Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
Browse
8 results
Search Results
Item The African Variant of BKV in A Turkish Renal Transplant Patient(2014) Colakoglu, Sule; Dursun, Hasan; Cengiz, Nurcan; Bulat, Meryem Cosar; Noyan, Aytul; https://orcid.org/0000-0002-8817-494X; 24726687; AAB-7105-2020; GPX-7059-2022; AAD-5713-2021In renal transplant recipients, BK polyomavirus (BKV) is linked to nephropathy. BK virus genotypes have a strong geographic component. This paper presents the African variant of BKV in a Turkish renal transplant patient, which is a rare cause of infection in the Northern Hemisphere and, to our knowledge, the first case from Turkey. (C) 2014 Elsevier Inc. All rights reserved.Item Long-Term Outcomes of Kidney Transplant Recipients With Juvenile Nephronophthisis(2022) Avci, Begum; Baskin, Esra; Gulleroglu, Kaan; Yilmaz, Aysun Caltik; Kantar, Asli; Akdur, Aydincan; Moray, Gokhan; Haberal, Mehmet; 0000-0003-1434-3824; 0000-0003-0774-4419; 0000-0002-3462-7632; 35570616; AAJ-8833-2021; AAD-1877-2021; AAJ-8097-2021Objectives: Nephronophthisis is the most common genetic cause of kidney failure in childhood. Treatment for nephronophthisis is symptomatic, and kidney transplant is a good treatment option when kidney failure has developed. We reported the outcomes of kidney transplant recipients with primary diagnosis of juvenile nephronophthisis who were followed-up in our center. Materials and Methods: We retrospectively examined medical records of 17 kidney transplant patients with a primary diagnosis of juvenile nephronophthisis. We compared this group of 17 patients with kidney transplant recipients who had other etiologies of kidney failure in terms of transplant age, donor type, immunosuppressive treatment, acute rejection, graft loss rates, and glomerular filtration rates at 1 and 5 years posttransplant (N = 180 total analyzed). Results: Among 180 kidney transplant recipients, the 17 patients (9.4%) with nephronophthisis had a mean age of 12.6 +/- 4.3 years and mean follow-up time posttransplant of 79.5 +/- 41.9 months. Five of 17 patients received a kidney transplant from a deceased donor (29.4%), and the remaining 12 patients (70.6%) received transplants from living related donors. Preemptive kidney transplant was performed in 4 patients (23.5%). There was a statistically significant difference (P < .05) in terms of acute rejection between patients with nephronophthisis (17.6%) versus patients with other primary diagnoses (34%). However, the patients with nephronophthisis versus those with other primary diagnoses were similar (P > .05) in terms of transplant age (12.6 +/- 4.3 vs 13.8 +/- 6.7 years, respectively) and follow-up time (79.5 +/- 41.9 vs 59.1 +/- 38.8 months, respectively). Donor type, immunosuppressive treatment, and 1-year (96.7 +/- 23.2 vs 97.6 +/- 28.4 mL/min/1.73 m(2)) and 5-year (84.7 +/- 31.1 vs 86.7 +/- 21.7 mL/min/1.73 m(2)) glomerular filtration rates were also similar (P > .05) between groups. Conclusions: Posttransplant prognosis was good among kidney transplant recipients with juvenile nephronophthisis.Item Incidence of Urinary Complications With Double J Stents in Kidney Transplantation(2019) Kirnap, Mahir; Boyvat, Fatih; Torgay, Adnan; Moray, Gokhan; Yildirim, Sedat; Haberal, Mehmet; https://orcid.org/0000-0002-6829-3300; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-5735-4315; https://orcid.org/0000-0002-3462-7632; 30777542; AAH-9198-2019; F-4230-2011; AAJ-5221-2021; AAE-1041-2021; AAF-4610-2019; AAJ-8097-2021Objectives: Ureteral complications remain a major source of morbidity and occasional mortality in renal transplant. Among all ureteral complications, leaks are the most frequently encountered in the early posttransplant period. The routine use of a double-J ureteric stent remains controversial, with reported increased incidence of urinary tract infection. Here, we retrospectively compared the efficacy of a double J stent in kidney transplant patients to investigate ureteral complication incidence in our center. Materials and