Tıp Fakültesi / Faculty of Medicine
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Item A Single-Center Retrospective Clinicopathologic Study of Endomyocardial Biopsies After Heart Transplant at Baskent University Hospital in Ankara, 1993-2014(2015) Terzi, Ayen; Sezgin, Atilla; Tunca, Zeynep; Deniz, Ebru; Ayva, Ebru Sebnem; Reyhan, Nihan Haberal; Mulderrisoglu, Haldun; Ozdemir, Binnaz Handan; 0000-0002-2280-8778; 0000-0002-7528-3557; 0000-0002-1225-1320; 0000-0001-9852-9911; 25894188; AAK-1967-2021; X-8540-2019; F-7546-2013; AAK-4587-2021Objectives: The purpose of this study was to investigate the frequency and prognostic importance of acute cellular rejection after heart transplant. Materials and Methods: All 84 heart transplant patients at our center from January 1993 to January 2014, including all 576 endomyocardial biopsies, were evaluated with retrospective review of clinical records and endomyocardial biopsies. Routine and clinically indicated endomyocardial biopsies after heart transplant were graded for acute cellular rejection (2005 International Society for Heart and Lung Transplantation Working Formulation). Survival analysis was performed using Kaplan-Meier method. Results: There were 61 male (73%) and 23 female recipients. Median age at heart transplant was 29 years (range, 1-62 y). Posttransplant early mortality rate was 17.9% (15 patients). In the other 69 patients, 23 patients died and 46 patients (66.7%) were alive at mean 69.3 +/- 7.2 months after heart transplant. Mean follow-up was 35.4 +/- 29.8 months (range, 0.07-117.5 mo). Mean 8.4 +/- 4.2 endomyocardial biopsies (range, 1-19 biopsies) were performed per patient. Median first biopsy time was 7 days (range, 1-78 d). The frequency of posttransplant acute cellular rejection was 63.8% (44 of 69 patients) by histopathology; 86% patients experienced the first episode of acute cellular rejection within 6 months after transplant. There were 18 patients with acute cellular rejection >= grade 2R on >= 1 endomyocardial biopsy in 44 patients with acute cellular rejection. No significant difference was observed between survival rates of patients with grade 1R or >= grade 2R acute cellular rejection, or between survival rates of patients with or without diagnosis of any grade of acute cellular rejection. Acute cellular rejection was not related to any prognostic risk factor. Conclusions: Acute cellular rejection had no negative effect on heart recipient long-term survival, but it was a frequent complication after heart transplant, especially within the first 6 months.Item Results of Liver Transplant in Elderly Patients: A Single Center Experience(2015) Akdur, Aydincan; Fidan, Cihan; Soy, Ebru Ayvazoglu; Kirnap, Mahir; Karakayali, Feza Yarbug; Torgay, Adnan; Yildirim, Sedat; Moray, Gokhan; Haberal, Mehmet; 0000-0002-5735-4315; 0000-0002-9093-1524; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-1874-947X; 0000-0002-0993-9917; 0000-0003-2498-7287; 0000-0002-6829-3300; 25894140; AAF-4610-2019; AAH-9198-2019; F-5830-2019; AAA-3068-2021; AAJ-8097-2021; AAB-3888-2021; AAC-5566-2019; AAE-1041-2021; AAJ-5221-2021Objectives: With the increased life span, the need for liver transplant for elderly patients also increased in the world. In this study, we reviewed our experience to determine the outcomes and problems of patients aged > 60 years who had liver transplants. Materials and Methods: Data of recipients aged > 60 years were reviewed retrospectively. We analyzed 16 elderly patients who had liver transplant for chronic liver disease between 2001 and 2014 in our center. Results: In our series, there were 5 women and 11 men between age 60 and 65 years. The mean Child-Pugh score was 7.9 +/- 1.7 and Model for End-Stage Liver Disease score was 14.1 +/- 5.1. Primary liver disease was hepatitis B in 9 patients (34.5%), most of them with hepatocellular carcinoma. The other causes of liver failure were hepatitis C (n = 4), alcoholic cirrhosis (n = 2), and cryptogenic cirrhosis (n = 2); 1 patient had both hepatitis B and hepatitis C virus, and 1 patient had both hepatitis B virus and alcoholic cirrhosis. There were 9 patients who had hepatocellular carcinoma. Mortality was observed in 4 patients. The reasons for mortality were sepsis (n=3) and hepatocellular carcinoma (n=1). Conclusions: Liver transplant