Wos İndeksli Açık & Kapalı Erişimli Yayınlar
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Item Relationship Between Preoperative Diastolic Transpulmonary Gradient With Pulmonary Vascular Resistance and 1-Year and Overall Mortality Rates Among Patients Undergoing Cardiac Transplant(2019) Ciftci, Orcun; Unsal, Esma Nur; Dellaloglu, Zeynep; Aydan, Alp; Aksoy, Gokcen; Karakas, Makbule; Aydmalp, Alp; Sezgin, Atilla; Muderrisoglu, İbrahim Haldun; Haberal, Mehmet; 0000-0001-8926-9142; 30251939; W-5233-2018Objectives: Cardiac transplant is a life-saving procedure for patients with end-stage heart failure. Preoperative pulmonary vascular resistance is indicative of intrinsic pulmonary vascular disease and correlates with posttransplant survival. However, its measurement is costly and time consuming. Therefore, simpler techniques are required. Diastolic transpulmonary gradient reportedly indicates intrinsic pulmonary vascular disease. Here, we investigated the relationship between preoperative diastolic transpulmonary gradient with preoperative pulmonary vascular resistance and 1-year and overall mortality among cardiac transplant patients. Materials and Methods: Fifty-one patients who underwent cardiac transplant between 2006 and 2017 were included. All patients underwent preoperative right and left heart catheterization and oxygen study. Among these, diastolic transpulmonary gradient, mean transpulmonary gradient, and pulmonary vascular resistance were correlated with one another and 1st-year and overall mortality rates. Patients were grouped according to whether they received diastolic transpulmonary gradient or not, and both groups were compared with respect to 1-year and overall mortality. Binary logistic regression analysis was done to test whether diastolic transpulmonary gradient was a significant predictor of 1-year and overall mortality. Results: Mean patient age was 45.5 +/- 9.8 years. The 1-year and overall mortality rates were 21.6% (11/51) and 37.3% (19/51), respectively. Diastolic transpul monary gradient was significantly correlated with pulmonary vascular resistance, 1-year mortality, and overall mortality (P<.05) and was a significant predictor of 1-year and overall mortality (odds ratio 6.0; 95% confidence interval, 1.4-25.3; P <.05 and odds ratio 4.8; 95% CI, 1.4-17.5; P <.05, respectively). Patients with a diastolic transpulmonary gradient of >= 7 mm Hg had significantly higher 1-year and overall mortality (P<.05). Conclusions: Diastolic transpulmonary gradient can be used as a promising easy-to-use parameter of intrinsic pulmonary vascular disease and a predictor of 1-year and overall mortality among patients undergoing cardiac transplant.Item Incidence, clinical features, and outcomes of food allergy in children who underwent liver transplant: 16-year experience(2019) Baris, Zeren; Koksal, Burcu; Ozbek, Ozlem; Ozcay, Figen; Haberal, Mehmet; 0000-0001-9580-7656; 30884056; ABG-5684-2020; AAB-4153-2020Food allergies often develop after liver transplant, especially in young children. However, data are scarce on clinical characteristics and patient outcomes. When we evaluated our pediatric liver transplant patients over a 16-year period, food allergy incidence was 8% (19/236 patients). All patients with food allergies were <18 months old, with incidence in this age group of 19.2% (19/99). Two patients had a single food and 17 had multiple food allergies. Five patients showed only non-IgE-mediated food allergies. Eggs, milk, nuts, and wheat were the most common allergens. Presenting symptoms included diarrhea, flushing, angioedema attacks, wheezing/chronic cough, and vomiting. Seven patients had EBV, and two patients had CMV infections at time of food allergy diagnosis. Twelve patients had eosinophilia. Seven patients (36.8%) were able to regain tolerance to all food allergens. However, one patient with single nut allergy and three with multiple food allergies were still on allergen-eliminated diets. Eight patients with multiple food allergies gained tolerance to some of the food allergens. In conclusion, food allergies in our patients were mainly against multiple foods and IgE mediated. Infections like EBV and CMV may play a role in food allergies after liver transplant, especially in pretransplant-naive patients.Item Experience with antiviral agents for treatment of hepatitis C virus infection in hemodialysis patients on the kidney wait list(2019) Torun, Dilek; Soydas, Baris; Tekkarismaz, Nihan; Ozelsancak, Ruya; Micozkadioglu, Hasan; Haberal, Mehmet; 30762283Introduction Hepatitis C virus (HCV) infection is associated with increased mortality and morbidity in kidney transplant patients. The ability to establish a sustained viral response before renal transplant is important for these patients. Direct-acting antiviral agents can increase the sustained viral response in most patients with HCV infection. In this case series, we aimed to determine the efficacy and safety of a combined therapy of ombitasvir, paritaprevir, ritonavir, and dasabuvir with or without ribavirin in patients with HCV genotype 1 infection without cirrhosis and on hemodialysis who were awaiting deceased-donor kidney transplant. Methods Our study included eight male and two female HCV ribonucleic acid (RNA)-positive hemodialysis patients (mean age 50.7 +/- 15 years, mean hemodialysis duration 14 +/- 5.5 years, mean HCV duration 18 +/- 3.7 years). Findings Three patients with genotype 1a received oral therapy with 12.5 mg ombitasvir, 150 mg paritaprevir, 7 5 mg ritonavir, and 250 mg dasabuvir plus 200 mg ribavirin for 12 weeks. Seven patients with genotype 1b received 12.5 mg ombitasvir, 150 mg paritaprevir, 75 mg ritonavir, and 250 mg dasabuvir without ribavirin treatment for 12 weeks. The sustained virologic response rate was 100% at 12 weeks after completion of antiviral treatment in both treatment groups. No serious adverse effects were observed in either treatment group. Five patients had constitutional symptoms such as nausea, anorexia, and fatigue. During the treatment period, hemoglobin, white cell blood count, thrombocyte, and ferritin levels were similar to pretreatment levels. Treatment did not affect weekly erythropoietin and monthly intravenous iron treatment doses. Discussion Direct-acting antiviral agents are safe and effective for generating a sustained viral response in HCV genotype 1-infected hemodialysis patients on kidney wait lists.Item Adequacy of Infective Endocarditis Prophylaxis Before Dental Procedures among Solid Organ Transplant Recipients(2019) Karacaglar, Emir; Akgun, Arzu; Ciftci, Orcun; Altiparmak, Nur; Muderrisoglu, Haldun; Haberal, Mehmet; 0000-0002-9635-6313; 31464231; AAG-8233-2020Infective endocarditis (IE) is a life-threatening condition with high morbidity and mortality. The current IE guidelines recommend antibiotic prophylaxis only in patients with certain cardiac conditions and before certain dental procedures. However, there is not enough data about solid organ transplant (SOT) recipients. In this study, we aimed to investigate the IE prophylaxis in general dental and periodontal surgical procedures among our SOT recipients. Medical records of 191 SOT recipients (32 liver transplant recipients, 54 heart transplant recipients, and 105 kidney transplant recipients) who were admitted to our hospital between January 2016 and January 2018 were evaluated. A total of 65 patients who underwent dental procedures were included in the study. We investigated the adequacy of IE prophylaxis according to the current guidelines. Two groups were created according to whether they received antibiotic prophylaxis or not. The mean age was 44.2 +/- 13.6 years, and 66.1% were male. The majority of patients (67.6%) received antibiotic prophylaxis. The most commonly used antibiotic was amoxicillin (48.8%). Among the procedures, 23.1% were classified as invasive and 76.9% were classified as noninvasive. No complication was observed after invasive and noninvasive dental procedures. There were no complications in both antibiotic prophylaxis and no-prophylaxis groups. According to our results, IE prophylaxis has been used appropriately in SOT recipients in our center. No serious infection has been reported. In addition, no complication due to antibiotic use was also observed.Item The curative treatment of familial hypercholesterolemia: Liver transplantation(2019) Kirnap, Nazli Gulsoy; Kirnap, Mahir; Tutuncu, Neslihan Bascil; Moray, Gokhan; Haberal, Mehmet; 31626710; AAH-9198-2019Background Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder characterized by premature mortal cardiovascular complications. Liver transplantation (LT) is the only curative treatment option. In this study, the long-term clinical follow-up data of 8 patients who underwent LT with a diagnosis of FH in our center are presented. Materials and Methods A total of 638 LT were performed between December 1985 and June 2019 at Baskent University, of which 8 patients underwent LT with a diagnosis of FH and were evaluated retrospectively. Results Of the 8 patients, 4 underwent deceased donor and 4 living donor transplantation. Five patients had