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Öğe Brakiosefalik Av Fistüllerde Proksimal Sefalik Ven Darlıklarında Sefalik Ven ile Aksiller Ven Arasında Venovenostomi ile Onarım(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2008) Akın, Emin Barış; Memi, İzzet; Dayangaç, Murat; Taner, Burçin; Tokat, YamanArteriovenöz fistüllerde proksimal kısımda gelişen darlıklar fonksiyon bozukluğuna sebep olabilir ve damar yolunun tıkanmasıyla sonuçlanabilir. Antekübital bölgede anjioplasti yapılarak önkoldaki arteriovenöz fistüllerdeki proksimal darlıklar onarılabilir. Ancak üst kolda bulunan sefalik venin proksimal kısmına ulaşmak teknik olarak güçtür. Santral venlerde darlığı olmadan izole proksimal sefalik ven darlığı olan bir olguyu sunacağız. Hasta merkezimize yeterli kan çekilerek tam hemodiyaliz yapıldığı halde uygun kretinin klirensi sağlanamadığı için yönlendirildi. Fistülogram tetkiki proksimal sefalik vende santral venlere dökülme noktasında darlık olduğunu gösterdi. Hastaya trombektomi uygulandı ve sefalik ven yeni bir tünelden geçirilerek brakial vene anastamoz edildi. Tıkalı olan sefalik venden brakial venöz sisteme akımın yönlendirilmesi sonrasında brakiosefalik fistülde yeterli akım sağlandı. Brakiosefalik arteriovenöz fistüllerinde resürkilasyon olan ve yeterli klirens sağlanamayan olgularda fistülografi yapılarak izole sefalik ven darlığı tespit edilebilir. Üstkolda venovenostomi yapılarak proksimal sefalik ven darlığında akımın brakial venöz sisteme yönlendirilmesi teknik olarak kolay ve etkili bir yöntemdir.Öğe Development of a model to predict the risk of early graft failure after adult-to-adult living donor liver transplantation: An ELTR study(Lippincott Williams & Wilkins, 2024) Giglio, Mariano Cesare; Dolce, Pasquale; Yilmaz, Sezai; Tokat, Yaman; Acarli, Koray; Kilic, Murat; Zeytunlu, MuratGraft survival is a critical end point in adult-to-adult living donor liver transplantation (ALDLT), where graft procurement endangers the lives of healthy individuals. Therefore, ALDLT must be responsibly performed in the perspective of a positive harm-to-benefit ratio. This study aimed to develop a risk prediction model for early (3 months) graft failure (EGF) following ALDLT. Donor and recipient factors associated with EGF in ALDLT were studied using data from the European Liver Transplant Registry. An artificial neural network classification algorithm was trained on a set of 2073 ALDLTs, validated using cross-validation, tested on an independent random-split sample (n=518), and externally validated on United Network for Organ Sharing Standard Transplant Analysis and Research data. Model performance was assessed using the AUC, calibration plots, and decision curve analysis. Graft type, graft weight, level of hospitalization, and the severity of liver disease were associated with EGF. The model (http://ldlt.shinyapps.io/eltr_app) presented AUC values at cross-validation, in the independent test set, and at external validation of 0.69, 0.70, and 0.68, respectively. Model calibration was fair. The decision curve analysis indicated a positive net benefit of the model, with an estimated net reduction of 5-15 EGF per 100 ALDLTs. Estimated risks>40% and<5% had a specificity of 0.96 and sensitivity of 0.99 in predicting and excluding EGF, respectively. The model also stratified long-term graft survival (p<0.001), which ranged from 87% in the low-risk group to 60% in the high-risk group. In conclusion, based on a panel of donor and recipient variables, an artificial neural network can contribute to decision-making in ALDLT by predicting EGF risk.Öğe Karaciğer Nakli Sonuçları Üzerinde Kan Transfüzyonlarının Etkisi ve Transfüzyon Gereksinimini Etkileyen Faktörler(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2008) Yaprak, Onur; Dayangac, Murat; Balcı, Deniz; Duran, Cihan; Uraz, Süleyman; Ayanoğlu, Ömer; Yüzer, Yıldıray; Tokat, Yamanİntraoperatif kan transfüzyon ihtiyacı üzerindeki preoperatif hasta karekteristiklerinin etkisini araştırmak ve aynı zamanda kan transfüzyonunun postoperatif mortalite ve morbiditeye etkilerini değerlendirmek. MATERYAL ve METOD: Haziran 2004 ile Mayıs 2006 tarihleri arasında kliniğimizde son evre karaciğer hastalığı olan 16’sı kadaverik ve 65’i canlıdan olmak üzere toplam 81 hastaya karaciğer transplantasyonu uygulandı. Hastalar daha önceki çalışmalarda olduğu gibi 2 gruba ayrıldı). Yüksek transfüzyon yapılmış gurup (YTG) (>4 ünite eritrosit süspansiyonu) ve düşük transfüzyon yapılmış gurup (DTG) (<4 ünite eritrosit süspansiyonu). Dataların