JOEL AVANCINI ROCHA FILHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
13 resultados
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- Hypoxia among patients on the liver-transplant waiting list(2014) NACIF, Lucas Souto; ANDRAUS, Wellington; SARTORI, Kathryn; BENITES, Carlos Marlon; SANTOS, Vinicius Rocha; ROCHA-FILHO, Joel Avancini; D'ALBUQUERQUE, Luiz CarneiroBackground: Hepatopulmonary syndrome is formed by a triad of liver disease, intrapulmonary vascular dilatation and changes in blood gases. This condition is present in 4-32% of patients with cirrhosis. Aim : To analyze the blood gas changes data of patients in liver-transplant waiting list. Method: Clinical data of 279 patients in liver transplantation waiting list in May 2013 were studied. Overall patient was analyzed by the demographic aspects, laboratorial and image findings on exams that determine lung disease (hypoxemia) in these cirrhotic patients. The mean values and standard deviations were used to examine normally distributed variables. Results: There was a high prevalence of male patients (68%); the mean age was 51(±5,89) years, and the predominant reason for listing was hepatitis C cirrhosis. The MELD score mean was 16±5,89, without prioritization or special situation. The most common blood type was O in 129 cases (46%) and the mean of body max index was 25,94±4,58. Regarding arterial blood gas tests was observed 214 patients with PaO2 <90 mmHg, 80 with PaO2 <80 mmHg and 39 with PaO2 <50 mmHg. In relation to O2 saturation, 50 patients had <90%, 33 <80% and 10 <50%. Conclusion: Was observed a high rate of hypoxemia in patients on waiting list liver transplant. Due to the high severity and morbidity, is suggested better monitoring and therapeutic support to hypoxemic patients on liver transplant waiting list.
- Anesthetic Conditioning in Liver Transplantation: Results of a Multicenter Randomized Controlled Trial(2013) BONVINI, John M.; SCHADDE, Erik; CLAVIEN, Pierre-Alain; LESURTEL, Mickael; FIGUEIRA, Estela R. R.; FILHO, Joel A. Rocha; REYNTJENS, Koen; BREITENSTEIN, Stefan; BECK-SCHIMMER, BeatriceBackground data: In the age of organ scarcity and the increased use of older and steatotic organ grafts, protective strategies during transplantation are gaining importance. Volatile anesthetics such as sevoflurane attenuate ischemia-reperfusion injury in liver resection and lead to improved clinical outcome. Whether volatile anesthetics change clinical outcome in liver transplantation is unknown. Methods: Cadaveric liver recipients were randomized from 03/2009 to 08/2012 at three University Centers (Zurich, Sao Paulo, Ghent). Standard liver transplant patients were randomly assigned to propofol anesthesia (control group) or conditioning with sevoflurane (sevoflurane group). Postoperative peak of the aspartate transaminase (AST) was defined as primary endpoint. Secondary endpoints were in-hospital complications, hospital- and ICU stay. Results: Ninety-eight patients, who underwent liver transplantation, were randomized to propofol (n=48) or sevoflurane (n=50). Peak AST after transplantation was 925 U/l (512-3274) in the propofol group (p=0.73) and 1097 U/l (interquartile range 540-2633) in the sevofluorane one. While the overall complication rate was not different, there was a trend towards less severe complications in the sevoflurane group: median complication score was grade IIIa (IQR II-IVb) for the propofol and grade II (IQR 0-IIIb) for the sevoflurane group (Odds ratio 0.51, 0.24 to 1.09, p=0.08). Conclusions: This first multicenter trial with different anesthesia regimens in liver transplantation showed comparable surrogate markers postoperatively, but a trend towards less severe complications in the sevoflurane group. Future trials should be adequately powered to assess complications and identify subgroups, which might benefit from anesthetic conditioning.
