FLAVIO JOTA DE PAULA
Índice h a partir de 2011
13
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
19 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 19
conferenceObject Desensitization Using Only IVIG: Is That an Option for Highly-Sensitized Patients Waiting for Kidneys from Cadaveric Donors?(2019) PAIXAO, J. O.; ULISSES, L. R.; SOUZA, P. S.; BEZERRA, G.; AGENA, F.; RODRGUES, H. P.; PANAJOTOPOULOS, N.; PAULA, F. J.; DAVID-NETO, E.; CASTRO, M. R.- Outcomes and Mortality in Renal Transplant Recipients Admitted to the Intensive Care Unit(2015) MARQUES, I. D. B.; CAIRES, R. A.; MACHADO, D. J. B.; GOLDENSTEIN, P. T.; RODRIGUES, C. E.; PEGAS, J. C. R.; PAULA, F. J. de; DAVID-NETO, E.; COSTA, M. G.Introduction. In the intensive care unit (ICU), mortality is considered higher among renal transplant recipients than among nontransplantation patients. However, data regarding severe complications after kidney transplantation are scarce. Materials and Methods. In this study, we evaluated all consecutive renal transplant recipients admitted to our ICU between July 2012 and July 2013 (n = 70), comparing their outcomes with those of a control group of nontransplantation patients admitted during the same period (n = 153). Among the transplant recipients, we compared survivors and nonsurvivors to identify predictors of ICU mortality. Results. The mean age of the transplant recipients was 52 13 years. Of the 70 transplant recipients, 18 (25%) required mechanical ventilation, 28 (40%) required inotropic support, and 27 (39%) required hemodialysis, all of which are factors that worsen the prognosis significantly. Twenty-two (31%) of the transplant recipients died in the ICU and 17 (24%) died within 30 days after ICU discharge, rates similar to those observed for the control group. Conclusions. We observed similar mortality between recipient and control groups, albeit the mortality was higher in the clinical group. In the multivariate model, the need for mechanical ventilation and the need for hemodialysis were independently associated with mortality.
- Pneumocystis jirovecii pneumonia with an atypical granulomatous response after kidney transplantation(2014) RAMALHO, J.; MARQUES, I. D. Bacelar; AGUIRRE, A. R.; PIERROTTI, L. C.; PAULA, F. J. de; NAHAS, W. C.; DAVID-NETO, E.Pneumocystis jirovecii pneumonia (PCP) continues to be a leading cause of morbidity and mortality in kidney transplant recipients. Granulomatous PCP is an unusual histological presentation that has been described in a variety of immunosuppressive conditions. Previous studies have demonstrated an association between granulomatous disorders and hypercalcemia, the purported mechanism of which is extrarenal production of 1,25-dihydroxyvitamin D by activated macrophages. Here, we report a case of granulomatous formation in a kidney transplant recipient with PCP who presented with hypercalcemia and suppressed parathyroid hormone, both of which resolved after successful treatment of the pneumonia. In immunocompromised patients, pulmonary infection associated with hypercalcemia should raise the suspicion of PCP and other granulomatous disorders.
conferenceObject Desensitization Using Only Polyvalent Immunoglobulins (IVIG) for Kidney Transplantation with Living Donors (LD)(2019) ULISSES, L. R.; PAIXAO, J. O.; SOUZA, P. S.; BEZERRA, G.; RODRIGUES, H.; PANAJATOPOULOS, N.; PAULA, F. J. De; DAVID-NETO, E.; CASTRO, M. C. R.conferenceObject Plasma Cell Infiltration: General Overview of Clinical and Pathological Correlations in Renal Transplantation(2015) NIHEI, C.; LEMOS, F.; DAVID, D.; SOUZA, P.; PAULA, F. de; NAHAS, W.; DAVID-NETO, E.- Prioritization Due to Dialysis Access Failure Impacts on Patient Survival after Kidney Transplantation(2013) REUSING JR., J.; SOUZA, P.; GALANTE, N.; AGENA, F.; PAULA, F. de; NAHAS, W.; DAVID-NETO, E.Dialysis vascular access failure, recipient of a non-renal solid organ transplantation and previous kidney donation are current indications of priority allocation (PA) for kidney transplant (KT) at our centre. Mortality among PA patients under dialysis is high and risk factors for long-term patient outcomes after transplantation remain largely elusive. In this study we analyzed a cohort of patients that received KT from Jan/2007 to Dec/2011. Long-term patient survival was compared between PA and non PA recipients transplanted in this period of time and clinical relevant data were analyzed. Data were recorded as of Aug/2012. Results: 948 KT were performed at our institution and 93 (9.8%) were included in our PA program. Most PA patients (n=86) had access failure. The mean follow up time was 32 (0 – 69) months. 5-year patient survival was lower in PA patients (76vs 86%, p=0.001). Twenty (21.5%) PA patients died and all deaths occurred in those with access failure, being 70% of them in the first 3 months. Causes of death were infection in 10 patients, bleeding complications (n=6), uremia (n=1), mesenteric ischemia (n=1) and unspecified shock (n=2). Considering this high mortality rate in the first 3 months after transplantation, we compared patients who died in this period of time (group A) vs. those who survived more than 3 months (group B). Age, gender, previous kidney transplants, sensitization, number of HLA mismatches, pre-transplant DSA, pre-transplant diabetes, induction therapy, DGF, rejection, use of heparin, IVIg and time from inscription in the PA program to transplantation were not statistically different between groups. Among 47 patients who were screened for thrombophilia, 83.3% from group A were positive vs. 31.7% from group B (p=0.01). Infection after transplantation and hemorrhagic complications were more frequent in group A. Groups were not different regarding causes of death. PA patients have a lower survival and this excessive death rate occur in the first three months after transplantation mainly due to infections and bleeding. Thrombophilia is very frequent in PA patients with HR....... for death.
