WELLINGTON ANDRAUS
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
- PREOPERATIVE COMPUTED TOMOGRAPHY VOLUMETRY AND GRAFT WEIGHT ESTIMATION IN ADULT LIVING DONOR LIVER TRANSPLANTATION(2017) PINHEIRO, Rafael S.; CRUZ-JR, Ruy J.; ANDRAUS, Wellington; DUCATTI, Liliana; MARTINO, Rodrigo B.; NACIF, Lucas S.; ROCHA-SANTOS, Vinicius; ARANTES, Rubens M; LAI, Quirino; IBUKI, Felicia S.; ROCHA, Manoel S.; D´ALBUQUERQUE, Luiz A. C.ABSTRACT Background: Computed tomography volumetry (CTV) is a useful tool for predicting graft weights (GW) for living donor liver transplantation (LDLT). Few studies have examined the correlation between CTV and GW in normal liver parenchyma. Aim: To analyze the correlation between CTV and GW in an adult LDLT population and provide a systematic review of the existing mathematical models to calculate partial liver graft weight. Methods: Between January 2009 and January 2013, 28 consecutive donors undergoing right hepatectomy for LDLT were retrospectively reviewed. All grafts were perfused with HTK solution. Estimated graft volume was estimated by CTV and these values were compared to the actual graft weight, which was measured after liver harvesting and perfusion. Results: Median actual GW was 782.5 g, averaged 791.43±136 g and ranged from 520-1185 g. Median estimated graft volume was 927.5 ml, averaged 944.86±200.74 ml and ranged from 600-1477 ml. Linear regression of estimated graft volume and actual GW was significantly linear (GW=0.82 estimated graft volume, r2=0.98, slope=0.47, standard deviation of 0.024 and p<0.0001). Spearman Linear correlation was 0.65 with 95% CI of 0.45 - 0.99 (p<0.0001). Conclusion: The one-to-one rule did not applied in patients with normal liver parenchyma. A better estimation of graft weight could be reached by multiplying estimated graft volume by 0.82.
- Tumor growth pattern as predictor of colorectal liver metastasis recurrence(2014) PINHEIRO, Rafael S.; HERMAN, Paulo; LUPINACCI, Renato M.; LAI, Quirino; MELLO, Evandro S.; COELHO, Fabricio F.; PERINI, Marcos V.; PUGLIESE, Vincenzo; ANDRAUS, Wellington; CECCONELLO, Ivan; D'ALBUQUERQUE, Luiz CarneiroBACKGROUND: Surgical resection is the gold standard therapy for the treatment of colorectal liver metastases (CRM). The aim of this study was to investigate the impact of tumor growth patterns on disease recurrence. METHODS: We enrolled 91 patients who underwent CRM resection. Pathological specimens were prospectively evaluated, with particular attention given to tumor growth patterns (infiltrative vs pushing). RESULTS: Tumor recurrence was observed in 65 patients (71.4%). According to multivariate analysis, 3 or more lesions (P = .05) and the infiltrative tumor margin type (P = .05) were unique independent risk factors for recurrence. Patients with infiltrative margins had a 5-year disease-free survival rate significantly inferior to patients with pushing margins (20.2% vs 40.5%, P = .05). CONCLUSIONS: CRM patients with pushing margins presented superior disease-free survival rates compared with patients with infiltrative margins. Thus, the adoption of the margin pattern can represent a tool for improved selection of patients for adjuvant treatment.
