LUCAS SOUTO NACIF
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
17 resultados
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- Innovative Technique Avoiding Bleeding After Reperfusion in Living Donor Liver Transplant Using a Modified Right Lobe Graft(2022) PINHEIRO, Rafael S.; ANDRAUS, Wellington; FORTUNATO, Allana C.; FERNANDES, Michel Ribeiro; NACIF, Lucas Souto; MARTINO, Rodrigo Bronze De; DUCATTI, Liliana; WAISBERG, Daniel Reis; ARANTES, Rubens Macedo; ROCHA-SANTOS, Vinicius; GALVAO, Flavio Henrique Ferreira; CARNEIRO-D'ALBUQUERQUE, Luiz AugustoBackground. Living donor liver transplant (LDLT) is a valuable therapeutic option for over-coming the deceased donor shortage. Modified right lobe graft (MRLG) keeps the middle hepatic vein (MHV) trunk with the remnant liver to improve donor safety. Hemostasis in the MHV tributary reconstruction can be tricky; surgical stitches and energy coagulation are ineffective. Fibrin glues are excellent vascular sealants but are poor in maintaining hemostasis in an active hemorrhage or preventing resection surface-related complications after liver resection. We propose applying fibrin sealant during back table graft preparation to seal the hepatic edge and MHV reconstruction to avoid bleeding after graft revascularization. Methods. Our retrospective cohort study included all adult patients undergoing LDLT between August 2017 and December 2021. During the back table procedure, we performed the reconstruction of the inferior right hepatic vein and/or MHV tributaries from segment 5 (V5) and segment 8 (V8) using a vein harvested from a nonrelated deceased donor. Before initiating the hepatic graft implantation, we applied fibrin sealant in the resected parenchyma, especially in the V5 and V8 anastomosis, to seal the hepatic edge and hepatic vein reconstruction. Results. No bleeding was identified in the hepatic edge, and blood product transfusion was unnecessary for any recipients after reperfusion. Conclusion. In LDLT using MRLG with MHV reconstruction, the fibrin sealant, when applied on the raw hepatic surface, and vascular reconstruction during back table graft preparation avoided bleeding after graft revascularization.
- COVID-19 Pandemic Impact on Liver Donation in the Largest Brazilian Transplantation Center(2022) FORTUNATO, Allana C.; PINHEIRO, Rafael S.; FERNANDES, Michel Ribeiro; NACIF, Lucas Souto; ARANTES, Rubens Macedo; ROCHA-SANTOS, Vinicius; WAISBERG, Daniel Reis; MARTINO, Rodrigo Bronze De; DUCATTI, Liliana; HADDAD, Luciana Bertocco; SONG, Alice Tung; ABDALA, Edson; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, Luiz AugustoBackground. COVID-19 has spread worldwide and has become a public health emergency and a pandemic of international concern. The solid organ donation system was no different. This study aimed to investigate the effect of COVID-19 on the liver transplant (LT) system in Brazilian territory. Methods. We retrospectively reviewed all liver donor records allocated in Sao Paulo State, Brazil, 1 year before and 1 year during the COVID-19 pandemic. We defined the pre-COVID-19 (PRE) period as between April 2019 and April 2020 and the post-COVID-19 (POST) period as between April 2020 and April 2021. Moreover, we compared LT performed in our institution during these periods. To evaluate outcomes, we compared 30-day survival after LT. Results. In the PRE period, 1452 livers were offered for donation in Sao Paulo State and other Brazilian territories. Of these, 592 were used in LT. In the POST period, 1314 livers were offered for donation, but only 477 were used in LT. Organ refusal was higher in the POST period (P < .05). Our center performed 127 and 156 LTs in these periods, respectively, and an increase above 20% was significant (P = .039). There was no difference in 30-day survival between the periods (87.2% vs 87.9%, P > .5, respectively). Conclusions. The COVID-19 pandemic harmed potential and allocated donors and LTs per-formed. However, it is possible to maintain the LT volume of a transplant center without compromising survival outcomes through preventive strategies against COVID-19 propagation.
- 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 AugustoIntroduction. 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.
