Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
Browse
20 results
Search Results
Item Clinical Features of SARS-CoV-2 Infection in Patients Undergoing Solid-Organ Transplant: Baskent University Experience(2023) Yuce, Gulbahar Darilmaz; Ulubay, Gaye; Tek, Korhan; Bozbas, Serife Savas; Erol, Cigdem; Buyukasik, Piril; Haberal, Kemal Murat; Arslan, Ayse Hande; Akcay, Muserref Sule; Haberal, Mehmet; 0000-0002-2535-2534; 34635037; AAJ-1219-2021Objectives: The clinical features and treatment approaches, outcomes, and mortality predictors of COVID-19 in solid-organ transplant recipients have not been well defined. This study investigated the clinical features of COVID-19 infection in solid-organ transplant recipients at our center in Turkey. Materials and Methods: Our study included 23 solid-organ transplant recipients and 336 nontransplant individuals (143 previously healthy and 193 patients with at least 1 comorbidity) who were hospitalized due to COVID-19 disease in our hospital between March 2020 and January 2021. Demographic, clinical, and laboratory data of patients were compared. We used SPSS version 20.0 for statistical analysis. All groups were compared using chi-square and Mann-Whitney U tests. P <.05 was considered statistically significant. Results: Mean age of solid-organ transplant recipients was 49.8 +/- 13.7 years (78.3% men, 21.7% women). Among the 23 recipients, 17 (73.9%) were kidney and 6 (26.1%) were liver transplant recipients. Among nontransplant individuals, 88.7% (n = 298) had mild/moderate disease and 11.3% (n = 38) had severe disease. Among transplant recipients, 78.3% (n = 18) had mild/moderate disease and 21.7% (n = 5) had severe disease (P =.224). Transplant recipients had greater requirements for nasal oxygen (P =.005) and noninvasive mechanical ventilation (P =.003) and had longer length of intensive care unit stay (P =.030) than nontransplant individuals. No difference was found between the 2 groups in terms of mortality (P =.439). However, a subgroup analysis showed increased mortality in transplant recipients versus previously healthy patients with COVID-19 (P <.05). Secondary infections were major causes of mortality in transplant recipients. Conclusions: COVID-19 infection resulted in higher mortality in solid- organ transplant recipients versus that shown in healthy patients. More attention on secondary infections is needed in transplant recipients to reduce mortality.Item Posttransplant Lymphoproliferative Disorder After Liver and Kidney Transplant(2014) Ozkan, Eylem Akar; Ozdemir, B. Handan; Deniz, E. Ebru; Tunca, M. Zeyneb; Haberal, Mehmet; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0002-3462-7632; 24635813; X-8540-2019; AAJ-8097-2021Objectives: We evaluated posttransplant lymphoproliferative disorder after solid-organ transplant. Materials and Methods: All 2224 solid-organ transplant recipients who underwent transplant between 1985 and 2013 were included. Clinicopathological findings were examined, and all patients with posttransplant lymphoproliferative disorder were reclassified to World Health Organization 2008 lymphoma classification. Results: Only 27 of 2224 patients developed posttransplant lymphoproliferative disorder. The incidence of posttransplant lymphoproliferative disorder was 3.3-fold higher in children than in adults. The mean interval between transplant and diagnosis of posttransplant lymphoproliferative disorder was 65 months. Patients with tacrolimus were associated with a shorter posttransplant lymphoproliferative disorder development time compared with cyclosporine patients. Epstein-Barr virus-encoded small RNA positive showed shorter time for development of posttransplant lymphoproliferative disorder compared with EpsteinBarr virus-encoded small RNA negative patients. The risk of developing posttransplant lymphoproliferative disorder within the first year of transplant was higher in patients under tacrolimus protocol compared with patients under cyclosporine. Of 27 patients, 4 showed early lesion and 23 patients showed monomorphic posttransplant lymphoproliferative disorder. The development of T-cell monomorphic posttransplant lymphoproliferative disorder was significantly late compared with patients with B-cell monomorphic posttransplant lymphoproliferative disorder. Eight patients died at 38 50 months after posttransplant lymphoproliferative disorder diagnosis. Four patients with early type posttransplant lymphoproliferative disorder were alive, and 3 of 4 patients with T-cell monomorphic