Başkent Üniversitesi Yayınları

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Subject: search.filters.subject.Living-donor

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    Right-lobe Liver Transplant From Donors With Gilbert Syndrome
    (Başkent Üniversitesi, 2012-12) Demirbas, Tolga; Akyildiz, Murat; Yuzer, Yildiray; Tokat, Yaman; Yaprak, Onur; Dayangac, Murat; Piskin, Turgut
    Objectives: Donor safety is one of the most important aspects of living-donor liver transplant. The preoperative evaluation of candidates for such transplants essentially starts with serologic and biochemical analyses. However, some potential liver donors with normal liver function test results may have isolated mild hyperbilirubinemia (serum indirect bilirubin level > 20.5 µmol/L [1.2 mg/dL]). Gilbert syndrome is an autosomal recessive condition that is a common cause of nonhemolytic unconjugated hyperbilirubinemia, and its prevalence is 3% to 10% in the healthy US population. Mild hyperbilirubinemia episodes are expected in people with Gilbert syndrome when they are exposed to physical stress, such as operative intervention or low energy intake. The liver morphologic findings of these individuals are normal; however, there is a debate on the use of people with Gilbert syndrome as living-liver donors. The purpose of this study was to assess the results of right-lobe living-donor hepatectomy of liver donors with Gilbert syndrome. Materials and Methods: Between 2004 and 2010, two hundred twenty-five living-donor liver transplants using right-lobe grafts were performed in our hospital. Donors with Gilbert syndrome were defined as those whose serum bilirubin level was greater than 20.5 µmol/L (1.2 mg/dL). Six of 225 right-lobe living-donor liver transplants were performed using donors with Gilbert syndrome. Results: The median follow-up after transplant was 34 months (range, 18 to 51 mo). One week after the operation, the median bilirubin level for right-lobe liver donors was 34.5 µmol/L (2.02 mg/dL) (range, 17.1 to 51.3 µmol/L [1 to 3 mg/dL]), and the median prothrombin time (international normalized ratio) was 1.36 (range, 1.1 to 1.7). The median bilirubin level of the donors after 6 months was 29 µmol/L (1.7 mg/dL) (range, 20.5 to 41 µmol/L [1.2 to 2.4 mg/dL]). Conclusions: Living-donor liver transplant from Gilbert syndrome donors can be safely performed.
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    Reasons of Preclusion of Living-Related Donor Renal Transplants in Oman
    (Başkent Üniversitesi, 2010-12) Mohsin, Nabil; Metry, Abdelmessih
    Objectives: Renal transplant, especially from genetically related living-donors, is associated with excellent results. The security and free will of the donor are of paramount importance. A significant percentage of such transplants are not accomplished for both medical and nonmedical reasons. Materials and Methods: We looked retrospectively into the causes of nonaccomplishment of renal transplants from living-related donor transplants at our center from January 2006 through June 2008. Results: During this period, 69 and 99 potential renal transplant recipient and donors were investigated. Transplants could be performed only in 35 patients (51%). About 59% of the donors were rejected or declined. Reasons for exclusion were immunologic in 14 donors (14%). Medical and nonmedical conditions precluded donation in 35 donors (35%) and 12 donors (12%). Medical reasons consisted mainly of undiagnosed hypertension, obesity, diabetes mellitus, and renal anomalies. In the recipients, the major reason was option for transplant tourism, occurred in 11 cases (16%). Conclusions: A substantial number of investigated recipients and donors for living-related transplant are not accomplished. The major reasons are medical for the donor and transplant tourism for the recipient.
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    Postoperative Impact of Intraoperative Biochemical Changes at the Completion of Parenchymal Division in Living-Donor Liver Transplantat
    (Başkent Üniversitesi, 2006-12) Jain, Ashok; Orloff, Mark; Abt, Peter; Kashyap, Randeep; Mantry, Parvez; Bozorgzadeh, Adel
    Objectives: Biochemical abnormalities after living-donor hepatectomy are attributed to the loss of liver volume and steatosis or fibrosis. In this study, we evaluated the intraoperative biochemical changes caused by the separation of the hepatic lobes before removal and the impact of those changes on postoperative biochemical abnormalities in patients who underwent adult-to-adult living-donor liver transplantation (LDLT). Materials and Methods: The extent and postoperative impact of the biochemical changes that occur during hepatic parenchymal transection in adult-to-adult LDLT were studied in 38 patients who underwent that procedure (14 men and 24 women; mean age, 39.6 years; age range, 19.5-58.9 years). Preoperative, intraoperative, and postoperative biochemical values for the first 8 postoperative days were compared. Results: The mean total hepatic volume was 1703.0 mL, the mean weight of the resected mass was 887.0 g (52.6%), and the mean weight of the residual mass was 816.0 g (47.4%). The mean total bilirubin, aspartate amino transferase (AST), and amino alanine transferase (ALT) values were 8.6 U/L, 21.4 U/L, and 27.6 U/L, respectively, before surgery, compared with 27.4 U/L (an increase of 3.2 times), 257.9.2 U/L (an increase of 12.0 times), and 224.64 U/L (an increase of 8.1 times), respectively, after separation of the hepatic lobes. Patients (n = 21) with an intraoperative ALT value of >= 200 had a significantly higher peak postoperative ALT (P = .001) than did those (n = 17) with an ALT value of < 200. Conclusions: A significant increase in hepatic biochemical parameters occurs at the completion of hepatic parenchymal transection and before the removal of the right hepatic lobe from the donor. This has an impact on postoperative peak enzyme levels in the donor.