Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Blood Glucose Regulation During Living-Donor Liver Transplant Surgery(2015) Gedik, Ender; Toprak, Huseyin Ilksen; Koca, Erdinc; Sahin, Taylan; Ozgul, Ulku; Ersoy, Mehmet Ozcan; 0000-0002-7175-207X; 25894177; ABI-2971-2020Objectives: The goal of this study was to compare the effects of 2 different regimens on blood glucose levels of living-donor liver transplant. Materials and Methods: The study participants were randomly allocated to the dextrose in water plus insulin infusion group (group 1, n = 60) or the dextrose in water infusion group (group 2, n = 60) using a sealed envelope technique. Blood glucose levels were measured 3 times during each phase. When the blood glucose level of a patient exceeded the target level, extra insulin was administered via a different intravenous route. The following patient and procedural characteristics were recorded: age, sex, height, weight, body mass index, end-stage liver disease, Model for End-Stage Liver Disease score, total anesthesia time, total surgical time, and number of patients who received an extra bolus of insulin. The following laboratory data were measured pre- and postoperatively: hemoglobin, hematocrit, platelet count, prothrombin time, international normalized ratio, potassium, creatinine, total bilirubin, and albumin. Results: No hypoglycemia was noted. The recipients exhibited statistically significant differences in blood glucose levels during the dissection and neohepatic phases. Blood glucose levels at every time point were significantly different compared with the first dissection time point in group 1. Excluding the first and second anhepatic time points, blood glucose levels were significantly different as compared with the first dissection time point in group 2 (P < .05). Conclusions: We concluded that dextrose with water infusion alone may be more effective and result in safer blood glucose levels as compared with dextrose with water plus insulin infusion for living-donor liver transplant recipients. Exogenous continuous insulin administration may induce hyperglycemic attacks, especially during the neohepatic phase of living-donor liver transplant surgery. Further prospective studies that include homogeneous patient subgroups and diabetic recipients are needed to support the use of dextrose plus water infusion without insulin.Item Extracorporeal Membrane Oxygenation After Living-Related Liver Transplant(2015) Gedik, Ender; Celik, Muhammet Reha; Otan, Emrah; Disli, Olcay Murat; Erdil, Nevzat; Bayindir, Yasar; Kutlu, Ramazan; Yilmaz, Sezai; 0000-0002-7175-207X; 25894176; ABI-2971-2020Various types of extracorporeal membrane oxygenation methods have been used in liver transplant operations. The main indications are portopulmonary or hepatopulmonary syndromes and other cardiorespiratory failure syndromes that are refractory to conventional therapy. There is little literature available about extracorporeal membrane oxygenation, especially after liver transplant. We describe our experience with 2 patients who had living-related liver transplant. A 69-year-old woman had refractory aspergillosis pneumonia and underwent pumpless extracorporeal lung assist therapy 4 weeks after liver transplant. An 8-month-old boy with biliary atresia underwent urgent liver transplant; he received venoarterial extracorporeal membrane oxygenation therapy on postoperative day 1. Despite our unsuccessful experience with 2 patients, extracorporeal membrane oxygenation and pumpless extracorporeal lung assist therapy for liver transplant patients may improve prognosis in selected cases.Item The 2-Stage Liver Transplant: 3 Clinical Scenarios(2015) Gedik, Ender; Bicakcioglu, Murat; Otan, Emrah; Toprak, Huseyin Ilksen; Isik, Burak; Aydin, Cemalettin; Kayaalp, Cuneyt; Yilmaz, Sezai; 0000-0001-9293-8116; 0000-0002-2395-3985; 0000-0002-7175-207X; 0000-0003-4657-2998; 25894175; ABB-5579-2020; AAH-1764-2021; AAN-4023-2020; A-6657-2018; ABI-2971-2020The main goal of 2-stage liver transplant is to provide time to obtain a new liver source. We describe our experience of 3 patients with 3 different clinical conditions. A 57-year-old man was retransplanted successfully with this technique due to hepatic artery thrombosis. However, a 38-year-old woman with fulminant toxic hepatitis and a 5-year-old-boy with abdominal trauma had poor outcome. This technique could serve as a rescue therapy for liver transplant patients who have toxic liver syndrome or abdominal