PubMed İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4810
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Item Comparison of Mortality Rates in Patients Waiting for Liver Transplant and Patients With Colorectal Metastatic Tumors(2022) Erkent, Murathan; Aydin, H. Onur; Tezcaner, Tugan; Avci, Tevfik; Kavasoglu, Lara; Soy, Ebru H. Ayvazoglu; Yildirim, Sedat; Haberal, Mehmet; 0000-0002-3592-5092; 0000-0002-0664-5147; 0000-0002-0993-9917; 0000-0002-3462-7632; 35352633; CAA-2756-2022; AAJ-8219-2021; AAC-5566-2019; AAJ-8097-2021Objectives: We aimed to identify outcomes of liver surgery in patients with hepatocellular carcinoma and colorectal cancer, which result in primary and secondary liver tumors. Materials and Methods: Our study included 51 patients with colorectal cancer and liver metastases and 63 patients with hepatocellular carcinoma who were prepared for liver transplant due to cirrhosis who underwent hepatic resection or local ablation treatments; patients were seen between January 2011 and December 2021. Results: Most patients with colorectal cancer were men (58.8%). Mean age was 65.76 +/- 13.818 years (range, 27-88 y). Most patients had planned, elective surgery (86.3%). Neoadjuvant chemotherapy was administered to 58.8% of patients. The most common location of metastasis in the liver was in the right lobe (43.1%), and the most common surgery was low anterior resection (17 patients). During simultaneous liver surgery, 31 patients required metastasectomy and 7 patients required radiofrequency ablation plus metastasectomy. No deaths occurred in the early posttransplant period, and cumulative survival was 82.624 +/- 7.962 months. Disease-free survival was 45.2 +/- 7.495 months. Most patients with hepatocellular carcinoma were men (82.5%). Mean age was 58.73 +/- 17.428 years. Hepatocellular carcinoma lesions were mostly located in both the right and left lobes (23.8%). In the hepatocellular cancer group, 60.3% had transarterial chemoembolization and 42.9% had radiofrequency ablation. The primary surgical resection was metastasectomy (17.9%) because of multiple localized lesions. Median follow-up was 22 months (range, 1-126 mo). Overall survival was 101.898 +/- 7.169 months, with 10-year overall survival of 38%. Disease-free survival was 74.081 +/- 8.732 months, with 1-year and 5-year disease-free survival of 90.5% and 54%. Conclusions: Better survival was shown in patients with hepatocellular carcinoma than in patients with colorectal cancer. Therefore, more aggressive treatment options, as used in hepatocellular carcinoma, including liver transplant, may be options for patients with colorectal cancer.Item Single-Center Experience of Recurrence Patterns and Survival Analyses of Patients With Hepatocellular Carcinoma and Liver Transplant(2020) Rahatli, Samed; Soy, Ebru H. Ayvazoglu; Oguz, Arzu; Altundag, Ozden; Moray, Gokhan; Haberal, Mehmet; 0000-0003-0197-6622; 0000-0002-3462-7632; 0000-0003-2498-7287; 0000-0003-3163-7429; 0000-0001-6512-6534; 0000-0002-0993-9917; 32279656; W-9219-2019; AAJ-8097-2021; AAE-1041-2021; AAJ-3047-2021; W-8004-2019; AAC-5566-2019Objectives: Hepatocellular carcinoma remains a major health problem with increased rates of mortality. The curative treatment options are resection or liver transplant. Because the Milan criteria are restrictive for candidates, they have been expanded into alternative sets of criteria. We aimed to evaluate our indications for liver transplant and their results for hepatocellular carcinoma. Materials and Methods: Between December 1988 and January 2020, we performed 652 liver transplant procedures (443 living donors, 209 deceased donors) at Baskent University (Ankara, Turkey). At Baskent University, we developed liver transplant criteria for patients with hepatocellular carcinoma. For our criteria, liver transplant for hepatocellular carcinoma was performed in patients without major vascular invasion and distant metastasis. Clinical data on cancer demographics, recurrence patterns, and survival outcomes were evaluated retrospectively. Results: Of 652 total patients, 49 adult patients (8%) with diagnosis of hepatocellular carcinoma were included in this study. Median age was 55 years. Hepatocellular carcinoma recurrence after liver transplant was detected in 13 patients. Median overall survival was 64.3 months for all study patients; however, median survival was significantly lower in patients who had recurrence (126.3 vs 43.4 mo for nonrecurrent vs recurrent groups; P = .024). In the expanded criteria group (n = 25), 7 patients (28%) had hepatocellular carcinoma recurrence during follow-up, whereas this ratio was 25% (6/24 patients) in the Milan criteria group, with median time to recurrence of 12.6 versus 11.7 months, respectively (not significantly different). Conclusions: Multidisciplinary treatment modalities, including surgery, interventional radiology techniques, and medical treatments, will probably lead to prolonged survival in patients with hepatocellular carcinoma. According to our center's expanded criteria, recurrence rates and time to recurrence were similar to those shown with the Milan group. We showed that Milan criteria can be safely expanded with promising results even in patients beyond Milan criteria.Item Changes in ocular biometric parameters after renal transplantation(2020) Aksoy, Mustafa; Asena, Leyla; Gungor, Sirel Gur; Soy, Ebru H. Ayvazoglu; Akman, Ahmet; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-0993-9917; 0000-0001-6178-8362; 0000-0002-6848-203X; 0000-0003-1513-7686; 32415655; AAJ-8097-2021; AAC-5566-2019; E-5914-2016; AAD-5967-2021Purpose This study aimed to investigate the changes in postoperative ocular biometric parameters in end-stage renal disease patients who underwent renal transplantation. Material and methods This retrospective study included a total of 33 eyes of 33 patients. The ocular biometric measurements which were evaluated were axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), corneal keratometry (K1 and K2), degree of astigmatism, lens thickness (LT), and intraocular pressure (IOP). Refractive prediction error (RE) was calculated before and after renal transplantation using the same diopter (D) for intraocular lens (IOL) power calculation and evaluated for potential cataract surgery. Results The study included 15 male (45%) and 18 female (55%) patients. Mean patient age was 31.55 +/- 8.24 (range: 18-49 years). In the comparison of preoperative and 1-month postoperative measurements, there was a statistically significant difference in AL, LT, ACD, and CCT (p < 0.001). There was no statistically significant difference between K1, K2, and astigmatism measurements (p = 0.72; p = 0.35; p = 0.62, respectively). There was no statistically significant difference in RE (p = 0.61-Holladay 2). Conclusion While renal transplantation surgery does not lead to significant changes in astigmatism, predicted refractive error, corneal keratometry, or intraocular pressure, it causes significant decrease in axial length, lens thickness, and central corneal thickness and significant increase in anterior chamber depth. However, these changes do not result in significant changes in IOL power calculation in planned cataract surgery.Item Coronavirus Disease (COVID-19) in Kidney and Liver Transplant Patients: A Single-Center Experience(2020) Akdur, Aydincan; Karakaya, Emre; Soy, Ebru H. Ayvazoglu; Alshalabi, Omar; Kirnap, Mahir; Arslan, Hande; Ulubay, Gaye; Hekimoglu, Koray; Moray, Gokhan; Haberal, Mehmet; 0000-0002-0993-9917; 0000-0002-0805-0841; 0000-0002-3462-7632; 0000-0003-2478-9985; 0000-0003-2498-7287; 0000-0002-8726-3369; 0000-0002-4879-7974; 32519617; AAC-5566-2019; AAD-9097-2021; AAJ-8097-2021; AAB-5064-2021; AAE-1041-2021; AAA-3068-2021; AAD-5466-2021Objectives: The novel 2019 coronavirus (COVID-19) was first described in December 2019 in Wuhan, China and subsequently announced as a pandemic on March 12, 2020. In several studies, solid-organ transplant recipients were reported to have higher risk for COVID-19. Here, we aimed to determine the frequency of COVID-19 in our kidney and liver