Publications by authors named "Mehmet Haberal"

514 Publications

Effect of Post-Transplant Cardiac Angiographic Procedures on Post-Transplant Renal Function.

Transplant Proc 2022 Jul 30. Epub 2022 Jul 30.

Department of Cardiology, Başkent University Faculty of Medicine, Ankara, Turkey; Department of General Surgery, Başkent University Faculty of Medicine, Ankara, Turkey.

Background: Cardiac interventions often are performed before and after renal transplant for coronary artery disease. The aim of this study was to investigate whether post-transplant cardiac coronary procedures affect post-transplant renal function.

Method: We retrospectively included renal transplant recipients who underwent renal transplant procedures at Baskent University between April 28, 1997 and January 20, 2020. We analyzed the effect of cardiac catheterization in renal transplant recipients between 6 and 12 months post-transplant with post-transplant renal function assessed by glomerular filtration rate (GFR). We compared the effect of the type of coronary intervention on GFR change in group 1, whereby group 1 was divided into 2 subgroups (coronary artery bypass grafting [CABG] and stenting). Group 1 included patients who underwent cardiac intervention, whereas group 2 included those who had not undergone cardiac intervention.

Results: In all, 108 patients underwent coronary angiography; 45 (41.7%) had normal coronaries or minimal coronary artery disease (CAD); 37 (34.3%) underwent stent implantation; 26 (24.1%) underwent CABG. The mean post- transplantation GFR of all patients after cardiac catheterization was 84.26+25.91 (mL/min/1.73 m). The final, after 12 months mean GFR of all patients was 69.55+27.05. The final GFR was significantly lower than the initial post-renal GFR value in patients who underwent cardiac intervention but not in non-intervened patients.

Conclusion: Invasive cardiac revascularization procedures showed a negative effect on post-transplant renal function in renal transplant recipients. All renal transplant recipients who underwent cardiac intervention survived the intervention, and there was no mortality. The reason for this outcome was assumed to be because of the short follow-up period.
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http://dx.doi.org/10.1016/j.transproceed.2022.05.028DOI Listing
July 2022

Long-Term Outcomes of Kidney Transplant Recipients With Juvenile Nephronophthisis.

Exp Clin Transplant 2022 05;20(Suppl 3):122-125

From the Department of Pediatric Nephrology, Baskent University Faculty of Medicine, Ankara, Turkey.

Objectives: Nephronophthisis is the most common genetic cause of kidney failure in childhood. Treatment for nephronophthisis is symptomatic, and kidney transplant is a good treatment option when kidney failure has developed. We reported the outcomes of kidney transplant recipients with primary diagnosis of juvenile nephronophthisis who were followed-up in our center.

Materials And Methods: We retrospectively examined medical records of 17 kidney transplant patients with a primary diagnosis of juvenile nephronophthisis. We compared this group of 17 patients with kidney transplant recipients who had other etiologies of kidney failure in terms of transplant age, donor type, immunosuppressive treatment, acute rejection, graft loss rates, and glomerular filtration rates at 1 and 5 years posttransplant (N = 180 total analyzed).

Results: Among 180 kidney transplant recipients, the 17 patients (9.4%) with nephronophthisis had a mean age of 12.6 ± 4.3 years and mean follow-up time posttransplant of 79.5 ± 41.9 months. Five of 17 patients received a kidney transplant from a deceased donor (29.4%), and the remaining 12 patients (70.6%) received transplants from living related donors. Preemptive kidney transplant was performed in 4 patients (23.5%). There was a statistically significant difference (P < .05) in terms of acute rejection between patients with nephronophthisis (17.6%) versus patients with other primary diagnoses (34%). However, the patients with nephronophthisis versus those with other primary diagnoses were similar (P > .05) in terms of transplant age (12.6 ± 4.3 vs 13.8 ± 6.7 years, respectively) and follow-up time (79.5 ± 41.9 vs 59.1 ± 38.8 months, respectively). Donor type, immunosuppressive treatment, and 1-year (96.7 ± 23.2 vs 97.6 ± 28.4 mL/min/1.73 m2) and 5-year (84.7 ± 31.1 vs 86.7 ± 21.7 mL/min/1.73 m2) glomerular filtration rates were also similar (P > .05) between groups.

Conclusions: Posttransplant prognosis was good among kidney transplant recipients with juvenile nephronophthisis.
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http://dx.doi.org/10.6002/ect.PediatricSymp2022.O39DOI Listing
May 2022

The Role of Platelet-Lymphocyte Ratio and Neutrophil-Lymphocyte Ratio in Predicting the Delayed Graft Function in Pediatric Renal Transplant Patients.

Exp Clin Transplant 2022 05;20(Suppl 3):118-121

From the Department of Pediatric Nephrology, Baskent University Faculty of Medicine, Ankara, Turkey.

Objectives: Delayed graft function is a common adverse outcome after renal transplant. Attempts for early prediction and prevention of delayed graft function are often challenging and misleading. Herein, we investigated for the first time the correlation between delayed graft function and preoperative noninvasive hematologic parameters to predict the possible adverse outcomes for renal transplant in pediatric patients.

Materials And Methods: In this study, preoperative hematologic parameters of 51 pediatric renal transplant recipients followed between 2015 and 2021 were analyzed retrospectively. The selected 16 renal transplant patients with delayed graft function and 35 patients without delayed graft function had no concomitant comorbidities. The cutoff values for platelet-to-lymphocyte ratio of <5 and neutrophilto- lymphocyte ratio of <175 were considered low.

Results: We retrospectively evaluated a total of 51 (male/female, 33/18) pediatric kidney transplant recipients with a median age of 12 (interquartile range, 8-18) years. Median level of circulating lymphocytes was significantly higher in patients with delayed graft function compared with patients without delayed graft function (2 vs 1, P = .040). The preoperative low values for platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were more prevalent in recipients who developed delayed graft function versus those who did not develop delayed graft function (68.8% vs 31.4% [P = .014] and 68.8% vs 34.3% [P = .023], respectively).

Conclusions: Pretransplant low platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte were associated with increased number of delayed graft dysfunction. These novels and noninvasive inflammatory biomarkers may contribute to an early prediction of delayed graft function in pediatric kidney transplant recipients.
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http://dx.doi.org/10.6002/ect.PediatricSymp2022.O38DOI Listing
May 2022

BK Polyomavirus Infection and Risk Factors in Pediatric Patients Undergoing Kidney Transplant.

Exp Clin Transplant 2022 05;20(Suppl 3):105-111

From the Department of Pediatric Nephrology, Başkent University Faculty of Medicine, Ankara, Turkey.

Objectives: BK polyomavirus infection is a critical complication affecting graft survival after kidney transplant. We aimed to determine the frequency, the effect on graft function, and the risk factors of BK polyomavirus infection in pediatric kidney transplant patients.

Materials And Methods: We retrospectively reviewed data of 144 pediatric patients (female/male: 67/77; 0-18 years of age) who received kidney transplants in the past 10 years at our center. Demographic/ laboratory data, kidney failure etiologies, donor types, and immunosuppressive treatments were recorded. Patients were grouped as those with and without BKV infection, with groups compared in terms of transplant age, sex, kidney failure etiology, donor type, immunosuppressive treatments, presence of ureteral stents, acute rejection episodes, accompanying viral infections, glomerular filtration rate, and graft loss rate.

