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R Bellusci

Publications and source records attributed to R Bellusci.

At least 19 recordsLinked to original sources
PubMed2000

Abstension from treatment of low-level pp65 cytomegalovirus antigenemia after liver transplantation: a prospective study.

BACKGROUND: Ganciclovir is a highly effective and relatively safe drug to treat cytomegalovirus (CMV) infection in liver transplant patients; CMV resistance to ganciclovir is progressively emerging due to the extensive use of the drug in transplant and AIDS patients; CMV pp65 antigenemia allows early diagnosis of CMV infection and quantitation of the viral load; preemptive antigenemia-guided therapy of CMV infection can prevent CMV disease but the threshold of antigenemia value above which treatment has to be instituted is unclear. METHODS: To demonstrate the safety of abstention from preemptive treatment in the presence of low levels of antigenemia 77 consecutive liver transplant recipients were prospectively evaluated. Antigenemia was tested twice a week from transplantation until discharge, then once a week until the third postoperative month. In absence of risk factors for CMV disease, namely donor positive/recipient negative CMV serology, treatment with antibodies to lymphocytes and retransplantation, only patients with antigenemia of more than 50 or symptoms possibly related to CMV infection had preemptive treatment. RESULTS: A total of 32 patients had at least one positive antigenemia test with a value less than 50; 22 (68.7%) spontaneously cleared the virus, 3 were treated with i.v. ganciclovir for the presence of fever, and the other 7 (21,8%) progressed to values of antigenemia of more than 50 and were treated even if asymptomatic. No CMV disease was observed in these patients. CONCLUSION: CMV antigenemia less than 50 in liver transplant recipients with low and intermediate risk for CMV disease does not mandate preemptive ganciclovir treatment. Close surveillance with repeated determination of antigenemia until its negativization and careful clinical and laboratory monitoring is advisable.

Adult↗
PubMed1999

Porcine living liver transplantation using a vascular prosthesis to replace the intrahepatic vena cava.

BACKGROUND: This study aimed to determine whether the porcine model could be adapted to accommodate living donor liver transplantation (LLT). Because the pig hepatic anatomy precludes a standard approach, a study was designed to evaluate the results using a segment of vascular prosthesis to replace the intrahepatic portion of the inferior vena cava (IVC) with establishment of hepatic venous drainage into the graft. METHODS: A total of 10 LLT were performed using 20 pigs. After left hepatectomy, the intrahepatic IVC was replaced with a modified aorto-iliac prosthesis, anastomosing the proximal (aortic limb) to the infradiaphragmatic IVC, one distal iliac limb to infrahepatic IVC and the other (after shortening) to establish hepatic venous drainage after transplant. Conventional venous bypass was used, and no immunosuppressives were administered. RESULTS: All donors survived the 10-day posthepatectomy observation period. Eight of the 10 transplanted pigs survived at least 2 days (mean 7.6 days; range 3-13 days). No evidence of caval graft thrombosis was observed. CONCLUSIONS: Replacement of the recipient intrahepatic IVC by a vascular prosthesis allows to overcome the major technical obstacle which has limited the use of pigs in LLT.

Anastomosis, Surgical↗
PubMed1997

De novo hepatitis B and C viral infection after liver transplantation.

