Fakülteler / Faculties
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Item Early Proteinuria After Renal Transplantation and Allograft Outcomes(2014) Gulleroglu, K.; Baskin, E.; Bayrakci, U.; Akdur, A.; Moray, G.; Haberal, M.; https://orcid.org/0000-0003-1434-3824; https://orcid.org/0000-0003-4361-8508; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24507040; AAJ-8833-2021; B-5785-2018; AAA-3068-2021; AAE-1041-2021; AAJ-8097-2021Background. Proteinuria is among the major and nonspecific sign of the renal disease. It is well known that late-onset proteinuria after renal transplantation has been associated with poor allograft outcomes and with mortality. Knowledge about the impact of early proteinuria on the various outcomes is limited. We have evaluated the utility of measuring early proteinuria in the management of pediatric renal transplant recipients. Methods. We analyzed the effect of proteinuria at 3 months of posttransplantation on allograft rejection, graft loss, and estimated glomerular filtration rate (GFR) at 3 years. Proteinuria was assessed using 24-hour urine protein excretion. Renal biopsy was performed when elevated creatinine levels were elevated during routine follow-up and an acute rejection episode was proven with biopsy. Results. Sixty-seven pediatric renal transplant recipients were included to the study. Mean follow-up time after transplantation was 48.8 +/- 12.1 months. Thirty-nine recipients (58%) have proteinuria >500 mg/d. The relationship could not be shown between proteinuria at posttransplant month 3 and other outcomes parameters, such as graft loss and lower estimated GFR. A significant positive correlation between acute rejection and the proteinuria at posttransplant month 3 was shown. Conclusion. We demonstrated that early proteinuria is a common finding in children after transplantation. Posttransplant early proteinuria cannot be used as a long-term prognostic marker of poor renal outcome. However, early proteinuria is associated with an high risk of acute rejection episodes. This would permit an opportunity for early intervention.Item MDCT Evaluation of Early Pulmonary Infection Types After Liver Transplantation(2015) Hekimoglu, K.; Tezcan, S.; Coskun, M.; Dogrul, M. I.; Moray, G.; Haberal, M.; 0000-0002-0805-0841; 0000-0003-2498-7287; 0000-0002-3462-7632; 0000-0001-5630-022X; 0000-0001-7204-3008; 25769594; AAD-9097-2021; AAE-1041-2021; AAJ-8097-2021; AAM-4120-2021Introduction. Opportunistic pulmonary infections frequently occur after liver transplantation, and affect mortality and morbidity significantly. The purpose of this study was to define the incidence, types, and imaging characteristics of pulmonary infections in liver transplant recipients with multidetector CT (MD CT) evaluation. Methods. Thirty-five adult transplant recipients diagnosed with a pulmonary infection within the first 45 days posttransplantation were reviewed retrospectively from March 2002 to December 2013. MDCT features were evaluated retrospectively by 2 radiologists in consensus. All diagnoses were made by sputum analysis, cultures, biopsies, and postmortem histopathologic evaluation. Results. Pneumococcus pneumonia was found in 7 patients. Five patients had nonspecific pneumonia, Candidiasis, Klebsiella, and Aspergillosis separately. S aureus pneumonia was detected in 2 patients and the other 2 patients had Escherichia coli pneumonia. Two patients had active tuberculosis and 1 patient had Acinetobacter pneumonia also. Four main MDCT patterns were identified: patchy infiltrations (10%), tree-in-bud pattern (9.5%), ground-glass opacity (8.5%), and nodules with halo sign (6%). One patient had a cavitary lesion owing to tuberculosis. Conclusion. Although the incidence of pulmonary complications in liver recipients was relatively low, mortality from serious infections was high. Care must be taken with pulmonary infectious complications in the posttransplant period. For any suspicious case, MDCT evaluation for specific patterns of early accurate