- Hypertonic saline solution decreases oxidative stress in liver hypothermic ischemia(2021) NUNES, Giolana; FIGUEIRA, Estela Regina Ramos; ROCHA-FILHO, Joel Avancini; LANCHOTTE, Cinthia; NACIF, Lucas Souto; FERREIRA, Diego Mendes; ROMANO, Vitor Carminatti; ABDO, Emilio Elias; D'ALBUQUERQUE, Luiz Augusto Carneiro; GALVAO, Flavio Henrique FerreiraBackground: Liver ischemia reperfusion injury is still an unsolved problem in liver surgery and transplantation. In this setting, hypothermia is the gold standard method for liver preservation for trans-plantation. Hypertonic saline solution reduces inflammatory response with better hemodynamic recovery in several situations involving ischemia reperfusion injury. Here, we investigated the effect of hypertonic saline solution in hypothermic liver submitted to ischemia reperfusion injury. Methods: Fifty male rats were divided into 5 groups: SHAM, WI (animals submitted to 40 minutes of partial warm liver ischemia and reperfusion), HI (animals submitted to 40 minutes hypothermic ischemia), HSPI (animals submitted to hypothermic ischemia and treated with 7.5% hypertonic saline solution preischemia), and HSPR (animals submitted to hypothermic ischemia and treated with hypertonic saline solution previously to liver reperfusion). Four hours after reperfusion, the animals were euthanized to collect liver and blood samples. Results: Aspartate aminotransferase and alanine aminotransferase, histologic score, and hepatocellular necrosis were significantly decreased in animals submitted to hypothermia compared with the warm ischemia group. Malondialdehyde was significantly decreased in hypothermic groups with a further decrease when hypertonic saline solution was administrated preischemia. Hypothermic groups also showed decreased interleukin-6, interleukin-10, and tumor necrosis factor-alpha concentrations and better recovery of bicarbonate, base excess, lactate, and glucose blood concentrations. Moreover, hypertonic saline solution preischemia was more effective at controlling serum potassium concentrations. Conclusion: Hypertonic saline solution before hypothermic hepatic ischemia decreases hepatocellular oxidative stress, cytokine concentrations, and promotes better recovery of acid-base disorders secondary to liver ischemia reperfusion.
conferenceObject EFFECTS OF ANAESTHETIC PRECONDITIONING PLUS POSTCONDITIONING WITH SEVOFLURANE IN WARM LIVER ISCHEMIA/REPERFUSION INJURY IN RATS(2012) FILHO, J. A. R.; FIGUEIRA, E. R. R.; SCHIMMER, B. B.; ANDRE, V. O.; BUTO, M. F. de Souza; NAKATANI, M.; PRADO, F. J. G.; CARMONA, M. J. C.; CLAVIEN, P. A.; D'ALBUQUERQUE, L. A. C.Background: Preconditioning is a therapeutic strategy aimed to increase ischemic tissue tolerance against ischemia/reperfusion (IR) injury. Recent studies demonstrated that volatile anaesthetics may improve postischemic recovery by an ischemic preconditioning-like mechanism. Postconditioning is a new concept that may have hepatoprotective effect. We hypothesized that sevoflurane preconditioning combined with postconditioning may reduce the hepatocellular damage in a rat model of warm liver IR. Methods: Ten Wistar rats under mechanical ventilation were divided into 2 groups of 5; 1) IR: rats subjected to 45 min of warm liver ischemia of left and median lobes, followed by resection of non-ischemic lobes at early reperfusion; and 2) SEVO + IR: rats were exposed to sevoflurane 2.5% for 15 min, followed by 5 min washout, before ischemia, plus sevoflurane 2.5% for 15 minat reperfusion. Carotid artery was cannulated for mean arterial pressure(MAP). Mean portal flow (MPF) was assessed by perivascular flowprobe. MAP and MPF were recorded at baseline, pre-repefusion and 4 h postreperfusion. Liver transaminases, creatinine, pH, bicarbonate (BIC) and base excess (BE), potassium (K), glucose and lactate were measured at 4 h postreperfusion. Results: AST and ALT were decreased in SEVO + IR group (12.118 ± 3.611 and 7.870 ± 1.586 U/L) compared to IR group (16.890 ± 1.630 and13.418 ± 1.088 U/L), P < 0.05. BIC, and K were increased in SEVO + IR group (11.20 ± .86 mmol/l and 6.1 ± 1.3 mEq/dl) compared to IR (6.70 ± 3.32 mmol/l and 4.7 ± 0.7 mEq/dl),P < 0.05. There were no differ- ences in MAP, MPF, creatinine, glucose, lactate, pH and BE; however glucose tended to be higher in SEVO + IR group (50.8 ± 26.0 mg/dl) compared to IR (35.0 ± 18.4 mg/dl). Conclusions: In experimental warm liver ischemia/reperfusion, sevoflurane preconditioning plus postconditioning reduced the hepatocellular injury demonstrated by lower levels of transaminases with a better behaviour of acid base variables and good hemodynamic recovery. These preliminary results are encouraging because postconditioning may have the advantage of being implemented at the moment of reperfusion, what is more feasible to be applied during liver transplantation surgery.