Effect of Kidney Transplantation on Smoking Habits of Kidney Donors.

INTRODUCTION: Smoking increases the risk for cardiovascular disease in kidney donors, as is the case with normal individuals; it may also result in the development and progression of chronic renal failure. The present study aimed to investigate the effect of kidney transplant on smoking habits of kidney donors. METHOD: The study included 98 donors in total (54 female, 44 male). A questionnaire was administered to donors about smoking status. Smoking status was asked about before surgery and 12 months postoperatively, and the preoperative and postoperative values were compared. The Fagerstörm test for nicotine dependence was administered to individuals who were still smokers and those who had smoked but quit. RESULTS: The mean age of the participants was 48.27 ± 10.8 years. The preoperative smoking status was 47% (n = 46), whereas the postoperative rate decreased to 29% (n = 28). This reduction in smoking rate was significant (P = .001). There was no difference in Fagerström levels between donors who continued smoking and those who quit smoking after the surgery (P = .583). CONCLUSIONS: A person who becomes a kidney transplant donor has the chance to quit smoking, which is a cardiovascular risk factor. In addition to the psychosocial benefits of being a donor, it should be noted that it might also provide some medical benefits. However, some patients continue smoking after surgery. Smoking should be questioned in the postoperative follow-ups of donors and the support required for smoking cessation should be provided.

Neutrophil-Lymphocyte Ratio Is Significantly Decreased in Preemptive Renal Transplant Patients.

AIM: Cardiovascular diseases and infections are the leading two causes of morbidity and mortality in end-stage renal disease (ESRD) patients. Kidney transplantation is the preferred method for renal replacement owing to better survival. There are reports of irreversibly damaged immune system in dialysis patients, which did not return to normal even after kidney transplantation. The neutrophil-lymphocyte ratio (NLR) is an easily applicable method for evaluation of inflammation. We hypothesized that preemptive kidney transplantation can improve inflammatory state compared with nonpreemptive recipients. To test our hypothesis, we retrospectively investigated pretransplant and posttransplant NLR and C-reactive protein (CRP) levels of ESRD patients and compared them with values in healthy controls. MATERIALS AND METHODS: We retrospectively analyzed NLR, CRP, and other hematologic parameters of ESRD patients who were transplanted between January 2005 and January 2014 on the day of transplantation and at the end of first year. We grouped the patients as preemptive and nonpreemptive ones. We excluded patients with coronary artery disease, obesity, hypotension, hyperthyroidism, uncontrolled diabetes mellitus, hematologic or solid organ cancers, and active documented infection at any evaluation period. RESULTS: We included 137 ESRD patient and 34 healthy control individual in our study. Of the 137 ESRD patients, 52 (38%) were transplanted preemptively. Of the patients, 85 were already on either hemodialysis or peritoneal dialysis therapy at the time of transplantation. The white blood cell count value of the patient and control group (7246.72 ± 1460.26 and 76661.76 ± 1286.29, respectively; P = .43), NLR of the control group was significantly lower than patient group (1.98 ± 0.94 and 3.47 ± 2.33, respectively; P = .007). The NLR of the preemptive group was decreased substantially at the end of first year posttransplantation, the NLR of the preemptive group was significantly lower than the nonpreemptive group (3.08 ± 1.32 and 3.71 ± 2.33; P = .01). CONCLUSIONS: We showed that all ESRD patients had an increased inflammation rate according to CRP and NLR when compared with healthy controls. We also found that improvement of inflammatory state in preemptive patients is significantly better than nonpreemptive patients at the end of first year evaluation.

High-Grade Inflammation in Renal Failure Patients, According to Mean Platelet Volume, Improves at the End of Two Years After Transplantation.

