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Luiz Sergio Leonardi

Bio: Luiz Sergio Leonardi is an academic researcher from State University of Campinas. The author has contributed to research in topics: Liver transplantation & Transplantation. The author has an hindex of 14, co-authored 74 publications receiving 667 citations.


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Journal ArticleDOI
Gary A. Levy1, Gian Luca Grazi2, Fernando Sanjuán, Youmin Wu3, Ferdinand Mühlbacher4, Didier Samuel, S. Friman5, Robert M Jones6, Guido Cantisani, Frederico Villamil7, Umberto Cillo8, Pierre-Alain Clavien9, Goran B. Klintmalm10, Gerd Otto11, Stephen Pollard12, P. Aiden McCormick13, V. Descalsi7, Adrián Gadano14, A. Villamil14, Peter W Angus6, Stephen V. Lynch15, Glenda A. Balderson15, G. Jeffreys16, B. Chester16, Rudolf Steininger4, B. de Hemptinne17, Roberto Troisi17, M. L. Zanotelli, Luiz Sergio Leonardi18, Ilka de Fátima Santana Ferreira Boin18, Sérgio Mies19, B. D. Guardia19, Les Lilly1, Paul Marotta20, William Wall20, K. Peltekian, André Roy21, Denis Marleau21, C. Scudamore, M. Yoshida, J. Tchervenkov, M. Cantarovich, Olivier Boillot, Pierre-Henri Bernard, Yvon Calmus, Filomena Conti, Daniel Cherqui, Christophe Duvoux, Christian Ducerf, R. Maar, Jean Gugenheim, A. Myx, D. Neau-Cransac, K. Mouette, Faouzi Saliba, Lionel Rostaing, Nassim Kamar, C. Moench13, M. O'Rourke, Davide F. D'Amico8, G. Varotti22, A. Maffei-Faccioli8, Giorgio Enrico Gerunda8, Roberto Merenda8, A. Risaliti23, U. Baccarani23, Massimo Rossi23, Pasquale Berloco23, K. Tanaka24, F. Oike24, Stephen Munn24, Edward Gane24, I. Brekke, K. M. Boberg, A. Bernardos, I. Garcia, V. Cuervas25, J. M. Moreno25, Antoni Rimola, I. Cirera, F. Sanjuan, Martín Prieto, M. Salcedo, G. Clemente, B. Ericson5, H. Gjertsen5, Gustaf Herlenius26, Zakiyah Kadry9, David Mayer27, P. Hayes12, J. Davidson12, J. Hodgson28, John S Bynon28, Gary L. Davis10, Jorge Ortiz29, C. Manzarbeita29, R. Mennon30, R. H. Weisner30, Y. Wu30, R. Y. Chensu30, John R Lake1, Abhinav Humar31 
TL;DR: The efficacy of CsA‐ME monitored by blood concentration at 2 hours postdose and tacrolimus in liver transplant patients is equivalent to 12 months, and renal function is similar.

98 citations

Journal ArticleDOI
01 Apr 2008
TL;DR: It was observed that patients receiving over 6 red blood cell units intraoperatively displayed reduced survival, and predictive factors for this risk factor were high donor level of sodium and of age.
Abstract: Patients undergoing liver transplantation often experience coagulopathy and massive intraoperative blood loss that can lead to morbidity and reduced survival. The aim of this study was to verify the survival rate and discover predictive factors for death among liver transplant patients who received massive intraoperative blood transfusions. This cohort study was based on prospective data collected retrospectively from January 2004 to July 2006. The 232 patients were distributed according to their blood requirements, (namely, more or less than 6 units), including red blood cell saver. The statistical analyses were performed using Student t test, Cox hazard regression, and the Kaplan-Meier method (log-rank test). The massively transfused cohort displayed higher Child-Pugh classifications (10.2 vs 9.6; P = .03); model for end-stage liver disease (MELD) scores (19 vs 17; P = .02); recipient weights (75.4 vs 71 kg; P = .03); as well as warm ischemia times (70.7 vs 56.4 minutes; P or = 6 vs <6 U of blood transfusion of 63.8% vs 83.3%; 53.9% vs 76.3%; 40% vs 60%; 34.5% vs 49.2%. In conclusion, we observed that patients receiving over 6 red blood cell units intraoperatively displayed reduced survival. Predictive factors for this risk factor were high donor level of sodium and of age.

