Başkent Üniversitesi Yayınları
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Item Plasma Cell-Rich Acute Rejection With Monoclonal Gammopathy in a Renal Transplant Recipient(Başkent Üniversitesi, 2013-04) Sun, In O; Yang, Chul Woo; Choi, Yeong Jin; Kim, Yong Soo; Park, Cheol Whee; Park, Gyeong Sin; Choi, Bum Soon; Chung, Byung Ha; Hong, Yu Ah; Cho, Yul HeePlasma cell infiltration into a renal allograft comprises a spectrum of lesions from acute rejection to posttransplant lymphoproliferative disease. We report an unusual case of plasma cell infiltration into a renal allograft with monoclonal gammopathy. A 42-year-old woman was admitted because of graft dysfunction after noncompliance with immunosuppressive therapy for 5 months. A graft biopsy showed acute T-cell–mediated rejection and massive plasma cell infiltration. Despite initial treatment with steroids and antithymocyte globulin, there was persistence of graft dysfunction, monoclonal gammopathy, and plasma cell infiltration. Subsequent treatment with bortezomib improved graft function and caused the monoclonal gammopathy to resolve. Immunohistochemical evaluation of markers of B cells (CD20 and CD138) and the ratio of kappa-to-lambda light chain (15:1) showed that infiltrating cells were plasma cells producing kappa light chain. This suggested that plasma cell-rich acute rejection with monoclonal gammopathy in this patient might have been in an early stage of kappa light chain-producing posttransplant lymphoproliferative disease confined to the renal allograft, and that bortezomib may be effective in treating a patient with this condition.Item Use of Early Postoperative MAG3 Renal Scan To Predict Long-Term Outcomes of Renal Transplants(Başkent Üniversitesi, 2013-04) Park, UI-Jun; Zeon, Seok-Kil; Han, Seung-Yeup; Kim, Hyun-Chul; Park, Sung-Bae; Hwang, Eun-Ah; Kim, Min-Young; Cho, Won-Hyun; Kim, Hyoung-TaeObjectives: A Tc-99m mercaptoacetyltriglycine renal scan has been used to evaluate perfusion and excretory function of renal allografts. A Tc-99m mercaptoacetyltriglycine renal scan has been reported to correlate with early allograft outcomes. This study was done to determine whether a Tc-99m mercaptoacetyltriglycine renal scan has any relation with long-term renal transplant outcomes. Materials and Methods: A total of 311 consecutive kidney transplant recipients were included in the study. All had Tc-99m mercaptoacetyltriglycine renal scans on posttransplant days 3 and 7. Patterns of the renography curve was graded as follows: 0=normal perfusion and excretion; 1=normal perfusion, reduced excretion; 2=normal perfusion, flat excretion; and 3=reduced perfusion and rising curve. Early postoperative Tc-99m mercaptoacetyltriglycine scintigraphy findings were correlated with serum creatinine values, acute rejection episodes, and long-term graft survival. Results: A Tc-99m mercaptoacetyltriglycine renography of a deceased-donor kidney transplant showed a significantly higher grade on both days 3 and 7 than did live-donor kidney transplant (P < .001). Serum creatinine was positively correlated with the renography grades on days 3 and 7. The acute rejection rate was higher in the renography on days 3 and 7. Grade 2 renography on day 3 showed a significantly higher graft failure rate compared with the other grades (8.8% vs 8.6% vs 31.6% vs 7.3%; P = .014). Also, the renography showed the worst 5-year graft survival rate (95.9% vs 93.3% vs 89.5% vs 94.1%; P = .019). There were no differences in the graft failure rate or in graft survival rate according to the Tc-99m mercaptoacetyltriglycine renography grades on day 7. Conclusions: Our data show that a Tc-99m mercaptoacetyltriglycine renography grade correlate not only with early postoperative kidney function and incidence of acute rejection, but also with long-term outcomes of a renal allograft. A grade 2 renography pattern, with normal uptake and flat excretion, indicates a dismal prognosis for the long-term allograft survival.Item Effect of Reduced Form of Coenzyme Q10 on Cyclosporine Nephrotoxicity(Başkent Üniversitesi, 2013-02) Sato, Toshikazu; Homma, Yukio; Ishikawa, AkiraObjectives: Cyclosporine, a potent immunosuppressant, has nephrotoxic adverse effects that may be mediated by oxidative stress. The reduced form of coenzyme Q10 has antioxidant effects. The aim of the present study was to evaluate the effect of