EDSON ABDALA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina - Docente
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/47 - Laboratório de Hepatologia por Vírus, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/47 - Laboratório de Hepatologia por Vírus, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
bookPart Transplante e Emergências Infecciosas em Doentes Transplantados(2013) ABDALA, Edson- Surgical site infections in liver transplant recipients in the model for end-stage liver disease era: An analysis of the epidemiology, risk factors, and outcomes(2013) FREIRE, Maristela Pinheiro; OSHIRO, Isabel C. V. Soares; BONAZZI, Patricia Rodrigues; GUIMARAES, Thais; FIGUEIRA, Estela Regina Ramos; BACCHELLA, Telesforo; COSTA, Silvia Figueiredo; D'ALBUQUERQUE, Luiz Augusto Carneiro; ABDALA, EdsonIn recipients of liver transplantation (LT), surgical site infection (SSIs) are among the most common types of infection occurring in the first 60 days after LT. In 2007, the Model for End-Stage Liver Disease (MELD) scoring system was adopted as the basis for prioritizing organ allocation. Patients with higher MELD scores are at higher risk for developing SSIs as well as other health care-associated infections. However, there have been no studies comparing the incidence of SSIs in the pre-MELD era with the incidence in the period since its adoption. Therefore, the objectives of this study were to evaluate the incidence, etiology, epidemiology, and outcomes of post-LT SSIs in those 2 periods and to identify risk factors for SSIs. We evaluated all patients who underwent LT over a 10-year period (2002-2011). SSI cases were identified through active surveillance. The primary outcome measure was an SSI during the first 60 days after LT. Risk factors were analyzed via logistic regression, and 60-day survival rates were evaluated via Cox regression. We evaluated 543 patients who underwent LT 597 times. The SSI rates in the 2002-2006 and 2007-2011 periods were 30% and 24%, respectively (P=0.21). We identified the following risk factors for SSIs: retransplantation, the transfusion of more than 2 U of blood during LT, dialysis, cold ischemia for >400 minutes, and a cytomegalovirus infection. The overall 60-day survival rate was 79%. Risk factors for 60-day mortality were retransplantation, dialysis, and a longer surgical time. The use of the MELD score modified the incidence and epidemiology of SSIs only during the first year after its adoption. Risks for SSIs were related more to intraoperative conditions and intercurrences after LT than to a patient's status before LT. Liver Transpl 19:1011-1019, 2013. (c) 2013 AASLD.
conferenceObject Predictive factors of survival in liver retransplantation for hepatitis C recurrence: the importance of HCV therapy(2013) SONG, Alice T.; SOBESKY, Rodolphe; VINAIXA, Carmen; DUMORTIER, Jerome; RADENNE, Sylvie; DURAND, Francois; CALMUS, Yvon; ROUSSEAU, Geraldine; LATOURNERIE, Marianne; FERAY, Cyrille; DELVART, Valerie; ROCHE, Bruno; HAIM-BOUKOZA, Stephanie; ROQUE-AFONSO, Anne-Marie; CASTAING, Denis X.; ABDALA, Edson; DUCLOS-VALLEE, Jean-Charles; BERENGUER, Marina; SAMUEL, Didier- Predictive Factors of Survival and Prognostic Score Validation in Liver Retransplantation for Severe Hepatitis C Recurrence: The Importance of HCV Therapy before and after Retransplantation(2013) SONG, A. T. W.; SOBESKY, R.; VINAIXA, C.; DUMORTIER, J.; RADENNE, S.; ROUSSEAU, G.; DURAND, F.; DELVART, V.; ROCHE, B.; HAIM-BOUKOBZA, S.; VIBERT, E.; CASTAING, D.; ABDALA, E.; BERENGUER, M.; DUCLOS-VALLEE, J. C.; SAMUEL, D.Indications and results of retransplantation (RT) for HCV recurrence are debatable. Recently, a Swiss group proposed the Andres RT survival score specifically designed for HCV-positive patients. Aim: To identify risk factors associated with survival in RT patients for HCV recurrence and to evaluate the Andres score. Methods: Retrospective and multicentric study to determine prognostic factors of survival. A cohort of patients presenting F4 or FCH without RT was also analysed. Results: From 1984 to 2012, 77 patients were retransplanted for HCV recurrence. 