Researcher:
Koçak, Burak

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Burak

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Koçak

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Koçak, Burak

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2020 - 202418

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    Successful kidney transplantation in MYH-9-related disease presenting with severe macrothrombocytopenia
    (Galenos Publishing House, 2023) N/A; Bülbül, Mustafa Cem; Avcı, Şahin; Yelken, Berna; Koçak, Burak; Akay, Olga Meltem; School of Medicine; Koç University Hospital
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    Should calcineurin inhibitors/sirolimus be ceased completely in posterior reversible encephalopathy syndrome?
    (Elsevier Science Inc, 2024) N/A; Karataş, Cihan; Akyollu, Başak; Arpalı, Emre; Koçak, Burak; School of Medicine; Koç University Hospital
    Background. To investigate the relationship between immunosuppressive treatments and posterior reversible encephalopathy syndrome (PRES) in transplant patients. Methods. We presented a retrospective study of 4 cases of PRES in transplant patients. Patient records were reviewed to identify potential risk factors, clinical presentations, radiological find- ings, and immunosuppressive treatments used. Results. Our analysis revealed a potential association between immunosuppressive treatments and the development of PRES in transplant patients. Specifically, we found that adjusting or switching immunosuppressive treatments can improve outcomes and prevent the recurrence of PRES. Conclusion. Our findings highlight the importance of recognizing PRES as a potential complication of immunosuppressive treatments in transplant patients. Early detection and management, including a review of immunosuppressive treatments, may improve patient outcomes and prevent further complications.
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    Effects of erector spinae plane block on opioid consumption in patients undergoing hand-assisted laparoscopic donor nephrectomy: a randomized controlled trial
    (Edizioni Minerva Medica, 2024) Karakaya, Muhammet A.; Yenigun, Yilmaz; Özkalaycı, Özlem; Çetin, Seçil; Darçın, Kamil; Akyollu, Başak; Arpalı, Emre; Koçak, Burak; Gürkan, Yavuz; School of Medicine; Koç University Hospital
    Background: The erector spinae plane block is a relatively new regional anesthesia technique that is expected to provide some benefits for postoperative analgesia. This study investigated the effects of erector spinae plane block on postoperative opioid consumption in kidney donors undergoing hand-assisted laparoscopic donor nephrectomy for renal transplantation. Methods: Fifty-two donors scheduled for elective hand-assisted laparoscopic donor nephrectomy were randomly divided into the block (25 donors) and control (27 donors) groups. Donors in the block group received 30 mL of 0.25% bupivacaine under ultrasound guidance, whereas the control group received no block treatment. The primary outcome measure was the amount of fentanyl administered via patient-controlled analgesia at 24 h. Secondary outcomes included the duration of stay, opioid consumption in the post-anesthesia care unit, and pain scores during the recording hours. Results: No significant differences were observed between the groups regarding total opioid consumption converted to intravenous morphine equivalent administered via patient-controlled analgesia (33.3 +/- 21.4 mg vs. 37.5 +/- 18.5 mg; P=0.27) and in the postanesthesia care unit (1.5 +/- 0.9 mg vs. 1.4 +/- 0.8 mg; P=0.55). The duration of stay in the postanesthesia care unit (86.3 +/- 32.6 min vs. 85.7 +/- 33.6 min; P=0.87) was similar between the groups. There was no significant difference between the groups in the postoperative donor-reported NRS pain scores (P>0.05 for all the time points). Conclusions: Preoperative erector spinae plane block is not an effective strategy for reducing postoperative pain or opioid consumption in patients undergoing hand-assisted laparoscopic donor nephrectomy. Different block combinations are needed for optimal pain management in hand-assisted laparoscopic donor nephrectomy.
