WILLIAM CARLOS NAHAS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder
17 resultados
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- Prioritization Due to Dialysis Access Failure Impacts on Patient Survival after Kidney Transplantation(2013) REUSING JR., J.; SOUZA, P.; GALANTE, N.; AGENA, F.; PAULA, F. de; NAHAS, W.; DAVID-NETO, E.Dialysis vascular access failure, recipient of a non-renal solid organ transplantation and previous kidney donation are current indications of priority allocation (PA) for kidney transplant (KT) at our centre. Mortality among PA patients under dialysis is high and risk factors for long-term patient outcomes after transplantation remain largely elusive. In this study we analyzed a cohort of patients that received KT from Jan/2007 to Dec/2011. Long-term patient survival was compared between PA and non PA recipients transplanted in this period of time and clinical relevant data were analyzed. Data were recorded as of Aug/2012. Results: 948 KT were performed at our institution and 93 (9.8%) were included in our PA program. Most PA patients (n=86) had access failure. The mean follow up time was 32 (0 – 69) months. 5-year patient survival was lower in PA patients (76vs 86%, p=0.001). Twenty (21.5%) PA patients died and all deaths occurred in those with access failure, being 70% of them in the first 3 months. Causes of death were infection in 10 patients, bleeding complications (n=6), uremia (n=1), mesenteric ischemia (n=1) and unspecified shock (n=2). Considering this high mortality rate in the first 3 months after transplantation, we compared patients who died in this period of time (group A) vs. those who survived more than 3 months (group B). Age, gender, previous kidney transplants, sensitization, number of HLA mismatches, pre-transplant DSA, pre-transplant diabetes, induction therapy, DGF, rejection, use of heparin, IVIg and time from inscription in the PA program to transplantation were not statistically different between groups. Among 47 patients who were screened for thrombophilia, 83.3% from group A were positive vs. 31.7% from group B (p=0.01). Infection after transplantation and hemorrhagic complications were more frequent in group A. Groups were not different regarding causes of death. PA patients have a lower survival and this excessive death rate occur in the first three months after transplantation mainly due to infections and bleeding. Thrombophilia is very frequent in PA patients with HR....... for death.
conferenceObject PEDIATRIC KIDNEY TRANSPLANTATION: STUDYING DONOR AND RECIPIENT CHARACTERISTICS ON LONG-TERM OUTCOMES(2013) TORRICELLI, Fabio C. M.; MESSI, Gustavo B.; ANTONOPOULOS, Ioannis M.; PIOVESAN, Affonso C.; FALCI JR., Renato; KANASHIRO, Hideki; EBAID, Gustavo X.; SCHVARTSMAN, Benita G. S.; WATANABE, Andreia; VAISBICH, Maria H.; DAVID-NETO, Elias; NAHAS, William C.PURPOSE: To study donor and recipient characteristics on graft and pediatric patient survival rates. METHOD: We retrospectively reviewed 287 electronic charts of patients (under 18 year-old) underwent kidney transplantation from 01/1985 to 10/2012. Outcomes were analyzed based on the type of donor (deceased vs. living kidney donor) and recipient ESRD cause (nephrological vs. urological disease). The outcomes from recipients of deceased donors were also analyzed based on age of donors (< 17 vs. ≥ 18 years). Thereafter, the outcomes from first transplant and retransplant were compared apart. Graft and patient survival rates were compared with Kaplan-Meier curve and analyzed with Log-rank test. RESULTS: There were 309 pediatric kidney transplants in 287 children. 274 were first, 33 were second, and 2 were third grafts. 193 of 274 (67.2%) and 18 of 33 (54.5%) were living kidney transplantation. 62% of deceased donors were under 17 year-old. Regarding ESRD 195 (68%) patients presented with a nephrological cause, while 92 (32%) presented with a urological one. Of those with a urological cause, 28 (30.4%) underwent bladder augmentation. Mean follow-up was 13.7 (0–27) years. Overall, graft survival rate in one, 5 and 10 years of follow-up was 90.1%, 73.2% and 57.9%, while patient survival rate was 96.0%, 91.9% and 87.2%, respectively. There was a tendency of a higher graft survival rate in children with living kidney donors (p=0.058). There was no difference in the outcomes from first and second transplant, except by a higher immunological graft loss in retransplant group (p=0.032). There was also no difference in the graft survival rates regarding age of donor (p=0.630) and recipient ESRD cause (p=0.890). CONCLUSION: Long-term outcomes from pediatric kidney transplantation are not related to age of donor and recipient ESRD cause, since the urogenital abnormality has been corrected. Living kidney transplantation seems to present a higher graft survival rate.conferenceObject Early Protocol Biopsies Can Identify Antibody-Mediated Rejection in Sensitized Patients(2013) SOUZA, P.; MACHADO, D.; AGUIRRE, A.; DAVID, D.; BARBOSA, E.; PAULA, F. de; NAHAS, W.; DAVID-NETO, E.; CASTRO, M.HLA sensitized patients are at risk for antibody-mediated rejection (ABMR). Our purpose was to evaluate the importance of early protocol biopsies. From Jul/2010 to Jun/2012, 101 sensitized patients defined as PRA>10% (class I and/or II by Flow-PRA) were transplanted at our institution. Out of them, 60 performed donor-specific antibodies (DSA) at transplant and a protocol-bx at day 7 (D7) and were included in this study. A second for cause indication biopsy (IB) was done at the physician’s discretion in 18 patients without previous acute rejection (AR) diagnosis. DSA were analyzed by single antigen bead assays at the time of biopsies (classified according to Banff’09 criteria). Patients (pts) mean age was 48±12 years, 48 were female (80%),45 first transplant (75%) and 42 (70%) received a kidney from deceased donor. 34 pts never presented AR episodes while 26 did. 20/26 (77%) of AR were diagnosed in the first 3 weeks after transplantation (median 13 days). Day 7 protocol biopsies (PB) showed AR in 12/26 (46%): 10 (85%) ABMR and 2 (15%) T-cell-mediated rejection (TCMR). The IB (n=18) done at a median of 11 days from the PB (range 3-112), showed AR in another 14 pts (56%): 10(71%) ABMR and 4 (29%) TCMR, as presented in Table 1 Pre-Tx mean MFI in ABMR pts did not differ among PB: 6001 (1596-11181) vs IB 2304 (840-14600)(p=NS). It also did not differ at the time of biopsy (2823 vs. 2277 in PB vs IB, respectively; p=NS). Patients with early ABMR diagnosis at PB had a trend to higher long-term MDRD (49±12mL/min) compared to patients with ABMR at IB (41±11mL/min) and similar to the whole non-ABMR patients (50±17mL/min). In conclusion, protocol biopsy is useful to diagnosis ABMR as early as in the first week pos-Tx. Early recognition of ABMR allows earlier treatment and possibly better long-term graft function in sensitized patients.- POSTOPERATIVE OUTCOME OF PEDIATRIC PATIENTS UNDERGOING RENAL TRANSPLANTATION(2013) PADOVAN, Fabiola Lucia; COUTO, Saulo Brasil do; PINTO, Gabriela; MENEZES, Aline Motta; SAKITA, Luciana Henrique dos Santos; METRAN, Camila Cardoso; SILVA, Joao Domingos Montoni da; WATANABE, Andreia; VAISBICH, Maria Helena; DELGADO, Arthur Figueiredo; NAHAS, William Carlos; SCHVARTSMAN, Benita Galassi SoaresBJECTIVE: To evaluate the postoperative outcome in the Intensive Care Unit (ICU) in the first month after kidney transplant. PATIENTS AND METHODS: Thirty-two patients (33 transplants), 21 male, age: 9.5 ± 3.1 yrs. Retrospective study from July/2008 to March/2012 through the variables: cold ischemia time, PRISM, mechanical ventilation (MV), vasoactive drugs (VAD), immunosuppression, infection, surgical complications, dialysis, renal function (CrCl), diuresis, hospitalization length and mortality. Statistics: Fischer and Pearson. RESULTS: Causes of CKF: uropathy-19, glomerulopathy-3, tubulopathy-2, other-7. Cold ischemia: 20hs median. PRISM score: 1.3% (0.2–6.2%), FiO2 max: 30% (21–60%), MV: 1d (0–10d), VAD 18/33 1D(0–6d). 10/33 transplants used thymoglobulin, 23/33 basiliximab. Infections: catheter-related-4, urinary-2,peritonitis-2, sepsis-1. Surgical complications: bleeding-4, thrombosis-3, urinary fistula-1. Of 5/32 dialyzed. CrCl and diuresis first postoperative day: 20 mL/min/1.73 m2 and 3.6 mL/kg/h and at 30 days: 90 mL/min/1.73 m2 and 3.7 mL/kg/h. There was an inverse correlation between cold ischemia time and CrCl in the 1st postoperative day (p = 0.01 and r = 0.45), not seen at 30d. Hospitalization length ICU = 4d (2–23d), total 15d (5 – 45d). There was no difference in infection, MV duration, use of VAD, CrCl, ICU and total hospitalization length between thymoglobulin X basiliximab use (p > 0.05). However duration of VAD utilization was higher for Thymoglobulin (p = 0.05). One patient died from sepsis (3%). CONCLUSION: The outcome after renal transplantation was satisfactory, with short ICU stay, but high use of vasoactive drugs. Bleeding was the most common surgical complication. The patient and graft survival after 1 month of transplantation was 97% and 91%, respectively.
