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Öğe An investigation of post-traumatic growth experiences among living kidney donors(Elsevier Science Inc, 2015) Yücetin, Levent; Bozoklar, C. A.; Yanık, O.; Tekin, S.; Tuncer, Murat; Demirbaş, A.More than 1 million patients are estimated to have undergone transplantation in the past years. In recent years, living-donor kidney transplantation accounted for more than 50% of all transplantations. Kidney transplantation from living donors is regarded as a contradictory case to the "do no harm" principle as a major surgical intervention is performed on a normal and healthy person at the expense of recovery of the organ recipient. The purpose of this study was to investigate positive psychological experiences, specifically post-traumatic growth (PTG), among living kidney donors. The sample consisted of a total of 184 kidney donors. The age of donors ranged between 21-76 (mean, 50.76; SD, 10.93). In this study 67.9% of donors were female. The recipients on dialysis group had higher scores than the recipients who did not have dialysis; the mean difference was significant on the subscales of change in life philosophy, change in relationships, change in self-perception, and in the PTGI score. The donors with higher education levels received higher scores on the subscale of change in relationships in comparison with donors with low education. The donors who were married and older than 51 years had higher scores than donors who were not married or younger on the subscale of change in self-perception. This is a single-center study; this center performs more than 500 kidney transplantations per year. There is a good system and experience at each step before and after transplantation for donor and recipient and relatives. It is a really big potential trauma to donate a kidney to your relative; you can change this negative effect to a positive effect with a good system. The present study also showed that when compared with the scale's absolute midpoint, kidney donors in the study sample experienced moderate-to-high levels of PTG.Öğe Comparision of ureteral stent colonization between deceased and live donor renal transplant recipients(Elsevier Science Inc, 2017) Sarıer, M.; Seyman, D.; Tekin, S.; Duman, I.; Uygun, B.; Demir, M.; Yavuz, A. H.Background. The use of a ureteral stent can cause a urinary tract infection (UTI), although it reduces urologic complications. UTIs are associated with a higher rate of ureteral stent colonization (USC). The aim of this study was to compare USC in living and deceased donor renal transplant recipients. Material and Methods. We conducted a prospective study of 48 patients who underwent renal transplantation between January and December 2016. The stents were removed aseptically, the inner surface of proximal and distal ends of stents were irrigated with liquid culture medium, and then they were vortexed for bacteriological investigation. Urine cultures were taken at the same time. Results. A total of 45 renal transplantation patients (21 from cadavers, 24 from live donors) were evaluated in the study. The duration time of stent retention in patients with live donors was 25.04 +/- 4.55 and in patients with deceased donors was 26.19 +/- 4.08 days (P = .376). USC was observed in 12 (57.1%) and 6 (25%) patients while positive urine culture (PUC) was detected in 5 (23.8%) and 2 (8.3%) patients in deceased and live donor transplant recipients, respectively. Although the USC rate was significantly higher in the deceased donor renal transplant group (P = .022), there was no significant different in the rates of PUC (P = .137). Enterecoccus species was the common pathogen isolated from ureteral stent and urine. The micro-organisms isolated from ureteral stent in deceased and live donors, respectively, were distributed as follows: Enterococcus 5/3, Candida 3/1, Escherichia coli 2/1, Kebsiella pneumonia 1/1, and staphylococci in 1/0 patients. All E coli and K pneumoniae are extended spectrum beta-lactamase (ESBL)-positive isolates and resistant to sulfamethoxazole-trimethoprim (SMX/TMP). Conclusions. We report a high incidence of USC in deceased renal transplants. Enterecoccus instead of E coli is the most common pathogen during the first month after transplantation. Transplantation centers should be aware that deceased donor renal transplant recipients are more prone to stent-related infection and the antibacterial resistance rapidly increases in uropathogens.