E Chaib

University of São Paulo, São Paulo, Estado de Sao Paulo, Brazil

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Publications (52)37.89 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: BACKGROUND: Hepatitis B virus (HBV) infection is a major cause of morbidity and mortality worldwide. Chronic hepatitis B infection is associated with an increased risk of cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Our aim is to analyze, through a mathematical model, the potential impact of anti-HBV vaccine in the long-term (that is, decades after vaccination) number of LT. METHODS: The model simulated that the prevalence of HBV infection was 0.5% and that approximately 20% of all the liver transplantation carried out in the state of São Paulo are due to HBV infection. RESULTS: The theoretical model suggests that a vaccination program that would cover 80% of the target population would reach a maximum of about 14% reduction in the LT program. CONCLUSION: Increasing the vaccination coverage against HBV in the state of São Paulo would have a relatively low impact on the number of liver transplantation. In addition, this impact would take several decades to materialize due to the long incubation period of liver failure due to HBV.
    Clinical Transplantation 10/2012; · 1.63 Impact Factor
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    ABSTRACT: Galvao FHF, Soler W, Pompeu E, Waisberg DR, Mello ES, Costa ACL, Teodoro W, Velosa AP, Capelozzi VL, Antonangelo L, Catanozi S, Martins A, Malbouisson LMS, Cruz RJ, Figueira ER, Filho JAR, Chaib E, D'Albuquerque LAC. Immunoglobulin G profile in hyperacute rejection after multivisceral xenotransplantation. Xenotransplantation 2012; 19: 298-304. © 2012 John Wiley & Sons A/S. Abstract:  Introduction:  Xenotransplantation is a potential solution for the high mortality of patients on the waiting list for multivisceral transplantation; nevertheless, hyperacute rejection (HAR) hampers this practice and motivates innovative research. In this report, we describe a model of multivisceral xenotransplantation in which we observed immunoglobulin G (IgG) involvement in HAR. Methods:  We recovered en bloc multivisceral grafts (distal esophagus, stomach, small intestine, colon, liver, pancreas, and kidneys) from rabbits (n = 20) and implanted them in the swine (n = 15) or rabbits (n = 5, control). Three hours after graft reperfusion, we collected samples from all graft organs for histological study and to assess IgG fixation by immunofluorescence. Histopathologic findings were graded according to previously described methods. Results:  No histopathological features of rejection were seen in the rabbit allografts. In the swine-to-rabbit grafts, features of HAR were moderate in the liver and severe in esophagus, stomach, intestines, spleen, pancreas, and kidney. Xenograft vessels were the central target of HAR. The main lesions included edema, hemorrhage, thrombosis, myosites, fibrinoid degeneration, and necrosis. IgG deposition was intense on cell membranes, mainly in the vascular endothelium. Conclusions:  Rabbit-to-swine multivisceral xenotransplants undergo moderate HAR in the liver and severe HAR in the other organs. Moderate HAR in the liver suggests a degree of resistance to the humoral immune response in this organ. Strong IgG fixation in cell membranes, including vascular endothelium, confirms HAR characterized by a primary humoral immune response. This model allows appraisal of HAR in multiple organs and investigation of the liver's relative resistance to this immune response.
    Xenotransplantation 09/2012; 19(5):298-304. · 2.57 Impact Factor
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    ABSTRACT: The swine is an essential model for carrying out preclinical research and for teaching complex surgical procedures. There is a lack of experimental models describing anatomical and surgical aspects of total pancreatectomy in the pig. The experiments were performed on 10 white male swine weighing 27-33 kg. The animals were premedicated with midazolam (0.4 mg/kg, i.m.) and ketamine (4 mg/kg, i.m.). Anesthesia was induced with propofol (1-2 mg/kg, i.v.) and was maintained with propofol and fentanyl (0.3 mg and 0.1 μg/kg/min, respectively, i.v.). The surgical period ranged from 44 to 77 min. The pancreas anatomy, and the main arterial, venous and pancreatic duct anatomy were assessed. The pancreas anatomy was composed of 3 lobes, the 'splenic', 'duodenal' and 'connecting' lobe which is attached to the anterior portion of the portal vein. The splenic artery and the junction of the splenic vein and portal vein were divided. The left gastric artery was dissected and separated from its origin at the splenic artery. The head of the pancreas is disposed in a C shape. The pancreas was dissected and liberated from the right portion of the portal vein and the infrahepatic vena cava. The pancreas was separated from the duodenum preserving the pancreaticoduodenal artery, then we performed the total pancreatectomy preserving the duodenum, common bile duct and spleen. Total pancreatectomy with duodenum, bile duct and spleen preservation in the pig is feasible and an important instrument for research purposes and teaching surgical technique.
