Browsing by Author "Demirag, Alp"

Now showing 1 - 8 of 8

Analysis of Panel Reactive Antibodies in Renal Transplant Recipients Detected by Luminex: A Single-Center Experience
(2016) Inal, Ali; Ozcelik, Umit; Uyanik, Ebru Ogan; Kulah, Eyyup; Demirag, Alp; 0000-0002-0690-2529; 0000-0003-1073-2494; 0000-0001-6041-4254; 26517205; J-8056-2012; AAG-8651-2021; AAJ-5764-2021
Objectives: The role of panel reactive antibody has gained universal acceptance in solid-organ transplant. This parameter is used to gauge the level of sensitization of prospective solid-organ recipients. More than one-third of patients on wait lists for kidney transplant are sensitized. Most have previously formed donor-specific and non-donor-specific serum antibodies and/or positive crossmatch by complementdependent cytotoxicity and/or flow cytometry. We present the rate of positivity at our institution for human leukocyte antigen antibodies and describe the condensation of antibodies in human leukocyte antigens for renal pretransplant recipients. Materials and Methods: Between January 2011 and December 2012, six hundred twenty consecutive renal transplant recipients on the wait list at the Baskent University were evaluated for this retrospective study. Panel reactive antibody screening and definition tests were studied with Luminex assays for the combination of class I (A, B, C) and class II antigens (DR, DQ). Results: We found a panel reactive antibody screening positivity in 20.4% of our patients on renal transplant waiting list. Panel reactive antibody defining tests were meaningful in 12.2% of the whole list. We observed that only panel reactive antibody class I positivity was seen in 2.2%, only panel reactive antibody class II positivity was seen in 2.7%, and both panel reactive antibody class I and class II positivities were seen in 7.2% of the defining tests. Conclusions: The estimated risk of sensitization for patients with a living donor is determined from the combined results of the crossmatch with the donor and those of the recipient's panel reactive and donorspecific antibodies. Compared with complementdependent cytotoxicity crossmatch, Luminex assays provide greater sensitivity and specificity in detection of donor-specific antibodies.
Anesthesia Management with Ultrasound Guided Thoracic Paravertebral Block for Donor Nephrectomy: A Prospective Randomized Study
(2017) Yenidunya, Ozlem; Bircan, Huseyin Yuce; Altun, Dilek; Caymaz, Ismail; Demirag, Alp; Turkoz, Ayda; 28235492; AAR-7467-2020; R-6394-2019
Study objective: To determine the efficacy of ultrasound-guided thoracic paravertebral block intraoperatively and 24 hours postoperatively in patients undergoing donor nephrectomy. Design: Prospective randomized controlled study. Setting: Private foundation university hospital; November 2014 to June 2015. Patients: Thirty-two patients undergoing donor nephrectomy (exclusion criteria: coagulation disorders, allergy to local anesthetics, and unwillingness to participate). The final study population comprised 30 patients (15 male, 15 female) randomly assigned to either Group P (paravertebral block, n = 14) or Group M (morphine, n = 16). Interventions: In Group P, a unilateral paravertebral catheter was inserted 1 day preoperatively; on the day of surgery, a single-level unilateral paravertebral block was administered through the catheter before general anesthesia. Infusion of bupivacaine continued intraoperatively and postoperatively. Patients in Group M received only general anesthesia, and morphine patient-controlled analgesia was begun postoperatively. Measurements: Intraoperative analgesic and anesthetic requirement, postoperative numerical rating scale pain scores, additional analgesic consumption during the postoperative period, and incidence of complications related to thoracic paravertebral block (TPVB) like pleural puncture, pneumothorax, epidural spread, injection into the subarachnoid space, intravascular injection, and Homer's syndrome and rate of opioid related adverse reactions like nausea and vomiting, itching, constipation, and respiratory depression. Results: Intraoperative remifentanil consumption was significantly higher in Group M, and postoperative morphine consumption was significantly lower in Group P (P <.001). During the first 24 hours postoperatively, the mean numerical rating scale pain scores were similar and there were no significant differences between the 2 groups. There were no statistically significant differences in the additional analgesic consumption and rate of adverse reactions between the 2 groups. We didn't detect any complication related to TPVB in group P. Conclusions: Continuous thoracic paravertebral block provides good intraoperative stability with a low anesthetic requirement and reduces postoperative morphine consumption for up to 24 hours. Ultrasound guided technique enhanced the safety of TPVB and provides analgesia without major complications. (C) 2016 Elsevier Inc. All rights reserved.
