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    Alloimmune Hemolytic-Anemia After Renal-Transplantation
    (Oxford Univ Press United Kingdom, 1995) Ok, E; Akcicek, F; Coker, A; Tombuloglu, M; Toz, H; Tokat, Y; Cirit, M; Tobu, M; Onder, G; Basci, A
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    ATG versus OKT3 in the treatment of steroid-resistant rejection following living-related donor renal transplantation
    (Elsevier Science Inc, 1997) Uslu, A; Tokat, Y; Ok, E; Unsal, A; Ilkgul, O; Kaplan, H
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    Castleman's disease in a renal allograft recipient
    (Karger, 1997) Cagirgan, S; Cirit, M; Ok, E; Sencan, M; Hekimgil, M; Unsal, A; Saydam, G.; Tokat, Y
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    Chronic allograft nephropathy in well functioning allografts: A protocol biopsy study
    (Oxford Univ Press, 2005) Ertilav, M; Sen, S; Toz, H; Hoscoskun, C; Sezis, M; Ozkahya, M; Ok, E
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    Clinicopathological features of hepatitis C virus infection in dialysis and renal transplantation
    (Wichtig Editore, 2002) Toz, H; Ok, E; Yilmaz, F; Akarca, US; Erensoy, S; Zeytinoglu, A; Ozkahya, M; Karasu, Z; Yuce, G; Basci, A
    Background: Liver biopsy (LB) gives an accurate picture of the severity of hepatitis C virus (HCV) infection in end-stage renal disease. The aim of this study was to find out whether clinical and histopathological course of HCV infection in renal transplant (RT) patients (pts) is different from dialysis (Dx) pts. Methods: Forty Dx and 46 RT pts underwent LB. Clinical and biochemical data were retrospectively collected from medical charts. ALT level above the upper limit was described as elevated. LB was done regardless of the ALT level. LB specimens were examined using a semiquantitative scoring system locally modified from Scheuer. Histological activity (grade) and fibrosis (stage) were scored separately. Results: ALT was elevated in 65% of Dx pts. At the time of LB 30% of Dx pts had elevated ALT and 95% were viremic. Normal/minimal inflammation was detected in 25% of LBs, chronic hepatitis in 72.5%, cirrhosis in 2.5%. Stage and grade were respectively 1.08 +/- 1.02 and 4.30 +/- 2.98. Normal/minimal inflammation was detected in 9% of the 46 RT pts, chronic hepatitis in 84%, cirrhosis in 7%. Stage and grade were respectively 1.74 +/- 1.1 and 5.39 +/- 2.21. Although there was no significant difference in the histological grade between Dx and RT pts, histological stage was significantly higher in RT pts than Dx. The frequency of cirrhosis, hepatitis and normal inflammation was similar in the two groups. Conclusion: Histopathological liver injury due to HCV infection seems to be more severe in RT than Dx pts but this does not seem to be clear at the clinical and biochemical level. Sequential histopathological assessment and longer follow-up will be required to clarify this issue.
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    Clinicopathological features of rapidly progressive hepatitis C virus infection in HCV antibody negative renal transplant recipients
    (Oxford Univ Press, 1998) Ok, E; Unsal, A; Celik, A; Zeytinoglu, A; Ersoz, G; Tokat, Y; Erensoy, S; Akarca, US; Basci, A; Yuce, G
    Background. Hepatitis C virus (HCV) infection acquired during dialysis treatment generally shows a relatively benign course after renal transplantation (RTx). However, less is known about the course of HCV infection acquired during or after RTx. Methods. Clinical and histopathological assessment of 15 renal transplant recipients who acquired HCV infection during or after RTx. Results. Alanine aminotransferase levels rose for the first time 1-19 weeks after RTx. HCV RNA was found positive in all patients, but anti-HCV became positive in only nine of them. During a mean follow-up of 21 +/- 12 months, jaundice appeared in 12 patients while ascites and/or hepatic encephalopathy occurred in six. Azathioprine was stopped in all patients. Cyclosporin was also stopped in four patients and in two of them prednisolone was also interrupted for a period of 3-7 weeks. Following this, ascites, hepatic encephalopathy and biochemical disturbances improved, while no deterioration was seen in graft function. Nine of the 15 patients had undergone two consecutive liver biopsies (LB). The first LB revealed cirrhosis in three and chronic hepatitis in six patients; the second LB showed cirrhosis in seven patients. The histological activity index (Knodell's score) progressed from 11.8 +/- 3.5 to 13.8 +/- 3.8. Conclusions. The results suggest that HCV infection acquired during or after RTx may run an unusual and rapidly progressive clinical and histopathological course at least in some of these patients. Decrease or withdrawal of immunosuppressive drugs may improve early hepatic failure without detrimental effect on graft function during that period.
