DEBORA RAQUEL BENEDITA TERRABUIO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
12 resultados
Resultados de Busca
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- Pre-transplant multidrug-resistant infections in liver transplant recipients-epidemiology and impact on transplantation outcome(2024) LEMOS, Gabriela T.; TERRABUIO, Debora R. B.; NUNES, Nathalia N.; SONG, Alice T. W.; OSHIRO, Isabel C. V.; D'ALBUQUERQUE, Luiz Augusto C.; LEVIN, Anna S.; ABDALA, Edson; FREIRE, Maristela P.Background Cirrhotic patients are highly exposed to healthcare services and antibiotics. Although pre-liver transplantation (LT) infections are directly related to the worsening of liver function, the impact of these infections on LT outcomes is still unclear. This study aimed to identify the effect of multidrug-resistant microorganism (MDRO) infections before LT on survival after LT.Methods Retrospective study that included patients who underwent LT between 2010 and 2019. Variables analyzed were related to patients' comorbidities, underlying diseases, time on the waiting list, antibiotic use, LT surgery, and occurrences post-LT. Multivariate analyses were performed using logistic regression, and Cox regression for survival analysis.Results A total of 865 patients were included; 351 infections were identified in 259 (30%) patients, of whom 75 (29%) had >= 1 pre-LT MDRO infection. The most common infection was spontaneous bacterial peritonitis (34%). The agent was identified in 249(71%), 53(15%) were polymicrobial. The most common microorganism was Klebsiella pneumoniae (18%); the most common MDRO was ESBL-producing Enterobacterales (16%), and carbapenem-resistant (CR) Enterobacterales (10%). Factors associated with MDRO infections before LT were previous use of therapeutic cephalosporin (p = .001) and fluoroquinolone (p = .001), SBP prophylaxis (p = .03), ACLF before LT (p = .03), and days of hospital stay pre-LT (p < .001); HCC diagnosis was protective (p = .01). Factors associated with 90-day mortality after LT were higher MELD on inclusion to the waiting list (p = .02), pre-LT MDRO infection (p = .04), dialysis after LT (p < .001), prolonged duration of LT surgery (p < .001), post-LT CR-Gram-negative bacteria infection (p < .001), and early retransplantation (p = .004).Conclusion MDRO infections before LT have an important impact on survival after LT.
- Evolution of Biomarkers of Atherogenic Risk in Liver Transplantation Recipients(2018) LINHARES, L. M. C.; OLIVEIRA, C. P.; ALVARES-DA-SILVA, M. R.; STEFANO, J. T.; BARBEIRO, H. V.; BARBEIRO, D. F.; TERRABUIO, D. R. B.; ABDALA, E.; SORIANO, F. G.; CARRILHO, F. J.; FARIAS, A. Q.; SIDDIQUI, M. S.; D'ALBUQUERQUE, L. A. C.Background. Cardiovascular disease is a major contributing factor to long-term mortality after liver transplantation (LT). Methods. This study evaluated the evolution of atherogenic risk in liver transplant recipients (LTRs). Thirty-six subjects were prospectively enrolled at 12 months and followed for 48 months after liver transplantation. Serum biomarkers of endothelial dysfunction (sICAM-1 and sVCAM-1), chronic inflammation (serum amyloid A), and oxidative stress (myeloperoxidase) were measured at 12 and 48 months after LT. Additionally, at 12 months all patients underwent a cardiac computed tomography (CT) scan and a coronary artery calcium score (CACS). Results. The prevalence of risk factors of metabolic syndrome (MS) increased over the course of the study. The patients' sVCAM-1 and sICAM-1 increased from 1.82 +/- 0.44 ng/mL to 9.10 +/- 5.82 ng/mL (P < .001) and 0.23 +/- 0.09 ng/mL to 2.7 +/- 3.3 ng/mL, respectively from month 12 to 48. Serum myeloperoxidase increased from 0.09 +/- 0.07 ng/mL to 3.46 +/- 3.92 ng/mL (P < .001) over the course of the study. Serum amyloid A also increased from 21.4 +/- 40.7 ng/mL at entry to 91.5 +/- 143.6 ng/mL at end of study (P < .001). Conclusion. No association between these biomarkers and MS was noted. The cardiac CT revealed mild and moderate disease in 19% and 25% of the cohort, respectively. No association between serum biomarkers and CACS was noted. Serum biomarkers of atherogenic risk increase rapidly in LTRs and precede coronary plaques.
