Person: VELİOĞLU, ARZU
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VELİOĞLU
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ARZU
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Publication Open Access The 3-step model of informed consent for living kidney donation: A proposal on behalf of the DESCaRTES working group of the european renal association(2023-01-01) VELİOĞLU, ARZU; Grossi A. A., Sever M. S., Hellemans R., Mariat C., Crespo M., Watschinger B., Peruzzi L., Demir E., VELİOĞLU A., Gandolfini I., et al.Living donation challenges the ethical principle of non-maleficence in that it exposes healthy persons to risks for the benefit of someone else. This makes safety, informed consent (IC) and education a priority. Living kidney donation has multiple benefits for the potential donor, but there are also several known short- and long-term risks. Although complete standardization of IC is likely to be unattainable, studies have emphasized the need for a standardized IC process to enable equitable educational and decision-making prospects for the prevention of inequities across transplant centers. Based on the Three-Talk Model of shared decision-making by Elwyn et al., we propose a model, named 3-Step (S) Model, where each step coincides with the three ideal timings of the process leading the living donor to the decision to pursue living donation: prior to the need for kidney replacement therapy (team talk); at the local nephrology unit or transplant center, with transplant clinicians and surgeons prior to evaluations start (option talk); and throughout evaluation, after having learned about the different aspects of donation, especially if there are second thoughts or doubts (decision talk). Based on the 3-S Model, to deliver conceptual and practical guidance to nephrologists and transplant clinicians, we provide recommendations for standardization of the timing, content, modalities for communicating risks and assessment of understanding prior to donation. The 3-S Model successfully allows an integration between standardization and individualization of IC, enabling a person-centered approach to potential donors. Studies will assess the effectiveness of the 3-S Model in kidney transplant clinical practice.Publication Open Access COVID-19 in hospitalized lung and non-lung solid organ transplant recipients: A comparative analysis from a multicenter study(WILEY, 2021-08) VELİOĞLU, ARZU; Heldman, Madeleine R.; Kates, Olivia S.; Safa, Kassem; Kotton, Camille N.; Georgia, Sarah J.; Steinbrink, Julie M.; Alexander, Barbara D.; Hemmersbach-Miller, Marion; Blumberg, Emily A.; Crespo, Maria M.; Multani, Ashrit; Lewis, Angelica, V; Beaird, Omer Eugene; Haydel, Brandy; La Hoz, Ricardo M.; Moni, Lisset; Condor, Yesabeli; Flores, Sandra; Munoz, Carlos G.; Guitierrez, Juan; Diaz, Esther, I; Diaz, Daniela; Vianna, Rodrigo; Guerra, Giselle; Loebe, Matthias; Rakita, Robert M.; Malinis, Maricar; Azar, Marwan M.; Hemmige, Vagish; McCort, Margaret E.; Chaudhry, Zohra S.; Singh, Pooja; Hughes, Kailey; Velioglu, Arzu; Yabu, Julie M.; Morillis, Jose A.; Mehta, Sapna A.; Tanna, Sajal D.; Ison, Michael G.; Tomic, Rade; Derenge, Ariella Candace; van Duin, David; Maximin, Adrienne; Gilbert, Carlene; Goldman, Jason D.; Sehgal, Sameep; Weisshaar, Dana; Girgis, Reda E.; Nelson, Joanna; Lease, Erika D.; Limaye, Ajit P.; Fisher, Cynthia E.Lung transplant recipients (LTR) with coronavirus disease 2019 (COVID-19) may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been explored. We performed a multicenter cohort study of adult SOTR with COVID-19 to compare mortality by 28 days between hospitalized LTR and non-lung SOTR. Multivariable logistic regression models were used to assess comorbidity-adjusted mortality among LTR vs. non-lung SOTR and to determine risk factors for death in LTR. Of 1,616 SOTR with COVID-19, 1,081 (66%) were hospitalized including 120/159 (75%) LTR and 961/1457 (66%) non-lung SOTR (p = .02). Mortality was higher among LTR compared to non-lung SOTR (24% vs. 16%, respectively, p = .032), and lung