Browsing by Author "Torgay, Adnan"

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Anesthesia Management of a Deceased Cadaveric-Donor Combined Liver and Kidney Transplant for Primary Hyperoxaluria Type 1: Report of a Case
(2015) Ersoy, Zeynep; Araz, Coskun; Kirnap, Mahir; Zeyneloglu, Pinar; Torgay, Adnan; Arslan, Gulnaz; 0000-0003-2312-9942; 0000-0003-0767-1088; 0000-0002-6829-3300; 0000-0002-4927-6660; 26640925; AAH-9198-2019; C-3736-2018; AAF-3066-2021; AAJ-5221-2021; AAJ-4576-2021
Primary hyperoxaluria type 1 is an autosomal recessive disorder that is responsible for the overproduction of oxalate and has an incidence of 1 in 120 000 live births. Indications for combined liver and kidney transplant are still debated. However, combined liver and kidney transplant is preferred in various conditions, including primary hyperoxaluria, liver-based metabolic abnormalities affecting the kidney, and structural diseases affecting both the liver and the kidney, such as congenital hepatic fibrosis and polycystic kidney disease. When compared with sequential liver and kidney transplant, the rejection rate of both liver and kidney allografts was reported to be lower than with combined liver and kidney transplant. With proper anesthesia management, the probable increased complications with combined liver and kidney transplant can be prevented. In this report, we present the anesthesia care of a 22-year-old patient with primary hyperoxaluria type 1 who had deceased-donor combined liver and kidney transplant.
Anesthetic Management in Pediatric Orthotopic Liver Transplant For Fulminant Hepatic Failure and End-stage Liver Disease
(2014) Camkiran, Aynur; Araz, Coskun; Balli, Sevgi Seyhan; Torgay, Adnan; Moray, Gokhan; Pirat, Arash; Arslan, Gulnaz; Haberal, Mehmet; https://orcid.org/0000-0003-1470-7501; https://orcid.org/0000-0002-4927-6660; https://orcid.org/0000-0002-6829-3300; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635805; AAJ-4576-2021; AAJ-5221-2021; AAE-1041-2021; AAJ-8097-2021
Objectives: We assessed the anesthetic management and short-term morbidity and mortality in pediatrics patients who underwent an orthotopic liver transplant for fulminant hepatic failure or end-stage liver disease in a university hospital. Material and Methods: We retrospectively analyzed the records of children who underwent orthotopic liver transplant from May 2002 to May 2012. Patients were categorized into 2 groups: group fulminant hepatic failure (n=22) and group end-stage liver disease (n=19). Perioperative data related to anesthetic management and intra-operative events were collected along with information related to postoperative course and survival to hospital discharge. Results: Mean age and weight for groups fulminant hepatic failure and end-stage liver disease were 8.6 +/- 2.7 years and 10.8 +/- 3.8 years (P= .04) and 29.2 +/- 11.9 kg and 33.7 +/- 16.9 kg (P= .46). There were no differences between the groups regarding length of anhepatic phase (65 +/- 21 min vs 73 +/- 18 min, P= .13) and operation time (9.1 +/- 1.6 h vs 9.5 +/- 1.8 h, P= .23). When compared with the patients in group fulminant hepatic failure, those in group end-stage liver disease more commonly had a Glasgow Coma score of 7 or less (32% vs 6%, P= .04). Compared with patients in group fulminant hepatic failure, those in group end-stage liver disease were more frequently extubated in the operating room (31.8% versus 89.5% P <.001). Postoperative duration of mechanical ventilation (2.78 +/- 4.02 d vs 2.85 +/- 10.21 d, P = .05), and the mortality rates at 1 year after orthotopic liver transplant (7.3% vs 0%, P = .09) were similar between the groups. Conclusions: During pediatric orthotopic liver transplant, those children with fulminant hepatic failure require more intraoperative fluids and more frequent perioperative mechanical ventilation than those with end-stage liver disease.