- Prediction models for carbapenem-resistant Enterobacterales carriage at liver transplantation: A multicenter retrospective study(2022) FREIRE, Maristela Pinheiro; RINALDI, Matteo; TERRABUIO, Debora Raquel Benedita; FURTADO, Mariane; PASQUINI, Zeno; BARTOLETTI, Michele; OLIVEIRA, Tiago Almeida de; NUNES, Nathalia Neves; LEMOS, Gabriela Takeshigue; MACCARO, Angelo; SINISCALCHI, Antonio; LAICI, Cristiana; CESCON, Matteo; DT'ALBUQUERQUE, Luiz Augusto Carneiro; MORELLI, Maria Cristina; SONG, Alice T. W.; ABDALA, Edson; VIALE, Pierluigi; CHIAVEGATTO FILHO, Alexandre Dias Porto; GIANNELLA, MaddalenaBackground: Carbapenem-resistant Enterobacterales (CRE) colonisation at liver transplantation (LT) increases the risk of CRE infection after LT, which impacts on recipients' survival. Colonization status usually becomes evident only near LT. Thus, predictive models can be useful to guide antibiotic prophylaxis in endemic centres. Aims: This study aimed to identify risk factors for CRE colonisation at LT in order to build a predictive model. Methods: Retrospective multicentre study including consecutive adult patients who underwent LT, from 2010 to 2019, at two large teaching hospitals. We excluded patients who had CRE infections within 90 days before LT. CRE screening was performed in all patients on the day of LT. Exposure variables were considered within 90 days before LT and included cirrhosis complications, underlying disease, time on the waiting list, MELD and CLIF-SOFA scores, antibiotic use, intensive care unit and hospital stay, and infections. A machine learning model was trained to detect the probability of a patient being colonized with CRE at LT. Results: A total of 1544 patients were analyzed, 116 (7.5%) patients were colonized by CRE at LT. The median time from CRE isolation to LT was 5 days. Use of antibiotics, hepato-renal syndrome, worst CLIF sofa score, and use of beta-lactam/beta-lactamase inhibitor increased the probability of a patient having pre-LT CRE. The proposed algorithm had a sensitivity of 66% and a specificity of 83% with a negative predictive value of 97%. Conclusions: We created a model able to predict CRE colonization at LT based on easyto-obtain features that could guide antibiotic prophylaxis
- Coronavirus Disease 2019 in the Early Postoperative Period of Liver Transplantation: Is the Outcome Really So Positive?(2021) WAISBERG, Daniel Reis; ABDALA, Edson; NACIF, Lucas Souto; DUCATTI, Liliana; HADDAD, Luciana Bertocco; MARTINO, Rodrigo Bronze; PINHEIRO, Rafael Soares; ARANTES, Rubens Macedo; GALVAO, Flavio Henrique; GOUVEIA, Larissa Nunes; TERRABUIO, Debora Raquel; DARCE, George Felipe; ROCHA-SANTOS, Vinicius; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto
conferenceObject Cardiovascular risk and coronary artery calcium score after liver transplantation: study at fouth year(2017) LINHARES, L. M.; OLIVEIRA, C. P.; ALVARES-DA-SILVA, M. R.; STEFANO, J. T.; GEBRIM, E. M.; BARBEIRO, H. V.; BARBEIRO, D. F.; TERRABUIO, D. R.; ABDALA, E.; SORIANO, F. G.; CARRILHO, F. J.; FARIAS, A. Q.; AUGUSTO, L.; ALBUQUERQUE, C. D'- Insights in the approach of long-term liver transplant recipients with COVID-19(2021) TERRABUIO, Debora Raquel Benedita; HADDAD, Luciana; DUCATTI, Liliana; GOUVEIA, Larissa Nunes; ROCHA-SANTOS, Vinicius; FERREIRA, Renee Mignolo Tanaka; DARCE, George Felipe; CARDOSO, Ana Julia Andrade; CARRILHO, Flair Jose; ANDRAUS, Wellington; ABDALA, Edson; D'ALBUQUERQUE, Luiz Augusto Carneiro
- Hepatic Artery Thrombosis in Liver Transplantation in Adult Recipients Using Pediatric Deceased Donors(2020) FORTUNATO, Allana C.; PINHEIRO, Rafael S.; NACIF, Lucas S.; WAISBERG, Daniel R.; DUCATTI, Liliana; ROCHA-SANTOS, Vinicius; GALVAO, Flavio H. F.; HADDAD, Luciana B. P.; ABDALA, Edson; SONG, Alice T. W.; TERRABUIO, Debora R. B.; BEZERRA, Regis O. F.; MACEDO, Rubens A.; MARTINO, Rodrigo B.; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, Luiz A.
