ANDRE DONG WON LEE

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • article 6 Citação(ões) na Scopus
    THE EFFECT OF ILEOCECAL VALVE REMOVAL IN A MODEL OF SHORT BOWEL SYNDROME
    (2019) SOLER, Wangles Vasconcellos; LEE, Andre Dong; D'ALBUQUERQUE, Eugenia Machado Carneiro; CAPELOZZI, Vera; ALBUQUERQUE, Luiz Carneiro; CAPELHUCHNICK, Peretz; LANCELOTTI, Carmem Penteado; GALVAO, Flavio Henrique Ferreira
    Background: Short bowel syndrome is a harmful condition that needs experimental research. Aim: To assess the impact of the ileocecal valve removal in a model of short bowel syndrome, in order to investigate the evolution of the colon under this circumstance. Method: Fifteen Wistar rats were equitable divided into: Control (Sham), Group I (70% enterectomy preserving ileocecal valve) and Group II (70% enterectomy excluding ileocecal valve). After enterectomy was performed jejunoileal or jejunocecal anastomosis and sacrificed the animals on 30""' postoperative day for histomorphometric study of the colon. During this period, was observed the clinical evolution of the animals weekly including body weight measurement. Results: Group I and II presented progressive loss of weight. in Group I was observed diarrhea, perinea! hyperemia and purple color of the colon during autopsy. Histomorphometry assay showed hypertrophy and hyperplasia of colon mucosa in Group I. in Group II the colon wall was thicker due to hypertrophy and muscular hyperplasia, and in mucosa vascular proliferation and inflammatory infiltrate were intense. Conclusion: This short bowel syndrome model is relevant and achieve 100% of survival. Animal's weight loss was not altered by the presence or exclusion of the ileocecal valve. Animals with 70% of small bowel removal and presence of the ileocecal valve attained a better clinical evolution and histological colon adaptation than those without ileocecal valve.
  • article 27 Citação(ões) na Scopus
    Home parenteral nutrition provision modalities for chronic intestinal failure in adult patients: An international survey
    (2020) PIRONI, Loris; STEIGER, Ezra; BRANDT, Chrisoffer; JOLY, Francisca; WANTEN, Geert; CHAMBRIER, Cecile; AIMASSO, Umberto; SASDELLI, Anna Simona; ZERASCHI, Sarah; KELLY, Darlene; SZCZEPANEK, Kinga; JUKES, Amelia; CARO, Simona Di; THEILLA, Miriam; KUNECKI, Marek; DANIELS, Joanne; SERLIE, Mireille; POULLENOT, Florian; WU, Jian; COOPER, Sheldon C.; RASMUSSEN, Henrik H.; COMPHER, Charlene; SEGUY, David; CRIVELLI, Adriana; PAGANO, Maria C.; HUGHES, Sarah-Jane; GUGLIELMI, Francesco W.; KOZJEK, Nada Rotovnik; SCHNEIDER, Stephane M.; GILLANDERS, Lyn; ELLEGARD, Lars; THIBAULT, Ronan; MATRAS, Przemyslaw; ZMARZLY, Anna; MATYSIAK, Konrad; GOSSUM, Andre Van; FORBES, Alastair; WYER, Nicola; TAUS, Marina; VIRGILI, Nuria M.; O'CALLAGHAN, Margie; CHAPMAN, Brooke; OSLAND, Emma; CUERDA, Cristina; SAHIN, Peter; JONES, Lynn; LEE, Andre Dong Won; MASCONALE, Luisa; ORLANDONI, Paolo; LZBEKI, Ferenc; SPAGGIARI, Corrado; BUENO, Marta; DOITCHINOVA-SIMEONOVA, Maryana; GARDE, Carmen; SERRALDE-ZUNIGA, Aurora E.; OLVEIRA, Gabriel; KRZNARIC, Zeljko; CZAKO, Laszlo; KEKSTAS, Gintautas; SANZ-PARIS, Alejandro; JAUREGUI, Estrella Petrina; MURILLO, Ana Zugasti; SCHAFER, Eszter; ARENDS, Jann; SUAREZ-LLANOS, Jose P.; LAL, Simon
    Background & aims: The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in their provision of HPN and the types of intravenous supplementation (IVS)-admixtures prescribed to patients with chronic intestinal failure (CIF). Methods: In March 2015, 65 centers from 22 countries enrolled 3239 patients (benign disease 90.1%, malignant disease 9.9%), recording the patient, CIF and HPN characteristics in a structured database. The HPN-provider was categorized as health care system local pharmacy (LP) or independent home care company (HCC). The IVS-admixture was categorized as fluids and electrolytes alone (FE) or parenteral nutrition, either commercially premixed (PA) or customized to the individual patient (CA), alone or plus extra FE (PAFE or CAFE). Doctors of HPN centers were responsible for the IVS prescriptions. Results: