ESTELA AZEKA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
37 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 37
- 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.
- 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
- 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
- Use of Short-term Circulatory Support as a Bridge in Pediatric Heart Transplantation(2015) CANEO, Luiz Fernando; MIANA, Leonardo Augusto; TANAMATI, Carla; PENHA, Juliano Gomes; SHIMODA, Monica Satsuki; AZEKA, Estela; MIURA, Nana; GALAS, Filomena Regina Barbosa Gomes; GUIMARAES, Vanessa Alves; JATENE, Marcelo BiscegliBackground: Heart transplantation is considered the gold standard therapy for the advanced heart failure, but donor shortage, especially in pediatric patients, is the main limitation for this procedure, so most sick patients die while waiting for the procedure. Objective: To evaluate the use of short-term circulatory support as a bridge to transplantation in end-stage cardiomyopathy. Methods: Retrospective clinical study. Between January 2011 and December 2013, 40 patients with cardiomyopathy were admitted in our Pediatric Intensive Care Unit, with a mean age of 4.5 years. Twenty patients evolved during hospitalization with clinical deterioration and were classified as Intermacs 1 and 2. One patient died within 24 hours and 19 could be stabilized and were listed. They were divided into 2 groups: A, clinical support alone and B, implantation of short-term circulatory support as bridge to transplantation additionally to clinical therapy. Results: We used short-term mechanical circulatory support as a bridge to transplantation in 9. In group A (n = 10), eight died waiting and 2 patients (20%) were transplanted, but none was discharged. In group B (n = 9), 6 patients (66.7%) were transplanted and three were discharged. The mean support time was 21,8 days (6 to 984h). The mean transplant waiting list time was 33,8 days. Renal failure and sepsis were the main complication and causeof death in group A while neurologic complications were more prevalent en group B. Conclusion: Mechanical circulatory support increases survival on the pediatric heart transplantation waiting list in patients classified as Intermacs 1 and 2.
- The past, present and future of clinical research(2011) AZEKA, Estela; FREGNI, Felipe; AULER JUNIOR, Jose Otavio Costa
- Mechanical Circulatory Assistance in Children: Clinical Outcome(2023) CORBI, Maria Julia De Aro Braz; JATENE, Marcelo Biscegli; SIQUEIRA, Adailson Wagner Da Silva; GRAU, Claudia Regina Pinheiro Castro; TAVARES, Glaucia Maria Penha; IKARI, Nana Miura; AZEKA, EstelaBackground. In countries where organ donation is scarce, mortality in the pediatric heart transplant waiting list is high, and ventricular assist devices (VADs) are therapeutic alternatives in these situations. Berlin Heart EXCOR is currently 1 of the few VADs specific for children.Methods. This retrospective study includes pediatric patients who underwent Berlin Heart EXCOR placement in a Brazilian hospital between 2012 and 2021. Clinical and laboratory data at the time of VAD implantation and the occurrence of complications and outcomes (success as a bridge to transplant or death) were analyzed.Results. Eight patients, from 8 months to 15 years, were included: 6 with cardiomyopathy and 2 with congenital heart disease. Six were on Intermacs 1 and 2 on Intermacs 2. The most common complications observed were stroke and right ventricular dysfunction. Six were transplanted, and 2 died. Those submitted to transplant had a higher mean weight than those who died, with no statistically significant difference. The underlying disease had no impact on the outcome. The group undergoing transplant had lower brain natriuretic peptide and lactate values, but no laboratory variable showed a statistically significant difference in the outcome. Conclusion. A VAD is an invasive treatment with potentially serious adverse effects and is still poorly available in Brazil. However, as a bridge to transplant, it is a useful treatment for children in progressive clinical decline. In this study, we did not observe any clinical or laboratory factor at the time of VAD implantation that implied better outcomes.