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conseguindo prolongar a vida&#44; embora com um impacto insuficiente na qualidade de vida dos doentes<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a>&#46; Ainda assim&#44; a transplanta&#231;&#227;o continua a constituir a derradeira oportunidade de vida para doentes refrat&#225;rios a estas novas terap&#234;uticas e tecnologias&#44; n&#227;o tendo sido notada uma diminui&#231;&#227;o na taxa de referencia&#231;&#227;o<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#44;6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">No nosso centro&#44; o programa de transplanta&#231;&#227;o card&#237;aca foi iniciado em novembro de 2003 e os resultados globais dos primeiros cinco anos de atividade&#44; tanto em termos de morbilidade como no que respeita &#224; mortalidade&#44; bem como a sobreviv&#234;ncia e qualidade de vida dos doentes transplantados&#44; foram alvo de um relat&#243;rio pormenorizado anteriormente publicado nesta revista<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Neste trabalho&#44; pretendemos expandir essa an&#225;lise aos dados de uma d&#233;cada e analisar a experi&#234;ncia entretanto colhida desta atividade&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Doentes</span><p id="par0020" class="elsevierStylePara elsevierViewall">Desde novembro de 2003 at&#233; dezembro de 2013 foram transplantados um total de 258 doentes&#44; estando a maioria deles &#40;71&#37;&#41; classificados como urgentes ou emergentes &#40;internados na UTICA&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Na maior parte dos casos&#44; os doentes foram diagnosticados e tratados medicamente nesta institui&#231;&#227;o antes de serem transplantados&#46; Quase metade dos doentes &#40;126&#59; 48&#44;8&#37;&#41; foi referenciada por institui&#231;&#245;es de sa&#250;de de fora da &#225;rea natural de refer&#234;ncia do Hospital da Universidade de Coimbra &#40;CHUC&#41;&#46; 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foi conhecido ap&#243;s a transplanta&#231;&#227;o&#44; o que ter&#225; condicionado o esquema de imunossupress&#227;o nalguns casos&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A colheita do &#243;rg&#227;o foi sempre efetuada por elementos da equipe transplantadora&#46; A t&#233;cnica cir&#250;rgica de transplanta&#231;&#227;o utilizada foi anteriormente descrita e segue o m&#233;todo <span class="elsevierStyleItalic">standard</span> de anastomose bicava seguido na maior parte dos centros transplantadores&#44; mas com pequenas altera&#231;&#245;es e adapta&#231;&#245;es resultantes da experi&#234;ncia entretanto adquirida&#44; no sentido de minimizar o tempo de isquemia&#44; nomeadamente com a realiza&#231;&#227;o precoce da anastomose a&#243;rtica e respetiva desclampagem&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O protocolo de imunossupress&#227;o utilizado de rotina consiste em terap&#234;utica de indu&#231;&#227;o com <span class="elsevierStyleItalic">basiliximab&#44; corticosteroides e micofenolato de mofetil oral</span>&#44; imediatamente antes e durante a interven&#231;&#227;o&#44; seguida de imunossupress&#227;o de manuten&#231;&#227;o tripla com corticosteroides&#44; micofenolato de mofetil e inibidores da calcineurina&#44; ciclosporina na maior parte dos casos&#44; cujas doses s&#227;o determinadas tendo em conta diferentes fatores&#44; como os respetivos n&#237;veis s&#233;ricos&#44; o valor do PRA&#44; o resultado das bi&#243;psias endomioc&#225;rdicas seriadas e outros elementos de ordem cl&#237;nica&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lise estat&#237;stica</span><p id="par0045" class="elsevierStylePara elsevierViewall">Desde o in&#237;cio do programa&#44; e com conhecimento e consentimento dos doentes&#44; est&#225; a ser realizada uma an&#225;lise simultaneamente retrospetiva e prospetiva dos resultados&#44; consistindo na recolha dos dados de ordem cl&#237;nica relativos ao per&#237;odo pr&#233; e peritransplante&#44; bem como os de intercorr&#234;ncias cl&#237;nicas no per&#237;odo p&#243;s&#8208;transplante&#44; utilizando uma extensa base de dados constru&#237;da em conjunto com a Sociedade Portuguesa da Transplanta&#231;&#227;o &#40;SPT&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">As vari&#225;veis cont&#237;nuas s&#227;o apresentadas como m&#233;dia &#177; desvio padr&#227;o&#46; As vari&#225;veis categ&#243;ricas s&#227;o expressas em frequ&#234;ncias e percentagens&#46; A sobreviv&#234;ncia global e por grupos foi avaliada pelo m&#233;todo de Kaplan&#8208;Meier&#44; tendo o significado estat&#237;stico sido analisado atrav&#233;s do teste de Log Rank&#46; Valores de p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foram considerados estatisticamente significativos&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Doentes</span><p id="par0055" class="elsevierStylePara elsevierViewall">A idade m&#233;dia dos 258 doentes era 53&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;7 anos&#44; com um intervalo de 3&#8208;72 anos e predomin&#226;ncia do sexo masculino &#40;77&#44;5&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#41;&#46; A distribui&#231;&#227;o por idade dos recetores est&#225; representada na <a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#44; tendo a maioria dos doentes entre 40&#8208;65 anos&#46; Foram transplantados seis doentes com mais de 70 anos&#46; O tempo m&#233;dio de espera na lista para transplanta&#231;&#227;o foi 43&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>45&#44;4 dias&#44; com tend&#234;ncia para aumentar nos &#250;ltimos anos &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figura 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">A maior parte dos doentes sofria de cardiomiopatia isqu&#233;mica &#40;37&#44;2&#37;&#41;&#44; seguido da etiologia idiop&#225;tica &#40;36&#44;4&#37;&#41; e 28&#44;7&#37; tinham tido cirurgia card&#237;aca pr&#233;via &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figura 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">O &#237;ndice de massa corporal m&#233;dio da popula&#231;&#227;o &#224; data da transplanta&#231;&#227;o era de 23&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;4<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; Quase um ter&#231;o dos doentes eram diab&#233;ticos &#40;27&#44;9&#37;&#41; e a uma percentagem significativa estavam associadas a hipertens&#227;o arterial &#40;37&#44;6&#37;&#41;&#44; a dislipidemia &#40;46&#44;9&#37;&#41; e o tabagismo &#40;14&#44;0&#37;&#41;&#46; Ainda no campo das comorbilidades&#44; registou&#8208;se doen&#231;a vascular perif&#233;rica em 32&#44;6&#37; dos doentes e doen&#231;a carot&#237;dea em 5&#44;4&#37;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A m&#233;dia da fra&#231;&#227;o de eje&#231;&#227;o do ventr&#237;culo esquerdo era 20&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;9&#37;&#46; A press&#227;o sist&#243;lica da art&#233;ria pulmonar era 48&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;3<span class="elsevierStyleHsp" style=""></span>mmHg&#44; as resist&#234;ncias vasculares pulmonares 3&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2 unidades Wood e o gradiente transpulmonar 9&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;6<span class="elsevierStyleHsp" style=""></span>mmHg&#46; A creatinina basal era 1&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;6 &#40;0&#44;5&#8208;5&#44;6&#41; mg&#47;dl&#44; a hemoglobina 12&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;1<span class="elsevierStyleHsp" style=""></span>g&#47;l e a desidrogenase l&#225;ctica 338<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>686<span class="elsevierStyleHsp" style=""></span>U&#47;l&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Dadores</span><p id="par0075" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas dos dadores est&#227;o detalhadas na <a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#46; A idade m&#233;dia era 34&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;3 anos&#44; o sexo masculino &#40;75&#44;6&#37;&#41; e o grupo sangu&#237;neo 0 &#40;53&#44;5&#37;&#41; foram predominantes&#46; A causa de morte foi maioritariamente traum&#225;tica &#40;57&#44;8&#37;&#41;&#44; seguida de AVC hemorr&#225;gico &#40;32&#44;9&#37;&#41;&#44; mas com uma tend&#234;ncia crescente no n&#250;mero de dadores v&#237;timas de acidente cerebrovascular&#44; que representam quase 35&#37; da totalidade da s&#233;rie&#44; tendo&#8208;se atualmente j&#225; invertido a raz&#227;o causa traum&#225;tica&#47;causa neurol&#243;gica prim&#225;ria&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Um n&#250;mero significativo de dadores estava com apoio ventilat&#243;rio ou inotr&#243;pico prolongado &#40;mais de uma semana&#59; 12&#44;4 e 4&#44;3&#37;&#44; respetivamente&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A maioria das colheitas foi realizada nos hospitais de fora de Coimbra &#40;58&#44;5&#37;&#41; e a principal origem &#224; dist&#226;ncia foi a regi&#227;o Norte&#44; que contribui com 29&#44;8&#37; dos dadores&#44; tendo sido feita uma colheita na Regi&#227;o Aut&#243;noma dos A&#231;ores &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figura 4</a>&#41;&#46; A m&#233;dia da dist&#226;ncia de colheita foi de 97&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>100&#44;9<span class="elsevierStyleHsp" style=""></span>km&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Cirurgia e unidade de cuidados intensivos</span><p id="par0090" class="elsevierStylePara elsevierViewall">O tempo m&#233;dio de isquemia foi 89&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&#44;4 minutos&#44; sendo inferior a 45 minutos em todos os casos com colheita local&#46; O tempo de circula&#231;&#227;o extracorp&#243;rea foi 100&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>45&#44;1 minutos&#46; Durante a transplanta&#231;&#227;o foi associada outra cirurgia no cora&#231;&#227;o do dador em 16 casos &#40;6&#44;2&#37;&#41;&#46; Assim&#44; foi efetuada valvuloplastia mitral em 12 doentes &#40;4&#44;7&#37;&#41;&#44; valvuloplastia tric&#250;spide em dois &#40;0&#44;8&#37;&#59; isolada ou associada &#224; mitral num doente cada&#41; e revasculariza&#231;&#227;o da art&#233;ria descendente anterior em dois doentes &#40;0&#44;8&#37;&#41;&#46; Num outro doente foi necess&#225;rio proceder &#224; substitui&#231;&#227;o da aorta ascendente&#46; Em quatro doentes &#40;1&#44;6&#37;&#41;&#44; que aguardavam transplanta&#231;&#227;o renal&#44; esta foi efetuada simultaneamente com a card&#237;aca &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">A maioria dos doentes foram extubados cerca de 12 horas ap&#243;s a interven&#231;&#227;o e o tempo m&#233;dio de ventila&#231;&#227;o mec&#226;nica foi de 20&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#44;8 horas&#46; Disfun&#231;&#227;o ventricular p&#243;s&#8208;transplante&#44; requerendo suporte inotr&#243;pico prolongado&#44; afetou 11&#44;8&#37; dos doentes e em 13 destes &#40;5&#44;0&#37;&#41; o suporte inotr&#243;pico revelou&#8208;se insuficiente&#44; necessitando de suporte mec&#226;nico por bal&#227;o intra&#8208;a&#243;rtico&#44; assist&#234;ncia ventricular esquerda ou ECMO&#44; segundo as situa&#231;&#245;es&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Rejei&#231;&#227;o e complica&#231;&#245;es associadas</span><p id="par0100" class="elsevierStylePara elsevierViewall">Noventa por cento dos doentes foram mantidos com terap&#234;utica imunossupressora tripla&#44; incluindo ciclosporina&#46; Os restantes receberam tacrolimus em v&#225;rias combina&#231;&#245;es&#46; Em 23 doentes foi necess&#225;rio alterar o esquema de imunossupress&#227;o inicial devido a complica&#231;&#245;es renais e&#47;ou neopl&#225;sicas e rejei&#231;&#227;o humoral&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Regularmente&#44; foram realizadas bi&#243;psias endomioc&#225;rdicas&#44; observa&#231;&#227;o ecocardiogr&#225;fica e avalia&#231;&#227;o angiogr&#225;fica para diagn&#243;stico de rejei&#231;&#227;o&#46; Quarenta e seis doentes &#40;17&#44;8&#37;&#41; sofreram 60 epis&#243;dios de rejei&#231;&#227;o &#8805;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>R da escala da ISHLT&#44; requerendo terap&#234;utica de pulso com corticosteroides e&#47;ou ajustamento das doses de imunossupressores&#46; Cento e sete doentes &#40;41&#44;5&#37;&#41; n&#227;o tiveram nenhum epis&#243;dio de rejei&#231;&#227;o celular &#40;0<span class="elsevierStyleHsp" style=""></span>R&#41;&#46; Os restantes tiveram pelo menos um epis&#243;dio de rejei&#231;&#227;o ligeira &#40;1<span class="elsevierStyleHsp" style=""></span>R&#41; que n&#227;o necessitou de tratamento&#46; A maior incid&#234;ncia de rejei&#231;&#227;o &#8805;<span class="elsevierStyleHsp" style=""></span>2R aconteceu durante o primeiro ano