HCC (66%) was the most common HPN provider, with no difference noted between benign-CIF and malignant-CIF. LP was the main modality in 11 countries; HCC prevailed in 4 European countries: Israel, USA, South America and Oceania (p < 0.001). IVS-admixture comprised: FE 10%, PA 17%, PAFE 17%, CA 38%, CAFE 18%. PA and PAFE prevailed in malignant-CIF while CA and CAFE use was greater in benign-CIF (p < 0.001). PA + PAFE prevailed in those countries where LP was the main HPN-provider and CA + CAFE prevailed where the main HPN-provider was HCC (p < 0.001). Conclusions: This is the first study to demonstrate that HPN provision and the IVS-admixture differ greatly among countries, among HPN centers and between benign-CIF and cancer-CIF. As both HPN provider and IVS-admixture types may play a role in the safety and effectiveness of HPN therapy, criteria to homogenize HPN programs are needed so that patients can have equal access to optimal CIF care.
  • article 21 Citação(ões) na Scopus
    Characteristics of adult patients with chronic intestinal failure due to short bowel syndrome: An international multicenter survey
    (2021) PIRONI, Loris; STEIGER, Ezra; JOLY, Francisca; JEPPESEN, Palle B.; WANTEN, Geert; SASDELLI, Anna S.; CHAMBRIER, Cecile; AIMASSO, Umberto; MUNDI, Manpreet S.; SZCZEPANEK, Kinga; JUKES, Amelia; THEILLA, Miriam; KUNECKI, Marek; DANIELS, Joanne; SERLIE, Mireille; POULLENOT, Florian; COOPER, Sheldon C.; RASMUSSEN, Henrik H.; COMPHER, Charlene; SEGUY, David; CRIVELLI, Adriana; SANTARPIA, Lidia; GUGLIELMI, Francesco W.; KOZJEK, Nada Rotovnik; SCHNEIDER, Stephane M.; ELLEGARD, Lars; THIBAULT, Ronan; MATRAS, Przemyslaw; MATYSIAK, Konrad; GOSSUM, Andre Van; FORBES, Alastair; WYER, Nicola; TAUS, Marina; VIRGILI, Nuria M.; O'CALLAGHAN, Margie; CHAPMAN, Brooke; OSLAND, Emma; CUERDA, Cristina; UDVARHELYI, Gabor; JONES, Lynn; LEE, Andre D. Won; MASCONALE, Luisa; ORLANDONI, Paolo; SPAGGIARI, Corrado; DIEZ, Marta Bueno; DOITCHINOVA-SIMEONOVA, Maryana; SERRALDE-ZUNIGA, Aurora E.; OLVEIRA, Gabriel; KRZNARIC, Zeljko; CZAKO, Laszlo; KEKSTAS, Gintautas; SANZ-PARIS, Alejandro; JAUREGUI, Ma Estrella Petrina; MURILLO, Ana Zugasti; SCHAFER, Eszter; ARENDS, Jann; SUAREZ-LLANOS, Jose P.; SU, P.; YOUSSEF, Nader N.; BRILLANTI, Giorgia; NARDI, Elena; LAL, Simon
    Background and aims: The case-mix of patients with intestinal failure due to short bowel syndrome (SBSIF) can differ among centres and may also be affected by the timeframe of data collection. Therefore, the ESPEN international multicenter cross-sectional survey was analyzed to compare the characteristics of SBS-IF cohorts collected within the same timeframe in different countries. Methods: The study included 1880 adult SBS-IF patients collected in 2015 by 65 centres from 22 countries. The demographic, nutritional, SBS type (end jejunostomy, SBS-J; jejuno-colic anastomosis, SBS-JC; jejunoileal anastomosis with an intact colon and ileocecal valve, SBS-JIC), underlying disease and intravenous supplementation (IVS) characteristics were analyzed. IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorized as <1, 1-2, 2-3 and >3 L/day. Results: In the entire group: 60.7% were females and SBS-J comprised 60% of cases, while mesenteric ischaemia (MI) and Crohn' disease (CD) were the main underlying diseases. IVS dependency was longer than 3 years in around 50% of cases; IVS was infused >5 days/week in 75% and FE in 10% of cases. Within the SBS-IF cohort: CD was twice and thrice more frequent in SBS-J than SBS-JC and SBS-JIC, respectively, while MI was more frequent in SBS-JC and SBS-JIC. Within countries: SBS-J represented 75% or more of patients in UK and Denmark and 50-60% in the other countries, except Poland where SBS-JC prevailed. CD was the main underlying disease in UK, USA, Denmark and The Netherlands, while MI prevailed in France, Italy and Poland. Conclusions: SBS-IF type is primarily determined by the underlying disease, with significant variation between countries. These novel data will be useful for planning and managing both clinical activity and research studies on SBS.
