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Nakledilmiş Böbreğini Kaybetmiş Olan Hastalar

Patients with a Failed Renal Transplant

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DOI: 
DOI 10.5262/tndt.2012.1003.01
Abstract (2. Language): 
Renal transplantation is the best method of renal replacement therapy for patients with end-stage renal disease. On the other hand in the early or late period of transplantation, majority of patients suffer from allograft failure and return to the dialysis. These patients carry the risks of adverse effects of previous immunosuppressive therapy (i.e infections and cancers). Furthermore, worse quality of life and many limitations of dialysis result in psychological problems. The controversial issues in treatment of these patients can be summarized under the headings of : 1- In which stage of allograft failure these patients should return to dialysis? 2- Which is the most appropriate renal replacement therapy after the renal allograft failure? 3- What are the main problems during dialysis practice and how should these problems be managed? 4- How should the immunosupression regimen be managed? 5- What are the indications for transplant nephrectomy? 6- What are the advantages and drawbacks of retransplantation? In this review these problems were discussed.
Abstract (Original Language): 
Renal transplantasyon, son dönem böbrek yetmezliği (SDBY)’nin en iyi tedavisidir. Öte yandan, transplantasyondan sonra erken veya geç dönemde hastaların büyük bir kısmında graft kaybı ortaya çıkmakta ve hastalar diyalize dönmektedir. Bu hastalar immünsupresif tedavi sürecinden geçmiştir ve rutin diyaliz hastalarına kıyasla pek çok tıbbi komplikasyon (özellikle enfeksiyon ve kanser gelişimi) için riskli durumdadır. Ayrıca, transplantasyonun sağladığı kaliteli hayattan sonra diyalizin getirdiği kısıtlamalar psikolojik problemlere yol açabilir. Söz konusu problemlerin nasıl önlenebileceği veya ortaya çıktıkları zaman nasıl tedavi edileceği konusu tartışmalıdır. Bu hastaların tedavi sürecindeki belirsizliklerini şu başlıklar altında incelemek mümkündür. 1- Graft disfonksiyonunun hangi aşamasında hastalar diyalize geri dönmelidir? 2- Graft kaybı sonrasında en uygun replasman tedavisi hangisidir? 3- Bu hastalarda diyaliz süresinde ortaya çıkabilecek başlıca problemler hangileridir ve nasıl tedavi edilmelidir? 4- Hastaların almakta oldukları immünsupresif ilaçlar hangi protokole göre kesilmelidir? 5- Graft nefrektomi indikasyonları nelerdir? 6-Retransplantasyonun getiri ve götürüleri nelerdir? Bu derlemede söz konusu problemlerin çözümleri irdelenmiştir.
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