Başkent Üniversitesi Yayınları
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Item Two-hour Postdose Level of Cyclosporine Monitoring of Solid Organ Transplant Patients(Başkent Üniversitesi, 2012-08) Einollahi, BehzadItem Mortality Prediction After Kidney Transplantation: Comparative Clinical Use of 7 Comorbidity Indices(Başkent Üniversitesi, 2011-02) Shabir, Shazia; Borrows, Richard; Moore, Jason; He, Xiang; Liu, Xiang; Johnston, Atholl; Little, Mark A.; Inston, Nicholas; Cockwell, Paul; Ball, SimonObjectives: Despite comorbidity associated with chronic kidney disease, little data exist applying comorbidity scoring systems to renal transplant recipients. This study compared the performance of 7 established comorbidity scores in predicting mortality after kidney transplantation. Materials and Methods: We retrospectively analyzed prospectively collected data from 2033 incident renal transplant recipients. Comorbidity was assessed at baseline, and the following scores were derived: Recipient Risk Score, Charlson Comorbidity Index, Age-adjusted Charlson Comorbidity Index, Modified End-Stage Renal Disease Charlson Comorbidity Index, Foley Score, Wright-Khan Index, and Davies Index. Cox models investigated the association of each comorbidity score with mortality; performance characteristics were tested using receiver operating characteristic curve analysis. Results: Age-stratified Cox analyses showed the Recipient Risk Score-based model displayed the best fit, and receiver operating characteristic curve analysis showed the Recipient Risk Score demonstrated greatest predictive use (5-year mortality c-statistic: 0.787). The independent effect of age on mortality was demonstrated after analysis of scores not containing age as a component (the Charlson Comorbidity Index, the Modified End-Stage Renal Disease Charlson Comorbidity Index, the Davies Index); addition of age to these scores improved fit. Conclusions: Of the currently available comorbidity scores, the Recipient Risk Score demonstrated greatest use. This has implications for deceased-donor allocation algorithms, assessment of confounders in clinical research, and potentially, individual patient management.Item Liver Transplant in a Patient with Active Pulmonary Tuberculosis(Başkent Üniversitesi, 2010-09) Yankol, Yucel; Kalayoglu, Munci; Acarli, Koray; Alan, Servet; Kanmaz, Turan; Kocak, Burak; Topaloglu, SerdarObjectives: Immunosuppressive treatment generally increases the severity of active infection. Therefore, liver transplant is contraindicated in the presence of active tuberculosis. Despite the importance of supportive treatment, liver transplant is the only treatment for fulminant hepatic failure. Materials and Methods: We report a case of successful liver transplant for fulminant hepatic failure in the presence of active tuberculosis infection. Results: We immediately performed a liver transplant from a live donor. The patient received low-dose immunosuppressive treatment and antituberculosis treatment. The patient was cured and discharged on the 25th day after surgery. We stopped antituberculosis treatment 10 months after discharge. The patient has been followed for 32 months after transplant with normal graft function and has been free of pulmonary tuberculosis infection. Conclusions: Liver transplant can be performed in cirrhotic patients with active infections, such as tuberculosis, as a life-saving procedure.Item TEST(2025) TESTItem Risk Factors of Long-Term Graft Loss in Renal Transplant Recipients with Chronic Allograft Dysfunction(Başkent Üniversitesi, 2010-12) Khalkhali, Hamid Reza; Kazemnejad, Anoushirvan; Hajizadeh, Ebrahim; Ghafari, AliBackground: Graft loss owing to chronic allograft dysfunction is a major concern in renal transplant recipients. We assessed the affect of immune and nonimmune risk factors on death-censored graft loss in renal transplant recipients with chronic allograft dysfunction. Materials and Methods: We performed a retrospective, single-center study on 214 renal transplant recipients with chronic allograft dysfunction among 1534 renal transplant recipients at the Urmia University Hospital from 1997 to 2005. Data registry includes details from all renal transplants. The renal transplant recipient information is regularly updated to determine current graft function, graft loss, or renal transplant recipient’s death. The selection criteria were a functional renal allograft for at least 1 year and a progressive decline in allograft function. Results: Increasing donor age (RR=1.066; P < .001), recipient age (RR=1.021, P = .0), recipient weight (RR=1.024; P = .029), and waiting time on dialysis to transplant. (RR=1.047; P = .006), pretransplant hypertension (RR=3.126; P < .001), pretransplant diabetes (RR=5.787; P < .001), delayed graft function (RR=6.087; P < .001), proteinuria (RR=2.663; P = .001), posttransplant diabetes (RR=2.285; P = .015), posttransplant hypertension (RR=2.047; P = .017), and AR (RR=3.125; P < .001). Patients in stage 2 at the beginning of chronic allograft dysfunction relative to stage 1 (RR=4.823; P < .001) and patients in stage 3 at the beginning of chronic allograft dysfunction relative to stage 1 (RR=123.06; P < .001) were significant risk factors for death-censored graft loss. Using mycophenolate mofetil versus azathioprine reduced death-censored graft loss (RR=0.499; P ≤ .001). Conclusion: We found that age of donor, pretransplant hypertension, pretransplant diabetes, type of immunosuppression (mycophenolate mofetil vs azathioprine), delayed graft function, proteinuria, and stage of allograft dysfunction at the start of chronic allograft dysfunction are the major risk factors for late renal allograft dysfunction.Item Liver Transplant in a Patient with Active Pulmonary Tuberculosis(Başkent Üniversitesi, 2010-09) Yankol, Yucel; Kalayogl, Munci; Acarli, Koray; Alan, Servet; Kanmaz, Turan; Kocak, Burak; Topaloglu, SerdarObjectives: Immunosuppressive treatment generally increases the severity of active infection. Therefore, liver transplant is contraindicated in the presence of active tuberculosis. Despite the importance of supportive treatment, liver transplant is the only treatment for fulminant hepatic failure. Materials and Methods: We report a case of successful liver transplant for fulminant hepatic failure in the presence of active tuberculosis infection. Results: We immediately performed a liver transplant from a live donor. The patient received low-dose immunosuppressive treatment and antituberculosis treatment. The patient was cured and discharged on the 25th day after surgery. We stopped antituberculosis treatment 10 months after discharge. The patient has been followed for 32 months after transplant with normal graft function and has been free of pulmonary tuberculosis infection. Conclusions: Liver transplant can be performed in cirrhotic patients with active infections, such as tuberculosis, as a life-saving procedure.Item Hand-Assisted Laparoscopic Donor Nephrectomy in Patients With Aberrant Inferior Vena Caval Anatomy(Başkent Üniversitesi, 2010-09) Dellen, David van; Inston, Nicholas G.; Ready, Andrew R.Objectives: Hand-assisted laparoscopic donor nephrectomy has become an established technique for live-donor organ retrieval. In most cases, the left kidney is removed because of its more favorable anatomic relations, particularly with the major abdominal vessels. Materials and Methods: We present 2 cases of live donation in which a hand-assisted laparoscopic approach was used to remove the right kidney as indicated by the presence of aberrant vascular anatomy, 1 being situs inversus totalis, the other a left-sided inferior vena cava. Results: A 41-year-old woman and a 51-year-old man underwent assessment for live-kidney donation. During preoperative investigation, they underwent magnetic resonance imaging that demonstrated situs inversus totalis and a left-sided inferior vena cava. No contraindications to live donation were found during the investigation. In both cases, a right donor nephrectomy was performed owing to an anatomically longer right renal vein. Living donation proceeded without complication in both cases, and both patients had uneventful recoveries. Conclusions: Abnormalities in vascular anatomy should not be considered an absolute contraindication to donation, even by the hand-assisted laparoscopic donor approach. The use of magnetic resonance scanning preoperatively allows detailed planning of the approach required.Item Influence of Hypothermia and Cardioplegic Solutions on Expression of α-Gal Epitope on Porcine Aortic Endothelial Cells(Başkent Üniversitesi, 2010-09) Keller, Miriam; Brenner, Paolo; Reichart, Bruno; Schmoeckel, Michael; Beiras-Fernandez, Andresbjectives: The Galα1-3Galβ1-4GlcNAc-R is the major antigen on pig tissue bound by human xenoreactive natural antibodies in xenotransplant. We have investigated in vitro the influence of hypothermic storage with cardioplegic solutions on expression of Galα1-3Galβ1-4GlcNAc-Rs and hyperacute xenograft rejection. Materials and