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Author: search.filters.author.Soy, Ebru H. Ayvazoglusearch.filters.applied.f.publicationcategory: search.filters.publicationcategory.Makale - Uluslararası Hakemli Dergi

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    Liver Transplant Recipients Who Survive for More Than 10 Years: A Long-Term Survey
    (2022) Soy, Ebru H. Ayvazoglu; Akdur, Aydincan; Karakaya, Emre; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-4879-7974; https://orcid.org/0000-0002-3462-7632; 35384803; AAD-5466-2021; AAJ-8097-2021
    Objectives: Liver transplant is the gold standard treatment for end-stage liver failure. Short-term and midterm surveys have been published, but there are few long-term surveys. Here, we report the outcomes of our long-term liver transplant survivors. Materials and Methods: Since 1988, wehave performed 694 liver transplants (366 adult, 328 pediatric), including the first deceased donor transplant in Turkey (December 8, 1988); the first pediatric segmental living related transplant in Turkey, the Middle and Near East, and Europe; the world's first adult segmental living related transplant (April 24, 1990); and the world's first living related donor combined liver-kidney transplant (May 16, 1992). We retrospectively evaluated data from recipients who survived >10 years with normal graft function. Results: Of 215 recipients, survival ranges were =20 years (n = 13), 15 to 19 years (n = 86), and 10 to 14 years (n = 116); 211 remain alive today with normal liver function. There were 5 retransplants to treat chronic graft rejection, of which 4 recipients are alive with normal graft function after a second liver transplant (15, 20, 22, and 31 years after first transplant). One patient died soon after the second liver transplant (15 years after first transplant). Acute rejection episodes were seen in 72 (34%), and 7 were steroid resistant. There were 48 (22.7%) drug-induced complications. Ten patients had de novo malignancy: 5 lymphoma, 2 squamous cell carcinoma, 1 gastrointestinal stromal tumor, 1 thyroid papillary carcinoma, and 1 multiple myeloma. There were also 31 patients with hepatocellular carcinoma before liver transplant: 13 were beyond Milan criteria, 6 had incidental HCC, and 12 were within Milan. Conclusions: Long-term survival after liver transplant is possible with expert care. Few reports have mentioned long-term surveys; our long-term liver transplant survey is among the largest series in the literature.
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    Long-Term Follow-up of Over 600 Living Related Kidney Donors: Single-Center Experience
    (2022) Sayin, Burak; Akdur, Aydincan; Karakaya, Emre; Soy, Ebru H. Ayvazoglu; Haberal, Mehmet; https://orcid.org/0000-0002-4879-7974; https://orcid.org/0000-0002-3462-7632; 35384802; AAD-5466-2021; AAJ-8097-2021
    Objectives: Kidney transplant is the treatment of choice in patients with end-stage renal disease because it offers improved survival and better quality of life. Although most epidemiologic studies have suggested that 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. Here, we examined the long-term results of living-related kidney donors who donated kidneys at the Baskent University Ankara Hospital over the past 25 years. Materials and Methods: We were able to examine 607 kidney transplant donors (mean age of 52.03 +/- 11.54 years) who were seen at our center from 1986 to 2021 and who agreed to a general health evaluation. Collected data included donor age, sex, blood type, body mass index, duration after donation, blood pressure measurements, biochemical parameters, abdominal ultrasonograph for size, structure, and renal blood flow of the solitary kidney, comorbid conditions, chronic drug use, and surgical procedures after donation. Results: Mean time after donation was 10.4 +/- 3.2 years. Twenty-four donors (3.9%) were diagnosed with diabetes and 21 (3.4%) with thyroid disease, 64 (10.5%) developed hypertension, and 48 (8.8%) developed atherosclerotic cardiovascular disease. Obesity was found to be an increasing problem in our donor population, with 174 (28.6%) developing mild to moderate obesity (body mass index >25 kg/m2). Older age, obesity, smoking, and hyperlipidemia were found to be the major and independent risk factors of both hypertension and atherosclerotic cardiovascular disease in donors. None of our donors developed endstage renal disease. Conclusions: Obesity and hypertension were the most common comorbidities that developed in our kidney donor population. Our principle is to avoid unrelated and nondirected donors because of the possible long-term complications. Unrelated donors may be desperate if a family member needs donation in the future.