p&#243;s&#8208;transplanta&#231;&#227;o&#44; com uma tend&#234;ncia a diminuir progressivamente nos anos subsequentes&#46; A sobreviv&#234;ncia livre de rejei&#231;&#227;o 2<span class="elsevierStyleHsp" style=""></span>R ou superior aos seis meses e a um e cinco anos foi de 86&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2&#37;&#44; 82&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;5&#37; e 80&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;7&#37;&#44; respetivamente &#40;<a class="elsevierStyleCrossRef" href="#fig0025">figura 5</a>&#41;&#46; Em 8 doentes &#40;3&#44;1&#37;&#41; foi observada rejei&#231;&#227;o humoral e doen&#231;a vascular do enxerto &#40;DVE&#59; diagnosticada por angiografia coron&#225;ria&#44; como algum grau de irregularidade <span class="elsevierStyleItalic">de novo</span> nos grandes vasos coron&#225;rios ou dos seus ramos principais&#44; ainda que a les&#227;o seja inferior a 50&#37;&#41; foi diagnosticada em 22 &#40;8&#44;5&#37;&#41;&#44; sendo ainda de grau ligeiro na maior parte dos casos&#46; A sobreviv&#234;ncia livre de DVE aos dez anos foi 80&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;5&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Figura 6</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Outra morbilidade</span><p id="par0110" class="elsevierStylePara elsevierViewall">Todos os doentes&#44; exceto dois&#44; foram seguidos no centro cir&#250;rgico&#44; ainda assim&#44; com informa&#231;&#227;o completa de todos&#46; O tempo de seguimento m&#233;dio foi de 4&#44;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;05 anos&#46; Trinta e tr&#234;s doentes &#40;12&#44;8&#37;&#41; desenvolveram diabetes <span class="elsevierStyleItalic">de novo</span> &#40;<span class="elsevierStyleItalic">new onset diabetes after transplantation</span> &#91;NODAT&#93;&#41;&#44; 29 dos quais no primeiro ano p&#243;s&#8208;transplanta&#231;&#227;o&#46; Infe&#231;&#245;es graves durante os primeiros 12 meses ap&#243;s a transplanta&#231;&#227;o&#44; que necessitaram de internamento e tratamento antibi&#243;tico endovenoso dirigido ocorreram em 43 doentes &#40;16&#44;7&#37;&#41;&#46; As pneumonias antes dos seis meses foram o principal tipo de infe&#231;&#227;o registado &#40;9&#44;7&#37; dos doentes&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Geralmente observou&#8208;se uma recupera&#231;&#227;o da fun&#231;&#227;o renal nos primeiros meses p&#243;s&#8208;transplante&#44; melhoria que persistiu durante o primeiro ano&#46; Apenas cinco doentes &#40;1&#44;9&#37;&#41; necessitaram de terapia de substitui&#231;&#227;o renal precoce &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>m&#234;s p&#243;s&#8208;transplante&#41;&#46; Por&#233;m&#44; a partir dos 12 meses ap&#243;s a opera&#231;&#227;o foi not&#243;ria uma deteriora&#231;&#227;o progressiva e persistente da fun&#231;&#227;o renal&#44; como consequ&#234;ncia da terap&#234;utica imunossupressora e antibi&#243;tica &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Tabela 5</a>&#41;&#46; Tr&#234;s doentes foram entretanto submetidos a transplanta&#231;&#227;o renal e outros dois encontram&#8208;se sujeitos a terap&#234;utica de substitui&#231;&#227;o e aguardam transplanta&#231;&#227;o&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Mortalidade e sobrevida</span><p id="par0120" class="elsevierStylePara elsevierViewall">Doze doentes &#40;4&#44;7&#37;&#41; faleceram nos primeiros 30 dias ou durante o internamento&#44; por fal&#234;ncia do enxerto e acidente vascular cerebral em cinco cada&#44; e por rejei&#231;&#227;o hiperaguda em dois&#44; e outros 50 faleceram durante o <span class="elsevierStyleItalic">follow&#8208;up</span>&#44; para uma mortalidade global de 24&#44;0&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabela 6</a>&#41;&#46; As principais causas de morte tardia foram as complica&#231;&#245;es infeciosas &#40;7&#44;0&#37;&#41;&#44; seguidas das vasculares &#40;5&#44;0&#37;&#41;&#44; neopl&#225;sicas &#40;3&#44;9&#37;&#41; e card&#237;acas &#40;3&#44;5&#37;&#41;&#46; A sobreviv&#234;ncia global foi de 87&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;9&#37; a um ano&#44; 77&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;8&#37; aos cinco anos&#44; 68&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;8&#37; aos oito anos e 65&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;4&#37; aos dez anos &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Figura 7</a>&#41;&#46; N&#227;o se observou diferen&#231;a significativa na sobreviv&#234;ncia entre doentes dos dois sexos &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Figura 8</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discuss&#227;o</span><p id="par0125" class="elsevierStylePara elsevierViewall">A transplanta&#231;&#227;o card&#237;aca tem&#8208;se afirmado como uma modalidade de tratamento eficaz da insufici&#234;ncia card&#237;aca terminal e refrat&#225;ria&#46; Contudo&#44; esta interven&#231;&#227;o est&#225; associada a um conjunto de complica&#231;&#245;es graves&#44; algumas potencialmente fatais&#44; que fazem com este seja efetivamente um procedimento paliativo a m&#233;dio e longo prazo&#46; Na atualidade&#44; a sobreviv&#234;ncia a dez anos &#233; de cerca de 50&#8208;60&#37; e a sobrevida m&#233;dia dos sobreviventes &#224; transplanta&#231;&#227;o &#233; de 12&#8208;13 anos<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">O programa de transplanta&#231;&#227;o card&#237;aca do CHUC foi iniciado em novembro de 2003&#46; Os dados dos doentes transplantados nos primeiros cinco anos de atividade foram apresentados e analisados em relat&#243;rio ent&#227;o publicado na RPC<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Dele constava tamb&#233;m uma resenha hist&#243;rica&#44; bem como outras considera&#231;&#245;es sobre a atividade de transplanta&#231;&#227;o card&#237;aca em Portugal e seu contexto europeu&#44; de que recomendamos a leitura&#44; pelo que n&#227;o abordaremos aqui esse assunto&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">No presente trabalho analisamos os resultados obtidos em 258 doentes transplantados na primeira d&#233;cada completa deste programa&#46; Foram&#44; pois&#44; realizados uma m&#233;dia de 25 transplantes anualmente&#44; constituindo o cumprimento global dos objetivos ent&#227;o definidos&#44; considerando&#8208;se esta elevada atividade transplantadora vantajosa&#44; certamente com impacto nos resultados p&#243;s&#8208;transplanta&#231;&#227;o&#44; sobretudo nos casos da maior urg&#234;ncia ou de maior risco&#46; Trata&#8208;se&#44; efetivamente&#44; da maior experi&#234;ncia acumulada por qualquer centro nacional&#46; A rela&#231;&#227;o entre a qualidade dos resultados e o volume da atividade de transplanta&#231;&#227;o est&#225; bem estabelecida<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#8211;12</span></a>&#46; Por outro lado&#44; a experi&#234;ncia assim adquirida tem permitido o alargamento das indica&#231;&#245;es&#44; a explora&#231;&#227;o de alternativas t&#233;cnicas e o aproveitamento de dadores marginais&#44; deste modo estendendo as fronteiras da doa&#231;&#227;o&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Tem&#8208;se assistido a um aumento progressivo n&#227;o s&#243; da idade m&#233;dia dos recetores como do n&#250;mero de doentes que no momento da transplanta&#231;&#227;o estavam internados por insufici&#234;ncia card&#237;aca descompensada&#44; necessitando de apoio farmacol&#243;gico intensivo e&#44; por vezes&#44; de apoio mec&#226;nico cardiocirculat&#243;rio e ventilat&#243;rio&#46; O resultado &#233; um crescente n&#250;mero de recetores em pior estado cl&#237;nico&#44; situa&#231;&#227;o que n&#227;o s&#243; eleva o grau de urg&#234;ncia para a transplanta&#231;&#227;o&#44; mas tamb&#233;m tende a aumentar o risco de insucesso&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">A escala de prioridade para a transplanta&#231;&#227;o card&#237;aca utilizada no nosso pa&#237;s &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">Tabela 7</a>&#41;&#44; inicialmente implementada pela Organiza&#231;&#227;o Portuguesa de Transplanta&#231;&#227;o &#40;OPT&#41;&#44; subsequentemente pela ASST e recentemente pelo IPST&#44; baseada na defini&#231;&#227;o da situa&#231;&#227;o cl&#237;nica do candidato &#224; data da inscri&#231;&#227;o na lista de espera&#44; tendo como consequ&#234;ncia que o doente mais cr&#237;tico passe &#224; frente de outros cuja situa&#231;&#227;o cl&#237;nica lhes permita aguardar mais tempo&#44; tamb&#233;m contribui para esta situa&#231;&#227;o&#46; Contudo&#44; esta escala e escalas similares utilizadas noutros pa&#237;ses n&#227;o esclarecem nem quantificam o perfil de risco dos doentes&#46; &#201; sabido que os resultados imediatos da transplanta&#231;&#227;o s&#227;o muito sens&#237;veis &#224; qualidade dos &#243;rg&#227;os do dador e ao estado cl&#237;nico do candidato<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a>&#46; Estes s&#227;o os principais fatores respons&#225;veis por alguns resultados insatisfat&#243;rios na fase imediata &#224; transplanta&#231;&#227;o<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Pelo contr&#225;rio&#44; os doentes em mais baixo grau de prioridade beneficiam do ambiente domiciliar e acompanhamento familiar&#44; e de uma maior mobilidade&#44; factos que contribuem para uma otimiza&#231;&#227;o do estado psicol&#243;gico e f&#237;sico&#44; e para uma redu&#231;&#227;o dr&#225;stica da incid&#234;ncia e gravidade das infe&#231;&#245;es nosocomiais p&#243;s&#8208;transplanta&#231;&#227;o&#46; Indubitavelmente&#44; estes s&#227;o aspetos que ajudam a diminuir o potencial de risco do doente<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; Mas Lietz e Mokadam demonstraram que durante o tempo de espera para transplanta&#231;&#227;o h&#225; uma deteriora&#231;&#227;o da condi&#231;&#227;o cl&#237;nica em 32&#8208;48&#37; dos pacientes em <span class="elsevierStyleItalic">status</span> 2<span class="elsevierStyleHsp" style=""></span>da <span class="elsevierStyleItalic">United Network for Organ Sharing</span> &#40;UNOS&#44; organiza&#231;&#227;o privada que coordena o sistema de transplanta&#231;&#227;o de &#243;rg&#227;os americano&#41;&#44; equivalente ao nosso grau de prioridade <span class="elsevierStyleSmallCaps">VI&#8208;VII</span><a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;18</span></a>&#46; Os doentes deste grupo chegam&#44; pois&#44; &#224; transplanta&#231;&#227;o em situa&#231;&#227;o cl&#237;nica adversa com estados sintom&#225;ticos de instabilidade intermitente&#44; descompensa&#231;&#245;es recorrentes e frequentes ou sintomas cr&#243;nicos persistentes frequentemente associados a uma elevada morbilidade<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Um outro grupo de risco &#233; o dos doentes diab&#233;ticos&#46; Como seria de esperar nesta popula&#231;&#227;o&#44; mais de um quarto dos doentes &#40;27&#44;9&#37;&#41; eram diab&#233;ticos na altura da transplanta&#231;&#227;o&#46; Por outro lado&#44; 29 doentes &#40;11&#44;27&#37;&#41; adquiriram diabetes <span class="elsevierStyleItalic">de novo</span> no primeiro ano ap&#243;s a transplanta&#231;&#227;o&#46; A rela&#231;&#227;o entre a imunossupress&#227;o&#44; especialmente os corticosteroides e o tacrolimus&#44; e o agravamento ou aparecimento <span class="elsevierStyleItalic">de novo</span> da diabetes <span class="elsevierStyleItalic">melitus</span> &#233; bem conhecida e a diabetes &#233; um dos mais importantes fatores de risco para o desenvolvimento da arteriosclerose que envolve tanto a circula&#231;&#227;o coron&#225;ria como a sist&#233;mica<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46; Em trabalhos anteriormente publicados n&#227;o encontr&#225;mos diferen&#231;as significativas&#44; tanto no que respeita &#224; morbilidade como no que concerne &#224; mortalidade&#44; entre os doentes diab&#233;ticos e os n&#227;o diab&#233;ticos&#44; at&#233; cinco anos ap&#243;s a transplanta&#231;&#227;o<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Contudo&#44; essa situa&#231;&#227;o parece modificar&#8208;se a mais longo prazo<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">A diabetes &#233; tamb&#233;m importante na g&#233;nese e propaga&#231;&#227;o das infe&#231;&#245;es&#46; Mais do que a rejei&#231;&#227;o aguda&#44; que hoje raramente &#233; mortal&#44; as infe&#231;&#245;es s&#227;o atualmente a principal causa de morbilidade e mortalidade tardia ap&#243;s a transplanta&#231;&#227;o&#46; Nesta s&#233;rie&#44; 43 doentes &#40;16&#44;7&#37;&#41; sofreram de infe&#231;&#245;es graves durante o primeiro ano&#44; na maior parte dos casos pneumonias&#44; requerendo internamento e tratamento antibi&#243;tico endovenoso&#44; e foram a principal causa de mortalidade tardia&#44; seguidas das causas vasculares e neopl&#225;sicas&#46; &#201; prov&#225;vel que tal