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 Outcomes of De Novo Allograft Diabetic Nephropathy in Renal Allograft Recipients(Başkent Üniversitesi, 2013-06) Prasad, Narayan; Gupta, Amit; Kaul, Anupama; Sharma, Raj Kumar; Bhadauria, Dharmendra; Jain, Manoj; Gupta, PallavObjectives: Despite increased use of diabetogenic immunosuppressive drugs and increased incidence of new-onset diabetes after transplant in renal allograft recipients, there are few case studies on the subject of de novo allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes. We sought to study the outcomes of allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes in patients with new-onset diabetes after transplant. Materials and Methods: We reviewed the case records of all new-onset diabetes after transplant patients who underwent graft biopsy for graft dysfunction from 1992 to 2010. We analyzed the clinical characteristics and outcomes of new-onset diabetes after transplant patients with de novo allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes. Results: Of the 1989 recipients, 421 patients developed new-onset diabetes after transplant and 26 underwent graft biopsy. Of the 26 patients, 9 had histopathologic evidence of de novo allograft diabetic nephropathy, and 17 had interstitial fibrosis/tubular atrophy without specific glomerular changes. The mean duration from transplant to developing novo allograft diabetic nephropathy was 115.2 months (range, 33-192 mo), and from developing new-onset diabetes after transplant to allograft diabetic nephropathy, was 109.66 months (range, 27-188.4 mo). Of the 9 patients with de novo allograft diabetic nephropathy, 3 died (33.3%), 2 reached end-stage renal disease (22.2%), and 4 remained stable (44.4%). Of the 17 with interstitial fibrosis/tubular atrophy, 2 died (11.7%), 5 developed end-stage renal disease (29.4%), and 10 remained stable on triple immunosuppression and insulin therapy during follow-up (58.8%). Conclusions: De novo allograft diabetic nephropathy is a significant cause of graft and patient loss in renal allograft recipients who develop new-onset diabetes after transplant.Item Mortality Predictors of Bloodstream Infections in Solid-Organ Transplant Recipients(Başkent Üniversitesi, 2013-06) Wan, Qiquan; Zhou, Jiandang; Ye, QifaObjectives: Bloodstream infections are of great concerns and a major cause of mortality in solid-organ transplant recipients. This study investigated the possible predictors influencing survival among solid-organ transplant recipients with bloodstream infections. Materials and Methods: We performed a retrospective analysis of bloodstream infections in patients who underwent solid-organ transplant between January 2002 and November 2011. During the study, 133 episodes of bloodstream infections occurred in 98 solid-organ transplant recipients. The predictors were identified by univariate and multivariate logistic regression analyses. Results: The mean age for the 98 enrolled patients was 42.3 years (42.3 ± 12.8 y). The majority of infections were nosocomial (79.6%), and the bloodstream infection-related mortality rate was 39.8% (39 of 98 patients). The univariate analysis identified the following variables as predictors of bloodstream infection-related mortality: intra-abdominal/biliary focus (P = .011), polymicrobial infection (P < .001), liver transplant (P = .002), platelet count < 50 000 × 109/L (P < .001), lymphocyte count < 300 × 109/L (P = .027), and septic shock (P < .001). The multivariate logistic regression analysis identified platelet count < 50 000 × 109/L and septic shock as independent predictors of mortality. Conclusions: The predictors significantly associated with increased mortality in solid-organ transplant recipients with bloodstream infections included decreased platelet count and septic shock. Even with appropriate antimicrobial therapy, bloodstream infections, accompanied by septic shock or decreased platelet count, are associated with high mortality rates. Therefore, steps must be taken to reduce the incidence of bloodstream infections in solid-organ transplant patients.Item Factors That Hinder Organ Donation: Religio-Cultural or Lack of Information and Trust(Başkent Üniversitesi, 2013-06) Tumin, Makmor; Manikam, Rishya; Abdullah, Nawi; Chong, Chin-Sieng; Jajri, Idris; Noh, AbdillahObjectives: This paper examines factors that influence Malaysian persons with a tertiary level of education on their willingness to donate organs. Materials and Methods: A survey was done in the Klang Valley (Kuala Lumpur and its suburbs) at several designated locations. A total of 1420 people were approached, and we focused the sample of 688 respondents with a tertiary level of education. Respondents were given 2 sets of answers: (1) a religio-cultural category and (2) a structural category. They were allowed to choose more than 1 reason. Results: Our findings