Browsing by Author "Harmanci, Ozgur"

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The Effect of Pretransplant Chronic Hepatitis C Virus Infection Treatment on Graft and Patient Survival in Renal Transplant Recipients
(2015) Korkmaz, Murat; Faki, Sevgul; Ocal, Serkan; Harmanci, Ozgur; Ensaroglu, Fatih; Selcuk, Haldun; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-8445-6413; 0000-0002-9333-782X; 0000-0003-3719-9482; 0000-0002-0643-4980; 25894152; AAJ-8097-2021; AAJ-6976-2021; AAM-1330-2020; ABH-4817-2020
Objectives: Studies have demonstrated worse graft and patient survival among hepatitis C virus-positive patients following kidney transplant. Eradication of hepatitis C virus infection before renal transplant with interferon should be considered in hepatitis C virus-infected patients undergoing dialysis who are on the waiting list for transplant. We investigated whether pretransplant hepatitis C virus infection treatment affected graft and patient survival, and we evaluated other contributing factors to these outcomes. Materials and Methods: We enrolled 83 antihepatitis C virus-positive patients who were diagnosed with chronic hepatitis C virus infection by serology or histopathology and had renal transplant at Baskent University Ankara Hospital from 1982 to 2013. Data were obtained from patient medical files retrospectively. Patients were divided into 2 groups that had or did not have interferon treatment. Results: In 83 renal transplant patients with chronic hepatitis C virus infection (57 male [69%] and 26 female [31%]), median age was 46 years (range, 26 - 69 y), and most patients were genotype 1-dominant (92%). Interferon monotherapy was received by 30 patients before renal transplant and 28 of 30 patients had long-term follow-up data. There were 14 of 28 patients (50%) who achieved sustained virologic response, and only 1 patient had relapse. Graft survival was significantly lower in patients who had treatment (6 y vs 9 y; P <= .003). However, patient survival rates were similar between groups. Patients who had interferon were younger and had longer hemodialysis duration before renal transplant than patients without treatment. Higher viral load was associated with higher mortality which was caused by sepsis. Conclusions: Pretransplant hepatitis C virus infection treatment, although recommended before renal transplant, does not always have good outcomes. Pretransplant dialysis treatment period, age of recipient, and posttransplant higher viral replication rates may be important contributing factors related to graft and patient survival.
Hepatitis B- and Hepatitis D-Virus Related Liver Transplant: Single-Center Data
(2015) Ocal, Serkan; Korkmaz, Murat; Harmanci, Ozgur; Ensaroglu, Fatih; Akdur, Aydincan; Selcuk, Haldun; Moray, Gokhan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-8726-3369; 0000-0003-3719-9482; 0000-0002-9333-782X; 0000-0003-2498-7287; 0000-0002-8445-6413; 0000-0002-0643-4980; 25894142; AAJ-8097-2021; AAA-3068-2021; ABH-4817-2020; AAM-1330-2020; AAE-1041-2021; AAJ-6976-2021
Objectives: Hepatitis B and D virus coinfection or superinfection lead to chronic liver disease and have poor treatment results and poor prognosis. After transplant, these patients have difficult problems. We aimed to report long-term data of liver transplant recipients who had hepatitis B and D virus-related chronic liver disease. Materials and Methods: This retrospective, longitudinal study included 25 consecutive hepatitis B surface antigen-positive patients with anti-hepatitis D virus antibodies. Patient data (age, sex, antiviral treatment, posttransplant use of hepatitis B hyperimmunoglobulin and/or nucleoside/nucleotide analogues, the presence of hepatocellular carcinoma, age at transplant, follow-up) were extracted from patient records. Results: Females comprised 32% patients. The median age was 44 years (range, 23-63 y). The serum Hepatitis B envelope antigen level was negative in all patients. At the time of transplant, 4 patients were positive for hepatitis B virus DNA and 11 patients also had hepatocellular carcinoma. Posttransplant follow-up was 59 months (range, 3-120 mo). During follow-up, 4 patients died, 4 patients were lost to follow-up, and 17 patients were alive. Posttransplant survival of patients with hepatocellular carcinoma was 50.45 months (range, 3-84 mo) and without hepatocellular carcinoma was 65.8 months (range, 4-120 mo). There were 3 patients who had acute rejection and were treated successfully with pulse doses of prednisolone. Hyperimmunoglobulin therapy was used in conjunction with oral nucleotide/nucleoside analogues for 12 months (range, 3-24 mo) and then stopped. After transplant, 4 patients had antiviral medicine changed to adefovir or entecavir because of drug resistance, and otherwise all patients remained negative for hepatitis B virus DNA during follow-up. Conclusions: Patients transplanted for hepatitis B and D virus cirrhosis, even with hepatocellular carcinoma, had favorable prognosis and good long-term results. Close follow-up of patients and effective viral suppression with suitable drugs were key factors for efficient patient care.
