Many studies suggest that 1,25-dihydroxyvitamin D3 (1,25-[OH](2) D3) and its analogues are potent dose-reducing drugs for other immunomodulators, helping to prevent graft rejection. In this study, we retrospectively grouped renal transplant recipients into two cohorts based on 1,25-[OH](2) D3 use to analyze the immunomodulatory effects. Ninety-two subjects were initially enrolled: group A (n = 43) recipients who had osteoporosis and were treated with 1,25-[OH](2) D3, and group B (n = 49) was a control group. We evaluated the effects on the number of acute rejection episodes, the immunosuppressive drug doses, serum calcium levels, and overall graft survival. Although before treatment the number of acute rejection episodes was statistically higher among group A than group B patients, after introduction of 1,25-[OH](2) D3, the difference became nonsignificant. This study showed that osteoporotic renal transplant recipients experienced fewer acute rejection episodes after 1,25-[OH](2) D3 treatment.

Adult↗

PubMed2003

Hepatocyte growth factor in hepatic allograft biopsies: an immunohistochemical study.

Hepatocyte growth factor (HGF) is a multipotent growth factor that is a powerful stimulator of DNA synthesis in a variety of cell types, especially hepatocytes. This factor is produced by nonparenchymal cells in the liver, presumably Kupffer cells, Ito cells, and sinusoidal endothelial cells. Research has shown that HGF is involved in tissue regeneration, wound healing, normal tissue growth, tumor progression, embryogenesis, and tumor invasion. Elevated serum levels of HGF have been documented in patients with acute renal failure and in renal transplant recipients; however, the importance of HGF in liver transplantation is unknown. The aim of this study was to determine whether induction of HGF expression is associated with acute rejection in liver transplants. We assessed the presence and density of HGF in hepatic allograft biopsy specimens compared with those from a control group of healthy patients.

Biopsy↗

PubMed2003

Treatment results in renal transplant recipients with non-Hodgkin's lymphoma.

The purpose of this study was to investigate the incidence of non-Hodgkin's lymphoma (NHL), response to treatment, and survival time in renal transplant recipients at our center who developed this form of neoplasia. Between October 1985 and August 2002, 1077 renal transplantations were carried out at our center. The incidence of NHL after transplantation was 1.1% (12/1077). All patients had their immunosuppressive doses reduced after they were diagnosed with NHL. Complete remission was achieved in eight cases, and five of these individuals were still alive at the time of writing. The circumstances for each of the three deaths in this group were as follows: (1) progressive gastric adenocarcinoma 9 years after being diagnosed with NHL, (2) stage III NHL cured with chemotherapy, but died of infection 2 years after NHL diagnosis, and (3) recurrent intestinal lymphoma, with death during second line chemotherapy. Of the five survivors in the remission group, one had to return to hemodialysis. The four patients who did not enter remission all died. The median time from transplantation to diagnosis of NHL was 66 months. At the time of writing, the median survival time for the eight patients who achieved complete remission was 41.5 months. The study showed that treatment of localized disease (skin or intestinal NHL) with surgery and/or radiotherapy/chemotherapy leads to complete remission and long survival times; however, patients in remission are at risk for other causes of death.

Adult↗

PubMed2003

Organ donation: a cross-sectional survey of the knowledge and personal views of Turkish health care professionals.

Health care professionals (HCPs) represent a key element in the cadaveric organ donation process. This cross-sectional survey assessed HCPs' knowledge, attitudes, and behavior related to cadaveric organ donation and transplantation. One thousand one hundred eighty-four HCPs were randomly selected from various units of five health care institutions located in three major Turkish cities. Each individual completed a questionnaire. The ages ranged between 18 and 63 years. By examining the tendency to organ procurement, 78.6% of the physicians and 69.5% of the nurses stated that establishing brain death during ventilator support is the optimum condition. The results indicated good overall knowledge of the criteria for brain death. Physicians displayed significantly better understanding of the criteria for brain death and optimal conditions for organ procurement. While physicians have significantly better knowledge about kidney transplantation, there was no difference for liver transplantation. Compared to nurses, doctors had significantly better knowledge of which organs can be used in the current transplantation process. Although 44.2% claimed they were willing to donate their organs, only 17.9% actually carried a legal donation card. The rate of willingness to donate was significantly higher among doctors than nurses. Physicians have significantly better knowledge about legal aspects of organ donation and transplantation. Overall, the survey revealed that lack of knowledge has a negative impact on people's attitudes toward organ donation even among health care professionals. Improvements must be made to develop a nationwide Donor Hospital Education Program that will provide training concerning transplantation and organ donation.

Brain Death↗

PubMed2003

Results of cataract surgery in renal transplantation patients.

PURPOSE: To evaluate the results of conventional extracapsular cataract extraction and phacoemulsification cataract surgery, in renal transplant patients. METHODS: A total of 11 eyes of eight renal transplant recipients who underwent cataract surgery in Ankara between 1995 and January 2001 were evaluated. Each individual underwent routine ophthalmologic examination including visual acuity with Snellen chart testing, slit-lamp examination, intraocular pressure measurement, and fundus examination. Of these, seven patients had posterior subcapsular cataracts and four had nuclear cataracts. Conventional extracapsular cataract extraction (cECCE) was performed in four eyes with single-piece all-polymethylmethacrylate posterior chamber intraocular lens implantation. The other seven eyes were treated with small-incision phacoemulsification and implantation of a foldable hydrophilic acrylic lens. RESULTS: We observed intraoperative posterior capsule rupture and vitreous loss in one patient, postoperative intraocular tension elevation in one patient, and sterile suture infiltration in one patient in our series. Average of the visual acuities 6 months after the operation was 20/30 (range, 20/60-20/20). CONCLUSIONS: In this, the first published report to describe outcomes of cataract surgery in renal transplant patients, most complications were associated with high of steroids use and immunosuppressives, and were independent of the type of cataract surgery used, either ECCE or phacoemulsification surgery. The study suggests the need for additional care before, during, and after operation.

Adult↗