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Öğe Aborted donor hepatectomy in living donor liver transplantation: lessons learned(Sa Medical Assoc, 2020) Kutluturk, K.; Akbulut, S.; Baskiran, A.; Gonultas, F.; Dirican, A.; Isik, B.; Yilmaz, S.Background: Aborted donor hepatectomy (ADH) during any stage of living donor hepatectomy (LDH) is a rare event. We describe our experience and discuss the lessons from these events. Methods: From September 2005 to January 2019, 77 of 2 031 (3.79%) LDH were aborted at various stages of surgical procedure due to donor or recipient related reasons. Demographic and clinical data of aborted donor candidates and the clinical course of their potential recipients were analysed. Results: LDH of 77 donor candidates was aborted due to donor (n = 53) or recipient (n = 24) related reasons. The most common donor related reason was the quality of liver parenchyma (n = 31). The most common recipient related reason was haemodynamic instability (n = 11). Twenty-three recipients underwent either living donor liver transplantation (LDLT) (n = 21) or deceased donor liver transplantation (DDLT) (n = 2) at a median of 6 days following ADH. In one aborted due to a donor reason and two aborted for recipient reasons, LDLT was performed using the same donor candidates. Thirty-six recipients had no liver transplantation (LT) and died a median of 17.5 days following ADH. Conclusions: We believe that ADH will decrease with experience and meticulous preoperative clinical and radiological evaluations. Abandoning the donor hepatectomy is always a valid option at any stage of the surgery when the unexpected is encountered.Öğe Analysis of risk factors affecting the development of infection in artificial vascular grafts used for reconstruction of middle hepatic vein tributaries in LDLT(LIPPINCOTT WILLIAMS & WILKINS, TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA, 2018) Koç, C.; Akbulut, S.; Işık, B.; Yoloğlu, S; Yılmaz, S.Öğe Analysis of risk factors affecting the development of infection in artificial vascular grafts used for reconstruction of middle hepatic vein tributaries in LDLT(Lippincott Williams & Wilkins, 2018) Koc, C.; Akbulut, S.; Isik, B.; Yologlu, S.; Yilmaz, S.[Abstract Not Available]Öğe Chronic Graft-Versus-Host Disease After Liver Transplantation: A Case Report(Elsevier Science Inc, 2012) Yilmaz, M.; Ozdemir, F.; Akbulut, S.; Ersan, V.; Koc, C.; Koc, S.; Yilmaz, S.Graft-versus-host disease (GVHD) after orthotopic liver transplantation pun is a rare but significant complication, occuring in 1%-2% of cases with a mortality rate of 85%-90%. It occurs when donor passenger lymphocytes mount an alloreactive response against the host's histocompatibility antigens. It presents as fever, rash, and diarrhea with or without pancytopenia. Between March 2002 and September 2011, among 656 OLT patients 1 (0.15%) had acute GVHD. A biopsy at the 7th posttransplantation month revealed chronic GVHD. Consequently, in the cases that had fever, rash, and/or desquamation of the any part of body after liver transplantation, GVHD must be considered and skin biopsies must be planned for the diagnosis.Öğe Circumferential Fence With the Use of Polyethylene Terephthalate (Dacron) Vascular Graft for All-in-One Hepatic Venous Reconstruction in Right-Lobe Living-Donor Liver Transplantation(Elsevier Science Inc, 2015) Ara, C.; Akbulut, S.; Ince, V.; Aydin, C.; Gonultas, F.; Kayaalp, C.; Unal, B.Integration of hepatic vein tributaries with a diameter >= 5 mm into the drainage system in right-lobe living-donor liver transplantation (LDLT) is of vital importance for graft function. Recently, the most commonly emphasized hepatic venous reconstruction model is the all-in-one reconstruction model. In the final stage of this model that aims to form a common large opening, allogeneic vascular grafts are almost always used to construct a circumferential fence. To date, no other study has reported the use of polyethylene terephthalate (Dacron) vascular graft as a circumferential fence in LDLT. We aimed to present the 1st 4 cases of circumferential fences created with Dacron vascular graft. Four right-lobe grafts weighing 522-1,040 g were used. A polytetrafluoroethylene vascular graft was used for the integration of segment 5 vein and segment 8 vein into the drainage model, whereas a Dacron graft was used to creating a circumferential fence. The patency of hepatic outflow evaluated with the use of multi-detector computerized tomography at postoperative day 7. Venous outflow obstruction was not detected in any cases. This study suggested that owing to its flexible structure the polyethylene terephthalate vascular graft can be an alternative to allogeneic vascular grafts in forming circumferential fence.