Başkent Üniversitesi Makaleler
Permanent URI for this collectionhttps://hdl.handle.net/11727/13096
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Item Seroprevalence of HTLV-1 Among Kidney Graft Recipients: A Single-Center Study(Başkent Üniversitesi, 2010-06) Khameneh, Zakieh Rostamzadeh; Taghizade-Afshari, Ali; Masudi, Sima; Sepehrvand, NarimanBackground: Renal transplant recipients are susceptible to viral infections because of their immunocompromised background. HTLV-1 is a retrovirus that leads to adult T-cell leukemia/lymphoma or myelopathies. This study aimed to evaluate HTLV-1 antibodies among renal transplant recipients in Urmia, Iran. Materials and Methods: Serum samples of 91 renal transplant recipients from Urmia, Iran, were examined serologically for antibodies against HTLV type 1 using an enzyme-linked immunosorbent assay. Results: Mean age was 37.26 ± 14.22 years old. Only 1 patient had a positive anti-HTLV-1 enzyme-linked immunosorbent assay test, which was confirmed by Western blot. The HTLV-1–positive case did not have HTLV-associated clinical manifestation. This patient was a 45-year-old man, with no history of blood transfusion, but he did have a history of hemodialysis before transplant. Conclusions: The frequency of HTLV-1 among renal transplant recipients of our region in the northwest of Iran was not so high, and it is similar to the HTLV-1 seroprevalence among hemodialysis patients. Still, it is more frequent among healthy blood donors as representative of the general population in our region.Item Renal Transplant Outcome After Endoscopic Treatment of Vesicoureteral Reflux Using the Subureteric Injection of Calcium Hydroxyapatite(Başkent Üniversitesi, 2010-03) Dirim, Ayhan; Haberal, Mehmet; Ozkardes, Hakan; Turunc, Tahsin; Aygun, Cem; Hasirci, Eray; Celik, HuseyinObjectives: To evaluate the results of end-stage renal failure in transplanted cases due to vesicoureteral reflux after a subureteric injection of calcium hydroxyapatite (Coaptite). Materials and Methods: Twenty-three patients (39 renal units) with end-stage renal failure secondary to vesicoureteral reflux were included. Reflux was bilateral in 16 cases and unilateral in 7 of the cases. There were 3 degrees of reflux according to the distribution of renal units. They were low-grade reflux (grades 1 and 2; n=10); medium-grade reflux (grade 3; n=23); and high-grade reflux (grades 4 and 5; n=6). Results: Reflux resolved completely in 17 patients (28 renal units; 71.8%). There was a regression to grade 1 in 3 patients (5 renal units; 12.8%). Twenty-one patients underwent renal transplant; however, 2 of the patients were excluded from the study as it was not possible to monitor them after transplant. Within an approximately 18.6 month follow-up (range, 3-36 months), 1 of the cases had acute, and 3 of the cases had chronic rejection. Conclusions: Successful results can be achieved in reflux treatment by an injection of subureteric calcium hydroxyapatite before transplant in patients with end-stage renal failure that developed secondary to vesicoureteral reflux.Item Therapeutic Failure in a Renal Transplant Patient with Pneumocystis Jiroveci Pneumonia: A Case Report(Başkent Üniversitesi, 2009-06) Archontoulis, Nikolaos K.; Staikou, Chryssoula V.Objectives: Pneumocystis jiroveci pneumonia is common in immunocompromised individuals. Patients: This case report describes an immunosuppressed patient who acquired P jiroveci pneumonia 6 months after renal transplant surgery. Results: The patient experienced many pneumonia-related complications and adverse effects from drug therapy, and despite treatment with various antibiotic agents, he died on the 62nd day after his admission to the intensive care unit. Conclusions: The therapeutic failure of the drug of choice (co-trimoxazole) was evident. This case raises questions about the development of P jiroveci resistance to current therapies.Item Brain Tumor as an Unusual Presentation of Posttransplant Lymphoproliferative Disorder(Başkent Üniversitesi, 2009-03) Azarpira, Negar; Rakei, Mohamad; Torabineghad, SiminObjectives: Posttransplant lymphoproliferative disorder following solid organ transplant is a life-threatening form of posttransplant malignancy. Its occurrence is typically associated