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Öğe A case of cardiac cyst hydatid with multiple system involvement(2021) Dogan, Gulec Mert; Dogan, Sait Murat; Tasolar, Sevgi; Okut, Gokalp; Sigirci, Ahmet; Elkiran, Ozlem; Karakurt, CemsitThe larval form of the Echinococcus granulosus causes cystic echinococcosis. The liver and the lungs are the most commonly affected organs. Echinococcosis can also be present in other organs although it is rare. We reported a case with sacral bone, cardiac, lung and liver involvement. Clinical and radiological findings of this unique case were discussed. At the Thoracic Computed On the thoracic computed tomography (CT) scan of a 16-year-old female patient was seen multiple parenchymal and subpleural nodular lesions and a cystic mass in the right ventricular cavity. Echocardiographic examination of the patient also observed on CT. Most cases of cardiac cystic echinococcosis were occurred on adult patients, while only 20 cases were in children. For the 20 reported cases in children, there were 9 cases of cardiac echinococcosis involving left ventricle. Because of the possible complications in the presence of cardiac hydatid cyst, treatment should be surgery.Öğe A case of cardiac cyst hydatid with multiple system involvement(2021) Dogan, Gulec Mert; Dogan, Sait Murat; Tasolar, Sevgi; Okut, Gokalp; Sığırcı, Ahmet; Elkıran, Özlem; Karakurt, CemşitAbstract: The larval form of the Echinococcus granulosus causes cystic echinococcosis. The liver and the lungs are the most commonly affected organs. Echinococcosis can also be present in other organs although it is rare. We reported a case with sacral bone, cardiac, lung and liver involvement. Clinical and radiological findings of this unique case were discussed. At the Thoracic Computed On the thoracic computed tomography (CT) scan of a 16-year-old female patient was seen multiple parenchymal and subpleural nodular lesions and a cystic mass in the right ventricular cavity. Echocardiographic examination of the patient also observed on CT. Most cases of cardiac cystic echinococcosis were occurred on adult patients, while only 20 cases were in children. For the 20 reported cases in children, there were 9 cases of cardiac echinococcosis involving left ventricle. Because of the possible complications in the presence of cardiac hydatid cyst, treatment should be surgery.Öğe A case of cardiac cyst hydatid with multiple systeminvolvement(2021) Dogan, Gulec Mert; Dogan, Sait Murat; Taşolar, Sevgi; Okut, Gokalp; Sığırcı, Ahmet; Elkiran, Ozlem; Karakurt, CemsitThe larval form of the Echinococcus granulosus causes cystic echinococcosis. The liver and the lungs are the most commonlyaffected organs. Echinococcosis can also be present in other organs although it is rare. We reported a case with sacral bone, cardiac,lung and liver involvement. Clinical and radiological findings of this unique case were discussed. At the Thoracic Computed On thethoracic computed tomography (CT) scan of a 16-year-old female patient was seen multiple parenchymal and subpleural nodularlesions and a cystic mass in the right ventricular cavity. Echocardiographic examination of the patient also observed on CT. Mostcases of cardiac cystic echinococcosis were occurred on adult patients, while only 20 cases were in children. For the 20 reportedcases in children, there were 9 cases of cardiac echinococcosis involving left ventricle. Because of the possible complications in thepresence of cardiac hydatid cyst, treatment should be surgery.Öğe The causes of death-censored graft loss among kidney transplant recipients(2024) Ciftci, Felat; Simsek, Arife; Piskin, Turgut; Unal, Bulent; Dogan, Sait Murat; Ulutas, Ozkan; Tabel, YilmazAim: This study presents the causes of death-censored graft loss among kidney transplant recipients. Materials and Methods: Medical records of the patients, who had undergone kidney transplantation at a tertiary center between November 2010 and December 2018, were retrospectively reviewed. Death-censored graft loss was described as an irreversible graft failure signified by return to long-term dialysis (or re-transplantation). Inclusion criteria were: