LUCAS MATOS FERNANDES
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
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
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- 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.
- Acute Fibrinoid Organizing Pneumonia in Lung Transplant: The Most Feared Allograft Dysfunction(2016) COSTA, Andre Nathan; CARRARO, Rafael Medeiros; NASCIMENTO, Ellen Caroline Toledo; AFONSO JUNIOR, Jose Eduardo; CAMPOS, Silvia Vidal; CAMARGO, Priscila Cilene Leon Bueno de; TEIXEIRA, Ricardo Henrique de Oliveira Braga; SAMANO, Marcos Naoyuki; FERNANDES, Lucas Matos; ABDALLA, Luis Gustavo; DOLHNIKOFF, Marisa
- Stents for Bronchial Stenosis After Lung Transplantation: Should They Be Removed? (vol 47, pg 1029, 2015)(2015) FONSECA, 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.
- Posterior Reversible Encephalopathy Syndrome in Lung Transplantation: 5 Case Reports(2014) ARIMURA, F. E.; CAMARGO, P. C. L. B.; COSTA, A. N.; TEIXEIRA, R. H. O. B.; CARRARO, R. M.; AFONSO JR., J. E.; CAMPOS, S. V.; SAMANO, M. N.; FERNANDES, L. M.; ABDALLA, L. G.; PEGO-FERNANDES, P. M.Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiologic entity characterized by typical neurologic symptoms with characteristic cerebral image alterations. It has been reported in solid organ transplantations, especially related to the use of calcineurin inhibitors. The incidence of PRES in lung transplantation is unknown and probably under-reported in the literature. Here we describe 5 cases of PRES after bilateral lung transplantation. One of the reported cases was the first in the literature in which the neurologic onset precluded the introduction of calcineurin inhibitor. Therefore, although calcineurin inhibitors are known to play an important role in the development of PRES in the setting of lung transplantation, other causes seems to be involved in the physiopathology of this syndrome.
- Technical Challenges in Lung Transplantation of Kartagener Syndrome Recipients: A Unique Team Experience With 12 Patients(2020) CASTRO, Caio Cesar Bianchi de; REIS, Flavio Pola dos; CARVALHO, Guilherme Vieira Soares de; FERNANDES, Lucas Matos; ABDALLA, Luis Gustavo; SAMANO, Marcos Naoyuki; AFONSO JUNIOR, Jose Eduardo; PEGO-FERNANDES, Paulo Manoel
conferenceObject Cryobiopsy in the Diagnosis of Lung Allograft Rejection: Brazilian Case Series(2022) BELON, Carlos E. F.; OKUNO, Elissa A.; CAMPOS, Silvia V.; RODRIGUES, Ascedio J.; LIMA, Evelisse; SCORDAMAGLIO, Paulo R.; CAMARGO, Priscila C. L. B.; TEIXEIRA, Ricardo H. O. B.; CARRARO, Rafael M.; COSTA, Andre N.; PIRES, Juliana P.; REIS, Flavio P.; FERNANDES, Lucas M.; ABDALLA, Luis G.; FERNANDES, Paulo M. P.; FILHO, Mauro R.; SANTOS, Samuel L.conferenceObject How to Do It: Use of Octopus Tissue Stabilizer for Minimal Manipulation Approach of the Bronchial Anastomosis in Lung Transplant(2022) RAZUK FILHO, Mauro; SANTOS, Samuel L. Dos; REIS, Flavio P. Dos; ABDALLA, Luis Gustavo; FERNANDES, Lucas M.; PEGO-FERNANDES, Paulo M.- Tracheal Diverticulum as a Cause of Recurrent Infection in Post-Lung Transplant Patients: A Report of 2 Cases(2022) FORTUNATO, Hugo Garcia; REIS, Flavio Pola Dos; CASTRO, Bianchi Cesar Bianchi De; ABDALLA, Luis Gustavo; FERNANDES, Lucas Matos; PEGO-FERNANDES, Paulo ManuelBackground. Tracheal diverticulum (TD) is a rare entity in clinical practice, accidentally found by imaging methods. It is a potential factor for the development of chronic respiratory infections, contributing to the progression of preexisting lung diseases and putting the success of lung transplantation at risk.Objectives. This paper reports 2 cases of TD with atypical clinical presentation in post-lung transplant patients with recurrent infections and aims to present the importance of this differential