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    Bacterial Translocation in Experimental Acute Necrotizing Pancreatitis: Effects of Infliximab
    (Lippincott Williams & Wilkins, 2010) Aydin, S.; Isik, A. T.; Unal, B.; Comert, B.; Ozyurt, M.; Deveci, S.; Erdem, G.
    [Abstract Not Available]
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    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.
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    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.
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    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.
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    En Bloc and Dual Kidney Transplantation: Two Initial Cases from a New Kidney Transplantation Center
    (Elsevier Science Inc, 2012) Unal, B.; Piskin, T.; Koz, S.; Ulutas, O.; Yilmaz, M.; Yilmaz, S.
    Aim. The aim of this study was to share our initial successful experiences with en bloc dual kidney transplantation. Cases. En bloc kidney were obtained, for case 1 from a 3-year-old deceased pediatric donor who had undergone cadaveric liver transplantation due to fulminant hepatitis A virus infection 1 week prior. The donor length was 97 cm and weight 13 kg. According to the age and weight of the donor, we selected a 50-year-old respectively. For case 2, a kidney was retrieved from a 20-month-old pediatric donor after development of hypoxic brain injury secondary to status epilepticus. The donor lengh and weight were 75 cm and 13 kg respectively. A 30-year-old female patient was of 162 cm and 59 kg. The suprarenal aorta, suprarenal vena cava, and caval and aortic lumbar branches were closed with running sutures during the backtable procedures. After the classic Gibson incision, the donor aorta was anastomosed to the recipient right common iliac artery, and the donor inferior vena cava to the recipient right common iliac vein in end-to-side fashion. The ureters were implanted with mucosa-to-mucosa ureteroneocystostomies separately according to the Lich-Gregoir technique. After the vascular anastomoses the kidneys had immediate good perfusion in both cases. Postoperative recovery was rapid, the recipients were discharged uneventfullly. Conclusion. En bloc dual kidney transplantation from young pediatric patients to adult recipients can be performed with low mortality and morbidity even by new centers.
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    Ethyl Pyruvate Protects Colonic Anastomosis From Ischemia-Reperfusion Injury
    (Sage Publications Inc, 2009) Unal, B.; Karabeyoglu, M.; Huner, T.; Canbay, E.; Eroglu, A.; Yildirim, O.; Dolapci, M.
    Ethyl pyruvate is a simple derivative in Ca+2- and K+-containing balanced salt solution of pyruvate to avoid the problems associated with the instability of pyruvate in solution. It has been shown to ameliorate the effects of ischemia-reperfusion (I/R)injury in many organs. It has also been shown that I/R injury delays the healing of colonic anastomosis. In this study, the effect of ethyl pyruvate on the healing of colon anastomosis and anastomotic strength after I/R injury was investigated. Anastomosis of the colon was performed in 32 adult male Wistar albino rats divided into 4 groups of 8 individuals: (1) sham-operated control group (group 1); (2) 30 minutes of intestinal I/R by superior mesenteric artery occlusion (group 2); (3) I/R+ ethyl pyruvate (group 3), ethyl pyruvate was administered as a 50-mg/kg/d single dose; and (4) I/R+ ethyl pyruvate (group 4), ethyl pyruvate administration was repeatedly (every 6 hours) at the same dose (50 mg/kg). On the fifth postoperative day, animals were killed. Perianastomotic tissue hydroxyproline contents and anastomotic bursting pressures were measured in all groups. When the anastomotic bursting pressures and tissue hydroxyproline contents were compared, it was found that they were decreased in group a when compared with groups 1,3, and 4 (P < .05). Both anastomotic bursting pressure (P = .005) and hydroxyproline content (P < .001) levels were found to be significantly increased with ethyl pyruvate administration when compared with group 2. When ethyl pyruvate administration doses were compared, a significant difference was not observed (P > .05). Ethyl pyruvate significantly prevents the delaying effect of I/R injury on anastomotic strength and healing independent from doses of administration.
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    Factors affecting the accuracy of 18F-FDG PET/CT in detecting additional tumor foci in breast cancer
    (Athens Medical Soc, 2021) Simsek, A.; Kutluturk, K.; Comak, A.; Akatli, A.; Kekilli, E.; Unal, B.
