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    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.
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    Comparative results of transurethral incision with transurethral resection of the prostate in renal transplant recipients with benign prostate hyperplasia
    (Urol & Nephrol Res Ctr-Unrc, 2018) Sarıer, Mehmet; Duman, İbrahim; Kılıç, Süleyman; Yüksel, Yücel; Demir, Meltem; Aslan, Mesut; Emek, Mestan; Yücetin, Levent; Tekin, Sabri; Yavuz, Asuman Havva
    Purpose: The aim of this study is to compare the results of transurethral incision of the prostate (TUIP) and transurethral resection of the prostate (TURP) for the surgical treatment of benign prostate hyperplasia (BPH) in patients with renal transplantation. Materials and Methods: Between April 2009 and May 2016, BPH patients with renal transplants whose prostate volumes were less than 30 cm(3) were treated surgically. Forty-seven patients received TURP and 32 received TUIP. The patients' age, duration of dialysis, duration between transplant and TURP/TUIP, preoperative and postoperative serum creatinine (SCr), International Prostate Symptom Score (IPSS), maximum flow rate (Qmax) and postvoid residual volume (PVR) were recorded. At 1-,6- and 12-month follow-up, early and long-term complications were assessed. Results were evaluated retrospectively. Results: In both groups, SCr, PVR and IPSS decreased significantly after the operation, while Qmax increased significantly (P < .001). There was no difference between the two groups in terms of increase in Qmax and decrease in IPSS, SCr and PVR (P = .89, P = .27, P = .08, and P = .27). Among postoperative complications, urinary tract infection (UTIs) and retrograde ejaculation (RE) rates were higher in the TURP group than the TUIP group (12.7% versus 6.2% and 68.1% versus 25%,respectively), whereas urethral strictures were more prevalent in the TUIP group (12.5% versus 6.3%). Conclusion: For the treatment of BPH in renal transplant patients with a prostate volume less than 30 cm(3) , both TUIP and TURP are safe and effective.
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    Donors with hepatitis B surface antigen positivity: Contraindication for renal transplantation or not?
    (Oxford Univ Press, 2015) Yavuz, Asuman; Tekin, Sabri; Yüksel, Yücel; Yücetin, Levent; Tuncer, Murat; Demirbaş, Alper
    Because of the organ shortage, the number of patients awaiting kidney transplantation has increased rapidly requiring physicians to implement new methods to increase the number of grafts. In this study, we compared clinical and biochemical parameters of patients who received kidneys from hepatitis B surface antigen-positive (group 1) versus other living related kidney donors (group 2). The study included 414 female (15 group 1 and 399 group 2) and 816 male (20 group 1 and 796 group 2) donors for 1195 living related kidney transplantations performed between April 21, 2008 and March 1, 2011. Group 1 kidney transplantations were undertaken only if the recipient displayed a hepatitis B antibody titer >10 mIU/mL and donor hepatitis B virus (HBV) DNA was negative. Demographic characteristics, 1- and 2-year serum creatinine levels, glomerular filtration rates (GFR), and liver function test results were similar between the 2 groups. There were no new HBV infections throughout the study period. Acute rejection rates (7/35 in group 1 vs 232/1195 in group 2; P = .988), graft loss (1/35 in group 1 vs 55/1195 in group 2; P = .624), and patient loss (0/35 in group 1 vs 34/1195; P = .311) were similar between the 2 groups. Our study showed that hepatitis B surface antigen positivity was not a contraindication to living kidney donation.
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    First international paired exchange kidney transplantations of Turkey
    (Elsevier Science Inc, 2015) Tuncer, M.; Tekin, Sabri; Yüksel, Yücel; Yücetin, Levent; Dosemeci, L.; Şengul, A.; Demirbaş, A.
    Objective. We estimated that many patients on the waiting list for kidney transplantation in Turkey have immunologicaly incompatible suitable living donors. Paired exchange kidney transplantation (PETx) is superior to desensitization for patients with incompatible donors. Recently we decided to begin an international PETx program. Methods. We report three international living related paired kidney transplantations which occurred between May 14,2013, and March 7, 2014. The international donor and recipient operations were performed at Medical Park Hospital, Antalya, Turkey. All pairs were living related and written proofs were obtained according to Turkish laws. As with the donor procedures, the transplantation procedures were performed at the same time. Results. The uniqueness of these transplantations was that they are the first international exchange kidney transplantations between Turkey and Kirghizia. Currently all recipients are alive with wel-functioning grafts. Conclusion. In our institute, a 5% increase was obtained in living-related kidney transplantations by the help of PETx on a national basis. We believe that international PETx may also have the potential to expand the donor pool.
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    Post-transplantation malignancy after kidney transplantation in Turkey
    (Elsevier Science Inc, 2015) Keleş, Yıldız; Tekin, Sabri; Düzenli, M.; Yüksel, Yücel; Yücetin, Levent; Döşemeci, L.; Tuncer, M.
    Objective. Kidney transplantation is the best treatment option for end-stage renal disease patients. Increased incidence of post-transplantation malignancy can be caused by immunosuppressive drugs and some oncogenic infections. The aim of this study is to show the incidence of post-transplantation malignancy in patients who had surgery and were followed up in the Organ Transplant Center, Medical Park Antalya, Antalya, Turkey. Method. The study was based on 2100 kidney transplantation patients who had surgery between May 2008 and December 2012 and also on 1900 patients who had surgery by members of our team in other centers and who were followed up routinely. In all of our patients, the type of malignancy, the time that malignancy developed, immunosuppressive regimens, and viral status (Epstein-Barr virus and cytomegalovirus) were investigated. Results. Malignancy was developed in 30 patients (60% of them were male, median age was 52.1 years). Post-transplantation malignancy development time was a median of 5.1 years. The types of malignancies were as follows: non-melanoma skin cancer in 12 patients (40%), urogenital cancer in 7 patients (24%), breast cancer in 4 patients (14%), lymphoproliferative disease in 3 patients (10%), thyroid cancer in 2 patients (6%), and lung cancer in 2 patients (6%). Discussion. In this study, we did not find any increased post-transplantation malignancy risk in our patients. This finding could be due to the low-dosage immunosuppressive protocols that we used.
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    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.