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Biomedical subjects

H Karakayali

Publications and source records attributed to H Karakayali.

At least 127 records · Page 7Linked to original sources
PubMed1998

Delayed graft function: predictive factors and impact on outcome in living-related kidney transplantations.

The aim of this study was to determine the incidence and possible causes of delayed graft function (DGF) and its impact on outcome in living-related kidney transplantations. We analyzed 158 consecutive living-related kidney transplant recipients. DGF is described as the failure of serum creatinine to fall below pretransplant levels within 1 week of the operation, regardless of urine output. Of the 158 patients studied, 14 (8.8%) fit this criterion. Donor and recipient factors such as age, gender, body weight, recipient/donor weight ratio, HLA match, cyclosporine level, blood group, and anastomosis time of patients with DGF were compared to those of patients without DGF. Apart from donor gender, body weight, and recipient/donor body weight ratio, these parameters were similar in the two groups. In the DGF group the majority of the donors were female (11/14), whereas this was not the case in the controls (64/144; p < 0.02). Mean donor weight in patients experiencing DGF (59.6 +/- 9.2 kg) was significantly lower than in those without DGF (67.8 +/- 10.4 kg; p < 0.05). The mean recipient/donor weight ratio for the DGF group (1.26) was significantly higher than that of the control group (1.03, p < 0.02). The 5-year graft survival rates for patients with and without DGF were 74% and 77%, respectively (NS). On the other hand, the 5-year graft survival rate for patients with DGF complicated by an acute rejection episode (n = 6, 61%) was significantly lower than that of control group patients who experienced acute rejection (n = 43, 74%; p < 0.02). These results indicate that female donor gender and higher recipient/donor weight ratio are major predictive factors in the development of DGF following living-related kidney transplantation. Although DGF alone did not affect the outcome, long-term graft survival was significantly reduced when DGF was associated with acute rejection episodes.

Adult↗
PubMed1998

Long-term follow-up of 102 living kidney donors.

This study evaluated 102 randomly selected living-related kidney donors who were operated between November 1975 and December 1996 after a mean follow-up period of 10.2 years (range 8 months to 22 years). The donor male:female ratio was 45:57, and mean age was 41.0 years (range 21 to 65 years). The average preoperative and last follow-up blood creatinine levels were 73.37 micromol/l (range 44.2-106.8 micromol/l) and 78.67 micromol/l (range 8.84-318.2 micromol/l), respectively (p:NS), and the corresponding average creatinine clearance values were 108.4 ml/min (range 100-130 ml/min) and 96.8 ml/min (range 27 to 125 ml/min) (p: NS). Four donors had 24-hour urine protein excretion above 0.1 gram (2 G, 0.7 G, 0.2 G, and 0.14 G, specifically). The donors' mean systolic blood pressures before, and after the operation on the last follow-up were 131.7 +/- 21.2 mmHg and 139.6 +/- 20.9 mmHg, respectively (p:NS). Nine donors (8.8%) developed hypertension which required anti-hypertensive treatment. The mean age of the hypertensive group was 48.0 years (range 30 to 65 years), whereas that for the nonhypertensive group was 39.4 years (range 18 to 76 years) (p <0.02). Only one donor (0.9%), a 41 year-old female, was diagnosed with chronic renal disease related to pyelonephritis. These results support the utilization of living donors for kidney transplantation, an option which helps broaden a limited donor pool.

Adolescent↗
PubMed1997

Comparison of Neoral and Sandimmun for induction and maintenance immunosuppression after kidney transplantation.

We compared the mean trough level/dose (L/D) ratio, mean coefficient of variation (CV) of individual patients, and graft, patient, and rejection-free survival rates of 40 renal transplant recipients receiving Neoral (CyE) with 103 consecutive renal transplant recipients receiving Sandimmun (CyA). The mean L/D ratio on the 3rd post-transplant day (16.2 vs 11.8, P < 0.04), in the 1st week (24.6 vs 16.1; P < 0.03), and 1st month (39.1 vs 28.7; P < 0.05) were higher in the CyE group. In both groups the L/D ratio improved in proportion to the duration of time post-transplant and reached a maximum in the 3rd post-transplant month. In the early post-transplant period in particular, the number of patients achieving target levels was significantly higher, and the mean dose needed to achieve target levels lower, in the CyE group. The variation in trough levels, demonstrated by the CV, was lower in the CyE group (0.41 +/- 0.14) than in the CyA group (0.62 +/- 0.21; P < 0.005). Actuarial 1-year patient and graft survival rates in the CyE group were 100% and 96%, respectively; these were similar to the 100% and 95% in the CyA group. The 1-year rejection-free survival rate in the CyE group was 61% compared to 43% in the CyA group (P < 0.02). We conclude that it is possible to obtain higher blood trough levels at lower doses by administering CyE, particularly in the early post-transplant period. The lower variability of trough levels and the higher L/D ratio in the CyE group, which are related ti improved bioavailability of CyE, may explain the lower rejection rate among these patients. In this study, the microemulsion formulation of cyclosporin (CyE) was found to be more beneficial and cost-effective as induction and maintenance immunosuppression than the conventional formulation (CyA).

Azathioprine↗
PubMed1997

Primary extramedullary plasmacytoma of the liver.

Extramedullary plasmacytoma of the liver is a rare tumour, only two cases of which have been reported so far. A third case arising in a 22 year old woman, who presented with abdominal pain and enlargement of the liver, is described. Ultrasound and a computed tomography scan showed a solitary hepatic mass, 12 cm diameter, involving both lobes of the liver. Serum immunoelectrophoresis revealed an IgG kappa monoclonal gammopathy. Histologically, the tumour was composed of mature plasma cells with mild atypia. The plasma cells infiltrated the liver parenchyma and showed kappa light chain restriction. The monoclonal nature of the tumour was also demonstrated by PCR amplification of the immunoglobulin heavy chain genes. There was no evidence of bone involvement and repeated bone marrow aspirates and biopsy specimens were normal. The patient was treated with eight courses of chemotherapy. One year after diagnosis, the patient is well, the size of the tumour has decreased and the paraproteinaemia has disappeared.

Adult↗