Hepatitis B (HBV) and hepatitis C (HCV) viral infections often recur after orthotopic liver transplantation (OLT), but viral infections acquired with OLT have not been widely investigated. The aim of the study was to evaluate the incidence, evolution, and diagnostic problems of de novo HBV and HCV infections in liver transplant recipients with long-term follow-up. Altogether 121 transplant recipients entered the study. HBV, HDV, and HCV infections were diagnosed by means of serology and the polymerase chain reaction (PCR). Three patients became hepatitis B surface antigen (HBsAg)-positive after OLT, all of whom showed signs of persistent viral replication. Twelve patients became anti-HCV-positive after OLT: After clearance of passive antibodies, active anti-HCV seroconversion was usually delayed. The viral genome was detected in 9 of 12 patients, with fluctuations of viremia during their follow-up. The other three patients, who were HBsAg-positive before and after OLT, were repeatedly HCV-RNA-negative despite persistent anti-HCV reactivity. Four pre-OLT HBsAg-positive patients had evidence of HBV-related liver transplant disease. The remaining 8 of 12 patients experienced repeated alanine aminotransferase increases more than two times normal after transplant. De novo infections due to primary hepatotropic viruses were frequent after OLT in our experience. Early diagnosis of infection, especially when the HCV is involved, may be problematic and should be taken into account in patients showing persistent aminotransferase abnormalities. Monitoring viral markers and accurate evaluation of biopsy specimens are mandatory. The interference between HBV and HCV might play a role in the replicative cycle of one or both viruses in co-infected patients.

Antibodies, Viral↗
PubMed1996

[Portosystemic shunts in the treatment of bleeding esophageal varices in cirrhotic patients: between sclerotherapy and transplantation].

In view of the proven efficacy of endoscopic sclerotherapy and the even improving results of liver transplantation, the present role of porto-systemic shunt should be reconsidered. From 1986 (when our liver transplant program began), to March 1994, 59 cirrhotic patients (males = 40, females = 19, mean age 53.17 +/- 12.04) underwent a porto-systemic shunt, 22 under emergency conditions and 37 in an elective setting. Patients were subdivided according to age, emergency or elective surgery, type of operation, and liver function. In the emergency procedures previous sclerotherapy and time between admission and surgery were also considered in the assessment. Mean follow-up was 46.49 +/- 31.48 months. Overall 5-year actuarial survival was 62.5%. In the emergency porto-systemic shunts the worst short-term results were obtained in patients over 55 years of age (p < 0.05) and when operations were performed within the first 24 hours after admission (p < 0.005). Long-term survival was not significantly influenced by the variables considered although patients over 55 years of age and patients with reduced liver function (Child B and C) seemed to have a more dismal outcome. Those patients under 55 years of age, with no portal thrombosis, considered as potential liver transplant candidates, had a better short-term survival rate (p < 0.05) than that of the rest of the patient population studied, mainly because of the better outcome after emergency surgery. Our data confirm the efficacy of porto-systemic shunt procedures in preserving the patient from variceal bleeding. They have a definite role in the complex treatment strategy of portal hypertension, and they must not be considered only a rescue procedure. However, liver transplantation remains the best option to resolve both portal hypertension and the underlying liver disease.

Actuarial Analysis↗
PubMed1995

Fatal necrotizing pancreatitis caused by hepatitis B virus infection in a liver transplant recipient.

A 32-year-old man who had undergone liver transplantation for fulminant hepatitis due to HBV infection developed fatal acute necrotizing pancreatitis on the 60th post-transplant day, while showing signs of intense viral replication. Immunohistochemistry and in situ hybridization of the pancreas following autopsy showed the presence of HBsAG and HBV-DNA in the cytoplasm of acinar cells, together with the picture of necrotizing pancreatitis. Clinical and histological features seem to indicate that pancreatitis was directly caused by HBV infection.

Acute Disease↗
PubMed1995

Ruptured hepatocellular carcinoma: an important cause of spontaneous haemoperitoneum in Italy.

