Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Locoregional Therapy and Recurrence of Hepatocellular Carcinoma After Liver Transplant(2014) Kirnap, Mahir; Boyvat, Fatih; Akdur, Aydincan; Karakayali, Feza; Arslan, Gulnaz; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-1874-947X; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635819; AAH-9198-2019; F-4230-2011; AAA-3068-2021; AAB-3888-2021; AAE-1041-2021; AAJ-8097-2021Objectives: Locoregional therapy may decrease the tumor stage and enable liver transplant in patients who have hepatocellular cancer. The purpose of the present study was to assess the relation between locoregional therapy and recurrence of hepatocellular carcinoma after transplant. Materials and Methods: In 50 patients who had liver transplant for treatment of end-stage liver disease from hepatocellular carcinoma and cirrhosis, outcomes were evaluated for associations with locoregional therapy before transplant and Milan criteria. Results: Most patients had locoregional therapy before transplant (31 patients [62%]: transarterial catheter radiofrequency ablation alone, 16 patients; chemoembolization alone, 10 patients; both transarterial catheter radiofrequency ablation and chemoembolization, 5 patients). Follow-up at median 90 months after transplant showed that 9 patients (18%) had recurrence at median 45 months (range, 120 +/- 12 mo) (recurrence: locoregional therapy, 5 of 31 patients [16%]; no locoregional therapy, 4 of 19 patients [21%]; not significant). Locoregional therapy was associated with a significantly lower frequency of recurrence in patients who were outside the Milan criteria. Conclusions: In patients who have liver transplant for treatment of hepatocellular carcinoma, preoperative locoregional therapy may decrease recurrence in patients who are outside the Milan criteria.Item Postoperative Gastrointestinal Bleeding After an Orthotopic Liver Transplant: A Single-Center Experience(2014) Fidan, Cihan; Kirnap, Mahir; Akdur, Aydincan; Ozcay, Figen; Selcuk, Haldun; Arslan, Gulnaz; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-9093-1524; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-5214-516X; https://orcid.org/0000-0002-8445-6413; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635817; F-5830-2019; AAH-9198-2019; AAA-3068-2021; ABG-5684-2020; AAJ-6976-2021; AAE-1041-2021; AAJ-8097-2021Objectives: The overall incidence, causes, and treatment of posttransplant gastrointestinal bleeding, have been previously described. In this study, we examined the causes and treatment of postoperative gastrointestinal bleeding after orthotopic liver transplant. Materials and Methods: Clinical data of 335 patients who underwent an orthotopic liver transplant at our institution between September 2001 and December 2012 were analyzed retrospectively. The diagnosis and treatment of postoperative gastrointestinal bleeding after an orthotopic liver transplant were reviewed. Results: Gastrointestinal bleeding occurred in 13 patients (3.8%) after an orthotopic liver transplant. Five patients (38.4%) were adult and 8 patients (61.6%) were pediatric. The sites of the bleeding were Roux-en-Y anastomosis bleeding in 5 cases, peptic ulcer in 3 cases, erosive gastritis in 3 cases, gastric and esophageal varices in 1 case, and hemobilia in 1 case. These 13 patients with gastrointestinal bleeding were managed with conservative treatment, endoscopic treatment, radiologic interventional embolism, or exploratory laparotomy. No patients died because of gastrointestinal bleeding. During follow-up, 4 patients died because of sepsis and 1 patient died of recurrence of hepatocellular carcinoma. Conclusions: Gastrointestinal bleeding after liver transplant and its incidence, causes, and treatment are not well-described in the literature. Diagnosis and management of gastrointestinal bleeding requires a multidisciplinary approach involving surgeons, hepatologists, advanced and experienced endoscopists, and interventional radiologists.Item Acute Renal Injury in Liver Transplant Patients and Its Effect on Patient Survival(2014) Kirnap, Mahir; Colak, Turan; Baskin, Esra; Akdur, Aydincan; Moray, Gokhan; Arslan, Gulnaz; Haberal, Mehmet; https://orcid.org/0000-0002-8372-7840; https://orcid.org/0000-0003-4361-8508; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635816; AAH-9198-2019; AAJ-8554-2021; B-5785-2018; AAA-3068-2021; AAE-1041-2021; AAJ-8097-2021Objectives: Acute renal injury is a common complication in liver transplant patients. Acute kidney injury is due to nephrotoxic drugs used after liver transplant, infections, and hemorrhage. Though it is generally reversible, it has effects on grafts and patients survival. In this retrospective observational study carried out at a single center, the effects of acute renal disease on liver recipient's survival