    OBJECTIVE To evaluate the effectiveness of F-18-FDG PET/CT for detecting additional tumor foci in breast cancer. MATERIAL-METHOD The data were reviewed retrospectively of 232 women who underwent F-18-FDG PET/CT examination prior to breast cancer surgery between January 2013 and December 2018. RESULTS Additional tumor foci were suspected in 95 cases on F-18-FDG PET/ CT, which were confirmed by histopathological analysis in 81 cases. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of F-18-FDG PET/CT in detection of additional tumor foci were 77.7%, 79.48%, 66.3%, 87.32%, and 79.23%, respectively. The false negative and false positive rates were 22.22% and 20.51%, respectively. In univariate analysis, only the patient's age was positively associated with accuracy of F-18-FDG PET/CT in detecting additional tumor foci. The accuracy was lower in women aged <= 50 years, with a substantial increase in false positive findings in women in that age group. CONCLUSIONS F-18-FDG PET/CT alone cannot replace conventional diagnostic procedures for evaluating additional tumor foci in breast cancer, as a substantial increase in false positive findings is recorded with this method in women aged <= 50 years old.
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    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.
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    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.
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    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.
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    HLA-A, -B,-DRB1 Allele and Haplotype Frequencies and Comparison With Blood Group Antigens in Dialysis Patients in the East Anatolia Region of Turkey
    (Elsevier Science Inc, 2013) Kayhan, B.; Kurtoglu, E. L.; Taskapan, H.; Piskin, T.; Sahin, I.; Otlu, G.; Unal, B.
    Aim. The first aim of that study was to investigate HLA class I and class II allele and haplotype frequencies in renal dialysis patients who live in East Anatolia in Turkey. Our second aim was to investigate whether there was a relationship between ABO and D blood group antigens and HLA alleles and haplotypes for the study group. Materials and methods. HLA class I and II polymorphisms in 408 renal dialysis patients were studied using sequence-specific primers (SSP) and sequence-specific oligonucleotides (SSO). Blood group antigens were detected by agglutination methods on microplates. Results. A total of 16 HLA-A, 34 HLA-B, and 15 HLA-DRB1 alleles were identified. The most frequent HLA-A alleles were HLA-A*02, HLA-A*24, and HLA-A*11. The most frequent HLA-B alleles were HLA-B*35, HLA-B*51, and HLA-B*44. In case of HLA-DRB1; HLA-DRB1*11, HLA-DRB1*04, and HLA-DRB1*13 were first 3 alleles with higher frequency, in order. In the combination of those 3 alleles, the most frequent HLA-A-B-DRB1 haplotypes were HLA-A*02-B*51-DRB1*11, HLA-A*11-B*35-DRB1*11, A*24-B*35-DRB1*11. The frequency of ABO, D blood group antigens were observed as 0.168 for A Rh(+), 0.019 for A Rh(-), 0.057 for B Rh(+), 0.013 for B Rh(-), 0.123 for O Rh(+), 0.014 for O Rh(-), 0.018 for AB Rh(+), and 0.001 for AB Rh(-). While A Rh(+) samples with HLA-A*02 and HLA-DRB1*11 had the highest frequencies (0.067 and 0.088, respectively), O Rh(+) samples with HLA-B*51 had the highest frequency (0.06). Conclusion. According to haplotype frequencies HLA-A*02-B*51-DRB1*11 is also found at higher frequencies in Bulgarian and Armenian populations. In case of HLA-associated diseases, the east Anatolian population could be susceptible to myastenia gravis, Behcet's disease, and systemic sclerosis due to the high frequencies of HLA-A*24, HLA-B*51, and HLA-DRB1*11 respectively. We did not observe a correlation between blood group antigens and HLA alleles or haplotypes in renal dialysis patients.
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    Incidental Appendectomy in Donors Undergoing Hepatectomy for Living-Donor Liver Transplantation
    (Elsevier Science Inc, 2012) Yilmaz, M.; Olmez, A.; Piskin, T.; Unal, B.; Ersan, V.; Sarici, K. B.; Dirican, A.
    Background. The aim of this study was to investigate the morbidity associated with appendectomy in living liver donors undergoing hepatectomy. Methods. The medical records of 338 donors who underwent hepatectomies for living-donor liver transplantation between 2008 and 2010 were reviewed retrospectively. The patients were divided into 2 groups on the basis of appendectomy: patients in group A (n = 126) received incidental appendectomies in conjunction with donor hepatectomy, and those in group B (n = 212) underwent hepatectomy alone. Results. No significant difference in age, gender, or body mass index was found between groups. The wound infection rate (P = .037) and length of hospital stay (P = .0038) were higher in group A than in group B. Intraoperative findings in 126 donors in group A were subserosal (n = 4), retrocecal (n = 6), or hard nodular (n = 11) appendix; hyperemic appendix with edema (n = 9); appendix length >= 8 cm (n = 18); and palpable fecalith (n = 78). Histopathologic examination of appendix specimens revealed lymphoid hyperplasia with a fecalith (n = 32), fecalith only (n = 32), acute appendicitis (n = 20), normal anatomy (n = 18), fibrous obliteration (n = 9), lymphoid hyperplasia (n = 9), Enterobius vermicularis (n = 3),appendiceal neuroma (n 1), carcinoid tumor (n = 1), and mucoceles (n = 1). Conclusion. Although incidental appendectomy increased the wound infection rate and length of hospital stay, this procedure is necessary for the prevention of potential complications due to appendicitis when the exploration of the ileocecal region in patients undergoing donor hepatectomy reveals one or more of the following: appendix length >= 8 cm; dropsical, hyperemic, subserosal, nodular, and/or retrocecal appendix; and/or palpable fecaloma.
