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Öğe Acinetobacter Infection in a Liver Transplantation Intensive Care Unit(Elsevier Science Inc, 2013) Otan, E.; Aydin, C.; Usta, S.; Kutluturk, K.; Kayaalp, C.; Yilmaz, S.Objective. Despite the advances in surgical technique and postoperative care, infectious complications are associated with high mortality rates. Acinetobacter species are emerging as a leading worldwide nosocomial pathogen in intensive care unit (ICU) patients. This study was designed to evaluate the results of the patients who developed Acinetobacter infection in the ICU after liver transplantation. Methods. We retrospectively analyzed 220 patients who had undergone liver transplantation between August 2011 and August 2012. Among the 55 positive culture results with clinical signs of infection, Acinetobacter was the single infectious agent for 10 of them, who were included in the study. Results. The mean age of the patients was 43.1 +/- 11.79 years with a male dominance (70%, n = 7). Eighty percent of the patients underwent living donor liver transplantations (n = 8). Mean Model for End-stage Liver Disease score was 28.5 +/- 14.99. Graft dysfunction was present in 50% (n = 5), all of whom had a history of preoperative hospitalization (100%, n = 10). Forty percent (n = 4) of patients had a history of diabetes mellitus and 60% were subject to extended mechanical ventilation. Mean platelet count was 20.32 +/- 8.1 x 10(9)/mL. The majority of the patients had multiple culture-positive sites (90%, n = 9). Positive culture results for Acinetobacter species included bloodstream (n = 8), drain fluid (n = 5), sputum (n = 3), paracenthesis material (n = 3), and catheter (n = 1). The mean period of postoperative positive culture results was 12.7 +/- 9.5 days. Mortality was 90% (n = 9). Conclusion. Acinetobacter infections in the ICU after liver transplantation were asociated with a high mortality presenting with thrombocytopenia.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 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 Outcomes of Left-Lobe Donor Hepatectomy for Living-Donor Liver Transplantation: A Single-Center Experience(Elsevier Science Inc, 2013) Usta, S.; Ates, M.; Dirican, A.; Isik, B.; Yilmaz, S.Living-donor liver transplantation (LDLT) is an excellent option for patients with end-stage liver disease in situations of donor shortage. The aims of this study were to evaluate our experience with left-lobe donor hepatectomy for LDLT and to grade postoperative complications using the 5-tier Clavien classification system. Data from medical records of 60 adult living liver donors (30 men, 30 women) who underwent left-lobe hepatectomy between November 2006 and April 2012 were reviewed. The median donor age was 31.7 +/- 8.9 (range, 19-63) years. Sixteen complications were observed in 12/60 (20%) donors. Complications developed in 6/15 (40%) donors who underwent left hepatectomy and in 6/45 (13.3%) donors who underwent left lateral segmentectomy. Seven of 16 (43.7%) complications were Grade I and 2 (12.5%) were Grade II. Major complications consisted of 4 (25%) Grade IIIa and 3 (18.7%) Grade IIIb complications; no Grade IVb or V complications occurred. The most common complication was biliary, occurring in 7 (11.6%) donors and comprising 43.7% of all 16 complications. The mean duration of follow-up was 30 +/- 7.1 (range, 2-58) months. No donor mortality occurred. Left-lobe donor hepatectomy for LDLT, which does not benefit the completely healthy donor, was performed safely and with low complication rates, but carries the risk of morbidity. Low morbidity rates following living-donor hepatectomy can be expected when surgical and clinical monitoring and follow-up are adequate and the surgeon has gained increased experience.