were investigated. Materials and Methods: Liver transplant recipients of live-donor and deceased-donor transplants between January 2002 and May 2013 were included in this study; there were 310 liver transplant patients (mean age, 28 y; age range, 6 mo-62 y; 165 males, 145 females). The acute kidney disease diagnosis and staging was based on the nephrology department evaluation and daily serum creatinine levels. Patients with acute kidney injury before undergoing liver transplant and those undergoing a transplant for the second time were excluded. Kidney functions were evaluated by the nephrology department 1 week, 3 months, and 1 year after the liver transplant. Results: Acute kidney disease rates in these patients were 5%, 8%, and 12%. Four patients developed chronic kidney failure during follow-up. The mortality rate was higher (18%) in acute renal failure patients compared with those that did not have acute renal failure. The mortality rate was 11% in patients without acute renal failure. Conclusions: Acute renal injury is common after liver transplant and has an effect on mortality.Item 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-8097-2021Objectives: 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.Item The History of Liver Transplantation in Turkey(2014) Moray, Gokhan; Arslan, Gulnaz; Haberal, Mehmet; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635786; AAE-1041-2021; AAJ-8097-2021Liver transplantation is the definitive treatment for end-stage liver diseases. The first successful liver transplant was performed in the United States by Thomas Starzl in 1967. The first successful solidorgan transplant in Turkey was a living-related kidney transplant performed by Dr. Haberal in 1975. After much effort by Dr. Haberal, the Turkish parliament enacted a law about organ transplantation in 1979. After clinical and experimental studies, the first liver transplant in Turkey was performed by Dr. Haberal in 1988. The first successful partial living-donor liver transplant in children in Turkey was performed by the same team on March 15, 1990. On April 24, 1990, the first living-donor liver transplant was performed on a child in Turkey using a left lateral segment by Dr. Haberal and coworkers. On May 16, 1992, Dr. Haberal performed a simultaneous living-donor liver and kidney transplantation to an adult from the same donor. There currently are 30 liver transplantation centers in Turkey. According to data from the Ministry of Health, there presently are 2065 patients in Turkey who are waiting for a liver transplantation. From January 2002 to June 2013, there were 6091 liver transplants performed in Turkey (4020 living-donor [66%] and 2071 deceased-donor liver transplants [34%]). From January 2011 to June 2013, there were 2514 patients who had liver transplants in Turkey, and 437 patients (17%) died. The number of liver transplants per year in Turkey reached 1000 transplants in 2012 and more than 1150 transplants in 2013 (15.1/million/y). Therefore, Turkey has one of the highest volumes of liver. transplantation per population worldwide, with 90% survival within 1 year after transplantation.Item Nonmelanoma Skin Cancer After Kidney Transplant(2014) Tepeoglu, Merih; Ayva, Sebnem; Atilgan, Alev Ok; Tunca, M. Zeyneb; Ozdemir, B. Handan; Moray, Gokhan; Yildirim, Sedat; Arslan, Gulnaz; Haberal, Mehmet; https://orcid.org/0000-0002-9894-8005; https://orcid.org/0000-0002-2280-8778; https://orcid.org/0000-0001-8595-8880; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-5735-4315; https://orcid.org/0000-0002-3462-7632; 24907724; AAK-5222-2021; AAK-1967-2021; AAK-3333-2021; X-8540-2019; AAE-1041-2021; AAF-4610-2019; AAJ-8097-2021Objectives: Solid-organ transplant recipients have a high risk of developing nonmelanoma skin cancers. This study sought to determine the incidence of skin cancer and identify possible risk factors for skin cancer in kidney transplant recipients. Materials and Methods: Nonmelanoma skin cancer was diagnosed and confirmed with histology in 33 of 1275 kidney transplant recipients (2.6%). Demographic and clinical findings were reviewed retrospectively. Results: Nonmelanoma skin cancers included squamous cell carcinoma in 10 patients (30%), basal cell carcinoma in 9 patients (27%), Kaposi sarcoma in 9 patients (27%), squamous cell carcinoma in situ in 3 patients (9%), and cutaneous lymphoma in 2 patients (6%). The ratio of squamous cell carcinoma to basal cell carcinoma was 1.1:1. The mean time from transplant to skin cancer diagnosis was 65 +/- 55 months (range, 0-180 mo). Immunosuppressive therapy was based on cyclosporine in 22 patients (67%), tacrolimus in 8 patients (24%), and combination therapy (cyclosporine and azathioprine) in 3 patients (9%). Conclusions: Nonmelanoma skin cancer is an important clinical problem in kidney transplant