Başkent Üniversitesi Yayınları
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Item Mean Platelet Volume as a Potential Predictor of Renovascular Thrombosis After Renal Transplant(Başkent Üniversitesi, 2013-02) Sakallı, Hale; Haberal, Mehmet; Moray, Gökhan; Gülleroğlu, Kaan Savaş; Bayrakçı, Umut Selda; Baskın, EsraObjectives: We sought to evaluate the importance of mean platelet volume as a marker to follow-up, the tendency for hemorrhagic diatheses, and/or thrombotic complications in patients before and after renal transplant. Materials and Methods: Thirty-four patients (aged, 5 to 18 y) were included. Demographics of the patients, cause of chronic renal failure, dialysis modality, duration of dialysis, arterio-venous fistula thrombosis, and posttransplant immunosuppressive regimens were recorded and laboratory variables were evaluated. Results: At the end of the first posttransplant month, mean platelet volume level was decreased significantly when compared with pretransplant levels (8.3 ± 1.5 vs 7.7 ± 0.9; P = .04). A significant increase was observed in platelet levels during posttransplant measures (273.750 ± 97.700 vs 318.740 ± 84.586; P = .02). Prothrombin time and partial thromboplastin time levels did not differ before and after transplant. None of the patients had any thrombotic events and/or renal allograft loss. A negative correlation was observed between mean platelet volume and C-reactive protein (r=-0.53). Mean platelet volume level was not found to be related to the cause of renal failure, pretransplant dialysis modality, or posttransplant immunosuppressive regimens. Conclusions: Platelet numbers increased and mean platelet volume decreased after pediatric renal transplant, but the potential for increased thrombosis was not observed.Item Emergency Endovascular Repair in a Patient With Abdominal Aortic Aneurysm With Pelvic Transplant Kidneys: Case Report(Başkent Üniversitesi, 2012-12) Smedile, Gianluca; Tisone, Giuseppe; Leporelli, Paolo; Orlando, Giuseppe; Booth, Christopher; Luca, Linda De; Castrucci, Tommaso; Laria, Giuseppe; Bellini, Maria IreneAbdominal aortic aneurysms after a kidney transplant are becoming treated more frequently owing to the extension of renal transplant in severely arteriosclerotic older patients. Renal transplant recipients with autosomal dominant polycystic kidney disease are prone to develop abdominal aortic aneurysms. We present the case of a ruptured abdominal aortic aneurysm that occurred in a renal transplant patient with autosomal dominant polycystic kidney disease. The patient was treated with emergency endovascular repair because open surgery could not be performed successfully owing to the presence of massive polycystic native kidneys and a liver that was occupying the entire peritoneal cavity. His postoperative course was uneventful without complications. The important lessons to be learned from our case are 2-fold: (1) Autosomal dominant polycystic kidney disease renal transplant recipients should be screened annually for abdominal aortic aneurysms to prevent ruptures and (2), emergency endovascular repair may be a preferred treatment in renal transplant recipients owing to its low surgical risk and success.Item Renoprotective Effects of Cotransplanted Allogeneic Testicular Sertoli Cells in a Renal Acute Rejection Model in Rats(Başkent Üniversitesi, 2012-12) Mai, Hai-xing; Zhang, Xu; You, Hua-; Li, Jian-Tao; Wang, Ya-Ling; Zhao, Li; Qu, Nan; Chen, Li-jun; Yu, LeiObjectives: We sought to study the renoprotective effect of cotransplanted allogeneic testicular Sertoli cells on renal acute rejection in rats. Materials and Methods: A renal acute rejection model using kidneys from Sprague-Dawley (n=30) transplanted into Wistar rats (n=30) was constructed. The rats were randomly divided into 3 groups: (1) the cyclosporine group, which was treated with daily hypodermic injections of cyclosporine (15 mg/kg) after transplant, (2) the Sertoli cells group with cell suspension (n = 2 × 106 cells) into the subcapsular space of the renal graft, and (3) the control group, which received no posttransplant intervention. Graft function was measured based on serial serum creatinine. Graft histology was examined at 10 days posttransplant, and survival duration was recorded. Results: Serum creatinine was significantly higher in the Sertoli cells and cyclosporine groups than in the controls. Survival duration was significantly longer in the Sertoli cells (19.50 ± 4.3 d) and cyclosporine groups (21.50 ± 5.9 d) than in the controls (14 ± 3.1 d). Allografts in the control group exhibited typical severe acute rejection, including widespread interstitial infiltration with tubulous, patchy necrosis and hemorrhage, severe glomerulitis with extensive capillary occlusion caused by endothelial swelling, and intimal arteritis in the cortex. Findings of acute rejection were less in the Sertoli cells and cyclosporine groups. Conclusions: Sertoli cell implantation is an effective method for increasing survival duration in rat renal transplant, and it has potential as a new alternative to cyclosporine immunosuppression.Item Treatment Update of Sensitized Pediatric Kidney Transplant Recipients: A Review(Başkent Üniversitesi, 2012-12) Otukesh, Hasan; Rahimzadeh, Nahid; Hoseini, RozitaSensitization of recipients is an increasing problem in children. Some case series in children exist comparing the diverse desensitizing protocols. These protocols include intravenous immunoglobulin, cytomegalovirus immune globulin, plasmapheresis, and some adjunctive therapies such as rituximab. Desensitizing protocols have advantages and disadvantages. Clinical trials are required to determine suitable protocols for sensitized pediatric recipients. We performed a systematic review of these protocols in children. A massive search was done in PubMed, Embase, and the Cochrane library system. The results of these studies are compared.Item Isolated Ocular Surface Squamous Neoplasia in a Renal Transplant Recipient(Başkent Üniversitesi, 2012-10) Aktas, Nimet; Aytac, Berna; Kilic, Nurten; Yazici, Bulent; Ersoy, AlparslanOcular surface squamous neoplasia is a rare complication after a kidney transplant, related with increased risk and poor prognosis. Generally, ocular surface squamous neoplasia in kidney transplant patients is associated with skin lesions. We report a case of ocular surface squamous neoplasia without skin lesions in a kidney transplant recipient. Systematic periodic ophthalmic evaluation of recipients may help ensure the early diagnosis of subtle ocular surface squamous neoplasia.Item Long-term Results of Renal Transplant From Living Donors Aged Over 60 Years(Başkent Üniversitesi, 2012-10) Lan, Gongbin; Xie, Xubiao; Yu, Shaojie; Wang, Yu; Peng, Fenghua; Peng, Longkai; Yang, LuoyanObjectives: This study sought to determine whether recipients of grafts from donors aged 60 years or older achieve the same benefit as those from younger donors in the long term. Materials and Methods: Between January 2004 and July 2008, one hundred seventeen living renal transplants were performed. The patients were divided into an older donor group (aged ≥ 60 y, n=23) and a younger donor group (aged < 60 y, n=94). Characteristics and evolution of the donors and recipients were compared between the groups. Results: There was no statistically significant difference between the groups respecting sex, body mass index, duration on dialysis, ischemia time, human leukocyte antigen matches and incidence of primary nonfunction, delayed graft function, acute rejection, and infection (P > .05). The 1-, 3-, and 5-year graft survival for the older group versus the younger group was 95.7% versus 97.9% (P > .05), 91.3% versus 93.6% (P > .05), and 81.8% versus 83.3% (P > .05). Patient survival at 1, 3, and 5 years was 100% versus 100% (P > .05), 95.7% versus 96.8% (P > .05), and 90.9% versus 88.9% (P > .05) with no significant difference in the log-rank test for Kaplan-Meier. Conclusions: Our studies suggest that in the long term, renal transplant from live donors older than 60 years it is an acceptable alternative.Item Effective Therapy for Acute Antibody-Mediated Rejection With Mild Chronic Changes: Case Report and Review of the Literature(Başkent Üniversitesi, 2012-08) Osama Gheith,; Ibraheim, Mona; Saied, Tarek; Muzeirei, Ibraheem; Al-Waheeb, Salah; Nair, Prasad; Halim, Medhat; Nampoory, Narayanan; Al-Otaibi, TorkiTo