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Item Relationship Between Perioperative Factors and Splenic Artery Steal Syndrome After Orthotopic Liver Transplant: A Retrospective Clinical Study(2023) Kuscu, Ozlem Ozkan; Kus, Murat; Incekas, Caner; Ozmete, Ozlem; Ergenoglu, Pinar; Yildirim, Sedat; Torgay, Adnan; Haberal, Mehmet; 37885290Objectives: After orthotopic liver transplant, ischemia of biliary tract and graft loss may occur due to impaired hepatic arterial blood flow. This situation with hypersplenism and impaired hepatic arterial blood flow is defined as splenic artery steal syndrome. The aim of this study was to investigate the relationship between perioperative factors and splenic artery steal syndrome in orthotopic liver transplant patients. Materials and Methods: Forty-five patients who underwent orthotopic liver transplant between 2014 and 2022 were included in the study. The data for the patients were obtained from the hospital database, including the intraoperative anesthesiology and postoperative intensive care records. Results: Eleven patients were diagnosed with splenic artery steal syndrome. Patients with splenic artery steal syndrome had higher need for intraoperative vasopressor agents (P = .016) and exhibited lower intraoperative urine output (P = .031). In the postoperative intensive care follow-up, patients with splenic artery steal syndrome had higher levels of C-reactive protein during the first 48 hours (P = .030). Conclusions: Intraoperative administration of vasopressor drugs, low urine output, and early postoperative high C-reactive protein levels were associated with the development of splenic artery steal syndrome in patients undergoing orthotopic liver transplant. Future studies should focus on investigation of biomarkers associated systemic hypoperfusion that may contribute to the development of splenic artery steal syndrome.Item Anesthetic Management in Pediatric Orthotopic Liver Transplant For Fulminant Hepatic Failure and End-stage Liver Disease(2014) Camkiran, Aynur; Araz, Coskun; Balli, Sevgi Seyhan; Torgay, Adnan; Moray, Gokhan; Pirat, Arash; Arslan, Gulnaz; Haberal, Mehmet; https://orcid.org/0000-0003-1470-7501; https://orcid.org/0000-0002-4927-6660; https://orcid.org/0000-0002-6829-3300; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635805; AAJ-4576-2021; AAJ-5221-2021; AAE-1041-2021; AAJ-8097-2021Objectives: We assessed the anesthetic management and short-term morbidity and mortality in pediatrics patients who underwent an orthotopic liver transplant for fulminant hepatic failure or end-stage liver disease in a university hospital. Material and Methods: We retrospectively analyzed the records of children who underwent orthotopic liver transplant from May 2002 to May 2012. Patients were categorized into 2 groups: group fulminant hepatic failure (n=22) and group end-stage liver disease (n=19). Perioperative data related to anesthetic management and intra-operative events were collected along with information related to postoperative course and survival to hospital discharge. Results: Mean age and weight for groups fulminant hepatic failure and end-stage liver disease were 8.6 +/- 2.7 years and 10.8 +/- 3.8 years (P= .04) and 29.2 +/- 11.9 kg and 33.7 +/- 16.9 kg (P= .46). There were no differences between the groups regarding length of anhepatic phase (65 +/- 21 min vs 73 +/- 18 min, P= .13) and operation time (9.1 +/- 1.6 h vs 9.5 +/- 1.8 h, P= .23). When compared with the patients in group fulminant hepatic failure, those in group end-stage liver disease more commonly had a Glasgow Coma score of 7 or less (32% vs 6%, P= .04). Compared with patients in group fulminant hepatic failure, those in group end-stage liver disease were more frequently extubated in the operating room (31.8% versus 89.5% P <.001). Postoperative duration of mechanical ventilation (2.78 +/- 4.02 d vs 2.85 +/- 10.21 d, P = .05), and the mortality rates at 1 year after orthotopic liver transplant (7.3% vs 0%, P = .09) were similar between the groups. Conclusions: During pediatric orthotopic liver transplant, those children with fulminant hepatic failure require more intraoperative fluids and more frequent perioperative mechanical ventilation than those with end-stage liver disease.Item Postoperative Effects of Intraoperative Hyperglycemia in Liver Transplant Patients(2015) Komurcu, Ozgur; Camkiran, Aynur; Kaplan, Serife; Torgay, Adnan; Pirat, Arash; Haberal, Mehmet; Arslan, Gulnaz; 