patients who had undergone kidney transplantation, and subsequently lost their first graft, and a follow-up of more than one year after kidney transplantation. Results: Of 269 kidney transplant recipients, 33 recipients with a mean age of 33.54 ± 15.37 years (17 male and 16 female) were included in the study. The rate of death-censored graft loss was 12.26%. Of graft failures, 3.03% occurred in the hyperacute phase, 18.18% in the acute phase, and 78.78% in the chronic phase. Chronic allograft nephropathy was the leading cause of graft failure (48.48%). Other causes were medical problems (18.18), immunological problems (18.18%) and surgical complications (15.15%). Conclusion: Identification of the true causes of graft failure described under the heading chronic allograft nephropathy is noteworthy. Comprehensive biochemical, physiological, pathological, immunological, and genetÖğe Classical Maple Syrup Urine Disease successfully treated with living donor liver transplantation(2021) Dogan, Gulec Mert; Dogan, Sait Murat; Okut, Gokalp; Sigirci, Ahmet; Yilmaz, SezaiMaple syrup urine disease (MSUD) is a disease that causes ketoacid accumulation in body. Diffusion-weighted imaging (DWI) is an important imaging modality for the diagnosis. Two children were diagnosed with MSUD at the neonatal period. They had uncontrolled ketosis and epileptic seizures although they were in compliance with their medical nutrition. Their DWIs were similar and showed high signal intensity localized within the myelinated white matter areas. Both of the patients were treated with living donor liver transplantation. The patients with classic form of MSUD are normal at birth. If the disease is not diagnosed and treated early, it can lead to serious neurological complications. Most researchers conclude that, the best choice for detecting MSUD encephalopathy in newborns is DWI. The traditional treatment of MSUD had been a protein-restricted diet until the liver transplantation became an alternative and better option for the cure of the patients..Öğe Comprehensive Analysis of Long-term Splenic Volume Changes in Pediatric Liver Transplant Patients: Does It Correlate With Adverse Graft Outcomes?(Elsevier Science Inc, 2021) Dogan, Gulec Mert; Dogan, Sait Murat; Okut, Gokalp; Karakas, Serdar; Kutluturk, Koray; Ulubaba, Hilal Er; Sahin, Tevfik TolgaObjectives. Splenomegaly and hypersplenism caused by liver failure increase the mortality and morbidity of patients even after liver transplantation if they do not regress. We evaluated the relation of splenic volume change and transplanted liver function. Material and Methods. A total of 59 of 207 pediatric patients who had liver transplantation between 2013 and 2018 in our institute were evaluated. The relation of spleen volume changes (splenic volume to standard splenic volume ratio [SV/SSV]) were measured at 0, 1, 6, 12, 24, and 36 months of follow-up by constructing electronic three-dimensional structure of the spleen at dynamic computed tomography (CT), and the course of liver functions were evaluated. Results. The SV/SSV ratio decreases in the first postoperative 6 months. After 6 months, SV increases and SV/SSV increases gradually. In a normal functioning graft, SV/SSV significantly decreased in all time points (P < .001). In patients with adverse events, SV/SSV started to increase after 6 months. In patients with fulminant hepatic failure, SV/SSV started to increase after postoperative 6 months. Adverse events in patients with fulminant hepatic failure were more than the patients with chronic liver disease (58% vs 28%). There was an inverse correlation between SV/SSV and thrombocyte levels (P < .001). Conclusions. SV/SSV seems to be correlated to the adverse events (ie, rejection). Together with thrombocyte levels, it can be used as a noninvasive test for follow-up of transplant patients in terms of adverse events in graft function.