Başkent Üniversitesi Yayınları
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Item Treatment of Pure Red-Cell Aplasia With Cyclosporine in a Renal Transplant Patient(Başkent Üniversitesi, 2013-02) Yildirim, Rahsan; Aydinli, Bulent; Gokbulut, Puren; Uyanik, Abdullah; Keles, Mustafa; Bilen, YusufAcquired pure red-cell aplasia is a rare disorder that can be either idiopathic or associated with certain autoimmune diseases, pregnancy, lymphoproliferative disorders, nutritional deficiencies, or medicines. We present a deceased-donor renal transplant patient who developed pure red-cell aplasia associated with mycophenolate mofetil or tacrolimus and was treated with cyclosporine. A 20-year-old woman was transplanted from a deceased donor 1 month earlier and presented to us with symptoms of fatigue, prostration, and palpitation. The results of a laboratory examination revealed anemia. A diagnostic work-up resulted in a diagnosis of pure red-cell aplasia. Mycophenolate mofetil was discontinued. Tacrolimus also was replaced with cyclosporine 2 months after mycophenolate mofetil was halted because of a lack of improvement in anemia. Three months later, her anemia improved with cyclosporine. Starting cyclosporine instead of tacrolimus or mycophenolate mofetil showed good improvement in our patient within 6 months of therapy.Item CD20 Antigen Expression by Lymphoproliferative Disorders after Kidney Transplant is Independently Associated with a Poor Outcome: PTLD.Int Survey(Başkent Üniversitesi, 2012-08) Khedmat, Hossein; Taheri, SaeedObjectives: Antigen expression by neoplastic cells is important because of its effects on the behavior and survival of patients. We sought to gather data on renal transplant recipients who had developed posttransplant lymphoproliferative disorders in their posttransplant era, and had a documented report on CD20 antigen testing. Materials and Methods: A comprehensive search of the literature was done for reports that indicate test results for the CD20 antigen in kidney recipients having lymphoproliferative disorders after transplant. Their demographics, disease characteristics, and prognoses were analyzed. Results: CD20-positive posttransplant lymphoproliferative disorder patients had a significantly shorter time from transplant to developing posttransplant lymphoproliferative disorder (P < .001). None of patients who had early onset posttransplant lymphoproliferative disorder was CD20 negative. Bone marrow involvement was significantly more prevalent among CD20-negative patients (P < .05) with no CD20-positive patient developing a bone marrow metastasis. Log-rank test showed a relatively worse survival for renal recipients expressing the CD20 antigen (P = .07). Conclusions: CD20-positive posttransplant lymphoproliferative disorder lesions in kidney transplant patients are significantly more likely to develop early after transplant and represent an inferior outcome. We suggest that all renal transplant recipients who develop posttransplant lymphoproliferative disorder within their early time after surgery should be given anti-CD20 therapy. Future prospective studies are required to confirm our conclusions.Item Inguinal Oblique Incision as an Alternative Route To Extract the Kidney During Laparoscopic Donor Nephrectomy(Başkent Üniversitesi, 2011-10) Wang, Ke; Wang, Lin; Lin, Chun-hua; Zhao, Jun-jie; Wang, Jian-ming; Gao, Zhen-li; Wan, Feng-chunObjectives: Evaluate the advantages of inguinal oblique incision in extracting the kidney during laparoscopic donor nephrectomy. Materials and Methods: From April 2005 to June 2009, sixty-seven cases of transperitoneal laparoscopic live-donor nephrectomies were performed at our hospital, all data were analyzed retrospectively. All donors were grouped as a test group (n=37, inguinal oblique incision) and a control group (n=30, paramidline or subcostal incision) according to graft retrieval incision selection. Donors were compared with regard to operative time and warm ischemia time, operative blood loss, hospital stay and cosmetic satisfaction. Recipients were compared with regard to graft function and 1-year graft survival rate. Results: All 67 cases of transperitoneal live-donor nephrectomies were successfully accomplished, without donor death, serious complications, and conversion to open surgery. There were no differences in mean operation time, mean blood loss, mean warm ischemic time, graft function, and 1-year graft survival rate between the groups. But in the test group, the mean hospital stay was shorter, P < .01; and cosmetic satisfaction was higher P < .01. Conclusions: The inguinal oblique incision is a safe and practical graft retrieval incision in live-donor nephrectomies, and can be thought to be applied generally.Item Outcome of a Solitary Kidney Transplant Into Adult Recipients From Pediatric Donors After Controlled Circulatory Death(Başkent Üniversitesi, 2011-06) Yuan, Qing; Chen, Zhonghua; Li, Jindong; Zhu, Youhua; Zhou, Meisheng; Zeng, Li; Wang, Liming; Zhang, LeiObjectives: We sought to evaluate the outcomes of a single kidney transplant from pediatric donors into adult recipients after controlled circulatory death. Materials and Methods: A retrospective, single-center review of all adult recipients who received a single pediatric kidney from controlled-cardiac deceased-donors (aged, < 9 years old) between January 2006 and March 2008 was performed. Results: Eleven adult recipients (aged, 16-41 years) used single renal grafts from the controlled-cardiac deceased-donors (median donor age, 74 months; range, 49-106 months; median donor weight, 20.95 kg; range, 16.6-37.8 kg). The median recipient age was 27 years (range, 16-41 years; median recipient weight, 47 kg; range 39.5-53.6 kg). The patient’s serum creatinine level gradually decreased, and the estimated glomerular filtration rate increased stably more than 2 times during follow-up. The graft length increased significantly the first week after transplant compared with that recorded immediately after reperfusion (P < .001) and grew slightly thereafter. Acute rejection occurred in 1 patient. Nine patients had high renal artery blood flow velocity index at 1 to 2 cm. Beside the anastomosis (167-321 cm/s), only 1 patient developed hypertension and slightly increased serum creatinine at 14 weeks after transplant. The 1-year patient/graft survival was 100%. Conclusions: Use of single kidneys from pediatric donors after controlled cardiac death could expand the donor pool without compromising recipient outcomes.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 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.