0000-0002-6829-3300; 0000-0001-6762-895X; 0000-0002-3462-7632; 0000-0003-1470-7501; 25894186; AAJ-5221-2021; GLV-1652-2022; AAJ-8097-2021Objectives: The aim of this study was to determine the effects of intraoperative hyperglycemia on postoperative outcomes in orthotopic liver transplant recipients. Materials and Methods: After ethics committee approval was obtained, we retrospectively analyzed the records of patients who underwent orthotopic liver transplant from January 2000 to December 2013. A total 389 orthotopic liver transplants were performed in our center, but patients aged < 15 years (179 patients) were not included in the analyses. Patients were divided into 2 groups based on their maximum intraoperative blood glucose level: group 1 (patients with intraoperative blood glucose level < 200 mg/dL) and group 2 (patients with intraoperative blood glucose level > 200 mg/dL). Postoperative complications between the 2 groups were compared. Results: There were 58 patients (37.6%; group 1, blood glucose < 200 mg/dL) who had controlled blood glucose and 96 patients (62.3%; group 2, blood glucose > 200 mg/dL) who had uncontrolled blood glucose. The mean age and weight for groups 1 and 2 were similar. There were no differences between the 2 groups regarding the duration of anhepatic phase (P=.20), operation time (P=.41), frequency of immediate intraoperative extubation (P=.14), and postoperative duration of mechanical ventilation (P=.06). There were no significant differences in frequency of patients who had postoperative infectious complications, acute kidney injury, or need for hemodialysis. Mortality rates after liver transplant were similar between the 2 groups (P=.81) Conclusions: Intraoperative hyperglycemia during orthotopic liver transplant was not associated with an increased risk of postoperative infection, acute renal failure, or mortality.Item Efficacy of Cell Saver Use in Living-Donor Liver Transplant(2015) Kirnap, Mahir; Tezcaner, Tugan; Soy, Hatice Ebru Ayvazoglu; Akdur, Aydincan; Yildirim, Sedat; Torgay, Adnan; Moray, Gokhan; Haberal, Mehmet; 0000-0002-8726-3369; 0000-0002-3641-8674; 0000-0002-6829-3300; 0000-0003-2498-7287; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-0993-9917; 25894181; AAA-3068-2021; AAD-9865-2021; AAJ-5221-2021; AAE-1041-2021; AAH-9198-2019; AAJ-8097-2021; AAF-4610-2019; AAC-5566-2019Objectives: Liver transplant currently is the best treatment option for end-stage liver disease. During liver transplant, there is major blood loss due to surgery and primary disease. By using a cell saver, the need for blood transfusion is markedly reduced. In this study, we aimed to evaluate the efficacy of cell saver use on morbidity and mortality in living-donor liver transplant. Materials and Methods: We retrospectively evaluated 178 living-donor liver transplants, performed from 2005 to 2013 in our center. Child-Turcotte-Pugh A patients, deceased-donor liver transplants, and liver transplants performed for fulminant hepatic failure were not included in this study. Intraoperative blood transfusion was done in all patients to keep hemoglobin level between 10 and 12 g/dL. Cell saver was used in all liver transplants except in patients with malignancy, hepatitis B, and hepatitis C. Results: We included 126 patients in the study. Cell saver was used in 84 liver transplants (66%). In 42 patients (34%), liver transplant was performed without a cell saver. In living-donor liver transplant with cell saver use, 10 mL/kg blood (range, 2-50 mL/kg blood) was transfused from the cell saver; in addition, 5 to 10 mL/kg allogeneic blood was transfused. In living-donor liver transplant without cell saver, 20 to 25 mL/kg allogeneic blood was transfused. Conclusions: During liver transplant, major blood transfusion is needed because of surgery and primary disease. Cell saver use markedly decreases the need for allogeneic blood transfusion and avoids adverse events of massive transfusion.Item Fatal Outcome After Renal Transplant in a Pediatric Patient With Noonan Syndrome(2015) Araz, Coskun; Kaval, Ebru; Torgay, Adnan; Moray, Gokhan; Haberal, Mehmet; 0000-0003-2498-7287; 0000-0002-6829-3300; 0000-0002-4927-6660; 0000-0002-3462-7632; 25894171; AAE-1041-2021; AAJ-5221-2021; AAJ-4576-2021; AAJ-8097-2021Noonan syndrome is a congenital, common, hereditary disorder. Facial dysmorphism, growth retardation, and various heart defects are typical clinical features. In patients with minor cardiac pathology, life expectancy is normal. We report a case of renal transplant in a pediatric patient with Noonan syndrome that ended with death of the patient. Our patient presented with unexpected and refractory postoperative neurological complications that were unresponsive to intensive therapy, and the patient died because of secondary complications.