Huseyin Kocak

Preliminary results of the first human uterus transplantation from a multiorgan donor

OBJECTIVE To describe the first-year results of the first human uterus transplantation case from a multiorgan donor. DESIGN Case study. SETTING University hospital. PATIENT(S) A 21-year-old woman with complete müllerian agenesis who had been previously operated on for vaginal reconstruction. INTERVENTION(S) Uterus transplantation procedure consisting of orthotopic replacement and fixation of the retrieved uterus, revascularization, end to site anastomoses of bilateral hypogastric arteries and veins to bilateral external iliac arteries and veins was performed. MAIN OUTCOME MEASURE(S) Resumption of menstrual cycles. RESULT(S) The patient had menarche 20 days after transplant surgery. She has had 12 menstrual cycles since the operation. CONCLUSION(S) We have described the longest-lived transplanted human uterus to date with acquirement of menstrual cycles.

Clinical pregnancy after uterus transplantation

OBJECTIVE To present the first clinical pregnancy after uterus transplantation. DESIGN Case study. SETTING Tertiary center. PATIENT(S) A 23-year-old Mayer-Rokitansky-Kuster-Hauser syndrome patient with previous vaginal reconstruction and uterus transplantation. INTERVENTION(S) Eighteen months after the transplant, the endometrium was prepared for transfer of the thawed embryos. MAIN OUTCOME MEASURE(S) Implantation of embryo in an allografted human uterus. RESULT(S) The first ET cycle with one day 3 thawed embryo resulted in a biochemical pregnancy. The second ET cycle resulted in a clinical pregnancy confirmed with transvaginal ultrasound visualization of an intrauterine gestational sac with decidualization. CONCLUSION(S) We have presented the first clinical pregnancy in a patient with absolute uterine infertility after uterus allotransplantation. Although the real success is the delivery of a healthy near-term baby, this clinical pregnancy is a great step forward and a proof of concept that the implantation phase works.

Early and late urological complications corrected surgically following renal transplantation

The purpose of this study was to assess outcomes of urological complications after kidney transplantation operation. Nine‐hundred and sixty‐five patients received a kidney transplant between 2000 and 2006. In total, 58 (6.01%) developed urological complications, including urinary leakage (n = 15, 1.55%), stenosis (n = 29, 3%), vesicoureteral reflux (VUR) (n = 12, 1.2%), calculi (n = 1, 0.1%) and parenchymal fistulae (n = 1, 0.1%). Urinary leakage cases were treated by ureteroneocystostomy (UNS) via a double‐J stent and stenosis cases by UNS. Fenestration was performed in patients developing lymphoceles and unresponsive to percutaneous drainage. VUR treatment was performed by ureteroneocystostomy revision or UNS. Stent usage during ureteric reimplantation was observed to reduce urinary leakage. Surgical complication rates in renal transplantation recipients according to donor type (living versus cadaveric) and the status of stent use (with stent versus without stent) were 5.53% vs. 7.27% (P = 0.064) and 5.24% vs. 20% (P < 0.01) respectively. No recurrence, graft loss or death was seen after these interventions. Comparison of recipients with and without urological complication showed that there was no difference between groups (P > 0.05) with respect to last creatinine level. No graft or patient loss was associated with urological complications. Urological complications that can be surgically corrected should be aggressively treated by experienced surgeons and graft loss avoided.

Advanced oxidative protein products are independently associated with endothelial function in peritoneal dialysis patients

Aim:  Oxidative stress (OS) and asymmetric dimethylarginine (ADMA) are accepted as non‐classical cardiovascular risk factors in end‐stage renal disease patients. To clarify the role of these factors in the atherosclerotic process, we investigated if OS and ADMA are associated with endothelial function (EF) in peritoneal dialysis (PD) patients.