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    The role of anticomplement therapy in the management of the kidney allograft
    (Wiley, 2024) Ortiz, Alberto; Kanbay, Mehmet; Çöpür, Sidar; Yılmaz, Zeynep Yağmur; Baydar, Dilek Ertoy; Bilge, İlmay; Süsal, Caner; Koçak, Burak; Koç University Transplant Immunology Research Centre of Excellence (TIREX); School of Medicine
    As the number of patients living with kidney failure grows, the need also grows for kidney transplantation, the gold standard kidney replacement therapy that provides a survival advantage. This may result in an increased rate of transplantation from HLA-mismatched donors that increases the rate of antibody-mediated rejection (AMR), which already is the leading cause of allograft failure. Plasmapheresis, intravenous immunoglobulin therapy, anti-CD20 therapies (i.e., rituximab), bortezomib and splenectomy have been used over the years to treat AMR as well as to prevent AMR in high-risk sensitized kidney transplant recipients. Eculizumab and ravulizumab are monoclonal antibodies targeting the C5 protein of the complement pathway and part of the expanding field of anticomplement therapies, which is not limited to kidney transplant recipients, and also includes complement-mediated microangiopathic hemolytic anemia, paroxysmal nocturnal hemoglobinuria, and ANCA-vasculitis. In this narrative review, we summarize the current knowledge concerning the pathophysiological background and use of anti-C5 strategies (eculizumab and ravulizumab) and C1-esterase inhibitor in AMR, either to prevent AMR in high-risk desensitized patients or to treat AMR as first-line or rescue therapy and also to treat de novo thrombotic microangiopathy in kidney transplant recipients.
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    Imlifidase in kidney transplantation
    (Oxford Univ Press, 2024) Callemeyn, Jasper; Segelmark, Marten; Kanbay, Mehmet; Çöpür, Sidar; Güldan, Mustafa; Topçu, Ahmet Umur; Özbek, Laşin; Hasbal, Nuri Barış; Süsal, Caner; Koçak, Burak; Koç University Transplant Immunology Research Centre of Excellence (TIREX); School of Medicine; Koç University Hospital
    Kidney transplantation, the gold-standard therapeutic approach for patients with end-stage kidney disease, offers improvement in patient survival and quality of life. However, broad sensitization against human leukocyte antigens often resulting in a positive crossmatch against the patient's living donor or the majority of potential deceased donors in the allocation system represents a major obstacle due to a high risk for antibody-mediated rejection, delayed graft function and allograft loss. Kidney-paired donation and desensitization protocols have been established to overcome this obstacle, with limited success. Imlifidase, a novel immunoglobulin G (IgG)-degrading enzyme derived from Streptococcus pyogenes and recombinantly produced in Escherichia coli, is a promising agent for recipients with a positive crossmatch against their organ donor with high specificity towards IgG, rapid action and high efficacy in early pre-clinical and clinical studies. However, the rebound of IgG after a few days can lead to antibody-mediated rejection, making the administration of potent immunosuppressive regimens in the early post-transplant phase necessary. There is currently no comparative study evaluating the efficiency of imlifidase therapy compared with conventional desensitization protocols along with the lack of randomized control trials, indicating the clear need for future large-scale clinical studies in this field. Besides providing a practical framework for the clinical use of the agent, our aim in this article is to evaluate the underlying mechanism of action, efficiency and safety of imlifidase therapy in immunologically high-risk kidney transplant recipients.
