Tıp Fakültesi / Faculty of Medicine

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Author: search.filters.author.Yildirim, SedatSubject: search.filters.subject.Liver transplantation

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    Pulmonary Embolism in a Liver Donor: A Case Report and Review of the Literature
    (2023) Esendagli, Dorina; Akcay, Sule; Yildirim, Sedat; Haberal, Mehmet; 0000-0002-6619-2952; 37503803; ABF-9398-2020
    Liver transplant is an important treatment option for end-stage liver disease, and living related donation is an option to shorten or eliminate the waiting period for the patients, especially when shortage of organs is of concern. It is crucial to provide optimal safety for the donors and to thoroughly examine them preoperatively in order to decrease perioperative and postoperative complications. Here, we report the case of a living donor who had undergone a left liver lobectomy and on postoperative day 2 presented with a radiologically severe pulmonary embolism, despite the absence of any risk factor for venous thromboembolism or pulmonary embolism. The patient was treated with tissue plasminogen activator and heparin infusions and was discharged 1 week later.
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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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    Liver Transplant for Fulminant Hepatic Failure: A Single-Center Experience
    (2015) Kirnap, Mahir; Akdur, Aydincan; Ozcay, Figen; Soy, Ebru; Yildirim, Sedat; Moray, Gokhan; Haberal, Mehmet; 0000-0002-8726-3369; 0000-0003-2498-7287; 0000-0002-3462-7632; 0000-0002-0993-9917; 0000-0002-5214-516X; 0000-0002-5735-4315; 26029995; AAH-9198-2019; AAA-3068-2021; AAE-1041-2021; AAJ-8097-2021; AAC-5566-2019; ABG-5684-2020; AAF-4610-2019
    Objectives: Acute liver failure is a life-threatening condition with sudden onset liver injury, decreased liver functions, hepatic encephalopathy, and coagulopathy in patients without preexisting liver disease. In this study, we sought to evaluate the results of liver transplant as a treatment for acute liver failure. Materials and Methods: Between November 1988 and March 2015, we performed 482 liver transplants in 471 patients. We performed 36 liver transplants in 35 patients because of acute liver failure. Only 5 of these were from deceased donors. Thirty of those 34 patients were pediatric (85%) and 5 were adults (15%). Results: Five patients died (4 in early postoperative period and 1 during the 18th month of living-donor liver transplant). We diagnosed 11 acute rejections (32%); 6 biliary leaks (17%); 6 intraabdominal hemorrhage (17%); 5 hepatic arterial thromboses (15%), and 1 venous complication (3%) during the early postoperative period. We have no morbidity or mortality in living-donor liver transplants. Conclusions: Living-donor liver transplants are an efficient and successful treatment for acute liver failure patients. In our center, we mostly consider and prefer living-donor liver transplants to deceased-donor liver transplant because of the paucity of organ donation, especially for pediatric patients. Considering acceptable postoperative complications, living-donor liver transplant is a lifesaving treatment for acute liver failure.
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    Results of Biliary Reconstruction Using a Polytetrafluoroethylene Graft in Liver Transplant Patients
    (2017) Haberal, Mehmet; Soy, Ebru H. Ayvazoglu; Moray, Gokhan; Caliskan, Kenan; Yildirim, Sedat; Torgay, Adnan; 0000-0003-2498-7287; 0000-0002-5735-4315; 0000-0002-0993-9917; 0000-0002-3462-7632; 0000-0002-8767-5021; 0000-0002-6829-3300; 28260438; AAE-1041-2021; AAF-4610-2019; AAC-5566-2019; AAJ-8097-2021; AAJ-7201-2021; AAJ-5221-2021
    Objectives: Biliary complications after liver transplant are a major concern with their high incidence, the need for repeated and long-term treatment, and their potential effects on graft and patient survival. We report our experience with biliary anastomosis using a spiral polytetrafluoroethylene graft. Materials and Methods: Between December 8, 1988, and July 2016, we performed 538 liver transplant procedures. We used a spiral polytetrafluoroethylene graft for biliary anastomosis in 10 patients: for biliary stricture reconstruction after liver transplant in 4 patients and during the primary liver transplant in 6 patients. Results: Four patients who underwent biliary stricture reconstruction are doing well, with normal liver function. Of the 6 patients who received the graft during primary liver transplant, 2 died from sepsis, although they maintained normal liver function. Of the 4 living patients, 1 had a biliary complication that was reconstructed surgically. The 4 living patients are currently doing well, with normal liver function. Conclusions: Our small series of patients shows that the use of a spiral polytetrafluoroethylene graft is effective at reducing biliary complications in transplant patients.