preoperative cardiovascular disease and consequent interventional operations. There was significant reduction in postoperative LDL-C and TC levels starting from the first week, and stabilizing at the first month and first year. The median survival time of patients was 5 years (2-12 years). All patients are still alive. None of the complications of patients with preoperative cardiovascular complications had progressed. Conclusion Liver transplantation is the preferred curative treatment for the pathophysiology of FH. In our study, LDL-C levels were brought under control with LT performed on patients with FH. Median 5-year follow-up of patients showed that the progression of cardiac complications was abated.Item Evaluation of New Baskent University Preservation Solution for Kidney Graft During Cold Ischemia: Preliminary Experimental Animal Study(2019) Haberal, Mehmet; Kirnap, Mahir; Erdem, S.Remzi; Ozdemir, B.Handan; Lux, K. Michael; Bacanli, Didem; 31145052Objectives: Organ damage due to long cold ischemia time remains a hurdle in transplantation. In this preliminary animal study, we compared the new Baskent University Preservation Solution (BUPS) with the University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions. Materials and Methods: BUPS composition included electrolytes, raffinose, mannitol, N-acetylcysteine, taurine, adenosine, and ascorbic acid. In experiment 1, kidneys from 50 male Sprague-Dawley rats were placed into BUPS, HTK, or UW solution to assess cold ischemia injury, with biopsies taken at different time points for pathologic evaluation. In experiment 2, to investigate ischemia-reperfusion injury, 5 rats were renal transplant donors to 10 rats and 6 pigs were used as transplant donors-recipients among each other. Results: In experiment 1, no significant cellular injury was shown at up to 3 hours of perfusion with any solution. At 6- to 48-hour perfusion, tubular injury was shown, with lowest injury in BUPS and HTK versus UW and control groups (P < .01). The BUPS group showed more moderate degree of tubular apoptosis and cytoskeletal rearrangement than the HTK and UW groups at 12-, 24-, and 48-hour perfusion (P < .01). In experiment 2, after ischemia-reperfusion injury, no significant differences were found between HTK and BUPS groups regarding tubular damage. Although no significant differences were shown regarding tubular cytoskeletal rearrangment and apoptosis in pig reperfusion group with BUPS versus HTK, significant differences were shown with these solutions in other groups. Conclusions: Tubular damage during ischemia-reperfusion injury (cytoskeletal disruption, increased apoptosis) were lower with BUPS. BUPS can be a costeffective perfusion solution in transplantation.Item Preoperative Cardiac Risk Assessment in Renal Transplant Recipients: A Single-Center Experience(2019) Yilmaz, Kerem Can; Akgun, Arzu Neslihan; Ciftci, Orcun; Muderrisoglu, Haldun; Sezer, Siren; Moray, Gokhan; Haberal, Mehmet; 0000-0002-9635-6313; 29025386; AAG-8233-2020Objectives: Cardiovascular disease is the major cause of morbidity and mortality in patients on renal replacement therapy and in kidney transplant recipients. There are no specific recommendations for preoperative cardiac risk assessment before renal transplant. The aim of our study was to analyze preoperative cardiac test frequencies, test results, patient characteristics, and relations between cardiac stress test results and severe coronary artery disease. Materials and Methods: We retrospectively examined patients who underwent renal transplant between December 2011 and December 2016 in our hospital (Ankara, Turkey). Our study group included 216 patients. All patients had preoperative echocardiography. We recorded results of exercise stress tests, myocardial perfusion scintigraphy, and coronary angiography. For all patients, preoperative complete blood cell count, creatinine, high-density lipoprotein, triglycerides, low-density lipoprotein, and red cell distribution width values were obtained and recorded. Results: We classified patient groups according to presence or absence of severe coronary artery disease. Fourteen of 66 patients had severe coronary artery disease. In univariate analyses, age, having a history of familial coronary artery disease, diabetes mellitus, presence of coronary artery disease, and triglyceride levels were risk factors for severe coronary artery disease. In multivariate analysis, diabetes mellitus, presence of coronary artery disease, and having a history of familial coronary artery disease were statistically