JULIANO GOMES PENHA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- PEDIATRIC HEART TRANSPLANTATION PROGRAM: SINGLE CENTER EXPERIENCE OF 20 YEARS(2013) AZEKA, Estela; GALAS, Filomena; TANAMATI, Carla; PENHA, Juliano; FERNANDES, Marcos; SENAHA, Luciano; XAVIER, Johnny; DELGADO, Ana Beatriz Romani; KAJITA, Luiz; AIELLO, Vera; BENVENUTI, Luiz; MIURA, Nana; AULER JUNIOR, Jose Otavio Costa; JATENE, MarceloOBJECTIVE: Heart transplantation has been the treatment of choice for children with refractory to conventional therapy. To report the experience with heart transplantation in a single center. MATERIAL AND METHODS: To report the single center experience of hearttransplantation. Data analysis was demographic characteristics, clinical outcome and survival Kaplan Meier curve. RESULTS: From October 30, 1992 to October 2nd, 2012, 120 transplants were performed and 115 patients were submitted to heart transplantation at Heart Institute (InCor) University of Sao Paulo Medical School, Sao Paulo, Brazil. The causes of indication for transplantation were: cardiomyopathies (76%) and congenital heart disease (24%). Five patients were submitted to re-transplantation. Three of them were re-transplanted on the early postoperative period with high mortality (66.6%). One patient was submitted to simultaneous re-transplantation and kidney transplantation after 13.9 yrs of follow-up and one of patient was successful re-transplanted after 10 yr of follow-up. The post-operative immunosuppression regimen was double immunosuppression and polyclonal anti-thymocyte serum induction therapy. The actuarial survival was 80%, 71%, and 61% at 1, 5, and 10 yr, respectively. CONCLUSION: Heart transplantation has been a promising option for children. The use of double immunosuppression with polyclonal anti-thymocyte serum induction therapy combined with surveillance of acute rejection with non-invasive tests may provide favorable clinical outcome.
- NEUROLOGICAL COMPLICATIONS AFTER PEDIATRIC HEART TRANSPLANTATION(2013) FERNANDES, Marcos; AZEKA, Estela; SENAHA, Luciano; DELGADO, Ana Beatriz Romani; GALAS, Filomena; GUIMARAES, Vanessa; HAJJAR, Ludmilha; TANAMATI, Carla; PENHA, Juliano; AULER JUNIOR, Jose Otavio Costa; JATENE, MarceloOBJECTIVES: Neurological complications can occur after pediatric heart transplantation and its outcome may cause disabilities and limit the prognosis of children who have undergone this procedure. The aim of the study is to evaluate the neurological complications during the first 30 days after the heart transplantation. MATERIAL AND METHODS: A survey was made at based on the InCor records to find the data. RESULTS: From September 2011 to September 2012, 15 heart transplants were performed at the Heart Institute (InCor) University of Sao Paulo Medical School. The mean age was 11.1± yr5.34 yrs, median 9.63 yrs. There were 8 (53.3%) males. The diagnosis for heart transplantation was 80% cardiomiopathies. Two of them wereë. re-transplantation. One patient was with ECMO before transplantation and one was with assist device. Seven of them were priority when listed for the heart transplantation. The immunosuppression therapy was calcineurin inhibitor and cytostatic drug. Induction therapy was performed with antithymocyte globulin. Eight (53%) of 15 patients developed neurological complications. The main cause were strokes in 37.5%. The other causes were anisocoria in 1 (12%) patient, ischemic vascular accident 1 (12%) patient, hemorrhagic vascular accident 1 (12%). Three (20%) of them died due to multiple organ failure and infection, two of them were in priority before transplant (one with assist device) and were intubated with renal failure and sedated. These two patients were the ones that showed the worse neurological complications after the transplant. CONCLUSION: Neurological complications were common after heart transplantation, patient can have favorable clinical outcome after treatment.
