UO Chirurgia Generale e Trapianti di Fegato

Milano, Italy

UO Chirurgia Generale e Trapianti di Fegato

Milano, Italy
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Maggi U.,U.O. chirurgia Generale e Trapianti di Fegato | Andorno E.,UOC Chirurgia Generale e Trapianti dOrgano | Rossi G.,U.O. chirurgia Generale e Trapianti di Fegato | de Carlis L.,Chirurgia Generale 2 e dei Trapianti dellA.O. Ospedale Niguarda Ca Granda | And 9 more authors.
PLoS ONE | Year: 2012

This study is the largest Italian survey on liver retransplantations (RET). Data report on 167 adult patients who received 2 grafts, 16 who received 3 grafts, and one who received 4 grafts over a 11 yr period. There was no statistically significant difference in graft survival after the first or the second RET (52, 40, and 29% vs 44, 36, and 18% at 1,5,and 10 yr, respectively: Log-Rank test, p = 0.30). Survivals at 1, 5, and 10 years of patients who underwent 2 (n = 151) or 3 (n = 15) RETs, were 65, 48,and 39% vs 59, 44, and 30%, respectively (p = 0.59). Multivariate analysis of survival showed that only the type of graft (whole vs reduced) was associated with a statistically significant difference (HR = 3.77, Wald test p = 0. 05); the donor age appeared to be a relevant factor as well, although the difference was not statistically significant (HR = 1.91, Wald test p = 0.08). Though late RETs have better results on long term survival relative to early RETs, no statistically significant difference can be found in early results, till three years after RET. Considering late first RETs (interval>30 days from previous transplantation) with whole grafts the difference in graft survival in RETs due to HCV recurrence (n = 17) was not significantly different from RETs due to other causes (n = 53) (65-58 and 31% vs 66-57 and 28% respectively at 1-5 and 10 years, p = 0.66). © 2012 Maggi et al.


Maggi U.,U.O. Chirurgia Generale e Trapianti di Fegato | Russo R.,Instituto Of Anestesia E Rianimazione | Conte G.,U.O. Chirurgia Generale e Trapianti di Fegato | Chiumello D.,Instituto Of Anestesia E Rianimazione | And 6 more authors.
Transplantation Proceedings | Year: 2011

Varicella is a well-known contagious disease of childhood that can also affect both immunodepressed and immunocompetent adults. The present observations concern a previously healthy adult patient who presented with a fulminant hepatitis evolving in multiorgan failure (MOF), associated with an atypical papulo-ethemateous cutaneous rash without fever. An hepatic biopsy showed massive necrosis. Because of the persistent MOF and severe hemodynamic instability, total hepatectomy was performed as a bridge to urgent liver transplantation (OLT). Despite temporary improvement, the patients condition progressively deteriorated and he died 11 hours after the hepatectomy, i.e. 7 days after admission to the intensive care unit. High viral loads of varicella zoster virus (VZV) and human herpes virus 6 (HHV6) were demonstrated in the blood and in DNA at post mortem examination of the liver, kidneys, lung, and heart. We hypothesize that VZV infection may occasionally occur in immunocompetent patients due to extremely virulent strains that can be rapidly fatal. The clinical influence of simultaneous infection with HHV6 is not clear. Moreover, the role of a previous steroid treatment as a trigger for a temporary immunodepressed state must be considered. The diagnosis of liver disease from VZV should always be clinically suspected in the presence of concurrent atypical skin lesions and a temporarily immunocompromised state. Therapy with acyclovir was ineffective in our patient. Based on the wide spectrum of VZV infections, fulminant MOF in immunocompetent adults must raise the possibility of VZV with simultaneous HHV6 infection with early listing of the patient for a urgent OLT, possibly with a total hepatectomy as a bridge, due to the therapeutic uncertainty of medical treatments. © 2011 by Elsevier Inc. All rights reserved.


