Başkent Üniversitesi Yayınları
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Item Mini-Incision Donor Nephrectomy Techniques: A Systematic Review(Başkent Üniversitesi, 2010-06) Aboutaleb, Esam; Hakim, Nadey; Crane, Jeremy; Herbert, PaulObjectives: The aim of this article is to compare different mini-incision donor nephrectomy techniques in the literature. Materials and Methods: We did a literature search using PUBMED using the search term “donor nephrectomy.” We compared different surgical techniques using different parameters like length of incision, length of operation, pain medications required after the operation, site of the operation, and intraoperative and postoperative complications. Results: We found 7 different surgical techniques of mini-invasive donor nephrectomy. Hakim and associates described the smallest initial incision size of 4 cm. There also are limited data on the analgesia requirements in 4 of the series, and 3 series that describe the requirements vary. Conclusions: These techniques offer advantages and disadvantages to the donor and the kidney. We hope to encourage further work. Ideally, there must be a working discussion, long-term outcomes of donor kidney and recipient, as well as accurate pain records, both quantitative and qualitative, and a discussion of time to mobilization.Item Oxidative Stress Status in Renal Transplant Recipients(Başkent Üniversitesi, 2010-03) Lessan-Pezeshki, Mahbob; Einollahi, Behzad; Zahmatkesh, Maryam; Kadkhodaee, Mehri; Mahdavi-Mazdeh, Mitra; Ghaznavi, Rana; Hemati, Mohamad; Seifi, Behjat; Golab, Fereshteh; Hasani, KeyvanObjectives: Despite the demonstration of oxidative stress in patients with end-stage renal disease, the oxidative status during and after a renal transplant are not completely understood. Hepatocyte growth factor is reported to act as an endogenous factor against oxidative stress. The aim of this study was to evaluate the pattern of changes in plasma oxidative status and hepatocyte growth factor levels in living-donor renal transplant recipients during the early phase after transplant. Materials and Methods: Nineteen patients who underwent a renal transplant were included. All were on cyclosporine-based immunosuppression. Plasma levels of malondialdehyde, ferric reducing activity, hepatocyte growth factor, vitamin E, erythrocyte glutathione, and superoxide dismutase activities were determined before, and on the second, seventh, and 12th days after the transplant. Results: High malondialdehyde concentration and low superoxide dismutase activity were seen before and 48 hours after transplant compared with healthy subjects. Significant reductions in plasma ferric reducing activity, malondialdehyde, and hepatocyte growth factor were seen on the seventh and twelfth days after transplant, compared with the before-transplant data. Direct correlations were found between hepatocyte growth factor levels and ferric reducing activity of plasma as well as hepatocyte growth factor and creatinine or uric acid. Conclusions: Renal transplant recipients display persistent oxidative stress during the early phase of transplant. The pattern of oxidative changes should be considered for appropriate time, dosage, type, and the duration of antioxidant therapy in these patients.Item Characteristics of Patients With Banff Borderline Changes in Renal Allograft Biopsies(Başkent Üniversitesi, 2009-12) Wafa, Ehab W.; Ghoneim, Mohamed A.; El-Agroudy, Amgad E.; El-Baz, Mahmoud; Gheith, Osama A.; El-Husseini, Amr; Abbas, Tarek M.Objectives: The aim of this retrospective study was to characterize the patients who experienced borderline rejection. Materials and Methods: Patients with a minimum follow-up of 2 years were enrolled in this study. Forty-seven patients out of 106 patients with borderline rejection (after exclusion of those with associated chronic interstitial fibrosis) were compared with patients with acute cellular rejection grade 1 (n=650), and patients free of rejection episodes (n=444) regarding the different characteristics. Results: Patients aged 20 years or younger were frequently in borderline rejection group than other groups (which was statistically significant) (P = .001). Significant differences were found in recipient and donor ages, consanguinity, pretransplant blood transfusion, and immunosuppression plan. Most patients in borderline rejection group received triple immunosuppression therapy than other groups (P = .001). Univariate and multivariate regression analysis of different variables on graft survival in borderline rejection patients revealed that none of them was statistically significant. Conclusions: Borderline rejection is a frequent finding in biopsy-proven acute rejection after kidney transplant. Time of occurrence, frequency, treatment or not, and response to therapy were not predictors to graft survival.Item Acute Tubular Necrosis After Renal Allograft Segmental Infarction: The Nephrotoxicity of Necrotic Material(Başkent Üniversitesi, 2008-12) Ardalan, Mohammad Reza; Shoja, Mohammadali Mohajel; Ghabili, Kamyar; Nasri, HamidObjectives: Renal allograft dysfunction can be caused by renal vessel thrombosis, acute tubular necrosis, hyperacute or acute rejection, nephrotoxicity induced by cyclosporine or