Pagina Iniziale » Fegato » Interventi Chirurgici sul Fegato » Trapianto di Fegato
Il Trapianto di Fegato
In cosa consiste il Trapianto?
Con questo intervento si sostituisce il fegato ammalato di un paziente con uno sano che può provenire:
- da un donatore cadavere a cuore battente;
- da un donatore vivente;
- da un donatore cadavere a cuore non battente.
Quali sono le malattie per cui si fa il Trapianto?
L’intervento può essere fatto per malattie croniche del fegato e per malattie epatiche acute.
Le malattia cronica più comune è la cirrosi epatica, quando causa un malfunzionamento progressivo del fegato. La cirrosi può svilupparsi in seguito all’infezione con il virus dell’epatite B, dell’epatite C, a causa di un prolungato abuso di bevande alcooliche o come conseguenza di una sindrome metabolica.
Il grado di alterazione del fegato nel caso della cirrosi viene misurato con il modello MELD o, più recentemente, con il modello MELD 3.0.
Alcuni tumori del fegato possono costituire un’altra indicazione al trapianto. L’epatocarcinoma è il principale tumore che viene operato, se rientra entro certi criteri clinici. Recentemente sono stati proposti per l’intervento selezionatissimi pazienti portatori di colangiocarcinoma e di metastasi al fegato da tumore del colon-retto non asportabili con una resezione epatica convenzionale.
La principale malattia acuta del fegato che può portare all’intervento è l’epatite fulminante, che può essere causata da un’intossicazione (come aver mangiato alcuni tipi di funghi velenosi) o dall’infezione con alcuni particolari virus.
Un’ulteriore indicazione è poi l’insufficienza epatica successiva all’esecuzione di un intervento chirurgico convenzionale (una resezione epatica che abbia asportato una quantità eccessiva di tessuto) oppure un trapianto in cui l’organo trapiantato non riprende la sua funzione.
Fino a che età si può fare il Trapianto?
Nell’epoca iniziale del trapianto, era stato posto il limite di età superiore per l’intervento a 65 anni.
Oggi questo limite è stato superato e non viene più applicato in maniera “burocratica”.
Il paziente viene valutato per l’intervento caso per caso ed i medici che si occupano della selezione degli ammalati giudicano in base
- alle condizioni generali;
- alla presenza di malattie concomitanti (cardiache, polmonari, sistemiche, …);
- allo stadio della malattia per cui il paziente deve essere operato;
anche se il paziente ha più di 65 anni.
Dove si può fare il Trapianto?
I centri di Trapianto in Italia sono diversi. Quasi ogni Regione ne ha almeno uno.
Una lista aggiornata dei centri trapianto si può consultare presso il sito del Centro Nazionale Trapianti seguendo questo link.
A chi bisogna rivolgersi per essere inseriti in una lista di attesa?
La valutazione per la possibile idoneità al trapianto viene condotta dai medici di ogni singolo centro.
I criteri per l’inclusione nella lista di attesa non sono esattamente identici da centro a centro.
Quindi, per vedere se si può essere ritenuti idonei, il percorso è:
- verificare con il proprio gastroenterologo/epatologo (o medico di fiducia) se lui/lei ha già una qualche connessione in corso con un qualche centro trapianti;
- in alternativa, identificare il centro trapianti a cui rivolgersi; questo link porta alla lista completa dei centri italiani da poter consultare;
- verificare chi sono i chirurghi che operano nel centro trapianti identificato;
- fissare un appuntamento con i chirurghi di questo centro per una prima visita di valutazione.
- Ultimo aggiornamento della pagina: 10/06/2023
Linee Guida per il Trapianto di Fegato
2023
Pollok J M; Tinguely P; Berenguer M; Niemann C U; Raptis D A; Spiro M
Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference Journal Article
In: Lancet Gastroenterol Hepatol, vol. 8, no 1, pp. 81–94, 2023, ISSN: 2468-1253.
