Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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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 Postoperative Pulmonary Complications in Living-Liver Donors: A Retrospective Analysis of 188 Patients(2015) Ulubay, Gaye; Dedekarginoglu, Balam Er; Kupeli, Elif; Sever, Ozlem Salman; Eyuboglu, Fusun Oner; Haberal, Mehmet; 0000-0003-2478-9985; 0000-0002-5525-8207; 0000-0002-5826-1997; 0000-0002-3462-7632; 25894187; AAB-5064-2021; AAR-4338-2020; AAB-5345-2021; AAJ-8097-2021Objectives: Living-donor liver transplant has become a viable option and an important source of hepatic grafts. The goal of this study is to establish postoperative pulmonary complications of liver donation surgery in our center. Materials and Methods: Data from 188 subjects (median age, 33.7 +/- 8.4 y; male/female, 51.1%/48.9%) who had liver donation surgery from 1988 to 2013 were analyzed retrospectively. Patient demographic and clinical features were recorded. Postoperative complications and the correlation of risk factors for postoperative pulmonary complications were investigated. Results: The incidence of early postoperative complications was 17% (n = 32), and 16 of these patients had postoperative pulmonary complications (8.5%); 2 of the postoperative pulmonary complications were detected on the day of surgery and the other 14 complications were observed between the second and seventh day after surgery. Most postoperative pulmonary complications were minor complications including atelectasis, pleural effusion, and pneumonia. There was 1 major postoperative pulmonary complication: pulmonary embolism that occurred on the fourth day after surgery in 1 patient. Late pulmonary complications also were reviewed and no late postoperative pulmonary complications were observed. There was no significant difference in early and late postoperative pulmonary complications between ex-smokers and smokers. Postoperative atelectasis was significantly higher in patients with body mass index <= 20 kg/m(2) than patients with body mass index > 21 kg/m(2) (P = .027). In our study population, no postoperative mortality was recorded. Conclusions: We believe that preoperative weight reduction strategies and early mobilization with postoperative respiratory physiotherapy could be important factors to reduce postoperative pulmonary complications in liver donors.Item Acute Respiratory Failure in Cardiac Transplant Recipients(2015) Komurcu, Ozgur; Ozdemirkan, Aycan; Firat, Aynur Camkiran; Zeyneloglu, Pinar; Sezgin, Atilla; Pirat, Arash; 0000-0003-2312-9942; 0000-0003-1470-7501; 26640904; C-3736-2018; AAH-7003-2019Objectives: This study sought to evaluate the incidence, risk factors, and outcomes of acute respiratory failure in cardiac transplant recipients. Materials and Methods: Cardiac transplant recipients >15 years of age and readmitted to the intensive care unit after cardiac transplant between 2005 and 2015 were included. Results: Thirty-nine patients were included in the final analyses. Patients with acute respiratory failure and without acute respiratory failure were compared. The most frequent causes of readmission were routine intensive care unit follow-up after endomyocardial biopsy, heart failure, sepsis, and pneumonia. Patients who were readmitted to the intensive care unit were further divided into 2 groups based on presence of acute respiratory failure. Patients' ages and body weights did not differ between groups. The groups were not different in terms of comorbidities. The admission sequential organ failure assessment scores were higher in patients with acute respiratory failure. Patients with acute respiratory failure were more likely to use bronchodilators and n-acetylcysteine before readmission. Mean peak inspiratory pressures were higher in patients in acute respiratory failure. Patients with acute respiratory failure developed sepsis more frequently and they were more likely to have hypotension. Patients with acute respiratory failure had higher values of serum creatinine before admission to intensive care unit and in the first day of intensive care unit. Patients with acute respiratory failure had more frequent bilateral opacities on chest radiographs and positive blood and urine cultures. Duration of intensive care unit and hospital stays were not statistically different between groups. Mortality in patients with acute respiratory failure was 76.5% compared with 0% in patients without acute respiratory failure. Conclusions: A