- Total Pancreatectomy: Porcine Model for Inducing Diabetes - Anatomical Assessment and Surgical Aspects(2011) CHAIB, E.; GALVAO, F. H. F.; ROCHA-FILHO, J. A.; SILVEIRA, B. L.; CHEN, L.; CARVALHO, M. P. D. de C.; PARIZ, C. E.; ALMEIDA, F. S. de; WAISBERG, D. R.; SOUZA, Y. E. D. M. de; MACHADO, M. C. C.; D'ALBUQUERQUE, L. A. C.Background: The swine is an essential model for carrying out preclinical research and for teaching complex surgical procedures. There is a lack of experimental models describing anatomical and surgical aspects of total pancreatectomy in the pig. Materials and Methods: The experiments were performed on 10 white male swine weighing 27-33 kg. The animals were premedicated with midazolam (0.4 mg/kg, i.m.) and ketamine (4 mg/kg, i.m.). Anesthesia was induced with propofol (1-2 mg/kg, i.v.) and was maintained with propofol and fentanyl (0.3 mg and 0.1 mu g/kg/min, respectively, i.v.). The surgical period ranged from 44 to 77 min. The pancreas anatomy, and the main arterial, venous and pancreatic duct anatomy were assessed. Results: The pancreas anatomy was composed of 3 lobes, the 'splenic', 'duodenal' and 'connecting' lobe which is attached to the anterior portion of the portal vein. The splenic artery and the junction of the splenic vein and portal vein were divided. The left gastric artery was dissected and separated from its origin at the splenic artery. The head of the pancreas is disposed in a C shape. The pancreas was dissected and liberated from the right portion of the portal vein and the infrahepatic vena cava. The pancreas was separated from the duodenum preserving the pancreaticoduodenal artery, then we performed the total pancreatectomy preserving the duodenum, common bile duct and spleen. Conclusion: Total pancreatectomy with duodenum, bile duct and spleen preservation in the pig is feasible and an important instrument for research purposes and teaching surgical technique.
- Does autologous blood transfusion during liver transplantation for hepatocellular carcinoma increase risk of recurrence?(2016) ARAUJO, Raphael L. C.; PANTANALI, Carlos Andres; HADDAD, Luciana; ROCHA FILHO, Joel Avancini; D'ALBUQUERQUE, Luiz Augusto Carneiro; ANDRAUS, WellingtonAIM: To analyze outcomes in patients who underwent liver transplantation (LT) for hepatocellular carcinoma (HCC) and received autologous intraoperative blood salvage (IBS). METHODS: Consecutive HCC patients who underwent LT were studied retrospectively and analyzed accor-ding to the use of IBS or not. Demographic and sur-gical data were collected from a departmental pro-spective maintained database. Statistical analyses were performed using the Fisher's exact test and the Wilcoxon rank sum test to examine covariate differences between patients who underwent IBS and those who did not. Univariate and multivariate Cox regression models were developed to evaluate recurrence and death, and survival probabilities were estimated using the Kapla-Meier method and compared by the log-rank test. RESULTS: Between 2002 and 2012, 158 consecutive patients who underwent LT in the same medical center and by the same surgical team were identified. Among these patients, 122 (77.2%) were in the IBS group and 36 (22.8%) in the no-IBS group. The overall survival (OS) and recurrence free survival (RFS) at 5 years were 59.7% and 83.3%, respectively. No differences in OS (P = 0.51) or RFS (P = 0.953) were detected between the IBS and no-IBS groups. On multivariate analysis for OS, degree of tumor differentiation remained as the only independent predictor. Regarding patients who received IBS, no differences were detected in OS or RFS (P = 0.055 and P = 0.512, respectively) according to the volume infused, even when outcomes at 90 d or longer were analyzed separately (P = 0.518 for both outcomes). CONCLUSION: No differences in RFS or OS were detected according to IBS use. Trials addressing this question are justified and should be designed to detect small differences in long-term outcomes.
