LUCIANA BERTOCCO DE PAIVA HADDAD
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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
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- Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility(2018) EJZENBERG, Dani; ANDRAUS, Wellington; MENDES, Luana Regina Baratelli Carelli; DUCATTI, Liliana; SONG, Alice; TANIGAWA, Ryan; ROCHA-SANTOS, Vinicius; ARANTES, Rubens Macedo; SOARES JR., Jose Maria; SERAFINI, Paulo Cesar; HADDAD, Luciana Bertocco de Paiva; FRANCISCO, Rossana Pulcinelli; D'ALBUQUERQUE, Luiz Augusto Carneiro; BARACAT, Edmund ChadaBackground Uterus transplantation from live donors became a reality to treat infertility following a successful Swedish 2014 series, inspiring uterus transplantation centres and programmes worldwide. However, no case of livebirth via deceased donor uterus has, to our knowledge, been successfully achieved, raising doubts about its feasibility and viability, including whether the womb remains viable after prolonged ischaemia. Methods In September, 2016, a 32-year-old woman with congenital uterine absence (Mayer-Rokitansky-KusterHauser [MRKH] syndrome) underwent uterine transplantation in Hospital das Clinicas, University of Sao Paulo, Brazil, from a donor who died of subarachnoid haemorrhage. The donor was 45 years old and had three previous vaginal deliveries. The recipient had one in-vitro fertilisation cycle 4 months before transplant, which yielded eight cryopreserved blastocysts. Findings The recipient showed satisfactory postoperative recovery and was discharged after 8 days' observation in hospital. Immunosuppression was induced with prednisolone and thymoglobulin and continued via tacrolimus and mycophenalate mofetil (MMF), until 5 months post-transplantation, at which time azathioprine replaced MMF. First menstruation occurred 37 days post-transplantation, and regularly (every 26-32 days) thereafter. Pregnancy occurred after the first single embryo transfer 7 months post-transplantation. No blood flow velocity waveform abnormalities were detected by Doppler ultrasound of uterine arteries, fetal umbilical, or middle cerebral arteries, nor any fetal growth impairments during pregnancy. No rejection episodes occurred after transplantation or during gestation. Caesarean delivery occurred on Dec 15, 2017, near gestational week 36. The female baby weighed 2550 g at birth, appropriate for gestational age, with Apgar scores of 9 at 1 min, 10 at 5 min, and 10 at 10 min, and along with the mother remains healthy and developing normally 7 months post partum. The uterus was removed in the same surgical procedure as the livebirth and immunosuppressive therapy was suspended. Interpretation We describe, to our knowledge, the first case worldwide of livebirth following uterine transplantation from a deceased donor in a patient with MRKH syndrome. The results establish proof-of-concept for treating uterine infertility by transplantation from a deceased donor, opening a path to healthy pregnancy for all women with uterine factor infertility, without need of living donors or live donor surgery.
- Attitude and knowledge of medical students toward donation after circulatory death(2021) MARTINO, Rodrigo Bronze de; GUIDOTTE, Diogo Visconti; WAISBERG, Daniel Reis; SANTOS, Alexandre Guerra dos; CASSENOTE, Alex Jones Flores; ARANTES, Rubens Macedo; HADDAD, Luciana Bertocco; GALVAO, Flavio Henrique; CARNEIRO-D'ALBUQUERQUE, Luiz AugustoOBJECTIVE: A survey among medical students in a Brazilian public university was performed to investigate the acceptance of organ donation in Brazil, particularly donation after circulatory death (DCD). METHODS: A questionnaire including 26 objectives and Likert scale questions was validated and sent to all medical students of our institution. The answers were analyzed considering the whole set of individuals as well as by dividing the medical students into two groups: less graduated students and more graduated students. RESULTS: From 1050 students, 103 spontaneous answers (9.8%) were retrieved after 3 weeks. A total of 89.3% agreed totally with deceased donor organ donation and 8.7% agreed partially. However, only 50.5% of the students agreed totally and 31.1% agreed partially to living donation. Students revealed that 82.6% know the concept of brain death. On the other hand, 71.8% of them declared not knowing the concept of planned withdrawal of life-sustaining therapy, mainly cardiorespiratory support. A total of 85.4% of students agreed totally with donation after brain death and 11.7% agreed partially. However, when questioned about donation in awaiting circulatory death after a planned withdrawal of life-sustaining therapy, only 18.4% agreed totally and 32% agreed partially. Both groups of less and more graduated students showed similar results. CONCLUSIONS: Our study found a clear lack of information and consequently in acceptance of DCD. Education in the field of end-oflife management may improve not only the acceptance of DCD donation but also the whole understanding of planned withdrawal of life-sustaining therapy.
