Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Bone Marrow Biopsy in Patients With Renal Transplant: Spectrum of Findings and Diagnostic Use(2015) Borcek, Pelin; Ozdemir, B. Handan; Ozkan, Eylem Akar; Taslica, F. Zeynep; Haberal, Mehmet; 0000-0002-7528-3557; 0000-0002-3462-7632; 25894168; X-8540-2019; AAJ-8097-2021Objectives: Renal transplant may be complicated by cytopenia, fever of unknown etiology, or hematolymphoid malignancies. Bone marrow biopsy may be indicated to evaluate these complications. However, to the best of our knowledge, no previous study has systematically documented the characteristics of bone marrow biopsy in these patients. The present study reports the range of bone marrow findings in renal transplant recipients. Materials and Methods: We selected 85 patients who underwent bone marrow biopsy among 1745 renal transplant recipients who had transplant at Baskent University from January 1990 to December 2013. The files of these patients were reviewed for age, sex, age at renal transplant, underlying renal disease, donor type, immunosuppressive therapy, presence or absence of acute humoral or cellular rejection, duration between transplant and bone marrow biopsy, indication for bone marrow biopsy, and histopathologic diagnoses of bone marrow biopsies. Results: The most common cause of renal insufficiency leading to transplant in this patient group was unknown etiology, observed in 24 patients (28.2%). The most common indication for bone marrow biopsy was blood cytopenia, detected in 56 patients (65.9%). Neoplastic involvement of the bone marrow was detected in 6 patients (7.1%), all of which were hematolymphoid malignancies. Corticosteroids were the most commonly used immunosuppressive agents, administered to all patients. Conclusions: Bone marrow biopsy provides important information in renal transplant recipients, especially in cases of neoplastic bone marrow involvement, specific inflammation, and amyloidosis, which are uncommon in this patient group. The overall diagnostic use is related to the individual situation of each patient.Item Divergent Role of Programmed Death -Ligand 1 (PD-L1) in Renal Allografts with Antibody-Mediated Rejection (AMR)(2018) Ozdemir, B. Handan; Akcay, Eda; Atilgan, Alev Ok; Borcek, Pelin; Tepeoglu, Merih; Polat, Aysegul Yucel; Deniz, Melis; Haberal, Mehmet; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0001-6831-9585; https://orcid.org/0000-0001-8595-8880; https://orcid.org/0000-0002-9894-8005; https://orcid.org/0000-0002-3590-9375; AAJ-8097-2021; X-8540-2019; AAK-1960-2021; AAK-3333-2021; AAK-5222-2021; AAP-3975-2021; https://orcid.org/0000-0002-3462-7632Item The Relation Between The Inflamatory Cytokine Expression with Acute Rejection Episodes and Hepatitis Recurrence in Liver Allograft Recipients(2016) Ozgun, Gonca; Ozdemir, Binnaz Handan; Akcay, Eda Yilmaz; Borcek, Pelin; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0001-6831-9585; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; X-8540-2019; AAK-1960-2021; AAE-1041-2021; AAJ-8097-2021Item Renal Allograft with Calcium Oxalate Deposition: Its Association with Urinary Tract Infection and Development of Interstitial Fibrosis(2016) Ozdemir, Handan; Ozdemir, Gokce; Ayva, Sebnem; Ozdemir, Nurhan; Borcek, Pelin; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0003-2545-0078; https://orcid.org/0000-0002-2280-8778; https://orcid.org/0000-0002-5682-0943; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; AAL-4282-2020; AAK-1967-2021; AAK-1697-2021; AAE-1041-2021; AAJ-8097-2021Item The Protective Effect of Lycopene on Kidney Against Experimentally Induced Unilateral Ureteral Obstruction(2016) Atilgan, Hasan Ikbal; Aydin, Arif; Sadic, Murat; Korkmaz, Meliha; Karakan, Tolga; Ogus, Elmas; Borcek, Pelin; Koca, GokhanIntroduction: To investigate the possible protective effect of lycopene on kidney after unilateral ureteral obstruction. Materials and methods: Twenty-one Wistar albino rats were divided into three groups in experimental study. In lycopene group, lycopene was administered two days before left ureteral ligation and was continued for 15 days. In control group, left ureteral ligation was applied with no medication. In sham group, midline incision was made to abdomen and then closed. Histopathological, biochemical and scintigraphic evaluations were made. Results: Microscopic score was 50.56 +/- 34.32 in lycopene, 97.22 +/- 39.14 in control and 28.33 +/- 12.58 in sham group. Microscopic score was lower in lycopene group than control group (p= 0.033). In biochemical analysis, mean value of myeloperoxidase (MPO), malondialdehyde (MDA) and nitrite levels were 0.05 +/- 0.03, 4.64 +/- 1.49 and 0.06 +/- 0.01 respectively in lycopene group, 0.10 +/- 0.03, 8.37 +/- 3.31 and 0.14 +/- 0.09 in control group and 0.04 +/- 0.01, 18.76 +/- 9.30 and 0.05 +/- 0.01 in sham group. MPO, MDA and nitrite levels were lower in lycopene group than in control group (p= 0.033, p= 0.007 and p < 0.001, respectively). Postoperative mean Technetium-99m dimercaptosuccinic acid (Tc-99m DMSA) uptake values of left kidneys were 6.26 +/- 5.17 in lycopene, 2.09 +/- 1.03 in control and 49.17 +/- 1.37 in sham group. There was no statistically significant difference between lycopene and control groups in respect of postoperative DMSA uptake values (p= 0.063). Conclusion: Lycopene is effective for the protection of kidney after ureteral obstruction as shown by microscopic parameters and decreased reactive oxygen species.Item Splenic Peliosis Resulting in Spontaneous Splenic Rupture in a Concomitant Hepatic and Renal Allograft Recipient(2016) Borcek, Pelin; Ozdemir, B. Handan; Akcay, Eda Yilmaz; Haberal, Mehmet; 0000-0002-7528-3557; 0000-0001-6831-9585; 0000-0002-3462-7632; 27805528; X-8540-2019; AAK-1960-2021; AAJ-8097-2021Splenic peliosis is an exceedingly rare complication following liver and kidney transplant, with few previously reported cases. A 24-year-old man with chronic renal and hepatic failure due to primary oxalosis underwent concomitant renal and hepatic transplant. On the eighth day of successful transplant, he showed signs and symptoms of hypovolemia with suspicion of intra-abdominal bleeding. Diagnostic laparotomy was performed, yielding splenic rupture, and a splenectomy was performed. Macroscopically, the spleen was ruptured, and the cut surface displayed multiple parenchymal blood-filled cysts. Microscopically, the splenic microarchitecture was distorted by numerous irregular hemorrhagic lacunes partially lined by sinusoidal endothelium. Splenic peliosis was diagnosed. The patient recovered with splenectomy. Peliosis is a condition characterized by multiple blood-filled cavities in parenchymatous organs, and it most frequently affects the liver. It is thought to be related to many conditions, including hematologic malignancies, acquired immuno deficiency syndrome, chronic alcoholism, use of oral contraceptives, and posttransplant immunodeficiency state. However, peliosis of the spleen, compared with the liver, is relatively rare, and it may cause spontaneous splenic rupture. Although rare, splenic peliosis and secondary splenic rupture is a significant post transplant complications leading to unexplained hypovolemia.Item Histologic Changes in Bone Marrow Biopsies From Liver Transplant Patients(2016) Borcek, Pelin; Ozdemir, B. Handan; Sercan, Cigdem; Akcay, Eda Yilmaz; Karakus, Sema; Haberal, Mehmet; 0000-0002-7528-3557; 0000-0001-6831-9585; 0000-0001-7615-4581; 0000-0002-3462-7632; 27805526; X-8540-2019; AAK-1960-2021; W-9092-2019; AAJ-8097-2021Objectives: Liver transplant may complicated by various hematologic conditions, resulting in indication for bone marrow biopsy. Immunosuppressive therapies, specific infections, and secondary neoplasms affect bone marrow. In the present study, we evaluated the histologic spectrum of bone marrow findings in liver allograft recipients. Materials and Methods: Of 338 patients who received liver transplants and were followed at the Baskent University, Faculty of Medicine, 44 patients underwent bone marrow biopsy. The medical and pathologic information about these patients were evaluated, including age at liver transplant, age at bone marrow biopsy, sex, primary disease, bone marrow histology, and indication for bone marrow biopsy. Results: Of 44 patients who required bone marrow sampling, 30 were male (68.2%), and 14 were female (31.8%). Fifteen patients (34.1%) were in pediatric age group at the time of transplant. The most common cause of liver insufficiency leading to liver transplant was viral hepatitis in 11 patients (25%), followed by cryptogenic cirrhosis in 10 patients (22.8%). The source of the graft liver was a living donor in 40 patients (90.9%). The average age at transplant was 28.8 years, and the mean age at bone marrow sampling was 29.9 years. Nineteen patients (43.2%) required bone marrow sampling within the first year after transplant. The most common histologic findings were hypocellular, and normocellular bone marrow, observed in 18 patients (40.9%) each. Six patients (13.6%) had bone marrow biopsies for staging of posttransplant lympho proliferative disorder. Only 1 patient of the 6 with this disease (16.7%) had malignant infiltration of the bone marrow, which was a case of Burkitt lymphoma developed as posttransplant lymphoproliferative disorder, and this was the only malignant infiltration in this patient group (2.3%). Neither specific infections nor granulomatous inflammation was detected. Conclusions: Bone marrow morphology