conferenceObject Evidence of Hepatitis E Virus Infection in Liver Transplant Recipients from Brazil(2013) GOMES-GOUVEA, Michele S.; FERREIRA, Ariana C.; FEITOZA, Bruna; PESSOA, Mario G.; ABDALA, Edson; TERRABUIO, Deborah R.; MORAES, Adriano C.; BONAZZI, Patricia R.; D'ALBUQUERQUE, Luiz C.; CARRILHO, Flair J.; PINHO, Joao R.- The impact of hepatitis E infection on hepatic fibrosis in liver transplanted patients for hepatitis C infection(2021) MORAES, Adriano Claudio Pereira de; GOUVEA, Michele Gomes; FERREIRA, Ariana Carolina; PINHO, Joao Renato Rebello; MELLO, Evandro Sobroza de; D'ALBUQUERQUE, Luiz Augusto Carneiro; TERRABUIO, Debora; ABDALA, Edson; CARRILHO, Flair Jose; PESSOA, Mario GuimaraesHepatitis E Virus (HEV) is an infection known worldwide for its asymptomatic and self-limited course in most cases. Some cases progressing to chronicity have been described in immunosuppressed patients, especially in recipients of solid organ transplants. We evaluated laboratory parameters of HEV infection (HEV RNA, anti-HEV IgM and anti-HEV IgG) through enzyme-linked immunosorbent assay (Elisa), confirmed by immunoblotting, in a cohort of 294 patients who received liver transplants at the HCFMUSP (Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo). Laboratory and demographic data were collected from the entirety of the transplanted population. Hepatic biopsies of 122 patients transplanted due liver failure secondary to hepatitis C (HCV), with or without serological or molecular markers of HEV, were analyzed according to METAVIR score. Out of 24 (8.2%) patients tested positive for anti-HEV IgG, six (2%) were positive for anti-HEV IgM and 17 (5.8%) for HEV RNA. Of the patients transplanted because of HCV infection, 95 (77.8%) had received treatment including ribavirin for at least six months before blood sample collection. Among patients transplanted due to HCV cirrhosis who tested positive for anti-HEV IgG, only three (37.5%) showed fibrosis beyond stage 2, while five (41.7%) of the HEV RNA-positive patients had liver fibrosis beyond stage 2. Overall, the prevalence of HEV in the post-hepatic transplant scenario appears to be low, and, at least histologically, seemingly not harmful. We conclude that, although some studies reported a risk of HEV chronification, patients who had their livers transplanted due to HCV and showed serological or molecular markers of HEV did not have higher levels of fibrosis compared to patients who showed no indications of HEV infection at the time of the analysis. (C) 2021 Sociedade Brasileira de Infectologia.
conferenceObject CORONARY ARTERY CALCIUM SCORE AND FRAMINGHAM SCORE IN EVALUATION OF CARDIOVASCULAR RISK AFTER LIVER TRANSPLANTATION(2016) CARONE, L.; OLIVEIRA, C. P.; ALVARES-DA-SILVA, M. R.; STEFANO, J. T.; TERRABUIO, D. R. B.; ABDALA, E.; CARRILHO, F. J.; FARIAS, A. Q.; D'ALBUQUERQUE, L. A. C.