Başkent Üniversitesi Yayınları
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Item Vertigo After Renal Transplantation: A Sign of Paucisymptomatic Cryptococcal Meningitis(Başkent Üniversitesi, 2006-12) Mehrenberger, Marion; Kamar, Nassim; Borde, Jean-Sébastien; Estève-Fraysse, Marie-Josée; Viguier, Alain; Recco, Paulette; Durand, Dominique; Rostaing, LionelWe report what is to our knowledge the first case of severe isolated vertigo that developed after renal transplantation and was a manifestation of cryptococcal meningitis. Treatment with antifungal therapy resulted in the complete resolution of vertiginous symptoms. Immunosuppressed patients with an opportunistic infection of the central nervous system can present with extremely tenuous features of infection and atypical neurologic signs.Item Changes in Health-Related Quality of Life in Greek Adult Patients 1 Year After Successful Renal Transplantation(Başkent Üniversitesi, 2006-12) Balaska, Aikaterini; Moustafellos, Panagiotis; Gourgiotis, Stavros; Pistolas, Dimitrios; Hadjiyannakis, Evangelos; Vougas, Vassilis; Drakopoulos, SpirosObjectives: This study was undertaken to compare and to evaluate the health-related quality of life (HRQOL) in Greek adult transplant recipients before and 1 year after successful renal transplantation (RT) and to examine which parameters had the greatest effects on their HRQOL. The SF-36 survey score was used. Materials and Methods: Eighty-five Greek hemodialysis patients underwent RT at the Transplant Unit of Evangelismos General Hospital of Athens, including 44 men and 41 women (mean age, 43.8 years; range, 21-59 years). Thirty-nine patients had received a kidney from a living-related donor, and 46 from a cadaver. The scale scores of a Greek version of the SF-36 survey were compared between the transplant and the hemodialysis patients. We also examined the relationships of the scale scores with the patients’ age and the type of donor. Results: According to the SF-36 health survey, transplant recipients had better results for general health perception (P <= .001), role-physical functioning (P <= .01), role-emotional functioning (P <= .01), and vitality (P <= .01). In addition, the scale scores of physical functioning, general health, and vitality of the patients who were younger than 30 years old at the time of transplantation were significantly higher than those of the patients who were older than 30 years, while the scores of bodily pain, general health, and physical functioning were significantly lower in cadaveric graft recipients compared with living-related graft recipients. Conclusions: The SF-36 health survey is a validated and comprehensive instrument for evaluating renal transplant patients’ HRQOL. Our data demonstrate an improvement in HRQOL in renal transplant patients from before to 1 year after successful RT. The data also confirm that the recipients’ age at transplantation and the type of donor were important factors affecting the HRQOL.Item Majocchi’s Granuloma After Kidney Transplantation(Başkent Üniversitesi, 2006-12) Burg, Michael; Jaekel, Dagmar; Kiss, Eva; Kliem, VolkerMycosis may follow an atypical course in an individual undergoing immunosuppressive therapy. We describe a patient with a fungal infection that was manifested as a bilateral inguinal granuloma. Owing to suspected inguinal lymphadenopathy characterized by distinct subcutaneous swellings in the groin, a 39-year-old man who had undergone kidney transplantation 14 years earlier was admitted to the Nephrologisches Zentrum in Hann. Muenden, Germany. The results of a clinical examination revealed bilateral, soft, partly fluctuant, indolent swellings in the groin as well as onychomycosis of the right great toe. An ultrasonographic scan showed bilateral hypoechogenic lesions (<= 1.5 cm) in the groin. The lesions were surgically removed, and the results of histologic examination revealed severe granulating pseudocystic inflammation with a distinct foreign body reaction. Dermatophytes of the species Trichophyton rubrum were detected microbiologically. After the lesions had been resected, the wound healed without complications. Immunosuppressive treatment with tacrolimus 8 mg/d and steroids 7.5 mg/d was not changed. Local