Öğe Genitourinary Cancers Following Kidney Transplant: Our 20 Years of Experience With Mechanistic Target of Rapamycin Inhibitors(Baskent Univ, 2022) Karatas, Murat; Okut, Gokalp; Simsek, Cenk; Dogan, Sait Murat; Zengel, Baha; Alkan, Funda Tasli; Tatar, ErhanObjectives:We investigated patientswithgenitourinary cancer after kidney transplant and the effects of immunosuppression reduction and switching to mechanistic target of rapamycin inhibitors. Materials and Methods: We retrospectively evaluated kidney transplant recipients seen at our center between January 2000 and January 2020. Patients with <1 year of follow-up were excluded. Results: Of 827 patients, genitourinary cancer was detected in 11 (1.3%): prostate cancer in 5 patients (45%), renal cell carcinoma in native kidney in 3 (27%), renal cell carcinoma in allograft kidney in 2 (18%), and transitional cell carcinoma of the bladder in 1 (9%). All patients had surgery. Two patients had bone metastasis due to prostate cancer at diagnosis. Two patients had allograft nephrectomy due to de novo renal cell carcinoma. Mean followup and age were 97 +/- 45 months (range, 26-189) and 50 +/- 10.2 years (19% female). After cancer diagnosis, excluding the 2 patients with allograft nephrectomy, immunosuppression was changed in 8 patients (88.8%) (1 patient received the same treatment before and after cancer diagnosis). Six patients received double-drug and 3 received triple-drug protocols. Of 9 patients, 2 were already using mechanistic target of rapamycin inhibitors before cancer diagnosis and 7 were switched: 4 to double-based and 3 to triplebased regimens. Six were switched from tacrolimus. With new treatments, patients showed no progressive kidney failure or rejection (38 +/- 40 mo average follow-up). At last follow-up, mean glomerular filtration rate was 62.8 +/- 34 mL/min/1.72 m2, which was similar to rate at cancer diagnosis (58.9 +/- 24 mL/ min/1.72 m2; P =.78). During follow-up, no patients developed local recurrence of primary tumor or new metastasis, and none showed adverse effects after switch to mechanistic target of rapamycin inhibitors. Three patients died of malignancy-unrelated reasons (ileus, urinary sepsis, heart failure). Conclusions: Mechanistictarget of rapamycin inhibitorbased drugs can be an important maintenance immunosuppressive treatment option for kidney transplant recipients with genitourinary cancers.Öğe Living Donor Kidney Transplantation: Why Potential Donors and Recipients do not Achieve it. Malatya Algorithm(Asoc Regional Dialisis Trasplantes Renales, 2020) Simsek, Arife; Dogan, Sait Murat; Gurbu, Huseyin; Ulutas, Ozkan; Toplu, Sibel; Turgut, Asli; Yildirim, Ismail OkanIntroduction: In some countries, organ donation is not widespread enough due to medical, cultural, ethical and socioeconomic factors. Living-donor kidney transplant constitutes the main source of kidney donation. Aim: To evaluate the causes of cancellation of living-donor kidney transplant and improve the effectiveness of transplant programs. Methods: Medical records of possible donors and recipients who were evaluated for living-donor kidney transplant at a tertiary medical center between November 2010 and September 2019 were reviewed retrospectively. Results: Evaluations were performed on 364 potential donors and 338 living-donor kidney transplant recipients; 207 of the latter (61.24%) underwent living-donor kidney transplant. Immune disorders represented the majority of cancellations (38.84%). Fifty-six donors (15.38%) were rejected mainly due to renal disorders (39%). Conclusion: Timely referral of patients to transplant centers must be guaranteed in order to overcome immune problems. Transplant centers should invest in programs adequate both for their resources and for their patients: paired kidney exchange, desensitization protocols, future research, etc.Öğe Living Donor Versus Deceased Donor Liver Transplantation for HCC(Springer, 2020) Dogan, Sait Murat; Kutluturk, KorayIntroduction Liver transplantation is the definitive treatment modality of the patients having an end-stage liver disease with hepatocellular carcinoma. Discussion The number of living donor liver transplantations has been increased because of the deceased donor organ shortage, especially in Asian countries. Conclusion Reports of different clinics about the postoperative course and tumor recurrence rates comparing living donor versus deceased donor liver transplantations, besides patient selection criteria, are reviewed along with our clinic's experiences.