Hüseyin Töz

Ege University, Ismir, İzmir, Turkey

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Publications (64)149.24 Total impact

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    ABSTRACT: Aim: Lupus nephritis (LN) is an important complication of systemic lupus erythematosus (SLE). The aim is to use indication and protocol biopsies to determine clinicopathological findings and outcomes of patients with LN undergoing kidney transplantation (KTx). Methods: Patients who underwent KTx due to LN were retrospectively analyzed. Recurrent LN (RLN) was diagnosed by transplant kidney biopsy. Results: Among 955 KTx patients, 12 patients with LN as the cause of end-stage renal disease were enrolled. Five patients were male. Mean follow-up time was 63 ± 34 months. At the last follow-up visit, mean levels of serum creatinine and proteinuria were 137.0 ± 69.0 µmol/L and 0.26 ± 0.26 gm/day, respectively. Eighteen indication and 22 protocol biopsies were performed; 27 of biopsies were additionally evaluated by immunofluorescence. In 2 recipients, subclinical RLN was confirmed by protocol biopsies. Clinical recurrence occurred in 4 patients. Among patients with RLN, time from diagnosis of LN to KTx was significantly shorter and use of ATG as induction treatment was significantly lower. Graft loss occurred in 2 recipients who had clinical RLN. Five-year overall graft survival was 85.7%. Conclusions: KTx is a reasonable option for patients with ESRD secondary to SLE. However, recurrence of LN is not rare if protocol biopsies are included in posttransplantation surveillance. This article is protected by copyright. All rights reserved.
    No preview · Article · Oct 2015 · Nephrology
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    ABSTRACT: Monitoring of allograft function entails methods more accurate than serum creatinin and creatinin-based GFR equations (eGFR). This prospective trial aimed at investigating the diagnostic accuracy of creatinin and cystatin-C based eGFR with measured GFR (mGFR) and compared them with graft fibrosis detected by protocol biopsies (PBx). Forty-four kidney transplant recipients were enrolled. PBx were obtained post-engraftment and at 6(th) and 12(th) months. GFR measured by Tc99m-DTPA at 3(th) , 6(th) and 12(th) months after transplantation. Significant correlation existed between eGFR and mGFR at 3, 6, and 12 months (p<0.0001). Cystatin-C based Hoek and Larsson equations had the lowest bias and highest accuracy. The sum of interstitial fibrosis and tubular atropy score increased from implantation to 6(th) and 12(th) month (0.52±0.79, 0.84±0.88, 1.50±1.35). This was accompanied by reduction of mGFR from 54.1±15.2, to 49.9±15.2 and 46.8±16.5 ml/min/1.73m(2) , while serum creatinin, cystatin-C, and eGFR remained stable. Neither creatinin nor cystatin C based GFR equations are reliable for detecting insidious graft fibrosis. In the first year after transplantation, mGFR, with its' best proximity to histopathology, can be used to monitor allograft function and insidious graft fibrosis. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2015 · Transplant International
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    ABSTRACT: Transplantation is the most effective treatment strategy for end-stage renal failure. We aimed to investigate the correlation of volume control parameters with health-related quality of life (HRQoL) in renal transplant patients in the pre- and post-transplant periods. Seventy-seven patients who underwent renal transplantation from deceased donors between January 2011 and January 2013 were included in the study. The biochemical markers, complete blood count, and creatinine levels were measured during the pre-transplant and at post-transplant 6th month. The Turkish version of Short Form 36 (SF-36) health survey questionnaires was used for the assessment of HRQoL. Blood pressure (BP) and echocardiographic measurements were used to evaluate the volume status. Significant improvements were achieved in all echocardiographic measurements, biochemical parameters except for Ca(2+) and SF-36 questionnaire domain score (DS)s except for vitality in the post-transplant period. Systolic BP (SBP), the left atrium index, vena cava inferior collapsibility index (VCCI), and diastolic BP were associated with vitality (P = .02, .03, .05, and .04, respectively), SBP was associated with social functioning (P < .01), and role emotional (P < .01) and left ventricular mass index were associated with mental health (P = .05) DSs in the pre-transplant period. In the post-transplant period, VCCI, left ventricular mass index, and SBP were associated with general health (P = .02, .05, and .05, respectively), VCCI and SBP were also associated with mental health (P = .05 and .01, respectively), and the left atrium index was associated with role emotional (P = .05) DSs. Concomitant improvement in the volemic status may contribute to improvements in HRQoL after renal transplantation. Copyright © 2014 Elsevier Inc. All rights reserved.
