Giovanni Vizzini

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

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Bruno Gridelli

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Salvatore Gruttadauria

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Angelo Luca

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Giada Pietrosi

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Riccardo Volpes

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Duilio Pagano

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Roberto Miraglia

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Marco Spada

Bambino Gesù Children's Hospital

Pier Giulio Conaldi

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Davide Cintorino

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Cooperative Institutions

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

152

Istituti di Ricovero e Cura a Carattere Scientifico

122

University of Palermo

121

University of Pittsburgh

Ospedale Vincenzo Cervello

University of Pittsburgh Medical Center

Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo

University of Milan

Hospital Universitário Onofre Lopes

Consorci Institut D'Investigacions Biomediques August Pi I Sunyer

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DISTRIBUTION OF CYP3A5 AND MDR-1 SINGLE NUCLEOTIDE POLYMORPHISMS IN CAUCASIAN LIVER TRANSPLANT PATIENTS

Natale D’Alessandro Giuseppe Vizzini Manuela Labbozzetta Ambra Provenzani Monica Notarbartolo Di Villarosa

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Effectiveness of an electronic health record-data warehouse system implementation: return on investment analysis

International Journal of Medical Engineering and Informatics (2017)

Cinzia Muriana Giovanni Vizzini Tommaso Piazza Giulio Gilia Vincenzo Mistretta

Electronic health records (EHRs) allow the storing of a patient's history, and retrieval of information. Despite studies have pointed out the impact of EHRs in reducing healthcare structures' costs and increasing revenues, it is not clear if the return on investment (ROI) justifies the initial effort required. This paper proposes an advanced EHR joined to a data ware house (DWH) enabling business intelligence analysis, for structuring documents and manipulating atomic data. A case study is presented dealing with the implementation of a prototypal version of the EHR-DWH developed within the Smart Health 2.0 project (PON04a2_C), carried out between 2012 and 2015, at IRCCS-ISMETT, an Italian transplant institute. The ROI, the pay-back period, and the net present value have been calculated based on actual investment costs, and estimated maintenance costs. Results show that the ROI is in line with that of the reference sector, making profitable investments in EHRs.

Investment

Health records

Structuring

10.1504/ijmei.2017.086900

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Citations (7)

How to Improve Patients' Perceived Quality of Sleep During Hospitalization Through a Multicomponent “Good Sleep Bundle”: A Prospective Before and After Controlled Study

Global Journal on Quality and Safety in Healthcare (2022)

Barbara Ragonese Valeria Denotti Vincenzina Lo Re Giovanni Vizzini Brigida Corso

ABSTRACT Introduction Despite sound evidence on the importance of sleep for human beings and its role in healing, hospitalized patients still experience sleep disruption with deleterious effects. Many factors affecting patients' sleep can be removed or minimized. We evaluated the efficacy of a multicomponent Good Sleep Bundle (GSB) developed to improve patients' perceived quality of sleep, through which we modified environmental factors, timing of nighttime clinical interventions, and actively involved patients in order to positively influence their experience during hospitalization. Methods: In a prospective, before and after controlled study, two different groups of 65 patients each were admitted to a cardiothoracic unit in two different periods, receiving the usual care (control group) and the GSB (GSB group), respectively. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI) at the admission, discharge, and 30 days after discharge in all patients enrolled. Comparisons between the two groups evaluated changes in PSQI score from admission to discharge (primary endpoint), and from admission to 30 days after discharge (secondary endpoint). Results: The mean PSQI score difference between admission and discharge was 4.54 (SD 4.11) in the control group, and 2.05 (SD 4.25) in the GSB group. The mean difference in PSQI score change between the two groups, which was the primary endpoint, was 2.49 (SD 4.19). This difference was highly significant (p = 0.0009). Conclusion: The GSB was associated with a highly significant reduction of the negative effects that hospitalization produces on patients' perceived quality of sleep compared with the usual care group.

