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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 T-Cell Acute Lymphoblastic Leukemia After Liver Transplant(2014) Ozkan, Eylem Akar; Ozdemir, B. Handan; Akcay, Eda Yilmaz; Atilgan, Alev Ok; Haberal, Mehmet; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0001-6831-9585; https://orcid.org/0000-0001-8595-8880; https://orcid.org/0000-0002-3462-7632; 24635812; X-8540-2019; AAK-1960-2021; AAK-3333-2021; AAJ-8097-2021T-cell posttransplant lymphoproliferative disorders after solid-organ transplant are rare and may be clinically aggressive. A 3-year-old boy had liver transplant from his grandfather because of hepatoblastoma. The immunosuppressive regimen was based on tacrolimus and prednisolone. At 22 months after transplant (age, 5 years)., the patient presented to the hospital because of severe cough. Computed tomography scan of the chest showed a large left mediastinal mass (9 x 7.2 x 7 cm) and left pleural effusion. A Tru-Cut biopsy of the mediastinal mass showed diffuse infiltration with blast cells, and the diagnosis of 1-cell acute lymphoblastic leukemia was made. Immunohistochemical examination of blasts showed strong and diffuse terminal deoxynucleotidyl transferase and CD3 antibody expression; Ki-67 proliferation index was > 95%, and tumor cells were negative for Epstein-Barr virus. Tacrolimus was stopped, sirolimus was started, and chemotherapy was given, but he died 2 months after diagnosis because of chemotherapy-induced sepsis. Monomorphic 1-cell posttransplant lymphoproliferative disorder with features of acute lymphoblastic leukemia and lymphoblastic lymphoma is rare after liver transplant.Item Synchronous Posttransplant Lymphoproliferative Disorder and Inflammatory Myofibroblastic Tumor of the Lung in a 2-Year-Old Liver Transplanted Boy: A Case Report(2015) Tepeoglu, Merih; Atilgan, Alev Ok; Ozdemir, B. Handan; Haberal, Mehmet; 0000-0001-8595-8880; 0000-0002-7528-3557; 0000-0002-9894-8005; 0000-0002-3462-7632; 25184247; AAK-3333-2021; X-8540-2019; AAK-5222-2021; AAJ-8097-2021Inflammatory myofibroblastic tumor is a rare benign lesion found mostly in children and young adults. It originates from the lung, abdominopelvic region, and retroperitoneum. The tumor is composed of myofibroblasts and inflammatory cell infiltration in the tissue. The cause and pathogenesis of this tumor are not completely understood. Epstein-Barr virus has been held responsible in some reported cases of inflammatory myofibroblastic tumors. Another tumor (which is known to be related to the Epstein-Barr virus) is posttransplant lymphoproliferative disorder. We report the case of a 2-year-old boy who underwent a liver transplant at the age of 9 months (the donor was his mother) because of biliary atresia. At 11 months after transplant, we detected posttransplant lymphoproliferative disorder and inflammatory myofibroblastic tumor concurrently. This entity is presented to highlight possible Epstein-Barr virus involvement in inflammatory myofibroblastic tumor of lung.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 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 Lung Metastasis of Fatty Hepatocellular Carcinoma After Liver Transplant: A Case Report(2014) Tepeoglu, Merih; Ozdemir, B. Handan; Atilgan, Alev Ok; Akdur, Aydincan; Haberal, Mehmet; https://orcid.org/0000-0002-9894-8005; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0001-8595-8880; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-3462-7632; 24635803; AAK-5222-2021; X-8540-2019; AAK-3333-2021; AAA-3068-2021; AAJ-8097-2021Hepatocellular carcinoma with prominent fatty change is rare, and to date only a few cases have been reported. In this article, we present a 57-year-old woman who underwent a liver transplant for hepatocellular carcinoma. Ten months after liver transplant, she presented with a persistent cough. Computed tomography of the chest was performed, revealing a solid lung mass that measured 1 Chi 0.9 cm in the right inferior lobe. Right inferior lobectomy was performed, and the final diagnosis was noted as hepatocellular carcinoma with prominent fatty change. Fatty change was extensive in the tumor; therefore, lipoid pneumonia was the first condition that was considered in the differential diagnosis during examination of the lobectomy material. For the differential diagnosis, the immunohistochemistry panel was studied to show the hepatocellular nature of the tumor. Although metastasis of hepatocellular carcinoma to the lungs is expected, hepatocellular carcinoma with prominent fatty change can cause diagnostic difficulties, such as lipoid pneumonia, especially in small lung biopsies.Item Eculizumab Therapy in A Patient with Dense-Deposit Disease Associated with Partial Lipodystropy(2014) Ozkaya, Ozan; Nalcacioglu, Hulya; Tekcan, Demet; Genc, Gurkan; Meydan, Bilge Can; Ozdemir, B. Handan; Baysal, M. Kemal; Keceligil, Hasan Tahsin; https://orcid.org/0000-0002-7528-3557; 24464478; X-8540-2019Dense deposit