ESTELA AZEKA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
64 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 64
- PEDIATRIC HEART TRANSPLANTATION PROGRAM: SINGLE CENTER EXPERIENCE OF 20 YEARS(2013) AZEKA, Estela; GALAS, Filomena; TANAMATI, Carla; PENHA, Juliano; FERNANDES, Marcos; SENAHA, Luciano; XAVIER, Johnny; DELGADO, Ana Beatriz Romani; KAJITA, Luiz; AIELLO, Vera; BENVENUTI, Luiz; MIURA, Nana; AULER JUNIOR, Jose Otavio Costa; JATENE, MarceloOBJECTIVE: Heart transplantation has been the treatment of choice for children with refractory to conventional therapy. To report the experience with heart transplantation in a single center. MATERIAL AND METHODS: To report the single center experience of hearttransplantation. Data analysis was demographic characteristics, clinical outcome and survival Kaplan Meier curve. RESULTS: From October 30, 1992 to October 2nd, 2012, 120 transplants were performed and 115 patients were submitted to heart transplantation at Heart Institute (InCor) University of Sao Paulo Medical School, Sao Paulo, Brazil. The causes of indication for transplantation were: cardiomyopathies (76%) and congenital heart disease (24%). Five patients were submitted to re-transplantation. Three of them were re-transplanted on the early postoperative period with high mortality (66.6%). One patient was submitted to simultaneous re-transplantation and kidney transplantation after 13.9 yrs of follow-up and one of patient was successful re-transplanted after 10 yr of follow-up. The post-operative immunosuppression regimen was double immunosuppression and polyclonal anti-thymocyte serum induction therapy. The actuarial survival was 80%, 71%, and 61% at 1, 5, and 10 yr, respectively. CONCLUSION: Heart transplantation has been a promising option for children. The use of double immunosuppression with polyclonal anti-thymocyte serum induction therapy combined with surveillance of acute rejection with non-invasive tests may provide favorable clinical outcome.
- ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation(2020) KIRK, Richard; I, Anne Dipchand; DAVIES, Ryan R.; MIERA, Oliver; CHAPMAN, Gretchen; CONWAY, Jennifer; DENFIELD, Susan; GOSSETT, Jeffrey G.; JOHNSON, Jonathan; MCCULLOCH, Michael; SCHWEIGER, Martin; ZIMPFER, Daniel; ABLONCZY, Laszlo; ADACHI, Iki; ALBERT, Dimpna; ALEXANDER, Peta; AMDANI, Shahnawaz; AMODEO, Antonio; AZEKA, Estela; BALLWEG, Jean; BEASLEY, Gary; BOHMER, Jens; BUTLER, Alison; CAMINO, Manuela; CASTRO, Javier; CHEN, Sharon; CHRISANT, Maryanne; CHRISTEN, Urs; DANZIGER-ISAKOV, Lara; DAS, Bibhuti; EVERITT, Melanie; FEINGOLD, Brian; FENTON, Matthew; GARCIA-GUERETA, Luis; GODOWN, Justin; GUPTA, Dipankar; IRVING, Claire; JOONG, Anna; KEMNA, Mariska; KHULBEY, Sanjeev Kumar; KINDEL, Steven; KNECHT, Kenneth; LAL, Ashwin K.; LIN, Kimberly; LORD, Karen; MOLLER, Thomas; NANDI, Deipanjan; NIESSE, Oliver; PENG, David M.; PEREZ-BLANCO, Alicia; PUNNOOSE, Ann; REINHARDT, Zdenka; ROSENTHAL, David; SCALES, Angie; SCHEEL, Janet; SHIH, Renata; SMITH, Jonathan; SMITS, Jacqueline; THUL, Josef; WEINTRAUB, Robert; ZANGWILL, Steve; ZUCKERMAN, Warren A.The number of potential pediatric heart transplant recipients continues to exceed the number of donors, and consequently the waitlist mortality remains significant. Despite this, around 40% of all donated organs are not used and are discarded. This document (62 authors from 53 institutions in 17 countries) evaluates factors responsible for discarding donor hearts and makes recommendations regarding donor heart acceptance. The aim of this statement is to ensure that no usable donor heart is discarded, waitlist mortality is reduced, and post-transplant survival is not adversely impacted.