Anesthetic Management of a Glycogen Storage Disease Type 1A With Air Embolism During Liver Transplantation: A Case Report
(2022) Kandemir, Emre; Cekmen, Nedim; Torgay, Adnan; Haberal, Mehmet; 0000-0002-6829-3300; 0000-0002-3462-7632; 0000-0002-9601-8007; AAJ-5221-2021; AAJ-8097-2021; AAK-4525-2021
Application of Ileobladder for Clinical Kidney Transplantation: Two Case Reports
(2018) Haberal, Mehmet; Kirnap, Mahir; Akdur, Aydincan; Soy, Ebru H. Ayvazoglu; Yildirim, Sedat; Moray, Gokhan; Kayhan, Zeynep; Torgay, Adnan; 0000-0002-3462-7632; 0000-0002-8726-3369; 0000-0002-0993-9917; 0000-0002-5735-4315; 0000-0003-2498-7287; 0000-0003-0579-1115; 0000-0002-6829-3300; AAJ-8097-2021; AAH-9198-2019; AAA-3068-2021; AAC-5566-2019; AAF-4610-2019; AAE-1041-2021; AAJ-4623-2021; AAJ-5221-2021
Auxiliary Partial Orthotopic Living Liver Transplant for Wilson Disease
(2017) Haberal, Mehmet; Akdur, Aydincan; Moray, Gokhan; Boyacioglu, Sedat; Torgay, Adnan; Arslan, Gulnaz; Ozdemir, Binnaz Handan; 0000-0002-6829-3300; 0000-0002-3462-7632; 0000-0003-2498-7287; 0000-0002-8726-3369; 0000-0002-7528-3557; 0000-0002-9370-1126; 28260463; AAJ-5221-2021; AAJ-8097-2021; AAE-1041-2021; AAA-3068-2021; X-8540-2019; AAE-7637-2021
Wilson disease is a genetic disease involving copper metabolism disturbances that result in copper accumulations, especially in the liver and brain. Wilson disease can be treated with pharmacologic agents, such as chelators that induce urinary excretion of copper or zinc salts that inhibit copper absorption in the digestive tract. Liver transplant is the only treatment option for Wilson disease when liver failure has occurred. In some patients, that is, in those with Child-Pugh A score, neurologic disease can be seen without hepatic failure. Our recommendation is for these patients to have auxiliary partial orthotopic liver transplant. Here, we present a 36-year-old male patient with neurologic disease associated with Wilson disease who had successful related living-donor auxiliary partial orthotopic liver transplant using a left lobe. The patient, as a result of neurologic symptoms that included tremor walking and speaking problems and low serum ceruloplasmin level of 7 mg/dL, was diagnosed with Wilson disease, and a liver biopsy was performed. Chronic necroinflammatory disease activity was 4/18, and the patient received chelation treatment. His hepatic functions were normal. The donor was the patient's 57-year-old father whose liver function tests were also normal. The graft-to-recipient weight ratio was 1% using a left lobe graft. After transplant, serum ceruloplasmin levels on day 15 and month 1 were 14 and 19 mg/dL. At month 1, liver function tests were normal. Doppler ultrasonography showed normal vascular flow of the native liver and the graft. The patient's neurologic symptoms were progressively reduced. Progressive neurologic deterioration with no hepatic insufficiency is considered a suitable indication for auxiliary partial orthotopic liver transplant; this procedure is suggested before the neurologic and liver failure symptoms of Wilson disease occur.
Baskent University Organ Transplantation Activities in Mid Asia
(2018) Moray, Gokhan; Torgay, Adnan; Haberal, Mehmet; 0000-0003-2498-7287; 0000-0002-6829-3300; 0000-0002-3462-7632; 29895239; AAE-1041-2021; AAJ-5221-2021; AAJ-8097-2021
Bridging Technique of Bile Duct Anastomosis Using An Expanded Polytetrafluoroethylene (Eptfe) Graft in A Porcine Model
(2016) Haberal, Mehmet; Ozdemir, Handan; Bacanli, Didem; Ozcay, Necdet; Ersoy, Zeynep; Torgay, Adnan; https://orcid.org/0000-0002-3462-7632; https://orcid.org/0000-0003-0767-1088; AAJ-8097-2021; AAF-3066-2021
Deceased-donor transplantation activities at Baskent University
(2019) Haberal, Mehmet; Kirnap, Mahir; Akdur, Aydincan; Moray, Gokhan; Karakayali, Feza Yarbug; Yildirim, Sedat; Caliskan, Kenan; Torgay, Adnan; Arslan, Gulnaz
Deceased-donor transplantation activities in Turkey
(2019) Haberal, Mehmet; Akdur, Aydincan; Moray, Gokhan; Karakayali, Feza Yarbug; Yildirim, Sedat; Caliskan, Kenan; Torgay, Adnan; Arslan, Gulnaz
Effect of Graft Weight to Recipient Body Weight Ratio on Hemodynamic and Metabolic Parameters in Pediatric Liver Transplant: A Retrospective Analysis
(2017) Haberal, Mehmet; Ersoy, Zeynep; Kaplan, Serife; Ozdemirkan, Aycan; Torgay, Adnan; Arslan, Gulnaz; Pirat, Arash; 0000-0003-0767-1088; 0000-0002-6829-3300; 0000-0002-3462-7632; 28260433; AAF-3066-2021; AAJ-5221-2021; AAJ-8097-2021; AAH-7003-2019
