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    Analysis of vascular complications requiring surgical intervention after kidney transplantation
    (2016) Tuğmen, Cem; Sert, İsmail; Doğan, Sait Murat; Kebapçı, Eyüp; Çolak, Hülya; Ersan, Sibel; Ölmez, Mustafa; Karaca, Cezmi
    Öz: Böbrek nakli sonrası görülen vasküler komplikasyonların, hasta ve greft prognozu üzerine olumsuz etkisi olabilmektedir. Bu çalışmanın amacı böbrek nakli sonrası, cerrahi müdahale gerektiren ciddi vasküler komplikasyonları analiz etmektir.Yöntem: Kadavradan ve canlı böbrek nakli yapılmış 462 hastadan vasküler komplikasyonlar nedeniyle reoperasyon geçirenlerin verileri retrospektif olarak incelendi. Grade 3b ve 4 Vasküler komplikasyon nedeniyle re-operasyon geçiren 13 hastanın verileri analiz edildi.Bulgular: On beş vasküler komplikasyon nedeniyle 13 (2.8%) hastaya re-operayon yapıldı. Ortanca vasküler komplikasyonların görülme zamanı 12±19 gün olarak saptandı (min: 1, maksimum: 72 gün). Reoperasyonların nedenleri; hematom, renal ven trombozu, arter anostomozunda ayrılma, arterial katlanma, enfekte hematom, renal arter trombozu olarak bulundu. Greft nefrektomi, kontrol edilemeyen vasküler komplikasyon nedeniyle 5 hastaya (%38.5) yapıldı. Birinci yıl hasta ve greft sağ kalımı sırasıyla; %90.9 ve %61.5 iken ikici yıl hasta ve greft sağ kalımı sırasıyla; %90.9 ve % 46.2 olarak saptandı. Sonuç: Böbrek nakli sonrası vasküler komplikasyonlar oranları, böbrek naklinin güvenli ve uygulanabilir olduğunu göstermektedir. Böbrek nakli sonrası gelişen ve cerrahi müdahale gerktiren vasküler komplikasyonlar gelişen hastalarda greft sağ kalımı kabul edilebilir seviyelerdedir
  • Küçük Resim
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    Classical Maple Syrup Urine Disease successfully treatedwith living donor liver transplantation
    (2021) Doğan, Güleç Mert; Doğan, Sait Murat; Okut, Gokalp; Sığırcı, Ahmet; Yılmaz, Sezai
    Maple syrup urine disease (MSUD) is a disease that causes ketoacid accumulation in body. Diffusion-weighted imaging (DWI) is animportant imaging modality for the diagnosis. Two children were diagnosed with MSUD at the neonatal period. They had uncontrolledketosis and epileptic seizures although they were in compliance with their medical nutrition. Their DWIs were similar and showedhigh signal intensity localized within the myelinated white matter areas. Both of the patients were treated with living donor livertransplantation. The patients with classic form of MSUD are normal at birth. If the disease is not diagnosed and treated early, it canlead to serious neurological complications. Most researchers conclude that, the best choice for detecting MSUD encephalopathyin newborns is DWI. The traditional treatment of MSUD had been a protein-restricted diet until the liver transplantation became analternative and better option for the cure of the patients..
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    Donor Characteristics of Intestinal Graft in Turkey
    (2020) Sert, İsmai?L; Tuğmen, Cem; Baran, Maşallah; Doğan, Sait Murat; Avcı, Emran Kuzey; Kebabçı, Eyüp
    Abstract: Objective: Intestinal transplantation is a challenging procedure and many factors effect the success of the intestinal transplantation. One of the important point is selection of the suitable donor. The characteristics of suitable donor for intestinal graft have not well defined yet. The purpose of the present study is to analysis the characteristics of intestinal graft in Turkey and discuss the results with those reported in the the literature. Method: We retrospectively analyzed the donor characteristics (age, weight, cause of death, blood type, creatinine level, serum Na, etc.) of intestinal graft in Turkey. Also medical records of recipients like; age, weight, waiting time on the list, etc. were analyzed. The results were presented by percentages and numbers. Results: Forty-two patients with intestinal failure were registered for intestinal transplantation since 2003. Thirtytwo patients underwent intestinal transplantation. Five patients on waiting list died. The present study includes full data of 24 intestinal grafts and intestinal transplant recipients. Only14 (58.3%) donors met The Organ Procurement and Transplantation Network (OPTN) criteria for intestinal transplantation. Sixteen (%66) donors were male. Median donor age and weight were 29 years and 75 kg, respectively. Median stay of the donor at Intensive care unit (ICU) was 3 days. Median donor/recipient body weight ratio was 1,41 (min: 0,84,max: 8,00). Ideal weight match was obtained for only 5 (20.8%) transplantations (1,1-0,76). Conclusion: Intestinal transplantations are being performed in Turkey. Due to donor shortage, ideal donors are not available for use in Turkey. For pediatric donors, reduced size intestinal grafts might be used, but unfortunately recipient-donor weight match is still the most essential problem for improvement of intestinal transplantation procedures.
