RUBENS MACEDO ARANTES JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Innovative technique avoiding bleeding after reperfusion in living donor liver transplatation using a modified right lobe graft(2021) PINHEIRO, R. S.; ANDRAUS, W.; NACIF, L. S.; MARTINO, R. B.; DUCATTI, L.; ARANTES, R. M.; WAISBERG, D. R.; FORTUNATO, A.; ROCHA-SANTOS, V.; D'ALBUQUERQUE, L. C.conferenceObject A new Model of Hipothermic Pancreas Ischemia-Reperfusion in Rats(2013) SANTOS, Vinicius; FERRO, Oscar; PANTANALI, Carlos; ARANTES, Rubens; PECORA, Rafael; DAVID, Andre; CHAIB, Eleazar; D'ALBUQUERQUE, Luiz- Innovative Technique Avoiding Bleeding After Reperfusion in Living Donor Liver Transplant Using a Modified Right Lobe Graft(2022) PINHEIRO, Rafael S.; ANDRAUS, Wellington; FORTUNATO, Allana C.; FERNANDES, Michel Ribeiro; NACIF, Lucas Souto; MARTINO, Rodrigo Bronze De; DUCATTI, Liliana; WAISBERG, Daniel Reis; ARANTES, Rubens Macedo; ROCHA-SANTOS, Vinicius; GALVAO, Flavio Henrique Ferreira; CARNEIRO-D'ALBUQUERQUE, Luiz AugustoBackground. Living donor liver transplant (LDLT) is a valuable therapeutic option for over-coming the deceased donor shortage. Modified right lobe graft (MRLG) keeps the middle hepatic vein (MHV) trunk with the remnant liver to improve donor safety. Hemostasis in the MHV tributary reconstruction can be tricky; surgical stitches and energy coagulation are ineffective. Fibrin glues are excellent vascular sealants but are poor in maintaining hemostasis in an active hemorrhage or preventing resection surface-related complications after liver resection. We propose applying fibrin sealant during back table graft preparation to seal the hepatic edge and MHV reconstruction to avoid bleeding after graft revascularization. Methods. Our retrospective cohort study included all adult patients undergoing LDLT between August 2017 and December 2021. During the back table procedure, we performed the reconstruction of the inferior right hepatic vein and/or MHV tributaries from segment 5 (V5) and segment 8 (V8) using a vein harvested from a nonrelated deceased donor. Before initiating the hepatic graft implantation, we applied fibrin sealant in the resected parenchyma, especially in the V5 and V8 anastomosis, to seal the hepatic edge and hepatic vein reconstruction. Results. No bleeding was identified in the hepatic edge, and blood product transfusion was unnecessary for any recipients after reperfusion. Conclusion. In LDLT using MRLG with MHV reconstruction, the fibrin sealant, when applied on the raw hepatic surface, and vascular reconstruction during back table graft preparation avoided bleeding after graft revascularization.
- Arterial Pseudoaneurysm Associated with Pancreas and Kidney Transplantation: A Case Report(2017) ARANTES, Rubens Macedo; PANTANALI, Carlos Andres Rodriguez; SANTOS, Vinicius Rocha; D'ALBUQUERQUE, Luiz Augusto CarneiroObjective: Unusual clinical course Background: Pseudoaneurysm is a rare vascular complication in pancreas transplantation. This complication develops from a disruption of the arterial continuity, usually related to trauma, infection, vasculitis, or complications in vascular procedures. Case Report: A 43-year-old man underwent simultaneous pancreas and kidney transplantation for end-stage renal disease. He subsequently developed acute pancreatitis and acute kidney cellular rejection as late complications, thus returning to hemodialysis. A new, uneventful kidney transplantectomy and living donor kidney transplant was performed. One year after the last transplant, the patient presented with moderate abdominal pain, fever, and a pulsatile tumor located in the right iliac fossa. A pseudoaneurysm located in the pancreatic Y graft was observed. The patient was treated using an endovascular and surgical approach. Conclusions: A combined procedure using an endovascular and surgical approach promoted a good vascular control with a lower risk of bleeding in a rare case of pseudoaneurysm in a transplant patient.
