WAGNER DE CASTRO ANDRADE
Índice h a partir de 2011
6
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/30 - Laboratório de Investigação em Cirurgia Pediát, Hospital das Clínicas, Faculdade de Medicina
LIM/30 - Laboratório de Investigação em Cirurgia Pediát, Hospital das Clínicas, Faculdade de Medicina
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- Living donor liver transplantation in children: Should the adult donor be operated on by an adult or pediatric surgeon? Experience of a single pediatric center(2014) ANDRADE, Wagner de Castro; VELHOTE, Manoel Carlos Prieto; AYOUB, Ali Ahman; SILVA, Marcos Marques; GIBELLI, Nelson Elias M.; TANNURI, Ana Cristina A.; SANTOS, Maria Merces; PINHO-APEZZATO, Maria Lucia; BARROS, Fabio de; MOREIRA, Daniel Rangel; MIYATANI, Helena T.; PEREIRA, Raimundo Renato; TANNURI, UenisBackground/Purpose: Living donor liver transplantation has become a cornerstone for the treatment of children with end-stage hepatic dysfunction, especially within populations or countries with low rates of organ utilization from deceased donors. The objective is to report our experience with 185 living donors operated on by a team pediatric surgeons in a tertiary center for pediatric liver transplantation. Methods: Retrospective analysis of medical records of donors of hepatic grafts for transplant undergoing surgery between June 1998 and March 2013. Results: Over the last 14 years, 185 liver transplants were performed in pediatric recipients of grafts from living donors. Among the donors, 166 left lateral segments (89.7%), 18 left lobes without the caudate lobe (9.7%) and 1 right lobe (0.5%) were harvested. The donor age ranged from 16 to 53 years, and the weight ranged from 47 to 106 kg. In 10 donors, an additional graft of the donor inferior mesenteric vein was harvested to substitute for a hypoplastic recipient portal vein. The transfusion of blood products was required in 15 donors (8.1%). The mean hospital stay was 5 days. No deaths occurred, but complications were identified in 23 patients (12.4%): 9 patients experienced abdominal pain and severe gastrointestinal symptoms and 3 patients required reoperations. Eight donors presented with minor bile leaks that were treated conservatively, and 3 patients developed extra-peritoneal infections (1 wound collection, 1 phlebitis and 1 pneumonia). Eight grafts (4.3%) showed primary dysfunction resulting in recipient death (3 cases of fulminant hepatitis, 1 patient with metabolic disease, 1 patient with Alagille syndrome and 3 cases of biliary atresia in infants under 1 year old). There was no relation between donor complications and primary graft dysfunction (P = 0.6). Conclusions: Living donor transplantation is safe for the donor and presents a low morbidity. The donor surgery may be performed by a team of trained pediatric surgeons.
bookPart Anomalias da diferenciação sexual(2020) ANDRADE, Wagner de Castro- Transmission of clear cell tumor in a graft liver from cadaveric donor: Case report(2012) BACKES, Ariane N.; TANNURI, Ana Cristina A.; MELLO, Evandro Sobroza de; GIBELLI, Nelson Elias M.; ANDRADE, Wagner de Castro; TANNURI, UenisNeoplasms in children after organ transplantation are related to the type and intensity of immunosuppression and the donorrecipient serostatus, especially in relation to the EpsteinBarr virus. The patient was a two-yr-old female child with biliary atresia who underwent a liver transplantation from a female cadaver donor. Two adults received kidney transplants from the same donor. Nine months after transplantation, one of the adult recipients developed an urothelial tumor in the kidney graft. Imaging tests were repeated monthly in the liver-transplanted child and revealed no abnormalities. However, one yr and two months after the transplantation, the patient developed episodes of fever. At that time, imaging and liver biopsy showed a clear cell tumor of urothelial origin in the graft and the disease was limited to the liver. The patient underwent liver retransplantation, and she is currently free of tumor recurrence. Although rare, the occurrence of tumors in the post-transplant period from cadaver donors, without previously diagnosed tumors, is one of the many problems encountered in the complex world of organ transplantation.
