Browsing by Author "Gürkan, Alp"

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A Comparative Analysis of Once-daily and Twice-daily Formulation of Tacrolimus in De Novo Kidney Transplant Recipients
(Kare Publ, 2021) Ferhatoglu, Murat Ferhat; Kartal, Abdulcabbar; Kivilcim, Taner; Filiz, Ali Ilker; Yildiz, Gursel; Gurkan, Alp
Objectives: We aimed to compare the once-daily and twice-daily formulation of tacrolimus concerning the efficiency and effects on graft function in de novo kidney transplant patients. Methods: Twenty once-daily (TAC-OD) and twenty twice-daily (TAC-BID) tacrolimus administrated de novo kidney recipients who had received initial immunosuppressive therapy according to protocols at our institution (0.2 mg/kg of tacrolimus combined with 1000 milligrams of steroid taper plus 720 mg of mycophenolate and with 2.5mg/kg anti-thymocyte globulin) assessed concerning demographics, drug doses and blood concentration, and graft function. Results: The mean tacrolimus blood concentration measurements were higher in the TAC-OD group in the first sixty days after transplantation, and the TAC- OD group showed more blood concentration overshoots/fluctuations in the first 30 days of the treatment. The initial drug dose was significantly higher in the TAC-OD group than the TAC-BID group (p=0.04). There was no meaningful difference among groups according to graft function (creatinine measurements) (p>0.05). Conclusion: Between de novo kidney recipients, the new TAC-OD formulation presents a similar short-term efficacy profile as TACBID. However, a higher daily dosage of TAC-OD is needed to achieve similar blood concentrations in the early postoperative period.
Evaluation of Male Circumcision: Retrospective Analysis of One Hundred and Ninety-eight Patients
(Springernature, 2019) Ferhatoglu, Murat F.; Kartal, Abdulcabbar; Gurkan, Alp
Introduction Circumcision is the oldest and most frequently used surgical procedure. It dates back to at least 10,000 years from today. The debate on the benefits and necessity of circumcision is ongoing. In this study, we aimed to determine the complications and complication rate of circumcisions occurring in our circumcision clinic and to compare these with the complication rates in the world. Methods A total of 198 male patients circumcised between 2011 at 2019 at Bursa State Hospital was enrolled in the presented retrospective study. Demographic data of the patients were assessed and the height and weight of the patients were evaluated according to the child growth standards and weight for age percentile charts for boys of the World Health Organization (WHO). All early or late complications were noted after circumcision. Results The mean age of the patients was 93.57 +/- 40.12 (2-248) months. The mean follow-up time was 16.32 +/- 9.24 (2-35) months. Sixteen patients had bleeding, four patients had a penile hematoma, and 108 patients had penile edema. There is no statistically significant difference in the penile edema occurrence according to the weight of the patients (p=0.58). Conclusion Circumcision is a frequently applied procedure. Like any other surgery, perioperative and postoperative complications can be observed. More importantly, a significant number of these complications can be prevented by careful surgery and postoperative care.
Evaluation of the relationship between perioperative urine culture and postoperative urinary tract infections in renal transplant patients
(2019) Murat Ferhat FERHATOĞLU; Ali İlker FİLİZ; Abut KEBUDİ; Abdülcabbar KARTAL; Alp GÜRKAN; Taner KIVILCIM; Gürsel YILDIZ
Aim: The aim of the study was to determine the prevalence and risk factors of bacterial urinary tract infection (UTI) in patientsundergoing renal transplantation and to evaluate the possible bacterial agents that colonize the bladder in patients with or withoutmicturition beforehand.Material and Methods: A total of 89 renal transplant patients were included in the study. Demographic characteristics of the patientssuch as age and gender, as well as the presence of micturition before transplantation, clinical findings, urine culture, and agents thatshowed growth were all retrospectively analyzed and the relevant data were recorded.Results: Of the total 89 patients, 17 (19.10%) developed a urinary tract infection within 12 months after transplantation. Eight ofthese patients required hospitalization for treatment, while four had at least two infection episodes. Escherichia coli and Klebsiellapneumonia were the two most common causative agents. A comparison of the groups with and without UTI revealed that micturitionbefore transplantation was not a factor that affected the development of UTI (p > 0.05).Conclusion: Because UTI represents a severe problem for renal transplant patients, it must be evaluated in all patients. No correlationwas found between preoperative micturition and postoperative UTI.
