LUCIANA BERTOCCO DE PAIVA HADDAD
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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- Adverse Outcomes and Economic Burden of Congenital Adrenal Hyperplasia Late Diagnosis in the Newborn Screening Absence(2020) MIRANDA, Mirela Costa de; HADDAD, Luciana Bertocco de Paiva; MADUREIRA, Guiomar; MENDONCA, Berenice Bilharinho de; BACHEGA, Tania A. S. S.Objective: To establish short- and long-term adverse outcome frequencies related to a late diagnosis of congenital adrenal hyperplasia (CAH) in the absence of newborn screening (NBS) and to determine respective treatment costs, which have never been reported. Design: A retrospective analysis of a CAH cohort diagnosed without NBS. Methods: We evaluated medical record data concerning 195 patients (141 females) diagnosed with CAH through clinical suspicion and confirmed using hormonal and CYP21A2 analysis, who were followed from 1980 to 2016 at Sao Paulo University. We measured mortality, dehydration, mental impairment frequencies, and hospitalization length outcomes in the salt-wasting form; the frequency of genetic females raised as males in both forms, frequency of depot GnRh analog (GnRha) and GH therapies in the simple virilizing form, and related outcome costs were calculated. Results: Mortality rates and associated costs, varying from 10% to 26% and from $2,239,744.76 to $10,271,591.25, respectively, were calculated using the Brazilian yearly live-births rate, estimated productive life years, and gross domestic product. In the salt-wasting form, 76% of patients were hospitalized, 8.6% were mentally impaired, and 3% of females were raised as males (total cost, $86,230/salt-wasting patient). GnRha and growth hormone were used for 28% and 14% of simple virilizing patients, respectively, and 18% of females were raised as males (preventable cost, $4232.74/simple virilizing patient). Conclusions: A late CAH diagnosis leads to high mortality and morbidity rates, notably increasing public health costs, and may result in physical and psychological damage that is not easily measurable. (C) Endocrine Society 2019.
- Living-donor liver transplantation in Budd-Chiari syndrome with inferior vena cava complete thrombosis: A case report and review of the literature(2021) ROCHA-SANTOS, Vinicius; WAISBERG, Daniel Reis; PINHEIRO, Rafael Soares; NACIF, Lucas Souto; ARANTES, Rubens Macedo; DUCATTI, Liliana; MARTINO, Rodrigo Bronze; HADDAD, Luciana Bertocco; GALVAO, Flavio Henrique; ANDRAUS, Wellington; CARNEIRO-D'ALBURQUERQUE, Luiz AugustoBACKGROUND Budd-Chiari syndrome (BCS) is a challenging indication for liver transplantation (LT) due to a combination of massive liver, increased bleeding, retroperitoneal fibrosis and frequently presents with stenosis of the inferior vena cava (IVC). Occasionally, it may be totally thrombosed, increasing the complexity of the procedure, as it should also be resected. The challenge is even greater when performing living-donor LT as the graft does not contain the retrohepatic IVC; thus, it may be necessary to reconstruct it. CASE SUMMARY A 35-year-old male patient with liver cirrhosis due to BCS and hepatocellular carcinoma beyond the Milan criteria underwent living-donor LT with IVC reconstruction. It was necessary to remove the IVC as its retrohepatic portion was completely thrombosed, up to almost the right atrium. A right-lobe graft was retrieved from his sister, with outflow reconstruction including the right hepatic vein and the branches of segment V and VIII to the middle hepatic vein. Owing to massive subcutaneous collaterals in the abdominal wall, venovenous bypass was implemented before incising the skin. The right atrium was reached via a transdiaphragramatic approach. Hepatectomy was performed en bloc with the retrohepatic vena cava. It was reconstructed with an infra-hepatic vena cava graft obtained from a deceased donor. The patient remains well on outpatient clinic follow-up 25 mo after the procedure, under an anticoagulation protocol with warfarin. CONCLUSION Living-donor LT in BCS with IVC thrombosis is feasible using a meticulous surgical technique and tailored strategies.
