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
18 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 18
- Pneumocystis jirovecii pneumonia with an atypical granulomatous response after kidney transplantation(2014) RAMALHO, J.; MARQUES, I. D. Bacelar; AGUIRRE, A. R.; PIERROTTI, L. C.; PAULA, F. J. de; NAHAS, W. C.; DAVID-NETO, E.Pneumocystis jirovecii pneumonia (PCP) continues to be a leading cause of morbidity and mortality in kidney transplant recipients. Granulomatous PCP is an unusual histological presentation that has been described in a variety of immunosuppressive conditions. Previous studies have demonstrated an association between granulomatous disorders and hypercalcemia, the purported mechanism of which is extrarenal production of 1,25-dihydroxyvitamin D by activated macrophages. Here, we report a case of granulomatous formation in a kidney transplant recipient with PCP who presented with hypercalcemia and suppressed parathyroid hormone, both of which resolved after successful treatment of the pneumonia. In immunocompromised patients, pulmonary infection associated with hypercalcemia should raise the suspicion of PCP and other granulomatous disorders.
conferenceObject Obesity: A Major Risk Factor for Wound and Parietal Complications in Renal Transplantation.(2014) ANDRADE, H.; PALUELLO, D.; BATAGELLO, C.; BULL, A.; EBAID, G.; KANASHIRO, H.; FALCI, R.; ANTONOPOULOS, I.; NAHAS, W.; PIOVESAN, A.- Alteracoes vasculares em rins de doadores falecidos retardam a recuperacao da funcao do enxerto apos o transplante renal(2014) MARQUES, Igor Denizarde Bacelar; REPIZO, Liliany Pinhel; PONTELLI, Renato; PAULA, Flavio Jota de; NAHAS, William Carlos; DAVID, Daisa Silva Ribeiro; DAVID NETO, Elias; LEMOS, Francine Brambate CarvalhinhoObjective: The purpose of this study was to evaluate the impact of donor and recipient characteristics on duration of delayed graft function (DGF) and 1-year serum creatinine (SCr), as a surrogate endpoint for allograft survival. Methods: We reviewed 120 first cadaver kidney transplants carried out consecutively at our center to examine the effect on 1-year SCr of the presence and duration of DGF. Results: DGF rate was 68%, with a median duration of 12 days (range, 1-61). Forty-four (38%) patients presented DGF lasting 12 or more days (prolonged DGF group). Mean donor age was 43 ± 13 years, 37% had hypertension and in 59% the cause of brain death was cardiovascular accident. The mean cold ischemia time was 23 ± 5 hours. Twenty-seven (23%) donors were classified as expanded-criteria donors according to OPTN criteria. The mean recipient age was 51 ± 15 years. The recipients median time in dialysis was 43 months (range, 1-269) and 25% of them had panel reactive antibodies > 0%. Patients with prolonged DGF presented higher 1-year SCr in comparison with patients without DGF (1.7 vs. 1.3 mg/dL, respectively, p = 0.03). In multivariate logistic regression analysis, the only significant factor contributing to the occurrence of prolonged DGF was the presence of vascular lesions in the kidney allograft at time of transplantation (HR 3.6, 95% CI 1.2-10.2; p = 0.02). Conclusion: The presence of vasculopathy in the kidney allograft at time of transplantation was identified as an important factor independently associated with prolonged DGF. Prolonged DGF negatively impacts 1-year graft function.