significant number of cardiac transplant recipients were readmitted to the intensive care unit. Patients presenting with acute respiratory failure on readmission more frequently developed sepsis and hypotension, suggesting a poorer prognosis.Item Effect of Smoking on Peripheral Blood Lymphocyte Subsets of Patients With Chronic Renal Failure(2016) Birben, Ozlem Duvenci; Akcay, Sule; Sezer, Siren; Sirvan, Sale; Haberal, Mehmet; 0000-0002-8360-6459; 0000-0002-3462-7632; 27805522; AAB-5175-2021; AAJ-8097-2021Objectives: Smoking is known to suppress the immune system. It is also known that chronic renal failure affects the immune system. However, the number of studies investigating the effects of chronic renal failure and smoking together is limited. In our study, we examined whether smoking affects the diminished response of the immune system in patients with chronic renal failure. Materials and Methods: We compared peripheral blood lymphocyte subsets in smoking and nonsmoking patients with chronic renal failure. We also used the Fagerstrom Test for Nicotine Dependence to evaluate its correlation with the lymphocyte subset count in patients who are current smokers. Results: Our study included 126 patients with chronic renal failure. According to their smoking habits, patients were divided into 2 groups: smokers and nonsmokers. The average age of patients who were smokers was 53.2 +/- 1.5 years, with average age of nonsmokers being 59.2 +/- 2.2 years. The average duration of smoking in smokers was 30.7 +/- 2.7 pack-years. We found that the percentage of cluster of differentiation 16-56 cells (natural killer cells) and lymphocyte percentage were significantly lower among smokers in our study (P < .05). We compared the lymphocyte subset panel to pack-years and found that the rate of cluster of differentiation 16-56 cells decreased as smoking duration increased. Conclusions: Our study revealed that smoking suppresses the immune system, as measured by lymphocyte subsets, in patients with chronic renal failure, similar to that shown in healthy smokers. According to our findings, patients with chronic renal failure, where infection is the primary reason for mortality and morbidity, must be questioned for smoking and referred to smoking cessation clinics. Because of its immunosuppressive effects, smoking behaviors must be solved preoperatively in transplant candidates.Item Effect of Adipose-Derived Stem Cells on Colonic Anastomosis in Rats Immunosuppressed With Everolimus: An Experimental Study(2021) Karakaya, Emre; Akdur, Aydincan; Atilgan, Alev Ok; Uysal, Ahmet Cagri; Ozer, Huriye Eda Ozturan; Yildirim, Sedat; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-8726-3369; 34269651; AAJ-8097-2021; AAA-3068-2021Objectives: Immunosuppressed patients sometimes require colorectal surgery. We investigated whether adipose tissue-derived stem cells contributed to anastomosis healing in rats immunosuppressed with the mTOR inhibitor everolimus. Materials and Methods: Sixty male Sprague-Dawley rats were randomly divided into 4 groups of 14 each, with all groups undergoing descending colon anastomosis; the 4 remaining rats were used for stem cell retrieval. Group 1 (control) underwent surgery only, group 2 received stem cell injection, group 3 received everolimus only, and group 4 received everolimus plus stem cell injection. After treatment, each group was randomly divided into 2 equal subgroups according to the day of euthanasia (posttreatment day 4 or day 7). We measured anastomosis bursting pressure and tissue hydroxyproline level and performed histopathological evaluation. Results: At both posttreatment days 4 and 7, median weight loss in group 3 was higher than in group 1, group 3 had higher severity of intraabdominal adhesion than group 4, and group 2 had mean hydroxyproline level higher than the other groups. At posttreatment day 4, mean bursting pressure was significantly different in group 1 versus groups 2 and 4 (P = .002) and group 2 versus groups 3 and 4 (P < .001). No significant differences were shown in pathological analysis except for vascular proliferation on day 7 (P = .003). Conclusions: Injection of adipose tissue-derived stem cells in the anastomosis site prevented anastomosis leakage by contributing to healing. Injection of adipose tissue-derived stem cells in the anastomosis region, especially in the early period after solid-organ transplant in recipients and after gastrointestinal surgery in immunosuppressed patients, may help reduce mortality and morbidity.