LUIZ AUGUSTO CARNEIRO D ALBUQUERQUE
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina - Líder
7 resultados
Resultados de Busca
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conferenceObject Is Steroid (Almost) Free Immunosuppression a Safe Approach in Adult Liver Transplantation? Long-Term Outcome of a Prospective Double Blind, Placebo-Controlled Randomized Investigator Driven Study.(2013) PINHEIRO, Rafael S.; LAI, Quirino; JURI, Juan M. R.; SANTA, Edward C.; CICCARELLI, Olga; D'ALBUQUERQUE, Luiz A. C.; LERUT, Jan- Abdominal wall hernia in cirrhotic patients: emergency surgery results in higher morbidity and mortality(2015) ANDRAUS, Wellington; PINHEIRO, Rafael Soares; LAI, Quirino; HADDAD, Luciana B. P.; NACIF, Lucas S.; D'ALBUQUERQUE, Luiz Augusto C.; LERUT, JanBackground: Patients with cirrhosis have a high incidence of abdominal wall hernias and carry an elevated perioperative morbidity and mortality. The optimal surgical management strategy as well as timing of abdominal hernia repair remains controversial. Methods: A cohort study of 67 cirrhotic patients who underwent hernia repair during the period of January 1998-December 2009 at the University Hospital of Sao Paulo were included. After meeting study criteria, a total of 56 patients who underwent 61 surgeries were included in the final analysis. Patient characteristics, morbidity (Clavien score), mortality, Child-Turcotte-Pugh score, MELD score, use of prosthetic material, and elective or emergency surgery have been analysed with regards to morbidity and 30-day mortality. Results: The median MELD score of the patient population was 14 (range: 6 to 24). Emergency surgery was performed in 34 patients because of ruptured hernia (n = 13), incarceration (n = 10), strangulation (n = 4), and skin necrosis or ulceration (n = 7). Elective surgery was performed in 27 cases. After a multivariable analysis, emergency surgery (OR 7.31; p 0.017) and Child-Pugh C (OR 4.54; p 0.037) were risk factors for major complications. Moreover, emergency surgery was a unique independent risk factor for 30-day mortality (OR 10.83; p 0.028). Conclusions: Higher morbidity and mortality are associated with emergency surgery in advanced cirrhotic patients. Therefore, using cirrhosis as a contraindication for hernia repair in all patients may be reconsidered in the future, especially after controlling ascites and in those patients with hernias that are becoming symptomatic or show signs of possible skin necrosis and rupture. Future prospective randomized studies are needed to confirm this surgical strategy.
- Abdominal hernias in cirrhotic patients: Surgery or conservative treatment? Results of a prospective cohort study in a high volume center: Cohort study(2020) PINHEIRO, Rafael Soares; ANDRAUS, Wellington; WAISBERG, Daniel Reis; NACIF, Lucas Souto; DUCATTI, Liliana; ROCHA-SANTOS, Vinicius; DINIZ, Marcio A.; ARANTES, Rubens Macedo; LERUT, Jan; D'ALBUQUERQUE, Luiz Augusto CarneiroBackground: Surgical treatment of abdominal hernias in cirrhotics is often delayed due to the higher morbidity and mortality associated with the underlying liver disease. Some patients are followed conservatively and only operated on when complications occur (""wait and see"" approach). The aim of this study is to compare outcomes of cirrhotic patients undergoing conservative non-operative care or elective hernia repair. Methods: A prospective observational study including 246 cirrhotic patients with abdominal hernia was carried out. Patients were given the option to select their treatment: elective hernia repair or conservative non-operative care. Demographics, characteristics of underlying liver disease, type of hernia, complications and mortality were analyzed. During follow-up of patients who opted for the ""wait and see"" approach, emergency hernia repair was performed in case of hernia complications. Results: Elective hernia repair was performed in 57 patients and 189 patients were kept in conservative care, of which 43 (22.7%) developed complications that required emergency hernia repair. Elective surgery provided better five-years survival than conservative care (80% vs. 62%; p = 0.012). Multivariate analysis identified multiples hernias [Hazards Ratio (HR):6.7, p < 0.001] and clinical follow-up group (HR 3.62, p = 0.005) as risk factors for mortality. Among patients undergoing surgical treatment, multivariate analysis revealed MELD> 11 (HR 7.8; p = 0.011) and emergency hernia repair (HR 5.35; p = 0.005) as independent risk factors for 30-day mortality. Conclusions: Elective hernia repair offers an acceptable morbidity and ensures longer survival. ""Wait and see"" approach jeopardizes cirrhotic patients and should be avoided, given the higher incidence of emergency surgery due to hernia complications.
- Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia(2020) PEREZ-NADALES, Elena; GUTIERREZ-GUTIERREZ, Belen; NATERA, Alejandra M.; ABDALA, Edson; MAGALHAES, Maira Reina; MULARONI, Alessandra; MONACO, Francesco; PIERROTTI, Ligia Camera; FREIRE, Maristela Pinheiro; IYER, Ranganathan N.; STEINKE, Seema Mehta; CALVI, Elisa Grazia; TUMBARELLO, Mario; FALCONE, Marco; FERNANDEZ-RUIZ, Mario; COSTA-MATEO, Jose Maria; RANA, Meenakshi M.; STRABELLI, Tania Mara Varejao; PAUL, Mical; FARINAS, Maria Carmen; CLEMENTE, Wanessa Trindade; ROILIDES, Emmanuel; MUNOZ, Patricia; DEWISPELAERE, Laurent; LOECHES, Belen; LOWMAN, Warren; TAN, Ban Hock; ESCUDERO-SANCHEZ, Rosa; BODRO, Marta; GROSSI, Paolo Antonio; SOLDANI, Fabio; GUNSEREN, Filiz; NESTOROVA, Nina; PASCUAL, Alvaro; MARTINEZ-MARTINEZ, Luis; AGUADO, Jose Maria; RODRIGUEZ-BANO, Jesus; TORRE-CISNEROS, Julian; SONG, A. T. Wan; ANDRAUS, W.; D'ALBUQUERQUE, L. A. Carneiro; DAVID-NETO, E.; PAULA, F. Jota de; ROSSI, F.; OSTRANDER, D.; AVERY, R.; RIZZI, M.; LOSITO, A. R.; RAFFAELLI, F.; GIACOMO, P. Del; TISEO, G.; LORA-TAMAYO, J.; SAN-JUAN, R.; GRACIA-AHUFINGER, I; CASTON, J.; RUIZ, Y. A.; ALTMAN, D. R.; V, S. Campos; BAR-SINAI, N.; KOPPEL, F.; ALMAJANO, F. Arnaiz de las Revillas; RICO, C. Gonzalez; MARTINEZ, M. Fernandez; MOURAO, P. H. O.; NEVES, F. A.; FERREIRA, J.; PYRPASOPOULOU, A.; IOSIFIDIS, E.; ROMIOPOULOS, I; V, M. Minero; SANCHEZ-CARRILLO, C.; LARDO, S.; COUSSEMENT, J.; DODEMONT, M.; JIAYUN, K.; MARTIN-DAVILA, P.; FORTUN, J.; ALMELA, M.; MORENO, A.; LINARES, L.; GASPERINA, D. D.; BALSAMO, M. L.; ROVELLI, C.; CONCIA, E.; CHIESI, S.; SALERNO, D. N.; OGUNC, D.; PILMIS, B.; SEMINARI, E. M.; CARRATALA, J.; DOMINGUEZ, A.; CORDERO, E.; LEPE, J. A.; MONTEJO, M.; LUCAS, E. Merino de; ERIKSSON, B. M.; DELDEN, C. van; MANUEL, O.; ARSLAN, H.; TUFAN, Z. Kocak; KAZAK, E.; DAVID, M.; LEASE, E.; CORNAGLIA, G.; AKOVA, M.Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score >= 8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score >= 8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.
- Place of Liver Transplantation in the Treatment of Hepatocellular Carcinoma in the Normal Liver(2011) LERUT, Jan; MERGENTAL, Hynek; KAHN, Delawir; ALBUQUERQUE, Luiz; MARRERO, Juan; VAUTHEY, Jean Nicolas; PORTE, Robert J.
- Conditioning With Sevoflurane in Liver Transplantation: Results of a Multicenter Randomized Controlled Trial(2015) BECK-SCHIMMER, Beatrice; BONVINI, John M.; SCHADDE, Erik; DUTKOWSKI, Philipp; OBERKOFLER, Christian E.; LESURTEL, Mickael; DEOLIVEIRA, Michelle L.; FIGUEIRA, Estela R. R.; ROCHA FILHO, Joel A.; AULER JR., Jose Otavio Costa; D'ALBUQUERQUE, Luiz A. C.; REYNTJENS, Koen; WOUTERS, Patrick; ROGIERS, Xavier; DEBAERDEMAEKER, Luc; GANTER, Michael T.; WEBER, Achim; PUHAN, Milo A.; CLAVIEN, Pierre-Alain; BREITENSTEIN, StefanBackground. During times of organ scarcity and extended use of liver grafts, protective strategies in transplantation are gaining importance. We demonstrated in the past that volatile anesthetics such as sevoflurane attenuate ischemia-reperfusion injury during liver resection. In this randomized study, we examined if volatile anesthetics have an effect on acute graft injury and clinical outcomes after liver transplantation. Methods. Cadaveric liver transplant recipients were enrolled from January 2009 to September 2012 at 3 University Centers (Zurich/Sao Paulo/Ghent). Recipients were randomly assigned to propofol (control group) or sevoflurane anesthesia. Postoperative peak of aspartate transaminase was defined as primary endpoint, secondary endpoints were early allograft dysfunction, in-hospital complications, intensive care unit, and hospital stay. Results. Ninety-eight recipients were randomized to propofol (n = 48) or sevoflurane (n = 50). Median peak aspartate transaminase after transplantation was 925 (interquartile range, 512-3274) in the propofol and 1097 (interquartile range, 540-2633) in the sevoflurane group. In the propofol arm, 11 patients (23%) experienced early allograft dysfunction, 7 (14%) in the sevoflurane one (odds ratio, 0.64 (0.20 to 2.02, P = 0.45). There were 4 mortalities (8.3%) in the propofol and 2 (4.0%) in the sevoflurane group. Overall and major complication rates were not different. An effect on clinical outcomes was observed favoring the sevoflurane group (less severe complications), but without significance. Conclusions. This first multicenter trial comparing propofol with sevoflurane anesthesia in liver transplantation shows no difference in biochemical markers of acute organ injury and clinical outcomes between the 2 regimens. Sevoflurane has no significant added beneficial effect on ischemia-reperfusion injury compared to propofol.
- A POSSIBLE COMPLICATION AFTER LIVER TRANSPLANTATION IN A GASTRIC BYPASS BARIATRIC PATIENT: DON'T FORGET THE EXCLUDED STOMACH! CASE REPORT AND REVIEW OF THE LITERATURE(2020) PERDUCA, Pietro; WAISBERG, Daniel Reis; PINHEIRO, Rafael Soares Nunes; HOURNEAUX-DE-MOURA, Eduardo Guimaraes; D'ALBUQUERQUE, Luiz Augusto Carneiro; ANDRAUS, Wellington