Yalova University
Urology
Among 772 kidney transplant recipients in two centers 25 patients developed Kaposi's sarcoma (KS) (3.2%). The twenty-two of 25 recipients with regular follow-up records were compared for predisposing factors with another group of 22 renal... more
Among 772 kidney transplant recipients in two centers 25 patients developed Kaposi's sarcoma (KS) (3.2%). The twenty-two of 25 recipients with regular follow-up records were compared for predisposing factors with another group of 22 renal transplant recipients. All patients received cyclosporine (CsA), azathioprine, or mycophenolate mofetil and steroids; patients who received cadaver donor organs additionally received antilymphocyte globulin for induction. KS was diagnosed at a mean of 25.8 months after transplantation. The male to female ratio; mean age; mean follow-up period; hepatitis B, hepatitis C, cytomegalovirus status; and other infection rates were similar in the two groups. Some HLA-DR antigens were detected only in patients with KS. All patients had mucocutaneous involvement, which was multiple in 54.5%. Visceral involvement, and lymph node involvement, or both was detected in seven patients. First-line treatment was to stop CsA and reduce the doses of the other drugs. Three patients underwent additional surgical excision. Fourteen (63.6%) patients experienced complete remissions, including six who required additional chemotherapy or radiotherapy after incomplete or lack of responses to first-line treatment. Two patients died with functioning grafts due to generalized KS. Seven patients returned to hemodialysis at a mean of 36 months after the diagnosis of KS. No significant predisposing factor was observed other than the prevalence of specific HLA-DR antigens. Chemotherapy or radiotherapy should be initiated for patients with multiple, diffuse, and rapidly progressive lesions or organ dysfunction in addition to withdrawal of CsA and tapering of other drugs. Generalized KS displays the poorest prognosis.
To investigate the effects of blood pressure (BP) on kidney function, we reviewed 116 patients who had a median follow-up of 40.5 months. Systolic and diastolic hypertension (HTN) at month 6 resulted in significantly higher serum... more
To investigate the effects of blood pressure (BP) on kidney function, we reviewed 116 patients who had a median follow-up of 40.5 months. Systolic and diastolic hypertension (HTN) at month 6 resulted in significantly higher serum creatinine (SCr) levels at 1 year, compared with patients with normal BP, namely, 2.2 versus 1.4 mg/dL (P ϭ .0001) and 1.87 versus 1.5 mg/dL (P ϭ .04), respectively. Mean systolic and diastolic BP at the end of 1 and 6 months were significantly higher among patients who had returned to hemodialysis or who had an SCr Ն2 mg/dL at their last follow-up. Mean age, mean donor age, donor type, and sex had no significant effect on graft function. Patients receiving Rapamune-based treatment (n ϭ 9) had no graft failure; graft outcomes were similar between cyclosporinebased and tacrolimus-based immunosuppression therapy. Patients with biopsy-proved acute rejection showed significantly lower graft survival. By multivariate analysis, systolic HTN at the end of 1 month (P ϭ .006) and 6 months (P ϭ .01), and diastolic HTN at the end of 6 months (P ϭ .04) were independent risk factors for graft outcome. Actuarial 5-year graft survival was 95%, versus 76% in patients with normal BP versus systolic HTN at 1 month, respectively (P ϭ .02). A significant difference in 5-year graft survival was observed between patients with normal diastolic BP and diastolic HTN at 6 months (95% versus 67%, respectively; P ϭ .001). Since systolic and diastolic BP at different times before and after transplantation correlate with graft function, more attention should be paid to maintain normal BP in patients with renal transplants.
- by Ibrahim Berber and +1
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- Transplantation, Acute rejection
Aim. The incidence of urologic complications after renal transplantation has been reported to be between 2.5% and 27%. The aim of this study was to evaluate urologic complications of and their surgical treatment in our series of renal... more
Aim. The incidence of urologic complications after renal transplantation has been reported to be between 2.5% and 27%. The aim of this study was to evaluate urologic complications of and their surgical treatment in our series of renal transplantations. Materials and methods. We retrospectively evaluated urologic complications among 395 renal transplant recipients in our institute.