Öğe Comment on: Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial(Oxford Univ Press, 2020) Akbulut, S.; Sahin, T. T.; Yilmaz, S.[Abstract Not Available]Öğe Comparison of standard and modified standart organ procurement technique for deceased donors(Lippincott Williams & Wilkins, 2018) Koc, C.; Akbulut, S.; Yilmaz, S.[Abstract Not Available]Öğe Comparison of standard and modified standart organ procurement technique for deceased donors(LIPPINCOTT WILLIAMS & WILKINS, TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA, 2018) Koç, C.; Akbulut, S.; Yılmaz, S.Öğe Early Hepatic Artery Thrombosis After Pediatric Living Donor Liver Transplantation(Elsevier Science Inc, 2019) Kutluturk, K.; Sahin, T. T.; Karakas, S.; Unal, B.; Bag, H. G. Gozukara; Akbulut, S.; Aydin, C.Aim. Hepatic artery thrombosis is one of the major complications affecting patient and graft survival after liver transplantation. In this study, we analyzed the factors affecting the development of early hepatic artery thrombosis (eHAT) and its outcomes in pediatric liver transplantation. Methods. A total of 175 pediatric patients underwent living donor liver transplantation between January 2013 and November 2018. Factors affecting eHAT and its outcomes were examined. Results. Nine patients (5.1%) developed eHAT. In multivariate analysis, intraoperative hepatic artery revision and Roux-en-Y hepaticojejunostomy biliary reconstruction type were statistically significant (all, P < .05). Thrombectomy and reanastomosis was performed in 5 patients. Two of them were successful. In total, 3 retransplantations were performed and all of those patients are still alive. Conclusion. The factors affecting eHAT are still a matter of debate. Intraoperative hepatic artery anastomosis revision and Roux-en-Y hepaticojejunostomy reconstruction were independent risk factors for development of eHAT. In the present study, the confidence interval of the variables is high, therefore exact determination of the risk factors may not be possible. Early detection and thrombectomy and reanastomosis may be the first treatment of choice to rescue the patient and graft. When it fails, retransplantation must be an alternative. The results of the present study state that at least once a day the vascular anastomosis must be examined by Doppler ultrasonography in the post-transplant first week. It must be repeated when liver enzymes increase. The patients under high risk for eHAT may be followed up closer.Öğe Ectopic bone formation in thyroid gland: report of sixteen cases and comprehensive literature review(Verduci Publisher, 2023) Sogutcu, N.; Akbulut, S.; Sari, A.; Yavuz, R.; Yagmur, Y.; Colak, C.- OBJECTIVE: This study aimed to analyze the outcomes of patients with ectopic bone formation (EBF) diagnosed in thyroidecto-my specimen.PATIENTS AND METHODS: We retrospec-tively analyzed the data of 16 patients who un-derwent thyroidectomy between February 2009 and June 2018 and whose pathology examina-tion diagnosed EBF. RESULTS: Fourteen patients underwent bilat-eral total thyroidectomy (BTT), one patient re-quired BTT with central lymph node dissection, and one patient was subjected to BTT with func-tional lymph node dissection. On histopatholog-ical examination, left lobe EBF was diagnosed in four patients; left lobe EBF with bilateral pap-illary thyroid carcinoma (PTC) in two; left lobe EBF with left lobe PTC in one; left lobe EBF with left follicular adenoma in one; left lobe EBF with right lobe papillary thyroid microcarcinoma in one; bilateral EBF in one; right lobe EBF with ex-tramedullary hematopoiesis in one; right lobe EBF in three; right lobe EBF with right lobe med-ullary thyroid carcinoma in one, and right lobe EBF with bilateral lymphocytic thyroiditis in one. One of the five patients who underwent bone marrow biopsy was diagnosed with myelopro-liferative dysplasia, and another with polycythe-mia vera. Three patients were treated medically for anemia because no other pathological find-ings could be observed.CONCLUSIONS: There is a lack of literature data about the clinical significance of EBF in the thyroid gland in cases with no concomitant he-matological diseases. People who have been di-agnosed with EBF in the thyroid gland should be checked for hematological diseases.