trauma. These patients required intensive support during long anhepatic states. The transplant team should decide early whether to use this technique before irreversible conditions develop.Item Percutaneous Dilational Tracheotomy in Solid-Organ Transplant Recipients(2015) Ozdemirkan, Aycan; Ersoy, Zeynep; Zeyneloglu, Pinar; Gedik, Ender; Pirat, Arash; Haberal, Mehmet; 0000-0003-0767-1088; 0000-0002-3462-7632; 0000-0003-2312-9942; 0000-0002-7175-207X; 26640911; AAF-3066-2021; AAH-7003-2019; AAJ-8097-2021; C-3736-2018; ABI-2971-2020Objectives: Solid-organ transplant recipients may require percutaneous dilational tracheotomy because of prolonged mechanical ventilation or airway issues, but data regarding its safety and effectiveness in solid-organ transplant recipients are scarce. Here, we evaluated the safety, effectiveness, and benefits in terms of lung mechanics, complications, and patient comfort of percutaneous dilational tracheotomy in solid-organ transplant recipients. Materials and Methods: Medical records from 31 solid-organ transplant recipients (median age of 41.0 years [interquartile range, 18.0-53.0 y]) who underwent percutaneous dilational tracheotomy at our hospital between January 2010 and March 2015 were analyzed, including primary diagnosis, comorbidities, duration of orotracheal intubation and mechanical ventilation, length of intensive care unit and hospital stays, the time interval between transplant to percutaneous dilational tracheotomy, Acute Physiology and Chronic Health Evaluation II score, tracheotomy-related complications, and pulmonary compliance and ratio of partial pressure of arterial oxygen to fraction of inspired oxygen. Results: The median Acute Physiology and Chronic Health Evaluation II score on admission was 24.0 (interquartile range, 18.0-29.0). The median interval from transplant to percutaneous dilational tracheotomy was 105.5 days (interquartile range, 13.0-2165.0 d). The only major complication noted was left-sided pneumothorax in 1 patient. There were no significant differences in ratio of partial pressure of arterial oxygen to fraction of inspired oxygen before and after procedure (170.0 [inter quartile range, 102.2-302.0] vs 210.0 [interquartile range, 178.5-345.5]; P=.052). However, pulmonary compliance results preprocedure and postprocedure were significantly different (0.020 L/cm H2O [interquartile range, 0.015-0.030 L/cm H2O] vs 0.030 L/cm H2O [interquartile range, 0.020-0.041 L/cm H2O); P=.001]). Need for sedation significantly decreased after tracheotomy (from 17 patients [54.8%] to 8 patients [25.8%]; P=.004]). Conclusions: Percutaneous dilational tracheotomy with bronchoscopic guidance is an efficacious and safe technique for maintaining airways in solid-organ transplant recipients who require prolonged mechanical ventilation, resulting in possible improvements in ventilatory mechanics and patient comfort.Item Late Intensive Care Unit Admission in Liver Transplant Recipients: 10-Year Experience(2015) Atar, Funda; Gedik, Ender; Kaplan, Serife; Zeyneloglu, Pinar; Pirat, Arash; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-7175-207X; 0000-0003-2312-9942; 0000-0001-6762-895X; 26640903; AAJ-8097-2021; ABI-2971-2020; C-3736-2018; GLV-1652-2022Objectives: We evaluated late intensive care unit admission in liver transplant recipients to identify incidences and causes of acute respiratory failure in the postoperative period and to compare these results with results in patients who did not have acute respiratory failure. Materials and Methods: We retrospectively screened the data of 173 consecutive adult liver transplant recipients from January 2005 through March 2015 to identify patients with late admission (> 30 d posttransplant) to an intensive care unit. Patients were divided into 2 groups: patients with and without acute respiratory failure. Acute respiratory failure was defined as severe dyspnea, respiratory distress, decreased oxygen saturation, hypoxemia or hypercapnia on room air, or need for noninvasive or invasive mechanical ventilation. Demographic, laboratory, clinical, and respiratory data were collected. Model for End-Stage Liver Disease, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores; lengths of intensive care unit and hospital stays; and hospital mortality were assessed. Results: Among 173 patients, 37 (21.4%) were admitted to an intensive care unit, including 22 (59.5%) with acute respiratory failure. The leading cause of acute respiratory failure was