General surgeons’ approach to laparoscopic inguinal hernia surgery and training expectations in Turkey: A webbased survey
(2019) Murat Ferhat FERHATOĞLU; Alp GÜRKAN; Taner KIVILCIM; Abdulcabbar KARTAL; Abut KEBUDİ; Ali İlker FİLİZ
Aim: In this study, we aimed to determine the approach of general surgeons toward laparoscopic inguinal hernia surgery and trainingneeds of surgeons and to collate data that will help formation of training programs or the development of current training programs.Material and Methods: A survey study was designed with 15 questions, including questions regarding determination of characteristicsof their trainings, surgical preferences, and their knowledge and approach toward laparoscopic inguinal hernia surgery. Generalsurgeons in Turkey invited to study on a voluntary basis by using Turkish Surgical Association’s official website.Results: A total of 160 surveys were completed included to the study. Of the total participants, 54.4% included laparoscopic herniasurgery in their daily applications. It was observed that most prevalently used surgical method (60.9%) was total extraperitonealapproach. Of 73 participants, 39 (52.8%) who did not include laparoscopic inguinal hernia surgery into daily surgical proceduresstated that they inform the patients about laparoscopic inguinal hernia surgery during the pre-operative evaluation. The rate ofperforming laparoscopic inguinal hernia surgery was found to be lower among those who had been working for ≥10 years (p = 0.001).Moreover, it was observed that only 18 (34.6%) of the 52 participants, who had been working for ≥10 years and who did not includelaparoscopic hernia repair into their daily surgical procedures, wanted to receive training.Conclusion: General surgeons have a difference of opinion on the benefits of laparoscopic inguinal hernia repair. It is necessary todetermine the obstacles for laparoscopic inguinal hernia surgery to be performed prevalently. Academic institutions designing andbringing the training programs into action can help inform surgeons who want and need the trainings, and success can be obtainedin shortening the time the learning curve takes and lowering of the recurrence and complication rates by continuous medical trainingprograms conducted routinely.
The Positive Effects of Preoperative Chlorhexidine Rinse To Reduce Postoperative Pneumonia After Kidney Transplantation Surgery
(Royal College Surgeons Edinburgh, 2025) Ferhatoglu, Murat Ferhat; Sahin, Osman Z.; Kivilcim, Taner; Gurkan, Alp
Background: Postoperative pneumonia is one of the most observed hospital-acquired infections and increases the postoperative mortality rate. Further, it drives the healthcare systems under a severe financial burden. Preventing postoperative pneumonia is an incredibly challenging issue for clinicians. Since immunosuppression therapy, the patients who had kidney transplants are more vulnerable to postoperative infections. There is no data in the scientific literature focusing on the effects of preoperative oral care with chlorhexidine antiseptic solutions on postoperative pneumonia in kidney transplantation surgery cases. In the present research, we studied this topic. Methods: A prospective, randomized clinical trial was conducted at our institution between August 2020 and August 2022. Group A: Received 0.12 % chlorhexidine oral rinse preoperatively; Group B: Not received 0.12 % chlorhexidine oral rinse preoperatively. We analyzed the differences between the two trial groups using a chi-square or t-test. The Mann-Whitney U test was used for the categorical data. Results: Nine patients (17.6 %) were diagnosed with postoperative pneumonia in Group A and fourteen (25.9 %) in Group B (p < 0.05). Hospitalization time of Group B was prolonged (p < 0.05). In multivariate analysis, significant risk factors associated with postoperative pneumonia were advanced age, diabetes mellitus, smoking, delayed graft function and not gargling with 0.12 % chlorhexidine (p < 0.05). Conclusions: To reduce postoperative pneumonia risk in patients undergoing kidney transplantation surgery, an oral health protocol including 0.12 % chlorhexidine mouth rinse seems beneficial.