- by Ibrahim Berber and +2
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Objective. The aim of this study was to investigate the quality of life of renal donors during long-term follow-up. Patients and Methods. The short form health survey (SF-36) questionnaire was compared between renal donors and the general... more
Objective. The aim of this study was to investigate the quality of life of renal donors during long-term follow-up. Patients and Methods. The short form health survey (SF-36) questionnaire was compared between renal donors and the general population. We evaluated the relationship to postoperative complications and preoperative information with the quality of life. Results. Fifty renal donors of mean age 55.8 Ϯ 12 years (range, 29 -70 years) had a mean follow-up of 55.1 Ϯ 47.2 months (range, 12-168 months). Complications after donor nephrectomy were related with physical function loss (r ϭ Ϫ.397; P Ͻ .05) and vitality (r ϭ Ϫ.463; P ϭ .01). Renal donor candidates who did not have satisfactory information before the operation experienced difficulty with decision making (r ϭ Ϫ.555; P ϭ .0001). Physical function, limitation of physical role and limitation of emotional role were comparable to the general population. Pain scale was worse among donors compared with the general population (P ϭ .001). Educational status of renal donors was related to the pain scale and vitality (r ϭ .369; P Ͻ .05 and r ϭ .523; P Ͻ .05, respectively). General health perception, vitality, mental health, and social functioning were worse compared with the general population (P ϭ .0001, P ϭ .002, P ϭ .0001, and P ϭ .001, respectively). Health problems occurring after donation were related to negation of interfamily relations (r ϭ .695; P ϭ .0001).
- by Ibrahim Berber and +2
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- Decision Making, Transplantation
Aim. Anatomical landmark technique for central venous catheter insertion preoperatively during renal transplantation may result in serious complications. In this prospective study, we sought to evaluate the results of... more
Aim. Anatomical landmark technique for central venous catheter insertion preoperatively during renal transplantation may result in serious complications. In this prospective study, we sought to evaluate the results of ultrasonography-guided central venous catheter insertion before renal transplantation. Patients and Methods. Since March 2004 routine ultrasonography-guided central venous catheter insertion was performed before the operation for living related renal transplantation. Chest X-ray was used as a control after catheter insertion. Visual pain scale was evaluated after the procedure. We recorded the duration of the procedure, amount of local anesthetic, number of punctures, and complications, namely, hematoma, carotid artery puncture, hemorrhage, and hemo-pneumothorax. Results. Since March 2004, 120 jugular venous catheters were inserted into renal transplant recipients preoperatively. Mean visual pain scale was 2.5 Ϯ 1.2 cm (range, 0.6 -4.1 cm). Mean duration of the procedure was 9 Ϯ 3 minutes (range, 6 -15 minutes); the amount of local anesthetic injected was 1.6 Ϯ 0.6 mL (range, 0.9 -2.3 mL). There was no carotid artery puncture, hemo-pneumothorax, or hematoma. During the study period, 3 of the first 10 catheter insertions required more than 1 puncture, for the rest 1 puncture was sufficient for catheter insertion. There was no bleeding or intravenous fluid leakage from the catheter insertion site. Conclusion. Ultrasonography-guided jugular venous catheter insertion is a successful safe method. Routine ultrasonography-guided procedures before renal transplantation avoided the complications related to catheter insertion.
- by Ibrahim Berber and +2
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- Pain Measurement
Aim. Cytokines are early predictors of graft dysfunction. In this study we evaluated pretransplant cytokine levels and graft outcomes among renal transplant recipients. Patients and methods. Donor selection was based on results of blood... more
Aim. Cytokines are early predictors of graft dysfunction. In this study we evaluated pretransplant cytokine levels and graft outcomes among renal transplant recipients. Patients and methods. Donor selection was based on results of blood group matching and negative crossmatches. A panel of 35 human serum samples from patients (female/ male ϭ 0.4) awaiting renal transplantation and 15 healty control sera were analyzed for interleukin (IL) 1␣, IL-2, IL-6, IL-10, tumor necrosis factor-␣, interferon-␥, transforming growth factor- concentrations by enzyme-linked immunosorbent assay. The average age of the patients was 34.5 Ϯ 10.1 years (range 15 to 60). The average duration of renal replacement therapy before renal transplantation was 42.1 Ϯ 57.9 months (range 0 to 288). The types of renal replacement therapy were; hemodialysis (n ϭ 27) and CAPD (n ϭ 8).