- Registry of the International Society of Uterus Transplantation: First Report(2023) BRANNSTROM, Mats; TULLIUS, Stefan G.; BRUCKER, Sara; DAHM-KAHLER, Pernilla; FLYCKT, Rebecca; KISU, Iori; ANDRAUS, Wellington; WEI, Li; CARMONA, Francisco; AYOUBI, Jean-Marc; SCOLLO, Paolo; WEYERS, Steven; FRONEK, JiriBackground.Uterus transplantation (UTx) is a novel type of transplantation to treat infertility in women with an absent or nonfunctioning uterus. The International Society of Uterus Transplantation (ISUTx) has developed a registry to monitor worldwide UTx activities while serving as a repository for specific research questions. Methods.The web-based registry has separate data fields for donor, recipient, surgeries, immunosuppression, rejections, pregnancies with live birth(s), and transplant hysterectomies. Data are prospectively registered. Results.A total of 45 UTx procedures have been registered; the majority (78%) of those procedures were live donor (LD) transplants. Median age of the LDs, deceased donors, and recipients were 50 y (range 32-62), 38.5 y (19-57), and 29 y (22-38), respectively. The duration of LD surgery was approximately twice as long as the recipient surgery. Postoperative complications of any Clavien-Dindo grade were registered in 20% of LDs and 24% of recipients. Rejection episodes were more frequent (33%) early after transplantation (months 1-5) compared with later time points (months 6-10; 21%). Healthy neonates were delivered by 16 recipients, with 3 women giving birth twice. The total live birth rate per embryo transfer was 35.8%. Median length of pregnancy was 35 gestational weeks. Twelve uteri were removed without childbirth, with 9 transplant hysterectomies occurring during the initial 7 mo post-UTx. Conclusions.A mandatory registry is critical to determine quality and process improvement for any novel transplantation. This registry provides a detailed analysis of 45 UTx procedures performed worldwide with a thorough analysis of outcomes and complications.
- Dimensão da margem cirúrgica nas ressecções de metástase hepática de câncer colorretal: impacto na recidiva e sobrevida(2013) HERMAN, Paulo; PINHEIRO, Rafael S.; MELLO, Evandro S.; LAI, Quirino; LUPINACCI, Renato M.; PERINI, Marcos V.; PUGLIESE, Vincenzo; ANDRAUS, Wellington; COELHO, Fabricio F.; CECCONELLO, Ivan; D'ALBUQUERQUE, Luiz C.BACKGROUND: Approximately 50% of the patients with a colorectal tumor develop liver metastasis, for which hepatectomy is the standard care. Several prognostic factors have been discussed, among which is the surgical margin. This is a recurring issue, since no consensus exists as to the minimum required distance between the metastatic nodule and the liver transection line. AIM: To evaluate the surgical margins in liver resections for colorectal metastases and their correlation with local recurrence and survival. METHODS: A retrospective study based on the review of the medical records of 91 patients who underwent resection of liver metastases of colorectal cancer. A histopathological review was performed of all the cases; the smallest surgical margin was verified, and the late outcome of recurrence and survival was evaluated. RESULTS: No statistical difference was found in recurrence rates and overall survival between the patients with negative or positive margins (R0 versus R1); likewise, there was no statistical difference between subcentimeter margins and those greater than 1 cm. The disease-free survival of the patients with microscopically positive margins was significantly worse than that of the patients with negative margins. The uni- and multivariate analyses did not establish the surgical margin (R1, narrow or less than 1 cm) as a risk factor for recurrence. CONCLUSION: The resections of liver metastases with negative margins, independently of the margin width, had no impact on tumor recurrence (intra- or extrahepatic) or patient survival
- Abdominal wall hernia in cirrhotic patients: emergency surgery results in higher morbidity and mortality(2015) ANDRAUS, Wellington; PINHEIRO, Rafael Soares; LAI, Quirino; HADDAD, Luciana B. P.; NACIF, Lucas S.; D'ALBUQUERQUE, Luiz Augusto C.; LERUT, JanBackground: Patients with cirrhosis have a high incidence of abdominal wall hernias and carry an elevated perioperative morbidity and mortality. The optimal surgical management strategy as well as timing of abdominal hernia repair remains controversial. Methods: A cohort study of 67 cirrhotic patients who underwent hernia repair during the period of January 1998-December 2009 at the University Hospital of Sao Paulo were included. After meeting study criteria, a total of 56 patients who underwent 61 surgeries were included in the final analysis. Patient characteristics, morbidity (Clavien score), mortality, Child-Turcotte-Pugh score, MELD score, use of prosthetic material, and elective or emergency surgery have been analysed with regards to morbidity and 30-day mortality. Results: The median MELD score of the patient population was 14 (range: 6 to 24). Emergency surgery was performed in 34 patients because of ruptured hernia (n = 13), incarceration (n = 10), strangulation (n = 4), and skin necrosis or ulceration (n = 7). Elective surgery was performed in 27 cases. After a multivariable analysis, emergency surgery (OR 7.31; p 0.017) and Child-Pugh C (OR 4.54; p 0.037) were risk factors for major complications. Moreover, emergency surgery was a unique independent risk factor for 30-day mortality (OR 10.83; p 0.028). Conclusions: Higher morbidity and mortality are associated with emergency surgery in advanced cirrhotic patients. Therefore, using cirrhosis as a contraindication for hernia repair in all patients may be reconsidered in the future, especially after controlling ascites and in those patients with hernias that are becoming symptomatic or show signs of possible skin necrosis and rupture. Future prospective randomized studies are needed to confirm this surgical strategy.
- Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia(2020) PEREZ-NADALES, Elena; GUTIERREZ-GUTIERREZ, Belen; NATERA, Alejandra M.; ABDALA, Edson; MAGALHAES, Maira Reina; MULARONI, Alessandra; MONACO, Francesco; PIERROTTI, Ligia Camera; FREIRE, Maristela Pinheiro; IYER, Ranganathan N.; STEINKE, Seema Mehta; CALVI, Elisa Grazia; TUMBARELLO, Mario; FALCONE, Marco; FERNANDEZ-RUIZ, Mario; COSTA-MATEO, Jose Maria; RANA, Meenakshi M.; STRABELLI, Tania Mara Varejao; PAUL, Mical; FARINAS, Maria Carmen; CLEMENTE, Wanessa Trindade; ROILIDES, Emmanuel; MUNOZ, Patricia; DEWISPELAERE, Laurent; LOECHES, Belen; LOWMAN, Warren; TAN, Ban Hock; ESCUDERO-SANCHEZ, Rosa; BODRO, Marta; GROSSI, Paolo Antonio; SOLDANI, Fabio; GUNSEREN, Filiz; NESTOROVA, Nina; PASCUAL, Alvaro; MARTINEZ-MARTINEZ, Luis; AGUADO, Jose Maria; RODRIGUEZ-BANO, Jesus; TORRE-CISNEROS, Julian; SONG, A. T. Wan; ANDRAUS, W.; D'ALBUQUERQUE, L. A. Carneiro; DAVID-NETO, E.; PAULA, F. Jota de; ROSSI, F.; OSTRANDER, D.; AVERY, R.; RIZZI, M.; LOSITO, A. R.; RAFFAELLI, F.; GIACOMO, P. Del; TISEO, G.; LORA-TAMAYO, J.; SAN-JUAN, R.; GRACIA-AHUFINGER, I; CASTON, J.; RUIZ, Y. A.; ALTMAN, D. R.; V, S. Campos; BAR-SINAI, N.; KOPPEL, F.; ALMAJANO, F. Arnaiz de las Revillas; RICO, C. Gonzalez; MARTINEZ, M. Fernandez; MOURAO, P. H. O.; NEVES, F. A.; FERREIRA, J.; PYRPASOPOULOU, A.; IOSIFIDIS, E.; ROMIOPOULOS, I; V, M. Minero; SANCHEZ-CARRILLO, C.; LARDO, S.; COUSSEMENT, J.; DODEMONT, M.; JIAYUN, K.; MARTIN-DAVILA, P.; FORTUN, J.; ALMELA, M.; MORENO, A.; LINARES, L.; GASPERINA, D. D.; BALSAMO, M. L.; ROVELLI, C.; CONCIA, E.; CHIESI, S.; SALERNO, D. N.; OGUNC, D.; PILMIS, B.; SEMINARI, E. M.; CARRATALA, J.; DOMINGUEZ, A.; CORDERO, E.; LEPE, J. A.; MONTEJO, M.; LUCAS, E. Merino de; ERIKSSON, B. M.; DELDEN, C. van; MANUEL, O.; ARSLAN, H.; TUFAN, Z. Kocak; KAZAK, E.; DAVID, M.; LEASE, E.; CORNAGLIA, G.; AKOVA, M.Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score >= 8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score >= 8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.
