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Colak H, Kivılcim T, Unverdi OF, Yildiz G, Gurkan A. Description and Outcomes of Three Different End-to-Side Microsurgical Techniques for the Anastomosis of Accessory Renal Artery With the Dominant Renal Artery in Kidney Transplantation. Transplant Proc 2021; 53:2900-2906. [PMID: 34782171 DOI: 10.1016/j.transproceed.2021.08.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/04/2021] [Accepted: 08/30/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND In this study, we compared the outcomes of three different surgical microscope-assisted end-to-side anastomosis techniques between the dominant and accessory renal arteries during living donor kidney transplant. METHODS The demographics, serum creatinine levels, warm and cold ischemia times, rate of complications, and incidence of delayed graft function of 135 kidney recipients were analyzed according to the type of arterial anastomosis. Group A (n = 98) had one dominant renal artery (DRA) with one end-to-side anastomosis to the external iliac artery (EIA) using a surgical microscope. Group B (n = 17) had one DRA plus one accessory renal artery (ARA) with two separate end-to-side anastomoses to the EIA using a surgical microscope. Group C (n = 20) had one DRA with end-to-side anastomosis to the EIA and one ARA with an ex vivo on-bench end-to-side anastomosis to the DRA using a surgical microscope. RESULTS Compared with groups A and B, the cold ischemia time and the rate of delayed graft function were significantly higher in group C (P ≤ .001). At 6 months after transplant, group B demonstrated a higher creatinine value (2.40 ± 3.41 mg/dL) than group A and group B (P = .032). Also, the decrease in creatinine at postoperative month 6 was limited in group B as compared with groups A and C. CONCLUSIONS An end-to-side anastomosis between ARA (group B) and DRA (group A) of the kidney graft using a surgical microscope on the bench ex vivo results in superior outcomes. Single arterial anastomosis techniques are associated with a better function in a 6-month follow-up than two separate arterial anastomoses.
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Affiliation(s)
- Hulya Colak
- Department of Nephrology, Faculty of Medicine, İzmir Health Sciences University Tepecik, Izmir, Turkey.
| | - Taner Kivılcim
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Omer Faruk Unverdi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Gursel Yildiz
- Department of Nephrology, Cam Sakura Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Alp Gurkan
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
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Ferhatoglu MF, Atli E, Gurkan A. Effect of Visceral, Subcutaneous and Retroperitoneal Adipose Tissue on Renal Function After Living Donor Nephrectomy: A Retrospective Analysis of 69 Cases. Urol J 2020; 17:379-385. [PMID: 32207136 DOI: 10.22037/uj.v0i0.5558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/30/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Recent studies reported that the presence of metabolic syndrome is closely correlated with impaired kidney function after living donor nephrectomy. Since the measurement of body mass index cannot differentiate the amount of body adipose tissue from total body weight, body mass index is not a reliable parameter for determining metabolic syndrome. In the present study, we investigated the correlation between body adipose tissue and kidney function recovery following living donor nephrectomy. MATERIALS AND METHODS The patients who underwent living kidney donor nephrectomy consequently from July 2016 through December 2017 were enrolled in the study. We preoperatively measured the visceral (VAdT), retroperitoneal (RPAdT), and subcutaneous (SCAdT) adipose tissue volume by a computed tomography scan. Body mass index, adipose tissue measurements, and postoperative estimated glomerular filtration rate (eGFR) were evaluated. RESULTS The decrease between preoperative eGFR, and the first day, the first month and the sixth month eGFR after surgery were statistically significant (P = .001; P = .001; P = .001, respectively). The negative correlation between VAdT/SCAdT measurements and changes in eGFR at the first and the sixth postoperative month compared to preoperative eGFR were statistically significant (P = .049; P = .041, respectively). Additionally, RPAdT measurements and changes in eGFR at the first and the sixth postoperative month compared to preoperative eGFR (decreasing as RPAdT value increased) were statistically significant (P = .035; P = .026, respectively). CONCLUSION According to a preoperative computed tomography scan, VAdT, RPAdT, and VAdT-to-SAdT ratio can predict impaired kidney function recovery. Furthermore, RPAdT measurement is a new variable to predict the impaired kidney function after living donor nephrectomy.
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Affiliation(s)
- Murat Ferhat Ferhatoglu
- Department of General Surgery, Istanbul Okan University, Faculty of Medicine, Tuzla Istanbul 34759, Turkey.
| | - Eray Atli
- Department of Radiodiagnostics, Istanbul Okan University, Faculty of Medicine, Tuzla Istanbul 34759, Turkey.
| | - Alp Gurkan
- Department of General Surgery, Istanbul Okan University, Faculty of Medicine, Tuzla Istanbul 34759, Turkey.
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Abstract
Introduction Circumcision is the oldest and most frequently used surgical procedure. It dates back to at least 10,000 years from today. The debate on the benefits and necessity of circumcision is ongoing. In this study, we aimed to determine the complications and complication rate of circumcisions occurring in our circumcision clinic and to compare these with the complication rates in the world. Methods A total of 198 male patients circumcised between 2011 at 2019 at Bursa State Hospital was enrolled in the presented retrospective study. Demographic data of the patients were assessed and the height and weight of the patients were evaluated according to the child growth standards and weight for age percentile charts for boys of the World Health Organization (WHO). All early or late complications were noted after circumcision. Results The mean age of the patients was 93.57±40.12 (2-248) months. The mean follow-up time was 16.32±9.24 (2-35) months. Sixteen patients had bleeding, four patients had a penile hematoma, and 108 patients had penile edema. There is no statistically significant difference in the penile edema occurrence according to the weight of the patients (p=0.58). Conclusion Circumcision is a frequently applied procedure. Like any other surgery, perioperative and postoperative complications can be observed. More importantly, a significant number of these complications can be prevented by careful surgery and postoperative care.
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Affiliation(s)
| | | | - Alp Gurkan
- General Surgery, Okan University Medical Faculty, Istanbul, TUR
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Yalın SF, Eren N, Sinangil A, Yilmaz VT, Tatar E, Ucar AR, Sevinc M, Can Ö, Gurkan A, Arik N, Alisir Ecder S, Uyar M, Yasar M, Gulcicek S, Mese M, Dheir H, Cakir U, Köksal Cevher Ş, Turkmen K, Guven B, Guven Taymez D, Erkalma Senates B, Ecder T, Kocak H, Uslu A, Demir E, Basturk T, Ogutmen MB, Kinalp C, Dursun B, Bicik Bahcebasi Z, Sipahi S, Dede F, Oruc M, Caliskan Y, Genc A, Yelken B, Altıparmak MR, Turkmen A, Seyahi N. Fabry Disease Prevalence in Renal Replacement Therapy in Turkey. Nephron Clin Pract 2019; 142:26-33. [PMID: 30739116 DOI: 10.1159/000496620] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fabry disease (FD) is an X-linked lysosomal storage disorder resulting from lack of alpha-galactosidase A (AGALA) activity in lysosomes. OBJECTIVE In this multicenter study, we aimed to evaluate the prevalence of FD in renal transplant (Tx) recipients in Turkey. We also screened dialysis patients as a control group. METHODS All Tx and dialysis patients were screened regardless of the presence of a primary disease. We measured the AGALA activity in all male patients as initial analysis. Mutation analysis was performed in male patients with decreased AGALA activity and in female patients as the initial diagnostic assay. RESULTS We screened 5,657 patients. A total of 17 mutations were identified. No significant difference was observed between the groups regarding the prevalence of patients with mutation. We found FD even in patients with presumed primary kidney diseases. Seventy-one relatives were analyzed and mutation was detected in 43 of them. We detected a patient with a new, unknown mutation (p.Cys223) in the GLA gene. CONCLUSIONS There are important implications of the screening. First, detection of the undiagnosed patients leads to starting appropriate therapies for these patients. Second, the transmission of the disease to future generations may be prevented by prenatal screening after appropriate genetic counseling. In conclusion, we suggest screening of kidney Tx candidates for FD, regardless of etiologies of chronic kidney disease.
