LUANA REGINA BARATELLI CARELLI MENDES
Projetos de Pesquisa
Unidades Organizacionais
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility(2018) EJZENBERG, Dani; ANDRAUS, Wellington; MENDES, Luana Regina Baratelli Carelli; DUCATTI, Liliana; SONG, Alice; TANIGAWA, Ryan; ROCHA-SANTOS, Vinicius; ARANTES, Rubens Macedo; SOARES JR., Jose Maria; SERAFINI, Paulo Cesar; HADDAD, Luciana Bertocco de Paiva; FRANCISCO, Rossana Pulcinelli; D'ALBUQUERQUE, Luiz Augusto Carneiro; BARACAT, Edmund ChadaBackground Uterus transplantation from live donors became a reality to treat infertility following a successful Swedish 2014 series, inspiring uterus transplantation centres and programmes worldwide. However, no case of livebirth via deceased donor uterus has, to our knowledge, been successfully achieved, raising doubts about its feasibility and viability, including whether the womb remains viable after prolonged ischaemia. Methods In September, 2016, a 32-year-old woman with congenital uterine absence (Mayer-Rokitansky-KusterHauser [MRKH] syndrome) underwent uterine transplantation in Hospital das Clinicas, University of Sao Paulo, Brazil, from a donor who died of subarachnoid haemorrhage. The donor was 45 years old and had three previous vaginal deliveries. The recipient had one in-vitro fertilisation cycle 4 months before transplant, which yielded eight cryopreserved blastocysts. Findings The recipient showed satisfactory postoperative recovery and was discharged after 8 days' observation in hospital. Immunosuppression was induced with prednisolone and thymoglobulin and continued via tacrolimus and mycophenalate mofetil (MMF), until 5 months post-transplantation, at which time azathioprine replaced MMF. First menstruation occurred 37 days post-transplantation, and regularly (every 26-32 days) thereafter. Pregnancy occurred after the first single embryo transfer 7 months post-transplantation. No blood flow velocity waveform abnormalities were detected by Doppler ultrasound of uterine arteries, fetal umbilical, or middle cerebral arteries, nor any fetal growth impairments during pregnancy. No rejection episodes occurred after transplantation or during gestation. Caesarean delivery occurred on Dec 15, 2017, near gestational week 36. The female baby weighed 2550 g at birth, appropriate for gestational age, with Apgar scores of 9 at 1 min, 10 at 5 min, and 10 at 10 min, and along with the mother remains healthy and developing normally 7 months post partum. The uterus was removed in the same surgical procedure as the livebirth and immunosuppressive therapy was suspended. Interpretation We describe, to our knowledge, the first case worldwide of livebirth following uterine transplantation from a deceased donor in a patient with MRKH syndrome. The results establish proof-of-concept for treating uterine infertility by transplantation from a deceased donor, opening a path to healthy pregnancy for all women with uterine factor infertility, without need of living donors or live donor surgery.
