Browsing by Author "Karakayali, Hamdi"

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A Novel Technique for Hepatic Arterial Reconstruction in Living-Donor Liver Transplant
(Başkent Üniversitesi, 2007-06) Haberal, Mehmet; Sevmis, Sinasi; Karakayali, Hamdi; Moray, Gokhan; Yilmaz, Ugur; Ozcay, Figen; Torgay, Adnan; Aydogan, Cem; Arslan, Gulnaz
Objectives: Arterial reconstruction in patients undergoing living-donor liver transplant is technically difficult because of the small diameter of the vessels in the partial liver graft. In this study, we present our technique for hepatic arterial reconstruction. Methods: Since December 2005, we have performed 54 living-donor liver transplants, which are analyzed retrospectively in this report. In our technique now used at our institution, native and graft hepatic arteries are spatulated from both the anterior and posterior walls to provide a wide anastomosis. Computed tomographic angiography is used to evaluate the vascular anatomy and to measure the diameter of the graft hepatic arteries. Results: Mean follow-up was 7.2 ± 5.5 months (range, 1-17 months). Nine of the 54 recipients died within 4 months of the surgery. At the time of this writing, the remaining 45 recipients (84%) are alive and demonstrating good graft function. In 2 recipients (3.7%) in this series, hepatic artery thromboses developed, which were treated with an interventional radiologic technique. Conclusions: Our arterial reconstruction technique has enabled reconstruction of smaller arteries and arteries of various diameters without an operating microscope. The rate of complications in our patients is similar to that reported in similar individuals.
Endovascular Treatment of Active Bleeding after Liver Transplant
(Başkent Üniversitesi, 2007-06) Harman, Ali; Boyvat, Fatih; Hasdogan, Baris; Aytekin, Cuneyt; Karakayali, Hamdi; Haberal, Mehmet
Objectives: To evaluate the incidence of active bleeding complications following transplant and the efficacy of interventional radiologic management. Materials and Methods: Between June 2000 and February 2007, 14 liver transplant patients with active bleeding were treated via endovascular techniques (coils, glue, or graft-covered stents). Active bleeding was spontaneous in 6 patients through the inferior epigastric artery (n=1), the inferior phrenic artery (n=1), the superior mesenteric artery (n=2), the internal mammary artery (n=1), and the hepatic artery (n=1). In 8 patients, active bleeding was due to transhepatic biliary or endovascular interventions. Hemobilia (n=2) due to pseudoaneurysm formation after transhepatic biliary interventions was embolized with coils. Hepatic artery rupture was observed in 6 patients during endovascular interventions performed on hepatic artery stenosis or thrombosis that had been treated with graft-covered stents. Technical success, clinical improvement, and complications were documented. Results: Active bleeding was stopped by endovascular intervention in 13 of 14 patients. Embolizations with coils or glue were successful. In 1 patient with hepatic artery bleeding, the graft-covered stent failed to seal the rupture site, and this patient underwent reoperation. Conclusion: Arterial bleeding complications after liver transplant during the early and late postoperative period, due either to spontaneous active bleeding or to percutaneous or endovascular interventions, can be successfully managed with interventional radiologic techniques.
Interventional Radiology in Liver Transplant
(Başkent Üniversitesi, 2008-06) Boyvat, Fatih; Haberal, Mehmet; Karakayali, Hamdi; Aytekin, Cuneyt
An increased number of transplant centers now actively perform deceased-donor as well as living-related liver transplants. Although postoperative vascular and nonvascular complications after liver transplant have been well documented, early diagnosis and intervention are important to increase graft and recipient survival. With improvements in interventional radiologic techniques and a multidisciplinary approach to liver transplant, management of complications by percutaneous and endovascular techniques is possible with less morbidity and mortality. This article outlines the recent developments in, and applications of, interventional radiologic techniques in liver transplant patients.