- First Successful Isolated Intestinal Transplant in a Brazilian Series(2021) ANDRAUS, Wellington; PINHEIRO, Rafael Soares; FORTUNATO, Allana Christina; GALVAO, Flavio Henrique Ferreira; ARANTES JUNIOR, Rubens Macedo; WAISBERG, Daniel Reis; LEE, Andre Dong; ROCHA, Mariana Hollanda Martins da; NACIF, Lucas Souto; SANTOS, Vinicius Rocha; DUCATTI, Liliana; MARTINO, Rodrigo Bronze de; HADDAD, Luciana Bertocco de Paiva; TANIGAWA, Ryan Yukimatsu; BEZERRA, Regis O. F.; SONG, Alice Tung Wan; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto
- Healthcare resource utilization and costs of outpatient follow-up after liver transplantation in a university hospital in Sao Paulo, Brazil: cost description study(2015) SOAREZ, Patricia Coelho de; LARA, Amanda Nazareth; SARTORI, Ana Marli Christovam; ABDALA, Edson; HADDAD, Luciana Bertocco de Paiva; D'ALBUQUERQUE, Luiz Augusto Carneiro; NOVAES, Hillegonda Maria DutilhCONTEXT AND OBJECTIVE: Data on the costs of outpatient follow-up after liver transplantation are scarce in Brazil. The purpose of the present study was to estimate the direct medical costs of the outpatient follow-up after liver transplantation, from the first outpatient visit after transplantation to five years after transplantation. DESIGN AND SETTING: Cost description study conducted in a university hospital in Sao Paulo, Brazil. METHODS: Cost data were available for 20 adults who underwent liver transplantation due to acute liver failure (ALF) from 2005 to 2009. The data were retrospectively retrieved from medical records and the hospital accounting information system from December 2010 to January 2011. RESULTS: Mean cost per patient/year was R$ 13,569 (US$ 5,824). The first year of follow-up was the most expensive (R$ 32,546 or US$ 13,968), and medication was the main driver of total costs, accounting for 85% of the total costs over the five-year period and 71.9% of the first-year total costs. In the second year after transplantation, the mean total costs were about half of the amount of the first-year costs (R$ 15,165 or US$ 6,509). Medication was the largest contributor to the costs followed by hospitalization, over the five-year period. In the fourth year, the costs of diagnostic tests exceeded the hospitalization costs. CONCLUSION: This analysis provides significant insight into the costs of outpatient follow-up after liver transplantation due to ALF and the participation of each cost component in the Brazilian setting.
