N Cautero

Azienda Ospedaliero Universitaria Policlinico Modena, Modène, Emilia-Romagna, Italy

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Publications (89)191.99 Total impact

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    ABSTRACT: Neurological complications (NCs) can frequently and significantly affect morbidity and mortality of liver transplant (LT) recipients. We analysed incidence, risk factors, outcome and impact of the immunosuppressive therapy on NC development after LT. We analyzed 478 LT in 440 patients, 93 (19.5%) were followed by NCs. The average LOS was longer in patients experiencing NCs. The 1-, 3- and 5-year graft and patient survival was similar in patients with or without a NC. Multivariate analysis showed the following as independent risk factors for NC: a MELD-score≥20 (OR=1.934 CI=1.186-3.153) and an immunosuppressive regimen based on calcineurin inhibitors (CNIs) (OR=1.669 CI=1.009-2.760). Among patients receiving an everolimus-based immunosuppression the 7.1% developed NCs, versus the 16.9% in those receiving a CNI(p=0.039). There was a 1-, 3- and 5-year NC-free survival of 81.7%, 81.1% and 77.7% in patients receiving a CNI-based regimen and 95.1%, 93.6% and 92.7% in those not receiving a CNI-based regimen (p<0.001). In patients undergoing a LT and presenting with non-modifiable risk factors for developing NCs an immunosuppressive regimen based on CNIs is likely to result in a higher rate of NCs compared to mTOR inhibitors. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Transplant International 03/2015; 28(7). DOI:10.1111/tri.12564 · 3.16 Impact Factor
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    ABSTRACT: Aim: To define the body composition of patients awaiting liver transplantation and analyze the effect of the nutritional counseling. Methods: This retrospective study involved 335 patients in screening for liver transplantation. The evaluation of the nutritional status at the first access to the Center comprised: anthropometrical evaluations and Mini Nutritional Assessment. For cases that reached transplantation (N. 110), evaluated two times, the second control comprised also the Subjective Global Assessment. Results: The Body Max Index at the first observation showed a prevalence of overweight or obesity while the Mini Nutritional Assessment and anthropometric evaluation showed that a large number of patients were at risk of malnutrition or bad nourished with a decrease of fat and/or of muscular mass. Immediately before transplantation and after a nutritional follow up with a personalized diet fat mass has been normalized in 91% and muscular mass remained stable in 56% of cases. Conclusions: Malnutrition is largely diffused in patients undergoing liver transplantation. An evaluation by simple methods such as anthropometry and nutritional counseling is needed to ameliorate their conditions. Particular attention must be paid to counteract the decrease of fat mass and muscular mass in females.
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    ABSTRACT: Introduction. One of the critical factors that influence graft function after live donor liver transplantation is the presence or absence of global or sectorial liver congestion. Many authors advocate for routine middle hepatic vein (MHV) reconstruction because it is often difficult to determine when the MHV or one of its major branches have functional significance. Predictive tests to assess hemodynamic and functional significance of the MHV and its tributaries are still under study. Case Report. We have described a novel intraoperative manipulation and Doppler ultrasonographic evaluation that led to the decision to include the MHV with the right lobe graft.
