Yazar "Koc, S." seçeneğine göre listele
Listeleniyor 1 - 10 / 10
Sayfa Başına Sonuç
Sıralama seçenekleri
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 Chronic Graft-Versus-Host Disease After Liver Transplantation: A Case Report(Elsevier Science Inc, 2012) Yilmaz, M.; Ozdemir, F.; Akbulut, S.; Ersan, V.; Koc, C.; Koc, S.; Yilmaz, S.Graft-versus-host disease (GVHD) after orthotopic liver transplantation pun is a rare but significant complication, occuring in 1%-2% of cases with a mortality rate of 85%-90%. It occurs when donor passenger lymphocytes mount an alloreactive response against the host's histocompatibility antigens. It presents as fever, rash, and diarrhea with or without pancytopenia. Between March 2002 and September 2011, among 656 OLT patients 1 (0.15%) had acute GVHD. A biopsy at the 7th posttransplantation month revealed chronic GVHD. Consequently, in the cases that had fever, rash, and/or desquamation of the any part of body after liver transplantation, GVHD must be considered and skin biopsies must be planned for the diagnosis.Öğe Comparison of Plasmapheresis and Molecular Adsorbent Recirculating System Efficacy in Graft Failure After Living Donor Liver Transplantation(Elsevier Science Inc, 2013) Ince, V.; Aydin, C.; Otan, E.; Karabulut, K.; Koc, S.; Kayaalp, C.; Yilmaz, S.Introduction. Liver transplantation may result in graft failure, requiring time and supportive treatment for regeneration of the graft. The aim of this study was to compare the laboratory parameter changes after single-session molecular adsorbent recirculating system (MARS) and plasmapheresis procedures among living donor liver transplantation patients experiencing graft failure. Patients and Method. We analyzed retrospectively the results in 45 liver transplantation patients treated with plasmapheresis and/or MARS between June 2011 and July 2012: (plasmapheresis, n = 17; MARS, n = 15; MARS + plasmapheresis, n = 13). When cadaveric donor cases (n = 11) were excluded, the remaining 34 included patients, underwent. MARS (n = 18) or plasmapheresis (n = 16) at the first session. Findings. Both groups were similar in age, sex, and body mass index features. The MARS group displayed significantly higher levels of international normalized ratio, blood urea nitrogen, and Model for End-stage Liver Disease score. The plasmapheresis cohort, displayed significantly higher levels of initial direct bilirubin and gamma glutamyl transferase (P < .05). The plasmapheresis group showed a significant decrease in GGT after treatment (P < .05). Results. An initial MARS session provided significantly greater decrease in renal function associated with graft failure after living donor liver transplantation.Öğe Futility Versus Acceptability of the Use of Grafts Taken From End of Line in the National Organ-Sharing Network(Elsevier Science Inc, 2015) Soyer, V.; Koc, S.; Onur, A.; Sarici, B.; Kayaalp, C.; Isik, B.; Unal, B.Background. The number of suitable donors for organ transplantation is limited in many countries. This limitation can be overcome with the use of organs removed from marginal donors (expanded-criteria donors [ECDs]). We examined the long-term results of 187 patients who underwent marginal cadaveric liver transplantation in our institution. Methods. The data of patients who underwent cadaveric liver transplantation from January 2007 to April 2014 were retrospectively reviewed. ECDs were evaluated by considering 19 internationally accepted criteria. The clinical data of recipients including age, clinical status, and Model for End-Stage Liver Disease (MELD) score were also assessed. Results. A total of 287 patients underwent cadaveric liver transplantation. A graft from an ECD was used in 181 (63.06%) patients. The mean MELD score was 18.8. In all, 45 patients (24.86%) underwent transplantations for fulminant liver failure and 136 patients (75.14%) underwent transplantations for other chronic conditions. The majority of donors died of cerebrovascular disease and trauma. Only hypotension requiring inotropic drugs and obesity significantly affected survival. The 90-day and 12-month survival rates of the recipients who received a graft from an ECD were 51.93% and 46.2%, respectively. Conclusions. The use of ECD allografts immediately and significantly expands the existing donor pool. Because of persistent organ scarcity, pressure to use a greater proportion of the existing donor pool will continue to increase.