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
12 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 12
conferenceObject CORONARY ASSESSMENT IN YOUNG PATIENTS ON HEMODIALYSIS(2020) LIMA, Jose De; GOWDAK, Luis Henrique W.; PAULA, Flavio J. de; DAVID NETO, Elias; BORTOLOTTO, Luiz A.- 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 Treatment of Carbapenem resistant Enterobacteriaceae with reduced susceptibility to polymyxin among kidney transplant recipients experience during an outbreak period(2016) FREIRE, Maristela; PAULA, Flavio J. De; AZEVEDO, Luiz Sergio; LAZARO, Ana Carolina; ROSSI, Flavia; DAVID-NETO, Elias; NAHAS, Willian; PIERROTTI, Ligia C.- Risk Factors for Mortality among Kidney Transplant Recipients with Pneumocystis Jirovecii Infection(2018) MORTARI, Naima; FREIRE, Maristela; AZEVEDO, Luis Sergio; PAULA, Flavio Jota De; CAIAFFA-FILHO, Helio; NAHAS, William; DAVID-NETO, Elias; PIERROTTI, Ligia C.
- Amikacin Prophylaxis and Risk Factors for Surgical Site Infection After Kidney Transplantation(2015) FREIRE, Maristela P.; ANTONOPOULOS, Ioannis M.; PIOVESAN, Affonso Celso; MOURA, Maria L.; PAULA, Flavio Jota de; SPADAO, Fernanda; GUIMARAES, Thais; DAVID-NETO, Elias; NAHAS, William C.; PIERROTTI, Ligia C.Background. Antibiotic prophylaxis plays a major role in preventing surgical site infections (SSIs). This study aimed to evaluate antibiotic prophylaxis in kidney transplantation and identify risk factors for SSIs. Methods. We evaluated all kidney transplantation recipients from January 2009 and December 2012. We excluded patients who died within the first 72 hr after transplantation, were undergoing simultaneous transplantation of another organ, or were below 12 years of age. The main outcome measure was SSI during the first 60 days after transplantation. Results. A total of 819 kidney transplants recipients were evaluated, 65% of whom received a deceased-donor kidney. The antibiotics used as prophylaxis included cephalosporin, in 576 (70%) cases, and amikacin, in 233 (28%). We identified SSIs in 106 cases (13%), the causative agent being identified in 72 (68%). Among the isolated bacteria, infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae predominated. Multivariate analysis revealed that the risk factors for post-kidney transplantation SSIs were deceased donor, thin ureters at kidney transplantation, antithymocyte globulin induction therapy, blood transfusion at the transplantation procedure, high body mass index, and diabetes mellitus. The only factor associated with a reduction in the incidence of SSIs was amikacin use as antibiotic prophylaxis. Factors associated with reduced graft survival were: intraoperative blood transfusions, reoperation, human leukocyte antigen mismatch, use of nonstandard immunosuppression therapy, deceased donor, post-kidney transplantation SSIs, and delayed graft function. Conclusion. Amikacin prophylaxis is a useful strategy for preventing SSIs.
- Does the urinary tract infection caused by carbapenem-resistant Gram-negative bacilli impact the outcome of kidney transplant recipients?(2018) FREIRE, Maristela Pinheiro; MENDES, Clara V.; PIOVESAN, Affonso C.; PAULA, Flavio Jota de; SPADAO, Fernanda; NAHAS, Willian C.; DAVID-NETO, Elias; PIERROTTI, Ligia CameraThe incidence of urinary tract infection (UTI) after kidney transplantation (KT) caused by multidrug-resistant (MDR) bacteria is growing. The aim of this study was to analyze the impact of UTI caused by carbapenem-resistant Gram-negative bacteria (CR-GNB) in the survival of graft and recipients following KT. This was a retrospective cohort study involving patients who underwent KT between 2013 and 2016. Patients were followed since the day of the KT until loss of graft, death or end of the follow-up period (31th December 2016). The outcomes measured were UTI by MDR following KT and graft and patient survival. Analyses were performed using Cox regression; for the graft and patient survival analysis, we used a propensity score for UTI by CR-GNB to matching a control group. UTI was diagnosed in 178 (23.9%) of 781 patients, who developed 352 UTI episodes. 44.6% of the UTI cases were caused by MDR bacteria. Identified risk factors for UTI by MDR bacteria were DM, urologic disease as the cause of end-stage renal failure, insertion of ureteral stent, carbapenem use, and delayed graft function (DGF). Risk factors for death during the follow-up period were female gender, patients over 60years old at the time of KT, DM, body mass index over 31.8, UTI caused by CR-GNB. In conclusion, UTIs caused by CR-GNB have great impact on patients' survival after KT.
- De Novo Thrombotic Microangiopathy After Kidney Transplantation: Clinical Features, Treatment, and Long-Term Patient and Graft Survival(2012) CAIRES, R. A.; MARQUES, I. D. B.; REPIZO, L. P.; SATO, V. A. H.; CARMO, L. P. F.; MACHADO, D. J. B.; PAULA, F. J. de; NAHAS, W. C.; DAVID-NETO, E.Introduction. Posttransplant thrombotic microangiopathy (TMA)/hemolytic uremic syndrome (HUS) can occur as a recurrent or de novo disease. Methods. A retrospective single-center observational study was applied in order to examine the incidence and outcomes of de novo TMA/HUS among transplantations performed between 2000 and 2010. Recurrent HUS or antibody-mediated rejections were excluded. Results. Seventeen (1.1%) among 1549 kidney transplant recipients fulfilled criteria for de novo TMA. The mean follow-up was 572 days (range, 69-1769). Maintenance immunosuppression was prednisone, tacrolimus (TAC), and mycophenolic acid in 14 (82%) patients. Mean age at onset was 40 +/- 15 years, and serum creatinine was 6.1 +/- 4.1 mg/dL. TMA occurred at a median of 25 days (range, 1-1755) after transplantation. Nine (53%) patients developed TMA within 1 month of transplantation and only 12% after 1 year. Clinical features were anemia (hemoglobin < 10 g/dL) in 9 (53%) patients, thrombocytopenia in 7 (41%), and increased lactate dehydrogenase in 12 (70%). Decreased haptoglobin was observed in 64% and schistocytes in 35%. Calcineurin inhibitor (CM) withdrawal or reduction was the first step in the management of 10/15 (66%) patients, and 6 (35%) received fresh frozen plasma (FFP) and/or plasmapheresis. TAC was successfully reintroduced in six patients after a median of 17 days. Eight (47%) patients needed dialytic support after TMA diagnosis and 75% remained on dialysis. At 4 years of follow-up, death-censored graft survival was worse for TMA group (43.0% versus 85.6%, log-rank = 0.001; hazard ratio = 3.74) and there was no difference in patient survival (53.1% versus 82.2%, log-rank = 0.24). Conclusion. De novo TMA after kidney transplantation is a rare but severe condition with poor graft outcomes. This syndrome may not be fully manifested, and clinical suspicion is essential for early diagnosis and treatment, based mainly in CM withdrawal and FFP infusions and/or plasmapheresis.
conferenceObject Which Induction Therapy Should Be Used in Kidney Transplants with Prolonged Cold Ischemia Time?(2012) ARAUJO, M. J. C. L. N.; ONUSIC, V. L.; BATTAINI, L. C.; BARBOSA, E. A.; BOJIKIAN, R. T.; DAVID, D. R.; ANTONOPOULOS, I. M.; PAULA, F. Jota de; NAHAS, W. C.; NETO, E. D.; LEMOS, F. B. C.; CASTRO, M. C. Ribeiro de- Effect of polyoma viremia on 3-year allograft kidney function(2019) DAVID-NETO, Elias; AGENA, Fabiana; DAVID, Daisa Silva Ribeiro; PAULA, Flavio Jota de; PIERROTTI, Ligia Camera; FINK, Maria Cristina Domingues; AZEVEDO, Luiz Sergio Fonseca deBackground Polyoma viremia is associated with damage to renal tubular and urothelial cells. This may imply that a certain level of viremia, even cleared thereafter, could be associated with long-term renal dysfunction. Methods We, retrospectively, analyzed 390 first renal transplants adult recipients (>= 18 years) who were monitored for BK viremia in the first 12 months and evaluated estimated GFR (MDRD-4 equation) at 1 month and at the last follow-up (959 +/- 392 days). Results One hundred and ninety-nine patients (51%) developed at least one positive viremia: 105 (53%) low viremia (<10(4) copies/mL), 36 (18%) high viremia (4 x 10(4) > viremia >= 10(4) copies/mL) and 58 (15%) viremia (>= 4 x 10(4) copies/mL) consistent with polyoma virus associated nephropathy (PyVAN). Out of these 58 patients, 24 (6%) developed bx-proven (SV40+) PyVAN and 34(8.7%) presumptive PyVAN (SV40-). Baseline characteristics, immunosuppression, KDRI, rejection episodes, etc., did not differ among groups but there were more deceased donors and ATG induction therapy in the high viremia group. At last follow-up, all patients in the low, high viremia and presumptive PyVAN (except 2) had cleared BK viremia. Bx-proven PyVAN led to 14 graft losses, 10 due to PyVAN. In the presumptive PyVAN there was only one graft loss registered as due to PyVAN. eGFR, at 1 month after KTx, did not differ among groups (51 +/- 22 vs 48 +/- 24 vs 45 +/- 27 vs 43 +/- 18 vs 46 +/- 22 mL/min/1.73 m(2)), for no, low and high viremia as well for presumptive PyVAN and bx-proven PyVAN groups, respectively. At the last follow-up, eGFR did not differ between the no, low, and high viremia compared to baseline and to each other but was statistically lower in the presumptive and bx-proven PyVAN (38 +/- 15 and 17 +/- 7 mL/min/1.73 m(2)) either compared to baseline or to the other groups. Conclusions This study shows that low and high levels of BK viremia do not lead to GFR changes although very high viremia levels, compatible with presumptive or bx-proven PyVAN, even if cleared thereafter, lead to allograft damage and decreased GFR.