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Bir Üniversite Hastanesinde Üç Yıllık Böbrek Nakli Deneyimi

Three Years of Kidney Transplantation Experience at a University Hospital

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Abstract (2. Language): 
PURPOSE: Kidney transplantation is the preferred therapy for end-stage renal failure patients due to its advantages of improving survival and life quality. The aim of this study was to present the clinical and laboratory data of patients who were transplanted between October 2005 and December 2009 in our reformed kidney transplantation program. METHODS: Seventy-nine patients (45 males, 34 females, mean age:32.4±10.9 years), received a kidney transplant during this period. The duration of renal replacement therapy was 34.7±40.3 months and 12 of the recipients were preemptive. Mean donor (35 males, 44 females) age was 41.2±14.5 years with a HLA-mismatch of 3.2±1.4. RESULTS: The duration of follow-up was 19±11.6 months. Fifteen patients received a kidney from nine cadaveric donors, in which seven of them were donated in the last 12 months. Sixty-four patients received kidneys from living donors (40 laparoscopic, 24 open donor nephrectomies). Mean cold ischemia time for cadaveric donors was 686±289.6 minutes. Graft nephrectomies were performed for vascular problems in two patients; one of them developed primary nonfunction and the other one had received an en-bloc kidney transplant from a cadaveric donor. One patient was lost in the early posttransplant period. Serum creatinine levels were 1.24±0.55 and 1.23±0.47 mg/dl in the remaining 76 functioning allografts at the first and twelfth months respectively. A double-J catheter was placed for every patient with a removal time of 21.7±5.7days. Ten patients developed acute rejection episodes, eight were biopsy proven and nine patients were treated with good response for antirejection therapy. Four lmyphoceles, two venous thrombosis, two arterial thrombosis, one arterial stenosis, one urinary leak, one ureteral stricture, two hematomas and six wound infections were observed during the posttransplant period. CONCLUSION: The first, second and third years of patient survival rates were all 99% while graft survival rates were 96% for each of the first three years. Besides these encouraging results, a remarkable increase in the number of cadaveric donations in the last 12 months implies the success of our program. A preemptive transplantation rate of 15% also seems promising.
Abstract (Original Language): 
AMAÇ: Son dönem böbrek yetmezliğinin tedavisinde böbrek nakli, hem sağkalım avantajı hem de yaşam kalitesini artırması nedeniyle artan sıklıkta tercih edilen yöntemdir. Bu çalışmanın amacı, 2005 yılı Ekim ayında Üniversitemiz Böbrek Nakli Merkezi’nde başlatılan böbrek nakli programında Ocak 2009’a kadar nakil yapılan hastaların klinik ve laboratuvar izlemlerini sunmaktır. YÖNTEM ve GEREÇLER: Ortalama yaşı 32,4±10,9 yıl olan 79 hastaya (45 erkek, 34 kadın) böbrek nakli yapıldı. Hastaların renal replasman tedavi süresi ortalama 34,7±40,3 aydı. Hastaların 12’si preemptif dönemdeydi. Vericilerin (35 erkek, 44 kadın) yaş ortalamaları 41,2±14,5 yıldı. Alıcı ve verici HLA uyumsuzluğu ortalama olarak 3,2±1,4 idi. BULGULAR: Posttransplant izlem süresi ortalama 19±11,6 aydı. Hastalardan 15’ine 9 adet kadavradan nakil yapıldı, bu kadavraların yedi tanesi son 12 ay içinde bağışlandı. Altmış dört hastaya canlıdan böbrek nakli yapıldı. Canlı vericilerin 40’ına laparoskopik, 24’üne açık donör nefrektomi uygulandı. Soğuk iskemi süresi kadavra vericili nakillerde ortalama 686±289,6 dk idi. Fonksiyone greftli 76 hastanın serum kreatinin ortalamaları 1. ayda 1,24±0,55 mg/dl, 12. ayda 1,23±0,47 mg/dl bulundu. Her alıcıya standart olarak 12 cm 4.8F double-J kateter yerlestirildi, ortalama 21,7±5,7 günde çekildi. On hastada, sekizinde biyopsi ile kanıtlanmış, akut rejeksiyon izlendi ve dokuzu antirejeksiyon tedaviye yanıt verdi. Posttransplant dönemde lenfosel dört, venöz tromboz iki, arteryel tromboz iki, arteryel stenoz bir, üriner kaçak bir,üreter darlığı bir, hematom iki, yara enfeksiyonu altı hastada gözlendi. Primer işlevsizlik gelişen bir hastaya ve pediatrik kadavra donörden ‘en-bloc’ böbrek nakli yapılan başka bir hastaya, vasküler problemler nedeniyle greft nefrektomi yapıldı. Bir olgu ise erken dönemde kaybedildi. SONUÇ: Hastalarımızın ilk üç yıllık sağkalım oranları her yıl için %99 iken, greft sağkalımları aynı dönemler için %96 olarak hesaplanmıştır. Bunların yanında, son bir yıl içinde kadavra bağış oranının artması programın başarılı olduğunu göstermektedir. Ayrıca preemptif nakillerin oranının % 15 olması da sevindiricidir.

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