Aim. The aim of this study was to evaluate the long-term medical risks of living-related donors in our center. Patients and Methods. 185 living-related donors participated in the study. The factors assessed were creatinine clearance rate... more
Aim. The aim of this study was to evaluate the long-term medical risks of living-related donors in our center. Patients and Methods. 185 living-related donors participated in the study. The factors assessed were creatinine clearance rate (CrCl), serum creatinine (SCr), BUN, hematocrit levels, proteinuria, microalbuminuria and hypertension rates, and renal parenchyma thickness and kidney dimensions predonation as well as at the last follow-up. In addition, we examined postoperative complications. A lombotomy incision was the choice for donor nephrectomy procedure routinely. Results. The mean length of hospital stay after donor nephrectomy was 3.2 Ϯ 0.6 days (range, 2-5 days). Seven donors readmitted during the first month after operation with surgical site infection were treated successfully. Four donors were reoperated for incisional hernia repairs and discharged without complication. The mean follow-up period was 61.6 Ϯ 50.4 months (range, 2-180 months). Mean ages of the donors at operation and at the last follow-up were 50.9 Ϯ 12.7 years (range, 20 -81 years) and 56.5 Ϯ 11.9 years (range, 29 -77 years), respectively. The male-to-female ratio was 0.69. Mean SCr levels and CrCl rates predonation and at the last follow-up were 0.83 Ϯ 0.22 mg/dL versus 1.1 Ϯ 0.2 mg/dL (P Ͻ .001), and 103.9 Ϯ 28.8 mL/min versus 88.3 Ϯ 25.9 mL/min (P ϭ .03), respectively. SCr levels were within normal limits in all donors at predonation and at the last follow-up. At the last follow-up, CrCl was also within expected normal limits in all donors. Hypertension was detected in 13 donors. Mean predonation and at the last follow-up renal parenchymal thickness, BUN, and hematocrit levels were similar. Kidney dimensions were significantly different at the last follow-up after donation (P ϭ .001). Eleven donors displayed proteinuria and 19 had microalbuminuria at the last follow-up, which had been negative for all donors predonation. There were seven surgical site infections and 4 incisional herniae. Conclusion. Donor nephrectomy was performed with low surgical morbidity and comparable results of clinical and laboratory data to the age-matched general population.
- by Ibrahim Berber and +2
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- Risk Analysis
We performed an outcome analysis of 28 pediatric renal transplant recipients whose mean age at transplantation was 15.2 Ϯ 2 years (range: 11 to 17 years) and the M/F ratio, 0.75. Four patients received cadaveric grafts. One patient needed... more
We performed an outcome analysis of 28 pediatric renal transplant recipients whose mean age at transplantation was 15.2 Ϯ 2 years (range: 11 to 17 years) and the M/F ratio, 0.75. Four patients received cadaveric grafts. One patient needed retransplantation due to primary nonfunction. Mean HLA match was 3.6 (range: 3 to 5). Immunosuppression was cyclosporine (n ϭ 13) or tacrolimus (n ϭ 11) or sirolimus (n ϭ 4), as well as steroids and azathioprine or mycophenolate mofetil. Delayed graft function occurred in four patients. The main complications were arterial hypertension (n ϭ 11), anemia (n ϭ 4), urinary tract infection (n ϭ 10), hypercholesterolemia (n ϭ 7), and cytomegalovirus infection (n ϭ 1). An acute rejection episode (ARE) occurred in four patients. ARE and hypertension rates were similar between the immunosuppressive drug groups. All the patients with graft failure were on cyclosporine (P ϭ .03). Hemodialysis and peritoneal dialysis (median duration: 6 months) were performed preoperatively in 25 and 3 patients, respectively. The length of pretransplant dialysis was longer among patients with graft failure (P Ͼ .05). Noncompliance (10.7%) resulted in an ARE in one patient and graft loss in two patients. One patient died with a functioning graft. Primary disease recurred in one patient. The median follow-up period was 44 months (range: 6 to 157 months). Mean serum creatinine level was 1.35 Ϯ 0.74 mg/dL at the last follow-up. One-and 3-year graft survival rates were 92% and 86%, respectively, and patient survival was 100%, each. Seventeen patients (60.7%) continued their education after the transplantation; six started working. Successful transplantation in the pediatric age group together with intensive rehabilitation posttransplantation are important to make these children productive individuals to the society.
