RAFAEL SOARES NUNES PINHEIRO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Acute-on-chronic liver failure (ALCF) and liver transplantation(2018) NACIF, L.; AQUINO, F.; TANIGAWA, R.; ANDRAUS, W.; HADDAD, L.; PINHEIRO, R.; MARTINO, R.; ROCHA-SANTOS, V.; FARIAS, A.; D'ALBUQUERQUE, L. Carneiro; ALVES, V.- Translational medical research and liver transplantation: systematic review(2018) NACIF, Lucas Souto; KIM, Vera; GALVAO, Flavio; ONO, Suzane Kioko; PINHEIRO, Rafael Soares; CARRILHO, Flair Jose; D'ALBUQUERQUE, Luiz CarneiroTranslational medicine has become a priority, but there is still a big difference between the arrival of new treatments and investment. Basic science should not be neglected because the translation from basic research is not sustained in the absence of basic research. The purpose of this literature review was to analyze the translational medicine in the liver transplant field: liver ischemia-reperfusion injury (IRI), immunosuppression, clinical and surgical complications, small-for-size syndrome (SFSS), rejection, and ongoing innovations (liver machine, liver preservation, artificial livers, and regenerative medicine). We performed a systematic literature review that were updated in October 2016. The searches were performed in the Cochrane Central Register of Controlled Trials and Review, PubMed/Medline, Embase, and LILACS databases. All the selected studies on the management of translational medical research in liver transplantation (LT) were analyzed. Initially the search found 773 articles. Methodological viewing and analysis of the articles, followed by the application of scientific models, including translational medicine in the liver transplant field. In conclusions, this review demonstrates the application of scientific research with translation medical benefits regarding the LT. The literature has a great tendency, improvements and investments in the study of translational medicine in LT. Innovative studies and technologies from basic science help to clarify clinical doubts. Moreover, evidence increases the importance of scientific research in quality of clinical practice care.
- Imatinib-induced fulminant liver failure in chronic myeloid leukemia: Role of liver transplant and second-generation tyrosine kinase inhibitors: A case report(2018) NACIF, L. S.; WAISBERG, D. R.; PINHEIRO, R. S.; LIMA, F. R.; ROCHA-SANTOS, V.; ANDRAUS, W.; D'ALBUQUERQUE, L. C.Background: There is a worldwide problem of acute liver failure and mortality associated with remaining on the waiting for a liver transplant. In this study, we highlight results published in recent years by leading transplant centers in evaluating imatinib-induced acute liver failure in chronic myeloid leukemia and follow-up in liver transplantation. Case presentation: A 36-year-old brown-skinned woman (mixed Brazilian race) diagnosed 1 year earlier with chronic myeloid leukemia was started after delivery of a baby and continued for 6 months with imatinib mesylate (selective inhibitor of Bcr-Abl tyrosine kinase), which induced liver failure. We conducted a literature review using the PubMed database for articles published through September 2017, and we demonstrate a role of liver transplant in this situation for imatinib-induced liver failure. We report previously published results and a successful liver transplant after acute liver failure due to imatinib-induced in chronic myeloid leukemia treatment. Conclusions: We report a case of a successful liver transplant after acute liver failure resulting from imatinib-induced chronic myeloid leukemia treatment. The literature reveals the importance of prompt acute liver failure diagnosis and treatment with liver transplant in selected cases. © 2018 The Author(s).
