Publications by authors named "Vivarelli M"
Objective: To validate the ISGPS complexity grading system for minimally invasive pancreaticoduodenectomy (MIPD).
Background: Although concerns about patient safety persist, MIPD is gaining popularity. The ISGPS recently introduced a difficulty grading system to improve patient selection by aligning procedural complexity with surgeon and center expertise.
Background: C3 glomerulopathy is a rare clinical entity characterized by dysregulation of the alternative complement pathway in glomerular disease. Studies defining the natural history of C3G in the pediatric population are scarce.
Methods: Patients included in this retrospective study were diagnosed between 2011 and 2020 in 12 European pediatric nephrology units.
Article Synopsis
- The study investigated the effectiveness and safety of rituximab for treating childhood steroid-resistant nephrotic syndrome (SRNS) across 28 pediatric nephrology centers globally.
- Researchers found that children with a longer history of calcineurin inhibitors (CNIs) treatment before rituximab had lower remission rates compared to those with shorter treatment periods.
- Overall, rituximab showed enhanced remission rates in a portion of SRNS patients, was mostly safe, and achieving complete remission was linked to better kidney survival outcomes.
Article Synopsis
- The haemolytic uraemic syndromes (HUS) include various conditions, with some linked to complement activation (CaHUS).
- The 2023 International Society of Nephrology HUS Forum featured experts discussing the latest knowledge, uncertainties, and proposed solutions in diagnosing and managing HUS.
- Key areas needing research include naming conventions, complement testing, identifying biomarkers, genetic factors for aHUS, treatment strategies for C5 inhibitors, and improving access to care for patients.
Article Synopsis
- The lack of standardized definitions for clinical trial endpoints in pediatric kidney diseases makes it difficult to assess the effectiveness of treatments, particularly for steroid-resistant nephrotic syndrome (SRNS).
- SRNS is challenging to manage, often leading to kidney failure despite current therapies having low cure rates.
- An international group has developed standardized definitions for trial outcomes in SRNS, focusing on measurements like urine protein/creatinine ratios and estimated glomerular filtration rates to better evaluate treatment effectiveness.
Article Synopsis
- The study investigates how the length of time taken during liver surgeries affects the likelihood of postoperative complications in patients undergoing different types of liver resections.
- A total of 5,424 patients were analyzed from multiple centers between 2000 and 2022, focusing on procedures like right hemihepatectomy, technically major resection, and left lateral sectionectomy.
- Results show that patients in the longest operative time group had a significantly higher risk of complications, particularly in various surgical approaches like open, laparoscopic, and robotic surgeries.
Article Synopsis
- IgA nephropathy and IgA vasculitis with nephritis are kidney conditions that can occur in kids, but they're pretty rare.
- Unlike adults, children often show more severe symptoms quickly, like blood in their urine, and their kidneys look more inflamed when doctors check.
- There's not a lot of good information on how to treat these conditions because they're different in kids, and experts from around the world are trying to figure out better ways to help affected children.
Article Synopsis
- Recent international guidelines have defined metabolic dysfunction-associated steatotic liver disease (MASLD), leading to a rise in its prevalence as a reason for liver transplantation (LT) in Italy between 2012 and 2022.
- * An analysis of 1,941 patients with MASLD and 11,201 without MASLD revealed that while the prevalence of MASLD patients waiting for LT increased significantly, it did not independently affect patient survival post-transplant.
- * Patients with non-HCC MASLD faced higher mortality rates on the waiting list but projected better 5-year transplant survival benefits than those without MASLD or HCC.
Background: 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.
Article Synopsis
- A study was conducted to compare robotic minor liver resections (RMLR) with laparoscopic minor liver resections (LMLR) in patients undergoing surgery on the anterolateral liver segments.
- The analysis included over 10,000 patients and employed propensity score matching to balance the groups for accuracy in comparisons.
- Results indicated RMLR had benefits like less blood loss, lower major morbidity, and shorter hospital stays than LMLR, although the difference in 30-day readmission rates suggested RMLR may have some drawbacks.
Article Synopsis
- Liver transplantation (LT) was once thought not to work for a type of cancer called perihilar cholangiocarcinoma (pCCA), but a new method from the Mayo Clinic showed it could help if patients followed strict rules and took certain treatments first.
- In a study of 22 liver transplant centers in Italy, 53 patients with pCCA were looked at, with some getting special treatment before the transplant and others not.
- The results showed that patients who had the pre-treatment did better after 1, 3, and 5 years compared to those who didn’t, leading to talks about making new rules for how to treat this cancer better in Italy.
Article Synopsis
- Post-cholecystectomy bile duct injuries (BDIs) are serious complications that can negatively affect patient outcomes, with various surgical and endoscopic methods proposed for treatment but showing high failure rates.
- An individual patient data systematic review analyzed 342 cases (including 19 from their own study) to identify risk factors for treatment failure, particularly focusing on injuries categorized by Strasberg's classification.
- Findings revealed a 34.2% failure rate overall, with higher rates in surgical interventions, and identified specific injury types and treatment settings as key predictors for unsuccessful outcomes.