Maggi U.,UO Chirurgia Generale e Trapianti di Fegato | Maggi U.,Ufr Of Medecine Of Iuniversite Paris Xii Creteil | Conte G.,UO Chirurgia Generale e Trapianti di Fegato | Nita G.,UO Chirurgia Generale e Trapianti di Fegato | And 8 more authors.
Transplantation Proceedings | Year: 2013

Liver transplantation (LT) in patients with hereditary hemorrhagic telangiectasia (HHT), or Rendu-Osler-Weber, disease is a problematic procedure. In patients with hepatic involvement due to clinically significant arterovenous malformations, there is high risk of intraoperative bleeding and intra- or perioperative complications. Some surgical corrections have been proposed for venous problems, concerning the vena caval anastomosis. A common finding in HHT is arterial enlargement of the celiac trunk and of the common hepatic artery. We report 2 cases of LT in HHT where the arterial anastomosis was successfully performed using the splenic artery of the recipient, which shows less tendency for enlargement than the celiac trunk. © 2013 by Elsevier Inc. All rights reserved.


Maggi U.,Uo Unita Operativa Chirurgia Generale E Trapianti Of Fegato | Maggi U.,Ufr Unite Of Formation Et Of Recherche Of Medecine Of Luniversite Paris | Consonni D.,UO Epidemiologia Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico di Milan | Manini M.A.,University of Milan | And 8 more authors.
PLoS ONE | Year: 2013

Background:De novo tumors (DNT) after liver transplantation (LT) represent a growing concern.Patients and Methods:We analyzed the incidence of DNT, type, time of onset, risk factors and mortality (as of 2010) in 494 adult patients transplanted in the last 26 years (1983-2009).Results:DNT occurred in 41 (8.3%) of the patients. The Standardized Incidence Ratio (SIR) compared with the Italian population was 1.8. There was a higher incidence in males (SIR 2.0), an expected extremely high rate of Kaposi's sarcoma (SIR 127.95) and unexpected higher rates of tumors of the bladder in males (SIR 3.3). The incidence of DNT was higher within the first two years of LT (SIR 2.7) for Kaposi's sarcoma (SIR 393.3) and after 10 years (SIR 1.7) for bladder tumors (SIR 10.6). Multivariate analysis identified alcoholic cirrhosis (HR = 3.0, 95% CI = 1.2-7.8) and sclerosing cholangitis (HR = 3.5, 95% CI = 1.1-11.3) in the recipient as main risk factors for the occurrence of DNT.Conclusions:Surveillance protocols for DNT must be specifically oriented to patients transplanted for alcoholic cirrhosis and sclerosing cholangitis. They should focus on early detection of Kaposi's sarcomas, and more remarkably, on late development bladder tumors in men after LT. © 2013 Maggi et al.


Maggi U.,UO Chirurgia Generale e Trapianti di Fegato | Maggi U.,Ufr Of Medecine Of 1Universite Paris Xii Creteil | Nita G.,UO Chirurgia Generale e Trapianti di Fegato | Gatti S.,UO Chirurgia Generale e Trapianti di Fegato | And 6 more authors.
Transplantation Proceedings | Year: 2013

Hyperbilirubinemia often accompanies liver failure; therefore, artificial liver support devices are currently used as a bridge to more definitive treatments to eliminate water-soluble and albumin-bound toxins. We report 2 patients, of which, after liver transplantation, the first experienced early allograft dysfunction and the other hyperbilirubinemia linked to chronic rejection. After 3 cycles of coupled plasma filtration adsorption (CPFA), the bilirubin promptly decreased in both cases. CPFA is an extracorporeal therapy that uses plasma filtration associated with an adsorbent cartridge and hemofiltration to remove cytokines and inflammatory mediators associated with septic shock, severe sepsis, and multiple organ dysfunction syndrome. Each cycle of treatment lowered the bilirubin of our patients by ∼40%. CPFA deserves attention as a potential inexpensive short-lasting device to treat hyperbilirubinemia after liver surgery or transplantation. Moreover, the effects of CPFA should be further studied to address inflammatory mediators in chronic rejection after liver transplantation or other immunologic disorders. © 2013 by Elsevier Inc. All rights reserved.