transplant was independently associated with death after adjusting for age and comorbidities (aOR 1.7, 95% CI 1.0-2.6, p = .04). Among LTR, chronic lung allograft dysfunction (aOR 3.3, 95% CI 1.0-11.3, p = .05) was the only independent risk factor for mortality and age >65 years, heart failure and obesity were not independently associated with death. Among SOTR hospitalized for COVID-19, LTR had higher mortality than non-lung SOTR. In LTR, chronic allograft dysfunction was independently associated with mortality.Publication Open Access Pseudoporphyria in a Peritoneal Dialysis Patient(MULTIMED INC, 2015-03) VELİOĞLU, ARZU; Velioglu, Arzu; Ergun, Tulin; Ozener, CetinPublication Open Access Low bone density, vertebral fracture and FRAX score in kidney transplant recipients: A cross-sectional cohort study(PUBLIC LIBRARY SCIENCE, 2021-04-30) VELİOĞLU, ARZU; Velioglu, Arzu; Kaya, Burcu; Aykent, Basar; Ozkan, Bige; Karapinar, Melis Sevil; Arikan, Hakki; Asicioglu, Ebru; Bugdayci, Onur; Yavuz, Dilek Gogas; Tuglular, SerhanBackground Kidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients. Patients-method Patients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD. Results One hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,511,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024-1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015-0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (>= 20% risk of fracture), and 23.5% had high hip fracture probability (>= 3% risk of hip fracture) according to FRAX. Conclusion Exploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population.Publication Open Access Immunosuppression of HLA identical living-donor kidney transplant recipients: A systematic review(2023-12-01) VELİOĞLU, ARZU; Pérez-Sáez M. J., Montero N., Oliveras L., Redondo-Pachón D., Martínez-Simón D., Abramovicz D., Maggiore U., Mariat C., Mjoen G., Oniscu G. C., et al.Background: Kidney transplant (KT) recipients of HLA identical siblings (HLAid) have lower immunological risk, but there are no specific recommendations for immunosuppression. Our aim was to analyze evidence about results from HLAid living-donor recipients under different immunosuppression in the current era of immunological risk assessment. Methods: Systematic review of studies describing associations between outcomes of HLAid living-donor KT recipients according to their immunological risk and applied immunosuppression. Results: From 1351 studies, 16 (5636 KT recipients) were included in the analysis. All studies were retrospective, ten comparing immunosuppression strategies, and six immunological risk strata. Of those ten, six studies were published in 1990 or earlier and only three included tacrolimus. The evidence is poor, and the inclusion of calcineurin inhibitors does not demonstrate better results. Furthermore, only few studies describe different immunosuppression regimens according to the patient immunological risk and, in general, they do not include the assessment with new solid phase assays. Conclusions: There are no studies analyzing the association of outcomes of HLAid KT recipients with current immunological risk tools. In the absence of evidence, no decision or proposal of immunosuppression adapted to modern immunological risk assessment can be made currently by the Descartes Working Group.Publication Open Access Propensity score-matched analysis of long-term outcomes for living kidney donation in alternative complement pathway diseases: A pilot study(2023-02-01) VELİOĞLU, ARZU; Caliskan Y., Safak S., Oto O. A., Velioglu A., Yelken B., Mirioglu S., Dirim A. B., Yildiz A., Guller N., Yazici H., et al.Background Atypical hemolytic syndrome (aHUS) and C3 glomerulopathy (C3G) are complement-mediated rare diseases with excessive activation of the alternative pathway. Data to guide the evaluation of living-donor candidates for aHUS and C3G are very limited. The outcomes of living donors to recipients with aHUS and C3G (Complement disease-living donor group) were compared with a control group to improve our