revealed that only 47.5 percent of respondents declined becoming organ donors. The highest frequency recorded was “I am not convinced that my body part will be used beneficially” (30.1%), followed by “I do not have enough access to information” (29.2%), “I want my body to remain intact after death” (16.9%), and “It is against my religion” (9.9%). Conclusions: Our study revealed that religio-cultural factors are not a prime explanation for the lack of organ donation in the Malaysian case. This study suggests that better procurement methods used by dedicated agencies, as well as better education, could reduce the shortage between organ supply and demand.Item Long-Term Outcome of Reusing a Kidney Allograft Retrieved From a Living Recipient and Retransplanted Into a Second Recipient(Başkent Üniversitesi, 2013-04) Bellière, Julie; Rostaing, Lionel; Kamar, Nassim; Guilbeau-Frugier, Céline; Sallusto, FedericoThis case report shows that the 5-year outcome of a reused kidney from live-kidney allograft recipients because of intractable recurrence of thrombotic microangiopathy was excellent.Item Successful Treatment With Third Stem Cell Transplant From an Allogeneic Donor for a Patient With Relapsed Diffuse Large B-Cell Lymphoma(Başkent Üniversitesi, 2013-04) Takasaki, Hirotaka; Tomita, Naoto; Motomura, Shigeki; Sakai, Rika; Ishigatsubo, Yoshiaki; Tsuchihashi, Hitoshi; Yamamoto, Wataru; Ishii, YoshimiHigh-dose chemotherapy with autologous stem cell transplant is commonly used for diffuse large B-cell lymphoma that recurs after successful salvage chemotherapy. However, in patients in whom the disease recurs again, the prognosis is poor. A 40-year-old woman who underwent allogeneic stem cell transplant 4 years after autologous stem cell transplant developed recurrent diffuse large B-cell lymphoma 3 years after the initial autologous stem cell transplant. She then underwent reduced-intensity hematopoietic stem cell transplant from a human leukocyte antigen-matched, unrelated donor who was not the previous autologous stem cell transplant donor. She achieved a long survival (328 days after the reduced-intensity hematopoietic stem cell transplant and 1844 days after the first allogeneic transplant). A second allogenic transplant may provide survival benefits in a proportion of patients with malignant lymphoma recurring after allogeneic transplant, although careful consideration is required because of the high risk of treatment-related mortality with second allogenic transplant.Item Total Laparoscopic Donor Nephrectomy In Situs Inversus Totalis: A Case Report(Başkent Üniversitesi, 2013-04) Berber, Ibrahim; Gurkan, Alihan; Cakir, Ulkem; Alim, Altan; Gurluler, Ercument; Gures, NazimSitus inversus totalis is a rare anomaly characterized by the total inversion of all abdominal and thoracic organs. For the first time, we report a case of a donor nephrectomy in a patient with situs inversus totalis, completed with a full laparoscopic approach. At the time of this writing, the donor and the recipient are doing well after 6 month’s follow-up. Our experience shows that patients with situs inversus totalis may be eligible candidates for laparoscopic donor nephrectomy, provided that detailed preoperative imaging studies as well as precise preoperative planning are performed before the transplant.Item Plasma Cell-Rich Acute Rejection With Monoclonal Gammopathy in a Renal Transplant Recipient(Başkent Üniversitesi, 2013-04) Sun, In O; Yang, Chul Woo; Choi, Yeong Jin; Kim, Yong Soo; Park, Cheol Whee; Park, Gyeong Sin; Choi, Bum Soon; Chung, Byung Ha; Hong, Yu Ah; Cho, Yul HeePlasma cell infiltration into a renal allograft comprises a spectrum of lesions from acute rejection to posttransplant lymphoproliferative disease. We report an unusual case of plasma cell infiltration into a renal allograft with monoclonal gammopathy. A 42-year-old woman was admitted because of graft dysfunction after noncompliance with immunosuppressive therapy for 5 months. A graft biopsy showed acute T-cell–mediated rejection and massive plasma cell infiltration. Despite initial treatment with steroids and antithymocyte globulin, there was persistence of graft dysfunction, monoclonal gammopathy, and plasma cell infiltration. Subsequent treatment with bortezomib improved graft function and caused the monoclonal gammopathy to resolve. Immunohistochemical evaluation of markers of B cells (CD20 and CD138) and the ratio of kappa-to-lambda light chain (15:1) showed that infiltrating cells were plasma cells producing kappa light chain. This suggested that plasma cell-rich acute rejection with monoclonal gammopathy in this patient might have been in an early stage of kappa light chain-producing posttransplant lymphoproliferative disease confined to the renal allograft, and that bortezomib may be effective in treating a patient with this condition.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.