Başkent Üniversitesi Makaleler
Permanent URI for this collectionhttps://hdl.handle.net/11727/13096
Browse
33 results
Search Results
Item Relation of Resistive and Pulsatility Indices With Graft Function After Renal Transplant(Başkent Üniversitesi, 2012-12) Ghorbani, Ali; Taheri, Azade; Mansoori, Pooria; Sametzadeh, Mozhgan; Shirazi, Ahmad SoltaniObjectives: There are conflicting data regarding the use of some measured indices by Doppler ultrasound such as the resistive index and the pulsatility index in predicting renal allograft dysfunction. This study sought to evaluate the association of early postoperative Doppler indices and 3-month serum creatinine levels in renal transplant recipients. Materials and Methods: During a 1-year period, all patients who underwent renal transplant at our hospital were recruited into a prospective study. Doppler ultrasound was performed on all patients 6 days and 3 months after the transplant and the resistive index and the pulsatility index were calculated for each patient. Then, the association between these indices and 3-month outcomes of patients were investigated. Results: Thirty-eight patients including 21 men (mean age, 36.6 ± 13.1 y) were evaluated. There was a positive correlation between the resistive index and the pulsatility index at 6 days after transplant and the serum creatinine measured at the same day (P < .001 and r=0.570 for resistive index; P < .001 and r=0.547 for pulsatility index). There was also a positive correlation between the pulsatility index and the resistive index at 6 days after transplant and 3-month serum creatinine level (P = .009 and r=0.420 for resistive index; P = .009 and r=0.417 for pulsatility index). There were negative correlations between the resistive index and the pulsatility index on the sixth day after surgery and creatinine clearance measured at 6 days and 3 months after transplant. Conclusions: This study reveals a strong-to-medium correlation between the resistive index and the pulsatility index, serum creatinine level, measured 6 days after transplant.Item Gender-Based Analysis of Outcome After Heart Transplantation(Başkent Üniversitesi, 2012-08) Eifert, Sandra; Meiser, Bruno; Kaczmarek, Ingo; Beiras-Fernandez, Andres; Bigdeli, Amir Khosrow; Horster, Sophia; Nickel, Thomas; Kofler, SieglindeObjectives: Gender differences between donors and recipients might have an effect on outcome after heart transplantation. Literature and registries reveal controversial results. We reviewed 1000 heart transplantations at our center focusing on the influence of gender differences on short- and long-term outcome after heart transplantation. Materials and Methods: We performed a retrospective analysis of 1000 (960 primary and 40 redo-heart transplantations) between August 1981 and July 2008. In contrast to other studies, the data for gender differences (donor gender and recipient gender) were evaluated for recipient survival and survival conditional to early mortality. Results: Female donors are significantly older than male donors (females, 36.5 ± 14.5 years; males, 31.2 ± 13.8 years). One-year survival was significantly inferior in male recipients receiving female donor hearts (mR/fD: 73.7%) compared to females receiving male donor organs (fR/mD: 90.9%) (P = .045). Univariate analysis revealed that, for recipients who survived > 1 year, survival at 10 years was significantly greater for female donors and female recipients (90%) than it was for male donors and male recipients (72%; P = .034). Multivariate analysis showed that the gender combination with female donors and female recipients was an independent indicator for greater long-term survival (P = .04). Conclusions: The gender combination of female donors and male recipients had a greater risk for early mortality after heart transplantation, and the combination of male donors and female recipients resulted in favorable short-term outcomes. In long-term follow-up, recipients of hearts from female donors had better survival, especially female recipients.Item Minimal Access Kidney Transplant: A Novel Technique To Reduce Surgical Tissue Trauma(Başkent Üniversitesi, 2012-08) Brockschmidt, Claas; Henne-Bruns, Doris; Wittau, Mathias; Hartmann, Bertram; Paschke, Stephan; Huber, NadineObjectives: Minimally invasive surgery and minimal access surgery has replaced conventional surgical procedures during the last 15 years with benefits including a decrease in postoperative pain, time spent convalescing, early return to normal activities, and pleasing cosmetic results. Many centers perform kidney transplant through an oblique or J-shaped approach deep into the iliac fossa. Both approaches have possible disadvantages regarding the extent of tissue trauma. Therefore, we introduced a new minimal access kidney transplant technique in our kidney transplant program in 2008 and report the outcomes of the first 10 patients transplanted with this technique. Materials and Methods: Between November 2008 to May 2009, ten kidney recipients were subjected to the minimal access kidney transplant technique. These patients represent a consecutive series