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Öğe A Case Report of Excessive Inflammation After TACE That Mimicked Tumor Invasion of Adjacent Tissues(Sage Publications Inc, 2023) Ince, Volkan; Garzali, Ibrahim Umar; Usta, Sertac; Kutlu, Ramazan; Yilmaz, Sezai[Abstract Not Available]Öğe A Combination of Blood Lymphocytes and AST Levels Distinguishes Patients with Small Hepatocellular Carcinomas from Non-cancer Patients(Springer, 2021) Carr, Brian, I; Bag, Harika Gozukara; Ince, Volkan; Akbulut, Sami; Ersan, Veysel; Usta, Sertac; Isik, BurakPurpose HCC patients typically present at an advanced tumor stage, in which surgical therapies cannot be used. Screening ultrasound exams can increase the numbers of patients diagnosed with small tumors, but are often not used in patients at risk for HCC. We evaluated clinically available and cheap potential blood tests as biomarkers for screening patients at risk for HCC. Methods A comparison was made of commonly used blood count and liver function parameters in a group of patients (n = 101) with small HCCs (<= 3 cm) or without HCC (n = 275), who presented for liver transplantation in our institute. Results Significant differences were found for blood lymphocytes and AST levels. This 2-parameter combination was found to be significantly different between patients with small HCCs versus no HCC. Using the combination of lymphocytes and AST levels to dichotomize the HCC patients, only blood levels of alpha-fetoprotein among the tumor characteristics were found to be significantly different among the 2 HCC groups, as well as levels of blood total bilirubin, ALKP, and PLR ratio. The results were confirmed using a separate smaller cohort of non-transplanted small size HCC patients. Conclusion The combination of elevated blood levels of lymphocyte counts and AST levels holds promise for screening of patients with chronic liver disease who are at risk for HCC.Öğe Comment on the high-end range of biliary reconstruction in living donor liver transplant(Lippincott Williams & Wilkins, 2020) Yilmaz, Sezai; Akbulut, Sami; Koc, Cemalettin; Usta, Sertac; Baskiran, Adil; Karakas, Serdar; Sahin, Tevfik Tolga[Abstract Not Available]Öğe Concomittant Liver Transplantation and Low Anterior Resection in Patient with Neuroendocrine Tumor and Chronic Hepatitis B Infection(Springer, 2022) Tuncer, Adem; Ogut, Zeki; Usta, Sertac; Akbulut, Sami; Sahin, Tevfik Tolga; Yilmaz, Sezai[Abstract Not Available]Öğe Critical overview of resection for Bismuth-Corlette type IV perihilar cholangiocarcinoma(Taylor & Francis Ltd, 2023) Ersan, Veysel; Usta, Sertac; Aydin, Cemalettin; Carr, Brian, I; Karatoprak, Sinan; Yilmaz, SezaiBackground Current standard treatment for perihilar cholangiocarcinoma (pCCA) is surgical resection. Bismuth-Corlette (BC) type IV pCCA is accepted as an unresectable disease. In the present study, the results of non-transplant surgical approaches in patients with BC type IV pCCA were examined. Methods Medical records of consecutive patients with BC type IV pCCA between 2010 and 2021 were retrospectively reviewed. Patients were subdivided according to operation type. Postoperative survival rates were compared. Results Hemihepatectomy with caudate lobe and extrahepatic bile duct (EHBD) resection was performed in 15 patients and only EHBD resection was performed in 10 patients. Ten of the cases were found to be unresectable at the stage of laparotomy. Median follow-up was 41.3 (24.8-57.9) months. Overall survival rate for all 35 patients was 56.4% at 1 year, 32.2% at 2 years, and 16.1% at 3 years. When survivals were compared according to operation type, 1, 2, and 3-year survivals were 80%, 57.1% and 42.9% for the hepatectomy group; 55.6%, 44.4% and 11.1% for the EHBD resection group; 75%, 0% and 0% in laparotomy-only group, respectively (p = 0.13). The best survival rates were obtained in patients with pCCA who underwent hepatectomy and were lymph node negative, 100% for 1 year, 66.7 for 2 years and 50% for 3 years. Conclusion It is difficult to achieve high survival rates in BC type IV pCCA. However, these patients mostly benefit from resective treatments. Acceptable survival rates can be achieved, especially in the R0N0 patient group.