RUY JORGE CRUZ JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
15 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 15
- Transplante de intestino delgado(2013) PÉCORA, Rafael Antonio Arruda; DAVID, André Ibrahim; LEE, André Dong; GALVÃO, Flávio Henrique; CRUZ-JUNIOR, Ruy Jorge; D'ALBUQUERQUE, Luiz Augusto CarneiroBACKGROUND: Small bowel transplantation evolution, because of its complexity, was slower than other solid organs. Several advances have enabled its clinical application. AIM: To review intestinal transplantation evolution and its current status. METHOD: Search in MEDLINE and ScIELO literature. The terms used as descriptors were: intestinal failure, intestinal transplantation, small bowel transplantation, multivisceral transplantation. Were analyzed data on historical evolution, centers experience, indications, types of grafts, selection and organ procurement, postoperative management, complications and results. CONCLUSION: Despite a slower evolution, intestinal transplantation is currently the standard therapy for patients with intestinal failure and life-threatening parenteral nutrition complications. It involves some modalities: small bowel transplantation, liver-intestinal transplantation, multivisceral transplantation and modified multivisceral transplantation. Currently, survival rate is similar to other solid organs. Most of the patients become free of parenteral nutrition.
- Successful liver allograft inflow reconstruction with the right gastroepiploic vein(2016) PINHEIRO, Rafael S.; CRUZ JR., Ruy J.; NACIF, Lucas S.; VANE, Matheus F.; D'ALBUQUERQUE, Luiz A. C.Portal vein thrombosis is a common complication in cirrhotic patients. When portal vein thrombectomy is not a suitable option, a large collateral vessel can be used for allograft venous inflow reconstruction. We describe an unusual case of successful portal revascularization using the right gastroepiploic vein. The patient underwent a cadaveric orthotropic liver transplantation with end-to-end anastomosis of the portal vein to the right gastroepiploic vein. Six months after liver transplantation the patient is well with good liver function. The use of the right gastroepiploic vein for allograft venous reconstruction is feasible and safe, with a great advantage of avoiding the need of venous jump graft.
- PREOPERATIVE COMPUTED TOMOGRAPHY VOLUMETRY AND GRAFT WEIGHT ESTIMATION IN ADULT LIVING DONOR LIVER TRANSPLANTATION(2017) PINHEIRO, Rafael S.; CRUZ-JR, Ruy J.; ANDRAUS, Wellington; DUCATTI, Liliana; MARTINO, Rodrigo B.; NACIF, Lucas S.; ROCHA-SANTOS, Vinicius; ARANTES, Rubens M; LAI, Quirino; IBUKI, Felicia S.; ROCHA, Manoel S.; D´ALBUQUERQUE, Luiz A. C.ABSTRACT Background: Computed tomography volumetry (CTV) is a useful tool for predicting graft weights (GW) for living donor liver transplantation (LDLT). Few studies have examined the correlation between CTV and GW in normal liver parenchyma. Aim: To analyze the correlation between CTV and GW in an adult LDLT population and provide a systematic review of the existing mathematical models to calculate partial liver graft weight. Methods: Between January 2009 and January 2013, 28 consecutive donors undergoing right hepatectomy for LDLT were retrospectively reviewed. All grafts were perfused with HTK solution. Estimated graft volume was estimated by CTV and these values were compared to the actual graft weight, which was measured after liver harvesting and perfusion. Results: Median actual GW was 782.5 g, averaged 791.43±136 g and ranged from 520-1185 g. Median estimated graft volume was 927.5 ml, averaged 944.86±200.74 ml and ranged from 600-1477 ml. Linear regression of estimated graft volume and actual GW was significantly linear (GW=0.82 estimated graft volume, r2=0.98, slope=0.47, standard deviation of 0.024 and p<0.0001). Spearman Linear correlation was 0.65 with 95% CI of 0.45 - 0.99 (p<0.0001). Conclusion: The one-to-one rule did not applied in patients with normal liver parenchyma. A better estimation of graft weight could be reached by multiplying estimated graft volume by 0.82.
- Diffuse Liver Cholangiocarcinoma Presenting as Fulminant Liver Failure(2013) PECORA, Rafael; CRUZ JR., Ruy J.; PINHEIRO, Rafael S.; MARTINO, Rodrigo Bronze de; TANIGAWA, Ryan Y.; D'ALBUQUERQUQ, Luiz Augusto CarneiroIntroduction: Cryptogenic acute liver failure (ALF) can occur in up to 40 % of cases. There are few reports of diffuse liver tumors (primary or metastatic) leading to ALF. We herein report an unusual case of ALF secondary to diffuse cholangiocarcinoma. Case report: A 55-year-old woman was admitted to hospital with jaundice over the past 15 days, associated with general fatigue, nausea, vomiting and fever. During the admission the patient developed confusion, lactic acidosis and hypotension. Her past medical history revealed a cholecystectomy and myomectomy 10 months ago, without any history of hepatotoxic medication use. There were no others comorbidities. Laboratory evaluation included: TB 11.3 mg/dL; AST 4248 IU/L; GGTP 289 IU/L, and INR of 2.66. Hepatitis serologies were negative. Ultrasound and CT scan revealed: heterogeneous enlarged liver without any focal lesions and no signs of portal hypertension. Main portal and hepatic veins were patent. Based on clinical and laboratory evaluation, patient underwent to liver transplantation 48 hours after ICU admission. Intraoperative liver macroscopy was compatible with ALF. Explanted liver revealed a diffuse poorly differentiated liver cholangiocarcinoma with multiple microvascular tumoral emboli. There were no signs of underlying disease (i.e. cirrhosis). Immunostaining for both cytokeratins 7 and 19 were positive. Conclusion: To the best of our knowledge this is the first report of ALF associated with cholangiocarcinoma. Neoplastic involvement of liver should be considered in the differential diagnosis of ALF of unknown etiology. Pre-transplant diagnosis should be always pursued due to the dismal prognosis of these conditions. Given the limitation of imaging studies in this setting, liver biopsy can be an option to obtain an accurate diagnosis.
