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Öğe Cytoprotective effects of amifostine, ascorbic acid and N-acetylcysteine against methotrexate-induced hepatotoxicity in rats(Baishideng Publishing Group Inc, 2014) Akbulut, Sami; Elbe, Hulya; Eris, Cengiz; Dogan, Zumrut; Toprak, Gulten; Otan, Emrah; Erdemli, ErmanAIM: To investigate the potential role of oxidative stress and the possible therapeutic effects of N-acetyl cysteine (NAC), amifostine (AMF) and ascorbic acid (ASC) in methotrexate (MTX)-induced hepatotoxicity. METHODS: An MTX-induced hepatotoxicity model was established in 44 male Sprague Dawley rats by administration of a single intraperitoneal injection of 20 mg/kg MTX. Eleven of the rats were left untreated (Model group; n = 11), and the remaining rats were treated with a 7-d course of 50 mg/kg per day NAC (MTX + NAC group; n = 11), 50 mg/kg per single dose AMF (MTX + AMF group; n = 11), or 10 mg/kg per day ASC (MTX + ASC group; n = 11). Eleven rats that received no MTX and no treatments served as the negative control group. Structural and functional changes related to MTX- and the various treatments were assessed by histopathological analysis of liver tissues and biochemical assays of malondialdehyde (MDA), superoxide dismutase (SOD), catalase, glutathione (GSH) and xanthine oxidase activities and of serum levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and total bilirubin. RESULTS: Exposure to MTX caused structural and functional hepatotoxicity, as evidenced by significantly worse histopathological scores [median (range) injury score: control group: 1 (0-3) vs 7 (6-9), p = 0.001] and significantly higher MDA activity [409 (352-466) nmol/g vs 455.5 (419-516) nmol/g, p < 0.05]. The extent of MTX-induced perturbation of both parameters was reduced by all three cytoprotective agents, but only the reduction in hepatotoxicity scores reached statistical significance [4 (3-6) for NAC, 4.5 (3-5) for AMF and 6 (5-6) for ASC; p = 0.001, p = 0.001 and p < 0.005 vs model group respectively]. Exposure to MTX also caused a significant reduction in the activities of GSH and SOD antioxidants in liver tissues [control group: 3.02 (2.85-3.43) mu mol/g and 71.78 (61.88-97.81) U/g vs model group: 2.52 (2.07-3.34) mu mol/g and 61.46 (58.27-67.75) U/g, p < 0.05]; however, only the NAC treatment provided significant increases in these antioxidant enzyme activities [3.22 (2.54-3.62) mu mol/g and 69.22 (61.13-100.88) U/g, p < 0.05 and p < 0.01 vs model group respectively]. CONCLUSION: MTX-induced structural and functional damage to hepatic tissues in rats may involve oxidative stress, and cytoprotective agents (NAC > AMF > ASC) may alleviate MTX hepatotoxicity. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.Öğe Effect of autotransfusion system on tumor recurrence and survival in hepatocellular carcinoma patients(Baishideng Publ Grp Co Ltd, 2013) Akbulut, Sami; Kayaalp, Cuneyt; Yilmaz, Mehmet; Ince, Volkan; Ozgor, Dincer; Karabulut, Koray; Eris, CengizAIM: To investigate the therapeutic efficacy and safety of continuous autotransfusion system (CATS) during liver transplantation of hepatocellular carcinoma patients. METHODS: Eighty-three hepatocellular carcinoma (HCC) patients who underwent liver transplantation with intraoperative CATS (n = 24, CATS group) and without (n = 59, non-CATS group) between April 2006 and November 2011 at the Liver Transplant Institute of Inonu University were analyzed retrospectively. Postoperative HCC recurrence was monitored by measuring alpha-fetoprotein (AFP) levels at 3-mo intervals and performing imaging analysis by thoracoabdominal multidetector computed tomography at 6-month intervals. Inter-group differences in recurrence and correlations between demographic, clinical, and pathological data were assessed by ANOVA and chi(2) tests. Overall and disease-free survivals were calculated by the univariate Kaplan-Meier method. RESULTS: Of the 83 liver transplanted HCC patients, 89.2% were male and the overall mean age was 51.3 +/- 8.9 years (range: 18-69 years). The CATS and non-CATS groups showed no statistically significant differences in age, sex ratio, body mass index, underlying disease, donor type, graft-to-recipient weight ratio, Child-Pugh and Model for End-Stage Liver Disease scores, number of tumors, tumor size, AFP level, Milan and University of California San Francisco selection criteria, tumor differentiation, macrovascular invasion, median hospital stay, recurrence rate, recurrence site, or mortality rate. The mean follow-up time of the non-CATS group was 17.9 +/- 12.8 mo, during which systemic metastasis and/or locoregional recurrence developed in 25.4% of the patients. The mean follow-up time for the CATS group was 25.8 +/- 15.1 mo, during which systemic metastasis and/or locoregional recurrence was detected in 29.2% of the patients. There was no significant difference between the CATS and non-CATS groups in recurrence rate or site. Additionally, no significant differences existed between the groups in overall or disease-free survival. CONCLUSION: CATS is a safe procedure and may decrease the risk of tumor recurrence in HCC patients. (c) 2013 Baishideng. All rights reserved.