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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 Can an Extended Right Lobe be Harvested from a Donor with Gilbert's Syndrome for Living-Donor Liver Transplantation? Case Report(Elsevier Science Inc, 2012) Yilmaz, M.; Unal, B.; Isik, B.; Ozgor, D.; Piskin, T.; Ersan, V.; Gonultas, F.Gilbert's syndrome (GS) is a common cause of inherited benign unconjugated hyperbilirubinemia that occurs in the absence of overt hemolysis, other liver function test abnormalities, and structural liver disease. GS may not affect a patient's selection for living-donor liver transplantation (LDLT). Between February 2005 and April 2011, 446 LDLT procedures were performed at our institution. Two of the 446 living liver donors were diagnosed with GS. Both donors underwent extended right hepatectomies, and donors and recipients experienced no problem in the postoperative period. Their serum bilirubin levels returned to the normal range within 1-2 weeks postoperatively. In our opinion, extended right hepatectomy can be performed safely in living liver donors with GS if appropriate conditions are met and remnant volume is >30%. Livers with GS can be used successfully as grafts in LDLT recipients.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 Donor Complications Among 500 Living Donor Liver Transplantations at a Single Center(Elsevier Science Inc, 2012) Ozgor, D.; Dirican, A.; Ates, M.; Gonultas, F.; Ara, C.; Yilmaz, S.Introduction. Living donor liver transplantation (LDLT) has become necessary because of the shortage of cadaveric organs. We retrospectively analyzed 500 living donor hepatectomies using the Clavien classification system for complications to grade their severity. Materials and methods. We retrospectively identified and applied the Clavien clasification to 500 consecutive donors who underwent right for LDLT left hepatectomy between January 2007 and August 2011. Results. The 149 complications were observed in 93 of 500 (18.6%) donors who were followed for a mean 30 months. There wan no donor mortality. Complications developed in 85 (18.6%) right 5 (35.7%) left, and 3 (10%) left lateral segment hepatectomy donors. The overall incidence of reoperations was 7.2%. Seventy-seven of 149 complications were grade I (51.6%) or 9 grade II (6%). The major complications consisted of 27 (18.1%) grade IIIa, 35 (23.4%) grade IIIb, and 1 (0.6%) grade IVa. Grade IVb and grade V complications did not occur. The most common problems were biliary complications in 14 of 181 donors (7.7%). Conclusion. Donors for LDLT experienced a range of complications.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 Factors affecting the accuracy of 18F-FDG PET/CT in evaluating axillary metastases in invasive breast cancer(Wolters Kluwer Medknow Publications, 2019) Kutluturk, K.; Simsek, A.; Comak, A.; Gonultas, F.; Unal, B.; Kekilli, E.Background and Aim: There are conflicting results of studies on accuracy of positron emission tomography (PET)/computed tomography (CT) for axillary staging. The aim of this study is to determine the factors affecting the efficacy of 18F-fluorodeoxyglucose (F-18-FDG) PET/CT in detecting axillary metastases in invasive breast cancer. Materials and Methods: Data of 232 patients with invasive breast cancer who underwent F-18-FDG PET/CT examination before surgery between January 2013 and September 2017 were reviewed retrospectively. Histopathological examination of axillary lymph nodes (ALNs) was used as a reference to assess the efficacy of F-18-FDG PET/CT in detecting axillary metastases. Results: While 134 (57.8%) patients had axillary metastases as detected in F-18-FDG PET/CT scans, histopathologically axillary metastases were detected in 164 (70.7%) patients. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of F-18-FDG PET/CT in detection of axillary metastasis were 72.56%, 77.94%, 88.8%, 54%, and 74.1%, respectively. The false-negative and false-positive rates were 27.4% and 22%, respectively. In univariate analysis, patients' age, estrogen receptor positivity, higher ALN SUVmax, greater tumor size, and lymph node size determined by F-18-FDG PET/CT were all significantly associated with accuracy of F-18-FDG PET/CT for axillary metastasis. In multivariate analysis, tumor size determined by F-18-FDG PET/CT and ALN SUVmax were independent variables associated with axillary metastasis. The accuracy of F-18-FDG PET/CT for axillary metastasis was higher in patients with a larger tumor (>= 19.5 mm) and a higher ALN SUVmax (>= 3.2). Conclusion: F-18-FDG PET/CT should not be routinely used for axillary staging, especially in patients with small tumors. It cannot eliminiate the necessity of sentinel lymph node biopsy. When it is used, both visual information and optimal cut-off value of axillary node SUVmax should be taken into consideration.