Başkent Üniversitesi Makaleler
Permanent URI for this collectionhttps://hdl.handle.net/11727/13096
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Item Cytomegalovirus Disease in Renal Transplant Recipients: An Iranian Experience(Başkent Üniversitesi, 2008-06) Nemati, Eghlim; Einollahi, Behzad; Pourfarziani, Vahid; Taheri, SaeedBackground: Cytomegalovirus is considered the most important infectious cause of mortality and morbidity in organ transplant recipients. In the current study, we evaluate the potential impact of cytomegalovirus infection and cytomegalovirus disease on the outcomes of renal allograft recipients under different conditions. Materials and Methods: We retrospectively analyzed the data from 48 renal transplant recipients who had undergone a transplant at the Baqiyatallah Hospital in Tehran, Iran, between 1984 and 2007. We included all patients with valid laboratory test results for cytomegalovirus infection. Values for P less than .05 were considered statistically significant. Results: Overall, 48 patients (2.1%) were documented as developing cytomegalovirus disease. From these, 1 patient (2%) died, and 3 (6%) lost their allograft function. Compared with mycophenolic-acid–based triple immunosuppressive therapy, azathioprine was less likely to induce cytomegalovirus disease and also promised better survival (P < .0001 and P < .001). Being negative for the anti-cytomegalovirus IgG antibody and receiving an allograft from a positive donor also were associated with cytomegalovirus disease development and poorer patient survival (P = .03 and P < .0001). Conclusions: Cytomegalovirus infection induces unfavorable outcomes in renal allograft recipients, especially when the infection occurs early on in the posttransplant phase. We suggest close monitoring of cytomegalovirus-positive patients and the use of less-intensive immunosuppressive treatments. Future prospective studies seem necessary.Item Risk Factors for Delayed Graft Function Defined as Need for Dialysis or Failure of Creatinine to Fall by 10% in the First 24 Hours After Transplant(Başkent Üniversitesi, 2008-03) Stratopoulos, Charalabos; Friend, Peter J.; Sinha, Sanjay; Vaidya, Anil; Muthusamy, Anand; Zilvetti, Miguel; Brockmann, Jens; Roberts, Ian S. D.Objectives: Delayed graft function after deceased-donor transplant remains a significant clinical problem. The conventional definition of delayed graft function is the requirement of dialysis within the first week after transplant, but this criterion has many problems that have led to many controversies including those of incidence and significance. Therefore, we sought to identify the possible risk factors of delayed graft function and to investigate their effect on short-term graft survival, according to a composite criterion. Materials and Methods: We reviewed the records of 94 renal transplants obtained from heart-beating deceased donors done at our center during a 2-year period. Variables related to the donor, recipient, and graft were retrospectively collected. Follow-up was 12 months. Delayed graft function was defined as the need for dialysis or the failure of the creatinine level to fall by 10% during the first 24 hours after transplant. To confirm suspected rejection, protocol biopsies were done, irrespective of graft function, on the seventh and 28th days after transplant, or when indicated to confirm suspected rejection. Results: The overall incidence of delayed graft function was 31.9%. Multivariate analysis showed donor age as a significant independent predictor of delayed graft function (OR=1.05, P = .03, 95% CI: 1.01-1.09), whereas donor hypotension was the only independent risk factor associated with a worse 1-year graft survival rate (OR=4.6, P = .021, 95% CI: 1.3-16.5). No association could be established between delayed graft function, acute rejection, and graft survival. Conclusions: Advanced donor age is a predictor of delayed graft function defined as the need for dialysis or the failure of creatinine to fall by 10% during the first 24 hours after transplant. Preventing hemodynamic instability should be an important aspect of donor care.Item Nomogram That Predicts Graft Survival Probability Following Living-Donor Kidney Transplant(Başkent Üniversitesi, 2008-03) Akl, Ahmed; Ghoneim, Mohamed A.; Mostafa, AmaniObjectives: The goal of this project was to develop a nomogram that predicts the probability of graft survival at 5 years. Materials and Methods: From our dataset, 1581 patients were used to construct a nomogram (modeling group), the remaining 319 patients (testing group) were used for its validation. Initially, the modeling group variables were correlated with graft survival by univariate analysis. Significant factors were subjected to a multivariate analysis using a Cox regression model. The results formed the basis of our nomogram construction. Internal validation was done first by discrimination using the concordance index. Second, the calibration was assessed graphically. And finally, for external validation, the nomogram was used to predict graft survival using the testing group. The predicted probability(s) was compared with the actual survival estimates. Results: Validation of the nomogram yielded a concordance index of 0.77, and the observed correspondence between predicted and actual outcomes suggested