Results: Twelve patients (8.3%) had BK polyomavirus infection. All 12 patients had viruria (8.3%), 8 (5.5%) had viremia, and 4 (2.8%) had BK polyomavirus nephropathy. Two patients (1.4%) had graft loss because of BK polyomavirus nephropathy. When patients with and without infection were compared, no significant differences were found in terms of sex, transplant age, donor type, presence of a ureteral stent, acute rejection, graft loss, or immunosuppressive treatment (P > .05). Rates of congenital anomalies of the kidney and urinary tract were 30.3% and 66.6% in those without and with BK polyomavirus infection, respectively (P < .05). The group positive for BK polyomavirus had a significantly higher incidence of cytomegalovirus infection versus the group without infection (P < .05). Glomerular filtration rate values at years 1 and 3 were similar between groups (P > .05).

Conclusions: Frequency of BK polyomavirus nephropathy in pediatric patients undergoing kidney transplant in our center was consistent with data from other centers. Graft loss can be prevented by early detection and treatment through close periodic control and adequate evaluation of risk factors.
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http://dx.doi.org/10.6002/ect.PediatricSymp2022.O34DOI Listing
May 2022

Peripapillary Vascular Density Measurement in Pediatric Renal and Liver Transplant.

Exp Clin Transplant 2022 05;20(Suppl 3):96-101

From the Department of Ophthalmology, Baskent University Faculty of Medicine, Ankara, Turkey.

Objectives: Noninvasive monitorization of retinal structures of the eye could be a predictor for systemic microvasculature dysfunction in transplant recipients. In this study, our purpose was to determine the optic disc and peripapillary microvascular changes in pediatric patients who had undergone liver or renal transplant surgery.

Materials And Methods: The study was performed at Başkent University. The medical records were reviewed, and patients who had liver or renal transplant in the last 10 years and were between 4 and 18 years old were included in the study. The optic disc and peripapillary vascular density parameters were obtained by optical coherence tomography angiography (Avanti RTVue XR). The results were compared with the results from age-matched, sex-matched, and spherical equivalent-matched healthy subjects.

Results: Our study included 32 eyes of 16 liver transplant patients, 20 eyes of 10 renal transplant patients, and 64 eyes of 32 healthy participants (control). Whole image peripapillary, inside disc, peripapillary, superior and inferior hemisphere, and superior, inferior, temporal, and nasal quadrant peripapillary vascular densities were evaluated. No statistically significant differences in any parameter were noted between the healthy control group and the patient groups (P > .05 for all parameters).

Conclusions: Peripapillary vascular density measurements were not affected in pediatric renal and liver transplant patients.
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http://dx.doi.org/10.6002/ect.PediatricSymp2022.O32DOI Listing
May 2022

Macular Vessel Density Measurement in Pediatric Renal and Liver Transplant.

Exp Clin Transplant 2022 05;20(Suppl 3):89-95

From the Department of Ophthalmology, Baskent University Faculty of Medicine, Ankara, Turkey.

Objectives: Microcirculatory dysfunction is known to be associated with organ failure and increased mortality in transplant patients. Noninvasive monitorization of retinal structures of the eye could be a predictor for systemic microvasculature in these patients. Therefore, in this study we aimed to evaluate the retinal microvascular changes in pediatric patients who had undergone liver or renal transplant surgery, using optical coherence tomography angiography.

Materials And Methods: The medical records of pediatric patients who had liver or renal transplant in the past 10 years were reviewed. The macular vessel density parameters were obtained by optical coherence tomography angiography (Avanti RTVue XR). The results were compared with the age-matched, sex-matched, and spherical equivalent-matched healthy participants (control group). The IBM SPSS (version 25.0) statistics program was used for data analysis.

Results: We included 32 eyes of 16 liver transplant patients, 20 eyes of 10 renal transplant patients, and 64 eyes of 32 healthy participants (control group). Superficial macular whole image, superficial perifoveal, and deep foveal vessel densities were found to be lower in the liver transplant group compared with the healthy control group (P = .02, P = .01, and P = .01, respectively). Superficial foveal, deep macular whole image, deep foveal, and deep perifoveal vessel densities were found to be lower in the renal transplant group compared with the healthy control group (P = .03, P = .04, P = .01, and P = .02, respectively).

Conclusions: Macular vessel density measurements are affected in pediatric renal and liver transplant patients. In those patients, retinal optical coherence tomography and optical coherence tomography angiography measurements may provide a noninvasive window to the microcirculation.
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http://dx.doi.org/10.6002/ect.PediatricSymp2022.O31DOI Listing
May 2022

Our Pediatric Liver and Kidney Transplant Activities in 2021.

Exp Clin Transplant 2022 05;20(Suppl 3):85-88

From the Baskent University, Department of General Surgery, Division of Transplantation, Ankara, Turkey.

Objectives: In children with end-stage renal disease, chronic liver failure, or acute liver failure, liver transplant and kidney transplant are the most effective modalities for better clinical outcomes compared with other therapies. However, children are particularly susceptible to surgical complications, so pediatric solid-organ transplants should be reserved for centers with substantial experience and multidisciplinary expertise. Here, we assessed liver and kidney transplants performed at our center in 2021.

Materials And Methods: From November 3, 1975, to December 31, 2021, we performed 701 liver transplants and 3290 kidney transplants. From January 1, 2021, to December 31, 2021, we performed 21 liver transplants (19 in children) and 114 kidney transplants (12 in children). We recorded age, sex, body mass index, comorbidities, etiologies, laboratory values, and clinical outcomes.

Results: For the year 2021, we performed 19 pediatric liver transplants and 12 pediatric kidney transplants. Mean age of liver recipients was 3.4 years, and 8 were male patients. The most common etiology was biliary atresia (n = 7). All liver grafts were from living related donors who were first-degree (n = 16) or second- degree (n = 3) relatives of the recipients. Mean hospital stay was 17.6 days. All but 2 liver transplant recipients were discharged successfully (2 died from sepsis in the early postoperative period). Mean age of kidney transplant recipients was 14.1 years, and 4 were male patients. The most common etiology was vesicoureteral reflux (n = 3). One kidney graft was from a deceased donor, with the rest from living related donors who were first-degree relatives of the recipients (n = 11; mother for 8 recipients and father for 3 recipients). Mean hospital stay was 4.3 days. All kidney transplant recipients were discharged successfully.

Conclusions: Solid-organ transplants for young children are often complex but can be performed successfully at experienced transplant centers.
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http://dx.doi.org/10.6002/ect.PediatricSymp2022.O29DOI Listing
May 2022

Vascular Complications in Pediatric Liver Transplants and Their Management.

Exp Clin Transplant 2022 05;20(Suppl 3):72-75

From the Department of General Surgery, Division of Transplantation, Baskent University Faculty of Medicine, Ankara, Turkey.

Objectives: The blood supply of the liver occurs through the hepatic artery and portal vein. Outflow of blood circulation in the liver is via the hepatic veins. Any disruption in this blood circulation results in deterioration of liver functions. In this study, we evaluated early vascular complications in pediatric liver transplant recipients seen at our center.

Materials And Methods: From November 1988 to December 2021, our team has performed 701 liver transplant procedures, which have included 334 pediatric liver transplants. Among these pediatric liver transplant recipients (mean age of 7.34 y), 176 were male patients. Nineteen patients (5.7%) were recipients of deceased donors. Reason for liver failure was mainly biliary atresia (n = 169). Mean weight of recipients was 23.3 kg. Most graft types were left lateral grafts (n = 204).