Methods: To analyze effects of hypothermia on the Galα1-3Galβ1-4GlcNAc-Rs, cultured porcine aortic endothelial cells were exposed to a temperature of 4°C for 1 hour, 4 hours, and 6 hours. Cell cultures of the control groups were incubated at the same time at 38°C. To investigate the influence of cardioplegic solutions on the Galα1-3Galβ1-4GlcNAc-Rs, porcine aortic endothelial cells were exposed to 4°C for 4 hours in the presence of University of Wisconsin solution or histidine-tryptophan-ketoglutarate solution. Cells of the control groups were cooled at 4°C for 4 hours without cardioplegic solution. After treatment, porcine aortic endothelial cells were submitted to fluorescence-activated cell sorter. Results: Hypothermia of 4°C showed no significant effect on the quantity of Galα1-3Galβ1-4GlcNAc-Rs. However, the treatment of porcine aortic endothelial cells with University of Wisconsin solution resulted in a highly significant reduction of Galα1-3Galβ1-4GlcNAc-Rs by 50% (P = .006). Treatment of porcine aortic endothelial cells with histidine-tryptophan-ketoglutarate solution decreased α-Gal quantity significantly by 32% (P = .011). Conclusions: Our data offer new perspectives in the prevention of hyperacute, humoral xenograft rejection by reducing the Galα1-3Galβ1-4GlcNAc-Rs after exposure to different cardioplegic solutions.Item Thrombotic Microangiopathy in Allogeneic Stem Cell Transplantation in Childhood(Başkent Üniversitesi, 2010-09) Erbey, Fatih; Tanyeli, Atila; Uckan, Duygu; Cetin, Mualla; Yilmaz, Sema; Kuskonmaz, Baris; Bayram, IbrahimObjectives: We define the incidence, risk factors, and mortality rates for the occurrence of thrombotic microangiopathy in 50 children who underwent transplants between January 2006 and June 2008 at 2 Turkish pediatric centers. Materials and Methods: The diagnosis of thrombotic microangiopathy was done according to the reports of International Working Group in 2007. Results: Fifty patients (27 male and 23 female; age range, 3 months to 18 years) were included. Patients with malignant and nonmalignant diseases were 13 (26%) and 37 (74%). Myeloablative and nonmyeloablative conditioning regimens were used in 29 (58%) and 21 patients (42%). Bone morrow was used as the source of stem cells in 32 patients (62%) and peripheral blood was used in 18 patients (36%). Thrombotic microangiopathy was seen in 3 of 50 cases (6%). Thrombotic microangiopathy developed in 3 of 18 patients in whom peripheral blood was used as the source of stem cells while none of 32 patients who had bone marrow as the source developed thrombotic microangiopathy (P < .05). Conclusions: Using peripheral blood as a source of stem cells is a risk factor for development of thrombotic microangiopathy.Item Estimated Glomerular Filtration Rate in Patients With Surgically Acquired Single Kidney Compared With Patients With Congenital Single Kidney: Implications For Kidney Transplant From Live Donors(Başkent Üniversitesi, 2010-09) Bob, Flaviu; Vernic, Corina; Gadalean, Florica Nicoleta; Gluhovschi, Gheorghe; Trandafirescu, Virginia; Petrica, Ligia; Velciov, Silvia; Bozdog, Gheorghe; Gluhovschi, CristinaObjectives: The pathophysiology of the single kidney is involved in the evolution toward end-stage renal disease. Furthermore, most data suggest that the renal function of the donor is maintained after nephrectomy. This study sought to analyze the difference between surgically acquired single kidney and the congenital single kidney, regarding kidney function at a similar moment in time of the existence of a single kidney. Materials and Methods: Two groups were enrolled in this study. Group A consisted of 28 patients with surgically acquired single kidney, time from nephrectomy was 30.23 ± 10.82 years; mean age, 54.42 ± 14.99 years. Group B consisted of 20 patients with a congenital single kidney (mean age, 30.3 ± 10.43 years). We assessed glomerular filtration rate (Modification of Diet in Renal Disease 4 Study Equation) and the presence of classic and nonclassic risk factors for chronic kidney disease. Results: The estimated glomerular filtration rate showed no statistically significant difference between the 2 groups. Conclusions: Our study did not show any influence of surgical nephrectomy on the evolution of kidney function. Kidney function in the surgically acquired single kidney was similar to the kidney function in the congenital single kidney at a comparable time interval. Our results have potential favorable implications for kidney transplant from living donors.