Türkiye'de Yeni Hastane Modelinde Böbrek Nakli: Ankara Şehir Hastanesi'nde 3 Yıllık Deneyim

Year 2023, , 359 - 364, 30.06.2023

Mehmet Yılmaz , Mehmet Emin Şirin , Mustafa Karaaslan , Muhammed Emin Polat , Esin Ölçücüoğlu , Erkan Ölçücüoğlu

https://doi.org/10.18663/tjcl.1291171

Abstract

Öz
Amaç: Şehir hastaneleri, yeni bir model hastane olarak Türkiye'de yaklaşık 20 farklı ilde hizmet vermeye başlamıştır. Bu çalışmada, Ankara Şehir Hastanesi böbrek nakli ünitesinin 100 vakayı aşan 3 yıllık deneyimini sunmayı amaçladık.

Materyal ve Yöntem: Ankara Şehir Hastanesi Üroloji Kliniğinde canlı veya kadavradan böbrek nakli yapılan 101 son dönem böbrek (SDBH) hastasının verileri retrospektif olarak toplandı. Alıcı ve vericinin demografik verileri ameliyat sonrası komplikasyonlar, hasta sağkalımı ve greft fonksiyonları kaydedildi.

Bulgular: Hasta ve greft sağkalım oranları sırasıyla %96 ve %98 idi. Post-op ilk gün, 1 ay, 6 ay, 12 ay, 18 ay, 24 ay ve 36 ay sonraki ortanca serum kreatinin düzeyi 1,3 (aralık, 0,7-5,7) mg/dl, 1,3 (aralık, Sırasıyla 0,8-1,7) mg/dl, 1,3 (aralık, 0,8-2,5) mg/dl, 1,3 (aralık, 0,7-2) mg/dl, 1,2 (aralık, 0,8-1,9) mg/dl, 1,4 (aralık, 0,8-2,4) mg/dl ve 1,4 (aralık, 1-2,4) mg/dl olarak bulundu. Ürinomu olan 6 (%5,9) hastalar üriner kateterizasyon ve perkütan drenaj ile konservatif olarak tedavi edildi. Renal arter stenozu 2 (%2) hastada gözlendi.

Sonuçlar: Böbrek nakli, dünyada olduğu gibi Türkiye'de de SDBH hastaları için halen en önemli tedavi seçeneğidir. Merkezimizde 36 aylık takipte greft fonksiyon sonuçlarının kabul edilebilir derecede iyi olduğunu gözlemledik.

Anahtar Kelimeler: böbrek nakli, greft fonksiyonu, şehir hastanesi

Keywords

böbrek nakli, greft fonksiyonu, şehir hastanesi

Kidney Transplantation in the New Hospital Model in Turkey: 3 Years of Experience in Ankara City Hospital

Abstract

ABSTRACT

Objective: City hospitals, as a new model hospital, started to serve in approximately 20 different cities in Turkey. In this study, we aimed to present the 3 years experience of Ankara City Hospital kidney transplant unit, which has exceeded 100 cases, as a new hospital model.

Materials and Methods: We retrospectively collected the data of 101 end-stage renal disease patients who underwent live or cadaveric kidney transplantation in the Department of Urology at Ankara City Hospital. The demographic data of the recipient and donor, postoperative complications, patient survival and graft functions were recorded.

Results: Patient and graft survival rates of the recipients were 96% and 98% at 36 months follow-up, respectively. The median serum creatinine level at post-op first day, 1 months, 6 months, 12 months, 18 months, 24 months and 36 months posttransplantion was 1,3 (range, 0,7-5,7) mg/dl, 1,3 (range, 0,8-1,7) mg/dl, 1,3 (range, 0,8-2,5) mg/dl, 1,3 (range, 0,7-2) mg/dl, 1,2 (range, 0,8-1,9) mg/dl, 1,4 (range, 0,8-2,4) mg/dl and 1,4 (range, 1-2,4) mg/dl, respectively. 6 (5,9%) patients with urinoma were treated conservatively with urinary catheterization and percutaneous drainage. Renal artery stenosis was observed in 2 (2%) patients.

Conclusion: Kidney transplantation is still the most important treatment option for ESRD patients in Turkey as in the world. In our center, we observed that graft function results were acceptably good at 36 months follow-up.

Keywords: city hospital, graft function, kidney transplantation

Keywords

kidney transplantation, graft function, city hospital

References

• 1. Davis, C.L. and F.L. Delmonico, Living-donor kidney transplantation: a review of the current practices for the live donor. J Am Soc Nephrol, 2005. 16(7): p. 2098-110.
• 2. Cordeiro, E.D.O., et al., Quality of life of individuals receiving kidney transplantation in Amazonas State. Rev Lat Am Enfermagem, 2020. 28: p. e3291.
• 3. van der Mei, S.F., et al., Barriers to and Facilitators of Sustained Employment: A Qualitative Study of Experiences in Dutch Patients With CKD. Am J Kidney Dis, 2021. 78(6): p. 780-792.
• 4. Shapiro, R., R.L. Simmons, and T.E. Starzl, Renal transplantation. 1997: McGraw-Hill/Appleton & Lange.
• 5. Poggio, E.D., et al., Performance of the modification of diet in renal disease and Cockcroft-Gault equations in the estimation of GFR in health and in chronic kidney disease. J Am Soc Nephrol, 2005. 16(2): p. 459-66.
• 6. System, U.S.R.D., 2021 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
• 7. Karakayali, H. and M. Haberal, The history and activities of transplantation in Turkey. Transplant Proc, 2005. 37(7): p. 2905-8.
• 8. Haberal, M., et al., Cadaver kidney transplantation with cold ischemia time from 48 to 95 hours. Transplant Proc, 1984. 16(5): p. 1330-2.
• 9. https://organkds.saglik.gov.tr/dss/PUBLIC/ONM_ KidneyTransplantCenter.aspx.
• 10. Andacoglu, O. and F.T. Aki, Global Perspective on Kidney Transplantation: Turkey. Kidney360, 2021. 2(7): p. 1160-1162.
• 11. Buttigieg, J., et al., Early urological complications after kidney transplantation: An overview. World J Transplant, 2018. 8(5): p. 142-149.
• 12. Hamouda, M., A. Sharma, and A. Halawa, Urine Leak After Kidney Transplant: A Review of the Literature. Exp Clin Transplant, 2018. 16(1): p. 90-95.
• 13. Capocasale, E., et al., Surgical site and early urinary tract infections in 1000 kidney transplants with antimicrobial perioperative prophylaxis. Transplant Proc, 2014. 46(10): p. 3455-8.
• 14. Ebadzadeh, M.R. and M. Tavakkoli, Lymphocele after kidney transplantation: where are we standing now? Urol J, 2008. 5(3): p. 144-8.
• 15. Piskin, T., et al., A kidney transplant center's initial experiences in eastern Turkey. Transplant Proc, 2012. 44(6): p. 1685-9.
• 16. Aktas, S., et al., Analysis of vascular complications after renal transplantation. Transplant Proc, 2011. 43(2): p. 557-61.
• 17. Fananapazir, G. and C. Troppmann, Vascular complications in kidney transplant recipients. Abdom Radiol (NY), 2018. 43(10): p. 2546-2554.
• 18. Chen, W., et al., Transplant renal artery stenosis: clinical manifestations, diagnosis and therapy. Clin Kidney J, 2015. 8(1): p. 71-8.
• 19. Deininger, S., et al., Minimal-invasive management of urological complications after kidney transplantation. Int Urol Nephrol, 2021. 53(7): p. 1267-1277.