ESTELA REGINA RAMOS FIGUEIRA
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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conferenceObject Elastography for the Diagnosis and Graduation of Liver Disease in Patients with Long Term Parenteral Nutrition(2021) GALVAO, F.; VEZOZZO, D.; LEE, A.; WAISBERG, D.; ROCHA, M.; NACIF, L.; PINHEIRO, R.; FIGUEIRA, E.; CASSENOTE, A.; CARRILHO, F.; WAITZBERG, D.; CARNEIRO-D'ALBUQUERQUE, L.conferenceObject Prognostic Factors for Recurrence of Sporadic Pancreatic Neuroendocrine Tumors after Surgical Resection(2016) FIGUEIRA, E. R. R.; BACCHELLA, T.; JUREIDINI, R.; CUNHA, J. E. M.; NAMUR, G. N.; RIBEIRO, T. C.; OKUBO, J.; V, A. G. Fernandes; CECCONELLO, I- Anesthetic Conditioning in Liver Transplantation: Results of a Multicenter Randomized Controlled Trial(2013) BONVINI, John M.; SCHADDE, Erik; CLAVIEN, Pierre-Alain; LESURTEL, Mickael; FIGUEIRA, Estela R. R.; FILHO, Joel A. Rocha; REYNTJENS, Koen; BREITENSTEIN, Stefan; BECK-SCHIMMER, BeatriceBackground data: In the age of organ scarcity and the increased use of older and steatotic organ grafts, protective strategies during transplantation are gaining importance. Volatile anesthetics such as sevoflurane attenuate ischemia-reperfusion injury in liver resection and lead to improved clinical outcome. Whether volatile anesthetics change clinical outcome in liver transplantation is unknown. Methods: Cadaveric liver recipients were randomized from 03/2009 to 08/2012 at three University Centers (Zurich, Sao Paulo, Ghent). Standard liver transplant patients were randomly assigned to propofol anesthesia (control group) or conditioning with sevoflurane (sevoflurane group). Postoperative peak of the aspartate transaminase (AST) was defined as primary endpoint. Secondary endpoints were in-hospital complications, hospital- and ICU stay. Results: Ninety-eight patients, who underwent liver transplantation, were randomized to propofol (n=48) or sevoflurane (n=50). Peak AST after transplantation was 925 U/l (512-3274) in the propofol group (p=0.73) and 1097 U/l (interquartile range 540-2633) in the sevofluorane one. While the overall complication rate was not different, there was a trend towards less severe complications in the sevoflurane group: median complication score was grade IIIa (IQR II-IVb) for the propofol and grade II (IQR 0-IIIb) for the sevoflurane group (Odds ratio 0.51, 0.24 to 1.09, p=0.08). Conclusions: This first multicenter trial with different anesthesia regimens in liver transplantation showed comparable surrogate markers postoperatively, but a trend towards less severe complications in the sevoflurane group. Future trials should be adequately powered to assess complications and identify subgroups, which might benefit from anesthetic conditioning.
conferenceObject Elastography for the Diagnosis and Graduation of Liver Disease in Patients with Long Term Parenteral Nutrition(2021) GALVAO, F.; VEZOZZO, D.; LEE, A.; WAISBERG, D.; ROCHA, M.; NACIF, L.; PINHEIRO, R.; FIGUEIRA, E.; CASSENOTE, A.; CARRILHO, F.; WAITZBERG, D.; CARNEIRO-D'ALBUQUERQUE, L.conferenceObject EFFECTS OF ANAESTHETIC PRECONDITIONING PLUS POSTCONDITIONING WITH SEVOFLURANE IN WARM LIVER ISCHEMIA/REPERFUSION INJURY IN RATS(2012) FILHO, J. A. R.; FIGUEIRA, E. R. R.; SCHIMMER, B. B.; ANDRE, V. O.; BUTO, M. F. de Souza; NAKATANI, M.; PRADO, F. J. G.; CARMONA, M. J. C.; CLAVIEN, P. A.; D'ALBUQUERQUE, L. A. C.Background: Preconditioning is a therapeutic strategy aimed to increase ischemic tissue tolerance against ischemia/reperfusion (IR) injury. Recent studies demonstrated that volatile anaesthetics may improve postischemic recovery by an ischemic preconditioning-like mechanism. Postconditioning is a new concept that may have hepatoprotective effect. We hypothesized that sevoflurane preconditioning combined with postconditioning may reduce the hepatocellular damage in a rat model of warm liver IR. Methods: Ten Wistar rats under mechanical ventilation were divided into 2 groups of 5; 1) IR: rats subjected to 45 min of warm liver ischemia of left and median lobes, followed by resection of non-ischemic lobes at early reperfusion; and 2) SEVO + IR: rats were exposed to sevoflurane 2.5% for 15 min, followed by 5 min washout, before ischemia, plus sevoflurane 2.5% for 15 minat reperfusion. Carotid artery was cannulated for mean arterial pressure(MAP). Mean portal flow (MPF) was assessed by perivascular flowprobe. MAP and MPF were recorded at baseline, pre-repefusion and 4 h postreperfusion. Liver transaminases, creatinine, pH, bicarbonate (BIC) and base excess (BE), potassium (K), glucose and lactate were measured at 4 h postreperfusion. Results: AST and ALT were decreased in SEVO + IR group (12.118 ± 3.611 and 7.870 ± 1.586 U/L) compared to IR group (16.890 ± 1.630 and13.418 ± 1.088 U/L), P < 0.05. BIC, and K were increased in SEVO + IR group (11.20 ± .86 mmol/l and 6.1 ± 1.3 mEq/dl) compared to IR (6.70 ± 3.32 mmol/l and 4.7 ± 0.7 mEq/dl),P < 0.05. There were no differ- ences in MAP, MPF, creatinine, glucose, lactate, pH and BE; however glucose tended to be higher in SEVO + IR group (50.8 ± 26.0 mg/dl) compared to IR (35.0 ± 18.4 mg/dl). Conclusions: In experimental warm liver ischemia/reperfusion, sevoflurane preconditioning plus postconditioning reduced the hepatocellular injury demonstrated by lower levels of transaminases with a better behaviour of acid base variables and good hemodynamic recovery. These preliminary results are encouraging because postconditioning may have the advantage of being implemented at the moment of reperfusion, what is more feasible to be applied during liver transplantation surgery.conferenceObject Liver Transplantation for Gastroenteropancreatic Neuroendocrine Tumors(2016) FIGUEIRA, E. R. R.; ROCHA FILHO, J. A.; HADDAD, L. B. P.; OLIVEIRA, A. C.; OKUBO, J.; FERNANDES, A. G. V.; D'ALBUQUERQUE, L. A. C.conferenceObject Viral hepatitis is not the main cause of acute liver failute leading to liver transplantation in Brazil(2018) SANTOS JUNIOR, Genario O.; FIGUEIRA, E.; DIAS, M.; ARTEIRO, N.; BOIN, I.; PORTA, G.; SILVA, R. Da; VIANA, C.; FARIA, L.; REIS, M.; LISBOA, P.; MORAES, A.; MORSOLETTO, D.; PARANA, R.conferenceObject Anesthetic Conditioning in Liver Transplantation: A multicenter randomized controlled trial(2013) KAJDI, Marie-Elisabeth; BONVINI, John M.; SCHADDE, Erik; FIGUEIRA, Estela R. R.; FILHO, Joel A. Rocha; REYNTJENS, Koen; PUHAN, Milo A.; CLAVIEN, Pierre-Alain; BREITENSTEIN, Stefan; BECK-SCHIMMER, BeatriceconferenceObject EFFECTS OF ANAESTHETIC PRECONDITIONING WITH SEVOFLURANE IN WARM LIVER ISCHEMIA/REPERFUSION INJURY IN RATS(2012) FIGUEIRA, E. R. R.; FILHO, J. A. R.; SCHIMMER, B. B.; NAKATANI, M.; TATEBE, E. R.; ANDRE, V. O.; PRADO, F. J. G.; CARMONA, M. J. C.; D'ALBUQUERQUE, L. A. C.Background: Preconditioning is a therapeutic strategy aimed to increase ischemic tissue tolerance against ischemia/reperfusion (IR) injury. Recentstudies demonstrated that volatile anaesthetics may improve postischemic recovery by an ischemic preconditioning-like mechanism. We hypothesized that pharmacological preconditioning with sevoflurane may reduce the hepatocellular damage in a rat model of warm liver IR. Methods: Ten Wistar rats under mechanical ventilation were divided into 2 groups of 5 animals: I) IR: rats subjected to 45 min of warm liver ischemia of the left and median lobes, followed by resection of the non-ischemic lobes at early reperfusion; and II) SEVO+IR: rats were exposed to sevoflurane 2.5% for 15 min, followed by washout during 5 min, before IR. The carotid artery was cannulated for mean arterial pressure (MAP) monitoring. The mean portal venous flow (MPF) was assessed by perivascular flowprobe. MAP and MPF were recorded at baseline, pre reperfusion and 4 hours post-reperfusion. Liver transaminases, creatinine, pH, bicarbonate (BIC) and base excess (BE), potassium (K), glucose and lactate were measured at 4 hours post-reperfusion. Results: AST and ALT were decreased in SEVO+IR group (10.056 ± 5.830 and 8.586 ± 5.296 U/L) compared to IR group (16.890 ± 1.630 and 13.418 ± 1.088 U/L), P < 0.05. BIC, BE and K were increased in SEVO+IR group (12.42 ± 4.39, -14.72 ± 4.46 mmol/l and 6.3 ± 0.9 mEq/dl) compared to IR (6.70 ± 3.32, -20.48 ± 4.22 mmol/l and 4.7 ± 0.7 mEq/dl), P< 0.05. MAP at 4 hours post-reperfusion was decreased in SEVO+IR group (65 ± 24 mmHg) compared to IR (93 ± 14 mmHg), P < 0.05. There were no differences in MPF, creatinine, glucose and lactate. Glucose tended to be higher and lactate lower in SEVO+IR group (54.0 ± 22.7 and 42.8 ± 18.6 mg/dl) compared to IR (35.0 ± 18.4 and 66.8 ± 25.9 mg/dl). Conclusions: In liver IR, sevoflurane preconditioning reduced hepatocellular injury demonstrated by lower levels of transaminases. Despite the lower mean arterial pressure presented in sevoflurane treated animals, no detrimental effect was observed in portal venous flow, hepatic metabolism and renal function. This study highlight the need for clarifying the mechanisms of sevoflurane preconditioning, and if there is additional hepatoprotection against cold IR injury.conferenceObject HEMODYNAMIC STUDY OF THE PORTAL VENOUS SYSTEM IN A MODEL OF WARM LIVER ISCHEMIA/REPERFUSION INJURY IN RATS(2012) BUTO, M. F. de Souza; FIGUEIRA, E. R. R.; FILHO, J. A. R.; NAKATANI, M.; TATEBE, E. R.; ANDRE, V. O.; MARTINS, A. R. de Carvalho; JUREIDINI, R.; CARMONA, M. J. C.; BACCHELLA, T.; CHAIB, E.; CECCONELLO, I.; ALBUQUERQUE, L. A. C. D.Background: Liver transplantation and resections require temporary interruption of the hepatic blood flow resulting in ischemia/reperfusion (IR) injury. The hepatic microcirculatory impairment is related to the severity of the IR injury and may be reflected in the liver macro hemodynamic. There is aninverse correlation between hepatic blood flow and the postoperative transaminases. The aim of the study was to evaluate the hemodynamic of the portal venous system after warm liver IR injury. Methods: Eighteen Wistar rats were divided into 3 groups: I) Control; II) sham: rats submitted to resection of right and caudate liver lobes; III) Ischemia (IR): rats subjected to 60 min of partial warm liver ischemia of left and median lobes, followed by resection of non-ischemic lobes at reperfusion. Four hours after reperfusion rats were anesthetized and submitted to mechanical ventilation. Carotid artery was cannulated for mean arterial pressure (MAP). Mean portal venous flow (MPF) was assessed by a perivascular flowprobe. A micropressure probe was introduced into portal vein to assess the mean portal venous pressure (MPP). At the end blood was collected for AST and ALT analysis. Results: The mean weigh of rats was 229 ± 18 g. AST and ALT were increased in IR group (6.675 ± 1.687 and 5.793 ± 1.119 U/L) compared to sham (897 ± 303 and 815 ± 433 U/L) and control groups (99 ± 28 and 64 ± 27 U/L), P < 0.05. MAP was decreased in IR group (90 ± 17 mmHg) compared to control group (114 ± 9 mmHg), P < 0.05; but there is no difference when compared to sham group (106 ± 16 mmHg). MPP was increased in sham group (9.3 ± 1.8 mmHg) compared to control (6.2 ± 1.7 mmHg) and IR (4.5 ± 1.7 mmHg) groups, P< 0.05. MPF was decreased in IR group (5.0 ± 2.2 ml/min) compared to sham (12.3 ± 2.1 ml/min) and control (12.2 ± 1.9 ml/min) groups, P< 0.05. Conclusions: This study showed that four hours after warm liver ischemia/reperfusion, the total hepatic blood flow is reduced, demonstrated by the decrease of 60% in mean portal flow and 21% in mean arterial pressure. These changes in the hepatic hemodynamics may be correlated with the severity of the liver ischemia/reperfusion injury. This model can be a tool to evaluate protective strategies against liver IR that impact hepatic macro hemodynamics.