Başkent Üniversitesi Kurumsal Akademik Arşivi
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Prevalence and Risk Factors of Renal Dysfunction After Liver Transplant: A Single-Center Experience
(Başkent Üniversitesi, 2008-03) Dehghani, Seyed Mohsen; Malek-Hosseini, Seyed Ali; Jalaeian, Hamed; Gholami, Siavash; Taghavi, Seyed Ali Reza; Derakhshan, Ali
Objectives: Renal dysfunction is one of the most significant complications after liver transplant. It is attributed mainly to nephrotoxicity caused by calcineurin inhibitors. We evaluated the renal functioning in liver transplant recipients alive for at least 6 months after liver transplant.
Materials and Methods: One hundred seventy patients (108 male [63.5%], 62 female [36.5%]; mean age, 31.4 ± 13.3 years; age range, 13-61 years) were included in this study. Patients who had undergone a liver transplant between 1994 and 2006 at the Organ Transplantation Center of the Shiraz University of Medical Sciences in Shiraz, Iran, and had been alive for at least 6 months after surgery were included. Data were collected regarding age, sex, body mass index, underlying liver disease, graft type, immunosuppressive medications, serum creatinine levels, and glomerular filtration rate before, 1, and 6 months after liver transplant. Renal dysfunction was defined as a serum creatinine level above 132.6 µmol/L or a glomerular filtration rate less than 60 mL/min/1.73 m2, based on our reference range. Glomerular filtration rate was calculated using the Schwartz formula (glomerular filtration rate mL/min/1.73 m2 = K × Ht (cm) / Cr mg/dL). Data were analyzed with SPSS software.
Results: The mean follow-up was 25.9 ± 23.5 months (range, 6-156 months). The main indications for liver transplant were cryptogenic cirrhosis (n=42), hepatitis B infection (n=34), autoimmune cirrhosis (n=30), Wilson’s disease (n=21), and primary sclerosing cholangitis (n=18). The mean pretransplant glomerular filtration rate was 93.7 ± 35.6 mL/min/1.73 m2. The mean glomerular filtration rates in the first and sixth months after liver transplant were 81.6 ± 29.3 mL/min/1.73 m2 and 83.6 ± 32.9 mL/min/1.73 m2. Sex, body mass index, type of immunosuppressive medication, and underlying liver disease were not predictors of renal dysfunction (P > .05). Posttransplant renal dysfunction was significantly more common in older patients (ie, those aged 38.8 years and older) (P = .0001) and those with a family history of renal disease (P < .05).
Conclusions: Renal dysfunction may be a significant problem for patients after liver transplant, and early detection of renal dysfunction in patients after liver transplant is important. Of all the risk factors studied here, only older age and family history of renal disease were correlated with development of renal dysfunction after liver transplant.
Liver Transplant for Hepatocellular Carcinoma: Experience in a Saudi Population
(Başkent Üniversitesi, 2008-03) Allam, Naglaa; Khalaf, Hatem; Fagih, Mosa; Al-Sebayel, Mohamed
Objectives: We present our experience with deceased-donor liver transplant and living-donor liver transplant for hepatocellular carcinoma. Between 2001 and 2007, we transplanted 133 organs (84 deceased-donor liver transplants, 49 living-donor liver transplants) in 126 patients (4 retransplants). Twenty-three patients had hepatocellular carcinoma (14 deceased-donor liver transplants and 9 living-donor liver transplants).
Materials and Methods: The medical records of these patients were reviewed for recipient clinical, biochemical, and imaging characteristics. Slides of explants were assessed. Overall survival and tumor recurrence states were determined. All characteristics were tested for their prognostic significance.
Results: The median age of the patients was 55 years and the median Mayo End-stage Liver Disease score was 16. The alpha-fetoprotein was ≥400 ng/mL in 4 patients. Histopathology revealed incidental cholangiocarcinoma in 2 patients and a hepatoblastoma in 1. The mean tumor size was 4 cm; the mean number of lesions was 2. Most tumors were graded as well or moderately differentiated; 4 were poorly differentiated. Gross macrovascular invasion was seen in 2 patients, while microvascular invasion was seen in 9. After a mean follow-up of 736 days, overall patient and graft survival rates were 80.9% and 76.2%; overall disease-free patient and graft survival rates were 76.2% and 71.4%. Two patients died of primary graft nonfunction within 1 week of the transplant. Three had tumor recurrence at 10, 13, and 18 months after transplant; 2 of these occurred in patients with cholangiocarcinoma. Two of these 3 died from an advanced tumor within few months. Significant risk factors for recurrence were gross major vessel invasion, microvascular invasion, tumor size, poor histologic differentiation, and absence of pretransplant tumor control therapy. The latter 2, in addition to Mayo End-stage Liver Disease score and preoperative alpha-fetoprotein, were independent predictors of mortality.
Conclusions: In our small experience, deceased-donor liver transplant and living-donor liver transplant for hepatocellular carcinoma showed good long-term outcomes. Liver transplant for hepatocellular carcinoma accompanying cholangiocarcinoma had a poor outcome with late tumor recurrence. Use of marginal donors in patients with hepatocellular carcinoma might compromise the outcome in these patients.
