M. Del Gaudio, M. Cescon, G. Ercolani, A. Cucchetti, M. Zanello, A. Dazzi, A. Lauro, M. Ravaioli, C. Morelli, A.D. Pinna
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  ABSTRACT: Background: To analyze the safety of a 1:1 dose conversion from twice-daily tacrolimus (Prograf(registered trademark)) to once-daily tacrolimus Advagraf(registered trademark) in liver transplant (LT) recipients. Methods: This prospective study on 200 of 600 LT, that had LT between 2003 and 2009, examined tacrolimus levels after conversion to Advagraf(registered trademark) therapy. Mean patient age was 53 (38 -65) years. Conversion occurred at 12 (12 - 85) months posttransplantation, and follow-up was 201 (30-385) days. Levels of tacrolimus, total bilirubin, aspartate aminotransferase, alanine aminotransferase, g-glutamyl transferase, alkaline phosphatase, and creatinine were recorded on the day before conversion to Advagraf and 10 days, 3 months, 6 months after conversion. Results: Of the 200 patients converted to Advagraf(registered trademark), 80 (40%) had cirrhosis HCV related, 60 (30%) HBV related, 30 (15%) had alcoholic cirrhosis. The tacrolimus whole blood trough level at T0 (the day before conve
  Transplant International. 01/2011; 24:249.
• Article: Effect of prolongation of antiviral treatment beyond conventional time limits on survival and fibrosis progression in non-responders to interferon+ribavirin for HCV recurrence after liver transplantation

  V.R. Bertuzzo, M. Cescon, M.R. Tame, M.C. Morelli, P. Di Gioia, S. Lorenzini, P. Andreone, M. Del Gaudio, A. Cucchetti, M. Zanello, A. Dazzi, G. Ercolani, M. Ravaioli, A. D'Errico-Grigioni, A.D. Pinna
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  ABSTRACT: The management of patients treated for hepatitis C (HCV) recurrence after liver transplantation (LT) and not achieving virological response following antiviral treatment (AVT) with interferon+ribavirin is controversial. A retrospective analysis of the outcomes of 71 non-responders to AVT after LT at a single Center was performed. Twenty-three patients (33%; Group A) were treated for <12, months and 47 patients (67%; Group B) for >12 months. Group A patients deceased due to HCV recurrence during AVT were excluded from the analysis. Survivals were computed starting from the initiation of AVT. The median followup was 54.3 months. Patient sex, age, body mass index, prevalence of hepatitis B co-infection, MELD score at transplant, donor age, prevalence of HCVpositive and of HBcAb-positive donors, viral genotype, type of immunosuppression, pre-treatment hepatitis staging score and time between LT and initiation of AVT were comparable between groups (P>0.05 for all comparisons). Median duration of AVT was 8.2
  Transplant International. 01/2011; 24:121.
• Article: Sirolimus in liver transplant recipients: a large single-center experience.

  M Vivarelli, A Dazzi, A Cucchetti, A Gasbarrini, M Zanello, P Di Gioia, G Bianchi, M R Tamè, M D Gaudio, M Ravaioli, M Cescon, G L Grazi, A D Pinna
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  ABSTRACT: Sirolimus (SRL) is a newer immunosuppressant whose possible benefits and side effects in comparison to calcineurin inhibitors (CNIs) still have to be addressed in the liver transplantation setting. We report the results of the use of SRL in 86 liver transplant recipients, 38 of whom received SRL as the main immunosuppressant in a CNI-sparing regimen. Indications for the use of SRL were: impaired renal function (n = 32), CNI neurotoxicity (n = 16), hepatocellular carcinoma (HCC) at high risk of recurrence (n = 21), recurrence of HCC (n = 6), de novo malignancies (n = 4), cholangiocarcinoma (n = 1), and the need to reinforce immunosuppression (n = 6). Among patients on SRL-based treatment, four episodes of acute rejection were observed, three of which occurred during the first postoperative month. Renal function significantly improved when sirolimus was introduced within the third postoperative month, while no change was observed when it was introduced later. Neurological symptoms resolved completely in 14/16 patients. The 3-year recurrence-free survival of patients with HCC on SRL was 84%. Sixty-two patients developed side effects that required drug withdrawal in seven cases. There was a reduced prevalence of hypertension and new-onset diabetes among patients under SRL. In conclusion, SRL was an effective immunosuppressant even when used in a CNI-sparing regimen. It was beneficial for patients with recently developed renal dysfunction or neurological disorders.
  Transplantation Proceedings 09/2010; 42(7):2579-84. · 1.00 Impact Factor
• Article: Harm and benefits of primary liver resection and salvage transplantation for hepatocellular carcinoma

