Browsing by Author "Cicek, Sevim Nuran Kuslu"

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Comparison of Domino Transplantation with Two-Way Paired Exchange and Normal Transplantation: Acute Rejection, Surgical Complications, and 5-Year Survival Outcomes
(Springer, 2025) Huseynov, Amil; Cicek, Sevim Nuran Kuslu
Background Domino kidney paired donation and Two-Way Paired Exchange have emerged as vital strategies to expand the donor pool in renal transplantation, especially for patients facing ABO or HLA incompatibilities. Despite their potential benefits, concerns remain regarding immunological risks, infectious complications, and long-term graft survival. Methods In this retrospective cohort study conducted at Medicana Transplant Center, 980 adult kidney transplant recipients were categorized into three groups: Domino (n = 144), Two-Way Paired Exchange (n = 350), and Normal Transplant (n = 486). Baseline characteristics, acute rejection rates, and surgical or infectious complications were collected, alongside data on 1-year and 5-year patient and graft survival. Statistical analysis included Kaplan-Meier survival curves and Cox proportional hazards modeling for independent predictors of graft outcomes. Results The Domino group had the highest 1-year acute rejection rate (17.4%) compared to Two-Way Paired Exchange (4.3%) and Normal Transplant (3.7%), yet 1-year graft survival rates remained comparable (92%, 95%, and 96%, respectively; p = 0.271). Infectious complications were more frequent in the Domino group (25%) than in others (p < 0.01). Extended follow-up to 5 years indicated no statistically significant difference in overall graft or patient survival among the three groups (log-rank p = 0.197), despite a trend toward lower 5-year graft survival in the Domino group. Donor-specific antibodies and higher HLA mismatches independently predicted acute rejection. Conclusions Domino transplantation, while associated with higher immunologic challenges, achieves acceptable short-term and 5-year outcomes akin to Two-Way Paired Exchange and Normal Transplant. Careful immunosuppressive strategies, vigilant monitoring, and collaborative protocols are integral for optimizing long-term success in high-risk transplant scenarios.
Factors Affecting the Presence of Renal Cortical Cysts in Kidney Donors
(Aves, 2024) Cicek, Sevim Nuran Kuslu; Huseynov, Amil
Objective: Simple renal cysts (SRCs) represent the most frequently occurring type of renal cysts, frequently observed in the elderly population. While generally considered benign, SRCs may sometimes be connected to comorbid conditions such as hypertension, aortic diseases, and renal dysfunction. This research aims to investigate the factors influencing the development of SRCs in kidney donors and the associated risks. Methods: This retrospective cohort study included 1012 living kidney donors, aged 18-87 years, who underwent renal transplant donor nephrectomy between 2008 and 2023. Data on demographic information, cyst characteristics, comorbidities, and associated risk factors were collected and analyzed using statistical methods, including Binary Logistic Regression Analysis. Renal cysts were identified and classified using computed tomography (CT) and magnetic resonance imaging (MRI) methods. Results: Renal cortical cysts were more frequently observed in males (52.76%) compared to females (47.24%), with a significant difference (P = .031). Donors with renal cortical cysts were significantly older (mean age 54.43 +/- 12.17 years) compared to those without cysts (46.26 +/- 12.35 years, P < .001). Substantial differences were likewise noted in fasting blood glucose, uric acid, creatinine, HbA1c, and glomerular filtration rate (GFR).The prevalence of aortic atherosclerosis was notably elevated in donors with cysts (47.74%) compared to those without (23.57%, P < .001). Binary logistic regression analysis indicated that older age and being male were significant factors influencing the presence of cortical cysts. Conclusion: The study confirms that SRCs are the most common renal cyst type and are more frequently observed in the elderly population. While generally benign, SRCs may be associated with increased uric acid levels and other comorbidities, suggesting potential impacts on kidney health. Additional studies are required to investigate these associations. The presence of SRCs in kidney donors is significantly associated with male gender, age, uric acid levels, and creatinine levels. These findings should be considered during the evaluation of potential kidney donors, particularly regarding the associated risks and management of SRCs.