Öğe Hepatic Artery Thrombosis-Related Risk Factors After Living Donor Liver Transplantation: Single-Center Experience From Turkey(Elsevier Science Inc, 2013) Unal, B.; Gonultas, F.; Aydin, C.; Otan, E.; Kayaalp, C.; Yilmaz, S.Aim. The purpose of this retrospective study is to evaluate the risk factors hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT) in a consecutive series from a single center. Materials and Methods. Between January 2010 and May 2012, we performed 278 living donor liver transplantations, including 189 males and 89 females. We compared the risk factors between HAT and non-HAT groups according to the following variables: age, gender, body mass index (BMI), graft weight, use of graft, Child-Pugh and model for end stage liver disease score, level of hemoglobin, blood pressure, operation time, blood transfusion, presence of ascites, international normalized ratio (INR) level, and etiology. Results. Eighteen patients, including 15 males and 3 female, had HAT after the operation (mean age, 45.1 years; age range, 22-60 years). There were no pediatric patients in the HAT group. HAT rate was 6.5% in our series. Graft loss and retransplantation due to HAT was 38.7% in a 2-year period. Biliary leakage was observed in 72 (25.8%) living donor liver transplantations; this rate was higher in patients with HAT (n = 8; 44.4%). The infection rate was 50% (n = 9) in the HAT group and was 32.7% (n = 91) in the non-HAT group. Mean INR value was 2.15 in the HAT group and 1.72 in the non-HAT group. When we compared the groups according to use of graft for anastomosis, biliary lekage, infection, and INR value, the differences were statistically significant (P < .05). Conclusion. Although the results of OLT have improved over the past years, HAT is still associated with substantial morbidity, high incidence of graft failure, and high mortality rates. The most important findings associated with HAT in our series were found as INR levels, bile leakage, and resistant infections. Use of vascular graft for hepatic artery anastomosis was found to increase HAT risk.Öğe Incidentally Detected Gastric Gastrointestinal Stromal Tumor during Living Donor Liver Transplant Surgery for Hepatocellular Carcinoma: The First Two Cases(Avicenna Organ Transplant Center, 2021) Barut, B.; Ince, V; Usta, S.; Gonultas, F.; Yilmaz, S.Coexistence of hepatocellular carcinoma and gastrointestinal stromal tumor is rare. In this case series, we aimed to present an unusual coincidence of a gastrointestinal stromal tumor and hepatocellular carcinoma in patients who underwent living donor liver transplantation for hepatocellular carcinoma who had an incidental gastric gastrointestinal tumor which was detected intraoperatively.Öğe Is Routine Sternotomy Necessary for Organ Recovery from Deceased Donors? A Comparative Retrospective Study(Elsevier Science Inc, 2012) Yilmaz, M.; Piskin, T.; Akbulut, S.; Ersan, V.; Gonultas, F.; Yilmaz, S.Background. Traditionally, sternotomy and laparotomy are performed to recover thoracoabdominal organs from deceased donors; however, recovering abdominal organs without sternotomy is possible. We evaluated and compared organ recovery from deceased donors, with and without sternotomy. Methods. Between February 2006 and November 2011, organ recovery was performed in 68 deceased donors by our transplantation team. The recovery procedure was carried out using standard techniques in 31 donors (with sternotomy; Group A) and with modified techniques in 37 donors (without sternotomy; Group B). Average age, gender, body mass index (BMI), and time to cold ischemia were compared retrospectively in both groups. The demographic and clinical parameters were compared using a Student I test and chi-square test. The level of statistical significance was set at P < .05. Results. Organ recovery was performed on 31 of 67 (45.6%) deceased donors with sternotomy (Group A) and 37 of 67 (54.4%) without sternotomy (Group B). Thirty-six donors were male and 32 were female. The average donor age was 40.4 +/- 3.4 years in Group A and 52.4 +/- 4.6 years in Group B (P < .02). The average BMI of donors was 26.2 +/- 0.8 kg/m(2) in Group A and 23.9 +/- 0.8 kg/m(2) in Group B. The average time to cold ischemia was 127 +/- 6.2 minutes in Group A and 47.5 +/- 1.8 minutes in Group B (P < .0001). Conclusion. The transition time to cold ischemia can be shortened by harvesting organs without sternotomy in unstable donors, or under conditions in which intrathoracic organs are not recovered.