Öğe Effect of a honey and arginine-glutamine-hydroxymethylbutyrate mixture on the healing of colon anastomosis in rats immunosuppressed with tacrolimus(Taylor & Francis Ltd, 2019) Akbulut, S.; Dogan, Z.; Baskiran, A.; Elbe, H.; Turkoz, Y.We compared the effect of honey and a mixture of arginine-glutamine-hydroxymethylbutyrate (AGHMB) on healing of a descending colon anastomosis in rats that were immunosuppressed with tacrolimus (Tac). Sprague-Dawley rats were divided into four groups: untreated control, Tac, Tac + honey and Tac + AGHMB. Colon resection and anastomosis were performed on day 14 and re-laparotomy was performed on the day 21 of the study. Anastomotic bursting pressure, macroscopic adhesion score, weekly body weight changes, histopathological features and immunohistochemical staining of TGF-beta 1 were determined for all groups. We found no significant difference in anastomotic bursting pressure among the experimental groups. We found significant weekly increases in body weight for the Tac + honey group. We found no significant difference in the weekly body weight measurements for the Tac + AGHMB group. We found significant increases in TGF-beta 1 expression in the Tac + honey group compared to the control and Tac groups. No significant differences in inflammatory cell infiltration, fibroblast proliferation or collagen deposition were found between the Tac + honey and Tac + AGHMB groups; however, a significant difference in neovascularization between these groups was found. Neovascularization in the Tac + honey group was significantly greater than for the Tac + AGHMB group. We found that both honey and the AGHMB mixture were beneficial for anastomotic wound healing in rats that were immunosuppressed using Tac.Öğe Effect of ursodeoxycholic acid on liver regeneration capacity after living donor hepatectomy: a prospective, randomized, double-blind clinical trial(Verduci Publisher, 2023) Aloun, A.; Akbulut, S.; Garzali, I. J.; Gonultas, F.; Baskiran, A.; Hargura, A. S.; Colak, C.- OBJECTIVE: Ursodeoxycholic acid (UDCA) has multiple hepatoprotective ac-tivities: it modifies the bile acid pool, decreas-es levels of endogenous, hydrophobic bile ac-ids while increasing the proportion of nontoxic hydrophilic bile acids. It also has cytoprotective, antiapoptotic, and immunomodulatory proper-ties. The aim of this study was to analyze the ef-fect of postoperative administration of UDCA on liver regeneration capacity.PATIENTS AND METHODS: This is a sin-gle-center, prospective, randomized, dou-ble-blind study that was carried out in our Liv-er transplant Institute. Sixty living liver donors (LLDs) who underwent right lobe living donor hepatectomy were divided into two groups us-ing computer-generated random numbers: one group received oral UDCA 500 mg 12 hourly for 7 days (UDCA group; n=30) from the first postop-erative day (POD) and the other did not receive UDCA (non-UDCA group; n=30). Both groups were compared in terms of the following param-eters: clinical and demographic parameters, liv-er enzymes (ALT, AST, ALP, GGT, total bilirubin, direct Bilirubin), and INR. RESULTS: The median ages in the UDCA and non-UDCA were 31 years (95% CI for median: 26-38) and 24 years (95% CI for median: 23-29), respectively. Liver function tests showed signif-icant differences at various times within the first seven PODs. The INR was lower in UDCA group patients on POD3 and POD4. However, GGT was significantly lower on POD6 and POD7 for the UDCA group. Total bilirubin was also significant-ly lower on POD3 for the UDCA group patients, but ALP was lower all from POD1 to POD7. A sig-nificant difference was also observed in AST on POD3, POD5 and POD6. CONCLUSIONS: Postoperative administra-tion of oral UDCA significantly improves liver function tests and INR among LLDs.Öğe Endovascular Approach to Giant Splenic Artery Aneurysm after Liver Transplantation(Lippincott Williams & Wilkins, 2017) Akbulut, S.; Kutlu, R.; Kolu, M.; Karipkiz, Y.; Yilmaz, S.