Results: Three patients had hepatic vein complications. All 3 patients were successfully treated with interventional radiological methods by placing a stent in the anastomosis region. Portal vein complications occurred in 3 patients. One patient had hemostasis performed surgically. The second patient had surgically revision of the anastomosis because of thrombus formation. Because of stenosis of more than 50% in the portal vein anastomosis, the third patient required stent placement in the anastomosis region. Hepatic artery complications occurred in 54 patients: 31 patients had hepatic artery thrombosis, 13 patients had hepatic artery stenosis, 7 patients had bleeding from hepatic artery anastomosis, 2 patients had hepatic artery dissection, and 1 patient had pseudoaneurysm in the hepatic artery. Forty-three of these patients were successfully treated with interventional radiological methods and 11 required surgical treatment.

Conclusions: Vascular complications after liver transplant can cause deterioration in hepatic functions and acute liver failure. Vascular complications can be successfully treated in experienced organ transplant centers.
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http://dx.doi.org/10.6002/ect.PediatricSymp2022.O23DOI Listing
May 2022

Clinical Features and Outcomes Following SARS-CoV-2 Infection in Pediatric Liver Transplant Patients.

Exp Clin Transplant 2022 05;20(Suppl 3):66-71

From the Department of Pediatrics, Baskent University Faculty of Medicine, Ankara, Turkey.

Objectives: Several studies suggest that chronic immunosuppression in pediatric liver transplant patients may affect the severity and mortality rates of SARS-CoV-2 infection.

Materials And Methods: We assessed a total of 118 pediatric liver transplant recipients for SARS-CoV-2 infection, aged 1 to 18 years, followed between March 2019 and January 2022. We compared the clinical characteristics and outcomes of SARS-CoV-2 infection in pediatric liver transplant patients to 187 non-liver transplant pediatric patients with SARSCoV-2 infection who had been diagnosed at our institution between March 15, 2020, and December 31, 2020. Demographic data, clinical features, and laboratory findings from the patients were retrospectively collected from hospital reports and telephone inquiries.

Results: A total of 20 liver transplant patients with SARS-CoV-2 infection were identified. Median age of liver transplant recipients with SARS-CoV-2 infection was higher than non-liver transplant pediatric patients with SARS-CoV-2 (14.8 [range, 7-16] vs 6.8 [range, 2-14] years; P = .016). There were no significant differences in mild and moderate disease courses of SARS-CoV-2 infection between liver transplant recipients and non-liver transplant pediatric patients (18 [90.0%] vs 133 [71.1%] patients [P = .188] and 2 [10%] vs 49 [26.2%] patients [P = .118], respectively). Fever was less frequently observed in liver transplant patients with SARS-CoV-2 infection compared with non-liver transplant patients (55.0% vs 80.2%; P = .015). We found no intergroup differences in sex (P = .342), hospitalization rate (P = .161), and overall clinical presentation.

Conclusions: Despite the immunosuppression regimens, liver transplant patients in our series survived SARS-CoV-2 infection without serious sequelae and without graft rejection. Overall, liver transplant and non-liver transplant pediatric patients with SARSCoV-2 infection experienced a mild disease course.
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http://dx.doi.org/10.6002/ect.PediatricSymp2022.O22DOI Listing
May 2022

Endovascular Management of Hematomas in Pediatric Transplant Patients.

Exp Clin Transplant 2022 05;20(Suppl 3):56-61

From the Department of Radiology, Baskent University Ankara Hospital, Ankara, Turkey.

Objectives: Transcatheter arterial embolization is used to control active hemorrhage at different anatomic locations. Because hematomas can suddenly deteriorate and become life threatening for transplant patients, they require prompt diagnosis and intervention rather than conservative management. Here, we evaluated computed tomography in treatment planning and transcatheter embolization effectiveness for hematoma management in pediatric liver transplant patients.

Materials And Methods: Between June 2012 and December 2021, 10 pediatric liver transplant patients were referred to our interventional radiology unit. Computed tomography and angiograms were reviewed for hematoma location and presence of extravasation. We analyzed correlations between computed tomography and angiography findings and technical and clinical success of the endovascular interventions.

Results: Active leak of contrast material during arterial phase was detected on 9/10 CT scans. Although there was no active bleeding on CT in 1 patient, active arterial bleeding was detected on angiography. On the contrary, in 2 patients, although active bleeding was observed on computed tomography, it was not detected on angiography. Source of bleeding was superior mesenteric artery branches in 4, hepatic artery branch in 2, superior epigastric artery in 1, and phrenic artery in 1 patient. Six of 8 patients with active bleeding were treated with endovascular procedures. The remaining 2 patients received surgery: 1 had bleeding from liver cut surface originating from a hepatic artery branch and received open surgery because the bleeding branch was too thin for catheterization, and 1 was hemodynamically unstable and selective catheterization of the internal thoracic artery would take time. Two patients received embolization procedures with N-butyl 2-cyanoacrylate (glue) diluted with iodized oil, and 1 patient had coil and glue with iodized oil. Embolization with coils was performed in 3 patients. Rate of success with transcatheter arterial embolization was 75%. No complications related to patient comorbidities or embolization procedures were shown. No deaths occurred due to progression of the hematoma.

Conclusions: Transcatheter arterial embolization is effective and safe for treatment of pediatric liver transplant patients with hematomas. Computed tomography has value in identifying the bleeding source and its anatomic relationships and may enhance our intervention abilities to become quicker, more effective, and more secured.
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http://dx.doi.org/10.6002/ect.PediatricSymp2022.O19DOI Listing
May 2022

An Alternative Abdominal Closure Technique After Pediatric Liver Transplant: Bogota Bag Technique.

Exp Clin Transplant 2022 05;20(Suppl 3):53-55

From the Baskent University, Department of General Surgery, Division of Transplantation, Ankara, Turkey.

Objectives: In conditions such as large-for-size syndrome, postreperfusion hepatic edema, and intestinal edema, primary closure of the abdominal wall can cause respiratory complications and thrombosis of vascular structures. Here, we compared results of primary abdominal closure versus a temporary patch closure technique (the Bogota bag technique) in pediatric liver transplant recipients.

Materials And Methods: We performed primary abdominal closure in 295 recipients. In 39 pediatric liver transplant recipients, the Bogota bag technique was used as the abdominal closure technique because of suspected intraoperative tense abdominal closure. In patients who had the Bogota bag technique, we sutured the sterilized saline bag to the skin at the edge of the defect by shaping the defect so as not to cause abdominal hypertension. Primary abdominal closure was achieved in patients after control laparotomies at 48-hour intervals.

Results: The mean age of the primary abdominal closure group was 8.38 years, whereas the mean age of the Bogota bag group was 2 years. The average weight of patients in the primary abdominal closure group was 26.38 kg, and the average weight of patients in the Bogota bag group was 7.93 kg. Biliary atresia was the most common indication in both groups. Mean length of hospital stay was 21 days in the primary abdominal closure group and 24 days in Bogota bag group. Six patients in the Bogota bag group died from sepsis or bleeding in the early postoperative period. In the Bogota bag group, wound closure was achieved within 2 weeks in 25 patients and within 3 weeks in 8 patients.

Conclusions: Temporary patch closure techniques can be used safely in low-weight and young children, children with large-for-size grafts, and those who display increased intra-abdominal pressure.
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http://dx.doi.org/10.6002/ect.PediatricSymp2022.O18DOI Listing
May 2022

Use of Eculizumab in Pediatric Patients with Late Antibody-Mediated Rejection After Kidney Transplantation.

Exp Clin Transplant 2022 05;20(Suppl 3):49-52

From the Department of Pediatric Nephrology, Baskent University Faculty of Medicine, Ankara, Turkey.