- Laparoscopic cholecystectomy and cirrhosis: patient selection and technical considerations(2017) PINHEIRO, Rafael S.; WAISBERG, Daniel R.; LAI, Quirino; ANDRAUS, Wellington; NACIF, Lucas S.; ROCHA-SANTOS, Vinicius; D'ALBUQUERQUE, Luiz A. C.The incidence of cholelithiasis in cirrhotic patients is higher than in general population. In the past, open cholecystectomy (OC) was the standard approach for patients requiring cholecystectomy. However, laparoscopic cholecystectomy (LC) was introduced in 1980's and gradually became the preferred technique even to cirrhotic patients. The performance of gastrointestinal surgery procedures in cirrhotics patients is well-known to be associated with higher technical difficulty and increased morbidity-mortality. Cirrhosis is a major key intraoperative finding that contributes to surgical difficulty in LC. Model of End Stage Liver Disease (MELD) score and Child-Pugh Classification are the best devices to evaluate the underlying liver disease and to predict morbidity-mortality. Acute cholecystitis has higher incidence in patients with cirrhosis, emergency procedures in cirrhotics patients are associated with higher morbidity, longer postoperative hospitalization and a seven-fold higher mortality in comparison to elective surgery. LC in cirrhotics has a higher conversion rate to open procedure; however, LC demonstrated substantial advantage over OC providing shorter convalescence period and hospital stay.
- Allocation of liver grafts worldwide - Is there a best system?(2019) TSCHUOR, Christoph; FERRARESE, Alberto; KUEMMERLI, Christoph; DUTKOWSKI, Philipp; BURRA, Patrizia; CLAVIEN, Pierre-Alain; ANDRAUS, Wellington; CHEN, Chao-Long; CONTRERAS, Alan G.; CRAWFORD, Michael; CZERWINSKI, Jaroslaw; D'ALBUQUERQUE, Luiz Augusto Carneiro; DANEK, Teresa; ROSMALEN, Marieke de Rosner-van; DOKUS, Katherine; ECHEVERRI, Gabriel Jaime; EGAWA, Hiroto; ERICZON, Bo-Goran; ESHMUMINOV, Dilmurodjon; FRONEK, Jiri; V, Sergey Gautier; GROCHOLA, Lukasz Filip; HABERAL, Mehmet; HERNANDEZ-ALEJANDRO, Roberto; IMVENTARZA, Oscar; KANG, Koo Jeong; KAKAEI, Farzad; KAMBAKAMBA, Patryk; KIM, Myong Soo; KRON, Philipp; LENDOIRE, Javier; LESURTEL, Mickael; LINECKER, Michael; MABRUT, Jean-Yves; MALEK-HOSSEINI, Seyed Ali; MELUM, Espen; MONAKHOV, Artem; MULLHAUPT, Beat; NAGRAL, Sanjay; OBERKOFLER, Christian E.; PINTO-MARQUES, Hugo; ROWE, Ian A.; SANCHEZ-VELAZQUEZ, Patricia; SONG, Zhoulon; TAIMR, Pavel; TOMIYAMA, Koji; VOGELAAR, Serge; YILMAZ, Sezai; ZHENG, ShusenBackground & Aims: An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity. The most frequent principles for allocation policies in liver transplantation are therefore criteria that rely on pre-transplant survival (sickest first policy), post-transplant survival (utility), or on their combination (benefit). However, large differences exist between centers and countries for ethical and legislative reasons. The aim of this study was to report the current worldwide practice of liver graft allocation and discuss respective advantages and disadvantages. Methods: Countries around the world that perform 95 or more deceased donor liver transplantations per year were analyzed for donation and allocation policies, as well as recipient characteristics. Results: Most countries use the model for end-stage liver disease (MELD) score, or variations of it, for organ allocation, while some countries opt for center-based allocation systems based on their specific requirements, and some countries combine both a MELD and center-based approach. Both the MELD and center-specific allocation systems have inherent limitations. For example, most countries or allocation systems address the limitations of the MELD system by adding extra points to recipient's laboratory scores based on clinical information. It is also clear from this study that cancer, as an indication for liver transplantation, requires special attention. Conclusion: The sickest first policy is the most reasonable basis for the allocation of liver grafts. While MELD is currently the standard for this model, many adjustments were implemented in most countries. A future globally applicable strategy should combine donor and recipient factors, predicting probability of death on the waiting list, post-transplant survival and morbidity, and perhaps costs. Lay summary: An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity. While the model for end-stage liver disease is currently the standard for this model, many adjustments were implemented in most countries. A future globally applicable strategy should combine donor and recipient factors predicting probability of death on the waiting list, post-transplant survival and morbidity, and perhaps costs.
