Expected Life Expectancy on Liver Transplantation and Aging Donor.

In this study, our aim was to show the life expectancy according to donor age groups at 1, 3, 5, 10, 15, and 20 years after liver transplant in liver transplant recipients. In this retrospective study, we analyzed the survival rate of 236 patients who had liver transplant procedures between 1988 and 2021. The 5-year life expectancy of recipients with donors over age 50 years in the literature has been shown to vary between 50% and 80%. Little information could be found on life expectancy after 10, 15, and 20 years in other studies. In the studies from Haberal and colleagues, life expectancy at 10, 15, and 20 years was 49%, 42%, and 42%, respectively. This study presents an evidence-based example of the use of elderly donors to enlarge the donor pool.

Emergency Department Visits After Kidney, Liver, and Heart Transplantation in a Hospital of a University in Turkey: A Retrospective Study.

OBJECTIVES: In our country, there are few publications evaluating emergency department visits among kidney, liver, and heart transplant recipients. Here, we examined emergency department visits of transplant recipients after initial hospital discharge following organ transplant performed in a medical faculty hospital in Ankara, Turkey. MATERIALS AND METHODS: We retrospectively analyzed hospital records of 1144 transplant recipients (700 kidney, 332 liver, and 112 heart) who underwent living-donor and deceased-donor organ transplant procedures in a university hospital between 2007 and 2017 and were admitted to the emergency department during the same period. RESULTS: The study population (1144 organ transplants) consisted of kidney (61.2%), liver (29.0%), and heart (9.8%) transplant recipients. Among them, 67.9% of kidney transplant recipients and 62.0% of liver transplant recipients were male, whereas 65.2% of heart transplant recipients were female. Average ages were 32.8 ± 15.5, 24.26 ± 21.6, and 29.9 ± 18.7 years, respectively. Among all groups, 41.4% visited the emergency department within 2 years after transplant. Median time to emergency department visit for kidney, liver, and heart transplant recipients was 4.7 months, 3.5 months, and 11.5 months, respectively. Emergency department admissions were due to complaints of abdominal/pelvic pain, fever, nausea/vomiting, hypertension, and nonspecific chest pain. Among all groups, the main diagnoses were most commonly classified by fluid and electrolyte disorders, abnormal results of renal function, urinary tract infections, and acute respiratory infections. One-third of patients were hospitalized. CONCLUSIONS: Nearly one-quarter of kidney transplant recipients, one-fifth of liver transplant recipients, and one-tenth of heart transplant recipients visited the emergency department within 30 days of transplantation. Considering that one-third were rehospitalized, the recipients could be targeted for better transitions of care and for earlier or more frequent outpatient follow-up and also be informed about what symptoms are not normal and in which situations they should seek emergency care.

Quality of Life Through Gender Role Perspective in Candidate Renal Transplant Recipients: A Report From Baskent University Using the Short Form 36 Health Survey.

OBJECTIVES: The aim of the study was to evaluate the quality of life of patients with end-stage renal disease through a "gender role perspective." Patients were on hemodialysis treatment and on a wait list for transplant. MATERIALS AND METHODS: This study was conducted at the Baskent University Adana, Ankara, and Istanbul hemodialysis centers. Patients completed Short Form 36 Health Survey questionnaires voluntarily to evaluate quality of life. The questions were answered independently by patients while they were undergoing hemodialysis treatment. RESULTS: The mean age of participants was 54 ± 16.5 years. Quality of life was found to be higher in men (44.7 ± 19.2), and there was a negative correlation between quality of life and age in both sexes, as well as marriage age, number of pregnancies, and age of patient at the first live birth in women (P < .05). We found statistically significant differences between men and women regarding physical health and mental health dimensions. Quality of life scores increased with level of education (P < .001). In addition, patients in Ankara had the highest quality of life compared with Istanbul and Adana (P < .01). Average time on hemodialysis treatment, the number of weekly hemodialysis sessions, mean time of the disease, and mean duration of abandoning hemodialysis sessions were negatively associated with all components of quality of life (P < .05). CONCLUSIONS: We found that sex, education level, social status, and home city of patients had a high impact on quality of life. Thus, it is essential to educate both male and female patients regarding sex/gender and health issues before transplant to increase the recipient's physical and mental health dimensions.

Factors Predisposing to the Use of Complementary Therapies in Patients With Chronic Renal Failure.

