PAULO CELSO BOSCO MASSAROLLO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
14 resultados
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- Consensus, Dilemmas, and Challenges in Living Donor Liver Transplantation in Latin America(2016) SALVALAGGIO, Paolo R.; NETO, Joao Seda; ALVES, Jefferson Andre; FONSECA, Eduardo A.; ALBUQUERQUE, Luiz Carneiro de; ANDRAUS, Wellington; MASSAROLLO, Paulo B.; GARCIA, Valter Duro; MAURETTE, Rafael J.; RUF, Andres E.; PACHECO-MOREIRA, Lucio F.; RUSCA, Luis A. Caicedo; OSORIO, Veronica Botero; MATAMOROS, Maria Amalia; VARELA-FASCINETTO, Gustavo; JARUFE, Nicolas P.We reviewed the history, volume, outcomes, uniqueness, and challenges of living donor liver transplantation (LDLT) in Latin America. We used the data from the Latin American and Caribbean Transplant Society, local transplant societies, and opinions from local transplant experts. There are more than 160 active liver transplant teams in Latin America, but only 30 centers have used LDLT in the past 2 years. In 2014, 226 LDLTs were done in the region (8.5% of liver transplant activities). Living donor liver transplantation is mainly restricted to pediatric patients. Adult-to-adult LDLT activities decreased after the implementation of the model for end-stage liver disease score and a concomitant increase on the rate of deceased donors per million population. Posttransplant outcome analysis is notmandatory, transparent or regulated in most countries. More experienced teams have outcomes comparable to international expert centers, but donor and recipient morbidity might be underreported. Latin America lags behind in terms of the number of adult LDLT and the rate of living donor utilization in comparison with other continents with similar donation rates. Local alliances and collaborations with major transplant centers in the developed world will contribute to the development of LDLT in Latin America.
- Pre- and Posttransplant Monitoring of Alloantibodies by Complement-Dependent Cytotoxicity and Luminex Methodologies in Liver Transplantation(2012) MONTEIRO, F.; RODRIGUES, H.; KALIL, J.; CASTRO, M. C.; PANAJOTOPOULOS, N.; PAREDES, M.; MASSAROLO, P.; MIES, S.Background. This study evaluated the influence of circulating anti-HLA antibodies on outcomes of 97 liver allografts from deceased donors. Methods. Human leukocyte antigen (HLA) antibody screening was performed by both complement-dependent cytotoxicity (CDC) and multiparameter Luminex microsphere-based assays (Luminex assay). Results. The agreements between T- and B- cell CDC and Luminex assays were 67% and 77% for pre- and posttransplant specimens, respectively. Graft dysfunction was not associated with either positive pretransplant CDC or Luminex panel-reactive antibody (PRA) values. Likewise, positive posttransplant T- or B- cell CDC PRA values were not associated with graft dysfunction. In contrast, posttransplant Luminex PRA values were significantly higher among patients with graft dysfunction compared with subjects with good outcomes (P = .017). Conclusion. Posttransplant monitoring of HLA antibodies with Luminex methodology allowed identification of patients at high-risk for poor graft outcomes.
- Comparative Morphometric Analysis of 5 Interpositional Arterial Autograft Options for Adult Living Donor Liver Transplantation(2014) IMAKUMA, E. S.; BORDINI, A. L.; MILLAN, L. S.; MASSAROLLO, P. C. B.; CALDINI, E. T. E. G.In living donor liver transplantation, the right-sided graft presents thin and short vessels, bringing forward a more difficult anastomosis. In these cases, an interpositional arterial autograft can be used to favor the performance of the arterial anastomosis, making the procedure easier and avoiding surgical complications. Objective. We compared the inferior mesenteric artery (IMA), the splenic artery (SA), the inferior epigastric artery (TEA), the descending branch of the lateral circumflex femoral artery (LCFA), and the proper hepatic artery (PHA) as options for interpositional autograft in living donor liver transplantation. Method. Segments of at least 3 cm of all 5 arteries were harvested from 16 fresh adult cadavers from both genders through standardized dissection. The analyzed measures were proximal and distal diameter and length. The proximal diameter of the RHA and the distal diameter of the SA, IMA, IEA and the LCFA were compared to the distal diameter of the RHA. The proximal and distal diameters of the SA, TEA and LCFA were compared to study caliber gain of each artery. Results. All arteries except the IMA showed statistical significant difference in relation to the RHA in terms of diameter. Regarding caliber gain, the arteries demonstrated statistical significant difference. All the harvested arteries except PHA were 3 cm in length. Conclusion. The IMA demonstrated the best compatibility with the RI-TA in terms of diameter and showed sufficient length to be employed as interpositional graft. The PHA, the SA, the TEA and the LCFA presented statistically significant different diameters when compared to the RHA. Among these vessels, only the PHA did not show sufficient mean length.
