DEBORA RAQUEL BENEDITA TERRABUIO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
32 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 32
- Anti-mitochondrial Antibody-Negative Primary Biliary Cholangitis Is Part of the Same Spectrum of Classical Primary Biliary Cholangitis(2022) CANCADO, Guilherme Grossi Lopes; BRAGA, Michelle Harriz; FERRAZ, Maria Lucia Gomes; VILLELA-NOGUEIRA, Cristiane Alves; TERRABUIO, Debora Raquel Benedita; CANCADO, Eduardo Luiz Rachid; NARDELLI, Mateus Jorge; FARIA, Luciana Costa; GOMES, Nathalia Mota de Faria; OLIVEIRA, Elze Maria Gomes; ROTMAN, Vivian; OLIVEIRA, Maria Beatriz; CUNHA, Simone Muniz Carvalho Fernandes da; CUNHA-SILVA, Marlone; MENDES, Liliana Sampaio Costa; IVANTES, Claudia Alexandra Pontes; CODES, Liana; BORGES, Valeria Ferreira; PACE, Fabio Heleno de Lima; PESSOA, Mario Guimaraes; SIGNORELLI, Izabelle Venturini; CORAL, Gabriela Perdomo; BITTENCOURT, Paulo Lisboa; LEVY, Cynthia; COUTO, Claudia AlvesBackground Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease in which anti-mitochondrial antibodies (AMA) are the diagnostic hallmark. Whether AMA-negative PBC patients represent a different phenotype of disease is highly debated. Aims The purpose of our study was to compare AMA-positive and AMA-negative PBC patients in a large non-white admixed Brazilian cohort. Methods The Brazilian Cholestasis Study Group multicentre database was reviewed to assess demographics, clinical features and treatment outcomes of Brazilian PBC patients, stratifying data according to AMA status. Results A total of 464 subjects (95.4% females, mean age 56 +/- 5 years) with PBC were included. Three hundred and eighty-four (83%) subjects were AMA-positive, whereas 80 (17%) had AMA-negative PBC. Subjects with AMA-negative PBC were significantly younger (52.2 +/- 14 vs. 59.6 +/- 11 years, p = 0.001) and had their first symptom at an earlier age (43.2 +/- 13 vs. 49.5 +/- 12 years, p = 0.005). Frequency of type 2 diabetes was significantly increased in subjects with AMA-negative PBC (22.5% vs. 12.2%, p = 0.03). Lower IgM (272.2 +/- 183 vs. 383.2 +/- 378 mg/dL, p = 0.01) and triglycerides (107.6 +/- 59.8 vs.129.3 +/- 75.7 mg/dL, p = 0.025) and higher bilirubin (3.8 +/- 13.5 vs. 1.8 +/- 3.4 mg/dL, p = 0.02) levels were also observed in this subgroup. Response to ursodeoxycholic acid varied from 40.5 to 63.3% in AMA-positive and 34 to 62.3% in AMA-negative individuals, according to different response criteria. Outcomes such as development of liver-related complications, death and requirement for liver transplantation were similar in both groups. Conclusions AMA-negative PBC patients are similar to their AMA-positive counterparts with subtle differences observed in clinical and laboratory features.