Sleep

Clinical endpoint

10.36401/jqsh-22-1

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Primary and Reactivated HHV8 Infection and Disease After Liver Transplantation: A Prospective Study

American Journal of Transplantation (2011)

Giada Pietrosi Giovanni Vizzini Loredana Pipitone Giuseppina Di Martino Marta I. Minervini

Human herpesvirus 8 (HHV8) is pathogenic in humans, especially in cases of immunosuppression. We evaluated the risk of HHV8 transmission from liver donors, and its clinical impact in southern Italy, where its seroprevalence in the general population is reported to be as high as 18.3%. We tested 179 liver transplant recipients and their donors for HHV8 antibodies at the time of transplantation, and implemented in all recipients a 12-month posttransplant surveillance program for HHV8 infection. Of the 179 liver transplant recipients enrolled, 10.6% were HHV8 seropositive before transplantation, whereas the organ donor's seroprevalence was 4.4%. Eight seronegative patients received a liver from a seropositive donor, and four of them developed primary HHV8 infection. Two of these patients had lethal nonmalignant illness with systemic involvement and multiorgan failure. Among the 19 HHV8 seropositive recipients, two had viral reactivation after liver transplantation. In addition, an HHV8 seronegative recipient of a seronegative donor developed primary HHV8 infection and multicentric Castleman's disease. In conclusion, primary HHV8 infection transmitted from a seropositive donor to a seronegative liver transplant recipient can cause a severe nonmalignant illness associated with high mortality. Donor screening for HHV8 should be considered in geographic areas with a high prevalence of such infection.

Immunosuppression

Seroprevalence

Liver disease

10.1111/j.1600-6143.2011.03769.x

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Citations (54)

Head and neck and esophageal cancers after liver transplant: results from a multicenter cohort study. Italy, 1997-2010

Transplant International (2015)

Pierluca Piselli Patrizia Burra Augusto Lauro Umberto Baccarani Giuseppe Maria Ettorre

Cumulative incidence

10.1111/tri.12555

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Citations (17)

VEGFR-2, HSP90 and GRP78/BiP expression and HCC recurrence after Liver Transplantation

Lydia Giannitrapani M. Cervello Sveva Corsale Maurizio Soresi Loredana Pipitone

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Critical use of extended criteria donor liver grafts in adult-to-adult whole liver transplantation: A single-center experience

Liver Transplantation (2008)

Salvatore Gruttadauria Giovanni Vizzini Domenico Biondo Lucio Mandalà Riccardo Volpes

This study presents our experience with the use of extended criteria donor (ECD) liver grafts. One hundred fifteen liver transplants were divided into 2 groups: standard (S) and nonstandard (NS). Fifty-eight patients in group S received a liver procured from an ideal donor, whereas 57 patients in group NS received an organ from an ECD. On the basis of the number of risk factors, patients were divided into 3 subgroups: the S group with 58 receiving a standard graft, the NS1 group with 44 receiving a graft with 1 or 2 risk factors, and the NS2 group with 13 receiving a graft with 3 to 4 risk factors. Patient survival was not different at 6, 12, and 24 months (P > 0.05), whereas graft survival was different (P = 0.0079). Both patient survival and graft survival were influenced by the cumulative number of risk factors. The univariate analysis of the donor risk factors detected hemodynamic factors as predictive of graft failure (P = 0.024) and death (P = 0.018). In the multivariate analysis, which was adjusted for recipient age and donor and recipient gender, hemodynamic risk factors and Model for End-Stage Liver. Disease score in the recipient were the only variables independently associated with graft failure (P = 0.006, P = 0.012, negatively). Finally, we observed a reduction of dropout from the list to 9% from 14.1% (P = 0.04) and of mortality on the list to 32.55% from 41.01% (P = 0.11). Critical use of ECD liver grafts allowed recipients in the waiting list to have a greater chance of being transplanted. Liver Transpl 14:220–227, 2008. © 2008 AASLD.

