JOSE EDUARDO AFONSO JUNIOR

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  • conferenceObject
    Management of Tuberculosis After Lung Transplantation in na Endemic Region
    (2017) CAMPOS, S. V.; SAMANO, M. N.; PEGO-FERNANDES, P. M.; TEIXEIRA, R. O.; FERNANDES, L. M.; ABDALLA, L. G.; CARRARO, R. M.; AFONSO-JUNIOR, J. E.; COSTA, A. N.
  • article 10 Citação(ões) na Scopus
    Experience of Lung Transplantation in Patients with Lymphangioleiomyomatosis at a Brazilian Reference Centre
    (2017) BALDI, Bruno Guedes; SAMANO, Marcos Naoyuki; CAMPOS, Silvia Vidal; OLIVEIRA, Martina Rodrigues de; AFONSO JUNIOR, Jose Eduardo; CARRARO, Rafael Medeiros; TEIXEIRA, Ricardo Henrique Oliveira Braga; MINGUINI, Isabela Pasqualini; BURLINA, Roni; PATO, Eduardo Zinoni Silva; CARVALHO, Carlos Roberto Ribeiro; COSTA, Andre Nathan
    Lung transplantation (LT) is the standard of care for patients with advanced lung diseases, including lymphangioleiomyomatosis (LAM). LAM accounts for only 1% of all LTs performed in the international registry. As a result, the global experience, including the use of mechanistic target of rapamycin (mTOR) inhibitors before and after LT in LAM, is still limited. We conducted a retrospective review of all LAM patients who underwent LT at our centre between 2003 and 2016. Pre- and post-transplant data were assessed. Eleven women with LAM underwent LT, representing 3.3% of all procedures. Ten (91%) patients underwent double-LT. The mean age at diagnosis was 39 +/- 6 years and the mean FEV1 before LT was 28 +/- 14%. Only one patient underwent pleurodesis for recurrent pneumothorax. Pulmonary hypertension was confirmed in 3 (27%) patients. Four (36%) patients received sirolimus preoperatively; three of them received it until the day of LT, and there was no occurrence of bronchial anastomotic dehiscence after the procedure. Four patients (36%) received mTOR inhibitors post-transplant. The median follow-up from LT was 44 months. There were 3 deaths (27%) during the study and survival probabilities at 1, 3, and 5 years after LT were, 90, 90, and 77%, respectively. This data reinforces the role of LT for LAM patients with end-stage disease. The use of sirolimus seems to be safe before LT and the occurrence of complications after LT, including those LAM-related, should be continuously monitored.
  • conferenceObject
    Clinical Assessment of Cytomegalovirus Specific Cell Mediated Immunity in a Prospective Cohort of Lung Transplant Recipients
    (2017) CAMPOS, S. V.; SAMANO, M. N.; PEGO-FERNANDES, P. M.; TEIXEIRA, R. O.; CARRARO, R. M.; AFONSO-JUNIOR, J. E.; COSTA, A. N.; MACHADO, C. M.; SOUZA, A. C.; PEREIRA, B. B.; FERNANDES, L. M.; ABDALLA, L.
  • article 1 Citação(ões) na Scopus
    Histopathological Findings Associated With Gastroesophageal Reflux Disease and Aspiration After Lung Transplantation: Initial Brazilian Single-Center Experience
    (2017) CARRARO, R. M.; NASCIMENTO, E. C. T.; SZACHNOWICZ, S.; CAMARGO, P. C. L. B.; CAMPOS, S. V.; AFONSO JR., J. E.; SAMANO, M. N.; PEGO-FERNANDES, P. M.; DOLHNIKOFF, M.; TEIXEIRAA, R. H. O. B.; COSTA, A. N.
    Background. Gastro-esophageal reflux disease (GERD) and broncho-aspiration (BA) are known to increase the risk for chronic lung allograft dysfunction (CLAD). However, specific lung injury mechanisms are not clearly known. The objective of the study was to describe histopathological findings in surveillance lung transbronchial biopsies that can be correlated with episodes of BA in the lung allograft. Methods. This retrospective analysis of surveillance transbronchial biopsies was performed in lung transplant recipients, with available data of broncho-alveolar fluid (cultures and cytology), lung function parameters, and esophageal functional tests. Results. Were analyzed 11 patients, divided into 3 groups: (1) GERD group: 4 patients with GERD and CLAD diagnosis; (2) control group: 2 patients without GERD or CLAD; and (3) BA group: 5 patients with foreign material in lung biopsies. A histopathological pattern of neutrophilic bronchitis (NB) was present in 4 of 4 cases in the GERD group and in 1 of 5 cases in the BA group in 2 or more biopsy samples; culture samples were all negative; the 5 NB-positive patients developed CLAD and died (3/5) or needed re-transplantation (2/5). The other 3 patients in the BA group had GERD without NB or CLAD. Both patients in the control group had transient NB in biopsies with positive cultures but remained free of CLAD. Conclusions. Surveillance transbronchial biopsies may provide useful information other than the evaluation of acute cellular rejection and can help to identify high-risk patients for allograft dysfunction related to gastro-esophageal reflux.