OBJETIVO: Analisar a taxa de aproveitamento de pulmões disponibilizados em São Paulo no ano de 2006, bem como caracterizar o perfil dos doadores de pulmão deste período. MÉTODOS: Estudo retrospectivo de 497 prontuários de doadores de pulmão, no período de janeiro a dezembro de 2006. RESULTADOS: Não houve oferta de doação de pulmões para transplante em 149 (30%) dos prontuários analisados, sendo excluídos do estudo. A idade média dos 348 doadores eleitos para o estudo foi de 37,4 ± 16,1 anos, e 56,9% deles eram do sexo masculino. As principais causas da morte cerebral dos doadores foram: acidente vascular cerebral (40,5%); trauma cranioencefálico (34,2%); e hemorragia subaracnóidea (10,9%). A grande maioria dos doadores recebia drogas vasoativas (90,5%), sendo que 13,5% haviam apresentado parada cárdio-respiratória. Do ponto de vista infeccioso, o leucograma médio foi de 15.008 ± 6.467 células/mm³, 67,8% recebiam antibioticoterapia e 26,1% apresentavam infecção pulmonar. Quase 40% dos doadores apresentavam alterações radiográficas. Apenas 4,9% dos doadores foram aceitos, representando 28 pulmões (taxa de aproveitamento de órgãos de 4%). Os motivos de recusa foram: alteração gasométrica (30,1%); infecção (23,7%); e distância (10,9%). CONCLUSÕES: A taxa de aproveitamento de pulmões em nosso meio é baixa quando comparada às taxas médias de aproveitamento mundial. Além disso, mais de 50% das recusas deveram-se à gasometria arterial inadequada e infecção pulmonar. Aliar melhor cuidado ao potencial doador à menor rigidez nos critérios de seleção poderia aumentar a utilização dos órgãos doados.

OBJECTIVE: To analyze the rate at which lungs available for transplantation in the state of São Paulo in 2006 were utilized and to determine the lung donor profile in the same period. METHODS: A retrospective study of 497 clinical charts of lung tissue donors from January to December of 2006. RESULTS: According to the clinical charts, lungs were not offered for transplant in 149 cases (30%), which were therefore excluded from the study. Among the 348 lung donors eligible for inclusion in the study, the mean age was 37.4 ± 16.1 years, and 56.9% were males. The main causes of brain death among the donors were stroke (in 40.5%), skull-brain trauma (in 34.2%) and subarachnoid hemorrhage (in 10.9%). The great majority of these lung donors (90.5%) received vasoactive agents, and 13.5% presented cardiopulmonary arrest. The mean donor leukocyte count was 15,008 ± 6,467 cells/mm³, 67.8% of the donors received anti-bacterial agents, and 26.1% presented lung infection. Nearly 40% of the lung donors presented chest X-ray abnormalities. Only 4.9% of the lung donors were accepted, representing 28 lungs (allograft utilization rate of 4%). The causes for donor exclusion were gas exchange alterations (in 30.1%), infection (in 23.7%) and distance (in 10.9%). CONCLUSIONS: The lung utilization rate in the state of São Paulo is low when compared to mean rates worldwide. In addition, more than half of the donor pool was excluded due to altered gas exchange or pulmonary infection. The combination of better care of the potential donor and more flexible selection criteria could increase allograft utilization.

OBJETIVO: Avaliar os efeitos da azatioprina sobre o sistema mucociliar em um modelo de secção e anastomose brônquica em ratos. MÉTODOS: Trinta e seis ratos machos da raça Wistar-Furth foram submetidos à secção e anastomose brônquica esquerda e separados aleatoriamente em dois grupos para receberem solução salina ou azatioprina. Após 7, 15 e 30 dias de terapia, seis animais de cada grupo foram sacrificados, e foram realizadas as medidas da velocidade de transporte mucociliar in situ, da transportabilidade do muco in vitro e do ângulo de contato do muco nos brônquios direito (intacto) e esquerdo (seccionado). RESULTADOS: A velocidade de transporte mucociliar in situ foi significativamente menor nos brônquios seccionados do que nos brônquios intactos (p < 0,001). Houve redução da velocidade de transporte mucociliar in situ nos brônquios intactos dos animais tratados com azatioprina por 7 dias (p < 0,05), havendo completa recuperação após 30 dias de terapia. O ângulo de contato do muco foi maior nos brônquios seccionados dos animais tratados com solução salina por 30 dias (p < 0,001), estando de acordo com a redução da transportabilidade do muco in vitro observada nos mesmos animais (p < 0,001). CONCLUSÕES: Concluímos que, nos brônquios seccionados de ratos, a terapia com azatioprina causa um prejuízo apenas transitório do transporte mucociliar, enquanto a administração de solução salina prejudica o transporte mucociliar por até 30 dias. Além disso, a azatioprina contribui para prevenir alterações nas propriedades da superfície do muco.

