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    Contraception and Child Birth in Kidney Transplant Patients: What Are We Missing as Physicians?
    (Aves, 2020) Gunay, Emrah; Gokalp, Cenk
    Objective: The primary aim of our study was to evaluate the knowledge of young female patients about pregnancy and contraception after kidney transplantation and to reveal the role of physicians in patient information processes. The secondary aim was to determine the pregnancy outcomes. Materials and Methods: Women who were not older than 40 years at the time of transplantation were included in the study. A questionnaire consisting of 30 questions was prepared. Results: Sixty-six patients were examined. The mean age was 30.3 years, and the mean transplantation time was 49.8 months. Twenty patients (30.3%) were not offered contraception at the time of transplantation. Contraception was recommended to 46 patients. Only 19.5% of recommenders were physicians. When the questionnaire was administered, 23 of 29 sexually active patients were using contraception. Withdrawal (52%), condom (30.4%), and intrauterine device (IUD) (8.6%) were the preferred contraception methods. Nine patients conceived successfully. For all six live births, the mode of delivery was cesarean section. Five of them were premature. Three pregnancies are ongoing. When we asked the patients which drugs should not be used during pregnancy, 38 of them (57.5%) replied they did not know; 16, 7, and 5 patients reported that mycophenolate mofetil, mycophenolate sodium, and tacrolimus should not be used during pregnancy, respectively. Conclusion: Before and after a kidney transplant, the recommendation of contraceptive choices and protection from pregnancy in female patients are being overlooked. We conclude that physicians mostly pay attention to this matter when the patient expresses a desire to become pregnant.
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    Investigation of the Factors Affecting Allograft Kidney Functions: Results of 10 Years
    (Elsevier Science Inc, 2019) Gunay, Emrah; Celebi, Tugba; Sen, Sait; Asci, Gulay; Kumbaraci, Banu Sarsik; Gokalp, Cenk; Yilmaz, Mumtaz
    Introduction. Significant improvements in patient and graft survival and reductions in the frequency of acute rejection were obtained in the early period after renal transplantation, but this success was not sufficiently reflected in the long term. Allograft kidney losses in the long term remain a significant problem. In this study, we investigated the specific causes of graft losses in patients who had a good clinical course in the first year but developed graft loss in the long term. Methods. A total of 118 patients who underwent kidney transplantation in 2005 and 2006 in the Organ Transplantation Center of Ege University Medical Faculty Hospital were evaluated. The inclusion criteria were to be older than 18 years and have a serum creatinine value of <2 mg/dL at the 12th month after transplantation. Results. Sixty-one percent of the recipients were male, and the mean age at the time of transplantation was 34 +/- 11 years (18 to 61). We observed 29 graft losses during the mean follow-up period of 129 +/- 35 months (27 to 162). Three of the graft losses were death by functional graft. Of the 26 patients with graft loss, 16 had chronic rejection, and 8 had recurrent glomerulonephritis. The relationship between nonimmune causes and graft loss was not detected. Conclusions. In conclusion, nonimmune factors may not be as important as we think in relatively young and healthier recipients. Chronic rejection and recurrent glomerulonephritis are the main causes of long-term graft loss of patients with good graft function at the end of the first year. Improvement of long-term survival will be possible with the prevention and effective treatment of these 2 problems.