Başkent Üniversitesi Makaleler
Permanent URI for this collectionhttps://hdl.handle.net/11727/13096
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Item Conversion of Cyclosporine to Sirolimus Before 12 Months is Associated With Marked Improvement in Renal Function and Low Proteinuria in a South African Renal Transplant Population(Başkent Üniversitesi, 2010-03) Maharaj, Suman; Assounga, Alain GuyObjectives: Avoidance of calcineurin inhibitor-associated nephrotoxicity has recently gained focus. To assess the impact of the conversion to sirolimus, we performed a retrospective audit on renal transplant patients switched to sirolimus at the Inkosi Albert Luthuli Central Hospital (South Africa) from 2003 until June 2007. Materials and Methods: Medical records of transplant recipients were analyzed. Twenty-four–hour urine protein excretion and estimated glomerular filtration rates before initiation of sirolimus (baseline), and at their last clinic visit, were compared. Patients were then subcategorized according to their specific indications for switching to sirolimus. Results: Thirty patients were included. Average follow-up was 25 months. Indications for use of sirolimus were group 1 (cyclosporine-induced biochemical toxicity, n=6); group 2 (chronic allograft nephropathy, n=6); group 3 (severe gum hypertrophy, n=9); group 4 (posttransplant diabetes, n=4); group 5 (calcineurin-inhibitor–induced histologic nephrotoxicity, n=2); and group 6 (calcineurin inhibitor associated malignancy, n=3). Average urine protein excretion rate and estimated glomerular filtration rate before starting sirolimus were 0.44 ± 0.08 g/24 h and 50.1 ± 3.1 mL/min respectively, compared to 0.94 ± 0.2 g/24 h and 52.1 ± 4.8 mL/min, at an average follow-up of 25 months. On subgroup analysis, estimated glomerular filtration rate was increased/unchanged in groups 1 (47.3 vs 51.16 mL/min) and 4 (60.0 vs 60.0 mL/min) when compared to baseline, but decreased in groups 2 (47 vs 27.6 mL/min), 3 (51.3 vs 42.2 mL/min), 5 (54.0 vs 29.5 mL/min), and 6 (60.0 vs 56.5 mL/min). Combining the latter 2 groups, most patients (80%) received sirolimus within 1 year of transplant, whereas only 2 patients in the former groups (10%) received the drug within 1 year of transplant. Conclusions: Overall, sirolimus therapy was associated with improved estimated glomerular filtration rate, and also an increase in urine protein excretion rates. Maximum benefit was achieved when patients were switched to sirolimus within the first transplant year.Item Neuromuscular Complication After Liver Transplant in Children: A Single-Center Experience(Başkent Üniversitesi, 2010-03) Dehghani, Seyed Mohsen; Malek-Hosseini, Seyed Ali; Haghighat, Mahmood; Bahador, Ali; Kazemi, Kourosh; Gholami, Siavash; Inaloo, Soroor; Honar, NaserObjectives: Neurologic complications are a significant cause of morbidity in children after liver transplant. In this study, we sought to evaluate the neurologic complications in children after liver transplant. Materials and Methods: All children aged younger than 18 years old who had undergone liver transplant between June 2004 and June 2007 were included in this prospective study. There were 30 boys (62.5%) and 18 girls (37.5%) (mean age, 9.6 ± 4.3 years; mean duration of follow-up, 21.6 ± 9.4 months). The most common indications for liver transplant were biliary atresia (n=12, 25%), Wilson disease (n=7, 14.6%), tyrosinemia (n=7, 14.6%), progressive familial intrahepatic cholestasis (n=6, 12.5%), and autoimmune cirrhosis (n=5, 10.4%). Results: Immunosuppressive medication consisted tacrolimus (n=44, 91.7%) or cyclosporine (n=4, 8.3%) combined with mycophenolate mofetil (n=33, 68.7%) and prednisolone (n=18, 37.5%). The most-common neurologic complications were tremor (n=8, 16.7%), convulsions (n=6, 12.5%), insomnia (n=6, 12.5%), headache (n=5, 10.4%), muscle cramps (n=5, 10.4%), paresthesia (n=3, 6.2%), and weakness (n=3, 6.2%). Conclusions: We conclude that the most-common neurologic complication after liver transplant in children in contrast to other studies is tremor, same as adult patients. This may be due to higher rate of use of tacrolimus in our patients.Item Effect of Liver Transplant on Pulmonary Functions in Adult Patients with Alpha 1 Antitrypsin Deficiency: 7 Cases(Başkent Üniversitesi, 2010-03) Kashyap, Randeep; Orloff, Mark; Jain, Ashokkumar B.; Patil, Vrishali; Sheikh, Baber; Apostolakos, Michael; Ryan, CharlotteObjectives: Alpha 1 antitrypsin (A1A) is a 52 kD glycoprotein that is mainly synthesized in the liver. As a major protease inhibitor, it binds to and neutralizes neutrophil elastase, thereby limiting the damage to the normal tissues after an inflammatory response. A deficiency in A1A leads to end-stage liver disease, both in children and in adults. In addition, the deficiency also has a detrimental effect in the lungs of the adult population. Alpha 1 antitrypsin deficiency is corrected with hepatic replacement; however, the changes in pulmonary functions have not been studied before and after liver