- Resilience and the struggle for medical research in Brazil(2018) CUNHA, Lucas Leite; HADDAD, Luciana Bertocco de Paiva; RIERA, Rachel; WARD, Laura Sterian
conferenceObject COVID-19 Infection in Liver Transplant Recipients: Results From a Brazillian Multicentric Historical Cohort(2022) BOIN, Ilka F. S. F.; RICCETTO, Eduardo; GENZINI, Tercio; MOREIRA, Lucio F. P.; STUCCHI, Raquel S. B.; SILVA, Renato F.; HADDAD, Luciana; ALMEIDA, Marcio D.; WATANABE, Andre; PEIXOTO, Gustavo S.; MELO, Claudio M. L.; TEFFILI, Nertan L.; HALPERN, Marcia; GODOY, Maira C.; MANCERO, Jorge M. P.; GARCIA, Jose Huygens P.; ATAIDE, Elaine C.- The economic impact of COVID-19 treatment at a hospital-level: Investment and financial registers of Brazilian hospitals(2021) ETGES, A. P. B. Da Silva; CARDOSO, R. B.; MARCOLINO, M. S.; RUSCHEL, K. B.; COUTINHO, A. P.; PEREIRA, E. C.; ANSCHAU, F.; ARANHA, F.; CARRILHO, F.; VIETTA, G.; BASTOS, G. A. N.; BATISTA, J. D. L.; CHATKIN, J. M.; NOGUEIRA, J. Da Silva; MOREIRA, L. B.; HADDAD, L.; KOPITTKE, L.; FLORIANI, M.; SIQUEIRA, M. T. De; ZIEGELMANN, P.; MARTELLI, P. J. De Lima; POZZA, R.; LAGIOIA, U. C. T.; POLANCZYK, C. A.Background: The economic impact associated with the treatment strategies of coronavirus disease-2019 (COVID-19) patients by hospitals and health-care systems in Brazil is unknown and difficult to estimate. This research describes the investments made to absorb the demand for treatment and the changes in occupation rates and billing in Brazilian hospitals. Methods: This research covers the initial findings of ""COVID-19 hospital costs and the proposition of a bundled reimbursement strategy for the health-care system,"" which includes 10 hospitals. The chief financial officer, the chief medical officer, and hospital executives of each participating hospital provided information regarding investments attributed to COVID-19 patient treatment. The analysis included variations in occupation rates and billing from 2019 to 2020 observed in each institution, and the investments for medical equipment, individual protection materials and building construction per patient treated. Results: The majority of hospitals registered a decrease in hospitalization rates and revenue from 2019 to 2020. For intensive care units (ICUs), the mean occupancy rate ranged from 88% to 83%, and for wards, it ranged from 85% to 73%. Monthly average revenue decreased by 10%. The mean hospital investment per COVID-19 inpatient was I$6800 (standard deviation 7664), with the purchase of ventilators as the most common investment. For this item, the mean, highest and lowest acquisition cost per ventilator were, respectively, I$31 468, I$48 881 and I$17 777. Conclusion: There was significant variability in acquisition costs and investments by institution for responding to the COVID-19 pandemic. These findings highlight the importance of continuing microeconomic studies for a comprehensive assessment of hospital costs. Only with more detailed analyses, will it be possible to define and drive sustainable strategies to manage and reimburse COVID-19 treatment in health-care systems. © 2021 Columbia Data Analytics. All rights reserved.
