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Öğe Böbrek naklinde sitomegalovirüs enfeksiyonu için düşük doz valgansiklovir profilaksisinin etkinliği(Galenos, 2020) Özçelik Ü.; Alpay N.; Eren, Eryiğit; Uslu, Bora; Yardımcı, A.C.Amaç: Valgansiklovir böbrek nakli hastalarında Sitomegalovirüs (CMV) profilaksisi için tercih edilen ilaçtır. Standart dozun (900 mg/gün) böbrek fonksiyonlarına olan olumsuz etkisi ve lökopeni yan etkisi nedeniyle düşük doz (450 mg/gün) Valgansiklovir kullanımı giderek yaygınlaşmaktadır. Bu çalışmada düşük doz Valgansiklovirin etkinliği ile ilişkili sonuçlarımızı sunduk. Yöntemler: 01 Aralık 2017 ile 01 Eylül 2018 tarihleri arasında İstanbul Aydın Üniversitesi Tıp Fakültesi, Uygulama ve Araştırma Merkezi Hastanesi ve İstinye Üniversitesi Tıp Fakültesi, Uygulama ve Araştırma Merkezi Hastaneleri’nde yapılmış olan böbrek nakli hastaları incelendi. Hastaların demografik bulguları, preoperatif CMV durumları, postoperatif CMV ve lökopeni insidansı değerlendirildi. Bulgular: Ortalama yaşı 42,85 olan toplam 113 hasta (46 kadın, 67 erkek) dahil edildi. Hastaların tümünün preop CMV IgG (+), donörlerin de tümünün preop CMV IgG (+) idi. Ortalama takip süresi 7 ay (6-13 ay) idi. Bu süreçte iki hastada CMV hastalığı (%1,76) gelişti. Her iki hasta da intravenöz gansiklovir ile tedavi edildi. CMV’ye bağlı herhangi bir komplikasyon gelişmedi. Hiçbir hastada valgansiklovire bağlı lökopeni görülmedi. Sonuç: Bu çalışmada düşük doz Valgansiklovirin donör ve alıcı CMV pozitif olan böbrek nakli alıcılarında CMV profilaksisi için etkin olduğu görülmüştür. Biz de çalışmamızda postoperatif CMV insidansının düşük olması nedeniyle düşük doz Valgansiklovir kullanımını öneriyoruzÖğe Improvement of Left Ventricular Function after Renal Transplantation Is Related with Multiple Parameters(Turkish Society of Cardiology, 2022) Şahin, Ahmet Anıl; Uslu, Bora; Göksülük, Hüseyin; Turhan, HasanWe have read with great interest the article titled “Improvement in cardiac function after renal transplantation in four patients with severe left ventricular systolic dysfunction,” which was written by Aslanger et al.1 Authors evaluated preoperative and postoperative echocardiographic results including improvement of systolic and diastolic functions of four patients who underwent kidney transplantation because of kidney failure. We would like to first thank the authors that we do also inspect the improvement of cardiac function and recovery of the ventricular diameters in these patient groups after transplantation as our institution is also a major transplantation center in the country. The authors discussed their findings and they have stated that the improvement might be related to multiple parameters including the correction of volume and pressure overload, the restoration of normal hemoglobin levels, the clearance of uremic toxins, and being able to take heart failure medications. Even though major studies which have been held about this subject by Wali et al2 and Hawwa et al3 found no significant association between urea reduction ratio and body mass index in these patient groups, they have also stated that the change of ejection might be related to volume overload and uremic toxins, similar to your comments. However, there is no information about the hemoglobin levels, urea levels, and weight or body mass index of the patients before and after the transplantation in your cases. We believe that providing this information in your patient group would benefit the discussion and assessment of your findings.Öğe Is the Presence of 2 Renal Allograft Arteries Associated with Adverse Outcomes in Live Donor Kidney Transplantation?(Aves, 2023) Eren, Eryigit; Tokac, Mehmet; Uslu, Bora; Sahin, Taylan; Aktokmakyan, Talar Vartanoglu; Dinckan, AyhanObjective: Although it was postulated that renal grafts with multiple arteries could lead to unfavorable recipient outcomes, this subject remains controversial. This study aimed to compare the outcomes of recipients receiving renal allografts with a single artery with those receiving renal grafts with two arteries. Materials and Methods: Adult patients who received live donor kidney transplantation in our center between January 2020 and October 2021 were included. Data including age, gender, body mass index, renal allograft side, pre-kidney transplantation dialysis status, human leukocyte antigen mismatch