Başkent Üniversitesi Yayınları
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Item Pentoxifylline Protects the Small Intestine After Severe Ischemia and Reperfusion(Başkent Üniversitesi, 2013-06) Carsi, José Miguel Lloris; Pereyra, Luis Horacio Toledo; Fernandez, Cristobal Zaragoza; Toledo, Alexander Horacio; Lapeña, Dolores CejalvoObjectives: Pentoxifylline, a methylxanthine derivative with significant hemorheologic properties, is used for claudication in patients with peripheral vascular disease, and experimentally for ischemic injury to organs because of its antioxidant and anti-inflammatory effects. We used a rat model of severe small intestinal ischemia and reperfusion to determine the ability of pentoxifylline in improving survival, molecular response, and pathological protection. Materials and Methods: We used 6 groups of male Wistar rats (n=25 each). The superior mesenteric artery was occluded for 120 minutes. Laboratory and tissue studies were done on 5 animals, 1 hour after reperfusion, and animal survival was assessed at 7 days. There were 2 control groups that received normal saline, either before ischemia or during reperfusion. The 4 treated groups received pentoxifylline 1 or 10 mg/kg at the same times mentioned above. Laboratory studies included measuring serum lactic acid dehydrogenase, tumor necrosis factor-α, interleukin-1β, and interleukin-6. Intestinal tissue malondialdehyde and myeloperoxidase in small intestine tissue also were measured. Histology and laser vascular blood flow at baseline and reperfusion were obtained, and survival was determined 7 days after ischemia. Results: A significant survival benefit in the animals treated with 10 mg/kg of pentoxifylline at reperfusion was noted. This coincided with a reduction in biochemical markers of cell damage—specifically, serum lactic acid dehydrogenase, and tissue malondialdehyde, ischemia, and reperfusion. Additionally, we saw decreased levels of tumor necrosis factor-α, interleukin-1β, and interleukin-6. Improved postreperfusion blood flow shown by laser Doppler technology also was seen in the treated groups. Histologically, we observed less neutrophil infiltration in the intestine of ischemic-treated rats. Also seen in the control animals were increased necrotic lesions in the microvilli with a higher presence of lysozyme in the Paneth cells. Survival was significantly better at 7 days (70% vs 40%) when we compared the pentoxifylline group treated at reperfusion (10 mg/kg) to the ischemic controls. Conclusions: Pentoxifylline had a significant protective effect on severely ischemic bowel when administered during reperfusion at a dosage of 10 mg/kg. Better survival, improved histology, and molecular response should urge consideration of the consideration of applying these findings in some general surgery and transplant conditions.Item Allografts Positive for Hepatitis B Surface Antigen in Liver Transplant for Disease Related to Hepatitis B Virus(Başkent Üniversitesi, 2013-06) Ju, Weiqiang; He, Xiaoshun; Huang, Jiefu; Zhu, Xiaofeng; Wang, Dongping; Guo, Zhiyong; Chen, MaogenObjectives: Liver grafts from hepatitis B surface antigen-negative and anti-core antibody-positive donors are safe for liver transplant. However, the use of hepatitis B surface antigen-positive liver donors in liver transplants is controversial. We assessed the safety and effectiveness of liver transplants using hepatitis B surface antigen-positive liver grafts to patients with diseases related to hepatitis B virus. Materials and Methods: We retrospectively reviewed 23 patients who had a deceased-donor liver transplant using hepatitis B surface antigen-positive liver grafts. All patients had end-stage liver disease secondary to hepatitis B virus infection. Recipients had oral entecavir and intravenous or intramuscular injection of hepatitis B immune globulin for > 1 year after the transplant. Results: Two patients died from severe perioperative pneumonia, and the other 21 patients were followed for 9 to 38 months after transplant. All 21 patients remained hepatitis B surface antigen-positive. A repeat liver transplant was performed in 1 patient at 5 months after the initial transplant because of biliary ischemia. There were 3 patients who died from recurrent liver cancer at 9, 14, and 18 months after transplant. There were 18 patients (78%) who survived and 17 grafts (74%) that survived. Conclusions: Liver transplant using hepatitis B surface antigen-positive liver grafts is safe for patients with end-stage liver disease secondary to hepatitis B virus infection.Item Systematic Kidney Biopsies After Acute Allograft Pyelonephritis(Başkent Üniversitesi, 2013-06) Cartery, Claire; Kamar, Nassim; Rostaing, Lionel; Game, Xavier; Cointault, Olivier; Cardeau-Desangles, Isabelle; Guitard, Joelle; Sallusto, Federico; Esposito, Laure; Guilbeau-Frugier, CélineObjectives: Scarce data exist regarding the effect of acute graft pyelonephritis on kidney histology after a kidney transplant. This study sought to assess the kidney histology at 1 month, and kidney function at 1 year, after acute graft pyelonephritis in kidney transplant