Radiocontrast administration is an important cause of acute renal failure. In this study, compare... more Radiocontrast administration is an important cause of acute renal failure. In this study, compared the plasma creatinine levels with spot urine IL-18 levels following radiocontrast administration. Twenty patients (11 males, 9 females) underwent radiocontrast diagnostic and therapeutic-enhanced examinations. The RIN Mehran risk score was low (≤5). The radiocontrast agents used were 623 mg/mL Iopromid (1.5 mL/kg), and 100 mL of 650 mg/mL meglumine diatrizoate as three-way oral and rectal contrast material for abdominal computed tomography (CT) scans. Serum blood urea nitrogen, creatinine, Na, K, Cl, Ca, P, creatinine clearance, and spot urine IL-18 levels were analyzed before and repeated at 24, 48, and 72 h after radiocontrast administration. Six and 24-h urinary IL-18 levels were measured with a human IL-18 ELISA kit following radiocontrast administration. An increase in plasma creatinine 24 and 48 h following radiocontrast administration was observed compared with precontrast values, but it was not statistically significant (P=0.052 and P=0.285, respectively). A statistically significant increase in IL-18 levels was observed at 6 and 24 h, compared with precontrast values (P=0.048 and P=0.028, respectively). A tendency for postcontrast 24-h urinary IL-18 levels to increase was observed compared with 6 h, but the increase was not statistically significant (P=0.808). Our results show that plasma creatinine starts to increase at 24 th hour; however, spot urine IL-18 levels go up at 6 th hour following radiocontrast administration implying urine IL-18 to be an earlier parameter for kidney injury.
PURPOSE: Excision followed by natal cleft depth reduction should be performed, with no leftover m... more PURPOSE: Excision followed by natal cleft depth reduction should be performed, with no leftover midline scar tissue, to prevent recurrence of pilonidal sinus, which is the main problem in the treatment of this disease. We investigated the potential advantages of this advancing flap technique, which we developed. METHOD: An S-type incision together with a bilateral gluteus maximus fascia advancing flap was applied on 278 (89 percent) patients, who did not have extensive gluteal involvement, of the 312 patients who had pilonidal sinus disease, between January 1997 and January 2007. No drainage was performed on any patient. RESULTS: All patients were discharged within 24 hours. Total complication rate was 7.2 percent and recurrence rate was 0.7 percent. The mean time off from work was 12 T 2 days (range, 10 to 22). The mean follow-up period was 66 T 32 months (range, 12 to 120). CONCLUSION: We suggest that this surgical procedure may successfully be applied to a large majority of the patients. It does not lead to unnecessary excision of healthy tissue because of its significantly simpler nature compared with the full-layer flap technique and its S-type incision, it does not create a midline scar tissue, and it is able to flatten the gluteal sulcus.
The coronavirus disease 2019 (COVID‐19) has affected more than a hundred million individuals and ... more The coronavirus disease 2019 (COVID‐19) has affected more than a hundred million individuals and caused more than three million deaths worldwide. Specific risk groups were defined for increased risk of mortality and morbidity in COVID‐19, and renal transplant recipients are at a significantly increased risk regarding outcomes due to their immunosuppressed conditions. This study evaluated the general characteristics of kidney transplant recipients with COVID‐19 infection. Among 1257 transplant cases, 56 had COVID‐19 infection, and 23 (41%) were hospitalized during the 9‐month study period. Among all COVID‐19 cases, 58% were male with a mean age of 45.5 (±13.2, 19–71) years, and the most frequent comorbidities were hypertension (70.9%) and diabetes (23.6%). Hospitalized patients were older (p = 0.03) and had higher rates of hypertension (p = 0.008), diabetes (p = 0.002), and ischemic heart disease (p = 0.03). Therapeutic management included antimetabolite withdrawal and prednisolone increase in 71%, calcineurin inhibitor withdrawal in 8% and decrease in 58%, hydroxychloroquine in 17%, tocilizumab in 3%, and antivirals in 67% of patients. Acute kidney injury and respiratory failure developed in 34% and 85%, respectively. The mortality rate was 23%. These results emphasized that the COVID‐19 infection in renal transplant recipients significantly increases the risk of morbidity and mortality. Therefore, these patients should be intervened earlier and monitored closely to prevent poor outcomes.
Objective: Alport syndrome is an inherited disease that occurs in 1/50,000 and is characterized b... more Objective: Alport syndrome is an inherited disease that occurs in 1/50,000 and is characterized by hematuria, kidney failure, deafness and ocular anomalies. Alport syndrome, which is inherited as X-linked recessive with a rate of 85%, may be inherited also as autosomal dominant or autosomal recessive. Defective type-4 collagen participating in the structure of glomerular basement membrane causes a progressive decline in kidney functions. This research investigates the results of end-stage renal failure in patients with Alport syndrome following kidney transplantation. Methods: In our Hospital Organ Transplant Center 11 kidney transplantations were performed in 10 patients with Alport syndrome between October 2010 and December 2020. The recipients were analyzed retrospectively for acute rejection, complication rate, graft and patient survival. Results: Eleven (0.88%) of 1,251 kidney transplants were performed in patients with Alport syndrome. Acute rejection did not occur in any patient after kidney transplantation and no medical or surgical complications were observed in the early postoperative period. One patient died 19 months after surgery because of pneumonia and sepsis while his graft was functional. Graft loss was observed in two patients. In one of these patients, graft loss developed due to drug incompatibility in the 11 th month after kidney transplantation. In the other patient, graft loss was observed due to chronic allograft nephropathy in the 63 rd month postoperatively. This patient underwent a second kidney transplant surgery from a living donor. Conclusion: Alport syndrome is a rare cause of chronic kidney failure. Kidney transplantation is an effective and successful treatment method for end-stage renal disease patients with Alport syndrome.