  A. Cucchetti, M. Cescon, G. Luca Grazi, G. Ercolani, M. Ravaioli, M. Del Gaudio, G. Vetrone, M. Zanello, A. Dazzi, P. Di Gioia, A. D. Pinna
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  ABSTRACT: Primary transplantation offers longer life-expectancy in comparison to hepatic resection (HR) for hepatocellular carcinoma (HCC) followed by salvage transplantation; however, livers not used for primary transplantation can be reallocated to the remaining waiting-list patients, thus, the harm caused to resected patients could be balanced, or outweighed, by the benefit obtained from reallocation of livers originating from HCC patients first being resected. A Markov model was developed to investigate this issue based on literature data or estimated from the United Network for Organ Sharing database. Markov model shows that primary transplantation offers longer life-expectancy in comparison to HR and salvage transplantation if 5-year posttransplant survival remains higher than 60%. The balance between the harm for resected patients and the benefit for the remaining waiting list depends on (a) the proportion of HCC candidates, (b) the percentage shifted to HR and (c) the median expected time-to-transplant.
  Liver Transplantation. 01/2010; 16:S140.
• Article: Sirolimus in liver transplant recipients: A large single-center experience

  M. Vivarelli, A. Dazzi, A. Cucchetti, A. Gasbarrini, M. Zanello, P. Di Gioia, G. Bianchi, M.R. Tam, M.D. Gaudio, M. Ravaioli, M. Cescon, G.L. Grazi, A.D. Pinna
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  ABSTRACT: Sirolimus (SRL) is a newer immunosuppressant whose possible benefits and side effects in comparison to calcineurin inhibitors (CNIs) still have to be addressed in the liver transplantation setting. We report the results of the use of SRL in 86 liver transplant recipients, 38 of whom received SRL as the main immunosuppressant in a CNI-sparing regimen. Indications for the use of SRL were: impaired renal function (n = 32), CNI neurotoxicity (n = 16), hepatocellular carcinoma (HCC) at high risk of recurrence (n = 21), recurrence of HCC (n = 6), de novo malignancies (n = 4), cholangiocarcinoma (n = 1), and the need to reinforce immunosuppression (n = 6). Among patients on SRL-based treatment, four episodes of acute rejection were observed, three of which occurred during the first postoperative month. Renal function significantly improved when sirolimus was introduced within the third postoperative month, while no change was observed when it was introduced later. Neurological symptoms resolved completely in
  Transplantation Proceedings. 01/2010; 42:2579-2584.
• Article: Daclizumab and Alemtuzumab as Induction Agents in Adult Intestinal and Multivisceral Transplantation: Rejection and Infection Rates in 40 Recipients During the Early Postoperative Period

  C. Zanfi, A. Lauro, M. Cescon, A. Dazzi, G. Ercolani, G.L. Grazi, M. Zanello, M. Vivarelli, M. Del Gaudio, M. Ravaioli, [......], G. Vetrone, F. Tuci, P. Di Gioia, T. Lazzarotto, A. D'Errico, A. Bagni, S. Faenza, A. Siniscalchi, L. Pironi, A.D. Pinna
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  ABSTRACT: Background: Allograft rejection in intestinal transplantation occurs frequently, and bacterial, fungal, and viral infections related to strong immunosuppression regimens remain an important complication posttransplantation. Induction therapy has enabled improvement in graft and patient survival rates. Objectives: In analyze the effects of daclizumab and alemtuzumab as induction therapies on inflections complications and incidence of acute cellular rejection (ACR) during the early posttransplantation period. Patients and Methods: Between December 2000 and August 2009, we performed 43 intestinal transplantation procedures in 42 adult recipients (median [SD] age, 34.8 [9.5] years; male-female ratio, 22:20; isolated or multivisceral graft, 32/11), and compared findings during the first 30 days posttransplantation in 40 recipients. Patients were divided into 2 groups: 12 treated with daclizumab (Zenapax; Hoffman-La Roche Ltd, Basel, Switzerland): 8 isolated intestinal grafts and 4 multivisceral grafts) and
  Transplantation Proceedings. 01/2010; 42:35-38.
• Article: Comprehensive Surgical Intestinal Rescue and Transplantation Program in Adult Patients: Bologna Experience