tacrolimus, thrombotic microangiopathy, or urinary tract obstruction. Materials and Methods: We describe a renal transplant recipient in whom oliguria developed during the first week after transplant, although his early renal allograft function was good. Results: A Doppler ultrasonographic study revealed a lack of perfusion in the lower pole of the allograft. A perfusion defect was noted in the lower pole that was supplied by a polar artery, which had been damaged during engraftment. Light microscopy disclosed tubular cell necrosis without evidence of vascular or humoral rejection. Conclusions: We suggest that toxic molecules such as tumor necrosis factor-alpha released from a segmental infarcted area can induce tubular cell damage and necrosis leading to renal allograft dysfunction.Item Association Between Increased Body Mass Index, Calcineurin Inhibitor Use, and Renal Graft Survival(Başkent Üniversitesi, 2008-09) Ghahramani, Nasrollah; Hollenbeak, Christopher; Reeves, W. BrianObjectives: Using data from the US Renal Data System, we examined the relation between body mass index and graft survival as mediated through calcineurin inhibitor use. Materials and Methods: Adult patients who received a first kidney-only transplant, with at least 6 months’ survival were classified into 5 categories (underweight, normal, overweight, obese, and extremely obese) according to body mass index. Associations between calcineurin inhibitor use, body mass index categories, and outcomes were investigated. Results: Underweight and normal-weight recipients lived longer than the other 3 categories, regardless of calcineurin inhibitor use. Graft survival was significantly inferior among obese and extremely obese patients. Average graft survival was significantly higher for recipients with a normal body mass index than it was for overweight, obese, and extremely obese recipients. Risk ratio for graft failure was constant for the calcineurin inhibitor versus the noncalcineurin inhibitor group across all body mass index categories. Mean body mass index for the group with rejection episodes was similar to the group with no rejections; there was no correlation between body mass index and rejection risk. Conclusions: Increased body mass index is associated with inferior patient and graft survival, independent of calcineurin inhibitor use. Because we found no correlation between body mass index and risk of rejection, we assume that, at least after the initial 6 months, the adverse effect of obesity on graft outcome is partially mediated through nonimmunologic mechanisms. When analyzing graft and patient survival rates, we recommend that body mass index be considered a risk factor.Item Clinicoepidemiologic Study of Posttransplant Diabetes After Living-Donor Renal Transplant(Başkent Üniversitesi, 2008-03) Elmagd, Mogahid M Abu; Wahab, Ahmad M abd El; AMetwally, Abdel Hameed; Bakr, Mohammed A.Objectives: We sought to evaluate posttransplant diabetes mellitus with regard to its incidence, risk factors for occurrence, complications, impact on graft function, and impact on patient and graft survival rates. Materials and Methods: A total of 1580 patients received living-donor renal allografts at Mansoura University, Egypt, between March 1976 and November 2004. Of these, 286 recipients developed diabetes after transplant (diabetic group). These patients were matched with 316 kidney transplant recipients who did not develop diabetes after transplant (control group). A complete clinical history was obtained and a clinical examination was done. Laboratory analyses including urine analysis, complete blood count, total serum cholesterol, fasting and 2-hour postprandial plasma glucose, Hb A1c, serum creatinine, and creatinine clearance were obtained in all patients. In each patient, presence of hepatitis B and C was determined with polymerase chain reaction, and a graft biopsy was obtained to diagnose renal allograft rejection. Results: The onset of diabetes mellitus among our recipients occurred primarily during the first 6 months after transplant (in 52.4% of the patients). Significant correlations were found between posttransplant diabetes mellitus and the recipients’ age (P = .0001), obesity (P = .001), positive family history of diabetes mellitus (P = .001), hepatitis C virus infection (P = .039), cumulative dose of steroids in the first 3 months (P = .047), and calcineurin inhibitor-based immunosuppressive therapy (P = .001). Moreover, posttransplant diabetes mellitus significantly affected rates of coronary heart disease (P = .001), hypertension (P = .02), and hypercholesterolemia (P = .001). Graft survival was similar in both groups until 15-year follow-up, at which time graft survival began to decrease in patients with diabetes mellitus compared with those without diabetes mellitus (43.5% vs 53.6%, P = .013). Similarly, patient survival was similar until 8-year follow-up, at which time survival rates began to decline in patients with diabetes as compared with patients without diabetes (79.9% vs 86.1%, P = .001); this trend continued to the 15-year follow-up (60.6% vs 77.8%, P = .001). Conclusions: Posttransplant diabetes mellitus is a major problem that endangers patient and graft survival. In our population, the incidence of