- Enabling liver transplantation during the COVID-19 era: More than screening donors and recipients for SARS-CoV-2(2020) ABDALA, Edson; WAISBERG, Daniel Reis; HADDAD, Luciana Bertocco; DUCATTI, Liliana; ROCHA-SANTOS, Vinicius; MARTINO, Rodrigo Bronze de; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto
- Technological Innovation in Outpatient Assistance for Chronic Liver Disease and Liver Transplant Patients During the Coronavirus Disease Outbreak: A Method to Minimize Transmission(2020) ONO, Suzane Kioko; ANDRAUS, Wellington; TERRABUIO, Debora Raquel Benedita; COBELLO-JUNIOR, Vilson; ARAI, Lilian; DUCATTI, Liliana; HADDAD, Luciana Bertocco de Paiva; D'ALBUQUERQUE, Luiz Augusto Carneiro; CARRILHO, Flair Jose
- The best approach for diagnosing primary sclerosing cholangitis(2011) ANDRAUS, Wellington; HADDAD, Luciana; NACIF, Lucas Souto; SILVA, Felipe D.; BLASBALG, Roberto; AUGUSTO, Luiz; D'ALBUQUERQUE, Carneiro
- Uterine transplantation: a systematic review(2016) EJZENBERG, Dani; MENDES, Luana Regina Baratelli Carelli; HADDAD, Luciana Bertocco de Paiva; BARACAT, Edmund Chada; D'ALBUQUERQUE, Luiz Augusto Carneiro; ANDRAUS, WellingtonUp to 15% of the reproductive population is infertile, and 3 to 5% of these cases are caused by uterine dysfunction. This abnormality generally leads women to consider surrogacy or adoption. Uterine transplantation, although still experimental, may be an option in these cases. This systematic review will outline the recommendations, surgical aspects, immunosuppressive drugs and reproductive aspects related to experimental uterine transplantation in women.
- Predictors of micro-costing components in liver transplantation(2017) HADDAD, Luciana Bertocco de Paiva; DUCATTI, Liliana; MENDES, Luana Regina Baratelli Carelli; ANDRAUS, Wellington; D'ALBUQUERQUE, Luiz Augusto CarneiroOBJECTIVES: Although liver transplantation procedures are common and highly expensive, their cost structure is still poorly understood. This study aimed to develop models of micro-costs among patients undergoing liver transplantation procedures while comparing the role of individual clinical predictors using tree regression models. METHODS: We prospectively collected micro-cost data from patients undergoing liver transplantation in a tertiary academic center. Data collection was conducted using an Intranet registry integrated into the institution's database for the storing of financial and clinical data for transplantation cases. RESULTS: A total of 278 patients were included and accounted for 300 procedures. When evaluating specific costs for the operating room, intensive care unit and ward, we found that in all of the sectors but the ward, human resources were responsible for the highest costs. High cost supplies were important drivers for the operating room, whereas drugs were among the top four drivers for all sectors. When evaluating the predictors of total cost, a MELD score greater than 30 was the most important predictor of high cost, followed by a Donor Risk Index greater than 1.8. CONCLUSION: By focusing on the highest cost drivers and predictors, hospitals can initiate programs to reduce cost while maintaining high quality care standards.
- Model for establishing a new liver transplantation center through mentorship from a university with transplantation expertise(2022) PINHEIRO, Rafael Soares; ANDRAUS, Wellington; ROMEIRO, Fernando Gomes; MARTINO, Rodrigo Bronze de; DUCATTI, Liliana; ARANTES, Rubens Macedo; PELAFSKY, Leonardo; HASIMOTO, Claudia Nishida; YAMASHIRO, Fabio da Silva; NACIF, Lucas Souto; HADDAD, Luciana Bertocco de Paiva; SANTOS, Vinicius Rocha; WAISBERG, Daniel Reis; VANE, Matheus Fachini; ROCHA-FILHO, Joel Avancini; OLIVEIRA, Walmar Kerche de; CARNEIRO-D'ALBUQUERQUE, Luiz AugustoBackgroundSetting up new liver transplant (LT) centers is essential for countries with organ shortages. However, good outcomes require experience, because LT learning depends on a high number of surgeries. This study aims to describe how a new center was set up from a partnership between the new center and an experienced one. The step-by-step preparation process, the time needed and the results of the new center are depicted. Material and methodsThe mentoring process lasted 40 months, in which half of the 52 patients included on the transplant list received LT. After the mentorship, a 22-month period was also analyzed, in which 46 new patients were added to the waiting list and nine were operated on. ResultsThe 30-day survival rates during (92.3%) and after (66.7%) the partnership were similar to the other LT centers in the same region, as well as the rates of longer periods. The waiting time on the LT list, the characteristics of the donors and the ischemia times did not differ during or after the mentorship. ConclusionThe partnership between universities is a suitable way to set up LT centers, achieving good results for the institutions and the patients involved.