LUCAS MATOS FERNANDES
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
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- Lung transplantation: overall approach regarding its major aspects(2015) CAMARGO, Priscila Cilene Leon Bueno de; TEIXEIRA, Ricardo Henrique de Oliveira Braga; CARRARO, Rafael Medeiros; CAMPOS, Silvia Vidal; AFONSO JUNIOR, Jose Eduardo; COSTA, Andre Nathan; FERNANDES, Lucas Matos; ABDALLA, Luis Gustavo; SAMANO, Marcos Naoyuki; PEGO-FERNANDES, Paulo ManuelO transplante pulmonar é uma terapia bem estabelecida para pacientes com doença pulmonar avançada.A avaliação do candidato para o transplante é uma tarefa complexa e envolve uma equipe multidisciplinar que acompanha o paciente para além do período pós-operatório.O tempo médio atual em lista de espera para transplante pulmonar é de aproximadamente 18 meses no estado de São Paulo. Em 2014, dados da Associação Brasileira de Transplante de Órgãos mostram que 67 transplantes pulmonares foram realizados no Brasil e que 204 pacientes estavam na lista de espera para transplante pulmonar.O transplante pulmonar é principalmente indicado no tratamento de DPOC, fibrose cística, doença intersticial pulmonar, bronquiectasia não fibrocística e hipertensão pulmonar.Esta revisão abrangente teve como objetivos abordar os aspectos principais relacionados ao transplante pulmonar: indicações, contraindicações, avaliação do candidato ao transplante, avaliação do candidato doador, gestão do paciente transplantado e complicações maiores. Para atingirmos tais objetivos, utilizamos como base as diretrizes da Sociedade Internacional de Transplante de Coração e Pulmão e nos protocolos de nosso Grupo de Transplante Pulmonar localizado na cidade de São Paulo.
- Stents for Bronchial Stenosis After Lung Transplantation: Should They Be Removed?(2015) FONESCA, H. V. S.; IUAMOTO, L. R.; MINAMOTO, H.; ABDALLA, L. G.; FERNANDES, L. M.; CAMARGO, P. C. L.; SAMANO, M. N.; PEGO-FERNANDES, P. M.Background. Airway complications after lung transplantation are the major cause of morbidity, affecting up to 33% of all cases. Bronchial stenosis is the most common complication. The use of stents has been established as the most effective therapy; however, their removal is recommended after 3-6 months of use. We have been using self-expandable stents as a definitive treatment and remove them only if necessary. For this report, we evaluated the use of self-expandable stents as a definitive treatment for bronchial stenosis after lung transplantation. Methods. We performed a retrospective cohort study to evaluate patients with bronchial stenosis from August 2003 to April 2014. Clinical and pulmonary function test data were collected. Results. Two hundred lung transplants were performed, 156 of which were bilateral. Sixteen patients experienced airway complications: 4 had dehiscence, 2 necrosis, and 10 bronchial stenosis. Of these patients, 7 had undergone bilateral procedures, and 2 patients developed stenosis in both sides. Twelve anastomotic stenoses were observed. The follow-up after stenting ranged from 1 to 7 years. All patients had increased lung function, and 4 remained stable with sustained increase in pulmonary function without episodes of infection. Three patients required removal of their prosthesis 6 months to 1 year after implantation because of complications. Two patients died owing to unrelated causes. Conclusions. Definitive treatment of bronchial stenosis with self-expandable stents is a viable option. The 1st year seems to be the most crucial for determining definitive treatment, because no patients required removal of their stent after 1 year.
- Acute Fibrinoid Organizing Pneumonia in Lung Transplant: The Most Feared Allograft Dysfunction(2016) COSTA, Andre Nathan; CARRARO, Rafael Medeiros; NASCIMENTO, Ellen Caroline Toledo; AFONSO JUNIOR, Jose Eduardo; CAMPOS, Silvia Vidal; CAMARGO, Priscila Cilene Leon Bueno de; TEIXEIRA, Ricardo Henrique de Oliveira Braga; SAMANO, Marcos Naoyuki; FERNANDES, Lucas Matos; ABDALLA, Luis Gustavo; DOLHNIKOFF, Marisa
- Stents for Bronchial Stenosis After Lung Transplantation: Should They Be Removed? (vol 47, pg 1029, 2015)(2015) FONSECA, H. V. S.; IUAMOTO, L. R.; MINAMOTO, H.; ABDALLA, L. G.; FERNANDES, L. M.; CAMARGO, P. C. L.; SAMANO, M. N.; PEGO-FERNANDES, P. M.
conferenceObject The Use of Intraoperative Ecmo in Lung Transplantation: A Retrospective Analysis from the Largest Lung Transplant Center in Brazil(2023) SANTOS, S. dos; RAZUK FILHO, M.; POLA, F.; ABDALLA, L. G.; FERNANDES, L. M.; PEGO-FEMANDES, P.- Ex-Vivo Lung Perfusion for Infected Non-Acceptable Donor Lungs: A Pilot Study(2014) SAMANO, M. N.; ABDALLA, L. G.; FERNANDES, L. M.; NEPOMUCENO, N. A.; BRAGA, K. A. Oliveira; AZEVEDO-PEREIRA, A. E.; PEGO-FERNANDES, P. M.