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Affiliation(s)
- Serkan Feyyaz Yalın
- Department of Nephrology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Necmi Eren
- Department of Nephrology, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Ayse Sinangil
- Department of Nephrology, Bilim University Medical Faculty Medical, Istanbul, Turkey
| | - Vural Taner Yilmaz
- Division of Nephrology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Erhan Tatar
- Department of Nephrology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Ali Riza Ucar
- Division of Nephrology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Sevinc
- Department of Nephrology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Özgür Can
- Department of Nephrology, Haydarpasa Training and Research Hospital, Istanbul, Turkey
| | - Alp Gurkan
- Department of Nephrology, Medicana, Istanbul, Turkey
| | - Nurol Arik
- Department of Nephrology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | - Sabahat Alisir Ecder
- Division of Nephrology, Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Murathan Uyar
- Department of Nephrology, Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Murat Yasar
- Department of Nephrology, Pamukkale University Medical Faculty, Denizli, Turkey
| | - Sibel Gulcicek
- Department of Nephrology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Meral Mese
- Department of Nephrology, Dr. Lufti Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Hamad Dheir
- Department of Nephrology, Sakarya University Tip Medical Faculty, Sakarya, Turkey
| | - Ulkem Cakir
- Department of Nephrology, Acibadem University Medical Faculty, Istanbul, Turkey
| | - Şimal Köksal Cevher
- Department of Nephrology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Kultigin Turkmen
- Division of Nephrology, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | - Bahtisen Guven
- Department of Nephrology, Bahcesehir University Medical Faculty, Istanbul, Turkey
| | | | - Banu Erkalma Senates
- Department of Nephrology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Tevfik Ecder
- Department of Nephrology, Bilim University Medical Faculty Medical, Istanbul, Turkey
| | - Huseyin Kocak
- Division of Nephrology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Adam Uslu
- Department of Nephrology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Erol Demir
- Division of Nephrology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Taner Basturk
- Department of Nephrology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Melike Betul Ogutmen
- Department of Nephrology, Haydarpasa Training and Research Hospital, Istanbul, Turkey
| | - Can Kinalp
- Department of Nephrology, Medicana, Istanbul, Turkey
| | - Belda Dursun
- Department of Nephrology, Pamukkale University Medical Faculty, Denizli, Turkey
| | - Zerrin Bicik Bahcebasi
- Department of Nephrology, Dr. Lufti Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Savas Sipahi
- Department of Nephrology, Sakarya University Tip Medical Faculty, Sakarya, Turkey
| | - Fatih Dede
- Department of Nephrology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Meric Oruc
- Department of Nephrology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Yasar Caliskan
- Division of Nephrology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Ahmed Genc
- Department of Nephrology, Sakarya University Tip Medical Faculty, Sakarya, Turkey
| | - Berna Yelken
- Department of Nephrology, Memorial Hospital, Istanbul, Turkey
| | - Mehmet Rıza Altıparmak
- Department of Nephrology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey,
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Ferhatoglu MF, Kartal A, Ekici U, Gurkan A. Evaluation of the Reliability, Utility, and Quality of the Information in Sleeve Gastrectomy Videos Shared on Open Access Video Sharing Platform YouTube. Obes Surg 2019; 29:1477-1484. [PMID: 30706318 DOI: 10.1007/s11695-019-03738-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Abdulcabbar Kartal
- Faculty of Medicine, Department of General Surgery, Okan University, Istanbul, Turkey
| | - Ugur Ekici
- Istanbul Gelisim University Health Sciences Colleges, Istanbul, Turkey
| | - Alp Gurkan
- Faculty of Medicine, Department of General Surgery, Okan University, Istanbul, Turkey
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Ozakbas S, Piri Cinar B, Gurkan A, Ozturk O, Idiman E. Pattern of cognitive impairment and related factors in clinically isolated syndrome. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Akkoc H, Gurkan A, Kelle I, Hekimoglu A, Erdinc M. Investigating the Effect of the Poly(Adp-ribose) Polymerase Inhibitor 5-aminoisoquinolinone and the Na+-H+ Exchanger Inhibitor Zoniporide on Isolated Perfused Rat Hearts during Ischemia-reperfusion Injury. Drug Res (Stuttg) 2013; 63:521-6. [DOI: 10.1055/s-0033-1347241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- H. Akkoc
- Department of Pharmacology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - A. Gurkan
- Department of Pharmacology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - I. Kelle
- Department of Pharmacology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - A. Hekimoglu
- Department of Pharmacology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - M. Erdinc
- Department of Pharmacology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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Gures N, Gurluler E, Berber I, Karayagiz AH, Kemik O, Sumer A, Cakir U, Gurkan A. Comparison of the right and left laparoscopic live donor nephrectomies: a clinical case load. Eur Rev Med Pharmacol Sci 2013; 17:1389-1394. [PMID: 23740454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The aim of the present study was to retrospectively compare the results of right- and left-laparoscopic donor nephrectomy (LDN) performed in our Center. PATIENTS AND METHODS Two hundred and eight patients who were operated on between October 2010 and October 2011 were included. Of the patients, 65 underwent right-LDN and 143 underwent left-LDN. The groups were compared in terms of duration of surgery, warm ischemia time, postoperative complications, length of hospital stay, and donor outcomes. RESULTS The mean duration of surgery was 144±19.7 min and 147.8±20.2 min in the right- and left-LDN groups, respectively. The mean warm ischemia times were 139.1±54.1 s and 141.5±37.9 in the right- and left-LDN groups, respectively. The mean length of hospital stay was 2.4±1.0 days for both groups. No major complications were observed in the groups. There was no significant difference between the groups in terms of donor outcomes. CONCLUSIONS The right-LDN is approached cautiously because of short length of vein and the risk for thrombosis. The results of the present study demonstrated that the right-LDN is as safe and effective as the left-LDN.