diagnosis is very important.Item The Evaluation of Hemodynamic Changes During the Reperfusion Phase in Adult Living Donor Liver Transplantations: The Role of Cardiovascular Problems(2015) Ayhan, A.; Araz, C.; Komurcu, O.; Kaplan, S.; Torgay, A.; Haberal, M.; 0000-0003-3299-6706; 0000-0002-4927-6660; 0000-0002-6829-3300; 0000-0002-3462-7632; 0000-0001-6762-895X; 26036553; AAJ-2057-2021; AAJ-2066-2021; AAJ-4576-2021; AAJ-5221-2021; AAJ-8097-2021; GLV-1652-2022Objective. This study sought to evaluate the hemodynamic changes of and to analyze the effects of coronary artery disease (CAD) as well as its risk factors on hemodynamic parameters during the reperfusion phase (RP) in adult living donor liver transplantation (ALDLT). Patients and Methods. This single-center retrospective study evaluated 154 adult patients being assessed from January 2001 to December 2013 for orthotopic liver transplantation (OLT). The patients were divided into separate groups according to the presence or absence of CAD and its risk factors, including diabetes, hypertension, dyslipidemia, smoking, sex, and age. The hemodynamic parameters were noted during the RP with respect to the patient files. The comparison of the groups and the effects of cardiovascular problems on hemodynamic parameters were statistically analyzed. Results. A decrease of more than 20% in systolic arterial pressure was seen in 16 (16.7%), 7 (43.8%), and 17 (40.5%) patients without CAD, with CAD, and with its high risk factors (>2), respectively (P < .05). Moreover, diastolic hypotension was seen in 59 (38.3%) patients during RP; of those, 10 (62.5%) had CAD and 19 (45.2%) had CAD high-risk factors. The decline in both systolic and diastolic arterial pressure was significantly correlated with the increased number of risk factors (P < .05). Conclusions. RP in ALDLT remains an issue not only for the surgeons but also for the anesthesiologists. Clinicians should be aware of CAD and its risk factors before OLT and successful management of such problems are mandatory for hemodynamic stability during this formidable process.Item Pulmonary Hypertension Is Closely Related to Arterial Stiffness in Renal Transplant Patients(2015) Bal, Z.; Sezer, S.; Uyar, M. E.; Bal, U.; Kulah, E.; Guliyev, O.; Tutal, E.; Haberal, M.; 0000-0002-3462-7632; 0000-0002-9446-2518; 0000-0001-6041-4254; 26036550; AAJ-8097-2021; IAO-2608-2023; AAK-4322-2021; AAZ-5795-2021; AAJ-5764-2021Introduction and Aims. Pulmonary hypertension (PH) is an independent predictor of increased mortality in patients on dialysis and those undergoing renal transplantation. We investigated PH and its association with vascular calcification and endothelial dysfunction in renal transplant patients. Methods. The records of 300 consecutive patients who underwent renal transplant in our center between 2005 to 2012 were evaluated. PH was defined as systolic pulmonary artery pressure (sPAP) >= 35 mm Hg. Demographic information, clinical characteristics, pulse wave velocity (PWv), and renal recessive indices (RRI) were collected and compared among patients with and without PH. Results. Eight patients in PH group (age 36 [19] years) and 87 subjects in nPH group (age 35 [9] years) were evaluated. Demographic and clinical characteristics and laboratory data of the 2 groups were similar. Additionally, sPAP was positively correlated with PWv (r = 0.263, P = .01). In multivariate analyses, RRI (P = .004), serum CRP (P = .025), and PWv (P = .001) were associated with pulmonary artery pressure. Conclusion. PH is significantly associated with arterial stiffness in renal transplant recipients who have a high risk for cardiovascular disease. Considering the common prevalence of cardiovascular diseases, including PH, we suggested that all patients with renal transplantation should be evaluated for regular echocardiographic examination in clinical practice.Item Graft Function and Arterial Stiffness: Can Bioimpedance Analysis Be Useful in Renal Transplant Recipients?