the reduced form of coenzyme Q10 on cyclosporine nephrotoxicity. Materials and Methods: Six-week-old male Wistar rats were divided into 3 groups (10 animals each). Group 1 (control) received olive oil only. Group 2 received cyclosporine (30 mg/kg/d, which is an experimentally nephrotoxic dose). Group 3 received cyclosporine (30 mg/kg/d) and the reduced form of coenzyme Q10 (600 mg/kg/d). The cyclosporine and the reduced form of coenzyme Q10 were given orally for 4 weeks. Daily urinary albumin excretion, serum creatinine level, and urinary 8-hydroxydeoxyguanosine level were measured, and renal tissue was evaluated by immunohistochemistry. Results: In rats treated with cyclosporine and the reduced form of coenzyme Q10 (group 3), there were significantly less abnormalities in mean urinary albumin excretion (group 1: 2.8 ± 0.5; group 2: 41 ± 7; group 3: 21 ± 4 µg/d), serum creatinine (group 1: 1.0 ± 0.2; group 2: 1.8 ± 0.4; group 3: 1.4 ± 0.3 mg/dL), and urine 8-hydroxydeoxyguanosine levels (group 1: 7 ± 3; group 2: 10 ± 3; group 3: 7 ± 1 mg/mL creatinine) than rats treated with cyclosporine alone (group 2). There were 8-hydroxydeoxyguanosine deposits seen in the proximal tubular cells of group 2 that were not present in rats treated with the reduced form of coenzyme Q10 (group 3). Conclusions: The reduced form of coenzyme Q10 may prevent or minimize cyclosporine nephrotoxicity by an antioxidant effect.Item Rhinomaxillary Mucormycosis in a Renal Transplant Recipient: Case Report(Başkent Üniversitesi, 2012-12) Azarpira, Negar; Khademi, Bighan; Kazemi, Kourosh; Ashraf, Mohamd JavadObjectives: Rhinomaxillary mucormycosis is a clinical manifestation of zygomycosis in solid-organ transplant recipients. Without proper diagnosis and treatment, rhino-orbital-cerebral zygomycosis, particularly a central nervous system disease, will develop with substantial complications. Case report: A 42-year-old man who had undergone renal transplant was admitted to our otolaryngology department with unilateral bloody nasal discharge. Mucormycosis was detected in the necrotic tissue of the maxillary sinus. Surgical ablation of the infected parts, along with antifungal treatment, restricted extension of the infection. Conclusions: Early detection of opportunistic infections in transplant recipients plays an important role in preventing dissemination. Fungal infections, including zygomycosis, should be considered in all solid-organ recipients, especially in persons with local unusual manifestations. Early diagnosis and successful treatment reduce mortality.Item Safety of Nephrectomy in Morbidly Obese Donors(Başkent Üniversitesi, 2012-12) O’Brien, Benjamin; Papalois, Vassilios; Hakim, Nadey; Crane, Jeremy; Mastoridis, SotirisObjectives: To satisfy donor organ shortage, overweight and obese donors are becoming a greater proportion of the kidney donor pool. Although good safety data exist in overweight and moderately obese individuals (body mass index = 25 to 35 kg/m2), there is little information about outcomes in morbidly obese donors (body mass index ≥ 40 kg/m2). The purpose of this study was to review the experience with morbidly obese donors in a single center and assist in the discussion about the feasibility of nephrectomy in such cases. Materials and Methods: Outcomes of nephrectomy in morbidly obese donors between January 2005 and June 2010 were reviewed retrospectively and compared with outcomes in nonobese donors. Results: Of 386 nephrectomies, 7 involved morbidly obese donors. Mortality and major complication rates were low in all body mass index categories. A high incidence of minor postoperative complications was observed in the morbidly obese, with 57% morbidly obese patients requiring treatment for complications including respiratory infection, compared with 30% in nonobese donors (P < .05). There were no significant differences in mean operative time, estimated blood loss, and length of hospital stay between all body mass index categories. Limited follow-up data (mean, 20 mo) showed similar renal function parameters between groups. Conclusions: The limited data suggest that nephrectomy may be feasible in selected morbidly obese donors. Further study is needed before major conclusions can be made.Item Comparison of 2 Devices in Pigs To Induce Hypothermia in Laparoscopic Orthotopic Kidney Transplant(Başkent Üniversitesi, 