@article{pmid36495912,
title = {Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference},
author = {Joerg M Pollok and Pascale Tinguely and Marina Berenguer and Claus U Niemann and Dimitri A Raptis and Michael Spiro},
doi = {10.1016/S2468-1253(22)00268-0},
issn = {2468-1253},
year = {2023},
date = {2023-01-01},
urldate = {2023-01-01},
journal = {Lancet Gastroenterol Hepatol},
volume = {8},
number = {1},
pages = {81--94},
abstract = {There is much controversy regarding enhanced recovery for recipients of liver transplants from deceased and living donors. The objectives of this Review were to summarise current knowledge on individual enhanced recovery elements on short-term outcomes, identify key components for comprehensive pathways, and create internationally accepted guidelines on enhanced recovery for liver-transplant recipients. The ERAS4OLT.org collaborative partnered by the International Liver Transplantation Society performed systematic literature reviews on the effect of 32 relevant enhanced perioperative recovery elements on short-term outcomes, and global specialists prepared expert statements on deceased and living donor liver transplantation. The Grading Recommendations, Assessment, Development and Evaluations approach was used for rating of quality of evidence and grading of recommendations. A virtual international consensus conference was held in January, 2022, in which results were presented, voted on by the audience, and discussed by an independent international jury of eight members, applying the Danish model of consensus. 273 liver transplantation specialists from 30 countries prepared expert statements on elements of enhanced recovery for liver transplantation based on the systematic literature reviews. The consensus conference yielded 80 final recommendations, covering aspects of enhanced recovery for preoperative assessment and optimisation, intraoperative surgical and anaesthetic conduct, and postoperative management for the recipients of liver transplants from both deceased and living donors, and for the living donor. The recommendations represent a comprehensive overview of the relevant elements and areas of enhanced recovery for liver transplantation. These internationally established guidelines could direct the development of enhanced recovery programmes worldwide, allowing adjustments according to local resources and practices.},
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}
2022
Brustia R; Monsel A; Skurzak S; Schiffer E; Carrier F M; Patrono D; Kaba A; Detry O; Malbouisson L; Andraus W; Vandenbroucke-Menu F; Biancofiore G; Kaido T; Compagnon P; Uemoto S; Laiz G R; Boer M D; Orloff S; Melgar P; Buis C; Zeillemaker-Hoekstra M; Usher H; Reyntjens K; Baird E; Demartines N; Wigmore S; Scatton O
Guidelines for Perioperative Care for Liver Transplantation: Enhanced Recovery after Surgery (ERAS) Recommendations Journal Article
In: Transplantation, vol. 106, no 3, pp. 552 – 561, 2022, ISSN: 00411337, (Cited by: 10; All Open Access, Green Open Access).
@article{Brustia2022552,
title = {Guidelines for Perioperative Care for Liver Transplantation: Enhanced Recovery after Surgery (ERAS) Recommendations},
author = {Raffaele Brustia and Antoine Monsel and Stefano Skurzak and Eduardo Schiffer and François Martin Carrier and Damiano Patrono and Abdourahamane Kaba and Olivier Detry and Luiz Malbouisson and Wellington Andraus and Franck Vandenbroucke-Menu and Gianni Biancofiore and Toshimi Kaido and Philippe Compagnon and Shinji Uemoto and Gonzalo Rodriguez Laiz and Marieke De Boer and Susan Orloff and Paola Melgar and Carlijn Buis and Miriam Zeillemaker-Hoekstra and Helen Usher and Koen Reyntjens and Emily Baird and Nicolas Demartines and Stephen Wigmore and Olivier Scatton},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85125006375&doi=10.1097%2fTP.0000000000003808&partnerID=40&md5=082ddb84c23154f85ae4617dbd1f8be7},
doi = {10.1097/TP.0000000000003808},
issn = {00411337},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
journal = {Transplantation},
volume = {106},
number = {3},
pages = {552 – 561},
publisher = {Lippincott Williams and Wilkins},
