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Maggi U.,UO Chirurgia Generale e Trapianti di Fegato | Dondossola D.,UO Chirurgia Generale e Trapianti di Fegato | Consonni D.,U.O. Epidemiologia Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico | Gatti S.,UO 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.


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.,UO Chirurgia Generale e Trapianti di Fegato | Fornoni G.,UO Chirurgia Generale e Trapianti di Fegato | Centonze L.,UO Chirurgia Generale e Trapianti di Fegato | Melada E.,UO 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.,UO Chirurgia Generale e Trapianti di Fegato | Andorno E.,UOC Chirurgia Generale e Trapianti dOrgano | Rossi G.,UO 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.,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.

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