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    Alpha-fetoprotein and albumin inversely relate to each other and to tumor parameters in patients with hepatocellular carcinoma
    (Kare Publ, 2024) Carr, Brian; Guerra, Vito; Ince, Volkan; Isik, Burak; Yilmaz, Sezai
    Background and Aim: Alpha-fetoprotein (AFP), an oncofetal protein and biomarker in hepatocellular carcinoma (HCC), has unclear roles and ac-tions.To evaluate the relationships between AFP, liver function tests, and HCC aggressiveness. Materials and Methods: A retrospective analysis of an HCC patient data-base was conducted to examine the relationships between baseline serum AFP values, liver function tests, and tumor characteristics. Results: Statistically significant positive trends were observed between AFP levels and both AST and bilirubin, along with negative trends between AFP and albumin. Significant correlations were also found between AFP and MTD, multifocality, and PVT. Increases in MTD, multifocality, and PVT were noted even at low AFP levels, indicating both AFP-independent and AFP-dependent processes. However, these parameter changes were minimal compared to the substantial changes in AFP levels. Relationships between AFP-related liver and tumor characteristics were found to be sim-ilar but inverse to those for albumin, with normal albumin levels associated with more favorable tumor characteristics. Additionally, serum levels of albumin and AFP were inversely related. Conclusion: AFP and albumin levels significantly, but inversely, correlate with tumor parameters, suggesting that albumin may suppress HCC func-tions and could serve as a potential prognostic marker.
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    Characteristics of HCC Patients with Portal Vein Thrombosis: Albumin and Survival
    (Karger, 2025) Carr, Brian; Donghia, Rossella; Yilmaz, Sezai
    Introduction: Presence of macroscopic portal vein thrombosis (PVT) in patients with hepatocellular carcinoma (HCC) has been found to be a major poor prognosis characteristic. Aims: The aim of the study was to examine patients with PVT for their clinical characteristics and factors related to both PVT and survival. Methods: A large HCC database containing 1,094 patients with PVT and 2,513 patients without PVT was examined. Patients had routine baseline serum liver parameters and alpha-fetoprotein (AFP) levels measured, as well as radiological assessment of maximum tumor diameter (MTD), tumor number, presence of macroscopic PVT, plus survival. Results: The percent of patients with PVT increased with increase in both MTD and serum AFP levels and liver parameter levels were worse in patients with PVT than without it. A logistic regression model showed that the combination of MTD >5 cm plus AFP >100 IU/mL plus albumin <3.5 g/dL had an odds ratio of 10.988 for the presence of PVT. Normal serum albumin levels significantly reduced the hazard ratio for death in a Cox proportional hazard model and were associated with decreased liver failure. Conclusion: Logistic regression showed the significance of MTD, AFP, and albumin in the presence of PVT, and the Cox model highlighted the importance of albumin levels in decreasing death.
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    LIVING DONOR LIVER TRANSPLANTATION FOR HEPATIC EPITHELIOID HEMANGIOENDOTHELIOMA: SINGLE CENTER EXPERIENCE
    (2023) Ersan, Veysel; Ince, Volkan; Usta, Sertaç; Barut, Bora; Samdancı, Emine; Carr, Brian; Yılmaz, Sezai
    Introduction: Hepatic epithelioid hemangioendothelioma (HEHE) is a rare malignant vascular tumor of the liver. Liver transplantation (LT) is the treatment of choice for patients with advanced-stage HEHE. The aim of this study is to present the results of HEHE patients treated with living donor LT. Material and Method : Between March 2002 and December 2021, 3121 liver transplantations were performed at our institute, 2632 of these were living donor LT. Demographic characteristics, symptoms and clinical findings, laboratory, radiological, and posttransplant histopathological examinations, recurrence rates, disease-free survival, and overall survival rates of the patients were analyzed. Results: The mean age was 41.7 years and %57.6 of the patients were women. Five patients were referred to our institute with signs of chronic liver failure. Four of these patients (57.1%) had Budd-Chiari syndrome. The median follow-up was 35.0 (12.8 - 119.4) months. In all patients, the tumor recurrence rate after transplantation was 71.4%. The overall survival rate for 1 and 5 years was 100 – 57.1% and the disease free survival rate for 1 and 5 years was 71.4 - 38.1%, respectively. Conclusion: Living donor liver transplantation can be considered a viable treatment option for selected HEHE patients. However, multicenter collaborations are crucial to enhance our understanding of this rare malignancy and improve treatment outcomes for these patients.
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    A Recipient and Donor Both Have COVID-19 Disease. Should We Perform a Liver Transplant?
    (Springer, 2021) Tuncer, Adem; Akbulut, Sami; Baskiran, Adil; Karakas, Ezgi Erdal; Baskiran, Deniz Yavuz; Carr, Brian; Yilmaz, Sezai
    Coronavirus 2019 (COVID-19) is a new infectious disease that continues to spread globally. There is growing concern about donor-induced transmission of Coronavirus 2 (SARS -CoV-2). For liver transplantation, the COVID-19 PCR test is routine, in addition to epidemiological history and clinical and radiological examination 24-48 h before surgery. One of the liver transplant candidates was found to be infected with COVID-19, as well as the planned donor candidate. Since COVID-19 will be a high-risk operation for both the recipient and the donor, the operation was postponed by giving medical treatment. After the treatment and quarantine process was over, the patient and the donor then had a negative COVID-19 PCR test and the patient received a living donor liver transplant. We present a case of donor and recipient who initially both tested positive for COVID-19. This liver transplantation scenario has not previously been reported in the literature.