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 Treatment of Biliary Complications After Liver Transplant: Results of a Single Center(2015) Yildirim, Sedat; Soy, Ebru Hatice Ayvazoglu; Akdur, Aydincan; Kirnap, Mahir; Boyvat, Fatih; Karakayali, Feza; Torgay, Adnan; Moray, Gokhan; Haberal, Mehmet; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-0993-9917; 0000-0002-6829-3300; 0000-0002-1874-947X; 0000-0003-2498-7287; 25894131; AAA-3068-2021; F-4230-2011; AAH-9198-2019; AAJ-8097-2021; AAF-4610-2019; AAC-5566-2019; AAJ-5221-2021; AAB-3888-2021; AAE-1041-2021Biliary complications are major sources of morbidity after liver transplant due to vulnerable vascularization of the bile ducts. Biliary complications are the "Achilles' heel" of liver transplant with their high incidence, need for repeated and prolonged treatment, and potential effects on graft and patient survival. Although standardization of reconstruction techniques and improvements in immunosuppression and organ preservation have reduced the incidence of biliary complications, in early reports the morbidity rates are 50%, with related mortality rate 25% to 30%. Prophylaxis is a major issue. Although many risk factors (old donor age, marginal graft, prolonged ischemia time, living-donor liver transplant, partial liver transplant, donation after cardiac death, hepatic arterial thrombosis, organ preservation, chronic rejection, and other donor and recipient characteristics) do not directly affect biliary complications, accumulation of the factors mentioned above, should be avoided. However, no accepted standard has been established. Treatment strategy is a subject of debate. Recently, non-operative treatment of biliary complications have been preferred for diagnosis and therapy, because percutaneous or endoscopic treatment may prevent the need for surgical intervention. In this study, we reviewed our treatment of early and late biliary complications after liver transplant.Item Report of 3 Patients With Urea Cycle Defects Treated With Related Living-Donor Liver Transplant(2015) Ozcay, Figen; Baris, Zeren; Moray, Gokhan; Haberal, Nihan; Torgay, Adnan; Haberal, Mehmet; 0000-0003-2498-7287; 0000-0001-9852-9911; 0000-0002-6829-3300; 0000-0002-5214-516X; 0000-0002-3462-7632; 26640932; AAE-1041-2021; AAB-4153-2020; AAK-4587-2021; AAJ-5221-2021; ABG-5684-2020; AAJ-8097-2021Urea cycle defects are a group of metabolic disorders caused by enzymatic disruption of the urea cycle pathway, transforming nitrogen to urea for excretion from the body. Severe cases present in early infancy with life-threatening metabolic decompensation, and these episodes of hyperammonemia can be fatal or result in permanent neurologic damage. Despite the progress in pharmacologic treatment, long-term survival is poor especially for severe cases. Liver trans plant is an alternative treatment option, providing sufficient enzymatic activity and decreasing the risk of metabolic decompensation. Three patients with urea cycle defects received related living-donor liver transplants at our hospital. Patients presented with late-onset ornithine transcarbamylase deficiency, argininosuccinate lyase deficiency, and citrullinemia. Maximum pretransplant ammonia levels were between 232 and 400 mu mol/L (normal range is 18-72 mu mol/L), and maximum posttransplant values were 52 to 94 mu mol/L. All patients stopped medical treatment and dietary protein restriction for urea cycle defects after transplant. The patient with late-onset ornithine transcarbamylase deficiency already had motor deficits related to recurrent hyperammonemia attacks pretransplant. A major improvement could not be achieved, and he is wheelchair dependent at the age of 6 years. The other 2 patients had normal motor and mental skills before transplant, which have continued 12 and 14 months after transplant. Hepatic artery thrombosis in the patient with the ornithine transcarbamylase deficiency, intra-abdominal infection in the patient with argininosuccinate lyase deficiency, and posterior reversible encephalopathy syndrome in