  • article 110 Citação(ões) na Scopus
    Clinical classification of adult patients with chronic intestinal failure due to benign disease: An international multicenter cross-sectional survey
    (2018) PIRONI, Loris; KONRAD, Denise; BRANDT, Chrisoffer; JOLY, Francisca; WANTEN, Geert; AGOSTINI, Federica; CHAMBRIER, Cecile; AIMASSO, Umberto; ZERASCHI, Sarah; KELLY, Darlene; SZCZEPANEK, Kinga; JUKES, Amelia; CARO, Simona Di; THEILLA, Miriam; KUNECKI, Marek; DANIELS, Joanne; SERLIE, Mireille; POULLENOT, Florian; WU, Jian; COOPER, Sheldon C.; RASMUSSEN, Henrik H.; COMPHER, Charlene; SEGUY, David; CRIVELLI, Adriana; PAGANO, Maria C.; HUGHES, Sarah Jane; GUGLIELMI, Francesco W.; KOZJEK, Nada Rotovnik; SCHNEIDER, Stephane M.; GILLANDERS, Lyn; ELLEGARD, Lars; THIBAULT, Ronan; MATRAS, Przemyslaw; ZMARZLY, Anna; MATYSIAK, Konrad; GOSSUM, Andre Van; FORBES, Alastair; WYER, Nicola; TAUS, Marina; VIRGILI, Nuria M.; O'CALLAGHAN, Margie; CHAPMAN, Brooke; OSLAND, Emma; CUERDA, Cristina; SAHIN, Peter; JONES, Lynn; LEE, Andre D. W.; BERTASI, Valentino; ORLANDONI, Paolo; IZBEKI, Ferenc; SPAGGIARI, Corrado; DIEZ, Marta Bueno; DOITCHINOVA-SIMEONOVA, Maryana; GARDE, Carmen; SERRALDE-ZUNIGA, Aurora E.; OLVEIRA, Gabriel; KRZNARIC, Zeljko; CZAKO, Laszlo; KEKSTAS, Gintautas; SANZ-PARIS, Alejandro; JAUREGUI, Estrella Petrina; MURILLO, Ana Zugasti; SCHAFER, Eszter; ARENDS, Jann; SUAREZ-LLANOS, Jose R.; SHAFFER, Jon; LAL, Simon
    Background & aims: The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classification of chronic intestinal failure, based on patients' intravenous supplementation (IVS) requirements for energy and fluids, and to evaluate factors associated with those requirements. Methods: ESPEN members were invited to participate through ESPEN Council representatives. Participating centers enrolled adult patients requiring home parenteral nutrition for chronic intestinal failure on March 1st 2015. The following patient data were recorded though a structured database: sex, age, body weight and height, intestinal failure mechanism, underlying disease, IVS volume and energy need. Results: Sixty-five centers from 22 countries enrolled 2919 patients with benign disease. One half of the patients were distributed in 3 categories of the ESPEN clinical classification. 9% of patients required only fluid and electrolyte supplementation. IVS requirement varied considerably according to the pathophysiological mechanism of intestinal failure. Notably, IVS volume requirement represented loss of intestinal function better than IVS energy requirement. A simplified 8 category classification of chronic intestinal failure was devised, based on two types of IVS (either fluid and electrolyte alone or parenteral nutrition admixture containing energy) and four categories of volume. Conclusions: Patients' IVS requirements varied widely, supporting the need for a tool to homogenize patient categorization. This study has devised a novel, simplified eight category IVS classification for chronic intestinal failure that will prove useful in both the clinical and research setting when applied together with the underlying pathophysiological mechanism of the patient's intestinal failure.