Are there any differences between age groups regarding colorectal surgery in elderly patients?
(2014) Bircan, Huseyin Yuce; Koc, Bora; Ozcelik, Umit; Adas, Gokhan; Karahan, Servet; Demirag, Alp
Background: Surgical procedures with curative or palliative intentions in subjects aged over 70 represent a colorectal surgical challenge due to the issue they raise: Benefits versus increased morbidity. In this study, we proposed to compare the impact of surgery with the surgical intervention short-term results and analyze the factors that may influence these results in elderly age groups. Methods: We retrospectively analyzed a database containing information about patients who underwent colorectal surgery from January 2008 to December 2013 at the Baskent University Istanbul Research Hospital and the Okmeydani Training and Research Hospital. Results: A total of 265 patients were enrolled and analyzed in this retrospective study. Of these patients operated during the study period, 110 were between 60 and 69 years of age (group 1), 99 were between 70 and 79 years of age and 56 were older than 80 years of age. In total, there were 138 (52%) men and 127 (48%) women that underwent colorectal surgery. Intraoperative complications did not differ between group 1 and group 2, group 2 and group 3; however, some differences were observed between group 1 and group 3 (p = 0.001). Systemic complications were more frequent in group 3 than in groups 1 (p = 0.039) and 2 (p = 0.002). Furthermore, there were no significant systemic complication differences between groups 1 and 2. The mean length of postoperative hospital stay was 9.91 +/- 2.65 days in the first group, 9.38 +/- 2.44 days in the second group and 11.8 +/- 4.35 days in the third group. Conclusion: Colon surgery for both malignant and non-malignant diseases can be performed safely in different elderly age groups; thus, age should not be considered as an obstacle in elderly patients undergoing colorectal resection.
Delaying Renal Transplant after Radical Prostatectomy for Low-Risk Prostate Cancer
(2015) Ozcelik, Umit; Bircan, Huseyin Yuce; Karakayali, Feza; Moray, Gokhan; Demirag, Alp; 0000-0002-1874-947X; 0000-0003-1073-2494; 0000-0003-2498-7287; 26640918; AAB-3888-2021; AAG-8651-2021; AAE-1041-2021; R-6394-2019
To minimize the recurrence of a previously treated neoplasm in organ recipients, a period of 2 to 5 years without recurrence is advocated for most malignancies. However, prostate cancer is different because of its biological properties, diagnosis, and treatment. Most prostate cancers are detected at a low stage and demonstrate slow growth after detection. Definitive treatment with radical prostatectomy affords excellent results. Renal transplant candidates with early-stage prostate cancer have a higher risk of dying on dialysis than dying from prostate cancer; therefore, renal transplant candidates with organ-confined prostate cancer should be immediately considered for transplant.
Development of an Information Model for Kidney Transplant Wait List
(2015) Bircan, Huseyin Yuce; Ozcelik, Umit; Uysal, Nida; Demirag, Alp; Haberal, Mehmet; 0000-0003-1073-2494; 0000-0002-3462-7632; 26640914; R-6394-2019; AAG-8651-2021; AAJ-8097-2021
Objectives: Deceased-donor kidney transplant is unique among surgical procedures that are an urgent procedure performed in an elective population. It has not been possible to accurately determine when a given patient will be called for transplant. Patients on the active transplant list can be called for a transplant at any time. As a result, every effort must be made to optimize their health according to best practices and published clinical practice guidelines. Materials and Methods: Once the patient is placed on the transplant wait list after undergoing an initial extensive evaluation, continued surveillance is required. Therefore, we developed a kidney transplant wait list surveillance software program that alerts organ transplant coordinator on time regarding which patients need a work-up. Results: The new designed software has a database of our waiting patients with their completed and pending controls. The software also has built-in functions to warn the responsible staff with an E-mail. If one of the controls of a recipient delayed, the software sends an automated E-mail to the staff regarding the patients delayed controls. The software is a Web application that works on any platform with a Web browser and Internet connection and allows access by multiple users. The software has been developed with NET platform. The database is SQL server. The software has the following functions: patient communication info, search, alert list, alert E-mail, control entry, and system management. Conclusions: As of January 2014, a total of 21 000 patients were registered on the National Kidney Transplant wait list in Turkey and the kidney transplant wait list had been expanding by 2000 to 3000 patients each year. Therefore computerized wait list programs are crucial to help to transplant centers to keep their patients up-to-date on time.