Öğe The Effect of Donor Characteristics on the Survival in Patients Undergone Deceased Donor Liver Transplantation(Wiley-Blackwell, 2012) Yilmaz, Mehmet; Akbulut, Sami; Eris, Cengiz; Karabulut, Koray; Yilmaz, Sezai[Abstract Not Available]Öğe Effects of antioxidant agents against cyclosporine-induced hepatotoxicity(Academic Press Inc Elsevier Science, 2015) Akbulut, Sami; Elbe, Hulya; Eris, Cengiz; Dogan, Zumrut; Toprak, Gulten; Yalcin, Erhan; Otan, EmrahBackground: To investigate the potential protective antioxidant role of ursodeoxycholic acid (UDCA), melatonin, and allopurinol treatment in cyclosporine (CsA)-induced hepatotoxicity. Methods: Hepatotoxicity was established in Sprague-Dawley rats by daily administration of CsA. Treatment groups were additionally administered UDCA, melatonin, or allopurinol treatments. Rats that received no CsA and no treatments served as a control group. Liver samples from each group were examined by histopathologic analysis to determine the effects of CsA treatment on liver morphology. Biochemical assays were also used to determine the effect of CsA treatment on liver function, in the presence or absence of UDCA, melatonin, or allopurinol. Results: CsA treatment induced hepatotoxicity, resulting in sinusoidal dilatation, congestion, infiltration, hydropic degeneration, and loss of glycogen storage in the liver. From a molecular perspective, the CsA treatment increased levels of malondialdehyde (MDA) levels, decreased levels of reduced glutathione and xanthine oxidase, and decreased activities of superoxide dismutase and catalase. The CsA treatment also resulted in decreased serum total antioxidant capacity, whereas alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin levels, and total oxidant status were increased. Treatment with UDCA, melatonin, or allopurinol reduced the CsA-induced histopathologic changes, as compared with CsA-treated samples. In addition, UDCA, melatonin, or allopurinol treatment mitigated the CsA-induced effects on glutathione and MDA levels, and on superoxide dismutase and catalase activities, as well as reduced the CsA-mediated perturbations in serum levels of total antioxidant capacity, total oxidant status, and alkaline phosphatase. Conclusions: UDCA, allopurinol, and melatonin may each help to protect against CsA-induced damage to liver tissues, possibly through effects on the antioxidant system. (C) 2015 Elsevier Inc. All rights reserved.Öğe Is Radiologic and Histopathological Correlation Always Necessary for Hepatosteatosis Assessment in Patients Undergone Donor Hepatectomy?(Wiley-Blackwell, 2012) Yilmaz, Mehmet; Akbulut, Sami; Kutlu, Ramazan; Eris, Cengiz; Yilmaz, Sezai[Abstract Not Available]Öğe Is There an Increased Risk of Tumor Recurrence When Intraoperative Blood Salvage Autotransfusion Used for Liver Transplantation in Patients with Hepatocellular Carcinoma?(Wiley-Blackwell, 2012) Akbulut, Sami; Kayaalp, Cuneyt; Yilmaz, Mehmet; Ozgor, Dincer; Karabulut, Koray; Eris, Cengiz; Toprak, Huseyin Ilksen[Abstract Not Available]Öğe Living Donor Liver Transplantation for Budd Chiari Syndrome(Wiley-Blackwell, 2012) Sakcak, Ibrahim; Akbulut, Sami; Kayaalp, Cuneyt; Eris, Cengiz; Yonder, Huseyin; Yilmaz, Sezai[Abstract Not Available]Öğe Living Donor Liver Transplantation Using the Right Hepatic Lobe without the Right Hepatic Vein: How Was the Drainage Problem Solved?