conferenceObject EFFECTS OF ANAESTHETIC PRECONDITIONING WITH SEVOFLURANE IN WARM LIVER ISCHEMIA/REPERFUSION INJURY IN RATS(2012) FIGUEIRA, E. R. R.; FILHO, J. A. R.; SCHIMMER, B. B.; NAKATANI, M.; TATEBE, E. R.; ANDRE, V. O.; PRADO, F. J. G.; CARMONA, M. J. C.; D'ALBUQUERQUE, L. A. C.Background: Preconditioning is a therapeutic strategy aimed to increase ischemic tissue tolerance against ischemia/reperfusion (IR) injury. Recentstudies demonstrated that volatile anaesthetics may improve postischemic recovery by an ischemic preconditioning-like mechanism. We hypothesized that pharmacological preconditioning with sevoflurane may reduce the hepatocellular damage in a rat model of warm liver IR. Methods: Ten Wistar rats under mechanical ventilation were divided into 2 groups of 5 animals: I) IR: rats subjected to 45 min of warm liver ischemia of the left and median lobes, followed by resection of the non-ischemic lobes at early reperfusion; and II) SEVO+IR: rats were exposed to sevoflurane 2.5% for 15 min, followed by washout during 5 min, before IR. The carotid artery was cannulated for mean arterial pressure (MAP) monitoring. The mean portal venous flow (MPF) was assessed by perivascular flowprobe. MAP and MPF were recorded at baseline, pre reperfusion and 4 hours post-reperfusion. Liver transaminases, creatinine, pH, bicarbonate (BIC) and base excess (BE), potassium (K), glucose and lactate were measured at 4 hours post-reperfusion. Results: AST and ALT were decreased in SEVO+IR group (10.056 ± 5.830 and 8.586 ± 5.296 U/L) compared to IR group (16.890 ± 1.630 and 13.418 ± 1.088 U/L), P < 0.05. BIC, BE and K were increased in SEVO+IR group (12.42 ± 4.39, -14.72 ± 4.46 mmol/l and 6.3 ± 0.9 mEq/dl) compared to IR (6.70 ± 3.32, -20.48 ± 4.22 mmol/l and 4.7 ± 0.7 mEq/dl), P< 0.05. MAP at 4 hours post-reperfusion was decreased in SEVO+IR group (65 ± 24 mmHg) compared to IR (93 ± 14 mmHg), P < 0.05. There were no differences in MPF, creatinine, glucose and lactate. Glucose tended to be higher and lactate lower in SEVO+IR group (54.0 ± 22.7 and 42.8 ± 18.6 mg/dl) compared to IR (35.0 ± 18.4 and 66.8 ± 25.9 mg/dl). Conclusions: In liver IR, sevoflurane preconditioning reduced hepatocellular injury demonstrated by lower levels of transaminases. Despite the lower mean arterial pressure presented in sevoflurane treated animals, no detrimental effect was observed in portal venous flow, hepatic metabolism and renal function. This study highlight the need for clarifying the mechanisms of sevoflurane preconditioning, and if there is additional hepatoprotection against cold IR injury.conferenceObject HEMODYNAMIC STUDY OF THE PORTAL VENOUS SYSTEM IN A MODEL OF WARM LIVER ISCHEMIA/REPERFUSION INJURY IN RATS(2012) BUTO, M. F. de Souza; FIGUEIRA, E. R. R.; FILHO, J. A. R.; NAKATANI, M.; TATEBE, E. R.; ANDRE, V. O.; MARTINS, A. R. de Carvalho; JUREIDINI, R.; CARMONA, M. J. C.; BACCHELLA, T.; CHAIB, E.; CECCONELLO, I.; ALBUQUERQUE, L. A. C. D.Background: Liver transplantation and resections require temporary interruption of the hepatic blood flow resulting in ischemia/reperfusion (IR) injury. The hepatic microcirculatory impairment is related to the severity of the IR injury and may be reflected in the liver macro hemodynamic. There is aninverse correlation between hepatic blood flow and the postoperative transaminases. The aim of the study was to evaluate the hemodynamic of the portal venous system after warm liver IR injury. Methods: Eighteen Wistar rats were divided into 3 groups: I) Control; II) sham: rats submitted to resection of right and caudate liver lobes; III) Ischemia (IR): rats subjected to 60 min of partial warm liver ischemia of left and median lobes, followed by resection of non-ischemic lobes at reperfusion. Four hours after reperfusion rats were anesthetized and submitted to mechanical ventilation. Carotid artery was cannulated for mean arterial pressure (MAP). Mean portal venous flow (MPF) was assessed by a perivascular flowprobe. A micropressure probe was introduced into portal vein to assess the mean portal venous pressure (MPP). At the end