pneumonia (n = 19, 86.4%). Patients with acute respiratory failure had significantly lower levels of albumin before intensive care unit admission (P =.003). In patients with acute respiratory failure, severe sepsis and septic shock were more frequently observed and tracheotomy was more frequently performed (P=.041). Conclusions: Acute respiratory failure developed in 59.5% of liver transplant recipients with late intensive care unit admission. The leading cause was pneumonia, with this group of patients having higher requirements for invasive mechanical ventilation and tracheotomy, longer stays in an intensive care unit, and higher mortality.Item The Clinical Outcomes of Covid-19 Disease in Patients with Solid Organ Transplantation(2021) Yuce, Gulbahar Darilmaz; Ulubay, Gaye; Karakaya, Emre; Tek, Korhan; Akdur, Aydincan; Bozbas, Serife Savas; Gedik, Ender; Kupeli, Elif; Erol, Cigdem; Arslan, Hande; Akcay, Sule; Haberal, Mehmet; https://orcid.org/0000-0002-4879-7974; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-2535-2534; https://orcid.org/0000-0002-5708-7915; https://orcid.org/0000-0002-3462-7632; JBS-4193-2023; AAD-5466-2021; AAA-3068-2021; AAJ-1219-2021; ABG-7034-2021; AAJ-8097-2021Item Venoarterial Extracorporeal Membrane Oxygenation Support As A Bridge To Heart Transplantation: Report of Three Cases(2016) Gedik, Ender; Ulas, Aydin; Ersoy, Ozgur; Atar, Funda; Firat, Aynur Camkiran; Zeyneloglu, Pinar; Sezgin, Atilla; Pirat, Arash; https://orcid.org/0000-0002-7175-207X; ABI-2971-2020Item Left Ventricular Assist Device As The Bridge to Heart Transplantation: Five-Case Series(2016) Firat, Aynur Camkiran; Akovali, Nukhet; Gedik, Ender; Zeyneloglu, Pinar; Ozkan, Murat; Sezgin, Atilla; Pirat, Arash; https://orcid.org/0000-0002-7175-207X; ABI-2971-2020Item Acute Respiratory Distress Syndrome in Solid Organ Transplant Recipients(2016) Zeyneloglu, Pinar; Ozdemirkan, Aycan; Komurcu, Ozgur; Ulas, Aydin; Atar, Funda; Gedik, Ender; Pirat, Arash; https://orcid.org/0000-0002-7175-207X; AAH-7003-2019; ABI-2971-2020Item Perioperative Venoarterial Extracorporeal Membrane Oxygenation Support During Heart Transplant(2017) Gedik, Ender; Atar, Funda; Ozdemirkan, Aycan; Firat, Aynur Camkiran; Zeyneloglu, Pinar; Sezgin, Atilla; Pirat, Arash; 0000-0002-7175-207X; 0000-0003-2312-9942; 0000-0003-1470-7501; 28260473; AAH-7003-2019; ABI-2971-2020; C-3736-2018Objectives: Heart transplant is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to heart transplant. This technique may be used after heart transplant for conditions refractory to medical treatment like primary graft failure. Previously, we reported our experience with patients who received extracorporeal support as a bridge to emergency heart transplant. In this study, we present our perioperative experience with heart transplants in which extracorporeal support was used. Materials and Methods: We retrospectively screened the data of 31 patients who were seen at our center between January 2014 and June 2016. We screened for patients who were admitted to the intensive care unit before transplant and who required venoarterial extracorporeal membrane oxygenation for circulatory support and postoperative patients who required extracorporeal support. Patient demographics and characteristics, clinical data, and extracorporeal support data were collected from our electronic database and patient medical records. Results: There were 14 patients who required peri operative extracorporeal support. Preoperative sup port was performed in 3 patients before transplant, and postoperative support was performed in 11 patients after transplant. The mean age was 37.7 years in patients within the preoperative group and 29.7 years in patients within the postoperative group. One patient with preoperative support and 5 with postoperative support were pediatric patients. The main indication for transplant was dilated cardiomyopathy in both groups (100% and 63.7%). Overall mortality rates were 33% in the preoperative group and 63.7% in the postoperative group. Conclusions: For patients on heart transplant wait lists who are worsening despite optimal medical therapy, venoarterial extracorporeal membrane oxygenation support is a safe and viable last resort. In addition, extracorporeal support can be used during the posttransplant period as salvage therapy in heart recipients with hemodynamic deterioration. In our experience, preoperative extracorporeal support had lower mortality rates compared with postoperative support.