transplant. The purpose of this study was to observe the changes in the pulmonary functions of patients who underwent liver transplant for the treatment of A1A deficiency. Materials and Methods: Nine patients underwent liver transplant for A1A deficiency. Seven patients (5 men, 2 women; mean age, 49.95 ± 7.09 years) had their pulmonary function tests available before the liver transplant (mean, 5.6 ± 3.4; range, 0.9-10.1 months) and after the liver transplant (mean, 30.3 ± 18.4, range 7.8-48.1 months) for analysis. Results: The mean, preliver, transplant, FEV1 was 2.69 ± 0.9 L, which was nearly unchanged after the liver transplant to a mean of 2.7 ± 1.2 L. During the mean total interval of nearly 3 years, an estimated decline of 250 mL in FEV1 was expected. Conclusions: It appears from the results of our study that liver transplant probably prevented the progression of pulmonary disease in A1A-deficient patients. Further study and close, postliver, transplant follow-up is warranted to support our initial findings.Item Role of Ischemic Preconditioning in Liver Transplant: A Review of Literature(Başkent Üniversitesi, 2010-03) Macedo, Francisco Igor Bulcão; Miranda, Luiz Eduardo CorreiaInterruption of blood flow and subsequent organ reperfusion lead to significant tissue damage. This well-studied phenomenon is recognized as ischemia/reperfusion injury. Ischemic preconditioning refers to a mechanism in which a prior, short, ischemic period induces some protection against a subsequent prolonged ischemic and reperfusion damage. The mechanisms involved in ischemic preconditioning and its applications for clinical and basic research are discussed in this paper.Item Epididymo-Orchitis and Central Nervous System Nocardiosis in a Bone Marrow Transplant Recipient for Acute Lymphoblastic Leukemia(Başkent Üniversitesi, 2009-12) Dehghani, Mehdi; Davarpanah, Mohammad-AliObjectives: We report a case of epididymo-orchitis and central nervous system nocardiosis in a 22-year-old man with T-cell acute lymphoblastic leukemia; he was an allogeneic marrow recipient with acute and chronic graft-versus-host disease. Materials and Methods: He had microscopic hematuria and cytomegalovirus antigenemia. He deteriorated subsequently while on cyclosporine and steroids, requiring hospital admission owing to fever and swelling of the left testis and generalized tonic-clonic convulsions. Results: Brain magnetic resonance imaging showed abnormal signal area in right parietal and left parieto-occipital lobes. The lesions had mass effect, edema, and ring enhancement. Findings were indicative of a brain abscess. A testicular biopsy from the lower pole of the left testis was done. A white-to-yellowish discharge was seen and subsequently, Nocardia grew in culture. Conclusions: Trimethoprim-sulfamethoxazole was prescribed, and significant improvement was seen after 2 weeks. The patient was discharged. He was subsequently referred after 3 weeks due to graft-versus-host disease and died of pancytopenia.Item Off-Pump Coronary Surgery for Allograft Vasculopathy 8 Years After Heart Transplant(Başkent Üniversitesi, 2009-12) Michel, Sebastian; Vicol, Calin; Reichart, Bruno; Abicht, Jan; Ueberfuhr, Peter; Beiras-Fernandez, Andres; Kaczmarek, IngoCardiac allograft vasculopathy is a severe complication after heart transplant, and is the major cause of death in patients surviving 1 year after transplant. We present a 59-year-old patient undergoing off-pump, coronary artery bypass surgery, 8 years after heart transplant. Owing to toxic liver disease, the lipid lowering therapy with statins had to be stopped 6 years after transplant, and coronary artery disease developed rapidly within 2 years. Off-pump, coronary bypass surgery was performed using a new, multisuction cardiac positioner; a disposable stabilizer; and a proximal seal system to avoid clamping of the aorta. The patient received 3 bypass grafts: the left internal thoracic artery; to the left anterior descending coronary artery; 1 saphenous vein graft to the marginal branch of the circumflex artery; and 1 saphenous vein graft to the right coronary artery. His postoperative course was uneventful.Item Hepatic Abscesses After Liver Transplant: 1997–2008(Başkent Üniversitesi, 2009-12) Malek-Hosseini, Seyed Ali; Janghorban, Parisa; Nikeghbalian, Saman; Salahi, Roohallah; Salahi, Heshmatallah; Bahador, Ali; Kakaie, Farzad; Kazemi, KorushObjectives: Infectious complications (such as liver abscesses) remain one of the major causes of posttransplant morbidity and mortality. Management may be problematic and is often based on experience with hepatic abscess in nontransplant patients. We reviewed our experience with hepatic abscess in liver transplant recipients to assess their presentation, clinical features, treatment, and outcome. Materials and Methods: A retrospective review of all liver transplant in Shiraz transplant center from September 1997 through September 2008 was performed. Hepatic abscess was defined as a parenchymal hepatic lesion consistent with abscess (as