antimycotic treatment of the onychomycosis with ciclopirox cream was initiated. At the patient’s 2-year follow-up examination, there was no evidence of recurrence. In transplant recipients, local fungal infections should be treated as a matter of course, because dermatophytosis is present in almost every other such patient. In patients with a suspicious inguinal lesion, an atypical form of dermatophytosis must be considered. T rubrum, the most frequently occurring dermatophyte, causes 80% of the dermatophytosis that develops in immunosuppressed patients.Item Weight-Gain–Related Factors in Renal Transplantation(Başkent Üniversitesi, 2005-06) Nazemian, Fatemeh; Naghibi, MasihObjectives: Previous studies of renal transplant recipients have suggested that weight gain after transplantation is relatively common. The purpose of this study was to define the occurrence, magnitude, and predictors of weight gain in this group. Material and Methods: We conducted a prospective study of 100 renal transplant recipients from 2002 to 2004 at Imam-Reza Hospital in Mashhad, Iran, to identify patterns of weight change attributed to sex, age at transplantation, socioeconomic class, and duration of dialysis. A descriptive study also was made on serum cholesterol and triglyceride levels in renal transplant recipients 12 months after transplantation. Patients’ weights were evaluated at 3, 6, 9, and 12 months after transplantation. Results: Univariate analyses at 1 year posttransplantation showed that women had greater weight gains than did men (P = 0.003); older recipients had greater weight gains than did younger recipients (P = 0.009); weight gain was correlated with an increase in serum triglyceride and cholesterol levels (P = 0.000 and P = 0.004); and socioeconomic class was not correlated with weight changes (P = 0.955). Conclusions: Female sex, older age, and increasing incidences of hypercholesterolemia and hypertriglyceridemia were significantly associated with weight gain 1 year after organ transplantation.Item Laparoscopic Donor Nephrectomy—An Iranian Model for Developing Countries: A Cost-Effective No-Rush Approach(Başkent Üniversitesi, 2004-12) Simforoosh, Nasser; Basiri, Abbas; Tabibi, Ali; Shakhssalim, NasserObjectives: This study aimed to evaluate donor and graft outcome in kidney transplantations from laparoscopic donor nephrectomies. Materials and Methods: From June 2000 to June 2004, 341 laparoscopic donor nephrectomies were performed. Demographics and hospital records were reviewed. Mean ages of donors and recipients were 27.59 ± 4.80 years (range, 20-56 years) and 35.36 ± 14.85 years (range, 3-75 years). Results: Nephrectomy was left sided in 96.2%. Mean follow-up was 13.32 ± 35.98 months. Mean warm ischemia time was 8.17 minutes (range, 2.5-19 minutes). Mean operative time was 260.34 minutes. Median serum creatinine levels (mg/dL) of the recipients were 1.30, 1.45, and 1.20 at day 7, and at 1 and 12 months. One-year graft survival was 92.7%, 94.6%, and 92.6% in the laparoscopic donor nephrectomy groups with warm ischemia times of less than 6, 6-10, and more than 10 minutes (P = NS). Conversion to open surgery occurred in 2.1% of donors, and reoperation was performed in 3.8% of laparoscopic donor nephrectomies. Blood transfusion was required in 7.1% of donors. Ureteral complications were observed in 2.1% of recipients. Vascular control was performed using medium-large clips instead of endo GIA, and the kidney was extracted via a suprapubic approach using the hand instead of an ENDOCATCH bag; hence, $600 was saved in each nephrectomy. No vascular accident occurred from pedicular vessels. Conclusions: Laparoscopic donor nephrectomy can be performed with a less-expensive setup (to be expanded in developing countries) without jeopardizing results. Because warm ischemic time in our study did not affect graft outcome significantly, there appears to be no need to rush harvesting the kidney to achieve a better quality kidney. Vascular control using nonautomatic clips instead of more costly endo GIA and hand extraction of the kidney is safe, practical, and economical.Item Basic and Clinical Research in Polyomavirus Nephropathy(Başkent Üniversitesi, 