Öğe Donors with hepatitis B surface antigen positivity(Elsevier Science Inc, 2015) Yavuz, H. Asuman; Tekin, S.; Yüksel, Y.; Ateş, I.; Yücetin, L.; Demir, M.; Demirbaş, A.Objective. There is a still controversy among transplantation centers regarding acceptance of hepatitis B surface antigen (HBsAg)-positive donors for renal transplantation. However, some reports show that these donors can be used under a special protocol. In this study, we compared the clinical and biochemical parameters of patients who received kidneys from HBsAg-positive (group 1) versus other living-related kidney donors (group 2). Materials and Methods. We retrospectively analyzed the outcomes of 2168 living-related renal transplantations performed between December 2008 and April 2014 at Medical Park Hospital Transplantation Center, Antalya, Turkey. One hundred eleven donors were HbsAg-positive (group 1), and 2057 donors were HbsAg-negative (group 2). Group 1 kidney transplantations were undertaken only if the recipient displayed a hepatitis B antibody titer >10 mIU/mL and donor hepatitis B virus DNA was negative. Results. Demographic characteristics; 1-, 2- and 4-year serum creatinine levels; glomerular filtration rates; and liver function test results were similar between the two groups. There were no new hepatitis B virus infections throughout the study period. Acute rejection rates (26/111 in group 1 vs 375/2168 in group 2; P = .887), graft loss (4/111 in group 1 vs 123/2168 in group 2; P = .546), and patient loss (6/111 in group 1 vs 102/2168; P = .132) were similar between the two groups. Conclusion. Our study showed that hepatitis B surface antigen positivity was not a contraindication to living-kidney donation.Öğe Kidney transplantation from elderly donor(Elsevier Science Inc, 2015) Tekin, S.; Yavuz, H. A.; Yüksel, Y.; Yücetin, L.; Ateş, I.; Tuncer, M.; Demirbaş, A.Aim. In recent years, there has been an increase in usage of grafts from advanced-age donors because of the shortage of organ availability. Acceptance of elderly living-kidney donors remains controversial due to the higher incidence of comorbidity and greater risk of postoperative complications. The objective of this study was to evaluate the graft function and patient survival using kidneys from living-related and unrelated donors who were older than 65 years of age. Materials and Methods. From December 2008 until December 2013 we compared the outcomes of 294 patients (mean age, 47.67 +/- 12.4 years; range, 16 to 74 years old) who received grafts from donors >= 65 years old to 2339 patients who received grafts from donors who were younger than 65 years old. Results. We observed no significant differences in sex, time on dialysis, or cold ischemia time between the groups. The recipient ages between two groups were similar. For survival analysis we used the Kaplan-Meier survival estimator. Patient survival at 1, 2, and 3 years was 91.1%, 89.1%, and 88.5%, respectively, for patients transplanted with kidneys from donors >= 65-years-old vs 96.7%, 95.9%, and 95.0%, respectively, in the <65-year-old donor group. Multivariate analysis showed the variables associated with patient survival to be donor age at time of transplantation in years (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.59-1.71; P < .05), time on dialysis in months (HR, 1.22; 95% CI, 1.21-1.23; P = .002). Graft survival rates at 1, 2, and 3 years censored for death with functional graft at was 97.6%, 96.4%, and 94.1%, respectively, for patients transplanted with kidneys from donors older than 65 years vs 97.5%, 96.8%, and 95.2%, respectively, in the <65-year-old donor group. Multivariate analysis, HLA-DR mismatches (HR, 1.23; 95% CI, 1.12-1.55; P = .050), delayed graft function (HR, 1.77; 95% CI, 1.53-2.07; P = .021), and perhaps acute rejection (HR 1.14; 95% CI, 0.82-1.95; P = .093) were the variables associated with graft survival. Conclusion. We concluded that the use of kidneys from donors older than 65 years of age allows us to increase the rate of renal transplantation to approximately 15 to 20 per million population, with good graft and patient survivals provided that the protocol for expanded criteria organs ensured proper macroscopic and microscopic evaluation of the organ for transplantation.