The focus of the Unit is to improve transplantation outcomes. Kidney transplantation is the only available cure for end-stage kidney disease; similarly, beta cell replacement (i.e. pancreas or pancreatic islet transplantation) represents the only available therapy to achieve insulin independence in type 1 diabetes. Enhancing patient access to these procedures, when indicated, and preserving organ function after transplantation is pivotal to reduce the burden of end-stage kidney disease and type 1 diabetes.
Our clinical research activity relates to different aspects of kidney and pancreas transplantation, with a high specialization in pancreatic islet transplantation. Our Unit is also involved in clinical research projects aimed at understanding and treating the mechanisms underlying the metabolic abnormalities associated with obesity, both in transplant recipients and in the general population.
- Beta cell replacement (pancreas transplantation, islet transplantation). Our research aims at identifying the immunosuppressive regimens with the most favorable risk-benefit ratio for patients undergoing beta cell replacement, and the most appropriate site for pancreatic islet transplantation. Furthermore, beta cell replacement allows studying the effect of type 1 diabetes remission on diabetes-related complications (e.g. diabetic nephropathy, retinopathy, diabetic bone disease), which in turn may help improve our understanding of the mechanisms underlying such complications and develop novel strategies to prevent them.
- Kidney transplantation. Viral infections may lead to graft loss in kidney transplant recipients. Our Unit participates in multicenter randomized clinical trials to assess the efficacy of novel drugs to tackle cytomegalovirus (CMV) and BK virus infections. Our efforts are also directed at identifying predictors of progression to BK virus-associated nephropathy. Post-transplantation diabetes (PTDM) is another complication that may severely affect both short- and long-term outcomes of kidney transplant recipients in terms of graft and patient survival. The Unit is developing research protocols to assess the efficacy of prevention strategies as well as the efficacy and safety of different therapeutic approaches to improve metabolic control and long-term outcomes. Our Unit, in collaboration with the Transplant and Metabolic/Bariatric Surgery Unit, is also assessing the role of hypothermic machine perfusion in the prediction of postoperative kidney transplantation outcomes.
- Obesity and insulin resistance. Morbid obesity may contraindicate transplant surgery. On the other hand, weight gain and obesity are frequent after organ transplantation, due to several factors including immunosuppressive drugs and psychological factors. The presence of obesity increases risk of PTDM and adverse outcomes in transplant recipients. In collaboration with the Transplant and Metabolic/Bariatric Surgery Unit, our Unit is studying the role of weight loss surgery in the management of kidney transplant candidates and recipients. Sarcopenic obesity (SO), i.e. obesity with reduced muscle mass/strength, is associated with increased morbidity/mortality and metabolic derangements. In collaboration with the Transplant and Metabolic/Bariatric Surgery Unit, we are developing protocols to dissect the mechanisms underlying SO and identify biomarkers for diagnosing and monitoring the condition.
- Phase I trials. The Transplant Medicine Unit has submitted to AIFA the certification as Accredited Phase I Research Unit.
Balzano G, Nano R, Maffi P, Mercalli A, Melzi R, Aleotti F, Gavazzi F, Tinti C, De Cobelli F, Magistretti P, Scavini M, Capretti G, Secchi A, Del Maschio A, Zerbi A, Falconi M, Piemonti L. Salvage islet auto transplantation after relaparatomy. Transplantation 2017 Oct;101(10):2492-2500.
Codella R, Adamo M, Maffi P, Piemonti L, Secchi A, Luzi L. Ultra-marathon 100 km in an islet-transplanted runner. Acta Diabetol. 2017 Jul;54(7):703-706.
Mfarrej B, Tresoldi E, Stabilini A, Paganelli A, Caldara R, Secchi A, Battaglia M. Generation of donor-specific tr1 cells to be used after kidney transplantation and definition of the timing of their in vivo infusion in the presence of immunosuppression. Journal of Translational Medicine 2017 Feb 21;15(1):40.
Bassi R, Niewczas M, Biancone L, Bussolino S, Tezza S, D’Addio F, Ben Nasr M, Valderrama-Vasquez A, Usuelli V, De Zan V, El Essawy B, Venturini M, Secchi A, Lin A, Chandraker A, Fiorina P. Metabolomic profiling in individuals with a failing kidney allograft. PlosOne 2017 Jan; 12(1): e0169077.
Balzano G, Maffi P, Nano R, Mercalli A, Melzi R, Aleotti F, Zerbi A, De Cobelli F, Gavazzi F, Magistretti P, Scavini M, Peccatori J, Secchi A, Ciceri F, Del Maschio A, Falconi M, Piemonti L. Autologous islet transplantation in patients requiring pancreatectomy: a broader spectrum of indications beyond chronic pancreatitis. Am J Transplant 2016 Jun;16(6):1812-26.
Venturini M, Sallemi C, Colantoni C, Agostini G, Balzano G, Esposito A, Secchi A, De Cobelli F, Falconi M, Piemonti L, Maffi P, Del Maschio A. Single- centre experienceof extending indications for percutaneous intraportal islet autotransplantation (pipiat) after pancreatic surgery to prevent diabetes: feasibility, radiological aspects, complications and clinical outcome. Br J Radiol 2016; 89(1064):20160246.
Chiari D, Bissolati M, Gazzetta PG, Guarnei G, Tomanin D, Maffi P, Secchi A, Rosati R, Socci C. Pancreas transplantation from very small pancreatic donor using the cephalic placement technique: a case report. Transplant Poc. 2016 Mar;48(2):435-7.
D'addio F, La Rosa S, Maestroni A, Jung P, Orsenigo E, Ben Nasr M, Tezza S, Bassi R, Finzi G, Marando A, Vergani A, Frego R, Albarello L, Andolfo A, Manuguerra R, Viale E, Staudacher C, Corradi D, Batlle E, Breault D, Secchi A, Folli F, Fiorina P. Circulating igf-i and igfbp3 levels control human colonic stem cell function and are disrupted in diabetic enteropathy. Cell Stem Cell 2015;17(4):486-498.
Venturini M, Maffi P, Querques G, Agostini G, Piemonti L, Sironi S, De Cobelli F, Fiorina P, Secchi A, Del Maschio A. Hepatic steatosis after islet transplantation: can ultrasound predict the clinical outcome? A longitudinal study in 108 patients. Pharmacol Res. 2015 Aug;98:52-9.
Maffi P, Secchi A. Clinical results of islet transplantation. Pharmacol Res. 2015; 98: 86-91.