number, warm ischemia time, the number of renal allograft arteries (single/double), complications, duration of hospitalization, postoperative creatinine levels, glomerular filtration rates, early graft rejection, graft loss, and mortality were collected. Subsequently, patients who received single-artery renal allografts were compared with those who received double-artery renal allografts. Results: Overall, 139 recipients were included. The mean recipient age was 43.73 +/- 13.03 (21-69). While 103 recipients were male, 36 were female. The comparison between the 2 groups revealed that mean ischemia time was significantly longer in the double-artery than in the single-artery group (48.0 vs. 31.2 minutes) (P =.00). In addition, the single-artery group had significantly lower postoperative day 1 and day 30 mean serum creatinine levels. Also, the mean postoperative day 1 glomerular filtration rates were significantly higher in the single-artery group than in the double-artery group. However, the 2 groups were similar concerning the glomerular filtration rates measured at other times. On the other hand, there was no difference between the 2 groups regarding duration of hospitalization, surgical complication, early graft rejection, graft loss, and mortality rates. Conclusion: The presence of 2 renal allograft arteries does not have adverse effects on the postoperative parameters of the kidney transplantation recipients, including graft function, duration of hospitalization, surgical complication, early graft rejection, graft loss, and mortality rates.Öğe Mesalazine induced focal segmental glomerulosclerosis in a patient with ulcerative colitis(Wolters Kluwer Medknow Publications, 2020) Yılmaz F.; Uslu, Bora; Akkaya B.; Çetinkaya R.Focal segmental glomerulosclerosis (FSGS) and other glomerulonephritis due to the use of 5-aminosalicylic acid derivatives have been reported in the literature. A 38-year-old male who had been using mesalazine for four years because of ulcerative colitis applied to doctor due to swelling in the lower extremities. The patient was diagnosed with nephrotic syndrome (NS). Renal biopsy was performed, and FSGS was diagnosed. Antiproteinuric treatments were initiated with steroid therapy. The patient has been followed with the normal renal function of the after treatment. 5-aminosalicylic acid derivatives affect renal functions at different levels and caused in NS. © 2020 Saudi Center for Organ Transplantation.Öğe Renal transplantation in high immunological risk patients: A single-center experience(Elsevier Science Inc, 2019) Alpay, Nadir; Özcelik, Umit; Eren, Eryiğit; Uslu, BoraBackground. Renal transplantation (RT) in high-risk patients is increasingly performed due to an inadequate organ pool and increased rate of RT after a failed transplantation. Safety and prognosis of RT in such patients with high risk is an ongoing debate. Herein we aimed to present our single-center experience on RT of high-risk patients. Methods. A total of 89 consecutive RT patients were included into this study in a 10-month period. Patients were divided into 3 groups: the low-risk group (n = 47) with negative panel reactive antibody (PRA), medium-risk group (n = 18) with positive PRA but mean fluorescence intensity (MFI) <2000, and high-risk group (n = 24) with positive PRA and MFI >2000 or donor specific antibody (DSA) positivity. Groups were compared in terms of demographic features, serum creatinine levels, acute rejection rates, delayed graft function (DGF), and patient or graft loss. Results. Age of the recipients were similar between the groups. Desensitization (7% vs 11% vs 42%, respectively, in low-, medium-, and high-risk groups; P = .001), plasmapheresis (6% vs 11% vs 46%, respectively, P < .001), and rituximab treatments (0% vs 0% vs 25%, respectively, P < .001) were significantly more frequently performed in high-risk patients. Serum creatinine levels at 1 month and 6 months after RT were similar between the groups (P = .43 and P = .71, respectively). Rates of acute rejection (6% vs 6% vs 16%, respectively, P = .52) and DGF (9% vs 11% vs 29%, respectively, P = .15) were similar between the groups. Frequencies of loss of patient or graft were also similar (0% vs 6% vs 4%, P = .15). Conclusion. RT may be successfully performed in high-risk patients without an increase in the risk of acute rejection, DGF, or patient/graft loss.
