Başkent Üniversitesi Makaleler
Permanent URI for this collectionhttps://hdl.handle.net/11727/13096
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Item Three Aspects Are Critical for Carrying Out Intraportal Islet Transplants Successfully in a Diabetes Mouse Model(Başkent Üniversitesi, 2012-06) Wang, Yanyun; Zhang, Lin; Wang, TaoItem Kidney Transplant After Preexisting Posterior Reversible Encephalopathy Syndrome Induced by Goodpasture's Syndrome(Başkent Üniversitesi, 2012-06) Lahmer, Tobias; Thürmel, Klaus; Lutz, Jens; Heemann, Uwe; Schirmer, Lucas; Küchle, ClaudiusPosterior reversible encephalopathy syndrome is characterized by varying neurologic symptoms associated with brain vasogenic edema. Posterior reversible encephalopathy syndrome can be associated with severe hypertension (eg, in eclampsia or HELLP syndrome), but it also has been observed without hypertension and in several clinical conditions including infections and autoimmune disorders. The literature offers several reports of posterior reversible encephalopathy syndrome detected or induced after bone-marrow and solid-organ transplant, or induction by immunosuppression. We describe what is, to the best of our knowledge, the first case of man who successfully underwent a kidney transplant with preexisting posterior reversible encephalopathy syndrome induced by Goodpasture's syndrome.Item Everolimus-induced Lymphedema in a Renal Transplant Recipient: A Case Report(Başkent Üniversitesi, 2012-06) Ersoy, Alparslan; Koca, NizameddinThe mammalian target of rapamycin inhibitors is commonly preferred for solid organs for transplantation. Although these drugs have various adverse effects, sirolimus-related lymphedema has been rarely reported. We report a case of lymphedema related to everolimus after a kidney transplant. A 60-year-old woman successfully received a deceased-donor kidney. Everolimus was added to the treatment in postoperative month 3 owing to other immunosuppressive drugs’ adverse effects. Edema occurred first on her feet in the first year after the transplant. During 3 months’ follow-up, with no immunosuppressive adjustment, the edema progressed. Diagnosis of lymphedema was established. Several weeks after discontinuing everolimus, the patient’s lymphedema began to resolve itself and completely disappeared in 3 months. The mammalian target of rapamycin inhibitors rarely causes lymphedema by inhibiting different subtypes of vascular endothelial growth factors, which results in impaired lymphangiogenesis. While there are few reports about sirolimus-related lymphedema, this case represents the first everolimus-related case of lymphedema. Further studies are warranted to explain the underlying mechanisms.Item Renal Artery Aneurysm in Robotic Donor Nephrectomy: A Case Report(Başkent Üniversitesi, 2012-06) Tzvetanov, Ivo; Garcia-Roca, Raquel; Benedetti, Enrico; Oberholzer, Jose; Osipova, Maria; Jeon, Hoonbae; Spaggiari, MarioObjectives: With the current disparity between donor organ availability and recipient need, creative techniques help optimize the use of available organs. We present a case of a woman, who was worked-up as a kidney donor, who was incidentally found to have a saccular aneurysm on her renal artery. The patient was asymptomatic, normotensive, and had normal renal function. Materials and Methods: We performed a laparoscopic robotic donor nephrectomy, repaired the aneurysm on the back table, and transplanted the organ into the recipient. Results: The donor underwent a successful robotic nephrectomy, successfully eradicating any risk of aneurysmal complications; the recipient received an anatomically normal organ with excellent function. Conclusions: An altruistic act by the donor identified a potentially fatal lesion, which was not only remedied, but the intended donation proceeded when a creative approach was used.Item Successful Transplant of a Kidney With Fibromuscular Dysplasia Having Higher Glomerular Filtration Rate Than the Contralateral Kidney(Başkent Üniversitesi, 2012-06) Sun, In O; Choi, Bum Soon; Kim, Yong Soo; Yang, Chul Woo; Park, Cheol Whee; Chung, Byung Ha; Choi, Sun Ryoung; Park, Hoon Suk; Kim, Hyun Gyung; Hong, Yu AhFibromuscular dysplasia is the second-most commonly encountered anatomic abnormality in potential renal donors. Normotensive patients with medial fibroplasia and low-grade lesions have been used as renal donors. However, no studies have reported the optimal choice of a kidney for donation where the