Flow cytometric evaluation of T and B lymphocyte percentage in chronic kidney disease

Introduction. T and B lymphocytes play crucial roles in adaptive immunity. These cells are negatively affected in multiple disorders, including chronic kidney disease. The purpose of this study was to compare T and B lymphocyte ratios between patients with chronic kidney disease and healthy controls. Methods. In this study, we evaluated the percentages of patient and donor (healthy control) lymphocytes referred to our laboratory between 2012 and 2014. In total 103 patient-donor couples were tested by the FCXM method. CD3-PerCP and CD19-PE monoclonal antibodies were used in order to differentiate T and B cells, respectively. T and B cell percentages of the participants were statistically compared. Results. The mean age of the investigated patients and donors was 36.3 ± 13.7 and 46.2 ± 12.4 years, respectively. Of the studied patients, 45.6% and 54.3% were female and male, whereas 54.3% and 45.6% of donors were female and male, respectively. In the investigated group, 42 patients were preemptive, 45 subjects were treated with haemodialysis, and 16 individuals were on peritoneal dialysis. T and B lymphocyte percentages in the healthy group were higher than in patients with chronic kidney disease. However, the difference reached statistical significance only for T lymphocytes (p < 0.05). The percentages of total lymphocytes, and T and B lymphocytes in patients treated with haemodialysis were numerically lower than in those on peritoneal dialysis. In addition, we found that patients with chronic kidney disease had lower concentrations of haemoglobin and albumin than healthy controls. Conclusion. This study suggests that patients with advanced chronic kidney disease have lower rates of lymphocytes that healthy controls. This fact may at least partially explain impaired immunity in this setting. However, our findings require confirmation and detailed investigation of underlying mechanisms in further studies.

Isolated Small Bowel Transplantation in Turkey: A Single Center Experience Running Title: Isolated Small Bowel Transplantation in Turkey

Background SBTx has become a feasible therapeutic option for patients with irreversible intestinal failure. Increase in the number and in the improvement of the patient and graft survival in SBTx has a slow course when compared to other solid organ transplantation. Aim The aim of this study is to analyze 25 isolated SBTx performed since 2003 at a single center. It also aims to compare the patient and graft survivals rate during the early (before 2010) and late (after 2010) period. Materials and Methods Medical charts of 24 patients were analyzed retrospectively. To compare the center’s experience during a twelve year period, the results were divided into two groups (before (n:7) and after 2010 (n:18)). At the appropriate time, data were reported as mean± standard deviation, median, and range. Kaplan Meier method was used for the survival analysis of the graft and the patients. Results Median age of the patients was 39 (min 6 months, max: 56 yr). Six of them were in the pediatric age group. Compared to before 2010, graft survival rates increased from 28.1% to 53.8% in 3 months, from 28.6% to 35.9% in 6 months, and from 14.3% to 29.9% in one year after 2010. At the same period, patient survival rate increased from 57.1% to 72.2% in 3 months, from 28.6% to 38.9% in 6 months, and from 14.3% to 33.3% in one year. In the pediatric age group, patient and graft survival rates were 85.7% in 3 months, 71.4% in 6 months, and 71.4 % in 1 year. Conclusion SBTx is an effective treatment choice for selected patients with intestinal failure. Although patient and graft survival rates were improved after 2010 in our center, it was inferior. Patient and graft survival rates in pediatric SBTx are favourable and promising

The effect of cold ischemia time on delayed graft function and acute rejection in kidney transplantation

The objective of this study is to evaluate the impact of cold ischemia time (CIT) on delayed graft function (DGF) and acute rejection (AR) among deceased donor kidney transplant recipients. The medical records of 111 patients who underwent kidney transplantation from deceased donors between November 1994 and July 2009 were retrospectively analyzed. DGF was observed in 54% of the patients and the prevalence of AR in the first year after transplantation was 9.9%. The incidence of DGF was higher among patients with longer CIT. There was no correlation between CIT and AR episodes. Higher body weight of recipients and donors, history of prior blood transfusion and advanced donor age were related with DGF. Patients with DGF had higher serum creatinine levels at the first, third and fifth years. There was a negative correlation between recipient body weight and creatinine clearance at the first year. CIT has an important role in the development of DGF as a modifiable risk factor. Moreover, donors with advanced age and higher body weight as well as recipients with higher body weight and history of blood transfusions are at risk for the development of DGF. Prevention of DGF may help to improve graft function at the first, third and fifth years and shorten the hospital stay

