Evaluation of renal transplantations performed in the Transplantation Center at Sanko University Medical School.

INTRODUCTION: Renal transplantation is the optimum treatment to improve the quality and length of life in end-stage renal disease. The aim of this study is to evaluate patients who underwent renal transplantation in our transplantation center and to present our clinical experience. METHODS: Living donor and cadaveric renal transplants performed in the Transplantation Center of Sanko University Medical School between 2011 and 2014 were evaluated retrospectively. In our study, important parameters, such as delayed graft function, early and late phase infections and urologic complications after the operation, results of renal transplants with marginal donors with high creatinine levels, and increase in posttransplant body mass index were evaluated regarding to the living donor and cadaveric renal transplants performed in our transplantation center. RESULTS: We included 136 patients were (92 males [68%] and 44 females [32%]), with an average age of 38.9 ± 9.8 years (range, 17-67). There were 63 living donor renal transplantations (43%) and 73 cadaveric renal transplantations (57%). The youngest cadaveric donor was 3 years old, and the oldest was 86. Fifteen of the cadaveric donors had blood creatinine levels around 1.5 g/dL. The highest level of creatinine from cadaveric donors was 5.1 g/dL. CONCLUSIONS: Living donor renal transplantations have higher success rate than cadaveric renal transplantations. Ureteroneocystostomy and native ureteropyelostomy seem to be safe and efficient treatment methods for ureteral complications. High creatinine levels in marginal donors do not affect graft function in early stages.

Increase in Body Mass Index After Renal Transplantation.

The aim of this study was to determine the changes in body mass index (BMI) of patients after renal transplantation regarding causes like steroid use, lower necessity for dietary restrictions, and changes in eating habits. Ninety-seven patients were enrolled in this retrospective study; they had undergone cadaver or living donor renal transplantation between 2011 and 2013. Demographic features of patients, height, weight, and BMI were evaluated before and 6 and 12 months after surgery. The patients were grouped as malnutritioned, normal, overweight, and obese. Statistical analyses were performed using the SPSS 11.0 statistics program. Mean age of patients was 39.1 ± 10.7 years. Twenty-six (26.8%) were female and 71 (73.1%) were male. Mean BMI before surgery was 22.52 ± 3.97 kg/m(2). Six months post-transplantation the mean BMI was 24.40 ± 4.1 kg/m(2) and after 12 months it was 25.56 ± 4.14 kg/m(2) (P < .05). Also, 68% of patients showed improvement 12 months after surgery; they were in the preoperative malnutrition group. There is a significant increase in the BMI of patients in the first year who undergo renal transplantation, and the reason is multifactorial. BMI is relevant to diabetes, hypertension, and allograft nephropathy. BMI should be carefully considered in the follow-up of patients who have undergone renal transplantation, and early nutritional changes with dietary and exercise programs should be performed in overweight cases.

Cilostazol and diltiazem attenuate cyclosporine-induced nephrotoxicity in rats.

AIM: Cyclosporine (CsA), an important agent used in organ transplantation to prevent rejection, displays nephrotoxicity as the most important side effect limiting usage. In this study, we sought to evaluate the effects of cilostazol and diltiazem to counter the nephrotoxicity induced by the calcineurin inhibitor CsA. MATERIALS AND METHODS: Animals were randomly divided into seven groups, each consisting of eight animals: sham, controls, cilostazol, diltiazem, CsA, CsA plus diltiazem, and CsA plus cilostazol treatment. At the end of a 60-minute ischemic period, we administered the drugs after reperfusion for 7 days thereafter. CsA (10 mg/kg/d) was intraperitoneally for 7 days; cilostazol (10 mg/kg/d) orally by catheter for 7 days; diltiazem (5 mg/kg/d) intraperitoneally for 7 days. At the end of the 7-day treatment period, blood and tissue samples were harvested for biochemical, and serological evaluation. RESULTS: Ischemia-reperfusion injury significantly increased malondialdehyde (MDA) levels as well as decreased catalase (CAT) activities and superoxide dysmutase (SOD) content. The lowest MDA mean level was observed in the diltiazem and, the highest in the control group. The lowest CAT mean levels were noted in the CsA and diltiazem groups with highest CAT content was in the CsA and cilostazol groups. The lowest SOD mean level occurred in the sham group; the highest, in the CsA group. CONCLUSION: Cilostazol and especially diltiazem were effective to mitigate renal ischemia-reperfusion injury.