BACKGROUND: Chronic kidney disease (CKD) is a worldwide disorder which is characterized by the presence of systemic low-grade inflammation. There is also acquired immune deficiency in this patient group which is clinically present with increased incidence of severe infections, poor response to vaccination, and increased risk of virus-associated cancers. Renal transplantation is one of the renal replacement modalities that restore renal functions. Mean platelet volume (MPV) is emerging as a marker of inflammation in many clinical conditions. In this study we aimed to disclose the improvement of paired immune response of ESRF patients after renal transplantation even though they are under immunosuppressive therapy. METHODS: We retrospectively investigated C-reactive protein, MPV, platelets (PLT), and other hematologic parameters on the day of transplantation and at the end of the 1st and 2nd years after transplantation of 58 preemptive and 112 nonpreemptive renal transplant patients. We compared them with a healthy control group. RESULTS: The MPV of the control group was 8.00 ± 0.73. The mean MPV of transplant patients before transplantation and at the end of the 1st and 2nd years after transplantation were 7.66 ± 1.01, 8.06 ± 0.97, and 8.20 ± 0.84, respectively. The initial MPV of the patient group was statistically significantly lower than the control group (P = .04). There was a statistically significant increase of MPV after transplantation. At the end of the 2nd year the difference of MPV between the patient and control groups was gone. CONCLUSIONS: We detected that CKD patients had a decreased MPV compared with normal individuals and that it normalized at the end of the 2nd year after renal transplantation. We speculated that the decreased MPV in CKD patients is related to increased inflammation and uremic toxins owing to uremia which was improved after renal transplantation.

Comparison of Serum Vitamin D Levels Among Patients With Chronic Kidney Disease, Patients in Dialysis, and Renal Transplant Patients.

OBJECTIVE: Vitamin D is a hormone with a variety of functions, and its deficiency and insufficiency are commonly seen both in the general population and in patients with chronic renal disease. The aim of this study was to compare vitamin D levels in patients with chronic renal disease who are on hemodialysis, peritoneal dialysis, or no renal replacement therapy and patients who underwent renal transplantation. METHODS: A total of 169 patients who had not used vitamin D for ≥ 1 year and who had no diabetes mellitus or proteinuria were included in the study. These included: 40 patients with renal transplantation, 40 patients on hemodialysis, 49 patients on peritoneal dialysis, and 40 patients with chronic renal failure stage 1, 2, 3, or 4. 25-Hydroxy vitamin D levels were evaluated in the sera of the patients. RESULTS: 25-Hydroxy vitamin D levels in patients with renal transplantation and in predialysis patients were 12.74 ± 10.24 ng/mL and 11.16 ± 12.25 ng/mL, respectively. The levels were 7.77 ± 6.71 ng/mL and 5.96 ± 4.87 ng/mL in patients on hemodialysis and peritoneal dialysis, respectively. CONCLUSIONS: Vitamin D levels are lower in patients on hemodialysis and peritoneal dialysis compared with the patients with renal transplantation for a variety of reasons. In this study, objective results were obtained supporting the administration of vitamin D supplements without glomerular filtration rate measurement in all patient groups with the diagnosis of chronic renal failure in accordance with the guidelines.

Changes in Exfoliative Cell of Oral Mucosa in Kidney Transplant Patients.

OBJECTIVES: The aim of this study was to investigate quantitative cytologic changes in oral mucosal smears collected from kidney transplant patients by modern stereologic methods. METHODS: We enrolled 32 kidney transplant patients. Smears were obtained from the buccal mucosa transplant patients before and 12 months after kidney transplantation. Smears from each individual were stained using the Papanicolaou method and were analyzed using a stereological method. RESULTS: Statistically, the nuclear volumes and cytoplasmic volumes in the cells of buccal mucosa were markedly higher after kidney transplantation (P < .05). There was a decreased positive cell density in the oral epithelial cells after kidney transplantation compared with before renal transplantation (P < .05). CONCLUSIONS: These findings suggest that there are alterations in the oral epithelial cells after kidney transplantation, which are detectable by microscopy and cytomorphometry.

Accumulation of heavy metals in water, sediments and wetland plants of kizilirmak delta (samsun, Turkey).

In this study, concentrations of heavy metals (Fe, Mn, Ni, Co, Zn, Cu, and Pb) were measured in water bodies including streams, bottom sediments and various wetland plants of Kizilirmak Delta. Kizilirmak Delta is one of the largest and the most important natural wetlands in Turkey and has been protected by Ramsar convention since 1993. The heavy metal concentrations in water were found lower than that of national standards for protected lakes and reserves. In bottom sediments and wetland plants, however, the accumulated amounts of different heavy metals varied in the following order: Fe>Mn>Zn>Ni>Co>Cu>Pb, and Fe>Mn>Zn>Ni>Co respectively. Heavy metal uptake of Hydrocharis morsus-ranae and Myriophyllum verticillatum plants among others were found far above the toxic levels and they might be used as bio-indicators and heavy metal accumulators in polluted natural areas.

Does a predialysis education program increase the number of pre-emptive renal transplantations?