Öğe Diagnostic and therapeutic management algorithm for biliary complications in living liver donors(Frontiers Media Sa, 2021) Yilmaz, Sezai; Akbulut, Sami; Usta, Sertac; Ozsay, Oguzhan; Sahin, Tevfik Tolga; Sarici, Kemal Baris; Karabulut, ErtugrulThis study aimed to demonstrate the efficacy of our diagnostic and therapeutic management algorithm and catheter-assisted (percutaneous transhepatic biliary tract drainage [PTBD] or transanastomotic feeding tube) hepaticojejunostomy (HJ) procedures in living liver donors (LLDs) with biliary complications. Living donor hepatectomy (LDH) was performed between September 2005 and April 2021 in 2 489 LLDs. Biliary complications developed in 220 LLDs (8.8%), 136 of which were male, and the median age was 29 (interquartile range [IQR]: 12) years. Endoscopic sphincterotomy +/- stenting was performed in 132 LLDs, which was unsuccessful in 9 LLDs and required HJ. Overall, 142 LLDs underwent interventional radiologic procedures. Fifteen LLDs with biliary complications underwent HJ (PTBD catheter = 6 and transanastomotic feeding tube = 9) at a median of 44 days (IQR: 82). Following HJ, 14 LLDs did not have any complications throughout the median follow-up period of 1619 days (IQR: 1454). However, percutaneous dilation for HJ anastomotic stricture was performed in one patient. Biliary complications are very common following LDH; therefore, surgeons in the field should have a low threshold to perform HJ for biliary complications that persist after other treatments. Our catheter-assisted HJ techniques demonstrated a high success rate and aided HJ in a hostile abdomen during revisional surgery.Öğe Distal Gastroduodenal Arterial Inflow as a Salvage Strategy for Extensive Intraoperative Arterial Dissection in Living Donor Liver Transplantation(Lippincott Williams & Wilkins, 2022) Yilmaz, Sezai; Akbulut, Sami; Usta, Sertac; Koc, Cemalettin; Kutluturk, Koray[Abstract Not Available]Öğe THE EFFECT OF PRE-TRANSPLANT LIPID PROFILE ON POST-TRANSPLANT HCC RECURRENCE(Wiley, 2021) Ince, Volkan; Carr, Brian I.; Usta, Sertac; Ersan, Veysel; Bag, Harika G.; Yilmaz, Sezai[Abstract Not Available]Öğe The Effect of Pre-transplant Lipid Profile on Post-transplant Hepatocellular Carcinoma Recurrence: Retrospective Single-Center Analysis(Aves, 2022) Ince, Volkan; Carr, Brian, I; Usta, Sertac; Ersan, Veysel; Bag, Harika Gozukara; Yilmaz, SezaiBackground: Plasma lipids have been shown to relate to tumor biology. We aimed to analyze the effect of pre-transplant plasma lipid profiles on post-transplant tumor recurrence in patients with hepatocellular carcinoma and to identify any possible relationship between the pre-transplant lipid profile with maximum tumor diameter, number of tumor nodules, tumor differentiation, portal vein invasion, or serum biomarker levels. Methods: Patients with hepatocellular carcinoma who underwent liver transplants between 2006 and 2021 had data collected prospectively and were analyzed retrospectively. Patients who did not have lipid profile data before transplant and whose post-transplant follow-up period was <90 days were excluded. Patients who had pre-transplant plasma lipid data and whose post-transplant follow-up period was >90 days were included in this study (n = 254). Results: Lower high-density lipoprotein cholesterol levels were found to be significantly associated with post-Tx recurrence (38 vs 29.5, P <.001) and were also significantly associated with macroscopic portal vein thrombosis (39 vs 30.4, P <.021). There was no significant association between plasma lipids and tumor differentiation. Higher high-density lipoprotein cholesterol levels were significantly associated with good overall and disease-free survivals (P =.024 and P =.001). Conclusion: Pre-transplant low plasma high-density lipoprotein cholesterol levels were significantly associated with portal vein thrombosis and poor post-transplant overall and disease-free survivals.Öğe An Elbow Patch Reconstruction Technique for Narrowed Remnant Portal Veins during Right Lobe Living Donor Hepatectomy: A Rescue Surgery(Mdpi, 2024) Usta, Sertac; Akbulut, Sami; Sarici, Kemal Baris; Garzali, Ibrahim Umar; Ozdemir, Fatih; Gonultas, Fatih; Baskiran, AdilBackground: Treatment of established portal vein narrowing after living donor hepatectomy is challenging. We aimed to present a new approach termed the elbow patch reconstruction technique to correct the narrowed remnant portal vein just or late after right lobe living donor hepatectomy. Methods: Demographic and clinical data of 12 living liver donors with narrowed remnant portal veins and treated with the elbow patch reconstruction technique were prospectively collected and retrospectively evaluated. Anatomic variation of the portal vein was defined in accordance with the Nakamura classification; six of the living liver donors had type A, three had type B, and the remaining three had type C. In eight of the living liver donors with a narrowed remnant portal vein, diagnosis was detected by intraoperative Doppler ultrasonography and visual inspection by experienced transplant surgeons in the living donor hepatectomy procedure. In the remaining four living liver donors, diagnosis was performed postoperatively when elevation of liver enzymes was noticed during the routine