Başkent Üniversitesi Yayınları
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Item Infectious Complications in Kidney Transplant: A Lebanese Perspective(Başkent Üniversitesi, 2010-06) Abou-Jaoude, Maroun M.; Almawi, Wassim Y.; Daoud, Ziad; Shaheen, Joseph; Nawfal, NajiObjectives: Infections remain a frequent, potentially life-threatening complication of kidney transplant. Subjects and Methods: Between 1998 and 2006, we evaluated the incidence of infections in 114 kidney transplant patients, with a 1-year follow-up. All patients received a posttransplant anti-infectious prophylaxis regimen. Induction therapy was given to 94 patients (82.4%), and maintenance immunosuppression consisted of calcineurin inhibitor (cyclosporin microemulsion or tacrolimus), together with mycophenolate mofetil and prednisone. Results: In total, 56 patients (49.1%) developed a total of 95 infections up to 1-year after kidney transplant, including 46 in-hospital infections in 38 patients. Bacterial infections were the most frequent (97.8%), and were mainly urinary, followed by drain, central line catheter, and pulmonary infections. The most-frequent isolated bacteria were E. coli, followed by Klebsiella, Acinetobacter, and Pseudomonas. No viral infections were detected. Up to 1 year after discharge from the hospital, 49 infections occurred in 26 patients, of which 79.5% were bacterial; mainly urinary tract infections due to E. coli, in addition to 7 cases of cytomegalovirus, 1 herpes, and 2 cases of fungal infections. Conclusions: This is the first Lebanese study that deals with posttransplant infections in kidney transplant patients and underscores the importance of close patient monitoring and follow-up. Comparison with international data shows similar patterns.Item Procalcitonin and C-reactive Protein Serum Levels After Hematopoietic Stem-Cell Transplant(Başkent Üniversitesi, 2009-06) Azarpira, Negar; Daraie, Masumeh; Aghdaie, Mahdokht; Ramzi, ManiObjectives: Hematopoietic stem-cell transplant is a curative therapy for several malignant and nonmalignant disorders. The purpose of this study was to investigate the association of serum levels of high-sensitivity C-reactive protein and procalcitonin with complications such as acute graft-versus-host disease, veno-occlusive disease, and infection after hematopoietic stem-cell transplant. Materials and Methods: Serum high-sensitivity C-reactive protein and procalcitonin levels were sequentially measured with an enzyme-linked immunosorbent assay and a semiquantitative immunochromatographic assay in 35 patients who had undergone hematopoietic stem-cell transplant. Results: The high-sensitivity C-reactive protein serum level was increased in patients with acute graft-versus-host disease and in those with sepsis. Increased procalcitonin levels were associated only with bacterial infection. Only procalcitonin levels differentiated patients with infection from those with another transplant-related complication. Veno-occlusive disease did not alter C-reactive protein or procalcitonin levels. Conclusions: Our results support theories that serum levels of high-sensitivity C-reactive protein and procalcitonin are biomarkers for transplant-related complications such as graft-versus-host disease or infection and that the procalcitonin level can differentiate patients with infection from those with graft-versus-host disease.Item Cytomegalovirus Disease in Renal Transplant Recipients: An Iranian Experience(Başkent Üniversitesi, 2008-06) Nemati, Eghlim; Einollahi, Behzad; Pourfarziani, Vahid; Taheri, SaeedBackground: Cytomegalovirus is considered the most important infectious cause of mortality and morbidity in organ transplant recipients. In the current study, we evaluate the potential impact of cytomegalovirus infection and cytomegalovirus disease on the outcomes of renal allograft recipients under different conditions. Materials and Methods: We retrospectively analyzed the data from 48 renal transplant recipients who had undergone a transplant at the Baqiyatallah Hospital in Tehran, Iran, between 1984 and 2007. We included all patients with valid laboratory test results for cytomegalovirus infection. Values for P less than .05 were considered statistically significant. Results: Overall, 48 patients (2.1%) were documented as developing cytomegalovirus disease. From these, 1 patient (2%) died, and 3 (6%) lost their allograft function. Compared with mycophenolic-acid–based triple immunosuppressive therapy, azathioprine was less likely to induce cytomegalovirus disease and also promised better survival (P < .0001 and P < .001). Being negative for the anti-cytomegalovirus IgG antibody and receiving an allograft from a positive donor also were associated with cytomegalovirus disease development and poorer patient survival (P = .03 and P < .0001). Conclusions: Cytomegalovirus infection induces unfavorable outcomes in renal allograft recipients, especially when the infection occurs early on in the posttransplant phase. We suggest close monitoring of cytomegalovirus-positive patients and the use of less-intensive immunosuppressive treatments. Future prospective studies seem necessary.Item Perihepatitis and Perinephric Abscess Due to Mycoplasma hominis in a Kidney Transplant Patient(Başkent Üniversitesi, 