recipients. Interventions that may benefit kidney transplant recipients may include intensive patient education, protection against sun exposure, and dermatologic screening programs.Item Postoperative Effects of Intraoperative Hyperglycemia in Liver Transplant Patients(2015) Komurcu, Ozgur; Camkiran, Aynur; Kaplan, Serife; Torgay, Adnan; Pirat, Arash; Haberal, Mehmet; Arslan, Gulnaz; 0000-0002-6829-3300; 0000-0001-6762-895X; 0000-0002-3462-7632; 0000-0003-1470-7501; 25894186; AAJ-5221-2021; GLV-1652-2022; AAJ-8097-2021Objectives: The aim of this study was to determine the effects of intraoperative hyperglycemia on postoperative outcomes in orthotopic liver transplant recipients. Materials and Methods: After ethics committee approval was obtained, we retrospectively analyzed the records of patients who underwent orthotopic liver transplant from January 2000 to December 2013. A total 389 orthotopic liver transplants were performed in our center, but patients aged < 15 years (179 patients) were not included in the analyses. Patients were divided into 2 groups based on their maximum intraoperative blood glucose level: group 1 (patients with intraoperative blood glucose level < 200 mg/dL) and group 2 (patients with intraoperative blood glucose level > 200 mg/dL). Postoperative complications between the 2 groups were compared. Results: There were 58 patients (37.6%; group 1, blood glucose < 200 mg/dL) who had controlled blood glucose and 96 patients (62.3%; group 2, blood glucose > 200 mg/dL) who had uncontrolled blood glucose. The mean age and weight for groups 1 and 2 were similar. There were no differences between the 2 groups regarding the duration of anhepatic phase (P=.20), operation time (P=.41), frequency of immediate intraoperative extubation (P=.14), and postoperative duration of mechanical ventilation (P=.06). There were no significant differences in frequency of patients who had postoperative infectious complications, acute kidney injury, or need for hemodialysis. Mortality rates after liver transplant were similar between the 2 groups (P=.81) Conclusions: Intraoperative hyperglycemia during orthotopic liver transplant was not associated with an increased risk of postoperative infection, acute renal failure, or mortality.Item Accuracy of Continuous Noninvasive Arterial Pressure Monitoring in Living-Liver Donors During Transplantation(2015) Araz, Coskun; Zeyneloglu, Pinar; Pirat, Arash; Veziroglu, Nukhet; Firat, Aynur Camkiran; Arslan, Gulnaz; 0000-0003-2312-9942; 0000-0002-4927-6660; 0000-0003-1470-7501; 25894178; C-3736-2018; AAJ-4576-2021Objectives: Hemodynamic monitoring is vital during liver transplant surgeries because distinct hemodynamic changes are expected. The continuous noninvasive arterial pressure (CNAP) monitor is a noninvasive device for continuous arterial pressure measurement by a tonometric method. This study compared continuous noninvasive arterial pressure monitoring with invasive direct arterial pressure monitoring in living-liver donors during transplant. Materials and Methods: There were 40 patients analyzed while undergoing hepatic lobectomy for liver transplant. Invasive pressure monitoring was established at the radial artery and continuous noninvasive arterial pressure monitoring using a finger sensor was recorded simultaneously from the contralateral arm. Systolic, diastolic, and mean arterial pressures from the 2 methods were compared. Correlation between the 2 methods was calculated. Results: A total of 5433 simultaneous measurements were obtained. For systolic arterial blood pressure, 55% continuous noninvasive arterial pressure measurements were within 10% direct arterial measurement; the correlation was 0.479, continuous noninvasive arterial pressure bias was -0.3 mm Hg, and limits of agreement were 32.0 mm Hg. For diastolic arterial blood pressure, 50% continuous noninvasive arterial pressure measurements were within 10% direct arterial measurement; the correlation was 0.630, continuous noninvasive arterial pressure bias was -0.4 mm Hg, and limits of agreement were 21.1 mm Hg. For mean arterial blood pressure, 60% continuous noninvasive arterial pressure measurements were within 10% direct arterial measurement; the correlation was 0.692, continuous noninvasive arterial pressure bias was +0.4 mm Hg, and limits of agreement were 20.8 mm Hg. Conclusions: The 2 monitoring techniques did not show acceptable agreement. Our results suggest that continuous noninvasive arterial pressure monitoring is not equivalent to invasive arterial pressure monitoring in donors during living-donor liver transplant.Item Liver and Kidney Transplant in Primary Hyperoxaluria: A Single Center Experience(2015) Moray, Gokhan; Tezcaner, Tugan; Ozcay, Figen; Baskin, Esra; Akdur, Aydincan; Kirnap, Mahir; Yildirim, Sedat; Arslan, Gulnaz; Haberal, Mehmet; 0000-0002-5735-4315; 