  C. Zanfi, A. Lauro, M. Cescon, A. Dazzi, G. Ercolani, G.L. Grazi, M. Zanello, M. Vivarelli, M. Del Gaudio, M. Ravaioli, [......], G. Vetrone, F. Tuci, P. Di Gioia, T. Lazzarotto, A. D'Errico, A. Bagni, S. Faenza, A. Siniscalchi, L. Pironi, A.D. Pinna
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  ABSTRACT: Introduction: Surgical approaches to complicated benign intestinal failure are accepted worldwide, especially in the pediatric population. Intestinal transplant surgery is thought to rescue patients in whom complications of total parenteral nutrition (TPN) develop. Objective: To report our experience with surgical intestinal rescue in an adult population with intestinal failure. Patients and Methods: An intestinal rehabilitation program initiated at our institution included comprehensive medical rehabilitation, surgical bowel rescue, and transplantation. From 2000 to 2009, of 81 adult patients referred by our gastroenterologists for bowel rehabilitation, 42 (51,8%) underwent 43 transplantations (32 isolated intestinal grafts and 11 multivisceral grafts). Underlying diseases were primarily short-bowel syndrome, Gardner syndrome, and intestinal pseudo-obstruction. Thirty-nine patients (48,2%) underwent surgical rescue (40 cases) consisting of bowel resection, adhesiolysis, stricturoplasty, liver transpla
  Transplantation Proceedings. 01/2010; 42:39-41.
• Article: Psychological Adaptation and Quality of Life of Adult Intestinal Transplant Recipients: University of Bologna Experience

  L. Golfieri, A. Lauro, E. Tossani, L. Sirri, A. Venturoli, A. Dazzi, C. Zanfi, M. Zanello, G. Vetrone, A. Cucchetti, G. Ercolani, M. Vivarelli, M. Del Gaudio, M. Ravaioli, M. Cescon, G.L. Grazi, S. Faenza, S. Grandi, A.D. Pinna
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  ABSTRACT: Introduction: Intestinal transplantation has become an accepted therapy for individuals permanently dependent on total parenteral nutrition (TPN) with life-threatening complications. Quality of life and psychological well-being can be seen as important outcome measures of transplantation surgery. Methods: We evaluated 24 adult intestinal transplant recipients and 24 healthy subjects (a control group). All subjects were administered the Italian Version of the Psychological Well-Being Scales (PWB) by C. Ryff, the World Health Organization Quality of Life-Brief (WHOQOL), and the Symptom Questionnaire (SQ) by R. Kellner and G.A. Fava, a symptomatology scale. Quality of life and psychological well-being were assessed in transplant recipients in relationship to the number of rejections, the number of admissions, and the immunosuppressive protocol. Results: Intestinal transplant recipients reported significantly higher scores in the "personal growth" category (P = .036) and lower scores in the "positive relat
  Transplantation Proceedings. 01/2010; 42:42-44.
• Article: Effect of different immunosuppressive schedules on recurrence-free survival after liver transplantation for hepatocellular carcinoma

  M. Vivarelli, A. Dazzi, M. Zanello, A. Cucchetti, M. Cescon, M. Ravaioli, M. Del Gaudio, A. Lauro, G.L. Grazi, A.D. Pinna
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  ABSTRACT: Background. Tumor recurrence represents the main limitation of liver transplantation in patients with hepatocellular carcinoma (HCC) and can be favored by exposure to calcineurin inhibitors. Methods. We investigated the effect of an immunosuppressant schedule that minimizes the exposure to calcineurin inhibitors on patients transplanted for HCC to ascertain whether this can reduce the tumor recurrence rate. For this purpose, we conducted a matched-cohort study: 31 patients with HCC transplanted between 2004 and 2007 who received sirolimus as part of their immunosuppression (group A) were compared with a control group of 31 patients (group B) transplanted in the same period who had the same prognostic factors but were given standard immunosuppression based on tacrolimus. RESULTS.: Three-year recurrence-free survival was 86% in group A and 56% in group B (P=0.04). Although the prevalence of microvascular invasion G3-G4 grading and alpha-fetoprotein more than 200 ng/mL was identical in the two groups, exp
  Transplantation. 01/2010; 89:227-231.
• Article: Trends in long-term survival after hepatectomy for colorectal metastases over the last two decades at a single center