[Abstract Not Available]Öğe Evaluation of Blood Thiamine and Pyridoxine Levels in Patients with Chronic Liver Disease: A Prospective Study(Lippincott Williams & Wilkins, 2017) Akbulut, S.; Abbasov, P.; Karakas, S.; Yilmaz, S.[Abstract Not Available]Öğe Evaluation of Morphological and Microbiological Characteristics of Gall Bladder in Living Liver Donors: A Prospective Descriptive Study(Lippincott Williams & Wilkins, 2017) Tolan, K.; Akbulut, S.; Yilmaz, S.[Abstract Not Available]Öğe Factors affecting anxiety, depression, and stress among patients with hepatocellular carcinoma during COVID-19 pandemic(Verduci Publisher, 2023) Akbulut, S.; Tamer, M.; Kucukakcali, Z.; Akyuz, M.; Saritas, H.; Bagci, N.; Ciftci, F.- OBJECTIVE: Patients with chron-ic disease whose treatments are limited may ex-perience depression, anxiety, and stress-related symptoms, as well as an increase in the levels of these conditions. This study aims to determine the factors affecting the depression, stress, and anxiety levels of hepatocellular carcinoma (HCC) patients due to the fear of COVID-19 exposure.PATIENTS AND METHODS: 118 patients with ad-vanced HCC treated with non-transplant treatment options or on the waiting list due to the lack of a do-nor were enrolled. To evaluate the stress, depres-sion, and anxiety levels during the COVID-19 pro-cess, Depression Anxiety Stress Scales (DASS-21) and the Coronavirus Anxiety Scale (CAS) were ad-ministered to 118 patients through a face-to-face interview. Sociodemographic and clinical charac-teristics were recorded, and the primary endpoint measure was the total score of DASS. In addition, the multilayer perceptron (MLP) model was con-structed to predict the scores of the DASS-21 total.RESULTS: There were significant differences be-tween DASS depression (p=0.010; p=0.030) DASS anxiety (p=0.010; p=0.010) and DASS total (p=0.046; p=0.023) scores in terms of gender and protective effect of the vaccine. Also, a significant difference between gender for the CAS scale was determined (p=0.044). The median score of the DASS total in the COVID-19 group was higher than in the non-COVID-19 group; however, the increase was not sig-nificant. MLP model revealed that chronic disease, gender, age, place of residence, smoking, type of vaccine, and COVID-19 exposure were the most im-portant predictors for the DASS total. CONCLUSIONS: Chronic disease, gender, and age were prominent factors in predicting the DASS-21 total score in HCC patients. There-fore, the crucial factors were clinically consid-ered for managing depression, stress, and anxi-ety in HCC patients.Öğe Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging-guided risk assessment in living donor liver transplant patients with postoperative complications: a pilot study(Verduci Publisher, 2021) Kolu, M.; Kahraman, A. S.; Akbulut, S.; Yildirim, I. O.OBJECTIVE: To evaluate whether gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI), the measurements of quantitative and qualitative parameters on hepatobiliary phase images can predict the risk of postoperative complications in patients underwent living donor liver transplantation (LDLT) PATIENTS AND METHODS: We obtained Gd-EOB-DTPA-enhanced 3 Tesla MRI before living donor hepatectomy in donors (donor group: n=30) and after LDLT in their recipients (recipient group; n=30). MRIs were evaluated in terms of quantitative and qualitative variables. Quantitative parameters included relative liver enhancement value, biliary signal intensity value, and muscle signal index value. Qualitative parameters included visual evaluation of the liver and biliary enhancement on hepatobiliary phase images. Patients were followed up for postoperative biliary and vascular complications and divided according to the presence and absence of complications. The relationship between MRI parameters and postoperative complications was statistically analyzed. RESULTS: The mean relative liver enhancement values, mean biliary signal values, and muscle signal index were significantly lower in recipients with postoperative complications than those in donors and recipients without complications (p < 0.001). Visual assessments of liver enhancement and biliary signal were also significantly different in recipients with postoperative complications than that in donors and recipients without complications (p < 0.001). CONCLUSIONS: Quantitative and qualitative MRI parameters obtained by Gd-EOB-DTPA-en- hanced MRI on hepatobiliary phase images may potentially become a reliable tool for the assessment of the risk for postoperative complications after LDLT.