Başkent Üniversitesi Yayınları
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Item The Effect of Machine Perfusion on the Arteries of Porcine Kidneys(Başkent Üniversitesi, 2005-12) Peerlinck, Inge D L.; Barlas, Alexander; Karameris, Andreas; Papalois, Vassilios E.Objectives: Machine perfusion is an excellent method of assessing the viability of a kidney graft and can also potentially improve the quality of an equivocal kidney. Several authors have expressed concerns that machine perfusion can potentially damage the vessels of the kidney but until now, no studies have been performed to clarify this issue. We aimed to examine the effect of machine perfusion on the renal arteries of porcine kidneys. Materials and Methods: Eight pairs of kidneys were removed from pigs in the abattoir. One kidney of each pair was preserved on ice for 24 hours. The other kidney from the same animal was initially stored on ice until arrival at the laboratory when it was perfused on the RM3 machine for 4 hours and then stored again on ice for the remainder of the 24 hours. After 24 hours, since the retrieval and initial storage on ice at the abattoir, tissue samples were obtained from all renal arteries at 3 different sites. These samples were sent for histologic evaluation. Results: Machine perfusion caused more damage at a statistically significant level compared with simple cold storage only for the first sample site, which was the part of the renal artery closest to the perfusion cannula. Conclusions: Our experiments suggest that machine perfusion, even when it is done lege artis, can damage the part of the renal artery closest to the adaptor, which can potentially result in a higher incidence of posttransplant arterial thrombosis. Therefore, excision of the first part of the renal artery should be considered prior to transplantation, and modifications of the perfusion technique must be developed to minimize damage to the renal arteries.Item Noncompliance With Immunnosuppressive Medications After Renal Transplantation(Başkent Üniversitesi, 2003-06) Ghods, Ahad J.; Nasrollahzadeh, DariushNoncompliance with immunosuppressive medications in renal transplant recipients results in higher rate of acute rejection episodes, allograft dysfunction, graft loss and patient death. We studied incidence and risk factors of medications noncompliance in 286 renal transplant recipients who were consecutively seen in our renal transplant clinic between February and April 2002. One hundred and seventy were male, 116 female. Their age ranged from 12 to 70 years (mean 39.1 ± 11.6). The length of time since the date of transplantation ranged from 5 to 231 months (mean 76.7 ± 53.5). The results of study showed that 70 patients (24.5%) to be noncompliant (7.7% noncompliant minor and 16.8% noncompliant major). The time since the date of transplanation was a significant risk factor in both noncompliant minor and major groups (P < 0.001 and P < 0.001). The other risk factors associated with major noncompliance was young age (P < 0.001), lower level of education (P < 0.01), lower socioeconomic class (P < 0.05), addiction and psychiatric disorders (P < 0.05). Transplant recipients with major noncompliance also had more acute rejection episodes (P < 0.001) and allograft dysfunction (P < 0.01). We conclude that noncompliance with immunosuppressive medications is very common in renal transplant recipients and it results to significant acute rejection episodes and allograft failure.Item Noncompliance With Immunnosuppressive Medications After Renal Transplantation(Başkent Üniversitesi, 2003-06) Ghods, Ahad J.; Nasrollahzadeh, DariushNoncompliance with immunosuppressive medications in renal transplant recipients results in higher rate of acute rejection episodes, allograft dysfunction, graft loss and patient death. We studied incidence and risk factors of medications noncompliance in 286 renal transplant recipients who were consecutively seen in our renal transplant clinic between February and April 2002. One hundred and seventy were male, 116 female. Their age ranged from 12 to 70 years (mean 39.1 ± 11.6). The length of time since the date of transplantation ranged from 5 to 231 months (mean 76.7 ± 53.5). The results of study showed that 70 patients (24.5%) to be noncompliant (7.7% noncompliant minor and 16.8% noncompliant major). The time since the date of transplanation was a significant risk factor in both noncompliant minor and major groups (P < 0.001 and P < 0.001). The other risk factors associated with major noncompliance was young age (P < 0.001), lower level of education (P < 0.01), lower socioeconomic class (P < 0.05), addiction and psychiatric disorders (P < 0.05). Transplant recipients with major noncompliance also had more acute rejection episodes (P < 0.001) and allograft dysfunction (P < 0.01). We conclude that noncompliance with immunosuppressive medications is very common in renal transplant recipients and it results to significant acute rejection episodes and allograft failure.Item Sirolimus: A Current Perspective(Başkent Üniversitesi, 2003-06) Yakupoğlu, K. Yarkin; D. Kahan, BarrySirolimus, a macrocyclic lactone that displays a novel mechanism of immunosuppressive action, is a critical-dose drug requiring therapeutic drug monitoring for optimal outcomes. The compound was documented in two multicenter, blinded clinical trials to reduce the incidence of acute rejection episodes when used in combination with cyclosporine and steroids vs. azathioprine or placebo comparators. Furthermore, studies utilizing cyclosporine withdrawal documented a long-term benefit on renal function of chronic sirolimus therapy, albeit with a modestly enhanced incidence of acute rejection episodes. Although this application may be useful in selected cases, we believe that minimal initial cyclosporine exposures de novo mitigate the need for eventual withdrawal for chronic nephropathy, while preserving the immunosuppressive synergy during the maintenance phase. Recipients treated de novo with a sirolimuscyclosporine combination tolerate steroid withdrawal at 1 month after living-donor or at 3 to 6 months after cadaveric kidney transplantation with only a 5% risk of acute rejection episodes and 6% incidence of chronic reactions within 3 years. However, sirolimus exacerbates the hypertriglyceridemic and hypercholesterolemic proclivities of transplant recipients, as well as exerts myelosuppressive effects, which are augmented by concomitant therapy with azathioprine or, particularly, with mycophenolate mofetil. Due to its apparent lack of nephrotoxicity, sirolimus has been employed for induction therapy in a calcineurin antag-onist-free regimen in combination with either basiliximab or rabbit antilymphocyte sera for weak or strong immune responders, respectively, followed by introduction of a calcineurin antagonist upon resolution of the ischemia-reperfusion injury. Therefore, sirolimus proffers a potent and unique platform for new immunosuppressive strategies in organ transplantation.