RAFAEL ANTONIO ARRUDA PECORA
Projetos de Pesquisa
Unidades Organizacionais
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- 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 CarneiroBACKGROUND: 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.
- 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 CarneiroIntroduction: 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.
- Intentional use of Schistosoma mansoni-infected grafts in living donor liver transplantation(2012) ANDRAUS, Wellington; PUGLIESE, Vicenzo; PECORA, Rafael; D'ALBUQUERQUE, Luiz Augusto C.
- 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, EdsonSince 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.
conferenceObject Hepatocellular Carcinoma Meld Exception in Brazil.(2014) PINHEIRO, Rafael S.; NACIF, Lucas S.; ANDRAUS, Wellington; LOPES, Liliana D.; PECORA, Rafael A.; ROCHA-SANTOS, Vinicius; IBRAHIM, Andre D.; HADDAD, Luciana B.; CALIL, Igor L.; CRUZ JR., Ruy J.; D'ALBUQUERQUE, Luiz A. C.conferenceObject Validation of Preoperative Coefficient Factor for Graft Weight Estimation in Living Donor Liver Transplantation(2013) PINHEIRO, Rafael S.; PECORA, Rafael A.; ANDRAUS, Wellington; MARTINS, Rodrigo B.; DAVID, Andre I.; HADDAD, Luciana B.; ARANTES, Rubens M.; SANTOS, Rafael M.; CRUZ JR., Ruy J.; PUGLIESE, Vincenzo; D'ALBUQUERQUE, Luiz A. C.conferenceObject Femoral Hernia and Massive Ascites(2013) PINHEIRO, Rafael S.; ANDRAUS, Wellington; PECORA, Rafael A.; HADDAD, Luciana B.; DAVID, Andre I.; NACIF, Lucas; MARTINS, Rodrigo B.; CRUZ JR., Ruy J.; PUGLIESE, Vincenzo; D'ALBUQUERQUE, Luiz A. C.- The Effects of Profound Hypothermia on Pancreas Ischemic Injury A New Experimental Model(2014) ROCHA-SANTOS, Vinicius; FERRO, Oscar Cavalcante; PANTANALI, Carlos Andres; SEIXAS, Marcel Povlovistsch; PECORA, Rafael Antonio Arruda; PINHEIRO, Rafael Soares; CLARO, Laura Carolina Lopez; ABDO, Emilio Elias; CHAIB, Eleazar; D'ALBUQUERQUE, Luiz Augusto CarneiroObjective: Pancreatic ischemia-reperfusion (IR) has a key role in pancreas surgery and transplantation. Most experimental models evaluate the normothermic phase of the IR. We proposed a hypothermic model of pancreas IR to evaluate the benefic effects of the cold ischemic phase. Methods: We performed a reproducible model of hypothermic pancreatic IR. The ischemia was induced in the pancreatic tail portion (1-hour ischemia, 4-hour reperfusion) in 36 Wistar rats. They are divided in 3 groups as follows: group 1 (control), sham; group 2, normothermic IR; and group 3, hypothermic IR. In group 3, the temperature was maintained as close to 4.5-C. After reperfusion, serum amylase and lipase levels, inflammatory mediators (tumor necrosis factor alpha, interleukin 6), and pancreas histology were evaluated. Results: In pancreatic IR groups, amylase, cytokines, and histological damage were significantly increased when compared with group 1. In the group 3, we observed a significant decrease in tumor necrosis factor alpha (P = 0.004) and interleukin 6 (P = 0.001) when compared with group 2. We did not observe significant difference in amylase (P = 0.867), lipase (P = 0.993), and histology (P = 0.201). Conclusions: In our experimental model, we reproduced the cold phase of pancreas IR, and the pancreas hypothermia reduced the inflammatory mediators after reperfusion.
- Trombose de veia porta no transplante hepático(2012) PÉCORA, Rafael Antonio Arruda; CANEDO, Bernardo Fernandes; ANDRAUS, Wellington; MARTINO, Rodrigo Bronze de; SANTOS, Vinicius Rocha; ARANTES, Rubens Macedo; PUGLIESE, Vincenzo; D´ALBUQUERQUE, Luiz Augusto CarneiroBACKGROUND: Portal vein thrombosis was considered a contraindication for liver transplantation in the past because of the high morbidity and mortality rates. Many advances made the results better. AIM: Review the advances and surgical strategies for liver transplantation in presence of portal vein thrombosis. METHOD: Survey of publications in Medline, Scielo and Lilacs databases. Headings crossed: portal vein thrombosis, liver transplantation, vascular complications, jump graft, graft failure, multivisceral transplant. Data analyzed were epidemiology, risk factors, classification, diagnosis, surgical strategies and outcomes. CONCLUSION: Portal vein thrombosis is not a contraindication for liver transplantation anymore. There are many strategies to perform the liver transplantation in this condition, depending on portal vein thrombosis grade. Regardless higher morbidity and re-trhombosis rates, the outcomes of liver transplantation in portal vein thrombosis are similar to series without portal vein thrombosis.
- Increasing Survival Results in High MELD Recipients, What We Learn(2013) DAVID, Andre I.; TREVIZOL, Allison; PECORA, Rafael A. A.; YAMASHITA, Eduardo T.; PINHEIRO, Rafael S. N.; CRUZ JUNIOR, Ruy J.; D'ALBUQUERQUE, Luiz Augusta C.High MELD recipients are very usual cases in development countries, like Brazil, because of donor shortage and few transplant centers, most in Sao Paulo State and few or none in other States. Despite high MELD recipients, extended criteria donors are commonly used in a dangerous combination. Attitudes to improve survival are necessary to keep satisfactory survival results. Casuistic: Were analized 72 cases done in the last 14 months, after some providences to improve results. The most important were: donor selection, multi-professional training at international transplant centers (most in US and Europe), investment in hospital infra-structure and research at LIM 37 (Laboratory of Investigative Medicine). Patients with high MELD where considered when MELD Score was more or equal to 30. Results: The improve in survival curve detached of the Sao Paulo State curve (Figure 1), in a development country with the largest Public Transplant Program of the world, Sao Paulo has the largest Liver Program. Conclusion Providences like high investment in human resources and infra-structure and improve the experience of the transplant (donor/recipient) team as in basic research are keys to keep good results in development countries.