  M. Cescon, G. Vetrone, G. L. Grazi, G. Ercolani, G. Stacchini, M. Ravaioli, M. Del Gaudio, A. Cucchetti, A. Lauro, A. Dazzi, P. Di Gioia, F. Tuci, C. Zanfi, A.D. Pinna
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  ABSTRACT: Background: Long-term outcomes after hepatectomy for liver metastases from colorectal cancer (CRC) have recently improved. However, single-center evaluations of trends in postoperative survivals in the last two decades are lacking. Methods: From 1990 to 2008, 468 patients underwent hepatectomy for metastases from CRC with a curative intent at our Institution. Two-hundred forty-eight (53%) patients were operated on before the year 2000 (group A), and 220 (47%) did afterwards (group B). Demographic, clinical, tumor-related, and surgical and outcome parameters were compared between the 2 groups. Results: Group B patients were significantly older, with a higher number of co-morbidities and of liver metastases vs. group A patients. Group B received more frequently extended hepatectomies and simultaneous colon resections, but also less intraoperative blood transfusions vs. group A. Postoperative morbidity and mortality were 18% vs. 27% (P = 0.03), and 1.2% vs. 2.3% (P = 0.3) in group A vs. group B, respectiv
  HPB. 01/2010; 12:266-267.
• Article: Liver transplantation in HIV-HCV coinfected patients: A single italian center experience in the MELD era

  M. Del Gaudio, C. Morelli, G. Ercolani, M. Cescon, A. Lauro, A. Cucchetti, M. Zanello, G. Vetrone, A. Dazzi, C. Zanfi, F. Tuci, G.L. Grazi, A.D. Pinna
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  ABSTRACT: Background: It is unclear whether coinfection with hepatitis C virus (HCV) increases mortality in liver transplanted patients with human immunodeficiency virus (HIV) infection during the era of highly active antiretroviral therapy (HAART). Methods: We retrospectively reviewed our experience at University of Bologna about 45 HIV listed patients for liver transplantation (OLT) between November 2004 until January 2009. Among this period, 20 OLT were performed in 19 HIV patients and 17/19 (89%) were HCV coinfected and the remaining 2/19 (11%) HBV coinfected patients. Seventeen (89%) were male and 2(11%) were female; median age at OLT was 44 (plus or minus) 7.53 years (34-65), in 9(47%) cases an hepatocellular carcinoma (HCC) was associated. MELD score at time of OLT resulted 27(plus or minus) 9.62 (6-39), mean waiting time was 258 (plus or minus) 269.83 days (9-826). CD4+ blood count was 426.15 (plus or minus) 191.88 cells/mmc (219-876). Among 17 HIV-HCV coinfected patients, 12 (70%) had HCVRNA viral load
  Liver Transplantation. 01/2010; 16:S194.
• Article: Liver transplantation for HCC: A new prognostic score

  M. Ravaioli, V. Bertuzzo, G.L. Grazi, G. Ercolani, M. Cescon, M.D. Gaudio, A. Cucchetti, G. Vetrone, M. Zanello, A. Dazzi, F. Tuci, C. Zanfi, P.D. Gioia, A. Lauro, A.D. Pinna
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  ABSTRACT: Background: patients survival after liver transplantation (LT) for hepatocellular carcinoma (HCC) improved over the time due to selection criteria based on the pre-operative prognostic score. The future improvements will be due to adjuvant treatments stratified according to the post-operative prognostic score. Methods: from 1997 to 2008, we prospectively revised the outcome of 299 patients transplanted for HCC. Following our previous studies, a new prognostic score was elaborated based on four variables related to the risk of tumor recurrence: alfa-feto protein level higher than 30 ng/dL at the time of LT, out of the Milan criteria, poor differentiation degree and tumor microvascular invasion on the sample. Group A had 0-1 risk factor (RF), group B had 2 RF, group C had 3 RF and group D had all the RF. Results: among the population study the median follow-up was 2.9 years and the HCC recurrences were 29 (9.7%). The 1- and 5- year patient survival was 85% and 69%. In the group A there were 167 patients
  Liver Transplantation. 01/2010; 16:S240.
• Article: Bacterial translocation in adult small bowel transplantation.