Objective: Tacrolimus is used in more than 80% of kidney transplant recipients due to its ability... more Objective: Tacrolimus is used in more than 80% of kidney transplant recipients due to its ability to avoid rejection. Irregularities in tacrolimus level may affect clinical outcomes by subjecting patients to adverse events associated with graft rejection or immunosuppressive therapy. There are two forms of tacrolimus; immediate-release (IR-T) and prolonged release (PR-T). This study is designed to compare the clinical follow-up of kidney transplant patients who are receiving prolonged-release (PR-T; Advagraf) and immediate-release (IR-T; Prograf) tacrolimus in the posttransplant first week. Methods: This study included 78 de novo, adult kidney transplant patients to prolonged-release tacrolimus 0.15 mg/kg/day (group 1, n=39) and immediate-release tacrolimus 0.15 mg/kg/day (group 2, n=39) for the first week in the posttransplant period. Demographic features, whole blood tacrolimus levels and kidney function were compared between the two groups. The presence of acute rejection and adverse events, antihypertensive drug use and arterial blood pressure of all patients were considered. Drug doses were determined according to the previously targeted tacrolimus level. SPSS 22 for Windows was used for statistical analysis. Results: Acute rejection was not seen in any patient and there were no adverse events in the posttransplant first week. However, group 2 patients were found to have higher tacrolimus levels on the posttransplant 1 st , 4 th and 7 th days (p=0.02, p=0.009 and p=0.013 respectively). Serum creatinine levels were significantly increased in group 2 patients on the posttransplant 7 th day (p=0.02). Systolic, diastolic or mean arterial blood pressure were not different between the groups. Conclusion: Prolonged-release tacrolimus is effective in preventing acute rejection when adequate blood levels are maintained, and appears promising as it makes it possible to avoid interindividual variation in absorption and early calcineurin inhibitor toxicity.
Background: The use of grafts with multiple renal arteries has been considered a relative contrai... more Background: The use of grafts with multiple renal arteries has been considered a relative contraindication because of the increased incidence of vascular and urologic complications The aim of this study is to determine whether the kidney grafts with multiple arteries have any adverse effect upon post-transplant graft and patient survival. Methods: We reviewed the records of 225 adult kidney transplants done consecutively at our institution. Twenty-nine patients (12.8%) had grafts with multiple renal arteries. We analyzed the incidence of post-transplant hypertension and vascular complications, mean creatinine levels, patient and graft survival. In 17 cases reconstruction was done as conjoined anastomosis between two arteries of equal size, and in 6 cases as end-to-side anastomosis of smaller arteries to larger arteries. Multiple anastomoses were performed in 6 cases. Results: In one patient postoperative bleeding occurred. Mean systolic blood pressures, creatinine levels at first year and last follow-up and complication rates were all in acceptable ranges. There was no significant difference in graft and patient survival between multiple and single renal artery allografts. Conclusion: Although the kidney grafts with multiple renal arteries have been considered a relative contraindication because of the increased risk of complications, in our study allografts with multiple arteries were used successfully in kidney transplantation.
All primary radiocephalic fistulas created between January 1991 and July 2001 at the transplantat... more All primary radiocephalic fistulas created between January 1991 and July 2001 at the transplantation unit of Haydarpasa Research and Teaching Hospital, one of the reference centers of Istanbul that supplies 12 dialysis units, were included in the study. All of the operations were performed by the authors belonging to this center. Characteristics of patients in relation to fistula patency were recorded. In all patients, a normal radial pulse and distensible veins at the wrist were determined by clinical examination. Patients undergoing other types of vascular access or secondary fistula formation were excluded. All fistulas were created in a side of artery and end of vein fashion with 7/0 polypropylene under local anesthesia. The artery and the vein were flushed with 1/50 diluted heparin. Venous patch technique (Fig. 1): This technique has been described previously in detail (7). Briefly, in cases where the anatomy was feasible, the cephal
BACKGROUND The calcium sending receptor (CaSR) allows parathyroid and kidney tubular cells to reg... more BACKGROUND The calcium sending receptor (CaSR) allows parathyroid and kidney tubular cells to regulate PTH secretion and tubular calcium reabsorption. In the present report, we examined the relationship between CaSR gene polymorphisms and parathyroid CaSR expression and serum calcium/parathyroid hormone (PTH) levels and clinical progress in ESRD patients in the Turkish population. METHODS We genotyped the CaSR R990G and Q1011E variants in 192 end-stage renal disease (ESRD) patients by allele-specific PCR. CaSR expression in parathyroid tissues of operated 33 patients was quantified with quantitative reverse transcription-PCR. RESULTS Compared with other genotypes, the ratio of both codon 990-AA and 1011-CC polymorphisms was found higher in operated patients (p = 0.001). In the total patient group PTH levels were found higher in patients with CC1011 genotype than those with CG1011 (1015.15 +/- 925.41 pg/ml; 523.84 +/- 544.6 pg/ml, respectively, p = 0.002). There were statistically im...
