This study aims to present our cadaveric and living related donor kidney transplantation experience.
Between September 2009 to February 2015, renal transplantations were performed to 417 patients in ...Medicana International Ankara Hospital organ transplantation center.
Of the patients, 231 were male, and 186 were female. Of the transplantations, 385 came from a living donor, and 32 came from a cadaver donor. The degree of kinship; 324 (77.7%) transplants were received from relatives, 5 (14.1%) with approval by the ethical committee, 32 (7.7%) from cadavers and two (0.5%) with cross-matching. Post-Operative Complications in recipients; lymphocele was found within the graft in two cases, urinary anastomosis leakage was detected in two cases, wound infection was detected in four cases, and hematoma in one case. We had no mortality in post operative or early follow up periods.
The morbidity and mortality rates in our organ transplantation center, regarding renal transplantations, are consistent with the literature.
Aim: In this study, we evaluated our method of using bipolar sealing and cutting of terminal ureter in donor nephrectomy and discussed its safety
and effectiveness.
Materials and Methods: A total of ...200 patients who underwent laparoscopic donor nephrectomy between August 2018 and August 2020 were
included in the study. All the surgeries were performed by the same surgeon with the same technique. Patient variables including age, gender, body
mass index, estimated blood loss, surgical times and postoperative drainage creatinine values were all recorded.
Results: On the first postoperative day, creatinine measurement was performed from drainage collection which was repeated on the second
postoperative day. After the second recording of creatinine level, the drain was taken out. In all of the patients, the values were all within ranges
of the blood creatinine levels, which was consistent with no urinary leak. We did not need to perform any further invasive test to check for a leak
like a cystography.
Conclusion: Our results demonstrate that the use of energy devices for sealing vessels can be used safely and effectively for sealing distal ureter.
The risk of fistula formation is a major concern after incision and drainage of an anorectal abscess.
Our objective was to the test the effects of antibiotic treatment on fistula formation after ...incision and drainage of anorectal abscesses.
Randomized, placebo-controlled, double-blind study.
Multicenter trial at 3 teaching hospitals in Turkey.
Patients who underwent abscess drainage between September 2005 and January 2008 were evaluated for eligibility. Exclusion criteria included penicillin allergy, antimicrobial agent usage before enrolment, other infection, previous anorectal surgery, inflammatory bowel disease, suspicion of Fournier gangrene, secondary and recurrent anorectal abscesses, anal fistula at time of the surgery, immune compromised states, and pregnancy.
Patients were randomly assigned to receive placebo or amoxicillin-clavulanic acid combination treatment for 10 days after abscess drainage.
The primary end point was rate of anorectal fistula formation at 1-year follow-up.
: Of 334 patients assessed for eligibility, 183 entered the study (placebo, 92; antibiotics, 91). Data were available for per-protocol analysis from 151 patients (placebo, 76; antibiotics, 75) with a mean age of 37.6 years; 118 patients (78.1%) were men. Overall, 45 patients (29.8%) developed anal fistulas during 1-year follow-up. Fistula formation occurred in 17 patients (22.4%) in the placebo group and in 28 patients (37.3%) in the antibiotic group (P = .044). Risk of fistula formation was increased in patients with ischiorectal abscess (odds ratio, 7.82) or intersphincteric abscess (odds ratio, 3.35) compared with perianal abscess.
Antibiotic treatment following the drainage of an anorectal abscess has no protective effect regarding risk of fistula formation.
Aim: Once daily extended-release tacrolimus (tac-ER) was introduced to support medication adherence in kidney transplant (KTx) recipients, with similar efficacy to immediate-release tacrolimus ...(tac-IR). However, most of the experiences regarding tac-ER efficacy were obtained from the switches from tac-IR to tac-ER in kidney transplant recipients (KTRs). In this study, we aimed to demonstrate 1-year outcomes of de novo use of tac-ER in KTRs.
Material and Method: This single-center retrospective study included 72 de novo KTRs between January 2020 and January 2021. KTRS were divided into two groups who received a tac-ER or tac-IR. 1-year allograft functions, allograft survival, daily doses of tacrolimus in milligram/day and milligram/kg/day, trough levels, and acute rejection episodes were compared between the two groups. The factors that might have an impact on allograft functions and acute rejection episodes also were investigated.