(2015) Sezer, S.; Demirci, B. Gurlek; Guliyev, O.; Sayin, C. B.; Colak, T.; Acar, F. N. Ozdemir; Haberal, M.; 0000-0002-5682-0943; 0000-0002-8372-7840; 0000-0002-3462-7632; 26036549; AAK-1697-2021; AAJ-8554-2021; AAJ-8097-2021Objective. We aimed to determine the total body water (TBW) by means of bioimpedance analysis (BIA) and to analyze the association of TBW, graft function, and arterial stiffness by means of pulse-wave velocity (PWV) and echocardiographic measurements in renal transplant (RT) recipients. Methods. Eighty-two RT recipients (mean age, 38.7 +/- 11.5 y; 58 male) who were using >= 1 antihypertensive treatment were enrolled in the study. Biochemical parameters, 24-hour urinary protein loss, estimated glomerular filtration rate (eGFR), transthoracic echocardiography, bioimpedance analysis according to systolic blood pressure, TBW, lean tissue index (LTI), extracellular water (ECW), intracellular water (ICW), lean tissue mass (LTM), phase angle (Phi50) levels, and renal resistive index (RRI) were evaluated. Results. TBW and ECVV were significantly correlated with systolic blood pressure. Urinary protein loss, pulmonary artery pressure, frequency of overhydration, systolic blood pressure, TBW, LTI, ECW, ICVV, LTM, and Phi50 values were significantly higher in patients with estimated glomerular filtration rate (eGFR) 15-49 mL/min but similar in patients with eGFR 50-70 mL/min. Conclusions. Hypertensive RT recipients have increased TBW, LTI, ICW, FTI, LTM, and Phi50 values. Graft function is positively correlated with systolic blood pressure and BIA parameters. Therefore, hypertensive RT recipients should be closely followed with the use of BIA for an early diagnosis of loss of graft function.Item Post-transplantation Anemia Predicts Cardiovascular Morbidity and Poor Graft Function in Kidney Transplant Recipients(2015) Demirci, B. Gurlek; Sezer, S.; Sayin, C. B.; Tulal, E.; Uyar, M. E.; Acar, F. N. Ozdemir; Haberal, M.; 0000-0002-3462-7632; 0000-0002-5682-0943; 26036548; IAO-2608-2023; AAJ-8097-2021; AAK-1697-2021Objective. We aimed to investigate whether low post-transplantation-period hemoglobin levels are predictive of cardiovascular morbidity in terms of left ventricular (LV) hypertrophy and vascular stiffness and to determine the contributing factors of post-transplantation anemia in kidney transplant (KT) recipients. Methods. One hundred fifty (mean age, 38.9 +/- 10.8 y; 113 male) KT recipients with functioning grafts were enrolled in the study. All subjects underwent clinical and laboratory evaluations (24-hour urinary protein loss, complete blood count) and transthoracic echocardiography to assess LV systolic function. Arterial stiffness was measured by means of carotid-femoral pulse-wave velocity (PWV). Mean hemoglobin levels were analyzed at the 1st, 6th, 12th, and 24th months after transplantation. Patients were divided into 2 groups according to presence of anemia: patients with anemia (group 1; n = 120) and normal (group 2; n = 30). Results. PWV values (6.8 +/- 1.9 m/s vs 6.4 +/- 1.1 m/s in groups 1 and 2, respectively; P = .002) and LV mass index (LVMI; 252.1 +/- 93.7 g/m(2) vs 161.2 +/- 38.5 g/m(2) groups 1 and 2, respectively; P = .001) were significantly higher in group 1. Estimated glomerular filtration rate and (64 +/- 28.5 m/min vs 77.8 +/- 30 m/min in groups 1 and 2, respectively; P = .001) LV systolic function (57.2 +/- 5.8% vs 77.8 +/- 30% in groups 1 and 2, respectively; P < .005) were significantly lower in group 1. In regression analysis, LV systolic function and LVMI were predictors of post-transplantation hemoglobin levels. Conclusions. Post-transplantation anemia contributes to cardiovascular morbidity by deteriorating LV function and increasing PWV and is therefore associated with poor prognosis for graft survival. Early correction of post-transplantation anemia, especially with the use of erythropoietin, may be beneficial for both graft and recipient survivals.Item Post-Transplant C-Reactive Protein Predicts Arterial Stiffness and Graft Function