transplant patients. Materials and Methods: Our study included 583 transplant patients who were admitted to our outpatient transplant clinics and emergency departments between March 1 and May 1, 2020. Seventy-four of them were liver transplant recipients (46 male, 28 female, of which 14 were pediatric and 60 were adult patients) and 509 of them were kidney transplant recipients (347 male, 162 female, of which 16 were pediatric and 493 were adult patients). We retrospectively evaluated demographic characteristics, currently used immunosuppressant treatment, present complaints, treatment and diagnosis of comorbid diseases, and results of COVID-19 tests. Results: Of 583 transplant recipients, 538 were seen in our outpatient transplant clinics and 45 were seen in our emergency departments. Of these, 18 patients who had had cough and fever were evaluated by respiratory clinic doctors, and nasopharyngeal swab samples were taken. One kidney transplant recipient had a positive COVID-19 test; he was followed with home isolation. He received treatment with hydroxychloroquine (400 mg/day). The other 17 patients had negative tests. There were no mortalities due to COVID-19. Conclusions: Transplant patients also got affected during the COVID-19 pandemic. According to the data of our centers, this effect is not much more different from the normal population. We recommend that transplant recipients should be warned in terms of personal hygiene and should be closely monitored by organ transplant centers. If there is an indication for hospitalization, they should be followed in an isolated unit, with no aggressive changes made to immunosuppressive doses unless necessaryItem Incidence and Immunologic Analysis of Coronavirus Disease (COVID-19) in Hemodialysis Patients: A Single-Center Experience(2020) Arslan, Hande; Musabak, Ugur; Soy, Ebru H. Ayvazoglu; Azap, Ozlem Kurt; Sayin, Burak; Akcay, Sule; Haberal, K. Murat; Akdur, Aydincan; Yildirim, Sedat; Haberal, Mehmet; 0000-0001-8287-6572; 0000-0003-1511-7634; 0000-0002-5735-4315; 0000-0002-0993-9917; 0000-0002-8726-3369; 0000-0002-3171-8926; 0000-0002-8360-6459; 0000-0002-3462-7632; 0000-0002-8211-4065; 32519618; J-3707-2015; AAU-1810-2020; AAF-4610-2019; AAC-5566-2019; AAA-3068-2021; AAK-4089-2021; AAB-5175-2021; AAJ-8097-2021; R-9398-2019Objectives: COVID-19 is a great threat to the modern world and significant threat to immunocompromised patients, including patients with chronic renal failure. We evaluated COVID-19 incidence among our hemodialysis patients and investigated the most probable immune mechanisms against COVID-19. Materials and Methods: Baskent University has 21 dialysis centers across Turkey, with 2420 patients on hemodialysis and 30 on peritoneal dialysis. Among these, we retrospectively evaluated 602 patients (257 female/345 male) with chronic renal failure receiving hemodialysis as renal replacement therapy; 7 patients (1.1%) were infected with SARS-CoV-2. We retrospectively collected patient demographic characteristics, clinical data, and immunological factors affecting the clinical course of the disease. We divided patients into groups and included 2 control groups ( individuals with normal renal functions): group I included COVID-19-positive patients with normal renal function, group II included COVID-19-positive hemodialysis patients, group III included COVID-19-negative hemodialysis patients, and group IV included COVID-19-negative patients with normal renal function. Lymphocyte subsets in peripheral blood and typing of human leukocyte antigens were analyzed in all groups, with killer cell immunoglobulin-like receptor genes analyzed only in COVID-19-positive patients and healthy controls. Results: No deaths occurred among the 7 COVID-19-positive hemodialysis patients. Group I patients were significantly older than patients in groups II and III ( P = .039, P = .030, respectively) but not significantly different from group IV (P = .060). Absolute counts of natural killer cells in healthy controls were higher than in other groups (but not