    European Surgical Research 01/2011; 46(1):52-5. · 0.75 Impact Factor
  • Transplantation 01/2010; 90. · 3.78 Impact Factor
  • Transplantation 01/2010; 90. · 3.78 Impact Factor
  • Transplantation 01/2010; 90. · 3.78 Impact Factor
  • E Chaib, C Fridman, E Massad
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    ABSTRACT: Liver transplantation increased 1.84-fold from 1988 to 2004. However, the number of patients on the waiting list for a liver increased 2.71-fold, from 553 to 1500. We used a mathematical equation to analyze the potential effect of using ABO-compatible living-donor liver transplantation (LDLT) on both our liver transplantation program and the waiting list. We calculated the prevalence distribution of blood groups (O, A, B, and AB) in the population and the probability of having a compatible parent or sibling for LDLT. The incidence of ABO compatibility in the overall population was as follows: A, 0.31; B, 0.133; O, 0.512; and AB, 0.04. The ABO compatibility for parent donors was blood group A, 0.174; B, 0.06; O, 0.152; and AB, 0.03; and for sibling donors was A, 0.121; B, 0.05; O, 0.354; and AB, 0.03. Use of LDLT can reduce the pressure on our liver transplantation waiting list by decreasing its size by at least 16.5% at 20 years after its introduction. Such a program could save an estimated 3600 lives over the same period.
    Transplantation Proceedings 11/2009; 41(9):3775-8. · 0.95 Impact Factor
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    ABSTRACT: We propose a mathematical model to simulate the dynamics of hepatitis C virus (HCV) infection in the state of São Paulo, Brazil. We assumed that a hypothetical vaccine, which cost was taken to be the initial cost of the vaccine against hepatitis B exists and it is introduced in the model. We computed its cost-effectiveness compared with the anti-HCV therapy. The calculated basic reproduction number was 1.20. The model predicts that without intervention a steady state exists with an HCV prevalence of 3%, in agreement with the current epidemiological data. Starting from this steady state three interventions were simulated: indiscriminate vaccination, selective vaccination and anti-HCV therapy. Selective vaccination proved to be the strategy with the best cost-effectiveness ratio, followed by indiscriminate vaccination and anti-HCV therapy.
    Epidemiology and Infection 02/2009; 137(2):241-9. · 2.87 Impact Factor
  • E Chaib, E Massad
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    ABSTRACT: São Paulo is the first Brazilian state to perform liver transplantation in 1968. Since then the recipient waiting list has increased; now approximately 150 new cases per month are referred to the single list at the central organ procurement organization. Official data have shown 37.3 monthly deaths on the waiting list in the state of São Paulo. The number of liver transplants has increased after the creation of São Paulo transplant notification centers but are insufficient to deal with the increasing waiting list. The aim of this study was to demonstrate the performance of our state liver transplantation program and analyze when the number of liver transplantations will meet our waiting list demand.
    Transplantation Proceedings 01/2006; 37(10):4329-30. · 0.95 Impact Factor
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    ABSTRACT: The major indication for pancreas or islet transplantation is diabetes mellitus type I. This process has to supply the insulin necessity keeping glucose under control. We have studied isogenic islet transplantation on the rat (WAG-RT1u) liver. The method of isolation and purification of the islets obtained 2.834 +/- 551.64 islets with purity of 83 +/- 2.45%. Diabetes was induced by streptozotocin and seric glucose prior transplantation was 35 mmol/L. The islet transplantation of 2.834 +/- 551.64 islets in the rat liver has normalized glucose test from 9.62 +/- 2.65 mmol/L 10 days after transplantation to 7.43 +/- 0.27 mmol/L later in the follow-up (P < 0.05). The median survival time of the islets was 73 days. In conclusion both the method of isolation and purification of the islets and islet transplantation was effective in the control of the diabetes induced by streptozotocin with median survival time of both islet and rat more than 73 days when rats were sacrified.
    Arquivos de Gastroenterologia 01/2000; 37(1):44-51.