Single Center

Univariate analysis

Liver disease

10.1002/lt.21359

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Citations (45)

Lamivudine monoprophylaxis for de novo HBV infection in HBsAg-negative recipients with HBcAb-positive liver grafts

Clinical Transplantation (2010)

Giovanni Vizzini Salvatore Gruttadauria Riccardo Volpes Adele D’Antoni Giada Pietrosi

We followed the efficacy of long-term lamivudine monotherapy in preventing development of de novo hepatitis B (DNHB) in a large cohort of hepatitis B surface antigen (HBsAg)-negative recipients with grafts from hepatitis B core antibody (HBcAb)-positive donors. Recipients were observed over a long follow-up. Between July 1999 and December 2008, 45 patients (median age 54, range 19-67) who were HBsAg negative before transplantation were included in the study of monoprophylaxis with lamivudine starting on post-operative day 1, and continuing for life. Mean follow-up: 37.9 months; median 32.1 months (range 2.4-117). No suspension of therapy was reported during the study. Post-transplantation, no DNHB was observed in follow-up: all 45 HBsAg-negative recipients remained HBsAg and HBV DNA negative. Thirty-four of these HBsAg-negative recipients were alive at conclusion of the study. A total of 11 patients died, five of HCV recurrence, two of hepatocellular carcinoma (HCC) recurrence, two of disseminated KSV infection, and two of multiorgan failure because of early graft dysfunction. Patient and graft survival of HBsAg-negative recipients with HBcAb-positive donor grafts (45 cases) were not significantly different from those of the HBsAg-negative recipients with HBcAb-negative donor grafts (302 cases). In our experience, lamivudine monoprophylaxis provided complete protection against HBV reactivation and showed long-term efficacy.

10.1111/j.1399-0012.2010.01329.x

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Citations (24)

Hepatitis C Virus Infection in a Living‐Related Liver Donor

American Journal of Transplantation (2009)

Salvatore Gruttadauria Duilio Pagano Ioannis Petridis Giovanni Vizzini Riccardo Volpes

To the Editor: In November 2007, a 27‐year‐old‐male was found to be a suitable candidate for living donation to his 61‐year‐old mother, suffering from HCV‐related cirrhosis and hepatocellular carcinoma. He reported having received the hepatitis B vaccine series. The antibody to HCV on the index‐donation plasma unit was nonreactive (AxSYM HCV version 3.0; ELISA, Abbott, Chicago, IL), and his hemogram, renal function tests and liver profile were normal. Preoperative liver donor biopsy 15 days before surgery showed normal lobular architecture of hepatic parenchyma. In December 2007, a right hepatectomy was performed, without allogeneic blood transfusion. Blood samples were drawn one day before donation and hemogram, renal function tests, and liver profile were normal. The early postoperative course was uneventful, and the patient was discharged home on postoperative day seven. On postoperative day 19, his transaminases values were again elevated (10 times the upper normal limit). Abdominal CT‐scan and MRI showed no morphological signs of complication. Liver enzymes were significantly reduced when rechecked 3 days later, but on postoperative day 40 they went up again (ALT 459 IU/mL). At this point, we immediately performed a complete workup, including HAV, HCV, HBV, CMV, HSV, VZV, EBV, HHV‐6 and HHV‐8, to rule out infectious hepatitis. Anti‐HCV antibodies were negative, even when tested with a third‐generation anti‐HCV assay (Ortho‐Clinical Diagnostics, Inc., Johnson & Johnson, New Brunswick, NJ), however, HCV‐RNA was positive in peripheral blood samples, with 1 250 000 genome copies per mL (Cobas TaqMan HCV Test, v2.0; Roche Diagnostics, Branchburg, NJ). The HCV genotype identified in the donor was 1b, the same as the recipient. We investigated all transplant‐related procedures, and operating rooms, and found no potential source of transmission. No cross‐contamination occurred during the procedure, because we used different operating rooms, surgical instruments and medical and nursing staff. The donor and recipient did not share living space in the postoperative course, and stayed in separate rooms at the hospital. They also had normal, healing postoperative wounds upon discharge. We opted for expectant management (1Afdhal NH Lok ASF Di Bisceglie AM Management of incidental hepatitis C virus infection.N Engl J Med. 2009; 360: 1902-1906Crossref PubMed Scopus (12) Google Scholar). Anti‐HCV antibodies became positive on postoperative day 57. However, a persistently elevated transaminases level and HCV‐RNA positivity (3730 genome copies per mL) in the third postoperative month prompted us to start therapy. HCV therapy with peginterferon and ribavirin was started in April 2008, with clearance of HCV‐RNA after 52 days of treatment and normalization of transaminases levels after a cycle of 12 weeks. The patient remained HCV‐RNA negative, with normal liver function tests at the last follow‐up visit, 6 months after treatment discontinuation. To the best of our knowledge there is a single reported case of a living liver‐donor with sustained liver dysfunction due to a new onset HCV infection without having undergone allogeneic transfusion (2Umeshita K Fujiwara K Kiyosawa K et al.Operative morbidity of living liver donors in Japan.Lancet. 2003; 362: 687-690Abstract Full Text Full Text PDF PubMed Scopus (250) Google Scholar). We cannot exclude a potential acquisition during the postoperative course, although we believe the infection could have been acquired prior to surgery in the window period between initial evaluation and surgical procedures. Therefore, we suggest that every potential donor be tested for anti‐HCV antibodies and HCV‐RNA at the time of evaluation and immediately before donation. If HCV infection is detected, donation must be cancelled.