- Experimental Clinical Model of Liver Transplantation in Large White Pigs Without Venovenous Bypass: Pre-, Intra-, and Maintenance Care(2022) NACIF, Lucas Souto; ALVAREZ, Paola Sofia Espinoza; PINHEIRO, Rafael Soares; NETO, Amadeo Batista Da Silva; FONSECA, Giovana De Maria Rocha; FERNANDES, Michel Ribeiro; SANTOS, Joao Paulo Costas; ERNANI, Lucas; ROCHA-SANTOS, Vinicius; MARTINO, Rodrigo Bronze De; WAISBERG, Daniel Reis; MACEDO, Rubens Arantes; DUCATTI, Liliana; HADDAD, Luciana; GALVAO, Flavio Henrique Ferreira; ANDRAUS, Wellington; CARNEIRO-DALBUQUERQUE, LuizBackground. Liver transplantation in an animal model is challenging due to hemodynamics and intraoperative anesthetic care. Several models are described in the literature employing different techniques such as venovenous bypass or aortic cross-clamping to maintain hemodynamic stability, although few groups keep the animal alive in the postoperative period. This study aims to evaluate a liver transplantation clinical model in pigs without venovenous bypass or aortic cross-clamping. Methods. Male pigs weighing 20 to 35 kg underwent liver transplantation surgery without using venovenous bypass or aorta cross-clamping. Protocols were approved by the Animal Care and Use Committee of the University of Sao Paulo, Brazil. Results. Ten LTs were performed. Cold ischemia and warm ischemia were 119 +/- 33.28 minutes and 26 +/- 9.6 minutes, respectively. Hemodynamic changes were significantly higher after the postrevasculazation phase: heart rate (P < .001), medium arterial pressure (P < .001), and cardiac output (P = .03). Hypotension was treated with intravenous fluids and, in some cases, with vasoactive drugs especially during the post-reperfusion period. No animals died during the procedure and almost survival until the first postoperative day. Serum aspartate aminotransferase and lactate increased their values in the post-reperfusion phase. Conclusions. Practice-based on laboratory animals improves surgical skills and the development of experimental models aimed at new advances in this field. Perfecting our technique on the swine model, we could move forward to create a small-for-size model, test new therapeutic strategies, and define the boundaries for safely performing an enlarged liver resection or a partial liver graft transplant.
- Prognostic Factors Evaluation for Liver Transplant Mismatching: A New Way of Selecting and Allocating Organs(2022) NACIF, Lucas Souto; ZANINI, Leonardo Yuri Kasputis; FERNANDES, Michel Ribeiro; PINHEIRO, Rafael Soares; ROCHA-SANTOS, Vinicius; MARTINO, Rodrigo Bronze De; WAISBERG, Daniel Reis; MACEDO, Rubens Arantes; DUCATTI, Liliana; HADDAD, Luciana; GALVAO, Flavio Henrique Ferreira; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, LuizBackground. Liver transplant (LT) is the standard therapy for end-stage liver disease. Advances in surgical techniques and immunosuppression protocols improved the results of LT by increasing long-term survival. Nevertheless, an adequate match between the donor and recipient is paramount for avoiding futile liver transplants. We aimed to identify the prognostic factors in donor-recipient LT matching. Methods. Retrospective analysis of adult LT was conducted from January 2006 to December 2018, which included the following transplant modalities: deceased donor LT (DDLT), living donor LT (LDLT), combined liver-kidney transplant (CLKT), and domino LT (DLT). Results. Among 1101 patients who underwent LT, 958 patients underwent DDLT, 92 patients underwent LDLT, 45 patients underwent CLKT, and 6 patients underwent DLT. The overall survival (OS) in 1, 5, and 10 years were 89%, 83%, and 82%, respectively. For DDLT, OS in 1, 5, and 10 years were 91%, 84%, and 82%, respectively. For LDLT, OS in 1, 5, and 10 years were 89%, 72%, and 69%, respectively. For CKLT, OS in 1, 5, and 10 years were 90%, 71%, and 71%, respectively. None of the DLT patients died. For DDLT, the factors that affected OS were the presence of fulminant liver failure (odds ratio [OR], 2.23; 95% CI, 1.18-4.18; P = .001), hemodialysis before LT (OR, 2.12; 95% CI, 1.27-3.5; P = .004), retransplant (OR, 4.74; 95% CI, 2.75-8.17; P = .000), and recipient age > 60 years (OR, 1.86; 95% CI, 1.27-2.73; P = .001). For hospitalization before LT (due to an acute-on-chronic liver failure), the OR was 2.10 (95% CI, 1.29-3.42; P = .003). Donor intensive care unit time > 7 days (OR, 1.46; 95% CI, 1.04-2.06; P = .02) was also associated with overall mortality. Conclusions. We identified prognostic factors in donor-recipient LT matching. Furthermore, we demonstrated that an adequate organ allocation with donor-recipient selection might increase graft survival and reduce waiting list mortality.
- Septuagenarian Donors and Recipients in Deceased Donor Liver Transplantation: A Brazilian Single Center Experience and Literature Review(2022) FERNANDES, Michel Ribeiro; WAISBERG, Daniel Reis; LIMA, Marisa Rafaela Damasceno; ROCHA-SANTOS, Vinicius; MARTINO, Rodrigo Bronze; PINHEIRO, Rafael Soares; NACIF, Lucas Souto; DUCATTI, Liliana; ARANTES, Rubens Macedo; SANTOS, Joao Paulo Costa; ALVAREZ, Paola Sofia Espinoza; SILVA, Natalie Almeida; RIVA, Daniel Fernandes Dala; SILVA, Amanda Maria; SONG, Alice Tung; LEE, Andre Dong; HADDAD, Luciana Bertocco; GALVAO, Flavio Henrique; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, LuizBackground: The number of elderly patients who have end-stage liver disease and require liver transplantation has dramatically increased. On the other hand, liver grafts from elderly donors have been offered more frequently for transplantation. The present study aims to analyze the results of liver transplants performed with donors and recipients aged >= 70 years. Methods: We performed a single-center retrospective study of deceased donors liver transplants that involved recipients aged >= 7070 years or recipients who received grafts from donors aged >= 70 years from 2011 to 2021. A literature review on the results of liver transplantation in elderly recipients was also performed. Results: Thirty septuagenarian recipients were included; their overall 1- and 5-years survival was 80% and 76.6%, respectively. The prevalence of recipients aged >= 70 years in our department was 2.65%. Twenty recipients received grafts form septuagenarian donors; their overall 1- and 5-years survival was 75%. The prevalence of donors aged >= 70 years in our department was 1%. In the literature review, 17 articles were analyzed. The 5-years survival of recipients aged >= 70 years ranged from 47.1% to 78.5%. Conclusions: Septuagenarian recipients and patients who received grafts from elderly brain-dead donors present adequate overall survival after liver transplantation. Optimized donor-recipient matching is paramount for achieving good outcomes. The combination of high-risk donors with septuagenarian recipients should be avoided as well as using grafts of elderly donors that present others risk factors. Thus, the age of the donor or recipient alone cannot be considered an absolute contraindication for liver transplantation.