has a major role in the follow-up of liver transplant patients, who may present with peripheral blood cytopenias. The present study represents the first systematic evaluation of bone marrow findings in liver allograft recipients.Item Posttransplant Lymphoproliferative Disorder Manifesting as Intestinal Epstein-Barr Virus-Positive Anaplastic Large-Cell Lymphoma in an Adult Renal Transplant Recipient(2016) Borcek, Pelin; Ozdemir, B. Handan; Ozgun, Gonca; Haberal, Mehmet; 0000-0002-7528-3557; 0000-0002-3462-7632; 27805515; X-8540-2019; AAJ-8097-2021Posttransplant lymphoproliferative disorder is a relatively common posttransplant malignancy affecting as many as 10% of all solid-organ recipients. Most cases of posttransplant lymphoproliferative disorder are of B-cell origin, with common Epstein-Barr virus association. Posttransplant lymphoproliferative disorders of T-cell origin are much rarer and less frequently associated with Epstein-Barr virus. Here, we report an unusual case of Epstein-Barr virus-positive anaplastic large-cell lymphoma causing an intestinal perforation in an adult renal transplant recipient. A 52-year-old male patient with renal allograft developed cryptogenic end-stage liver failure and was accepted as a candidate for liver transplant. Before transplant, he was admitted with severe abdominal pain, which turned out to result from ileal perforation. Pathologic evaluation of the intestinal resection showed diffuse malignant lymphoid infiltration of the ileum, consistent with anaplastic large-cell lymphoma. The tumor was positive for Epstein-Barr virus genome. Anaplastic large-cell lymphoma is a rare form of T-cell posttransplant lymphoproliferative disorder that is infrequently associated with Epstein-Barr virus. The occurrence of this extraordinary form of post transplant lymphoproliferative disorder, its late onset, intestinal localization, and Epstein-Barr virus as sociation represent a unique clinical rarity.Item Importance of Liver Biopsy Findings on Prognosis of Kidney Transplant Patients(2016) Ozgun, Gonca; Ozdemir, Binnaz Handan; Tunca, Muzeyyen Zeyneb; Borcek, Pelin; Haberal, Mehmet; 0000-0002-7528-3557; 0000-0002-3462-7632; 27805508; X-8540-2019; AAJ-8097-2021(O)bjectives: Chronic hepatitis infection among kidney transplant recipients is not infrequent, with those with hepatitis C virus infection having worse survival. Here, we evaluated liver biopsy changes and its effects on prognosis in kidney transplant recipients. Materials and Methods: Patients with liver biopsies were selected from 1275 kidney transplant recipients who were treated at Baskent University from January 1990 to December 2012. Demographic and clinical findings were evaluated, including age, sex, liver biopsy findings, amyloid and hemosiderin accumulation, and patient survival. Results: Among 1275 renal transplant patients, only 149 patients had liver biopsies. Of 149 patients, 68 patients (45.3%) had liver biopsy only before and 81 patients had liver biopsy after transplant, with 20 of the 81 patients also having biopsy before transplant. The 81 patients who had a liver biopsy after renal transplant were included in the study. In our patient group, mean follow-up was 166 +/- 29 months, female-to-male ratio was 26/55, and mean age was 30.2 +/- 9.87 years (range, 15-56 y). Only 2 of 81 liver biopsies (2.4%) were diagnosed as normal or nonspecific. Biopsy findings of the remaining 79 patients (97.6%) showed variable pathologies, including hepatocellular damage and minimal cholestatic changes in 29 patients (35.8%), chronic nonviral hepatitis in 9 (11.1%), and viral hepatitis in 41 (50.6%). The mean time between the first liver biopsy taken before transplant and second biopsy after transplant was 44.5 +/- 38.0 months (range, 11-139 mo). Among 81 patients, 6 (7.4%) showed amyloid deposition and 13 (16.0%) showed hemosiderosis. Conclusions: Testing for viral infections is critical in transplant recipients. It is well known that these infections can affect the frequency of rejection episodes and also negatively affect survival in solidorgan transplant recipients. Livers should be evaluated by biopsy even if the variance in liver enzymes or serology is minimal.Item Solid Liver Lesions in an Infant With Neonatal Cholestasis: Is it Always Malignant?(2017) Baris, Zeren; Borcek, Pelin; Haberal, Kemal Murat; Ozcay, Figen; 0000-0002-8211-4065; 0000-0002-5214-516X; 28816798; AAB-4153-2020; R-9398-2019; ABG-5684-2020In this report we describe a patient with neonatal cholestasis who was found to have a liver lesion with suspicious imaging features, although ultimately it was histologically proved to be a pseudotumor. We discuss the characteristic features and imaging findings of macroregenerative nodules of the liver.