Late antibody-mediated rejection triggered by donor-specific antibodies is a leading cause of kidney allograft failure. Effective treatment options for late antibody-mediated rejection are limited in renal transplant recipients. Here, we report 2 pediatric cases of severe late antibody-mediated rejection resistant to conventional immunosuppressive therapy who were successfully treated with eculizumab. Two patients who fulfilled the late antibody-mediated rejection diagnostic criteria (positive donor-specific antibodies, elevated mean fluorescence index, acute and/or chronic morphological lesions in the microvasculature, and abnormal kidney function test) were included in this study. Both patients were previously unsensitized with negative panel-reactive antibody. Case 1 was a 12-year-old male patient with kidney failure secondary to vesicoureteral reflux who underwent related-living donor kidney transplantation 2 years ago. Eleven months later, he was diagnosed with late antibody-mediated rejection. Despite an aggressive conventional immunosuppressive regimen, signs of rejection persisted. After the patient was treated with 2 doses of eculizumab, his mean fluorescence index dropped and serum creatinine decreased from 3.8 to 1.5 mg/dL. Case 2 was an unsensitized 16-year-old male patient with kidney failure secondary posterior urethral valve who underwent related-living donor kidney transplantation 4 years ago. Two years later, he was diagnosed with late antibody-mediated rejection. Despite an aggressive conventional immunosuppressive regimen, signs of rejection persisted. After treatment with 2 doses of eculizumab, his mean fluorescence index dropped and serum creatinine decreased from 2.1 to 1.01 mg/dL. In both patients, eculizumab therapy effectively reduced the markers of late antibody-mediated rejection and improved the kidney function.
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http://dx.doi.org/10.6002/ect.PediatricSymp2022.O15DOI Listing
May 2022

Association Between Vitamin D Deficiency and Anemia in Pediatric Kidney Transplant Recipients.

Exp Clin Transplant 2022 05;20(Suppl 3):39-44

From the Department of Pediatric Nephrology, Başkent University Faculty of Medicine, Ankara, Turkey.

Objectives: The association between vitamin D deficiency and anemia is known. Vitamin D deficiency and anemia are common in kidney transplant recipients. We examined the relationship between vitamin D levels and anemia in pediatric kidney transplant recipients.

Materials And Methods: We reviewed retrospectively the data of 75 pediatric kidney transplant recipients (0-18 years of age). Patients were evaluated in 3 groups according to serum 25-hydroxyvitamin D levels (<20, 20-30, and >30 ng/mL) in the first year posttransplant: group 1 was the vitamin D deficiency group, group 2 was the vitamin D insufficiency group, and group 3 was normal vitamin D level group, respectively. Groups were compared in terms of anemia parameters, calcium, phosphorus, alkaline phosphatase, and parathyroid hormone levels, as well as infection, rejection, and graft loss status. All patients included in the study were grouped as those with anemia and without anemia, and the 2 groups were compared in terms of vitamin D levels, serum parathyroid hormone values, estimated glomerular filtration rate, and infection, rejection, and graft loss status.

Results: There were 41 patients (54.7%) in group 1, 24 patients (32%) in group 2, and 10 patients (13%) in group 3. There were 65 patients (86.7%) with vitamin D deficiency/insufficiency. When groups were compared, the hematocrit level was found to be lower in groups 1 and 2 (P < .05) and ferritin level was found to be lower in group 1 (P < .05). Anemia was present in 20 patients (26.6%): 61% of patients with anemia had vitamin D deficiency and 33% had vitamin D insufficiency (P > .05). In total, 94% of patients with anemia had vitamin D deficiency/insufficiency.

Conclusions: Vitamin D deficiency/insufficiency is common in pediatric kidney transplant recipients. Vitamin D levels should be measured, especially in all kidney transplant recipients with persistent anemia. Thus, risk factors associated anemia can be reduced by treating the deficiency/insufficiency.
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http://dx.doi.org/10.6002/ect.PediatricSymp2022.O6DOI Listing
May 2022

Historical Background of Pediatric Kidney and Liver Transplantation in Turkey.

Authors:
Mehmet Haberal

Exp Clin Transplant 2022 05;20(Suppl 3):1-6

From the Department of General Surgery, Division of Transplantation, Baskent University, Ankara, Turkey.

The cornerstone events of kidney and liver transplant history in Turkey are summarized herein. In 1975, we performed the first pediatric living-related renal transplant in Turkey. We followed this in 1978 with the first deceased donor kidney transplant, using an organ supplied by Eurotransplant. In 1979 the law on harvesting, storage, grafting, and transplant of organs and tissues was enacted; the first local deceased donor kidney transplant was performed by our team in 1979. In 1988, another ground-breaking event in Turkey, the Middle East, and North Africa was successfully achieved: the first successful deceased-donor liver transplant, and in 1990, the first pediatric living-related segmental liver transplant in Turkey, the region and Europe was performed by our team. One month later, an adult-to-adult living-related liver transplant (left lobe) in the World was successfully performed. On May 16, 1992, we performed the first combined liver-kidney transplant from a living-related donor, which was the first operation of its kind in the World. Between November 1975 and January 2022, we have performed 3288 kidney (380 pediatric) at the Hacettepe University Hospitals and later on at Baskent University; since 1988, 701 (334 pediatric) liver transplants have been performed. In over 40 years of kidney and liver transplants history in Turkey, 46876 kidney (2502 pediatric patients) and 18203 liver (2612 pediatric patients) transplants have been performed nationwide. In 2001, the Ministry of Health established the National Coordination Center as an umbrella organization to promote transplant activities, especially for deceased donor organ procurement. Transplant activities are accelerating daily throughout the country, but deceased donors are still far below the desired rates.
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http://dx.doi.org/10.6002/ect.PediatricSymp2022.LDOI Listing
May 2022

Effect of meal intake for evaluating hepatic artery by Doppler ultrasonography in liver transplants: Does fasting matter for screening hepatic artery due to hemodynamic changes in splanchnic circulation?

Clin Transplant 2022 Jul 20;36(7):e14674. Epub 2022 Apr 20.

Department of General Surgery, Başkent University Medical Faculty, Ankara, Turkey.

Purpose: The aim of this study is to assess the utility of fasting on Doppler ultrasonography findings of hepatic artery in liver transplants.

Methods: Liver transplant patients without vascular abnormalities were prospectively evaluated between December 2017 and January 2020. Doppler sonography was used to describe hemodynamic changes in response to a standard meal. The diameter, peak systolic velocity, blood flow, resistive index (RI) of the main hepatic artery and portal vein peak velocity were measured.

Results: The mean hepatic arterial diameter of 44 patients was higher in the fasting group (4.5 mm) than in the postprandial group (3.3 mm) (p < .05). The mean hepatic arterial blood flow decreased (from .276 to .127 L/min) and hepatic arterial RI increased (from .66 to .71) following meal ingestion (p < .05). Hepatic arterial velocity was significantly lower and portal venous velocity was higher after oral intake.

Conclusion: Meal ingestion has an important effect on hepatic artery Doppler features in liver transplants. Therefore, Doppler ultrasound evaluation should be considered after appropriate fasting due to postprandial responses of liver transplant.
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http://dx.doi.org/10.1111/ctr.14674DOI Listing
July 2022

COVID-19 Infections in Pediatric Renal Transplant Recipients.

Exp Clin Transplant 2022 03;20(Suppl 1):156-160

From the Başkent University Department of Pediatric Nephrology, Ankara, Turkey.

Objectives: The new coronavirus SARS-CoV-2 (COVID-19) first appeared in Turkey in March 2020, spread rapidly, and caused many deaths. Although COVID-19 is mostly a respiratory disease, it can cause kidney and multiorgan failure in some cases. We believe that by sharing information about the course and effects of COVID-19 infection in kidney transplant recipients receiving long-term immunosuppressive therapy our understanding will improve.