- Access to Liver Transplantation in Different ABO-Blood Groups and ""Exceptions Points"" in a Model for End-Stage Liver Disease Allocation System: A Brazilian Single-Center Study(2018) MARTINO, R. B.; WAISBERG, D. R.; DIAS, A. P. M.; INOUE, V. B. S.; ARANTES, R. M.; HADDAD, L. B. P.; ROCHA-SANTOS, V.; PINHEIRO, R. S. N.; NACIF, L. S.; D'ALBUQUERQUE, L. A. C.Background. In the Model for End-Stage Liver Disease (MELD) system, patients with ""MELD exceptions"" points may have unfair privilege in the competition for liver grafts. Furthermore, organ distribution following identical ABO blood types may also result in unjust organ allocation. The aim of this study was to investigate access to liver transplantation in a tertiary Brazilian center, regarding ""MELD exceptions"" situations and among ABO-blood groups. Methods. A total of 465 adult patients on the liver waitlist from August 2015 to August 2016 were followed up until August 2017. Patients were divided into groups according to ABO-blood type and presence of ""exceptions points."" Results. No differences in outcomes were observed among ABO-blood groups. However, patients from B and AB blood types spent less time on the list than patients from A and O groups (median, 46, 176, 415, and 401 days, respectively; P=.03). ""Exceptions points"" were granted for 141 patients (30.1%), hepatocellular carcinoma being the most common reason (52.4%). Patients with ""exceptions points"" showed higher transplantation rate, lower mortality on the list, and lower delta-MELD than non-exceptions patients (56.7% vs 19.1% [P<.01]; 18.4% vs 38.5% [P<.01], and 2.0 +/- 2.6 vs 6.9 +/- 7.0 [P<.01], respectively). Patients with refractory ascites had a higher mortality rate than those with other ""exceptions"" or without (48%). Conclusions. The MELD system provides equal access to liver transplantation among ABO-blood types, despite shorter time on the waitlist for AB and B groups. The current MELD exception system provides advantages for candidates with ""exception points,"" resulting in superior outcomes compared with those without exceptions.
- Better Selection Criteria With Prognostic Factors for Liver Transplantation(2018) NACIF, L. S.; PINHEIRO, R. S.; ROCHA-SANTOS, V.; BARBOSA, V. M.; DIAS, A. P. de Moura; MARTINO, R. B.; MACEDO, R. A.; DUCATTI, L.; HADDAD, L.; GALVAO, F.; ANDRAUS, W.; D'ALBUQUERQUE, L. CarneiroBackground. Liver transplantation has evolved significantly in recent years, with each advancement part of the effort toward increasing patient and graft survival as well as quality of life. The objective of this study was to evaluate the prognostic factors and selection criteria for liver transplantation. Methods. Our study was a statistical analysis, logistic regression, and survival evaluation of a total of 80 liver transplants that were performed between June 1, 2016 and September 24, 2016. Recipient factors evaluated included age, retransplantation, hemodialysis, cardiac risk, portal vein thrombosis, hospitalization, fulminant hepatitis, previous surgery, renal failure, and Model for End-stage Liver Disease (MELD) score. Donor factors included age, cardiac arrest, acidosis, days in the intensive care unit, steatosis, and vasoactive drug use. Results. Of the 80 patients transplanted, 65 deceased donor liver transplants (DDLTs) and 15 living donor liver transplants (LDLTs) were performed. LDLT overall 1-year patient survival was 77.5% and graft survival 75%, and DDLT overall patient survival was 89.23% and graft survival was 86.15%. On evaluated score criteria analyzed we observed a significant score on recipient (P=.01) and not significant on donor (P=.45). Isolated factors evaluated included recipient age (relative risk [RR] 3.15, 95% confidence interval [CI] 0.89 to 11.09; P=.074), retransplant (RR 4.22, 95% CI 1.36 to 13.1; P=.013), and hemodialysis (RR 4.23, 95% CI 1.45 to 12.31, P=.008). On donor evaluation, we observed moderate and severe steatosis (RR 3.8, 95% CI 0.86 to 16.62; P=.06). Conclusion. In conclusion, we demonstrate a relevant model of criteria selection of liver transplant patients that is able to make a better match between the donor and recipient allocation for a better graft and patient survival.
