Tıp Fakültesi / Faculty of Medicine

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

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Subject: search.filters.subject.Cytomegalovirus

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    Infections in Liver Transplant Recipients
    (2014) Arslan, Hande; https://orcid.org/0000-0002-5708-7915; 24635787; ABG-7034-2021
    Liver transplant is a life-saving procedure for many end-stage liver diseases. Despite measures such as the use of protective barriers, antimicrobial prophylaxis, and vaccination, infections still represent a major cause of morbidity and mortality after liver transplant. This article reviews major infectious concerns after liver transplant.
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    Early Postoperative Infections After Liver Transplant
    (2018) Soy, Ebru H. Ayvazoglu; Akdur, Aydincan; Yildirim, Sedat; Arslan, Hande; Haberal, Mehmet; 0000-0002-0993-9917; 0000-0002-8726-3369; 0000-0002-5735-4315; 0000-0002-5708-7915; 0000-0002-3462-7632; 29528013; AAC-5566-2019; AAA-3068-2021; AAF-4610-2019; ABG-7034-2021; AAJ-8097-2021
    Objectives: Despite surgical advances and effective prophylactic strategies in liver transplant, infection is still a major cause of morbidity and mortality. Up to 80% of liver recipients will develop at least 1 infection during the first year after liver transplant. The spectrum and manifestations of these infections are broad and variable. Their diagnosis and treatment are often delayed because immunosuppressive therapy diminishes inflammatory responses. However, if an infection is not identified early enough and treated properly, it can have devastating consequences. In addition, prophylactic approaches remain controversial. Our aim was to review our early postoperative infection management after liver transplant. Materials and Methods: We retrospectively evaluated infections that occurred during the first hospital stay of transplant patients. Infections were grouped as surgical site and nonsurgical site infections. Consequences and treatment protocols of infections were stratified according to the Clavien scale. Results: Between December 1988 and January 2017, we performed 561 liver transplants at our center (patient age range, 6 months to 64 years), which included 401 living-donor (72%) and 160 deceased-donor (28%) liver transplants. Early postoperative infections were detected in 131 patients (23.3%), comprising 67 surgical site (51%), 56 nonsurgical site (43%), and 8 combined surgical and nonsurgical site infections (6%). Although no mortalities occurred in patients with single nonsurgical or surgical site infections, there were 4 mortalities in patients with combined surgical and nonsurgical site infections. In the 4 other patients with combined infections, 3 patients required endoscopic or radiologic intervention and 1 recovered from single-organ dysfunction. Conclusions: Initiation of appropriate prophylactic and therapeutic protocols at the right time decreases morbidity and mortality due to infection in liver transplant recipients. Increased understanding and effective approaches to prevent infection are essential to improving both graft and recipient survival.
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    Renal Allograft With Calcium Oxalate Deposition: Association with Urinary Tract Infection and Development of Interstitial Fibrosis
    (2018) Ozdemir, B. Handan; Ayva, Sebnem; Ozdemir, Gokce; Atilgan, Alev Ok; Ozdemir, F. Nurhan; Haberal, Mehmet; 0000-0002-7528-3557; 0000-0002-2280-8778; 0000-0003-2545-0078; 0000-0001-8595-8880; 0000-0002-5682-0943; 0000-0002-3462-7632; 29528009; X-8540-2019; AAK-1967-2021; AAL-4282-2020; AAK-3333-2021; AAK-1697-2021; AAJ-8097-2021
    Objectives: The interaction between calcium oxalate deposition and urinary tract infection is not well established. We aimed to identify the association between these and to determine the role of calcium oxalate deposition on interstitial fibrosis development. Materials and Methods: Renal allograft biopsies of 967 patients were reviewed to identify those with calcium oxalate deposition in the renal allograft, with 27 (2.8%) identified. Follow-up biopsies were conducted to reevaluate for calcium oxalate presence and interstitial fibrosis development. At time of biopsy, presence of urinary tract infection and oxaluria was also examined from medical records. Results: Mean time for development of calcium oxalate deposition in renal allografts was 1.7 +/- 0.4 and 32.7 +/- 21.6 months in patients with primary and secondary oxalosis, respectively (P < .001). Of 27 patients with calcium oxalate deposition, 7 (25.9%) showed tubulointerstitial nephritis, with 2 also having urinary tract infection. Four patients (14.8%) had only urinary tract infection. Causes of tubulointerstitial nephritis were secondary to bacterial infection in 2 and secondary to viral infection in 5 patients (2 polyomaviruses, 2 cytomegaloviruses, 1 adenovirus). Time until development of interstitial fibrosis after calcium oxalate deposition was 3.5 +/- 2.1 and 10.3 +/- 4.1 months in patients with primary and secondary oxalosis, respectively (P = .01). Time until graft loss after calcium oxalate deposition was 9.3 +/- 7.8 and 21.8 +/- 12 months in those with primary and secondary oxalosis (P < .001), with 1-, 3-, and 5-year kidney graft survival of 43%, 28%, and 0% and 100%, 100%, and 67% in those with primary and secondary oxalosis, respectively. Conclusions: Calcium oxalate deposits increased the risk of urinary tract infection and tubulointerstitial nephritis, with bacteria inducing increased presence of calcium oxalate deposition in a renal allograft. Calcium oxalate deposition had a significant influence on interstitial fibrosis development, therefore negatively affecting graft survival.