WALMAR RONCALLI PEREIRA DE OLIVEIRA

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

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  • bookPart
    Doenças sexualmente transmissíveis
    (2019) OLIVEIRA, Walmar Roncalli Pereira de; ROCHA, Maria Isabel Ramos Saraiva
  • article 1 Citação(ões) na Scopus
    Cutaneous infections from viral sources in solid organ transplant recipients
    (2023) MIOTTO, Isadora Zago; NETO, Cyro Festa; OLIVEIRA, Walmar Roncalli Pereira de
    Introduction: Solid organ transplant recipients (SOTRs) are susceptible to various dermatological complications caused by long-term immunosuppressive therapy. Of these complications, viral infections are noteworthy because of their high prevalence and the potential morbidity associated with viral carcinogenesis.Objectives: To evaluate the occurrence of cutaneous viral infections in SOTRs and their correlation with clinical features, transplant type, and the length and intensity of immunosuppressive therapy. Methods: This retrospective cohort study included SOTRs followed up at the Department of Dermatology in a tertiary hospital. The outcomes analyzed were the occurrence of cutaneous viral infections, including human papillomavirus (HPV) infection, herpes simplex, herpes zoster, molluscum contagiosum, Merkel cell carcinoma, Kaposi's sarcoma, and cytomegalovirus, and the occurrence of HPV-related neoplasms. Clinical variables, such as length and intensity of immunosuppression, type of transplanted organ, and comorbidities, were analyzed as possible risk factors for cutaneous viral infections in SOTRs.Results: A total of 528 SOTRs were included in this study, among which 53.8% had one or more viral infections. Of these, 10% developed a virus-associated malignancy (HPV-associated carcinoma, Merkel cell carcinoma, or Kaposi's sarcoma). The higher risk of viral infections among SOTRs was associated with cyclosporine intake (1.40-fold higher risk) and younger age at transplantation. The use of an immunosuppressive regimen, including additional drugs, was associated with a higher risk of genital HPV infection (1.50-fold higher risk for each in-cremental drug).Conclusions: The occurrence of cutaneous viral infections in SOTRs is directly associated with the duration and intensity of immunosuppressive therapy. Patients at higher risk were those taking drugs with a stronger impact on cellular immunity and/or those on an immunosuppressive regimen comprising various drugs.
  • article 1 Citação(ões) na Scopus
    Epidermodysplasia verruciformis: Report of two patients with autosomal dominant inheritance
    (2021) MIOTTO, I. Z.; OLIVEIRA, W. R. P. de
    Epidermodysplasia verruciformis is a rare genodermatosis associated with mutations in the EVER1/TMC6 and EVER2/TMC8 genes. The inheritance is considered to be autosomal recessive, but reports suggesting an autosomal dominant inheritance indicate disease genetic heterogeneity. Its onset occurs in early childhood and presents as a combination of pityriasis versicolor-like, flat wart-like and seborrheic keratosis-like lesions, with a potential for malignant transformation, mainly squamous cell carcinoma. © 2021 Dermatology Online Journal. All rights reserved.
  • conferenceObject
    Lobular panniculitis of the thigh as the only cutaneous manifestation of reactivation of Chagas disease in a renal transplant patient: A case report
    (2018) ROMERO-SANDOVAL, Karina; MAGALHAES, Tiara Souza; ARNONE, Marcelo; GIANNOTTI, Marcelo; OLIVEIRA, Walmar Roncalli Pereira de
  • bookPart 0 Citação(ões) na Scopus
    Cutaneous Side Effects of Immunosuppressive Drugs Other Than Neoplasms
    (2022) MIOTTO, I. Z.; OLIVEIRA, W. R. P. de
    Solid organ transplant recipients are susceptible to various dermatological side effects as a consequence of long-term immunosuppressive therapy. Malignancies and infections are well-studied complications, but there is less information regarding other nonmalignant skin changes, such as inflammatory manifestations. The aim of this chapter is to describe the cutaneous side effects related to the following drugs: Systemic steroids, azathioprine, mycophenolate mofetil, cyclosporine, tacrolimus, mTOR inhibitors (sirolimus and everolimus), and newer agents, such as monoclonal antibodies and biologic drugs. Transplant care providers must be able to recognize and properly manage these cutaneous findings in order to limit associated morbidity and mortality. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
  • article 6 Citação(ões) na Scopus
    Clinicopathological features, MCPyV status and outcomes of Merkel cell carcinoma in solid-organ transplant recipients: a retrospective, multicentre cohort study
    (2022) FERRANDIZ-PULIDO, C.; GOMEZ-TOMAS, A.; LLOMBART, B.; MENDOZA, D.; MARCOVAL, J.; PIASERICO, S.; BAYKAL, C.; BOUWES-BAVINCK, J. N.; RACZ, E.; KANITAKIS, J.; HARWOOD, C. A.; CETKOVSKA, P.; GEUSAU, A.; MARMOL, V Del; MASFERRER, E.; CANO, C. Orte; RICAR, J.; OLIVEIRA, W. R. de; SALIDO-VALLEJO, R.; DUCROUX, E.; GKINI, M. A.; LOPEZ-GUERRERO, J. A.; KUTZNER, H.; KEMPF, W.; SECKIN, D.