abstract = {Background. Enhanced Recovery After Surgery (ERAS) is a multimodal, evidence-based, program of care developed to minimize the response to surgical stress, associated with reduced perioperative morbidity and hospital stay. This study presents the specific ERAS Society recommendations for liver transplantation (LT) based on the best available evidence and on expert consensus Methods. PubMed and ClinicalTrials.gov were searched in April 2019 for published and ongoing randomized clinical trials on LT in the last 15 y. Studies were selected by 5 independent reviewers and were eligible if focusing on each validated ERAS item in the area of adult LT. An e-Delphi method was used with an extended interdisciplinary panel of experts to validate the final recommendations. Results. Forty-three articles were included in the systematic review. A consensus was reached among experts after the second round. Patients should be screened for malnutrition and treated whenever possible. Prophylactic nasogastric intubation and prophylactic abdominal drainage may be omitted, and early extubation should be considered. Early oral intake, mobilization, and multimodal-balanced analgesia are recommended. Conclusions. The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the e-Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol. © 2022 Lippincott Williams and Wilkins. All rights reserved.},
note = {Cited by: 10; All Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2021
Cherqui D; Ciria R; Kwon C H D; Kim K; Broering D; Wakabayashi G; Samstein B; Troisi R I; Han H S; Rotellar F; Soubrane O; Briceño J; Alconchel F; Ayllón M D; Berardi G; Cauchy F; Luque I G; Hong S K; Yoon Y; Egawa H; Lerut J; Lo C; Rela M; Sapisochin G; Suh K
In: Annals of Surgery, vol. 273, no 1, pp. 96 – 108, 2021, ISSN: 00034932, (Cited by: 13).
@article{Cherqui202196,
title = {Expert consensus guidelines on minimally invasive donor hepatectomy for living donor liver transplantation from innovation to implementation: A joint initiative from the international laparoscopic liver society (ILLS) and the Asian-Pacific hepato-pancreato-biliary association (A-PHPBA)},
author = {Daniel Cherqui and Ruben Ciria and Choon Hyuck David Kwon and Ki-Hun Kim and Dieter Broering and Go Wakabayashi and Benjamin Samstein and Roberto I. Troisi and Ho Seong Han and Fernando Rotellar and Olivier Soubrane and Javier Briceño and Felipe Alconchel and María Dolores Ayllón and Giammauro Berardi and Francois Cauchy and Irene Gómez Luque and Suk Kyun Hong and Young-Yin Yoon and Hiroto Egawa and Jan Lerut and Chung-Mau Lo and Mohamed Rela and Gonzalo Sapisochin and Kyung-Suk Suh},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85098676552&doi=10.1097%2fSLA.0000000000004475&partnerID=40&md5=93cd12ffcabe36ce8cde34e0c0368823},
doi = {10.1097/SLA.0000000000004475},
issn = {00034932},
year = {2021},
date = {2021-01-01},
urldate = {2021-01-01},
journal = {Annals of Surgery},
volume = {273},
number = {1},
pages = {96 – 108},
publisher = {Lippincott Williams and Wilkins},
abstract = {Objective: The Expert Consensus Guidelines initiative on MIDH for LDLT was organized with the goal of safe implementation and development of these complex techniques with donor safety as the main priority. Background: Following the development of minimally invasive liver surgery, techniques of MIDH were developed with the aim of reducing the short- and long-term consequences of the procedure on liver donors. These techniques, although increasingly performed, lack clinical guidelines. Methods: A group of 12 international MIDH experts, 1 research coordinator, and 8 junior faculty was assembled. Comprehensive literature search was made and studies classified using the SIGN method. Based on literature review and experts opinions, tentative recommendations were made by experts subgroups and submitted to the whole experts group using on-line Delphi Rounds with the goal of obtaining >90% Consensus. Pre-conference meeting formulated final recommendations that were presented during the plenary conference held in Seoul on September 7, 2019 in front of a Validation Committee composed of LDLT experts not practicing MIDH and an international audience. Results: Eighteen Clinical Questions were addressed resulting in 44 recommendations. All recommendations reached at least a 90% consensus among experts and were afterward endorsed by the validation committee. Conclusions: The Expert Consensus on MIDH has produced a set of clinical guidelines based on available evidence and clinical expertise. These guidelines are presented for a safe implementation and development of MIDH in LDLT Centers with the goal of optimizing donor safety, donor care, and recipient outcomes. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.},
note = {Cited by: 13},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2020
Millson C; Considine A; Cramp M E; Holt A; Hubscher S; Hutchinson J; Jones K; Leithead J; Masson S; Menon K; Mirza D; Neuberger J; Prasad R; Pratt A; Prentice W; Shepherd L; Simpson K; Thorburn D; Westbrook R; Tripathi D
Adult liver transplantation: A UK clinical guideline - Part 1: Pre-operation Journal Article
In: Frontline Gastroenterology, vol. 11, no 5, pp. 375 – 384, 2020, ISSN: 20414137, (Cited by: 11; All Open Access, Green Open Access, Hybrid Gold Open Access).