se possa atribuir a excesso de terap&#234;utica imunossupressora&#44; havendo j&#225; centros com excelentes resultados com protocolos imunossupressores muito atenuados em rela&#231;&#227;o aos protocolos cl&#225;ssicos<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; No nosso centro o protocolo inicial foi recentemente modificado&#44; sendo ainda cedo para avaliar o impacto nas principais complica&#231;&#245;es ligadas &#224; transplanta&#231;&#227;o&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Frequentemente relacionada com a rejei&#231;&#227;o cr&#243;nica &#233; a DVE que&#44; contudo&#44; continua a ser uma entidade de g&#233;nese e comportamento largamente desconhecidos&#46; Esta complica&#231;&#227;o aparece tardiamente&#44; geralmente a partir dos cinco anos&#44; e conduz a disfun&#231;&#227;o grave progressiva do enxerto&#44; at&#233; &#224; perda total&#44; com a morte do doente&#44; a menos que seja retransplantado&#44; o que nesta &#225;rea &#233; uma raridade<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; Estranhamente&#44; nesta s&#233;rie&#44; a maior parte dos casos de DVE foram diagnosticados nos primeiros tr&#234;s anos ap&#243;s a transplanta&#231;&#227;o&#46; No entanto&#44; quando diagnosticada precocemente&#44; a evolu&#231;&#227;o da DVE pode ser significativamente atenuada pela altera&#231;&#227;o do regime imunossupressor&#44; especialmente com a introdu&#231;&#227;o dos inibidores de mTOR &#40;sirolimus e everolimus&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Num esfor&#231;o para aumentar o n&#250;mero de dadores&#44; tem&#8208;se vindo progressivamente a aumentar o limite de idade&#46; No entanto&#44; a utiliza&#231;&#227;o de dadores mais velhos n&#227;o parece ser t&#227;o relevante como seria de esperar e noutro estudo baseado nesta nossa experi&#234;ncia demonstr&#225;mos id&#234;ntica sobreviv&#234;ncia entre os recipientes de cora&#231;&#245;es de dadores mais idosos&#44; mesmo em recipientes jovens&#44; pelo que a idade dos dadores&#44; pelo menos at&#233; aos 60 anos&#44; n&#227;o parece ser fator limitativo<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;27</span></a>&#46; Recomenda&#8208;se&#44; contudo&#44; que estes cora&#231;&#245;es n&#227;o sejam submetidos a tempos de isquemia prolongados<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; Por isso&#44; nestas condi&#231;&#245;es temos privilegiado dadores referenciados por institui&#231;&#245;es mais pr&#243;ximas do nosso centro&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">A utiliza&#231;&#227;o de cora&#231;&#245;es com ligeiras anomalias estruturais&#44; mas pass&#237;veis de corre&#231;&#227;o&#44; enquadra&#8208;se tamb&#233;m no esfor&#231;o para aumentar o aproveitamento de dadores&#58; 12 doentes receberam cora&#231;&#245;es com graus ligeiros a moderados de doen&#231;a mitral&#44; conhecida antes da colheita em todos menos um&#44; que foi corrigida antes da implanta&#231;&#227;o&#44; e dois doentes receberam uma anuloplastia tric&#250;spide&#46; Finalmente&#44; dois doentes foram submetidos a revasculariza&#231;&#227;o da art&#233;ria descendente anterior&#44; num deles utilizando a art&#233;ria mam&#225;ria usada na interven&#231;&#227;o pr&#233;via de revasculariza&#231;&#227;o coron&#225;ria&#46; Alguns destes casos foram alvo de publica&#231;&#245;es anteriores<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;30</span></a>&#46; At&#233; ao momento&#44; todos os doentes est&#227;o bem&#44; sem complica&#231;&#245;es relacionadas com estes procedimentos&#44; com exce&#231;&#227;o de um que faleceu algumas semanas p&#243;s&#8208;transplanta&#231;&#227;o por AVC&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Em 17&#37; dos nossos casos verificou&#8208;se uma discrep&#226;ncia de sexo &#40;dador feminino em recetor masculino&#41;&#46; Esta discrep&#226;ncia tem sido frequentemente associada a resultados inferiores<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46; No entanto&#44; nesta s&#233;rie n&#227;o foi observada diferen&#231;a significativa da incid&#234;ncia de complica&#231;&#245;es e mortalidade nos casos de discrep&#226;ncia de sexo&#44; quando comparados com os doentes sem discrep&#226;ncia&#44; pelo que continua&#44; neste programa&#44; a n&#227;o ser causa de rejei&#231;&#227;o de dadores&#44; desde que observadas outras regras de sele&#231;&#227;o&#44; como uma adequada correla&#231;&#227;o morfol&#243;gica &#40;peso e IMC&#41;&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">A sobrevida dos doentes transplantados foi de 87&#37; no primeiro ano&#44; 78&#37; aos cinco anos e 65&#37; aos dez anos&#44; o que se compara favoravelmente com os resultados de outras s&#233;ries publicadas&#44; especialmente do registo de mais de 100 000 casos da <span class="elsevierStyleItalic">International Society for Heart and Lung Transplantation</span> &#40;ISHLT&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; havendo que ter em conta&#44; no entanto&#44; o componente hist&#243;rico daquele registo&#46; &#201;&#44; talvez&#44; ainda cedo para daqui serem derivadas conclus&#245;es&#44; uma vez que a partir da primeira d&#233;cada as curvas de sobreviv&#234;ncia parecem assumir um declive maior&#44; como consequ&#234;ncia de mortalidade resultante das complica&#231;&#245;es de aparecimento mais tardio&#44; como a DVE e as neoplasias&#44; bem como da deteriora&#231;&#227;o progressiva da fun&#231;&#227;o renal&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">A deteriora&#231;&#227;o da fun&#231;&#227;o renal causada pela toxicidade medicamentosa &#233; uma constante nestes doentes<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;33</span></a>&#46; Os valores de creatinina pr&#233;&#8208;operat&#243;ria baixaram no primeiro m&#234;s ap&#243;s a transplanta&#231;&#227;o&#44; mas subiram progressivamente at&#233; ao final do primeiro ano&#44; ultrapassando os valores iniciais&#46; Na maior parte dos casos os valores tenderam a manter&#8208;se relativamente est&#225;veis nos primeiros cinco anos&#44; mas a partir da&#237; v&#225;rios doentes tiveram uma deteriora&#231;&#227;o significativa da fun&#231;&#227;o renal&#46; Nesta experi&#234;ncia&#44; tr&#234;s doentes foram j&#225; submetidos a transplanta&#231;&#227;o renal e outros dois est&#227;o presentemente submetidos a terap&#234;utica de substitui&#231;&#227;o&#44; aguardando transplanta&#231;&#227;o&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclus&#227;o</span><p id="par0195" class="elsevierStylePara elsevierViewall">O n&#250;mero de doentes &#224; espera de transplante tem vindo a aumentar&#44; ao contr&#225;rio da oferta de dadores&#46; Esta situa&#231;&#227;o torna&#8208;se mais complexa quando se constata um aumento no n&#250;mero de doentes cujo estado cl&#237;nico se agravou fazendo&#8208;os cair para graus de prioridade elevados &#40;<span class="elsevierStyleSmallCaps">II&#8208;V</span>&#41;&#46; Este panorama obriga&#44; por um lado&#44; a for&#231;ar as fronteiras da doa&#231;&#227;o e&#44; por outro&#44; a ponderar de forma respons&#225;vel e pragm&#225;tica a escolha dos candidatos para transplanta&#231;&#227;o&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">De um modo geral&#44; os doentes transplantados derivam grande benef&#237;cio da transplanta&#231;&#227;o card&#237;aca&#44; tanto do ponto de vista da qualidade de vida como na da longevidade&#46; Contudo&#44; um n&#250;mero consider&#225;vel de doentes sofre de complica&#231;&#245;es graves&#44; algumas fatais&#44; que obrigam a cont&#237;nua monitoriza&#231;&#227;o e assist&#234;ncia&#46; Esta &#233; uma atividade intensa&#44; de grande peso nas equipas transplantadoras&#44; que requer&#44; ainda&#44; uma organiza&#231;&#227;o diferente da assist&#234;ncia noutras &#225;reas m&#233;dicas&#46; Deste modo&#44; e porque os resultados est&#227;o muito dependentes da experi&#234;ncia adquirida&#44; a transplanta&#231;&#227;o card&#237;aca&#44; tal como outras&#44; deveria ser reservada a centros com um n&#237;vel razo&#225;vel de atividade&#44; sendo completamente desaconselhada a sua dispers&#227;o&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">No nosso pa&#237;s&#44; as necessidades nesta &#225;rea est&#227;o atualmente razoavelmente satisfeitas&#44; mas o n&#250;mero de centros &#233;&#44; provavelmente&#44; excessivo para a popula&#231;&#227;o assistida&#44; pelo que se recomenda uma reaprecia&#231;&#227;o do problema&#44; de modo a garantir a qualidade da assist&#234;ncia prestada aos doentes com insufici&#234;ncia card&#237;aca terminal e refrat&#225;ria &#224;s terap&#234;uticas convencionais e conservadoras&#46; A atual situa&#231;&#227;o de competi&#231;&#227;o pelos dadores n&#227;o serve os objetivos de uma distribui&#231;&#227;o mais adequada pelos doentes em espera nos v&#225;rios centros transplantadores&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">A diminui&#231;&#227;o do n&#250;mero de dadores que se tem vindo a verificar nos &#250;ltimos anos pode vir a alterar a situa&#231;&#227;o relativamente favor&#225;vel que atingimos na &#250;ltima d&#233;cada ap&#243;s o in&#237;cio do nosso programa de transplanta&#231;&#227;o&#46; No entanto&#44; algumas a&#231;&#245;es de sensibiliza&#231;&#227;o e de reorganiza&#231;&#227;o dos programas de identifica&#231;&#227;o e capta&#231;&#227;o de dadores podem j&#225; estar a surtir efeito&#46; De facto&#44; o ano de 2013 parece ter marcado um ponto de viragem em todas as &#225;reas da transplanta&#231;&#227;o&#46; S&#243; no nosso centro foram transplantados 30 doentes&#44; um n&#250;mero que antes s&#243; havia sido atingido em 2005&#46; No entanto&#44; ainda temos um longo caminho a percorrer at&#233; se atingir um grau de aproveitamento m&#225;ximo das potencialidades existentes&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Responsabilidades &#233;ticas</span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Prote&#231;&#227;o de pessoas e animais</span><p id="par0215" class="elsevierStylePara elsevierViewall">Os autores declaram que para esta investiga&#231;&#227;o n&#227;o se realizaram experi&#234;ncias em seres humanos e&#47;ou animais&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Confidencialidade dos dados</span><p id="par0220" class="elsevierStylePara elsevierViewall">Os autores declaram ter seguido os protocolos do seu centro de trabalho acerca da publica&#231;&#227;o dos dados de pacientes&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Direito &#224; privacidade e consentimento escrito</span><p id="par0225" class="elsevierStylePara elsevierViewall">Os autores declaram ter recebido consentimento escrito dos pacientes e&#47; ou sujeitos mencionados no artigo&#46; O autor para correspond&#234;ncia deve estar na posse deste documento&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflito de interesses</span><p id="par0230" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o e objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analisar a experi&#234;ncia adquirida em dez anos do programa de transplanta&#231;&#227;o card&#237;aca dos Hospitais da Universidade de Coimbra&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">De novembro de 2003 a dezembro de 2013&#44; 258 doentes com idade m&#233;dia de 53&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;7 anos &#40;limites 3&#8208;72 anos&#41; e predomin&#226;ncia do sexo masculino &#40;78&#37;&#41; foram transplantados&#46; Mais de um ter&#231;o dos doentes tinha miocardiopatia isqu&#233;mica &#40;37&#44;2&#37;&#41; e 36&#44;4&#37; idiop&#225;tica&#46; A idade m&#233;dia dos dadores era 34&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;3 anos e 195 eram do sexo masculino &#40;76&#37;&#41;&#44; com disparidade de sexo entre dador e recetor &#40;F&#58;M&#41; em 32&#37; dos casos e disparidade AB0 &#40;grupos n&#227;o id&#234;nticos mas compat&#237;veis&#41; em 18&#37;&#46; A colheita foi feita &#224; dist&#226;ncia em 59&#37; dos casos&#46; Em todos os casos foi utilizada a t&#233;cnica de transplanta&#231;&#227;o total&#44; com anastomose bicava&#44; modificada neste centro&#46; O tempo m&#233;dio de isquemia foi 89&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&#44;4 minutos&#46; Todos os doentes receberam terap&#234;utica de indu&#231;&#227;o&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A mortalidade precoce foi 4&#44;7&#37; &#40;12 doentes&#41;&#44; por fal&#234;ncia do enxerto e acidente vascular cerebral em cinco cada&#44; e por rejei&#231;&#227;o hiperaguda em dois&#46; Treze doentes &#40;5&#37;&#41; necessitaram de ventila&#231;&#227;o prolongada e 25 &#40;11&#44;8&#37;&#41; requereram suporte inotr&#243;pico por mais de 48 horas&#44; sete necessitaram de implanta&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span>&#46; O tempo m&#233;dio de internamento foi de 15&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;3 dias &#40;mediana&#44; 