TY - JOUR T1 - COVID-19 Pandemisi Sırasında Canlı Donör Böbrek Nakli: Tek Merkez Deneyimi TT - Living Donor Kidney Transplantation During The COVID-19 Pandemic: A Single Center Experience AU - Fırat, Necattin AU - Akın, Emrah AU - Dheir, Hamad AU - Çelebi, Fehmi AU - Sarıgedik, Enes AU - Yiğit, Merve AU - Altıntoprak, Fatih PY - 2021 DA - April Y2 - 2021 DO - 10.34084/bshr.894480 JF - Journal of Biotechnology and Strategic Health Research JO - J Biotechnol and Strategic Health Res PB - Deneysel, Biyoteknolojik, Klinik ve Stratejik Sağlık Araştırmaları Derneği WT - DergiPark SN - 2587-1641 SP - 78 EP - 84 VL - 5 IS - 1 LA - tr AB - Amaç: COVID-19 pandemisi nedeniyle global düzeyde pek çok merkezde böbrek nakli operasyonları ya durdurulmuş yada seçilmiş hasta gruplarında yapılmak üzere kısıtlamaya gidilmiştir. Böbrek nakil süreci, cerrahisi ve postoperatif dönemde uygulanan immünosüpresyon tedavisi ile birlikte değerlendirildiğinde karmaşık ve yakın takip gerektiren bir uygulamadır. Çalışmamızın amacı; pandemi sürecinde yaptığımız nakil operasyonlarını, hastaların operasyon öncesi hazırlık, operasyon sonrası takip süreçlerini ve uyguladığımız tedavi yaklaşımlarını sunmaktır.Yöntem : Pandemi süresince nakil merkezimizde gerçekleştirilen böbrek transplantasyonu operasyonları retrospektif olarak değerlendirildi. Alıcı ve vericilerin demografik özellikleri, greft fonksiyo testleri, COVID-19 PCR sonuçları, HLA uyumları, sıcak-soğuk iskemi süreleri ve nakil sonrası görülen komplikasyonları kaydedildi. İndüksiyon tedavisi olarak hastalar antitimusit globülin (ATG) uygulanan Grup 1 ve Basiliksimab uygulananlar Grup 2 olmak üzere iki gruba ayrıldı. Gruplar preoperatif ve postoperatif 1. Gün 7. Gün ve 1. Ay serum kreatinin düzeyleri, ATG kümülatif düzeyi, HLA uyumları açılarından değerlendirildi.Bulgular: Merkezimizde Mart 2020 Kasım 2020 tarihleri arasında 22 böbrek nakli operasyonu gerçekleştirildi. 21 hastaya canlı vericili böbrek nakli uygulandı. Hastaların 7’si kadın 14’ü erkekti. Hastaların ortalama yaşı 41,95±15,11 yıl ve vücut kitle indeksi 26,37±5,04 kg/m2 idi. İndüksiyon tedavisi olarak hastaların 7’sine ATG, 13‘üne basiliksimab uygulandı. Tam uyum olan bir hastaya indüksiyon tedavisi uygulanmadı. Erken dönemde akut rejeksiyon veya herhangi bir nedenle greft disfonksiyonu açısından istatistiksel olarak iki grup arasında anlamlı fark yoktu (p>0.05).Sonuç: Pandemi döneminde bulaş sıklığının azaldığı dönemlerde yakın takip ve sıkı izolasyon tedbirleri altında deneyimli merkezlerde böbrek nakli operasyonları düşük yoğunlukta yapılabilir.Living Donor Kidney Transplantation During The COVID-19 Pandemic: A Single Center ExperienceAbstractObjective: Due to the COVID-19 pandemic, renal transplantation operations were either stopped or restricted to be performed in selected patient groups in many centers globally. When evaluated together with the kidney transplantation process surgery and immunosuppression therapy applied in the postoperative period, it is a complex procedure, and requires close follow-up. The purpose of our study; to present the renal transplantation operations that performed during the pandemic process, the pre-operative preparation of the patients, the post-operative follow-up processes, and applied treatment approaches.Method : Renal transplantation operations which are performed in our transplant center during the pandemic were evaluated retrospectively. The demographic characteristics of the recipients and donors, graft function tests, COVID-19 PCR results, HLA matches, hot-cold ischemia times and post-transplantation complications were recorded. As induction therapy, the patients were divided into two groups as Group 1 with antithymuside globulin (ATG), and Group 2 with Basiliximab. The groups were evaluated in terms of preoperative and postoperative day 1, day 7, and 1st month serum creatinine levels, ATG cumulative level and HLA compatibility.Results: Twenty-two kidney transplantations were performed in our center between March 2020 and November 2020. Living donor