conferenceObject Outcomes of Liver Transplantation for Unresectable Liver Malignancy in Children.(2014) ROHAN, V.; CRUZ, R.; RANGANATHAN, S.; SOLTYS, K.; BOND, G.; MAZARIEGOS, G.; SUN, Q.; SINDHI, R.- An innovative model of autologous anorectal transplantation with pudendal nerve reconstruction(2012) GALVAO, Flavio Henrique Ferreira; SEID, Victor Edmund; WAISBERG, Daniel Reis; CRUZ- JR., Ruy Jorge; HIRANO, Hugo; CATANOZI, Sergio; CHAIB, Eleazar; D'ALBUQUERQUE, Luiz Augusto Carneiro
conferenceObject Hepatocellular Carcinoma Meld Exception in Brazil.(2014) PINHEIRO, Rafael S.; NACIF, Lucas S.; ANDRAUS, Wellington; LOPES, Liliana D.; PECORA, Rafael A.; ROCHA-SANTOS, Vinicius; IBRAHIM, Andre D.; HADDAD, Luciana B.; CALIL, Igor L.; CRUZ JR., Ruy J.; D'ALBUQUERQUE, Luiz A. C.conferenceObject Validation of Preoperative Coefficient Factor for Graft Weight Estimation in Living Donor Liver Transplantation(2013) PINHEIRO, Rafael S.; PECORA, Rafael A.; ANDRAUS, Wellington; MARTINS, Rodrigo B.; DAVID, Andre I.; HADDAD, Luciana B.; ARANTES, Rubens M.; SANTOS, Rafael M.; CRUZ JR., Ruy J.; PUGLIESE, Vincenzo; D'ALBUQUERQUE, Luiz A. C.- Immunoglobulin G profile in hyperacute rejection after multivisceral xenotransplantation(2012) GALVAO, Flavio H. F.; SOLER, Wangles; POMPEU, Eduardo; WAISBERG, Daniel R.; MELLO, Evandro S. D.; COSTA, Anderson C. L.; TEODORO, Walcy; VELOSA, Ana P.; CAPELOZZI, Vera L.; ANTONANGELO, Leila; CATANOZI, Sergio; MARTINS, Alessandro; MALBOUISSON, Luiz M. S.; CRUZ JR., Ruy J.; FIGUEIRA, Estela R.; FILHO, Joel A. R.; CHAIB, Eleazar; D'ALBUQUERQUE, Luiz A. C.Galvao FHF, Soler W, Pompeu E, Waisberg DR, Mello ES, Costa ACL, Teodoro W, Velosa AP, Capelozzi VL, Antonangelo L, Catanozi S, Martins A, Malbouisson LMS, Cruz RJ, Figueira ER, Filho JAR, Chaib E, D'Albuquerque LAC. Immunoglobulin G profile in hyperacute rejection after multivisceral xenotransplantation. Xenotransplantation 2012; 19: 298304. (c) 2012 John Wiley & Sons A/S. Abstract: Introduction: Xenotransplantation is a potential solution for the high mortality of patients on the waiting list for multivisceral transplantation; nevertheless, hyperacute rejection (HAR) hampers this practice and motivates innovative research. In this report, we describe a model of multivisceral xenotransplantation in which we observed immunoglobulin G (IgG) involvement in HAR. Methods: We recovered en bloc multivisceral grafts (distal esophagus, stomach, small intestine, colon, liver, pancreas, and kidneys) from rabbits (n = 20) and implanted them in the swine (n = 15) or rabbits (n = 5, control). Three hours after graft reperfusion, we collected samples from all graft organs for histological study and to assess IgG fixation by immunofluorescence. Histopathologic findings were graded according to previously described methods. Results: No histopathological features of rejection were seen in the rabbit allografts. In the swine-to-rabbit grafts, features of HAR were moderate in the liver and severe in esophagus, stomach, intestines, spleen, pancreas, and kidney. Xenograft vessels were the central target of HAR. The main lesions included edema, hemorrhage, thrombosis, myosites, fibrinoid degeneration, and necrosis. IgG deposition was intense on cell membranes, mainly in the vascular endothelium. Conclusions: Rabbit-to-swine multivisceral xenotransplants undergo moderate HAR in the liver and severe HAR in the other organs. Moderate HAR in the liver suggests a degree of resistance to the humoral immune response in this organ. Strong IgG fixation in cell membranes, including vascular endothelium, confirms HAR characterized by a primary humoral immune response. This model allows appraisal of HAR in multiple organs and investigation of the livers relative resistance to this immune response.
conferenceObject Outcomes of Liver Transplantation for Unresectable Liver Malignancy in Children(2014) ROHAN, V.; CRUZ, R.; RANGANATHAN, S.; SOLTYS, K.; BOND, G.; MAZARIEGOS, G.; SUN, Q.; SINDHI, R.