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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Pentoxifylline Protects the Small Intestine After Severe Ischemia and Reperfusion
(Başkent Üniversitesi, 2013-06) Carsi, José Miguel Lloris; Pereyra, Luis Horacio Toledo; Fernandez, Cristobal Zaragoza; Toledo, Alexander Horacio; Lapeña, Dolores Cejalvo
Objectives: Pentoxifylline, a methylxanthine derivative with significant hemorheologic properties, is used for claudication in patients with peripheral vascular disease, and experimentally for ischemic injury to organs because of its antioxidant and anti-inflammatory effects. We used a rat model of severe small intestinal ischemia and reperfusion to determine the ability of pentoxifylline in improving survival, molecular response, and pathological protection.
Materials and Methods: We used 6 groups of male Wistar rats (n=25 each). The superior mesenteric artery was occluded for 120 minutes. Laboratory and tissue studies were done on 5 animals, 1 hour after reperfusion, and animal survival was assessed at 7 days. There were 2 control groups that received normal saline, either before ischemia or during reperfusion. The 4 treated groups received pentoxifylline 1 or 10 mg/kg at the same times mentioned above. Laboratory studies included measuring serum lactic acid dehydrogenase, tumor necrosis factor-α, interleukin-1β, and interleukin-6. Intestinal tissue malondialdehyde and myeloperoxidase in small intestine tissue also were measured. Histology and laser vascular blood flow at baseline and reperfusion were obtained, and survival was determined 7 days after ischemia.
Results: A significant survival benefit in the animals treated with 10 mg/kg of pentoxifylline at reperfusion was noted. This coincided with a reduction in biochemical markers of cell damage—specifically, serum lactic acid dehydrogenase, and tissue malondialdehyde, ischemia, and reperfusion. Additionally, we saw decreased levels of tumor necrosis factor-α, interleukin-1β, and interleukin-6. Improved postreperfusion blood flow shown by laser Doppler technology also was seen in the treated groups. Histologically, we observed less neutrophil infiltration in the intestine of ischemic-treated rats. Also seen in the control animals were increased necrotic lesions in the microvilli with a higher presence of lysozyme in the Paneth cells. Survival was significantly better at 7 days (70% vs 40%) when we compared the pentoxifylline group treated at reperfusion (10 mg/kg) to the ischemic controls.
Conclusions: Pentoxifylline had a significant protective effect on severely ischemic bowel when administered during reperfusion at a dosage of 10 mg/kg. Better survival, improved histology, and molecular response should urge consideration of the consideration of applying these findings in some general surgery and transplant conditions.
Allografts Positive for Hepatitis B Surface Antigen in Liver Transplant for Disease Related to Hepatitis B Virus
(Başkent Üniversitesi, 2013-06) Ju, Weiqiang; He, Xiaoshun; Huang, Jiefu; Zhu, Xiaofeng; Wang, Dongping; Guo, Zhiyong; Chen, Maogen
Objectives: Liver grafts from hepatitis B surface antigen-negative and anti-core antibody-positive donors are safe for liver transplant. However, the use of hepatitis B surface antigen-positive liver donors in liver transplants is controversial. We assessed the safety and effectiveness of liver transplants using hepatitis B surface antigen-positive liver grafts to patients with diseases related to hepatitis B virus.
Materials and Methods: We retrospectively reviewed 23 patients who had a deceased-donor liver transplant using hepatitis B surface antigen-positive liver grafts. All patients had end-stage liver disease secondary to hepatitis B virus infection. Recipients had oral entecavir and intravenous or intramuscular injection of hepatitis B immune globulin for > 1 year after the transplant.
Results: Two patients died from severe perioperative pneumonia, and the other 21 patients were followed for 9 to 38 months after transplant. All 21 patients remained hepatitis B surface antigen-positive. A repeat liver transplant was performed in 1 patient at 5 months after the initial transplant because of biliary ischemia. There were 3 patients who died from recurrent liver cancer at 9, 14, and 18 months after transplant. There were 18 patients (78%) who survived and 17 grafts (74%) that survived.
Conclusions: Liver transplant using hepatitis B surface antigen-positive liver grafts is safe for patients with end-stage liver disease secondary to hepatitis B virus infection.
Systematic Kidney Biopsies After Acute Allograft Pyelonephritis
(Başkent Üniversitesi, 2013-06) Cartery, Claire; Kamar, Nassim; Rostaing, Lionel; Game, Xavier; Cointault, Olivier; Cardeau-Desangles, Isabelle; Guitard, Joelle; Sallusto, Federico; Esposito, Laure; Guilbeau-Frugier, Céline
Objectives: Scarce data exist regarding the effect of acute graft pyelonephritis on kidney histology after a kidney transplant. This study sought to assess the kidney histology at 1 month, and kidney function at 1 year, after acute graft pyelonephritis in kidney transplant patients.