understanding of the clinical course and outcomes of living donation in this context.Methods Complement disease-living donor group [n = 28; aHUS(53.6%), C3G(46.4%)] and propensity score-matched control-living donor group (n = 28) were retrospectively identified from 4 centers (2003-2021) and followed for major cardiac events (MACE), de novo hypertension, thrombotic microangiopathy (TMA), cancer, death, estimated glomerular filtration rate (eGFR) and proteinuria after donation.Results None of the donors for recipients with complement-related kidney diseases experienced MACE or TMA whereas two donors in the control group developed MACE (7.1%) after 8 (IQR, 2.6-12.8) years (p = 0.15). New-onset hypertension was similar between complement disease and control donor groups (21.4% vs 25%, respectively, p = 0.75). There were no differences between study groups regarding last eGFR and proteinuria levels (p = 0.11 and p = 0.70, respectively). One related donor for a recipient with complement-related kidney disease developed gastric cancer and another related donor developed a brain tumor and died in the 4th year after donation (2, 7.1% vs none, p = 0.15). No recipient had donor-specific human leukocyte antigen antibodies at the time of transplantation. Median follow-up period of transplant recipients was 5 years (IQR, 3-7). Eleven (39.3%) recipients [aHUS (n = 3) and C3G (n = 8)] lost their allografts during the follow-up period. Causes of allograft loss were chronic antibody-mediated rejection in 6 recipients and recurrence of C3G in 5. Last serum creatinine and last eGFR of the remaining patients on follow up were 1.03 +/- 038 mg/dL and 73.2 +/- 19.9 m/min/1.73 m2 for aHUS patients and 1.30 +/- 0.23 mg/dL and 56.4 +/- 5.5 m/min/1.73 m2 for C3G patients.Conclusion The present study highlights the importance and complexity of living related-donor kidney transplant for patients with complement-related kidney disorders and motivates the need for further research to determine the optimal risk -assessment for living donor candidates to recipients with aHUS and C3G.Publication Open Access Middle-term outcomes in renal transplant recipients with covid-19: A national, multicenter, controlled study(2022-04-01) VELİOĞLU, ARZU; KAYA, BURCU; Oto O. A., Ozturk S., ARICI M., VELİOĞLU A., DURSUN B., Guller N., ŞAHİN İ., Eser Z. E., PAYDAŞ S., TRABULUS S., et al.Background In this study, we evaluated 3-month clinical outcomes of kidney transplant recipients (KTR) recovering from COVID-19 and compared them with a control group. Method The primary endpoint was death in the third month. Secondary endpoints were ongoing respiratory symptoms, need for home oxygen therapy, rehospitalization for any reason, lower respiratory tract infection, urinary tract infection, biopsy-proven acute rejection, venous/arterial thromboembolic event, cytomegalovirus (CMV) infection/disease and BK viruria/viremia at 3 months. Results A total of 944 KTR from 29 different centers were included in this study (523 patients in the COVID-19 group; 421 patients in the control group). The mean age was 46 +/- 12 years (interquartile range 37-55) and 532 (56.4%) of them were male. Total number of deaths was 8 [7 (1.3%) in COVID-19 group, 1 (0.2%) in control group; P = 0.082]. The proportion of patients with ongoing respiratory symptoms [43 (8.2%) versus 4 (1.0%); P Conclusion The prevalence of ongoing respiratory symptoms increased in the first 3 months post-COVID in KTRs who have recovered from COVID-19, but mortality was not significantly different.Publication Open Access Recommendations for kidney patients in covid-19 era based on current evidence(2022-01-01) VELİOĞLU, ARZU; TUĞLULAR, ZÜBEYDE SERHAN; Ozturk S., VELİOĞLU A., TUĞLULAR Z. S.Patients with chronic kidney disease, patients on dialysis, and kidney transplant recipients are at high risk of mortality and morbidity due to coronavirus disease-19. Most patients with chronic kidney disease are elderly and have other comorbidities. In addition, some of these patients have been exposed to immunosuppressive drugs to