Objectives: To analyze how graft-weight-to-body-weight ratio in pediatric liver transplant affects intraoperative and early postoperative hemodynamic and metabolic parameters. Materials and Methods: We reviewed data from 130 children who underwent liver transplant between 2005 and 2015. Recipients were divided into 2 groups: those with a graft weight to body weight ratio > 4% (large for size) and those with a ratio <= 4% (normal for size). Data included demographics, preoperative laboratory findings, intraoperative metabolic and hemodynamic parameters, and intensive care follow-up parameters. Results: Patients in the large-graft-for-size group (>4%) received more colloid solution (57.7 +/- 20.1 mL/kg vs 45.1 +/- 21.9 mL/kg; P = .08) and higher doses of furosemide (0.7 +/- 0.6 mg/kg vs 0.4 +/- 0.7 mg/kg; P = .018). They had lower mean pH (7.1 +/- 0.1 vs 7.2 +/- 0.1; P = .004) and PO2 (115.4 +/- 44.6 mm Hg vs 147.6 +/- 49.3 mm Hg; P = .004) values, higher blood glucose values (352.8 +/- 96.9 mg/dL vs 262.8 +/- 88.2 mg/dL; P < .001), and lower mean body temperature (34.8 +/- 0.7 degrees C vs 35.2 +/- 0.6 degrees C; P = .016) during the neohepatic phase. They received more blood transfusions during both the anhepatic (30.3 +/- 24.3 mL/kg vs 18.8 +/- 21.8 mL/kg; P = .013) and neohepatic (17.7 +/- 20.4 mL/kg vs 10.3 +/- 15.5 mL/kg; P = .031) phases and more fresh frozen plasma (13.6 +/- 17.6 mL/kg vs 6.2 +/- 10.2 mL/kg; P = .012) during the neohepatic phase. They also were more likely to be hypotensive (P < .05) and to receive norepinephrine infusion more often (44% vs 22%; P < .05) intra-operatively. More patients in this group were mechanically ventilated in the intensive care unit (56% vs 31%; P = .035). There were no significant differences between the groups in postoperative acute renal dysfunction, graft rejection or loss, infections, length of intensive care stay, and mortality (P > .05). Conclusions: High graft weight-to-body-weight ratio is associated with adverse metabolic and hemodynamic changes during the intraoperative and early postoperative periods. These results emphasize the importance of using an appropriately sized graft in liver transplant.
The effects and consequences of blood transfusion after pediatric kidney transplantation
(2019) Kirnap, Mahir; Baskin, Esra; Torgay, Adnan; Moray, Gokhan; Haberal, Mehmet; 0000-0003-4361-8508; B-5785-2018; AAH-9198-2019
Efficacy of Cell Saver Use in Living-Donor Liver Transplant
(2015) Kirnap, Mahir; Tezcaner, Tugan; Soy, Hatice Ebru Ayvazoglu; Akdur, Aydincan; Yildirim, Sedat; Torgay, Adnan; Moray, Gokhan; Haberal, Mehmet; 0000-0002-8726-3369; 0000-0002-3641-8674; 0000-0002-6829-3300; 0000-0003-2498-7287; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-0993-9917; 25894181; AAA-3068-2021; AAD-9865-2021; AAJ-5221-2021; AAE-1041-2021; AAH-9198-2019; AAJ-8097-2021; AAF-4610-2019; AAC-5566-2019
Objectives: Liver transplant currently is the best treatment option for end-stage liver disease. During liver transplant, there is major blood loss due to surgery and primary disease. By using a cell saver, the need for blood transfusion is markedly reduced. In this study, we aimed to evaluate the efficacy of cell saver use on morbidity and mortality in living-donor liver transplant. Materials and Methods: We retrospectively evaluated 178 living-donor liver transplants, performed from 2005 to 2013 in our center. Child-Turcotte-Pugh A patients, deceased-donor liver transplants, and liver transplants performed for fulminant hepatic failure were not included in this study. Intraoperative blood transfusion was done in all patients to keep hemoglobin level between 10 and 12 g/dL. Cell saver was used in all liver transplants except in patients with malignancy, hepatitis B, and hepatitis C. Results: We included 126 patients in the study. Cell saver was used in 84 liver transplants (66%). In 42 patients (34%), liver transplant was performed without a cell saver. In living-donor liver transplant with cell saver use, 10 mL/kg blood (range, 2-50 mL/kg blood) was transfused from the cell saver; in addition, 5 to 10 mL/kg allogeneic blood was transfused. In living-donor liver transplant without cell saver, 20 to 25 mL/kg allogeneic blood was transfused. Conclusions: During liver transplant, major blood transfusion is needed because of surgery and primary disease. Cell saver use markedly decreases the need for allogeneic blood transfusion and avoids adverse events of massive transfusion.