    Background The proportion of Merkel cell carcinomas (MCCs) in solid-organ transplant recipients (SOTR) harbouring Merkel cell polyomavirus (MCPyV) is unknown, as are factors affecting their outcomes. Objective To describe clinicopathological features of MCC in SOTR, investigate the tumoral MCPyV-status and identify factors associated with tumour outcomes. Methods Retrospective, international, cohort-study. MCPyV-status was investigated by immunohistochemistry and polymerase chain reaction. Results A total of 30 SOTR and 44 consecutive immunocompetent patients with MCC were enrolled. SOTR were younger at diagnosis (69 vs. 78 years, P < 0.001). Thirty-three percent of SOTR MCCs were MCPyV-positive vs. 91% of immunocompetent MCCs (P = 0.001). Solid-organ transplantation was associated with an increased cumulative incidence of progression (SHR: 3.35 [1.57-7.14], P = 0.002), MCC-specific mortality (SHR: 2.55 [1.07-6.06], P = 0.034) and overall mortality (HR: 3.26 [1.54-6.9], P = 0.002). MCPyV-positivity and switching to an mTOR inhibitor (mTORi) after MCC diagnosis were associated with an increased incidence of progression (SHR: 4.3 [1.5-13], P = 0.008 and SHR: 3.6 [1.1-12], P = 0.032 respectively) in SOTR. Limitations Retrospective design and heterogeneity of SOTR cohort. Conclusions MCPyV appears to play a less prominent role in the aetiopathogenesis of MCC in SOTR. SOTR have a worse prognosis than their immunocompetent counterparts and switching to an mTORi after the diagnosis of MCC does not improve progression.
  • conferenceObject
    Epidermodysplasia verruciformis: Successful therapeutic approach of two squamous cell carcinomas with imiquimod
    (2015) OLIVEIRA, Walmar; SILVA, Lana Luiza; FESTA NETO, Cyro; TYRING, Stephen
  • conferenceObject
    Claudins expression profile in squamous cell carcinoma of epidermodysplasia verruciformis
    (2014) TANABE, Claudia Kwei Fong Dai; HALPERN, Ilana; SILVA, Lana Luiza da Cruz; MATTOS, Mayra Servilha Grion; SOTTO, Mirian N.; OLIVEIRA, Walmar Roncalli Pereira
  • bookPart 0 Citação(ões) na Scopus
    Sexually Transmitted Infections
    (2022) MIOTTO, I. Z.; OLIVEIRA, W. R. P. de
    Sexually transmitted infections (STIs) represent a significant global public health burden, with approximately 1 million new cases daily. Systematic serology screening for STIs is generally performed in transplant donors and recipients, which include testing for human immunodeficiency virus (HIV), viral hepatitis B and C, herpes simplex virus, and syphilis. Infection by human papillomavirus (HPV) should be properly recognized by clinical and histopathological examination, once lesions can undergo malignant transformation. STIs in solid organ transplant recipients (SOTRs) may have an atypical presentation and tricky diagnosis. Transplant caregivers must be aware of these peculiarities, and patients must be followed-up closely, in order to reduce associated morbidity. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
  • article 23 Citação(ões) na Scopus
    Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients A Delphi Consensus Statement
    (2021) MASSEY, Paul R.; SCHMULTS, Chrysalyne D.; LI, Sara J.; ARRON, Sarah T.; ASGARI, Maryam M.; BAVINCK, Jan Nico Bouwes; BILLINGSLEY, Elizabeth; BLALOCK, Travis W.; BLASDALE, Katie; CARROLL, Bryan T.; CARUCCI, John A.; CHONG, Alvin H.; CHRISTENSEN, Sean R.; CHUNG, Christina Lee; DESIMONE, Jennifer A.; DUCROUX, Emilie; ESCUTIA-MUNOZ, Begona; FERRANDIZ-PULIDO, Carla; FOX, Matthew C.; GENDERS, Roel E.; GEUSAU, Alexandra; GJERSVIK, Petter; HANLON, Allison M.; HARKEN, Edit B. Olasz; HOFBAUER, Guenther F. L.; HOPKINS, R. Samuel; LEITENBERGER, Justin J.; LOSS, Manisha J.; MARMOL, Veronique Del; MASCARO JR., Jose M.; MYERS, Sarah A.; NGUYEN, Bichchau T.; OLIVEIRA, Walmar R. P.; OTLEY, Clark C.; PROBY, Charlotte M.; RACZ, Emoke; RUIZ-SALAS, Veronica; SAMIE, Faramarz H.; SECKIN, Deniz; SHAH, Syed N.; SHIN, Thuzar M.; SHUMACK, Stephen P.; SOON, Seaver L.; STASKO, Thomas; ZAVATTARO, Elisa; ZEITOUNI, Nathalie C.; ZWALD, Fiona O'Reilly; HARWOOD, Catherine A.; JAMBUSARIA-PAHLAJANI, Anokhi
    IMPORTANCE There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs). OBJECTIVE To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs. EVIDENCE REVIEW Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses. FINDINGS The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage-based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately >= 20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC. CONCLUSIONS AND RELEVANCE Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.