Materials And Methods: Between March 2020 and October 2021, COVID-19 was researched in kidney transplant recipients under the age of 20 years who were followed at the Başkent University Transplantation Center. We documented the clinical characteristics and prognosis of pediatric kidney transplant recipients with COVID-19 disease.

Results: Our study group included 23 patients with COVID-19 infection from 215 pediatric kidney transplant recipients. The mean age of the patients was 14.6 ± 4.7 years; there were 9 female patients. The mean follow-up time posttransplant was 62.3 ± 43.2 months. In 13 patients (56.5%), fever was the most frequent symptom. Most patients (n = 18, 78%) had minor symptoms and recovered completely after receiving supportive treatment. Four patients (17%) required hospitalization. One was diagnosed with COVID-19 infection 1 week after being treated with rituximab for acute antibody-mediated rejection. That patient died because of significant lung disease and multiorgan failure.

Conclusions: Despite the fact that most of our pediatric transplant recipients had mild symptoms of COVID-19, we believe that particular caution should be observed in patients who have recently received intensive immunosuppressive medications. As a result of potential new vaccines, national immunization programs, and the emergence of novel virus strains, the clinical picture may change in the future. We believe that, as information sharing increases, we will learn more about COVID-19 in renal transplant recipients.
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http://dx.doi.org/10.6002/ect.MESOT2021.P82DOI Listing
March 2022

Cytomegalovirus Viremia in Solid-Organ Transplant Patients in the First Year After Transplantation.

Exp Clin Transplant 2022 03;20(Suppl 1):125-128

From the Department of Infectious Diseases, Başkent University Medical School, Ankara, Turkey.

Objectives: Cytomegalovirus infection is an important problem for transplantation. Although effective antivirals for prophylaxis or preemptive therapy have reduced the severity and consequences of infection, cytomegalovirus viremia and cytomegalovirusrelated disease are still matters for patients and for graft survival. The aim of our study was to determine the frequency of cytomegalovirus infections during the first year after transplant.

Materials And Methods: In this study, we analyzed the data of 252 liver and kidney transplant patients who had procedures between May 2016 and May 2020. Demographic and laboratory data of patients were recorded retrospectively and analyzed with the SPSS version 25 statistical program.

Results: Our study included 35 liver (14%) and 217 kidney transplant recipients. The ratio of male to female was 3.8, and the median age was 41 years (range, 18-71 years). In our study group, there were 32 patients (12.7%) with cytomegalovirus DNAemia, 13 patients (5%) with cytomegalovirus syndrome, and 6 patients (2.4%) with cytomegalovirus endorgan diseases. Four patients were diagnosed with gastrointestinal disease with histopathology, and 2 patients were diagnosed with cytomegalovirus pneumonia with bronchoscopy and radiology. The mortality rate was 0.8% in the first year.

Conclusions: Cytomegalovirus reactivations in the first year after transplant play a critical role on graft survival in solid-organ transplant. Regular follow-up of cytomegalovirus DNAemia is crucial for modifying prophylactic and preemptive antiviral regimens.
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http://dx.doi.org/10.6002/ect.MESOT2021.P54DOI Listing
March 2022

Relation of Anxiety, Depression, and Behavioral Problems With Time Allocated to Television, Computer, and Smartphone in Children Receiving Renal Replacement Therapy.

Exp Clin Transplant 2022 03;20(Suppl 1):100-106

From the Department of Child and Adolescent Psychiatry, Baskent University Ankara Hospital, Ankara, Turkey.

Objectives: Children and adolescents with chronic diseases have more screen exposure time compared with their healthy peers. In this study, we investigated screen exposure time of children who received renal replacement therapy, which included kidney transplant and dialysis treatment, versus a healthy control group.

Materials And Methods: Our study included 55 children and adolescents between the ages of 8 and 18 years. Although 28 participants did not have any chronic disease, 27 had chronic diseases and received renal replacement therapy. Among these patients, 17 had kidney transplant and 10 were receiving dialysis. A sociodemographic information form and the Conners Short-Form Parent Rating Scale were given to parents. Pediatric and adolescent patients completed the Children's Depression Inventory and Spielberger State-Trait Anxiety Scale-2. We analyzed differences between the groups with and without renal replacement therapy and examined relations between continuous variables.

Results: Duration of television screen time was significantly higher in children and adolescents receiving renal replacement therapy. Patients in the renal replacement therapy group showed a positive correlation between the Conners Short-Form Parent Rating Scale anxiety subscores and duration of smartphone use. In the kidney transplant recipient group, smartphone and computer durations were positively correlated and television duration was negatively correlated with the Conners Short-Form Parent Rating Scale behavioral problems subscores.

Conclusions: Children on renal replacement therapy may be at risk in terms of excessive television exposure. Children who are on dialysis and have had a kidney transplant may be more prone to the negative effects of screen exposure than healthy peers who do not have chronic illnesses. These children and adolescents should be closely monitored to avoid the negative effects of excessive screen exposure.
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http://dx.doi.org/10.6002/ect.MESOT2021.P42DOI Listing
March 2022

Primary Focal Segmental Glomerulosclerosis Recurrence After Pediatric Renal Transplantation.

Exp Clin Transplant 2022 03;20(Suppl 1):55-60

From the Department of Pediatric Nephrology, Baskent University, Ankara, Turkey.

Objectives: Focal segmental glomerulosclerosis recurrence after renal transplant occurs frequently in pediatric patients and is associated with poor graft survival when patients reach adulthood. We investigated recurrence rates, recurrence risk factors, management strategies, and long-term graft function among pediatric renal transplant recipients with focal segmental glomerulosclerosis as primary disease.

Materials And Methods: We retrospectively evaluated medical records of 34 pediatric patients with primary focal segmental glomerulosclerosis who had undergone renal transplant between 2004 and 2019 at our center. Focal segmental glomerulosclerosis recurrence was diagnosed by the presence of nephrotic range proteinuria after transplant and confirmed by graft biopsy. Preoperative prophylactic plasma exchange was administered to pediatric renal transplant recipients with primary focal segmental glomerulosclerosis. Plasma exchange was also used to treat focal segmental glomerulosclerosis recurrence, with rituximab added if the patient did not respond to plasma exchange.

Results: All patients (male-to-female ratio of 19:15) in our group underwent renal transplant. Mean patient age at the time of transplant was 12.72 ± 5.46 years. Twenty-nine patients received living- related donor allografts (85.3%) and 5 received organs from deceased donors (14.7%). We identified focal segmental glomerulosclerosis recurrence in 5 recipients (14.7%). Time from focal segmental glomerulosclerosis diagnosis to end-stage renal disease and duration of dialysis were shorter in the recurrence group than in the nonrecurrence group (48.4 months [range, 2-90 mo] vs 65.1 months [range, 8-123 mo] and 1.41 ± 0.82 vs 3.18 ± 1.88 years, respectively; P < .05). Donor type and transplant age were similar in both groups. Of those with recurrence who had received plasma exchange and rituximab, 3 patients (75%) had complete remission and 1 patient (25%) had partial remission.

Conclusions: Prophylactic plasma exchange and the combined plasma exchange-rituximab regimen for treatment of focal segmental glomerulosclerosis recurrence resulted in low recurrence and good remission rates in our pediatric cohort.
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http://dx.doi.org/10.6002/ect.MESOT2021.O24DOI Listing
March 2022

Stereotactic Ablative Body Radiotherapy as a Bridge to Liver Transplant for Hepatocellular Carcinoma: Preliminary Results of Başkent University Experience.

