Tıp Fakültesi / Faculty of Medicine

Permanent URI for this collectionhttps://hdl.handle.net/11727/1403

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Author: search.filters.author.Soy, Ebru H. AyvazogluSubject: search.filters.subject.Kidney transplantation

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    Vascular Complications After Renal Transplant: A Single-Center Experience
    (2017) Soy, Ebru H. Ayvazoglu; Akdur, Aydincan; Kirnap, Mahir; Boyvat, Fatih; Moray, Gokhan; Haberal, Mehmet; 0000-0002-8726-3369; 0000-0003-2498-7287; 0000-0002-0993-9917; 0000-0002-3462-7632; 28260440; AAA-3068-2021; AAH-9198-2019; AAE-1041-2021; F-4230-2011; AAC-5566-2019; AAJ-8097-2021
    Objectives: Despite surgical and medical advances, vascular complications are still among the major concerns after renal transplant, with a reported incidence of 3% to 15%. We evaluated the incidence and management of our transplant team's vascular complications over 40 years. Materials and Methods: From November 1975 to the present, we have performed a total of 2594 renal transplant procedures. Of these, 1997 grafts (76%) were obtained from living donors, and 597 grafts (24%) were obtained from deceased donors. All renal transplant procedures, including those performed in pediatric patients, used the extraperitoneal approach to the contralateral iliac fossa. Revascularization was performed for all grafts. A single end-to-end internal iliac artery anastomosis was performed in 1082 patients (41.8%), an end-to-side external iliac artery anastomosis was performed in 1289 patients (49.7%), and an end-to-side common iliac artery anastomosis was performed in 66 patients (2.5%). In 157 procedures (6%), there were at least 2 renal arteries, and both internal iliac arteries or external iliac arteries were used for anastomosis. Results: We observed 57 vascular complications (2.1%) in 54 renal transplant procedures. The most frequent complication was renal artery stenosis (n = 17; 0.6%). There were 8 instances of renal artery thrombosis (0.4%), 7 of renal artery kinking (0.3%), 5 of renal vein thrombosis (0.2%), 9 of renal vein kinking (0.5%), 3 of external iliac artery dissection (0.01%), 5 renal vein lacerations (0.2%), and 3 renal artery lacerations (0.01%). We performed urgent surgery for 41 vascular complications; 38 were managed successfully. Percutaneous interventional techniques were used successfully for 18 vascular complications. Conclusions: The vascular complication rate in our patients is lower than that reported in the literature. Surgical complications can be minimized with careful transplant technique and close follow-up, as early diagnosis is crucial to early management and successful treatment of complications.
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    The New Anterior Less Invasive Crescentic Incision for Living Donor Nephrectomy
    (2020) Haberal, Mehmet; Soy, Ebru H. Ayvazoglu; Akdur, Aydincan; AlShalabi, Omar; Yildirim, Sedat; Moray, Gokhan; Torgay, Adnan; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-0993-9917; 0000-0002-6829-3300; 0000-0003-2498-7287; 33143599; AAA-3068-2021; AAJ-8097-2021; AAF-4610-2019; AAC-5566-2019; AAJ-5221-2021; AAE-1041-2021
    Objectives: Living-donor nephrectomy is a devoted procedure performed in a healthy individual; for these procedures, it is essential to complete the surgery with the lowest possible risk and morbidity and allow donors to regain their normal daily activity. To minimize anatomic and physiologic damage, we modified a surgical technique. Here, we report our experiences with the new anterior less invasive crescentic donor nephrectomy technique. Metarials and Methods: We retrospectively evaluated 728 donor nephrectomy patients who had the new anterior less invasive cresentic incision (n = 224), the classic open (n = 431), or the laparoscopic living-donor nephrectomy (n = 73) procedures. Demographic characteristics, preoperative and postoperative parameters, acute renal graft dysfunction, and firstyear graft and patient survival rates were compared between groups. Results: During the operation, the new cresentic incision living-donor nephrectomy allowed a safe and comfortable position for the patient and the anesthesiologist. Also, it procures safe access especially for grefts with multiple vessels. Patients had lower pain scores (P = .010), shorter hospital stays (2.25 vs 3.49 days) than those who received the classic open living-donor nephrectomy. Patients who received laparoscopic living-donor nephrectomy had significantly longer mean operation time (P = .016) and warm ischemia time (P <= .001) than those who had the new cresentic incision technique. All groups showed similar rates of first-year survival and delayed graft dysfunction. Conclusions: The new anterior less invasive cresentic incision open-donor nephrectomy approach is a safe, comfortable, effective, and less invasive modification of the living donor nephrectomy. Also, it procures safe access for grefts with multiple vessels.