posttransplant lymphoproliferative disorder died shortly after diagnosis. Five of 19 patients with B-cell monomorphic posttransplant lymphoproliferative disorder died at a mean 29 18 months. A significant difference was found between the histologic types regarding patient survival. A significant difference was found between the Epstein-Barr virus-encoded small RNA positive and Epstein-Barr virus-encoded small RNA negative patients regarding mean survival time. Conclusions: To decrease the incidence of posttransplant lymphoproliferative disorder, risk factors should be evaluated and new approaches must be derived for prophylaxis, diagnosis, and treatment.Item Burkitt Lymphoma After Transplant: An Aggressive Lymphoproliferative Disease(2014) Ozkan, Eylem Akar; Ozdemir, B. Handan; Akdur, Aydincan; Deniz, E. Ebru; Haberal, Mehmet; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0002-8726-3369; 24635811; X-8540-2019; AAA-3068-2021Posttransplant lymphoproliferative disorder (Burkitt lymphoma) may occur after liver transplant. A 3.5-year-old boy who was 17 months after liver transplant developed multiple millimeter-sized nodular lesions in the liver. Before transplant, the patient tested seronegative for Epstein-Barr virus; within 1 month after transplant, he tested seropositive for Epstein-Barr virus (1000 copies). Biopsy of the liver nodules showed posttransplant lymphoproliferative disorder (Burkitt lymphoma). Tacrolimus was stopped, sirolimus was started, and the patient was treated with chemotherapy (etoposide, doxorubicin, cyclophosphamide, corticosteroids and intrathecal methotrexate). Remission was achieved, and follow-up at 76 months after transplant showed no recurrence of the posttransplant lymphoproliferative disorder. In conclusion, posttransplant lymphoproliferative disorder (Burkitt lymphoma) may occur after liver transplant, and monitoring Epstein-Barr virus level may helpful after transplant because of the association between Epstein-Barr virus and Burkitt lymphoma.Item Hepatic Angiosarcoma and Liver Transplant: A Report of 2 Cases With Diagnostic Difficulties(2014) Terzi, Aysen; Deniz, Emine Ebru; Haberal, Nihan; Moray, Gokhan; Ozdemir, Binnaz Handan; https://orcid.org/0000-0002-1225-1320; https://orcid.org/0000-0001-9852-9911; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-7528-3557; 24635809; F-7546-2013; AAK-4587-2021; AAE-1041-2021; X-8540-2019Angiosarcoma is a rare primary malignant mesenchymal tumor of the liver. The prognosis of hepatic angiosarcoma is poor with an average life expectancy of 6 months after diagnosis. Diagnosing hepatic angiosarcoma is challenging because of nondiagnostic liver biopsy or specious history and radiologic presentation. We report 2 cases with hepatic angiosarcoma which were diagnosed histopathologically in the native liver after liver transplant. One of 2 patients was lost to follow-up, and another patient died of relapsing hepatic angiosarcoma 18 months after the liver transplant.Item Pathological Findings of Liver Allografts Evaluated at Autopsy(2014) Ayva, E. Sebnem; Ozdemir, B. Handan; Tepeoglu, Merih; Haberal, Mehmet; https://orcid.org/0000-0002-2280-8778; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0002-9894-8005; https://orcid.org/0000-0002-3462-7632; 24635808; AAK-1967-2021; X-8540-2019; AAK-5222-2021; AAJ-8097-2021Objectives: We review the pathological findings as determined by autopsy of the liver allografts. Materials and Methods: We retrospectively analyzed 408 patients who had a liver transplant between January 1990 and December 2012. Thirteen of the 408 patients underwent postmortem examination. Clinicopathologic findings including the age at death, causes of death, and main pathological findings were evaluated. Results: The study group of 13 patients who underwent a liver transplant had a mean age of 29 years at the time of death. Mean survival was 6 1 months (range, 10-72 mo). Ten of 13 patients (76.9%) died 90 days after the liver transplant. The remaining 3 patients died, 1 case in 1 year, in 2 cases after 1 year. Causes of the deaths were infection (9 cases), respiratory distress (1 cases), multiorgan failure (1 cases), primary graft failure (1 cases), and massive intra-abdominal bleeding (1 cases). The causes of the infection were bacterial infection in 6 cases (67%) and invasive fungal infection in other 3 cases (33%). The main pathological finding was hepatic infarction in 9 cases (69%). Bridging fibrosis (3 cases) and hematoma (1 case) were obtained in the remaining cases. Conclusions: Our results emphasize that infections are the main cause of death and hepatic infarction is the main histopathologic findings among these 13 patients within the first year of transplant. We consider postmortem examination to have important role in determining the primary graft failure and other causes that increased mortality in liver transplant recipients. An autopsy can provide understanding of the main causes and cause of death.Item A Case of Cerebral Tuberculosis After Liver Transplant and Literature Review(2014) Tunca, M. Zeyneb; Akcay, Eda Yilmaz; Moray, Gokhan; Ozen, Ozlem; Ozdemir, B. Handan; https://orcid.org/0000-0001-6831-9585; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-9082-1317; https://orcid.org/0000-0002-7528-3557; 24635807; AAK-1960-2021; AAE-1041-2021; AAK-4468-2021; X-8540-2019The risk of active tuberculosis is high in solid-organ recipients. We evaluated the clinical presentation of tuberculosis. Pulmonary locations were the most frequent, and extrapulmonary locations were rarely seen. Among extrapulmonary sites, intracranial tuberculosis is rare, with a few case reports reported in the literature. We report a case of 27-year-old man, who received deceased-donor liver transplant due to hepatitis B virus-related chronic liver failure. One month after the liver transplant, neurologic symptoms developed, then he had attacks of tonicclonic convulsions. Cerebral stereotactic needle biopsy of left temporal lobe was performed. Histopathologically gliosis, rare lymphocyte infiltration, and epithelioid histiocytes were seen. Histochemical staining by Ziehl Neelsen stain noted acid-fast resistant bacillus. The case was diagnosed as granulomatous inflammation which led to tuberculosis. In addition to antituberculosis therapy, he was given antiviral therapy for prophylaxis. During therapy, reactivation of hepatitis B virus was noted, and the recurrent diseases of hepatitis B virus-related viral hepatitis was diagnosed on serial biopsies. Ten months after transplant, he died from liver failure. Tuberculosis is a serious opportunistic infection in transplant recipients. The incidence of transplant recipients worldwide ranges from 0.35% to 15%. In nonrenal transplant, rejection within 6 months before the onset of tuberculosis and type of primary immunosuppressive regimen were predictors of tuberculosis infection occurring 12 months after transplant. The diagnosis and effective management of tuberculosis after transplant warnings recognition of the epidemiologic and clinical characteristics of tuberculosis in transplant recipients.Item Diagnostic Significance of the Hepatic Parenchymal Retention Index as Determined by Hepatobiliary Scintigraphy in Liver Transplant Recipients(2014) Gencoglu, Esra Arzu; Aktas, Ayse; Haberal, Mehmet; https://orcid.org/0000-0003-4631-1683; https://orcid.org/0000-0003-0149-2265; https://orcid.org/0000-0002-3462-7632; 24635801; ABG-1864-2020; AAI-8772-2021; AAJ-8097-2021Objectives: The aim of this study was to evaluate the usefulness of the hepatic parenchymal retention index in the early diagnosis of parenchymal complications in liver transplant recipients as determined by hepatobiliary scintigraphy. Materials and Methods: This retrospective study reviewed 100 liver transplant recipients who had undergone orthotopic liver transplant. In all cases, hepatobiliary scintigraphy images recorded 7 to 10 days posttransplant were quantitatively reinterpreted according to hepatic parenchymal retention index. The hepatocyte extraction fraction value was also calculated. Scintigraphic findings as well as clinical, laboratory, and biopsy results were assessed. Results: Quantitative analysis showed normal hepatocyte extraction fraction value in all subjects. However, significant differences in hepatic parenchymal retention index were observed. Thus, subjects were divided into 3 groups: group 1 (n=75), normal; group 2 (n=15), severely elevated; group 3 (n=10), mildly-to-moderately elevated hepatic parenchymal retention index. Evaluation of histopathological, clinical, and laboratory findings showed normal grafts in all group 1 recipients, acute rejection in all group 2 recipients, and hepatocyte damage/intrahepatic cholestasis in all group 3 recipients. Conclusions: Based on these findings, we determined that hepatocyte extraction fraction value was not useful, whereas hepatic parenchymal retention index was beneficial for early and accurate diagnosis of parenchymal complications in liver transplant recipients.Item Neurologic