Öğe Outcomes of 6 Human Leukocyte Antigen-Mismatched Living Donor Kidney Transplant: A Study With Biopsy Amendment(Baskent Univ, 2022) Karatas, Murat; Okut, Gokalp; Simsek, Cenk; Dogan, Sait Murat; Tatar, Erhan; Uslu, AdamObjectives: In this study, we examined the graft and patient survival outcomes in patients with end-stage kidney disease who received 6 HLA-mismatched incompatible living donor kidney transplant. Materials and Methods: Patients who underwent living donor kidney transplant between January 2010 and March 2020 were evaluated retrospectively. Group A included kidney transplant recipients with 6 HLA mismatches, and group B included kidney transplant recipients with 0 to 5 HLA mismatches. Patients with <1 year of follow-up were excluded. All rejection episodes were diagnosed via Tru-Cut biopsy and histopathological evaluation. Results: There were 15 patients in group A and 176 patients in group B. The mean follow-up was 54.1 +/- 30 months. The number of patients who underwent pretransplant immune desensitization and received tacrolimus-based triple maintenance immunosuppression therapy was significantly higher in group A. In group A, there were 13 acute rejections seen in 9 patients (81%); in group B, there were 67 acute rejections seen in 51 patients (28.9%; P =.019). No differences were observed between the groups in terms of baseline glomerular filtration rate (60 +/- 16 vs 61.6 +/- 20 mL/min/1.72 m(2); P =.76), final control glomerular filtration rate (60.7 +/- 15 vs 58 +/- 19 mL/ min/1.72 m(2); P =.59), graft loss (0% vs 4%; P =.94), and mortality (6.6% vs 3%; P =.39). Conclusions: The presence of 6 HLA mismatches was associated with higher rates of biopsy-proven acute rejection. However, 6 HLA-mismatched incompatible living donor kidney transplant can be safely performed in centers where posttransplant followup is supported by indication and protocol biopsies and where there is a pathological infrastructure with extensive knowledge and experience.Öğe Splenic Artery Transposition for Hepatic Artery Reconstruction During Liver Transplantation: Is It the Best Choice for Adequate Arterial Inflow in Extraordinary Conditions?(Lippincott Williams & Wilkins, 2021) Yilmaz, Sezai; Akbulut, Sami; Kutluturk, Koray; Dogan, Sait Murat; Baskiran, Adil; Ersan, Veysel; Koc, Cemalettin[Abstract Not Available]Öğe Surgical complications after pediatric kidney transplantation; Single center experience(2021) Okut, Gokalp; Gulec, Mert Dogan; Dogan, Sait MuratAbstract: Aim: Kidney transplantation is the most effective treatment for end stage renal disease in all age groups. In this study, we analyzed our surgical complications after pediatric kidney transplantation. Materials and Methods: The data of pediatric patients who underwent kidney transplantation in our center between April 2009 and April 2019 were retrospectively analyzed. We divided the complications of the patients requiring secondary surgery into two groups as early and late according to their appearance in the first week and after. Wound problems, local or systemic infections, incisional hernias were not included in the surgical complication group. Results: Among the 27 pediatric kidney transplant procedures performed in our center, there were 11 surgical complications (6% early and 5 late complications) (40%). 4 of the complications in the early transplant period were due to bleeding, 1 was due to the torsion of the vascular structures belonging to the graft, and 1 was due to lymphocele development. Three of the late complications were ureteral stenosis, and two were due to vesicoreteral reflux to the transplant kidney. In our study group, there was no patient loss due to transplantation. Graft loss was not related to surgical complication in any patient. Conclusion: Pediatric kidney transplantation is a procedure that can be safely performed in our center, by looking at our patient and graft survival results and low surgical complications. Immediate identification and treatment of any complications are critical to the graft and patient survival.
