Başkent Üniversitesi Makaleler
Permanent URI for this collectionhttps://hdl.handle.net/11727/13096
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Item Relation Between Pretransplant Serum Levels of Soluble CD30 and Acute Rejection During the First 6 Months After a Kidney Transplant(Başkent Üniversitesi, 2013-06) Shooshtarizadeh, Tina; Ataipour, Yousef; Ossareh, Shahrzad; Mohammadali, AliObjectives: The immunologic status of kidney allograft recipients affects transplant outcome. High levels of pretransplant serum soluble CD30 correlate with an increased risk of acute rejection. Studies show conflicting results. We evaluated the relation between pretransplant serum sCD30 levels with the risk of posttransplant acute kidney rejection in renal transplant recipients. Materials and Methods: This prospective cohort study was performed between March 2010 and March 2011 on 77 kidney transplant recipients (53 men [68.8%], 24 women [31.2%]; mean age, 41 ± 14 y). Serum samples were collected 24 hours before transplant and analyzed for soluble CD30 levels by enzyme-linked immunosorbent assay. Patients were followed for 6 months after transplant. Acute biopsy-proven rejection episodes were recorded, serum creatinine levels were measured, and glomerular filtration rates were calculated at the first and sixth months after transplant. Preoperative serum soluble CD30 levels were compared in patients with and without rejection. Results: The mean pretransplant serum soluble CD30 level was 92.1 ± 47.3 ng/mL. At 6 months’ follow-up, 10 patients experienced acute rejection. Mean pretransplant soluble CD30 levels were 128.5 ± 84 ng/mL versus 86.7 ± 37 ng/mL in patients with and without acute rejection episodes (P = .008). At 100 ng/mL, the sensitivity, specificity, and positive and negative predictive values of pretransplant serum soluble CD30 level to predict acute rejection were 70%, 73.6%, 29.1%, and 94.3%. Conclusions: We showed a significant relation between pretransplant serum soluble CD30 levels and acute allograft rejection. High pretransplant levels of serum soluble CD30 can be a risk factor for kidney transplant rejection, and its high negative predictive value at various cutoffs make it useful to find candidates with a low risk of acute rejection after transplant.Item Evaluating Safety and Efficacy of Rabbit Antithymocyte Globulin Induction in Elderly Kidney Transplant Recipients(Başkent Üniversitesi, 2013-06) Khanmoradi, Kamran; Dinh, Duy-Bao; Ortiz, Jorge A.; Zaki, Radi F.; Campos, Stalin; Jawa, Pankaj; Parsikia, Afshin; Feyssa, Eyob L.; Knorr, John P.Objectives: The optimal immunosuppression regimen for elderly kidney transplant recipients is poorly defined. We sought to evaluate the short-term efficacy and safety of thymoglobulin in geriatric recipients of deceased-donor kidneys. Materials and Methods: A single-center, retrospective analysis was undertaken between elderly (≥ 65 years) (n=137) and nonelderly (n=276) kidney transplant recipients who received rabbit antithymocyte globulin induction and calcineurin inhibitor, mycophenolic acid, and prednisone maintenance. Results: The mean age was 70 versus 52 years. Fewer elderly patients had an earlier transplant or panel reactive antibodies > 20%, but had more machine perfused, older, and extended criteria donor kidneys. Elderly patients received lower rabbit antithymocyte globulin (5.4 vs 5.6 mg/kg; P = .04) and initial mycophenolic acid doses (1620 vs 1774 mg; P = .002), and experienced less delayed graft function (31.1% vs 50.0%; P < .001). Death-censored graft survival and graft function at 3 years and biopsy-proven acute rejection at 1 year were comparable; however, there was lower 3-year patient survival in elderly patients. Donor age was the only factor associated with reduced patient survival. Rates of malignancy, infection, or thrombocytopenia were similar; however, leukopenia occurred less frequently in elderly patients (11.7% vs 19.9%; P = .038). Conclusions: Elderly kidney transplant recipients receiving rabbit antithymocyte globulin did not experience different short-term graft survival, graft function or rates