79% were males, mean age 53±9 years, genotype 1 in 74%, 58.4% received HCV therapy preRT. MELD at RT was 24±8 and 25.7% received steroid boluses post-RT. Overall, 3, 5 and 10-year survival rates were 63%, 55%, and 52% respectively. 79% had an Andres score >40 (n=48). Andres score underestimated survival, as in their cohort, those with a score >40 presented a 5y survival of 27%. 42 patients with F4 or FCH post-transplant presenting decompensation presented survival rates of 15%, 7% and 0% at 3, 5 and 10 ys (p<0.0001). In univariate analysis, factors associated with better survival post-RT were: male gender (p=0.08), non-genotype 1 (p=0.06), interval between 1st transplant and acute hepatitis (p=0.006), undetectable viremia preRT (p=0.04), tacrolimus post-RT (p=0.08), HCV therapy post-RT (p=0.002), preRT bilirubin (p=0.04), RT donor age (p=0.06), recipient age at 1st transplant (p=0.06), interval between 1st transplant and RT (p=0.05), lower Andres score (p=0.006). In multivariate analysis, factors associated with survival were: HCV therapy post-RT (p=0.01), recipient age at 1st transplant (p=0.03), RT donor age (p=0.03), pre-RT bilirubin (p=0.01), non-genotype 1 (p=0.02). Conclusions: HCV therapy post-RT, non-genotype 1, recipient and RT donor age represent major prognostic factors for RT.
conferenceObject Evidence of Hepatitis E Virus Infection in Liver Transplant Recipients from Brazil(2013) GOMES-GOUVEA, Michele S.; FERREIRA, Ariana C.; FEITOZA, Bruna; PESSOA, Mario G.; ABDALA, Edson; TERRABUIO, Deborah R.; MORAES, Adriano C.; BONAZZI, Patricia R.; D'ALBUQUERQUE, Luiz C.; CARRILHO, Flair J.; PINHO, Joao R.conferenceObject PREDICTIVE FACTORS OF SURVIVAL AND PROGNOSTIC SCORE VALIDATION IN LIVER RETRANSPLANTATION FOR SEVERE HEPATITIS C RECURRENCE: THE IMPORTANCE OF HCV THERAPY BEFORE AND AFTER RETRANSPLANTATION(2013) SONG, A. T. W.; SOBESKY, R.; VINAIXA, C.; DUMORTIER, J.; RADENNE, S.; ROUSSEAU, G.; DELVART, V.; HAIM-BOUKOBZA, S.; ROQUE-AFONSO, A. -M.; ROCHE, B.; VIBERT, E.; CASTAING, D.; ABDALA, E.; BERENGUER, M.; DUCLOS-VALLEE, J. -C.; SAMUEL, D.Background: Liver retransplantation (RT) is the only therapeutic option for irreversible failure of the liver graft. Indications and results of RT for HCV-related disease are debatable. Recently, a Swiss group proposed a retransplantation survival score specifically designed for HCV-positive patients in order to aid in candidate selection. Aim: To identify risk factors associated with survival in patients retransplanted for HCV-related disease, and to evaluate the Andres survival score in this population. Methods: We have conducted a retrospective and multicentric study (4 centers) to determine prognostic factors of 3, 5 and 10-year patient survival. Results: Sixty-seven patients were retransplanted for HCV recurrence, from January 1984 until September 2012. Baseline characteristics were: 76.1% males, mean age 53 ± 9 years, genotype 1 in 44 (75.9%), 19 (29.7%) received corticosteroid boluses after RT, 38 (56.7%) received HCV therapy before RT, and of these, 7 (10.4%) presented SVR. Mean MELD score at RT was 24 ± 8. Overall, 3, 5 and 10-year survival rates were 65%, 57%, and 53% respectively. Among 37 patients in whom data for Andres score application was available, 26 (70.3%) had a score above 40. For patients with an Andres score below 40 and above 40, 5-year survival was 81% and 47%, respectively. In univariate analysis, factors potentially associated with better survival were: female gender (p=0.04), deceased donor versus living or domino (p=0.02), undetectable HCV viremia before RT (p=0.059), tacrolimus-based immunosupression after RT (p=0.047), antiviral treatment after RT (p=0.01), lower BMI (p=0.01), younger age at first transplantation (p=0.027), longer interval between first transplantation and