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Item Virtual contrast enhancement for CT scans of abdomen and pelvis(2022) Liu, Jingya; Tian, Yingli; Duzgol, Cihan; Akin, Oguz; Agildere, A. Muhtesem; Haberal, K. Murat; Coskun, Mehmet; 0000-0002-8211-4065; 35914340; R-9398-2019Contrast agents are commonly used to highlight blood vessels, organs, and other structures in magnetic resonance imaging (MRI) and computed tomography (CT) scans. However, these agents may cause allergic reactions or nephrotoxicity, limiting their use in patients with kidney dysfunctions. In this paper, we propose a generative adversarial network (GAN) based framework to automatically synthesize contrast-enhanced CTs directly from the non-contrast CTs in the abdomen and pelvis region. The respiratory and peristaltic motion can affect the pixel-level mapping of contrast-enhanced learning, which makes this task more challenging than other body parts. A perceptual loss is introduced to compare high-level semantic differences of the enhancement areas between the virtual contrast-enhanced and actual contrast-enhanced CT images. Furthermore, to accurately synthesize the intensity details as well as remain texture structures of CT images, a dual-path training schema is proposed to learn the texture and structure features simultaneously. Experiment results on three contrast phases (i.e. arterial, portal, and delayed phase) show the potential to synthesize virtual contrast-enhanced CTs directly from non-contrast CTs of the abdomen and pelvis for clinical evaluation.Item A case of primer angiosarcoma in a young woman: lessons from multi-modality imaging(2022) Coskun, Mehmet; Hasirci, Senem Has; Ozdemir, Handan; Coskun, Mehmet; Sezgin, Atilla; Muderrisoglu, I. Haldun; Sade, Leyla Elif; 0000-0002-7528-3557; X-8540-2019Item 17 Years Of Pediatric Liver Transplantation Experience For Cirrhosis And Hepatocellular Carcinoma(2022) Ozcay, Figen; Sezer, Oya Balci; Sarialioglu, Faik; Boyvat, Fatih; Coskun, Mehmet; Reyhan, Nihan Haberal; Haberal, Mehmet; https://orcid.org/0000-0002-3462-7632; AAJ-8097-2021Item Use of Computed Tomography Volumetry to Assess Liver Weight in Patients With Cirrhosis During Evaluation Before Living-Donor Liver Transplant(2021) Haberal, Kemal Murat; Rahatli, Feride Kural; Turnaoglu, Hale; Ozgun, Gonca; Coskun, Mehmet; 0000-0002-8211-4065; 0000-0002-4226-4034; 0000-0002-0781-0036; 0000-0001-5630-022X; 30398100; R-9398-2019; AAL-9808-2021; AAK-8242-2021; AAM-4120-2021Objectives: Computed tomography liver volumetry has been widely used to detect total and segmental liver volume in living-donor liver transplantation. However, use of this technique to evaluate the cirrhotic liver remains unclear. In this study, we evaluated the accuracy of freehand computed tomography volumetry to assess total liver volume by comparing weights of total hepatectomy specimens in patients with cirrhosis. For our analyses, we considered the density of a cirrhotic liver to be 1.1 kg/L. Materials and Methods: Liver volume was measured using a freehand computed tomography technique in 52 patients with cirrhosis from different causes and who had no solid lesions before transplant. Measurements were made with a 16-slice multidetector computed tomography scanner (Siemens Somatom Sensation 16, Erlangen, Germany). For volumetric measurements, 10-mm-thick slices with 10-mm reconstruction intervals were preferred. Total hepatectomy weights of explant livers and computed tomography volumetry data were compared. Results: We excluded 3 cirrhotic patients with Budd-Chiari syndrome due to wide variations in scatterplot results. In the 49 patients included in the final analyses, average estimated liver volume by computed tomography was 721 +/- 398 mL and actual cirrhotic liver weight was 727.8 +/- 415 g. No significant differences were shown between these measurements. A simple regression analysis used to analyze correlations between estimated liver volume by computed tomography and real cirrhotic liver weight showed correlation of 0.957 (P < .001). When computed tomography liver volumetry as the independent variable and cirrhotic liver weight as dependent variable were considered, regression analyses showed R-2 = 0.915. Conclusions: Freehand computed tomography liver volumetry can be confidently used to evaluate liver volume in cirrhotic liver patients similar to use of this technique to estimate actual weights in normal livers. This technique can also be valuable during pretransplant and liver resection evaluations to ensure a more successful outcome.Item Liver and Kidney Transplant During a 6-Month Period in the COVID-19 Pandemic: A Single-Center Experience(2020) Akdur, Aydincan; Karakaya, Emre; Soy, Ebru H. Ayvazoglu; Karakayali, Feza Yarbug; Yildirim, Sedat; Torgay, Adnan; Sayin, Cihat Burak; Coskun, Mehmet; Moray, Gokhan; Haberal, Mehmet; 0000-0002-1874-947X; 0000-0002-6829-3300; 0000-0002-8726-3369; 0000-0002-0993-9917; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-4879-7974; 0000-0003-2498-7287; 0000-0001-5630-022X; 33143601; AAB-3888-2021; AAJ-5221-2021; AAA-3068-2021; AAC-5566-2019; AAJ-8097-2021; AAF-4610-2019; AAD-5466-2021; AAE-1041-2021; AAM-4120-2021Objectives: With the declaration of COVID-19 as a pandemic, many studies have indicated that elective surgeries should be postponed. However, post-ponement of transplants may cause diseases to get worse and increase the number in wait lists. We believe that, with precautions, transplant does not pose a risk during pandemic. Here, we aimed to evaluate our transplant results, which we safely performed during a 6-month pandemic period. Materials and Methods: Until September 2020, 3140 kidney and 667 liver transplants have been performed in our centers. We evaluated 38 kidney transplants and 9 liver transplants procedures performed during the pandemic (March 1 to September 2, 