Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Clinical Features of SARS-CoV-2 Infection in Patients Undergoing Solid-Organ Transplant: Baskent University Experience(2023) Yuce, Gulbahar Darilmaz; Ulubay, Gaye; Tek, Korhan; Bozbas, Serife Savas; Erol, Cigdem; Buyukasik, Piril; Haberal, Kemal Murat; Arslan, Ayse Hande; Akcay, Muserref Sule; Haberal, Mehmet; 0000-0002-2535-2534; 34635037; AAJ-1219-2021Objectives: The clinical features and treatment approaches, outcomes, and mortality predictors of COVID-19 in solid-organ transplant recipients have not been well defined. This study investigated the clinical features of COVID-19 infection in solid-organ transplant recipients at our center in Turkey. Materials and Methods: Our study included 23 solid-organ transplant recipients and 336 nontransplant individuals (143 previously healthy and 193 patients with at least 1 comorbidity) who were hospitalized due to COVID-19 disease in our hospital between March 2020 and January 2021. Demographic, clinical, and laboratory data of patients were compared. We used SPSS version 20.0 for statistical analysis. All groups were compared using chi-square and Mann-Whitney U tests. P <.05 was considered statistically significant. Results: Mean age of solid-organ transplant recipients was 49.8 +/- 13.7 years (78.3% men, 21.7% women). Among the 23 recipients, 17 (73.9%) were kidney and 6 (26.1%) were liver transplant recipients. Among nontransplant individuals, 88.7% (n = 298) had mild/moderate disease and 11.3% (n = 38) had severe disease. Among transplant recipients, 78.3% (n = 18) had mild/moderate disease and 21.7% (n = 5) had severe disease (P =.224). Transplant recipients had greater requirements for nasal oxygen (P =.005) and noninvasive mechanical ventilation (P =.003) and had longer length of intensive care unit stay (P =.030) than nontransplant individuals. No difference was found between the 2 groups in terms of mortality (P =.439). However, a subgroup analysis showed increased mortality in transplant recipients versus previously healthy patients with COVID-19 (P <.05). Secondary infections were major causes of mortality in transplant recipients. Conclusions: COVID-19 infection resulted in higher mortality in solid- organ transplant recipients versus that shown in healthy patients. More attention on secondary infections is needed in transplant recipients to reduce mortality.Item Postoperative Pulmonary Complications in Living-Liver Donors: A Retrospective Analysis of 188 Patients(2015) Ulubay, Gaye; Dedekarginoglu, Balam Er; Kupeli, Elif; Sever, Ozlem Salman; Eyuboglu, Fusun Oner; Haberal, Mehmet; 0000-0003-2478-9985; 0000-0002-5525-8207; 0000-0002-5826-1997; 0000-0002-3462-7632; 25894187; AAB-5064-2021; AAR-4338-2020; AAB-5345-2021; AAJ-8097-2021Objectives: Living-donor liver transplant has become a viable option and an important source of hepatic grafts. The goal of this study is to establish postoperative pulmonary complications of liver donation surgery in our center. Materials and Methods: Data from 188 subjects (median age, 33.7 +/- 8.4 y; male/female, 51.1%/48.9%) who had liver donation surgery from 1988 to 2013 were analyzed retrospectively. Patient demographic and clinical features were recorded. Postoperative complications and the correlation of risk factors for postoperative pulmonary complications were investigated. Results: The incidence of early postoperative complications was 17% (n = 32), and 16 of these patients had postoperative pulmonary complications (8.5%); 2 of the postoperative pulmonary complications were detected on the day of surgery and the other 14 complications were observed between the second and seventh day after surgery. Most postoperative pulmonary complications were minor complications including atelectasis, pleural effusion, and pneumonia. There was 1 major postoperative pulmonary complication: pulmonary embolism that occurred on the fourth day after surgery in 1 patient. Late pulmonary complications also were reviewed and no late postoperative pulmonary complications were observed. There was no significant difference in early and late postoperative pulmonary complications between ex-smokers and smokers. Postoperative atelectasis was significantly higher in patients with body mass index <= 20 kg/m(2) than patients with body mass index > 21 kg/m(2) (P = .027). In our study population, no postoperative mortality was recorded. Conclusions: We believe that preoperative weight reduction strategies and early mobilization with postoperative respiratory physiotherapy could be important factors to reduce postoperative pulmonary complications in liver donors.Item Association Between Preoperative Pulmonary Risk Scores and Postoperative Complications in Renal Transplant Recipients(2016) Kupeli, Elif; Dedekarginoglu, Balam Er; Ulubay, Gaye; Haberal, Mehmet; 0000-0002-5826-1997; 0000-0003-2478-9985; 0000-0002-3462-7632; 