    Transplantation Proceedings 08/2014; 46(7). DOI:10.1016/j.transproceed.2013.09.058 · 0.95 Impact Factor
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    ABSTRACT: Salvage liver transplantation (SLT) is an attractive sequential strategy which combines liver resection (LR) for hepatocellular carcinoma (HCC), followed by LT in the event of HCC recurrence or progressive liver deterioration. To compare the long-term results of SLT with PLT. Between 2000 and 2011, 125 patients (72 transplantable) underwent LR and 226 underwent LT in our unit. The outcome of SLT was analyzed in a 2-step fashion: firstly, SLT (n=28) was compared with primary liver transplant (PLT) (n=198), secondly an intention-to-treat analysis was performed on all transplantable HCC patients who underwent LR (LRT group = 72) compared to PLT (n= 198). The 5-year overall survival (OS) was 65.4% vs. 49.2% (p=0-63), and disease-free survival (DFS) was 89.7% vs. 80.6% (p= 0.31) for PLT and SLT respectively. Predictive factors for DFS after LT included HCC total diameter (Hazard ratio [HR] 1.29 p=0.003), α-fetoprotein (HR 1.002 p< 0.001) and number of HCC nodules (HR 1.317 p= 0.035), whereas HCV positivity (HR 1.911 p=0.03) and outside Up-to-Seven criteria (HR 2.652 p < 0.001) were negative independent prediction factors of OS. Intention to treat analysis showed that OS at 5 years was improved in PLT vs. LRT (LRT n=72 including SLT plus LR group) and was 69.4% vs. 42.2% (p < 0.004), with an additional increase in DFS (89.2% vs. 54.5% respectively p < 0.001). Salvage liver transplantation is a safe treatment strategy, as it does not impair long-term survival. At intention-to-treat analysis, PLT showed improved survival compared with LRT. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 02/2014; 34(6). DOI:10.1111/liv.12497 · 4.41 Impact Factor
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    ABSTRACT: Chronic intestinal pseudo-obstruction (CIPO) has been treated in adults by total parenteral nutrition (TPN) or, if complications arise, by multivisceral transplantation because the stomach is often involved. Eleven adults with CIPO were transplanted by intestinal graft in our center from 2000 to 2011. Nine patients underwent isolated intestinal transplant and 2 patients had multivisceral transplant. Immunosuppression was represented by FK and steroids plus induction with alemtuzumab, daclizumab, or thymoglobulin. Average age at transplant was 33.5 years. We reported 1 graftectomy, followed by retransplantation. Seven patients are currently alive with working small bowel; cause of death was infection in the 4 remaining cases. In 9 isolated intestinal transplants, we performed different digestive reconstructions to allow gastric emptying. In 2 cases we were forced, after transplant, to perform ileostomy to improve intestinal motility. Graft and patient survival after 5 years are 60% and 70%, respectively, while after 10 years, 45% and 56%, respectively. Adults with CIPO and irreversible TPN complications benefit from isolated intestinal transplant with different surgical techniques to empty the native stomach: this strategy achieves good gastric emptying, with effective establishment of oral feeding and graft and patient survivals comparable to isolated intestinal transplant for short bowel syndrome.
    Transplantation Proceedings 11/2013; 45(9):3351-5. DOI:10.1016/j.transproceed.2013.06.014 · 0.95 Impact Factor
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    ABSTRACT: Prognostic factors for hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) are still a matter of debate. The absence of viable tumor in the native liver, due to effectiveness of pre-LT locoregional treatment or liver resection, is an intriguing prognostic factor that had never been evaluated. Between November 2000 and December 2011, 210 LTs were performed in patients with evidence of HCC and cirrhosis. Fifty-three (25.2%) patients did not show any evidence of active residual HCC in the native liver (Group NVH), whereas 157 (74.8%) patients showed viable HCC (Group VH). All patients in Group NVH were treated before LT with a multimodal approach combining transarterial chemoembolization, liver resection, radiofrequency ablation, percutaneous ethanol injection, or sorafenib, whereas, in Group VH, 110 of the 157 (70.1%) patients received bridging therapy (P<0.001). HCC recurrence occurred in none of the patients in Group NVH (0%) and in 25 (15.9%) patients in Group VH (P=0.003). Liver resection was the most effective treatment in obtaining absence of HCC on liver explantation. The results of multivariate analysis showed that existence of pathologic HCC findings outside of the University of California-San Francisco criteria (P=0.001; odds ratio, 4; confidence interval, 1.7-9.2) and the presence of viable HCC (P=0.003; odds ratio, 5.9; confidence interval, 1.5-17.6) were independently associated with HCC recurrence. The histologic absence of viable HCC in the native liver after LT and morphologic criteria, due to the high effectiveness of pre-LT bridging treatments, is a highly positive prognostic factor against HCC recurrence after LT.
    Transplantation 09/2013; 97(2). DOI:10.1097/TP.0b013e3182a8607e · 3.78 Impact Factor
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    ABSTRACT: Portal vein thrombosis (PVT) is a well-recognized complication of chronic liver disease with a prevalence ranging from 1% to 16%. We performed a retrospective review of 447 consecutive patients who underwent liver transplantation (OLT) between October 2000 and December 2011 comparing 51 recipients with PVT (study group) with 399 without PVT (control group). The aim of this study was to determine the impact of pre-existent PVT on the surgical procedure, to identify specific preventable perioperative complications, and based on our studies and other works, to determine whether this group of patients are acceptable candidates for OLT. Among the 51 patients with PVT, 44 showed partial and 7 complete thrombosis. In 47 cases, we performed a thromboendovenectomy. There were six anastomoses at the confluence of the superior mesenteric vein (SMV) and one, with a venous graft interposition. In four complete thrombosis recipients we performed an extra-anatomic by pass between the main trunk of the SMV and the donor portal vein. Compared with the control group, regarding preoperative characteristics, PVT patients were older at the time of transplantation (P = .001) and had a higher use of TIPS (P = .02). The operative characteristics showed a longer warm ischemia time in the PVT group (46.9 ± 22.5 vs 39.3 ± 15 min; P = .004). There were significant differences in postoperative evaluations, nor in the complication rates. Overall survivals at 10 years were similar: 61.7% versus 65.3%; (P = .9). Although PVT was associated with greater operative complexity, it had no influence on postoperative complications or overall survival.