disease (DDD) (also known as membranoproliferative glomerulonephritis type II) in childhood is a rare glomerulonephritis with frequent progression to end-stage renal disease (ESRD) and a high recurrence after kidney transplantation. The pathophysiologic basis of DDD is associated with the uncontrolled systemic activation of the alternative pathway (AP) of the complement cascade. A 14-year-old girl presented with edema and nephrotic range proteinuria. Blood tests showed hypoalbuminemia, nephrotic range proteinuria, normal renal function, and a low C3 level. Renal biopsy confirmed the diagnosis of crescentic DDD. Complement analysis revealed strong AP activation (low C3), positive C3 nephritic factor (C3NeF), and a decreased complement factor H (CFH) levels with CFH polymorphisms. Therapy with eculizumab was considered after the failure of corticosteroid and plasmapheresis to modulate the ongoing massive proteinuria and persistence of low serum C3 levels. There was a marked clinical and biochemical response following the administration of eculizumab. Our case emphasizes the efficacy of eculizumab in the management of crescentic DDD in a patient with a normal renal function, in a short follow-up period. Considering previously reported cases, it appears that eculizumab represents a promising new approach which may prevent progression to ESRD in a subset of patients with DDD.Item Nonmelanoma Skin Cancer After Kidney Transplant(2014) Tepeoglu, Merih; Ayva, Sebnem; Atilgan, Alev Ok; Tunca, M. Zeyneb; Ozdemir, B. Handan; Moray, Gokhan; Yildirim, Sedat; Arslan, Gulnaz; Haberal, Mehmet; https://orcid.org/0000-0002-9894-8005; https://orcid.org/0000-0002-2280-8778; https://orcid.org/0000-0001-8595-8880; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-5735-4315; https://orcid.org/0000-0002-3462-7632; 24907724; AAK-5222-2021; AAK-1967-2021; AAK-3333-2021; X-8540-2019; AAE-1041-2021; AAF-4610-2019; AAJ-8097-2021Objectives: Solid-organ transplant recipients have a high risk of developing nonmelanoma skin cancers. This study sought to determine the incidence of skin cancer and identify possible risk factors for skin cancer in kidney transplant recipients. Materials and Methods: Nonmelanoma skin cancer was diagnosed and confirmed with histology in 33 of 1275 kidney transplant recipients (2.6%). Demographic and clinical findings were reviewed retrospectively. Results: Nonmelanoma skin cancers included squamous cell carcinoma in 10 patients (30%), basal cell carcinoma in 9 patients (27%), Kaposi sarcoma in 9 patients (27%), squamous cell carcinoma in situ in 3 patients (9%), and cutaneous lymphoma in 2 patients (6%). The ratio of squamous cell carcinoma to basal cell carcinoma was 1.1:1. The mean time from transplant to skin cancer diagnosis was 65 +/- 55 months (range, 0-180 mo). Immunosuppressive therapy was based on cyclosporine in 22 patients (67%), tacrolimus in 8 patients (24%), and combination therapy (cyclosporine and azathioprine) in 3 patients (9%). Conclusions: Nonmelanoma skin cancer is an important clinical problem in kidney transplant recipients. Interventions that may benefit kidney transplant recipients may include intensive patient education, protection against sun exposure, and dermatologic screening programs.Item Role of Bronchoalveolar Lavage in Diagnosis of Fungal Infections in Liver Transplant Recipients(2015) Tepeoglu, Merih; Atilgan, Alev Ok; Ozdemir, B. Handan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0001-8595-8880; 0000-0002-7528-3557; 0000-0002-9894-8005; 25894185; AAJ-8097-2021; AAK-3333-2021; X-8540-2019; AAK-5222-2021Objectives: Pulmonary fungal infections remain the most important cause of morbidity and mortality in liver transplant recipients. Fast and accurate causative diagnoses are essential for a good outcome. Bronchoscopy with bronchoalveolar lavage frequently is performed to diagnose pulmonary infections in immunocompromised patients. The aim of this study was to evaluate the diagnostic use of bronchoalveolar lavage in liver transplant recipients with pulmonary infections. Materials and Methods: We retrospectively analyzed the data of 408 patients who underwent liver transplant from January 1990 to December 2012. Patients who underwent bronchoalveolar lavage after transplant were included in this study. Results: There were 18 of 408 liver transplant recipients (4.41%) who underwent bronchoalveolar lavage after transplant. The mean age was 49.5 +/- 18 years. In 5 patients (27.8%), fungal microorganisms were observed in the cytology of bronchoalveolar lavage specimens, including Aspergillus fumigatus in 3 patients and Candida albicans in 2 patients. Death occurred in 4 of 5 patients (80%) with fungal infections. No association was observed between the presence of fungal infection and clinical and radiographic findings of the patients. Conclusions: Bronchoscopy with bronchoalveolar lavage is a useful, noninvasive diagnostic tool for the rapid diagnosis of infections in solid-organ transplant recipients.