Araştırma Makalesi
BibTex RIS Kaynak Göster

Impact of Kidney Transplantation-related Complications on Patient and Graft Outcomes in Early Period

Yıl 2023, Cilt: 49 Sayı: 3, 381 - 388, 31.12.2023

Hakan Düğer Alparslan Ersoy

https://doi.org/10.32708/uutfd.1385050

Öz

Early patient and graft survival after kidney transplantation depends on many complex, interrelated factors. In this study, we aimed to evaluate the frequency of intra- and post-operative medical and surgical complications in kidney transplant patients and the effects of these complications on patient and graft survival in the early period. The data of patients who underwent kidney transplantation in a single centre in ten years were examined retrospectively. Recipients' demographics, dialysis and transplantation information, and intra- and post-operative complications were obtained from medical records. Risk factors affecting the development of complications and patient and graft survival were evaluated. In our study, the frequency of intra-operative surgical complications in transplants with living donors and the frequency of post-operative medical and post-operative medical and surgical complications in transplants with deceased donors was found to be significantly higher. Post-operative surgical complications and post-operative medical and surgical complications statistically significantly shortened the graft and patient survival times. In the development of intra-operative medical and surgical complications, a 1-unit increase in donor age increased the risk of complications by 1.027 times (OR: 1.027, 95% CI: 1.003-1.052, p=0.026). Peritoneal dialysis as the pre-transplant dialysis modality reduced the risk of developing intra-operative medical and surgical complications by 73.8% compared to hemodialysis (OR: 0.262, 95% CI: 0.079-0.863, p=0.028). As a result, it has been observed that medical and surgical complications are common in the early period, and these complications can affect patient and graft survival. In conclusion, early medical and surgical complications are common in kidney transplant recipients, and these complications may affect patient and graft survival.