in Renal Transplant Recipients(2015) Demirci, B. Gurlek; Sezer, S.; Colak, T.; Sayin, C. B.; Tutal, E.; Haberal, M.; 0000-0002-8372-7840; 0000-0002-3462-7632; 26036547; AAJ-8554-2021; AAJ-8097-2021Background. The aim of this study was to evaluate the renal and cardiovascular outcomes of post-transplant c-reactive protein (CRP) levels. Methods. One hundred fifty renal transplant recipients (113 men; median age, 38.9 10.8 years) were cross-sectionally analyzed. Mean pre-transplant and post-transplant CRP levels were analyzed by the 1st, 3rd, 6th, 12th, and 24th months of transplantation. Patients were divided into 3 groups according to mean post-transplantation CRP levels: group 1 (CRP >20 mg/L and fluctuating levels; n = 34), group 2 (CRP, 6-20 mg/L; n = 40), and group 3 (CRP <6 mg/L; n = 76). Arterial stiffness was measured by means of carotid femoral pulse-wave velocity (PWv) by use of the SphygmoCor system. Results. Patients in group 1 had significantly lower estimated glomerular filtration rate (eGFR) (P = .000) and left ventricular systolic function and higher duration of dialysis before transplantation, pulse-wave velocity (PWv), proteinuria, and left ventricular mass index when compared with the other two groups. In regression analysis, eGFR and PWv were detected as the predictors of post-transplantation CRP levels. Conclusions. Fluctuating and high stable (>20 mg/L) post-transplant CRP levels predict eGFR, proteinuria, left ventricular mass index, and PWv after transplantation. Thus, CRP levels may be a useful marker to anticipate graft survival and cardiovascular morbidity in renal transplant recipients.Item High Grade Proteinuria as a Cardiovascular Risk Factor in Renal Transplant Recipients(2015) Guliyev, O.; Sayin, B.; Uyar, M. E.; Genctoy, A.; Sezer, S.; Bal, Z.; Demirci, B. G.; Haberal, M.; 0000-0001-8287-6572; 0000-0002-3462-7632; 0000-0002-5145-2280; 26036546; J-3707-2015; AAJ-8097-2021; AAZ-5795-2021; IAO-2608-2023; AAJ-5551-2021Background. Proteinuria is a marker of graft damage and is closely associated with a higher risk of morbidity, mortality, and cardiovascular disease in kidney transplant recipients (KTRs). Arterial stiffness is a well-known predictor of vascular calcification and systemic arteriosclerosis. In our study, we aimed to investigate. the association between proteinuria and graft/patient survival and to determine whether proteinuria may be a predictor for cardiovascular disease in our KTR population. Methods. Ninety KTRs (31 women; age, 38.7 +/- 11 years, with 45.9 +/- 9.6 months post-transplantation period) with normal graft functions in the 3 to 5 years of the post-transplantation period were enrolled. All patients were evaluated for their standard clinical (age, sex, and duration of hemodialysis) parameters. High-grade proteinuria was defined as proteinuria >500 mg/day in the 24-hour urine collection. All patients were evaluated by means of pulse-wave velocity (PWV) measurement at the initiation of the study. Results. Patients were divided into 2 groups: group 1 (high-grade proteinuria) patients with >= 500 mg/24 hours (n = 30) and group 2 (low-grade proteinuria) patients with <500 mg/24 hours (n = 60). High-grade proteinuria was correlated with higher PWV measurements and lower estimated glomerular filtration levels. Proteinuria appears to precede the elevation of serum creatinine and thus may be a useful marker of renal injury and may also be a contributing factor on deterioration of the graft. Conclusions. High-grade (>500 mg/day) proteinuria in KTRs is strongly associated with poor graft survival and increased risk of cardiovascular events. In our study, we proved the significant difference between high-grade and low-grade proteinuric patients, and we suggest 500 mg/day as the threshold of proteinuria in KTR population.Item Hyperviscosity in Renal Transplant Recipients(2015) Tutal, E.; Uyar, M. Erkmen; Uyanik, S.; Bal, Z.; Guliyev, O.; Toprak, S. K.; Ilhan, O.; Sezer, S.; Haberal, M.; 0000-0002-3462-7632; 0000-0001-7717-5827; 