The protective effects of ketamine and propofol in obstructive jaundice: an experimental study.

OBJECTIVE: In this study, we investigated the protective effects of frequently used intravenous anesthetics (ketamine, propofol, thiopental, and fentanyl) in oxidative stress in a rat liver model of obstructive jaundice. MATERIALS AND METHODS: Thirty-two Wistar albino rats were divided into four groups in a randomized fashion. All rats were subjected to laparotomy, common bile duct ligation and severance on day 0. Following 7 days, laparotomy was again performed using ketamine, propofol, pentobarbital, or fentanyl anesthesia. After 2 hours, the animals were sacrificed and tissue specimens were acquired for histopathological scoring and determination of malondialdehyde (MDA), superoxide dismutase (SOD) and catalase (CAT) activities. RESULTS: All rats demonstrated enlargement in the bile duct, obstructive jaundice, and histopathologic ductal proliferation. MDA and SOD levels were significantly lower in the ketamine group compared with the thiopental and fentanyl groups. CAT was significantly increased in the ketamine group compared with the other groups. The best portal polymorphonuclear leukocyte and necrosis scores were in the ketamine group, but this difference was not statistically significant ( p=0.07). CONCLUSION: Ketamine and propofol were observed to cause the least amount of oxidative stress in this rat model of induced oxidative stress generated by ligation of the common bile duct. This experiment is the first study on this subject in the literature (Tab. 3, Ref. 65).

The comparison of the effects of hepatic regeneration after partial hepatectomy, silybum marinaum, propofol, N-acetylcysteine and vitamin E on liver.

AIM: We investigated the comparison of the effects of N-acetylcysteine, silybum marinaum, propofol, and vitamin E on liver hepatic regeneration after partial hepatectomy. METHOD: Forty-eight rats were randomized into 6 different groups of the same age and weight. After partial hepatectomy, all animals were resuscitated with 5 ml of isotonic sodium chloride solution administered subcutaneously while group 1 (sham) did not receive any injection, group 2 (control) received serum physiologic intraperitoneally, group 3 received 25 mg /kg of propofol intraperitoneally, group 4 received 20 mg/kg of N-acetylcysteine intraperitoneally, group 5 received 400 mg/kg of vitamin E intraperitoneally, and group 6 received 10 mg/kg of silybum intraperitoneally. None of these groups were given antibitotics. On the third day, a half of the rats, and on the seventh day, the other half of rats were reoperated and sacrificed. RESULTS: Blood samples were used for biochemical parameters (AST, ALT). Ki-67 proliferation index was used for histopathologic parameters. A statistically meaningful difference was detected in silybum, vitamin E, N-acetylcysteine, and propofol groups for AST, ALT levels when compared to control and sham groups (p<0.05). Ki-67 regeneration proliferation index of all groups, which were given agents on the third and seventh days were statistically higher than the control and sham groups (p<0.05). During the evaluation, AST, ALT, Ki-67, Ro (regeneration value) levels of silybum group displayed a statistically significant difference according to other groups (p<0.05). CONCLUSION: Our experimental study indicates that hepatic regeneration after partial hepatectomy was meaningful and significant in groups with intraperitoneal administration of silybum marinaum,vitamin E, N-acetylcysteine and propofol. Hepatic regeneration rate was particularly higher in silybum group compared to other groups (Fig. 16, Ref. 26).

Protective effects of N-acetylcysteine and beta-glucan pretreatment on oxidative stress in cecal ligation and puncture model of sepsis.