Results: A total of 69 de novo kidney allograft recipients (30 recipients in the tac-ER and 39 recipients in the tac-ER groups); were evaluated. Three KTRs were excluded due to the deaths within the early posttransplant period. Serum creatinine and tacrolimus trough levels were similar for 12 months after transplantation (p>0.05). More daily tacrolimus doses (in milligram/day and milligram/kg/day) were required to obtain a targeted trough level up to 3 months in the tac-ER group. Acute rejection rates also were found similar between the two groups (p=0.281). Univariate regression analysis demonstrated that higher total daily tacrolimus doses within a posttransplant month 1 may (milligram/kg/day) have an impact on lower acute rejection episode(s) independent of tacrolimus trough levels (p=0.02).
Conclusion: De novo use of extended-release tacrolimus Advagraf® is as effective as immediate-release tacrolimus in preventing acute rejection episode(s) and provides satisfactory 1-year allograft function and survival.
Amaç: Böbrek nakli alıcılarında günde tek doz uzamış salınımlı takrolimus (tac-ER) kullanımı, erken salınımlı takrolimus (tac-IR) kullanımına benzer etkinlik ve daha iyi ilaç uyumu sağlaması amacıyla geliştirilmiştir. Ancak uzamış salınımlı takrolimus ile ilgili deneyimler daha çok nakil sonrası dönemde yapılan “switch” protokollerine dayanmaktadır. Bu çalışmada böbrek alıcılarında de novo tac-ER kullanımı ile ilgili deneyimlerimizi ve 1 yıllık sonuçları sunmayı amaçladık.
Gereç ve Yöntem: Bu tek merkezli retrospektif çalışmaya Ocak 2022-Ocak 2021 arasında yapılan 72 de novo böbrek nakli hastası dahil edilmiştir. Hastalar tac-ER ve tac-IR alan iki gruba ayrıldı. Bir yıllık allogreft fonksiyonları ve sağ kalımları, hastaların günlük ilaç dozları ve bunların akut rejeksiyon atakları ile ilişkileri karşılaştırıldı. Allogreft fonksiyonları ve akut rejeksiyon atakları üzerine etki eden faktörler incelendi.
Bulgular: Toplam 69 hastanın (uzamış salınımlı grupta 30 hasta ve erken salınımlı grupta 39 hasta) verileri incelendi. Üç hasta posttransplant erken dönemde öldüğü için analize dahil edilmedi. Nakil sonrası 12 aylık izlem boyunca her iki grup arasında serum kreatinin ve takrolimus çukur değerler bencer bulundu (p>0,05). İlk 3 ay içinde hedef takrolimus değerlere ulaşmak için, tac-ER grubunda daha yüksek günlük dozlar (milligra/gün ve milligram/gün/kg) gerekti (p
Abstract
Although it rather became a routine procedure to evaluate and use a cadaveric horseshoe kidney, using one from a living donor is quite rare. In this paper, we present methods we used during ...such a case which may benefit the procedures in the future. A 29-year-old female patient was considered for transplant and only viable living donor was her 59-year-old mother. Dynamic computed tomography revealed horseshoe anomaly with one renal artery and one renal vein for each side, a long but thin isthmus connecting lower poles with no visible arterial supply. Descending urography showed no connecting caliceal system. Donor nephrectomy was performed and isthmus separation was carried out with vascular stapler. Recipient was discharged on the 6th day with no complications. Patient was followed up for 6 months with normal creatinine levels. When properly assessed before the surgery, using a horseshoe kidney is not so challenging as thought.
The aim of this prospectively designed study was to postoperatively assess the subjective complaints or relief of symptoms of achalasia patients' who underwent Laparoscopic Hellers' myotomy and ...partial fundoplication in our clinic.