OBJECTIVES: Our aim was to gather information about complementary medicine applications used by chronic renal failure patients and their relation to demographic factors. MATERIALS AND METHODS: Of 1750 chronic renal disease patients who were undergoing hemodialysis, only 450 patients attended in the study. Among 450 patients, 388 gave consent and were interviewed using a previously tested questionnaire. Questions about complementary and alternative medicine use, a list of commonly used methods, and the sources of knowledge about these were asked of all patients. RESULTS: We observed a significant difference in the patients who were using complementary and alternative medicines before and after diagnosis of chronic renal disease (P < .001). We noted that 87% of the patients used complementary and alternative medicines before diagnosis and 49.8% used these after diagnosis. Among the patients who used complementary and alternative medicines, 76% had faith in these therapies. Of patients who used complementary and alternative medicines, 95% believed that the remedies or processes used were beneficial to their health. Furthermore, 71% of users had great confidence in these therapies and had no belief that these could be harmful. Of those who used complementary and alternative therapies, 51% had no idea whether these therapies were harmful. The source of knowledge was mass media tools (47%), social life (friends, relatives, neighbors, colleagues; 45%), and other patients with chronic renal disease (8%). CONCLUSIONS: Complementary and alternative medicine therapies have a significant impact on patients with chronic renal disease. Doctors can warn patients about possible dangers of complementary and alternative medicine remedies and treatments.

Influence of Social, Economic, Familial, Marital Status, and Disease Adaptation on the Physical and Mental Health Dimensions of Patients Who Are Candidates for Renal Transplant.

OBJECTIVES: End-stage renal disease is a disease with a long duration, requiring patients to live with the limitations imposed by their condition. Stressors associated with this disease are demanding, with patients dependent on support from their social environment. Here, we aimed to show the influences of familial, social, economic, and marital status on quality of life in patients with end-stage renal disease. MATERIALS AND METHODS: Patients (190 women/188 men) who were under hemodialysis treatment and on transplant wait lists were included in the study. To evaluate the quality of life, patients completed the Short Form 36 health survey questionnaire voluntarily while undergoing hemodialysis treatment. All Short Form 36 questionnaire components were analyzed separately, and all social, economic, and business life dimensions were examined with another questionnaire. RESULTS: Significant differences were observed between single and married patients regarding physical and mental health dimensions (P < .001), with quality of life higher in single patients than in married. Patients who lived in villages had lower health quality than patients who resided in cities or towns (P < .01). Patients who were home owners and who had a job had higher degrees of health quality than those who did not (P < .01). The lowest Short Form 36 scores were in housewives and farmers (P < .001). Comparisons between patients who went home after hemodialysis versus those who went to work showed better Short Form 36 scores in working patients (P < .001). Patients with private insurance and family support had better Short Form 36 scores (P < .001). Patients who did not comply with their doctor and dietician showed the lowest health quality (P < .05). Regular or irregular drug use did not affect scores. CONCLUSIONS: Familial, social, economic, and marital statuses, in addition to the influence of disease adaptation, independently affected the well-being of patients with end-stage renal disease.

Smoking Behaviors of Renal Transplant Recipients: An Analysis of 113 Patients.

OBJECTIVES: Smoking is the most important remediable risk factor for the progression of renal diseases. Smoking has serious adverse effects, such as cardiovascular disease, kidney function impairment, and cancer in kidney transplant recipients who are already at high risk for these diseases. In this study, our objective was to evaluate descriptive characteristics and smoking status of renal transplant recipients. MATERIALS AND METHODS: We evaluated 113 patients who underwent renal transplant at Baskent University Hospital between 1990 and 2015. The medical records of all patients were retrospectively reviewed. Patient demographics, cause of renal diseases, mortality status, smoking status, and amount of smoking were recorded. RESULTS: In our study, 82 patients (72.7%) were male and 31 were female. The mean age was 38.50 ± 12.94 years. Causes of renal failure were as follows: 15.9% from hypertension, 12.4% from diabetes mellitus (all types), 8% from glomerulonephritis, 8% from vesicoureteral reflux, 6.2% from polycystic kidney disease, 17.6% other, and 31.9% unknown. Comorbid systemic disease was found in 57.6% of the patients. Fifty patients (44.2%) were current smokers, and 63 patients (55.8%) were nonsmokers. Mean age of smokers was 44.68 ± 10.60 years, with most being male patients (92.0%). There was a statistically significant difference between smoking status and sex (P < .001). The presence of comorbid diseases was significantly different between smokers and nonsmokers (P = .001). The smoking status of patients with hypertension (28.2%) was significantly different (P = .032) than others. CONCLUSIONS: Smoking cessation is associated with substantial health benefits for all smokers. For kidney transplant recipients, cigarette smoking has many adverse effects, causing cardiovascular disease and other comorbid diseases. Therefore, every attempt should be made to encourage kidney transplant candidates to stop smoking.

Carotid Artery Intima Media Thickness and HsCRP; Predictors for Atherosclerosis in Prediabetic Patients?

