Many studies reported a higher risk of COVID-19 disease among patients on dialysis or with kidney... more Many studies reported a higher risk of COVID-19 disease among patients on dialysis or with kidney transplantation, and the poor outcome of COVID-19 in these patients. Patients in conservative management for chronic kidney disease (CKD) have received attention only recently, therefore less is known about how COVID-19 affects this population. The aim of this study was to provide evidence on COVID-19 incidence and mortality in CKD patients followed up in an integrated healthcare program and in the population living in the same catchment area.The study population included CKD patients in conservative management recruited in the Emilia-Romagna Prevention of Progressive Renal Insufficiency (PIRP) project, followed up in the 4 nephrology units (Ravenna, Forlì, Cesena and Rimini) of the Romagna Local Health Authority (Italy) and alive at 1.01.2020. We estimated the incidence of COVID-19, its related mortality and the excess mortality within the PIRP cohort as of 31.07.2020. COVID-19 inciden...
Pretransplant donor biopsy (PTDB)-based marginal donor allocation systems to single or dual renal... more Pretransplant donor biopsy (PTDB)-based marginal donor allocation systems to single or dual renal transplantation could increase the use of organs with Kidney Donor Profile Index (KDPI) in the highest range (e.g. >80 or >90), whose discard rate approximates 50% in the United States. To test this hypothesis, we retrospectively calculated the KDPI and analyzed the outcomes of 442 marginal kidney transplants (340 single transplants: 278 with a PTDB Remuzzi score <4 [median KDPI: 87; interquartile range (IQR): 78-94] and 62 with a score ¼ 4 [median KDPI: 87; IQR: 76-93]; 102 dual transplants [median KDPI: 93; IQR: 86-96]) and 248 single standard transplant controls (median KDPI: 36; IQR: 18-51). PTDB-based allocation of marginal grafts led to a limited discard rate of 15% for kidneys with KDPI of 80-90 and of 37% for kidneys with a KDPI of 91-100. Although 1-year estimated GFRs were significantly lower in recipients of marginal kidneys (À9.3, À17.9 and À18.8 mL/min, for dual transplants, single kidneys with PTDB score <4 and ¼4, respectively; p < 0.001), graft survival (median follow-up 3.3 years) was similar between marginal and standard kidney transplants (hazard ratio: 1.20 [95% confidence interval: 0.80-1.79; p ¼ 0.38]). In conclusion, PTDB-based allocation allows the safe transplantation of kidneys with KDPI in the highest range that may otherwise be discarded.
European Journal of Vascular and Endovascular Surgery, 1999
Introduction: this prospective study defines the immune response to fresh arterial homograft repl... more Introduction: this prospective study defines the immune response to fresh arterial homograft replacement for graft infection. Materials and methods: ten patients who underwent ABO-compatible homograft transplantation were studied for anti-HLA antibody production, and CD3-CD4-CD8-positive lymphocytes subset. Immunological studies were performed preoperatively, and at early (1, 3, 7 days) and late (1, 3, 6, 12, 18, 24 months) follow-up. All patients received immunosuppressive treatment with cyclosporine (1-3 mg/kg/day). Abdominal CT scans were performed postoperatively at the 1, 6, 12, 18, 24 months follow-up. Results: preoperatively, antibodies could not be detected. Postoperatively, as from 1st month post-transplant, a progressive increase in % PRA was observed in all patients, up to the 12th month of follow-up. Subsequently, at 18 and 36 months, a progressive decrease in % PRA was detected. Data showed that the recipient antibodies were directed against donorspecific antigens. During the immediate postoperative period (1, 3, 7 days) CD3-and CD4-positive T lymphocytes slightly increased, whereas CD8 simultaneously decreased. Later, CD3 and CD4 progressively decreased and CD8 increased. Clinically, all patients were cured of infection at late follow-up. CT scans showed thickening of the aortic wall (range: 2.5-4.5 mm), with no signs of aneurysmal degeneration. Conclusions: fresh arterial homografts are immunogenic. Implanted homografts induce a strong anti-HLA antibody response, similar to chronic rejection, in spite of immunosuppressive treatment.