@article{Millson2020375,
title = {Adult liver transplantation: A UK clinical guideline - Part 1: Pre-operation},
author = {Charles Millson and Aisling Considine and Matthew E Cramp and Andrew Holt and Stefan Hubscher and John Hutchinson and Kate Jones and Joanna Leithead and Steven Masson and Krish Menon and Darius Mirza and James Neuberger and Raj Prasad and Anthony Pratt and Wendy Prentice and Liz Shepherd and Ken Simpson and Doug Thorburn and Rachel Westbrook and Dhiraj Tripathi},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85081693914&doi=10.1136%2fflgastro-2019-101215&partnerID=40&md5=630321fcf4832e47fc9820f8516d6370},
doi = {10.1136/flgastro-2019-101215},
issn = {20414137},
year = {2020},
date = {2020-01-01},
urldate = {2020-01-01},
journal = {Frontline Gastroenterology},
volume = {11},
number = {5},
pages = {375 – 384},
publisher = {BMJ Publishing Group},
abstract = {Liver transplantation is a highly successful treatment for all types of liver failure, some non-liver failure indications and liver cancer. Most referrals come from secondary care. This first part of a two-part guideline outlines who to refer, and how that referral should be made, including patient details and additional issues such as those relevant to alcohol and drug misuse. The process of liver transplant assessment involves the confirmation of the diagnosis and non-reversibility, an evaluation of comorbidities and exclusion of contraindications. Finally, those making it onto the waiting list require monitoring and optimising. Underpinning this process is a need for good communication between patient, their carers, secondary care and the liver transplant service, synchronised by the transplant coordinator. Managing expectation and balancing the uncertainty of organ availability against the inevitable progression of underlying liver disease requires sensitivity and honesty from all healthcare providers and the assessment of palliative care needs is an integral part of this process. © Author(s) (or their employer(s)) 2020.},
note = {Cited by: 11; All Open Access, Green Open Access, Hybrid Gold Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Millson C; Considine A; Cramp M E; Holt A; Hubscher S; Hutchinson J; Jones K; Leithead J; Masson S; Menon K; Mirza D; Neuberger J; Prasad R; Pratt A; Prentice W; Shepherd L; Simpson K; Thorburn D; Westbrook R; Tripathi D
Adult liver transplantation: UK clinical guideline - Part 2: Surgery and post-operation Journal Article
In: Frontline Gastroenterology, vol. 11, no 5, pp. 385 – 396, 2020, ISSN: 20414137, (Cited by: 12; All Open Access, Green Open Access, Hybrid Gold Open Access).