significantly). Activated T cells were significantly increased in both COVID-19-positive groups versus COVID-19-negative groups. Groups showed significant differences in C and DQ loci with respect to distribution of alleles in both HLA classes. Conclusions: Although immunocompromised patients are at greater risk for COVID-19, we found lower COVID-19 incidence in our hemodialysis patients, which should be further investigated in in vitro and molecular studies.Item Liver and Kidney Transplant During a 6-Month Period in the COVID-19 Pandemic: A Single-Center Experience(2020) Akdur, Aydincan; Karakaya, Emre; Soy, Ebru H. Ayvazoglu; Karakayali, Feza Yarbug; Yildirim, Sedat; Torgay, Adnan; Sayin, Cihat Burak; Coskun, Mehmet; Moray, Gokhan; Haberal, Mehmet; 0000-0002-1874-947X; 0000-0002-6829-3300; 0000-0002-8726-3369; 0000-0002-0993-9917; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-4879-7974; 0000-0003-2498-7287; 0000-0001-5630-022X; 33143601; AAB-3888-2021; AAJ-5221-2021; AAA-3068-2021; AAC-5566-2019; AAJ-8097-2021; AAF-4610-2019; AAD-5466-2021; AAE-1041-2021; AAM-4120-2021Objectives: With the declaration of COVID-19 as a pandemic, many studies have indicated that elective surgeries should be postponed. However, post-ponement of transplants may cause diseases to get worse and increase the number in wait lists. We believe that, with precautions, transplant does not pose a risk during pandemic. Here, we aimed to evaluate our transplant results, which we safely performed during a 6-month pandemic period. Materials and Methods: Until September 2020, 3140 kidney and 667 liver transplants have been performed in our centers. We evaluated 38 kidney transplants and 9 liver transplants procedures performed during the pandemic (March 1 to September 2, 2020). Recipient and donor candidates were screened for COVID-19 with polymerase chain reaction and thoracic computed tomography. All recipients had routine immunosuppressive protocol. During hospitalization at our COVID-19-free transplant facility, we restricted the interactions during multidisciplinary rounds. Results: During the pandemic, 38 kidney transplants with an average length of hospital stay of 8.1 days were performed. Mean serum creatinine values of recipients were 0.91, 0.86, and 0.74 mg/dL on postoperative days 7, 30, and 90, respectively. During the pandemic, 9 living donor liver transplants (1 adult, 8 pediatric) were performed with an average length of hospital stay of 17.1 days. Mean serum total bilirubin levels were 0.9, 0.5, and 0.4 mg/dL on postoperative days 7, 30, and 90, respectively. Mean serum aspartate aminotransferase levels were 38.1, 28.3, and 22.3 U/L on postoperative days 7, 30, and 90, respectively. All recipients and donors were successfully discharged. Only 1 liver recipient died (on day 55 after discharge as a result of oxalosis-induced heart failure). Conclusions: According to our results, when precautions are taken, transplant does not pose a risk to patients during the pandemic period. We attribute the safety and success shown to our newly developed protocol in response to the COVID-19 pandemic.Item The New Anterior Less Invasive Crescentic Incision for Living Donor Nephrectomy(2020) Haberal, Mehmet; Soy, Ebru H. Ayvazoglu; Akdur, Aydincan; AlShalabi, Omar; Yildirim, Sedat; Moray, Gokhan; Torgay, Adnan; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-0993-9917; 0000-0002-6829-3300; 0000-0003-2498-7287; 33143599; AAA-3068-2021; AAJ-8097-2021; AAF-4610-2019; AAC-5566-2019; AAJ-5221-2021; AAE-1041-2021Objectives: Living-donor nephrectomy is a devoted procedure performed in a healthy individual; for these procedures, it is essential to complete the surgery with the lowest possible risk and morbidity and allow donors to regain their normal daily activity. To minimize anatomic and physiologic damage, we modified a surgical technique. Here, we report our experiences with the new anterior less invasive crescentic donor nephrectomy technique. Metarials and Methods: We retrospectively evaluated 728 donor nephrectomy patients who had the new