liver function test and Doppler US. The diagnosis was confirmed by multidetector computed tomography. Results: Data from nine males and three females aged 18 to 54 years were analyzed. All of the living liver donors were followed up for a median of 1710 days (min-max: 1178-4447 days; IQR: 1516 days), and none of the living liver donors had any structural or functional complications in the portal vein. Conclusions: Narrowing remnant portal veins are rare, but they are a life-threatening complication in living liver donors, and this condition requires urgent management. Image guided interventions and narrowed segment resection with end-to-end anastomosis using a vascular graft carried a potential risk for thrombosis and restenosis. To avoid these complications, we shared a technique named elbow patch reconstruction technique. This technique can be very effective in relieving the narrowing of the remnant portal vein after right lobe living donor hepatectomy.Öğe A gallstone impacting to stomach wall imitating a gastric tumour(Professional Medical Publications, 2011) Yilmaz, Mehmet; Dirican, Abuzer; Usta, Sertac; Baskiran, Adil; Isik, BurakAuthors describe a case of 78 years old female who presented with the right upper abdominal pain. Ultrasonography showed a gallstone. The patient underwent laparascopic cholecystectomy. The laparoscopic procedure was converted to laparotomy because the adhesions between gallblader and stomach could not be dissected on the correct plane. A gallstone impacted to the stomach antrum wall was observed during dissection. When dense adhesions are noted between the gallbladder and stomach during a routine laparascopic cholecystectomy, one should consider an impacted gallstone on the gastric wall via a cholecystogastric connection.Öğe Gamma glutamyl transpeptidase as a prognostic biomarker in hepatocellular cancer patients especially with >5 cm tumors, treated by liver transplantation(Sage Publications Ltd, 2020) Ince, Volkan; Carr, Brian I.; Bag, Harika Gozukara; Koc, Cemalettin; Usta, Sertac; Ersan, Veysel; Baskiran, AdilBackground Serum AFP levels are typically elevated in less than 50% of hepatocellular cancer (HCC) patients. Gamma-glutamyl transpeptidase (GGT) levels have been suggested to be a potentially useful HCC biomarker. Aims To assess in a cohort of prospectively evaluated HCC patients who underwent liver transplant and whose survival was known; the occurrence, prognosis, and clinical characteristics of patients with elevated serum GGT levels. Results Serum GGT levels were found to be elevated in a higher proportion in patients with either small or large HCC than alpha-fetoprotein (AFP) levels, and were significantly related to prognosis in patients with large size HCCs. There was no clear correlation between GGT and AFP levels, likely reflecting different HCC characteristics or HCC cell lineages associated with these two markers. Furthermore, elevated GGT was found in 24% of low-AFP patients with small tumors and 46% with large tumors. Elevated GGT levels were also significantly associated with microvascular invasion and tumor diameter. Conclusions Elevated serum GGT levels were associated with HCC size and worse survival, and were unrelated to AFP levels. GGT may be a useful prognostic tumor marker, especially for low-AFP HCC patients.Öğe The impact of tumor localization on prognosis of the patients following liver transplantation for hepatocellular carcinoma(2020) Baskiran, Adil; Sarigoz, Talha; Sahin, Tevfik Tolga; Ince, Volkan; Usta, SertacAim: Hepatocellular carcinoma usually occurs in the setting of liver cirrhosis and therefore, resection is not possible in majority of the cases. Orthotopic liver transplantation (OLS) is a gold standard treatment option in hepatocellular carcinoma. The aim of the present retrospective study was to evaluate the prognosis of hepatocellular carcinoma localized in left or right side of the liver in patients who underwent OLS. Materials and Methods: 120 patients received OLS for hepatocellular carcinoma between 2007 and 2018 in the institute of liver transplantation. Tumors that were centrally located were excluded from the analysis. The remaining 104 patients were divided into two groups; Group 1 (right lobe, n=85 [81.7%]), Group 2 (left lobe, n=19 [18.3%]). The clinical and demographic data of the patients along with preoperative laboratory values such as alpha fetoprotein (AFP), gamma-glutamyl transpeptidase (GGT) and thrombocyte count were retrospectively evaluated. Results: The Median age in Group 1 and 2 were 54 (4-72) and 50.5 (37-68) years, respectively. Preoperative AFP levels in Group 1 and 2 were 9.25 (1-10800) ng/ml and 13 (1.5-317) ng/ml, respectively. The Model for end stage liver disease (MELD) scores in Group 1 and 2 were 12 (6-52) and 9 (6-21), respectively. None of the clinical, demographic and laboratory values along with disease-free survival, early mortality and recurrence were significantly different among the study groups (p>0.05). Conclusions: Although there is a big discrepancy in terms of patient’s numbers in right and left-sided tumors, our data failed to show any survival difference among the groups. Further studies, especially in hepatocellular carcinoma beyond the Milan criteria, are needed to validate our results.