Background: It is well known that laparoscopic liver surgery can offer advantages over open liver surgery in selected patients. However, what type of procedures can benefit most from a laparoscopic approach has been investigated poorly thus far. The aim of this study is thus to define the extent of advantages of laparoscopic over open liver surgery for lesions in the anterolateral (AL) and posterosuperior (PS) segments.
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- The term atypical hemolytic uremic syndrome (aHUS) originated in the 1970s to differentiate between familial/sporadic cases and typical epidemic cases associated with Shiga toxin.
- Over time, aHUS has become a broad term for various diseases that don't relate to Shiga toxin, complicating the definition and treatment strategies due to its diverse causes.
- A group of experts used a consensus-building method called the Delphi approach to discuss and clarify the terminology and issues surrounding aHUS in light of advancements in medical science and targeted therapies.
Purpose: Single large hepatocellular carcinoma >5cm (SLHCC) traditionally requires a major liver resection. Minor resections are often performed with the goal to reduce morbidity and mortality. Aim of the study was to establish if a major resection should be considered the best treatment for SLHCC or a more limited resection should be preferred.
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- - This national survey aimed to assess the use of liver hypertrophy techniques in Italy, focusing on trends and differences among various medical centers.
- - In December 2022, 46 centers completed a detailed online questionnaire, revealing that hypertrophy techniques were used in 6.2% of liver resections, with PVE and ALPPS being the most common techniques employed.
- - The findings indicated that while these techniques play a crucial role in increasing resectability, there is substantial inconsistency in how centers define the need for them and the protocols used for patient allocation.
Article Synopsis
- The study aimed to create global benchmark outcome indicators for laparoscopic right posterior sectionectomies (L-RPS/H67) to improve surgical standards.
- It analyzed data from 854 patients across 57 centers globally, establishing key performance benchmarks for low-risk cases based on specific outcome indicators.
- The findings set standard benchmarks for metrics like operation time and complication rates, serving as a reference for surgical auditing and improvement.
Article Synopsis
- The study investigates the risk factors and outcomes related to open conversion during minimally invasive liver resections (MILR), especially in minor hepatectomies, highlighting its association with inferior results.
- Analysis was conducted on data from over 10,500 patients who underwent laparoscopic or robotic liver resections from 2004 to 2020, identifying key independent predictors for open conversion.
- Results show that patients who required open conversion experienced longer recovery times, increased blood loss, higher complications, and elevated 90-day mortality rates compared to those who had successful minimally invasive surgeries.
Article Synopsis
- Uncontrolled activation of the complement system can lead to kidney damage in various diseases, notably affecting conditions like atypical hemolytic uremic syndrome and C3 glomerulopathy, with recent evidence linking it to diabetic nephropathy and other glomerulonephritides.
- In 2022, a conference organized by Kidney Diseases: Improving Global Outcomes (KDIGO) focused on the importance of complement dysregulation in kidney diseases, discussing its role in diagnosis and treatment strategies.
- Conference discussions highlighted patient concerns regarding genetic testing and the integration of new therapies, as well as the need for better understanding of biomarkers and the microenvironment of the kidneys to improve monitoring and treatment of these diseases.
Purpose: To introduce percutaneous selective injection of autologous platelet-rich fibrin as a novel technique for persistent bile leakage repair and sharing the results of our preliminary experience.
Materials And Methods: Seven patients (57.1% females; mean age 69.
Background: Minimal change disease and primary focal segmental glomerulosclerosis in adults, along with idiopathic nephrotic syndrome in children, are immune-mediated podocytopathies that lead to nephrotic syndrome. Autoantibodies targeting nephrin have been found in patients with minimal change disease, but their clinical and pathophysiological roles are unclear.
Methods: We conducted a multicenter study to analyze antinephrin autoantibodies in adults with glomerular diseases, including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, IgA nephropathy, antineutrophil cytoplasmic antibody-associated glomerulonephritis, and lupus nephritis, as well as in children with idiopathic nephrotic syndrome and in controls.
Article Synopsis
- The 2022 Barcelona Clinic Liver Cancer algorithm advises against liver resection for patients with multiple small tumors (2 or 3 nodules, each ≤3 cm) in hepatocellular carcinoma.
- This study retrospectively analyzed data from over 12,000 patients to compare survival outcomes among those undergoing liver resection (LR), percutaneous radiofrequency ablation (PRFA), and transarterial chemoembolization (TACE).
- Results showed that LR had the highest survival rates at 1, 3, and 5 years (89.11%, 70.98%, 56.44% respectively) compared to PRFA and TACE, indicating that LR may offer better long-term outcomes in treating early multin
Liver transplant oncology (TO) represents an area of increasing clinical and scientific interest including a heterogeneous group of clinical-pathological settings. Immunosuppressive management after LT is a key factor relevantly impacting result. However, disease-related guidance is still lacking, and many open questions remain in the field.
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- A significant portion of atypical hemolytic uremic syndrome (aHUS) in children is linked to autoantibodies against complement factor H, prompting treatments like plasma exchange and eculizumab.
- In a study of 12 children treated with eculizumab, varying immunosuppressive strategies were used, but the decrease in anti-FH antibody levels was consistent regardless of the regimen.
- The study concluded that eculizumab is a safe and effective long-term treatment for aHUS related to anti-FH antibodies, and combining it with mycophenolate mofetil (MMF) may be sufficient for management.