Late-Onset Drug-Induced Cholestasis in a Living-Related Liver Transplant Donor With Progressive Familial Intrahepatic Cholestasis
(2015) Harmanci, Ozgur; Ensaroglu, Fatih; Ozcay, Figen; Ocal, Serkan; Korkmaz, Murat; Ozdemir, B. Handan; Selcuk, Haldun; Moray, Gokhan; Haberal, Mehmet; 0000-0002-7528-3557; 0000-0003-3719-9482; 0000-0002-9333-782X; 0000-0002-3462-7632; 0000-0002-8445-6413; 0000-0003-2498-7287; 0000-0002-5214-516X; 0000-0002-0643-4980; 26640927; X-8540-2019; ABH-4817-2020; AAM-1330-2020; AAJ-8097-2021; AAJ-6976-2021; AAE-1041-2021; ABG-5684-2020
We present a rare case of progressive familial intrahepatic cholestasis within a family. A 34-year-old female became a living-related liver transplant donor for her son, who had the disease. Nine years after the transplant, the mother developed severe intrahepatic cholestasis, for which she was evaluated after using an oral contraceptive drug. She presented with jaundice, pruritus, and increased bilirubin levels, together with elevated gamma glutamyl transferase and alkaline phosphatase levels. A liver biopsy revealed findings consistent with intrahepatic cholestasis. However, despite follow-up management and cessation of the insulting drug, her total bilirubin count continuously increased to 20 mg/dL and was accompanied by intractable pruritus. A total of 9 plasmapheresis sessions were performed, and she was started on a regimen of ursodeoxycholic acid (13 mg/kg/d) and cholestyramine (4 g, 3 times daily). The clinical and laboratory picture dramatically improved following cessation of the oral contraceptive, plasmapheresis sessions, and drug treatment. The patient's cholestasis normalized within 3 months, and she recovered uneventfully. A genetic analysis of the whole family revealed that both parents were heterozygous for the mutation c.124G>A in ABCB11, and the son was homozygous for this mutation. These findings supported varying degrees of bile salt export pump deficiency in the family members. Defective bile salt excretory system function can result in a wide spectrum of clinical presentations, ranging from progressive familial intrahepatic cholestasis requiring liver transplant to late-onset drug-induced cholestasis. Our findings suggest that, in a heterozygous carrier of a progressive familial intrahepatic cholestasis mutation, drug-induced cholestasis is responsive to treatment, after which the clinical picture can normalize within 3 months.
Panel Reactive Antibodies in Predicting Hepatitis C Virus Treatment Outcome in Kidney Transplant Candidates
(2015) Ocal, Serkan; Harmanci, Ozgur; Korkmaz, Murat; Ensaroglu, Fatih; Colak, Turan; Selcuk, Haldun; Moray, Gokhan; Haberal, Mehmet; 0000-0002-8372-7840; 0000-0002-8445-6413; 0000-0003-3719-9482; 0000-0002-9333-782X; 0000-0003-2498-7287; 0000-0002-3462-7632; 0000-0002-0643-4980; 25894153; AAJ-8554-2021; AAJ-6976-2021; ABH-4817-2020; AAM-1330-2020; AAE-1041-2021; AAJ-8097-2021
Objectives: Chronic hepatitis C virus infection compromises hemodialysis patients and increases liver-related mortality. Interferon treatment is associated with improved sustained virological response rates and increased risk of graft loss after kidney transplant. This may be related to the development of antihuman leukocyte antigen antibodies, which may be a surrogate marker of potent immune response. We evaluated panel reactive antibody 1 and 2 levels for prediction of sustained viral response in patients with kidney transplant. Materials and Methods: In this retrospective cohort study, we reviewed data from hepatitis C virus-infected hemodialysis patients who received interferon treatment before kidney transplant. Panel reactive antibody > 20% was considered positive. Sustained viral response rates for interferon treatment were obtained and compared with panel reactive antibody 1 and 2 values. Results: There were 40 patients (16 female and 24 male patients; mean age, 41.5 y; range, 18-65 y). Sustained viral response rate was 18/40 (45%). Panel reactive antibody 1 was negative in 31 patients and positive in 9 patients. Sustained viral response ratio was not correlated with panel reactive antibody 1 positivity. Panel reactive antibody 2 was negative in 31 patients (sustained viral response: present, 11 patients; absent, 20 patients) and positive in 9 patients (sustained viral response: present, 7 patients; absent, 2 patients). Sustained viral response ratio was significantly correlated with panel reactive antibody 2 positivity. Conclusions: We showed a correlation between panel reactive antibody 2 positivity and sustained viral response rates that may be a predictive tool for hepatitis C virus treatment response. In patients with other complications that compromise hepatitis C virus treatment, panel reactive antibody 2 may be a surrogate marker for sustained viral response prediction. The induction of cellular immunity may cause clearance of hepatitis C virus infection and formation of high panel reactive antibody 2 levels.