bookPart Insuficiência cardíaca congestiva e transplante cardíaco na criança(2016) AZEKA, Estela; RIBEIRO, Anna Christina; THOMAZ, Ana Maria; GUIMARãES, Vanessa; GALAS, Filomena Regina; HOROWITZ, Estela; SIQUEIRA, Adailson; BENVENUTI, Luiz; ZORZANELLI, Leina; JATENE, Marcelo- The Fontan immunophenotype and post-transplant outcomes in children: A multi-institutional study(2023) MANTELL, Benjamin S.; AZEKA, Estela; CANTOR, Ryan S.; CARLO, Waldemar F.; CHRISANT, Maryanne; DYKES, John C.; HOFFMAN, Timothy M.; KIRKLIN, James K.; KOEHL, Devin; L'ECUYER, Thomas J.; MCALLISTER, Jennie M.; PRADA-RUIZ, Adriana C.; RICHMOND, Marc E.BackgroundPatients after Fontan palliation represent a growing pediatric population requiring heart transplant (HTx) and often have lymphopenia (L) and/or hypogammaglobinemia that may be exacerbated by protein-losing enteropathy (PLE, P). The post-HTx effects of this altered immune phenotype are not well studied. MethodsIn this study of the Pediatric Heart Transplant Society Registry, 106 Fontan patients who underwent HTx between 2005 and 2018 were analyzed. The impact of lymphopenia and PLE on graft survival, infection, rejection, and malignancy was analyzed at 1 and 5 years post-HTx. ResultsThe following combinations of lymphopenia and PLE were noted: +L+P, n = 37; +L-P, n = 23; -L+P, n = 10; and -L-P, n = 36. Graft survival between the groups was similar within the first year after transplant (+L+P: 86%, +L-P: 86%, -L+P: 87%, -L-P: 89%, p = .9). Freedom from first infection post-HTx was greatest among -L-P patients compared to patients with either PLE, lymphopenia, or both; with a 22.1% infection incidence in the -L-P group and 41.4% in all others. These patients had a significantly lower infection rate in the first year after HTx (+L+P: 1.03, +L-P: 1, -L+P: 1.3, -L-P: 0.3 infections/year, p < .001) and were similar to a non-single ventricle CHD control group (0.4 infections/year). Neither freedom from rejection nor freedom from malignancy 1 and 5 years post-HTx, differed among the groups. ConclusionsFontan patients with altered immunophenotype, with lymphopenia and/or PLE, are at increased risk of infection post-HTx, although have similar early survival and freedom from rejection and malignancy. These data may encourage alternative immunosuppression strategies and enhanced monitoring for this growing subset of patients.
- Clinical approach to mechanical circulatory support in the transplant patient from the Pediatric Heart Transplant Society(2022) BEARL, David W.; JEEWA, Aamir; AUERBACH, Scott R.; AZEKA, Estela; PHELPS, Christina; SACKS, Loren D.; ROSENTHAL, David; CONWAY, JenniferThe use of mechanical circulatory support (MCS) for pediatric patients who have undergone heart transplant has grown rapidly in the past decade. This includes support in the immediate post-transplant period and ""rescue"" therapy for patient later in their transplant course. Extracorporeal membrane oxygenation (ECMO) remains a standard modality of support for intraoperative concerns and for acute decompensation in the immediate post-transplant period. However, both pulsatile and continuous flow ventricular assist devices (VADs) have been used with increasing success in transplant patients for longer durations of support. Centers participating in the Pediatric Heart Transplant Society (PHTS) were queried to provide their internal protocols and rationale for mechanical circulatory support following heart transplant. These protocols coupled with evidence-based literature were used to provide the following description of clinical approaches to MCS in the transplant patient highlighting areas of both broad consensus and significant practice variation.
