NELSON ELIAS MENDES GIBELLI
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/30 - Laboratório de Investigação em Cirurgia Pediát, Hospital das Clínicas, Faculdade de Medicina
LIM/30 - Laboratório de Investigação em Cirurgia Pediát, Hospital das Clínicas, Faculdade de Medicina
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- The role of interleukin-6, endothelins, and apoptotic genes in small bowel transplantation, in a swine model of ischemia and reperfusion injury(2011) PINHO-APEZZATO, Maria Lucia de; MAKSOUD-FILHO, Joao Gilberto; VALINETTI, Emilia Aparecida; SANTOS, Maria Merces; TANNURI, Ana Cristina Aoun; MELLO, Evandro Sobroza; SILVA, Luiz Fernando; COELHO, Maria Cecilia de Mendonca; GIBELLI, Nelson Elias Mendes; ROCHA, Rafael Malagoli; NONOGAKI, Suely; GUIMARAES, Raimundo Renato Nunes; TANNURI, UenisIRI is closely related to sepsis in ITx setting. Complete understanding of the mechanisms involved in IRI development may improve outcomes. Ortothopic ITx without immunosuppression was performed in order to characterize IRI-associated mucosal damage. Twenty pigs underwent ITx. Two groups were assigned to different CI times: G1: 90 min and, G2: 180 min. Euro-Collins was used as preservation solution. Jejunal fragments were collected at donor laparotomy, 30 min, and 3 days after reperfusion. IRI assessment involved: histopathologic analysis, quantification of MPO-positive cells through immunohistochemical studies, quantification of epithelial apoptotic cells using TUNEL staining, and quantification of IL-6, ET-1, Bak, and Bcl-XL genes expression by RT-PCR. Neutrophilic infiltration increased in a similar fashion in both groups, but lasted longer in G2. Apoptosis detected by TUNEL staining increased and anti-apoptotic gene Bcl-XL expression decreased significantly in G1, 3 days after surgery. Endothelin-1 and IL-6 genes expression increased 30 min after the procedure and returned to baseline 3 days after surgery. In conclusion, IL-6 and ET-1 are involved precociously in the development of intestinal IRI. Apoptosis was more frequently detected in G1 grafts by TUNEL-staining and by RT-PCR.
- Extrahepatic portal vein thrombosis after umbilical catheterization: is it a good choice for Rex shunt?(2011) GIBELLI, Nelson Elias Mendes; TANNURI, Ana Cristina Aoun; PINHO-APEZZATO, Maria Lucia; MAKSOUD-FILHO, Joao Gilberto; TANNURI, UenisBackground: Extrahepatic portal vein thrombosis (EHPVT) is an important cause of portal hypertension in children. Rex shunt has been used successfully to treat these patients. Methods: We report our experience in 19 infants and children (5 months to 14 years) with HPVT eligible for a mesenteric-portal surgical shunt with left internal jugular vein autograft. Eight children had idiopathic EHPVT, nine had post-umbilical catheterization EHPVT, one had portal vein agenesis, and one had posttransplant EHPVT. Results: It was possible to perform the Rex shunt in all patients except for 8 of 9 cases in the post-umbilical catheterization EHPVT group. A Warren procedure was performed in 4 of those patients and a proximal splenorenal shunt in 1. Current follow-up ranges from 3 to 26 months. Shunt thrombosis occurred in one patient with portal vein agenesis and associated cardiac anomaly. Portal hypertension has significantly improved after surgery. None of our patients have experienced new bleeding episodes until now. Conclusions: The Rex shunt should be considered in the treatment of children with idiopathic EHPVT experiencing repeated gastrointestinal bleeding episodes refractory to endoscopic treatment. Nevertheless, the role of this operation for children with post-umbilical catheterization EHPVT is yet to be clearly evaluated.