Öğe Management of wet ascitic type of peritoneal tuberculosis: single center experience(Verduci Publisher, 2023) Gonultas, F.; Akbulut, S.; Sarici, K. B.; Toprak, S.; Kilci, B.; Bilgic, Y.; Kose, A.OBJECTIVE: We aimed to present our experience with the management of 17 patients with ascites who underwent diagnostic laparoscopy or laparotomy, and histologic con-firmation of wet ascitic type of peritoneal tuber-culosis (TB).PATIENTS AND METHODS: Between Janu-ary 2008 and March 2019, 17 patients whose as -cites were investigated by a gastroenterologist and who were thought to have non-cirrhotic as -cites were referred to our Surgery clinic for peri-toneal biopsy. The clinical, biochemical, radio-logical, microbiological, and histopathological data of the patients who underwent diagnostic laparoscopy or laparotomy were analyzed ret-rospectively. Histopathological examination of peritoneal tissue samples in hematoxylin-eo-sin-stained preparations revealed necrotiz-ing granulomatous inflammation with caseous necrosis and Langhans type giant cells. Eh-rlich-Ziehl-Neelsen (EZN) staining was studied with the suspicion of TB. Acid-fast bacilli (AFB) were detected in EZN stained slide. Histopatho-logical findings were also considered.RESULTS: Seventeen patients aged 18 to 64 years were included in this study. The most common symptoms were ascites and abdomi-nal distention, weight loss, night sweats, fever and diarrhea. Radiological examination revealed peritoneal thickening, ascites, omental cacking, and diffuse lymphadenopathy. Histopathologi-cally, necrotizing granulomatous peritonitis con-sistent with peritoneal TB were detected. While direct laparoscopy was preferred in sixteen pa-tients, laparotomy was preferred in the remain-ing one due to previous surgical procedures. However, seven were converted to open laparot-omy.CONCLUSIONS: Diagnosis of abdominal TB requires high index of suspicion, and the treat-ment should be prompt to reduce the morbidity and mortality associated with delay in treatment.Öğe Narrowing of the Inferior Vena Cava following Closure of the Right Hepatic Vein Stump in a Patient undergoing Living Donor Hepatectomy(Avicenna Organ Transplant Center, 2021) Demyati, K.; Akbulut, S.; Gonultas, F.; Yilmaz, S.Living donor hepatectomy is not without risks, and some complications can end up with serious morbidities if not timely diagnosed and appropriately managed. In this report, we described a very unusual but significant surgical problem in living liver donor surgery in which a significant narrowing occurred in the inferior vena cava after the closure of the stump of the right hepatic vein and inferior right hepatic vein close to the right hepatic vein together, and describe the cavoplasty technique used to repair this narrowing. To the best of our knowledge, the technique of solving this problem in living liver donors was described only once in literature, which was previously published by our team.Öğe Vessel sealing system vs. conventional knot-tying for hilar dissection during living donor hepatectomy: a prospective, randomized, double-blinded study(Verduci Publisher, 2022) Gunes, O.; Akbulut, S.; Atay, A.; Gonultas, F.; Tuncer, A.; Baskiran, A.; Yilmaz, S.- OBJECTIVE: LT has become the gold standard treatment for many liver diseases, especially chronic liver disease. A commonly seen problem, even in donors who do not develop any major complications after living donor hepatecto-my (LDH), is the persistent drainage of lymphatic fluid from the hepatectomy site drain, which causes extensive hospitalization and consequent loss to the workforce. To our knowledge, no study has yet been published comparing LVSS and conventional knot-tying methods for hilar dissection, which is an important stage of the LDH procedure. We aimed to prospectively compare the outcomes of these two treatment methods. PATIENTS AND METHODS: Donor candi-dates were divided into two groups: convention-al suture tying (conventional knot-tying group; n=34) and Ligasure vessel sealing system (LVSS; n=34). A simple randomization method of draw-ing lots was used to assign the patients to each group. The following parameters were analyzed for all patients: age, gender, BMI, duration of surgery, postoperative drainage amounts, drain removal times and complications, length of hos-pital stay, morbidity, and mortality. RESULTS: There were no significant differ-ences in terms of operative times, postoperative drainage levels, hospital stay or drain removal times. CONCLUSIONS: In this study, the use of LVSS in LDH was found to be safe, although it did not offer any advantage over conventional methods. Nevertheless, it seems probable that the use of LVSS could reduce operative time and amounts of lymphatic drainage, especially in centers with minimal experience with LDH, such as new LDH centers.