patients. Materials and Methods: All kidney transplant patients with acute graft pyelonephritis between October 2006, and December 2008, underwent a kidney biopsy 1 month later (n=28). Histologic findings were compared with those observed in a control group (n=28) who underwent a protocol kidney biopsy at 1 year posttransplant and did not present with acute graft pyelonephritis. Patients were matched according to age, sex, and immunosuppressive regimen. Results: Kidney function was impaired by the acute graft pyelonephritis episodes at the time of biopsy. In 40% of patients, the estimated glomerular filtration rate did not return to baseline by 1 month after acute graft pyelonephritis and remained impaired thereafter. Three patients had features of acute rejection. Tubulitis was seen more frequently in the acute graft pyelonephritis group, especially in patients in whom estimated glomerular filtration rate did not completely recover by 1 month after acute graft pyelonephritis. Patients with acute graft pyelonephritis who had inflammatory infiltrate of > 20% 1 month after acute graft pyelonephritis had worse kidney function 1 year later.Item Insulin Requirement After a Renal Transplant in Patients With Type 2 Diabetes: The Choice of Calcineurin Inhibitors(Başkent Üniversitesi, 2013-06) Hoogen, Martijn W. F. van den; Hilbrands, Luuk B.; Hoeven, Anna M. van derObjectives: Hyperglycemia is a common adverse event of immunosuppressive drugs used in organ transplant. Because cyclosporine is less diabetogenic than tacrolimus is, cyclosporine may be preferred in patients with pre-existing diabetes mellitus type 2, to prevent insulin treatment after a transplant. Patients and Methods: From March 2005 to June 2011, adult renal transplant patients with pre-existing diabetes mellitus type 2, who were not treated with insulin before a transplant, were treated with cyclosporine in combination with mycophenolate mofetil and corticosteroids. For comparison, we used historical controls who were treated with tacrolimus instead of cyclosporine. Results: Of the 16 patients treated with cyclosporine, only 4 remained free of insulin treatment after a follow-up of least 1 year, compared with 2 of 12 patients who were treated with tacrolimus (25% vs 17%; P = .67). Almost all patients required insulin treatment within 2 months of the transplant, and patients required comparable doses of insulin at different times after the transplant in both groups. None of the baseline characteristics could sufficiently predict the need to start insulin treatment. Conclusions: Cyclosporine cannot be preferred over tacrolimus to minimize either the chance of requiring insulin treatment posttransplant or the dosage of insulin in patients with pre-existing diabetes mellitus type 2.Item Liver Transplant Using Donors After Cardiac Death: A Single-Center Approach Providing Outcomes Comparable to Donation After Brain Death(Başkent Üniversitesi, 2013-04) Vanatta, Jason M.; Eason, James D.; Satapathy, Sanjaya K.; Nezakatgoo, Nosratollah; Campos, Luis; Modanlou, Kian A.; Nair, Satheesh; Hathaway, Donna K.; Dean, Amanda G.Objectives: Organ donation after cardiac death remains an available resource to meet the demand for transplant. However, concern persists that outcomes associated with donation after cardiac death liver allografts are not equivalent to those obtained with organ donation after brain death. The aim of this matched case control study was to determine if outcomes of liver transplants with donation after cardiac death donors is equivalent to outcomes with donation after brain death donors by controlling for careful donor and recipient selection, surgical technique, and preservation solution. Materials and Methods: A retrospective, matched case control study of adult liver transplant recipients at the University of Tennessee/Methodist University Hospital Transplant Institute, Memphis, Tennessee was performed. Thirty-eight donation after cardiac death recipients were matched 1:2, with 76 donation after brain death recipients by recipient age, recipient laboratory Model for End Stage Liver Disease score, and donor age to form the 2 groups. A comprehensive approach that controlled for careful donor and recipient matching, surgical technique, and preservation solution was used to minimize warm ischemia time, cold ischemia time, and ischemia-reperfusion injury. Results: Patient and graft survival rates were similar in both groups at 1 and 3 years (P = .444 and P = .295). There was no statistically significant difference in primary nonfunction, vascular complications, or biliary complications. In particular, there was no statistically significant difference in ischemic-type diffuse intrahepatic strictures (P = .107). Conclusions: These findings provide further evidence that excellent patient and graft survival rates expected with liver transplants using organ donation after brain death donors can be achieved with organ donation after cardiac death donors without statistically higher rates of morbidity or mortality when a comprehensive approach that controls for careful donor and recipient matching, surgical technique, and