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Öğe Do Antithymocyte Globulin-Free Acute Rejection Therapies Increase the Risk of Polyoma Nephropathy in Renal Transplant Recipients?(Elsevier USA, 2019) Günay E.; Zeytinoğlu A.; Şen S.; Yılmaz M.; Atay G.; Aşcı G.; Sezer T.O.; Töz H.Introduction: BK virus nephropathy is a serious complication that can lead to allograft kidney loss. Excessive immunosuppression increases the risk. We aimed to evaluate whether there is an increased risk of BK viremia and nephropathy in patients who underwent high-dose immunosuppression because of the development of acute rejection in the early period after kidney transplantation. Methods: This retrospective cohort study was performed between April 2015 and March 2016. Twenty-nine patients who had biopsy-proven acute rejection in the first 3 months were evaluated for BK viremia and nephropathy. Thirty patients who had transplantations at the same period were the control group. Plasma BK-DNA values were examined at 1, 2, 3, 6, 9, and 12 months after the rejection treatment and at 3, 6, 9, and 12 months in the control group. Presence of polyoma nephropathy was examined with surveillance biopsies at the 6 and 12 months. Results: Acute rejection treatment was started on the 12th day after transplantation (2–37 days). Seventeen cellular rejections and 12 humoral rejections were reported by biopsy. Two of the 12 humoral rejections were suspicious. Only pulse steroid (PS)(n = 18); PS, plasmapheresis, and intravenous immunoglobulin (n = 8); PS and intravenous immunoglobulin (n = 2); and PS and plasmapheresis (n = 1)treatments were performed. In 21 patients in the rejection group and 25 patients in the control group, BK-DNA was not positive at all. Two patients had graft loss at 11 and 36 months in the rejection group. Graft losses were secondary to rejection. Conclusions: Treatment with antithymocyte globulin-free regimens after acute rejection episodes did not lead to an increase in BK viremia. © 2019 Elsevier Inc.Öğe Factors CD10, cytokeratin 19 and staging-grading systems in predicting the prognosis of pancreatic neuroendocrine tumors (PNET)(2012) Uguz A.; Unalp O.V.; Yeniay L.; Farajov R.; Yoldas T.; Sezer T.O.; Ipek N.Y.; Nart D.; Yilmaz F.; Sozbilen M.; Coker A.Objective. This study was undertaken to examine prognostic factors in patients with pancreatic neuroendocrine tumors (PNET) undergoing surgical treatment to evaluate the prognostic value of recently introduced immunohistochemical staining methods of CD10 and cytokeratin 19. Materials and Methods. Tumors were classified on the basis of 2004 WHO Classification Guidelines and European Neuroendocrine Tumor Society (ENETS) grading system. Immunohistochemical staining with Ki- 67, CD10 and cytokeratin 19 was performed. Results. A total of 36 patients with a mean age of 53.7 ± 12.0 years were included. Overall, 33 patients had a long-term follow-up with 10 patients (30.3%) experiencing recurrence. Seven patients (21.1%) died. Clinical parameters that were associated with recurrence included liver metastasis at the time of surgery and extra-pancreatic invasion (p < 0.005). Positive surgical margins, extra-pancreatic invasion, and multi-focal disease were associated with reduced survival (p < 0.05). In addition, there was an association between survival and WHO 2004 classification (p < 0.05). Conclusions. Although vascular and peripancreatic invasion showed increased risk of recurrence, they were unrelated to survival. Of the histopathological examinations, Ki-67 and mitotic activity showed a correlation with both recurrence and survival, while immunohistochemical staining with cytokeratin 19 and CD 10 did not provide adequate prognostic information.Öğe Long-Term Follow-up Results of Renal Transplantation in Pediatric Patients With Focal Segmental Glomerulosclerosis: A Single-Center Experience(Elsevier USA, 2019) Bulut I.K.; Taner S.; Keskinoglu A.; Toz H.; Sarsik B.; Sezer T.O.; Kabasakal C.Introduction and Aim: Focal segmental glomerulosclerosis (FSGS)is a common cause of end-stage renal disease in children. We analyzed the long-term outcome of pediatric patients with FSGS undergoing renal transplantation. The objective of the study is to report the experience of a single center and determine the incidence of recurrence, rejection, graft loss, and related risk factors. Materials and Method: This retrospective cohort study was performed between 1991 and 2018. Thirty patients with a pathologic diagnosis of primary FSGS were included in the study. The patients were diagnosed with FSGS according to histologic features in biopsies. Results: Twenty-one of the donors were deceased (70%)and 9 were alive (30%). FSGS recurred in only 2 patients. Graft loss occurred in 6 patients (20%). The causes of graft loss were chronic rejection in 4 patients and acute rejection in 2. Our graft survival rate was 100% at 1 year, 91% at 5 years, 80% at 10 years, 70% at 15 years, and 42% at 20 years. Five- and 10-year graft survival rates were 83% and 83% in living donors and 94% and 79% in deceased donors, respectively. According to Kaplan-Meier analysis, there was no statistically significant difference in terms of graft survival between living and deceased donors. Conclusion: This study, with its contribution to literature in terms of long follow-up of FSGS patients from childhood to adulthood, is important. However, further studies are required. © 2019 Elsevier Inc.