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    Extraction of kidney via suprapubic or inguinal incision in total laparoscopic donor nephrectomy
    (2019) Sümer, Fatih; Gündoğan, Ersin; Altunkaya, Neslihan; Aydın, Mehmet Can; Usta, Sertaç; Doğan, Sait Murat; Pişkin, Turgut; Kayaalp, Cüneyt
    Abstract: Introduction: The objective of this study was to investigate the results of the fist 48 patients who underwent total laparoscopic transperitoneal donor nephrectomy at a single institution and to present the impact of the kidney extraction site on ischemia time. Materials and Methods: The study included patients who underwent kidney donor surgery between February 2017 and December 2018. Evaluation of the kidney transplantation candidates was performed by the kidney transplantation council. A total of 4 trocars were used for a right-side nephrectomy, and 3 trocars were used for a left-side nephrectomy. The kidneys were extracted through a suprapubic incision in the fist 18 cases and through the inguinal region in the last 30 cases. A comparison was made of the demographic characteristics and the intraoperative and postoperative results of the 2 groups. Results: Of the study patients, 30 were female and 18 were male, with a mean age of 48.0±9.6 years (range: 30–71 years). All of the patients underwent a total laparoscopic transperitoneal donor nephrectomy. Four patients underwent a right-side nephrectomy and 44 underwent a left-side nephrectomy. There was no case of conversion to open surgery. The mean operative time was 251.4±72.4 minutes (range: 127–420 minutes). In the fist 18 cases, the organ was extracted through a suprapubic incision and the ischemia time was 318±140 seconds (range: 150–720 seconds). In the last 30 cases, the organ was extracted through an inguinal incision and the mean ischemia time was 151.5±55.1 seconds (range: 80–265 seconds). The mean length of hospital stay was 5.4±1.1 days (range: 3-10 days). Conclusion: The application of minimally invasive surgery in healthy individuals undergoing donor nephrectomy leads to better physical, psychological, and social outcomes. Surgical experience and the choice of extraction site can shorten the warm ischemia time signifiantly. Extraction through the inguinal region is recommended, as it provides for a faster removal and shortens the warm ischemia time. Laparoscopic donor nephrectomy can be used safely in centers with experience performing advanced laparoscopy
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    Is peritoneal dialysis prior to kidney transplantation a risk factor for ureteral stenosis after adult to adult live kidney transplantation
    (2020) Kutlutürk, Koray; Şahin, Tevfik Tolga; Çimen, Serhan; Dalda, Yasin; Gönültaş, Fatih; Doğan, Sait Murat; Toplu, Sibel; Ünal, Bülent; Pişkin, Turgut
    Abstract: Objective: Major urinary complications such as urinary leaks, stenosis or urinary tract infections after kidney transplantation can lead to graft or patient loss. The effect of peritoneal dialysis on post-kidney transplantation complications have been discussed but its effect on ureteral stenosis is unknown. In this study, it was aimed to analyze factors effecting major ureteral complications after living donor kidney transplantation and impact of peritoneal dialysis and double J-stents (JJ stents). Material and Methods: This study included 116 adult to adult living donor kidney transplant patients. Factors effecting major urologic complications after living donor kidney transplantation were analyzed. The donors were primary relatives of the recipients. Results: Major urologic complications after living donor kidney transplantation was 8/116 (6.9%). Urinary leak was present in 2 (1.7%) patients. Ureteral stenosis was encountered in 6 (5.2%) patients. Double J stents were used in 84 (72.4%) of the cases. The effect of JJ ureteral stent was not statistically significant for urinary leak, ureteral stenosis (p= 0.074, p= 0.470, respectively). A total of 29 (25%) patients had peritoneal dialysis before kidney transplantation. Preoperative peritoneal dialyses and bacteriuria after kidney transplantation were independent risk factors for ureteral stenosis in multivariate analysis (p= 0.013, and p= 0.010 respectively). Conclusion: In the guidance of the results of the present study, peritoneal dialysis prior to kidney transplantation and bacteriuria are independent risk factors for ureteral stenosis after living donor kidney transplantation. JJ stents have no effect on urologic complications after living donor kidney transplantation.
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    Pediatric renal transplantation; 10 years experience
    (2021) Okut, Gokalp; Dogan, Gulec Mert; Doğan, Sait Murat
    Objective: Although renal transplantation (RT) is the first treatment option for children with end-stage renal failure, the number of transplanted children remains low compared to adults. Experience of the individual pediatric transplant center is very important in the prognosis of pediatric transplant recipients. In this study, our pediatric RT experience was presented. Material and Methods: We retrospectively analyzed the data of 27 patients who had RT in our clinic between April 2009 and April 2019. Results: Fifteen of the patients were males, and mean age of all patients was 12.36 ± 4.18 years (range 4-17 years). The most frequent etiology for endstage renal disease (ESRD) was vesicourethral reflux. Eighteen (66.7%) of the transplanted kidneys came from cadaveric donors and 9 (33.3%) from live donors. One patient had preemptive RT and one patient had a re-RT. Twenty-two patients were on peritoneal dialysis program and four patients were on hemodialysis program. Mean dialysis time before transplantation was 29 (3-104) months. Bleeding was the most common surgical complication. Delayed graft function developed in four patients, and all of their grafts were from cadaveric donors. Rejection developed in 12 of our patients, graft loss was observed in only four of them. Considering all patients, graft survival rates were 100% in the 1st and 3rd years, and 92% in the 5th year. Conclusion: Pediatric RT program is difficult to establish, maintain and develop. Complications after transplantation are not uncommon; therefore, early detection and appropriate management are needed. Strategies are still needed to increase post-transplant success.