12 dias&#41;&#46; Noventa por cento dos doentes foram mantidos com terap&#234;utica imunossupressora tripla&#44; incluindo ciclosporina&#46; Os restantes receberam tacrolimus&#46; Em 23 doentes foi necess&#225;rio alterar o esquema de imunossupress&#227;o devido a complica&#231;&#245;es renais e&#47;ou neopl&#225;sicas e rejei&#231;&#227;o humoral&#46; Todos os doentes&#44; exceto dois&#44; s&#227;o seguidos no centro cir&#250;rgico&#46; Cinquenta doentes &#40;19&#44;4&#37;&#41; faleceram tardiamente por infe&#231;&#227;o &#40;18 doentes&#41;&#44; neoplasia &#40;dez doentes&#41;&#44; causa vascular &#40;oito doentes&#41;&#44; neuropsiqui&#225;trica &#40;quatro doentes&#41;&#44; card&#237;aca &#40;dois doentes&#41; ou outras &#40;oito doentes&#41;&#46; Quarente e seis doentes &#40;17&#44;8&#37;&#41; tiveram epis&#243;dios de rejei&#231;&#227;o celular &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>R da ISHLT&#41; e oito tiveram rejei&#231;&#227;o humoral &#40;3&#44;1&#37;&#41;&#44; e em 22 h&#225; evid&#234;ncia de doen&#231;a vascular enxerto &#40;8&#44;5&#37;&#41;&#46; A sobreviv&#234;ncia atuarial a um&#44; cinco&#44; e oito anos foi de 87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#37;&#44; 78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#37; e 69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#37;&#44; respetivamente&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#227;o</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Nesta s&#233;rie de dez anos obtiveram&#8208;se resultados equivalentes ou superiores aos referidos em experi&#234;ncias mais vastas e mais longas&#44; progressivamente melhorados pela introdu&#231;&#227;o de fatores suscitados pela pr&#243;pria experi&#234;ncia&#46; Com este programa foi poss&#237;vel elevar e manter a taxa de transplanta&#231;&#227;o card&#237;aca em valores acima da m&#233;dia europeia&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introduction and Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To analyze the experience gained in 10 years of the heart transplantation program of the University Hospital of Coimbra&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Between November 2003 and December 2013&#44; 258 patients with a mean age of 53&#46;0&#177;12&#46;7 years &#40;3&#8208;72 years&#41; and predominantly male &#40;78&#37;&#41; were transplanted&#46; Over a third of patients had ischemic &#40;37&#46;2&#37;&#41; and 36&#46;4&#37; idiopathic cardiomyopathy&#46; The mean age of donors was 34&#46;4&#177;1&#46;3 years and 195 were male &#40;76&#37;&#41;&#44; with gender difference between donor and recipient in 32&#37; of cases and ABO disparity &#40;non&#8208;identical groups but compatible&#41; in 18&#37;&#46; Harvest was distant in 59&#37; of cases&#46; In all cases total heart transplantation with bicaval anastomoses&#44; modified at this center&#44; was used&#46; Mean ischemia time was 89&#46;7&#177;35&#46;4 minutes&#46; All patients received induction therapy&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Early mortality was 4&#46;7&#37; &#40;12 patients&#41; from graft failure and stroke in five patients each&#44; and hyperacute rejection in two&#46; Thirteen patients &#40;5&#37;&#41; required prolonged ventilation&#44; 25 &#40;11&#46;8&#37;&#41; required inotropic support for more than 48 hours&#44; and seven required pacemaker implantation&#46; Mean hospital stay was 15&#46;8&#177;15&#46;3 days &#40;median 12 days&#41;&#46; Ninety percent of patients were maintained on triple immunosuppressive therapy including cyclosporine&#44; the remainder receiving tacrolimus&#46; In 23 patients it was necessary to change the immunosuppression protocol due to renal and&#47;or neoplastic complications and humoral rejection&#46; All but two patients have been followed in the Surgical Center&#46; Fifty patients &#40;19&#46;4&#37;&#41; subsequently died from infection &#40;18&#41;&#44; cancer &#40;10&#41;&#44; vascular &#40;eight&#41;&#44; neuropsychiatric &#40;four&#41;&#44; cardiac &#40;two&#41; or other causes &#40;eight&#41;&#46; Forty&#8208;six patients &#40;17&#46;8&#37;&#41; had episodes of cellular rejection &#40;&#62;2 R on the ISHLT classification&#41;&#44; eight had humoral rejection &#40;3&#46;1&#37;&#41;&#44; and 22 have evidence of graft vascular disease &#40;8&#46;5&#37;&#41;&#46; Actuarial survival at 1&#44; 5&#44; and 8 years was 87&#177;2&#37;&#44; 78&#177;3&#37; and 69&#177;4&#37;&#44; respectively&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">This 10&#8208;year series yielded results equivalent or superior to those of centers with wider and longer experience&#44; and have progressively improved following the introduction of changes prompted by experience&#46; This program has made it possible to raise and maintain the rate of heart transplantation to values above the European average&#46;</p>"
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                  \t\t\t\t">37&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tabagismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hist&#243;ria familiar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reopera&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#170; vascular perif&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#170; carot&#237;dea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fra&#231;&#227;o de eje&#231;&#227;o do VE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#205;ndice card&#237;aco &#40;L&#47;m<span class="elsevierStyleSup">2</span>&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gradiente TP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resist&#234;ncia RVP &#40;uW&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VO<span class="elsevierStyleInf">2</span> max &#40;ml&#47;kg&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemoglobina &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Plaquetas &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">211<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LDH &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">338<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>686&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GOT &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>286&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GPT &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GGT &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>319&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bilirrubina &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFG &#40;ml&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Creatinina &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "imagenFichero" => array:1 [
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas dos doentes transplantados</p>"
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      9 => array:7 [
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                  \t\t\t\t" style="border-bottom: 2px solid black">Dador&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Recetor M com dador F&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Grupo sangu&#237;neo</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>B&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Assist&#234;ncia ventilat&#243;ria &#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">1 semana</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas dos dadores</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Cirurgia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">258&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Valvuloplastia mitral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anuloplastia tric&#250;spide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Revasculariza&#231;&#227;o DA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transplante renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de isquemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de CEC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>45&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">T&#46; ventila&#231;&#227;o mec&#226;nica &#40;horas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inotr&#243;picos &#62;<span class="elsevierStyleHsp" style=""></span>48 horas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Assist&#234;ncia mec&#226;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Revis&#227;o da hemostase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Derrame peric&#225;rdico &#40;30<span class="elsevierStyleHsp" style=""></span>d&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">NODAT&#58; diabetes de novo &#40;<span class="elsevierStyleItalic">new onset diabetes after transplantation</span>&#41;&#46;</p>"
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            0 => array:2 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Seguimento&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">258&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">NODAT antes de um ano</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Infec&#231;&#245;es</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pneumonia antes dos seis meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">9&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fungos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CMV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pielonefrite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">6&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">7&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pr&#243;stata&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gastrointestinal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sangue&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cerebral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mama&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemodi&#225;lise&#47;transplante renal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Implanta&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span>&nbsp;\t\t\t\t\t\t\n
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        ]
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Morte precoce &#8804;<span class="elsevierStyleHsp" style=""></span>6M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vascular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neopl&#225;sica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Card&#237;aca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neuropsiqui&#225;trica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outras&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleSmallCaps">i</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Choque cardiog&#233;nico com assist&#234;ncia ventricular &#40;CEC&#44; ECMO&#44; VAD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleSmallCaps">iii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Choque cardiog&#233;nico com bal&#227;o intra&#8208;a&#243;rtico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Choque cardiog&#233;nico e suporte ventilat&#243;rio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleSmallCaps">v</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Urgente</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Internado com inotr&#243;picos ou arritmias malignas ou hemodi&#225;lise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSmallCaps">vi</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Internado na UCI para tratamento da ICC&#44; duas ou mais vezes&#44; nos &#250;ltimos seis meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSmallCaps">vii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o urgente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Tabela de graus de prioridade para transplanta&#231;&#227;o em uso no nosso pa&#237;s</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliografia"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:33 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Registry of the International Society for Heart and Lung Transplantation&#58; Thirtieth Official Adult Heart Transplant Report&#8208;2013"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46;H&#46; Lund"
                            1 => "L&#46;B&#46; Edwards"
                            2 => "A&#46;Y&#46; Kucheryavaya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.healun.2013.08.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Heart Lung Transplant&#46;"
                        "fecha" => "2013"
                        "volumen" => "32"
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Uma década de transplantação cardíaca em Coimbra. O valor da experiência
A decade of cardiac transplantation in Coimbra: The value of experience
David Prieto, Pedro Correia, Manuel Batista, Emília Sola, Fátima Franco, Susana Costa, Pedro E. Antunes, Manuel J. Antunes
Autor para correspondência
antunes.cct.chuc@mail.telepac.pt

Autor para correspondência.