- Alternative solution for ex vivo lung perfusion, experimental study on donated human lungs non-accepted for transplantation(2015) FERNANDES, Lucas Matos; MARIANI, Alessandro Wasum; MEDEIROS, Israel Lopes de; SAMANO, Marcos Naoyuki; ABDALLA, Luís Gustavo; CORREIA, Aristides Tadeu; NEPOMUCENO, Natália Aparecida; CANZIAN, Mauro; PêGO-FERNANDES, Paulo ManuelPURPOSE: To evaluate a new perfusate solution to be used for ex vivo lung perfusion. METHODS: Randomized experimental study using lungs from rejected brain-dead donors harvested and submitted to 1 hour of ex vivo lung perfusion (EVLP) using mainstream solution or the alternative. RESULTS: From 16 lungs blocs tested, we found no difference on weight after EVLP: Steen group (SG) = 1,097±526g; Alternative Perfusion Solution (APS) = 743±248g, p=0.163. Edema formation, assessed by Wet/dry weigh ratio, was statistically higher on the Alternative Perfusion Solution group (APS = 3.63 ± 1.26; SG = 2.06 ± 0.28; p = 0.009). No difference on PaO2 after EVLP (SG = 498±37.53mmHg; APS = 521±55.43mmHg, p=0.348, nor on histological analyses: pulmonary injury score: SG = 4.38±1.51; APS = 4.50±1.77, p=0.881; apoptotic cells count after perfusion: SG = 2.4 ± 2.0 cells/mm2; APS = 4.8 ± 6.9 cells/mm2; p = 0.361). CONCLUSION: The ex vivo lung perfusion using the alternative perfusion solution showed no functional or histological differences, except for a higher edema formation, from the EVLP using Steen Solution(r) on lungs from rejected brain-dead donors.
conferenceObject Management of Tuberculosis After Lung Transplantation in na Endemic Region(2017) CAMPOS, S. V.; SAMANO, M. N.; PEGO-FERNANDES, P. M.; TEIXEIRA, R. O.; FERNANDES, L. M.; ABDALLA, L. G.; CARRARO, R. M.; AFONSO-JUNIOR, J. E.; COSTA, A. N.article 4 Citação(ões) na Scopus Ex vivo experimental model: split lung block technique(2011) MARIANI, Alessandro Wasum; MEDEIROS, Israel Lopes de; PEGO-FERNANDES, Paulo Manuel; FERNANDES, Flavio Guimares; UNTERPERTINGER, Fernando do Valle; FERNANDES, Lucas Matos; CANZIAN, Mauro; JATENE, Fabio BiscegliSince they were first established, ex vivo models of lung reconditioning have been evaluated extensively. When rejected donor lungs are used, the great variability among the cases can hinder the progress of such studies. In order to avoid this problem, we developed a technique that consists of separating the lung block into right and left blocks and subsequently reconnecting those two blocks. This technique allows us to have one study lung and one control lung.- Cold ischemia or topical-ECMO for lung preservation: a randomized experimental study(2014) MARIANI, Alessandro Wasum; MEDEIROS, Israel Lopes; PEGO-FERNANDES, Paulo Manuel; FERNANDES, Flavio Guimaraes; UNTERPERTINGUER, Fernando Do Vale; FERNANDES, Lucas Matos; CARDOSO, Paulo Francisco; CANZIAN, Mauro; JATENE, Fabio BiscegliCONTEXT AND OBJECTIVE: Lung preservation remains a challenging issue for lung transplantation groups. Along with the development of ex vivo lung perfusion, a new preservation method known as topical-ECMO (extracorporal membrane oxygenation) has been proposed. The present study compared topical-ECMO with cold ischemia (CI) for lung preservation in an ex vivo experimental model. DESIGN AND SETTING: Randomized experimental study, conducted at a public medical school. METHOD: Fourteen human lungs were retrieved from seven brain-dead donors that were considered unsuitable for transplantation. The lung bloc was divided and each lung was randomized to be preserved by means of topical-ECMO or CI (4-7 degrees C) for eight hours. These lungs were then reconnected to an ex vivo perfusion system for functional evaluation. Lung biopsies were obtained at three times. The functional variables assessed were oxygenation capacity (OC) and pulmonary artery pressure (PAP); and the histological variables were lung injury score (LIS) and apoptotic cell count (ACC). RESULTS: The mean OC was 468 mmHg (+/- 81.6) in the topical-ECMO group and 455.8 (+/- 54) for CI (P = 0.758). The median PAP was 140 mmHg (120-160) in the topical-ECMO group and 140 mmHg (140-150) for CI (P = 0.285). The mean LIS was 35.57 (+/- 4.5) in the topical-ECMO group and 33.86 (+/- 6.1) for CI (P = 0.367). The ACC was 25.00 (+/- 9.34) in the topical-ECMO group and 24.86(+/- 10.374) for CI (P = 0.803). CONCLUSIONS: The present study showed that topical-ECMO was not superior to cold ischemia for up to eight hours of lung preservation.