Kidney transplantation in a child with bladder dysfunction who underwent prior bladder augmentation: A case report

WOS: 00032138720232

Lymphedema Treatment in a Patient with a History of Intestinal Transplantation and Mesenchymal Stem Cell Transplantation

WOS: 000353480500017Lymphedema is a rare complication of sirolimus treatment in transplantation patients. We present a case of a 14-year-old female patient who developed lymphedema in three extremities. The patient had undergone ileal and colon resections after sustaining a gunshot to her abdomen. Four months after the injury, she had developed a short bowel syndrome and underwent small intestine transplantation from a cadaver and mesenchymal stem cell transplantation to prevent rejection. Because kidney failure developed at postoperative month 3, mycophenolate mofetil therapy was discontinued and sirolimus therapy was initiated. The patient was monitored under this therapy until postoperative month 11 when she had swelling in both the legs and left arm. Her condition significantly improved with complex decongestive therapy. This is the first case in the literature involving mesenchymal stem cell transplantation together with ileum transplantation. This case is also noteworthy in terms of lymphedema treatment administered and the involvement of three extremities

S-Shaped Wide Excision with Primary Closure for Extensive Chronic Pilonidal Sinus Disease

Background. The management of complex pilonidal sinus disease (PSD) with multiple pits on and beside the natal cleft is variable, contentious, and problematic. Wide excision of the sinus and reconstruction of the defect using different flap techniques have become more popular in recent years. Case Report. We report a case with a complex chronic PSD to which we applied primary closure after S-shaped wide excision. The patient’s postoperative course was uneventful, and at the end of one-year followup he is now disease-free and comes for routine checkups. Conclusion. The simplicity of the technique and the promising results support the applicability of the S-shaped wide excision in chronic bilaterally extended large PSDs. Further studies entailing large patient populations are needed to reach a definite conclusion

Renal Tubular Acidosis in Renal Transplant Patients: The Effect of Immunosuppressive Drugs

Background: Renal tubular acidosis (RTA) is a non-anion gap metabolic acidosis and is generally mild and asymptomatic in kidney recipients. Calcineurine inhibitors (CNIs) increase the frequency of RTA but the frequency of RTA development in kidney transplant recipients receiving mammalian target of rapamycin inhibitors (mTORi) treatment remains unclear. In this study, we aimed to investigate the frequency of RTA in kidney transplant recipients on mTORi and CNI treatment and to compare both groups

Assessment and outcome of pediatric intestinal pseudo-obstruction: A tertiary-care-center experience from Turkey

WOS: 000463369400008PubMed ID: 30666970Background/Alms: Pediatric intestinal pseudo-obstruction (PIPO) is a severe disorder of gut motility. In this rare and difficult-to-manage disease, complex treatment method, such as intestinal transplantation, is sometimes needed. This study evaluated the management and follow-up results of patients with PIPO who received treatment at our center. Materials and Methods: The cases of 13 patients with PIPO were reviewed retrospectively. Demographic data, clinical features, etiologies, pharmacological and surgical treatments, nutritional support, anthropometric findings, small bowel transplantation (SBT), and survival rates were assessed. Results: Two of the patients were diagnosed at 1 and 5 years of age, while other patients were diagnosed during neonatal period. The etiological cause could not be identified for 5 patients. Pharmacological treatment response was observed in 38.4% of patients. Post-pyloric feeding was applied in 4 patients, but no response was observed. Gastrostomy decreased the clinical symptoms in 3 patients during the abdominal distension period. Total oral nutrition was achieved in 38.4% of the total-parenteral-nutrition (TPN)-dependent patients. It was observed that anthropometric findings improved in patients with total oral nutrition. Liver cirrhosis developed in 1 patient. Venous thrombosis developed in 4 patients. The SBT was performed on 3 patients. One of these patients has been followed up for the last 4 years. Conclusion: Pediatric intestinal pseudo-obstruction is a rare disease that can present with a wide range of clinical symptoms. While some patients require intestinal transplantation, supportive care may be sufficient in others. For this reason, patients with PIPO should be managed individually