- Donor Risk Index Does Not Predict Graft Survival After Pancreas Transplantation in Brazil(2015) AMARAL, P. H. F.; GENZINI, T.; PEROSA, M.; MASSAROLLO, P. C. B.Background. Pancreas donor risk index (DRI) was developed by using large multicenter American data to predict the risk of adverse outcomes in pancreas transplantation based on donor and technical/logistical characteristics. Aim. The goal of this study was to evaluate the usefulness of the DRI in predicting graft survival in a Brazilian population of pancreas transplant recipients. Method. We conducted a retrospective analysis of the 570 procedures performed by the same surgical team between 1996 and 2011. Because of the lack of sufficient data for the calculation of DRI values, only 154 cases were studied (27%), of which 105 underwent simultaneous pancreas-kidney transplantation, 33 underwent pancreas after kidney transplantation, and 16 underwent pancreas transplantation alone. Donor cause of death was classified as cerebrovascular accident (CVA) and non-CVA. Graft origin was divided into three groups: local, if the graft was obtained in the metropolitan area of the city of Sao Paulo; regional, if collected in other cities of the state of Sao Paulo; and national, if obtained outside the state. Results. Logistic regression analysis did not find a statistically significant association between DRI values and 1-year graft survival (odds ratio = 0.676; 95% confidence interval 0.152 to 3.014; P = .60). One-year graft survival calculated by the Kaplan-Meier method was 89.8% in transplants with DRI <= 1, 77.9% in those with 1 < DRI < 1.5, and 93.3% in those with DRI >= 1.5 (P = .106). Conclusion. The pancreas DRI model did not prove effective in predicting pancreas graft survival in a Brazilian sample of recipients.
bookPart Principais acessos em cirurgia inguinal(2019) MASSAROLO, Paulo; OTOCH, José Pinhata; JACOMO, Alfredo Luiz; HOJAIJ, Flávio Carneiro; ANDRADE, Mauro Figueiredo Carvalho de- LIVER TRANSPLANTATION FOR CARCINOMA HEPATOCELLULAR IN SÃO PAULO: 414 CASES BY THE MILAN/BRAZIL CRITERIA(2016) SÁ, Gustavo Pilotto D.; VICENTINE, Fernando P. P.; SALZEDAS-NETTO, Alcides A.; MATOS, Carla Adriana Loureiro de; ROMERO, Luiz R.; TEJADA, Dario F. P.; MASSAROLLO, Paulo Celso Bosco; LOPES-FILHO, Gaspar J.; GONZALEZ, Adriano M.ABSTRACT Background: The criterion of Milan (CM) has been used as standard for indication of liver transplantation (LTx) for hepatocellular carcinoma (HCC) worldwide for nearly 20 years. Several centers have adopted criteria expanded in order to increase the number of patients eligible to liver transplantation, while maintaining good survival rates. In Brazil, since 2006, the criterion of Milan/Brazil (CMB), which disregards nodules <2 cm, is adopted, including patients with a higher number of small nodules. Aim: To evaluate the outcome of liver transplantation within the CMB. Methods: The medical records of patients with HCC undergoing liver transplantation in relation to recurrence and survival by comparing CM and CMB, were analyzed. Results: 414 LTx for HCC, the survival at 1 and 5 years was 84.1 and 72.7%. Of these, 7% reached the CMB through downstaging, with survival at 1 and 5 years of 93.1 and 71.9%. The CMB patient group that exceeded the CM (8.6%) had a survival rate of 58.1% at five years. There was no statistical difference in survival between the groups CM, CMB and downstaging. Vascular invasion (p<0.001), higher nodule size (p=0.001) and number of nodules >2 cm (p=0.028) were associated with relapse. The age (p=0.001), female (p<0.001), real MELD (p<0.001), vascular invasion (p=0.045) and number of nodes >2 cm (p<0.014) were associated with worse survival. Conclusions: CMB increased by 8.6% indications of liver transplantation, and showed survival rates similar to CM.
