FABIO CESAR MIRANDA TORRICELLI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- Urological complications, vesicoureteral reflux, and long-term graft survival rate after pediatric kidney transplantation(2015) TORRICELLI, Fabio C. M.; WATANABE, Andreia; PIOVESAN, Affonso C.; ANTONOPOULOS, Ioannis M.; DAVID-NETO, Elias; NAHAS, William C.To describe a single-center experience with kidney transplantation and then study some donor and recipient features that may impact on graft survival and urological complication rates. We reviewed our database searching for pediatric patients who underwent kidney transplantation from August 1985 through November 2012. Preoperative data and postoperative complications were recorded. Graft survival rates were analyzed and compared based on the type of donor, donor's age from deceased donors, and recipients' ESRD cause. Kaplan-Meier curves with log rank and Wilcoxon tests were used to perform the comparisons. There were 305 pediatric kidney transplants. The mean recipient's age was 11.7 yr. The mean follow-up was 11.0 yr. Arterial and venous thrombosis rates were 1.6% and 2.3%, respectively, while urinary fistula and symptomatic vesicoureteral reflux were diagnosed in 2.9% and 3.6% of cases, respectively. Deceased kidney transplantation had a lower graft survival rate than living kidney transplantation (log rank, p = 0.005). Donor's age (p = 0.420) and ESRD cause (p = 0.679) were not significantly related to graft survival rate. In long-term follow-up, type of donor, but not donor's age, impacts on graft survival rate. ESRD cause has no impact on graft survival rate, showing that well-evaluated recipients may have good outcomes.
conferenceObject PEDIATRIC KIDNEY TRANSPLANTATION: STUDYING DONOR AND RECIPIENT CHARACTERISTICS ON LONG-TERM OUTCOMES(2013) TORRICELLI, Fabio C. M.; MESSI, Gustavo B.; ANTONOPOULOS, Ioannis M.; PIOVESAN, Affonso C.; FALCI JR., Renato; KANASHIRO, Hideki; EBAID, Gustavo X.; SCHVARTSMAN, Benita G. S.; WATANABE, Andreia; VAISBICH, Maria H.; DAVID-NETO, Elias; NAHAS, William C.PURPOSE: To study donor and recipient characteristics on graft and pediatric patient survival rates. METHOD: We retrospectively reviewed 287 electronic charts of patients (under 18 year-old) underwent kidney transplantation from 01/1985 to 10/2012. Outcomes were analyzed based on the type of donor (deceased vs. living kidney donor) and recipient ESRD cause (nephrological vs. urological disease). The outcomes from recipients of deceased donors were also analyzed based on age of donors (< 17 vs. ≥ 18 years). Thereafter, the outcomes from first transplant and retransplant were compared apart. Graft and patient survival rates were compared with Kaplan-Meier curve and analyzed with Log-rank test. RESULTS: There were 309 pediatric kidney transplants in 287 children. 274 were first, 33 were second, and 2 were third grafts. 193 of 274 (67.2%) and 18 of 33 (54.5%) were living kidney transplantation. 62% of deceased donors were under 17 year-old. Regarding ESRD 195 (68%) patients presented with a nephrological cause, while 92 (32%) presented with a urological one. Of those with a urological cause, 28 (30.4%) underwent bladder augmentation. Mean follow-up was 13.7 (0–27) years. Overall, graft survival rate in one, 5 and 10 years of follow-up was 90.1%, 73.2% and 57.9%, while patient survival rate was 96.0%, 91.9% and 87.2%, respectively. There was a tendency of a higher graft survival rate in children with living kidney donors (p=0.058). There was no difference in the outcomes from first and second transplant, except by a higher immunological graft loss in retransplant group (p=0.032). There was also no difference in the graft survival rates regarding age of donor (p=0.630) and recipient ESRD cause (p=0.890). CONCLUSION: Long-term outcomes from pediatric kidney transplantation are not related to age of donor and recipient ESRD cause, since the urogenital abnormality has been corrected. Living kidney transplantation seems to present a higher graft survival rate.- Current outcome of prioritized patients for kidney transplantation(2012) KANASHIRO, Hideki; TORRICELLI, Fabio Cesar Miranda; FALCI JUNIOR, Renato; PIOVISAN, Affonso Celso; ANTONOPOULOS, Ioannis Michel; NAHAS, William CarlosPurpose: To analyze the outcome of deceased donor recipients given priority in allocation due to lack of access for dialysis and compare this data to the one obtained from non-prioritized deceased donor kidney transplant recipients. Materials and Methods: we reviewed electronic charts of 31 patients submitted to kidney transplantation that were given priority in transplantation program due to lack of access for dialysis from January 2005 to December 2008. Immunological and surgical complications rates, and grafts and patients survival rates were analyzed. These data were compared to those obtained from 100 regular patients who underwent kidney transplantation without allocation priority during the same period. Results: Overall surgical complication rate was 25.8% and 27% in the patients with priority in allocation and in the non-prioritized patients, respectively. There was no statistical significant difference for surgical complications (p = 1.0), immunological complications (p = 0.21) and graft survival (p = 0.19) rates between the groups. However, patient survival rate was statistically significant worse in prioritized patients (p = 0.05). Conclusions: patients given priority in allocation owing to lack of access for dialysis have higher mortality rate when compared to those non-prioritized.