Ekstrakorporeal membran oksijenasyonu uygulanan hastaların değerlendirilmesi: Dört yıllık sonuçlarımız
(Başkent Üniversitesi Tıp Fakültesi, 2016) Adıbelli, Bilgehan; Torgay, Adnan
Peroperatif kardiyojenik şok ve kardiyak arrest sonrası ECMO uygulaması günümüzde giderek yaygınlaşmaktadır. Bu çalışmanın birincil amacı 4 yıllık süreçte kliniğimizde kardiyak nedenler ile VA ECMO cihazı takılan hastaların sonuçlarını paylaşmak ve ikincil olarak ECMO uygulaması önce ve sonrasındaki takip boyunca bakılan parametrelerin 1 ve 6 aylık sağ kalım ile ilişkisini ortaya koymaktır. Ocak 2012 - Aralık 2015 tarihleri arasında, kliniğimizde 69 hastanın ECMO ihtiyacı gündeme gelmiş olup, bunlardan 46 tanesine kardiyak nedenler ile VA ECMO cihazı takılmıştır. Bunların % 15.2 (n=7)' si santral yollardan sağ atrium ve asendan aorta kullanılarak takılırken, %84.8 (n=39)' ü periferik yoldan femoral arter ve ven kullanılarak Medos ve Macque markalı sentrifugal pompalar takılmıştır. Periferik yollar kullanılırken USG eşliğinde perkütan teknik kullanılmış olup, kanül lokalizasyonları yine USG ile subkostal pencereden teyit edilmiştir. Çalışmaya dahil edilen 46 VA ECMO hastasının, 31 (%67.4) 'i erkek, 15 (%32.6) 'i kadın olup, yaş ortalaması 47.7 ± 20.9 (minimum 11, maksimum 83) tir. Hastaların ortalama vücut kitle indeksi 26.1 ± 6.4 kg/m2 (minimum 15.5 kg/m2, maksimum 39.2 kg/m2) olup, 12 (%26) tanesi obezdir (VKİ >30 kg/m2). 46 hastanın yoğun bakıma kabulünde ortalama APACHE-2 skoru 19.6 ± 6.2 iken, hastaların ortalama RESP skoru -2.9 ± 4.2 (minimum -14, maksimum 4) bulunmuştur. Kırk altı hastanın herbirine kardiyak nedenler ile VA ECMO cihazı takılmış olup takılan ECMO cihazlarının 30 (%65) tanesi kalp cerrahisi sırasında veya sonrasında takılırken, 16 (%35) tanesi non-operatif durumlarda takılmıştır. Bunların, 6 (%13) tanesine CPR sonrası VA ECMO uygulanmıştır. Hastaların 14 (%30.4) tanesi ECMO desteği ihtiyacının sonlanmasından dolayı, başarılı bir şekilde ECMO cihazından ayrılabilmiş, 32 (%69.6) si ise ECMO desteğine rağmen eksitus ile sonuçlanmıştır. Hastaların 20 (%43.5) tanesinde ECMO dışı destek bulunmakla beraber, bunların 8 (%40) tanesi sol ventrikül kalp destek cihazı (LVAD), 12 (%60) tanesi ise kalp transplantasyonudur. Hastalara yoğun bakıma kabullerinden ortalama 83.6 ± 184.9 (minimum 0, maksimum 980) saat sonra ECMO takılmış olup, ECMO süresi 226.9 ± 283.4 (minimum 12, maksimum 1440) saattir. 46 hastanın ortalama 4. saat ECMO akımı 2.8 ± 0.7 (minimum 1.17, maksimum 4.10) lt/dk iken, 2 hastanın ECMO sonrası 24 saatten az sağkalımı olduğu için 44 hastanın 24. saat akımı ortalama 3.2 ± 0,8 (minimum 1.34, maksimum 4.5) lt/ dk 'dır. VA ECMO takılan 46 hastanın 36 (%78.3) tanesinde çeşitli nedenlerle komplikasyon gelişmiş olup, 26 (%56.5) tanesinde hemorajik, 15 (%32.6) tanesinde nörolojik, 14 (%30.4) tanesinde renal, 6 (%13.0) tanesinde metabolik, 7 (%15.2) tanesinde pulmoner, 4 (%8.7) tanesinde ise mekanik komplikasyon gelişmiştir. Çalışma grubumuzda 46 hastanın 32 (%69.6)' sinde yoğun bakım yatışı sırasında farklı zamanlarda alınan kültürlerde bir ve/veya birden fazla bölgede üreme tespit edilmiştir. 30 (%65.2) hastada DTA kültüründe, 23 (%50) hastada santral venöz kan kültüründe, 11 (%23.9) hastada arteriyel kan kültüründe, 9 (%19.6) hastada idrar kültüründe, 8 (%17.4) hastada çeşitli bölgelerden alınan sürüntü kültürlerinde, 4 (%8.7) hastada balgam kültüründe, 1 (%2.8) hastada periferik venöz kan kültüründe üreme saptanmıştır. Farklı zamanlarda 46 hastanın 26 (%56.5) tanesinde acinetobacter sp., 19 (%41.3) tanesinde E.Coli, 11 (%23.9) tanesinde klebsiella sp., 10 (%21.7) tanesinde enterokok sp., 10 (%21.7) tanesinde stafilokok sp., 7 (%15.2) tanesinde psödomonas sp., 2 (%4.3) tanesinde kandida sp., 2 (%4.3) tanesinde proteus sp. ve 1 (%2.8) tanesinde serratia sp. üremiştir. Hasta grubumuzda da 30 günlük sağkalım %41 iken, 6 aylık sağkalım % 20 düzeyinde kalmıştır. Elde edilen verilerin hem bir aylık hemde altı aylık sağ kalım üzerine etkileri araştırılmış elde edilen veriler mevcut literatür ile kıyaslanarak hasta tedavileri süresince prognostik değerleri incelenmiştir. Sonuç olarak ekstrakorporeal membran oksijenasyonu gerek yoğun bakım yatışı sırasında gerekse kardiyak cerrahi geçiren hastalarda perioperatif dönemde, kardiyojenik şok tedavisinde medikal ve diğer mekanik destek cihazlarına oldukça iyi bir alternatif olarak yoğun