    No preview · Article · Jan 2015 · Transplantation Proceedings
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    ABSTRACT: The aim of the present study was to investigate the effect of cyclosporine-A (CsA) medication on gingival crevicular fluid (GCF) LL-37, human neutrophil peptide (HNP)1-3 and adrenomedullin (ADM) levels. CsA-treated renal transplant recipients with GO (CsA GO+) and without GO (CsA GO-), tacrolimus-medicated renal transplant recipients (n=20/group), systemically healthy subjects with gingivitis (n=21) and individuals free of periodontal and systemic diseases (n=20) were included in the present study. Periodontal parameters were recorded and GCF samples were obtained from the study participants. GCF LL-37, HNP1-3 and ADM levels were analyzed by enzyme-linked immunosorbent assay. GCF LL-37 total amount was higher at GO+ sites than the other study sites (p<0.05). Total amount of GCF HNP1-3 was higher in immunosuppressive treatment groups than healthy and gingivitis groups, regardless of GO presence (p<0.05). GCF ADM total amount was similar in all study groups. GCF volume, papillary bleeding index and hyperplastic index (p<0.05) were significantly correlated with GCF LL-37 total amounts (p<0.05), but not with GCF HNP1-3 and ADM total amount at GO+ sites (p>0.05). Neutrophil infiltration due to extended inflammation might have increased GCF LL-37 levels at GO+ sites and contributed to the pathogenesis of CsA-induced GO. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Full-text · Article · Dec 2014 · Archives of Oral Biology
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    ABSTRACT: Abstract The imbalance between organ demand and supply causes the increasing use of suboptimal donors. The aim of this study is to investigate the survival and allograft function of kidney transplantation from standard (SLD) and elderly living (ELD), standard criteria (SCDD) and expanded criteria deceased (ECDD) donors. All patients transplanted from 1997 to 2005 were investigated according to the donor characteristics. Data were collected retrospectively during the 83.4 ± 43.1 months of follow-up period. ELD was defined as donor age ≥60 years. ECDD was defined as UNOS criteria. A total of 458 patients were divided into four groups: SLD (n:191), ELD (n:67), SCDD (n:154), and ECDD (n:46). Seven-year death-censored graft survival in SLD, ELD, SCDD, and ECDD were 81.6%, 64.8%, 84.7%, and 68.3%, respectively (p = 0.003). The death-censored graft survival in ELD group was lower than in SLD (p = 0.007) and SCDD (p = 0.007) groups, while in ECDD group it was lower than in SCDD group (p = 0.026). Patient survival was similar. In ECDD group, 83% of total deaths occurred within the first 3 years, mainly due to infections (66.6%) (p < 0.05). Estimated glomerular filtration rate (eGFR) was lower in ELD (compared with SLD and SCDD); and ECDD (compared with SCDD) at last visit. In multivariate analysis, ELD, experience of an acute rejection episode and presence of delayed graft function were the independent predictors for death censored graft loss. Transplantation of a suboptimal kidney provides inferior graft survival and function. A higher number of deaths due to infection in the early post-transplant period in the ECDD group are noteworthy.
    Full-text · Article · Dec 2014 · Renal Failure
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    ABSTRACT: West Nile virus (WNV) infection which is asymptomatic or mild in normal population, it may cause serious clinical conditions leading to death in eldery and immunosupressed patients. The virus is mainly transmitted by mosquito bites, however transfusion, transplantation, transplasental and nosocomial ways have also been reported to be responsible for viral transmission. It is known that WNV may cause life-threatining conditions such as central nervous system (CNS) infections especially in bone marrow and solid organ transplant recipients. In this report, the first case of WNV encephalitis in an immunosuppressed patient with renal transplant in Turkey was presented. A 25-year-old male patient admitted to our hospital with the complaints of generalized myalgia, nausea and vomiting, after the 24. day of renal transplantation from a live donor. Since he developed diffuse tonic clonic seizures during his follow up, he was diagnosed as meningoencephalitis with the results of cranial magnetic resonance imaging (MR) and cerebrospinal fluid (CSF) biochemistry. Bacterial and fungal cultures of blood and CSF yielded negative results. CMV antigenemia test and CMV IgM in blood, and nucleic acid tests for CMV, EBV, HSV-1/2, VZV, HHV-6, enterovirus and parvovirus in CSF were also negative. However, WNV RNA was detected in CSF by an in-house reverse transcriptase (RT) nested PCR method. The sequence analysis (GenBank BLAST) of the virus showed that it had 99% similarity with Lineage-1 WNV strains. To define the transmission way of the virus to the recipient, WNV-RNA was searched in the renal biopsy sample and found negative by RT nested PCR. The clinical condition of the patient was improved with supportive therapy and by the de-escalation of immunosuppressive drugs [Mycophenolate mofetil (MMF; 1 g/day), cyclosporin (1 mg/kg/day)]. However WNV meningoencephalitis recurred one month later. The patient presented with fever, myalgia, confusions, leukocytosis, anemia, and repeating WNV-RNA positivity in CSF. This time cyclosporin was stopped, MMF was given in low dose (1 g/day), and high dose parenteral acyclovir and intravenous immunoglobulin (400 mg/kg/day, 7 days) were initiated. The patient recovered completely after 10 days without any neurological abnormalities. In conclusion, especially in endemic areas, WNV should be considered in the differential diagnosis of CNS infections develop in solid organ transplant cases and patients with other immunodeficiencies who present with fever, generalized myalgia, gastrointestinal symptoms and/or neurological disorders.
