Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item The Impact of COVID-19 Infection on Hemodialysis Patients vs Kidney Transplant Patients(2023) Tasci, Halil Ibrahim; 38131360AIM: AS in the whole world, there has been a decrease in the number of both cadaveric and living-donor kidney transplants in our country due to the COVID-19 pandemic. This study aimed at comparing the data of patients who previously underwent a kidney transplant in our clinic and patients on hemodialysis treatment and were diagnosed with COVID-19 during their follow-ups to find answer to the question "Should we postpone kidney transplants during the pandemic or perform transplants as soon as possible?". MATERIAL AND METHOD: Among those diagnosed with COVID-19 during follow-ups between March 2020 and March 2021 and treated on an inpatient or outpatient basis, the data of patients who previously underwent a kidney transplant in Baskent University Faculty of Medicine, Department of Transplantation, Konya Practice and Research Hospital and hemodialysis patients followed up by the Nephrology Clinic were retrospectively analyzed. RESULTS: In our study, intensive care stay (Group 1:48.8%, Group 2: 40.4%, P=.34), intubation requirement (Group 1: 35%, Group 2: 34.6%, P=.96) and mortality (Group 1: 36.3%, Group 2: 34%, P=.84) rate was higher in the hemodialysis group, although no statistically significant difference was found. CONCLUSION: All this literature information and our study suggests that mortality rates were statistically similar or lower for transplant group. So it is unnecessary to delay kidney transplantation in patients with appropriate indications.Item Relation of Anxiety, Depression, and Behavioral Problems With Time Allocated to Television, Computer, and Smartphone in Children Receiving Renal Replacement Therapy(2022) Taner, Hande Ayraler; Baskin, Esra; Kaya, Zulal Torenli; Sari, Burcu Akin; Taskiran, Candan; Akdur, Aydincan; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0003-1428-0739; https://orcid.org/0000-0002-9730-7206; https://orcid.org/0000-0002-3462-7632; 35384817; AAK-7065-2021; S-3910-2019; AAJ-8097-2021Objectives: Children and adolescents with chronic diseases have more screen exposure time compared with their healthy peers. In this study, we investigated screen exposure time of children who received renal replacement therapy, which included kidney transplant and dialysis treatment, versus a healthy control group. Materials and Methods: Our study included 55 children and adolescents between the ages of 8 and 18 years. Although 28 participants did not have any chronic disease, 27 had chronic diseases and received renal replacement therapy. Among these patients, 17 had kidney transplant and 10 were receiving dialysis. A sociodemographic information form and the Conners Short-Form Parent Rating Scale were given to parents. Pediatric and adolescent patients completed the Children's Depression Inventory and Spielberger State-Trait Anxiety Scale-2. We analyzed differences between the groups with and without renal replacement therapy and examined relations between continuous variables. Results: Duration of television screen time was significantly higher in children and adolescents receiving renal replacement therapy. Patients in the renal replacement therapy group showed a positive correlation between the Conners Short-Form Parent Rating Scale anxiety subscores and duration of smartphone use. In the kidney transplant recipient group, smartphone and computer durations were positively correlated and television duration was negatively correlated with the Conners Short-Form Parent Rating Scale behavioral problems subscores. Conclusions: Children on renal replacement therapy may be at risk in terms of excessive television exposure. Children who are on dialysis and have had a kidney transplant may be more prone to the negative effects of screen exposure than healthy peers who do not have chronic illnesses. These children and adolescents should be closely monitored to avoid the negative effects of excessive screen exposure.Item Primary Focal Segmental Glomerulosclerosis Recurrence After Pediatric Renal Transplantation(2022) Baskin, Esra; Avci, Begum; Gulleroglu, Kaan; Akdur, Aydincan; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-5375-379X; https://orcid.org/0000-0003-1434-3824; https://orcid.org/0000-0002-3462-7632; 35384808; GYU-5220-2022; AAJ-8833-2021; AAJ-8097-2021Objectives: Focal segmental glomerulosclerosis recurrence after renal transplant occurs frequently in pediatric patients and is associated with poor graft survival when patients reach adulthood. We investigated recurrence rates, recurrence risk factors, management strategies, and long-term graft function among pediatric renal transplant recipients with focal segmental glomerulosclerosis as primary disease. Materials and