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Affiliation(s)
- N Gures
- Acibadem University, International Hospital Organ Transplant Center, Istanbul, Turkey
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Yildirim T, Yilmaz R, Altindal M, Turkmen E, Arici M, Altun B, Erdem Y, Guliyev O, Erkmen Uyar M, Tutal E, Bal Z, Sezer S, Erkmen Uyar M, Bal U, Bal Z, Tutal E, Say n B, Guliyev O, Erdemir B, Sezer S, O'Rourke-Potowki A, Gauge N, Penny H, Cronin A, Frame S, Goldsmith DJ, Yagan JA, Chandraker A, Velickovic Radovanovic RM, Catic Djordjevic A, Mitic B, Stefanovic N, Cvetkovic T, Serpieri N, Grosjean F, Sileno G, Torreggiani M, Esposito V, Mangione F, Abelli M, Castoldi F, Catucci D, Esposito C, Dal Canton A, Vatazin AV, Zulkarnaev AB, Borst C, Liu Y, Thoning J, Tepel M, Libetta C, Margiotta E, Borettaz I, Canevari M, Martinelli C, Lainu E, Abelli M, Meloni F, Sepe V, Dal Canton A, Miguel Costa R, Vasquez Martul E, Reboredo J, Rivera C, Simonato F, Tognarelli G, Daidola G, Gallo E, Burdese M, Cantaluppi V, Biancone L, Segoloni GP, Burdese M, Priora M, Messina M, Tamagnone M, Daidola G, Linsalata A, Lavacca A, Biancone L, Segoloni G, Zuidema W, Erdman R, van de Wetering J, Dor F, Roodnat J, Massey E, Timmerman L, IJzermans J, Weimar W, Goldsmith DJ, Sibley-Allen C, Hilton R, Moghul M, Burnapp L, Blake G, Koo TY, Park JS, Park HC, Kim GH, Lee CH, Oh IH, Kang CM, Hwang JK, Park SC, Choi BS, Chun HJ, Kim JI, Yang CW, Moon IS, Van Laecke S, Van Biesen W, Nagler EV, Taes Y, Peeters P, Vanholder R, Pruthi R, Ravanan R, Casula A, Harber M, Roderick P, Fogarty D, Cho A, Shin JH, Jang HR, Lee JE, Huh W, Kim DJK, Oh HY, Kim YG, Sancho Calabuig A, Gavela Martinez E, Kanter Berga J, Beltran Catalan S, Avila Bernabeu AI, Pallardo Mateu LM, Gonzalez E, Polanco N, Molina M, Gutierrez E, Garcia Puente L, Sevillano A, Morales E, Praga M, Andres A, Banasik M, Boratynska M, Koscielska-Kasprzak K, Bartoszek D, Myszka M, Zmonarski S, Nowakowska B, Wawrzyniak E, Halon A, Chudoba P, Klinger M, Rojas-Rivera J, Gonzalez E, Polanco N, Morales E, Andres A, Morales JM, Egido J, Praga M, Kopecky CM, Haidinger M, Kaltenecker C, Antlanger M, Marsche G, Holzer M, Kovarik J, Werzowa J, Hecking M, Saemann MD, Hwang JK, Kim JM, Koh ES, Chung BH, Park SC, Choi BS, Kim JI, Yang CW, Kim YS, Moon IS, Banasik M, Boratynska M, Koscielska-Kasprzak K, Krajewska M, Mazanowska O, Kaminska D, Bartoszek D, Zabinska M, Halon A, Malkiewicz B, Patrzalek D, Klinger M, Sulowicz J, Szostek S, Wojas-Pelc A, Ignacak E, Sulowicz W, Bellizzi V, Calella P, Cupisti A, Capitanini A, D'Alessandro C, Giannese D, Camocardi A, Conte G, Barsotti M, Bilancio G, Luciani R, Locsey L, Seres I, Kovacs D, Asztalos L, Paragh G, Wohlfahrtova M, Balaz P, Rokosny S, Wohlfahrt P, Bartonova A, Viklicky O, Kers J, Geskus RB, Meijer LJ, Bemelman F, ten Berge IJM, Florquin S, Hwang JC, Jiang MY, Lu YH, Weng SF, Testa A, Porto G, Sanguedolce M, Spoto B, Parlongo R, Pisano A, Enia G, Tripepi G, Zoccali C, Zuidema W, Mamode N, Lennerling A, Citterio F, Massey E, Van Assche K, Sterckx S, Frunza M, Jung H, Pascalev A, Johnson R, Loven C, Weimar W, Dor F, Soleymanian T, Keyvani H, Jazayeri SM, Fazeli Z, Ghamari S, Mahabadi M, Chegeni V, Najafi I, Ganji MR, Meys KME, Groothoff JW, Jager K, Schaefer F, Tonshoff B, Mota C, Cransberg K, van Stralen K, Gurluler E, Gures N, Alim A, Gurkan A, Cakir U, Berber I, Van Laecke S, Caluwe R, Nagler E, Van Biesen W, Peeters P, Van Vlem B, Vanholder R, Sulowicz J, Wojas-Pelc A, Ignacak E, Betkowska-Prokop A, Kuzniewski M, Krzanowski M, Sulowicz W, Masson I, Flamant M, Maillard N, Cavalier E, Moranne O, Alamartine E, Mariat C, Delanaye P, Canas Sole LL, Iglesias Alvarez E, Pastor MCMC, Moreno Flores FF, Abujder VV, Graterol FF, Bonet Sol JJ, Lauzurica Valdemoros RR, Yoshikawa M, Kitamura K, Nakai K, Goto S, Fujii H, Ishimura T, Takeda M, Fujisawa M, Nishi S, Prasad N, Gurjer D, Bhadauria D, Gupta A, Sharma R, Kaul A, Cybulla M, West M, Nicholls K, Torras J, Sunder-Plassmann G, Feriozzi S, Lo S, Wong PYH, Ip D, Wong CK, Chow VCC, Mo SKL, Molnar M, Ujszaszi A, Czira ME, Novak M, Mucsi I, Cruzado JM, Coelho S, Porta N, Bestard O, Melilli E, Taco O, Rivas I, Grinyo J, Pouteau LM, N'Guyen JM, Hami A, Hourmant M, Ghahramani N, Karparvar Z, Shadrou S, Ghahramani M, Fauvel JP, Hadj-Aissa A, Buron F, Morelon E, Ducher M, Heine C, Glander P, Neumayer HH, Budde K, Liefeldt L, Montero N, Webster AC, Royuela A, Zamora J, Crespo M, Pascual J, Adema AY, van Dorp WTH, Mallat MJK, de Fijter HW, Kim YS, Hong YA, Chung BH, Park CW, Yang CW, Kim YS, Choi BS, Suleymanlar G, Uzundurukan Z, Kapuagas A, Sencan I, Akdag R, Pascual J, Torio A, Mas V, Perez-Saez MJ, Mir M, Faura A, Montes-Ares O, Checa MD, Crespo M, Sawinski D, Trofe-Clark J, Sparkes T, Patel P, Goral S, Bloom R, Kim HJ, Park SJ, Kim TH, Kim YW, Kim YH, Kang SW, Abdel Halim M, Gheith O, Al-Otaibi T, Mosaad A, Awadeen W, Said T, Nair P, Nampoory MRN. Transplantation: clinical studies - A. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ozel L, Marur T, Unal E, Kara M, Erdoğdu E, Demir T, Berber I, Gurkan A, Kiliçoğlu G, Bakal N, Titiz M. Avoiding Abdominal Flank Bulge after Lumbotomy Incision: Cadaveric Study and Ultrasonographic Investigation. Transplant Proc 2012; 44:1618-22. [DOI: 10.1016/j.transproceed.2012.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gurkan A, Gulhan YB, Tilif S, Gul Y. Channels of being informed about kidney transplantation centers for patients with end stage kidney disease. Turk J Surg 2012. [DOI: 10.5097/1300-0705.ucd.1446-12.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Uyar M, Sahin S, Dheir H, Gurkan A. The influence of hepatitis B and C virus infections on patient and allograft outcomes in kidney transplantation. Transplant Proc 2011; 43:850-2. [PMID: 21486613 DOI: 10.1016/j.transproceed.2011.01.148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the most important causes of chronic liver diseases among end-stage kidney disease patients. Our aim was to evaluate the influence of HBV and HCV infections on patient and allograft outcomes after successful kidney transplantation. PATIENTS AND METHODS We retrospectively analyzed 592 kidney transplantations performed between December 2008 and August 2010. We compared patient and graft survivals as well as age, gender, immunosuppression status, pretransplant dialysis duration, chronic allograft dysfunction, and causes of death. RESULTS Thirty-two patients (5.4%; group 1) were positive for HCV antibody, whereas 16 (2.7%) were positive for hepatitis B surface antigen (HBsAg) (group 2). Two patients (0.3%) were positive concurrently for both HCV antibody and HBsAg. Five hundred forty-two patients (91.6%; group 3) were negative for both. Patients were divided into groups with respect to viral infection. The groups were analyzed for age, gender, immunosuppression, pretransplant dialysis duration, chronic allograft dysfunction, and causes of death, as well as patient and graft outcomes. There were no differences in patient and graft survivals among the groups. None of the patients showed signs of hepatic failure. No patient or graft loss was observed among hepatitis groups when compared with disease-free patients. CONCLUSION Graft and patient survivals were not influenced by HBV and/or HCV infections. HBV and HCV infections are not contraindications for kidney transplantation.
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Affiliation(s)
- M Uyar
- Ozel Gaziosmanpasa Hastanesi, Department of Kidney Transplantation and Nephrology, Istanbul, Turkey.
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Dheir H, Sahin S, Uyar M, Gurkan A, Turunc V, Kacar S, Bayirli Turan D, Basdemir G. Intensive Polyoma Virus Nephropathy Treatment as a Preferable Approach for Graft Surveillance. Transplant Proc 2011; 43:867-70. [DOI: 10.1016/j.transproceed.2011.01.112] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Affiliation(s)
- S Ozmen
- Department of Pediatric Allergy and Asthma, Dr. Sami Ulus Woman's Health and Children, Education and Research Hospital, 63/23 Basin Cad. Basinevler, Ankara, Turkey
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16
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Abstract
This research was planned as a descriptive study for the purpose of examining the suicidal thoughts of first-year university students and the factors that might affect them. The research was conducted with the participation of first-year students (class of 1992) at Ege University between January 2003 and October 2004. The research data were collected on a form prepared by the researcher to determine the university students' socio-demographic characteristics and their suicidal thoughts, the trait anger, expression of anger inventory and the brief symptom inventory. It was determined that 2.4% of the students had suicidal thoughts, and 11.2% of the students had previously attempted suicide. The risk factors of the students' suicidal thoughts were determined to be issues of gender, school problems, family relationships, anger expression, somatization, hostility, psychotic symptoms, phobic anxiety, anxiety disorder and interpersonal sensitivity.