  A Cucchetti, A Siniscalchi, A Bagni, A Lauro, M Cescon, N Zucchini, A Dazzi, C Zanfi, S Faenza, A D Pinna
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  ABSTRACT: The application of intestinal transplantation is limited by the high rate of infectious complications that can occur; the migration of enteric microorganisms to extraintestinal sites (bacterial translocation) has been suggested to be responsible for this event. We reviewed 95 intestinal biopsies performed on 28 transplanted patients to identify histologic features predictive of isolation of enteric microorganisms in extraintestinal sites within the first month after transplantation. At least 1 isolation of enteric microorganisms in the peritoneal cavity and/or in blood samples was obtained in 13 patients (46.4%); this event led to higher 1-year mortality (38.5% vs. 6.7%; P = .041). Of the 95 biopsies, 38 were followed by positive cultures (40.0%), showing higher degrees of mucosal vascular alterations (Ruiz grade) and ischemia/reperfusion injuries (Park/Chiu grade) compared with the negative cases (P < .05). We also observed an higher prevalence of positive cultures in relation to acute cellular rejection episodes (P = .091). Neither clinical or surgical factors nor immunosuppressive therapy were observed to be significantly related to positive cultures. Histologic alterations of the small bowel allograft are related to isolation of enteric microorganisms in extraintestinal sites. The degree of these histologic features can identify patients at high risk of potentially life-threatening infectious complications and death.
  Transplantation Proceedings 05/2009; 41(4):1325-30. · 1.00 Impact Factor
• Article: Hepatocelllular carcinoma on cirrhosis: Liver resection, liver transplantation or both surgical treatments? An intention to treat analysis

  M. Del Gaudio, G. Ercolani, M. Ravaioli, M. Cescon, A. Lauro, M. Vivarelli, A. Cucchetti, M. Zanello, G. Vetrone, C. Zanfi, A. Dazzi, F. Tuci, C. Morelli, G.L. Grazi, A.D. Pinna
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  ABSTRACT: Background: The management of patients with cirrhosis and early hepatocellular carcinoma (HCC) meeting the Milan criteria is controversial. Methods: From January 1996 to November 2008, 360 consecutive patients with transplantable hepatocellular carcinoma (HCC) according to Milan criteria were treated by liver resection (LR)(n = 128) or liver transplantation (LT) (n = 232 of 426 listed for LT) at our institution. Results: Among 128 patients eligible for transplantation who underwent LR, 51 (40%) developed HCC recurrence and 38/51 (74%) of these patients presented HCC recurrence into Milan criteria. Only 18 of the 51 patients underwent LT as salvage procedure, with a transplantation rate of 35% of patients with HCC recurrence. According to intention-to-treat analysis of transplantable HCC patients who underwent LR (n = 128), compared to all those listed for transplantation (n =426), 5-year overall survival was 71% in the LR group versus 62% in patients listed for LT, respectively (p =NS); 5-year disease-
  Liver Transplantation. 01/2009; 15:S252.
• Article: Portal vein thrombosis and liver transplantation: Evolutions during 10-years experience at the university of Bologna

  M. Ravaioli, M. Zanello, G.L. Grazi, G. Ercolani, M. Cescon, M. Del Gaudio, A. Cucchetti, G. Vetrone, A. Dazzi, F. Tuci, C. Zanfi, P. Di Gioia, G. Ramacciato, C. Morelli, A.D. Pinna
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  ABSTRACT: Background: portal vein thrombosis (PVT) may be a contraindication to liver transplantation (LT); we reviewed our 10-years experience on LT and PVT. Methods: during 1998-2008 (1st era 1998-2002 and 2nd era 2003-2008), patients with non-neoplastic PVT intra-operatively confirmed, formed the study group (PVT) and were sub-classified according to Yerdel classification: partial PVT (grade 1-2) and complete PVT (grade 3-4). Patients without PVT were the control group (non-PVT). Results: Among 889 consecutive LTs, we intra-operatively diagnosed 91 PVT (10.2%): 51 partial PVT (56%) and 40 total PVT(44%). The rate of complete PVT increased from the 1st to the 2nd era (2.2% vs. 6.7%, p<0.005). At multivariate analysis, previous surgery, HCC on sample and alcoholic cirrhosis were independently related to PVT (C.I.=2.7-46.8, p=0,001; C.I.=1.1-3, p=0,022; C.I.=1.9-6.1, p=0,001 respectively). Partial PVT were treated with thrombectomy in 27 cases (54%) or anastomosis to spleno-mesenteric confluence in 23 (46%). Com
  Liver Transplantation. 01/2009; 15:S170.
• Article: Liver transplantation for hepatocellular carcinoma with unfavourable prognostic factors: Recurrence free survivalis improved by adequate immunosuppression

