Başkent Üniversitesi Dergileri
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Item Liver Transplant for Mixed Capillary-cavernous Hemangioma Masquerading as Hepatocellular Carcinoma in a Patient With Hepatocellular Carcinoma(Başkent Üniversitesi, 2011-10) Unal, Ethem; Teperman, Lewis; Morgan, Glyn; Xu, Ruliang; Aquino, Alger; Francis, FrantoHemangioma is the most common benign tumor of the liver. Unlike cavernous hemangioma, hepatic capillary or mixed capillary-cavernous hemangioma is a rare type of tumor in adults. Clinical presentation of hemangioma may mimic that of hepatocellular carcinoma. Furthermore, radiologic features on computed tomography and magnetic resonance imaging may not be typical for hemangioma and can be confused with hepatocellular carcinoma. Symptomatic hemangiomas require some form of treatment, such as corticosteroids, interferon, radiation, arterial embolization, surgical resection, or liver transplant. In the present case study, we present a patient treated with liver transplant for hemangioma mimicking hepatocellular carcinoma. This case report illustrates the atypical imaging appearance of hemangioma and possible confusion it can cause in diagnosing hepatocellular carcinoma, especially in a hepatitis C carrier.Item Simultaneous Cytomegalovirus and Mycobacterium Tuberculosis Infection Presenting as Hemorrhagic Colitis 3 Years After a Kidney Transplant(Başkent Üniversitesi, 2011-10) Santoro-Lopes, Guilherme; Valiante, Marcos Nunes; Santos, Marcos André Alves Rosa; Gonçalves, Renato Torres; Halpern, Márcia; Lemos, Alberto dos Santos deCytomegalovirus is an important cause of colonic disease in solid organ transplant recipients. Although several reports have shown that simultaneous infection with other pathogens may aggravate the course of cytomegalovirus colitis, to our knowledge, no case of colitis caused by simultaneous cytomegalovirus and Mycobacterium tuberculosis has been previously reported. We describe a case of hemorrhagic colitis associated with simultaneous cytomegalovirus/ Mycobacterium tuberculosis infection in a 26-year-old woman, 38 months after a kidney transplant. Initial results of histopathologic analyses of gastrointestinal biopsies showed that tuberculosis was the only cause of colitis, as no morphologic alteration suggestive of cytomegalovirus infection was observed on hematoxylin-eosin staining. However, further analysis with immunoperoxidase staining confirmed the clinical suspicion of cytomegalovirus infection. This report shows that cytomegalovirus/tuberculosis coinfection may be a cause of late-onset colitis among solid organ transplant recipients. It also illustrates that coinfection with other pathogens may pose an additional challenge for diagnosing gastrointestinal cytomegalovirus disease.Item Chronic Myeloid Leukemia Within a Year of Kidney Transplant With Elevated Alkaline Phosphatase Correlated With Imatinib Therapy(Başkent Üniversitesi, 2011-10) Sayar, Hamid; Mehta, Rakesh; Taber, Tim E.; Sharfuddin, Asif A.The incidence of certain malignancies is significantly higher after organ transplant. However, there are rare reports of chronic myeloid leukemia in the posttransplant setting. The average reported interval between a transplant and the diagnosis of chronic myeloid leukemia is 44 months (range, 10-96 mo). We report 2 patients with chronic myeloid leukemia within 1 year of a kidney transplant, which is significantly shorter than those previously reported. Both patients were receiving mycophenolate mofetil and tacrolimus for immunosuppression. They were treated with imatinib for chronic myeloid leukemia, and both patients demonstrated an isolated elevation of serum alkaline phosphatase that was directly correlated with imatinib. Despite a potential interaction between the 2 drugs, blood levels of tacrolimus and imatinib were not elevated during the course of treatment. Isolated elevation of alkaline phosphatase in this particular setting has not been reported previously.Item Cyclosporine Level at the Second Hour in Pediatric Hematopoietic Stem Cell Transplant Patients(Başkent Üniversitesi, 2011-10) Balci, Yasemin Isik; Uckan, Duygu; Cetin, Mualla; Hascelik, Gulsen; Akyol, Fatma; Kucukbayrak, Ozlem; Baris Kuskonmaz,; Karabulut, Erdem; Tavil, BetulIn this retrospective study, cyclosporine levels at the second hour (C2 levels) were measured during oral cyclosporine intake in 28 pediatric hematopoietic stem cell transplant patients, and the relations between cyclosporine dosage and C0, C2 levels, C2/C0 ratio, and cyclosporine-related adverse