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    ABSTRACT: The authors present a case of newborn pre-term with birthweight of 2,250 g. There was polyhydramnios. On the first day she developed jaundice suggested upper intestinal obstruction. A plain radiograph of the abdomen confirmed the previous finding of obstruction of the duodenum, which showed a "double bubble" image with no other gas shadow in the rest of the abdomen. Contrast rodiologic examination of the abdomen confirmed total obstruction of the duodenum second portion. On the 2nd day after birth, laparotomy revealed an annular pancreas. The reconstruction was made by a side-to-side proximal duodeno-jejuno-anastomosis. The postoperative course was uneventful. Barium radiography at one month postoperatively was good.
    Arquivos de Gastroenterologia 01/1996; 33(1):29-31.
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    ABSTRACT: Angiomyolipoma, a form of mixed mesenchymal tumor, a not uncommon tumor of the kidney, is rarely found in the liver. We report a case of angiomyolipoma of the liver in a 34-year-old woman, in whom diagnosis was made by computed tomography (CT), magnetic resonance imaging, superior mesenteric and celiac trunk angiography and histological examination. The treatment of choice was a successful extended right hepatectomy.
    International surgery 01/1996; 81(3):320-2. · 0.31 Impact Factor
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    ABSTRACT: Solitary hepatic cysts an uncommon disease in the past, which incidental diagnosis is increasing with the advent of ultrasound and computed tomography, are nowadays very frequent. Cysts that reach massive proportions often become symptomatic and necessitate surgical intervention. Surgical wide unroofing technique is a simple procedure advocated for the treatment of symptomatic patients. Ten patients with solitary liver cysts were submitted to wide unroofing with good immediate and late results.
    Arquivos de Gastroenterologia 01/1996; 33(1):6-9.
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    ABSTRACT: It is possible to obtain two good-quality hepatic transplants from a single cadaveric liver by separation of the right and left lobes of the liver. We attempted to define a relationship based only on donor body weight for predicting donor total liver weight as well as donor right (segments V-VIII) and left (segments II-IV) hepatic lobe weight. Segment I (caudate lobe) is resected and thus lost in this procedure. The study was performed on 60 human cadaveric livers. We correlated cadaveric body weight (mean +/- SD), 72.43 +/- 9.54 kg, with total liver weight, 1.54 +/- 0.36 kg, and right and left lobe weight, 0.88 +/- 0.23 kg and 0.65 +/- 0.17 kg, respectively, with total liver weight. A formula was obtained by linear regression which provided the following relationships: total liver weight (g) = [245.57 + 17.92 x (body weight, kg)]; right lobe weight (g) = [67.58 + 0.52 x (total liver weight, g)]; left lobe weight (g) = [-63.38 + 0.47 x (total liver weight, g)]. The selection of the recipient on the liver transplant waiting list can be made on the basis of these relationships.
    Brazilian Journal of Medical and Biological Research 08/1995; 28(7):759-60. · 1.14 Impact Factor
  • British Journal of Surgery 04/1995; 82(3):355. · 4.84 Impact Factor
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    ABSTRACT: Sixty fresh adult livers were obtained from cadavers together with celiac trunk, head of the pancreas and superior mesenteric artery. The right portal vein, left portal vein and their respective branches were dissected as well as the hepatic veins. There was only one right hepatic vein in 59 cases. The median hepatic vein was present in 53 (88.3%) cases and the left hepatic vein only in 46(76.3%). In 59(98.3%) cases, there were right and left portal vein but in one (1.6%) case no portal bifurcation has been found. The median portal vein has been found only in 9(15.2%) cases.
    Revista do Hospital das Clínicas 01/1995; 50(1):49-51.
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    ABSTRACT: Biliary complications after liver transplantation are common and cause significant morbidity and mortality. In order to evaluate the complications related to different sorts of biliary reconstruction, from January 1984 to July 1992 we retrospectively analysed 187 consecutive liver transplants in 136 paediatric patients at Addenbrooke's Hospital, Cambridge. There were 51 (27.2%) retransplantations. Biliary reconstruction consisted of: type 1-common bile duct-Roux loop (CBD-RL); n = 90 (48.1%); type 2-gallbladder conduit-Roux loop (GC-RL), n = 51 (27.2%); type 3-gallbladder conduit-common bile duct (GC-CBD), n = 20 (10.6%); type 4-common bile duct-common bile duct (CBD-CBD), n = 18 (9.6%); and type 5-common bile duct-common bile duct+gallbladder drainage (CBD-CBD+GB), n = 8 (4.2%). There were, in all 26 biliary complications (14%). Of these 26 complications, biliary stricture was the most common (17/26; 65.3%) and 6 out of these 17 (35.2%) were associated with chronic rejection. Hepatic artery thrombosis was directly related to biliary leakage in 6 out of 26 (23.1%) biliary tract complications. This series demonstrated that type 1 and type 4 reconstructions were related to fewer biliary complications (9/90, 10% and 2/18; 11%, respectively) than the other techniques: 8/51 (16%) for GC-RL 5/20 (25%) for GC-CBD and 2/8 (25%) for CBD-CBD+GB (P = 0.09).