Anahtar Kelimeler

Kidney transplantation Graft function Complication

Kaynakça

  • 1. ISN-Global Kidney Health Atlas (ISN-GKHA). New global kidney health report sheds light on current capacity around the world to deliver kidney care. International Society of Nephrology. March 30, 2023. Available at: https://www.theisn.org/wp-content/uploads/2023/03/Press-release-long-ISN-GKHA-2023_v2.1.-1.pdf.
  • 2. Süleymanlar G, Utaş C, Arinsoy T, et al. A population-based survey of Chronic REnal Disease In Turkey--the CREDIT study. Nephrol Dial Transplant. 2011;26(6):1862-71
  • 3. Registry of The Nephrology, Dialysis and Transplantation in Turkey. Registry 2021. Ministry of Health and Turkish Society of Nephrology Joint Report. In: Ateş K, Seyahi N, Koçyiğit İ, eds. Ankara: Miki Matbaacılık San. ve Tic. Ltd. Şti.: 2022.
  • 4. Ersoy A. Böbrek nakline yaklaşım. İç: Ayar Y, Usta M, eds. Nefroloji El Kitabı. 1. baskı. Ankara: Akademisyen Kitabevi A.Ş.; 2021:187-209.
  • 5. Guimarães J, Araújo AM, Santos F, Nunes CS, Casal M. Living-donor and deceased-donor renal transplantation: Differences in early outcome--A single-center experience. Transplant Proc. 2015;47(4):958-62.
  • 6. Ayar Y, Ersoy A, Ocakoglu G, et al. Risk factors affecting graft and patient survivals after transplantation from deceased donors in a developing country: A single-center experience. Transplant Proc. 2017;49(2):270-77.
  • 7. Kronish K, Olmos A, Niemann CU. Perioperative care of patients undergoing kidney transplantation. In: Knechtle SJ, Marson LP, Morris PJ, eds. Kidney Transplantation Principles and Practice. 8th ed. Philadelphia: Elsevier; 2020:184-97.
  • 8. Schroder PM, Marson LP, Knechtle SJ. Early course of the patient with a kidney transplant. In: Knechtle SJ, Marson LP, Morris PJ, eds. Kidney Transplantation Principles and Practice. 8th ed. Philadelphia: Elsevier; 2020:197-211.
  • 9. Brahmbhatt Y. Medical complications after kidney transplantation: early. In: Ramirez CGB, McCauley J, eds. Contemporary Kidney Transplantation. 1st ed. Cham, Switzerland: Springer Nature; 2018:177-96.
  • 10. Koning OH, Ploeg RJ, van Bockel JH, et al. Risk factors for delayed graft function in cadaveric kidney transplantation: a prospective study of renal function and graft survival after preservation with University of Wisconsin solution in multi-organ donors. European Multicenter Study Group. Transplantation. 1997;63(11):1620-8.
  • 11. Ojo AO, Wolfe RA, Held PJ, Port FK, Schmouder RL. Delayed graft function: risk factors and implications for renal allograft survival. Transplantation. 1997;63(7):968-74.
  • 12. Levey AS, Stevens LA, Schmid CH, et al; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-12.
  • 13. Midtvedt K, Hartmann A. Hypertension after kidney transplantation: are treatment guidelines emerging? Nephrol Dial Transplant. 2002;17(7):1166-9.
  • 14. Opelz G, Döhler B; Collaborative Transplant Study. Improved long-term outcomes after renal transplantation associated with blood pressure control. Am J Transplant. 2005;5(11):2725-31.
  • 15. Heino A, Orko R, Rosenberg PH. Anaesthesiological complications in renal transplantation: a retrospective study of 500 transplantations. Acta Anaesthesiol Scand. 1986;30(7):574-80.
  • 16. Kasiske BL, Anjum S, Shah R, et al. Hypertension after kidney transplantation. Am J Kidney Dis. 2004;43(6):1071-81.
  • 17. Troppmann C, Gillingham KJ, Gruessner RW, et al. Delayed graft function in the absence of rejection has no long-term impact. A study of cadaver kidney recipients with good graft function at 1 year after transplantation. Transplantation. 1996;61(9):1331-7.
  • 18. Yarlagadda SG, Coca SG, Formica RN Jr, Poggio ED, Parikh CR. Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis. Nephrol Dial Transplant. 2009;24(3):1039-47.
  • 19. Geddes CC, Woo YM, Jardine AG. The impact of delayed graft function on the long-term outcome of renal transplantation. J Nephrol. 2002;15(1):17-21.
  • 20. Wiggins MC, Woolums AR, Hurley DJ, Sanchez S, Ensley DT, Donovan D. The effect of various Mycoplasma bovis isolates on bovine leukocyte responses. Comp Immunol Microbiol Infect Dis. 2011;34(1):49-54.
  • 21. Israni AK, Li N, Cizman BB, et al. Association of donor inflammation- and apoptosis-related genotypes and delayed allograft function after kidney transplantation. Am J Kidney Dis. 2008;52(2):331-9.
  • 22. Pham PT, Sarkar M, Pham PM, Pham PC. Diabetes mellitus after solid organ transplantation. 2022 Jul 13. In: Feingold KR, Anawalt B, Blackman MR, et al, eds. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000. Available at: https://www.ncbi.nlm.nih.gov/books/NBK378977/.
  • 23. Fakhr Yasseri AM, Namdari F, Gooran S, et al. Living versus deceased kidney transplantation: Comparison of complications. Urologia. 2021;88(3):185-9.
  • 24. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.
  • 25. Kumar A, Verma BS, Srivastava A, Bhandari M, Gupta A, Sharma RK. Long-term followup of elderly donors in a live related renal transplant program. J Urol. 2000;163(6):1654-8.
  • 26. De La Vega LS, Torres A, Bohorquez HE, et al. Patient and graft outcomes from older living kidney donors are similar to those from younger donors despite lower GFR. Kidney Int. 2004;66(4):1654-61.
  • 27. Pita-Fernández S, Valdés-Cañedo F, Seoane-Pillado T, et al. Influence of early graft function after renal transplantation and its impact on long-term graft and patient survival. Transplant Proc. 2010;42(8):2856-8.
  • 28. Fiorentino M, Pesce F, Schena A, Simone S, Castellano G, Gesualdo L. Updates on urinary tract infections in kidney transplantation. J Nephrol. 2019;32(5):751-61.
  • 29. Araújo AM, Santos F, Guimarães J, Nunes CS, Casal M. Living-donor kidney transplantation: Predictive factors and impact on post-transplant outcome. Transplant Proc. 2015;47(4):938-41.
  • 30. Huang HF, Zhou JY, Xie WQ, Wu JY, Deng H, Chen JH. Basiliximab versus rabbit antithymocyte globulin as induction therapy for living-related renal transplantation: a single-center experience. Int Urol Nephrol. 2016;48(8):1363-70.
  • 31. Krajewski W, Dembowski J, Kołodziej A, et al. Urological complications after renal transplantation - a single centre experience. Cent European J Urol. 2016;69(3):306-11.
  • 32. European Renal Best Practice Transplantation Guideline Development Group. ERBP Guideline on the Management and Evaluation of the Kidney Donor and Recipient. Nephrol Dial Transplant. 2013:28 Suppl 2:ii1-71.
  • 33. Pillot P, Bardonnaud N, Lillaz J, et al. Risk factors for surgical complications after renal transplantation and impact on patient and graft survival. Transplant Proc. 2012;44(9):2803-8.
  • 34. Wolff T, Schumacher M, Dell-Kuster S, et al. Surgical complications in kidney transplantation: no evidence for a learning curve. J Surg Educ. 2014;71(5):748-55.
  • 35. Szabo-Pap M, Zadori G, Fedor R, et al. Surgical complications following kidney transplantations: A single-center study in Hungary. Transplant Proc. 2016;48(7):2548-51.
  • 36. Ying T, Shi B, Kelly PJ, Pilmore H, Clayton PA, Chadban SJ. Death after kidney transplantation: An analysis by era and time post-transplant. J Am Soc Nephrol. 2020;31(12):2887-99.
  • 37. Gerbase-DeLima M, de Marco R, Monteiro F, Tedesco-Silva H, Medina-Pestana JO, Mine KL. Impact of combinations of donor and recipient ages and other factors on kidney graft outcomes. Front Immunol. 2020;11:954.
  • 38. Goh A. Graft survival trends in kidney transplants: an analysis of the UNOS database. Clin Transpl. 2009:41-54.