RENAL TRANSPLANTASYON HAZIRLIĞINDA MULTİ-DEDEKTÖR BİLGİSAYARLI TOMOGRAFİ ANJİYOGRAFİ İLE DONÖR ADAYLARININ DEĞERLENDİRİLMESİ
(2024) Doğan, Demet; Gökce, Kağan; Kıvılcım, Taner; Gürkan, Alp
Amaç: Böbrek donör adayı olarak başvuran kişilere uygulanan Multidedektörlü Bilgisayarlı Tomografi Anjiyografi (MDBTA) incelemesinde; kişinin donör olmasını engelleyebilecek veya cerrahi yaklaşımın değişmesine neden olabilecek renal ve ekstra renal bulgularımızı bildirmeyi amaçlamaktayız. Nakil öncesi donör değerlendirmesi için yapılan MDBTA incelemesinin ve sonuçlarının transplantasyon planlaması üzerindeki etkisinin altını çizmeyi hedeflemekteyiz. Yöntem: Çalışmamızda Ocak 2017 ile Kasım 2022 tarihleri arasında 496 böbrek verici adayına uygulanan renal MDBTA tetkiki retrospektif olarak değerlendirdi. Her iki böbreğin boyutu ve parankim kalınlığı ölçüldü. Her iki taraf renal arter ve venin çapı, sayıları, varyasyonları, anomalileri tespit edildi. Renal ve diğer batın içi patolojiler belirlendi. Tüm bu değerlendirmelerin sonucunda böbrek nakline engel olan bulgular saptandı. Böbrek nakli için donör adaylarının preoperatif değerlendirilmesinde MDBTA bulguları ve bu bulguların cerrahi yaklaşımı ne oranda etkilediği belirlendi. Bulgular: 496 böbrek verici adayının 273’ü erkek, 223’ü kadın idi. Verici adaylarının yaş aralığı 20-85 arasındaydı, yaş ortalaması ise 46,25±13,2 idi. 278 tanesi donör adayı olmuş, 218 aday çeşitli nedenler ile elenmiştir. Bunların 22 tanesi MDBTA’de tespit edilen bulgulara bağlı olarak donör olamamıştır. Nakile engel olan en sık MDBTA bulgusu ise bilateral böbrek taşı idi. Sonuç: Renal transplant öncesi nakile engel olacak batın içi renal ve ekstrarenal patolojilerin değerlendirilmesi oldukça önemlidir. Renal MDBTA; canlı böbrek donörlerinin minimal invaziv, hızlı ve doğru bir şekilde değerlendirilmesini sağlar. Bu nedenle MDBTA renal transplantasyon öncesi değerlendirmede kullanımı gittikçe yaygınlaşan bir görüntüleme yöntemidir.
Retrospective Analysis of the first 100 Kidney Transplants at the Istanbul Okan University, Health Application and Research Center
(Kare Publ, 2019) Ferhatoglu, Murat Ferhat; Kartal, Abdulcabbar; Kivilcim, Taner; Filiz, Ali Ilker; Kebudi, Abut; Gurkan, Alp
Objectives: The renal transplant program of Istanbul Okan University Hospital started in August 2017. Five cadaveric and 95 living donor kidney transplants have been performed for over 16 months. In this study, we aimed to share our experiences regarding kidney transplantation. Methods: In this study, a retrospective analysis of 100 patients who underwent kidney transplantation at the Istanbul Okan University over 16 months, the Health Application and Research Center was carried out. Patients' demographics, creatinine levels of donors and recipients, co-morbid conditions, postoperative complications, features of arterial anastomosis and arterial variations observed on computed tomography angiography of donor-patient were assessed. Results: Mean age of donor patients was 44.05 +/- 13.76 (18-71) years. All living donors had computed tomography angiography for assessment of the vascular structure of both kidneys. Accessory right kidney artery was the most dominant vascular variation (16.5%). The primary cause of chronic renal disease was diabetes mellitus (36.4%) and hypertension (15.6%). Mean warm and cold ischemia time was 1.82 +/- 0.44 (1-3) and 40.25 +/- 6.12 (31-57) minutes, respectively. The most observed postoperative complication was stenosis of ureter anastomosis (4.1%). End-to-end arterial anastomosis between renal and internal iliac arteries was the most preferred anastomosis (57.2%). Conclusion: Increasing kidney transplantation, which is the most appropriate treatment in terms of cost-effectiveness, will be beneficial for patient health and economy of the country.
Vascular variations of the kidney, retrospective analysis of computed tomography images of ninety-one laparoscopic donor nephrectomies, and comparison of computed tomography images with perioperative findings
(Via Medica, 2020) Ferhatoglu, M. F.; Atli, E.; Gurkan, A.; Kebudi, A.
Background: In this retrospective study, we aimed to determine the variations of kidney arteries and veins in kidney donor patients who underwent preoperative, computed tomography angiography (CTA). Materials and methods: We analysed kidney CTA findings of 91 donor nephrectomy patients operated from July 2016 through December 2017. Demographics, vascular diameters, abnormalities, numbers, branching variations, routing variations of arteries, and veins were assessed according to CTA images. We also compared the radiological findings with perioperative findings. Two radiologists evaluated CTA images, and the same surgical team performed all donor nephrectomies by laparoscopic approach. Results: Ninety-one of the 96 patients involved to study. Forty-six (50.5%) patients were female. Thirty-five (38.4%) of 91 cases had accessory arteries. Seven (7.6%) right, 1 (1.1%) left and 8 (8.7%) bilateral double hilar artery was observed on CTA. No statistically significant difference was observed in the evaluation of the side of accessory/polar arteries (p > 0.05), and in the evaluation of the distribution of arterial/venous variations according to perioperative findings (p > 0.05). However, in the evaluation of CTA images, we found that the diameter of the kidney artery and vein differed according to gender and side. Conclusions: The knowledge of the vascular variations of the kidney is essential for surgeons performing kidney transplantation. It is also essential for urologist and vascular surgeons. Incompatible with the literature, the right kidney has more vascular variations and, one kidney artery is found in the majority of Turkish kidney donor patients.