Publications by authors named "Roberta Angelico"
In obese patients, metabolic dysfunction-associated steatotic liver disease is becoming a leading etiology of end-stage liver disease and HCC. Simultaneous liver transplantation and sleeve gastrectomy (LT-SG) have been proposed in the United States, but the safety and efficacy of the procedure have not been widely explored in Europe. Between January 2016 and December 2022, morbidly obese patients listed for liver transplantation at Tor Vergata University were enrolled in the LT-SG study.
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- This study looked at how different hospitals approach treating liver cancer, especially regarding liver transplants.
- They surveyed 75 hospital directors to see if those with liver transplant programs treat patients differently compared to those without.
- The results showed that hospitals with transplant programs were more likely to recommend transplants for certain types of liver cancer and other liver diseases than those without, showing a need for better communication between the two types of centers.
Article Synopsis
- - Patients with ulcerative colitis (UC) who undergo liver transplantation (LT) due to primary sclerosing cholangitis (PSC) are at a higher risk for developing colorectal cancers (CRC), showing a cumulative incidence of 5.5% within the first three years post-transplant.
- - A systematic review analyzed 15 studies involving 88 patients, finding that those with long-standing UC and active colitis develop tumors shortly after LT, with disease-free survival (DFS) rates at one, two, and three years being 92%, 82%, and 75%, respectively.
- - Despite the high risk of CRC, surgical resection post-CRC showed successful outcomes, with 94% of patients maintaining good graft
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.
View Article and Find Full Text PDFBackground: Intraductal papillary neoplasms of the bile duct (IPNB) are rare precancerous lesions with implications for the development of cholangiocarcinoma (CCA). Recognizing IPNB and managing its recurrence pose challenges in clinical practice. We present two cases.
View Article and Find Full Text PDFBackground: The challenge of transplant waiting-lists is to provide organs for all candidates while maintaining efficiency and equity.
Aims: We investigated the probability of being transplanted or of waiting-list dropout in Italy.
Methods: Data from 12,749 adult patients waitlisted for primary liver-transplantation from January 2012 to December 2022 were collected from the National Transplant-Registry.
In the last decade, immunotherapy (IT) has revolutionized oncology and found indications in many cancers, including hepatocellular carcinoma (HCC). In HCC, IT has become the leading systemic therapy for advanced diseases. At the same time, it carries the promise of being a valuable therapy in other settings, including intermediate-stage and unresectable disease, as a downstaging or conversion modality.
View Article and Find Full Text PDFBackground: Liver transplant (LT) recipients often experience adverse effects of immunosuppressive (IS) drugs, especially on metabolic profiles. Selected LT recipients can achieve successful IS withdrawal; however, its effects on metabolic syndrome (MS) are unknown.
Methods: This is a retrospective single-center study investigating the incidence and/or regression of MS in 75 selected LT recipients who were previously enrolled in prospective IS withdrawal trials between 1999 and 2017.
Article Synopsis
- Minimally invasive liver surgery (MILS) is becoming a big deal in treating liver cancer over the last 20 years.
- More patients who are not able to have traditional surgery can now get MILS because new treatments are making it possible.
- MILS is generally better than open surgery for recovery and has also opened up options for more people needing liver surgery.
Background: International and national registries consistently report substantial differences in kidney transplant (KT) activity despite demonstrable clinical and financial benefits. The study aims to estimate the financial resources gained by KT and produce a benchmark analysis that would inform adequate strategies for the growth of the service.
Methods: We analyzed the KT activity in our region between 2017 and 2019.
Article Synopsis
- Solid organ transplant (SOT) recipients, especially kidney transplant (KT) patients, showed a weaker immune response to COVID-19 vaccines compared to liver transplant (LT) recipients, prompting the use of monoclonal antibodies tixagevimab-cilgavimab (TGM/CGM) for pre-exposure prophylaxis (PrEP).
- In a study involving 306 SOT patients who completed their vaccine series, 80.3% had protective antibody levels, but KT recipients had significantly lower protection rates at 75.6% compared to 89.0% in LT patients.
- Of those who were non-protected, fewer developed COVID-19 after receiving PrEP, highlighting its efficacy, as
Background & Aims: Mortality on the paediatric liver transplantation (pLT) waiting list (WL) is still an issue. We analysed the Italian pLT WL to evaluate the intention-to-treat (ITT) success rate and to identify factors influencing success.
Methods: All children (<18 years) listed for pLT in Italy between 2002-2018 were included (Era 1 [2002-2007]: centre-based allocation; Era 2 [2008-2014]: national allocation; Era 3 [2015-2018]: national allocation+mandatory-split policy).