article 4 Citação(ões) na Scopus Novel Technique in a Sheep Model of Uterine Transplantation(2020) ARANTES, Rubens Macedo; NACIF, Lucas Souto; PINHEIRO, Rafael Soares; ROCHA-SANTOS, Vinicius; MARTINO, Rodrigo Bronze de; WAISBERG, Daniel Reis; PANTANALI, Carlos Andres Rodriguez; FORTUNATO, Allana; LIMA, Marisa Rafaela; DUCATTI, Liliana; HADDAD, Luciana Bertocco de Paiva; EJZENBERG, Dani; GALVAO, Flavio Henrique; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, Luiz- PREOPERATIVE COMPUTED TOMOGRAPHY VOLUMETRY AND GRAFT WEIGHT ESTIMATION IN ADULT LIVING DONOR LIVER TRANSPLANTATION(2017) PINHEIRO, Rafael S.; CRUZ-JR, Ruy J.; ANDRAUS, Wellington; DUCATTI, Liliana; MARTINO, Rodrigo B.; NACIF, Lucas S.; ROCHA-SANTOS, Vinicius; ARANTES, Rubens M; LAI, Quirino; IBUKI, Felicia S.; ROCHA, Manoel S.; D´ALBUQUERQUE, Luiz A. C.ABSTRACT Background: Computed tomography volumetry (CTV) is a useful tool for predicting graft weights (GW) for living donor liver transplantation (LDLT). Few studies have examined the correlation between CTV and GW in normal liver parenchyma. Aim: To analyze the correlation between CTV and GW in an adult LDLT population and provide a systematic review of the existing mathematical models to calculate partial liver graft weight. Methods: Between January 2009 and January 2013, 28 consecutive donors undergoing right hepatectomy for LDLT were retrospectively reviewed. All grafts were perfused with HTK solution. Estimated graft volume was estimated by CTV and these values were compared to the actual graft weight, which was measured after liver harvesting and perfusion. Results: Median actual GW was 782.5 g, averaged 791.43±136 g and ranged from 520-1185 g. Median estimated graft volume was 927.5 ml, averaged 944.86±200.74 ml and ranged from 600-1477 ml. Linear regression of estimated graft volume and actual GW was significantly linear (GW=0.82 estimated graft volume, r2=0.98, slope=0.47, standard deviation of 0.024 and p<0.0001). Spearman Linear correlation was 0.65 with 95% CI of 0.45 - 0.99 (p<0.0001). Conclusion: The one-to-one rule did not applied in patients with normal liver parenchyma. A better estimation of graft weight could be reached by multiplying estimated graft volume by 0.82.
- Hérnias abdominais e inguinais em pacientes cirróticos: qual é a melhor conduta?(2012) SILVA, Felipe Duarte; ANDRAUS, Wellington; PINHEIRO, Rafael Soares Nunes; ARANTES-JUNIOR, Rubens Macedo; LEMES, Marcus Paulo Lemos; DUCATTI, Liliana de Souza e Silva; D'ALBUQUERQUE, Luiz Augusto CarneiroBACKGROUND: Traditionally, elective abdominal procedures in cirrhotic patients have been largely discouraged due to high morbidity and mortality consequent to complications of cirrhosis, described by several authors. Other services, however, obtained different results, advocating in favor of elective surgery. METHODS: A literature review using as key-words ""abdominal wall hernia"" and ""cirrhotic patients"" was performed using PubMed database. Twenty-eight articles were considered. RESULTS: The incidence of abdominal wall hernias is relatively high in cirrhotic patients, specially those with ascites, and many of these are unfavorable and require specific surgical treatment. Currently, with the advent of MELD score for organ allocation, many centers are reconsidering their approach on leading these situations, since most of patients in question are on waiting list for liver transplantation. Thus elective surgery has achieved major position in managing this condition in order to reduce morbidity and mortality in these patients. Moreover, the quality of life was an important factor to be considered, being badly damaged in this condition. CONCLUSION: Few studies with large samples have been conducted so far and there is no consensus on which conduct is the most suitable taking into consideration rates of morbidity and mortality.