Progression of Hepatic Histopathology in Kidney Transplant Recipients With Chronic Hepatitis C Virus Infection and Effect of Immunosuppression on the Course of Hepatitis C Virus Infection
(2015) Korkmaz, Murat; Faki, Sevgul; Ocal, Serkan; Harmanci, Ozgur; Selcuk, Haldun; Haberal, Mehmet; 0000-0003-3719-9482; 0000-0002-3462-7632; 0000-0002-8445-6413; 0000-0002-9333-782X; 0000-0002-0643-4980; 25894147; ABH-4817-2020; AAJ-8097-2021; AAJ-6976-2021; AAM-1330-2020
Objectives: There is no correlation between alanine aminotransferase levels, viral load, and histologic findings at dialysis in patients with chronic hepatitis C virus infection. Identification of the severity of hepatitis C-related liver disease before transplant could provide valuable data about the risk for liver-related mortality after transplant. In this study, we aimed to identify the severity of liver disease in end-stage renal disease patients with chronic hepatitis C virus infection, the progression of hepatic histopathology after kidney transplant, and whether immunosuppressive therapy affected post-transplant viral replication and hepatic histology. Materials and Methods: Antihepatitis C virus-positive kidney transplant recipients (45 patients) enrolled in the study. Liver biopsy was performed in 45 patients before and 16 patients after kidney transplant. Interferon was given to 28 of 45 patients before kidney transplant. Biopsy before and after kidney transplant was performed in 5 of 14 patients. Results: Patients had higher viral load, with genotype 1 predominancy (91%). Sustained viral response was achieved in 14 of 28 patients (50%). The histopathologic features of 45 patients who had pretransplant liver biopsy were as follows: 22 patients had mild hepatocellular injury, 17 patients had mild chronic hepatitis, 5 patients had moderate chronic hepatitis, and 1 patient had serious hepatitis. Follow-up biopsy after kidney transplant (mean, 2 y) in 16 of 45 patients showed that 3 of 16 patients had mild hepatocellular injury, 4 of 16 patients had mild hepatitis, 6 of 16 patients had moderate hepatitis, 2 of 16 patients had serious hepatitis, and 1 patient had cirrhosis. Patients showed neither progression, regression, nor stable liver histology. Conclusions: Even with worse genotype profiles, chronic hepatitis C virus infection has an indolent progression in patients with end-stage renal disease and kidney transplant. Follow-up biopsies of kidney transplant recipients show reasonable progression during the first 2 years.
Significance of Colonoscopic Findings in Patients After Kidney Graft
(2015) Ensaroglu, Fatih; Harmanci, Ozgur; Ocal, Serkan; Korkmaz, Murat; Moray, Gokhan; Ozdemir, Handan; Colak, Turan; Selcuk, Haldun; Haberal, Mehmet; 0000-0002-7528-3557; 0000-0003-3719-9482; 0000-0002-8445-6413; 0000-0002-8372-7840; 0000-0003-2498-7287; 0000-0002-9333-782X; 0000-0002-3462-7632; 0000-0002-0643-4980; 26640913; X-8540-2019; ABH-4817-2020; AAJ-6976-2021; AAJ-8554-2021; AAE-1041-2021; AAM-1330-2020; AAJ-8097-2021
Objectives: We aimed to investigate the colonoscopy findings in patients after kidney transplant. Materials and Methods: We retrospectively analyzed kidney transplant patients who had colonoscopy examinations for various indications between 2011 and 2015. Results: Eighty-one patients (25 women and 56 men) with a mean age of 39 years (range, 18-64 y) were identified. Mean follow-up after transplant was 9 years (range, 1-29 y). The most common indications for colonoscopy were diarrhea (41%), anemia (29%), gastrointestinal bleeding (12%), abdominal pain (12%), and unexplained weight loss (6%). Either colitis or ileitis or both were diagnosed in 20 patients (25%), whereas polyps were found in 9 patients (11%). One patient presented with hematochezia, which was diagnosed as cytomegalovirus colitis. The remaining cases of colitis or ileitis were diagnosed as nonspecific inflammation. Indications for colonoscopy were not correlated with age, duration after transplant, or use of immunosuppressive drugs. A subgroup analysis for mycophenolate-induced colitis found that 88% of patients used mycophenolate, but presence of colitis or ileitis had no statistical correlation with its use. In patients with poor gastrointestinal symptoms, the only significant predictor of presence of colitis or ileitis was a high C-reactive protein value (> 5 mg/dL; P=.02). Conclusions: Incidence of colitis and/or ileitis is a relatively common finding in patients after kidney transplant. Opportunistic infections, mycophenolate use, and mild degree of indeterminate colitis or ileitis disease may be the underlying condition. Cytomegalovirus infection should be screened in all recipients because it may cause serious complications or death in chronically immuno-compromised patients.