Methods: Our study included 382 kidney transplant patients. At 5 weeks after transplant, the double J stent was removed under sedation. Patients were divided into 2 groups: 125 patients with double J stent placement (group 1) and 257 patients without double J stent placement (group 2). Results: We observed no significant demographic differences between the 2 groups with regard to patient age (median patient age of 30 y [range, 2-73 y] for group 1; median patient age of 33 y [range, 4-69 y] for group 2), patient sex (30.2% females in group 1, 32.4% females in group 2), and body mass index (median of 25.1 vs 24.9 kg/m 2 in groups 1 and 2, respectively). Cold and warm ischemia time for donor organ, delayed graft function, and episodes of acute rejection did not differ significantly between the groups. Urinary tract infection was observed in 25/125 (20.4%) and 50/257 patients (19.2%) in groups 1 and 2, respectively. Urinary leak was present in 8/125 group 1 (6.4%) and 6/257 group 2 patients (2.3%). Conclusions: A double J stent in ureteral anastomosis was not likely to decrease the frequency of leakage but is likely to reduce the gravity of the complication and the need for reoperation. In addition, the use of a double J stent was not associated with increased urinary tract infections in renal transplant recipients.Item Rituximab Therapy and Infection Risk in Pediatric Renal Transplant Patients(2016) Gulleroglu, Kaan; Baskin, Esra; Moray, Gokhan; Ozdemir, Handan; Arslan, Hande; Haberal, Mehmet; https://orcid.org/0000-0003-1434-3824; https://orcid.org/0000-0003-4361-8508; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0002-5708-7915; https://orcid.org/0000-0002-3462-7632; 26742572; AAJ-8833-2021; B-5785-2018; AAE-1041-2021; X-8540-2019; ABG-7034-2021; AAJ-8097-2021Objectives: Rituximab is a monoclonal antibody directed against the CD20 molecule on pre-B and mature B cells and is used in transplant recipients for the prevention and treatment of alloantibody-mediated rejection or for the treatment of disease recurrence after transplant. In most patients, rituximab has been safe and well-tolerated, but the long-term adverse effects of rituximab are currently unknown. Materials and Methods: We retrospectively evaluated 78 pediatric renal transplant recipients for the occurrence of infectious disease. Patients who received rituximab therapy were divided into 2 groups: those who developed an infection and those who did not. The 2 groups were compared for serious infections, hospitalization, graft loss, and death rates. Results: Eighteen transplant patients received rituximab therapy for various causes. The number of rituximab courses given varied according to the cause and ranged from 1 to 8 courses. The dose at each course was 375 mg/m(2). Median age of all recipients was 16.00 years (min-max:, 5.00-22.00 y), and median follow-up time was 2.00 years (min-max:, 1.00-3.00 y). Serious infections (bacterial sepsis, tuberculosis, Cytomegalovirus infection, varicella-zoster virus infection, Polyomavirus-associated nephropathy, and acute pyelonephritis) were observed in 8 patients who received rituximab therapy. We observed that patients with antibody-mediated rejection had significantly increased infection rate. Patients who had used rituximab combined with antithymocyte globulin and higher rituximab course number and higher pretreatment CD19 and CD20 levels had higher risk of infection (P<.05). Conclusions: The combined use of rituximab with additional treatments such as antithymocyte glob ulin, intravenous immunoglobulin, and repeated plasma exchange may be associated with high risk of infectious disease. Especially for those patients who required intensive and repetitive treatment, such as antibody-mediated rejection, rituximab treatment should be used with caution. Infection risk should be closely monitored, although mainly in patients who receive T-cell-depleting agents.Item Doppler Ultrasonography Findings During Recovery Period of Transplanted Kidney After Infarction and Necrosis Due to Renal Vein