Methods: We retrospectively evaluated medical records of 34 pediatric patients with primary focal segmental glomerulosclerosis who had undergone renal transplant between 2004 and 2019 at our center. Focal segmental glomerulosclerosis recurrence was diagnosed by the presence of nephrotic range proteinuria after transplant and confirmed by graft biopsy. Preoperative prophylactic plasma exchange was administered to pediatric renal transplant recipients with primary focal segmental glomerulosclerosis. Plasma exchange was also used to treat focal segmental glomerulosclerosis recurrence, with rituximab added if the patient did not respond to plasma exchange. Results: All patients (male-to-female ratio of 19:15) in our group underwent renal transplant. Mean patient age at the time of transplant was 12.72 +/- 5.46 years. Twenty-nine patients received livingrelated donor allografts (85.3%) and 5 received organs from deceased donors (14.7%). We identified focal segmental glomerulosclerosis recurrence in 5 recipients (14.7%). Time from focal segmental glomerulosclerosis diagnosis to end-stage renal disease and duration of dialysis were shorter in the recurrence group than in the nonrecurrence group (48.4 months [range, 2-90 mo] vs 65.1 months [range, 8-123 mo] and 1.41 +/- 0.82 vs 3.18 +/- 1.88 years, respectively; P <.05). Donor type and transplant age were similar in both groups. Of those with recurrence who had received plasma exchange and rituximab, 3 patients (75%) had complete remission and 1 patient (25%) had partial remission. Conclusions: Prophylactic plasma exchange and the combined plasma exchange-rituximab regimen for treatment of focal segmental glomerulosclerosis recurrence resulted in low recurrence and good remission rates in our pediatric cohort.Item Significant Improvement of Cardiac Dysfunction After Kidney Transplant: A Case Report(2022) Sayin, Begum Yetis; Karacaglar, Emir; Ozin, Bulent; 36377806Kidney transplant is known to reverse cardiac dysfunction in patients with end-stage renal disease, and low ejection fraction in kidney transplant candidates is considered to be a contraindication for transplant. We present a significant improvement in cardiac dysfunction after successful kidney transplant in a 21-year- old male recipient. Kidney transplant may be beneficial for cardiac function in transplant recipients who have impaired cardiac function prior to the procedure and caused by uremic toxins.Item The Role of Platelet-Lymphocyte Ratio and Neutrophil-Lymphocyte Ratio in Predicting the Delayed Graft Function in Pediatric Renal Transplant Patients(2022) Siddiqui, Meraj Alam; Baskin, Esra; Gulleroglu, Kaan Savas; Yilmaz, Aysun Caltik; Moray, Gokhan; Haberal, Mehmet; 0000-0003-1434-3824; 0000-0002-5739-6590; 0000-0003-0774-4419; 0000-0002-3462-7632; 35570615; AAJ-8833-2021; ABF-7609-2022; AAD-1877-2021; AAJ-8097-2021Objectives: Delayed graft function is a common adverse outcome after renal transplant. Attempts for early prediction and prevention of delayed graft function are often challenging and misleading. Herein, we investigated for the first time the correlation between delayed graft function and preoperative noninvasive hematologic parameters to predict the possible adverse outcomes for renal transplant in pediatric patients. Materials and Methods: In this study, preoperative hematologic parameters of 51 pediatric renal transplant recipients followed between 2015 and 2021 were analyzed retrospectively. The selected 16 renal transplant patients with delayed graft function and 35 patients without delayed graft function had no concomitant comorbidities. The cutoff values for platelet-to-lymphocyte ratio of <5 and neutrophil-to-lymphocyte ratio of <175 were considered low. Results: We retrospectively evaluated a total of 51 (male/female, 33/18) pediatric kidney transplant recipients with a median age of 12 (interquartile range, 8-18) years. Median level of circulating lymphocytes was significantly higher in patients with delayed graft function compared with patients without delayed graft function (2 vs 1, P = .040). The preoperative low values for platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were more prevalent in recipients who developed delayed graft function versus those who did not develop delayed graft function (68.8% vs 31.4% [P = .014] and 68.8% vs 34.3% [P = .023], respectively). Conclusions: Pretransplant low platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte were associated with increased number of delayed graft dysfunction. These novels and noninvasive inflammatory biomarkers may contribute to an early prediction of delayed graft function in pediatric kidney transplant recipients.Item Macular Vessel Density Measurement in Pediatric Renal and Liver Transplant(2022) Sezenoz, Almila Sarigul; Tortumlu, Gokhan; Akkoyun, Imren; Oto, Sibel; Haberal, Mehmet; 