    Transplantation Proceedings 09/2013; 45(7):2692-9. DOI:10.1016/j.transproceed.2013.07.046 · 0.95 Impact Factor
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    ABSTRACT: BACKGROUND: The aim of our work is to assess the clinical outcomes of liver transplantation (LT) for hepatocellular carcinoma (HCC) in HIV-coinfected patients. This is a multicenter study involving three Italian transplant centers in northern Italy: University of Modena, University of Bologna, and University of Udine. PATIENTS AND METHODS: We compared 30 HIV-positive patients affected by HCC who underwent LT with 155 HIV-uninfected patients who received the same treatment from September 2004 to June 2009. At listing, there were no differences between HIV-infected and -uninfected patients regarding HCC features. Patients outside the University of California, San Francisco criteria (UCSF) were considered eligible for LT if a down-staging program permitted a reduction of tumor burden. RESULTS: HIV-infected patients were younger, they were more frequently anti-HCV positive, and a higher number of HIV-infected patients presented a coinfection HBV-HCV. Pre-LT treatments (liver resection and or locoregional treatments) were similar between the two groups. Histological characteristics of the tumor were similar in patients with and without HIV infection. No differences were observed in terms of overall survival and HCC recurrence rates. CONCLUSION: LT for HCC is a feasible procedure and the presence of HIV does not particularly affect the post-LT outcome.
    The Oncologist 05/2013; 18(5). DOI:10.1634/theoncologist.2012-0255 · 4.54 Impact Factor
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    ABSTRACT: Incisional hernias (IHs) are common complications after liver transplantation (LT) with a reported incidence of 1.7% to 34.3%. The purpose of this retrospective study was to evaluate the risk factors for IH development after LT with a focus on the role of immunosuppressive therapy during the first month after LT. We analyzed 373 patients who underwent LT and divided them into 2 groups according to their postoperative course: an IH group (121 patients or 32.4%) and a no-IH group (252 patients or 67.6%). A univariate analysis demonstrated that the following were risk factors related to IH development: male sex (P = 0.03), a body mass index ≥ 29 kg/m(2) (P = 0.005), LT after 2004 (P = 0.02), a Model for End-Stage Liver Disease (MELD) score ≥ 22 (P = 0.01), and hepatitis B virus infection (P = 0.01). The highest incidence of IHs was found in patients treated with mammalian target of rapamycin (mTOR) inhibitors (54.5%, P = 0.004). A multivariate analysis revealed male sex (P = 0.03), a pretransplant MELD score ≥ 22 (P = 0.04), and the use of mTOR inhibitors (P = 0.001) to be independent risk factors for IHs after LT. In conclusion, immunosuppressive therapy with mTOR inhibitors is an important independent risk factor for IH development after LT. To reduce the incidence of IHs, mTOR inhibitors should be avoided until the fourth month after LT unless their use is deemed to be strictly necessary.
    Liver Transplantation 02/2012; 18(2):188-94. DOI:10.1002/lt.22445 · 4.24 Impact Factor
  • Journal of the American College of Surgeons 12/2011; 214(2):e1-4. DOI:10.1016/j.jamcollsurg.2011.10.019 · 4.45 Impact Factor
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    ABSTRACT: To assess the safety and long-term results of hepatic resection of colorectal liver metastases (CLM) in older adults. Case-control. Single liver and multivisceral transplant center. Individuals with CLM: 32 aged 70 and older (older group) and 32 younger than 70 (younger group) matched in a 1:1 ratio according to sex, primary tumor site, liver metastases at diagnosis, number of metastases, maximum tumor size, infiltration of cut margin, type of hepatic resection, and hepatic resection timing. Postoperative complications and survival rates. There was no significant difference in preoperative clinical findings between the two study groups. The incidence of cumulative postoperative complications was similar in the older (28.1%) and younger (34.4%) groups (P = .10). One-, 3-, and 5-year disease-free survival rates were 57.6%, 32.9%, and 16.4%, respectively, in the younger group and 67.9%, 29.2%, and 19.5%, respectively, in the older group (P = .72). One-, 3-, and 5-year participant survival rates were 84.1%, 51.9%, and 33.3%, respectively, in the older group and 93.6%, 63%, and 28%, respectively, in the younger group (P = .50). Resection of colorectal liver metastases in older adults can be performed with low mortality and morbidity and offers a long-time survival advantage to many of these individuals. Based on the results of this case-control study, older adults should be considered for surgical treatment whenever possible.
