Tıp Fakültesi / Faculty of Medicine

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Author: search.filters.author.Boyvat, FatihSubject: search.filters.subject.Liver transplantation

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    Treatment of Biliary Complications After Liver Transplant: Results of a Single Center
    (2015) Yildirim, Sedat; Soy, Ebru Hatice Ayvazoglu; Akdur, Aydincan; Kirnap, Mahir; Boyvat, Fatih; Karakayali, Feza; Torgay, Adnan; Moray, Gokhan; Haberal, Mehmet; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-0993-9917; 0000-0002-6829-3300; 0000-0002-1874-947X; 0000-0003-2498-7287; 25894131; AAA-3068-2021; F-4230-2011; AAH-9198-2019; AAJ-8097-2021; AAF-4610-2019; AAC-5566-2019; AAJ-5221-2021; AAB-3888-2021; AAE-1041-2021
    Biliary complications are major sources of morbidity after liver transplant due to vulnerable vascularization of the bile ducts. Biliary complications are the "Achilles' heel" of liver transplant with their high incidence, need for repeated and prolonged treatment, and potential effects on graft and patient survival. Although standardization of reconstruction techniques and improvements in immunosuppression and organ preservation have reduced the incidence of biliary complications, in early reports the morbidity rates are 50%, with related mortality rate 25% to 30%. Prophylaxis is a major issue. Although many risk factors (old donor age, marginal graft, prolonged ischemia time, living-donor liver transplant, partial liver transplant, donation after cardiac death, hepatic arterial thrombosis, organ preservation, chronic rejection, and other donor and recipient characteristics) do not directly affect biliary complications, accumulation of the factors mentioned above, should be avoided. However, no accepted standard has been established. Treatment strategy is a subject of debate. Recently, non-operative treatment of biliary complications have been preferred for diagnosis and therapy, because percutaneous or endoscopic treatment may prevent the need for surgical intervention. In this study, we reviewed our treatment of early and late biliary complications after liver transplant.
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    Role of Interventional Radiology in the Management of Early Vascular Complications After Liver Transplant
    (2022) Igus, Behlul; Boyvat, Fatih; Ozen, Ozgur; Soy, Ebru Hatice Ayvazoglu; Karakaya, Emre; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0001-7122-4130; 0000-0002-4879-7974; 0000-0003-4874-8141; 36718007; AAJ-8097-2021; AAN-1681-2021; AAD-5466-2021; AAN-1040-2021
    Objectives: A hepatic vascular complication after liver transplant is a critical situation, often resulting in graft failure and potentially leading to patient death. Early diagnosis and treatment of vascular complications can provide prolonged graft survival and prohibit further complications. This study presents our experiences with endovascular treatment during the first week after liver transplant. Materials and Methods: Between January 2012 and February 2021, 240 liver transplants were performed, with 43 patients having early endovascular treatment (37 men; mean age 27 +/- 2.9 years) at a single center. Early endovascular interventions were carried out 1 to 7 days (mean +/- SD of 2.7 +/- 0.24 days) after transplant. Patients with vascular complications were grouped by arterial, venous, and portal complications. In addition, arterial complications were subgrouped by occlusive (hepatic artery thrombosis) and nonocclusive (hepatic artery stenosis/splenic artery steal syndrome) complications. Patients had median follow- up of 47 +/- 4 months. Results: In the first week after liver transplant, vascular complications included splenic artery steal syndrome in 27 patients (62.7%), hepatic complications in 10 patients (23.2%) (7 with hepatic artery thrombosis, 3 with hepatic artery stenosis), hepatic venous outflow complications in 4 patients (9.3%), and portal vein complications in 2 patients (4.6%). Only 1 patient required revision surgery because of excessive arterial kinking; the remaining patients with arterial complications were successfully managed with multiple endovascular treatment attempts. Patients with splenic artery steal syndrome were treated by selective arterial embolization with coil devices. Resistivity index, peak systolic velocity of hepatic arteries, and portal vein maximal velocity significantly improved (P <.001). Patients with hepatic venous outflow and portal vein complications who had endovascular treatments and vascular structures maintained good results over follow-up. Conclusions: Early endovascular intervention is feasible and safe for hepatic vascular complications following liver transplant, with high success treatment rates with advances in interventional radiology.
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    Interventional Radiologic Treatment of Hepatocellular Carcinoma
    (2017) Boyvat, Fatih; 28301995; F-4230-2011
    The current treatment modalities for patients with hepatocellular carcinoma are discussed in this review. Hepatocellular carcinoma arises in up to 90% of cirrhotic patients, mainly due to chronic viral hepatitis and alcohol abuse. Nearly two-thirds of all patients with hepatocellular carcinoma are diagnosed at advanced stages, thus causing problems with treatment. Regardless of the stage of the disease, interventional radiology offers both curative and palliative treatment options in the management of this disease. Selecting the most appropriate treatment requires an initial staging assessment and detailed clinical and radiologic workup. Treatment allocation is based on liver function, size and number of tumors, macrovascular invasion, and extrahepatic spread of disease.