effects were investigated. Cyclosporine levels at the second hour levels were found to be significantly lower in children younger than 7 years old, suggesting age-related differences in absorption and metabolism of the drug. There were statistically significant correlations of both C0 and C2 levels with blood creatinine values. In addition, a statistically significant negative relation was found between C0 and C2 levels and serum potassium levels; this unexpected finding was attributed to multiple drug effects in the early posttransplant period. The common adverse effects of cyclosporine (gingival overgrowth, gynecomastia, and hypertrichosis) were also evaluated in this study, and no correlation was found between those adverse effects and C0, C2 levels, C2/C0 ratio, and cyclosporine dosage. In the present study, despite the highly significant correlation of C2 levels with renal and metabolic effects, in pediatric hematopoietic stem cell transplant patients, measurement of C2 levels as a standard practice did not provide an advantage over C0 monitoring. However, the preliminary results suggest that C2 level monitoring could be useful in selected patients with increased risk of renal toxicity or in states where a better estimation of gastrointestinal absorption is needed.Item Liver Transplantation in Patients With Hepatocellular Carcinoma: A Single-center Experience(Başkent Üniversitesi, 2011-10) Azzam, Ayman Zaki; Sebayel, Mohammed Al; Sofayan, Mohammad Al; Al-hamoudi, Waleed; Abalkhail, Faisal; Kamel, Yasser; Mohammed, Hazem; Bahili, Hamad Al; Khalaf, Hatem; Hegab, BassemObjectives: Liver transplantation has become one of the best treatment options for early hepatocellular carcinoma in cirrhosis. We sought to study the results of liver transplantation in patients with hepatocellular carcinoma and to evaluate the outcome of the patients. Materials and Methods: The medical records of 256 recipients who underwent a liver transplantation from April 2001 to January 2010 were reviewed. One hundred seventy-six patients received their livers from deceased donors, and 80 received their livers from living donors. Fifty-two patients underwent liver transplantation for hepatocellular carcinoma. Results: From April 2001 until now, 52 patients (20.3%) underwent liver transplantation for hepatocellular carcinoma. Eighteen patients (34.6%) were performed from living-related donors, and 34 (65.4%) were from deceased donors. The patients were 37 males and 15 females (median, 55 years old; age range, 5 through 68 years). Model for end-stage liver disease score ranged from 6 to 40 with a median of 14. All patients were within the Milan criteria by the preoperative evaluation. Hospital stay ranged from 6 to 338 days with a median 14 days. Operating time ranged from 4 to 15 hours with a median 7.5 hours. Blood transfusion ranged from 0 to 19 units median 5 units. Thirty-four complications occurred in 23 patients (44.2%). Recurrence of hepatocellular carcinoma in 7 patients (13.5%), of which recurrent cholangiocarcinoma was diagnosed in 3 (5.7%), accidentally discovered in the explant. One deceased donor had hepatitis B core antibody positive. One explant showed macrovascular invasion. Sixteen patients died, 7 of 52 (13.5%) from hepatocellular carcinoma recurrence, including the 3 cases of accidental discovery of cholangiocarcinoma (5.7%). Conclusions: Apart from the common complications that can occur with any transplantation, liver transplantation remains the most-promising solution for patients with hepatocellular carcinoma among the available ones, and represents a cornerstone in managing hepatocellular carcinoma. It is the only acceptable option for complete eradication of both the disease and the predisposing factor.Item Turkey's Evaluation in Kidney Transplantation Research(Başkent Üniversitesi, 2011-10) Bas, Kadir Koray; Besim, Hasan; Gunay, Levent MertObjectives: The objective this study is to evaluate the trend of Turkey’s contribution in terms of number of publications included in the Science Citation Index Expanded in kidney transplantation between 1980 and 2009. Materials and Methods: All scientific papers published included in Science Citation Index Expanded in the English language between 1980 and 2009 were analyzed using the “Web of Science.” A general search was conducted using key words of “kidney transplantation,” “renal transplantation,” “kidney transplant,” and “renal transplant.” We analyzed these results using the “analyze” function of the software in terms of countries, documentation types, number