Background And Aims: Obesity is a growing healthcare challenge worldwide and a significant risk factor for liver failure as seen with non-alcoholic steatohepatitis (NASH). Combining metabolic-bariatric surgery (MBS) with liver transplantation (LT) appears as attractive strategy to treat both, the underlying liver disease and obesity. However, there is an ongoing debate on best timing and patient selection.
View Article and Find Full Text PDF: The role of tailored immunosuppression (IS) in the development of the humoral response (HR) to SARS-CoV-2 mRNA-based vaccination in liver transplant (LT) recipients is unknown. : This is a single-centre prospective study of patients who underwent LT between January 2015 and December 2021 and who have received three doses of mRNA-based SARS-CoV-2 vaccination. Patients undergoing Tacrolimus-based immunosuppression (TAC-IS) were compared with those undergoing Everolimus-based immunosuppression (EVR-IS).
View Article and Find Full Text PDFIntroduction: Machine perfusion (MP) was developed to expand the donor pool and improve liver transplantation (LT) outcomes. Despite optimal results in clinical trials, the real-world MP benefit in centers with low-/mid-volume activity (LVCs) is still being determined.
Methods: Online survey on MP for LT, distributed to worldwide LT-centers representatives.
Article Synopsis
- COVID-19 made it harder for doctors to perform surgeries, but some new ways of working could be helpful in the future.
- A survey of Italian surgeons showed that they started using online consultations and education much more after the pandemic hit.
- Though there were fewer surgeries, the pandemic encouraged new technologies like telemedicine, which many doctors found useful and want to keep using.
This review aims to evaluate the current preclinical state of liver bioengineering, the clinical context for liver cell therapies, the cell sources, the delivery routes, and the results of clinical trials for end-stage liver disease. Different clinical settings, such as inborn errors of metabolism, acute liver failure, chronic liver disease, liver cirrhosis, and acute-on-chronic liver failure, as well as multiple cellular sources were analyzed; namely, hepatocytes, hepatic progenitor cells, biliary tree stem/progenitor cells, mesenchymal stromal cells, and macrophages. The highly heterogeneous clinical scenario of liver disease and the availability of multiple cellular sources endowed with different biological properties make this a multidisciplinary translational research challenge.
View Article and Find Full Text PDFBackground & Aims: Split liver transplant(ation) (SLT) is still considered a challenging procedure that is by no means widely accepted. We aimed to present data on 25-year trends in SLT in Italy, and to investigate if, and to what extent, outcomes have improved nationwide during this time.
Methods: The study included all consecutive SLTs performed from May 1993 to December 2019, divided into three consecutive periods: 1993-2005, 2006-2014, and 2015-2019, which match changes in national allocation policies.
Background: Growing interest has been recently reported in the potential detrimental role of donor gamma-glutamyl transferase (GGT) peak at the time of organ procurement regarding the risk of poor outcomes after liver transplantation (LT). However, the literature on this topic is scarce and controversial data exist on the mechanisms justifying such a correlation. This study aims to demonstrate the adverse effect of donor GGT in a large European LT cohort regarding 90-day post-transplant graft loss.
View Article and Find Full Text PDFBackground: Post-hepatectomy liver failure is a severe complication after major liver resection and is associated with a high mortality rate. Nevertheless, there is no effective treatment for severe liver failure. In such a setting, rescue liver transplantation (LT) is used only in extraordinary cases with unclear results.
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- - The Renal Biopsy for Kidney Transplantation Therapy (ReBIrth) meeting held on May 31, 2022, in Bologna, Italy, focused on advancements in kidney transplantation, bringing together key experts in nephrology, surgery, and pathology.
- - The paper highlights experiences with kidney transplants and aims to report on the histopathological features of failed kidney allografts, analyzed through a digital pathology platform.
- - Findings suggest that digital pathology effectively identifies critical morphological and immunohistochemical traits, potentially enhancing the use of immunosuppressive therapy to reduce graft failure and improve patient care.
Background: In this study, the Keynesian principle "savings may be used as investments in resources" is applied to Kidney Transplantation (KT), contextualizing the whole Organs Donation and Transplantation (ODT) service as a unique healthcare entity. Our aim was to define the financial resources that may be acquired in the form of savings from the KT activity.
Methods: We analyzed registry and funding data for ODT in our region, between 2015 and 2019.
Article Synopsis
- The study examines the long-term safety and effectiveness of withdrawing hepatitis B immunoglobulins (HBIg) in patients who underwent liver transplantation for hepatitis Delta and hepatitis B-related cirrhosis.
- A cohort of 16 patients who discontinued HBIg after a median of 24.5 months showed no recurrence of HDV/HBV infections during a follow-up period of over 11 years, with half developing immunity to HBV.
- The findings suggest that HBIg withdrawal is a viable strategy post-transplant and may warrant a reevaluation of existing prophylactic treatment guidelines for these patients.