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    Comparison of enalapril and losartan in the treatment of posttransplant erythrocytosis
    (Karger, 2000) Celik, A; Ok, E; Unsal, A; Toz, H; Atabay, G
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    Comparison of peripheral blood lymphocyte subtypes in renal transplant patients with or without hepatitis C infection
    (Elsevier Science Bv, 2002) Sezis, M; Ersoz, G; Toz, H; Karasu, Z; Kokuludag, A; Ok, E; Celebi, A; Akarca, U; Terzioglu, E
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    Comparison of tacrolimus and cyclosporin in renal transplantation by the protocol biopsies
    (Elsevier Science Inc, 2004) Toz, H; Sen, S; Sezis, M; Duman, S; Ozkahya, M; Ozbek, S; Hoscoskun, C; Atabay, G; Ok, E
    Acute and chronic lesion scores on renal allograft protocol biopsies may predict long-term graft function. The aim of this study was to compare the effects of tacrolimus (Tac) and cyclosporine microemulsion (CsA) based immunosuppressive protocols using protocol biopsies from well-functioning renal allografts. 35 consecutive renal transplant patients were randomized to Tac (n: 17) versus CsA (n: 18) treatment arms. Patient age and sex, donor type and age, histocompatibility, cold ischemia time and prior delayed graft function were similar between the two groups. Treatment protocol consisted of prednisolone, azathioprine and Tac or CsA. Biopsies performed on the third, sixth and twelfth months were blindly evaluated by the same pathologist. The incidences of acute rejection (AR) episodes among CsA vs Tac groups were 33% vs 29%, respectively (NS). The Creatinine level was lower in Tac than CsA, although it was not significant (Table). Subclinical AR and subclinical chronic allograft nephropathy were detected on protocol biopsies in 3 (2 CsA, 1 Tac) and 12 (7 CsA, 5 Tac) patients, respectively. Acute lesion score at the third month PBx was significantly lower in the Tac group (p < 0.05). Chronic lesion scores in all biopsies were lower in the Tac group, although not significantly. The protocol biopsy findings suggest that graft injury may be less pronounced among the Tac group.