2004-06) Trofe, Jennifer; Gordon, Jennifer; Roy-Chaudhury, Prabir; Koralnik, Igor; Atwood, Walter; Eash, Sylvia; Alloway, Rita R; Khalili, Kamel; Alexander, J W; Woodle, E SteveOver the last decade, polyomavirus nephropathy (PVN) has emerged as an important cause of renal allograft dysfunction and graft loss. PVN occurs with a prevalence of 1%-8% in renal transplant recipients and is most commonly reported within the first 12 months posttransplant. The human polyomavirus, BK virus, is thought to be the primary etiologic agent of PVN. Risk factors for PVN are not well defined and are most likely a result of a complex interaction between multiple donor and recipient factors. Definitive diagnosis of PVN is made through histological assessment of a renal allograft biopsy. Recent studies have also evaluated noninvasive urine and serum markers for screening of BK virus replication and as adjunct tools in PVN diagnosis and monitoring. The principal treatment for PVN is immunosuppression reduction, but this must be balanced against the risks of rejection. If rejection occurs concurrently with PVN, a brief increase in immunosuppression to treat the rejection episode followed by a subsequent reduction in immunosuppression is recommended. No antiviral treatments for PVN have been approved by the Food and Drug Administration. Although the antiviral drug cidofovir has shown invitro activity against murine polyomaviruses, and has been effective in some patients, it is associated with significant nephrotoxicity. Small series of patients treated with leflunomide and intravenous immune globulin therapy for PVN have also recently been reported. Retransplantation after graft loss due to PVN is feasible, but experience is limited. Current research is focusing on identifying PVN risk factors, refining screening, diagnostic and monitoring methods, and developing therapy for prophylaxis and treatment of PVN with the goals of decreasing the prevalence of PVN and improving allograft outcomes in renal transplant recipients diagnosed with PVN. This review will present recent advances in basic and clinical research related to PVN and renal transplantation.Item İlk Böbrek Nakli Deneyimlerimiz(Başkent Üniversitesi, 2005-05) M. Eriklioğlu,; Ş. T., Süleyman,; Z. Tonbul,; İ. Güney,; M. YeksanAmaç: Yeni kurulan böbrek nakli merkezimizde gerçekleştirilen ilk 19 renal transplantasyon vakasını sunmayı amaçladık. Materyal ve metod: Organ Nakli merkezimizde kuruluşundan bu yana 15 canlıdan 4 kadavradan toplam 19 hastaya böbrek nakli uygulandı. Hastaların 12’si erkek, 7’si bayan ve yaş ortalaması 38.4 idi. Ortalama takip süresi 11.9 ay idi. Tüm nakiller sağ fossa iliaca‘ya yapıldı. Bulgular: Donörlerin biri hariç diğer tüm donörler tek arter, tek ven ve tek üreteri vardı. Donörlerden birinde ise çift arter mevcuttu. Tüm nakillerde eksternal iliak arter ve ven ile renal arter ve ven uç yan anastomoz edildi. Onyedi hasta da immunosuressif protokol olarak Prednizolon, Mikofenolat Mofetil (MMF), FK-506 ve Basiliximab (1 ve 4. gün), 2 hastada ise Prednizolon, MMF, Siklosporin A ve Basiliximab (1 ve 4. gün) uygulandı. Hastaların ameliyat sonrası takipleri rutin kan ve idrar tetkikleri, karaciğer ve böbrek fonksiyon testleri, Doppler ultrasonografi, renal sintigrafi, Magnetik rezonans anjiografi (MRI- Anjiografi) ile yapıldı. Canlı donörden yapılan nakillerden biri ameliyat sonrası 6. günde üreteroneosistostomi kaçağı nedeniyle yeniden ameliyat edildi. Kadavra nakillerden birinde ameliyat sonrası 2. günde renal arter trombozu nedeniyle greft nekrozu gelişti ve transplant nefrektomi uygulandı. Canlı donörden yapılan çift arterli transplant vakasına ameliyat sonrası 8. saatte üst polar arterde tromboz nedeniyle embolektomi uygulandı. Bu vakada ameliyat sonrası 1. ayda pnomöni, 2. ayda Fournier gangreni ve otitis media gelişti. Pnomöni ve otitis media medikal olarak tedavi edildi. Fournier gangreni ise geniş cerrahi debritman ve yoğun antibiyotik tedavisi ile düzeldi. Bir hastada ameliyat sonrası erken dönemde atelektazi gelişti ve medikal olarak tedavi edildi. Bir hastada ise ameliyat sonrası 1. ayda tüberküloz gelişti ve antitüberküloz tedavi başlandı. Bir hastada FK-506’ya bağlı diabetes mellitus gelişti ve insülin tedavisi ile düzeldi. Takip süresince rejeksiyon