a high level of calibration. Nomogram predictions of the testing group revealed no differences in the means of predicted and observed graft survival at 5 years, with a high correlation coefficient and accepted predictive accuracy (concordance index, 0.72). Conclusions: We developed a well-validated and reasonably precise nomogram for predicting 5-year graft survival.Item Perihepatitis and Perinephric Abscess Due to Mycoplasma hominis in a Kidney Transplant Patient(Başkent Üniversitesi, 2007-12) Camara, Boubou; Mouzin, Marc; Kamar, Nassim; Rostaing, Lionel; Durand, Dominique; Game, Xavier; Guitard, Joelle; Esposito, Laure; Ribes, DavidMycoplasma hominis has been incriminated in several genital and extragenital infections. Here, we report the first case of perihepatitis associated with a perinephric abscess in a woman who had received a kidney transplant. Four months after the transplant, the patient was admitted for perirenal allograft pain, fever, and elevated inflammatory parameters and liver enzyme levels. A renal ultrasonography found a collection of fluid. Results of blood and urine analyses were within normal limits. Fluid aspiration of the peritoneal cavity was performed, and the results of cultures for bacteria and fungi were negative. The patient was treated by surgical lavage of the peritoneal cavity. Her fever resolved 5 days later. Two months after surgical lavage of the peritoneal cavity, her liver enzyme levels returned to the normal range. Three months after surgical lavage, cultures of the perinephric fluid showed Mycoplasma hominis. We conclude that in patients who present with perinephric fluid suspected of being infected, bacteriologic analysis of the fluid (from surgical lavage of the peritoneal cavity) should be performed. Antibiotics active against intracellular bacteria should be administered.Item Kidney Transplant from Sickle Cell Trait Donor to Sickle Cell Trait Recipient(Başkent Üniversitesi, 2007-12) Rehman, Khalil ur; Al-Ghamdi, Saeed M. G.; Bridges, Kenneth; Awad, Abdullah; Kelta, Mouhammed; Al-Amoudi, AbdullahThere have been concerns about using kidneys from potential donors with sickle cell trait because kidneys from these donors may not concentrate urine properly. We report a case of living-related renal transplant, in which both the recipient and the donor had sickle cell trait, and the postoperative course for both was uneventful.Item Vertigo After Renal Transplantation: A Sign of Paucisymptomatic Cryptococcal Meningitis(Başkent Üniversitesi, 2006-12) Mehrenberger, Marion; Kamar, Nassim; Borde, Jean-Sébastien; Estève-Fraysse, Marie-Josée; Viguier, Alain; Recco, Paulette; Durand, Dominique; Rostaing, LionelWe report what is to our knowledge the first case of severe isolated vertigo that developed after renal transplantation and was a manifestation of cryptococcal meningitis. Treatment with antifungal therapy resulted in the complete resolution of vertiginous symptoms. Immunosuppressed patients with an opportunistic infection of the central nervous system can present with extremely tenuous features of infection and atypical neurologic signs.Item Changes in Health-Related Quality of Life in Greek Adult Patients 1 Year After Successful Renal Transplantation(Başkent Üniversitesi, 2006-12) Balaska, Aikaterini; Moustafellos, Panagiotis; Gourgiotis, Stavros; Pistolas, Dimitrios; Hadjiyannakis, Evangelos; Vougas, Vassilis; Drakopoulos, SpirosObjectives: This study was undertaken to compare and to evaluate the health-related quality of life (HRQOL) in Greek adult transplant recipients before and 1 year after successful renal transplantation (RT) and to examine which parameters had the greatest effects on their HRQOL. The SF-36 survey score was used. Materials and Methods: Eighty-five Greek hemodialysis patients underwent RT at the Transplant Unit of Evangelismos General Hospital of Athens, including 44 men and 41 women (mean age, 43.8 years; range, 21-59 years). Thirty-nine patients had received a kidney from a living-related donor, and 46 from a cadaver. The scale scores of a Greek version of the SF-36 survey were compared between the transplant and the hemodialysis patients. We also examined the relationships of the scale scores with the patients’ age and the type of donor. Results: According to the SF-36 health survey, transplant recipients had better results for general health perception (P <= .001), role-physical functioning (P <= .01), role-emotional functioning (P <= .01), and vitality (P <= .01). In addition, the scale scores of physical functioning, general health, and vitality of the patients who were younger than 30 years old at the time of transplantation were significantly higher than those of the patients who were older than 30 years, while the scores of bodily pain, general health, and physical functioning were significantly lower in cadaveric graft recipients compared with living-related graft recipients. Conclusions: The SF-36 health survey is a validated and comprehensive instrument for evaluating renal transplant patients’ HRQOL. Our data demonstrate an improvement in HRQOL in renal transplant patients from before to 1 year after successful RT. The data also confirm that the recipients’ age at transplantation and the type of donor were important factors affecting the HRQOL.Item Majocchi’s Granuloma After Kidney