- Understanding the Elevated Lethality of COVID-19 in Liver Transplant Recipients: Does Immunosuppression Management Matter? Results from a Brazilian Multicentric Historical Cohort(2023) BOIN, Ilka Fsf; RICCETTO, Eduardo; GENZINI, Tercio; SANTOS, Regina Gomes; MOREIRA, Lucio Figueira Pacheco; PINTO, Laura Cristina Machado; GARCIA, Jose Huygens Parente; STUCCHI, Raquel Sb; PERALES, Simone Reges; ZANAGA, Leticia; SILVA, Renato Fereira Da; SILVA, Rita Cm Fereira Da; HADDAD, Luciana; D'ALBUQUERQUE, Luiz Ac; DEALMEIDA, Marcio Dias; WATANABE, Andre; PEIXOTO, Gustavo S.; MELO, Claudio Moura Lacerda De; BEZERRA, Renata Ferreira; TEFILLI, Nertan Luiz; HALPERN, Marcia; GODOY, Maira Silva; NOGARA, Marcelo; MANCERO, Jorge Marcelo Padilla; NOUJAIM, Huda Maria; RANGEL, Erika Bevilaqua; ATAIDE, Elaine CristinaBackground. Infections by SARS-CoV-2 in liver transplant recipients (LT) patients are of particular concern, notably due to perceived added risks related to immunosuppression and comorbidity burden. Current literature on this topic often relies on small, non-standardized, and geographically limited studies. This manuscript describes COVID-19 presentations and causes for elevated mortality in a large cohort of LT recipients. Methods. This study was designed as a multicentric historical cohort, including LT recipient patients with COVID-19 in 25 study centers, with the primary endpoint being COVID-related death. We also collected demographic, clinical, and laboratory data regarding presentation and disease progression. Results. Two hundred and thirty-four cases were included. The study population was predominantly male and White and had a median age of 60 years. The median time from transplantation was 2.6 years (IQR 1-6). Most patients had at least one comorbidity (189, 80.8%). Patient age (P = .04), dyspnea (P < .001), intensive care unit admission (P < .001), and mechanical ventilation (P < .001) were associated with increased mortality. Modifications of immunosuppressive therapy (P < .001), specifically the suspension of tacrolimus, maintained significance in multi-variable analysis. Conclusions. Attention to risk factors and the individualization of patient care, especially regarding immunosuppression management, is crucial for delivering more precise interventions to these individuals.
- Does autologous blood transfusion during liver transplantation for hepatocellular carcinoma increase risk of recurrence?(2016) ARAUJO, Raphael L. C.; PANTANALI, Carlos Andres; HADDAD, Luciana; ROCHA FILHO, Joel Avancini; D'ALBUQUERQUE, Luiz Augusto Carneiro; ANDRAUS, WellingtonAIM: To analyze outcomes in patients who underwent liver transplantation (LT) for hepatocellular carcinoma (HCC) and received autologous intraoperative blood salvage (IBS). METHODS: Consecutive HCC patients who underwent LT were studied retrospectively and analyzed accor-ding to the use of IBS or not. Demographic and sur-gical data were collected from a departmental pro-spective maintained database. Statistical analyses were performed using the Fisher's exact test and the Wilcoxon rank sum test to examine covariate differences between patients who underwent IBS and those who did not. Univariate and multivariate Cox regression models were developed to evaluate recurrence and death, and survival probabilities were estimated using the Kapla-Meier method and compared by the log-rank test. RESULTS: Between 2002 and 2012, 158 consecutive patients who underwent LT in the same medical center and by the same surgical team were identified. Among these patients, 122 (77.2%) were in the IBS group and 36 (22.8%) in the no-IBS group. The overall survival (OS) and recurrence free survival (RFS) at 5 years were 59.7% and 83.3%, respectively. No differences in OS (P = 0.51) or RFS (P = 0.953) were detected between the IBS and no-IBS groups. On multivariate analysis for OS, degree of tumor differentiation remained as the only independent predictor. Regarding patients who received IBS, no differences were detected in OS or RFS (P = 0.055 and P = 0.512, respectively) according to the volume infused, even when outcomes at 90 d or longer were analyzed separately (P = 0.518 for both outcomes). CONCLUSION: No differences in RFS or OS were detected according to IBS use. Trials addressing this question are justified and should be designed to detect small differences in long-term outcomes.
