Publications by authors named "Eleonora De Martin"
Article Synopsis
- Immune checkpoint inhibitors (ICIs) have significantly improved the treatment of liver cancers (HCC) and biliary tract cancer, enhancing survival rates and reshaping care standards.
- Despite these advancements, there is a lack of reliable predictors for patient response to ICIs, which poses risks of liver toxicity and worsening chronic liver disease.
- The article reviews the mechanisms behind the effectiveness and toxicity of ICIs in liver tumors and explores how liver health affects the outcomes of treatment, providing insights for future clinical research.
Article Synopsis
- Liver transplantation (LT) is the best treatment for hepatocellular carcinoma (HCC), but donor shortages have led to strict eligibility criteria, prompting efforts to expand these criteria as donor availability increases and new therapies emerge.
- The introduction of immune checkpoint inhibitors (ICIs) has transformed HCC treatment but creates challenges for LT, particularly regarding immunosuppression management before and after the procedure.
- The review aims to assess new evidence and its impact on LT for HCC, focusing on balancing individual patient needs with benefits for the broader population in the transplantation system.
The evolving field of liver transplant (LT) oncology calls for tailored immunosuppression protocols to minimize the risk of tumor recurrence. We systematically reviewed the available evidence from inception to May 2023 regarding immunosuppression protocols used in patients undergoing LT for cholangiocarcinoma, neuroendocrine tumors (NET), hepatic-endothelial hemangioendothelioma, and colorectal liver metastases (CRLM) to identify common practices and to evaluate their association with oncological outcomes. Studies not involving humans, case reports, and short case series (ie, n < 10) were excluded.
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- Gene therapy is being developed for various genetic disorders and has shown success, particularly through methods like adeno-associated virus vectors which are effective in delivering therapeutic genes in vivo.
- Several gene therapies have received approval for treating conditions such as haemophilia A and B, spinal muscular atrophy, and specific liver diseases, but they can lead to liver reactions that vary significantly in severity and type among patients.
- Management strategies, including the use of corticosteroids, are employed to minimize liver injury and ensure the efficacy of the gene therapy, with an emphasis on tailored approaches depending on the individual's response and underlying condition.
Background & Aims: Utility, a major principle for allocation in the context of transplantation, is questioned in patients with acute-on-chronic liver failure grade 3 (ACLF-3) who undergo liver transplantation (LT). We aimed to explore long-term outcomes of patients included in a three-centre retrospective French study published in 2017.
Method: All patients with ACLF-3 (n = 73), as well as their transplanted matched controls with ACLF-2 (n = 145), 1 (n = 119) and no ACLF (n = 292), who participated in the Princeps study published in 2017 were included.
Article Synopsis
- CDK4/6 inhibitors, essential for treating HR+/HER2- metastatic breast cancer, are linked to higher instances of liver toxicity, described poorly in existing research.
- A retrospective study identified 22 cases of severe hepatitis induced by these drugs, with significant findings including acute centrilobular hepatitis confirmed by biopsies and cases resolved with corticosteroids.
- The research calls for better monitoring of liver health in patients using CDK4/6 inhibitors and suggests they be classified as causing autoimmune-like hepatitis, informing future management strategies for oncologists and patients.
Chemotherapy associated with Immune Checkpoint Inhibitors is currently the standard of care in several tumor indications. This combination approach improves progression free survival (PFS), overall survival (OS) and complete pathological response (pCR) in several cancer types both in the early and metastatic approaches. However, the distinct spectrum of toxicities between cytotoxic side effects and immune related adverse events (irAEs) with similar clinical presentations and different management strategies remains a challenge in daily practice for healthcare professionals.
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- - The 2023 Congress of ILTS, ELITA, and LICAGE in Rotterdam was a pivotal event for the liver transplant community, marking a recovery after COVID-19 with 1159 participants and increased abstract submissions.
- - The conference centered around "Liver Disorders and Transplantation: Innovations and Evolving Indications," covering various topics in Hepatology, Surgical Approaches, and more.
- - It served as a vital platform for discussions on advancements and collaborative efforts in the liver transplant field, highlighting ongoing innovations and evolving practices.
Article Synopsis
- Primary liver cancer can originate from two cell types, leading to different types of tumors: hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICCA), with combined tumors (cHCC-CCA) displaying mixed characteristics.
- Researchers utilized deep learning to categorize tumors in a study involving 405 cHCC-CCA patients, successfully distinguishing between HCC and ICCA types.
- This deep learning method showed potential for enhancing treatment strategies and improving patient outcomes for those with complex liver cancers.
Background & Aims: Retrospective studies have reported good results with liver transplantation (LTx) for acute-on-chronic liver failure (ACLF) in selected patients. The aim of this study was to evaluate the selection process for LTx in patients with ACLF admitted to the intensive care unit (ICU) and to assess outcomes.