26036545; AAJ-8097-2021; H-9131-2012; IAO-2608-2023; AAZ-5795-2021; ABC-8182-2021Objective. The resistance of blood to flow is called plasma viscosity. Increased blood viscosity has been described in patients with coronary and peripheral arterial disease. In this study, we evaluated the influence of clinical and laboratory findings on plasma viscosity in renal transplant recipients. Methods. Eighty-one kidney transplant recipients (37.8 +/- 11.3 years old, 50.38 +/- 16.8 months post-transplantation period, 27 female) with normal graft functions were enrolled. The biochemical and clinical parameters in the 1st year after transplantation were retrospectively recorded, and graft function was evaluated by means of the yearly decline in eGFR. Plasma viscosity was measured and searched for the association with cross-sectionally analyzed cardiovascular parameters including body composition analyses, ambulatory blood pressure monitoring (ABPM) data, and pulse-wave velocity. Results. Patients were divided into 2 groups according to the median value of serum viscosity. Patients with high viscosity had higher serum low-density lipoprotein (P = .042) and C-reactive protein (P = .046) levels than lower viscosity group. In ABPM, daytime (P = .047) and office systolic (P = .046) blood pressure levels and left ventricular mass index (LVMI; P = .012) were significantly higher in patients with hyperviscosity. Patients with high viscosity had higher hip circumference (P = .038) and fat mass (P = .048). Estimated glomerular filtration rate decline was significantly higher in high-viscosity patients than in patients with low viscosity levels (12.9% vs 17.2%; P = .001) at 2 years' follow-up. Conclusions. We suggest that the hyperviscous state of the renal transplant recipients may arise from the inflammatory state, hypertension, and increased fat mass and increased LVMI. Hyperviscosity is also closely related to renal allograft dysfunction.Item Sagittal Abdominal Diameter as an Anthropometric Measure of Cardiovascular and Graft Loss Risk in Renal Transplant Recipients(2015) Bal, Z.; Uyar, M. E.; Tutal, E.; Guliyev, O.; Colak, T.; Sezer, S.; Haberal, M.; 0000-0002-3462-7632; 0000-0002-8372-7840; 26036544; IAO-2608-2023; AAJ-8097-2021; AAZ-5795-2021; AAJ-8554-2021Background. Sagittal abdominal diameter (SAD) has been presented as a stronger prognostic factor for all-cause and cardiovascular mortality in the general population. The aim of this study was to evaluate the relationship between SAD and its associated parameters in renal transplant recipients. Methods. One hundred eighty-one renal transplant recipients were enrolled in the study. All patients were evaluated according to standard clinical and biochemical parameters. Anthropometric measurements were performed for all patients. Pulse-wave velocity (PWV) was determined from pressure tracing over carotid and femoral arteries with the use of the Sphygmocor system. Results. Patients were divided into 2 groups according to SAD measurements. Group 1 (n = 127) was defined as SAD <24.3 cm, and group 2 (n = 54) was defined as SAD > 24.3 cm. Patients in group 2 had significantly higher triglycerides, C-reactive protein (CRP), uric acid, systolic blood pressure, PWV, and body mass index measurements compared with group 1 (P < .05 for all). In group 2, estimated glomerular filtration rate (eGFR) was significantly lower than group 1 (P = .022). SAD had positive correlation with PWV, systolic and diastolic blood pressure, body mass index, triglycerides, fasting glucose, CRP, and uric acid (P < .05 for all). On stepwise linear regression analyses, proteinuria (P = .005), SAD (P = .001), and CRP (P = .015) independently predicted the degree of percentage change of eGFR. Conclusions. Considering the significant association of visceral fat with inflammation and cardiovascular disease, estimating visceral fat by means of SAD could be a useful tool to stratify cardiovascular risk as well as graft function in renal transplant recipients.