Centro de Cirurgia Cardiotorácica e Transplantação de Órgãos Torácicos, Centro Hospitalar e Universitário e Faculdade de Medicina de Coimbra, Coimbra, Portugal
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seguido da etiologia idiop&#225;tica &#40;36&#44;4&#37;&#41; e 28&#44;7&#37; tinham tido cirurgia card&#237;aca pr&#233;via &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figura 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">O &#237;ndice de massa corporal m&#233;dio da popula&#231;&#227;o &#224; data da transplanta&#231;&#227;o era de 23&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;4<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; Quase um ter&#231;o dos doentes eram diab&#233;ticos &#40;27&#44;9&#37;&#41; e a uma percentagem significativa estavam associadas a hipertens&#227;o arterial &#40;37&#44;6&#37;&#41;&#44; a dislipidemia &#40;46&#44;9&#37;&#41; e o tabagismo &#40;14&#44;0&#37;&#41;&#46; Ainda no campo das comorbilidades&#44; registou&#8208;se doen&#231;a vascular perif&#233;rica em 32&#44;6&#37; dos doentes e doen&#231;a carot&#237;dea em 5&#44;4&#37;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A m&#233;dia da fra&#231;&#227;o de eje&#231;&#227;o do ventr&#237;culo esquerdo era 20&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;9&#37;&#46; A press&#227;o sist&#243;lica da art&#233;ria pulmonar era 48&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;3<span class="elsevierStyleHsp" style=""></span>mmHg&#44; as resist&#234;ncias vasculares pulmonares 3&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2 unidades Wood e o gradiente transpulmonar 9&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;6<span class="elsevierStyleHsp" style=""></span>mmHg&#46; A creatinina basal era 1&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;6 &#40;0&#44;5&#8208;5&#44;6&#41; mg&#47;dl&#44; a hemoglobina 12&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;1<span class="elsevierStyleHsp" style=""></span>g&#47;l e a desidrogenase l&#225;ctica 338<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>686<span class="elsevierStyleHsp" style=""></span>U&#47;l&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Dadores</span><p id="par0075" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas dos dadores est&#227;o detalhadas na <a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#46; A idade m&#233;dia era 34&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;3 anos&#44; o sexo masculino &#40;75&#44;6&#37;&#41; e o grupo sangu&#237;neo 0 &#40;53&#44;5&#37;&#41; foram predominantes&#46; A causa de morte foi maioritariamente traum&#225;tica &#40;57&#44;8&#37;&#41;&#44; seguida de AVC hemorr&#225;gico &#40;32&#44;9&#37;&#41;&#44; mas com uma tend&#234;ncia crescente no n&#250;mero de dadores v&#237;timas de acidente cerebrovascular&#44; que representam quase 35&#37; da totalidade da s&#233;rie&#44; tendo&#8208;se atualmente j&#225; invertido a raz&#227;o causa traum&#225;tica&#47;causa neurol&#243;gica prim&#225;ria&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Um n&#250;mero significativo de dadores estava com apoio ventilat&#243;rio ou inotr&#243;pico prolongado &#40;mais de uma semana&#59; 12&#44;4 e 4&#44;3&#37;&#44; respetivamente&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A maioria das colheitas foi realizada nos hospitais de fora de Coimbra &#40;58&#44;5&#37;&#41; e a principal origem &#224; dist&#226;ncia foi a regi&#227;o Norte&#44; que contribui com 29&#44;8&#37; dos dadores&#44; tendo sido feita uma colheita na Regi&#227;o Aut&#243;noma dos A&#231;ores &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figura 4</a>&#41;&#46; A m&#233;dia da dist&#226;ncia de colheita foi de 97&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>100&#44;9<span class="elsevierStyleHsp" style=""></span>km&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Cirurgia e unidade de cuidados intensivos</span><p id="par0090" class="elsevierStylePara elsevierViewall">O tempo m&#233;dio de isquemia foi 89&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&#44;4 minutos&#44; sendo inferior a 45 minutos em todos os casos com colheita local&#46; O tempo de circula&#231;&#227;o extracorp&#243;rea foi 100&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>45&#44;1 minutos&#46; Durante a transplanta&#231;&#227;o foi associada outra cirurgia no cora&#231;&#227;o do dador em 16 casos &#40;6&#44;2&#37;&#41;&#46; Assim&#44; foi efetuada valvuloplastia mitral em 12 doentes &#40;4&#44;7&#37;&#41;&#44; valvuloplastia tric&#250;spide em dois &#40;0&#44;8&#37;&#59; isolada ou associada &#224; mitral num doente cada&#41; e revasculariza&#231;&#227;o da art&#233;ria descendente anterior em dois doentes &#40;0&#44;8&#37;&#41;&#46; Num outro doente foi necess&#225;rio proceder &#224; substitui&#231;&#227;o da aorta ascendente&#46; Em quatro doentes &#40;1&#44;6&#37;&#41;&#44; que aguardavam transplanta&#231;&#227;o renal&#44; esta foi efetuada simultaneamente com a card&#237;aca &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">A maioria dos doentes foram extubados cerca de 12 horas ap&#243;s a interven&#231;&#227;o e o tempo m&#233;dio de ventila&#231;&#227;o mec&#226;nica foi de 20&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#44;8 horas&#46; Disfun&#231;&#227;o ventricular p&#243;s&#8208;transplante&#44; requerendo suporte inotr&#243;pico prolongado&#44; afetou 11&#44;8&#37; dos doentes e em 13 destes &#40;5&#44;0&#37;&#41; o suporte inotr&#243;pico revelou&#8208;se insuficiente&#44; necessitando de suporte mec&#226;nico por bal&#227;o intra&#8208;a&#243;rtico&#44; assist&#234;ncia ventricular esquerda ou ECMO&#44; segundo as situa&#231;&#245;es&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Rejei&#231;&#227;o e complica&#231;&#245;es associadas</span><p id="par0100" class="elsevierStylePara elsevierViewall">Noventa por cento dos doentes foram mantidos com terap&#234;utica imunossupressora tripla&#44; incluindo ciclosporina&#46; Os restantes receberam tacrolimus em v&#225;rias combina&#231;&#245;es&#46; Em 23 doentes foi necess&#225;rio alterar o esquema de imunossupress&#227;o inicial devido a complica&#231;&#245;es renais e&#47;ou neopl&#225;sicas e rejei&#231;&#227;o humoral&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Regularmente&#44; foram realizadas bi&#243;psias endomioc&#225;rdicas&#44; observa&#231;&#227;o ecocardiogr&#225;fica e avalia&#231;&#227;o angiogr&#225;fica para diagn&#243;stico de rejei&#231;&#227;o&#46; Quarenta e seis doentes &#40;17&#44;8&#37;&#41; sofreram 60 epis&#243;dios de rejei&#231;&#227;o &#8805;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>R da escala da ISHLT&#44; requerendo terap&#234;utica de pulso com corticosteroides e&#47;ou ajustamento das doses de imunossupressores&#46; Cento e sete doentes &#40;41&#44;5&#37;&#41; n&#227;o tiveram nenhum epis&#243;dio de rejei&#231;&#227;o celular &#40;0<span class="elsevierStyleHsp" style=""></span>R&#41;&#46; Os restantes tiveram pelo menos um epis&#243;dio de rejei&#231;&#227;o ligeira &#40;1<span class="elsevierStyleHsp" style=""></span>R&#41; que n&#227;o necessitou de tratamento&#46; A maior incid&#234;ncia de rejei&#231;&#227;o &#8805;<span class="elsevierStyleHsp" style=""></span>2R aconteceu durante o primeiro ano p&#243;s&#8208;transplanta&#231;&#227;o&#44; com uma tend&#234;ncia a diminuir progressivamente nos anos subsequentes&#46; A sobreviv&#234;ncia livre de rejei&#231;&#227;o 2<span class="elsevierStyleHsp" style=""></span>R ou superior aos seis meses e a um e cinco anos foi de 86&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2&#37;&#44; 82&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;5&#37; e 80&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;7&#37;&#44; respetivamente &#40;<a class="elsevierStyleCrossRef" href="#fig0025">figura 5</a>&#41;&#46; Em 8 doentes &#40;3&#44;1&#37;&#41; foi observada rejei&#231;&#227;o humoral e doen&#231;a vascular do enxerto &#40;DVE&#59; diagnosticada por angiografia coron&#225;ria&#44; como algum grau de irregularidade <span class="elsevierStyleItalic">de novo</span> nos grandes vasos coron&#225;rios ou dos seus ramos principais&#44; ainda que a les&#227;o seja inferior a 50&#37;&#41; foi diagnosticada em 22 &#40;8&#44;5&#37;&#41;&#44; sendo ainda de grau ligeiro na maior parte dos casos&#46; A sobreviv&#234;ncia livre de DVE aos dez anos foi 80&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;5&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Figura 6</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Outra morbilidade</span><p id="par0110" class="elsevierStylePara elsevierViewall">Todos os doentes&#44; exceto dois&#44; foram seguidos no centro cir&#250;rgico&#44; ainda assim&#44; com informa&#231;&#227;o completa de todos&#46; O tempo de seguimento m&#233;dio foi de 4&#44;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;05 anos&#46; Trinta e tr&#234;s doentes &#40;12&#44;8&#37;&#41; desenvolveram diabetes <span class="elsevierStyleItalic">de novo</span> &#40;<span class="elsevierStyleItalic">new onset diabetes after transplantation</span> &#91;NODAT&#93;&#41;&#44; 29 dos quais no primeiro ano p&#243;s&#8208;transplanta&#231;&#227;o&#46; Infe&#231;&#245;es graves durante os primeiros 12 meses ap&#243;s a transplanta&#231;&#227;o&#44; que necessitaram de internamento e tratamento antibi&#243;tico endovenoso dirigido ocorreram em 43 doentes &#40;16&#44;7&#37;&#41;&#46; As pneumonias antes dos seis meses foram o principal tipo de infe&#231;&#227;o registado &#40;9&#44;7&#37; dos doentes&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Geralmente observou&#8208;se uma recupera&#231;&#227;o da fun&#231;&#227;o renal nos primeiros meses p&#243;s&#8208;transplante&#44; melhoria que persistiu durante o primeiro ano&#46; Apenas cinco doentes &#40;1&#44;9&#37;&#41; necessitaram de terapia de substitui&#231;&#227;o renal precoce &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>m&#234;s p&#243;s&#8208;transplante&#41;&#46; Por&#233;m&#44; a partir dos 12 meses ap&#243;s a opera&#231;&#227;o foi not&#243;ria uma deteriora&#231;&#227;o progressiva e persistente da fun&#231;&#227;o renal&#44; como consequ&#234;ncia da terap&#234;utica imunossupressora e antibi&#243;tica &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Tabela 5</a>&#41;&#46; Tr&#234;s doentes foram entretanto submetidos a transplanta&#231;&#227;o renal e outros dois encontram&#8208;se sujeitos a terap&#234;utica de substitui&#231;&#227;o e aguardam transplanta&#231;&#227;o&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Mortalidade e sobrevida</span><p id="par0120" class="elsevierStylePara elsevierViewall">Doze doentes &#40;4&#44;7&#37;&#41; faleceram nos primeiros 30 dias ou durante o internamento&#44; por fal&#234;ncia do enxerto e acidente vascular cerebral em cinco cada&#44; e por rejei&#231;&#227;o hiperaguda em dois&#44; e outros 50 faleceram durante o <span class="elsevierStyleItalic">follow&#8208;up</span>&#44; para uma mortalidade global de 24&#44;0&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabela 6</a>&#41;&#46; As principais causas de morte tardia foram as complica&#231;&#245;es infeciosas &#40;7&#44;0&#37;&#41;&#44; seguidas das vasculares &#40;5&#44;0&#37;&#41;&#44; neopl&#225;sicas &#40;3&#44;9&#37;&#41; e card&#237;acas &#40;3&#44;5&#37;&#41;&#46; A sobreviv&#234;ncia global foi de 87&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;9&#37; a um ano&#44; 77&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;8&#37; aos cinco anos&#44; 68&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;8&#37; aos oito anos e 65&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;4&#37; aos dez anos &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Figura 7</a>&#41;&#46; N&#227;o se observou diferen&#231;a significativa