MARCOS NAOYUKI SAMANO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
- Lung transplantation: overall approach regarding its major aspects(2015) CAMARGO, Priscila Cilene Leon Bueno de; TEIXEIRA, Ricardo Henrique de Oliveira Braga; CARRARO, Rafael Medeiros; CAMPOS, Silvia Vidal; AFONSO JUNIOR, Jose Eduardo; COSTA, Andre Nathan; FERNANDES, Lucas Matos; ABDALLA, Luis Gustavo; SAMANO, Marcos Naoyuki; PEGO-FERNANDES, Paulo ManuelO transplante pulmonar é uma terapia bem estabelecida para pacientes com doença pulmonar avançada.A avaliação do candidato para o transplante é uma tarefa complexa e envolve uma equipe multidisciplinar que acompanha o paciente para além do período pós-operatório.O tempo médio atual em lista de espera para transplante pulmonar é de aproximadamente 18 meses no estado de São Paulo. Em 2014, dados da Associação Brasileira de Transplante de Órgãos mostram que 67 transplantes pulmonares foram realizados no Brasil e que 204 pacientes estavam na lista de espera para transplante pulmonar.O transplante pulmonar é principalmente indicado no tratamento de DPOC, fibrose cística, doença intersticial pulmonar, bronquiectasia não fibrocística e hipertensão pulmonar.Esta revisão abrangente teve como objetivos abordar os aspectos principais relacionados ao transplante pulmonar: indicações, contraindicações, avaliação do candidato ao transplante, avaliação do candidato doador, gestão do paciente transplantado e complicações maiores. Para atingirmos tais objetivos, utilizamos como base as diretrizes da Sociedade Internacional de Transplante de Coração e Pulmão e nos protocolos de nosso Grupo de Transplante Pulmonar localizado na cidade de São Paulo.
- Cytokine levels in pleural fluid as markers of acute rejection after lung transplantation(2014) CAMARGO, Priscila Cilene Leon Bueno de; AFONSO JR., Jose Eduardo; SAMANO, Marcos Naoyuki; ACENCIO, Milena Marques Pagliarelli; ANTONANGELO, Leila; TEIXEIRA, Ricardo Henrique de Oliveira BragaOur objective was to determine the levels of lactate dehydrogenase, IL-6, IL-8, and VEGF, as well as the total and differential cell counts, in the pleural fluid of lung transplant recipients, correlating those levels with the occurrence and severity of rejection. We analyzed pleural fluid samples collected from 18 patients at various time points (up to postoperative day 4). The levels of IL-6, IL-8, and VEGF tended to elevate in parallel with increases in the severity of rejection. Our results suggest that these levels are markers of acute graft rejection in lung transplant recipients.
- Stents for Bronchial Stenosis After Lung Transplantation: Should They Be Removed?(2015) FONESCA, H. V. S.; IUAMOTO, L. R.; MINAMOTO, H.; ABDALLA, L. G.; FERNANDES, L. M.; CAMARGO, P. C. L.; SAMANO, M. N.; PEGO-FERNANDES, P. M.Background. Airway complications after lung transplantation are the major cause of morbidity, affecting up to 33% of all cases. Bronchial stenosis is the most common complication. The use of stents has been established as the most effective therapy; however, their removal is recommended after 3-6 months of use. We have been using self-expandable stents as a definitive treatment and remove them only if necessary. For this report, we evaluated the use of self-expandable stents as a definitive treatment for bronchial stenosis after lung transplantation. Methods. We performed a retrospective cohort study to evaluate patients with bronchial stenosis from August 2003 to April 2014. Clinical and pulmonary function test data were collected. Results. Two hundred lung transplants were performed, 156 of which were bilateral. Sixteen patients experienced airway complications: 4 had dehiscence, 2 necrosis, and 10 bronchial stenosis. Of these patients, 7 had undergone bilateral procedures, and 2 patients developed stenosis in both sides. Twelve anastomotic stenoses were observed. The follow-up after stenting ranged from 1 to 7 years. All patients had increased lung function, and 4 remained stable with sustained increase in pulmonary function without episodes of infection. Three patients required removal of their prosthesis 6 months to 1 year after implantation because of complications. Two patients died owing to unrelated causes. Conclusions. Definitive treatment of bronchial stenosis with self-expandable stents is a viable option. The 1st year seems to be the most crucial for determining definitive treatment, because no patients required removal of their stent after 1 year.