- Livebirth After Uterus Transplantation From a Deceased Donor in a Recipient With Uterine Infertility(2019) EJZENBERG, Dani; ANDRAUS, Wellington; MENDES, Luana Regina Baratelli Carelli; DUCATTI, Liliana; SONG, Alice; TANIGAWA, Ryan; ROCHA-SANTOS, Vinicius; ARANTES, Rubens Macedo; SOARES JR., Jose Maria; SERAFINI, Paulo Cesar; HADDAD, Luciana Bertocco de Paiva; FRANCISCO, Rossana Pulcinelli; D'ALBUQUERQUE, Luiz Augusto Carneiro; BARACAT, Edmund ChadaInfertility is common and affects about 10% to 15% of couples. In such couples, 1 in 500 women has infertility due to uterine causes, with uterine agenesis (Mayer-Rokitansky-Kuster-Hauser [MRKH] syndrome), or due to hysterectomy, malformation, or the sequelae of infection or surgery. Prior hysterectomy is the most common uterine cause of infertility, whereas MRKH syndrome is relatively uncommon and affects 1 in 4500 women. In the past, the only available option for these women to have a child was adoption or surrogacy, until the first uterine transplantation and successful livebirth was reported in Gothenburg, Sweden, in 2013. To date, only 1 Swedish center and 1 US center have published on livebirths from transplanted uteri, and these previous successful livebirths have been all involved live donors. The use of deceased donors would greatly broaden access to this treatment, but uncertainty regarding the feasible of uterine transplantation from a deceased donor arose after report of an unsuccessful pregnancy and subsequent miscarriage 2 years with use of a uterus from a deceased donor. The authors describe a case of uterine transplantation using a donated uterus from a deceased donor. In September 2016, a 32-year-old woman with congenital uterine absence (MRKH syndrome) underwent uterine transplantation in Hospital das Clinicas, University of Sao Paulo, Brazil, from a donor who died of subarachnoid hemorrhage. The 45-year-old donor had had 3 previous vaginal deliveries. The recipient underwent 1 in vitro fertilization cycle 4 months before transplant, which yielded 8 cryopreserved blastocysts. Based on their literature review, the authors believe this to be the first such successful livebirth following transplant from a deceased donor. The recipient showed satisfactory postoperative recovery and was discharged after 8 days' observation in hospital. Immunosuppression was induced with prednisolone and thymoglobulin and continued via tacrolimus and mycophenalate mofetil, until 5 months posttransplantation, at which time azathioprine replaced mycophenalate mofetil. First menstruation occurred 37 days posttransplantation and regularly (every 26-32 days) thereafter. Pregnancy occurred after the first single embryo transfer 7 months posttransplantation. No blood flow velocity waveform abnormalities were detected by Doppler ultrasound of uterine arteries, fetal umbilical, or middle cerebral arteries, nor any fetal growth impairments during pregnancy. No rejection episodes occurred after transplantation or during gestation. Cesarean delivery occurred onDecember 15, 2017, near gestational week 36. The female newborn weighed 2550 g at birth, appropriate for gestational age, with Apgar scores of 9 at 1 minute, 10 at 5 minutes, and 10 at 10 minutes, and along with the mother remains healthy and developing normally 7 months postpartum. The uterus was removed in the same surgical procedure as the livebirth and immunosuppressive therapy were suspended. The researchers concluded that the results establish proof-of-concept for treating uterine infertility by transplantation froma deceased donor, opening a path to healthy pregnancy for all women with uterine factor infertility, without need of living donors or live donor surgery.
- Sheep Model for Uterine Transplantation: The Best Option Before Starting a Human Program(2017) ANDRAUS, Wellington; EJZENBERG, Dani; SANTOS, Rafael Miyashiro Nunes dos; MENDES, Luana Regina Baratelli Carelli; ARANTES, Rubens Macedo; BARACAT, Edmund Chada; D'ALBUQUERQUE, Luiz Augusto CarneiroOBJECTIVE: This study reports the first four cases of a uterine transplant procedure conducted in sheep in Latin America. The aim of this study was to evaluate the success of uterine transplantation in sheep. METHOD: The study was conducted at Laboratory of Medical Investigation 37 (LIM 37) at the University of Sao Paulo School of Medicine. Four healthy mature ewes weighing 40-60 kg were used as both the donor and recipient for a transplant within the same animal (auto-transplant). Institutional guidelines for the care of experimental animals were followed. RESULTS: The first two cases of auto-transplant were performed to standardize the technique. After complete uterine mobilization and isolation of the blood supply, the unilateral vascular pedicle was sectioned and anastomosed on the external iliac vessels. After standardization, the protocol was implemented. Procurement surgery was performed without complications or bleeding. After isolation of uterine arteries and veins as well as full mobilization of the uterus, ligation of the distal portion of the internal iliac vessels was performed with subsequent division and end-to-side anastomosis of the external iliac vessels. After vaginal anastomosis, the final case presented with arterial thrombosis in the left uterine artery. The left uterine artery anastomosis was re-opened and flushed with saline solution to remove the clot from the artery lumen. Anastomosis was repeated with restoration of blood flow for a few minutes before another uterine artery thrombosis appeared on the same side. All four animals were alive after the surgical procedure and were euthanized after the experimental period. CONCLUSION: We describe the success of four uterine auto-transplants in sheep models.