Background: Cardiovascular death remains the number one cause of mortality in kidney transplant r... more Background: Cardiovascular death remains the number one cause of mortality in kidney transplant recipients. Cardiovascular events alone are associated with signifi cant morbidity. Unfortunately, current trends in cardiovascular events after kidney transplantation are poorly understood. Methods: We conducted a retrospective observational study using Ontario's linked healthcare databases to follow all fi rst-time kidney-only transplant recipients between 1994 to 2009. Our primary outcome was a composite of death or fi rst major cardiovascular event defi ned as one of myocardial infarction, coronary angioplasty, coronary bypass surgery, or stroke within three years of the transplant date. Results: There were 4954 fi rst-time kidney-only transplant recipients during the study period, of which 63% were male. The median age steadily increased from 43 years (interquartile range [IQR] 33-54) in 1994 to 53 years (IQR 42-62) in 2009 as did the proportion of recipients aged 65 years old older (3.8% in 1994 to 20.4% in 2009). There was also an increase in the proportion of recipients with diabetes (19.2% in 1994 to 29.9% in 2009) and coronary artery disease (23.7% in 1994 to 37.7% in 2009). A total of 444 recipients (8.8%) died or experienced a major cardiovascular event within three years of transplantation and this incidence remained stable throughout the study period. Conclusion: Despite transplant centres accepting recipients who are older with more co-morbidities, the three-year incidence of death or major cardiovascular event has remained stable from 1994 to 2009. These results are reassuring for transplant programs.
All primary radiocephalic fistulas created between January 1991 and July 2001 at the transplantat... more All primary radiocephalic fistulas created between January 1991 and July 2001 at the transplantation unit of Haydarpasa Research and Teaching Hospital, one of the reference centers of Istanbul that supplies 12 dialysis units, were included in the study. All of the operations were performed by the authors belonging to this center. Characteristics of patients in relation to fistula patency were recorded. In all patients, a normal radial pulse and distensible veins at the wrist were determined by clinical examination. Patients undergoing other types of vascular access or secondary fistula formation were excluded. All fistulas were created in a side of artery and end of vein fashion with 7/0 polypropylene under local anesthesia. The artery and the vein were flushed with 1/50 diluted heparin. Venous patch technique (Fig. 1): This technique has been described previously in detail (7). Briefly, in cases where the anatomy was feasible, the cephal
Purpose. Correlating with the obesity epidemic, the number of obese transplant candidates is incr... more Purpose. Correlating with the obesity epidemic, the number of obese transplant candidates is increasing. This study was designed to evaluate the effect of obesity on the survival of our kidney transplant recipients. Methods. Among 1033 kidney transplants performed during the last 7.5 years in our center, 750 adult recipients were transplanted from living donors and were evaluated, and 561 of them were included in the study. Demographic and clinical data were collected. Body mass index (BMI) values at the time of transplant and post-transplant during the first year, the presence of delayed graft function, hospitalization duration, number of readmissions within the first year post-transplant, presence of post-transplant diabetes mellitus (PTDM) and cardiovascular disease, and graft and patient survival rates at 1, 3, and 5 years were investigated. Results. Obesity (BMI >30) was observed in 148 (19.7%) at the time of the transplant (initial obesity) and in 174 (23.2%) recipients at post-transplant first year. Initial obesity was not only found to be correlated with delayed wound healing (P ¼ .03), increased hospitalization duration (P ¼ .03), number of readmissions within the first year (P ¼ .04), presence of PTDM (P ¼ .02), and cardiovascular disease (P ¼ .03) but also with lower graft survival rate (P ¼ .04) at the first year. On the other hand, obesity at posttransplant the first year was associated with lower 3-and 5-year grafts (P ¼ .04 and P ¼ .03, respectively) and 5-year patient (P ¼ .03) survival rates. Conclusion. Obesity should not be considered as a contraindication for kidney transplantation; however, to achieve better results, certain precautions should be taken pre-and postoperatively.
