JOEL AVANCINI ROCHA FILHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- Hypoxia among patients on the liver-transplant waiting list(2014) NACIF, Lucas Souto; ANDRAUS, Wellington; SARTORI, Kathryn; BENITES, Carlos Marlon; SANTOS, Vinicius Rocha; ROCHA-FILHO, Joel Avancini; D'ALBUQUERQUE, Luiz CarneiroBackground: Hepatopulmonary syndrome is formed by a triad of liver disease, intrapulmonary vascular dilatation and changes in blood gases. This condition is present in 4-32% of patients with cirrhosis. Aim : To analyze the blood gas changes data of patients in liver-transplant waiting list. Method: Clinical data of 279 patients in liver transplantation waiting list in May 2013 were studied. Overall patient was analyzed by the demographic aspects, laboratorial and image findings on exams that determine lung disease (hypoxemia) in these cirrhotic patients. The mean values and standard deviations were used to examine normally distributed variables. Results: There was a high prevalence of male patients (68%); the mean age was 51(±5,89) years, and the predominant reason for listing was hepatitis C cirrhosis. The MELD score mean was 16±5,89, without prioritization or special situation. The most common blood type was O in 129 cases (46%) and the mean of body max index was 25,94±4,58. Regarding arterial blood gas tests was observed 214 patients with PaO2 <90 mmHg, 80 with PaO2 <80 mmHg and 39 with PaO2 <50 mmHg. In relation to O2 saturation, 50 patients had <90%, 33 <80% and 10 <50%. Conclusion: Was observed a high rate of hypoxemia in patients on waiting list liver transplant. Due to the high severity and morbidity, is suggested better monitoring and therapeutic support to hypoxemic patients on liver transplant waiting list.
- Pentoxifylline enhances the protective effects of hypertonic saline solution on liver ischemia reperfusion injury through inhibition of oxidative stress(2014) ROCHA-SANTOS, Vinicius; FIGUEIRA, Estela R. R.; ROCHA-FILHO, Joel A.; COELHO, Ana M. M.; PINHEIRO, Rafael Soraes; BACCHELLA, Telesforo; MACHADO, Marcel C. C.; D'ALBUQUERQUE, Luiz A. C.BACKGROUND: Liver ischemia reperfiision (IR) injury triggers a systemic inflammatory response and is the main cause of organ dysfunction and adverse postoperative outcomes after liver surgery. Pentoxifylline (PTX) and h-ypertonic saline solution (HTS) have been identified to have beneficial effects against IR injury This study aimed to investigate if the addition of PTX to HTS is superior to HTS alone for the prevention of liver IR injury. METHODS: Male Wistar rats were allocated into three groups. Control rats underwent 60 minutes. of partial liver ischemia, HTS rats were treated with 0.4 mL/kg of intravenous 7.5% NaC1 15 minutes before reperfusion, and HPTX group were treated with 7.5% NaC1 plus 25 mg/kg of PTX 15 minutes before reperfusion. Samples were collected after reperfusion for determination of ALT, AST, TNF-alpha, IL-6, IL-10, mitochondrial respiration, lipid peroxidation, pulmonary permeability and myeloperoxidase. RESULTS: HPTX significantly decreased TNF-alpha 30 minutes after reperfusion. HPTX and HTS significantly decreased ALT, AST, IL-6, mitochondrial dysfunction and pulmonary myeloperoxidase 4 hours after reperfusion. Compared with HTS only, HPTX significantly decreased hepatic oxidative stress 4 hours after reperfusion and pulmonary permeability 4 and 12 hours after reperfusion. CONCLUSION: This study showed that PTX added the beneficial effects of HTS on liver IR injury through decreases of hepatic oxidative stress and pulmonary permeability.