conferenceObject No Impact of One Year of Everolimus, as Compared to MPA, in the Reversal of Left Ventricular Hypertrophy in Elderly Renal Transplant Recipients - Preliminary Data from Then Everold Study(2017) DAVID-NETO, E.; AGENA, F.; FURTADO, M.; RODRIGES, A.; ANDRADE, J.; LEMOS, F.; PAULA, F.conferenceObject Early Protocol Biopsies Can Identify Antibody-Mediated Rejection in Sensitized Patients(2013) SOUZA, P.; MACHADO, D.; AGUIRRE, A.; DAVID, D.; BARBOSA, E.; PAULA, F. de; NAHAS, W.; DAVID-NETO, E.; CASTRO, M.HLA sensitized patients are at risk for antibody-mediated rejection (ABMR). Our purpose was to evaluate the importance of early protocol biopsies. From Jul/2010 to Jun/2012, 101 sensitized patients defined as PRA>10% (class I and/or II by Flow-PRA) were transplanted at our institution. Out of them, 60 performed donor-specific antibodies (DSA) at transplant and a protocol-bx at day 7 (D7) and were included in this study. A second for cause indication biopsy (IB) was done at the physician’s discretion in 18 patients without previous acute rejection (AR) diagnosis. DSA were analyzed by single antigen bead assays at the time of biopsies (classified according to Banff’09 criteria). Patients (pts) mean age was 48±12 years, 48 were female (80%),45 first transplant (75%) and 42 (70%) received a kidney from deceased donor. 34 pts never presented AR episodes while 26 did. 20/26 (77%) of AR were diagnosed in the first 3 weeks after transplantation (median 13 days). Day 7 protocol biopsies (PB) showed AR in 12/26 (46%): 10 (85%) ABMR and 2 (15%) T-cell-mediated rejection (TCMR). The IB (n=18) done at a median of 11 days from the PB (range 3-112), showed AR in another 14 pts (56%): 10(71%) ABMR and 4 (29%) TCMR, as presented in Table 1 Pre-Tx mean MFI in ABMR pts did not differ among PB: 6001 (1596-11181) vs IB 2304 (840-14600)(p=NS). It also did not differ at the time of biopsy (2823 vs. 2277 in PB vs IB, respectively; p=NS). Patients with early ABMR diagnosis at PB had a trend to higher long-term MDRD (49±12mL/min) compared to patients with ABMR at IB (41±11mL/min) and similar to the whole non-ABMR patients (50±17mL/min). In conclusion, protocol biopsy is useful to diagnosis ABMR as early as in the first week pos-Tx. Early recognition of ABMR allows earlier treatment and possibly better long-term graft function in sensitized patients.conferenceObject Thymoglobulin Induction with Tacrolimus and Everolimus Maintenance Therapy in Elderly Kidney Transplantation Results in Prolonged Lymphocyte Depletion and Do Not Favor Regulatory Profile.(2019) DAVID-NETO, E.; FREITAS, G. Ramos de; FERNANDES, M.; AGENA, F.; LEMOS, F. Brambate Carvalhinho; PAULA, F. Jota de; COELHO, V.; GALANTE, N. ZocolerconferenceObject Screening for Inherited and Acquired Thrombophilia Prior to Renal Transplantation(2013) SILVA, R.; MORAES, C.; MARQUES, I.; PAULA, F. de; DAVID-NETO, E.All patients with a history of a thromboembolic event, early or recurrent vascular access thrombosis, family history of thrombosis, or multiple miscarriages underwent laboratory screening for thrombophilia. Since the introduction of the screening for hypercoagulable risk factors, 156 candidates for renal transplantation underwent laboratory evaluation. Eighty-eight patients (56%) exhibited at least one prothrombotic laboratory parameter, besides of isolated hyperhomocysteinemia, which confirmed a thrombophilic state. Lupus anticoagulant, anticardiolipin and beta-2-glycoprotein was present in 30%, 18% and 13%, and antithrombin III, protein C and protein S deficiencies in 11%, 8% and 10%, respectively. Factor V Leiden mutation was present in only one patient and prothrombin gene G20210 mutation was not found. Among the 156 patients, 30 underwent renal transplantation and were followed for a median of 199 days (range, 9 – 418). All patients were on triple immunosuppressive regimen compromising mycophenolate, tacrolimus and prednisone. Thrombophilia was identified in 16 (53%). Seventeen (57%) received perioperative anticoagulation with unfractionated heparin (9 patients with thrombophilia and 8 without laboratory confirmed thrombophilia). Five (30%) of these patients developed perinephric hematomas. Three patients with thrombophilia developed thrombotic complications (2 upper limbs deep-vein thrombosis and 1 allograft artery thrombosis) and 1 patient without thrombophilia developed allograft vein thrombosis, p=0.35. Nine patients developed acute rejection (5 in the group with thrombophilia and 4 in the group without thrombophilia, p=0.87). Mean glomerular filtration rate was similar between thrombophilic and non-thrombophilic patients in the last follow-up (54±27 vs. 47±22 mL/min/1.73m², p=0.35). One graft loss and 1 patient death were observed in each group. In conclusion, prothrombotic risk factors, especially antiphospholipid antibodies, are highly prevalent in patients awaiting renal transplantation with a clinical or familial history suggestive of thrombophilia, including early and recurrent vascular access failure. Despite pre-transplant screening and perioperative treatment and/or monitoring, thrombotic and bleeding complications are still frequent and severe.