- Risk factors and outcomes associated with recurrent autoimmune hepatitis following liver transplantation(2022) MONTANO-LOZA, Aldo J.; RONCA, Vincenzo; EBADI, Maryam; HANSEN, Bettina E.; HIRSCHFIELD, Gideon; ELWIR, Saleh; ALSAED, Mohamad; MILKIEWICZ, Piotr; JANIK, Maciej K.; MARSCHALL, Hanns-Ulrich; BURZA, Maria Antonella; EFE, Cumali; CALISKAN, Ali Riza; HARPUTLUOGLU, Murat; KABACAM, Gokhan; TERRABUIO, Debora; ONOFRIO, Fernanda de Quadros; SELZNER, Nazia; BONDER, Alan; PARES, Albert; LLOVET, Laura; AKYILDIZ, Murat; ARIKAN, Cigdem; MANNS, Michael P.; TAUBERT, Richard; WEBER, Anna-Lena; SCHIANO, Thomas D.; HAYDEL, Brandy; CZUBKOWSKI, Piotr; SOCHA, Piotr; OLDAK, Natalia; AKAMATSU, Nobuhisa; TANAKA, Atsushi; LEVY, Cynthia; MARTIN, Eric F.; GOEL, Aparna; SEDKI, Mai; JANKOWSKA, Irena; IKEGAMI, Toru; RODRIGUEZ, Maria; STERNECK, Martina; WEILER-NORMANN, Christina; SCHRAMM, Christoph; DONATO, Maria Francesca; LOHSE, Ansgar; ANDRADE, Raul J.; PATWARDHAN, Vilas R.; HOEK, Bart van; BIEWENGA, Maaike; KREMER, Andreas E.; UEDA, Yoshihide; DENEAU, Mark; PEDERSEN, Mark; MAYO, Marlyn J.; FLOREANI, Annarosa; BURRA, Patrizia; SECCHI, Maria Francesca; BERETTA-PICCOLI, Benedetta Terziroli; SCIVERES, Marco; MAGGIORE, Giuseppe; JAFRI, Syed-Mohammed; DEBRAY, Dominique; GIRARD, Muriel; LACAILLE, Florence; LYTVYAK, Ellina; MASON, Andrew L.; HENEGHAN, Michael; OO, Ye HtunBackground & Aims: Autoimmune hepatitis can recur after liver transplantation (LT), though the impact of recurrence on patient and graft survival has not been well characterized. We evaluated a large, international, multicenter cohort to identify the probability and risk factors associated with recurrent AIH and the association between recurrent disease and patient and graft survival. Methods: We included 736 patients (77% female, mean age 42 +/- 1 years) with AIH who underwent LT from January 1987 through June 2020, among 33 centers in North America, South America, Europe and Asia. Clinical data before and after LT, biochemical data within the first 12 months after LT, and immunosuppression after LT were analyzed to identify patients at higher risk of AIH recurrence based on histological diagnosis. Results: AIH recurred in 20% of patients after 5 years and 31% after 10 years. Age at LT <= 42 years (hazard ratio [HR] 3.15; 95% CI 1.22-8.16; p = 0.02), use of mycophenolate mofetil post-LT (HR 3.06; 95% CI 1.39-6.73; p = 0.005), donor and recipient sex mismatch (HR 2.57; 95% CI 1.39-4.76; p = 0.003) and high IgG pre-LT (HR 1.04; 95% CI 1.01-1.06; p = 0.004) were associated with higher risk of AIH recurrence after adjusting for other confounders. In multivariate Cox regression, recurrent AIH (as a time-dependent covariate) was significantly associated with graft loss (HR 10.79, 95% CI 5.37-21.66, p <0.001) and death (HR 2.53, 95% CI 1.48-4.33, p = 0.001). Conclusion: Recurrence of AIH following transplant is frequent and is associated with younger age at LT, use of mycophenolate mofetil post-LT, sex mismatch and high IgG pre-LT. We demonstrate an association between disease recurrence and impaired graft and overall survival in patients with AIH, highlighting the importance of ongoing efforts to better characterize, prevent and treat recurrent AIH. Lay summary: Recurrent autoimmune hepatitis following liver transplant is frequent and is associated with some recipient features and the type of immunosuppressive medications use. Recurrent autoimmune hepatitis negatively affects outcomes after liver transplantation. Thus, improved measures are required to prevent and treat this condition.
- COST EFFECTIVENESS OF USING TERLIPRESSIN TO TREAT HEPATORENAL SYNDROME(2022) FERREIRA, Luciana Marcondes; TERRABUIO, Débora Raquel; FERREIRA, Caroline Marcondes; MAZO, Daniel Ferraz de Campos; HADDAD, Luciana Bertocco de PaivaABSTRACT Background Hepatorenal syndrome (HRS) is the most severe form of acute kidney injury in patients with advanced cirrhosis, and it is associated with high mortality. It is usually diagnosed according to criteria defined by the International Ascites Club. Currently, the most frequently indicated pharmacological therapy for the treatment of HRS is a combination of splanchnic vasoconstrictors (terlipressin or norepinephrine) in combination with albumin. With the progressive increase in healthcare spending, it is important to conduct a cost-effectiveness analysis of pharmacological treatment in patients who are diagnosed with HRS. Objective: To perform a cost-effectiveness assessment for the use of terlipressin in combination with albumin to treat HRS in patients with cirrhosis. Methods: Economic evaluation of cost-effectiveness based on secondary data from studies showed the efficacy of terlipressin therapy compared with norepinephrine combined with albumin or albumin alone. The cost-effectiveness analysis was calculated using an incremental cost-effectiveness ratio (ICER), and a sensitivity analysis was developed by varying the values of therapies and probabilities. The Brazilian real was the currency used in the analysis, and the results were converted to US dollars. Results: After selection, eligibility, and evaluation of the quality of publications, the results demonstrated that administration of terlipressin or norepinephrine in combination with albumin in patients diagnosed with HRS type 1 was efficacious. The cost of treatment with terlipressin in combination with albumin was USD $1,644.06, administration of albumin alone was USD $912.02, and norepinephrine plus albumin was USD $2,310.78. Considering that the combination therapies demonstrated effectiveness, the incremental cost of terlipressin and norepinephrine in combination with albumin was USD $666.73, and an effectiveness of 0.570 was found for terlipressin in combination with albumin and 0.200 for norepinephrine in combination with albumin. The incremental effectiveness was 0.370, and the ICER was USD $1,801.97. Thus, the parameters of increasing cost per therapy and ICER indicated that the combined therapy of terlipressin plus albumin was cost effective compared to albumin alone or norepinephrine plus albumin in a public single-payer healthcare system. Conclusion: A cost-effectiveness analysis showed that terlipressin in combination with albumin when administered concomitantly to patients who were diagnosed with type 1 HRS is cost-effective compared to norepinephrine in combination with albumin administered in a controlled environment.