The prevalence of post-transplant malignancies, in renal transplant recipients, is higher than th... more The prevalence of post-transplant malignancies, in renal transplant recipients, is higher than that expected in age and sex-matched controls from the general population, and there is a markedly increased incidence of certain cancers. In 1137 renal transplant recipients (1020 from cadaveric and 117 from living donors, M/F 771/366) performed at the S. Orsola Renal Transplantation Centre since 10/1976 to 9/2001, we studied the post-transplant cancer prevalence, the correlation between cancer prevalence and population characteristics, the risk factors (smoke, cancer history, positive HBsAg and antiHCV infection) and the immunosuppressive therapy. The prevalence of malignancies was 3.86% (52 malignancies in 44 patients). The period between transplant and diagnosis of malignant disease was 59 +/- 85 months. Skin cancer was the most common (n=16; 30.7%), followed by lymphoproliferative disorders (n=8; 15.4%), Kaposi s sarcoma (n=6; 11.5%), uterine cancer (n=6; 11.5%), renal carcinoma of na...
Intradialytic coagulative and platelet activation, one of the main consequences of blood-membrane... more Intradialytic coagulative and platelet activation, one of the main consequences of blood-membrane contact, was studied in a group of 5 RDT patients with a comparative evaluation of 3 different dialytic membranes: Cuprophan (CU), Polysulfone (PS) and Cellulose Triacetate (CT). Each patient underwent 5 consecutive dialysis sessions with the above mentioned membranes. Intradialytic platelet activation was studied through a morpho-functional evaluation between the mean platelet volume (MPV) and Serotonin (S), beta-Thromboglobulin (beta-TG) and Platelet Factor 4 (PF4) serum levels. These determinations were made before HD (time 0) and after 30', 120', and 240'. We also checked the intradialytic status of thrombogenesis and fibrinolysis determining aPTT, thrombin time, fibrinogen, antithrombin III (AT III), alpha-2 antiplasmin and plasminogen, at the same time intervals. All membranes tested (CU, PS, CT) caused appreciable intradialytic platelet activation, above all after 15&...
Abnormalities in the amino acid patterns are a constant finding in chronic renal failure and can ... more Abnormalities in the amino acid patterns are a constant finding in chronic renal failure and can be regarded as one of the typical biochemical alterations of uremia. This paper evaluates the long-term effects of various artificial substitutive treatments and renal transplantation on plasma and tissue amino acid patterns in chronically uremic patients. Fifty-three patients were included in the study: 35 on artificial treatments (9 on hemodialysis, 9 on hemofiltration, 4 on hemoperfusion, 6 on continuous ambulatory peritoneal dialysis, and 7 on intermittent peritoneal dialysis) and 18 with well-functioning renal transplants. Complete plasma aminograms were performed in all patients before starting the treatment, and repeated every 3 months up to 1 year (artificial therapies) and 3 years (renal transplantation). The amino acid composition of the bone was also determined in 8 dialysis patients and 9 transplant patients. None of the artificial therapies was associated with normal plasma ...
Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia, 2002
BACKGROUND The prevalence of post-transplant malignancies, in renal transplant recipients, is hig... more BACKGROUND The prevalence of post-transplant malignancies, in renal transplant recipients, is higher than that expected in age and sex-matched controls from the general population, and there is a markedly increased incidence of certain cancers. METHODS In 1137 renal transplant recipients (1020 from cadaveric and 117 from living donors, M/F 771/366) performed at the S. Orsola Renal Transplantation Centre since 10/1976 to 9/2001, we studied the post-transplant cancer prevalence, the correlation between cancer prevalence and population characteristics, the risk factors (smoke, cancer history, positive HBsAg and antiHCV infection) and the immunosuppressive therapy. RESULTS AND CONCLUSIONS The prevalence of malignancies was 3.86% (52 malignancies in 44 patients). The period between transplant and diagnosis of malignant disease was 59 +/- 85 months. Skin cancer was the most common (n=16; 30.7%), followed by lymphoproliferative disorders (n=8; 15.4%), Kaposi s sarcoma (n=6; 11.5%), uterine...