Objective. The aim of this study was to compare the results of standard laparoscopic donor nephre... more Objective. The aim of this study was to compare the results of standard laparoscopic donor nephrectomy with vaginal extraction (SLDN-VE) and laparoendoscopic single-site donor nephrectomy with vaginal extraction (LESSDN-VE). Methods. We analyzed the data of 95 female donors who underwent SLDN-VE (group I; n ¼ 87) and LESSDN-VE (group II; n ¼ 8) in our center. Parameters regarding donor age, body mass index (BMI), length of hospitalization, duration of surgical procedure, amount of blood loss, warm and cold ischemia times, side of graft nephrectomy, number of renal arteries and veins, postoperative visual analog pain scores at 6th and 12th hours (VAS6, VAS12), peri-and postoperative complications of donors and recipients, and graft function at discharge and follow-up were compared between the 2 groups. Results. No significant difference regarding donor age, mean operative time, amount of blood loss, or warm ischemia time was observed between the 2 groups. However, BMI (P ¼ .018) and pain scores (VAS6: P ¼ .047; VAS12: P ¼ .009) were lower and length of hospitalization (P ¼ .005) shorter in group II. On the other hand, cold ischemia time (P ¼ .047) was lower in group I. No peri-or postoperative complications occurred for donors and recipients in both groups. Graft function at discharge and during follow-up were similar in both groups. Conclusions. Because our first priority is to minimize the morbidity of donors, LESSDN-VE can be chosen in selected female donors for not only decreased pain and hospital stay, but also for better cosmetic outcomes.
Background. Kidney transplant recipients are known to have bone disease, specifically osteoporosi... more Background. Kidney transplant recipients are known to have bone disease, specifically osteoporosis. In this descriptive clinical study we aimed to evaluate the incidence of osteoporosis and to determine the risk factors among our transplant recipients. Methods. A total of 109 patients (82 males and 27 females) aged from 19 to 70 years, who had undergone kidney transplantation 12 to 69 months previously, were included in the study. Bone mineral densitometry was performed using dual-energy X-ray absorptiometry. The correlation between femur and lumbar spine T-scores with age, gender, posttransplantation duration, serum 25 hydroxy vitamin D, parathyroid hormone, calcium, phosphorus, creatinine, and hemoglobin values were investigated. Results. The incidence of osteoporosis was 22% (24 of 109 patients). The most common sites of osteoporosis were the femur (osteoporotic in 17 patients [15.5%] and osteopenic in 57 [52.2%]) and the lumbar spine (osteoporotic in 24 patients [22%] and osteopenic in 50 [45.8%]). Osteoporosis was found to have no relationship with age and gender. There was a significant negative correlation between serum parathyroid hormone levels with both femur and lumbar spine T-scores (P ¼ .013 and .033, respectively). However, serum phosphorus levels were negatively correlated with only femur T-scores (P ¼ .037). A positive correlation of hemoglobin with lumbar T-scores and a negative correlation with posttransplantation duration (P ¼ .038 and .012, respectively) were also observed. Conclusion. Bone disease after transplantation is a frequent complication, which may decrease the quality of life, so we believe it is important to reduce the morbidity; it is required to detect and correct the risk factors of this complex pathophysiological situation.
The object of this study was to better define the relevant anatomy and innervation of the anterol... more The object of this study was to better define the relevant anatomy and innervation of the anterolateral abdominal wall musculature seeking to avoid abdominal wall complication after open donor nephrectomy. We dissected four cadavers and retrospectively assessed donor ultrasonographic imaging of anterolateral abdominal muscle atrophy after donor nephrectomy with a lumbotomy incision. Anatomic study was performed on four cadavers using bilateral dissections. The 8th, 9th, 10th, 11th, and 12th (subcostal) intercostal nerves were dissected from the intercostal space to the rectus sheath. With the experience gained from anatomic study, we performed 40 living donor incisions 1.5 to 2 cm medial to the tip of 12th rib, toward the lateral border of the rectus muscle and the umbilicus. Donors were invited to the hospital at 1 year postoperative to examine abdominal wall complications. Ultrasonography (USG) was performed to assess the thickness of the abdominal wall muscles bilaterally to ascertain whether there was atrophy. All distal intercostal nerves ran as multiple mixed segmental nerves, communicating with each other widely within the neurovascular plane. The thick 12th nerve was located at 1.5 to 2 cm medial and under the tip of the 12th rib, running to the suprapubic area. Postoperative USG confirmed that the mean percent thickness of the abdominal muscles of the operative side was not significantly different from the other side (P < .05). Most significant intercostal nerve contributions to the anterolateral abdominal wall arise from T12. Damage to the intercostal nerves will be minimal if the lombotomy incision is performed above the safe line between the tip of the 12th rib and the umbilicus.
Purpose. This study sought to evaluate the outcomes of laparoscopic donor nephrectomy in donors a... more Purpose. This study sought to evaluate the outcomes of laparoscopic donor nephrectomy in donors age 70 years and older, who may be considered extremely old. Patients and Methods. We compared the outcomes of grafts from donors age 70 years and older (group ! 70; n ¼ 28) with donors younger than 55 years (group < 55; n ¼ 28) after matching these 2 groups in terms of sex, date of surgery, body mass index, and immunological features, retrospectively. Results. There was no statistical difference between the 2 groups in terms of operation duration, estimated blood loss, and cold ischemia time. However, warm ischemia time was found to be slightly longer in the younger group. The mean hospital stay length was similar for both groups, and no postoperative complications occurred in any donor. Early and intermediate-term serum creatinine levels of donors and their recipients were not statistically different in both groups. Conclusions. Laparoscopic donor nephrectomy can be performed safely in selected extremely old donors without concern for early and intermediate-term graft function, with the aim of extending donor pool.