  • article 0 Citação(ões) na Scopus
    Incidence of Donor Hepatic Artery Thrombosis in Liver Grafts Recognized During Organ Procurement and Backtable: A Rare but Treacherous Pitfall In Liver Transplantation
    (2022) SILVA, Natalie Almeida; WAISBERG, Daniel Reis; FERNANDES, Michel Ribeiro; PINHEIRO, Rafael Soares; SANTOS, Joao Paulo Costa; LIMA, Marisa Rafaela Damasceno; ALVAREZ, Paola Sofia Espinoza; ERNANI, Lucas; LINS-ALBUQUERQUE, Marcos Vinicius; NACIF, Lucas Souto; ROCHA-SANTOS, Vinicius; MARTINO, Rodrigo Bronze; DUCATTI, Liliana; ARANTES, Rubens Macedo; SONG, Alice Tung; LEE, Andre Dong; HADDAD, Luciana Bertocco; RIVA, Daniel Fernandes Dala; SILVA, Amanda Maria; GALVAO, Flavio Henrique; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto
    Introduction. Donor hepatic artery thrombosis (dHAT) identified during liver procurement and backtable is a rare and little-reported event that can make liver transplants unfeasible.Methods. This is a retrospective study of dHAT identified during liver grafts procurements or backtable procedures. All grafts were recovered from brain-dead donors. The demographic characteristics of the donors and the incidence of dHAT were analyzed. The data were also compared to a cohort of donors without dHAT.Results. There was a total of 486 donors during the study period. The incidence of dHAT was 1.85% (n = 9). The diagnosis of dHAT was made during procurement in 5 cases (55.5%) and during the backtable in 4 (44.4%). Most donors were female (n = 5), with an average BMI of 28.14 6.9 kg/m2, hypertensive (n = 5), and with stroke as cause of brain death (n = 8). The most prevalent site of dHAT was a left hepatic artery originating from the left gastric artery (n = 4). Of the 9 cases reported, 2 livers were used for transplantation, and 7 were discarded. Comparing those cases to a cohort of 260 donors without dHAT, we found a higher incidence of anatomic variations in the hepatic artery (P = .01) and of stroke as cause of brain death (P = .05).Conclusion. The occurrence of dHAT before liver procurement is a rare event, however it may become a treacherous pitfall if the diagnosis is late. Grafts with anatomic variations recovered from women with brain death due to stroke and with past history of hypertension seem to be at a higher risk of presenting dHAT.
  • article 38 Citação(ões) na Scopus
    Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure
    (2020) PIRONI, Loris; STEIGER, Ezra; JOLY, Francisca; WANTEN, Geert J. A.; CHAMBRIER, Cecile; AIMASSO, Umberto; SASDELLI, Anna Simona; SZCZEPANEK, Kinga; JUKES, Amelia; THEILLA, Miriam; KUNECKI, Marek; DANIELS, Joanne; SERLIE, Mireille J.; COOPER, Sheldon C.; POULLENOT, Florian; RASMUSSEN, Henrik Hojgaard; COMPHER, Charlene W.; CRIVELLI, Adriana; HUGHES, Sarah-Jane; SANTARPIA, Lidia; GUGLIELMI, Francesco William; KOZJEK, Nada Rotovnik; ELLEGARD, Lars; SCHNEIDER, Stephane M.; MATRAS, Przemyslaw; FORBES, Alastair; WYER, Nicola; ZMARZLY, Anna; TAUS, Marina; O'CALLAGHAN, Margie; OSLAND, Emma; THIBAULT, Ronan; CUERDA, Cristina; JONES, Lynn; CHAPMAN, Brooke; SAHIN, Peter; VIRGILI, Nuria M.; LEE, Andre Dong Won; ORLANDONI, Paolo; MATYSIAK, Konrad; CARO, Simona Di; DOITCHINOVA-SIMEONOVA, Maryana; MASCONALE, Luisa; SPAGGIARI, Corrado; GARDE, Carmen; SERRALDE-ZUNIGA, Aurora E.; OLVEIRA, Gabriel; KRZNARIC, Zeljko; JAUREGUI, Estrella Petrina; MURILLO, Ana Zugasti; SUAREZ-LLANOS, Jose P.; NARDI, Elena; GOSSUM, Andre Van; LAL, Simon
    Background and aim No marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity. Methods At baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1-2, 2-3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI). Results Fifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN 1 L/day), patients' death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2-3 and PN >3 L/day). Conclusions The type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.