Oxidative Stress and Asymmetric Dimethylarginine Is Independently Associated with Carotid Intima Media Thickness in Peritoneal Dialysis Patients

Backgrounds: Oxidative stress (OS) and asymmetric dimethylarginine (ADMA) are accepted as nonclassical cardiovascular risk factors in end-stage renal disease patients. To clarify the role of these factors in the atherosclerotic process, we investigated if OS and ADMA are associated with common carotid artery intima media thickness (CIMT) in peritoneal dialysis (PD) patients. Methods: Thirty PD patients without known atherosclerotic disease and classical cardiovascular risk factors as well as age- and gender-matched 30 healthy individuals were included. We measured serum thiobarbituric acid-reactive substances (TBARS), malondialdehyde (MDA), advanced glycation end product (AGE), pentosidine, advanced oxidation protein products (AOPP), ADMA and CIMT in each subjects. Results: TBARS, MDA, AOPP, AGE, pentosidine and ADMA levels were significantly higher in PD patients than in controls (p < 0.001). CIMT in patients was higher than in the control group (0.83 ± 0.09 vs. 0.77 ± 0.06 mm; p < 0.01). CIMT was independently correlated with TBARS (β = 0.33, p < 0.01), MDA (β = 0.27, p < 0.01), AOPP (β = 0.22, p < 0.02), AGE (β = 0.45, p < 0.01), pentosidine (β = 0.56, p < 0.01) and ADMA (β = 0.54, p < 0.01). Conclusions: OS markers and serum ADMA levels independently predict the CIMT level in PD patients.

Levels of asymmetric dimethylarginine, nitric oxide and lipid peroxidation markers in patients with end-stage renal disease having peritoneal dialysis treatment

OBJECTIVES In this study, we aimed to investigate the activities of paraoxonase-1 (PON1) and nitric oxide synthase (NOS) and the levels of asymmetric dimethylarginine (ADMA), nitric oxide (NO), oxidized low-density lipoprotein (oxLDL), ceruloplasmin (CP), thiobarbituric acid-reactive substances (TBARS), malondialdehyde (MDA), 4-hydroxynonenal (HNE) and lipids in serum of patients with end-stage renal disease (ESRD) having continuous ambulatory peritoneal dialysis (CAPD) treatment and controls living in the Antalya region, Turkey. DESIGN AND METHODS Fifty-three patients with ESRD were enrolled in this study and were treated by CAPD. As the control group (n=32), subjects with normal renal function were included. RESULTS Serum PON1 activity and high-density lipoprotein-cholesterol (HDL-C) levels were decreased in ESRD patients whereas ADMA, NO, oxLDL, CP, TBARS, MDA and HNE levels and NOS activity were increased with regard to control group. In CAPD patients, ADMA positively correlated with NO, CP, oxLDL, TBARS and MDA levels whereas negatively correlated with PON1 activity. On multiple logistic regression analysis, risk factors associated with ESRD included CP, TBARS, triglycerides (TG) and very low-density lipoprotein-cholesterol (VLDL-C) levels. CONCLUSIONS Our data have demonstrated that ESRD patients on CAPD treatment exhibit increased lipid peroxidation reactions and decreased antioxidant protection. The assay of serum HNE and MDA may be useful to evaluate the individual accumulation of these toxic aldehydes to test the efficiency of new dialysis strategies in removing them.

Surgical correction of vesico-ureteric reflux for recurrent febrile urinary tract infections after kidney transplantation.

To evaluate the outcome of anti‐reflux revision surgery in patients diagnosed with at least a grade 3 reflux at voiding cysto‐urethrography in patients with recurrent urinary tract infection (UTI) after renal transplantation.

Protective effect of the vasopressin agonist terlipressin in a rat model of contrast-induced nephropathy.