- The Cost-Effectiveness of Congenital Adrenal Hyperplasia Newborn Screening in Brazil: A Comparison Between Screened and Unscreened Cohorts(2021) MIRANDA, Mirela Costa de; HADDAD, Luciana Bertocco de Paiva; TRINDADE, Evelinda; CASSENOTE, Alex; HAYASHI, Giselle Y.; DAMIANI, Durval; COSTA, Fernanda Cavalieri; MADUREIRA, Guiomar; MENDONCA, Berenice Bilharinho de; BACHEGA, Tania A. S. S.Background: Newborn screening for congenital adrenal hyperplasia (CAH-NBS) is not yet a worldwide consensus, in part due to inconclusive evidence regarding cost-effectiveness because the analysis requires an understanding of the short- and long-term costs of care associated with delayed diagnosis. Objective: The present study aimed to conduct a cost-effectiveness analysis (CEA) to compare the costs associated with CAH-NBS and clinical diagnosis. Methods: A decision model comparing the two strategies was tested by sensitivity analysis. The cost analysis perspective was the public health system. Unscreened patients' data were extracted from medical records of Hospital das Clinicas, Sao Paulo, and screened data were extracted from the NBS Referral Center of Sao Paulo. The population comprised 195 classical patients with CAH, clinically diagnosed and confirmed by hormonal/CYP21A2 analysis, and 378,790 newborns screened during 2017. Adverse outcomes related to late diagnosis were measured in both cohorts, and the incremental cost-effectiveness ratio (ICER) was calculated. We hypothesized that CAH-NBS would be cost-effective. Results: Twenty-five screened infants were confirmed with CAH (incidence: 1:15,135). The mortality rate was estimated to be 11% in unscreened infants, and no deaths were reported in the screened cohort. Comparing the unscreened and screened cohorts, mean serum sodium levels were 121.2 mEq/L (118.3-124.1) and 131.8 mEq/L (129.3-134.5), mean ages at diagnosis were 38.8 and 17 days, and hospitalization occurred in 76% and 58% of the salt-wasting patients with the in the two cohorts, respectively. The NBS incremental cost was US$ 771,185.82 per death averted, which yielded an ICER of US$ 25,535.95 per discounted life-year saved. Conclusions: CAH-NBS is important in preventing CAH mortality/morbidity, can reduce costs associated with adverse outcomes, and appears cost-effective.
- Peroral endoscopic myotomy (POEM) is more cost-effective than laparoscopic Heller myotomy in the short term for achalasia: economic evaluation from a randomized controlled trial(2020) CONTE, Tatiana Morgado; HADDAD, Luciana Bertocco de Paiva; RIBEIRO, Igor Braga; MOURA, Eduardo Turiani Hourneaux de; D'ALBUQUERQUE, Luiz Augusto Carneiro; MOURA, Eduardo Guimaraes Hourneaux deBackground and study aims We aimed to perform an economic evaluation of peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) for the treatment of achalasia. Materials and methods An economic cost-utility analysis was carried out over a time horizon of 1 year. Patients with achalasia who were admitted to the gastroenterology outpatient clinic of a public tertiary referral hospital were assigned to undergo POEM or LHM. The monetary amounts were extracted from the intranet of the institution using microcosting. All costs associated with the procedure, hospitalization, clinical follow-up and resolution of therapeutic complications were included. The utility data were measured in quality-adjusted life years (QALYs), which were estimated from the scores of a quality-of-life questionnaire. Results Forty patients (20 POEM patients and 20 LHM patients) were included. The final cost associated with POEM and LHM was US$2,619.19399.53 and US$1,696.44 +/- 412.21, respectively ( P<0.001). However, the QALYs in the POEM group (0.434 +/- 0.215 vs 0.332 +/- 0.222, P=0.397) were slightly higher than those in the LHM group.The incremental cost-utility ratio (ICUR) suggested that an additional US$9,046.41/QALY gained was required when using POEM. Conclusion For the treatment of achalasia in the public health system, POEM appears to be more cost-effective than LHM in the short term.
- Journey of short bowel syndrome patients with chronic intestinal failure that underwent intestinal transplantation in Brazil(2023) ROCHA, Mariana Hollanda Martins da; BOTEON, Yuri Longatto; HADDAD, Luciana; SANTOS, Claudia Yang; CALIL, Igor Lepski; LEE, Andre Dong Won; MARQUES, Fernanda; DALBUQUERQUE, Luiz Augusto Carneiro; PECORA, Rafael; PERROTTI, Marcos