Long-term Results of Kidney Transplantation in Patients With Familial Mediterranean Fever and Amyloidosis.

INTRODUCTION: Amyloid A amyloidosis is most commonly caused by familial Mediterranean fever (FMF) in Turkey. Amyloidosis secondary to FMF is an important cause of end-stage renal failure, and kidney transplantation (KT) in these cases can be complicated, with long-term results oftentimes inferior compared with organ transplant in patients without FMF. The present study aims to show the long-term results of patients with secondary amyloidosis caused by FMF undergoing KT . METHODS: We enrolled 27 patients with a history of FMF amyloidosis undergoing KT and a control group of 614 patients undergoing KT between 2005 and 2018 at Ankara University Medical School. All data were recorded retrospectively from patients files. RESULTS: Twenty-two patients (81.5%) were treated with triple immunosuppressive therapy consisting of mycophenolate mofetil, tacrolimus, and a steroid; 5 patients (18.5%) were treated with tacrolimus, azathioprine, and prednisolone. Acute cellular rejection was seen in 3 patients (11.1%), and acute cellular- and antibody-mediated rejection occurred in 1 patient (3.7%). During the follow-up period, graft loss due to acute cellular rejection was observed in only 1 patient. One patient was lost to follow-up.

Preperitoneal fat tissue may be associated with arterial stiffness in obese adolescents.

Vascular aging is a chronic process, and many negative effects of obesity in this process have been well defined. We assessed arterial stiffness in obese adolescents and evaluated the relationship between intra-abdominal fat distribution and arterial stiffness. Arterial stiffness parameters and pulse wave velocity (PWV) were evaluated in 61 obese adolescents and 58 healthy controls. Carotid-femoral PWV was calculated by arterial tonometry. Additionally, all obese children were evaluated for metabolic syndrome and insulin resistance. Intra-abdominal fat distribution, including subcutaneous, preperitoneal and visceral fat thicknesses, was assessed by ultrasonography. PWVs of obese children were significantly higher than those of healthy controls (5.0 ± 0.7 m/s vs. 4.7 ± 0.5 m/s). Parameters affecting PWV were evaluated by regression analysis. The independent variable in the regression analysis model was PWV, and the dependent variables were age, metabolic syndrome, body mass index and Homeostasis Model Assessment--Insulin Resistance, as well as subcutaneous, preperitoneal and visceral fat tissue thicknesses measured by ultrasonography. The only parameter associated with PWV was preperitoneal fat tissue thickness. Vascular changes related to obesity may begin in adolescence, as illustrated by the increased PWV. Preperitoneal fat tissue may be related to arterial stiffness. Intra-abdominal fat distributions obtained by ultrasonography may provide clinicians with valuable information needed to determine cardiovascular disease risk factors in obese adolescents.

Assessment of left ventricular diastolic function with Doppler tissue imaging: effects of preload and place of measurements.

Mitral inflow velocities are widely used for the evaluation of left ventricular (LV) diastolic function. However, they are closely affected by other factors such as preload. The purpose of this study was to evaluate the usefulness of tissue Doppler velocities obtained from the mitral annulus for the evaluation of ventricular relaxation in patients under different loading conditions. We also evaluated the effect of preload at different sides on the mitral annulus. The study population consisted of 62 consecutive patients (38 male, 24 female with a mean age of 42 +/- 13 years) who have undergone hemodialysis. Both mitral inflow velocities (E wave, A wave, E wave deceleration time and isovolumetric relaxation time) and mitral annulus tissue Doppler velocities (E', A') from the septal, lateral, anterior, posterolateral and inferior sides of the mitral annulus were measured immediately before and after hemodialysis. Mitral inflow E and A wave velocities and E/A ratio decreased significantly (p < 0.001, p = 0.007, p < 0.001, respectively) after hemodialysis. Mitral annulus E' wave velocities and E'/A' ratios obtained from five different sides of the annulus also changed significantly (p < 0.001 for all); however, there was no change in the A' wave velocity (p > 0.05 for all) after hemodialysis. The decrease in E wave and E/A ratio in mitral inflow measurements and E' velocities and E'/A' ratios in tissue Doppler measurements were correlated with the amount of fluid extracted (for mitral inflow E wave, r = 0.392, p = 0.002 and E/A ratio, r = 0.280 and p = 0.027; for lateral side E', r = 0.329, p = 0.009 and E'/A' ratio, r = 0.286, p = 0.04; for septal side E', r = 0.376, p = 0.003 and E'/A' ratio, r = 0.297, p = 0.019; for anterior side E', r = 0.342, p = 0.007 and E'/A' ratio, r = 0.268, p = 0.035; for posterolateral side E', r = 0.423, p = 0.001 and E'/A' ratio, r = 0.343, p = 0.007; and for inferior side E', r = 0.326, p = 0.01 and E'/A' ratio, r = 0.278, p = 0.029). We conclude that mitral annular velocities obtained by tissue Doppler are preload dependent parameters for the evaluation of LV diastolic function.