Micronuclei and other nuclear anomalies in buccal epithelial cells of children with chronic kidney disease
(2016) Baskin, Esra; Aykanat, Banu; Demircigil, Gonca Cakmak; Buyan, Necla; Gulleroglu, Kaan; Fidan, Kibriya; Bayrakci, Umut Selda; Dalgic, Aydin; Karakayali, Hamdi; Haberal, Mehmet; Burgaz, Sema; 0000-0003-1434-3824; 0000-0003-4361-8508; 0000-0002-3462-7632; 28033104; B-5785-2018; AAJ-8833-2021; AAJ-8097-2021
The objective of this study was to reveal the likely genomic instability in children with chronic kidney disease (CKD) using micronucleus (MN) assay on buccal epithelial cells (BEC). We investigated the frequencies of micronuclei and other nuclear anomalies, such as nuclear buds, binucleated cells, condensed chromatin, and karyorrhectic and pyknotic cells in BEC. Children with CKD were grouped as follows: children in the pre-dialysis (PreD) stage (N=17), children on regular haemodialysis (HD) (N=14), and children who have undergone transplantation (Tx) (N=17). As a control group, twenty age-and gender-matched healthy children were selected. The MN frequency in BEC of all groups of children with CKD was significantly elevated (5-to 7-fold) as compared to the control group (p<0.001). In contrast, the frequencies of nuclear buds were not significantly higher in the study groups compared to the control group. The frequencies of binucleated cells and condensed chromatin cells were significantly higher in all subgroups of children with CKD relative to the control group (p<0.001). Our results show that the BEC of pediatric PreD, HD, and Tx patients with CKD display increased cytogenetic, cytokinetic, and cytotoxic effects. They also point to the sensitivity and usefulness of the BEC MN assay in the assessment of genetic susceptibility of patients with CKD.
Pediatric Liver Transplant: Results of a Single Center
(Başkent Üniversitesi, 2008-03) Haberal, Mehmet; Arslan, Gulnaz; Demirhan, Beyhan; Torgay, Adnan; Yilmaz, Ugur; Moray, Gokhan; Ozcay, Figen; Karakayali, Hamdi; Sevmis, Sinasi
Objectives: Liver transplant in the pediatric population has become an accepted treatment modality for children with end-stage liver disease. In this study, we analyze our experiences with pediatric liver transplant at our center. Materials and Methods: Since September 2001, 8 deceased-donor and 96 living-donor liver transplants have been done in 101 children (mean age, 6.7 ± 5.5 years; range, 2 months to 17 years). The children’s charts were reviewed retrospectively. Results: Indications for liver transplant were cholestatic liver disease (n=17), biliary atresia (n=24), Wilson’s disease (n=16), fulminant liver failure (n=18), hepatic tumor (n=13), and other (n=13). The median pediatric end-stage liver disease score was 23.1 ± 11.1 (range, –8 to 48). The median follow-up was 24.2 ± 19.4 months (range, 1-77 months). Three children underwent retransplant. The main complications were infections (25.9%) and surgical complications (39.5%) (including biliary complications and vascular problems). The incidence of acute cellular rejection was 42.3%. Sixteen children died during follow-up, and, at the time of this writing, the remaining 85 children (85%) were alive with good graft functioning, showing patient survival rates of 90%, 85%, and 83% at 6, 12, and 36 months, respectively. Conclusions: In conclusion, the overall outcomes of pediatric liver transplantation at our center are quite promising.
Perioperative Anesthetic Management for Recipients of Orthotopic Liver Transplant Undergoing Nontransplant Surgery
(Başkent Üniversitesi, 2007-12) Zeyneloglu, Pinar; Arslan, Gulnaz; Karakayali, Hamdi; Torgay, Adnan; Sulemanji, Demet; Pirat, Arash
Objectives: The number of organ transplant recipients who present for nontransplant surgery has increased annually. The aim of this study was to evaluate the perioperative anesthetic management of recipients of an orthotopic liver transplant who have undergone nontransplant surgery at Baskent University Hospital. Patients and Methods: The medical records of 22 recipients of an orthotopic liver transplant who had undergone a total of 32 nontransplant elective surgeries between December 1988 and February 2006 were retrospectively reviewed. Demographic information, including the anesthetic management and the results of perioperative liver and renal function tests, was recorded. Results: The mean age of the patients at the time of transplant was 20.2 ± 17.9 years. The mean interval from liver transplant to the first surgery was 739.1 ± 502.2 days. The most frequent type of surgery was abdominal (28.1%). The types of anesthetic techniques used were general (75%), regional (9.4%), local (9.4%), and sedoanalgesia (6.3%). General anesthesia was induced with thiopental, propofol, or ketamine, and was maintained with isoflurane and nitrous oxide. Endotracheal intubation was performed in 43.8% of the patients. Spinal anesthesia was induced in 3 patients, and peripheral neural blockage was used in 2 patients. Prothrombin time, activated partial thromboplastin time, international normalized ratio, and levels of serum alanine transaminase, aspartate transaminase, total bilirubin, blood urea nitrogen, and creatinine were similar preoperatively and on the first day after surgery (P > .05). Conclusions: In this study, neither regional nor general anesthesia was associated with a deterioration of liver function. We suggest that recipients of orthotopic liver transplant can undergo nontransplant surgery without postoperative graft dysfunction if hepatic perfusion is maintained with appropriate anesthetic management.