- Venous thromboembolism in in-hospital cirrhotic patients: A systematic review(2022) RENO, Leonardo da Cruz; TUSTUMI, Francisco; WAISBERG, Daniel Reis; ROCHA-SANTOS, Vinicius; PINHEIRO, Rafael Soares; MACEDO, Rubens Arantes; NACIF, Lucas Souto; DUCATTI, Liliana; MARTINO, Rodrigo Bronze De; TREVISAN, Alexandre Maximiliano; CARNEIRO-D'ALBUQUERQUE, Luiz; ANDRAUS, WellingtonIntroduction: Patients with liver cirrhosis are at a higher risk of hospitalization. The present review aimed to assess the risk of thromboembolism and its burden on hospitalized cirrhotic patients. Materials and methods: A systematic review (PROSPERO: CRD42021256869) was conducted in PubMed, Embase, Cochrane, Lilacs, and a manual search of references. It evaluated studies that compare cirrhotic patients with venous thromboembolism (VTE) with cirrhotic patients without VTE or studies that compare cirrhotic patients with non-cirrhotic patients. No restrictions were set for the date of publication or language. The last search was conducted in June 2021. Results: After selection, 17 studies were included from an initial search of 5,323 articles. The chronic liver disease etiologies comprise viral, alcohol, autoimmune, NASH (non-alcoholic steatohepatitis), cryptogenic, hemochromatosis, cholestasis, and drug-related. The included studies were conflicted regarding the outcomes of VTE, pulmonary embolism, or bleeding. Patients with cirrhosis associated with VTE had prolonged length of hospital stay, and patients with cirrhosis were at higher risk of portal thrombosis. Conclusion: In-hospital cirrhotic patients are a heterogeneous group of patients that may present both thrombosis and bleeding risk. Clinicians should take extra caution to apply both prophylactic and therapeutic anticoagulation strategies.
- Model for establishing a new liver transplantation center through mentorship from a university with transplantation expertise(2022) PINHEIRO, Rafael Soares; ANDRAUS, Wellington; ROMEIRO, Fernando Gomes; MARTINO, Rodrigo Bronze de; DUCATTI, Liliana; ARANTES, Rubens Macedo; PELAFSKY, Leonardo; HASIMOTO, Claudia Nishida; YAMASHIRO, Fabio da Silva; NACIF, Lucas Souto; HADDAD, Luciana Bertocco de Paiva; SANTOS, Vinicius Rocha; WAISBERG, Daniel Reis; VANE, Matheus Fachini; ROCHA-FILHO, Joel Avancini; OLIVEIRA, Walmar Kerche de; CARNEIRO-D'ALBUQUERQUE, Luiz AugustoBackgroundSetting up new liver transplant (LT) centers is essential for countries with organ shortages. However, good outcomes require experience, because LT learning depends on a high number of surgeries. This study aims to describe how a new center was set up from a partnership between the new center and an experienced one. The step-by-step preparation process, the time needed and the results of the new center are depicted. Material and methodsThe mentoring process lasted 40 months, in which half of the 52 patients included on the transplant list received LT. After the mentorship, a 22-month period was also analyzed, in which 46 new patients were added to the waiting list and nine were operated on. ResultsThe 30-day survival rates during (92.3%) and after (66.7%) the partnership were similar to the other LT centers in the same region, as well as the rates of longer periods. The waiting time on the LT list, the characteristics of the donors and the ischemia times did not differ during or after the mentorship. ConclusionThe partnership between universities is a suitable way to set up LT centers, achieving good results for the institutions and the patients involved.
conferenceObject INFLUENCE OF CYP3A4, CYP3A5, POR AND ABCB1 GENES ON TACROLIMUS RESPONSE IN LIVER TRANSPLANT RECIPIENTS(2022) NALDI, Graziella D'A. R.; PEREIRA, Thales Dalessandro; FOSSALUZA, Victor; NACIF, Lucas; D'ALBUQUERQUE, Luiz Augusto Carneiro; CARRILHO, Flair J.; ONO, Suzane Kioko- 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 AugustoBackground. 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.