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Affiliation(s)
- E Engin
- Department of Psychiatric Nursing, Ege University School of Nursing, Izmir, Turkey.
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17
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Colak T, Mesci A, Yaprak M, Pestereli E, Karaveli S, Alimoglu E, Gurkan A, Dinckan A, Akaydin M. Local recurrence of breast cancer following mastectomy. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70613-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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18
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Karaman Y, Kebapci E, Gurkan A. The preemptive analgesic effect of lornoxicam in patients undergoing major abdominal surgery: a randomised controlled study. Int J Surg 2008; 6:193-6. [PMID: 18434268 DOI: 10.1016/j.ijsu.2008.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 02/28/2008] [Accepted: 03/04/2008] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The aim of this study was to examine the effect of lornoxicam used in preemptive analgesia on the intensity of pain and requirement for analgesics in the perioperative period for major abdominal surgery. METHODS Sixty patients scheduled for elective major abdominal surgery were randomly assigned to three groups after ethics committee approval. Patients in Group PRE (n=20) received lornoxicam i.v. 8 mg 20 min before incision and saline i.v. after skin closure; patients in Group POST (n=20) received saline i.v. 20 mins before incision and lornoxicam i.v. 8 mg after skin closure; patients in Group C (n=20) received saline i.v. 5 min before incision and after skin closure. A standardized general anesthetic was used. All patients were started on i.v. tramadol patient-controlled analgesia during the postoperative period. Pain intensity was measured using the visual analog scale (VAS), and tramadol consumption. In addition, the incidences of side effects were recorded at the end of the study period. RESULTS There were no significant differences among the three groups of the demographic data. Groups PRE and POST demonstrated significantly reduced pain scores compared to Group C at various points in time. Group PRE also demonstrated a weakly significant reduction in analgesic consumption of tramadol postoperatively compared to Groups POST and C. CONCLUSION Lornoxicam administered preemptively appears to improve the quality of postoperative analgesia and leads to reduced consumption of tramadol postoperatively in patients undergoing major abdominal operations.
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Affiliation(s)
- Yucel Karaman
- Tepecik Hospital, Department of Anaesthesiology, Izmir 35120, Turkey
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19
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Karapinar L, Gurkan A, Kacar S, Polat O. Post-transplant femoral head avascular necrosis: a selective investigation with MRI. Ann Transplant 2007; 12:27-31. [PMID: 18344935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 12/20/2007] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND We investigated the presence of femoral head avascular osteonecrosis (FHAVN) by a selective investigation with MRI at follow-up. MATERIAL/METHODS A total of 331(200 men, 131 women) renal transplants were included. They were transplanted at the mean age of 31.4 (9-63) years. The mean follow-up time of all patients after transplantation was 60.6 (6-233) months, and the mean current age 36.6 (11-66) years. All transplants filled out a questionnaire on musculoskeletal symptoms and underwent a detailed clinical examination. Magnetic resonance imaging was done in cases of hip joint pain in groin, buttock, thigh and knee and in 50 asymptomatic transplants. FHAVN were identified according to Ficat Arlet classification. RESULTS 43(13%) patients reported pain without previous trauma. In the clinical examination, limited ranges of motion of the hip were noted in 13 of them. FHAVN was detected in 11 of 43 patients. Disease was bilateral in two of the eleven patients. Of the 662 femoral heads, 43 were associated with hip pain whereas the remaining 619 were asymptomatic. Avascular osteonecrosis was not confirmed in the asymptomatic 100 hips with magnetic resonance imaging. CONCLUSIONS A selective investigation of FHAVN may be used to diagnose in renal allograft recipients with painful hips at follow-up. With a retrospective selective analysis, the presence of FHAVN was low among renal transplantation recipients at the end of the study.
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Affiliation(s)
- Levent Karapinar
- Department of Orthopedics and Traumatology, Izmir-Tepecik Training and Research Hospital, Izmir, Turkey.
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20
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Kocak H, Ceken K, Dinckan A, Mahsereci E, Yavuz A, Yucetin L, Akbas SH, Gurkan A, Erdogan O, Ersoy F, Yakupoglu G, Demirbas A, Tuncer M. Assessment and comparison of endothelial function between dialysis and kidney transplant patients. Transplant Proc 2006; 38:416-8. [PMID: 16549135 DOI: 10.1016/j.transproceed.2006.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dialysis and kidney transplant patients display endothelial dysfunction. Previous studies concerning comparisons of endothelial function in dialysis and kidney transplant patients included subjects with cardiovascular risk factor(s) that alone may lead to endothelial dysfunction. In this study, we compared endothelial function between dialysis and transplant patients who did not show known cardiovascular risk factors that lead to endothelial dysfunction. We studied age- and gender-matched cohorts: 30 hemodialysis (HD), 30 peritoneal dialysis (PD), and 30 kidney transplant patients. We also included 20 age- and gender-matched healthy controls. We assessed the endothelial function of patients and controls by a noninvasive technique. Serum biochemistry profiles of patients were also similar to controls in terms of lipid profile and fasting blood glucose level. Although mean FMD% levels of HD and PD patients were similar (6.6% +/- 3.1% vs 6.8% +/- 3.0%, P > .05), the mean percent of flow-mediated endothelium-dependent dilatation (FMD%) level in transplant patients was higher than those in HD or PD patients (10.50% +/- 3.0% vs 6.6% +/- 3.1% and 6.8% +/- 3.0%, respectively; P < .01). In addition, the mean FMD% level in healthy controls was higher than those in HD, PD, and transplant patients (14.0% +/- 2.3% vs 6.6% +/- 3.1%, 6.8% +/- 3.0% and 10.50% +/- 3.0%; P < .01, respectively). In conclusion, endothelial functions in transplant patients were better than those in dialysis patients.
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Affiliation(s)
- H Kocak
- Internal Medicine, Renal Division, Department of Nephrology, Akdeniz University School of Medicine, Antalya, Turkey.
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21
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Abstract
BACKGROUND AND OBJECTIVE Previous studies in adults have demonstrated a clinically useful correlation between central venous pressure (CVP) and peripheral venous pressure (PVP). The current study prospectively compared CVP measurements from a central versus a peripheral catheter in kidney recipients during renal transplantation. METHODS With ethics committee approval and informed consent, 30 consecutive kidney recipients were included in the study. We excluded patients who had significant valvular disease or clinically apparent left ventricular failure. For each of 30 patients, CVP and PVP were measured on five different occasions. The pressure tubing of the transducer system was connected to the distal lumen of the central or to the peripheral venous catheter for measurements following induction of anesthesia, after induction, 1 hour after induction, reperfusion of the kidney, and the end of the operation, yielding 150 hemodynamic data points. Each hemodynamic measurement included heart rate, mean arterial pressure, mean CVP, and mean PVP determined at end-expiration. RESULTS The mean PVP was 13.5 +/- 1.8 mm Hg and the mean CVP was 11.0 +/- 1.5 mm Hg during surgery. The mean difference was 2.5 +/- 0.5 (P < .01). Repeated-measures analysis of variance indicated a highly significant relationship between PVP and CVP (P < .01) with a Pearson correlation coefficient of 0.97. CONCLUSION Under the conditions of this study, PVP showed a consistently high agreement with CVP in the perioperative period among patients without significant cardiac dysfunction.
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Affiliation(s)
- N Hadimioglu
- Department of Anesthesiology and Intensive Care Medicine, Akdeniz University, School of Medicine, Antalya, Turkey.