- Clinical approach to antibody-mediated rejection from the pediatric heart transplant society(2022) AMDANI, Shahnawaz; HENDERSON, Heather; EVERITT, Melanie D.; BEASLEY, Gary; SHIH, Renata; EXIL, Vernat; ALEJOS, Juan; WALLIS, Gonzalo; AZEKA, Estela; NANDI, Deipanjan; PROFITA, Elizabeth; SPINNER, Joseph; MAGNETTA, Defne; MARTINEZ, Hugo; FENTON, Matthew; CONWAY, Jennifer; URSCHEL, SimonObjective This document is designed to outline the definition, pathogenesis, diagnostic modalities and therapeutic measures to treat antibody-mediated rejection in children postheart transplant Methods Literature review was conducted by a Pediatric Heart Transplant Society (PHTS) working group to identify existing pediatric and adult studies on antibody-mediated rejection (AMR). In addition, the centers participating in PHTS were asked to submit their approach to diagnosis and management of pediatric AMR. This document synthesizes information gathered from both these sources to highlight a practical approach to diagnosing and managing a child with AMR postheart transplant. This document may not represent the practice at all centers in the PHTS and serves as a starting point to understand an approach to this clinical scenario.
- Heart Transplantation in Pediatric Population and in Adults With Congenital Heart Disease: Long-term Follow-up, Critical Clinical Analysis, and Perspective for the Future(2014) AZEKA, E.; JATENE, M.; GALAS, F. R. B.; TANAMATI, C.; PENHA, J.; BENVENUTI, L.; MIURA, N.; JUNIOR, J. O. C.Background. Heart transplantation is a treatment option for children as well as for adults with congenital heart disease. Objective. To report the experience of a tertiary center with heart transplant program in pediatric population and in adults with congenital heart disease. Patients and Methods. The study consisted of the evaluation of pediatric as well as adult patients undergoing heart transplantation for congenital heart disease. We evaluated the following indication and complications such as renal dialysis, graft vascular disease, tumors and survival. Results. From October 1992 to November 2013, 134 patients had transplantation, and there were 139 transplantations and 5 retransplantations. The immunosuppression regimen is based on calcineurin inhibitors and cytostatic drugs. The type of heart disease indicated for transplantation was cardiomyopathies in 70% and congenital heart disease in 30%. Of these 134 patients, 85 patients were alive. Actuarial survival is 77.4%, 69.6%, 59.3% at 1, 5, and 10 years after transplantation. Three patients underwent renal transplantation, 1 patient is in renal dialysis, and 8.2% of patients had post-transplant lymphoproliferative disease. Two patients had retransplantation for graft vascular disease; 1 of them required a simultaneous kidney transplant and died 30 days after the procedure and 1 patient is clinically well 2 years after retransplantation. Conclusion. Heart transplantation in children and in adults with congenital heart disease is a promising therapeutic option and enables long-term survival for these patients.
- The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients(2023) VELLECA, Angela; SHULLO, Michael A.; DHITAL, Kumud; AZEKA, Estela; COLVIN, Monica; DEPASQUALE, Eugene; FARRERO, Marta; GARCIA-GUERETA, Luis; JAMERO, Gina; KHUSH, Kiran; LAVEE, Jacob; POUCH, Stephanie; PATEL, Jignesh; MICHAUD, C. J.; SCHUBERT, Stephan; ANGELINI, Annalisa; CARLOS, Lilibeth; MIRABET, Sonia; PHAM, Michael; URSCHEL, Simon; KIM, Kyung-Hee; MIYAMOTO, Shelly; CHIH, Sharon; DALY, Kevin; GROSSI, Paolo; JENNINGS, Douglas L.; KIM, In-cheol; LIM, Hoong Sern; MILLER, Tara; POTENA, Luciano; EISEN, Howard; BELLUMKONDA, Lavanya; DANZIGER-ISAKOV, Lara; DOBBELS, Fabienne; HARKESS, Michelle; KIM, Daniel; LYSTER, Haifa; PELED, Yael; REINHARDT, Zdenka
conferenceObject HEART TRANSPLANTATION IN PEDIATRIC AND ADULT WITH CONGENITAL HEART DISEASE: CURRENT STATUS.(2017) COUTINHO, K.; SIQUEIRA, A.; BENVENUTI, L.; MIURA, N.; JATENE, M.; AZEKA, E.- Heart Retransplantation for Coronary Allograft Vasculopathy in Children: 25 Years of Single -Center Experience(2020) AZEKA, Estela; WALKER, Thomas; SIQUEIRA, Adailson Wagner da Silva; PENHA, Juliano; MIANA, Leonardo; CANEO, Luiz Fernando; MASSOTI, Maria Raquel; TANAMATI, Carla; MIURA, Nana; JATENE, Marcelo Biscegli