ve mortalite görülmedi. Sonuç: İmmunosupressif tedavideki gelişmeler, cerrahi teknikte ilerlemeler, komplikasyonların erken tanısını sağlayan gelişmiş görüntüleme yöntemleri ve transplantasyon çalışmalarındaki deneyimlerin artması ile hasta ve greft yaşam sürelerinin artacağı kanaatindeyiz. Our Renal Transplantation Experiences Objectives: We aimed to present the first nineteen cases of renal transplantation in the newly established renal transplantation centre in our faculty. Materials and method: Renal transplantation was performed in 19 cases with chronic renal failure from 15 living and 4 cadaver donor in our newly established renal transplantation center. The mean age of the patients was 38.4 years. The patients were 12 males and 7 females. The mean follow-up period was 11.9 months. All transplantations were performed in the right iliac fossa. Results: Except one donor, all donor kidneys were containing single artery, single vein and single ureter. One donor had double artery, single vein and single ureter. Arterial and venous anastomoses were done as end to side anastomoses. In seventeen patients, immunosuppresiveprotocol, including prednisolon, Mycophenolate mofetil (MMF), Tacrolimus (FK-506) and Basiliximab (1.and 4.days) combination, was used. In two patients, including prednisolon, MMF, cyclosporine (Cy A) and Basiliximab (1.and 4.days) combination, was used. In the postoperative period, the patients were followed-up by using Doppler ultrasonography (US), renal sintigraphy, magnetic resonance imaging (MRI) angiography and biochemical analysis. One of transplanted case from living donor was reoperated in the 6th postoperative day due to urinary leakeage. In one cadaveric transplantation case, graft necrosis was developed in the 2nd postoperative day due to renal artery thrombosis. Then transplant nephrectomy was performed. After diagnosis of upper polar renal artery thrombosis, embolectomy was performed in the 1st postoperative day in one live donor transplantation case with double artery. Pneumonia, Fournier’s gangrene and otitis media were developed in this patient. Pneumonia and otitis media were treated medically. Fournier’s gangrene was treated by extensive debridement and antibiotic therapy. One patient developed tuberculosis that was treated with antitubeculosis therapy. Atelectasia was developed in one patient and Diabetes Mellitus (DM) in another. These two conditions were also treated medically. In one patient lymphocele was developed, and it was drained to the periton. There was no rejection and mortality. Conclusion: With successful surgical techniques, evolutions immunosuppressive therapy, modern imaging technique, and improved renal transplantation experiences, we consider that the patients and graft survival will increase.Item Böbrek Nakli için Bekleyen Hastaların HLA-A, B ve Dr Tiplendirmesi(Başkent Üniversitesi, 2005-01) M. Erikoğlu; T. Çora; İ. Güney; M. Büyükdoğan; Ş. Tavlı; Z. Tonbul S. TürkAmaç: Son dönem böbrek yetmezlikli hastaların en önemli tedavisi böbrek naklidir. Organ nakli öncesi HLA uyumu hala önemini korumaktadır. HLA uyumunun daha iyi olması çok daha az rejeksiyon olayı ve çok daha uzun süreli graft survival i sağlamaktadır. Bu çalışmada amacımız Böbrek Nakli Ünitemizde kadavradan organ nakli için bekleme listesine kayıtlı olan 221 hastanın kan grubu, doku grubunu belirlemek ve Konya populasyonuna ait etnik HLA antijen dağılımını tespit etmektir. Materyal ve Metod: Bu çalışmada Selçuk Üniversitesi Meram Tıp Fakültesi Böbrek Nakli bekleme listesindeki hastaların doku grubu tayinleri, Klas I (HLA-A/B/C) mikrolenfositotoksisite tekniğiyle, Klas II (HLA-DR) PCR-SSP (Polymerase Chain Reaction-Single Strand Polymorphism) tekniği ile belirlenmiştir. Sonuçlar: Hastaların 123’nü (%56) erkek, 98’i bayan (%44) idi. Yaş ortalaması 37,5 (11-66) olarak tespit edildi. Hastalardan 154’ü (%70’i) hemodiyaliz, 67’si (%30’u) periton diyalizi almaktadır. Hastaların 93’ü (%42) A kan grubu, 35(%16)’sı B grubu, 19(%9)’u AB grubu, 74 (%33)hasta 0 grubu idi. HLA ( Human lokosit antijenleri) doku tipleri incelendiğinde sıklıkla rastlanan HLA tipleri olarak HLA-A2: 95 hastada, A3: 68 hastada ve A24: 68 hastada, A1:41 hastada tespit edildi. HLA-B grubunda sık