2012-12) Han, Xiuwu; Zhang, Yuhai; Gao, Qiang; Zhao, Zhiwei; Yan, Wei; Zhang, BaoObjectives: To laparoscopically compare the effectiveness of 2 cooling devices for renal hypothermia and investigate the feasibility of laparoscopic orthotopic kidney transplant using a pig model. Materials and Methods: Eight pigs were divided into 2 groups of 4 animals each. Laparoscopic nephrectomy and autotransplant were performed first on only the right kidney. One week later, these procedures were performed on the left kidney, while the first transplanted autograft was removed. After 1 more week, the left autograft was removed for observation. In 1 group, the silicon tube cage was used to induce hypothermia during laparoscopic orthotopic kidney transplant (silicon tube cage group), and in the other group, the plastic bag jacket was used to induce hypothermia during laparoscopic orthotopic kidney transplant (plastic bag jacket group). Results: Two pigs in the silicon tube cage group survived for 7 days after the second autotransplant with serum creatinine levels of 210 µmol/L and 1010 µmol/L. One pig in the plastic bag jacket group survived for 5 days. The mean surface temperature of the grafts was maintained at 9°C ± 3°C and 12°C ± 3°C in the silicon tube cage and plastic bag jacket groups (P = .166). Three of 6 plastic bag jacket devices were ruptured by stitches or instruments. The mean venous and arterial anastomotic times in the silicon tube cage group were significantly shorter than were those in the plastic bag jacket group. Conclusions: Our study shows that the silicon tube cage may be a reliable renal cooling device for use in laparoscopic kidney transplant and indicates the feasibility of laparoscopic orthotopic kidney transplant in pigs.Item Relation of Resistive and Pulsatility Indices With Graft Function After Renal Transplant(Başkent Üniversitesi, 2012-12) Ghorbani, Ali; Taheri, Azade; Mansoori, Pooria; Sametzadeh, Mozhgan; Shirazi, Ahmad SoltaniObjectives: There are conflicting data regarding the use of some measured indices by Doppler ultrasound such as the resistive index and the pulsatility index in predicting renal allograft dysfunction. This study sought to evaluate the association of early postoperative Doppler indices and 3-month serum creatinine levels in renal transplant recipients. Materials and Methods: During a 1-year period, all patients who underwent renal transplant at our hospital were recruited into a prospective study. Doppler ultrasound was performed on all patients 6 days and 3 months after the transplant and the resistive index and the pulsatility index were calculated for each patient. Then, the association between these indices and 3-month outcomes of patients were investigated. Results: Thirty-eight patients including 21 men (mean age, 36.6 ± 13.1 y) were evaluated. There was a positive correlation between the resistive index and the pulsatility index at 6 days after transplant and the serum creatinine measured at the same day (P < .001 and r=0.570 for resistive index; P < .001 and r=0.547 for pulsatility index). There was also a positive correlation between the pulsatility index and the resistive index at 6 days after transplant and 3-month serum creatinine level (P = .009 and r=0.420 for resistive index; P = .009 and r=0.417 for pulsatility index). There were negative correlations between the resistive index and the pulsatility index on the sixth day after surgery and creatinine clearance measured at 6 days and 3 months after transplant. Conclusions: This study reveals a strong-to-medium correlation between the resistive index and the pulsatility index, serum creatinine level, measured 6 days after transplant.Item Changes in Oxidative Stress in Renal Graft Patients Receiving Calcineurin Inhibitors: Cyclosporine Versus Tacrolimus(Başkent Üniversitesi, 2012-10) Akbasli, Ayse Ceylan; Nebioglu, Serpil; Erbay, Bulent; Keven, KenanObjectives: The effects of calcineurin inhibitors on oxidative stress after renal transplant are obscure. This study sought to investigate the changes in plasma oxidative stress and lipid levels in patients receiving cyclosporine or tacrolimus before and after renal transplant for 6 months. Materials and Methods: Twenty-one patients and 15 healthy controls were involved in our study. Twelve of the patients were treated with cyclosporine and 9 were treated with tacrolimus. Plasma