72 citations

Journal ArticleDOI
01 May 2004
TL;DR: The experience concerning the high waiting list mortality rate for orthotopic liver transplantation (OLT) using the MELD (Model for End-Stage Liver Disease), which has been shown to predict short-term survival better than Child-Turcotte-Pugh (CTP) classification, was evaluated.
Abstract: We sought to evaluate our experience concerning the high waiting list mortality rate for orthotopic liver transplantation (OLT) using the MELD (Model for End-Stage Liver Disease), which has been shown to predict short-term survival better than Child-Turcotte-Pugh (CTP) classification. The predominant end-stage disease was cirrhosis due to hepatitis C virus (67%), patient mean age was 36.8 years, and 72.1% were men. When the patients were included on a waiting list, the MELD score was stratified into W: 0 to 10; X: 11 to 20, and Y: 21 to 40 and the CPT as A: 5 to 6, B: 7 to 9, and C: 10 to 15. It was also observed that 77.8% of patients were on the waiting list, 16.4% underwent OLT and 5.8% had been removed. The estimated survival rate after 1 year was W = 85.4%; X = 83.3%, Y = 46.8%; A = 81.3%, B = 84.2%, C = 45.9%. Child median score was 8 +/- 1.5 (5 to 15) and the MELD was 14.7 +/- 5.1 (8 to 43). The mortality rate was 20.2%. Severe patients classified as Y or C showed greater mortality than the other groups (P <.001), but no significant difference between Y and C strata. The mortality rate was the same as in previous years.

29 citations

Journal ArticleDOI
TL;DR: In this article, a model for end-stage liver disease (MELD) was developed to predict short-term mortality in patients with cirrhosis, which was used to assess the value of pretransplant MELD in the prediction of posttransplant survival.
Abstract: BACKGROUND: The model for end-stage liver disease (MELD) was developed to predict short-term mortality in patients with cirrhosis. There are few reports studying the correlation between MELD and long-term posttransplantation survival. AIM: To assess the value of pretransplant MELD in the prediction of posttransplant survival. METHODS: The adult patients (age >18 years) who underwent liver transplantation were examined in a retrospective longitudinal cohort of patients, through the prospective data base. We excluded acute liver failure, retransplantation and reduced or split-livers. The liver donors were evaluated according to: age, sex, weight, creatinine, bilirubin, sodium, aspartate aminotransferase, personal antecedents, brain death cause, steatosis, expanded criteria donor number and index donor risk. The recipients' data were: sex, age, weight, chronic hepatic disease, Child-Turcotte-Pugh points, pretransplant and initial MELD score, pretransplant creatinine clearance, sodium, cold and warm ischemia times, hospital length of stay, blood requirements, and alanine aminotransferase (ALT >1,000 UI/L = liver dysfunction). The Kaplan-Meier method with the log-rank test was used for the univariable analyses of posttransplant patient survival. For the multivariable analyses the Cox proportional hazard regression method with the stepwise procedure was used with stratifying sodium and MELD as variables. ROC curve was used to define area under the curve for MELD and Child-Turcotte-Pugh. RESULTS: A total of 232 patients with 10 years follow up were available. The MELD cutoff was 20 and Child-Turcotte-Pugh cutoff was 11.5. For MELD score > or =20, the risk factors for death were: red cell requirements, liver dysfunction and donor's sodium. For the patients with hyponatremia the risk factors were: negative delta-MELD score, red cell requirements, liver dysfunction and donor's sodium. The regression univariated analyses came up with the following risk factors for death: score MELD > or = 25, blood requirements, recipient creatinine clearance pretransplant and age donor > or =50. After stepwise analyses, only red cell requirement was predictive. Patients with MELD score or =25 were 39.13%, 29.81% and 22.36% respectively. Patients without hyponatremia were 65.16%, 50.28% and 41,98% and with hyponatremia 44.44%, 34.28% and 28.57% respectively. Patients with IDR > or =1.7 showed 53.7%, 27.71% and 13.85% and index donor risk 50 years showed 38.4%, 26.21% and 13.1% and age donor < or =50 years showed 65.58%, 26.21% and 13.1%. Association with delta-MELD score did not show any significant difference. Expanded criteria donors were associated with primary non-function and severe liver dysfunction. Predictive factors for death were blood requirements, hyponatremia, liver dysfunction and donor's sodium. CONCLUSION: In conclusion MELD over 25, recipient's hyponatremia, blood requirements, donor's sodium were associated with poor survival.