Öğe Liver Transplantation With Livers From Octogenarians and a Nonagenarian(Elsevier Science Inc, 2015) Dirican, A.; Soyer, V.; Koc, S.; Yagci, M. A.; Sarici, B.; Onur, A.; Unal, B.Introduction. A shortage of deceased donors has compelled the use of extended-criteria donor organs in liver transplantation. The purpose of this study was to evaluate the impact of using deceased donors older than 80 years. Materials and Methods. We retrospectively evaluated 13 patients who received a liver graft from cadaveric donors older than 80 years between December 2007 and March 2014. We analyzed the donor and their recipient characteristics together with morbidity and mortality of recipients. Results. All 13 donors were older than 80 years (median age, 82.7; range, 80-93). There were 9 male and 4 female recipients with an average age of 50.7 (range, 2-65) years. All of the recipients did not have a living donor for liver transplantation. Recipients' mean model for end-stage liver disease (MELD) score was 14.2 (range, 7-20). Graft with macroscopic steatosis was not accepted. Medium follow-up was 19.5 months. The most frequent cause for liver transplantation (LT) was hepatitis B virus (HBV) cirrhosis (8/13 patients). We had 1 case of primary nonfunction, and 4 patients died in 2 weeks after surgery. Of these patients, 2 of them received a split transplant from an 80-year-old cadaver liver. Overall the survival rate after 1 year was 61.5%. Conclusions. Deceased elderly donor usage in LT could expand the donor pool. Liver grafts from donors older than 80 years can be used in necessity or emergency situations. However, care should be taken to avoid early mortality and primary nonfunction. Procedures extending cold ischemia time such as split liver transplantation may increase the risk of primary nonfunction.Öğe Living Donor Liver Transplantation for Mushroom Intoxication Caused Acute Liver Failure(Lippincott Williams & Wilkins, 2017) Dirican, A.; Yilmaz, M.; Baskiran, A.; Ozgor, D.; Ates, M.; Koc, S.; Ince, V[Abstract Not Available]Öğe Protective effect of benfotiamine on methotrexate induced gastric damage in rats(Taylor & Francis Ltd, 2021) Koc, S.; Erdogan, M. A.; Erdogan, E.; Yalcin, A.; Turk, A.; Erdogan, M. M.Methotrexate (MTX) is widely used for treating cancers and inflammatory diseases; it is a potential anti-metabolite and folate antagonist. We investigated potential protective effects of benfotiamine on MTX damage. We used a rat model of MTX induced gastric injury to assess changes in gastric histopathology, oxidative stress and visfatin levels due to MTX treatment. Rats were divided into four groups: an untreated control group, an MTX group treated with a single dose of MTX, a benfotiamine group treated with benfotiamine daily for two weeks, and a benfotiamine + MTX group treated with a single dose of MTX followed by benfotiamine daily for two weeks. Total serum antioxidant status (TAS), total oxidant status (TOS) and visfatin levels were measured at the end of the experiment. At the end of the experiment, we investigated both visfatin expression and the histopathology of gastric tissues. The mean visfatin level was lower in the MTX group than in the benfotiamine group. The mean serum TOS levels were higher in MTX group than in the control, benfotiamine or benfotiamine + MTX groups. Significant gastric gland dilation, and erosion and loss of mucosa were found on the gastric surface in the MTX group compared to the control group. The dilation, erosion and mucosal loss were decreased significantly in the benfotiamine + MTX group compared to the MTX group. Compared to the control group, visfatin immunoreactivity was reduced significantly in the MTX group. Decreased visfatin levels appear to play a role in the mechanism of gastric damage. Benfotiamine may be useful for preventing MTX induced gastric injuries.