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Öğe Can Patients Who Develop Cerebral Death in Fulminant Liver Failure Despite Liver Transplantation Be Previously Forseen?(Elsevier Science Inc, 2017) Sarici, K. B.; Karakas, S.; Otan, E.; Ince, V.; Koc, C.; Koc, S.; Bayraktar, H.Background. The outcome of medical treatment is worse in fulminant liver failure (FLF) developing on acute or chronic ground. Recently, liver transplantations with the use of living and cadaveric donors have been performed in these diseases and good results obtained. In this study, we aimed to present the factors affecting the recovery of cerebral functions after liver transplantation in hepatic encephalopathy (HE) developing in FLF, to identify irreversible patient groups and to prevent unnecessary liver transplantation. Methods. In Inonu University's Liver Transplant Institute, 69 patients who made an emergency notice to the National Coordination Center for liver transplantation owing to FLF from January 2012 to December 2015 were included in the study. Patients were divided into 2 groups. Group 1 consisted of 52 patients who underwent liver transplantation and recovered normal brain function, and group 2 had 17 patients who underwent liver transplantation and did not recover normal brain function and had cerebral death. All patients were evaluated before surgery for clinical encephalopathy stage, light reflex, and convulsions. Groups were compared and assessed according to age (>40, 10-40 and <10 years), body mass index, etiologic factor, preoperative laboratory values, transplantation type, mortality, and encephalopathy level. Multivariate analysis was done for specific parameters. Results. Prothrombin time (PT), international normalized ratio (INR), and total bilirubin values were significantly different between the groups. There was no significant difference between the groups regarding ammonia and lactate levels. There was a statistically significant difference between the groups regarding sodium and potassium levels from serum electrolytes. However, the averages of both groups were within normal limits. pH and total bilirubin levels were meaningful for multivariate analysis. Conclusions. HE reversibility, mortality, and morbidity are important in patients with HE who undergo liver transplantation. Therefore, West Haven clinical staging and serum INR, PT, and total bilirubin level may be helpful in predicting the reversibility of FLF patients with HE before liver transplantation. It was determined that West Haven encephalopathy grading is important in determining the reversibility of HE after transplantation in FLF; especially the probability of reversibility of stage 4 HE decreases significantly. High PT and INR levels, hyperbilirubinemia, and serum sodium and potassium concentrations were risk factors for the reversibility of HE in this study.Öğe Detection of early gamma response by estimation of its spectro-temporal coherent energy(Elsevier Science Bv, 2006) Tagluk, M. E.; Cakmak, E. D.; Karakas, S.[Abstract Not Available]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 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 The experimental study of types of response inhibition specific to Attention Deficit Hyperactivity Disorder(Elsevier Science Bv, 2008) Ceylan, A. Ozkan; Baran, Z.; Dincer, E. Dogutepe; Karakas, H. M.; Karakas, S.[Abstract Not Available]Öğe A hybrid technique of source localization using electroencephalography and structural magnetic resonance imaging: EEG/ERP-MRI(Elsevier Science Bv, 2008) Karakas, S.; Baran, Z.; Dincer, E. Dogutepe; Ceylan, A. Ozkan; Tail, E. T.; Karakas, H. M.[Abstract Not Available]Öğe In vitro effects of neopterin on invasion, metastasis and proliferation of hepatocellular cancer cell lines(Lippincott Williams & Wilkins, 2023) Satilmis, B.; Sahin, T. T.; Otan, E.; Kutluturk, K.; Karakas, S.; Yilmaz, S.[Abstract Not Available]Öğe The incidence and risk factors for persistent unconsciousness following liver transplantation for acute liver failure(Lippincott Williams & Wilkins, 2019) Sarici, K. B.; Otan, E.; Ince, V; Sahin, T. T.; Karakas, S.; Saglam, K.; Aydin, C.