Complications After Liver Transplant: Experience at a Single Center(2015) Derle, Eda; Kibaroglu, Seda; Ocal, Ruhsen; Kirnap, Mahir; Can, Ufuk; Benli, Sibel; Haberal, Mehmet; 0000-0003-2122-1016; 0000-0002-3964-268X; 0000-0001-8689-417X; 0000-0002-3462-7632; 0000-0002-9975-3170; 25894184; V-3553-2017; AAH-9198-2019; AAI-8830-2021; AAJ-2956-2021; AAJ-2999-2021; AAJ-8097-2021; AAJ-4403-2021Objectives: Neurologic complications occur frequently after liver transplants. Up to 43% of patients experience severe postsurgical neurologic complications. These complications are significantly associated with longer hospital stay, morbidity, and mortality. The aim of this retrospective study was to evaluate the type and incidence of neurologic complications after liver transplants in adult patients. Materials and Methods: We retrospectively evaluated the medical records of 176 adult patients who had undergone liver transplants between 1995 and 2013. We recorded the demographic data, type of neurologic complications, type, and level of immunosuppressive treatment, and cause of liver failure. Results: Our study sample consisted of 48 deceased-donor liver transplants and 128 living-donor transplants (n = 176). Fifty-three of the patients (30.1%) were female. The age range of the total sample was 18 to 66 years (mean age, 43.1 +/- 13.7 y). As immunosuppressive treatment, most patients received tacrolimus alone (52%) or tacrolimus combined with mycophenolate mofetil (33%). Neurologic complications occurred in 74 of the patients (42%). The most common neurologic complications were diffuse encephalopathy (22.2%) and seizure (14.2%). Other neurologic complications were posterior reversible encephalopathy (1.7%), peripheral neuropathy (1.7%), cerebrovascular disease (1.1%), and central nervous system infection (1.1%). Age, cause of liver failure, and type of transplant were not associated with occurrence of neurologic complications. Conclusions: There was a high incidence of neurologic complications after liver transplants. Diffuse encephalopathy and seizure were common complications. Physicians should be aware of the high risk of neurologic complications after liver transplants. Factors such as immunosuppressive toxicity and metabolic imbalance that predispose patients to neurologic complications after liver transplants should be evaluated immediately, and treatment of postoperative neurologic complications should be initiated as early as possible.Item Seizure as a Neurologic Complication After Liver Transplant(2015) Derle, Eda; Kibaroglu, Seda; Ocal, Ruhsen; Kirnap, Mahir; Kilinc, Munire; Benli, Sibel; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0001-7979-0276; 0000-0003-2122-1016; 0000-0002-3964-268X; 0000-0002-9975-3170; 25894183; AAJ-8097-2021; AAJ-8674-2021; AAI-8830-2021; AAJ-2956-2021; AAH-9198-2019; AAJ-4403-2021; V-3553-2017Objectives: Seizure is a common complication after liver transplant and has been reported to occur in up to 42% of patients in different case series. Multiple factors can trigger seizures, including immunosuppressive toxicity, sepsis, metabolic imbalance, and structural brain lesions. The aim of this retrospective study was to evaluate seizure types and associated factors in adult liver transplant patients. Materials and Methods: We retrospectively evaluated the medical records of 142 adult patients who received a liver transplant between 2005 and 2013. We recorded demographic data, immunosuppressive treatment, seizure type, cause, recurrence, and treatment. Results: Of the 146 patients, 23 (15.7%) had a seizure after the liver transplant. This group included 10 females and 13 males, with ages ranging between 18 and 63 (39.9 +/- 14.8 y). Generalized tonic-clonic seizures were the most common, occurring in 20 patients (87%). We observed complex partial seizure and status epilepticus in 1 and 2 patients. Immunosuppressive drug-related seizure occurred in 8 patients (34.8%) with normal drug blood levels, and all but 1 of these patients experienced seizure within the first week after transplant. Multiple factors (26.1%), metabolic imbalance (17.4%), structural lesion (13%), and sepsis (8.7%) were the other factors identified as underlying conditions. Conclusions; In conclusion, seizure occurred in a significant proportion of patients who underwent liver transplant. Immunosuppressive drugs were the most common factor associated with seizure occurrence and drug cessation prevented seizure recurrence.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.