na sobreviv&#234;ncia entre doentes dos dois sexos &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Figura 8</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discuss&#227;o</span><p id="par0125" class="elsevierStylePara elsevierViewall">A transplanta&#231;&#227;o card&#237;aca tem&#8208;se afirmado como uma modalidade de tratamento eficaz da insufici&#234;ncia card&#237;aca terminal e refrat&#225;ria&#46; Contudo&#44; esta interven&#231;&#227;o est&#225; associada a um conjunto de complica&#231;&#245;es graves&#44; algumas potencialmente fatais&#44; que fazem com este seja efetivamente um procedimento paliativo a m&#233;dio e longo prazo&#46; Na atualidade&#44; a sobreviv&#234;ncia a dez anos &#233; de cerca de 50&#8208;60&#37; e a sobrevida m&#233;dia dos sobreviventes &#224; transplanta&#231;&#227;o &#233; de 12&#8208;13 anos<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">O programa de transplanta&#231;&#227;o card&#237;aca do CHUC foi iniciado em novembro de 2003&#46; Os dados dos doentes transplantados nos primeiros cinco anos de atividade foram apresentados e analisados em relat&#243;rio ent&#227;o publicado na RPC<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Dele constava tamb&#233;m uma resenha hist&#243;rica&#44; bem como outras considera&#231;&#245;es sobre a atividade de transplanta&#231;&#227;o card&#237;aca em Portugal e seu contexto europeu&#44; de que recomendamos a leitura&#44; pelo que n&#227;o abordaremos aqui esse assunto&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">No presente trabalho analisamos os resultados obtidos em 258 doentes transplantados na primeira d&#233;cada completa deste programa&#46; Foram&#44; pois&#44; realizados uma m&#233;dia de 25 transplantes anualmente&#44; constituindo o cumprimento global dos objetivos ent&#227;o definidos&#44; considerando&#8208;se esta elevada atividade transplantadora vantajosa&#44; certamente com impacto nos resultados p&#243;s&#8208;transplanta&#231;&#227;o&#44; sobretudo nos casos da maior urg&#234;ncia ou de maior risco&#46; Trata&#8208;se&#44; efetivamente&#44; da maior experi&#234;ncia acumulada por qualquer centro nacional&#46; A rela&#231;&#227;o entre a qualidade dos resultados e o volume da atividade de transplanta&#231;&#227;o est&#225; bem estabelecida<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#8211;12</span></a>&#46; Por outro lado&#44; a experi&#234;ncia assim adquirida tem permitido o alargamento das indica&#231;&#245;es&#44; a explora&#231;&#227;o de alternativas t&#233;cnicas e o aproveitamento de dadores marginais&#44; deste modo estendendo as fronteiras da doa&#231;&#227;o&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Tem&#8208;se assistido a um aumento progressivo n&#227;o s&#243; da idade m&#233;dia dos recetores como do n&#250;mero de doentes que no momento da transplanta&#231;&#227;o estavam internados por insufici&#234;ncia card&#237;aca descompensada&#44; necessitando de apoio farmacol&#243;gico intensivo e&#44; por vezes&#44; de apoio mec&#226;nico cardiocirculat&#243;rio e ventilat&#243;rio&#46; O resultado &#233; um crescente n&#250;mero de recetores em pior estado cl&#237;nico&#44; situa&#231;&#227;o que n&#227;o s&#243; eleva o grau de urg&#234;ncia para a transplanta&#231;&#227;o&#44; mas tamb&#233;m tende a aumentar o risco de insucesso&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">A escala de prioridade para a transplanta&#231;&#227;o card&#237;aca utilizada no nosso pa&#237;s &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">Tabela 7</a>&#41;&#44; inicialmente implementada pela Organiza&#231;&#227;o Portuguesa de Transplanta&#231;&#227;o &#40;OPT&#41;&#44; subsequentemente pela ASST e recentemente pelo IPST&#44; baseada na defini&#231;&#227;o da situa&#231;&#227;o cl&#237;nica do candidato &#224; data da inscri&#231;&#227;o na lista de espera&#44; tendo como consequ&#234;ncia que o doente mais cr&#237;tico passe &#224; frente de outros cuja situa&#231;&#227;o cl&#237;nica lhes permita aguardar mais tempo&#44; tamb&#233;m contribui para esta situa&#231;&#227;o&#46; Contudo&#44; esta escala e escalas similares utilizadas noutros pa&#237;ses n&#227;o esclarecem nem quantificam o perfil de risco dos doentes&#46; &#201; sabido que os resultados imediatos da transplanta&#231;&#227;o s&#227;o muito sens&#237;veis &#224; qualidade dos &#243;rg&#227;os do dador e ao estado cl&#237;nico do candidato<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a>&#46; Estes s&#227;o os principais fatores respons&#225;veis por alguns resultados insatisfat&#243;rios na fase imediata &#224; transplanta&#231;&#227;o<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Pelo contr&#225;rio&#44; os doentes em mais baixo grau de prioridade beneficiam do ambiente domiciliar e acompanhamento familiar&#44; e de uma maior mobilidade&#44; factos que contribuem para uma otimiza&#231;&#227;o do estado psicol&#243;gico e f&#237;sico&#44; e para uma redu&#231;&#227;o dr&#225;stica da incid&#234;ncia e gravidade das infe&#231;&#245;es nosocomiais p&#243;s&#8208;transplanta&#231;&#227;o&#46; Indubitavelmente&#44; estes s&#227;o aspetos que ajudam a diminuir o potencial de risco do doente<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; Mas Lietz e Mokadam demonstraram que durante o tempo de espera para transplanta&#231;&#227;o h&#225; uma deteriora&#231;&#227;o da condi&#231;&#227;o cl&#237;nica em 32&#8208;48&#37; dos pacientes em <span class="elsevierStyleItalic">status</span> 2<span class="elsevierStyleHsp" style=""></span>da <span class="elsevierStyleItalic">United Network for Organ Sharing</span> &#40;UNOS&#44; organiza&#231;&#227;o privada que coordena o sistema de transplanta&#231;&#227;o de &#243;rg&#227;os americano&#41;&#44; equivalente ao nosso grau de prioridade <span class="elsevierStyleSmallCaps">VI&#8208;VII</span><a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;18</span></a>&#46; Os doentes deste grupo chegam&#44; pois&#44; &#224; transplanta&#231;&#227;o em situa&#231;&#227;o cl&#237;nica adversa com estados sintom&#225;ticos de instabilidade intermitente&#44; descompensa&#231;&#245;es recorrentes e frequentes ou sintomas cr&#243;nicos persistentes frequentemente associados a uma elevada morbilidade<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Um outro grupo de risco &#233; o dos doentes diab&#233;ticos&#46; Como seria de esperar nesta popula&#231;&#227;o&#44; mais de um quarto dos doentes &#40;27&#44;9&#37;&#41; eram diab&#233;ticos na altura da transplanta&#231;&#227;o&#46; Por outro lado&#44; 29 doentes &#40;11&#44;27&#37;&#41; adquiriram diabetes <span class="elsevierStyleItalic">de novo</span> no primeiro ano ap&#243;s a transplanta&#231;&#227;o&#46; A rela&#231;&#227;o entre a imunossupress&#227;o&#44; especialmente os corticosteroides e o tacrolimus&#44; e o agravamento ou aparecimento <span class="elsevierStyleItalic">de novo</span> da diabetes <span class="elsevierStyleItalic">melitus</span> &#233; bem conhecida e a diabetes &#233; um dos mais importantes fatores de risco para o desenvolvimento da arteriosclerose que envolve tanto a circula&#231;&#227;o coron&#225;ria como a sist&#233;mica<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46; Em trabalhos anteriormente publicados n&#227;o encontr&#225;mos diferen&#231;as significativas&#44; tanto no que respeita &#224; morbilidade como no que concerne &#224; mortalidade&#44; entre os doentes diab&#233;ticos e os n&#227;o diab&#233;ticos&#44; at&#233; cinco anos ap&#243;s a transplanta&#231;&#227;o<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Contudo&#44; essa situa&#231;&#227;o parece modificar&#8208;se a mais longo prazo<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">A diabetes &#233; tamb&#233;m importante na g&#233;nese e propaga&#231;&#227;o das infe&#231;&#245;es&#46; Mais do que a rejei&#231;&#227;o aguda&#44; que hoje raramente &#233; mortal&#44; as infe&#231;&#245;es s&#227;o atualmente a principal causa de morbilidade e mortalidade tardia ap&#243;s a transplanta&#231;&#227;o&#46; Nesta s&#233;rie&#44; 43 doentes &#40;16&#44;7&#37;&#41; sofreram de infe&#231;&#245;es graves durante o primeiro ano&#44; na maior parte dos casos pneumonias&#44; requerendo internamento e tratamento antibi&#243;tico endovenoso&#44; e foram a principal causa de mortalidade tardia&#44; seguidas das causas vasculares e neopl&#225;sicas&#46; &#201; prov&#225;vel que tal se possa atribuir a excesso de terap&#234;utica imunossupressora&#44; havendo j&#225; centros com excelentes resultados com protocolos imunossupressores muito atenuados em rela&#231;&#227;o aos protocolos cl&#225;ssicos<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; No nosso centro o protocolo inicial foi recentemente modificado&#44; sendo ainda cedo para avaliar o impacto nas principais complica&#231;&#245;es ligadas &#224; transplanta&#231;&#227;o&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Frequentemente relacionada com a rejei&#231;&#227;o cr&#243;nica &#233; a DVE que&#44; contudo&#44; continua a ser uma entidade de g&#233;nese e comportamento largamente desconhecidos&#46; Esta complica&#231;&#227;o aparece tardiamente&#44; geralmente a partir dos cinco anos&#44; e conduz a disfun&#231;&#227;o grave progressiva do enxerto&#44; at&#233; &#224; perda total&#44; com a morte do doente&#44; a menos que seja retransplantado&#44; o que nesta &#225;rea &#233; uma raridade<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; Estranhamente&#44; nesta s&#233;rie&#44; a maior parte dos casos de DVE foram diagnosticados nos primeiros tr&#234;s anos ap&#243;s a transplanta&#231;&#227;o&#46; No entanto&#44; quando diagnosticada precocemente&#44; a evolu&#231;&#227;o da DVE pode ser significativamente atenuada pela altera&#231;&#227;o do regime imunossupressor&#44; especialmente com a introdu&#231;&#227;o dos inibidores de mTOR &#40;sirolimus e everolimus&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Num esfor&#231;o para aumentar o n&#250;mero de dadores&#44; tem&#8208;se vindo progressivamente a aumentar o limite de idade&#46; No entanto&#44; a utiliza&#231;&#227;o de dadores mais velhos n&#227;o parece ser t&#227;o relevante como seria de esperar e noutro estudo baseado nesta nossa experi&#234;ncia demonstr&#225;mos id&#234;ntica sobreviv&#234;ncia entre os recipientes de cora&#231;&#245;es de dadores mais idosos&#44; mesmo em recipientes jovens&#44; pelo que a idade dos dadores&#44; pelo menos at&#233; aos 60 anos&#44; n&#227;o parece ser fator limitativo<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;27</span></a>&#46; Recomenda&#8208;se&#44; contudo&#44; que estes cora&#231;&#245;es n&#227;o sejam submetidos a tempos de isquemia prolongados<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; Por isso&#44; nestas condi&#231;&#245;es temos privilegiado dadores referenciados por institui&#231;&#245;es mais pr&#243;ximas do nosso centro&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">A utiliza&#231;&#227;o de cora&#231;&#245;es com ligeiras anomalias estruturais&#44; mas pass&#237;veis de corre&#231;&#227;o&#44; enquadra&#8208;se tamb&#233;m no esfor&#231;o para aumentar o aproveitamento de dadores&#58; 12 doentes receberam cora&#231;&#245;es com graus ligeiros a moderados de doen&#231;a mitral&#44; conhecida antes da colheita em todos menos um&#44; que foi corrigida antes da implanta&#231;&#227;o&#44; e dois doentes receberam uma anuloplastia tric&#250;spide&#46; Finalmente&#44; dois doentes foram submetidos a revasculariza&#231;&#227;o da art&#233;ria descendente anterior&#44; num deles utilizando a art&#233;ria mam&#225;ria usada na interven&#231;&#227;o pr&#233;via de revasculariza&#231;&#227;o coron&#225;ria&#46; Alguns destes casos foram alvo de publica&#231;&#245;es anteriores<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;30</span></a>&#46; At&#233; ao