2020). Recipient and donor candidates were screened for COVID-19 with polymerase chain reaction and thoracic computed tomography. All recipients had routine immunosuppressive protocol. During hospitalization at our COVID-19-free transplant facility, we restricted the interactions during multidisciplinary rounds. Results: During the pandemic, 38 kidney transplants with an average length of hospital stay of 8.1 days were performed. Mean serum creatinine values of recipients were 0.91, 0.86, and 0.74 mg/dL on postoperative days 7, 30, and 90, respectively. During the pandemic, 9 living donor liver transplants (1 adult, 8 pediatric) were performed with an average length of hospital stay of 17.1 days. Mean serum total bilirubin levels were 0.9, 0.5, and 0.4 mg/dL on postoperative days 7, 30, and 90, respectively. Mean serum aspartate aminotransferase levels were 38.1, 28.3, and 22.3 U/L on postoperative days 7, 30, and 90, respectively. All recipients and donors were successfully discharged. Only 1 liver recipient died (on day 55 after discharge as a result of oxalosis-induced heart failure). Conclusions: According to our results, when precautions are taken, transplant does not pose a risk to patients during the pandemic period. We attribute the safety and success shown to our newly developed protocol in response to the COVID-19 pandemic.Item Our Living Donor Protocol for Liver Transplant: A Single-Center Experience(2020) Karakaya, Emre; Akdur, Aydincan; Soy, Ebru H. Ayvazoglu; Harman, Ali; Coskun, Mehmet; Haberal, Mehmet; 0000-0002-0993-9917; 0000-0002-4879-7974; 0000-0002-3462-7632; 0000-0002-8726-3369; 0000-0001-5630-022X; 33187462; K-9824-2013; AAC-5566-2019; AAD-5466-2021; AAJ-8097-2021; AAA-3068-2021; AAM-4120-2021Objectives: The shortage of deceased donor organs is a limiting factor in transplant. The growing discrepancy between the wait list demand versus the supply of deceased donor organs has created an incentive for consideration of living donor liver transplant as an alternative. Here, we describe our evaluation process and donor complications. Materials and Methods: Since 1988, we have performed 659 (449 living donor and 210 deceased donor) liver transplants. The most important evaluation criteria is the relationship between donor and recipient, and we require that the donor must be related to the recipient. The evaluation protocol has 5 stages. Donor complications were defined as simple, moderate, and severe. Results: We retrospectively investigated data for 1387 candidates, and 938 (67.7%) were rejected; subsequently, 449 living donor liver transplants were performed. There were no complications in 398 of the donors (88.7%). Total complication rate was 11.3%. Simple complications were seen in 31 patients (6.9%). Moderate complications were seen in 19 patients (4.2%). We had only 1 severe complication, ie, organ failure from unspecified liver necrosis, which resulted in death. Conclusions: The relationship between donor and recipient and donor safety should be the primary focus for living donor liver transplant. Donor selection should be made carefully to minimize complications and provide adequately functional grafts.Item LONG-TERM FOLLOW UP OF THE ORTHOPIC RENAL TRANSPLANT CASE WITH SPLENORENAL ANASTOMOSIS(2020) Soy, Ebru H. Ayvazoglu; Bovyat, Fatih; Coskun, Mehmet; Sezgin, Atilla; Haberal, Mehmet A.Item Massive portal venous gas detected by ultrasound of a pediatric patient after liver transplantation(2019) Uslu, Nihal; Soy, Ebru H. Ayvazoglu; Coskun, Mehmet; Moray, Gokhan; haberal, Mehmet; 0000-0002-0993-9917; AAC-5566-2019; ABC-5258-2020Item Effect of Right Posterior Bile Duct Anatomy on Biliary Complications in Patients Undergoing Right Lobe Living Donor Liver Transplant(2019) Tezcaner, Tugan; Dinc, Nadire; Karakayali, Feza Y.; Kirnap, Mahir; Coskun, Mehmet; Moray, Gokhan; Haberal, Mehmet; 28128721Objectives: Our aim was to evaluate the influence of the localization of right posterior bile duct anatomy relative to portal vein of the donors on posttransplant bile duct complications. Materials and Methods:We retrospectively investigated 141 patients who had undergone living donor liver transplant using right hemiliver grafts. The patients were classified based on the pattern of the right posterior bile duct and divided into infraportal and supraportal types. Clinical donor and recipient risk factors and surgical outcomes were compared for their relationship with biliary complications using logistic regression analyses. Results: The 2 groups were similar according to demographic and clinical features. The biliary complication rate was 23.7% (9/38) in the infraportal group and 47.4% (37/78) in the supraportal group (P = .014). An analysis of risk factors for the development of anastomotic bile leak using logistic regression showed that a supraportal right posterior bile duct anatomy was a statistically significant positive predictor, with odds ratio of 18.905 (P = .012; confidence interval, 1.922-185.967). The distance of the right posterior bile duct from confluence was significantly lower in patients with biliary complications than in those without (mean of 7.66 vs 0.40 mm; P = .044). According to receiver operating characteristic analyses, the cutoff point for the length of right bile duct to right posterior bile duct from the hepatic confluence was 9.5 mm regarding presence of complications. Conclusions: Factors influencing bile duct anastomosis leakage were supraportal-type donor bile duct anatomy and length of the right main bile duct from biliary confluence. Hepatic arterial complications were similarly a risk factor for biliary strictures. Because of the multiple factors leading to complications in living donor liver transplant, it is challenging to group these patients by operative risk; however, establishing risk models may facilitate the prediction of complications.