of kidney transplants performed by the senior surgeon or under the supervision of the senior surgeon of transplant surgery. Results: The mean (± SD) age of the recipients was 47 ± 14.7 years (range, 28-67 y), the body mass index was 25 ± 2.02 (range, 23-30), the time of procedure was 126.2 ± 27.5 minutes (range, 90-165 min) with a mean (± SD) anastomoses time of 27.7 ± 8.4 minutes (range, 19-45 min). Follow-up for all recipients was at least 18 months. There was no reintervention necessary, no wound infections, no primary nonfunction or a delayed graft function, no need for dialysis, no acute rejection episodes, no graft loss, no wound dehiscence, no incisional hernia, or lymphocele. Furthermore, no urologic complications or vascular complications were observed. Conclusions: Our reported technique was used on heart-beating donor kidneys as well as on living-donor organs and is safe with less comorbidity. This minimal access kidney transplant technique might be an alternative procedure for avoiding some of the disadvantages of conventional approaches used for kidney transplant.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 Importance of Education in Organ Donation(Başkent Üniversitesi, 2011-12) Yilmaz, Tonguc UtkuObjectives: Transplanting is the sole therapy for the majority of organ insufficiencies, but the lack of organ donation limits transplanting. We evaluated the effect of education about “Organ Donation and Transplantation” over the false beliefs of the participants. Materials and Methods: This interventional study was performed in a military unit between January and March 2010. Data on organ donation and demographic characteristics were collected by a questionnaire. The researcher gave the lesson, and then collected the data by the same questionnaire 2 months later. Results: The rate of volunteering for organ donation increased from 45.4% to 84.8% (P < .001). Rate of consent for organ donations by relatives increased from 41% to 80.3% (P < .001). Also, general knowledge about organ donation increased from 34.8% to 93.7% (P < .001). Wrong beliefs about organ donation disappeared after the education. The entire organ donation rate among the volunteer participants increased from 60% to 84% (P < .001). No significant relation was found between volunteering to donate organs, and education and economic status. Conclusions: Education could correct false information and might lead to higher organ donation rates. This education (which gave positive results in a military unit) could become widespread.Item Determinants of Coronary Artery Disease in Liver Transplant Candidates(Başkent Üniversitesi, 2010-06) Muderrisoglu, Haldun; Haberal, Mehmet; Aydinalp, Alp; Atar, Ilyas; Bal, Ugur; Aktas, Ayse; Ertan, Cagtay; Atar, Asli; Yildirir, Aylin; Ozin, BulentObjectives: The potential for perioperative and late cardiovascular complications in liver transplant candidates makes careful preoperative risk assessment imperative. We sought to identify the determinants of coronary artery disease in liver transplant candidates. Materials and Methods: Liver transplant candidates with end-stage liver disease who were more than 40 years old and undergoing coronary angiography were retrospectively included in this study. Patients with known coronary heart disease or valvular heart disease were excluded. Symptoms, coronary artery disease risk factors, blood tests, electrocardiogram, echocardiography, treadmill stress test, myocardial perfusion scintigraphy, and coronary angiography results were recorded. A multivariable logistic regression model was used to assess the independent predictors of coronary artery disease. Results: A total of 139 patients (mean age, 52 ± 8; 110 male [79%]) were included in the analysis. Coronary angiography revealed that 13 patients (9.4%) had coronary artery disease. The frequency of diabetes mellitus, stable angina symptoms, positive smoking status, presence of 2 or more risk factors for coronary artery disease, and mean low-density lipoprotein cholesterol levels were significantly higher in patients with coronary artery disease than in patients without coronary artery disease. The electrocardiogram, echocardiography, and noninvasive stress test results were not valuable tools in liver transplant candidates for the diagnosis of coronary artery disease. In multivariate analysis, typical angina symptoms and low-density lipoproteins cholesterol levels appeared to be independent factors that were predictive of coronary artery disease. Conclusions: Typical anginal symptoms and low-density lipoprotein cholesterol levels seem to be the best predictors of coronary artery disease in liver transplant candidates.Item An International Survey of the Diagnosis, Management, and Treatment of Hepatitis C in Patients with End-Stage Renal Disease(Başkent Üniversitesi, 2009-12) Araya, Victor; Ortiz, Jorge; Olson, Mira R.; Grewal, Kevin S.; Bingaman, Adam; Zaki, Radi; Stewart, Shelby; Horton, JohnObjectives: Hepatitis C is one of the leading causes of death from liver disease in the United States, and is frequently associated with renal disease. Two major