in years of publications, journals, and institutes. We also used the same function separately analyze papers from Turkey in last 3 decades between 1980 and 1989, 1990 and 1999, and 2000 and 2009 for statistical evaluation. Results: In total, we found 46 983 papers related to kidney transplant were published included in the Science Citation Index Expanded in the English language between 1980 and 2009. Overall, 964 of those papers were from Turkey (2.05%). There were 12 papers from Turkey between 1980 and 1989, 200 papers between 1990 and 1999, and 752 papers between 2000 and 2009. The rank of Turkey among other countries, ranked by the number of papers published, was 33 between 1980 and 1989 and 11 between 2000 and 2009. Conclusions: Turkey has shown a significant positive trend in publishing papers in the field of kidney transplantation—further evidence of the progress Turkey has made in its contributions to the field of kidney transplantation in recent decades.Item Inguinal Oblique Incision as an Alternative Route To Extract the Kidney During Laparoscopic Donor Nephrectomy(Başkent Üniversitesi, 2011-10) Wang, Ke; Wang, Lin; Lin, Chun-hua; Zhao, Jun-jie; Wang, Jian-ming; Gao, Zhen-li; Wan, Feng-chunObjectives: Evaluate the advantages of inguinal oblique incision in extracting the kidney during laparoscopic donor nephrectomy. Materials and Methods: From April 2005 to June 2009, sixty-seven cases of transperitoneal laparoscopic live-donor nephrectomies were performed at our hospital, all data were analyzed retrospectively. All donors were grouped as a test group (n=37, inguinal oblique incision) and a control group (n=30, paramidline or subcostal incision) according to graft retrieval incision selection. Donors were compared with regard to operative time and warm ischemia time, operative blood loss, hospital stay and cosmetic satisfaction. Recipients were compared with regard to graft function and 1-year graft survival rate. Results: All 67 cases of transperitoneal live-donor nephrectomies were successfully accomplished, without donor death, serious complications, and conversion to open surgery. There were no differences in mean operation time, mean blood loss, mean warm ischemic time, graft function, and 1-year graft survival rate between the groups. But in the test group, the mean hospital stay was shorter, P < .01; and cosmetic satisfaction was higher P < .01. Conclusions: The inguinal oblique incision is a safe and practical graft retrieval incision in live-donor nephrectomies, and can be thought to be applied generally.Item Evaluation of Right Versus Left Laparoscopic Donor Nephrectomy(Başkent Üniversitesi, 2011-10) Bachir, Bassel G.; Khauli, Raja B.; Abu-Dargham, Rana; Nasr, Rami; Hussein, MaherObjectives: With the advent of laparoscopic donor nephrectomy, there has been a general underuse of right laparoscopic donor nephrectomy versus left because of concerns regarding higher complication rates and poorer outcomes. We performed a retrospective analysis of our laparoscopic donor nephrectomy series with an emphasis on the side of the kidney retrieved and the outcomes of donors and recipients Materials and Methods: Data on 94 consecutive donor-recipient pairs (188 patients) were reviewed. All donor nephrectomies were performed by pure laparoscopy. There were 74 left laparoscopic donor nephrectomies and 20 right laparoscopic donor nephrectomies. Intraoperative parameters and graft outcome were recorded and the data were analyzed to compare right laparoscopic donor nephrectomy versus left laparoscopic donor nephrectomy using a computer software system. Follow-up ranged from 1 to 6 years (mean, 3.4 years). Results: There were no significant differences in any intraoperative or postoperative parameters, except in a slightly higher warm ischemia time in right laparoscopic donor nephrectomy versus left laparoscopic donor nephrectomy, but this did not translate into an adverse effect on renal recovery. Acute graft rejection was observed in 2 of 74 patients who had a left laparoscopic donor nephrectomy (2.7%) and none of the patients who had a right laparoscopic donor nephrectomy. Chronic graft loss was observed in 2 of 74 patients who had a left laparoscopic donor nephrectomy (2.7%); 1 of recurrent pyelonephritis and sepsis and 1 renal oxalosis. No graft losses were observed in any patient who had a right laparoscopic donor nephrectomy. Mean serum creatinine levels in recipients at 1, 3, 6, 9, and 12 months were equivalent for right laparoscopic donor nephrectomy versus left laparoscopic donor nephrectomy; they