This study was designed to compare the effect of pretreatment with N-acetylcysteine (NAC) and beta -glucan (beta GLU) on inflammatory response in a rat model of sepsis. The study was performed in the animal laboratory of the Kahramanmaras Sutcu Imam University, School of Medicine. Forty rats were randomized into four groups (control, sham, NAC, and beta GLU). Control and Sham groups received saline or NAC (200 mg/kg, po) in the NAC group and beta GLU (50 mg/kg, po) in the betaGLU group via intragastric gavage once a day for 10 days and 30 min prior to surgery. Sepsis was induced by cecal ligation and puncture (CLP) in rats. In the NAC, beta GLU, and control groups, a laparotomy was performed with the CLP procedure. In the sham group, laparotomy was performed and cecum was manipulated but not ligated or perforated. TNF-alpha and IL-6 levels were significantly elevated in the control group and decreased in the NAC and beta GLU groups. IL-10 levels were significantly increased in the beta GLU group (p < .05). Superoxide dismutase and catalase levels in the liver tissue were significantly increased in the NAC and beta GLU groups, whereas superoxide dismutase levels were higher in the beta GLU pretreatment group than the NAC pretreatment group (p < 0.05). Malondialdehyde levels in the liver tissue were significantly elevated in the control group and decreased in the NAC and beta GLU groups (p < .05). Prophylactic administration of NAC or beta GLU similarly ameliorated sepsis syndrome by reduction of the proinflammatory cytokines and increase of the anti-inflammatory cytokine levels and accession of cellular antioxidants, which protect cells from oxidative stress, thereby recruiting inflammatory cells into tissue.

Predictors of mortality and morbidity in acute obstructive jaundice: implication of preventive measures.

BACKGROUND/AIMS: The afferent events in acute obstructive jaundice (AOJ) are characterized by endotoxemia-induced decrease in systemic vascular resistance and bile salt mediated natriuresis and diuresis leading to diminished effective plasma volume. METHODOLOGY: A prospective protocol aimed at preventing those alterations was carried out in 104 consecutive patients with AOJ. The preoperative risk factors that predict postoperative mortality and morbidity were reevaluated and correctable factors were identified. RESULTS: The average duration between the initiation of jaundice and surgery was 9.3 days. The perioperative mortality was 0%. The essentials of the treatment protocol were lactulose and cefazolin administration respectively for the prevention of portal endotoxemia and biliary sepsis and maintenance of body weight with adequately replaced fluid and electrolytes. Clinically relevant nutritional deficit was not observed in any of the patients during the perioperative period. The unique factor that predicted late mortality was the preoperative alanine transaminase value. Renal hemodynamics and hematologic parameters were completely correctable before the operation and patients with malignant or benign biliary strictures benefited and responded to the treatment similarly. CONCLUSIONS: Measures taken to prevent the activation and progression of the afferent events in AOJ, have resulted in excellent clinical outcomes.

Two-day induction with thymoglobulin in kidney transplantation: risks and benefits.

INTRODUCTION: The aim of this study was to develop an induction protocol to reduce allograft rejection with fewer posttransplant infections and malignancies. METHODS: In this prospective randomized study, a T- and B-cell depletion protocol, consisting of IV thymoglobulin (ATG 5 mg/kg/d) plus methylprednisolone (500 mg/d) plus azathiopurine (2 mg/kg/d), was on days 0 and 1 after renal transplantation. CyA was introduced at day 3.39 among patients undergoing either primary living related (n = 16) or cadaveric (n = 23) transplants excluding recipients of full-HLA-matched sibling, or five- and six-HLA-matched cadaveric donor kidneys. The adequacy of immunosuppression was evaluated by flow cytometric analysis for total, CD3+ (T-cell), and CD19+ (B-cell) lymphocytes. RESULTS: The acute rejection rate was 6% and 37/39 patients are alive with functioning grafts at an average follow-up of 14.5 months. The overall patient and graft survival rate was 95%. Their mean creatinine value was 1.27 mg/dL. Six patients (16%) required hospitalization due to serious infections. The two deaths were attributed to septicemia and brain abcess caused by unusual agents, namely, Rhodococcus equi and Sporobolomyces. One patient presented with a cutaneous Kaposi sarcoma in the 11th month posttransplant. CONCLUSION: A Two-day induction protocol with thymoglobulin yields acceptable acute rejection rates among renal transplants. However, caution is necessary for adverse events, particularly atypical bacterial and fungal infections.