Öğe Long-term outcomes of kidney transplants with multiple renal arteries: A retrospective study(2012) Sezer T.O.; Solak I.; Toz H.; Kardaslar B.; Er A.; Hoscoskun C.Objective: The aim of this study was to investigate whether kidney transplantations performed using grafts with multiple arteries negatively affected renal function or increased the risk of vascular or urologic complications. Methods: Among 249 kidney transplant patient followed for at least 1 year between 2000 and 2005, we retrospectively evaluated their donor renal artery anatomy to compare postoperative vascular and urologic complications: creatinine clearance at 1, 2, and 5 years, as well as graft survival at 3 and 5 years. Results: While 214 (85.9%) displayed a single artery (group 1), 35 (14.1%) showed multiple renal arteries (group 2). Thirty-one of the group 2 allografts had two, three donors had three, and one had four arteries. The postoperative vascular and urologic complications and the creatinine clearance values at 1, 2, and 5 years of both groups were similar. The 3- and 5-year graft survivals among group 1 were 95% and 90%, whereas those of group 2 were 94% and 91% respectively (P <.05). Conclusion: Our study indicated that multiple renal arteries did not adversely affect postoperative urologic or vascular complications or kidney allograft or patient survival compared with single renal artery cases. © 2012 Elsevier Inc. All rights reserved.Öğe Recovery of chronic dialysis hypotension after kidney transplantation: A case report(2014) Yaprak M.; Turan M.N.; Çeltik A.; Sezer T.O.; Hoşçoşkun C.; Özkahya M.; Töz H.Chronic dialysis hypotension is described as low systolic blood pressure (<100 mmHg) during interdialytic period. The presence of low predialysis systolic blood pressure, typically <110 mmHg, is significantly associated with increased mortality. Kidney transplantation is the preferred model of renal replacement therapy in the treatment of end-stage renal disease (ESRD) as it improves quality of life and survival. In this article, a long-term hemodialysis (HD) patient with chronic hypotension improved after kidney transplantation is presented. A 39-year-old male patient received a deceased donor kidney transplant. The patient was on HD for 23 years. The patient had suffered from chronic persistent hypotension for the last 8 years. Blood pressure was 70/50 mmHg before dialysis and 60/40 mmHg after dialysis. In the post-transplant period, blood pressure was maintained above 110/70 mmHg by intermittent infusion of dopamine. Hypotension was improved after 24 days and dopamine was discontinued. Various etiologies may cause chronic hypotension in patients receiving long-term HD treatment. Kidney transplantation may improve survival and quality of life by correcting hypotension in these patients. Therefore kidney transplantation should not be avoided as renal replacement therapy in ESRD patients with hypotension.Öğe Spousal versus living unrelated renal transplantation: A retrospective analysis of allograft outcomes(2012) Solak I.; Sezer T.O.; Toz H.; Tatar E.; Isayev C.; Firat O.; Hoscoskun C.Objective: To compare the outcomes of spousal and living unrelated donor (LUD) allografts. Patients and methods: The 378 ABO-compatible living and cadaveric kidney transplantations between February 2005 and August 2010 included 25 wife-to-husband (group 1), 15 husband-to-wife (group 2), and 20 LUD cases (group 3). Donor nephrectomy was performed by open surgery. Induction therapy with antithymocyte globulin or anti-interleukin-2 receptor antibody was followed by maintenance regimens using cyclosporine (CsA) or tacrolimus (Tac) plus mycophenolate mofetil (MMF) and corticosteroids. We compared spousal donor and LUDs in terms of clinical characteristics as well as graft and patient survival rates. Results: Fifty-six (93.3%) patients underwent induction therapy with either antithymocyte globulin (n = 30) or anti-interleukin-2 receptor antibody (n = 26). Maintenance immunosuppression was administered with Tac + MMF (n = 37; 61.6%) or CsA + MMF (n = 23; 38.4) with corticosteroids. Mean follow-up was 34 ± 16 months. There were four graft losses and five patient deaths. There were no significant differences between spousal and living unrelated transplants in terms of clinical characteristics or biopsy-proven acute rejection episodes. The Kaplan-Meier analysis showed 3-year patient survival rates of 94%, 100%, and 88% in group 1, group 2, and group 3, respectively (P >.05). Overall graft survival rates were 94%, 100%, and 77% in group 1, group 2, and group 3, respectively (P >.05). Graft and patient survival rates were similar at 3 years for wife-to-husband, husband-to-wife, or LUDs. Conclusion: In conclusion, family members should be encouraged as LUD or spousal donors, based on similar patient and graft survival rates. © 2012 Elsevier Inc. All rights reserved.