Inpatient Management of the Acutely Decompensating Lung Transplant Candidate
(2022) SODER, Stephan A.; FONTENA, Eduardo; SALGADO, Juan C.; SHAHMOHAMMADI, Abbas; SAMANO, Marcos N.; MACHUCA, Tiago N.- Respiratory failure after lung transplantation: extracorporeal membrane oxygenation as a rescue treatment(2012) PEGO-FERNANDES, Paulo Manuel; HAJJAR, Ludhmila Abrahao; GALAS, Filomena Regina Barbosa Gomes; SAMANO, Marcos Naoyuki; RIBEIRO, Alexandre Kazantzi Fonseca; PARK, Marcelo; SOARES, Rodolfo; OSAWA, Eduardo; JATENE, Fabio Biscegli
- Alternative solution for ex vivo lung perfusion, experimental study on donated human lungs non-accepted for transplantation(2015) FERNANDES, Lucas Matos; MARIANI, Alessandro Wasum; MEDEIROS, Israel Lopes de; SAMANO, Marcos Naoyuki; ABDALLA, Luís Gustavo; CORREIA, Aristides Tadeu; NEPOMUCENO, Natália Aparecida; CANZIAN, Mauro; PêGO-FERNANDES, Paulo ManuelPURPOSE: To evaluate a new perfusate solution to be used for ex vivo lung perfusion. METHODS: Randomized experimental study using lungs from rejected brain-dead donors harvested and submitted to 1 hour of ex vivo lung perfusion (EVLP) using mainstream solution or the alternative. RESULTS: From 16 lungs blocs tested, we found no difference on weight after EVLP: Steen group (SG) = 1,097±526g; Alternative Perfusion Solution (APS) = 743±248g, p=0.163. Edema formation, assessed by Wet/dry weigh ratio, was statistically higher on the Alternative Perfusion Solution group (APS = 3.63 ± 1.26; SG = 2.06 ± 0.28; p = 0.009). No difference on PaO2 after EVLP (SG = 498±37.53mmHg; APS = 521±55.43mmHg, p=0.348, nor on histological analyses: pulmonary injury score: SG = 4.38±1.51; APS = 4.50±1.77, p=0.881; apoptotic cells count after perfusion: SG = 2.4 ± 2.0 cells/mm2; APS = 4.8 ± 6.9 cells/mm2; p = 0.361). CONCLUSION: The ex vivo lung perfusion using the alternative perfusion solution showed no functional or histological differences, except for a higher edema formation, from the EVLP using Steen Solution(r) on lungs from rejected brain-dead donors.
- Avaliação e recondicionamento de pulmões doados para transplante por meio da perfusão pulmonar ex vivo(2019) ABDALLA, Luis Gustavo; OLIVEIRA-BRAGA, Karina Andrighetti de; FERNANDES, Lucas Matos; SAMANO, Marcos Naoyuki; CAMERINI, Paula Refinetti; PEGO-FERNANDES, Paulo ManuelObjective: To assess the feasibility and impact of ex vivo lung perfusion with hyperoncotic solution (Steen Solution (TM)) in the utilization of these organs in Brazil. Methods: In this prospective study, we subjected five lungs considered to be high risk for transplantation to 4 hours of ex vivo lung perfusion, with evaluation of oxygenation capacity. High-risk donor lungs were defined by specific criteria, including inflammatory infiltrates, pulmonary edema and partial pressure of arterial oxygen less than 300mmHg (inspired oxygen fraction of 100%). Results: During reperfusion, the mean partial pressure of arterial oxygen (inspired oxygen fraction of 100%) of the lungs did not change significantly (p=0.315). In the first hour, the mean partial pressure of arterial oxygen was 302.7mmHg (+/- 127.66mmHg); in the second hour, 214.2mmHg (+/- 94.12mmHg); in the third hour, 214.4mmHg (+/- 99.70mmHg); and in the fourth hour, 217.7mmHg (+/- 73.93mmHg). Plasma levels of lactate and glucose remained stable during perfusion, with no statistical difference between the moments studied (p=0.216). Conclusion: Ex vivo lung perfusion was reproduced in our center and ensured the preservation of lungs during the study period, which was 4 hours. The technique did not provide enough improvement for indicating organs for transplantation; therefore, it did not impact on use of these organs.