diagnosis.Discussion. Case 1: A 30-year-old man with terminal lung disease underwent bilateral lung transplantation with a satisfactory postoperative period. He presented with TD as a focus of recurrent infection associated with persistent hemoptysis. Indicated for surgical resection (cervicotomy with resection of tracheal diverticulum), without complications. He evolved uneventfully in the postoperative period and was clinically stable at follow-up. Case 2: A 57-year-old woman with hypersensitivity pneumonia associated with secondary pulmonary arterial hypertension and bronchiectasis underwent bilateral lung transplantation without complications. She presented with TD as a focus of infection associated with esophageal symptoms. Indicated for the surgical approach (cervicotomy with resection of tracheal diverticulum), she was asymptomatic at follow-up.Conclusion. Conservative treatment is recommended in elderly and asymptomatic patients. Surgical resection is based on the recurrence of symptoms and failure of clinical therapy and is the preferred approach for reported cases.
- Risk Factors and Survival Impact of Primary Graft Dysfunction After Lung Transplantation in a Single Institution(2012) SAMANO, M. N.; FERNANDES, L. M.; BARANAUSKAS, J. C. B.; CORREIA, A. T.; AFONSO JR., J. E.; TEIXEIRA, R. H. O. B.; CARAMORI, M. L.; PEGO-FERNANDES, P. M.; JATENE, F. B.Background. Lung transplantation has become a standard procedure for some end-stage lung diseases, but primary graft dysfunction (PGD) is an inherent problem that impacts early and late outcomes. The aim of this study was to define the incidence, risk factors, and impact of mechanical ventilation time on mortality rates among a retrospective cohort of lung transplantations performed in a single institution. Methods. We performed a retrospective study of 118 lung transplantations performed between January 2003 and July 2010. The most severe form of PGD (grade III) as defined at 48 and 72 hours was examined for risk factors by multivariable logistic regression models using donor, recipient, and transplant variables. Results. The overall incidence of PGD at 48 hours was 19.8%, and 15.4% at 72 hours. According multivariate analysis, risk factors associated with PGD were donor smoking history for 48 hours (adjusted odds ratio [OR], 4.83; 95% confidence interval [CI], 1.236-18.896; P = .022) and older donors for 72 hours (adjusted OR, 1.046; 95% CI, 0.997-1.098; P = .022). The operative mortality was 52.9% among patients with PGD versus 20.3% at 48 hours (P = .012). At 72 hours, the mortality rate was 58.3% versus 21.2% (P = .013). The 90-days mortality was also higher among patients with PGD. The mechanical ventilation time was longer in patients with PGD III at 48 hours namely, a mean time of 72 versus 24 hours (P = .001). When PGD was defined at 72 hours, the mean ventilation time was even longer, namely 151 versus 24 hours (P < .001). The mean overall survival for patients who developed PGD at 48 hours was 490.9 versus 1665.5 days for subjects without PGD (P = .001). Considering PGD only at 72 hours, the mean survival was 177.7 days for the PGD group and 1628.9 days for the other patients (P < .001). Conclusion. PGD showed an important impacts on operative and 90-day mortality rates, mechanical ventilation time, and overall survival among lung transplant patients. PGD at 72 hours was a better predictor of lung transplant outcomes than at 48 hours. The use of donors with a smoking history or of advanced age were risk factors for the development of PGD.
conferenceObject The Use of ECMO in Lung Transplant and hybrid Cannulation: 10 Years of a Single Center Experience(2022) SANTOS, Samuel; RAZUK, Mauro; POLA, Flavio; NAKAHIRA, Evelyn; ABDALLA, Luis G.; FERNANDES, Lucas M.; PEGO-FERNANDES, Paulo M.