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    Comparison of the Effects of Enalapril and Theophylline on Polycythemia After Renal-Transplantation
    (Williams & Wilkins, 1995) Ok, E; Akcicek, F; Toz, H; Kursat, S; Tobu, M; Basci, A; Mees, Ejd
    Posttransplant erythrocytosis (PTE) is a potentially serious complication for which (apart from phlebotomy) two alternative treatments have been proposed: theophylline (Theo) and angiotensin-converting enzyme inhibitors. We investigated 28 patients with PTE, who were assigned to 3 matched groups. Group 1 (10 patients) received 10 mg of Enalapril (Ena)/day. After 2 months, mean hematocrit (Ht) had dropped from 0.57 (range 0.52-0.62) to 0.45 (0.34-0.49), Ena was stopped and, after a period of 3.8+/-0.3 months, Ht had risen again to baseline values (0.56, range 0.52-0.61) in 8 of them, These 8 patients were then given 5 mg/day Ena. Ht decreased more slowly, and after 3 months reached a mean of 0.49 (0.44-0.54). Group 2 (9 patients) received 600 mg/day Thee in 2 doses. After 2 months, Ht had decreased from 0.56 (0.52-0.61) to 0.52 (0.46-0.63), but in 5 patients, Ht remained above 0.51. After I month discontinuation of treatment, PTE persisted in 7 patients. These patients were given 10 mg/day Ena, whereupon Ht decreased from 0.55 (0.52-0.64) to 0.46 (0.40-0.53) after 2 months and to 0.41 (0.33-0.47) after 3 months. Group 3 did not receive medical treatment, After 3 months, PTE persisted in 8 out of the 9 patients and remained unchanged during the following 3 months. Mean values for Ht were: baseline, 0.55 (0.52-0.58); after 3 months, 0.56 (0.53-0.59); and after 6 months, 0.55 (0.52-0.60). We conclude that Ena is superior to Theo in the treatment of PTE, There were no resistant patients, but individual sensitivity differs, Its effect is dose dependent, reversible, and reproducible, Excessive Ht decrease may occur; thus, doses should be titrated individually.
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    Cryptosporidiosis and blastocystosis in renal transplant recipients
    (Karger, 1997) Ok, UZ; Cirit, M; Uner, A; Ok, E; Akcicek, F; Basci, A; Ozcel, MA
    Some intestinal parasitic infections are frequently seen in renal transplant recipients. Parasites such as Cryptosporidium spp. and Blastocystis hominis are often asymptomatic or responsible for limited infections in normals, but may cause prolonged and heavy infections with gastrointestinal complaints, mainly diarrhea, in immunocompromised patients. Such infections can often not be detected by routine diagnostic procedures, but special concentration and staining methods are needed. We investigated 115 fecal specimens from 69 renal transplant recipients and 42 fecal specimens from 42 control cases. Of the 69 recipients, 27 (39.1%) had B. hominis and 13 (18.8%) had Cryptosporidium spp. in at least one fecal specimen. Prevalence of symptomatic Cryptosporidium infections was significantly higher in the renal transplant recipients, when compared with the control group (p < 0.05). Special parasitological procedures must be performed in immunocompromised patients with chronic gastrointestinal complaints. Disappearance of symptoms after antiparasitic drugs in some of 16 symptomatic patients are described, suggesting that these infections are more pathogenic in transplant recipients.
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    Disappearance of mitral and tricuspid regurgitation in haemodialysis patients after ultrafiltration
    (Oxford Univ Press, 1998) Cirit, M; Ozkahya, M; Cinar, CS; Ok, E; Aydin, S; Akcicek, F; Mees, EJD
    Background. Doppler echocardiography has recently revealed frequent occurrence of valvular (in particular mitral) regurgitation in dialysis (HD) patients. We hypothesized that this may be in part 'functional' and related to the cardiac dilatation which is also frequently present. Thus it would be possible to improve it by ultrafiltration. Methods. Mitral and tricuspid regurgitation was detected in 21 haemodialysis patients who had cardiomegaly but no manifest cardiac failure. They were treated by intensified ultrafiltration sessions, as much as they could tolerate, while all antihypertensive drugs were stopped. Doppler echocardiograms were then repeated. Results. Mitral regurgitation disappeared in 13 and tricuspid regurgitation in 14 patients, while lesser degrees of either of them persisted in seven. This was accompanied by decreases of body weight (5.4 +/- 2.7 kg) mean arterial pressure(l25 +/- 15 to 95 +/- 11 mmHg), cardiothoracic index (from 0.57 to 0.47), and left atrial (28 +/- 4 to 22 +/- 3 mm/m(2)), left ventricular systolic (25 +/- 5 to 21 +/- 55 mm/m(2)) and left ventricular diastolic (31 +/- 5 to 27 +/- 5 mm/m(2)), and mitral annular diameters (19.4 +/- 2 to 16.6 +/- 2 mm/m(2)). Ejection fraction increased but remained below 50% in 11 patients. Conclusion. Most of the mitral and tricuspid regurgitations seen in HD patients are partly or completely functional, due to dilatation of the mitral annulus which is related to volume overload. A more aggressive approach, while discontinuing antihypertensive drugs can correct or improve many of them and also ameliorate cardiac function.
