Başkent Üniversitesi Yayınları

Permanent URI for this communityhttps://hdl.handle.net/11727/13092

Browse

Filters

2008 - 20102

Settings

Author: search.filters.author.Demirhan, Beyhan

Search Results

Now showing 1 - 2 of 2
  • No Thumbnail Available
    Item
    Steroid-Resistant Acute Rejections After Liver Transplant
    (Başkent Üniversitesi, 2010-06) Aydogan, Cem; Haberal, Mehmet; Demirhan, Beyhan; Karakayali, Hamdi; Aktas, Sema; Sevmis, Sinasi
    Objectives: Liver transplant is the definitive treatment for the end-stage liver disease. Although effective immunosuppressants are available, steroid-resistant acute rejection can be encountered. Materials and Methods: Between September 2001 and April 2010, 285 adult and pediatric liver transplant were done on 279 patients from deceased donors and living-related donors at our center. All patients received tacrolimus-based immunosuppressive therapy. Steroids were tapered in 3 months. Liver biopsy was done to confirm acute rejection after vascular or biliary complications had been excluded. High-dose steroids were administered for acute rejections. If there was no response to steroids, acute rejection was defined as steroid-resistant acute rejection. After confirming steroid-resistant acute rejection by a second biopsy, antithymocyte globulin was given to patients until liver functions return to normal level with ganciclovir prophylaxis. Results: Acute rejection was detected in 87 liver transplants (30.5%). Steroid-resistant acute rejections were detected in 12 of 87 patients (7 male, 5 female; 8 pediatric, 4 adult patients; mean age, 16.08 ± 12.1 years) (13.7%). Mean time from transplant to steroid-resistant acute rejection was 73.58 ± 59.24 days (range, 20-181 days). The predominant cause of liver disease before liver transplant in patients who had steroid-resistant acute rejection was fulminant hepatic failure. Steroid-resistant acute rejection therapy was successful in 10 of 12 patients (83.3%). Two patients did not respond to therapy; therefore, they advanced to chronic rejection. Adverse effects due to cytokine release were the most frequently encountered reactions in the early period of antithymocyte globulin treatment. The mean follow-ups after steroid-resistant acute rejection treatment were 38.2 ± 26 months (range, 2-85 months). We did not encounter any serious reaction, serious infection, or long-term adverse effect after antithymocyte globulin treatment. Conclusions: According to our experience, antithymocyte globulin can be considered as a good therapeutic option in steroid-resistant acute rejection with acceptable adverse effects.
  • No Thumbnail Available
    Item
    Pediatric Liver Transplant: Results of a Single Center
    (Başkent Üniversitesi, 2008-03) Haberal, Mehmet; Arslan, Gulnaz; Demirhan, Beyhan; Torgay, Adnan; Yilmaz, Ugur; Moray, Gokhan; Ozcay, Figen; Karakayali, Hamdi; Sevmis, Sinasi
    Objectives: Liver transplant in the pediatric population has become an accepted treatment modality for children with end-stage liver disease. In this study, we analyze our experiences with pediatric liver transplant at our center. Materials and Methods: Since September 2001, 8 deceased-donor and 96 living-donor liver transplants have been done in 101 children (mean age, 6.7 ± 5.5 years; range, 2 months to 17 years). The children’s charts were reviewed retrospectively. Results: Indications for liver transplant were cholestatic liver disease (n=17), biliary atresia (n=24), Wilson’s disease (n=16), fulminant liver failure (n=18), hepatic tumor (n=13), and other (n=13). The median pediatric end-stage liver disease score was 23.1 ± 11.1 (range, –8 to 48). The median follow-up was 24.2 ± 19.4 months (range, 1-77 months). Three children underwent retransplant. The main complications were infections (25.9%) and surgical complications (39.5%) (including biliary complications and vascular problems). The incidence of acute cellular rejection was 42.3%. Sixteen children died during follow-up, and, at the time of this writing, the remaining 85 children (85%) were alive with good graft functioning, showing patient survival rates of 90%, 85%, and 83% at 6, 12, and 36 months, respectively. Conclusions: In conclusion, the overall outcomes of pediatric liver transplantation at our center are quite promising.