Öğe Hepatitis B/D-Related Hepatocellular Carcinoma. A Clinical Literature Review(Springer, 2021) Baskiran, A.; Atay, A.; Baskiran, D. Y.; Akbulut, S.Aim Given the current literature data, this article aims to shed light on the epidemiological and clinical effects of HBV, as well as its impact on the development of hepatocellular carcinoma (HCC). Methods A review of the English language literature based on a MEDLINE (PubMed) database was searched. The keywords were cirrhosis, hepatocellular carcinoma, epidemiology, hepatitis delta virus, hepatitis B virus, and co-infection. All references from retrieved papers were reviewed systematically to find additional collection of reports. Results The study has broadly confirmed the contribution of HDV viremia to liver disease and cirrhosis. However, uncertainty over the mechanism of action on HCC development remains. As the recent data has demonstrated, the HCC-HDV has a unique molecular profile which is distinct from that of HBV-HCC. Conclusion Owing to the dependence of HDV on HBV, it is not clear whether HCC is a consequence of the cumulative effect of both HBV and HDV, an effect of the underlying cirrhosis, or a direct oncogenic effect of HDV. Many questions concerning the oncogenic role of HDV remain unanswered. To better understand the role of HDV in carcinogenesis, studies at the molecular level that consider genotype differences should be increased. Multicenter, high-volume, and prospective studies that compare HBV/HDV co-infected and HBV-infected individuals will be pivotal in determining the oncogenic role of HDV.Öğe Histopathologic Findings of Cholecystectomy Specimens in Patients Who Underwent Donor Hepatectomy for Living Donor Liver Transplantation(Elsevier Science Inc, 2015) Akbulut, S.; Karagul, S.; Ertugrul, I.; Aydin, C.; Yilmaz, M.; Yilmaz, S.Background. The aim of this study was to discuss the macroscopic and microscopic properties of gallbladder specimens obtained from living liver donors. Methods. The study retrospectively analyzed the clinical and histopathological data of 1088 donors who underwent living donor hepatectomy between March 2005 and September 2014 at Inonu University Faculty of Medicine, Liver Transplantation Center. Age, sex, macroscopic, and microscopic properties of the gallbladder (bladder length, diameter, content, and histopathological properties) were recorded by 2 researchers. Results. A total of 1009 donors aged 17 to 66 years (31.1 +/- 9.5) met the inclusion criteria, whereas 79 donors were excluded due to missing data. In total, 587 donors were male (30.5 +/- 9.1 years [16-63 years]) and 422 were female (31.8 +/- 9.8 years [18-66 years]). Preoperative tests revealed Gilbert syndrome in 3 subjects, whereas other donors' biochemical tests were within normal ranges. The macroscopic examination of gallbladders revealed mean gallbladder wall thickness, length, and width of 1.82 +/- 0.8 mm (1-10 mm), 72 +/- 11.4 mm (40-120 mm), and 52.5 +/- 14 mm (15-90 mm), respectively. The microscopic gallbladder examination showed that 740 donors had a normal gallbladder, 193 had chronic cholecystitis (1 donor had antral metaplasia and 1 had intestinal metaplasia), 40 had cholesterolosis (1 donor had both tubular adenoma and intestinal metaplasia), 15 had minimal chronic cholecystitis (1 donor had pyloric metaplasia), 14 had cholelithiasis, 2 had adenomyosis, 2 had muscular hypertrophy, 1 had papillary hyperplasia, 1 had microdiverticulitis, and 1 had mucosal lymphatic ectasia. Conclusion. The results of this study reflect the actual gallbladder pathologies that can be detected in healthy people. Clearer conclusions can be reached about the epidemiological data on gallbladder as the number of living liver donors increases in the future.Öğe How should we approach to incidentally detected neuroendocrine tumor during living donor hepatectomy?(Lippincott Williams & Wilkins, 2018) Akbulut, S.; Isik, B.; Samdanci, E.; Yilmaz, S.[Abstract Not Available]
