Rafael Jose Maurette - Academia.edu (original) (raw)

Papers by Rafael Jose Maurette

Transplantation, Jun 27, 2006

Presence of preformed lymphocytotoxic antibodies may represent a barrier to isolated intestinal t... more Presence of preformed lymphocytotoxic antibodies may represent a barrier to isolated intestinal transplantation (IITx). We developed an intravenous immunoglobulins (IVIg) based desensitization protocol for candidates with high panelreactive antibodies (PRA). Six patients with a mean PRA of 72Ϯ22% were included in a four-level (L) protocol with escalating doses of IVIg (L1, L2), addition of mycophenolate mofetil (MMF) or plasmapheresis (L3); and anti-CD20 (Rituximab) (L4). Four of six candidates improved their PRAs (from a mean of 66.2% to 25.5%; Pϭ0.01) and were successfully transplanted. At a mean follow-up of 8 months, number and severity of rejection episodes of protocol patients did not differ from patients with low PRA transplanted during the same period. These data support the use of IVIg to desensitize patients waiting for IITx. It increases the applicability of IITx, and reduces the waiting time and mortality on the waiting list with outcomes comparable to nonsensitized recipients.

Palabras claves: linfomas T periféricos, linfoma T NOS, linfoma T hepato-esplénico, trasplante au... more Palabras claves: linfomas T periféricos, linfoma T NOS, linfoma T hepato-esplénico, trasplante autólogo de células progenitoras hematopoyéticas (TAMO), CHOP, CHOEP, trasplante alogénico de médula ósea (TALLO).

Transplantation Proceedings, 2008

Background. Chronic kidney disease (CKD) is an important risk factor for morbidity and mortality ... more Background. Chronic kidney disease (CKD) is an important risk factor for morbidity and mortality post-liver transplantation (OLT). This study focused on investigating the incidence and risk factors associated with the development CKD after OLT. Methods. We performed a retrospective cohort study of recipients followed at least 5 years at our institution. CKD was diagnosed and classified according to National Kidney Foundation and the Kidney Disease Outcomes Quality Initiative guidelines. Results. There were 231 patients, 64% men, 67% Caucasian, 16% African-American, and 17% others, with a mean age of 56 Ϯ 13 years. The mean glomerular filtration rate (GFR) of the population was 56 Ϯ 28 mL/min/1.73 m 2. CKD was defined as GFR less than 60 mL/min; 144 patients (61%) were identified as having CKD. When these patients were compared to the non-CKD group, the former were significantly older (62 Ϯ 9 vs 52 Ϯ 12 years, P ϭ .03), more likely to be hypertensive (59% vs 38%, P ϭ .003), and required more antihypertensive medications (0.83 Ϯ 0.81 vs 0.52 Ϯ 0.77, P ϭ .02); 26% of all patients had diabetes. However, the incidence of diabetes (43.3% vs 19.3%, P ϭ .02) as well as the incidence of insulin dependency (21.6% vs 12.5%, P ϭ .001) was significantly higher in the CKD population. Mean uric acid levels were higher in CKD patients compared to non-CKD patients (8.00 Ϯ 2.00 mg/dL vs 6.70 Ϯ 1.99 mg/dL respectively, P ϭ .001); patients with uric acid more than 6.0 had a 1.7 risk of having CKD. Conclusions. CKD defined as GFR Ͻ 60 mL/min is highly prevalent in long-term OLT survivors. Older age, elevated systolic blood pressure, insulin-dependent diabetes mellitus, and elevated uric acid levels are independently associated with CKD.

Transplantation Proceedings, 2009

Small donors have long been considered a potential source of organs for simultaneous pancreas-kid... more Small donors have long been considered a potential source of organs for simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone (PTA). Our aim was to analyze our experience with SPK and PTA using small donors weighing <28 kg. Between September 2006 and October 2008, we performed 68 SPK, 3 PTA, and 3 pancreas after kidney transplantations (PAK). All recipients were adults with type 1 diabetes mellitus, including 8 who received small donor organs (<28 kg): 6 SPK and 2 PTA. We used 3 graft combinations for SPK: pancreas and single kidney; pancreas and en bloc kidneys; and en bloc dual kidney-pancreas. In contrast, we used conventional grafts for PTA. Mean weight among donors was 20.82 kg (range, 9.6-27 kg). We observed neither delayed graft function nor mortality. At a follow-up of approximately 281 days, all patients were free of insulin and dialysis treatments. Kidneys and pancreas from donors weighing <28 kg can be used in adult type 1 diabetic patients with excellent results. These small pediatric donors enabled us to enlarge the number of transplantations by 10.81%.