Öğe Pulmonary Complications After 1150 Living Donor Hepatectomies(Elsevier Science Inc, 2015) Ates, M.; Kinaci, E.; Dirican, A.; Sarici, B.; Soyer, V.; Koc, S.; Yilmaz, S.Aim. Donor safety is the major concern in living-donor liver transplantation. Studies in literature related to donor hepatectomy (DH) have generally considered intra-abdominal complications. The aim of this study is to specifically evaluate pulmonary complications (PCs) after DH. Materials and Methods. We evaluated retrospectively 1150 living donors who underwent to DH between January 2007 and July 2014. Patients with PCs, such as pneumonia, pleural effusion, pneumothorax, and respiratory insufficiency, were considered. A complication was considered only when it was clinically apparent and/or requiring interventions. Any special diagnostic tool was used to expose the clinically silent pathologies. Results. A total of 986 right hepatectomies (RH) and 164 left hepatectomies (LH) (left lobectomy or left lateral segmentectomy) were performed in the study interval. There were 18 (1.6%) donors with PCs (15 males and 3 females). Mean age was 33.8 +/- 9.3 years (18-51). Mean hospital stay was 23.8 +/- 13.5 days (5-62). Presented PCs were pleural effusion (n = 5, 0.4%), pneumonia (n = 4, 0.3%), combinations (n = 2, 0.2%), pneumothorax (n = 2, 0.2%), and acute respiratory insufficiency (n = 5, 0.4%). Sixteen cases (1.7%) were seen after RH, whereas 2 cases (1.2%) were seen after LH (P = 1.000). Conclusion. The most common PCs after living donor hepatectomy were pleural effusion and acute respiratory insufficiency. There was no significant difference between RH and LH. It is possible to overcome those PCs with careful monitoring and timely and appropriate treatment.Öğe Significance and Outcome of Living-donor Liver Transplantation in Acute Mushroom Intoxication(Wolters Kluwer Medknow Publications, 2018) Baskiran, A.; Dirican, A.; Ozgor, D.; Kement, M.; Koc, S.; Sahin, T. T.; Ates, M.Introduction: Mushroom intoxication ( MT) can lead to acute liver injury which may result in Mushroom intoxication-related liver failure ( M-ALF) requiring liver transplantation ( LT). In the present study, we want to share the experience of our institute regarding living-donor LT ( LDLT) due to mushroom poisoning. Aim: The aim of this study is to identify the predictors of poor prognosis in patients with ALF secondary to mushroom intoxication requiring LDLT. Materials and Methods: All patients with MT between 2008 and 2016 were evaluated. Demographics, symptoms, interval between symptoms and admission to our institute, laboratory data, model for end-stage liver disease ( MELD)/ pediatric end-stage liver disease ( PELD) scores, clinical course, and outcomes of supportive therapy and LT were evaluated. There were two groups in the study: Group A = responsive to supportive therapy ( n = 9) versus Group B = unresponsive to supportive therapy ( n = 9). Results: During the study, a total of 18 patients were admitted with M-ALF. Twelve ( 66.7%) of them were female, and the mean age was 39.9 +/- 18.2 years. All of the nine patients in Group A fully recovered with supportive therapy. In Group B, one patient died during waiting period for LT and 8 patients received LDLT LDLT. Three of the eight patients who were transplanted died in the postoperative early period within postoperative 5 days. The patients in Group B had significantly higher MELD/ PELD scores and encephalopathy rate than in Group A ( P < 0.05). International normalized ratio ( INR), bilirubin, ammonium levels, and platelet count were significantly different between groups ( P < 0.05). The patients in Group B had significantly longer interval before admission to our institute ( P < 0.05). Conclusion: The presence of encephalopathy, higher MELD/ PELD, INR, bilirubin, ammonium levels, and lower platelet count was related to poor prognosis in MT. LDLT provides a good therapeutic option in patients with M-ALF. The time is a crucial factor in successful treatment of MT. Early admission to a tertiary referral center with expertise in LT results in a better prognosis and increased survival following M-ALF.Öğe Venous Outflow Obstruction Following Living Donor Liver Transplantation: Analysis of 1011 Liver Transplant Cases(Lippincott Williams & Wilkins, 2017) Koc, S.; Akbulut, S.; Soyer, V; Yilmaz, M.; Barut, B.; Kutlu, R.; Yilmaz, S.[Abstract Not Available]