Pediatric Liver Transplant: Results of a Single Center
(Başkent Üniversitesi, 2008-03) Haberal, Mehmet; Arslan, Gulnaz; Demirhan, Beyhan; Torgay, Adnan; Yilmaz, Ugur; Moray, Gokhan; Ozcay, Figen; Karakayali, Hamdi; Sevmis, Sinasi
Objectives: Liver transplant in the pediatric population has become an accepted treatment modality for children with end-stage liver disease. In this study, we analyze our experiences with pediatric liver transplant at our center.
Materials and Methods: Since September 2001, 8 deceased-donor and 96 living-donor liver transplants have been done in 101 children (mean age, 6.7 ± 5.5 years; range, 2 months to 17 years). The children’s charts were reviewed retrospectively.
Results: Indications for liver transplant were cholestatic liver disease (n=17), biliary atresia (n=24), Wilson’s disease (n=16), fulminant liver failure (n=18), hepatic tumor (n=13), and other (n=13). The median pediatric end-stage liver disease score was 23.1 ± 11.1 (range, –8 to 48). The median follow-up was 24.2 ± 19.4 months (range, 1-77 months). Three children underwent retransplant. The main complications were infections (25.9%) and surgical complications (39.5%) (including biliary complications and vascular problems). The incidence of acute cellular rejection was 42.3%. Sixteen children died during follow-up, and, at the time of this writing, the remaining 85 children (85%) were alive with good graft functioning, showing patient survival rates of 90%, 85%, and 83% at 6, 12, and 36 months, respectively.
Conclusions: In conclusion, the overall outcomes of pediatric liver transplantation at our center are quite promising.
Effect of Donor Cell Type on Complement-Dependent Cytotoxicity Crossmatch Outcome for Patients Immunized Against HLA Class-II Antigens
(Başkent Üniversitesi, 2008-03) Arnold, Marie-Luise; Spriewald, Bernd M.; Doxiadis, Ilias I. N.; Ensminger, Stephan M.
Objectives: In the Eurotransplant zone, the crossmatch serum exchange program was established to reduce unnecessary organ shipment, using the complement-dependent cytotoxicity crossmatch as the reference to make the decision. Crossmatching at the donor center dictates whether the transplant should be shipped to the recipient center where a decisive crossmatch would then be done. However, in recent years, the target cell used for the crossmatching has changed from spleen cells to peripheral blood lymphocytes. In this study, we assess the impact of this change on the outcome of complement-dependent cytotoxicity crossmatches for patients immunized against HLA-class II.
Materials and Methods: The influence of the donor cell type was analyzed by crossmatching unseparated peripheral blood lymphocytes, separated T and B lymphocytes, as well as spleen cells from 12 organ donors with sera from 40 immunized kidney retransplant candidates. Negative sera and sera harboring only anti-HLA class-II antibodies were used as additional controls.We did more than 1200 complement-dependent cytotoxicity crossmatches.
Results: Crossmatches with sera containing anti-HLA class-I plus class-II alloantibodies (n=113 per cell type) were positive in 42% of peripheral blood lymphocytes, 72% of spleen cells, and 81% of B cells. Crossmatches with sera containing exclusively anti-HLA class-II antibodies (n=89 per cell type) were positive in 1% of peripheral blood lymphocytes, 30% of spleen cells, and in 31% of B cells. Overall, spleen or separated B cells identified approximately 30% more positive donor-recipient pairs.
Conclusions: The data show that the change from spleen cells to peripheral blood lymphocytes as donor target cells for complement-dependent cytotoxicity crossmatching increased risk of false negative results for patients harboring anti-HLA class-II antibodies.
Alteration of Direct and Indirect Effects of Cytomegalovirus
(Başkent Üniversitesi, 2007-12) Kamar, Nassim; Rostaing, Lionel; Mengelle, Catherine
For recipients of a solid organ transplant, cytomegalovirus infection causes many pathological conditions including direct and indirect effects, most notably owing to the potency of the immunosuppressive medications used. Effects attributed to cytomegalovirus infection include graft rejection, decreased graft and patient survival rates, predisposition to other opportunistic infections, virally mediated malignancies, and various injuries specific to the transplanted organs (eg, accelerated coronary atherosclerosis following heart transplant, bronchiolitis obliterans syndrome in lung transplants, and vanishing bile-duct syndrome in liver allografts). Other indirect effects include posttransplant lymphoproliferative disorders, posttransplant new onset diabetes, and recurrence of hepatitis C virus infection. Direct effects are related to viral burden, whereas indirect effects may be observed even in the presence of low levels of cytomegalovirus replication. Being a function of the interaction between the virus and the host’s immune and inflammatory responses, the underlying indirect effects of viral infection are not completely understood. Whereas it has been shown that cytomegalovirus prophylaxis can decrease the direct and indirect effects of the virus, recent data indicate that pre-emptive therapy has no long-term impact upon the indirect effects. Prevention of cytomegalovirus-related indirect effects might be achieved only with prophylaxis.