preservation solution is used.Item Thyroid Hormone Levels in Children With Liver Cirrhosis Awaiting a Liver Transplant(Başkent Üniversitesi, 2013-04) Dehghani, Seyed Mohsen; Malek-Hoseini, Seyed Ali; Imanieh, Mohammad Hadi; Malekpour, Abdorrasoul; Karamifar, Hamdollah; Eghbali, Fatemeh; Haghighat, MahmoodObjectives: Evidence exists that decreased in triiodothyronine (T3) and thyroxine (T4) levels are associated with the severity of liver disease, and these hormones could be used as disease prognostic factors, but there are paradoxes in this regard in the literature. This study aimed at evaluating the correlation between thyroid hormone levels and severity of liver disease. Materials and Methods: We measured thyroid hormone levels in 83 children with liver cirrhosis using radioimmunoassay techniques. Results: Four patients (4.8%) showed a decrease in the amount of T3 and 9 patients (10.8%) revealed increased levels of T3. Also, decreases were seen in the T4 levels of 7 patients (8.4%), and 4 patients (4.8%) showed increases in levels of T4. The serum albumin levels were lower and international normalized ratio was higher in patients with low T3 and low T4. This study reveals that the Model for End-Stage Liver Disease and Pediatric End-Stage Liver Disease scores are statistically related to the decreased amounts of T4 (P = .036). The Model for End-Stage Liver Disease and Pediatric End-Stage Liver Disease scores and the Child scores were higher in low T3 patients, but this was not significant (P > .05). Conclusions: Decreased levels of thyroid hormones are correlated with the severity of disease and can be seen in more advanced cirrhosis. Patients with decreased T4 levels need a liver transplant more immediately than those patients that do not have decreased T4 levels.Item Uterine Transplantation as an Innovative Method for Restoring Reproductive Function in Absolute Uterine Factor Infertility(Başkent Üniversitesi, 2026-06) Soloviova, Anastasiia; Valentyna, OleksiienkoObjectives: Absolute uterine factor infertility is a condition characterized by the absence of a functional uterus, resulting in the inability to achieve or maintain pregnancy. Uterus transplantation has emerged as an experimental therapeutic option aimed at restoring reproductive capacity in women with absolute uterine factor infertility. Here, we reviewed the current clinical experience with uterus transplantation, focusing on surgical approaches, donor sources, reproductive outcomes, and ethical considerations. Materials and Methods: We conducted a narrative review of the literature using the PubMed, Scopus, and Google Scholar databases. We screened publications from 2000 through 2025 using the keywords “uterus transplantation,” “absolute uterine factor infertility,” and “MRKH syndrome.” We included 42 relevant publications that described clinical outcomes, surgical techniques, and ethical aspects of uterus transplantation. We focused on reports of successful pregnancies and births following uterus transplantation. Results: Uterus transplantation has progressed from experimental animal models to clinical application. To date, more than 90 transplants have been performed worldwide, resulting in over 50 live births. The procedure involves complex microsurgical vascular anastomoses and requires long-term immunosup-pression until childbirth. All pregnancies are achieved through in vitro fertilization with cryopreserved embryos. Both living and deceased donors have been successfully used, each associated with specific ethical and surgical considerations. Conclusions: Uterus transplantation represents a promising experimental therapy for women with absol-ute uterine factor infertility. Although encouraging reproductive outcomes have been reported, the proce-dure remains technically demanding and associated with substantial ethical, surgical, and immunological challenges. Further multicenter studies and long-term follow-up are required to establish standardized protocols and evaluate long-term maternal and neonatal outcomes.Item Relation Between Pretransplant Serum Levels of Soluble CD30 and Acute Rejection During the First 6 Months After a Kidney Transplant(Başkent Üniversitesi, 2013-06) Shooshtarizadeh, Tina; Ataipour, Yousef; Ossareh, Shahrzad; Mohammadali, AliObjectives: The immunologic status of kidney allograft recipients affects transplant outcome. High levels of pretransplant serum soluble CD30 correlate with an increased risk of acute rejection. Studies show conflicting results. We evaluated the relation between pretransplant serum sCD30 levels with the risk of posttransplant acute kidney rejection in renal transplant recipients. Materials and Methods: This prospective cohort study was performed between March 2010 and March 2011 on 77 kidney transplant recipients (53 men [68.8%], 24 women [31.2%]; mean age, 41 ± 14 y). Serum samples were collected 24 hours before transplant and analyzed for soluble CD30 levels by enzyme-linked immunosorbent assay. Patients were followed for 6 months after transplant. Acute biopsy-proven rejection episodes were recorded, serum creatinine levels were measured, and glomerular