OBJECTIVE: To evaluate the incidence of rupture of the tumour with intraperitoneal bleeding in a series of patients with hepatocellular carcinoma and its relative incidence as a cause of spontaneous haemoperitoneum, and to evaluate the results of the surgical treatment of a consecutive series of patients who presented with spontaneous haemoperitoneum caused by ruptured hepatoma. DESIGN: Retrospective study. SETTING: University hospital, Italy. SUBJECTS: 8 patients whose hepatocellular carcinoma ruptured (out of a total of 518) and caused spontaneous haemoperitoneum, and 34 patients who were admitted with spontaneous haemoperitoneum. INTERVENTIONS: Seven hepatic resections; in one case direct haemostasis was attempted because of the poor hepatic reserve. RESULTS: Rupture of the tumour with intraperitoneal bleeding occurred in 8/518 (2%) of cases of hepatocellular carcinoma. Ruptured hepatocellular carcinoma was the second most common cause of spontaneous haemoperitoneum (8/34; 24%), after gynaecological diseases (15/34; 44%). Of the 7 patients who presented with ruptured hepatocellular carcinoma and were treated by hepatic resection, 3 are alive (one with a recurrent disease) after a mean follow-up of six months (range 3 to 12 months) and 4 died of carcinomatosis within 12 months. The patient for whom resection was not feasible died immediately postoperatively of irreversible shock. CONCLUSIONS: Rupture of hepatocellular carcinoma is a relatively common cause of spontaneous haemoperitoneum. Diagnosis at the onset of symptoms has important therapeutic implications: as the results of surgical treatment are unsatisfactory, other procedures with the limited goal of achieving satisfactory haemostasis can be considered if the hepatocellular carcinoma has been diagnosed.

Adult↗
PubMed1994

[The intraperitoneal bleeding of hepatocellular carcinoma].

Intraperitoneal bleeding due to spontaneous rupture of hepatocellular carcinoma (HCC) is often a life-threatening condition as well as a poor prognostic sign in terms of the spread of neoplastic disease. Up to 12% of the patients with HCC are reported to develop this complication in Asia, while few cases have been observed to date in western countries, even in areas such as Italy where incidence of hepatocellular carcinoma is high. There is a lack of specific symptoms, therefore a correct diagnosis can be made only if the possibility of hepatocellular carcinoma rupture is taken into account in case of spontaneous hemoperitoneum and if imaging procedures are carefully focused on the liver. Once the presence of the malignant liver neoplasm is demonstrated, non surgical management, aimed solely at controlling the hemorrhage, can be considered. Herein we report 8 cases of spontaneous intraperitoneal bleeding observed in our Department. Our experience confirms that an exact diagnosis is rarely made before laparotomy and that long-term prognosis is poor even after surgical resection of the tumor: 5 of 7 patients who had hepatic resection developed an early recurrence and 4 of them died within one year.

Adult↗
PubMed1993

[Early thrombosis of the portal vein after orthoptic liver transplantation. A case report].

We report on a case of early portal vein thrombosis occurring after liver transplantation in a patient with alcoholic cirrhosis. Although this complication is usually accompanied by acute graft failure and/or gastroesophageal bleeding, in this patient the portal thrombosis occurred with the appearance of general dropsy and encephalopathy, serum protein deficiency and a slight rise in liver function test values. Echo-Doppler and arteriography showed portal thrombosis, arterial hyperflow and the persistence of a large spontaneous spleno-renal shunt, identified before the transplant had taken place. Endoscopy did not reveal gastroesophageal varices. Since there was no sign of serious ischemic damage or of a serious deterioration of liver function, the patient was treated non-operatively. Some particular hemodynamic aspects implicated in the appearance of portal thrombosis in our case are discussed. However, the authors consider that spontaneous portal-systemic shunt, in the presence of advanced cirrhosis, inverted portal flow, without gastroesophageal varices, can be considered as a surgical total diverting shunt and should be taken as a risk for portal thrombosis after transplantation.

Diabetes Mellitus, Type 1↗
PubMed1992

Bleeding esophageal varices: today's role of portosystemic shunts.

Emergency portosystemic shunting has once again become a significant option in the management of bleeding esophageal varices and portal hypertension. The decision to perform such a shunt and the choice of shunt procedure requires a rational assessment of the pathophysiology and hepatoportal hemodynamics of the patient's disease and the manner in which it is anticipated that the selected procedure may alter portal flow. Since shunt surgery may interfere with hepatic transplantation, the patient's suitability as a future transplant recipient must also be considered in choosing a shunt procedure. Furthermore, if a shunt is to be performed on an emergency basis to control acute bleeding, this procedure must be done before the patient's condition deteriorates sufficiently to represent a prohibitive surgical risk.

Emergencies↗