Böbrek Nakli Operasyonuyla ilişkili Komplikasyonların Erken Dönem Hasta ve Graft Sonuçları Üzerine Etkisi

Yıl 2023, Cilt: 49 Sayı: 3, 381 - 388, 31.12.2023

Hakan Düğer Alparslan Ersoy

https://doi.org/10.32708/uutfd.1385050

Öz

Böbrek nakli sonrası erken dönem hasta ve graft sağkalımı, birbiriyle ilişkili birçok karmaşık faktöre bağlıdır. Bu çalışmada; canlı ve kadaverik vericiden böbrek nakli yapılan hastalarda intra- ve post-operatif gelişen medikal ve cerrahi komplikasyonların sıklığı ve bu komplikasyonların erken dönemde hasta ve graft sağkalımı üzerine olan etkileri araştırıldı. Tek merkezde on yıllık dönemde böbrek nakli yapılan 498 hasta verileri retrospektif olarak incelendi. Alıcıların demografik, diyaliz ve nakil bilgileriyle, intra- ve post-operatif komplikasyonlar tıbbi kayıtlardan elde edildi. Komplikasyon gelişimi ile hasta ve graft sağkalımını etkileyen risk faktörler değerlendirildi. Çalışmamızda, canlı vericili nakillerde intra-operatif cerrahi komplikasyon, kadaverik vericili nakillerde post-operatif medikal ile post-operatif medikal ve cerrahi komplikasyon sıklığı anlamlı olarak yüksek saptandı. Gündüz çalışma saatleri dışında yapılan operasyonlarda post-operatif medikal komplikasyonlar daha sık görüldü. Post-operatif cerrahi komplikasyon ile post-operatif medikal ve cerrahi komplikasyon görülmesi ise istatistiksel olarak graft sağkalım süresini ve hasta sağkalım süresini anlamlı olarak kısalttı. İntra-operatif medikal ve cerrahi komplikasyon gelişiminde; verici yaşındaki 1 birimlik artış komplikasyon riskini 1.027 kat arttırdı. Nakil öncesi diyaliz modalitesinin hemodiyaliz olması, periton diyalizi olmasına kıyasla intraoperatif medikal ve cerrahi komplikasyon gelişme riskini 3.816 kat arttırdı. Sonuç olarak, gözlemlerimiz erken dönemde medikal ve cerrahi komplikasyonların sık görüldüğünü ve bu komplikasyonların hasta ve graft sağkalımını etkileyebileceğini düşündürmektedir.