[Abstract Not Available]Öğe INFECTIONS IN THE INTENSIVE CARE UNIT FOLLOWING LIVER TRANSPLANTATION: PROFILE OF A SINGLE CENTER(Federal Research Center Transplantology & Artificial Organs V I Shumakov, 2013) Otan, E.; Usta, S.; Aydin, C.; Karakas, S.; Unal, B.; Mamedov, R.; Kayaalp, C.Introduction. Despite the advances in antibiotherapy and critical care management, infectious complications remain among the leading complications after liver transplantation related with mortality and morbidity. This study analysis the incidence and pattern of infections and possible prognostic factors of infectious complications retrospectively in a single center. Patients and Methods. Results of 30 consecutive patients with a primary liver transplantation history in a single center between August 2011 and August 2012 and a positive culture result in the first month in the ICU were analysed retrospectively. Results. During the first 1 month stay in the ICU postoperatively 30 (13,63%) patients had at least 1 infection. Total number of infections were 68. Mortality rate of the infected patients was 53,3% (n = 16). Among these infections, 25 (36,76%) of them were in deep surgical sites. Eighteen of the 30 patients (60%) were infected with a single microorganism. Eleven patients (36,66%) had a single infection episode. Microorganism were gram negative in 52 (76,47%) of the infections, gram positive in 14 (20,58%) of the infections, rest of the 2 (2,94%) infections were due to Candidiasis. Among the possible risk factors contributing to mortality, there was a statistically signifi cant difference (p < 0,001) between the platelet counts of the mortality and surviving groups of the patients. Conclusion. Infections are among the preventable risk factors for mortality and morbidity after liver transplantation. Our data reveals a signifi cant relation between trombocytopenia and mortality among the infected patients. Further studies focusing on this relation would expose the mechanisms and any possible contribution in clinical management of the patients.Öğe Liver paired exchange transplantation: overcoming the obstacles in living donor liver transplantation(Lippincott Williams & Wilkins, 2023) Sahin, T. T.; Yilmaz, S.; Emre, S.; Kutluturk, K.; Karakas, S.; Otan, E.; Cicek, E.[Abstract Not Available]Öğe Mapping learning and working memory(Elsevier Science Bv, 2008) Ceylan, A. Ozkan; Karakas, H. M.; Karakas, S.[Abstract Not Available]Öğe Mapping linguistic and executive functions(Elsevier Science Bv, 2008) Dincer, E. Dogutepe; Karakas, H. M.; Karakas, S.[Abstract Not Available]Öğe Mapping visual, auditory, sensory-motor modalities and emotional arousal(Elsevier Science Bv, 2008) Baran, Z.; Karakas, H. M.; Karakas, S.[Abstract Not Available]Öğe New and different expanded criteria for liver transplantation in hepatocellular carcinoma: Malatya criteria(Lippincott Williams & Wilkins, 2019) Ince, V; Akbulut, S.; Otan, E.; Ersan, V; Karakas, S.; Sahin, T. T.; Baskiran, A.[Abstract Not Available]Öğe Postoperative Pulmonary Complications After Liver Transplantation: Assessment of Risk Factors for Mortality(Elsevier Science Inc, 2015) Aydin, C.; Otan, E.; Akbulut, S.; Karakas, S.; Kayaalp, C.; Karagul, S.; Colak, C.Background. The aim of this study was to identify the risk factors related to mortality in liver transplant (LT) patients with post-transplantation pulmonary complications. Method. Patients who underwent liver transplantation in our clinic between January 2010 and January 2012 were retrospectively reviewed for post-transplantation pulmonary complications. Demographic, clinical, radiologic, and postoperative chart data of 153 patients with pulmonary complications were analyzed using an independent samples Student t test, Pearson's chi(2) test, Fisher's exact test, and Yate's corrected chi(2) test. Mortality was analyzed using a multiple logistic regression model. The best-fit breakpoint resulting in a cut-off value for the variables of interest was determined using ROC curves and the Youden index. Results. The 153 patients with pulmonary complication were divided into 2 groups: mortality (n = 53) and survival (n = 100). Univariate analyses showed significant differences between these 2 groups with respect to MELD score (P = .035), duration of mechanical ventilation (P>.001), pneumonia (P = .01), and endotracheal culture results (P = .001). In the multivariate analysis, hemoglobin (P = .03, odds ratio [OR]: 1.239), MELD score (P = .027, OR: 1.064), duration of mechanical ventilation (P = .003, OR: 1.091), and age (P = .042, OR: 1.001) were significant risk factors for mortality. The best-fit breakpoint analysis yielded cut-off values for hemoglobin (>11.2, sensitivity: 50.9%, specificity: 70%), MELD score (>16, sensitivity: 73.6%, specificity: 42%) and duration of mechanical ventilation (>3, sensitivity: 62.3%, specificity: 76%). Conclusion. Advanced age, high hemoglobin level, high MELD score, and long-term mechanical ventilation are significant risk factors for mortality in liver transplant patients with postoperative pulmonary complications.