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    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.
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    Influence of Liver Transplantation on Neuropsychiatric Manifestations of Wilson Disease
    (Elsevier Science Inc, 2015) Yagci, M. A.; Tardu, A.; Karagul, S.; Ertugrul, I.; Ince, V.; Kirmizi, S.; Unal, B.
    Objectives. This study sought to evaluate the effect of liver transplantation on the neuropsychological manifestations of Wilson disease. Materials and Methods. Nine of 42 Wilson disease patients had neuropsychological symptoms before liver transplantation. They were 7 male and 2 female subjects with a median age of 19 years (range 10 to 25). They were analyzed for their preoperative and postoperative hepatic, neurological, and psychological scores described by the Unified Wilson Disease Rating Scale after a mean 36.6 months of follow-up. Results. Preoperative mean Model for End-Stage Liver Disease and Child-Pugh scores were 18.3 (range 15 to 26) and 8.9 (range 6 to 12), respectively. One patient had acute postoperative ischemic stroke unrelated to Wilson disease and was excluded from the statistical analysis. Preoperative and postoperative hepatic, neurological, and psychological scores of the remaining 8 patients were 7.4 +/- 2.3 vs 2.4 +/- 1.3 (P = .0005), 17.7 +/- 11.7 vs 12.7 +/- 12.5 (P = .055), and 9.0 +/- 1.7 vs 7.0 +/- 2.1 (P = .033). Conclusions. Liver transplantation for Wilson disease can provide some improvement of the neuropsychological symptoms in addition to the hepatic recovery.
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    A Kidney Transplant Center's Initial Experiences in Eastern Turkey
    (Elsevier Science Inc, 2012) Piskin, T.; Unal, B.; Koz, S.; Ulutas, O.; Yagmur, J.; Beytur, A.; Kayhan, B.
    Objectives. Kidney transplantation is the best treatment method associated with improved quality of life and better survival for patients with end-stage renal disease. We started performing kidney transplantations in November 2010. We have performed 19 kidney transplantations so far. Fourteen of these were from living donors and five from deceased donors. Here, we present our initial experiences with 1.4 kidney transplant recipients from living donor kidney transplantations. Materials and methods. All recipients and their donors underwent detailed clinical history and examination. Recipients and their donors were followed in the transplant clinic during hospitalization. Results. The male-to-female ratio was 11:3 in recipients. The mean age of recipients was 27.8 years (range 4-58 years). The number of the related, emotionally related, and unrelated transplantations were 9, 3, 2, respectively. The mean warm ischemic time was 95.7 seconds (range 52-1.68 seconds). Urine output started immediately after vascular anastomosis in all. The mean time of discharge from hospital was postoperative day 8 (range 4-18 days). The mean flow up was 125 days (range 18-210 days). Graft survival was 100% in this period, but one patient died from sepsis after 56 days. No kidney was lost from rejection, technical causes, infection, or recurrent disease. Conclusion. If transplant centers are as equipped and experienced as ours, kidney transplant programs should be started immediately so that they can reduce the number of the patients in waiting list for kidney transplantation.
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    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.
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    Living Donor Liver Transplantation With Vena Cava Replacement
    (Elsevier Science Inc, 2015) Yagci, M. A.; Tardu, A.; Karagul, S.; Ince, V.; Ertugrul, I.; Kirmizi, S.; Unal, B.
    Objectives. This study sought to evaluate the indications, techniques, and results of inferior vena cava (IVC) replacement at living donor liver transplantation (LDLT). Materials and Methods. We performed 821 LDLTs and 11 (1.3%) patients required concomitant IVC replacement. We analyzed the indications, replacement materials, and outcomes. Results. Right, left, and left lateral liver lobes were transplanted in 7, 2, and 2 patients, respectively. The indications for IVC replacement were thrombosis/fibrosis in 7 patients (Budd-Chiari 4, hereditary tyrosinemia 1, congenital hepatic fibrosis 1, cryptogenic 1), involvement with mass in 3 patients (Echinococcus alveolaris 2, hepatoblastoma 1) and iatrogenic narrowing at IVC in 1 patient. Cryopreserved grafts (aorta n = 5, IVC n = 4, iliac vein n = 1) or synthetic graft (n = 1) were used for replacements. In 1 patient, hepatic outflow obstruction developed at 39 days and was treated successfully by interventional radiology. There was only 1 hospital mortality (8.9%) that was unrelated to caval replacement (subarachnoid hemorrhage). Of the remaining patients, the caval grafts were patent after a mean 7.7 months of follow-up (range 1 to 17 months). Conclusions. Although rare, IVC replacement can be necessary at LDLT. Budd-Chiari and E. alveolaris are the main underlying diseases for replacement requirements. Caval replacement with cryopreserved vascular grafts can provide successful short-term and long-term patency.