- REX SHUNT FOR ACUTE PORTAL VEIN THROMBOSIS AFTER PEDIATRIC LIVER TRANSPLANT IN CHILDREN WITH BILIARY ATRESIA(2013) GIBELLI, Nelson Elias Mendes; ANDRADE, Wagner de Castro; VELHOTE, Manoel Carlos Prieto; AYOUB, Ali Abdul Rahman; SILVA, Marcos Marques da; PINHO-APEZZATO, Maria Lucia de; TANNURI, Ana Cristina Aoun; BARROS, Fabio de; RICARDI, Luis Roberto Schlaich; MOREIRA, Daniel de Albuquerque Rangel; MIYATANI, Helena Thie; PEREIRA, Paulo Renato Alencar; TANNURI, UenisBACKGROUND/PURPOSE: zPost transplant portal vein thrombosis (PVT)can be extremely disastrous, and portal hypertension and other consequences of the long term privation of portal inflow to the graft may be hazardous, especially in the very young children. Since 1998, Rex shunt has been used successfully to treat these patients. In 2007 we started to perform this surgery in patients with idiopathic PVT and late post transplant PVT. We report our experience with this technique in acute post transplant PVT. METHODS: Case report of six patients (age–12–18 months) submitted to cadaveric (1) and living donor (5) liver transplant (LT). All patients had biliary atresia with portal vein hipoplasia and developed acute portal vein thrombosis (PVT) in the first post-operative day. They were submitted to a mesenteric-portal surgical shunt (Rex shunt) with left internal jugular vein autograft (5) and cadaveric iliac vein graft (1) in the first post-operative day. RESULTS: Current follow-up of 12 months. Postoperative Doppler ultrasounds confirmed shunt patency. There were no biliary complications until now. CONCLUSION: The mesenteric-portal shunt (Rex shunt) with left internal jugular vein autograft should be considered in children with acute PVT after liver transplantation. These children usually have small portal veins, and reanastomosis is often unsuccessful. In addition, this technique has the advantage that we do not manipulate the biliary anastomosis and the hepatic hilum, thus avoiding biliary complications. Although this is an initial experience, we conclude that this technique is feasible, with great benefits for these patients and with low risks.
- Current management of biliary atresia based on 35 years of experience at a single center(2018) ANDRADE, Wagner de Castro; SILVA, Marcos Marques; TANNURI, Ana Cristina Aoun; SANTOS, Maria Merces; GIBELLI, Nelson Elias Mendes; TANNURI, UenisOBJECTIVE: The prognosis of patients with biliary atresia undergoing Kasai portoenterostomy is related to the timing of the diagnosis and the indication for the procedure. The purpose of the present study is to present a practical flowchart based on 257 children who underwent Kasai portoenterostomy. METHODS: We conducted a retrospective cohort study of patients who underwent Kasai portoenterostomy between 1981 and 2016. RESULTS: During the first period (1981 to 2009), 230 infants were treated, and the median age at the time of surgery was 84 days; jaundice was resolved in 77 patients (33.5%). During the second period, from 2010 to 2016, a new diagnostic approach was adopted to shorten the wait time for portoenterostomy; an ultrasonography examination suggestive of the disease was followed by primary surgical exploration of the biliary tract without complementary examination or liver biopsy. Once the diagnosis of biliary atresia was confirmed, a portoenterostomy was performed during the same surgery. During this period, 27 infants underwent operations; the median age at the time of surgery was 66 days (p <0.001), and jaundice was resolved in 15 patients (55.6% - p=0.021), with a survival rate of the native liver of 66.7%. CONCLUSION: Primary surgical exploration of the biliary tract without previous biopsy was effective at improving the prognostic indicators of patients with biliary atresia undergoing Kasai portoenterostomy.