with Epstein-Barr virus and profound immunosuppressive therapy. We describe a case of posttransplant lymphoproliferative disorder in the brain parenchyma, 4 years after renal transplant. Case Report: A 23-year-old man was evaluated for generalized headache 4 years after receiving a deceased donor renal transplant. After initial immunosuppression with tacrolimus and prednisolone, mycophenolate mofetil was added for maintenance immunosuppression. A tumor in the right occipitoparietal lobe was detected by magnetic resonance imaging and excised. Immunohistochemical testing of the tumor revealed B-cell marker and Epstein-Barr virus. After surgery, the dosage of immunosuppressive drugs was reduced, and the patient was treated with chemotherapy and radiotherapy. Our patient is well after treatment. Conclusions: Reduction in immunosuppressive therapy is an important component of treatment for Epstein-Barr virus-positive posttransplant lymphoproliferative disorder and may lead to remission in early disease. If reduced immunosuppression fails to control early disease, cytotoxic chemotherapy, surgery and radiotherapy, antiviral therapies, and cell-based therapies are other options for treatment.Item Calciphylaxis-Associated Second Renal Graft Failure and Patient Loss: a Case Report and Review of the Literature(Başkent Üniversitesi, 2008-12) Aabed, Gamal; Helmy, Ahmed; Ghamedi, Abdulla Al; Mana, Hadeel Al; Al-Lehbi, Ali; Furayh, Othman AlObjectives: Calciphylaxis is a small vessel disease that affects 1% to 4% of patients undergoing dialysis. Only 21 cases of postrenal transplant calciphylaxis have been reported, but none has been associated with primary graft failure or has occurred in a second graft. We present the first case of second renal graft calciphylaxis leading to primary graft failure and death. Materials and Methods: We reviewed the 22 cases, including ours, and assessed risk factors, management, and mortality for these cases. Results: The mean age was 34.2 ± 10.6 years, 11 patients were males (50%), and 13 (57.9%) underwent a deceased-donor renal transplant. The mean pretransplant dialysis period was 35.7 ± 39.3 months, 22 patients (100%) were on steroid therapy, 8 (36.4%) had a rejection, 18 (81.8%) underwent postcalciphylaxis parathyroidectomy, and 11 patients died (50%). Acute graft rejection and its management in the presence of high parathormone and divalent ion levels may be associated with postrenal transplant calciphylaxis. Conclusions: If the high parathormone levels are not adequately suppressed with medical treatment, prerenal transplant preparation should include parathyroidectomy. In addition, steroids and other immunosuppressive medications should be tapered quickly in calciphylaxis patients, especially if a patient’s life is at risk.Item Early Diagnosis and Successful Treatment of Acute Antibody-Mediated Rejection of a Renal Transplant(Başkent Üniversitesi, 2008-09) Yang, Ya-Wen; Tsai, Meng-Kun; Lee, Po-Huang; Wu, Ming-Shiou; Lin, Wei-ChouAntibody-mediated rejection is a delicate situation. It rarely occurs but when it does, it usually results in graft dysfunction and frequently, graft loss. There has been no standard protocol for treating antibody-mediated rejection, although several therapeutic protocols have been recommended. Early detection and treatments of suspected antibody-mediated rejection can secure the graft and improve its function. Here, we describe a typical case of antibody-mediated rejection in a 46-year-old woman who was successfully treated with intravenous immunoglobulin, plasmapheresis, and the anti-CD20 monoclonal antibody, rituximab.Item Serial Resistive Index and Pulsatility Index for Diagnosing Renal Complications in the Early Posttransplant Phase: Improving Diagnostic Efficacy by Considering Maximum Values(Başkent Üniversitesi, 2008-06) Radmehr, Ali; Shakiba, Madjid; Taheri, Amir Pejman Hashemi; Jandaghi, Ali BabaeiObjectives: To present new approaches to using duplex Doppler scanning to detect kidney complications in the early posttransplant period. Materials and Methods: We assessed the resistive index and the pulsatility index in 127 renal transplant patients (73 men, mean age, 35.2 ± 14 years) who underwent duplex Doppler scanning on the first, third, and