Pulmonary Complications and Mortality After Liver Transplant
(Başkent Üniversitesi, 2008-12) Bozbas, Serife Savas; Haberal, Mehmet; Karakayali, Hamdi; Sevmis, Sinasi; Arslan, Nevra Gullu; Ergur, Figen Ozturk; Eyuboglu, Fusun Oner
Objectives: Pulmonary complications after liver transplant significantly affect mortality and morbidity; however, their relation has not been clearly established. We sought to determine pulmonary complications during the early and late term after liver transplant and identify risk factors for mortality. Materials and Methods: At our institution, 130 liver transplant patients (mean age, 40.1 ± 14.6 years; 71.1% male) were retrospectively evaluated, and 114 adult orthotopic liver transplant patients were included. Cause of liver disease, pulmonary function test results, arterial blood gas analyses, surgery duration, length of stay in the intensive care unit and the hospital, pulmonary complications, and mortality causes were noted. Results: Pulmonary complications were detected in 48 patients (42.1%), pneumonia in 24 patients (21.1%), and pleural effusion in 21 patients (18.4%). Development of pulmonary complications was found to be significantly related to survival (P = .001). Fifty-two patients (45.6%) were smokers, a significant predictor of pulmonary complications (P = .03). There was no relation between pulmonary function test results and orthodeoxia and pulmonary complications and mortality. Early and late survival rates were significantly lower in patients in whom a microorganism was isolated on deep tracheal aspirate culture, while early survival was significantly reduced in the presence of a pleural effusion (P < .005). Conclusions: Pulmonary complications after liver transplant are common. Care must be taken to determine preoperative risk factors, and patients should be observed closely for development of respiratory complications after liver transplant.
Renal Autotransplantation for Complex Renal Arterial Disease: A Case Report
(Başkent Üniversitesi, 2006-12) Sevmis, Sinasi; Karakayali, Hamdi; Boyvat, Fatih; Colak, Turan; Aydogan, Cem; Gencoglu, E. Arzu; Haberal, Mehmet
A renal artery aneurysm in a stenotic renal artery is a rare clinical entity with an incidence of 0.015% to 1% in patients with renovascular hypertension. Interventional stent placement is the first line of treatment for simple aneurysms of the proximal renal artery. However, renal autotransplantation has been used as an alternative treatment for complex lesions and for lesions originating from the distal renal artery. We present a patient with a renal artery aneurysm, renal artery stenosis of the segmental branches of the left kidney, and occlusion of the right renal artery. The surgical strategy included renal explantation, ex vivo renal preservation, ex vivo reconstruction of the 2 renal artery branches, and renal heterotopic autotransplantation. We conclude that renal autotransplantation is a safe and effective surgical procedure for patients with complex renal arterial disease.
Urologic Complication Rates in Kidney Transplantation after a Novel Ureteral Reimplantation Technique
(Başkent Üniversitesi, 2006-12) Haberal, Mehmet; Karakayali, Hamdi; Sevmis, Sinasi; Moray, Gokhan; Arslan, Gulnaz
Our transplantation team has performed 1615 renal transplantations since 1975. After September 2003, we began a corner-saving technique for urinary tract continuity. In this study, we analyzed these 174 renal transplantations retrospectively. The mean recipient age was 31.6 years (range, 7 to 66). The mean donor age was 39.8 years (range, 6 to 67). For ureteral reimplantation, a running suture is started 3 mm ahead of the middle of the posterior wall and is finished 3 mm afterward. After the last stitch, both ends of the suture material are pulled, and the posterior wall of the ureter and bladder are approximated tightly. The anterior wall is sewn either with the same suture or another running suture. Since using this technique, we have not employed a double-J or any other stent to prevent ureteral complications at the anastomosis site. We have seen only 4 (2.2%) ureteral complications (2 ureteral stenosis and 2 anastomotic leaks) during a follow-up period of 18.9 months. In conclusion, due to the low complication rate, we believe that our new technique is the safest way to perform a ureteroneocystostomy.