Luiz Estevam Ianhez

Hospital Alemão Oswaldo Cruz

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E Sabbaga

Universidade de São Paulo

Elias David‐Neto

Universidade de São Paulo

William Carlos Nahas

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Maria Cristina Ribeiro de Castro

Universidade de São Paulo

Pedro Renato Chocair

Hospital Alemão Oswaldo Cruz

Sami Arap

Universidade de São Paulo

Jorge Kalil

Universidade de São Paulo

Willian Carlos Nahas

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Luís Balthazar Saldanha

Centro Hospitalar de Lisboa Ocidental

Luiz Balthazar Saldanha

Secretaria de Planejamento e Gestão

Cooperative Institutions

Universidade de São Paulo

159

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

134

Hospital São Paulo

Universidade Brasil

Harvard University

Hospital Sírio-Libanês

Hospital Universitário da Universidade de São Paulo

Brigham and Women's Hospital

Universidade Federal de São Paulo

Hospital de Clínicas de Porto Alegre

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Acute vascular rejection: a clinical and morphological study

Transplant International (1998)

Maria Cristina Ribeiro de Castro Daísa Silva Ribeiro David Luís Balthazar Saldanha E Sabbaga S Arap

Oliguria

10.1111/j.1432-2277.1998.tb01101.x

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Citations (4)

Hypertension, metabolic derangements and renal dysfunction in renal transplant patients using cyclosporine or tacrolimus

Brazilian Journal of Transplantation (2006)

Luiz Estevam Ianhez David José de Barros Machado

Purpose: To assess metabolical and hypertension adverse events and renal function outcomes in patients with renal transplant receiving neoral cyclosporin or tacrolimus in an outpatient service in Brazil. Methods: All consecutive patients with renal transplant performed at Hospital Alemão Oswaldo Cruz between March 2000 and December 2003 were enrolled. Patients were divided in groups I with 24 patients taking tacrolimus and II with 23 patients taking neoral cyclosporin. It was compared their metabolical and hypertension adverse events and renal function outcomes. Results: Both groups presented comparable outcomes at baseline related to age, gender, race, end-stage renal disease and weight. Serum total cholesterol (186.6 ± 42 x 244.1 ± 48.1 p= 0.002; mg/dl), low-density lipoprotein (LDL) cholesterol (98.01± 23.3 x 153.2 ± 41.5 p= 0.011; mg/dl) and triglyceride (181.2 ± 91.1 x 292.5 ± 258.1 – p= 0.012; mg/dl) were significantly lower in patients receiving tacrolimus than those on cyclosporin. The antihyperlipidaemic medication to control lipid levels required by the cyclosporin group was strongly greater (70 vs 26%, p=0.04). Significantly more patients on cyclosporin than on tacrolimus presented hypertension (60 vs17%, p= 0.009). Post-transplant diabetes mellitus frequency showed no difference between groups (24.1 vs 16.6%). The serum creatinine level at the third month of tacrolimus treated patients was significantly lower than the cyclosporin treated patients (1.15  0.21 vs 1.40  0.38; p=0,009). Conclusion: Patients receiving maintenance immunosuppression with tacrolimus as opposed to ciclosporin present better renal function and reduced cardiovascular risk factors.

Immunosuppression

10.53855/bjt.v9i2.358

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C2 MONITORING FOR TACROLIMUS, MPA AND CYA. A SINGLE APPROACH FOR THERAPEUTIC DRUG MONITORING.

Transplantation (2004)

Elias David‐Neto Luíz Miguel Pereira Maria Cristina Ribeiro de Castro Carlucci Gualberto Ventura R M. Mattos

P244 Therapeutic drug monitoring (TDM) is essential for transplant success. The use of multiple drugs requires a homogenous approach for TDM in clinical practice. CyA is best monitored by the blood level at the second hour (C2). However, this has not been documented for tacrolimus (TAC) and mycophenolic acid (MPA). We prospectively performed 12-hour pharmacokinetic (PK) studies at days 7, 14, 30, 60 and 180 after kidney Tx, in 37 pts with a mean age of 38±12y under TAC/MMF/Pred. TAC (n=155) and MPA (n=145) PKs were available for analysis. TAC daily doses (mg/kg/d) were 0.23±0.07 (D7), 0.26±0.07 (D14), 0.25±0.09 (D30), 0.17±0.08 (D60) and 0.11±0.05 (D180). Mean±SD TAC levels were C0 (trough) :11.8±5.03, C2 : 26.2±11.2 ng/ml and AUC : 209.6±79.9ng.hr/ml. There was a progressive increase in TAC-AUC (208±93, 252±74, 275± 97 ng.hr/ml, p<0.01) and C2 (25.6±13.3, 30.6±11.3 and 34.4±16.0ng/ml (p<0.01) from day 7 through 30 and then a decrease in AUC (188±53 and 153±62 ng.hr/ml, p<0.01) and C2 (23.7±7.6 and 19.5±9.0 ng/ml,(p<0.01) from day 60 to 180, respectively. The same happened to C0 along time (12.0±6.0, 13.5±4.2, 15.1±5.8, 10.9±2.9 and 9.1±3.9ng/ml at the same time-points, p<0.01). However, C2 had a better correlation with TAC-AUC (R2=0.79) than C0 (R2=0.67) or C12 (R2=0.77) and AUC can be calculated by the equation AUC = 44.37 + (6.31xC2) with a Bland and Altman (BA) difference of ±35 ng.hr/mL; C0 equation provided a difference of ±45ug.hr/ml (p=NS). MMF daily doses were 27.4±7.0 (D7), 27.4±6.5 (D14), 28.8±8.3 (D30), 24.4±8.2 (D60) and 23.4±1.6 (D180) mg/kg/d. Mean±SD total MPA levels (EMIT) were C0:3.12±3.0, C2:5.1±3.1ug/ml and AUC:40±22ug.hr/ml. MPA-C2 correlated better with AUC (R2=0.71) than C0 (R2= 0.34) or C12 (R2=0.67). MPA-AUC can be calculated using C2 by AUC = 9.5+(6 x C2), B-A difference of ±11.5 ng.hr/ml. This equation was further tested in another cohort of 19 patients on CyA/MMF/Pred who had 80 MPA-PK studies available. In these patients, mean MPA-AUC using C2 equation was not different from trapezoidal AUC (45±21 vs 41±21 ug.hr/ml) with a mean difference between them of 3.7±12.1 ug.hr/ml. These data indicate that similar to CyA, tacrolimus and MPA can be monitored by C2, therefore providing a homogenous approach for TDM.