- Uterine transplantation: a systematic review(2016) EJZENBERG, Dani; MENDES, Luana Regina Baratelli Carelli; HADDAD, Luciana Bertocco de Paiva; BARACAT, Edmund Chada; D'ALBUQUERQUE, Luiz Augusto Carneiro; ANDRAUS, WellingtonUp to 15% of the reproductive population is infertile, and 3 to 5% of these cases are caused by uterine dysfunction. This abnormality generally leads women to consider surrogacy or adoption. Uterine transplantation, although still experimental, may be an option in these cases. This systematic review will outline the recommendations, surgical aspects, immunosuppressive drugs and reproductive aspects related to experimental uterine transplantation in women.
- Predictors of micro-costing components in liver transplantation(2017) HADDAD, Luciana Bertocco de Paiva; DUCATTI, Liliana; MENDES, Luana Regina Baratelli Carelli; ANDRAUS, Wellington; D'ALBUQUERQUE, Luiz Augusto CarneiroOBJECTIVES: Although liver transplantation procedures are common and highly expensive, their cost structure is still poorly understood. This study aimed to develop models of micro-costs among patients undergoing liver transplantation procedures while comparing the role of individual clinical predictors using tree regression models. METHODS: We prospectively collected micro-cost data from patients undergoing liver transplantation in a tertiary academic center. Data collection was conducted using an Intranet registry integrated into the institution's database for the storing of financial and clinical data for transplantation cases. RESULTS: A total of 278 patients were included and accounted for 300 procedures. When evaluating specific costs for the operating room, intensive care unit and ward, we found that in all of the sectors but the ward, human resources were responsible for the highest costs. High cost supplies were important drivers for the operating room, whereas drugs were among the top four drivers for all sectors. When evaluating the predictors of total cost, a MELD score greater than 30 was the most important predictor of high cost, followed by a Donor Risk Index greater than 1.8. CONCLUSION: By focusing on the highest cost drivers and predictors, hospitals can initiate programs to reduce cost while maintaining high quality care standards.
- COST-EFFECTIVENESS OF EVEROLIMUS IN LIVER TRANSPLANTATION(2015) MENDES, L. R.; HADDAD, L.; D'ALBUQUERQUE, L. A.
- Association Between Readmission After Liver Transplant and Adverse Immunosuppressant Reactions: A Prospective Cohort With a 1-Year Follow-up(2017) HADDAD, L.; ANDRADE, K.; MENDES, L.; DUCATTI, L.; D'ALBUQUERQUE, L. A.; ANDRAUS, W.Objective. To measure the association between readmission after liver transplantation and corresponding adverse drug reactions. Methods. A total of 48 patients undergoing liver transplantation were prospectively followed for 1 year. Of these, 23 were readmitted and evaluated by a pharmacist for causes of adverse drug reaction. The detection of adverse drug reactions was based on a combination of clinical interviews and physical and laboratory exams. Adverse reactions were defined in accordance with the Naranjo algorithm. Results. A total of 67.6% of all readmissions were related to adverse drug reactions, with tacrolimus accounting for 80% of the drug reactions. The most common cause of readmission was infection (48.6%), followed by procedure-related reasons (29.7%). Of all patients requiring admission, 39.1% had Model for End-stage Liver Disease (MELD) scores below 21 at the time of transplantation, 17.4% had MELD scores between 21 and 29, and 43.5% had MELD scores above 29. Most (66.7%) of those readmitted more than twice had MELD scores above 29. Conclusion. Adverse drug reactions related to immunosuppressants frequently lead to readmission among liver transplant patients, and in our series tacrolimus was the most frequently associated drug.