conferenceObject Surgical Porto-Caval Shunt and liver transplantation: systematic review(2018) NACIF, L.; ZANINI, L.; SARTORI, V.; PINHEIRO, R.; ARANTES, R.; DUCATTI, L.; GALVAO, F.; ANDRAUS, W.; DALBUQUERQUE, L. Carneiro- Liver biopsy may facilitate pancreatic graft evaluation: Positive association between liver steatosis and pancreatic graft adipose infiltration(2018) NACIF, Lucas S.; ROCHA-SANTOS, Vinicius; CLARO, Laura C. L.; VINTIMILLA, Agustin; FERREIRA, Leandro A.; ARANTES, Rubens M.; PINHEIRO, Rafael S.; ANDRAUS, Wellington; ALVES, Venancio A. F.; D'ALBUQUERQUE, Luiz CarneiroOBJECTIVES: The number of pancreatic transplants has decreased in recent years. Pancreatic grafts have been underutilized compared to other solid grafts. One cause of discard is the macroscopic appearance of the pancreas, especially the presence of fatty infiltration. The current research is aimed at understanding any graft related association between fatty tissue infiltration of the pancreas and liver steatosis. METHODS: From August 2013 to August 2014, a prospective cross-sectional clinical study using data from 54 multiple deceased donor organs was performed. RESULTS: Micro-and macroscopic liver steatosis were significantly correlated with the donor body mass index ([BMI]; p=0.029 and p=0.006, respectively). Positive gamma associations between pancreatic and liver macroscopic and microscopic findings (0.98; confidence interval [CI]: 0.95-1 and 0.52; CI 0.04-1, respectively) were observed. Furthermore, comparisons of liver microscopy findings showed significant differences between severe versus absent (p<0.001), severe versus mild (p<0.001), and severe versus moderate classifications (p<0.001). The area under the receiver operating curve was 0.94 for the diagnosis of steatosis by BMI evaluation using a cut-off BMI of 27.5 kg/m(2), which yielded 100% sensitivity, 87% specificity, and 100% negative predictive value. CONCLUSIONS: We observed a positive association of macroscopic and microscopic histopathological findings in steatotic livers with adipose infiltration of pancreatic grafts.
conferenceObject Liver transient elastography following liver transplantation(2018) NACIF, L.; PARANAGUA-VEZOZZO, D.; GOMES, C.; REINOSO, G.; MISCHIATTI, M.; ANDRAUS, W.; PINHEIRO, R.; ARANTES, R.; ONO, S.; CARRILHO, F.; D'ALBUQUERQUE, L. Carneiro- Resection for intrahepatic cholangiocellular cancer: new advances(2018) WAISBERG, Daniel R.; PINHEIRO, Rafael S.; NACIF, Lucas S.; ROCHA-SANTOS, Vinicius; MARTINO, Rodrigo B.; ARANTES, Rubens M.; DUCATTI, Liliana; LAI, Quirino; ANDRAUS, Wellington; D'ALBUQUERQUE, Luiz C.Intrahepatic cholangiocarcinoma (ICC) is the second most prevalent primary liver neoplasm after hepatocellular carcinoma (HCC), corresponding to 10% to 15% of cases. Pathologies that cause chronic biliary inflammation and bile stasis are known predisposing factors for development of ICC. The incidence and cancer-related mortality of ICC is increasing worldwide. Most patients remain asymptomatic until advance stage, commonly presenting with a liver mass incidentally diagnosed. The only potentially curative treatment available for ICC is surgical resection. The prognosis is dismal for unresectable cases. The principle of the surgical approach is a margin negative hepatic resection with preservation of adequate liver remnant. Regional lymphadenectomy is recommended at time of hepatectomy due to the massive impact on outcomes caused by lymph node (LN) metastasis. Multicentric disease, tumor size, margin status and tumor differentiation are also important prognostic factors. Staging laparoscopy is warranted in high-risk patients to avoid unnecessary laparotomy. Exceedingly complex surgical procedures, such as major vascular, extrahepatic bile ducts and visceral resections, ex vivo hepatectomy and autotransplantation, should be implemented in properly selected patients to achieve negative margins. Neoadjuvant therapy may be used in initially unresectable lesions in order to downstage and allow resection. Despite optimal surgical management, recurrence is frustratingly high. Adjuvant chemotherapy with radiation associated with locoregional treatments should be considered in cases with unfavorable prognostic factors. Selected patients may undergo re-resection of tumor recurrence. Despite the historically poor outcomes of liver transplantation for ICC, highly selected patients with unresectable disease, especially those with adequate response to neoadjuvant therapy, may be offered transplant. In this article, we reviewed the current literature in order to highlight the most recent advances and recommendations for the surgical treatment of this aggressive malignancy.