can be safely performed and has acceptable long-term outcomes in low-risk elderly recipients. Age alone should not be a contraindication for liver transplant in elderly patients.Item Docetaxel, Cisplatin, and Fluorouracil Combination in Neoadjuvant Setting in The Treatment of Locally Advanced Gastric Adenocarcinoma: Phase II NEOTAX Study(2014) Ozdemir, Nuriye; Abali, Huseyin; Vural, Murat; Yalcin, Suayib; Oksuzoglu, Berna; Civelek, Burak; Oguz, Dilek; Bostanci, Birol; Yalcin, Bulent; Zengin, Nurullah; https://orcid.org/0000-0001-5596-0920; 25234436; D-7660-2016This phase II trial aimed to evaluate the efficacy and safety of docetaxel, cisplatin, and fluorouracil (DCF) combination in neoadjuvant setting in patients with locally advanced gastric adenocarcinoma. Fifty-nine patients with resectable or unresectable locally advanced gastric and gastroesophageal cancer were recruited in this multicenter, single-arm, open-label, local clinical phase II study conducted at three centers from Turkey between June 2006 and March 2012. Patients had T3-4 or lymph node-positive disease. After staging with imaging and laparotomy or laparoscopy, they received three cycles of DCF with lenograstim. Imaging studies were repeated after the last two cycles. Patients who underwent surgery were followed up for at least 1 year after the surgery. Toxicity and response were evaluated in accordance with NCI-CTC version3.0 and RECIST 1.0. At baseline, 66.1 % of patients were considered resectable. In 47 patients evaluable, partial response in 16 (34.0 %), stable disease in 27 (57.5 %), and progressive disease in four (8.5 %) were observed. Forty-six patients underwent surgery. In 38 (64.4 %; 95 % confidence interval (CI) 52.2-76.6 %) out of 59 patients, complete resection (R0) was achieved. Median overall and disease-free survival were 19.1 months (95 % CI 13.5-24.7) and 11.6 months (95 % CI 5.9-17.4), respectively. The most frequent grade 3-4 adverse events were neutropenia (52.5 %), febrile neutropenia (11.9 %), leukopenia (39.0 %), and diarrhea (10.5 %). One patient died from an unknown cause. Classical DCF triplet with lenograstim showed a good clinical response with acceptable safety profile in the treatment of locally advanced gastric and gastroesophageal cancer with a significant R0 rate and manageable toxicity.Item Outcomes of Patients With Hepatocellular Carcinoma After Liver Transplant(2015) Moray, Gokhan; Kirnap, Mahir; Akdur, Aydincan; Soy, Ebru; Tezcaner, Tugan; Boyvat, Fatih; Ozdemir, Handan; Haberal, Mehmet; 0000-0002-0993-9917; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-3641-8674; 0000-0003-2498-7287; 0000-0002-7528-3557; 26640906; AAC-5566-2019; AAA-3068-2021; AAJ-8097-2021; AAD-9865-2021; F-4230-2011; AAH-9198-2019; AAE-1041-2021; X-8540-2019Objectives: Liver transplant is one of the few effective treatments for hepatocellular carcinoma. Our aim in this study was to evaluate the risk factors for hepatocellular carcinoma recurrence after liver transplant. Materials and Methods: In this retrospective study, conducted between October 1988 and March 2015, four hundred seventy-three liver transplants were performed at our institution. Of these, 231 were pediatric and 242 were adult. Among these patients, liver transplant was performed in 58 patients (12.3%) for treatment of hepatocellular carcinoma. Results: Hepatocellular carcinoma recurrence was detected in 14 patients (24.1%). Overall 5-year and 10-year survival rates of patients underwent liver transplant beyond the Milan criteria for hepatocellular carcinoma were 50.3% and 43.1%. Overall, 5- and 10-year survival rates of patients underwent liver transplant within the Milan criteria for hepatocellular carcinoma were 78.4% and 72.6%. The main predictive variable was whether the tumor had expensed beyond the Milan criteria. Conclusions: As expected, outcomes were significantly better in the Milan criteria group. Although the overall- and disease-free survival rates were promising in such a group of patients who had no better chance, it could be asserted that liver transplant is a safe and effective treatment option with promising results, even if the tumor expanse is beyond the Milan criteria.Item Stereotactic Body Radiotherapy and Tyrosine Kinase Inhibitors in Patients with Oligometastatic Renal Cell Carcinoma: A Multi-Institutional Study(2023) Onal, Cem; Oymak, Ezgi; Guler, Ozan Cem; Tilki, Burak; Yavas, Guler; Hurmuz, Pervin; Yavas, Cagdas; Ozyigit, Gokhan; https://orcid.org/0000-0002-2742-9021; 36450836; HOC-5611-2023Purpose Few studies have determined the viability of stereotactic body radiotherapy (SBRT) and tyrosine kinase inhibitors (TKIs) in the treatment of metastatic renal cell carcinoma (mRCC). We examined the results of RCC patients who had five or fewer lesions and were treated with TKI and SBRT.Methods The clinical data of 42 patients with 96 metastases treated between 2011 and 2020 were retrospectively evaluated. The prognostic factors predicting overall survival (OS) and progression-free survival (PFS) were assessed in uni-and multivariable analyses.Results Median follow-up and time between TKI therapy and SBRT were 62.3 and 3.7 months, respectively. The 2-year OS and PFS rates were 58.0% and 51.3%, respectively, and 2-year local control rate was 94.1% per SBRT-treated lesion. In univariable analysis, the time between TKI therapy and SBRT and treatment response were significant prognostic factors for OS and PFS. In multivariable analysis, a time between TKI therapy and SBRT of less than 3 months and complete response were significant predictors of better OS and PFS. Only 12 patients (28.6%) had a systemic treatment change at a median of 18.2 months after SBRT, mostly in patients with a non-complete treatment response after this therapy. Two patients (4.8%) experienced grade III toxicity, and all side effects observed during metastasis-directed therapy subsided over time.Conclusion We demonstrated that SBRT in combination with TKIs is an effective and safe treatment option for RCC patients with <= 5 metastases. However, distant metastasis was observed in 60% of the patients, indicating that distant disease control still has room for improvement.Item Treatment Outcomes of Breast Cancer Liver Metastasis Treated with Stereotactic Body Radiotherapy(2018) Onal, Cem; Guler, Ozan Cem; Yildirim, Berna Akkus; https://orcid.org/0000-0002-2742-9021; https://orcid.org/0000-0001-6908-3412; https://orcid.org/0000-0001-6661-4185; 30296648; HOC-5611-2023; AAC-5654-2020; V-5717-2017Background: To assess the outcomes of breast cancer liver metastasis (BCLM) treated with stereotactic body radiotherapy (SBRT) and systemic treatment. Materials and methods: Patients with oligometastasis at the time of liver metastasis (LM) or who became oligometastatic (<= 5 metastases) after systemic treatment were assessed. Twenty-nine liver metastatic lesions were treated with a total of 54 Gy delivered in 3 fractions. The local control (LC), overall survival (OS), and progression-free survival (PFS) rates were calculated using Kaplan-Meier analyses. Results: A total of 22 patients with 29 liver metastatic lesions treated with liver SBRT between April 2013 and September 2017 were retrospectively analyzed. After a median follow-up time of 16.0 months (range 4.4-59.4 months), 18 patients (82%) had disease recurrence, median of 7.4 months (range 1.0-27.9 months) after completion of liver SBRT. The 1- and 2-year OS rates were 85% and 57%, and the 1- and 2-year PFS rates were 38% and 8%, respectively. The 1- and 2-year LC rates were 100% and 88%, respectively. No significant prognostic factors, including disease extension, size of metastasis, number of liver metastasis and timing of liver metastasis, hormonal status affecting OS, PFS and LC were found. No patients experienced Grade 4 or 5 toxicity; furthermore, only one patient experienced rib fracture 6 months after completion of treatment, and one patient had a duodenal ulcer. Conclusion: This study is the first to evaluate the feasibility of SBRT to BCLM patients. Liver SBRT is a conservative approach with excellent LC and limited toxicities. (C) 2018 Elsevier Ltd. All rights reserved.Item Impact of Presence and Degree of Pretreatment Weight Loss in Locally-Advanced Pancreatic Cancer Patients Treated with Definitive Concurrent Chemoradiotherapy(2016) Yildirim, Berna Akkus; Ozdemir, Yurday; Colakoglu, Tamer; Topkan, Erkan; 0000-0001-6661-4185; 0000-0002-2218-2074; 0000-0001-8120-7123; 27029854; V-5717-2017; AAG-5629-2021; AAG-2213-2021Background: To assess the impact of the presence and degree of pretreatment weight loss (WL) on