Başkent Üniversitesi Yayınları

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Subject: search.filters.subject.Deceased donor

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    Risk Factors for Delayed Graft Function Defined as Need for Dialysis or Failure of Creatinine to Fall by 10% in the First 24 Hours After Transplant
    (Başkent Üniversitesi, 2008-03) Stratopoulos, Charalabos; Friend, Peter J.; Sinha, Sanjay; Vaidya, Anil; Muthusamy, Anand; Zilvetti, Miguel; Brockmann, Jens; Roberts, Ian S. D.
    Objectives: Delayed graft function after deceased-donor transplant remains a significant clinical problem. The conventional definition of delayed graft function is the requirement of dialysis within the first week after transplant, but this criterion has many problems that have led to many controversies including those of incidence and significance. Therefore, we sought to identify the possible risk factors of delayed graft function and to investigate their effect on short-term graft survival, according to a composite criterion. Materials and Methods: We reviewed the records of 94 renal transplants obtained from heart-beating deceased donors done at our center during a 2-year period. Variables related to the donor, recipient, and graft were retrospectively collected. Follow-up was 12 months. Delayed graft function was defined as the need for dialysis or the failure of the creatinine level to fall by 10% during the first 24 hours after transplant. To confirm suspected rejection, protocol biopsies were done, irrespective of graft function, on the seventh and 28th days after transplant, or when indicated to confirm suspected rejection. Results: The overall incidence of delayed graft function was 31.9%. Multivariate analysis showed donor age as a significant independent predictor of delayed graft function (OR=1.05, P = .03, 95% CI: 1.01-1.09), whereas donor hypotension was the only independent risk factor associated with a worse 1-year graft survival rate (OR=4.6, P = .021, 95% CI: 1.3-16.5). No association could be established between delayed graft function, acute rejection, and graft survival. Conclusions: Advanced donor age is a predictor of delayed graft function defined as the need for dialysis or the failure of creatinine to fall by 10% during the first 24 hours after transplant. Preventing hemodynamic instability should be an important aspect of donor care.
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    Horseshoe Kidney for Transplant: Report of 3 Cases
    (Başkent Üniversitesi, 2007-12) Dinckan, Ayhan; Demirbas, Alper; Tuncer, Murat; Erdogan, Okan; Gurkan, Alihan; Kocak, Huseyin; Turkyilmaz, Serdar; Tekin, Ahmet
    Owing to the limited donor pool at transplant centers, grafts may be taken from marginal donors with congenital abnormalities, one of the most common of which is a fusion abnormality. Horseshoe kidneys may be transplanted to a single recipient en bloc or to 2 recipients after division. In our clinic, 3 grafts (1 obtained from a living donor and 2 from a deceased donor) were successfully transplanted to 3 patients. In select patients, horseshoe kidneys may be used for transplant.
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    Kidney Transplantation in a Veterans Administration Medical Center: 40 Years’ Experience
    (Başkent Üniversitesi, 2004-12) Kizilisik, A. T.; Ray, J. B.; Nylander, W. A.; Langone, A. J.; Helderman, J. H.; Shaffer, D.
    Objectives: Advances in immunosuppressive therapy have led to substantial improvements in kidney transplant outcomes in the past 20 years. Kidney transplantation activity started in 1963 at the Veterans Administration Medical Center in Nashville, Tennessee, and continues to grow with increasing numbers of transplants from living-related and unrelated donors. In this study, patient and graft survival rates during 2 different periods were evaluated and compared with non–veterans-administration centers. Materials and Methods: Six hundred fourteen kidney transplants were performed between March 1963 and December 2002. For analytic purposes, the 40-year experience was divided into 2 eras based on the immunosuppressive agents used. Azathioprine and prednisone were the immunosuppressive agents used in era 1. A calcineurin-inhibitor–based triple immunosuppressive regimen initially including azathioprine and prednisone and later, mycophenolate mofetil and prednisone, was the preferred immunosuppressive regimen in era 2. Results: In era 1, 1-year patient and graft survival rates were 72.5% and 50%, and 89% and 75% for deceased-donor and living-donor transplants respectively. In era 2, patient survival rates increased to 95.1% and 87.8% for 1 and 3 years respectively, while graft survival increased to 87.6% and 74.9%. Forty-three percent of deceased-donor and 21% of living-donor kidneys were lost owing to rejection in era 1. In era 2, the incidence of acute rejection was 14.5% overall. Conclusions: Overall, our results are comparable with non–veterans-administration centers and the national average and show that kidney transplantation offers veteran patients with end-stage renal disease a safe and effective treatment with increased quality of life.