Materials and Methods: All kidney transplant patients with acute graft pyelonephritis between October 2006, and December 2008, underwent a kidney biopsy 1 month later (n=28). Histologic findings were compared with those observed in a control group (n=28) who underwent a protocol kidney biopsy at 1 year posttransplant and did not present with acute graft pyelonephritis. Patients were matched according to age, sex, and immunosuppressive regimen.
Results: Kidney function was impaired by the acute graft pyelonephritis episodes at the time of biopsy. In 40% of patients, the estimated glomerular filtration rate did not return to baseline by 1 month after acute graft pyelonephritis and remained impaired thereafter. Three patients had features of acute rejection. Tubulitis was seen more frequently in the acute graft pyelonephritis group, especially in patients in whom estimated glomerular filtration rate did not completely recover by 1 month after acute graft pyelonephritis. Patients with acute graft pyelonephritis who had inflammatory infiltrate of > 20% 1 month after acute graft pyelonephritis had worse kidney function 1 year later.
Insulin Requirement After a Renal Transplant in Patients With Type 2 Diabetes: The Choice of Calcineurin Inhibitors
(Başkent Üniversitesi, 2013-06) Hoogen, Martijn W. F. van den; Hilbrands, Luuk B.; Hoeven, Anna M. van der
Objectives: Hyperglycemia is a common adverse event of immunosuppressive drugs used in organ transplant. Because cyclosporine is less diabetogenic than tacrolimus is, cyclosporine may be preferred in patients with pre-existing diabetes mellitus type 2, to prevent insulin treatment after a transplant.
Patients and Methods: From March 2005 to June 2011, adult renal transplant patients with pre-existing diabetes mellitus type 2, who were not treated with insulin before a transplant, were treated with cyclosporine in combination with mycophenolate mofetil and corticosteroids. For comparison, we used historical controls who were treated with tacrolimus instead of cyclosporine.
Results: Of the 16 patients treated with cyclosporine, only 4 remained free of insulin treatment after a follow-up of least 1 year, compared with 2 of 12 patients who were treated with tacrolimus (25% vs 17%; P = .67). Almost all patients required insulin treatment within 2 months of the transplant, and patients required comparable doses of insulin at different times after the transplant in both groups. None of the baseline characteristics could sufficiently predict the need to start insulin treatment.
Conclusions: Cyclosporine cannot be preferred over tacrolimus to minimize either the chance of requiring insulin treatment posttransplant or the dosage of insulin in patients with pre-existing diabetes mellitus type 2.
Liver Transplant Using Donors After Cardiac Death: A Single-Center Approach Providing Outcomes Comparable to Donation After Brain Death
(Başkent Üniversitesi, 2013-04) Vanatta, Jason M.; Eason, James D.; Satapathy, Sanjaya K.; Nezakatgoo, Nosratollah; Campos, Luis; Modanlou, Kian A.; Nair, Satheesh; Hathaway, Donna K.; Dean, Amanda G.
Objectives: Organ donation after cardiac death remains an available resource to meet the demand for transplant. However, concern persists that outcomes associated with donation after cardiac death liver allografts are not equivalent to those obtained with organ donation after brain death. The aim of this matched case control study was to determine if outcomes of liver transplants with donation after cardiac death donors is equivalent to outcomes with donation after brain death donors by controlling for careful donor and recipient selection, surgical technique, and preservation solution.
Materials and Methods: A retrospective, matched case control study of adult liver transplant recipients at the University of Tennessee/Methodist University Hospital Transplant Institute, Memphis, Tennessee was performed. Thirty-eight donation after cardiac death recipients were matched 1:2, with 76 donation after brain death recipients by recipient age, recipient laboratory Model for End Stage Liver Disease score, and donor age to form the 2 groups. A comprehensive approach that controlled for careful donor and recipient matching, surgical technique, and preservation solution was used to minimize warm ischemia time, cold ischemia time, and ischemia-reperfusion injury.
Results: Patient and graft survival rates were similar in both groups at 1 and 3 years (P = .444 and P = .295). There was no statistically significant difference in primary nonfunction, vascular complications, or biliary complications. In particular, there was no statistically significant difference in ischemic-type diffuse intrahepatic strictures (P = .107).
Conclusions: These findings provide further evidence that excellent patient and graft survival rates expected with liver transplants using organ donation after brain death donors can be achieved with organ donation after cardiac death donors without statistically higher rates of morbidity or mortality when a comprehensive approach that controls for careful donor and recipient matching, surgical technique, and preservation solution is used.