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    Living Related Donor Liver Transplantation with Atrio-Caval Anastomosis of Inferior Vena Cava Graft Stored in Deep-Freeze for Budd-Chiari Syndrome
    (Avicenna Organ Transplant Center, 2015) Yaylak, F.; Ince, V.; Barut, B.; Unal, B.; Kilic, M.; Yilmaz, S.
    We have previously reported our experience in inferior vena cava resection and reconstruction techniques during liver transplantation for Budd-Chiari syndrome. Herein, we present on a case that demonstrates the importance of experience in complex vascular reconstruction techniques for living donor liver transplantation. A 15-year-old boy was scheduled for living donor liver transplantation for Budd-Chiari syndrome. Venous occlusion was extended up to the right atrial orifice of the supra-hepatic vena cava. Retro- and supra-hepatic segments of the vena cava was resected. Inferior vena cava graft stored in deep-freeze was available. Venous reconstruction was performed with end-to-end atrio-caval anastomosis. Surgical treatment was completed with the implantation of the right liver lobe donated by the patient's mother. Post-surgical course was uneventful.
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    Living-Donor Liver Transplantation for Budd-Chiari Syndrome-Resection and Reconstruction of the Suprahepatic Inferior Vena Cava With the Use of Cadaveric Aortic Allograft: Case Report
    (Elsevier Science Inc, 2015) Cetinkunar, S.; Ince, V.; Ozdemir, F.; Ersan, V.; Yaylak, F.; Unal, B.; Yilmaz, S.
    Background. Living-donor liver transplantation with inferior vena cava resection and reconstruction is rarely indicated for Budd-Chiari syndrome. The aim of this case presentation was to present and discuss the inferior vena cava reconstruction with the use of cadaveric aortic allograft after resection of the suprahepatic inferior vena cava in a patient with Budd-Chiari syndrome who was treated with living-donor liver transplantation. Case Report. A 29-year-old male patient with end-stage liver disease and suprahepatic inferior vena cava obstruction was referred to our center. He was scheduled for living-donor liver transplantation. The suprahepatic inferior vena cava was resected and reconstruction was achieved by means of interposition of the cadaveric aortic allograft between the right atrium and inferior vena cava. Postoperative course was uneventful. Discussion. Liver transplantation and vena cava reconstruction is indicated in some patients with end-stage liver disease and Budd-Chiari syndrome Limitations in cadaveric organ donation may be compensated for with the use of living-donor liver. In this condition, various aspects of inferior vena cava reconstruction may be discussed. Conclusions. Budd-Chiari syndrome due to suprahepatic inferior vena cava obstruction close to the right atrium may be treated with vascular reconstruction with the use of a cadaveric aortic allograft.
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    Outcomes of Kidney Transplantations From the Same Deceased Donor to Two Different Recipients: A Single-Center Experience
    (Elsevier Science Inc, 2017) Piskin, T.; Unal, B.; Kutluturk, K.; Yildirim, I. O.; Berktas, B.; Dogan, S. M.; Yagmur, J.
    Background. Kidney transplantation is the best treatment method for end-stage renal disease. Technically, left kidney transplantation is easier than right kidney, and the complication rates in the right are higher than the left kidney. We performed 28 kidney transplantations from 14 deceased donors between November 2010 and May 2016. Our aim was to share our outcomes and experiences about these 28 patients. Methods. We performed 182 kidney transplantations between November 2010 and May 2016. Fifty-four kidney transplantations were performed from deceased donors. Thirty-two of these were performed from 16 of the same donors. These 32 recipients' data were collected and, retrospectively analyzed. We excluded the transplantations from two same donors to their four recipients in this study. The remaining 28 recipients were included in the study. Results. The left and right kidney recipients' 'numbers were equal (14:14). The left kidney:right kidney rate was 11:3 in the first kidney transplantation recipient group; in the second kidney transplantation recipient group, the rate was 3:11. The difference was statistically significant (P =.002). We found no statistical differences for sex, mean age, and body mass index of recipients, total ischemic time of grafts, hospitalization times, creatinine levels at discharge time, and current ratio of postoperative complications of recipients (P >.05). Conclusions. There were no differences in the left or the right kidneys or in the first and the second kidney transplantations during the long follow-up period.