FRANCINE BRAMBATE CARVALHINHO LEMOS
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- Chikungunya in kidney transplant recipients: A series of cases(2017) PIERROTTI, Ligia Camera; LOPES, Max Igor Banks Ferreira; NASCIMENTO, Ana Patricia do; CAIAFFA-FILHO, Helio; LEMOS, Francine Brambate Carvalhinho; REUSING JR., Jose Otto; SEJAS, Odeli Nicole Encinas; DAVID-NETO, Elias; AZEVEDO, Luiz SergioChikungunya (CHIK) is a mosquito-borne virus (CHIKV) infection that recently appeared in the Americas and thousands of confirmed cases have been reported in Brazil since the first autochthonous cases were reported in September 2014. We reported four cases of CHIK in kidney transplant recipients. The diagnosis was confirmed by positive CHIKV real-time polymerase chain reaction in two cases and positive CHIKV-IgM serology in two patients. The time between transplantation and CHIKV infection ranged from 2 to 11 years. All of them had arthralgia, and 3 of them had fever. Other symptoms were mild conjunctivitis, rash, and retro-orbital pain. Kidney function remained stable in all cases. In three patients prednisone doses were temporally increased and the symptoms disappeared concurrently with the increase of the dose. As for the fourth patient, the prednisone dose remained unchanged and yet she improved. Other immunosuppressive drugs were not changed for the four cases. As far as we know, there are only two previously reported cases of CHIK among solid organ transplant recipients besides the four cases reported here. Despite the small number of cases, we can speculate that the use of immunosuppression might have played a role in the paucity of symptoms and the gradual complete recovery with no complication. (C) 2017 The Authors.
conferenceObject No Impact of One Year of Everolimus, as Compared to MPA, in the Reversal of Left Ventricular Hypertrophy in Elderly Renal Transplant Recipients - Preliminary Data from Then Everold Study(2017) DAVID-NETO, E.; AGENA, F.; FURTADO, M.; RODRIGES, A.; ANDRADE, J.; LEMOS, F.; PAULA, F.- Randomized Trial of Machine Perfusion Versus Cold Storage in Recipients of Deceased Donor Kidney Transplants With High Incidence of Delayed Graft Function(2017) TEDESCO-SILVA JUNIOR, Helio; OFFERNI, Juliano Chrystian Mello; CARNEIRO, Vanessa Ayres; PAULA, Mayara Ivani de; NETO, Elias David; LEMOS, Francine Brambate Carvalhinho; MOURA, Lucio Roberto Requiao; SILVA FILHO, Alvaro Pacheco e; CUNHA, Mirian de Fatima de Morais; SILVA, Erica Francisco da; MIORIN, Luiz Antonio; DEMETRIO, Daniela Priscila; LUCONI, Paulo Sergio; LUCONI, Waldere Tania da Silva; BOBBIO, Savina Adriana; KUSCHNAROFF, Liz Milstein; NORONHA, Irene Lourdes; BRAGA, Sibele Lessa; BARSANTE, Renata Cristina; MOREIRA, Joao Cezar Mendes; FERNANDES-CHARPIOT, Ida Maria Maximina; ABBUD-FILHO, Mario; ANDRADE, Luis Gustavo Modelli de; GARCIA, Paula Dalsoglio; SABER, Luciana Tanajura Santamaria; LAURINDO, Alan Fernandes; CHOCAIR, Pedro Renato; CUVELLO NETO, Americo Lourenco; ZANOCCO, Juliana Aparecida; SOARES FILHO, Antonio Jose Duboc de Almeida; AGUIAR, Wilson Ferreira; PESTANA, Jose MedinaBackground. This study compared the use of static cold storage versus continuous hypothermic machine perfusion in a cohort of kidney transplant recipients at high risk for delayed graft function (DGF). Methods. In this national, multicenter, and controlled trial, 80 pairs of kidneys recovered from brain-dead deceased donors were randomized to cold storage or machine perfusion, transplanted, and followed up for 12 months. The primary endpoint was the incidence of DGF. Secondary endpoints included the duration of DGF, hospital stay, primary nonfunction, estimated glomerular filtration rate, acute rejection, and allograft and patient survivals. Results. Mean cold ischemia time was high but not different between the 2 groups (25.6 +/- 6.6 hours vs 25.05 +/- 6.3 hours, 0.937). The incidence of DGF was lower in the machine perfusion compared with cold storage group (61% vs. 45%, P = 0.031). Machine perfusion was independently associated with a reduced risk of DGF (odds ratio, 0.49; 95% confidence interval, 0.26-0.95). Mean estimated glomerular filtration rate tended to be higher at day 28 (40.6 +/- 19.9 mL/min per 1.73 m(2) vs 49.0 +/- 26.9 mL/min per 1.73 m(2); P = 0.262) and 1 year (48.3 +/- 19.8 mL/min per 1.73 m2 vs 54.4 +/- 28.6 mL/min per 1.73 m(2); P = 0.201) in the machine perfusion group. No differences in the incidence of acute rejection, primary nonfunction (0% vs 2.5%), graft loss (7.5% vs 10%), or death (8.8% vs 6.3%) were observed. Conclusions. In this cohort of recipients of deceased donor kidneys with high mean cold ischemia time and high incidence of DGF, the use of continuous machine perfusion was associated with a reduced risk of DGF compared with the traditional cold storage preservation method.