the patient with citrullinemia were early postoperative complications. Histopathologic changes in livers explanted from patients with ornithine transcarbamylase deficiency and citrullinemia were nonspecific. The argininosuccinate lyase-deficient patient had portoportal fibrosis and cirrhotic nodule formation. In conclusion, liver transplant was a lifesaving procedure for our patients. Proper timing for transplant is important because high ammonia levels may result in permanent neurologic damage; however, transplant at younger ages also may increase morbidity.Item Perioperative Characteristics of Siblings Undergoing Liver or Kidney Transplant(2015) Ersoy, Zeynep; Ozdemirkan, Aycan; Pirat, Arash; Torgay, Adnan; Arslan, Gulnaz; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-6829-3300; 0000-0003-0767-1088; 26640926; AAJ-8097-2021; AAH-7003-2019; AAJ-5221-2021; AAF-3066-2021Objectives: Reasons for chronic liver and kidney failure may vary; sometimes more than 1 family member may be affected, and may require a transplant. The aim of this study was to examine the similarities or differences between the peri operative characteristics of siblings undergoing liver or kidney transplant. Materials and Methods: The medical records of 6 pairs of siblings who underwent liver transplant and 4 pairs of siblings who underwent kidney transplant at Baskent University Hospital between 1989 and 2014 were retrospectively analyzed. Collected data included demographic features; comorbidities; reasons for liver and kidney failure; perioperative laboratory values; intraoperative hemodynamic parameters; use and volume of crystalloids, colloids, blood products, cell saver system, and albumin; duration of anesthesia; urine output; and postoperative follow-up data. Results: The mean age of the 6 sibling pairs who underwent liver transplant was 16.3 +/- 12.2 years. All 12 patients had Child-Pugh grade B cirrhosis, with mean disease duration of 7.8 +/- 3.9 years. There were no significant differences between siblings with respect to intraoperative blood product transfusion, crystalloid and colloid fluid replacements, hypotension frequency, blood gas analyses, urinary output, duration of anhepatic phase, inotropic agent administration, post operative laboratory values, need for mechanical ventilation and vasopressors, occurrence of acute renal failure and infections, and duration intensive care unit stay (P>.05). The mean age of the 4 sibling pairs who underwent kidney transplant was 21.3 +/- 6.4 years, with mean duration of renal insufficiency of 2.2 +/- 1.6 years. There were no significant differences between siblings with respect to intraoperative crystalloid and colloid fluid administration, duration of anesthesia, intra operative mannitol and furosemide administration, and postoperative laboratory values (P>.05). Conslusions: In conclusion, the 6 sibling pairs who underwent liver transplant and 4 sibling pairs who underwent kidney transplant in our cohort had similar perioperative characteristics.Item Anesthesia Management of a Deceased Cadaveric-Donor Combined Liver and Kidney Transplant for Primary Hyperoxaluria Type 1: Report of a Case(2015) Ersoy, Zeynep; Araz, Coskun; Kirnap, Mahir; Zeyneloglu, Pinar; Torgay, Adnan; Arslan, Gulnaz; 0000-0003-2312-9942; 0000-0003-0767-1088; 0000-0002-6829-3300; 0000-0002-4927-6660; 26640925; AAH-9198-2019; C-3736-2018; AAF-3066-2021; AAJ-5221-2021; AAJ-4576-2021Primary hyperoxaluria type 1 is an autosomal recessive disorder that is responsible for the overproduction of oxalate and has an incidence of 1 in 120 000 live births. Indications for combined liver and kidney transplant are still debated. However, combined liver and kidney transplant is preferred in various conditions, including primary hyperoxaluria, liver-based metabolic abnormalities affecting the kidney, and structural diseases affecting both the liver and the kidney, such as congenital hepatic fibrosis and polycystic kidney disease. When compared with sequential liver and kidney transplant, the rejection rate of both liver and kidney allografts was reported to be lower than with combined liver and kidney transplant. With proper anesthesia management, the probable increased complications with combined liver and kidney transplant can be prevented. In this report, we present the anesthesia care of a 22-year-old patient with primary hyperoxaluria type 1 who had deceased-donor combined liver and kidney transplant.