    Journal of the American Geriatrics Society 12/2011; 59(12):2282-90. DOI:10.1111/j.1532-5415.2011.03734.x · 4.22 Impact Factor
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    ABSTRACT: Pancreatic metastases are rare, with a reported incidence varying from 1.6% to 11% in autopsy studies of patients with advanced malignancy. In clinical series, the frequency of pancreatic metastases ranges from 2% to 5% of all pancreatic malignant tumors. However, the pancreas is an elective site for metastases from carcinoma of the kidney and this peculiarity has been reported by several studies. The epidemiology, clinical presentation, and treatment of pancreatic metastases from renal cell carcinoma are known from single-institution case reports and literature reviews. There is currently very limited experience with the surgical resection of isolated pancreatic metastasis, and the role of surgery in the management of these patients has not been clearly defined. In fact, for many years pancreatic resections were associated with high rates of morbidity and mortality, and metastatic disease to the pancreas was considered to be a terminal-stage condition. More recently, a significant reduction in the operative risk following major pancreatic surgery has been demonstrated, thus extending the indication for these operations to patients with metastatic disease.
    World Journal of Gastroenterology 11/2011; 17(43):4747-56. DOI:10.3748/wjg.v17.i43.4747 · 2.43 Impact Factor
  • Journal of the American Geriatrics Society 07/2011; 59(7):1359-61. DOI:10.1111/j.1532-5415.2011.03462.x · 4.22 Impact Factor
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    ABSTRACT: The growing prevalence of hepatitis C virus (HCV) infection in the general population has resulted in an increased frequency of potential organ donors that carry the virus. Given the significant disparity between organ supply and demand for transplantation, it becomes essential to consider whether livers from anti-HCV-positive donors may be considered suitable for transplantation. Based on a multicenter European database, 694 patients with HCV-related cirrhosis underwent liver transplantation and 11% of them received the graft from anti-HCV-positive donors. Of this group, we selected 63 patients (study group) and, after a 1:1 case-control approach, compared them with 63 patients that received an anti-HCV-negative donor graft (control group). Only grafts with preperfusion liver biopsy results with a fibrosis score of not more than 1 were used for transplantation. Patients who received anti-HCV-positive grafts had a cumulative survival rate of 83.6% and 61.7% at 1 and 5 years, respectively, vs. 95.1% and 68.2% for the control group. In comparing overall patient and graft survival, there was no statistically significant difference between the two groups (P=0.22 and 0.11). Recurrence of hepatitis C tended to be more rapid in the group of patients who received anti-HCV-positive grafts, although it did not reach statistical significance (P=0.07). We do not recommend the indiscriminate use of anti-HCV-positive donors, especially if HCV-RNA positive, as the use of this kind of graft could be linked to an advanced stage of fibrosis, the main risk factor we observed for earlier hepatitis C recurrence.
    Transplantation 06/2011; 91(11):1265-72. DOI:10.1097/TP.0b013e318219eb8f · 3.78 Impact Factor
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    ABSTRACT: Highly effective antiretroviral therapy in the last decade has increased the survival rates of HIV-positive patients, yielding a greater number of HIV patients suffering from liver-related disease. Liver transplantation (LT) is the only curative treatment for end-stage liver disease (ESLD) associated or not with hepatocellular carcinoma (HCC). From June 2003 to September 2010, 23 patients underwent cadaveric donor LT for ESLD at our institution. Inclusion criteria followed the Italian Protocol for LT in HIV-positive patients. Immunosuppressive regimens were based on cyclosporine or tacrolimus, eventually switched to Rapamycin. The median CD4 T-cell count was 275/mmc (range=119-924). All patients were affected by ESLD, which was associated with HCC in 14 cases. Ten patients were within the Milan criteria and four patients exceeded them but were within the San Francisco criteria. Conversion from calcineurin inhibitors (CNI) to rapamycin occurred in ten cases. Hepatitis C virus (HCV) recurrence occurred in 13/21 HCV-positive patients. Acute cellular rejection occurred in eight patients with one developing chronic cellular rejection. Overall patient and graft survivals at 80 months were 50% and 45% respectively. LT in HIV-positive patients is a feasible procedure, even if in our experience was burdened by a greater incidence of complications including HCV recurrence and infection compared with HIV-negative patients.
