MARIA HELENA VAISBICH
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject PEDIATRIC KIDNEY TRANSPLANTATION: STUDYING DONOR AND RECIPIENT CHARACTERISTICS ON LONG-TERM OUTCOMES(2013) TORRICELLI, Fabio C. M.; MESSI, Gustavo B.; ANTONOPOULOS, Ioannis M.; PIOVESAN, Affonso C.; FALCI JR., Renato; KANASHIRO, Hideki; EBAID, Gustavo X.; SCHVARTSMAN, Benita G. S.; WATANABE, Andreia; VAISBICH, Maria H.; DAVID-NETO, Elias; NAHAS, William C.PURPOSE: To study donor and recipient characteristics on graft and pediatric patient survival rates. METHOD: We retrospectively reviewed 287 electronic charts of patients (under 18 year-old) underwent kidney transplantation from 01/1985 to 10/2012. Outcomes were analyzed based on the type of donor (deceased vs. living kidney donor) and recipient ESRD cause (nephrological vs. urological disease). The outcomes from recipients of deceased donors were also analyzed based on age of donors (< 17 vs. ≥ 18 years). Thereafter, the outcomes from first transplant and retransplant were compared apart. Graft and patient survival rates were compared with Kaplan-Meier curve and analyzed with Log-rank test. RESULTS: There were 309 pediatric kidney transplants in 287 children. 274 were first, 33 were second, and 2 were third grafts. 193 of 274 (67.2%) and 18 of 33 (54.5%) were living kidney transplantation. 62% of deceased donors were under 17 year-old. Regarding ESRD 195 (68%) patients presented with a nephrological cause, while 92 (32%) presented with a urological one. Of those with a urological cause, 28 (30.4%) underwent bladder augmentation. Mean follow-up was 13.7 (0–27) years. Overall, graft survival rate in one, 5 and 10 years of follow-up was 90.1%, 73.2% and 57.9%, while patient survival rate was 96.0%, 91.9% and 87.2%, respectively. There was a tendency of a higher graft survival rate in children with living kidney donors (p=0.058). There was no difference in the outcomes from first and second transplant, except by a higher immunological graft loss in retransplant group (p=0.032). There was also no difference in the graft survival rates regarding age of donor (p=0.630) and recipient ESRD cause (p=0.890). CONCLUSION: Long-term outcomes from pediatric kidney transplantation are not related to age of donor and recipient ESRD cause, since the urogenital abnormality has been corrected. Living kidney transplantation seems to present a higher graft survival rate.- POSTOPERATIVE OUTCOME OF PEDIATRIC PATIENTS UNDERGOING RENAL TRANSPLANTATION(2013) PADOVAN, Fabiola Lucia; COUTO, Saulo Brasil do; PINTO, Gabriela; MENEZES, Aline Motta; SAKITA, Luciana Henrique dos Santos; METRAN, Camila Cardoso; SILVA, Joao Domingos Montoni da; WATANABE, Andreia; VAISBICH, Maria Helena; DELGADO, Arthur Figueiredo; NAHAS, William Carlos; SCHVARTSMAN, Benita Galassi SoaresBJECTIVE: To evaluate the postoperative outcome in the Intensive Care Unit (ICU) in the first month after kidney transplant. PATIENTS AND METHODS: Thirty-two patients (33 transplants), 21 male, age: 9.5 ± 3.1 yrs. Retrospective study from July/2008 to March/2012 through the variables: cold ischemia time, PRISM, mechanical ventilation (MV), vasoactive drugs (VAD), immunosuppression, infection, surgical complications, dialysis, renal function (CrCl), diuresis, hospitalization length and mortality. Statistics: Fischer and Pearson. RESULTS: Causes of CKF: uropathy-19, glomerulopathy-3, tubulopathy-2, other-7. Cold ischemia: 20hs median. PRISM score: 1.3% (0.2–6.2%), FiO2 max: 30% (21–60%), MV: 1d (0–10d), VAD 18/33 1D(0–6d). 10/33 transplants used thymoglobulin, 23/33 basiliximab. Infections: catheter-related-4, urinary-2,peritonitis-2, sepsis-1. Surgical complications: bleeding-4, thrombosis-3, urinary fistula-1. Of 5/32 dialyzed. CrCl and diuresis first postoperative day: 20 mL/min/1.73 m2 and 3.6 mL/kg/h and at 30 days: 90 mL/min/1.73 m2 and 3.7 mL/kg/h. There was an inverse correlation between cold ischemia time and CrCl in the 1st postoperative day (p = 0.01 and r = 0.45), not seen at 30d. Hospitalization length ICU = 4d (2–23d), total 15d (5 – 45d). There was no difference in infection, MV duration, use of VAD, CrCl, ICU and total hospitalization length between thymoglobulin X basiliximab use (p > 0.05). However duration of VAD utilization was higher for Thymoglobulin (p = 0.05). One patient died from sepsis (3%). CONCLUSION: The outcome after renal transplantation was satisfactory, with short ICU stay, but high use of vasoactive drugs. Bleeding was the most common surgical complication. The patient and graft survival after 1 month of transplantation was 97% and 91%, respectively.
conferenceObject LONG-TERM FOLLOW-UP OF RENAL TRANSPLANTATION PLUS CYSTEAMINE FOR CYSTINOSIS - THE GRAFT GOES WELL, THE PATIENT NOT AS MUCH.(2013) VAISBICH, Maria Helena; SULETRONI, Vivian; SCHVARTSMAN, Benita Galassi Soares; NAHAS, William Carlos; DAVID-NETO, Elias- Uso do eculizumab na síndrome hemolítica urêmica atípica: relato de caso e revisão da literatura(2013) VAISBICH, Maria Helena; HENRIQUES, Luciana dos Santos; WATANABE, Andréia; PEREIRA, Lilian Monteiro; METRAN, Camila Cardoso; MALHEIROS, Denise Avancini; MODANEZ, Flávia; SILVA, João Domingos Montoni da; VIEIRA, Simone; MACEDO, Ana Catarina Lunz; MASSAROPE, Bianca; FURUSAWA, Érika Arai; SCHVARTSMAN, Benita Galassi SoaresSHU atypical (aHUS), that is, not associated with Escherichia coli Shiga toxinproducing, is seen in 5 to 10% of cases of Hemolytic Uremic Syndrome (HUS), and can occur at any age and may be sporadic or familial. The prognosis in these cases is reserved, with high mortality and morbidity in the acute phase of the disease, and about 50% of cases can develop chronic kidney disease. The increased knowledge of the pathogenesis of aHUS (overactivation of the alternative pathway of complement), was accompanied by the appearance of a drug, eculizumab, which acts as an inhibitor of membrane attack complex. Our goal is to report a case of infant with aHUS with excellent clinical and laboratory response with the use of eculizumab. 14 month old infant, previously healthy, male, presented anemia and thrombocytopenia at 12 months of age. He was treated with corticosteroids and forwarded to our service for high blood pressure. However, the scans showed nephrotic proteinuria with renal involvement and hypoalbuminemia with direct Coombs negative. He developed anemia, thrombocytopenia, worsening of renal function and hypertension. Renal biopsy showed thrombotic microangiopathy (TMA). On the non-hemolytic anemia, thrombocytopenia and acute renal failure with histological substrate MAT, was diagnosed of aHUS. The patient received eculizumab excellent clinical and laboratory response. This case shows the importance of early diagnosis and treatment of the aHUS. Eculizumab is effective and keeps long-term remission, avoiding invasive measures such as plasmapheresis, which resolves only part of the picture.