  • article 2 Citação(ões) na Scopus
    Small bowel transplantation in outbred rats
    (2011) WAISBERG, Daniel Reis; LEE, Andre Dong Wong; SANTOS, Rafael Miyashiro Nunes dos; MORY, Eduardo Kenji; COSTA, Anderson Lino; MONTERO, Edna Frasson de Souza; CHAIB, Eleazar; D'ALBUQUERQUE, Luis Augusto Carneiro; GALVAO, Flavio Henrique Ferreira
    PURPOSE: To investigate the clinical evolution of orthotopic small bowel transplantation in outbred rats. METHODS: Seventy-two outbred Wistar rats weighting from 250 to 300g were used as donor and recipient in 36 consecutives ortothopic small intestine transplantation without immunosuppression. The graft was transplanted into the recipient using end-to-side aortic and portacaval microvascular anastomosis. Procedure duration, animal clinical course and survival were evaluated. Survival shorter than four days was considered technical failure. Recipients were sacrificed with signs of severe graft rejection or survival longer than 120 days. Necropsies were performed in all recipients to access histopathological changes in the graft. RESULTS: Median time for the procedure was 107 minutes. Six recipients (16.7%) presented technical failure. Twenty-seven recipients were sacrificed due to rejection, being nineteen (52.7%) between 7(th) and 15(th) postoperative day and eight (22.2%) between 34(th) and 47(th) postoperative day. Graft histology confirmed severe acute cellular rejection in those recipients. Uneventful evolution and survival longer than 120 days without rejection were observed in three recipients (8.3%). CONCLUSION: Intestinal transplantation in outbred rats without immunosuppressant regiment accomplishes variable clinical evolution.
  • article 2 Citação(ões) na Scopus
    Hepatic Venous Outflow Obstruction in Adult Deceased Donor Liver Transplantation: Classic Piggyback Implantation Versus a Modified Technique that Widens the Ostium of the Recipient's Left and Middle Hepatic Veins
    (2022) SILVA, Amanda Maria; WAISBERG, Daniel Reis; FERNANDES, Michel Ribeiro; MARTINO, Rodrigo Bronze; ROCHA-SANTOS, Vinicius; PINHEIRO, Rafael Soares; NACIF, Lucas Souto; ARANTES, Rubens Macedo; DUCATTI, Liliana; GALVAO, Flavio Henrique; LEE, Andre Dong; HADDAD, Luciana Bertocco; SILVA, Natalie Almeida; RIVA, Daniel Fernandes Dala; MOREIRA, Airton Mota; OLIVEIRA, Ricardo Abdala; CARNEVALE, Francisco Cesar; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto
    Background. The classic piggyback technique uses the union of the 3 hepatic veins to perform the cavo-caval anastomosis. However, due to the lateral localization of the right hepatic vein, the partial clamping of the vena cava in this technique significantly reduces the venous return to the right atrium. To avoid this, we adopted in 2015 a modified piggyback technique, in which we use the common trunk of the middle and left hepatic veins and also perform a lateral incision toward the right in the anterior wall of the vena cava in order to widen the final ostium of the cavo-caval anastomosis. The aim of the study was to analyze the incidence of hepatic venous out-flow obstruction between those 2 techniques. Methods. Retrospective study of liver transplant recipients undergoing venography for sus-pected hepatic venous outflow obstruction from January 2009 to June 2021. Patients undergoing transplantation with living donors or split grafts and pediatric cases were excluded from the study. Results. From January 2009 to December 2014 and from January 2015 to June 2021, 587 (group 1) and 730 (group 2) deceased-donor liver transplants were performed with the classic and the modified piggyback techniques, respectively. The incidence of cases with suspected hepatic venous outflow obstruction in groups 1 and 2 were 1.87% (n = 11) and 0.95% (n = 7), respectively (P = 0,15). The number of confirmed patients with outflow blockage that required endovascular treatment during venography in groups 1 and 2 were 4 (0.68%) and 5 (0.68%), respectively (P = 0,31). Conclusions. This modified piggyback technique did not increase the incidence of hepatic venous outflow obstruction at our service.