- Anesthetic Conditioning in Liver Transplantation: Results of a Multicenter Randomized Controlled Trial(2013) BONVINI, John M.; SCHADDE, Erik; CLAVIEN, Pierre-Alain; LESURTEL, Mickael; FIGUEIRA, Estela R. R.; FILHO, Joel A. Rocha; REYNTJENS, Koen; BREITENSTEIN, Stefan; BECK-SCHIMMER, BeatriceBackground data: In the age of organ scarcity and the increased use of older and steatotic organ grafts, protective strategies during transplantation are gaining importance. Volatile anesthetics such as sevoflurane attenuate ischemia-reperfusion injury in liver resection and lead to improved clinical outcome. Whether volatile anesthetics change clinical outcome in liver transplantation is unknown. Methods: Cadaveric liver recipients were randomized from 03/2009 to 08/2012 at three University Centers (Zurich, Sao Paulo, Ghent). Standard liver transplant patients were randomly assigned to propofol anesthesia (control group) or conditioning with sevoflurane (sevoflurane group). Postoperative peak of the aspartate transaminase (AST) was defined as primary endpoint. Secondary endpoints were in-hospital complications, hospital- and ICU stay. Results: Ninety-eight patients, who underwent liver transplantation, were randomized to propofol (n=48) or sevoflurane (n=50). Peak AST after transplantation was 925 U/l (512-3274) in the propofol group (p=0.73) and 1097 U/l (interquartile range 540-2633) in the sevofluorane one. While the overall complication rate was not different, there was a trend towards less severe complications in the sevoflurane group: median complication score was grade IIIa (IQR II-IVb) for the propofol and grade II (IQR 0-IIIb) for the sevoflurane group (Odds ratio 0.51, 0.24 to 1.09, p=0.08). Conclusions: This first multicenter trial with different anesthesia regimens in liver transplantation showed comparable surrogate markers postoperatively, but a trend towards less severe complications in the sevoflurane group. Future trials should be adequately powered to assess complications and identify subgroups, which might benefit from anesthetic conditioning.
- Perioperative blood transfusion decreases long-term survival in pediatric living donor liver transplantation(2021) GORDON, Karina; FIGUEIRA, Estela Regina Ramos; ROCHA-FILHO, Joel Avancini; MONDADORI, Luiz Antonio; JOAQUIM, Eduardo Henrique Giroud; SEDA-NETO, Joao; FONSECA, Eduardo Antunes da; PUGLIESE, Renata Pereira Sustovitch; VINTIMILLA, Agustin Moscoso; JR, Jose Otavio Costa Auler; CARMONA, Maria Jose Carvalho; D'ALBURQUERQUE, Luiz Augusto CarneiroBACKGROUND The impact of perioperative blood transfusion on short- and long-term outcomes in pediatric living donor liver transplantation (PLDLT) must still be ascertained, mainly among young children. Clinical and surgical postoperative complications related to perioperative blood transfusion are well described up to three months after adult liver transplantation. AIM To determine whether transfusion is associated with early and late postoperative complications and mortality in small patients undergoing PLDLT. METHODS We evaluated the effects of perioperative transfusion on postoperative complications in recipients up to 20 kg of body weight, submitted to PLDLT. A total of 240 patients were retrospectively allocated into two groups according to postoperative complications: Minor complications (n = 109) and major complications (n = 131). Multiple logistic regression analysis identified the volume of perioperative packed red blood cells (RBC) transfusion as the only independent risk factor for major postoperative complications. The receiver operating characteristic curve was drawn to identify the optimal volume of the perioperative RBC transfusion related to the presence of major postoperative complications, defining a cutoff point of 27.5 mL/kg. Subsequently, patients were reallocated to a low-volume transfusion group (LTr; n = 103, RBC <= 27.5 mL/kg) and a high-volume transfusion group (HTr; n = 137, RBC > 27.5 mL/kg) so that the outcome could be analyzed. RESULTS High-volume transfusion was associated with an increased number of major complications and mortality during hospitalization up to a 10-year follow-up period. During a short-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and bleeding complications, with a decrease in rejection complications compared to the LTr. Over a long-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and minor neoplastic complications, with a decrease in rejection complications. Additionally, Cox hazard regression found that high-volume RBC transfusion increased the mortality risk by 3.031-fold compared to low-volume transfusion. The Kaplan-Meier survival curves of the studied groups were compared using log-rank tests and the analysis showed significantly decreased graft survival, but with no impact in patient survival related to major complications. On the other hand, there was a significant decrease in both graft and patient survival, with high-volume RBC transfusion. CONCLUSION Transfusion of RBC volume higher than 27.5 mL/kg during the perioperative period is associated with a significant increase in short- and long-term postoperative morbidity and mortality after PLDLT.