@article{Millson2020385,
title = {Adult liver transplantation: UK clinical guideline - Part 2: Surgery and post-operation},
author = {Charles Millson and Aisling Considine and Matthew E Cramp and Andrew Holt and Stefan Hubscher and John Hutchinson and Kate Jones and Joanna Leithead and Steven Masson and Krish Menon and Darius Mirza and James Neuberger and Raj Prasad and Anthony Pratt and Wendy Prentice and Liz Shepherd and Ken Simpson and Doug Thorburn and Rachel Westbrook and Dhiraj Tripathi},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85081578908&doi=10.1136%2fflgastro-2019-101216&partnerID=40&md5=b1f346377e62d61cd21a9ff44b52b1d9},
doi = {10.1136/flgastro-2019-101216},
issn = {20414137},
year = {2020},
date = {2020-01-01},
urldate = {2020-01-01},
journal = {Frontline Gastroenterology},
volume = {11},
number = {5},
pages = {385 – 396},
publisher = {BMJ Publishing Group},
abstract = {Survival rates for patients following liver transplantation exceed 90% at 12 months and approach 70% at 10 years. Part 1 of this guideline has dealt with all aspects of liver transplantation up to the point of placement on the waiting list. Part 2 explains the organ allocation process, organ donation and organ type and how this influences the choice of recipient. After organ allocation, the transplant surgery and the critical early post-operative period are, of necessity, confined to the liver transplant unit. However, patients will eventually return to their referring secondary care centre with a requirement for ongoing supervision. Part 2 of this guideline concerns three key areas of post liver transplantation care for the non-transplant specialist: (1) overseeing immunosuppression, including interactions and adherence; (2) the transplanted organ and how to initiate investigation of organ dysfunction; and (3) careful oversight of other organ systems, including optimising renal function, cardiovascular health and the psychosocial impact. The crucial significance of this holistic approach becomes more obvious as time passes from the transplant, when patients should expect the responsibility for managing the increasing number of non-liver consequences to lie with primary and secondary care. © Author(s) (or their employer(s)) 2020.},
note = {Cited by: 12; All Open Access, Green Open Access, Hybrid Gold Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2016
Burra P; Burroughs A; Graziadei I; Pirenne J; Valdecasas J C; Muiesan P; Samuel D; Forns X
EASL Clinical Practice Guidelines: Liver transplantation Journal Article
In: Journal of Hepatology, vol. 64, no 2, pp. 433 – 485, 2016, ISSN: 01688278, (Cited by: 497).
@article{Burra2016433,
title = {EASL Clinical Practice Guidelines: Liver transplantation},
author = {Patrizia Burra and Andrew Burroughs and Ivo Graziadei and Jacques Pirenne and Juan Carlos Valdecasas and Paolo Muiesan and Didier Samuel and Xavier Forns},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84954380926&doi=10.1016%2fj.jhep.2015.10.006&partnerID=40&md5=38d57da89522e00bb97e9097fa4a26e2},
doi = {10.1016/j.jhep.2015.10.006},
issn = {01688278},
year = {2016},
date = {2016-01-01},
urldate = {2016-01-01},
journal = {Journal of Hepatology},
volume = {64},
number = {2},
pages = {433 – 485},
publisher = {Elsevier B.V.},
note = {Cited by: 497},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2015
Cillo U; Burra P; Mazzaferro V; Belli L; Pinna A D; Spada M; Costa A N; Toniutto P; Avolio A; Cescon M; Regalia E; Romagnoli R; Santaniello W; Rossi M; Corno V; Caraceni P; Coco B; Fraquelli M; Rendina M; Angelico M; Fagiuoli S; Bruno R; Costa A N; Feo T D; Ridolfi L; Pretagostini R; Amoroso A; Biancofiore G; Gasperi A D; Rocca G D; Feltracco P; Colli A; Sacchini D; Pegoraro R; Gardini I
A Multistep, Consensus-Based Approach to Organ Allocation in Liver Transplantation: Toward a "Blended Principle Model" Journal Article
In: American Journal of Transplantation, vol. 15, no 10, pp. 2552 – 2561, 2015, ISSN: 16006135, (Cited by: 126; All Open Access, Bronze Open Access).