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22
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Akbas SH, Yurdakonar E, Yucetin L, Senol Y, Tuncer M, Kocak H, Akbas M, Gurkan A, Demirbas A, Gultekin M. Relation of C-2 monitoring with serum lipid profile in stable renal transplant patients. Transplant Proc 2006; 38:460-2. [PMID: 16549147 DOI: 10.1016/j.transproceed.2005.12.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
C-2 monitoring has been proposed as a more effective strategy than C-0 to predict the risk of acute rejection in the early stages posttransplantation. However, cyclosporine (CsA) is associated with posttransplant dyslipidemia. The aim of this retrospective study was to evaluate the correlations of C-0 and C-2 levels with atherogenic risk factors in the first 6 months versus after 6 months posttransplantation. We evaluated the data from 127 stable renal transplant recipients (89 males, 38 females) of mean age 38.10 +/- 12.79 years who received Neoral-based immunosuppression to investigate the relation of C-2 levels to serum lipid profile compared with C-0 values in the early and late posttransplantation periods. Receiver operating characteristic (ROC) analyses were performed to define a C-2 cutoff level that identified subjects with hypercholesterolemia, defined as a total cholesterol (TC) >200 mg/dL. There were significant positive correlations between both C-0 and C-2 levels and TC as well as the ratio of total cholesterol/HDL cholesterol (TC/HDL) in the late period. When the C-2 levels in the late posttransplantation period were stratified, serum TC concentrations showed statistically significant differences between the groups. Whole blood C-2 levels above 850 ng/mL were associated with increased serum TC concentrations; the C-2 cutoff level leading to hypercholesterolemia was 888 ng/mL. Maintenance immunosuppressive therapy under the proposed whole blood C-2 level of 888 ng/mL seemed to preserve graft function while preventing atherogenic risks for cardiovascular diseases in the late posttransplantation period.
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Affiliation(s)
- S H Akbas
- Central Laboratory, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
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23
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Kocak H, Yakupoglu U, Karatas GU, Yavuz A, Gurkan A, Erdogan O, Ersoy FF, Yakupoglu G, Demirbas A, Tuncer M. Tacrolimus plus low-dose mycophenolate mofetil in renal transplant recipients: better 2-year graft and patient survival than with a higher mycophenolate mofetil dose. Transplant Proc 2006; 37:3009-11. [PMID: 16213288 DOI: 10.1016/j.transproceed.2005.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Mycophenolate mofetil (MMF) has become more widely prescribed in recent years, but its adverse effects on the gastrointestinal system and bone marrow restrict its use in certain settings. The aim of this study was to compare the demographic features and clinical data for 173 renal transplant recipients who received tacrolimus (TAC) plus 1 g/d MMF (group I, n = 112) versus TAC plus 2 g/d MMF (group II, n = 61 patients) over a 2-year period. Each patient received similar TAC doses. METHODS We compared demographic data and clinical data for each case: acute rejection (AR) episodes, chronic rejection (CR) episodes, death, graft loss, development of posttransplantation diabetes mellitus (PTDM), and posttransplantation hypertension rates. RESULTS Demographic features were similar. There were also no significant differences between groups I and II with respect to number of AR episodes (17/112 vs 12/61, respectively), number of CR episodes (4/112 vs 1/61, respectively), PTDM, and hypertension rate (P > .05). Kaplan-Meier survival analysis revealed 2-year graft survival rates of 94% in group I versus 83% in group II. The corresponding 2-year patient survival rates were 100% in group I versus 91% in group II. The graft survival and patient survival rates in group I were significantly higher than those in group II (log-rank 0.005 and 0.001, respectively). CONCLUSIONS The 2-year graft and patient survival rates for the renal transplant recipients in this study suggest that the combination of a full TAC dose with 1 g/d MMF is a better choice than 2 g/d MMF.
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Affiliation(s)
- H Kocak
- Department of Nephrology, Akdeniz University School of Medicine, Antalya, Turkey.
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24
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Yakupoglu YK, Dinckan A, Gurkan A, Tuncer M, Erdogan O, Altunbas H, Yakupoglu U, Sari R, Demirbas A. Kidney-pancreas transplantation: single-center experience at a university hospital in Turkey. Transplant Proc 2005; 37:3205-8. [PMID: 16213349 DOI: 10.1016/j.transproceed.2005.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION One treatment option for patients with type 1 diabetes mellitus with end-stage nephropathy is combined pancreas-kidney transplantation, which can be performed either simultaneously (SPK) or following kidney transplantation (PAK). PATIENTS AND METHODS Between February 2003 and November 2004, 14 patients, including 10 males and 4 females of overall mean age of 31.3 +/- 6.1 years (range, 23-44 years), presented with end-stage renal disease secondary to type 1 diabetes mellitus. Five patients (35.7%) received SPK; 7 patients (50%) received PAK; and 2 patients (14.3%) received simultaneous pancreas and living-related kidney (SPLK) transplantations. RESULTS Two among 14 pancreas grafts were lost in the early postoperative period secondary to venous thrombosis despite anticoagulation including 1 with poor portal drainage. Insulin therapy was reinitiated in 1 patient after a second rejection episode in the seventh postoperative month. By the ninth median follow-up month (range, 1-21 months), all kidney grafts were functioning. CONCLUSION Our single-center short-term experience with 14 consecutive kidney-pancreas transplantations suggests that while the pancreas transplant is effective and safe to reestablish normoglycemia, this transplant creates additional surgical and immunosuppressive stresses on the patient.
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Affiliation(s)
- Y K Yakupoglu
- Akdeniz University Organ Transplantation Center, Antalya, Turkey.
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25
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Tuncer M, Gurkan A, Erdogan O, Yucetin L, Demirbas A. Lack of Impact of Human Leukocyte Antigen Matching in Living Donor Kidney Transplantation: Experience at Akdeniz University. Transplant Proc 2005; 37:2969-72. [PMID: 16213277 DOI: 10.1016/j.transproceed.2005.07.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lack of expansion of the deceased donor supply has resulted in a severe shortage of organs worldwide. Spousal donors are one possible alternative organ source for patients on the kidney transplant waiting list. Despite human lymphocyte antigen (HLA) matching between recipients and unrelated donors being poor, the reported survival rates for these grafts, including spouses, are comparable to those for grafts from living related donors and higher than those for deceased donor kidneys. In 2000, our renal transplantation program began accepting living donor-recipient pairs with one or zero HLA matches. The purpose of this study was to assess this policy for accepting living unrelated donors. The 3-year graft survival rates for the transplants from living unrelated donors were similar to that for transplants from living related donors (log-rank = 0.078). The number of HLA mismatches did not significantly influence the survival rates for either of these groups of living donor transplants. Multivariate analysis revealed that dialysis duration (P = .057) and recipient age (P = .066) negatively influenced patient survival in living donor kidney transplantation. The graft and patient survival rates for the donor transplantations were higher than those for deceased donor transplantations. In light of these findings and considering the increasing problem of organ shortage, we conclude that living unrelated kidney transplantation should be performed, with strict guidelines. Spousal donation is the most favorable form of living unrelated renal transplantation.
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Affiliation(s)
- M Tuncer
- Division of Nephrology, Akdeniz University Medical School, Antalya, Turkey.
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26
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Karatas GU, Yakupoglu U, Yakupoglu YK, Kocak H, Yavuz A, Dinckan A, Tuncer M, Demirbas A, Yakupoglu G, Ersoy FF, Gurkan A. Sirolimus as Primary Immunosuppression Agent in Kidney Transplant Recipients: Akdeniz University Experience. Transplant Proc 2005; 37:3006-8. [PMID: 16213287 DOI: 10.1016/j.transproceed.2005.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Recently usage of sirolimus as the primary immunosuppressant is widening among kidney transplant recipients. We reviewed the clinical follow-up of patients transplanted at our center using sirolimus protocols. METHODS Sirolimus including primary immunosuppressive treatment protocols were begun in February 2002. Among the 21 patients (15 men, six women) who received sirolimus, six patients were prescribed sirolimus + prednisolone; seven, sirolimus + mycophenolate mofetil + prednisolone; and eight, sirolimus + cyclosporine + prednisolone. The mean age of the patients was 32.9 +/- 7.3 years and the mean posttransplantation follow-up, 13.2 +/- 4.5 months. RESULTS Three patients experienced acute rejection episodes, which were treated successfully with steroids. None of the patients had either hematologic or wound healing problems. Lymphoceles developed in eight patients. Serum creatinine level was 1.4 +/- 0.5 mg/dL at 12 months. There was a serious increase in serum cholesterol and triglyceride levels starting from the first month posttransplant (total cholesterol levels pretransplant and at 1 month, respectively: 159.3 +/- 29.5 and 255.7 +/- 52.3 mg/dL, P = .0001; triglycerides pretransplant and at 1 month, respectively: 146.9 +/- 89.5 and 215.1 +/- 102.5 mg/dL, P = .001). Despite routine antihyperlipemic treatment those high levels were maintained for 12 months. CONCLUSIONS We achieved 100% graft and patient survival rates for 1 year among patients who were using sirolimus. But the most important role in defining the morbidity and mortality in this group of patients is cardiovascular events; for this reason the abnormalities in the lipid profile must be taken seriously.