Transplantation, 2008

them have excellent pancreas and kidney graft function with mCsA and MMF, 1 patient is insulin-de... more them have excellent pancreas and kidney graft function with mCsA and MMF, 1 patient is insulin-dependent with good kidney function. Controlling the CsApharmacokinetics 4 years after PNTX revealed an AUC of 3604 ± 851 ng/ml x h and showed a shift of mean Tmax from C3 (496 ± 119 ng/ml) to C2 (716 ± 99 ng/ml). Conclusion: These results demonstrate an improved gastrointestinal resorption thus indicating the amelioration of existing autonomic neuropathy. Neoquadruple therapy with mCsA reveals suffi cient immunosuppression in PNTX. In the long-term course mCsA pharmacokinetics are able to evaluate the course of diabetic gastroparesis.

Journal of Gastrointestinal Surgery, 2005

Background: Protein transduction is a new evolving technology that allows direct delivery of prot... more Background: Protein transduction is a new evolving technology that allows direct delivery of proteins/peptides to cells, via fusion with small cationic cell penetrating peptides, known as protein transduction domains(PTDs). Full length proteins or peptides fused to TAT-PTD, a cell penetrating domain comprising 11 residues from transactivating domain of TAT-HIV protein, readily translocates into a wide variety of cells and tissues. We have generated a novel cytoprotective protein TAT-Ngb, consisting of human neuroglobin (Ngb) fused to TAT-PTD. Ngb is a member of oxygen binding globin family recently discovered in brain, retina and islets of Langerhans. The protein has been reported to protect neurons from hypoxia. Aims: To investigate whether TAT-Ngb could inhibit spontaneous cell death in cultured islets. Methods and Results: TAT-Ngb-FITC readily enters into cultured human islets. Efficiency of transduction was evaluated by flow cytometry and by confocal microscopy of live, unfixed islets. Human islets cultured in the presence of TAT-Ngb showed greatly improved viability and functionality of beta-cells. Islets were assessed by cell viability assay using 7AAD dye exclusion test, Newport Green-Zn binding to insulin and finally assessment of mitochondrial membrane potential by fluorescent probe TMRE. The glucose static insulin secretion assay was used to evaluate the functionality of long term-cultured islets. Conclusions: TAT-Ngb improves viability of beta cells and functionality of islets and therefore could be an asset in improvement of islets in culture conditions before transplantation.

World Journal of Surgery, 2020

Background Laparoscopic liver resections (LLR) have been increasingly performed in recent years. ... more Background Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. Methods From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. Results Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. Conclusions This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.

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Medicina, 2020

The COVID-19 pandemic declared in March 2020, has generated worldwide concern due to its effect o... more The COVID-19 pandemic declared in March 2020, has generated worldwide concern due to its effect on the health of the population and the potential health collapse. The strategy of "flattening the curve" through social distancing made it possible to adapt the resources of the health system to patients with COVID-19, but results in other areas of health could not be predicted. The objective of this work was to analyze the consequences of the pandemic on liver transplantation in general and for hepatocarcinoma (HCC). The following studies were carried out: a) a retrospective analysis using data from the CRESI / INCUCAI to compare admission to the waiting list, mortality on the list, donation and liver transplantation from 03/20 to 08/15, 2019 and the same period in 2020, and b) a survey of the transplant centers with the highest transplant activity to assess the effect of the measures taken in different institutional and regional situations. The first analysis showed a 55% dec...

Revista Argentina De Cirugia, 2000

Revista argentina de cirugía, Jan 9, 2016

Background: In patients with colorectal cancer with synchronous liver metastases (CLM), complete ... more Background: In patients with colorectal cancer with synchronous liver metastases (CLM), complete resection of the primary tumor with the metastases is the only option for curative treatment. Several case series have been reported but no randomized controlled trials have been published. Objective: The aim was to evaluate if the simultaneous laparoscopic resection of the primary colon tumor and liver metastases is feasible and safe. Material and methods: A retrospective study was conducted with patients with suspected CLM scheduled for simultaneous laparoscopic resection of the primary tumor of the colon and liver metastases. The preoperative and operative variables, shortand long-term outcomes and pathological variables were analyzed. Results: A total of 89 laparoscopic liver resections (LLR) were performed during the study period. In 28 patients, LLR was simultaneous with other procedures, 21 of which corresponded to laparoscopic colon resection. Mean surgical time for both procedur...