Radiocontrast administration is an important cause of acute renal failure. In this study, compare... more Radiocontrast administration is an important cause of acute renal failure. In this study, compared the plasma creatinine levels with spot urine IL-18 levels following radiocontrast administration. Twenty patients (11 males, 9 females) underwent radiocontrast diagnostic and therapeutic-enhanced examinations. The RIN Mehran risk score was low (≤5). The radiocontrast agents used were 623 mg/mL Iopromid (1.5 mL/kg), and 100 mL of 650 mg/mL meglumine diatrizoate as three-way oral and rectal contrast material for abdominal computed tomography (CT) scans. Serum blood urea nitrogen, creatinine, Na, K, Cl, Ca, P, creatinine clearance, and spot urine IL-18 levels were analyzed before and repeated at 24, 48, and 72 h after radiocontrast administration. Six and 24-h urinary IL-18 levels were measured with a human IL-18 ELISA kit following radiocontrast administration. An increase in plasma creatinine 24 and 48 h following radiocontrast administration was observed compared with precontrast values, but it was not statistically significant (P=0.052 and P=0.285, respectively). A statistically significant increase in IL-18 levels was observed at 6 and 24 h, compared with precontrast values (P=0.048 and P=0.028, respectively). A tendency for postcontrast 24-h urinary IL-18 levels to increase was observed compared with 6 h, but the increase was not statistically significant (P=0.808). Our results show that plasma creatinine starts to increase at 24 th hour; however, spot urine IL-18 levels go up at 6 th hour following radiocontrast administration implying urine IL-18 to be an earlier parameter for kidney injury.
PURPOSE: Excision followed by natal cleft depth reduction should be performed, with no leftover m... more PURPOSE: Excision followed by natal cleft depth reduction should be performed, with no leftover midline scar tissue, to prevent recurrence of pilonidal sinus, which is the main problem in the treatment of this disease. We investigated the potential advantages of this advancing flap technique, which we developed. METHOD: An S-type incision together with a bilateral gluteus maximus fascia advancing flap was applied on 278 (89 percent) patients, who did not have extensive gluteal involvement, of the 312 patients who had pilonidal sinus disease, between January 1997 and January 2007. No drainage was performed on any patient. RESULTS: All patients were discharged within 24 hours. Total complication rate was 7.2 percent and recurrence rate was 0.7 percent. The mean time off from work was 12 T 2 days (range, 10 to 22). The mean follow-up period was 66 T 32 months (range, 12 to 120). CONCLUSION: We suggest that this surgical procedure may successfully be applied to a large majority of the patients. It does not lead to unnecessary excision of healthy tissue because of its significantly simpler nature compared with the full-layer flap technique and its S-type incision, it does not create a midline scar tissue, and it is able to flatten the gluteal sulcus.
The coronavirus disease 2019 (COVID‐19) has affected more than a hundred million individuals and ... more The coronavirus disease 2019 (COVID‐19) has affected more than a hundred million individuals and caused more than three million deaths worldwide. Specific risk groups were defined for increased risk of mortality and morbidity in COVID‐19, and renal transplant recipients are at a significantly increased risk regarding outcomes due to their immunosuppressed conditions. This study evaluated the general characteristics of kidney transplant recipients with COVID‐19 infection. Among 1257 transplant cases, 56 had COVID‐19 infection, and 23 (41%) were hospitalized during the 9‐month study period. Among all COVID‐19 cases, 58% were male with a mean age of 45.5 (±13.2, 19–71) years, and the most frequent comorbidities were hypertension (70.9%) and diabetes (23.6%). Hospitalized patients were older (p = 0.03) and had higher rates of hypertension (p = 0.008), diabetes (p = 0.002), and ischemic heart disease (p = 0.03). Therapeutic management included antimetabolite withdrawal and prednisolone increase in 71%, calcineurin inhibitor withdrawal in 8% and decrease in 58%, hydroxychloroquine in 17%, tocilizumab in 3%, and antivirals in 67% of patients. Acute kidney injury and respiratory failure developed in 34% and 85%, respectively. The mortality rate was 23%. These results emphasized that the COVID‐19 infection in renal transplant recipients significantly increases the risk of morbidity and mortality. Therefore, these patients should be intervened earlier and monitored closely to prevent poor outcomes.
Objective: Alport syndrome is an inherited disease that occurs in 1/50,000 and is characterized b... more Objective: Alport syndrome is an inherited disease that occurs in 1/50,000 and is characterized by hematuria, kidney failure, deafness and ocular anomalies. Alport syndrome, which is inherited as X-linked recessive with a rate of 85%, may be inherited also as autosomal dominant or autosomal recessive. Defective type-4 collagen participating in the structure of glomerular basement membrane causes a progressive decline in kidney functions. This research investigates the results of end-stage renal failure in patients with Alport syndrome following kidney transplantation. Methods: In our Hospital Organ Transplant Center 11 kidney transplantations were performed in 10 patients with Alport syndrome between October 2010 and December 2020. The recipients were analyzed retrospectively for acute rejection, complication rate, graft and patient survival. Results: Eleven (0.88%) of 1,251 kidney transplants were performed in patients with Alport syndrome. Acute rejection did not occur in any patient after kidney transplantation and no medical or surgical complications were observed in the early postoperative period. One patient died 19 months after surgery because of pneumonia and sepsis while his graft was functional. Graft loss was observed in two patients. In one of these patients, graft loss developed due to drug incompatibility in the 11 th month after kidney transplantation. In the other patient, graft loss was observed due to chronic allograft nephropathy in the 63 rd month postoperatively. This patient underwent a second kidney transplant surgery from a living donor. Conclusion: Alport syndrome is a rare cause of chronic kidney failure. Kidney transplantation is an effective and successful treatment method for end-stage renal disease patients with Alport syndrome.