conferenceObject TRANSPLANTABILITY EVALUATION IN HIGH RISK PATIENTS WITH END STAGE RENAL DISEASE ENROLLED IN THE WAITING LIST OF KIDNEY TRANSPLANTATION. AN OBSERVATIONAL COHORT STUDY(2017) IZQUIERDO, Andrea Andrade; ONUSIC, Vivian L.; OTTO JR., Jose; LEMOS, Francine Bc; PAULA, Flavio J. De; NAHAS, William C.; DAVID-NETO, Elias- Longitudinal Pharmacokinetics of Everolimus When Combined With Low-level of Tacrolimus in Elderly Renal Transplant Recipients(2017) DAVID-NETO, Elias; AGENA, Fabiana; RAMOS, Fernanda; TRIBONI, Ana Heloisa Kamada; ROMANO, Paschoalina; EBNER, Persio de Almeida Rezende; COELHO, Venceslau; GALANTE, Nelson Zocoler; LEMOS, Francine Brambate CarvalhinhoBackground Although the proportion of elderly patients among renal transplant recipients has increased, pharmacokinetic (PK) studies of immunosuppressants rarely include older patients. Methods We studied 12-hour everolimus (EVL) PK in 16 elderly renal transplant recipients (all whites; 10 men; mean age, 64 2 years (61-71 years), in 4 separate timepoints (at 7, 30, 60, and 150 days) after EVL introduction, corresponding to a mean postrenal transplantation day: PK1 (43 4 days), PK2 (65 +/- 7 days), PK3 (106 +/- 17 days), and PK4 (206 +/- 40 days). Patients received EVL (target trough level (C-trough, 3-8 ng/mL), prednisone, and tacrolimus (TCL) (target C-trough, 2-5 ng/mL). Results Mean TCL-C-trough was 7.2 +/- 3.8, 4.9 +/- 2.2, 4.9 +/- 2.2, and 4.5 +/- 1.2 ng/mL at PK1, PK2, PK3, and PK4, respectively. There were no differences among timepoints for mean EVL daily dose (data shown as PK3) (3.5 +/- 1.3 mg/d), C-trough (4.7 +/- 2.5 ng/mL), AUC(0-12h) (106 +/- 51 ng/h per mL), C-average (8.8 +/- 4.2 ng/mL), C-max (19.2 +/- 9.7 ng/mL), apparent Half-life (11.7 +/- 4.2 hours), estimated total body clearance (0.39 +/- 0.27 L/h), or fluctuation (166 +/- 65%). Also, none of those PK parameters differed statistically when adjusted for body weight. EVL-C-trough showed a very high correlation (r(2) = 0.849) with AUC(0-12h). Conclusions Our data indicate that elderly renal transplant recipients starting EVL 1 month after transplantation along with a steady-state TCL level, present stable EVL-PK parameters without significant changes in dose or exposure during the first 6 months after renal transplantation.