    Transplant International 02/1994; 7(1):39-42. · 3.16 Impact Factor
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    ABSTRACT: Current immunosuppressive agents have potentially dangerous side-effects, are non-specific and most are also diabetogenic. We investigated tolerance induction with intrathymic injection of purified antigen-presenting cells (APC) plus a single dose of antilymphocyte serum (ALS) intraperitoneally before allogeneic islet transplantation in the rat model WAG to Lewis (RT1u to RT1l). Purified donor APC [non-parenchymal cells (NPC) or dendritic cells (DC)] were prepared from liver and spleen, respectively. Isograft function for more than 120 days proved that islet isolation, purification and transplantation procedures were adequate. A total of WAG DC (4 x 10(5)) or NPC (2 x 10(6)) in 20 microl were injected into both lobes of the thymus of 140-210 g Lewis recipients followed by a single injection of ALS. Three days later, diabetes was induced with streptozotocin (60 mg/kg). Four days later allogeneic islets were grafted into the liver by intraportal injection of 3000 WAG islets. Control animals (n = 8) received 20 microl saline intrathymically instead of APC. Graft function was assessed by blood glucose measurements with glucose levels above 15 mmol/l on 3 consecutive days defined as graft rejection. Animals given DC (n = 9) or NPC (n = 8) intrathymically plus 1 ml of ALS, rejected their grafts in an accelerated fashion with a median survival time (MST) of 3 days. However, control animals rejected their grafts with a MST of 7 days, but with two animals surviving for more than 2 months. In conclusion, intrathymic inoculation with purified APC plus a single dose of ALS did not prolong allogeneic islet graft function but induced accelerated rejection of the islet allografts.
    Transplant International 02/1994; 7 Suppl 1:S423-5. · 3.16 Impact Factor
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    ABSTRACT: Colon interposition for benign esophageal disease has so many complications among them stricture and anastomotic leak are the most common. Three patients with esphagocolonic stricture due to colon interposition have been successfully treated by sternotomy after being submitted to endoscopic balloon dilatation. Sternotomy would seen a safe and reliable method for treating anastomotic stricture in patients with recurrent stenosis after esophagocolonic anastomosis due to extrinsic compression.
    Revista do Hospital das Clínicas 01/1994; 49(6):253-5.
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    ABSTRACT: We prospectively studied anatomical variations and diseases of the liver in 100 consecutive donor operations during a period of 1 year. The "normal" arterial anatomy with a single hepatic artery (HA) from the celiac trunk was seen in 76% of all cases. Seven of twelve different major variations of the HA may be considered as "rare", one of which cannot be found in the earlier literature. During harvesting, 6% of the livers were discarded, 3% on the basis of infection and 1% because of a polycystic disease. Two cases were rejected as the liver was found to be severely hypoperfused or hypoxic in an otherwise stable donor. Severe steatosis was macroscopically and histologically diagnosed in 3% of the cases, and in three donors a benign tumour was found in the liver or in the gall bladder. Two primarily nonfunctioning livers in the present series of 94 recipient operations were retrieved from this group of severely steatotic livers. As the donor liver was totally "normal" in only 2 out of 3 of the cases, the present study underlines the importance of searching for extremely variable anomalies of the HA and for liver-related diseases during organ harvesting.
    Transplant International 02/1993; 6(6):325-9. · 3.16 Impact Factor

Publication Stats

76 Citations
2 Downloads
2k Views
37.89 Total Impact Points

Institutions

  • 1988–2011
    • University of São Paulo
      • • Departamento de Gastroenterologia (FM) (São Paulo)
      • • Hospital das Clínicas (FMUSP)
      • • Faculty of Medicine (FM)
      São Paulo, Estado de Sao Paulo, Brazil
  • 1994
    • University of Cambridge
      • Department of Surgery
      Cambridge, ENG, United Kingdom
  • 1990–1991
    • Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
      San Paulo, São Paulo, Brazil