of infection, malignancy or hematologic adverse reactions than did nonelderly patients; they experienced fewer episodes of delayed graft function, but had lower 3-year patient survival.Item Torsion of Extraperitoneally Transplanted Kidney: An Unusual Complication(Başkent Üniversitesi, 2013-04) Ozmen, Mehmet Mahir; Koc, Mahmut; Ziraman, Ipek; Bilgic, IsmailTorsion of the extraperitoneally transplanted kidney is rare complication with no clinical data in the literature. The authors present the case of a 44-year-old man with end-stage renal disease who received a kidney transplant from his father. On postoperative day 4, serum urea and creatinine levels increased and urine output decreased. Renal ultrasonography revealed the renal hilum to be rotated to the lateral pelvic border, causing mild pelvocaliectasis, and Doppler ultrasonography, the patients showed a poststenotic flow pattern. After the patient underwent urgent reoperation, all laboratory values and ultrasonography findings returned to normal. To the authors’ knowledge, this is the first published case report of torsion of the extraperitoneally transplanted kidney. When posttransplant deterioration in renal function occurs, renal torsion should be considered in the differential diagnosis.Item Classification of Ureteral Stenosis and Associated Strategy for Treatment After Kidney Transplant(Başkent Üniversitesi, 2013-04) He, Bulang; Han, Ying; Bremner, AlexandraObjectives: Ureteral stenosis is a common complication after a kidney transplant. Treatment for ureteral stenosis ranges from interventional procedures to open surgery. The aim of this study is to present classification for ureteral stenosis and recommend the targeted strategy for effective treatment. Materials and Methods: Twelve cases of ureteral stenosis were diagnosed among 193 kidney transplants, of which 91 were from a live donor and 102 from a deceased donor. The mean age was 46.22 ± 13.23 years. The diagnosis of ureteral stenosis includes serum creatinine elevation, hydronephrosis, and presence of stricture on a pyelogram. The criterion for classification is based on the severity of stricture. Results: One of ureteral stenoses was classified as grade 1, six were grade 2, and five were grade 3. Of 12 cases, 10 were live-donor kidney transplant, 4 had lymphocele, and 2 had a hematoma after transplant. The corresponding strategy for each grade of ureteral stenosis is as follows: grade 1, ureteral stent reinsertion; grade 2, cutting balloon dilatation or endoscopic incision of stenosis; grade 3, open surgery urinary tract reconstruction. All cases were successfully treated using these strategies. Conclusions: This classification of ureteral stenosis provides guidance for effective management and avoids unnecessary procedures. In this series, ureteral stenosis was significantly associated with a live donor and surgical complications.Item Posttransplant Hypertension: Multipathogenic Disease Process(Başkent Üniversitesi, 2013-04) Barbari, AntoineArterial hypertension is prevalent among kidney transplant recipients. The multifactorial pathogenesis involves the interaction of the donor and the recipient’s genetic backgrounds with several environmental parameters that may precede or follow the transplant procedure (eg, the nature of the renal disease, the duration of the chronic kidney disease phase and maintenance dialytic therapy, the commonly associated cardiovascular disease with atherosclerosis and arteriosclerosis, the renal mass at implantation, the immunosuppressive regimen used, life of the graft, and de novo medical and surgical complications that may occur after a transplant). Among calcineurin inhibitors, tacrolimus seems to have a better cardiovascular profile. Steroid-free protocols and calcineurin inhibitor-free regimens seem to be associated with better blood pressure control. Posttransplant hypertension is a major amplifier of the chronic kidney disease-cardiovascular disease continuum. Despite the adverse effects of hypertension on graft and patient survival, blood pressure control remains poor because of the high cardiovascular risk profile