Background/Aims: Contrast-induced nephropathy (CIN) remains a leading cause of iatrogenic acute renal failure. Terlipressin, a long-acting analog of vasopressin, may improve renal function. This study aimed to investigate the possible protective effect of terlipressin against the development of experimental CIN in rats. Methods: Wistar albino rats (n = 32) were allocated randomly into four equal groups of 8 each, i.e. control, terlipressin, contrast media (CM), and terlipressin plus contrast media (TCM). CIN was induced by intravenous administration of indomethacin (10 mg/kg), N-nitro L-arginine methyl ester (L-NAME, 10 mg/kg, twice at 15 and 30 min), and high-osmolar contrast media meglumine amidotrizoate 60%. Renal function parameters, kidney histology, and tubular expression of vascular endothelial growth factor (VEGF) were determined. Results: Mean serum creatinine levels were decreased (p < 0.05) and creatinine clearance (p < 0.05) increased in the TCM group compared with the CM group. Notably, rats in the TCM group displayed less tubular necrosis (p < 0.05), medullary congestion (p < 0.05), and a reduced tubular expression of VEGF (p < 0.05) compared with the CM group. Conclusion: These results demonstrate that terlipressin can inhibit the development of CIN.

Pancreas survival in simultaneous pancreas-kidney and pancreas-after-kidney transplantations: A five-year follow-up report

BACKGROUND Pancreas transplantation methods, such as simultaneous pancreas-kidney (SPK) transplantation and pancreas-after-kidney (PAK) transplantation, have become the most important treatments for patients with type-1 diabetes mellitus (DM)-related end-stage renal diseases (ESRD). The purpose of the study was to compare the clinical results of the pancreas graft in patients after SPK and PAK transplantations and to present the findings of our 5-year follow-up. MATERIAL/METHOD A total of 55 patients who had kidney and pancreas transplantation between February 2003 and December 2010 were included in the study. The patients were divided into 2 groups based on the timing of the pancreas transplantation: SPK (n=21) and PAK (n=34). RESULT The patients in the SPK group consisted of 13 males and 8 females, with a mean age of 33.6±6.8 years; whereas 25 males and 9 females formed the PAK group, with a mean age of 32.0±6.0 years. In the early postoperative period, the SPK group had 3 patients with vascular thrombosis (2 venous, 1 arterial) and the PAK group had 7 patients with thrombosis (4 venous, 3 arterial) (p=0.319). At the end of the 5-year follow-up, the patient, kidney and pancreas survival rates in the SPK group were 95.2%, 95.2%, and 61.9% respectively, and the corresponding values in the PAK group were 97%, 91.2%, 61.8% (p=0.382, p=0.504, p=0.927). CONCLUSIONS We concluded that PAK is just as effective as SPK to prevent the destructive effects of DM when the waiting time for SPK is long and a potential live donor is present.

The association of advanced glycation end-products with glutathione status

Abstract Background The aim of this study was to investigate oxidative stress with regard to the concentrations of advanced oxidation protein products (AOPP), advanced glycation end-products (AGEs), pentosidine, glycated albumin, reduced glutathione (GSH) and oxidized glutathione (GSSG), glutathione redox ratios and thiobarbituric acid-reactive substances (TBARS) in non-diabetic patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods The study group consisted of 52 non-diabetic CAPD patients and 34 healthy controls. AOPP, AGEs, pentosidine and glycated albumin were measured in plasma, whereas GSH, GSSG and TBARS concentrations were measured in erythrocytes of both patients and controls. Results All parameters were found to be significantly increased, except the glutathione redox ratio, which was found to be decreased in patients undergoing CAPD. Multiple regression analysis showed that AGEs were the only independent predictor of glutathione redox ratio, whereas AGEs, glycated albumin and TBARS were each found to be independent predictors of albumin concentration. Conclusion Our results support the hypothesis that oxidative stress and AOPPs/AGEs constitute important risk factors in CAPD patients. The negative relationship between albumin and both AGEs and TBARS suggests that the decrease in albumin may contribute to the increased advanced glycation and lipid peroxidation. The negative relationship between glutathione redox ratio and AGEs suggests that late products of glycation play an important role in the development of oxidative stress observed in patients undergoing peritoneal dialysis treatment.