The International Journal of Artificial Organs, 2005
We are pleased and honored to welcome you to the XXXII Congress of the European Society for Artif... more We are pleased and honored to welcome you to the XXXII Congress of the European Society for Artificial Organs (ESAO), which is held in Bologna from 5 to 8 October, 2005. The Congress is combined with the First Congress of the International Federation for Artificial Organs (IFAO), which is a newly formed ISAO-derived umbrella structure, embracing ESAO, the American Society for Artificial Internal Organs (ASAIO) and the Japanese Society for Artificial Organs (JSAO).
Seventy-four uremic patients in chronic hemodialysis were studied by X-ray of the thorax before a... more Seventy-four uremic patients in chronic hemodialysis were studied by X-ray of the thorax before and after the same dialysis. Radiological signs and variables (originally proposed by Milne) related to hemodynamics of pulmonary and systemic circulation were evaluated in relation to fluid subtraction. The study demonstrated the high sensitivity and the clinical value of thoracic radiography in the follow-up of these patients and particularly in the evaluation of fluid overload.
M.D. computing : computers in medical practice, 1991
This study concerns the use of commercial software (a spreadsheet combined with database and grap... more This study concerns the use of commercial software (a spreadsheet combined with database and graphic functions) to analyze data on kidney transplantation. The program consists of a section containing (macro) instructions, a section for entering data, a database, a set of spreadsheets (one for each field) with which the statistical calculations and summary tables are executed, and a set of diagrams for the final visual output. Three kinds of data are made available: descriptive statistics, actuarial survival rates, and risk factor evaluation. The program can analyze the importance of the variables considered and estimate the effect of a therapeutic or diagnostic maneuver.
Many studies reported a higher risk of COVID-19 disease among patients on dialysis or with kidney... more Many studies reported a higher risk of COVID-19 disease among patients on dialysis or with kidney transplantation, and the poor outcome of COVID-19 in these patients. Patients in conservative management for chronic kidney disease (CKD) have received attention only recently, therefore less is known about how COVID-19 affects this population. The aim of this study was to provide evidence on COVID-19 incidence and mortality in CKD patients followed up in an integrated healthcare program and in the population living in the same catchment area.The study population included CKD patients in conservative management recruited in the Emilia-Romagna Prevention of Progressive Renal Insufficiency (PIRP) project, followed up in the 4 nephrology units (Ravenna, Forlì, Cesena and Rimini) of the Romagna Local Health Authority (Italy) and alive at 1.01.2020. We estimated the incidence of COVID-19, its related mortality and the excess mortality within the PIRP cohort as of 31.07.2020. COVID-19 inciden...
Pretransplant donor biopsy (PTDB)-based marginal donor allocation systems to single or dual renal... more Pretransplant donor biopsy (PTDB)-based marginal donor allocation systems to single or dual renal transplantation could increase the use of organs with Kidney Donor Profile Index (KDPI) in the highest range (e.g. >80 or >90), whose discard rate approximates 50% in the United States. To test this hypothesis, we retrospectively calculated the KDPI and analyzed the outcomes of 442 marginal kidney transplants (340 single transplants: 278 with a PTDB Remuzzi score <4 [median KDPI: 87; interquartile range (IQR): 78-94] and 62 with a score ¼ 4 [median KDPI: 87; IQR: 76-93]; 102 dual transplants [median KDPI: 93; IQR: 86-96]) and 248 single standard transplant controls (median KDPI: 36; IQR: 18-51). PTDB-based allocation of marginal grafts led to a limited discard rate of 15% for kidneys with KDPI of 80-90 and of 37% for kidneys with a KDPI of 91-100. Although 1-year estimated GFRs were significantly lower in recipients of marginal kidneys (À9.3, À17.9 and À18.8 mL/min, for dual transplants, single kidneys with PTDB score <4 and ¼4, respectively; p < 0.001), graft survival (median follow-up 3.3 years) was similar between marginal and standard kidney transplants (hazard ratio: 1.20 [95% confidence interval: 0.80-1.79; p ¼ 0.38]). In conclusion, PTDB-based allocation allows the safe transplantation of kidneys with KDPI in the highest range that may otherwise be discarded.