Methods: This prospective, non-interventional, single high-volume center study collected data on patients with ACLF admitted to the ICU between 2017-2020.
Article Synopsis
- Solid organ transplant recipients are at a heightened risk for severe COVID-19 infections, needing further exploration of associated factors.
- A study used health data from France to assess the impact of health conditions and immunosuppressive medications on COVID-19 hospitalizations in solid organ transplant recipients.
- The results showed variable hospitalization rates for COVID-19 among different transplant groups, indicating that factors like age, sex, comorbidities, and type of immunosuppressive drugs play a significant role in the severity of the disease.
Autoimmune hepatitis (AIH) may recur after liver transplantation (LT). The aims of this study were to evaluate the incidence and risk factors for recurrent autoimmune hepatitis (rAIH). A multicenter retrospective French nationwide study, including all patients aged ≥16 transplanted for AIH, with at least 1 liver biopsy 1 year after LT, was conducted between 1985 and 2018.
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- * A Consensus Scientific committee, comprised of 106 members from 21 countries, conducted an in-depth literature review and reached recommendations regarding ideal graft-to-recipient weight ratios, monitoring portal pressure and flow, and diagnosing SFSS around postoperative day 7.
- * The committee proposed a new 3-grade severity stratification system to help clinicians identify patients at risk for SFSS early on, suggesting that further studies are necessary to validate this system.
Background: Rescue liver transplantation (LT) is the only life-saving option for posthepatectomy liver failure (PHLF) whenever it is deemed as irreversible and likely to be fatal. The goals were to perform a qualitative systematic review of rescue LT for PHLF and a survey among various international LT experts.
Methods: A literature search was performed from 2000 to 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Population, Intervention, Comparison, Outcome framework, and to this, the authors' experience was added.
Background: Immune-checkpoint inhibitor (ICI) hepatitis, which does not improve with steroids and requires additional immunosuppressant, is defined as steroid-refractory ICI hepatitis. The outcome of patients with steroid-refractory ICI hepatitis remains poorly determined. Herein, we investigated the incidence, clinical features, and outcome of patients treated with second-line immunosuppressant for steroid-refractory ICI hepatitis.
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- There is limited data on the safety and effectiveness of immunomodulatory drugs for treating autoimmune hepatitis (AIH), even though they are commonly used for other autoimmune conditions.
- A survey of hepatology centers in Europe revealed 25 AIH patients, most of whom received standard AIH treatment before starting unconventional therapies to address other autoimmune diseases.
- At the end of the follow-up period, 13 patients achieved a complete biochemical response, though some experienced relapses or insufficient response, and side effects from treatments were reported.
Background And Aims: Treatment of patients with acute on chronic liver failure (ACLF) admitted to the ICU is very limited. The aim of this pilot study was to evaluate the efficiency on liver function and safety of therapeutic plasma exchange (TPE) in critically ill cirrhotic patients admitted with ACLF in a liver ICU.
Methods: This is a prospective cohort of patients with ACLF grade > 2 treated by TPE admitted to the ICU that was matched to a control group.
Currently, one-year survival following liver transplantation (LT) exceeds 90% in large international registries, and LT is considered definitive treatment for patients with end-stage liver disease and liver cancer. Recurrence of disease, including hepatocellular carcinoma (HCC), significantly hampers post-LT outcomes. An optimal approach to immunosuppression (IS), including safe weaning, may benefit patients by mitigating the effect on recurrent diseases, as well as reducing adverse events associated with over-/under-IS, including chronic kidney disease (CKD).
View Article and Find Full Text PDFAcute-on-chronic liver failure (ACLF) is a clinical syndrome defined by an acute deterioration of the liver function associated with extrahepatic organ failures requiring intensive care support and associated with a high short-term mortality. ACLF has emerged as a major cause of mortality in patients with cirrhosis and chronic liver disease. ACLF has a unique pathophysiology in which systemic inflammation plays a key role; this provides the basis of novel therapies, several of which are now in clinical trials.
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- The 27th Annual Congress of the International Liver Transplantation Society took place from May 4 to 7, 2022, in Istanbul, with a hybrid format allowing both in-person and online attendance.
- The event saw participation from 1123 liver transplant professionals across 61 countries, and nearly 500 scientific abstracts were presented.
- The Vanguard Committee intended to summarize important invited lectures and noteworthy abstracts from the congress to benefit the liver transplant community.
Drug-induced liver injury (DILI) can mimic almost all other liver disorders. A phenotype increasingly ascribed to drugs is autoimmune-like hepatitis (ALH). This article summarises the major topics discussed at a joint International Conference held between the Drug-Induced Liver Injury consortium and the International Autoimmune Hepatitis Group.
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