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Affiliation(s)
- G U Karatas
- Akdeniz University Organ Transplantation Center, Antalya, Turkey
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27
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Yakupoglu U, Kocak H, Karatas GU, Yakupoglu YK, Dinckan A, Kececioglu N, Gurkan A, Demirbas A, Yegin O, Tuncer M. Simvastatin Therapy in Lymphocyte Cross-Match–Positive Kidney Transplantation Candidates. Transplant Proc 2005; 37:2933-5. [PMID: 16213265 DOI: 10.1016/j.transproceed.2005.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Recent identification of several mechanisms by which statins decrease recruitment of monocytes and T cells into the arterial wall and inhibit both T-cell and B-cell activation and proliferation in vitro prompted us to study the immunomodulatory effects of statins. In this study, we examined the effect of simvastatin therapy on lymphocyte cross-match positivity in kidney transplantation candidates. METHODS Simvastatin therapy (20 mg/d) was administered to 25 patients (18 men, 7 women of mean age 34 +/- 11.7 years who displayed positive lymphocyte cross-matches between July 2002 and October 2004. The etiologies of end-stage renal disease were vesicoureteral reflux (n = 5), urinary stone disease (n = 4), glomerulonephritis (n = 6), amyloidosis secondary to familial Mediterranean fever (n = 1), and unknown (n = 9). RESULTS The lymphocyte cross-match became negative in 10 patients 4-9 months, and successful kidney transplantation was performed in 6 of them. The serum creatinine levels of these patients ranged between 0.8 and 1.4 mg/dL. Two patients required higher doses, but none suffered from adverse effects. The remaining 4 patients are still undergoing pretransplantation evaluation. CONCLUSION Simvastatin therapy seems to be a cost-effective and useful method for lymphocyte cross-match-positive kidney transplantation candidates compared with immunoadsorption or intravenous immunoglobulin use.
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Affiliation(s)
- U Yakupoglu
- Akdeniz University Organ Transplantation Center, Antalya, Turkey.
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28
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Gurkan A, Kacar SH, Varilsuha C, Karaca C, Kose S, Karaoglan M, Akman F, Basak K. Non-heart-beating donors: is it worthwhile? Ann Transplant 2005; 10:20-2. [PMID: 16218028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE Due to organ shortage in renal transplantation, many transplant centers attempt to increase the donor pool. Non-heart-beating donors seem to be a promising alternative. PATIENTS AND METHODS We performed 14 renal transplantations from 8 non-heart-beating donors. 2, 1, 3 and 2 donors were from groups 1, 2, 3 and 4, respectively, according to Maastricht classification. RESULTS In 6 of the patients' warm ischemia time was over 30 minutes. Three of them had primary non-function. In 6 patients delayed graft function was seen. The remaining 5 kidneys functioned immediately. Two patients whose kidney functioned returned to hemodialysis in the I I and 13th months after their transplantations. One of the patients with primary non-function died. 9 kidneys function well in their follow-up period between 5-111 months. 1 and 5-year graft survival rates were 69.8 and 61.1 percent, respectively. The mean graft survival time is 69.9 +/- 14.5 months. CONCLUSION Despite the high primary non-function rate, we think that non-heart-beating donors especially in Maastricht classification 3 and 4 should be used due to dramatic shortage of organs.
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Affiliation(s)
- Alp Gurkan
- SSK Tepecik Hospital, Organ Transplantation Unit, Izmir, Turkey
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Kacar S, Gurkan A, Akman F, Varýlsuha C, Karaca C, Karaoglan M. Multiple renal arteries in laparoscopic donor nephrectomy. Ann Transplant 2005; 10:34-7. [PMID: 16218031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Laparoscopic donor nephrectomy has gained popularity throughout the world recently. The more centers became experienced the more this technique began to be used, even in extreme cases. Kidneys with multiple renal arteries are one of the difficult cases for laparoscopic donor nephrectomy. PATIENTS AND METHOD Thirty living laparoscopic donor nephrectomies have been performed between January 2001 and December 2002. Twenty-three of them had single and seven kidneys had multiple renal arteries. Single (SA) and multiple (MA) artery groups were statistically similar in terms of donor age, rate of received right kidneys and serum creatinine clearance of the donors. RESULTS The mean duration of the donor surgery was 225 min and 240 min in SA and MA groups. In the SA and MA groups, the mean warm and cold ischemia times were statistically similar. Laparoscopic nephrectomy was converted to open procedure in five and one donors, in the SA and MA artery groups, respectively. Intraoperative bleeding (single artery: 4, multiple arteries: 1) was the most common cause for conversion. Postoperative urinary complications were seen in four and one patients, in the SA and MA groups, respectively. Lengths of hospital stay of the donors were similar in both groups. Serum creatinine levels of the patients on seventh, 30th, 90th days, and 1 year were found to be statistically similar in both groups. CONCLUSION Laparoscopic donor nephrectomy was found to be a safe procedure in the donors with multiple renal arteries by the experienced surgical teams, as much as in donors with single arteries.
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Affiliation(s)
- Serdar Kacar
- SSK Tepecik Hospital, Organ Transplantation Unit, Izmir, Turkey.
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30
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Gurkan A, Kacar SH, Varilsuha C, Tilif S, Coker I, Karaca C, Karaoglan M. Exchange kidney transplantation: A good solution in living kidney transplantation. Transplant Proc 2004; 36:2952-3. [PMID: 15686668 DOI: 10.1016/j.transproceed.2004.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Kidney transplantation seems to be the best treatment modality for end-stage renal disease patients. But not every patient on the waiting list is able to find a kidney. To increase transplantations, centers have tried to find new options. MATERIAL AND METHODS In the period of November 1994 through June 2004, among 265 renal transplantations, 182 (68.6%) were from living related donors, namely first- and second-degree relatives, spouses, or parents-in-law of the patients. Four patients, who did not have living related donors, had the opportunity of renal transplantation from living donors by exchanging their donors. RESULTS All the kidneys functioned immediately. No complications and no acute rejection episodes were observed in the postoperative period up to 12 months. Serum creatinine levels were 1.9, 1.2, 1.6, and 2.4 mg/dL on postoperative day 7; 1.4, 1.0, 1.1, and 1.1 mg/dL at 1 month after transplantation; 1.5 and 1.2 mg/dL at month 6 after transplantation; 1.6 and 1.4 mg/dL at 1 year after transplantation. CONCLUSION We believe that exchange kidney transplantations represent a good alternative for end-stage renal patients who do not have suitable close living related donors.
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Affiliation(s)
- A Gurkan
- Department of General Surgery and Organ Transplantation, SSK Tepecik Hospital, Izmir, Turkey.