posttransplant diabetes mellitus was 18.2%. Further studies are recommended to screen for patients with impaired fasting glucose and impaired glucose tolerance for prediction, early detection, and better management of posttransplant diabetes mellitus.Item Renal Allograft Abscesses Following Transplant: Case Report and Literature Review(Başkent Üniversitesi, 2007-12) Shoja, Mohammadali M.; Varshochi, Mojtaba; Tubbs, R. Shane; Etemadi, Jalal; Ardalan, Mohamad R.Intrarenal and perinephric abscess formations are infrequent infectious complications in kidney allograft recipients. A 37-year-old man who was a victim of mustard gas chemical weapons from the Iran-Iraq war received a live-donor kidney transplant for end-stage renal disease. The posttransplant course was complicated by clinical rejection, which subsided after a 2-week infusion of antithymocyte globulin. One month subsequent to this, the patient presented with renal allograft dysfunction and multiple intrarenal abscesses. Culture from the purulent aspirate of a percutaneously drained renal abscess revealed multidrug-resistant Pseudomonas aeruginosa. A concomitant acute cytomegalovirus infection was detected based on positive serologic tests. Treatment with intravenous meropenem (3 g/day for 3 weeks) and oral ciprofloxacin was begun, which resulted in the complete resolution of the intrarenal abscesses. To our knowledge, this report represents the first description of pseudomonal renal abscesses in a renal transplant recipient. A review of the relevant literature is presented.Item Life in Death: an Overview of Solid Organ Transplant in Shiraz, Iran(Başkent Üniversitesi, 2007-12) Mehdizadeh, Alireza; Fazelzadeh, AfsoonAdvances in organ preservation, immunosuppression, and surgical procedures have resulted in improved outcomes and survival rates. However, regarding organ transplant in different communities, these advances raise major ethical, policy, and religious issues. Transplant progress in Iran, in relation to the rest of the world, has been slow at times and quick during others. Between 1988 and 1993, there was a rapid surge in experiments with tissue transplant in Iran, and the Shiraz Organ Transplantation Center, established in 1988, rose to become a pioneer of the most significant improvements, a leading center for organ transplant, and the only center for liver transplant in Iran. In this article, we review milestones in the development of a successful organ transplant program and implementation of legislation in Iran. The Shiraz model of transplant is a new program that attempts to overcome the problems of organ shortage. We provide a description of the Iranian model of transplant and its restrictions and examine the most promising future trends in this exciting field.Item Steroid Avoidance in Renal Transplant Patients Maintained on a Cyclosporine-based Protocol(2007-12) Ko, Tina Y; Julie A Haddy,; Sureshkumar, Kalathil K.; Breckenridge, Molly; Patel, Satish; Marcus, Richard J.; Sandroni, Stephen E.; McGill, Rita L.; Carpenter, Barbara J.; Nghiem, Dai D.Objective: The aim of this study was to analyze the effect of steroid avoidance, as compared with our pre-existing protocol that contained steroids, on renal allograft and patient survival. Secondary outcomes included body weight, diabetes, hyperlipidemia, and infection. Materials and Methods: This retrospective chart review of the results of steroid avoidance was performed in 169 patients who had undergone renal transplant between January 2000 and March 2002 and had received an immunosuppression regimen of cyclosporine, mycophenolate mofetil, and prednisone; and 148 patients who had undergone transplant between November 2002 and November 2004 who had received induction immunosuppression with a steroid taper by postoperative day 4 and were maintained on cyclosporine and mycophenolate mofetil. Results: One-year allograft survival rates, rejection-free graft survival rates, and patient survival rates were 88%, 76%, and 97%, respectively, in the steroid-maintenance group compared with 90%, 74%, and 96%, respectively, in the steroid-avoidance group (P = NS). No differences were detected in multiple secondary variables related to the metabolic effects of steroid therapy. Conclusions: These data suggest that steroid avoidance can be performed safely and effectively in patients on a cyclosporine-based protocol of immunosuppression. Longer follow-ups are suggested to determine the effects of limited steroid exposure on the metabolic profiles of patients.Item An Outbreak of Chickenpox in Adult Renal Transplant Recipients(Başkent Üniversitesi, 2007-06) Shahbazian, Heshmatollah; Ehsanpour, AliInfection with the varicella-zoster virus, the etiologic agent of chickenpox and herpes zoster, is more serious in immunosuppressed renal transplant recipients than it is in the general population. Chickenpox is a rare infection in adult renal transplant recipients; however, it is significant owing to the severity of its clinical features and its associated high mortality rate. To date, there are no reported outbreaks of primary varicella-zoster virus infection in adult renal transplant recipients. Here, we report 3 patients with chickenpox who presented to our center between May 2006 and June 2006.