LUCAS SOUTO NACIF

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 23
  • article 0 Citação(ões) na Scopus
    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 Augusto
    Background. 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.
  • article 4 Citação(ões) na Scopus
    Novel Technique in a Sheep Model of Uterine Transplantation
    (2020) ARANTES, Rubens Macedo; NACIF, Lucas Souto; PINHEIRO, Rafael Soares; ROCHA-SANTOS, Vinicius; MARTINO, Rodrigo Bronze de; WAISBERG, Daniel Reis; PANTANALI, Carlos Andres Rodriguez; FORTUNATO, Allana; LIMA, Marisa Rafaela; DUCATTI, Liliana; HADDAD, Luciana Bertocco de Paiva; EJZENBERG, Dani; GALVAO, Flavio Henrique; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, Luiz
  • article 1 Citação(ões) na Scopus
    Ten Years' Evaluation of Potential Pancreas Donors in Sao Paulo, Brazil
    (2014) PINHEIRO, R. S.; ROCHA-SANTOS, V.; PECORA, R. A.; MACEDO, R. A.; NACIF, L. S.; ANDRAUS, W.; DAVID, A. I.; PANTANALI, C. A.; BENITES, C. M.; D'ALBUQUERQUE, L. A. C.
    Background. Pancreas transplantation is a treatment for advanced type 1 diabetes and offers significant improvement in quality of life. Recent advances in surgical techniques and immunosuppression regimes lead to good outcomes. However, despite significant higher rates of multiorgan donors in Brazil, pancreas transplantation seems to have remained stable. This study aimed to investigate the acceptance rate of potential pancreas donors in the past 10 years in Sao Paulo State. Methods. We retrospectively evaluated potential pancreas donors characteristics and its acceptance rate in Sao Paulo State in the past 10 years. We divided this period into 2 eras: 1st era from January 2003 to January 2008; and 2nd era from January 2008 to January 2013. Data were obtained from Sao Paulo's government official website. Results. During the whole period, 5,005 deceased donors of all ages were available for pancreas transplantation. According to eras, we had 1,588 donors in the 1st and 3,417 in the 2nd era. In the 2nd era, donors >49 years old were significantly more common (P < .001). Blood test abnormalities, donor comorbidities, and high dosage of vasopressors also were significantly higher in the 2nd era. Rate of graft acceptance had a significant decrease in the 2nd era, from 46.4% to 25% (P < .05). Conclusions. Despite greater organ availability, pancreas transplantations performed in Sao Paulo State remained stable. Rate of graft acceptance is dramatically lower in more recent years.
  • article 2 Citação(ões) na Scopus
    Adult -to -Adult Living Donor Liver Transplant: Hemodynamic Evaluation, and Selection
    (2020) NACIF, Lucas Souto; ZANINI, Leonardo Yuri; WAISBERG, Daniel Reis; SANTOS, Joao Paulo Costa dos; PEREIRA, Juliana Marquezi; PINHEIRO, Rafael Soares; ROCHA-SANTOS, Vinicius; MARTINO, Rodrigo Bronze; ARANTES, Rubens Macedo; DUCATTI, Liliana; HADDAD, Luciana; GALVAO, Flavio Henrique; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, Luiz
  • article 6 Citação(ões) na Scopus
    Intraoperative Temporary Portocaval Shunt in Liver Transplant
    (2020) NACIF, Lucas Souto; ZANINI, Leonardo Yuri; SANTOS, Joao Paulo Costa dos; PEREIRA, Juliana Marquezi; PINHEIRO, Rafael Soares; ROCHA-SANTOS, Vinicius; MARTINO, Rodrigo Bronze de; WAISBERG, Daniel Reis; ARANTES, Rubens Macedo; DUCATTI, Liliana; HADDAD, Luciana; GALVAO, Flavio Henrique; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, Luiz
  • article 1 Citação(ões) na Scopus
    Access to Liver Transplantation in Different ABO-Blood Groups and ""Exceptions Points"" in a Model for End-Stage Liver Disease Allocation System: A Brazilian Single-Center Study
    (2018) MARTINO, R. B.; WAISBERG, D. R.; DIAS, A. P. M.; INOUE, V. B. S.; ARANTES, R. M.; HADDAD, L. B. P.; ROCHA-SANTOS, V.; PINHEIRO, R. S. N.; NACIF, L. S.; D'ALBUQUERQUE, L. A. C.