bakımlarda yerini almıştır. Merkezlerdeki kullanım sıklığı arttıkça, tek merkezden çıkan daha büyük hasta sayılarıyla yapılan çalışmalar doğrultusunda elde edilen daha sağlıklı veriler ile ECMO' nun kardiyojenik şok tedavisindeki yerini daha net ortaya koyacaktır. Extracoporeal membrane oxygenarator usage is widely raising after cardiogenic shock and cardiac arrest. The primary outcome for this study is to share a 4 year results of the patients whom we applied VA ECMO for cardiac reasons. The secondary outcomes are the effects of the parameters that we scan, to 1 and 6 month survival. Sixty nine patients needed ECMO between January 2012 and December 2015 and we applied VA ECMO for cardiac reasons to 46 of these patients. We applied 7 (%15.2) of them centrally via right atrium to ascending aorta and 39 of them periferally via femoral vein to artery. In our clinic we are using the brands Medos and Macque which are centifugal pumps. While we are using periferic ways, we always applied it with USG guidance and then checked the places of the cannules with USG, too. All 46 patients were supported by VA ECMO due to cardiac problems and 30 (%65) of them were applied during or after the cardiac surgery, 16 (%35) of them were applied in non-operatif circumstances. 14 (%30.4) of the patients weaned from ECMO with success, but 32 (%69.6) of them ended with exitus despite ECMO support. 20 of the patients had also another cardiac support rather than ECMO. 8 (%40) of them had left ventricular assit device and 12 (%60) of them had heart transplantation besides ECMO support. Thirty one (%67.4) of the patients are male and 15 (%32.6) of them are female. The average age of the patients is 47.7 ± 20.9 (minimum 11, maximum 83). The average body mass index is 26.1 ± 6.4 kg/m2 (minimum 15.5 kg/m2, maximum 39.2 kg/m2) and 12 (%26) of them are obese (BMI >30 kg/m2). At the acceptance of the 46 patients to the ICU, the average APACHE - 2 score is 19.6 ± 6.2 and the average RESP score is -2.9 ± 4.2 (minimum -14, maximum 4). We initiated ECMO support to the patients with the average of 83.6 ± 184.9 (minimum 0, maksimum 980) hours after the addmission to the ICU and the average ECMO duration is 226.9 ± 283.4 (minimum 12, maximum 1440) hours. The average 4th hour ECMO flow of 46 patients is 2.8 ± 0.7 (minimum 1.17, maximum 4.10) lt/min. 2 patients died in 24 hours just after the ECMO was applied so, the rest of the 44 patients' average 24th hour ECMO flow is 3.2 ± 0,8 (minimum 1.34, maximum 4.5) lt/min. Many complications occured due to various reasons in 36 (%78.3) patients whom we applied VA ECMO to. 26 (%56.5) of them had hemoragic, 15 (%32.6) of them had neurologic, 14 (%30.4) of them had renal, 6 (%13) of them had metabolic, 7 (%15.2) of them had pulmonary and 4 (%8.7) of them had mechanic complications due to ECMO administiration. During ICU stay, we determined one or more microorganism proliferation on cultures that we had taken from different parts of the 32 (%69.6) patients. We determined microorganisms on; DTA cultures of 30 (%65.2) patients, central venous blood cultures of 23 (%50) patients, arterial blood cultures of 11 (%23.9) patients, urine cultures of 9 (%19.6) patients, cotton swap cultures taken from different skin parts of 8 (%17.4) patients, sputum cultures of 4 (%8.7) patients and periferic venous culture of 1 (%2.8) patient. We detected acinetobacter sp. in 26 (%56.5) patients, E.Coli in 19 (%41.3) patients, klebsiella sp. in 11 (%23.9) patients, enterococcus sp. in 10 (%21.7) patients, staphilococcus sp. in 10 (%21.7) patients, pseudomonas sp. in 7 (%15.2) patients, candida sp. in 2 (%4.3) patients, proteus sp. in 2 (%4.3) patients and serratia sp. in 1 (%2.8) patient. Our 30 days survival is % 41 and 6 months survival is % 20. We have researched the effects of the variables which we scaned for this study to the 30 days and 6 months survival. Then the results were compared with the available literature and their prognostic value on patients treatment was evaluated. Recently, extracorporeal membrane oxygenarator has become a credible alternative to medical and mechanical support treatments used for cardiogenic shock in ICU. The more it is used in big numbers in ICU departments, the more reliable data regarding ECMO will be available which will demostrate its role in cardiogenic shock and cardiac arrest treatment more clearly.