treat their underlying primary disease or to prevent allograft rejection. This general profile of chronic kidney disease patients renders them susceptible to a more severe course of coronavirus disease-19 once they are infected with severe acute respiratory syndrome coronavirus 2. Many studies showed that impaired kidney function on admission is an independent risk factor for a more severe course of coronavirus disease-19 with significantly increased risk for hospital and intensive care unit admission, intubation, mechanical ventilation, and death. Coronavirus disease-19 vaccination is crucial to create immunity in the general community, but the evidence addressing this specific population is scarce. However, based on the current evidence, all patients with chronic kidney disease are strongly recommended to receive the available vaccine in their country against coronavirus disease-19, and booster doses will presumably prove necessary for this group of patients. Furthermore, vigilant use of protective measures is strongly recommended for this patient population. Current studies and recommendations from health authorities should be followed closely.Publication Open Access Peritoneal dialysis-related peritonitis with an unexpected micro-organism: enterococcus hirae(2017-01-01) BARUTÇU ATAŞ, DİLEK; AŞICIOĞLU, EBRU; VELİOĞLU, ARZU; TUĞLULAR, ZÜBEYDE SERHAN; ARIKAN, İZZET HAKKI; BARUTÇU ATAŞ D., AYKENT M. B., AŞICIOĞLU E., ARIKAN İ. H., VELİOĞLU A., TUĞLULAR Z. S., ÖZENER İ. Ç.Enterococcus Hirae is a gram-positive, facultative, anaerobic bacterium which is usually a zoonotic pathogen rarely isolated from human infections. There are no published reports describing continuous ambulatory peritoneal dialysis (CAPD) related- peritonitis with Enterococcus Hirae in the literature. With the following report, we describe the case of peritoneal dialysis (PD)-related peritonitis due to Enterococcus Hirae.Publication Open Access Low serum 25-OH vitamin D levels are associated with increased D/P creatinine ratio in peritoneal dialysis patients(2021-09-01) BARUTÇU ATAŞ, DİLEK; TUĞCU, MURAT; VELİOĞLU, ARZU; ARIKAN, İZZET HAKKI; AŞICIOĞLU, EBRU; BARUTÇU ATAŞ D., AYKENT M. B., ARIKAN İ. H., TUĞCU M., VELİOĞLU A., AŞICIOĞLU E.Low 25-OH vitamin D levels have been linked to peritonitis and cardiovascular mortality in peritoneal dialysis (PD) patients. In this study we aimed to investigate the association of 25-OH vitamin D levels with peritoneal membrane characteristics in chronic PD patients. Consecutive 103 PD patients were enrolled in this retrospective study. Peritoneal dialysate to plasma (D/P) creatinine increase more than 0.1 with time were accepted as significant according Roc curve analysis. Patients with and without an increase in the D/P creatinine ratio of 0.1 were classified as Group 1 and Group 2, respectively. The relationship between baseline 25-OH vitamin D and peritoneal membrane characteristics were investigated. Mean age of the patients was 53.4±14.9 years and duration of PD was 72.1±50.3 months. There were thirty (29.1%) patients in Group 1. The duration of PD [73.5 (52.3-133.8) vs 49.0 (33.5-94.0) months, p:0.008]; hemoglobin [11.4 (10.4-12.2) vs. 10.2 (9.4-11.0) g/dL, p:0.001]and PTH [500.5 (254.5-748.3) vs 329.0 (205.0-549.5)ng/mL, p:0.047] levels were significantly higher in Group 1, whereas 25-OH vitamin D levels [5.0 (3.0-9.3) vs 7.8 (4.5-11.1)μg/L, p:0.027] and CRP [4.0 (3.0-7.2) vs. 8.0 (3.0-13.5)mg/L, p:0.028] were significantly lower. Multivariate analysis revealed duration of PD [Exp(B):1.012 (95%CI:1.001-1.022), p:0.028]; hemoglobin [Exp(B):1.756 (95%CI:1.199-2.571), p:0.004]; C-reactive protein (CRP) [Exp(B):0.882 (95%CI:0.789-0.985), p:0.026] and 25-OH vitamin D [Exp(B):0.853 (95%CI:0.754-0.965), p:0.012] were independent predictors of an increase in D/P creatinine ratio in PD patients. Increased D/P creatinine ratio was negatively correlated with 25-OH vitamin D level (r: -0.217, p:0.028). Lower levels of initial 25-OH vitamin D were associated with an increase in D/P creatinine ratio over-time.