kidney with fibromuscular dysplasia had a larger volume and a higher glomerular filtration rate than the unaffected side. Herein, we report a case of renal transplant using a kidney with fibromuscular dysplasia that had higher glomerular filtration rate than the normal side. After transplant, hypertension and abnormal serum creatinine did not occur in either the donor or the recipient during 12 months’ follow-up.Item Prevention and Management of Graft Thrombosis in Pancreatic Transplant(Başkent Üniversitesi, 2012-06) Patel, Shaneel R.; Hakim, NadeyPancreatic transplant effectively cures type 1 diabetes mellitus and maintains consistent long-term euglycemia. However, technical failure, and in particular graft thrombosis, accounts for the vast majority of transplants lost in the early postoperative period. The pancreas’ inherently low microvascular flow state makes it vulnerable to vascular complications, as does the hypercoagulable blood of diabetic patients. Ultimately, the phenomenon is most definitely multifactorial. Prevention, as opposed to treatment, is key and should focus on reducing these multiple risk factors. This will involve tactical donor selection, optimal surgical technique and some form of anticoagulation. Close monitoring and early intervention will be crucial when treating thrombosis once preventative methods have failed. This may be achieved by further anticoagulation, graft salvage, or pancreatectomy with retransplant. This article will explore the multiple factors contributing to graft thrombus formation and the ways in which they may be addressed to firstly prevent, or more likely, reduce thrombosis. Secondly, we will consider the management strategies which can be implemented once thrombosis has occurred.Item Comparison of Serum and Bronchoalveolar Lavage Galactomannan in Diagnosing Invasive Aspergillosis in Solid-Organ Transplant Recipients(Başkent Üniversitesi, 2012-06) Tabarsi, Payam; Sarrafzadeh, Shokooh Azam; Mansouri, Davood; Javanmard, Pedram; Najafizadeh, Katayoon; Droudinia, Atoosa; Baghaei, Parvaneh; Zandian, Paris; Marjani, Majid; Soraghi, AbdolrezaObjectives: This study sought to compare the sensitivities of serum galactomannan and bronchoalveolar lavage galactomannan in diagnosing invasive aspergillosis in solid-organ transplant recipients (lung and heart). Materials and Methods: This study took place in the lung transplant center of the National Research Institute for Tuberculosis and Lung Disease. All patients with clinical and radiologic manifestations suggestive of pulmonary infection were included. Serum and bronchoalveolar lavage galactomannan were measured. Results: Seventeen patients were included (lung, 15; heart, 1; heart-lung, 1). Probable or definite invasive aspergillosis was diagnosed in 9 patients. With a cutoff ≥ 0.5, serum galactomannan sensitivity and specificity for diagnosing invasive aspergillosis were 77.18% and 100%. Negative predictive value and positive predictive value were 80% and 100%. The sensitivity and specificity of bronchoalveolar lavage galactomannan for diagnosing invasive aspergillosis with cutoff of ≥ 0.5 was 100%. Conclusions: Regarding the high levels of mortality and problems in diagnosing this disease, using bronchoalveolar lavage galactomannan could be a suitable option.Item Everolimus in Different Combinations as Maintenance Immunosuppressive Therapy in Heart Transplant Recipients(Başkent Üniversitesi, 2012-06) Schweiger, Martin; Tscheliessnigg, Karlheinz; Prenner, Guenther; Wasler, Andre; Sereinigg, Michael; Puntschart, Andreas; Stiegler, PhilippObjectives: We examined the experiences of heart transplant recipients receiving everolimus as maintenance therapy in different combinations over a long time. Materials and Methods: Between 2004 and 2009, forty patients (29 men, 11 women; mean age, 51.6 y) were switched from a routine immunosuppressive regimen to everolimus. Indications were other (2), renal insufficiency (17), cardiac allograft vasculopathy (14), and ongoing cellular rejection (7). Combinations were either along with cyclosporine (24), mycophenolate mofetil (14), or others (2). Indications for the introduction of everolimus including safety, efficacy, different combinations of everolimus, biopsy-proven acute rejections, renal function, and infections were evaluated retrospectively. Results: Five patients died, 4 of them were still on everolimus at the time of death; they died from intracerebral hemorrhage (1), embolism (1), cardiac