Fatal Outcome After Renal Transplant in a Pediatric Patient With Noonan Syndrome
(2015) Araz, Coskun; Kaval, Ebru; Torgay, Adnan; Moray, Gokhan; Haberal, Mehmet; 0000-0003-2498-7287; 0000-0002-6829-3300; 0000-0002-4927-6660; 0000-0002-3462-7632; 25894171; AAE-1041-2021; AAJ-5221-2021; AAJ-4576-2021; AAJ-8097-2021
Noonan syndrome is a congenital, common, hereditary disorder. Facial dysmorphism, growth retardation, and various heart defects are typical clinical features. In patients with minor cardiac pathology, life expectancy is normal. We report a case of renal transplant in a pediatric patient with Noonan syndrome that ended with death of the patient. Our patient presented with unexpected and refractory postoperative neurological complications that were unresponsive to intensive therapy, and the patient died because of secondary complications.
Immediate Tracheal Extubation After Pediatric Liver Transplantation
(2021) Sahinturk, Helin; Ozdemirkan, Aycan; Yilmaz, Olcay; Zeyneloglu, Pinar; Torgay, Adnan; Pirat, Arash; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0003-0159-4771; 30346263; AAJ-8097-2021; AAJ-1419-2021
Objectives: We examined whether immediate tracheal extubation among pediatric liver transplant recipients was safe and feasible. Materials and Methods: We retrospectively analyzed medical records of pediatric liver transplant recipients at Baskent University Hospital from January 2012 to December 2017. We grouped children who were extubated in the operating room versus those extubated in the intensive care unit. Results: In our study group of 81 pediatric patients, median age was 4 years (range, 4 mo to 16 y) and 44 (54%) were male. Immediate tracheal extubation in the operating room was performed in 39 patients (48%). Children who remained intubated (n = 42) had more frequent massive hemorrhage (14% vs 0%; P = .015), received larger amounts of packed red blood cells (19.3 vs 10.2 mL/kg; P < .001), and had higher serum lactate levels (9.0 vs 6.9 mmol/L; P = .001) intraoperatively. All children with open abdomens postoperatively remained intubated (n = 7). Patients extubated in the operating room received less vasopressors (1 [3%] vs 12 [29%]; P = .002) and antibiotics (11 [28%] vs 22 [52%]; P = 0.041) and developed infections less frequently postoperatively (3.0 [8%] vs 15.0 [36%]; P = .003). Children extubated in the operating room had shorter mean stay in the intensive care unit (2.0 vs 4.5 days; P < .001). Hospital mortality was higher in children who remained intubated (12% vs 0%; P = .026). Conclusions: Immediate tracheal extubation was well tolerated in almost half of our patients and did not compromise their outcomes. Patients who remained intubated had longer intensive care unit stays and higher hospital mortalities. Therefore, we recommend immediate tracheal extubation in the operating room after pediatric liver transplant among those children without intraoperative requirements for massive blood transfusion, high-dose vasopressors, high serum lactate levels, and open abdomen.