of the donor-recipient pair. Although the optimal blood pressure level remains unknown, it is recommended to maintain the blood pressure at < 130/80 mm Hg and < 125/75 mm Hg in the absence or presence of proteinuria.Item Treatment of Antibody-Mediated Rejection in Kidney Transplant Recipients: A Single-Center Experience With a Bortezomib-Based Regimen(Başkent Üniversitesi, 2012-12) Nigos, Janice G.; Sureshkumar, Kalathil K.; Ko, Tina Y.; Marcus, Richard J.; Hussain, Sabiha M.; Nath, Parineesha; Arora, SwatiObjectives: Antibody-mediated rejection after kidney transplant is less responsive to conventional antirejection therapies. The proteasome inhibitor bortezomib has activity against mature plasma cells that produce damaging donor-specific antibodies. We present our experience of using a bortezomib-based regimen in patients with severe antibody-mediated rejection. Materials and Methods: A retrospective chart review was performed on patients with biopsy-proven antibody-mediated rejection after kidney transplant at our institution over 12 months. Diagnosis of antibody-mediated rejection was made on the basis of positive peritubular capillary C4d staining along with either histologic evidence of acute rejection or positive donor-specific antibody titers. Treatment for antibody-mediated rejection included plasmapheresis, intravenous immunoglobulin, steroids, single-dose rituximab (375 mg/m2) along with bortezomib (1.3 mg/m2) on days 1, 4, 8, and 11. Antibody-mediated rejection was diagnosed in 6 patients. Patients received induction with either alemtuzumab (n=4) or rabbit-antithymocyte globulin (n=2) and were maintained on a tacrolimus/mycophenolate mofetil/early steroid withdrawal protocol. Results: Four of 6 patients responded to treatment. Patients had stable kidney function during follow-up (median 14 months) after bortezomib therapy. Conclusions: In this series, we demonstrated the effectiveness of a bortezomib-based treatment regimen in achieving reduction of donor-specific antibody titers and stable renal function in patients experiencing severe antibody-mediated rejection.Item Mycophenolate Mofetil-related Pancolitis in a Kidney Transplant Recipient(Başkent Üniversitesi, 2012-10) Hamouda, Mouna; Elmay, Mezri; Skhiri, Habib; Mahmoudi, HoudaGastrointestinal adverse effects are common with mycophenolate mofetil administration, especially diarrhea. We report a case of mycophenolate mofetil-related colitis in a kidney transplant recipient. Colonoscopy revealed an ulcerative diffuse colitis. The colonoscopic biopsy specimen showed mild crypt distortion, accompanied by cryptitis and focal graft-versus-host disease like changes. The patient’s symptoms improved after we discontinued the mycophenolate mofetil. A repeat colonoscopy 2 months after we discontinued the mycophenolate mofetil showed reparative changes. Mycophenolate mofetil is an important drug in organ transplant immune-suppression regimens; however, with its widespread use, additional adverse effects continue to be recognized.Item Sex Matching Plays a Role in Outcome of Kidney Transplant(Başkent Üniversitesi, 2012-10) Abou-Jaoude, Maroun M.; Almawi, Wassim Y.; Abou-Jaoude, Walid J.Objectives: The effect of sex matching between donors and recipients was studied in 135 kidney transplant operations performed in our center between December 1998 and December 2007. Materials and Methods: Patients were divided into 4 groups: group 1 (63 patients, male donor-male recipient), group 2 (25 patients, male donor-female recipient), group 3 (37 patients, female donor-male recipient), and group 4 (10 patients, female donor-female recipient). Except for donor age, recipient body mass index and donor-recipient HLA AB-DR matching, recipient, and donor demographics, and the immunosuppression were comparable in all groups. Results: Acute rejection and the need for anti-thymocyte globulin Fresenius rescue therapy were comparable between the 4 donor-recipient combinations. Excellent 1-year actuarial patient and graft survival, comparable hospital stay, and incidence of delayed graft and slow graft function were comparable between the 