- Guidelines for Perioperative Care for Liver Transplantation: Enhanced Recovery After Surgery (ERAS) Recommendations(2022) BRUSTIA, Raffaele; MONSEL, Antoine; SKURZAK, Stefano; SCHIFFER, Eduardo; CARRIER, Francois Martin; PATRONO, Damiano; KABA, Abdourahamane; DETRY, Olivier; MALBOUISSON, Luiz; ANDRAUS, Wellington; VANDENBROUCKE-MENU, Franck; BIANCOFIORE, Gianni; KAIDO, Toshimi; COMPAGNON, Philippe; UEMOTO, Shinji; LAIZ, Gonzalo Rodriguez; BOER, Marieke De; ORLOFF, Susan; MELGAR, Paola; BUIS, Carlijn; ZEILLEMAKER-HOEKSTRA, Miriam; USHER, Helen; REYNTJENS, Koen; BAIRD, Emily; DEMARTINES, Nicolas; WIGMORE, Stephen; SCATTON, OlivierBackground. Enhanced Recovery After Surgery (ERAS) is a multimodal, evidence-based, program of care developed to minimize the response to surgical stress, associated with reduced perioperative morbidity and hospital stay. This study presents the specific ERAS Society recommendations for liver transplantation (LT) based on the best available evidence and on expert consensus Methods. PubMed and were searched in April 2019 for published and ongoing randomized clinical trials on LT in the last 15 y. Studies were selected by 5 independent reviewers and were eligible if focusing on each validated ERAS item in the area of adult LT. An e-Delphi method was used with an extended interdisciplinary panel of experts to validate the final recommendations. Results. Forty-three articles were included in the systematic review. A consensus was reached among experts after the second round. Patients should be screened for malnutrition and treated whenever possible. Prophylactic nasogastric intubation and prophylactic abdominal drainage may be omitted, and early extubation should be considered. Early oral intake, mobilization, and multimodal-balanced analgesia are recommended. Conclusions. The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the e-Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol.
- Living donor liver transplantation for hepatocellular cancer: An (almost) exclusive Eastern procedure?(2017) PINHEIRO, R. S.; WAISBERG, D. R.; NACIF, L. S.; ROCHA-SANTOS, V.; ARANTES, R. M.; DUCATTI, L.; MARTINO, R. B.; LAI, Q.; ANDRAUS, W.; DALBUQUERQUE, L. A. C.Hepatocellular carcinoma (HCC) is the fifth most prevalent cancer and it is linked with chronic liver disease. Liver transplantation (LT) is the best curative treatment modality, since it can cure simultaneously the underlying liver disease and HCC. Milan criteria (MC) are the benchmark for selecting patients with HCC for LT, achieving up to 91% 1-year survival post transplantation. However, when considering intention-to-treat (ITT) rates are substantially lower, mainly due dropout. Additionally, Milan criteria (MC) are too restrictive and more inclusive criteria have been reported with good outcomes. Mainly, in Eastern countries, deceased donors are scarce, therefore Asian centers have developed living-donor liver transplantation (LDLT) to a state-of-art status. There are many eastern centers reporting huge numbers of LDLT with outstanding results. Regarding HCC patients, they have reported many criteria including more advanced tumors achieving reasonable outcomes. Western countries have well-established deceased-donor liver transplantation (DDLT) programs. However, organ shortage and restrictive criteria for listing patients with HCC endorses LDLT as a good option to offer curative treatment to more HCC patients. However, there are some controversial reports claiming higher rates of HCC recurrence after LDLT than DDLT. An extensive review included 30 studies with cohorts of HCC patients who underwent LDLT in both East and West countries. We reported also the results of our Institution, in Brazil, where it was performed the first LDLT. This review also addresses the eligibility criteria for transplanting patients with HCC developed in Western and Eastern countries. © Translational Gastroenterology and Hepatology. All rights reserved.