- Sevoflurane Preconditioning plus Postconditioning Decreases Inflammatory Response with Hemodynamic Recovery in Experimental Liver Ischemia Reperfusion(2019) FIGUEIRA, Estela Regina Ramos; ROCHA-FILHO, Joel Avancini; LANCHOTTE, Cinthia; COELHO, Ana Maria Mendonca; NAKATANI, Mauro; TATEBE, Eduardo Ryoiti; LIMA, Jonathan Augusto Venceslau; MENDES, Camilla Oliveira; ARAUJO, Bruno Camargo Rocha Paim de; ABDO, Emilio Elias; D'ALBUQUERQUE, Luiz Carneiro; GALVAO, Flavio Henrique FerreiraObjective. The inhalation anesthetic sevoflurane has presented numerous biological activities, including anti-inflammatory properties and protective effects against tissue ischemic injury. This study investigated the metabolic, hemodynamic, and inflammatory effects of sevoflurane pre- and postconditioning for short periods in the rescue of liver ischemia-reperfusion (IR) injury using a rat model. Materials and Methods. Twenty Wistar rats were divided into four groups: sham group, control ischemia group (partial warm liver ischemia for 45min followed by 4h of reperfusion), SPC group (administration of sevoflurane 2.5% for 15min with 5min of washout before liver IR), and SPPoC group (administration of sevoflurane 2.5% for 15min before ischemia and 20min during reperfusion). Results. All animals showed a decrease in the mean arterial pressure (MAP) and portal vein blood flow during ischemia. After 4h of reperfusion, only the SPPoC group had MAP recovery. In both the SPC and SPPoC groups, there was a decrease in the ALT level and an increase in the bicarbonate and potassium serum levels. Only the SPPoC group showed an increase in the arterial blood ionized calcium level and a decrease in the IL-6 level after liver reperfusion. Therefore, this study demonstrated that sevoflurane preconditioning reduces hepatocellular injury and acid-base imbalance in liver ischemia. Furthermore, sevoflurane postconditioning promoted systemic hemodynamic recovery with a decrease in inflammatory response.
- PRELIMINARY RESULTS OF TOPICAL HEPATIC HYPOTHERMIA IN A MODEL OF LIVER ISCHEMIA/REPERFUSION INJURY IN RATS(2017) ABDO, Emilio Elias; FIGUEIRA, Estela Regina Ramos; ROCHA-FILHO, Joel Avancini; CHAIB, Eleazar; D’ALBUQUERQUE, Luiz Augusto Carneiro; BACCHELLA, TelesforoABSTRACT BACKGROUND Ischemia/reperfusion causes organ damage but it is mandatory in hepatic transplantation, trauma and other complex liver surgeries, when Pringle maneuver is applied to minimize bleeding during these procedures. It is well known that liver ischemia/reperfusion leads to microcirculatory disturbance and cellular injury. In this setting hypothermia is known to reduce oxygen demand, lowering intracellular metabolism. OBJECTIVE: To evaluate the effects of hypothermia in liver ischemia/reperfusion injury, using a new model of topic isolated liver hypothermia. METHODS We used male Wistar rats weighting about 250 grams, kept in ad libitum feeding regime and randomly divided into two groups of nine animals: 1) Normothermic group, rats were submitted to normothermic ischemia of the median and left hepatic lobes, with subsequent resection of right and caudate lobes during liver reperfusion; and 2) Hypothermic group, rats were submitted to liver ischemia under hypothermia at 10°C. Liver ischemia was performed for 45 minutes. The animals were euthanized 48 hours after liver reperfusion for blood and liver tissue sampling. RESULTS The transaminases analyses showed a significant decrease of AST and ALT in Hypothermic group (P<0.01) compared to Normothermic group (1403±1234 x 454±213 and 730±680 x 271±211 U/L, respectively). Histology showed severe necrosis in 50% and mild necrosis in 50% of cases in Normothermic group, but severe necrosis in 10% and mild or absent necrosis 90% of the cases in hypothermic group. CONCLUSION: A simplified model of liver ischemia/reperfusion that simulates orthotopic liver autotransplantion was demonstrated. Topical hypothermia of isolated hepatic lobules showed liver protection, being a viable and practical method for any kind of in vivo liver preservation study.
