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Öğe Effects of nutritional vitamin D supplementation on markers of bone and mineral metabolism in children with chronic kidney disease(Oxford Univ Press, 2018) Lerch, Christian; Shroff, Rukshana; Wan, Mandy; Rees, Lesley; Aitkenhead, Helen; Bulut, Ipek Kaplan; Thurn, Daniela; Bayazit, Aysun Karabay; Niemirska, Anna; Canpolat, Nur; Duzova, Ali; Azukaitis, Karolis; Yilmaz, Ebru; Yalcinkaya, Fatos; Harambat, Jerome; Kiyak, Aysel; Alpay, Harika; Habbig, Sandra; Zaloszyc, Ariane; Soylemezoglu, Oguz; Candan, Cengiz; Rosales, Alejandra; Melk, Anette; Querfeld, Uwe; Leifheit-Nestler, Maren; Sander, Anja; Schaefer, Franz; Haffner, Dieter; Cortina, G.; Arbeiter, K.; Dusek, J.; Harambat, J.; Ranchin, B.; Fischbach, M.; Zalosczyk, A.; Querfeld, U.; Habbig, S.; Galiano, M.; Buescher, R.; Gimpel, C.; Kemper, M.; Melk, A.; Thurn, D.; Schaefer, F.; Doyon, A.; Wuehl, E.; Pohl, M.; Wygoda, S.; Jeck, N.; Kranz, B.; Wigger, M.; Montini, G.; Lugani, F.; Testa, S.; Vidal, E.; Matteucci, C.; Picca, S.; Jankauskiene, A.; Azukaitis, K.; Zurowska, A.; Drodz, D.; Tkaczyk, M.; Urasinski, T.; Litwin, M.; Niemirska, A.; Szczepanska, M.; Texeira, A.; Peco-Antic, A.; Bucher, B.; Laube, G.; Anarat, A.; Bayazit, A. K.; Yalcinkaya, F.; Basin, E.; Cakar, N.; Soylemezoglu, O.; Duzova, A.; Bilginer, Y.; Erdogan, H.; Donmez, O.; Balat, A.; Kiyak, A.; Caliskan, S.; Canpolat, N.; Candan, C.; Civilibal, M.; Emre, S.; Alpay, H.; Ozcelik, G.; Mir, S.; Sozeri, B.; Yavascan, O.; Tabel, Y.; Ertan, P.; Yilmaz, E.; Shroff, R.; Prytula, A.; Bachetta, J.; Haffner, D.; Klaus, G.; Gessner, M.; Schmitt, C. P.; Stabouli, S.; Reusz, G.; Verrina, E.; Groothoff, J.; Tondel, C.; Gamero, M. A.; Petrosyan, E.; Bakkaloglu, S. A.; Dursun, I.; Shroff, R.Background. We investigated the effects of nutritional vitamin D supplementation on markers of bone and mineral metabolism, i.e. serum levels of fibroblast growth factor 23 (FGF23), Klotho, bone alkaline phosphatase (BAP) and sclerostin, in two cohorts with chronic kidney disease (CKD). Methods. In all, 80 vitamin D-deficient children were selected: 40 with mild to moderate CKD from the ERGO study, a randomized trial of ergocalciferol supplementation [ estimated glomerular filtration rate (eGFR) 55 mL/min/1.73 m(2)], and 40 with advanced CKD from the observational Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) study (eGFR 24 mL/min/1.73 m2). In each study, vitamin D supplementation was started in 20 children and 20 matched children not receiving vitamin D served as controls. Measures were taken at baseline and after a median period of 8 months. Age- and gender-related standard deviation scores (SDSs) were calculated. Results. Before vitamin D supplementation, children in the ERGO study had normal FGF23 (median 0.31 SDS) and BAP (-0.10 SDS) but decreased Klotho and sclerostin (-0.77 and -1.04 SDS, respectively), whereas 4C patients had increased FGF23 (3.87 SDS), BAP (0.78 SDS) and sclerostin (0.76 SDS) but normal Klotho (-0.27 SDS) levels. Vitamin D supplementation further increased FGF23 in 4C but not in ERGO patients. Serum Klotho and sclerostin normalized with vitamin D supplementation in ERGO but remained unchanged in 4C patients. BAP levels were unchanged in all patients. In the total cohort, significant effects of vitamin D supplementation were noted for Klotho at eGFR 40-70 mL/min/1.73 m(2). Conclusions. Vitamin D supplementation normalized Klotho and sclerostin in children with mild to moderate CKD but further increased FGF23 in advanced CKD.Öğe Immunosuppression after Liver Transplantation in Pediatric Population(Springer Nature, 2023) Umman, V.; Zeytunlu, M.; Emre, S.Pediatric liver transplantation has become the standard of care for children with end-stage liver disease, owing to advancement of surgical techniques including split liver transplantation and living donor liver transplantation which increased available organs. Furthermore, technological advancements, better understanding of disease process, patient selection and improved pre- and postoperative ICU care, better managing of short- and long-term complications secondary to increasing experience, and team effort have played important role for patient outcomes and satisfaction. In addition to these factors, understanding the immunological issues and development of new immunosuppressive medications have made the field of liver transplantation as an acceptable treatment modality. These advancements improved outcomes dramatically to 94% 1-year survival [1, 2]. Immunosuppressive therapy has substantial contribution in these results by prevention of rejection and early complications. On the other hand, immunosuppressive management of pediatric recipients has continued to be challenging for various reasons. In this chapter we aim to overview the current immunosuppressive medications, their mechanism of actions, pharmacokinetics, pharmacodynamics, side effects, and immunosuppressive strategies/protocols. © Springer Nature Singapore Pte Ltd. 2023.Öğe Liver paired exchange transplantation: overcoming the obstacles in living donor liver transplantation(Lippincott Williams & Wilkins, 2023) Sahin, T. T.; Yilmaz, S.; Emre, S.; Kutluturk, K.; Karakas, S.; Otan, E.; Cicek, E.[No abstract available]Öğe Predictive Value of Red Blood Cell Distribution Width, Platelet Count to Lymphocyte Count Ratio, and Neutrophil Count to Lymphocyte Count Ratio Values for the Detection of Postoperative Infection in Patients Undergoing Liver Transplantation(Elsevier Inc., 2023) Umman, V.; Gumus, T.; Kivratma, H.G.; Tabatabayi, P.; Uguz, A.; Zeytunlu, M.; Emre, S.Background: The red blood cell distribution width (RDW) value is a simple and fast parameter that shows an elevation in the presence of infectious disease. It is thought that proinflammatory signals cause changes in the cell wall of the erythrocytes. In our study, we aimed to investigate the prognostic value of RDW and other parameters in patients undergoing liver transplantation. Methods: We retrospectively investigated 200 patients who underwent liver transplantation (LT) in our center. The study group was 100 patients who underwent LT and developed a postoperative abdominal or catheter-related infection in the early period between the first and second weeks of hospitalization. The control group comprises 100 patients who underwent LT and were discharged without complications. In 4 different periods, inflammatory markers and RDW, platelet count to lymphocyte count ratio, and neutrophil count to lymphocyte count ratio (NLR) values were compared in the 2 groups. Results: In our study, we found RDW and NLR parameters to be elevated in correlation with infection in patients who underwent LT (P <.05). Other markers were elevated but not significantly correlated with infection. Conclusions: These parameters can be simple and effective additional tools to implement in patients suspected of infection. Further prospective studies with larger patient groups and varying infection states are required for validating RDW and NLR as additional diagnostic markers. © 2023 Elsevier Inc.Öğe Use of donation after circulatory death donors in pediatric liver transplantation(Elsevier Inc., 2023) Umman, V.; Zeytunlu, M.; Emre, S.After advancement of technical aspects, use of well-established and novel immunosuppressive therapies, and better pre and postoperative care, which resulted in high overall survival rates with liver transplantation, waiting list mortality has become the main issue for pediatric patients with end stage liver disease. Insufficient organ donors have become a challenging issue especially in the pediatric patient population, for whom size match of donor or graft is harder to achieve. In order to expand the donor pool and decrease the gap between the demand and supply of donor organs, use of donation after circulatory death (DCD) donors have been proportionally increased. In this chapter we aim to discuss current practices, issues and outcomes with DCD in pediatric liver transplantation, as well as future strategies for improvement of results. © 2023