organizations—the American Association for the Study of Liver Disease and the National Kidney Foundation—have published recommendations regarding the treatment of hepatitis C in the presence of chronic kidney disease; however, these guidelines do not always provide the same recommendations. Given the paucity of data on adherence to the current guidelines, a survey was conducted to provide information about the current practices of physicians in comparison to the published guidelines. Materials and Methods: An observational study was conducted via a global survey asking physicians treating patients who had concurrent hepatitis C and chronic kidney disease. Results: The 218 questionnaires collected requested the physician’s subspecialty, the number of transplants performed at the hospital, the usual method of screening for hepatitis C, the preferred route, the indication and frequency of liver biopsy, the use of ribavirin and interferon, the use of hepatitis-C–positive donors in kidney transplant, and consent requirements. Conclusions: Our results showed that many physicians do not follow current recommendations. We argue that a consensus group be formed to set forth guidelines for the management of hepatitis C to optimize outcomes, and improve overall morbidity.Item Risk Factors for Biliary Complications After Living-Donor Liver Transplant: A Single-Center Experience(Başkent Üniversitesi, 2008-06) Alawi, Khalil; Sebayel, Mohammed; Abdo, Ayman; Al-Hamoudi, Waleed; Al-Bahili, Hamad; Al-Sofayan, Mohamed; Al-Saghier, Mohamed; Allam, Naglaa; Medhat, Yaser; Khalaf, HatemObjectives: Biliary complications remain a major concern in living-donor liver transplant. They can lead to patient and graft loss. In this study, we retrospectively analyzed patients’ records to identify factors that increase the frequency of biliary complications in living-donor liver transplant with an aim toward decreasing this frequency. Materials and Methods: We performed 53 living-donor liver transplants between November 2002 and September 2007. Five cases were excluded because of graft or patient loss within 2 weeks resulting in 48 cases available for analysis. The effect of the following variables on the frequency of biliary complications was analyzed: recipient age, liver lobe used, number of graft bile ducts, number of biliary anastomoses, type of biliary anastomosis, and bile duct diameter 4 mm or smaller. Results: Biliary complications were seen in 14 cases (29.1%). These included 9 biliary strictures, 3 bile leaks, and 2 bile leaks eventually healing as biliary strictures. The presence of more than 1 graft bile duct increased the frequency of biliary complications (P = .03). The other variables did not have a statistically significant effect on the frequency of biliary complications. Conclusions: The rate of complications in our experience is comparable to that already published. The presence of more than 1 bile duct in the graft is a risk factor for biliary complications in living-donor liver transplant. A review of the data suggests additional risk factors.Item Sinus Bradycardia Associated With Daclizumab in Liver Transplant Recipients: Report of 3 Cases(Başkent Üniversitesi, 2008-12) Bassily-Marcus, Adel; Benjamin, Ernest; Manasia, Anthony; Oropello, John; Murgolo, Victor; Leibowitz, Andrew; Kohli-Seth, RoopaDaclizumab is a commonly used immunosuppressive agent for prophylaxis of solid organ rejection. Although rare, the cardiovascular adverse effects of daclizumab include sinus tachycardia, hypotension, and hypertension. Here, we report 3 patients who developed significant and prolonged sinus bradycardia after receiving daclizumab following orthotopic liver transplant. Daclizumab should be considered a possible cause of bradycardia following its administration in orthotopic liver transplant.Item Renal Allograft Abscesses Following Transplant: Case Report and Literature Review(Başkent Üniversitesi, 2007-12) Shoja, Mohammadali M.; Varshochi, Mojtaba; Tubbs, R. Shane; Etemadi, Jalal; Ardalan, Mohamad R.Intrarenal and perinephric abscess formations are infrequent infectious complications in kidney allograft recipients. A 37-year-old man who was a victim of mustard gas chemical weapons from the Iran-Iraq war received a live-donor kidney transplant for end-stage renal disease. The posttransplant course was complicated by clinical rejection, which subsided after a 2-week infusion of antithymocyte globulin. One month subsequent to this, the patient presented with renal allograft dysfunction and multiple intrarenal abscesses. Culture from the purulent aspirate of a percutaneously drained renal abscess revealed multidrug-resistant Pseudomonas aeruginosa. A concomitant acute cytomegalovirus infection was detected based on positive serologic tests. Treatment with intravenous meropenem (3 g/day for 3 weeks) and oral ciprofloxacin was begun, which resulted in the complete resolution of the intrarenal abscesses. To our knowledge, this report represents the first description of pseudomonal renal abscesses in a renal transplant recipient. A review of the relevant literature is presented.