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 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.- 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.
- CIRRHOTIC PATIENTS WITH ACUTE KIDNEY INJURY (AKI) HAVE HIGHER MORTALITY AFTER ABDOMINAL HERNIA SURGERY(2021) DUCATTI, Liliana; HADDAD, Luciana B. P.; MEYER, Alberto; NACIF, Lucas S.; ARANTES, Rubens M.; MARTINO, Rodrigo B.; ROCHA-SANTOS, Vinicius; WAISBERG, Daniel R.; PINHEIRO, Rafael S.; D'ALBUQUERQUE, Luiz A. C.; ANDRAUS, WellingtonBackground: The incidence of abdominal hernia in cirrhotic patients is as higher as 20%; in cases of major ascites the incidence may increase up to 40%. One of the main and most serious complications in cirrhotic postoperative period (PO) is acute kidney injury (AKI). Aim: To analyze the renal function of cirrhotic patients undergoing to hernia surgery and evaluate the factors related to AKI. Methods: Follow-up of 174 cirrhotic patients who underwent hernia surgery. Laboratory tests including the renal function were collected in the PO.AKI was defined based on the consensus of the ascite's club. They were divided into two groups: with (AKI PO) and without AKI .Results: All 174 patients were enrolled and AKI occurred in 58 (34.9%). In the AKI PO group, 74.1% had emergency surgery, whereas in the group without AKI PO it was only 34.6%.In the group with AKI PO, 90.4% presented complications, whereas in the group without AKI PO they occurred only in 29.9%. Variables age, baseline MELD, baseline creatinine, creatinine in immediate postoperative (POI), AKI and the presence of ascites were statistically significant for survival. Conclusions: There is association between AKI PO and emergency surgery and, also, between AKI PO and complications after surgery. The factors related to higher occurrence were initial MELD, basal Cr, Cr POI. The patients with postoperative AKI had a higher rate of complications and higher mortality.
conferenceObject Scoring Criteria for Intestinal Failure Assessment(2021) LEE, A.; GALVAO, F.; WAISBERG, D.; PINHEIRO, R.; ARANTES, R.; ROCHA, M.; ANDRAUS, W.; DUCATI, L.; BRONZE, R.; SANTOS, V; QUEIROZ, M.; D'ALBUQUERQUE, L. Carneiro- Living-donor liver transplantation in Budd-Chiari syndrome with inferior vena cava complete thrombosis: A case report and review of the literature(2021) ROCHA-SANTOS, Vinicius; WAISBERG, Daniel Reis; PINHEIRO, Rafael Soares; NACIF, Lucas Souto; ARANTES, Rubens Macedo; DUCATTI, Liliana; MARTINO, Rodrigo Bronze; HADDAD, Luciana Bertocco; GALVAO, Flavio Henrique; ANDRAUS, Wellington; CARNEIRO-D'ALBURQUERQUE, Luiz AugustoBACKGROUND Budd-Chiari syndrome (BCS) is a challenging indication for liver transplantation (LT) due to a combination of massive liver, increased bleeding, retroperitoneal fibrosis and frequently presents with stenosis of the inferior vena cava (IVC). Occasionally, it may be totally thrombosed, increasing the complexity of the procedure, as it should also be resected. The challenge is even greater when performing living-donor LT as the graft does not contain the retrohepatic IVC; thus, it may be necessary to reconstruct it. CASE SUMMARY A 35-year-old male patient with liver cirrhosis due to BCS and hepatocellular carcinoma beyond the Milan criteria underwent living-donor LT with IVC reconstruction. It was necessary to remove the IVC as its retrohepatic portion was completely thrombosed, up to almost the right atrium. A right-lobe graft was retrieved from his sister, with outflow reconstruction including the right hepatic vein and the branches of segment V and VIII to the middle hepatic vein. Owing to massive subcutaneous collaterals in the abdominal wall, venovenous bypass was implemented before incising the skin. The right atrium was reached via a transdiaphragramatic approach. Hepatectomy was performed en bloc with the retrohepatic vena cava. It was reconstructed with an infra-hepatic vena cava graft obtained from a deceased donor. The patient remains well on outpatient clinic follow-up 25 mo after the procedure, under an anticoagulation protocol with warfarin. CONCLUSION Living-donor LT in BCS with IVC thrombosis is feasible using a meticulous surgical technique and tailored strategies.
- First Successful Isolated Intestinal Transplant in a Brazilian Series(2021) ANDRAUS, Wellington; PINHEIRO, Rafael Soares; FORTUNATO, Allana Christina; GALVAO, Flavio Henrique Ferreira; ARANTES JUNIOR, Rubens Macedo; WAISBERG, Daniel Reis; LEE, Andre Dong; ROCHA, Mariana Hollanda Martins da; NACIF, Lucas Souto; SANTOS, Vinicius Rocha; DUCATTI, Liliana; MARTINO, Rodrigo Bronze de; HADDAD, Luciana Bertocco de Paiva; TANIGAWA, Ryan Yukimatsu; BEZERRA, Regis O. F.; SONG, Alice Tung Wan; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto
- A challenge for medium and small pancreatic transplant groups: How can the learning curve from the retrieval team affect the pancreas graft thrombosis?(2021) ROCHA-SANTOS, Vinicius; WAISBERG, Daniel Reis; ARANTES, Rubens Macedo; CARNEIRO-D'ALBUQUERQUEA, Luiz Augusto
conferenceObject Small Bowel Transplantation at Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Brazil(2021) GALVAO, F.; LEE, A.; WAISBERG, D.; ARANTES, R.; NACIF, L.; MARTINO, R.; SANTOS, V; LOPES, L.; ANDRAUS, W.; CARNEIRO-D'ALBUQUERQUE, L.- Coronavirus Disease 2019 in the Early Postoperative Period of Liver Transplantation: Is the Outcome Really So Positive?(2021) WAISBERG, Daniel Reis; ABDALA, Edson; NACIF, Lucas Souto; DUCATTI, Liliana; HADDAD, Luciana Bertocco; MARTINO, Rodrigo Bronze; PINHEIRO, Rafael Soares; ARANTES, Rubens Macedo; GALVAO, Flavio Henrique; GOUVEIA, Larissa Nunes; TERRABUIO, Debora Raquel; DARCE, George Felipe; ROCHA-SANTOS, Vinicius; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto