APOL1 high-risk variants predispose to chronic kidney disease (CKD) in individuals of African genetic ancestry due to podocyte toxicity. As congenital anomalies of the kidney and urinary tract (CAKUT) have variable outcomes potentially driven by podocyte injury, we hypothesize that the outcome of children with CAKUT is influenced by APOL1 risk genotypes. APOL1 risk status was determined in children and adults with CAKUT from African genetic ancestry using DNA microarrays or exome sequencing. Phenotypic information and CKD outcomes at last follow-up were collected. We computed odds ratios (OR) and hazard ratios between APOL1-high risk (HR) vs. low risk (LR) carriers under different models using logistic regression and Cox proportional hazards. Clinical data were available for 195 patients (median age 15.35 years, [IQR 11.01–19.87]), including 20 (10.3
Abstract Background and aims Despite adequate anticoagulation, patients with atrial fibrillation (AF) still experience a 13% annual risk of recurrent stroke. We investigated in a multicentre prospective study whether a strategy based on DOAC prescribed according to plasma levels was superior to standard DOAC prescription in the prevention of recurrent stroke. Methods This study enrolled consecutive patients admitted with stroke while on DOAC for AF from 2024 to 2026 (currently) at 9 comprehensive stroke centres. Anticoagulation was restarted after stroke according to current guidelines, with DOAC chosen by the clinician. Three centers (RN, CE, BA) transitioned to a dosing strategy, measuring peak-trough DOAC plasma level after anticoagulation restart, switching DOAC until reaching therapeutic plasma levels (tailored group). The remaining centers maintained a standard of care policy, with prescription of DOAC without plasma level dosage. Recurrence of ischemic stroke, hemorrhagic stroke, TIA and major cardiovascular events were adjudicated by at 3 and 12-months through hot and cold pursuit. Results Overall 510 consecutive patients with stroke while on DOACs were consecutively included across all centers, 65 in the tailored group and 445 in the standard of care group. Mean age was 78 years, 50.5% male. No differences in terms of clinical features, cardiovascular risk factors and hyperacute treatment were found across groups. The 3-month recurrent stroke rate was 4.2% in tailored group and 5.9% in the standard of care group. Conclusions We expect to reach 85 patients in tailored group in Feb2026, finalizing the analysis for recurrent ischemic stroke and ICH in April 2026. Conflict of interest
Home-based inotropic therapy represents a therapeutic strategy in patients with advanced heart failure (AdvHF), both for a bridge to life-saving treatments such as heart transplant or ventricular assist devices and for palliative care in patients not eligible for these therapeutic options. In this review, we explore the role of home-administered inotropes, specifically dobutamine, milrinone, dopamine, and levosimendan, in the management of AdvHF patients through a summary of current literature and the presentation of management models adopted in selected Italian centers. Reported experiences suggest improved quality of life, reduced hospital admissions, and enhanced clinical stability in patients with AdvHF. These models may serve as practical examples for organizing care pathways in a clinical context that remains poorly defined by current guidelines.
Cardiovascular diseases remain the leading cause of mortality globally and in Italy, with a growing burden exacerbated by ageing populations and underdeveloped strategies for managing chronic cardiovascular conditions. This position paper, resulting from the 2024 ANMCO General Assembly, addresses the current state of cardiovascular chronicity management in Italy, highlighting critical gaps and proposing sustainable, integrative solutions. Despite improvements in acute cardiovascular care, the lack of structured post-acute management, insufficient adoption of secondary prevention protocols, limited access to innovative therapies, and a slow digital transition continue to hinder effective chronic care. The document stresses the pivotal role of cardiologists, not only in acute intervention but also in long-term care and secondary prevention, emphasising the need for a multidisciplinary, multichannel healthcare model. The paper explores the potential of e-Health and artificial intelligence to revolutionize chronic disease management. It advocates for the widespread implementation of integrated care pathways, digital tools like electronic health records and telemedicine platforms, which together could enhance early detection, patient monitoring, and therapeutic adherence while reducing unnecessary hospitalisations. It also underscores the necessity of updating national and regional pharmaceutical policies to improve equitable access to disease-modifying therapies. Furthermore, the integration of palliative care in end-stage cardiovascular disease and the enhancement of post-acute care networks are deemed essential. Ultimately, the document advocates for a comprehensive systemic and cultural transformation spearheaded by scientific societies such as ANMCO, where technological innovation, organisational reform, and patient-centred care align to ensure a sustainable and universally accessible healthcare system. This vision is consistent with the objectives of the PNRR, the 2030 Agenda, and, most importantly, the foundational principles of the Italian Constitution.
PURPOSE:Advances in surgical procedures and immunosuppressive therapies have considerably improved the outcomes of patients who have undergone liver transplantation in the past few decades. In 2020, the Italian Liver Transplant Working Group published practice-oriented algorithms for immunosuppressive therapy (IT) in adult liver transplant (LT) recipients. Due to the rapidly evolving LT field, regular updates to the recommendations are required. This review presents a consensus- and evidence-based update of the 2020 recommendations. METHODS:The Italian Liver Transplant Working Group set out to address new IT issues, which were discussed based on supporting literature and the specialists' personal experiences. The panel deliberated on and graded each statement before consensus was reached. RESULTS:A series of consensus statements were formulated and finalized on: (i) oncologic indications for LT; (ii) management of chronic LT rejection; (iii) combined liver-kidney transplantation; (iv) immunosuppression for transplantation with an organ donated after circulatory death; (v) transplantation in the presence of frailty and sarcopenia; and (vi) ABO blood group incompatibility between donor and recipient. Algorithms were updated in the following LT groups: standard patients, critical patients, oncology patients, patients with specific etiology, and patients at high immunologic risk. A steroid-free approach was generally recommended, except for patients with autoimmune liver disease and those at high immunologic risk. CONCLUSION:The updated consensus- and evidence-based 2024 recommendations for immunosuppression regimens in adult patients with ABO-compatible LT address a range of clinical variables that should be considered to optimize the choice of the immunosuppression treatment in clinical practice in Italy.