The number of patients on the kidney waiting list is increasing, creating a shortage of donor organs. To solve this problem, there is an interest in transplanting organs formerly considered marginal or undesirable. We performed seven... more
The number of patients on the kidney waiting list is increasing, creating a shortage of donor organs. To solve this problem, there is an interest in transplanting organs formerly considered marginal or undesirable. We performed seven (four living related, three cadaveric) kidney transplants from hepatitis B surface antigen (HBsAg)-positive donors. Hepatitis B e antigen (HBeAg) and hepatitis B virus (HBV) DNA were negative in the living donors and were unknown in cadaveric donors. Liver function tests were in the normal range in all of the donors. All of the recipients were HBsAg-negative and hepatitis B surface antibody (anti-HBs)-positive. Recipients receiving kidneys from cadaveric donors were given prophylactic lamivudine treatment postoperatively. Anti-HBs remained positive throughout the follow-up period in all but one patient with a cadaveric graft. None of the patients receiving a kidney from an HBsAg-positive donor developed clinical HBV infection in a mean follow-up period of 42.6 Ϯ 36.8 months (range: 16 to 121 months, median 30 months). Liver function tests remained in the normal ranges in all patients. All the grafts are still functioning with a mean serum creatinine level of 1.6 Ϯ 0.85 mg/dL. In conclusion, transplants from HBsAg-positive and HBeAg-/HBV DNA-negative donors seem to carry no risk to the recipients who are immune to HBV. Even cadaveric donors with HBsAg-positivity and unknown HBeAg/HBV DNA status can be used with caution in selected recipients without significantly affecting graft and patient outcome.
- by Ibrahim Berber and +1
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- Transplantation, Kidney Transplant
The aim of this study was to evaluate etiologic, diagnostic, and management aspects of stone disease in renal transplant recipients and donors. Calculi from five patients were analyzed. The immunosuppressive regimen included tacrolimus or... more
The aim of this study was to evaluate etiologic, diagnostic, and management aspects of stone disease in renal transplant recipients and donors. Calculi from five patients were analyzed. The immunosuppressive regimen included tacrolimus or cyclosporine, mycophenolate mofetil, and corticosteroids in all cases. The etiology of the stone disease was cadaveric donor-gifted in one patient and de novo stone formation after transplantation in two patients. Additionally, stone disease was found and treated in living related donors in two patients. The mean follow-up was 32.4 Ϯ 19.7 months. In the living related donors, stones were initially treated by ESWL. Pyelotomy at the back table during the transplantation was required in one of them. The patient with cadaver-gifted stone was also treated by ESWL. In patients with de novo stone formation after transplantation, the stones were related to urinary infections and foreign body double-j (JJ) stent. A small stone in one of these patients (de novo formation) passed spontaneously after removal of the foreign body. Endoscopical lithotripsy was performed in the other patient. Stones are more frequently transplanted with allografts than expected; therefore, preoperative imaging of the donor is important. ESWL is recommended for medium-sized calculi in transplant kidneys. JJ stent insertion before ESWL might be needed in stones larger than 10 mm.
The use of grafts with multiple renal arteries has been considered a relative contraindication because of the increased incidence of vascular and urologic complications The aim of this study is to determine whether the kidney grafts with... more
The use of grafts with multiple renal arteries has been considered a relative contraindication because of the increased incidence of vascular and urologic complications The aim of this study is to determine whether the kidney grafts with multiple arteries have any adverse effect upon post-transplant graft and patient survival. We reviewed the records of 225 adult kidney transplants done consecutively at our institution. Twenty-nine patients (12.8%) had grafts with multiple renal arteries. We analyzed the incidence of post-transplant hypertension and vascular complications, mean creatinine levels, patient and graft survival. In 17 cases reconstruction was done as conjoined anastomosis between two arteries of equal size, and in 6 cases as end-to-side anastomosis of smaller arteries to larger arteries. Multiple anastomoses were performed in 6 cases. In one patient postoperative bleeding occurred. Mean systolic blood pressures, creatinine levels at first year and last follow-up and comp...