Thrombosis: A Case Report(2017) Ozturk, Funda Ulu; Uslu, Nihal; Akcay, Eda Yilmaz; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-6733-8669; 0000-0001-6831-9585; 28260477; AAJ-8097-2021; ABC-5258-2020; AAK-1960-2021A 47-year-old male patient underwent living-related renal transplant. On day 3 posttransplant, without evidence of associated clinical symptoms, the patient's serum creatinine levels had increased. The patient was given immunosuppressive medication, and a follow-up Doppler ultrasonography revealed hypoechoic areas in the inferior pole of the renal parenchyma. Eventually, on day 25, there was no perfusion in the superior and inferior poles of the transplanted kidney. No venous flow was shown in the middle segment, and only arterial vascularization with a high resistive index and negative diastolic phase was observed. Renal biopsy showed acute humoral rejection. This was interpreted as venous thrombosis secondary to acute humoral rejection. Tissue plasminogen activator infusion, plasmapheresis, and hemodialysis were administered. After 1.5 months, arterial flow returned to its normal pattern and the renal allograft recovered by gaining back its full vascularity at the end of month 8.Item Timing for Removal of Peritoneal Dialysis Catheters in Pediatric Renal Transplant Patients(2016) Melek, Engin; Baskin, Esra; Gulleroglu, Kaan Savas; Kirnap, Mahir; Moray, Gokhan; Haberal, Mehmet; 0000-0003-4361-8508; 0000-0003-1434-3824; 0000-0003-2498-7287; 0000-0002-3462-7632; 27805518; B-5785-2018; AAJ-8833-2021; AAH-9198-2019; AAE-1041-2021; AAJ-8097-2021Objectives: Peritoneal dialysis, the preferred long-term renal replacement modality in the pediatric population, can also be used during the post transplant period. Although it is well known that peritonitis or other complications may occur related to the peritoneal dialysis catheter, less is known about complications related to the peritoneal dialysis during the post transplant period. Our objective was to evaluate the complications related to use of a peritoneal dialysis catheter during the posttransplant period and to determine the optimum time for removal of the peritoneal dialysis catheter. Material and Methods: We retrospectively analyzed 33 chronic peritoneal dialysis patients. Pretransplant and posttransplant demographics and clinical and laboratory data for each patient were recorded, including incidence of peritonitis and incidence of peritoneal dialysis catheter requirement after transplant. Results: Mean age of patients at transplant was 12.8 +/- 4.0 years (range, 3.5-18.0 y). Mean catheter removal time was 81.1 +/- 36.2 days (range, 22.0-152.0 d). The peritoneal dialysis catheter was used in 6 of 33 patients (18.2%); none of these patients developed peritonitis. In contrast, 2 of the 27 patients who did not use the peritoneal dialysis catheter developed peritonitis. Our data suggest that the need for catheter use occurs predominantly during the first month, and infectious complications usually happen later. Conclusions: Previously, the trend was to not remove the peritoneal dialysis catheter at the time of transplant. However, in light of recent literature and our present study, we recommend that the time of catheter removal should be modified and decided for each patient on an individual basis.Item Four-Year Analyses of Renal Graft Biopsies: A Single-Center Pathology Experience(2017) Canpolat, Tuba; Ozdemir, Binnaz Handan; Torun, Dilek; Caliskan, Kenan; Haberal, Mehmet; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0002-6267-3695; https://orcid.org/0000-0002-8767-5021; https://orcid.org/0000-0002-3462-7632; 27099951; AAK-8107-2021; X-8540-2019; AAD-9111-2021; AAJ-7201-2021; AAJ-8097-2021Objectives: Kidney transplant is the best treatment for patients with end-stage renal disease. Long-term graft survival depends on the protection of renal allograft function. Renal allograft biopsy is the most important method for examining an allograft function. Biopsy provides critical information, enabling diagnosis and grading of pathologic