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    Over 5 Years of Excellent Graft Kidney Function Determinants: Baskent University Experience
    (2019) Sayin, Burak; Ozdemir, Aydan; Soy, Ebru H. Ayvazoglu; Kirnap, Mahir; Akdur, Aydincan; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0001-8287-6572; https://orcid.org/0000-0002-0993-9917; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 30777527; J-3707-2015; ABH-7372-2020; AAC-5566-2019; AAH-9198-2019; AAA-3068-2021; AAE-1041-2021; AAJ-8097-2021
    Objectives: Kidney graft survival may be evaluated according to the duration of time with a functioning graft. Survival alone may not satisfy expectations of a successful kidney transplant if the graft kidney does not show excellent function. In our study, we analyzed the characteristics of kidney transplant recipients who showed excellent graft function after 5 to 10 years of follow-up in an aim to improve graft survival and to ensure the best kidney function in the long term. Materials and Methods: We retrospectively evaluated graft function and demographic characteristics of 288 patients who underwent kidney transplant between January 2008 and December 2012. Results: We found that 149 patients (51.7%) had excellent graft function, 88 patients (30.5%) had a functioning graft with a glomerular filtration rate lower than 60 mL/min and/or had signs of graft kidney dysfunction, and 45 patients (15.6%) experienced graft loss. Of 288 kidney transplant recipients enrolled in the study, most were male (56%), and mean age was 30.47 +/- 14.36 years at time of transplant. Median time on dialysis was 39.09 +/- 59.30 months. The overall graft survival rate in the patient group was 82.2% after 5 to 10 years of follow-up. Multivariate analysis showed that excellent graft survival predictors beyond 5 years were negative panel reactive antibody levels, lower donor age, shorter duration on dialysis, absence of acute rejection episodes, 3 or less HLA mismatches, lower immunosuppressive levels, and lower recipient age at transplant. Conclusions: Lower panel reactive antibody levels, lower donor age, shorter duration on dialysis, absence of acute rejection episodes, 3 or less HLA mismatches, and lower recipient age at transplant are major determinants of excellent graft survival in our kidney transplant recipients.
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    Liver Transplant in a Patient With Hemophagocytic Lymphohistiocytosis
    (2019) Soy, Ebru H. Ayvazoglu; Alam, Humaira; Olcay, Lale; Baris, Zeren; Yildirim, Sedat; Torgay, Adnan; Haberal, Mehmet; https://orcid.org/0000-0002-0993-9917; https://orcid.org/0000-0002-5684-0581; https://orcid.org/0000-0002-5735-4315; https://orcid.org/0000-0002-6829-3300; https://orcid.org/0000-0002-3462-7632; 30777561; AAC-5566-2019; AAK-3548-2021; AAB-4153-2020; AAF-4610-2019; AAJ-5221-2021; AAJ-8097-2021
    Hemophagocytic lymphohistiocytosis is a rare and life-threatening systemic disease that can cause hepatic infiltration and present as acute liver failure. Here, we report a case of a 3-year-old pediatric patient who presented with acute liver failure and hepatic encephalopathy secondary to hemophagocytic lymphohistiocytosis. She had left lateral segment liver transplant from her father. After 27 months, she had bone marrow transplant from her sister. At the time of reporting (36 months after liver transplant), she showed normal liver function and blood peripheral counts. We found that liver transplant can be a curative treatment for this type of rare disorder, not only to improve the quality of life but also to prolong survival.
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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.
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    Vascular Complications After Renal Transplant: A Single-Center Experience
    (2017) Soy, Ebru H. Ayvazoglu; Akdur, Aydincan; Kirnap, Mahir; Boyvat, Fatih; Moray, Gokhan; Haberal, Mehmet; 0000-0002-8726-3369; 0000-0003-2498-7287; 0000-0002-0993-9917; 0000-0002-3462-7632; 28260440; AAA-3068-2021; AAH-9198-2019; AAE-1041-2021; F-4230-2011; AAC-5566-2019; AAJ-8097-2021
    Objectives: Despite surgical and medical advances, vascular complications are still among the major concerns after renal transplant, with a reported incidence of 3% to 15%. We evaluated the incidence and management of our transplant team's vascular complications over 40 years. Materials and Methods: From November 1975 to the present, we have performed a total of 2594 renal transplant procedures. Of these, 1997 grafts (76%) were obtained from living donors, and 597 grafts (24%) were obtained from deceased donors. All renal transplant procedures, including those performed in pediatric patients, used the extraperitoneal approach to the contralateral iliac fossa. Revascularization was performed for all grafts. A single end-to-end internal iliac artery anastomosis was performed in 1082 patients (41.8%), an end-to-side external iliac artery anastomosis was performed in 1289 patients (49.7%), and an end-to-side common iliac artery anastomosis was performed in 66 patients (2.5%). In 157 procedures (6%), there were at least 2 renal arteries, and both internal iliac arteries or external iliac arteries were used for anastomosis. Results: We observed 57 vascular complications (2.1%) in 54 renal transplant procedures. The most frequent complication was renal artery stenosis (n = 17; 0.6%). There were 8 instances of renal artery thrombosis (0.4%), 7 of renal artery kinking (0.3%), 5 of renal vein thrombosis (0.2%), 9 of renal vein kinking (0.5%), 3 of external iliac artery dissection (0.01%), 5 renal vein lacerations (0.2%), and 3 renal artery lacerations (0.01%). We performed urgent surgery for 41 vascular complications; 38 were managed successfully. Percutaneous interventional techniques were used successfully for 18 vascular complications. Conclusions: The vascular complication rate in our patients is lower than that reported in the literature. Surgical complications can be minimized with careful transplant technique and close follow-up, as early diagnosis is crucial to early management and successful treatment of complications.