bookPart Abdome agudo na criança(2019) ANDRADE, Wagner de Castro- Effects of the administration of pentoxifylline and prednisolone on the evolution of portal fibrogenesis secondary to biliary obstruction in growing animals: immunohistochemical analysis of the expression of TGF-BETA; and VEGF(2012) ANDRADE, Wagner de Castro; SILVA, Luiz Fernando Ferraz da; COELHO, Maria Cecilia de Mendonca; TANNURI, Ana Cristina Aoun; ALVES, Venancio Avancini Ferreira; TANNURI, UenisOBJECTIVE: During the neonatal and infancy periods, some chronic liver diseases may lead to progressive hepatic fibrosis, which is a condition that can ultimately result in the loss of organ function and severe portal hypertension necessitating hepatic transplantation. In a previous report, pharmacological interventions were demonstrated to modulate hepatic fibrosis induced by bile duct ligation in young rats. The administration of pentoxifylline or prednisolone, or the combination of both, resulted in reduced fibrogenesis in portal spaces. The objectives of the present study were to evaluate the expression of transforming growth factor beta and vascular endothelial growth factor after bile duct ligation in young rats and to assess the effect of those same drugs on cytokine expression. METHODS: In this experimental study, 80 young rats (21 or 22 days old) were submitted either to laparotomy and common bile duct ligation or to sham surgery. The animals were allocated into four groups according to surgical procedure, and the following treatments were administered: (1) common bile duct ligation + distilled water, (2) sham surgery + distilled water, (3) common bile duct ligation + pentoxifylline, or (4) common bile duct ligation + prednisolone. After 30 days, a hepatic fragment was collected from each animal for immunohistochemical analysis using monoclonal antibodies against transforming growth factor beta and vascular endothelial growth factor. Digital morphometric and statistical analyses were performed. RESULTS: The administration of pentoxifylline reduced the transforming growth factor beta-marked area and the amount of transforming growth factor beta expressed in liver tissue. This effect was not observed after the administration of prednisolone. There was a significant reduction in vascular endothelial growth factor expression after the administration of either drug compared with the non-treatment group. CONCLUSIONS: The administration of pentoxifylline to cholestatic young rats resulted in the diminished expression of transforming growth factor beta and vascular endothelial growth factor in liver tissue. The administration of steroids resulted in the diminished expression of vascular endothelial growth factor only. These pathways may be involved in hepatic fibrogenesis in young rats submitted to bile duct ligation and exposed to pentoxifylline or prednisolone.
- 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.
- Videocirurgia na criança: estado da arte. Experiência com 1408 procedimentos no Instituto da Criança "Pedro de Alcântara"(2012) VELHOTE, Manoel Carlos Prieto; TANNURI, Uenis; ANDRADE, Wagner de Castro; MAKSOUD FILHO, João Gilberto; APEZZATO, Maria Lucia do Pinho; TANNURI, Ana Cristina AounThe videosurgery in Pediatric Surgery has a large field of applications unfortunately still underexplored. There are few services that routinely use this techinic , and Brazilian articles published are scarce. The Institute of Children's Hospital of the Faculty of Medicine, University of São Paulo, has been using for fifteen years the videosurgery which is now the first choice of treatment, among other diseases as gastroesophageal reflux, the cholecystolithiasis, the nonpalpable undescended testicles and megaesophagus. In this article we report our experience in laparoscopic pediatric surgery, acquired with 1408 surgical procedures, to present this useful method, and beneficial to a large number of situations and still underused in Pediatric Surgery.
- Choledochal cysts in children: How to Diagnose and Operate on(2020) TANNURI, Ana Cristina Aoun; HARA, Lucas Arjona de Andrade; PAGANOTI, Guilherme de Freitas; ANDRADE, Wagner de Castro; TANNURI, UenisOBJECTIVE: To identify the best mode for diagnosing and treating the patients with choledochal cysts. METHODS: A retrospective study was performed with medical records of patients diagnosed with choledochal cysts from January 1994 to December 2017. In all cases, the diagnosis was based on ultrasound examination. All the patients underwent cyst resection and were divided in two groups: bile enteric anastomosis in the high portion of the common hepatic duct or in the dilated lower portion. RESULTS: Eighty-one cases were studied. The age of presentation was 4 y 2 mo +/- 4 y 1 mo, and the age for the surgical treatment was 5 y 5 mo +/- 4 y 6 mo. In 61 cases, US was the only image examination performed. There were 67 cases of Todani type I (82.7%), 13 cases of type IV (16.0%) and one case of type III (1.2%). Nine patients (29.0%) in the first period and 2 patients (4.0%) in the second period presented with postoperative complications (p=0.016). CONCLUSION: In patients with choledochal cysts, US is the only necessary diagnostic imaging. Performing the bile enteric anastomosis in the lower portion of the common hepatic duct is safer and has a lower risk of complications.
- Current management of biliary atresia based on 35 years of experience at a single center(2018) ANDRADE, Wagner de Castro; SILVA, Marcos Marques; TANNURI, Ana Cristina Aoun; SANTOS, Maria Merces; GIBELLI, Nelson Elias Mendes; TANNURI, UenisOBJECTIVE: The prognosis of patients with biliary atresia undergoing Kasai portoenterostomy is related to the timing of the diagnosis and the indication for the procedure. The purpose of the present study is to present a practical flowchart based on 257 children who underwent Kasai portoenterostomy. METHODS: We conducted a retrospective cohort study of patients who underwent Kasai portoenterostomy between 1981 and 2016. RESULTS: During the first period (1981 to 2009), 230 infants were treated, and the median age at the time of surgery was 84 days; jaundice was resolved in 77 patients (33.5%). During the second period, from 2010 to 2016, a new diagnostic approach was adopted to shorten the wait time for portoenterostomy; an ultrasonography examination suggestive of the disease was followed by primary surgical exploration of the biliary tract without complementary examination or liver biopsy. Once the diagnosis of biliary atresia was confirmed, a portoenterostomy was performed during the same surgery. During this period, 27 infants underwent operations; the median age at the time of surgery was 66 days (p <0.001), and jaundice was resolved in 15 patients (55.6% - p=0.021), with a survival rate of the native liver of 66.7%. CONCLUSION: Primary surgical exploration of the biliary tract without previous biopsy was effective at improving the prognostic indicators of patients with biliary atresia undergoing Kasai portoenterostomy.
- 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.