    Transplantation Proceedings 05/2011; 43(4):1114-8. DOI:10.1016/j.transproceed.2011.03.017 · 0.95 Impact Factor
  • Onkologie 03/2011; 34(4):193-5. DOI:10.1159/000326999 · 0.84 Impact Factor
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    ABSTRACT: Although human immunodeficiency virus (HIV) infection has been a major global health problem for almost 3 decades, with the introduction of highly active antiretroviral therapy in 1996 and effective prophylaxis and management of opportunistic infections, mortality from acquired immunodeficiency syndrome has decreased markedly. In developed countries, this condition is now being treated as a chronic condition. As a result, rates of morbidity and mortality from other medical conditions leading to end-stage liver, kidney, and heart disease are steadily increasing in individuals with HIV. Because the definitive treatment for end-stage organ failure is transplantation, the demand for it has increased among HIV-infected patients. For these reasons, many transplant centers have eliminated HIV infection as a contraindication to transplantation, as a result of better patient management and demand.
    Transplant Infectious Disease 03/2011; 13(5):501-6. DOI:10.1111/j.1399-3062.2011.00622.x · 1.98 Impact Factor
  • Transplantation 11/2010; 90. DOI:10.1097/00007890-201007272-00327 · 3.78 Impact Factor
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    ABSTRACT: Surgery is the only effective treatment able to improve survival of patients with hilar cholangiocarcinoma (CCA). However, the significance of prognostic factors on overall survival is still debated. We evaluated early and long-term outcomes of patients resected for hilar cholangiocarcinoma over a 3-year period to determine the role of prognostic factors and their effect on overall survival. Medical records of patients with hilar CCA who underwent resection between January 2001 and December 2004 were retrospectively reviewed. Univariate and multivariate analysis was performed to identify prognostic factors associated with survival. Thirty-two of 45 patients underwent surgical resection with curative intent. Morbidity was 24.4 per cent; perioperative mortality was 0 per cent. Overall median survival was 22.3 months. Well-differentiated tumor grading and R0 resection were independently associated with better survival at multivariate analysis. Aggressive surgery, including biliary resection combined with major hepatectomy, is a safe procedure with low morbidity and mortality in a tertiary referral hepatobiliary center. The main aim of an aggressive surgical approach is to obtain a microscopic margin-negative resection, which is associated with better prognosis. Another important prognostic factor is tumor grading, which is independently associated with survival.
    The American surgeon 11/2010; 76(11):1260-8. · 0.92 Impact Factor
  • Journal of the American Geriatrics Society 09/2010; 58(9):1816-8. DOI:10.1111/j.1532-5415.2010.03039.x · 4.22 Impact Factor

Publication Stats

546 Citations
191.99 Total Impact Points

Institutions

  • 2010–2015
    • Azienda Ospedaliero Universitaria Policlinico Modena
      Modène, Emilia-Romagna, Italy
  • 2002–2014
    • Università degli Studi di Modena e Reggio Emilia
      • Department of Biomedical, Metabolical and Neurosciences
      Modène, Emilia-Romagna, Italy
  • 2005–2013
    • University of Bologna
      • Department of Experimental, Diagnostic and Specialty Medicine DIMES
      Bolonia, Emilia-Romagna, Italy
  • 2008
    • Università Politecnica delle Marche
      Ancona, The Marches, Italy
  • 2007
    • Azienda Ospedaliero Universitaria Ancona
      Ancona, The Marches, Italy
  • 1998–2007
    • University of Udine
      • Department of Medical and Biological Sciences
      Udine, Friuli Venezia Giulia, Italy
  • 2006
    • Sant'Andrea Medical Hospital
      Spezia, Liguria, Italy
  • 2004
    • Università degli studi di Cagliari
      • Department of Surgical Science
      Cagliari, Sardinia, Italy