momento&#44; todos os doentes est&#227;o bem&#44; sem complica&#231;&#245;es relacionadas com estes procedimentos&#44; com exce&#231;&#227;o de um que faleceu algumas semanas p&#243;s&#8208;transplanta&#231;&#227;o por AVC&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Em 17&#37; dos nossos casos verificou&#8208;se uma discrep&#226;ncia de sexo &#40;dador feminino em recetor masculino&#41;&#46; Esta discrep&#226;ncia tem sido frequentemente associada a resultados inferiores<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46; No entanto&#44; nesta s&#233;rie n&#227;o foi observada diferen&#231;a significativa da incid&#234;ncia de complica&#231;&#245;es e mortalidade nos casos de discrep&#226;ncia de sexo&#44; quando comparados com os doentes sem discrep&#226;ncia&#44; pelo que continua&#44; neste programa&#44; a n&#227;o ser causa de rejei&#231;&#227;o de dadores&#44; desde que observadas outras regras de sele&#231;&#227;o&#44; como uma adequada correla&#231;&#227;o morfol&#243;gica &#40;peso e IMC&#41;&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">A sobrevida dos doentes transplantados foi de 87&#37; no primeiro ano&#44; 78&#37; aos cinco anos e 65&#37; aos dez anos&#44; o que se compara favoravelmente com os resultados de outras s&#233;ries publicadas&#44; especialmente do registo de mais de 100 000 casos da <span class="elsevierStyleItalic">International Society for Heart and Lung Transplantation</span> &#40;ISHLT&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; havendo que ter em conta&#44; no entanto&#44; o componente hist&#243;rico daquele registo&#46; &#201;&#44; talvez&#44; ainda cedo para daqui serem derivadas conclus&#245;es&#44; uma vez que a partir da primeira d&#233;cada as curvas de sobreviv&#234;ncia parecem assumir um declive maior&#44; como consequ&#234;ncia de mortalidade resultante das complica&#231;&#245;es de aparecimento mais tardio&#44; como a DVE e as neoplasias&#44; bem como da deteriora&#231;&#227;o progressiva da fun&#231;&#227;o renal&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">A deteriora&#231;&#227;o da fun&#231;&#227;o renal causada pela toxicidade medicamentosa &#233; uma constante nestes doentes<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;33</span></a>&#46; Os valores de creatinina pr&#233;&#8208;operat&#243;ria baixaram no primeiro m&#234;s ap&#243;s a transplanta&#231;&#227;o&#44; mas subiram progressivamente at&#233; ao final do primeiro ano&#44; ultrapassando os valores iniciais&#46; Na maior parte dos casos os valores tenderam a manter&#8208;se relativamente est&#225;veis nos primeiros cinco anos&#44; mas a partir da&#237; v&#225;rios doentes tiveram uma deteriora&#231;&#227;o significativa da fun&#231;&#227;o renal&#46; Nesta experi&#234;ncia&#44; tr&#234;s doentes foram j&#225; submetidos a transplanta&#231;&#227;o renal e outros dois est&#227;o presentemente submetidos a terap&#234;utica de substitui&#231;&#227;o&#44; aguardando transplanta&#231;&#227;o&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclus&#227;o</span><p id="par0195" class="elsevierStylePara elsevierViewall">O n&#250;mero de doentes &#224; espera de transplante tem vindo a aumentar&#44; ao contr&#225;rio da oferta de dadores&#46; Esta situa&#231;&#227;o torna&#8208;se mais complexa quando se constata um aumento no n&#250;mero de doentes cujo estado cl&#237;nico se agravou fazendo&#8208;os cair para graus de prioridade elevados &#40;<span class="elsevierStyleSmallCaps">II&#8208;V</span>&#41;&#46; Este panorama obriga&#44; por um lado&#44; a for&#231;ar as fronteiras da doa&#231;&#227;o e&#44; por outro&#44; a ponderar de forma respons&#225;vel e pragm&#225;tica a escolha dos candidatos para transplanta&#231;&#227;o&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">De um modo geral&#44; os doentes transplantados derivam grande benef&#237;cio da transplanta&#231;&#227;o card&#237;aca&#44; tanto do ponto de vista da qualidade de vida como na da longevidade&#46; Contudo&#44; um n&#250;mero consider&#225;vel de doentes sofre de complica&#231;&#245;es graves&#44; algumas fatais&#44; que obrigam a cont&#237;nua monitoriza&#231;&#227;o e assist&#234;ncia&#46; Esta &#233; uma atividade intensa&#44; de grande peso nas equipas transplantadoras&#44; que requer&#44; ainda&#44; uma organiza&#231;&#227;o diferente da assist&#234;ncia noutras &#225;reas m&#233;dicas&#46; Deste modo&#44; e porque os resultados est&#227;o muito dependentes da experi&#234;ncia adquirida&#44; a transplanta&#231;&#227;o card&#237;aca&#44; tal como outras&#44; deveria ser reservada a centros com um n&#237;vel razo&#225;vel de atividade&#44; sendo completamente desaconselhada a sua dispers&#227;o&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">No nosso pa&#237;s&#44; as necessidades nesta &#225;rea est&#227;o atualmente razoavelmente satisfeitas&#44; mas o n&#250;mero de centros &#233;&#44; provavelmente&#44; excessivo para a popula&#231;&#227;o assistida&#44; pelo que se recomenda uma reaprecia&#231;&#227;o do problema&#44; de modo a garantir a qualidade da assist&#234;ncia prestada aos doentes com insufici&#234;ncia card&#237;aca terminal e refrat&#225;ria &#224;s terap&#234;uticas convencionais e conservadoras&#46; A atual situa&#231;&#227;o de competi&#231;&#227;o pelos dadores n&#227;o serve os objetivos de uma distribui&#231;&#227;o mais adequada pelos doentes em espera nos v&#225;rios centros transplantadores&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">A diminui&#231;&#227;o do n&#250;mero de dadores que se tem vindo a verificar nos &#250;ltimos anos pode vir a alterar a situa&#231;&#227;o relativamente favor&#225;vel que atingimos na &#250;ltima d&#233;cada ap&#243;s o in&#237;cio do nosso programa de transplanta&#231;&#227;o&#46; No entanto&#44; algumas a&#231;&#245;es de sensibiliza&#231;&#227;o e de reorganiza&#231;&#227;o dos programas de identifica&#231;&#227;o e capta&#231;&#227;o de dadores podem j&#225; estar a surtir efeito&#46; De facto&#44; o ano de 2013 parece ter marcado um ponto de viragem em todas as &#225;reas da transplanta&#231;&#227;o&#46; S&#243; no nosso centro foram transplantados 30 doentes&#44; um n&#250;mero que antes s&#243; havia sido atingido em 2005&#46; No entanto&#44; ainda temos um longo caminho a percorrer at&#233; se atingir um grau de aproveitamento m&#225;ximo das potencialidades existentes&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Responsabilidades &#233;ticas</span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Prote&#231;&#227;o de pessoas e animais</span><p id="par0215" class="elsevierStylePara elsevierViewall">Os autores declaram que para esta investiga&#231;&#227;o n&#227;o se realizaram experi&#234;ncias em seres humanos e&#47;ou animais&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Confidencialidade dos dados</span><p id="par0220" class="elsevierStylePara elsevierViewall">Os autores declaram ter seguido os protocolos do seu centro de trabalho acerca da publica&#231;&#227;o dos dados de pacientes&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Direito &#224; privacidade e consentimento escrito</span><p id="par0225" class="elsevierStylePara elsevierViewall">Os autores declaram ter recebido consentimento escrito dos pacientes e&#47; ou sujeitos mencionados no artigo&#46; O autor para correspond&#234;ncia deve estar na posse deste documento&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflito de interesses</span><p id="par0230" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o e objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analisar a experi&#234;ncia adquirida em dez anos do programa de transplanta&#231;&#227;o card&#237;aca dos Hospitais da Universidade de Coimbra&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">De novembro de 2003 a dezembro de 2013&#44; 258 doentes com idade m&#233;dia de 53&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;7 anos &#40;limites 3&#8208;72 anos&#41; e predomin&#226;ncia do sexo masculino &#40;78&#37;&#41; foram transplantados&#46; Mais de um ter&#231;o dos doentes tinha miocardiopatia isqu&#233;mica &#40;37&#44;2&#37;&#41; e 36&#44;4&#37; idiop&#225;tica&#46; A idade m&#233;dia dos dadores era 34&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;3 anos e 195 eram do sexo masculino &#40;76&#37;&#41;&#44; com disparidade de sexo entre dador e recetor &#40;F&#58;M&#41; em 32&#37; dos casos e disparidade AB0 &#40;grupos n&#227;o id&#234;nticos mas compat&#237;veis&#41; em 18&#37;&#46; A colheita foi feita &#224; dist&#226;ncia em 59&#37; dos casos&#46; Em todos os casos foi utilizada a t&#233;cnica de transplanta&#231;&#227;o total&#44; com anastomose bicava&#44; modificada neste centro&#46; O tempo m&#233;dio de isquemia foi 89&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&#44;4 minutos&#46; Todos os doentes receberam terap&#234;utica de indu&#231;&#227;o&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A mortalidade precoce foi 4&#44;7&#37; &#40;12 doentes&#41;&#44; por fal&#234;ncia do enxerto e acidente vascular cerebral em cinco cada&#44; e por rejei&#231;&#227;o hiperaguda em dois&#46; Treze doentes &#40;5&#37;&#41; necessitaram de ventila&#231;&#227;o prolongada e 25 &#40;11&#44;8&#37;&#41; requereram suporte inotr&#243;pico por mais de 48 horas&#44; sete necessitaram de implanta&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span>&#46; O tempo m&#233;dio de internamento foi de 15&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;3 dias &#40;mediana&#44; 12 dias&#41;&#46; Noventa por cento dos doentes foram mantidos com terap&#234;utica imunossupressora tripla&#44; incluindo ciclosporina&#46; Os restantes receberam tacrolimus&#46; Em 23 doentes foi necess&#225;rio alterar o esquema de imunossupress&#227;o devido a complica&#231;&#245;es renais e&#47;ou neopl&#225;sicas e rejei&#231;&#227;o humoral&#46; Todos os doentes&#44; exceto dois&#44; s&#227;o seguidos no centro cir&#250;rgico&#46; Cinquenta doentes &#40;19&#44;4&#37;&#41; faleceram tardiamente por infe&#231;&#227;o &#40;18 doentes&#41;&#44; neoplasia &#40;dez doentes&#41;&#44; causa vascular &#40;oito doentes&#41;&#44; neuropsiqui&#225;trica &#40;quatro doentes&#41;&#44; card&#237;aca &#40;dois doentes&#41; ou outras &#40;oito doentes&#41;&#46; Quarente e seis doentes &#40;17&#44;8&#37;&#41; tiveram epis&#243;dios de rejei&#231;&#227;o celular &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>R da ISHLT&#41; e oito tiveram rejei&#231;&#227;o humoral &#40;3&#44;1&#37;&#41;&#44; e em 22 h&#225; evid&#234;ncia de doen&#231;a vascular enxerto &#40;8&#44;5&#37;&#41;&#46; A sobreviv&#234;ncia atuarial a um&#44; cinco&#44; e oito anos foi de 87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#37;&#44; 78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#37; e 69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#37;&#44; respetivamente&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#227;o</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Nesta s&#233;rie de dez anos obtiveram&#8208;se resultados equivalentes ou superiores aos referidos em experi&#234;ncias mais vastas e mais longas&#44; progressivamente melhorados pela introdu&#231;&#227;o de fatores suscitados pela pr&#243;pria experi&#234;ncia&#46; Com este programa foi poss&#237;vel elevar e manter a taxa de transplanta&#231;&#227;o card&#237;aca em valores acima da m&#233;dia europeia&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introduction and Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To analyze the experience gained in 10 years of the heart transplantation program of the University Hospital of Coimbra&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Between November 2003 and December 2013&#44; 258 patients with a mean age of 53&#46;0&#177;12&#46;7 years &#40;3&#8208;72 years&#41; and