0000-0002-2860-7424; 0000-0002-3462-7632; 0000-0003-0171-4200; 0000-0002-7030-5454; 35570609; AAK-7713-2021; AAJ-8097-2021; AAJ-4668-2021; AAJ-4860-2021Objectives: Microcirculatory dysfunction is known to be associated with organ failure and increased mortality in transplant patients. Noninvasive monitorization of retinal structures of the eye could be a predictor for systemic microvasculature in these patients. Therefore, in this study we aimed to evaluate the retinal microvascular changes in pediatric patients who had undergone liver or renal transplant surgery, using optical coherence tomography angiography. Materials and Methods: The medical records of pediatric patients who had liver or renal transplant in the past 10 years were reviewed. The macular vessel density parameters were obtained by optical coherence tomography angiography (Avanti RTVue XR). The results were compared with the age-matched, sex-matched, and spherical equivalent-matched healthy participants (control group). The IBM SPSS (version 25.0) statistics program was used for data analysis. Results: We included 32 eyes of 16 liver transplant patients, 20 eyes of 10 renal transplant patients, and 64 eyes of 32 healthy participants (control group). Superficial macular whole image, superficial perifoveal, and deep foveal vessel densities were found to be lower in the liver transplant group compared with the healthy control group (P = .02, P = .01, and P = .01, respectively). Superficial foveal, deep macular whole image, deep foveal, and deep perifoveal vessel densities were found to be lower in the renal transplant group compared with the healthy control group (P = .03, P = .04, P = .01, and P = .02, respectively). Conclusions: Macular vessel density measurements are affected in pediatric renal and liver transplant patients. In those patients, retinal optical coherence tomography and optical coherence tomography angiography measurements may provide a noninvasive window to the microcirculation.Item 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-8097-2021Objectives: 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.Item Fragmented QRS on 12-Lead Electrocardiogram Is Correlated With Severe Coronary Artery Disease and Abnormal Myocardial Perfusion Scintigraphy Results in Renal Transplant Candidates(2018) Ciftci, Orgun; Keskin, Suzan; Karacaglar, Emir; Yilmaz, Kerem Can; Aktas, Ayse; Sezer, Siren; Moray, Gokhan; Muderrisoglu, Ibrahim Haldun; Haberal, Mehmet; 0000-0001-8926-9142; 0000-0002-2538-1642; 0000-0003-2498-7287; 0000-0002-3462-7632; 30066622; W-5233-2018; ABI-6723-2020; AAJ-1331-2021; AAE-1041-2021; AAJ-8097-2021Objectives: Coronary artery disease is a major cause of mortality and morbidity after renal transplant. Fragmented QRS on standard 12-lead electrocardiograms has been proposed as a marker of myocardial scar, mainly due to coronary artery disease. Here, we aimed to investigate fragmented QRS to detect severe coronary artery disease in renal transplant candidates. Materials and Methods: We retrospectively reviewed the medical records of 534 patients with end-stage renal failure who were on the deceased-donor renal transplant wait list at Baskent University Faculty of Medicine due to having no living kidney donor available. We evaluated patients with standard 12-lead electrocardiograms, myocardial perfusion scintigraphy, and coronary angiography. We compared fragmented QRS prevalence versus myocardial perfusion scintigraphy abnormalities and severe coronary artery disease. Correlations among these were analyzed. Results: Of 92 renal transplant candidates (median age of 56.5 y; range, 24-80 y), 87 patients (94.6%) had myocardial perfusion defects and 72 (78.3%) had myocardial wall motion abnormalities on myocardial perfusion scintigraphy. Forty-four patients (47.8%) had severe coronary artery disease on coronary angiography, and 51 patients (55.4%) had fragmented QRS. Fragmented QRS was significantly more common among patients with myocardial scar. Coronary artery disease was significantly more common in patients with fragmented QRS (P = .042) and in those with fragmented QRS combined with myocardial perfusion defects (P < .01). Fragmented QRS was significantly correlated with presence of myocardial scar and any perfusion defects. When combined with myocardial perfusion defects, fragmented QRS was significantly correlated with severe coronary artery disease (P < .05). Conclusions: Fragmented QRS was significantly correlated with abnormal myocardial perfusion scintigraphy and severe coronary artery disease in renal transplant candidates.This simple parameter can provide valuable information on severe coronary artery disease and help to prevent excess patient morbidity and mortality from this disease after renal transplant.Item Utility Of Continuous Performance Test (MOXO-CPT) In Children With