- Severe type 1 upgrading leprosy reaction in a renal transplant recipient: a paradoxical manifestation associated with deficiency of antigen-specific regulatory T-cells?(2017) VIEIRA, Ana Paula; TRINDADE, Maria Angela Bianconcini; PAULA, Flavio Jota de; SAKAI-VALENTE, Neusa Yurico; DUARTE, Alberto Jose da Silva; LEMOS, Francine Brambate Carvalhinho; BENARD, GilBackground: Due to its chronic subclinical course and large spectrum of manifestations, leprosy often represents a diagnostic challenge. Even with proper anti-mycobacteria treatment, leprosy follow up remains challenging: almost half of leprosy patients may develop reaction episodes. Leprosy is an infrequent complication of solid organ transplant recipients. This case report illustrates the challenges in diagnosing and managing leprosy and its reactional states in a transplant recipient. Case presentation: A 53-year-old man presented 34 months after a successful renal transplantation a borderline-tuberculoid leprosy with signs of mild type 1 upgrading reaction (T1R). Cutaneous manifestations were atypical, and diagnosis was only made when granulomatous neuritis was found in a cutaneous biopsy. He was successfully treated with the WHO recommended multidrug therapy (MDT: rifampicin, dapsone and clofazimine). However he developed a severe T1R immediately after completion of the MDT but no signs of allograft rejection. T1R results from flare-ups of the host T-helper-1 cell-mediated immune response against Mycobacterium leprae antigens in patients with immunologically unstable, borderline forms of leprosy and has been considered an inflammatory syndrome in many aspects similar to the immune reconstitution inflammatory syndromes (IRS). The T1R was successfully treated by increasing the prednisone dose without modifying the other immunosuppressive drugs used for preventing allograft rejection. Immunological study revealed that the patient had a profound depletion of both in situ and circulating regulatory T-cells and lack of expansion of the Tregs upon M. leprae stimulation compared to T1R leprosy patients without iatrogenic immunosuppression. Conclusions: Our case report highlights that leprosy, especially in the transplant setting, requires a high degree of clinical suspicion and the contribution of histopathology. It also suggests that the development of upgrading inflammatory syndromes such as T1R can occur despite the sustained immunosuppressors regimen for preventing graft rejection. Our hypothesis is that the well-known deleterious effects of these immunosuppressors on pathogen-induced regulatory T-cells contributed to the immunedysregulation and development T1R.
- Randomized Trial of Machine Perfusion Versus Cold Storage in Recipients of Deceased Donor Kidney Transplants With High Incidence of Delayed Graft Function(2017) TEDESCO-SILVA JUNIOR, Helio; OFFERNI, Juliano Chrystian Mello; CARNEIRO, Vanessa Ayres; PAULA, Mayara Ivani de; DAVID NETO, Elias; LEMOS, Francine Brambate Carvalhinho; MOURA, Lucio Roberto Requiao; SILVA FILHO, Alvaro Pacheco e; CUNHA, Mirian de Fatima de Morais; SILVA, Erica Francisco da; MIORIN, Luiz Antonio; DEMETRIO, Daniela Priscila; LUCONI, Paulo Sergio; LUCONI, Waldere Tania da Silva; BOBBIO, Savina Adriana; KUSCHNAROFF, Liz Milstein; NORONHA, Irene Lourdes; BRAGA, Sibele Lessa; BARSANTE, Renata Cristina; MOREIRA, Joao Cezar Mendes; FERNANDES-CHARPIOT, Ida Maria Maximina; ABBUD-FILHO, Mario; ANDRADE, Luis Gustavo Modelli de; GARCIA, Paula Dalsoglio; SABER, Luciana Tanajura Santamaria; LAURINDO, Alan Fernandes; CHOCAIR, Pedro Renato; CUVELLO NETO, Americo Lourenco; ZANOCCO, Juliana Aparecida; SOARES FILHO, Antonio Jose Duboc de Almeida; AGUIAR, Wilson Ferreira; PESTANA, Jose MedinaBackground. This study compared the use of static cold storage versus continuous hypothermic machine perfusion in a cohort of kidney transplant