LUIZ ALBERTO BENVENUTI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject High Prevalence of Myocardial Fibrosis in Patients After Heart Transplantation(2015) SILVA FILHO, M. R.; SETUGUTI, D. T.; CARVALHO, V. O.; BENVENUTI, L. A.; SILVA, L. F.; BOCCHI, E. A.- Trypanosoma cruzi persistence in the native heart is associated with high-grade myocarditis, but not with Chagas' disease reactivation after heart transplantation(2014) BENVENUTI, Luiz A.; ROGGERIO, Alessandra; NISHIYA, Anna S.; CAMPOS, Silvia V.; FIORELLI, Alfredo I.; LEVI, Jose E.BACKGROUND: Chagas' disease reactivation (CDR) after heart transplantation (HTx) is characterized by relapse of the infectious disease, with direct detection of Trypanosoma cruzi parasites in blood, cerebrospinal fluid, or tissues. We investigated whether a detailed pathologic examination of the explanted heart at HTx with evaluation of myocarditis and parasitic persistence or load in the myocardium could be useful to identify patients at high risk of CDR. METHODS: The native hearts of 18 chagasic patients who presented CDR after HTx (CDR+ group) were compared with the native hearts of 16 chagasic patients who never presented CDR in a follow-up of at least 18 months after HTx (CDR- group). The intensity of myocarditis was evaluated semiquantitatively. Parasite persistence/load in the myocardium was investigated through immunohistochemistry for T cruzi antigens and by qualitative and quantitative real-time PCR for T cruzi DNA. RESULTS: The rate of high-grade myocarditis, parasite persistence, and the median of parasitic load and parasitic load/10(6) cells in the CDR+ group were 83.3%, 77.8%, 8.43 x 10(-3), and 9.890, respectively, whereas in the CDR- group the values were 87.5%, 50%, 7.49 x 10(-3), and 17.800. There was no statistical difference between the groups. High-grade myocarditis was present in all 22 samples (100%) with parasite persistence and in 7 of 12 samples (58.3%) with no parasite persistence (p = 0.003). CONCLUSIONS: Although associated with high-grade myocarditis, T cruzi parasite persistence in the myocardium of the native heart is not associated with the occurrence of CDR after HTx.
- The challenging diagnosis of Chagas disease reactivation in endomyocardial biopsies from heart-transplanted patients(2017) BENVENUTI, Luiz Alberto; AIELLO, Vera Demarchi
- Sequential Measurement of Trypanosoma cruzi Parasitic Load in Endomyocardial Biopsies for Early Detection and Follow-up of Chagas Disease Reactivation After Heart Transplantation(2019) BENVENUTI, L. A.; ROGGERIO, A.; NISHIYA, A. S.; MANGINI, S.; LEVI, J. E.
- Usefulness of qualitative polymerase chain reaction for Trypanosoma cruzi DNA in endomyocardial biopsy specimens of chagasic heart transplant patients(2011) BENVENUTI, Luiz A.; ROGGERIO, Alessandra; COELHO, Guilherme; FIORELLI, Alfredo I.BACKGROUND: Chagas' disease reactivation (CDR) after heart transplantation is characterized by relapse of the infectious disease, with direct detection of Trypanosoma cruzi parasites in blood, cerebrospinal fluid, or tissues. CDR affecting the myocardium induces lymphocytic myocarditis and should be distinguished from acute cellular rejection in endomyocardial biopsy (EMB) specimens. METHODS: We performed retrospectively qualitative polymerase chain reaction for T cruzi DNA using 2 sets of primers targeting nuclear DNA (nDNA) or kinetoplast DNA (kDNA) in 61 EMB specimens of 11 chagasic heart transplant recipients who presented with CDR. Thirty-five EMB specimens were obtained up to 6 months before (pre-CDR group) and 26 up to 2 years after the diagnosis of CDR. The control group consisted of 6 chagasic heart transplant recipients with 18 EMB specimens who never experienced CDR. RESULTS: Amplification of kDNA occurred in 8 of 35 (22.9%) EMB specimens of the pre-CDR group, in 5 of 18(27.8%) of the control group, and in 17 of 26(65.4%) EMB specimens obtained after the successful treatment of CDR. Amplification of nDNA occurred in 3 of 35 (8.6%) EMB specimens of the pre-CDR group, 0 of 18 (0%) of the control group, and 6 of 26 (23.1%) EMB specimens obtained after the successful treatment of CDR. CONCLUSIONS: Amplification of kDNA in EMB specimens is not specific for the diagnosis of CDR, occurring also in patients with no evidence of CDR (control group). However, amplification of nDNA occurred in a few EMB specimens obtained before CDR, but in none of the control group specimens. Qualitative PCR for T cruzi DNA in EMB specimens should not be used as a criterion for cure of CDR because it can persist positive despite favorable clinical evolution of the patients. J Heart Lung Transplant 2011;30:799-804 (C) 2011 International Society for Heart and Lung Transplantation. All rights reserved.
conferenceObject Study of Necropsies of Patients Submitted to Heart Transplantation: NEHTS-NecropsyHeartTransplantationStudy(2012) AYUB-FERREIRA, S. M.; VALETTE, T. N.; BENVENUTI, L. A.; BOCCHI, E. A.Purpose: Autopsy has been considered the gold standard for diagnosing the cause of death. Discrepancies between pre and post-mortem diagnosis continue to be reported, ranging from 4.1 to 49.8% of cases referred for autopsy examination. Methods and Materials: Retrospective study. It was included all autopsies of heart transplanted patients performed between 2000-2010. Clinical data of patients, medical cause of death and cause of death at autopsy were analyzed. Then pre-mortem diagnosis was confronted with the cause ofdeath at necropsy according to the criteria of Goldman et al. (N Engl J Med 1983;308:1000.) Results: 48 autopsies were analyzed; 29 (60.4%) had a nondiscrepant diagnosis, 16 (33.3%) had a discrepant diagnosis and 3 (6.3%) had uncertain autopsy diagnosis. Among the discrepant diagnosis, 15 (31.3%) had possible impact on survival and 1 (2.1%) had no impact on survival. Among those pre-morten diagnoses associated with discrepancies, infection (31.3%) heads the list, followed by hyperacute rejection (18.8%), pulmonary thromboembolism (18.8%) and acute cellular rejection (18.8%). Conclusions: Even with advances in diagnostic technology, there are still differences between the clinical diagnosis and post-mortem findings. Furthermore, in most cases an accurate clinical diagnosis could led to a change in therapy and prolonged survival.conferenceObject Immunohistochemical Counting of Mononuclear Infiltrates in Endomyocardial Biopsy Fragments: A New Method To Improve the Diagnosis of Rejection after Heart Transplantation(2013) BOCCHI, E. A.; BENVENUTTI, L. A.; TANIGAWA, R.; BRANDAO, S.; ISSA, V. S.; AYUB-FERREIRA, S.; CRUZ, F.; POMERANTZEFF, P.; HONORATO, R.; LOURENCO-FILHO, D. D.; FIORELLI, A. I.; CHIZZOLA, P.; SOUZA, G.; BACAL, F.