2007-12) Camara, Boubou; Mouzin, Marc; Kamar, Nassim; Rostaing, Lionel; Durand, Dominique; Game, Xavier; Guitard, Joelle; Esposito, Laure; Ribes, DavidMycoplasma hominis has been incriminated in several genital and extragenital infections. Here, we report the first case of perihepatitis associated with a perinephric abscess in a woman who had received a kidney transplant. Four months after the transplant, the patient was admitted for perirenal allograft pain, fever, and elevated inflammatory parameters and liver enzyme levels. A renal ultrasonography found a collection of fluid. Results of blood and urine analyses were within normal limits. Fluid aspiration of the peritoneal cavity was performed, and the results of cultures for bacteria and fungi were negative. The patient was treated by surgical lavage of the peritoneal cavity. Her fever resolved 5 days later. Two months after surgical lavage of the peritoneal cavity, her liver enzyme levels returned to the normal range. Three months after surgical lavage, cultures of the perinephric fluid showed Mycoplasma hominis. We conclude that in patients who present with perinephric fluid suspected of being infected, bacteriologic analysis of the fluid (from surgical lavage of the peritoneal cavity) should be performed. Antibiotics active against intracellular bacteria should be administered.Item Cytomegalovirus Disease in Renal Transplant Recipients: A Single-Center Experience(Başkent Üniversitesi, 2007-06) Basri, Nawal; Abdullah, K. A. K.; Shaheen, F. A. M.Objectives: Cytomegalovirus is the most common viral infection following kidney transplant, with overall frequencies of 50% to 80% for the infection and 20% to 60% for cytomegalovirus disease. Materials and Methods: We retrospectively analyzed the medical records of 689 kidney transplant recipients at Jeddah Kidney Center in the Kingdom of Saudi Arabia between January 2000 and December 2005 for cytomegalovirus infection and disease. We examined the source of the donated kidneys (deceased versus living donor), the cytomegalovirus serostatus of the donor and recipient, the immunosuppressive protocol, the presence of cytomegalovirus prophylaxis, the clinical presentation of acute cytomegalovirus disease, the patient’s response to treatment, and the effect of cytomegalovirus disease on graft and patient survival. Results: Of 689 kidney transplant recipients, 25 (3.6%) had acute cytomegalovirus disease. All 25 patients had cytomegalovirus IgG positive/IgM negative test results prior to transplant. We noticed 2 distinct groups of patients: the first group included 9 patients with cytomegalovirus syndrome, 6 of whom received cytomegalovirus prophylaxis with ganciclovir. All patients in this group had low cytomegalovirus viral loads on polymerase chain reaction, mild disease, and responded to treatment with complete recovery and no adverse effects with respect to themselves or their grafts. The second group included 16 patients with invasive cytomegalovirus disease, 3 of whom received cytomegalovirus prophylaxis. All patients in this group had very high cytomegalovirus viral loads on polymerase chain reaction. Thirteen patients in this group (81%) responded to treatment with full recovery, and normal graft function was maintained in 10 (62%). Of the original 16 patients in this group, 3 (18.8%) died from cytomegalovirus disease and its complications. Conclusions: We report a low incidence (3.6%) of cytomegalovirus disease at our center. Cytomegalovirus prophylaxis was associated with a milder form of the disease. At our center, treatment of invasive cytomegalovirus disease produced a patient survival rate of 81% and a graft survival rate of 62%.Item Infection Related Renal Impairment: A Major Cause of Acute Allograft Dysfunction(Başkent Üniversitesi, 2003-06) Nampoory, Mangalathillam R.N.; Johny, Kaivilayil V.; Costandy, Jamal N.; Nair, Madhavan P.; Said, Tarek; Homoud, Hani; Al-Muzairai, Ibrahim; Samhan, Mohmoud; Al-Moussawi, MustafaWe prospectively analyzed the impact of post transplant infections on the renal function in 532 stable renal transplant recipients (M=340; F=192) over a period of 5 years. Their age ranged from 3-75 years (40 + 14 years). During the follow-up period, 52 patients expired and 64 lost on follow-up. We defined renal impairment (RI) as a persistent rise in serum creatinine above 20% from baseline value. 495 episodes of RI occurred in 269 recipients. This included 180-36% episodes of acute rejection, 53-10.7% Cyclosporine toxicity, 236-47.7% infection related renal impairment [IRRI] and 26-5.3% others. The severity of renal failure is less in IRRI (100 + 90.2) than that of acute rejection (166 + 127.1), but was more than that in cyclosporine toxicity (50 + 42.2) . Sites of infection in IRRI were urinary (33%), respiratory (26.3%), septicemia (15.7%) and others (25.4%). Episode of IRRI occurred more frequently in LURD (159-67.4%) compared to LRD-RTR (50-21.2%). Occurrence of IRRI is more significantly higher in patients on triple drug immunosuppression (IS) (34.3%) than those on two drug IS (13.2%) (P=<0.01). Ecoli (23.1%), Pseudomonas (11.1%), Salmonella (8.8%), Klebsiella (8.8%) and Staphylococai (8.3%) were the major organisms producing IRRI. IRRI is frequent (27.8%) during the first six months. Present study denotes that IRRI is a major cause of acute failure in RTR.