anterior less invasive cresentic incision (n = 224), the classic open (n = 431), or the laparoscopic living-donor nephrectomy (n = 73) procedures. Demographic characteristics, preoperative and postoperative parameters, acute renal graft dysfunction, and firstyear graft and patient survival rates were compared between groups. Results: During the operation, the new cresentic incision living-donor nephrectomy allowed a safe and comfortable position for the patient and the anesthesiologist. Also, it procures safe access especially for grefts with multiple vessels. Patients had lower pain scores (P = .010), shorter hospital stays (2.25 vs 3.49 days) than those who received the classic open living-donor nephrectomy. Patients who received laparoscopic living-donor nephrectomy had significantly longer mean operation time (P = .016) and warm ischemia time (P <= .001) than those who had the new cresentic incision technique. All groups showed similar rates of first-year survival and delayed graft dysfunction. Conclusions: The new anterior less invasive cresentic incision open-donor nephrectomy approach is a safe, comfortable, effective, and less invasive modification of the living donor nephrectomy. Also, it procures safe access for grefts with multiple vessels.Item Oxalosis Crystals' Redeposition in Cardiac Tissue Leading to New-Onset Fatal Cardiac Complication After Liver Transplant in Primary Oxalosis Patient: Case Report(2020) AlShalabi, Omar; Soy, Ebru H. Ayvazoglu; Akdur, Aydincan; Karakaya, Emre; Kahraman, Gokhan; Moray, Gokhan; Haberal, Mehmet; 0000-0002-4879-7974; 0000-0002-3462-7632; 0000-0002-0993-9917; 0000-0002-8726-3369; 0000-0003-2498-7287; 33187466; AAD-5466-2021; AAJ-8097-2021; AAC-5566-2019; AAA-3068-2021; AAE-1041-2021Primary oxalosis is a rare hereditary disorder of metabolism resulting in accumulation of calcium oxalate in almost all tissues of the body. All published data point out the improvement of cardiac function after transplant. Here, we report the first case in the literature of an 8-year-old patient with primary oxalosis in which oxalosis implantations increased in cardiac tissue after liver transplant and manifested as new-onset ventricular tachycardia and cardiomyopathy, leading to death.Item Our Living Donor Protocol for Liver Transplant: A Single-Center Experience(2020) Karakaya, Emre; Akdur, Aydincan; Soy, Ebru H. Ayvazoglu; Harman, Ali; Coskun, Mehmet; Haberal, Mehmet; 0000-0002-0993-9917; 0000-0002-4879-7974; 0000-0002-3462-7632; 0000-0002-8726-3369; 0000-0001-5630-022X; 33187462; K-9824-2013; AAC-5566-2019; AAD-5466-2021; AAJ-8097-2021; AAA-3068-2021; AAM-4120-2021Objectives: The shortage of deceased donor organs is a limiting factor in transplant. The growing discrepancy between the wait list demand versus the supply of deceased donor organs has created an incentive for consideration of living donor liver transplant as an alternative. Here, we describe our evaluation process and donor complications. Materials and Methods: Since 1988, we have performed 659 (449 living donor and 210 deceased donor) liver transplants. The most important evaluation criteria is the relationship between donor and recipient, and we require that the donor must be related to the recipient. The evaluation protocol has 5 stages. Donor complications were defined as simple, moderate, and severe. Results: We retrospectively investigated data for 1387 candidates, and 938 (67.7%) were rejected; subsequently, 449 living donor liver transplants were performed. There were no complications in 398 of the donors (88.7%). Total complication rate was 11.3%. Simple complications were seen in 31 patients (6.9%). Moderate complications were seen in 19 patients (4.2%). We had only 1 severe complication, ie, organ failure from unspecified liver necrosis, which resulted in death. Conclusions: The relationship between donor and recipient and donor safety should be the primary focus for living donor liver transplant. Donor selection should be made carefully to minimize complications and provide adequately functional grafts.