were 120, 110, 110, 110, 110 µmol/L, versus 110, 110, 110, 110, 110 µmol/L. (1.35, 1.21, 1.24, 1.21, 1.26 mg/dL versus 1.22, 1.17, 1.17, 1.17, 1.23 mg/dL). Conclusions: This single center study demonstrates equivalent results with left laparoscopic donor nephrectomy and right laparoscopic donor nephrectomy with no adverse effects of right laparoscopic donor nephrectomy on donor-recipient outcome or renal function.Item Chronic Graft Dysfunction and Improvement by Cytokine Response Modifier a Protein Transfection(Başkent Üniversitesi, 2011-10) Xiao, Zheng; Li, Youping; Long, Dan; Li, Shengfu; Lu, Jun; Feng, Li; Luo, Lei; Li, Chengwen; Shan, JuanObjectives: Cytokine response modifier A protein is a caspase inhibitor that inhibits caspase activity and protects cells from apoptosis. Chronic cyclosporine nephropathy is a significant cause of chronic graft dysfunction. We explored cytokine response modifier A protein-alleviated chronic cyclosporine nephropathy for ways of improving chronic graft dysfunction. Materials and Methods: Cytokine response modifier A protein-transferring HK-2 cells were cultured with different concentrations of cyclosporine. Cytokine response modifier A protein mRNA and proteins were detected by real-time polymerase chain reaction and Western blot, cell viability was detected by (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide), and apoptosis was detected by flow cytometry. Results: Cyclosporine caused a concentration-dependent and time-dependent loss of cell viability in HK-2 cells. Cytokine response modifier A protein mRNA was expressed at 48 and 72 hours (P < .05), while protein was detected at 72 hours. Cell viability in the cytokine response modifier A protein-transfected group was significantly greater than that of the control group when treated with 1 µg/mL, 10 µg/mL, or 20 µg/mL cyclosporine at 24 or 48 hours (P < .05). The apoptosis in cytokine response modifier A protein-transfected cells was significantly lower than that of controls (P < .05). Conclusions: Cytokine response modifier A protein protects renal cells from cyclosporine injury by inhibiting activated caspases. Cytokine response modifier A protein transfection may improve chronic cyclosporine nephropathy and provide for improving chronic graft dysfunction.Item Alemtuzumab Preconditioning Allows Steroid-calcineurin Inhibitor-free Regimen in Live-donor Kidney Transplant(Başkent Üniversitesi, 2011-10) Refaie, Ayman F.; Ghoneim, Mohamed A.; Kamal, Ahmed I.; Sheashaa, Hussein A.; Ismail, Amani M.; Mahmoud, Khaled M.Objectives: This prospective study was designed to develop a steroid and calcineurin inhibitor-free regimen for kidney transplants using alemtuzumab. Materials and Methods: A single dose of alemtuzumab (30 mg) was given preoperatively. Phase 1: Twenty-one patients were randomized into 2 groups; the tacrolimus (n=11) and the sirolimus groups (n=10). Steroids were given for 5 days. Azathioprine (1 mg/kg) was added when white blood cells ≥ 4000 cells/cm3. Mean follow-up was 48 ± 2.8 and 48.2 ± 1.6 months for the tacrolimus and sirolimus groups. Phase 2: Twenty patients were included and the study design was modified. Tacrolimus was given for 2 months, and was replaced by sirolimus thereafter. The mean follow-up was 28.3 ± 2.1 months. Results: Phase 1: Acute rejection episodes were encountered in 5 patients of the tacrolimus versus 2 cases in the sirolimus group (P = .44). Antibody-mediated rejection was diagnosed in 2 recipients in each group. Four patients were switched from sirolimus to tacrolimus owing to resistant rejection, significant proteinuria, persistent thrombocytopenia, lymphocele, and urinary leakage. One patient was shifted from tacrolimus to sirolimus owing to Kaposi sarcoma. Glomerular filtration rate was significantly higher in the sirolimus group. Currently, 14 patients (8 tacrolimus, and 6 sirolimus) are steroid-free. One patient died from the tacrolimus group owing to fulminant hepatitis. Two grafts were lost in the sirolimus group versus 1 graft in the tacrolimus group. Phase 2: Five patients developed successfully treated borderline changes with no antibody-mediated rejection. Mean serum creatinine was 114.9 ± 17.7 µmol/L. Currently, 17 patients are steroid-free and 15 of them are calcineurin inhibitor-free as well. In this phase, only 1 patient died with a functioning graft. Conclusions: This clinical trial provides a good insight into a potentially effective steroid and calcineurin inhibitor-free protocol with the use of alemtuzumab induction in combination with sirolimus.