European Journal of Vascular and Endovascular Surgery, 1999
Introduction: this prospective study defines the immune response to fresh arterial homograft repl... more Introduction: this prospective study defines the immune response to fresh arterial homograft replacement for graft infection. Materials and methods: ten patients who underwent ABO-compatible homograft transplantation were studied for anti-HLA antibody production, and CD3-CD4-CD8-positive lymphocytes subset. Immunological studies were performed preoperatively, and at early (1, 3, 7 days) and late (1, 3, 6, 12, 18, 24 months) follow-up. All patients received immunosuppressive treatment with cyclosporine (1-3 mg/kg/day). Abdominal CT scans were performed postoperatively at the 1, 6, 12, 18, 24 months follow-up. Results: preoperatively, antibodies could not be detected. Postoperatively, as from 1st month post-transplant, a progressive increase in % PRA was observed in all patients, up to the 12th month of follow-up. Subsequently, at 18 and 36 months, a progressive decrease in % PRA was detected. Data showed that the recipient antibodies were directed against donorspecific antigens. During the immediate postoperative period (1, 3, 7 days) CD3-and CD4-positive T lymphocytes slightly increased, whereas CD8 simultaneously decreased. Later, CD3 and CD4 progressively decreased and CD8 increased. Clinically, all patients were cured of infection at late follow-up. CT scans showed thickening of the aortic wall (range: 2.5-4.5 mm), with no signs of aneurysmal degeneration. Conclusions: fresh arterial homografts are immunogenic. Implanted homografts induce a strong anti-HLA antibody response, similar to chronic rejection, in spite of immunosuppressive treatment.
The prevalence of post-transplant malignancies, in renal transplant recipients, is higher than th... more The prevalence of post-transplant malignancies, in renal transplant recipients, is higher than that expected in age and sex-matched controls from the general population, and there is a markedly increased incidence of certain cancers. In 1137 renal transplant recipients (1020 from cadaveric and 117 from living donors, M/F 771/366) performed at the S. Orsola Renal Transplantation Centre since 10/1976 to 9/2001, we studied the post-transplant cancer prevalence, the correlation between cancer prevalence and population characteristics, the risk factors (smoke, cancer history, positive HBsAg and antiHCV infection) and the immunosuppressive therapy. The prevalence of malignancies was 3.86% (52 malignancies in 44 patients). The period between transplant and diagnosis of malignant disease was 59 +/- 85 months. Skin cancer was the most common (n=16; 30.7%), followed by lymphoproliferative disorders (n=8; 15.4%), Kaposi s sarcoma (n=6; 11.5%), uterine cancer (n=6; 11.5%), renal carcinoma of na...
Intradialytic coagulative and platelet activation, one of the main consequences of blood-membrane... more Intradialytic coagulative and platelet activation, one of the main consequences of blood-membrane contact, was studied in a group of 5 RDT patients with a comparative evaluation of 3 different dialytic membranes: Cuprophan (CU), Polysulfone (PS) and Cellulose Triacetate (CT). Each patient underwent 5 consecutive dialysis sessions with the above mentioned membranes. Intradialytic platelet activation was studied through a morpho-functional evaluation between the mean platelet volume (MPV) and Serotonin (S), beta-Thromboglobulin (beta-TG) and Platelet Factor 4 (PF4) serum levels. These determinations were made before HD (time 0) and after 30', 120', and 240'. We also checked the intradialytic status of thrombogenesis and fibrinolysis determining aPTT, thrombin time, fibrinogen, antithrombin III (AT III), alpha-2 antiplasmin and plasminogen, at the same time intervals. All membranes tested (CU, PS, CT) caused appreciable intradialytic platelet activation, above all after 15&...