recipients at high risk for delayed graft function (DGF). Methods. In this national, multicenter, and controlled trial, 80 pairs of kidneys recovered from brain-dead deceased donors were randomized to cold storage or machine perfusion, transplanted, and followed up for 12 months. The primary endpoint was the incidence of DGF. Secondary endpoints included the duration of DGF, hospital stay, primary nonfunction, estimated glomerular filtration rate, acute rejection, and allograft and patient survivals. Results. Mean cold ischemia time was high but not different between the 2 groups (25.6 +/- 6.6 hours vs 25.05 +/- 6.3 hours, 0.937). The incidence of DGF was lower in the machine perfusion compared with cold storage group (61% vs. 45%, P = 0.031). Machine perfusion was independently associated with a reduced risk of DGF (odds ratio, 0.49; 95% confidence interval, 0.26-0.95). Mean estimated glomerular filtration rate tended to be higher at day 28 (40.6 +/- 19.9 mL/min per 1.73 m(2) vs 49.0 +/- 26.9 mL/min per 1.73 m(2); P = 0.262) and 1 year (48.3 +/- 19.8 mL/min per 1.73 m(2) vs 54.4 +/- 28.6 mL/min per 1.73 m(2); P = 0.201) in the machine perfusion group. No differences in the incidence of acute rejection, primary nonfunction (0% vs 2.5%), graft loss (7.5% vs 10%), or death (8.8% vs 6.3%) were observed. Conclusions. In this cohort of recipients of deceased donor kidneys with high mean cold ischemia time and high incidence of DGF, the use of continuous machine perfusion was associated with a reduced risk of DGF compared with the traditional cold storage preservation method.
- Longitudinal Pharmacokinetics of Tacrolimus in Elderly Compared With Younger Recipients in the First 6 Months After Renal Transplantation(2017) DAVID-NETO, Elias; ROMANO, Paschoalina; TRIBONI, Ana Heloisa Kamada; RAMOS, Fernanda; AGENA, Fabiana; EBNER, Persio Almeida Rezende; ALTONA, Marcelo; GALANTE, Nelson Zocoler; LEMOS, Francine Brambate CarvalhinhoBackground. Elderly (Eld) (>= 60 years) recipients are receiving renal transplants more frequently. The pharmacokinetics (PK) studies of immunosuppressive drugs in healthy volunteers, rarely, include old patients. Methods. We studied 208 12-hour tacrolimus (TAC) PK (0, 20, 40, 60, 90, 120, 180, 240, 360, 480, 600, 720 min) in 44 Eld (65 +/- 3 years) and compared the results with 31 younger controls (Ctrl) (35 +/- 6 years) recipients, taking oral TAC/mycophenolate sodium (MPS)/prednisone, at 4 different timepoints: PK1 (8 +/- 2 days; n = 72), PK2 (31 +/- 4 days; n = 61), PK3 (63 +/- 6 days; n = 44), and PK4 (185 +/- 10 days; n = 31). Tacrolimus PK was measured by ultraperformance liquid chromatography coupled to a mass spectrometer repetition and noncompartmental PKs were analyzed using Phoenix WinNonlin. Results. Mean TAC dose was lower in the Eld group than in Ctrl ones throughout timepoints either by total daily dose or adjusted (Adj) per body weight. Mean TAC trough level (Cmin), used to adjust daily dose, was not different between the 2 groups in all timepoints. AdjCmax and AdjTAC-area under the curve at dosing interval were both higher in the Eld compared to the Ctrl group in PKs1, 3, and 4. Estimated total body clearance normalized by dose and weight was lower in the Eld group compared with the Ctrl in all PKs and statistically lower at PKs 1 and 3. Similar to younger recipients TAC trough level has also a high correlation (R-2 = 0.76) with area under the curve at dosing interval. Conclusions. These data indicate that Eld recipients have a lower TAC clearance and therefore need a lower TAC dose than younger recipients.
conferenceObject Senescence and Uremia Effects in Circulating T Cells Diverge in TREG Population and Cause T Cell Shift to a Memory Profile.(2017) FREITAS, G.; FERNANDES, M.; AGENA, F.; JABUUL, O.; COELHO, V.; LEMOS, F.; RAMOS, F.; TRIBONI, A.; DAVID-NETO, E.; GALANTE, N.