Objective: Tacrolimus is used in more than 80% of kidney transplant recipients due to its ability... more Objective: Tacrolimus is used in more than 80% of kidney transplant recipients due to its ability to avoid rejection. Irregularities in tacrolimus level may affect clinical outcomes by subjecting patients to adverse events associated with graft rejection or immunosuppressive therapy. There are two forms of tacrolimus; immediate-release (IR-T) and prolonged release (PR-T). This study is designed to compare the clinical follow-up of kidney transplant patients who are receiving prolonged-release (PR-T; Advagraf) and immediate-release (IR-T; Prograf) tacrolimus in the posttransplant first week. Methods: This study included 78 de novo, adult kidney transplant patients to prolonged-release tacrolimus 0.15 mg/kg/day (group 1, n=39) and immediate-release tacrolimus 0.15 mg/kg/day (group 2, n=39) for the first week in the posttransplant period. Demographic features, whole blood tacrolimus levels and kidney function were compared between the two groups. The presence of acute rejection and adverse events, antihypertensive drug use and arterial blood pressure of all patients were considered. Drug doses were determined according to the previously targeted tacrolimus level. SPSS 22 for Windows was used for statistical analysis. Results: Acute rejection was not seen in any patient and there were no adverse events in the posttransplant first week. However, group 2 patients were found to have higher tacrolimus levels on the posttransplant 1 st , 4 th and 7 th days (p=0.02, p=0.009 and p=0.013 respectively). Serum creatinine levels were significantly increased in group 2 patients on the posttransplant 7 th day (p=0.02). Systolic, diastolic or mean arterial blood pressure were not different between the groups. Conclusion: Prolonged-release tacrolimus is effective in preventing acute rejection when adequate blood levels are maintained, and appears promising as it makes it possible to avoid interindividual variation in absorption and early calcineurin inhibitor toxicity.
Background: The use of grafts with multiple renal arteries has been considered a relative contrai... more Background: The use of grafts with multiple renal arteries has been considered a relative contraindication because of the increased incidence of vascular and urologic complications The aim of this study is to determine whether the kidney grafts with multiple arteries have any adverse effect upon post-transplant graft and patient survival. Methods: We reviewed the records of 225 adult kidney transplants done consecutively at our institution. Twenty-nine patients (12.8%) had grafts with multiple renal arteries. We analyzed the incidence of post-transplant hypertension and vascular complications, mean creatinine levels, patient and graft survival. In 17 cases reconstruction was done as conjoined anastomosis between two arteries of equal size, and in 6 cases as end-to-side anastomosis of smaller arteries to larger arteries. Multiple anastomoses were performed in 6 cases. Results: In one patient postoperative bleeding occurred. Mean systolic blood pressures, creatinine levels at first year and last follow-up and complication rates were all in acceptable ranges. There was no significant difference in graft and patient survival between multiple and single renal artery allografts. Conclusion: Although the kidney grafts with multiple renal arteries have been considered a relative contraindication because of the increased risk of complications, in our study allografts with multiple arteries were used successfully in kidney transplantation.
All primary radiocephalic fistulas created between January 1991 and July 2001 at the transplantat... more All primary radiocephalic fistulas created between January 1991 and July 2001 at the transplantation unit of Haydarpasa Research and Teaching Hospital, one of the reference centers of Istanbul that supplies 12 dialysis units, were included in the study. All of the operations were performed by the authors belonging to this center. Characteristics of patients in relation to fistula patency were recorded. In all patients, a normal radial pulse and distensible veins at the wrist were determined by clinical examination. Patients undergoing other types of vascular access or secondary fistula formation were excluded. All fistulas were created in a side of artery and end of vein fashion with 7/0 polypropylene under local anesthesia. The artery and the vein were flushed with 1/50 diluted heparin. Venous patch technique (Fig. 1): This technique has been described previously in detail (7). Briefly, in cases where the anatomy was feasible, the cephal
BACKGROUND The calcium sending receptor (CaSR) allows parathyroid and kidney tubular cells to reg... more BACKGROUND The calcium sending receptor (CaSR) allows parathyroid and kidney tubular cells to regulate PTH secretion and tubular calcium reabsorption. In the present report, we examined the relationship between CaSR gene polymorphisms and parathyroid CaSR expression and serum calcium/parathyroid hormone (PTH) levels and clinical progress in ESRD patients in the Turkish population. METHODS We genotyped the CaSR R990G and Q1011E variants in 192 end-stage renal disease (ESRD) patients by allele-specific PCR. CaSR expression in parathyroid tissues of operated 33 patients was quantified with quantitative reverse transcription-PCR. RESULTS Compared with other genotypes, the ratio of both codon 990-AA and 1011-CC polymorphisms was found higher in operated patients (p = 0.001). In the total patient group PTH levels were found higher in patients with CC1011 genotype than those with CG1011 (1015.15 +/- 925.41 pg/ml; 523.84 +/- 544.6 pg/ml, respectively, p = 0.002). There were statistically im...