- by Ibrahim Berber and +1
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- Kidney Transplant
Background. Abnormalities of cell numbers and apoptosis have been observed in renal failure. As uncontrolled expression of c-myc is known to induce apoptosis, we thought that polymorphism in the other myc gene, L-myc gene, which is... more
Background. Abnormalities of cell numbers and apoptosis have been observed in renal failure. As uncontrolled expression of c-myc is known to induce apoptosis, we thought that polymorphism in the other myc gene, L-myc gene, which is structually similar to c-myc and reported to be expressed in the kidney, may have a role in the induction of apoptosis and thus have role in chronic renal failure. The aim of this study was to investigate the relationship between the distribution of L-myc genotypes and renal failure.
Aim. Cytokines are early predictors of graft dysfunction. In this study we evaluated pretransplant cytokine levels and graft outcomes among renal transplant recipients. Patients and methods. Donor selection was based on results of blood... more
Aim. Cytokines are early predictors of graft dysfunction. In this study we evaluated pretransplant cytokine levels and graft outcomes among renal transplant recipients. Patients and methods. Donor selection was based on results of blood group matching and negative crossmatches. A panel of 35 human serum samples from patients (female/ male ϭ 0.4) awaiting renal transplantation and 15 healty control sera were analyzed for interleukin (IL) 1␣, IL-2, IL-6, IL-10, tumor necrosis factor-␣, interferon-␥, transforming growth factor- concentrations by enzyme-linked immunosorbent assay. The average age of the patients was 34.5 Ϯ 10.1 years (range 15 to 60). The average duration of renal replacement therapy before renal transplantation was 42.1 Ϯ 57.9 months (range 0 to 288). The types of renal replacement therapy were; hemodialysis (n ϭ 27) and CAPD (n ϭ 8). Results. Pretransplant IL-6 levels were higher among recipients who displayed acute rejection episodes compared with those fact of this complications (P Ͻ .05) or control sera (P Ͻ .05). Pretransplant IL-6 levels were higher among recipients with graft failure than those with a functioning graft (P Ͻ .05). Pretransplant IL-10 levels were higher among recipients with acute rejection episodes and graft failure than those without acute rejection or control subjects, but the difference did not reach significance. There was no correlation between pretransplant cytokine levels and age, gender, type, or duration of renal replacement therapy (P Ͼ .05). Conclusion. High pretransplant serum IL-6 levels are associated with an increased risk of acute rejection episodes and graft failure. IL-10 might contribute an anti-inflammatory action to patients with high serum IL-6 levels.
Methods: We determined IL-1alpha, TNF-alpha, IFN-gamma, IL-10 and TGF-beta in 87 blood samples by ELISA (RayBiotech, Inc). Group1 (n=35) included kidney transplant patients at postoperative 1st year whose preoperative blood samples were... more
Methods: We determined IL-1alpha, TNF-alpha, IFN-gamma, IL-10 and TGF-beta in 87 blood samples by ELISA (RayBiotech, Inc). Group1 (n=35) included kidney transplant patients at postoperative 1st year whose preoperative blood samples were studied (n=35) and all were ...
Chronic rejection is an immune process leading to graft failure. By regulating the trafficking of leukocytes, chemokines and chemokine receptors are thought to be one of the reasons causing acute renal rejection (ARE), which increases the... more
Chronic rejection is an immune process leading to graft failure. By regulating the trafficking of leukocytes, chemokines and chemokine receptors are thought to be one of the reasons causing acute renal rejection (ARE), which increases the possibility of chronic rejection and organ destruction. This study was designed to investigate, in the Turkish population, an association of chemokine receptor genetic variants, CCR2V641, CCR5-59029-A/G, CCR5-D32 and acute renal rejection after renal transplant surgery. We carried out our study in 85 Turkish renal transplant patients (45 men, 40 women; mean age 39 AE 2 years) by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) techniques. We found no significant difference in the incidence of rejection among patients possessing or lacking CCR5-D32. For the groups with and without acute renal rejection, we found a significant difference between the groups in A and G allele distribution in both CCR2V641and CCR559029 gene variants (p ¼ 0.003 and p ¼ 0.003, respectively). According to our findings, the risk of acute rejection in renal transplantation may be associated with genetic variation in the chemokine receptor genes CCR5-59029 and CCR2V641 in Turkey, and studies on these gene polymorphisms could be an ideal target for future interventions intended to prevent renal transplant loss.