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    Improving the urine spot protein/creatinine ratio by the estimated creatinine excretion to predict proteinuria in pediatric kidney transplant recipients
    (Wiley, 2021) Palaoğlu, Kerim Erhan; N/A; İncir, Said; Taşdemir, Mehmet; Koçak, Burak; Yelken, Berna; Arpalı, Emre; Akyollu, Başak; Baygül, Arzu Eden; Bilge, İlmay; Türkmen, Aydın; Doctor; Faculty Member; Faculty Member; Doctor; Doctor; Doctor; Faculty Member; Faculty Member; Doctor; N/A; School of Medicine; School of Medicine; N/A; N/A; N/A; School of Medicine; School of Medicine; N/A; Koç University Hospital; N/A; N/A; Koç University Hospital; Koç University Hospital; Koç University Hospital; N/A; N/A; Koç University Hospital; 175430; 175867; 220671; N/A; N/A; N/A; 272290; 198907; N/A
    Background Since the daily creatinine excretion rate (CER) is directly affected by muscle mass, which varies with age, gender, and body weight, using the spot protein/creatinine ratio (Spot P/Cr) follow-up of proteinuria may not always be accurate. Estimated creatinine excretion rate (eCER) can be calculated from spot urine samples with formulas derived from anthropometric factors. Multiplying Spot P/Cr by eCER gives the estimated protein excretion rate (ePER). We aimed to determine the most applicable equation for predicting daily CER and examine whether ePER values acquired from different equations can anticipate measured 24 h urine protein (m24 h UP) better than Spot P/Cr in pediatric kidney transplant recipients. Methods This study enrolled 23 children with kidney transplantation. To estimate m24 h UP, we calculated eCER and ePER values with three formulas adapted to children (Cockcroft-Gault, Ghazali-Barratt, and Hellerstein). To evaluate the accuracy of the methods, Passing-Bablok and Bland-Altman analysis were used. Results A statistically significant correlation was found between m24 h UP and Spot P/Cr (p < .001, r = 0.850), and the correlation was enhanced by multiplying the Spot P/Cr by the eCER equations. The average bias of the ePER formulas adjusted by the Cockcroft-Gault, Ghazali-Barratt, and Hellerstein equations were -0.067, 0.031, and 0.064 g/day, respectively, whereas the average bias of Spot P/Cr was -0.270 g/day obtained by the Bland-Altman graphics. Conclusion Using equations to estimate eCER may improve the accuracy and reduce the spot urine samples' bias in pediatric kidney transplantation recipients. Further studies in larger populations are needed for ePER reporting to be ready for clinical practice.
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    Post-transplant recurrence of masked monoclonal gammopathy of renal significance in a patient with C3 glomerulonephritis: a case report
    (Lippincott Williams & Wilkins, 2022) N/A; N/A; N/A; N/A; N/A; N/A; N/A; Yelken, Berna; Arpalı, Emre; Akyollu, Başak; Koçak, Burak; Baydar, Dilek Ertoy; Akay, Olga Meltem; Türkmen, Aydın; Doctor; Doctor; Doctor; Faculty Member; Faculty Member; Faculty Member; Doctor; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine, School of Medicine; N/A; N/A; N/A; N/A; 8025; 170966; N/A
    Introduction: Monoclonal gammopathy of renal significance (MGRS) is a recently defined group of renal diseases caused by monoclonal immunoglobulin secreted by nonmalignant proliferative B cell or plasma cell causes renal damage. Here we report a case known as primary kidney disease C3 glomerulonephritis but after kidney transplant diagnosed MGRS. Case presentation: A 32-year old man underwent live related renal transplant in December 2020 for ESRF secondary C3 glomerulonephritis. At 2 months post-transplant, his serum kreatinin levels increased from a basaline creatinine of 1.2 mg/dl to 1.7mg/dl, and he developed proteinuria (1.2 gr/day). Renal biopsy showed monoclonal membranoproliferative glomerulonephritis. His serum and urine kappa/lambda light chain ratio was normal and he had no monoclonal protein in serum and urine immunfixation electrophoresis. After the patient was treated with Rituximab (4 cycles), his serum creatinin levels and proteinuria increased and repeat biopsy showed increase of monoclonal immun complexes in glomeruler capillers. The patient was treated bortezomib-based chemotherapy (4 cycles). Repeat biopsy showed no regression renal pathology. His renal functions and proteinuria continued to deteriorate. There were a rise in urine kappa/lambda light chain ratio. He received no further chemotherapy, a decision was taken to manage her kidney condition conservatively. Conclusions: Monoclonol immunoglobulin deposits may not be detectable in standart immunofluorescence techniques and can result missing the diagnosis of MGRS. Patiens with C3glomerulonephritis should be examined in detail for monoclonal gammapathy before kidney transplantation. 