- Liver elastography can predict degree of advanced fibrosis for autoimmune hepatitis in biochemical remission(2023) PARANAGUA-VEZOZZO, Denise Cerqueira; TERRABUIO, Debora Raquel Benedita; REINOSO-PEREIRA, Gleicy Luz; MOUTINHO, Renata; ONO, Suzane Kioko; SALAS, Veronica Walwyn; FRANCA, Joao Italo Dias; ALVES, Venancio Avancini Ferreira; CANCADO, Eduardo Luiz Rachid; CARRILHO, Flair JoseBackground and AimThe aim was to analyze the concordance of liver stiffness measurement (LSM) either by transient elastography (TE) or ARFI with liver biopsy in autoimmune hepatitis (AIH) patients with biochemical remission and to identify those with histological remission. Liver biopsy is still the golden standard for AIH diagnosis. However, it is an invasive procedure and these patients, most of the time, require many biopsies, so it would be valuable to search for noninvasive method that could select all these patients and keep under observation. MethodsThirty-three patients with AIH were submitted for liver biopsy to evaluate histological remission after at least 18 months of normal aminotransferases. The efficiency of LSM and fibrosis stages was tested by a receiver operating characteristic curve analysis (AUROC). ResultsOne patient (3%) was F0, 6 (18.2%) were F1, 8 (24.2%) were F2, 10 (30.3%) were F3, and 8 (24.2%) were F4, according to METAVIR. Thirteen of thirty-three (39.4%) patients did not achieve histological remission. AUROC for F4 stage was 0.83 (IC: 0.76-0.99) for TE and 0.78 (IC: 0.65-0.95) for ARFI. Optimal LSM cutoff values were 12.3 kPa (Se = 87.5%, Sp = 88%) for TE and 1.65 m/s (Se = 87.5%, Sp = 76%) for ARFI. The tests were unable to differentiate patients with histological activity from those in histological remission (P < 0.05). ConclusionTE and ARFI accurately identify liver fibrosis by METAVIR score in AIH patients with biochemical remission. No cutoff value was detected to indicate whether the patient achieved histological remission.
- Chloroquine in monotherapy is safe and effective for induction of remission in anti-SLA/LP positive patients with autoimmune hepatitis(2018) TERRABUIO, D.; EVANGELISTA, A. S.; GUEDES, A. L. V.; GALVAO, A. R. de Moreto Longo; CARRILHO, F. J.; CANCADO, E.