conferenceObject Obesity: A Major Risk Factor for Wound and Parietal Complications in Renal Transplantation.(2014) ANDRADE, H.; PALUELLO, D.; BATAGELLO, C.; BULL, A.; EBAID, G.; KANASHIRO, H.; FALCI, R.; ANTONOPOULOS, I.; NAHAS, W.; PIOVESAN, A.bookPart Litíase urinária e transplante renal(2014) BULL, Alexandre S.; PIOVESAN, Affonso C.; KANASHIRO, Hideki; YAMAçAKE, Kleiton G. R.; KATO, Raphael; NAHAS, Willian C.conferenceObject Transurethral Resection or Incision of the Prostate After Renal Transplantation: Is There a Safe Time for the Procedure?(2014) PIOVESAN, A.; ANDRADE, H.; KANASHIRO, H.; FALCI, R.; ANTONOPOULOS, I.; NAHAS, W.- Revascularization of Living-Donor Kidney Transplant With Multiple Arteries: Long-term Outcomes Using the Inferior Epigastric Artery(2014) ANTONOPOULOS, Ioannis M.; YAMACAKE, Kleiton Gabriel Ribeiro; OLIVEIRA, Lorena M.; PIOVESAN, Affonso C.; KANASHIRO, Hideki; NAHAS, Willian C.OBJECTIVE To study the safety and long-term outcomes of use of the inferior epigastric artery (IEA) for revascularization of small accessory kidney arteries (3 mm or less). MATERIALS AND METHODS Data of 602 living-donor kidney transplants were reviewed. Age was 37.4 +/- 15 years (range, 3-78 years). Multiple arteries were present in 98 kidneys (16.3%); of these, 83 (84.7%) had 2 and arteries and 15 (15.3%) had 3 arteries. In 21 kidneys (21.4%) with multiple arteries (group I [GI]), the IEA was used for reconstruction. Four (14.3%) had 3 arteries, and 17 (85.7%) had 2 arteries. In 77 patients (group II [GII]), the inferior accessory renal artery was reconstructed with a side-to-side or an end-to-side anastomosis to the main renal artery. Follow-up was 43.8 +/- 38.1 months (range, 1-124 months). The Fisher exact test and the 2-tailed t test were used for statistical analysis. RESULTS Delayed graft function occurred in 1 GI patient (4.8%) and in 5 GII patients (6.5%; P >.05). One partial renal infarction occurred in each group (4.8% vs 1.3%; P >.05). There was 1 urinary fistula in GI and 3 urinary fistulas and 1 ureteral stenosis in GII (P >.05). One graft (4.8%) lost function in GI and 5 (6.5%) in GII (P >.05). Eleven patients (53.4%) were hypertensive in GI and 53 (68.8%) in GII (P >.05). CONCLUSION The use of the IEA for revascularization of a living-donor kidney transplant with multiple arteries is safe and effective, yielding similar long-term outcomes compared with the standard technique. Use of the IEA avoids the risks of manipulation of the main renal artery. (C) 2014 Elsevier Inc.
conferenceObject Comparison of Two Different Schemes of Preemptive Anticoagulation for Patients With High Risk for Allograft Thrombosis in Renal Transplantation: A Single-Center Experience.(2014) PIOVESAN, A.; ANDRADE, H.; BULL, A.; MESSI, G.; EBAID, G.; KANASHIRO, H.; FALCI, R.; ANTONOPOULOS, I.; NAHAS, W.- Current management issues of immediate postoperative care in pediatric kidney transplantation(2014) TORRICELLI, Fabio Cesar Miranda; WATANABE, Andreia; DAVID-NETO, Elias; NAHAS, William CarlosThe number of pediatric kidney transplants has been increasing in many centers worldwide, as the procedure provides long-lasting and favorable outcomes; however, few papers have addressed the immediate postoperative care of this unique population. Herein, we describe the management of these patients in the early postoperative phase. After the surgical procedure, children should ideally be managed in a pediatric intensive care unit, and special attention should be given to fluid balance, electrolyte disturbances and blood pressure control. Antibiotic and antiviral prophylaxes are usually performed and are based on the recipient and donor characteristics. Thrombotic prophylaxis is recommended for children at high risk for thrombosis, although consensus on the optimum therapy is lacking. Image exams are essential for good graft control, and Doppler ultrasound must be routinely performed on the first operative day and promptly repeated if there is any suspicion of kidney dysfunction. Abdominal drains can be helpful for surveillance in patients with increased risk of surgical complications, such as urinary fistula or bleeding, but are not routinely required. The immunosuppressive regimen starts before or at the time of kidney transplantation and is usually based on induction with monoclonal or polyclonal antibodies, depending on the immunological risk, and maintenance with a calcineurin inhibitor (tacrolimus or ciclosporin), an anti-proliferative agent (mycophenolate or azathioprine) and steroids.
conferenceObject Transurethral Resection or Incision of the Prostate After Renal Transplantation: Is There a Safe Time for the Procedure?(2014) PIOVESAN, A.; ANDRADE, H.; KANASHIRO, H.; FALCI, R.; ANTONOPOULOS, I.; NAHAS, W.