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    Case report: a kidney transplant patient with mild COVID-19
    (Wiley, 2020) N/A; N/A; N/A; N/A; N/A; N/A; Arpalı, Emre; Akyollu, Başak; Yelken, Berna; Tekin, Süda; Türkmen, Aydın; Koçak, Burak; Doctor; Doctor; Doctor; Faculty Member; Doctor; Faculty Member; N/A; N/A; N/A; School of Medicine; N/A; School of Medicine; Koç University Hospital; N/A; N/A; N/A; 42146; N/A; 220671
    Coronavirus Disease 2019 (COVID-19) is currently a pandemic with a mortality rate of 1%-6% in the general population. However, the mortality rate seems to be significantly higher in elderly patients, especially those hospitalized with comorbidities, such as hypertension, diabetes, or coronary artery diseases. Because viral diseases may have atypical presentations in immunosuppressed patients, the course of the disease in the transplant patient population is unknown. Hence, the management of these patients with COVID-19 is an area of interest, and a unique approach is warranted. Here, we report the clinical features and our treatment approach for a kidney transplant patient with a diagnosis of COVID-19. We believe that screening protocols for SaRS-Cov-2 should be re-evaluated in patients with solid-organ transplants.
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    Risk factors for febrile urinary tract infections in the first year after pediatric renal transplantation
    (Wiley, 2020) Akinci, Serkan; Gunaydin, Bilal; Nayir, Ahmet; N/A; N/A; N/A; N/A; N/A; Arpalı, Emre; Karataş, Cihan; Akyollu, Başak; Şal, Oğuzhan; Koçak, Burak; Doctor; Doctor; Doctor; Undergraduate Student; Faculty Member; N/A; N/A; N/A; School of Medicine; School of Medicine; Koç University Hospital; Koç University Hospital; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; 341966; 220671
    Urinary tract infection is the most common infectious complication following kidney transplant. Anatomic abnormalities, bladder dysfunction, a positive history of febrile urinary tract infection, and recipient age are reported risk factors. The aim of this study was to determine the risk factors for fUTI, which necessitated hospitalization in the first year after renal transplantation in our pediatric transplant population. A retrospective review of 195 pediatric patients who underwent kidney transplant between 2008 and 2017 from a single institution was performed. All patients admitted to the hospital with fUTI were marked for further analyses. The risk factors including age, gender, dialysis type, history of urologic disorders, and preoperative proteinuria for fUTI in the first year after kidney transplantation and graft survivals were investigated. Independent-sample t test and chi-square tests were used for univariate analysis. Exhaustive CHAID algorithm was used for multivariate analysis. The data of 115 male and 80 female patients were retracted. The mean ages of our cohort for males and females were 9.5 +/- 5.1 and 10 +/- 4.8 years, respectively. The age of the patients at transplant and their gender were found to be a statistically significant risk factors for developing fUTIs. Multivariate analysis showed that fUTI was common in female patients and a subgroup of male patients who had preoperative proteinuria, but no neurogenic bladder had higher risk compared with male patients without proteinuria. Patient surveillance and antibiotic prophylaxis algorithms can be developed to prevent febrile urinary tract infections seen after pediatric kidney transplantation in risky population.
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    Implanting a robot-assisted kidney transplant program for transplant surgeons with no robotic surgery background
    (Lippincott Williams and Wilkins, 2022) N/A; N/A; Koçak, Burak; Çelik, Neslihan; Arpalı, Emre; Akyollu, Başak; Kılıçer, Beşir; Canda, Abdullah Erdem; Kordan, Yakup; Faculty Member; PhD Student; Doctor; Doctor; Other; Faculty Member; Faculty Member; School of Medicine; Graduate School of Health Sciences; N/A; N/A; N/A; School of Medicine; School of Medicine; N/A; N/A; Koç University Hospital; Koç University Hospital; Koç University Hospital; N/A; N/A; 220671; N/A; N/A; N/A; N/A; 116202; 157552
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