RT (p=0.037) and Andres score below 40 (p=0.098). In multivariate analysis, factors associated with survival were: undetectable HCV- RNA before RT (p=0.044, RR=8.42), lower BMI at RT (p=0.009, RR=1.13), and antiviral treatment after RT (p=0.015, RR=0.33). Conclusions: Overall 3, 5 and 10-year survival rates were 65%, 57%, and 53% respectively. Anti-HCV therapy before and after RT represents a major prognostic factor, and patients that received therapy before RT or are potentially able to receive it after RT, may have good prognosis. In our cohort, Andres score underestimated survival rates.- Infection Related to Implantable Central Venous Access Devices in Cancer Patients: Epidemiology and Risk Factors(2013) FREIRE, Maristela P.; PIERROTTI, Ligia C.; ZERATI, Antonio E.; ARAUJO, Pedro H. X. N.; MOTTA-LEAL-FILHO, J. M.; DUARTE, Laiane P. G.; IBRAHIM, Karim Y.; SOUZA, Antonia A. L.; DIZ, Maria P. E.; PEREIRA, Juliana; HOFF, Paulo M.; ABDALA, EdsonOBJECTIVE. To describe the epidemiology of infections related to the use of implantable central venous access devices (CVADs) in cancer patients and to evaluate measures aimed at reducing the rates of such infections. DESIGN. Prospective cohort study. SETTING. Referral hospital for cancer in Sao Paulo, Brazil. PATIENTS. We prospectively evaluated all implantable CVADs employed between January 2009 and December 2011. Inpatients and outpatients were followed until catheter removal, transfer to another facility, or death. METHODS. Outcome measures were bloodstream infection and pocket infection. We also evaluated the effects that the creation of a multidisciplinary team for CVAD care, avoiding in-hospital implantation of CVADs, and limiting CVAD insertion in neutropenic patients have on the rates of such infections. RESULTS. During the study period, 966 CVADs (mostly venous ports) were implanted in 933 patients, for a combined total of 243,792 catheter-days. We identified 184 episodes of infection: 154 (84%) were bloodstream infections, 21 (11%) were pocket infections, and 9 (5%) were surgical site infections. During the study period, the rate of CVAD-related infection dropped from 2.2 to 0.24 per 1,000 catheter-days (P < .001). Multivariate analysis revealed that relevant risk factors for such infection include surgical reintervention, implantation in a neutropenic patient, in-hospital implantation, use of a cuffed catheter, and nonchemotherapy indication for catheter use. CONCLUSIONS. Establishing a multidisciplinary team specifically focused on CVAD care, together with systematic reporting of infections, appears to reduce the rates of infection related to the use of these devices.
conferenceObject Risk factors for severe complications during febrile neutropenic episodes in patients with solid tumors(2013) MARTINS, R.; CECOTTI, H. C.; PIERROTTI, L. C.; ABDALA, E.; HOFF, P. M.; CASTRO, G.- Health care-associated infections in hematology-oncology patients with neutropenia: A method of surveillance(2013) IBRAHIM, Karim Yaqub; PIERROTTI, Ligia Camera; FREIRE, Maristela Pinheiro; GUTIERREZ, Patricia Pinheiro; DUARTE, Laiane do Prado Gil; BELLESSO, Marcelo; PEREIRA, Juliana; CHAMONE, Dalton de Alencar Fischer; ABDALA, EdsonWe present a prospective method of surveillance of health care-associated infection in hematology-oncology inpatients with neutropenia. Incidence rates were calculated on the basis of the number of hospitalized patients, the duration of hospital stay (in days), the number of days of neutropenia, and (in cases of central line-associated blood stream infection) the number of central line-days. We detected 11.4 and 66.4 episodes of febrile neutropenia per 1,000 hospital-days and per 1,000 days of neutropenia, respectively. The incidence of central line-associated blood stream infection was 2.6 per 1,000 central line-days. Gram-negative bacteria were the most prevalent pathogens. Efforts should be made to monitor infection rates on hematology-oncology wards.