(Wiley-Blackwell, 2012) Yilmaz, Mehmet; Akbulut, Sami; Ozdemir, Fatih; Eris, Cengiz; Kutlu, Ramazan; Kayaalp, Cuneyt; Yilmaz, Sezai[Abstract Not Available]Öğe Living-Donor Liver Transplant Using the Right Hepatic Lobe Without the Right Hepatic Vein: Solving the Drainage Problem(Baskent Univ, 2013) Akbulut, Sami; Yilmaz, Mehmet; Eris, Cengiz; Kutlu, Ramazan; Yilmaz, SezaiAlthough rare, major congenital defects of the hepatic veins are detectable at autopsy, advanced, noninvasive imaging techniques such as Doppler ultrasonography and multislice computed tomography can accurately define these anomalies. One of these anomalies is congenital absence of the main right hepatic vein. We present a 21-year-old woman living-liver donor candidate with congenital absence of the right hepatic vein who underwent an extended right donor hepatectomy. She was tested for transplant compatibility with her 45-year-old brother, who had chronic liver failure secondary to hepatitis B. Multislice computed tomography revealed an absence of the right hepatic vein, and the right hepatic lobe was drained by 4 inferior hepatic veins with diameters ranging from 4 to 8.4 mm. An extended right-donor hepatectomy was performed. A common-large opening drainage reconstruction model that included all of the inferior hepatic veins and middle hepatic vein was created using the saphenous vein and an aortic homograft. There were no postoperative complications related to hepatic venous drainage thanks to the common-large opening model. We demonstrate that a right donor hepatectomy is feasible in congenital absence of the right hepatic vein solving the drainage problem using common-large opening reconstruction technique.Öğe Polycystic liver transplant: a case report(Innovision Communications, 2013) Sakcak, Ibrahim; Olmez, Aydemir; Ozgor, Dincer; Eris, Cengiz; Kayaalp, Cuneyt; Yilmaz, SezaiA liver from a donor with brain death due to a ruptured cerebral aneurysm was transplanted. The liver had multiple bilobar simple cysts; the largest was less than 3 cm in diameter. The noncystic liver volume was greater than 50%, and the liver had neither fibrosis nor venous congestion. The donor surgery was performed in accordance with the standard protocol without rupture of the cysts. The recipient was a 40-year-old man with cirrhosis associated with hepatitis B. The recipient operation was done by using the piggyback method with no complications. Excessive drainage of chylous ascites (10 000 mL/d) started in the first days after surgery and continued, gradually decreasing until the end of the second month. The patient was discharged with no complications at the end of the third month. No growth in the cysts was observed on follow-up computed tomography scans. Excluding this particular case, a total of 7 other patients have received a polycystic liver transplant. In all 7 cases, the fact that the donor had polycystic liver disease was not known but was encountered by coincidence during procurement. The case reported here is the first case where the polycystic liver disease was diagnosed before procurement and the transplant was still carried out. It appears that, if the donor liver has enough healthy noncystic volume, polycystic livers can be transplanted. (C) 2013 NATCO, The Organization for Transplant ProfessionalsÖğe Splenic Artery Transposition Graft Usage for the Supply of the Right Hepatic Artery: A Case Report(Int College Of Surgeons, 2013) Odabasi, Mehmet; Eris, Cengiz; Yildiz, Mehmet Kamil; Abuoglu, Hasan; Akbulut, Sami; Saglam, AbdullahHepatic artery aneurysms are responsible for 12% to 20% of all visceral arterial aneurysms. Because most patients are asymptomatic, this disease is generally diagnosed incidentally during radiologic examination. Aneurysm rupture develops in 14% to 80% of cases, depending on the aneurysmatic segment's diameter and location, as well as other etiologic factors. Mortality rates associated with rupture range between 20% and 70%. Thus, early diagnosis and timely initiation of medical interventions are critical to improve survival rates. Here, we present a male patient, age 69 years, with a hepatic artery aneurysm that was detected incidentally. The 3-cm aneurysm was detected on contrast enhanced computed tomography and extended from the common hepatic artery to the hepatic trifurcation. A laparotomy was performed using a right subcostal incision. After dissection of the hepatoduodenal ligament, the common, right, and left hepatic arteries, as well as the gastroduodenal artery, were suspended separately. Then, the aneurysmatic hepatic artery segment was resected, and the gastroduodenal artery stump was ligated. An end-to-end anastomosis was formed between the left and common hepatic arteries, followed by an end-to-end anastomosis formed between the right hepatic artery and splenic artery using a splenic artery transposition graft. Postoperative follow-up examinations showed that both hepatic arterial circulations were good, and no splenic infraction had developed.