Exp Clin Transplant 2022 03;20(Suppl 1):39-45

From the Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey.

Objectives: Hepatocellular carcinoma is the most common primary liver tumor, with curative treatment options being liver transplant and resection. However, approximately 20% to 30% of patients have substantial disease progression while awaiting transplant. Here, we report our initial experience on stereotactic ablative body radiotherapy as a bridge to liver transplant for patients with hepatocellular carcinoma.

Materials And Methods: Seven patients with 9 lesions received stereotactic ablative body radiotherapy as a bridge treatment to transplant. All patients underwent radiofrequency ablation, transcatheter arterial chemoembolization, or hepatic resection before stereotactic ablative body radiotherapy. Magnetic resonance imaging was used to evaluate radiographic responses 1 month later.

Results: Median age of patients was 65 years (range, 63-71 years), median stereotactic ablative body radiotherapy dose was 45 Gy (range, 30-54 Gy; delivered in 3-5 fractions), and median tumor diameter was 17 mm (range, 12-30 mm). Before stereotactic ablative body radiotherapy, all patients underwent liver-directed therapies, including transcatheter arterial chemoembolization for 3 lesions, transcatheter arterial chemoembolization and radiofrequency ablation for 4 lesions, surgical resection for 1 lesion, and surgical resection plus transcatheter arterial chemoembolization for the remaining lesion. Patients showed no evidence of gastrointestinal toxicity or radiation-induced liver disease. Acute toxicity was negligible; all patients completed the treatment course. One month after stereotactic ablative body radiotherapy administration, response rates were assessed with magnetic resonance imaging, with complete responses obtained in 5 lesions (55.5%), partial responses for 2 lesions, and stable disease for 2 lesions. No disease progression was shown following stereotactic ablative body radiotherapy application.

Conclusions: Stereotactic ablative body radiotherapy is an effective, safe, and tolerable bridging therapy option. Although we observed an early response after treatment, exact response rates will not be known for at least 3 months following stereotactic ablative body radiotherapy. Thus, our findings should be confirmed through additional prospective studies with longer follow-up.
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http://dx.doi.org/10.6002/ect.MESOT2021.O15DOI Listing
March 2022

Clinical Outcomes of Liver Transplantation for Patients Over 60 Years Old: A Single-Center Experience.

Exp Clin Transplant 2022 03;20(Suppl 1):31-38

From the Department of General Surgery, Division of Transplantation, Baskent University, Ankara, Turkey.

Objectives: Although advanced age is no longer considered an absolute contraindication for liver transplant, transplant in elderly patients with comorbid diseases remains debatable because of high risks with surgery. Here, we report patient outcomes in this population.

Materials And Methods: We retrospectively reviewed medical records of 276 liver transplant recipients, grouped by age. Group 1 (≤59 years old) consisted of 247 recipients, and group 2 (≥60 years old) consisted of 29 recipients. Reviewed data included age, sex, cause of liver disease, presence of hepatocellular carcinoma, Child-Pugh and Model for End-Stage Liver Disease scores, survival, and posttransplant complications.

Results: In both groups, most patients (n = 108) required liver transplant for hepatitis B virus. Mean age was 40 ± 12.3 and 63 ± 2.3 years in groups 1 and 2, respectively, with more men than women in both group 1 (71.7% vs 28.3%) and group 2 (75.9% vs 24.1%). No significant differences were shown between groups for patient characteristics, except group 1 had significantly higher Model for End-Stage Liver Disease score. Group 1 mean survival time was 10.2 ± 0.6 years, with patient survival rates at 1, 5, 10, and 15 years of 65.5%, 53%, 46.3%, and 40%, respectively. In group 2, respective results were 10.6 ± 1.3 years and 75.9%, 68.6%, 61%, and 48.8% (no significant difference vs group 1).

Conclusions: Liver transplant recipients >60 years of age had survival rates, acute rejection rates, and complications similar to younger recipients. Liver transplant should not be withheld from older recipients on the basis of age alone. However, comprehensive screening for comorbidities should be performed.
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http://dx.doi.org/10.6002/ect.MESOT2021.O14DOI Listing
March 2022

Liver Transplant Recipients Who Survive for More Than 10 Years: A Long-Term Survey.

Exp Clin Transplant 2022 03;20(Suppl 1):20-23

From the General Surgery Department, Division of Transplantation, Baskent University, Ankara, Turkey.

Objectives: Liver transplant is the gold standard treatment for end-stage liver failure. Short-term and midterm surveys have been published, but there are few long-term surveys. Here, we report the outcomes of our long-term liver transplant survivors.

Materials And Methods: Since 1988, we have performed 694 liver transplants (366 adult, 328 pediatric), including the first deceased donor transplant in Turkey (December 8, 1988); the first pediatric segmental living related transplant in Turkey, the Middle and Near East, and Europe; the world's first adult segmental living related transplant (April 24, 1990); and the world's first living related donor combined liver-kidney transplant (May 16, 1992). We retrospectively evaluated data from recipients who survived >10 years with normal graft function.

Results: Of 215 recipients, survival ranges were ≥20 years (n = 13), 15 to 19 years (n = 86), and 10 to 14 years (n = 116); 211 remain alive today with normal liver function. There were 5 retransplants to treat chronic graft rejection, of which 4 recipients are alive with normal graft function after a second liver transplant (15, 20, 22, and 31 years after first transplant). One patient died soon after the second liver transplant (15 years after first transplant). Acute rejection episodes were seen in 72 (34%), and 7 were steroid resistant. There were 48 (22.7%) drug-induced complications. Ten patients had de novo malignancy: 5 lymphoma, 2 squamous cell carcinoma, 1 gastrointestinal stromal tumor, 1 thyroid papillary carcinoma, and 1 multiple myeloma. There were also 31 patients with hepatocellular carcinoma before liver transplant: 13 were beyond Milan criteria, 6 had incidental HCC, and 12 were within Milan.

Conclusions: Long-term survival after liver transplant is possible with expert care. Few reports have mentioned long-term surveys; our long-term liver transplant survey is among the largest series in the literature.
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http://dx.doi.org/10.6002/ect.MESOT2021.O8DOI Listing
March 2022

Long-Term Follow-up of Over 600 Living Related Kidney Donors: Single-Center Experience.

Exp Clin Transplant 2022 03;20(Suppl 1):17-19

From the Department of Nephrology, Başkent University Faculty of Medicine, Ankara, Turkey.

Objectives: Kidney transplant is the treatment of choice in patients with end-stage renal disease because it offers improved survival and better quality of life. Although most epidemiologic studies have suggested that living kidney donors have a minimal lifetime risk of developing end-stage renal disease, long-term complications and physiologic and psychologic sequelae resulting from donation remain unclear. Here, we examined the long-term results of living-related kidney donors who donated kidneys at the Başkent University Ankara Hospital over the past 25 years.

Materials And Methods: We were able to examine 607 kidney transplant donors (mean age of 52.03 ± 11.54 years) who were seen at our center from 1986 to 2021 and who agreed to a general health evaluation. Collected data included donor age, sex, blood type, body mass index, duration after donation, blood pressure measurements, biochemical parameters, abdominal ultrasonograph for size, structure, and renal blood flow of the solitary kidney, comorbid conditions, chronic drug use, and surgical procedures after donation.

Results: Mean time after donation was 10.4 ± 3.2 years. Twenty-four donors (3.9%) were diagnosed with diabetes and 21 (3.4%) with thyroid disease, 64 (10.5%) developed hypertension, and 48 (8.8%) developed atherosclerotic cardiovascular disease. Obesity was found to be an increasing problem in our donor population, with 174 (28.6%) developing mild to moderate obesity (body mass index >25 kg/m2). Older age, obesity, smoking, and hyperlipidemia were found to be the major and independent risk factors of both hypertension and atherosclerotic cardiovascular disease in donors. None of our donors developed endstage renal disease.