    No preview · Article · Oct 2014 · Mikrobiyoloji bülteni
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    Full-text · Conference Paper · Oct 2014
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    ABSTRACT: Chronic dialysis hypotension is described as low systolic blood pressure (<100 mmHg) during interdialytic period. The presence of low predialysis systolic blood pressure, typically <110 mmHg, is significantly associated with increased mortality. Kidney transplantation is the preferred model of renal replacement therapy in the treatment of end-stage renal disease (ESRD) as it improves quality of life and survival. In this article, a long-term hemodialysis (HD) patient with chronic hypotension improved after kidney transplantation is presented. A 39-year-old male patient received a deceased donor kidney transplant. The patient was on HD for 23 years. The patient had suffered from chronic persistent hypotension for the last 8 years. Blood pressure was 70/50 mmHg before dialysis and 60/40 mmHg after dialysis. In the post-transplant period, blood pressure was maintained above 110/70 mmHg by intermittent infusion of dopamine. Hypotension was improved after 24 days and dopamine was discontinued. Various etiologies may cause chronic hypotension in patients receiving long-term HD treatment. Kidney transplantation may improve survival and quality of life by correcting hypotension in these patients. Therefore kidney transplantation should not be avoided as renal replacement therapy in ESRD patients with hypotension.
    Full-text · Article · Jan 2014
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    ABSTRACT: Abstract Various reasons such as malignancies and chronic infections may cause weight loss in kidney transplant patients. In this report, iron overload as a rare cause of weight loss in a kidney transplant patient is presented. Forty-seven-year-old male patient who transplanted from a deceased donor 5 years ago was hospitalized because of 20 kg of weight loss. In medical history, he had history of hemodialysis for 89 months and received 100-300 mg of intravenous iron therapy per week before transplantation and transfused eight units of blood. In physical examination, weight and height were 45 kg and 185 cm, respectively. Respiratory and cardiac auscultation was normal. Laboratory results revealed as follow: glucose 76 mg/dL, urea 60 mg/dL, creatinine 1.35 mg/dL, aspartate aminotransferase 74 U/L, alanine aminotransferase 77 U/L, C-reactive protein 2.59 mg/dL, albumin 3.3 g/dL, globulin 3.4 g/dL, white blood cells 3200/mm(3), hemoglobin 13.1 g/dL and platelets 190,000/mm(3). Chest and abdominal tomography didn't reveal any pathology. Portal Doppler ultrasound showed signs of early cirrhosis. Viral and autoimmune hepatitis markers were negative. Ferritin was 5300 ng/mL and transferrin saturation was 82%. In liver biopsy, hemosiderosis was diagnosed and heterozygous H63D gene mutation was detected. Totally, 19 units of phlebotomy were performed. Liver function tests and serum ferritin decreased gradually. At outpatient follow-up in 6 months, he returned to former weight. In conclusion, there can be several causes of weight loss in kidney transplant patients. Iron overload can come across as a rare cause of weight loss. In these patients, ferritin levels should be checked and diagnosis should be clarified by liver biopsy and gene mutation analysis.
