Başkent Üniversitesi Kurumsal Akademik Arşivi
Başkent Üniversitesi DSpace, üniversitemiz tarafından doğrudan veya dolaylı olarak yayınlanan kitap, makale, tez, bildiri, rapor ve araştırma verisi gibi tüm akademik kaynakları uluslararası standartlarda dijital ortamda depolar. Bu sistem, üniversitemizin akademik performansını izlemeye aracılık eder, kaynakları uzun süreli saklar ve yayınların etkisini artırmak amacıyla telif haklarına uygun olarak Açık Erişim imkanı sağlar.
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Noncompliance With Immunnosuppressive Medications After Renal Transplantation
(Başkent Üniversitesi, 2003-06) Ghods, Ahad J.; Nasrollahzadeh, Dariush
Noncompliance with immunosuppressive medications in renal transplant recipients results in higher rate of acute rejection episodes, allograft dysfunction, graft loss and patient death. We studied incidence and risk factors of medications noncompliance in 286 renal transplant recipients who were consecutively seen in our renal transplant clinic between February and April 2002. One hundred and seventy were male, 116 female. Their age ranged from 12 to 70 years (mean 39.1 ± 11.6). The length of time since the date of transplantation ranged from 5 to 231 months (mean 76.7 ± 53.5). The results of study showed that 70 patients (24.5%) to be noncompliant (7.7% noncompliant minor and 16.8% noncompliant major). The time since the date of transplanation was a significant risk factor in both noncompliant minor and major groups (P < 0.001 and P < 0.001). The other risk factors associated with major noncompliance was young age (P < 0.001), lower level of education (P < 0.01), lower socioeconomic class (P < 0.05), addiction and psychiatric disorders (P < 0.05). Transplant recipients with major noncompliance also had more acute rejection episodes (P < 0.001) and allograft dysfunction (P < 0.01). We conclude that noncompliance with immunosuppressive medications is very common in renal transplant recipients and it results to significant acute rejection episodes and allograft failure.
Chronic Rejection: Prospects for Therapeutic Intervention in Fibroproliferative Vascular Disease
(Başkent Üniversitesi, 2003-06) Häyry, Pekka; Aavik, Einari; Sarwal, Minnie; Toit, Daniel du; Vamvakopoulos, Joannis
Vascular disease, manifesting as either transplant arteriopathy or native atherosclerosis, is currently the main obstacle to successful transplant outcome. In addition, vascular restenosis following balloon angioplasty or stenting continues to limit the long-term efficacy of these procedures. Neointimal hyperplasia is refractory to conventional immunosuppression although newer agents, such as rapamycin, have shown considerable promise in controlling it. By allowing large-scale study of gene expression during vascular remodelling, the emerging field of genomics is poised to revolutionise the drug discovery process. Here we summarise our initial experience using genomic methods to identify new targets for therapeutic intervention in vascular disease.
Recent Developments and Future Prospects in Pancreatic Transplantation
(Başkent Üniversitesi, 2003-06) Hakim, Nadey S.
Pancreas transplantation is not a life-saving procedure, so the benefits should be sufficient in terms of quality of life to outweigh the risks. Successful transplants give patients more positive health perceptions, improved social interaction, more satisfaction with diet and increased vitality. Studies are unanimous in finding that patients with successful transplants rate their lives better after transplantation than before. The effect of a double transplant in uraemic diabetic patients can be dramatic; patients rate their quality of life higher than diabetics who receive a kidney transplant alone.
The Relationship Between HLA Typing and HCV Infection and Outcome of Renal Transplantation in HCV Positive Patients
(Başkent Üniversitesi, 2003-06) Hadhoud, Alaa; Abdulaziz, Azza M.; Al Menawi, Lubna; Shaheen, F.A.; Abdulghaffar, Aliah; Abas, Fahd Al; F. Al Mobrak, Mohammed
The role of Human Leukocytic Antigen (HLA) antigens in susceptibility to Hepatitis C Virus (HCV) infection is still being debated. We analyzed HLA phenotype frequencies in two major ethnic groups, namely Egyptian and Saudi nationals. The Egyptian group included 110 patients of whom 55 were HCV positive and the other 55 HCV negative (control group). The Saudi group included 146 HCV positive patients and 122 HCV negative individuals (control group). The results for the Egyptian population revealed increased frequencies of some HLA phenotypes and decreased frequencies of others but without any statistically significant difference. In contrast, in the Saudi population, the HLA-A19 phenotype was significantly increased in HCV positive patients when compared with the control group while significantly decreased frequencies were found for HLA-B8, HLA-DRI and HLA DR3. Our data suggest that there was no significant association between HLA phenotypes and susceptibility to HCV infection among the Egyptian population while the overall data of the Saudi population seem to indicate that the expression of particular HLA alleles could be associated with susceptibility or resistance to the HCV infection. Further studies on larger numbers of patients are needed to support the role of the HLA system in HCV infection. A total of 108 HCV positive patients underwent renal transplantation at the Jeddah Kidney Center and the results were compared with 100 age and sex-matched controls. Graft survival at 36 months was 82% and 86% for HCV positive and control subjects respectively while patient survival was respectively 90% and 91%. Our data suggest that the outcome, at least in the short-time, of renal transplantation in HCV positive patients is very good.
Sirolimus: A Current Perspective
(Başkent Üniversitesi, 2003-06) Yakupoğlu, K. Yarkin; D. Kahan, Barry
Sirolimus, a macrocyclic lactone that displays a novel mechanism of immunosuppressive action, is a critical-dose drug requiring therapeutic drug monitoring for optimal outcomes. The compound was documented in two multicenter, blinded clinical trials to reduce the incidence of acute rejection episodes when used in combination with cyclosporine and steroids vs. azathioprine or placebo comparators. Furthermore, studies utilizing cyclosporine withdrawal documented a long-term benefit on renal function of chronic sirolimus therapy, albeit with a modestly enhanced incidence of acute rejection episodes. Although this application may be useful in selected cases, we believe that minimal initial cyclosporine exposures de novo mitigate the need for eventual withdrawal for chronic nephropathy, while preserving the immunosuppressive synergy during the maintenance phase. Recipients treated de novo with a sirolimuscyclosporine combination tolerate steroid withdrawal at 1 month after living-donor or at 3 to 6 months after cadaveric kidney transplantation with only a 5% risk of acute rejection episodes and 6% incidence of chronic reactions within 3 years. However, sirolimus exacerbates the hypertriglyceridemic and hypercholesterolemic proclivities of transplant recipients, as well as exerts myelosuppressive effects, which are augmented by concomitant therapy with azathioprine or, particularly, with mycophenolate mofetil. Due to its apparent lack of nephrotoxicity, sirolimus has been employed for induction therapy in a calcineurin antag-onist-free regimen in combination with either basiliximab or rabbit antilymphocyte sera for weak or strong immune responders, respectively, followed by introduction of a calcineurin antagonist upon resolution of the ischemia-reperfusion injury. Therefore, sirolimus proffers a potent and unique platform for new immunosuppressive strategies in organ transplantation.