conferenceObject FACTORS ASSOCIATED WITH RECURRENCE OF AUTOIMMUNE HEPATITIS AFTER LIVER TRANSPLANTATION AND EFFECTS ON GRAFT AND PATIENT SURVIVAL(2019) MONTANO-LOZA, Aldo J.; EBADI, Maryam; HANSEN, Bettina E.; HIRSCHFIELD, Gideon; MASON, Andrew L.; MILKIEWICZ, Piotr; JANIK, Maciej; MARSCHALL, Hanns-Ulrich; BURZA, Maria Antonella; PARES, Albert; LLOVET, Laura Patricia; TERRABUIO, Debora; AKYILDIZ, Murat; ARIKAN, Cigdem; LIBERAL, Rodrigo; KERKAR, Nanda; BOER, Ynte S.; LOHSE, Ansgar W.; DRENTH, Joost P. H.; FLOREANI, Annarosa; CZUBKOWSKI, Piotr; SOCHA, Piotr; OLDAK, Natalia; BELLIDO, Raul Jesus Andrade; BURRA, Patrizia; SECCHI, Maria Francesca; LYTVYAK, Ellina; JANKOWSKA, Irena; RODRIGUEZ, Maria; STERNECK, Martina; WEILER-NORMANN, Christina; SCHRAMM, Christoph; TERZIROLI, Benedetta; SCHIANO, Thomas D.; HAYDEL, Brandy; DEBRAY, Dominique; GIRAND, Muriel; LACAILLE, Florence; DONATO, Maria Francesca; AKAMATSU, Nobuhisa; TANAKA, Atsushi; IKEGAMI, Toru; UEDA, Yoshihide; VERGANI, Diego; HENEGHAN, Michael A.- Anti-ribosomal P protein: a novel antibody in autoimmune hepatitis(2013) CALICH, Ana L.; VIANA, Vilma S. T.; CANCADO, Eduardo; TUSTUMI, Francisco; TERRABUIO, Debora R. B.; LEON, Elaine P.; SILVA, Clovis A.; BORBA, Eduardo F.; BONFA, EloisaBackground Autoantibodies to ribosomal P proteins (anti-rib P) are specific serological markers for systemic lupus erythematosus (SLE) and are associated with liver involvement in this disease. The similarity in autoimmune background between autoimmune hepatitis (AIH) and SLE-associated hepatitis raises the possibility that anti-rib P antibodies might also have relevance in AIH. Aims To evaluate the frequency and clinical significance of anti-rib P antibodies in a large AIH cohort. Methods Sera obtained at diagnosis of 96 AIH patients and of 82 healthy controls were tested for IgG anti-ribosomal P protein by ELISA. All of the sera were also screened for other lupus-specific autoantibodies, three patients with the presence of anti-dsDNA (n=1) and anti-Sm (n=2) were excluded. Results Moderate to high titres (>40U) of anti-rib P antibody were found in 9.7% (9/93) of the AIH patients and none of the controls (P=0.003). At presentation, AIH patients with and without anti-rib P antibodies had similar demographic/clinical features, including the frequency of cirrhosis (44.4 vs. 28.5%, P=0.44), hepatic laboratorial findings (0.05). Importantly, at the final observation (follow-up period 10.2 +/- 4.9years), the AIH patients with anti-rib P had a significantly higher frequency of cirrhosis compared with the negative group (100 vs. 60%, P=0.04). Conclusion The novel demonstration of anti-rib P in AIH patients without clinical or laboratory evidence of SLE suggests a common underlying mechanism targeting the liver in these two diseases. In addition, this antibody appears to predict the patients with worse AIH prognoses.
conferenceObject Transient Elastography (TE) And Acoustic Radiation Force Impulse Imaging (ARFI) Can Predict Degree Of Advanced Fibrosis For Autoimmune Hepatitis In Biochemical Remission(2017) PARANAGUA-VEZOZZO, Denise; TERRABUIO, Debora R.; MOUTINHO, Renata D.; CANCADO, Eduardo L.; ONO, Suzane; SALAS, Veronica; CARRILHO, Flair; ALVES, Venancio FerreiraconferenceObject Inflammatory Bowel Diseases and Autoimmune Hepatitis: Is Anti-TNF Therapy an Option?(2019) ROCHA, Beatriz; QUEIROZ, Natalia; AZEVEDO, Matheus; ALEXANDRE, Carlos; MILANI, Luciane; CANCADO, Eduardo; TERRABUIO, Debora; BARROS, Luisa; OBA, Jane; LEITE, Andre; SIPAHI, Aytan; DAMIAO, Aderson- Coronavirus Disease 2019 in the Early Postoperative Period of Liver Transplantation: Is the Outcome Really So Positive?(2021) WAISBERG, Daniel Reis; ABDALA, Edson; NACIF, Lucas Souto; DUCATTI, Liliana; HADDAD, Luciana Bertocco; MARTINO, Rodrigo Bronze; PINHEIRO, Rafael Soares; ARANTES, Rubens Macedo; GALVAO, Flavio Henrique; GOUVEIA, Larissa Nunes; TERRABUIO, Debora Raquel; DARCE, George Felipe; ROCHA-SANTOS, Vinicius; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto