Başkent Üniversitesi Dergileri
Permanent URI for this collectionhttps://hdl.handle.net/11727/13093
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Item Strategies For Successfully Establishing a Kidney Transplant in a Mouse Model(Başkent Üniversitesi, 2011-10) Ge, Fangmin; Gong, WeihuaObjectives: Kidney transplant in mouse model is quite useful and valuable for studying transplant immunobiology. However, its technical complexity and high mortality have hindered widespread use. We sought to review and analyze the various techniques of kidney transplant in mice to prevent pitfalls and reduce complications. Materials and Methods: We searched PubMed using the key words “kidney transplant” or “renal transplant,” “mouse” or “mice,” and “technique” or “model” for articles published between January 1973 and June 2010. We found a series of factors that were collected and analyzed, which may influence establishing a mouse kidney transplant model. Results: A mouse kidney transplant model is practical for research. Mouse body weight, sex, animal strain, type of anesthesia, and type of flushing solution are relevant but do not determine a successful transplant. Warm and cold ischemia time should be less than 35 minutes and 2.5 hours. Conclusions: End-to-side vascular anastomosis and ureter-to-bladder or bladder-to-bladder for ureter reconstruction is preferred for establishing a kidney transplant model in mice.Item Prospective Study of Posttransplant Polyomavirus Infection in Renal Transplant Recipients(Başkent Üniversitesi, 2011-06) Hu, Jianhua; Ma, Weihang; Fan, Jun; Yang, Meifang; Gao, Hainv; Zhang, Xuan; Huang, Yaping; Zhao, HongObjectives: The BK virus is the most common pathogen in renal transplant recipients. Limited information is available regarding JC virus or Simian virus infections in renal transplant recipients. This prospective study sought to investigate the rate of BK virus, JC virus, and Simian virus 40 infections and their influence on allograft function in the early stages after surgery. Materials and Methods: In total, 50 renal transplant recipients and 20 healthy blood donors were studied. The BK virus, the JC virus, and the Simian virus 40 were detected by nested qualitative polymerase chain reaction assays in urine and plasma. The difference of glomerular filtration rate among BK virus-infected, JC virus-infected, and uninfected patients was compared using the Kruskal-Wallis test. Results: The polyomavirus viruria was detected in 46% of renal transplant recipients (4% of the BK virus and 42% of the JC virus viruria) and 10% of the healthy blood donors (5% for the BK virus and the JC virus viruria). No polyomavirus viremia was detected. No difference of glomerular filtration rate was found among the 3 groups (X2 = 0.228; P = .892). Conclusions: Polyomavirus infections are not uncommon, and the incidence of JC virus infection is much higher in renal transplant recipients than it is in BK virus. Neither BK virus nor JC virus infections appeared to influence graft function in the early stages after surgery.Item Postrenal Transplant Urinary Leakage Caused by Segmental Infarction of a Renal Allograft Treated by Partial Nephrectomy(Başkent Üniversitesi, 2011-04) Salehipour, Mehdi; Malek-hosseini, Seyed Ali; Bahador, Ali; Salahi, Heshmatollah; Nikeghbalian, Saman; Eshraghian, Ahad; Roozbeh, JamshidKidney transplant is the final treatment for patients with end-stage renal disease. Urinary leakage is the most-common surgical complication early after transplant. Another complication in the early posttransplant period is segmental allograft infarction. We report a kidney recipient who developed urinary leakage secondary to a segmental infarction of the upper pole of the transplanted kidney 2 months after transplant. The patient was treated successfully by a partial nephrectomy of the infracted upper lobe of the kidney. Three months after the partial nephrectomy of the allograft, serum blood urea nitrogen and creatinine were normal, and the patient was able to partake in her daily activities. Partial nephrectomy in the context of infarction of a kidney allograft is safe and can be used in similar cases.Item Steroid Avoidance Reduce the Cost of Morbidities After Live-donor Renal Allotransplants: A Prospective, Randomized, Controlled Study(Başkent Üniversitesi, 2011-04) Gheith, Osama A.; Ghoneim, Mohamed A.; Shokeir, Ahmed A.; Refaie, Ayman; Bakr, Mohamed A.; Nematalla, Ahmed H.Objectives: Steroids have had the main role in renal transplant for more than 4 decades. However, chronic use of steroids is associated with many comorbidities, owing to a lack of assessing cost-benefit of steroid avoidance in live-donor renal allotransplants. In this prospective, randomized, controlled study, we aimed to assess the cost-benefit of a steroid-free immunosuppression regimen among Egyptian live-donor renal transplants. Materials and Methods: One hundred patients were randomly allocated to receive tacrolimus, mycophenolate mofetil, and steroids for only 3 days (n=50 patients; study group) or tacrolimus, mycophenolate mofetil, and steroids on a maintenance basis (n=50 patients; control group). All patients received basiliximab (Simulect) induction, with median follow-up of 12 months. Results: Both groups showed comparable graft and patient survivals, rejection episodes, and graft functioning. Posttransplant comorbidities were significantly more prevalent in the steroid-maintenance group. Hypertension was detected in 4% of steroid-free group versus 24% in the steroid-maintenance group (P = .0009). Posttransplant diabetes mellitus, serious infections, and hyperlipidemia were significantly more prevalent in the steroid-maintenance group (P < .05). Associated hospitalization costs were 2.2-fold higher in the steroid-maintenance group than they were in the steroid-free group. One year after transplant, the cost of managing posttransplant comorbidities was significantly higher in steroid-maintenance group, despite comparable costs of immunosuppression. Conclusions: In low, immunologic risk recipients of live-donor renal transplants, using basiliximab induction and maintenance with tacrolimus, mycophenolate mofetil, steroid avoidance was associated with lower first annual total costs despite comparable immunosuppression costs, which was attributed to lower costs of associated morbidities.Item Importance of Socioeconomic, Clinical, and Psychological Factors on Health-related Quality of Life in Adolescents After Kidney Transplant(Başkent Üniversitesi, 2011-02) Malekahmadi, Mohammad Reza; Assari, Shervin; Einollahi, Behzad; Lankarani, Maryam Moghani; Nejad, Mohammad Lorgard Dezfuli; Rahimzadeh, ShadiObjectives: Health-related quality of life after kidney transplant in adolescents is a major concern; nevertheless, there is a paucity of data on the variables that have an effect on it. This study evaluated the extent to which socioeconomic, clinical, and psychological characteristics explain the variance in the health-related quality of life of adolescent Iranian kidney transplant recipients. Materials and Methods: Into a hierarchical regression analysis, the cross-sectional socioeconomic, clinical, and psychological characteristics were entered among 55 adolescent Iranian kidney transplant recipients. Results: The relative predictive power of socioeconomic, clinical, and psychological variables with respect to health-related quality of life was 21.8% (P = .088), 21.2% (P = .014), and 27.6% (P = .001). Conclusions: Psychological factors had a greater relative predictive power in postrenal transplant health-related quality of life of adolescents than did the socioeconomic and clinical characteristics. Further research should target to improve the health-related quality of life in adolescent kidney recipients by psychological intervention.Item Conversion From Cyclosporine to Sirolimus in Chronic Renal Allograft Dysfunction: A 4-Year Prospective Study(Başkent Üniversitesi, 2011-02) Han, Fei; Chen, Jianghua; Wang, Huiping; Wang, Suya; Wang, Yimin; He, Qiang; Zhang, Xiaohui; Huang, Hongfeng; Wu, JianyongObjectives: The long-term use of cyclosporine always contributes to chronic renal allograft dysfunction. Converting from cyclosporine to sirolimus and reducing cyclosporine dosage under high mycophenolate mofetil levels are 2 common therapies. Their efficacy and safety have not been compared in Chinese patients. Materials and Methods: In this prospective, open-label, randomized study, 51 kidney recipients with an estimated glomerular filtration rate between 30 and 60 mL/min/1.73 m2 were enrolled. Patients in the sirolimus group (n=22) initiated sirolimus 12 hours after cessation of cyclosporine. Patients in the cyclosporine group (n=29) significantly reduced cyclosporine dosage under high mycophenolate mofetil dosages. Both groups were followed-up for 4 years. Results: The baseline estimated glomerular filtration rate was 36.46 ± 6.22 mL/min/1.73 m2 in sirolimus group and 36.07 ± 6.18 mL/min/1.73 m2 in the cyclosporine group (P = NS). In cyclosporine group, the estimated glomerular filtration rate declined significantly at 12, 18, 24, 30, 36, 42, and 48 months after inclusion compared with baseline, and was lower than the sirolimus group at 30, 36, 42, and 48 months after inclusion (P < .05). As for the endpoints of graft loss and return to dialysis, the 4-year graft survival was 77.3% in the sirolimus group and 55.2% in the cyclosporine group (P = NS). As for the endpoint of serum creatinine doubling, 4-year survival was 77.3% in the sirolimus group and 41.4% in the cyclosporine group (P < .05). Three patients in sirolimus group (2 acute rejections, 1 pneumonia) and 2 patients in the cyclosporine group (owing to acute rejection) dropped out (P = NS). Conclusions: Conversion from cyclosporine to sirolimus could improve long-term survival of renal grafts in Chinese patients.Item Retroperitoneoscopic Live-donor Right Nephrectomy: A Chinese Single Center(Başkent Üniversitesi, 2011-02) Ma, Lulin; Chen, Yingtao; Tang, Wenhao; Tian, Xiaojun; Wang, Guoliang; Zhao, Lei; Hou, Xiaofei; Huang, Yi; Li, GangObjectives: To evaluate our right-retroperitoneoscopic live-donor nephrectomy by comparing the left side with the right side, and reporting our single-center experience for right-retroperitoneoscopic live-donor nephrectomy. Patients and Methods: In China, live-kidney transplant is limited. It is even more essential now, because the deceased-donor kidney has become fewer after enacting the Chinese Regulation on Human Organ Transplantation. Therefore, there is a continued need to use the limited live-donor population. We chose 103 consecutive cases (84 left and 19 right) that underwent retroperitoneoscopic live-donor nephrectomy between December 2005 and December 2009, to compare the intraoperative and postoperative characteristics between the left and right sides, and report our experiences for 19 right-retroperitoneoscopic live-donor nephrectomies. Results: All 84 left and 19 right-retroperitoneoscopic live-donor nephrectomies were accomplished successfully without open conversion and transfusion. No significant differences were observed between the 2 groups regarding operative time, warm ischemia time, estimated blood loss, length of hospital stay, and serum creatinine level at discharge (Table 1). Eight of the donors and 3 of the grafts had minor complications that were all resolved with conservative treatment. The recipients’ serum creatinine levels at 1 day and 1 month after surgery were the same in both groups. No acute renal tubule necrosis or delayed graft function was observed in the recipients. Conclusions: Our right-retroperitoneoscopic live-donor nephrectomy achieves comparable outcomes with the left side and proves to be a feasible, cost-effective, safe, and minimally invasive alternative for live-kidney donation. This maximally uses the innately limited donors and potentially increases the donor pool in China.