  M. Vivarelli, A. Dazzi, M. Zanello, A. Cucchetti, M. Ravaioli, M. Cescon, M. Del Gaudio, G.L. Grazi, A.D. Pinna
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  ABSTRACT: Tumor recurrence represents the main limitation of liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). In a recent report we demonstrated that exposure to the calcineurin inhibitors is a prognostic factor for HCC recurrence together with microvascular tumor invasion, histological grading and preoperative serum alphafetoprotein level. In the present report we investigate the effect of an immunosuppressant schedule that minimizes the exposure to calcinuerin inhibitors on a population of patients transplantad in the presence of HCC with poor prognostic factors to ascertain whether the tumor recurrence rate can be reduced by such a policy. For this purpose we reviewed the records of 31 patients with HCC transplanted between 2004 and 2007 who received sirolimus as part of their immunosuppression and compared them with a control group of 31 patients (group B) transplanted in the same period who had the same prognostic factors but were given standard immunosuppression based on tacrolim
  Liver Transplantation. 01/2009; 15:S77.
• Article: Combined heart and liver transplantation: A single center experience

  M. Cescon, M. Zanello, G.L. Grazi, M. Ravaioli, G. Ercolani, M. Del Gaudio, A. Cucchetti, G. Vetrone, A. Dazzi, F. Tuci, C. Zanfi, P. Di Gioia, A.D. Pinna
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  ABSTRACT: Aim: A single-center experience of combined heart-liver transplant (CHLT) was retrospectively evaluated. Methods: from March 1999 to November 2008, 8 cases of CHLTs and 1 of heart-liver-kidney transplantation were performed at our Institution. The indications for combined transplantation were familial amyloidotic polyneuropathy secondary to NMet30 variation (FAP group) in 8 patients, and HCV cirrhosis associated with dilatative cardiomyopathy in 1 patient. There were 8 men and 1 woman, with a median age of 46 years (range: 2260). In the FAP group, preoperative nutritional status was evaluated with weight loss (WL) and modified body max index (mBMI). Two patients had WL >10 Kg and 6 patients had WL <5 Kg. All patients had mBMI >600. Polyneuropathy was assessed with modified polineuropathy disability score (PND): 1 patient had score III, 3 patients had score II and 4 patients had score I. Induction therapy with Thymoglobulins was used in 4 patients (44%). Immunosuppression was based on cyclosporine-azath
  Liver Transplantation. 01/2009; 15:S274.
• Article: Survival benefit after liver transplantation: A single european center experience

  M. Ravaioli, G.L. Grazi, A. Dazzi, V. Bertuzzo, G. Ercolani, M. Cescon, A. Cucchetti, M. Masetti, G. Ramacciato, A.D. Pinna
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  ABSTRACT: BACKGROUND.: The evaluation of the survival achieved with liver transplantation (LT) compared with remaining on the waiting list, the transplant benefit, should be the underlying principle of organ allocation. METHODS.: During 2004 to 2007 with an allocation system based on Model for End-Stage Liver Disease (MELD) score with exceptions, we prospectively evaluated the transplant benefit and its relation to the match between recipient and donor characteristics. RESULTS.: Among 575 patients listed for chronic liver disease, 218 (37.9%) underwent LT and 115 (20%) were removed from the list (76 deaths, 25 tumor progressions, and 14 sick conditions). The 1-and 3-year survival rates on the list were significantly related to MELD score more than or equal to 20 (57% and 33% vs. 88% and 66%, P<0.001) and to its progression during the waiting time, such as s-Na levels less than or equal to 135 mEq/L (73% and 48% vs. 86% and 69%, P<0.001). These two variables had no impact on survival after LT, except in hepatitis
  Transplantation. 01/2009; 88:826-834.