Introduction: Quality of life has been extensively discussed and numerous research have tried to account for the main dimensions constitutive of the quality of life of patients in the transplantation process. However a model grounded in... more
Introduction: Quality of life has been extensively discussed and numerous research have tried to account for the main dimensions constitutive of the quality of life of patients in the transplantation process. However a model grounded in the patients' experience and concerns to our knowledge has not been developed. Research mainly focus on the predictive value of different variables on transplantation outcomes and survival of the patient or of the graft. Methods: In a qualitative longitudinal study following 71 patients, semi-structured interviews were performed at the registration on the waiting list, 6, 12 and 24 months after transplantation. Patients awaiting heart, liver, lung and kidney transplantation were contacted at their registration on the waiting list, and follow-up interviews were proposed at the different pre-defined milestones. These interviews took place at home or in a place selected by the patients. The interviews were not limited in time and were conducted in a reflexive methodological background. Certain topics were pre-selected based on previous research, but interviews stayed open to the specific themes or concerns the patients would like to discuss at each step of the transplantation process. Results: A qualitative thematic and reflexive analysis was performed, based on the themes discussed by the patients. A five dimensional model constitutive of what quality of life means from the perspective of the patients at each step of the transplantation process was developed. Each dimension was defined differently according to the secific concerns expressed at each milestone of transplantation. The two first milestones are presented here: at the registration on the waiting list and 6 months after transplantation. Conclusion: What we have learned from the interviews of the patients is that quality of life is not a stable construct. It evolves with illness, its constraints and stakes. However, main dimensions constitutive of quality of life can be defined, each of them containing different sub-categories depending on the transplantation milestone and on the organ related problematic. The model presented here can contribute to the definition of psychological support, adapted to the person, his/her medical constraints and challenges. Adequacy between the patients concerns and the medical priorities can participate to better adherence to treatment and to the long-term success of transplantation.
Among 772 kidney transplant recipients in two centers 25 patients developed Kaposi's sarcoma (KS) (3.2%). The twenty-two of 25 recipients with regular follow-up records were compared for predisposing factors with another group of 22 renal... more
Among 772 kidney transplant recipients in two centers 25 patients developed Kaposi's sarcoma (KS) (3.2%). The twenty-two of 25 recipients with regular follow-up records were compared for predisposing factors with another group of 22 renal transplant recipients. All patients received cyclosporine (CsA), azathioprine, or mycophenolate mofetil and steroids; patients who received cadaver donor organs additionally received antilymphocyte globulin for induction. KS was diagnosed at a mean of 25.8 months after transplantation. The male to female ratio; mean age; mean follow-up period; hepatitis B, hepatitis C, cytomegalovirus status; and other infection rates were similar in the two groups. Some HLA-DR antigens were detected only in patients with KS. All patients had mucocutaneous involvement, which was multiple in 54.5%. Visceral involvement, and lymph node involvement, or both was detected in seven patients. First-line treatment was to stop CsA and reduce the doses of the other drugs. Three patients underwent additional surgical excision. Fourteen (63.6%) patients experienced complete remissions, including six who required additional chemotherapy or radiotherapy after incomplete or lack of responses to first-line treatment. Two patients died with functioning grafts due to generalized KS. Seven patients returned to hemodialysis at a mean of 36 months after the diagnosis of KS. No significant predisposing factor was observed other than the prevalence of specific HLA-DR antigens. Chemotherapy or radiotherapy should be initiated for patients with multiple, diffuse, and rapidly progressive lesions or organ dysfunction in addition to withdrawal of CsA and tapering of other drugs. Generalized KS displays the poorest prognosis.
