DANIEL DE ALBUQUERQUE RANGEL MOREIRA
Projetos de Pesquisa
Unidades Organizacionais
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
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- Pediatric acute liver failure in Brazil: Is living donor liver transplantation the best choice for treatment?(2016) TANNURI, Ana Cristina Aoun; PORTA, Gilda; MIURA, Irene Kazue; SANTOS, Maria Merces; MOREIRA, Daniel de Albuquerque Rangel; REZENDE, Nathassia Mancebo Avila de; MIYATANI, Helena Thie; TANNURI, UenisAcute liver failure (ALF) in children is a life-threatening condition that often leads to urgent liver transplantation (LT). The aim of the present investigation was to describe the experience in Brazil in treating pediatric ALF, with an emphasis on the role of living donor liver transplantation (LDLT) in treating this condition. All children with ALF who fulfilled the criteria for an urgent LT were admitted to the intensive care unit. Patients were divided into 2 groups based on the moment of admission: before and after June 2007, when the LDLT program for ALF was started. Statistical analyses were performed to identify prognostic factors of patients with ALF. For the study, 115 children with ALF were admitted. All patients had some degree of encephalopathy. Among the patients, 26% of them required intracranial pressure monitoring (IPM), 12.8% of the patients required hemodialysis, and 79 patients underwent transplantation (50 deceased donors and 29 living donors) corresponding to 12.4% of all pediatric LTs. Only 9 children recovered without LT. The need for IPM and nonperformance of LT were related to a higher mortality. The mortality rate of patients who underwent LT was significantly lower than that of children with ALF who did not undergo a LT (48.1% versus 75%; P = 0.02). The incidences of primary nonfunction and mortality were statistically higher among deceased donor liver transplantations than LDLTs. Finally, it was verified that the overall survival rate of transplanted patients was increased after the introduction of LDLT (P = 0.02). In conclusion, ALF in children continues to be a severe and devastating condition, and a LT should be performed promptly. The introduction of LDLT could increase the survival rate of patients in Brazil. Liver Transplantation 22 1006-1013 2016 AASLD
- REX SHUNT FOR ACUTE PORTAL VEIN THROMBOSIS AFTER PEDIATRIC LIVER TRANSPLANT IN CHILDREN WITH BILIARY ATRESIA(2013) GIBELLI, Nelson Elias Mendes; ANDRADE, Wagner de Castro; VELHOTE, Manoel Carlos Prieto; AYOUB, Ali Abdul Rahman; SILVA, Marcos Marques da; PINHO-APEZZATO, Maria Lucia de; TANNURI, Ana Cristina Aoun; BARROS, Fabio de; RICARDI, Luis Roberto Schlaich; MOREIRA, Daniel de Albuquerque Rangel; MIYATANI, Helena Thie; PEREIRA, Paulo Renato Alencar; TANNURI, UenisBACKGROUND/PURPOSE: zPost transplant portal vein thrombosis (PVT)can be extremely disastrous, and portal hypertension and other consequences of the long term privation of portal inflow to the graft may be hazardous, especially in the very young children. Since 1998, Rex shunt has been used successfully to treat these patients. In 2007 we started to perform this surgery in patients with idiopathic PVT and late post transplant PVT. We report our experience with this technique in acute post transplant PVT. METHODS: Case report of six patients (age–12–18 months) submitted to cadaveric (1) and living donor (5) liver transplant (LT). All patients had biliary atresia with portal vein hipoplasia and developed acute portal vein thrombosis (PVT) in the first post-operative day. They were submitted to a mesenteric-portal surgical shunt (Rex shunt) with left internal jugular vein autograft (5) and cadaveric iliac vein graft (1) in the first post-operative day. RESULTS: Current follow-up of 12 months. Postoperative Doppler ultrasounds confirmed shunt patency. There were no biliary complications until now. CONCLUSION: The mesenteric-portal shunt (Rex shunt) with left internal jugular vein autograft should be considered in children with acute PVT after liver transplantation. These children usually have small portal veins, and reanastomosis is often unsuccessful. In addition, this technique has the advantage that we do not manipulate the biliary anastomosis and the hepatic hilum, thus avoiding biliary complications. Although this is an initial experience, we conclude that this technique is feasible, with great benefits for these patients and with low risks.
- Does a meso-caval shunt have positive effects in a pig large-for-size liver transplantation model?(2017) TANNURI, Ana Cristina Aoun; MOREIRA, Daniel de Albuquerque Rangel; BELON, Alessandro; COELHO, Maria Cecilia Mendonca; GONCALVES, Josiane Oliveira; SERAFINI, Suellen; TANNURI, UenisIn pediatric liver transplantations with LFS grafts, higher incidences of graft dysfunction probably occur due to IRI. It was postulated that increasing the blood supply to the graft by means of a meso-caval shunt could ameliorate the IRI. Eleven pigs underwent liver transplantation and were divided into two groups: LFS and LFS+SHUNT group. A series of flowmetric, metabolic, histologic, and molecular studies were performed. No significant metabolic differences were observed between the groups. One hour after reperfusion, portal flow was significantly lower in the recipients than in the donors, proving that the graft was maintained in low portal blood flow, although the shunt could promote a transient increase in the portal blood flow and a decrease in the arterial flow. Finally, it was verified that the shunt promoted a decrease in inflammation and steatosis scores and a decrease in the expression of the eNOS gene (responsible for the generation of nitric oxide in the vascular endothelium) and an increase in the expression of the proapoptotic gene BAX. The meso-caval shunt was responsible for some positive effects, although other deleterious flowmetric and molecular alterations also occurred.