Abnormalities in the amino acid patterns are a constant finding in chronic renal failure and can ... more Abnormalities in the amino acid patterns are a constant finding in chronic renal failure and can be regarded as one of the typical biochemical alterations of uremia. This paper evaluates the long-term effects of various artificial substitutive treatments and renal transplantation on plasma and tissue amino acid patterns in chronically uremic patients. Fifty-three patients were included in the study: 35 on artificial treatments (9 on hemodialysis, 9 on hemofiltration, 4 on hemoperfusion, 6 on continuous ambulatory peritoneal dialysis, and 7 on intermittent peritoneal dialysis) and 18 with well-functioning renal transplants. Complete plasma aminograms were performed in all patients before starting the treatment, and repeated every 3 months up to 1 year (artificial therapies) and 3 years (renal transplantation). The amino acid composition of the bone was also determined in 8 dialysis patients and 9 transplant patients. None of the artificial therapies was associated with normal plasma ...
Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia, 2002
BACKGROUND The prevalence of post-transplant malignancies, in renal transplant recipients, is hig... more BACKGROUND The prevalence of post-transplant malignancies, in renal transplant recipients, is higher than that expected in age and sex-matched controls from the general population, and there is a markedly increased incidence of certain cancers. METHODS In 1137 renal transplant recipients (1020 from cadaveric and 117 from living donors, M/F 771/366) performed at the S. Orsola Renal Transplantation Centre since 10/1976 to 9/2001, we studied the post-transplant cancer prevalence, the correlation between cancer prevalence and population characteristics, the risk factors (smoke, cancer history, positive HBsAg and antiHCV infection) and the immunosuppressive therapy. RESULTS AND CONCLUSIONS The prevalence of malignancies was 3.86% (52 malignancies in 44 patients). The period between transplant and diagnosis of malignant disease was 59 +/- 85 months. Skin cancer was the most common (n=16; 30.7%), followed by lymphoproliferative disorders (n=8; 15.4%), Kaposi s sarcoma (n=6; 11.5%), uterine...
The International Journal of Artificial Organs, 2005
We are pleased and honored to welcome you to the XXXII Congress of the European Society for Artif... more We are pleased and honored to welcome you to the XXXII Congress of the European Society for Artificial Organs (ESAO), which is held in Bologna from 5 to 8 October, 2005. The Congress is combined with the First Congress of the International Federation for Artificial Organs (IFAO), which is a newly formed ISAO-derived umbrella structure, embracing ESAO, the American Society for Artificial Internal Organs (ASAIO) and the Japanese Society for Artificial Organs (JSAO).
Seventy-four uremic patients in chronic hemodialysis were studied by X-ray of the thorax before a... more Seventy-four uremic patients in chronic hemodialysis were studied by X-ray of the thorax before and after the same dialysis. Radiological signs and variables (originally proposed by Milne) related to hemodynamics of pulmonary and systemic circulation were evaluated in relation to fluid subtraction. The study demonstrated the high sensitivity and the clinical value of thoracic radiography in the follow-up of these patients and particularly in the evaluation of fluid overload.
M.D. computing : computers in medical practice, 1991
This study concerns the use of commercial software (a spreadsheet combined with database and grap... more This study concerns the use of commercial software (a spreadsheet combined with database and graphic functions) to analyze data on kidney transplantation. The program consists of a section containing (macro) instructions, a section for entering data, a database, a set of spreadsheets (one for each field) with which the statistical calculations and summary tables are executed, and a set of diagrams for the final visual output. Three kinds of data are made available: descriptive statistics, actuarial survival rates, and risk factor evaluation. The program can analyze the importance of the variables considered and estimate the effect of a therapeutic or diagnostic maneuver.
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