4 groups. One death occurred, each, in groups 1 and 2; posttransplant complications being comparable. While 1-year graft survival (death censored and uncensored) were comparable, 1-year graft function (serum creatinine) showed that the worst graft function was seen in group 3 (female-to-male). Significant differences between the 4 patient groups also were seen in pretransplant and posttransplant hemoglobin levels as well as in posttransplant arterial hypertension and high-density lipoprotein cholesterol blood levels. Other metabolic indices were generally comparable between the 4 patient groups. Conclusions: These results revealed that sex mismatching (group 2, male donor to female recipient) had the best 1-year graft function but the same 1-year patient and graft survival.Item Risk Factors and Outcomes of New-Onset Diabetes After Transplant: Single-Centre Experience(Başkent Üniversitesi, 2012-10) Al-Ghareeb, Sumaya M.; Alhellow, Hamad A.; Arrayed, Ahmed Al; Arrayed, Sameer M. Al; El-Agroudy, Amgad E.Objectives: We sought to study the prevalence, risk factors, and long-term prognosis of posttransplant diabetes mellitus. Materials and Methods: We studied all patients with end-stage renal disease without diabetic nephropathy who received a kidney transplant and were followed-up at our center since 1983 (n=218; age, 44.3 ± 13.1 y). Patients with new-onset diabetes after transplant were compared to kidney transplant recipients without risk factors for diabetes mellitus. Patients with new-onset diabetes after transplant were divided into subgroups according to time of onset (early; < 90 d vs late, ≥ 90 d). Results: In total, 73/218 patients (33%) developed new-onset diabetes after transplant. Patients with new-onset diabetes after transplant were significantly older (51.2 ± 11.4 vs 40.7 ± 12.5 y; P < .001) and had a tendency to have a higher body mass index (29.6 ± 8.7 vs 21.6 ± 7.8 kg/m2; P =.05) than those that did not have new-onset diabetes after transplant. In multivariate analysis, age (P < .001), hepatitis C virus infection (P < .05), family history of diabetes mellitus (P < .03), and tacrolimus use (P < .001) were independent risk factors. Five- and 10-year death censored patient survival rates were worse in those that had new-onset diabetes after transplant compared with controls (log rank, 0.04), whereas there was no difference in outcomes between the early and late subgroups. Conclusions: The prevalence of new-onset diabetes after transplant was 33%. Age, body weight at time of transplant, tacrolimus use, family history of diabetes mellitus, and hepatitis C virus infection are independent risk factors for new-onset diabetes after transplant. New-onset diabetes after transplant has a negative effect on patient survival, irrespective of the time of onset and duration of diabetes.Item A New Index for Acute Rejection After Renal Transplant: Notch Receptor-1(Başkent Üniversitesi, 2012-10) Zheng, Kai; Tan, Jianming; Cai, Jinquan; Yang, Shunliang; Wu, Weizhen; Sun, XinghuiObjectives: This study aimed at investigating the relation between expression of Notch receptor-1 (Notch 1) in peripheral blood mononuclear cells and acute rejection after renal transplant. Materials and Methods: Ninety-seven patients receiving a renal transplant were randomly selected. Peripheral blood samples before transplant and days 1, 3, 5, 7, 10, 14, 21, and 30 after transplant were retrospectively observed. Expression of Notch 1 was detected by flow cytometry and real-time quantitative polymerase chain reaction. Results: Expression of Notch 1 was correlated with acute rejection and long-term renal function after transplant (as detected by the level of serum creatinine 6 months after transplant). Expression of Notch 1 in peripheral blood mononuclear cells increased before serum creatinine increased. Expression of Notch 1 can reveal the immune state of recipients after transplant, and Notch 1 expression at early time points after transplant can predict long-term renal function. Conclusions: Notch 1 can serve as an important index for acute rejection and long-term renal function after transplant.