Liver transplants

The mission is to contribute, through the various applications of liver transplantation in oncology, to advancing knowledge and improving treatment outcomes for primary and metastatic liver cancers. Since the second half of the 1990s, within the HPB (Hepato-Biliary-Pancreatic), within which the Liver Transplantation Unit is based, guidelines were established for the selection of cancer patients to undergo transplantation (the so-called ‘Milan Criteria’), as well as the definitive inclusion of liver transplantation as the only type of solid organ transplantation universally accepted in cancer treatment. ORGANISATION This is a simple unit attached to the Complex Structure GENERAL ONCOLOGICAL SURGERY 1 – Hepato-Gastro-Pancreatic. The Unit has both medical and surgical functions and activities. CLINICAL ACTIVITIES:
 Hepatological/oncological assessment of patients with primary and/or metastatic hepatobiliary neoplasms who are potential candidates for liver transplantation:
 Development of diagnostic and therapeutic pathways for patients assessed and accepted following multidisciplinary evaluation for inclusion on the liver transplant waiting list (follow-up and pre-transplant management)
 Coordination of logistical and organisational activities relating to the inclusion and management of the waiting list, with particular reference to the guidelines issued by the Society and regulatory bodies regarding urgency, clinical benefit, priority of the list, which varies depending on the outcome of treatments administered whilst on the waiting list, allocation of resources in exceptional cases and/or in advance, transplant benefits, pursuit of the best donor-recipient match, etc.
 Management of the actual transplant phase in collaboration with coordinating nursing staff, in order to ensure the necessary timing for the transport of donor and recipient teams, consent procedures, reassessments, quality monitoring and optimisation of therapies;
 Management of the post-transplant hospitalisation phase in relation to immunosuppression requirements and the consequent increased clinical risk. Establishment of collaborative pathways with the various specialities involved in case management;
 Management of the post-transplant phase on an outpatient basis, which can be classified as chronic care, as transplant patients can no longer be definitively assigned to a specific local area but must maintain an ongoing, lifelong relationship with the Transplant Centre. Given the situation of chronic immunosuppression and chronic liver disease resulting from the transplant status, outpatients are notoriously high-demand cases for internal medicine; in many instances, they require readmissions and corrective therapies entirely managed by the National Health Service
 Management of chronic immunosuppression and identification of diagnostic and therapeutic pathways for various post-transplant conditions, depending on the quality of the transplanted organ, the patient’s pre-existing conditions, and the main complications experienced during the peri-transplant period.
 Management of diagnostic and therapeutic pathways for patients experiencing a recurrence of their underlying condition (liver/gastroenterological or oncological)  Fulfilment of the numerous reporting obligations to the supervisory and regulatory authorities. RESEARCH ACTIVITIES In addition to its clinical and research activities, the SS is supported by a voluntary organisation (ODV) comprising volunteers and former patients, known as PROMETEO (an acronym for: Project for Liver Diseases, Transplantation and Oncology), which provides logistical and social support to meet the needs of hospitalised patients and their families, as well as contributing to the fulfilment of the SC’s technical and project-related requirements. The Association also addresses the accommodation needs of transplant recipients and transplant candidates who come from different regions of Italy for specialist consultations and treatment, providing them with various accommodation options just a short walk from the Foundation (Casa Prometeo). Significant projects currently active in clinical research, with broad long-term prospects, are focused on:
 Studies on the use of liver transplantation in the treatment of various forms of primary and secondary liver cancer;
 Studies on the combination of locoregional therapies and new treatments with checkpoint inhibitors (immunotherapy) in the downstaging of liver and gastrointestinal cancers;
 Studies to identify profiles that favour versus hinder the use of immunotherapy in relation to non-alcoholic steatohepatitis (NASH) in patients with solid tumours, not limited to strictly hepatological contexts

Contribution to theranostic studies (therapy + diagnostics) in solid tumours of the digestive tract, through the identification and isolation of microvesicles from the plasma of patients with cancer.
 Studies involving the systematic outpatient monitoring of patient-reported outcomes in the assessment of the long-term efficacy of liver transplantation.
EDUCATIONAL ORGANISATION The Department participates in numerous projects developed over the years in the field of Transplant Oncology in collaboration with the Scientific Directorate, the Lombardy Region and the Ministry of Health, as well as in various types of collaborative projects involving national and international scientific societies. The SS contributes to the activities of the University Chair of Surgery at the University of Milan, within the framework of the agreement between INT and UniMi for education and training programmes at various levels for healthcare professions, both undergraduate (medical students) and postgraduate (specialist schools and master’s programmes). Members of the SS regularly undertake teaching activities as part of the ‘Surgery’ course for the fifth and sixth years of study at the Faculty of Medicine and Surgery (taught in English) at the University of Milan (IMS: International Medical School), as well as at the Specialisation Schools in Surgery, Medical Oncology and Internal Medicine at the University of Milan. Intensive educational activities are carried out within the framework of various courses and master’s programmes organised by scientific societies such as the AISF (Italian Association for the Study of the Liver) and the National Academy of Medicine. FUNCTIONAL RELATIONSHIPS
Internal
- Strategic Management
- Scientific Management
- Staff units reporting to Strategic Management and Scientific Management
- Organisational units within the Foundation’s operational and functional departments.
External
- National and international universities
- Regional and national IRCCS centres
- Centres of excellence
- Lombardy Region (in particular the Directorate-General for Welfare and the Budget Directorate)
- Suppliers and other public and private entities
- ATS and ASST bodies of the Province and the Region