arrest (2), and unknown (1). Everolimus was discontinued in 6 patients owing to severe adverse effects: Edema (2), gastrointestinal adverse effects (3), and dermal adverse effects (1). Mean everolimus trough levels were 5.8 µmol/L at 6 months and 4.9 at 60 months. Mean cyclosporine levels were 67.62 µmol/L at 6 months and 47.3 µmol/L at 60 months. Mean serum creatinine levels were stable (147.9 µmol/L after 60 months). Four life-threatening infections (all pneumonia) occurred but resulted in complete recovery. Conclusions: Everolimus is safe with different immunosuppressive combinations after receiving a heart transplant.Item Autotransplanting of Bone Marrow-Derived Mononuclear Cells for Complete Cases of Canine Paraplegia and Loss of Pain Perception, Secondary to Intervertebral Disc Herniation(Başkent Üniversitesi, 2012-06) Tamura, Katsutoshi; Hara, Yasushi; Tagawa, Masahiro; Ide, Chizuka; Suzuki, Yoshihisa; Yogo, Takuya; Nezu, Yoshinori; Ishino, Hirokazu; Itoi, Takamasa; Nagashima, Naho; Harada, YasujiObjectives: Severe intervertebral disc herniation causes complete paraplegia and loss of pain sensation in canines. The prognosis is poor, even when decompression surgery is performed immediately after onset. Studies suggest that bone marrow-derived mononuclear cells will regenerate the injured spinal cord and restore neurologic function. This study was conducted to assess the clinical efficacy of bone marrow-derived mononuclear cell autotransplanting in severe cases of canine intervertebral disc herniation. Materials and Methods: Eighty-two dogs (miniature dachshunds) with severe thoracolumbar intervertebral disc herniation were used. All had intervertebral disc herniation accompanied by paraplegia and loss of pain perception. In 36 dogs, bone marrow-derived mononuclear cells were autotransplanted to the lesioned spinal cord immediately after decompression surgery. Bone marrow was collected from the proximal humerus and subjected to density gradient centrifugation to isolate the bone marrow-derived mononuclear cells. The remaining 46 dogs (receiving surgical treatment only) were assigned as controls. Therapeutic efficacy was compared based on the rate of ambulatory recovery. Results: Ambulatory recovery was observed in 88.9% and 56.5% of animals in the bone marrow-derived mononuclear cells and control groups, and a significant difference was found. No complications were found in bone marrow-derived mononuclear cells group. Conclusions: Bone marrow-derived mononuclear cell transplanting revealed a significant increase in the recovery rate and, as has been reported in rats and humans, bone marrow-derived mononuclear cell autotransplanting shows efficacy in canines as well.Item Twenty-Four Hour Steroid Avoidance Immunosuppressive Regimen in Liver Transplant Recipients(Başkent Üniversitesi, 2012-06) Ju, Wei-qiang; Zhu, Xiao-feng; Tai, Qiang; Han, Ming; Hu, An-bin; Wu, Lin-wei; He, Xiao-shun; Ling, Xiaoting; Guo, Zhi-yongObjectives: To investigate the efficacy and safety of an immunosuppressive regimen of steroid avoidance in combination with induction therapy and tacrolimus in liver transplant recipients. Materials and Methods: Eighty-two adult liver transplant recipients were randomized into 2 groups: standard protocol group (n=41) in which steroids were withdrawn 3 months after the operation, and a 24-hour steroid avoidance group (n=41) in which steroids were eliminated within 24-hours. The incidence of acute rejections, infections (bacterial, fungal, and cytomegalovirus), and metabolic complications were analyzed between the groups. Results: The incidence of early posttransplant diabetes mellitus and the average dosage of insulin consumption among diabetic recipients were significantly higher in recipients in the standard protocol group than in the 24-hour avoidance group (P < .05). In addition, the incidence of hypertension and infection during the follow-up were also higher in patients of the standard protocol group (P < .05). The incidence of hypertension in the early posttransplant period, hyperlipemia, and acute rejection during the follow-up were comparable between the groups (P > .05). Conclusions: Twenty-four hour steroid avoidance combined with induction therapy and tacrolimus maintenance is a safe and efficient immunosuppression strategy that can significantly reduce posttransplant infections and other complications owing to long-term use of steroids, without increasing the risk of acute rejection.