Öğe Middle hepatic vein tributary reconstruction of a right hepatic graft in adult living donor liver transplantation: A case report(Elsevier Science Inc, 2015) Tekin, S.; Yüksel, Y.; Yücetin, L.; Yavuz, H. A.In adult living donor (right liver) lobe transplantations (LDLT), the removal of the middle hepatic vein (MHV) with the graft and reconstruction carried out in the donor are of great importance. Here a 44-year-old male patient with hepatitis B-related end-stage liver failure is reported of whom his 34-year-old brother was evaluated as a donor candidate. At routine preoperative screening tests, neither the patient nor the donor candidate was found to have any pathological findings that might interfere with the transplantation. The donor candidate was assessed using multislice computed tomography for a standard liver volume measurement and anatomical structure evaluation and extended right hepatectomy including MHV was planned. MHV of the donor removed together with the graft was reconstructed to the common orifice of MHV-left hepatic vein using a cryopreserved aortic graft. In conclusion, if the MHV is removed with the graft in adult LDLT, appropriate reconstruction in the donor is also an important issue. Reconstruction carried out without creating tension and folding in the right hepatic vein is crucial for avoiding congestion and of great importance for the prevention of graft dysfunction.Öğe Optimal timing for removal of the double-j stent after kidney transplantation(Elsevier Science Inc, 2017) Yüksel, Y.; Tekin, S.; Yüksel, D.; Duman, I.; Sarıer, M.; Yücetin, L.; Asuman, Y. H.Background. Urologic complications (UC) have gradually decreased in recent years after advanced surgical experience. The incidence of urologic complications varies between 0.22% and 30% in different medical studies. There is no routine usage of double-J stenting (DJS) during renal transplantation (RT) in the literature. It is a necessity, and optimal timing for stent removal is an important question for many transplantation centers. Methods. This study includes 818 renal transplant patients whose ureteroneocystostomy anastomoses were completed by use of the Lich-Gregorie procedure during a 2-year period at a transplantation center. We performed 926 renal transplantations at Antalya Medical Park Hospital Renal Transplantation Center between January 2014 and January 2016. The patients were divided into four groups according to the timing of DJS removal. Results. For group 1, removal time for DJS was between 5 and 7 days; group 2, Removal time for DJS was between 8 and 14 days; group 3, removal time for DJS was between 15 and 21 days; and group 4, removal time for DJS was later than 22 days. The patients were divided into two groups according to removal time of stent as 5 to 14 days and >15 days. DJS was performed again in the patients whose urine output was reduced during the first 5 days after removal of the DJS, whose creatine level increased, and whose graft ureter and collecting tubules were extended as an ultrasonographic finding. Conclusions. There is no declared optimal time for the removal of DJS. The removal time was reported between postoperative first week and 3 months in some of the reports of RT centers, according to their protocols. We emphasize that the optimal time for the removal of DJS is 14 to 21 days after RT, based on the findings of our large case report study.Öğe Pregnancy and delivery in the sequel of, kidney transplantation: Single-center study of 8 years' experience(Elsevier Science Inc, 2017) Yüksel, Y.; Tekin, S.; Yüksel, D.; Duman, I.; Sarıer, M.; Yücetin, L.; Demirbaş, A.; Uğurlu, T.; Celep, H.; İnal, M. M.Background. Depending on hyphothalamic, hyphophyseal, and gonadal axis dysfunction, anovulatory irregular cycles occur and the probability of pregnancy decreases in the patients with chronic kidney disease (CKD). Maternal mortality and morbidity rates are increased in CKD patients; the risk of premature delivery is 70% and the risk of preeclampsia is 40% more than normal among those with a creatine level of >2.5 mg/dL. Methods. If a pregnancy is expected in the sequel of kidney transplantation (KT), a multidisciplinary team approach should be adopted and both the gynecologist and the nephrologist should follow the patient simultaneously. Among 3883 patients who underwent KT at Antalya Medical Park Hospital Transplantion Department between November 2009 and October 2016, the records of 550 female patients between the ages of 18 and 40 years were examined retrospectively; 31 patients who complied with these criteria were included in the study group. In 6 of these patients who had an unplanned pregnancy, medical abortion was performed after the families were informed about the possible fetal anomalies caused by the use of everolimus in the first trimester, and they were excluded from the study (pregnant group). The control group consisted of 43 patients who had a KT and became pregnant, and of those who had recently undergone KT and shared similarities regarding age, CKD etiology, duration of dialysis, and number of