Background: Diagnostic delay associated to COVID-19 pandemic led patients to present with more ad... more Background: Diagnostic delay associated to COVID-19 pandemic led patients to present with more advanced conditions than usual. The aim of this study was to analyze Laparoscopic Cholecystectomies (LC) performed for acute gallstone-related disease during the pandemic and to compare them with two control groups. Methods: All LC performed between April and July 2020 (Group 3: G3) were analyzed and compared with LC performed in the same period in 2019 (Group 2: G2) and 2018 (Group 1: G1). Results: In G3 80 LC were performed, of which 36 (45%) were due to acute disease, while in G1 of 192 LC 45 (23.44%) and in G2 of 234 LC 37 (15.81%) were due to acute disease (p <0.01). Time from symptom onset until hospital consultation was longer during the pandemic (G3: 3.8 days vs 2.87 days for G1 and 2.26 days for G2; p <0.05). Mean operative time in minutes was also longer: 78.56 (SD ± 31.6) for G3, 57.69 (SD ± 26.5) for G1 and 63.51 (SD ± 29.4) for G2 (p <0.01).

Transplantation Proceedings, 2015

UNLABELLED There are few reports about laparoscopic approach after liver transplantation (LT). Th... more UNLABELLED There are few reports about laparoscopic approach after liver transplantation (LT). The aim of this paper is to analyze in terms of feasibility and therapeutic effectiveness an initial experience with laparoscopy in patients who have had a liver transplantation. METHODS Laparoscopic procedures were divided into "early" and "late" laparoscopy. RESULTS A total of 10 laparoscopic procedures after LT were performed in 9 patients: 3 early and 7 late. The early laparoscopic procedures were performed in 3 patients who had a torpid evolution in their liver transplant: 2 were diagnostic only and 1 was also therapeutic. There were no intraoperative events or conversions. We recorded 2 complications. In 7 patients a late laparoscopy was performed: 4 in the upper abdomen and 3 in the lower abdomen. Of the 4 in the upper abdomen, 3 were liver procedures and 1 was in the transverse colon, on the other side; in addition, 2 laparoscopic inguinal hernia repairs and 1 laparoscopic appendectomy also were performed. None of these 7 cases was converted, and there were no intraoperative events. CONCLUSIONS The early postoperative period, in critically ill patients diagnostic and eventually therapeutic laparoscopy was feasible and effective in our cases. Late laparoscopy in the upper abdomen is difficult due to adhesions and adds to the risk of poor graft function, but was feasible for both diagnostic and therapeutic purposes. Late laparoscopy in the lower abdomen with good graft function has the same safety and efficacy as those performed on nontransplanted patients.

Journal of Surgery Research and Practice, 2021

Case Reports in Surgery

Bouveret’s syndrome is a complication of cholelithiasis that presents with gastric outlet obstruc... more Bouveret’s syndrome is a complication of cholelithiasis that presents with gastric outlet obstruction due to an impacted gallstone in the duodenum following cholecystoduodenal fistula. This is a rare presentation of biliary-enteric fistula; therefore, there are no standardized guidelines for the management of this disease. We present a case of a patient with Bouveret’s syndrome managed with laparoscopic surgery after an unsuccessful attempt of endoscopic removal.

Ecancermedicalscience, 2017

Laparoscopic liver resections (LLRs) have been shown to be both feasible and safe. However, no ra... more Laparoscopic liver resections (LLRs) have been shown to be both feasible and safe. However, no randomised control studies have been performed to date comparing results with those of the open surgery approach. To analyse LLR long-term results and compare them with a similar group of open resections in patients with colorectal carcinoma liver metastasis (CRCLM). Retrospective study on a prospective database. All patients with anatomopathological diagnosis of CRCLM resected between July 2007 and July 2015. Twenty-two open resections and 18 laparoscopic resections which presented favourable lesions for laparoscopic approach were analysed. Postoperative grade III morbidity was similar in both groups (p = 0.323). Disease-free survival at 1, 3, and 8 years in the laparoscopy group (n =16) was 81%, 58%, and 58%, respectively, while in the open surgery group (n = 17) it was 64%, 37%, and 19% respectively; no differences were found (p = 0.388). Global survival in the laparoscopy group was 93%...