Öğe Incidental Hepatocellular Carcinoma after Liver Transplantation: Clinicopathologic Features and Prognosis(Mdpi, 2023) Ozdemir, Fatih; Ince, Volkan; Usta, Sertac; Carr, Brian I. I.; Bag, Harika G. G.; Akatli, Ayse Nur; Kahraman, Aysegul SagirBackground: The prognostic impact and clinicopathologic features of incidental hepatocellular carcinoma (iHCC) detected in explanted livers of patients undergoing liver transplantation (LT) has been a controversial issue in previous studies when compared with patients who are diagnosed with hepatocellular carcinoma (pdHCC) before LT. We aimed to review and compare these patient groups in a high-volume LT center. Methods: The present study involves a retrospective analysis of 406 HCC patients who received LT between January 2002 and April 2022. Among these patients, demographic data, histopathologic features and prognosis for iHCC and pdHCC were evaluated. Results: In our series, 406 patients' final diagnosis was HCC after they had received LT, nevertheless 54 patients in this HCC group were diagnosed incidentally after the pathological evaluation of the explanted livers. The etiology of the underlying liver disease between pdHCC (n = 352) and iHCC (n = 54) groups had some differences in our study population. Most of the patients in the pdHCC group had moderately differentiated tumors (45.7%). On the other hand, most of the patients in the iHCC group had well differentiated tumors (79.6%). There were 158 (44%) patients who met the Milan criteria in the pdHCC group while there were 48 (92%) patients in the iHCC group (p < 0.001). IHCC patients had statistically better 1, 3, 5 and 10 years disease-free and overall survival rates when compared with pdHCC patients. There was only 1 (1.8%) patient who had tumor recurrence in the iHCC group while 76 (21%) patients had tumor recurrence in the pdHCC group (p = 0.001). There is no disease free and overall survival difference when iHCC patients are compared with pdHCC patients who met the Milan criteria. Conclusion: It is the first study to show that iHCC patients may differ from pdHCC patients in terms of etiological features. IHCC tumors show better histopathologic features than pdHCC with low recurrence rate and iHCC patients have better survival rates than pdHCC patients.Öğe Liver transplant for large hepatocellular carcinoma in Malatya: The role of gamma glutamyl transferase and alpha-fetoprotein, a retrospective cohort study(Baishideng Publishing Group Inc, 2020) Ince, Volkan; Carr, Brian, I; Bag, Harika Gozukara; Ersan, Veysel; Usta, Sertac; Koc, Cemalettin; Gonultas, FatihBACKGROUND There is increasing interest in transplanting patients with hepatocellular carcinoma (HCC) with tumors greater than 5 cm (Milan criteria). AIM To investigate possible prognostically-useful factors for liver transplantation in HCC patients with large tumors. METHODS In this clinical study, 50 patients with HCC who were transplanted at our Liver Transplant Center between April 2006 and August 2019 and had tumors greater than 6 cm maximum diameter were retrospectively analyzed. Their survival and full clinical characteristics were examined, with respect to serum alpha-fetoprotein (AFP) and gamma glutamyl transpeptidase (GGT) levels. Kaplan-Meier survival estimates were used to determine overall survival and disease-free survival in these patients. The inclusion criterion was evidence of HCC. Exclusion criteria were the presence of macroscopic portal vein thrombosis or metastasis and a follow-up period of less than 90 d. RESULTS Using receiver operating characteristic curve (ROC) analysis, cutoff values of AFP 200 ng/mL and GGT 104 IU/L were identified and used in this study. Significantly longer overall survival (OS) and disease-free-survival (DFS) were found in patients who had lower values of either parameter, compared with higher values. Even greater differences in survival were found when the 2 parameters were combined. Two tumor size bands were identified, in searching for the limits of this approach with larger tumors, namely 6-10 cm and > 10 cm. Combination parameters in the 6-10 cm band reflected 5-year OS of 76.2% in patients with low AFP plus low GGT vs 0% for all other groups. Patients with tumors greater than 10 cm, did not have low AFP plus low GGT. The most consistent clinical correlates for longer survival were degree of tumor differentiation and absence of microscopic portal venous invasion. CONCLUSION Serum levels of AFP and GGT, both alone and combined, represent a simple prognostic identifier in patients with large HCCs undergoing liver transplant-ation.