Anahtar Kelimeler

Böbrek nakli Komplikasyon Graft fonksiyonu

Etik Beyan

Etik Kurul Onay Bilgisi: Onaylayan Kurul: Bursa Uludağ Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu Onay Tarihi: 29.11.2016 Karar No: 2016-20/9

Destekleyen Kurum

Destekleyen kurum bulunmamaktadır

Teşekkür

Yazarlar, çalışmaya dahil edilen böbrek nakli alıcılarının hazırlık, operasyon ve operasyon sonrası bakım ve tedavisinde görev alan Dr. Hakan Vuruşkan ve Dr. Gürkan Türker başta olmak üzere tüm hekim, hemşire ve sağlık personeline, ayrıca çalışma verilerinin analizine katkısından dolayı Dr. Gülser Çalışkan’a teşekkür eder.

Kaynakça

  • 1. ISN-Global Kidney Health Atlas (ISN-GKHA). New global kidney health report sheds light on current capacity around the world to deliver kidney care. International Society of Nephrology. March 30, 2023. Available at: https://www.theisn.org/wp-content/uploads/2023/03/Press-release-long-ISN-GKHA-2023_v2.1.-1.pdf.
  • 2. Süleymanlar G, Utaş C, Arinsoy T, et al. A population-based survey of Chronic REnal Disease In Turkey--the CREDIT study. Nephrol Dial Transplant. 2011;26(6):1862-71
  • 3. Registry of The Nephrology, Dialysis and Transplantation in Turkey. Registry 2021. Ministry of Health and Turkish Society of Nephrology Joint Report. In: Ateş K, Seyahi N, Koçyiğit İ, eds. Ankara: Miki Matbaacılık San. ve Tic. Ltd. Şti.: 2022.
  • 4. Ersoy A. Böbrek nakline yaklaşım. İç: Ayar Y, Usta M, eds. Nefroloji El Kitabı. 1. baskı. Ankara: Akademisyen Kitabevi A.Ş.; 2021:187-209.
  • 5. Guimarães J, Araújo AM, Santos F, Nunes CS, Casal M. Living-donor and deceased-donor renal transplantation: Differences in early outcome--A single-center experience. Transplant Proc. 2015;47(4):958-62.
  • 6. Ayar Y, Ersoy A, Ocakoglu G, et al. Risk factors affecting graft and patient survivals after transplantation from deceased donors in a developing country: A single-center experience. Transplant Proc. 2017;49(2):270-77.
  • 7. Kronish K, Olmos A, Niemann CU. Perioperative care of patients undergoing kidney transplantation. In: Knechtle SJ, Marson LP, Morris PJ, eds. Kidney Transplantation Principles and Practice. 8th ed. Philadelphia: Elsevier; 2020:184-97.
  • 8. Schroder PM, Marson LP, Knechtle SJ. Early course of the patient with a kidney transplant. In: Knechtle SJ, Marson LP, Morris PJ, eds. Kidney Transplantation Principles and Practice. 8th ed. Philadelphia: Elsevier; 2020:197-211.
  • 9. Brahmbhatt Y. Medical complications after kidney transplantation: early. In: Ramirez CGB, McCauley J, eds. Contemporary Kidney Transplantation. 1st ed. Cham, Switzerland: Springer Nature; 2018:177-96.
  • 10. Koning OH, Ploeg RJ, van Bockel JH, et al. Risk factors for delayed graft function in cadaveric kidney transplantation: a prospective study of renal function and graft survival after preservation with University of Wisconsin solution in multi-organ donors. European Multicenter Study Group. Transplantation. 1997;63(11):1620-8.
  • 11. Ojo AO, Wolfe RA, Held PJ, Port FK, Schmouder RL. Delayed graft function: risk factors and implications for renal allograft survival. Transplantation. 1997;63(7):968-74.
  • 12. Levey AS, Stevens LA, Schmid CH, et al; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-12.
  • 13. Midtvedt K, Hartmann A. Hypertension after kidney transplantation: are treatment guidelines emerging? Nephrol Dial Transplant. 2002;17(7):1166-9.
  • 14. Opelz G, Döhler B; Collaborative Transplant Study. Improved long-term outcomes after renal transplantation associated with blood pressure control. Am J Transplant. 2005;5(11):2725-31.
  • 15. Heino A, Orko R, Rosenberg PH. Anaesthesiological complications in renal transplantation: a retrospective study of 500 transplantations. Acta Anaesthesiol Scand. 1986;30(7):574-80.
  • 16. Kasiske BL, Anjum S, Shah R, et al. Hypertension after kidney transplantation. Am J Kidney Dis. 2004;43(6):1071-81.
  • 17. Troppmann C, Gillingham KJ, Gruessner RW, et al. Delayed graft function in the absence of rejection has no long-term impact. A study of cadaver kidney recipients with good graft function at 1 year after transplantation. Transplantation. 1996;61(9):1331-7.
