Başkent Üniversitesi Dergileri
Permanent URI for this collectionhttps://hdl.handle.net/11727/13093
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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 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.Item Lepromatous Leprosy in a Kidney Transplant Recipient: A Case Report(Başkent Üniversitesi, 2011-06) Ardalan, Mohammadreza; Shoja, Mohammadali M.; Ghabili, Kamyar; Ghaffari, AlirezaLeprosy is a chronic granulomatous disease of the skin and peripheral nerves caused by Mycobacterium leprae. Among mycobacterial infections, leprosy is rare in renal transplant recipients. Here, we report the manifestations of lepromatous leprosy in a 41-year-old renal transplant recipient. Before the renal transplant, the patient had recurrent bullous lesions on his extremities with no systemic complaints. He was on an immunosuppressive regimen that included prednisolone (1 mg/kg/d), cyclosporine (6 mg/kg), and mycophenolate mofetil (2000 mg/d), and had 2 serologically confirmed acute episodes of cytomegalovirus infection that responded favorably to intravenous ganciclovir. The density of his bullous skin lesions decreased after renal transplant. During his regular posttransplant visits, we noticed a decrease in his eyebrow hairs on their lateral margins bilaterally. Later, he developed generalized, symmetric, erythematous papules. With a positive acid-fast bacilli with Fite staining, the results of a skin biopsy showed diffuse foamy histiocyte infiltration in the dermis. These findings are compatible with lepromatous leprosy. After antileprosy therapy, no deterioration of renal allograft function or lepra reactions was noted in a 4-month follow-up. Clinicians should consider leprosy in the differential diagnosis of skin lesions in immunocompromised hosts, and in particular, solid organ transplant recipients in endemic areas.Item Expanding the Live Kidney Donor Pool: Ethical Considerations Regarding Altruistic Donors, Paired and Pooled Programs(Başkent Üniversitesi, 2011-06) Patel, Shaneel Rajendra; Papalois, Vassilios; Chadha, PriyankaIn renal transplant, there is a well-known deficiency in organ supply relative to demand. Live donation provides superior results when compared with deceased donation including a better rate of graft success and fewer immunologic complications. This deficiency in organs leads to significant morbidity and mortality rates. Alternative avenues have been extensively explored that may expand the live donor pool. They include altruistic donation as well as paired and pooled exchange programs. Altruistic donation is a truly selfless act from a donor unknown to the recipient. Kidney paired donation involves 2 incompatible donor-recipient pairs swapping donors to produce compatibility. Pooled donation involves at least 2 pairs, and can take the form of domino chains in which altruistic input sets up a chain of transplants, in which each recipient’s incompatible donor makes a donation for the next recipient. Despite application of these various methods, there lie extensive ethical issues surrounding them. Misconceptions frequently occur; for instance, the perceived benefit that donating an organ to a loved one is greater for a related donor than for an altruistic one. Additionally, it is frequently believed that immunologic incompatibility offers coerced donors liberation from surgery, and that overcoming these barriers by introducing exchange programs provides vulnerable donors less protection. This article explores these and other complex ethical issues surrounding the various methods of expanding the donor pool. The authors offer opinions that challenge the ethical issues and attempt to overcome those views that hinder progress in the field.Item Switch From Beta-Thalassemia Major to Beta-Thalassemia Intermedia After Secondary Graft Failure(Başkent Üniversitesi, 2010-09) Mellouli, Fethi; Béjaoui, Mohamed; Othman, Tarek Ben; Hmida, Slama; Ladeb, Saloua; Abdelkefi, Abderrahman; Torjmen, Lamia; Lakhal, Amel; Ksouri, HabibIn this article, we report a switch of β-thalassemia major to intermedia β-thalassemia after allogeneic bone marrow transplant of a 6-year-old girl from her HLA-matched brother. After stable mixed chimerism, the patient had a secondary graft rejection and returned to total recipient chimerism as assessed by real-time polymerase chain reaction assay. Nonetheless, with a medium hemoglobin rate of 89 g/L, she did not need further transfusions for 60 months after rejection. We conclude that complete loss of donor cells after bone marrow transplant for β-thalassemia major is compatible with a stable clinical state, probably due to a γ-globin gene demethylation that enhances γ-globin chain production and further allows constitution of a fetal hemoglobin rate compatible with free transfusion survival.