Öğe Microscopic Portal Vein Invasion in Relation to Tumor Focality and Dimension in Patients with Hepatocellular Carcinoma(Springer, 2022) Carr, Brian, I; Guerra, Vito; Donghia, Rossella; Ince, Volkan; Akbulut, Sami; Ersan, Veysel; Usta, SertacBackground Microscopic portal vein invasion (microPVI) and tumor multifocality are hepatocellular carcinoma (HCC) prognosis factors. To investigate whether microPVI and multifocality are directly related to each other. Methods We retrospectively analyzed the relationships between microPVI, multifocality, and maximum tumor diameter (MTD) in prospectively collected transplanted HCC patients. Results HCCs with 1, 2, or >= 3 foci had more microPVI in larger than in smaller HCCs, with microPVI being present in 52.24% of single large foci. Conversely, microPVI patients had similar percentages of single and multifocal lesions. A linear regression model of MTD, showed microPVI best associated with MTD, with 2.49 as coefficient, whereas multifocality had a 0.83 coefficient. A logistic regression model of microPVI showed significant association with tumor multifocality, especially for small HCCs. Trends for microPVI and multifocality in relation to MTD revealed that both increased with MTD but more significantly for microPVI. Survival was similar in patients with small HCCs, with or without microPVI, but was significantly worse in microPVI patients with larger HCCs. No patient survival differences were found in relation to focality. Conclusions MTD had stronger associations with microPVI than with multifocality. microPVI was associated with worse survival in patients with large HCCs, but survival was not impacted by number of tumor foci. microPVI and multifocality appear weakly related, having different behavior in relation to MTD and survival.Öğe Narrowing of giant gastric perforation by purse-string suture before omental plugging(Elsevier Sci Ltd, 2015) Usta, Sertac; Kayaalp, Cuneyt; Gozeneli, OrhanIntroduction: Timely diagnosis of the gastroduodenal perforation usually allows primary repair or resection. Treatment of a large gastric perforation is more difficult than the common duodenal ulcer perforation by plugging and usually requires agastric resection. On the other hand, gastric resection fora hemodynamically compromised patient in sepsis hasa high rate of anastomotic failure and mortality. Here, we described a practical surgical technique that can avoid emergency gastric resection in such situations. Presentation of case: A 83 year-old female admitted with peritonitis, severe sepsis and hemodynamic instability. After the diagnosis of hollow organ perforation and supportive therapy, laparotomy revealed a delayed and large (7 cm) gastric perforation. Instead of gastrectomy, we downsized the large defect by means of a purse-string suture around the perforation and made it suitable for the application of omental plugging. Discussion: The patients with poor performance status who are not suitable for the gastric resection, a free omental plug fixation to the narrowed perforation area by a purse-string suture can overcome the problem. Conclusion: This method can be keep in mind as a damage control surgery technique in the non-traumatic abdominal emergencies due to large gastric perforations. (C) 2015 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Limited. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Öğe De Novo Malignancies After Liver Transplantation: Experience of a High-Volume Center(Springer, 2022) Saglam, Kutay; Sahin, Tevfik Tolga; Ogut, Zeki; Ince, Volkan; Usta, Sertac; Yilmaz, SezaiPurpose Patient care, newer immunosuppressive medications, and advances in surgical technique, have resulted in significant prolongation of survival after liver transplantation in recent years. However, as life expectancy increased and the early mortality rates have decreased, different problems have evolved due to chronic immunosuppressive therapy. The aim of the present study is to evaluate patients who were transplanted and then developed de novo malignancies, in terms of the type of malignancies and the follow-up period. Methods The study was conducted on 2814 patients who received liver transplantation between 2008 and 2020 in Inonu University Liver Transplant Institute. In total, the data of 23 patients were evaluated retrospectively. Results Non-melanoma skin cancer was the most common de novo malignancy (21.7%), followed by gynecological cancers (17.3%). The interval between the time of transplantation until the development of de novo malignancy was 36 (6-75) months. The median follow-up period after the diagnoses of the de novo malignancies was 4.11 years. One, 3-, 5-year survival rates of patients after the diagnoses of de novo malignancies were 69.6%, 56.5%, and 41.9%; respectively. Conclusion Non-melanotic skin cancers were the most common de novo cancers in liver transplant recipients. A strict surveillance program is very important in the follow-up of liver transplant recipients.