OBJECTIVE: We aimed to assess carotid intima media thickness (CIMT) and serum high-sensitivity C-reactive protein (hs-CRP) levels as estimated markers of subclinical atherosclerosis and inflammation in prediabetic patients. METHODOLOGY: One hundred and ten patients were defined as prediabetic and seventy-six subjects (age and sex matched) were assigned as control group in our cross sectional study. Bilateral CIMT measurements and hs-CRP levels were evaluated. RESULTS: The prevalance of hypertension, hyperlipidemia, angiotensin receptor blockers and antihyperlipidemic medication use were statistically higher in the prediabetic group. Serum hs-CRP levels, left, right and maximum CIMT were statistically higher among prediabetics compared to control group. There was a positive, significant correlation between left, right, maximum CIMT and fasting blood glucose, HbA1c, hs-CRP levels and BMI. CONCLUSION: Recognising and focusing on the intervention of prediabetic state as early as possible and identifying the susceptible patients who may benefit from more aggressive preventive therapy is an important issue of primary prevention of diabetes and cardiovascular diseases.

Vitamin D deficiency is a problem for adult out-patients? A university hospital sample in Istanbul, Turkey.

OBJECTIVE: To investigate the frequency of vitamin D deficiency in relation to demographics, clinical diagnosis, season of measurement and laboratory parameters in adult out-patients. DESIGN: Descriptive, retrospective study concerning evaluation of the initial 25-hydroxyvitamin D (25(OH)D) levels determined at admission in relation to demographics, clinical diagnosis, season of measurement and laboratory parameters. 25(OH)D levels ,20 ng/ml were classified as deficiency, 20­30 ng/ml as insufficiency and .30 ng/ml as sufficiency. SETTING: Out-patient clinics at a tertiary care centre. SUBJECTS: A total of 2488 adult patients (mean age: 53?3 (SD 15?2) years; 85?2% were females) admitted to out-patient clinics at Baskent University Istanbul Hospital were included. RESULTS: Mean level of 25(OH)D in the overall population was 17?4 (SD 11?5) ng/ml while insufficiency and deficiency were evident in 24% and 66% of patients, respectively. Mean 25(OH)D levels in males .45 years old were higher than in their female counterparts (19?4 (SD 11?3) ng/ml v. 17?8 (SD 12?2) ng/ml; P,0?05). Mean 25(OH)D levels obtained in summer (18?6 (SD 11?1) ng/ml) and autumn (23?3 (SD 13?6) ng/ml) were significantly higher than levels in spring (16?1 (SD 10?3) ng/ml) and winter (14?6 (SD 10?2) ng/ml; P,0?01). Mean 25(OH)D levels were determined to be significantly lower in obese patients compared with non-obese patients (15?6 (SD 10?4) ng/ml v. 17?6 (SD 11?6) ng/ml; P,0?05). Levels of 25(OH)D were significantly negatively correlated with serum parathyroid hormone levels (r520?194; P,0?001) while significantly positively correlated with phosphorus (r50?059; P,0?01) and HDL cholesterol (r50?070; P,0?01) levels. CONCLUSIONS: Our findings indicate that vitamin D deficiency is very common among out-patients in Turkey, regardless of gender and age, especially among obese people and during winter and spring.

Knowledge and attitudes of high school students related to organ donation and transplantation: a cross-sectional survey in Turkey.

We have very little information about the knowledge and attitude of high school students towards organ donation and transplantation. The aim of this study was to identify student-related factors that might affect organ donation, and then use this information to develop some essential strategies and policies. Two hundred students from one urban high school were surveyed with a questionnaire. After completing the first interview, the students underwent a training program on organ donation and transplantation. Once this was complete, the students filled out the same questionnaire in a second interview session. We then analyzed the changes from before to after the educational program in order to assess the program's effectiveness. Concerning brain-death, 66.1% of the respondents identified the correct definition of this concept before training, and 92% did so after training (p<0.001). The correct definition of transplantation was chosen by 68.3% of the respondents before training, and by 90.6% after training (p<0.001). It is clear that this educational program greatly enhanced the students' level of knowledge related to many aspects of organ donation and transplantation and significantly expanded awareness. By leading to changes in opinion, such training programs will significantly increase the number of donors and the rate of transplantation in Turkey.

Transplant coordination activities in the Baskent University Hospital Network.

Our transplantation center adopted a new model of operation, with 3 affiliated centers of the Baskent University. The aim of this system is to standardize procedures related to organ procurement and transplantation, to increase organ donation, and to improve the quality of services. The transplant team is composed of a transplant coordinator, and transplant clinicians and surgeons. The transplant coordinator works independently, and promotes organ donation and procurement, organizes interviews with donor families, and is in contact with national and international organ-sharing organizations. The organs and tissues are transplanted in the Ankara hospital of the network if the cadaver organ source is one of the Baskent University hospitals. If no appropriate recipient is available, the organs and tissues are offered to the National Coordination Center for other transplantation centers. To implement this system most efficiently and effectively, periodic situation analyses were made.