26 citations

Journal ArticleDOI
TL;DR: In this article, a model for end-stage liver disease (MELD) was developed to predict short-term mortality in patients with cirrhosis in patients who underwent liver transplantation.
Abstract: BACKGROUND: The model for end-stage liver disease (MELD) was developed to predict short-term mortality in patients with cirrhosis There are few reports studying the correlation between MELD and long-term posttransplantation survival AIM: To assess the value of pretransplant MELD in the prediction of posttransplant survival METHODS: The adult patients (age >18 years) who underwent liver transplantation were examined in a retrospective longitudinal cohort of patients, through the prospective data base We excluded acute liver failure, retransplantation and reduced or split-livers The liver donors were evaluated according to: age, sex, weight, creatinine, bilirubin, sodium, aspartate aminotransferase, personal antecedents, brain death cause, steatosis, expanded criteria donor number and index donor risk The recipients' data were: sex, age, weight, chronic hepatic disease, Child-Turcotte-Pugh points, pretransplant and initial MELD score, pretransplant creatinine clearance, sodium, cold and warm ischemia times, hospital length of stay, blood requirements, and alanine aminotransferase (ALT >1,000 UI/L = liver dysfunction) The Kaplan-Meier method with the log-rank test was used for the univariable analyses of posttransplant patient survival For the multivariable analyses the Cox proportional hazard regression method with the stepwise procedure was used with stratifying sodium and MELD as variables ROC curve was used to define area under the curve for MELD and Child-Turcotte-Pugh RESULTS: A total of 232 patients with 10 years follow up were available The MELD cutoff was 20 and Child-Turcotte-Pugh cutoff was 115 For MELD score > 20, the risk factors for death were: red cell requirements, liver dysfunction and donor's sodium For the patients with hyponatremia the risk factors were: negative delta-MELD score, red cell requirements, liver dysfunction and donor's sodium The regression univariated analyses came up with the following risk factors for death: score MELD > 25, blood requirements, recipient creatinine clearance pretransplant and age donor >50 After stepwise analyses, only red cell requirement was predictive Patients with MELD score 25 were 3913%, 2981% and 2236% respectively Patients without hyponatremia were 6516%, 5028% and 41,98% and with hyponatremia 4444%, 3428% and 2857% respectively Patients with IDR > 17 showed 537%, 2771% and 1385% and index donor risk 50 years showed 384%, 2621% and 131% and age donor <50 years showed 6558%, 2621% and 131% Association with delta-MELD score did not show any significant difference Expanded criteria donors were associated with primary non-function and severe liver dysfunction Predictive factors for death were blood requirements, hyponatremia, liver dysfunction and donor's sodium CONCLUSION: In conclusion MELD over 25, recipient's hyponatremia, blood requirements, donor's sodium were associated with poor survival

25 citations


Cited by
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Journal ArticleDOI
01 Feb 2016-Medicine
TL;DR: A systematic review and meta-analysis aimed to compare the discriminative ability of Child–Pugh versus MELD score to assess the prognosis of cirrhotic patients and found that their benefits might be heterogeneous in some specific conditions.

312 citations

Journal ArticleDOI
TL;DR: There is an urgent need to develop methods to identify the populations at particular risk of disease progression and validate endpoints that reflect meaningful changes in health status in this population.

273 citations

Journal ArticleDOI
TL;DR: The projected impact of recurrent hepatitis C on graft and patient survival can only be avoided by the development of safe and effective antiviral strategies which can both prevent initial graft infection and eradicate established hepatitis C recurrence.

250 citations

Journal ArticleDOI
TL;DR: A systematic review of randomized clinical trials (RCT) was undertaken to evaluate the beneficial and harmful effects of immunosuppression with cyclosporin versus tacrolimus for liver transplanted patients, finding that tacolimus reduced the number of recipients with acute rejection and steroid‐resistant rejection but four additional patients would develop diabetes after liver transplantation.

231 citations

Journal ArticleDOI
TL;DR: The absence of portocaval shunt and the duration of cold ischemia were independent predictors of intraoperative PRS and provide realistic clinical targets to improve patient outcome after OLT for cirrhosis.

209 citations