Laparoscopic Hand-Assisted Donor Nephrectomy: A Decade of Single-Center Experience and Outcomes
(AVES, 2024) Cicek, Sevim Nuran Kuslu; Huseynov, Amil
Objective: Kidney transplantation is the most effective treatment for end-stage renal disease, but the shortage of cadaveric donors has increased reliance on living donors. Traditional open donor nephrectomy, while effective, is associated with significant morbidity. Hand-assisted laparoscopic donor nephrectomy (HALDN) combines the advantages of minimally invasive surgery with the tactile feedback of open surgery. This study presents the outcomes of HALDN procedures performed at the center. Methods: A total of 1221 living donor nephrectomies performed between September 2009 and August 2021 at Medicana & Idot;stanbul Hospital were analyzed. Donor characteristics, surgical details, and postoperative outcomes were recorded. Data analysis was conducted using SPSS version 22.0, with continuous variables assessed for normality and expressed accordingly. Results: Donor ages ranged from 19 to 87 years (mean 48.50 +/- 12.75 years), with 54.8% female donors. The average body mass index (BMI) was 27.99 +/- 3.7 kg/m2. Left-sided nephrectomies constituted 78.5% of cases, with HALDN performed in 94.7% of these surgeries. Warm ischemia time averaged 99.21 +/- 56.67 seconds. The average blood loss was 70 mL, and the mean hospital stay was 4.12 +/- 1.2 days. Complications included conversion to open surgery due to bleeding in 3.3% of cases, postoperative atelectasis (0.6%), incisional hernia (0.33%), wound infection (0.16%), and scrotal swelling (0.25%). The findings indicate that HALDN is a safe and effective method for donor nephrectomy, aligning with similar studies regarding operation and warm ischemia times. The minimally invasive nature of HALDN contributes to shorter hospital stays and quicker postoperative recovery. The rate of conversion to open surgery was within acceptable limits, and complications were manageable. Obesity (BMI > 30 kg/m2) was identified as a risk factor for incisional hernia, suggesting the need for careful surgical technique in this group. Conclusion: Hand-assisted laparoscopic donor nephrectomy offers a minimally invasive, safe, and effective alternative for living donor nephrectomy, enhancing donor recovery and potentially encouraging organ donation. Its adoption may play a significant role in reducing the number of patients awaiting organ transplants.
De Novo Malignancy Development Following Kidney Transplantation: Managing Risks and Outcomes in Clinical Practice
(Galenos Publ House, 2025) Huseynov, Amil; Cicek, Sevim Nuran Kuslu
Objective: Denovo malignancy is a significant complication following kidney transplantation, attributed to prolonged immunosuppression.This study evaluates the incidence, risk factors, and clinical outcomes of denovo malignancies in kidney transplant recipients. Material and Methods: A retrospective cohort analysis was conducted on 1200 kidney transplant recipients between 2016 and 2023. Patients were categorized based on the presence or absence of de novo malignancies. Statistical analyses were performed to identify risk factors, including age, sex, comorbidities, and immunosuppressive regimens. Patient and graft survival were assessed using Kaplan-Meier analysis and the log-rank test. Results: Among the study population, 43 patients (3.6%) developed de novo malignancies. The most frequent malignancy types were non-melanoma skin cancers (27.9%) and post-transplant lymphoproliferative disorders (18.6%). Patients with malignancies exhibited a lower three-year survival rate (83.7%) compared to those without malignancies (91.4%), though the difference was not statistically significant (p=0.067). Graft survival at three years was slightly lower in the malignancy group (84.0% vs. 88.7%, p=0.146). Older recipient age was identified as a significant risk factor (hazard ratio=1.03 per year, p=0.025). Conclusion: De novo malignancy remains a concern in kidney transplant recipients, particularly among older patients. Regular screening protocols, lifestyle interventions, and individualized immunosuppressive regimens are essential to mitigate risk and improve outcomes.
Results in Kidney Transplant Recipients from Living Donors 75 Years of Age or Older
(Elsevier Science Inc, 2024) Cicek, Sevim Nuran Kuslu; Huseynov, Amil; Tuncer, Murat
The increasing age of patients receiving renal replacement therapy (RRT) in Turkey, coupled with a shortage of kidney donors, has led to longer waiting times for transplants and an escalation in mortality rates. This retrospective study aimed to assess the effect on transplant outcomes of accepting kidneys from donors >= 70 years of age, given the rising number of older patients in the population. In all, 1400 patients were transplanted with kidneys from donors >50 years, with patient and graft survival as primary endpoints. Our results demonstrated that the most significant risk factors for graft function were recipient age >65 years, male sex, and presence of type 2 diabetes. Moreover, kidneys from donors >= 75 years of age achieved a half-life of 5 years. These findings suggest that donor age does not necessarily correlate with graft failure and that transplantation from older donors could help alleviate the organ shortage. Further research is needed to substantiate these conclusions.