bookPart Principais acessos em cirurgias abdominais(2019) OTOCH, José Pinhata; JACOMO, Alfredo Luiz; MASSAROLO, Paulo; HOJAIJ, Flávio Carneiro; ANDRADE, Mauro Figueiredo Carvalho de- Favorable Long-term Outcome in Patients Submitted to Liver Transplantation After Downstaging of Hepatocellular Carcinoma According to a Brazilian Selection Protocol(2016) MASSAROLLO, P. C. B.; COPPINI, A. Z.; SALZEDAS-NETTO, A. A.; COELHO, F. F.; MINAMI, T.; GONZALEZ, A. M.Background. In October 2008, the Brazilian Ministry of Health authorized listing of downstaged hepatocellular carcinoma (HCC) for liver transplantation, according to a standardized protocol. The aim of this study was to compare the outcome of patients submitted to liver transplantation after downstaging of HCC with the results other standard indications in Brazil. Methods. We conducted a retrospective analysis of 2,667 adult 1st elective deceased donor liver transplantations registered at the database of the Transplant Notification Center of the Sao Paulo State Health Secretariat. These cases are classified into 3 groups: ""cirrhosis,"" including 1,709 patients transplanted because of end-stage liver disease; ""Milan-HCC,"" including 873 HCC patients initially meeting the Milan criteria; and ""downstaging"" group, including 85 HCC patients submitted to tumor downstaging to the Milan criteria before liver transplantation. Results. One-, 3-, 5-, and 6-year patients survivals were, respectively, 82.7%, 72.0%, 66.1%, and 66.1%, in the ""downstaging"" group and 76.7%, 68.4%, 63.9%, and 63.5% in the ""Milan-HCC"" group (P = .483). At the same time intervals, patient survivals were 67.8%, 62.9%, 60.9%, and 60.2% in the ""cirrhosis"" group. These probabilities were significantly lower than those of both ""downstaging"" (P = .047) and ""Milan-HCC"" (P = .001) groups. Conclusions. Patients submitted to liver transplantation after downstaging of HCC, according to a Brazilian selection protocol, present long-term outcomes similar to HCC patients initially within the Milan criteria and better survival than recipients with end-stage liver disease.
bookPart Acessos cirúrgicos na região cervical(2019) HOJAIJ, Flávio Carneiro; JACOMO, Alfredo Luiz; ANDRADE, Mauro Figueiredo Carvalho de; AKAMATSU, Flavia Emi; MASSAROLLO, Paulo; OTOCH, José Pinhataarticle 3 Citação(ões) na Scopus Long-term Outcome of a Modified Piggyback Liver Transplantation Technique Using the Recipient?s Right and Middle Hepatic Veins(2020) MASSAROLLO, Paulo Celso Bosco; COELHO, Fabricio Ferreira; BRESCIA, Marilia D'Elboux Guimaraes; BAIA, Carlos Eduardo Sandoli; LALLEE, Margareth Pauli; ALMEIDA, Marcio Dias de; SALZEDAS-NETTO, Alcides Augusto; COPPINI, Adriana Zuolo; MASSAROLLO, Daniel Braga; MIES, Sergio