Pre-Dialysis Chronic Kidney Disease, Dialysis And Kidney Transplantation(2022) Buyukkaragoz, Bahar; Soysal Acar, A. Sebnem; Ekim, Mesiha; Bayrakci, Umut Selda; Bulbul, Mehmet; Caltik Yilmaz, Aysun; Bakkaloglu, Sevcan A.; 000829126000001Background Children with chronic kidney disease and on kidney replacement therapy may have neurocognitive and psychosocial disorders. Although kidney transplantation improves quality of life, psychological problems may exist in children who undergo kidney transplantation. Herein, we aimed to investigate attention-deficit hyperactivity disorder-like symptoms with MOXO-continuous performance test in children with pre-dialysis chronic kidney disease, dialysis and kidney transplantation. Methods The MOXO-continuous performance test measures four domains of attention-deficit hyperactivity disorder-like symptoms, including attention, timeliness, hyperactivity and impulsivity. Patients with at least three scores < - 1.5 standard deviations were considered as positive to MOXO-continuous performance test. Test scores of the pre-dialysis chronic kidney disease, dialysis (divided into peritoneal dialysis and hemodialysis subgroups) and kidney transplantation groups were compared. Correlations of test scores with the patient's clinical and laboratory characteristics and effects of hospitalizations and schooling were assessed. Results Seventy-two patients aged 13.3 +/- 3.4 years (23 with kidney transplantation, 23 on dialysis and 26 with pre-dialysis chronic kidney disease) were evaluated. Overall MOXO-continuous performance test positivity was 29%. No differences were detected between the three groups concerning total or z scores. Attention and timeliness z scores were significantly higher in females (p = 0.004 and p = 0 .008 , respectively). Age was positively correlated to attention and timeliness total scores (p = 0.000, r = 0.445 and p = 0.004, r = 0.243, respectively), and inversely correlated to hyperactivity total scores (p = 0.000, r = - 0.415). Conclusions Prevalence of attention-deficit hyperactivity disorder-like symptoms in the study population was much higher than that of pediatric attention-deficit hyperactivity disorder. We believe that the MOXO-continuous performance test is a valid supportive measure for evaluation of attention-deficit hyperactivity disorder diagnosis in children with various stages of chronic kidney disease or on kidney replacement therapy.Item Acoustic Radiation Force Impulse Elastography Findings of Achilles Tendons in Patients on Chronic Hemodialysis and in Renal Transplant Patients(2021) Rahatli, Feride Kural; Turnaoglu, Hale; Haberal, Kemal Murat; Kirnap, Mahir; Fidan, Cihan; Sayin, Cihat Burak; Uslu, Nihal; Haberal, Mehmet; 0000-0002-8211-4065; 0000-0002-9093-1524; 0000-0002-9093-1524; 30398098; R-9398-2019; F-5830-2019; F-5830-2019Objectives: The Achilles tendon, which is composed of tendinous parts of gastrocnemius and soleus muscles, is the strongest and the largest tendon in the human body. Chronic renal disease can lead to reduced physical activity and exercise capacity. Spontaneous rupture of the Achilles tendon can occur in patients with chronic renal failure, with recurrent microtraumas, hypoxia, and chronic acidosis as predisposing factors. Here, we assessed and compared the elastographic findings in the Achilles tendon using acoustic radiation force impulse elastography in patients on chronic hemodialysis, in renal transplant patients, and in healthy volunteers. Materials and Methods: Our study included 25 patients on chronic hemodialysis, 25 renal transplant patients, and 25 healthy individuals (control group). The thickness and shear wave velocity of the Achilles tendons were measured bilaterally by ultrasonography and acoustic radiation force impulse elastography. Results: The mean shear wave velocity was 3.67 m/s in the right and 3.64 m/s in the left Achilles tendon in the hemodialysis group. In the renal transplant group, the mean shear wave velocity was 4.29 and 4.25 m/s for the right and left Achilles tendon, respectively. In the control group, the mean shear wave velocity was 6.68 and 6.59 m/s, respectively for the right and left Achilles tendon. A statistically significant difference in shear wave velocities was shown among the groups (P<.05). Conclusions: Achilles tendons in patients with chronic renal failure and on hemodialysis were softer than in renal transplant patients and softer than in the control group. Chronic tendinopathy causes softening of the tendon. In the renal transplant group, stiffness of the Achilles tendon was increased versus the hemodialysis group but still softer than the control group, which could be explained as a positive clinical effect of renal transplant. Acoustic radiation force impulse elastography is an objective, easy, and noninvasive method to assess Achilles tendinopathy.