malondialdehyde, nitrite/nitrate, vitamin C, vitamin E, and plasma glutathione levels, as well as total cholesterol and triglyceride levels, were evaluated before and after transplant for 6 months. Results: Before the transplant, patients had higher malondialdehyde and plasma glutathione levels than did healthy controls (3.76 ± 0.79 nmol/mL vs 3.21 ± 0.57 nmol/mL; P < .05, and 66.6 ± 23.2 µmol/L vs 43.3 ± 26.9 µmol/L; P < .05). In the overall group of patients, a significant increase in malondialdehyde levels was detected 3 and 6 months after transplant (3.76 ± 0.79 nmol/mL vs 4.38 ± 0.87 nmol/mL in the third month; P = .02; and 3.76 ± 0.79 nmol/mL vs 4.28 ± 0.69 nmol/mL in the sixth month; P = .04). A significant reduction in plasma glutathione levels 1 month after transplant and nitrite/nitrate levels 6 months after transplant was found. No changes in vitamin C and vitamin E levels were detected before and after transplant. After 3 and 6 months of transplant, cyclosporine-treated patients had higher levels of total cholesterol and triglycerides when compared with tacrolimus-treated patients. Conclusions: An enhancement in plasma malondialdehyde levels was found after transplant at 6-month follow-up. However, no significant change in vitamin C, vitamin E, nitrite/nitrate levels between patients and controls was recorded. Although both calcineurin inhibitors showed similar effects on oxidative stress, cyclosporine-treated patients had higher levels of total cholesterol and triglycerides.Item Clinical Experience in Organ Transplant From The Shiraz Transplant Center: 2011(Başkent Üniversitesi, 2012-08) Nikeghbalian, Saman; Malekhosseini, Seyed Ali; Salehipour, Mahdi; Bahador, Ali; Salahi, Heshmatollah; Mehdi, Syed Heider; Bahreini, Amin; Far, Alireza Shamsaee; Kazemi, Kourosh; Aliakbarian, MohsenObjectives: The Shiraz Organ Transplant Center, the largest transplant center in Iran, has expanded its program of organ transplant during recent years. This article seeks to summarize organ transplantation over the last 2 decades and evaluate its status as of 2011. Materials and Methods: We retrospectively analyzed the clinical records of all organ transplants performed in our center in 2011. We reviewed the patients’ demographics, underlying disease, operation details as well as postoperative complications. Results: During this period, 655 organ transplants including 345 liver, 297 kidney, 29 pancreas, and 11 intestine and multivisceral transplants were done. Among 345 liver transplants, 291 patients received a deceased-donor graft including 18 cases of split liver transplants while 54 patients received living-donor liver transplants. The 1-year graft and patient survival rates were 90.1% and 91%. Conclusions: In recent years, our program in organ transplantation has expanded in number and variety of organs transplanted. This improvement is related to our multidisciplinary strategies to expand the donor pool and the experiences obtained during our transplant activities.Item Neurologic Complications of Renal Transplant(Başkent Üniversitesi, 2012-06) Ce, Pinar; Uslu, Adam; Nart, Ahmet; Gedizlioglu, Muhtesem; Coban, Gokmen; Koskderelioglu, AsliObjectives: Neurologic problems have a major effect on the survival and quality of life in renal transplant recipients. This study sought to review the incidence and character of neurologic complications after renal transplant. Materials and Methods: Medical records of 319 renal transplant recipients admitted to the Transplant Outpatient Clinic were reviewed retrospectively for neurologic complications. Results: Of the 319 transplant recipient patients reviewed, 124 patients (39%) were women and 193 patients (61%) were men. The mean patient age was 41 ± 11 years, and the transplanted kidney was received from deceased donors in 161 patients (51%) and living donors in 158 patients (49%). There were 50 patients (16%) who had neurologic complications, most commonly herpes zoster infection associated with immunosuppressive medication. Only 1 patient, who had glioblastoma multiforme, died. Treatment included corticosteroids in 296 patients (93%) and calcineurin inhibitors (including tacrolimus) in 111 patients (35%). Conclusions: Neurologic complications are common after renal transplant. Most complications are associated with immunosuppressive medications.
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