Conclusions: Obesity and hypertension were the most common comorbidities that developed in our kidney donor population. Our principle is to avoid unrelated and nondirected donors because of the possible long-term complications. Unrelated donors may be desperate if a family member needs donation in the future.
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http://dx.doi.org/10.6002/ect.MESOT2021.O4DOI Listing
March 2022

Comparison of Mortality Rates in Patients Waiting for Liver Transplant and Patients With Colorectal Metastatic Tumors.

Exp Clin Transplant 2022 03;20(3):273-278

From the Department of General Surgery, Medical School, Baskent University, Ankara.

Objectives: We aimed to identify outcomes of liver surgery in patients with hepatocellular carcinoma and colorectal cancer, which result in primary and secondary liver tumors.

Materials And Methods: Our study included 51 patients with colorectal cancer and liver metastases and 63 patients with hepatocellular carcinoma who were prepared for liver transplant due to cirrhosis who underwent hepatic resection or local ablation treatments; patients were seen between January 2011 and December 2021.

Results: Most patients with colorectal cancer were men (58.8%). Mean age was 65.76 ± 13.818 years (range, 27-88 y). Most patients had planned, elective surgery (86.3%). Neoadjuvant chemotherapy was administered to 58.8% of patients. The most common location of metastasis in the liver was in the right lobe (43.1%), and the most common surgery was low anterior resection (17 patients). During simultaneous liver surgery, 31 patients required metastasectomy and 7 patients required radiofrequency ablation plus metastasectomy. No deaths occurred in the early posttransplant period, and cumulative survival was 82.624 ± 7.962 months. Disease-free survival was 45.2 ± 7.495 months. Most patients with hepatocellular carcinoma were men (82.5%). Mean age was 58.73 ± 17.428 years. Hepatocellular carcinoma lesions were mostly located in both the right and left lobes (23.8%). In the hepatocellular cancer group, 60.3% had transarterial chemoembolization and 42.9% had radiofrequency ablation. The primary surgical resection was metastasectomy (17.9%) because of multiple localized lesions. Median follow-up was 22 months (range, 1-126 mo). Overall survival was 101.898 ± 7.169 months, with 10-year overall survival of 38%. Disease-free survival was 74.081 ± 8.732 months, with 1-year and 5-year disease-free survival of 90.5% and 54%.

Conclusions: Better survival was shown in patients with hepatocellular carcinoma than in patients with colorectal cancer.Therefore, more aggressive treatment options, as used in hepatocellular carcinoma, including liver transplant, may be options for patients with colorectal cancer.
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http://dx.doi.org/10.6002/ect.2021.0452DOI Listing
March 2022

Seventeen Years of Pediatric Liver Transplantation Experience for Cirrhosis and Hepatocellular Carcinoma.

Exp Clin Transplant 2022 Mar 15. Epub 2022 Mar 15.

From the Department of Pediatric Gastroenterology, Başkent University, Ankara, Turkey.

Objectives: This was a retrospective analysis of liver transplant for pediatric patients with liver cirrhosis and hepatocellular carcinoma.

Materials And Methods: Fourteen pediatric patients with chronic liver disease and hepatocellular carcinoma underwent liver transplant from 2004 to 2021. Preexisting diseases were tyrosinemia (n = 6), progressive familial intrahepatic cholestasis type 2 (n = 2) and type 3 (n = 3), cryptogenic cirrhosis (n = 2), hepatitis B and D (n = 1), and biliary atresia (n = 1).

Results: Mean age was 9.43 ± 4.9 years (range, 13 months to 16 years). Three patients had 1 tumor, 4 had 2 tumors, and 7 had multiple (≥3) lesions. Six patients were classified as Pretreatment Extent of Disease Staging System for Hepatoblastoma (PRETEXT) stage IV, 3 as stage II, and 5 as stage I. Some patients received systemic chemotherapy before (n = 4) or after transplant (n = 3) or transarterial chemoembolization and microwave ablation pretransplant (n = 1). Hepatocellular carcinoma posttransplant recurrence was observed at 23, 47, and 108 months in 3 patients (21%). Recurrence sites were omentum (n = 1) and liver graft (n = 2). One patient was treated with hepatic resection, radiofrequency ablation, and radiotherapy, while the other received radiofrequency ablation and chemotherapy for graft tumor recurrence. Relapse-free patient survival rates were 92%, 82.5%, and 72.2% at 2, 4, and 10 years, respectively. Four recipients (28.5%) died; posttransplant cause of death was infection at 19 (n = 1) and 188 months (n = 1) or hepatocellular carcinoma recurrence at 79 (n = 1) and 165 months (n = 1). Median follow-up was 178 months (range, 13-204 months). Mean estimated survival was 171.25 ± 16.6 months. Overall patient posttransplant survival was 100%, 92.3%, 92.3%, 83%, and 72% at 1, 2, 5, 10, and 15 years, respectively.

Conclusions: Hepatocellular carcinoma was mainly associated with inherited liver diseases in our pediatric series. Liver transplant provided a long-term survival advantage to pediatric patients with preexisting cirrhosis and hepatocellular carcinoma.
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http://dx.doi.org/10.6002/ect.2021.0469DOI Listing
March 2022

Treatment of Posttransplant Hepatocellular Carcinoma Recurrence.

Exp Clin Transplant 2022 01;20(1):59-61

From the Department of General Surgery, Division of Transplantation, Baskent University Faculty of Medicine, Ankara, Turkey.

Objectives: In patients who receive liver transplant to treat hepatocellular carcinoma, 10% to 15% posttransplant recurrence is observed. In the present study, we evaluated the long-term outcomes of patients who had received liver transplant for treatment of hepatocellular carcinoma.

Materials And Methods: Of the 683 livertransplants that we performed, 72 were in response to hepatocellular carcinoma. The physical examination and laboratory and imaging results of the patients were retrospectively analyzed and recorded. The recipients were evaluated according to the Başkent criteria and divided into 2 groups: early diagnosis and late diagnosis.

Results: Among 72 total patients in our study, 19 (26.3%) were pediatric recipients. Hepatocellular carcinoma recurred in 7 patients (9.7%; 5 adult, 2 pediatric). Except for one patient, all were in the late diagnosis group.The mean survivaltime of all patients was 137.45 ± 10 months.The mean survival in the early diagnosis group was longer than in the late diagnosis group. During follow-up, 11 patients died from recurrence and distant metastasis.

Conclusions: In patients with hepatocellular carcinoma who received liver transplant, we found that postoperative recurrence of hepatocellular carcinoma and distant metastasis can be treated with surgery and/or with interventional radiology methods, which may improve patient survival after liver transplant.
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http://dx.doi.org/10.6002/ect.2021.0450DOI Listing
January 2022

Effect of Ozone Added to University of Wisconsin Solution on Preservation Damage in Perfused Liver.

Exp Clin Transplant 2022 Jan 14. Epub 2022 Jan 14.

From the Department of General Surgery, Medical School, Baskent University, Ankara, Turkey.

Objectives: Ischemia is defined as the inability of the tissue to provide oxygen and other metabolites by the circulation and the removal of residual products. The University of Wisconsin solution is widely used to preserve ischemia and to preserve organs for transplant. Ozone is used in various areas of ischemia damage due to its antioxidant properties. The aim of our study was to investigate the effects of ozone added to University of Wisconsin solution on perfused liver preservation injury.