blood was collected for AST and ALT analysis. Results: The mean weigh of rats was 229 ± 18 g. AST and ALT were increased in IR group (6.675 ± 1.687 and 5.793 ± 1.119 U/L) compared to sham (897 ± 303 and 815 ± 433 U/L) and control groups (99 ± 28 and 64 ± 27 U/L), P < 0.05. MAP was decreased in IR group (90 ± 17 mmHg) compared to control group (114 ± 9 mmHg), P < 0.05; but there is no difference when compared to sham group (106 ± 16 mmHg). MPP was increased in sham group (9.3 ± 1.8 mmHg) compared to control (6.2 ± 1.7 mmHg) and IR (4.5 ± 1.7 mmHg) groups, P< 0.05. MPF was decreased in IR group (5.0 ± 2.2 ml/min) compared to sham (12.3 ± 2.1 ml/min) and control (12.2 ± 1.9 ml/min) groups, P< 0.05. Conclusions: This study showed that four hours after warm liver ischemia/reperfusion, the total hepatic blood flow is reduced, demonstrated by the decrease of 60% in mean portal flow and 21% in mean arterial pressure. These changes in the hepatic hemodynamics may be correlated with the severity of the liver ischemia/reperfusion injury. This model can be a tool to evaluate protective strategies against liver IR that impact hepatic macro hemodynamics.- Conditioning With Sevoflurane in Liver Transplantation: Results of a Multicenter Randomized Controlled Trial(2015) BECK-SCHIMMER, Beatrice; BONVINI, John M.; SCHADDE, Erik; DUTKOWSKI, Philipp; OBERKOFLER, Christian E.; LESURTEL, Mickael; DEOLIVEIRA, Michelle L.; FIGUEIRA, Estela R. R.; ROCHA FILHO, Joel A.; AULER JR., Jose Otavio Costa; D'ALBUQUERQUE, Luiz A. C.; REYNTJENS, Koen; WOUTERS, Patrick; ROGIERS, Xavier; DEBAERDEMAEKER, Luc; GANTER, Michael T.; WEBER, Achim; PUHAN, Milo A.; CLAVIEN, Pierre-Alain; BREITENSTEIN, StefanBackground. During times of organ scarcity and extended use of liver grafts, protective strategies in transplantation are gaining importance. We demonstrated in the past that volatile anesthetics such as sevoflurane attenuate ischemia-reperfusion injury during liver resection. In this randomized study, we examined if volatile anesthetics have an effect on acute graft injury and clinical outcomes after liver transplantation. Methods. Cadaveric liver transplant recipients were enrolled from January 2009 to September 2012 at 3 University Centers (Zurich/Sao Paulo/Ghent). Recipients were randomly assigned to propofol (control group) or sevoflurane anesthesia. Postoperative peak of aspartate transaminase was defined as primary endpoint, secondary endpoints were early allograft dysfunction, in-hospital complications, intensive care unit, and hospital stay. Results. Ninety-eight recipients were randomized to propofol (n = 48) or sevoflurane (n = 50). Median peak aspartate transaminase after transplantation was 925 (interquartile range, 512-3274) in the propofol and 1097 (interquartile range, 540-2633) in the sevoflurane group. In the propofol arm, 11 patients (23%) experienced early allograft dysfunction, 7 (14%) in the sevoflurane one (odds ratio, 0.64 (0.20 to 2.02, P = 0.45). There were 4 mortalities (8.3%) in the propofol and 2 (4.0%) in the sevoflurane group. Overall and major complication rates were not different. An effect on clinical outcomes was observed favoring the sevoflurane group (less severe complications), but without significance. Conclusions. This first multicenter trial comparing propofol with sevoflurane anesthesia in liver transplantation shows no difference in biochemical markers of acute organ injury and clinical outcomes between the 2 regimens. Sevoflurane has no significant added beneficial effect on ischemia-reperfusion injury compared to propofol.
conferenceObject Liver transplant recipients infected with Sars-CoV-2 in the early versus late postoperative period: is there a difference in outcomes?(2021) LIMA, M. R. Damasceno; WAISBERG, D.; TERRABUIO, D. R. Benedita; SONG, A.; ABDALA, E.; DUCATTI, L.; HADDAD, L. Bertocco; GOUVEIA, L. Nunes; ROCHA-SANTOS, V.; MARTINO, R. Bronze; NACIF, L. Souto; PINHEIRO, R. Soares; ARANTES, R. Macedo; ERNANI, L.; GALVAO, F. H.; LEE, Dong Won A.; MALBOUISSON, L. M.; ROCHA FILHO, J. Avancini; ANDRAUS, W.; CARNEIRO-D'ALBUQUERQUE, L. A.