- Ex vivo lung perfusion in Brazil(2016) ABDALLA, Luis Gustavo; BRAGA, Karina Andrighetti de Oliveira; NEPOMUCENO, Natalia Aparecida; FERNANDES, Lucas Matos; SAMANO, Marcos Naoyuki; PEGO-FERNANDES, Paulo ManuelObjetivo: Avaliar o emprego da técnica de perfusão pulmonar ex vivo (PPEV) clinicamente com a finalidade de transplante. Métodos: Estudo prospectivo envolvendo o recondicionamento de pulmões limítrofes, definidos por critérios específicos, tais como relação PaO2/FiO2 < 300 mmHg, com um sistema de PPEV. Entre fevereiro de 2013 e fevereiro de 2014, os pulmões de cinco doadores foram submetidos à PPEV por até 4 h. Durante a PPEV, a mecânica pulmonar foi avaliada continuamente. Amostras do perfusato foram colhidas a cada hora, assim como foi realizada a avaliação funcional dos órgãos. Resultados: A média de PaO2 dos pulmões captados foi de 262,9 ± 119,7 mmHg, sendo que, ao final da terceira hora de perfusão, essa foi de 357,0 ±108,5 mmHg. A capacidade de oxigenação dos pulmões apresentou discreta melhora durante a PPEV nas primeiras 3 h (246,1 ± 35,1; 257,9 ± 48,9; e 288,8 ± 120,5 mmHg, respectivamente), sem diferenças significativas entre os momentos (p = 0,508). As médias de complacência estática foram de, respectivamente, 63.0 ± 18,7; 75,6 ± 25,4; e 70,4 ± 28,0 mmHg após 1, 2 e 3 h, com melhora significativa entre a hora 1 e 2 (p = 0,029), mas não entre a hora 2 e 3 (p = 0,059). A resistência vascular pulmonar permaneceu estável durante a PPEV, sem diferenças entre os momentos (p = 0,284). Conclusões: Os pulmões avaliados permaneceram em condições fisiológicas de preservação; no entanto, o protocolo não foi efetivo para promover a melhora na função pulmonar, inviabilizando o transplante
- Effect of methylprednisolone on perivascular pulmonary edema, inflammatory infiltrate, VEGF and TGF-beta immunoexpression in the remaining lungs of rats after left pneumonectomy(2011) GUIMARAES-FERNANDES, F.; SAMANO, M. N.; VIEIRA, R. P.; CARVALHO, C. R.; PAZETTI, R.; MOREIRA, L. F. P.; PEGO-FERNANDES, P. M.; JATENE, F. B.Pneumonectomy is associated with high rates of morbimortality, with postpneumonectomy pulmonary edema being one of the leading causes. An intrinsic inflammatory process following the operation has been considered in its physiopathology. The use of corticosteroids is related to prevention of this edema, but no experimental data are available to support this hypothesis. We evaluated the effect of methylprednisolone on the remaining lungs of rats submitted to left pneumonectomy concerning edema and inflammatory markers. Forty male Wistar rats weighing 300 g underwent left pneumonectomy and were randomized to receive corticosteroids or not. Methylprednisolone at a dose of 10 mg/kg was given before the surgery. After recovery, the animals were sacrificed at 48 and 72 h, when the pO(2)/FiO(2) ratio was determined. Right lung perivascular edema was measured by the index between perivascular and vascular area and neutrophil density by manual count. Tissue expression of vascular endothelial growth factor (VEGF) and transforming growth factor-beta (TGF-beta) were evaluated by immunohistochemistry light microscopy. There was perivascular edema formation after 72 h in both groups (P = 0.0031). No difference was observed between operated animals that received corticosteroids and those that did not concerning the pO(2)/FiO(2) ratio, neutrophil density or TGF-beta expression. The tissue expression of VEGF was elevated in the animals that received methylprednisolone both 48 and 72 h after surgery (P = 0.0243). Methylprednisolone was unable to enhance gas exchange and avoid an inflammatory infiltrate and TGF-beta expression also showed that the inflammatory process was not correlated with pulmonary edema formation. However, the overexpression of VEGF in this group showed that methylprednisolone is related to this elevation.
- Experience of Lung Transplantation in Patients with Lymphangioleiomyomatosis at a Brazilian Reference Centre(2017) BALDI, Bruno Guedes; SAMANO, Marcos Naoyuki; CAMPOS, Silvia Vidal; OLIVEIRA, Martina Rodrigues de; AFONSO JUNIOR, Jose Eduardo; CARRARO, Rafael Medeiros; TEIXEIRA, Ricardo Henrique Oliveira Braga; MINGUINI, Isabela Pasqualini; BURLINA, Roni; PATO, Eduardo Zinoni Silva; CARVALHO, Carlos Roberto Ribeiro; COSTA, Andre NathanLung transplantation (LT) is the standard of care for patients with advanced lung diseases, including lymphangioleiomyomatosis (LAM). LAM accounts for only 1% of all LTs performed in the international registry. As a result, the global experience, including the use of mechanistic target of rapamycin (mTOR) inhibitors before and after LT in LAM, is still limited. We conducted a retrospective review of all LAM patients who underwent LT at our centre between 2003 and 2016. Pre- and post-transplant data were assessed. Eleven women with LAM underwent LT, representing 3.3% of all procedures. Ten (91%) patients underwent double-LT. The mean age at diagnosis was 39 +/- 6 years and the mean FEV1 before LT was 28 +/- 14%. Only one patient underwent pleurodesis for recurrent pneumothorax. Pulmonary hypertension was confirmed in 3 (27%) patients. Four (36%) patients received sirolimus preoperatively; three of them received it until the day of LT, and there was no occurrence of bronchial anastomotic dehiscence after the procedure. Four patients (36%) received mTOR inhibitors post-transplant. The median follow-up from LT was 44 months. There were 3 deaths (27%) during the study and survival probabilities at 1, 3, and 5 years after LT were, 90, 90, and 77%, respectively. This data reinforces the role of LT for LAM patients with end-stage disease. The use of sirolimus seems to be safe before LT and the occurrence of complications after LT, including those LAM-related, should be continuously monitored.