Sibel Gulcicek

Assessment of Anemia and Quality of Life in Patients With Renal Transplantation

PURPOSE Anemia is associated with poor quality of life in dialysis patients. However, data on this association are scarce on transplant patients. We aimed to find the frequency of anemia, and the effect of anemia on the quality-of-life parameters in patients who have undergone kidney transplantation. METHODS Anemia was defined by a hemoglobin (Hgb) level of <12 g/dL and severe anemia by a Hgb level of <10 g/dL. All patients were evaluated with the Kidney Disease Quality of Life (KDQOL-SF) scale forms. RESULTS Two hundred patients (128 male and 72 female; mean age, 39.2 ± 11.5 years) were examined. Anemia was found in 19% and severe anemia was found in 4.5% of all patients. Low glomerular filtration rate, young age, and female gender were demographic parameters associated with anemia. Parathormone levels were higher in the anemic group. The use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and mammalian target of rapamycin inhibitors was significantly higher in the anemic group. In addition, patients with anemia had a lower KDQOL-SF mental health component score than that of the patients without anemia. CONCLUSIONS Anemia was related to the degree of renal function in posttransplant patients. Anemia had an important influence on mental health in renal transplant patients.

Single-frequency and multi-frequency bioimpedance analysis: What is the difference?

Bioelectrical impedance analysis is a promising method in determining the body compartments in haemodialysis patients. In this study, we aimed to investigate the agreement between two widely used methods: the single‐frequency and multi‐frequency bioelectrical impedance analyses.

The Frequency and Associated Factors for BK Virus Infection in a Center Performing Mainly Living Kidney Transplantations

Purpose: BK virus (BKV) nephropathy has increasingly become an important cause of morbidity in renal transplant recipients. We evaluated the frequency and associated factors for BKV infection in a center performing mainly living donor transplantations over a long time period. Methods: One hundred consecutive renal transplant patients were included. Quarterly visits were planned to examine urine for decoy cells and to measure the BKV DNA in the blood and urine. Renal biopsy was performed in case of deteriorated allograft function. Serological examinations for BKV immunoglobulin G (IgG) were performed in donors. Results: Throughout the entire follow-up period, the rates of viruria, viremia, and the positivity of decoy cells were 12%, 6%, and 13%, respectively. The negative and positive predictive values of decoy cells were 93.1% and 69.2%, respectively, for viruria, and 99.2% and 45.5%, respectively, for viremia. Biopsy-proven BKV nephropathy was observed in 1 patient. The BKV IgG was positive in all living donors. Viruria and viremia were associated with deceased donor transplantation, acute rejection, and pulse steroid therapy. In addition, viremia was associated with antithymocyte globulin therapy and a short duration of the posttransplant period. Conclusions: The frequency of BKV infection was lower in our transplant unit compared to previous reports. Reduced doses of immunosuppression seem to be the main factor that may explain the reduced frequency. However, an active screening strategy is still of importance for this patient group.

Long-Term Progression of Coronary Artery Calcification Is Independent of Classical Risk Factors, C-Reactive Protein, and Parathyroid Hormone in Renal Transplant Patients

Aims: Compared to the general population, mortality is significantly increased in renal transplant recipients. In the general population, coronary artery calcification (CAC) and its evolution over time are associated with cardiovascular and all-cause mortality, and the study of this biomarker could provide useful information for describing the long-term progression of coronary heart disease in renal transplant recipients. Methods: We followed up a cohort of 113 renal transplant patients by performing three multi-detector computed tomography studies over 83.6 ± 6.8 months. Data analysis was performed by logistic regression analysis and by mixed linear modelling. Results: Progression was observed in 34.5% of patients. Baseline CAC and time-to-transplantation were the sole variables that predicted CAC evolution over time. Neither classical nor nontraditional risk factors, biomarkers of renal function (GFR) and kidney damage (albuminuria) or biomarkers of bone mineral disorder (BMD), such as serum phosphorus, calcium, and PTH, were associated with the long-term progression of coronary calcification. Serum triglycerides predicted CAC progression only in logistic regression analysis, while in addition to baseline CAC, time to transplantation was the sole variable predicting CAC progression when the data were analyzed by mixed linear modelling. These data suggested that, in addition to the background calcification burden, other unmeasured factors play major roles in promoting the evolution of coronary calcification in the transplant population. Conclusion: CAC progression continued over the long-term follow-up of renal transplant patients. This phenomenon was unaccounted for by classical and nontraditional risk factors, as well as by biomarkers of renal dysfunction and renal damage.

Gangliocytoma Presenting With Tacrolimus Neurotoxicity in a Renal Transplant Recipient: Case Report

Tacrolimus is a widely used macrolide immunosuppressant in transplant surgery, with mild and major neurologic side effects. A 21-year-old woman had undergone preemptive transplantation of a kidney from her mother. On the 1st postoperative day, the patient had headache, nausea, vomiting, and agitation. Magnetic resonance imaging (MRI) of the brain showed hyperintensity and a lesion in the right mesial temporal lobe. After we switched from tacrolimus to cyclosporine, the symptoms regressed. Persistence of the lesion, confirmed by repeated MRI, required that the patient be operated on. Pathologic examination showed the gangliocytoma, a rare brain tumor. Our case shows that preexisting brain lesions may cause tacrolimus-induced neurotoxicity in the early postoperative period.

A Solid Mass in the Chest Wall: An Unusual Presentation of Posttransplant Lymphoproliferative Disorder in a Renal Transplant Recipient.

Posttransplant lymphoproliferative disorder (PTLD) is one of the most common malignancies after kidney transplantation. Different clinical and histopathological forms of PTLD related to immunosuppression can be observed after organ transplantations. We report a 42-year-old woman who had undergone deceased donor renal transplantation with an unusual presentation of PTLD. The immunosuppressive treatment was discontinued and appropriate chemotherapy was started. However, the patient died despite this treatment. Different presentations of PTLD in transplant patients should also be kept in mind.

Ambulatory Blood Pressure Monitoring and Echocardiographic Findings in Renal Transplant Recipients

Hypertension is common in renal transplant recipients (RTRs). Ambulatory blood pressure (BP) monitoring (ABPM) is important in diagnosing hypertension and diurnal BP variation. The authors set out to compare office BP and ABPM measurements to determine diurnal pattern and to evaluate echocardiographic findings in RTRs. ABPM and office BP measurements were compared in 87 RTRs. Echocardiographic evaluation was performed for each patient. The correlations between office and 24‐hour ABPM were 0.275 for mean systolic BP (P=.011) and 0.260 for mean diastolic BP (P=.017). Only 36.8% had concordant hypertension between office BP and ABPM, with a masked hypertension rate of 16.1% and white‐coat effect rate of 24.1%. Circadian BP patterns showed a higher proportion of nondippers (67.8%). Left ventricular mass index was increased in 21.8% of all recipients. There was a significant but weak correlation between office BP and ABPM.