Liver function

10.1111/j.1600-6143.2009.02874.x

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Octreotide Compared With Placebo in A Treatment Strategy for Early Rebleeding in Cirrhosis. A Double Blind, Randomized Pragmatic Trial

Hepatology (1998)

Gennaro D’Amico F. Politi Alberto Morabito Adele D’Antoni Daniela Guerrera

β–Blockers and sclerotherapy prevent long–term upper digestive rebleeding in cirrhosis but they seem ineffective for early rebleeding. We compared octreotide with a placebo for the prevention of early rebleeding in cirrhotic patients. After control of acute upper digestive bleeding, 262 consecutive cirrhotic patients were randomized to octreotide 100 μg subcutaneously three times a day for 15 days (n = 131) or to the placebo (n = 131), in a double blind pragmatic trial in which β–blockers and/or sclerotherapy were allowed together with the experimental treatment. Separate randomization and analysis were performed according to whether patients were eligible for β–blockers and/or sclerotherapy (101 placebo, 97 octreotide) or not (30 placebo, 34 octreotide). Rebleeding within 15 days was the primary measure of treatment efficacy; 6–week rebleeding rate was also assessed as a secondary measure. Fifteen–day cumulative proportions of patients rebleeding were 28% in the placebo group and 24% in the octreotide group ( P = .40); corresponding figures among the 198 patients eligible to β–blockers and/or sclerotherapy were 26% and 16% ( P = .05) and among the 64 not eligible for these treatments 33% and 49% ( P = .29). Among patients eligible to β–blockers and/or sclerotherapy, a significant reduction of rebleeding episodes (35 vs. 18, P = .03), blood transfusions (75 vs. 50, P = .04), and days of stay in hospital (1,544 vs. 1,190, P = .0001) was also found in the octreotide group: this beneficial effect was confirmed 6 weeks after randomization. Mortality was not affected by octreotide in either group of patients. It is suggested that octreotide may reduce the risk of early rebleeding in cirrhotic patients treated with β–blockers and/or sclerotherapy after control of acute upper digestive bleeding. Further studies are needed to confirm this result.

10.1002/hep.510280507

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Citations (78)