    Full-text · Article · Sep 2013 · Renal Failure
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    ABSTRACT: OBJECTIVE: Measurement of carotid artery intima-media thickness (CA-IMT) is directly associated with cardiovascular (CV) outcomes. We retrospectively investigated the impact of CA-IMT progression on new CV events in patients on peritoneal dialysis (PD). MATERIAL and METHODS: All PD patients who have been followed in our unit (n=163) were screened. The patients who had no CA-IMT were excluded. Ninety-six patients who had baseline CA-IMT measurement were included. Fifty-two patients had second CA-IMT measurement. Fatal and nonfatal CV events were screened from patients' charts. RESULTS: At baseline, mean CA-IMT was 0.62±0.16 mm (median 0.60 mm). In patients treated with PD more than 2 years, CV event rate was higher in patients with high CA-IMT (>0.60 mm) compared to the patients with low CA-IMT at baseline (22.2% versus 4.2%, p=0.041).
    Full-text · Article · Jul 2013
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    ABSTRACT: The term cardiorenal syndrome (CRS) has been used to define interactions between acute or chronic dysfunction of the heart or kidney. When primary chronic kidney disease contribute to cardiac dysfunction, it is classified as type 4 CRS. Cardiac dilatation, valve regurgitations, and left ventricular dysfunction are observed in end-stage renal failure patients with uremic cardiomyopathy. Because of perioperative risks in these patients, they may not be considered a candidate for kidney transplantation. However, uremic cardiomyopathy can be corrected when volume control is achieved by appropriate dose and duration of ultrafiltration. By presenting two cases with occult hypervolemia in uremic cardiomyopathy whose cardiac functions improved early after kidney transplantation, attention is drawn to the importance of kidney transplantation on cardiac function in such patients primarily and the importance of strict volume control on cardiac function in dialysis patients waiting for kidney transplantation.
    Full-text · Article · Apr 2013 · Renal Failure
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    ABSTRACT: Although the number of end-stage renal disease patients on the waiting list has increased, the number of deceased kidney donors has not increased proportionately. Therefore, the use of kidney donors defined as "marginal" has become an issue. Since the acceptance of deaths due to poisoning or suicide as donors has been proposed, we evaluated the clinical courses of kidney transplantations from suicidal death donors. We analyzed retrospectively the outcomes of nine deceased donor kidneys (8 males) from suicide victims between 2001 and 2012. Demographic and clinical characteristics of donors and recipients were collected from medical files. The mean donor age was 27.8 ± 11.9 years. Causes of death were: gunshot wounds to the head (n:4), pesticide intoxication (n:2), methanol intoxication (n:1), hanging (n:1), or carotid artery laceration (n:1). Mean donor creatinine level, urine output per hour, and 24-hour urine volume were 0.94 ± 0.53 mg/dL, 270 ± 113 mL, and 5496 ± 832 mL, respectively. Mean cold ischemia time was 12.3 ± 5.7 hours. Primary allograft nonfunction occurred in one recipient requiring nephrectomy. The average posttransplantation creatinine level at 1 year was 1.19 ± 0.62 mg/dL. The mean follow-up was 55 ± 49 months. Allograft loss occurred due to chronic rejection in three patients at 10, 37, and 40 months. Five patients are still undergoing follow-up with functioning grafts. Brain death cases caused by the suicide should be considered for organ donation.
    Full-text · Article · Apr 2013 · Transplantation Proceedings
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    Ö. Güngör · Erhan Tatar · H. Töz
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    ABSTRACT: In clinical practice, plasmapheresis is utilized to remove circulating immune complexes, endotoxins and high molecular weight molecules such as lipoproteins containing cholesterol. It is useful in certain diseases in rheumatology, oncology, dermatology and nephrology. Renal transplantation is the most exclusive treatment modality in end stage renal failure. Acute and chronic rejections along with the recurrence of the primary kidney disease at the post-transplant period shorten graft survival. Plasmapheresis treatment can be used both at the pre- and post-transplant period in cases of ABO incompatibility, highly sensitized patients, acute and chronic rejections, recurring glomerulonephritis and thrombotic microangiopathies.
    Full-text · Article · Jan 2013
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    ABSTRACT: Solid organ transplantation is a risk factor for mucormycosis. Mucormycosis is a necrotizing opportunistic fungal infection with high morbidity and mortality. We report a fatal mucormycosis case with rhino-orbital-cerebral involvement in a renal transplant patient, which presented with orbital apex syndrome and hemiplegia.
