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 A 10-Year Experience of Tuberculosis in Solid-Organ Transplant Recipients(2015) Ulubay, Gaye; Kupeli, Elif; Birben, Ozlem Duvenci; Seyfettin, Emine Pinar; Dogrul, Mustafa Ilgaz; Ugurlu, Aylin Ozsancak; Eyuboglu, Fusun Oner; Haberal, Mehmet; 0000-0002-5525-8207; 0000-0002-3462-7632; 0000-0003-2478-9985; 0000-0003-3598-3986; 0000-0002-5826-1997; 25894157; AAR-4338-2020; AAJ-8097-2021; AAB-5064-2021; AAA-2925-2020; AAB-5345-2021Objectives: Tuberculosis remains an important problem in solid-organ transplant patients due to their immunocompromised state. The objective of the present study was to report the incidence, demographic characteristics, and various presentations of tuberculosis in solid-organ transplant recipients. Materials and Methods: We evaluated a total of 999 patients (male/female = 665/334, 661 renal and 338 liver transplants) who underwent solid-organ transplant between 2003 and 2013. The medical records of all patients were retrospectively reviewed. Patients' demographics, transplant type, primary site of tuberculosis specimen culture and pathology results, chest radiograph, and thoracic computed tomography findings, total blood count and chemistry were all recorded. Results: Among the 999 subjects, 19 patients (1.9%) (male/female: 15/4, mean +/- SD age, 42 +/- 18.5 y) were diagnosed with tuberculosis. The majority of patients (85%) were diagnosed with tuberculosis within 6 months after transplant, and 15% were diagnosed within 3 months. Most diagnoses of tuberculosis were based on histopathologic examination of biopsy material. Of these patients, 9 were diagnosed with pulmonary tuberculosis, 8 had extrapulmonary tuberculosis, and 2 had both. Nontuberculosis mycobacteria infections were detected in 3 patients. Conclusions: Even with a negative exposure history, tuberculosis can manifest as different clinic presentations in solid-organ transplant patients on immunosuppressive drugs, particularly in the first 6 months after transplant. Therefore, clinicians should always consider tuberculosis as the potential cause of an infectious disease with unknown cause to successfully diagnose and manage solid-organ transplant recipients.Item Role of Serum Procalcitonin Levels in Solid-Organ Transplant Patients(2016) Bozbas, Serife Savas; Dedekarginoglu, Balam Er; Ulubay, Gaye; Haberal, Mehmet; 0000-0002-7230-202X; 0000-0003-2478-9985; 0000-0002-3462-7632; 27805529; AAI-8064-2021; AAB-5064-2021; AAJ-8097-2021Objectives: Systemic infection is among the common complications after solid-organ transplant and is associated with increased mortality and morbidity. Because it has prognostic significance, timely diagnosis and treatment are crucial. Procalcitonin is a propeptide of calcitonin and has been increasingly used as a biomarker of bacterial infection. Here, we investigated procalcitonin's role in identifying infectious complications in solid-organ transplant recipients. Materials and Methods: We retrospectively evaluated the records of 86 adult patients who underwent solid-organ transplant (between 2011 and 2015) with procalcitonin levels determined at our center. Clinical and demographic variables and laboratory data were noted. Relation between C-reactive protein and procalcitonin serum levels were compared in patients who were diagnosed as having pneumonia on clinical, microbiologic, and radiologic findings. Results: Mean age of our patients was 45.5 +/- 13.4 years (range, 18-70 y), with 61 male patients (70.9%). We included 26 liver, 44 kidney, 14 heart, and 2 heart and renal transplant recipients. Procalcitonin was positive in 43 patients (50%). Of the 39 patients who were diagnosed with pneumonia, procalcitonin was positive in 18 patients (46.2%). There was a significant correlation between serum levels of procalcitonin and C-reactive protein (r = 0.45; P < .001) and neutrophil count (r = 0.24; P = .025). There was no correlation between mortality and procalcitonin level, CRP level, or leukocyte count (P > .05). Conclusions: Our findings indicate that procalcitonin is a promising biomarker to detect infectious complications in transplant recipients. Physical examination and radiologic findings of bacterial pneumonia may be nonspecific, and in a considerable number of immunocompromised patients the site of infection could not be identified. Serum levels of procalcitonin should not be used as sole criteria for clinical decision making; however, it can guide us in therapy of such conditions in addition to currently used serum markers of infection.Item Culture-Positive Pulmonary Aspergillosis Infection: Clinical and Laboratory Features of Solid-Organ Transplant Recipient(2017) Dedekarginoglu, Balam Er; Bozbas, Serife Savas; Ulubay, Gaye; Eyuboglu, Fusun