Alvaro, Domenico
Mayo Clinic
Department of Translational and Precision Medicine Sapienza University of Rome Italy.
Citations 2
Management of Liver Cirrhosis in Percutaneous and Surgical Cardiac Interventions
Spadaccio, C., Mehta, Krishna, Pisani, Angelo , Osho, Asishana, Juarez‐Casso, Fernando, Alvaro, Domenico, Arif, Imran, Panza, Antonio, Vester, Russell S., Louis, Louis B., Sundt, Thoralf M., Crestanello, Juan, Alvaro, Domenico , Osho, Asishana A. , Spadaccio, Cristiano , Pisani, Angelo , Osho, Asishana , Juarez-Casso, Fernando, Alvaro, Domenico , Panza, Antonio , Louis, Louis B , Sundt, Thoralf , Crestanello, Juan A , Rose, David , Spadaccio, Cristiano , Nenna, Antonio , Juarez-Casso, Fernando M. , Arif, Imran, Vester, Russell Samuel , Sundt, Thoralf M. , Rose, David
Journal of the American Heart Association | February 24, 2026 | Volume: 15 | Issue: 5 | Pages: No page available
The systemic impairment that accompanies liver cirrhosis is known to carry a significant burden on death and postoperative complications in cardiovascular interventions. This review analyzes the impact of liver cirrhosis on short‐ and long‐term outcomes after cardiac surgery and percutaneous procedures, providing an evidence‐based guidance in the decision‐making process and perioperative management of these patients. Several parameters should be considered by the heart teams when assessing eligibility, indications for intervention, and perioperative management of these patients. Life expectancy, long‐term procedural outcomes, Child–Pugh or the Model for End‐Stage Liver Disease score, presence of gastroesophageal varices and hepatic venous pressure gradient were extrapolated as the main determinants in decision making in patients with cirrhosis. Assessment and treatment of gastroesophageal varices is mandatory. Hepatic venous pressure gradient values >20 mm Hg preclude patients from a surgical approach. Considering the poor prognosis of advanced liver cirrhosis, futile treatments should be avoided. A multidimensional heart team approach involving surgical, cardiologic, anesthesiologic, hepatological, and medical considerations is recommended.
Genetic association analysis identifies variants associated with disease progression in primary sclerosing cholangitis
Alberts, Rudi , Vries, Elisabeth M. G. de, Goode, Elizabeth C. , Jiang, Xiaojun , Sampaziotis, Fotis , Rombouts, Krista , Böttcher, Katrin , Folseraas, Trine , Weismüller, Tobias J. , Alexander, Graeme, Alvaro, Domenico , Bergquist, Annika , Björkström, Niklas K. , Beuers, Ulrich , Boberg, Kirsten Muri , Bowlus, Christopher L. , Bragazzi, Maria Consiglia , Chazouillères, Olivier , Cheung, Angela , Dalekos, Georgios, Eaton, John E. , Eksteen, Bertus , Ellinghaus, David , Färkkilâ, Martti , Festen, Eleonora A. , Floreani, Annarosa , Franceschet, I., Gotthardt, Daniel , Hoek, Bart van , Holm, Kristian , Hov, Johannes R. , Imhann, Floris , Juran, Brian D., Lenzen, Henrike , Marschall, Hanns–Ulrich , Marzioni, Marco , Melum, Espen , Milkiewicz, Piotr , Müller, Tobias , Parés, Albert , Rupp, Christian , Rust, Christian, Sandford, Richard , Schrumpf, Erik, Silverberg, Mark S. , Srivastava, Brijesh, Sterneck, Martina , Teufel, Andreas , Vallier, Ludovic , Verheij, Joanne , Vila, Arnau Vich , Vries, Boudewijn de, Zachou, Kalliopi , Chapman, Roger W. , Manns, Michael P. , Rushbrook, Simon, Anderson, Carl A. , Karlsen, Tom H. , Ponsioen, Cyriel Y. , Weersma, Rinse K. , Eaton, John, Lazaridis, Konstantinos N. , Ellinghaus, David , Bowlus, Christopher L , Marzioni, Marco , Mason, Andrew L. , Wang, Weiwei , Bjornsson, Einar Stefan , Carbone, Marco , Dalekos, Georgios, Hirschfield, Gideon M. , Hohenester, Simon D. , Invernizzi, Pietro , Lieb, Wolfgang , Liu, Jimmy Z. , Schramm, Christoph , Schreiber, Stefan , Pinzani, Massimo , Franke, André , Bergquist, Annika , Milkiewicz, Piotr , Alvaro, Domenico , Hov, Johannes R , Anderson, Carl A
Gut | August 4, 2017 | Volume: 67 | Issue: 8 | Pages: 1517-1524
Objective Primary sclerosing cholangitis (PSC) is a genetically complex, inflammatory bile duct disease of largely unknown aetiology often leading to liver transplantation or death. Little is known about the genetic contribution to the severity and progression of PSC. The aim of this study is to identify genetic variants associated with PSC disease progression and development of complications. Design We collected standardised PSC subphenotypes in a large cohort of 3402 patients with PSC. After quality control, we combined 130 422 single nucleotide polymorphisms of all patients—obtained using the Illumina immunochip—with their disease subphenotypes. Using logistic regression and Cox proportional hazards models, we identified genetic variants associated with binary and time-to-event PSC subphenotypes. Results We identified genetic variant rs853974 to be associated with liver transplant-free survival (p=6.07×10–9). Kaplan-Meier survival analysis showed a 50.9% (95% CI 41.5% to 59.5%) transplant-free survival for homozygous AA allele carriers of rs853974 compared with 72.8% (95% CI 69.6% to 75.7%) for GG carriers at 10 years after PSC diagnosis. For the candidate gene in the region, RSPO3, we demonstrated expression in key liver-resident effector cells, such as human and murine cholangiocytes and human hepatic stellate cells. Conclusion We present a large international PSC cohort, and report genetic loci associated with PSC disease progression. For liver transplant-free survival, we identified a genome-wide significant signal and demonstrated expression of the candidate gene RSPO3 in key liver-resident effector cells. This warrants further assessments of the role of this potential key PSC modifier gene.