transplants. Results. In both groups, the ages of the patients, their follow-up span and dialysis duration, tissue compatibility, age of the donor, and time elapsed until the pregnancy was analyzed, whereas in the control group, creatinine levels in the first, second, third, and fourth years after the KT were reviewed. Additionally, in the pregnant group, creatinine levels of the first, second, and third trimesters; delivery week; birth weight of the baby; APGAR scores of the first minute; postnatal creatinine levels of first, second, and third years; and prenatal, maternal, and postnatal acute rejections were reviewed. We measured the creatine clearance by use of the Cockcroft-Gault formula in the pregnancy group before pregnancy and during delivery [Cockcroft-Gault formula: (140 - age) x body weight (kg)/72 x plasma creatine level (mg/dL) x 0.85]. Conclusions. Pregnancy after KT is risky both for the mother and the baby; however, if planned and followed in coordination within an experienced center, both the pregnancy period and the birth process can occur without distress.Öğe Renal transplantation in recipients older than 65 years: Retrospective analysis of the results of a 4-year (2008-2012) experience(Elsevier Science Inc, 2015) Tekin, S.; Yavuz, H. A.; Yüksel, Y.; Ateş, I.; Yücetin, L.; Döşemeci, L.; Demirbaş, A.Background. We analyze the results of renal transplantation among recipients older than 65 years old over a 4-year period (2008-2012) from a single renal transplantation unit and compare results with younger recipients. Methods. We retrospectively analyzed the outcomes of 2018 renal transplantations performed between November 2008 and December 2012. The chi(2) test was used for the comparison of categorical data, and the Student t test was used for the analysis of continuous variables. Patient and graft cumulative actuarial survivals were calculated using the Kaplan-Meier analysis and we tested for differences with the Mantel-Cox log-rank test. Results. Seventy-five (3.7%) recipients were aged >= 65 years with a median age of 68 (range, 65 to 82) years. Actuarial graft survivals at 1, 2, and 3 years were 93.8%, 92.5%, and 90.3%, respectively, for the <65 group and 89.7%, 88.1%, and 83.1%, respectively, for the >= 65 group (P < .03). Actuarial patient survivals at 1, 2, and 3 years were 96.3%, 95.5%, and 94.7%, respectively, for the younger and 91.8%, 90.2%, and 88%, respectively, for the older samples (P < .03). When graft survival was censored for patient death with a functioning kidney at 1, 2, and 3 years, the results were similar between groups with 95.5%, 94%, and 92.8%, respectively, for recipients aged <65 years and 94.7%, 89.2%, and 89.2%, respectively, for recipients aged >= 65 years (P = .213). Conclusions. Our results showed that renal transplantation in selected patients older than 65 years was associated with good outcomes; this indicates that it seems safe and effective to treat end-stage renal disease in the elderly knowing there are acceptable rates of graft and patient survival.Öğe Simultaneous cardiac surgery and renal transplantation compared wth renal transplantation after cardiac surgery(Elsevier Science Inc, 2015) Tekin, S.; Zengin, M.; Tekin, I.; Yücetin, Levent; Yavuz, H. A.; Okutan, H.; Demirbaş, A.Patients with end-stage renal disease (ESRD) have a high prevalence of coronary artery disease and cardiovascular death. The mortality and the morbidity rates of cardiac surgery are particularly high in these patients with end-stage renal disease. Performing cardiac surgery and kidney transplantation in the same session can reduce these complications in the early postoperative period by normalizing renal function. We compared the mortality and morbidity rates between patients who had undergone cardiac surgery and kidney transplantation separately and patients who had combined surgeries. This retrospective study consisted of 75 patients. One group of 60 patients underwent cardiac surgery and kidney transplantation in separate sessions, and the other group of 15 patients had combined surgeries in the same session, between March 2008 and September 2012. Patients who had combined surgeries achieved fluid electrolytic balance more easily, had shorter extubation times, used less blood and blood products, and had fewer major complications. The patients recovered faster and thus had shorter stays in the intensive care unit and hospital. This combined surgical approach allows normalized kidney function in patients with end-stage renal disease, so mortality and morbidity in the early postoperative period could be significantly reduced.