fifth days after transplant. Biopsies were performed in patients suspected of having graft dysfunction owing to clinical and laboratory findings. To differentiate complicated from healthy grafts, a receiver operating characteristic curve analysis was done, and an area under the curve was calculated for each variable. Results: In total, 47 grafts (37%) became complicated (40 rejections). The mean resistive index and mean pulsatility index were statistically significantly higher on the first, third, and fifth days after transplant in patients with complicated grafts than they were in patients with noncomplicated grafts (P < .0001). The mean resistive index and mean pulsatility index showed a significant rise from the first to the fifth day in patients with complicated grafts (P ≤ .014). The area under the curve of the receiver operating characteristic curve for resistive index and pulsatility index on successive days was statistically significant (P < .0001). The resistive index and the pulsatility index area under the curve were statistically significantly lower on the first day than they were on subsequent days. Considering the maximum value of a serially measured resistive index and pulsatility index (which were determined by comparing 3 measurements on the fifth day and selecting the highest one) as a new variable showed a better area under the curve compared with that calculated on the third day (P = .05 for resistive index; P = .012 for pulsatility index). Conclusions: The resistive index and the pulsatility index are effective means of diagnosing posttransplant renal complications. Including a serial assessment and considering the maximum values could improve the diagnostic efficacy on the fifth day after transplant.Item Influence of Long Chain Polyunsaturated Fatty Acids and Ornithine Concentrations on Complications After Renal Transplant(Başkent Üniversitesi, 2008-06) Alexander, J. Wesley; Woodle, E. Steve; James, J. Howard; Moser, Ann B.; Kuo, Paul C.; Light, Jimmy A.; Succop, Paul; Goodman, Hope R.Objectives: The present study, registered at clinicaltrials.gov with the unique registration number NCT00560014, sought to evaluate the relations between fatty acid concentrations in red blood cells or plasma and amino acid concentrations in plasma on rejection, calcineurin inhibitor toxicity, and new-onset diabetes mellitus. Materials and Methods: Lipid profiles on plasma or red blood cell samples were performed preoperatively and postoperatively in 54 patients. Plasma amino acid profiles were obtained in 49 of these patients. Results: High concentrations of total ω-3 fatty acids, eicosapentaenoic and docosahexaenoic acids in red blood cells, and ornithine in plasma, all were associated with a significantly lower incidence of rejection, whereas high total ω-6 fatty acids were associated with a high rejection rate. Calcineurin inhibitor toxicity was associated with low levels of docosahexaenoic acid, ornithine, and the ω-3 index, and high total ω-6 and ω-3/ω-6 ratios. Inhibition of new-onset diabetes mellitus was seen only with high levels of ornithine. Peak concentrations of fatty acids in red blood cells were not obtained until after 30 days. High levels of arginine were not associated with reduced complications. Conclusions: The levels of selected nutrients in plasma and red blood cell membranes appear to have a profound effect on complications after renal transplant. These preliminary results need confirmation in prospective randomized clinical trials.Item Rescue Immunosuppressive Therapies in Living-Related Renal Allotransplant: A Long-term Prospective Randomized Evaluation(Başkent Üniversitesi, 2008-03) Bakr, Mohemed Adel; Ghoneim, Mohamed Ahmed; El-Dein, Ahmed Bayomi Shehab; Baz, Mahmoud El; Ismael, Amani Mostafa; Gheith, Osama AshryObjectives: The majority of our patients are maintained on prednisolone, cyclosporine, and azathioprine as primary immunosuppression. In the presence of repeated episodes of acute rejection, this maintenance immunosuppressive regimen is increased by replacing cyclosporine with tacrolimus or azathioprine with mycophenolate mofetil. To the best of our knowledge, there are no available data among living-related renal allotransplants that evaluate the long-term efficacy and