OBJECTIVE: To evaluate the effects of azathioprine on the mucociliary system in a model of bronchial section and anastomosis in rats. METHODS: Thirty-six male Wistar-Furth rats were submitted to left bronchial section and anastomosis and divided into two groups to receive either saline solution or azathioprine. After 7, 15 and 30 days of treatment, six animals from each group were killed, after which in situ mucociliary transport velocity, in vitro mucus transportability, and contact angle of mucus in the right (intact) and left (sectioned) bronchi were measured. RESULTS: In situ mucociliary transport velocity was significantly lower in the sectioned bronchi than in the intact bronchi (p < 0.001). In situ mucociliary transport velocity was lower in the intact bronchi of the animals treated with azathioprine for 7 days (p < 0.05), and those bronchi presented full recovery after 30 days of treatment. The contact angle was higher in the mucus samples collected from the sectioned bronchi of the animals treated with saline solution for 30 days (p < 0.001), which is in accordance with the decreased in vitro mucus transportability observed in the same animals (p < 0.001). CONCLUSIONS: We conclude that, in the sectioned bronchi of rats, treatment with azathioprine causes only transitory impairment of mucociliary transport, whereas administration of saline solution impairs mucociliary transport for up to 30 days. In addition, azathioprine protects against alterations in mucus surface properties.

Terapias de imunossupressão, a que pacientes transplantados devem ser submetidos, os expõe a um alto risco de desenvolver desordens linfoproliferativas pós-transplante (PTLD). Descrevemos o caso de uma criança submetida a transplante cardíaco aos sete meses de idade e que acabou desenvolvendo PTLD, aos nove anos, diagnosticada por meio de retirada de nódulo pulmonar.

Immunosuppressive therapy for transplanted patients exposes them to a high risk of developing posttransplantation lymphoproliferative disorders (PTLD). We report the case of a child undergoing heart transplantation at seven months of age who developed PTLD at nine years of age, diagnosed by resection of a pulmonary nodule.

As complicações decorrentes da anastomose brônquica nos transplantes pulmonares, embora tenham diminuído ao longo do tempo, ainda figuram como um dos principais fatores de morbi-mortalidade nesses pacientes. As formas de tratamento dessas complicações incluem dilatação por balão, fotocoagulação por laser, endopróteses de silicone e metálicas, e reoperação. Relata-se o caso de um paciente que apresentou estenose brônquica após transplante pulmonar unilateral esquerdo, cujo tratamento foi realizado com endoprótese metálica auto-expansível de nitinol (Ultraflex®). Embora seja um caso pioneiro no Brasil, a boa resposta clínica, concordante com os dados da literatura, sugere que esse tratamento seja uma boa alternativa nesses casos.

Although the incidence of bronchial anastomosis as a complication of lung transplantation has decreased in recent years, it remains a significant cause of morbidity and mortality in these patients. Treatment options include balloon dilatation, laser photocoagulation, placement of a stent (silicone or metal), and performing a second operation. We report the case of a patient who presented bronchial stenosis after left lung transplantation and was treated with a self-expanding metal alloy (nitinol) stent (Ultraflex®). Despite the fact that this was the first case of stenosis treated in this fashion in Brazil, the positive clinical response, in agreement with results reported in the literature, indicates that this treatment is a viable alternative in such cases.

OBJECTIVE: To test the hypothesis that short periods of ischemia may increase the myocardial protection obtained with intermittent crossclamping of the aorta. METHODS: In the control group (18 patients), surgery was performed with systemic hypothermia at 32ºC and intermittent crossclamping of the aorta. Extracorporeal circulation was used. In the preconditioning group (17 patients), 2 crossclampings of the aorta lasting 3min each were added prior to the intermittent crossclamping of the conventional technique with an interval of 2min of reperfusion between them. Blood samples for analyses of pH, pCO2, pO2, sodium, potassium, calcium, and magnesium were obtained from the coronary sinus at the beginning of extracorporeal circulation (time 1), at the end of the first anastomosis (time 2), and at the end of extracorporeal circulation (time 3). RESULTS: No difference was observed in the results of the 2 groups, except for a variation in the ionic values in the different times of blood withdrawal; sodium values, however, remained stable. All patients had a good clinical outcome. CONCLUSION: The results of intermittent crossclamping of the aorta with moderate hypothermia were not altered by the use of ischemic preconditioning.