0000-0003-2498-7287; 0000-0002-5214-516X; 0000-0002-8726-3369; 0000-0003-4361-8508; 0000-0002-3462-7632; 0000-0002-3641-8674; 25894144; AAF-4610-2019; AAE-1041-2021; ABG-5684-2020; AAA-3068-2021; B-5785-2018; AAJ-8097-2021; AAH-9198-2019; AAD-9865-2021Objectives: Primary hyperoxaluria, especially type 1, is a severe disease with multisystem morbidity and high mortality. We present 3 primary hyperoxaluria type 1 patients who underwent liver transplant, including living-donor liver transplant or combined liver and kidney transplant in our institution. Case Reports: Patients who underwent liver transplant or combined liver/kidney transplant at our institution were evaluated, retrospectively. Between January 2002 and 2013, there were 3 patients who underwent transplant for primary hyperoxaluria. All 3 patients had disease onset in childhood, and the definitive diagnosis was established at age < 1, 6, and 8 years. Although early diagnosis was made, primary hyperoxaluria resulted in end-stage renal disease in 2 patients, and hemodialysis was introduced before liver transplant. All 3 patients underwent living-donor liver transplant. Case 1 was a 10-year-old girl who had an uneventful course after living-donor liver transplant, and she received a living-donor kidney transplant from the same donor 4 months after living-donor liver transplant. Case 2 was a 7-year-old boy who was the younger brother of the first patient; he did not have end-stage renal disease or any renal disorder after successful living-donor liver transplant. Case 3 was a 3-year-old boy who was diagnosed at age 2 months with renal disorders; although he was discharged from the hospital after living-donor liver transplant, he was readmitted because of unconsciousness that developed 1 day after discharge, and he died because of intracranial hemorrhage 2 months after liver transplant, unable to receive a kidney transplant. Conclusions: Primary hyperoxaluria is a rare disorder that is difficult to diagnose until end-organ damage is severe. Outcomes may be improved with early and accurate diagnosis, aggressive supportive treatment, and correction of the enzyme defect by liver transplant before systemic oxalosis develops. However, kidney transplant or combined liver and kidney transplant is required in many primary hyperoxaluria type 1 patients because of the delayed diagnosis or long organ waiting time.Item Large-for-Size Liver Transplant: A Single-Center Experience(2015) Akdur, Aydincan; Kirnap, Mahir; Ozcay, Figen; Sezgin, Atilla; Soy, Hatice Ebru Ayvazoglu; Yarbug, Feza Karakayali; Yildirim, Sedat; Moray, Gokhan; Arslan, Gulnaz; Haberal, Mehmet; 0000-0002-8726-3369; 0000-0002-5735-4315; 0000-0003-2498-7287; 0000-0002-3462-7632; 0000-0002-0993-9917; 0000-0002-5214-516X; 25894137; AAA-3068-2021; AAF-4610-2019; AAE-1041-2021; AAJ-8097-2021; AAH-9198-2019; AAC-5566-2019; ABG-5684-2020Objectives: The ideal ratio between liver transplant graft mass and recipient body weight is unknown, but the graft probably must weigh 0.8% to 2.0% recipient weight. When this ratio > 4%, there may be problems due to large-for-size transplant, especially in recipients < 10 kg. This condition is caused by discrepancy between the small abdominal cavity and large graft and is characterized by decreased blood supply to the liver graft and graft dysfunction. We evaluated our experience with large-for-size grafts. Materials and Methods: We retrospectively evaluated 377 orthotopic liver transplants that were performed from 2001-2014 in our center. We included 188 pediatric transplants in our study. Results: There were 58 patients < 10 kg who had living-donor living transplant with graft-to-body-weight ratio > 4%. In 2 patients, the abdomen was closed with a Bogota bag. In 5 patients, reoperation was performed due to vascular problems and abdominal hypertension, and the abdomen was closed with a Bogota bag. All Bogota bags were closed in 2 weeks. After closing the fascia, 10 patients had vascular problems that were diagnosed in the operating room by Doppler ultrasonography, and only the skin was closed without fascia closure. No graft loss occurred due to large-for-size transplant. There were 8 patients who died early after transplant (sepsis, 6 patients; brain death, 2 patients). There was no major donor morbidity or donor mortality. Conclusions: Large-for-size graft may cause abdominal compartment syndrome due to the small size of the recipient abdominal cavity, size discrepancies in vascular caliber, insufficient portal circulation, and disturbance of tissue oxygenation. Abdominal closure with a Bogota bag in these patients is safe and effective to avoid abdominal compartment syndrome. Early diagnosis by ultrasonography in the operating room after fascia closure and repeated ultrasonography at the clinic may help avoid graft loss.