OBJECTIVES: Renal transplantation (RT) is the most appropriate form of treatment for end-stage renal disease (ESRD). Pre-emptive RT decreases the rates of delayed graft function and acute rejection episodes, increasing patient and graft survival, while reducing costs and complications associated with dialysis. In this study, we investigated the relationship between a predialysis education program (PDEP) for patients and their relatives and pre-emptive RT. METHODS: We divided 88 live donor kidney transplant recipients into 2 groups: transplantation without education (non-PDEP group; n = 27), and enrollment in an education program before RT (PDEP group n = 61). RESULTS: Five patients in the non-PDEP group underwent pre-emptive transplantation, versus 26 of the PDEP group. The rate of pre-emptive transplantations was significantly higher among the educated (42.62%) versus the noneducated group (18.51%; P < .001). CONCLUSION: PDEP increased the number of pre-emptive kidney transplantations among ESRD patients.

Comparison of the oxidant-antioxidant parameters and sialic acid levels in renal transplant patients and peritoneal dialysis patients.

OBJECTIVE: Several studies have shown that in end-stage renal failure, increased oxidative stress and reduced antioxidant system functions may play an important role in inflammation, atherosclerosis, and many other complications. Paraoxonase (PON) and arylesterase (ARE) are antioxidant and malondialdehyde (MDA) an oxidant agent. Increased sialic acid (SyA) levels in uremic patients is an acute-phase response showing tissue and organ damage. The aim of this study was to compare PON, ARE, MDA, and SyA among continuous ambulatory peritoneal dialysis (CAPD) and renal transplant patients. METHODS: Twenty-six CAPD patients including 7 women and 19 men of overall mean age 40.5 ± 10.66 years were included in this study. There were 28 preemptive transplant patients, namely 6 women and 22 men of overall mean age 36.5 ± 10.97 years. CAPD was the initial sole replacement therapy. Serum PON, ATE, MDA, and SyA levels were measured at 13-15 months of treatment. RESULTS: Higher PON (P = .015) and ARE (P = .002) and lower MDA (P = .002) and SyA (P = .000) values were determined among transplanted compared with CAPD patients. CONCLUSIONS: In the transplant group, antioxidant parameters were higher and oxidant parameters lower with less activation of SyA than in the CAPD group. We observed that renal transplantation had a constructive effect on the oxidant-antioxidant system and consequent tissue destruction, which were impaired in uremic subjects. This study showed that renal transplantation is a more appropriate replacement treatment than CAPD.

Exfoliative cytology of oral mucosa in kidney transplant patients: a cytomorphometric study.

OBJECTIVES: The aim of this study was to investigate quantitative cytologic changes in oral mucosal smears collected from kidney transplant patients by modern stereologic methods. METHODS: Smears were obtained from the clinically healthy buccal mucosa and floor of mouth of transplant patients (n = 21) and healthy volunteers (n = 27). Smears from each individual stained by the Papanicolaou method were analyzed using a stereologic method. Nuclear (NV) and cytoplasmic (CV) volumes were evaluated with Stereo Investigator software. RESULTS: CV values were 123,012.71 ± 15,840.96 fL in the floor of the mouth and 133,667.10 ± 26,653.39 fL in the buccal mucosa of the kidney transplant patients. CV values were 133,746.93 ± 14,210.67 fL in the floor of the mouth and 167,797.78 ± 21,007.70 fL in the buccal mucosa of the control group. NV values were 945.68 ± 65.85 fL in the floor of the mouth and 845.15 ± 81.56 fL in the buccal mucosa of the kidney transplant patients and 485.17 ± 18.03 fL in the floor of the mouth and 410.25 ± 52.84 µm(3) in the buccal mucosa of the control group. Significantly higher NV (P = .000) and NV/CV (P = .000) and lower CS (P = .000) values were found in the patient group compared with the control group. CONCLUSION: The findings suggest that there were alterations in oral epithelial cells, detectable by microscopy and cytomorphometry in kidney transplant patients.

Central retinal vein thrombosis and hyperhomocysteinemia in a young patient with renal transplantation.

A 28-year-old woman was admitted with a sudden loss of vision in the right eye. She underwent renal transplantation in June 1999 for chronic renal failure secondary to amyloidosis. Upon ophthalmologic examination, the patient was diagnosed with central retinal vein occlusion. Physical and laboratory examinations failed to disclose any remarkable pathology except for high homocysteine levels. Hyperhomocysteinemia has been reported as a potential risk factor requiring treatment and a significant association has been found between this condition and central retinal vein thrombosis.

