Başkent Üniversitesi Kurumsal Akademik Arşivi
Başkent Üniversitesi DSpace, üniversitemiz tarafından doğrudan veya dolaylı olarak yayınlanan kitap, makale, tez, bildiri, rapor ve araştırma verisi gibi tüm akademik kaynakları uluslararası standartlarda dijital ortamda depolar. Bu sistem, üniversitemizin akademik performansını izlemeye aracılık eder, kaynakları uzun süreli saklar ve yayınların etkisini artırmak amacıyla telif haklarına uygun olarak Açık Erişim imkanı sağlar.
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Endovascular Treatment of Active Bleeding after Liver Transplant
(Başkent Üniversitesi, 2007-06) Harman, Ali; Boyvat, Fatih; Hasdogan, Baris; Aytekin, Cuneyt; Karakayali, Hamdi; Haberal, Mehmet
Objectives: To evaluate the incidence of active bleeding complications following transplant and the efficacy of interventional radiologic management.
Materials and Methods: Between June 2000 and February 2007, 14 liver transplant patients with active bleeding were treated via endovascular techniques (coils, glue, or graft-covered stents). Active bleeding was spontaneous in 6 patients through the inferior epigastric artery (n=1), the inferior phrenic artery (n=1), the superior mesenteric artery (n=2), the internal mammary artery (n=1), and the hepatic artery (n=1). In 8 patients, active bleeding was due to transhepatic biliary or endovascular interventions. Hemobilia (n=2) due to pseudoaneurysm formation after transhepatic biliary interventions was embolized with coils. Hepatic artery rupture was observed in 6 patients during endovascular interventions performed on hepatic artery stenosis or thrombosis that had been treated with graft-covered stents. Technical success, clinical improvement, and complications were documented.
Results: Active bleeding was stopped by endovascular intervention in 13 of 14 patients. Embolizations with coils or glue were successful. In 1 patient with hepatic artery bleeding, the graft-covered stent failed to seal the rupture site, and this patient underwent reoperation.
Conclusion: Arterial bleeding complications after liver transplant during the early and late postoperative period, due either to spontaneous active bleeding or to percutaneous or endovascular interventions, can be successfully managed with interventional radiologic techniques.
Severe Tacrolimus Toxicity in Rabbits
(Başkent Üniversitesi, 2007-06) Giessler, Goetz A.; Gades, Naomi M.; Friedrich, Patricia F.; Bishop, Allen T.
Objectives: Tacrolimus is an effective immunosuppressant, safely administered in clinical practice by monitoring blood levels. In experimental transplants, many dosage regimens have been reported, often without such determinations. Anorexia and organ toxicity commonly occur. We report the toxic effects of tacrolimus in rabbits receiving intramuscular injections (1 mg/kg/d) and the subsequent dosage modifications that resulted in improved animal survival without toxic effects.
Materials and Methods: To obtain nontoxic drug concentrations in the blood, 3 dosage regimens were required. Drug concentrations were targeted using therapeutic human values as a guide (range, 5-20 ng/mL). First, a group of 12 Dutch Belted rabbits received vascularized femoral allografts and were treated with intramuscular dosages of tacrolimus (1 mg/kg/d) for 14 days. Subsequently, dosage reductions in 10 more rabbits, to 0.2 mg/kg/d for 14 days, were necessary. Finally, another group of 20 rabbits was treated with 0.08 mg/kg for 3 days, and then every other day thereafter. Weight loss > 30%, cardiopulmonary failure, and/or creatinine levels > 221 µmol/L were the criteria approved by our local Institutional Animal Care and Use Committee for euthanizing the animals. Treated animals were compared with 20 nonimmunosuppressed controls that underwent the same operation.
Results: At an intramuscular dosage of 1 mg/kg/d, the mean tacrolimus blood level was 90.7 ng/mL. Ten of the 12 animals in the original group died or required euthanasia. At necropsy, renal failure, cardiac abnormalities, and pulmonary edema were found. The tacrolimus dosage of 0.2 mg/kg/d produced a mean tacrolimus blood level of 17.6 ng/mL; however, 8 of the subsequent 10 rabbits died when given this dosage. Ultimately, the 0.08 mg/kg regimen in 20 rabbits permitted survival of 18 animals with a mean tacrolimus blood level of 6.8 ng/mL. None of 20 nonimmunosuppressed controls died after surgery.
Conclusions: For successful immunosuppression, Dutch-Belted rabbits require intramuscular tacrolimus dosages lower those required in other rabbit breeds. This has not been reported previously. The 0.08 mg/kg/d dosage combined with intermittent drug level monitoring permits survival without significant complications.
A Novel Technique for Hepatic Arterial Reconstruction in Living-Donor Liver Transplant
(Başkent Üniversitesi, 2007-06) Haberal, Mehmet; Sevmis, Sinasi; Karakayali, Hamdi; Moray, Gokhan; Yilmaz, Ugur; Ozcay, Figen; Torgay, Adnan; Aydogan, Cem; Arslan, Gulnaz
Objectives: Arterial reconstruction in patients undergoing living-donor liver transplant is technically difficult because of the small diameter of the vessels in the partial liver graft. In this study, we present our technique for hepatic arterial reconstruction.
Methods: Since December 2005, we have performed 54 living-donor liver transplants, which are analyzed retrospectively in this report. In our technique now used at our institution, native and graft hepatic arteries are spatulated from both the anterior and posterior walls to provide a wide anastomosis. Computed tomographic angiography is used to evaluate the vascular anatomy and to measure the diameter of the graft hepatic arteries.
Results: Mean follow-up was 7.2 ± 5.5 months (range, 1-17 months). Nine of the 54 recipients died within 4 months of the surgery. At the time of this writing, the remaining 45 recipients (84%) are alive and demonstrating good graft function. In 2 recipients (3.7%) in this series, hepatic artery thromboses developed, which were treated with an interventional radiologic technique.
Conclusions: Our arterial reconstruction technique has enabled reconstruction of smaller arteries and arteries of various diameters without an operating microscope. The rate of complications in our patients is similar to that reported in similar individuals.
Innate Alloimmunity: History and Current Knowledge
(Başkent Üniversitesi, 2007-06) Land, Walter Gottlieb
Is There a Bias Against Women in Kidney Transplantation Practices in Saudi Arabia?
(Başkent Üniversitesi, 2006-12) Hejaili, F.; Juhani, A.; Flaiw, A.; Ghamdi, G.; Jondeby, M.; Eid, A.; Jaradat, M.; Shaheen, F.; Al Khader, A.