Öğe Use of kidney donors with hepatitis B, hepatitis C, or brain tumor: A single-center experience(2012) Tatar E.; Turan M.N.; Firat O.; Sezer T.O.; Sozbilen M.; Solak I.; Toz H.; Hoscoskun C.Introduction: With the rapid increase in the number of patients on the waiting lists, the idea of using organs from donors who were previously classified as "marginal" has emerged. The aim of this study was to evaluate the clinical outcomes of the patients who received kidneys from donors with hepatitis B, hepatitis C, or brain tumors. Patients and Method: Between 2003 and 2010, 27 transplantations were performed from donors with hepatitis B, hepatitis C or brain tumors between 2003 and 2010. Demographic and clinical characteristics of donors and recipients were retrospectively collected from medical files. Results: Fifteen patients received kidneys from donors with hepatitis B: 9 from deceased donors having a positive hepatitis B surface antigen (HBsAg) and six from living donors with positive HBsAg having negative results of qualitative hepatitis B DNA analysis. Two of the fifteen recipients were previously diagnosed with chronic active mild hepatitis B infection. The remaining 13, who were HBsAg (-)/anti-HBs(+) at the time of transplantation, underwent hepatitis B immune globulin and lamivudine therapy. Median follow up time was 40 ± 35 months. One patient developed decompensated liver disease owing to noncompliance to lamivudine therapy. Five patients who received grafts from anti-HCV(+) deceased donors were anti-HCV(+) at the time of transplantation with alanine aminotransferase (ALT) levels <40 U/L. All grafts remained functional at a median of 70 months. Seven subjects received grafts from deceased donors with brain tumors, none of whom had a history of a craniotomy or a ventriculoperitoneal shunt. All recipients had serious vascular access problems. No graft loss or de novo malignancies was observed among these patients after a median follow-up of 69 ± 26 months. Conclusion: With appropriate patient selection, the donated organ pool can be expanded by addition of donors with hepatitis or brain tumors. © 2012 Elsevier Inc. All rights reserved.Öğe What kind of changes occurred in clinical characteristics of deceased kidney donor recipients after national allocation system in Turkey? A single-center retrospective analysis(2012) Solak I.; Sezer T.O.; Toz H.; Tatar E.; Sozbilen M.; Firat O.; Hoscoskun C.Objective: Clinical characteristics of recipients of deceased donor renal transplantations were evaluated in the period before versus after implmentation of The National Allocation System (NAS). Patients and Methods: We evaluated retrospectively clinical profiles of the 42 after NAS (June 2008-December 2010) versus 42 consecutive deceased donor renal transplantation patients before NAS. Patient and graft survival rates were assessed using the Kaplan-Meier method; graft function was assessed based on creatinine clearance with the Cockcroft Gault equation. Patient and donor data were obtained from medical records. Results: Recipients were older in the pre-NAS group (39 ± 8 vs 33 ± 8 years, respectively; P =.001) and median duration of preoperative dialysis was longer in the post-NAS group (103 ± 61 months vs 50 ± 36 months, respectively; P =.000). The average number of human leukocyte antigen-mismatched antigens were pre-NAS 3.4 ± 1.0 versus post-NAS 3.9 ± 1.2 (P =.05). Considering the recipients serological status 9 were hepatitis C virus (HCV)(+) and 2 hepatitis B virus (HBV)(+) among the post-NAS versus no HBV(+) and only 1 HCV(+) patient pre-NAS. Kaplan-Meier analysis of graft survival rates showed 90% at 1 and 85% at 3 years pre-NAS. Similar to 95% at 1 and 86% at 3 years for the post-NAS group (P >.05). Likewise, patient survival rates for both groups at 1 and 3 years were 97%. The mean parameter of donor age, allograft loss, cold ischemia time, patient death, number of retransplantations, HBV(+) patients, and delayed graft function were similar between groups (P >.05). Discussion: After NAS the transplant recipients were older, had a longer duration of dialysis, greater number of HLA mismatched antigens and, more HCV(+). No differences were observed in short-term patient and graft survival rates. © 2012 Elsevier Inc. All rights reserved.