  • 18. Yarlagadda SG, Coca SG, Formica RN Jr, Poggio ED, Parikh CR. Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis. Nephrol Dial Transplant. 2009;24(3):1039-47.
  • 19. Geddes CC, Woo YM, Jardine AG. The impact of delayed graft function on the long-term outcome of renal transplantation. J Nephrol. 2002;15(1):17-21.
  • 20. Wiggins MC, Woolums AR, Hurley DJ, Sanchez S, Ensley DT, Donovan D. The effect of various Mycoplasma bovis isolates on bovine leukocyte responses. Comp Immunol Microbiol Infect Dis. 2011;34(1):49-54.
  • 21. Israni AK, Li N, Cizman BB, et al. Association of donor inflammation- and apoptosis-related genotypes and delayed allograft function after kidney transplantation. Am J Kidney Dis. 2008;52(2):331-9.
  • 22. Pham PT, Sarkar M, Pham PM, Pham PC. Diabetes mellitus after solid organ transplantation. 2022 Jul 13. In: Feingold KR, Anawalt B, Blackman MR, et al, eds. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000. Available at: https://www.ncbi.nlm.nih.gov/books/NBK378977/.
  • 23. Fakhr Yasseri AM, Namdari F, Gooran S, et al. Living versus deceased kidney transplantation: Comparison of complications. Urologia. 2021;88(3):185-9.
  • 24. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.
  • 25. Kumar A, Verma BS, Srivastava A, Bhandari M, Gupta A, Sharma RK. Long-term followup of elderly donors in a live related renal transplant program. J Urol. 2000;163(6):1654-8.
  • 26. De La Vega LS, Torres A, Bohorquez HE, et al. Patient and graft outcomes from older living kidney donors are similar to those from younger donors despite lower GFR. Kidney Int. 2004;66(4):1654-61.
  • 27. Pita-Fernández S, Valdés-Cañedo F, Seoane-Pillado T, et al. Influence of early graft function after renal transplantation and its impact on long-term graft and patient survival. Transplant Proc. 2010;42(8):2856-8.
  • 28. Fiorentino M, Pesce F, Schena A, Simone S, Castellano G, Gesualdo L. Updates on urinary tract infections in kidney transplantation. J Nephrol. 2019;32(5):751-61.
  • 29. Araújo AM, Santos F, Guimarães J, Nunes CS, Casal M. Living-donor kidney transplantation: Predictive factors and impact on post-transplant outcome. Transplant Proc. 2015;47(4):938-41.
  • 30. Huang HF, Zhou JY, Xie WQ, Wu JY, Deng H, Chen JH. Basiliximab versus rabbit antithymocyte globulin as induction therapy for living-related renal transplantation: a single-center experience. Int Urol Nephrol. 2016;48(8):1363-70.
  • 31. Krajewski W, Dembowski J, Kołodziej A, et al. Urological complications after renal transplantation - a single centre experience. Cent European J Urol. 2016;69(3):306-11.
  • 32. European Renal Best Practice Transplantation Guideline Development Group. ERBP Guideline on the Management and Evaluation of the Kidney Donor and Recipient. Nephrol Dial Transplant. 2013:28 Suppl 2:ii1-71.
  • 33. Pillot P, Bardonnaud N, Lillaz J, et al. Risk factors for surgical complications after renal transplantation and impact on patient and graft survival. Transplant Proc. 2012;44(9):2803-8.
  • 34. Wolff T, Schumacher M, Dell-Kuster S, et al. Surgical complications in kidney transplantation: no evidence for a learning curve. J Surg Educ. 2014;71(5):748-55.
  • 35. Szabo-Pap M, Zadori G, Fedor R, et al. Surgical complications following kidney transplantations: A single-center study in Hungary. Transplant Proc. 2016;48(7):2548-51.
  • 36. Ying T, Shi B, Kelly PJ, Pilmore H, Clayton PA, Chadban SJ. Death after kidney transplantation: An analysis by era and time post-transplant. J Am Soc Nephrol. 2020;31(12):2887-99.
  • 37. Gerbase-DeLima M, de Marco R, Monteiro F, Tedesco-Silva H, Medina-Pestana JO, Mine KL. Impact of combinations of donor and recipient ages and other factors on kidney graft outcomes. Front Immunol. 2020;11:954.
  • 38. Goh A. Graft survival trends in kidney transplants: an analysis of the UNOS database. Clin Transpl. 2009:41-54.
Toplam 38 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular İç Hastalıkları
Bölüm Özgün Araştırma Makaleleri
Yazarlar

