RAFAEL ANTONIO ARRUDA PECORA

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  • article 3 Citação(ões) na Scopus
    Home Parenteral Nutrition Program and Referral of Potential Candidates for Intestinal and Multivisceral Transplantation in a Single Brazilian Center
    (2014) LEE, A. D. W.; GALVAO, F. H. F.; DIAS, M. C. G.; CRUZ, M. E.; MARIN, M.; PEDROL, C. N.; DAVID, A. I.; PECORA, R. A. A.; WAITZBERG, D. L.; D'ALBUQUERQUE, L. A. C.
    Intestinal failure is a multifaceted condition that may require high-complexity treatment and a multidisciplinary program, including home parenteral nutrition therapy (HPNT) and intestinal transplantation. In this article, we profile a Brazilian single-center experience with 128 cases of HTPN followed for the last 30 years and appraise the referral for potential intestinal and multivisceral transplantation.
  • article 4 Citação(ões) na Scopus
    Transplante de intestino delgado
    (2013) PÉCORA, Rafael Antonio Arruda; DAVID, André Ibrahim; LEE, André Dong; GALVÃO, Flávio Henrique; CRUZ-JUNIOR, Ruy Jorge; D'ALBUQUERQUE, Luiz Augusto Carneiro
    BACKGROUND: Small bowel transplantation evolution, because of its complexity, was slower than other solid organs. Several advances have enabled its clinical application. AIM: To review intestinal transplantation evolution and its current status. METHOD: Search in MEDLINE and ScIELO literature. The terms used as descriptors were: intestinal failure, intestinal transplantation, small bowel transplantation, multivisceral transplantation. Were analyzed data on historical evolution, centers experience, indications, types of grafts, selection and organ procurement, postoperative management, complications and results. CONCLUSION: Despite a slower evolution, intestinal transplantation is currently the standard therapy for patients with intestinal failure and life-threatening parenteral nutrition complications. It involves some modalities: small bowel transplantation, liver-intestinal transplantation, multivisceral transplantation and modified multivisceral transplantation. Currently, survival rate is similar to other solid organs. Most of the patients become free of parenteral nutrition.
  • conferenceObject
    A new Model of Hipothermic Pancreas Ischemia-Reperfusion in Rats
    (2013) SANTOS, Vinicius; FERRO, Oscar; PANTANALI, Carlos; ARANTES, Rubens; PECORA, Rafael; DAVID, Andre; CHAIB, Eleazar; D'ALBUQUERQUE, Luiz
  • bookPart
    Aspectos Técnicos dos Transplantes de Órgãos do Aparelho Digestório
    (2013) DAVID, André Ibrahim; PéCORA, Rafael Antonio Arruda; PUGLIESE, Vincenzo
  • 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.
  • conferenceObject
    Diffuse Liver Cholangiocarcinoma Presenting as Fulminant Liver Failure
    (2013) PECORA, Rafael; CRUZ JR., Ruy J.; PINHEIRO, Rafael S.; MARTINO, Rodrigo Bronze de; TANIGAWA, Ryan Y.; D'ALBUQUERQUQ, Luiz Augusto Carneiro
    Introduction: Cryptogenic acute liver failure (ALF) can occur in up to 40 % of cases. There are few reports of diffuse liver tumors (primary or metastatic) leading to ALF. We herein report an unusual case of ALF secondary to diffuse cholangiocarcinoma. Case report: A 55-year-old woman was admitted to hospital with jaundice over the past 15 days, associated with general fatigue, nausea, vomiting and fever. During the admission the patient developed confusion, lactic acidosis and hypotension. Her past medical history revealed a cholecystectomy and myomectomy 10 months ago, without any history of hepatotoxic medication use. There were no others comorbidities. Laboratory evaluation included: TB 11.3 mg/dL; AST 4248 IU/L; GGTP 289 IU/L, and INR of 2.66. Hepatitis serologies were negative. Ultrasound and CT scan revealed: heterogeneous enlarged liver without any focal lesions and no signs of portal hypertension. Main portal and hepatic veins were patent. Based on clinical and laboratory evaluation, patient underwent to liver transplantation 48 hours after ICU admission. Intraoperative liver macroscopy was compatible with ALF. Explanted liver revealed a diffuse poorly differentiated liver cholangiocarcinoma with multiple microvascular tumoral emboli. There were no signs of underlying disease (i.e. cirrhosis). Immunostaining for both cytokeratins 7 and 19 were positive. Conclusion: To the best of our knowledge this is the first report of ALF associated with cholangiocarcinoma. Neoplastic involvement of liver should be considered in the differential diagnosis of ALF of unknown etiology. Pre-transplant diagnosis should be always pursued due to the dismal prognosis of these conditions. Given the limitation of imaging studies in this setting, liver biopsy can be an option to obtain an accurate diagnosis.
  • conferenceObject
    The Shortage of Donor for Intestinal and Multivisceral Transplantation in Brazil.
    (2015) CALIL, Igor; LEITE, Andre Z.; ANDRADE, Guilherme; MALBOUISSON, Luis Marcelo; SALIBA, Gustavo; DUCATTI, Liliana; PINHEIRO, Rafael S.; ROCHA, Vinicius S.; BRONZE, Rodrigo M.; ANDRAUS, Wellington; SOLER, Wangles V.; HADDAD, Luciana; NACIF, Lucas S.; PANTANALI, Carlos; PECORA, Rafael A.; DAVID, Andre I.; GALVAO, Flavio H.; D'ALBUQUERQUE, Luiz Augusto C.
  • article 8 Citação(ões) na Scopus
    Intentional use of Schistosoma mansoni-infected grafts in living donor liver transplantation
    (2012) ANDRAUS, Wellington; PUGLIESE, Vicenzo; PECORA, Rafael; D'ALBUQUERQUE, Luiz Augusto C.
  • conferenceObject
    Double Balloon Enteroscopy Assessment as a Relevant Approach to Evaluate the Evolution and Diagnosis of Intestinal Failure Complications
    (2015) LEE, Andre; SAFATLE-RIBEIRO, Adriana V.; ROCHA, Mariana H.; MINCHELONI, Natalia D.; NOVA, Lidiane C. Casa; GUIDI, Paula; GALVAO, Flavio H.; GONCALVES-DIAS, Maria C.; CALIL, Igor L.; DAVID, Andre I.; SOLER, Wangles V.; PECORA, Rafael A.; WAITZBERG, Dan L.; D'ALBUQUERQUE, Luis C.
  • article 70 Citação(ões) na Scopus
    Liver transplantation: Fifty years of experience
    (2014) SONG, Alice Tung Wan; AVELINO-SILVA, Vivian Iida; PECORA, Rafael Antonio Arruda; PUGLIESE, Vincenzo; D'ALBUQUERQUE, Luiz Augusto Carneiro; ABDALA, Edson
    Since 1963, when the first human liver transplantation (LT) was performed by Thomas Starzl, the world has witnessed 50 years of development in surgical techniques, immunosuppression, organ allocation, donor selection, and the indications and contraindications for LT. This has led to the mainstream, wellestablished procedure that has saved innumerable lives worldwide. Today, there are hundreds of liver transplant centres in over 80 countries. This review aims to describe the main aspects of LT regarding the progressive changes that have occurred over the years. We herein review historical aspects since the first experimental studies and the first attempts at human transplantation. We also provide an overview of immunosuppressive agents and their potential side effects, the evolution of the indications and contraindications of LT, the evolution of survival according to different time periods, and the evolution of methods of organ allocation.