Öğe Parameters Predicting Microvascular Invasion and Poor Differentiation in Hepatocellular Carcinoma Patients with Normal Alpha-fetoprotein Level Before Liver Transplantation(Aves, 2023) Kilci, Burak M.; Ince, Volkan; Carr, Brian I.; Usta, Sertac; Bag, Harika G.; Samdanci, Emine; Isik, BurakBackground/Aims: The aim of this study is to evaluate the parameters that might be associated with pathologically diagnosed microvascular invasion and poor differentiation, using complete blood count and routine clinical biochemistry test results, in hepatocellular carcinoma patients before liver transplantation. Materials and Methods: The data of patients who underwent liver transplantation for hepatocellular carcinoma at our institute, between March 2006 and November 2021, was researched retrospectively. Results: The incidence of microvascular invasion was 28.6%, poor differentiation rate was 9.3%, hepatocellular carcinoma recurrence rate after liver transplantation was 12.1%, and median time to recurrence was 13 months, in the patients with normal alpha-fetoprotein levels. After univariate and multivariate analysis, maximum tumor diameter >4.5 cm and the number of nodules (n > 5) were found to be independent risk factors for microvascular invasion, and number of nodules >4 and mean platelet volume =8.6 fL were found to be independent risk factors for poor differentiation. Serum alpha-fetoprotein levels were still within the normal range at the recurrence time, in 53% of the patients who had recurrence after liver transplantation, but surprisingly were elevated in 47% of the patients at time of hepatocellular carcinoma recurrence. Conclusion: In hepatocellular carcinoma patients with normal alpha-fetoprotein levels before liver transplantation, independent risk factors of the presence of microvascular invasion were maximum tumor diameter and number of nodules, and independent risk factors of poor differentiation were mean platelet volume and number of nodules. Furthermore, serum alpha-fetoprotein levels were still normal at time of recurrence in 53% of hepatocellular carcinoma patients whose alpha-fetoprotein levels were normal before liver transplantation but were elevated in 47% of the patients at recurrence time, despite having normal levels before liver transplantation.Öğe Portal vein reconstruction with cryopreserved vascular grafts: A two-edged sword(Wiley, 2022) Saglam, Kutay; Sahin, Tevfik Tolga; Usta, Sertac; Koc, Cemalettin; Otan, Emrah; Kayaalp, Cuneyt; Aydin, CemalettinBackground Portal vein anastomotic complications related to size discrepancy are important causes of morbidity and mortality in pediatric liver transplantation. Interposed vascular grafts in portal vein anastomosis can solve this problem. The aim of this study is to evaluate the results of pediatric liver transplantations performed using cryopreserved interposed vascular grafts between graft portal vein and superior mesenteric vein (SMV)-splenic vein (SpV) confluence. Methods Twenty-nine pediatric patients received liver transplantation using cryopreserved venous grafts in our Liver Transplant Institute between 2013 and 2020 were included in this study. Demographic, clinical, and operative characteristics and postoperative follow-up were analyzed. Results Sixteen patients (55.2%) had portal hypoplasia and five patients (17.2%) had portal vein thrombosis. In total, six patients (20.6%) suffered portal vein thrombosis in the early postoperative period. Three patients (10.3%) experienced portal vein thrombosis in the late postoperative period. Late portal vein thrombosis rate was significantly higher in patients with early portal vein thrombosis (3/6 patients [50%] versus 0/23 patients [0%]; p = .034). Lack of portal flow was significantly higher in patients with both early (50% versus 0%; p = .002) and late portal vein thrombosis (66.7% versus 6.7%; p = .03). Conclusion Preoperative portal vein thrombosis and insufficient flow are important factors affecting success of liver transplant in children. The use of interposed vein grafts in problematic portal anastomoses can overcome portal flow problems.