In Memoriam - Arash Pirat (1971-2017)
(2018) Arslan, Gulnaz; Torgay, Adnan; Zeyneloglu, Pinar; 0000-0002-6829-3300; AAJ-5221-2021
Incidence of Acute Kidney Injury Following Liver Transplantation
(2018) Ersoy, Zeynep; Ozdemirkan, Aycan; Zeyneloglu, Pinar; Pirat, Arash; Torgay, Adnan; Haberal, Mehmet; 0000-0003-0767-1088; 0000-0002-6829-3300; 0000-0002-3462-7632; AAF-3066-2021; AAH-7003-2019; AAJ-5221-2021; AAJ-8097-2021
Incidence of Urinary Complications With Double J Stents in Kidney Transplantation
(2019) Kirnap, Mahir; Boyvat, Fatih; Torgay, Adnan; Moray, Gokhan; Yildirim, Sedat; Haberal, Mehmet; https://orcid.org/0000-0002-6829-3300; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-5735-4315; https://orcid.org/0000-0002-3462-7632; 30777542; AAH-9198-2019; F-4230-2011; AAJ-5221-2021; AAE-1041-2021; AAF-4610-2019; AAJ-8097-2021
Objectives: Ureteral complications remain a major source of morbidity and occasional mortality in renal transplant. Among all ureteral complications, leaks are the most frequently encountered in the early posttransplant period. The routine use of a double-J ureteric stent remains controversial, with reported increased incidence of urinary tract infection. Here, we retrospectively compared the efficacy of a double J stent in kidney transplant patients to investigate ureteral complication incidence in our center. Materials and Methods: Our study included 382 kidney transplant patients. At 5 weeks after transplant, the double J stent was removed under sedation. Patients were divided into 2 groups: 125 patients with double J stent placement (group 1) and 257 patients without double J stent placement (group 2). Results: We observed no significant demographic differences between the 2 groups with regard to patient age (median patient age of 30 y [range, 2-73 y] for group 1; median patient age of 33 y [range, 4-69 y] for group 2), patient sex (30.2% females in group 1, 32.4% females in group 2), and body mass index (median of 25.1 vs 24.9 kg/m 2 in groups 1 and 2, respectively). Cold and warm ischemia time for donor organ, delayed graft function, and episodes of acute rejection did not differ significantly between the groups. Urinary tract infection was observed in 25/125 (20.4%) and 50/257 patients (19.2%) in groups 1 and 2, respectively. Urinary leak was present in 8/125 group 1 (6.4%) and 6/257 group 2 patients (2.3%). Conclusions: A double J stent in ureteral anastomosis was not likely to decrease the frequency of leakage but is likely to reduce the gravity of the complication and the need for reoperation. In addition, the use of a double J stent was not associated with increased urinary tract infections in renal transplant recipients.
Kalp dışı ameliyat yapılan hastalarda eşlik eden kardiyak sorunların sıklığı ve morbidite, mortalite üzerine etkileri
(Başkent Üniversitesi Tıp Fakültesi, 2014) Baran Gürler, Müge; Torgay, Adnan
Dünyada artan nüfus ve ortalama yaşam sürelerinin uzamasıyla kalp dışı ameliyat sayısı da artmıştır. Yaşam süresinin uzaması cerrahi gereksinimi olan hastalarda yandaş hastalık olasılığını da arttırmaktadır. Yandaş hastalıklarla beraber perioperatif morbidite ve mortalite oranları da artış göstermektedir. Perioperatif gözlenen morbidite ve mortalitenin en sık sebeplerinden birisi kardiyak komplikasyonlardır. Bu çalışmada, kalp dışı cerrahi nedeniyle opere olan hastalardaki kardiyak hastalık oranını belirlenmesi ve bu kardiyak sorunların perioperatif kardiyak morbidite ve mortalite üzerine etkisinin olup olmadığının retrospektif olarak saptanması amaçlandı. Başkent Üniversitesi Tıp ve Sağlık Bilimleri Araştırma Kurulu onayı alındıktan sonra Mayıs 2012 – Haziran 2013 tarihleri arasında Başkent Üniversitesi Ankara Hastanesi’nde on sekiz yaş üstü kalp dışı cerrahi geçiren 3003 hasta retrospektif olarak incelendi. Hastaların demografik özellikleri, eşlik eden hastalıkları, kullandıkları ilaçlar, operasyon sırasındaki verileri (anestezi şekli, cerrahi girişimin tipi, vital bulgular, kullanılan kristalloid ve kolloid miktarları, kan ve kan ürünü replasmanı, oluşan hemodinamik komplikasyonlar), operasyon sonrası verileri (ilk 48 saatteki hemodinamik komplikasyonlar, ilk 48 saatteki mortalite varlığı, yoğun bakım ihtiyacı ve kalış süresi, hastane kalış süresi) kaydedildi. Çalışmaya dahil edilen 3003 hastanın 32’sinde (%1,1) kardiyak mortalite, 1163’ünde (%38,7) kardiyak morbidite saptandı. Kardiyak hastalıklar tüm hastalar içinde 