Materials And Methods: Our study included 24 Sprague Dawley rats with an average weight of 300 to 350 g. Animals were divided into 4 groups: group 1 (Ringer lactate), group 2 (Ringer lactate + ozone), group 3 (University of Wisconsin solution), and group 4 (University of Wisconsin + ozone). Solutions were perfused from the liver portal vein and aorta. After perfusion, rats were killed and liver biopsies were taken at 0, 6, and 12 hours of storage for pathological examination. For biochemical analysis, samples were collected from liver specimen storage solutions at 0, 6, and 12 hours.

Results: Mean alanine aminotransferase/aspartate aminotransferase levels in group 3 were 77/82 U/L at hour 0, 680/461 U/L at hour 6, and 1027/682 U/L at hour 12. In group 4, these levels were 35/31 U/L at hour 0, 415/295 U/L at hour 6, and 546/372 U/L at hour 12.

Conclusions: In terms of liver function values, we observed favorable result with University of Wisconsin solution with added ozone. Therefore, we suggest that the addition of ozone to the University of Wisconsin solution may be effective in preventing liver preservation damage.
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January 2022

Tacrolimus intrapatient variability in BK virus nephropathy and chronic calcineurin toxicity in kidney transplantation.

Saudi J Kidney Dis Transpl 2021 Mar-Apr;32(2):348-354

Department of General Surgery, Division of Transplantation, Baskent University Ankara Hospital, Ankara, Turkey.

Intrapatient variability (IPV) in tacrolimus has been increasingly acknowledged as a risk factor for poor graft survival after kidney transplantation. Although past studies have mainly accounted for IPV in acute or chronic rejection states as due to underimmunosuppression, this is not yet clear. So far, tacrolimus IPV for BK virus-associated nephropathy (BKVN) and chronic calcineurin inhibitor toxicity (CNIT) has not been investigated. Here, we evaluated IPV in tacrolimus for BKVN and chronic CNIT, which are mainly considered as overimmunosuppression states. In this case-control study, kidney allograft biopsies conducted between 1998 and 2018 were included, with patients grouped by biopsy results as BKVN alone group, CNIT alone group, and normal graft function (control group). IPV was estimated as mean absolute deviation. Our study groups included 25 kidney transplant recipients with BKVN alone, 91 patients with CNIT alone, and 60 patients with normal 5-year graft survival (control group). In analyses of IPV in tacrolimus six months before graft biopsy, IPV was highest in the BKVN group (P = 0.001). The BKVN group also had the highest IPV in tacrolimus at 12 months after biopsy (P = 0.001), with all pairwise comparisons statistically different between groups. At 12 months after biopsy, five patients (20%) in the BKVN group and 10 patients (10.9%) in the CNIT group had graft loss. Among other risk factors, BKVN and chronic CNIT are consequences related to high IPV. Quantification of IVP for tacrolimus in clinical practice would help to optimize kidney transplant outcomes.
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http://dx.doi.org/10.4103/1319-2442.335446DOI Listing
February 2022

Differences in Antibody Responses Between an Inactivated SARS-CoV-2 Vaccine and the BNT162b2 mRNA Vaccine in Solid-Organ Transplant Recipients.

Exp Clin Transplant 2021 12;19(12):1334-1340

From the Department of Infectious Diseases and Clinical Microbiology, Başkent University, Ankara, Turkey.

Objectives: Vaccination against SARS-CoV-2 may reduce COVID-19 mortality and complications in solidorgan transplant recipients, and we evaluated the associated antibody responses and adverse effects in this high-risk population.

Materials And Methods: This prospective observational study (April-June 2021) included 10 liver and 38 kidney transplant recipients who received 2 vaccine doses (Sinovac, n = 31; or BioNTech, n = 17) and 56 healthy adults (Sinovac), all of whom provided 3 blood samples (prevaccination, 4 weeks after first dose, and 4-6 weeks after second dose) for quantitative tests (Abbott Quant assay forimmunoglobulin G antibodies against SARS-CoV-2 spike protein). Type I error was α = .05 in all statistical analyses (SPSS, version 25).

Results: We analyzed demographic data, antibody responses, and adverse events after 2 doses of SARSCoV-2 vaccine, comparedimmune responses from solidorgan transplant recipients (median age, 36.5 years) versus healthy patients (median age, 37.5 years), and observed significantly higher seropositivity in healthy versus transplant patients after Sinovac vaccination (100% vs 67.5%; P = .001). However, we observed no significant seropositive differences for Sinovac versus BioNTech second doses in transplantrecipients. Median SARS-CoV-2 immunoglobulin G level after second dose was significantly higher in BioNTech (1388.6 AU/mL) versus Sinovac patients (136.6 AU/mL) (P = .012). The seropositivity difference between the 2 vaccines was significant in participants 24 to 44 years old (P = .040). The rate of at least 1 side effect was 82.4% (n = 14) for BioNTech vaccine and 32.3% (n = 10) for Sinovac vaccine, and the difference was statistically significant.The most common side effect was arm pain (significantly higher in BioNTech group).

Conclusions: Solid-organ transplant recipients demonstrated inadequate vaccine responses (higher risk of complications and mortality) versus healthy patients. Furthermore, immune responses may differ between vaccines. Therefore, additional vaccine doses and strict control measures remain crucial.
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http://dx.doi.org/10.6002/ect.2021.0402DOI Listing
December 2021

Clinical Features of SARS-CoV-2 Infection in Patients Undergoing Solid-Organ Transplant: Baskent University Experience.

Exp Clin Transplant 2021 Oct 11. Epub 2021 Oct 11.

From Department of Pulmonary Diseases, Baskent University Faculty of Medicine, Ankara, Turkey.

Objectives: The clinical features and treatment approaches, outcomes, and mortality predictors of COVID-19 in solid-organ transplant recipients have not been well defined. This study investigated the clinical features of COVID-19 infection in solid-organ transplant recipients at our center in Turkey.

Materials And Methods: Our study included 23 solidorgan transplant recipients and 336 nontransplant individuals (143 previously healthy and 193 patients with at least 1 comorbidity) who were hospitalized due to COVID-19 disease in our hospital between March 2020 and January 2021. Demographic, clinical, and laboratory data of patients were compared. We used SPSS version 20.0 for statistical analysis. All groups were compared using chi-square and Mann-Whitney U tests. P < .05 was considered statistically significant.

Results: Mean age of solid-organ transplant recipients was 49.8 ± 13.7 years (78.3% men, 21.7% women). Among the 23 recipients, 17 (73.9%) were kidney and 6 (26.1%) were liver transplant recipients. Among nontransplant individuals, 88.7% (n = 298) had mild/moderate disease and 11.3% (n = 38) had severe disease. Among transplant recipients, 78.3% (n = 18) had mild/moderate disease and 21.7% (n = 5) had severe disease (P = .224). Transplant recipients had greater requirements for nasal oxygen (P = .005) and noninvasive mechanical ventilation (P = .003) and had longer length of intensive care unit stay (P = .030) than nontransplant individuals. No difference was found between the 2 groups in terms of mortality (P = .439). However, a subgroup analysis showed increased mortality in transplant recipients versus previously healthy patients with COVID-19 (P < .05). Secondary infections were major causes of mortality in transplant recipients.

Conclusions: COVID-19 infection resulted in higher mortality in solid-organ transplant recipients versus that shown in healthy patients. More attention on secondary infections is needed in transplant recipients to reduce mortality.
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http://dx.doi.org/10.6002/ect.2021.0361DOI Listing
October 2021
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