Başkent Üniversitesi Makaleler

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    Impact of Pancreatic Allograft Function on 1-Year Survival Rates After Simultaneous Pancreatic-Renal Transplant
    (Başkent Üniversitesi, 2008-12) Rangel, Érika B.; Medina-Pestana, José O.; Salzedas, Alcides; Sá, João R. de; Linhares, Marcelo M.; Gonzalez, Adriano M.; Melaragno, Cláudio S.
    Objectives: Simultaneous pancreatic-renal transplant is an effective treatment for insulin-dependent patients with chronic renal failure. We sought to identify the main influences on pancreatic and patient survival rates after simultaneous pancreas-kidney transplants. Patients and Methods: The 1-year patient and pancreas survival rates of 150 patients who had undergone simultaneous pancreas-kidney transplant were analyzed by the Cox proportional hazards regression model and the Kaplan-Meier method. Uni- and multivariate analyses were performed in terms of transplant-, recipient-, and donor-related risk factors. Results: At 1 year, patient and pancreatic allograft survival rates were 82% and 76.7%, respectively. Delayed graft function in the kidney (P = .001, HR 5.41), acute kidney rejection (P = .016, HR 3.36), and intra-abdominal infection (P < .0001, HR 4.15) were the main factors related to 1-year patient survival. Pancreatic allograft survival at 1 year was related to intra-abdominal infection (P < .0001, OR 12.83), vascular thrombosis (P = .002, OR 40.55), acute kidney rejection (P = .027, OR 3.06), donor sodium greater than 155 mEq/L (P = .02, OR 3.27), and dopamine administration exceeding 7.6 μg/kg/min (P = .046, OR 2.85). Conclusions: Delayed kidney allograft function and intra-abdominal infection had an important effect on both patient and pancreatic allograft survival rates.
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    Characteristics of Recipients Whose Kidney Allograft Has Functioned for More Than 20 Years
    (Başkent Üniversitesi, 2008-06) El-Agroudy, Amgad E.; Ghoneim, Mohamed A.; Shokeir, Ahmed A.; Ismail, Amani M.; Abbass, Tarek M.; El-Dahshan, Khaled
    Objectives: To study the characteristics of, and predictors for, survival in renal transplant recipients with an allograft functioning for more than 20 years. Materials and Methods: Of 144 renal transplants done between 1976 and 1985, 31 allografts were still functioning for more than 20 years (range, 21-28.5 years). The characteristics of the patients and determinants of the outcomes were obtained by reviewing the patients’ medical records. Results: Fourteen patients were treated with cyclosporine, while 17 patients had primary immunosuppression with azathioprine-based regimens. Episodes of acute rejection occurred in 17 patients (58%), 7 of these experienced 2 or more episodes. At most-recent follow-up, the mean serum creatinine level was 132 ± 44 µmol/L . Four patients were assessed by graft biopsy 15 or more years after the transplant, revealing 2 cases of mild glomerulosclerosis and 2 cases of moderate chronic allograft nephropathy. The most common complication was hypertension (54%). The independent determinants of long-term graft survival were donor age and source, hypertension both before and after renal transplant, and histopathological findings of chronic allograft nephropathy. Conclusions: Renal transplant offers a near-normal life to patients with end-stage renal disease soon after transplant and for upwards of 20 years and more. We found no significant benefit to cyclosporine-based immunosuppression on long-term graft survival.
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    Cytomegalovirus Disease in Renal Transplant Recipients: An Iranian Experience
    (Başkent Üniversitesi, 2008-06) Nemati, Eghlim; Einollahi, Behzad; Pourfarziani, Vahid; Taheri, Saeed
    Background: 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.