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    Diuretic Effect of Frusemide In Patients With Nephrotic Syndrome - Is It Potentiated By Intravenous Albumin
    (British Med Journal Publ Group, 1995) Akcicek, F; Yalniz, T; Basci, A; Ok, E; Mees, Ejd
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    Drug-induced acute interstitial nephritis and vasculitis or vasculary rejection in renal allografts
    (W B Saunders Co, 2001) Sen, S; Bayrak, R; Ok, E; Basdemir, G
    We describe a patient who sought treatment for acute renal allograft dysfunction 2 weeks after renal transplantation. Renal allograft biopsy (RAB) showed intimal arteritis, severe interstitial infiltration with a few eosinophils, and severe tubulitis, Pathologic diagnosis was acute rejection (grade 2b- Banff 93); however, another clinical diagnosis, drug-induced acute interstitial nephritis (AIN), was not excluded, Before the RAB, his trimethaprim-sulfamethoxazole (TMP-SMZ) treatment was discontinued. Renal function began to improve on biopsy day without antirejection therapy, Recovery of renal function without antirejection treatment and discontinuation of TMP-SMZ shows that renal pathology might be related to drug-induced dysfunction and drug-induced AIN and vasculitis, After 5 years, the patient and his renal allograft function are both well. (C) 2001 by the National Kidney Foundation, Inc.
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    Effectiveness of pulse cyclophosphamide plus oral steroid therapy in idiopathic membranoproliferative glomerulonephritis
    (Oxford Univ Press, 1997) Toz, H; Ok, E; Unsal, A; Asci, G; Basdemir, G; Basci, A
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    The efficiency of fractionated parenteral iron treatment in CAPD patients
    (Peritoneal Dialysis Publications, 1997) Akcicek, F; Ozkahya, M; Cirit, M; Ok, E; Unsal, A; Toz, H; Celik, A; Atabay, G; Basci, A; Khanna, R
    Some chronic renal failure patients respond poorly to recombinant human erythropoietin (rHuEPO). In continuous ambulatory peritoneal dialysis (CAPD) patients, such a poor response may indicate inadequate dialysis or low body iron stores. To correct iron deficiency, once-a-week intravenous iron supplementation is recommended. However, hemodialysis patients receive iron supplements three times a week. This study was designed to compare the efficacy of iron supplementation between once-weekly and twice-weekly regimens. In both groups, rHuEPO doses were similar. Seventeen CAPD patients were studied. All had hemoglobin levels less than 10 g/dL. Ten patients were given 50 mg intravenous iron twice weekly until a total iron dose of 600 mg was achieved (stage I). The patients were crossed over to receive another 600 mg iron (stage II). Hematocrit increased significantly in patients receiving twice-a-week iron supplementation (+3.8% and 6%) commentation (+1.3% and 1.4%) during stages I and II. The ferritin levels were not different between the groups. In conclusion, rHuEPO is more effective when administered with intravenous iron.
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    Enalapril Treatment In Posttransplant Erythrocytosis (Pe)
    (Blackwell Science Publ Inc Cambridge, 1995) Ok, E; Akcicek, F; Coker, A; Karaca, E; Basak, K; Akalin, E; Basci, A; Yararbas, O
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    Evaluation of Patients Transplanted In Countries Other Than Turkey
    (Elsevier Science Inc, 1994) Coker, A; Ok, E; Tokat, Y; Hoscoskun, C; Kaplan, H; Yararbas, O