Aims: After the first kidney transplantation performed by Murray in 1954, it has been considered as the best treatment choice for endstage renal disease around the world. However, in spite of the expertness of the procedure, improvement... more
Aims: After the first kidney transplantation performed by Murray in 1954, it has been considered as the best treatment choice for endstage renal disease around the world. However, in spite of the expertness of the procedure, improvement of new immunosuppressant drugs, and improvement of understanding about human immune system, rejection still is the dilemma of kidney transplantation. This study is designed to find the predictor for long-term renal allograft survival in episodes of rejection. Methods: We analyzed 239 recipient patients who experienced rejection among 1509 kidney transplantation cases done in Asan Medical Center between June 1990 and January 2004. Cases corresponded to simultaneous pancreas-kidney transplantation and immediate allograft removal hyperacute rejected transplant were excluded from the study. We paid attention to time of onset of rejection, HLA-DR matching, types of immunosuppressant regimen, amount of perioperative transfusion, serum creatinine level before and after the first attack of rejection, and reversibility of functional allograft survival rates. All the data were analyzed using SPSS software (Release 10.0, SPSS Inc., IL). Kaplan Meier method and Cox proportional hazards model were used for comparing the data. Results: 1) In a viewpoint of onset time of rejection (3, 6 month, 1 year after kidney transplantation), there was no statistical significance shown in renal allograft survival. 2) There were no statistically significant numbers of HLA-DR matching in renal allograft survival. 3) There was no statistical significance shown in renal allograft survival in the viewpoint of immunosuppressant regimen. 4) There was no statistical significance shown in renal allograft survival in the viewpoint of amount of perioperative transfusion. 5) There was no statistical significance shown in renal allograft survival in the viewpoint of immunosuppressant regimen. 6) There was statistical significance shown in renal allograft survival between groups of 1 day creatinine level after operation above and below 4.0(pϭ0.01). 7) DCr was defined as difference between highest and lowest creatinine level in the course of first rejection, and there was statistical significance shown in renal allograft survival between groups of DCr above and below 1.0(pϭ0.03). 8) DDCr was defined as difference between lowest creatinine level in the course of first rejection and baseline creatinine level primarily after kidney transplantation, and there was statistical significance shown in renal allograft survival between groups of DDCr, that is, -0.3ϳ0.3, 0.4ϳ0.6, 0.7ϳ1.0, 1.1ϳ1.5, more than 1.6, less than -0.4(pϭ0.0019). 9) rejCr was defined as highest creatinine level in the course of first rejection, and there was statistical significance shown in renal allograft survival between groups of rejCr above and below 3.0(pϭ0.0003). 10) There was statistic significance shown in renal allograft survival between groups of one month creatinine level after completion of rejection treatment above and below 1.7(pϭ0.046). 11) In multivariate analysis, DCr, rejCr, DDCr, one month creatinine level after completion of rejection treatment were found as statistically significant factors(pϭ0.027, 0.002, Ͻ0.0001, 0.023). Conclusions: Rejection after kidney transplantation has been known as major factor having a negative effect upon the renal allograft survival. As of occurrence of rejection, prediction of long-term renal allograft survival will be a great help to our decision making about treatment. At this point we suggest that DCr, DDCr of initial rejection episode is a great predictor on long-term renal allograft survival.
To determine whether the use of kidney allograft with multiple renal arteries adversely affects post transplant out come and complications. Background: Transplantation of kidney with multiple renal arteries is generally avoided. The... more
To determine whether the use of kidney allograft with multiple renal arteries adversely affects post transplant out come and complications. Background: Transplantation of kidney with multiple renal arteries is generally avoided. The disadvantages of multiple vessel graft includes technical diffi culty to anastomose, longer warm ischaemia and hence increased incidence of ATN, early graft dysfunction, various urologic and vascular complications. Methods: We reviewed the records of 35 living related adult kidney transplants done at our centre over a period of 3 years (from January 2005 to December 2007). We divided the study population into two groups: Group A -20 Patients with single renal artery and group B-15 patients with multiple renal arteries. Single, end to side anastomosis was done with recipient's external iliac artery. All patients were placed on conventional immunosuppressant in the post operative period. We compared the incidence of post transplant complications like ATN, Hematoma, technical obstruction of ureter, Urine leak, lymphocele, sloughed ureter, graft nephrectomy etc. between two groups. Result: Of the 34 patients; 20 patients (57%) had single renal artery and 15 (43%) had multiple renal arteries. In group-A: 1 (5%) developed hematoma, 1 (5%) technical obstruction of ureter, 1 (5%) ATN, 1 (5%) developed sloughed ureter and 1 (5%) patient required graft nephrectomy for coagulation necrosis. In group B, hematoma was found in 2 (13% patients, technical obstruction of ureter in 1 (6%) urine leak in 3 (20%), ATN in 3 (20%) sloughed ureter in 1 (6%) patients and 1 (6%) required graft nephrectomy. In Kidneys with multiple renal arteries, only the incidence of ATN, Urine leak and technical obstruction of ureter was higher compared to single artery grafts, which were also not signifi cant statistically. Conclusion: Although kidney grafts with multiple renal arteries carry a relatively higher incidence of some complications, even then it should not be avoided, because post transplant out come and complications are comparable with single artery grafts.