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31
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Gurkan A, Erdogan G, Erdogan O, Pestereli E, Ogus M, Karaveli S, Colak T. Expression of c-erbB-2 and p53 in Breast Carcinoma Patients: Comparison with Traditional Prognostic Factors and Survival. J Int Med Res 2004; 32:455-64. [PMID: 15458277 DOI: 10.1177/147323000403200502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We aimed to determine the correlations between standard clinicopathological factors and expression of c-erbB-2 and p53 proteins, and to investigate the significance of these variables in relapse and disease-free survival (DFS) in breast carcinoma patients. Data from 200 patients who had undergone mastectomy for breast carcinoma were evaluated. Significant correlations were found between c-erbB-2 positivity and high histological grade (grade 3) tumour, p53 positivity and high grade tumour, and age < 60 years and oestrogen receptor negativity. Twenty-six patients (13%) developed a recurrence. Disease relapse was more frequent in patients who had axillary lymph node (ALN) metastasis, high grade tumour, c-erbB-2 positivity and p53 positivity; these variables were also associated with a shorter DFS. The effects of ALN metastasis and p53 positivity were significant. In conclusion, ALN metastasis and p53 positivity were important factors for predicting disease relapse in mastectomy-treated breast carcinoma patients; other clinicopathological criteria and c-erbB-2 positivity were not predictive.
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Affiliation(s)
- A Gurkan
- School of Medicine, Department of General Surgery, Akdeniz University, Kampiis, 07070 Antalya, Turkey
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Kacar S, Gurkan A, Varilsuha C, Karaca C, Karaoglan M, Akman F, Basak K. Marginal donors in kidney transplantation. Ann Transplant 2004; 9:5-7. [PMID: 15884427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Due to organ shortage, it is not easy to find an ideal donor in renal transplantation. To enhance donor pool, marginal donors can be acceptable even in living renal transplantations. We compared optimal and marginal donor transplantations in terms of graft and patient survival. METHODS We performed 32 living related renal transplantations, 11 of which were from marginal donors, from January 1999 to December 2000. Recipients from optimal and marginal donors were compared in terms of renal function, acute tubular necrosis (ATN) and acute rejection (AR) rates. RESULTS Although mean serum creatinine level in the seventh day was found to be higher in the recipients from marginal donors (1,88 mg/dl vs. 2,51 mg/dl); it did not reach to a statistical difference (p = 0.1). Serum creatinine levels after thirtieth day, ATN and AR rates were statistically similar in both groups, as well. In optimal and marginal groups, 3-year graft survival rates were found to be 85 and 72 percent respectively (p = 0.72). 3-year patient survival rates were also found to be similar in both groups (90% vs. 91%) (p = 0.91). CONCLUSION Functional and survival results in the transplantations from marginal donors were as good as from optimal donors. So, we thought that marginal donors could be used safely with a good preoperative evaluation to increase donor pool.
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Affiliation(s)
- Serdar Kacar
- SSK Tepecik Teaching Hospital Organ Transplantation Service, Izmir, Turkey
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Akbas SH, Yavuz A, Tuncer M, Ruhi C, Gurkan A, Cetinkaya R, Demirbas A, Gultekin M, Akaydin M, Ersoy F. Serum cystatin C as an index of renal function in kidney transplant patients. Transplant Proc 2004; 36:99-101. [PMID: 15013312 DOI: 10.1016/j.transproceed.2003.11.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Management of renal transplant patients requires periodic measurement of renal function, which is usually assessed by measuring the glomerular filtration rate (GFR). The most commonly used marker for GFR is serum creatinine, although muscle wasting and tubular secretion may lead to overestimation of the actual GFR. Serum concentrations of the low-molecular-weight proteins, cystatin C and beta(2)-microglobulin (B(2)M), may afford useful markers to determine a reduced GFR. We investigated whether these molecules provide reliable indicators of renal function in 75 renal transplant patients. Cystatin C and B(2)M correlated significantly with creatinine (r =.648, P <.05 and r =.578, P <.05, respectively). Inverse serum creatinine was superior to inverse cystatin C and inverse B(2)M when renal function equations were used (r =.95, P <.05, according to MDRD; r =.87, P <.05, according to Cockroft-Gault). Receiver operating characteristic (ROC) analysis was performed to quantitate the accuracy of the different markers to detect reduced GFR using a cutoff value of 70 mL/min. No significant difference between the areas under the ROC curves comparing cystatin C and B(2)M was observed; however, serum creatinine demonstrated a significantly greater value than cystatin C (.981 vs.724, P =.001). We conclude that serum creatinine is a more efficacious marker than serum cystatin C to assess renal function.
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Affiliation(s)
- S H Akbas
- Central Laboratory, Akdeniz University Faculty of Medicine, Antalya, Turkey.
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Akbas SH, Yavuz A, Tuncer M, Yurdakonar E, Akcit F, Gurkan A, Demirbas A, Gultekin M, Ersoy F, Akaydin M. Evaluation of the new EMIT tacrolimus assay in kidney and liver transplant recipients. Transplant Proc 2004; 36:86-8. [PMID: 15013308 DOI: 10.1016/j.transproceed.2003.11.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Tacrolimus (FK506) is a potent macrolide immunosuppressant used for prevention of organ transplant rejection following transplantation. Monitoring of blood tacrolimus concentrations is essential to assess organ rejection and toxicity, because of the agent's narrow therapeutic range, wide inter- and intraindividual pharmacokinetic variability as well as drug interactions mediated by alteration in cytochrome P450. Several methods have been developed to monitor tacrolimus; immunoassays, bioassays, and HPLC/MS. The purpose of this study was to compare two analytical methods: the well-established MEIA II tacrolimus immunoassay using the IMx analyzer and the new EMIT 2000 tacrolimus immunoassay on the Cobas Integra 400 system. Tacrolimus results obtained using the two methods have been compared on 180 whole blood samples from kidney and liver transplant patients. The analytical sensitivities of both methods were defined as 1.2 ng/mL for EMIT and 1.5 ng/mL for MEIA II. The within-run CVs (n = 15) obtained with four-level controls were 9.08%, 9.41%, 5.23% and 4.4% for EMIT 2000. The comparison showed the following relationship between two methods: MEIA = 1.08.EMIT + 0.20 (r =.893). In conclusion, the EMIT 2000 tacrolimus immunoassay is a reliable alternative for the MEIA II method to monitor tacrolimus in organ transplant recipients. It provides a valid quantitative measurement of tacrolimus with comparable % CVs in quality-control as well as patient blood samples. Additionally, the EMIT 2000 method provides a rapid analysis of a large number of samples in one run with a low turnaround time and possibilities to reanalyze critical samples.
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Affiliation(s)
- S H Akbas
- Department of Central Laboratory, Akdeniz University, Antalya, Turkey
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Akbas SH, Tuncer M, Gurkan A, Yucetin L, Yavuz A, Demirbas A, Ersoy F, Gultekin M, Yakupoglu G, Akaydin M. Plasma homocysteine levels in renal transplant patients on tacrolimus therapy. Transplant Proc 2004; 36:159-60. [PMID: 15013332 DOI: 10.1016/j.transproceed.2003.11.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Increased plasma total homocysteine levels afford an independent risk factor to assess cardiovascular morbidity in patients with normal and impaired renal function, including stable transplant recipients. The purpose of this study was to evaluate plasma homocysteine levels and factors known to influence homocysteine metabolism (folate and Vitamin B(12)) in renal transplanted patients treated with tacrolimus. Plasma homocysteine, serum folate and serum vitamin B(12) concentrations were measured in 18 cadaveric renal transplant patients with stable function both before and 3 months after the renal transplantation. While the mean plasma homocysteine level in the renal transplant group was significantly higher than in the control group, no significant change was observed following renal transplantation under tacrolimus therapy (16.84 +/- 6.43 micromol/L vs 16.02 +/- 6.54 micromol/L). The levels of folate before and after transplantation were considerably lower than the control group; a significant effect of tacrolimus has not been observed (7.32 +/- 4.68 ng/mL and 7.55 +/- 5.20 ng/mL). Serum vitamin B(12) levels in the transplant group were significantly lower than the control group; a significant decline was seen 3 months after the renal transplantation (448.94 +/- 230.03 pg/mL vs 334.38 +/- 240.61 pg/mL). Consequently, although plasma homocysteine levels of renal transplant recipients are higher, a lowering effect of tacrolimus therapy was not observed on plasma homocysteine levels. The lower levels of folate and Vitamin B(12) in the transplant group compared to a control group supports therapy with folate and Vitamin B(12) to decrease homocysteine concentrations.