the survival of locally-advanced pancreas cancer (LAPC) patients treated with concurrent chemoradiotherapy (C-CRT). Methods: Seventy-three patients who received 50.4 Gy C-CRT were analyzed. All patients underwent laparoscopy (n = 18) or laparotomy (n = 55), and biopsies were obtained for histologic examination of the primary tumor and enlarged/metabolically active regional lymph nodes. Pretreatment WL and percentage WL (PWL) were calculated by utilizing data obtained 6 months prior to and during hospital admission. The primary objective was to assess the influence WL status on overall survival (OS), and the secondary objective was the identification of a PWL cut-off value, if available. Results: Forty-five (61.6%) patients had WL. Median OS was 14.4 months for the entire study population which was significantly longer in the non-WL than the WL cohort (21.4 vs. 11.3 months; p < 0.003). On further analysis a cut-off value of 3.1% was identified for WL. Accordingly, patients with WL < 3.1% had significantly longer OS than those with WL >= 3.1% (25.8 vs. 10.1 months; p < 0.001). In multivariate analysis, both the WL status (p < 0.001) and PWL (p = 0.002) retained their independent significance. Conclusion: Both the presence and degree of WL prior to C-CRT had strong adverse effects on the survival of LAPC patients, even if they presented with a BMI > 20 kg/m(2). Additionally, a WL of >= 3.1% in the last 6 months appeared to be a strong cut-off for the stratification of such patients into distinctive survival groups.(C) 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.Item Obesity and Loss of Kidney Function: Two Complications to Face for Older Living Kidney Donors(2017) Kaya, Demet Firat; Sayin, Burak; Saglam, Hatice; Demirci, Bahar Gurlek; Colak, Turan; https://orcid.org/0000-0001-8287-6572; https://orcid.org/0000-0002-8372-7840; 28260454; J-3707-2015; AAJ-8554-2021Objectives: Although living kidney donors have a minimal lifetime risk of developing end-stage renal disease, long-term complications and physiologic and psychologic sequelae resulting from donation remain unclear because of lack of optimum follow-up after transplant. Here, we evaluated renal function, complications, and physical and mental performance of living kidney donors. Materials and Methods: We evaluated 147 patients who donated living kidneys between 1981 and 2012 at Baskent University Hospital. We collected data on donor age, sex, body mass index, smoking status, hypertension before and after nephrectomy, proteinuria, estimated glomerular filtration rate according to the Modification of Diet in Renal Disease formula, and duration after donation. All donors answered the Medical Outcomes Study short-form general health survey; results were evaluated according to answers to 11 questions totaling 22 points. Results: Body mass index of donors showed that 31 (21.1%) were in normal range, 66 (44.9%) had mild obesity (body mass index of 26-30 kg/m(2)), and 30 (34%) had moderate to high obesity (body mass index > 30 kg/m(2)). Results from the general health survey showed that 117 donors (80%) had no loss, 13 (9%) had mild loss, 12 (8%) had moderate loss, and 5 (3%) had high loss of ability. When we compared estimated glomerular filtration rates according to donor age, donors who were 18 to 34 years had a mean estimated glomerular filtration rate of 113.5 +/- 40, donors 35 to 49 years had a mean rate of 95.01 +/- 23.4, donors 50 to 64 years had a mean rate of 87.43 +/- 25.4, and donors older than 65 years had a mean rate of 63.76 +/- 11.35 mL/min/1.73 m(2), revealing a statistically significant loss of kidney function with aging (P = .001). Conclusions: Careful evaluation of kidney donors before and after donation is essential for the most common risk factors, such as obesity, and for loss of kidney function, especially in older donors.Item Smoking Behavior of Heart Transplant Patients: A Retrospective Study(2018) Sozen, Fisun; Cetinel, Yasemin; Kul, Ozdemir Efe; Sezgin, Atilla; 0000-0002-1951-2693; 29528018; AAC-1823-2021Objectives: Smoking is an important risk factor for development of complications in heart transplant patients and plays an important role in the mortality of these patients.The aim of this study was to compare the survival of heart transplant patients after transplant versus