Öğe Pregnancy After Liver Transplantation: Risks and Outcomes(Elsevier Science Inc, 2017) Baskiran, A.; Karakas, S.; Ince, V.; Kement, M.; Ozdemir, F.; Ozsay, O.; Kutluturk, K.Objective. The aim of this study was to evaluate the outcomes of liver transplant recipients who became pregnant after transplantation. Methods. The clinical data of all patients who underwent liver transplantation between January 2007 and December 2016 in our liver transplantation institute were reviewed. The following data were analyzed: indications for transplantation, recipient age at the beginning of pregnancy, the interval between transplantation and pregnancy, maternal and fetal complications, type of delivery, the health condition of neonates, and modifications in immunosuppressive therapy. Results. During the study period, 1890 patients underwent liver transplantation. There were 185 women (9.8%) in childbearing age (15-45 years old), and 18 (9.7%) of them became pregnant during the study period. There were a total of 26 pregnancies. The mean age of patients at the time of operation was 25.3 +/- 5.2 years, and the mean interval between operation and conception was 32.7 +/- 15.3 months. Seventeen pregnancies (65.4%) ended in a live birth in the study. Six pregnancies (23%) resulted with no maternal or fetal complications. The most frequent maternal complication during pregnancy was pregnancy induced hypertension (n = 3; 16.6%). Conclusions. Despite advances in immunosuppressive therapy and increasing experience in the management of these patients, pregnancies in liver transplant recipients are still more risky than in the general population for both the mother and the fetus. Thus, the issues related to fertility should be comprehensively discussed with the patients and their partners, preferably before transplantation, and pregnancies in liver transplant recipients should be followed up more carefully by a multidisciplinary team.Öğe The risk facotrs of mortality following liver transplantation in acute liver failure: Single center experience(Lippincott Williams & Wilkins, 2019) Sahin, T.; Sarici, K. B.; Karakas, S.; Kutluturk, K.; Aydin, C.; Yilmaz, S.[Abstract Not Available]Öğe Should We Use an Orphan Graft?(Avicenna Organ Transplant Center, 2017) Baskiran, A.; Ozdemir, F.; Barut, B.; Ince, V.; Koc, C.; Ersan, V.; Karakas, S.[Abstract Not Available]Öğe Surgical Treatment of Portal Vein Thrombosis With the Use of Cadaveric Venous Patch After Donor Hepatectomy: A Case Report(Elsevier Science Inc, 2017) Ozdemir, F.; Ersan, V.; Baskiran, A.; Ince, V.; Karakas, S.; Kahraman, A. S.; Yilmaz, S.Live donors should be the priority of transplant professionals to prevent surgery-related morbidity and mortality during living-donor liver transplantation. Portal vein thrombosis after donor hepatectomy is an important complication which can be prevented by careful preoperative as well as perioperative evaluation. If portal vein thrombus occurs after donor hepatectomy, anticoagulation and surgical thrombectomy and even portal vein reconstruction should be kept in mind. Cadaveric venous patches can be used for the reconstruction of narrowed and angulated portal veins. Here we report the surgical treatment of a donor with a cadaveric venous patch who developed portal vein thrombosis after donor hepatectomy.Öğe Telescopic Biliary Reconstruction in Patients Undergoing Liver Transplantation With 1-Year Follow-up(Elsevier Science Inc, 2017) Karakas, S.; Sarici, K. B.; Ozdemir, F.; Ersan, V.; Ince, V.; Baskiran, A.; Kayaalp, C.Background. Biliary complications are important during liver transplantation because of their effect on recipient and graft survival, incidence, and the long treatment period. These complications are associated with 50% morbidity and 30% mortality rates in recent studies. One of the most important reasons for biliary anastomosis complications is arterial ischemia. We present the results of our telescopic biliary anastomosis technique performed on the mucosa of the main biliary duct. Patients and Methods. Fifty-six cases of telescopic biliary reconstruction were performed in 203 patients during 2015. Fifty cases and 52 patients who underwent standard reconstruction were chosen and compared. All patients had been scanned retrospectively. Statistical analyses were conducted with chi(2) and Mann-Whitney U tests for the complications that occurred during the first 3 months. A P value <.05 was considered significant. Results. No clinical or demographic differences were detected between the groups. About 90% of both groups were living donor liver transplantation cases. Five (10%) anastomotic leaks occurred in telescopic reconstruction group (n = 50), and 13 (25%) occurred in the standard reconstruction group (n = 52; P < .05). Conclusion. The arterial blood supply is better if the biliary anastomosis is made on the mucosal side of the main biliary duct. Early period anastomotic leaks may decrease significantly.