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Affiliation(s)
- S H Akbas
- Akdeniz University, Faculty of Medicine, Central Laboratory, Clinical Biochemistry Unit, Antalya, Turkey.
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36
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Gurkan A, Tuncer M, Erdogan O, Colak T, Akaydin M, Yakupoglu G. Effect of HCV infection on graft survival in renal transplant patients. Transplant Proc 2002; 34:2129-30. [PMID: 12270340 DOI: 10.1016/s0041-1345(02)02878-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A Gurkan
- Akdeniz University Medical School Transplantation Center, Department of Nephrology and General Surgery, Antalya, Turkey.
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Affiliation(s)
- A Gurkan
- Akdeniz University Medical School Transplantation Center, Department of Nephrology, Antalya, Turkey.
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Abstract
Macroregenerative nodules (MRN) have been detected with increased incidence in explanted livers since orthotopic liver transplantation (OLTx) has become a routine treatment for end-stage liver disease. Autopsy series suggest that MRN may be more common than once thought, and several studies point to the malignant potential of these lesions. With increasing waiting times for OLTx, the propensity for these premalignant lesions to arise in cirrhotic livers has important implications for the supervision of patients on OLTx waiting lists. We present here a striking example of a MRN and review a topic that is generating considerable interest.
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Affiliation(s)
- A Gurkan
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, Australia
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Verran DJ, Gurkan A, Dilworth P, Painter D, Chui A, Dorney S, Shun A, Koorey D, McCaughan G, Sheil AG. Inferior liver allograft survival from cadaveric donors >50 years of age? Clin Transplant 2001; 15:106-10. [PMID: 11264636 DOI: 10.1034/j.1399-0012.2001.150205.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The growing imbalance between the number of cadaveric organ donors and recipients has led to an increasing use of high-risk donors as an option to expand the donor pool. The aim of this study was to evaluate our experience with the use of older liver (donor>50 yr of age) allografts. The medical records, postreperfusion biopsies and laboratory results were reviewed of the 393 patients who underwent orthotopic liver transplantation between 1986 and 1997. The outcome of the 61 patients who received older livers (OL) was compared to that of the other 332 recipients. Increasing use of OL was evident from 1992 onwards. Recipients of OL were older than recipients of younger livers (YL, p<0.001) and more commonly had underlying chronic viral hepatitis (CVH) or fulminant hepatic failure (p<0.05). Patient and allograft survival were only slightly less in recipients of OL versus YL (p=NS). Although postperfusion biopsies showed more damage in OL than YL allografts (p<0.05), this was not associated with increased primary graft failure. OL allografts can be transplanted with acceptable results into recipients without the concern of early allograft loss. SUMMARY OF ARTICLE: This report of one centre's experience with 61 recipients of older donor liver allografts identifies recipient factors that may also have a negative impact on allograft outcome. These factors include a diagnosis of either CVH or fulminant hepatic failure at the time of transplantation. Postreperfusion biopsies of older donor allografts tend to show more damage, but this is not associated with primary non-function.
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Affiliation(s)
- D J Verran
- Australian Liver Transplant Unit, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
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Abstract
BACKGROUND Mutism/speech apraxia has been well documented as a toxic effect of cyclosporine after liver transplantation but has been reported only rarely with tacrolimus. Brain imaging with magnetic resonance or computed tomography has failed to demonstrate abnormalities in affected patients. METHODS We present the first example of an acute onset of loss of speech associated with a sudden elevation of serum tacrolimus level after successful orthotopic liver transplantation. We also describe the positron emission tomography (PET) scan of this patient's brain. RESULTS PET scan imaging of the brain was abnormal, demonstrating decreased metabolism in the posterior temporo-parieto-occipital regions. Statistical probability mapping revealed additional areas of hypometabolism in the cingulate gyrus. CONCLUSIONS PET scan revealed abnormalities of the brain in a patient with tacrolimus-induced mutism. The cingulate gyrus may play a role in the mutism/speech apraxia syndrome seen with cyclosporine/tacrolimus neurotoxicity.
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Affiliation(s)
- D J Bronster
- Department of Neurology, Recanati/Miller Transplantation Institute, New York, New York, USA
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Verran DJ, Gurkan A, Chui AK, Dilworth P, Koorey D, McCaughan G, Sheil AG. Pancreatitis in adult orthotopic liver allograft recipients: risk factors and outcome. Liver Transpl 2000; 6:362-6. [PMID: 10827240 DOI: 10.1053/lv.2000.5203] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis (AP) has been described after orthotopic liver transplantation but is uncommon in stable patients after the initial perioperative phase. The aim of this study is to review our experience with AP occurring more than 2 months after primary allografting and determine possible contributing factors plus patient outcome. A review of patient files and the unit database was performed. AP was diagnosed in 9 of 298 patients (3%) on 12 occasions. The incidence of AP was greater in men (8 of 163 men) than women (1 of 135 women; P <.04). Underlying factors to each episode of AP were biliary manipulation (4 of 12 episodes; 33%), history of recent alcohol ingestion (3 of 12 episodes; 25%), and malignancy in the region of the pancreas (2 of 12 episodes; 16%). AP was associated with a diagnosis of either hepatic artery thrombosis combined with biliary tract complications (P <.005) or malignancy (P <.004). In 7 of 12 episodes of AP (58%), conservative management alone was successful. In 3 of 9 patients (33%), subsequent surgery was required. One patient died of pancreatic malignancy. In conclusion, AP is uncommon in stable liver transplant recipients. Male sex, complications of hepatic artery thrombosis, and malignancy in the region of the pancreas are associated with AP in this study.
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Affiliation(s)
- D J Verran
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
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Gurkan A, Emre S, Fishbein TM, Brady L, Millis M, Birnbaum A, Kim-Schluger L, Sheiner PA. Unsuspected bile duct paucity in donors for living-related liver transplantation: two case reports. Transplantation 1999; 67:416-8. [PMID: 10030288 DOI: 10.1097/00007890-199902150-00013] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Alagille's syndrome is a common cause of liver disease in children and may lead to the need for orthotopic liver transplantation. Alagille's syndrome is inherited in an autosomal dominant manner, with variable penetration, and may also be present in patients' parents, who may be considered potential donors for living-related transplantation. We report here on two cases in which the living-related donors for children with Alagille's syndrome had no liver function abnormalities or characteristic features of Alagille's syndrome. In both cases, the operation for living-related donation had to be aborted because of a paucity of bile ducts discovered intraoperatively. Given the variable presentation of Alagille's syndrome, we believe that it is necessary preoperatively to evaluate the biliary system of family members who are potential living-related donors for patients with this condition.
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Affiliation(s)
- A Gurkan
- Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, New York 10029, USA
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Atillasoy E, Gurkan A, Mor E, Altaca G, Sheiner P, Guy S, Schwartz M, Miller C, Berk P, Emre S. Cholesterol levels long-term after liver transplant. Transplant Proc 1998; 30:2049-50. [PMID: 9723387 DOI: 10.1016/s0041-1345(98)00535-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- E Atillasoy
- Department of Medicine, Mount Sinai Medical Center, New York, New York 10029, USA
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Canakkalelioglu L, Gurkan A. The management of bleeding from a pancreatic pseudocyst: a case report. Hepatogastroenterology 1996; 43:278-81. [PMID: 8682479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hemorrhage from pancreatic pseudocyst or a pseudoaneurysm is a rare, fatal complication of chronic pancreatitis. Elastase may cause erosion of adjacent vessels in the course of acute pancreatitis and spontaneous bleeding may occur. One therapeutic modality is embolotherapy, but surgery is the traditional therapy. Resection of the bleeding site of the pancreas, ligation of the affected vessels or compression by occluding the cyst with a balloon are good alternatives. We present a case having massive gastric hemorrhage from the splenic artery after cystogastrostomy, treated by occluding the artery with a foley catheter.
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Gurkan A, Ayabakan S, Yalcin O. A case of true hermaphroditism diagnosed at laparotomy. Eur J Surg 1994; 160:249-50. [PMID: 8049318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- A Gurkan
- Department of Surgery, SSK Hospital, Manisa, Turkey
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