changes, prediction of response to therapy, and long-term graft prognosis. Materials and Methods: We reviewed the medical records of patients who underwent renal transplant from living and deceased donors at Baskent University Adana Teaching and Research Hospital between 2010 and 2014 and who had an indication for biopsy. Clinical characteristics and laboratory results of patients were recorded. Patient biopsy samples were examined according to the Banff 2009 classification. Results: Between 2010 and 2014, there were 175 renal transplants performed at our hospital, with 134 recipients (76.6%) having living-donor and 41 recipients (23.4%) having deceased-donor transplants. Fifty-one patients (29.1%) were children, and 124 patients (70.9%) were adults. We found that there were 123 biopsies made from 75 transplant patients over a 4-year period. When examined according to Banff 2009 criteria, the biopsy samples revealed acute T-cell-mediated rejection alone in 14.1% of the samples, acute antibody-mediated rejection in 4%, and a combination of the 2 rejections in 5.7%. Specific infections were detected in 12 patients. The graft nephrectomy rate was 5.1%. Conclusions: This study investigated biopsy results, their relation with patient clinical status and 4-year survival rates, and our pathology experience and found that rejection and infection rates were similar to the literature. Our future studies with a longer follow-up and a larger sample size will likely provide more accurate information about graft survival and biopsy results.Item Successful Treatment With Direct-Acting Antiviral Agents of Hepatitis C in Patients With End-Stage Renal Disease and Kidney Transplant Recipients(2019) Etik, Digdem Ozer; Suna, Nuretdin; Ocal, Serkan; Selcuk, Haldun; Dagli, Ulku; Colak, Turan; Hilmioglu, Fatih; Boyacioglu, Ahmet Sedat; Haberal, Mehmet; 0000-0003-3719-9482; 0000-0003-0664-0976; 0000-0002-9370-1126; 30719954; ABH-4817-2020; AAE-7637-2021; S-4068-2018Objectives: The introduction of direct-acting antiviral agents has allowed significant chances for treatment for difficult-to-treat populations. This study aimed to investigate the efficacy, tolerability, and safety of these therapies in both patients with end-stage renal disease and kidney transplant recipients with chronic hepatitis C virus infection. Materials and Methods: This study was a retrospective analysis with prospective follow-up of patients. The antiviral combination of ombitasvir 25 mg, paritaprevir 75 mg, ritonavir 50 mg, and dasabuvir 50 mg was prescribed to patients with end-stage renal disease or kidney transplant recipients with noncirrhotic or compensated cirrhotic liver disease. The other antiviral combination consisted of sofosbuvir 400 mg and ledipasvir 90 mg, which was recommended to patients with decompensated cirrhosis or those who could not tolerate the first combination regimen. Ribavirin was given to all patients with genotype 1a hepatitis C virus infection. All clinical and laboratory data were recorded at week 4, at end of the treatment, and at 12 weeks after completion of treatment. Results: In terms of efficacy, sustained virologic response at 12 weeks was achieved in 94% of patients in the end-stage renal disease group and 92% of patients in the kidney transplant group. In terms of tolerability, antiviral treatment was well tolerated in both groups. Cardiac arrest and cerebrovascular accident were seen in the end-stage renal disease group; severe mucositis and glossitis were seen in the kidney transplant group. Hospitalization was needed in 2 patients for treatment of drug interactions with tacrolimus and sirolimus. Renal allograft function worsened in 2 patients, with 1 patient having biopsyproven antibody-mediated rejection. Conclusions: We observed great efficacy and safety in both kidney transplant recipients and patients with end-stage renal disease with these agents in treatment of chronic hepatitis C. However, clinicians should remain aware of drug interactions and adverse events in this fragile patient population.