conferenceObject CLINICAL CHALLENGES AFTER PEDIATRIC HEART TRANSPLANTATION: 20 YEARS OF EXPERIENCE(2013) AZEKA, Estela; AULER, Jose Otavio; GALAS, Filomena; TANAMATI, Carla; PENHA, Juliano; KAJITA, Luiz; AIELLO, Vera; BENVENUTI, Luiz; JATENE, MarceloPURPOSE: Heart transplantation has been the treatment of choice for children with refractory to conventional therapy. Objective: to report the clinical experience with heart transplantation in a single center. METHOD: To report the single center experience of heart transplantation. Data analysis was demographic characteristics, clinical outcome and survival Kaplan Meier curve. RESULTS: From October 30, 1992 to October 2nd, 2012, 120 transplants were performed and 115 patients were submitted to heart transplantation at Heart Institute (InCor) University of Sao Paulo Medical School, Sao Paulo, Brazil. The causes of indication for transplantation were: cardiomyopathies (76%) and congenital heart disease (24%). Five patients were submitted to re-transplantation. Three of them were re-transplanted on the early postoperative period with high mortality (66.6%). One patient was submitted to simultaneous re-transplantation and kidney transplantation after 13.9 years of follow-up and one of patient was successful re-transplanted after 10 year of follow-up. The post-operative immunosuppression regimen was double immunosuppression and polyclonal anti-thymocyte serum induction therapy. The actuarial survival was 80%, 71%, and 61% at 1, 5, and 10 yr, respectively. CONCLUSION: Heart transplantation has been a promising option for children. The use of double immunosuppression with polyclonal anti-thymocyte serum induction therapy combined with surveillance of acute rejection with non-invasive tests may provide favorable clinical outcome.- CONGENITAL HEART DISEASE IN ADOLESCENT AND ADULTS: INDICATION FOR HEART TRANSPLANTATION AND CLINICAL OUTCOME(2013) FARHAT, Juliana; JATENE, Marcelo; FERNANDES, Marcos; SENAHA, Luciano; DELGADO, Ana Beatriz Romani; TANAMATI, Carla; AIELLO, Vera; BENVENUTI, Luiz; PENHA, Juliano; VALDO, Melinade Oliveira; BRITO, Pedro Thiago; AZEKA, EstelaOBJECTIVE: The aim of the study was to evaluate the patients who were submitted to heart transplantation due to congenital heart disease. MATERIAL AND METHODS: It was considered a retrospective analysis of the medical records of the patients who were submitted to heart transplantation at Heart Institute (InCor) University of Sao Paulo Medical School from 2002 through 2012. RESULTS: From 2002 through 2012, 115 patients have undergone heart transplantation at Heart Institute (InCor) University of Sao Paulo Medical School. Of those, 29 (25.2%) had congenital heart diseases, having one of them submitted to re-transplantation 9 yrs after transplantation. The mean age was 8.56 yrs old (range of 0.11–26.06). The assessed congenital heart diseases were: double outlet (three patients), hypoplastic heart syndrome (two patients), pulmonary atresia (two patients), ventricular septal defect (one patient), Ebstein anomaly (two patients),Uhl anomaly (one patient), congenital heart block (three patients), tetralogy of Fallot (one patient), av canal (one patient), complex congenital heart disease (12 patients). Twenty patients had submitted to cardiac surgery before transplantation. The mean ischemia time was 170.8 min. Thirteen patients (44.8%) died (due to surgical complications, heart failure due to acute rejection and multiple organ insufficiency). Mean follow-up period of 4.7 yrs. CONCLUSION: Heart transplantation is an indication for patients with congenital heart disease and allowed long term survival for this population.
- THE IMPACT OF TACROLIMUS AS RESCUE THERAPY IN CHILDREN USING DOUBLE IMMUNOSSUPRESSIVE REGIMEN AFTER HEART TRANSPLANTATION(2013) BRANCO, Klebia Castello; AZEKA, Estela; JATENE, Marcelo; TRINDADE, Evelinda; GALAS, Filomena Regina Barbosa Gomes; HAJJAR, Ludhmila Abrahao; BENVENUTI, Luiz; RISO, Arlindo; TANAMATI, Carla; PENHA, Juliano; AULER JUNIOR, Jose Otavio Costa; ATIK, EdmarOBJETIVE: The aim of this study was to evaluate the clinical outcome of children undergoing heart transplantation who required conversion from a cyclosporine-based steroid free therapy to a tacrolimus-based immunosuppressive regimen. MATERIAL AND METHODS: We performed a prospective observational cohort study in 28 children who underwent conversion from a cyclosporine- based steroid free therapy to a tacrolimus-based therapy for refractory or late rejection or intolerance to cyclosporine. RESULTS: There was complete resolution of refractory rejection episodes and adverse side effects in all patients. The incidence rate (x100) of rejection episodes before and after conversion was 7.98 and 2.11, respectively (p≤0.0001). Actuarial 1 month, 1 and 5 yr survival, in patients converted to tacrolimus was 100%, 96% and 85.5% respectively. CONCLUSION: Tacrolimus is effective as rescue therapy for refractory rejection and is a Terapeutic option for pediatric patients.
- SIMULTANEOUS RENAL TRANSPLANTATION AND HEART RE-TRANSPLANTATION: SINGLE CENTER EXPERIENCE(2013) DELGADO, Ana Beatriz Romani; JATENE, Marcelo; DAVID-NETO, Elias; FERNANDES, Marcos; MOURA, Mariana Tiemi Minede; GALAS, Filomena Regina; HAJJAR, Ludhmilla; PENHA, Juliano; TANAMATI, Carla; RISO, Arlindo; BENVENUTI, Luiz Alberto; AIELLO, Vera; AULER JUNIOR, Jose Otavio Costa; NAHAS, William; AZEKA, EstelaOBJECTIVES: To report a simultaneous renal transplantation and heart re-transplantation in pediatric population at single center. MATERIAL AND METHODS: To report the prevalence and the clinical outcome of kidney transplantation and heart re-transplantation at Heart Institute (Incor) University of Sao Paulo Medical School. RESULTS: From October 1992 to October 2012, 115 patients were submitted to heart transplantation and 120 transplants were performed. One of 115 patients was submitted to kidney and heart re-transplantation at our institution. A 17 yrs old adolescent was submitted to hear transplantation at age of 4 yrs old. The indication for heart transplantation was dilated cardiomyopathy. He developed graft vascular disease 6 yrs after transplant and renal failure due to calcineurin inhibitors 10 yrs later the transplantation. He was admitted at Emergency room and needed vasoative drug infusion. He was listed to simultaneous kidney and heart re-transplantation. He was submitted to procedure and the ischemic time for the heart was 180 min. The donor was male and the cause of brain death was trauma. He developed severe coagulopathy. The patient died after 13 yrs of the first heart transplantation and 31 days after the second transplant due to multiple organ failure. CONCLUSION: Simultaneous kidney and heart re-transplantation can be performed although being complex procedure.