reduce the long-term toxicities of immunosuppressant drugs, corticosteroid-sparing and calcineurin-inhibitor–sparing immunosuppression protocols have become increasingly popular in managing kidney transplant recipients. The most vexing clinical condition caused by antibodies in organ transplants is antibody-mediated rejection. Limitations of the current antibody-mediated rejection therapies include (1) antibody-mediated rejection reversal tends to be gradual rather than prompt, (2) expense, (3) rejection reversal rates below 80%, (4) common appearance of chronic rejection after antibody-mediated rejection treatment, and (5) long-term persistence of donor specific antibodies after therapy. Because these limitations may be due to a lack of effects on mature plasma cells, the effects of bortezomib on mature plasma cells may represent a quantum advance in antihumoral therapy. Our experiences represent the first clinical use of bortezomib as an antihumoral agent in renal allograft recipients in Kuwait. We present 2 cases with resistant-acute antibody-mediated rejection to the standard therapies that were managed successfully with bortezomib.Item "True"Mycotic Aneurysm of the Anastomotic Site of the Renal Allograft Artery(Başkent Üniversitesi, 2012-08) Reddy, Chilumula Ram; Murthy, PVLN; Dakshinamurty, Kaligotla Venkata; Prayaga, Aruna; Krishna, Lanka S. R.; Swarnalatha, Gudithi; Ram, RapurThe incidence of vascular complications after renal transplant as reported varies from 3.5% to 14%. Pseudoaneurysm formation at the site of the anastomosis is a rare complication, and only a few cases have been reported. There also were only a few reports of "true" mycotic aneurysms of the renal allograft artery. We present 2 patients with true mycotic aneurysmal formation of the renal allograft artery after a renal transplant. Both patients presented with fever and increasing serum creatinine levels. Cultures from aneurysm tissue samples have grown Aspergillus flavus. Both patients were subjected to an allograft nephrectomy, and amphotericin was given.Item Surgical Correction of Nephrogenic Ascites in a Renal Transplant Recipient(Başkent Üniversitesi, 2012-08) Jaffers, Gregory J.; Fasola, Carlos G.; Narayanan, MohanramThe unusual development of massive ascites, 3 years after renal transplant, caused by undefined, innate renal allograft pathology is described. Challenges of surgical correction of this problem, allowing for salvage of the allograft, are reviewed.Item Vaccination Status of Children Considered for Renal Transplant: Missed Opportunities for Vaccine Preventable Diseases(Başkent Üniversitesi, 2012-08) Genc, Gurkan; Nalcacioglu, Hulya; Yakupoglu, Yarkin Kamil; Aygun, Canan; Ozkaya, OzanObjectives: Infectious diseases, even vaccine preventable ones, might affect transplanting and the life course in pediatric solid-organ recipients. Owing to immunosuppression and decreased antibody production, susceptibility to infections is increased in these patients. Materials and Methods: The present study was designed to assess the vaccination and antibody status of the pediatric renal transplant patients. Fifty-one patients who were admitted to the regional transplant center for renal transplant were retrospectively evaluated. Patient’s vaccination charts were examined, and their immunization status was determined by antibody titers against hepatitis B, hepatitis A, measles, mumps, rubella, and varicella. Results: The study group was composed of 23 males and 28 females (mean age, 10.8 y; age range, 2-17 y). All patients’ vaccination status was appropriate with their ages according to national vaccination program. Antibodies were positive for hepatitis B in 84.3% patients, 76.5% for hepatitis A, 72.5% for measles, 64.7% for mumps, 64.7% for rubella, and 72.5% for varicella. Conclusions: Seronegativity for common childhood diseases may complicate the posttransplant period owing to increased risk of infections. Especially in developing countries, immunization protocols and vaccination program schedules should be reviewed before transplant to prevent serious complications caused by these diseases.
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