their smoking status before transplant. Materials and Methods: Patients who had heart transplant procedures at the Baskent University Hospital Cardiovascular Surgery Department between 2005 and 2016 were analyzed retrospectively with regard to their smoking status and survival after transplant. We divided the 51 included adult patients into 2 groups: nonsmokers and ex-smokers. Data were analyzed with SPSS software (Statistical Package for Social Sciences for Windows, version 23.0, SPSS Inc., Chicago, IL, USA). Descriptive statistics are shown as means +/- standard deviation, and differences between means were determined with t tests. Survival statistics were evaluated with Kaplan-Meier analyses using log rank test. Results: Of 51 heart transplant patients, 40 were male (78.4%) and 11 were female (21.6%) patients. Mean age was 42.5 +/- 14.2 years in male patients and 30.4 +/- 13.2 years in female patients (95% confidence interval, 2.4-21.8). Although 36 patients(70.6%) were still living at follow-up, 15 patients had died (29.4%). According to smoking status, 30 patients (58.8%) were nonsmokers and 21 patients (41.2%) were ex-smokers, who showed smoking rate of 23.7 +/- 26.0 packs/year. We found that patients who were nonsmokers survived longer; however, at time of analysis (September 30, 2017), survival was not mature yet for the nonsmoking group. Median survival time for patients who were ex-smokers was 93.0 months(log-rank test = .099) Conclusions: Our study showed that patients in the nonsmoking group survived longer after heart transplant. Early smoking cessation can prolong survival of heart transplant patients.Item Posttransplant Pulmonary Hypertension Is Correlated With Acute Rejection and Death Among Cardiac Transplant Recipients: A Single Center Study(2018) Ciftci, Orcun; Akgun, Neslihan Arzu; Yilmaz, Kerem Can; Karacaglar, Emir; Aydinalp, Alp; Sezgin, Atilla; Muderrisoglu, I. Haldun; Haberal, Mehmet; 0000-0001-8926-9142; 0000-0002-2538-1642; 0000-0002-3761-8782; 0000-0002-3462-7632; 29527998; W-5233-2018; AAJ-1331-2021; ABI-6723-2020; AAD-5841-2021; AAJ-8097-2021Objectives: Endomyocardial biopsy sampling is used to check acute rejection after cardiac transplant. However, it may lead to tricuspid valve injury and cardiac perforation; therefore, less invasive tools may be useful. Right heart catheterization provides valuable information about cardiac hemodynamics. Herein, we aimed to determine the correlation of right heart catheterization parameters with acute rejection and death during cardiac transplant follow-up. Materials and Methods: We retrospectively evaluated follow-up right heart catheterization and endomyocardial biopsy results from 47 adult patients who underwent cardiac transplant at Baskent University Faculty of Medicine between 2004 and 2016. Right heart catheterization parameters were compared between deceased and surviving patients and were correlated with acute cellular and humoral rejection. Averaged right heart catheterization parameters were correlated with death. We used Cox regression analysis to determine risk of death and acute cellular rejection and Kaplan-Meier survival analysis to determine any survival differences associated with pulmonary hypertension. Results: There were 47 patients (38 males, 9 females) with a mean age of 44 +/- 10 years at transplant. In our patient group, 18 patients (38.3%) died at a median time of 11.2 months. Ninety endomyocardial biopsy samples (22.1%) showed cellular rejection, and 61 samples (4.5%) showed humoral rejection. The deceased patients had significantly greater mean and systolic pulmonary artery pressures, which were significantly correlated with acute cellular rejection. Death was significantly correlated with averaged values of mean and systolic pulmonary artery pressures. Our Cox regression analysis revealed that pulmonary hypertension was significantly associated with risk of death and acute cellular rejection. A Kaplan-Meier survival analysis revealed that pulmonary hypertension was associated with a significantly lower median survival. Conclusions: Pulmonary artery pressures are significantly correlated with acute cellular rejection and death after cardiac transplant. Pulmonary hypertension significantly increases the risk of death and shortens survival after cardiac transplant.