filtration rates were calculated at the first and sixth months after transplant. Preoperative serum soluble CD30 levels were compared in patients with and without rejection. Results: The mean pretransplant serum soluble CD30 level was 92.1 ± 47.3 ng/mL. At 6 months’ follow-up, 10 patients experienced acute rejection. Mean pretransplant soluble CD30 levels were 128.5 ± 84 ng/mL versus 86.7 ± 37 ng/mL in patients with and without acute rejection episodes (P = .008). At 100 ng/mL, the sensitivity, specificity, and positive and negative predictive values of pretransplant serum soluble CD30 level to predict acute rejection were 70%, 73.6%, 29.1%, and 94.3%. Conclusions: We showed a significant relation between pretransplant serum soluble CD30 levels and acute allograft rejection. High pretransplant levels of serum soluble CD30 can be a risk factor for kidney transplant rejection, and its high negative predictive value at various cutoffs make it useful to find candidates with a low risk of acute rejection after transplant.Item Evaluating Safety and Efficacy of Rabbit Antithymocyte Globulin Induction in Elderly Kidney Transplant Recipients(Başkent Üniversitesi, 2013-06) Khanmoradi, Kamran; Dinh, Duy-Bao; Ortiz, Jorge A.; Zaki, Radi F.; Campos, Stalin; Jawa, Pankaj; Parsikia, Afshin; Feyssa, Eyob L.; Knorr, John P.Objectives: The optimal immunosuppression regimen for elderly kidney transplant recipients is poorly defined. We sought to evaluate the short-term efficacy and safety of thymoglobulin in geriatric recipients of deceased-donor kidneys. Materials and Methods: A single-center, retrospective analysis was undertaken between elderly (≥ 65 years) (n=137) and nonelderly (n=276) kidney transplant recipients who received rabbit antithymocyte globulin induction and calcineurin inhibitor, mycophenolic acid, and prednisone maintenance. Results: The mean age was 70 versus 52 years. Fewer elderly patients had an earlier transplant or panel reactive antibodies > 20%, but had more machine perfused, older, and extended criteria donor kidneys. Elderly patients received lower rabbit antithymocyte globulin (5.4 vs 5.6 mg/kg; P = .04) and initial mycophenolic acid doses (1620 vs 1774 mg; P = .002), and experienced less delayed graft function (31.1% vs 50.0%; P < .001). Death-censored graft survival and graft function at 3 years and biopsy-proven acute rejection at 1 year were comparable; however, there was lower 3-year patient survival in elderly patients. Donor age was the only factor associated with reduced patient survival. Rates of malignancy, infection, or thrombocytopenia were similar; however, leukopenia occurred less frequently in elderly patients (11.7% vs 19.9%; P = .038). Conclusions: Elderly kidney transplant recipients receiving rabbit antithymocyte globulin did not experience different short-term graft survival, graft function or rates of infection, malignancy or hematologic adverse reactions than did nonelderly patients; they experienced fewer episodes of delayed graft function, but had lower 3-year patient survival.Item Outcomes of De Novo Allograft Diabetic Nephropathy in Renal Allograft Recipients(Başkent Üniversitesi, 2013-06) Prasad, Narayan; Gupta, Amit; Kaul, Anupama; Sharma, Raj Kumar; Bhadauria, Dharmendra; Jain, Manoj; Gupta, PallavObjectives: Despite increased use of diabetogenic immunosuppressive drugs and increased incidence of new-onset diabetes after transplant in renal allograft recipients, there are few case studies on the subject of de novo allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes. We sought to study the outcomes of allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes in patients with new-onset diabetes after transplant. Materials and Methods: We reviewed the case records of all new-onset diabetes after transplant patients who underwent graft biopsy for graft dysfunction from 1992 to 2010. We analyzed the clinical characteristics and outcomes of new-onset diabetes after transplant patients with de novo allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes. Results: Of the 1989 recipients, 421 patients developed new-onset diabetes after transplant and 26 underwent graft biopsy. Of the 26 patients, 9 had histopathologic evidence of de novo allograft diabetic nephropathy, and 17 had interstitial fibrosis/tubular atrophy without specific glomerular changes. The mean duration from transplant to developing novo allograft diabetic nephropathy was 115.2 months (range, 33-192 mo), and from developing new-onset diabetes after transplant to allograft diabetic nephropathy, was 109.66 months (range, 27-188.4 mo). Of the 9 patients with de novo allograft diabetic nephropathy, 3 died (33.3%), 2 reached end-stage renal disease (22.2%), and 4 remained stable (44.4%). Of the 17 with interstitial fibrosis/tubular atrophy, 2 died (11.7%), 5 developed end-stage renal disease (29.4%), and 10 remained stable on triple immunosuppression and insulin therapy during follow-up (58.8%). Conclusions: De novo allograft diabetic nephropathy is a significant cause of graft and patient loss in renal allograft recipients who develop new-onset diabetes after transplant.