safety of these rescue immunosuppressive therapies. Therefore, we sought to evaluate the long-term efficacy and safety of rescue immunosuppressive therapies among living-related renal allotransplant recipients. Materials and Methods: We reviewed the long-term follow-up data of 212 renal transplant recipients at the Urology and Nephrology Center Mansoura University in Mansoura, Egypt, who had been maintained on a primary immunosuppressive protocol that included prednisolone, cyclosporine, and azathioprine. Patients were randomized at a ratio of 1:2 to receive more-intensive maintenance immunosuppression by replacing cyclosporine with tacrolimus in 65 patients (group TAC) and replacing azathioprine with mycophenolate mofetil in 147 patients (group MMF). Results: We found no statistically significant difference between the 2 groups regarding rejection-free patients or those who experienced 1 or more episodes of acute rejection (P > .5). In group TAC and group MMF, graft survival rates were 87.3% and 96.3% at 2 years and 78.7% and 80% at 5 years, respectively (P = .07). The corresponding patient survival rates were 98.4% and 98.5% at 1 year, 98.4% and 97.7% at 2 years, and 94.4% and 94.4% at 5 years, respectively (P = .65%). There were more patients with diabetes and serious bacterial infections in group TAC than there were in group MMF (P = .001 and .04, respectively). Conclusions: Conversion from cyclosporine to tacrolimus or from azathioprine to mycophenolate mofetil is a safe, equipotent rescue especially with repeated acute rejections. However, mycophenolate mofetil rescue therapy was more beneficial regarding graft survival.Item The Cairo Kidney Center Protocol for Rapamycin-based Sequential Immunosuppression in Kidney Transplant Recipients: 2-Year Outcomes(Başkent Üniversitesi, 2007-12) Barsoum S. , Rashad; Morsy, A. Ahmed; Iskander, Irene R.; Morgan, Manal M.; Fayad, Tarek M. F.; Atalla, Nasr T.; Wafik, Hani; Grace, Renne A.; Adel, Noha; Khalil, Soha S.Objective: This study examines the outcomes of de novo kidney transplants treated by a sequential protocol, designed to target the succession of immunologic events following engraftment. Subjects: A total of 113 sequential live-donor recipients were randomized into 2 arms. Patients in arm A received prednisolone, cyclosporine, and sirolimus for 3 months (phase 1), followed by replacement of cyclosporine with mycophenolate mofetil (phase 2). Those in arm B (controls) received prednisolone/cyclosporine/mycophenolate mofetil throughout the study. The primary endpoints were patient and graft survival rates at 2 years. Secondary endpoints included biopsy-proven acute rejection, early and late graft function, hypertension, and adverse reactions. Results: The 2-year intent-to-treat patient and graft survival rates (95.8% vs 91.4% and 94.6% vs 90.2%) were numerically but not significantly higher in arm A. The overall incidence of biopsy-proven acute rejection was numerically lower (13.5% vs 18.9%), yet it occurred exclusively with cyclosporine C2 levels below 770 ng/mL (P = .28). Mean time for serum creatinine to reach 132 µmol/L was significantly longer in arm A (7.3 vs 2.9 days). Graft function at 2 years (eGFR, 70.2 vs 55.9 mL/min) and number of drugs needed to control blood pressure (mean 1.7 vs 2.25) were significantly more favorable in group A. Significant adverse effects for patients in arm A included proteinuria (36.8% vs 18.6%), hyperlipidemia (peak cholesterol > 7.75 mmol/L in 32.9% vs 23.7% of patients) and thrombocytopenia (platelet count < 100 × 109/L in 32.9% vs 13.5 % of patients). Conclusions: The described protocol reduced the incidence of biopsy-proven acute rejection in patients after kidney transplant, particularly in those with adequate cyclosporine blood levels. Despite the significantly higher incidence of certain adverse effects (ie, delayed graft function, proteinuria, hyperlipidemia, and transient thrombocytopenia), patient and graft survival rates at 2 years were numerically, though not statistically, improved in patients in arm A. At 2-year analysis, compared with patients in the control arm (arm B), graft function significantly improved in patients in arm A, and the number of drugs needed to control blood pressure was significantly lower.