Hakan Düğer 0000-0001-5478-3192

Alparslan Ersoy 0000-0002-0710-0923

Yayımlanma Tarihi 31 Aralık 2023
Gönderilme Tarihi 2 Kasım 2023
Kabul Tarihi 5 Aralık 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 49 Sayı: 3

Kaynak Göster

APA Düğer, H., & Ersoy, A. (2023). Böbrek Nakli Operasyonuyla ilişkili Komplikasyonların Erken Dönem Hasta ve Graft Sonuçları Üzerine Etkisi. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 49(3), 381-388. https://doi.org/10.32708/uutfd.1385050
AMA Düğer H, Ersoy A. Böbrek Nakli Operasyonuyla ilişkili Komplikasyonların Erken Dönem Hasta ve Graft Sonuçları Üzerine Etkisi. Uludağ Tıp Derg. Aralık 2023;49(3):381-388. doi:10.32708/uutfd.1385050
Chicago Düğer, Hakan, ve Alparslan Ersoy. “Böbrek Nakli Operasyonuyla ilişkili Komplikasyonların Erken Dönem Hasta Ve Graft Sonuçları Üzerine Etkisi”. Uludağ Üniversitesi Tıp Fakültesi Dergisi 49, sy. 3 (Aralık 2023): 381-88. https://doi.org/10.32708/uutfd.1385050.
EndNote Düğer H, Ersoy A (01 Aralık 2023) Böbrek Nakli Operasyonuyla ilişkili Komplikasyonların Erken Dönem Hasta ve Graft Sonuçları Üzerine Etkisi. Uludağ Üniversitesi Tıp Fakültesi Dergisi 49 3 381–388.
IEEE H. Düğer ve A. Ersoy, “Böbrek Nakli Operasyonuyla ilişkili Komplikasyonların Erken Dönem Hasta ve Graft Sonuçları Üzerine Etkisi”, Uludağ Tıp Derg, c. 49, sy. 3, ss. 381–388, 2023, doi: 10.32708/uutfd.1385050.
ISNAD Düğer, Hakan - Ersoy, Alparslan. “Böbrek Nakli Operasyonuyla ilişkili Komplikasyonların Erken Dönem Hasta Ve Graft Sonuçları Üzerine Etkisi”. Uludağ Üniversitesi Tıp Fakültesi Dergisi 49/3 (Aralık 2023), 381-388. https://doi.org/10.32708/uutfd.1385050.
JAMA Düğer H, Ersoy A. Böbrek Nakli Operasyonuyla ilişkili Komplikasyonların Erken Dönem Hasta ve Graft Sonuçları Üzerine Etkisi. Uludağ Tıp Derg. 2023;49:381–388.
MLA Düğer, Hakan ve Alparslan Ersoy. “Böbrek Nakli Operasyonuyla ilişkili Komplikasyonların Erken Dönem Hasta Ve Graft Sonuçları Üzerine Etkisi”. Uludağ Üniversitesi Tıp Fakültesi Dergisi, c. 49, sy. 3, 2023, ss. 381-8, doi:10.32708/uutfd.1385050.
Vancouver Düğer H, Ersoy A. Böbrek Nakli Operasyonuyla ilişkili Komplikasyonların Erken Dönem Hasta ve Graft Sonuçları Üzerine Etkisi. Uludağ Tıp Derg. 2023;49(3):381-8.
 Kapak Resmi İndir

ISSN: 1300-414X, e-ISSN: 2645-9027

Uludağ Üniversitesi Tıp Fakültesi Dergisi "Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License" ile lisanslanmaktadır.


Creative Commons License
Journal of Uludag University Medical Faculty is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

2023