significant. Conclusions: Renal transplant recipients are a special patient population, and there must be specific suggestions for this population. If patients present with more than 1 risk factor, a stress test should be performed to evaluate cardiovascular risk. In some patients, especially those whose risk factors include prior cardiovascular disease or diabetes mellitus, stress tests should be skipped and patients should directly undergo coronary angiography to look for severe coronary artery disease.Item Surgical Interventions for Late Complications of Arteriovenous Fistulas(2014) Belli, Sedat; Yabanoglu, Hakan; Aydogan, Cem; Parlakgumus, Alper; Yildirim, Sedat; Haberal, Mehmet; 25058786Our aim was to determine the most effective surgical treatment for arteriovenous fistula (AVF) complications after all other methods of salvage have failed. We evaluated 110 patients for 139 complications that occurred after the initial AVF placement and for whom surgical intervention was the last hope for retaining fistula access. Vascular steal syndrome and venous hypertension were the most common complications seen in our patients. The anastomoses of 17 of the vascular steal syndrome cases were narrowed either by stitches or by a polytetrafluoroethylene graft. The second most performed revision surgery was excision of the aneurysm and repair with primary suturing, followed by excision of the aneurysm and interposition grafting. Successful surgical outcomes were achieved in 111 of 139 procedures after revision surgery without constructing a new AVF. AVF salvage surgery is of paramount importance in order to increase the patency rate, which prolongs survival and increases the patient's quality of life.Item Evaluation of Demographic and Clinical Characteristics of Patients who Attempted Suicide by Self-Inflicted Burn Using Catalyzer(2015) Yabanoglu, Hakan; Aytac, Huseyin Ozgur; Turk, Emin; Karagulle, Erdal; Belli, Sedat; Sakallioglu, Ayse Ebru; Tarim, Mehmet Akin; Moray, Gokhan; Haberal, Mehmet; 25692434Our aim was to assess demographic and clinical characteristics of patients treated at our units who attempted suicide by self-incineration, and to compare the results of burns with or without catalyzer use. Twenty patients who attempted suicide by self-incineration were examined in terms of clinical and demographic characteristics. Average age of the study population was 35 years (range 13-85 years). Average percentage of total body surface area burn was 53% (9%-100%). Six (30%) patients used gasoline and 5 (25%) used paint thinner in order to catalyze burning. Of these 11 patients who used a catalyzer, 5 (45.4%) had inhalation injury and 7 (63.6%) died. Among 9 patients who did not use any catalyzer, 1 (11.1%) had inhalation injury and 4 (44.4%) died. In general, inhalation injury was diagnosed in 6 patients (30%) while 11 (55%) patients died. A high morbidity and mortality rate was found in patients who used a catalyzer.Item New-Onset Diabetes and Glucose Regulation Are Significant Determinants of Left Ventricular Hypertrophy in Renal Transplant Recipients(2015) Sezer, Siren; Uyar, Mehtap Erkmen; Tutal, Emre; Bal, Zeynep; Guliyev, Orhan; Colak, Turan; Hasdemir, Efe; Haberal, Mehmet; 25945353Background. New-onset diabetes after transplantation (NODAT) is associated with decreased graft survival and an increased risk for cardiovascular disease. The objective of this study was to evaluate the risk factors for development of NODAT and its' relationship with arterial stiffness and left ventricular mass index (LVMI) in kidney transplant recipients. Methods. 159 kidney transplant recipients were selected from our transplantation center who underwent renal transplantation between years 2007 and 2010. Results. Among 159 patients, 57 (32.2%) patients were with NODAT who were significantly older than patients without diabetes (P: 0.0001). Patients with NODAT had significantly higher pulse wave velocity (PWv) (P: 0.033) and left ventricular mass index LVMI (P: 0.001) compared to patients without NODAT. Further analysis was done according to LVMI as follows: LVMI > 130 g/m(2) (n: 57) and LVMI <= 130 g/m(2) (n: 102). We observed higher office systolic and diastolic BP, serum trygliceride, glucose, creatinine, age, and HbA1c (P: 0.0001) levels in patients with LVMI > 130 g/m(2). Linear regression analysis revealed that HbA1c was the major determinant of LVMI (P: 0.026, beta: 0.361). Conclusions. HbA1c is the major determinant of LVMI, so strict control of serum glucose levels is essential for preventing cardiovascular disease in patients with NODAT.