Transplantation(Başkent Üniversitesi, 2006-12) Burg, Michael; Jaekel, Dagmar; Kiss, Eva; Kliem, VolkerMycosis may follow an atypical course in an individual undergoing immunosuppressive therapy. We describe a patient with a fungal infection that was manifested as a bilateral inguinal granuloma. Owing to suspected inguinal lymphadenopathy characterized by distinct subcutaneous swellings in the groin, a 39-year-old man who had undergone kidney transplantation 14 years earlier was admitted to the Nephrologisches Zentrum in Hann. Muenden, Germany. The results of a clinical examination revealed bilateral, soft, partly fluctuant, indolent swellings in the groin as well as onychomycosis of the right great toe. An ultrasonographic scan showed bilateral hypoechogenic lesions (<= 1.5 cm) in the groin. The lesions were surgically removed, and the results of histologic examination revealed severe granulating pseudocystic inflammation with a distinct foreign body reaction. Dermatophytes of the species Trichophyton rubrum were detected microbiologically. After the lesions had been resected, the wound healed without complications. Immunosuppressive treatment with tacrolimus 8 mg/d and steroids 7.5 mg/d was not changed. Local antimycotic treatment of the onychomycosis with ciclopirox cream was initiated. At the patient’s 2-year follow-up examination, there was no evidence of recurrence. In transplant recipients, local fungal infections should be treated as a matter of course, because dermatophytosis is present in almost every other such patient. In patients with a suspicious inguinal lesion, an atypical form of dermatophytosis must be considered. T rubrum, the most frequently occurring dermatophyte, causes 80% of the dermatophytosis that develops in immunosuppressed patients.Item Weight-Gain–Related Factors in Renal Transplantation(Başkent Üniversitesi, 2005-06) Nazemian, Fatemeh; Naghibi, MasihObjectives: Previous studies of renal transplant recipients have suggested that weight gain after transplantation is relatively common. The purpose of this study was to define the occurrence, magnitude, and predictors of weight gain in this group. Material and Methods: We conducted a prospective study of 100 renal transplant recipients from 2002 to 2004 at Imam-Reza Hospital in Mashhad, Iran, to identify patterns of weight change attributed to sex, age at transplantation, socioeconomic class, and duration of dialysis. A descriptive study also was made on serum cholesterol and triglyceride levels in renal transplant recipients 12 months after transplantation. Patients’ weights were evaluated at 3, 6, 9, and 12 months after transplantation. Results: Univariate analyses at 1 year posttransplantation showed that women had greater weight gains than did men (P = 0.003); older recipients had greater weight gains than did younger recipients (P = 0.009); weight gain was correlated with an increase in serum triglyceride and cholesterol levels (P = 0.000 and P = 0.004); and socioeconomic class was not correlated with weight changes (P = 0.955). Conclusions: Female sex, older age, and increasing incidences of hypercholesterolemia and hypertriglyceridemia were significantly associated with weight gain 1 year after organ transplantation.Item Laparoscopic Donor Nephrectomy—An Iranian Model for Developing Countries: A Cost-Effective No-Rush Approach(Başkent Üniversitesi, 2004-12) Simforoosh, Nasser; Basiri, Abbas; Tabibi, Ali; Shakhssalim, NasserObjectives: This study aimed to evaluate donor and graft outcome in kidney transplantations from laparoscopic donor nephrectomies. Materials and Methods: From June 2000 to June 2004, 341 laparoscopic donor nephrectomies were performed. Demographics and hospital records were reviewed. Mean ages of donors and recipients were 27.59 ± 4.80 years (range, 20-56 years) and 35.36 ± 14.85 years (range, 3-75 years). Results: Nephrectomy was left sided in 96.2%. Mean follow-up was 13.32 ± 35.98 months. Mean warm ischemia time was 8.17 minutes (range, 2.5-19 minutes). Mean operative time was 260.34 minutes. Median serum creatinine levels (mg/dL) of the recipients were 1.30, 1.45, and 1.20 at day 7, and at 1 and 12 months. One-year graft survival was 92.7%, 94.6%, and 92.6% in the laparoscopic donor nephrectomy groups with warm ischemia times of less than 6, 6-10, and more than 10 minutes (P = NS). Conversion to open surgery occurred in 2.1% of donors, and reoperation was performed in 3.8% of laparoscopic donor nephrectomies. Blood transfusion was required in 7.1% of donors. Ureteral complications were observed in 2.1% of recipients. Vascular control was performed using medium-large clips instead of endo GIA, and the kidney was extracted via a suprapubic approach using the hand instead of an ENDOCATCH bag; hence, $600 was saved in each nephrectomy. No vascular accident occurred from pedicular vessels. Conclusions: Laparoscopic donor nephrectomy can be performed with a less-expensive setup (to be expanded in developing countries) without jeopardizing results. Because warm ischemic time in our study did not affect graft outcome significantly, there appears to be no need to rush harvesting the kidney to achieve a better quality kidney. Vascular control using nonautomatic clips instead of more costly endo GIA and hand extraction of the kidney is safe, practical, and economical.