27805520; AAB-5345-2021; AAB-5064-2021; AAJ-8097-2021Objectives: Patients who are being considered for renal transplant must undergo thorough preoperative pulmonary evaluation to determine risk of post operative pulmonary complications. The aim of this study was to determine the relation between the preoperative pulmonary risk factor score and pulmonary complications in patients undergoing renal transplant. Materials and Methods: Medical records of patients who underwent renal transplant at our institution between 2004 and 2015 were retrospectively reviewed. Patient demographics, smoking history, comorbidities, and preoperative pulmonary risk factors (age, oxygen saturation, hemoglobin level, type of incision, duration of surgery, history of lower respiratory tract infection 1 month before surgery, urgency of surgery), and type of pulmonary complications within 1 month after transplant were recorded. Results: Our study included 131 patients (94 male patients; mean age of 38.25 +/- 12.96 y). Of total patients, 21(16%) developed complications during the first month after transplant, with 10 of the 21 (7.6% overall) developing pulmonary complications. These complications were pleural effusion (2 patients), pneumonia (3 patients), respiratory failure (2 patients), and pulmonary embolism (1 patient). There were no deaths directly attributed to the pulmonary complications. A significant correlation was observed between the preoperative pulmonary risk factor score and postoperative pulmonary complications in renal transplant recipients (P =.003). A positive correlation between the preoperative pulmonary scores and postoperative pulmonary complications existed among life-long nonsmokers (r = 0.371; P =.003). Conclusions: Renal transplant is an established modality in treatment of chronic renal failure. Prevention of pulmonary complications is essential for successful outcomes following transplant. Health care professionals involved with renal transplant and transplant centers should be aware of preoperative pulmonary risk factors. Patients should be observed so that these risk factors can be reduced before planned transplant. Moreover, we also suggest that smoking history should be considered as a preoperative pulmonary risk factor as it was found to be a factor leading to postoperative pulmonary complications in our study.Item Role of Procalcitonin in Differential Diagnosis of Pneumonia and Pulmonary Congestion Associated With End-Stage Renal Failure(2016) Akcay, Sule; Dogrul, Ilgaz; Sezer, Siren; Haberal, Mehmet; 0000-0002-8360-6459; 0000-0002-3462-7632; 27805517; AAB-5175-2021; AAJ-8097-2021Objectives: We aimed to determine the role of procalcitonin in distinguishing between infectious and noninfectious causes, specifically the cause of the infiltrative appearances detected on lung radiographs of patients with end-stage renal failure receiving hemodialysis. Materials and Methods: Sixty-six patients between 19 and 87 years of age were enrolled. Patients were divided into 3 groups, with each group consisting of 22 patients: group 1 comprised pneumonia patients without end-stage renal failure, group 2 comprised pulmonary congestion patients with end-stage renal failure, and group 3 were healthy participants. All demographic and clinical characteristics of patients and healthy participants were noted, anteroposterior lung radiographs were taken, and blood samples were obtained for complete blood count, C-reactive protein, and procalcitonin measurements. Patients in group 2 received control posteroanterior lung radiography. Results: Group 1 demonstrated a significantly lower mean procalcitonin value than group 2 (P =.001) but significantly higher mean C-reactive protein and leukocyte levels (P <.05). In terms of mean C-reactive protein and leukocyte levels, there was no difference between groups 2 and 3 (P >.05). The classification performed by recognizing 0.5 ng/mL as the cutoff point for procalcitonin resulted in no significant differences between groups 1 and 2 (P =.103). However, a significant difference (P =.014) was found between these groups when basing the classification as 1.5 ng/mL cutoff point in group 2 and 0.5 ng/mL cutoff point in group 1. Procalcitonin level was below 1.5 ng/mL in all group 2 patients. Conclusions: Our findings support that procalcitonin has no superiority over C-reactive protein in diagnosis of community-acquired pneumonia. Moreover, at procalcitonin values below 1.5 ng/mL in patients with end-stage renal failure who have pulmonary congestion but without clinical signs of infection, infiltrative appearances on lung images may be attributed to hypervolemia, which would in turn prevent unnecessary antibiotic therapies. We believe that measurement of C-reactive protein is still preferable to procalcitonin in revealing the inflammatory response due to its cost-effectiveness and ease in performance and the high diagnostic performance in transplant candidates.