40 patients were enrolled in the study that underwent Laparoscopic Hellers' myotomy and partial fundoplication (toupet or dor) for idiopathic achalasia in our clinic between years 2002 and 2012. Postoperative follow-up was conducted at 1st, 3rd. and 6th months in each patient for symptoms and a follow-up questionnaire was completed which is classified according to Vantrappen and Hellemans' modified classification.
34 patients underwent Laparoscopic Heller myotomy with Toupet fundoplication whereas 6 patients underwent Laparoscopic Heller myotomy with Dor fundoplication. After 3 months, 2 patients' complaints of dysphagia were detected (5%). In the 6 month follow-up, one of these two patient dysphagia symptoms got worsened and a balloon dilatation was performed (2.5%). In the other one no clinical reason was found for dysphagia and medical therapy was initiated. In the 6 th month only three patients (7.5%) were presented with gastroesophageal reflux which successful medical treatment was initiated.
Laparoscopic myotomy with fundoplication seems to be the most effective surgical technique that provides both short and long term symptomatic relief with released hospitalization time and less complication rate.
Purpose
Sodium-glucose co-transporter-2 inhibitor (SGLT-2i) administration is associated with some concerns in regard to the increased risk of genital and urinary tract infections (UTI) in kidney ...transplant recipients (KTR). In this study, we present the results of SGLT-2i use in KTR, including the early post-transplant period.
Methods
Participants were divided into two groups: SGLT-2i-free diabetic KTR (Group 1, n = 21) and diabetic KTR using SGLT-2i (Group 2, n = 36). Group 2 was further divided into two subgroups according to the posttransplant prescription day of SGLT-2i; < 3 months (Group 2a) and ≥ 3 months (Group 2b). Groups were compared for development of genital and urinary tract infections, glycated hemoglobin a1c (HgbA1c), estimated glomerular filtration rate (eGFR), proteinuria, weight change, and acute rejection rate during 12-month follow-up.
Results
Urinary tract infections prevalence was 21.1% and UTI-related hospitalization rate was 10.5% in our cohort. Prevalence of UTI and UTI-related hospitalization, eGFR, HgbA1c levels, and weight gain were similar between the SGLT-2i group and SGLT-2i-free group, at the 12-month follow-up. UTI prevalence was similar between groups 2a and 2b (p = 0.871). No case of genital infection was recorded. Significant proteinuria reduction was observed in Group 2 (p = 0.008). Acute rejection rate was higher in the SGLT-2i-free group (p = 0.040) and had an impact on 12-month follow-up eGFR (p = 0.003).
Conclusion
SGLT-2i in KTR is not associated with an increased risk of genital infection and UTI in diabetic KTR, even in the early posttransplant period. The use of SGLT-2i reduces proteinuria in KTR and has no adverse effects on allograft function at the 12-month follow-up
.
Recent advancements in surgical instruments, energy sources, vascular staplers, and increased experience altogether led to several modifications in the laparoscopic donor nephrectomy (LDN) technique. ...In the conventional approach, the renal artery and vein are divided separately by vascular stapling. This study aimed to evaluate the safety and feasibility of using single vascular stapling technique for dividing the renal artery and vein simultaneously.
Patients who underwent LDN performed by the same surgeon between January 2018 and January 2020 were included. Demographic data, body mass index, number of arteries and veins, vascular division technique, estimated blood loss, surgical time, warm ischemia time, surgical complications, and length of hospital stay were recorded. Descriptive statistics were used to describe the characteristics of the dataset.
A total of 196 donors were included in the cohort. The mean age was 44.5 years (19-80 years, standard deviation: 13.2). A total of 132 donors (82.65%) underwent left-sided LDN, and 34 (17.35%) underwent right-sided LDN. The mean surgical time and warm ischemia time were 68.4 ± 24.7 (32-116) and 2.8 ± 1.2 (1.6-4.0) minutes, respectively. Two cases were converted to open donor nephrectomy (1.02%). The single stapling technique was successfully performed in 168 (85.7%) donors with a single renal artery and vein.
Single stapling for the concurrent division of the renal artery and vein in the setting of LDN seems to be a safe and feasible approach. It also has the potential to shorten warm ischemia time and reduce the cost of LDN.
PDF