- LIVER TRANSPLANTATION IN CHILDREN: 14 YEARS OF EXPERIENCE WITH LIVING DONORS(2013) ANDRADE, Wagner de Castro; VELHOTE, Manoel Carlos Prieto; AYOUB, Ali Abdul Rahman; SILVA, Marcos Marques da; GIBELLI, Nelson Elias Mendes; PINHO-APEZZATO, Maria Lucia de; TANNURI, Ana Cristina Aoun; BARROS, Fabio de; RICARDI, Luis Roberto Schlaich; MOREIRA, Daniel de Albuquerque Rangel; MIYATANI, Helena Thie; PEREIRA, Paulo Renato Alencar; TANNURI, UenisOBJECTIVES: Report on the experience with 170 living donors in pediatric liver transplantation. MATERIAL AND METHODS: Retrospective analysis of the medical records of donors operated between June 1998 and October 2012. RESULTS: Over the past 14 yrs, 169 liver transplants were performed in pediatric recipients of living donor grafts. In a potential left lateral segment donor, there was a minor injury in the right branch of portal vein, repaired without consequences for the patient, but resulting in abortion of the transplant. From the remaining donors, 151 left lateral segments (89.34%), 17 left lobes (10.06%) and 1 right lobe (0.6%) were removed. Donor age ranged from 16 to 53 yrs and weight ranged from 47 to 106 kg. Transfusion of blood products was required in 14 donors (8.3%). The mean hospital stay was 5 days. Complications were identified in 21 patients (12.4%): 11 showed intense dyspeptic symptoms and abdominal pain (two patients underwent reoperation), seven presented minor bile leaks, and three developed extra-peritoneal infection (incision abscess, phlebitis and pneumonia). There was no mortality in this series. Eight grafts (4.7%) had primary dysfunction, resulting in death of the recipient (three cases of fulminant hepatitis, one metabolic disease carrier, one Alagille Syndrome carrier and three cases of biliary atresia in infants under 1 yr of age). CONCLUSION: Living-related liver transplantation in children generates low risk and morbidity for the donors of left lobe or left lateral segment grafts, with good outcomes for the recipients, eliminating the disadvantages of the waiting list for cadaveric grafts.
- ACUTE LIVER FAILURE WITH ASSOCIATED APLASTIC ANEMIA IN CHILDREN(2013) MOREIRA, Daniel de Albuquerque Rangel; ANDRADE, Wagner de Castro; VELHOTE, Manoel Carlos Prieto; AYOUB, Ali Abdul Rahman; SILVA, Marcos Marques da; GIBELLI, Nelson Elias Mendes; PINHO-APEZZATO, Maria Lucia de; TANNURI, Ana Cristina Aoun; BARROS, Fabio de; MIYATANI, Helena Thie; PEREIRA, Paulo Renato Alencar; TANNURI, UenisOBJECTIVES: Herein we describe the experience of six cases of acute liver failure with associated aplastic anemia treated at ICR – HCFMUSP. MATERIAL AND METHODS: We reviewed the records of patients undergoing liver transplantation for acute liver failure with associated aplastic anemia treated at ICR–HCFMUSP between 2007 and 2012. We collected information regarding the type of treatment offered, diagnosis, bone marrow recovery time, interval between onset of symptoms until liver transplantation and the diagnosis of bone marrow aplasia. RESULTS: In this period we found five patients who met the criteria established, four boys and a girl. The mean age was 9.6 yrs (9–12). The time between onset of symptoms and liver transplantation was 25.2 days (17–30) and until the appearance of pancytopenia 35 days (20–45). Two patients were treated with thymoglobulin and median time to recovery of bone marrow function after treatment was 17.5 days. One patient died from sepsis after treatment and another from bleeding without taking thymoglobulin. CONCLUSION: Aplastic anemia is a potentially fatal complication associated with acute liver failure. There is no standardized treatment in the literature. Reports show cases of liver and bone marrow recovery after immunosuppressive therapy with anti-thymocyte globulin and anti-lymphocytes despite the risk inherent in the use of such substances in critically ill patients the presence of large numbers of activated T lymphocytes in the marrow and liver biopsies from these patients corroborates this therapeutic. In severe cases of aplastic anemia with HLA compatible sibling hematopoietic stem cell transplantation has been performed successfully in the treatment of this condition.