Therapeutic Drug Monitoring

Trough level

Trough Concentration

10.1097/00007890-200407271-00739

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Citations (1)

Table of Contents

The Nephron journals/Nephron journals (1978)

Eli A. Friedman Murray Epstein Kenneth A. Ketter Gary L. Slick David W. Ploth

10.1159/000181417

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Citations (0)

Transplante renal em pacientes com lupus eritematoso disseminado

Revista da Associação Médica Brasileira (1988)

L.S. Azevedo João Egídio Romão Luiz Estevam Ianhez Luís Balthazar Saldanha E Sabbaga

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Antibodies eluted from acutely rejected renal allografts bind to and activate human endothelial cells

Human Immunology (2000)

Newton Lucchiari N Panajotopoulos Chen Xu H. Rodrigues Luiz Estevam Ianhez

Immunosuppression

Pathophysiology

10.1016/s0198-8859(00)00109-9

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Citations (60)

Mycophenolic acid pharmacokinetics in stable pediatric renal transplantation

Pediatric Nephrology (2003)

Elias David‐Neto Lilian M. P. Araújo Nairo Massakazu Sumita Maria E. Mendes Maria Cristina Ribeiro de Castro

Trough level

Mycophenolate

Body surface area

10.1007/s00467-002-1057-1

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Citations (45)

BILATERAL NEPHRECTOMY OF HUGE POLYCYSTIC KIDNEYS ASSOCIATED WITH A RECTUS ABDOMINIS DIASTASIS AND UMBILICAL HERNIA

Clinics (2006)

Marcos Lucon Luiz Estevam Ianhez Antonio Marmo Lucón Jose L Chambo E Sabbaga

Patients with end-stage renal failure due to huge autosomal dominant polycystic kidney disease usually have an umbilical hernia and rectus abdominis diastasis, which are very troublesome. Pretransplant bilateral nephrectomy techniques does not manage the umbilical hernia and rectus abdominis diastasis. We report our experience in performing bilateral nephrectomy and repairing the rectus abdominis diastasis and umbilical hernia through the one, small incision.Four patients aged 37 to 43 years with huge polycystic kidneys, an umbilical hernia, and a rectus abdominis diastasis underwent bilateral pretransplant nephrectomy through a midline supraumbilical incision including the umbilical hernia defect. The kidneys were removed through this incision. The incision was closed with the transposition of rectus abdominis muscle, pants-over-vest-style, to correct the diastasis and the umbilical hernia.The average operative time was 160 minutes (range, 130-180); the average larger kidney size was 33 cm (range, 32-34 cm); no major complications occurred; one patient who had preoperative low hemoglobin required blood transfusion. Patients were discharged from the hospital on postoperative day 7 with an esthetically pleasing belly, no rectus abdominis diastasis, and no umbilical hernia. One to two months after bilateral nephrectomy, the patients received a live donor kidney with an uneventful outcome.A midline supraumbilical incision is an excellent approach for bilateral nephrectomy of huge polycystic kidneys. In addition, an umbilical hernia and rectus abdominis diastasis may be successfully repaired through same incision with good cosmetic results.

Diastasis

Umbilical hernia

Rectus abdominis muscle

10.1590/s1807-59322006000600007

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Citations (2)

Catheter-associated urinary infection in kidney post-transplant patients

Sao Paulo Medical Journal (2001)

Luiz C. Oliveira Antonio Marmo Lucón Willian Carlos Nahas Luiz Estevam Ianhez Sami Arap

There is still controversy as to the use and dosage of antimicrobial prophylaxis of the urinary infection associated with urethral catheterization in the post renal transplant period.

Urinary catheterization

Meatus

10.1590/s1516-31802001000500003

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Citations (19)

COVID‐19 pneumonia in kidney transplant recipients—Where we are?

Transplant Infectious Disease (2020)

David José de Barros Machado Luiz Estevam Ianhez

In late December 2019, China reported cases of respiratory illness in humans that involved a novel coronavirus SARS-CoV-2. On March 20, 2020, the first coronavirus disease 2019 (COVID-19) in Brazil was diagnosed, and by now, we present the report on the first case of COVID among transplant recipients in our country. A liver and kidney transplant patient with SARS-CoV-2 pneumonia without respiratory failure was treated in a clinical multimodal strategy consisting of symptomatic support therapy, immunosuppression reduction, use of anti-coronavirus drugs and heparin leading to a progressive improvement of patient symptoms till discharge. The authors also present a comprehensive review of published cases.

2019-20 coronavirus outbreak

Betacoronavirus

Coronavirus Infections

10.1111/tid.13306

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Citations (27)