Maggi U.,U.O. Chirurgia Generale e Trapianti di Fegato | Fornoni G.,U.O. Chirurgia Generale e Trapianti di Fegato | Centonze L.,U.O. Chirurgia Generale e Trapianti di Fegato | Melada E.,U.O. Chirurgia Generale e Trapianti di Fegato | And 2 more authors.
Transplantation Proceedings | Year: 2014

The aim of our study was to retrospectively evaluate the impact of ischemia time and other clinical factors on the development of liver allograft primary nonfunction (PNF). We enrolled 531 consecutive liver transplantations from 1998 to 2013, identifying 10 PNF (1.9%). PNF was found to be statistically related to 4 different variables: donor age >60 years (P =.01), female donor gender (P =.01), total ischemia time >10 hours (P =.03) and infusion of more than 30 fresh frozen plasma units during surgery (P =.02). The study focused on the clinical impact of total ischemia time. We grouped total ischemia time into 4 groups (Group 1: ≤7.5 hours; Group 2: between 7.5 and 10 hours; Group 3: between 10 and 12 hours; Group 4: >12 hours) and 2 groups (assigning a cut-off value of 10 hours): both these grouping systems significantly influenced the development of PNF and 1-year graft survival, with limited impact on long-term survival. We split total ischemia time in a "technical time," "hepatectomy time," and "warm ischemia time." Only the first 2 components were found to be statistically related to PNF development with P =.02 and P =.003, respectively. Further studies should focus on these aspects of PNF. © 2014 Elsevier Inc. All rights reserved.


Maggi U.,U.O. Chirurgia Generale e Trapianti di Fegato | Dondossola D.,U.O. Chirurgia Generale e Trapianti di Fegato | Consonni D.,U.O. Epidemiologia Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico | Gatti S.,U.O. Chirurgia Generale e Trapianti di Fegato | And 3 more authors.
PLoS ONE | Year: 2011

There are only few reviews concerning visceral aneurysms in cirrhotics, and a small number of papers on visceral aneurysms in liver transplant patients. The present paper investigates this condition in both groups of patients in a 10-year-retrospective study. © 2011 Maggi et al.


PubMed | U.O. Chirurgia Generale e Trapianti di Fegato and University of Milan
Type: Case Reports | Journal: Transplantation proceedings | Year: 2016

Biliary stones after liver transplantation (LT) rarely occur but a focus on those complications and their treatment is needed.In total, 390 adult patients who underwent an LT from July 2004 to July 2014 entered the study. Biliary complications and notably biliary stones after LT were identified.In total, 365 LT were analyzed. Biliary stones were identified in 14 patients (3.8%). Predictive factors for the onset of biliary stones after LT were hepatocellular diseases (P= .038; OR= 9.7) and biliary stenosis (P= .000; OR= 11.9). Treatments consisted of percutaneous transhepatic procedures (4 patients), endoscopic retrograde procedures (9 patients), and in open surgery (1 case); in 2 cases, due to a failure of previous treatments, holmium intraductal laser lithotripsy (HILL) was used: the first patient, a 35-year-old woman developed multiple intrahepatic biliary stones after LT. Percutaneous transhepatic cholangiography (PTC) was ineffective and a HILL was performed, clearing the right common bile duct but leaving residual stones in the left duct. The patient underwent a retransplantation due to recurrent hepatitis C virus infection but died 3 months later because of graft failure. The second patient, a 42-year-old 14 years after retransplantation, developed biliary sludge and stones; after several attempts with PTC and endoscopic retrograde cholangiopancreatography, a HILL was performed. All stones except one big one were treated. The patient is alive and well.When usual treatments are unsuccessful and biliary stones are large, their fragmentation and treatment could be done with HILL, a promising procedure after LT.


PubMed | U.O. Chirurgia Generale e Trapianti di Fegato and University of Milan
Type: Evaluation Studies | Journal: Transplantation proceedings | Year: 2014

The aim of our study was to retrospectively evaluate the impact of ischemia time and other clinical factors on the development of liver allograft primary nonfunction (PNF). We enrolled 531 consecutive liver transplantations from 1998 to 2013, identifying 10 PNF (1.9%). PNF was found to be statistically related to 4 different variables: donor age>60 years (P=.01), female donor gender (P=.01), total ischemia time>10 hours (P=.03) and infusion of more than 30 fresh frozen plasma units during surgery (P=.02). The study focused on the clinical impact of total ischemia time. We grouped total ischemia time into 4 groups (Group 1: 7.5 hours; Group 2: between 7.5 and 10 hours; Group 3: between 10 and 12 hours; Group 4: >12 hours) and 2 groups (assigning a cut-off value of 10 hours): both these grouping systems significantly influenced the development of PNF and 1-year graft survival, with limited impact on long-term survival. We split total ischemia time in a technical time, hepatectomy time, and warm ischemia time. Only the first 2 components were found to be statistically related to PNF development with P=.02 and P=.003, respectively. Further studies should focus on these aspects of PNF.

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