    Full-text · Article · Sep 2012 · International Urology and Nephrology

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  • No preview · Article · Jan 2012
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    ABSTRACT: The number of women who would like to have a baby after renal transplantation has increased. The aim of this study was to evaluate the effects of pregnancy on the lipid profiles and renal functions among transplantation patients as well as the maternal and fetal results of pregnancy. We searched files of female patients who underwent renal transplantation between 1998 and 2008 to discover 31 pregnancies among 24 women. Mean duration of dialysis and age at transplantation for the 24 cases were 22.7 ± 24.1 months (range, 0-72) and 21.2 ± 4.6 years (range, 13-34), respectively. The time between transplantation and conception as well as age at conception were 5.2 ± 1.9 and 26.4 ± 4.4 years, respectively. Creatinine levels in the second trimester were significantly lower (P = .000). Gestational bicarbonate and albumin levels were significantly lower (P = .009 and P = .001, respectively). There were significant differences between the preconception triglyceride (TG) and those in the second and third trimesters (P = .006 and P = .00, respectively). TG levels increased as trimesters progressed (P = .000). Moreover, TG levels were higher among patients taking cyclosporine. Of pregnancies that passed the first trimester, 88.4% resulted in live births. There were 23 (74.19%) live births among 31 pregnancies with a cesarean section rate of 58%. Of the cases, 16.1% delivered preterm and 19.4% of babies had low birth weights. We believe that women with renal transplants can have healthy babies with close monitoring during pregnancy and without any effect on graft survival.
    No preview · Article · Sep 2011 · Transplantation Proceedings
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    ABSTRACT: The aim of this cross-sectional study is to investigate gingival crevicular fluid (GCF) osteocalcin, cross-linked N-terminal telopeptide (NTx), and calprotectin levels in cyclosporin A (CsA)-induced gingival overgrowth (GO). Forty medicated patients with CsA including 20 with GO (CsA GO+), 10 without GO (CsA GO-), 10 with GO and chronic periodontitis (CsA CP) and 60 patients with CP alone, 20 patients with gingivitis, and 20 healthy patients were enrolled. Probing depth, clinical attachment level, plaque index, and papillary bleeding index were recorded. GCF calprotectin, osteocalcin, and NTx levels were analyzed by enzyme-linked immunosorbent assay. Parametric tests were used for statistical analysis. The CsA GO+ and CP groups had significantly lower GCF osteocalcin levels and osteocalcin/NTx ratio than the healthy group, whereas GCF osteocalcin levels and osteocalcin/NTx ratio in the gingivitis group were higher than the CsA GO+, CsA GO-, CsA CP, and CP groups (P <0.05). The CP group had elevated GCF calprotectin levels compared to the other study groups (P <0.05). The CsA GO+ and CsA GO- groups also had higher GCF calprotectin levels compared to the CsA CP, gingivitis, and healthy groups (P <0.05). Increased GCF calprotectin and decreased GCF osteocalcin levels in the CsA GO+ and CsA GO- groups might suggest that CsA plays a role on the levels of these markers. The similarity of GCF osteocalcin, NTx, and calprotectin levels in the CsA GO+ and CsA GO- groups might suggest that these molecules are not involved in the pathogenesis of GO.
    Full-text · Article · Feb 2011 · Journal of Periodontology

  • No preview · Article · Jan 2011 · Journal of Periodontology
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    ABSTRACT: The rationale of this study was to address whether local or systemic changes reflect proteolytic (matrix metalloproteinase-13) or oxidative (myeloperoxidase) stress in renal transplant patients receiving cyclosporine-A (CsA) and having gingival overgrowth (GO), in patients receiving CsA therapy and having no GO and patients receiving tacrolimus therapy. Gingival crevicular fluid (GCF) samples were collected from sites with (GO+) and without GO (GO-) in CsA patients having GO; GO- sites in CsA patients having no GO; sites from tacrolimus, gingivitis and healthy subjects. GCF and serum myeloperoxidase (MPO) and matrix metalloproteinase-13 (MMP-13) levels were determined by ELISA. GO+ sites in CsA patients having GO had elevated GCF MPO levels than those of CsA patients having no GO, tacrolimus and healthy subjects (p<0.005), but comparable to those of gingivitis. GCF MPO levels were higher in GO+ compared to GO- sites in CsA patients having GO (p<0.05). Patient groups had similar, but higher GCF MMP-13 levels than healthy group. These results show that CsA and tacrolimus therapy have not a significant effect on GCF MPO and MMP-13 levels, and gingival inflammation seems to be the main reason for their elevations.
    Full-text · Article · Oct 2010 · Archives of oral biology