1183 hastada (%39,4) saptandı. Kardiyak hastalığı olan hastaların 588’inde (%19,6) perioperatif morbidite, 16’sında (%0,5) perioperatif mortalite gözlemlendi. İleri yaş, vücut ağırlığı, koroner arter hastalığı, hipertansiyon, konjestif kalp yetmezliği, valvüler kapak hastalığı, aritmi, hiperlipidemi, kronik obstrüktif akciğer hastalığı, kronik böbrek hastalığı, diyabetes mellitus, inme, anemi, koagulopati ve kanserin varlığının; beta bloker, diüretik, kalsiyum kanal blokeri, anjiyotensin dönüştürücü enzim ihibitörü, anjiyotensin reseptör blokeri, vazodilatör, antikoagulan, antitrombotik, statin, oral antidiyabetik, insülin, antitiroid ve bronkodilatör kullanımının; Amerikan Anestezi Birliği (American Society of Anaesthesiology, ASA) sınıflamasının; genel cerrahi, kulak burun boğaz ve torasik cerrahinin; total kristalloid, kolloid, eritrosit süspansiyonu ve taze donmuş plazma miktarlarının perioperatif kardiyak morbidite sıklığı üzerine istatiksel olarak anlamlı etkisi bulundu (hepsi için p<0,05). Aritmi, kronik böbrek yetmezliği, anemi ve nörodefisitin perioperatif mortalite sıklığı üzerine etkisi olduğu bulundu (hepsi için p<0,05). ii Sonuç olarak tüm parametreler içinde yaş, ileri yaş, koroner arter hastalığı, kanser, diüretik kullanımı, ASA, intraoperatif kullanılan total eritrosit ve kolloid miktarı kalp dışı cerrahi geçiren hastalarda perioperatif kardiyak morbidite için risk faktörü olarak bulundu. Perioperatif kardiyak mortalite içinse kronik böbrek yetmezliği ve nörodefisit risk faktörü olarak bulundu. Kalp dışı cerrahi yapılan hastalarda perioperatif kardiyak morbidite ve mortalite için belirlediğimiz risk faktörlerinden düzeltilebilir olanların değiştirilmesi veya iyileştirilmesi ile perioperatif kardiyak komplikasyon sıklığının azalacağı düşünüldü.
Liver and Kidney Transplant During a 6-Month Period in the COVID-19 Pandemic: A Single-Center Experience
(2020) Akdur, Aydincan; Karakaya, Emre; Soy, Ebru H. Ayvazoglu; Karakayali, Feza Yarbug; Yildirim, Sedat; Torgay, Adnan; Sayin, Cihat Burak; Coskun, Mehmet; Moray, Gokhan; Haberal, Mehmet; 0000-0002-1874-947X; 0000-0002-6829-3300; 0000-0002-8726-3369; 0000-0002-0993-9917; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-4879-7974; 0000-0003-2498-7287; 0000-0001-5630-022X; 33143601; AAB-3888-2021; AAJ-5221-2021; AAA-3068-2021; AAC-5566-2019; AAJ-8097-2021; AAF-4610-2019; AAD-5466-2021; AAE-1041-2021; AAM-4120-2021
Objectives: With the declaration of COVID-19 as a pandemic, many studies have indicated that elective surgeries should be postponed. However, post-ponement of transplants may cause diseases to get worse and increase the number in wait lists. We believe that, with precautions, transplant does not pose a risk during pandemic. Here, we aimed to evaluate our transplant results, which we safely performed during a 6-month pandemic period. Materials and Methods: Until September 2020, 3140 kidney and 667 liver transplants have been performed in our centers. We evaluated 38 kidney transplants and 9 liver transplants procedures performed during the pandemic (March 1 to September 2, 2020). Recipient and donor candidates were screened for COVID-19 with polymerase chain reaction and thoracic computed tomography. All recipients had routine immunosuppressive protocol. During hospitalization at our COVID-19-free transplant facility, we restricted the interactions during multidisciplinary rounds. Results: During the pandemic, 38 kidney transplants with an average length of hospital stay of 8.1 days were performed. Mean serum creatinine values of recipients were 0.91, 0.86, and 0.74 mg/dL on postoperative days 7, 30, and 90, respectively. During the pandemic, 9 living donor liver transplants (1 adult, 8 pediatric) were performed with an average length of hospital stay of 17.1 days. Mean serum total bilirubin levels were 0.9, 0.5, and 0.4 mg/dL on postoperative days 7, 30, and 90, respectively. Mean serum aspartate aminotransferase levels were 38.1, 28.3, and 22.3 U/L on postoperative days 7, 30, and 90, respectively. All recipients and donors were successfully discharged. Only 1 liver recipient died (on day 55 after discharge as a result of oxalosis-induced heart failure). Conclusions: According to our results, when precautions are taken, transplant does not pose a risk to patients during the pandemic period. We attribute the safety and success shown to our newly developed protocol in response to the COVID-19 pandemic.