conferenceObject Adequate Exposure to Tacrolimus with Sublingual Administration(2021) MACIEL, A.; FORTUNATO, A.; WAISBERG, D.; GALVAO, F.; LEE, A.; ARANTES, Jr R.; ROCHA, M.; TANIGAWA, R.; DUCATTI, L.; MARTINO, R.; NACIF, L.; ROCHA-SANTOS, V; ANDRAUS, W.; D'ALBUQUERQUE, L.- Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility(2018) EJZENBERG, Dani; ANDRAUS, Wellington; MENDES, Luana Regina Baratelli Carelli; DUCATTI, Liliana; SONG, Alice; TANIGAWA, Ryan; ROCHA-SANTOS, Vinicius; ARANTES, Rubens Macedo; SOARES JR., Jose Maria; SERAFINI, Paulo Cesar; HADDAD, Luciana Bertocco de Paiva; FRANCISCO, Rossana Pulcinelli; D'ALBUQUERQUE, Luiz Augusto Carneiro; BARACAT, Edmund ChadaBackground Uterus transplantation from live donors became a reality to treat infertility following a successful Swedish 2014 series, inspiring uterus transplantation centres and programmes worldwide. However, no case of livebirth via deceased donor uterus has, to our knowledge, been successfully achieved, raising doubts about its feasibility and viability, including whether the womb remains viable after prolonged ischaemia. Methods In September, 2016, a 32-year-old woman with congenital uterine absence (Mayer-Rokitansky-KusterHauser [MRKH] syndrome) underwent uterine transplantation in Hospital das Clinicas, University of Sao Paulo, Brazil, from a donor who died of subarachnoid haemorrhage. The donor was 45 years old and had three previous vaginal deliveries. The recipient had one in-vitro fertilisation cycle 4 months before transplant, which yielded eight cryopreserved blastocysts. Findings The recipient showed satisfactory postoperative recovery and was discharged after 8 days' observation in hospital. Immunosuppression was induced with prednisolone and thymoglobulin and continued via tacrolimus and mycophenalate mofetil (MMF), until 5 months post-transplantation, at which time azathioprine replaced MMF. First menstruation occurred 37 days post-transplantation, and regularly (every 26-32 days) thereafter. Pregnancy occurred after the first single embryo transfer 7 months post-transplantation. No blood flow velocity waveform abnormalities were detected by Doppler ultrasound of uterine arteries, fetal umbilical, or middle cerebral arteries, nor any fetal growth impairments during pregnancy. No rejection episodes occurred after transplantation or during gestation. Caesarean delivery occurred on Dec 15, 2017, near gestational week 36. The female baby weighed 2550 g at birth, appropriate for gestational age, with Apgar scores of 9 at 1 min, 10 at 5 min, and 10 at 10 min, and along with the mother remains healthy and developing normally 7 months post partum. The uterus was removed in the same surgical procedure as the livebirth and immunosuppressive therapy was suspended. Interpretation We describe, to our knowledge, the first case worldwide of livebirth following uterine transplantation from a deceased donor in a patient with MRKH syndrome. The results establish proof-of-concept for treating uterine infertility by transplantation from a deceased donor, opening a path to healthy pregnancy for all women with uterine factor infertility, without need of living donors or live donor surgery.
- Attitude and knowledge of medical students toward donation after circulatory death(2021) MARTINO, Rodrigo Bronze de; GUIDOTTE, Diogo Visconti; WAISBERG, Daniel Reis; SANTOS, Alexandre Guerra dos; CASSENOTE, Alex Jones Flores; ARANTES, Rubens Macedo; HADDAD, Luciana Bertocco; GALVAO, Flavio Henrique; CARNEIRO-D'ALBUQUERQUE, Luiz AugustoOBJECTIVE: A survey among medical students in a Brazilian public university was performed to investigate the acceptance of organ donation in Brazil, particularly donation after circulatory death (DCD). METHODS: A questionnaire including 26 objectives and Likert scale questions was validated and sent to all medical students of our institution. The answers were analyzed considering the whole set of individuals as well as by dividing the medical students into two groups: less graduated students and more graduated students. RESULTS: From 1050 students, 103 spontaneous answers (9.8%) were retrieved after 3 weeks. A total of 89.3% agreed totally with deceased donor organ donation and 8.7% agreed partially. However, only 50.5% of the students agreed totally and 31.1% agreed partially to living donation. Students revealed that 82.6% know the concept of brain death. On the other hand, 71.8% of them declared not knowing the concept of planned withdrawal of life-sustaining therapy, mainly cardiorespiratory support. A total of 85.4% of students agreed totally with donation after brain death and 11.7% agreed partially. However, when questioned about donation in awaiting circulatory death after a planned withdrawal of life-sustaining therapy, only 18.4% agreed totally and 32% agreed partially. Both groups of less and more graduated students showed similar results. CONCLUSIONS: Our study found a clear lack of information and consequently in acceptance of DCD. Education in the field of end-oflife management may improve not only the acceptance of DCD donation but also the whole understanding of planned withdrawal of life-sustaining therapy.