@article{Cillo20152552,
title = {A Multistep, Consensus-Based Approach to Organ Allocation in Liver Transplantation: Toward a "Blended Principle Model"},
author = {U. Cillo and P. Burra and V. Mazzaferro and L. Belli and A. D. Pinna and M. Spada and A. Nanni Costa and P. Toniutto and Alfonso Avolio and Matteo Cescon and Enrico Regalia and Renato Romagnoli and Walter Santaniello and Massimo Rossi and Vittorio Corno and Paolo Caraceni and Barbara Coco and Mirella Fraquelli and Maria Rendina and Mario Angelico and Stefano Fagiuoli and Raffaele Bruno and Alessandro Nanni Costa and Tullia De Feo and Lorenza Ridolfi and Renzo Pretagostini and Antonio Amoroso and Giandomenico Biancofiore and Andrea De Gasperi and Giorgio Della Rocca and Paolo Feltracco and Agostino Colli and Dario Sacchini and Renzo Pegoraro and Ivan Gardini},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84941937152&doi=10.1111%2fajt.13408&partnerID=40&md5=acefb63024bdb5be01af492342953e9b},
doi = {10.1111/ajt.13408},
issn = {16006135},
year = {2015},
date = {2015-01-01},
urldate = {2015-01-01},
journal = {American Journal of Transplantation},
volume = {15},
number = {10},
pages = {2552 – 2561},
publisher = {John Wiley and Sons Inc},
abstract = {Since Italian liver allocation policy was last revised (in 2012), relevant critical issues and conceptual advances have emerged, calling for significant improvements. We report the results of a national consensus conference process, promoted by the Italian College of Liver Transplant Surgeons (for the Italian Society for Organ Transplantation) and the Italian Association for the Study of the Liver, to review the best indicators for orienting organ allocation policies based on principles of urgency, utility, and transplant benefit in the light of current scientific evidence. MELD exceptions and hepatocellular carcinoma were analyzed to construct a transplantation priority algorithm, given the inequity of a purely MELD-based system for governing organ allocation. Working groups of transplant surgeons and hepatologists prepared a list of statements for each topic, scoring their quality of evidence and strength of recommendation using the Centers for Disease Control grading system. A jury of Italian transplant surgeons, hepatologists, intensivists, infectious disease specialists, epidemiologists, representatives of patients' associations and organ-sharing organizations, transplant coordinators, and ethicists voted on and validated the proposed statements. After carefully reviewing the statements, a critical proposal for revising Italy's current liver allocation policy was prepared jointly by transplant surgeons and hepatologists. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.},
note = {Cited by: 126; All Open Access, Bronze Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2014
Martin P; Dimartini A; Feng S; Brown R; Fallon M
In: Hepatology, vol. 59, no 3, pp. 1144 – 1165, 2014, ISSN: 15273350, (Cited by: 509).
@article{Martin20141144,
title = {Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation},
author = {Paul Martin and Andrea Dimartini and Sandy Feng and Robert Brown and Michael Fallon},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84896833751&doi=10.1002%2fhep.26972&partnerID=40&md5=7e4ce834a5af7266516093a6b9ee57bc},
doi = {10.1002/hep.26972},
issn = {15273350},
year = {2014},
date = {2014-01-01},
urldate = {2014-01-01},
journal = {Hepatology},
volume = {59},
number = {3},
pages = {1144 – 1165},
note = {Cited by: 509},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2012
Newsome P N; Allison M E; Andrews P A; Auzinger G; Day C P; Ferguson J W; Henriksen P A; Hubscher S G; Manley H; McKiernan P J; Millson C; Mirza D; Neuberger J M; Oben J; Pollard S; Simpson K J; Thorburn D; Tomlinson J W; Wyatt J S
Guidelines for liver transplantation for patients with non-alcoholic steatohepatitis Journal Article
In: Gut, vol. 61, no 4, pp. 484 – 500, 2012, ISSN: 14683288, (Cited by: 56; All Open Access, Bronze Open Access, Green Open Access).
@article{Newsome2012484,
title = {Guidelines for liver transplantation for patients with non-alcoholic steatohepatitis},
author = {Philip Noel Newsome and M. E. Allison and P. A. Andrews and G. Auzinger and C. P. Day and J. W. Ferguson and P. A. Henriksen and S. G. Hubscher and H. Manley and P. J. McKiernan and C. Millson and D. Mirza and J. M. Neuberger and J. Oben and S. Pollard and K. J. Simpson and D. Thorburn and J. W. Tomlinson and J. S. Wyatt},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84857802209&doi=10.1136%2fgutjnl-2011-300886&partnerID=40&md5=4d1b4be8c510cb254385476f61d6c47b},
doi = {10.1136/gutjnl-2011-300886},
issn = {14683288},
year = {2012},
date = {2012-01-01},
urldate = {2012-01-01},
journal = {Gut},
volume = {61},
number = {4},
pages = {484 – 500},
note = {Cited by: 56; All Open Access, Bronze Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