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    Unusual Indications for a Liver Transplant: A Single-Center Experience
    (2017) Akdur, Aydincan; Kirnap, Mahir; Soy, Ebru H. Ayvazoglu; Ozcay, Figen; Moray, Gokhan; Arslan, Gulnaz; Haberal, Mehmet; 0000-0002-5214-516X; 0000-0002-3462-7632; 0000-0002-0993-9917; 0000-0002-8726-3369; 0000-0003-2498-7287; 28260452; ABG-5684-2020; AAH-9198-2019; AAJ-8097-2021; AAC-5566-2019; AAA-3068-2021; AAE-1041-2021
    Objectives: This study sought to evaluate the efficacy of liver transplant for unusual liver diseases. Materials and Methods: The results of 476 patients who underwent liver transplant from 1988 to January 2015 were retrospectively analyzed. Two hundred forty-five of them were adult patients and 231 of them were pediatric. Thirty-one patients had unusual liver disease. Results: Of the 31 patients with unusual liver disease, 9 (29%) were adult and 22 (71%) were pediatric patients. In the pediatric group, indications for liver transplant were Alagille syndrome (n = 5), Crigler-Najjar syndrome type 1 (n = 5), glycogen storage disease (n = 3), oxalosis (n = 3), familial hypercholesterolemia (n = 2), alpha-1-antitrypsin deficiency (n = 2), Caroli disease (n = 1), and cystic neuroblastoma metastasis (n = 1). Six patients (27.2%) had acute rejection episodes and were successfully treated with pulse steroids. In 2 patients, retransplant was performed for chronic rejection. Three patients died during follow-up (13.6%): 2 because of sepsis and 1 because of cranial hemorrhage. In the adult group, indications for liver transplant were neuroendocrine tumor metastasis (n = 1), liver angiosarcoma (n = 1), familial hypercholesterolemia (n = 2), alveolar hydatid disease (n = 2), cystic fibrosis (n = 1), congenital hepatic fibrosis (n = 1), and oxalosis (n = 1). Four patients (44.4%) had acute rejection episodes and were successfully treated with pulse steroid therapy. One patient died due to the recurrence of primary disease (liver angiosarcoma) during follow-up (11.1%). Conclusions: Advances in liver transplant and our understanding about unusual liver disease have led to significant improvements in managing these diseases. Liver transplant effectively treats the underlying defect and the complications of portal hypertension, or risk of malignancy for those disorders, in which the liver is affected.
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    Incisional Hernia After Liver Transplant
    (2017) Soy, Ebru H. Ayvazoglu; Kirnap, Mahir; Yildirim, Sedat; Moray, Gokhan; Haberal, Mehmet; 0000-0003-2498-7287; 0000-0002-0993-9917; 0000-0002-5735-4315; 0000-0002-3462-7632; 28260464; AAE-1041-2021; AAH-9198-2019; AAC-5566-2019; AAF-4610-2019; AAJ-8097-2021
    Objectives: An incisional hernia seriously burdens the quality of life after liver transplant. The incidence of incisional hernia after liver transplant is reported to be 4% to 20%. Here, we evaluated incisional hernias that occurred after adult liver transplant and incisional hernias intentionally made in infant liver transplant procedures. Materials and Methods: Between December 1988 and May 2016, we performed 536 liver transplant procedures in 515 patients. Demographic features, surgical outcomes, and predisposing factors were evaluated. Results: Of 452 liver transplant patients included, incisional hernias were diagnosed in 29 patients (6.4%; 7 pediatric, 22 adult). Most were males (77%) with Child-Pugh score C cirrhosis (62%), moderate/severe ascites (81%), and serum albumin levels < 3.5 g/L (86%). Incisional hernia developed in 16 of 51 patients (31%) with wound infection. Twelve incisional hernias were seen in 40 recipients (30%) with body mass index >= 30 kg/m(2). Eight of 45 patients (18%) with repeated surgery had incisional hernias. Five of 22 adult incisional hernias (23%) had primary fascia repair, and 17 (77%) were repaired with Prolene mesh graft (3 sublay, 14 onlay). No other complications and no hernia recurrence were shown during follow-up (range, 8-138 mo). Of 7 pediatric liver transplant patients with intentionally made incisional hernias during liver transplant, 5 patients had primary fascia repair and 2 patients had onlay mesh repair. No complications or recurrence were shown during follow-up (range, 12-60 mo). Conclusions: Repeated surgery, postoperative wound infection, and obesity were found to be predisposing risk factors for incisional hernia development after liver transplant in adults. Abdomen closure in infant liver transplant with large-for-size grafts is a different area of discussion. Here, we suggest that an intentionally made incisional hernia with staged closure of the abdomen is safe and effective for graft and patient survival.