    Background. In the Model for End-Stage Liver Disease (MELD) system, patients with ""MELD exceptions"" points may have unfair privilege in the competition for liver grafts. Furthermore, organ distribution following identical ABO blood types may also result in unjust organ allocation. The aim of this study was to investigate access to liver transplantation in a tertiary Brazilian center, regarding ""MELD exceptions"" situations and among ABO-blood groups. Methods. A total of 465 adult patients on the liver waitlist from August 2015 to August 2016 were followed up until August 2017. Patients were divided into groups according to ABO-blood type and presence of ""exceptions points."" Results. No differences in outcomes were observed among ABO-blood groups. However, patients from B and AB blood types spent less time on the list than patients from A and O groups (median, 46, 176, 415, and 401 days, respectively; P=.03). ""Exceptions points"" were granted for 141 patients (30.1%), hepatocellular carcinoma being the most common reason (52.4%). Patients with ""exceptions points"" showed higher transplantation rate, lower mortality on the list, and lower delta-MELD than non-exceptions patients (56.7% vs 19.1% [P<.01]; 18.4% vs 38.5% [P<.01], and 2.0 +/- 2.6 vs 6.9 +/- 7.0 [P<.01], respectively). Patients with refractory ascites had a higher mortality rate than those with other ""exceptions"" or without (48%). Conclusions. The MELD system provides equal access to liver transplantation among ABO-blood types, despite shorter time on the waitlist for AB and B groups. The current MELD exception system provides advantages for candidates with ""exception points,"" resulting in superior outcomes compared with those without exceptions.
  • article 12 Citação(ões) na Scopus
    Transient Elastography in Acute Cellular Rejection Following Liver Transplantation: Systematic Review
    (2018) NACIF, L. S.; GOMES, C. D. C.; MISCHIATTI, M. N.; KIM, V.; PARANAGUA-VEZOZZO, D.; REINOSO, G. L.; CARRILHO, F. J.; D'ALBUQUERQUE, L. C.
    Background. Transient elastography (TE) is a noninvasive technique that measures liver stiffness. When an inflammatory process is present, this is shown by elevated levels of stiffness. Acute cellular rejection (ACR) is a consequence of an inflammatory response directed at endothelial and bile epithelial cells, and it is diagnosed through liver biopsy. This is a systematic review of the viability of TE in ACR following liver transplantation. Methods. The Cochrane Library, Embase, and Medline PubMed databases were searched and updated to November 2016. The MESH terms used were ""Liver Transplantation,"" ""Graft Rejection,"" ""Elasticity Imaging Techniques"" (PubMed), and ""Elastography"" (Cochrane and Embase). Results. Seventy studies were retrieved and selected using the PICO (patient, intervention, comparison or control, outcome) criteria. Three prospective studies were selected to meta-analysis and evaluation. A total of 33 patients with ACR were assessed with TE. One study showed a cutoff point of >7.9 kPa to define graft damage and <5.3 kPa to exclude graft damage (receiver operating characteristic 0.93; P<.001). Another study showed elevated levels of liver stiffness in ACR patients. However, in this study, no cutoff point for ACR was suggested. The final prospective study included 27 patients with ACR at liver biopsy. Cutoff points were defined as TE > 8.5 kPa, moderate to severe ACR, with a specificity of 100% and receiver operating characteristic curve of 0.924. The measurement of TE < 4.2 kPa excludes the possibility of any ACR (P=.02). Conclusions. TE may be an important tool for the severity of ACR in patients following liver transplantation. Further studies should be performed to better define the cutoff points and applicability of the exam.
  • article 2 Citação(ões) na Scopus
    Histopathologic Evaluation of Acute on Chronic Liver Failure
    (2020) NACIF, Lucas Souto; AQUINO, Flavia; TANIGAWA, Ryan Yukimatsu; ZANINI, Leonardo Yuri; PINHEIRO, Rafael Soares; ROCHA-SANTOS, Vinicius; MARTINO, Rodrigo Bronze; SONG, Alice; ARANTES, Rubens Macedo; DUCATTI, Liliana; WAISBERG, Daniel Reis; GALVAO, Flavio Henrique; ANDRAUS, Wellington; ALVES, Venancio Avancini Ferreira; CARNEIRO-D'ALBUQUERQUE, Luiz
  • article 1 Citação(ões) na Scopus
    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 Augusto
    Background. 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.
  • 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.