Oner; Haberal, Mehmet; https://orcid.org/0000-0002-7230-202X; https://orcid.org/0000-0003-2478-9985; https://orcid.org/0000-0002-5525-8207; https://orcid.org/0000-0002-3462-7632; 28260471; AAI-8064-2021; AAB-5064-2021; AAR-4338-2020; AAJ-8097-2021Objectives: Aspergillosis is a common fungal infection among solid-organ transplant recipients. Even after awareness of this infection occurs, there are still gaps in nonculture diagnostic tests, which can delay treatment initiation. Here, we aimed to define the common traits of pulmonary aspergillosis infection among solid-organ transplant recipients, thus shedding light on prevention and early diagnosis. Materials and Methods: We conducted a database search of patients at Baskent University who had a positive aspergillosis culture between January 2010 and March 2016. Among 20 patients identified, 15 (mean age of 50.93 +/- 11.17 y, 2 female and 13 male patients) with solid-organ transplant were included in the study. Results: Of the 15 study patients, 7 were heart transplant, 6 were kidney transplant, and 2 were liver transplant recipients. Three patients had positive aspergillosis cultures from extrapulmonary specimens (1 brain biopsy and 2 wound swap cultures). Other patients with positive cultures were from broncho alveolar lavage (6 patients), sputum (4 patients), both bronchoalveolar lavage and sputum (1 patient), and deep tracheal aspiration specimen (1 patient). Aspergillus fumigatus was the most common species. Mean hospitalization duration was 31.53 days (range, 2-135 d). Although all patients had positive culture results, 7 patients (46.7%) had negative galacto mannan test results at the time of culture specimen collection. Positive galactomannan test results were statistically higher in 6 heart transplant patients (P = .045). All patients had fever at presentation, and 13 patients had been referred to the pulmonary disease department before positive culture results were obtained. Conclusions: Risk factors for pulmonary aspergillosis and its clinical presentation in solid-organ transplant recipients are still unclear. Although the expected time for aspergillosis infection in solid-organ transplant recipients is 6 months after transplant, clinicians must remember the nonspecific presentation of infections in these patients and be aware of the reliability of diagnostic tools.Item Utility of Mean Platelet Volume to Diagnose Pneumonia in Patients With Solid-Organ Transplant(2018) Ulubay, Gaye; Soy, Ebru Ayvazoglu; Serifoglu, Irem; Sozen, Fisun; Moray, Gokhan; Haberal, Mehmet; 0000-0003-2478-9985; 0000-0002-0993-9917; 0000-0002-1951-2693; 0000-0003-2498-7287; 0000-0002-3462-7632; 29528024; AAB-5064-2021; AAC-5566-2019; AAS-6628-2021; AAC-1823-2021; AAE-1041-2021; AAJ-8097-2021Objectives: Despite improved success with solid-organ transplant procedures, recipients remain at risk for infections, including pneumonia, due to their immunosuppressive regimens. In solid-organ transplant patients, clinical findings of pneumonia can be nonspecific, and diagnosis of pneumonia may be difficult as several conditions (drug lung, hypervolemia, infections, hemorrhage) can led to pulmonary infiltrates, mimicking pneumonia in these patients. The role of mean platelet volume, a predictor of inflammatory disease, with elevated values inversely correlated with inflammatory problems, in the diagnosis of pneumonia has not yet been investigated in solid-organ transplant patients. Here, we retrospectively investigated mean platelet volume in diagnosis of pneumonia in transplant patients. Materials and Methods: Medical records of solid-organ transplant patients from 2011 to 2016 were reviewed for demographic, clinical, radiographic, laboratory, and microbiology data. Transplant type, immunosuppressive drugs, and clinical outcomes were noted. Pneumonia diagnosis was based on clinical respiratory symptoms and signs, imaging findings, positive microbiological tests, pathologic findings, laboratory findings, or effective clinical treatment trials. Results: Our study included 70 patients (47 male/23 female; mean age of 46 +/- 14 years), comprising 26 liver and 44 renal transplant recipients. Pneumonia was diagnosed radiologically in 30 patients (42.9%), with procalcitonin positive in 11 patients (36.7%), C-reactive protein elevated in 29 patients (96.7%), and leukocytes increased in 6 patients (20%). When laboratory measurements were compared with mean platelet volume, mean platelet volume values were significantly lower in patients with pneumonia who had elevated procalcitonin levels (P=.038). Conclusions: We found that mean platelet volume for diagnosis of pneumonia in solid-organ transplant patients was not a promising tool. Considering the difficulties in caring for transplant patients with pulmonary infiltrates, clinical decisions should be based on clinical, laboratory, microbiological, and radiologic findings.