- Caliceal-cutaneous Fistula After Kidney Transplantation(2012) TORRICELLI, Fabio Cesar Miranda; PIOVESAN, Affonso Celso; ANTONOPOULOS, Ioannis Michel; FALCI JR., Renato; SAITO, Fernando Jose Akira; KANASHIRO, Hideki; EBAID, Gustavo Xavier; NAHAS, William CarlosUrinary fistula is a one of the most common complications after kidney transplantation. Conservative treatment with stent and Foley catheter drainage may be tried, however in some cases more invasive approach is needed. Caliceal fistula is a rare condition and the diagnosis may be missed. Here we present an interesting case of caliceal-cutaneous fistula diagnosed by computed tomography after living kidney transplantation. After failure of conservative management, the patient was successfully treated with partial nephrectomy. UROLOGY 79: e71, 2012. (C) 2012 Elsevier Inc.
- Single Center Experience With Elective Surgical Patients as Living Kidney Donors(2012) FALCI JR., R.; TORRICELLI, F. C.; ANTONOPOULOS, I. M.; PIOVESAN, A. C.; KANASHIRO, H.; SAITO, F.; EBAID, G. X.; NAHAS, W. C.Purpose. To report a single center experience with elective surgical patients as living kidney donors. Methods. We retrospectively analyzed a prospective database of 458 living kidney donors from September 2005 to May 2011. Fifteen (3.2%) of them were elective surgical patients simultaneously undergoing living donor nephrectomy. We reviewed age, gender, operative time, intraoperative blood transfusion, intra- and postoperative complications, as well as length of hospital stay. Recipients were evaluated for delayed graft function. Four hundred forty-three patients undergoing living donor nephrectomy alone composed the control group. Results. Among the elective surgical patients group, the mean (range) operative time was 155 (90 to 310) minutes and mean (range) length of hospital stay was 3 (2 to 9) days. One (6.7%) recipient displayed delayed graft function. Among the regular living kidney donors group, the mean (range) operative time was 100 (70 to 150) minutes, mean (range) length of hospital stay was 3 (2 to 5) days, and delayed graft function was observed in 5.6% of recipients. Only operative time (P = .03) was significantly different between the groups. Conclusions. Elective surgical patients are potential donors who may be treated at the same time as the living donor nephrectomy.
- Urologic issues in pediatric transplant recipients(2019) TORRICELLI, Fabio C. M.; WATANABE, Andrea; PIOVESAN, Affonso C.; DAVID-NETO, Elias; NAHAS, William C.The limited supply of kidneys for pediatric transplantation leads to a large number of children in waiting transplant list. These patients have to be properly evaluated and prepared before organ transplantation to increase its success. The aim of this review is focus on urologic issues of pediatric kidney transplants such as preoperative evaluation and urinary tract abnormalities correction, surgical technique, and postoperative complications. All children that are candidates for kidney transplantation should be submitted to abdominal ultrasound. If bladder dysfunction is suspected, a more detailed evaluation is mandatory, including a voiding cystourethrography and urodynamic study. Patients with a poor bladder capacity and compliance will require bladder augmentation. Whenever possible the native ureter is recommended for that. Regarding kidney transplantation, recipient surgery can be safely performed through an extraperitoneal access, even in children weighting less than 10 kilograms. It allows adequate access to iliac vessels, aorta and vena cava. Graft survival continued to improve over the past decade and it is around 80% in 5 years. Postoperative complications such as urinary fistula may occur in less than 5% of cases, while vascular complications are reported in 1% to 2% of cases.
- Histologic Inflammatory Changes on the Prostatic Gland Due to Immunosuppression for Kidney Transplantation(2012) PIOVESAN, Affonso Celso; TORRICELLI, Fabio Cesar Miranda; ANTONOPOULOS, Ioannis Michel; FALCI JUNIOR, Renato; KANASHIRO, Hideki; NAHAS, William CarlosOBJECTIVE To determine the incidence of type IV prostatitis in patients with kidney transplantation receiving an immunosuppression regimen and to compare it with that of a nonimmunosuppressed control group. METHODS We retrospectively reviewed 216 electronic charts of patients who had undergone surgical treatment for benign prostatic hyperplasia from August 2000 to January 2006. Of the 216 patients, 183 did not receive immunosuppressive therapy and were included in the control group (group 1). The other 33 patients had undergone kidney transplantation and were included in the study group (group 2). The patient data were accessed for age at surgery, International Prostate Symptom Score, prostate volume, preoperative serum prostate-specific antigen level, history of acute urinary retention, and surgical approach (open vs transurethral resection of prostate). Histologic findings from the surgical specimens were also recorded. RESULTS The mean age at surgery, mean serum prostate-specific antigen level, mean prostate volume, and mean International Prostate Symptom Score were not significantly different between both groups. However, histologic evidence of chronic prostatitis was obtained in 145 surgical specimens (78%) from group 1 and in just 3 specimens from group 2 (9%; P < .001). Moreover, nonimmunosuppressed patients had a 38.2 times greater risk of presenting with prostatitis than did the immunosuppressed patients. CONCLUSION Imunnosuppresion therapy in kidney transplantation has a protective factor in the prostatitis incidence. UROLOGY 79: 662-664, 2012. (C) 2012 Elsevier Inc.