Başkent Üniversitesi Yayınları

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    Fungal Infections in Solid Organ Recipients
    (Başkent Üniversitesi, 2005-12) Badiee, Parisa; Kordbacheh, Parivash; Alborzi, Abdolvahab; Zeini, Farideh; Mirhendy, Hossein; Mahmoody, Mahmood
    Background: Fungal infections are a major cause of morbidity and mortality after organ transplantation. The incidence of these infections has increased considerably over the last decade. Objectives: The aim of this study was to evaluate the incidence of fungal infections, to identify the most common fungal pathogens, and to determine the associated risk factors in solid organ recipients. Methods: One hundred twenty renal and 50 liver recipients were transplanted at the organ transplant unit of Nemazi Hospital in Shiraz, Iran, from September 2004 to August 2005 and were followed for fungal infections for at least 6 months. On admission to the hospital, all patients were evaluated for fungal colonization by mouth, vagina, urine, and rectal swabs cultured in Sabouraud Dextrose Agar. Samples of sputum, bronchoalveolar lavage, urine, cerebrospinal fluid (CSF), pleural tap, and tissue biopsy were evaluated by direct microscopic examination and were cultured for any clinical signs of fungal infections. Results: Fifty-four kidney recipients (45%) had Candida colonization in different sites of their bodies. Fungal infections presented in 13 of 120 recipients (10.8%). Five recipients had invasive fungal infections (3 had fungal pneumonitis and 2 had severe esophagitis), and 8 patients had cutaneous and mucocutaneous infections. All of the recipients with invasive fungal infections were colonized with Candida, and 2 of them died. Forty-two (84%) liver recipients had Candida colonization in different sites of their bodies. Fungal infections presented in 6 liver recipients. In 4 patients, invasive fungal infections occurred (2 fungal pneumonitis, 1 meningitis, and 1 severe esophagitis), 2 patients showed mucocutaneous infections. Three recipients with invasive fungal infections had Candida colonization. The mean time to diagnosis was 70 days after transplantation. The most common etiologic agent for fungal infections was Candida albicans. Conclusions: Renal and liver recipients with Candida colonization are at high risk for fungal infections and therefore, control of fungal colonization in liver and renal transplant candidates would reduce the risk of invasive fungal infections after transplantation.
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    Marjinal Donörler
    (Başkent Üniversitesi, 2004-01) G. Moray
    Marjinal donör, çeşitli özellikleri nedeni ile gecikmiş fonksiyon görme veya hiç fonksiyon görmeme riskini taşıyan organları olan donörleri tanımlamada kullanılan bir terimdir. Son zamanlarda aynı amaçla "Genişletilmiş Kriterli Donör" (expanded criteria donor) terimi de kullanılmaktadır. Her geçen gün çoğalan organ ihtiyacı bu tanıma uyan organların kullanılma gereğini artırmaktadır. Etik olarak kabul gören bu uygulama standart organ nakillerinden çeşitli farklar göstermekte, ameliyat sonrası erken dönem fonksiyonlar ile uzun süreli greft ve hasta sağkalımında değişiklikler olabilmektedir. Bu derlemede böbrek ve karaciğer açısından marjinal kabul edilen greftlerin özellikleri değerlendirilmiştir. The terminology of "Marginal Donor" or "Expanded Criteria Donor" are used to define the donors whom have some inappropriate criteria for a standart organ donor. The organs that can be procured from these kind of donors have the risk of primary non-functioning or delayed graft function after transplantation. Today the increasing demand for organ transplantation have enhanced the utility of marginal donors. Such kind of ethically approved practice have some differences from the standart transplantation procedures. The post-operative complications and the overall cost of transplantation procedure may be increase, the graft and patient survivals can decrease. In this review the issue of marginal kidney and liver grafts are discussed in detail.