described by a radiologist), positive liver or concurrent blood cultures, or both (within 24 hours), and compatible clinical findings. Results: Of 560 liver recipients, we identified 5 patients (23-42 y) who had experienced 7 episodes of hepatic abscess, 30-240 days after transplant. All patients had received liver from deceased donors. Biliary reconstruction was done by duct-to-duct anastomosis in 4 and hepatico-jejunostomy in 1 case. Pretransplant diagnoses included hepatitis B cirrhosis, autoimmune hepatitis (2 cases), Caroli disease, and cryptogenic cirrhosis. Liver aspirates showed E. coli in 4 cases, and Aspergillus in 1 case. The main predisposing factor was bile-to-duct anastomosis stricture in 3, diabetes mellitus in 2, and hepatic artery thrombosis in 1 of the patients. Two patients died owing to liver and multiorgan failure, despite percutaneous and operative drainage with broad spectrum antibiotics and antifungals. Conclusions: Hepatic abscess, a rare complication after liver transplant, was associated with hepatic artery thrombosis, biliary anastomosis stricture, and diabetes mellitus. Mortality was higher than in patients who had not undergone transplant. Prolonged antibiotic therapy and drainage are required to improve the outcome in these patients.Item Peroneal Neuropathy Following Liver Transplantation: Possible Predisposing Factors and Outcome(Başkent Üniversitesi, 2009-12) Singhal, Ashish; Gupta, Subash; Wadhawan, Manav; Vij, Vivek; Goyal, Neerav; Varma, MukulIntroduction: Perioperative peroneal neuropathy is an uncommon complication following operations remote from the leg or in supine position including liver transplant. Materials and Methods: We retrospectively reviewed the medical records of 132 living-donor liver transplant recipients done at our center between September 2006 and December 2008. Various potential preoperative, intraoperative, and postoperative factors were studied in the cases that developed perioperative peroneal neuropathy. Results: Peroneal neuropathy was reported in 7 recipients (5.3%) following liver transplant. Apart from intraoperative positioning, other identifiable predisposing factors appear to be poor nutritional status, tall and slender body shape, alcoholic liver disease, and higher pretransplant model for end-stage liver disease score. All patients were treated conservatively, including nutritionally balanced diet and vitamin supplements combined with physical rehabilitation therapy. The motor power returned to normal within 6 months in all 7 patients. Conclusions: Perioperative peroneal neuropathy may be contributed by various preoperative factors apart from intraoperative nerve compression. It can be effectively prevented by being aware of the predisposing factors and implicating adequate precautions perioperatively.Item Bentall Procedure for the Treatment of Aortic Dissection After Cardiac Transplant: A Case Report(Başkent Üniversitesi, 2009-12) Saritas, Bulent; Aslamaci, Sait; Akay, Tankut; Ozkan, Murat; Korun, Oktay; Sezgin, AtillaAortic dissection affecting the donor aorta after cardiac transplant is a rarely seen complication. Data on the literature about the subject is restricted to case reports. Here, we present a case of type A aortic dissection after cardiac transplant that was successfully treated by the Bentall procedure.Item Autologous Bone Marrow Derived Mononuclear Cell Therapy for Spinal Cord Injury: A Phase I/II Clinical Safety and Primary Efficacy Data(Başkent Üniversitesi, 2009-12) Kumar, Arachimani Anand; Baskaran, Mayakesavan; Arul, Kanagarajan; Narayanan, Raghavachary; Kumar, Sankaran RajObjective: We sought to assess the safety and therapeutic efficacy of autologous human bone marrow derived mononuclear cell transplantation on spinal cord injury in a phase I/II, nonrandomized, open-label study, conducted on 297 patients. Materials and Methods: We transplanted unmanipulated bone marrow mononuclear cells through a lumbar puncture, and assessed the outcome using standard neurologic investigations and American Spinal Injury Association (ASIA) protocol, and with respect to safety, therapeutic time window, CD34+ cell count, and influence on sex and age. Results: No serious complications or adverse events were reported, except for minor reversible complaints. Sensory and motor improvements occurred in 32.6% of patients, and the time elapsed between the injury and the treatment considerably influenced the outcome of the therapy. The CD34+ cell count determined the state of improvement, or no improvement, but not the degree of improvement. No correlation was found between level of injury and improvement, and age and sex had no role in the outcome of the cellular therapy. Conclusion: Transplant of autologous human bone marrow derived mononuclear cells through a lumbar puncture is safe, and one-third of spinal cord injury patients show perceptible improvements in the neurologic status. The time elapsed between injury and therapy and the number of CD34+ cells injected influenced the outcome of the therapy.