Multiple Brain Abscesses Due to Phialemonium in a Renal Transplant Recipient: First Case Report in the Literature
(2015) Aydin, Mehtap; Ozcelik, Umit; Cevik, Halime; Cinar, Ozlem; Evren, Ebru; Demirag, Alp; 0000-0003-1073-2494; 0000-0003-4044-9366; 26640919; AAG-8651-2021; HLX-0937-2023; JAZ-1759-2023
Fungal brain abscesses are a rare but serious complication in transplant recipients. Phialemonium organisms are rare causes of invasive mold infections. Here, we present the first case of a renal transplant recipient with multiple brain abscesses caused by Phialemonium infection A. A 51-year-old female kidney transplant recipient was admitted with pneumonia of an unknown cause and treated with empiric intravenous antibiotics. Her treatment was uneventful, and she was discharged 1010 days later. After 5 days, she was readmitted with fever, cerebral palsy, and speech disorder. The patient had undergone living-donor renal transplant 7 months earlier. A cranial computed tomography and magnetic resonance imaging were performed for a possible cerebro vascular pathology. The magnetic resonance imaging scan showed multiple brain abscesses located at the left parietal, frontal and occipital lobes; right parietal and occipital lobes; right basal ganglia; and left cerebellum. The patient received meropenem, linezolid, sulfamethoxazole and trimethoprim, and AmBisome for probable pathogenic infection, and immunosuppressive agents dosage was reduced increasingly immuno suppressed. We identified Phialemonium in cerebrospinal fluid culture. The patient received voriconazole 200 mg twice daily. Lesions could not be drained due to lack of capsula formation. The patient died on the 30th day of antifungal therapy. Phialemonium organisms, although a rare cause of fungal infections, are associated with a high mortality rate in immunocompromised patients. To our knowledge, this is the first case report in the literature describing multiple brain abscesses due to Phialemonium in a transplant recipient. Clinicians recipient should be alert about these rare opportunistic fungi in the differential diagnosis of brain abscess, and bronchoscopy and broncho alveolar lavage are recommended for transplant patients when they are admitted with pneumonia exclude fungal infections.
Rectal diverticulitis mimicking rectal carcinoma with intestinal obstruction: Case report
(2015) Ozcelik, Umit; Bircan, Huseyin Yuce; Eren, Eryiğit; Demiralay, Ebru; Isiklar, Iclal; Demirag, Alp; Moray, Gokhan; 25698274
Although diverticular disease of the colon is common, the occurrence of rectal diverticula is extremely rare with only sporadic reports in the literature since 1911. Symptomatic rectal diverticula are seen even less frequently, and surgical intervention is needed for only complicated cases. Here we report the case of a 63-year-old woman presenting with rectal diverticulitis mimicking rectal carcinoma with intestinal obstruction.
Use of Biological Prosthesis in a Patient With Kidney and Pancreas Transplant and a Giant Incisional Hernia: Case Report
(2015) Ozcelik, Umit; Cevik, Halime; Bircan, Huseyin Yuce; Demirag, Alp; 0000-0003-1073-2494; 0000-0001-7276-3240; 25894161; AAG-8651-2021; R-6394-2019; JWP-7324-2024
Objectives: The use of synthetic mesh in transplant patients is controversial. Recent studies have shown that biological prostheses have a greater ability to integrate into tissues, resist bacterial colonization, and reduce cytotoxic or allergic reactions, and provide similar functional results, compared with synthetic prostheses. Biological prostheses do not require any reduction or discontinuation of immunosuppressive therapy. We present the case of a kidney and pancreas transplant recipient who had a giant incisional hernia that was treated successfully with a biological prosthesis. Case Report: A 40-year-old male kidney and pancreas transplant recipient was admitted to our hospital with a giant incisional hernia, 2 years after transplant. The defect on the abdominal wall was 40 x 30 cm. We used 2 biological prostheses (40 x 20 cm and 30 x 20 cm) to close the abdominal wall. The patient was discharged on postoperative day 5 without complications. An abdominal magnetic resonance imaging scan showed complete integrity of the biological prostheses at 1 year after surgery. Conclusions: Transplant recipients have higher risks with use of synthetic prostheses because of being immunosuppressed, compared with other patients. Recent studies show that biological prostheses provided similar functional results without complications compared with synthetic prostheses. These prostheses are versatile and do not require any changes in immunosuppressive therapy. Therefore, they seem to be a better option than synthetic prostheses. In our opinion, biological prostheses are more safe, effective, and reliable than synthetic prostheses, especially for large incisional hernias in transplant recipients. We believe that further larger studies can support our opinion.