kidney transplantation was performed in 21 patients. There were 7 female and 14 were male patients. The mean age of the patients was 41.95 ± 15.11 years and the body mass index was 26.37 ± 5.04 kg / m2. As induction therapy, ATG was applied to 7 patients and basiliximab to 13 patients. Induction therapy was not applied to one patient with full compliance. There was no statistically significant difference between the two groups in terms of early acute rejection or graft dysfunction for any reason (p> 0.05).Conclusion: During the pandemic period when the frequency of transmission is decreasing kidney transplantation operations can be performed at low intensity in experienced centers under close follow-up and strict isolation measures during periods Keywords: Kidney transplantation, chronic renal disease, laparoscopic donor nephrectomy, COVID-19, induction therapy KW - Böbrek nakli KW - Kronik böbrek yetmezliği KW - Laparoskopik donör nefrektomi KW - COVİD-19 KW - İndüksiyon tedavisi N2 - Objective: Due to the COVID-19 pandemic, renal transplantation operations were either stopped or restricted to be performed in selected patient groups in many centers globally. When evaluated together with the kidney transplantation process surgery and immunosuppression therapy applied in the postoperative period, it is a complex procedure, and requires close follow-up. The purpose of our study; to present the renal transplantation operations that performed during the pandemic process, the pre-operative preparation of the patients, the post-operative follow-up processes, and applied treatment approaches.Method: Renal transplantation operations which are performed in our transplant center during the pandemic were evaluated retrospectively. The demographic characteristics of the recipients and donors, graft function tests, COVID-19 PCR results, HLA matches, hot-cold ischemia times and post-transplantation complications were recorded. As induction therapy, the patients were divided into two groups as Group 1 with antithymuside globulin (ATG), and Group 2 with Basiliximab. The groups were evaluated in terms of preoperative and postoperative day 1, day 7, and 1st month serum creatinine levels, ATG cumulative level and HLA compatibility.Results: Twenty-two kidney transplantations were performed in our center between March 2020 and November 2020. Living donor kidney transplantation was performed in 21 patients. There were 7 female and 14 were male patients. The mean age of the patients was 41.95 ± 15.11 years and the body mass index was 26.37 ± 5.04 kg / m2. As induction therapy, ATG was applied to 7 patients and basiliximab to 13 patients. Induction therapy was not applied to one patient with full compliance. There was no statistically significant difference between the two groups in terms of early acute rejection or graft dysfunction for any reason (p> 0.05). COVID-19 infection developed in 3 patients within a 6-month postoperative period.Conclusion: During the pandemic period when the frequency of transmission is decreasing kidney transplantation operations can be performed at low intensity in experienced centers under close follow-up and strict isolation measures during periods CR - Referanslar: Referans1. Firat N, Dhei̇r H, Akin E, et al. Canlı Donörden Böbrek Nakli: İlk Deneyimlerimiz. Online Türk Sağlık Bilimleri Dergisi. 2020;5(2):356-363. doi:10.26453/otjhs.705092 CR - Referans2. Scherer MN, Banas B, Mantouvalou K, et al. Current concepts and perspectives of immunosuppression in organ transplantation. Langenbecks Arch Surg. 2007;392(5):511-523. doi:10.1007/s00423-007-0188-z CR - Referans3. Manuel O, Estabrook M. RNA respiratory viral infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9). doi:10.1111/ctr.13511 CR - Referans4. Del Rio C, Malani PN. 2019 Novel Coronavirus-Important Information for Clinicians. JAMA. 2020;323(11):1039-1040. doi:10.1001/jama.2020.1490 CR - Referans5. Chen Q, Zheng Z, Zhang C, et al. Clinical characteristics of 145 patients with corona virus disease 2019 (COVID-19) in Taizhou, Zhejiang, China. Infection. Published online April 28, 2020:1-9. doi:10.1007/s15010-020-01432-5 CR - Referans6. Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. N Engl J Med. 2020;382(10):970-971. doi:10.1056/NEJMc2001468 CR - Referans7. Alberici F, Delbarba E, Manenti C, et al. A single center observational study of the clinical characteristics and short-term outcome of 20 kidney transplant patients admitted for SARS-CoV2 pneumonia. Kidney Int. 2020;97(6):1083-1088. doi:10.1016/j.kint.2020.04.002 CR - Referans8. Kataria A, Yakubu I, Winstead R, Gowda M, Gupta G. COVID-19 in Kidney Transplantation: Epidemiology, Management Considerations, and the Impact on Kidney Transplant Practice. Transplant Direct. 2020;6(8). doi:10.1097/TXD.0000000000001031 CR - Referans9. Boyarsky BJ, Po-Yu Chiang T, Werbel WA, et al. Early impact of COVID-19 on transplant center practices and policies in the United States. Am J Transplant. 2020;20(7):1809-1818. doi:10.1111/ajt.15915 CR - Referans10. Coates PT, Wong G, Drueke T, Rovin B, Ronco P. Early experience with COVID-19 in kidney transplantation. Kidney Int. 2020;97(6):1074-1075. doi:10.1016/j.kint.2020.04.001 CR - Referans11. West CP, Montori VM, Sampathkumar P. COVID-19 Testing. Mayo Clin Proc. 2020;95(6):1127-1129. doi:10.1016/j.mayocp.2020.04.004 CR - Referans12. Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. Published online February 26, 2020. doi:10.1148/radiol.2020200642 CR - Referans13. Kumar D, Manuel O, Natori Y, et al. COVID-19: A global transplant perspective on successfully navigating a pandemic. Am J Transplant. 2020;20(7):1773-1779. doi:10.1111/ajt.15876 CR - Referans14. Coronavirus Disease (COVID-19) Situation Reports. Accessed March 8, 2021. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports CR - Referans15. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the `Cytokine Storm’ in COVID-19. J Infect. 2020;80(6):607-613. doi:10.1016/j.jinf.2020.03.037 CR - Referans16. Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. Published online February 28, 2020. doi:10.1056/NEJMoa2002032 CR - Referans17. Joob B, Wiwanitkit V. COVID-19 and Organ Transplantation. Int J Organ Transplant Med. 2020;11(2):93. CR - Referans18. Akalin E, Azzi Y, Bartash R, et al. Covid-19 and Kidney Transplantation. N Engl J Med. 2020;382(25):2475-2477. doi:10.1056/NEJMc2011117 CR - Referans19. Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M. COVID-19 infection in kidney transplant recipients. Kidney Int. 2020;97(6):1076-1082. doi:10.1016/j.kint.2020.03.018 CR - Referans20. Goyal P, Choi JJ, Pinheiro LC, et al. Clinical Characteristics of Covid-19 in New York City. N Engl J Med. 2020;382(24):2372-2374. doi:10.1056/NEJMc2010419 CR - Referans21. Imam A, Abukhalaf SA, Imam R, Abu-Gazala S, Merhav H, Khalaileh A. Kidney Transplantation in the Times of COVID-19 - A Literature Review. Ann Transplant. 2020;25:e925755. doi:10.12659/AOT.925755 CR - Referans22. Bouvy AP, Klepper M, Kho MML, et al. The impact of induction therapy on the homeostasis and function of regulatory T cells in kidney transplant patients. Nephrol Dial Transplant. 2014;29(8):1587-1597. doi:10.1093/ndt/gfu079 CR - Referans23. Huang H-F, Zhou J-Y, Xie W-Q, Wu J-Y, Deng H, Chen J-H. Basiliximab versus rabbit antithymocyte globulin as induction therapy for living-related renal transplantation: a single-center experience. Int Urol Nephrol. 2016;48(8):1363-1370. doi:10.1007/s11255-016-1307-y CR - Referans24. Patel HV, Kute VB, Vanikar AV, et al. Low-dose rabbit anti-thymoglobin globulin versus basiliximab for induction therapy in kidney transplantation. Saudi J Kidney Dis Transpl. 2014;25(4):819-822. doi:10.4103/1319-2442.135057 CR - Referans25. Wang K, Xu X, Fan M. Induction therapy of basiliximab versus antithymocyte globulin in renal allograft: a systematic review and meta-analysis. Clin Exp Nephrol. 2018;22(3):684-693. doi:10.1007/s10157-017-1480-z UR - https://doi.org/10.34084/bshr.894480 L1 - https://dergipark.org.tr/en/download/article-file/1630094 ER -