kategorizasyonu ve hesaplanmasından sonra kantitatif parametreler independent student’s t- test, kalitatif parametreler ise chi-squared test ile değerlendirildi. BULGULAR: Ortalama transfüze edilen eritrosit süspansiyonu 5.4 ünite idi. İntraoperatif kan transfüzyonu gereksinimi üzerinde hasta yaşı, primer hastalık olarak HCV, hastanın Child skoru anlamlı parametreler olarak saptandı. YTG hastalarda postoperatif reoperasyon ve mortalite oranı anlamlı düzeyde daha yüksek bulundu. Ayrıca YTG hastalarda postoperatif enfeksiyon gelişimi daha fazla idi. SONUÇ: Bu araştırmada yüksek kan transfüzyonunun posttransplant komplikasyonlar ve mortalite üzerinde önemli bir etken olduğu sonucuna varılmıştır.Öğe LIVING DONOR LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA: TWO-CENTER PRELIMINARY RESULTS(John Wiley & Sons Inc, 2009) Tokat, Yaman; Yilmaz, Sezai; Kirimlioglu, Vedat; Kirimlioglu, Hale; Kayaalp, Cuneyt; Yuzer, Yildiray[Abstract Not Available]Öğe Right Lobe Liver Transplantation Using Hyperbilirubinemic Donors(John Wiley & Sons Inc, 2010) Demirbas, Baha Tolga; Piskin, Turgut; Orug, Taner; Dayangac, Murat; Yaprak, Onur; Yuzer, Yildiray; Tokat, Yaman[Abstract Not Available]Öğe Right-lobe Liver Transplant From Donors With Gilbert Syndrome(Baskent Univ, 2012) Demirbas, Tolga; Piskin, Turgut; Dayangac, Murat; Yaprak, Onur; Akyildiz, Murat; Tokat, Yaman; Yuzer, YildirayObjectives: Donor safety is one of the most important aspects of living-donor liver transplant. The preoperative evaluation of candidates for such transplants essentially starts with serologic and biochemical analyses. However, some potential liver donors with normal liver function test results may have isolated mild hyperbilirubinemia (serum indirect bilirubin level > 20.5 mu mol/L [1.2 mg/dL]). Gilbert syndrome is an autosomal recessive condition that is a common cause of nonhemolytic unconjugated hyperbilirubinemia, and its prevalence is 3% to 10% in the healthy US population. Mild hyperbilirubinemia episodes are expected in people with Gilbert syndrome when they are exposed to physical stress, such as operative intervention or low energy intake. The liver morphologic findings of these individuals are normal; however, there is a debate on the use of people with Gilbert syndrome as living-liver donors. The purpose of this study was to assess the results of right-lobe living-donor hepatectomy of liver donors with Gilbert syndrome. Materials and Methods: Between 2004 and 2010, two hundred twenty-five living-donor liver transplants using right-lobe grafts were performed in our hospital. Donors with Gilbert syndrome were defined as those whose serum bilirubin level was greater than 20.5 mu mol/L (1.2 mg/dL). Six of 225 right-lobe living-donor liver transplants were performed using donors with Gilbert syndrome. Results: The median follow-up after transplant was 34 months (range, 18 to 51 mo). One week after the operation, the median bilirubin level for rightlobe liver donors was 34.5 mu mol/L (2.02 mg/dL) (range, 17.1 to 51.3 mu mol/L [1 to 3 mg/dL]), and the median prothrombin time (international normalized ratio) was 1.36 (range, 1.1 to 1.7). The median bilirubin level of the donors after 6 months was 29 mu mol/L (1.7 mg/dL) (range, 20.5 to 41 mu mol/L [1.2 to 2.4 mg/dL]). Conclusions: Living-donor liver transplant from Gilbert syndrome donors can be safely performed.Öğe Successful Treatment of Severe Hepatorenal Syndrome with Living Donor Liver Transplantation(H G E Update Medical Publishing S A, 2012) Demirbas, Baha Tolga; Piskin, Turgut; Dayangac, Murat; Yaprak, Onur; Oklu, Levent; Yuzer, Yildiray; Tokat, YamanHepatorenal syndrome is defined as renal failure caused by acute or chronic liver failure without any laboratory or histological reasons. The exact etiology of this syndrome is unknown. However, vasodilatation in the splanchnic area as a result of cirrhosis and portal hypertension, reflex systemic and splanchnic vasoconstriction are the basic pathophysiological reasons of this syndrome. The decrease of renal perfusion, decrease in glomerular filtration rate, sodium retention and deterioration of excretion of free water are the major renal problems and these remain progressive according to the stage of liver disease. The treatment of this syndrome is correction of the underlying problem. Here, we report a patient who was having hemodialysis, due to renal failure as a consequence of liver cirrhosis for three months and returned back to his normal life without a need for dialysis after liver transplantation.