Antioxidant enzyme activities and lipid peroxidation levels in erythrocytes of patients with oesophageal and gastric cancer.

In this study, levels of lipid peroxidation and antioxidant enzyme activities were investigated in the erythrocytes of patients with oesophageal and gastric cancers. Erythrocytes were obtained from 17 patients with oesophageal cancer, 37 patients with gastric cancer and 20 healthy controls. Levels of malondialdehyde (MDA), a lipid peroxidation marker, and activities of copper- and zinc-containing superoxide dismutase (CuZn-SOD), catalase (CAT) and glutathione peroxidase (GPx) were determined using spectrophotometric methods. MDA levels and CuZn-SOD activity were significantly higher and GPx and CAT activities significantly lower in patients with oesophageal and gastric cancer than in controls. There were no statistically significant differences in the parameters measured in relation to disease stage in either patient group. These results indicate significant changes in the antioxidant defence system in patients with oesophageal and gastric cancer. It is postulated that this may lead to enhanced action of oxygen radicals, resulting in lipid peroxidation.

Evaluation of the mass spectrometric patterns of volatile liquid anaesthetics to predict the temperature--metal caused decomposition pathway.

In this study, prediction of the thermal decomposition pathway of the volatile liquid anaesthetics such as halothane, enflurane and isoflurane in contact with various metal/metal oxides at elevated temperatures has been deduced by evaluating the mass spectrometric fragmentation pattern of each anaesthetic observed in the ionisation process. In the light of the molecular structures and fragmentation components, it was believed that the thermal decomposition pathway of each anaesthetic on metal/metal oxide surface, particularly at higher temperatures, is similar to the ionisation mechanism occurring in the mass spectrometer ionisation process with minor differences for each molecule. The ionisation clusters for each anaesthetic molecule show the most likely fragment and radicals formed in the mass spectrometric ionisation process by considering the isotopic effect. From these clusters, thermal decomposition pathway of the liquid anaesthetics and formation mechanisms of the major halogenated thermal decomposition products have been predicted. It was concluded that the ionisation and thermal decomposition pathway resembles each other, but are not completely similar.

Spectrophotometric determination of the tannin contents of various Turkish black tea, beer and wine samples.

This study reports tannin contents of various tea (19), beer (6) and wine (6) samples, produced or sold in Turkey under different brand names. Determinations were carried out by employing a previously reported UV-vis spectrophotometric method. The standard addition procedure was also compared to the direct determination procedure and found to be more reliable. The tannin contents of hot water extracts of tea, tea bag and herbal tea samples ranged between 6.20-8.33, 8.03-6.59 and 2.76-6.54 percent (w/w) respectively. Tannin contents of beer and wine samples determined without extraction were found ranging between 66.36-77.26 and 67.18-107.62 micrograms/mL respectively. Iron contents of analysed wine samples were also found ranging between 0.36 and 10.33 ppm by AAS and no relation is found between tannin and iron contents.

Effect of temperature and some common metals on the stability of volatile anaesthetic-Entonox mixtures.

Thermal stability of pressurised ready-to-use volatile liquid anaesthetic mixtures (halothane, isoflurane and enflurane) in Entonox (commercially available premixed 50% N2O, 50% O2 mixture) were investigated at temperatures of 20, 258, 400, 503 and 602 degrees C on glass, stainless steel, copper and aluminium by gas chromatography and GC-MS. It was found that most of the decomposition products formed were halogenated compounds and the observed thermal stabilities in glass, stainless steel and copper allowed a thermal treatment up to 250 degrees C without any decomposition problem. Aluminium was found to be the most effective metal at causing decomposition of the anaesthetic mixtures even at lower temperatures.

Gas chromatography in anaesthesia. I. A brief review of analytical methods and gas chromatographic detector and column systems.

Practical applications and relevant studies involving the anaesthetic gases, have been extensively described in the literature. Many eminent analytical methods have already been developed for medical practice where routine analysis of anaesthetics is frequently needed, particularly during anaesthesia, and in related and respiratory research programmes. The determination of halothane, isoflurane, enflurane and nitrous oxide concentrations from vaporizers, in exhaled and inhaled gas mixtures, in body fluids and tissues is necessary to control anaesthetic concentrations, and thus, the relevant and adverse effects successfully. Therefore, a literature review, with particular emphasis on gas chromatography would provide important information for investigators in the search for a suitable analytical method for the analysis of multi-component mixtures of anaesthetic gases.