Background: Cardiovascular death remains the number one cause of mortality in kidney transplant r... more Background: Cardiovascular death remains the number one cause of mortality in kidney transplant recipients. Cardiovascular events alone are associated with signifi cant morbidity. Unfortunately, current trends in cardiovascular events after kidney transplantation are poorly understood. Methods: We conducted a retrospective observational study using Ontario's linked healthcare databases to follow all fi rst-time kidney-only transplant recipients between 1994 to 2009. Our primary outcome was a composite of death or fi rst major cardiovascular event defi ned as one of myocardial infarction, coronary angioplasty, coronary bypass surgery, or stroke within three years of the transplant date. Results: There were 4954 fi rst-time kidney-only transplant recipients during the study period, of which 63% were male. The median age steadily increased from 43 years (interquartile range [IQR] 33-54) in 1994 to 53 years (IQR 42-62) in 2009 as did the proportion of recipients aged 65 years old older (3.8% in 1994 to 20.4% in 2009). There was also an increase in the proportion of recipients with diabetes (19.2% in 1994 to 29.9% in 2009) and coronary artery disease (23.7% in 1994 to 37.7% in 2009). A total of 444 recipients (8.8%) died or experienced a major cardiovascular event within three years of transplantation and this incidence remained stable throughout the study period. Conclusion: Despite transplant centres accepting recipients who are older with more co-morbidities, the three-year incidence of death or major cardiovascular event has remained stable from 1994 to 2009. These results are reassuring for transplant programs.
All primary radiocephalic fistulas created between January 1991 and July 2001 at the transplantat... more All primary radiocephalic fistulas created between January 1991 and July 2001 at the transplantation unit of Haydarpasa Research and Teaching Hospital, one of the reference centers of Istanbul that supplies 12 dialysis units, were included in the study. All of the operations were performed by the authors belonging to this center. Characteristics of patients in relation to fistula patency were recorded. In all patients, a normal radial pulse and distensible veins at the wrist were determined by clinical examination. Patients undergoing other types of vascular access or secondary fistula formation were excluded. All fistulas were created in a side of artery and end of vein fashion with 7/0 polypropylene under local anesthesia. The artery and the vein were flushed with 1/50 diluted heparin. Venous patch technique (Fig. 1): This technique has been described previously in detail (7). Briefly, in cases where the anatomy was feasible, the cephal
Purpose. Correlating with the obesity epidemic, the number of obese transplant candidates is incr... more Purpose. Correlating with the obesity epidemic, the number of obese transplant candidates is increasing. This study was designed to evaluate the effect of obesity on the survival of our kidney transplant recipients. Methods. Among 1033 kidney transplants performed during the last 7.5 years in our center, 750 adult recipients were transplanted from living donors and were evaluated, and 561 of them were included in the study. Demographic and clinical data were collected. Body mass index (BMI) values at the time of transplant and post-transplant during the first year, the presence of delayed graft function, hospitalization duration, number of readmissions within the first year post-transplant, presence of post-transplant diabetes mellitus (PTDM) and cardiovascular disease, and graft and patient survival rates at 1, 3, and 5 years were investigated. Results. Obesity (BMI >30) was observed in 148 (19.7%) at the time of the transplant (initial obesity) and in 174 (23.2%) recipients at post-transplant first year. Initial obesity was not only found to be correlated with delayed wound healing (P ¼ .03), increased hospitalization duration (P ¼ .03), number of readmissions within the first year (P ¼ .04), presence of PTDM (P ¼ .02), and cardiovascular disease (P ¼ .03) but also with lower graft survival rate (P ¼ .04) at the first year. On the other hand, obesity at posttransplant the first year was associated with lower 3-and 5-year grafts (P ¼ .04 and P ¼ .03, respectively) and 5-year patient (P ¼ .03) survival rates. Conclusion. Obesity should not be considered as a contraindication for kidney transplantation; however, to achieve better results, certain precautions should be taken pre-and postoperatively.