conferenceObject Does Autologous Blood Transfusion during Liver Transplantation for Hepatocellular Carcinoma Increase Risk of Recurrence?(2014) ARAUJO, Raphael L. C.; ANDRAUS, Wellington; PANTANALI, Carlos Andres; HADDAD, Luciana; ROCHA FILHO, Joel Avancini; D'ALBUQUERQUE, Luiz Augusto Carneiro- Creatinine-lactate score predicts mortality in non-acetaminophen-induced acute liver failure in patients listed for liver transplantation(2021) FIGUEIRA, Estela Regina Ramos; ROCHA-FILHO, Joel Avancini; LANCHOTTE, Cinthia; NACIF, Lucas Souto; HADDAD, Luciana Bertocco de Paiva; ASSALIN, Adriana Rochetto; SHINKADO, Yumi Ricucci; VINTIMILLA, Agustin Moscoso; GALVAO, Flavio Henrique Ferreira; D'ALBUQUERQUE, Luiz Augusto CarneiroBackground The aim of this study was to analyze prognostic indicators of in-hospital mortality among patients listed for urgent liver transplantation (LT) for non-acetaminophen (APAP)-induced acute liver failure (ALF). Methods ALF patients listed for LT according to the King's College Criteria were retrospectively reviewed. Variables were recorded from medical records and electronic databases (HCMED and RedCap). Results The study included 100 patients, of which 69 were subject to LT and 31 died while waiting for LT. Patients were 35.5 +/- 14.73 years old, and 78% were females. The main etiologies were virus (17%), drug-induced (32%), autoimmune (15%), and indeterminate hepatitis (31%). The prioritization-to-LT time interval was 1.5 days (0-9). The non-LT patients showed higher lactate (8.71 +/- 5.36 vs. 4.48 +/- 3.33 mmol/L), creatinine (229 +/- 207 vs. 137 +/- 136 mu m/L), MELD (44 +/- 8 vs. 38 +/- 8), and BiLE scores (15.8 +/- 5.5 vs. 10.3 +/- 4.1) compared to LT patients (p < 0.05). Multiple logistic regression analysis identified creatinine and lactate as independent prognostic factors, and a creatinine-lactate (CL) score was developed. ROC analysis showed that creatinine, lactate, MELD, BiLE, and CL scores had considerable specificity (71-88%), but only BiLE, lactate, and CL presented high sensitivities (70%, 80%, and 87% respectively). AUCs were 0.696 for creatinine, 0.763 for lactate, 0.697 for MELD, 0.814 for BiLE, and 0.835 for CL. Conclusions CL and BiLE scores predict mortality with more accuracy than MELD in patients with ALF during prioritization time. Creatinine and lactate are independent prognostic factors for mortality.
- Hepatic ischemic preconditioning increases portal vein flow in experimental liver ischemia reperfusion injury(2014) FIGUEIRA, Estela R. R.; ROCHA-FILHO, Joel A.; NAKATANI, Mauro; BUTO, Marcelo F. S.; TATEBE, Eduardo R.; ANDRE, Vitor; CECCONELLO, Ivan; D'ALBUQUERQUE, Luiz A. C.BACKGROUND: Ischemic preconditioning (IPC) has been shown to decrease liver injury and to increase hepatic microvascular perfusion after liver ischemia reperfusion. This study aimed to evaluate the effects of IPC on hemodynamics of the portal venous system. METHODS: Thirty-two rats were randomized into two groups: IPC group and control group. The rats of the IPC group underwent IPC by 10 minutes of liver ischemia followed by 10 minutes of reperfusion before liver ischemia, and the rats of the control group were subjected to 60 minutes of partial liver ischemia. Non-ischemic lobes were resected immediately after reperfusion. The animals were studied at 4 hours and 12 hours after reperfusion. Mean arterial pressure, heart rate, portal vein flow and pressure were analyzed. Blood was collected for the determination of the levels of aspartate aminotransferase, alanine aminotransferase, calcium, lactate, pH, bicarbonate, and base excess. RESULTS: IPC increased the mean portal vein flow at 4 hours and 12 hours after reperfusion. IPC recovered 78% of the mean portal vein flow at 12 hours after reperfusion. IPC decreased the levels of aspartate aminotransferase, alanine aminotransferase and lactate, and increased the levels of ionized calcium, bicarbonate and base excess at 12 hours after reperfusion. CONCLUSIONS: This study demonstrated that IPC increases portal vein flow and enhances hepatoprotective effects in liver ischemia reperfusion. The better recovery of portal vein flow after IPC may be correlated with the lower levels of transaminases and with the better metabolic profile.