predominantly male &#40;78&#37;&#41; were transplanted&#46; Over a third of patients had ischemic &#40;37&#46;2&#37;&#41; and 36&#46;4&#37; idiopathic cardiomyopathy&#46; The mean age of donors was 34&#46;4&#177;1&#46;3 years and 195 were male &#40;76&#37;&#41;&#44; with gender difference between donor and recipient in 32&#37; of cases and ABO disparity &#40;non&#8208;identical groups but compatible&#41; in 18&#37;&#46; Harvest was distant in 59&#37; of cases&#46; In all cases total heart transplantation with bicaval anastomoses&#44; modified at this center&#44; was used&#46; Mean ischemia time was 89&#46;7&#177;35&#46;4 minutes&#46; All patients received induction therapy&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Early mortality was 4&#46;7&#37; &#40;12 patients&#41; from graft failure and stroke in five patients each&#44; and hyperacute rejection in two&#46; Thirteen patients &#40;5&#37;&#41; required prolonged ventilation&#44; 25 &#40;11&#46;8&#37;&#41; required inotropic support for more than 48 hours&#44; and seven required pacemaker implantation&#46; Mean hospital stay was 15&#46;8&#177;15&#46;3 days &#40;median 12 days&#41;&#46; Ninety percent of patients were maintained on triple immunosuppressive therapy including cyclosporine&#44; the remainder receiving tacrolimus&#46; In 23 patients it was necessary to change the immunosuppression protocol due to renal and&#47;or neoplastic complications and humoral rejection&#46; All but two patients have been followed in the Surgical Center&#46; Fifty patients &#40;19&#46;4&#37;&#41; subsequently died from infection &#40;18&#41;&#44; cancer &#40;10&#41;&#44; vascular &#40;eight&#41;&#44; neuropsychiatric &#40;four&#41;&#44; cardiac &#40;two&#41; or other causes &#40;eight&#41;&#46; Forty&#8208;six patients &#40;17&#46;8&#37;&#41; had episodes of cellular rejection &#40;&#62;2 R on the ISHLT classification&#41;&#44; eight had humoral rejection &#40;3&#46;1&#37;&#41;&#44; and 22 have evidence of graft vascular disease &#40;8&#46;5&#37;&#41;&#46; Actuarial survival at 1&#44; 5&#44; and 8 years was 87&#177;2&#37;&#44; 78&#177;3&#37; and 69&#177;4&#37;&#44; respectively&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">This 10&#8208;year series yielded results equivalent or superior to those of centers with wider and longer experience&#44; and have progressively improved following the introduction of changes prompted by experience&#46; This program has made it possible to raise and maintain the rate of heart transplantation to values above the European average&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">Receptor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">HTA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">97&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tabagismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hist&#243;ria familiar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reopera&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#170; vascular perif&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#170; carot&#237;dea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fra&#231;&#227;o de eje&#231;&#227;o do VE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#205;ndice card&#237;aco &#40;L&#47;m<span class="elsevierStyleSup">2</span>&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gradiente TP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resist&#234;ncia RVP &#40;uW&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VO<span class="elsevierStyleInf">2</span> max &#40;ml&#47;kg&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemoglobina &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Plaquetas &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">211<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LDH &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">338<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>686&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GOT &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>286&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GPT &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>204&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GGT &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>319&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bilirrubina &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFG &#40;ml&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Creatinina &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "imagenFichero" => array:1 [
                0 => "xTab586990.png"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas dos doentes transplantados</p>"
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      9 => array:7 [
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Dador&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Recetor M com dador F&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Recetor F com dador M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grupo sangu&#237;neo</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>B&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Assist&#234;ncia ventilat&#243;ria &#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">1 semana</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab586992.png"
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                  \t\t\t\t" style="border-bottom: 2px solid black">Cirurgia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Valvuloplastia mitral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anuloplastia tric&#250;spide&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Revasculariza&#231;&#227;o DA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transplante renal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de isquemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de CEC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>45&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">T&#46; ventila&#231;&#227;o mec&#226;nica &#40;horas&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inotr&#243;picos &#62;<span class="elsevierStyleHsp" style=""></span>48 horas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Assist&#234;ncia mec&#226;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Revis&#227;o da hemostase&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Derrame peric&#225;rdico &#40;30<span class="elsevierStyleHsp" style=""></span>d&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Seguimento&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pneumonia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">24&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pneumonia antes dos seis meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">9&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fungos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CMV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pielonefrite&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infe&#231;&#245;es graves antes de um ano&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pr&#243;stata&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gastrointestinal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sangue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cerebral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mama&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemodi&#225;lise&#47;transplante renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doen&#231;a vascular perif&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Implanta&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
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            1 => array:2 [
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        ]
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                  <table border="0" frame="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Seguimento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">258&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Incid&#234;ncia</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Morte global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Morte hospitalar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Morte precoce &#8804;<span class="elsevierStyleHsp" style=""></span>6M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Morte &#8804;<span class="elsevierStyleHsp" style=""></span>1 ano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Morte tardia &#62;<span class="elsevierStyleHsp" style=""></span>1 ano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Causa</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infeciosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vascular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neopl&#225;sica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Card&#237;aca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neuropsiqui&#225;trica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outras&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Incid&#234;ncia e causas de mortalidade</p>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleSmallCaps">i</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="4" align="left" valign="\n
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                  \t\t\t\t">Emergente</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Fal&#234;ncia aguda do enxerto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleSmallCaps">ii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Choque cardiog&#233;nico com assist&#234;ncia ventricular &#40;CEC&#44; ECMO&#44; VAD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSmallCaps">iii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Choque cardiog&#233;nico com bal&#227;o intra&#8208;a&#243;rtico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSmallCaps">iv</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Choque cardiog&#233;nico e suporte ventilat&#243;rio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSmallCaps">v</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urgente</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Internado com inotr&#243;picos ou arritmias malignas ou hemodi&#225;lise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSmallCaps">vi</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Internado na UCI para tratamento da ICC&#44; duas ou mais vezes&#44; nos &#250;ltimos seis meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSmallCaps">vii</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o urgente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Tabela de graus de prioridade para transplanta&#231;&#227;o em uso no nosso pa&#237;s</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliografia"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:33 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Registry of the International Society for Heart and Lung Transplantation&#58; Thirtieth Official Adult Heart Transplant Report&#8208;2013"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46;H&#46; Lund"
                            1 => "L&#46;B&#46; Edwards"
                            2 => "A&#46;Y&#46; Kucheryavaya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.healun.2013.08.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Heart Lung Transplant&#46;"
                        "fecha" => "2013"
                        "volumen" => "32"
                        "paginaInicial" => "951"
                        "paginaFinal" => "964"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24054804"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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Informação do artigo
ISSN: 08702551
Idioma original: Português
DOI:10.1016/j.repc.2014.03.010
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