Objective. The aim of this study was to compare the results of standard laparoscopic donor nephre... more Objective. The aim of this study was to compare the results of standard laparoscopic donor nephrectomy with vaginal extraction (SLDN-VE) and laparoendoscopic single-site donor nephrectomy with vaginal extraction (LESSDN-VE). Methods. We analyzed the data of 95 female donors who underwent SLDN-VE (group I; n ¼ 87) and LESSDN-VE (group II; n ¼ 8) in our center. Parameters regarding donor age, body mass index (BMI), length of hospitalization, duration of surgical procedure, amount of blood loss, warm and cold ischemia times, side of graft nephrectomy, number of renal arteries and veins, postoperative visual analog pain scores at 6th and 12th hours (VAS6, VAS12), peri-and postoperative complications of donors and recipients, and graft function at discharge and follow-up were compared between the 2 groups. Results. No significant difference regarding donor age, mean operative time, amount of blood loss, or warm ischemia time was observed between the 2 groups. However, BMI (P ¼ .018) and pain scores (VAS6: P ¼ .047; VAS12: P ¼ .009) were lower and length of hospitalization (P ¼ .005) shorter in group II. On the other hand, cold ischemia time (P ¼ .047) was lower in group I. No peri-or postoperative complications occurred for donors and recipients in both groups. Graft function at discharge and during follow-up were similar in both groups. Conclusions. Because our first priority is to minimize the morbidity of donors, LESSDN-VE can be chosen in selected female donors for not only decreased pain and hospital stay, but also for better cosmetic outcomes.
Background. Kidney transplant recipients are known to have bone disease, specifically osteoporosi... more Background. Kidney transplant recipients are known to have bone disease, specifically osteoporosis. In this descriptive clinical study we aimed to evaluate the incidence of osteoporosis and to determine the risk factors among our transplant recipients. Methods. A total of 109 patients (82 males and 27 females) aged from 19 to 70 years, who had undergone kidney transplantation 12 to 69 months previously, were included in the study. Bone mineral densitometry was performed using dual-energy X-ray absorptiometry. The correlation between femur and lumbar spine T-scores with age, gender, posttransplantation duration, serum 25 hydroxy vitamin D, parathyroid hormone, calcium, phosphorus, creatinine, and hemoglobin values were investigated. Results. The incidence of osteoporosis was 22% (24 of 109 patients). The most common sites of osteoporosis were the femur (osteoporotic in 17 patients [15.5%] and osteopenic in 57 [52.2%]) and the lumbar spine (osteoporotic in 24 patients [22%] and osteopenic in 50 [45.8%]). Osteoporosis was found to have no relationship with age and gender. There was a significant negative correlation between serum parathyroid hormone levels with both femur and lumbar spine T-scores (P ¼ .013 and .033, respectively). However, serum phosphorus levels were negatively correlated with only femur T-scores (P ¼ .037). A positive correlation of hemoglobin with lumbar T-scores and a negative correlation with posttransplantation duration (P ¼ .038 and .012, respectively) were also observed. Conclusion. Bone disease after transplantation is a frequent complication, which may decrease the quality of life, so we believe it is important to reduce the morbidity; it is required to detect and correct the risk factors of this complex pathophysiological situation.
The object of this study was to better define the relevant anatomy and innervation of the anterol... more The object of this study was to better define the relevant anatomy and innervation of the anterolateral abdominal wall musculature seeking to avoid abdominal wall complication after open donor nephrectomy. We dissected four cadavers and retrospectively assessed donor ultrasonographic imaging of anterolateral abdominal muscle atrophy after donor nephrectomy with a lumbotomy incision. Anatomic study was performed on four cadavers using bilateral dissections. The 8th, 9th, 10th, 11th, and 12th (subcostal) intercostal nerves were dissected from the intercostal space to the rectus sheath. With the experience gained from anatomic study, we performed 40 living donor incisions 1.5 to 2 cm medial to the tip of 12th rib, toward the lateral border of the rectus muscle and the umbilicus. Donors were invited to the hospital at 1 year postoperative to examine abdominal wall complications. Ultrasonography (USG) was performed to assess the thickness of the abdominal wall muscles bilaterally to ascertain whether there was atrophy. All distal intercostal nerves ran as multiple mixed segmental nerves, communicating with each other widely within the neurovascular plane. The thick 12th nerve was located at 1.5 to 2 cm medial and under the tip of the 12th rib, running to the suprapubic area. Postoperative USG confirmed that the mean percent thickness of the abdominal muscles of the operative side was not significantly different from the other side (P &lt; .05). Most significant intercostal nerve contributions to the anterolateral abdominal wall arise from T12. Damage to the intercostal nerves will be minimal if the lombotomy incision is performed above the safe line between the tip of the 12th rib and the umbilicus.
Purpose. This study sought to evaluate the outcomes of laparoscopic donor nephrectomy in donors a... more Purpose. This study sought to evaluate the outcomes of laparoscopic donor nephrectomy in donors age 70 years and older, who may be considered extremely old. Patients and Methods. We compared the outcomes of grafts from donors age 70 years and older (group ! 70; n ¼ 28) with donors younger than 55 years (group < 55; n ¼ 28) after matching these 2 groups in terms of sex, date of surgery, body mass index, and immunological features, retrospectively. Results. There was no statistical difference between the 2 groups in terms of operation duration, estimated blood loss, and cold ischemia time. However, warm ischemia time was found to be slightly longer in the younger group. The mean hospital stay length was similar for both groups, and no postoperative complications occurred in any donor. Early and intermediate-term serum creatinine levels of donors and their recipients were not statistically different in both groups. Conclusions. Laparoscopic donor nephrectomy can be performed safely in selected extremely old donors without concern for early and intermediate-term graft function, with the aim of extending donor pool.
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Papers by Ibrahim Berber