rastlananlara göre HLA-B35: 77 hastada, B51: 35 hastada, B44:30 hastada tespit edildi. HLA-DR grubundan ise DR11:77 hastada, DR4:72 hastada, DR3: 37, DR15:37, DR1:29 hastada tespit edildi. Yorum: Doku gruplarına göre hastaların kadavra havuzunda toplanması ve bu bilgilerin güncelleştirilmesi çalışmaların verimliliğinin ve kadavra organ sayısını arttırılmasında, bilimsel kurallara ve tıbbi etik anlayışa uygun, adaletli organ dağıtımının sağlanmasında oldukça önem arz etmektedir. Kadavra havuzunda bulunan hastalarımızın doku tipleri incelendiğinde etnik olarak Konya bölgesinde en sık görülen doku tipleri HLA-A2, HLA-B35, HLA-DR11 dir. HLA-A, B and DR Typing For Patients On A Renal Transplantation Waiting List Objective: Renal transplantation is the best treatment for patients with end-stage renal failure. Assessment of human lymphocyte antigen (HLA) matching prior to organ transplantation is still considered important. Closer HLA matching is associated with lower incidence of acute rejection and longer graft survival. The aim of this study was to determine blood groups, tissue groups, and HLA antigen profiles relative to ethnic background for patients on a waiting list for cadaveric renal transplantation in Turkey. Materials and Methods: The study involved 221 patients who were on the kidney transplantation list at the renal transplantation unit of Selcuk University Hospital in Konya, Turkey. Tissue typing was done using the microlymphocytotoxicity technique for Class I antigens (HLA-A/B/C) and the polymerase chain reaction-single strand polymorphism technique for Class II antigens (HLA-DR). Results: The subjects were 123 males (56%) and 98 females (44%) of average age 37.5 years (range, 11-66 years). One hundred and fifty-four patients (70%) were on hemodialysis and 67 (30%) were on peritoneal dialysis.Blood grouping identified 93 patients (42%) as group A, 35 (16%) as group B, 19 (9%) as group AB, and 74 (33%) as group O. Regarding HLA tissue types, 95 patients were HLA-A2, 68 patients were HLA-A3, 68 patients were HLA-A24, and 41 patients were HLA-A1. The most common types of HLA-B antigens identified were HLA-B35 (77 patients), HLA-B51 (35 patients), and HLA-B44 (30 patients). Regarding HLA-DR antigens, 77 patients were positive for HLA-DR11, 72 were positive for HLA-DR4, 37 were positive for HLA-DR3, 37 were positive for HLA-DR15, and 29 were positive for HLA-DR1. Conclusion: Categorizing cadavers according to tissue groups and updating the clinical information for each cadaver will allow for more judicious organ distribution and greater efficiency and success with cadaveric organ transplantation. The results of this study indicate that the most common tissue types in renal transplant candidates from the Konya region of Turkey are HLA-A2, HLA-B35, and HLA-DR11.Item Kronik Diyaliz Tedavisi Gören Hepatitli Hastalarda Transplantasyona Hazırlık(Başkent Üniversitesi, 2004-01) S. BoyacıoğluKlasik hastalarda görülen kronik viral hepatilerin doğal seyri, tedavilerine yaklaşım, monitorizasyon, tarama ve bulaşmayı önleme yöntemleri iyi bilinmektedir. Ancak, kronik böbrek yetmezliğinin de içinde bulunduğu bazı hastalıklarda hücresel ve hümoral immunite bozulduğu için bunlardaki kronik viral hepatitlerin klinik seyri ve tedavi yaklaşımları klasik hastalardakinden farklıdır. Bu hastaların önemli bir çoğunluğu aynı zamanda renal transplantasyon adayıdır. Bu hastalarda en uygun şartlarda ve ideal zamanda renal transplantasyon yapılması beklenen sonucun daha iyi olmasını sağlar. Bu bölümde kronik diyaliz tedavisi gören ve renal transplantasyon adayı olan hastalardaki sorunlar ve onların transplantasyona hazırlanmasının ilkeleri anlatılacaktır. Natural course, management, monitorization, screening and prevention of hepatitis B and C are well known. However, this well known issues differ in patients with chronic renal failure on hemodialysis, because they suffer from impaired immune defense mechanisms. Most of these patients are also renal transplantation candidates. The optimization of the timing transplantation is important for the outcome. In this article the problem of hepatitis B and C infection is discussed in end stage renal failure patients who are also renal transplantation candidates.