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    Ultrasonography Findings of Acute Tubulointerstitial Nephritis and Multiple Abscesses Following Renal Transplant: A Case Report
    (2017) Tezcan, Sehnaz; Uslu, Nihal; Soy, Ebru H. Ayvazoglu; Haberal, Mehmet; https://orcid.org/0000-0001-7204-3008; https://orcid.org/0000-0002-6733-8669; https://orcid.org/0000-0002-0993-9917; https://orcid.org/0000-0002-3462-7632; 28260478; ABC-5258-2020; AAC-5566-2019; AAJ-8097-2021
    Urinary tract infection is the most common complication after kidney transplant that can cause graft loss. An early diagnosis of urinary infections decreases morbidity and mortality. Besides clinical and laboratory examinations, ultrasonography is considered as the primary imaging modality for the diagnosis of urinary tract infections. Here, we report a 53-year-old woman who presented with fever and pain at surgical site. Ultrasonography examination showed multiple, ill-defined or irregularly margined hypoechoic areas within the cortex. Ultrasonography-guided percutaneous renal biopsy was performed. Histopathologic findings were compatible with acute tubulointerstitial nephritis and multiple abscesses. Ultrasonography is the most widely applied imaging modality for diagnoses of complications after renal transplant. Although ultrasonography findings of infections are generally nonspecific, it still plays an important role in the diagnosis of urinary infections after renal transplant.
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    Early Postoperative Infections After Liver Transplant
    (2018) Soy, Ebru H. Ayvazoglu; Akdur, Aydincan; Yildirim, Sedat; Arslan, Hande; Haberal, Mehmet; 0000-0002-0993-9917; 0000-0002-8726-3369; 0000-0002-5735-4315; 0000-0002-5708-7915; 0000-0002-3462-7632; 29528013; AAC-5566-2019; AAA-3068-2021; AAF-4610-2019; ABG-7034-2021; AAJ-8097-2021
    Objectives: Despite surgical advances and effective prophylactic strategies in liver transplant, infection is still a major cause of morbidity and mortality. Up to 80% of liver recipients will develop at least 1 infection during the first year after liver transplant. The spectrum and manifestations of these infections are broad and variable. Their diagnosis and treatment are often delayed because immunosuppressive therapy diminishes inflammatory responses. However, if an infection is not identified early enough and treated properly, it can have devastating consequences. In addition, prophylactic approaches remain controversial. Our aim was to review our early postoperative infection management after liver transplant. Materials and Methods: We retrospectively evaluated infections that occurred during the first hospital stay of transplant patients. Infections were grouped as surgical site and nonsurgical site infections. Consequences and treatment protocols of infections were stratified according to the Clavien scale. Results: Between December 1988 and January 2017, we performed 561 liver transplants at our center (patient age range, 6 months to 64 years), which included 401 living-donor (72%) and 160 deceased-donor (28%) liver transplants. Early postoperative infections were detected in 131 patients (23.3%), comprising 67 surgical site (51%), 56 nonsurgical site (43%), and 8 combined surgical and nonsurgical site infections (6%). Although no mortalities occurred in patients with single nonsurgical or surgical site infections, there were 4 mortalities in patients with combined surgical and nonsurgical site infections. In the 4 other patients with combined infections, 3 patients required endoscopic or radiologic intervention and 1 recovered from single-organ dysfunction. Conclusions: Initiation of appropriate prophylactic and therapeutic protocols at the right time decreases morbidity and mortality due to infection in liver transplant recipients. Increased understanding and effective approaches to prevent infection are essential to improving both graft and recipient survival.