- LIVER TRANSPLANTATION IN CHILDREN: 14 YEARS OF EXPERIENCE WITH LIVING DONORS(2013) ANDRADE, Wagner de Castro; VELHOTE, Manoel Carlos Prieto; AYOUB, Ali Abdul Rahman; SILVA, Marcos Marques da; GIBELLI, Nelson Elias Mendes; PINHO-APEZZATO, Maria Lucia de; TANNURI, Ana Cristina Aoun; BARROS, Fabio de; RICARDI, Luis Roberto Schlaich; MOREIRA, Daniel de Albuquerque Rangel; MIYATANI, Helena Thie; PEREIRA, Paulo Renato Alencar; TANNURI, UenisOBJECTIVES: Report on the experience with 170 living donors in pediatric liver transplantation. MATERIAL AND METHODS: Retrospective analysis of the medical records of donors operated between June 1998 and October 2012. RESULTS: Over the past 14 yrs, 169 liver transplants were performed in pediatric recipients of living donor grafts. In a potential left lateral segment donor, there was a minor injury in the right branch of portal vein, repaired without consequences for the patient, but resulting in abortion of the transplant. From the remaining donors, 151 left lateral segments (89.34%), 17 left lobes (10.06%) and 1 right lobe (0.6%) were removed. Donor age ranged from 16 to 53 yrs and weight ranged from 47 to 106 kg. Transfusion of blood products was required in 14 donors (8.3%). The mean hospital stay was 5 days. Complications were identified in 21 patients (12.4%): 11 showed intense dyspeptic symptoms and abdominal pain (two patients underwent reoperation), seven presented minor bile leaks, and three developed extra-peritoneal infection (incision abscess, phlebitis and pneumonia). There was no mortality in this series. Eight grafts (4.7%) had primary dysfunction, resulting in death of the recipient (three cases of fulminant hepatitis, one metabolic disease carrier, one Alagille Syndrome carrier and three cases of biliary atresia in infants under 1 yr of age). CONCLUSION: Living-related liver transplantation in children generates low risk and morbidity for the donors of left lobe or left lateral segment grafts, with good outcomes for the recipients, eliminating the disadvantages of the waiting list for cadaveric grafts.
- ACUTE LIVER FAILURE WITH ASSOCIATED APLASTIC ANEMIA IN CHILDREN(2013) MOREIRA, Daniel de Albuquerque Rangel; ANDRADE, Wagner de Castro; VELHOTE, Manoel Carlos Prieto; AYOUB, Ali Abdul Rahman; SILVA, Marcos Marques da; GIBELLI, Nelson Elias Mendes; PINHO-APEZZATO, Maria Lucia de; TANNURI, Ana Cristina Aoun; BARROS, Fabio de; MIYATANI, Helena Thie; PEREIRA, Paulo Renato Alencar; TANNURI, UenisOBJECTIVES: Herein we describe the experience of six cases of acute liver failure with associated aplastic anemia treated at ICR – HCFMUSP. MATERIAL AND METHODS: We reviewed the records of patients undergoing liver transplantation for acute liver failure with associated aplastic anemia treated at ICR–HCFMUSP between 2007 and 2012. We collected information regarding the type of treatment offered, diagnosis, bone marrow recovery time, interval between onset of symptoms until liver transplantation and the diagnosis of bone marrow aplasia. RESULTS: In this period we found five patients who met the criteria established, four boys and a girl. The mean age was 9.6 yrs (9–12). The time between onset of symptoms and liver transplantation was 25.2 days (17–30) and until the appearance of pancytopenia 35 days (20–45). Two patients were treated with thymoglobulin and median time to recovery of bone marrow function after treatment was 17.5 days. One patient died from sepsis after treatment and another from bleeding without taking thymoglobulin. CONCLUSION: Aplastic anemia is a potentially fatal complication associated with acute liver failure. There is no standardized treatment in the literature. Reports show cases of liver and bone marrow recovery after immunosuppressive therapy with anti-thymocyte globulin and anti-lymphocytes despite the risk inherent in the use of such substances in critically ill patients the presence of large numbers of activated T lymphocytes in the marrow and liver biopsies from these patients corroborates this therapeutic. In severe cases of aplastic anemia with HLA compatible sibling hematopoietic stem cell transplantation has been performed successfully in the treatment of this condition.