conferenceObject DIAGNOSIS OF ANTIBODY-MEDIATED REJECTION THROUGH EARLY PROTOCOL BIOPSIES IN SENSITIZED PATIENTS(2013) SOUZA, Patricia S.; MACHADO, David; AGUIRRE, Anna Rita; DAVID, Daisa; BARBOSA, Erick; PAULA, Flavio Jota de; NAHAS, Willian; DAVID-NETO, Elias; CASTRO, Maria Cristina R.- Protective response in renal transplantation: no clinical or molecular differences between open and laparoscopic donor nephrectomy(2013) MACHADO, Christiano; MALHEIROS, Denise Maria Avancini Costa; ADAMY, Ari; SANTOS, Luiz Sergio; SILVA FILHO, Agenor Ferreira da; NAHAS, William Carlos; LEMOS, Francine Brambate CarvalhinhoOBJECTIVE: Prolonged warm ischemia time and increased intra-abdominal pressure caused by pneumoperitoneum during a laparoscopic donor nephrectomy could enhance renal ischemia reperfusion injury. For this reason, laparoscopic donor nephrectomy may be associated with a slower graft function recovery. However, an adequate protective response may balance the ischemia reperfusion damage. This study investigated whether laparoscopic donor nephrectomy modified the protective response of renal tissue during kidney transplantation. METHODS: Patients undergoing live renal transplantation were prospectively analyzed and divided into two groups based on the donor nephrectomy approach used: 1) the control group, recipients of open donor nephrectomy (n = 29), and 2) the study group, recipients of laparoscopic donor nephrectomy (n = 26). Graft biopsies were obtained at two time points: T-1 = after warm ischemia time and T+1 = 45 minutes after kidney reperfusion. The samples were analyzed by immunohistochemistry for the Bcl-2 and HO-1 proteins and by real-time polymerase chain reaction for the mRNA expression of Bcl-2, HO-1 and vascular endothelial growth factor. RESULTS: The area under the curve for creatinine and delayed graft function were similar in both the laparoscopic and open groups. There was no difference in the protective gene expression between the laparoscopic donor nephrectomy and open donor nephrectomy groups. The protein expression of HO-1 and Bcl-2 were similar between the open and laparoscopic groups. Furthermore, the gene expression of B-cell lymphoma 2 correlated with the warm ischemia time in the open group (p = 0.047) and that of vascular endothelial growth factor with the area under the curve for creatinine in the laparoscopic group (p = 0.01). CONCLUSION: The postoperative renal function and protective factor expression were similar between laparoscopic donor nephrectomy and open donor nephrectomy. These findings ensure laparoscopic donor nephrectomy utilization in renal transplantation.
conferenceObject One Hundred Pancreas Transplantation in University of Sao Paulo - Brazil Analysis of the Recipients and Complications(2013) SANTOS, Vinicius; PECORA, Rafael; ARANTES, Rubens; FERRO, Oscar; PANTANALI, Carlos; DAVID, Andre; CHAIB, Eleazar; DAVID-NETO, Elias; NAHAS, Willian; D'ALBUQUERQUE, LuizconferenceObject LONG-TERM FOLLOW-UP OF RENAL TRANSPLANTATION PLUS CYSTEAMINE FOR CYSTINOSIS - THE GRAFT GOES WELL, THE PATIENT NOT AS MUCH.(2013) VAISBICH, Maria Helena; SULETRONI, Vivian; SCHVARTSMAN, Benita Galassi Soares; NAHAS, William Carlos; DAVID-NETO, EliasconferenceObject THROMBOPHILIA AND PRIORITIZATION DUE TO DIALYSIS ACCESS FAILURE IMPACT EARLY ON PATIENT SURVIVAL AFTER KIDNEY TRANSPLANTATION(2013) REUSING JR., Jose O.; SOUZA, Patricia S.; GALANTE, Nelson Z.; AGENA, Fabiana; PAULA, Flavio J.; NAHAS, William Carlos; DAVID-NETO, EliasconferenceObject THE IMPACT OF NATIVE KIDNEY DISEASE ON LONG-TERM ALLOGRAFT OUTCOME. A REPORT OF THE LAST DECADE(2013) DAVID-NETO, Elias; LEMOS, Angelica Dias; AGENA, Fabiana; GALANTE, Nelson Zocoler; DAVID, Daisa Ribeiro; NAHAS, William Carlos